Practice Based Community Health Research Reports

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  An Exploration of Alternative Policing Models in Hamden, CT: Community Considerations and Feasibility

  Shannon Carter, Jacob Chen, Georgiana Esteves, and Mariko Rooks

  American community-police partnerships have over three decades of history. Recent social movements and high-profile police brutality cases have provided great impetus for municipalities to examine traditional policing practices. Study objectives include examining existing social work-police partnership models and crisis intervention programs, understanding the community’s unique safety needs, increasing community engagement by integrating feedback into future program planning and implementation, and determining associated costs and funding options for Hamden, CT.

  Our team conducted an environmental scan of current alternative policing models to identify options and develop a set of assessment criteria. This research informed focus groups, semi-structured interviews, and surveys with key stakeholders (ex: community leaders, police officers, residents impacted by policing changes) which were conducted virtually via snowball recruitment to identify perspectives on implementation. Participants were asked to evaluate and provide feedback on both existing Hamden Police Department practices and a range of current models. Transcribed qualitative data was analyzed for emergent themes regarding police perceptions, existing services, and model implementation recommendations. Quantitatively, a cost-benefit analysis was conducted using a potential outcomes framework to determine projected resource allocation.

  Alternative policing in the Town of Hamden is an existing emergent formation. Significant partnerships currently exist between Hamden Police Department officers and community health providers that can be expanded and standardized into a more comprehensive hybrid first response model. Currently unmet cost and staffing needs were identified as crucial to successful implementation, which we believe can be offset by a number of cost-reduction practices and funding sources such as federal and state grants.

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  Health and Social Impacts of the Covid-19 Pandemic on Uninsured Communities in the City of New Haven

  Eesha Dave, Betty Duran-Becerra, Alyssa Kim, Senyte Pierce, and Weixi Wu

  The Covid-19 pandemic has exacerbated the uninsured community’s already limited access to healthcare. In collaboration with the HAVEN Free Clinic, a mixed methods approach was used to conduct an initial pilot study to collect preliminary information on the impact of the Covid-19 pandemic on the health and social needs of the uninsured community in New Haven, CT. Qualitative semi-structured interviews were conducted with staff members from two partner community organizations, and an electronic survey that drew on existing Coronavirus impact instruments was administered to 36 uninsured New Haven residents in both English and Spanish. Results from the survey showed that a majority of participants experienced moderate to severe changes in family income, stress, and access to social support. Having no insurance was seen as the most prevalent barrier to medical and mental healthcare among participants. Additionally, healthcare, food, and financial assistance were identified as the top three resources needed by the survey respondents.

  The qualitative interviews supported the quantitative results as the predominant themes that were discussed included the exacerbation of existing disparities due to the pandemic and the increased burden on the community organizations as the trusted messengers of critical information. The interviews also provided insight not captured by the survey, such as the policies and residential status as barriers to resources among uninsured people who are also undocumented. The pilot study has assisted in creating recommendations for recruitment strategies to administer the survey at a larger scale. This community-based approach will help bridge the gap between local organizations and the needs of the uninsured population by helping organizations better prepare for future challenges. Subsequently, local organizations can use these data collection methods as a toolkit to assess the impacts of the pandemic in order to reevaluate, adjust, and improve services and outreach to this community.

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  Improving Care Pathway Access and Utilization in an HIV/AIDS Skilled Nursing Center in New Haven, CT

  Katherine Ho, Serena Ly, Christine Pham, and Chinenye Okafor

  Background: Individuals living with HIV/AIDS are at greater risk for developing chronic conditions, such as diabetes, cardiovascular diseases, hypertension, and cognitive impairment. These individuals are also more likely to present with complex social and mental health needs. Unstable housing, lack of transportation, unemployment, substance abuse, depression, anxiety, and other psychiatric disorders are disproportionately experienced by HIV/AIDS patients. The confluence of these conditions result in high usage of Emergency Department (ED) services for non-urgent needs.

  Methods: We conducted a preliminary landscape analysis to explore factors that influence patient access and adherence to care pathways. Medical records of 28 Leeway Residential Care Home (RCH) residents up to May 2021 were extracted and analyzed. Of these 28 residents, 12 were selected for participation in semi-structured, in-depth qualitative interviews. Additionally, 6 RCH staff members participated in qualitative interviews.

