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2013 LEADS Scholarly Project

Our LEADS Scholars




 CASBHC - “Funding and Implementation of Mental Health Care in the School Based Health Care System”

Amanda Neidermyer and Stephen Quach
LEADS Faculty Mentor: Cathy Battaglia                                                                  Organization Mentor: 
8 week project goals: 
Developing recommendations on how best to finance the integration of behavioral health services into the school-based health center clinics.           
Our goal at the end of the summer is to have written a report for CASBHC detailing how mental health care is currently provided and funded at school based health centers, what some of the barriers are to better integration and funding, and some recommendations are to better improve care.  Our plan is to finish interviews by the end of June and to spend July writing the report itself.
Very Brief Background or Rationale of Project: 
Currently, thousands of students around Colorado have access to care through school-based health centers.  These clinics are easily accessible by students since they are located at or near schools, and are committed to serving students regardless of ability to pay.  These clinics are also an excellent model of integrated care, bringing providers from many different disciplines together under one roof.  However, there are significant barriers preventing mental and physical healthcare from being well integrated, as well as financial barriers preventing mental health care from being sustainable.

 CCHI - CCHI Member Audit

Laura Kahn and Sam Skovgaard
LEADS Faculty Mentor: Jeremy Long                                                                        Organization Mentor:
8-week Project Goals
Determining knowledge of coming health benefits exchange in Colorado.  Assess needs of member organization.  Develop report back to member organizations.
The work in Progress that we have been doing is a needs assessment of grassroots organizations, identifying barriers to enrolling members in the Colorado Health Insurance Marketplace when open enrollment starts on Oct 1st.  It has overall gone very smoothly, especially considering the pressing nature of the issue.  Dede de Percin has been a great person to learn from, she has a phenomenal sense of the current political climate.  I haven’t met with Jeremy Long often, but I’ve had the sense that he was available if needed.
Very Brief Background or Rationale of Project:
Completed roughly 25 interviews with representatives from CCHI member organizations – most often either the Executive Director, or the person in the organization who was most involved with policy analysis and advocacy.  The data we collected was largely narrative and qualitative; that was at the request of CCHI’s membership coordinator, Adam Fox, who works closely enough with member organizations that he was interested in a high level of detail.
CCHI is a unique organization, one that is solidly positioned in the “middle” of the field; it brings together grassroots organizations, supports them in their constituency work, and has a consensus-driven voice to advocate for consumer rights on a legislative level.  Though they can’t always reach member consensus at policy meetings, when they can it represents a powerful ability to say to legislators, “We represent 50+ diverse member organizations, by proxy millions of Coloradoans, and we feel strongly about this legislation.”  To me, CCHI represents an important nexus between the governmental end of things and the grassroots – an area that can often become a bottleneck in implementation.  CCHI functions as a voice, a watchdog and a resource.  It was very interesting to speak with the members of CCHI, because they represented such a diverse group of organizations – disease focused groups like the National MS Society, demographic groups like the Rocky Mountain Farmers Union, mission-based groups like Denver Urban Ministries, and more.  All had their own unique goals and organizational needs, and all were seeking to assist their population, usually with little money and few staff.
I think Sam and I were really lucky to work with CCHI; they are an incredibly well-run organization, filling a niche very well.  They are flexible; they have a moderate scope, are very clear about what they don’t do, and do the policy analysis and communications end of things superbly well.  The project was perfect for a summer assignment, because the task was manageable: interview around 50 organizations, see what they need, create a qualitative report.  Open enrollment in Colorado’s Health Insurance Marketplace begins on October 1st; the fact that this project was so topical made it relevant, even though it was small in scale.  We are hoping that organizations in other states can use our report in the future, if they are similarly placed and find themselves confronting Healthcare Marketplace open enrollment in the future.

