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Degree: MPH-45 Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Practice Organization Project Title and Abstract Boston Children's Hospital Healthcare Provider Perceptions of Social Determinants of Health Screening in the Pediatric Emergency Department Social determinants of health (SDH) often exert a stronger influence on the health of children and families than biological causes of disease, but often go undetected during encounters with the medical system. This is particularly true in the Emergency Department (ED), where physicians identify medical conditions most likely to cause harm to patients in the immediate future, and needs outside the realm of “health” are rarely addressed. However, Pediatric EM physicians are actually well-positioned to address the broader social needs of children and families. Children in the ED may be more likely to come from underserved communities and utilize the ED as a primary source of medical care. Recognizing this opportunity, ED physicians at Boston Children’s Hospital (BCH) piloted a study to implement an app-based tool, HelpSteps, to screen for unmet social needs in the BCH ED. The survey screens for families’ unmet needs and provides referrals to appropriate health and social agencies. A semi- systematic literature review revealed varying perspectives on the part of healthcare providers regarding screening for social determinants of health in the ED. Overall, there is a relative paucity of high-quality literature available. Guided by this review, additional studies on provider perceptions of SDH screening in the ED are recommended. Further, relationships between Pediatric EDs and local social services should be strengthened, and comprehensive education and training in SDH assessment should be standard for ED healthcare providers. Together, these actions can help to make strides against SDH such as homelessness, food insecurity, and abuse among children. Boston Medical Center Pediatric Clinic Interviewing Youth with Opioid Use Disorder and Caretakers to Adapt Office-Based Opioid Treatment Using qualitative analysis the research team plans to interview 12 experts in adolescent opioid use disorder treatment, 12 adolescent and young adult patients who attend a opioid use disorder treatment clinic, and 12 caregivers. The one-on-one interviews will explore how treatment programs could be tailored the better serve this population and their caregivers. Southern Jamiacian Plan Health Clinic/ Henry Ford Hospital/ Insitutite of Healthcare Improvement The History of Racism in Health and Healthcare, a teaching module for health service providers. Structural and institutional racism is in the foundation of our nation’s history. Acts of racism, rooted in creating and maintaining relationships of power and oppression, have been imbedded in the foundation of all society’s systems todays, including but not limited to healthcare, education, housing, jobs, criminal justice etc. To address health inequities caused by avoidable, unnecessary, and unjust act of racism, we must understand and dismantle our structural systems that are rooted in these practices. This requires an understanding of history that contributed to the production of these structures, as some historical themes continue to present. The module I created for the Institute of Healthcare Improvements (IHI) is designed to provide a brief surveillance of history, while describing specific contributions to medicine and the structural foundations of healthcare that have been built on racist ideologies. By providing health service providers, including physicians, students, community health organizations, public health practitioners, etc, with this introduction to the foundations of structural racism, the focus is to encourage learning more, bringing racism into conversations, and to create a focus on interventions that address systems level barriers to equity.

Degree: MPH-45 Field of Study: Health and Social Behavior ... · Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Harvard T.H. Chan School of Public Health

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Page 1: Degree: MPH-45 Field of Study: Health and Social Behavior ... · Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Harvard T.H. Chan School of Public Health

Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Practice Organization Project Title and Abstract

Boston Children's Hospital Healthcare Provider Perceptions of Social Determinants of Health Screening in the Pediatric Emergency Department Social determinants of health (SDH) often exert a stronger influence on the health of children and families than biological causes of disease, but often go undetected during encounters with the medical system. This is particularly true in the Emergency Department (ED), where physicians identify medical conditions most likely to cause harm to patients in the immediate future, and needs outside the realm of “health” are rarely addressed. However, Pediatric EM physicians are actually well-positioned to address the broader social needs of children and families. Children in the ED may be more likely to come from underserved communities and utilize the ED as a primary source of medical care. Recognizing this opportunity, ED physicians at Boston Children’s Hospital (BCH) piloted a study to implement an app-based tool, HelpSteps, to screen for unmet social needs in the BCH ED. The survey screens for families’ unmet needs and provides referrals to appropriate health and social agencies. A semi-systematic literature review revealed varying perspectives on the part of healthcare providers regarding screening for social determinants of health in the ED. Overall, there is a relative paucity of high-quality literature available. Guided by this review, additional studies on provider perceptions of SDH screening in the ED are recommended. Further, relationships between Pediatric EDs and local social services should be strengthened, and comprehensive education and training in SDH assessment should be standard for ED healthcare providers. Together, these actions can help to make strides against SDH such as homelessness, food insecurity, and abuse among children.

