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The Capstone Project gives Health Advocacy students the opportunity to integrate academic learning with field experience, and examine how theoretical advocacy themes are made operational in workplace settings.

Through this yearlong project, students engage deeply with an agency/organizational partner. Together, they select a problem or issue, and the student works to address that issue through a substantial program-related project.

Table of Contents


Taking Action Beyond the Clinic: Strengthening Advocacy Skills in Reproductive Health Providers

Kate E. Bailey MA ’17

There are many challenges to equal and affordable health care access in the United States. Barriers to sexual and reproductive health care specifically require political, not just medical, solutions. Health care providers have historically been active players in advocacy, sometimes to move progressive agendas and other times to reinforce oppression in health care settings. It is important for physicians and clinicians to have a firm grasp on the political history of the reproductive rights and justice movements to best care for their patients’ health needs. The right to decide when, if, and how to parent a child in a safe and healthy environment—reproductive justice—is still determined by laws and politics rather than by individual freedom and choice. Restricting access to abortion services and state-sanctioned forced sterilization are examples of reproductive oppression of vulnerable groups, particularly communities of color, immigrants, young people, and people with disabilities. This has very real health consequences which cannot be treated in an exam room. Reproductive Health Access Project (RHAP) is a non-profit organization that works to remove reproductive health barriers within family medicine and primary care through clinical training, support, and advocacy. This capstone project partnered with RHAP and created an advocacy training program for their physician advocates which offered a convincing argument to take action and provided a framework and tools for effective advocacy engagement. As more providers advocate, they will help amplify the vision that reproductive autonomy and justice are necessary and important parts of basic health care.

Site: Reproductive Health Access Project (RHAP)
Site Supervisor: Lisa Maldonado
Advisor: Ellen Gurzinsky


Bridging the Gaps: Improving Accessibility & Navigation of Community Support Resources for Alzheimer’s/Dementia Caregivers

Marlene George MA ’17

Caregiving occurs universally, and is a role taken on informally by family members and friends. The life of an informal caregiver is stressful, the role impacting caregiver’s careers, and the lives of their own families. Caregivers of persons with Alzheimer’s (AD) or another dementia are reported to experience higher levels of chronic stress, therefore requiring an increased level of resources and supports. Through partnership with the Westchester County Department of Senior Programs and Services, interviews were conducted with community organization stakeholders and AD caregivers in Westchester County and Winnipeg, Canada, looking at the best ways to bridge the gaps and remove the systemic barriers between AD caregivers and community supports. Participation in Stage I and II of the study was successful in both communities, AD caregivers sharing their experiences and identified unmet needs. The majority of study participants were the adult child of the care recipient, were frustrated with the complexities of navigating supportive resources, and reported not receiving useful direction from their care recipient’s physician. I suggest improving the education and training of health care and service professionals to best care and support AD caregivers.

Site: Westchester County, Department of Senior Programs and Services
Site Supervisor: Marikay Capasso
Advisor: Rebecca O. Johnson


Aging Out of Foster Care: Youth in Transition to Independent Living

Linda S. Gross MA ’17

The Youth in Transition to Independent Living goal is to prepare the young men of Kaplan House to live healthy and productive lives. Young adults aging out of foster care without a connection to a community, such as individuals and institutions, are more likely to be unemployed and/or homeless and are more probable to enter the criminal justice system.

The program connects young adults of the Kaplan House to a community mentorship/alumni network of business leaders and alumni. Kaplan House is a residential treatment center for young men aged seventeen to twenty-one who are aging out of foster care. The mission of the program is to help the young men transition successfully into adulthood. The program includes one-on-one coaching, transitional workshops, sessions with business leaders, and sessions with the alumni of Kaplan House.

In January, 15 percent of the clients were employed fulltime or in a vocational training program. Currently 69 percent are employed or in a program, and 23 percent have had interviews that look very positive. The program is in its early phase, but has seen success in the vocational work opportunities of the program participants with the creation of the mentorship alumni network.

Site: The Jewish Board
Site Supervisor: Jennifer Higgins/Leonardo Rodriguez
Advisor: Michael Orth


Patient-centered Implementation of Social Determinants of Health Screening in Primary Care

Melissa B. Haber MA ’17

There is ample evidence that social determinants of health (SDH), the context where people live, work, learn and play, affect health outcomes more than biological factors or clinical care. This project followed the implementation of a new project to incorporate systematic screening for SDH into primary care at Montefiore Medical Group. Activities included work toward selection of a screening tool, collection of patient feedback on tools and workflows for patient-centered implementation, and data tracking for two pilot cycles.

Work showed that selection of the screening tool must be a deliberate and collaborative process. Clinic capacity helps shape workflows and screening criteria. Workflows should reflect feedback from all staff involved in the process. Thirty percent of 236 patients screened had at least one social challenge. Many patients had two or more concerns, which intersected with frequent diagnoses of diabetes, hypertension, depression, and anxiety.

As the project scales up, clinics will develop and share knowledge on most effective resources to address frequent concerns. This capstone collected baseline health data through chart reviews, but future experience will show whether addressing SDH will improve outcomes. Although clinics do not have the power to change social systems that affect at-risk patients, providers can use data to help guide clinical decision-making and provide patient-centered care.

