TRIUMPH Class of 2023 - M3 Posters

Class of 2023 – M3 Posters

Women’s Health in the Carceral and Post-Carceral Setting: Formative Research of Health Needs among Justice-Involved Women in the Implementation of the Returning Citizen’s Transitions Clinic

Cassie Crifase Advocate Aurora Healthcare

Women’s Health in the Carceral and Post-Carceral Setting: Formative Research of Health Needs among Justice-Involved Women* in the Implementation of the Returning Citizen’s Transitions Clinic Cassandra Crifase, MS3, AB; Myeesha Young†; Lavansa Jackson†; Kjersti Knox, MD; Sarah Reimer, MD University of Wisconsin School of Medicine and Public Health, Advocate Aurora Health, Progressive Community Health Centers

Background RETURNING CITIZEN’S TRANSITIONS CLINIC

• Identify women’s healthcare needs, experiences, and outcomes, including any disparities or inequities, in the justice-involved population in the literature and in the local population

1,2 The United States has the highest incarceration rate in the world •

• Identify systems-level weaknesses in the healthcare of justice-involved women prior, during, and

>2 million in American criminal justice system >1.2 million in state prisons

after incarceration in Wisconsin

Methods

•

Community Health Worker (CHW) Retention

• Preliminary literature review performed to explore issues faced by justice-involved women via collaboration with CHWs,

•

COVID-19 Pandemic

>95% of state prisoners return to the community

• These returning citizens are among the sickest members of

The ongoing pandemic has significantly affected implementation, directing efforts toward operation and away from secondary projects.

• Secondary literature reviews performed to better characterize menstrual equity in jails and prisons in Wisconsin,

Data from the Milwaukee County Jail and the Milwaukee House of

describe any association between justice involvement and preterm birth rates, and describe any association between justice involvement and sexually transmitted infection (STI) epidemiology

167,000 justice-involved individuals over the • Key informant interviews with clinical staff at the Wisconsin Department of Corrections, including physicians and social past 10 years in the Milwaukee catchment, including 109,000 Corrections identified

Advocate Aurora Health (AAH) patients.

workers, as well as subject experts

5

• The Wisconsin Department of Corrections, Advocate Aurora Health, and

• Field experience via 4-week clinical acting internship rotation at Milwaukee Secure Detention Facility (MSDF)

Progressive Community Health Centers have partnered with the Transitions Clinic Network (TCN) to implement a Returning Citizen’s Transitions Clinic (RCTC), an evidence-based primary care model that trains primary care teams in unique population-specific needs and is coupled with community health workers (CHWs) with lived experience of incarceration.

JUSTICE-INVOLVED WOMEN

• Women represent the fastest growing population of incarcerated persons in United States,

>700%

6,7

increase between 1980 and 2019

2x rate of growth compared to men •

The Milwaukee Secure Detention Facility (MSDF), a predominantly men’s facility, serves as the primary site of recruitment for the newly established Milwaukee RCTC.

Progress has been limited due to CHW staffing difficulties.

research databases searches, and publications from Transitions Clinic Network, Bureau of Justice Statistics, law and legal reference libraries, and justice and re-entry advocacy groups

13x mortality risk in first two weeks after release

CHALLENGES Gender Ratio at Primary Site

care visits at the RCTC

American society with higher rates of chronic disease, communicable disease, mental illness, and substance use disorders 2, 4

Justice-involved women are medically complex, underserved, and make up a large and growing population in the United States. Special attention should be paid to their unique experiences in the carceral and post-carceral setting.

•

• Identify strategies to ensure women’s health issues are adequately addressed during primary

2,3 The vast majority of prisoners will return to the community •

•

Discussion

Project Aims

8

Women are marginalized in intersectional ways7 with biases toward their…

Gender Race/ethnicity Class Status as a criminal offender

• Benefits of TCN programming for returning citizens that identify as women have been documented in autonomy, empowerment, health literacy, and healthcare engagement9

Preliminary Results • Awareness of healthcare system operations at one local correctional site • Priority of sustainability in implementation over short-term impact in local initiatives • National need for increased attention to: • Sexual health, including family planning, menstrual hygiene, & sexually transmitted infections • Reproductive health, including pregnancy, postpartum, & parenting • Trauma, substance use, & mental illness • Equitable access to educational, vocational, & rehabilitative programming Figure 1. Statistics on women in the incarcerated setting8

References: 1. Sawyer W, Wagner P. Mass Incarceration: The Whole Pie 2020 [Internet]. Prison Policy Initiative; 2020 Mar. Available from: https://www.prisonpolicy.org/reports/pie2020.html 2. Transitions Clinic Network National Headquarters. Transitions Clinic Network [Internet]. 2014.

Available from: https://transitionsclinic.org/transitions-clinic-network/ 3. Reentry Trends in the United States [Internet]. Bureau of Justice Statistics. 2021. Available from: https://www.bjs.gov/content/reentry/releases.cfm 4. Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, et al. Release from Prison — A High Risk of Death for Former Inmates. New England Journal of Medicine. 2007 Jan 11;356(2):157– 65.

5. Council on Offender Reentry, Wisconsin Department of Corrections. Council On Offender Reentry 2020 Annual Report. 2020.

33% test positive for STIs on admission

60% are mothers of children under 18

66% have a mental health diagnosis

Future Directions • Continued formative research directly with study population • Wisconsin menstrual equity fact sheet, position statement, advocacy efforts • Focused study design surrounding health needs in Milwaukee population † Lavansa Jackson and Myeesha Young made significant contributions to project inception and design, however are no longer with the organization and have not reviewed this work * This research does not reflect the experiences of all women, largely reflecting the experiences of the female sex regardless of gender

90% report history of trauma

6. Mignon S. Health issues of incarcerated women in the United States. Ciênc saúde coletiva. 2016 Jun;21:2051–60.

7. Braithwaite RL, Treadwell HM, Arriola KRJ. Health disparities and incarcerated women: A population ignored. J Public Health 2005; 95(10):1679-1681.

8. The Sentencing Project. Incarcerated women 2012, revised September. Available from http://www.sentencingproject.org/doc/publications/cc_incarcerated_women_factsheet_sep24sp.pdf 1.57" 9. Thomas K, Wilson JL, Bedell P, Morse DS. “They didn’t give up on me”: a women’s transitions clinic from the perspective of re-entering women. Addict Sci Clin Pract. 2019 Dec;14(1):12.

10. National Commission on Correctional Health Care Board of Directors. Women’s Health Care in Correctional Settings. 2020. Available from: https://www.ncchc.org/womens-health-care.

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Learn more @ https://www.med.wisc.edu/education/md-program/triumph/

A Hepatitis C Virus Testing and Referral to Treatment Program

Cassie Nytes UMOS

A Hepatitis C Virus Testing and Referral to Treatment Program Authors: Cassandra Nytes1, Gina Allende2, and Theresa Umhoefer-Wittry, MD1,3 1. University of Wisconsin School of Medicine and Public Health 2. UMOS, Inc. Health Promotions 3. Ascension Medical Group

Introduction Intravenous drug use and sharing of injection equipment is the most common risk factor for acute Hepatitis C virus (HCV) infection1.

Methods

Results

Program Development

Since September 2021Total tested: 40

• Coordinated with DHS of WI for training on HCV testing process • Contacted various health clinics to establish best methods for referral to HCV treatment • Created referral and internal data tracking forms • Established process steps and trained UMOS, Inc. staff

Desired Outcomes/Impact

30% Total Positive

HCV Testing Process

The opioid epidemic has been associated with a rise in HCV1.

