News

History and Health Consequences of Solitary Confinement

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                    [post_content] => Solitary confinement has been called “torture, pure and simple,” a “cruel and evil punishment,” and a “soul-crushing experience.” On the other side of the debate, its proponents describe it as a “necessary tool for corrections officers.”

Solitary confinement is a practice where prisoners are isolated as punishment for small or large infractions within the prison. Some are placed in solitary confinement after committing egregious crimes, such as the Boston Marathon bombing, and others for their own protection.

The practice began, in the United States, as an experiment in the early 1800s under the assumption that prisoners would use the time alone to repent their sins. But the results were much less positive than hoped for. Prisoners who experienced solitary confinement began to develop mental disorders, sometimes referred to as “prison psychosis.”
In 1890, the US Supreme Court recognized the dangers of solitary confinement, noting that “a considerable number of the prisoners fell, after even a short confinement, into a semi-fatuous condition.”  
In 1890, the US Supreme Court recognized the dangers of solitary confinement, noting that “a considerable number of the prisoners fell, after even a short confinement, into a semi-fatuous condition.” After this, prisons and jails slowly moved away from using solitary confinement. During the 1960s, prison administrators, once again, began using solitary confinement as a way of dealing with violence and overcrowding. After this, its use expanded greatly. Within 30 years, the “building boom” of supermax prisons designed specifically for isolation began. Today, nearly 20% of prisoners and 18% of jail inmates have spent time in solitary confinement. Some prisoners are at greater risk for forced isolation than others. Black prisoners are more likely to be placed in isolation than White prisoners. This disparity was noted as far back as 1843, when Dr. B.H. Coates wrote about it to the Philadelphia College of Physicians. He reported that, in one prison, there were seven Black prisoners in solitary confinement for every two White prisoners. Developmentally-delayed inmates and those who identify as lesbian, gay, or bisexual are also more likely to be placed in solitary confinement.
Developmentally-delayed inmates and those who identify as lesbian, gay, or bisexual are also more likely to be placed in solitary confinement.  
The detrimental impact of solitary confinement on mental health is well-documented. One study found prisoners who experienced isolation accounted for over half of the acts of self-harm in the New York City jail system despite only making up 7% of the prison population. Advocacy organizations like the Vera Institute of Justice and the California Innocence Project have called for the end of solitary confinement. Many have argued, for decades, that solitary confinement is a form of “cruel and unusual punishment,” violating the Eighth Amendment. Others have argued that the financial cost is far too great, estimating one year of solitary confinement at $78,000 per prisoner, which is three times more expensive than keeping an inmate in a general prison unit. Currently, Senate Bill 4784 which would restrict the use of “segregated confinement” in New York state and create alternatives to this punishment, is sitting in committee. Activists in New York are pushing their representatives to support the bill for humanitarian and financial reasons. Feature image: stocknroll/iStock [post_title] => History and Health Consequences of Solitary Confinement [post_excerpt] => Solitary confinement fell out of favor in the 1890s but expanded greatly after the 1960s. Some prisoners are more at risk of isolation than others, and the detrimental impact of solitary on mental health is well-documented. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => history-and-health-consequences-of-solitary-confinement [to_ping] => [pinged] => [post_modified] => 2018-11-19 06:46:01 [post_modified_gmt] => 2018-11-19 11:46:01 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5816 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Solitary confinement fell out of favor in the 1890s but expanded greatly after the 1960s. Some prisoners are more at risk of isolation than others, and the detrimental impact of solitary on mental health is well-documented.

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News

Mining and Mobile Units

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                    [post_content] => Coal workers’ pneumoconiosis, or “black lung,” is at its highest rate in over two decades. The resurgence of black lung—a scarring of the lungs due to airborne dust that’s inhaled—has been particularly apparent in the central Appalachian region that includes Kentucky, Virginia, and West Virginia.

Why are we seeing this increase in black lung, especially in Appalachia? In an interview with PHP, Cara Halldin, the supervisory program management officer for the Coal Workers’ Surveillance Program in Morgantown, West Virginia, mentioned several possibilities.

