Improving Health Care Workforce Development the SMAHEC Way

1. Improving Health Care Workforce Development the SMAHEC Way Stacey Curry, MPH Director Southern Mississippi Area Health Education Center

2. Mississippi Health Disparities • Building healthy communities means bridging the gaps in health disparities. So… • What is meant by health disparities? • Health Disparities are: "...differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States."~ National Institutes of Health (NIH) Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities (October 6, 2000)

3. Mississippi Health Disparities Cont. • Both national and state levels are concentrating on health disparities. • Unfortunately, there are still significant differences in the quality of health care between different races and ethnicities in the U.S. and in Mississippi. • All Americans are impacted by health disparities statewide and nationally.

4. Mississippi Health Disparities Cont. • The MSDH establishes the fact that health needs and disparities within Mississippi minorities result from the following: • Lower educational levels • Poverty • Limited manpower, especially in more rural areas called HPSA’s (Health professional shortage areas)

5. Mississippi Health Disparities Cont. • Former president Bill Clinton identified 6 areas of health disparities for the U.S in 1998 including: • Cardiovascular disease • Diabetes • Cancer screenings • HIV/AIDS • Adult/Child immunizations • Infant mortality

6. Mississippi at a Glance (2009, 2000) • Population: 2,918,785 • Male: 48.5% • Female (2009):51.5% • African Americans (2009): 37.2% • White (non Hispanic) (2009): 60.5% • Asian (2009): 0.9% • Hispanic or Latino (2009): 2.5% • Persons under 18 years old (2009): 26.0% • Persons 65 years old and over (2009): 12.8% • High school graduates, percent of persons age 25+, (2000) : 72.9% • Bachelor's degree or higher, pct of persons age 25+, (2000): 16.9% • Median household income, (2009) : $37,818 • Persons below poverty, percent, (2009): 20.8% compared to 13.2% in US

7. Diabetes in Mississippi • Estimate percentages for diabetes in MS • 11.10% diagnosed in 2007 • 24% undiagnosed in 2007 • Diabetes is a major concern for African Americans • Nonwhite females have a self-reported rate of diabetes at 13.1% • White females have a rate of 9.2% in 2004 • African Americans are 1.6 times more likely to develop diabetes than white Americans. • African Americans are more likely to develop diabetes complications • kidney failure, blindness, amputation of feet and legs, and stroke. • Type II Diabetes is preventable and/or manageable through lifestyle changes

8. Cancer in Mississippi • Lung and Bronchus • Lung/Bronchus cancer accounts for 14.6% of cancer diagnoses and 33.3% of all cancer deaths. • Mortality rate for lung/bronchus cancer is 68.4 per 100,000. • Lung/bronchus cancer has declined for men, but it has increased for women since the 1990s • Female breast and cervical in 2004 • The mortality rate was 27.8 per 100,000 for all women. • The mortality rate for white women was 24.2 per 100,000, while the mortality rate for non-white women was 35.2 per 100,000. • The mortality rates for white women with cervical cancer was 2.2 per 100,000 compared to 6.6 per 100,000 for non-white women.

9. Cancer in Mississippi Cont. • Colorectal cancer • Colorectal cancers account for 10.9% of all cancer diagnoses and 10.1% of cancer deaths • Colorectal cancer is the third most common cancer for both men and women • Prostate Cancer • Mortality rate was 38.0 per 100,000 in 2004. • Non-white men had a mortality rate or 72.4 per 100,000 compared to 25.7 per 100,000 for white men in 2004.

10. Cancer Disparities • Cancer Disparities • Cancer mortality and reoccurrence disparities are the result of: • Inaccessible quality health care • Differences in screening, treatment, follow-up, etc. • Health disparities in Mississippi occur in racial/ethnic, age, gender socioeconomic, and geographic categories. • Cancer prevention, detection, diagnosis, and treatment barriers in Mississippi occur in both urban and rural areas.