Total Negative

Of those who tested positive, no confirmatory tests were taken and no referrals to treatment were made.

Medium Term Long Term

Raise awareness of testing availability at UMOS

Increase awareness in the Decrease the amount of community regarding HCV prevalence in the prevalence of HCV and community possibility of cure

Optimize/improve testing to referral process for clients

Influence decisions to Clients will be aware of their decrease sharing of drug equipment own HCV status

Improve overall health and well-being of clients

Connect clients to treatment for HCV Additionally, connect clients to the health system overall via access to insurance and/or medical home Increasing amount of confirmatory testing after rapid HCV testing

Discussion

Point-of-care testing for HCV at community sites with linkage to care has been shown to be an appropriate and effective method to increase diagnosis and treatment of HCV in the population of people who inject drugs (PWID)2,3, with the intention of preventing further transmission of disease.

Our Goal: This project with UMOS, Inc. Health Promotions seeks to set up an HCV testing program with referral to treatment as part of its syringe exchange program.

Thus, identifying those who are infected, increasing access to treatment, and eventually decreasing rates of HCV in the PWID community of Milwaukee using UMOS' services.

70%

Short Term

Data Collection: • Collection of demographic data is required by DHS. They provide forms.

• Logging of this data internally to better understand the population UMOS Needle Exchange is supporting • Tracking of treatment referrals and client’s ability to attend appointments

A significant portion of the population served by UMOS, Inc. Health Promotions Needle Exchange Program tested positive for HCV. All so far who tested positive had previously shared injection equipment. This data corresponds with identified trends in Wisconsin. Some of UMOS’ clients who tested positive had previously been treated for HCV; however, we could not identify if they had been re-infected. Rapid tests only show the presence of antibodies to HCV in the blood. Some of those who test positive could have cleared the virus.

Unexpected Challenges • All of those who tested positive for HCV antibodies with the rapid test declined confirmatory testing for active virus or staff were unable to draw blood from collapsed veins.

• Staffing turn over also led to more limitations on testing.

Next Steps • Follow up with clients that tested positive to discuss reasons for refusal of confirmatory testing and possible solutions • Discussion with other organization that test for HCV regarding challenges with confirmatory testing • Reevaluate program and make changes necessary after preliminary data gathered – will need to extend this period so that information regarding success of referrals can also be analyzed

References: 1) Department of Health Services. Hepatitis C in Wisconsin. Wisconsin Hepatitis C Virus Surveillance Annual Review, 2020. https://www.dhs.wisconsin.gov/publications/p00440-2020.pdf. Accessed March 12, 2022.

2) Bajis, Sahar et al. Interventions to enhance testing, linkage to care and treatment uptake for hepatitis C virus infection among people who inject drugs: A systematic review. International Journal of Drug Policy. 2017; 47:34-46. DOI https://doi.org/10.1016/j.drugpo.2017.07.002. Accessed March 12, 2022.

3) Latham, Ned et al. Community-based, point-of-care hepatitis C testing: perspectives and preferences of people who inject drugs. Journal of Viral Hepatitis. 2019; 26(7), 919-922. DOI https://doi-org.ezproxy.library.wisc.edu/10.1111/jvh.13087. Accessed March 12, 2022.

Addressing Food Insecurity in Medically Complex & Socially At-Risk Patients

Cathryn Phouybanhdyt Advocate Aurora Healthcare

Addressing Food Insecurity in Medically Complex & Socially At-Risk Patients Cathryn Phouybanhdyt, BA1 , Zeeshan Yacoob, MD, MPH2, Stephenie Quirke, DO2, Do Duy Dang, BS1, Jessica J.F. Kram, MPH3, George Neureuther4 , Glenda Sundberg, NP2 1

University of Wisconsin School of Medicine and Public Health, 2Aurora Family Medicine Residency Program, 3Aurora UW Medical Group, Center for Urban Population Health, Aurora Sinai Medical Center ,, 4 Interchange Food Pantry

Introduction The Issue: Food Insecurity in Milwaukee

• The projected food insecurity rate in Milwaukee households prior to COVID-19 was 11.8%1.

• Milwaukee County is known for poor health outcomes, ranking 71 out of 72 counties in Wisconsin2.

• Poverty undoubtably plays a role in access to fresh food, and there is decreased availability of fresh and nutritious foods in low-income neighborhoods.

The Initiative: Bridging the Gap Between Clinics and Food Security • • •

Many patients at Aurora Sinai and St. Luke’s Hospitals are medically complex, socially at-risk for increased hospital admissions (hotspots), and are on fixed budgets.

Clinics do not routinely screen patients for food security.

The purpose of our study is to identify and address the importance of screening for food security and pilot a creative solution to assist our patients.

Methods

• 45 patients were screened for food insecurity.

• 15 patients (33%) were noted to have “very low food security”.

Of these, 8 were randomly selected for the intervention group.

• Over the next 6 months, the intervention group received monthly food deliveries from a local food pantry, Interchange Food Pantry, which was delivered by the medical team.

• Food deliveries were determined by what the food pantry had in season, but always included meat, fruits, and vegetables.

• The control group received information on local food pantries and food resources.

• The World Health Organization Abbreviated Quality of Life (WHOQOL-BREF), an abbreviated and validated quality of life survey, were administered to all participants both before and after the intervention.3

Results

• In the social relationship domain, a statistically significant improvement in quality of life was noted among our intervention group but not our control group. However, overall quality of life scores remained unchanged for both the intervention and control group.

I liked it a lot. It helped with staying up with the food so that I [...] have food in my refrigerator and in my freezer so I’m thankful for that.

The Food Recipients:

The Food Delivery Team:

I don’t have to go out and I don’t have to worry about the next meal. The vegetables are good. I’m thankful.

It’s been a big help.

I haven’t been able to get to the store since I’ve been in and out of the hospital.

Since they removed my teeth, I lost 30 lbs. You guys brought me things that I can actually eat.

4 qualitative themes emerged: 1. Appreciated Food Visits 2. Enjoyed Food Quality and Quantity 3. Improved Food Insecurity 4. Bridged Transportation Access

Discussion

• A statistically significant improvement was noted in the social relationships quality of life domain, suggesting participants connected with the study team, since it was the same individuals seeing them monthly for 6 months.

• The study benefitted patients and their families and/or caregivers due to decreased stress to meet food needs, which could improve interfamily relations, which was evident when family coordinated with the team to receive the delivery.

• We were limited by a small sample size, which made it difficult to achieve statistically significant changes in quality-of-life scores.

• We continue to partner with Interchange Food Pantry to deliver food to our Hotspotting Patients with low food insecurity.

• Eventually, we would like to expand this program to our general clinic populations and routinely screen patients for food security.

References 1. Feeding America. Map the Meal Gap 2019. 2019. https://www.feedingamerica.org/sit es/default/files/2019-05/2017-mapthe-meal-gap-all-modules_0.pdf.

2. County Health Rankings. https://www.countyhealthrankings. org/app/wisconsin/2020/measure/f actors/133/description 3. https://www.who.int/tools/ whoqol/whoqol-bref.

