School of Public Health

HSC team receives national Innovative Teaching Award for work addressing sexual and gender minority healthcare needs

By Sally Crocker

Cultural CompetencyMore than 16 million people in the U.S. identify as sexual and gender minorities (SGM). The healthcare needs of these populations are different, especially in terms of reproductive health.

Visiting a health provider or accessing services has never been a one-size-fits-all experience. A lot depends on how included, respected and comfortable a patient feels.

The SGM community has often been overlooked when it comes to Maternal and Child Health (MCH) care, prompting a team from the HSC School of Public Health to want to make a difference in this area.

Through an Innovative Teaching Award from the Association of Teachers of Maternal and Child Health (ATMCH), HSC Assistant Professors Stacey Griner, PhD, MPH, and Erica C. Spears, PhD, MA, have developed MCH graduate course materials for Advancing Cultural Competence toward Sexual and Gender Minorities that are now available nationally as a resource to educators. HSC graduate Smriti Maskey (SPH ’20) assisted in the project.

HSC’s MPH concentration in Maternal and Child Health prepares professionals from a variety of backgrounds for leadership roles in organizations focused on promoting the health of women, children and families.

Stacey Griner
Dr. Stacey Griner

“We had MPH students in mind as we developed this lecture and activities,” Dr. Griner said.

“A lot of research has been conducted on cultural competence and its important role in delivering health services and programs, but many people, educators and providers included, are uncomfortable or unsure about ways of addressing sexual orientation, gender identity, and the reproductive and maternal and child health needs of the SGM community.”

Cultural competence has to do with relationships, communication and respect for the diverse lives and backgrounds of others. Studies have shown that tailoring healthcare and public health services through cultural competence can go a long way in reducing health disparities and improving patient outcomes.

“We’ve all heard of the golden rule,” Dr. Griner said. “Through cultural competence, the focus shifts to the ‘platinum rule’ of treating people how they want to be treated.”

Health disparities among African American, Hispanic and other marginalized populations have been exacerbated in 2020 by the effects of the COVID pandemic and widening cultural divides. For SGM members of these already-at-risk populations who identify as lesbian, gay, bisexual, transgender, non-binary, queer or questioning, the public health challenges are even greater.

“It’s marginalization inside marginalization; many of the health disparities experiences of race, culture, sexual orientation and gender identity intersect among these groups,” said Dr. Spears, a public health researcher dedicated to finding solutions for communities of color.

“There has been a lack of community acceptance because people don’t fit the boxes. People want to be respected and treated as their full selves, but that’s not widely happening yet. Even the registration forms for visiting a provider or accessing healthcare services can be discouraging if the pronoun choices don’t fit appropriately for the individual.”

In any population, there are different segments with different needs.

Heads Up
Dr. Erica Spears

“In terms of the current social justice issues facing our world, there are many different hashtags,” Dr. Spears said. “For African Americans, that might mean Black Lives Matter, Black Trans Lives Matter, Black Women Matter and others, each a different community with its own stories, its own need to be recognized.”

“I would like to think we would have been doing this anyway in public health and healthcare, treating people as they wish and need to be treated, but we’re not there yet,” she said.

As a School of Public Health student involved in helping to develop and test the course lecture and materials, Maskey said she sees SGM cultural competence as especially important for professionals interacting with patients and community populations.

“Many people may be afraid to disclose their orientation for fear of bias or not receiving the services they need,” she said. “For students and future maternal and child health leaders, it’s critical to put cultural sensitivities into practice, to hopefully improve systems for the future and better meet people where they are in their own lives.”

The course lecture is already in use at HSC and can be downloaded by any educator through the ATMCH website.

“Cultural competency isn’t something new – it’s been important for a very long time,” Maskey said.

“We all want and need a meaningful experience with our provider and when navigating health-related services, to be met honestly and openly as who we are. That’s the heart of respect and communication in any setting, and especially in healthcare and public health.”

Cultural Competency
School of Public Health

Why you should vote

By now we are all intimately familiar with the horrific events that have occurred in 2020. It has been a year full of multifaceted injustices ranging from the outrageously high COVID-19 death toll that has disproportionately affected communities of color, to the violence and deaths that have resulted from police brutality. There have been substantial attacks on the rights of the LGBTQ+ community as well as substantial attacks on the democracy of the United States itself. Given the human lives and the human rights that are at stake in this upcoming election, it is arguably more important now than ever before that we exercise our right to vote.

Vote As citizens of the United States, it is our job to be active participants in the democratic process through casting our ballots in elections. As such, it is absolutely vital to the health and to the wellbeing of our country that we all vote this fall, regardless of our excitement or lack thereof for a particular presidential candidate. Additionally, it is of the utmost importance that we make an informed decision when choosing candidates listed on our ballots. This means that we must all educate ourselves on both the political records and the platforms of each candidate on the ballot, regardless of the office they are running for. Although change can happen at a federal level, change often begins with officials elected for local offices, so make sure you are choosing candidates that stand for what you believe in.

