HOW CAN EMERGENCY DEPARTMENTS COLLABORATE WITH SOCIAL WELFARE INSTITUTIONS TO BETTER MEET OUR PATIENTS' HEALTH-RELATED SOCIAL NEEDS?

HEALTH ADVOCATES

Principal Investigator: Harrison Alter, M.D., M.S.

Project Directors: Dennis Hsieh, M.D., J.D., Resident, Department of Emergency Medicine; Lia Losonszy, M.D., M.P.H.,  Resident, Department of Emergency Medicine; Valerie Edwards, LCSW, Director, Department of Social Services; Rebecca Alvarado, MSW, Director, Health Advocates; Kimi Tahara, Coordinator, Health Advocates

Health Advocates is an innovative project, jointly developed by the Levitt Center and the Alameda Health System, that aims to enhance our capacity to meet the resource and legal needs of our patients from a perspective that recognizes the critical importance of social and economic determinants of health. Our goal is to improve the health of low-income patients, enhance the patient experience, increase access to primary care, and ultimately reduce emergency room utilization, inpatient hospitalization, and health care costs. The project brings together student volunteers, social workers, and lawyers to provide a continuum of care for our patients’ social, economic, and legal needs that allows each patient advocate to work at the top of his or her license.

 This project has its roots in the creative resource desk model of Health Leads as well as the Medical-Legal Partnership (MLP) model. Health Leads is a non-profit organization that mobilizes the volunteer power of college students to connect patients with community services that are critical to health and well-being.

The other component of this project is our medical-legal partnership with the East Bay Community Law Center, in collaboration from Centro Legal and Bay Are Legal Aid. MLPs help to bridge the gap that often exists between a patient’s medical recovery in the hospital and barriers to health that exist in the home environment. Legal needs that directly impact health include access to public benefits, housing subsidies, sanitary housing conditions, discrimination in employment and education, legal asylum, and domestic violence. 

The creation of Health Advocates incorporating both a Health Leads model and a medical-legal partnership with our existing social work staff at Highland has improved patient care, addresses social and economic determinants of health, and reduces overall healthcare costs.  The project opened in January 2013 with a focus on the Emergency Department and the HOPE clinic.  We quickly expanded to 7 desks throughout the Alameda Health System. 


STOP TRAFFICKING NOW: ENDING THE COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN

Project Director: Hillary Larkin, PA-C

Principal Investigator: Harrison Alter, MS, MD 

The Levitt Center is actively engaged with other agencies in the Bay Area, particularly the HEAT (Human Exploitation And Trafficking) Watch initiative, to fashion a coordinated response by the medical community for trafficked children.  We are also working with researchers at UCSF, Stanford and UC Berkeley to understand better what are the needs of this most vulnerable group, and how the emergency care system might respond to these needs.

In addition, in 2015 Dr. Alter was named to the HEAT Institute, a statewide blue-ribbon commission exploring California's response to the scourge of modern slavery.  The commission completed hearings in mid-2016 and the Institute will complete its first report to the governor and the legislature with the year.


EVALUATION OF A TABLET-BASED DOMESTIC VIOLENCE REPORTING AND REFERRAL TOOL

Project Directors: Hilary Larkin, PA-C; Dana Kelly, PA-C, MPH

Funder: Alameda County Family Justice Center

The Levitt Center is spearheading a formative and summative evaluation of a novel tablet-based application, the Domestic Violence Reporting and Referral tool, in conjunction with the Alameda County Family Justice Center. The tool is designed to fulfill California providers' mandatory reporting duty while simultaneous uploading reports to officials in law enforcement, prosecutors and advocates. 


PRIOR PROJECTS:

EFFECTS OF RACIAL SEGREGATION ON NEIGHBORHOOD VIOLENT INJURY RATES

Project Director: Josh Berezin

Principal Investigator: Harrison Alter, MS, MD 

African Americans and Hispanics experience higher rates of violent injury and death than Whites. In 2004, homicide was the 21st leading cause of death for non-Hispanic Whites of all ages, but the 6th and 7th for African Americans and Hispanics respectively.  This disparity is particularly pronounced for young males. For example, among causes of death in males 20-24 years old, homicide accounted for 48.4% of deaths among African Americans, 25% of deaths among Hispanics, and 9.7% of deaths among Whites.

In attempting to explain these disparities, some scholars have examined the role of housing discrimination and its effect on communities. The United States has a long and ignominious history of racial residential segregation, which Douglas Massey defines as the “degree to which two or more groups live separately from one another, in different parts of the urban environment.”

A researcher associated with the Levitt Center, Josh Berezin, working with colleagues at UC Berkeley, performed a cross-sectional, ecological, neighborhood-level study of the relationship between diversity and violent injury in Oakland, California.  The methods involved determining the number of injuries in Oakland block groups, calculating a measure of diversity for those block groups, and analysis of the data.

Berezin and his co-investigators found that in block groups with at least one violent injury had a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.22; 95% CI 0.10 – 0.48). They found a similar relationship for predominantly African American block groups (IRR 0.23; 95% CI 0.083 – 0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI 0.01 – 0.76).  Diversity was not significantly associated with violent injury in predominantly White or Asian block groups.