Site: Montefiore Medical Group
Site Supervisor: Namita Azad
Advisor: Julie Novas


Intersecting Research and Advocacy to Create Sanctuary: Emotional Wellbeing Assessment for the Diverse Student Body at Sarah Lawrence College

Erik Harden MA ’17

Undocumented immigrants in the United States historically have experienced a myriad of challenges that were expected to increase following Donald Trump’s presidency. In response to Mr. Trump’s immigration policies, many entities across the US began to announce their support for undocumented immigrants. This included a wave of colleges and universities declaring themselves “sanctuary campus”. These academic institutions promised students that they would not comply with immigration officers, however protections predominately ended there. Sanctuary should extend beyond disobedience to include health services that are formed based upon relevant data. For this initiative an emotional wellbeing survey that focused on the diverse student body at Sarah Lawrence College, which included natural born citizens, naturalized citizens, documented people, and undocumented people, was conducted. 138 people participated in this study and findings indicate that current emotional wellbeing on campus is largely fair to poor. Almost half of students indicated that their emotional wellbeing was not good for almost a week and reported suffering anxious moods, depressed moods, and sleep disturbances. Personal, public, group, and public events had a substantial negative impact on students’ emotional wellbeing. Undocumented students appear to suffer special challenges that are created by an intersection of their immigration and student status. In order to better understand and address this situation the college should continue to maintain the emotional wellbeing survey, directly reach out to the undocumented student body, and provide educational material to prepare faculty and staff to deal with immigration matters.

Site: Sarah Lawrence College
Site Supervisor: Thomas Blum
Advisor: Shena Elrington


Implementing a Curriculum for the Awareness, Intervention and Prevention of Intimate Partner Violence and Sexual Assault at Major League Baseball

Renita Hutchinson-Gamble MA ’17

Intimate partner violence (IPV) and sexual assault (SA) are global problems. IPV and SA are social problems that do not target specific groups of people. Both problems transcend race, socioeconomic status, age, education and sexual orientation. IPV takes on many forms: physical, emotional, psychological, financial, and sexual abuse. Major League Baseball takes IPV and SA seriously and recognizes the importance the roles of awareness, education, intervention and prevention play in an effort to decrease the incidence of violence and ensure victims seek and receive help. The goal of this project is to define IPV and SA, discuss behaviors that constitute abuse, how bystanders can safely intervene and where to acquire help. The goal is to create a space for open and honest dialogue to bring about meaningful change surrounding IPV and SA, invoking awareness to eradicate the occurrences of IPV and SA at Major League Baseball.

Site: Major League Baseball
Site Supervisor: Ricardhy Grandoit
Advisor: Cora de Leon


Ending Violence in Schools: An Anti-Bullying Program Pilot

Taylor Mccue MA ’17

While reviewing the literature on bullying for this capstone it was discovered that the Owleus Model, the global gold standard of anti-bullying programs, was not always effective at reducing bullying for students in eighth grade and higher. This capstone attempted to address the need for an effective program by designing a program proposal for a pilot anti-bullying program aimed at middle and high school students. The program named Westchester Beyond Bullying: Civics Curriculum for the 21st Century Learner was designed to be a Westchester County-specific civics curriculum comprised of modular classes with district-adaptable and teacher-informed components to improve school climate and fulfill DASA plan-for-change requirements and recommendations. The objective of this curriculum is to increase necessary skills and provide tools for the 21st century learner in the areas of digital citizenship, critical thinking, nonhierarchical thinking, conflict resolution, media messaging, understanding paradigm, and the impact of bias. After the completion of this project we hope that students will have the skills to identify why bullying happens, and the kinds of violence, both relational and physical, that occurs within their peer communities. As a result, students will be able to advocate within their own groups to undo the systems that create and benefit people who bully and harass. The project resulted in a grant proposal which the host organization the Westchester Martin Luther King, Jr. Institute for Nonviolence, was able to use to apply for funding.

Site: Westchester Martin Luther King Jr. Center for Non Violence
Site Supervisor: Rev. Doris Dalton / Marisa Ragonese
Advisor: Rebecca O. Johnson


Creating Community amongst Students with Disabilities at Barnard College

Rachel Sherman-Presser MA ’17

A sense of community is an important factor in order for students to be successful in college. Community, in this context, means a sense of belonging – that students feel visible and validated on campus. At Barnard College, there is a group for students of color, students who identify as LGBTQ, and first generation students. There is not, however, a formalized group for students with disabilities (SWD) on campus. The goal of this project was to identify why SWDs tend not to form communities in college and to find ways that the college can help promote the overall wellbeing of their SWDs. Through interviews and focus groups, it became clear that SWDs have been creating small communities amongst their friends with disabilities and through social media. It is clear that SWDs have a desire to connect with other SWDs, which can be seen in the three main themes identified during the project which deal with stigma SWDs feel from themselves and their peers. This capstone recommends that Barnard College should create more spaces on campus for SWDs, with the hope that eventually, SWDs will be able to form a larger community themselves that makes them feel more visible and valid at Barnard.