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Family Medicine Residents’ Knowledge, Comfort, and Prescribing Behavior Related to Expedited Partner Therapy for STIs

Claudia Evaristo United Way of Greater Milwaukee and Waukesha County

Family Medicine Residents’ Knowledge, Comfort, and Prescribing Behavior Related to Expedited Partner Therapy for STIs Claudia Evaristo, BA, Nicole Angresano, MPH, Melissa Lemke, MA

Introduction

Project Goals

Due to the COVID-19 pandemic, STI testing efforts were reduced to a minimum across testing sites in Wisconsin. Despite this reduction, from 2019 to 2020, cases of gonorrhea and syphilis increased 13.08% and 38.46%, respectively (1). While there are multiple risk factors for infection, the most significant risk factor for reinfection is continued sexual contact with an untreated infected partner (2). This increases the probability not only of increased community spread of STIs, but also adverse health effects such as pelvic inflammatory disease and its potential consequences including pelvic pain, increased risk for ectopic pregnancy, and infertility. Treatment of infected patients and their partners is critical to preventing progression to these outcomes.

1) Assess Family Medicine residents’ knowledge of and comfort with prescribing EPT 2) Increase resident knowledge and comfort through educational modules developed specifically for the resident class 3) Increase prescription of EPT for partners of patients diagnosed with STIs in resident clinics and beyond in their future practices

Expedited partner therapy (EPT) is prescription of antibiotic treatment to sexual partners of patients with a curable STI without separate evaluation by a healthcare provider. Since 2010, EPT has been legal to prescribe in Wisconsin for treatment of trichomoniasis, gonorrhea, and chlamydia. EPT lowers the barrier for patients’ partners who would otherwise be unable or unlikely to seek care to receive curative treatment for these infections and prevent reinfection of the original patient.

Residents in family medicine are trained to diagnose and treat STIs, however, EPT is still under prescribed. This project works to understand residents’ knowledge of and comfort with EPT and to understand its current use in this group.

Discussion

Methods Goal 1: A questionnaire will be developed to analyze resident characteristics (eg: post-graduate year, sex, intended career path post-residency), evaluate their clinical practices (frequency of treating patients with STIs, frequency of past EPT prescription), assess residents’ current knowledge of laws and clinic policy regarding prescription of EPT, and evaluate their comfort with and barriers to prescribing EPT. It will also evaluate what learning method would be most impactful in learning about and increasing comfort with providing EPT. Goal 2: Following analysis of the questionnaire, an educational module around EPT will be developed to help increase knowledge and comfort, and ideally subsequent use, of EPT by family medicine residents at Aurora.

Goal 3: Finally, following administration of the educational module, residents will receive a follow-up survey to re-evaluate knowledge of EPT and comfort with prescribing it in the future. These results will be compared to those from the original survey. They will also receive a long-term follow-up survey to evaluate potential changes in their prescription of EPT.

Expedited partner therapy is an evidence-based approach to lowering barriers to STI treatment for partners of people diagnosed with an STI. Preventing reinfection and further spread of STIs reduces community burden of infection and helps prevent adverse health outcomes that can impact those without easy access to healthcare.

Ensuring our future primary care providers feel comfortable and confident providing this treatment is an important step towards reducing the high infectious burden in our communities and increasing access and equity in the realm of sexual health.

Next Steps 1. Implementation • Distribution of surveys and analysis of preliminary data • Development of educational module • Distribution of follow-up surveys and analysis of data 2. Recruitment of additional programs • EPT is relevant not only to future family medicine physicians, but also other primary care physicians in internal medicine and pediatrics • Applying this methodology to residents from these fields would be both important and interesting to glean insight from 3. Broader application of insights

References: 1. Wisconsin Department of Health Services. (2021, December 2). Sexually Transmitted Infections Wisconsin, 2020. Sexually Transmitted Disease Surveillance Data. Retrieved April 2, 2022, from https://www.dhs.wisconsin.gov/publications/p00415-2020.pdf 2. Centers for Disease Control and Prevention. (2021, April 19). Expedited Partner Therapy. Sexually Transmitted Diseases: Treatment and Screening. Retrieved April 2, 2022, from https://www.cdc.gov/std/ept/default.htm

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Expanding Home Visits with Advocate Aurora Midtown Clinic

Jalin Roberson Advocate Aurora Midtown Clinic

Expanding Home Visits Aurora Midtown Clinic Jalin Roberson, MS3; Rachel Castillo, MSW, Kjersti Knox, MD, Anne Getzin, MD, Sharon Krukowski, NP

Introduction

Methods

Goals

Aurora Midtown clinic is a unique community focused clinic located in Milwaukee, Wisconsin.

The clinic serves some of the most impoverished zip codes in Wisconsin, including the 53206-zip code. 80.5% of the patient population at Midtown identify as African-American. 10% of the patients are currently uninsured, with 40% on Medicare, 30% on Medicaid, and 20% on commercial insurance. Many of these patients live which chronic, complex disease and need extra support navigating health care.

“Hotspotting” is an idea that was designed by Dr. Jeffery Brenner for the Camden Coalition of Healthcare to help patients with navigation of healthcare.1 “Hotspotting” focuses on assisting “super-utilizers” of the health care system, including excessive ED/Inpatient stays, as well as “under-utilizers”. This process involves multidisciplinary input, with nurses, physicians, pharmacists, and legal teams being involved.

Intakes and home visits are an important aspect of “hotspotting”, that allows insight into the patients' daily life and allows providers to meet patients where they are.

In 2019, Aurora Midtown Clinic adopted a “hotspotting” model that was based off of Dr. Brenner’s version and 2 pilot programs ran through Aurora St. Luke’s and Aurora Sinai.

During COVID, personnel shortage became an issue with continuing the “hotspotting” program, as well as effectively discontinuing home visits. The lack of residents, pharmacists, and other providers to form home visiting teams to aid in “hotspotting” became a major reason for decreased function of the hotspotting program.

Future Results

Figure 1: Hotspotting program style

• Increase personnel with recruitment of residents from family medicine, psychiatry, and internal medicine.

• Use clinic electronic resources, such as Ipads, to perform electronic home health visits with providers at clinic.

• Increase spectrum of care offered with involvement of law and pharmacy specialists.

Strategie s

• Discussion with Aurora healthcare regarding incorporating hotspotting at Midtown as an elective.

• Have a designated hotspotting team to visit homes.

• Partner with local universitys, like Marquette and Concordia.

Envisioned Outcomes • Increased patient satisfaction rates and decreased inappropriate usage of resources.

• Increased appropriate health care utilization.

• Increased opportunities for patient to be seen by medical professional and career growth for residents.

• Decreased adverse medication events and law disputes.

Discussion The lack of personnel has been the greatest difficulty in the lifespan of the “Hotspotting” program at Aurora Midtown Clinic. The use of pharmacists, legal teams, and residents for “hotspotting” at Aurora Midtown Clinic would allow for more contact with patients and ease of accessibility for home visiting. Without these extra personnel, home visits became unfeasible at the clinic. Telehealth home visiting could allow the “hotspotting” team to circumvent that issue and may allow for a more cohesive and concise home visit model that aims to be more sustainable for current personnel at the clinic.

Figure 2: Aurora Midtown Location

References: 1. Introduction to hotspotting. Camden Coalition. (2021, August 5). Retrieved April 13, 2022, from https://camdenhealth.org/intro-to-hotspotting

/

Limitations: - The timing for video visitation with patient’s provider during these home visits will be difficult to coordinate in order to not disrupt the provider’s patients that are coming to the clinic.

