Morning welcome to our session changes ahead no return to the old normal i’m cynthia bauer i’m the director of the horowitz center for health literacy at the university of maryland college park and i’m happy to be here today at the opening plenary to be your moderator for two very interesting presentations
And i hope a lively discussion so before we turn to our speakers i have some housekeeping work that i need to do the first thing pertains to questions if you have any tech questions or questions about the conference please see the virtual help desk located on the conference homepage for contact information
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Pressing the play button okay with that i think i’ve covered everything in terms of the housekeeping and we’re ready to get started with our session so to kick us off today is dr neil sika who is a professor and a practicing emergency physician at george washington university
He has over a dozen years of experience providing and developing telehealth services he’s the fellowship director for the gw telehealth and digital health fellowship program and has led a number of projects one of which he’s going to talk to us about today called health desk an uh academic community partnership on digital health
Literacy so welcome dr sikka thank you um so thanks for the opportunity to share um a little bit about our program called health desk um so we we built this program following on a previous grant that the dc healthcare finance dc medicaid essentially had provided us to expand capacity for
Telehealth in underserved parts of washington dc that was back in 2018 and we did that in partnership with the pennsylvania avenue baptist church and that was a really exciting project we were able to build a telehealth clinic within the church but it was we learned a lot about the challenges and engaging
Engaging community members to utilize telehealth and i think this has been one of the challenges with using technology in healthcare or specifically with offering telehealth services and that is often if you build it no one comes um and that’s for a variety of different reasons that we’ll explore during this talk
Um health desk was the follow-up grant funded through dc healthcare finance and um was actually awarded to the church and we partnered with them uh developed closely with the church leadership with our community volunteers and with my digital health fellow dr alan and so in essence uh health desk is a digital health
Literacy pop-up and we’ll go into some more details about that next slide please so um here’s the list of objectives for uh this session and um you know we’ll really focus on digital health literacy and how the digital divide has become so much more apparent uh during the
Pandemic and how health desk has tried to tackle some of these challenges next slide please so uh what is health desk i want to go into you know further detail what it’s it is a uh it is a pop-up it was an at community and academic partnership where we bring together volunteer
Digital health coaches who are both community members and members of the academic medical center to work as a team and we really focus on meeting our dc residents where they are with technology and helping them understand and become more comfortable with improving self self-care uh leveraging their mobile devices
And so i mean i think we’re we’re all becoming more attuned to the fact that there are multiple aspects to the digital divide and it’s goes way beyond just access to technology and connectivity but really the knowledge and comfort and the possibility of utilizing the technology to improve your health
So we spent a lot of time um talking into community members trying to understand what those barriers might be and we continue to do that work actually and in grants even today but trying to design um and provide content and coaching that that could be meaningful useful and actionable
Uh to a resident whether they’re having an acute medical problem that they’re dealing with today or if they’re managing the health of a family caregiver or if they’re just trying to manage their own health like a chronic condition that’s been ongoing for a long period of time next slide please
So um who are health desk volunteers um we in the i mentioned the previous grant where we set up the telemedicine clinic we had um at that point recruited about 15 community volunteers who came from really all walks of life within the community many of them were very active
In the church but others were both in and outside of the health care system so some people were nurses some were technicians who worked at different hospitals within the city others had nothing to do with the health care system but i would say the theme that was most common within our community volunteers
Was that they had either suffered through some type of a complicated health condition where they had they felt like they had to fend for themselves to navigate the health care system or they had a family member that they cared for and that they had to support um through that same type of challenge
Um and so health desk volunteers were recruited um through the church leadership um through a variety of different like newsletters and church marketing uh social media apps like nextdoor and instagram you know all of these types of mechanisms were used to try to identify volunteers and then the volunteers would go through
A training program and the training program was focused on on two aspects one was kind of content and the other was operation so if you start with operations there’s various roles to make a health desk pop-up work you need to have someone who helps kind of engage
Community members so if the pop-up shows up at a community health event or even a non-health but community event um we we really wanted um people who are comfortable to go and talk to folks and kind of draw them in the second was a technician so someone
We called a technician so someone who could really hands-on support a resident through um you know working on their own device to make it work for them and and then finally you know you have to measure the eff the impact of of your program
And so we had um folks who were kind of focused on exit um and those were you know doing satisfaction surveys providing giveaways and freebies at the end um and then there actually were leadership roles so folks who would help to schedule and organize and make sure people showed up and set up
And so everyone had their own comfort zone and that was part of the design of the health desk that it had all these different layers so if you were a volunteer you could slide yourself into where you felt most comfortable um the training on content was about four hours it’s a
It was built into a google classroom it was developed delivered multiple times both in person and then online as the as the project went on next slide please so as i mentioned those different roles there is a process for the help desk and it’s it’s really modeled after the apple genius bar experience
Very seamless very digital um very efficient usually so we um we would show up we would set up our tents and we developed a digital registration system so we had ipads all mounted into kiosks and our registration staff would be wandering around an event and draw someone in
And then as you can see in this photo you know bring them to the kiosk and and at the kiosk we would we would register the person and so that would be actually staying away from a lot of personal information but focusing on um why are they there what
What what are they struggling with and would they want to be um connected to uh credible and reliable resources and at the end of the registration process what we would learn about is okay if we’re offering content in five or six different areas please select the one that you’re most interested in
And then it would get handed off to the technician to do that one-on-one coaching but it was really designed to eliminate paper make it a digital experience develop a positive atmosphere and kind of set the stage for this kind of one-on-one coaching relationship next slide please