  Results: Staff support, barriers to care utilization, substance use treatment and management, community-building at Leeway, building resident self-efficacy, and navigating mental health and social needs were major themes that emerged from Leeway RCH staff and resident interviews. 89.3% of residents had at least one mental health condition diagnosis and 64.3% of residents had a history of substance use. The most common comorbidities among residents were neurological disorders (82.1%), complications of the lungs (64.3%), and cardiovascular disease (60.7%). The most common mental health conditions among residents were depression (46.4%), suicide (32.1%), and schizophrenia/schizoaffective disorder (28.6%). The highest number of ER visits per year among RCH residents was 22. The most common ER diagnoses were other, pain, and lung issues.

  Conclusion: Residents reported having medical and basic needs met through services at Leeway. Residents’ complex psychosocial and emotional needs as well as difficulties managing substance use could contribute to poor utilization of care pathways. Identifying and leveraging community assets to meet residents’ psychosocial and emotional needs and implementing peer-support and/or community health worker models to build resident self-efficacy could improve care pathway utilization.

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  From Tent City to Tiny House Villages: Exploring Non-traditional Transitional Housing Models for New Haven

  Anna Kapolka; Seema Doshi; John Park; Lakai Legg; Debbie Humphries , (Faculty Advisor); Mark Colville; and André Medeiros

  Homelessness is a pressing issue in New Haven and has worsened during the COVID-19 pandemic. In response, in the summer of 2020, Amistad Catholic Worker acted as a catalyst in establishing a tent encampment––Tent City––on unoccupied land along the West River in New Haven. This study aims to explore alternative models to transitional housing for Tent City through semi-structured interviews with seven representatives from established village-type housing models across the country, twelve New Haven stakeholders, and nine Tent City residents. Through qualitative rapid analysis, six main themes emerged: 1) There is a mismatch between the structure of New Haven’s shelter system and the realities of those it is meant to serve, 2) Tent encampments have existed in New Haven and will continue to exist for the foreseeable future, 3) New Haven made strides in improving the shelter system during the COVID-19 pandemic and should build on this momentum, 4) A city-sanctioned tent encampment or tiny house village will require supportive services, 5) A village model of housing is cost-effective, promotes harm reduction, and provides benefits that are absent from traditional shelter systems, and 6) Transitional village models are ultimately not the answer to homelessness; more low-income housing is.

  Given our findings, we recommend the following to the city of New Haven:
  1. Formally recognize and support Tent City as an immediate response to the reality of the shelter system.
  2. Phase out congregate shelters and learn from the experience with hotel shelters to make them accessible to a wider spectrum of people.
  3. Build a village model of housing, such as a tiny house village, that is transitional and targeted towards individuals who do not fit within New Haven’s shelter system. 4. Invest more resources in wrap-around supportive services to get people into housing and help them maintain their housing.
  5. Investing in low-income housing is key.

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  West Hartford-Bloomfield Health District Community Needs Assessment: A Mixed Methods Study Identifying COVID-19 Knowledge, Perceptions, and Health Disparities

  Yue Song, Paola Bojorquez-Ramirez, Esther Luo, Yinqiao Wang, and Sawsan Dabit

  Background: The West Hartford-Bloomfield Health District (WHBHD) is a regional health department serving the towns of West Hartford and Bloomfield in Connecticut. From February to April of 2020, elderly and Black residents accounted for 59% and 38% of COVID-19 related deaths, respectively. Since the district has not assessed community health needs previously and is interested in becoming accredited, a community needs assessment will serve as the first step in implementing effective and timely interventions to address needs, disparities, and misperceptions about the pandemic.

  Methods: A comprehensive survey was adapted from existing NIH COVID-19 research instruments. 779 responses were collected on the topics of community health and COVID-19 knowledge, practices and perceptions. Five semi-structured key informant interviews were conducted with faith-based organizations and local government leaders to corroborate findings from the survey. Quantitative analyses were performed via SAS and R, and qualitative data was summarized.

  Results: Demographic distributions significantly differed between West Hartford and Bloomfield in age, income, race, marital status and household size. While there were differences in community health problems, social/environmental problems, and health care barriers, both towns shared individual health problems and perceived certain populations as most underserved. Both towns have adequate COVID-19 knowledge regarding symptoms and transmissions, low perceived risk of infection, and positive attitude towards preventative actions and measures. There were significant differences in COVID-19 testing accessibility between towns (p = 0.002), with nearly double the proportion of West Hartford residents reporting difficulty accessing testing. COVID-19 vaccination status is also different between towns, with both reporting lack of available vaccines as the primary reason preventing or delaying vaccination.

