The U.S. Surgeon General, Vice Admiral Jerome M. Adams,MD, MPH, and Ellen Kurtzman, PhD, RN, FAAN. Photo credit: Office of the Surgeon General

Wondering what to expect on the health policy front in 2020? We were, too, so we reached out to someone in the know. Ellen Kurtzman, PhD, RN, FAAN, associate professor at the George Washington University School of Nursing, recently completed a Robert Wood Johnson Foundation Health Policy Fellowship to gain hands-on policy experience in the nation’s capital. Fellows make the rounds of government agencies and administration offices to learn about their work, then immerse themselves in an assignment on Capitol Hill or in an executive branch office. Kurtzman experienced both. She spent nine months in the office of the Speaker of the U.S. House of Representatives, the Honorable Nancy Pelosi, and four months in the Office of the U.S. Surgeon General, Vice Admiral Jerome M. Adams, MD, MPH. In both placements, Kurtzman gleaned insights into the current health policy landscape and how nurses can employ their expertise to advance policy.

Which policy developments will you be following most closely in the year ahead?

I’ll be watching to see what happens with coverage in terms of Medicare for All versus improvements in strengthening the Affordable Care Act. I think there’s still life left in doing something around prescription drug prices, and I think there’s definitely an appetite for doing something about surprise billing because everybody agrees that insured patients shouldn’t get saddled with huge out-of-network bills after receiving care. Additionally, there will be an election next November. People should be highly engaged in that, and, I would argue, they should participate.

Do you anticipate seeing congressional action on health policy in the coming year?

It’s a very difficult, partisan environment. There is a lot of activity, but legislation is not moving through both Houses, as it would have to in order for anything to become law. You can look on congress.gov and find thousands of bills that have been introduced in the 116th Congress. As of late October, there were something like 4,500 bills introduced in the House. Ten percent of them were in the health space, but only four passed the House and the Senate and were signed into law, and these bills were reauthorizations of programs that already existed. So, if you’re a citizen, you effectively observe no change. Impeachment is also a major distraction, and even though it’s not specific to health care, until that’s resolved, the attention is not likely to shift back to other things.

What did you observe in the Office of the U.S. Surgeon General?

That it is a very productive, deliverable-oriented office. The surgeon general has a set of really important priorities. They include substance use disorders, e-cigarettes and vaping, and oral health, recognizing that the mouth is just another part of the body. He has some initiatives around how health impacts our national security, and he’s got an interesting initiative in the social determinants space. He calls it CHEP, which stands for Community Health and Economic Prosperity. The idea is that it’s good business to invest in health—not only the health of your employees, but the health of your communities—and that when businesses do that, it makes both the businesses and the communities more prosperous.

Tell me more about CHEP.

The U.S. surgeon general has spent a great deal of time traveling the country in search of exemplary businesses that are working alongside community developers to support affordable housing, food programs, and [other upstream factors] that contribute to health and well-being. In Oklahoma, for example, the owner of the NBA basketball team, the chamber of commerce, local business leaders, and local departments of health, education, public safety, and justice are working to improve the efficiency and effectiveness of the criminal justice system. The work has contributed to a better business environment and put people to work. In the hiring space, there’s an example the surgeon general uses quite often of a commercial bakery in Yonkers, N.Y. They have an open hiring model, [which means] there basically are no hiring requirements—no background check, no resume, no interviews, no tests—other than that you can do the job.

You said the surgeon general’s office is focused on deliverables. What can we expect to see in 2020?

We’ll likely see several publications from the Office of the Surgeon General related to Dr. Adams’ priorities. This is an enormous contribution. These reports suggest there’s a huge and compelling evidence base to guide people and communities on those issues.

Did you hear any discussion of social determinants of health on Capitol Hill?

Ellen Kurtzman, PhD, RN, FAAN, associate professor at the George Washington University School of Nursing.

My impression is that there’s a lot of interest in social determinants but less clarity about how to address them. While I was on the Hill, I observed efforts to protect housing assistance, early education programs, and social security. And there is interest in addressing adverse childhood experiences (ACES). These and other social determinants of health such as socioeconomic status or where you live are really strong predictors of future health problems, so lawmakers want to know more. The idea is if you can prevent certain negative exposures from happening, or at least identify who’s at greatest risk, you have a chance of reducing our health care expenditures dramatically.

