The CBUHP is home to an array of educational programs, the hallmark of which is the Master of Arts in Urban Bioethics (MAUB). Students pursue the MAUB because they are currently confronting, or anticipate confronting, extreme inequities of health and access to medical, legal, and other resources that are prevalent in our urban context of density, diversity, and disparities. The MAUB program provides not only a solid foundation in traditional bioethics, but practical training and resources for understanding and analyzing the ethics, values, and value conflicts relevant to the urban setting.
MAUB students represent a variety of disciplines and professions. About half of our students are dual degree students (currently we offer dual degrees with programs in the Lewis Katz School of Medicine and the College of Public Health), and half are physicians or staff from the Temple University Health System.
The MAUB Core Faculty are: Dr. Nora Jones, directs the MA in Urban Bioethics and the associated Graduate Certificate in Urban Bioethics and is the course director for the introductory seminars; Dr. Norma Alicea-Alvarez, who leads our community engagment course; Dr. Kathleen Reeves, faculty for the introductory seminars; and Dr. William Aaronson, who teaches our health economics and policy course. Dr. Matthew Lucas manages the graduate programs and offers support in the introductory seminars.
In addition, our faculty and staff lend their expertise and instruction throughout Temple University. Dr. Jones teaches bioethics-related courses for the Doctor of Physical Therapy program, at the Dental School, with oral surgery residents, with graduate programs in the Colleges of Liberal Arts and Public Health, and with medical students at the Katz School of Medicine. Dr. Reeves provides instruction for medical students at the Katz School of Medicine. Dr. Lucas teaches both undergraduate and graduate students in the Department of Philosophy.
Temple University’s Grand-Aides program is a collaborative venture with the Grand-Aides Foundation based in Houston, which has developed and implemented a model to improve health care delivery by using trained community members, or “Grand-Aides.” These individuals visit patients and families in their homes to address medical issues, improve health care quality, and help to prevent unnecessary use of health services.
The “Grand-Aides” follow algorithms of care and report to nurse supervisors for oversight and management. They are in contact with the nurses through electronic media, using tablet computers and telecommunications applications such as Skype. We have implemented this model during the hospital discharge period to reduce readmission of patients with congestive heart failure (CHF).
Our primary research question at Temple is: do patients in the Grand-Aides program after hospitalization for CHF have lower rates of re-hospitalization and emergency room care during the first 30, 90, and 180 days after discharge than similar patients who do not participate?
This model is distinct because it involves: (1) direct and frequent in-home, personal contact between the Grand-Aide and patients, and (2) the use of treatment algorithms that allow relatively low-cost Grand-Aides to collect and share pertinent data through telemedicine with the nurses. We are testing this model for reduction in health costs as well as improvement in patient adherence, post-discharge monitoring, patient satisfaction, and quality of care. All of our manualized procedures, protocols, training, and outcomes assessments conform to the Grand-Aides Foundation protocols and we are in continual contact with the program’s developers about protocol implementation and data collection.
The Grand-Aides program has four goals at Temple. These are to provide access to appropriate health care for primary and chronic care while freeing professionals to do what only they can do; to reduce congestion in emergency departments, clinics, and hospitals by caring for people at home, resulting in improved access for those who need to be seen elsewhere; to educate patients in preventing secondary complications and in self-care; and to “bend the cost curve” with more affordable care.
Helping Hurt People
Healing Hurt People (HHP) is the cornerstone project of the Center for Nonviolence and Social Justice, based out of the Drexel University School of Public Health. HHP is a community-focused, hospital-based program designed to reduce reinjury and retaliation among youth ages 8-30. The program was initiated by the Emergency Department at Hahnemann University Hospital and the Drexel University College of Medicine. It has since expanded to St. Christopher's Hospital for Children, and we are now establishing a site at Temple University Hospital.
HHP works with clients who are seen in an emergency department for intentional injuries (gunshot, stab, or assault wounds). Often, individuals who have been violently injured have reported that while in the emergency department, their thoughts are to either change their way of life or to retaliate. Most often these youth return, without any supports, to the hostile environment in which they were injured. Healing Hurt People uses a trauma-informed approach to capitalize on this potentially life-changing moment and address the needs of these youth by providing connection to resources such as:
emotional support for post-traumatic stress
working with schools to help students affected by school violence
substance abuse treatment
after-school program referral
job training and placement
parenting education and support
Through the Healing Hurt People program, a prototype for other level 1 trauma centers in urban settings may emerge so that victims of violence may heal in a comprehensive and compassionate manner. In this way, a “Best Practice” model may be developed that outlines the approach and steps to creating similar programs across the country.
Medical Narratives and Urban Health
As a result of a long standing partnership with Asociación Puertorriqueños en Marcha (Association of Puerto Ricans on March, APM), the Center for Bioethics, Urban Health, and Policy will employ a Medical Narrative (personal stories) model among the Latino and African American community within APM’s catchment area. The purpose of this project is to gather data to address and identify accessibility and barriers to care, health, disease management, and the effects of social determinants of health (SDoH).
North Philadelphia residents are negatively impacted by SDoH, the physical and social environment where they live, work and interact with each other. Residents living in dense, complex, urban communities face social, economic, language, and transportation barriers contributing to their psychological, emotional, and mental health. In North Philadelphia, residents experience disparate care related to their SDoH as evidenced by 32% of African American and 42% Latino residents live in poverty compared with the national percentage of 7.4%. Differences in SDoH result in disparities in health amongst racial and ethnic minorities and lead to lower quality of health services, lower likelihood of receiving routine medical procedures, lower chance of having care guided by consensus guidelines, significantly higher rates of chronic disease, higher rates of emergency room visits, higher number of admissions, and a higher rate of preterm births.