11. Cancer and SES • Socioeconomic status is considered a major health determinant. • Lower SES has been attributed to cancer risk behaviors and poor cancer outcomes for breast, colon, and prostate cancers. • Contributing factors include: • Lower level of education • Cultural/ethnic beliefs • Access to quality health care

12. Infant Mortality in MS • Mississippi has one of the highest rates of infant mortality in the U.S., with an infant mortality rate of 9.7 in per 1, 000 live births in 2009. • The infant mortality rate for nonwhites in Mississippi is 12.5 per 1,000 live births, compared to 7.1 per 1,000 live births for whites in 2009. • In 2009, a higher percentage of nonwhite teens gave birth than white teens age 15-19 in Mississippi. • The highest rates of infant mortality and teen births are found in the Delta region of Mississippi.

13. HPSAs • Health Professional Shortage Areas (HPSAs) are designated by HRSA as having shortages of primary medical care, dental health care, or mental health providers. • They may be geographic, demographic (low income population) or institutional. • Medically Underserved Areas/Populations are areas or populations designated by HRSA as having: • Too few primary care providers, • High infant mortality, • High poverty, and/or • High elderly population

14. What can we do? • How do we address health disparities within communities with high levels of poverty and limited health care resources?

15. MS AHEC • Vision: The Mississippi Area Health Education Center is a statewide program that focuses on the elimination of health care disparities and increasing the availability, acceptability, and access of quality health care for all medically underserved populations and citizens in identified Health Professional Shortage Areas (HPSA). • It is partially funded by HRSA

16. HRSA • Health Resource and Services Administration • Helps provide health resources for medically underserved populations • Works to build the health care workforce • Maintains the NHSC and helps build the health care workforce through many training and education programs • Also serves mothers and children • Serves people living with HIV/AIDS through Ryan White CARE Act programs • Oversees nation’s organ transplantation system

17. SMAHEC • Southern Mississippi Area Health Education Center • An affiliate of the Mississippi AHEC at the University of Mississippi Medical Center • Hosted by the University of Southern Miss • Maintains offices on the Hattiesburg and the Gulf Coast campuses • Serves the fifteen southern-most counties of Mississippi

18. As SMAHEC We… • Work to improve health care workforce development • Focus on programs that promote the awareness of health careers among k-12 and pre-professional college students • Manage clinical rotations for DO students • Manage internships/practicum hours for Public Health students • Increase continuing education opportunities for health care providers • Provide outreach opportunities that bring our health care providers to the community

19. How do we make our vision a reality? • We work to eliminate health disparities in HPSAs through various means: • High School and Pre-Professional Health Care Professional Recruitment Programs • Clinical Rotation Management for students in professional schools • Community Health Awareness and Prevention Initiatives/Outreach • Coalition Building and/or Participation • Continuing Education Opportunities for Mississippi Health Care Professionals • Most importantly: We do everything through state and regional collaborations!

20. As SMAHEC We… • Overall we are a resource for all health care professionals, students interested in health careers, and communities in need of adequate health care throughout the 15 southern counties in Mississippi!!

21. 1. Health Care Recruitment • Limited Health Care Professionals in Mississippi • Health Careers Road Show • Pre-professional Lecture Series • DO Clinical Rotations • Public Health Professionals Programs

22. Mississippi’s Medical Care Report Card • Mississippi is traditionally underserved • Some areas have few docs and nurses, while other areas have adequate amounts • Large numbers of people living in poverty • Large numbers of minorities • Large numbers of elderly • 75 HPSA counties in MS for primary care • 40% dentists found in Jackson or Gulf Coast • Highest number of Masters level+ social workers found in Hinds, Harrison, and Forrest Counties

23. Nursing Shortages • Nursing shortages continue in MS • 7.7% RN vacancy rate in hospitals • 22% turnover rate • 8% projected increase in nursing staff demand over next two years • 50+% turnover rate for RNs in long-term care with a 7.4% vacancy for RNs and an 8.2% vacancy for LPNs

