SCOFF Screening for eating disorders.
index.phpAdriana Brayman RD, LDN, CNSC, is a licensed, registered dietitian. Adriana has extensive clinical pediatric and adult nutrition experience with a specialty in eating disorders. She was has been the senior pediatric dietitian and inpatient and outpatient eating disorder dietitian at Hasbro Children’s Hospital in Providence, RI and led the eating disorder program at at Silver Hill psychiatric hospital and the primary dietitian at One Source Nutrition, a practice based in Stamford, CT. She also worked with patient of all ages including infants and toddlers through adults and with various diagnoses including bulimia nervosa and substance abuse. Adriana currently runs her own practice located in the Historic district of East Greenwich.
Christina L. Boisseau, PhD, is research psychologist at Butler Hospital and an Assistant Professor (Research) in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. She specializes in the research and treatment of eating and anxiety disorders.
Lindsay Daskalopoulos, LICSW, is a psychotherapist in private practice in Providence. She has extensive experience working with young adults and specializes in eating disorders and body image issues, adjustment, grief, depression, trauma and cross cultural issues. She practices from a psychodynamic and relational perspective and focuses on listening,understanding and problem solving to help create change, hope and effective coping. She worked in multiple college counseling settings and in community mental health prior to opening her practice in 2004.
Abigail Donaldson, MD, is a board certified in both Pediatrics and Adolescent Medicine. She received her medical degree from the University of Vermont School of Medicine, she completed pediatric residency at Robert Wood Johnson University Hospital and her Adolescent Medicine Fellowship at the Johns Hopkins Hospital. She is the Medical Director of the Hasbro Children’s Hospital Eating Disorder Program, and an Assistant Professor of Pediatrics at The Warren Alpert Medical School of Brown University. She provides subspecialty care in eating disorders in the inpatient and outpatient settings, and works with a multidisciplinary team to provide comprehensive management for eating disordered patients in the region.
Carrie Bridges Feliz, MPH, is lead its Community Health Services at Lifespan. She has an extensive background in public health having served as the team lead for Health Disparities and Access to Care in the R.I. Department of Health. In that role, she supervised the offices of Minority Health, Women’s Health, and Primary and Rural Health. She also served as a public health prevention specialist for the Centers for Disease Control and Prevention (CDC), where she concentrated on Rhode Island refugee health; HIV, sexually transmitted diseases, and tuberculosis prevention efforts; and infectious diseases.
Teri Pearlstein, MD, is Associate Professor of Psychiatry and Human Behavior and Associate Professor of Medicine at the Alpert Medical School of Brown University. Since August 1, 2011, she has been the Director of Women’s Behavioral Medicine at the Women’s Medicine Collaborative, affiliated with Miriam Hospital. She was the Director of the Center for Women’s Behavioral Health at Women and Infants Hospital 1996-2011 and the Director of the Women’s Treatment Program at Butler Hospital 1990-2000. Dr. Pearlstein has been a leader in various capacities in her professional organizations and has published over 70 peer-reviewed manuscripts in the areas of premenstrual dysphoric disorder, perinatal mood disorders, perimenopause, eating disorders, post-traumatic stress disorder, and other mental health disorders in women.
Karen Rosene-Montella, MD, is the Senior Vice President for Women’s Services and
Clinical Integration at Lifespan. Dr. Rosene-Montella is a Professor and Vice Chair of Medicine at the Warren Alpert Medical School of Brown University. Previously she served as Chief of Medicine at Women & Infant’s Hospital. Dr. Rosene-Montella is a founding member and current Chair of the Women’s Health Council of RI.
Christina Tortolani, PhD, is a Staff Psychologist in the Division of Child and Family
Psychiatry at Rhode Island Hospital. She is an Assistant Professor, Department of Counseling,Educational Leadership, School Psychology, Rhode Island College and Adjunct Assistant Professor of Psychiatry and Human Behavior, Alpert Medical School at Brown University. She earned her MA from Boston College and doctorate from Northeastern University. She completed her internship in Clinical Psychology at Dartmouth Medical School and postdoctoral fellowship in traumatic stress at Brown Medical School. Christina’s clinical and research interests include the treatment of eating disorders, body image and trauma.
Survey Results from this year’s conference.
index.php2012 Women’s Health Report Card (side 1) socioeconomic determinants of health (side 1)
2012 Women’s Health Report Card (side 2) socioeconomic determinants of health (side 2)
index.phpVision 2020 is a national initiative developed by the Institute for Women’s Health and Leadership at Drexel University College of Medicine to make equality a national priority through shared leadership among women and men
Healthy Work Survey statistics concerning challenges that women face in the workplace.
index.phpBehavioral Health Report Card shows statistics concerning substance abuse, mental illness, self harm and suicide in Rhode Island.
Physical Health Report Card shows statistics concerning community indicators, cancer, cardiovascular health and diabetes in RI.
Women’s Health Report Card contains data vignettes reporting on RI Women’s Health.
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Constance A. Howes, JD introduces the the Women’s Health Council of RI workshop.
Amy S. Gottlieb, MD presents statistics and information about Intimate Partner Violence.
Sarah C. DeCataldo describes the dynamics, of IPV and of power and control wheel.
Deborah DeBare, MMHS introduces Maria, a hypothetical patient. Each presenter hereafter builds on Maria’s story.
Amy S. Gottlieb, MD details the importance of IPV screening and interactions with patients.
Margaret Howard, PhD describes non-judgmental, empathic screening and non-verbal cues to notice.
Amy Goldberg, MD discusses the impact on children who witness or experience IPV.
Sandra M. Shaw, MSN, RN discusses the content and importance of initial assessment for IPV.
Jennifer E. Lang, MSW, LCSW discusses creating a safety plan for victims/survivors of IPV.
Detective Sergeant William Merandi describes law enforcement responsibilities around IPV.
Amy S. Gottlieb, MD details how a systems based approach can improve the health care response to IPV.
Yvonne M. Heredia, MSN, RN, CDOE speaks about the transition from victim of IPV to survivor.
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Screening for Food Insecurity Pocket Card
Tips to Increase Calories and Protein on a Low Sodium Diet
index.phpDinner Slides: Healthy Eating for a Healthy Heart
Making Sense of Diet Recommendations
Eating Better to Prevent Heart Disease and Stroke
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Carrie Bridges Feliz, MPH, is the Director of the Lifespan Community Health Institute. She has an extensive background in public health having served as the team lead for Health Disparities and Access to Care in the R.I. Department of Health. In that role, she supervised the offices of Minority Health, Women’s Health, and Primary and Rural Health. She also served as a public health prevention specialist for the Centers for Disease Control and Prevention (CDC), where she concentrated on Rhode Island refugee health; HIV, sexually transmitted diseases, and tuberculosis prevention efforts; and infectious diseases. She is Co-chair of the Women’s Health Council of RI.
Eileen Hayes, LICSW has been a social worker for 32 years. She has held a variety of positions including the Director of Services for Adolescents and Young Families at the YWCA of New York and the Director of Parenting Education Services for the New York City Department of Health. Since 1990 she has served as a national consultant for MDRC, PPV and National Fatherhood Initiative, consulting on issues of poverty, marriage education, fatherhood and parenting. Ms. Hayes is currently the President/CEO of Amos House, a social service agency and soup kitchen in Providence Rhode Island that serves poor and homeless men, women, and children.
Michelle N. Karn, MA, Communications Director, American Heart Association, is a graduate of the University of Rhode Island with a Bachelor of Arts degree in both Music and Communications. Since joining the American Heart Association in 2007, Michelle has been working on campaigns in the Southern New England region that help raise awareness, fund prevention and research programs to fight heart disease and stroke. After transitioning to the role of Communications Director in 2013, Michelle has worked to elevate the brand of the American Heart Association as a leading resource for cardiovascular disease information in the region. By developing a comprehensive multi-channel communications and public relations program, she works to increase awareness about cardiovascular diseases, assist with community health efforts, and support the mission to build healthier, longer lives in Rhode Island and Southeastern, MA.
Peg Miller, MD, FACP, is Director of the Women’s Medicine Collaborative, a Lifespan Partner, and is an Associate Professor of Medicine at the Warren Alpert Medical School of Brown University. She is a board-certified internist whose primary area of interest is medical problems in pregnancy. Dr. Miller is a member of the International Society of Obstetric Medicine, currently serves as the President of the North American Society of Obstetric Medicine and Co-Chair of the Women’s Health Council of RI. Her clinical and research interests include medical problems in pregnancy and cardiovascular risk in women with pregnancy complications.
Amy Nunn, MS, ScD, is an Associate Professor of Behavioral and Social Sciences at the Brown University School of Public Health and in the Division of Infectious Diseases at Brown Medical School. She is also the Executive Director of the Rhode Island Public Health Institute (RIPHI). She currently conducts HIV/AIDS, Hepatitis C (HCV) prevention research and is Principal Investigator of an NIH grant. A social scientist by training, she has conducted domestic and international research on a variety of health topics and has conducted global health policy research. Dr. Nunn has received research grants from Harvard University, the US Departments of Defense and Education, and many others and received an “Outstanding New Researcher Award” at the 2009 CDC HIV Prevention Conference and an NIH Career Development Award in 2010. Dr. Nunn holds masters and doctoral degrees from the Harvard School of Public Health and is a former Fulbright Scholar.
Karen Rosene-Montella, MD, FACP, is the Senior Vice President for Women’s Services and Clinical Integration at Lifespan. Dr. Rosene-Montella is a Professor and Vice Chair of Medicine at the Warren Alpert Medical School of Brown University. Previously she served as Chief of Medicine at Women & Infant’s Hospital. Dr. Rosene-Montella is a founding member and current Chair of the Women’s Health Council of RI.
Chef Todd Seyfarth, MS, RD, CSSD, is an Associate Professor, Department Chair & Program Director, Culinary Nutrition Program, College of Culinary Arts at Johnson & Wales University, and a Registered Dietitian and a resource within his profession and by journalists in culinary nutrition. In addition to his role as an associate professor he has been a faculty advisor to the JWU Nutrition Society Student Organization, has consulted on the ‘Simply Ming’ PBS television program, with Chef Ming Tsai, for over a decade, and has been an key resource for the Tulane University “Culinary Medicine” initiative. Chef Seyfarth is a popular speaker and has spoken widely. Chef Seyfarth holds degrees in Culinary Arts and Culinary Nutrition from Johnson & Wales University and an MS in Healthcare Policy and Management, Stony Brook University and is a Registered Dietitian (RD/RDN) and a Certified Specialist in Sports Dietetics (CSSD).
Eliza Sutton, MPH has been working in the public health field for many years. She began her career working in community HIV prevention programs in New York City. Her interest in food access strengthened as she spent time in diverse communities in New York. Eliza worked at Southside Community Land Trust working with low-income families for seven years. Currently, she is the Food Access Manager at Thundermist Health Center, increasing food access for low-income patients at Thundermist’s 3 sites. Eliza received her BA from Antioch College and her MPH from Hunter College, City University of NY.
Jennifer Thiesen, MS, RNP, has 28 years of nursing experience in roles of increasing responsibility in both nursing education, nursing administration and as a nurse practitioner. She is the Director of Care Transitions and presently oversees the Heart Failure Transition Program at The Miriam Hospital.
A practical workshop that focuses on the real issues of healthy eating, accessing healthy food and coaching your patients to change their behavior and their health.
