RISE (LEAP): Recovery In Shared Experiences
Cambridge Health Alliance launched the RISE program in 2014 to provide evidence-based early intervention, in order to help teens and young adults build resiliency and skills vital to recovery. With group therapy (based on NAVIGATE model) as the foundation, RISE clients also receive individualized medication management, psychological assessment, peer and employment support, opportunities to hang out with each other before and after appointments in our Community Room, and other services as needed. RISE is well-integrated within the larger CHA network, including inpatient psychiatry (child and adult), emergency departments (with medical and psychiatric providers), primary care (pediatrics, family and internal medicine), and active presence in local communities and public schools.
The following services are provided: Psychiatric assessment, Psychopharmacology, individual therapy, Group therapy, Cognitive Behavior Therapy, Social skills training, Substance abuse counseling, Social milieu activities, Family education and engagement, Co-located primary care and lab, Employment and education support, Peer Support Specialist, and Health education & wellness coaching.
HERLab supplied the Assessment Coordinator position, which conducts assessment (currently, the EPINET battery) in a clinical capacity.
RIZE: Innovations in Anti-Racism to Address the Opioid Overdose Crisis
The HERLab at CHA was selected as an evaluator to partner with RIZE and the four grantee sites to support implementation and mixed methods evaluation of their efforts:
Boston Public Health Commission: Will use the grant to create a comprehensive awareness and information initiative on smoking and inhaling safer, specifically targeting African-American, Latino, and Indian drug users.
Casa Esperanza: funds will be to expand the use of the language access application of the Comprehensive Healthcare Improvement Support System – Spanish (CASA-CHESS) to address racial and ethnic disparities in access to treatment for the Disorder. Substance Use (SUD), reduce isolation among Spanish speakers, strengthen recovery networks and disseminate information about COVID-19.
Codman Square Health Center: Will use the grant to conduct a comprehensive needs assessment of its SUD services through the lens of racial justice, including examining how workflows and protocols are determined; what services may be missing; and to what extent the community they serve is involved.
Prisoner Legal Services: will use the funds to plan an innovative state project that will advocate for evidence-based access to SUD for incarcerated individuals as a necessary model of public health treatment and racial equity. The project is a medical advocacy partnership with residents and the Boston Medical Center School of Internal Medicine.
Investigators: Benjamin Lê Cook, Dharma Cortes, Ana Progovac, Michael Flores, Valeria Chambers
MEDICAID PAYMENT POLICY AND ACCESS TO CARE FOR DUAL ELIGIBLE INDIVIDUALS (NIMHD R01)
Dr. Cook and Dr. Vicki Fung at Massachusetts General Hospital (MGH) were granted a NIMHD R01 grant for 5 years with the aim to assess the impact of recent Medicare policy changes on racial/ethnic disparities in mental health care. The Lab will assess the effects of policy changes on racial/ethnic minorities in medical care use, quality process measures, clinical events and total and component medical spending. Racial/ethnic minorities are less likely to receive mental health care than Whites and these Medicare policies have the potential for reducing these disparities. Data to be used are a 20% sample of fee-for-service beneficiaries linked to provider and area-level data implementing difference-in-difference and within-person statistical analysis.
PI: Benjamin Lê Cook, Vicki Fung (MGH)
Alcohol treatment in Medicaid managed care plans: Disparities in policies and outcomes
Fewer than 10% of those with alcohol use disorder (AUD) receive evidence-based treatment, and racial/ethnic minorities and women are less likely to access any treatment at all. Medicaid programs are among the most important payers for AUD treatment and rates of AUD in the Medicaid population are especially high. Medicaid provides health insurance for more than 77 million Americans, including a large and disproportionate share of racial/ethnic minorities, women, and rural Americans. Almost all state Medicaid programs contract with Medicaid managed care organizations (MMCOs) to deliver and manage health care services and nearly 70% of Medicaid enrollees are now in managed care. However, there is almost no information or transparency on MMCO policies related to alcohol treatment services. This study systematically examines AUD treatment policies in MMCOs, an under-explored area of research with potentially large influence on disparities in AUD treatment access and outcomes.