Boston Medical Center Pediatric Clinic

Interviewing Youth with Opioid Use Disorder and Caretakers to Adapt Office-Based Opioid Treatment Using qualitative analysis the research team plans to interview 12 experts in adolescent opioid use disorder treatment, 12 adolescent and young adult patients who attend a opioid use disorder treatment clinic, and 12 caregivers. The one-on-one interviews will explore how treatment programs could be tailored the better serve this population and their caregivers.

Southern Jamiacian Plan Health Clinic/ Henry Ford Hospital/ Insitutite of Healthcare Improvement

The History of Racism in Health and Healthcare, a teaching module for health service providers. Structural and institutional racism is in the foundation of our nation’s history. Acts of racism, rooted in creating and maintaining relationships of power and oppression, have been imbedded in the foundation of all society’s systems todays, including but not limited to healthcare, education, housing, jobs, criminal justice etc. To address health inequities caused by avoidable, unnecessary, and unjust act of racism, we must understand and dismantle our structural systems that are rooted in these practices. This requires an understanding of history that contributed to the production of these structures, as some historical themes continue to present. The module I created for the Institute of Healthcare Improvements (IHI) is designed to provide a brief surveillance of history, while describing specific contributions to medicine and the structural foundations of healthcare that have been built on racist ideologies. By providing health service providers, including physicians, students, community health organizations, public health practitioners, etc, with this introduction to the foundations of structural racism, the focus is to encourage learning more, bringing racism into conversations, and to create a focus on interventions that address systems level barriers to equity.

Page 2: Degree: MPH-45 Field of Study: Health and Social Behavior ... · Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Harvard T.H. Chan School of Public Health

Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Harvard T.H. Chan School of Public Health

The Need for Five Levels When Analyzing Sun Protective Behavior Sun protective behavior research is important for both public health and medicine as it allows clinicians and researchers to identify areas where individuals need to improve their protective behaviors. Many national health practices databases require respondents to classify their sun protective behaviors as never, rarely, sometimes, often, and always. It is common in dermatology and public health literature for researchers to condense variables. The condensing of variables into smaller categories leads to important sun protective information being lost. Data from the Health Information National Trends Survey (HINTS) 4 Cycle 3 was used for this study. Five sun protective questions from the data were used to collect information on sun protective behaviors. Our research supports the need for dermatology and public health research to use five levels instead of two or three levels when determining trends in sun protective behaviors. After controlling for multiple variables there were differences in sun protective behaviors when comparing binary behavioral levels to five. Differences in sun protective practices exist between individuals who have a history of skin cancer and those that do not. For future public health and medical research, it is important researchers consider using five levels of sun protective behavior. By using five behavioral levels public health researchers can identify gaps in sun protective behavior across different races, genders, age groups, as well as additional variables. The use of five sun protection levels allows the fields of public health and medicine to identify which sun protective behaviors should be improved across vulnerable populations.

Cambridge Health Alliance Disrupting Disparities: Using Enhanced Systems of Care to Improve Treatment Access and Outcomes for Children We designed and evaluated an integrated care model at Cambridge Health Alliance between Pediatrics and Child/Adolescent Psychiatry. The integrated care model by the name of Enhancing Systems of Care (ESOC) utilizes social workers, non-clinician family support staff, and child psychiatrists to provide comprehensive and frequent care to underserved populations living in Massachusetts. My practicum looked at preliminary findings in regards to clinical outcomes, Medicaid claims expense data, follow up/engagement, and ED utilization rates. We saw significant improvements in clinical outcome scores, follow up, and ED utilization. Costs in the 3 month period post intervention increased as expected, consistent with prior findings, but normalized to non-intervention results in the 6-9 month period.

Boston University School of Medicine

Qualitative Evaluation of Community Health Workers' (CHW) Perceived Capacity to Task-shift (Deliver Mental Health Services) to Address Unmet Needs of Underserved Caregivers of Children with Autism Spectrum Disorder (ASD) Studies show that caregivers of children with autism spectrum disorder (CASD) suffer depression twice the rate of the US general public. Mental-health needs, however, have been shown to go unmet due to shortages in mental-health providers. To address shortages, the World Health Organization called for ‘task-shifting,’ the use of non-specialist Community Health Workers (CHWs) to take on services traditionally delivered by mental-health professionals. Few studies document how CHWs perceive the addition of tasks to their, often, already heavy workload. In addition, little data exists on how CHWs view mental-health; this is particularly important as mental-health is highly stigmatized. According to the CHW generic logic model, CHWs' self-efficacy, confidence, motivation and pre-existing stigma can directly influence service impact at the population-level. Thus, this study assessed CHWs' self-

