Digital Commons Network^™

Research To Practice: Vocational Rehabilitation Services Received By Youth With Autism: Are They Associated With An Employment Outcome?, Jaime Lugas, Jaimie Ciulla Timmons, Frank A. Smith

Research to Practice Series, Institute for Community Inclusion

While youth with autism represent a small percentage of all vocational rehabilitation (VR) closures, the number who closed out of VR more than tripled between 2003 and 2008 (see Institute for Community Inclusion Data Note 26). As increasing numbers of youth with autism are accessing VR services, it is important to understand how they are using these services and the relationship of these services to outcomes and costs.

Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove

Counseling and School Psychology Faculty Publication Series

Clinicians practicing today need to be aware of the ways in which the current industry-dominated climate may undermine the integrity of the scientific process and, thus, may compromise patient care. In the mental health field, corporate sponsorship bias can affect psychiatric taxonomy and clinical Practice Guidelines (CPG). Financial conflicts of interest (FCOI) can occur when there are financial associations between researchers, authors, or panel members developing psychiatric diagnostic and treatment guidelines, and the pharmaceutical industry, or when randomized clinical trials (RCTs) are industry funded. Therefore, clinicians need to be especially vigilant about the informed consent process when patients are prescribed …

Diagnosing Conflict-Of-Interest Disorder, Lisa Cosgrove

Counseling and School Psychology Faculty Publication Series

In June 2010, the Association of American Medical Colleges issued the third and final portion of its conflict-of-interest policy initiatives. The task force on “Conflicts of Interest in Clinical Care” did not mince words when it described the impetus for these initiatives: “It is imperative that the possibility or perception of [financial conflict of interest] be advertently examined and appropriately evaluated to ensure that academic medicine in all of its missions is fundamentally dedicated to the welfare of patients and the improvement of public health.”

This report is especially timely because of recent questions raised by investigative journalists and policy …

The Health Of Latinos In Massachusetts: A Snapshot, Dharma Cortés, Rodolfo R. Vega

Gastón Institute Publications

People’s health outcomes are shaped in part by non-biological factors. Most immediately, limited access to health care services can have a deleterious impact on individuals’ health outcomes (Andrulis, 1998). In turn, access to healthcare services is influenced by socioeconomic factors such as whether a person has health insurance or the financial means to pay for their health care. Familiarity with the health care system is another important factor that may influence an individual’s access to healthcare services (Morgan et al., 2008). Language also plays an important role in health outcomes. For instance, individuals with limited English proficiency may find it …

Women’S Health Disparities And Midwifery Care: Spotlight On Connecticut, Dorothy Hiersteiner, Kaye Inandan

Publications from the Center for Women in Politics and Public Policy

Although Connecticut’s Medicaid programs, Husky A and B, are essential providers of coverage for maternity care, there are still major racial and ethnic disparities in access to, use of, and quality of prenatal care in Connecticut. The cesarean birth rate in the state is almost 9% higher than the US average. African American/black and Hispanic mothers experience comparatively high rates of low birth weight births. Furthermore, Connecticut is home to a substantial rural population which experiences unique challenges to accessing adequate health care. While 75% of the Connecticut population is non-Hispanic white, 9% is African American/black, 12% is Hispanic and …

Women’S Health Disparities And Midwifery Care: Spotlight On Rhode Island, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

Rhode Islanders face unique health disparities based on race, ethnicity and location. Just over six percent (6.3%) of the Rhode Island population is living in Primary Care Health Professional Shortage Areas (HPSAs), according to 2008 data. Native American and African American/black communities face particular health disparities, specifically in the areas of reproductive and infant health. In 2008, 79% of the Rhode Island population was non-Hispanic white, while 5% was African-American/black, 11% was Hispanic and 5% had other racial/ethnic backgrounds. In 2005, 12.4% of the total Rhode Island population was foreign born.

Women’S Health Disparities And Midwifery Care, Adeola Oni-Orisan, Dorothy Hiersteiner, Althea Swett

Publications from the Center for Women in Politics and Public Policy

This fact sheet was developed for the roundtables project “Midwifery Care in New England: Addressing the Needs of Underserved and Diverse Communities of Women.” Sponsored by the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (Region I), this initiative addresses the challenges and opportunities related to the provision of midwifery care to underserved and vulnerable populations of women. The project aims to increase our understanding of regional midwifery workforce needs in the context of ensuring that all women living in New England have access to timely, affordable, and high-quality health care.

The September 2010 roundtables were …

Women’S Health Disparities And Midwifery Care: Spotlight On Vermont, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

In Vermont, racial and ethnic dispariti es in low birth weight and preterm birth rates exist alongside racial and ethnic disparities in health insurance coverage and use of preventative care. As of 2005, the percentage of racial and ethnic minorities in Vermont was approximately 3.3%, compared to 25% for the nation as a whole. In 2005, 3.4% of the Vermont population was foreign born.

