Tennessee Health Research Articles

Our way of being: Infant and Early Childhood Mental Health workforce development in Tennessee.

The optimal relational experiences of infants and young children demand a cross-sector workforce informed by Infant and Early Childhood Mental Health (IECMH) principles and practices. A recent review by the Alliance for the Advancement of Infant Mental Health, Inc identified seven themes that help define "What makes an IECMH association strong?": (1) Identity, (2) Cross-Systems Collaborations, (3) Sound Organizational Structure, (4) Competency-Informed Training, (5) Reflective Supervision Capacity, (6) Policy, and (7) Higher Education. The present paper documents the story of the Association of Infant Mental Health in Tennessee (AIMHiTN) and the role of the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting IECMH in that growth across those seven themes with the additional themes of (8) Funding and, (9) Diversity, Equity, Inclusion, and Belonging. First, foundational literature is reviewed to summarize IECMH-informed workforce development. Next, AIMHiTN's story of workforce development is mapped onto the nine themes and challenges and lessons learned are summarized. The article aims to serve as a roadmap for other states, provinces, territories, or nations hoping to develop their own Association for Infant Mental Health (AIMH) as well as a guide for those with existing AIMHs for promoting continued growth and sustainability.

Fault Detection and Health Assessment of Equipment Based on Fuzzy DPCA Spatial Eigenvalue Similarity

To improve the fault recognition rate of the dynamic principal component spatial data drive method, a fault diagnosis and equipment health status assessment method based on similarity fuzzy dynamics principal component analysis was proposed. First, the data are fuzzified according to the error function, and an augmented matrix is constructed. The eigenvalues are decomposed to obtain a score matrix and residual matrix of the fuzzy principal component. Further, the similarity between fault data and normal data is calculated. Meanwhile, a health assessment of the equipment is realized. The contribution rate of the observed variables is calculated. Finally, general Tennessee Eastman data and health assessment of a hydraulic press are used to validate the algorithm. The results show that the SFDPCA has a 100 % fault recognition rate for some faults, and the recognition rate for other faults is also higher than that of DPCA-Diss, DPCA-SPE, and PCA-SPE. The SDDPCA accurately identifies abnormal phenomena. It can determine the health level of prefilling and effectively make up for the shortcomings of PCA − T 2 , PCA-SPE, DPCA-Diss, and other methods and also can be applied to data-driven fault diagnosis to improve the fault recognition rate.

Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward.

The rising prevalence of opioid use disorder (OUD) among those living in the United States has demanded a collaborative response from health care and policy spheres. Addressing OUD among pregnant women is especially difficult, given the controversies surrounding the medical and ethical balance between meeting maternal versus fetal/newborn needs. Most medical organizations discourage the criminalization of drug use in pregnancy due to the adverse public health outcomes of such an approach. Despite this recommendation, many states continue to use punitive law to address drug use in pregnancy. In 2014, the Fetal Assault Law in Tennessee (TN) became the first law in the United States to directly allow women to be prosecuted for drug use in pregnancy. Since its expiration in 2016, this law has been re-introduced several times to the TN legislature in support of permanent implementation. This article outlines the impact of the initial Fetal Assault Law on maternal/newborn health in TN and provides alternative immediate, short-term, and long-term health policy strategies through which health care providers and legislators can better advocate for the well-being of both mothers with OUD and their infants.

Poverty and Health in Tennessee

Understanding the impact of poverty on health can inform efforts to target social programs and regional economic development. This study examined the effects of poverty on health among the 95 counties of Tennessee. All of the counties of Tennessee were ranked by 5-year median household income, from the wealthiest to the poorest. The counties were divided into quintiles, from wealthiest to poorest, to reflect the general impact of wealth on health. Next, the five wealthiest counties and the five poorest counties were identified, allowing for examination of the extremes of poverty and wealth within Tennessee. Comparisons of quintiles and five wealthiest and poorest counties on key measures were performed using the independent t test. People living in the wealthiest quintile lived on average 2.5 to 4 years longer and had lower rates of all health behaviors and health outcomes investigated compared with those in the poorest quintile. This disparity was even more pronounced when comparing the wealthiest five counties to the poorest five. The five poorest counties, for example, had twice the years of potential life lost and were overwhelmingly rural in character, with similar accompanying disparities such as median income, high unemployment, and a more aged population. This study highlights the fact that lower income is associated with significantly worse health outcomes in Tennessee and reinforces the importance of economic development, specifically, and addresses the social determinants, more generally, in helping to improve Tennessee's overall health statistics.

