Dear friends and alumni:
Welcome to the College of Public Health’s 2018 Year In Review. Our college continues to redefine the boundaries of public health education, research and practice, and this year we marked several major milestones in our unprecedented expansion:
- School-level accreditation by the Council on Education for Public Health in Fall 2017 (in addition to our 26 program-specific accreditations).
- The opening of state-of-the-art clinical education spaces for our physical therapy, occupational therapy and athletic training programs, as well as our other clinical disciplines.
- The founding of the College of Public Health Alumni Association, which builds on the energy of our more than 40,000 alumni.
- Perhaps most exciting, plans for a new college building that will house all of our departments for the first time. We expect to begin construction on the college’s new home in late 2019.
Throughout this growth runs a continuous drive to anticipate and respond to sweeping changes in the healthcare landscape. We see a future where collaboration between public health and clinical fields is imperative, and where interprofessional teams are the standard for ensuring better patient outcomes. Our college’s transdisciplinary structure—which connects health services, social welfare and traditional public health disciplines—means that we are uniquely equipped to address the most pressing health issues in the coming years.
We are making innovative connections, and the stories we share here reflect this. At our Center for Obesity Research and Education, for example, faculty are collaborating with Temple’s Kornberg School of Dentistry to introduce nutrition and obesity screenings into routine dentist visits for children. In the face of global obesity trends, novel interventions like this are more than just a good idea—they are essential.
We are also reimagining clinical education. This year our bachelor of science in nursing (BSN) program launched Community Home, a population-based clinical training approach that places each student within one of several Philadelphia neighborhoods for the length of their undergraduate program. In addition to practicing supervised clinical care, students work with community partners—from educators to neighborhood leaders to service providers—on initiatives that contribute to the well-being of the community. Among many other projects, BSN students have helped to establish a new lending library for elementary school children in North Philadelphia. This forward-thinking educational paradigm emphasizes the link between community and individual health, which in turn prepares students to promote health in its fullest form as practicing nurses.
These and other stories in this magazine explore the bridges we are building—between our college and our community, between research and practice—that reflect our vision for the future of healthcare. Our interprofessional approach defines and energizes our work, and it is key to making the changes required of our fields in a shifting health landscape. At the College of Public Health, we know that the only constant is change—and we are ready for it.
Dean of the College of Public Health
Laura H. Carnell Professor of Public Health
About the College
Temple’s College of Public Health is leading a new movement to reimagine the future of public health. Through transdisciplinary research and interprofessional 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, as well as the School of Social Work. Across our 20 disciplines and 43 academic programs, we are working to serve our students and our community.
Temple’s College of Public Health received full accreditation by the Council on Education for Public Health (CEPH) in October 2017. The college is one of only two CEPH-accredited schools of public health in the Philadelphia region, and one of three in the state of Pennsylvania. The college’s accreditation is in addition to its 26 program specific accreditations including its master of public health program, which has been CEPH-accredited since 1985.
Faculty in the Media
The New York Times
Dean and Laura H. Carnell Professor of Public Health Laura A. Siminoff was quoted in a story about the factors contributing to low organ donation rates in a city as large and progressive as New York. Read more.
NPR’s Latino USA
Lisa Bedore, department chair and professor of communication sciences and disorders, discussed what parents should expect and consider when raising children to be bilingual. Read more.
WHYY’s The Pulse
David B. Sarwer, associate dean for research and director of the Center for Obesity Research and Education, explained that Philadelphia’s controversial soda tax may already be making a positive impact on obesity rates in the city. Read more.
Roger Ideishi, program director and professor of occupational therapy, was featured in a story about the accessible performances he has helped the Pennsylvania Ballet to develop for children with autism spectrum disorder and their families. Read more.
Santa Barbara Independent
Associate Professor of Recreational Therapy Gretchen Snethen discussed a program she developed that helps individuals with severe mental illness to utilize Philadelphia’s city bike shares. Read more.
The Philadelphia Inquirer
William Aaronson, department chair and associate professor of health services administration and policy, spoke about the ways a proposed merger between CVS Health and Aetna could impact consumer choice in healthcare. Read more.
I am pleased to share that research at the College of Public Health continues to flourish. The numbers tell an impressive story: In the past fiscal year, our faculty were awarded 45 new grants totaling more than $18 million in funding, and the average award per project is just less than $400,000. Along with these measures of success, we also know that in order for our research to be truly meaningful, it must be impactful.
Our faculty members’ research activity reflects this. Some are conducting work that directly impacts the health and well-being of the Philadelphia community in which we are located. Others are contributing to public health policy and legislation at state and national levels. And still others have an international focus, with research that involves collaborations in Latin America, Southeast Asia and Eastern Europe.
This past year our faculty launched new projects in many of our areas of research strength—including obesity, traumatic brain injury and HIV/AIDS—which you will read about in this magazine. We have also secured grant funding for new areas of research. This includes the college’s first-ever Gates Foundation award to support an initiative on drinking water safety and a new grant from the U.S. Department of Defense that focuses on communication practices in organ donation, specifically surrounding new procedures of hand and face transplantation. These high-profile projects will serve as foundations for further expansion of our research portfolio.
I am also proud of our early-career researchers’ important work. Dr. Elizabeth Thomas received a five-year National Institutes of Health (NIH) grant to support her research on peer support services for individuals with serious mental illness. Dr. Gabriel Tajeu received a new NIH award to study hypertension and medication adherence in individuals with extreme obesity. They are among several younger researchers who have received awards this past year, which we are proud to share with you here. These achievements underscore both the talent of our faculty and our commitment to promoting research success among all of our investigators. They also illustrate the myriad ways in which our research advances health and well-being among a wide range of populations. The coming year holds great potential for many more advances in the college’s research activity, and I look forward to sharing further updates on our scholarship.
Associate Dean for Research
Professor of Social and Behavioral Sciences Director, Center for Obesity Research and Education
College Receives First Gates Foundation Grant
With new funding, Heather Murphy works with local partners toward improved sanitation worldwide
The United Nations estimates that, by 2050, one in four people will live in a country with shortages of fresh water. As it is now, nearly 2 billion people use water sources that are contaminated with fecal matter. The situation is dire: More children die from diarrheal diseases than higher-profile illnesses such as malaria.
More than 80 percent of these deaths are attributable to unsafe water, which also contributes to stunted growth, malnutrition, and decreases in education or, for workers, productivity. Whether due to untreated water or lack of access to a latrine, poor sanitation impacts a country in more than just public health; it is also a detriment to a nation’s economy and continued development. Despite this, sanitation guidelines still reference a 1983 publication, missing out on 30 years of research in water pathogens and treatment.
To address these issues, Heather Murphy, assistant professor in the Department of Epidemiology and Biostatistics, will work with stakeholders in Uganda and India to improve sanitation conditions as part of a project funded by the Bill and Melinda Gates Foundation—the first such grant received by the College of Public Health.
Led by Joan Rose at Michigan State University (MSU), the project builds off of the Global Water Pathogen Project (GWPP), a collaboration led by Rose and the United Nations Educational, Scientific and Cultural Organization (UNESCO). The GWPP involves more than 200 researchers around the world who are collecting and compiling data on water pathogens in order to develop the technology, tools and information to improve sanitation worldwide. Their findings were compiled into an open-access online knowledge base and will be printed in multilingual publications from UNESCO.
“Roughly 2.5 billion people in the world don’t have access to improved sanitation,” said Murphy, who traveled to Uganda at the end of June to begin implementing the GWPP’s findings. “They don’t have access to a toilet or a latrine, which has consequences on safe drinking water. These issues aren’t often talked about, but they are preventable.”
Murphy’s work abroad is part of the GWPP’s Water Pathogen Knowledge to Practice (Water-K2P) project, the phase of the GWPP that seeks to inform local decision-makers and water and safety planners about the updated pathogen data and information. In both Uganda and India, she and her colleagues from San Diego State University, MSU, Wageningen University and a team of stakeholders on the ground (including the Ugandan National Water and Sewerage Corporation) will explore how they can best apply information gathered from the GWPP to inform sanitation policy, guidelines and practices.