5:00-5:30 Dinner, Networking
5:30–5:40 Welcome
Carrie Bridges Feliz, MPH, and Peg Miller, MD, FACP Co-Chairs Women’s Health Council of RI
5:40-6:00 Making Sense of Diet Recommendations for Heart Health
Chef Todd Seyfarth, MS, RD, CSSD, Department Chair and Program Director, Department of Culinary Nutrition, Johnson & Wales University
6:00-6:50 Panel Discussion: Solving the Critical Access Problem
FACILITATOR: Jennifer Thiesen, MS, RNP, Director Care Transitions, Lifespan
PANELISTS: Eliza Sutton, MPH, Food Access Manager, Thundermist Health Centers Amy Nunn, MS, ScD, Executive Director, Rhode Island Public Health Institute Michelle N. Karn, MA, Communications Director, American Heart Association
6:50 – 7:45 Coaching Your Patients to Yes for Healthy Eating
Eileen Hayes, LICSW President & CEO, Amos House, Includes role playing
7:45-8:00 Feedback, Q&A and Closing Remarks
Karen Rosene-Montella, MD, FACP, Chair Women’s Health Council of RI
This interactive conference is designed to equip attendees with the tools to:
We are seeking providers or provider organizations that care for women and/or girls in Rhode Island to be nominated for this award. Nominees should promote innovative research, education, clinical care and policy/advocacy that improves medical, behavioral and/or social health of women in Rhode Island at any point in their lifespan. Size of initiative is not relevant. The service, process or program must have been in place for at least 1 year with demonstrable results. Our definition of provider includes anyone that cares for the social, medical and behavioral health of women which could include direct care givers, payors or policy makers who work in institutions or the community, e.g. educators, public health professionals, social service providers.
Nominations should be sent by email to Krystal Brancoat kbranco@lifespan.org between April 1 and August 1 of the calendar year. Individuals may submit nominations for themselves or for others.
Please Click on this Link for More Information: The Karen Rosene-Montella Spark Award for Innovation in Women’s Health in RI
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“We have to understand that by not addressing these socioeconomic issues, we’re going to spend more money on our health and suffer worse morbidity and mortality. By not paying for it now, we’re paying for it later in terms of lost health and lives.” Tracey Cohen, MD, Neighborhood Health Plan of RI
Research shows that the social circumstances in which we are born, live and work – our jobs, schools, built space, transportation, even the quality of civic life – get under the skin, influencing our behaviors, access to resources, chronic stress levels and ultimately increasing or decreasing our chances for health.
Racial and ethnic health inequities don’t just reflect income. More African American, Native American, Latino and Pacific Islanders are in poor or fair health than whites at practically every income level.
“Recognizing this, RI payors are driving delivery system change by creating, providing, or paying for services which are designed to bridge socioeconomic barriers.” Renee Rulin, MD, MPH, RI, Medical Director, Medicaid/United Health Care
“Right now we’re in a period of total disruption of the healthcare system. The Affordable Care Act will be disruptive, but the biggest disruption will come from the shift to electronic medical records, which will completely flip how healthcare is delivered, and how our socioeconomic stressors are resolved.
“Primary care provider systems and practices will be increasingly encouraged by payors to offer a more holistic range of services, so private practices look more like community health centers and a fuller range of socioeconomic stressors can be managed from one place.
“We will see health insurance carriers responding to what health consumers want as opposed to what employers want and as opposed to what providers offer. As a new consumer based healthcare system evolves, there is an immediate opportunity to be part of the conversation about what plans and payment models consumers want to have and what provider services are most effective.” Christine Fergueson, Director, RI Health Insurance Exchange
“Now is the time to engage (in developing criteria for these new models of payment),” as Christy Ferguson said, “I want you to come to me and say ‘this is what I want.’ ”
“Many people in RI are underserved because of RI’s role as a safe haven for immigrants and undocumented folks. We need more data in order to formulate new policies to better serve this population.” Mary Reich Cooper, MD, JD Co Chair, Women’s Health Council
Starting in 1990, keynote speaker Michelle Berlin, MD, MPH, began to partner with the National Women’s Law Center (NWLC) and NIH to look at creating data collection on women’s health disparities and inequities, so that better policies could be promoted. She helped to define 26 health status indicators that are now used nationally and state-by-state to evaluate the status of women’s healthcare delivery. Divided into four categories, the units of measure are collected in every state across a consistent continuum of socioeconomic indicators that assess:
1. Women’s access to health care services
2. Addressing both wellness and prevention
3. Key health conditions, diseases and causes of death
4. Living in a healthy community
The results show that, as a country, our national grade has been unsatisfactory.
Click here for slides showing where RI meets the grade and where we need to improve. Michelle Berlin, MD, MPH, Oregon Health & Science University
Rhode Island’s cost of living is 2.5 times above the poverty level. Assistance from RI Works is 65% below the federal poverty level, and 44,000 women are without health coverage.
Poor RI women are no longer on the policy agenda to increase their benefits because there is such a lack of respect among legislators for the single mother population. The ACA will provide more insurance to all Rhode Islanders including women through the new Health Benefits Exchange. We must make sure it is affordable. Linda Katz, JD, Executive Director, Economic Progress Institute
A high percentage of new mothers, especially with premature babies, have significant social and environmental stressors. They suffer from a combination of depression, domestic violence and substance abuse. Rates of mental health issues in mothers have gone up 64% as home situations continue to worsen.Betty Vohr, MD, Women And Infants Hospital
RI Medicaid is evolving from fee for service payment to value-purchasing with managed care organizations. The new goal is to pay for what is important to the patient, and to wrap a better delivery system around member practices. Renee Rulin, MD, MPH
Blue Cross Blue Shield of RI is supporting the Patient Centered Medical Home model, encouraging the development of a care team within practices and having staff work to the top of their licensure. Andrea Galgay, MBA
Neighborhood Health Plan of RI focuses on care across the socioeconomic spectrum because “the ROI is better when the whole person is considered.”Tracey Cohen, MD
Providence Community Health Centers We “crosswalk them.” Working with underserved populations, the Health Center decreases the barriers to care and helps patients understand their own disease process combined with their mental health issues. Patients develop their own multi-part plan and then are helped to get to the right resource when they need it. Angela Reda, RN, Providence Community Health Centers
Health Leads goal is a healthcare system that addresses all of the patient’s basic resource needs as a standard part of quality care. Health Leads physicians, currently at Hasbro, write prescriptions for food, childcare, employment, job training, housing, and then walk patients over to the volunteer teams who follow the patient until their needs are met. Health Leads offers systemic deep integration of a practical solution for resolving socioeconomic determinants to health. Sonia Sarkar, MPH, Health Leads
Patient Centered Medical Home programs develop a patient care team within medical practices where all staff work to the top of their licensure and the whole patient is treated. The focus is on proactive care, like planning to complete tests and labs prior to patient visit with PCP. Patient engagement is the key. Andrea Galgay, MBA, Blue Cross & Blue Shield Of RI
Partnering with Parents Complex social environments contribute to the greatest risk of infant rehospitalizations. We’ve shown that increased parental support and education reduces infant rehospitalizations by 60% and since the average cost of rehospitalization is $22,000, this kind of intervention can have a significant impact on health care costs. Betty Vohr, MD, Women & Infants Hospital
Many private practices don’t have the facilities to partner with Medical Home models or access to all the stakeholders needed to care for vulnerable families.
Right now, payors like Blue Cross Blue Shield, United Health Care, RI Neighborhood Health and developers of the new Health Insurance Exchange are actively seeking ways to wrap a better health care package around your practice. Let them know what you and your patients want.
Suggestions for improving access to care and a more holistic approach can include:
Conference Survey Summary shows what percentage of conference attendees belong to each healthcare provider category.
The Affordable Care Act: A Quick Guide for Physicians explains ACA’s key provisions that impact physicians and patients.
Pregnancy as a Window to Future Health: Karen Rosene-Montella, MD – Detailed data on the kinds of pregnancy complications that can impact women’s future health.
index.phpPregnancy as a Window to Future Health: What long-term health issues to watch for based on a patient’s pregnancy history.
index.phpCouncil Co-chair Karen Rosene-Montella, MD opened this year’s Conference by describing the common themes that have come to define the Women’s Health Council of RI. Specifically, collaboration among members of many disciplines, practical application of new ideas, and the present push to bridge physical and behavioral health.
Information on this website showcases the Council’s areas of focus to date: Women’s Health in terms of obesity and exercise, Intimate Partner Violence, Smoking Cessation, Pregnancy as a health stress test, and a new focus on Bridging Physical and Behavioral Health in the area where women are at high risk: depression and suicide.
“In all these areas,” Dr. Rosene said “We need to continually address new program, policy and payment models.”
Lt. Gov. Elizabeth Roberts, MBA, greeted attendees by saying “Women’s health is a big determinant of family health.” She noted that people at this conference are changing the healthcare landscape. And policy makers are increasingly aware that they now have the opportunity to redefine health reform to get the healthier outcomes we all want.
Linda Carpenter, MD spoke in detail about the interface between depression and physical illness. 1 in 10 Americans have or had or will have Major Depressive Disorder. Patients typically focus on physical health with their primary care provider and don’t mention emotional or mental health. In 69% of patients, only physical symptoms were reported but all went on to meet criteria for depression. In describing how to recognize depression, the physician starts with 2 simple questions to determine if there has been a change in sense of well-being and a change in functioning. Dr. Carpenter’s slides showed the longer list of symptoms, including loss of hedonic drive and hopelessness leading to suicide. While there are multiple factors contributing to depression, early childhood stress including mother’s stress while infant is in utero, puts the patient at greater risk and makes recovery more difficult.
Teri Pearlstein, MD reviewed current treatment protocols for depression and suicide prevention. She stressed that primary care providers who screen for depression need to know where to refer patients for further evaluation and treatment. Screening is most beneficial when staff-assisted care and follow-up systems are in place. Evidence-based treatments for depression include psychotherapy, medication and alternative treatments, Efforts are ongoing to establish integrated care, ideally coordinated by care managers at regular PCP visits. The easy accessibility and follow-up of care is necessary because depressed patients face many barriers to receiving treatment. There is a 50% chance of another episode after first remission and anti-depressants work only 50-60% the first time.
Dr. Pearlstein also described the progressive phases of suicide, which begin with the idea, then thoughts, followed by plans. Successive suicide plans and attempts grow in intention and lethality until patient is successful or there is an intervention. She noted that suicidality may be a risk with anyone first starting anti-depressants and should be monitored.
Beatriz Perez, MPH, discussed suicide as a public health issue. In her role with the RI Department of Health, she described statewide violence and injury prevention programs she administers for the CDC and SAMSHA. She noted that RI women are below the national average for suicides, but suicide in men is showing a steeper increase than the national rate. Ms. Perez rarely sees an individual with just one risk factor and cautioned that any screening should consider multiple factors. Her programs make an effort to get to children at risk before depression sets in. And she teaches parents in at risk neighborhoods how to suicide-proof their homes by removing weapons and making medications unavailable.
Michaei Fine, MD, Director of the RI Department of Health,introduced the keynote speaker Regina Benjamin.
US Surgeon General Regina M. Benjamin, MD, MBA began her talk by observing that community events such as our council are important: they allow one person to stand up and make a difference whether in practice or policy.
Dr. Benjamin’s purpose as America’s Doctor is to stop illness and disease before it starts by using an integrative and holistic approach. She learned early in her career that practicing medicine was not about medicine alone, so she became involved in every organization that might help her patients receive better health services.
Today as Surgeon General her focus is on prevention and eradicating preventable causes of illness and disease.
In addition to the new American Affordable Healthcare Act, her policy agenda includes
Dr. Benjamin’s solutions focus on providing the best information available to live a healthy life. She has created the National Prevention, Health Promotion and Public Health Council, and released a National Prevention Strategy(www.healthcare.gov/prevention/nphpphc/strategy/report.pdf).
Her approach combines state of art medicine with an integrative and holistic approach for:
This approach she believes can reduce the five leading causes of illness and death.
“We need your help,” Dr. Benjamin said as she introduced a new campaign to help change how everyone looks at health. In her program, health is translated as joyful, active living and includes activities that bring joy.
Kicking off on December 2, 2011 is a radio campaign called the “Surgeon General’s Dance Break,” a 60-second music broadcast urging people to stop what they’re doing, stand up and dance for 60 seconds every day.
Her closing words of advice: “Take care of yourself first. Relax, enjoy, and dance!”
PANEL DISCUSSION
Moderated by Rebekah Gardner MD and facilitated by Lisa Shea, PhD
This wide-ranging discussion touched on the following topics:
CLOSURE Mary Reich Cooper, MD, JD
Dr. Cooper described RI as a “magical state,” because of people’s willingness to collaborate across disciplines on new solutions to improve women’s healthcare. “But,” as she thanked the participants, “we still have a lot of work to do!”