So the the coaching um as you can see in these images uh was very personal um and uh it was off often one-on-one or one-on-two where we could pair a community member with a volunteer from the academic medical center um and in certain scenarios we actually brought in
I would i would say expert coaches um so in this uh one of the images here you’ll see someone with the with the laptop and he is a i.t staff from our um from our uh practice who was able to help patients register for their patient portal
That took a lot more time and expertise and so having someone with a lot of experience there was very helpful what we found during these coaching sessions was that community members tended to shy away a little bit from the technical coaching and really focus on engagement and our students
Um and our academic medical center volunteers tended to do the opposite they sent her this shy away from community engagement and want to stay at the technician desk so i thought this was kind of an interesting paradigm that we we learned um and really as as the health desk
Hopefully returns into its in-person format after the pandemic um we will work on reversing that because we really want to build more comfort level with our coaches from the community to be able to provide this type of technical assistance and we want to make sure our students our residents our
Faculty become more comfortable interacting with the public in in the community and engaging engaging community members next slide please and then of course step three that’s that’s where kind of the fun is this is where the hugs happen because uh i have to say the number of times
You know uh a community member kind of had a eureka moment with their device was quite frequent and it it was really uh you know incredibly impactful to them um may have been something they’d been struggling with for a long time um you know often we would find that uh
You know a patient’s um device maybe they uh they had uh they couldn’t download an app because when they bought their phone it had a lot of advertisements and other kind of garbage stuff built into their phone and we just were able to show them how to
Delete those things and remove it and now they were able to download their photos or you know download their patient portal or you know do something else so um that that was one uh you know takeaway from almost every encounter was just the incredible kind of gratitude that um
There were people here to help them do this in person and not just kind of on the phone as a you know kind of an anonymous technical support but really this kind of in-person coaching also everyone was asked to fill out a survey on whether this was a useful engagement
And of course take something home to remember us by we had a lot of stress balls and we were surprised at how much stress and um how much interest there was in stress management and meditation um and mindfulness um that we we found among those who attended the health desk
Next slide please so this is these are some of the types of coaching that we provided both on digital health applications and around phone optimization and actually we really focused on phone optimization first even though i apologize to listen second on this slide um because that we really felt like we
Needed to build a basic knowledge and comfort with utilizing their device and also a lot of our pre-work and interviews had um had illuminated that there’s a lot of barriers to adopting or downloading an app you know people are somewhat hesitant due to privacy and security concerns or even just logistical
Concerns for example a lot of us may not recognize this but even if you ask a patient to download a free app depending on the last time they may have updated their credit card information with apple for example in the ios store app in the app store the
App store may ask you to confirm your credit card information and even though the app is free it suddenly changes the perception of that app being free because it’s being associated with a credit card confirmation and so um those those are just some of the barriers that we
We’ve learned and we’ve sometimes called these kind of adoption mechanics trying to understand what are those things that might drive drive adoption and what are those barriers that might limit adoption um so things as simple as helping someone who may be having difficulty um with their vision
Increase the font size uh on their phone that that was incredibly helpful to a lot of people um some people didn’t know that there were color blind settings uh and that they were they could enable voice commands one other very popular uh feature that we were able to help people with was
Setting using the phone alarms to set medication reminders you know for a long time kind of the mobile health and digital health push has been to find an app that helps you with a chronic disease and like i mentioned there are a lot of barriers to downloading an app but if
You can use innate phone functions like a medication alarm i think people have a lot less privacy and security concerns around that and so we had a lot of fun trying to help people set those up because you can customize the text associated with your alarm the times um
And how often it reminds you and things like that so definitely an activity we did a lot of and then on the application side we really focused on patient portals you know i think historically health care systems have um have been incentivized but struggled with the adoption of a patient portal and
Being able to share with uh community members the importance and the value of being able to own your own data to be able to take it with you if you’re receiving care for example in dc there’s eight different hospitals you could end up you know getting your care at georgetown
But ending up in the ed gw and sharing of that data of course is is often challenging so the value of being able to port your own data with you is is incredibly important to relay and then as an er doctor probably one of the most uh important uh you know takeaways from
From my perspective was having patients fill out the in case of emergency feature on their phone i find you know i could i could tell that story over and over and over again you know if if by chance something happened to you you had a stroke or a heart attack or
A traumatic injury where you could not communicate with us the case of emergency will help us identify if you have allergies to any medications what if you’re on blood thinners um or if we can find uh identify um a family caregiver who we may be able to communicate with so
I think people really kind of heard heard the importance of that and we had a lot of people adopt in case of emergency feature next slide please so here are just some of the outputs we measured um uh from uh our community members we we trained uh
Eight kind of trained the trainers and then uh they trained about 22 more so we had about 30 volunteers who became trained uh during the time period of the health desk prior to pandemic and um about 300 residents visited health desk activities at least those that we were able to count
And you can see here what people were most interested in hypertension and healthy lifestyle was definitely at the top and the activities that people were most excited to learn about are listed here as well but in case of emergency and alarms font size and the patient portal and as i mentioned before medication
Meditation and stress management were big big ones we um we had a partnership with headspace the meditation app and so we were able to provide six months of free access to um to that application and actually headspace came back and has now started to work with medicaid providers to provide headspace as a
As a benefit to those patients next slide please um you know if you look on to the the community uh sorry the impact on volunteers both in the community and at the medical center i think it’s just been you know really outstanding it’s opened the eyes of our faculty to
