2017 was a year of unprecedented growth for the college. I am proud to share that among our many milestones this year was our accreditation as a school of public health by the Council on Education for Public Health (CEPH). While 26 of our academic programs already maintain accreditation, our school-level accreditation marks a new era for us. It affirms our innovative approach to public health education and research, the excellence of our faculty and students, and the importance of our partnerships with local health organizations and community leaders.
These same qualities make our college’s work even more essential as we move forward as a national and international contributor to the health of populations and individuals. The need for a broad public health perspective was demonstrated in 2017 again and again as we saw efforts to dismantle the Affordable Care Act, an opioid epidemic that is the scourge of families and whole communities, and natural disasters that are threatening the health of entire regions, such as the Caribbean islands.
Effective responses to complex threats like these require thinking about health through an inter-professional lens. At our college, we know that public health begins with the individual, and so we incorporate healthcare and health services disciplines as well as traditional public health fields to bring better health to the home, to the bedside, and to our wider community-based institutions. Our faculty collaborate across many fields of study in order to promote and protect health and well-being—and they prepare our students to do the same.
In this magazine, we explore how members of our college community are pushing the boundaries of public health research, education and practice. Our cover story examines the work of researchers in social and behavioral health, social work and health policy who are developing new ways to address and prevent opioid misuse, while a nursing alumna operates on the front lines of the opioid crisis in the Kensington neighborhood of Philadelphia to treat individual patients. These stories share common threads: they are based on academic research but also draw on the wisdom of those outside traditional academia. While rooted in Philadelphia, the implications of this work reach far beyond our city.
Our work also extends to issues that gain less national attention but are no less important for population health. Researchers in our Department of Rehabilitation Sciences are partnering with public transit agencies to facilitate mobility for individuals with autism spectrum disorder and severe mental illness. Department of Physical Therapy faculty are designing lightweight devices that use virtual reality to detect concussions. And in our Department of Communication Sciences and Disorders, researchers and practitioners are developing an evidence base for novel treatments of aphasia—a language disorder that is less well-known but even more prevalent than Parkinson’s disease.
This year the college extended its physical footprint as well, opening new clinical education spaces with state-of-the-art teaching technology. In the coming years, we plan further expansions of our classroom, lab and clinical facilities, as well as of our inter-professional and community-based initiatives. As our college grows, we continue to reimagine what public health means; how it is studied, taught and practiced; and how it can address some of the world’s most significant challenges.
2018 will continue to bring new challenges, but the College of Public Health will be ready.
Laura A. Siminoff
Dean of the College of Public Health
Laura H. Carnell Professor of Public Health
College Profile and Accreditations
CEPH awards school-level accreditation
The College of Public Health received full accreditation as a school of public health by the Council on Education for Public Health (CEPH) in October 2017, making it one of two CEPH-accredited schools of public health in the Philadelphia region and one of three in the state of Pennsylvania. While 26 CPH academic programs are already accredited, this marks the first time the college has held school-level accreditation. This year also saw re-accreditations of the doctor of nursing practice, master of arts in speech-language-hearing, master of science in athletic training, master of science in kinesiology concentration in athletic training, and bachelor of science in therapeutic recreation programs.
In its report, CEPH highlighted some of the college’s strengths, recognizing faculty members’ passion and commitment to students, a curricular emphasis on fieldwork and practical experience, an integration of public health concepts across all of our academic programs, an extensive research infrastructure, and strong ties to community and government agencies across the region.
CEPH accreditation is a significant milestone for the college, and it underscores the college’s broader growth as an educational and research institution. CEPH accreditation affirms specific characteristics of a high-performing school: quality of education and training; excellence in practice, research and service; and collaboration with organizational and community leaders.
About the college
Temple’s College of Public Health (CPH) is leading a new movement to reimagine the future of public health. Through transdisciplinary research and inter-professional education, our faculty and students embrace public health as a catalyst for individual and community change and well-being. At our college, teams of professionals work together on innovative designs and delivery solutions for healthcare, disease prevention and social welfare. We are generating new knowledge, conducting state-of-the-art education, and training a new generation of clinicians and researchers.
The College of Public Health is one of the largest and most diverse colleges of its kind in the country, incorporating healthcare and health services disciplines as well as traditional public health programs. The college is home to the departments of communication sciences and disorders, epidemiology and biostatistics, health services administration and policy, kinesiology, nursing, physical therapy, rehabilitation sciences, and social and behavioral sciences, and the School of Social Work. Across our 17 disciplines and more than 50 academic programs, we are working to serve our students and our community.
Photo: Temple University’s new Aramark STAR Complex.
The College of Public Health welcomed three new clinical education spaces in 2017—a major expansion of our footprint on Temple’s Main Campus that features cutting-edge new facilities for our academic programs.
Clinical education at the Aramark Student Training and Recreation (STAR) Complex
A new wing at Temple’s Aramark STAR Complex is now home to the college’s top-ranked physical therapy and occupational therapy programs and also provides class space to other clinical programs at the college, such as recreation therapy and nursing. The building features new instructional technology, lecture halls and smart classrooms, in addition to specialized clinical training spaces such as an Activities of Daily Living (ADL) Suite—a simulated home environment in which students practice implementing adaptive techniques to help clients navigate tasks of everyday life. The $9.2 million space was designed and built specifically for the college’s clinical programs, and it currently serves more than 1,800 students at the college.
New Athletic Training clinical lab and Anatomy & Physiology classrooms
The college also completed a $1.2 million project in Pearson and McGonigle Halls, home to a state-of-the-art new clinical lab for the athletic training (AT) program and new anatomy and physiology (A&P) classrooms. The new AT facilities contain ceiling-mounted live cameras that enhance clinical instruction, as well as expanded modalities that include a hot/cold tub, electrical stimulation and ultrasound. The new facilities double the AT program’s training space and simulate AT rooms encountered in the field, helping the program fully meet accreditation requirements.
Upgraded A&P classrooms now serve many of the 3,500 students from across the university who enroll in A&P courses in the College of Public Health each year. The expanded lab spaces alleviate waitlists and enhance the learning experience in these courses, which are some of the most frequently-taken at the university.
As the College of Public Health matures, so, too, does its research mission. Nearly half of our faculty members are actively engaged in research, and our faculty and graduate students submitted 187 grant applications for extramural funding this year—a new record for the college. Our investigators had over $17 million in research funding, and the amount of funding per award averaged approximately $290,000—more than any other school or college at Temple University.
Among our faculty members are leading authorities in some of the most pressing public health issues of our time. Their groundbreaking contributions help us better understand the public health implications of cancer, HIV/AIDS, aging, neuromuscular disorders, organ transplantation, substance abuse and traumatic brain injury. They work tirelessly to develop cutting-edge treatments and therapies for communication disorders, severe mental illness, obesity and other conditions.
Many of these developments directly impact the health of our North Philadelphia community. For example, Dr. Chantelle Hart, an associate professor in the Department of Social and Behavioral Sciences, received major grants this year from both the American Diabetes Association and the National Institutes of Health to continue her novel research on sleep and weight gain in children. Her work—like that of countless other researchers at the college—has great potential to change the way we prevent and treat disease in Philadelphia and throughout the country.
In the coming year, we will continue to recruit experienced researchers to join the college, while also investing in professional development for our junior colleagues. An innovative training series helps our newest faculty members effectively launch their research programs and positions them for long-term success. We are also working closely with our graduate students to enhance their thesis and dissertation research. These investments—both in seasoned and newer researchers— position us for great success in the coming years.
