Avik Chatterjee

Improving linguistic and cultural competence in the health sector: a medical Spanish curriculum for resident physicians

Existing medical Spanish curricula have improved language skills, but are incompatible with resident-physician schedules, and do not always integrate cultural education. A 2009 survey at our institution revealed that residents saw Spanish-speaking patients regularly and wanted a medical Spanish curriculum designed for them. Our objective was to improve medical Spanish and cultural competency among resident physicians at our institution. Kramschs (1998) principle of combining language and cultural instruction, Gardners (1983) theory of multiple intelligences, and the American Council for the Teaching of Foreign Languages 5Cs provided a framework for the self-directed curriculum, which consisted of nine-month long modules with online and in-person grammar, vocabulary, listening comprehension and conversation practice. We conducted pre-intervention, midterm and final assessments of language and cultural competency. We found moderate correlations between the number of modules completed and self-reported flu...

An innovative medical Spanish curriculum for resident doctors.

What problems were addressed? Monolingual Spanish speakers make up a large part of the US patient population and language concordance is associated with improved communication with these patients. In a local needs assessment, the majority of residents at Yale–New Haven Hospital (YNHH) noted seeing Spanish-speaking patients weekly or more often, and expressed interest in a medical Spanish curriculum designed for residents. Existing medical Spanish offerings were too inflexible and, to our knowledge, there were no rigorous medical Spanish curricula that integrated well with a traditional resident schedule. What was tried? Working with the YNHH Office of Interpreter Services and a local non-profit Latino advocacy organisation, we created a medical Spanish curriculum consisting of nine systems-based, self-directed modules (e.g. on cardiovascular or pulmonary topics). Each module required approximately 8 hours and was to be completed within a month. Residents could choose which months to participate and were allowed to take 3 months off to allow for breaks during busy rotations. The curriculum incorporated multiple learning modalities including reading, writing, listening and speaking. Each module consisted of online grammar and vocabulary activities, a chapter from a medical Spanish video, self-scheduled role-play of common patient scenarios with a bilingual volunteer, and a simulated medical counselling session with a volunteer student of English as a second language from the non-profit organisation’s office. We hypothesised that residents would be satisfied with the curriculum, which would be feasible to complete, and would show improvements in written and oral evaluation scores. To this end, residents tracked their progress and were asked to complete preand post-curriculum surveys and written and oral evaluations, as well as to attend a focus group at the end of the year. Twenty selfselected paediatrics, internal medicine and combined medicine and paediatrics residents with at least a conversational level of Spanish participated during the 2010–2011 academic year. What lessons were learned? Overall, 83% of respondents to the final survey were satisfied with the curriculum and 67% felt their medical Spanish had improved. In the survey and focus group, residents reported they had difficulty in completing all of the modules, citing time as the main barrier. The practice sessions with the student-volunteers were identified as the most helpful part of the curriculum, but were the least well attended. The sessions were off-site and required advance scheduling, which made it more difficult for residents to attend. Additionally, residents had difficulty in attending the oral evaluation sessions because of their schedules, but the mean score on the written test, which was available online and thus easier to complete, improved from 30% initially to 45% at the end of the year (the difference was nonsignificant). The only cost of the curriculum was US

Chaos, Hubbub, and Order Scale and Health Risk Behaviors in Adolescents in Los Angeles.

70 per participant for the medical Spanish video. Given the preliminary success of the curriculum, we obtained financial support from the hospital to offer the curriculum to all hospital residents and have 55 participants enrolled for the 2011–2012 year. We will use the funding to improve curricular activities, to increase the programme’s convenience for residents (e.g. by offering transportation and meals to volunteers to enable them to come to the hospital) and to create more robust participant and curricular evaluations.