FOLLOW-UP The next Critical Workshop Training, Practical Applications: Bridging Physical and Behavioral Health, is scheduled for March 6, 2012. Presenters will offer more in-depth training for providers in how to implement the “chain of care” so patients receive more integrated and holistic treatment.
US Surgeon General Regina M. Benjamin, MD, MBA
Regina Benjamin wants to change the way we think about health in this country.
As the US Surgeon General, Dr. Benjamin is on a mission to improve preventive care and reduce the five leading causes of preventable death. Part of her efforts include a new campaign to redefine health as a “Journey to Joy.”
When she spoke at our Second Annual Quality Conference on November 10, 2011, Dr. Benjamin gave an overview of her perspectives on the current challenges in healthcare. In order to change our thinking, she said, we need to take a much more integrative and holistic approach. She invited us to help with the implementation of her new campaign by encouraging patients to find their own levels of fun and healthy activities, foods and friendships…and to bring more joy into their lives as well as our own.
“Public policies sustain socioeconomic stressors. We create risk through our policies, and we have the power to change these policies.”
ANA NOVAIS, RI DEPARTMENT OF PUBLIC HEALTH
In the 2013 Women’s Health Council Survey on Socioeconomic Stressors, we asked our members “What are the biggest socioeconomic gaps that impede your vulnerable population from accessing health care?”137 doctors, nurses and social workers completed the survey. Topping the list of their responses by a significant margin were Incomeand Unemployment, followed in ranking by Transportation, Education, Housing, Language and Food Insecurity.
In our April workshop, we learned that poverty is associated with higher risk for many diseases. Poor housing affects both physical and mental health; and a lower education predicts poorer health outcomes as well as a shorter life expectancy. Presenters and panelists came together from the provider, payor and policy maker sectors to describe the needs they see and the innovative solutions they are implementing as care providers across many dimensions in Rhode Island.
Perhaps the most important plea was “How do we all work together and avoid redundancy? We still have the habit of being in a silo; we need to find a better way to coordinate care across the state.” Lauren Morton, Blue Cross Blue Shield of RI. Barriers to women’s mental health continue, as it is very hard to find short-term care for women who are dual diagnosed and homeless, and also struggle with mental health issues. Psychiatry has to be at the table.
Two districts in Providence are part of a pilot program from Evidence2Success, which is a new strategic process to improve outcomes for all children by improving risk and protection factors at the community level. “Addressing just one risk can impact many outcomes, so we look for the most effective evidence-based solutions and help to implement them.” Justin Milner, Evidence2Success
“This program brings public health right into the educational system, with outcomes for kids that improve their education as well as emotional well-being, behaviors, positive relationships and physical health. What is really new is the mechanism for measurement and level of granularity we can get to in the most difficult areas where kids need to be buffered the most.” Carrie Bridges, Providence Public School System
RI has a history of successful public health efforts in reducing exposure and anti-tobacco messaging and is now far below national averages as a result. So there is a commitment in this state to redirect funds towards programs that are proven to be the most effective in reducing risk and improving protective factors for youth.
Here’s a look at what panelists from this workshop are saying and doing to improve access to coordinated health care for their patient populations.
Suzanne McLaughlin, MD at RI Hospital, talked about the host of challenges patients face before they get to the hospital; there is not enough opportunity to provide preventive care. Patients don’t have the reserves to sort out all the things they need, including behavioral health, nutrition and absence from work. She wants better parity of physical and mental health, both in provision and coverage. She is focused on promoting wellness from the first contact with a patient, saying “A healthy you is going to be a better mom, worker, and partner.”
Primary care for its homeless population has changed dramatically. From an outreach mobile van 7 years ago, now all primary care and internal medicine has been located inside the Crossroads building. Facing lack of transportation, it is difficult for the homeless population to find them. She recommends bringing more nurse care management into Community Health Centers.
Bernadette McDowell is a school nurse instructor and recommends increasing the number of school nurses who are responsible for student health for 6-8 hours every school day. Because of problems getting health insurance or access to primary care, the school nurse is often the only person they see. She recommends electronic medical records be made accessible to school nurses so student care is less fragmented.
Michelle Lupoli serves the Medicaid population via Neighborhood Health Care.
To better manage this vulnerable population, she hires community outreach workers to visit members homes and better understand their needs and conditions. Lack of transportation is a major barrier for members, so she hires pharmacists who do home visits. She also focuses on co-location of services at community health centers; and provides help with translations and childcare. She seconded the request for electronic medical records.
Nancy Harrison from United Healthcare also serves the Medicaid population and faces the same challenges the hospitals face in getting patients to engage in their own health care. She looks for new ways to deliver care to people who have long term health challenges, including behavioral health case managers or field managers, to do behind the scenes work that coordinates care for members on the street. She wants to give people hope that they can in fact navigate the healthcare system.
Lauren Morton described the Blue Cross Blue Shield of RI’s own Patient Centered Medical Home program, which focuses on using a nurse care manager to build trust between patient and provider and walk the patient through to the provider services. She is promoting electronic medical records to help patients get the most out of the system they can. Lauren asked how everyone might work together in a better way and avoid creating redundancy in the system. “We still have the habit of being in silos,” she cautioned. “ We need to understand all care management across the state, and find a better way to coordinate this care statewide.”
Iris Tong, MD, described the new Women’s Medicine Collaborative (WMC) as a practice of integrated services, with multidisciplinary programs. The 11 specialties included are primary care, obstetric medicine, gastroenterology, behavioral medicine, plus clinical services and specialists, plus lifestyle medicine like yoga and massage.
The WMC goal is to inspire women to achieve health in mind, body and spirit. So the first shared vision for every staff member is to care for them self first, to respect each other’s work and to share common goals. Staff and providers are encouraged to attend the Lunch and Learn sessions, join walking groups and take one of the Collaborative’s yoga or meditation classes.
This kind of intensive co-location makes a difference in providing coordinated integrated care. A checkout person can coordinate the next steps in patient care, on the spot, at checkout.
The nurses serve as case managers and coordinate care after ER, provide home care and facilitate referrals.
In the provider workspace, the Assistant and provider work side by side, so they know each other’s practices and preferences.
A patient navigator addresses the social needs of patients.
In this model of collaborative care, the various disciplines work together in real time to create and provide a team-activated plan of care.
Another new model of care recently introduced is the concept of “shared medical visits”, where multiple patients join in one room for a shared 90-minute medical visit with their doctor. Initially skeptical, providers have found that patients enjoy the sense of community and support that results. This is particularly effective with diabetes prevention, physical activity, nutrition improvement and stress reduction. Patients respond well to hearing about other people’s experiences, what they struggled with and how they have succeeded.
The next step for WMC is to build in the quality measures that will provide recognition that this model of co-located integrated care does in fact yield better healthcare results for patients, especially because it encourages proactive involvement in preventive care.
Survey Charts show survey responses from this year’s conference participants.
Additional Info on Survey Respondents
Resources Poster details opportunities and resources for women in RI.
“We, as providers, have to be all about making the choices right for teens; not with what we think is right, but with resources and voices that support the choices they’re trying to make, and have already made.”
With these words, Mary Reich Cooper, MD, JD, Co-chair Women’s Health Council of RI, summarized the presentations and panel discussions at the Council’s fourth Critical Workshop Training.
THE VENUE: Tsetse Gallery in Providence Featuring “Children of Children,”New Ideas in Adolescent Girls’ Healthcare begin with a “Strengths-Based” approach that engenders trust, safety and better choices.
All too often teens don’t feel safe telling their truths to their parents, or at school, or to their doctors. So they avoid getting the medical help or counseling they need, until they face a daunting problem.
“Rather than seeing teens at risk,” advised Keynote speaker Patricia Flanagan, MD, “instead see youth at promise.” Use knowledge of teenage girls’ developmental stages to help them build on their strengths, by praising the skills they have mastered and effective contributions they have made.
As one teen panelist recommended, “Be open with teens. Make it safe, because in reality teens want someone safe to talk with about what they are facing.”
What is needed in many situations is a closer relationship between pediatrics and psychology, so that a teen who is struggling with addiction, abuse, pregnancy and/or sexual identity is referred to a professional who can provide the counseling and resources she needs—and provide support for her choices.
Behavior Patterns While adolescents are generally healthy, they have high rates of STD’s, and the highest growth in HIV (18-25 group). 23% of adolescents have high glucose or other pre-diabetic signs. Early substance and alcohol abuse puts adolescents at greater risk for dependency in later years. It appears that when these patterns are set in adolescent years, it signals poorly for their health as adults.
Brain Patterns Adolescents experience a non-linear growth of their pre-frontal cortex during their teen years. In their developing brain, neuronal growth expands, followed by a pruning process. So with this changing mental environment, they need help making good choices, seeing alternative solutions, understanding nuanced social cues and suspending their own beliefs long enough to hear someone else’s story.
Protective Patterns Research proves that the protective effects of family are long-lasting. Teens who feel loved and accepted no matter what survive better, and thrive. Family can be found in many places. Helping a teen find the family she wants and needs builds resilience in her life, so she can grow into a strong adult with the capacity and resources to care for herself and her children.
Each of the panels in this workshop was comprised of a provider and a teenager who has shown exceptional resiliency in managing one of the following challenges. The spectrum of parental care the teens experienced ranged from strong support, to modeling addiction and recovery, to outright abuse and rejection.
Teen Pregnancy is a community issue. Providers need to promote pregnancy prevention and also embrace teens who are already pregnant or mothers, so they do not give up their dreams.
“I was so afraid to tell my mom I was pregnant, but getting a calm response from her has helped me a lot.” This teen did not want to drop out of school and give up her dreams. With the help of a supportive family, school and the baby’s father, she has learned how to manage motherhood, her education and now a job. “It’s a lot, but we’re learning how to manage it all.”
For a school project, she created a workshop that gave students the hard facts about being a teenage mom, including the day-to-day costs of infant care products, and details about the real demands motherhood makes.
Her recommendations: Provide emotional support by repeating “You can do it!” Schools can provide day care and help new moms keep up. This teen’s teacher brought school-work to her home so she could study every day after the birth and still graduate with her class.
Substance Abuse In addictive families, the priority is to keep the child safe, often by helping the parent address their own health needs.
This teen panelist’s stepfather was addicted to drugs; her mother to alcohol. She drank because she saw her mom do it. ‘I didn’t like the taste, but I liked how it made me feel. Happier and more energetic!” She didn’t have anyone to talk to about it, (she didn’t want to disappoint her mother), until she went to an AA meeting with her stepfather. “AA was a powerful reality check” and gave her the safe environment she was looking for. She is now sober, and both parents are in recovery.
She says: “Teens want to talk about what’s happening with them. They will, if it is safe.”
Sexual Identity Sex is not a teen thing, or a bad thing. The message should be to do it in a way that’s right for the individual
Teen: “I knew at the age of 10 that I was gay, but I never had anyone safe to talk to about it.” She didn’t trust her doctor because of emotional and sexual abuse at home. Her family pressured her to “get over it” When she finally found a gay foster home, she was encouraged to openly acknowledge her sexual identity. At school, a Gay-Straight Alliance teacher helped her deal with students who didn’t like her and attacked the way she dressed. “I’ve learned that if people don’t accept you for who you are, they are not your friends. Fortunately, I have broad shoulders that have helped me deal with the abuse.”
Her advice to providers: ‘Tell them you’re there for them, and that you support them.”
At puberty, psychosocial screening is as important as the physical exam. For help screening teenage girls, download the Adolescent Girl’s Health Pocket Card, which suggests questions to ask and resiliency skills to praise.
Suggestions:
1. See her alone. Ask her parent to consider you an ally. What the teen tells you is confidential unless there is a safety issue involved that the parent needs to know about.
2. Set manageable goals both you and the teen can agree on.
3. Build a scaffolding of support by helping her understand:
4. Acknowledge and support high aspirations. For example, the teen mother who determined that she did not want to be “just a statistic” (meaning a high-school drop out) because of her baby. She was committed to a college education and more. These kinds of aspirations need support from parents, doctors and school officials.