The Tennessee Men's Health Report Card: A Model for Men's Health Policy Advocacy and Education.

Tennessee is the only state in the United States that has regularly published a document monitoring men’s health and assessing men’s health disparities. Vanderbilt University, Vanderbilt University Medical Center, the Tennessee Department of Health, Meharry Medical College, Tennessee Men’s Health Network, and health providers and advocates across the state have come together to publish a set of indicators as the Tennessee Men’s Health Report Card (TMHRC). This article describes the origins, structure, development, and lessons learned from publishing report cards in 2010, 2012, 2014, and 2017. The report card highlights statistically significant changes in trends over time, identifies racial, ethnic, age, and geographic differences among men, highlights connections to regional and statewide public health initiatives, and suggests priorities for improving men’s health in Tennessee. State data were compared to Healthy People 2020 Objectives and graded based on the degree of discrepancy between the goal and the current reality for Tennessee men. Over the four iterations of the report card, the TMHRC team has made significant adjustments to the ways they analyze and present the data, utilize grades and graphics, consider the implications of the data for the economic well-being of the state, and disseminate the findings across the state to different stakeholders. It is important to go beyond creating a summary of information; rather, data should be shared in ways that are easily understood, actionable, and applicable to different audiences. It is also critical to highlight promising policy and programmatic initiatives to improve men’s health in the state.

Using Mini-Grants to Build Multi-Sector Partnerships in Rural Tennessee.

Rural counties in Tennessee, including those located in Appalachia, face some of the greatest health challenges in the nation. Unpublished data collated by the East Tennessee State University College of Public Health (ETSU) show that Tennessee’s 52 Appalachian counties vary dramatically from its 43 non-Appalachian counties in virtually all socioeconomic, behavioral, and health outcome metrics. Since 2011, the Tennessee Institute of Public Health (TNIPH) has actively encouraged local communities to address behavior change, enhance educational achievement, and improve economic conditions as essential components for improving health and well-being in rural Tennessee.

⁎A40 Integrating Transportation and Health with Policy, Funding, Data Collection and Model Calibration in Nashville, Tennessee (United States)

Abstract Background Tennessee was the least physically active US state in 2011, and among the top 5 most obese states in 2013. To address these issues, the Nashville area Metropolitan Planning Organization (MPO) is integrating health into the transportation planning process and increasing opportunities for active transportation. Our purpose is to describe the policy and research initiatives related to these areas. Methods Regarding policy, the MPO first adopted three policy priorities that Nashville residents identified in a transportation opinion survey: public transit, active transportation, and infrastructure preservation. Next, the MPO devised a transportation project scoring and selection system in which 60% of the criteria quantified how a future roadway project could increase opportunities for active transportation. Additionally, the MPO reserved 15% of its primary allocation from the U.S. Department of Transportation to fund its Active Transportation Program (ATP) for bicycle- and pedestrian-specific infrastructure and programs. Regarding research, the MPO conducted the Middle Tennessee Transportation and Health Study (MTTHS, n=6,000 households, 11,000+ individuals) to measure transportation behaviors and health attributes. Health questions included height, weight, general diet and health quality, and estimated time spent in physical activity and sitting. These data were used to calibrate the Integrated Transport and Health Impact Modeling (ITHIM) tool, which estimates the population health impacts of increased physical activity, reduced air pollution, and altered collision patterns. Results The policy changes in the MPO’s 2035 Regional Transportation Plan resulted in almost 70% of roadway projects including active transportation elements such as sidewalks and bikeways. In the previous 2030 plan, approximately 2% of roadway projects included these elements. Beyond roadway projects, the newly-funded ATP has awarded $13.6 million for active transportation infrastructure and education projects. The research conducted during the MTTHS yielded significant data about the transportation and health attributes of households throughout the MPO region. The data were used to create a Geographic Information System map of high health impact areas of the region, which are defined as areas with high prevalence of reported chronic diseases, low overall health quality, and low physical activity. The map enables the MPO staff to prioritize transportation projects in areas with potential positive health benefits. Finally, initial ITHIM modeling suggests that changes in physical activity, air-quality, and collisions may contribute to reduced mortality and morbidity in the region. Conclusions The Nashville Area MPO has made significant progress in integrating health into the transportation planning process by changing policy and allocating funding for active transportation research and modeling.