We will document Medical Narratives from community members regarding SDoH and potential issues related to redevelopment. The data collected will act to provide information and highlight the health care needs identified by and for this community. Together with APM, this project secured funding from the City of Philadelphia ‘Call of Ideas’ Awards and a Local Initiative Support Corporation (LISC) Implementation grant: The Creative Placemaking Project. Both grants support the Medical Narratives project to begin January 2016 through December 2016.
For further information, please contact Dr. Norma Alicea-Alvarez.
Obesity in Children with Disabilities
Children with developmental disabilities engage in less physical activity than typically-developing peers, although exercise and activity are well-known key aspects of successful weight management programs for youths as well as adults.
A successful approach to healthy lifestyles for children with disabilities needs to involve family members. In our earlier survey of parents of children with developmental disabilities, less than 20% were “definitely satisfied” with available opportunities while clearly recognizing their importance. Thus this NIH-funded study (R03 HD076588) focuses on physical activity as a critical element in reducing obesity risk, and assumes that improving children’s opportunities for physical activity can be the “hook” for education about diet, nutrition, and the need to reduce sedentary activity, all important aspects of achieving and maintaining healthy weight. Our community partner is United Cerebral Palsy of Central Pennsylvania.
We are now conducting the first stage: A systematic survey of parents’ perceptions of and interest in facilitating their children’s participation in exercise and sports. In later stages, we will ask youths of various ages and with varying functional limitations about their preferences for various activities, which are too often not taken into account. After confirming potential sites, trainers and mentors in the community, we will then evaluate several sustainable pilot programs that we implement based on the earlier information we collect.
Please click here to view our presentation to the National Institutes of Health’s invited conference on “Lessons Learned: Engaging Diverse Communities in Obesity Research,” reporting on our community-academic partnership and our earlier R13 conference networking grant that led to the current project.
For further information, please contact Dr. Mary Segal.
STEP UP in Health-Related Research
The Short Term Education Program for Undergraduate and Predoctoral students (STEP UP) in Health-related Research is designed to offer research training to academically qualified underrepresented students. The research training focuses in the areas of interest to the National Heart, Lung and Blood Institute (NHLBI) and is housed in the multidisciplinary research environment at Lewis Katz School of Medicine at Temple University.
The primary objective of STEP UP is to offer a rewarding experience in the research environment to minority students in the areas of interest to the NHLBI to foster a long-term commitment to pursue a professional graduate career.
STEP UP provides students with: 1) direct exposure to biomedical research via hands-on experience while working on a project in the areas of hematology and cardiovascular research; 2) productive interaction with the mentors, postdoctoral fellows and graduate students; 3) information on biomedical careers; 4) guidance in choosing multiples pathways leading to a biomedical research career; and 5) information on the health-related research network. The students will work in the laboratories of the mentors for 8-weeks during the summer and will be given the opportunity to continue their training in consecutive years.
The project has been continuously funded by the National Institutes of Health NHLBI since 2009 (R25HL096331).
CBUHP Intern Diana Huang took the lead in developing a science and health elective for the new Philadelphia public school Building 21. The first run of the course went from January 5 through March 17, 2015.
Ms. Huang, between her 2nd and 3rd years of medical school, recruited the help of other medical students, and she will have performed 100 hours of STEM (science, technology, engineering, and medicine) education with this school in Spring 2015. While a teacher partners with her, generally Ms. Huang is in front of the classroom.
Course topics include anatomy, physiology, microbiology, first aid and CPR, exercise and nutrition, common illnesses and treatments, research, and health advocacy and each topic is presented in an interactive learning environment. The experience also includes field trips to Katz School of Medicine and Temple University Hospital, which Temple faculty have helped to facilitate. They will also learn about all the different careers that are available in health care. At the end of the course the students will present a project centered on a specific disease or health career.
Nationally, homicide is the second leading cause of death among individuals ages 15 to 19. In Philadelphia it is the leading cause.
In 2008, there were 179 homicides committed against youth ages 7 to 24 in Philadelphia—a 20% increase over the previous year. Nearly all these deaths were attributed to shootings. More young people are the perpetrators of gun violence as well. In 2008, roughly two-thirds of shooting offenders in Philadelphia were between the ages of 14 and 24.
Originally developed in Chicago, CeaseFire is a violence intervention based on the premise that violence is a public health issue and can be prevented. Based in Temple’s Center for Bioethics, Urban Health, and Policy (CBUHP), Philadelphia CeaseFire duplicates the evidence-based methodology of the CeaseFire Chicago public health model, focusing its efforts in the 22nd Police District of North Philadelphia. In 2009, the 22nd Police District had the highest number of shootings in the city. In addition, the number and rate of shootings for youth ages 14 to 25 years was the highest in Philadelphia.
22nd Police District (click map to enlarge)
CeaseFire’s approach includes efforts to heighten community awareness about gun violence and encourage area residents, community, business and faith-based leaders to work together and get involved. CeaseFire uses the five core components of the Chicago model:
Criminal justice participation
Philadelphia CeaseFire is directed by Marla Davis-Bellamy.