News & Updates - 2019 In Review
CareZONE Mobile Health Program - 2 Years on the Street
Photo credit: Dr. Joe Wright via Twitter 12-3-19 @JoeWrightMD

It has been a busy and exciting 2019 for CareZONE, The Kraft Center's mobile addiction program in partnership with the Boston Health Care for the Homeless Program, Boston Public Health Commission's AHOPE program, and the GE Foundation. CareZONE is the first program under The Kraft Center's Community Care in Reach initiative that aims to expand access to addiction services through mobile health. In January, the program will celebrate 2 years in service! Since its launch in January 2018, the program has provided critical, clinical and outreach services to thousands of people and has promoted equitable access to addiction treatment for vulnerable populations in Boston.  

The program now offers clinical services in the Downtown Crossing, Nubian Square, West End, and Fenway neighborhoods. Many thanks to all of our community partners across the City for making the program so successful, to the clinicians and harm reduction specialists who offer compassionate care on the van, and to the generous contributions of Mr. Robert Kraft, The Kraft Family Foundation, The GE Foundation, and RIZE Massachusetts for making our program possible.

CareZONE Youth and Young Adult Pilot Program

Meet our CareZONE Youth and Young Adult team! Left to right: Nurse Practitioner Nebulla Stephen, Dr. Aura Obando, and Harm Reduction Specialist Isabel Plakas.

This fall, we launched a pilot program in partnership with The Grayken Center for Addiction Medicine at Boston Medical Center, Boston Health Care for the Homeless Program, and Bridge Over Troubled Waters to increase access to addiction services for youth and young adults (YYA) in Boston. Research shows that the YYA population is especially at high risk of not receiving addiction treatment.  After community engagement and a comprehensive needs assessment, the team has begun offering weekly evening sessions in Downtown Boston. As with our adult-oriented CareZONE program, we've brought the very best clinical and outreach team together with vast experience working with adolescents and young adults. In 2020, we will evaluate the program to gain a better understanding of the need and impact of the services for this population.

Addiction Medicine Fellows Join CareZONE Staff

2019 saw some new additions to our CareZONE team. Among them are two clinicians in the Massachusetts General Hospital (MGH) and Boston Medical Center (BMC) Addiction Medicine Fellowship program.

Dinah Applewhite, MD
Dr. Dinah Applewhite is an Internal Medicine physician currently completing her Addiction Medicine Fellowship at MGH. Dr. Applewhite has experience in mobile programming for homeless LGBT youth and volunteering in a mobile wound-care clinic. She is now thrilled to be providing medical care on the CareZONE van, and is constantly learning from, and inspired by, the AHOPE outreach team and the patients they serve. 

David Kispert, MD
Dr. Dave Kispert is an Internal Medicine physician currently completing his Addiction Medicine Fellowship at BMC. Dr. Kispert completed his residency program in Portland, Maine where he was first introduced to harm reduction programs. Now in Boston, he is excited to be a part of the CareZone team working to downshift stigma and accelerate compassionate care to our City's most vulnerable patients.

Former CareZONE Physician Joins Doctors Without Borders

Gabriel Wishik, MD
While we are excited about recent staff additions, we were sad to say goodbye to Dr. Gabriel Wishik, one of the CareZONE van's first clinicians, who moved to Maputo, Mozambique in October to begin his work with Doctors Without Borders. Dr. Wishik will be working to expand access to care for people who use drugs and for sex workers. We thank Dr. Wishik for all of his amazing work. We will miss him greatly, but wish him the best on his new journey. Doctors Without Borders is certainly lucky to have him!


CareZONE in the Media and Notable Visitors

The success of the CareZONE program has garnered statewide and national interest.  On June 12, Care ZONE was featured in a story by WBUR entitled  "The Van Vs. An Opioid Addiction: Taking Treatment To The Streets." The segment was later aired nationally on NPR's Here & Now program on August 22.  WBUR also ran a story on October 10 entitled "Boston Is Using A Chemical Warfare Device To Help Fight Fentanyl," that highlights a drug checking pilot run by our partners at AHOPE and funded by RIZE Massachusetts.

Left: U.S. Congressman Joe Kennedy III boards the CareZONE van; Right: City Councilor Annissa Essaibi-George with CareZONE staff.

We have also had several notable visitors to the van to meet with our amazing team and to tour the mobile unit. Visitors have included Marylou Sudders, Secretary of Health and Human Services for Massachusetts; Joe Kennedy III, U.S. Congressman of Massachusetts; Annissa Essaibi-George, Boston City Councilor At-Large; Jay Ash, President & CEO of Massachusetts Competitive Partnership; Dr. Matilde Castiel, Commissioner of Health and Human Services for Worcester; as well as visitors from our colleagues at The Kraft Family Foundation and The GE Foundation.