- Resident work hours may be difficult to be flexible to provide the greatest continuity of care for the “hotspotting” patients.

- Patients may not feel comfortable with having a new “provider” see them every home visit if it is a new resident every time.

Moving forward, a new system wide initiative is in place for Aurora, named “Advanced Care at Home”. It will be utilized in Aurora Midtown Clinic and followed to see if it can alleviate the strain on the clinic’s current resources that “hotspotting” had.

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Mindfulness for the People 2.2: Exploring Black-Centered “Emotional Media” Through A Mobile Health Application

Jasmine Love Mindfulness for the People

Mindfulness for the People 2.2 Exploring Black-centered “emotional media” through a mobile health application* o

Jasmine Love1, Angela Rose Black2, Savannah Windham2, Theresa Umhoefer1 University of Wisconsin School of Medicine & Public Health1, Mindfulness For the People2

METHODS

BACKGROUND Health disparities disproportionately affect historically marginalized communities. African Americans are more likely to be affected by chronic conditions such as diabetes and hypertension than white counterparts. 1,2 The social determinants of comorbidities in Black Americans is multifactorial in nature with contributions from access to care, socioeconomic factors, and race-based stress.2 It is therefore imperative to the health of Black people to create accessible and equitable means to reduce stress and improve health outcomes Mindfulness-based tools (MBT) support attention to thoughts, emotions, and physical sensations that occur in the present moment.3 MBTs positively impact stress reduction processes and subsequently result in improved health outcomes.

1-3 However, one of the barriers that exists for the incorporation of MBTs in the Black community is limited access to culturallyresponsive content. Recent studies have successfully explored and established mobile health applications as a means to provide culturally-informed content to Black consumers.3 Similarly, this study aims to establish a mobile health application targeted to a Black audience and assess its impact on health and wellbeing outcomes.

OBJECTIVE: The goal was to create a rebranded platform that housed new Black and queer-centered emotional media. In order to do this, it was necessary to gather vetted content, create an accessible platform to house such content, and explore its impact.

Curated content

• Podcasts conversations on healing • Books & Audiobooks stories of the Black experience • Meditations brief instructional tools • Music supports down regulation

Long-term

Increased awareness of mindfulness-based tools

Increased promotion of mental wellbeing

Implementation of mindfulness in everyday life

Increased relevance of Black and queer-centered emotional media

Incorporation of mindfulness practices in Black families

Development of long-term coping strategies

Providing access to Black and queer mindfulness leaders

Increased skill in emotional regulation

 Content will be housed via the platform Patreon  Recruit Black medical/graduate students via email, social media, word (https://www.patreon.com/mindfulnessforthepeople) of mouth  Eligibility & Consent Survey  Accessible through paid monthly subscription to  Pre-focus group questionnaire: baseline assessment of current stress content level, perceived coping skills  1 hour Black-led focus groups focused on participant experience, selfperceived stress/coping effects of content, mobile application feedback  Post-focus group questionnaire: post-intervention impacts of content on stress and coping, future use of mindfulness technique

Outcome measures

Satisfaction Relevance Perceived stress reduction Ease of access Use of mindfulness-based tools

FUTURE DIRECTIONS

Medium-term

Supporting Black and queer mindfulness professionals & businesses (authors, podcasts, yoga instructors)

Objective: Exploration of content impact

*Google images

Short-term

Self-reported stress reduction

Impact: Organized Focus Groups

Mobile Health Application Platform

Content research included exploring the following categories of material for inclusion into the data application from mindfulness providers and organizations worldwide:

ANTICIPATED RESULTS

Increased awareness of stress relief strategies

COMMUNITY PARTNER: Mindfulness for the People 2.2 is a "family of Black and Queer Creatives who curate heart-centered content for heart-centered folx”. Their mission is to increase access to Black and Queer-centered *“emotional media”: mindfulness-based media that connects us to ourselves.

Decreased stigma in regard to mindfulness and mental health Reduced race-related stress caused by racism and gaslighting

Improved health outcomes (i.e. lower Increased interprofessional rates of chronic disease) & decreased communication between mindfulness morbidity and mortality associated with professionals/providers chronic conditions

Status 1. Continued research and collection of content

On-going

2. Transfer curated content to mobile health application

Future

3. Begin recruitment for focus groups via email, social media, word of mouth

Future

4. Organize and host 1-hour MFP led-focus groups to explore content impact

Future

5. Promote and publicize application to the general public

On-going

6. Evaluate post launch initial outcome analysis

Future

SOURCES [1] Woods-Giscombe, C. L., Gaylord, S. A., Li, Y., Brintz, C. E., Bangdiwala, S. I., Buse, J. B., Mann, J. D., Lynch, C., Phillips, P., Smith, S., Leniek, K., Young, L., Al-Barwani, S., Yoo, J., & Faurot, K. (2019). A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes. Evidence-based complementary and alternative medicine : eCAM, 2019, 3962623. https://doi.org/10.1155/2019/3962623 [2] Woods-Giscombé, C. L., & Black, A. R. (2010). Mind-Body Interventions to Reduce Risk for Health Disparities Related to Stress and Strength Among African American Women: The Potential of Mindfulness-Based Stress Reduction, Loving-Kindness, and the NTU Therapeutic Framework. Complementary health practice review, 15(3), 115–131. https://doi.org/10.1177/1533210110386776 [3] Watson-Singleton, N. N., Pennefather, J., & Trusty, T. (2021). Can a culturally-responsive mobile health (mhealth) application reduce african americans’ stress?: A pilot feasibility study. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues. Advance online publication. https://doi.org/10.1007/s12144-021-01534-9

What is TRIUMPH? Training In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: http://www.med.wisc.edu/education/md/triumph/main/681

Mental Health Training for Non-Mental Health Professionals at Sixteenth Street Community Health Centers (SSCHC) Department of Environmental Health and Community Wellness (DEHCW)

Jordyn Anklam Sixteenth Street Community Health Centers

Mental Health Training for Non-Mental Health Professionals at Sixteenth Street Community Health Centers (SSCHC) Department of Environmental Health and Community Wellness (DEHCW) Jordyn Anklam, MS3 ; Jamie Ferschinger, MS ; Michelle Buelow, MD, MPH 1

2

3

University of Wisconsin School of Medicine and Public Health; 2Sixteenth Street Health Centers Director of Environmental Health and Community Wellness; 3Sixteenth Street Community Health Centers Department of Family Medicine

1

Methods

 Sixteenth Street Community Health Centers (SSCHC) is a federally qualified health center serving Milwaukee and the surrounding communities.  SSCHC’s patient and client population includes many people whose primary language is Spanish and clients with unmet mental health needs.  Participants in this series of presentations were Department of Environmental Health and Community Wellness (DEHCW) staff members at SSCHC who act as formal or informal community health workers.

This project involved developing resources for DEHCW with the goal of clarifying the non-mental health professional’s role and scope of practice, addressing when to refer clients to specialists, and building the non-specialists’ skills and resilience in working with this population. The modules were presented and facilitated by a third-year medical student.

Deliverables:  Creation and delivery of four mental health informational presentations for SSCHC-DEHCW  Presentation of these modules for partnering organizations and groups  Milwaukee Mental Health Resource Guide  Videos or Program Guides for future community health workers and non-mental health professionals

Results The anticipated outcomes of this intervention include developing a healthcare workforce with more awareness of mental health issues and concerns, more confidence to address those concerns within the scope of their current practice and increased personal resilience to continue caring for this population long term.

