14th Annual Community Health Symposium at Stanford Medicine. Hosted by the Office of Community Health

5:30 Welcome Ulysses Rosas, SMS V, and Keon Pearson, SMS I 2016 Community Health Symposium Coordinators Lloyd Minor, MD Carl & Elizabeth Naumann Professorship for the Dean of the School of Medicine Professor of Otolaryngology-HNS and, by courtesy, of Neurobiology and of Bioengineering Community Health Service & Research Poster Session 6:15 Opening Remarks Mark Cullen, MD Director, Stanford Center for Population Health Sciences Professor of Medicine 6:20 Introduction of Oral Presenters Ulysses Rosas, SMS V 2016 Community Health Symposium Coordinator Oral Presentations Akhila Narla, SMS II Determining Feasibility of Correlating Geography with Health Risk Factors in Aboriginal Australia Nicole M. Rodriguez, MS Engaging Citizen Scientists in Community Health Advocacy (A Partnership with the Santa Clara County Public Health Department) 6:45 Outstanding Community Partner Awards Introduction by Rhonda McClinton-Brown, MPH Executive Director, Office of Community Health Latinas Contra Cancer, San Jose, CA Cecil Benitez, PhD, SMS II Stanford School of Medicine Student 6:50 Keynote Address: A Brief History of Our Time Introduction by Keon Pearson, SMS I 2016 Community Health Symposium Coordinator Travis Gayles, MD, PhD Chief Medical Officer of the D.C. Department of Health Chief of the Division of Sexually Transmitted Diseases and Tuberculosis 7:20 Concluding Remarks Charles G. Prober, MD Senior Associate Dean, Medical Education Professor of Pediatrics (Infectious Diseases) and of Microbiology and Immunology
5 30  Welcome Ulysses Rosas, SMS V, and Keon Pearson, SMS I 2016 Community Health Symposium Coordinators Lloyd Minor, MD C...
Travis Gayles, MD PhD Dr. Travis Gayles is the Chief Medical Officer of the Washington, D.C. Department of Health’s HIV/AIDS, Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Administration (HAHSTA) and Chief for the Division of Sexually Transmitted Diseases and Tuberculosis Control. He earned his BA in Public Policy Studies and African American Studies at Duke University. He then earned his Ph.D in Community Health and Health Policy and his M.D. at the University of Illinois, Urbana-Champaign. Dr. Gayles completed his residency in pediatrics at Northwestern University, and he completed an NIH-supported fellowship in Academic Pediatrics and Adolescent Medicine at Lurie Children’s Hospital of Chicago. While at Northwestern, he served as Director of the HIV Treatment and Prevention Program and as a faculty member at the Feinberg School of Medicine, at the Institute of Public Health and Medicine, and at DePaul University College of Health Sciences. In addition to his academic work, he is a former board member of the Illinois State Medical Society, the AMA Minority Affairs Consortium, the Gay and Lesbian Medical Association, and the Chicago House Social Services Agency.
Travis Gayles, MD PhD Dr. Travis Gayles is the Chief Medical Officer of the Washington, D.C. Department of Health   s HIV ...
Latinas Contra Cancer Latinas Contra Cancer is a 12 year old San Jose based agency maximizing impact through model programs, and critical partnerships focusing on the cancer burden in the low income, Spanish speaking and immigrant community. The agency addresses the cancer continuum from prevention to detection and treatment, patient support, survivorship to end of life. LCC works to: increase awareness through culturally and linguistically appropriate education; develop programs and best practices based on working in community; provide access to care for Latinos through screening and partnerships with healthcare providers; navigate patients and families through the cancer experience with on-site hospital services and psychosocial support; and work with researchers to increase Latino participation in research and clinical trials to learn more about causes and potential treatments. Ysabel Duron, Chief Executive Officer, Latinas Contra Cancer For more information, please visit their website: latinascontracancer.org Past Community Partner Award Recipients BAY AREA NUTRITION & PHYSICAL ACTIVITY COLLABORATIVE (BANPAC) COMMUNITY HEALTH PARTNERSHIP OF SANTA CLARA COUNTY COLLECTIVE ROOTS FAIR OAKS CLINIC OF THE SAN MATEO MEDICAL CENTER FULL CIRCLE FARMS INDIAN HEALTH CENTER OF SANTA CLARA VALLEY INNVISION SHELTER NETWORK: OPPORTUNITY SERVICES CENTER MAYVIEW COMMUNITY HEALTH CENTER NUESTRO CANTO DE SALUD OF EL CONCILIO OF SAN MATEO COUNTY PUENTE A LA SALUD COMUNITARIA, OAXACA MEXICO PUENTE DE LA COSTA SUR RAVENSWOOD CITY SCHOOL DISTRICT RAVENSWOOD FAMILY HEALTH CENTER REDWOOD CITY SCHOOL DISTRICT SAN MATEO COUNTY HEALTH DEPARTMENT SANTA CLARA PUBLIC HEALTH DEPARTMENT
Latinas Contra Cancer Latinas Contra Cancer is a 12 year old San Jose based agency maximizing impact through model program...
Poster Presentations
Poster Presentations
GROUP I: IMPROVING HEALTH CARE SERVICES, ACCESS, AND QUALITY 1. Million Veteran Program: Creating a Framework to Bring Precision Medicine and Customized Healthcare to All Americans Uzma Ahmed MD, Sara Moied MD, Jan Urbano MD, Rona M. Relova MD, Philip Tsao PhD Community Partner: Department of Veterans Health Administration and NIH Precision Medicine Initiative, Palo Alto, CA 2. American Indian Caregivers: Analysis of the California Health Interview Survey Layton Lamsam SMS and Akhila Narla SMS Community Partner: California Health Interview Survey 3. Impact of Psychiatric Hospitalization on Diabetic Care in Patients with Comorbid Serious Mental Illness Gopin Saini MBBS, Supria Gill PhD, Rona M. Relova MD, Lauren Drag PhD, Tina Lee MD, Sarah Yasmin MD Community Partner: Department of Veterans Health Administration, Palo Alto, CA 4. Efficacy Of A Smartphone Application In Improving Referral Adherence Rate Caroline Yu SMS, Jacinta Leyden SMS, Cariad Chester BS Community Partner: The Cardinal Free Clinics, Stanford, CA 5. A Qualitative Evaluation of Guardian Attitudes and Behaviors Towards School Readiness in San Mateo and Santa Clara County Jessica Steinberg MSc SMS, Paloma Marin SMS, Janine Bruce DrPH Community Partner: African American Community Service Agency, San Jose, CA 6. Patient Perceptions of Laboratory Follow-Up Services at San Francisco Bay Area Free Clinics: A Multi-Site Evaluation Kapil Gururangan SMS, Jane Shin, Divya Gopisetty BA, Yangyang Shi, Jacinta Leyden SMS, Daniel Leon SMS, Silvia Vaca SMS, Steven Lin MD Community Partner: The Cardinal Free Clinics, Stanford, CA 7. Mental Health Resources for Underinsured Patient Populations Nancy Nkansah PharmD MBA SMS and Jason Wong MD Community Partner: Samaritan House, San Mateo, CA
GROUP I  IMPROVING HEALTH CARE SERVICES, ACCESS, AND QUALITY 1.  Million Veteran Program  Creating a Framework to Bring Pr...
8. The Importance and Challenges of Expanding Non-Physician Provider Roles in Areas of Need Christine Chen and Aabed Meer MD Community Partner: Santa Clara Valley Medical Center, San Jose, CA and Stanford Hospital, Palo Alto, CA 9. Doctor Advice about Nicotine in the Context of E-cigarettes – Observational Content Analysis from an Online Digital Health Site Andrea Burbank MD, Cati Brown-Johnson PhD, Geoffrey W. Rutledge MD PhD, Judith J. Prochaska PhD MPH Community Partner: HealthTap, Palo Alto, CA 10. Assessing the Effectiveness of an Intervention on the Patient-ProviderComputer Relationship in a Low-income Primary Care Clinic Vy Tran and Jennifer Tong, MD Community Partner: Santa Clara Valley Medical Center, San Jose, CA 11. Perioperative Outcomes of Adolescents Undergoing Laparoscopic Sleeve Gastrectomy: A Single Center Experience Joshua D. Jaramillo SMS, Elizabeth Snyder MA, James K. Wall MD, Matias Bruzoni MD Community Partner: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA 12. Developing a Healthcare Transition Protocol For Children With Special Healthcare Needs for Santa Clara County California Children’s Services Maxwell Kligerman SMS Community Partner: Santa Clara County Department of Public Health (California Children's Services), San Jose, CA 13. The Effectiveness of a Multimodal Intervention to Increase Compliance of Colorectal Cancer Screening Tests in Federally Qualified Health Centers in Monterey County Jasmaine Williams PhD, Erick Lopez, Ilya Kim, Maximiliano Cuevas MD, Dale O'Brien MD Community Partner: Cancer Patients Alliance, Monterey, CA
8.  The Importance and Challenges of Expanding Non-Physician Provider Roles in Areas of Need Christine Chen and Aabed Meer...