Is cost the main motivator?

Decision-makers are highly motivated to do the right thing, but they are acutely aware of the financial impacts. Protecting children is a part of the American value system, so they want to address ACES, but progress on the issue is likely to be accelerated if a policy reduces the federal deficit or stimulates the economy in some way.

Tell me a little bit about what set you on the journey from patient care to policy.

I just sort of found myself getting closer and closer to the decision-making apparatus. It happened during a time when I was very interested in health care quality, especially in skilled nursing homes. The long-term-care workforce is among the hardest working, most talented, and most well-intentioned, and yet it under-delivers on quality. It struck me that in order for that dynamic to change, it wasn’t about a nurse or a physician trying harder or working longer hours. It was about finding policy levers that could be pulled to make sure the system is aligned to produce better outcomes. Policy remedies have the possibility to save communities and nations, so policy seemed like a better place for me to invest my energy.

As a nurse educator, what role would you like to see policy play in nursing education?

Traditionally, bachelor’s nursing programs have a single policy course. If I could wave my magic wand, policy would be integrated across the curriculum, regardless of the degree, program, or level. That’s what we’re trying to do at GW (George Washington University School of Nursing), and the Center for Health Policy and Media Engagement is accelerating that process. Nurses can talk about the patient in the bed, but they don’t have the vocabulary to talk about the policy trade-offs—for example, paying for prevention versus treating chronic disease—and that shows when they come to Capitol Hill. Until policy is threaded throughout the curriculum, I don’t think any single course is going to move the needle on that.

Is there anything else you want to add?

Every policy is about allocating scarce resources, and, unfortunately, there are always winners and losers. As Americans, I think it’s very easy to criticize, but our government is incredibly complicated. Lawmakers are faced with really difficult choices, and, in most cases, they want to be responsive; they want to get it right. Being embedded in offices on the Hill and in the administration made me incredibly grateful that we have a talented, dedicated set of professionals who could have any job they want, yet they choose to make these tough decisions on our behalf and choose careers in public service.

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Sharron Crowder, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Health Policy Fellow and clinical associate professor at Indiana University School of Nursing, taught a health policy course for graduate nursing students in 2013 at the request of her dean, little realizing that she was embarking on a journey that would take her to Washington, D.C., to become a national leader in health policy.

Already active as a military spouse working to improve conditions for military families and in efforts to improve case management and chronic disease management for people with asthma, Crowder discovered that teaching health policy “pulled everything together” for her.

The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, released three years earlier (in 2010), had stressed the importance of increasing the number of nurses who were engaged in health policy and advocacy.

“The report reinforced the policy endeavors of nurses that occurred prior to 2010 and identified the critical need for more nurses to be involved in health policy on local, state, and national levels,” Crowder recalled.

With support from two nursing deans at Indiana University, Marion Broome, PhD, RN, FAAN, who left in 2014, and the current dean, Robin Newhouse, PhD, RN, NEA-BC, FAAN, Crowder expanded the health policy options at Indiana University. She collaborated with a member of the Indiana House of Representatives, Rep. Edward D. Clere, and the executive director of state relations at Indiana University, John Grew, to create the IU School of Nursing Legislative Fellowship.

Eight students since 2014 have participated in a semester-long fellowship experience with Clere, meeting with constituents and advocacy organizations, reviewing bills, and examining evidence-based data and resources. The goal: to get nurses to become health policy leaders.

Crowder also established an extensive mentoring program called The Eagles, comprised of 30 master’s, doctor of nursing practice, and doctor of philosophy nursing students. After they complete her health policy and advocacy course, they participate in advanced policy courses, advocacy practicums, and leadership experiences. Crowder continues to mentor them beyond graduation.

The best part of mentoring is “using who you are to empower another person to reach his or her potential and become a leader,” she says. “I have a commitment to developing a pipeline of leaders in health policy.”

The men and women she has mentored include chief nursing officers, presidents of state nursing organizations, and health policy professors. All of her mentees are active in state policy and advocacy, including in addressing the opioid crisis, serving on school and community boards, and emphasizing the importance of research to inform policy.