5. Consider how to make the time and place of meetings and screenings more accessible to teen schedules, especially If she is a teen mom without a good support system, or struggles with an addiction in a family where a parent is also addicted, or is an LGBTQQ teen whose family does not accept her identity.
6. Give her your card. New technology to consider: PING MD, whereby teen can text her provider, communicate in the way she is most comfortable, and still be protected by HIPPA standards.
7. Family Acceptance Projects teach parents to accept their children no matter what.
In a subsequent meeting, Lisa Carnevale, Interim Director of the Rhode Island Tobacco Control Network, warned that 13.3% of RI youth are using tobacco. The tobacco companies are relentless at creating addictive tobacco products that look like colorful candies, and which are readily accessible at convenience stores around the state. Without a close look, it’s hard to tell that these are nicotine-based products. Kids become loyal consumers and help to keep these stores profitable.
Carnevale advised: “This is not your grandmother’s tobacco. Parents should check the ingredients of any new product their child brings home…it just might contain nicotine!”
Clinicians are needed to talk to policy-makers at the State House about the considerable physical risks these products represent.
Contact Lisa Carnevale at 401 533 5175, or go to www.ritcn.org.
Many women know that smoking is dangerous but few know that it is especially dangerous for women and children, that smoking related disease kills almost half the women in the US and reduces their life expectancy by 14.5 years. Both the scope of the problem and its economic costs are enormous.
Women are more susceptible to the harm of smoking and second-hand smoke than men. The fastest growing segment of the smoking population is young women. Smoking has a negative impact on 40 different physiological functions.
Meanwhile, the tobacco industry continues to aggressively market colorful candy-flavored nicotine products to young people. And funding for smoking cessation programs has been cut.
Fortunately, the recommendation by a provider to quit smoking increases the quit rate by 30%, especially when the right words are used, and counseling with medication is recommended.
More information: RI Tobacco Control Network
New tobacco screening measures will become mandatory in the next few years.
Government and community health policies aggressively seek to make tobacco use less normal, less available, more expensive and considered an environmental pollutant.
70& of smokers would like to quit. Only 15% are offered help.
Stats show providers are less likely to make a smoking diagnosis or order spirometry in women.
Women will quit smoking for the health of their unborn child. Then start again, not knowing that smoking contributes to post-natal morbidity.
A non-smoker who lives with a smoker has a 20% increased risk of disease.
Acupuncture reduces addiction in patients who are willing to quit, at the same rate of effectiveness as medicine and counseling.
Each of the following interventions doubles the likelihood of quitting:
A study of 4000 smokers in RI showed that 42% don’t consider quitting an option, and another 40% aren’t ready to quit.
Assess their motivational levels by asking:
When they’re ready to quit, prescribe cessation medication (patch, gum, lozenge, inhaler, nicotine spray, buproprion, varenicline) and refer them toQuitWorks–RI for cessation counseling.
The combination of counseling and medication have the highest quit rate, but only 6% of smokers take advantage of this combination.
To make the right thing to do the easiest thing to do in your practice:
Remember that lecturing, labeling and statistics reduce motivation to quit. One way to increase motivation is to “develop a discrepancy.” Change is more likely to occur when a behavior is seen to be conflicting with important goals or values.
Step 1: Discover what is most important to the person (a value, relationship, goal or hobby)
Step 2: Explore the reasons why the person smokes
Step 3: Develop discrepancy by asking:
1 in 4 women will experience violence in their intimate relationships, (1 in 3 pregnant women). RI has a comprehensive response system in place, but violence against women continues. There are significant new steps women’s health professionals can institute now to de-stigmatize abuse, bring it out of hiding and give patients the tools to choose safety before lethality sets in.
Intimate Partner Violence (IPV) is defined as a pattern of coercive behaviors by someone involved in an intimate relationship with a victim. It is an on-going interplay of excessive power, control and victimization that ripples through family generations, work environments, social relationships, communities and governments.
The place women ought to feel the most safe, i.e., home, is not. Children who witness abuse face developmental delays and poor school performance (whether they have been abused or not). Because of denial and the fear of asking for help, or fear of harm to her children and/or pets, or fear that she’ll lose her children, it often takes six police interventions before a woman will seek safety. And because there are many layers of barriers to leaving a relationship (economic, cultural, habit, isolation, shame), women seldom admit their abuse or seek help. But the more frequent the abuse, the higher the risk of damage. If the woman doesn’t make a change, abuse becomes increasingly lethal.
Most abuse is hidden. Bring it out into the open by asking if it is occurring, using matter-of-fact language at the initial and follow-up screenings. Encourage repeat visits, saying, ”I am concerned about you and would like to see you again soon.”
Abusers believe they are entitled to their behavior. They are not. Arrest is mandatory. The third arrest is an automatic felony.
Providers are unsure of what to say when abuse is revealed. Use Information Cards and have referral phone numbers handy. It only takes a few minutes to acknowledge the situation, give the needed contact information and provide life-changing hope.
Victims fear losing children to DCYF or abandoning pets to harm. The Safe Families Collaboration Project requires absolute clarity about the risk to mother and child before reports to DCYF can be substantiated and acted upon. The Safe Pet Program provides immediate shelter for pets.
While there may be many layers of barriers to leaving an abusive relationship, there are also many layers of support provided by medical, legal and community resources. Often all that’s needed to give a victim hope is empathy, recognition and the phone number of a hotline or resource center, so she knows there is a path to safety. It can help her to know that police will intervene, get her to safety and arrest the abuser, and that she has up to three years to file a police report.
Steps on the path include:
1. Doctor’s office or ER These providers are uniquely placed to identify IPV at earliest stages and intervene with referrals to hotlines, community resource centers, police and court advocates.
2. Hotlines Operated 24/7, trained responders provide an immediate lifeline to help, resource centers and police intervention.
3. Resource Centers In RI, Day One provides immediate response to trauma and assault. Resource Centers around the state will always find shelter and a bed for a woman (and her children) who seek immediate safety.
4. Police Special Victims Unit 401 243 6236. Providers have great influence on directing victims to call law enforcement, whose intervention is often vital in breaking cycles of violence. Police help the victim get to safety or medical treatment, and must by law arrest the perpetrator (the abuser or person who has the most power in the relationship.)
5. Advocates These trained professionals advocate for women through the legal system and court process, i.e., how to obtain a restraining order or press charges. Advocates work from police stations and are available in every Rhode Island city and town.
Because stopping the lethality of abuse begins with identifying it early, recognize the critical role that providers play. Changes at the policy level in hospitals, clinics and private practices make a difference. These are the steps recommended by the Women & Infants Hospital’s Domestic Violence Team:
Every baby deserves a healthy mother for the long term.
The Women’s Health Council of RI recommends recasting women’s health from a focus on conception to long-term comprehensive care regardless of child-bearing status.
The leading cause of death for women is heart disease, yet most provider and payor focus remains on breast and gynecological health.
Symptoms experienced during pregnancy serve as a window into long-term health risks like heart disease, COPD, obesity and diabetes.
Early awareness for both provider and patient can help change behaviors and start preventive care early across a wide range of women’s health issues.
Link obstetric care to on-going primary care.
Encourage providers to train across disciplines and systems. Include obstetrics in the medical homes model.
Improve communication between the various health care disciplines.
Recognize the early signs of risk from pregnancy health results such as pre-eclampsia and gestational diabetes, and environmental issues like smoking, poverty and domestic violence. Include these notes in patient’s files when transferring from OB-GYN to PCP.
Recommend a PCP visit one year following pregnancy.
Obesity continues in large part because all the systems – healthcare, education, food distribution and physical locations – conspire to make the healthy choice the most effortful.
Violence against women continues because it is ages old, on-going, systematic and often culturally sanctioned.
When obstetric results are not linked across disciplines through primary care, women’s future risks for diabetes, obesity, depression, hypertension and heart disease are ignored and care opportunities missed.
And when the aggressive marketing tactics of tobacco companies are combined with the addictive nature of nicotine, simply suggesting a patient quit their lethal habit is seldom enough.
Research shows that focusing on numbers and spending millions of dollars on health education has not created change. Rather than publishing papers and articles, focusing on behavioral tactics bring results because they:
Today, New Policies developed by Council members and presenters are improving the availability of health care, improving the presence of healthy food, limiting the reach of tobacco, and de-stigmatizing domestic violence so it is no longer hidden.
In the Clinical Care setting, New Tools provide screening language, data and procedures that help providers create an environment in which their patients may make better choices.
On-going Education via Events for providers includes data and statistics, but also teaches the language that establishes trust with patients while screening, creates and takes advantage of teachable moments and helps patients choose behavioral change.
As Lt. Gov. Elizabeth Roberts said at the start of our 2011 Conference, “Healthcare today is like a deck of cards tossed up in the air. We have the opportunity to put the deck together in a new way, especially by building a better bridge between physical and mental health.”
While it may be difficult to get a handle on the overlap between physical health problems and emotional/mental health disabilities, what is known is that depression (the most prevalent mental health disorder) is a medical problem that portends much worse outcomes for other health problems. Depression isn’t just in the head; it affects nearly every internal organ system adversely. Women are twice as likely as men to suffer from depression.
Suicide is the 10th leading cause of death in the US and is recognized as a public health issue in RI even though the rate of suicide for women is below the national average. However, suicide rates for men are on the rise. The white population is most affected, although this population is least likely to live in poverty.
Depression has multiple causes. Some causes we have control over; others we do not. Preventable causes include: smoking, sedentary lifestyle, obesity, system inflammation and failure to report. But abundantly and strongly associated with depression is early childhood stress (abuse, neglect and poverty). Large-scale studies link this early life stress to many other preventable diseases.
Many risk factors for suicide are treatable but 80% of completed suicides went untreated. The number one cause of suicide is relationship separation or conflict. A program sponsored by the RI Youth Suicide Prevention Project focuses on core RI cities where more than 15% of children are living in poverty. Parents are taught how to suicide-proof their homes by such things as removing weapons and medication availability.
Recent studies show that some people are born with genes that protect them from depression and suicide no matter what their present or early-childhood stressors. Others have genes that indicate they are at greater risk.
Adverse social environments may impact physical and behavioral disease through epigenetic effects on genes that regulate physiological systems involved in stress and inflammation.
What blocks the bridge? Lack of access to universal healthcare. Access to good education. Decent housing. Stigma attached to mental health problems and suicide. Sensationalizing suicide by media.
Both the fact and the perception of “maternal warmth” is a mitigating factor in all aspects of physical and behavioral health. We have the ability to improve preventive care by providing people with better resources to take care of themselves, their children and each other.
Because early childhood stress is implicated in both physical and behavioral health, Freud’s question, “Tell me about your childhood” turns out to be a relevant question with any disease.
Regardless of economic status, housing or education, we can improve resilience by intervening at an early age. We may not be able to reduce poverty but we can lessen its effects on both physical and emotional health.
A physical health provider writing an anti-depressant prescription and seeing the patient six months or a year later is not enough. Institute a “chain of care” for depression and other behavioral health risks. Primary care providers who screen for depression need to know where to refer patients for further evaluation and treatment. Screening is most beneficial when staff-assisted care and follow-up systems are in place. Screening tools from this website and other sources provide the first link on the chain.
Recommended:
As Dr. Michael Fine, Director of the RI Department of Health, said at the start of our March 6, 2012 workshop: “We need to eliminate deaths from prescription drug overdoses.” RI has the third highest opioid pain-killer use in the country. And prescription drug overdose is now the leading cause of unintentional death in the state.
“Many, many people are involved with many, many prescription drugs, all prescribed by RI physicians and pharmacists.” These drugs are killing people. Dr. Fine’s goal is to work with the healthcare community to minimize misuse and still provide access to effective chronic pain management.
In describing the patterns of substance abuse in women, Panelist Catherine Friedman, MD, described it as an “exploding epidemic.” Opioids were available to women in tonic form 100 years ago and sold as “Mother’s Little Helper.” Women still tend to use prescription drugs as a coping mechanism. Teenagers get the drugs from their parent’s medicine cabinet. Pregnant girls have the highest rate of use, and the rate of depression is higher in opioid users. Also, the patterns are telescoping: users are more likely to progress from experiment to abuse and dependence in a shorter period of time; 3 years for women vs. 6 years for men.