GROUP II: PROMOTION OF HEALTH AWARENESS AND HEALTHCARE ACCESS THROUGH EDUCATION 14. Creating a Community-based, Tailored, Scalable Program to Improve Nutrition and Food Literacy for Latino Adults Meg M. Hauser MD MPA, Jylana Sheats PhD MPH, Cynthia Castro-Sweet PhD, Sandra Winter PhD MHA, Lisa Goldman Rosas PhD, Martha Gabaray BS, Maria Fernanda Garcia-Flemate, Abby King PhD Community Partner: JTS Northside Community Center, San Jose, CA 15. Exploratory Views from Job-Seeking Unemployed Tobacco Users in the Bay Area: A Photovoice Adaptation Project Anne Michalek, BS, Cati Brown-Johnson PhD, Judith J. Prochaska PhD MPH Community Partner: The San Francisco Employment Development Department, The Marin Employment Connection, and JobTrain 16. Understanding the Mental Health Needs and Concerns of Youth and Their Parents: An Exploratory Investigation Steven Adelsheim MD, Vicki Harrison, Brandon Ha, Aimee-Noelle Swanson, Kate Hardy PsyD Community Partner: BreakYoStigma, Palo Alto Unified School District, Asian Americans for Community Involvement, Palo Alto University, Ethnic and Cultural Communities Advisory Committee, Santa Clara County Behavioral Health, Chinese Health Initiative San Mateo County 17. Caring Contacts for Suicide Prevention: A Model for Post-hospitalization Support for Community Care and Crisis Intervention Settings Jihun Yeo, Matilda Stelzer MD, Labiba Shere BS, Lolade Kolade, Gopin Saini, MBBS Frederick Macrae MSW, Malathy Kuppuswamy MD, Tina Lee MD, Rona Relova MD, David Luxton PhD Community Partner: Palo Alto VA Hospital Career Training Center, Palo Alto, CA 18. CommunityFIT! Community Collaborations Between Ravenswood Family Health Center and Local Community Centers to Promote Health and WellBeing in East Palo Alto Veronica E. Manzo SMS and Rebecca Pinto PA-C Community Partner: Ravenswood Family Health Center, East Palo Alto, CA 19. Addressing Mental Health Needs in Community Settings: Development and Implementation of Wellness Programs Veronica Alvarez MSW, Cristina Cortez, Ryan Matlow PhD, John Rettger MD, PhD, Daryn Reicherter, Victor Carrion MD Community Partner: Aspire East Palo Alto Charter School, East Palo Alto, CA
GROUP II  PROMOTION OF HEALTH AWARENESS AND HEALTHCARE ACCESS THROUGH EDUCATION 14. Creating a Community-based, Tailored, ...
20. Developing a Novel Clinic Intervention to Reduce Substance Use Among Detained Youth Bonnie Halpern-Felsher PhD, Maria Roditis PhD, Anuradha Gorukanti MD, Arash Anoshiravani MD Community Partner: Santa Clara County Juvenile Custody Institutions, San Jose, CA 21. Engaging Citizen Scientists in Community Health Advocacy (A Partnership With the Santa Clara County Public Health Department) Nicole M. Rodriguez MS, Sandra J. Winter PhD, Bonnie Broderick MPH, Alisa Arce MPH, Andrea Flores BA, Abby C. King PhD Community Partner: Santa Clara County Public Health Department, San Jose, CA 22. Utilizing Emergency Department-Based Community Partnerships to Address Social Determinants of Health Alyssa Noll, Jordyn Irwin, Martine Madill, Jennifer Newberry MD, Ewen Wang MD Community Partner: Legal Aid Society of San Mateo County, Second Harvest Food Bank, and Single Stop 23. After Haiyan: Barriers to Health Care and Disaster Relief Deaf Community After the Typhoon Michael Nedelman SMS, Phil Delrosario BA, Noemi Pamintuan-Jara, Julieta Gabiola, MD Community Partner: Development and Accessibility Fund for the Deaf (DeAF) 24. The EARN-Health Trial Sanjay Basu, MD, PhD, Mark Cullen MD, David Rehkopf MD, Sepideh Modrek MD, Justin White PhD Community Partner: EARN, San Francisco, CA 25. Determining Feasibility of Correlating Geography with Health Risk Factors in Aboriginal Australia Akhila Narla SMS, Curtis Taylor, Michele Barry MD Community Partner: Parrngurr Community, Western Australia 26. Brain-Based Therapy and Trauma: A Culturally-Congruent Approach for Refugees in Jordan John Arden PhD, Rania Awaad MD;, Hala Fattah MD, Khaila Haddadin MFT, Bahar Hashemi MD, Rami Nsour MA, Saad Adnan Shakir MD Community Partner: Al-Alusi Foundation, Hayward, CA
20. Developing a Novel Clinic Intervention to Reduce Substance Use Among Detained Youth Bonnie Halpern-Felsher PhD, Maria ...
GROUP III: BUILDING CAPACITY LOCALLY AND GLOBALLY 27. LA Healthy Children: Educating Parents With Children Age 4-14 in LA County About Childhood Obesity Joel Hernandez, PA-S, Eva Rivas PA-S, Susan Sakugawa PA-S, Jared Chow PA-S, Dezeri Navarro PA-S, Joe Franceschi PA-S Community Partner: Los Reyes Clinica Medica, South Gate, CA 28. Creating and Implementing Low Literacy Cancer Education Materials: Bridging the Gap Lindsay E. Brown SMS, Veronica E. Manzo SMS, Sandra Luna-Fineman MD, Ami S. Bhatt MD Community Partner: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and Unidad Nacional de Oncologia Pediatrica (UNOP), Guatemala, Guatemala 29. Project IDEAL (Introductory Diabetes Education Assessment for Latinos) Joseph Pelej, PA-S, Whitney Porter, PA-S, Todd Brugos, PA-S, Mark Chan PA-S, Alana Smith-Heimer MPH, PA-S Community Partner: Marin Community Clinic Novato Health Center, Novato, CA 30. Say Ah!: A Pilot Program to Improve Dental Hygiene Practices and Access to Dental Care in the Underserved Adult Population Erin Carmody PA-S, RD, CNSC; Basharat Hussain PA-S; Joella Martinez PA-S; Kipley Pereles PA-S; Shawncey Rider PA-S; Geovanna Suarez PA-S Community Partner: The San Diego Dental Health Foundation, San Diego, CA 31. An Evaluation of a Tier 1 Yoga and Mindfulness Based School Curriculum to Promote Student Health and Wellness in an Underserved School District Travis Bradley MPP, Ryan Matlow PhD, John Rettger PhD, Katherine Espana BA, Jairo Velez BS, Sophia Schoenberg AA, Victor Carrion, M.D. Community Partner: Ravenswood City School District, East Palo Alto, CA 32. Health Education Initiative for Intimate Partner Violence (IPV) Survivors and their Families: A Community-Campus Partnership Hannah Karpel, Emily Stebbins, Jackie Maya-Silva, Maya Ragavan MD MPH Community Partner: Next Door Solutions to Domestic Violence, San Jose, CA
GROUP III  BUILDING CAPACITY LOCALLY AND GLOBALLY 27. LA Healthy Children  Educating Parents With Children Age 4-14 in LA ...
33. Implementing a Hepatitis B Screening and Vaccination Program at Mayview Community Health Center Paula Trepman SMS Community Partner: Mayview Community Health Center, Mountain View, CA 34. Building Educational Material to Engage Promotoras in President Obama’s Precision Medicine Initiative Cecil M. Benitez PhD SMS, Laura Fejerman MD, Ysabel Duron Community Partner: Latinas Contra Cancer, San Jose, CA 35. The Connected Horse-Equine Guided Support Research Project with Stanford University and the Stanford Red Barn Leadership ProgramWorkshops for People with Early Stage Dementia and their Care Partners Dolores Gallagher-Thompson PhD, Jacqueline Hartman, Elizabeth Landsverk MD, Nusha Askari PhD, Paula Hertel MSW, Nancy Schier Anselmo MGA, Elke Tekin Community Partner: Northern NV chapter of the Alzheimer's Association 36. Insights From a Lay Health Coach Assisting Patients with Cancer in Early Goals of Care Labiba Shere, Madhuri Agrawal MS, Arnold Milstein MD, Steven Asch MD, Manali Patel MD Community Partner: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
33. Implementing a Hepatitis B Screening and Vaccination Program at Mayview Community Health Center Paula Trepman SMS Comm...
