Social and Behavioral Sciences Commons^™

Advancing And Promoting Community Health: Opportunities For Accountable Communities For Health And Community Health Centers, Helen Mittmann, Jeffrey Levi, Janet Heinrich, Feygele Jacobs, Rebecca Morris, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Executive Summary:

Accountable Communities for Health (ACHs) are multi -sector, community-based partnerships that aim to address community health and social needs, and Community Health Centers (CHCs) provide important community-based healthcare services for underserved and medically vulnerable populations. Given the critical role that both ACHs and CHCs play in addressing health-related social needs and social determinants of health, a survey of ACHs on CHC engagement was conducted to better understand opportunities and challenges for CHC participation in ACHs. This survey, along with follow-up conversations with ACH and CHC representatives, confirmed that ACHs and CHCs are natural partners in the effort to …

Months Into The Covid-19 Pandemic, Community Health Centers Report Signs Of Improvement, But Face Financial Uncertainty, Jessica Sharac, James Hernandez, Feygele Jacobs, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Executive Summary:

This policy brief reports on the COVID-19 experience of the nation’s community health centers over a six-month period, utilizing data from the Health Resources and Services Administration’s (HRSA’s) weekly Health Center COVID-19 Survey from April 3rd, 2020 to October 2nd, 2020. The data demonstrate that community health centers were immediately responsive to the public health crisis, initiating diagnostic testing for the COVID-19 virus, and adapting care such as telehealth to address patient needs. However, with visits down overall and limited financial relief, the pandemic has taken an enormous financial toll on health centers. Cumulative patient revenue losses over …

How Collective Norms And Media Use Affect Attitudes About Violence Against Women And Contraception Use In Sub-Saharan Africa, Erica Sedlander, Rajiv N. Rimal

GW Research Days 2016 - 2020

Background: Contraceptive use and attitudes about violence against women, though enacted at the individual level, are also driven by factors at the interpersonal and social levels. The role of mass media in promoting social norms surrounding these attitudes and behaviors has not received much scholarly attention but can be helpful to illuminate areas for intervention.

Hypothesis: We proposed and tested the hypothesis that collective norms (defined as a groups aggregate behavior or attitudes) would be associated with individual level attitudes (tolerance towards violence against women) and behaviors (contraception use). This relationship was further hypothesized to vary by media use, such …

The Living The Example Social Media Substance Use Prevention Program: A Pilot Evaluation., William Evans, Elizabeth Andrade, Sandra Goldmeer, Michelle Smith, Jeremy Snider, Gunilla Girardo

Prevention and Community Health Faculty Publications

Reproduced with permission of JMIR Publications. JMIR Mental Health

Victims Or Heroes? How Did Journalists Frame The Ebola Crisis In Liberia?, Tamah Kamlem, Nwanneamaka Ume, Skylar Lisse, Eme Udoh, Jialin Meng

GW Research Days 2016 - 2020

The Ebola Virus Disease epidemic in West Africa in 2014 with over 11,000 deaths made headlines worldwide, causing fear and posing a challenge to traditional media, entrusted with the task of reporting about the spread of the disease. Individuals and communities rely on media to obtain health information, including decisions related to disease prevention and behavior to protect their health. Therefore, frames used by the media to report about health emergencies impact public perceptions. Mass media framing during crises has been associated with emotional and behavioral responses that are consistent with the thematic depiction of unfolding events. Moreover, message frames …

Projected Financial Losses Experienced By Community Health Centers Under A Scenario Of Major Cuts In Key Sources Of Federal Funding: 2018-2022, Avi Dor, Eric Luo, Ali Moghtaderi, Anne Rossier Markus

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Congress is currently considering options to significantly reduce federal funding for the Medicaid expansion and the Marketplace subsidies implemented under the Affordable Care Act (ACA). Separately, the Health Centers Fund, which currently accounts for 70% of all federal health center grant funding, is set to expire in September 2017. These potential changes in federal funding could have a dramatic impact on health centers and the communities they serve. The purpose of this brief is to simulate the potential combined impact of these major changes in federal funding that will directly affect community health centers. Secondarily, this brief also assesses the …

A Medical Student Foray Into The Depths Of Public Health: An Exploratory Investigation Toward A Community Dashboard Characterizing The Experiences Of Frailty In Order To Guide Improvement, An Harmanli, Danielle Fahoome, Burton Masem, Ellen Massey, Beverly Lunsford, Joanne Lynn, Elizabeth Cobbs

GW Research Days 2016 - 2020

While it is known that there are many shortcomings in the care of the elderly, their rate and impact on the community and the elderly themselves is not well understood. In exploring the possibilities for using existing data and available informants, a dashboard could be created that would enable a geographic community to understand the experience of living with disabilities in old age, to prioritize problems, and to test improvements.

