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Winter 2011, Issue 12

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News and Updates

Johns Hopkins Provides Free Specialty Care for the Uninsured in East Baltimore

Meet the UHI's Community-University Collaborating Committee: Judge Ellen Heller

Partners Say Transparency and Collaboration Key to Success for Community Health Initiative

Highlight on 2009 Small Grants Recipients: The Johns Hopkins Center for Injury Research and Policy Streamlines the Work of the Baltimore City Fire Department Through Data Driven Capacity Building

Highlights from Recent Events

UHI Race and Research Event Confronts Racism



Johns Hopkins Provides Free Specialty Care for the Uninsured in East Baltimore

In late 2007, a group of faith leaders and leadership from Johns Hopkins came together at a UHI forum and began a conversation about improving access to health care for the uninsured in East Baltimore. They talked about the Caroline Street Clinic for the Uninsured, which had closed its doors in 2006 as a result of inefficiencies in providing care to a large uninsured population, and about crowded emergency rooms that are often unable to treat chronic conditions effectively.

Today, as result of these conversations, uninsured and underinsured residents living in the neighborhoods surrounding The Johns Hopkins Hospital and Bayview Medical Center are eligible for comprehensive care at nearly no charge. It's called The Access Partnership—TAP for short—and it was launched in 2009 as a pilot program in two East Baltimore zip codes. TAP proved so successful it was expanded to include patients from five additional zip codes, bringing the total to seven: 21202, 21205, 21213, 21219, 21222, 21224, and 21231. The program is the first of its kind in Baltimore.

Crowd at TAP Forum
Over 70 representatives of the East Baltimore community gathered at the American Brewery on N. Gay St. for the TAP Forum on February 2.

On February 2, 2011, many of the same leaders that met in 2007 came together again to share what had been accomplished since that first conversation. Ronald Peterson, president of The Johns Hopkins Hospital, opened the forum.

"TAP started with the premise that we would be willing to take the responsibility for folks who live in a defined geographic area around the Johns Hopkins Medical Campus," said Peterson, "We'd start small and develop an organized process for enabling people to access specialty care."

To qualify, patients must live within the seven target zip codes, have a Johns Hopkins primary care provider, and be uninsured or underinsured due to low-income. This means a family of three, earning less than $36,000 per year would qualify for the program, as well as patients of Maryland's Primary Adult Care (PAC) program (Maryland residents age 19 and over, who earn less than the federal poverty level, and who do not have health insurance through Medicaid or Medicare are eligible for PAC).

This is how the TAP works: Eligible patients who are identified by their primary care doctor as needing specialty care are referred to specialty care doctors who provide comprehensive services. This includes, but is not limited to, cardiology tests, mammograms, MRI and CT Scans, physical therapy, surgeries and chemotherapy treatments. The actual price of admission for those who qualify is $20.

Anne Langley, Director of Health Policy Planning for the Johns Hopkins Health System says that the one-time fee is not meant to be a financial barrier, but a "sign of commitment" from the patient for their care.

"That $20 covers all care a patient requires, whether that is one MRI or an MRI followed by additional lab work and a neurology appointment," she said.

TAP operates like a concierge service. Patients who are referred to the program are linked with a "patient navigator" who directs them through their care by making and confirming appointments, and even arranging transportation if needed. The patient navigators and the one-time TAP fee are credited with the program's remarkably low appointment no-show rate of only seven percent (the average no show rate for Medicare and Medicaid patients is between 30% and 40%).

So far TAP has made about 1600 referrals and served 600 patients, with the majority of patients coming from zip codes 21213, 21224 and 21205. Dr. Sai Ma, a scientist at the Bloomberg School of Public Health, and her team conducted phone interviews with patients to assess satisfaction with TAP. Of the 214 participants contacted, over 90 percent were completely satisfied with the program.

Rev Debra Hickman and Anne Langley
Rev. Debra Hickman (left) and Anne Langley

TAP Medical Director, Dr. Barbara Cook, shared examples of the program's success, including one case about an uninsured 40-year-old man suffering from hip pain.

"It turns out that this gentleman was injured in a car accident 20 years ago," she said. "Over time he lost blood circulation to his hip and has been hobbling around for the last 10 years. Last month he had a total hip replacement."

Clergy who played a major role in the formation of TAP, attended the form and expressed their interest in working with Johns Hopkins to share information about TAP within their congregations.

"The faith community needs to bridge the gaps between clinics, Hopkins and community associations . . . to attract persons that are still utilizing emergency services so they will be engaged in this program," said Rev. Debra Hickman, president of Sisters Together and Reaching (STAR).

For more information about TAP, contact Anne Langley at 443-997-0727 or alangle2@jhmi.edu.