Site: Barnard College
Site Supervisor: Carolyn Corbran
Advisor: Rebecca O. Johnson


Protecting Consumers from High Prescription Drug Prices

Michelle Weiss MA ’17

Prescription drug prices continue their dramatic rise in the absence of adequate regulations, yet political action remains elusive. This project aims to protect consumers from the burden of runaway prescription drug prices. An analysis of pending legislation in New York, and of the only successfully enacted legislation in 2016, in Vermont, reveals that the interests of consumers will not be adequately represented by legislation. The project focused mainly on efforts by insurance companies to pass the high price of prescription drugs on to consumers. One identified change to insurance plan contracts provides a case-in-point of how consumers are made the payers of last resort due to insurance plan cost-shifting tactics. The legislative review, consumer advocacy, data analysis and a client interview all supported the outcome of a successful administrative action. The result means improved consumer protections, namely the restoration of appeal rights, around the issue of an egregiously high cost, known as an ancillary charge, to consumers who must take a brand name drug because the generic alternative is medically inappropriate. Continued case work and data analysis will provide oversight to ensure that moving forward, consumers are able to use their appeal rights to win exemption from the ancillary charge.

Site: Community Service Society of New York
Site Supervisor: Amber Wilson
Advisor: Lois Uttley


Healthy Eating Made Simple & Inexpensive

Indira Case MA ’16

The United States Department of Agriculture defines a food desert as a low-income urban area that does not have a grocery store within a one mile radius. The lower portion of Harrisburg, PA—the 17102, 17103, and 17104 area codes—are considered a food desert. In addition, these areas have the greatest need in terms of socio-economic status, education, and health outcomes. Working in collaboration with BlackGirlHealth.com—a website that focuses on preventative health care for black women—and Rafiyqa Muhammad—a local health advocate who runs a greenhouse—we held a healthy eating workshop at Capital Presbyterian Church, which is located in this area of Harrisburg. The participants taste tested food from the greenhouse and learned the benefits of healthy eating. We found that participants did not have a full understanding of certain terms such as: organic, antioxidants, and free radicals. This workshop gave participants insight into healthy alternatives and the importance of spreading awareness about food deserts. Continuing to hold workshops in churches will help engage and educate the community, build momentum and motivation for behavior change, support alternatives such as community gardens, and advocate for improved food access.

Site: BlackGirlHealth.com
Site Supervisor: Porcha Johnson
Advisor: Vicki Breitbart


Empowering Community through Incident Reporting and Grassroots Organizing

Kaeleigh Forsyth MA ’16 & Devon Santoro MA ’16

Based on the Environmental Justice and Health Alliance report “Who’s in Danger? Race, Poverty, and Chemical Disasters,” more than 134 million Americans live in the danger zones around 3,433 facilities in several common industries that store or use highly hazardous chemicals. The state of Delaware is at the fenceline of multiple chemical industry facilities, and is home to 87,471 children who attend school within the vulnerability zone of a high-risk chemical facility. That means nearly three in five students in Delaware from pre-school to high school face the possibility of experiencing chemical leaks, gas clouds, or explosions. The community of Wilmington, Delaware is home to the world’s fourth largest chemical company—DuPont—which has been placed on the EPA’s “severe violator” list, meaning they are guilty of “willful and repeat violations.”

Unfortunately, the current industry practice and EPA enforcement incentive structure rewards pollution and operates in a reactionary way. A paradigm shift toward a preventative model requires that open dialogue among communities, industry, and regulating bodies is established, and that engaging youth in awareness of environmental justice is paramount. An intergenerational grassroots-led movement toward environmental justice requires that the youth living in these grassroots communities are informed about the social issues affecting the places they live and that they become engaged in the discussions that move us toward equitable solutions. By holding youth workshops in Wilmington that provide participants with the vocabulary and critical analysis skills to observe and describe social justice factors that feed the inequality resulting in health disparities, we aim to make meaningful progress toward fence line community empowerment.

Site: Environmental Justice Health Alliance
Site Supervisor: Michelle Roberts
Advisor: Vicki Breitbart


Here I Am: Adolescent Refugee Acculturation

Jane Himmel MA ’16

Refugees have been forced to flee their home due to persecution or fear for their safety. Adolescents resettling in the United States face a dual challenge: navigating a new culture while managing the transition from childhood to adulthood.

The purpose of this Capstone project is to support healthy socio-emotional development in adolescent refugees at this time of change. A strong sense of racial and ethnic identity has been shown to promote self-esteem, resiliency, goal attainment, and avoidance of risky behaviors, underscoring the need for acculturation (adaptation) and not assimilation as they enter a new society. Under the sponsorship of the International Institute of Connecticut (IICONN), a refugee resettlement agency in Bridgeport, Connecticut, a series of workshops and interviews were conducted to answer this question: what will help adolescents feel safe, strong, and connected in a new life here in the United States?

Four workshops, each attended by eight to fourteen adolescents, explored expectations, culture, goal-setting, and creating a welcome. Parents were invited to, but did not attend, a planned workshop. This project largely achieved its intended outcomes: decreasing the adolescents’ sense of isolation; obtaining an understanding of their cultural strengths and reactions to American culture; gaining knowledge about the barriers to their academic success and social well-being; and generating an increased understanding of their resettlement experience to fill gaps in agency knowledge.

It is recommended that IICONN systematize an introduction and integration to high school; develop clients to become peer mentors and youth leaders; obtain parent input and concerns; and establish youth programs to promote socio-emotional learning and cultural expression.

