The Push for Healthy Communities

As COVID-19 took its toll on the U.S. in 2020, the numbers began to show that not everyone was equally affected by the virus. Data from the CDC and National Center for Health Statistics showed Black and Latinx populations were almost three times more likely to be hospitalized for COVID-19 than white populations, and it was two times more likely that their cases resulted in death.

But COVID-19 only revealed the health disparities that were already rampant in the nation. And, these underlying disparities did not only affect people of color, but also occurred based on other factors such as socioeconomic status, gender, sexual orientation, geography and age.

As the most economically and ethnically diverse university in the nation, the CSU is committed to ensuring all community members are served equally, including access to health care. Here are a few ways campuses are pushing for that access.​

A Little Motivation

The Stanislaus Recovery Center (SRC), which provides addiction recovery treatment for patients on Medicaid or Medi-Cal who are often unemployed or unhoused, is the site of a pilot study led by Shrinidhi Subramaniam, Ph.D., assistant professor of psychology at California State University, Stanislaus.

Working together since 2018, Dr. Subramaniam and the SRC team noticed when patients were transferring from residential to outpatient care, their participation in treatment dropped off. To address the issue, Subramaniam, her students and the SRC launched the project—funded by a Research, Scholarships and Creative Activities grant—to study whether monetary incentives, paid on reloadable credit cards, increased patient participation in outpatient services as well as improved abstinence and treatment outcomes.

“I expect the participants in our study to all be in the category of socioeconomic disadvantage, and hopefully the little bit of money that we can give them with the incentives will also encourage them to access other recovery resources through continuing care,” Subramaniam says.

This pilot study is based off research she conducted during her post-doc at the Johns Hopkins School of Medicine on motivational incentives in health care, including encouraging HIV patients to take their medication and chronically unemployed individuals recovering from substance use disorder to abstain from drug use. Another study also looked at the efficacy of incentivizing patients to do other important tasks like sign up for health insurance, complete job training or acquire identification like a Social Security card or ID.

Subramaniam hopes her work can expand to incentivize patients to use other services at SRC, includin​g its existing resources that link clients to training or local job opportunities—with the ultimate goal of setting up her own “therapeutic workplace” where individuals can receive treatment as well as help securing education, employment and housing.

“We have to deal with a lot of stigmas working with this population; both the stigma of addiction and the stigma that comes along with poverty,” Subramaniam says. “So, one of the major goals of my research program is to figure out what it takes to help people with that combination of addiction, unemployment and poverty to get out of their situation to the best of our ability. Of course, there are structural changes that need to be made to help people in that position, but there are also things psychology can do on an individual basis to help people access resources that are available. And incentives are a great way to help motivate people to do those difficult tasks.”​

The Next Generation

Named in honor of the unsung medical personnel dubbed heroes during the COVID-19 pandemic, the proposed Regional Healthcare Initiative Health Education, Research, and Clinical Outcomes (HEROs) Institute at San Diego State University would seek to improve health care services and reduce disparities in its community by addressing issues in health education.

“We can’t address access to health care if we don’t address access to health care education,” says Harsimran Baweja, Ph.D., associate professor in exercise and nutritional sciences. “Our idea is to make a grassroots-up change to health care delivery, so that these students who go out now, our alumni, will be the changemakers.”

Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

Specifically, the goal is to implement interprofessional education, in which classrooms would bring together students from different health care programs, reflecting the interdisciplinary teams they will experience in the workforce. By introducing this type of learning, their training times would be significantly shortened, and they could independently serve patients more quickly. In addition, the institute will form clinical partnerships with community health care providers, who will likewise provide instruction and training in the classroom and likely employ the students post-graduation.

“We will be accelerating the delivery [of health care] from bench to bedside or to the community, because the problem in health care access and delivery is the pace at which it’s given,” Dr. Baweja explains. “We need to reduce the burden on the health care system and reduce the burden on the money that is spent. Our trainees who will go out will know how to run the system more efficiently. We really have to create a better and more efficient work system and workflow.”

Spearheaded by Baweja, María Luisa Zúñiga, Ph.D., campus director of the Joint Doctoral Program in Interdisciplinary Research in Substance Abuse, and other faculty in research and innovation, public health and physical therapy, the HEROs Institute will also consolidate efforts currently occurring separately in the colleges. For example, the NIH-funded Addiction Scientists Strengthened Through Education and Training (ASSET) Program aims to increase the number of Black and Latinx scientists in substance abuse addiction and education, while the California Outreach Challenge, which SDSU participates in, has physical therapy programs compete for the most community service hours. Under the institute, similar programs could be implemented that extend across SDSU’s health care disciplines.