Quotes from participants:

“I am so optimistic about the help these trainings will give me when we do the summer community projects. I will be ready to be a full glass of love for residents.” ”[After these presentations] I have the information to assess my own mental health needs in order to perform/give my all in my work.”

Discussion what wedid: This project was designed with the goal of clarifying the non-mental health professional’s role and scope of practice, when to refer clients to specialists, and how to build their skills and resilience in working with this population.

This work aims to: address the shortage of trained mental health providers in Milwaukee and Wisconsin Help build confidence and resilience regarding interacting with and caring for patients and clients with mental illnesses for non-mental health professionals add another level of support to the community for people living with mental illness

what welearned: Implementing this training increased the participants’ knowledge, attitude, skills, and confidence in working with this population

Training non-mental health professionals in mental health care is effective and vital for increasing the capacity and quality of mental health services.

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Life Skills Programming for Housing Insecure Families

Juanita Fernandez Salvation Army

Life Skills Programming for Housing Insecure Families Juanita Fernandez; Steve Ohly RN, NP; Melissa Lemke, MA Salvation Army Emergency Lodge & University of Wisconsin School of Medicine and Public Health, TRIUMPH Program

Context

• According to the United States Interagency Council on Homelessness there were approximately 4500 individuals experiencing homelessness in the state of Wisconsin and of those, nearly 15 percent were family households (2018).

• Public school data from 2017-2018 showed nearly 19,000 students in Wisconsin experienced homelessness over the course of the year.

• There is currently not a great understanding of how a parent’s approach to caregiving can exacerbate or mitigate the risks that a child faces. Additionally research shows a significant impact of homelessness on the mental health of the parents themselves.

• In a systematic review of available qualitative data regarding the life experiences of homeless families and parenthood, the following framework was developed. It categorized experiences into two dimensions either supporting or mediating parenthood experiences of homeless parents. Our project addresses several of these dimensions— relationship with others, isolation, and disempowerment.

Methods

• Groups will be implemented weekly--1.5 hour long nurturing parenting sessions as part of a cycling 8 session curriculum.

• Topics will include:

Results

• One cycle of the curriculum was completed between 2021-2022.

• There were four participants, all residents of the Salvation Army Lodge.

•

Child development

• No participants attended all eight sessions

•

Family communication

•

Discipline

•

Self-care for parents

• At baseline, this project will allow us to glean an understanding of the challenges and strengths these members of our community face when navigating parenting while simultaneously experiencing homelessness.

• Additional results include helping improve client self-sufficiency upon leaving Lodge as well as improving mental health, life skills, and parenting strategies of Lodge families.

• We hope to start a broader shift in attitudes around parenting and coping with trauma in housing insecure families.

• Additionally, one of our major goals is aiding in the reuniting of families with children in foster care.

Individuals receive documentation of their completion of the curriculum to support them.

• Several of the parents used this certificate to aid in in their case when trying to regain custody of their children.

• Additionally, weekly sessions will provide a space for community building among parents residing at the Salvation Army Emergency Lodge in Milwaukee, WI.

Curriculum used -- Partners in Parenting Developed by the Institute of Behavioral Research at Texas Christian University

Discussion

• Through the implementation of this new parenting curriculum we hope to get more information about the parenting strategies of parent’s experiencing homelessness.

• This information is valuable given the significant percentage of the homeless population who are parenting, and the impact of parenting on mitigating or exacerbating the effects of homelessness on childhood development.

• Future iterations of the curriculum will be adjusted in duration to encourage a higher percentage of participants engage in 100% of the classes.

Acknowledgements

I would like to thank Steve Ohly, Antoinette Davis, Loni Fitzgerald, Melissa Lemke, Salvation Army Emergency Lodge, University of Wisconsin Madison School of Medicine and Public Health, and the TRIUMPH Program.

References Andrade, F. M. R., Simões Figueiredo, A., Capelas, M. L., Charepe, Z., & Deodato, S. (2020). Experiences of Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative Evidence. In International Journal of Environmental Research and Public Health (Vol. 17, Issue 8, p.

2712). MDPI AG. https://doi.org/10.3390/ijerph17082712

What is TRIUMPH? Training In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Sex Trafficking Training: a Collaboration between HCAST & 211

Julia Addams Progressive Community Health Centers

Sex Trafficking Training: a Collaboration between HCAST & 211 Julia Addams BA, Madelaine Tully MD, Angela Rabbitt DO FAAP, Wendi Ehrman MD, Marlanda Glandberry, Chuntazia Cox, Carla McKiver, José Salazar, Debbie Lassiter D. Div, Karen Hoffman A warm thank you to the survivors, many members of HCAST, 211 team members, and the AV Department at Children’s Hospital for lending their time, creativity, experience, perspective to this project

Introduction:

Methods: Slide Deck

Sex trafficking is form of modern-day slavery that is happening in our own backyard.

Synthesis of existing trainings

• •

In 2019, Wisconsin ranked the 6th state in the nation for new criminal human trafficking cases.

• Many of these cases were in Milwaukee.

Despite this, most healthcare providers surveyed reported little to no training on working with survivors of sex trafficking • The same is true for Milwaukee-area 211 operators

Given this scope, the Healthcare Collaborative Against Sex Trafficking (HCAST) teamed up with Impact 211 to create a training on working with callers/ patients who are in sex trafficking situations.

• •

Trainings: SOAR, HEAL, Dignity Health, Common Spirit Information: Wisconsin DOJ, Wisconsin Department of Children and Families, Polaris Project Resources: list of local resources vetted by survivors

• •

•

Statewide non-profit call center • Assesses callers’ needs • Housing, medical care, transportation, etc.

• Connects callers to appropriate local resources

Listening Sessions

Narration •

Written, recorded, and attached for use in self-paced training

• •

Above: Sample slide from slide deck

Methods: Videos Survivors, 211 representatives, and HCAST members shared their experiences and perspectives working for/ with the service, and from receiving resource referrals from it 3 one-hour long sessions over zoom Listening sessions recorded, transcribed, and analyzed for themes

Script Development: •

Themes were identified from the listening sessions and incorporated into the script Through an iterative process, each successive draft was revised and reworked until it satisfied all parties 4 meetings with 211 3 meetings with HCAST End result: 2 scripts showing exemplified scenarios in which 211 operators assist 1. a survivor calling alone 2. a physician calling on behalf of a survivor

• • • •

Urgent medical care Housing Advocates for law enforcement interviews

• •

Sex trafficking and minors: Improvement in correct answers from 54% to 85% Sex work vs. sex trafficking: decline in correct answers from 66.67% to 13.31%

•

After training, operators able to identify a greater number of recent calls suspicious for sex trafficking

•

• Survivor identification •

Satisfaction with trainings:

• 81% felt knowledge increased “quite a bit” or “a great deal”

Incorporating all parties’ perspectives in the development of the educational materials • Ensured relevancy, authenticity, and buy-in from a survivor perspective, as well as from a 211 operator perspective • Operators reported overwhelming satisfaction with finished product Expanded participants’ knowledge base • Gains in understanding on some aspects of the legal definition of sex trafficking • Allowed for 211 operators to retroactively identify more recent calls as potential sex trafficking cases

Areas for improvement:

trafficking, rather than sex work– even if no force, fraud, or coercion • Additional slide on distinguishing sex trafficking from sex work created

Improvement in knowledge about identification and response 60.00% 50.00%

Left: 54% of participants felt their knowledge increased “quite a bit” and 27% “a great deal.”