  Conclusions: The mixed methods approach to conducting this community needs assessment has provided consequential preliminary findings that will be useful in refining the health district’s current and future responses to COVID-19 and other public health issues.

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  Reducing Lead Exposure: A Qualitative Exploration of Service Providers’ Experiences Working with Families

  Haley Case, Rebecca Schapiro, Debbie Humphries, and Marta Kostecki

  While childhood lead poisoning has been declining, it remains a persistent and preventable problem in Connecticut. The Connecticut Department of Public Health’s 2017 annual report on lead poisoning found that over 1600 children in the state had blood lead levels greater than 5 ug/dL. No level of lead in the blood of children is considered safe. Well-documented adverse health effects in children caused by lead exposure include damage to the brain and nervous system, slowed growth and development, learning and behavior problems, and hearing and speech problems. These problems can cause lower IQ, decreased ability to pay attention, and underperformance in school. In adults and children, high levels of exposure can result in neuropathy to the upper and lower extremities, especially the hands and feet, psychiatric symptoms, tremor, lead colic, nephropathies, hypertension, and anemia. Two regional lead treatment centers were established in Connecticut to provide additional guidance and assistance with clinical management to the families of lead poisoned children. One of these regional treatment centers is located at Yale New Haven Hospital in New Haven, the Connecticut city with the highest caseload. The Yale New Haven Lead Program and Regional Treatment Center offers a variety of services to support families and reduce childhood lead poisoning.

  The objective of the project is as follows:

  Identify strategies to strengthen the educational and outreach efforts of the Yale New Haven Lead Program and Regional Treatment Center, with attention to effective strategies used by service providers working with lead-affected families.

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  Identifying Mechanisms for Increased Recruitment of Marginalized Populations in Medication Assisted Treatment Programs

  Mariah Frank, Eva Graf, Steven Susana-Castillo, Casie DeRosier, Heidi Lubetkin, Antonia Caba, and Debbie Humphries

  In 2017, Connecticut’s death rate from opioid overdose death was twice the national rate. Women, sexual minorities, and transgender individuals are all particularly at risk for opioid use disorder and overdose death as the result of prescribing practices, minority stressors, and social and behavioral determinants. According to a study of sexual minorities and incarceration, 9.3% of men in prison, 6.2% of men in jail, 42.1% of women in prison, and 35.7% of women in jail self-identify as a sexual minority. In addition, according to the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality, 2% of respondents reported incarceration in the past year. Given how these populations are impacted by OUD and incarceration, it is crucial to tailor recruitment efforts for opioid treatment programs, such as Medication Assisted Treatment (MAT).

  Community Renewal Team (CRT) is Connecticut’s oldest and largest community action organization. After receiving a Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2018, CRT was enabled to implement a Medication Assisted Treatment (MAT) Program for individuals experiencing Opioid Use Disorder (OUD) through the use of Suboxone (buprenorphine). This program is predominantly targeted to recently incarcerated individuals, as well as women and sexual and gender minorities. CRT now seeks to increase the number of women, sexual minorities (lesbian, gay, and bisexual), and transgender individuals so that they represent 20%, 18%, and 4% of enrollees respectively. Given this increased risk of opioid addiction and the importance of recruiting these populations to MAT programs, CRT will use the findings and recommendations from this project to adjust current recruitment practices and implemented new ones in order to increase the recruitment of these populations to CRT MAT.

  The objectives of this project are as follows:

  1. Provide recommendations for recruitment strategies tailored to CRT MAT’s target populations. 2. Given research limitations during Covid-19, identify best practices in MAT website content and design based on MAT-PDOA grantees’ websites.

