Medical Center’s community health mission reaches across the institution and deep into neighborhoods and homes.
By Michael Wentzel
On any given Thursday evening, a half-dozen University of Rochester School of Medicine and Dentistry students meet at Asbury First United Methodist Church in Rochester where they staff a free clinic for the homeless, the uninsured and anyone without the money to get health care.
The medical students, supervised by a volunteer physician, perform physicals, treat minor injuries, arrange care for chronic problems and even help serve a hot meal to the 15 or so patients who come to the evening clinic.
The Asbury clinic is a part of UR Well Student Outreach, through which medical students work at clinics and other programs that provide care and services to residents of the Rochester area. In the last 12 months, more than 210 medical students have volunteered in UR Well community projects.
“At the Asbury clinic, we see patients who do not have alternatives for health care. This is a huge opportunity for us to be engaged with our community and make a significant difference for those in need,” said Catherine Trimbur, co-director of the UR Well clinic and a member of the Class of 2012. “Additionally, it is a great learning opportunity, as we get to see a variety of patients in different clinical settings and work with and learn from attending physicians and our peers.”
The Asbury clinic is not a rare community-based project. Individual physicians, scientists and students throughout the Medical Center and School of Medicine and Dentistry routinely apply skills and resources to improve the health of the Rochester region.
Faculty, postdoctoral fellows and staff from the Department of Psychiatry, for example, join with social workers and counselors on a weekly basis to reach elderly people facing loneliness, depression and even suicide.
In at least four projects, the department has partnered with nonprofit community organizations in efforts to find ways to bring better mental health care to older adults. In a project called the Senior Health and Research Alliance, the department helped develop a system for screening older adults for depression at the agency level that has affected the care provided to thousands of people.
The project with Lifespan of Greater Rochester, the largest aging services agency in the Rochester region, and the Catholic Family Center was the first comprehensive effort to join social services and mental health providers to develop approaches to care for the elderly.
“Their work with us definitely has improved the health of older adults in our community. It has allowed us to assess our clients differently and get mental health services to them,” said Ann Marie Cook, executive director of Lifespan of Greater Rochester. “Everyone from the Medical Center we have worked with has a tremendous amount of respect for the work we do. There has not been one person who felt there was an ivory tower looking down at us.”
In fiscal year 2009, the Medical Center, including Highland Hospital, supported more than 300 community health improvement programs and community-building and community-based research projects with a value of $68.5 million.
“Our commitment to the community is longstanding,” said Mark Taubman, M.D., dean of the School of Medicine and Dentistry. “One of our most important jobs as an academic medical center is to conduct community-based research to evaluate new approaches to prevent, treat and cure disease. To do so, we must work with communities so that we can better understand their needs and priorities.”
An academic medical center’s responsibility
When he agreed to fund the creation of the School of Medicine and Dentistry in 1920, philanthropist George Eastman directed the University to use the skills and talents of faculty and students “to make Rochester one of the healthiest communities in the world.”
Jay H. Stein, M.D., former chief executive officer of the Medical Center, and Lowell Goldsmith, M.D., M.P.H., former dean of the School, echoed the directive when, in October 2000, they launched Project Believe, a campaign that aimed to make Rochester the healthiest community in the country by 2020. The idea came to Goldsmith as he made one of his regular drives through the city of Rochester.
“I had been searching for an audacious idea that would become the signature of the School, something that would be important for the School,” said Goldsmith, now a professor emeritus at the University of North Carolina School of Medicine. “We obviously provide medical care to the community. We already had many outreach programs but were we improving the health of the community at large? We knew it was going to have to involve everyone—students and faculty— in projects that made sense academically and made sense to the community.”
Utilizing small grants in its first years, Project Believe supported nutrition and fitness programs in Rochester and backed a stop-smoking project for teenagers. While the Project Believe name and structure are no longer used, the Eastman directive and what Goldsmith calls “this worthwhile task and mission” stand today as essential guideposts of the Medical Center and the School of Medicine and Dentistry.
In 2004, C. McCollister Evarts, M.D. (M ’57, R ’64), then chief executive officer of the Medical Center, officially made community health the fourth core mission of the Medical Center. In the same year, the Association of American Medical Colleges awarded the School of Medicine and Dentistry its Outstanding Community Service Award, recognizing the depth and breadth of community service fostered by the School.
