Effects of pandemic-era social policy changes on healthcare outcomes and disparities
As a part of a NINR R01 and NIMHD R01 (PI Rajan Sonik), the Health Equity Research Lab will be collaborating with researchers from Brandeis University on two studies to examine the impact of changing social policies during the COVID-19 pandemic on healthcare outcomes and disparities by race, ethnicity, and disability status.
The NIMHD R01 titled, “Growth and decline in SNAP generosity: outcome and equity implications” will utilize 1) US Medicaid data and novel, linked, Massachusetts-wide 2011-2025 healthcare claims, public health, and SNAP administrative data and 2) A natural experiment created by the Families First Coronavirus Response Act (FFCRA) to examine the effects of monthly SNAP benefit enhancements on healthcare outcomes and disparities.
The NINR R01 titled, “Unwinding pandemic-era social programs: Effects on healthcare outcomes and disparities” will study the effects of reductions in social welfare generosity after the initial period of the pandemic on healthcare outcomes and disparities by race, ethnicity, and disability status.
Investigators: Rajan Sonik, Benjamin Lê Cook
Point Person at the Lab: Akhil Reddy
Team Members: Kimberley Nicholson
Digital Health Equity Partnership Evaluation
The goal of the Digital Equity Partnership program is to increase digital inclusion among low-income people with disabilities and people with unstable housing by supporting participating organization to develop Tech Navigator programs. For the purposes of this program, the target population of people with disabilities includes people with serious mental illness, people with SUD, people with ID/DD, people with brain injury, people with physical disabilities and any other condition that is considered a disability.
Investigator: Dharma Cortés
Point Person at the Lab: Katie Holmes, Peyton Williams
EFFECTIVENESS AND IMPLEMENTATION OF A CLINICAL DECISION SUPPORT SYSTEM TO PREVENT SUICIDAL BEHAVIOR (nimh r01)
The months following discharge from a psychiatric hospitalization are a high risk time for suicide attempts. Machine learning and predictive algorithms could be advantageous in improving the ability to identify those at risk for suicide after discharge. The goal of this study is to test the effects of providing emergency department clinicians with enhanced information about their patients’ risk of a suicide attempt in the 6-months after leaving the emergency department through a prototype app that generates predicted probabilities of suicide attempt. As part of Massachusetts General Brigham’s Center for Suicide Research and Prevention P50, CHA’s Health Equity Research lab will be implementing the pilot study at CHA Cambridge Hospital Emergency Department.
Investigators: Nicholas Carson, Rajendra Aldis, Will Schleyer
Point Person at the lab: Peyton Williams
Team members and collaborators: Taylor Witkowski, Clara-Lea Bonzel
IMPROVING SUICIDE RISK PREDICTION IN RACIAL, ETHNIC, AND LINGUISTIC MINORITY YOUTH (nimh r34)
As part of Massachusetts General Brigham’s Center for Suicide and Prevention P50, CHA’s Health Equity Research lab will be working with MGH to implement a predictive suicide algorithm to predict suicide risk for racially, ethnically, and linguistically minority youth within 6 months of discharge at CHA Cambridge Hospital Emergency Department. We hope to evaluate the added predictive value of social determinants of health and computerized adaptive testing collected as part of standard care at CHA.
Investigator: Nicholas Carson
Point Person at the lab: Peyton Williams
Team members and collaborators: Taylor Witkowski, Clara-Lea Bonzel
Improving Mental Health Treatment for Individuals in Crisis Interacting with the Criminal Justice System (NCHATS)
As part of Michigan State University’s P50 for the National Center for Health and Justice Integration for Suicide Prevention (NCHATS), CHA’s Health Equity Research Lab will be working with the Cambridge Police Department (CPD) to assess the effectiveness of the Family and Social Justice Section (FSJS) intervention, a police-based multi-system intervention to train patrol officers in mental health first aid and trauma-informed policing, link community and healthcare services, and follow-up on mental health-related calls with police department-based case management by a team of specialty mental health resource officers and mental health clinicians. The FSJS intervention will be compared to usual treatment in neighboring towns and an enhanced FSJS intervention that includes a CHA-based family navigator who works closely to connect individuals to services when they are brought into the emergency department by CPD officers. These assessments will take place at both CHA and Mt. Auburn Hospital.