The Law of Unintended Consequences: Avoiding the Health Care Liability Act Booby Trap

In 2009, interest groups representing both healthcare providers and injured patients worked together to draft and pass several amendments to Tennessee's medical malpractice statute that aimed to improve medical malpractice litigation for all involved. As a result of these reforms, however, the 2009 amendments unexpectedly caused several cases to be dismissed without prejudice on grounds unrelated to the substantive merits of plaintiffs' claims due to their attorneys' technical procedural missteps. What has gone largely unrecognized, however, is a fatal litigation trap lurking beneath the surface of Tennessee's Health Care Liability Act that currently functions to transform even dismissals without prejudice into permanent bars to recovery. Specifically, based on the Tennessee Court of Appeals’ misreading of the Tennessee Supreme Court’s decision in Stevens ex rel. Stevens v. Hickman Community Health Care Services, Inc., the HCLA has been interpreted in such a way that it can be manipulated by defense practitioners to preclude recovery forever whenever a health care liability plaintiff fails to comply with a pre-trial notice requirement. This paper argues that the Tennessee Supreme Court should remedy this unintended consequence by holding that a plaintiff’s substantial compliance with the provisions of Tenn. Code Ann. § 29-26-121(a) as a whole is sufficient to earn the 120-day extension afforded by § 29-26-121(c).

Undergraduate training in public health should prepare graduates for the workforce.

Undergraduate training in public health should prepare graduates for the workforce.

APhA honors 2014 Immunization Champions

Pharmacists are uniquely positioned to educate patients on the importance of vaccines and to provide many of those vaccines themselves. They expand the "immunization neighborhood"—an APhA-coined term—and increase the accessibility and convenience of vaccines for patients from all walks of life. Their work eliminates the perceived barriers of appointments, physicians' offi ces, and prescriptions.

Lul Riek: helping to improve public health in South Sudan

Lul Riek: helping to improve public health in South Sudan

Medicaid Cuts in Health Care for Persons With Developmental Disabilities in Tennessee: Perspective From the Field

As a physical therapy practitioner who primarily works with persons who have developmental disabilities, I have become increasingly dismayed at the Medicaid cutbacks in Tennessee, the state in which I practice. I am confident that this is also the case in many other states that face budget shortfalls due to the current economic downturn. However, in Tennessee, this has been ongoing for more than just the past year or so. Medicaid has been on the chopping block for approximately the past 6 years. A position statement adopted by the Arc and the American Association on Intellectual and Developmental Disabilities (AAIDD) maintains that ‘‘Medicaid reform should address wait lists, the quality of service, providers and staff, and increased availability of quality health care services for individuals with intellectual and/or developmental disabilities’’ (AAIDD/The Arc of the United States, 2008). It is extremely disheartening to read this proclamation and realize that just the opposite is occurring. Although everyone with a developmental disability does not have Medicaid, the majority of the individuals I see in Tennessee with developmental disabilities have Medicaid as their primary insurance, and for others it may be a secondary source of payment. The Medicaid program in Tennessee has been given the designation of TennCare and is billed as Tennessee’s expanded Medicaid program. There is also a special statewide Medicaid Waiver program to assist some individuals over age 21 years with an intellectual disability who are deemed eligible, in addition to the TennCare Medicaid program. The TennCare plan is administered by several insurance entities, such as Blue Cross Blue Shield of Tennessee (BlueCare) and United Healthcare (Americhoice TennCare). TennCare currently covers 1.2 million residents in Tennessee and uses a managed care model (TennCare Overview, n.d.). According to professionals at the state TennCare Budget Presentation at the 106th General Assembly Legislative Budget Hearings (2010), states around the country are facing a $180 billion shortfall for Medicaid spending this year, and many are cutting back on services. It is apparent to me that TennCare was already underfunded prior to the nascent recession. Clients I have served over the past 5 years who rely on TennCare or Medicaid Waiver to reimburse for services such as therapy or nursing have continually faced threats that his or her services would be cut or eliminated entirely. In addition, these individuals and their families or caregivers have had problems finding physicians who accept TennCare; locating specialists to treat them is especially problematic. Other individuals I have seen have been denied needed devices, such as wheelchairs. Still others have been dropped from TennCare altogether and are unable to afford services. If service providers who accept TennCare can be found, delays in service are not uncommon. The added emotional stress and privation placed on the person with the developmental disability and his or her family and caregivers when services are not readily available, or are denied outright, can be immense. Families and other advocates must battle TennCare to merely preserve current levels of services, much less improve on what has been offered up until now. I have heard stories of families who are told by TennCare representatives that their son or daughter no longer qualifies for services such as in-home skilled nursing care. When the family member responds that they work during the day and cannot care for their loved one, the TennCare representative would counter that another family member could care for the individual. How can another family member be expected to be available 40 or more hours per week to care for an individual who has severe disabilities? Furthermore, many of the children and adults I see are cared for by a single parent. I am aware of several persons with INTELLECTUAL AND DEVELOPMENTAL DISABILITIES VOLUME 49, NUMBER 1: 50–52 | FEBRUARY 2011