RI has initiated a prescription drug monitoring task force, with the goal of creating a database to track all prescription medications prescribed and used, so that they can identify misusers earlier and intervene before they become addicted.
RI Medicaid has 175,000 members, nearly one-fifth of the population. Women with chronic pain use twice the number of services as men, at double the monthly cost. (Medicaid: Men $1200 average; women $2400).
Methadone has a much longer half-life than originally thought. It should be used with caution, especially when other opioids are prescribed.
Allison Croke, MHA, introduced the “Communities of Care” program begun 2 years ago by RI Medicaid. This targeted intervention provides short-term case management, using an interdisciplinary team, for people who have used the ER 4 or more times in a 12-month period where chronic pain has been the significant driver.
The integrated treatment plan includes a pain management program, a team of supporters including a peer navigator, and self-responsibility combined with complementary care. Holistic nurses who are trained in outreach meet with the patient to develop their treatment plan. In addition to medication, the program supports the patient’s well-being with both physical and behavioral healthcare, chiropractic treatments, acupuncture and massage.
Michael Maher, MD acknowledged that managing patients with chronic non-malignant pain is very difficult, and that “we are under-educated” about the drugs we are using. Originally there were no standards for how to manage patients on pain medication. Today standards include RI Department of Health Guidelines which require a physician and patient relationship, patient history and a physical exam.
Dr. Maher added strong suggestions for improved care that include determining the functional impact of the patient’s pain, and screening for substance use disorders. Other recommendations include:
Providers should recognize that treating pain is not just about bringing down the pain number; it is about improving the patient’s functionality. Can they go out and take care of themselves in a better way? Do they meet functional improvement goals? Rather than just handing out the next month’s prescription, ask if this medication is helping. Because these are dangerous medications, “If they are not helping the patient, get them off it.”
The World Health Organization predicts that by 2020 the leading disability in women worldwide will be depression. Women are at higher risk for both depression and suicide. At present, twice as many women as men (17%) will have a major depressive disorder in their lifetime. They have more severe symptoms, including self-criticism, guilt, worthlessness, anxiety, low energy and interpersonal sensitivity. (Carpenter)
Suicide is an escape behavior; a way to get out of seemingly unmanageable problems, including the pain of anxiety, guilt, hopelessness, loss of status, job and money, and/or relationship separation or conflict. Both disorders reflect the additional risk factors for women: intimate partner violence, eating disorders and hormonal changes. (Jordan)
Patients with multiple physical and behavioral health problems often are treated by providers, who “don’t talk to each other and make the patient way worse,” according to Jane Hayward, CEO and President of the Community Health Center Association. When chronic pain, substance abuse and chronic mental health issues are combined in one patient, the costs of treatment are 7 times higher than with just one situation. People with chronic mental illness are likely to die 25 years sooner than the average.
In many practices, including Community Health Centers, legal precedents and payor policies lag behind new integrated care solutions, and can inhibit effective patient treatment. This is a compelling issue now because of the epidemic issues around depression and prescription drug misuse, increase in illicit drug misuse and the unmet need for affordable, accessible mental health professionals.
Also of note: no one system of care is right for every setting. Effective systems of integrated care must be culturally specific. “If you’ve seen one health center, you’ve seen one health center.” (Hayward)
Depression is linked to multiple factors: aging, genes, hormone changes, exposure to toxins, infectious pathogens, injury and inflammation. Early childhood stress is a powerful contributor, including low socioeconomic class. Evidence of abuse and neglect is visible in brain tissue; abuse and neglect leaves a biological scar, which indicates risk of chronic inflammatory illnesses, depression and suicide.
Conditions linked to depression include diabetes, obesity, smoking, alcohol and a sedentary lifestyle. These co-existing conditions should be treated together. (Carpenter)
Bullying often precedes sexual violence and suicidal ideation. Students who are bullied at school are at higher risk of suicide. Men are exposed to more physical violence; women to more sexual abuse. (Perez)
Suicide is like having a glass already filled to the brim; just one more drop of agitation from panic, anger, helplessness—and in that moment the scale is tipped towards self-harm. It is the ultimate expression of hopelessness: “There is no answer for me and I’m giving up.” (Jordan)
Improved care from the Community Health perspective means increasing better outcomes and decreasing costs. Many patients require a level of complex care no one person can provide. Some basic principles for integrated care include
Rapid Access RI demonstrates one approach—an urgent care center designed to divert people from expensive and excessive ER use. The Providence Center is seeing good outcomes in their intersection of primary care and behavioral health care. The challenge remains: continue to look for ways to integrate disciplines and overcome legal and policy barriers, because “We forget that we need to focus on systems of care, not systems of silos.” (Hayward)
When the potential for depression or suicide appears, learn as much as possible about the patient’s history of trauma and functional impairment. Initial screening questions are listed on the Pocket Cards created for this workshop: Screening for Depression which includes the patient self-screening form (PHQ-9), and the series of suicide risk assessment questions known by the mnemonic IS PATH WARM? The SAFE-T card details Risk Factors, Protective Factors, Suicide Inquiry and recommended Interventions.
Other questions recommended at the workshop include:
Consider how to move from silos of care to integrated systems of care, where the approaches of PCP’s and therapists come together to create:
o Improved physical health, including nutrition (i.e. vitamin D for depression) and exercise to change sedentary lifestyle.
o Behavioral health care including sessions to raise hope and self-esteem, internalize qualities of maternal warmth and assume more self-responsibility.
o Social health including support groups for depression and suicide survivors, peer navigators and an on-going care team.
o Complementary activities including massage, chiropractic treatments, acupuncture for pain and improved energy, and light therapy to relieve depression.
These issues impact women and the patients they care for so the strategies can be used by providers for themselves and passed on to their patients.
“If we can walk away from this evening with a decision to be as kind and accepting of ourselves as we are for the people we care for in work and personal lives that would be a great start.” Judy Hoffman, Coastline EAP
“Learn to speak the language of functional and business outcomes. It enhances your credibility” Susan Colantuono, Leading Women
“Public policy can move the agenda and dictate culture, we don’t need to wait.” Marcia Cone, Women’s Fund
Survey: conducted in preparation for this conference.
The Vision 2020 report indicates that RI and the nation has a lot of work to do to resolving gender issues in the workplace.
Things organizations can do:
• Companies need to be more conscientious about doing wage equity audits on a routine basis; many don’t and even if they do the gaps will spread if they are done infrequently
• Managers have to be held accountable for not creating inequities
• Require diverse slates of candidates for senior level positions
Things women can do:
• Have to hold managers accountable for these stereotypes and counter them.
• Have conversations with Human Resources about doing wage equity audits and other best practices
• Share the Vision 2020 with Human Resources
• Get better at negotiating for compensation and benefits
• Must ask what is their company’s philosophy for advancing women
• Work with mentors to get help with setting and achieving professional goals, navigating politics, perspectives and de-stressing
• Use preparatory speech so comments and contributions are not discounted. Make conversation to bring men in and give them time to pay attention to what you are saying.
• Must add to identity, expand who you are as an employee and speak the language of all components of the organization:
o Understand the functional outcomes that contribute to organizational success beyond patient outcomes. Understand how you can contribute to improving them.
o Also pay attention to the business outcomes of the whole organization and understand how you can help the whole organization move forward. With this business acumen language you will be seen as someone who should be promoted.
What do male managers around the world say about barriers to advancement of women?
• Women don’t show enough business acumen, they don’t understand what the people at the top care about in terms of metrics. Don’t understand the business of running the business. Women believe individual achievements should get you ahead but it is not enough.
• Men’s culture of mentorship and business acumen is stronger than women’s
• Men are more comfortable with other men. People are more comfortable with people who are like them and tend to hire people who are similar to them.
• Women are expected to be the assistant, wife, mistress or lover; someone to talk with about problems. Men are not seeing women as executive or administrator.
• Similarly, med have insider status and women are outsiders
• Motherhood penalty/Fatherhood reward. In organizations women who are mothers are seen as less capable, competent and committed than men who are fathers. Fathers are seen as more capable than single men.
• The man is the breadwinner in the family and has the greater income needs; women are working for “pin money”
• Women who are mothers change their priorities and “wouldn’t want that job, there is too much travel”
• Most men see the work world as totally separate from their personal world and each has own rules. Most women see the work world as a piece of their personal world. The rules in one roll over to the other. When women become mothers, our work world is seen as shrinking by male counterparts. Even if a woman is seriously committed to advancing in her career and has resources in place to help her do both.
Women and men handle stressful situations differently so they need to bring different strategies for coping in the workplace. During transition women focus on:
• Brain dump
• To do list
• Replaying, questioning conversations, questioning decisions
• Negative self-talk
And not on:
• Basking in their day
• Conscious permission to let go of the day, think of something fun
Try these to enhance the interior journey:
• Strive for excellence not perfection
• Make a decision and then let it go. Interior post-decision monologue is a huge time waster; buy time and more peace of mind.
• Just say no. Get comfortable with saying no to other’s requests and demands and cut off any associated guilt.
• Repeat the phrase I am a mere mortal I can’t do everything. I do what I can and that is enough.
• Quiet the voice that is on a continuous loop. Self-help at www.anxieties.com or seek professional help if you need it.
• Reframe the Must Do list and realize that wish lists will be met over decades; you can have a sequential career not everything at the same time. Slow down and believe the evidence that mindfulness, yoga, exercise, meditation works. Get 6 to 8 hours sleep and save time during the day by not revisiting decisions.
• Save energy for dealing with what actually happens rather than spending it on what might happen.
• Enjoy the mystery of not knowing what the future may bring. May have to shift and use positive self-talk about strengths.
• Women must work together to make the shifts in organizations.
How can women push forward without losing who they are? Women aren’t being inauthentic by caring about the business metrics since the organization can’t grow without meeting them. If women care about the success of the organization they work for they must embrace the business metrics as well as the others.
Mindfulness Practice exercises cultivate the part of the nervous system that targets healing, wellbeing, ease and balance. In Mindfulness Practice you pay attention in the present moment on purpose and non-judgmentally. It helps to encounter who you are in the moment so other things can be let go and, thereby, reduce stress.
• Policy dictates Culture. Experience in Scandinavia confirmed that policy dictates culture. They have created policies to bring changes to work life balance and, as a result, the culture is shifting; people from all walks of life and backgrounds appear to believe in the policy. In the US we believe that culture dictates public policy and policies are born when the culture is amenable to it but this appears not to be the case.
Public policy moves the Agenda: Example Iceland Childcare Policy: In Iceland Universal childcare is standardized and starts at 9 months because family leave is 9 months: 3 months to the mother, 3 months to the father, and 3 months that can be split as the family chooses. This works despite the fact that Iceland has one of the highest birth rate in the world. Research shows better childcare has substantially improved health outcomes.
Public Policy moves the Agenda: Example Corporate Boards in Iceland:
The business community in Iceland passed a law that mandated corporate boards to have not less than 40% men or women and no more than 60%. Corporations were given 4 years to ramp up and not one board had the required percentage until the deadline.
• Research says that companies with women at the top perform better but this is not being recognized in individual companies. There has been some evolution with more women in the work force and more women as the primary breadwinners in their family than ever before but policy has not kept pace with these changes
• Unequal pay and benefits results in increased poverty. When 60% of the population aged 65 is female and almost 100% of the population age 90 is female and, in retirement, women are living on 50% less than men there are major economic implications for the population. RI is projected to be the second oldest state in the country so these issues will impact the state greatly.
Public Policy working on in RI to move women forward:
• Representation in corporate sector (Vision 2020); women need to be at the table to keep issues at the forefront. Have more than doubled the number of women served on commissions and boards.
• RI is the third state to pass paid family leave (4 weeks) with the broadest definition of family in the country and the only one in the country with job protection. (Rolls out 1/1/14). Since men or women can take leave it starts to shift the paradigm around who are the caregivers. Family Leave Act for caregivers is also gaining momentum on the federal level.