Women’S Health Disparities And Midwifery Care: Spotlight On Maine, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

With a large percentage of its population living in rural areas, Maine faces obstacles to providing adequate prenatal and maternity care to many women. The vast majority (96.2%) of Maine residents are non-Hispanic white, 1.2% are African American/black, 1.4% are Hispanic and 1.2% have other racial/ethnic backgrounds.

Women’S Health Disparities And Midwifery Care: Spotlight On Massachusetts, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

As a result of Massachusetts’ 2006 health insurance coverage law, there has been a significant decrease in the uninsurance rate for women of color. Access to and use of health care for all women in the Commonwealth has also increased. Despite these coverage and access gains, major racial/ethnic disparities in health conditions and outcomes still exist among women, especially in the use and quality of prenatal care, the occurrence of preterm and low birth weight births, and infant mortality rates. The proportion of Massachusetts births that were cesarean deliveries in 2007 was 8% higher than the national rate. Compared to …

Women’S Health Disparities And Midwifery Care: Spotlight On New Hampshire, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

New Hampshire faces significant obstacles to serving the nearly 6% of the population living in medically underserved areas. In addition, many residents of New Hampshire are uninsured, limiting their access to vital medical care. According to 2007-8 data, the racial/ethnic breakdown of New Hampshire residents is: 1% African American/black, 2% Hispanic, 94% non-Hispanic white and 3% Other. In 2005, 5.9% of the total New Hampshire population was foreign born.1 Since 1996, New Hampshire has seen increases in low birth weight births, cesarean births2, and infant mortality with racial/ethnic disparities reflected in most maternal and infant indicators.

Program Evaluation Of A Community-Based Door-Through-Door Medical Escort Service, Lauren A. Martin

Gerontology Institute Publications

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients.

What Do You See In This Picture?: Bias And Reflexivity In Physician Narratives Of Disparities, Michelle Levine

Graduate Masters Theses

Disparities in healthcare stem from historical, social, institutional, and interpersonal factors--all of which can manifest at the level of the clinical encounter. A growing body of research has addressed implicit bias and, more specifically, the implicit bias involved in aversive racism as a mediator of disparate care. While recent studies have suggested links between disparate treatment and implicit bias, little direct evidence exists for how implicit bias may effect disparate care. Qualitative research on physician understanding of processes by which implicit bias translates into disparate care can help fill this gap and identify areas for further research. This study conducted …

Undue Pharmaceutical Influence On Psychiatric Practice, Lisa Cosgrove, Harold J. Bursztajn

Counseling and School Psychology Faculty Publication Series

Within the past few years, increasing concerns have arisen about the ways in which corporate sponsorship of clinical trials and continuing medical education activities may bias the information that is published and disseminated about the benefits and risks of medications. Questions have also been raised about the extent of industry influence on the American Psychiatric Association’s diagnostic and treatment guidelines—namely, its DSM and Clinical Practice Guidelines.

Pharmaceutical Philanthropic Shell Games, Lisa Cosgrove, Harold J. Bursztajn

Counseling and School Psychology Faculty Publication Series

In response to increasing public distrust and congressional concerns regarding pharmaceutical company influence on medical research and education, professional organizations have taken steps to phase out or regulate industry-sponsored educational support. A related problem is industry funding of philanthropic organizations, such as patient advocacy groups. Thus, when the office of Sen Charles Grassley (R-Iowa) recently reported that the National Alliance for the Mentally Ill received substantial pharmaceutical funding, there was concern among the membership’s psychiatric patients and their families.

Advantages Of Using Estimated Depression- Free Days For Evaluating Treatment Efficacy, Steven D. Vannoy, Patricia Arean, JüRgen UnüTzer

Steven D Vannoy

Objective: Several common methods for measuring treatment response present a snapshot of depression symptoms. The construct of estimated depression-free days (DFDs) simultaneously captures treatment outcome and estimates the patient’s experience of depression over time. The study compared this measure with traditional measures used in depression treatment research. Methods: This secondary data analysis was based on data from the Improving Mood—Promoting Access to Collaborative Treatment trial, a multisite depression treatment study conducted in 18 primary care clinics in five states and representing eight health care sys- tems. The sample of older adults (N=906) had been randomly assigned to receive collaborative care …

Chapter Four: Parenting An Emerging Adult - 101, Varda Konstam

Varda Konstam

Parents of emerging adults are exploring terra incognito. It’s not that there are no rules; it’s that the rules are obsolete. They no longer fit today’s realities. For reasons we’ve discussed (and for others that we will discuss), it’s just not as easy for emerging adults today to jump into the river of adulthood as it was for previous generations. That means parents are likely to remain active parents for longer than ever before. And most of us are pretty clueless about how to make it work. Anxiety is inevitable given the lack of guidance and certainty. However, we can …

“They Don't Want Anything To Do With You”: Patient Views Of Primary Care Management Of Chronic Pain., Gonzalo Bacigalupe

Gonzalo Bacigalupe, EdD, MPH

No abstract provided.

