Now Viewing: Massachusetts (MA) NE

What Baltimore Taught Us: On a Journey to Strengthen Families

Oct 31, 2014, 1:12 PM, Posted by Kristin Schubert

Young mother with her children.

Recently a team from the Foundation went to Baltimore to talk to families and community leaders, gaining their insights into an essential question for us: What can the Foundation do to strengthen the systems—health care, education, community—to create a web of support for families, one in which those at greatest risk can’t easily fall through?

What follows are my colleagues’ reflections on our time in Baltimore.

Martha Davis: I spoke with a Violence Interruptor, a Safe Streets employee who works to stop street violence. He is a 37-year-old man who has spent nearly half his life in jail, and has been shot 14 times. When I asked him how it is that he got to where he is today, he told me he came to the streets to learn how to “be a man,” but the birth of his children inspired him to want to be on the “side of peace." His was a life of violence and suffering, deep poverty, and racism; now he makes people feel safe and hopeful. He and the other Violence Interruptors are living proof that change is possible.

View full post

RWJF Roadmaps to Health Prize Q&A: Claude-Alix Jacob

May 13, 2013, 4:02 PM

file Claude-Alix Jacob, far right, as the Cambridge community is awarded the RWJF Roadmaps to Health Prize

In February, the Robert Wood Johnson Foundation honored six communities with the inaugural RWJF Roadmaps to Health Prize, which recognizes outstanding community partnerships that are helping people live healthier lives.

Recently, NewPublicHealth spoke with Claude-Alix Jacob, chief public health officer at the Cambridge, Mass., department of health, one of the six prize-winning communities to be recognized by the Foundation. Mr. Jacob spoke to NPH about how collaborating around and winning the Prize has impacted the community, including resilience in the face of tragedy.

Apply for the RWJF Roadmaps to Health Prize. Watch a video on the Prize and what it means for communities.

NewPublicHealth: What did winning the RWJF Roadmaps to Health Prize mean to your community?

Claude Jacob: It has been great and exiting news for our community. Over the course of the last few months and through National Public Health Week last month we’ve had a chance to celebrate. We’ve been able to share our public health plans and community partnerships, but also under the aegis of the Robert Wood Johnson Foundation, we now have more credibility for all of our efforts. The Foundation is associated with promoting important health improvement efforts nationwide and just to be linked to the Foundation will open doors, especially now that we’re one of the six inaugural prize winning communities.

During National Public Health Week we invited our community stakeholders to celebrate to thank them for their hard work in helping us to prepare for the site visit that was required of prize finalists. So it’s been a phenomenal few weeks.

NPH: How has winning the prize impacted the health improvements of your community?

View full post

Nurse Practitioners and the Primary Care Shortage

Mar 20, 2013, 9:00 AM

In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.

A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.

Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.

View full post

Health Issues on Ballots Across the Country

Nov 9, 2012, 9:00 AM

Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:

- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.

- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.

- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.

- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.

- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.

- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.

- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.

- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Nine States Receive RWJF Grants to Build More Highly Educated Nursing Workforce

Aug 23, 2012, 12:15 PM

The Robert Wood Johnson Foundation’s Academic Progression in Nursing (APIN) program this week announced that California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas and Washington state have been chosen to receive grants to advance state and regional strategies aimed at creating a more highly educated, diverse nursing workforce. Each state will receive a two-year, $300,000 grant. 

The states will now work with academic institutions and employers on implementing sophisticated strategies to help nurses get higher degrees in order to improve patient care and help fill faculty and advanced practice nursing roles.  In particular, the states will encourage strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees.

In its groundbreaking report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020.  At present, about half of nurses in the United States have baccalaureate or higher degrees.

View full post

A Doctor Delivers Multiple Acts of Human Kindness to Homeless Women

Aug 3, 2012, 11:55 AM, Posted by Roseanna Means

Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston.  She is a 2010 Robert Wood Johnson Foundation Community Health Leader.

file

The prolonged recession of the last four years has hit many people hard.  My work is taking care of homeless women, which I have done for the past 20 years.  I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters.  We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.

I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers.  Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.

Here is a glimpse of our work.

Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.

She is hungover.  She drank to escape the horror of having been attacked.  She has been on and off the wagon so many times we have all lost count.  She’s also been raped and stabbed more times than any of us can remember.  She doesn’t go to the police any more.  She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork.  I give her a hug and remind her that I love her no matter what.  I know that she has a library of negative and self-loathing messages in her head.  Mine is the one that can break through that chatter and give her a shred of self-respect.

View full post

How Central Massachusetts Increased Access to Oral Health Care for Low-Income Children

Feb 21, 2012, 1:00 PM, Posted by John Gusha

February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.

Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?

John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.

HCB: Tell us about the school-based programs you put in place.

Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.

We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.

HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.

Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.

The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.

View full post

Investigator Award Winner Named Provost of Harvard

Apr 25, 2011, 2:37 PM, Posted by mtomlinson

Alan M. Garber, M.D., Ph.D., recipient of a 2003 RWJF Investigator Award in Health Policy Research (2003), will become the new provost of Harvard University on September 1. He attended Harvard as an undergraduate and also received his Ph.D. in economics there.

Garber is currently a professor of medicine and economics at Stanford University, where he earned his M.D. He directs the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford Medical School, and is a staff physician at the Veterans Affairs Palo Alto Health Care System.

“I think it’s very important to have somebody who has crossed disciplinary boundaries and schools and departments, because that remains an area where Harvard will have to get stronger and stronger,” current provost Steven E. Hyman said at a reception in Garber’s honor on April 15.

Learn more about the RWJF Investigator Awards in Health Policy Research.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.