Abstracts
Abstracts
GROUP I: IMPROVING HEALTH CARE SERVICES, ACCESS, AND QUALITY 1. Million Veteran Program: Creating a Framework to Bring Precision Medicine and Customized Healthcare to All Americans Uzma Ahmed MD, Sara Moied MD, Jan Urbano MD, Rona M. Relova MD, Philip Tsao PhD Community Partner: Department of Veterans Health Administration and NIH Precision Medicine Initiative, Palo Alto, CA The Department of Veterans Affairs’ (VA) Genomic Medicine Program, called the Million Veteran Program (MVP) is creating one of the world’s largest comprehensive medical databases, linking genetic, clinical, lifestyle and military-exposure information, with the goal of discovering the role of genes in health and disease. MVP shall provide researchers with the infrastructure for precision medicine initiative that shall move health care into an era of disease prevention and treatment that is tailored to individual patients on the basis of their genes and other essential factors. Participants donate blood, from which DNA is extracted, and fill out health surveys. They consent to having authorized researchers access their electronic health record, and to being re-contacted for future research. All information is kept secure and de-identified. Samples and data are coded to ensure patient confidentiality. To date, all-site enrollment is over 400,000. MVP is not hindered by tightly focused demographic sampling as the database has significant numbers of underserved minority populations. Also included are exceptionally elderly participants, ages 90 years or older. Genetic analyses and sequencing are underway in an effort to beta-test the utility of MVP datasets. Initial studies will investigate the genetic contributions of heart and kidney diseases, mental illness and substance abuse. MVP shall create the foundation of a sound data platform design and establish novel methods. The knowledge gained through MVP shall demonstrate a tangible impact on personalizing the health care that all Americans receive. 2. American Indian Caregivers: Analysis of the California Health Interview Survey Layton Lamsam SMS and Akhila Narla SMS Community Partner: California Health Interview Survey Health disparities have not been well documented between informal caregivers, who provide care for a family member or friend with an illness or disability, and non-caregivers in American Indian populations. In California, few of these caregivers are paid for their work and there are limited state-funded supportive services for caregivers (1). California has the largest American Indian population in the U.S., and the California Health Interview Survey (CHIS) is the largest continuous public health
GROUP I  IMPROVING HEALTH CARE SERVICES, ACCESS, AND QUALITY 1.  Million Veteran Program  Creating a Framework to Bring Pr...
survey that oversamples American Indians (2). Among those surveyed in the CHIS’s 2009 survey of informal caregivers, thirty-two percent of American Indians identified as caregivers and thirty-six percent lived in rural areas, which typically have fewer support services . The study found that the American Indian caregiver population is skewed toward young, healthy females. Regression analyses revealed statistically significant effects on delayed medical care (p<0.001) and delayed prescriptions (p<0.02) in American Indians serving as caregivers. Reinstatement and expansion of caregiver data collection in the CHIS would make it a valuable tool in longitudinally evaluating health programs that target American Indian caregivers in California. 3. Impact of Psychiatric Hospitalization on Diabetic Care in Patients with Comorbid Serious Mental Illness Gopin Saini MBBS, Supria Gill PhD, Rona M. Relova MD, Lauren Drag PhD, Tina Lee MD, Sarah Yasmin MD Community Partner: Department of Veterans Health Administration, Palo Alto, CA Individuals with serious mental illness (SMI) have an increased rate of diabetes, presumably due to atypical antipsychotics, sedentary lifestyles, and high calorie diets. Evidence also suggests that patients are less likely to receive standard diabetic care and HbA1c testing, leading to poor outcomes. We examined associations between inpatient mental health treatment, diabetic care, and HbA1c values in patients with SMI at the VA Palo Alto Hospital. Record reviews were conducted for patients who were admitted for psychiatric hospitalization from 2003-2007, with HbA1c levels documented within one year before and after their discharge. 311 patients who fulfilled inclusion criteria were divided in two categories based on preadmission HbA1c values: Population1 (HbA1c <6.5; N = 150) / Population2 (HbA1c >6.5; N=161). Predischarge and postdischarge HbA1c levels were compared. The population1 group showed an increase in HbA1c levels (M = .34); the population2 group showed a decrease (M = -.35), which is a significant group effect, t(234.60) = 4.19, p = 0.00. There was also significant correlation between length of inpatient stay and HbA1c difference scores for the Population2 group [r=-.19 (p=.02), but not the Population1 group. There was improvement in HbA1c levels and a positive impact of longer inpatient stay in Population2 compared to a Population1, suggesting that patients with active diabetic issues improved after psychiatric hospitalization. Providing effective treatment for one illness can complement the treatment of another illness, underscoring how essential interdisciplinary care is to improving health outcomes.
survey that oversamples American Indians  2 . Among those surveyed in the CHIS   s 2009 survey of informal caregivers, thi...
4. Efficacy Of A Smartphone Application In Improving Referral Adherence Rate Caroline Yu SMS, Jacinta Leyden SMS, Cariad Chester BS Community Partner: The Cardinal Free Clinics, Stanford, CA Background: Adherence to screening guidelines and having a long-term care provider have both been shown to improve healthcare outcomes. However, in at risk populations, knowledge about health maintenance is limited and adherence to referrals to long-term medical centers is less than 50%. Effective, simple, and generalizable interventions to improve referral adherence rates are needed. Objectives: To evaluate the effectiveness of a smartphone application in improving referral adherence. Methods and Approach: Patients greater than 18 years of age were recruited. The intervention group was provided with the smartphone application, Helm, and detailed instructions on how to use it. The control group went through the normal referral process. All participants received the same information on the benefits of having a long term care provider, as well as the importance of receiving regular health care screenings. The primary outcomes were whether or not patients followed through with the referral, as well as before and after survey data on their confidence to manage their health care. Results: Patients who used the Helm app had a significantly increased referral adherence of approximately 70% over a 8-week trial in a free clinic population, in contrast to the 45% referral adherence rate of the control group. Conclusions: Helm is a convenient and effective smartphone application that improves referral adherence and offers healthcare providers, especially those at transitional medical centers, a convenient and easy to use tool. 5. A Qualitative Evaluation of Guardian Attitudes and Behaviors Towards School Readiness in San Mateo and Santa Clara County Jessica Steinberg MSc SMS, Paloma Marin SMS, Janine Bruce DrPH Community Partner: African American Community Service Agency, San Jose, CA Background: School readiness by kindergarten predicts increased high school graduation, decreased juvenile arrest, and better health. Fewer than 30% of preschool age children in the US attend a high-quality early childhood education program. Insufficient school readiness disproportionately affects children from low-income families. Pediatricians have unique, nearly universal, access to children under five through annual well child visits, but remain an underused resource for school readiness interventions. Aim: To examine parental perceptions of school readiness, early childhood education and the role of parents and physicians in early childhood education through community based participatory research. Methods: Sixty-eight participants were recruited through snowball sampling and collaboration with key community stakeholders in Santa
4.  Efficacy Of A Smartphone Application In Improving Referral Adherence Rate Caroline Yu SMS, Jacinta Leyden SMS, Cariad ...
Clara and San Mateo County. All participants completed a 14-question survey and participated in one of twelve focus groups or three one-on-one interviews. Transcripts will be coded using an inductive iterative approach on Dedoose 6.7.12 software. Preliminary Results: Focus group participants were 37% Latinos, 34% Vietnamese, 25% African Americans, 3% multiracial and 1% Tongan. Most participants were low socioeconomic status with a household income below 200% of the Federal Poverty Line. Forty of the participants had completed less than a college degree. The preliminary findings demonstrate that parents are eager to prepare their children for kindergarten, but face several complex structural, emotional, educational, and financial barriers. A complete analysis will be completed this fall. 6. Patient Perceptions of Laboratory Follow-Up Services at San Francisco Bay Area Free Clinics: A Multi-Site Evaluation Kapil Gururangan SMS, Jane Shin, Divya Gopisetty BA, Yangyang Shi, Jacinta Leyden SMS, Daniel Leon SMS, Silvia Vaca SMS, Steven Lin MD Community Partner: The Cardinal Free Clinics, Stanford, CA Stanford students operate the Arbor and Pacific Free Clinics, which provide transitional medical care to underserved populations in the San Francisco Bay Area. We aimed to understand how perceptions of the quality of laboratory follow-up services might differ among the diverse groups that make up our patient population. We distributed surveys at both clinics to patients who received lab results within the past 12 months. We collected demographic information (i.e. gender, English literacy, ethnicity, age, and race), and asked patients to rate their satisfaction with lab follow-up and the quality of care (i.e. understanding of results, confidence in describing results themselves, and understanding one clear health goal) on a 7-point Likert scale. We recruited 14 patients at Arbor and 36 patients at Pacific (92% responded). Satisfaction with lab follow-up at Arbor and Pacific was 6.5±0.8 and 6.6±1.1, respectively (p=0.94). Follow-up quality at Arbor was 6.5±0.6, and 6.5±1.0 at Pacific (p=0.84). Gender, English literacy, ethnicity and age were not associated with significant differences in satisfaction or quality. However, non-white patients reported greater satisfaction than white patients (6.71±0.57 vs. 5.67±0.58, p<0.01), as well as higher quality of service (6.59±0.46 vs. 5.75±0.90, p<0.01). Patients expressed high levels of satisfaction with laboratory follow-up, and differences in satisfaction and quality were not associated with common barriers to effective medical care, such as literacy. Future studies to evaluate outcomes in these populations will be important to optimize lab follow-up services at free clinics.
Clara and San Mateo County. All participants completed a 14-question survey and participated in one of twelve focus groups...