I look forward to sharing still more of our research accomplishments with you in the future.
David B. Sarwer
Associate Dean for Research
Director, Center for Obesity Research and Education
Professor of Social and Behavioral Sciences
Talking It Out: Building a Better Therapy for Aphasia
The college receives a pioneering new grant for aphasia treatment.
Photo: Associate Professor Gayle DeDe (center), with (from left) Instructor Beth Levine, Professor Nadine Martin, Associate Professor Rena Krakow and Instructor Francine Kohen.
The most common symptom for people with aphasia, a chronic language disorder that presents after strokes or brain injury, is difficulty in finding words.
It’s like having a word “on the tip of your tongue” virtually every time you try to speak, according to Gayle DeDe, research associate professor and the interim chair of the Department of Communication Sciences and Disorders. The disorder also impacts a person’s ability to read, write and comprehend language.
In traditional aphasia therapy, clients work one-on-one with a speech-language pathologist to practice “targets,” or everyday words that are consistently challenging for them. It’s effective, but the clinical setting doesn’t always help the client summon words in everyday conversation.
“A conversation is unpredictable,” said DeDe. “People with aphasia can have a really hard time expressing themselves or understanding what others are saying.”
Conversational therapy, however, can potentially address language impairments and social isolation more effectively than current approaches. In conversational therapy, clients practice conversing as they would in real-world interactions, only at a more relaxed pace and in an environment that’s designed to boost their confidence. It incorporates sophisticated techniques and practices to help clients work on their specific difficulties, but when it’s working well, the treatment sounds like a regular conversation.
Thanks to a landmark grant from the National Institutes of Health (NIH), researchers from Temple University and Boston University are investigating the effectiveness of conversational therapy for people with aphasia. This year, DeDe began collaborating with a colleague in Boston on the three-year study. The grant marks the first time the NIH has funded research for conversational therapy in people with aphasia.
To test its effectiveness, DeDe and her colleagues are comparing the language abilities of two experimental groups of people with aphasia to a delayed control group, before and after treatment. The study began in May of 2017 with 48 participants, including the control group. The researchers are using both standardized tests and analyses of discourse; the bulk of the work is analyzing speech samples and the narrative flows of the conversations.
DeDe is now analyzing data from those groups and conducting treatment sessions for the delayed control group. Then, they’ll test all three groups again a year later to gauge how the treatment’s effects have held up over time. The results, ultimately, could lead to better treatment approaches for people with aphasia.
“I hope that we can show that we can generate meaningful changes using this method. And it’s my hope that we can do this in a way that is reportable and replicable,” said DeDe. “Larger than that, my hope is that the people who participate in the study, and in these conversation groups, are able to show improvements in their language and in their quality of life.”
Founded in 2006, Temple’s Center for Obesity Research and Education (CORE) draws researchers from around the university to research the causes, consequences, treatment and prevention of obesity. Over the past year, CORE faculty have examined the link between children’s sleep patterns and Type 2 diabetes, as well as the effect of snacking on childhood health. In many cases, their findings contradict conventional wisdom.
Eating away at the snack-filled diet
According to the American Academy of Pediatrics (AAP), toddlers and preschoolers should eat two to three healthy snacks a day. In many early care and education settings, snacks are also subsidized by the federal government. Judging by these recommendations, snacking appears to be an integral part of young children’s diets. But, cautions Jennifer Orlet Fisher, associate director of CORE and professor in the Department of Social and Behavioral Sciences, the evidence doesn’t necessarily support that assumption—especially when it comes to toddlers and preschoolers. “Anticipatory guidance and policy should be based on evidence, but when it comes to the role of snacking in kids’ diets there aren’t a lot of data out there, and the answers aren’t clear one way or the other,” she said.
Snacking has been a research subject of Fisher’s for half a decade, and in the past year she’s generated two studies and spoken at numerous conferences about the subject. It’s challenging to reach any strong conclusions, she stressed, since there aren’t many others investigating the subject. “It is surprising that there has been so little research on this topic given that U.S. kids consume almost a third of daily calories from snacks—more than from any other meal,” said Fisher.
She points to data showing increases in snacking among children and adults in recent decades, which has some researchers questioning whether snacking contributes extra calories to children’s diets. Her own findings lean toward the conclusion that frequent snacking isn’t necessary and could be detrimental in certain circumstances.
In an October 2016 study, Fisher found that snacking may be a riskier proposition for some children, particularly for heavier children with stronger appetites—a trait that may be inherent. The study of 181 Hispanic 4- and 5-year-olds in Houston found that children who snacked more frequently consumed more calories daily and had greater intakes of added sugars. Heavier children with greater motivation to eat consumed more snacks, and calories from snacks, daily.
,” said Fisher. The findings may help researchers, clinicians and caregivers identify children who may be most at risk to the pitfalls of snacking, such as eating high-calorie, low-nutrition foods. “Heavier children and those with greater motivation to eat may be susceptible to excessive intake from snacks,” she said.
“While children consume a significant amount of energy from snacks, and the snacks eaten tend to be of poor nutritional quality, the extent to which snacking contributes to excessive dietary intakes was unclear until now
This year, Fisher continued that research with analyses from a much larger dataset. Her pending study is a secondary analysis of a National Health and Nutrition Examination Survey (NHANES) dataset with thousands of subjects. Where the initial research concerned a small community, which allowed her to collect more intensive measures on a specific group, this study is more representative of the entire country. She found that obese toddlers and preschoolers eat a greater number of daily snacks than their peers and that those snacks are larger than snacks eaten by other children their age. It’s the first time a study has made this association.
Studies like these potentially contradict existing official opinions and policies regarding snacking for children. Fisher said she’s not necessarily opposed to such measures or recommendations, but she insists that whatever policies exist should be backed up by evidence. While her findings point to the contrary, there’s still a long way to go before making a decision leaning either way.
“It takes time to establish the evidence to move forward and feel confident that you know how these things operate and how they affect kids’ diets,” said Fisher.
Studying the links between sleep, obesity and Type 2 diabetes
Like snacking, pediatric sleep comes with its own recommendations and assumptions. According to the AAP and the American Academy of Sleep Medicine, children should receive anywhere from nine to 16 hours of sleep per 24-hour period, depending on their age. While a new study by Chantelle Hart, associate professor of social and behavioral sciences and CORE research scientist, doesn’t question these guidelines, it does take a look at an often overlooked aspect: the quality of sleep, not the quantity.
Thanks to grants from the American Diabetes Association (ADA) and National Institutes of Health (NIH), Hart is exploring, through two studies, how children’s sleep patterns affect weight regulation and the risk of developing Type 2 diabetes. The studies represent a shift in direction from previous work in this area, which is typically observational and focuses on the quantity of sleep.
By contrast, Hart’s work uses randomized controlled study designs and focuses on the effects of sleep duration and consistent sleep patterns on glucose regulation. In addition, unlike other studies, she is looking at how better sleep, combined with improved eating and activity behaviors, affects weight regulation.
“Previously, we enhanced the number of hours children slept and stabilized the timing, and observed improvements in eating and activity behaviors in a short period of time,” said Hart. “But we cannot untangle which drove the observed changes in obesity-related risk factors.”