Opportunities and challenges with using digital health i think the students who um were able to spend time with us out in the community just their comfort level um in communicating with with residents um especially shifting outside of the clinical setting where a lot of medical students
Um and pa students um any and often other students from a variety of different domains we had nursing students we had pt and ot students who would show up and volunteer um all of them be you know this is a change of setting because often you’re only communicating with your
Patients you know when you’re in a hospital setting or in a clinic setting and now you’re able to communicate with them in a community-based setting and have these kind of one-on-one relationships that you may not um have when you’re outside that clinical setting so i think you know all of us really really
Benefited from it and and the the community volunteers um you know were engaging with a lot of their um community members they knew or didn’t know but they also um found this comfort level with uh the volunteers from them from the medical center they got to see how dedicated
Our volunteers were how committed they were and how hard they worked to to make this happen and so i think it really did build relationships on both sides next slide please so um as we get close to here wrapping up a few more slides here you know the health desk
Really was a one-on-one in-person kind of activity and when coveted we were no longer able to do these in-person activities and so we’ve struggled now with how do we transition all of these learnings and these methodologies into some type of a new format um and uh so we took uh our first step
Uh next slide please which was creating health desk shorts um where we did interviews and short videos around coveted content um and they were i think moderately effective uh we were able to have some reach through the church and through their facebook live activities and and partnering with other community
Groups um but really didn’t have kind of the energy to scale this kind of content um so we’ve kind of gone back to the drawing board next slide please and now we’re we’re really going to focus on um developing more digital health coaching curriculum that can be distributed
We think that that’s probably our next step um because as people recognize the challenges with poor digital health literacy and digital literacy they need they need a roadmap they need information um you know as we all do you know how do i teach my colleague to be able to
In on the fly when they’re with a patient give them you know basic phone optimization um and promotion types of um information and i think a lot of us just don’t know where to start so we are starting a new study where we’re going to recruit patients who’ve never had a
Smartphone and go through the process with them we’re going to provide them a smartphone and we’re going to coach them through onboarding on that device and we’re going to try to kind of document where the challenges are where what are the simple things that we can do in
Short periods of time and then the end product for that will be content that we can share with lots of people to be able to then pass that on to their patient population next slide please so um we we really need to make patients more aware of the patient portal i think
That’s one thing that we’ve learned we need to make them aware of online scheduling resources um telling them about resources to be able to find devices and then you have to keep promoting this at every visit every time you interact with the patient so once you’ve gone through that content you
Know how to how to educate your end user you need to keep promoting it because over time i think people’s people will change and they will start to realize some of the value and where the return is on on the health care side is that if if your patients are more comfortable
Utilizing this technology at home it actually will make your practice more efficient and their engagement with your practice more efficient so if patients can become comfortable with online scheduling well that may take the load off of your phone scheduling um so or if patients have access to
Their health data now they don’t have to call and request lab results or or other explanations so i think there’s a real benefit um for engaging patients in digital health next slide please and so here’s the you know a proposed tiered fash approach to improving digital health
Literacy this is what we’ll be testing out in our next study but looking at how do you help people with innate features so setting up their phone making calls emails and using text sometimes it’s as basic as that a number of our patients didn’t have email
Addresses and we were able to help them set up a free email address using the camera because it’s such a social kind of activity connecting to wi-fi turning on their phone as a hotspot and then security and privacies are big ones and sometimes patients don’t understand how to use their lock screen
Um and so that’s another set so that’s where we think is like the the very very bottom where can we help patients and then we move into kind of more advanced features so adding contacts setting alarms and reminders changing the font size in case of emergency i mentioned so
These are things that still don’t require an app download they are still advanced features of your phone but don’t require you to go and put something on your device and then in the last stage you know the more mature stages well how do you download or utilize a video chat app
Um how do you install anything that you might you know want to install and how do you assess whether it’s something credible and useful um using the patient portal of course one of those i said is a is of critical importance self tracking is becoming you know i think um
More and more popular and it provides insights into how to manage your health and then remote patient monitoring is a you know emerging area and so as they’re more and more bluetooth and internet of medical thing devices how do people connect to those i mean if
You if you purchase them you got to connect to them you don’t know how many times in the ed i see a patient with a smart watch and i say oh did we did you record your heart rate on a smartwatch when you had palpitations or
Did you look at this you know this or that and and often people didn’t realize the power of the data that’s being collected and how they might be able to utilize that um next slide please so how can how can this be implemented you know i think hopefully there’s some takeaways here
About how you can educate your teams and yourself and become more and more comfortable with the common challenges that patients face with technology you can prioritize making your patient base more digitally literate um because we know there’s benefits to the patient and to the practice and um you can you know become more
Comfortable with applying these skills and i i like this at the bedside in the community and um i put this image here because things are completely changing we will be emerging into kind of this new normal um and maybe we’re afraid of that actually one of my colleagues has been
Terming this kind of fear of the new normal or phono um but you can see here like my ed looks like it vomited out all of its equipment into the rooms because when we were dealing with the height of covid we wanted to keep our rooms as clean as possible so it’d be
Simpler to turn you know turn those rooms and so everything is vomited out now things are moving back in but they’re different not everything moved back in they move back in and maybe new locations and in new ways and so hopefully um we’ll be able to adapt these strategies to help our patients
Adopt digital technologies in a new normal next slide please that’s all i have thank you great thank you so much for that very interesting presentation and look at the work that you’ve been doing in the community uh before i go to our next speaker i want to encourage you to
Post your questions to the speakers we shall should have plenty of time for discussion and q a um so on to our second speaker for this session dr april joy damian she is an epidemiologist and health services researcher with expertise in health equity social determinants of health psychiatric epidemiology and mixed methods