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

perceived capacity for delivering evidence-based depression screening and psychotherapy to underserved CASD of Boston, Massachusetts, to evaluate if task-shifting may be a desirable option for CHWs in the US. Methods: Qualitative semi-structured interviews among CHWs (n=7) were conducted. Participants were recruited from Boston Medical Center’s CHW-Autism program. Interviews were thematically analyzed using NVivo 12. Results: The primary outcome was CHWs' self-perceived capacity for delivering mental-health services; and secondary outcomes included CHWs' acceptability, stigma and motivation towards providing mental health services. Conclusion: This study will discuss the views and perceptions of CHWs on providing mental health services to CASD and how such findings can be used to design appropriate training experiences and inform policy for effective ‘task-shifting.'

Beth Israel Deaconess Medical Center OBGYN Department

Shared Decision Making in OBGYN Primary Spanish Speakers My practicum focused on differences in shared decision making and knowledge of consent in primary Spanish speaking and primary English speaking women receiving OBGYN care. I explored this issue by performing a scoping review of the literature and working on on-going research to compare differences in comprehension of the Beth Israel Deaconess OBGYN consent form between primary Spanish speakers and primary English speakers.

Massachusetts Commission on LGBTQ Youth

Family Acceptance Task Force at the Massachusetts Commission on LGBTQ Youth Family relationships have a significant impact on the health outcomes for LGBTQ youth in many areas including but not limited to: mental health/bullying, homelessness/housing instability, juvenile justice, and sexual health. The Massachusetts Commission on LGBTQ Youth was reinstated in 2006 with the task of writing annual recommendations to be delivered to the governor of Massachusetts, and the various offices and departments within the state government. This report summarizes the reasons for developing the Family Acceptance Task Force, a group of representatives from various government agencies, community organization leaders, youth movement leaders, and Commission members, who will work together to develop the groundwork for writing formal recommendations on how to improve positive family engagement in the life of LGBTQ youth. This report also discusses the evidence in the academic literature supporting the need for such a group, and how the findings will inform the next steps of the Task Force in writing formal recommendations in FY 2021. The main findings from the report demonstrate that family rejection has a significant negative impact on LGBTQ youth and increases their risk for mental and physical health problems, including increased likelihood to become homeless or to enter the juvenile justice system. On the other hand, family acceptance has a wide variety of protective factors that improve LGBTQ youth health outcomes. When the Family Acceptance Task Force develops formal recommendations for the FY2021 Commission report, it will be crucial to consider how family relationships can both have harmful and helpful effects on the health of LGBTQ youth.

National Alliance on Mental Illness

An Evaluation of the Emergency Service Program NAMI Massachusetts conducted a statewide evaluation of the Emergency Service Program (ESP) through a mixed-methods design including; surveys, interviews, and focus groups. The focus of the evaluation seeks to answer the following questions: (1) how consistent are response protocols (i.e., how does ESP respond based on insurances, how does ESP respond based on individual or family member calling), (2) to what extent are the needs of the recipients met (i.e., are the staff experienced, trained, and compassionate), and (3) do ESP’s meet the program goals based on recipient experience (i.e., response time, follow-up, and referrals).

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Atrius Health The Assessment of Social Determinants of Health Among Patients at a Multi-specialty Group Practice I performed the initial assessment of the results of a screening tool that has been used by Atrius Health to evaluate patients' needs in areas of social determinants of health. I also performed chart reviews of patients with "positive" questionnaires, and interviewed a clinician "champion" and two community health workers.

The Family Van Healthy Roads: Developing an Evidence-based Community Health Worker Model to provide mental health services on The Family Van We developed a community health worker mental health program that would be provided on the Family Van, which provides mobile health services. Application of the community health worker model to mental health has yet to be done in the U.S., and has not been applied to mobile settings. To develop our proposal, we completed a literature review to assess current evidence based screening tool and CHW models used in other countries. We also engaged the community through listening sessions to determine needs and priority topics. We also planned and executed a month long anti-stigma campaign. The final program proposal is to be submitted to potential funders.

WellCalm WellCalm Online Mental Health Resource Portal There is a need for increasing access to and utilization of mental health services among college students. WellCalm aimed to fill this gap by creating an easy to use online resource portal that connected students with mental health service providers and information on mental health services.