Crowder  also has developed advocacy practicums–during which students lead projects on particular topics or issues, often working with the Indiana State Nursing Association, government agencies, and professional and community organizations—as well as a partnership with Franciscan Health to develop policy and advocacy leadership initiatives among practicing nurses.

In 2018, Dean Newhouse identified the need for a special assistant to the dean for health policy initiatives. Crowder was appointed to that position. She said, “while serving in that role I facilitated students’ and faculty’s interactions with IU government relations, the Indiana General Assembly, and professional organizations. It has been rewarding to advance our involvement in civic engagement and health policy leadership on our campuses in Indianapolis, Ft. Wayne, and Bloomington. However, I wanted to do more.”

Crowder applied to be a Robert Wood Johnson Foundation (RWJF) Health Policy Fellow because she wanted a more formalized, real-world experience at the national level that included an internship in Congress or the Executive branch. She was one of six fellows—and the only nurse—selected for the 2019-2020 cohort.

For more than 40 years, the RWJF Health Policy Fellows program has offered exclusive, hands-on policy experience in Washington, D.C. Fellows meet with national health and health policy leaders, participate in seminars and leadership development, and engage with members of Congress and their staff. It is administered by the National Academy of Medicine.

More than 270 fellows have participated in this program and used that leadership experience to improve health, health care, and health policy. Nursing alumni of the program include Deborah Trautman, PhD, RN, president and CEO of the American Association of Colleges of Nursing (2007-2008), and Ellen-Marie Whelan, PhD, NP, RN, senior adviser, Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (2003-2004), among others.

Crowder has been impressed with the broad exposure to health policy leaders. In two months, she has participated in small group meetings with more than 150 health policy leaders from government, think tanks, private and public organizations, and industry.

She encourages all nurses who are interested in health policy to apply for the program. “It provides insight on where you can go to enhance your policy lens and focus,” she says.

For Crowder, that means returning to Indiana University and enhancing its policy programs and broadening interdisciplinary collaboration initiatives. She looks forward to continuing to mentor students, and using her newfound knowledge and connections at the national level.

“This fellowship has given me an awesome opportunity to recognize what we can do when we find our path and passion to be change agents and make a difference,” she says. “I want to take this experience and bring to the table policy changes that build health.”

For more information about the RWJF Health Policy Fellows program, click ere.

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Innovative thinking, persistence, courage, and compassion are among the reasons that five Americans have earned this year’s Heinz Awards, including nurse researcher Sarah L. Szanton, PhD, ANP, FAAN. Szanton, an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program, was honored for leading the development of the Community Aging in Place—Advancing Better Living for Elders (CAPABLE) program. CAPABLE was initially funded in part by RWJF.

“The recipients of this year’s awards are creating opportunities for individuals to access the foundations of a healthy, free and just society—well-paying jobs, a just legal system, equity of opportunity, and a life of dignity when we are not able to care for ourselves,” said Teresa Heinz, chair of the Heinz Family Foundation, in announcing the winners of the 24th Heinz Awards.

Szanton, who was recognized in 2018 as an American Academy of Nursing Edge Runner for co-designing CAPABLE, realized the need for the program while she was a nurse practitioner making house calls to low-income, older patients. She saw that everyday tasks more than medical needs were what kept people from being able to stay in their homes. CAPABLE brings simple home-repair services into older adults’ homes, along with in-home nursing and occupational therapy, allowing people to continue living independently.

Szanton’s insights led to a program that works closely with patients to understand their needs, and ultimately improves health and well-being—and costs less. CAPABLE programs now operate in 28 locations in 14 states.

Szanton, who won in the category of “human condition,” was one of five recipients this year, each of whom will receive $250,000. Other recipients include Kevin Jerome Everson, recognized in the category of arts and humanities; Rue Mapp, in the category of environment; Amanda Nguyen, in the category of public policy; and Brandon Dennison, in the category of technology, the economy and employment.

Szanton is endowed professor for health equity and social justice at the Johns Hopkins School of Nursing in Baltimore, and director of its Center for Innovative Care in Aging.