Women’s Fund wants to make RI the first gender equality place in the nation and will be focusing on:
• Representation including corporate boards,
• Workforce and work place policies such as equal pay, pregnancy discrimination and long-term care issues.
• Reducing the holes in RI pay equity law
• April 3, Women’s Health Council Workshop
Healthy Work and Healthy Women: Tools for Transformation
Continuing the strategic conversation
started at our 2013 Fourth Annual Quality Conference:
Healthy Work and Healthy Women: Today’s Issues for Women in the Workplace
Through case studies, role-playing and discussions with experts we will embrace the tools to transform how you and your patients function in the workplace.
• Leading Women: www.leadingwomen.biz
• The Women’s Fund of RI: www.wfri.org?
• Also see suggested readings for the Conference
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Belinda Borrelli, PhD, is a Professor of Psychiatry and Director of the Program in Nicotine and Tobacco Research, Alpert Medical School of Brown University and The Miriam Hospital. She is a clinical psychologist specializing in motivational interviewing techniques for health behavior change. Dr. Borrelli has trained many hundreds of physicians, nurses, and lay providers in best practices for smoking cessation in the US and abroad.
Mary Reich Cooper, MD, JD, is a Senior Vice President and the Chief Quality Officer of Lifespan, and is an Assistant Professor of Medicine at the Alpert Medical School of Brown University. In her current position, Dr. Cooper is responsible for articulating the quality and safety strategy for Lifespan and working closely with the state government and quality organizations in Rhode Island to improve safety and quality of care for the citizens of Rhode Island. She is Co-chair of the Women’s Health Council of RI.
Margaret (Peg) Miller, MD, is Director of the Women’s Medicine Collaborative, a Lifespan Partner; and Assistant Professor of Medicine at Alpert Medical School of Brown University. Dr. Miller is a board-certified internist whose primary area of interest is medical problems in pregnancy. Dr. Miller has also contributed to numerous peer-reviewed journal articles and book chapters on medical problems in pregnancy and speaks widely on topics related to the association between pregnancy-associated conditions and future chronic disease.
Patricia A. Nolan, MD, MPH, serves as the Executive Director of the Rhode Island Public Health Institute and is an Adjunct Associate Professor in the Department of Community Health at the Alpert Medical School at Brown University. The Public Health Institute is currently working to promote community health in Rhode Island through environmental assessments, health interviews, health information dissemination, and health promotion activities.
Athena Poppas, MD is the director of the echocardiography laboratory at Rhode Island Hospital and a Member of the Clinical Care Working Group of the National Center of Excellence in Women’s Health at Women & Infants Hospital. Dr. Poppas is an Assistant Professor of Medicine at Alpert Medical School of Brown University. As a cardiologist, her research is focused on the various facets of heart disease in women.
Karen Rosene-Montella, MD, is a Senior Vice President for Women’s Services and Clinical Integration and Vice Chair of Medicine for Quality and Outcomes for Lifespan. Dr. Rosene-Montella is the Division Chief of Obstetric Medicine and Professor of Medicine OB/GYN at Alpert Medical School of Brown University. She is Co-chair of the Women’s Health Council of RI.
Amity Rubeor, DO, is the Clinical Team B Leader at the Family Care Center in Pawtucket, RI, and supervises residents in the Brown Family Medicine Residency. Within the last year, her team has focused on Smoking Cessation quality improvement projects, working with Quality Partners of RI and Quitworks-RI. The Family Care Center has received Level 3 status through the NCQA and continues to work on other areas of chronic disease management through the Chronic Care Sustainability Index (CSI) of Rhode Island.
Sara Ryan, DAc, owns and operates a private Acupuncture and Traditional Chinese Medicine practice in Providence, RI. Her training includes a BA from Boston University and pre-medical studies at Providence College, a summa cum laude degree from the Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA, and additional studies and practice in Tibetan Medicine in Dharamsala, India. Her acupuncture treatments often include the NADA protocol, which uses needles on auricular points to stimulate detoxification and relieve chemical dependency.
Theresa Mrozak, RN, CPHER, is a Prevention Team Program Coordinator with Quality Partners of Rhode Island. She is responsible for the development, coordination and implementation of initiatives associated with QuitWorks-RI as well as the initiative on Prevention and EHR implementation in the physician office setting. She is a Certified Professional in Electronic Health Records and holds a Business Management Certificate from Bryant University.
Jennifer Wood, JD, is the Chief of Staff and General Counsel for RI’s Lieutenant Governor Elizabeth Roberts, where much of her work has been focused on healthcare reform. While in private practice she served for five years as Legal Counsel to the Rhode Island Senate Health Education and Welfare Committee where she worked on the development of Rhode Island’s ground breaking anti-smoking legislation.
Amy S. Gottlieb, MD, Workshop Co-Leader, is an Assistant Professor of Pediatrics at the Alpert Medical School of Brown University, and Attending Physician, Child Protection Program, Hasbro Children’s Hospital, Providence, RI. She is the Chair of Women & Infants Hospital’s Domestic Violence Task Force.
Sarah C. DeCataldo, Workshop Co-Leader, is the Legal Advocacy Services Coordinator for Day One, Rhode Island’s sexual assault and trauma resource center. Ms. DeCataldo coordinates the Sexual Assault Response Team (SART) and provides advocacy to victims throughout the criminal justice process. Additionally, Ms. DeCataldo coordinates and presents trainings on domestic violence, sexual assault and human trafficking to local law enforcement, hospitals, colleges and community agencies.
Deborah DeBare, MMHS, Workshop Facilitator, is Executive Director of the Rhode Island Coalition Against Domestic Violence, Warwick, RI. She is responsible for collaborative planning and statewide networking on behalf of the state’s battered women’s shelters. She also advocates for state and federal legislative initiatives affecting domestic violence issues.
Mary Reich Cooper, MD, JD, is a Senior Vice President and the Chief Quality Officer of Lifespan, and is an Assistant Professor of Medicine (Research) at the Alpert Medical School of Brown University. In her current position, Dr. Cooper is responsible for articulating the quality and safety strategy for Lifespan and working closely with the state government and quality organizations in Rhode Island to improve safety and quality of care for the citizens of Rhode Island. She is Co-Chair of the Women’s Health Council of RI.
Amy Goldberg, MD, serves as Attending Physician in the Child Protection Program at Hasbro Children’s Hospital, Providence, RI. She is Assistant Professor of Pediatrics at the Alpert Medical School of Brown University and actively engages with a number of community partners to improve recognition, response and prevention of child abuse and neglect.
Yvonne M. Heredia, MSN, RN, CDOE, serves as Adult Clinical Team Lead, Case Management at the Neighborhood Health Plan of Rhode Island, Providence, RI. She is CEO and founder of the Black Nurses Association, Inc. which promotes health and wellness to underserved populations in RI, and advancement of nursing leadership among minorities.
Margaret Howard, PhD, is the Director of the Postpartum Depression Day Hospital at Women & Infants Hospital, Providence, RI. She is also Clinical Associate Professor of Psychiatry and Human Behavior at the Department of Medicine, Alpert Medical School of Brown University. Dr. Howard has published and lectured widely on the topic of perinatal psychiatric disorders.
Constance A. Howes, JD, FACHE, is President and Chief Executive Officer of Women & Infants Hospital. She serves as chair of the Innovation Providence Implementation Committee. She is a member of the Board of Trustees of the Greater Providence Chamber of Commerce, a member of the Board of Directors of Day One, and a founding member of the Women’s Health Council of RI.
Jennifer E. Lang, MSW, LCSW, is a Clinical Social Worker in the Emergency Departments of Rhode Island and Hasbro Children’s Hospitals where she performs biopsychosocial assessments and screenings for abuse and neglect in adults and children. She also serves as Adjunct Faculty for Bachelor and Master level programs at Rhode Island.
Detective Sgt. William Merandi, is Commanding Officer of the Special Victims Unit, Providence Police Department, Providence, RI. His focus has been on improving the Department’s response to domestic violence and sexual assault, as well as investigating abuse in the elderly community. In 2010, Det. Sgt. Merandi formed the Domestic Violence TriageTeam which reduced the number of domestic violence homicides from 8 in 2009, to 2 in 2010.
Sandra M. Shaw, MSN, RN, is a faculty member of the VA Nursing Academy. In this role, she is a clinical instructor at Rhode Island College School of Nursing, teaching public health nursing with an emphasis on the care of veterans and their families. Formerly Health Services Coordinator for the Women’s Center of Southeastern Connecticut, she has helped providers develop their capacity for screening and responding to individuals living with domestic violence.
Carrie Bridges, MPH, is the Team Lead for Health Disparities and Access to Care in the Division of Community, Family Health and Equity at the Rhode Island Department of Health. Through policy development and direct service to local communities, her team focuses on eliminating health disparities disproportionately impacting racial and ethnic communities and other vulnerable populations.
Mary Reich Cooper, MD, JD, is a Senior Vice President and the Chief Quality Officer of Lifespan, and is an Assistant Professor of Medicine (Research) at the Alpert Medical School of Brown University. In her current position, Dr. Cooper is responsible for articulating the quality and safety strategy for Lifespan and working closely with the state government and quality organizations in Rhode Island to improve safety and quality of care for the citizens of Rhode Island.
Linn Freedman, ESQ, practices in health care law, privacy and security law and complex litigation. She advises healthcare providers, primarily hospital systems, hospitals and physicians on issues involving physician discipline, patient-related legal issues, behavioral health, regulatory compliance, Medicaid fraud, litigation and the federal health care reform legislation (the Patient Protection and Affordable Care Act, or PPACA) enacted in 2010. She serves as General Counsel of the Rhode Island Quality Institute.
Amy Gottlieb, MD, is an Assistant Professor of Medicine and OB/GYN (clinical) at the Alpert Medical School of Brown University, and the Director of Primary Care Curricula and Consultation in the Women’s Primary Care Center at Women & Infants Hospital. She is also the Chair of Women & Infants Hospital’s Domestic Violence Task Force.
Miriam E. Nelson, PhD, is Director of the John Hancock Research Center for Physical Activity, Nutrition and Obesity Prevention, and Associate Professor at the Friedman School of Nutrition Science and Policies at Tufts University. She is the author of the international best selling “Strong Women” book series. Dr. Nelson is a Luminari Health expert.
Barbara Roberts, MD, FACC, has been the Director of the Women’s Cardiology Center at the Miriam Hospital in Providence, RI since 2002. Dr. Roberts is the author of “How to Keep from Breaking Your Heart: what every woman needs to know about cardiovascular disease” and “Treating and Beating Heart Disease: A Consumers Guide to Cardiac Medicines.” She has lectured widely on cardiovascular disease in the United States and abroad.
Barbara Roberts, MD, FACC, has been the Director of the Women’s Cardiology Center at the Miriam Hospital in Providence, RI since 2002. Dr. Roberts is the author of “How to Keep from Breaking Your Heart: what every woman needs to know about cardiovascular disease” and “Treating and Beating Heart Disease: A Consumers Guide to Cardiac Medicines.” She has lectured widely on cardiovascular disease in the United States and abroad.
Aimee Thompson is the founder of Close to Home, a domestic violence prevention organization in Boston. At Boston Medical Center, Aimee developed a group therapy program for children and their mothers, and provided training for Boston police officers on children and trauma. Aimee has provided workshops on Close to Home’s approach throughout the United States, as well as in Germany, Uganda, South Africa, and the Caucasus.
Regina M. Benjamin, MD, MBA is the 18th Surgeon General of the United States. As America’s Doctor, she provides the public with the best scientific information available on how to improve their health and the health of the nation. Dr. Benjamin also oversees the operational command of 6,500 uniformed health officers who serve in locations around the world to promote, and protect the health of the American People.
Dr. Benjamin is Founder and Former CEO of the Bayou La Batre Rural Health Clinic in Alabama, former Associate Dean for Rural Health at the University of South Alabama College of Medicine in Mobile, and Past Chair of the Federation of State Medical Boards of the United States.
Dr. Benjamin is a member of the National Academy of Science’s Institute of Medicine, and a Fellow of the American Academy of Family Physicians. She was a Kellogg National Fellow and a Rockefeller Next Generation Leader.