She currently serves as the associate director of the weizmann institute which is a research education and policy center devoted to primary care transportation or sorry primary care transformation i think we can also use transportation right with a particular focus on vulnerable populations so welcome dr damian great thank you so much
Dr bauer and thank you to the iha staff and to all of you for the opportunity to join you this morning um so dr sick and i were charged with this plenary session and i believe the topic was changes ahead no return to the old normal so you just heard about
The role of digital literacy and technology which has clearly um played a major role and telehealth is definitely here to stay as is digital health literacy um the focus of my talk is more on the behavior health changes and recognizing that you know in addition to covid you know we’ve experienced
And observed or witnessed converging pandemics including a mental health crisis so my focus for this morning is understanding and addressing adverse childhood experiences which i’ll refer to as aces and adverse communal environments which are the social root causes i would describe of aces in the context of covid
Next slide please so for those of you who are less familiar with aces and maybe this is a refresher for those of you who are already familiar with this topic um the original study conducted by feletti and anda back in the 90s out of kaiser was looking at three subdomains of aces
So there’s abuse neglect and household dysfunction and you see the different subtypes within of those domains their study predominantly looked at this in the context of uh upper middle class white female population who are insured so just giving you context but since then so close to over 25 years
We’ve learned a lot about aces and looking at aces in the context of health disparities so next slide please so the cdc collects data on aces through its surveillance systems behavioral risk systems across the country and we see that their giano study published last year looked at the frequencies and
Disparities of aces in the u.s and we see that females persons of color those in the 25 to 34 year old age group lgbt populations low-income populations those with limited education and who are in what we call blue-collar positions had a higher uh frequency of aces compared to their respective counterparts so
Recognizing that there are these disparities um based on different demographics that exist um so that’s what we’ve learned in the last 25 or so years uh next slide please and i want to note you know it and i’ll go into detail about aces and the context of covet in a
Little bit but just wanted to note that you know stress in childhood often aces is interchange and there is overlap with childhood trauma but to note that there are different types of stress and i’m sure all of us have been exposed to some degree of this stress right there’s the positive stress um
Which you know for a child might be you know taking an exam i know there are some exceptions um with um the examples i’m giving you know the having exams you know starting in school helps prepare one to be able to handle stress and know that you know you can
Commit to a goal and excel in it and work really hard for something that really matters to you or helps with your own professional personal development there’s the tolerable stress so think of you know what happens with stress and challenges but in the context of having a mentor
Or a supportive adult or all these buffers then there’s a toxic stress right on the far right um and this is what we’re really interested in in terms of you know covid for example as a stressor you think of the impact it’s had on a child’s development even on adults
In terms of school disruptions not being able for those who might be the first in their family to go to college you know the difference in um not being able to um connect with you know loved ones or teachers or even their friends after school and that socializing component that’s so key to
Their development so what happens when there’s this toxic stress so we’ll call the stressor kovid uh and there’s no adult or buffer to be able to offset the stressor that they’re being exposed to right so this is the what we’re most concerned in these lifelong consequences everything from chronic medical conditions
To substance use challenges with learning mental health challenges cancer and even early death next slide please so i just want to show that you know although aces happens early on in the life course there are long-standing challenges on one’s health and health behavior physical mental health
Over the life course right this goes on in into our geriatric patient populations and knowing that there’s a dose response meaning that the higher the a score the higher risk for these unhealthy more risky behaviors as well as adverse physical mental health challenges uh next slide please
But i’m mindful so i given that i’m in public health and an epidemiologist you know we don’t solely look at aces in terms of the individual but also looking at social root causes so i just love this image because it really shows that and so will the next slide that you know
In addition to these aces that we might see as say the fruits um of uh public health challenges there are social root causes that are contributing why certain populations are experiencing aces at a higher rate than others or higher prevalence than others right we know that there’s historical or intergenerational trauma
Greater exposure to communal violence lack of employment poor housing and lack of affordable housing you know here in uh washington dc we have a huge homeless population and issues with housing instability you know poor access to social capital and social mobility right so understanding that yes aces we
Can look at at the individual level or even within a subpatient population but really understanding that there is are these communal factors um that have you know historical and structural root causes that can explain why we see these disparities in aces right and i will go into the
Environmental piece as well um later on this presentation so next slide so this is another this is to zoom in to what i was talking about right so the aces in terms of the fruits or the leaves of the tree but really looking at the roots of why
One are we seeing aces and two why are we seeing aces disproportionately affect certain populations more than others uh next slide please so knowing that we’ve all um level set it in terms of what aces are and then the social causes of adverse communal environments i thought that was an important
Background so that we’re all on the same page now i want to talk about aces and the direct and indirect pathways linking pandemics to aces so i’ll just go over six but there are several more um of linking pandemics to aces so next slide please so there’s the economic insecurity and
Poverty related stress so you remember these are the social root causes so to speak of the aces that we see in terms of the the fruits of the tree right so we know that a lot of businesses have closed including small businesses there’s a spike in unemployment applications and then
Unemployment rates right huge uh growing homeless population which is complicating the already existing um challenges with housing insecurity and you know that there’s food insecurity right we think of our um our young our youth who depend on um free or reduced lunch in public schools and what happens when schools are
You know have to pivot to remote and those lunches or meals that they count on might be their only meal that they have in a day are no longer available right so what happens um and knowing that you know not everyone you know i i was very fortunate and i’m sure um dr
Sika dr barrow you know several of us are very fortunate in that um we might be in positions where our work allows us to be at least partly remote right but knowing that those who um you know are responsible for ensuring you know sanitation of our streets of buildings