24. Health Care Recruitment Programs • SMAHEC works to recruit high school and community college students into health care professions through: • Classroom visits • Invitations to the University of Southern Miss • Health career booths at health and career fairs • Mail-outs • Health Careers Road Show

25. Health Careers Road Show • SMAHEC’s Health Career Road Show is an interactive program designed to bring: • Information, • Discussion, and • Experience about health careers to the high school student. • The overall goal: “to increase the number of students interested in pursuing health careers in Mississippi, thus increasing the manpower available in HPSAs.”

26. Health Careers Road Show Cont. • 2 goals • To increase the health career knowledge of high school juniors and seniors in two high schools within the fifteen SMAHEC counties. • To increase the intent of high school juniors and seniors in two high schools within the fifteen SMAHEC counties to pursue a health career. • We promote the importance of science and mathematics in health care careers in all Health Career Road Show Visits

27. Featured Health Careers • Each Health Career will be discussed by a professional in the field during the Health Careers Road Show • Physicians • Nursing • Dentistry • Public Health • Physical therapy/ PTA • Social Work • Dietitian

28. Health Careers Road Show • 3rd Annual Career Scene Investigation • Combination of HCRS and other disciplines/careers • Collaboration between SMAHEC, GHS, USM, MGCCC, and Local Business and Health Care Services • Location: Gulfport High School • 2 parts • Part I Classroom lecture/booths • 96 juniors and seniors participated • 55 declared intent to pursue health career • Part II Allied Health Lecture (mostly sophomores) • 38 students participated • 38 students declared intent to pursue health career • 36 students declared that SMAHEC experience increased their intent

29. Career Scene Investigation

30. Health Careers Road Show • Collaboration between SMAHEC and Greene County High School • Date: May 4, 2011 • Talked with 3 classes • 50+ students • 15 stated that they were interested in a health career

31. Pre-Professional Lecture Program • Overview • SMAHEC staff will go into pre-professional freshmen/sophomore science and mathematics classes at one university and one community college to present materials on various health care career choices • Focus • Medicine • Nursing • Other

32. Pre-Professional Lecture Program • 2 goals • To increase the knowledge of pre-professional college freshmen and sophomores in relation to health career knowledge and professional school application processes. • To increase the intent of pre-professional college freshmen and sophomores to practice a health care career in Mississippi.

33. Pre-Professional Lecture Program • University Component • The University of Southern Mississippi • Collaboration between SMAHEC and the University of Southern Mississippi’s CoST and CoH • Scheduled a lecture for CoST/CoH students • Hosted on the Hattiesburg Campus • Date: April 13, 2011 • Time: 5:30 p.m.-7:00 p.m.

34. Pre-Professional Lecture Program • Results • 7 students from CoST and COH attended the event • 13 students from CoST have requested assistance in obtaining shadowing opportunities • Several new collaborations in the making for future programs.

35. Pre-Professional Lecture Program • Community College Component • Still in the planning stages • Collaboration between SMAHEC and the Mississippi Gulf Coast Community College • Time-Frame: During the Summer Classes

36. DO Student Rotations Program • William Carey University (WCU) has recently initiated a School of Osteopathic Medicine, with the inaugural class beginning in the Fall of 2010. • The Dean of the School is working with the Mississippi AHEC and its centers to manage clinical rotations for the university’s DO students, starting in 2012.

37. DO Student Rotations Program • Between 2010 and 2012, SMAHEC will be managing four students from the Pikeville School of Osteopathic Medicine (PSOM) in Kentucky. • These students are interested in pursuing their medical careers in Mississippi and will be completing their rotations within the state.

