2015-2017 Practitioners

The following people make up the Kraft Center for Community Health's 4th class of practitioners. 

photo of practitioner Carolina Abuelo
Caroline Abuelo, MD
Trefler Practitioner; Internal Medicine, MGH Charlestown

Project Focus: Reducing Disparities in Cancer Screening in Charlestown 

Project Overview:  The city of Charlestown faces some of the greatest socioeconomic challenges in Boston, including the fact that 17% of the population and 38% of children live below the poverty line and there exists a 5% unemployment rate. Socioeconomic barriers commonly parallel health disparities, including disparities in cancer survival rates. Reasons for this disparity are diverse and complex, but one major contributing factor is differential cancer screening rates, a disparity that has been noted within Boston. This project will identify the population which is unscreened for breast, colon, and cervical cancers. Providers will identify risk factors for lack of screening in Charlestown to determine if these are similar to those noted in other geographical areas. The practitioners will apply existing resources of patient navigation to the problem and determine if patients truly require navigation or would otherwise get screened through regular care. 


Statement of need/problem to be addressed: 
Throughout the country, socioeconomic disparities often parallel disparities in health.  For example, the SEER data base has revealed disparities in cancer, such as among African Americans with the highest death rate from all cancer sites combined and from malignancies of the lung and bronchus, colon and rectum, female breast, prostate, and cervix of all racial or ethnic groups in the United States[2]. These reasons for these disparities are diverse and complex, but one major factor is differential screening rates. Closer to home, disparities in cancer screening have been noted in the Boston area, where women born outside the USA were less likely to have had a Pap smear[3]. Chelsea has a large immigrant and Latino population where lower rates of cancer screening were identified and a robust patient navigation (PN) program was successfully developed and deployed to address this problem. For example, patients with less than a high school education were noted to be less likely to be screened for colorectal cancer but 2 years after initiation of the PN, there was a statistically significant narrowing of the gap[4]. Similarly, disadvantaged women with a history of abnormal mammograms were more likely to have completed follow up mammography in practices with PN compared with those without PN (90.4% vs. 75.3%, adjusted p=0.006)[5] In other health systems in Boston, there has been differential success with PN for breast cancer screening based on characteristics of the patient in terms of resolution of abnormal results. For example 75% of women in the study had barriers to care and the presence of barriers was associated with less timely of abnormal mammograms[6]

Anticipated outcomes: 
We expect to characterize the population which is unscreened in terms of breast, colon, and cervical cancer. We will identify risk factors for lack of screening to determine if they are similar to those noted in other areas. We hope to apply existing resources of patient navigation to the problem to determine which patients truly require navigation vers
photo of practitioner Sunny Chavan
Sunny Chavan, MD, MPH
Internal Medicine, Brockton Neighborhood Health Center

Project Focus: Developing a Primary Care Rotation for the VA/Harvard Psychiatry Residency Program at Brockton Neighborhood Health Center 

Project Overview: The greater Brockton community, home to Brockton Neighborhood Health Center (BNHC), has struggled with a shortage of psychiatrists. This project will result in a primary care rotation for psychiatry residents from the VA Harvard program at BNHC. This will introduce the psychiatry residents to vulnerable and low income patient populations, as well as issues that surface in their treatment planning within the community health center, a setting much different than the VA. This goal of the project is to familiarize psychiatric providers with the community health setting, offer current BNHC providers teaching opportunities, and potentially recruit new providers to the health center.  

The focus of my Project is to develop primary care rotation for Psychiatry Residents from the VA Harvard program, at the Brockton Neighborhood Health Center ( BNHC). This has the potential of introducing Psychiatry Residents to the vulnerable and low income patient populations and issues that surface in their treatment planning, in a setting much different than the VA.vulnerable and low income patient populations and issues that surface in their treatment planning, in a setting much different than the VA.


Integrated care is a key element in primary care and I would like to approach this project with intension to provide evidence based clinical teaching to the residents. We are expected to have one psychiatry residents per month. They will have one months of rotation each, and will be scheduled with each participating attending for minimum 15 days. This will help resident to observe different work flow practice in primary care settings. The rotation will cover all primary care topics on case to case basis. Didactic sessions will be scheduled with residents during attending’s administrative hours. Residents will be given opportunity to see patients and discuss the treatment and plan with attending. Resident’s patient load will be gradually increased depending on residents comfort level and confidence in treating patients. During this rotation resident rotate with specialty clinics at Brockton neighborhood health center, which may include VIP clinic, STD clinic, shelter clinic and urgent care. Resident will be introduced to integrated health care approach and PCMH model.