In Kampala, Uganda, less than 10 percent of the population has access to a sewer system, and many people in rural areas still resort to open defecation. Murphy and her team will hold workshops with various stakeholders who focus on sewage and public health to train them on the updated sanitation knowledge generated by the GWPP. They hope to create a series of tools that those stakeholders can use, including a mobile local safe sanitation app for smartphones and visualization tools that map areas with poor sanitation. In July, they finished the first series of workshops in Kampala.
After two years of work in Uganda, they will shift their focus to India, where they will test whether these tools can easily transfer between countries. “We’re hoping that the project provides a foundation for how you can translate scientific knowledge from one country to another,” said Murphy. “We’ve made it available, but now we’re trying to make it accessible and usable.
Watch more about Murphy’s work in water safety:
Two studies at the College of Public Health offer a glimpse into the ways the college is working toward a better quality of life for military members and veterans who face battles—some visible, some not—even after they have finished their service.
Complex transplantation presents complex challenges
More than 1,600 service members from the conflicts in Afghanistan, Iraq and Syria have experienced devastating battle injuries—the loss of a face, for instance, or limbs, hands or feet—according to a 2015 report from the Congressional Research Service. While some veterans are treated through a combination of prosthetics and physical therapy, a new form of transplantation could help provide a new face or hands for those who experience particularly catastrophic blast injuries.
Known as vascularized composite allografts (VCAs), these larger sections of biological material are made up of multiple interconnected tissues and present a promising, relatively new form of transplantation after injury. Unlike a single organ (such as a kidney) or a tissue (like a piece of bone), VCAs involve very complex systems ofmuscle, bone, skin, nerves, blood vessels and connective tissues and include body parts such as the face, forearms, hands, legs, feet, and even uterus and penis.
Not only is VCA transplantation more difficult from a surgical perspective, but it also involves a bigger ask of families of deceased patients who could donate. In addition to asking a grieving family to donate something more known and familiar, such as a liver, the staff of organ procurement organizations must now discuss a larger and more visible organ.
“When the first U.S. face transplant occurred in 2005, even the professionals at the local organ procurement organization were unsure what it was and how a family would respond to the request for a donor patient’s face,” said Laura A. Siminoff, dean of the College of Public Health and Laura H. Carnell Professor of Public Health. “It’s still an open question as to how we should really raise this with a grieving family.”
Requests for VCA donation may call for new approaches when communicating with the donor’s family, she said. Those conversations are the subject of a new study by Siminoff and Heather Gardiner, director of community-engaged research and practice and associate professor in the Department of Social and Behavioral Sciences. Funded by a $1.5 million, three-year grant from the U.S. Department of Defense, Siminoff and Gardiner will develop a training program targeting organ procurement staff and the conversations that take place in the solicitation of VCAs.
Twenty-first century weaponry has outpaced our ability to heal the wounds that these weapons cause,” said Gardiner. “Military personnel come back from deployment with injuries that require large transplants that can restore functionality and help people more easily integrate into civilian life.”
Siminoff and Gardiner have an extensive history of organ donation research. Their previous studies have examined differences in organ donation attitudes and rates across the country; the factors that go into the decision to donate—or to refuse to donate; how to adequately explain the security risks of the data derived from tissue samples; and attitudes toward donation across different racial and ethnic groups. But this is their first study exploring VCA donation, which has only been federally regulated since 2014.
In the first year, the research team will use focus groups with members of the general public to understand perceptions surrounding VCA donation and the factors that would motivate individuals to donate. The team will also interview organ procurement staff about attitudes and knowledge regarding VCA donation, challenges faced in asking for donations, and thoughts about how to improve VCA requests. The findings will be incorporated into an evidence-based, online training program to educate procurement staff about VCA and communication techniques proven to increase the likelihood of donation. The program, Communicating Effectively about VCA Donation, will be adapted from a training program Siminoff and Gardiner previously developed to help procurement staff more effectively ask for solid organ tissue and organ donations.
There are a multitude of reasons that families or decision-makers might be hesitant to agree to a VCA donation, says Gardiner. Donation of facial tissue, for example, removes the possibility of a viewing or an open-casket funeral. Since VCA increases the chance of seeing a recognizable part of a loved one after they are deceased, some families may be concerned about ever meeting the recipient of the donation, even casually running into them in the supermarket or at the mall. Members of some cultures or religions may also hold beliefs that forbid dismemberment after death, making any type of organ, tissue or VCA donation culturally unacceptable.
However, Siminoff and Gardiner believe that once decision-makers are made aware of the benefits of VCA transplants—reducing pain, increasing mobility and function, and improving quality of life—they may be more inclined to donate.
It’s something the team has witnessed in solid organ and tissue donation, as well: Often, families report that knowledge that the donation saved or vastly improved the life of another person in need helps in grieving the loss of a beloved family member.
THE HIDDEN IMPACTS OF MTBI
Not all military injuries are visible. Studies have suggested that somewhere between 15 and 22 percent of personnel experience mild traumatic brain injury (mTBI)—affecting as many as 300,000 service members.
W. Geoffrey Wright, director of neuromotor science programs and associate professor in the Department of Physical Therapy, has long researched mTBI and its effects. Now, he’s applying his expertise to active duty U.S. Coast Guard personnel in a new study exploring postural control and stress reactivity, published in the March/April supplement to Military Medicine. For the study, he assessed stability, startle response and neurocognitive performance in coast guard members who previously experienced mTBI. It builds on Wright’s previous work with the Virtual Environment TBI Screen (VETS), a portable and easily deployed way to test the impacts of mTBI using video game technology.
“Because of better armor, helmets and overall protection, more soldiers are surviving combat in recent military conflicts,” said Wright. “This, of course, is a very happy outcome for our military, veterans and their families. The only downside is that there are hidden injuries that go unrecognized by the soldier and undetected by the clinician, yet can have serious long-term negative effects on the soldier’s well-being.”
The 36 participants had no deployment-limiting medical condition but had a history of brain injury, including 39 percent of participants who had a previous mTBI and some who had experienced more than one. Participants were recruited by experimenters at Coast Guard boat stations at Port Canaveral and Port Lauderdale in Florida. The mTBI came from a variety of sources: blasts, falls, sports and vehicle injuries, and other blunt force traumas. Each participant was tested for balance on a variety of surfaces and screen types (still images versus rotating) and for response to auditory stimuli.
Wright and his team found that the number of mTBI incidents had a significant effect on posture: When standing on an unstable foam surface and viewing a dynamically moving virtual scene, they found a difference (between those with a history of mTBI and those who reported no history) in stability and balance. In addition, those with a history of mTBI exhibited responses to audio stimuli that were smaller in magnitude than those without. These deficits were detected despite those participants self-reporting no symptoms—without this testing, such deficits may have gone undetected, even though they could have a meaningful impact on performance. And because the demands of military life require near-perfect cognition, small deficits can lead to big consequences.
“In other populations, the two deficits—startle reactivity and balance on unstable surfaces with conflicting visual stimuli—may not only go unnoticed but may be easily dismissed as having little functional impact,” Wright wrote.
A further challenge—and one that Wright has also explored, in research with a colleague at the U.S. Department of Veterans Affairs (VA)—is separating the effects of mTBI from the effects of PTSD, which impacts somewhere between 10 and 20 percent of veterans of the conflicts in Iraq and Afghanistan, according to the VA. “The research we’ve been doing initially focused on detecting lingering signs of mTBI, which could help guide clinical decision-making,rehabilitation and return-to-duty decisions,” said Wright. But, he added, “the symptoms of mTBI and PTSD often co-occur and are sometimes difficult to dissociate.”
Bryan McCormick receives Fulbright to study mental health organizations in postwar Southeastern Europe
Understanding the state of mental health services in Bosnia and Herzegovina starts with a brief history lesson, says Bryan McCormick, professor in the Department of Rehabilitation Sciences. In the early 1990s, the Socialist Federal Republic of Yugoslavia dissolved to make up seven independent countries. Following the dissolution, a series of ethnic conflicts ensued within many of these countries— most severely in Bosnia and Herzegovina, which contained a number of religious and ethnic groups. The Bosnian War raged for more than three years, further stressing a country with already-limited resources.