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  Documenting the Impact of a Food Pantry Program in Promoting Stability and Independence Among New Haven Residents

  Victoria Tran, Rucha Kandlur, Lakai Legg, Jakyung Lee, Debbie Humphries, Parmida Zarei, Bonita Grubbs, Nicole Smith, Mary Tyrrell, and Kelsey Hitchcock

  An estimated 22% of New Haven residents live with food insecurity. This means more than 1 in 5 residents of New Haven do not have enough food or enough money to buy food. Notably, issues of food insecurity disproportionately affect people of color and those of lower socioeconomic status, therefore exacerbating disparities in health issues related to food insecurity.2 Christian Community Action (CCA) is a local social service organization that provides housing, financial assistance, food, and other support services for low-income New Haven residents. Their food pantry program, which operates on an appointment-only basis, has regularly provided food to over 80 individuals and families in the New Haven area. CCA is interested in identifying areas for improvement to strengthen their service provision and are also collecting data to bolster their advocacy efforts.

  The objectives of this project are as follows:

  1. Assess satisfaction amongst users of a food pantry program in New Haven. 2. Develop a sustainable method for obtaining and incorporating feedback for quality improvement processes. 3. Strengthen understanding of how usage of CCA’s food pantry promotes stability and independence among food pantry users.

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  A Trauma-Informed Atmospheric Assessment for Food Assistance Programs

  Rachel Brase, Jane Dai, Alyssa Schneider, Steve Werlin, Rachel Ebling, Emily Pieper, and Debbie Humphries

  Downtown Evening Soup Kitchen (DESK) is a soup kitchen that provides daily suppers to individuals experiencing homelessness and/or food insecurity in New Haven, CT. DESK aims to provide services that promote health, community, and equity, but within the current framework of operation, guests who frequent DESK who have a history of trauma or ongoing experience with trauma may have unmet needs. Medical literature has established that trauma is more than an event, as it influences how an individual perceives and interacts with other people and other environments. However, there is little work on how Trauma-Informed Care model can be implemented in social service settings to transform spatial design and ultimately humanize and value the experiences of those who have experienced trauma. This project aimed to characterize how DESK can better serve its guests and identify best trauma-informed practices for carrying out its mission. Our team made recommendations rooted in trauma-informed spatial design that to address these concerns. Using Trauma-Informed Care to transform spatial design for food assistance programs is an innovative strategy for improving the quality and delivery of social services. The findings from this project will help DESK secure support from local and municipal stakeholders as it redefines itself as a model of trauma-informed care in food assistance programs.

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  Evaluating Behavioral Health Service Need for Sexual and Gender Minorities: A Community-Based Qualitative Study

  Antonia Caba, Joy Chen, Casey Chu, Alexandra Grimaldi, Abigail Raynor, Chris Cole, and John Pachankis

  The LGBTQ community experiences mental health challenges, such as anxiety, depression, and substance use disorders, at rates higher than heterosexual and cisgender counterparts. Given these disparities in mental health, it is crucial that the LGBTQ population has access to mental health services. However, LGBTQ individuals face barriers to accessing mental health care due to service affordability, availability, and/or lack of LGBT-inclusivity. A Place to Nourish your Health (APNH), formerly known as AIDS Project New Haven, has historically provided care to those in New Haven who live with HIV and AIDS. APNH is now seeking to re-define itself as an organization by expanding services to support those experiencing stigma related to gender identity, sexual orientation, addiction, and mental health. Thus, to aid APNH in their service expansion to stigmatized populations, we performed a qualitative community needs assessment in the greater New Haven area to inform where APNH’s priorities should lie in their expansion of services. Findings provided insight into the current mental health landscape of New Haven’s LGBTQ community and led to reccomendatios regarding APNH's expanion of behavoral health services.

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  Identifying Health Resources and Community Perceptions in the Greater New Haven Area

  Anthony Chui, Harry Hyunteh Kim, Lauren Kim, Uzma Amin, Augusta Mueller, Brita Roy, Emily Pieper, and Debbie Humphries

  As required by new laws of the Affordable Care Act, non-profit hospitals are required to produce a Community Health Needs Assessment (CHNA) on a triennial basis in order to receive Medicaid funding, among others. Identification of community health assets is now a requirement by the IRS, in order for the hospital to keep their non-profit status. Community asset mapping (CAM) is an important new component of the community health needs assessment required by the Affordable Care Act for non-profit hospitals. CAM allows these hospitals and the communities they serve to identify key fixtures in their communities that can be leveraged to promote better health and well-being, especially when external resources (e.g. grants) are not available. In partnership with Yale New Haven Health and UnitedWay 2-1-1, we compiled health assets from various towns and communities in the broad Connecticut region. They were classified into six broad areas of need. We conducted interviews with community leaders and residents from the Greater New Haven area, more specifically the West River neighborhood. We hoped to gather insight and perceptions of residents about health assets in their area. Lastly, we generated asset heat maps with GIS to visualize health asset service areas and possibly identify areas of need. Our project sought to expand upon the scope of the mandated CHNA to include community input. Outside of the list of health assets, we went a step further to try to identify possible areas of need based on low coverage by assets on the heat maps.