Hart’s ADA-funded study will enroll African-American children with overweight and obesity, a group at increased risk for developing Type 2 diabetes. All children will be asked to sleep as they normally do for a week. Then, each child follows a randomly chosen schedule for four weeks.
One group will stabilize their sleep patterns, meaning they’ll go to sleep and wake up at the same times each day, and increase their sleep duration by 90 minutes each night. Another will stabilize sleep and increase it by 45 minutes each night. A third only stabilizes their sleep pattern, and the fourth continues with their normal sleep habits. “Hopefully, we’ll have a signal of which approach may be helpful for decreasing diabetes risk in children,” said Hart.
Meanwhile, a separate study funded by a five-year, $3.78 million grant from the NIH assesses the relative efficacy of two approaches to weight regulation in school-aged children. While both studies examine the effect of sleep on diabetes risk, this study focuses more on the role sleep plays in weight regulation.
“There are potentially many ways sleep can affect obesity risk,” Hart explained. “In this study, we will be able to compare how improving children’s sleep alone, compared to improving sleep along with targeted eating and activity behaviors, affects weight regulation over 12 months.”
African-American children eight to 11 years old will be randomly assigned to one of two groups. Hart will ask children in the first group to increase the amount they sleep each night by approximately one hour. Children in a second group will be asked to increase their sleep and improve targeted eating and activity behaviors such as watching less television, drinking fewer sugar-sweetened beverages and increasing physical activity.
“We’re trying to determine if sleep is an important, novel strategy for weight regulation,” Hart explained. “We have some promising evidence from preliminary studies, and this new study will help determine if sleep, in and of itself or when combined with other effective strategies, is important.”
PHOTO CREDIT: iStock
Photo: Geoffrey Wright, director of the neuromotor sciences programs and associate professor in the Physical Therapy Department.
With a $1.2 million grant from the Department of Defense, Geoffrey Wright and his team at the Motion-Action-Perception (MAP) lab are developing portable, easy-to-use tests for concussions (the technical term is mild traumatic brain injury, or mTBI) made with equipment you could find in an average gaming setup—or even your pocket.
“The goal is to develop a system that can be used in any austere environment,” said Wright, the director of neuromotor sciences programs and associate professor in the Physical Therapy Department.
The Virtual Environment TBI Screen—or VETS—wouldn’t be out of place in a family media room: The prototype includes a flat-screen television, a Nintendo Wii platform and controllers.
You set the parameters for the test—firm surface, foam surface (which provides the challenge of instability and uneven terrain), eyes open, eyes closed. Press “start,” and a scene on the screen begins to move and rotate. Your objective: stay upright for the 30 seconds it takes to run the game.
“Standing and keeping our balance on two feet is an incredibly difficult thing that we take for granted. It actually requires a lot of neural processing,” explained Wright, who also is in the Bioengineering Department in the College of Engineering. “When that neural processing is altered, either through injury or a neuropathology, we can see its effects—if we measure the right things.”
In this case, the right things are biomarkers, or signs that can be reproduced, observed and measured objectively. VETS is designed to pick up on some of these biomarkers that suggest a person has sustained a concussion. Traditionally, most head injuries are diagnosed by asking the patient about a list of symptoms that can be caused by a concussion. Since diagnoses are based on the patient’s report of how they feel, they’re prone to error. VETS, by contrast, offers more objective and sensitive analysis.
While this approach isn’t new—the Smart Balance Master, the gold standard of postural control assessment, has been around since the late ’80s—the functionality, portability and affordability offered by VETS is unprecedented. The Smart Balance Master measures only forward and backward movements, is fixed in one place and costs about $75,000.
The first VETS prototype, with the flat screen TV and Nintendo Wii board, was validated earlier this year, meaning it meets the project’s design goals. The prototype could easily be assembled for $1,000, but Wright and his colleagues are developing a new version that operates with a smartphone and virtual reality headset, bringing the cost down even further and offering true portability.
In the virtual reality prototype, users download the program as an app on their phones and use readily-available products such as Google Cardboard, which can be purchased or created for under $10, to run it. The only major expense is the phone, which many people already have.
Neither VETS model is close to market, though the original prototype, which was designed for military use, is moving through an extensive approval process. In the meantime, Wright is partnering with the U.S. Department of Veterans Affairs to validate the smartphone model.
Wright would also have to consider whether the app would be available to the public or only for a limited time and with a prescription. Restricting its use would prevent people from misdiagnosing themselves or exacerbating their condition: People with mTBI must often refrain from using screens or even reading in order to let their brain heal properly.
“This problem has so many complicated aspects,” said Wright. “It’s really a race to find an answer, not in a competitive way, but so we know how to treat patients.”
A one-of-a-kind collaborative research space
Geoffrey Wright’s Motion-Action-Perception lab is part of Temple’s Neuromotor Science (NMS) Research Consortium, an interdisciplinary research facility that for the past four years has brought together nine faculty members and 20 students from various disciplines ranging from kinesiology and physical therapy to neuroscience and bioengineering. The labs investigate basic and clinical issues in human sensorimotor neuroscience, such as upper extremity function, posture and gait, spinal cord function, concussion, sensorimotor integration and assistive device development.
One of the only groups of labs of its kind in the country, the NMS Research Consortium houses two immersive virtual environments and a host of other state-of-the-art equipment: a KINARM robot that measures upper-limb motor control and mechanics, instrumented devices that can collect inertial measurement unit data from people in their home environment, a modified Biodex system that measures the forces generated in the lower limbs, advanced electromyography systems, motion capture systems and more. The advanced equipment allows researchers to collect granular, highly specific data that could lead to breakthroughs in how we understand and treat neuromotor issues, whether they’re from injury or aging.
Perhaps most importantly, the consortium is a way for students and faculty to communicate and collaborate with those in other disciplines and lines of research, both within the College of Public Health and at Temple as a whole.
“The plan was to create common workspaces for the students,” said Wright. “They might not get to engage with each other normally, but this gives them a space to collaborate, work together and discuss ideas.”
When the federal government declared the opioid crisis a national public health emergency in 2017, few were surprised. Between 2000 and 2015, opioids—whether prescription medications, heroin or far more potent drugs like fentanyl—have claimed more than half a million lives in the United States, decimating communities.
In Philadelphia and the surrounding area, the crisis is particularly hard-hitting. It is an issue with many facets deserving equal attention: helping those with addiction; treating overdose, illness and violent incidents related to the crisis; convincing people with addiction to seek assistance; and changing the way doctors treat and talk about pain management, to name a few.
Stopping addiction—before it starts
Health policy faculty are helping a local public health agency evaluate pain management programs.
At the Pain Academy, a federally qualified community health center run by the nonprofit Public Health Management Corporation (PHMC), people who suffer from chronic pain learn about pain management, including alternatives to opioids and the proper use of opioid-based medications. Misuse of opioid medication is common: According to the Centers for Disease Control and Prevention, prescriptions for opioid drugs quadrupled from 1999 to 2014. During the same period, deaths related to opioid overdose rose at nearly the same rate. While typical treatments seek to help people after addiction sets in, the Pain Academy offers a preventive approach.
It sounds like a no-brainer, but there’s one problem: We don’t know if it actually works.
Thanks to a collaboration between PHMC and the College of Public Health, that may soon change. Michael Halpern, associate professor in the Department of Health Services Administration and Policy, and Travis Cos, clinical psychologist at PHMC’s Care Clinic (which houses the Pain Academy), are conducting the first evaluation of the year-old program. They’re gauging how well it has worked so far and looking for ways to improve it.
