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Short HB, Guare EG, Spanos K, Karakoleva EV, Patel D, Truong N, Huang M, Lehman E, Mendez-Miller M. The Impact of a Student-Led Health Education Clinic on the Health Literacy and Behaviors of a Rural Community in the State of Pennsylvania, USA. J Community Health 2024; 49:458-465. [PMID: 38095814 DOI: 10.1007/s10900-023-01306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 04/02/2024]
Abstract
Rural populations experience a number of disparities that place them at increased risk of morbidity and mortality related to chronic disease, including lower health literacy and greater distance to medical care. Community-based free healthcare education can offer targeted preventive care to these vulnerable populations; however, limited quantitative research exists measuring their impact, specifically on health literacy and likelihood for behavior change. To investigate this, a student-led health education clinic was held in January 2023 in the rural community of Lykens, Pennsylvania by the Student-run and Collaborative Outreach Program for Health Equity (SCOPE). Fifty-five pre- and post-clinic surveys using Likert-style questions measured the knowledge and likelihood of behavioral change for several preventive health topics, including hypertension, diabetes mellitus, cancer screenings, childhood vaccinations, skin cancer, mental health, addiction, and nutrition. From pre- to post-clinic, there was a significant increase in knowledge of hypertension (p = 0.023) and diabetes (p = 0.014), likelihood of attending cancer screenings (p = 0.038), and confidence in identifying cancerous moles (p = < 0.001). There was a non-significant increase in understanding of mental health and nutrition, and no change in understanding of addiction or childhood vaccinations. It is likely that the level of interaction in education provided and relevance of information to participants contributed to effective uptake of information. The results demonstrate an immediate impact on health literacy and likelihood of behavioral change for several important preventive health topics, and advocate for the use of student-run healthcare interventions in addressing the prevalence of chronic disease in rural communities.
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Affiliation(s)
| | - Emma G Guare
- Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Devika Patel
- Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Powell SK, Serafini RA, Frere JJ, De Pins A, Saali A, Sultana SA, Ali M, Dale B, Datta D, Aaronson C, Meah Y, Katz CL, Gluhoski V. Provision of Cognitive Behavior Therapy for Depression and Anxiety Disorders by Medical Student Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:10-17. [PMID: 37770702 DOI: 10.1007/s40596-023-01873-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders. METHODS The authors assessed improvements in trainees' CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees' clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients' depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire. RESULTS Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning. CONCLUSIONS Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.
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Affiliation(s)
| | | | - Justin J Frere
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Agathe De Pins
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Muhammad Ali
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brandon Dale
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debjyoti Datta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cindy Aaronson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yasmin Meah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Craig L Katz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vicki Gluhoski
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Park N, Gundlach C, Judge T, Batavia AS, Charney P. Expanding Access to Psychiatric Care Through Universal Depression Screening: Lessons from an Urban Student-Run Free Clinic. J Community Health 2023; 48:932-936. [PMID: 37400658 DOI: 10.1007/s10900-023-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
The purpose of this study is to report the utility of a universal depression screening in a student-run free clinic (SRFC) to improve bridging to psychiatric care. Patients (n = 224) seen by an SRFC between April 2017 and November 2022 were screened for depression in the patient's primary language using the standardized Patient Health Questionnaire (PHQ-9). A PHQ-9 score greater or equal to 5 prompted psychiatry referral. Retrospective chart review was conducted to determine clinical characteristics and length of psychiatry follow-up. Out of 224 patients screened, 77 patients had positive depression screens and were referred to the SRFC's adjacent psychiatry clinic. Of these 77 patients, 56 patients (73%) were female, the average age was 43.7 (SD = 14.5), and the mean PHQ score was 10 (SD = 5.13). Thirty-seven patients (48%) accepted referral, while 40 (52%) declined or were lost to follow-up. There were no statistical differences in age or number of medical comorbidities between the two groups. Patients who accepted referrals were more likely to be female, as well as to have psychiatric histories, higher PHQ-9 scores, and a history of trauma. Reasons for declining and being lost to follow-up included transition to insurance, geographic relocation and deferral due to hesitancy in seeking psychiatric care. Implementation of a standardized depression screening reveals a significant rate of depressive symptoms among an urban uninsured primary care population. Universal screening may serve as a tool to improve the delivery of psychiatric care to underserved patients.
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Affiliation(s)
- Nana Park
- Weill Cornell Medical College, New York, NY, USA.
| | | | - Tyler Judge
- Weill Cornell Medical College, New York, NY, USA
| | - Ashita S Batavia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Zhou C, Fruitman K, Szwed S, Wickersham M, Spellun J, Zonana J. Weill Cornell Medicine Wellness Qlinic: Adapting the Student-Run Clinic Model to Expand Mental Health Services and Medical Education. Community Ment Health J 2022; 58:1244-1251. [PMID: 35084635 PMCID: PMC8792141 DOI: 10.1007/s10597-022-00943-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
The Weill Cornell Medicine Wellness Qlinic (Wellness Qlinic) is a student-run mental health clinic serving the lesbian, gay, bisexual, transgender, and queer (LGBTQ +) community in New York City. Student-run clinics have successfully provided primary care to underserved communities experiencing barriers to accessing health care. Psychiatric evaluation and medication management have also been implemented in several student-run clinics, but providing sustainable psychotherapy services has been a challenge. In this paper, we present a student-run mental health program incorporating interdisciplinary trainees to provide robust short-term psychiatric treatment, including individual psychotherapy, medication management, and group therapy. Results of a chart-review study to evaluate patient engagement and treatment outcomes are presented. The Wellness Qlinic's treatment model resulted in 90% patient retention and positive clinical outcomes for patients while addressing an education and training gap in LGBTQ + mental health for multidisciplinary mental health care providers.
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Affiliation(s)
- Constance Zhou
- Weill-Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, 1300 York Ave, Room C-103, New York, NY, 10065, USA.
| | - Kate Fruitman
- Weill Cornell Medicine, 1300 York Ave, Room C-118, New York, NY, 10065, USA
| | - Sarah Szwed
- Weill-Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, 1300 York Ave, Room C-103, New York, NY, 10065, USA
| | - Matthew Wickersham
- Weill-Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, 1300 York Ave, Room C-103, New York, NY, 10065, USA
| | - Jessica Spellun
- Weill Cornell Medicine, 525 East 68th Street, Box 140, New York, NY, 10065, USA
| | - Jess Zonana
- Weill Cornell Medicine, 525 East 68th Street, Box 140, New York, NY, 10065, USA
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Fischbein R, Gardner-Buckshaw S, Loucek A, Ravichandran S, Eicher M, Boltri JM. Pandemic Productivity: Student-Run Free Clinic Integrates Behavioral Health in the Wake of COVID-19. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:608-612. [PMID: 33205332 PMCID: PMC7671571 DOI: 10.1007/s40596-020-01368-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/28/2020] [Indexed: 05/21/2023]
Affiliation(s)
| | | | - Ashley Loucek
- Northeast Ohio Medical University, Rootstown, OH, USA
- Coleman Professional Services, Ravenna, OH, USA
| | | | | | - John M Boltri
- Northeast Ohio Medical University, Rootstown, OH, USA
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