In a time where there is much turmoil and unrest present in our country, it is imperative that we all remember change begins with us and with our votes. If you or somebody you love has been negatively affected by the COVID-19 pandemic, educate yourself on how candidates plan on handling the pandemic and choose the people you feel will make a difference in your community. If you have been devastated by the blatant acts of racism that are still plaguing us in 2020, it is your job to learn about the records and the platforms of each candidate so that you know who truly stands for justice and who does not. If you care deeply about any other issues that are influenced by policy makers, it is your responsibility to look up both the records and the platforms of each candidate to make sure that you are making an informed decision when you cast your ballot this fall. If there is not a candidate that you are excited to vote for, it is your job to educate yourself so that you can choose the candidates that will benefit the most vulnerable members of your community. If you are an undecided voter, factcheck your candidates through non-partisan resources to ensure you are making an informed decision.

In closing, if you are looking for justice, vote. If you are looking for a way out of this pandemic, vote. If you are looking for economic relief, vote. Urge your family and friends to vote. Find ways to become politically active in your community to help ensure your voice and the voices around you are heard. Use your voice to fight for justice for the most marginalized members of your community. And above all else, remember that change starts with you and with your vote, so please make a plan and make sure your voice gets heard.

Early voting in Texas lasts through October 30th and election day is November 3rd.

Authors:

Kayla Tate, School of Public Health PhD student

Julian Rangel, MPH, School of Public Health Alumni

Vote
School of Public Health

HSC Regents Professor Dr. Scott Walters and colleagues share progress addressing nation’s opioid crisis in new scientific publication

By Sally Crocker

Scott WaltersA special issue of the peer-reviewed scientific journal Drug and Alcohol Dependence has been released, profiling the efforts of a National Institutes of Health (NIH) study to address the nation’s opioid crisis.

$350 million in funding has been committed to this program between 2019-2022 in what is notably the largest implementation science study ever conducted in the field of addiction.

Scott Walters, PhD, Regents Professor at the University of North Texas Health Science Center at Fort Worth (HSC), is Steering Committee Chair of this program – the HEALing Communities Study (Helping to End Addiction Long-term) – developed through a partnership of the National Institute on Drug Abuse (NIDA) and SAMHSA, the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.

The study will create a national model to address the opioid crisis by speeding solutions and reducing opioid deaths in 67 highly impacted communities across four states – Ohio, Kentucky, Massachusetts and New York – representing more than 10 million people.

Over the last year, research sites at the University of Kentucky, Boston Medical Center, Columbia University and Ohio State University have been testing the implementation of a set of evidence-based strategies, with Dr. Walters managing the project from a national perspective.

The just-published, special edition of Drug and Alcohol Dependence contains 10 research papers on the HEALing Communities’ work over the last year, including the NIH vision and study protocol, implementation methods and measurement. Dr. Walters is one of three guest editors for the issue, along with NIDA and SAMHSA scientific directors. The entire edition is provided as open access, subscription-free, to the public.

“This special issue is important scientifically because of the scope of the problem and breadth of the study,” Dr. Walters said. “In 2017, almost 48,000 Americans died from an opioid overdose. More people died from opioid overdose than from car accidents. The irony is that all of this is preventable. There are proven strategies to reduce opioid use disorder and overdose.”

“As staggering as these numbers are, they are likely underestimates,” Dr. Walters said. “The U.S. has more than 2 million people with an opioid use disorder. It’s hard to imagine the damage that does to families and communities.”

Small gains in reducing those numbers that were achieved prior to 2020 were washed away this year as the nation struggled with anxiety, stress and negative mental health consequences of the COVID-19 pandemic.

“The sharp increases in overdose in the last six months have greatly affected the course of the HEALing Communities study,” Dr. Walters noted. “As we work to solve one crisis in the middle of a second crisis, we are creating a model for future ‘twindemics’ in the new world that exists right now.”

“We already know what works to reduce overdose and opioid use disorder – notably medication to help with recovery, and naloxone to reverse overdoses and safer prescribing practices. This study tests the implementation of those evidence-based practices, and ways to help a community actually put them into practice,” he added.

Healing Comms Bus Ad
Transit ads are a part of HEALing Communities public service campaigns in some communities

Dr. Walters likens these efforts to a “one, two, three punch,” with community engagement, a menu of evidence-based practices and communications campaigns to reduce the stigma around seeking help and increase demand for services.

“We’ve been able to capitalize on some aspects of the pandemic, for instance building attendance at community coalition meetings by taking them online, and ‘fast tracking’ distribution of naloxone to people released early from jail,” Dr. Walters noted. “We accelerated certain efforts, along with our accompanying media campaigns, to respond to the challenges of the pandemic.”