Their work came about thanks to meetings, and a small grant, at the 2016 Community-Driven Research Day, an event where faculty from Temple, Thomas Jefferson and Drexel Universities, as well as Children’s Hospital of Philadelphia and the University of Pennsylvania, met with community-based organizations and discussed research and potential collaborations. There, Halpern connected with representatives from PHMC, which runs six clinics in Philadelphia, including the Care Clinic.
“[The Pain Academy] is a very innovative program. It’s patient-focused and engages people to take the lead in their own health,” said Halpern. “It’s not prescriptive. Instead, it gives people information about pain management, offers alternative strategies and encourages them to find what works best for them.”
Now, Halpern is working with Care Clinic staff and two College of Public Health faculty members—Associate Professor Marsha Zibalese-Crawford of the School of Social Work and Assistant Professor Christen Rexing of the Department of Health Services Administration and Policy—to help the program reach its potential.
To do so, the research team is reviewing electronic medical records of Pain Academy participants, without their identifying information, and determining outcomes of the program. Then, they’ll host focus groups to find out what’s changed in those people’s lives and what aspects of the program could be improved.
The study began in June 2017 and will run for 12 months. If the data looks positive, Halpern said he and his colleagues will look for additional funding for a broader study. The focus at that point would be taking what’s most effective and finding ways to implement that at similar centers in Philadelphia and other places.
“This is a program that can really empower patients,” said Halpern. “It has tremendous potential.”
Research methods help prevent hepatitis C infection in IV drug users
Social and behavioral sciences faculty use marketing research technology to develop better interventions.
One common way to spread the word about healthcare issues is to cast a wide net: Tell a broad audience everything they ever wanted to know—and probably a lot they didn’t—about a condition, test, treatment or behavior.
“I call it the kitchen sink method,” says Associate Professor Sarah Bauerle Bass, director of the college’s Risk Communication Laboratory. “That can work up to a point, but it also can mean you miss a lot as well. With our research, we’re trying to pinpoint the information specific groups are concerned about, what factors move them toward one decision and away from others, and then develop tools that can lead to better outcomes.”
The lab’s secret weapon? Marketing. Bass and her colleagues apply the techniques of high-tech market research to the field of public health. Using methods like vector modeling, perceptual mapping and eye tracking, they take in information from targeted groups and decipher which types of information and communication methods are most likely to move individuals toward healthier choices—much like a marketer might get you to buy a product.
“This approach gives us a better idea of what we don’t need to talk about,” Bass says, “And since messages can vary for different segments of the population, this marketing strategy is an important tool in customizing interventions to different groups.”
This was illustrated by her recent work surrounding Hepatitis C (HCV), a potentially debilitating infection often transmitted through needle sharing. While treatments that cure the infection are now available, current and past IV drug user are less likely than the general public to seek them out. So, Bass looked for what messages might best move each group toward getting treatment.
Through a grant from the pharmaceutical company Gilead, Bass used perceptual mapping and vector modeling to understand how to approach HCV+ methadone patients. A key point, she found, was that this group wasn’t likely to prioritize HCV treatment over their daily methadone clinic visits and other responsibilities.
Bass used these findings, published in the Journal of Health Communication in December, to develop a mobile application called “Take Charge, Get Cured.” It’s a decision-making aid that uses content and tools to encourage HCV+ methadone patients to get treatment by speaking to their specific needs. The app is currently being tested in regional methadone clinics.
“Since these messages can vary, this marketing strategy is an important tool in customizing interventions to different groups,” Bass says.
Her work with current IV drug users with HCV unveiled a different set of challenges. Through a community participatory grant, Bass surveyed IV drug users about their barriers to getting treatment. She worked with a team that included an undergraduate research assistant and staff from Prevention Point Philadelphia, a group that offers harm reduction services, such as needle exchange and free medical care, for sex workers and people with addictions.
They found that most current IV drug users do not have a regular doctor and believe they’d be judged or treated differently than other patients by healthcare providers. This was in contrast to methadone patients, who are used to being in the healthcare system and most often have some type of health insurance.
It’s also difficult for an active user to prioritize going through the steps of getting medical treatment over their regular addiction-driven routine. This meant that messages for this group needed to focus more on feeling empowered and helping them access healthcare providers that understood their needs and wouldn’t stigmatize them.
Bass took these and other factors into consideration as her team created a series of posters, booklets and business cards tailored specifically to that group. They’re available at the Point Prevention location in the Kensington section of the city.
The idea, she says, was to increase awareness of the disease and have materials that addressed this population’s very specific needs so they could take the first step to get treated.
In this way, the campaign fits with Prevention Point’s approach of providing a safe space and making services and information available for when people decide to use them.
Clinical training at the heart of the crisis
Nursing alumni and students work with community-based organizations providing care to IV drug users.
In a mobile treatment van at Hancock Street and Indiana Avenue in the Kensington neighborhood of Philadelphia, nursing alumna Sheila Dhand administers treatment for injection-related wounds firsthand.
A 2009 graduate, Dhand works in the emergency room at the Episcopal Campus of Temple University Hospital. Like the treatment van, the Episcopal Campus is located in Kensington, where there are a large number of opioid-related emergencies. She also volunteers at the Catholic Worker Clinic, a community outreach center providing meals, clothes and social services for those in need.
In the past few years, she’s been involved with Prevention Point Philadelphia as a wound care clinic coordinator, providing free treatment of abscesses, ulcers and other wounds that often impact IV drug users. In addition, Dhand coordinates clinical rotations at Prevention Point for Temple BSN students.
“They appreciated the firsthand look at the opioid epidemic,” she said, referring to the first group of students in the rotation. “They gained skills like having productive conversations with people suffering from addiction. Some came back and continued working. It struck them deeply.”
The case for a collaborative approach
Using the principles of social work to facilitate partnerships between government and researchers.
Marsha Zibalese-Crawford, associate professor in the School of Social Work, doesn’t pretend to have the answer to the opioid epidemic. However, her career in public health is based on principles that she believes can help make an impact.
Over the past two years especially, Zibalese-Crawford has worked with local and federal organizations addressing the epidemic from a public health perspective. To do so, she draws from values and skills she’s cultivated over her entire career that she encourages others to adopt as well.
“Partnership and collaboration yields impact and outcomes, whether in specific communities with community-driven issues or particular indicators like the opioid epidemic,” said Zibalese-Crawford. “We have to be open and comfortable in dialoguing without bringing our own egos, or past or current agendas. Instead, we have to come together because there’s an issue to come together about.”
As simple as it sounds, it’s not always the obvious move—or easy to do. When dealing with social problems, there are many challenges to knowing which individuals, organizations or industries to approach and how to work with them.
That’s especially so with a problem as sprawling and complex as the opioid epidemic. In 2015, officials in the High Intensity Drug Trafficking Area (HIDTA) program discussed ways of approaching the crisis. Established by the Anti-Drug Abuse Act of 1988, the HIDTA program provides resources for federal, state and local law enforcement agencies to improve coordination when combating drug trafficking; when discussing the opioid epidemic, they quickly realized that public health groups would need to join the conversation.
“It became clear to HIDTA that law enforcement can’t do it alone—that they’re not having the impact that needs to happen,” said Zibalese-Crawford.