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  Characteristics of High-Risk Groups: Analysis of Norwalk Student Body Mass Index (BMI) Data

  Chandra Couzens, Marleen Jones-Pool, Elizabeth Raiff, Ryan Sutherland, Marina Marmolejo, Theresa Argondezzi, Kathleen O’Connor Duffany, and Debbie Humphries

  1 in 3 children in the United States is currently classified as overweight or obese, and this prevalence increases as age rises. Obesity varies by racial, environmental, ethnic and socioeconomic factors as well as genetic factors. Childhood obesity is more prevalent among African Americans, American Indians, and Mexican-Americans than in whites, as well as in lower income families.1 2 3 Connecticut has one of the lowest childhood obesity rates in the nation (~11%), yet Norwalk’s childhood obesity rate is well above this mark at 22%4. This project reflects a partnership between the Norwalk Health Department and Norwalk Public Schools to create a report on childhood obesity in Norwalk stratified by age, gender, race, and free and reduced-price lunch eligibility. The objectives of this project were to 1) Analyze BMI data to determine if disparities in obesity prevalence in Norwalk Public Schools exist by demographic characteristics and understand how trends in obesity prevalence have changed over time. 2) Conduct qualitative analyses to identify areas for improvement by both the Norwalk Health Department and the Norwalk Public School System.

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  Time Under the Curve: Assessing the Impact of Regional Lead Treatment Center Home Visit on the Length of Exposure in Lead Poisoned Children

  Diane Ma, Bethany Sanchez, Ayse Tuncel Bahar, Momoko Ishii, Marta Wilczynski, William Maher, and Debbie Humphries

  A high proportion of Connecticut residents are at risk of health effects due to lead exposure, especially children under the age of six. The Yale Regional Lead Treatment Center (YRLTC) assists families of children with blood lead levels (BLL) exceeding the Centers for Disease Control and Prevention (CDC) maximum BLL of 5 µg/dL. YRLTC incorporates home visits of lead-exposed children living in Southern Connecticut to mitigate lead poisoning by emphasizing public health initiatives and social work, rather than using a clinic-only approach. This project aimed to evaluate the merits of this new interdisciplinary approach and its tangible effects on health outcomes. Key informant interviews provided perspectives on the value and themes of home visits. Questions focused on physiological measures of lead poisoning and cognitive development, patient interactions during home visits as well as legal, and logistical challenges to lead abatement. The team also shadowed home visits in order to understand the intervention.

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  Community-Clinical Integration in the Connecticut Medicaid Context

  Sabrina Siddiqui, Kei Shao Tikkanen, Parmida Zarei, William Maher, Karen Siegel, and Debbie Humphries

  It is well established that interventions that address social determinants of health (SDHs) are an optimal strategy to improve health equity, however the efficacy of these interventions is limited by the challenges of addressing SDHs in clinical care. As a result, building linkages between clinical providers and community-based providers of social services, formally known as community-clinical integration, is crucial to helping vulnerable populations achieve holistic, long-term health. Our team employed a mixed-methods design to understand community-clinical integration in the Connecticut Medicaid context. We conducted a realist literature review to identify models of community-clinical integration throughout the United States. We supplemented our literature review with 7 semi-structured interviews with staff from federally qualified health centers to identify best practices for and barriers to integrating community-based services into clinical care. Using insights gained from our literature review and qualitative interviews, we provide a set of recommendations to improve community-clinical integration implementation for Medicaid enrolled children and families throughout Connecticut.

