Hybrid MPH Practicums Explore Health Initiatives Across Diverse Communities

Students in Dartmouth's online/on-campus MPH program have the opportunity to participate in a fully customizable practicum experience through additional elective courses in health policy, quality improvement, and health services research. Below, read about how four students embarked on different journeys through transformative practicum experiences. From rural landscapes to bustling university campuses, witness practitioners shaping integrative nutrition coaching, navigating business and community health intersections, and shedding light on trauma-informed care. These narratives offer compelling insights, echoing the commitment of Dartmouth's MPH program to foster innovation and positive change in public health practice.

Krista Harvey MPH'18

Opportunity: Working as an administrative services manager at Kearny County Hospital (KCH), Harvey and her colleagues heard stories about how difficult it was to find quality child care. The hospital also had reportedly experienced challenges recruiting new employees to move to the area due to difficulties finding reliable child care. Access to affordable, high-quality child care can have far-reaching effects on a child’s and on a family’s overall health, well-being, and economic stability. An avalanche of research has shown that development in early childhood lays the foundation for health and well-being, and parents without access to affordable, high-quality childcare may not be able to work outside the home or work full-time. A childcare shortage also can take its toll on the strength and viability of a community. 

“We wanted to know if this was a whole community problem or if there’s something we could do as a healthcare institution to make it easier for people to live here and raise healthy families here,” Harvey says. “In rural counties like ours, maintaining population can be a struggle. Our town is about 2,000, and our county is about 4,000 right now.”

Health Impact and Next Steps:
Working under the direction of KCH leadership, Harvey was a part of team that conducted multiple focus group sessions in diverse venues throughout Kearny County. She then worked with researchers from the University of Kansas School of Medicine to analyze and prepare data for a presentation to community stakeholders and potential partners (to KCH) in early childhood work—a diverse group that included local employers, state agencies, and local schools, among others. With the focus group research confirming that parents needed additional support in child care and parenting resources, stakeholders agreed on the need to build a community child care center (and program) that serves all families in the county, including those with special challenges. While the community stakeholders pursue funding for the center, a design team—comprised of hospital and school administrators, local home daycare providers, and other partners identified at the stakeholder gathering— is looking at utilizing existing resources that can be leveraged to support families in the interim. As part of the next steps, the University of Kansas School of Architecture will also draw up plans for a center that meets all needs identified by the design team, including meeting the needs of families with special challenges.

“If we do build a center (and a program) at the hospital, we want to make sure it is accessible to everyone, including our families in which English is a second language, those who need financial assistance, and children with special medical needs,” Harvey says.

Chelsea Strandberg, INHC, MPH’18

Opportunity:  Young adults who establish and maintain a healthy diet are less likely to become obese and develop high blood pressure, diabetes, and other chronic health conditions. As an integrative nutrition health coach (INHC), Strandberg understands well that what we consume on a daily basis now can impact our health decades later. College, she says, is a critical intervention point as many young people begin to exert dietary autonomy for the first time in their lives. 

“Integrative nutrition and wellness coaching is focused on a one-to-one client/provider relationship for people who want to make long-lasting lifestyle changes. Health coaches support clients in achieving short-term goals (like losing weight or eating more fruits and vegetables) while encouraging long-term behavior change,” Strandberg explains. “While many colleges, including Sacramento State, place emphasis on student wellness initiatives, I think there is a real opportunity to incorporate the principles of health coaching into the campus setting.”

Impact and Next Steps:  Working under the direction of Sacramento State’s Student and Health and Wellness Services (The Well), Strandberg reviewed the demographics of the student population, existing nutrition services, and the ecosystem of dining options on campus. She then designed a survey to help The Well better understand the factors that are influencing students’ dietary choices. Strandberg will review the results of the survey she created with The Well to inform their health and wellness strategy for upcoming school years. She also conducted a scan of four college campuses with demographics different from Sacramento State. Strandberg hopes to pitch an integrative nutrition health coaching program—one that would include one-to-one services and the integration of peer health coaches—to college wellness centers across the country for the prevention of overweight and obesity. 

