Promoting Healthy Weight Colloquium 3.0: A Socio-Ecological Perspective – Policy at All Levels

 

Dr. Shelnutt

Dr. Karla Shelnutt presenting her work for The University of Florida Extension’s Family Nutrition Program & Florida’s SNAP-Ed Program

The Promoting Healthy Weight (PHW) Colloquia are a biannual series, held each spring and fall, that highlights the latest research in maternal and child health nutrition. The Colloquia are for practitioners, health agency employees, students, faculty, researchers, families, and the community. Viewers can attend the event onsite or view the live or archived webcast remotely.

On Friday, March 29, 2019, The University of Tennessee’s MCH Nutrition Leadership team along with the Department of Nutrition hosted the Promoting Healthy Weight Colloquium. The event, which launched our 3rd PHW Colloquia series focused on illustrating how policy is used to promote healthy weight in the MCH population at all levels of the Socio-Ecological Model (SEM) by Urie Bronfenbrenner. 

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The Spring 2019 colloquium featured five speakers, which included distinguished faculty from the Departments of Child & Family Studies and Public Health at UT, Dr. Hillary Fouts and Dr. Carole Myers, who introduced the Socio-Ecological model as a framework for promoting healthy weight and discussed how policy can influence healthy weight promotion at all levels. The next speaker, Dr. Karla Shelnutt, from The University of Florida provided an overview of the extension program and SNAP-Ed interventions from the individual level to a Policy, Systems, and Environmental (PSE) approach. Our fourth speaker, Jennifer Russomanno a DrPH student in the Public Health Department, presented on ways to connect participants in the Women, Infants, and Children (WIC) program with local farmers. To conclude, Leslie Lewis, from the Louisiana Department of Health spoke about the Collaborative Improvement & Innovative Network (CoIIN) and its role in implementation of state-level policies for the promotion of children’s healthy weight.

To view the archived Spring 2019 colloquium, please visit the link below:
PHW3.0: A Socio-Ecological Perspective—Policy at All Levels

Improving CHW’s Work in the Spectrum of Cancer Care Across Minnesota

yetundeYetunde is a 2nd year trainee at the University of Minnesota – Twin Cities. She is currently finishing up her MPH and dietetic internship at the UMN School of Public Health. She earned her Bachelor in Science in Nutrition – Dietetics at Auburn University in 2017. Her interests include maternal and child health, mental health, and nutritional counseling. She hopes to primarily work with women and children of color. 

Community health workers (CHWs) are public health workers that typically come from the same culture, ethnicity and/or socioeconomic background, and speak the same language as the communities they serve. Because they often have similar life experiences as those they assist, they are able to build trusting relationships with their communities and are therefore an important link between health services and the people. CHWs are also involved in a number of other activities that seek to increase the health knowledge of both individuals and the community such as informal counseling, education, support, advocacy, outreach, and providing resources (1).

The Minnesota CHW Curriculum cancer course focuses on the role of the CHW when working with patients with cancer and their families. It places emphasis on understanding cancer, its risk factors, screening for detection and diagnosis, and the types of cancer treatments. It also seeks to understand the emotional factors involved when a cancer diagnosis is made, its treatment, and cultural considerations that must be addressed. Lastly, it helps CHWs in identifying resources and ensuring client access to those resources, as well as aid and support clients and families (2). However, the literature still reveals gaps in cancer training among CHWs in Minnesota.

The goal of my culminating experience (Master’s project) was to better understand the needs and barriers of CHWs and their health care employers as it relates to cancer detection, treatment, and survivorship of clients and their families across the state of Minnesota. Understanding these barriers could improve CHWs’ role in the spectrum of cancer care. I had the privilege of completing this project under the direction of the Program Coordinator of the Comprehensive Cancer Control at the Minnesota Department of Health, the Minnesota Cancer Alliance, and the Cancer Health Equity Network.

After completing a literature review, planning for data collection, and conducting 8 key informant interviews (2 more written responses to the interview questions were received totaling 10 participants), 9 top themes were discovered after thematic analysis: 1. Enrolling clients in screening programs; 2. Providing education; 3. Involvement in the community; 4. Providing culturally appropriate care; 5. Care coordination; 6. Transportation for clients; 7. Integration into the healthcare team; 8. Training for CHWs and 9. Defining the scope of the CHW. Based on the results of the interviews, there are a few recommendations that could be made to help elevate the work that CHWs do in the spectrum of cancer care in Minnesota: 1. Further formal training for CHWs, 2. Integration of CHWs into the primary care team, and 3. Clear scope of practice for CHWs.

CHWs have been shown to play a beneficial role on any interprofessional team, and this also applies to serving clients on the spectrum of cancer care. With further research and implemented recommendations, CHWs have the ability to enhance their work in the spectrum of cancer care in the state of Minnesota.

Through my research project, I acquired the Critical Thinking, Communication, Cultural Competency, and Working with Communities and Systems MCH Competencies.

References:

  1. https://www.health.state.mn.us/facilities/ruralhealth/emerging/chw/docs/2016chwtool.pdf
  2. http://mnchwalliance.org/wp-content/uploads/2012/12/Minnesota-CHW-Curriculum-Outline-Updated-Feb-2015.pdf

Western Partners Trainee Spotlight: Alicia Yang

Alicia is a 2nd year Master of Public Health candidate at the University of Washington, Seattle. She holds a degree in Food and Nutritional Sciences from Seattle Pacific University and completed her dietetic internship at Golden Gate Dietetic Internship. She worked in outpatient care and nutrition research as a registered dietitian before returning to school. Her interests include the intersection between social determinants of health and the public sector, and their impact on women’s health and nutrition. 

