Evaluation of the Massachusetts Health Disparities Collaborative
The Massachusetts League of Community Health Centers, in partnership with the Massachusetts Diabetes Prevention and Control Program, Boston Public Health Commission, MassPRO, and the University of Massachusetts Medical School (UMMS), has convened a state-based chronic disease quality improvement program in 17 community health centers (CHCs) across the state—the Massachusetts Health Disparities Collaborative. Currently, in this 13-month state-based quality improvement effort—modeled after the national Health Disparities Collaboratives—community health centers are focused on achieving strategic system change in the delivery of primary health care for patients living with diabetes by applying the Care Model (CM) in a quality improvement framework. Members of the UMMS Department of Family Medicine and Community Health are responsible for leading the evaluation component of the demonstration project.
Interpreter Services for Limited-English-Proficient (LEP) patients
LEP populations experience health communication and outcome disparities. Faculty members Mary Lindholm, Warren Ferguson and Lee Hargraves work with the UMassMemorial Interpreter Services Department to evaluate new technologies from the patient and provider perspective, and also are utilizing quality improvement interventions to improve the patient experience and outcomes of care.
Together for Kids
It seems that challenging child behavioral issues aren’t limited to the tween and teen ages. Carole Upshur is heading up research to ensure that appropriate services reach young at-risk children.
Early childhood behavioral problems appear to be increasing, with current estimates ranging from 7% to 25%. This increase in the incidence of young children exhibiting challenging behaviors has resulted in disrupted early childhood classrooms and children being expelled from programs. A recent national study confirms that more children are being expelled from preschool than for all other grades! Despite some well-developed and standardized programs that have been demonstrated to prevent or ameliorate early childhood behavior problems, many children and families go unserved until children are older, problems reach extremes, and evolve into longstanding and more intractable behavioral issues. Unfortunately, standardized and evidence-based practices are not widely used because of problems with availability and expense, problems with parent engagement; as well as supervision, and monitoring. Additionally, workforce issues present significant barriers including time commitment needed for training, lack of infrastructure to sustain programs when trained staff leave and in terms of serving the most behaviorally at risk children, a lack of behavioral health staff that are trained to work with very young children. Consistent with the President’s New Freedom Commission on Mental Health, this project, funded by NIMH, is developing and testing an approach to primary prevention for early externalizing behavior problems that can be implemented in childcare settings where many children first come to the attention of the service system. The overall goal of the project is to develop a transportable “real world” intervention model to decrease the number of children in preschool who require intensive behavioral intervention services, and provide a sustainable mechanism for identifying and appropriately intervening with those who do.
The project builds on a 5 year successful relationship evaluating the Together for Kids mental health consultation program for Worcester area child care programs. Four economically and ethnically diverse community child care programs are participating, randomly assigned to intervention and control conditions for phased intervention implementation. These programs enroll approximately 200 preschool children. Over the next two years, program leaders will be training initial intervention teachers on a child social and emotional development curriculum and will be measuring its impact on the high rates of behavior problems child care centers have been experiencing in preschool children. After initial efficacy data have been collected, the control sites will be trained on the intervention curriculum. Centers are being supported to assist with data collection and implementation activities and parents receive gift cards for returning questionnaires.
The “Together for Kids Coalition” that spurred the early work on preschool behavior problems consists of over 50 Worcester area agencies and has been supported by The Health Foundation of Central Massachusetts, the United Way of Central Massachusetts and the Fred Harris Daniels Foundation. Community Healthlink serves as the administrative agency, and the research sites are Rainbow child Development Center, Worcester Comprehensive Child Care Services, Edward M. Kennedy Community Health Center, the YMCA City Square Child Care Center and the YWCA Worcester Child Care Center.”