Investigators: Benjamin Lê Cook, James Barrett
Point Person at the Lab: Taylor Witkowski
Team members: Christopher Fischer, Will Schleyer, Valeria Chambers, Dharma Cortes, Michael Flores, Akhil Reddy, Peyton Williams
ALACRITY CENTER FOR EARLY SCREENING AND TREATMENT OF AT-RISK YOUTH (ESTORY)
Cambridge Health Alliance’s Health Equity Research Lab has been awarded a NIMH P50 grant entitled the Center for Early Screening and Treatment of at-Risk Youth (the eSToRY Center) (PIs Benjamin Cook and Philip Wang). The eSToRY Center is dedicated to early detection of mental illness, preventing adverse outcomes, improving quality of care, and fostering equity in treatment for racial, ethnic, and language (REL)-minority youth (defined as children, adolescents, and young adults <25 years of age). Across multiple research projects, we hope to establish a learning health community in the diverse neighborhoods surrounding Cambridge Health Alliance (CHA) to address the well-recognized barriers to care for youth with mental health needs, deploying a sophisticated health data infrastructure to adapt, test, and implement evidence-based practices to accelerate health care improvements. We will hold regular training events and pilot research grant opportunities intended to build capacity to identify and reduce racial, ethnic, and gender disparities in mental health treatment. Click here to read more about the R34s.
Investigators: Benjamin Lê Cook, Philip Wang
Point Person at the Lab: Taylor Witkowski
Team members: Margaret Weiss, Eleanor Richards, Nicholas Carson, Dharma Cortés, Ana Progovac, Valeria Chambers, Michael Flores, Lindsay Overhage, Gareth Parry, Akhil Reddy, Katie Holmes, Peyton Williams, Danta Bien-Aime, Sarah Mazen, Matthew Nock, Sharon-Lise Normand, Katherine Grimes, Diya Kallivayalil, Kate Zona, Caryn Rodgers
Assessing suicidal behavior using digital phenotyping among adolescents and transitional age youth
An EMA (ecological momentary assessment) and qualitative interview study examining suicidal thoughts and behaviors among youth of color and their families, and the effects of how family conflict, discrimination, and childhood trauma during the COVID-19 pandemic. Our aims in this study are to:
Establish feasibility and acceptability (as measured by qualitative responses and app utilization data) of a smartphone application for passive and active data collection related to suicidal behavior. The app will be optimized for use by disadvantaged youth and young adults in outpatient mental health treatment for suicidal behavior, as well as their caregivers.
Users will report the app is feasible and acceptable, with suggestions to address privacy concerns and maintain initial engagement in the app over longer periods of time.
Explore the experiences of despair, discrimination, and COVID-19-related stress of disadvantaged youth as they relate to their communities and household and the interplay of these spaces with the COVID-19 pandemic. The interviews will focus on 1) where, when, and how youth move in their day-to-day life; and 2) the relation between those spaces and their experience of suicidality, discrimination, and access to resilience recourses.
Establish digital phenotypes of suicidal individuals based on passive smartphone data and behavioral data recorded by adolescents and their caregivers.
We will identify associations between suicidal behavior, psychiatric symptoms, discrimination, trauma, and family conflict that will help to isolate intervention points for improved detection of suicidality.
Investigators: Nicholas Carson, Dharma Cortes, Todd Reid
Point Person at the lab: Peyton Williams
Team members and collaborators: Lily Xie, Eric Schlossberg
Impact of the New York State Medicaid Value-Based Payment Model on Opioid Use Treatment and Equity
Individuals living with Opioid Use Disorder (OUD) experience disproportionately high morbidity and premature mortality in the United States, with these burdens escalating among minoritized groups. As such, there is a need to identify state-level policy levers that can help ameliorate the devastating effects of OUD. To this end, our study assesses the overall impact of New York State’s Medicaid Value-Based Payment (VBP) policy on OUD-related outcomes and the policy’s racial and ethnic equity effects. We will also evaluate the moderating influence of individual- (e.g., comorbidities), area- (e.g., provider supply), and policy-level (e.g., variation in provider risk level within VBP arrangements) factors on OUD-related outcomes. Results from this study will fill an evidentiary gap regarding Medicaid VBP policies’ effects among vulnerable and high-need beneficiaries, providing valuable information to states implementing or considering VBP adoption. This research is being conducted in partnership with the New York State Department of Health.
Investigators: Michael Flores
Point Person at the lab: Sarah Mazen
Team members and collaborators: Benjamin Cook, Paloma Luisi, Marcela Horvitz-Lennon, Zev Schuman-Olivier, Maureen Stewart, Sharon-Lise Normand, Gareth Parry, Katie Holmes, Sarah Mazen
Check out our past projects here!