Biomedical subjects

Richard Lichtenstein

Publications and source records attributed to Richard Lichtenstein.

10 recordsLinked to original sources

PubMed2006

Drawing from Freirian empowerment methods to develop and use innovative learning maps: increasing enrollment of uninsured children on Detroit's eastside.

In 2001, virtually every child on Detroit's eastside was eligible for health coverage, yet approximately 3,000 children remained uninsured. The primary aim of the Eastside Access Partnership (EAP), a community-based participatory research collaboration, was to increase enrollment of uninsured children in state programs. To achieve this aim, one of the approaches that EAP is using is the innovative Learning Map titled Choosing the Healthy Path, which was developed in collaboration with Root Learning, Inc. Although Learning Maps were originally developed to assist corporations in implementing strategic change, their integration of visualization and interactive dialogue incorporates Freirian principles of empowerment education, making them a viable option for providing meaningful learning opportunities for community residents. This article presents the collaborative process involving the University of Michigan, local community-based organizations, community members, and Root Learning consultants to develop a visual map that enables community residents to understand and overcome the barriers that prevent them from obtaining health insurance for their children.

Adolescent↗

PubMed2006

Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle Urban Research Centers.

In order to address the social, physical and economic determinants of urban health, researchers, public health practitioners, and community members have turned to more comprehensive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received considerable attention over the past decade, and numerous publications have described theoretical underpinnings, values, principles and practice. Issues related to the long-term sustainability of partnerships and activities have received limited attention. The purpose of this article is to examine the experiences and lessons learned from three Urban Research Centers (URCs) in Detroit, New York City, and Seattle, which were initially established in 1995 with core support from the Centers for Disease Control and Prevention (CDC). The experience of these Centers after core funding ceased in 2003 provides a case study to identify the challenges and facilitating factors for sustaining partnerships. We examine three broad dimensions of CBPR partnerships that we consider important for sustainability: (1) sustaining relationships and commitments among the partners involved; (2) sustaining the knowledge, capacity and values generated from the partnership; and (3) sustaining funding, staff, programs, policy changes and the partnership itself. We discuss the challenges faced by the URCs in sustaining these dimensions and the strategies used to overcome these challenges. Based on these experiences, we offer recommendations for: strategies that partnerships may find useful in sustaining their CBPR efforts; ways in which a Center mechanism can be useful for promoting sustainability; and considerations for funders of CBPR to increase sustainability.

Centers for Disease Control and Prevention, U.S.↗

PubMed2006

Training welfare caseworkers in service excellence: increasing children's Medicaid coverage.

Many low-income children who are eligible for public sector health insurance remain uninsured. There are many barriers to enrolling these children, but one key issue is parents' reluctance to use the services of the local enrollment agency, which is usually the welfare office. The Eastside Access Partnership, a community-academic coalition on the Eastside of Detroit, addressed the problem of uninsured-but-eligible children through a variety of interventions focused on (1) enhancing community members' understanding of the enrollment process and (2) reducing institutional barriers to enrollment. One of these interventions addressed the institutional barriers by developing a customer service excellence training program for welfare caseworkers. The training program curriculum, which was developed following the principles of community-based participatory research, included extensive input from community residents, welfare agency staff, and academic researchers. The training sessions received positive evaluations from participants and agency executives. A more thorough evaluation of the project is under way.

Child↗

PubMed2005

Team leadership and patient outcomes in US psychiatric treatment settings.

Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team's emergent leader and the level of mutual respect among that team's members. The second model tested associations between mutual respect among staff and changes over time in patients' quality of life. The subjects for model 1 were psychiatric staff members (n=785) whose responses were aggregated for team-level analyses (n=78). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1,638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines' strengths to improve their impact.

Hospitals, Psychiatric↗

PubMed2005

Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit's eastside.

