Screening for Type 1 diabetes is crucial for earlier detection and management of the disease, but many people don’t know that they should be screened or how to access that screening. In the 2nd episode in our three-part series on T1D screening, University Hospital’s Chief of Staff - Office of President & CEO, Franklin Hickey, PhD, RN, NEA, BC, Executive Director of Community and Population Health, Colette Barrow Adams, PhD, MPA, MDiv, and JDRF Patient Navigator, Courtney Harris joined The Huddle to talk about a partnership with JDRF that has allowed more than 1,000 people to be screened for early T1D in the underserved Newark, New Jersey area. They also discuss the importance of meeting people where they are and understanding barriers to access when looking to increase screening rates. Educational grant support for this episode is provided by Sanofi.
Screening for Type 1 diabetes is crucial for earlier detection and management of the disease, but many people don’t know that they should be screened or how to access that screening. In the 2nd episode in our three-part series on T1D screening, University Hospital’s Chief of Staff - Office of President & CEO, Franklin Hickey, PhD, RN, NEA, BC, Executive Director of Community and Population Health, Colette Barrow Adams, PhD, MPA, MDiv, and JDRF Patient Navigator, Courtney Harris joined The Huddle to talk about a partnership with JDRF that has allowed more than 1,000 people to be screened for early T1D in the underserved Newark, New Jersey area. They also discuss the importance of meeting people where they are and understanding barriers to access when looking to increase screening rates.
Educational grant support for this episode is provided by Sanofi.
Learn more about University Hospital here: Hospital Administration - University Hospital (uhnj.org)
Lean more about JDRF here: JDRF - Diabetes - Type 1 Diabetes Research, Advocacy, and Support
Learn more about the partnership between University Hospitals and JDRF here: Inclusive Health: Creating Access to Type 1 Diabetes Screening in Underserved Communities (beyondtype1.org)
Jodi Lavin-Tompkins
Well, hello and welcome to ADCES's podcast, “The Huddle: Conversations with the Diabetes Care Team”. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Jodi Lavin -Tompkins, Director of Accreditation and Content Development at the Association of Diabetes Care and Education Specialists.
My guests today are Dr. Franklin Hickey, Chief of Staff, Office of President and CEO of University Hospital in Newark, New Jersey. We also have his colleagues, Dr. Colette Barrow-Adams, Executive Director, Community and Population Health, and Courtney Harris, Patient Navigator for the Type 1 Diabetes Screening Program. University Hospital has been doing some amazing work recently to promote the importance of Type 1 diabetes screening, particularly in underserved areas. So, in this episode we're going to talk about how this idea first sparked and how this work has helped increase screening rates in the communities surrounding University Hospital. Hello, Franklin, Colette, and Courtney. Welcome to The Huddle.
Franklin Hickey
Thanks for having us, Jodi. It's a pleasure being here.
Colette Barrow-Adams
Yeah, thank you, Jodi. I'm excited to be on today's episode.
Courtney Harris
Thanks, Jodi.
Jodi
All right, well, let's get started. And I want to start with Franklin first. And I want to ask you, Franklin, to set the stage for our conversation by telling our audience about yourself and your colleagues and what setting you do this work in and what led you down this path.
Franklin
As Jodi stated, I am the chief of staff here at University Hospital for the Office of the President and CEO. I've been at University Hospital approximately five years and this is my third role. I started as director of surgical subspecialties in the outpatient arena. I was then promoted to vice president for the outpatient arena. And as of June of last year, I was appointed to this role as chief of staff. You know, one of the things that's very unique about our organization is our location. We're located in Newark, New Jersey. We are a very heavily urban environment and a very diverse population. And we have to constantly engage our community to really get them involved in care and make sure their health care needs are met. Now this was really, really apparent specifically during COVID when we had a lot of people who were scared to even get tested and argued the vaccine when the vaccine became available. So we really had to put on our community health hats and really partner with local community, activists, churches, schools and other civic organizations to really take the vaccine out to the community.