PI: Maureen Stewart (Brandeis University)
Improving Limited English Proficient Patient Safety through Patient Portal Accessibility (crico)
Language barriers a risk for poor clinical outcomes, medical errors, and liability across the spectrum of care. We have partnered with Dr. Robert Marlin, a strong advocate of vulnerable populations, to assess the effects of implementing a Spanish-language patient online portal that accurately sends messages to low English proficiency patients in their native language with the aim to improve communication with the care team and mitigate risks that result from miscommunication. The project has recently started, and we look forward to evaluating patient satisfaction and clinical outcomes.
PI: Robert Marlin
BLACK VOICES IN RECOVERY
Black Voices in Recovery was created by and for Massachusetts residents with lived experience of behavioral health, trauma, substance use, and/or addictions as in support of each other’s recovery. Their mission is to promote self-determination, self-empowerment, advocacy, activism, and support in Black communities to promote psychological wellbeing, to educate to reduce mental/health disparities, to mitigate the effects of racism and implicit biases in systems, to reach out in order to reduce alienation, to speak out in order to reduce discrimination, and to emphasize healing, connection, and wellness of mind, body, and spirit. Thirteen years ago, mental health consumers of color in Massachusetts began a peer networking project to meet growing community demands for a space to discuss mental health, trauma, and substance use-related challenges – and their deep disappointment with existing mental health systems that largely failed to meet their needs. Now a statewide advocacy network, Black Voices in Recovery became that “space to talk.” The Health Equity Research Lab has worked closely with Black Voices in Recovery (BVR), led by Valeria Chambers, to raise awareness of the discrimination, racism, and Black community members’ dissatisfaction and resilience in the face of a fragmented mental health care system. We work in partnership with BVR to document and disseminate their origin, vision, and their established processes for making space, healing, and raising constituent voice.
PI: Valeria Chambers
PATIENT PREFERENCES AND DISCRIMINATION IN THE HEALTHCARE SYSTEM (PCORI)
The Patient Centered Outcomes Research Institute (PCORI) supports research to inform healthcare decisions and improve healthcare delivery and outcomes through integrity and evidence-based information. The Lab was awarded a three year grant to develop an instrument to understand patients’ treatment preferences in their depression and diabetes care. Incorporating patient preferences into treatment plan requires an understanding of patients’ past experiences and preferences, including experiences of discrimination and the influence of peers, family and community members regarding treatment options. A mismatch between treatment and patient preferences worsens health outcomes via lower patient engagement, poorer adherence, and higher attrition. We have developed a survey that combines conjoint analysis with measurement of prior healthcare experiences and socio-cultural factors to describe the influence of preferences among race/ethnic minorities. The survey was sent nationally to more than 1500 patients with either depression, diabetes or both. To further understand treatment preferences and prior experiences, we conducted interviews with patients and providers in person and by phone. We are sharing these findings with providers and raising awareness of the importance of including preferences as part of treatment planning. These research efforts were developed using community-based participatory research in collaboration with the Primary Care Practice Improvement team and the Volunteer Health Advisers at Cambridge Health Alliance and the Transformation Center, a peer-support organization that seeks to transform policy and practice in communities through the participation of people with mental health diagnoses.
To learn more, visit the PCORI page
Collaborating partners: The Transformation Center
The Cambridge Health Alliance Primary Care Practice Improvement
PI: Benjamin Lê Cook
GENDER MINORITY HEALTH AND HEALTHCARE DISPARITIES USING MEDICARE CLAIMS AND ELECTRONIC HEALTH RECORDS (NIMHD R03)
In 2016, the National Institutes of Health (NIH) formally designated gender minorities (i.e., transgender or gender non-binary persons) as a health disparity population, reflecting mounting evidence that this population has unique unmet health needs and that more research is needed to answer the epidemiological and health services questions which may help reduce disparities for this group. We seek to understand access and utilization of health services by identifying gender minority patients in Medicare claims and in electronic health records. Dr. Progovac has been granted a Harvard Catalyst Award as well as an R03 NIMHD to proceed with the studies. Key outcomes of interest include adequate treatment for depression, treatment for chronic conditions, suicide behavior, victimization from domestic violence, avoidable hospitalizations. We have developed strong collaborations with advocates, policymakers and clinicians who are working closely with and for this population to improve gender minority well-being and health.