Shelter-Based Opioid Treatment: Increasing Access to Addiction Treatment in a Family Shelter

OBJECTIVE To determine the relationship between household chaos and substance use, sexual activity, and violence-related risk behaviors in adolescents. STUDY DESIGN We analyzed cross-sectional data among 929 high-school students in Los Angeles who completed a 90-minute interview that assessed health behaviors and household chaos with the 14-question Chaos, Hubbub, and Order Scale (CHAOS). Using the generalized estimating equation and adjusting for personal, parental, and family covariates, we examined associations of CHAOS score with substance use, sexual activity, and violent behavior outcome variables. We also examined the role of depression and school engagement as mediators. RESULTS Mean (SD) age of the 929 students was 16.4 (1.3) years, 516 (55%) were female, and 780 (84%) were Latino. After adjustment, compared with students with CHAOS score 0, those students with the greatest scores (5-14) had ORs of 3.1 (95% CI 1.1-8.7) for smoking, 2.6 (95% CI 1.6-4.4) for drinking, 6.1 (95% CI 1.8-21) for substance use at school, and 1.9 (95% CI 1.1-3.3) for fighting in the past 12 months. Associations between CHAOS score and sexual risk and other violent behaviors were not significant. Depression and school engagement attenuated the associations. CONCLUSIONS In this group of adolescents, greatest CHAOS score was associated with increased odds of risky health behaviors, with depression and school engagement as potential mediators. In the future, CHAOS score could be measured to assess risk for such behaviors or be a target for intervention to reduce chances of engaging in these behaviors.

Maternal antenatal stress has little impact on child sleep: results from a prebirth cohort in Mexico City

The article discusses research regarding the shelter-based opioid treatment (SBOT) program which was developed by the Family Team at the Boston Health Care for the Homeless Program in 2015, and it mentions an effort to increase access to opioid addiction treatment through the utilization of a family motel-shelter in Massachusetts. According to the article, the twice-a-week outreach clinic is staffed by physicians, nurses, care managers, and behavioral health clinicians.

Student experiences with traffic-light labels at college cafeterias: a mixed methods study: Student experiences with traffic-light labels

Study objectives: Maternal antenatal stress may influence offspring development and behavior, but any association with child sleep is unknown. Methods: From 2007 to 2011, we recruited pregnant women in Mexico City to the Programming Research in Obesity, Growth, Environment, and Social Stressors prebirth cohort. Mothers completed the Perceived Stress Scale (PSS, a 4‐item questionnaire assessing past‐month stress) and the Crisis in Family Systems measure assessing negative life events (NLEs; how many domains among the 11 assessed in which the mother experienced a stressful event in the prior 6 months)—with higher scores reflecting higher stress—and provided 5 timed salivary samples per day on 2 consecutive days, from which we derived cortisol area under the curve, slope, and awakening response. At age 4‐6 years, childrens sleep was estimated using accelerometry over a 7‐day period. We performed secondary analysis of associations of antenatal maternal stress with child sleep duration and efficiency (time asleep/time in bed) using linear regression adjusted for maternal and child characteristics. Results: Among 594 mother‐child dyads, mean antenatal PSS score was 5.2 (SD = 3.2) out of 16, and mean NLE was 3.2 (SD = 2) out of 11; child sleep duration was 7.7 hours (SD = 0.7), and sleep efficiency was 79% (SD = 6). There was no association between any of the stress measures—PSS, NLE, or salivary cortisol—and sleep duration or sleep efficiency in adjusted or unadjusted models. Conclusions: Among mother‐child dyads in a Mexico City cohort, antenatal stress was not associated with important changes in child sleep at 4‐6 years.

The Family Team at Boston Healthcare for the Homeless Program: an integrated approach to care in outreach settings

To assess student perceptions of traffic‐light labels (TLLs) in college cafeterias.