Ariadne Labs City Challenge: Defining the role of cities as a platform for community investment in the wellbeing of mothers This practicum project supported the development of a strategy document and landscape analysis on the topic of racial, ethnic, and immigration status disparities in maternal outcomes in the greater Boston area. Background research included peer reviewed literature, white papers, grey-literature, toolkits, websites, and news with a particular focus on strategies for measuring and benchmarking city initiatives, maternal health, and the health environment more generally. Efforts in parallel domains are also of interest (e.g. task force for violence prevention). We also collected information on key stakeholders and potential partners.

Cambridge Health Alliance- Community Health Improvement Team

Somerville High School Dental Project: Strategy Work and Community Partnership Building to Strengthen and Systemize Program Service Delivery In partnership with Cambridge Health Alliance, the Somerville High School (SHS) Dental project, a school-based dental care program, was created in 2017 when an SHS volunteer noticed the barriers and difficulties students (particularly English language learner students) encountered related to oral health and accessing dental care. Although the project has made significant strides in providing dental care for students, it still faced challenges regarding student insurance status, emergency dental care, the operational flow of the project. As a practicum intern, I was responsible for spearheading some of the strategy work to address these concerns. We focused on codifying the student intake process of the dental project and expanding our insurance navigational support capacity. Steps we took to actualize these

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

areas of focus included drafting the mission, goals, and objectives for the dental project, forming partnerships with SHS leadership and the Cambridge Economic Opportunity Committee (CEOC), and creating a standardized insurance enrollment and health needs assessment worksheet to guide the health insurance assistance process. Through these steps, we were able to improve the operational flow of the clinic and provide the opportunity for CEOC’s services to be incorporated into the Somerville School District’s services that provide city-wide assistance to children and families.

Girls Health Champions Assessing Social Networks and Information Sharing Among Adolescent Girls In Mumbai India is home to the world’s largest adolescent population. In particular, being an adolescent girl in Mumbai comes with its own unique set of challenges, due to barious social, religious, cultural and infrastructural barriers. Girls Health Champions is an organization that uses a peer education model to disseminate information about nutrition and anemia, mental health, gender, relationship and safety, menstruation and reproductive health to primarily adolescent girls living in slums throughout Mumbai. The overarching goal of this organization is to provide girls with some of the information, social capital and leadership skills necessary to traverse adolescents in healthy and successful ways. The primary objective of my practicum was to evaluate social networks and information sharing dyanmics among adolescent girls in GHC. The secondary objective was to increase sustainable, local youth engagement and leadership- accomplished through developing a Youth Advisory Board. I used a mixed methods approach – using a combination of surveys and focus groups to obtain information on three major categories (information sharing, leadership embodiment, program feedback). We developed and piloted a survey to assess the size, frequency and diversity of social networks, as well as network dynamics and directionality, and conversation content. We also developed and piloted a semi-structured interview guide to better understand the social and environmental context, assess leadership embodiment and obtain program feedback. We plan on using the preliminary insights obtained from the pilot to edit our information sharing assessments, create a gender diverse curriculum, develop parent programming and follow up with the Youth Advisory Board.

Maestral LLC and the Better Care Network

Description and Analysis of Organizations that Promote Parent Advocacy in Child Welfare in the Global North and Global South A new trend in the Global North and South in child welfare is the emergence of parents who have previous experience with child welfare, called parent advocates, mentoring others who are new to the system. As it is a fairly new trend, it is integral to discuss what parent advocacy, as it is known, looks like in different contexts and what do the organizations that engage parent advocates and parent advocates themselves believe see as the impact of their work. This research identified and profiled 15 programs in the Global North and 6 in the Global South that work with parents to promote their involvement in child welfare on a case, program, and policy level. From our work, we understood that there is a movement to integrate parent advocates into formalized systems and a push to develop parent advocacy as a professional field. Gaps in training methods, including in legislative writing and self-care, were identified in organizations in US, Australia, and UK. Using a strength-based questionnaire, it was also ascertained that parent advocacy is an integral model of peer education that helps parents resolve long-traumas and help others avoid trauma. In the

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Global South, the parent advocacy model within child welfare systems are not as prevalent, but can potentially benefit from resources about training models. This project will function to promote parent advocacy and parent decision making globally, with a larger goal of protecting the rights of children and families by preventing unnecessary separation and strengthening systems that protect children.

Harvard Humanitarian Initiative

Uncovering the Pre-Hospital Care Delivery System in Tanzania This is an observational survey study of patients presenting to the Muhimbili National Hospital (MNH) Emergency Department (ED) in Dar-es-Salaam, Tanzania over an eight-week period. Local researchers consecutively surveyed all arriving patients to the ED from October 10 to December 10, 2014. Patients and those transporting them were questioned in their native language, and data was collected via paper survey, entered into an electronic spreadsheet, and analyzed with Excel and Stata.