The new Drug and Alcohol Dependence issue detailing the HEALing Communities’ work is consistent with the study’s goal to share information with other researchers.

“We want to conduct this project in a glass house, sharing methods as we are able, describing how communities are engaging, how our media campaigns drive demand, and showing better ways to measure outcomes,” Dr. Walters said.

“No state has been immune to the effects of the opioid epidemic. We all benefit from the work being done to offer new hope for individuals, families and communities impacted by this devastating public health crisis.”

Read more here about the HEALing Communities study in this special issue of Drug and Alcohol Dependence.

 

Examples of HEALing Communities public service campaigns across different states:

Healing Comms Sample Campaign Ny Healing Comms Sample Naloxone Campaign

 

Scott Walters
School of Public Health

Exploring the Journey for Homeless Mothers

Dr. Erika Thompson, SPH Assistant Professor and MPH Maternal and Child Health Program Director, will be the featured speaker at an October 20 online event – “Exploring the Journey for Homeless Mothers” – through the Center for Transforming Lives Lecture Series. This event is free and open to the public as part of the agency’s quarterly conversations with North Texas community leaders, researchers and advocates.

Lectureseries
For more information and to register, please click anywhere in the image above.
Lectureseries
School of Public Health

MHA Program Director Dr. Stephan Davis contributes to national diversity, equity and inclusion report

By Sally Crocker

Dr. Stephan DavisThe Josiah Macy Jr. Foundation, with contributions from the HSC School of Public Health, has released a set of recommendations for building a culture of fairness, respect and inclusion in health professions learning environments.

SPH Assistant Professor and MHA Program Director Stephan Davis, DNP, MHSA, FACHE, contributed to the Foundation’s report and development of four broad recommendations and specific action steps for addressing forms of harmful bias and eliminating discrimination, to make diversity, equity and inclusion top priorities in learning environments and in practice.

Dr. Davis is a recognized nursing leader, healthcare executive and educator who is active in a number of national organizations, including serving as Chair for the American College of Healthcare Executives (ACHE) LGBTQ Forum. He also serves as Co-Chair of the Equity, Diversity and Inclusion (EDI) Committee for the School of Public Health.

The Macy Foundation is dedicated solely to improving health professions education, based on the principle that these fields have at their core a strong social mission to serve the public’s needs and improve health.

“HSC is committed to promoting an understanding of diversity, equity and inclusion,” Dr. Davis said. “We are working together across campus and in partnership with other organizations to equip the public health and health professionals of tomorrow as they prepare to meet the needs of a dynamic global society.”

The Macy Foundation report and recommendations were initiated at the organization’s 2020 conference earlier this year, with input from more than 40 faculty, student and leadership representatives of medical and nursing schools and universities like HSC. Dr. Davis represented the HSC School of Public Health and MHA program. The report was revised and refined in recent months and formally released in September.

“Preparing future health and public health professionals for their important roles in society involves both curriculum and crucial conversations focusing on the ways that racism and other forms of bias can harm people’s health, influence decisions that perpetuate inequities and threaten lives,” Dr. Davis said.

“We have seen the devastating impacts of health inequity and social injustice unfold in tragic, unimaginable ways this year within Black communities, bringing national focus to the need for solutions. It’s time.”

Seeking to eliminate harmful bias and discrimination in the classroom and addressing ways that these issues manifest in professional and clinical environments, contributors to the Macy Foundation report developed four recommendations for the nation’s medical, nursing and health professions schools:

  • Build an institutional culture of fairness, respect and anti-racism by making diversity, equity and inclusion top priorities.
  • Develop, assess and improve systems to mitigate harmful biases and eliminate racism and all other forms of discrimination.
  • Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination, racism and all other forms of oppression.
  • Increase the numbers of health professions students, trainees, faculty and institutional administrators and leaders from historically marginalized and excluded populations.

Aligned with HSC’s campus-wide commitment to Diversity, Equity and Inclusion, the School of Public Health’s EDI committee is already working on initiatives corresponding to the Macy Foundation recommendations and action steps.

Read more about the Macy Foundation report here.

Dr. Stephan Davis
School of Public Health

Planning holiday get togethers during COVID-19

By Sally Crocker

Covid Holiday

Fall and winter holidays have a different feel during COVID-19 as families consider the safest ways to celebrate their usual traditions with friends, neighbors and loved ones.

It’s still possible to enjoy the season during the pandemic, says HSC’s Dr. Diana Cervantes, by approaching your plans and festivities in creative, new ways.

“Even though our world is different right now, people still want to maintain their traditions with those who are closest to them,” she said. “By practicing safe COVID guidelines and rethinking the possibilities, there’s no reason to have to miss the big events you enjoy celebrating each year.”

