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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Mari Armstrong-Hough, Louis Gregory, Yang Zhang, Alix Pose, Janneane Gent, Debbie Humphries, and Colette Matysiak
In the summer of 2015, the East Main Street branch of Optimus Health Care planned, developed, and initiated a quality improvement interven-tion for pediatric asthma care. The intervention consisted of a provider-designed EMR template to enhance asthma clinic visits, a new on-site spi-rometer, and new tools for patient and staff education. The objective was to support Optimus providers in their efforts to provide high quality, guideline-compliant care to their patients and thereby improve patient outcomes. A chart audit of 27 patient records conducted six months after the beginning of the project found high rates of compliance with two im-portant measures of quality asthma care: spirometer use (85% of charts) and documentation of an asthma action plan (96% of charts.)
Megan Carroll, Heather Ferguson, Monica Guo, Colette Matysiak, Debbie Humphries, and Jennifer Kertanis
Project used quantitative and qualitative data to describe the public health within the Farmington Valley Health District and identify community needs.
Chasmine Flax, Michael Perrin, Colette Matysiak, Debbie Humphries, Bonita Grubbs, and Merryl Easton
Project was to assess the availability of affordable housing in New Haven and understand the health effects of rent stress and homelessness.
Screening for Elder Abuse: Exploring the Acceptability of the Elder Abuse Suspicion Index to Law Enforcement Officers for Field Use
Elina Kurkurina, Sonam D. Lama, Brittany C. L. Lange, Erin Burk-Leaver, Joan Monin, and Debbie Humphries
National surveys conducted on community-dwelling older adults have reported the overall prevalence of elder abuse to be approximately 10% in the US.1 For every elder abuse case known to programs and agencies, an estimated 24 cases go unreported.2 Since the criminalization of elder abuse in the 1990's, law enforcement officers (LEOs) are in a unique position to detect and respond to elder abuse cases. Despite increased interaction between LEOs and elderly persons in the community, LEOs report significant knowledge gaps in responding to elder abuse cases.3,4 Currently, there are no known instruments used by LEOs to assess for risk of elder abuse. The Elder Abuse Suspicion Index (EASI),5 a screening tool previously validated for use by physicians in clinical settings, shows potential for use by officers. This report presents findings from a survey and interviews with LEOs and community advocates in the state of Connecticut exploring acceptability of the EASI as a law enforcement screening tool.
Identifying the Community Health Needs in the Yale New Haven Health System: Key Priorities, Barriers to Health, and Recommendations
Julia Anderson, Kathy Doan, Alexandra Hua, Maria Ma, Ema Tiburcio, Augusta Mueller, Carolyn Salsgiver, Kathy Carley-Spanier, Sarah Ali, Danya Keene, and Debbie Humphries
Bridgeport Hospital, Greenwich Hospital, and Yale-New Haven Hospital are nonprofit hospitals that are part of the Yale New Haven Health System (YNHHS). Table 1 outlines the towns covered by each hospital’s service delivery network.
In order for nonprofit hospitals to remain tax-exempt, they must comply with federal requirements to provide “community benefits,” as outlined in Section 9007 of the Affordable Care Act (ACA). One provision outlined in the ACA requires nonprofit hospitals to “give increased attention to working with others to determine community health needs and take action to meet those needs”. This requirement is fulfilled in part by the triennial completion of a Community Health Needs Assessment (CHNA) with community partners.
This report presents findings from the first stage of the second round of the community health improvement coalitions, which include all three YNHHS hospitals, CHNA: the key informant interviews. These interviews incorporate input from persons representing the broad community served by the hospitals, focusing on a range of public health issues relevant to the community at large. Input was gathered through an online survey of key informant perceptions surrounding community health.
Key informants comprised two groups: (1) Health and Human Service representatives and (2) Government and Community Leader representatives. This report outlines the top health issues and barriers to good health in the communities served as identified and prioritized by key informants, as well as suggestions they have to address these concerns.
Perceptions, Attitudes, and Behaviors of Active Transportation Among Key Stakeholders in Norwalk, CT
Courtney Choy, Luis E. Maldonado, Wilhelmenia Ross, Rui Ye, Alycia Santilli, Jennifer Grasso, Timothy Callahan, Theresa Argondezzi, Kaitlin Latham, and Debbie Humphries
To characterize the perceptions, attitudes, and behaviors surrounding active transportation among key stakeholders in Norwalk. Specifically, the project aimed to identify: 1. Social, physical, and financial barriers to walking and biking 2. Perceived importance and utility of bike lanes and sidewalks 3. Priority improvements to make the city more conducive to active transportation 4. The most important areas on which to educate the general public about active transportation
Gabrielle Daniels, Fkadu Gelaw, Brittany C. L. Lange, Colette Matysiak, Anji Yi, Catherine Zall, Jennifer Grasso, David Fiellin, and Debbie Humphries
Examines substance abuse at the New London Homeless Hospitality Center (NLHHC) and makes recommendations for safety and engagement for the Center regarding substance abuse.