7. Mental Health Resources for Underinsured Patient Populations Nancy Nkansah PharmD MBA SMS and Jason Wong MD Community Partner: Samaritan House, San Mateo, CA There is variability in the services provided by safety net clinics. Many of these clinics experience limited access to mental health services. Samaritan House is an example of a free clinic that actively collaborates with community partners and seeks out resources to extend its reach to provide high quality mental health care for its patients. The objective of this project was to compile a list of current mental health resources for patients, with cost information and type of service included. A convenience sample of patients were interviewed to assess preference for a paperbased or electronic format and to learn the type of telephone technology commonly utilized. Interviews (N=11) revealed that patients were happy with any form of information, but preferred a simple, information sparse, paper-based form. In addition, 8 of 11 patients used smart-phones, with all smart-phone users having an Android device. Most of the patients who used smart-phones did not personally use mobile applications or Internet plans. A paper-based mental health resource was created to satisfy this patient need. Further feedback will be collected on staff experience with the paper-based mental health resource and used to determine the extent to which an electronic database can be utilized to facilitate resource list updates for staff and patients. 8. The Importance and Challenges of Expanding Non-Physician Provider Roles in Areas of Need Christine Chen and Aabed Meer MD Community Partner: Santa Clara Valley Medical Center, San Jose, CA and Stanford Hospital, Palo Alto, CA Non-physician providers, such as PAs and NPs, play a growing role in ensuring quality of care for patients. The need is particularly pronounced in rural and underserved areas, where physician shortages lead to low health coverage for patients. As physician shortages continue to grow, it is critical to understand how NPPs may be able to contribute and to develop new ways for integrating NPPs into the healthcare team. Our research aims to explore ways to optimize the role of NPPs to provide highest quality of care for patients. We conducted an exhaustive literature review, focusing on key questions of how to improve patient quality of care in communities of need. We also developed a standardized questionnaire, which we have distributed to NPPs in various healthcare settings to assess various aspects of NPP dynamics. We identified primary care and surgical specialties as areas of greatest staffing need, and developed recommendations based on our literature review and surveys to create strategies for addressing those needs. While our research was carried out by surveying PAs/NPs in large hospital contexts, the recommendations from these findings can also be
7.  Mental Health Resources for Underinsured Patient Populations Nancy Nkansah PharmD MBA SMS and Jason Wong MD Community ...
meaningfully applied to other settings. Our goal is to craft a set of decisions that inform patient-centered health care decisions in a variety of contexts. 9. Doctor Advice about Nicotine in the Context of E-cigarettes – Observational Content Analysis from an Online Digital Health Site Andrea Burbank MD, Cati Brown-Johnson PhD, Geoffrey W. Rutledge MD PhD, Judith J. Prochaska PhD MPH Community Partner: HealthTap, Palo Alto, CA E-cigarettes (EC), a noncombustible form of nicotine delivery, have gained widespread community adoption. While patients have reported asking providers about this unregulated drug-delivery product, this advice was uncharacterized. We conducted a content analysis of US licensed doctors’ answers to anonymous patients’ questions concerning EC posted to a Bay Area digital health service, HealthTap, between 6/2010 - 6/2015. We thematically coded questions and answers and aggregated by doctor and specialty. We coded doctors’ attitude toward EC and nicotine as negative, positive, or neutral. We identified 512 patient questions with 748 answers from 368 doctors in 37 specialties. Most patients asked about EC safety (81%, 413/512). Nearly half of doctors were coded as negative toward EC overall (48%, 178/368), though 34% (126/368) preferred EC to cigarettes, and 22% (83/368) saw EC as an effective aid for quitting combustibles. Nearly half of doctors (44%) addressed nicotine, most stating it was unsafe (62%, 102/162) with 54% identifying adverse physiologic effects, 18% addiction, and 17% both while 10% did not explain why. Adverse physiologic effects included complications to pre-existing medical conditions, vasoconstriction, heart damage, impaired healing, stimulant effects, poisoning, and death. Specialties most concerned with nicotine were OB/GYN (40%, 4/10), pediatrics (31%, 9/29), surgery (30%, 10/33), and dentistry (28%, 8/29). Doctors’ views of EC highlighted concerns with nicotine. With rapid expansion of the EC market, nicotine may be a more effective regulatory criterion than multifaceted and ever-changing EC products. 10. Assessing the Effectiveness of an Intervention on the Patient-ProviderComputer Relationship in a Low-income Primary Care Clinic Vy Tran and Jennifer Tong, MD Community Partner: Santa Clara Valley Medical Center, San Jose, CA While the hospital adoption of comprehensive electronic health record (EHR) systems has increased more than eight-fold since the HITECH Act in 2009 (HHS, 2009), there has been little progress standardized training on computer use in the medical profession. While a skills-based model that integrates use of the EHR in patient-centered manner exists, it has yet been formally implemented and evaluated in a clinical setting and recent studies have proposed that training can help physicians optimize effective
meaningfully applied to other settings. Our goal is to craft a set of decisions that inform patient-centered health care d...
use of the EMR to overcome the interpersonal distancing, both verbally and non-verbally (Duke et al. 2013, Margalit et al. 2006). This research explores the effectiveness of an intervention on the Patient-ProviderComputer interaction in primary care. Pre and post- training patient surveys on satisfaction and provider behavior were collected and analyzed qualitatively using R-Deducer. Provider interviews were subsequently conducted and analyzed qualitatively using a grounded theory approach. The data suggests that while providers may feel increased satisfaction after the intervention, there was no statistical significance in patient satisfaction. Major findings indicate that a low-entitlement community is more likely to focus on the practical aspects of medicine (getting regular check ups, receiving medications, etc.) and have low expectations for the actual patient-provider interaction. Future research should conduct the study on different patients with higher SES patients and interview low SES patients to further understand their perception of the computer’s role in the primary care visit. 11. Perioperative Outcomes of Adolescents Undergoing Laparoscopic Sleeve Gastrectomy: A Single Center Experience Joshua D. Jaramillo SMS, Elizabeth Snyder MA, James K. Wall MD, Matias Bruzoni MD Community Partner: Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA Background. Obesity is a pervasive epidemic affecting more than one in every three adults and children in the United States and has a disproportionate impact on low income and minority communities. The success of bariatric surgery in the adult population has led to interest in surgical interventions in obese adolescences, yet it is still controversial. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for obese adolescences. To maximize the efficacy of LSG our patients participated in a multidisciplinary weight clinic including pediatricians, dieticians, psychiatrists, social workers, and pediatric surgeons. The aim of this study is to assess the efficacy of LSG in adolescent patients in the context of a multidisciplinary weight clinic. Methods. A retrospective study on obese adolescents that underwent LSG at our institution from 2010-2015. The primary outcomes were percent excess weight loss (%EWL) a year after surgery and resolution of comorbidities. Results. 26 patients, of whom 77% were female and 73% were Latino/African American/Native American, underwent LSG between 2010 and 2015. Mean age was 16.7 years, mean weight was 132.0 kg and mean BMI was 47.0. Mean %EWL was 18.8%, 27.1%, 33.5%, 44.1%, and 41.5% at 1.5, 3, 6, 9, and 12 month follow up visits, respectively. There was complete resolution of hypertension and hyperlipidemia. 5 out of 6 patients had a resolution of diabetes, while 1 decreased their HbA1c level.
use of the EMR to overcome the interpersonal distancing, both verbally and non-verbally  Duke et al. 2013, Margalit et al....
9 of 11 patients had resolution of OSA no longer requiring CPAP. Conclusion. LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. 12. Developing a Healthcare Transition Protocol For Children With Special Healthcare Needs for Santa Clara County California Children’s Services Maxwell Kligerman SMS Community Partner: Santa Clara County Department of Public Health (California Children's Services), San Jose, CA Approximately 750,000 Children with Special Healthcare Needs (CSHCN) in the United States transition to adult care annually. Although proper transitions are directly associated with improved healthcare outcomes, only 20% of CSHCN receive proper transitions. California Children’s’ Services (CCS) is a statewide program that offers treatment, case management, and physical therapy for CSHCN. Once the client turns 21, however, they are no longer eligible for the program and CCS coverage is discontinued. Santa Clara County (SCC) CCS serves approximately 5,500 clients annually, of which 15% are between the key transition age range of 18 and 21. As of spring 2015, there was no unified transition policy or guidelines in place for SCC CCS. I worked in conjunction with SCC CCS to identity the current transition needs and to help develop a new unified transition policy, transition protocol book, and accompanying informational materials for clients and their families. The new transition protocol includes informational packets for families, a transition class curriculum, and guidelines for social workers. We hope that this new policy and protocol will serve as a model for neighboring counties. 13. The Effectiveness of a Multimodal Intervention to Increase Compliance of Colorectal Cancer Screening Tests in Federally Qualified Health Centers in Monterey County Jasmaine Williams PhD, Erick Lopez, Ilya Kim, Maximiliano Cuevas MD, Dale O'Brien MD Community Partner: Cancer Patients Alliance, Monterey, CA Colorectal cancer (CRC) screening rates are low among vulnerable populations, and also low at Federally Qualified Health Centers (FQHCs). Studies have shown that outreach can improve CRC screening rates, but little is known about the effectiveness of multimodal intervention in priority populations at FQHCs. We sought to determine the efficacy of a multimodal approach to increase completion of CRC screening (using a fecal immunochemical test, or FIT) at four FQHCs of the Clinica de Salud del Valle de Salinas (CSVS) with high levels of priority populations. 90% of Salinas Valley residents are Latino; 92% of CSVS patients live below the poverty line. This study compared FIT completion rates during a two month
9 of 11 patients had resolution of OSA no longer requiring CPAP. Conclusion. LSG is an effective and safe method of treatm...