“The population went through a war that happened everywhere around them,” said McCormick. “There were no front lines; the fighting was everywhere. They saw ethnic cleansing and the razing of villages. Many people had nothing to go back to.”
The signing of the Dayton Accords ended the war, dividing the country along religious and ethnic lines. Though the fighting stopped, this created new challenges. The country was split into 10 cantons— smaller member municipalities that can vary widely in ethnic makeup and governing philosophies—and such division complicates large-scale changes, especially in the field of mental health.
“It is a fragmented system,” said McCormick. “The conditions that exist in one canton may not exist in another. This, combined with a stigma against those who use mental health services, makes change difficult.”
McCormick’s history in postwar mental health in Eastern Europe began when he interned with the International Organization for Migration in Kosovo in 2003, where he visited mental health facilities and trained workers on the therapeutic use of activity. A certified recreational therapist, McCormick is widely recognized as one of the top researchers in recreational therapy for people with severe mental illnesses. He is a member of the Temple University Collaborative on Community Inclusion, which improves community participation opportunities for people with psychiatric disabilities.
The work in Kosovo led to research in Serbia, where he looked at support networks in adults with serious mental illness. Next: a 2010 Fulbright award to study the relationship between city size and quality of mental health treatment in Kragujevac, Belgrade and other major Serbian cities.
In fall 2017 and summer 2018, McCormick traveled to Bosnia and Herzegovina, this time on a Fulbright Research and Teaching Award, to identify needs in community mental health organizations. The findings from McCormick’s evaluations will be used to improve the country’s “users’ associations,” which are groups created to facilitate self-advocacy among mental health service consumers. After the war, the EU and Switzerland helped fund a restructuring of the mental health system in Bosnia and Herzegovina to include these users’ associations, but there’s no systemwide mandate for how they should be run, and resources for their ongoing existence are scarce. As in other countries, stigma toward mental illness can inhibit the success of these organizations, which depend largely on their members self-identifying and self-advocating.
McCormick partnered with local nongovernmental organizations (NGOs) and used surveys and questionnaires to identify activities perceived as important by members of these users’ associations, as well as to assess outcomes and identify perceptions of the associations’ effectiveness. McCormick also lectured on community participation, community inclusion, and the health impact of isolation and inactivity at the University of Tuzla in Tuzla, Bosnia and Herzegovina.
McCormick said that the users’ associations can vary dramatically across the country. Some are little more than informal meetups with few services; others are managed by professional staff who can be dismissive of the needs of mental health service consumers; and others offer a full range of mental health services and are managed autonomously by the very people receiving those services.
Although systemwide changes may not be possible until the distant future, McCormick is optimistic about the power of the users themselves. “If the associations can continue to innovate and advocate for themselves as equal to other parts of the mental health systems, there’s hope that they could serve as an integral part of mental health treatment in the country,” he said.
In recent decades, the medical community has learned to better manage high blood pressure (HBP), the top risk factor for strokes and heart attacks, resulting in fewer people diagnosed with HBP. Still, many who technically had low blood pressure maintained an elevated risk for cardiovascular disease (CVD), high cholesterol and diabetes.
That’s why researchers began rethinking how we approach the disease. New research from Gabriel S. Tajeu, assistant professor of health services administration and policy, builds on previous landmark studies such as the Heart Outcomes Prevention Evaluation-3 trial (HOPE-3) and the Systolic Blood Pressure Intervention Trial (SPRINT) that pushed for re-evaluation of the way we detect and treat CVD. Thanks to this body of evidence, the American Heart Association lowered the threshold for HBP classification in November 2017.
Tajeu and a team of researchers surveyed more than 31,000 people who were recruited in the early- to mid-2000s for large cohort studies and who hadn’t had any CVD events such as heart attack or stroke. They obtained baseline demographic and clinical information from the cohorts and measured participants’ blood pressure over an average of 7.5 years.
The results, published in Circulation, pointed to the insufficiency of the former guidelines. Of those who experienced CVD events during the study, more than 60 percent had blood pressure under the former guidelines of 140/90. They also assessed the subjects’ 10-year CVD risk: More than 50 percent of the subjects with blood pressure under 140/90 had a 10-year CVD risk higher than 7.5 percent—a threshold at which doctors should address CVD risk factors through medication or lifestyle changes—but only a little more than a third of them were taking antihypertensive medication.
These results were part of a growing body of evidence that treatment of hypertension may need to occur at blood pressure thresholds lower than 140/90. Tajeu also asserted that using a 10-year risk assessment for CVD may be more beneficial than looking almost exclusively at blood pressure. That means calculating a patient’s cholesterol levels and factoring in whether he or she smokes or has diabetes, for instance, to predict whether the patient has more than a 7.5 percent chance of having a heart attack or stroke in the next 10 years.
“We’re doing a good job managing hypertension in the U.S., but there is still room for improvement,” said Tajeu. “We need to continue our efforts and now potentially get a little more sophisticated to determine who should be treated for chronic diseases that increase cardiovascular disease risk.”
The effects of psychosis can be devastating for both individuals and their families; it’s especially impactful for those aged 18 to 25, the period classified as emerging adulthood.
“Unfortunately, I’ve heard many stories through my work: People are doing well in school or recently started their careers, and they have an interruption that was caused by mental illness,” said Elizabeth Thomas, a research scientist in Temple University’s Collaborative on Community Inclusion (see sidebar). As these young adults experience symptoms like hallucinations or delusions, she said, “they start to withdraw socially...They often don’t know how to deal with that.”
Thanks to a new National Institute of Mental Health K08 award for early-career research, Thomas is beginning a four-year project seeking to better engage emerging adults with early psychosis in evidence-based early intervention services known as coordinated specialty care (CSC). She’ll develop a peer-delivered decision support intervention for these young adults, as people with mental illness typically are more engaged when receiving support from others who have shared that experience. Peers offer a level of emotional connection that other care providers often cannot, and they have the ability to share firsthand knowledge of the experience.
For the first two years, Thomas and others on the project will interview young people already in a local program providing early psychosis interventions. Together with a mentorship committee composed of researchers and international experts on early intervention, Thomas and her colleagues will try to answer questions that will guide the pilot program: What are these young people’s treatment decision-making needs? What have they experienced so far? What parts of their treatment experiences have been most difficult?
After this period of information gathering, the researchers will spend two years piloting the peer support program with
20 early adults in interventions at Psychosis Education, Assessment, Care and Empowerment (PEACE) in Philadelphia, a CSC program that helps people manage the early stages of psychosis.
The peers, who have experience living with psychosis symptoms, will coach CSC support staff and work firsthand with those young adults to help them make decisions about their care. As the early adults are in their first six months of treatment for psychosis, the program is targeting them at a critical point. Psychosis symptoms don’t have to prevent people from living fulfilling, functioning lives, Thomas said, and early and consistent treatment can help emerging adults minimize the long-term impact of their mental illness.
Megan Urbanski, a doctoral student pursuing her PhD in social and behavioral sciences at the college, received the Ruth L. Kirschstein National Research Service Award, a two-year pre-doctoral fellowship from the National Institute of Diabetes and Digestive and Kidney Diseases to study the treatment decision-making preferences of people diagnosed with kidney failure, or end-stage renal disease (ESRD). Heather Gardiner, associate professor of social and behavioral sciences, is sponsoring the project, with Dean Laura A. Siminoff as co-sponsor.
Urbanski is collaborating with Temple University Hospital to recruit participants and conduct the study. They plan to compare the experiences of those who receive an unexpected diagnosis of ESRD with those who have planned renal replacement initiation —that is, those who were aware of their kidney disease before they were diagnosed with ESRD and thus given a sufficient amount of time to learn more about the condition and prepare for treatment.