She joined the effort as HIDTA agencies teamed up with the CDC to form the Heroin Response Strategy team. Her involvement came about thanks to her decades-long relationship with Jeremiah Daley, a former police inspector in Philadelphia’s narcotics unit and current executive director of the Philadelphia-Camden HIDTA. Initially, her role involved suggesting strategies for bringing together public safety and public health activities and examining the impact and diversity of prevention and treatment resources high-risk communities. As the work progressed, she moved into providing guidance and support for public health analysts working with HIDTA in Appalachia and the Philadelphia area.
Meanwhile, Zibalese-Crawford’s latest project is based on Temple’s campus. In November, she and Temple’s Assistant Vice President of Human Resources Learning and Development Eric Brunner and Link Martin, the director of Temple University Harrisburg, began reviewing the university’s response to the opioid crisis. The group will determine if Temple should develop a comprehensive education and crisis management response for the university and surrounding community.
On a larger scale, Zibalese-Crawford is working with the Regional Overdose Prevention Task Force in the Philadelphia area. The group comprises public officials and health professionals from the five counties surrounding Philadelphia.
Still in its early stages, the task force is determining the key issues surrounding overdose, assessing the availability of resources and services in the area and looking for ways to partner on funding and project development.
Zibalese-Crawford was invited to join through Prevention Point Philadelphia, the same group working with Bass to improve treatment access and information.
“The people involved are truly vested in trying to figure out how we can wrap our heads around the issue and how can truly reduce the fatalities and the non-fatalities around overdoses,” said Zibalese-Crawford.
Community Partner Spotlight: Prevention Point Philadelphia
College of Public Health faculty and students collaborate with Prevention Point Philadelphia on a range of research and clinical initiatives. The organization’s Temple roots run deep: both Executive Director Jose Benitez and Associate Executive Director Silvana Mazzella are alumni of the college’s School of Social Work.
Associate Professor of Social and Behavioral Sciences Sarah Bass said that Prevention Point’s effectiveness comes in part from its enduring focus on public health principles. “They’ve been addressing the opioid epidemic for 25 years, before it was in the news,” she said. “Their ability to meet people where they are, and introduce harm reduction, is a significant public health strategy.”
Organ donation is a complicated—and highly regulated—affair. When the Organ Procurement and Transplantation Network (OPTN) was established in 1984, it broke the country into 11 regions called donor service areas (DSAs), each of which has its own practices for requesting donations and carrying out national guidelines.
Organ donations overall aren’t exactly low—family decision-makers authorize organ donation at a rate of 89.1 percent, according to a study published in the American Journal of Transplantation by Heather Traino, associate professor of social and behavioral sciences, and Laura A. Siminoff, dean of the College of Public Health and Laura H. Carnell Professor of Public Health. Regionally, donation rates range from 60.4 percent to 98.1 percent.
Though these rates seem high, the number of donations still don’t meet the demand. The nonprofit advocacy group Donate Life America reports that 119,000 people in the U.S. are currently awaiting transplants, and 8,000 deaths occur annually because an organ was not donated in time. What’s more, the rate of family authorization has remained largely static since 1988.
In these acute decision-making environments—organs are only viable for a limited time after brain function ceases—family members of the deceased must quickly make a serious choice in an emotionally charged situation. “You can’t change your mind a week later,” said Siminoff. “If the decision is not to authorize organ donation, the opportunity to save the lives of others is lost.”
The impact of such decisions is difficult to overstate: Through the donation of their heart, liver, lungs, kidneys, pancreas, and intestines, one individual can save or improve the lives of up to eight people. One tissue donor’s heart valves, bone, skin, tendon and other connective tissue can help upward of 50 people in need.
Many factors influence whether donations are authorized and how donor organs are ultimately used, but Siminoff and Traino have teased out one factor that appears to intersect with the rest: communication.\
Bringing decision-makers to “yes”
Traino and Siminoff wanted to understand what makes a family decision-maker agree to organ donation and what accounts for the variation in authorization rates across regions—a tricky endeavor, given the inscrutable nature of the decision-making process and the chance that decision-makers may forget some of the finer details from an emotional event.
“The best way to do this would be to audio-record requests for donation as they occur in real time, like a fly on the wall,” Traino said. “A lot of our research examines, mostly indirectly, the content and tone of the conversations between decision-makers and requesters to tease apart what is important to decision-making.”
In a study funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the U.S. Department of Health and Human Services, Siminoff and Traino interviewed 1,339 family decision-makers from across eight of the 11 DSAs. They found distinct correlations between the final donation decision and the quantity and quality of communication that occurs during the request.
Among study participants, family decision-makers in the three regions with the lowest authorization rates also were the least satisfied with the amount of time they spent discussing donation, reported feeling more pressured to donate, and were least comfortable with the decision to donate. Conversely, decision-makers from DSA Region 8, an area with historically the highest rates of authorization, reported the highest levels of perceived quality of care and concern from healthcare providers, comfort with the person discussing donation, satisfaction with the request process, and comfort with their donation decisions.
“There is ample evidence that communication is critical to helping people who are making healthcare decisions,” Siminoff said. “It points to the need for people in all health professions to be trained as skilled communicators even as they are trained in clinical skills.”
Securing donations for research
Donations serve as more than transplants; human tissue can be stored in biobanks and used for research on genetics, health, disease and more. Here, too, the number of donations depends on the quality of communication. In a separate study, published in Genetic Testing and Molecular Biomarkers, Siminoff and Traino examined how well families who donate tissue to a biobank, or decide not to donate, understand the risks and implications of a potential confidentiality breach. Like financial data in a credit bureau, the information in a biobank is at risk of security breaches; the technology to gather data from biobanked tissue samples has outpaced our ability to protect large databases from security breaches. Doctors and researchers are faced with a question: How do we continue receiving donations while honestly discussing the potential for security breaches?
Siminoff, Traino and colleagues from Temple University and Virginia Commonwealth University studied the families of deceased individuals who made decisions about donating that individual’s tissues to a biobank for use in genetic research, and what those families knew about associated risks. While a bank breach may compromise your finances and Social Security number, breaking into a biobank could mean that all of the data pulled from your tissue is in the hands of hackers and thieves.
They found that families who agreed to donate were more likely to know that there was a risk that a patient’s identity could be revealed through a breach of confidentiality; but they were less concerned about it than families who did not donate. The donor families were also more likely to understand that researchers would not have access to the patient’s exact identity. Family decision-makers who refused donation were more concerned about risks than those who agreed to donate, and they reported lower levels of support for medical research in general. The project was part of the Genotype-Tissue Expression (GTEx) project, a National Institutes of Health-funded study.
“Tissue donation for research is taking on increasing importance in understanding the role that genes and their interaction with the environment play in the development of disease. However, for most of the public, this is still terra incognito,” Siminoff said.
Focus on Asian-American communities
There are still many unanswered questions about how specific racial and ethnic communities in the United States perceive organ donation—an important challenge in efforts to increase donation rates. In a new study funded by the NIDDK, Siminoff and other investigators at the college seek to better understand attitudes toward organ donation among the United States’ diverse Asian-American communities.
In organ donation research, there has been far less attention on Asian Americans than on Hispanics, African Americans and other racial and ethnic groups. But although Asian Americans comprise only 5.4 percent of the U.S. population, they account for half of the country’s hepatitis B infections—a disease that puts many people at risk for liver failure and the need for a transplant.