Statement of need/problem to be addressed: 

Primary care rotation for psychiatry residents at BNHC will be a great initiative to strengthen current collaboration between BNHC and VA-Harvard residency program. This project will also meet overall annual goals for BNHC. Greater Brockton Community including Brockton Neighborhood Health Center, has struggled with the shortage of Psychiatrists in past. This project will help to expose upcoming psychiatrist and recruit them to community health center both in Brockton and in Massachusetts in general. By Giving teaching opportunities for current and future primary care provider will definitely help to retain and to recruit new primary care providers at health center. This rotation will also expose resident to a large number of female patient population, which is currently not feasible at VA residency program setting. Overall this project satisfies the current needs of involved stakeholders. 


Anticipated outcomes: 

Improvement in psychiatrist recruitment at community health center(CHC).

Developing an environment for current CHC providers to fulfill their academic interest.

Providing University affiliation to CHC providers which will help to recruit new and retain current providers

Integrated care is a key element in primary care and I would like to approach this project with intension to provide evidence based clinical teaching to the residents. We are expected to have one psychiatry residents per month. They will have one months of rotation each, and will be scheduled with each participating attending for minimum 15 days. This will help resident to observe different work flow practice in primary care settings. The rotation will cover all primary care topics on case to case basis. Didactic sessions will be scheduled with residents during attending’s administrative hours. Residents will be given opportunity to see patients and discuss the treatment and plan with attending. Resident’s patient load will be gradually increased depending on residents comfort level and confidence in treating patients. During this rotation resident rotate with specialty clinics at Brockton neighborhood health center, which may include VIP clinic, STD clinic, shelter clinic and urgent care. Resident will be introduced to integrated health care approach and PCMH model.


Statement of need/problem to be addressed: 

Primary care rotation for psychiatry residents at BNHC will be a great initiative to strengthen current collaboration between BNHC and VA-Harvard residency program. This project will also meet overall annual goals for BNHC. Greater Brockton Community including Brockton Neighborhood Health Center, has struggled with the shortage of Psychiatrists in past. This project will help to expose upcoming psychiatrist and recruit them to community health center both in Brockton and in Massachusetts in general. By Giving teaching opportunities for current and future primary care provider will definitely help to retain and to recruit new primary care providers at health center. This rotation will also expose resident to a large number of female patient population, which is currently not feasible at VA residency program setting. Overall this project satisfies the current needs of involved stakeholders. 

Anticipated outcomes: 
Improvement in psychiatrist recruitment at community health center(CHC).
Developing an environment for current CHC providers to fulfill their academic interest.
Providing University affiliation to CHC providers which will help to recruit new and retain current providers

 

photo of practitioner Sofia Chu
Sofia Chu, MD
Family Medicine, Manet Community Health Center

Project Focus: Identifying and Implementing Changes for High Risk Substance Use in a Primary Care Setting 

Project Overview: The city of Quincy has the 7th highest rate of opiate fatal and non-fatal overdoses of the cities and towns in Massachusetts. Manet Community Health Center currently has a presence in Quincy, Taunton and Hull, Massachusetts.  Manet cares for close to 15,000 patients each year, approximately 6,000 of which have been identified with a mental health diagnosis including but not limited to alcohol or polysubstance abuse/dependence. In order to better identify and detect unhealthy substance use, providers will be integrating the SBIRT (Screening, Brief Intervention, and Referral to Treatment) model into clinical practice.  SBIRT is an evidenced-based practice used to identify, reduce, and prevent problematic use, abuse and dependence on alcohol and illicit drug use.  Through integration of this model, the health center can better identify high risk alcohol and drug use in a clinical setting, train health care providers to promote behavior change through brief interventions, and enhance community partnerships to improve behavioral health and addiction service access.

photo of practitioner Cassis Henry
Cassis Henry , MD
Trefler Practitioner; Psychiatry, Boston Health Care for the Homeless Program

Project Focus: Reducing Disparities in Rates of Cancer Screening at Boston Health Care for the Homeless Program

Project Overview: Homeless people have a high burden of behavioral and environmental risk factors for cancer. Several studies have documented lower rates of colorectal cancer screening among homeless individuals generally, and completion of cervical and breast cancer screening may also be suboptimal in this population overall. Colorectal and female breast cancer rates among homeless individuals seen at BHCHP have recently been described to be diagnosed at later stages than among other Massachusetts adults, contributing to excess mortality. Cancer screening rates among individuals with behavioral health disorders (substance use and mental illness) may be even lower. The focus of this project is to characterize the rates of screening for colorectal, cervical, and breast cancer in individuals seen within the previous year, to attempt to understand what characteristics (including the presence of behavioral health disorders) correlate with lower screening rates, in order to improve screening - as one element of improving cancer outcomes in BHCHP patients generally. The project will also explore the feasability and acceptability of self-screening methods to identify particularly high-risk patients in this hard-to-reach population.  


photo of practitioner Alexandra Mendonca
Alexandra Mendonca, NP, MPH
Nurse Practitioner, East Boston Neighborhood Health Center