Beth Israel Deaconess Medical Center Neonatology Department

Statewide Initiative to Improve the Care of Newborns and Families Impacted by Perinatal Opioid Use and NAS NAS is a major public issue requiring effective clinical interventions to policy level strategies for its prevention. The institution is optimizing the effort with substantial efficacy in collaboration with the MA DPH. This practicum offers students to be engaged in the front line effort to contribute to the well being of mother-child dyads in MA. The Neonatal Quality Collaborative of Massachusetts (NeoQIC) and the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) bring together maternal and neonatal providers in collaborative quality improvement initiatives that seek to obtain measurable improvements in the health of mothers and newborns. In 2017, we launched an ambitious statewide initiative focused on mothers with opioid use disorder and their newborns with neonatal abstinence syndrome. Partners include over 30 hospitals across the state and multiple state agencies, including the Department of Public Health, the Health Policy Commission, the Bureau of Substance Abuse Services, the Department of Children and Families, and Early Intervention.

The Family Van Building Capacity for Community Health Worker Mental Health Training Programs The Family Van (TFV) is a Boston-based, non-profit organization established in 1992 that works with low-income Boston neighborhoods to improve the health and well-being of residents and their families through the use of physical health screenings. Through its developed relationship with the communities it serves, TFV has identified mental health and stress to be a growing concern among low-income Boston communities, and data shows a disproportionate burden of mood disorders among low-income households of color. A community needs assessment and literature review was performed in order to determine how to best address this identified need. The needs assessment took the form of informal “listening sessions”, which confirmed the desire for access to mental health services that are culturally sensitive and appropriate. The literature review identified multiple potential models for task-shifting mental health services delivered by community health workers, including PM+ of Partners in Health, IPC, psychoeducation, and behavioral activation. Given the partnership established with Partners in Health, and the manner in which PM+, as an evidence-based program, is structured to deliver a community health worker model to tackle people who experience significant practical and emotional problems living in adversity, it was decided that this would be the best model to follow as the primary structure of our intervention. In combination with feedback from the listening sessions, including mindfulness

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

towards stigma, confidentiality, and cultural sensitivity, PM+ will be modified and evaluated during a pilot year to address the unmet mental health burden faced in Boston.

Pontificia Universidad Católica de Chile

Implementation of brief smoking cessation intervention among hospitalized smokers in Chile Tobacco is a significant public health problem in Chile. The overall goal of the project was to develop a low-cost strategy to promote tobacco cessation among hospitalized patients in Chile. My practicum focused on implementation research aiming to assess the readiness among healthcare providers and identify barriers to perform a brief smoking cessation counseling to hospitalized patients.

Harvard Humanitarian Initiative

the long shadow: the association between Trauma, Depression, Violence, and Parental Style Among Mothers in Côte d'Ivoire Background: In November 2011, former president Laurent Gbagbo refused to cede power to Alassane Ouattara following the Côte d’Ivoire presidential election. What followed was months of deadly violence and conflict, where at least 3,000 people were killed and more than 150 women were victims of sexual violence. Objective: Though a growing body of literature has provided evidence that maternal response to trauma and proximity to the traumatic event are related to poor psychological outcomes in children, no study has been done that specifically explores the relationship between exposure to violence, mental health symptoms and parenting style, especially in a post-conflict context. 2–6 The primary objective of this study was to explore the relationship between exposure to violence, trauma, depression symptoms, and parenting style among mothers in post-conflict Côte d’Ivoire. Methods: A cross-sectional study conducted on 433 mothers in western Côte d’Ivoire. Interviews were conducted using structured, pretested questionnaires. Data were analyzed using SPSS version 25. Results: All mothers reported some level of exposure to violence, trauma, and depression. The total score for exposure to violence was positively associated with permissive and active parenting scores, (β = 0.135, p < 0.01; β = 0.116, p = 0.015). The total score for trauma was negatively associated with permissive, active, and autocratic parenting scores (β = -0.127, p < 0.01; β = -0.207, p < 0.001; β = -0.155, p = 0.001). The level of depression was not significantly associated with any specific parenting style. Conclusion: Parental exposure to violence and trauma was were found to be weakly predictive of parenting style. Recommendations informed by these findings include strengthening the professional development and training of the early childhood development

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

workforce, building partnerships with community service providers to facilitate screenings of and service provision to high-risk families, and developing therapeutic interventions that utilize a “family systems-based” approach that engages both the caregiver and child.

Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN)

Racial and Regional Disparities in Treatment and Outcomes of Opioid-Exposed Pregnancies in Massachusetts For my practicum project, I worked with PNQIN, the Perinatal-Neonatal Quality Improvement Network of Massachusetts. In Massachusetts, as around the country, the epidemic of opioid use includes people who are pregnant and parenting. Nationally, there are disparities in the rates of opioid use in pregnancy, the in the quality of care that women and newborns receive, and in the resulting outcomes. National studies have found that women of color face barriers to receiving recommended medication assisted treatment and have higher rates of untreated opioid use disorder. Women living in rural areas and those in poorer counties, have higher rates of opioid exposed pregnancies and worse treatment available to them. There is a large gap in the literature of NAS regarding disparities of in prevalence, treatment, and outcomes of along racial or socioeconomic lines . The goal of my practicum project was to analyze the existing data which PNQIN has collected from hospitals around the state to see if there is evidence of disparities in opioid-exposed pregnancies based on region or the race/ethnicity of the mother. My practicum was broken into three major parts: (1) a literature review of racial and geographic disparities in prevalence, treatment, and outcomes of opioid use in pregnancy, (2) an epidemiological review of the PNQIN database, and (3) recommendations for practice standardization across the state to reduce disparities.

Boston Children's Hospital & National Institutes of Neurosciences Hospital

Folic Acid Supplementation Use among High Risk Mothers in Bangladesh The 2006 March of Dimes Global Report on Birth Defects estimated Bangladesh had a neural tube defect (NTD) prevalence of 47 per 1000 live births. This rate is twice as high as the global prevalence. Moreover mothers who have already had a pregnancy affected by a neural tube defect are at a higher risk of a second NTD affected pregnancy. A meta-analysis of randomized trials indicated a 69-87% reduction with the use of folic acid supplementation for prevention of recurrent NTDs and an 85-100% reduction in observational studies. There have not been any secondary prevention efforts for these mothers in Bangladesh to date. The National Institutes of Neurosciences & Hospital (NINS) in Dhaka, Bangladesh is partnered with Boston Children's Hospital to improve pediatric health outcomes for neurological issues. A RO1 study is currently being done exploring arsenic, folic acid and neural tube defects and I created a phone follow-up survey as part of the existing study to understand use and barriers of Folic Acid Supplements among mothers who already have a child with a neural tube defect. I spent my January term in Dhaka working at NINs to create and conduct this phone survey. This information will be used to helping pediatric neurosurgeons and neurologists create an intervention to improve FA supplement use among mothers as a secondary prevention effort.

Brigham and Women's Hospital and Boston Children's Hospital

Educating and Empowering Urban School Aged Children about Asthma Children from urban areas and minority racial/ethnic backgrounds experience asthma at disproportionately higher rates. This school-based study aims to empower and educate

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

school-aged children to more effectively manage their asthma. This study was conducted with English and Spanish-speaking families and school nurses, and utilized tools such as asthma educational sessions and in-school medication management to improve asthma knowledge, self-management, and symptoms over time.

Harvard T.H. Chan School of Public Health India Research Center

Mental Health Research Priorities in Mumbai: Assessing Challenges and Opportunities Following the Mental Healthcare Act, 2017 India substantially increased its investment in mental health over the past decade. Most recently, the policy framework and human rights defined in the Mental Healthcare Act, 2017 (MHCA) will substantially impact how India’s rapidly-urbanizing population of 1.5 billion perceives, seeks, and manages mental health. Mumbai faces unique challenges regarding risk factors, scale, and diversity of mental health needs. A mixed-methods gap analysis was conducted through the Harvard Chan India Research Center to help prioritize local mental health-related research. Results from a scoping review of 136 academic articles in PubMed between January 2000 and March 2019 revealed that while the volume of research increased substantially over time, methods and outcomes of interest are unevenly distributed: 46% of research used quantitative cross-sectional methods, and 58% focused primarily on substance use. Common themes from semi-structured expert interviews included the evolution of mental health stigma in Mumbai society, the increasing burden for elderly and adolescent populations, and a lack of credentialed mental health providers across the continuum of care. These themes, however, were barely reflected in the academic literature. Five key areas of further research were identified: (i) Clinical and community definitions of mental health; (ii) cross-sector referrals between mental health professionals and organizations; (iii) prospectively-designed studies and rigorous intervention evaluations; (iv) mental health practitioner burnout; and (v) patient-centric mental health experiences. This gap analysis provides a unique perspective on how future research investment can contribute to reducing the mental health treatment gap in Mumbai in particular, and in India in general.

