Social Work and Public Health: A Natural Alliance

Amy DeGroff, PhD, MPH Division of Cancer Prevention and Control Centers for Disease Control & Prevention

National Association of Deans and Directors School of Social Work Conference October 26, 2011

Ida Cannon

CDC applies a Public Health Approach to Cancer

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Monitoring and surveillance

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Applied Research and Evaluation

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Underserved populations

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Education and outreach

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Improving infrastructure

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Quality of life for cancer survivors

CDC’s Role in Cancer Prevention and Control

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Provide national leadership in comprehensive public health approaches to cancer issues, including:

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Monitoring and surveillance Policy, systems, environmental change strategies Underserved and disparate populations Public education and outreach Clinical preventive services Improving infrastructure Improving quality of life for cancer survivors

CDC’s Vital Signs

Inaugural Issue Focus: Cancer Screening

Evidence-Based Clinical Preventive Services for Cancer

Screen for Life

 Aims to educate persons aged 50+ about the importance of regular CRC screening  Targeted to Medicare recipients, African Americans, Hispanics and Health Professionals  SFL materials adaptable to State and Local needs

Inside Knowledge

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Get the Facts About Gynecologic Cancer

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CDC conducted formative research, concept and material testing

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Campaign features ‘real’ women

 Emphasis on women who have survived or had a personal connection to gynecological cancer

Prevention Research Centers Program Thematic Networks

Cancer Prevention and Control Research Network (CPCRN)  Mission: Accelerate the adoption of evidence based cancer prevention and control in communities  Funded by CDC and National Cancer Institute

CPCRN Strengths

 Advancing public health science for implementation and translation research   Building strong community partnerships Focusing on underserved populations    geographic outreach Research focus that complements NCI & CDC priorities Infrastructure funding provides impetus to focus beyond discovery and be opportunistic

PI’s Michelle Kegler, DrPH Jennifer Allen, ScD, MPH, RN Marcia Ory, PhD, MPH Betsy Risendahl, PhD Roshan Bastani, PhD James Hebert, ScD, MSPH Cathy Melvin, PhD Kurt Ribisl, PhD (Coord Ctr) Maria Fernandez, PhD Vicky Taylor, MD, MPH Matthew Kreuter, PhD, MPH

CPCRN Map

Patient Navigation Study for Colonoscopy Screening

Defining Patient Navigation Across Cancer Continuum

 Patient-focused intervention intended to eliminate barriers to cancer screening, timely diagnosis, treatment, and survivorship  Emphasis on reducing health disparities through improved health care access and quality for medically underserved populations  PN used in other areas of public health, including other chronic diseases

Some Principles of Patient Navigation

    Patient-centric healthcare service delivery model Core function to eliminate barriers to timely care across cancer continuum PN serves to integrate a fragmented healthcare system for the individual patient PN often involves navigating patients across disconnected systems of care including primary care, specialty care, and tertiary care sites Freeman, HP, Rodriguez, RL. History and principles of patient navigation. Cancer. 2011;117(15 suppl):3539 3542

Momentum!

     Harold P. Freeman – Harlem Hospital (1990) 2005 Patient Navigation Outreach and Chronic Disease Prevention Act (reauthorized in ACA) 2010 Patient Protection and Affordable Care Act (ACA) 2011 National Prevention and Health Promotion Strategy (required by ACA) 2011 American College of Surgeon’s Commission on Cancer  2010 National Patient Navigation Leadership Summit, American Cancer Society

CDC Partners Working in Cancer-Related Patient Navigation

     American Cancer Society (ACS) Centers for Medicare and Medicaid Services (CMS) Health Resource & Service Administration (HRSA) National Cancer Institute (NCI) Academic and non-profit partners

Cancer,

Supplement to Cancer, National Patient Navigation Leadership Summit, Vol. 117, Issue 15, August 1, 2011

Colorectal Cancer Screening

 National colorectal cancer screening rates low – 65.4% (all screening tests combined)*   Extensive barriers to screening documented Colonoscopy is a complex screening procedure *Richardson LC, Tai E, Rim SH, Joseph D, Plescia M. Vital signs: Colorectal cancer screening, incidence, and mortality – United States, 2002-2010.

Morbidity and Mortality Weekly Report.

2011;60(26):884-889. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a4.htm?s_cid=mm6026a4_w. Accessed 10/20/11.

Patient Navigation Models

  Emerging evidence-base for PN in cancer* PN models vary  Multi-disciplinary team developed intervention model  Public health 

Oncology social work

 Clinical oncology   Evaluation Behavioral health research *Paskett, et al. 2011. Patient Navigation: An Update on the State of the Science. CA: Cancer J Clin.

Patient Navigation Research Intervention Model

    Patient-focused, barrier-focused Theory-based   Socio-ecological approach Individual-level behavioral theories Removing cultural, environmental/structural, and health care system barriers will support colorectal cancer screening adherence Theories suggest that changes in knowledge, attitudes, beliefs, intentions, and self-efficacy precede individual level behavior change

Primary Outcomes of Interest

 Individual/Intrapersonal-level outcomes    Improved adherence to colonoscopy screening Improved quality of bowel prep Patient satisfaction  Systems-level outcomes     Increased screening rate for referring primary care clinic Reduced number of “no-shows” for colonoscopy appointments Reduced time from screening referral to completion Provider satisfaction

Patient Navigation Study Design and Setting

 RCT (825 patients)  Treatment group – patient navigation  Control – usual care  Boston Medical Center (BMC)    Teaching hospital for BU Medical School Largest safety net hospital in New England Patients recruited from Internal Medicine (referred for colonoscopy)

Opportunities for Evaluators at CDC

    Evaluation is a multidisciplinary field Social scientists with strong methodological skills (quantitative, qualitative, mixed methods) New CDC fellowship program for PhD-level evaluators Practicum or Internships??

Social Work and Public Health: A Natural Alliance

    Shared commitment to social justice and reduced disparities  Social determinants of health ≈ The person in-environment Work within social ecological models Work in community and clinic settings Theoretical complementarity

Contact Information

Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion CDC

Amy DeGroff, PhD, MPH

[email protected]

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of CDC or ATSDR

Thank You!