period utilizing the standard clinic approach prior to the intervention to FIT completion rates at the clinics during the two month period during and after the completion of the intervention in October 2015. The intervention included training of clinic staff, meetings with medical providers, written instructions to staff, identification of patient navigators to identify and counsel patients, navigators checking for FIT compliance two weeks after the kit was provided, then contacting non-compliant patients by telephone to encourage completion, and offer brief education and support. We found a 3-fold increase in completion rates from the pre-intervention period to the post-intervention period. Our study indicates that a careful multifaceted interaction in conjunction with medical providers and patients can dramatically improve colorectal cancer testing rates, even in difficult settings with vulnerable patient populations. GROUP II: PROMOTION OF HEALTH AWARENESS AND HEALTHCARE ACCESS THROUGH EDUCATION 14. Creating a Community-based, Tailored, Scalable Program to Improve Nutrition and Food Literacy for Latino Adults Michelle Hauser MD MPA, Jylana Sheats PhD MPH, Cynthia Castro Sweet PhD, Sandra Winter PhD MHA, Lisa Goldman Rosas PhD, Martha Gabaray BS, Maria Fernanda Garcia-Flemate, Abby King PhD Community Partner: JTS Northside Community Center, San Jose, CA Background: Older Latinos are at increased risk for poverty and foodinsecurity compared with non-Hispanic white older adults. These challenges increase the risk for obesity and limit access to healthful foods. Passive health education strategies have generally been ineffective for building skills needed to improve nutrition or food literacy. Objectives: Engage low-income Latinos aged 50+ in developing and testing an intervention utilizing mobile technology and interactive groups session to improve diet quality, food literacy, and access to food insecurity resources. Methods/Approach: We developed a tailored, community-engaged nutrition and food literacy intervention. Three community centers serving low-income Latinos were recruited from Santa Clara County, CA (N=96) and randomized to the intervention group or 2 comparison arms. Baseline, 6-, and 12-month surveys are used to measure outcomes (see objectives). Intervention center participants (N=32) were engaged as “citizen scientists” to use e-tablets to document their food environments though photos and audio narratives; this information was used to tailor a 12-month curriculum of group-based classes held at the center and out in the community. Relfections/Implications/Recommendations: The intervention is inprogress. Here, we highlight the PROCESS of creating an innovative curriculum and show that an iterative design process can be used to
period utilizing the standard clinic approach prior to the intervention to FIT completion rates at the clinics during the ...
develop a low-cost, community-based, nutrition and food literacy intervention for low-income Latino adults that utilizes culturally-targeted technology, and yields a scalable program that can be easily tailored to other settings. 15. Exploratory Views from Job-Seeking Unemployed Tobacco Users in the Bay Area: A Photovoice Adaptation Project Anne Michalek, BS, Cati Brown-Johnson PhD, Judith J. Prochaska PhD MPH Community Partner: The San Francisco Employment Development Department, The Marin Employment Connection, and JobTrain This project aimed to implement a Photovoice adaptation data collection method to inform an intervention for a community-based participatory research project focused on job-seeking unemployed tobacco users. Participants were recruited from three employment centers in the Bay Area. Participants consented to this project and were asked to take 27 photographs related to their use of tobacco and job-seeking for one week using a study-provided disposable camera. Prompts related to job-seeking and tobacco were provided for structure. Photo release consent forms were provided for taking photos of other people. Participants reviewed the photos and provided audio-record narratives. Eleven male participants ages 34-63 were enrolled from May 13th to October 2015. Three participants were veterans, only 2 had stable housing, and four participants had a criminal history. Participants were looking for driving (n=3), cooking (n=2), customer service agent (n=1), and agriculture (n=1) positions. One participant was looking for “any” position and one did not specify. / Six participants returned disposable cameras (total of 97 photos) and five have provided narratives to date. Themes of the photos include littered cigarette butts and packs (n=21), “no smoking” signs (n=17), jobsites (n=11) and pictures of people smoking cigarettes (n= 9). A total of 60 pictures were tobacco related. Narratives are still being collected and coded. Participants were enthusiastic about this project and it provided a platform for them to communicate their experiences, stories and views about their community related to tobacco and job-seeking. 16. Understanding the Mental Health Needs and Concerns of Youth and Their Parents: An Exploratory Investigation Steven Adelsheim MD, Vicki Harrison, Brandon Ha, Aimee-Noelle Swanson, Kate Hardy PsyD Community Partner: BreakYoStigma, Palo Alto Unified School District, Asian Americans for Community Involvement, Palo Alto University, Ethnic and Cultural Communities Advisory Committee, Santa Clara County Behavioral Health, Chinese Health Initiative San Mateo County During the 2014-2015 academic year, Palo Alto faced its second youth suicide cluster in five years. In response to this community crisis, with the
develop a low-cost, community-based, nutrition and food literacy intervention for low-income Latino adults that utilizes c...
consent of the Office of Community Health, the Stanford Psychiatry Department Spectrum grant awardees re-focused their community efforts to partner with other community members to address this complex situation. In collaboration with BreakYoStigma, the Palo Alto Unified School District (PAUSD), Asian Americans for Community Involvement, Palo Alto University, the HEARD Alliance, Project Safety Net and other community members, Stanford Psychiatry faculty, trainees, and staff mobilized a working group to jointly respond to this difficult community situation. This collaborative team worked together in a cultural framework to create discussions intended to break down stigma related to mental health, enhance family-teen communication, and educate community members about mental health symptoms/treatment and resiliency development. Through this collaboration, four community panels took place at PAUSD middle and high schools over a 6-month period on a range of mental health topics. The creation of this community network has also allowed for coordination of treatment services, family support programs, and school-based interventions in a non-duplicative, collaborative fashion. In addition, focus groups with local parents and teens targeting perceptions regarding the mental health issues and needs of the community took place on November 7th at the Stanford Department of Psychiatry. The results of these discussions will guide future efforts to improve support for local youth and family. 17. Caring Contacts for Suicide Prevention: A Model for Post-hospitalization Support for Community Care and Crisis Intervention Settings Jihun Yeo, Matilda Stelzer MD, Labiba Shere BS, Lolade Kolade, Gopin Saini, MBBS Frederick Macrae MSW, Malathy Kuppuswamy MD, Tina Lee MD, Rona Relova MD, David Luxton PhD Community Partner: Palo Alto VA Hospital Career Training Center, Palo Alto, CA ‘Caring Contacts’ is a suicide prevention program that aims to prevent suicidal behavior in high-risk populations by sending brief caring emails to patients following psychiatric hospitalizations. Preliminary findings suggest that caring contacts may increase patient resilience and reduce suicide mortality rates. This multi-site randomized controlled trial in-progress report demonstrates how this low-cost intervention could be very impactful to community health. At VA Palo Alto, 342 participants were randomized to Usual Care (UC) or Caring Letters (CL) groups. The CL-group (n=158) receives 13 brief emailed letters at regular intervals for two years; UC-group (n=184) does not receive emails. To date, 18 participants indicated acute distress and were reconnected to care through established safety protocols. For the CL-group, 12 participants had readmissions within two years compared to 39 participants in UC -group. There were 2 suicide attempts in CL-group compared to 11 in UC-group. The mean number of
consent of the Office of Community Health, the Stanford Psychiatry Department Spectrum grant awardees re-focused their com...
subsequent hospitalizations was lower for CL (2.33) compared to the UCgroup (3.56). There were 4 suicides in the UC- group and none in the CLgroup. The ‘Caring Contact’ model provides a blueprint for adjuvant support for high-risk patients during the post-discharge period. Caring contact expands the reach of therapeutic interventions beyond the clinics, facilitates engagement between healthcare providers and patients, allows a route to promptly reconnect patients to care and motivates coping skills. This simple intervention can be implemented in a variety of care and crisis support settings to improve community health. 18. CommunityFIT!: Community Collaborations Between Ravenswood Family Health Center and Local Community Centers to Promote Health and WellBeing in East Palo Alto Veronica E. Manzo SMS and Rebecca Pinto` PA-C Community Partner: Ravenswood Family Health Center, East Palo Alto, CA Ravenswood Family Health Center (RFHC) is a federally qualified health center headquartered in East Palo Alto, a low-income area of San Mateo County. The residents of San Mateo County suffer from numerous chronic conditions requiring major lifestyle interventions, with over 85% of adults exhibiting at least one cardiovascular risk factor such as diabetes, high blood pressure, or high cholesterol (San Mateo County Community Health Needs Assessments, 2013). About half (48%) of RFHC’s 13,420 patients are obese with a BMI greater than 30. The communities RFHC serves lack affordable and accessible resources/services that promote healthy physical activities. About 86% of RFHC’s patients come from households with incomes 100% below the federal poverty level, 41% are uninsured, and 59% are enrolled in public health coverage programs. East Palo Alto, where the majority of RFHC’s patients reside, has a history of crime. Community members have reported feeling unsafe walking and exercising in the community. The CommunityFIT! Project at Ravenswood Family Health Center (RFHC) was created to help address the barriers to health and fitness for its low-income, underserved patients. It is centered upon building collaborations with community organizations to help address promote health, neighborhood safety, and trust in the community. This involved conducting a needs assessment and establishing necessary collaborations with community organizations that would be able to offer the activities community members were interested in.
subsequent hospitalizations was lower for CL  2.33  compared to the UCgroup  3.56 . There were 4 suicides in the UC- group...