Said Heinz in the announcement, “We are grateful to them for their contributions, which so beautifully exemplify the spirit of the Heinz Awards.”

The awards honor extraordinary achievements in areas important to the late U.S. Sen. John Heinz, for whom the annual recognition was begun.

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Photo courtesy of the Robert Wood Johnson Foundation. (c) 2018 Annabel Clark.

Twenty youths attempted suicide the first month that Kelly McGrady, RN, started as an at-risk mentor for the school district of New Town, North Dakota.

McGrady, a Robert Wood Johnson Foundation Clinical Scholar, understood the feelings of hopelessness that the youths experienced. McGrady is an enrolled member of the Three Affiliated Tribes and grew up on the same reservation, as well as the Turtle Mountain Reservation, and survived many of the same adverse childhood experiences (ACEs) as her students. She, too, attempted suicide, at the ages of 8 and 15. She credits the U.S. Army with giving her the structure, discipline, and ability to find her inner strength.

Now a trusted leader in her community, her goal is to help awaken in the teens the gifts, talents and abilities that are within, and thereby reduce suicide attempts.

Forty percent of people who die by suicide in American Indian communities are between the ages of 15 and 24. Among adults ages 18 to 24, American Indians have higher suicide rates than any other ethnicity and higher than the general population.

“Historical trauma stunts personal and professional growth,” McGrady says. “We can do awesome things if we are able to address our ACE scores, seek healing and are given opportunities. If I can do it, others can do it as well or better than me.”

Determined to stop the high number of suicide attempts, McGrady began meeting with Monica Taylor-Desir, MD, MPH, who at the time was the psychiatrist and the chief medical officer at New Town’s Elbowoods Memorial Health Center, and Leolani Ah Quin, a social worker and the Center’s behavioral health director.

Taylor-Desir saw a notice about the RWJF scholars program in an Indian Health Service listserv, and the three, along with pediatrician Anita Martin, MD, applied. They wanted to build their leadership skills and gain support in starting a Building Resilience, Building Health program for youth who are at risk for suicide or who have survived a suicide attempt. Their proposal was accepted, and they joined the 2017 cohort.

Building Resilience, Building Health is a psychoeducational program that another American Indian community used to decrease the rate of suicide attempts and completions. The program is for families of adolescents ages 12 to 18 who have been identified as having at least one mental health diagnosis, such as depression, anxiety, post-traumatic stress disorder, attention deficit/hyperactivity disorder, or substance use disorders. Over the course of five sessions, the program covers the diagnosis, medications, reintegration into the school system, and social support. The families share meals together and learn about their culture, including Native healing techniques to address anxiety and the tradition of listening to the elders of their community.

As a member of the New Town community, McGrady builds trust immediately and is able to amplify the impact of the program by connecting community members to the help they need, successfully getting teens to meet with a health care provider, incorporating information about trauma-informed care training in the school and community, and being a person who teens “turn to when they are in crisis,” says Taylor-Desir.

Often, McGrady says that teens will reach out to her to talk about their relationship or parental issues. “I will always answer a text or a call on the weekends, and I get youth help,” she says. “Many of them call me Auntie Kelly because I am genuine in how I care for people, plus I make myself available.”

McGrady always knew that she wanted to be a nurse. As a child, she injected her paternal grandmother with insulin shots to treat her diabetes. She admired her auntie/mom Madonna Azure who was a nurse, and she also took Health Careers at her high school, where she got to observe nurses and pharmacists. After graduating, McGrady joined the U.S. Army and became a medic. She saw life outside the reservation for the first time as an adult.

“I saw how good life could be,” she said. “I saw people who reminded me of my own family members, and they were able to do good things because of opportunities. I saw all of this untapped potential at home.”

McGrady became a young mother, but she never forgot her desire to become a nurse. While raising a family that grew to include six children, McGrady got her certified nursing assistant and licensed practical nursing degrees. In 2012, she graduated with her associate degree in nursing.

Her nursing roles have been dedicated to building a Culture of Health: She has worked to reduce falls in older adults, help members of her community navigate the Affordable Care Act marketplace, and taught exercise classes. She volunteered as the school’s cheer coach and bus driver for the gymnastics team.