Mines in central Appalachia tend to be small. Research published by Halldin and colleagues found that miners who work in smaller mines (with less than 50 employees) have a greater chance of developing black lung than those who work in larger mines. Small mines tend to have fewer resources, fewer staff trained on safety precautions, and less advanced mining equipment.
Coal miners are breathing in more silica, which causes scarring in the lungs. In a recent study, miners reported cutting through rock that can contain between 5% and 100% silica.  
The other possible factor is the thin seams of type of coal formation being mined. Thick seams (layers) of coal have mostly been expended, leading companies to search for thinner seams to maintain production. These thinner seams are surrounded by sandstone, which has a high silica content. Coal miners are breathing in more silica, which causes scarring in the lungs. In a recent study, miners reported cutting through rock that can contain between 5% and 100% silica. The Coal Workers’ Health Surveillance Program was created in 1969 as part of the Federal Coal Mine Health and Safety Act. Its goal was to prevent coal miners from developing black lung. As part of the Enhanced Coal Workers’ Health Surveillance Program, the National Institute for Occupational Safety and Health (NIOSH) operates mobile units that provide coal miners with chest x-rays and breathing tests." Halldin described the mobile units as “large U-Hauls with a NIOSH sticker.” The mobile units also measure blood pressure. Research published in 2017 by Halldin and colleagues found that over 30% of miners had a blood pressure reading in the hypertensive range. Though black lung gets the most attention when it comes to coal miners’ health, it is just one of many health concerns. The mobile units have visited every coal mining region in the United States except for Alaska. According to Halldin, participation is lower in central Appalachia compared to other parts of the United States. To improve participation, the mobile units stop at local parks and Wal-Mart parking lots and they provide services both early and late in the day to accommodate miners’ work schedules. The goal is for miners to are able to access the tests they need in order to be properly informed about their health. Feature image courtesy of NIOSH Coal Workers' Health Surveillance Program [post_title] => Mining and Mobile Units [post_excerpt] => Coal miners’ “black lung” is at its highest rate in over two decades. Mobile units, created under a program of the Federal Coal Mine Health and Safety Act, provide miners with chest x-rays and breathing tests to monitor their health. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => mining-and-mobile-units [to_ping] => [pinged] => [post_modified] => 2018-11-13 03:53:26 [post_modified_gmt] => 2018-11-13 08:53:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5817 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Coal miners’ “black lung” is at its highest rate in over two decades. Mobile units, created under a program of the Federal Coal Mine Health and Safety Act, provide miners with chest x-rays and breathing tests to monitor their health.

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News

How Massachusetts Ballot Question 1 May Change Healthcare

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                    [post_content] => On November 6th, Massachusetts voters will decide on three ballot measures. Question 1 asks about establishing mandated patient assignment limits for registered nurses working in hospitals. If enacted, hospitals would need to have one to six registered nurses per patient based on the type of unit. In 2014, Massachusetts legislation enacted a similar law that requires one or two registered nurses per patient in the intensive care unit based on a patient acuity tool. Voters will have to decide whether a similar set of criteria for minimum staffing requirements should be expanded to all other inpatient units of a hospital.

Support for Minimum Staffing Limits

A primary argument in favor of the proposal is that it would reduce the workload of nurses, which may allow nurses to spend more time with patients and potentially improve care outcomes. A large body of research has shown that greater staffing levels are associated with lower rates of hospital-acquired infections, readmission rates, mortality rates, and better cardiac arrest survival. The ballot initiative has widespread support among nurses who say that patients they care for now are in worse health compared to ten years ago. Nurses also feel they have less time to spend preparing and educating patients for their discharge and explaining new medications. When considering how the change may influence care, it is helpful to look to California as an example. In 1999, the state passed a law requiring minimum nurse-to-patient staffing ratios. Hospitals appeared able to meet these goals without reductions in the overall skill mix among nurses. One estimate suggests the cost of implementing the law would range between $36 to $47 million, making it a relatively low-cost, high-benefit proposal.

Reasons Against Minimum Staffing Limits

An argument against minimum staff levels is that patient-centered care may be compromised, resulting in less autonomy in decision-making for staffing. The law, if passed, would require approximately 10,000 new nurses to be hired by January 1, 2019. This would be a challenge and raises the question of just how hospitals would find qualified nurses in less than two months. Two recent cost estimate studies showed the law would have a substantially large increase in cost of care ($676 to 949 million annually). The cost is significantly higher than the potential for savings ($34 to 47 million annually) and could inflate to 1.3 billion in the first year. While hospitals in California met the staffing goals, this may have been due to hospital and bed section closures. Given the penalty of $25,000 per day for Massachusetts hospitals not meeting staffing requirements, hospitals may opt to close units that cannot be sufficiently staffed. The changes are estimated to hit behavioral health care especially hard, with a possible loss of 1,000 beds. Further, wait times in the emergency department greatly increased in California due to nurses being “called-in” to staff units before new patients could be admitted. Research has shown higher staffing levels associated with better care, but, when California enacted the law, quality of care and patient safety indicators did not change. Likewise, improvement in mortality or complication rates were not seen when Massachusetts implemented mandatory staffing requirements of the intensive care units in 2016.