Site: International Institute of Connecticut
Site Supervisor: Claudia Connor
Advisor: Vicki Breitbart


An Umbrella of Coping Skills for Anxiety

Daphne Kanellopoulos MA ’16

There are significant mental health disparities for the lesbian, gay, bisexual, trans, and questioning (LGBTQ) population and few services to meet their needs. This project provided a support group to teach coping skills to LGBTQ individuals who suffer with anxiety.

There were six sessions where members came to discuss anxiety as well as to learn ways to cope with anxiety. All sessions had three to seven participants in attendance. The facilitator incorporated icebreakers and coping skills into the sessions as well as setting opening and closing intentions. Many participants revealed that they had specific anxiety surrounding their orientation and/or gender identity. They also had anxiety about how they dealt with negative experiences related to revealing their identity or staying closeted in some or all aspects of their lives. Many participants also cited finances as a stressor.

An evaluation was performed to find out if the members felt they learned new skills and whether or not they benefited from being in the group. Participants indicated that they learned new coping skills and felt they benefited from having a space to be able to discuss their anxiety with others. A couple of sessions had so much participation that the 90-minute session was extended. The evaluation revealed that people in the LGBTQ population need a place to come and discuss their anxiety and are interested in learning new ways to deal with their anxiety.

Site: Pride Center of New Jersey
Site Supervisor: Joseph Spulick, Operations
Advisor: Vicki Breitbart


The Living Legacy Project: Group Memoir Workshops for Senior Citizens

Stephanie Montero MA ’16

As the percentage of the 65+ population grows larger in the United States, the movement to assist senior citizens “age in place” has gained momentum. Aging in place refers to the capacity for an individual to safely, independently, and comfortably remain in their own home and community, regardless of age, income, or ability (Centers for Disease Control and Prevention, 2013). Certain challenges common in older age can threaten a senior’s ability to age in place. Two of these are social isolation and reduced self-esteem. Society’s inability to value or accommodate seniors can make such challenges even worse. For seniors to avoid institutionalization or premature hospitalization, they require social and emotional support from their community.

This Capstone project sought to improve issues of social isolation and low self-esteem through a six-session series of guided, group memoir workshops. Sessions were held in New Rochelle, NY at the Hugh A. Doyle Senior Center, which is supported by the government-funded Office for the Aging of New Rochelle. Seven aging in place seniors from the New Rochelle community participated in the project. The workshops provided participants with examples, information, instructions, suggested exercises, and support in regards to creating a personal legacy document. The aim was to not only improve the wellness of the senior through the workshops, but also to create a tangible document for their loved ones to cherish beyond their lifespan.

Short-term outcomes included improved self-esteem, increased feeling of connection to the community, and decreased feelings of social isolation, as revealed by an evaluation survey. Based on the results of this project, it is recommended that the Hugh A. Doyle Senior Center continues holding similar workshops and group meetings going forward, including a separate group for Spanish-speakers, and encourages previous participants to volunteer in getting more seniors involved.

Site: New Rochelle Office for the Aging
Site Supervisor: Phillis Maucieri
Advisor: Vicki Breitbart


Enlisting Letter Carriers to Serve as Advocates for the Elderly Community

Jenna Perrier MA ’16

With the continuously growing elderly population in the United States, there is an increased demand for initiatives that seek to serve this population with our limited supply of resources. While a sector of the elderly population resides in independent living, assisted living, and skilled living facilities, some of these facilities are not appropriate for the elderly who cannot afford these fees or who would prefer to age in place in their homes. As a result, there arises a sector of the elderly population who are living independently at home, sometimes without a family or another support network. By living under these circumstances, the independent elderly person is at an increased risk for issues with safety and isolation.

I worked with the Glen Cove Senior Center and the local post office to create a system that would mitigate the negative side effects of living alone, while resolving the issue of cost and the desire of the elderly to remain at home. In this project, letter carriers are trained to identify warning signs that indicate that an elderly person living alone along their route may need outside help or emergency intervention and to report them to the Senior Center or to the police. Capitalizing on the letter carrier’s regular presence and familiarity with their community, two seemingly unrelated organizations cooperated to create a beneficial and sustainable service for the elderly living in Glen Cove, New York.

Site: Glen Cove Senior Center
Site Supervisor: Carol Waldman
Advisor: Vicki Breitbart


Understanding Campus Sexual Violence: A How-To for Educators & Administrators in Higher Education

Shannon Ruth-Leigh MA ’16

Students who perpetrate violent acts. These policy changes have major implications for adjudication of campus violence, as well as for the role of the mandated reporter. For administrators and faculty to understand the implications, education and dialogue is needed. A pilot program, Understanding Campus Sexual Violence: A How-To for Educators & Administrators in Higher Education was developed for higher education professionals. The program aims to inform administrators and faculty on the current discourse around violence on campus and prompt discussion to develop concrete tools to better support the continued learning and development of college students affected by sexual violence. Data indicates the pilot program achieved success at increasing participants’ competence to support students affected by violence, which ultimately could contribute to increased confidence among students in an institution’s ability to appropriately respond to violence.