40.00%

0.00%

Next steps:

Not at all

Somewhat

Moderately

Quite a bit

A great deal

Percent

Number of calls over the last 3 months involving potential trafficking 16 14 12

Piloting: twenty-six 211 operators participated in training piloting Pre and post tests administered • Knowledge acquisition • Overall satisfaction with training

Survivor in acute crisis Medical provider calling on behalf of a provider

• May have unintentionally biased operators to perceive a situation as sex

Audio Visual Services at Children’s Hospital Wisconsin donated their time, equipment, and expertise to shoot and edit both training videos

The Pilot:

• •

How dynamics change when the caller is a:

What we did well:

10.00%

•

Trauma-informed response Expectation Management & transparency

Discussion:

Knowledge acquisition: • Scope of problem: good awareness at baseline • Legal definitions:

20.00%

Shooting & Editing:

Navigating Difficult Emotions

Results:

30.00%

• •

• • •

Edits and improvements made as a group

About HCAST:

About Impact 211:

Legal definitions Screening Recognition

Slides and quiz questions structured around these

•

• •

•

Resources Available in Milwaukee:

Slides were reviewed by HCAST and 211 members

•

HWPP-funded collaborative made up of healthcare workers, survivors of sex trafficking, community workers, and others Education priorities: • Create multi-disciplinary curricula for those working with survivors • Trauma-informed, Milwaukeespecific, practical

• • •

Need for basic information

All parties agreed upon learning objectives

Listening Sessions:

•

Themes:

Right: after the trainings, participants were able to retroactively identify more recent calls that were suspicious for sex trafficking than they could before the training.

10

• • •

8 6 4

Trainings will be used for statewide 211 trainings HCAST website soon to go live •

Future trainings: • Primary Care •

2 0

Six educational slide decks available there

0

1

2 to 3 Pre-survey

4 to 5

more than 5

Progressive Community Health Center, Planned Parenthood

Post-survey

Above: volunteers from HCAST and 211 filming a scene

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Understanding and Addressing Disparities in COVID-19 Vaccination among Refugee Communities seen by Aurora Walker’s Point Community Clinic

Leah Cha Advocate Aurora Walker’s Point Community Clinic

Understanding and Addressing Disparities in COVID-19 Vaccination among Refugee Communities seen by Aurora Walker’s Point Community Clinic Leah Cha1, Po Too2, Sally Smaida, MPH2, Kjersti Knox, MD1, Steven Murphy, MD2 (1) University of Wisconsin School of Medicine and Public Health (UWSMPH), (2) Aurora Walker’s Point Community Clinic (WPCC)

Introduction

• Between 2002 to 2016, more than 13,000 refugees from more than 50 different countries have resettled in Wisconsin, with the vast majority residing in Milwaukee (64.5%).1 • The most common nations of origin for refugees resettling in Wisconsin include Myanmar (53.5%), Democratic Republic of Congo (11.2%), Iraq (10.8%), Somalia (10.5%).2 • Multiple factors place recently resettled refugees at a higher risk for more severe COVID-19 illness compared to the general U.S. population, including but not limited to: limited access to health care, baseline disease burden, social isolation, overcrowded living conditions, susceptibility to economic hardship.3 • Greater vulnerability among refugees to COVID-19 illness makes vaccination imperative to reduce COVID-19 exposure and complications • Emerging evidence suggests that ethnic minority populations, including migrants, may be more reluctant to accept COVID-19 vaccination than others.4

Results

Discussion

• COVID-19 vaccination rates among refugee communities seen by WPCC falls significantly behind national COVID-19 vaccination goal of 70%, set by the Biden administration.

• The community with the highest rate of completed COVID-19 vaccination is those who speak Dari, who largely represent Afghanistan.

• This statistic may be explained by recent arrival of Afghan communities, who needed to meet requirements set by the U.S. government to be vaccinated for COVID-19.5 • Less than 30% of each refugee community have completed the booster series.

• Low COVID-19 vaccination rates in refugee populations may be explained by: • Misconceptions about COVID-19 vaccines • Limited vaccination education/awareness • Barriers to transportation to appointments • Lack of interpreters in many vaccination sites • Gaps in sharing of medical records (i.e. nonWPCC PCP established) and dissemination of vaccination data (Epic vs. WIR) • These findings provide further evidence of the importance of COVID-19 vaccination dissemination of data and promotion efforts.

Objectives 1. Understand how COVID-19 vaccination data are collected by the Wisconsin Immunization Registry and Electronic Health Record (EHR) 2. Identify COVID-19 vaccination rates by refugee community to develop vaccination strategies specific to the population 3. Support Community Health Workers to promote COVID-19 vaccination through education and community interventions 4. Educate and train WPCC staff on how to obtain COVID-19 vaccination data via the EHR

Next Steps 1. Identify and implement a system for tracking vaccination rates in refugee communities seen at WPCC 2. Conduct individual or focus group interviews with WPCC staff, community leaders, and refugee communities to better understand reasons for COVID-19 vaccine hesitancy 3. Develop programs and interventions aimed at improving COVID-19 vaccination rates that cater to the specific needs and cultural backgrounds of refugee populations

Methods

• Using Epic SlicerDicer, identified COVID-19 vaccination rates in refugee communities seen by WPCC by filtering by language other than Spanish or English, WPCC Primary Care Provider, Wisconsin state, age ≥ 5 years, dates between 1/1/2017 to 1/1/2022 • Provided COVID-19 vaccination data reports disaggregated by refugee community, vaccine type (Pfizer, Moderna, J&J), and vaccination status (not, partially, or fully immunized) to WPCC Refugee Health Team • Developed and updated COVID-19 informational materials, including factsheets and PowerPoints, to educate staff and refugee communities about COVID-19

References 1.

FIGURE 3: TOP 10 REFUGEE COMMUNITIES WHO COMPLETED COVID-19 INITIAL AND BOOSTER SERIES, BY COUNT & PERCENTAGE Note: • (n) represents total population count • “fully immunized” indicates individuals who received ≥ 2 shots of Pfizer/Moderna or ≥ 1 shots of J&J vaccines

2.

3.

4.

5.

Refugee Resettlement in Wisconsin by City, 2002-2016. U.S. Department of State Accessed March 22, 2022. https://theatlas.com/charts/BJJSDD68g Countries of Origin for Top 15 Refugee Groups in Wisconsin, 2010-2022. U.S. Department of State Accessed March 22, 2022. https://www.wrapsnet.org/admissions-and-arrivals/ Rafieifar M, Naseh M, Potocky M, et al. Impacts of COVID-19 on refugees and immigrants in the United States: A call for action. International Social Work.

2021;64(5):771-776. doi:10.1177/00208728211017964 Crawshaw AF, Deal A, Rustage K, et al. What must be done to tackle vaccine hesitancy and barriers to COVID-19 vaccination in migrants? Journal of Travel Medicine.