An important choice

While voters will make many important decisions this upcoming election day, it is important to consider what the future of hospital services in the state may look like in the coming years. The headlines may present Question 1 as a simple choice between nurses caring for patients pitted against hospital profits, but the question is complex with conflicting findings for both sides. Feature image: foto-ruhrgebiet/iStock [post_title] => How Massachusetts Ballot Question 1 May Change Healthcare [post_excerpt] => The headlines may present Q1 1 as a simple choice but the question is complex with conflicting findings for both sides. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-massachusetts-ballot-question-1-may-change-healthcare [to_ping] => [pinged] => [post_modified] => 2018-11-06 20:00:43 [post_modified_gmt] => 2018-11-07 01:00:43 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5774 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

The headlines may present Q1 1 as a simple choice but the question is complex with conflicting findings for both sides.

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News

Public Health Post Fellowship

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                    [post_content] => Public Health Post is an online forum that reaches out to policymakers, journalists, scholars, and students. We catalyze conversation on population health and health policy at a local, national, and global scale through good writing and social media.

Who should apply?

Students passionate about public health communication, journalism, social media, and change-making should apply for our fellowship.

What you will do as a fellow

PHP fellows translate data and research to communicate critical issues in public health and social justice. As part of high-functioning team, your primary responsibilities are to research and write content for PHP's website and newsletters, and create social media conversation on PHP's Twitter, FacebookInstagram, and LinkedIn. You will interview health leaders, travel to conferences, and participate in the Public Health Post start-up culture.

Stipend

Fellows will receive a $12,000 stipend for their year of participation.

Eligibility

You must be a Boston University student currently enrolled in a Masters program.

Application requirements

Email the following to Melissa Davenport, Managing Editor, at davenpor@bu.edu
  • Cover letter
  • Your resume
  • Writing sample 1: write a paragraph analyzing one article from the Public Health Post site, describing the strengths and weaknesses of the article, and how you might improve it
  • Writing sample 2: choose an original research study from any academic public health journal and summarize its importance in two sentences (include a link to the journal article)

Fellowship Info reception

Join us at our drop-in info session on Wednesday, September 26, 2018 5:00-6:00 pm, in Talbot 332W. Bring your questions, meet and chat with this year's PHP fellows and editors. Refreshments will be served!

Questions?

Email Melissa Davenport at davenpor@bu.edu!

Application deadline:

Monday, October 15, 2018, 12 midnight EST 

The deadline for the 2018 Public Health Post Fellowship has passed. The next PHP fellowship deadline will be in October 2019. The date will be announced in early September 2019. Thank you to everyone who applied!   [post_title] => Public Health Post Fellowship [post_excerpt] => Public Health Post reaches out to policymakers, journalists, scholars, and students to catalyze conversations on population health policy. Students passionate about public health communication, journalism, social media, and change-making should apply for the Public Health Post fellowship. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => public-health-post-fellowship [to_ping] => [pinged] => [post_modified] => 2018-10-29 18:04:22 [post_modified_gmt] => 2018-10-29 22:04:22 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_news&p=686 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Public Health Post reaches out to policymakers, journalists, scholars, and students to catalyze conversations on population health policy. Students passionate about public health communication, journalism, social media, and change-making should apply for the Public Health Post fellowship.

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News

The Monthly Shaming of Women in State Prisons

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                    [post_content] => When Arizona’s all-male House of Representatives heard House Bill 2222 on feminine hygiene products, Representative Jay Lawrence said “I’m almost sorry I heard the bill…I didn’t expect to hear about pads and tampons and the problems of periods.” Introduced by Rep. Athena Salman, Arizona House Bill 2222 allocates funds to provide women in state prisons with unlimited and free access to feminine hygiene products. Access to sanitary menstrual products is considered a basic human right in European prisons. Not so in the US.

The House Rules Committee’s discomfort around the subject matter of feminine hygiene and menstruation stalled the bill. This led to the #LetItFlow campaign, in which women sent envelopes stuffed with letters, donations, and pads to Rep. Lawrence’s office. The overwhelming response pushed the Arizona Department of Corrections to release a statement of immediate policy change regarding sanitary product allocation in prisons, as well as the (marginal) passing of House Bill 2222.