And while out there, we identifed some other health equity issues that arose during the COVID pandemic, and those specifically sent around screenings. And some of those screenings were for forced mammography, cervical cancer, lung cancer, and those types of things. But at the same time, about a year after COVID had begun to dissipate, JDRF came to us and asked us if we would like to be a part of a pilot program where we actually started testing next of kin and close relatives to patients who have type 1 diabetes. We didn't hesitate. Once we looked at the literature and read all the research around it, we immediately jumped on board and so it is our mission to really take this out to the community. What we also loved is we were the first large inner city academic medical center to do this work. And so that's how we built our team in collaboration with JDRF, specifically around type 1 diabetes screening.
Jodi
Okay, well thanks for that information. And it's really interesting how you got started in this area and the partnership that you have. It seems like your site is really engaged in this and you have the perfect community to make it happen. So, I want to move to Colette and ask you to tell our audience more about the population you're working with and about your strategy to go to them instead of expecting them to come to you to make all this happen.
Colette Barrow-Adams
Thank you, Jodi. In answering that question, I think it's so very important just to give a little bit of context in the community that we're serving. And so, as Frank stated, yes, we're in a Newark, New Jersey, urban environment, but University Hospital is also an anchor institution. When we last checked, nearly 60% of our patients that come here for whether they're hospitalized, emergency department, or for outpatient services, they reside in nine zip codes surrounding the hospital. Eight of those zip codes are in Newark, and one is in Irvington. And what's so important about that is that these communities are faced with an exorbitant amount of socioeconomic disparities. And so we're talking about zip codes where there are food deserts, preponderance of low-income households, concentrated poverty, blight, high crime rates and so many other factors. You know, the social determinants of health and those inequities that we always talk about that impact a person's quality of life. And so when we think about screening and we think about the services that are needed in our community, we cannot address those problems without having in our minds and at the forefront of our mind, the challenges that are faced by our patients. Because if they reside in these communities, most likely, and in many cases we know this because we screen patients as well for social determinants of health, they too are facing some challenges.
And so here are some key facts that I'll jump into while we're bringing care to patients. And so in Newark, 27%, more than 27% of Newark is impoverished. That's twice the county's rate. Another statistic I like to look at is that 15% of residents in the American Community Survey say that they have experienced food insecurity. 25% are in SNAP benefits. And here's a stat that I look at all the time and I'm like, wow. And so when you think about Essex County, which Newark is in, 45% or 46% of the Essex County recipients of WIC live in Newark. And not only that, 86% of those who've experienced homelessness in Essex County guess where they live? They live in Newark. And so I can go on and on. And there's so many different factors. But this just kind of paints the picture.
And so a couple of years ago now, we did our community health needs assessment. Many hospitals do this assessment. And we do it because of our commitment to community. And in the community health needs assessment, one of the top 10 findings was that, actually the number one finding, was that the community was concerned about was access to health care and other services. And the rest of the needs are family support, mental health, COVID-19 prevention and impacts, patient-provided relationship, racism, discrimination, food insecurity, telehealth, substance abuse, and chronic disease. So one of the ways that we make sure that we are impacting the health outcomes of patients is we have to make sure that we are also addressing the barriers that are preventing them, in many instances, from improving their health or working on their health. And we do that by bringing the care to them. And so I always share this story. Some of us remember when we studied Maslow's hierarchy of needs is if someone has to eat today and they need a prescription, but they have limited funds, what are they going to do? They're going to eat. If someone has to, you know, they need to go for that preventative screening, but they're putting coins together to pay rent, what are they going to do? They're going to pay that rent. And so our number one concern, again, was access. And so we at UH take a concerted effort at removing barriers and bringing health prevention to where people are located. Hence, one of our premier programs is our Type 1 Detect, the Type 1 Diabetes Screening Program.
Jodi
So it's interesting that you have this screening program that you've added for that community and it sounds like you have a really robust project going on. So I wanted to ask Courtney some questions because I understand she has screened over a thousand people in the community for early type 1 diabetes. And I was curious, what steps did you take Courtney to accomplish that?