Site: Sarah Lawrence College
Site Supervisor: Dina Nunziato, LCSW, Director of Counseling & Psychological Services
Advisor: Vicki Breitbart


The Complexities of Connection: Unearthing Information on Patient-Physician Communication

Matthew Sheehan MA ’16

In the 21st century, the ideal of patient-centered care has become nearly ubiquitous within the American health care system. It is generally accepted that effective communication between patient and provider is crucial to achieving a patient-centered system. While this knowledge is established, it is unclear that it is consistently practiced remains unclear. To better understand the interactions, I interviewed a group of physicians in the Pediatric Emergency Room in a large city hospital about their experience learning to communicate with patients.

This project found that despite an increased focus on structured teaching of patient-centered communication in recent years, participants across the age spectrum learned predominantly through the observation of colleagues. Across the board, gaining the patient’s trust was recognized as the most important component of a clinical interaction. Participants indicated language differences between physicians and the immediate community presented formidable challenges. While physicians are certainly well-intentioned in their interactions, their varied paths to effective communication leave much to chance. Continuous learning opportunities that promote effective, evidence-based communication techniques should be emphasized. To help address existing language barriers, department leadership should prioritize the recruitment of Spanish speaking providers representative of the surrounding community.

Site: Columbia University Medical Center
Site Supervisor: Peter Dayan, MD
Advisor: Vicki Breitbart


Health Literacy and Understanding Montefiore MyChart

Rebecca Szer MA ’16

The United States Department of Health and Human Services defines “health literacy” as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Approximately nine out of every ten adults in the United States may not have a level of health literacy necessary to manage their health information. This contributes to low levels of activation and usage of patient portals. Patient portals are secure, electronic webpages designed to help patients access their healthcare information, communicate with multiple healthcare providers, facilitate care between various providers, view full prescription history, request prescription refills, and manage appointments.

The patient portal industry has seen a dramatic increase within the United States. As the United States healthcare system continues to employ patient portals in medical practice, patients will be expected to navigate a website and understand the portal functions to communicate with their physician and understand their healthcare. However, if patients with low health literacy levels do not properly understand how to access and navigate these patient portals, this could only increase health disparities.

Montefiore Healthcare System, a healthcare organization mostly within Bronx County, New York, recently adopted the patient portal system, Montefiore MyChart. With a majority of the patient population having low health literacy levels, I worked to create a patient-facing instructional video that would help increase patient portal use and decrease health inequalities among this community.

Site: Montefiore Care Management
Site Supervisor: Robert Green
Advisor: Vicki Breitbart


Creating Sexual Wellness Workshops for Domestic Violence Survivors with Disabilities

Natalie Taylor MA ’16

Eighty percent of women and sixty percent of men with disabilities are sexually assaulted before they reach adulthood. In a society that feels uncomfortable discussing sexual abuse or disability, it is vitally important to create spaces for people to learn and share about their sexual wellness. It is equally important that we allow for people to bring their full selves to these spaces. Conversations about sexual wellness should leave room for questions, fears, pleasure, trauma, intimacy, love, risk, and hope. Everything but the shame that is so commonly associated with sex, disability, and abuse.

A partnership with Freedom House, Barrier Free Living’s temporary housing in Harlem for domestic violence survivors which is the only shelter in the US that is fully accessible for people with disabilities, led to the creation of a series of workshops on sexual wellness. The small group workshops were designed to look at cultural expectations around sex and reproduction, offer general sexual wellness information and provide tools for how to have difficult conversations with partners, peers, and medical professionals about our sexual and reproductive health. The workshops were well attended and have sparked conversations about future trainings for residents and staff of Barrier Free Living. An additional workshop for staff on sex and disability broadened the interest and created a heightened awareness of the need to include sexual wellness in regular programming for the community.

Site: Barrier Free Living
Site Supervisor: Cynthia Amodeo
Advisor: Vicki Breitbart


Identifying the Barriers to Palliative Care Referrals

Bonnie Penny Verses MA ’16

This Capstone addresses Palliative Care, the treatment of chronically and terminally ill patients. Currently there must be a referral from a physician in order for a patient to be treated by a Palliative Care team. The protocol entails the ‘buy-in’ of the attending physician.

The strategy in conducting this research was to delve in-depth into the minds of healthcare providers with a focus on interventions on the healthcare infrastructure of medicine and the culture inherent in healthcare. Seventeen interviews were completed among: five thought leaders, four physicians of different specialties at community based hospitals; six recently trained nurses in Palliative Care; two professors in Palliative Care from the School of Nursing at Fairfield University; and one caregiver group with family members suffering from Parkinson’s disease.

The primary site of the research was at Greenwich Hospital, from which an IRB approval was granted. Greenwich Hospital is an affiliate of Yale New Haven Health System. Themes emerged as a result of the research: association of Palliative Care to hospice; a lack of understanding of Palliative Care; need for education; late referrals to Palliative Care; and concern for reimbursement. Recommendations focus on healthcare infrastructure, culture of medicine, and medical education.