Lack of sanitary products in prisons results in humiliation. The shame women experience during their period is heightened among women incarcerated, who are vulnerable to inhumane treatment, and humiliation by correctional officers.
A 2017 Bureau of Prisons report cited many prisoners continue to experience irregular allocation of products, restrictions on availability of product type or size, or having to pay for products.  
Although federal prisons passed legislation in 2017 to provide free menstrual products, reports indicate that many prisons were failing to provide adequate supplies. A 2017 Bureau of Prisons report cited many prisoners continue to experience irregular allocation of products, restrictions on availability of product type or size, or having to pay for products. Furthermore, the federal legislation only reaches a small portion of women prisoners as 95% of incarcerated women are housed in local jails or state prisons. Therefore, the number of sanitary hygiene products provided to incarcerated women each month varies by state. Only four states and New York City have passed legislation granting access to free feminine hygiene products in prisons. Access for prisoners in state facilities across the rest of the US is limited. More than half of the women in New York state prisons report not getting enough pads per month. Female inmates in West Virginia state prisons cannot possess more than two boxes of tampons at a time. Inmates in Delaware have to ask guards for sanitary pads, and are only given up to six at a time. And tampons must be purchased.
Incarcerated women also face health risks, particularly when they are forced to improvise menstrual hygiene supplies, using toilet paper or maxi pads as tampons, or notebook paper to wipe themselves.  
Menstrual products provided in state prisons are often of poor quality or provide minimal protection. In turn, women are forced to ask guards for more, a subject often uncomfortable or difficult to broach given that 40% of guards in female state prisons are male. Prisoners have the option to purchase hygiene products from a commissary which are often unaffordable on their less-than-a-dollar hourly salary. Furthermore, female inmates often do not have the outside financial support that male prisoners have, making sanitary products rare commodities, and traded as bargaining chips. Incarcerated women also face health risks, particularly when they are forced to improvise menstrual hygiene supplies, using toilet paper or maxi pads as tampons, or notebook paper to wipe themselves. These unhygienic and abrasive substitutions can result in bacterial infections, toxic shock syndrome, sepsis, and even death. Prisons have historically  been constructed for men, producing a system built around gender biases. Structures from health care to jail use assessments tools have been designed to test individuals who are gender-neutral or for men, leaving women to suffer from harsher jail assessments and inadequate access to health care. According to the American Civil Liberties Union, the United States is the only democratic nation that fails to have an autonomous agency to assess conditions and enforce health and safety standards of prisons. Feature image: Floortje/iStock [post_title] => The Monthly Shaming of Women in State Prisons [post_excerpt] => Access to sanitary menstrual products is considered a basic human right in European prisons. Not so in the United States. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => sanitary-products-women-state-prisons [to_ping] => [pinged] => [post_modified] => 2018-09-05 09:04:45 [post_modified_gmt] => 2018-09-05 13:04:45 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5464 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Access to sanitary menstrual products is considered a basic human right in European prisons. Not so in the United States.

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News

Reimagining Pediatric Care

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                    [post_content] => Pediatric care has not changed significantly in the last century, despite evolving patterns of morbidity and mortality for children. Although social and environmental problems may influence a child’s health, pediatric visits are often too short to address such challenges. Efforts to redesign care have been stymied in part because traditional payment models, with focus on volume of services or short term cost savings, inhibit innovations that promote long term health. The Boston Medical Center (BMC) Pediatrics’ Center for the Urban Child and Healthy Family, launched in January 2017, is building a vision for child health equity. Our proposed “Pediatric Practice of the Future,” is based upon the premise that all children have an equal opportunity to be healthy, ready to learn, and able to achieve their full potential.

Since its inception in 1864, BMC, known until 1996 as Boston City Hospital, has sought to provide “exceptional care without exception,” serving patients from across the region facing significant adversity. The BMC Department of Pediatrics has always been a leader in care innovation and addressing social drivers of health. Programs such as Reach Out and Read, Health Leads, and the Medical Legal Partnership, which address root causes of health disparities, originated in BMC Pediatrics and have since become national models. With this important prior work as a foundation, the Center for the Urban Child and Healthy Family is supporting the development, testing, and scaling of novel health delivery approaches, working in concert with families, communities, and other sectors engaged in delivering services to children and families.

The Center’s methods include human-centered design, quality improvement, rigorous evaluation and tailored approaches to scale. A core element of the Center’s mission is to place families at the center of the redesign process, using their voices to innovate the current healthcare model. The Center is also building capacity to better measure and evaluate the impact of new and ongoing programs on patient wellbeing. Through these efforts, the Center expects to create better linkages between patients and the services they need.

Healthy and Ready to Learn by 5

To move toward radical redesign of pediatric care, the Center has a set a goal that, by 2028, all children cared for by BMC Pediatrics will be healthy and ready to learn, with adequate supports to thrive in school by age 5. Services provided for children in this age group will focus on optimizing children’s physical and emotional health, supporting stable and nurturing relationships with adults, and providing opportunities for high quality early education. Focusing on this formational time for growth and development creates opportunities to address family wellness holistically. It also encourages education and social service sectors to share accountability for the health and wellbeing of families.

