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Research at Mass General
The leaders of the Community Research Program at MGH Chelsea discuss the role that research can play in improving the health outcomes of the residents in their community.
As part of our spotlight on community research this month, we spoke with Amy Izen, MS, CCC-SLP, Rohit Chandra, MD, and Julie Levison, MD, MPhil, MPH, the leaders of the Community Research Program at MGH Chelsea, about the research initiatives taking place there.
From left to right are Amy Izen, MS, CCC-SLP, Rohit Chandra, MD, and Julie Levison, MD, MPhil, MPH.
We first want to point out that Chelsea is a special community. The strength of the bonds of its members (and overall resiliency) and yet the depth of its needs seem to draw out the best in providers and researchers.
We are inspired to care for this diverse population and to study healthcare disparities in hopes of closing gaps. We emphasize research efforts which respond to community needs and priorities, studying topics of importance to the community such as health outcomes in multi-cultural populations, the social determinants of health, or health issues that impact Chelsea, such as substance use.
Our research often involves partnerships between researchers and community stakeholders towards common ends, and is often shared and disseminated within the community once completed, such as at our annual MGH Chelsea Community Research Day.
As much as possible, we aim to involve community partners from the development of the research question to the recruitment of participants, analysis of data and dissemination of the results.
Our patients have many barriers to accessing medical care including limited financial resources, reduced English proficiency, and mental health needs. They may be unfamiliar with the concepts of preventative care or other types of treatment due to their cultural background.
Transportation barriers and reduced education and health literacy impact adherence to diagnostic and treatment plans as well.
The MGH Chelsea Research Program offers an opportunity to discuss these clinical issues across disciplines and explore solutions that are innovative, resourceful, evidence-based and respond to the needs we observe.
We invite colleagues from all of Mass General's community healthcare centers to attend and present at our monthly Roundtable meetings, as well as at our annual Research Day. We have regular participation from colleagues at MGH Revere, MGH Charlestown and MGH Boston. We have shared our model with administrators at MGH Charlestown, who are interested in starting a Roundtable at their healthcare center.
At our second annual MGH Chelsea Community Research Day in October, our panel discussion featured two groups of research collaborators.
Primary care physician Hong Chen Cheung, MD, has been working with Robert Rapucci, executive director of the largest anti-poverty community agency in Chelsea called CAPIC, Inc. (Community Action Program Inner City) and with Ruben Rodriguez, director of the Hope of Christ Ministry, to identify the medical and spiritual needs of Chelsea's homeless.
Towards that end, she and her colleagues have been meeting with homeless individuals who reside under the Tobin Bridge, providing basic medical treatment and building relationships with hopes of encouraging them to seek the proper medical treatment, substance abuse treatment, and spiritual healing they need.
Dr. Chen Cheung, Repucci and Rodriguez reported on their efforts quite movingly at the event.
A newer but equally promising collaboration is between Martinos Center neuroscientist Eve Valera, PhD, and behavioral health social worker Georgia Green, LICSW, to screen women who have been victims of domestic violence for traumatic brain injuries.
Dr. Chen Cheung joined the outreach team of the Chelsea CAPIC (Community Action Program Inner City) to help individuals with substance use disorders (SUDs) in the city. She explains that despite the availability of medical treatments for SUDs, many individuals do not take advantage of them. Common barriers to treatment for SUDs include prior negative experiences with the health care system, a lack of identification, linguistic barriers, cultural differences, legal status, fear, mental illness and stigma, among others.
The CIPAC outreach team conducts weekly rounds in the community, carrying naltrexone (an opiate antagonist that helps to discourage drug use) and basic equipment for simple wound care and vital signs. "The objective is to build a permanent relationship of trust with the client in order to initiate primary care and preventative services," she says.
"Customarily, the population we serve are considered complex patients that are hard to engage or are in a blind spot of the health care system. Leveraging the trust that the outreach team has cultivated, clients are more open to express their perspective of how they can be supported to initiate recovery," she says.
"With the skillfulness of the street team, increasingly, we are being asked to advise on health care services. The street team also follows up with clients to sustain engagement."
"It is beneficial that social service organizations collaborate with community researchers at Mass General, since there is a direct relationship between poverty and health," adds Robert Rapucci, Executive Director of CAPIC. "Identification of the social determinants that contribute to illness and the barriers that prevent people from seeking acute and preventive healthcare is crucial in our endeavor to eliminate poverty. The collaboration between CAPIC and community researchers at Mass General has revealed important issues that enable us to create solutions for the population that we serve."
Eve Valera, PhD, is working to address the overlooked and understudied epidemic of intimate partner violence-related traumatic brain injuries. She has partnered with Georgia Green, LICSW, a social worker at the Chelsea Behavioral Health Clinic.
"Through connections made via Georgia, I received several letters of support for my grant submission. In writing such a grant, it is important that the reviewers believe that women in abusive situations will be interested in participating in this study.
These letters demonstrate a belief in my project from advocates and shelter workers, who can safely tell women about my study."
"I think it is important that we realize the best way to accomplish a goal, in any situation, is to connect with others outside our areas of expertise, recognize that each of us contributes uniquely to the puzzle we are trying to solve, and understand that working together is the only way to be truly successful," Valera adds.
Yes, we can think of a few examples. One example comes from our colleague, Efren Flores, MD, who presented his study of barriers in the care of radiology patients. He suggested that "no-show" appointments be re-conceptualized as "missed care opportunities," and several Departments have adapted this lexical change.
A second example is in regards to the work of Sanja Percac-Lima, MD, who piloted a patient navigation program 10 years ago for a group of patients from racial/ethnic minority groups who were at risk for cancer.
Working in conjunction with community health centers, the navigators reached out to those who were due for medical care and helped to guide them through the health care system and overcome barriers to accessing medical services.
This model has been expanded to other populations such as patients who have unstable housing, critical medical conditions, or are refugees, as it has been effective in increasing adherence to care and reducing cost of care across several high-risk populations.
For more information about the Community Research Program at MGH Chelsea, and to download the 2017 Community Research Day abstract book, please visit the MGH Chelsea Research Program website.
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