Um who run our grocery stores might not have the same privileges right of being able to conduct our work either fully remote or partly remotely next slide please but there’s also uh quarantines and social isolation right we’re hopefully coming out of on the pandemic and beginning to see the light
But recognizing that you know social isolation in terms of children who might you know usually go to school and be able to engage with you know mandated reporters those who are experiencing abuse i know in the initial weeks back in march 2020 they saw a dramatic drop in child abuse reports
And intimate partner violence reports right examples of aces but it’s not so much that abuse suddenly stopped right it’s that those who are mandated reporters such as teachers counselors healthcare providers might not have the same degree of interaction with uh parents with families with children as they would
Would schooling be in person or would moral act have activities that are usually done in person this you know sense of isolation and having to quarantine you know puts has put you know those populations who are at risk of aces um at greater risk right because they’re not able to
Engage with those who would be able to grant them the or connect them with the professional support that is needed next slide please there’s also greater exposure to exploitive relationships due to changing demographics right and we know that african american and latinx populations so this is from the la times are disproportionately
Affected in terms of deaths related to cobit right and so understanding what happens to the person to those persons who are left behind when loved ones who they relied on either from a financial standpoint or social standpoint are no longer available right so what happens when children now have to live
With you know uh maybe an abusive family member or there’s disruptions in the household right and or those that were the head of household and were financially supporting other family members are no longer available now that we know that there are increases in child labor challenges not just in the u.s but also
Globally so recognizing that there is this greater exposure to exploited relationships as a result of disruptions in household composition next slide please so we also note that there’s reduced health service availability access to first responders right so as um health care responders like dr circa are responding to kovid we know that
You know there there’s already uh this is something that i study and continue to address here at weitzman we already know that there’s a shortage in terms of our primary care workforce right and so what happens when you know your uh healthcare workforce now has to pivot and focus on covet related challenges
Right it’s not that these other health challenges including my focus in terms of mental health you know all of us that are no longer important or have gone away right but knowing that when you already have this surge in demand and your first responders now have to
Focus more on kovid you know the first responders who may usually be available you know and this is not solely limited to healthcare staff but also you know law enforcement those you know who work in fire departments now have to pivot and focus more on covid but you know usually would have
Been available in terms of responding to cases of abuse or violence um are now you know tapped out so to speak and have to focus on the current pandemic so recognizing that this reduced availability and access to first responders also puts a higher risk in terms of
Not only exposure to aces but being able to address them in a timely manner next slide please so there’s also virus specific sources of violence right so we talked about um in our article in the harvard kennedy school um misinformation review about health literacy and um the head of who talked about
The challenge of misinformation which was a new word that i learned as a result of pandemic and how the infodemic right of misinformation being used to scare people we’re hearing that in terms of you know what’s contributing to vaccine hesitancy but perpetrators of violence may use misinformation to control or blame women
And children you know withholding safety items such as hand sanitizer you know mass disinfectant withholding health insurance or economic support and then we know that there are also social and economic repercussions of the infections such as stimulation violence and destruction of property from family community members and there are
Emerging studies that have shown that all of these have increased since the start of the pandemic next slide please um and last but not least i want to highlight you know inability of women to temporarily escape violent partners right so what happens so i pointed out earlier in terms of um
Social isolation and quarantine um because of the pandemic and because of policies that were you know stay-at-home policies that were put in place but you know oftentimes um the case of you know having to stay with violent partners is from a financial reason right not only for um the women
And in case i’m giving example of women although i know that intimate partner violence also happens with men but in this case i’m talking more about women you know might stay with uh an abusive partner not only for themselves from a financial standpoint but also for their children right so understanding how um
Ipv which is or intimate partner violence which is a type of ace um has also heightened because of you know limited resources that might be available to be able to escape violent partners we know that courts also um during the pandemic closed so you know when there are usually
These procedures that were happening in person in the courts were delayed because of pandemic and different government institutions closing during the pandemic next slide please so i just wanted to highlight a few statistics for all of you to consider this is from the national institute for healthcare management
Or nihcm foundation so we know that you know before the pandemic 14 of households with children were experiencing food insecurity that doubled during the pandemic families with children accounted for a third of the homeless population before um kovid but we know that because of mass unemployment that there is increasing homelessness
And this is nationwide i talked about ipv in great detail in my earlier slides and then this last box on child abuse and neglect that you know child advocacy centers so i talked about these mandated reporters are seeing fewer children during the pandemic and so you know children becoming
Increasingly vulnerable um during the pandemic you know increased stress as a predictor of abuse school closures so having fewer contacts with adults to identify warning signs uh next slide please so before um the pandemic one in six children faced a mental health condition right just depression anxiety um as some more prevalent examples
Though experts suggest that the impact of the pandemic will only worsen mental health for children right so we’re only um we’re only about a year and a few months out since the pandemic but you can imagine not only the more immediate but the long-term consequences that the pandemic will have
On pediatric mental health not only in you know their current stage of development but um over time which we will you know continue to have to study um we know that increasing poverty rates you know when i talked about earlier about those root causes poverty being one of them of adverse
Communal environments contributing to aces could increase by 53 percent parents having to quit or reduce work hours because child care not being available right often times child care i know some of the schools here in d.c provide child care or extended after-school programming to assist with working class families
And what happens when that’s not available and parents have to reduce hours which means reduce fi you know reduce finances being available and then this relates to um dr sika’s talk about digital health literacy and knowing that there is a digital divide right and knowing that there are