Lastly, professors in the participating programs would imbue students with the values, cultural competence and community understanding that would prepare them to drive health care policy changes in the future.

“If we not just prep students to be ready for whatever is coming in the future, but we guide them with the value system that you have to serve your community before they graduate, then the health care system is going to be better prepared for itself than it was in the past 12 months,” Baweja says. “These are going to be the people who are going to be not only informing the workforce, but will be informing the policies in the future.”

The team is currently seeking public, private and industry partnerships to jumpstart the HEROs Institute, which is part of the​ SDSU Big Ideas Initiative​.

A Health Care Transformation

Building on the campus’s Mi Gente, Nuestra Salud (My People, Our Health) effort, California Polytechnic State University, San Luis Obispo is piloting a new institute that facilitates community-led initiatives to address health equity around the cities of Santa Maria and Guadalupe on California’s Central Coast.

“Our solution is a people’s movement for health ownership,” says Suzanne Phelan, Ph.D., professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “The Mi Gente, Nuestra Salud initiative flips our current system upside down, empowering people—and especially those who are currently minoritized in America—to identify and address their most pressing health concerns. We aim to transform health care into health ownership.”

To meet this goal, the Cal Poly Institute for Community Health Training and Research will largely provide resources that enable existing groups to better serve all members of the community with the help of collaborators from all six of the school’s colleges. These resources will include training in health equity principles, data on the community, funding opportunities and strategies for community partnerships, health advocacy and program evaluation.

“We see this effort as collaborative and, ultimately, community-driven,” says Marilyn Tseng, Ph.D., assistant professor of kinesiology and public health and co-principal investigator of Mi Gente, Nuestra Salud. “We see the institute as providing resources that will help the process along; we are only one piece in the complex health ecosystem in Santa Maria. If we can help generate ripples that will produce larger beneficial impacts on community mobilization, health ownership and health equity, we will consider the effort to be completely worthwhile.”

To secure support for the project, the team has already forged partnerships with the city of Santa Maria, nonprofits and University of California, Santa Barbara. It also recently received funding from the California Breast Cancer Research Program to study breast cancer risk disparities in the Latinx and immigrant communities of Santa Maria.

These efforts will also be bolstered by Cal Poly San Luis Obispo’s Women and Infants Mobile Health Unit, which, in addition to supporting local health workers and providing free medical care to uninsured women and infants, will serve as a connection point between the institute and the community.

Finally, the team hopes to introduce health advocacy and ambassadorship training into the classroom, preparing Cal Poly San Luis Obispo students to effectively care and advocate for these communities.

Inspiration for these efforts grew out of a program in Jamkhed, India, called the Jamkhed Comprehensive Rural Health Project (CRHP), aimed at empowering people to address health disparities in their communities by first addressing the social, cultural and economic challenges that exacerbate those inequities.

“All of us conduct research and teach courses in which we confront issues of health inequities rooted in systemwide, structural inequities in access to healthy environments, opportunities and resources,” Dr. Tseng says. “The Jamkhed CRHP has been successful and cost-effective in India, but more importantly, its principles resonated with all of us. We felt that health ownership was something we would like to see here given the stark disparities in health, even in our region.”

California State University (CSU) Palliative Care Certification for Social Workers

According to the National Institute of Health (NIH), palliative care is medical care necessary to support patients suffering from chronic illnesses such as cancer, HIV, rare genetic diseases, and other disorders in order to help provide the best quality of life.  In order for palliative care to work properly, it requires a team of doctors, nurses, and social workers to develop a plan of care to assist the patient and their families. Recently,  I had the opportunity to interview Helen McNeal who is the Executive Director of the California University Institute of Palliative Care at Cal State San Marcos. Here is our discussion:

SWH: Could you tell us about your background and position with California State University?

ipc_headshot_helenmcnealHM: My role is guide the Institute team in accomplishing its mission of educating current and future health care professionals about palliative care, and educating the public about palliative care, its importance, how to access it and advocate for it in the community. We are also charged to do and create a model for professional and community education that can be replicated at California State University campuses and others across the state and around the country.

I have been involved in hospice and palliative care for more than 25 years, beginning with helping to found a hospice in Ontario Canada and from that point forward consulting on palliative care with the provincial and federal governments in Canada, with the Department of Health and Human Services and the National Hospice and Palliative Care Organization here in the U.S. Prior to becoming involved with launching and establishing the CSU Institute for Palliative Care in July of 2012, I was the Vice President and Executive Director for the Institute for Palliative Medicine at San Diego Hospice. As you can tell, palliative care is my passion!