Pediatric Practice of the Future

To date, two clinics at BMC, supported by the Center, are testing innovative approaches to pediatric primary care delivery. The Supporting Our Families through Addiction and Recovery (SOFAR) clinic is providing care to mothers affected by substance use disorder and their babies. The Individualized Education Plan (IEP) Clinic is strengthening the linkage between school and primary care by offering specialized developmental and behavioral care and referrals for children who need support tailored to their specific needs. Additionally, the Center has established a Pediatric Family Advisory Board to ensure that the care redesign process continues to be aligned with the mantra popularized by the disability rights movement, “nothing about us without us.” In deep collaboration with families, community partners, and BMC leadership, faculty and employees, the Center is reimagining what pediatric care might look like if families facing the most adversity are empowered to define their own health priorities and given access to the most innovative care. Feature image: mapodile/iStock [post_title] => Reimagining Pediatric Care [post_excerpt] => The Center for the Urban Child and Healthy Family is building a vision for child health equity, based on the premise that all children should be healthy and achieve their full potential. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => reimagining-pediatric-care [to_ping] => [pinged] => [post_modified] => 2018-08-31 05:43:44 [post_modified_gmt] => 2018-08-31 09:43:44 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5444 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

The Center for the Urban Child and Healthy Family is building a vision for child health equity, based on the premise that all children should be healthy and achieve their full potential.

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News

Medicaid for Idaho?

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                    [post_content] => Idaho is a deeply red state—one of the most conservative in the country. Yet Idahoans have a fierce independent streak and do not like being told what they can and cannot do. A group of activists has collected signatures to put Medicaid expansion on the state’s ballot this November. Voters should get to decide, they argue, rather than a small group of legislators in Boise. These activists are gambling that expansion will pass on a popular vote.

We recently chatted about Idaho’s ballot initiative with Daniel Nelson, one of the activist leaders. He told us the story of two friends, Luke Mayville and Garrett Stirizich, creating the Medicaid for Idaho campaign in March 2017. They saw a disconnect between voters and the legislature on Medicaid expansion. They purchased a 1977 camper van, painted it green, emblazoned it with the words “Medicaid for Idaho,” and drove off to learn the health care stories of Idahoans across the state. Nine months later, they were convinced there could be enough momentum for expansion and they began the daunting task of collecting signatures to get on the ballot.

Nelson is a medical student at the University of Michigan who is taking a break to do a master’s degree in public policy at the Harvard Kennedy School. On election night in 2017 he was intrigued by Maine’s public referendum to expand Medicaid and excited to hear reporters say that a team in his home state of Idaho was working to do the same there. He immediately reached out to Mayville and Stirizich’s Medicaid campaign, looking for a way to get involved. He was later brought on as a policy advisor.
They purchased a 1977 camper van, painted it green, emblazoned it with the words “Medicaid for Idaho,” and drove off to learn the health care stories of Idahoans across the state.  
“Being someone who cares passionately about his home state, it has been pretty exciting to be able to see our state moving towards something that I think will benefit every Idahoan, and I think that’s been extraordinarily rewarding,” Nelson says. “It has been amazing to hear stories from people who have been caught in the Medicaid gap and who have felt helpless realize that Medicaid expansion is the way out of that. One woman told me the story of her sister. She was diagnosed with cancer in the fall of 2015 and within weeks she died. Because Idaho hadn’t expanded Medicaid, her family had no idea how she was going to afford end-of-life care. Imagine trying to grieve over your sister, but instead you’re worrying whether your family can pay for treatment. That’s not a situation anyone should have to be in.” Should Idaho expand Medicaid, approximately 62,000 more Idahoans will have insurance, which Nelson says is “A great number off the bat, but this [initiative] provides risk protection that everyone in the state can enjoy. Everybody in Idaho who faces the risk of losing their job benefits from knowing that should that happen, they don’t have to worry about where they’re going to get their health insurance. Currently, that’s just not the case – people have to worry that they’re going to fall into the gap.” While expansion’s impact could be great, there is a long journey ahead, as a November vote is not necessarily the end of the line for this initiative. Maine’s governor, Paul LePage, has vetoed Medicaid expansion legislation six times and has refused to acknowledge the public referendum vote of 2017, despite a federal court order. However, Nelson is optimistic that the same thing will not happen in Idaho. Current governor Butch Otter is not running for re-election and both of the leading candidates have announced that they will uphold November’s vote, regardless of whether or not they support expansion. Even if the initiative passes and the new governor stays out of the way, the legislature could still intervene. “Come January, when the legislature is back in session, it’s possible that they could overrule the Medicaid expansion, could tamper with the law in whatever way they see fit, or add on additional requirements,” Nelson explains. “If we are able to show sufficient support for Medicaid expansion at the ballot box, it will be a huge political risk for the legislature to oppose it strongly.” Although polls show that 61% of the state is in support of the initiative, “there is still a lot of feeling in the state that people would rather not have the government involved in health care,” Nelson explained. Additionally, the legislature is arguably more conservative than the population, given the rules around the primary and who turns out to vote. Regardless, the campaign remains optimistic. Whatever happens, it is clear that the ballot initiative process has allowed Idahoans to share their health coverage stories. Voters in Nebraska and Utah will have the same choice about Medicaid expansion in November. Expansion in these three conservative states would provide a fascinating counter-narrative to Republican efforts to repeal and replace the Affordable Care Act. It could also serve as a tipping point in the remaining 14 states that have not expanded Mediciaid and help the nearly two million people gain health insurance. Quotes have been lightly edited for brevity and clarity. Photo by Luke Mayville. [post_title] => Medicaid for Idaho? [post_excerpt] => A group of activists has collected signatures to put Medicaid expansion on the Idaho ballot this November. Idaho is a deeply red state, but they hope expansion will pass on a popular vote. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => medicaid-for-idaho [to_ping] => [pinged] => [post_modified] => 2018-07-24 14:34:55 [post_modified_gmt] => 2018-07-24 18:34:55 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=5331 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