Black and brown communities that are disproportionately impacted including rural communities disproportionately impacted by the digital divide and so what happens when classes are taught remotely but not everyone has access to a laptop i know for some schools in here in see they had a several months waiting period because
Dell just ran out of computer like could not keep up with demand because you know it’s not just schools that needed laptops but different businesses were going remote right so what happens when they don’t have internet access or computing devices what does that mean for their educational attainment and we you know
Don’t know the outcomes of you know being left behind so to speak in education what that could mean long term next slide please so i just want to highlight you know our focus so much as um which is justified has been on um kovid and pointed out mental health crisis as a converging
Pandemic which has really been the focal or the focus of my talk but i just want to highlight that there are other public health challenges um which i’ll say is natural man-made because it relates to our climate change christ climate crisis um right we had hurricanes um that resulted in billions of dollars
Of destructions california wildfires and you can imagine the disruptions this had not only on fam you know youth and families but also on small business owners next slide please in this week we recognize it’s uh the one-year anniversary since the murder of george floyd and that during this pandemic we’ve also seen
Um recognizing this is also asian-american pacific islander heritage month that we’ve also come to reckon um moral reckoning with our country’s you know 400 year public health crisis of racism right so understanding that these natural and man-made disasters you know whether it be hurricanes wildfires racism um all contribute to
A growing mental health crisis right it can exacerbate the adverse childhood experiences and youth development and knowing that those challenges as i’ve reiterated throughout my presentation don’t just have ramifications in early childhood but over one’s life course uh next slide please so i never want to leave a presentation
As if all is doomed right there there is there is hope um dr sika talked about you know being able to partner with churches in the communities and i think you know as as advanced as we get and as much as i love technology i’m not the most technologically savvy person um
That there is value in people right um that the communities have that rapport with each other and how can build resiliency and overcome um public health challenges so what does it mean for us as healthcare and public health professionals as researchers to be able to not just do our research
Our innovations our initiatives in communities but with communities and making sure that they are at the table and making decisions with us and not just at the receiving end uh next slide please you know understanding that you know some of this some of these examples include being able to partner with face
Base faith-based organizations we know that with there are medical societies that have a particular po focus on african communities and are by african-american um providers uh we know um inclu in the african-american community that fraternities and sororities play a huge role in the cultures and what does it mean to also partner
Um with those entities next slide please so just as i noted in the beginning of intergenerational trauma um i also want to note that there is power into intergenerational connections and that you know those who might be in the millennials or those who um are growing up in an era where it’s
Less of a stigma to talk about mental health can create these opportunities and family settings now that families are gathering not just in person but also remotely and leveraging zoom to be able to communicate with each other um to you know understand that yes it’s okay to use headspace right and like what
Does it mean to communicate with your grandma or your older uncle a family member to say yes mental health may have been stigmatized and we don’t talk about mental health or that cousin who has issues but to say to normalize seeking mental health support and to make it a
Part of a normal conversation on our family tables and next slide please so that is it for my another presentation um so i’ll turn it back over to dr bauer thank you thank you so much dr damian for that sobering look at vulnerability and also giving us some ideas about how we can
Speak to that so we have been getting some uh questions in for our speakers and i will turn to those now so dr sika um we got a question um from several people that wanted to know a little bit more about how much time your teams your coaches spent
With each person who was uh using the health desk services so both initially and then any follow-up in terms of some of the activities you were talking about like for example helping them get an email address or learn how to use their phone so if you could just talk about
The amount of time that was needed to do all those things you discussed yeah that’s a great question um you know what we observed in our community activities so that mostly when we set the pop-up up at um at health fairs or community events the throughput was about 15 to 20
Minutes with each person and we did try to limit um you know the kind of the the technical coaching to one or two activities that were most important to folks um at that time so um time you know the throughput in a sense uh in this type of
Intervention can be a challenge and so if you’re trying to adapt that you know into a clinic setting or such it could be could be very difficult but there’s lots of you know ways you might consider that it’s as if you could leverage um you know any of your
Staff doesn’t have to you know if you’re in a in a clinic setting for example it doesn’t have to be a nurse or doctor doing this type of coaching it could be almost anyone um who’s had a little bit of comfort with their devices um other other ways to leverage student volunteers and
And other other folks who are trying to get exposure into the healthcare system i think this is another great role for them i mean a number of our volunteers were actually pre-med pre-medicine students who wanted to get more exposure in the community and from a community volunteer standpoint um
I think uh like i said it’s kind of this transition as people became more comfortable with teaching um things go a little bit faster but we’re also good at kind of handing off oh there’s other people who might be able to help you you have a grandson he might be able to
You know he might be more comfortable with technology so make sure when you have a question go back to them and we are trying to build this dialogue with um people who attended a health desk that again got disrupted by the uh by the pandemic and so we we now
Are trying to figure out how do we go back to build those relationships right the people were also interested in any follow-up because you did speak to the fact that people completed a questionnaire at the end of their encounter was there any other follow-up that came after that
So we um well the the questionnaire was really designed on trying to use kind of marketing tools to understand if this was an engaging type of mechanism to work with the community and so we use the net promoter score um which some of you if you’re in
Marketing you may be familiar with and folks in healthcare have started using this as a as a way to see if um the service would be recommended so the the net promoter score for the health desk was extremely high was i think over 80 80 or something like that 82.85 so very
Very high um but in follow-up we when when people registered through our digital kind of intake they did check a box as to whether we could email them and we have tried a variety of campaigns uh to email back out to folks who attended the health desk and it’s been with i’d
Say moderate success um i think one a lot of emails were incorrect um people either didn’t put the complete email address or they put a wrong email address so that’s that’s a limiting factor on how you verify correct communication two we didn’t have a text messaging