MA Department of Public Health To Expand Mobile Addiction Services - Robert Kraft Donates Vehicles in Support

In 2019, CareZONE was featured as a best practice by the Massachusetts Harm Reduction Commission Report  and in November, the Massachusetts Department of Public Health (MDPH) released a request for applications to expand mobile addiction services across the Commonwealth. Robert K. Kraft, Chairman of The Kraft Family Foundation, is generously donating up to two mobile medical units to support the efforts of agencies who receive MDPH funding to expand mobile addiction services. We are thrilled to see the expansion of programs that replicate the Community Care in Reach model and look forward to supporting other agencies in their efforts to expand access to addiction services.
Kraft Center Awarded $7 Million National Cancer Institute Grant to Expand Cancer Care Equity Work

The Kraft Center, in partnership with the Harvard T. H. Chan School of Public Health (HSPH), has been awarded $7 million from the National Cancer Institute to expand its cancer care equity work statewide. This five-year award, funded through the federal 21st Century Cures Act, will support broad dissemination of proven-effective interventions for cancer screening and prevention in community health centers in Massachusetts.
 
Building off the success of The Trefler Cancer Care Equity Grants program, this new grant will allow for the development of an Implementation Laboratory (I-Lab) of community health centers across Massachusetts, enable a range of studies on the adoption and implementation of cancer prevention and control strategies, and allow for rapid-cycle testing of innovative approaches in settings that serve populations with health disparities. The effort will be led by Kraft Center executive director, Dr. Elsie Taveras, as well as Dr.  Karen Emmons , professor of social and behavioral sciences at Harvard Chan.

While there are disparities in outcomes for patients with all types of cancers, they are far more prevalent in preventable cancers such as cervical, lung, and colorectal, Dr. Emmons said. "There's a pattern that occurs over and over again. When an early detection or prevention strategy such as colonoscopy is developed, there is less uptake in settings that serve more vulnerable populations, and then we start to see differences in cancer outcomes by characteristics like race, ethnicity, and income." Through the new initiative the team hopes to identify strategies that will help community health centers identify and address barriers to care.

Reebok Campaign Supports Kraft Center Cancer Care Equity Program
 
From October 10-31, Reebok launched a fundraising campaign in support of the Kraft Center's Cancer Care Equity programming. With each purchase of the Nano 9 Fight Like Hell, Reebok donated 10% of the proceeds to The Kraft Center to support efforts to improve cancer screening and care for underserved populations through innovative programming, research, and implementation of proven-effective strategies in community health centers. We are grateful for Reebok's support in helping to create healthier communities.  
Mobile Addiction Services Convening in November, 2019
Julie Burns, Executive Director of RIZE Massachusetts Foundation, welcomes attendees.

On November 13, The Kraft Center, in partnership with RIZE Massachusetts Foundation, hosted its second Mobile Addiction Services Convening for Massachusetts agencies interested in providing mobile services. During this meeting, Dr. Jessie Gaeta previewed The Kraft Center's upcoming Mobile Addiction Services Toolkit which provides a comprehensive overview of how to launch and operate a mobile addiction program. To access the toolkit, please click here. Attendees also participated in a workshop with the FrameWorks Institute to discuss strategies for creating a culture of harm reduction across the Commonwealth.
Trefler Cancer Care Equity Program - Project Updates
Community Engagement and Education in Boston-area Community Health Centers 

Dr. Naomi Ko gives a lecture on breast cancer
Led by Dr. Naomi Ko of Boston Medical Center (BMC), this project has promoted interactions and collaboration between patients' trusted community health providers and their cancer care teams. Dr. Ko has established a network of physicians and has developed a community dialogue through a formal lecture series focused on what the primary care physician may need to know about cancer screening and treatment options. In 2020, the team will offer ten lectures in two new Boston-area community health centers. 

Decreasing Financial Burden of Clinical Trial Participation 

This project, led by Dr. Beverly Moy, has reduced barriers to participation in clinical trials for underrepresented populations including uninsured and racial/ethnic minority patients.  Expense reimbursements through the project have significantly reduced travel- and lodging-related financial burdens and findings have been published in  The Oncologist  and can be accessed  here . Moving forward, the team plans to conduct detailed analysis of financial burden of phase 1 clinical trails, emergency department utilization among clinical trial participants, and referrals to palliative care.

Promoting Equity in Cancer Care for Individuals with Serious Mental Illness: The Collaborative Care & Community Engagement Program 

Dr. Kelly Irwin presents at a recent Bridging the Divide Symposium
Dr. Kelly Irwin, a psychiatrist at Mass General, has worked to eliminate barriers and increase access to essential cancer care for individuals living with serious mental illness. In 2019, the program has worked with >50 patients, caregivers, and community based providers to help deliver evidence-based interventions and case management informed by the collaborative care model. This spring, Dr. Irwin also helped organize and host the  3rd Annual Bridging the Divide: Mental Health and Cancer Care Symposium. P articipants interacted with national experts, heard narratives from people with lived experience and joined panel discussions on caregiving, palliative care, and developing teams that meet people where they are.  Don't forget to also s ave the date for the 2020 Bridging the Divide Symposium on April 17, 2020. All are welcome!