SWH: What is Palliative Care, and what prompted California State University to create the first certificate program of its kind?

HM: Palliative care is specialized care that focuses on improving quality of life for people with serious or chronic illness and their families. It prevents and relieves suffering by addressing pain as well as the physical, emotional, psycho-social and spiritual problems associated with serious and chronic conditions. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, social workers, chaplains and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

The CSU is the largest workforce development “engine” in the country, graduating 80% of all health care professionals in California. With 1 in 8 Americans currently over the age of 65 and that number growing to 1 in 5 by 2030, the CSU recognized the importance of palliative care to current and future health professionals and, with the leadership of one of our trustees and President Karen Haynes of Cal State San Marcos, created the Institute.

Social workers are a vital part of the palliative care team. There are not a lot of educational options for social workers interested in improving their palliative care skills and the need for palliative care trained social workers is great. Creating the first online palliative care certificate program just made sense. President Haynes is a PhD Social Worker and former Dean of a School of Social Work, so she supported our making this program a priority. Initially, we had thought to make the program a hybrid, with the first of the three levels of the program done in person, but social workers told us to put it all online … and we have.

SWH: How can this certificate benefit social work practitioners and assist them in their career goals?

HM: Social workers are vital to the success of palliative care if we are to address the psycho-social needs of patients and families. In addition, social workers can play a vital role in advance-care planning and in addressing the practical issues that cause pain and suffering for those with chronic and serious illness and their families.

There is a true story that I often share about the impact of social workers in palliative care. A young immigrant mother with advanced breast cancer was suffering intractable pain and nothing seemed to help. A social worker was brought in to speak with her in her native language and learned that she was concerned for the well-being of her two children. She wanted, after her death, for them to be raised in Mexico by her mother instead of in the U.S. with her husband. The social worker was able to work this out with the husband and mother, and from that point forward, only minimal pain medication was required to keep her comfortable. Research has shown that patients who have the opportunity to work with a palliative care social worker have a more positive care experience as this story illustrates.

With 90% of those over 65 having at least one serious or chronic illness, the demand for palliative care trained social workers is going to continue growing. It offers a rewarding career path for both current and new social workers but it requires specialized skills, and that is what our program offers. In addition, with the emphasis on interdisciplinary practice, there are opportunities for social workers to take on more of a leadership role in delivering palliative care than ever before.

For social workers looking for a rewarding career and opportunities for leadership in today’s changing healthcare environment, our program provides the education that can help them achieve their goals. Our program consists of three levels. Level 1 provides participants with a firm grounding in the principles and role of the palliative care social worker. Level 2 enhances their skills in key areas including motivational interviewing, grief and loss, dealing with difficult cases and special populations. Level 3 prepares them for leadership and program building, while also facilitating their completing a project in the form of original research, developing a program or getting an article published. In short, it provides a strong foundation for career success in every dimension.

SWH: Some Social Work practitioners may be skeptical about online education, what can you tell us about the program at CSU that will help alleviate any concerns?

HM: What we hear from social workers is that they don’t have time to take off from work to do an advanced program and that while they want to learn more about palliative care, they need a program that they can do where they are, when they have time … and that is cost-effective. The Institute’s Post-MSW Palliative Care Certificate meets these requirements.

Social workers doing our program will do one module each month, doing one segment each week for three weeks and then have a one-week break. While the work for the week needs to be done that week, it can be done whenever the social worker has time … at lunch, in the evening, on Saturday morning. What could be easier and more convenient? With a maximum of 15 participants in the course, there will be lots of interaction with colleagues as well as with our outstanding faculty.

I understand that those who have not done online learning might be skeptical but as we hear from those who do our other online programs, doing an asynchronous learning program means that you can really bring real world challenges into the classroom, discuss them with colleagues and get rapid responses from your faculty. What participants are telling us is that online education brings learning closer to their daily clinical experience.

SWH: Are there plans to create other types of certifications to support post MSW learning, and are there any key points that you would like to personally relay to potential students interested in this program?

HM: Our focus is on educating professionals in palliative care. We are assessing the need for a post-BSW certificate in palliative care as so many BSW social workers work in hospice and long-term care settings. In addition, because we have certificate programs for all the individual members of the palliative care team, we are looking at doing an interdisciplinary program that would be undertaken by palliative care teams to enhance their skills at working as a team.

In the meantime, we would love to hear from social workers what they would like us to provide in palliative care training. After all, we know that social workers are committed to providing exceptional care to patients and families, and we are here to help them achieve that goal!

For more information on the Palliative Care Certificate Program, please visit using this link.

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