Site: Greenwich Hospital
Site Supervisor: Dr. Donna Coletti, Director of Palliative Care
Advisor: Vicki Breitbart


Listening to the Voices of Patients to Improve Healthcare and Outcomes

Kay Bellor MA ’15

Promising research shows that involving patients and family in efforts to improve hospital care can yield dramatic results. Better patient experience in the hospital can also lead to enhanced health outcomes. The HAP student, under the auspices of the Montefiore Health Systems Customer Service Department developed the Voices of the Patient/Family Task Force project, which sought to bring this innovative approach to Montefiore. The program’s twofold goals were to decrease the prevalence of key points of patient dissatisfaction and to ensure Montefiore’s compliance with Centers for Medicare and Medicaid requirements for responding to patient concerns. To achieve the program goals, project staff proposed the creation of a task force consisting of patients, their families and staff. The task force would serve as the mechanism for involving patients and their families in improving care at Montefiore. Through the task force, members would give their perspective on prevailing themes found in grievance narratives filed by patients. Project staff expected that the patients’ input would improve staff understanding of problems and concerns. Knowing the right problem would increase the chances of making the right fix. While substantial progress occurred in data collection of key themes, reporting, and recruiting Task Force members, Montefiore temporarily suspended the program when the project leader retired from the organization. In the meantime, the HAP student encouraged hospital leaders to continue to utilize the project data as it provides a solid foundation to guide efforts to improve patient experience.

Site: Montefiore Medical Center
Site Supervisor: Leslie Bank, Director
Advisor: Vicki Beitbart


Unmet Health Needs of the YWCA White Plains Residents

Marikay Capasso MA ’15

Health issues for women with a history of mental illness, trauma, and insecure housing are well documented. Race and socioeconomic status further impact health. Access to appropriate and effective preventative care and better coordination of care are critical for marginalized and vulnerable women aging in supportive community housing.

The YWCA White Plains Residence is the largest provider of supportive housing for single women in New York State and the only provider in Westchester County. Most of the 193 residents are in “fair to poor health”. This capstone project focused on moving from episodic emergency care to preventative and coordinated care for the residents.

A free, voluntary, non-invasive, preventative health care program was offered onsite. Student technicians visited twice a week to capture vital signs (blood pressure, oxygen levels, pulse, and weight) and transmit them to a nurse for remote monitoring. To date, empirical and anecdotal results demonstrate more personal awareness of health status and the value of preventative care. Coordination between Residence caseworkers and the local hospital’s care coordination and discharge planning team improved residents’ care plans and reduced episodic treatment. The preventative program will continue for two more years, the recommendation is to add other culturally relevant health programming and to further efforts with the local hospital to continue the journey of better preventative health and care coordination.

Site: YWCA Residence White Plains
Site Supervisor: Lori Stanlick, Associate Executive Director
Advisor: Rebecca O. Johnson


Creating Connections: Transforming the Isolation of Illness through a Narrative Experience

Debra G. Finn MA ’15

For those experiencing illness, expressive writing as an adjunct therapy can provide a wide range of benefits to health and well-being including reduction in anxiety, stress, and isolation. Visible Ink (VI) is a program within Memorial Sloan Kettering Cancer Center (MSKCC) that has worked with individuals utilizing expressive writing with cancer patients since 2008. Much research exists on the effects of narrative on the illness experience, most often as a personal and private experience. By transforming this individual initiative into a group process, this project aimed to expand the benefits of narrative. A Blog Workshop for VI/MSKCC was developed. Blogging is a more public form of narrative that can enhance interaction between patient and reader. This workshop was intended to cut through the walls of isolation and to determine the possible benefits of this form of narrative as a potential therapeutic tool. 22 patients/potential bloggers were brought together. The participants heard and spoke to experienced bloggers, and to each other. They explored a blog format that allowed improved communication with an audience of friends, family and beyond. At the workshop, 18 out of the 19 participants were able to initiate their own personal blog site and publish their first posting. All participants and panelists stayed 45 minutes beyond the allotted time, further addressing the issue of isolation through an observable sense of community. Recommendations include replicating the workshop for other VI participants, plus other patient groups, and developing a group workshop format with other communication methodologies.

Site: Visible Ink
Site Supervisor: Judith Kelman
Advisor: Vicki Breitbart


Assessing Latino Caregiver’s Knowledge and Understanding of Medication Management for Children

K. Jennifer Johal MA ’15

Accessing, understanding and using the United States healthcare system is difficult for almost everyone. For people with low literacy and who come from other cultures, these tasks can seem impossible. Existing literature states low parental health literacy among the Latino population is related to poor health outcomes for their children. This project under the auspices of ACN Community Outreach at NewYork-Presbyterian-Columbia University Medical Center, explores Latino caregiver’s health practices and the possible uses of technology, specifically Smartphone applications (apps) to provide information about their child’s health care. The project included two focus group sessions (one in English, one in Spanish) with a total of 17 caregivers of children under the age of five who attend a Washington Heights Head Start Program. The focus groups addressed two aims: (1) to understand caregivers' current knowledge and issues concerning medication administration and management for their children; (2) to assess the current use and effectiveness of existing technology, and Smartphone health apps by caregivers to obtain health information. The findings suggest that Latino caregivers are interested and could benefit from a culturally appropriate and linguistically responsive Smartphone health app. While both focus groups discussed features they would like to see in a health app, the Spanish speaking group emphasized their personal experiences with access, communication with providers, and challenges with navigating the health care system. Latino caregivers identified a lack of trust that they have with the medical system which suggests the need for education of physicians, pharmacists and other health care providers to improve their communication skills and understanding of the needs of the Latino population.

