Social Work and Public Health: A Natural Alliance

Amy DeGroff, PhD, MPHDivision 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

Monitoring and surveillance

Applied Research and Evaluation

Underserved populations

Education and outreach

Improving infrastructure

Quality of life for cancer survivors

CDC’s Role in Cancer Prevention and Control

Provide national leadership in comprehensive public health approaches to cancer issues, including: 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 SignsInaugural Issue Focus: Cancer Screening

Evidence-Based Clinical Preventive Services for Cancer

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

Screen for Life

Inside Knowledge: Get the Facts About Gynecologic

Cancer CDC conducted formative research, concept

and material testing Campaign features ‘real’ women

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

Prevention Research Centers Program

Thematic NetworksCancer 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

Betsy Risendahl, PhD

Roshan Bastani, PhD

Cathy Melvin, PhDKurt Ribisl, PhD (Coord Ctr)

Maria Fernandez, PhD

Vicky Taylor, MD, MPH

Matthew Kreuter, PhD, MPH

Marcia Ory, PhD, MPH

James Hebert, ScD, MSPH

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 NavigationResearch 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 StudyDesign 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 ControlNational Center for Chronic Disease Prevention and

Health PromotionCDC

Amy DeGroff, PhD, MPHadegroff@cdc.gov

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!