38. DO Student Rotations Program • Pikeville sent 4 students to the Hattiesburg area for their 2 years of clinical rotations • 1 student in 2009 • 3 students in 2010 • Since 2009, SMAHEC has set up over 45 rotations between the 4 students • Pikeville plans to send 2 more students to the Gulf Coast area for their 2 years of clinical rotations in August 2011.

39. DO Student Rotations Program • Many the hospitals in Mississippi are on board with this initiative • The support of Mississippi’s physicians is imperative to the success of this program. • Collaborations are more important than ever!

40. USM Community Health Sciences Internship Program • The Southern Mississippi Area Health Education Center has partnered with the CHS department in order to assist in the placement and management of students during their internships. • Goal • To assist in the internship placement and management of at least 35 students from the University of Southern Mississippi’s CHS department during the 2010-2011 program year.

41. Public Health Professional Programs • Public Health Shadowing/Volunteer Hours • 10 Coast CHS Health Promotion Students • Each student volunteers 10 hours to work on a SMAHEC public health project or to shadow a public health provider in a coastal MS community.

42. 2. Outreach Programs • Important in bringing existing health care providers and resources to underserved communities. • Community events • Coalition and partnership building

43. Community Health Awareness and Prevention Initiatives • Many chronic and infectious health conditions can be avoided and/or reduced through preventive measures: • Nutrition • Physical activity • Vaccinations • Smoking cessation • Stress reduction • Healthy sexual habits • Etc. • Screenings work to pinpoint health problems before they become detrimental.

44. Community Health Awareness and Prevention Initiatives • Problem: Much of the population remains uninsured or underinsured. Furthermore, many insurance carriers do not provide insurance for preventive measures. • Solution: Community Health Awareness Screening and Prevention Initiatives: • Health Fairs • Community events • Church or community health seminars • Schools • Small programs • The success of these programs involves numerous collaborations with the MSDH and non-profit organizations!

45. Community Health Awareness and Prevention Initiatives • Key issue: Anytime you provide screenings, you must be able to partner with health care providers for further services that may be needed for underinsured/uninsured patients!! • Ex. Providing glucose screenings only goes so far if those who have high glucose levels are unable to see a physician for follow-up testing and treatment! • Key issue: Educational materials must be culturally and educationally effective in order to reach minority populations. • Key issue: Materials should be geared toward various stages of behavioral change within the population. • “One size does NOT fit all”

46. Coalition Building and/or Participation • Coalitions involve: • Partnering yourself and/or you organization’s time and resources • Working together for a common goal • Coalitions allow you to: • keep track of what is already being done in your community • Look at what still needs to be accomplished. • Ex. Mississippi Partnership for Comprehensive Cancer Control Coalition • State Coalition • Regional Coalitions • Has over 300 members statewide and is still growing

47. Continuing Education Opportunities for Mississippi Health Care Professionals • It is imperative to offer cost efficient and local means for our existing health professionals to maintain their licensures and to stay abreast of community related information within the six areas of health disparities, among other topics. • This is especially true of places, such as coastal Mississippi, where economic hardships and Katrina recovery are issues.

48. CE for Health Professionals • Past Conference: • Healthy Mothers, Health Babies: Reducing Mississippi’s Infant Mortality Burden • A Community Conference to Increase the Awareness of the Role of Psychosocial Interventions for Cancer Patients, Survivors, and Families • Mi salud es nuestra salud, “My Health is Our Health:” Cross Cultural Sensitivity in Health Care • Diabetes and Cardiovascular Health

49. State and Regional Collaborative Efforts • Aside from major coalitions, collaboration with various organizations is an important aspect in building community health strategies. • Examples of collaborations include: • Working with your local and state health departments • Partnering with fellow-organizations to propose grants and programs • Partnering with organizations from other states who have already achieves favorable health outcomes.

50. Importance of Collaborations: Take Home Points • Every program we execute is accomplished with multiple collaborations. • Pros: • Increased manpower • Increased finances • Increased networking • Increased notoriety • Cons: • None!