19. Addressing Mental Health Needs in Community Settings: Development and Implementation of Wellness Programs Veronica Alvarez MSW, Cristina Cortez, Ryan Matlow PhD, John Rettger MD, PhD, Daryn Reicherter, Victor Carrion MD Community Partner: Aspire East Palo Alto Charter School, East Palo Alto, CA Individuals served by agencies in historically under-resourced communities often face mental health challenges that prevent successful engagement and follow-through with agency services. Addressing mental health needs is therefore paramount for ensuring client and agency success and for improving client outcomes. This poster presents on a partnership to address mental health needs at two community agencies in East Palo Alto, a community historically impacted by disproportionate rates of poverty, unemployment, and trauma. Following needs assessment resulting in recommendations for developing mental health resources, a program of ‘Wellness Services’ was implemented at each of the partner agencies to address identified needs. The service model involves integration of a trained mental health professional (the ‘Wellness Educator’) focused on providing psycho-education, mental health consultation, and service linkage and coordination. Wellness Educators also develop and support programs and activities that promote client and staff wellness. Ongoing needs assessment and outcome monitoring research involves collection of quantitative and qualitative data to inform program development and maintain ongoing communication and collaboration among stakeholders. Results demonstrate that Wellness Services are feasible, are utilized, and are well-received by agency staff and clients; in particular, the integration of the Wellness Educator has resulted in increased agency capacity to address mental health needs and to promote client and staff wellness. Specific program activities, research findings, and future directions are discussed. 20. Developing a Novel Clinic Intervention to Reduce Substance Use Among Detained Youth Bonnie Halpern-Felsher PhD, Maria Roditis PhD, Anuradha Gorukanti MD, Arash Anoshiravani MD Community Partner: Santa Clara County Juvenile Custody Institutions, San Jose, CA Background: Youth in juvenile detention are much more likely than the general population to smoke tobacco products and use marijuana. However, there are few clinical interventions that focus on reducing and preventing substance use among this high-risk population. This project addresses this gap by utilizing a community-based participatory research approach to conduct a needs assessment among clinicians and youth in a juvenile detention center. Aims: (1) Determine the unique psychosocial, behavioral and environmental factors contributing to high rates of
19. Addressing Mental Health Needs in Community Settings  Development and Implementation of Wellness Programs Veronica Alv...
substance use among youth in the juvenile detention setting that can be applied to improving clinical care for these high-risk youth; and (2) Identify factors that facilitate and/or constrain the development and implementation of brief clinical tobacco and marijuana interventions for detained youth. Methods: A mixed methods approach consisting of surveys, interviews and focus groups to identify factors involved in tobacco and marijuana use among high-risk youth as well key intervention messages and strategies. Results: Collaboration with the justice system has taken time, but we have strong interest from the clinicians and other staff in the center. We will present results from our focus groups on factors influencing substance use and possible ways to improve clinical care and clinical intervention programs to reduce tobacco and marijuana use and couse among these high risk youth in detention centers. 21. Engaging Citizen Scientists in Community Health Advocacy (A Partnership With the Santa Clara County Public Health Department) Nicole M. Rodriguez MS, Sandra J. Winter PhD, Bonnie Broderick MPH, Alisa Arce MPH, Andrea Flores BA, Abby C. King PhD Community Partner: Santa Clara County Public Health Department, San Jose, CA Background: The environments in which we spend our time impact our ability to lead healthy lives. Multi-sectoral approaches to improve local environments are needed to support healthy communities. Objective: To utilize a technology-driven, community engaged approach involving a multi-sectoral team of: 1) community resident “citizen scientists”, 2) the Santa Clara County Public Health Department (SCCPHD), and 3) researchers from the SPRC to inform the development of healthier neighborhoods. Methods: A tablet-based environmental assessment application – the Discovery Tool – allows citizen scientists to document via photos and audio narratives features of their environment that affect healthy living. The team implemented Discovery Tool assessments in three sites in Gilroy, CA an elementary and middle school to inform a new Safe Routes to School program and a neighborhood park in a low-income area to determine barriers and facilitators to park usage – and at an open-streets event in San Jose to assess how this type of program affects physical activity. Outcomes: Following the assessments in the schools and parks, the team met to prioritize issues, brainstorm solutions, identify partners then advocate to policymakers for neighborhood change. Lessons learned are threefold. The “citizen scientists” developed community advocacy skills, the SCCPHD enhanced their existing research methods, and the researchers developed important collaborative partnerships. This approach harnesses the strengths of community resident citizen scientists, public health personnel, and researchers to address important population health issues.
substance use among youth in the juvenile detention setting that can be applied to improving clinical care for these high-...
22. Utilizing Emergency Department-Based Community Partnerships to Address Social Determinants of Health Alyssa Noll, Jordyn Irwin, Martine Madill, Jennifer Newberry MD, Ewen Wang MD Community Partner: Legal Aid Society of San Mateo County, Second Harvest Food Bank, and Single Stop The Emergency Department (ED) serves as societal healthcare safety net, caring for a disproportionately high number of society’s most vulnerable families. Although it is widely accepted that social determinants directly influence health, few patients are asked by physicians about non-medical needs impacting their well-being. We present a model for a Help Desk integrated into ED care. Undergraduate students are trained as health advocates. They conduct standardized screenings of patient social and legal needs - such as housing instability, food insecurity, and financial instability- and then connect patients with appropriate resources based on their identified needs using county-specific algorithms. Resources offered range from direct referrals to Bay Area community partner organizations, to social work, and to legal aid. Undergraduates conduct follow up phone calls to ensure that needs are met. From 2014 to 2015, the Help Desk screened 1242 patients in the Stanford ED. The majority of these patients (61%) screened positive for at least one need, and of these, 50% accepted an offered intervention. 46% of referred patients agreed to enroll in our follow-up program. We propose the Help Desk model as a sustainable paradigm addressing patients’ basic resource needs and potential health risks. Help Desks can be easily integrated into the clinical workflow so that social needs screening, assessment, and resource help can be made a regular part of clinical care. 23. After Haiyan: Barriers to Health Care and Disaster Relief Deaf Community After the Typhoon Michael Nedelman SMS, Phil Delrosario BA, Noemi Pamintuan-Jara, Julieta Gabiola, MD Community Partner: Development and Accessibility Fund for the Deaf (DeAF) Context: In November 2013, Typhoon Haiyan surpassed records for wind speeds, casualties, and displaced persons—leaving the Philippines in a state of national disaster. In the years following, advocates for the Deaf community have raised questions about how persons with disabilities may be disproportionately affected by the typhoon and the long-term recovery phase. The latter has not been well documented by mainstream media. Objective: To explore the needs of the Deaf community in accessing disaster relief, health care, and social services. Methods: We conducted filmed interviews with Deaf community advocates, healthcare professionals, government officials, and other community members in
22. Utilizing Emergency Department-Based Community Partnerships to Address Social Determinants of Health Alyssa Noll, Jord...
Tacloban, Philippines. Our interviews addressed the topics of communication with Deaf individuals, Filipino Deaf culture, the distribution of aid and health care, and individual narratives. / Results: We produced a short documentary covering the above topics. We included testimonies from twelve of those interviewed in a nine-minute film. The main themes identified were poor communication between Deaf and hearing people, the exclusion of Deaf individuals by the standard neighborhood-based distribution of aid, and the need for appropriate training of healthcare professionals. Relevance: Narrativizing gaps in disaster relief, communication, and other policies may lead to both a deeper understanding of factors that affect the health and recovery of Deaf individuals in low-resource and post-disaster settings. Furthermore, a documentary product can be used as an adjunct tool for training of medical and government personnel. 24. The EARN-Health Trial Sanjay Basu, MD, PhD, Mark Cullen MD, David Rehkopf MD, Sepideh Modrek MD, Justin White PhD Community Partner: EARN, San Francisco, CA Poverty and debt increase the risk of negative health behaviors such as tobacco smoking, as well as negative health outcomes, particularly mental health. We have partnered with the community-based Bay Area non-profit organization EARN.org, one of the country’s largest sponsors of Individual Development Accounts (IDAs)—no cost, no fee online savings and debt repayment programs that were created after the recent economic recession, and have been found to significantly reduce poverty and debt. By conducting a randomized, controlled trial of the EARN.org IDA system, we aim to test the hypothesis that participants in the EARN.org IDA account, as compared to a wait-listed control group, will experience improved scores on mental health scales assessing symptoms of major depression, anxiety, and stress; and that participants in the EARN.org IDA account, as compared to a wait-listed control group, will experience lower odds of harmful behaviors associated with poverty and debt, specifically tobacco use and alcohol abuse. In a 12-month trial of participants (N=215 to date) versus a wait-listed control group (N=215 to date), baseline month 0 surveys revealed low self-rated health (0.59 on a scale from 0 to 1, versus 0.72 nationwide), physical health (0.82 vs. 0.92 nationwide), mental health (0.80 vs. 0.89 nationwide), and higher smoking (31% vs. 18% nationwide) and unsafe drinking rates (25% vs. 17% nationwide). Month 6 surveys are underway, to which post-intervention surveys (month 12, 6 months after intervention) will be compared. Among this high-risk population, economic intervention may reduce secondary health risks.
Tacloban, Philippines. Our interviews addressed the topics of communication with Deaf individuals, Filipino Deaf culture, ...