Dr. Benjamin has a BS in chemistry from Xavier University, New Orleans; attended Morehouse School of Medicine, and received her MD degree from the University of Alabama, Birmingham; She also has an MBA from Tulane University and fifteen honorary doctorates.
Linda Carpenter, MD, is Chief of the Affective Disorders Program at Butler Hospital in Providence, RI, and is Associate Professor of Psychiatry in the Warren Alpert Medical School at Brown University
Mary Reich Cooper, MD, JD, is a Senior Vice President and the Chief Quality Officer of Lifespan, and is an Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University. She is Co-chair of the Women’s Health Council of RI.
Rebekah Gardner, MD, is Senior Medical Scientist atHealthcentric Advisors and Assistant Professor of Medicine at Warren Alpert Medical School of Brown University. She is also an Attending Physician at Rhode Island Hospital.
Linda Nagy, MSN, RN, PMHCNS-BC, NEA-BC, is the new Chief Nursing Officer at Bradley Hospital in East Providence, RI. Previously she served for four years as Director of Behavioral Health for Salem Health, Salem OR.
Teri Pearlstein, MD is Director of Women’s Behavioral Medicine at the Women’s Health Collaborative in Providence. She is an Associate Professor of Psychiatry and Human Behavior at the Warren Alpert Medical School at Brown University.
Beatriz Perez, MPH, is the Manager of Safe Rhode Island, a program operated by the RI Department of Health. She currently administers federal grants from CDC and SAMHSA for statewide violence and injury prevention programs.
Lt. Governor Elizabeth Roberts, MBA is chair of the Rhode Island Healthcare Reform Commission created by Governor Chafee in 2010. She also serves as chair of Rhode Island’s Long Term Care Coordinating Council, the Small Business Advocacy Council, and the Emergency Management Advisory Council.
Karen Rosene-Montella, MD, is a Senior Vice President for Women’s Services and Clinical Integration for Lifespan. Dr. Rosene-Montella is the Division Chief of Obstetric Medicine and Professor of Medicine OB/GYN at the Warren Alpert Medical School of Brown University. She is Co-chair of the Women’s Health Council of RI.
Lisa Shea, MD, Facilitator, is the Associate Medical Director, Quality & Regulation at Butler Hospital in Providence RI. She is a Clinical Assistant Professor of Psychiatry and Human Behavior at Warren Alpert Medical School of Brown University.
2015 Report Card: Heart of a Woman.
index.php2012 Women’s Report Card: Socioeconomic Determinants of Health.
index.phpRI Adolescent Girls’ Health Report Card: Compares statistics between RI and US on topics of Demographics, High School Environments, General Health Indicators, Substance Use and Reproductive Health.
index.php2011 Women’s Behavioral Health Report Card: Reports RI’s incidences of mental illness are 25% – 33% higher than the national average. Opportunities include more research into contributing factors as well as links between behavior and illness.
2011 Women’s Physical Health Report Card: Indicates that women need a social and physical environment that supports healthy eating and active living, combined with increased access to timely, comprehensive, quality health services.
index.php2011 Smoking Report Card: What RI is doing right, i.e., passing the 2009 Smokefree Workplace & Public Place Law vs. under spending on state tobacco control programs.
index.php2010 Women’s Health Report Card: Snapshots into areas such as mandated cancer screening which have been successful, and lung cancer, COPD and Heart Disease where RI women are doing poorly.
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Intimate Partner Violence Risk Markers: Aimee Thompson – From Close 2 Home, a non-profit organization that has reduced the amount of domestic violence and increased the number of healthy relationships in a Boston neighborhood and around the world.
Intimate Partner Violence 1: Amy S. Gottlieb, MD – Definition and statistics show that the results of what we are doing is disappointing.
Intimate Partner Violence 2: Sarah DeCataldo – Understand the dynamics of abuse before you can properly screen patients.
Intimate Partner Violence 3: Amy S. Gottlieb, MD – Make asking about IPV routine. Use scripting for best results because women usually don’t disclose during a one-time encounter.
Intimate Partner Violence 4: Margaret Howard, PhD – Importance of repeat screening. Red flags: depression, anxiety, self-medication, low self-esteem.
Intimate Partner Violence 5: Amy Goldberg – ChildSafe program. How to assess the caregiver’s protective capacity.
Intimate Partner Violence 6: Sandra M. Shaw, MSN, RN – Role of the screener.
Intimate Partner Violence 7: Jennifer Lang, MSW, LCSW – Language for creating a comprehensive safety assessment and plan.
Intimate Partner Violence 8: Sarah DeCataldo – Resources for survivors and the path of referrals.
William-Intimate Partner Violence 9: Detective Sgt. William Merandi – The role of law enforcement as interveners.
Intimate Partner Violence 10: Yvonne Heredia – Recommendations from a survivor.
index.phpSmoking Cessation 1: Margaret Miller, MD. Assessing the many risks associated with smoking. Women know that it’s dangerous but don’t understand its relevance to them.
Smoking Cessation 2: Athena Poppas, MD. Statistics about increased risk of smoking and second hand smoke for women. Women are more susceptible to the effects of tobacco.
Smoking Cessation 3: Belinda Borrelli, PhD. How to increase motivation to quit through motivational interviewing.
Smoking Cessation 4: Sara Ryan DAc. Acupuncture and the NADA Protocol have a 31% quit rate and 90% relief of recidivism.
Smoking Cessation 5: Theresa Mrozak, RN How to create a sustainable quit practice using Quit WorksRI.
Smoking Cessation 6: Amity Rubeor, DO. An action plan for initiating a smoking cessation program.
index.phpKaren Rosene Montella, MD: Opening the Second Annual Conference with a review of the new ideas and new tools created in the past year, Dr. Rosene-Montella identifies the necessity for bridging physical and behavioral health for women.
Linda Carpenter, MD: Slides detail the complex interface between physical and behavioral health as well as the impact of environmental concerns and early-childhood experiences.
Teri Pearlstein, MD: This series of in-depth slides reviews treatment options for depression, as well as providers’ responsibility to follow up and why.
04-Beatriz-Perez-MPH: An overview of local and national government efforts to reduce the incidence of depression and suicide, especially in the younger, at-risk population.
index.phpFor people who take care of women: This Inaugural Conference introduced a new approach to providing quality women’s health care well beyond the traditional breast and gynecological focus.
Buffet Dinner 5:00-6:00 PM
Symposium 6:00-9:00 PM
Intimate Partner Violence 1: Initial screening questions to use before a patient has disclosed that they are being abused, because providers have great influence in directing a victim to places for intervention.
Intimate Partner Violence 2: Follow-up screening and trust-building statements once a patient has disclosed that they are being abused.
index.phpIdentification, Intervention & Community Resources: Our most recent Critical Workshop Training on Intimate Partner Violence. The Women’s Health Council of RI invited providers meet with a range of IPV experts who taught participants how to identify, intervene, and provide community-based resources for women experiencing partner abuse. If you’d like more information now about recognizing and responding to Partner Violence, please visit this website provided by the Domestic Violence Task Force at Women & Infants Hospital.
5:30 – 6:00 PM Opening Comments
Welcome Constance A. Howes, JD WHC Mission and IPV
About IPV Amy S. Gottlieb, MD; Sarah C. DeCataldo Why we’re here
Panel Introduction Deborah DeBare, Facilitator Meet the range of IPV experts present
6:00-6:30PM Addressing IPV
Women’s Health Amy S. Gottlieb, MD Screening for IPV
Behavioral Health Margaret Howard, PhD Understanding mental health effects
Children’s Health Amy Goldberg, MD Kids who witness
6:30–7:10 PM Responses to IPV
Initial Assessment Sandra Shaw, MS, RN How to conduct an assessment
Safety Planning Jennifer Lang, MSW, LCSW Creating a safety plan
Resources Sarah C. DeCataldo, Day One Whom to call and what happens
Law Enforcement Detective Sgt. William Merandi Police and court response
7:10–7:30 PM The Window Forward
Systems-Based Change Amy S. Gottlieb, MD Creating institutional protocols
Patient Experience Yvonne Heredia, MSN, RN, CDOE Transition from victim to survivor
7:30-8:00PM Closing Q&A with Panelists
Mary Reich Cooper, MD, JD What did we learn?
Smoking Cessation, Smoking Prevention: A series of 7 cards expand on the traditional Ask & Advise, Assess, Assist protocol (Assist: Positive Reinforcement, Assist: Pregnant Women Who Smoke, Assist: Second Hand Smoke). These cards include the kinds of tobacco use to look for, the stages of readiness to quit (Assist: Unwilling to Quit, Assist: Willing to Quit) how to move a patient towards quitting and how to help when they’re ready. Cards also address how to help pregnant women who smoke quit, and the risks of second hand smoke
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A free workshop, focused on what you can do now, using available resources, to help your patients quit.
5:30-5:40 Welcome and Introductions
Event Moderator Karen Rosene-Montella, MD
5:40-6:10 How We Are Helping
Reimbursement, Regulations and Public Policy Patricia A. Nolan, MD, MPH; Jennifer Wood, JD
6:10-6:40 Assessing the Risks
Getting your patient’s attention Margaret Miller, MD; Athena Poppas, MD
6:40-7:10 Motivating Patients
Recognizing teachable moments Belinda Borrelli, PhD; Sara Ryan, DAc
7:10-7:40 Making It Work
Incorporating cessation practices Theresa Mrozak, RN; Amity Rubeor, DO
7:40-7:55 How You Can Help
Integrating what you already know?with what we’ve learned today Karen Rosene-Montella, MD
7:55-8:00 Closing Comments
Mary Reich Cooper, MD, JD
This year’s Conference explores common themes that have come to define the Women’s Health Council of RI: Collaboration among members of many disciplines, practical application of new ideas, and the present push to bridge physical and behavioral health. The event showcased the Council’s areas of focus to date: Women’s Health in terms of obesity and exercise, Intimate Partner Violence, Smoking Cessation, Pregnancy as a health stress test, and a new focus on Bridging Physical and Behavioral Health in the area where women are at high risk: depression and suicide.
5:00 – 6:00 PM Buffet Dinner and Networking
6:00 – 6:30 PM Welcome and Introductions
Karen Rosene-Montella, MD
6:30 – 7:30 PM The Intersection of Physical and Behavioral Health
Linda Carpenter, MD
Teri Pearlstein, MD
Beatriz Perez, MPH
7:30 – 7:50 PM Keynote Address “National Prevention Strategies”
Vice Admiral Regina M. Benjamin, MD, MBA, U.S. Surgeon General
7:50 – 8:30 PM Panel Discussion
Vice Admiral Regina M. Benjamin, MD, MBA
Lt. Gov. Elizabeth Roberts
Teri Pearlstein, MD
Linda Carpenter, MD
Beatriz Perez, MPH
Linda Nagy, MSN, RN, PMHCNS-BC, NEA-BC
Lisa Shea, MD, Facilitator
8:30 – 8:50 PM Q&A Session with Audience
Rebekah Gardner, MD, Facilitator
8:50 – 9:00 PM Closing Remarks
Mary Reich Cooper, MD, JD
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Screening for Depression Physical and Behavioral Health: Details why clinicians should screen for depression, groups at greater risk for experiencing depression, and the patient self-assessment PHQ-9 clinicians can use to further understand a patient’s experience with mental health and wellness.
Screening for Suicide: Includes the most common list of questions used to determine patient’s risk of suicide. In mnemonic form, this list is known as “IS PATH WARM?”
Bridging Physical and Behavioral Health: Shows how depression affects both physical and behavioral health; includes an infographic illustrating the multiple external risk factors that are correlated to adverse health behaviors and outcomes.
Safe-T Suicide Assessment Five Step Evaluation and Triage: Provided by the National Suicide Prevention Lifeline, this card details risk factors, protective factors, suicidality patterns, and possible interventions.
index.phpManaging Women’s Physical and High-Risk Behavioral Health Practical Solutions.