Highlights of the MCH Nutrition Conference 2019 in Washington, DC

Overview

The MCH Nutrition Conference was a fortuitous opportunity to connect faces to many names and voices I had seen in e-mails and heard on Zoom calls. Many I had met at the Nutrition Leadership Network Conference in February (a networking conference of the MCH grantees and trainees in 13 Western states). However, this weekend in Washington D.C. had a different purpose. In addition to meeting each other and giving updates of our programs, trainees participated in cultural competency and policy trainings.

We started our day with updates on a federal, regional, state and program updates. In short:

  • Federal: Update and Q&A with Michael Warren and Lauren Raskin Ramos from the Maternal and Child Health Bureau (MCHB).
  • Regional: Obesity Enhancements led by University of Minnesota (Jamie Stang) and University of California, Los Angeles (Leslie Cunningham-Sabo)
  • Regional Leadership Programs
  • Emerging New Leaders in PH Nutrition
  • Western MCH Nutrition Leadership Network
  • Association of State Public Health Nutritionists: Children’s Healthy Weight Coalition
  • Trainee Peer Mentoring Network Update

Thoughts on Cultural Competency: Reflection on a Training from Tawara Goode

After lunch, we received valuable training from Tawara Goode, MA director of Georgetown University’s National Center for Cultural Competence. Her training on cultural competency noted the multiple dimensions of culture that “affects how we work, parent, love, marry, understand health, mental health, wellness, illness, disability and end of life.” As public health practitioners and professionals we are responsible for not only understanding how organizational cultural affects us, but also doing the work to recognize and seek understanding of the multiple cultural identities of the persons and populations we serve. Further, these individuals and populations interact with multiple systems at once. The convergence of multiple cultural contexts is illustrated below.

Slide on the Convergence of Cultural Contexts from the Cultural Competency training given by Dr. Tawara Goode.

I asked Dr. Goode about the connection between cultural competency and equity, diversity and inclusion (EDI), which I hear more often now than the former. (UW Seattle has a clear EDI initiative and the School of Public Health recently created.) She distinguished that they are acutely different. EDI, when it is clearly and specifically defined, aim to address external factors that negatively influence the diversity of individuals and/or group culture.

I interpreted this to mean that cultural competency is the internal, personal work this is required of us in order to truly address the systemic barriers to equity, diversity and inclusion. Future food for my personal thought: How can I bring cultural competency to the spaces I learn and work in, which are primarily focused on systemic and institutional EDI?

Policy Training: A Vital Component to the Nutrition Profession

Nancy Chapman, MPH, RDN (left) and Alison Hard, MS, RD in a hearing room on the Hill.

Currently, (as of March 2019) only two dietitians work on The Hill, as stated by Alison Hard, MS, RDN, staffer of the House Labor and Education Committee. In the photo above, Ms. Hard (right) speaks with Nancy Chapman, MPH, RDN, who has years of experience advocating for nutrition policy in Washington. Ms. Chapman organized four speakers to give us a glimpse of nutrition policy in the non-profit, immigration policy, and federal government contexts:

  • Jen Holcomb, US Advocacy and Outreach Manager for 1,000 Days
  • Renato R. Rocha, policy analyst for The Center for Law and Social Policy
  • Alison Hard, MS, RD, House Labor and Education Committee
  • Robert Rosado, Senate Committee on Agriculture, Nutrition, and Forestry

This was probably my favorite part of our two-day conference, mainly because I have had the least exposure to policy. Renato Rocha discussed how public comments can impact rulings on policy. Specifically, when it was proposed to add WIC to public charge, CLASP rallied several organizations and thousands of public comments to delay the public charge ruling. We discussed how public health practitioners and researchers can best contribute to public comments. Both Renato and Jen agreed a combination of personal stories from the field of how rulings can directly affect (or have already affected) individuals, families and communities in addition to compelling data are most effective.

We learned from Ms. Hard and Mr. Rosado about their roles and the process of writing and passing the Farm Bill as well as their role in education Congresswomen and Congressmen about it. Because so many Congress members are freshman, which requires a substantial amount of their time to educate them and their staffers in order to make informed decisions about the Farm Bill. Following, after a training on how to speak with our Representatives, we went to our respective state Congress members.

Congresswoman Primila Jayapal was on break back in Washington State, so I spoke with Stephanie Kang, her staffer working on health and nutrition issues. Unlike many Legislative Assistants, Stephanie is a fellow for Congressional Progressive Caucus Center. She is a Doctor of Public Health at Harvard University working on the Medicaid for All Bill. Because we are not allowed to advocate under as Title V recipients, my fellow trainee Alyssa Thomas (from Colorado State) and I spoke to Stephanie about the MCH Traineeship in developing nutrition leaders and how we could be a potential resource to Congresswoman Jayapal in the future. We continued to chat about the role of public health in federal policy; Stephanie shared that public health practitioners/students rarely stop in to speak with the Congresswoman or her LAs. She emphasized the need for public health students to experience the operations of developing policy.

The end of Day 2 involved grouping up to discuss and strategize future steps for trainees and grantees. Trainees discussed the future of this blog as well as how to continue to create connections and to make our group more cohesive.

Overall, this conference offered a plethora of information vital to our professions, regardless of the specific job. It was helpful to feel more involved in the traineeship through meeting other trainees, faculty and other grantees face-to-face. I would say it has been a highlight of the traineeship so far and would encourage any future trainee to make it a point to attend.