A group of activists has collected signatures to put Medicaid expansion on the Idaho ballot this November. Idaho is a deeply red state, but they hope expansion will pass on a popular vote.

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News

Measuring Social Recovery in Burn Survivors

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                    [post_content] => Treatment for burn injuries has improved over the past few decades, allowing more burn survivors to thrive. In addition to physical changes, burn survivors encounter changes in their social lives. The physical and emotional trauma of the injury may shape interactions with loved ones or strangers, at work or in the community. The social component of burn recovery is of great interest to clinicians and public health researchers. But the research community has not developed tools to describe, measure, and track changes in relationships or more general social comfort and acceptance.

To fill this gap in the “toolkit” for supporting burn survivors, our team has developed the Life Impact Burn Recovery Evaluation (LIBRE) Profile. This project is a collaboration between burn survivor advocates, researchers, and clinicians at the Phoenix Society for Burn Survivors; the Boston-Harvard Burn Injury Model System (BH BIMS), a program at Spaulding Rehabilitation Hospital and Massachusetts General Hospital; and Boston University School of Public Health. The LIBRE Profile tracks burn recovery and social participation with the goal of improving rehabilitation efforts and identifying areas where additional support is needed.

Two women, one with a burn injury on her face and arm, smiling with their arm around one another

Amy Acton, President of the Phoenix Society, has described the LIBRE Profile as a self-assessment tool that “asks questions in areas of our life that we may have challenges with when we return to our community.” It includes questions in six domains that burn survivors, clinicians, and medical support team members identified as important: 1) relationships with family and friends, 2) social activities, 3) social interactions, 4) work and employment, 5) romantic relationships, and 6) sexual relationships.

“This would have been an amazing questionnaire had I been able to do it closer to my burn injury,’” says Karen Collagen describing taking the LIBRE Profile in a video about the project. “I would be able to see the shift…between where I was and where I am. And that would mean that it would give me more hope.”  The LIBRE Profile offers an entry point to a conversation between a burn survivor and his or her care team about that individual’s strengths and needs. It also opens up opportunities to assess community needs, connect survivors with appropriate resources, or evaluate the effectiveness of an intervention such as a support group.

Man and a woman with a burn injury embracing

The LIBRE Profile is delivered as a computerized adaptive test (CAT), similar to the technology used for educational tests like the Graduate Record Examination (GRE), with 126 questions organized by difficulty. Based on the burn survivor’s response, the computer chooses the next question that will provide the most information about that person’s abilities. If someone answers positively, the next question will increase in difficulty and vice versa. The computer can calculate a score after asking 5-10 questions per domain. It is possible to get a precise score without requiring someone to answer the full list of questions.

Burn survivors and clinical experts shaped domain content, wording of questions, and plans for releasing the final tool. Burn survivors and clinicians from around the country have given critical input to make the tool relevant and usable. The LIBRE Profile will move to wider use over the next year. For example, the Boston-Harvard Burn Injury Model System recently began a project to track burn survivors’ LIBRE Profile scores over time.

Acknowledgement

The web-based platform for the LIBRE Profile CAT was developed by the BU Software & Application Innovation Lab (SAIL) at the Hariri Institute for Computing. For updates, visit the team’s website or connect on Facebook or Twitter. The LIBRE Profile is funded by the National Institute on Disability and Rehabilitation Research.