5:00-5:30 PM Registration, Buffet Dinner and Networking
5:30-5:35 PM Welcome
Karen Rosene-Montella, MD
5:35-5:45 PM Workshop Opening
Margaret Howard, PhD
5:45-6:00 PM Public Health Perspective
Michael Fine, MD
6:00-6:45 PM Managing Physical Health and Prescription Drug Misuse
Rebekah Gardner, MD Facilitator
Catherine L. Friedman, MD Women: Patterns of Substance Abuse
Alison L. Croke, MHA System-Based Approaches to Prescription Drug Misuse
Michael J. Maher, MD Better Tools from a Physician’s Perspective
6:45-7:00 PM Panel Q&A
7:00-7:15 PM Community Health Perspective
Jane Hayward, President & CEO, RI Health Center Association
7:15-8:00 PM Physical Health and High-Risk Mood Disorders
Lisa Shea, MD Facilitator
Linda Carpenter, MD Women: At Risk for Depression and Suicide
John R. Jordan, PhD Gender-informed Suicide Risk Assessment
Beatriz Perez, MPH A Public Health Approach to Suicide Prevention
8:00-8:15 Panel Q&A
8:15 Closing Remarks
Carrie Bridges, MPH
Resolving Socioeconomic Stressors: When providers recommend healthcare practices like exercise and safe behaviors, they make assumptions that their patients live in safe neighborhoods, are not in abusive relationships, have stable employment and can read the instructions on their medications. This card provides resources for a wide range of socioeconomic assistance
Affordable Care Act: Patient opportunities, including specific benefits for women that lower costs, improves care, improves access and helps families afford good insurance.
Affordable Care Act Timeline: This timeline from 2010 to 2014 shows when key provisions become effective that give more healthcare control back to doctors and their patients.
Resources for Addressing Socioeconomic Stressors
Resolving Socioeconomic Stressors Poster: This 11 inch x 17 inch poster is packed with Rhode Island Resources for patients with stressors related to socioeconomic issues.
Food Insecurity: A screening designed to identify food insecurity in a family as a whole.
index.phpStrengths-Based-Approach: This pocket card combines questions that “get into adolescent heads” with prompts to strengthen their resiliency indicators throughout the psychosocial screening.
CRAFFT: Helps determine the probability of substance abuse and dependency; from the Children’s Hospital in Boston.
index.phpPanel Dialogues between youth leaders and the providers who care for them.
5:00-5:50 PM Registration, Box Dinner and Exhibition Viewing
5:50-6:00 PM Workshop Opening Mary Reich Cooper, MD, JD
6:00-6:20 PM Introduction: A Strengths-Based Approach Patricia Flanagan, MD
6:20-7:35 PM PANEL DIALOGUES: Introductions by Rosa E. DeCastillo
PANEL 1 Teen Pregnancy: Prevention, Behaviors, Resources
Beata Nelken, MD
Jenylez Hance-Paneto
Adrian Molina
PANEL 2 Teen Substance Abuse: Prevention, Behaviors, Resources
Selby Conrad, PHD,
Colleen Hench
PANEL 3 Health Issues in the Teen LGBTQQ* Community: Prevention, Behaviors, Resources
Michelle Forcier, MD
Anita Parenty
7:35-7:55 Panel Q&A
Maureen Phipps, MD, Facilitator
7:55-8:00 Closing Remarks
Mary Reich Cooper, MD, JD
*LGBTQQ: Lesbian, Gay, Bi-Sexual, Transsexual, Queer and Questioning
index.phpResolving Socioeconomic Stressors for Stronger, Healthier Women: Innovative models of care and how to fund them.
5:00-5:30 PM Registration, Buffet Dinner and Networking
5:30-5:35 PM Conference Opening
Mary Reich Cooper, MD, JD Co-chair, Women’s Health Council of RI
5:35-6:20 PM Healthy Women 2020: Key Focus Areas and Objectives
Michelle Berlin, MD, MPH Oregon Health & Science University
6:20-6:35 PM Socioeconomics for RI Women
Linda Katz JD Co-founder and Policy Director, Economic Progress Institute
6:35-7:20 PM Panel 1: Innovative Care Models
Facilitator: Nelly Burdette, PsyD The Providence Center
Sonia Sarkar, MPH Chief of Staff to the CEO, Health Leads
Betty R. Vohr, MD Director, Neonatal Follow-Up Clinic, Women and Infant’s Hospital
Angela Reda, RN Providence Community Health Centers
7:20-7:35 PM Christine Ferguson, JD Director, RI Health Benefits Exchange
7:35-8:20 PM Panel 2: Innovative Payment Models
Karen Rosene-Montella, MD Co-chair, Women’s Health Council of RI
Andrea Galgay, MBA Manager of PCMH Performance – Blue Cross & Blue Shield of Rhode Island
Tracey Cohen, MD Medical Director, Neighborhood Health Plan of RI
Renee Rulin, MD, MPH Medical Director, RI Medicaid, United Health Care
8:20-8:40PM Q&A
Carrie B. Feliz, MPH Providence Public School Department
8:40-8:45PM Closing Remarks
Karen Rosene-Montella, MD Co-chair, Women’s Health Council of RI
Wrap Around Solutions to Socioeconomic Stressors: dialogues with providers and payers.
5:00-5:30 PM Registration, Buffet Dinner and Networking
5:30-5:35 PM Workshop Opening: Karen Rosene-Montella, MD Co-chair, Women’s Health Council of RI
5:35-5:45 PM Overview: Current Socioeconomic Gaps in Care
Linda Katz, JD Cofounder and Policy Director, Economic Progress Institute
5:45-6:05 PM Cultivating Youth Wellbeing: Evidence2Success
Carrie B. Feliz, MPH Director of Strategic Community Partnerships, Providence Public School Department.
6:05 -6:25 PM Providing Integrative Care: The Women’s Medicine Collaborative
Margaret Miller, MD Director, The Women’s Medicine Collaborative.
6:25-7:30 PM Wrap-around Dialogues: A Panel Discussion
Facilitator: Linda Katz, JD Economic Progress Institute.
Nora Conroy, Legal Assistant, Amos House Guest.
Nancy Harrison, Clinical Quality Specialist, United Health Care.
Eileen Hayes, MSW President & CEO, Amos House.
Jacqueline Lefebvre Blue Cross & Blue Shield of Rhode Island.
Michelle Lupoli, RN, MS, CCM Director, Medical Management, Neighborhood Health Plan.
Bernadette McDowell, RN Warwick Public Schools
Suzanne McLaughlin, MD Internist & Pediatrician, RI Hospital.
7:30-8:00PM Q&A and Close
Facilitator: Karen Rosene-Montella, MD, Co-Chair Women’s Health Council of RI
Healthy Work, Healthy Women: Today’s issues for women in the workplace. Including dynamic discussions with Susan Colantuono of Leading Women, Judy Hoffman of Coastline EAP, and Marcia Coné of Women’s Fund RI.
5:00-5:20 PM Registration, Dinner & Networking
5:20-5:30 PM Workshop Opening, Survey Results & Health Impact
Karen Rosene-Montella, MD, Chair, Women’s Health Council RI
5:30-6:00 PM No, It’s Not Just You! (Gender Dynamics & Life at Work)
Susan Colantuono, CEO and founder of Leading Women
6:00-6:20 PM What Women Tells Us on Their Phone On the Way from the Office
Judith Hoffman, LICSW, CEAP, Executive Director Coastline EAP
6:20-6:30 PM Mini Stress Reduction
Ellen Flynn, MD, Women’s Medicine Collaborative, Lifespan
6:30-7:30 PM Interactive Discussion
Facilitator: Karen Rosene-Montella
Susan Colantuono
Marcia Cone, PhD
Judith Hoffman, LICSW, CEAP
7:30-7:50 PM Cultural Shift Courtesy of Public Policy: Moving Forward
Marcia Cone, CEO Women’s Fund RI
7:50-8:00 PM Closing
Stacy Paterno Co-chair, Women’s Health Council of RI
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Healthy Work and Healthy Women: Tools for Transformation
Continuing the strategic conversation started at our 2013 Fourth Annual Quality Conference: Healthy Work and Healthy Women, Today Issues for Women in the Workplace. Through case studies, role playing, and discussions with experts we will embrace the tools to transform how you and your patients function in the workplace. Come join the conversation.
5:00-5:30 PM Registration, Dinner and Networking
5:30-5:35 PM Workshop Opening
Karen Rosene-Montella, MD Co-chair, Women’s Health Council of RI
5:35-5:55 PM Transforming Perceptions: Negotiating Can Be Fun
Lisa Bergeron, President, Leading Women New England Exercise
5:55-6:05 PM Transforming Attitudes: Reframing Accomplishment and Avoiding Negative Self-Talk
Judith Hoffman, Executive Director, Coastline EAP
6:05-7:05 PM Practicing the Tools: Women Must Ask
Facilitated small group work on Negotiation Strategies and Presentation
7:05-7:20 PM Transforming Action: Get involved to help Policy influence Culture
Marcia Cone, CEO, Women’s Fund Rhode Island
7:20-7:55 PM Brainstorming: What should be our next steps
Small group brainstorming
7:55-8:00 PM Closing
Carrie B. Feliz, MPH, Providence Public School System
Women and Body Image: Reclaiming, Recovering
An intimate look at teenage and adult issues through poetry, movement and conversations with patients and providers.
5:00-5:30 PM Registration, Dinner and Networking
5:30-5:40 PM Welcome
Karen Rosene-Montella, MD, Chair, Women’s Health Council of RI
5:40-6:25 PM Poetry and Movement: Portrait of a Teenage Girl
Colleen Cavanaugh, MD, Ob/Gyn, Lifespan Physicians Group, Artistic Director of Part of the Oath; and three students
6:25-6:55 PM Provider and Patient Dialogue
Catherine Gordon, MD, MSc, Director, Division of Adolescent Medicine, Hasbro Children’s Hospital; and her patient
6:55-7:35 PM Panel Discussion: Issues that Complicate & Issues for Adults
Facilitator – Abigail Donaldson, MD, Medical Director, Hasbro Children’s Hospital Eating Disorder Program
Panelist – Amy Funkenstein, MD, Attending Psychiatrist, Young Adult Behavioral Health Program, Lifespan
Panelist – Katharine Phillips, MD, Director, Body Dysmorphic Disorder Program, Rhode Island Hospital
Panelist – Barbara Morse Silva, Channel 10 Health Reporter
7:35-8:00 PM Questions and Answers: Ask the Experts
index.phpAdriana Brayman, RD, LDN, CNSC
index.phpEating Disorders in Women Identifying, Treating, Healing
Continuing the conversation started at our 2014 Annual Quality Conference, a multi-disciplinary group of providers will discuss the practicalities of recognizing the signs, providing treatment and helping to heal adult and adolescent women with eating disorders.
5:00-5:25 PM Registration, Dinner and Networking
5:25-5:30 PM Workshop Opening: Karen Rosene-Montella, MD, Chair, Women’s Health Council of RI
5:30-7:00 PM Multi-disciplinary Panel Presentation
Overview: Teri Pearlstein, MD
Diagnosis and Individual Psychotherapy: Christina Boisseau, PhD
Psychiatric Treatment: Teri Pearlstein, MD
Role of Dietitian: Adriana Brayman, RD, LDN, CNSC
Medical Complications and Inpatient Care: Abigail Donaldson, MD
Family Based Treatment: Christina Tortolani, PhD
7:00-7:30 PM Conversation with a Patient: Adriana Brayman, RD, LDN, CNSC
7:30-8:00 PM Q&A with all speakers
index.phpKaren E. Aspry, MD, MS, FNLA, FACC
Greg Salgueiro, MS, RD, LDN, CIC
index.phpHeart of a Woman: Emerging Prevention & Treatment Options
A multidisciplinary group of treatment providers discuss the unique cardiology issues for women.
5:00-5:25 PM Registration, Dinner and Networking
5:25-5:30 PM Workshop Opening
Karen Rosene-Montella, MD, FACP, Chair, Women’s Health Council of RI
5:30-5:35 PM Breathe Easy Mindfulness Exercise
Laura McPeake, MD
5:35-7:30 PM Multidisciplinary Panel Presentation
Panel Facilitator: Peg Miller, MD, FACP, Co-chair, Women’s Health Council of RI