25. Determining Feasibility of Correlating Geography with Health Risk Factors in Aboriginal Australia Akhila Narla SMS, Curtis Taylor, Michele Barry MD Community Partner: Parrngurr Community, Western Australia Indigenous people around the world experience some of the most drastic health disparities in comparison to other populations. The indigenous of Australia are part of targeted efforts from federal programs like “Close the Gap,” aiming to address the health inequities between aboriginal and nonaboriginal Australia. In Western Australia, responsibility has shifted from the federal to the state government to lead discussions with remote autonomous aboriginal communities, and the Western Australian government is proposing to close some of these communities. A literature review, gathering of publicly available data, and meetings with Australian researchers and community workers were conducted to assess the feasibility of gaining a more granular perspective of geographic differences in aboriginal health to inform policy. Nationalized surveys like the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIH) and the Australian Early Development Census (AEDC) aim to survey indigenous populations and explain health risk factors at the population level. These ecological surveys fall short of explaining health risk factors at the level of the individual, autonomous communities. For aboriginal communities in Western Australia, comparing health risk factors for remote and nonremote living members was not feasible due to their residential mobility and limitations of existing data. Future analyses would be better conducted through longitudinal, community-based fieldwork surveys or in collaboration with expanded census survey collections. 26. Brain-Based Therapy and Trauma: A Culturally-Congruent Approach for Refugees in Jordan John Arden PhD, Rania Awaad MD;, Hala Fattah MD, Khaila Haddadin MFT, Bahar Hashemi MD, Rami Nsour MA, Saad Adnan Shakir MD Community Partner: Al-Alusi Foundation, Hayward, CA By the fall of 2015, over 700,000 refugees have been registered with the UN in Jordan. Due to relentless war in the region, growing level of violence, traumatic experiences, and extreme deprivation in daily life, these refugees are re-traumatized on an ongoing basis. The authors present findings from an exploratory needs assessment trip to Jordan that took place in 10/14 and 3/15 that resulted in the development of a culturally congruent “train the trainers” curriculum for mental health workers who provide care to refugees in Jordan. A curriculum was developed to teach mental health aid workers and counselors how to use brain-based therapy with refugees who have been traumatized, plagued with anxiety, and depression. Special attention is paid to addressing the neurodynamics of trauma, PTSD, loss and depression. Great attention is paid to ensure cultural congruency of
25. Determining Feasibility of Correlating Geography with Health Risk Factors in Aboriginal Australia Akhila Narla SMS, Cu...
the training. A synthesized model of neuroscience, attachment theory and evidence-based treatment is employed to teach mental health aid workers how to more effectively treat refugees with PTSD. The findings suggest that traditional psychotherapeutic approaches with refugees fall short of meeting their mental health needs. On the other hand, recent advances in neuroscience have increased our knowledge of how people change and can be applied in a culturally congruent manner. Brain-based therapy synthesizes neuroscience, evidence-based treatment, psychotherapy research, and healthy practices into a hybrid therapeutic model. This model helps identify which elements of traditional psychotherapeutic schools are effective and which may be counter-therapeutic. GROUP III: BUILDING CAPACITY LOCALLY AND GLOBALLY 27. LA Healthy Children: Educating Parents With Children Age 4-14 in LA County About Childhood Obesity Joel Hernandez,PA-S, Eva Rivas PA-S, Susan Sakugawa PA-S, Jared Chow PAS, Dezeri Navarro PA-S, Joe Franceschi PA-S Community Partner: Los Reyes Clinica Medica, South Gate, CA Nationwide an estimated 15% of children are overweight. In South Gate, California where the majority of the population is Hispanic, the estimated percentage of overweight and obese children is 51.3%. The goal of this project was to reduce the prevalence of pediatric obesity among the 4-14 year old children in the South Gate community through a nutritional information session held at Los Reyes Clinica Medica. The main objective was to assess the parent’s knowledge of nutrition and obesity through a pre-workshop survey, then after the workshop, measured their gained knowledge via a post survey. During the workshop, parents were provided with information concerning BMI meaning, risks associated with obesity, importance of exercise, resources for exercise activities and healthy food options. Attendees were given a brochure to take home with healthy eating tips, healthy food choices and resources for exercise activities. The data was analyzed using a paired t-test. There was a significant increase in the amount of information regarding nutrition and obesity gained from both the session and the printed brochures. The results revealed that the session brought more awareness and education to parents and ultimately made a difference at the local level. Although the number of attendees was lower than our goal, we strongly believe that our work will provide a solid foundation for future group project implementation. We also think that hosting the workshop over the weekend or at a local community event such as a fair or farmers market would provide us with more attendees.
the training. A synthesized model of neuroscience, attachment theory and evidence-based treatment is employed to teach men...
28. Creating and Implementing Low Literacy Cancer Education Materials: Bridging the Gap Lindsay E. Brown SMS, Veronica E. Manzo SMS, Sandra Luna-Fineman MD, Ami S. Bhatt MD Community Partner: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and Unidad Nacional de Oncologia Pediatrica (UNOP), Guatemala, Guatemala Cancer care providers at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi identified a need for educational materials for their lowliterate patient population. No previous models exist of educational materials targeting low-literate cancer patients in sub-Saharan Africa. In June 2013, Global Oncology (GO), a non-profit community of professionals and students helping global partners alleviate suffering through providing quality cancer care, initiated the development of cancer educational materials for QECH’s low-literate patient population. To develop a clinically relevant and culturally appropriate product, GO partnered with THE MEME Design in Cambridge, MA, QECH, Partners In Health (PIH) in Rwanda, and consulted with health literacy experts in Boston and sub-Saharan Africa. In May 2014, GO completed the materials, available in English, Chichewe, and Kinyarwandan. Medical and public health graduate students assisted in quality improvement efforts at partner sites from July-September 2014. Focus groups were conducted among nurses at QECH and the distribution of booklets was evaluated at PIH’s Butaro Hospital. In Rwanda, the booklets are currently being used as a tool to teach patients about treatment and early evidence has suggested that they have facilitated conversations across the ward. Due to this response, translation to Spanish and a more thorough evaluation of materials is planned at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala for Summer 2016. Through this project, GO aims to improve clinical care, psychosocial support services, and patient adherence in resource-limited settings. 29. Project IDEAL (Introductory Diabetes Education Assessment for Latinos) Joseph Pelej, PA-S, Whitney Porter, PA-S, Todd Brugos, PA-S, Mark Chan PA-S, Alana Smith-Heimer MPH, PA-S Community Partner: Marin Community Clinic Novato Health Center, Novato, CA The Latino population of Marin County suffers from disproportionately high rates of type II diabetes due to lack of access to culturally competent health education and care. To address this gap in healthcare, several Marin-based community groups have implemented programs aimed at providing quality healthcare education to Spanish speaking patients. The present study examined the efficacy of using interactive group activities, provided in Spanish, to educate Marin County Latinos regarding diabetes prevention and care. To gain access to Marin County Latinos at high risk
28. Creating and Implementing Low Literacy Cancer Education Materials  Bridging the Gap Lindsay E. Brown SMS, Veronica E. ...
for or currently managing diabetes, project IDEAL (Introductory Diabetes Education Assessment for Latinos) partnered with Marin Community Clinic Novato Health Center. A culturally sensitive, Jeopardy-style game was presented in a group setting and participants completed pre and postsession surveys. The surveys were identical and consisted of 11 questions related to diabetes prevention and care. The pre and post survey scores were assessed, with the ultimate goal of the project being a group-wide improvement in score following the educational activity. Results showed that 100% of the 13 event participants had improved survey scores following the education session, with the <6 months diabetic participant showing the most dramatic improvement from a 3/11 to 10/11 score. Prediabetic participants showed the highest average final scores at 10.5/11. The culturally competent health education session improved short-term retention of diabetes education indicating that repeat sessions may improve long-term outcomes in diabetes management. 30. Say Ah! A Pilot Program to Improve Dental Hygiene Practices and Access to Dental Care in the Underserved Adult Population Erin Carmody PA-S, RD, CNSC; Basharat Hussain PA-S; Joella Martinez PA-S; Kipley Pereles PA-S; Shawncey Rider PA-S; Geovanna Suarez PA-S Community Partner: The San Diego Dental Health Foundation, San Diego, CA Background: Adults in the underserved communities of San Diego County lack access to dental care due to economic disadvantage and are unaware of basic oral health care practices due to a lack of education as well as cultural and language barriers. Objectives: The goals of this initiative were to improve patient knowledge of dental hygiene practices and their willingness to improve their individual habits by 50%. Methods/Approach: 100 underserved participants completed a pre-test evaluating their knowledge regarding appropriate dental hygiene and oral health care practices. Participants then viewed an educational video from the American Dental Association and completed a post-test to evaluate what they learned. All participants were provided with dental hygiene tools and referrals to dental clinics. Outcome: The average score on the pre and posttests were 76% and 91% respectively, with a score increase of 15.5% and an average increase in willingness to improve their habits by 10%. Reflections: Accommodations for the literacy status of participants need to be accounted for and inquiries regarding the dental insurance status of participants will need to be recorded upon follow up. Future Implications: Following up with the initial 100 participants to re-evaluate their current hygiene practices and dental visits as well as expanding the education program to additional clinic sites throughout San Diego County.
for or currently managing diabetes, project IDEAL  Introductory Diabetes Education Assessment for Latinos  partnered with ...