Site: New York Presbyerian Hospital
Site Supervisor: Dr. Dodi Meyer, Medical Director; Emelin Martinez, Program Manager
Advisor: Vicki Breitbart


Choose Well, Be Well: Indiana University Health Nutrition Services Transformation

Deborah L. Jones MA ’15

Indiana University Health, a statewide system of 19 hospitals, serves a state that ranks 9th in obesity and 41st in overall health in the United States. In order to be consistent with its mission to promote healing and wellness, IU Health looked at its retail food venues and mandated a transformation. Choose Well, Be Well (CWBW) is the project conducted by the HAP student in concert with IU Health’s Nutrition Services Department to create a program of evidence-based nutrition standards for general service patient menus and retail venues. CWBW was two-pronged: create a cohesive team from the ranks of Nutrition Services leaders who had never worked together, and devise flexible nutrition standards that would meet the needs of a socially, culturally, and geographically diverse system. The team succeeded in creating standards for 18 components of food and food marketing and started pilot implementation in March. Perhaps the most important accomplishment, however, was developing a way to work together that significantly improved the team’s dynamic—an improvement that can carry over to future Nutrition Services initiatives. Said one member, “I think we are beginning to trust each other.” Sustaining that cohesiveness will depend on the team’s ability to promote IU Health’s healing mission, innovate, communicate consistently with its peers at all locations, and educate its customers about healthful eating both on-campus and off.

Site: Indiana University Health
Site Supervisors: Jane Ewing, Executive Director; Beth Roberts, MS RDN, CD, Clinical Nutrition Services Manager
Advisor: Vicki Breitbart


At Home in the City: Redefining Aging in Place Opportunities for Yonkers Seniors

Melissa Mates MA ’15

Aging in Place (AIP) is defined as, “the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income or ability level.” The demand for this option is greatest amongst adults age 55 and up. However, there are not enough available resources to accommodate the related needs of the rapidly expanding population. While different kinds of AIP programming exists, there has been a shortage of successful community and consumer based urban models that are able to serve diverse audiences. Partnering with the Westchester-based Center for Aging in Place, this project set out to identify the needs and challenges faced by different groups of older adults trying to remain at home within a local urban center.

In order to uncover appropriate AIP programming and create an effective bottom-up model, it was crucial to investigate the population-at-large and to use their input to fill in knowledge. gaps. Older Yonkers residents were an ideal audience because they experience fairly consistent circumstances while trying to live on their own, including: diminished health, economic, and social status. We recruited adults, age 55 and up, into focus groups that explored service gaps and their individual and community needs as they attempt to age in place. These conversations were also meant to help identify community activists who will help define the framework for new program models.

Site: Center for Aging in Place
Site Supervisor: Lois Steinberg
Advisor: Vicki Breitbart


Reducing the Impact of Language Disparities in the Pediatric Emergency Department

Amy Persaud MA ’15

Hispanic parents with limited English proficiency (LEP) who seek medical care for their children, experience several barriers which can be divided into three categories: language, literacy and cultural. These barriers include not having or knowing how to access health insurance for their child, language issues, low medical literacy levels and for some, also being undocumented.

To reduce these barriers a pilot volunteer program was developed for the Westchester Medical Center’s Caregiver Center that uses trained bilingual Hispanic volunteers in the pediatric emergency department to meet the needs of Hispanic LEP parents. The Hispanic volunteers are not certified medical interpreters, rather they provide families with resources, listen empathically to their concerns, provide support and serve as a liaison between the Hispanic family and medical staff. Of equal importance, families and emergency department employees are provided with a pictographic Communication Tool that enables day-to-day meeting of basic needs of patients and caregivers while their child receives treatment.

Initial outcome of this program suggests it will provide considerable value to patients, their families and the hospital, including increased patient satisfaction scores, reduction in misunderstandings and the elimination of medical errors.

As follow-up it is recommended for the Caregiver Center, to fully implement the volunteer program; track usage and effectiveness of both the volunteers and the Communications Tool; customize the Communication Tool for various hospital units and languages; and lastly, encourage WMC to comprehensively provide for the language needs of all patients and families.

Site: Westchester Medical Center
Site Supervisor: Patricia Boyce, Director
Advisor: Rebecca O. Johnson


#EpilepsyExchange: Social Media Meets Clinical Care

Chloe Politis MA ’15

Peer-to-peer health care has molded the way patients handle the adverse effects that come with a medical diagnosis. It allows for patients and their caregivers through online health forums, to engage in conversation with others who share similar health concerns, share their personal journey of diagnosis and treatment, and receive emotional support that is most often times not provided by their physician. One population that does not have any available online health forums is patients with epilepsy and their caregivers. People with epilepsy need support resources such as online health forums, because they have a higher incidence of neurobehavioral disorders than the general public. Epilepsy Exchange was developed through the Mount Sinai Hospital Epilepsy Center and Digital and Social Media Department, to give Mount Sinai patients and caregivers opportunities they could not find elsewhere. Epilepsy Exchange is a private Facebook group that allows them to post narratives and engage in conversation with other group members and physicians. Since the development of Epilepsy Exchange, social media has now given a whole new meaning to clinical care for people with epilepsy.