Patterns of mental health are clearly associated with life circumstances, including educational and economic opportunities, access to safe and supportive neighborhoods, socially structured exposures to stressors and to supportive relationships. In this article, we examine the social and economic correlates of depressive symptoms among African American women residing within a predominantly African American urban neighborhood in Detroit, USA, with relatively few economic resources. We identify distinct stressors associated with financial strain, neighborhood social disorder (concern about police responsiveness, safety stress), and experiences of discrimination. We test the extent to which each of these stressors mediates relationships between household income, length of residence in the neighborhood, social support and depressive symptoms. Our results suggest that for women in this racially segregated area with a high concentration of poverty, relationships between household income and symptoms of depression are partially mediated by financial stress and social support, but that stressors associated with neighborhood disorder and discrimination influence depressive symptoms independent of household income. Furthermore, we find that length of residence in the neighborhood is negatively associated with financial stress and positively associated with police stress and social support, with no significant net effect on symptoms of depression. We conclude that higher household income may help reduce symptoms of depression by reducing financial stress and strengthening social support even within neighborhoods with high concentrations of poverty. However, increased household income does not protect African American women residing in a high poverty community from distress associated with neighborhood disorder or experiences of discrimination.

Adult↗

PubMed2005

Evaluation of an emergency department-based enrollment program for uninsured children.

STUDY OBJECTIVE: We evaluate the effectiveness of an emergency department (ED)-based outreach program in increasing the enrollment of uninsured children. METHODS: The study involved placing a full-time worker trained to enroll uninsured children into Medicaid or the State Children's Health Insurance Program in an inner-city academic children's hospital ED. Analysis was carried out for outpatient ED visits by insurance status, average revenue per patient from uninsured and insured children, proportion of patients enrolled in Medicaid and State Children's Health Insurance Program through this program, estimated incremental revenue from new enrollees, and program-specific incremental costs. A cost-benefit analysis and breakeven analysis was conducted to determine the impact of this intervention on ED revenues. RESULTS: Five thousand ninety-four uninsured children were treated during the 10 consecutive months assessed, and 4,667 were treated during program hours. One thousand eight hundred and three applications were filed, giving a program penetration rate of 39%. Eighty-four percent of applications filed were resolved (67% of these were Medicaid). Average revenue from each outpatient ED visit for Medicaid was US135.68 dollars, other insurance was US210.43 dollars, and uninsured was US15.03 dollars. Estimated incremental revenue for each uninsured patient converted to Medicaid was US120.65 dollars. Total annualized incremental revenue was US224,474 dollars, and the net incremental revenue, after accounting for program costs, was US157,414 dollars per year. CONCLUSION: A program enrolling uninsured children at an inner-city pediatric ED into government insurance was effective and generated revenue that paid for program costs.

Child↗

PubMed2005

Cross-functional team processes and patient functional improvement.

OBJECTIVE: To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. DATA SOURCES/STUDY SETTING: Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. STUDY DESIGN: A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. DATA COLLECTION METHODS: Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. PRINCIPAL FINDINGS: Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. CONCLUSIONS: Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

Activities of Daily Living↗

PubMed2005

Promoting diversity in health management: the University of Michigan Experience.

There has been a resurgence in the call for greater racial and ethnic diversity in the health workforce. Researchers in health services have made the "business case" for diverse leadership of healthcare organizations, arguing that this will make these organizations more effective in serving diverse populations. Greater diversity in health management training programs will also have positive effects on their students. This article has three purposes: to discuss the importance of diversity in health management training programs; to describe the University of Michigan's Summer Enrichment Program (SEP), a program to increase the number of students of color who receive graduate training in health management; and to report the results of a survey of SEP alumni, conducted after the program's 15th year, which describe the graduate school and career experiences of 167 SEP alumni. Based upon the survey results, the SEP appears to have been very successful in enlarging the pool of students of color who attend graduate programs in health management and who embark on careers in the field. It has also had a very positive effect on diversity within the University of Michigan program. The implications of the Michigan experience and recent Supreme Court decisions for other graduate programs are discussed.

Adult↗

PubMed2004

Status differences in cross-functional teams: effects on individual member participation, job satisfaction, and intent to quit.

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective.

Adult↗

PubMed2004

A Bridge Between Communities: Video-making using principles of community-based participatory research.

Health educators can play a critical role in bringing together the partners and resources to successfully make videos using principles of community-based participatory research (CBPR). This article is a "how-to" guide for making videos using community-based participatory research principles. The authors describe video-making and CBPR, then outline six steps on how to make a video using principles of CBPR: (a) engaging stakeholders, (b) soliciting funding and informed consent, (c) creation of shared ownership, (d) building cross-cultural collaborations, (e) writing the script together, and (f) pulling it all together: editing and music selection. Still photographs and key themes from the video A Bridge Between Communities are presented as a running case study to illustrate these steps. The article concludes with implications for health promotion research and practice.

Communication↗