Meet the UHI's Community-University Collaborating Committee: Judge Ellen Heller

Ellen Heller

What would it take to improve outcomes for children, youth and families in East Baltimore? This was the topic of conversation one afternoon in 2007 in Dean Michael Klag’s office at the Bloomberg School of Public Health. Dean Klag, along with newly-appointed UHI Director Robert Blum, Judge Ellen M. Heller, and Shale D. Stiller, then President of the Harry and Jeanette Weinberg Foundation, discussed how investments in early childhood development could have a positive impact in East Baltimore. The conversation set in motion what would become part of a comprehensive strategy for an early childhood education program in East Baltimore.

On that afternoon, Judge Heller, then President of the American Jewish Joint Distribution Committee Board, urged Dr. Blum to research Parents and Children Together (PACT), an early childcare program that was developed in Israel initially for Ethiopian children who had immigrated to Israel. Now serving 14,000 children in 15 cities, PACT emphasizes parental and community involvement, and partners with health, social service and other government and private family support providers to enrich its academic programming with language, art, music, science, math, and recreational offerings. Evaluations of the PACT program have consistently shown significant improvement of children in language and math skills at the end of first grade.

During the same time as these discussions, East Baltimore Development, Inc. (EBDI) was leading the redevelopment of an 88 acre site north of the Johns Hopkins East Baltimore campus. Central to the EBDI initiative will be a seven acre Learning Campus with a kindergarten through eighth grade public charter school and an early childhood learning center; both described as pivotal in creating an economically and racially diverse community.

Dr. Blum was asked to chair the working group for the early childhood learning center and subsequently convened a team of early childhood development leaders from across the city and the state to explore various models and programs, including several trips to visit the PACT program in Israel.

“The visit [in 2008] was transformative in that it not only galvanized our group but also gave us a vision of what was possible,” says Dr. Blum.

Countless hours and meetings later, in March 2010, this workgroup presented a concept paper to EBDI that built upon the work of PACT and Educare, an evidenced-based program started in the United States that has rigorous standards for small class sizes, teacher training, and high staff to child ratios. The goal of integrating Educare and PACT is to create a state-of-the-art facility and community-wide service model that will not only meet the needs of young children and their families in the EBDI community but also will serve as a replicable model across the United States. The vision of the Early Childcare Center (ECC) is that all children in the EBDI community, from the prenatal period through pre-kindergarten, will be healthy and ready to succeed in school. Working in partnership with the Johns Hopkins School of Education, EBDI is building a $10 million, 30,000 square foot early childcare center for ages 0 to 5 on the 7-acre East Baltimore Community Learning Campus. The center will have a capacity of roughly 230 children, of which approximately half will be from low income families.

A Baltimore native, Ellen Heller is an honors graduate of Johns Hopkins University and the University of Maryland School of Law. In 1986 she was appointed a Judge of the Circuit Court for Baltimore City where she became the Judge in Charge of the Civil Docket in 1993. She served in that position until 1999 when she was appointed the first female Circuit Administrative Judge in Maryland overseeing the entire court—a role she held until her retirement in 2003. During her law career, Judge Heller oversaw major reforms to relieve backlogs in both civil and criminal cases and implemented innovative alternative dispute resolution programs, including court ordered mediation for certain civil cases.

Today, Judge Heller is Chair of the American Jewish Joint Distribution Committee Board, an international relief organization which provides rescue, relief, and renewal activities for communities in need. She continues to preside over a Baltimore Circuit Court felony drug court, a program she started the same year of her retirement that diverts non-violent felony drug offenders into treatment instead of jail time. For three consecutive years she was named one of Maryland’s Top 100 Women by The Daily Record. She is a Trustee of the Harry and Jeanette Weinberg Foundation, a recipient of the Maryland State Bar’s Civility Award, and the University of Maryland School of Law’s Distinguished Graduate Award. In 2008, she was named to the Maryland Women’s Hall of Fame. 


Partners Say Transparency and Collaboration Key to Success for Community Health Initiative

Community Health Initiative
Creating a Healthier East Baltimore, Together

Adrian Mosley
Adrian Mosley reads comment and suggestions from collaborators at the March 10 All Partners Meeting.

The Community Health Initiative is bringing together East Baltimore and Johns Hopkins in an effort to make our neighborhood a healthier place to live. The planning process for the Community Health Initiative is supported by the UHI and includes more than 40 neighborhoods in five zip codes (21202, 21205, 21213, 21224, 21231).

Collaborative partners from East Baltimore and Johns Hopkins met as a group on Thursday, March 10 to discuss the progress of the Community Health Initiative. Adrian Mosley, administrator of the Johns Hopkins Office of Community Health, who has over 30 years of experience working in East Baltimore, facilitated the meeting. It was the group’s consensus that transparency and collaboration are key to success for the Community Health Initiative.