In 2006, the creation of the Center for Community Health under Evarts fortified partnerships with local organizations and became a focus of support for community-based research, education and connections of faculty, student and staff with community partners and programs. In 2008, the Medical Center’s new strategic plan called for an expansion of health interventions, research and collaboration as part of the community health mission.
“Across the United States, many academic medical centers are located in or near impoverished neighborhoods and communities with many needs,” Nancy M. Bennett, M.D., director of the Center for Community Health and professor of medicine. “It is our responsibility to tie our work to improving the health of these communities and to serve our communities very directly. If we work more closely with the community, our research will be more effective and we will improve the health of the people in the community. Some academic medical centers are just coming around to this view but we have understood for years that to improve human health we need to translate our research to community innovations.”
The Center for Community Health’s programs alone reach across the city and county. Its Cancer Services Program of Monroe County pays for screenings for breast, cervical and colorectal cancer annually for about 1,000 women and men between the ages of 40 and 64 who are uninsured or under-insured. Its Healthy Living Program and the Latino counterpart, Vida en Salud, take fitness and health education programs to African Americans and Latinos in the Rochester area in a partnership with churches, community organizations, the city of Rochester and the YMCA.
The Healthy Living Center, part of the Center for Community Health which opened in February, offers clinical lifestyle management services and conducts research on the design, evaluation, and implementation of programs to decrease tobacco use, prevent diabetes, boost physical activity, improve nutrition, and increase adherence to medications.
Headed by Geoff Williams, M.D., Ph.D. (PhD ’93), a professor of medicine at the Medical Center, the Healthy Living Center aims to better understand the factors that play a role in an individual’s health and to create resources for physicians, individuals, and community programs that support lifestyle changes to improve health.
“You will find elements of what we do as an institution at many other academic medical centers, but we have the most comprehensive approach. Our institution has made a commitment at a level that is unique,” Bennett said.
An intervention to prevent violence
You can find that commitment to community embedded in the School of Medicine and Dentistry curriculum. Every medical student hears the message of the community mission from the first days at the School. Community volunteer work is not only supported, it is encouraged.
The Community Health Improvement Clerkship (CHIC) is a requirement for graduation from the School of Medicine and Dentistry. The only required fourth-year clerkship of its kind in the country, CHIC provides medical students with a community-based educational experience, while increasing access to health care by underserved populations. Students are encouraged to develop or sustain projects that are beneficial to the community. Since its inception in 2002, CHIC has resulted in more than 190 unique community health improvement projects, involving more than 400 medical students.
You can find the community commitment in the Kessler Burn and Trauma Center in the Medical Center, where teenage patients who have gunshot or stab wounds are not uncommon and where the Rochester Youth Violence Partnership tries to break the lure of the streets.
The partnership is a hospital-based violence intervention program that targets trauma victims under the age of 18 when they are treated at the Medical Center for a knife or gun injury.
“When we ask the community what issues are most important to them, addressing violence is always at or near the top of the list,” Bennett said.
Established in 2006, the partnership is headed by the Kessler center and supported by 28 local non-profit, government, and service-based organizations. The Medical Center serves as the “first responder” by treating injuries and identifying at-risk patients. When the patient is stabilized and the psychological and social issues identified, a coordinated series of law-enforcement and community partner-led interventions occur to help prevent additional violent episodes.
Mark Gestring, M.D., the Kessler center medical director, heads the program. The team also includes Michael Scharf, M.D. (R ’01, FLW ’03), assistant professor of psychiatry and pediatrics, and clinical nurses and social workers.
At last count, since the inception of the program, 177 youths have been treated for gunshot or stab wounds at the Kessler center. Of these, 155 have received a comprehensive social work assessment; 108 were referred to the gang-intervention team; and 91 received in-patient psychiatric evaluations. In 2007, nine youths previously injured by violence returned as a result of violence. In the three years since then, none of have returned.
“These injuries rarely happen by accident and should be seen as indicators of unacceptable exposure to violence. Our program focuses on victims and families with a goal of preventing further violent injury,” Gestring said. “Kids should never get shot or stabbed.”
A coordinated attack on lead
Kids also should not face exposure to the toxic consequences of lead.
