Category Archives: Voices from the Field
Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.
When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.
But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?
It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.
Faith Ikarede Atte, RN, MSN, is a Future of Nursing Scholar studying for her PhD at Villanova University, supported by Independence Blue Cross Foundation. The Future of Nursing program is a project of the Robert Wood Johnson Foundation.
There are things in life so personal and private that when one vocalizes them, there is fear of being judged. It was eleven years ago that I had a personal encounter with myself. It is admittedly odd to look back at the path that I have walked on, now overgrown and distant—yet still so close to my heart.
Eleven years ago is when I lost a sense of who I was in the eyes of society, and I had to look within myself to find my footing. It is during this time that I had arrived from Kenya, full of vigor, light spirited and quick to laughter. I was hungry for knowledge and the sky was the limit.
Little did I know that life was about to teach me a lesson. It became obvious to me that my accent was different. Most immigrants can identify with the situation of being different. The more I spoke, be it in class or in a group of people, the more I felt isolated due to reactions like, “What did you say? Speak up. Your accent is too thick. I don’t know what you are saying.”
“In the NFL, you have to be ready for everything,” says Lutul Farrow, MD.
He should know: For more than three years, the orthopedic surgeon was a member of the medical staff for his hometown Cleveland Browns. With Farrow on the sidelines were a nonsurgical sports medicine doctor and an anesthesiologist; in the stands were a paramedic and a dentist. “That was just for our team,” he says.
Farrow currently works with the Yellow Jackets, a Division III team at his college alma mater, Baldwin Wallace University. Because football requires physician coverage at every game, he travels with the Yellow Jackets to games throughout the Ohio Athletic Conference. He’s also the head team physician for the Brunswick High School Blue Devils.
On game day, he has a field-level view of every play—and every injury. “We mostly see strains and sprains,” he says, including hamstring pulls, ankle sprains, and ligament sprains of the knee.
Farrow predicts that the current attention to concussions—most recently the NCAA’s settlement of a class-action lawsuit brought by former college players—will change the way the game is played.
Deborah E. Trautman, PhD, RN, is the new chief executive officer of the American Association of Colleges of Nursing (AACN) and executive director of the Center for Health Policy and Healthcare Transformation at Johns Hopkins Hospital. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program (2007-2008).
Human Capital Blog: Congratulations on your new position as CEO of AACN! What are your priorities as CEO?
Deborah Trautman: AACN is highly regarded in health care and higher education circles for advancing excellence in nursing education, research, and practice. I am honored to have this unique opportunity to support the organization’s mission and move AACN in strategic new directions. As CEO, I will place a high priority on continuing to increase nursing’s visibility, participation, and leadership in national efforts to improve health and health care. I look forward to working closely with the AACN board, staff, and stakeholders to advocate for programs that support advanced education and leadership development for all nurses, particularly those from underrepresented groups.
HCB: What are the biggest challenges facing nurse education today, and how will AACN address those challenges?
Trautman: Nurse educators today must meet the challenge of preparing a highly competent nursing workforce that is able to navigate a rapidly changing health care environment. As the implementation of the Affordable Care Act continues, health care is moving to adopt new care delivery models that emphasize team-based care, including the medical (health care) home and accountable care organizations.
These care models require closer collaboration among the full spectrum of providers and will impact how health care professionals are prepared for contemporary practice. Nursing needs to re-envision traditional approaches to nursing education and explore how best to leverage the latest research and technology to prepare future registered nurses (RNs) and advanced practice registered nurses (APRNs). Greater emphasis should be placed on advancing interprofessional education, uncovering the benefits of competency-based learning, identifying alternatives to traditional clinical-based education, and instilling a commitment to lifelong learning in all new nursing professionals.
Elizabeth Gross Cohn, PhD, RN, is director of the Center for Health Innovation at Adelphi University, an adjunct professor at the Columbia University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
It only took 24 hours for the hospital unit where I work to complete the Ice Bucket Challenge. My colleagues and I were quick to dump ice water on our heads and publicly post a video of it to YouTube. Compare that to the speed at which we adapt other initiatives—even those that benefit our own health.
Why the difference? What is prompting people to action and, more importantly, what can RWJF learn from this campaign as it works to advance a Culture of Health?