McGrady describes the opportunity to participate in RWJF Clinical Scholars as a “prayer being answered” to get the youth in her community the help they need to thrive.

Clinical Scholars is a leadership development opportunity for practitioners from diverse fields of health care. Interdisciplinary teams of health care providers collaborate across sectors, tackling complex health problems in their communities and building a Culture of Health nationwide.

McGrady has appreciated the network of professionals she has met through the program. After she described the lack of medical professionals in New Town, a fellow member of her cohort, pediatrician Omolara Uwemedimo, MD, MPH, an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, in New York, began sending pediatric residents to New Town for one month placements. The residents, who are primarily trained in New York City, experience for themselves the benefits and challenges of rural-based medicine in the U.S.

McGrady credits the program with giving her the courage to attempt things she never thought possible and see life from a whole new perspective. After learning how a campus connections program in North Carolina helped to rebuild a struggling neighborhood, McGrady joined her local parks and recreation board. She also joined the board of New Town City Library and started a food backpack program in her school district after hearing about similar programs in other communities.

Her experiences in Clinical Scholars inspired McGrady to return to school to pursue her Bachelor of Science in Nursing; she is now considering graduate education. She attends the University of North Dakota with her two oldest children, who she says, are breaking the cycles of poverty, substance abuse, hopelessness and young parenthood.

Clinical Scholars “is not solely about advancing the scholars’ leadership skills,” McGrady says. “It’s about making lives in our communities better.”

(For more information about Clinical Scholars, go here. The next call for applications will be in January for the 2020 cohort.)

The post An RWJF Clinical Nurse Scholar Tackles Youth Suicide appeared first on Campaign for Action.

Photo courtesy of the Center for Creative Leadership.

In a state hit hard by the opioid epidemic, West Virginia’s Gov. Jim Justice announced a pilot program in two counties that are among those suffering the highest rate of fatal drug overdoses. The effort will bring together medical professionals, health departments, first responders, law enforcement, faith community, behavioral health providers, schools, and recovery coaches.

Among those leading the effort is Angie Gray, BSN, RN, who was trained in the Public Health Nurse Leader program sponsored by the Robert Wood Johnson Foundation. Gray is director of nursing at the Berkeley-Morgan County Health Department.

The pilot program in Berkeley and Jefferson counties is a partnership between West Virginia University and the West Virginia Department of Health and Human Resources’ Office of Drug Control Policy and will coordinate actions with and among community partners to strengthen prevention and recovery resources.

As the Berkeley County lead, Gray’s role is to oversee the primary intervention areas of rural outreach teams, stigma reduction and  trauma awareness, and community Naloxone education and capacity.  In light of her expertise in public health education and harm reduction, Gray will have a particular role in the development and implementation of the rural outreach teams, a model that incorporates public health, behavioral health, case management, and recovery coaches.

“We are tremendously excited about the leadership skills and vision Ms. Gray brings to this initiative,” said Emma M. Eggleston, MD, MPH, associate vice president for Health Sciences, and dean, WVU School of Medicine Eastern Division. “In addition to her wealth of expertise in fighting the opioid epidemic and the attendant stigma and social harm it brings to individuals and families, Ms. Gray has a broad network of community relationships to engage and collaborate with. Like many nurse leaders,  she is a natural bridge builder.”

Gray credited the RWJF training with giving her the experience and skills to help lead the effort.

Wrote Gray in an email, “I am grateful for the opportunity to apply what I have learned, to help my fellow West Virginians rise out of the opioid epidemic.”

Read more about Gray and the Public Health Nurse Leader training.

Read the news release about the pilot programs.

The post RWJF Nurse Leader Contributes to Fighting Opioid Epidemic appeared first on Campaign for Action.

(c) 2019 Flynn Larsen. Photo courtesy of the Robert Wood Johnson Foundation.

Courtney Pladsen, DNP, FNP-BC, RN, a nurse practitioner and a participant in the Robert Wood Johnson Foundation’s (RWJF) Culture of Health Leaders program, was providing medical care to people experiencing homelessness at a soup kitchen in Washington, D.C., when a woman named Becky Smith* asked for wound dressing supplies. Pladsen assessed Smith’s wound and discovered an infected breast lesion—a sign of cancer.