At the same time, more Asian Americans have blood Type B than do other demographic groups in the U.S., making them less compatible with many available organs. The number of Asian Americans on organ transplantation waiting lists also far exceeds those who are organ donors, and these factors mean that Asian Americans stay on waiting lists much longer than other populations.
In the new study, Siminoff, Traino and other researchers will first engage a community advisory board composed of members of Chinese, Filipino and Southeast Asian communities in Philadelphia. The board will provide input to help the investigators form focus groups and create a national survey of individuals in Asian-American communities. Using the information they gather, their goal is to develop a culturally appropriate intervention that could increase the number of individuals in this population who are willing and intend to become organ donors.
Siminoff said that a better understanding of why Asian Americans are reluctant to become organ donors will address an important public health problem—and offer insight into similar questions relating to other groups.
“Because the Asian-American community has a lot of new immigrants, this will give us a better understanding of the kinds of education that we need to do amongst new immigrant communities in general,” she said.
Strong public transportation does more than quickly get us from point A to point B. It also can lead to cleaner air, easier access to work and fewer traffic accidents—and, as researchers in the college are showing, better quality of life for people with disabilities and mental illnesses.
Together, these studies contribute to our understanding of the importance of effective communication with organ donors and decision-makers. Other studies, some of them conducted by Traino and Siminoff, suggest that strategies such as starting the conversation early, providing additional support and information, discussing the specific benefits of donation, and requesters’ confidence, sensitivity and compassion may influence a family member’s decision to donate.
“We would like to see how and if communication approaches should be tailored to different audiences, such as Asian Americans or other minority communities who may not be as familiar or comfortable with the idea of organ donation,” said Siminoff, whose program Communicating Effectively about Donation (CEaD) provides free web-based training for organ procurement staff who are tasked with approaching families for organ donation. “I would like to see everyone have the opportunity to consider this option in a way that allows them to make decisions that reflect their genuine preferences and values.”
PHOTO CREDIT: Shutterstock
PHOTO CREDIT: Temple University
On the Right Track
Public transportation can be a headache. Trains run late, subway cars are cramped, and construction, line changes and convoluted bus routes can lead to frustrating commutes. Getting to work, or even around town to run some errands, can be difficult.
For people with disabilities, everyday commuting is even harder. They often don’t drive and depend on family members, caregivers and others for some of the most important activities of daily living. According to one 2015 study, 72 percent of individuals with disabilities missed at least some of their desired activities because they didn’t have transportation, and over 70 percent of their parents and caregivers also missed out on activities because they were transporting their adult child. Meanwhile, getting around with public paratransit services, while a welcome and necessary service, can be time-consuming and burdensome, requiring users to request rides and set aside large blocks of time for pickups and drop-offs.
Travel training led by occupational therapists helps circumvent these challenges. For Beth Pfeiffer, associate professor of occupational therapy, and Susan Santalucia, assistant professor of occupational therapy, this led to an idea. If travel training with occupational therapists is effective, can travel training with peers who have already been through the training be even more effective?
Pfeiffer has explored that possibility over the past year through a program called “Enhancing Community Participation and Utilization of Employment and Health Services through Peer-Mediated and Occupational Therapy Transportation Interventions.” Using a curriculum developed by the Kennedy Center, the program first coaches people with disabilities to use public transportation effectively. Then, it trains people with autism spectrum disorder (ASD) to take their peers through the curriculum themselves.
“Peers model skills and facilitate social interactions,” said Pfeiffer. “If a person is learning a skill from someone with similar challenges, this can enhance self-efficacy, their belief that they can perform the task, which may enhance learning and strengthen their social network.”
In Pfeiffer’s pilot program, 20 young adults ages 16 to 21 with ASD will learn from peer mentors, who also have ASD, about how to navigate Philadelphia’s public transportation system. So far, nine people have completed the training, and another six began in November.
“Those are some pretty big things that came out of it. There were some really nice relationships developing socially between the participants, each other, and their mentors,” said Pfeiffer. “It’s not something we measured, but we look at it as a positive outcome.”
The findings are still preliminary, as the project is ongoing. However, early outcomes like this, and the fact that already one of the first participants has become a peer mentor, are promising. As a result, Pfeiffer is considering both expanding the program and forming partnerships that can offer similar benefits to people with psychiatric conditions such as depression and schizophrenia.
“The goal is to help as many individuals with ASD and other developmental disabilities to access meaningful participation in their communities to improve outcomes in employment, healthcare and community inclusion,” said Pfeiffer. “We hope to reduce one of the biggest barriers to access, which is transportation.”
Bicycling toward better mental health outcomes
For many with serious mental illness, transportation options are limited. The cost of public transit often restricts where people travel and how often they go. For these and other reasons, people in the population often become sedentary, contributing to isolation, loneliness and poorer mental health.
Biking addresses a number of these challenges. Bike riding is an almost-free form of transportation, especially considering bike share programs—with Philadelphia’s Indego bike sharing system, people on public assistance can sign up for a $5-a-month membership that includes unlimited hour-long rides.
It’s good exercise, and research suggests that bike riding is also beneficial for mental health, but increasing access is still a work in progress. Gretchen Snethen, assistant professor of recreation therapy, and Brandon Snead, a recreational therapist and alumnus of the college’s recreation therapy program, are members of the Temple University Collaborative on Community Inclusion, a rehabilitation and training research center. Through previous surveys and intervention research, they found that biking was an unmet need for people with mental illnesses.
In response, they’ve created a program for people in Philadelphia with serious mental illnesses who want to ride bicycles: iCan Bike. In a collaboration with Indego, the program teaches bike safety and maintenance over three weeks and six sessions. Participants practice in parking lots, learn how to use an Indego station, and finally hit the open road. Upon completion, each person receives a three-month bike share membership and helmet.
So far, 15 community members in two cohorts have completed iCan Bike. Snethen and Snead are setting up a third cohort while analyzing ridership data through Indego and measuring the physical activity of those who’ve completed the program. Though there are no concrete results yet, the reaction so far has overwhelmingly been positive. “People really enjoy it,” said Snethen. “We’re able to look at their ridership, and they’re riding independently. One person, in particular, uses it all the time.”
Snethen sees iCan Bike as a first step toward establishing similar interventions that groups can replicate in almost any town or city. While her focus is on active transportation —modes like biking or walking that also involve physical activity—Snethen is also teaming up with Pfeiffer on her public transit work with people with ASD.
Ideally, said Snethen, all these elements can be used to create personalized transportation plans for people with mental illness: providing not only more options and more flexibility, but also simply a better chance to get around town.
Photo: Students in the Department of Kinesiology conduct tests on the KINARM, which measures the neural mechanisms of muscle coordination.
The rise of automation has led to dramatic shifts in manufacturing and industry—and transformative effects on the way we approach rehabilitation. The number of elderly Americans continues to climb, and with it comes a shortage of therapists. Could increasingly complex robotics be a solution?
Using robots for rehabilitation is hardly a case of technology for technology’s sake. Occupational therapists have some important puzzles to solve. In addition to a national shortage of therapists, current rehabilitation technology is not easily transported, affordable, or optimized for post-acute care—therapy that occurs in the crucial 60-day window when patients see the greatest improvements.
Rochelle Mendonca, assistant professor of instruction in rehabilitation sciences, is working with a team of fellow occupational therapists, computer scientists and engineers at Temple and the University of Pennsylvania to develop robotics that increase patient access to occupational therapy.