Evaluating the Impact of Common Ground High School, Urban Farm, and Environmental Education Center on Student Health Behaviors and Outcomes
Cara Donovan, Joanne Fernandez, Shaylen Foley, Melody Kingsley, Morgan Pratte, Mengxin Christie Zhu, Joel Tolman, Sarah Ali, Debbie Humphries, and Jeannette Ickovics
Discusses how the curriculum and other factors of Common Ground High School affect the health behaviors of students attending the high school.
Senate Amusu, Stephanie Boegeman, Yosuke Kita, and Ugochi Ukegbu
Optimus, a Joint Commission accredited and a federally qualified healthcare center (FQHC), serves over 1200 pregnant women a year. Excessive Gestational Weight Gain (GWG) can lead to maternal health complications, including gestational diabetes, preeclampsia and increased risk for C-section. This study seeks to assess the prevalence and magnitude of GWG among Optimus clients, evaluate nutrition services available for pregnant women at Optimus, and identify approaches to enhancing pregnancy outcomes through optimum GWG that can be made available to Optimus clients.
Data on weight gain patterns, socio- demographic information, and health history for all pregnant women with clinic visits between 01/01/2013 and 12/31/2013 were extracted from the Optimus’ electronic medical records system. Trends in weight gain during each trimester were compared and analyzed by age, education, race/ethnicity, country of origin and language. Gaps in available nutrition services for pregnant women were determined through staff interviews and surveys.
Overall, the weight trends of the clients who used Optimus’ prenatal services in 2013 increased across the trimesters. There were no significant differences in weight gain between trimesters by all variables evaluated (age, education, race/ethnicity, country of origin and language). Teenage mothers had the lowest weights during each trimester of pregnancy while mothers with advanced maternal age had the highest average weights per trimester. On average, Black women had the highest weight from the first trimester and continued to do so throughout pregnancy. Women with only elementary or middle school education gained on average of 9.19lbs over the course of the three trimesters. This value is lower than the minimum that is recommended by the Institute of Medicine for any women in spite of their 3 BMI (11lbs). Results from the survey showed that Optimus’ staff consider cost, time and emotional barriers to be potential barriers to caring for pregnant women at Optimus.
Special educational nutrition services should be offered to women who represent the highest risk groups at Optimus (teenage mothers, mothers of advance maternal age, mothers with only middle school education or lower and also African American women). Optimus’ staff should account for cost, time and emotional barriers when designing nutritional and other support services for Optimus’ clients.
Meghan Angley, Moiuri Siddique, and Kimberly Vasquez
Medicaid family planning expansion programs have been shown to improve reproductive health outcomes and reduce unintended pregnancies. Connecticut implemented Medicaid Family Planning Expansion in March of 2012 with the intention of expanding access to family planning services and improving reproductive health outcomes. The aims of this study are to evaluate the effectiveness of the Medicaid Family Planning Expansion in reducing unintended pregnancies, estimate the funds saved to the state of Connecticut due to the expansion and to demonstrate that women will choose highly effective methods of contraception when cost is not a barrier.
Mathematical models developed by the Guttmacher Institute were adapted to estimate the number of pregnancies averted in the state based on patterns of contraceptive use in participants after enrolling in the program and contraceptive failure rates. The number of pregnancies averted was used to determine the state funds saved by reducing pregnancies that would have resulted in births covered by Medicaid. Multivariate logistic regression was used to examine predictors of using a highly effective method of contraception.
Complete data were available for 1,153 women enrolled in the Medicaid Family Planning Expansion program. Our calculations indicated that an estimated 84 unintended pregnancies were averted in this group between 2011 and 2013, with an estimated 31.2 unintended births averted and $324,379 saved to the state of Connecticut. Women enrolled in the expansion program were more likely to choose a highly effective method of contraception than women not enrolled (OR: 7.16, 95% CI: 5.76, 8.90).
Our results support the conclusion that when the barrier of cost is removed, women are more likely to choose highly effective methods of contraception, helping them to avoid unintended pregnancies. Our results suggest the need for continued funding of Medicaid Family Planning Expansion in Connecticut, and further research on barriers to enrollment in the program.
Printing is not supported at the primary Gallery Thumbnail page. Please first navigate to a specific Image before printing.