CUNY Urban Food Policy Institute

Reducing Inequalities in Child Obesity in New York City My practicum project, titled Reducing Inequalities in Child Obesity in New York City, was completed in collaboration with the City University of New York (CUNY) Urban Food Policy Institute (the Institute). Since 2016, the Institute has worked with a network of CUNY faculty in public health, nutrition, sociology, urban planning, law and other disciplines. This organizations’s work addresses issues relating to nutrition and health equity, economic and social justice, food policy, and food security. Through collaboration with public officials, community organizations, and academics, the Institute strives to support and advance fair and effective urban food policies for New York City and beyond.

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

The goal of this project goal was to create a policy brief that addresses the problem of child obesity and related health inequity in New York City. The project entailed secondary data analysis to determine the current distribution of childhood obesity in New York City since 2011 and a literature review of the efficacy and feasibility of implementation of policy changes over the past decade. The project culminated with recommendations for future courses of action to reduce the overall prevalence of childhood obesity and close the gaps of health inequities in New York City. The final policy brief produced for this project will be one chapter in larger report on health inequities, which will serve as a reference on the current state of child obesity and gaps in care for the mayor’s office and other policy influencers. This project and the larger report fulfills the Institute’s goals of bringing issues such as health inequity, social justice, and food policy to light while proposing practical ways to tackle these problems.

Dana Farber/Boston Children's Cancer and Blood Disorders Center

Decisional Conflict in Pediatric Oncology within Low-and-Middle-Income Countries (LMIC): The Case of Hospital Infantil Teletón de Oncología in México Objective: As part of an international mixed-methods project exploring pediatric oncology (PO) decision-making during conflict in low-and-middle-income countries (LMIC), we examined the unique perspectives of staff from Hospital Infantil Teletón de Oncología (HITO), a free-standing PO hospital in Mexico. Methods: Nonprobability sampling methods were used to recruit participants (n=33). Using semi-structured interview guides, we conducted 19 in-depth interviews and 4 focus groups in English. Conversations were audio-recorded and transcribed. With Western ethical principles and the socio-ecological model as theoretical frameworks, we rapidly analyzed data using thematic analysis to explore the potential sources of conflict and the institutional factors contributing to conflict resolution. Results: Conflict involving patients/family resulted from difficulty coping with disease prognosis and/or social determinants of health (i.e. income). Among healthcare providers, differences in professional opinion regarding diagnosis and treatment led to conflict. Emerging themes for conflict resolution included (1) multidisciplinary teamwork, (2) shared decision-making, (3) face-to-face communication, (4) justice, and (5) institutional culture. Conclusion: This study provides a rare glimpse in how one low-resource PO institution tackles decision-making challenges. Significance: Other PO institutions in similar circumstances should consider adopting HITO’s model of care.

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Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Harvard Injury Control Research Center

Suicide Prevention Module Program Evaluation Suicides account for a significant proportion of the morbidity and mortality attributed to gun violence. In Utah, over the ten-year period from 2006 to 2015, 85 % of all firearm deaths were due to suicide, accumulating to a staggering 2,535 firearm suicides in all (1). To address this significant problem, the Harvard Injury Control Research Center partnered with Utah’s Bureau of Criminal Identification and the Utah Suicide Prevention Coalition to develop an intervention to reduce firearm suicides, and in 2016, developed a suicide prevention module to be included in firearm training courses for conceal carry permit applicants. The module has since been incorporated into Utah’s required curriculum for this course. My practicum project was to evaluate the impact of this intervention. To do this, I had a primary role in designing a survey for the firearm course instructors, analyzing the data, and writing up the results for academic and practical translation purposes. 1. Harvard T.H. Chan School of Public Health. (2018). Suicide and Firearm Injury in Utah: Linking Data to Save Lives.

National HPV Roundtable All Systems Go: Activating Integrated Delivery Systems to Increase HPV Vaccination This practicum will advance the work of this new task group which launched in June 2018. The group includes subject matter expert members from multiple health systems across the country which were early adopters of HPV vaccination initiatives, in addition to our organizational representatives. These systems have shared preliminary information with each other and plan to build out lessons learned. The group recently received supplemental funding from CDC to convene an in-person task group meeting to brainstorm and develop a collaborative workplan. This workplan will identify strategies and activities to impact large integrated delivery systems.