 CCMU - “Social Determinants of Health Research Project”

Markus Hannan
LEADS Faculty Mentor:  Cathy Battalia                                                                  Organization Mentor:  
8-week Project Goals:
·        Evaluate community health worker attitudes and knowledge around the determinants of health
·        Develop a toolkit to train community health workers in assessing the determinants of health facing their clients and linking them with appropriate resources
Internship at the Colorado Coalition for the Medically Underserved (CCMU) under the guidance of the ever-patient Aubrey Hill to attempt to generate some sort of toolkit to help healthcare providers address social determinants of health (SDoH).  Attempt to understand what exactly SDoH issues were. The concept sounds pretty intangible and vague, and I encountered quite a few different ways of defining it, but the way I ultimately personally defined social determinants was in this way:
Social determinant of health anything not directly decided by the healthcare system or genetics that ultimately influences your life or lifestyle
·        SDoH Video Fact Sheet – Create
o   The video itself will be represented from a first-person point of view as a patient goes to see the doctor while dealing with common social factors that impact his/her health. Four SDoH-related concepts will be discussed: transportation, affordability, health literacy, and how the clustering nature of SDoH issues creates complex health needs. Each concept will be introduced first by an experience, or “clinical flag,” that the patient has in the video, followed by a brief display of relevant statistics and a cut to a short interview with an actual healthcare worker who will share an anecdote. The video will end (possibly as the patient leaves the office), with a fade to an interviewee expressing his/her opinion of the importance of social determinants of health in clinical practice. The final screen will include a website that viewers can visit for more information.
Very Brief Background or Rationale of Project
Doctors all across the state have varying degrees of knowledge about SDoH issues, which especially matters for ACCs that seek to implement a holistic treatment plan for Medicaid patients to reduce costs. As such, a way to spark a conversation about SDoH is needed, and a video and possible supplementary materials is a good way to start. Eventually, further implementation of an educational program will be developed, but first, awareness must be raised.

 CO HealthOp - “Patient Engagement”

Jessica Nicholas, Lydia Archuleta and Mee Na Song
LEADS Faculty Mentor: Christine Gilroy                                                                 Organization Mentor:  
8-week Project Goals:
Come up with a plan to facilitate Health Coop member engagement that can be suggested for implementation at the conclusion of the internship this summer.  Investigating resource and policy to build a consumer toolbox in price transparency, member engagement, and value-based benefits
Very Brief Background or Rationale of Project:
Patient’s experience better satisfaction with healthcare, greater health literacy, and more personal responsibility for their health when they are engaged in their own healthcare. I would like to propose the implementation of a tool that health coop members can utilize to become more engaged.

 Heath TeamWorks - “Understand the impact and degree of preparation Colorado has for the influx of new patients expected in January 2014 resulting from the Medicaid expansion and Health Benefit “market place”

Geoff Slater and Sarah Tietz
LEADS Faculty Mentor: Cathy Battaglia                                                                   Organization Mentor:   
8-week Project Goals: 
Assessment of Medicaid expansion/exchange impact and capacity of providers
·        White Paper for HealthTeamWorks
·        Research for partner organizations
·        Inform the state
·        Colorado HealthOp?
·        Anybody else working on something similar?
·        Who else should we contact?
·        Other areas of research relating to primary care and health reform?
Very Brief Background or Rationale of Project:  
Areas to Research:
·        Primary care acceptance of Medicaid/new insurance and access for this population
·        How can PCPs take on more patients (PCMH)
·        Changes for specific income levels
·        Health needs of the newly insured
·        Demographics of other groups of newly insured (not just Medicaid)
·        Reducing inequities and disparities



 Hepatic C Program - “Created a Provider Survey on the Usage of the hepatitis C guidelines, and general knowledge of the referral and treatment process”

Erin Hagerman and Lynne Wood
LEADS Faculty Mentor: Jeremy Long                                                                        Organization Mentor:  
8-week Project Goals: 
Investigating resource and policy to build a consumer toolbox in price transparency, member engagement, and value-based benefits.
Literature Review of mediations for the treatment of hepatitis C that are currently in Phase II and III trials.
Gather and organized information on Syringe Access Programs for: people interested in starting an SAP, people interested in using current SAPs, pharmacists, and Law Enforcement personnel.
Reformatted, updated the current HealthTeamWorks hepatitis c guidelines
Visited Harm Reduction Action Center’s Syringe Access Program
Presented a summary of our role and the CDPHE to the class and got their input on our provider survey and most current version of the guidelines.
Will be presenting our findings from the survey at the next Team Hep C meeting on July 23rd
Very Brief Background or Rationale of Project: 
Worked primarily on a survey for providers that would help make the CDPHE/HealthTeamWorks hepatitis C guidelines better and easier to use. After we collected our data, we used the information gathered to work on the information in the guidelines and also the distribution after it was finished. We were able to collaborate with HealthTeamWorks to assemble as much of the original committee as possible for review and approval of our changes. We also met with the CDPHE Hepatitis C Team after our revisions were made and approved and presented for the department and one of their community partners, Hep C Connection. Hep C Connection was integral in disseminating the original guidelines and we hope they will also assist us in getting the word out about his electronic version as well.
We were also assigned a few side projects while we waited for survey results, edits etc. See above.