Non-fatal opioid-related overdoses among adolescents in Massachusetts 2012–2014

ABSTRACT Since 1986, the Family Team at Boston Health Care for the Homeless Program has implemented an integrated, inter-professional, team-based model of care to serve families experiencing homelessness. The Family Team employs key strategies delineated by the well-established Health Care for the Homeless model, which emphasizes the importance of outreach medicine and a case management “one-stop shop approach”. We include an account of a specific case where the Family Team’s unique model helped a refugee family in Massachusetts access medical and social services otherwise more difficult to obtain. The Family Team’s onsite presence in the hotel-shelter and the team-based approach facilitated diagnosis of and successful treatment for cervical cancer in a mother of eight children. This case report suggests that the Health Care for the Homeless model of care should be more widely adopted in order to best serve homeless families. Abbreviations: Boston Health Care for the Homeless Program (BHCHP); Emergency Assistance (EA); Health Care for the Homeless (HCH); Massachusetts General Hospital (MGH)

Exploring opioid use disorder, its impact, and treatment among individuals experiencing homelessness as part of a family

BACKGROUND Opioid-related overdoses and deaths among adolescents in the United States continue to increase, but little is known about adolescents who experience opioid-related non-fatal overdose (NFOD). Our objective was to describe (1) the characteristics of adolescents aged 11-17 who experienced NFOD and (2) their receipt of medications for opioid use disorder (MOUD) in the 12 months following NFOD, compared with adults. METHODS We created a retrospective cohort using six Massachusetts state agency datasets linked at the individual level, with information on 98% of state residents. Individuals entered the cohort if they experienced NFOD between January 1, 2012 and December 31, 2014. We compared adolescents to adults experiencing NFOD, examining individual characteristics and receipt of medications for opioid use disorder (MOUD)-methadone, buprenorphine, or naltrexone. RESULTS Among 22,506 individuals who experienced NFOD during the study period, 195 (0.9%) were aged 11-17. Fifty-two percent (102/195) of adolescents were female, whereas only 38% of adults were female (P < 0.001). In the year prior to NFOD, 11% (21/195) of adolescents received a prescription opioid, compared to 43% of adults (P < 0.001), and <5% (<10/195) received any MOUD compared to 23% of adults (P < 0.001). In the 12 months after NFOD, only 8% (15/195) of adolescents received MOUD, compared to 29% of adults. CONCLUSION Among individuals experiencing NFOD, adolescents were more likely to be female and less likely to have been prescribed opioids in the year prior. Few adolescents received MOUD before or after NFOD. Non-fatal overdose is a missed opportunity for starting evidence-based treatment in adolescents.

Quality Health Care for Homeless Children: Achieving the AAP Recommendations for Care of Homeless Children and Youth

BACKGROUND Opioid Use Disorder (OUD) causes significant morbidity and mortality among people experiencing homelessness. We aimed to explore the unique way in which OUD impacts individuals experiencing homelessness as part of a family. METHODS We conducted semi-structured interviews with adults experiencing OUD staying in Boston-area family shelters along with dependent children. We used Borkans Immersion-Crystallization method to uncover themes from interview transcripts. RESULTS We conducted 14 interviews. Eleven participants identified as female and three as male. Mean age was 35 (range 24-51) and median number of children was 2.5 (range 1-5). Emergent themes fell in three categories: 1) Initiation of OUD: Many patients were introduced to opioids through physician prescriptions, with recreational use coming first for some. Parents and partners also contributed to opioid use. 2) Impact of OUD: Overdose, homelessness, and unemployment were common impacts of OUD. Many patients described co-morbid chronic pain and mental illness. Psychosocial trauma, prominently due to loss of child custody, was common. 3) Treatment for OUD: Childcare, transportation to treatment at distant sites, and requirements that interfered with life responsibilities were barriers to treatment that shelter-based opioid treatment (SBOT) allowed patients to overcome. Family unity was universally seen as motivation for treatment. CONCLUSIONS According to a sample of adults experiencing OUD in the context of family homelessness, an ideal OUD treatment program would overcome logistical barriers, provide comprehensive treatment for comorbidities, support employment and housing needs, and focus care on the family. Future work should explore the generalizability and financial feasibility of this model.