Due to Smith’s mental illness, she was not able to navigate the health system alone. As a result, Pladsen accompanied Smith to the emergency room, where she was admitted to the hospital. During her admission Smith was diagnosed with breast cancer and underwent a radical mastectomy—an invasive procedure in which the surgeon removes all of the breast tissue along with the nipple, lymph nodes in the armpit, and the chest wall muscles under the breast. Within one week of her surgery she was discharged back to the streets, where she had lived for the past nine years. The oncologist who treated her made the difficult decision to delay chemotherapy until Smith was able to secure housing.

Pladsen checked on Smith in her tent four times a week and watched Smith’s health steadily deteriorate, despite her best efforts. Realizing that Smith would die without treatment, Pladsen organized a multidisciplinary team meeting among the soup kitchen managers at Miriam’s Kitchen, a community organization that provides meals daily and case management; Smith’s oncologists; and the local housing department.  Pladsen laid out Smith’s dire medical situation, her resources, and the barriers to her care.  Collectively, the group agreed that housing was Smith’s most pressing need.

Through their advocacy, Smith received housing priority, and within two months, the Interagency Council on Homelessness had secured a permanent supportive housing unit for her. Smith had food in her cabinets, transportation to her appointments, and Social Security benefits. With Smith’s housing, food, transportation, and financial needs met, she could receive life-saving chemotherapy.

“Housing saved Becky’s life,” Pladsen said. “As a nurse practitioner, my job description does not include housing placement, but when you treat the whole person, it becomes easier to identify and address the social and environmental factors that affect health.”

Smith’s case led Pladsen and her colleagues to set up a communication system that they now use for their most acutely ill homeless patients.  They huddle two times a week to take a collaborative approach to meeting patients’ needs.

Changing the Status Quo

Pladsen’s determination to change the status quo for Smith exemplifies why she was one of two nurses accepted in 2018 into the RWJF Culture of Health Leaders Program, a three-year leadership development opportunity for people working in every field and profession who want to increase their impact in advancing equity and health. The program provides leadership training, coaching, and opportunities to collaborate in building a Culture of Health, one that provides everyone a fair and just opportunity for health and well-being.

During Pladsen’s six years at the Federally Qualified Health Center (FQHC), Unity Healthcare, she developed and led the first medical respite program for women in Washington, D.C. In January 2018, she transitioned to another FQHC in Portland, Maine, to help develop the first medical respite program in the state. Medical respite provides care for individuals who are experiencing homelessness and who are too ill to safely recover on the street or in a shelter but not sick enough to need hospital-level care. Medical respite provides residential medical care including post-op care, wound care, medication management, IV antibiotics, and substance use treatment. It also offers the time and space to address patients’ social needs while healing from acute illness.

Pladsen was attracted to the Culture of Health Leaders program because of the opportunity to learn from leaders in other sectors, such as food access, community organizing, architecture, and housing. “I wanted to learn other perspectives and broaden my lens as a nurse,” she says. “You can’t create meaningful change alone as one discipline. We need to learn from one another and develop multidisciplinary solutions.”

She aims to utilize the skills learned from the Culture of Health Leaders program to develop new healthcare delivery models at the intersection of health and housing.

She says the program has taught her to look at problems through an equity, diversity, and inclusion lens.  She has started asking “who is at the table and why?” and seeks to have a more inclusive approach by engaging with people who are experiencing homelessness in the program design, employing a “nothing about us, without us” approach. As a result, Pladsen and her team are interviewing homeless individuals who are hospitalized and asking about their experiences, including the extent to which they felt their needs are and are not being met. The group is compiling and analyzing answers to incorporate into the medical respite program design.

Medical Respite Program to Launch This Fall

More than half of Maine’s homeless population lives in Portland, and the medical respite program will help to address their unique health needs. The main drivers of homelessness in Portland are lack of affordable housing, the opioid overdose crisis, and the lack of access to healthcare. Because Maine did not expand Medicaid until January 2019, it has been very difficult for under-resourced communities to access substance use treatment and mental health services.