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  Exploring Barriers to Primary Care Utilization in Transition-Age Males in Southern Connecticut

  Arsalan Ahmed, Tyler Johnson, Sowmya Kuruganti, Abby Raynor, Brittany Stollar, Haeyoon Chang, Alix Pose, Justin Markowski, Nelly Angah, and Debbie Humphries

  Optimus Health Care is a Joint Commission accredited and a federally qualified health center (FQHC) in Southern Connecticut, which serves thousands of male transition-age-youth per year. Attrition among males moving from pediatric to adult primary care is a nationally recognized issue. Literature suggests that there are three key barriers to young men seeking care: (1) concerns about confidentiality; (2) embarrassment and discomfort about disclosing their concerns; and (3) concerns about cost and accessibility (location, limited open hours). Studies highlight the importance of examining demographic trends and establishing consensus among transition protocols. This study seeks to assess the prevalence and magnitude of the young male attrition problem and evaluate transition services available to Optimus patients. This project will focus on the population of male transition age youth (TAY, 18-21 years old) who live within the Southern Connecticut areas (Bridgeport and Stamford) who move from pediatric to adult primary care at any one of Optimus Health Care’s locations.

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  Filling in the Food Security Gaps: Examining The Farmers' Market System in Norwalk, Connecticut

  Sally Alsup, Raquel Davis, Jacqueline Tremblay, Tianzhou Hu, Haeyoon Chang, Theresa Argondezzi, Rafael Perez-Escamilla, and Debbie Humphries

  Farmers’ markets are seen as important venues for increasing access to nutritious food and mitigating chronic diseases. The 2016 Community Health Needs Assessment found chronic disease/obesity to be the primary health priority for the Greater Norwalk Region. In Norwalk, the prevalence of adult obesity reported in 2017 (22%) was significantly higher than the surrounding towns (11%). Farmers’ markets (FM) could be a potential approach to mitigating Norwalk’s chronic disease/obesity challenges through increasing access to nutritious food sources. While there are several small farmers’ markets held each summer in Norwalk, not much is known about the benefits and challenges of farmers’ market utilization in Norwalk from the perspectives of key stakeholders. The Norwalk Health Department hopes to increase farmers’ market usage as an approach to filling important food security gaps. The objectives of this study were as follows: Identify barriers and benefits of the Norwalk farmers’ market system from the perspective of consumers, farmers, and market managers in the Norwalk farmers’ market system, and increase community access to local, state, and federal resources.

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  Adapting Dietary Guidelines to Client-Centered Preferences at the Downtown Evening Soup Kitchen (DESK)

  Olivia Campbell, Jessica Liu, Dashni Sathasivam, Victoria Shirriff, Steve Werlin, Amelia Reese Masterson, Leah Ferrucci, Nicole Hood, and Debbie Humphries

  The Downtown Evening Soup Kitchen (DESK) in New Haven, Connecticut exists to serve individuals who are food insecure, through the provision of meals. A majority of DESK’s food is sourced through donations and federal programs. A significant portion of these donations are from Yale University Dining, where trays of food from the dining hall are delivered multiple times a week. Connecticut faces a 6.4 percent prevalence of households with low food security, exceeding the 5.2 percent national average (Coleman-Jensen, 2017). Meals served at soup kitchens tend to contain high levels of fat and low levels of fiber, vitamins, and minerals (Lyles et al., 2013; Sisson, 2011), contributing to malnutrition, obesity, high blood pressure, and many other chronic conditions (Sisson, 2011). Currently, there are no national guidelines to regulate the nutrition of meals served specifically at these institutions, allowing for the continued distribution of meals with insufficient nutritional value (Koh et al., 2015; Kourgialis et al., 2001). The objectives of this study were as follows: Conduct a nutritional assessment of the dinners served by DESK, establish effective principles for the DESK menu based on the 2015-2020 Dietary Guidelines for Americans, and incorporate client food preferences in menu adaptations.

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  Planned Parenthood - Evaluation of Childbirth Education Needs in Southern New England

  Amy Caplon, Hailey Jordan, Wan (Wendy) Wang, Sophie Wheelock, Anthony Yakely, Christina Bastida, Debbie Humphries, and Pierrette Silverman

  In Connecticut (CT) and Rhode Island (RI), staggering disparities exist in maternal and child health outcomes along racial, ethnic, and socioeconomic lines. Planned Parenthood of Southern New England (PPSNE) is a regional leader in sexual and reproductive health services, annually providing services to more than 70,000 clients across CT and RI. PPSNE seeks to expand its services to include childbirth and parenting educational programming to help address these disparities. Before offering these programs, it is crucial to assess the need for such programs among current PPSNE patients to appropriately implement them. The objectives of this study were as follows: Characterize preferences for timing and formatting of childbirth educational programs among current PPSNE clients in Southern New England, and characterize perceived gaps in childbirth education curricula and best practices in providing childbirth education to PPSNE clients and mine appropriate childbirth preparation program topics to meet needs.