Images courtesy of the Phoenix Society for Burn Survivors.
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The social component of burn recovery is of great interest to clinicians and public health researchers. The LIBRE Profile tracks burn recovery and social participation with the goal of improving rehabilitation efforts and identifying areas where additional support is needed.

...more
News

Chelsea Police Create a Culture of Health

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                    [post_content] => Take a sharp right onto Fourth Street off of Boston’s Tobin Bridge going north, and you’ll immediately find yourself in Chelsea, sandwiched between a tight row of houses. If you drive up a few streets to Broadway you’ll soon see people crowding the sidewalks, and a police car parked in front of City Hall.

For Boston locals, Chelsea does not have the best reputation. Known for a high population of residents with substance use disorder, Chelsea has not been looked to as a model of public health by other cities. But the Chelsea Hub, a collaboration between the police department and public safety, health, and social services is changing that. Chelsea’s old reputation “is not today’s reality,” said City Manager, Thomas Ambrosino.

Chelsea was one of eight U.S. communities to win a $25,000 Robert Wood Johnson Foundation Culture of Health Prize in 2017. According to Ambrosino, “we wowed them with the level of collaboration” within the city. Chelsea’s Hub, based on a Canadian model, facilitates that collaboration.

Daniel Cortez, Community Engagement Specialist at the Chelsea Police Department, oversees the Hub’s weekly meetings. “I play the role of cheerleader sometimes,” said Cortez. Each Thursday morning, he and fifteen or so colleagues (police officers, child protective services and city code enforcement agents, social workers, substance-use counselors and recovery coaches, and medical center staff), gather around a table at the Chelsea Police Department and talk about individuals who need access to their services.

While each of these services existed before the Hub came to Chelsea in 2015, they didn’t collaborate as much in the past. “The community came to together, all service providers,” said Jason Owens, a community liaison with Roca Inc., a Chelsea-based organization that helps young men and women at risk of incarceration get back to school or work. “There are no more silos in our community so we can better serve our city."
The Chelsea Hub provides a way for people from different agencies to meet each other and learn about new ways to deliver services and serve the community efficiently, according to Cortez.  
The Hub provides a way for people from different agencies to meet each other and learn about new ways to deliver services and serve the community efficiently, according to Cortez. “We’re able to mobilize and deliver services faster than ever before,” he said. For law enforcement, the Hub means a new approach to public safety. Before their close relationship with social services took shape, the police would respond to the same houses and the same people repeatedly. They would address the immediate crime, but the root of the issue remained. Now, “they know there’s a place someone can be referred to,” said Cortez. “I think the police feel like they have more tools in their toolbox.” Because the program is so new, Chelsea only has anecdotal reports of success. But police departments in Canada using this method have reported that 79% of their interventions reach closure in two weeks or less. In one district, an evaluation found a significant drop in violent and property crime rates. In addition to the Hub, Chelsea’s police offer addiction services and youth community outreach programs. “Our police department does a good job of engendering trust in the community,” said Ambrosino. Their addiction recovery initiative, based on the Gloucester Police Department’s ANGEL program, aims to prevent overdoses and encourage utilization of treatment services. The department also hosts a youth athletic league, summer internships for high school students, a community criminal justice class for high school students, and a youth police initiative that allows teenagers and officers to build positive relationships. Walking down Broadway, jostling shoulders with people on the sidewalks, you can see the Tobin Bridge in the distance. This structure connecting Boston and Chelsea looms over the smaller city. Yet despite its size, the city of Chelsea has given its residents resources comparable to its larger neighbor, making collaboration between governmental service providers central to enriching the public health of the community. Photo: Jacqueline Rocheleau [post_title] => Chelsea Police Create a Culture of Health [post_excerpt] => The Chelsea Hub is a collaboration between police and social services to promote public health in the city. Chelsea won a $25,000 Robert Wood Johnson Foundation Culture of Health Prize in 2017. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => chelsea-police-create-a-culture-of-health [to_ping] => [pinged] => [post_modified] => 2018-05-07 08:19:10 [post_modified_gmt] => 2018-05-07 12:19:10 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=4237 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

The Chelsea Hub is a collaboration between police and social services to promote public health in the city. Chelsea won a $25,000 Robert Wood Johnson Foundation Culture of Health Prize in 2017.

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News

Crisis Pregnancy Centers Center Stage at SCOTUS

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                    [post_content] => The National Institute of Family and Life Advocates (NIFLA) is challenging the California Reproductive FACT (Freedom, Accountability, Comprehensive Care, and Transparency) Act before the U.S. Supreme Court. On March 20, 2018, SCOTUS heard oral arguments in the NIFLA v. Becerra case.

What is the Reproductive FACT Act?