The methods included a literature review to understand what and how easily information could be accessed, gathered, and presented. In regards to literature on data collection, CMS claims data, MDS, …

How Could Repealing Key Provisions Of The Affordable Care Act Affect Community Health Centers And Their Patients?, Sara J. Rosenbaum, Jessica Sharac, Thao-Chi Tran, Anne Rossier Markus, David Reynolds, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Analyses of repeal of the Affordable Care Act (ACA) have tended to focus on coverage. This study, which gauges the potential effects of repealing certain ACA provisions, looks at the question of primary health care access itself, with a focus on medically underserved communities. A survey developed and fielded in early 2017 asked community health centers to estimate the impact of ending the Health Centers Fund established under the ACA as well as ending expanded Medicaid coverage and subsidies designed to make private insurance affordable for lower income patients. Forty-one percent of health centers responded; 69 percent were located in …

The Changing Roles Of Community Health Workers, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

This report provides a snapshot of the varied landscape of CHW programs to better understand how CHWs are integrating with the health system both in …

Social Media And Sexual Behavior Among Adolescents: Is There A Link?, Megan Landry, Monique M. Turner, Amita N. Vyas, Susan Wood

Prevention and Community Health Faculty Publications

Background: Adolescent sexual risk taking and its consequences remain a global public health concern. Empirical evidence on the impact that social media has on sexual health behaviors among youth is sparse.

Objective: The study aimed to examine the relationship between social media and the change in sexual risk over time and whether parental monitoring moderates this relationship.

Methods: This study comprised a sample of 555 Latino youth aged 13-19 years from Maryland, United States completing baseline and follow-up surveys. Mixed-effects linear regression was used to examine the relationship between social media and the change in sexual risk over time and …

Adelante Ambassadors: Using Digital Media To Facilitate Community Engagement And Risk-Prevention For Latino Youth, Nicole Barrett, Ricardo Villalba, Elizabeth L. Andrade, Alison Beltran, W. Douglas Evans

Prevention and Community Health Faculty Publications

Digital and social media are now widely used to promote engagement in health programs and improve health behaviors across a variety of age groups and domains. However, limited research exists on applying culturally relevant, new media interventions specific to Latino immigrant youth. This paper describes the pilot Adelante Youth Ambassador program for Latino immigrant youth, which used digital media and community-based participatory research to build positive youth development (PYD) assets as a prevention mechanism to reduce co-occurring health risks of substance use, sexual risk, and interpersonal violence. We worked collaboratively with adolescents to create video content as a conduit for …

Health Reform Repeal Could Cause 3 Million People To Lose Jobs And Trigger Broad Economic Disruption, Leighton Ku, Erika Steinmetz, Erin Brantley, Brian K. Bruen

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans.

Goal: To determine the state-by-state effect of repeal on employment and economic activity.

Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal …

Community Health Centers: Recent Growth And The Role Of The Aca, Sara Rosenbaum, Julia Paradise, Anne Rossier Markus, Jessica Sharac, Chi Tran, David Reynolds, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are the nation’s largest source of comprehensive primary care for medically underserved communities and populations. Under the Affordable Care Act (ACA), increased patient revenues due to the expansion of Medicaid and private health insurance, along with substantially increased direct federal investment in the program, have led to growth in the number of health centers and their capacity to provide services. This brief draws on 2015 federal data on health centers and our 2016 Survey of Health Centers’ Experiences and Activities under the Affordable Care Act to provide a snapshot of health centers and their patients, analyze recent …

Training Us Health Care Professionals On Human Trafficking: Where Do We Go From Here?, Clydette Powell, Kirsten Dickins, Hanni Stoklosa

Pediatrics Faculty Publications

Some 21 million adults and children are labor-trafficked or sex-trafficked through force, fraud, or coercion. In recognition of the interface between trafficking victims and the healthcare setting, over the last 10 years there has been a notable increase in training of health care professionals (HCPs) on human trafficking (HT) and its health implications. Many organizations have developed curricula and offered training in various clinical settings. However, methods and content of this education on trafficking vary widely, and there is little evaluation of the impact of the training. The goal of this study was to assess the gaps and strengths in …

Improving Community Health Through Hospital Community Benefit Spending: Charting A Path To Reform, Sara J. Rosenbaum, Maureen Byrnes, Sara Rothenberg, Rachel Gunsalus

Health Policy and Management Faculty Publications

No abstract provided.

Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as …

How Are Migrant Health Centers And Their Patients Faring Under The Affordable Care Act?, Jessica Sharac, Rachel Gunsalus, Chi Tran, Peter Shin, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Migratory and seasonal agricultural workers (MSAWs) provide essential labor for farming in all its branches in the United States. Between 2.4 and 3 million MSAWs live across the U.S. in every state but are clustered in areas dense with agricultural employment. As a population already susceptible to poor health outcomes because of poverty and work-related health risks, MSAWs depend on community health centers, especially those known as migrant health centers that receive additional migrant funding. Reporting data from a national survey of agricultural workers, as well as findings from analyses of data from the Uniform Data System (UDS) that covers …

Social Media In The Sexual Lives Of African American And Latino Youth: Challenges And Opportunities In The Digital Neighborhood, Robin Stevens, Jamie Dunaev, Ellen Malven, Amy Bleakley, Shawnika J. Hull

Prevention and Community Health Faculty Publications

There has been significant interest in the role of social media in the lives of adolescents, particularly as it relates to sexual risk. Researchers have focused on understanding usage behaviors, quantifying effects of social media exposure and activity, and using social media to intervene. Much of this work has focused on college students and non-minority youth. In this paper, we examine the growing body of literature around social media use among US minority youth and its intersection with sexual risk behavior. We introduce the concept of the “digital neighborhood” and examine the intersection of social media and sexual health in …

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician …

Health Center Trends: Recent Experience In Medicaid Expansion And Non-Expansion States., Peter Shin, Jessica Sharac, Julia Zur, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In thousands of medically underserved communities across the U.S., community health centers enroll lowincome people in health coverage and provide care to millions of patients. Against the backdrop of significant health center expansion over several years and a full year of expanded health coverage under the Affordable Care Act (ACA), this brief examines change between 2013 and 2014 in the volume and health coverage profile of health center patients, and health center enrollment activities and service capacity, comparing states that implemented the ACA Medicaid expansion in 2014 and states that did not expand Medicaid in 2014. The study is based …

Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman

Health Workforce Research Center Publications

In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more …

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

Patient Experiences With Family Planning In Community Health Centers, Susan F. Wood, Tishra Beeson, Debora Goetz Goldberg, Holly Mead, Peter Shin, Aliyah Abdul-Wakil, Anna Rui, Bhakti Sahgal, Maya Shimony, Hallie Stevens, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Teaching Health Centers: A Promising Approach For Building Primary Care Work Force For The 21 St Century, Leighton Ku, Fitzhugh Mullan, Christine Cerrano, Zoe Barber, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Community Health Centers: A 2013 Profile And Prospects As Aca Implementation Proceeds, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2013, more than 1,200 federally funded community health centers provided access to care for low-income populations living in medically underserved communities throughout the country. The Affordable Care Act made expansion of health centers a key part of its strategy for ensuring that these communities would realize the benefits of increased health insurance coverage for their residents. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase. A key question going forward is whether health centers’ expanded capacity, developed over the past five …

Evaluating Obesity Prevention Efforts: What Have We Learned? Highlights From A Conversation Of Funders And Evaluators, Sumner M. Redstone Global Center For Prevention And Wellness

Sumner M. Redstone Global Center for Prevention and Wellness

Table of contents:

Executive Summary

Introduction

State of the Obesity Epidemic

The Community Context for Interventions and Evaluations

Investments to Date: Where Is the Strongest Agreement About What Works?

Early Care and Education Environments

Schools/Learning Environments

Parks, Trails, Open Spaces, and Recreation

Land Use and Transportation

The Next Tier: Mixed or Promising Results for Healthy Food Retail Interventions

Implementing Interventions: The Crucial Role of "How"

Other Topics

Summary and Next Steps

Appendix A: Citations and Resources for Key Elements/Components

Using Payment Reform Strategies To Strengthen Family Planning Services At Community Health Centers, Sara J. Rosenbaum, Peter Shin, Susan F. Wood, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2012 nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA’s large investment in the health center program provides new resources to help meet growing needs.

This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health …