Option where we could directly text to a phone we could only email to a phone um based on the technology platform we had built and we built this all basically with very minimal amount of money and very little technical expertise we built it on a google platform using all the
The google kind of drive suite applications with some students and and faculty who had some experience with this and we were able to recruit some members into other studies so for example when headspace wanted to further understand how the population was using headspace we reached out to that network and were able to
Acquire some community volunteers to join those studies thank you so dr damian you you alluded to the fact that um the pandemic introduced you to this concept of misinformation and you talked also about um the digital divide and sort of how that coincides with so many other factors for the families that you
Um have been studying so could you speak a little bit about um sort of your thinking now in terms of the role that like health information seeking and some of the um sort of technology approaches that dr sika um has uh was talking about how does that sort of fit in this mental
Health space because you know there’s a concept that many of our community have you know is familiar with of mental health literacy but that is has been traditionally been thought of as just being able to recognize signs related to mental health challenges but it’s really not gotten into like the health information seeking
The decision making the sharing of information a lot of the things that those of us in the health literacy community have been interested in so could you speak a little bit about sort of how your think what you’re thinking is today in terms of sort of where how to how do
People who are tradition kind of coming from your perspective and you know primarily concerned with mental health issues and those of us more on the health information side what is your thinking about where we might come together on some of these issues yeah no that that’s a great question um so we covered
In that article that i reference and i think it’s available for free um for those of you who want to look at it but this is really an opportunity for public health which i would say is where health literacy and health it has really lived in so to speak and primary
Care to converge right so so often when we talk about health promotion health communications that’s really been done in public health and not so much looking at it within the primary care setting so this is really an opportunity for the two to uh join our
Forces so to speak as we have during the pandemic um you know part of it and this is the literature supports is is the need to uh start internally within health uh workforce staff because as much as there’s been a lot of emphasis on um medical mistrust which i’m not ignoring it
Definitely continues to exist and persists but there’s also a lot of trust in healthcare providers right and so what does this mean to make sure that healthcare providers and and healthcare teams in the largest sense right from the medical assistants the physicians to registered nurses even community health workers that their own
Questions and concerns about the pandemic about vaccines about the use of apps and digital devices i was just actually answering this question internally earlier this week that they feel comfortable about all of the different i guess the evolution so to speak on continued growth of technology as it plays out in
Healthcare right so understanding that you know if a healthcare provider or member of healthcare team is not comfortable with technology and is kind of downplaying its importance within healthcare that will have an impact in how their attitudes that they’re conveying to patients right so what does this mean to do
Education internally um i think there’s the other piece i talked about earlier community-centered public health practice right so what does this mean to lean on the leaders in the community whether that be leaders of non-profit organizations faith-based organizations which dr sika has done to make sure that it’s not just us you
Know who is i would say helicoptering in as a researcher and saying this is the best stuff that’s inside spread but someone that they already have established rapport with making sure that they’re on board and conveying those public health messages or public service announcements to their congregations or to the populations that
They reach and i think the third piece is also um is understanding and this is why i like the the headspace this is helpful because we know that um mike phelps is one of the spokespersons for uh headspace right and talking about his own challenges with mental health and so what does this
Mean and i know that they’ve also leveraged celebrities in the past you know elvis presley in terms of um the polio vaccine today you know we have nba players and john legend saying the importance of getting the vaccine so the same goes for us right what does this mean to go outside
Of the people we traditionally partner with but knowing that there are other more influential voices right um mayor bowser had michelle obama as part of a public services announcement to stay to stay at home dc right so what does that mean to um partner outside of the circles that we’re used to
Engaging with in our efforts so that they’re the ones who are the spokes persons for what we’re trying to do um and i will add a fourth i should say things in three but i think the fourth is understanding what what do our the populations and the patients that we serve
Want right like what is what’s challenging about the technology like what you know is it you know fear of privacy is it just not knowing how to use it is it not being able to pay for it right um so you know sometimes it’s as simple as
Asking um to be able to better address and come up with solutions well the health literacy community you’re in the right place the health literacy community is all about seeing things from the perspective of the end user or the person who’s getting the information or trying to
Access the service so you’re in a very friendly environment when you say things like that that’s great um so dr sika i got a question here about digital health literacy that this person has been seeing that term used more often and his observation was that you were talking about digital literacy
In a health context so if you could say a little bit about this from your perspective do you think that people could potentially get confused and maybe some of the health literacy issues could get overshadowed by a focus on the technology yeah that’s that’s a good point i think
You’re you’re probably right maybe we are focused on digital literacy in a health context um and the term term may not be fully accurate but i think um you know we know the power of technology can impact you know lots of different aspects of someone’s life and so
Um while we’re focused on on kind of building that digital literacy and then telling you know explain what we do right our expertise is in health so how can you access the the health care information you might need to improve your health but it definitely bleeds into
Social economic education you know a lot of other areas and so for example one of the areas in our new study that we’ll be doing where we provide a phone um to those folks who’ve never had a smartphone before is that hotspot component is really critical because if you have if you’re
In a multi-generational family and you have you know kids at home who are trying to log into virtual school that maybe uh you know a hot spot would enable a better connection than a connection you may have so i definitely think that um that it may not matter so much i mean
We’re really as long as we can improve um understanding of how technology can be used then it can be used for you know applications that are that are patient-centered right or that are people-centered um for what their current need is and we know that healthcare needs are