As it is, approximately 36 percent of people who reach ESRD were likely unaware that they had kidney disease at all. The condition is often asymptomatic until end-stage, at which point people are typically faced with shortness of breath, fluid retention, nausea, confusion and other symptoms.
Patients then face a whirlwind of conversations, treatment plans and options. They are often instantly started on dialysis and may be given information about kidney transplantation; they may be told about home dialysis; and they may or may not be given the opportunity to ask all of the questions that they undoubtedly have. Communication about treatment can be inconsistent depending on the doctor, patient and situation, and part of the problem is that we don’t know how or when patients are given this information—and, most importantly, we don’t know how well they receive and comprehend it.
Urbanski will recruit participants and conduct interviews and analysis for 12-14 months; she plans to talk to approximately 25 patients who received unexpected diagnoses of ESRD, as well as 25 patients with planned renal replacement therapy, who typically face better outcomes. In addition, she’ll interview each patient’s nephrologist to compare the doctor’s interpretation of the events—how they communicated options and information on the disease—with that of the patient. The patients are from Temple University Hospital, which treats a large number of minorities, who Urbanski says are disproportionately affected by ESRD.
“The end-stage renal disease population is vulnerable, and this subset of the ESRD population in particular faces higher mortality rates and limited access to kidney transplantation,” said Urbanski. “We’re looking to see if there’s a way to improve those health outcomes, thereby helping to reduce some of the disparities that currently exist among this group.”
Schoolhouse Rock! may have answered the question, “Conjunction junction, what’s your function?” back in 1973, but that part of speech and its friends may do more than just hooking up words and phrases and clauses. Grammar and language skills—from understanding conjunctions to improving vocabulary—might also be the biggest predictor of a child’s success in school.
To determine the long-term effect of different subject areas on future success, Assistant Professor of Communication Sciences and Disorders Rebecca Alper looked at a comprehensive set of school readiness skills in a study led by researchers at the University of Washington and in collaboration with Temple’s College of Liberal Arts, the University of Delaware and the University of North Carolina.
They examined data from more than 1,200 children in the National Institute of Child Health & Human Development’s Study of Early Child Care and Youth Development, which measured academic and social skills at school entry and in first, third and fifth grade.
Drawing from that data, researchers examined skills in multiple areas: social/emotional ability, attention, health, reading, math and language. They found that a child’s proficiency with language skills when entering school predicted their performance in math, reading and social skills in addition to language ability; in comparison, other skills predicted proficiency in fewer subject areas.
“We found that early language skills are critical to children’s success in school,” said Alper. “The foundation for success in school starts long before the age of 5 with frequent, high-quality early communication interactions. Devoting time, energy and resources to supporting early interaction and language skills during the birth-to-5 period offers a large potential return on investment in helping children succeed.”
A different kind of dentist
For a child, a visit to the dentist is a routine affair: Playing with toys or coloring in the waiting area, a gentle call back to see the dentist, growing anxiety as the tools are prepared, and a series of questions: “Have you been brushing? Have you been flossing?” Then, the dentist asks about the child’s diet and has them step on the scale.
For now, that last part may not be so common, but a new collaboration between faculty members in the Department of Social and Behavioral Sciences and Temple’s Maurice H. Kornberg School of Dentistry aims to incorporate nutrition and obesity screenings into regular dental care.
The joint effort makes sense, says Gina Tripicchio, assistant professor of social and behavioral sciences, who is leading the nutrition and obesity prevention component of the project with David B. Sarwer, associate dean for research and director of the Center for Obesity Research and Education (CORE). The same foods and factors that lead to dental decay—think sugary foods, sodas, candy and the rest of the list likely plastered on your dentist’s wall—also contribute to childhood obesity. So, when dentists are looking for signs of tooth decay, they’re also looking for a kind of forensic evidence of poor nutrition. Since the child, caregiver and a medical provider are already together in one place, why not use the opportunity to talk about diet?
It’s part of a larger effort to train dentists to be more holistic healthcare providers, thanks to a $1.5 million grant awarded to Kornberg by the U.S. Health Resources and Services Administration. Each year, Kornberg receives funding to develop new curricula, community-based clinical rotations and other activities to improve students’ ability to provide dental services to children younger than 5 years old. The grant, led by Vinodh Bhoopathi of Kornberg, aims to equip students with an understanding of social determinants of health and teach them to apply population health principles while providing care to underserved children.
After receiving that grant, the Kornberg School of Dentistry reached out to Sarwer and Tripicchio to create a curriculum for dental students on pediatric obesity and child nutrition. Over the 2017–18 academic year, they developed a child nutrition and healthy weight screener and trained the dental students on healthy eating behaviors, screening for obesity or other signs of poor nutrition, and counseling on proper nutrition with patients and parents. Starting in the fall, the team will test the dental students on their ability to administer the screener, adding scales and stadiometers to their usual tools of drills, probes and scalers.
When discussing nutrition with dental patients, the approach differs depending on age. For ages 2 or younger, students were trained to ask caregivers about early feeding practices, such as bottle or breastfeeding, and the introduction of specific food items, like juice. For older children, they learned to discuss sleep and screen time, sugary drink consumption, and bedtime routines based on recommendations from the American Academy of Pediatrics. Despite the obvious connection, dental curricula across the United States typically don’t include training on nutrition. It’s a missing piece for the dental curriculum, says Tripicchio, who led two lectures and a clinical orientation for the dental students.
The team is working to turn the curriculum into a guidebook that can be disseminated to other schools and dental professionals. They also hope to continue training the Kornberg students in the future and to eventually bring similar training to other fields and professions; for now, they’re evaluating the success of the dental curriculum with the hopes of conducting a long-term analysis over the next year.
“There’s an opportunity to teach people,” said Tripicchio. “As a nutritionist and obesity researcher, you know that everybody isn’t thinking about these things as much as you are. It’s great to see how interested the dental students are and to make the connections between these very related and important aspects of child health.”
HOW SNACKS SHAPE OUR SMILES
Tooth decay may be the most common chronic disease of childhood, but it is also the most preventable. While healthy brushing and flossing keeps cavities at bay, developing healthy nutritional habits is another key to prevention—with the added benefit of staving off obesity, as well.
In a new five-year study, Temple’s College of Public Health, the Maurice H. Kornberg School of Dentistry and the Monell Chemical Senses Center are joining forces to tackle the challenges of children’s oral health and eating behaviors.
The College of Public Health’s Jennifer Orlet Fisher and the Monell Center’s Julie Mennella have been awarded a $3.7 million grant by the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health. The study will recruit mothers and young children to investigate snacking behavior and oral health.
“Snacking is nearly universal among young children and a part of children’s diets where there is a lot of room for improvement in nutritional quality of foods consumed,” explained Fisher, professor in the Department of Social and Behavioral Sciences, associate director of Temple’s Center for Obesity Research and Education (CORE), and the primary investigator for the college’s portion of the study.
“Because children eat what tastes good to them, we need to focus on how they learn to like the taste of healthy foods,” explained Mennella, a member at the Monell Center, a basic research institute in Philadelphia focused on the senses of taste and smell.
Researchers will enroll more than 100 mother-child pairs for a five-month period. The study will provide daily snacks for mothers to offer their children at home. Children’s taste and food preferences, as well as their intake of snack foods, will be assessed at monthly visits to Temple and Monell. There, mothers and children will receive education on oral health and preventing tooth decay, led by Marisol Tellez-Merchan of the Kornberg School of Dentistry.
Fisher and Mennella hope to learn how to shift children’s snacking habits in a healthier direction to support oral health.
“This kind of work is important because we are tackling two major public health issues at once,” Fisher explained. “Our goal is to help young kids develop good nutritional habits that keep their smiles healthy for years to come.”
Big Data Drives New Research
From the moment patients arrive at the hospital, they generate data. They fill out paperwork at intake; doctors record notes; test results are saved; prescriptions are written; discharge paperwork is drawn; and so on. It’s accessible to medical staff reviewing a patient’s file, and many hospitals make these records electronically available for patients, as well.
But in a Learning Health System (LHS), that data has the potential to influence much more— from generating research ideas to improving care delivery.