People who experience homelessness die 20-30 years before their housed peers. Having a medical respite program aims to improve health outcomes by addressing a particularly vulnerable time after a hospital admission by providing residential medical care as a buffer before returning to the community. People who experience homelessness have lengths of stay in the hospital twice as long as the general population. Despite this extra time in the hospital, they are much more likely to be re-admitted because they are often returning to environmental conditions that are not conducive to healing.

The 24-bed freestanding medical respite program will open this fall and will provide primary, mental health, and substance use treatment. The program will include 24-hour clinical staff who are trained to provide trauma-informed care and promote health equity in a patient population that is often marginalized by traditional health systems. Screening and addressing social determinants of health for all clients is an integral part of medical respite. It provides a unique opportunity for patients to receive necessary medical care, while also having case management staff who are developing relationships with clients and support client identified goals such as housing.

“Everyone deserves the dignity of a home; homelessness should be rare, brief, and nonrecurring,” Pladsen says.

A Personal Mission

Pladsen’s empathy and sense of mission to care for the homeless is personal: when she was a teenager her family experienced homelessness. “Losing my home, living in a shelter, and experiencing the indignity of poverty profoundly impacted the way I understand the world.” she says.

On rare occasions, she will share her story with clients who are feeling overwhelmed while trying to find housing and overcome other hurdles. “Sometimes it’s helpful to know that someone else knows what it is like to go through the experience of homelessness,” she says. “I can truly empathize.”

The Culture of Health program has increased Pladsen’s policy and advocacy passions, and she is considering running for office. “When nurses harness their bedside experience and run for office, it benefits the entire community. Nurses are uniquely positioned to understand how social determinants impact health and can utilize this knowledge to develop legislation that promotes health equity.”

For more information about the RWJF Culture of Health Leaders program, click here. The next application period closes February 20, 2019. For information about RWJF’s other leadership development programs (Clinical Scholars, Interdiscplinary Research Leaders, and Health Policy Research Scholars), click here.

*Ms. Smith’s name has been changed to protect privacy.

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Black girls in Allegheny County, Pennsylvania, are 11 times more likely to be referred to juvenile justice court than white girls—a figure that Kathi Elliott, DNP, MSW, CRNP, is determined to change.

Elliott is an RWJF Interdisciplinary Research Leader (IRL) and the executive director of Gwen’s Girls, an organization founded by her late mother to empower girls in Allegheny County ages 8-18 through holistic, gender-specific programs, education and experiences.

Gwen’s Girls offers an after-school and summer program that seeks to empower girls. More than 98 percent of the girls who participate are black, 95 percent live in single-parent households, and 90 percent live in neighborhoods that are economically disadvantaged and marred by violence and drugs.

It also offers a STEM initiative, career exploration and workforce readiness, with an emphasis on exposing girls to STEM-related careers, which can provide financial stability. Elliott often touts the benefits of pursuing a nursing career, which changed her own life.

“I often say that I am the ‘original Gwen’s Girl’ because I come from the same communities and single-parent household as our girls,” Elliott says. “Nursing changed my life.”

Each girl who enters the program receives an assessment and an individualized plan to help her succeed, as well as an opportunity to receive mental health services. “We assess and plan around their academics, their families, and their social and health needs,” Elliott says. “If their families are food-insecure or have housing issues, that’s going to affect the girl, so we’ll address that.”

Nationally, black girls are three times as likely to be referred to juvenile justice court than white girls. Research shows that black girls are more likely than white girls to experience harassment and abuse, and Elliott and her IRL colleagues Sara Goodkind, PhD, MSW, an associate professor at the University of Pittsburgh, and Britney Brinkman, PhD, an associate professor at Chatham University, postulate that some of the behavior that gets black girls referred to juvenile court arises out of attempts to protect themselves. They also hypothesize that the behavior may be expressions of frustration with adults who mistreat them or dismiss them, as well as with a lack of resources and opportunities. Research has also shown that much of the differential treatment of black girls in the justice system is the result of implicit biases.