Community Violence As Psychosocial Stressor: The Case Of Childhood Asthma In Boston, Gonzalo Bacigalupe, Takeo Fujiwara, Sabrina Selk, Meghan Woo

Gonzalo Bacigalupe, EdD, MPH

Childhood asthma is a critical public health problem of urban centers in the United States and other industrialized nations. Population-based and laboratory research studies indicate that psychosocial stress differentially affects asthma expression. Witnessing or experiencing community violence is a psychosocial stressor that results in long-term biological changes that may in turn contribute to asthma morbidity. This is a review of the literature that examines the exposure to violence as a psychosocial stressor that is independently associated with asthma morbidity even after adjustment for income, housing, and other adverse life events. In addition to acting as a physiological trigger for the …

Suicide Inquiry In Primary Care: Creating Context, Inquiring, And Following Up, Steven D. Vannoy, Tonya Fancher, Caitlyn Meltvedt, JüRgen UnüTzer, Paul Duberstein, Richard L. Kravitz

Steven D Vannoy

ABSTRACT PURPOSE We wanted to describe the vocabulary and narrative context of pri- mary care physicians’ inquiries about suicide. METHODS One hundred fifty-two primary care physicians (53% to 61% of those approached) were randomly recruited from 4 sites in Northern California and Rochester, New York, to participate in a study assessing the effect of a patient’s request for antidepressant medication on a physician’s prescribing behavior. Standardized patients portraying 2 conditions (carpal tunnel syndrome and major depression, or back pain and adjustment disorder with depressed mood) and 3 antidepressant request types (brand-specific, general, or none) made 298 unan- nounced visits to …

Tender Point Count, Pain, And Mobility In The Older Population: The Mobilize Boston Study, Suzanne G. Leveille, Laura H.P. Eggermont

Suzanne G. Leveille

Abstract: Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low …

State Agency Promising Practice: Michigan’S Job Development Incentive, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Michigan’s Department of Community Health, Mental Health and Substance Abuse Administration (MDCH) has expressed a strong desire to improve the state’s employment outcomes among people with intellectual and developmental disabilities (IDD). Set against this desire is a major obstacle: Michigan is among the states hardest hit by the continuing economic recession, with the highest unemployment rate in the nation. MCDH delivers supports through local Community Mental Health Services Programs (CMHSPs). These CMHSPs not only experience differences in employment rates but also have high variability in their funding levels and structures, payment methodologies, and reimbursement mechanisms. Local CMHSPs individualize their contracts …

State Agency Promising Practice: Massachusetts - Using A Collaborative, Person-Centered Planning Approach To Facilitate Community Employment, Jennifer Bose, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

The Northeast Region Supported Employment Project was developed by the North Shore area office of the Massachusetts Department of Developmental Services in 2007. This pilot program, open to any individual with ID/DD who wanted to work, emphasized a person-centered planning approach to achieving the individuals’ goals for employment in the community. The project emphasized the individual’s choice of employment providers, collaboration with the Massachusetts Rehabilitation Commission (MRC), and use of an independent facilitator to support career and life planning. The project was spearheaded by two DDS administrators dedicated to communicating the value of community-based employment to the Department.

State Agency Promising Practice: Maryland - Collaborating To Promote Self-Employment For People With Intellectual/Developmental Disabilities, Jennifer Bose, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

Self-employment has emerged as a viable option for individuals with intellectual or developmental disabilities (IDD). To meet increased self-employment demands, Maryland’s Developmental Disabilities Administration (DDA), in collaboration with the Maryland Division of Rehabilitation Services (DORS), adapted services offered through the Reach Independence through Self Employment (RISE) program. The RISE program, funded by DORS, provides technical assistance and financial support to people starting their own businesses. DDA’s role in this self-employment initiative has helped people with IDD start a wide variety of businesses and achieve meaningful employment.

Community Violence As Psychosocial Stressor: The Case Of Childhood Asthma In Boston, Gonzalo Bacigalupe, Takeo Fujiwara, Sabrina Selk, Meghan Woo

Counseling and School Psychology Faculty Publication Series

Childhood asthma is a critical public health problem of urban centers in the United States and other industrialized nations. Population-based and laboratory research studies indicate that psychosocial stress differentially affects asthma expression. Witnessing or experiencing community violence is a psychosocial stressor that results in long-term biological changes that may in turn contribute to asthma morbidity. This is a review of the literature that examines the exposure to violence as a psychosocial stressor that is independently associated with asthma morbidity even after adjustment for income, housing, and other adverse life events. In addition to acting as a physiological trigger for the …