“It’s a way to leverage data that may already exist efficiently and to then disseminate those findings in a useful way,” says Carole Tucker, chair of the Department of Physical Therapy. In 2015, she began working with Shriners Hospitals for Children to develop an LHS for their network. Together, they created SHONet (the Shriners Hospitals for Children Health Outcomes Network) and so far have implemented it in 21 of the 22 Shriners hospitals across North America, giving researchers and clinicians in one hospital access to data compiled thousands of miles away.
SHONet is a self-perpetuating system. Take all of the records and information generated by a single patient, then multiply this by all of the children who have been somewhere in the Shriners network, and you quickly have an abundance of data. The LHS first makes this usable, navigable and shareable (all in compliance with HIPAA).
Then, that data informs research. For instance, when interviewing study participants, researchers typically will ask many of the questions that have already been answered—and often answered more accurately—during that patient’s stay at Shriners. Instead of compiling that information for a second time, SHONet could allow them to gather that information at the outset.
It can also help narrow down the scope of studies or point researchers to potentially fruitful topics. One example: Shriners has more than 40,000 children with cerebral palsy in its database, each with a host of e-records, doctors’ notes, results and more. Researchers could potentially look at a large group of children who have had a hip replacement and compare outcomes within that population. Seeing better outcomes in one type of treatment might not be sound enough to conclude causation, but that information can inform a randomized control trial down the road. That is, it provides a basis from which further research can begin.
The generated knowledge is then implemented in hospital practice, leading to more effective treatment plans developed and delivered more efficiently than before. These implementations generate more data, and the LHS cycle perpetuates.
The result is an improvement to the operations at every part of the system. And it might have another long-overdue benefit: According to Tucker, once clinicians knew that their data was being used in this way, they pledged to take better notes—and, hopefully, more legible ones.
Study Finds Gaps in Athletic Training Education
With the continued prominence of the #MeToo movement in acknowledging the prevalence of workplace assault, the past year has been a watershed moment for holding accountable perpetrators of sexual harassment, assault and coercion. In Pennsylvania, a bombshell grand jury report in August brought allegations of more than 1,000 instances of sexual assault of children by Catholic priests. And late in 2017, former USA Gymnastics physician Larry Nassar was convicted of 10 counts of criminal sexual conduct after being accused by more than 250 women.
Even before such high-profile cases, Jamie Mansell, associate professor of instruction in the Department of Kinesiology, saw a worrying trend. In the world of athletics, it’s not just the athletes who are survivors of sexual harassment: One study has indicated that more than 60 percent of female athletic trainers were sexually harassed as a student or professional. Despite the prevalence, many athletic trainers are never coached in ways to respond to sexual harassment. In a new study, Mansell and a team of researchers looked at just how often that training is missing.
“Our students and clinicians are in vulnerable positions, and we would hear stories from students that didn’t sit well with us,” said Mansell. “We thought, do students know what to do when these things happen to them?”
They surveyed 885 athletic training students, both male and female, from across the United States about sexual harassment training in their programs. Students were asked about their knowledge of harassment resources at their school, details of the sexual harassment training they received (if they received it) and their perception of the people with whom they could discuss instances of sexual harassment. The results, published in the Athletic Training Education Journal in 2017, earned Mansell the journal’s annual award for Outstanding Original Research Manuscript.
The researchers found that more than half of the students did not receive sexual harassment training as part of their AT curriculum, and a lack of training corresponded to a lack of knowing what resources were available. Of the 41 percent of students who did receive training, nearly 60 percent received it from an external source—including informally, such as from parents or through an organization like the Boy Scouts. As a result, the efficacy of these trainings is inconsistent.
In addition, more than 80 percent of respondents said they would report harassment to a program director, but only about 25 percent would report to public safety or campus police. There were also differences according to gender: Fewer female students reported that they received training, though there was no significant difference between gender and the knowledge of available resources.
While the Commission on Accreditation of Athletic Training has created guidelines and standards to keep students physically safe in clinical experiences and rotations, there has not been a similar push to provide sexual harassment training and protections. These results point to the need for standardized sexual harassment training in athletic training programs, says Mansell.
“Students need to know how to identify harassment and what the reporting structure should be,” she said. “We are trying to protect our students as they go out into field experiences and clinical practice.”
Mansell and the team are now analyzing data about students’ ability to identify when harassment happens. They then hope to create training sessions based on these findings and test how these sessions inform students’ perceptions of sexual harassment.
Health disparities for transgender individuals are alarming. According to the American Public Health Association, people who are transgender report elevated rates of depression, anxiety, substance abuse and attempted suicide; they are more likely to experience homelessness or financial instability; and they have increased rates of HIV. Incarceration rates are higher than average, and they are often unable to receive critical medical supplies while in custody. For people who are both transgender and part of ethnic minority groups, the disparities increase even further.
That’s in addition to other forms of discrimination: exclusion from bathrooms and basic services, debates over their ability to serve in the military or marry, misgendering and the refusal by some to adopt more inclusive language, and frequent threats—and actions—of violence.
Though the disparities can seem overwhelming, faculty in the College of Public Health are working to improve outcomes for people who are transgender through a combination of clinical practice and community-driven research.
A BETTER FIT
What do you do when you don’t sound like you? For people who are transgender, this is a common dilemma, though one that many cisgender individuals may never consider. For those transitioning to female, hormone therapy won’t impact the sound of your voice—it doesn’t shrink the size of your vocal mechanisms— and surgery to immobilize part of your vocal cords is risky and not well tested.
The voice clinic in the College of Public Health’s Speech-Language-Hearing Center serves clients of any age and any type of voice disorder that affects quality, pitch, volume and other aspects of voice, but the large majority of the clinic’s clients are transgender. Through sessions led by students in the Master of Arts in Speech, Language and Hearing Science program, people who are transitioning can practice research-backed techniques that safely alter their voice to match their identified gender—and help them sound more like who they are.
Students lead each of the sessions, supervised by faculty members in the Department of Communication Sciences and Disorders. Six students work in the clinic each semester and take on a caseload of at least two clients each. For each client, the student conducts the initial consultation, works on a therapy plan, provides weekly individual one-hour sessions, develops work for the client to continue at home, and evaluates their progress.
And while not every student within the graduate program necessarily gains experience working with transgender clients —they can also complete their fieldwork hours outside of the Temple clinic—they will have learned in class about the specific voice needs of that population. This is something that Ann Addis, clinical instructor in the Department of Communication Sciences and Disorders, says isn’t always taught in speech-language pathology programs.
When clients come into the clinic, they answer questions about their medical and educational history, their family and social lives, and their goals for therapy. Then students assess voice characteristics like pitch, quality and intonation. In the lab, they measure the speaking and singing pitch range.
After the evaluation, clients go through drills. Then they go through more, progressively moving in complexity from hums to consonant sounds to phrases and sentences and, finally, conversational speaking. The length of treatment varies from one to three or more semesters (typically at 12 sessions a semester) and largely depends on how much the client can practice outside of the clinic—which, for this population, is not always possible.
“If we have someone who is able to practice or is living their gender full time, that can be a huge factor in their success,” said Addis. “For people who haven’t come out or who don’t live as female a majority of the time, progress can be slower, because they aren’t using this voice every day.”
Pitch is the most obvious change and the one most requested by clients in their initial consultation. But it’s also the most difficult: While hormones can enlarge the size of vocal mechanisms in those transitioning to male—thereby leading to a lower-pitched voice—those mechanisms cannot be made smaller. As a result, most of the clinic’s transgender clients are transitioning or have transitioned from male to female. While therapy usually cannot bring the voice to sound fully feminine, it can often bring the client to the female end of the gender-neutral part of the voice range.
Working on pitch is complicated by the possibility of damaging the vocal mechanisms that create speech. It’s not safe for someone with large vocal folds to speak in a very high pitch level, according to Addis, and it isn’t sustainable over time. Once those injuries begin, then the person strains their voice even harder to create the desired sound, and the cycle perpetuates until physical damage occurs, such as swelling or ruptured vessels. Some outside resources—those not vetted by speech pathologists or backed by research—can suggest speaking in falsetto, for instance, which Addis strictly warns against.