Ben Bulkey MPH'18

Opportunity:  With active non-profit organizations in the region—Michigan Health Improvement Alliance (MiHIA) and the Great Lakes Bay Region Alliance—this area north of Michigan has potent resources that can be utilized in developing programs aimed at improving health, health delivery, and economic growth. Not only does the area have strong community organizations, but it also has a solid anchor employer in Dow Chemical, as well as a significant health care ecosystem, including four hospitals and a medical school. In 2017, the Rippel Foundation’s national health initiative, ReThink Health, joined with MiHIA and the Great Lakes Bay Region Alliance to support a Health and Economy Initiative. This work included collecting stakeholder perspectives, mapping the system of health, and helping move toward a shared commitment to the most impactful initiatives. Thanks to an introduction from Dartmouth Institute Director Elliott Fisher, Ben Bulkley—whose past experience includes serving as the president of Aetna Pharmacy and vice president of Aetna specialty business—was able to bring his experience as a business leader to the project.

“When I was working on the business side, I didn’t realize fully the role that business could play in influencing the health of a community,” Bulkley says. “Now, that I’m pursuing this area of research, I think the potential is significant, particularly if we’re able to connect with the innovators from the business community who already see the power of investing strategically with other stakeholders.”

Impact and Next Steps:  Bulkley’s work on the initiative included conducting 75 stakeholder interviews in Saginaw, including an in-depth interview with the former Dow Chemical Chief Medical Officer. He also contributed to the design of the interview protocol and highlighted perspectives through the lens of a business leader. Insights gained included a confirmation of the powerful role anchor employers can play in convening, shaping, and governing a community process; how difficult it is to break out of the “medical establishment bias without a change of incentives;” and that while philanthropic efforts can be a driving force, they are often highly fragmented.

These insights were used by the team at ReThink when mapping priorities for the next steps in the project, while the next steps for Bulkley personally include traveling across the country to interview business leaders in other areas that have solid anchor employers.

“There are several areas around the country in which individual companies are still the major employers, and the potential they have to impact the health and well-being of the community there is quite significant,” Bulkley says. “I want to understand exactly what the narrative is and how we can better harness the untapped potential of the business community under these circumstances.”

Laura Ward MPH '18

Opportunity: Approximately 20-50% of adults in primary care settings in the United States report experiencing physical or sexual abuse during childhood, while reports of abuse may run as high as 70% in patients with substance abuse, depression, irritable bowel, or chronic pain. Yet, patients with a history of childhood trauma may receive inadequate or incomplete care when trauma history is overlooked or not discussed in a medical setting. A clear understanding of the patient’s perspective and preferences regarding the disclosure of childhood trauma is not well studied. Research in this area could lead to more effective screening protocols, treatment plans, and, ultimately, better health outcomes.

“I saw many women come in for treatment without awareness of any connection between their trauma and their physical symptoms,” Ward says. “At the same time, we found the women were infrequently screened for a history of trauma, and past trauma or abuse was rarely talked about in many health care settings.”

However, the women who were able to make a connection not only between their physical symptoms but also their (behaviors related to health conditions) were able to better understand their actions and, ultimately, to make positive changes. Working with the team from the Dissociative Disorders and Trauma Research Program at McLean, Ward designed a 15-item questionnaire to assess perceived connections between physical health and trauma exposure, experiences of disclosure, and beliefs around stigma reduction and trauma disclosure. 

Among the surprising findings: Survey participants—women with histories of childhood trauma currently in a hospital level of treatment—preferred to be screened and believed screening for a history of trauma was an important part of their medical care. Despite their desire to include trauma as part of their medical exam or history, participants expected the provider to initiate the screen, as they were not likely to self-disclose. They were most comfortable disclosing with physicians and in the primary care setting and felt less comfortable disclosing in urgent care or ER settings. Participants pointed to connections between physical symptoms and behaviors, such as headaches, gastrointestinal issues, and substance abuse, which they believed were related to past trauma.

Health Impact and Next Steps: 
Ward is working with a primary care physician group at Brigham and Women’s Hospital in Boston and will be making a final report to them in a combined presentation/feedback session later this winter. She hopes to obtain their feedback to help create a more detailed survey that addresses questions of interest to PCPs.

“If we can gain a deeper understanding of what the patient is looking for, we can utilize this information to help inform both the medical and research communities to design even more effective treatments, interventions, and all-around care that aligns with the critically important needs of this patient population,” Ward says.

POSTED 1/2/2018 AT 02:19 PM IN #practicum