Category Archives: Early intervention

Apr 8 2014
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Preventing Youth Violence May Cost Less Than You Think…

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

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Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).

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Nov 28 2012
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Gun Violence in Nashville

Manish K. Sethi, MD, is a health policy associate at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry Medical College and a Pilot Project Mini-Grant recipient and renowned orthopaedic trauma surgeon at Vanderbilt University’s Orthopaedic Institute Center for Health Policy. Sethi spoke this morning during the 2012-2013 Grand Rounds Series, sponsored by Meharry Medical College School of Medicine, on “Gun Violence in Nashville: Working Towards Community Based Solutions.”

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Human Capital Blog: What is the violence prevention program you’re directing with the RWJF Center for Health Policy at Meharry?

Sethi: We are doing a youth violence intervention program via partnership with Nashville schools funded by the RWJF Center for Health Policy at Meharry.

All of the data demonstrates that educational intervention with this age group demonstrates positive results. Currently, no such program exists in Nashville schools.

HCB: What drove your interest in this topic?

Sethi: I am a trauma surgeon and have been seeing an inordinate number of gun violence injuries in African American teenagers. I grew up in Tennessee and left for my medical training, but during childhood I never saw violence to this degree. Almost every week I see a teenager who either loses his life, or suffers major trauma secondary to a gun violence injury. I care very deeply about the future of these children and of Tennessee and I just feel that we have to do something.

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Mar 20 2012
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Let's Make it Easier for Caregivers to Protect Infants from Whooping Cough

By Deepa Camenga, MD, Robert Wood Johnson Foundation Clinical Scholar

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When I was pregnant with my first child, my husband and I diligently prepared for our new baby. We studiously researched the safest car seats, cribs and strollers, we took labor classes to prepare for the birth, and we ate a healthy diet. My husband accompanied me to every OB/GYN visit, and we both listened closely when the doctor recommended that we should both receive the flu and Tdap (Tetanus, diphtheria, and pertussis) vaccine.

Tdap protects against pertussis, or whooping cough, a debilitating respiratory infection that can be fatal in young infants. I had received Tdap during my pediatric residency as recommended by the hospital, and my OB/GYN provided the flu vaccine, but my husband, an overall healthy guy, had not seen a doctor in years and had not received Tdap. He went to our local pharmacy for a flu shot, so I could check that off our list, but as the months moved forward, still no Tdap.

Fast forward to the delivery, when upon discharge our nurse again reminded us about Tdap. I’m sure it sank in somewhere, but it was quickly forgotten when we pulled into our driveway and realized we didn’t know how to remove our son from the car seat. The weeks that followed quickly turned into months…and years. Ultimately, it took a full two years—and the birth of our second son—before my husband was finally vaccinated.

I’m sure this experience is shared by many new parents. It was no surprise to me when I learned that few eligible adults in the United States receive the Tdap vaccine.

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Aug 29 2011
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From Dependency to Interdependency: Coach Pat Summitt's Challenge to America

By Jason Karlawish, M.D., professor of medicine and medical ethics at the University of Pennsylvania, and recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (2008).

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Pat Summitt’s announcement that, at the age of 59, she has been diagnosed with dementia caused by Alzheimer’s disease is sad news. Her plan to continue working as the head coach of the eight-time NCAA Division I national championship University of Tennessee Lady Vols basketball team is a shot heard round an aging world.

A person diagnosed with dementia still working? The idea seems bizarre, and yet a big-money college athletic program does not run its coaching staff like a small town volunteer basketball program. The University’s decision to retain her as a coach is an opportunity for society to engage in a vigorous debate about how we will live with cognitive impairment as well as with other impairments associated with chronic diseases common to older adults.

Summitt’s exact story is unusual. Alzheimer’s disease is rare before the 7th decade of life. But the theme of her story is common, and, in the coming decades, it will be even more common.

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Aug 8 2011
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Fourth in a Series: A Call to Action on Oral Health Care, Bringing Dentistry to Children Who Need It

On July 13, the Institute of Medicine released reports calling for expanded access to oral health care. In this post, Kris Volcheck, D.D.S., M.B.A., a 2010 Robert Wood Johnson Foundation Community Health Leader, discusses community-specific solutions to oral health care disparities. Volcheck is director of the CASS Dental Clinic for the homeless and the Murphy Kids Dental Clinic in Phoenix, Arizona. See all the posts in this series.

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Just down the street from the CASS Dental Clinic for the Homeless in Phoenix are four elementary schools, in the very impoverished Murphy school district. Although this is the urban core, it might as well be rural America. The families in these neighborhoods live on minimal incomes and don’t have transportation, making everything a long distance hike – grocery stores with fresh produce, medical centers and, not surprisingly, dentists. When basic health care is secondary to just surviving, oral health care falls by the wayside.

Last year we decided to open a dental clinic for impoverished children, as an extension of the homeless clinic we’ve had in place for more than 10 years, and in collaboration with a community funded health center already in the works. But the tough economic times meant the Murphy elementary schools we had planned to serve were unable to pay for transportation and chaperones to bring students to our clinic. And because the schools’ funding is closely tied to student performance, they were hesitant to disrupt the school day to bring children to our site.

So we refocused, and decided to bring the dental clinic straight to the children.

We now operate a portable, school-based dental clinic in the elementary schools twice a year. The Murphy Kids Dental Clinic brings oral health professionals, supplies and technology into the elementary schools to provide comprehensive dental care to children who would otherwise go without it.

The care available to underserved and vulnerable populations –in rural settings and in the middle of a city alike – lags behind those available in middle- and high-income communities. There’s a high density of dentists in high-dollar areas, but we’re scarce in the urban core.

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Apr 21 2011
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Study by RWJF Physician Faculty Scholars Alumna Gives Good Marks to Nurse Interventions with Obese Children

Elsie Taveras, M.D., M.P.H., an alumna of the 2010 class of RWJF Physician Faculty Scholars, has an article in the April 4, 2011, issue of Archives of Pediatrics & Adolescent Medicine reporting on early results from a two-year study of interventions aimed at obese children. Her study tests a primary-care-based intervention that relies on regular follow-ups by nurses.

First year results show that girls in a test group receiving the intervention, as well as all children in the group from households earning less than $50,000, were less likely to gain weight during the first year of the program than children in a control group. The nurse interventions also helped children in the study group cut down on their television-watching and consumption of sodas and fast food.

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