Voice therapy, which many people are unaware is even an option, provides a safer, more effective approach. It incorporates other techniques, in addition to pitch adjustments, that can lead to more feminine speech. Think breathiness, as women tend to speak with more aspiration behind the words. Clients also work on altering their articulation patterns and intonation: Female speech patterns are usually more varied, with a wider range of pitches, than male.
Social dynamics of communication, like eye contact and the use of hand movements, are also considered. According to Addis, women tend to leave more room for others to speak than do men, who tend more to dominate in conversations. One client, who lived for years as a male business executive and only started transitioning at a later age, was astounded to hear how domineering she sounded in recordings. Until discussing it in the clinic, she never realized she sounded that way.
Together, all of these pieces can help clients speak in a way that feels closer to their gender. Addis reported that most clients express significant satisfaction with their new voice and frequently refer new people to the clinic; some contact the clinic after discharge to share stories of their ongoing success using the new communication skills. “Once they get very stable with each of the skills, you’ll start to notice that the breathy voice carries over to the pitch activities, for instance, so they’ll start using that all of the time,” said Addis. “It becomes part of them.”
Representation at every stage
When Omar Martinez begins a new research project, he starts by talking to the community. As an assistant professor in the School of Social Work, Martinez understands that community involvement is important in social work practice, but as a researcher, he also integrates community participation into every stage of a project—from creating participant screeners to disseminating study findings. It’s one way to make sure that studies meet the needs and concerns of individuals in vulnerable populations, such as those who are part of ethnic, sexual or gender minorities.
Before even recruiting participants in a new study on HIV prevention and treatment in transgender women, he consulted with a community advisory board. The board vetted screening questions, recruitment materials and questions asked of the participants; they provided feedback on the strengths of the study and areas of improvement; and they were asked of their thoughts on other ways to improve overall health of transgender populations.
Martinez plans to continue the community engagement throughout the project, which is still in its early stages. The project—strengthening the Trans Equity Project (formerly the Transhealth Information Project), a peer-led intervention that aims to address the sociocultural factors that may lead to increased HIV risk in transgender women—is an example of Martinez’s commitment to community based participatory action research. For this study, he is working with the two organizations that created the Trans Equity Project: Galaei, a queer Latin@ social justice organization, and Prevention Point Philadelphia, which has a history of working in HIV/AIDS prevention.
When designing research projects or interventions, it’s important to create campaigns that are linguistically and culturally appropriate by including the people from the population being studied, he said. He aims to include these communities at every stage of the process, from those initial community advisory board meetings to co-authorship of publications and the dissemination of findings.
“Even in topics unrelated to health, we should engage community members in research,” he said. “It’s beneficial not only to the quality of the research and study design, but it ensures that the community members benefit from the research, as well.”
Martinez has seen that effect firsthand in another project with Galaei, Connecting Latinos en Pareja (CLP). For that study, Martinez designed an intervention specifically for Latino men who have sex with men (MSM)—a population commonly excluded from other studies. Research involving couples typically looks at pairs of people who hold an emotional bond, such as spouses or partners, but that doesn’t account for all sexual relationships between men. Couples who may not fit those definitions—those in open relationships or relationships purely defined as sexual—are often not included in studies, and as a result they are excluded from programs supported by that research.
Funded by a four-year research grant from the Centers for Disease Control and Prevention, CLP is the only intervention to specifically address the social and cultural factors that may be unique among Latino men in same-sex relationships, according to Martinez. He emphasized that researchers often fail to look at the factors—access to services, citizenship status and the tendency to live in hidden networks on the periphery of society— that can lead to increased health risks in sexual minorities. CLP, for instance, addresses values specific to Latinos, such as machismo, that can pressure MSM to refrain from seeking support.
“We need to make sure that our participants have access to housing, have access to care, and we need to train the people who care for and work with these populations,” he said.
CLP addresses this through four sessions relating to a variety of topics ranging from the impact of cultural values on sexual health behaviors to communication skills for couples. Each of these sessions aims to help them discover ways to adopt healthier sexual behaviors, implement those methods in ways that are culturally and socially considerate, and stick to those modified behaviors after they complete the intervention. In one early exercise, for instance, program leaders walk the couple through an understanding of the societal and individual factors that influence behavior, sexual and otherwise.
It’s a way to try to get participants to see themselves as part of a larger system—to understand the social determinants of their health. And it couldn’t happen without researchers first including community members in developing projects, as Martinez is doing with the Trans Equity Project.
“As public health professionals, we should make sure that every piece of research we conduct is guided for and by community members—they should have a stake in the assessments, in the recruitment materials, in the dissemination of findings and in the interventions themselves,” he said.
On a wall inside a newly refurbished room in a community center in Philadelphia’s Kensington neighborhood is a series of signposts.
Narnia, reads one. The others: Oz, Mt. Olympus, Hogwarts, Wonderland, the Magic Tree House. Nearby, a first-grader walks around with a copy of Dr. Seuss’s ABC, heading to the back of a line of children eagerly waiting to sign out their books. Some are showing friends what they found; others are nose-deep reading before they’ve even finished checking out.
At the head of the line, two undergraduate students from Temple’s Department of Nursing are the librarians for this April day, the library’s opening. In the few weeks prior, they and their classmates have also been painters, builders and planners. Today, though, they are enjoying the fruits of weeks of hard work, as young students from a nearby elementary school discover the litany of literary works now available to them.
It is one of the early successes of the nursing department’s new Community Home curriculum for students in the bachelor of science in nursing (BSN) program. As part of Community Home, small groups of students and a faculty member partner with a community organization in a North Philadelphia neighborhood over multiple semesters to experience firsthand what nursing in a community setting is like.
This community home site is Open Door Ministries, led by Pastor Rodney Timmons and located across the street from John H. Webster Elementary School, a K-5 public school with nearly 900 students. Temple nursing students joined parishioners from Open Door Ministries and members of the Webster School community to help clean the space, build and paint shelves, and decorate the walls with quotes, artwork and inspirational messages about the power of reading. The nursing students held book drives, amassing more than 6,000 books—illustrated versions of classics like The Count of Monte Cristo and The Jungle Book, popular series like Harry Potter and Diary of a Wimpy Kid, picture books, books of poetry, the works of Shakespeare, young adult novels and more. And they did it all in a span of six weeks.
Opening a library may not fit what some think of as “nursing,” but there is a strong connection between this community work, students’ future careers and their potential to impact health and healthcare delivery.
“We’re able to build relationships with people,” said Emily Pinczka, a nursing student working with Open Door Ministries. “We get to see what people in the community are like.”
And for Timmons, who spearheaded the library’s creation at the community’s request, additional space in the community center can support services such as after-school programs and tutoring, physical activities and sports in the building’s gymnasium, and even skills and job training for parents in computer labs.
“The object is to enrich the community,” he said. “You have to meet people’s needs, and we’re offering multiple avenues.”
The vision of Community Home as a curriculum that spans a student’s academic career and occurs in partnership with community members and organizations did not materialize until 2017.
That summer, Martha Kubik, David R. Devereaux Chair, professor and director of the Department of Nursing, brought together a core group of nursing faculty, including Pat DiGiacamo, Letitia Gill, Sue Gresko and Barbara Stephens, to reach out to organizations working in North Philadelphia—faith-based groups, schools and after-school programs, senior citizen centers and sites serving women recovering from substance abuse or domestic violence. After multiple visits and conversations with leadership, 10 organizations expressed interest in being a community home site and in fall 2017 began working with nearly 300 nursing students.
“Hospital rotations provide nursing students experience with disease management and short-term care delivery in a complex setting, where the daily pace is often driven by a flurry of tests and treatments,” explained Kubik. “Community Home is focused on relationship-building, trust and understanding that develops over time and in a real-world setting. Balancing undergraduate clinicals between hospital and community settings helps students recognize the value of both and understand the connection between a hospitalization for poor diabetes management and the lack of affordable, healthy food options in the neighborhood, for instance.”
