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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • August 04, 2015

    By MedStar Health

    That “phantom pebble” and its accompanying pain may not be your imagination, but rather a common condition known as Morton's neuroma. Most often found in the spaces near the second or third toe, Morton's neuroma results from a swelling of a nerve or adjacent tissue.
  • August 03, 2015

    By MedStar Health

    Peripheral Vascular Disease is a potentially serious, but treatable circulation problem. It occurs when the vessels that supply blood flow to the legs are narrowed. PVD is typically caused by atherosclerosis, or plaque build-up inside the vessel walls.
  • January 08, 2015

    By MedStar Health

    Obstetrics and Gynecology
    Started in 1993 as a Resident
    Joined the Staff in 1997

    REMEMBERING LILLIAN MORSE: TRAINING A GENERATION

    Was it nerve wracking as a new nurse, tech, intern or resident? You bet. But those of us who worked with Lillian Morse, a retired surgical tech from Labor and Delivery, will always remember and be thankful for her mentoring ways.

    Lillian was a fixture in Labor and Delivery and always looked out for other employees, especially the new ones, literally reaching out to help them. When I was a resident in the operating room just barely learning procedures and wondering what to ask for next, Lillian would put the instrument in my hand before I would even ask for it. She would say "Here, this is what you need next" without saying anything more.

    A dedicated surgical tech, she taught many about the standard operating procedures they were just getting used to performing and made a lasting impact on a generation of employees. She would take new students, new nurses and new residents under her wing and make sure they learned how to scrub, gown and glove properly. She had a great personality, was positive, supportive and helpful.

    Lillian was dedicated to the Obstetrics unit and arrived early before her shift every day and well before surgery started. She made sure the OR was well-stocked every morning, was a constant presence and made things run smoothly for everyone.

  • January 08, 2015

    By MedStar Health

    Internal Medicine
    1958 - 1998

    THEN AND NOW:
    FROM LIMITED TREATMENT OPTIONS TO A VAST ARRAY

    In March of 1958, I was an intern at the old Garfield Hospital so by default, I became a member of the first medical resident class at MedStar Washington Hospital Center when Garfield's operations transferred over. A mere month later, our first child, Susan Elizabeth, was born here, further assuring that 1958 - and my introduction to MedStar Washington Hospital Center - would forever remain in my mind.

    MedStar Washington Hospital Center was a revelation - a great, modern building, with private and semi-private rooms where Garfield and the other old hospitals all had wards. That took some getting used to! I don't know if we were aware of it then, but all of medicine was on the cusp of going through a dramatic change. At the time, specialists and sub-specialists were pretty rare and general practitioners did almost everything - from caring for patients with infectious diseases like TB and spotted fever to delivering babies.

    This was also before the advent of all the changes in medical financing, like Medicaid, reimbursement rates and so on. My first year in private practice I made $11,000 from fee-for-service - I thought I was a millionaire! But because there were so few "safety nets" for poor patients who couldn't afford care, the Hospital Center also operated a clinic. I remember volunteering there half a day, every week, to work for free. A lot of us did.

    Then as now, the Hospital Center cared for the most complex cases. But by today's standards, the weapons in medicine's arsenal in 1958 were quite limited. We didn't yet know about cholesterol and lipids, and didn't have any effective drugs to treat high blood pressure. All we had was insulin, penicillin, streptomycin, sulfonamides, digitalis, Pitocin, Thorazine, phenobarbital - that was about it. Compare that to today's PDR - it's at least three inches thick!

  • January 08, 2015

    By MedStar Health

    Section Director, Surgical Critical Care Services
    Start Date: 1980

    ADVANCING CRITICAL CARE:
    THE GROWTH OF A DISCIPLINE

    I vividly remember my first day at MedStar Washington Hospital Center. I was starting as an attending internist along with another new doctor on the service: Joy Drass, now CEO of MedStar Georgetown University Hospital! We were joined by Fred Finelli—then a resident, now president of the Hospital Center's medical staff—and surgeons Bikram Paul and Mario Golocovsky, who were critical care and trauma attendings at the time. I still have the original schedule from that first week.

    It was an exciting time to be at the Hospital Center. Technological and therapeutic advances were allowing us to keep ill patients alive longer than ever before. To give them the best chance of survival, we found a need for physicians who were, in effect, generalists in all organs but with a special focus on the complexities of acute illness and injury. And thus was born the field of critical care medicine-and outgrowth of Internal Medicine, Surgery, Anesthesiology and Pediatrics.

    The Hospital Center was one of the first to establish its own Surgical Critical Care program, and today is one of the best in the nation. It has developed and evolved extensively over the years, and now includes an experienced critical care team representing many different disciplines, including nine intensivists. From two Surgical Intensive Care Units and 27 beds in 1980, we have grown to 59 beds spread out over five Critical and Intermediate Care Units.

    In parallel, the systems of medical and neonatal critical care have significantly evolved. Today, in addition to training the hospital's own surgical and pulmonary critical care residents, we also have students, residents and fellows from the National Institutes of Health, Walter Reed Army Medical Center, Bethesda Naval Medical Center, MedStar Georgetown University Hospital and the Uniformed Services University of the Health Sciences.

    While most surgical patients have better than a 95 percent survival rate, one difficult part of our job is knowing when to say "enough" for the few who are beyond help. We need the wisdom to recognize when patients won't get better, and to know when to step away from technology. Then our attention turns solely toward helping patients, families and even other providers through the final days of life, providing comfort to all.

    Every day, the Critical Care team is challenged to use our skills, technology and available resources expertly, safely and compassionately.

  • January 08, 2015

    By MedStar Health

    Before MedStar Washington Hospital Center even opened it doors in 1958, doctors were instrumental in planning and shaping the new organization.