Browsing by Author "Silverman, Ross"

Now showing 1 - 6 of 6
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    Community Health Workers: An Examination of State Policies and Analysis of a Healthcare-Based Intervention for Diabetes Management
    (2023-06) Hansotte, Elinor Alice; Stone, Cynthia; Dixon, Brian E.; Silverman, Ross; Staten, Lisa
    Community Health Workers (CHW) are trusted frontline members of the public health workforce with a unique understanding of the communities they serve. CHW interventions have been shown effective and economical in improving certain health outcomes, including diabetes-related complications and self-management. The ability of CHWs to relate to patients in a culturally appropriate manner positions them to better address social determinants of health and inequities than many allied health professionals. State-level CHW legislation varies by jurisdiction and can direct CHW processes including definitions, funding, and scope of practice. The Diabetes Project – Indianapolis Neighborhoods (DIP-IN) intervention employs clinic-based CHWs to work with high-risk patients with diabetes in three Indianapolis communities with disproportionately high diabetes prevalence rates. DIP-IN CHWs are based in select Eskenazi Health Federally Qualified Health Centers and deliver services to patients primarily through home visits or phone calls. This dissertation examines CHW policies and the impact of the DIP-IN CHW intervention on patient outcomes in relation to a comparison group. This dissertation includes three studies 1) a state-level policy surveillance exploring legislation that includes best practices for CHW policy, 2) a study using a difference-in-difference approach through the application of generalized linear mixed models to estimate the effect of DIP-IN on A1C and hospital outcomes, and 3) a study using multivariat regression and negative binomial modeling to estimate the impact of DIP-IN on COVID-19 hospitalization and length of stay. As financing influences duration and application of CHW interventions, this dissertation aims to explore the landscape over time of CHW legislation and evaluate a privately funded CHW program model intended to improve health outcome among high-risk patients with diabetes. It also aims to strengthen the knowledge base for CHW involvement in improving clinical-community linkages to support diabetes management.
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    Ebola Virus Disease - Legal and Ethical Considerations for Indiana
    (Richard M. Fairbanks School of Public Health, 2014-10) Williams, Matthew; Silverman, Ross; Duwve, Joan
    The Ebola Virus Disease (EVD), formally known as Ebola hemorrhagic fever, is a virulent and often deadly infectious disease. Fatality rates for the disease have reported to be as high as 90% following contraction. As of October 14, 2014, a total of 8,914 probable, confirmed, and suspected cases of EVD and 4,447 deaths due to the disease, have been reported to the World Health Organization (WHO) by the nations of Liberia, Guinea, and Sierra Leon.
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    An Examination of Opioid Prescribing Policy and Clinical Practice in the Context of the United States Opioid Crisis
    (2020-11) Danielson, Elizabeth Caitlin Anne; Menachemi, Nir; Harle, Christopher; Blackburn, Justin; Silverman, Ross
    In 2017, the United States government declared that the opioid epidemic was a public health emergency. Among responses to address the epidemic, the Centers for Disease Control and Prevention released a set of opioid prescribing guidelines for primary care clinicians. Since their release, federal agencies and experts have been interested and concerned about their application in policy and clinical practice. This dissertation examines how some of these federal recommendations were implemented in clinic practice and state law, as well as the effects of related prescribing laws. This dissertation includes three studies 1) a qualitative analysis of clinician and patient discussions about opioid-related risks, benefits, and treatment goals, 2) a policy surveillance study of state tapering laws and their consistency with the CDC guideline’s opioid tapering recommendations, and 3) an empirical study of the effects of morphine milligram equivalent daily dose laws and acute opioid prescribing laws on pain medication prescribing for patients with Medicaid. Overall, this dissertation attempts to understand the translation of national opioid prescribing guidelines into policy and their effects on healthcare delivery.
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    Examining the Variability in and Impact of State-Level Regulations of Opioid Treatment Programs
    (2019-09) Jackson, Joanna Rachel; Menachemi, Nir; Harle, Christopher; Silverman, Ross; Simon, Kosali
    The United States is experiencing a severe opioid use epidemic with more than 2 million people currently suffering from opioid use disorder (OUD), of which, over 1 million need treatment. Opioid treatment programs (OTPs) are evidence-based modality providing comprehensive care to individuals experiencing OUD. OTPs provide counseling, medical assessments, and medication-assisted treatment, which decrease the use of illicit opioids, reduce associated deaths, criminality, and improve the psychosocial wellbeing of its patients. However, OTPs have been extensively regulated at the federal, state, and local levels with little consistency and varying degrees of enforcement across the country, particularly at the state level, creating a “regulatory fog”. This complex regulatory environment has made it challenging to study new or changing regulations and their impact on health outcomes. In order to better understand the variation of OTP regulation, this dissertation: (1) employs public health law research methods to map the entire landscape of state-level regulation of OTPs and associated state characteristics in effect on January 1, 2017; (2) examine how state-level regulations affect the delivery of care from the perspective of OTP administrators through key-information interviews; and (3) examines associations between regulatory burden and related health outcomes of individuals experiencing OUD, by state.
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    How Can Public Health Leaders Improve School Compliance with the Indiana Department of Health Mandatory Vaccine Requirements for School-Aged Populations?
    (2023) Carlson, Megan Marie; Stone, Cynthia; Silverman, Ross; McCormick, David
    Primary and Secondary Schools in the United States have consistently served as a safety net to prevent outbreaks of vaccine-preventable diseases, with state policy enactment requiring vaccines for school entry. While states have long implemented vaccination mandates for schools as a public health measure, the enforcement of those mandates by states and schools has been inconsistent. Over the past few years, there has been a significant decline in the vaccination rates among Indiana children, which was recently accelerated by the COVID-19 pandemic. Public health officials and legislatures continue to adopt policies and laws to combat growing vaccine noncompliance and non-medical exemption requests. However, an essential component of this process is being overlooked, the implications for schools, particularly for schools without a medical professional on staff. The purpose of this study is to gather qualitative insights from school personnel regarding perceptions, challenges, and barriers impacting the enforcement of state-mandated school entry vaccines. The overall aim of this study is to draw on the experiences of these key participants and ‘experts’ to inform public health interventions or policy changes that will support improved vaccination reporting and compliance among school systems. The Consolidated Framework for Implementation Research (CFIR) framework was used to examine the implementation of the school vaccine mandate by school personnel who played a role in the vaccine requirement process. Semi-structured interviews were conducted with a range of personnel (n=25) supporting medical, non-medical, and administrative roles within a public or charter school or district. Interview Guides for the semi-structured interviews were developed focusing on known current processes of school vaccine mandates applied to constructs within the Inner Setting domain. Responses were categorized into themes based on eleven constructs from the CFIR Inner Setting domain. Findings show school personnel experience a variety of conditions, challenges, and barriers impacting their abilities to comply with state vaccine requirements. Findings also yielded several considerations for facilitators to improve vaccination uptake. A plan for change to improve vaccination rates through a policy analysis and subsequent policy change is presented.
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    Indiana Syringe Exchange Program
    (Richard M. Fairbanks School of Public Health, 2015-08) Servies, Alyssa; Reynolds, Melissa; Silverman, Ross
    According to the Centers for Disease Control and Prevention (CDC), “syringe exchange programs provide free sterile syringes and collect used syringes from injection-drug users to reduce transmission of blood borne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus.” Such an approach falls under the category of public health prevention known as “harm reduction,” which aim to minimize disease spread and injury (to the individual and to others) associated with high risk behaviors.