It’s a long-held tenet of public health that only a small fraction of one’s overall health is determined in a healthcare setting, such as a hospital or primary care clinic. Far more important are the social determinants of health—things like age, behavior, education, family and community life, and other social and economic factors—and the short burst of a hospital stay is insufficient to understand that complex portrait of a person’s life. Community Home is designed to address this gap.
“Nurses have a long history of community engagement and leadership when addressing health disparities,” said Kubik. “Our goal is to immerse students in a community so they learn from residents and organizations serving the community about the challenges that exist and why. They also learn to recognize community assets and strengths and how goals and outcomes are shaped when community residents, organizations and healthcare providers come together as a team to address a need identified by the community.”
The new curriculum begins in the first semester of a student’s sophomore year with a once weekly, seven-week rotation; each student continues to work with the same community every semester for five semesters. That’s 42 hours each semester—at least 200 hours over more than two years devoted to working directly with community members on-site and in roles with progressively more responsibility and complexity.
During the first year of the curriculum, students meet the community members and become familiar with the setting. They learn about the community through publicly available demographic and health data as well as personal stories shared by community members that, depending on the site, might include elders, young mothers with babies or small children at school eager for the nursing students to join them in a game of tag on the playground. Students sit at the table with the site’s leadership, said Kubik; they begin by listening and observing, and over time they become more active participants.
In these conversations, students engage directly with community members to determine how they can support efforts already underway or be the stimulus that turns an idea, like a library for children, into a reality. At Open Door Ministries, it was through Pastor Timmons and other community members that the need for a library was realized. Webster is without a library, and the nearest local library is a 20-minute walk away with limited evening hours, making it difficult for children with working parents to use it. Providing space for a library was a way to ensure books get into the hands of children who may have few opportunities to read.
As students progress through the curriculum, the nursing interventions become more involved. Students start with health education classes and a focus on healthy lifestyles, such as meditation to manage stress or how to prepare a healthy snack. Health screenings are then added along with educational programs that support improved self-management and better understanding about common diseases, such as diabetes and hypertension. By the final semester, students will work hand-in-hand with site leadership and community members to develop, implement and evaluate a program that addresses a need identified in partnership with the community, with sustainability as a key goal.
With the start of the new academic year, returning students are now re-establishing themselves in their community settings. As these students reacquaint themselves with community site leaders and community members from the previous year, faculty members are introducing a new group of sophomores into these communities.
“We are all partners in health,” said Kubik. “We are learning from one another, learning about ourselves, building trust, and all the while working toward the goal of becoming caring, competent nursing professionals.”
Summit unites experts to discuss prevention, treatment and policy
Between 2000 and 2015, opioids claimed more than half a million lives in the United States and decimated communities around the nation. In Philadelphia and the surrounding area, the crisis is particularly hard-hitting and continues to widen in scope. While the federal government declared the opioid crisis a national public health emergency in 2017, much of the most significant work being conducted in prevention, treatment and policy occurs at local and regional levels.
The College of Public Health is combating the opioid epidemic in a number of ways. Faculty members, students and alumni are working in the community, the lab and on the front lines of the crisis advocating for better prevention and treatment. In April 2018, the college united researchers and clinicians from across Temple University with policymakers and community members at the Southeastern PA Opioid Summit to address the epidemic’s impact on the region.
The event included keynotes and panel discussions led by faculty members from Temple’s College of Public Health, Lewis Katz School of Medicine and College of Liberal Arts, as well as representatives from the Pennsylvania Office of the Attorney General, Philadelphia Office of the Health Commissioner, regional nonprofits and others. Question-and-answer panels of faculty members and practitioners explored the causes of the epidemic, state- and citywide solutions, and emerging practices in treatment and prevention.
Hundreds receive Narcan training
That same month, the college offered free training in administering naloxone (also known by the brand name Narcan), a drug that reduces the effects of opioids and can reverse otherwise fatal overdoses. After registration for the first event on April 5 reached capacity—within hours of being available—a second training was organized two weeks later. In total, more than 200 students, faculty, staff and community members learned how to safely administer the drug.
The training was led by staff from Prevention Point Philadelphia, a local nonprofit that has led harm reduction efforts in the city since the AIDS epidemic in the early 1990s. Now, the group mostly works in combating Philadelphia’s opioid epidemic, which caused 1,200 deaths in 2017, according to the Philadelphia County Medical Examiner’s Office. Prevention Point has collaborated with the College of Public Health for years and regularly hosts fieldwork placements for students in a number of the college’s academic programs. Both Executive Director Jose Benitez and Associate Executive Director Silvana Mazzella are alumni of the college’s School of Social Work.
“This training was about collaborating with our community partners in new ways and preparing our students in a holistic and practical way,” said Kate Gallagher, director of the Office of Clinical Practice and Field Education. “We want our CPH students to be able to anticipate and respond to the reality of the opioid epidemic.”
Temple’s School of Social Work occupies an essential space within the College of Public Health’s broader focus on health and well-being. As the school prepares to mark its 50th anniversary in 2019, we asked those in the Temple social work community: What does it mean to be a social worker in today’s political, social and public health landscape?
Rachel Lawbaugh, MSW ’18
Lawbaugh found opportunities for Marley, a certified therapy dog, to join in Lawbaugh’s internships during the MSW program, where they worked with individuals recovering from trauma and substance abuse.
“I have seen systems fail the people that they were meant to serve, and I attribute this to the fact that people of the targeted population are often excluded from positions of power and from decision-making processes. As a social worker, it is vital that I come from a place of cultural humility. This means recognizing my own power, privilege and prejudice. It is important to understand that the client is the expert on their own life, and that they are the expert when it comes to their own lived experience.
“There is so much to be learned from our clients. We need to be listening.”
Philip McCallion, director of the School of Social Work and professor of social work
McCallion’s research fills an important niche in the field of social work, bridging scholarship on aging populations and those with intellectual disabilities such as Down syndrome. A renowned researcher, he has published more than 140 articles on interventions with older adults with chronic conditions, caregivers of frail elderly, and persons with intellectual or developmental disabilities.
“Globally and locally, we see the incredible ways that individuals, families and communities are responding to challenges with resilience, problem-solving and leadership. More than ever, social workers today are the champions of those responses. They are the creators of opportunities and the voices insisting that we can do better.”
Kiana Brown, master of social work student
Brown completed her bachelor of social work degree at the School of Social Work before continuing on to pursue her MSW.
“We have a responsibility to provide guidance and expertise, and to show what we have learned here at Temple University to the world. Each one of us has a unique story and brings individualized perspectives to the table. This table is not exclusive to the elite—it is up to us to stand up for what we believe in and voice our perspective to those in power. We deserve a seat at the table to discuss our thoughts and opinions in order to change the policies, procedures and legislation that affect all of us. We need to advocate for all communities to fight social injustices.”
J. Toni Oliver, MSW ’79
Oliver is president of the National Association of Black Social Workers and works to improve foster care, kinship care services and adoption opportunities, particularly for children of color. She delivered the college’s 2018 Commencement address.
“As in other fields in public health, I’m looking at outcomes for the population that I’m focused on. In any field where African American families are being served, you can identify disproportionalities and disparities.
“We want to say we treat all things the same; we want to say that whatever interventions we’re using should work the same way on all populations, but the reality is that they don’t. Until we begin to really look at those populations that don’t have the kinds of outcomes that we want, and determine what one population needs differently from another, we will continue to have these disparities.”
A Breath of Fresh Air
College-led task force aims to eliminate tobacco use on campus
By April 2018, more than 2,100 college campuses across the United States were completely smoke free. Thanks to a campuswide task force commissioned by President Richard M. Englert and led by the College of Public Health, Temple University will be joining the trend.