If you would like to add your thoughts and insight, or help us plan the Community Health Initiative, please contact Ariel Sloan at 410-502-0440 or asloan@jhsph.edu. Many of the planning teams, including the Research Methods Team, have recently re-grouped, and invite new participation to discuss key issues and priorities for the health assessment.

In addition, you can always find current information about the health initiative on our website.


Highlight on 2009 Small Grants Recipients: The Johns Hopkins Center for Injury Research and Policy Streamlines the Work of the Baltimore City Fire Department Through Data Driven Capacity Building

By Bobbi Nicotera

In 2007, a group of researchers from the Johns Hopkins Center for Injury Research and Policy (CIRP) began working on a Federally-funded project designed to study injury prevention interventions in East Baltimore. As part of this program, Center faculty—including Wendy Shields, Eileen McDonald, Shannon Frattaroli, David Bishai and Center Director Andrea Gielen—proposed to study the dissemination of lithium smoke alarms by the Baltimore City Fire Department (BCFD). Dissemination was done through the department’s home visiting program, in which fire fighters canvass neighborhoods to install smoke alarms.

While the group was in the process of studying the department’s existing program, Shields discovered that fire department personnel were unable to fully utilize the data collected during their canvassing program to target homes in need of a visit or plan for program needs city wide.

BCFDShields and her colleagues realized that the BCFD needed a better and more efficient way to collect, organize and analyze their canvassing data. A better system was need for the fire department as well as for the study team to meet the aims of the dissemination study. The group also knew they wouldn’t be able to use the money from the federal grant to address this need. That’s when Shields saw an announcement for the UHI Small Grants Program. Awarded in 2008, the Small Grants Program provided much needed additional funding for CIRP’s new project, giving them an opportunity to help fill a critical unmet need for the fire department.

The BCFD has been doing the canvassing program that includes home inspections and installation of smoke alarms for nearly three decades. It’s a valuable service to city-dwellers, as the presence of working fire alarms in residences has been proven to reduce the risk of death from fires by one-half. But with 57 firehouses in the city tasked with canvassing more than 200,000 homes in roughly 225 neighborhoods and no master list for keeping track of results, data collection was inefficient. Some houses were visited multiple times, others not at all. With so many people gathering information, and without the resources to organize it all, it was difficult, if not impossible, to catch the gaps and overlaps in home visiting and data reporting. The department needed a better system, one that would help them keep track of where they had been and where they needed to go. Working together, CIRP and the fire department were able to identify key elements of a new and improved system.

The first step was to determine the basic information—how many houses in the city were eligible for the canvassing program. Establishing an accurate number of homes and comparing that to the number of homes actually visited would yield a coverage rate, and this would paint a clearer picture of exactly what needed to be done. Shields and her colleagues used the MDProperty View database to establish this number, and then attached latitudinal and longitudinal coordinates to each address in a process called “geocoding.” Once the addresses were coded, they were mapped and entered into a computer system that allows users to geographically connect, organize and analyze information using spatial integration, also called a Geographic Information System (GIS). Using GIS technology and data from 2007, they were able to see that only 59% of eligible residences were visited. t. Forty-one percent of the total residences received no visit, while 29% had multiple visits. Not only were the numbers discouraging, but insufficient resources prevented the Department from using the data to inform program development. Clearly, a new system was needed.

Shields and her colleagues were able to design such a system because they had already developed a similar data system specifically for their research project. Using the 10,000 homes in her research study, Shields created a pilot program that allowed each firehouse to see the current status of residences by inspection area. The study used census tract information and included maps and an address status report that organized homes alphabetically by street names into the following four categories: Visited smoke alarm installation complete, Visited but no one at home, No visited, or Vacant property. This model program built on the research study experience and funded by UHI has promise for addressing the needs of the fire department for a better and more efficient way to collect, organize and analyze their canvassing data.

The reports from the pilot program have been shared with Fire Department leadership, who have shown an interest in implementing the system. Both Shields and Dr. Gielen agree that support for integrating the new system is strong. It’s just a matter of finding the manpower and resources to do it.

Shields says the fire department historically has had to manage with limited resources.

BCFD

“It’s important to understand that if the Fire Department had more resources, they would have likely come up with this kind of reporting and tracking system on their own,” she says. “They were doing the best they could under the circumstances.”

But the UHI award from the Small Grants Program allowed Shields and her CIRP colleagues to work with the BCFD to meet an important need for an improved data system. And Shields, for one, is grateful.

“Whenever you’re working with local agencies and organizations, you have to be prepared for the fact that there may be important unmet needs revealed,” she says. “In this case, it was really beneficial to have a mechanism to fund that unmet need. As a result, the BCFD has a new data system to utilize as they work towards city-wide smoke alarm coverage.