Project Focus: Implementation of Vaginal Swab Collection for Detection of Chlamydia Among Adolescent Females 

Project Overview:   The Centers for Disease Control and Prevention recently published updated guidelines for the screening and treatment of sexually transmitted diseases, which state that the optimal specimen type for detection of Chlamydia infection among females is by vaginal swab (either provider-collected or patient-collected). The goals of this project are to implement a work flow within the East Boston Neighborhood Health Centers’ Adolescent and Young Adult Clinic for a vaginal swab collection method, use educational materials to help adolescent females become more aware of the structure and function of their reproductive systems, identify facilitators and barriers to this new screening method, and encourage other health care providers to engage adolescents in discussions about sexual health. 

photo of practitioner Elizabeth Quinn
Elizabeth Quinn, MD
Family Medicine, Greater Lawrence Family Health Center

Project Focus: Screening for Food Insecurity at Greater Lawrence Family Health Center

Project Overview: There is a growing body of evidence that food insecurity has significant health consequences. Studies have linked food insecurity with childhood and adult obesity, poor diabetic control, and childhood behavioral problems. Rates of food insecurity and poverty have also been rising in recent years. At the Greater Lawrence Family Health Center, there is no current systematized way of asking patients about poverty or food insecurity. The objective of this project is to implement a brief USDA food insecurity screening at the Greater Lawrence Family Health Center while simultaneously developing interventions to offer patients who screen positive.

photo of practitioner Sneha Rao
Sneha Rao, PNP
Nurse Practitioner, South End Community Health Center

Project Focus: Establishing a CenteringParenting Program at the South End Community Health Center

Project Overview: CenteringParenting is a model of healthcare delivery in which routine well baby care is provided in a group setting that combines traditional physical assessment with clinician-led group discussion and education. This project aims to establish a CenteringParenting program at the South End Community Health Center, with the hope that this program will empower and motivate mothers while optimizing the department's efficiency and ability to support patients and their families.  Prior to establishing a CenteringParenting program, this project will also create a Baby Cafe. A Baby Cafe is an informal, drop-in breastfeeding support group where mothers gather to feed their babies, socialize, and learn about breastfeeding from each other and lactation specialists. 

photo of practitioner Lee Robinson
Lee Robinson, MD
Psychiatry, Windsor Street Health Center

Project Focus: Supporting Families of Children with Neurodevelopmental Disorders

Project Overview: Increasing numbers of children are being diagnosed with neurodevelopmental disorders, such as Autism Spectrum Disorder. Such disorders affect multiple domains of functioning and require extensive interventions across medical, mental health, academic, and community settings. Unfortunately for these children and their families, comprehensive care and support breaks down around two key elements: access and coordination. Few providers are willing to take on these challenging patients and few specialized services exist and services are rarely integrated across multiple settings, leaving parents to navigate a fragmented system. The goal of this project is to develop an infrastructure for integrated mental health care and care coordination within the primary care team to better address the problems of access and coordination of care for children with neurodevelopmental disorders.

photo of practitioner Amy Smith
Amy Smith, MD, MPH
Family Medicine, Cambridge Family Health/North

Project Focus: Screening for Food Insecurity in Children and Connecting Families to Existing Community Resources

Project Overview: Research has shown that age 0-5 is a critical period of physical, mental and emotional growth, and children who live in food insecure households are at increased risk for developmental delays and decreased school readiness. Approximately 15% of residents in the communities that Cambridge Health Alliance (CHA) serves live below the poverty line and thus face a greater risk of food insecurity. Moreover, CHA is entrusted with the care of over 9000 children ages 0-5, approximately 65% of whom are publicly insured. This project will focus on developing a clinical flow for screening and referring food insecure CHA patients ages 0-17 to Project Bread, a community partner. Project Bread will reach out to consenting patients and assist them with signing up for benefits for which they are eligible, and/or direct them to local resources that match their needs. The hope is to incorporate this process throughout all of CHA and use it as a model for addressing other social determinants of health. 

photo of practitioner Joseph Wright
Joseph Wright , MD
Internal Medicine, Boston Healthcare for the Homeless Program

Project Focus: Improving Access, Speed, and Treatment of the Riskiest Patients in an Office-Based Opioid Treatment Program 

Project Overview: Overdose was already the greatest cause of death in the Boston Health Care for the Homeless patient population in 2008 and overdoses have risen dramatically since then. One of the clinic's responses to the opioid crisis has been to provide buprenorphine-naloxone, with nurses and social workers providing most of the care; however, like many buprenorphine-naloxone programs, there is often a waiting list for treatment. The goal of this project is to use techniques from industrial process improvement to make the program’s work more efficient and more centered on what people with opioid use disorder need most. As a result, there will be more rapid access to treatment.