In September 2017, the College of Public Health was awarded a grant from the American Cancer Society to join the Tobacco-Free Campus Generation Initiative. The grant provides support to accelerate and expand the adoption and implementation of smoke- and tobacco-free policies on college and university campuses. While other institutions have successfully gone smoke free, researchers at the College of Public Health and across Temple are looking to free the campus of tobacco in all of its forms, including cigarettes, cigars, cigarillos, chewing tobacco and e-cigarettes.
The Smoke-free Campus Task Force is an example of the college’s push to improve health at the hyperlocal level, focusing on where students live, learn and work. “Creating a tobacco-free campus environment is important for several reasons,” said Jennifer Ibrahim, associate dean for academic affairs, associate professor of health administration and policy, and recipient of the grant. “We know that 18- to 24-year-olds have the highest rates of smoking, so we are trying to create an environment to help prevent students from becoming addicted. Additionally, exposure to secondhand smoke is bad for all members of our Temple community. Finally, tobacco-related litter is all over campus and streets at the edge of campus. There is an environmental impact as chemicals leach into the soil and a cost associated with cleaning it up.”
In the fall, an interdisciplinary group of faculty, students and staff from across Temple University, led by Laura A. Siminoff, dean of the College of Public Health and Laura H. Carnell Professor of Public Health, surveyed students, faculty and staff on their behaviors and perceptions about smoking on campus. They asked students and employees about their awareness of current campus policies; if, where and how they smoked; and the degree to which they felt that smoking was a problem on campus.
Although 63.5 percent of student respondents reported not using tobacco, 43 percent said they were exposed to secondhand smoke often; of employees, 65.5 percent reported not using tobacco, and 65.7 percent reported secondhand smoke exposure. Among both groups, more than 80 percent agreed that this exposure was bad for their health. A majority of both students and staff reported that they were aware of the campus smoking policy and that they adhered to it.
The task force also mapped the smoking hot spots on campus and shared observations about smoking behaviors, in addition to perceptions. According to current policy, smoking is only allowed at a minimum of 25 feet from the entrance of a building. At least half of the individuals observed smoking, however, were within that range, suggesting that compliance with the current policy is not as high as reported in the survey.
Changing tobacco policies in an urban university like Temple poses challenges that other universities may not face. Since the main campus lies on public streets in the middle of a city, it’s difficult to place restrictions in public areas. But the area also offers resources that Temple can use to craft a policy that works. Other Philadelphia universities already have smoke-free policies, and the task force communicated with officials at the institutions about how they implemented their policies. The Philadelphia Department of Public Health has also provided ongoing support and resources during the development of the report.
The task force crafted a number of recommendations. They called for adoption of a comprehensive tobacco-free, clean air policy for the entire university and the sidewalks or walkways on campus borders. They recommended the creation of an educational campaign to target campus community members and those visiting Temple, as well as an update to the employee rules and the student code to reflect the updated policy. Other suggestions include removing all ashtray receptacles and prohibiting the sale of tobacco on campus, including in privately owned retail stores. The task force stressed the importance of offering smoking cessation support alongside prohibiting tobacco use.
“It’s not a matter of punishment,” said Ibrahim. “We’re trying to prevent people from starting to smoke and offering support for individuals who are addicted to tobacco. The intent of the policy change is to create a healthier environment for our students, staff and faculty, as well as our North Philadelphia neighbors.”
Serving others through practice and generosity
By the time Ellen Schwartz watched The Miracle Worker, she knew where her career would take her.
She had always been interested in working with people with special needs, and seeing the 1962 depiction of Anne Sullivan’s efforts to tutor the deaf and blind Helen Keller sealed her decision.
Schwartz received her Temple master’s degree in speech-language pathology (SLP) in 1969 and worked her way up to director of SLP at Children’s Hospital of Philadelphia. There, she worked largely with children with medical issues, such as hearing impairment, cleft palate or cerebral palsy, that impacted their speech abilities. She later started her own private practice in Philadelphia, where for more than 30 years she has focused on treating preschool- and early elementary-aged children with communication disorders as well as counseling their families on management and intervention strategies used.
Schwartz’s generosity runs deep: At Temple, she and her husband, Jeremy Siegel, have endowed a $250,000 graduate scholarship for the Department of Communication Sciences and Disorders, and Schwartz is committed to offering career guidance and mentorship to scholarship recipients as they enter the field of SLP. She invites them to meet with her or visit her at her practice in order to see the field firsthand—or simply to chat.
Schwartz said that she wanted to help offset the costs of graduate school, which have changed since she received her master’s: “When I was in graduate school, the world was very different, and there was a lot of funding available for students,” she said. “That isn’t true anymore, and I understand how expensive college is and that many are unable to afford it. I thought it would be great to help someone who doesn’t have those resources to offset the costs of graduate school.”
Two philanthropic voices join together
For Mary Ammon, a graduate of Temple’s School of Social Administration (now the School of Social Work), a passion for social justice through education has lasted a lifetime.
“If you get a good education, they can’t take that away,” she said. In 2005, she established the Mary and Gary Ammon School of Social Work Scholarship Fund with her husband, who graduated from Temple’s Beasley School of Law.
It only made sense when Ammon connected with Harvey Crudup and Concerned Black Men (CBM), a nonprofit organization that provides mentorship, scholarships and resources for black youth, particularly high school seniors considering college. Founded in 1975 by a group of off-duty Philadelphia police officers, CBM has grown to include more than 20 chapters nationwide.
Like Ammon, Crudup knew that for students with both financial need and academic merit, a scholarship—and mentorship—can be transformative. To listen to members of CBM recount how they first became involved in the organization is to hear an anthology of stories about the impact of mentorship: working with incarcerated individuals in juvenile or adult corrections institutions; playing baseball as a child in makeshift neighborhood leagues organized by concerned neighbors; and being encouraged to give back by older family members.
In 2014, Ammon worked with Crudup and CBM to form the Mary, Gary and Douglas Ammon and Concerned Black Men Scholarship Fund, an endowed scholarship for College of Public Health students from North Philadelphia. While Crudup passed away in 2017, the scholarship was awarded for the first time this year.
“CBM has deep roots in the community when it comes to providing educational opportunities for our children,” said U.S. Rep. Dwight Evans, a member of the CBM board of directors. “This partnership just makes good sense.”
Ammon said that she keeps in touch with all of the past recipients of her family’s social work scholarship, and she hopes to continue that trend with the new awardees. The scholarship recipient has already been invited to meet with the CBM board—like Ammon, they plan to serve as a source of support and mentorship.
Since graduating from Temple’s master of public health program in 2003, Tinesha Banks has held leadership positions in a range of health and social services organizations. She is currently president and CEO of Tabor Services, Inc., a community-based organization in Philadelphia that provides a range of child welfare services including case management services, adoption, in-home familial support and life skills programming. Banks is most recently a recipient of the Philadelphia Business Journal’s 2018 Minority Business Leader Award.
We spoke with Banks about the power of viewing clinical and social services through a public health lens—and about what the College of Public Health offered that she couldn’t find anywhere else.
Why does your organization incorporate a public health perspective into the services it provides?
A public health mindset broadens your perspective and lends itself to collaborating across sectors. The further upstream you go in the social determinants of health, the more you realize you have to come out of your bubble.
Someone might say that there’s clinical health, and then there’s population health. But from my perspective, if any of us are impacting individual or community health, that means we’re all public health somewhere along the continuum. To me that’s really important, because our healthcare and social welfare systems are already siloed enough. If we’re truly going to see impact, we have to work together.
Why did you choose Temple’s MPH program?
Temple offered the inner-city atmosphere I was looking for, and its focus on community was important. I connected with mentors who were invaluable in navigating Philadelphia’s public health arena. Coursework is one thing. But the mentorship and guidance that you get from your professors—the investment that they make in you—that’s priceless.
What lessons did you take from your experience at the College of Public Health?
I entered Temple’s MPH program with a thirst for public health. The program feeds that thirst. But what you do after that is up to you. You have to walk through those doors and figure out your way. That’s one of the reasons I adore public health—it’s a big umbrella. I don’t know of many fields that give you the same flexibility. It’s a world of opportunities, and it gives you the control: You can do whatever you want, and that’s liberating.
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