2021;28(4):taab048. doi:10.1093/jtm/taab048 Operation Allies Welcome | Homeland Security. Accessed March 22, 2022. https://www.dhs.gov/allieswelcome

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Sixteenth Street Community Health Centers Diabetes Prevention Program: Developing a Community-Based Lifestyle Modification Program for Patients with Prediabetes

Marwat Salamin Sixteenth Street Community Health Centers

Sixteenth Street Community Health Centers Diabetes Prevention Program: Developing a Community-Based Lifestyle Modification Program for Patients with Prediabetes Marwat Salamin1 ,Tom Enright1,Alba Peterson2, Carmen Cosme2, Michelle Buelow, MD, MPH1,2 (1) University of Wisconsin School of Medicine and Public Health (UWSMPH), (2) Sixteenth Street Community Health Centers

Introduction

Methods: Program Assessment

• Type 2 diabetes mellitus (DM2) is a chronic and progressive disease with significant morbidity, mortality, and healthcare cost burdens.

• Prediabetes precedes DM2 and is characterized by asymptomatic insulin resistance.

• Lifestyle intervention is a highly effective means of preventing the progression of prediabetes to DM2.

• Sixteenth Street Community Health Centers (SSCHC) serves a primarily Latinx population (86%)1 in which the prevalence of DM2 is higher than the national average.2 • SSCHC serves > 1,000 patients/year with diagnosed prediabetes. A diabetes prevention program (DPP) could substantially reduce the individual and community burden of DM2.

B)

A)

Figure 4: 5 Samples of surveys used to evaluate program. A) Evaluates program accessibility. B) Evaluates no-show causes.

Current Goals

• Quality improvement project development based on program assessment method • Data collection and analysis of preliminary survey and patient drop out surveys • Problem identification, intervention proposal and assessment.

Methods: Overall Program Figure 2: 5 step process of program assessment. https://www.healthworkforceta.org/communityhealth-needs-assessment/

Future Steps

• Conduct pilot program with cohort of 10 patients.

• Gather and analyze data • Utilizing primary outcome data, participant survey responses, and SSCHC staff feedback from the pilot program, future programs will be modified.

• Expand program structure to incorporate a control cohort, a longer program follow-up duration (1 year), and established routes for referral to community resources.

• Engage existing health programs at SSCHC to form a multidisciplinary program.

References 1.

2.

Figure 3: Fishbone diagram to assess factors contributing to number of participants.

Figure 1: Schematic of overall program structure and workflow.

3.

Sixteenth Street Community Health Center Annual Report 2019-2020; 2.

Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev. 2019;35(2):e3097.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.

What is TRIUMPH? TRaining In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Website: https://www.med.wisc.edu/education/md-program/triumph/

Identifying Hypertension Interventions for Vulnerable, Urban African American Primary Care Patients: Literature Review and Patient Perspectives

Rebecca Nye Advocate Aurora Healthcare

Identifying Hypertension Interventions for Vulnerable, Urban African American Primary Care Patients: Literature Review and Patient Perspectives Rebecca Nye MPH, Wilhelm Lehmann MD, MPH, Kjersti Knox MD, Bonnie Bobot MD, Deborah Simpson, PhD Aurora Health Care | Milwaukee, Wisconsin

INTRODUCTION/BACKGROUND

RESULTS

HYPERTENSION (HTN) PREVALENCE IN AFRICAN AMERICANS (AA) • HTN is more prevalent in AA (51.7%) than white individuals (43.6%)1

LITERATURE SEARCH • 49 articles identified spanning 1998-2021 • Interventions focused on HBPM coupled with education and/or lifestyle changes

o AA are more likely to suffer adverse HTN consequences including cardiovascular disease and death o Among young AA (18-44 yo), 30% have HTN3 2

• Increased prevalence is attributable to many factors, including structural racism, distrust of the health care system, and lacking access to care • In our urban primary care residency clinic, a 10% disparity in HTN control between young African American patients and young white patients was found 3,4

PURPOSE • Identify interventions associated with improved HTN control in urban, vulnerable, young (18-50 yo) AA patients in a primary care (PC) residency program

METHODS LITERATURE SEARCH • Conducted in collaboration with a medical librarian to identify interventions applicable to vulnerable urban AA populations • Articles coded by publication year, article type, population studied, intervention, results, and barriers via spreadsheet

PATIENT DISCUSSIONS – QUALITY IMPROVEMENT (QI) • Random sample of AA patients (18-50 yo) with uncontrolled HTN in urban primary care clinic • Vetted by clinic staff as likely responsive to discussion with med student • Contacted via phone to explore interventions most applicable to their care • Open-ended and Likert scale items focused on: o Long-term effects of HTN o Barriers to HTN control o Interest in working with a PC physician to address their HTN including use of home blood pressure monitoring (HBPM)

• After 3 unsuccessful contact attempts, a different patient from the random sample was contacted for this QI effort

AIAMC 2022 Annual Meeting – NOLA & Virtual @nye_becca @ cottageviper @kjerstiknox @bonniebobot @deb.simpson3

o Interventions typically multi-faceted - difficult to determine effect of any one intervention 5 o Populations were rarely young adults under 50

PATIENT DISCUSSIONS • 9 patients responded o Knowledge of physiology and long-term consequences of uncontrolled HTN varied but was generally limited o Patients were asked about access to safe housing, safe exercise space, healthy, affordable food, and medication. Most respondents did not view these factors as barriers to controlling their HTN o Patients largely viewed HTN as a problem to work on independently through diet, exercise, and medication

• Likert Scale responses with scale of 1-4 (1 not really concerned, 4 very concerned) o Patients were relatively concerned about their BP (mean 2.9, range 1.5-4.0) o Patients were very interested in working to lower their BP (mean 3.4, range 2-4) • 44.4% had monitors, but 50% were wrist cuffs; 100% deemed HBPM a viable intervention “I didn’t have high blood pressure until I had a heart attack at age 37…I have high blood pressure due to chronic pain.”

“Not sure.” “[I] can’t run like [I] used to. I used to be able to run four blocks, now I’m lucky if can run two blocks or even walk around the block.”

“I don’t know.”

Statements from clinic patients, when asked about what having high BP does to their health over time.

Selected References

CONCLUSIONS • Patients’ HTN knowledge is limited • Patient self-reported barriers were discordant with literature yielding limited guidance for selecting a clinic-wide HTN QI intervention • Must consider that “barrier” to HTN control could have been better defined to patients • HBPM was identified in literature as tool to improve HTN control; 100% patient interest • When paired with patient education on HTN, may be a viable intervention if HBPM available to this urban, vulnerable AA group in a PC residency clinic

1. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017-2018. NCHS Data Brief. Apr 2020;(364):1-8.

2. Carnethon MR, Pu J, Howard G, et al. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation. Nov 21 2017;136(21):e393-e423.

3. Parcha V, Patel N, Kalra R, Arora G, Arora P. Prevalence, Awareness, Treatment, and Poor Control of Hypertension Among Young American Adults: Race-Stratified Analysis of the National Health and Nutrition Examination Survey. Mayo Clin Proc. 07 2020;95(7):1390-1403.

4. Maraboto C, Ferdinand KC. Update on hypertension in African-Americans. Prog Cardiovasc Dis. 2020 Jan - Feb 2020;63(1):33-39. doi:10.1016/j.pcad.2019.12.002 5. 4. Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. Aug 06 2013;159(3):185-94.