Mendonca and her team are developing two solutions to the shortage. The first is an inexpensive multistation system for outpatient gyms or clinics. Each station focuses on a different type of physical function, including shoulder, wrist and finger movement. The second is a mobile unit that would move around with clients who are more able to navigate their environment.
“Current systems focus on movement, but research indicates that movement doesn’t necessarily translate into function,” said Mendonca. Both of the team’s solutions focus on functional, everyday activities that patients practice as part of the therapy regimen, such as pouring water into a glass, brushing their teeth or using a pen.
The devices are still in testing stages. For each, researchers are building and testing components individually rather than creating a final product that may need to be scrapped if it’s not effective. They’re intended for use in hospitals and clinics in rural areas and parts of the world where resources are limited; both would enable human occupational therapists, who supervise and monitor all of the work between patient and robot, to divide their attention between multiple patients while still providing quality care.
Technical Assistance in stroke rehabilitation
In a separate project funded by the National Institutes of Health, Assistant Professor of Kinesiology Jinsook Roh is on a team led by researchers at Northwestern University that is creating a wearable stroke rehabilitation device. The project addresses abnormal co-activation, a common effect of post-stroke muscle impairment due to damage to the brain. Imagine, for example, a patient’s elbow involuntarily flexing when they try to lift their shoulder to the side.
The team uses a myoelectric computer interface (MCI) to record the electrical activity of each muscle and provide feedback on which muscles are activated during movement. Those results show up in real time on a screen the patient can view. Ideally, if the person can see what’s actually happening when they try to move a certain muscle group, they can re-learn how to activate just the one they want.
So far, the interface is developed and collecting data from acute stroke survivors. In early 2018, Roh will begin analyzing that data to help determine the underlying coordination patterns taking place in abnormal co-activation.
“This can make MCI therapy more intense and more similar to everyday movements, and enable stroke survivors to begin training early into their recovery to result in even greater functional improvement,” she said. functional, everyday activities that patients practice as part of the therapy regimen, such as pouring water into a glass, brushing their teeth or using a pen.
The devices are still in testing stages. For each, researchers are building and testing components individually rather than creating a final product that may need to be scrapped if it’s not effective. They’re intended for use in hospitals and clinics in rural areas and parts of the world where resources are limited; both would enable human occupational therapists, who supervise and monitor all of the work between patient and robot, to divide their attention between multiple patients while still providing quality care.
Chronic insufficient sleep is at epidemic levels in U.S. teens, and it is thought to be a cause of difficulty with self-regulation, or adjusting one’s thinking, emotions or behavior. It can heighten the effects of depression, lead to substance abuse, and worsen academic performance.
In two studies, Robert Whitaker, professor in the college’s Department of Epidemiology and Biostatistics, examined sleep levels, school start times and their intersection. Both studies were in collaboration with other researchers, including Judith Owens, director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital.
According to one of the studies, published in Pediatrics last November, the tendency to be a night owl—to go to bed late—is a better predictor of poor self-regulation than how many hours a teen sleeps each night.
“We were surprised to learn that it is not how long you sleep on school nights that has the biggest impact on self-regulation, but when you sleep in relation to the body’s circadian rhythms,” he explained, referring to the innate sleeping and waking patterns that dictate your body’s preferred bedtime and wake time.
It’s generally understood that a teenager’s circadian pattern changes during puberty so that they have an evening chronotype, meaning they are naturally more awake at night than in the early morning. Early start times at middle and high schools force teens to wake up during their lowest levels of alertness—the equivalent of asking adults (who have different sleep patterns) to wake up at 3 a.m.
“Sleep duration matters, but it’s not everything that matters for functioning,” said Whitaker. “Teens are in a part of their biologic development when they tend to be more awake in the evening but have social demands that require them to be alert in the early morning. But, even among high school students, there’s a range of dispositions, from morning types to evening types. Morning types report better self-regulation than evening types, even after accounting for how long they sleep at night.
This finding is not meant to overshadow the importance of sleep or sleep duration. A second study, published last May in Sleep Health, is one of the largest studies to date analyzing the impact of later school start times. It came about when the Fairfax School District in Virginia, the ninth largest in the country, moved its high school start time 50 minutes later and its middle school start time 30 minutes earlier.
Whitaker and his colleagues surveyed 2,017 students about the amount and quality of their sleep, before and after start time changes, in a two-year study. The results were as expected: the high schoolers reported getting more sleep and feeling less sleepy during the day while the middle school students reported the opposite. Despite having 50 extra minutes of potential sleep, however, the high schoolers only averaged 30 minutes more sleep each night. The middle schoolers averaged 15 minutes less sleep.
However, cautioned Whitaker, “Even with the start delay, high school students started the school day at 8:10 a.m., which might be too early for many teens to function optimally.” The American Academy of Pediatrics, for example, recommends that school start no earlier than 8:30 a.m. for teens.
If simply getting more sleep isn’t the entire answer to more well-rested teenagers, then this information raises broad questions about chronotypes—for instance, can they be modified?
“We’re not talking about eye color,” said Whitaker. “Chronotype is a complex trait. It is likely to be influenced by social forces in the environment and not just genetics.” He pointed to the evidence that the onset of puberty can be affected by a person’s environment; so, he argues, a person’s chronotype can likely be changed.
If it is possible to make such a change, then perhaps snooze buttons will finally get a well-deserved rest—even if it’s just for five more minutes.
PHOTO CREDIT: iStock
How confident do men feel about their ability to be a dad? It’s a question that’s not often asked, particularly in high-poverty communities, where social and financial pressures can complicate family systems.
“These can be very complex family situations, and there has been very little research looking at what that involves and what effect that has on a father’s parenting,” said Jay Fagan, a professor at the School of Social Work.
For the past two years, he has been looking at how fathers who have children with multiple mothers view the relationships they have with their children. In particular, Fagan focuses on how they co-parent with the mothers and extended family members often involved in raising the children.
His work in this area is done through the Fatherhood Research and Practice Network (FRPN), where Fagan is principal investigator. A five-year project funded by the U.S. Department of Health and Human Services, the FRPN provides support and funding to researchers and practitioners throughout the United States to conduct rigorous evaluations of community-based fatherhood programs providing job search, personal finance and parenting education and assistance.
FRPN researchers found a possible link between the quality of the relationships in a father’s co-parenting network and his feelings of closeness to his child. Those relationships also affect a father’s sense of self-efficacy, or the belief he can succeed, as a parent. That led Fagan and his team, including senior research coordinator and Temple master of social work alumna Rebecca Kaufman to interview 650 fathers last year who do not live with at least one of their children.
They found that the more cooperative the relationships are among a father’s co-parenting network, the more likely he is to feel a sense of self-efficacy and report feeling close to his child. But, noted Fagan, they aren’t sure why this may be true.
“Nobody has done research quite like this, so it’s a first step in trying to better understand these kinds of phenomena,” he said.
The findings were published in the Journal of Family Psychology in late 2016. Fagan, Kaufman and their colleagues also developed questionnaires based on that study, that help social work practitioners assess a father’s relationships with his children and co-parenting networks.
This year, Fagan continued exploring these links. In cases where fathers had children with multiple mothers, for instance, 13 percent of those Fagan interviewed don’t engage in co-parenting with any of the mothers. However, once co-parenting is established, the fathers reported high levels of contact and cooperation with their co-parenting networks. He also found that fathers’ co-parenting contact and cooperation with relatives was more frequent and cooperative than contact and cooperation with co-parenting mothers.