Site: Mount Sinai Hospital Center
Site Supervisor: John Ambrose, Director
Advisor: Rebecca O. Johnson


Understanding Dominican Women’s Perception of Diabetes

Jocelyn Rivas MA ’15

Diabetes is the fourth leading cause of death among Dominicans living in New York City (NYC). Even though they are the fastest growing Hispanic subgroup, there is little research available related to Dominican women’s views and management of diabetes. Conventional approaches to diabetes education don't take into account the unique cultural attitudes concerning chronic illnesses. As a result, they are often labeled ‘noncompliant’ by the medical community for not following the prescribed medical treatment. A qualitative study was conducted with 10 participants to further understand how Dominican women residing in NYC perceive diabetes. One focus group, one workshop, and three individual interviews were all conducted in Spanish. The data revealed the following themes: an understanding of what proper diabetes management involves; depression; uncertainty about where to find assistance; concerns over the cost of medications; and apprehension about the cost of healthy foods. Their negative experience with the condition of fresh produce in the Dominican Republic impacted their decisions about eating healthy foods. These findings suggest that medical professionals should provide alternative culturally relevant settings for diabetes education before concluding non-compliance. There also needs to be further exploration into self-organized informal groups as a more effective setting for supporting women in managing their diabetes. Finally, more community-based research on the health concerns and barriers for Dominican women in NYC is needed.

Site: Negritas Prayer Group
Site Supervisor: Bernalda Kesada
Advisor: Rebecca O. Johnson


Not Getting in on the Ground Floor: What a Hospital-Based Program Can Teach Us about Supporting Chronically Ill Students in Higher Education

Leslie Rott MA ’15

Chronically ill students have poorer educational outcomes when it comes to college than their healthy counterparts, including taking longer than average to graduate or not graduating at all. While this should be a concern for institutions of higher education, none contacted were responsive to this project. This capstone project therefore focused on students involved in the Charla de Lupus program, part of the Lupus Program at the Hospital for Special Surgery. For lupus patients, there were two main factors that impacted their knowledge about college: 1) Many students with lupus did not know about the resources available to them prior to college, and often found out about them when it was too late, and 2) Many people with lupus did not consider themselves to be disabled, which meant that even if they knew about resources, they did not take advantage of them. After conducting key informant and stakeholder interviews, and a targeted survey of students with lupus, a guide for physicians about how to talk to their patients about college was created, along with a tip sheet for students. For students and parents, 93 percent of participants felt that: 1) The tip sheet was useful, 2) They would use it in the future, and 3) They felt more confident about college planning. Some recommendations for the future include one-on-one coaching of students when they are applying to college, and using what was learned in this project and applying it to institutions of higher education.

Site: Hospital for Special Surgery
Site Supervisor: Jillian Rose; Dariana Pichardo
Advisor: Vicki Brietbart


Home Care Workers Community Based Participatory Research using Photovoice

Amy Russo MA ’15

Little prior research has been conducted by home care workers. Demand for home care workers arises from the aging of the population and a move to home-based care. Gaps between the fast-growing demand for and supply of workers persist. With two million employed and median annual earnings of $13,000, over half the workforce turns over annually. The workforce is 89 percent women and over half are people of color. Working with a Sarah Lawrence College Health Advocacy Program student under the sponsorship of the Paraprofessional Healthcare Institute, seven home care workers from Home Care Associates of Philadelphia participated in community-based participatory research using Photovoice. Workers attended structured workshops to discuss issues, share photographs, and identify common themes. Workers learned from each other’s experiences to form a richer understanding of their profession. They developed a sense of community. Common themes include the empathy and emotional intelligence required to do this work, conflicts when workers strive to achieve their standards of care within the confines of managed care and Medicaid/Medicare reimbursement policies, unsanitary and unsafe working conditions, challenges balancing home and work lives, economic challenges, and lack of respect for and understanding of their work on the part of the broader public and policy makers. Home care workers developed the capacity to analyze their working conditions, articulate messages to specific audiences, and understand how they can change their work lives.

Site: PHI (Paraprofessional Healthcare Institute)
Site Supervisor: Deane Beebe
Advisor: Rebecca O. Johnson


Fostering Resilience in Grandparents Raising Grandchildren

Brielle Weber MA ’15

The number of grandparents raising grandchildren in the US has increased by 50 percent in the last decade. These “grandfamilies” are in need of support and more resources than are currently available for them to be successful parents the second time around. Research identifies children and adults who succeed in spite of adversity as being resilient. This means they possess certain strengths that have allowed them to benefit from protective factors, such as close relationships with their caretakers or communities, and have helped them overcome adverse situations (or risk factors) over time. This project seeks to increase access to a like-minded community, so that individuals are better able to channel and use protective factors to minimize risk and therefore become more resilient. This intervention, in partnership with Riversong Christian Learning Center in California, Maryland, is to create a monthly support group for grandparents. This will help build awareness of the strengths and resources these grandparents already possess, and identify and fill gaps in needed support thereby reducing stress and increasing caregiver self-confidence. By utilizing a modified version of the Parenting the Second Time Around (PASTA) curriculum, this program will help build the parenting skills of these grandparents with the ultimate impact of increased resilience in both the grandchildren and the grandparents. It is recommended that this support group move to the Lexington Park Library as soon as possible and apply for funding from the Department of Aging under the National Caregiver Support Act.

Site: Riversong Christian Learning Center
Site Supervisor: Robin Beale, Director
Advisor: Rebecca O. Johnson