Exploring Barriers to Care for Returning Citizens

Symone McClain Advocate Aurora Healthcare

Exploring Barriers to Care For Returning Citizens Symone McClain, Lavansa Jackson, Bryan Winters, Kim Schoen, Dr. Bonnie Bobot Dr. Kjersti Knox, Dr. Sarah Reimer

Introduction

Methods

Results

The impact of incarceration on the health and well being of formerly incarcerated patients is substantial1.

Furthermore, the prison population carries a high burden of chronic conditions including2: • HTN • Type II diabetes • Tuberculosis • Substance use disorders • Mental health disorders

With the help of TCN/FCC community health workers, I completed the following:

Fourteen individuals were eligible to participate in follow-up phone recruitment.

• Three interviews were conducted by phone, one appointment was scheduled • All patients had health insurance upon release • patients were able to connect with a CHW and learn more about TCN. • patients had an established PCP. The primary mode of transportation was public transportation; all patient's reported FCC was accessible using this mode of transportation.

Many recently released individuals have multiple competing needs to take care of upon reentry, thus patients may have to make decisions that postpone addressing their healthcare needs3. . The Transition Clinic Network is a national network of clinics for recently released patients with the goal of improving health and reentry outcomes3 Historically, Milwaukee is a city with one of the highest incarcerations rates, making the reentry process quite difficult .In Milwaukee, the Family Care Center is a TCN clinic that partners with the Department of Corrections to identify currently incarcerated patients with chronic health conditions that may be interested in establishing health care upon release, with the aim of providing individualized healthcare that also addresses reentry challenges.

Objective: At the FCC and Progressive , there are many individuals returning home from prison who express interest in attending clinic but have not yet been able to. To explore this gap in clinic attendance, our objective is to explore patient perceptions and identify common barriers to reentry and accessing healthcare with the goal of improving initial clinic attendance.

Literature Review • Conducted a literature review to identify common barriers of the reentry process Patient Identification and contact • Used Epic and the FCC patient tracker, identified patients who expressed interest in attending clinic but have not yet scheduled an appointment • Used this data to create a script to conduct individualized patient interviews over the phone (n=5) Workflow Development • Developed a workflow to efficiently connect patients with FCC to schedule appointments

Demographics Patient 1

Patient 2

Patient 3

Race/Ethnicity Hispanic

Hispanic

White

Gender

Male

Transgender Male

Age

Male 18-60

18-60

18-60

Patient Health Concerns

asthma

GERD

abdominal hernia

Patient Barriers

seizure disorder

Quotes “ I always had help with food from family and I was on food stamps until I made too much money..haha…but I think having food bags at the clinic would be good” “I had a seasonal job, but now I'm back on the job hunt. I'm looking at temp jobs…you know how that goes, not that promising” “ I couldn’t find housing, kinda rough because of my case” “I'm not working at this time because I need to see a doctor first…I can’t lift more than 50 lbs…can’t move the left side of my body very well”

Implications

• Initial patient outreach efforts suggest that providing resources at the clinic that can serve as an incentive for people returning home from prison to attend clinic, although more interviews will need to be conducted to establish a more explicit connection • May be beneficial to explore other potential reasons patients have expressed interest in attending clinic but have not been able to attend such as mental health, perceived provider discrimination, stigma

Next Steps • Further patient outreach is needed to extend •

sample size and explore barriers to care Work closely with CHW to establish potential resources at clinic for prospective patients

References: 1. https://transitionsclinic.org 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC405945 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059495 Website: https://www.med.wisc.edu/education/md-program/triumph/

Let’s Talk About Health: Development of a Skills-Based Health Curriculum

Zoey Shultz United Way of Greater Milwaukee and Waukesha County

Let’s Talk About Health: Development of a Skills-Based Health Curriculum Zoey Shultz, MS3, Nicole Angresano, MPH, Joseph Schutz, Dakota Berg, Brett Fuller, Marcus Wenzel

Background

Methods

In the last 10 years, Milwaukee’s STI rate has increased out of proportion to the rates in the rest of the state of WI, with a syphilis outbreak that has increased by 300% since the start of the COVID pandemic1. The rate of STI’s is highest among young people less than 25 years old. Concurrently, the percentage of high schools teaching sex education across the country is declining (figure 1). Comprehensive and inclusive skills-based health education is an evidence-based strategy that can improve health outcomes amongst youth.

We meet every week virtually to develop and write a new curriculum in compliance with Wisconsin’s requirements for health education. We use the backwards design framework, creating lesson plans based on the skills-based standards set forth by the Wisconsin Department of Public Instruction (figure 3). Knowledge gained from medical school in anatomy and physiology is used to create evidence-based learning materials for the curriculum (figure 4). The process of the project is depicted below in figure 2.

Introduction

Figure 3. Example of lesson plan template and standards

Figure 1. Sex Education in Schools

The goal of the United Way STI Prevention Task Force is to form a coalition of community partners from various organizations around Milwaukee with the common goal of reducing STI rates among youth through various means. The Milwaukee Public School (MPS) health curriculum specialist invited United Way to join the Health Curriculum Advisory Board, a group of teachers and community members, to create a skills-based health curriculum for high school students that is comprehensive, accurate and inclusive.

Inputs Attend United Way STI Prevention Task Force Meetings to meet community partners and identify areas of collaboration

Implications Next Steps

Our goal is to finish writing lesson plans by the spring of 2022. Next steps include getting student feedback on the content and format, before ultimately presenting the curriculum to the school board for approval. Future directions of the project include evaluation of the implemented curriculum with student and teacher feedback.

Output/Activities

Develop Skills-based curriculum framework

References: 1. “American Adolescents' Sources of Sexual Health Information.” Guttmacher Institute, 3 Jan. 2019, www.guttmacher.org/fact-sheet/facts-american-teens-sources-information-about-sex#). 2.

Short term outcomes

Medium term outcomes

Long term outcomes

Attend weekly virtual Health Curriculum Advisory Board meetings with MPS health teachers to write curriculum and provide ongoing feedback

Increased knowledge amongst MPS students about safe sex practices and skills to navigate situations that impact health

Increased utilization of skills-based content about communication regarding sexual health

Increased utilization of local resources that decrease STI transmission, provide treatment, or facilitate prevention

Create inclusive and comprehensive evidencebased learning materials for curriculum covering topics like anatomy, physiology, STI’s, contraception, LGBTQ+ health, gender and sexuality

Understand youth perspective on how and where they learn information related to their health

Meet individually with community partners Research and best practices on health education

Figure 4. Example of learning materials created for teachers

This project has the potential to provide young people with skills, knowledge and resources needed to decrease STI transmission. The Milwaukee Public Schools serves almost 20,000 young people in grades 9-12, and when approved this new curriculum will be implemented across the entire district, so it has a large potential impact.

Strengthened partnerships amongst local youth-serving community organizations with common goals

Decreased STI rates of adolescents in Milwaukee Facilitated changed social norms to be more supportive of discussing sexual health amongst social circles

Conduct focus groups with high schoolers to get feedback on curriculum

Improved communication in adolescent relationships

Figure 2. Logic Model

What is TRIUMPH? Training In Urban Medicine and Public Health (TRIUMPH) is an educational program for University of Wisconsin School of Medicine and Public Health medical students which integrates clinical, community, personal and leadership skill development in Milwaukee, WI. TRIUMPH prepares students to become community-engaged physician leaders who will promote health equity for people living in urban health professional shortage areas.

Websitehttps://www.med.wisc.edu/education/md-program/triumph/

The Best is Yet to Come