PI: Ana Progovac
CAMBRIDGE HEALTH ALLIANCE HEALTH INTEGRATION PROGRAM EVALUATION (HMS KAPLEN FELLOWSHIP)
The Health Integration Program at the Central Street Health Center at CHA is a Behavioral Health Home that offers recovery-oriented care to adults with serious mental illness, including schizophrenia and other psychotic disorders. The project consists of a “reverse integration” program where primary care services are provided in a mental health care setting. It involves the participation of a multidisciplinary team including healthcare providers, nurse practitioners, case managers and administrative personnel. The Lab provides short and long-term evaluation of the program, including barriers/facilitators, appropriateness, acceptability, feasibility, sustainability and replicability. A mixed methods approach from analysis of electronic health records and narratives from semi-structured interviews with providers and patients, has identified that through enhanced training and care coordination, patients have received more screening tests and monitoring of co-morbid chronic and acute medical conditions. Dr. Progovac has earned a Kaplen award to continue with the analysis of the implemented project and define upcoming priorities as well as potential expansion to other CHA sites.
PI: Ana Progovac
NEIGHBORHOOD- LEVEL PREDICTORS OF OPIOID- RELATED MORTALITY (HMS ZINBERG FELLOWSHIP)
In 2017, the Department of Health and Human Services declared the opioid epidemic a “public health emergency.” The Centers for Disease Control and Prevention estimated 63,632 overdose deaths occurred in 2016. Close to two-thirds (66%) of these overdose deaths involved an opioid, either prescribed or illicitly obtained. The specific aims of this project are to identify the neighborhood-level factors that predict opioid-related mortality among CHA patients, determine the clinical and individual factors that predict health service use among CHA patients with opioid use and comorbid mental illness, and examine the barriers and facilitators of addiction treatment planning at CHA.
Point Person at the Lab: Michael Flores
SAFETY NET COLLABORATIVE AND CPD MENTAL HEALTH/CRIMINAL JUSTICE INITIATIVES (MILLER FOUNDATION AND DEPARTMENT OF JUSTICE)
Supported by a Department of Justice and the Miller Foundation, the Lab is partnering with the Cambridge Police Department (CPD) to conduct evaluation of their diversion program for youth with mental illness (Safety Net) and community policing efforts for adults. In the last 10 years, the CPD has transformed its community policing philosophy to focus more on prevention, intervention, and diversion. Because at least 70% of people in the criminal justice system are mentally ill, the city has been working to connect at risk individuals with mental health care prior to arrest and incarceration. An important part of this initiative is the CPD Community Services Unit, which includes officers and sworn personnel who are dedicated to addressing the needs of youth, the elderly, the homeless, and individuals with mental health issues by facilitating information sharing and coordination of care between CPD and partner organizations. We evaluate the current state of these programs, formalize partnerships, and develop toolkits to promote information sharing between law enforcement agencies looking to expand community policing services in their communities.
PI: Jamie Barrett
COMPARATIVE EFFECTIVENESS RESEARCH AND RACIAL/ETHNIC HEALTH CARE EQUITY (AHRQ R01)
We examine whether specific information in FDA warnings influenced disparity trends in psychotropic drug use and mental health care and to identify how provider characteristics and HMO enrollment act as mechanisms that underlie the differential diffusion of Comparative Effectiveness Research (CER) via health risk warnings. Identifying the influence of FDA risk warnings on trends in psychotropic drug use and related health care provides a platform to understand how CER will influence disparities and will help us to assess whether information regarding the risks and benefits of medications are being equitably disseminated. Our examination of how an increased reliance on CER will likely influence disparities in treatment after health care reform will provide policymakers with actionable information that might avert the negative equity consequences of incorporating CER into routine practice.
PI: Benjamin Lê Cook
THE IMPACT OF A COMPREHENSIVE ELECTRONIC PATIENT PORTAL ON THE HEALTH SERVICE USE OF PATIENTS OBTAINING SERVICES AT FOUR HOSPITALS IN MADRID: AN INTERRUPTED TIME-SERIES ANALYSIS
The objective of this study is to determine the extent to which an electronic patient portal was associated with improvements in health service use. Using a quasi-experimental interrupted time-series approach to analyzing administrative hospital data, we assessed health service use before (April 2012-March 2015) and after (April 2015-December 2016) the implementation of a comprehensive electronic patient portal in four hospitals from the Madrid Health System (Madrid, Spain). Our primary health service use outcomes consisted of number of outpatient visits, any hospital use, any 30-day all-cause readmission, and any emergency department (ED) use.
Point Person at the Lab: Benjamin Lê Cook