The research also revealed a cultural divide. There was virtually no difference between African-American, Hispanic and white fathers in terms of the average number of co-parenting mothers and other relatives they engaged with. However, Hispanic and African-American fathers had more contact and reported more cooperation with coparenting relatives than non-Hispanic white fathers.
“There are a lot of cultural differences in how these groups of fathers are relating to co-parenting relatives,” said Fagan. “The implication is that if you’re working with African- American and Hispanic fathers, co-parenting relatives play a more important part in their lives than their white counterparts.”
This information can inform how programs designed to help low-income fathers should work. Currently, Fagan noted, many programs address just one mother and father rather than everyone involved with raising the children.
“They really should start to pay attention to the relationships of all the relatives with whom the father co-parents and start to develop interventions that can address that,” he said. “Not just the mothers, but also how the whole system of co-parents are communicating and interacting with each other as a network.”
PHOTO CREDIT: iStock
Anjali Chainani earned her MSW and MPH degrees at Temple in 2010 while working in the office of Jannie L. Blackwell, Councilwoman for the 3rd District of Philadelphia. In January 2016, Chainani became director of policy in the Office of Philadelphia Mayor James F. Kenney.
What happens in a typical day at the Mayor’s Office?
As director of policy, I work closely with the executive team to forward the administration’s priorities, and I help coordinate policy development to ensure the success of important long-term investments such as universal pre-K, community schools, and systemic improvements to parks, recreation centers and libraries.
I also work closely with City Council to sustain a shared agenda that will improve the education, health and prosperity of children and families across the city of Philadelphia for years to come. I’m not sure I can say there are “typical” days. No day is the same, and it keeps me and my team on our toes.
What role does research play in formulating social policy?
Research is crucial to the development of social policy. It allows us to assess the risks and benefits of policy proposals, implement evidence-based interventions, and evaluate what works best. Because the government has limited resources and service provision is a huge priority, we don’t always have time to reflect and trace effectiveness to its causes.
In February 2017, the Kenney administration formally launched GovLabPHL, a multi-agency team led by the Mayor’s Policy Office to further embed evidence-based and data-driven methods across city government programs and services. My team and I lead the lab work, which is focused on three evidence-based frameworks—behavioral science, human-centered design and trauma-informed care—to inform broader research and create policy goals across the city.
What makes a social worker a good policy administrator?
As a social worker, I am confident in my abilities to authentically connect with individuals and with the communities to which they belong about what really matters to them, and how we can work together to make a real and meaningful difference for one another.
How did Temple help you prepare for your career?
I went to school in the evening, and I was surrounded by other students who were working during the day, which allowed me to build valuable connections. I was also always able to relate my work, and the issues going on in our city, to my coursework. The employment-based internship option really worked for me.
What does it mean to have a degree from Temple?
To me, being a Temple graduate means being disciplined, connected, noticeable and equipped with the skills to succeed —and, overall, it means that you are quite lovely.
As manager of care transitions at Temple University Hospital, Jeff Slocum seeks to provide what he calls “a conduit to better care” in patients’ medical homes and neighborhoods. Slocum, a student in the Doctor of Nursing Practice program, oversees a group of registered nurses, social workers and community health workers (CHWs) who assist patients with post-discharge needs after a hospitalization. Many patients skip doctor appointments, do not purchase medicine, and do not have access to reliable transportation, which present major barriers to long-term health outcomes.
The CHWs aim to address some of those problems. As a lack of health literacy can block access to care, the CHWs can “translate” the sometimes jargon-filled, scientific speak of medical institutions. They are patient advocates, lending assistance in securing transportation, food, housing and other needs, and they attend doctor’s appointments with the patient.
The CHWs also can assist with non-medical barriers, such as family and financial needs. As laypeople, rather than nurses or medical professionals, they can speak the language, and understand the concerns, of people in the community. “They are there to act as a non-medical, non-clinical person...as a peer-to-peer assistant,” said Slocum.
The CHWs also serve as educators for community programs. Through a grant from the Centers for Disease Control and Prevention, the workers provide classes to people who are diagnosed as pre-diabetic. CHWs go to churches and community centers and teach prevention strategies, such as tips on eating healthy, nutritional meals.
Each CHW receives initial job training at Temple’s Center for Social Policy and Community Development. The CHW program teaches open-ended questioning, conflict management and other interpersonal skills; in addition, they attend regular trainings from city agencies, homeless shelters and nonprofit organizations.
Slocum was hired as a heart failure nurse educator when he started at Temple University Hospital in 2012. Later, he joined the care transitions program, which formed as the hospital recognized that patients often encountered problems once they returned home. As a former home care nurse, Slocum understands the importance of more closely connecting people in the community with the healthcare they receive.
“As nurses and doctors, we’re often focused on taking care of the next patient,” said Slocum. “The community health workers can really focus on one person for an extended period of time.”
Since its inception in 2014, the program has grown from a three-employee operation into one with 14 CHWs, six registered nurses and one social worker. Each CHW attends to between 20 and 25 patient cases at any given time. Slocum reports that the program has been a success: Whereas many of the care recipients were previously treated only in the emergency room for non-emergent needs such as a sore throat, they are now engaging with their primary care physician, attending medical appointments, and having conversations about chronic care disease management and prevention.
PHOTO: Assistant Professor Tom Martin works with a student in his healthcare security class.
New Undergraduate Program Offers Path Toward Professional Degrees
In 2017, the Department of Kinesiology unveiled a new bachelor of science in health professions degree, an interdisciplinary program for students pursuing a professional degree in one of the health professions after their undergraduate studies. The program sets Temple apart from other universities in the Philadelphia area, which still only offer concentrations in various health professions.
In the new degree program, students work closely with advisors in creating a track that’s tailored to the professional programs that they are interested in pursuing. The format also frees up credit hours so that students can take more elective classes for a well-rounded education.
“The degree is not as much about the here and now as it is about what you need for later,” explained Lois Butcher, assistant professor of instruction in kinesiology. “Students will come out essentially with a complete section of their graduate school application. They’ll have the diversity of requirements that are requested and also the electives that make you look better as a candidate.”
Health Informatics Class Hacks into Healthcare Security
This year, students in the master of science in health informatics graduate program don’t just talk about protecting information; they also try to steal it.
The new Privacy and Security: Protecting Healthcare Data class offers a hands-on approach to keeping protected health information secure through “white hat hacking,” where people attempt to breach secure websites and online systems in order to test security rather than accomplish anything malicious.
The course fulfills a growing need for healthcare cybersecurity; in 2009, the federal government invested around $30 billion for digitizing virtually all patient records in the United States so they can be accessed electronically. Penalties for a security leak can be costly: For each record that gets out, companies can be liable for $50,000.
In the course, students experiment with everything from ancient cryptography to modern data encryption, website security and scamming techniques. In one assignment, for instance, they create “phishing” emails, where they forge legitimate emails from real healthcare professionals in attempts to trick their professor into divulging his personal account information. By understanding how these emails are constructed—from using staff and faculty photos found on the internet to creating fake website domains that are almost indistinguishable from real ones—students learn what to look for when they receive similar emails themselves.
“Students really respond to this type of learning environment,” said Assistant Professor and Graduate Program Director Thomas Martin. “When you challenge students and give them enough flexibility, I think they surprise you as an instructor.”