Trefler Cancer Care Equity Grantees Wrap Up Projects

Trefler Cancer Care Equity Grant Program recipients meet to discuss pilot project outcomes Nov. 22, 2019

In the fall of 2018, The Kraft Center, in partnership with the MGH Cancer Center and with generous funding from The Trefler Foundation, launched The Trefler Cancer Care Equity Grants program  to provide pilot funding to collaborative teams in Greater Boston area community health centers. These grants enabled community health centers to implement innovative, sustainable strategies to eliminate barriers to cancer screening and treatment for underserved populations. On November 22, grantees met with Kraft Center and MGH Cancer Center staff to discuss project outcomes and sustainability.

Codman Square Health Center
  • Codman Square Health Center's project worked to improve colorectal cancer screening and narrow the disparities in screening rates at their health center using an automated text message platform called CareMessage. 
  • Over the course of this project, screening rates from colorectal cancer have increased from 50.2% to 65.3%, 4th highest in the state compared to other health centers using the Azara DRVS network.
Charles River Community Health 
  • Charles River Community Health used the CareMessage platform to connect with high-risk patients and reduce their barriers to screening and treatment protocols for breast and cervical cancer. 
  • After conducting focus groups with patients, staff sent informational texts to 424 women identified as in need of mammography, and scheduled appointments with 29 women who responded.
The Dimock Center   
  • The Dimock Center's project worked to improve screening for endometrial and cervical cancer by (1) creating systematic workflows to ensure all eligible OB/GYN patients are offered HPV vaccination; (2) developing a targeted motivational interviewing protocol for patients with concerns about the HPV vaccines; (3) training staff to do on-site colposcopies; and (4) rolling out automated appointment reminders.
  • Through training and equipment upgrades, Dimock has increased their capacity to provide in-house screening procedures. For example, the number of colposcopies conducted per month rose from 3 in December 2018 to 11 in February 2019.
$250,000 Grant from Trefler Foundation To Fund
Virtual Equity Hub for Cancer Treatment

With $250,000 in funding from The Trefler Foundation, The Kraft Center and the MGH Cancer Center will develop the Virtual Equity Hub for Cancer Treatment, a technical assistance and clinical consultative center within Massachusetts General Hospital to  increase access to cancer treatment, clinical trials, and supportive care for underserved patients with complex needs. The center will combine telehealth technology with person-centered engagement across the cancer continuum with the goal of providing timely, person-centered care to all people at risk for or diagnosed with cancer.  Many thanks to the generosity of The Trefler Foundation who for years have supported and championed cancer care equity. We look forward to our continued partnership to improve cancer care and outcomes for patients across the state!
Kraft Center Hosts Health Career Connection Summer Intern
Keeping with the our tradition of community health training and education, The Kraft Center hosted a summer intern from the Health Career Connections program.  Annabelle Aguirre is a student at Emmanuel College and an alumna of the Massachusetts General Hospital (MGH) Youth Scholars Program. She worked on multiple community health projects across The Kraft Center this summer. Annabelle assisted in evaluating   the implementation of the Build Our Kids' Success program in Revere, MA and  helped with the planning and development of the CareZONE mobile health expansion to youth and young adults, community engagement campaigns, and communications initiatives. 
Updates from Kraft Center Alumni
Alums Genevieve Daftary & Kimberly Montez at AAP National Conference & Exhibition in Oct. 2019

Current and former participants in The Kraft Fellowship and Practitioner Programs continue to leave their impressive mark on the field of Community Health. Below are highlights of their work, including notable publications, career moves, and other personal news.    We encourage all Kraft Center alumni to send us updates by emailing  cregis1@mgh.harvard.edu   .

Erica Mintzer, MD: Erica has assumed her role as Medical Director at Cambridge Health Alliance (CHA) Malden Family Medicine Center (MFMC). She is also a current Linde Fellow in Primary Care Leadership working on standardizing group visit support at MFMC and CHA. Congratulations, Erica!

Selected Recent Publications:

Benjamin Bearnot, MD, MPH:
Access to Treatment for Drug Use Disorders at US Health Centers: a National Study. Journal of General Internal Medicine, May 2019.

Alcohol Availability Across Neighborhoods in Ontario Following Alcohol Sales Deregulation, 2013-2017. American Journal of Public Health, June 2019.

Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study. Journal of Substance Abuse Treatment, July 2019.

Smoking status and quit behaviors among health center patients with substance use disorders: A national study. Drug and Alcohol Dependence, September 2019.

Alex Keuroghlian, MD, MPH:
Required sexual orientation and gender identity reporting by U.S. health centers: First-year data. American Journal of Public Health, April 2019.

Psychological  Attempts to Change a Person's Gender Identity From Transgender to Cisgender: Estimated Prevalence Across US States, 2015.  American Journal of Public Health, October 2019.

Association Between  Recalled  Exposure to  Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry, September 2019.

Affirming  Gender  Identity of  Patients With  Serious  Mental Illness. Psychiatric Services, October 2019.

Meeting the  Behavioral  Health  Needs of  LGBT  Older Adults. Journal of the American Geriatrics Society, May 2019.

Leah Zallman, MD, MPH:
Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care. JAMA Pediatrics, July 2019.
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