Research conducted in the 1990’s at the Medical Center, which documented the impact of even slightly elevated blood lead levels on children’s cognitive development and IQ and directly linked this poisoning with the concentration of lead in the dust on the floors of their homes, informed federal standards for lead in dust. Today, Medical Center researchers continue to study lead’s role in osteoporosis and other serious health problems.
In 2001, the Coalition to Prevent Lead Poisoning was created in response to studies that showed that children in the city of Rochester had elevated blood lead levels that were 10 times the national average. University faculty and staff have been in leadership positions with the organization since its inception. The University has also been instrumental in several outreach programs including Get the Lead Out, a partnership with Orchard Street Community Health Center, local government agencies and several community groups to test the homes of children at risk of lead poisoning, and a “lead lab” which demonstrated lead safe practices.
Katrina Korfmacher, Ph.D., assistant professor in the Department of Environmental Medicine, has spent the last decade focused on reducing lead exposure for children in the Rochester area. Working with the coalition, Korfmacher helped devise and implement outreach, education, and advocacy activities. These efforts resulted in a far-reaching lead abatement ordinance passed by the city of Rochester in 2005.
Through the actions of the coalition, the number of children in the Rochester area with elevated blood lead levels was reduced from 1,293 children in 2002 to 283 children in 2009.
“This is a powerful example of the ability of science and outreach to inform and influence public policy decisions that improve public health,” Dean Taubman said. “While our physicians and scientists have played important roles in understanding and treating the health effects of lead exposure, it was clear that only a coordinated, community-based approach could address the root cause of this problem.”
Outside the Medical Center’s walls
Over the last five years, Department of Psychiatry faculty members have helped create a network of programs that address another often hidden health threatâ€”depression that hampers and burdens older adults and their caregivers.
A departmental partnership with the Rochester-area organization Jewish Senior Life and Jewish Family Services called the Geriatric Medical and Mental Health Care Collaborative (GEMM) provides integrated care to frail and homebound seniors and often treats their equally homebound caregivers. Jewish Senior Life physicians had targeted the homebound for much-needed medical services as part of their House Calls program, but they now also screen for mental disorders. If the screen is positive for a mental or cognitive issue, a Medical Center nurse practitioner or a social worker get involved. Since 2008, GEMM has served 189 homebound elders, with about a third identified as having significant mental health or cognitive problems.
The department continues its relationship with GEMM but also has helped launch PEARLS, or the Program to Encourage Active and Rewarding Lives for Seniors. This project started in 2010 with Eldersource, a joint venture of Lifespan of Greater Rochester and the Catholic Family Center. The department trains Eldersource social workers and care managers to screen for depression and to utilize a therapy, known as problem-solving therapy, that has been shown to help older adults with depression.
For many, depression is related to unsolved problems and an inability to engage in meaningful activities. The agency staff member works with the older adult to learn a method for identifying and solving a problem. The client also agrees with the agency counselor to do something pleasurable, social and physical each week. It could be as simple as calling a relative, speaking to a neighbor or lifting a soup can as a daily workout. The goal for PEARLS is treatment of as many as 150 people a year.
“In our clinic for older adults in the Medical Center, we only touch the tip of the iceberg,” said Deborah A. King, Ph.D. (FLW ’85), professor of psychiatry who oversees GEMM and PEARLS. “These programs are really getting out there and reaching people. We have to move so much of what we do outside our Medical Center walls.”
Wade Norwood, director of community engagement for the Finger Lakes Health Systems Agency, says he witnesses almost every day in his job and in the community in which he lives the value of the programs that have developed out of the Medical Center’s community health mission.
“This commitment and sensitivity to the community and the needs of community members is an important characteristic of the Rochester educational experience,” said Norwood, who serves as vice chair of the Medical Center’s community advisory council. “It is important because it is the right thing to do. Research and education require service to the community if they are to be truly of the highest order.
“I see the Medical Center’s role and partnership with the community everywhere I go. I see it when I can go into a lead-safe home. I see it in what we’re doing at city playgrounds to get kids more active and health. I see it in the dozens of University faculty members who are helping the health systems agency wrestle with the difficult challenges we face. The results of the community mission are palpable and clearly evidenced every day.”
This is the first in a series of articles about the community health mission.
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