Something Old Is New Again

This article is the result of inquiries and ethnographic encounters over a 15-year period, with the governmental agency known as the Tennessee Office of Minority Health (TOMH), a division of the Tennessee Department of Health. This article concerns the innovative and participatory response of TOMH to support African American health in Tennessee. For the purposes of this article, an innovative and participatory response to alleviate any form of human suffering is defined as mutual aid. How TOMH uses mutual aid will be considered. The intent of this article is to show that mutual aid has historic roots in African American communities and the Black Church. Yet today, government agencies like TOMH use mutual aid to create outputs-altering processes that support health and redress health needs for African American communities.

Technology exchange for cancer health network

19598 Background: The Technology Exchange for Cancer Health Network (TECH-Net) is a collaborative, multi-state effort to implement a systematic care program to improve cancer management in the rural communities of west Tennessee, north Mississippi and east Arkansas. This Health Information Technology (HIT) project uses a two-pronged approach to total clinical decision support: (1) provide access to oncology, hematology, and other specialists through the dedicated telehealth network of the University of Tennessee's Health Science Center in conjunction with the University of Tennessee Cancer Institute; and (2) rely on a distributed electronic health record (EHR) with integrated decision support systems for online management of cancer protocols, electronic orders, and medication management. Methods: Patients with a cancer diagnosis requiring treatment for at least one year are eligible to participate. The ultimate goal for this project is to enroll 250 patients (125 rural, 125 urban) and compare quality, safety, and cost outcomes for patients receiving rural Telehealth care versus “routine” urban care. Telehealth patients see their oncologist in person at the rural sites for initial care, and see their physician via telemedicine for approximately one-half of their subsequent visits. This approach allows the clinician to make in-person clinical assessments on a regular basis while still taking advantage of the time savings associated with telemedicine. Results: 163 patients have been enrolled in the study (127 rural, 36 urban) over 18 months. Patient satisfaction has been high - 95 % of patients indicated their telemedicine visit was as good as or better than an in-person office visit. Cost analysis comparing cost savings (physician travel time) with telemedicine costs (equipment, high speed lines) indicates that the cost-benefit depends critically on distance to the rural facility and number of physician trips avoided. Initial cost data indicate that telemedicine must save at least 5 hours of physician travel time per month to break even. Conclusions: Telemedicine offers a feasible method for increasing access to oncology care in rural areas that is well-accepted by both patients and clinicians. No significant financial relationships to disclose.

Managed Care for Mental Health in Tennessee

Managed Care for Mental Health in Tennessee

COLLABORATIVE HEALTH EDUCATION TRAINING FOR AFRICAN AMERICAN HEALTH MINISTERS AND PROVIDERS OF COMMUNITY SERVICES

A 56‐hr interdisciplinary “train‐the‐trainer” model was developed for lay representatives (health ministers) of African American churches and in‐service directors representing health and social service agencies in northeast Tennessee. Sessions were taught by East Tennessee State University faculty affiliated with the university's Center for Geriatrics and Gerontology and the Ohio Valley Appalachia Regional Geriatric Education Center. The content of the workshops included critical issues in aging, health promotion, and disease prevention for aging African Americans. Workshops took the form of group discussions, games, simulations, and audiovisual presentations. The program demonstrated positive outcomes of increased networking, a new formal linkages, and new resources within the African American community for health promotion and disease prevention activities. Problems encountered in implementing this project included the influence of religion on health beliefs, role shifts among the health ministers, and ...

Outline of Project for the Study of Negro Health in Tennessee

Outline of Project for the Study of Negro Health in Tennessee