31. An Evaluation of a Tier 1 Yoga and Mindfulness Based School Curriculum to Promote Student Health and Wellness in an Underserved School District Travis Bradley MPP, Ryan Matlow PhD, John Rettger PhD, Katherine Espana BA, Jairo Velez BS, Sophia Schoenberg AA, Victor Carrion, M.D. Community Partner: Ravenswood City School District, East Palo Alto, CA This poster will present a mixed-method evaluation of a yoga- and mindfulness- based curriculum. The Sonima Foundation’s manualized Health and Wellness curriculum, which is currently being implemented in an underserved K-8 school district, provides comprehensive, experiential healthy lifestyle education, and teaches students a range of relaxation, stress management, mindfulness, and yoga-based techniques. The poster will provide an overview of the study population, and describe the research design and initial results from the longitudinal, multi-method evaluation. Baseline (pre-intervention) data, including measures of psychosocial and academic functioning, were collected from a sample of n=692 3rd and 5th graders, and a purposive sub-sample of n=35 5th graders completed additional assessments of cognitive functioning, cortisol levels, sleep architecture, and brain structure and functioning. 32. Health Education Initiative for Intimate Partner Violence (IPV) Survivors and their Families: A Community-Campus Partnership Hannah Karpel, Emily Stebbins, Jackie Maya-Silva, Maya Ragavan MD MPH Community Partner: Next Door Solutions to Domestic Violence, San Jose, CA Background: Intimate partner violence (IPV) affects the physical, emotional, and psychological health of survivors and their children, however to our knowledge no comprehensive health curriculum exists for survivors. Objectives: To design and implement a community driven, health education curriculum for women and their children living in a transitional housing center for survivors of IPV. Methods: Thirteen workshops developed by topic experts were implemented and evaluated at two shelters in the Bay area. Workshop topics included nutrition, exercise, and connecting with healthcare providers. Workshops were chosen based on a needs assessment of women at the shelter and reviewed to ensure IPV sensitivity. Interviews with facilitators and staff and focus groups with women were coded using thematic analysis. The community partner was involved in all phases of development, following community based research methodology. Results: All parties found the curriculum engaging and expressed interest in continuing the program and community-campus partnership. All partners additionally agreed to have trained undergraduate students teach the workshops in the future, reflecting participants’ desire to have facilitator continuity in order to build trust. The thematic analysis further suggested it was possible to facilitate a health workshop for a multilingual community. Conclusions: The community-engaged health
31. An Evaluation of a Tier 1 Yoga and Mindfulness Based School Curriculum to Promote Student Health and Wellness in an Un...
education curriculum was considered sustainable, IPV sensitive, and interactive for participants. Moving forward the research focuses on replicability and creating a long-term partnership between Stanford Medicine and the community. 33. Implementing a Hepatitis B Screening and Vaccination Program at Mayview Community Health Center Paula Trepman SMS Community Partner: Mayview Community Health Center, Mountain View, CA Hepatitis B virus continues to infect 40,000 Americans annually despite the existence of a safe and effective vaccine (Hepatitis B Foundation). Hepatitis B infection can cause chronic liver cirrhosis, liver failure, and hepatocellular carcinoma. Asian and Pacific Islanders (APIs) account for more than 50% of Americans living with chronic Hepatitis B, and diabetics have higher rates of Hepatitis B than the general population. Moreover, the majority of chronic Hepatitis B is caused by perinatal transmission. Mayview Community Health Center is a clinic serving a 10% Asian population, approximately 35% of patients are uninsured, and the clinic runs diabetes panel management and prenatal programs. Mayview Clinic is located in Santa Clara County, which encompasses 13.47% of Hepatitis B infection in the state. This project aims to examine the efficacy of a patient education program on screening and vaccination rates for Hepatitis B. This is being implemented in collaboration with the Stanford Asian Liver Center, Team HBV, the Santa Clara County Department of Public Health, and the Community Health Partnership via a multi-pronged approach: (1) presentation at clinic-wide meetings to all levels of staff (2) integration into patient visits, including regular follow-ups, diabetes panel management appointments, and prenatal classes and (3) informational mailings to highrisk patients. The program has been piloted to target Asian, diabetic, and prenatal care patients and is being evaluated via Hepatitis B screening and vaccination rates. 34. Building Educational Material to Engage Promotoras in President Obama’s Precision Medicine Initiative Cecil M. Benitez PhD SMS, Laura Fejerman MD, Ysabel Duron Community Partner: Latinas Contra Cancer, San Jose, CA On January 30, 2015, President Obama presented the Precision Medicine Initiative, an initiative aimed at promoting the advancement of medicine and clinical care by sequencing the genome of 1,000 individuals. This large number would increase the power of extracting information that could aid in targeted approaches to cancer treatments. In order for this information to be applicable to all race and ethnic groups, a diverse gene pool must be sequenced. Latinos tend to be underrepresented in clinical trials and in
education curriculum was considered sustainable, IPV sensitive, and interactive for participants. Moving forward the resea...
clinical research and are currently the largest minority group in the United States. Thus, the goal of this project was to create educational material relevant to the Precision Medicine Initiative targeted to promotoras, or community health workers by partnering with Latinas Contra Cancer a nonprofit organization. The educational material was designed for those with limited education and knowledge of topics such as genetics and clinical genomics and included interactive exercises and test questions. Future work will include translating this module into Spanish and testing the material with a subset of promotoras. 35. The Connected Horse-Equine Guided Support Research Project with Stanford University and the Stanford Red Barn Leadership ProgramWorkshops for People with Early Stage Dementia and their Care Partners Dolores Gallagher-Thompson PhD, Jacqueline Hartman, Elizabeth Landsverk MD, Nusha Askari PhD, Paula Hertel MSW, Nancy Schier Anselmo MGA, Elke Tekin Community Partner: Northern NV chapter of the Alzheimer's Association The purpose of this pilot project is to determine if equine-assisted workshops attended both by the person with dementia (PWD) and their care partner (CP) will improve communication between the dyad members, along with reducing symptoms of depression, stress (from living with and coping with this debilitation disease with no known cure at present), and social isolation. The workshops are led by Ms. Hartman and the Red Barn staff and emphasize activities with horses, discussion groups, and mindfulness practices. Activities with horses include observing herd behavior, grooming, leading horses through the arena, and connecting with them over the fence. Prior research has found that equine assisted programs such as this have improved function in persons with schizophrenia and autism. This is the first study to explore its value with PWD. It uses a pre-post design with an estimated N of 20 dyads and is currently ongoing. Results are expected by January 2016. 36. Insights From a Lay Health Coach Assisting Patients with Cancer in Early Goals of Care Labiba Shere, Madhuri Agrawal MS, Arnold Milstein MD, Steven Asch MD, Manali Patel MD Community Partner: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA Objectives: The Engagement of Patients with Advance Cancer program was designed as a lay health worker led early goals of care program focused on patients diagnosed with Stage 3 and 4 cancers. As the first program in the nation, below, describes important insights of the program pilot from the perspective of the health coach at the VA Palo Alto Health Care System. Methods: The health coach was trained in health communication through a
clinical research and are currently the largest minority group in the United States. Thus, the goal of this project was to...
four-week curriculum. It involved multimedia curriculum in the Education in Palliative and End-of-Life Care for Oncology program and participated in Stanford University’s Internet based Successful Aging program. The health coach spent greater than 100 hours observing and shadowing the hospice and palliative care teams at the VAPAHCS. Practical training involved employing methods learned, under proper supervision. Results: At the VAPAHCS, a total of 108 patients received the intervention. With each patient, the health coach spent on average 10 hours developing a rapport over a period of two months. By four months after enrollment, patients engaged in goals of care conversations and identified their surrogate decision makers. Reflection: The Engagement of Patients with Advance Cancer program represents an innovative way to deliver patient-centered care by a well-trained coach without medical professional training. Patients responded with overwhelming acceptance and appreciated the support. Important insights include that the health coach’s rapport allows for feasible integration into the existing oncology team and has a well-defined role that does not interfere with the workflow.
four-week curriculum. It involved multimedia curriculum in the Education in Palliative and End-of-Life Care for Oncology p...
-Lloyd Minor, MD Dean, School of Medicine
-Lloyd Minor, MD Dean, School of Medicine
THE OFFICE OF COMMUNITY HEALTH AND THE STANFORD CENTER FOR CLINICAL & TRANSLATIONAL RESEARCH & EDUCATION The mission of the Office of Community Health is to develop, implement and integrate education, research and clinical training programs aimed at building leaders in community health and improving the health of underserved populations. The purpose of the Office of Community Health is to identify and bridge the intersection between community-defined health needs and the School of Medicine’s mission of medical education, research, and patient care. Our priorities are to create and sustain meaningful partnerships with community-based agencies and not-for-profits and to build a cadre of physicians with the knowledge and skills to impact health at a population level. OCH.STANFORD.EDU The following Stanford-based programs support substantive student engagement in community health: Asian Liver Center Practice of Medicine Population Health Curriculum Scholarly Concentration in Community Health Center for Education in Family and Community Medicine Center of Excellence in Diversity Stanford Community Health Advocacy Program Stanford Pediatric Advocacy Program Stanford Prevention Research Center Valley Foundation Fellowship Program Haas Center for Public Service Special Thanks to Keynote Speaker, Travis Gayles, MD, PhD Dean Lloyd Minor, MD Senior Associate Dean Charles Prober, MD Director, Stanford Center for Population Health Sciences, Mark Cullen, MD Professor of Medicine, Emeritus, Marilyn Winkleby, PhD, MPH Symposium Coordinators, Ulysses Rosas, SMS V and Keon Pearson SMS I Photographer, James Pan, SMS II Pianist, Sheun Aluko, SMS I Medical Student and Undergraduate Student Volunteers Office of Community Health Rhonda McClinton-Brown, MPH • Jill Evans, MPH Nell Curran, MPH • Jorge De Luna, MPH Glenda Estioko • Evelyn Ho, MPH
THE OFFICE OF COMMUNITY HEALTH AND THE STANFORD CENTER FOR CLINICAL   TRANSLATIONAL RESEARCH   EDUCATION  The mission of t...