Not always front and center of course and um they’re often only front and center at a time of crisis um and so uh if we can if we we have to be a vehicle to improve technology literacy then that may be the case but lots of people are working on this and
They’ll have their own context for it and it will bleed over into health as appropriate so dr damian we got a question for you um children specifically who’ve been spent quite a bit of time in the last year online both for education and other reasons
As they come back and are doing more in person is there anything that you would advise people to kind of be ready to do to support um teachers and other professionals who work with children in terms of helping them make this transition from this you know intensely online world back to
An in-person world yeah so just to make sure i got the question it’s more of the youth serving workforce yeah it said are there resources for teachers and other professionals who work with children to help them like with their uh emotional learning their communication as they’re coming back and
You know kind of coming out of this bubble they’ve been in this in you know kind of as you were describing this more sort of isolated environment they haven’t had access to their peers their teachers this you know social workers things like that they’re now going to start coming back
Into contact with this kind of larger world in a more intense way are there any resources or advice that you would give to people who are in those kind of you know helping roles yeah i mean one resource online which i’ve used for a very long time probably for the past
10 years is the national child traumatic stress network um so that shows um you know evidence-based practices in dealing with uh children who’ve experienced trauma because you know i talked about adverse childhood experiences or aces and the disparities but at this point you know every child has experienced some form of
Trauma because of cobit right like a school disruption um i talked about the unemployment rates right so understanding that there are evidence-based practices out there and even if teachers are not clinicians on that site there’s also uh resources on how teachers can engage with uh licensed therapists and clinicians who specialize
In childhood trauma right so the teachers already are overworked and i can have a whole different which i have i have a separate podcast on just the mental health challenges that teachers have to deal with in the classroom but understanding that there are licensed professionals and it’s also a great network
To be able to engage with because especially for um our educators who might be in rural areas and might not have the same resources within their own city in the same city or town then there’s that online resource support or portal to be able to engage with other practitioners and
From different disciplines from across the country i think the second which we wrote about it’s an article in the journal of school health is the need for teachers and you know assuming that there’s if there is a school-based health center co-located within the school that there’s greater communication and interaction between those different
Entities right sometimes school-based health center has worked independently of educators and what does this mean for those who are physically co-located but not not have necessarily pre-copied work together to now collaborate with each other and know that okay if a teacher’s is observing signs of depression or anxiety or
Challenges with a child being able to transition back into the classroom can they then refer the student to a licensed professional within the school-based health center then i think you know there’s also responsibility not solely from teachers but administrators to ensure that there’s mental health support for educators because there is
What’s called uh secondary traumatic stress or vicarious trauma and in terms of providers um usually i’ve studied in a healthcare provider setting but it’s also translate to other youth serving settings where those who work with populations youth and families who’ve experienced trauma are experiencing indirect trauma or burnout
From it so we know that teachers are already at risk for burnout or if not they’re already burned out so what does this mean for um administrators those who are in leadership positions to ensure that you know teachers have you know allocated time and the resources they need to
Promote their own self-care and mental health all right thank you so dr sitka we got a question about the curated content that you talked about if you could say a little bit more about where that content came from and the curation process sure so um
You know we what we found was that a lot of folks find information in a lot of different areas and actually partnered with some new different companies that are looking at this in in different ways but i think you know information gets passed down from a variety of sources of variable
Credibility and so um we struggled with that trying to figure out what what are credible sources for different communities and we’ve decided to settle in and this requires much more exploration but we settled in on pre-pandemic you know sites that were fairly consistent so cdc um the american heart association
Um uh there were a few other curated sites i’m trying to think of you know that come from agents like persa um government sites that um have content that are actually built for different communities and different cultures we tried to stick to those um and look for content that was at a
Pretty low education level that was easy to consume and understand we really liked content that’s video based so we didn’t have to worry about reading literacy that being said i i think you know what we’ve experienced through covid is that sometimes government agencies are not going to be
Considered trusted and we we probably need to take a better look at that as we go forward um i found that there was a better uptake and impact i think when you looked at some of this curated content when i would go through content with a person at the pop-up
Myself so someone had a question about hypertension we could talk about it and then we could go to our health desk website and say oh here’s you know here’s a video from the cdc that kind of reiterates this so you can watch it again at home and
Uh and i think that definitely helps with the concept of credibility because it comes from someone that you’ve seen and trusted and then it gets repeated but i can also see now especially living through covet how there that you know there can be confusion and maybe distrust of some of those sites
All right thank you very much well we’re down to our last couple of minutes for this session and i thought i would just put in a plug for those of you who are in locations that have either a school or program of public health
So in both of the talks it came up sort of how do you do that community engagement in a more sort of direct way i would encourage you as someone in a school of public health to really think about the public health programs and the areas that you
Um are in because there’s lots of students who are looking for that hands-on community experience and they’re trained in public health and they could be great partners for you as as well so i want to uh thank both of our speakers here today for bringing us two very interesting
Uh perspectives on how the world has changed and continues to change around us uh with a focus on how the pandemic is specifically bringing us a new set of circumstances we heard about how technology can play a role and some of the mental health and other challenges that many families are facing
And i think we can all agree there’s plenty of work still for us to do in a post-pandemic world so thank you very much again for joining us here today and i’m supposed to remind you to complete the individual session evaluations and the overall conference evaluation by visiting the conference homepage so
Thank you again and i hope you enjoy the rest of the conference
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