 JFK Partners - “Cross Systems Crisis Prevention & Intervention (CSCPI)”

Shamita Punjabi, Sterling McLaren, Zia Choudhury and Erin Hickey
CU LEADS Faculty Mentor: Rite Lee                                                      Organization Mentor: Brad Clark
8-week Project Goals:
Needs assessment and creation of a Colorado Crisis Intervention Team for patients with the dual-diagnosis of developmental delay and a mental health disorder.
START as a model for CSCPI
·        The CSCPI is based on the START model (Systemic, Therapeutic, Assessment, Respite and Treatment) developed in 1988 by Joan Beasley, PhD, and currently serving adults in seven states.
·        START is an evidence-based, person-centered approach to mental health disparities for persons with intellectual/developmental disabilities. 
·        This program:
o   Links existing systems of care to fill in service gaps
o   Reduces the use of emergency services
o   Enhances long-term outcomes for individuals who are dually diagnosed
Very Brief Background or Rationale of Project:
A wonderful summer involving an in depth understanding of what it takes to serve the population of psychiatric/behavioral and developmental dual diagnoses children in a crisis situation. The direct product of our LEADS research is the survey that we mailed (and created online). We have currently received around 45 responses and anticipate that we will receive more in the next few weeks. There are several barriers to care and service that we have assessed through the distribution of a survey to parents/caregivers and the construction of an online portal for providers, parents, adult users of services, and other (advocates and friends). All individuals who use or provide these services will have access the portal we have created, with a specific emphasis on dual diagnosis populations since this is where the need for services is the greatest.  We have been working with an excellent team up at JFK Partners and our PI Cordelia Robinson has been a pleasure to work with. We hope to receive at least 87 surveys as a baseline for analyzing the current situation of care for the population in Colorado and to assess whether starting the CSCPI program in Colorado is feasible7

 One Colorado - “Improving the health of LGBT Coloradans”

Philipp Hannan
LEADS Faculty Mentor: Dr.  Rita Lee                                                                        Organization Mentor: 
8-week project goals:
Develop a curriculum to train health care professionals and their staff on culturally responsive and clinically appropriate care of the LGBT population. I hope to have finished and published a CME on LGBT disparities in health care. The CME will focus on teaching health care providers how to remove these disparities and generate a welcoming environment for all of their patients.
Brief Background or Rationale of Project
One Colorado surveyed LGBT individuals in Colorado in 2011, and discovered a significant health care disparity that is independent of health insurance coverage. The disparity is due to perceived stigma by providers, insufficient training, and ignorance pertaining to LGBT health care.

 Urban Peaks - “Emergency Department Use Among a Sample of Shelter-Based Runaway and Homeless Youth”

Sarah Davis and Oluwatoyin Akintujoye
LEADS Faculty Mentor:  Christine Gilroy              Organization Mentor:  Clayton Gonzales and Krista McNamara
8-week Project Goals:
Assess client knowledge and attitudes on appropriate use of healthcare services with regards to Emergency Department Use.
             Create surveys designed to help understand the reasons homeless youth use the ED rather than free and sliding-scale clinics, their primary care provider, or other services.  Additionally, we will gain demographic info, information about their internet use, social media use, some mental health issues, health insurance status, etc.
             Administer a survey to 300 homeless youth
             Administer four focus groups with 4-8 participants
             Education plan- Develop an education plan to help those who are using the ED as their primary medical home. This plan will help them understand the risks of using the ED and the effects it can have on their credit and their financial situation long-term.  We will also outline alternative options to using the ED and how to access those options. 
Very Brief Background or Rationale of Project: 
There was a preliminary study done last year by a med student who found there were trends in ED use by homeless youth.  Although his sample size was small, this gave us an indication that there may be a higher use of the ED by homeless youth, especially for drug related and alcohol related medical issues.