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  Assessing Low-Income Community Members' Views on Food Access and Farmers' Markets in New Haven

  Hillary Chisholm, Joey Clingerman, Libby Didomizio, Janine Kara, Emmy Pieper, Jieqiong Zhou, Debbie Humphries, Rachel Perler, and Amelia Reese Masterson

  In 2004, CitySeed Inc. was formed to oversee and operate farmers’ markets (FMs) in New Haven. Since then, they have grown through a series of programs and incentives aimed at increasing availability of fresh fruits and vegetables (F&V) to all residents of New Haven. CitySeed has implemented the SNAP Double Value incentive program, which allows SNAP recipients to double the value of their purchases (i.e. $1 buys $2 worth of F&V) at FMs for up to $20. CitySeed has also implemented a SNAP customer Loyalty Program, Farmers Market Nutrition Coupon redemption, and F&V prescription program. With information from CitySeed and past studies in major cities that employed similar double-value programs, the authors focused on three primary objectives: Evaluate availability and accessibility of healthy food choices for low-income residents in New Haven, assess perspectives on barriers to CitySeed’s farmers’ markets among low-income community members, and recommend steps for CitySeed to tailor markets and programming to community needs and interests.

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  Public Health Implications of Evictions: Modeling the Costs for Landlords, Tenants, and Society

  Sam Levy, Madelynn Tice, Maria Sperduto, Ryan Yucha, Rachel Perler, Billy Huang, Debbie Humphries, and Jack Tsai

  In the United States, more than 13% of renters experience a formal or informal eviction in their lifetime. Forced moves contribute to a decline in job status, mental and physical health, material possessions, safety, social networks, housing aid, and neighborhood stability. Previous research has explored the risk factors, causes, and costs to those burdened by evictions. However, the costs of evictions incurred by all stakeholders involved in the process of evictions and homelessness remain largely unexplored. The homeownership rate in New Haven is less than 30%, and more than 52% of households are ‘cost-burdened,’ meaning more than 30% of income “is spent on housing costs associated with owning or renting a home.” Thus, this project set out to analyze the contributing burdens of costs within New Haven, Connecticut.

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  Yale New Haven Hospital - Regional Lead Treatment Center

  Cade McGovern, Natasha Wasim, Pooja Bollampally, Tammy Chen, Will Maher, Marta Wilczynski, Brianna Foley, Nicole Hood, and Debbie Humphries

  Lead exposure proves to be a preventable, but persistent problem in Connecticut because of varied barriers to effective prevention and treatment. Public health professionals serve diverse family situations and sociocultural circumstances to effectively navigate the complex web of political, medical, and social barriers to successful lead exposure treatment. Despite their wide swath of experience, limited resources and ever-changing circumstances limit the impact they are able to make. Partnering with the Yale Regional Lead Treatment Team allowed for further exploration of the experiences of patients that have experienced lead exposure and discovery of innovative ways to overcome the various political, medical, and social barriers.

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  Measuring & Mapping Mortality in the Elm City: Identifying and Addressing Health Inequities in New Haven with Years of Potential Life Lost (YPLL) and Other Health Determinants

  Natalie Olson, Wei Chang, Miranda Janvrin, Carolyn Park, Chengcheng Qiu, Brian Weeks, Brooke Logan, Byron Kennedy, Sheridan Finnie, and Debbie Humphries

  Population health in the City of New Haven, including health care access, health outcomes, and mortality, is influenced by socioeconomic disparities. These disparities exist on both the individual and neighborhood scale, and across demographics such as age, sex, race, and ethnicity. Continued analyses to understand these disparities is imperative to elucidate public health concerns and to design and to implement appropriate initiatives and interventions. The objectives of this study were as follows: To measure the leading causes of death, average life expectancy, and premature death in New Haven using mortality data and stratifying by key variables including age, sex, race, and ethnicity, and to characterize the relationships between mortality, geographic location, and other demographic variables.