WellCalm WellCalm There is an unmet need with regards to mental health in young adults. Enter: WellCalm. This organization is essentially a start-up focused on addressing the mental health needs of college students in the Boston area. There are numerous interventions that WellCalm has undertaken. These include learning resources for area schools about mental health, which include information about signs and symptoms of common psychiatric disorders in this age group. There is also an intention to produce a podcast in the near future in order to provide a platform for these issues through an emerging media source. Social media will also play an important role in WellCalm’s desire to meet the mental health needs of young people in Boston. My particular focus within WellCalm is on the resource portal. This Mental Health Resource Portal will act a consolidated database with information about area mental health providers. Information we wish to provide include things like location, hours, insurances accepted, and languages spoken. We also want to go further and put an emphasis on types of services provided, such as the types of therapy offered, and specialty areas of the provider. For instance, some providers have immense expertise in depression and anxiety and less so in psychotic disorders. We want to create a portal that is thorough in the information it provides

Page 12: Degree: MPH-45 Field of Study: Health and Social Behavior ... · Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Harvard T.H. Chan School of Public Health

Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

because we want to address the barrier of access in the context of mental health care, needs, and treatment.

Brigham and Women's Hospital

Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study Background: Higher income is associated with lower incident cardiovascular disease (CVD). However, there are limited data on the association between changes in income and incident CVD. Methods: The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort of community-dwelling men and women. 8,987 participants (mean age 53±6 years) were categorized based on whether their household income subsequently decreased >50%, increased >50%, or changed less than 50% (“unchanged”) over a mean period of 6.0±0.3 years between ARIC visit 1 and 3. We measured incidence of CVD post visit 3 as a composite of myocardial infarction (MI), fatal coronary heart disease (CHD), heart failure (HF), or stroke. This composite outcome and its components were observed over 17±7 years and were related to income changes using Cox regression, adjusted for baseline socio-demographic variables, health behaviors, and biomarkers. Results: 900 participants (10%) were classified as having an income drop, 6,282 participants (70%) unchanged, and 1,805 participants (20%) as having an income rise. After adjustment, those with an income drop experienced significantly higher risk of incident CVD compared to those whose income remained unchanged (HR=1.16; 95% CI 1.03, 1.32). After adjustment, those with an income rise experienced significantly lower risk of incident CVD compared to those whose income remained unchanged (HR=0.86; 95% CI 0.77, 0.96). Conclusions: In a population of middle-aged adults, an income drop was associated with 16% higher risk of incident CVD, while an income rise was associated with 14% lower risk of incident CVD.

Horizons for Homeless Children

Horizons for Homeless Children Measurement Evaluation This project worked with the organization in how the program is currently collecting data and see what changes can be made for future use, which will in turn inform priority areas for the program to focus on for funding purposes. This has the potential to directly impact the clients utilizing the program and make sure there are measurable outcomes for the organization to be able to show improvements to create change. The practicum gave the opportunity to work collaboratively with an organization in the community already using specific measures and expand upon the knowledge base in the area of health and homelessness. Survey research methods were utilized to develop suggestions for the improvement of the current pre and post survey for the Mobility Mentoring program where Family Advocates work with each family in the program to help create goals, make plans to reach their goals, and assist in accessing resources for education, job training, and other services. Recommendations for questions to add, subtract, change, and reorder were offered and the project will inform the next stage of data management for the children enrolled in the program.

Inner City Education Foundation

Embracing the Mind in Underserved Communities: Designing and Implementing a trauma-informed mental health and wellness program in an inner city TK-12th grade school district

Page 13: Degree: MPH-45 Field of Study: Health and Social Behavior ... · Field of Study: Health and Social Behavior Practicum Project Abstracts 2019 Harvard T.H. Chan School of Public Health

Degree: MPH-45

Field of Study: Health and Social Behavior Practicum Project Abstracts 2019

Black and brown children living in poverty are at greater risk of mental illness than white children, yet are less likely to receive mental health services. Unaddressed mental health issues negatively impact academic achievement. This project sought to address these needs through the creation of a trauma-informed mental wellness program called "Embrace the Mind” in collaboration with the Inner City Education Foundation, a charter management organization that owns and operates eight public schools in south LA and Inglewood, California. The mission of Embrace the Mind is threefold: to offer education on mental health, to reduce stigma associated with mental illness, and to equip students, teachers, and families with the tools to build mental wellness. Embrace the Mind will give all students the ability to understand and discuss mental health and mental illness, and to seek help if and when needed. Students will have the opportunity to learn about mental health and wellness through curriculum specifically designed to fit into the context of their cultural backgrounds (i.e. exploring how to find meaning and self-worth in a social and political environment that often undervalues minority populations), to rest and de-escalate in Wellness Spaces around campus, and to practice calming activities like mindfulness meditation. Students’ teachers and adult caregivers will learn about how to support students' mental health and also engage in their own burnout prevention. Per Bronfenbrenner’s ecological systems framework, this work also involved evaluating the school and community to ensure that the child’s environment is conducive to mental wellness.