An Assistant Professor and Director of the HSC School of Public Health MPH Epidemiology Program, Dr. Cervantes is considered one of Tarrant County’s trusted experts on COVID-19 safety, offering the community a steady stream of information and advice these last several months based on public health guidance and science.

FallcovidHalloween is all about masks anyway, so why not create your own this year,” she suggests.

“Kids can have fun designing cloth or surgical masks in clever ways. It only requires a few craft supplies you can order online.”

Going big with your decorations both inside and out is also a good way to get in the “spirit,” she said, and the more elaborate your lights, sounds, effects and front-yard scenes, the better.

Socially distanced costume parades on bicycles can be a great way to shift the focus away from group gatherings on neighbors’ doorsteps. Individual, small bags or cups of candy set outside on a festive table, or in strategic places around the front lawn, are good ways of distributing treats during the pandemic.

“It’s just not the time for all those little hands to reach into the same candy bowl,” Dr. Cervantes said.

Zoom costume parties and virtual pumpkin-carving contests are other ideas she suggests this year.

Thanksgiving is another big holiday just around the corner, and many families are approaching this one in unique ways as well.

“The safest way to get together in person is outside, in small groups of no more than 10,” Dr. Cervantes said. “Even with the Zoom exhaustion many people seem to be feeling right now, virtual events are also good choices.”

Cervantes Diana
Dr. Diana Cervantes

“Maintaining holiday traditions as safely as possible has a positive impact on mental health and can provide some much-needed relief to the pandemic isolation of the last several months.”

Bringing everyone into the planning makes it more of a “together” event. Dr. Cervantes recommends having honest conversations about your personal comfort levels and “non-negotiables.”

“If something doesn’t feel safe to you, don’t be afraid to voice your concerns,” she said. “We all want to be sensitive to the health of others, especially older adults, those with underlying health conditions and people at higher risk. It’s always your choice to skip an event, or to set the guidelines if you’re the host.”

Outdoor parties should have backup weather plans in place, including alternate rain dates and ways to keep warm if temperatures get chilly.

Social distancing, with tables set six feet apart for guests from different households, is still the recommendation, and masks should be available and easily accessible if someone has to go inside or be within close distance of other guests, especially those at high risk like the elderly.

“I like to provide ‘pandemic preparedness party packs’ for each table, with hand sanitizers, disposable napkins, masks in case they forget theirs and other items they might need,” Dr. Cervantes suggests.

Plans can include disposable plates and cutlery, with plenty of outdoor trashcans in strategic places. To further minimize risk, guests should avoid sharing drinks and food. Brainstorm ways to keep smaller kids occupied and in their own space.

“Kids like to hug, and especially if they haven’t seen grandparents or other relatives in a while, it can be a challenge,” Dr. Cervantes said. “Consider table games, puzzles, crafts, contests, bingo, an outdoor movie or other interesting options.”

Bathrooms pose a lot of questions during COVID. The best way to set yours up, Dr. Cervantes recommends, is with paper towels and liquid soap. Remove cloth towels and place an extra trashcan outside the door, so guests can avoid touching doorknobs and handles by grabbing a spare paper towel on the way out. Designate only one bathroom for guests, and limit access to the rest of the house.

“You’ll want to clean all high-touch surfaces after the party, and smaller kids will likely need extra handwashing reminders as they come and go,” she said.

If your party absolutely must move indoors, be sure guests stay socially distanced and wear masks except when eating or drinking, and do all you can to increase ventilation, including opening windows.

“Limit exposure by limiting your time together,” Dr. Cervantes recommends. “It’s helpful to designate one person to be the ‘bad guy’ focused on the time and the rules. People lose their inhibitions the longer parties go, especially if drinking is involved. Someone to end the party in a gracious way, or even to remind people to spread out or wash their hands, really helps.”

Many families and friends have joined in small “social bubbles” this year, so they can feel safer getting together with others who are social distancing in the same ways they are.

“For holiday events, that might mean that everyone quarantines 14 days prior, only going out for quick essential errands, and that they are not running a temperature, haven’t recently traveled or been in large crowds, and are symptom free,” Dr. Cervantes said.

December holidays should follow these same recommendations. Virtual cookie baking nights and tree-trimming from different households, holiday trivia games via Zoom or charades online are all great for including friends and family both nearby and miles apart. Even this year’s New Year’s Eve countdown from Times Square, a longtime New York tradition watched by millions around the world, has gone virtual.

“The goal is for no one to get sick. On average, the spread of COVID is more than one-to-one; a single person can infect 2-3 others,” Dr. Cervantes said. “You don’t have to feel sick to expose someone.”

“This isn’t a forever thing, it’s our way of keeping our friends and loved ones especially safe right now. It’s about all of us working together and doing our best for the health of everyone.”

Covid Holiday