For more information about this project, contact wshields@jhsph.edu or visit the Johns Hopkins Center for Injury Research and Policy.

Photos show the CIRP team working with the BCFD to install smoke alarms as part of the department’s home visiting program. (Photos by James Singewald)


UHI Race and Research Event Confronts Racism

In 2009, the UHI launched a special symposia series to confront the distrust and skepticism toward biomedical research that exists within the Black community, and to engage Johns Hopkins in conversations with the community to discuss what is needed to move forward. On March 8, the Race and Research Series turned to a fundamental conversation: Racism—what it is, why it exists, and how it manifests in the health of our nation today.

Cmara Jones
Dr. Camara Jones describes how racism manifests in the health of our nation.

Dr. Camara Jones, Research Director on Social Determinants of Health and Equity at the Centers for Disease Control and Prevention (CDC), spoke to a full house, sharing findings from her own research about how racism still permeates in our nation and offering ways to overcome these historically-rooted prejudices.

"Racism is not an individual character flaw, or a personal moral failing, or even a psychiatric illness," she said. "Racism is a system of power . . . it's a system of structuring opportunity and assigning value based on the social interpretation of how we look."

Throughout her career, Dr. Jones has worked to broaden the national health debate to include social determinants of health and social determinants of equity—including racism. She says that racism is one of the fundamental causes of racial disparities in health outcomes.

Responses to her "Reaction to Race" module, which was added in 2002 to the CDC's Behavioral Risk Factor Surveillance System (the country's largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984), reveals that being perceived as White is associated with better health and higher education, even among individuals who do not identify themselves as White. Dr. Jones says this is because "we live in a society that structures opportunity based on race."

She described three forms, or levels, of racism. The first is concealed within our culture and in our laws through "institutionalized" racism, which is when people have different degrees of access to goods, services, and opportunities, by race. Dr. Jones says that it's this kind of intangible discrimination that perpetuates historically-rooted prejudices. The second, "personally mediated" racism is how most people think about racism, as an outward act of prejudice or discrimination. The final level, "internalized" racism, is characterized by helplessness and hopelessness, self-devaluation, and the devaluation of one's own race. She says this kind of racism can help explain "Black on Black" crime, high rates of school drop-out, risky health behavior, and even failing to vote.

Dr. Jones then shared a simple yet profound allegory called A Gardener's Tale, which she uses as a metaphor to help people understand the many layers and nuances of racism. A gardener with two flower boxes fills one box with rich fertile soil and the other with poor rocky soil. The gardener prefers red over pink, so she plants the red seed in the rich fertile soil and the pink seed in the poor rocky soil. The red seeds flourish, while the pink flowers struggle to reach even medium height and health. The gardener, forgetting her original decision to separate the seeds into the two types of soil, proclaims "I was right to prefer red over pink!"

The gardener, Dr. Jones says, is the one with the power to decide, the power to act, and the control over the resources.

"The government is part of the gardener, as are the rich people behind government, as are foundations, and the media. Whoever the gardener is, it's dangerous when the gardener is allied with one group and not concerned with equity," says Jones.

In A Gardeners Tale, "institutionalized" racism is illustrated by the initial separation of the seed into the two types of soil, the flower boxes which keep the soil separate, and the inaction in the face of need by the gardener who fails to fertilize or mix up the soils. "Personally-mediated" racism is exemplified when the gardener, viewing pink as inferior to red, plucks a pink blossom before it can even go to seed. "Internalized" racism is exemplified by a pink flower saying to an approaching bee, "Don't bring me any of that pink pollen - I prefer the red!" because the pink flower has internalized the belief that red is inherently better than pink.

Dr. Jones says that to make things right in the garden, society must fully address institutionalized racism, even while addressing personally-mediated and internalized racism.

"If we at least address institutionalized racism, the other levels of racism may take care of themselves," she says.

Panel
Invited panelists offered their reactions to Dr. Jones’ presentation. From left to right: Rev. Frances “Toni” Draper, Dr. Maria Trent, and Dr. M. Chris Gibbons.

When the presentation turned to discussion, invited panelists offered their reaction. Rev. Frances "Toni" Draper, pastor of Freedom Temple A.M.E. Zion Church, said that "we need to acknowledge that racism exists and that there is racism within race."

Dr. Maria Trent, assistant professor of Pediatrics at the Johns Hopkins School of Medicine, reminded the crowd how difficult it can be to change behavior, but by not changing we continue to hurt ourselves as a nation.

"We're not able to complete globally because we haven't invested in our population like we should," she said.

Moving forward, Dr. Jones' hope is that we name racism when we see it, break out of our bubbles, embrace all children as our own children, and insist on inclusion and representation in decision-making.

View the symposium in its entirety.

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