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  Implementing an Effective Community-Based Advisory Board (CAB) at New Haven Farms

  Akshar Patel, Kendra Hanlon, Qingying Luo, Sheridan Finnie, Debbie Humphries, Marcella Nunez-Smith, and Laura Hansen

  New Haven has the second highest poverty and food insecurity rate in Connecticut. New Haven Farms (NHF) has been operating in the New Haven area since 2012, with a mission of using health promotion and community development programs to combat obesity, diabetes, and other diet-related diseases. NHF hopes to re-establish a community advisory board (CAB) to integrate community members into the organization to inform program development and strategy. The objectives of this study were as follows: Describe best practices for building an effective CAB within a community-based nonprofit organization, make relevant recommendations for restructuring the CAB, make recommendations for using community based best practices within a nonprofit.

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  Interfaith Approach to Elder Abuse: Developing a Screening Tool to Assist Faith Leaders Reporting of Elder Abuse

  Olayinka Agboola; Suraj Arshanapally; Haeyoon Chang; Erin Burk-Leaver , (Preceptor); Laura Snow , (Preceptor); Joan Monin , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Elina Kurkurina

  Background: Elder abuse is a complex public health issue that is receiving more media attention. The National Academies of Sciences defined elder abuse as either creating intentional harm or serious risk of harm towards a vulnerable elder, or the failure to satisfy the basic needs of an elder and protect them from harm (2002).Lachs and Pillemer (2004) reviewed the clinical and legal reports on elder abuse and have identified five main types: physical abuse, psychological abuse, sexual assault, material exploitation, and neglect. Previous research has demonstrated elders who have been abused to have higher rates of depression and chronic stress (Comijs et al., 1999), increased rates of post-traumatic stress disorder (Goldstein, 1996), increased helplessness, social isolation, and anxiety (Soloman, 1983; Booth, Bruno, and Marin, 1996), as well as decreased physical health outcomes (Lachs et al., 1998). Past research also demonstrates elders maintaining a strong relationship with their religious identity (Young and Dowling, 1987). Additionally, elders consider faith leaders at a high level of trust almost as important as the level of trust displayed toward their own family members (Daciuk, 2000).

  Main objectives: 1.) Provide basic information on elder abuse in Connecticut, 2.) Assess baseline knowledge and attitudes of elder abuse among faith leaders, 3.) Identify existing barriers that faith leaders may face when they suspect elder abuse, and 4.) Create a culturally relevant tool for faith leaders to detect elder abuse. Conclusion: The faith leader surveys and the semi-structured interview data collected on elder abuse detection and reporting and elder’s faith experiences in Southern Connecticut, respectively, is critical information to gain a deeper understanding of the complexity of elder justice. Future directions include pilot testing, reviewing, and eventually disseminating the Digital Detection Tool for Faith Leaders in Southern Connecticut to assist faith leaders in detecting and reporting elder abuse.

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  Yale New Haven Health Partnership Evaluation Pilot: Yale New Haven Hospital and Healthier Greater New Haven Partnership

  Majed Albache; Sara Chroniste; Xian Gu; Ang Li; Augusta Mueller , (Preceptor); Debbie Humphries , (Faculty Advisor); and Monica Guo , (TA)

  In 2010, new regulations associated with the Affordable Care Act mandated hospitals to demonstrate their involvement in community benefits programs to keep their tax-exempt status. This included implementation of a community needs assessment, a community health improvement plan (CHIP), and an evaluation of the implemented plan demonstrating efforts to meet the goals of the CHIP. The Healthier Greater New Haven Partnership is a coalition of more than sixty individuals and organizations working collaboratively within the Greater New Haven area to improve the health and quality of life in the community. The Partnership’s current CHIP is the result of a community health needs assessment conducted in 2015 and implemented in 2016. A CHIP outlines the priority health issues for a defined community, and how the issues will be addressed, including specific goals, strategies, measurable indicators (short and long-term), action steps and partners. The priority areas are Access to Care, Healthy Lifestyles and Mental Health and Substance Abuse.

  Conducting program evaluation is critical in obtaining feedback from the partnership which builds trust and specifies how the Partnership can improve. The majority of partnership members surveyed agreed that the partnership is diverse and functioning effectively and more than 90% believed that partnership is serving as a catalyst for positive change related to the health and well-being in the Greater New Haven area. There were areas identified for improvement, which will be implemented in the future as circumstances allow. The Data Dashboard is a necessary step in tracking the progress of the CHIP in the short- and long-term.