A Program to Empower Girls

In 2015, Elliott started the “See the Best in Me Program,” an initiative focused on the development of healthy self-esteem, critical thinking, and advocacy skills that will enable girls to better understand and express themselves about the issues that affect them daily. The program partners with community organizations to help the girls to develop advocacy skills, learn about civic engagement, social justice, restorative practices, and community activism. During the 2015-2016 fiscal year, every participant advanced to the next grade level, 98 percent did not become pregnant, and 90 percent did not become involved in the juvenile justice system.

For their IRL project, Elliott, Goodkind, and Brinkman are studying whether the “See the Best in Me Program” can prevent violence and improve the girls’ health. RWJF’s IRL program is a leadership development program for teams of two researchers and one community partner. Each team participates in leadership training and building new networks, as well as designs a project to improve health and equity in their community.

Elliott, Goodkind, and Brinkman’s research will also assess whether the program can shift narratives about black girls; they are including the girls’ perspectives as part of their research.

They expect their research will show that the “See the Best in Me Program” can serve as a model in violence prevention and health promotion interventions with black girls and other marginalized youth.  Elliott would like to see the program “replicated in other cities, states, and maybe even countries,” adding that she wants to “make systemic policy change.”

Following Her Mother’s Path

From an early age, Elliott watched her mother, Gwen, as one of the first women police officers in Pittsburgh, improve the lives of people in her neighborhood. Her mother was a founder of the Center for Victims, a community organization that provides services to crime victims, and she wanted to start an organization for girls to get them to believe in themselves and reach their full potential. Elliott’s mother realized her dream when she opened Gwen’s Girls after her retirement in 2002.

“I understood early on what it meant to help people, and caring for others is part of who I am,” Elliott says. “All of us need to help one another.”

That desire led Elliott to a career first as a victim’s advocate and then as a psychiatric nurse. She’s treated veterans for mood disorders at the Veterans Affairs Pittsburgh Healthcare System and offered services to a broad array of clients through her private practice. After her mother passed away in 2007, Elliott served on the board of Gwen’s Girls.

When the executive director position opened up in 2015, Elliott found her true calling.

“Everything in my life prepared me for this position,” she says. “I brought my background as a nurse, social worker, and community member.”

Making Research a Priority

Shortly before Elliott became the executive director of Gwen’s Girls, the organization collaborated with local universities, including the University of Pittsburgh and Chatham University, to form the Gwendolyn J. Elliott Institute to support research, provide training, and serve as a clearinghouse for best practices in research and programming that empowers young girls and women.

As one of the few organizations that was addressing the needs of black girls, Gwen’s Girls frequently received requests from researchers to conduct studies. “They would collect the data, but the results were not coming back to us or the community about what we could do to improve what we were doing with the girls,” Elliott recalled.

Elliott expanded the Institute’s work to include child welfare and education. The Institute offers trainings and professional development to policy-makers and educators.

A Call to Action: Addressing Inequities

In 2016, Elliott helped to convene 200 experts from the education, child welfare, health care, and juvenile justice fields for a Black Girls Equity Summit. The FISA Foundation, in partnership with the Heinz Endowments, commissioned Snapshot: Inequities Affecting Black Girls in Pittsburgh and Allegheny County to showcase the gender and racial disparities facing black girls in the Pittsburgh region. The report was authored by Goodkind, Elliott’s IRL colleague. Nearly a dozen community partners provided input and data to spotlight barriers that affect the health, well-being and education of black girls.

Elliott then organized four workgroups that meet monthly to collaborate on addressing inequities in health and wellness, school pushout and discipline, child welfare, and juvenile justice.

She credits the IRL program with helping her to navigate the collaboration between community organizations, government, and community members. It has also helped her to engage with the media and network with other leaders and to share ideas about violence prevention and empowerment programs for youth, she says.

Elliott intends to advocate for girls for the duration of her career. “We need to change our culture,” she says. “Women can be anything they want, and…I want to fight for that equality.”

For more information about the RWJF Interdisciplinary Research Leaders program, click here. This year, the program is accepting applications from two themes: “community development and health” and “clinical practice, social service, and health”. The next application period closes March 19, 2019. For information about RWJF’s other leadership development programs (Clinical Scholars, Culture of Health Leaders, and Health Policy Research Scholars), click here.

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