In case you’ve been unplugged over the past several weeks, the Ice Bucket Challenge started in golf and baseball but has spread virally. As of today, it has raised $100 million for Amyotrophic Lateral Sclerosis (ALS). Participation begins when you are challenged on social media to—within 24 hours—publicly accept, acknowledge the challenger by name, pour ice water over your head in as dramatic a method as you can imagine or afford, challenge two or three others to participate, and post the results to YouTube. This campaign has been embraced by the general public, celebrities, grandmothers, babies, and teams of teachers, firefighters, nurses, teachers and others.
We public health professionals can learn some important lessons about delivering information and impelling action from this extraordinary cultural phenomenon. Here are five factors that seem most potent to me. Do you see others?
Theresa Simpson, BS, is a 2003 alumna and acting assistant director of Project L/EARN, and a doctoral student at the Rutgers Department of Sociology. Dawne Mouzon, PhD, MPH, MA, is a 1998 alumna and former course instructor for Project L/EARN, and an assistant professor at Rutgers Edward J. Bloustein School of Planning and Public Policy. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
When we began co-teaching Project L/EARN in the summer of 2006, health disparities was gaining momentum as a field.
At the time, we were both Project L/EARN alumni who shared a background in public health. We were becoming increasingly immersed in disparities through our graduate studies in the health, population and life course concentration of the sociology doctoral program at Rutgers University.
Directly as a result of that coursework, we began significantly expanding the Project L/EARN curriculum in the area of health disparities. Now, every summer, we hit the ground running the opening week of the program.
In the first lecture, an overview of the field of health disparities, Dawne introduces various theoretical frameworks for studying health disparities, followed by data on the social demography on various race/ethnic groups. She concludes with a series of charts and graphs showing race/ethnic, gender and socioeconomic status (SES) inequities in the epidemiology of health and illness.
James Perrin, MD, FAAP, began a one-year term as president of the American Academy of Pediatrics (AAP) in January. A professor in the department of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Perrin received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1997.
Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?
James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.
First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.
Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.
Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice and a Robert Wood Johnson Foundation (RWJF) New Connections grantee.
In 1999, 28-year-old Demetrius DuBose, a linebacker for the Tampa Bay Buccaneers, was shot 12 times by two officers in his San Diego neighborhood. DuBose was a former co-captain of Notre Dame’s famed football team. His death came after he was questioned and harassed regarding a burglary in his neighborhood. Officers reported they had no choice but to shoot DuBose while he was handcuffed because they feared for their lives.
Many of these details sound similar to those surrounding the death of Michael (Mike) Brown Jr., who was shot at least six times in Ferguson, Missouri, this month. Brown was unarmed. He was reportedly fleeing from a police officer who also felt his life was in danger.
What is missing from this picture is that black males also feel threatened and distrustful of authority figures and are routinely disengaged from contexts such as schools, medical facilities and neighborhoods. The narrative remains the same: Black males who die from excessive force become involuntary martyrs for the sustained legacy of institutional and interpersonal racism that is associated with the health disparities plaguing black communities.
Carolyn Montoya, PhD, PNP, is associate professor and interim practice chair at the University of New Mexico College of Nursing and a recent graduate of the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing.
Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?
Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.
HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.
Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.
Briana Mezuk, PhD, is an assistant professor at Virginia Commonwealth University Medical Center and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently earned the Best Early Investigator Award for the top research study from the American Association for Geriatric Psychiatry.
Human Capital Blog: Congratulations on your award! What led to your interest in suicide risk in long-term care facilities?
Briana Mezuk: Older adults, particularly non-Hispanic white men, have the highest risk of suicide. This risk increases exponentially after age 75, and recent data suggest that men in the Baby Boomer generation have a higher suicide risk than previous cohorts. There are many risk factors for this group, including social isolation, feelings of disconnection to society, and lack of social supports and close confidantes. Older men are often unwilling to talk about mental health problems with their physicians; they think they are supposed to ‘grin and bear it.’
HCB: What was the goal of your study?
Mezuk: We were trying to understand the epidemiology of suicide in long-term care facilities, and in nursing homes and assisted-living facilities in particular. Suicide risk in these settings may be higher, or lower, than in the general community. For example, suicide risk may be lower in supervised settings because residents would have less access to a means to self-harm. But suicide risk might be higher because residents often have health problems and, frequently, depressive symptoms that are risk factors for suicide. We used data from the Virginia Violent Death Reporting System to identify suicides that occurred among residents of, and among individuals anticipating moving into, these types of facilities.
HCB: What did you find?