The Reproductive FACT Act was signed into law in California by Governor Jerry Brown on October 9, 2015. The law requires licensed medical facilities to post a notice stating that California has public programs where low-income women can access free or inexpensive family planning services, including abortion. It also requires unlicensed facilities, such as crisis pregnancy centers (CPCs), to post a notice stating that they are not a licensed medical facility. The notice that the licensed facilities must post states:

“California has public programs that provide immediate free or low-cost access to comprehensive family planning services (including all FDA-approved methods of contraception), prenatal care, and abortion for eligible women. To determine whether you qualify, contact the county social services office at [insert the telephone number].”

The notice that unlicensed facilities must post states:

“This facility is not licensed as a medical facility by the State of California and has no licensed medical provider who provides or directly supervises the provision of services.”

What are crisis pregnancy centers?

The mission of CPCs is to dissuade women from having abortions. These unlicensed facilities are often mistaken for medical clinics. Generally, though, there are no licensed medical staff present. CPCs are often located near licensed reproductive health clinics to confuse women seeking abortions and other family planning services. They use a variety of tactics to achieve this goal, including providing false information about the risks of abortion. Women are often told that having an abortion can lead to an increased risk of breast cancer or infertility, contrary to scientific evidence.

NIFLA’s Argument

NIFLA argued that the requirement to post the notices above violates the right to free speech guaranteed under the First Amendment. Michael P. Farris, representing NIFLA, said, “California took aim at pro-life pregnancy centers by compelling licensed centers to point the way to an abortion and imposing onerous advertising rules on unlicensed centers that do not provide ultrasounds or any other medical services.” When Justice Ruth Bader Ginsburg asked if it would also be unconstitutional to require abortion providers to tell patients that services were available if they chose to carry their pregnancies to term, Farris argued that it would not. He cited the Planned Parenthood of Southeastern Pennsylvania v. Casey ruling upholding most of Pennsylvania’s informed consent and waiting period requirements. He also cited Harris v. McRae, saying that the decisions in these cases “indicated that the state has an additional interest beyond the health of the woman in the interest of advancing the life of the unborn child, to a degree.” Farris also argued that the California statute targets pro-life pregnancy centers. He reasoned that the law is limited to primarily nonprofit community clinics, excluding private practices. He stated that “clinics that are in general practice” are exempt from this requirement, as well as clinics that sign up for the California Family PACT program. Based on these exemptions, Farris argued that the only facilities targeted are pro-life pregnancy centers.

Becerra’s Argument

Joshua A. Klein, representing the respondents, also cited Planned Parenthood of Southeastern Pennsylvania v. Casey in his argument, stating that the notices ensure patients are fully informed about their choices. He also argued that the law “empowers the woman by explaining that her financial circumstance does not make her unable to access alternative and supplemental care.” When asked about the NIFLA claim that the statute targets crisis pregnancy centers, Klein said, “Your Honor, the disclosure is targeted at women who seek free care for pregnancy, not at any particular viewpoint.” Justice Samuel A. Alito, Jr. challenged Klein on the numerous exempted facilities, such as private practices and clinics in the California Family PACT program. Klein responded that the state was trying to apply the speech requirements narrowly, something, he said, the Court has argued for in the past. Klein also argued that the law targets nonprofit clinics because they typically see women in need of low-cost or free pregnancy services. He stated that California Family PACT providers are exempt from posting the notice because they receive incentives to help women enroll in state healthcare programs. Finally, Klein cited Zauderer v. Office of Disciplinary Counsel in his argument. The decision in Zauderer states that requiring the dissemination of factual information is constitutional as long as it meets two conditions: 1) it is not “unduly burdensome”, and 2) it is “reasonably related to the State’s interest in preventing deception of consumers.”

When will we know the Court’s decision?

The U.S. Supreme Court is expected to announce its decision in June 2018. Feature image: Phil Roeder, Supreme Court of the United State, used under CC BY 2.0 [post_title] => Crisis Pregnancy Centers Center Stage at SCOTUS [post_excerpt] => NIFLA v. Becerra, currently before the Supreme Court, is a challenge to California's Reproductive FACT Act, which requires unlicensed facilities such as crisis pregnancy centers to post a notice stating that they are not a licensed medical facility. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => crisis-pregnancy-centers-center-stage-at-scotus [to_ping] => [pinged] => [post_modified] => 2018-04-23 06:58:00 [post_modified_gmt] => 2018-04-23 10:58:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_news&p=4189 [menu_order] => 0 [post_type] => bu_news [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

NIFLA v. Becerra, currently before the Supreme Court, is a challenge to California’s Reproductive FACT Act, which requires unlicensed facilities such as crisis pregnancy centers to post a notice stating that they are not a licensed medical facility.

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