Courtney Harris
Hi Jodi, well first I would like to say such a pleasure once again, having you on the podcast to be able to talk to the T1 Detect program. It's such a rewarding experience. One of the main steps that I did take is understanding my role as a patient navigator and its influence in the community. A lot of patients in the community that I've come across and I had the pleasure of connecting with had no prior knowledge of the T1 Detect program and what type 1 diabetes is. So me being able to arm them with the information they need to understand what type 1 diabetes is, understanding why the screening is important and how to get screened. Also what to do after receiving those results. So being able to connect with the community and understanding the audience and meeting them where they are is one of the most important steps because I also wanted to gain their trust in this newfound program here at University Hospital. It did entail a lot of awareness and education to the community where myself, along with some community partners, in addition to internal partners, we provided innovative ways to reach our audience to explain the Type 1 diabetes program.
Jodi
Right, right. And I imagine you had to develop specific strategies for engaging them in the screening. Especially since they were unaware of its availability. So how about sharing what some of those strategies were?
Courtney
So one of my major approaches was a patient-centered approach, meeting the patients where they are and addressing some of their psychosocial needs. And this is through the lens of a cultural perspective, such as explaining to them that the early detection program, it is a free program where there's no insurance needed, that can save lives.
Within the community, I have the opportunity to tap into existing platforms and networks that allow space for free screening. Working across various cultures, I'm able to facilitate health education and also spearhead health and wellness initiatives. Another important approach I took was partnering with adult clinic to identify the families of our patients with type 1 diabetes. Here, not only did we contact the patients, but we did ensure that they had visited to get screened for type 1 diabetes because of this early detection unique needs. Understanding our population in the community surrounding University Hospital is very important. And once again, meeting the patients where they are, being able to not only provide the education, but to understand what their needs are.
Jodi
Well, thank you for that. And I'm sure our audience is interested in learning some of the lessons you may have learned along the way so that they can also provide equitable care for the populations they work with. So would you mind sharing some of those lessons that you might have learned from your working with your population in this project?
Courtney
One intricate lesson that I've learned while driving results for the T1D Early Detection Program is that it's not a one-man show, you know, not by a long shot. This level of framework requires a multidisciplinary team approach where everyone understands the basis of the screening program, you know, where everyone knows how to make an impact from their role until the patient's lives. And ultimately, this level of impact is really, you know, passion is raw. And this also drives the patient experience here at University Hospital. Meeting the patients where they are, because I've come into connections with a lot of different patients from many walks of life. Understanding their education on diabetes and just overall health in general, but mainly type 1 diabetes, and being able to speak to what they may not understand and how it can benefit them in the long run. Here, this also allows me to build trusting relationships with the population as me being an honest representation of University Hospital. From a cultural perspective, a lot of patients may feel that the level of mistrust between the community and health care can be somewhat fractured. But once again, as a healthcare champion, I come in and empower the patients with the information that I do provide to them and ensure them of the services that we offer and the dedicated team of experts that we have to help along away.
Jodi
Yes, and I know how important building trust is with folks in the community and getting them access to what they need. So in wrapping this up, I'm sure we're interested in what any next steps are for this project and anything else you would like our listeners to know. And I want to open it up to all three of you for that. So just chime in.
Franklin
So Jodi, as an organization in partnership with JDRF, one of the next steps for us is to begin to incorporate this into annual wellness visits, the screening, as well as beginning to look at our adult type 2 population because the literature does show that there are people specifically of African-American and Latin descent who have been diagnosed with type 2 but really are type 1. So we wanna put some concern and effort around building screening in those two arenas. As well as we wanna really tighten up our quality aspect in terms of, you know, circling back to patients within a certain amount of time, within a year or so, to specifically those who did not test positive to do a follow-up testing, as well as those who did test positive, how they're doing follow-up with their treatment plan, things of that nature.
We do wanna broaden our scope in the community in terms of the reach. You know, we wanna get to some of the more communities around Newark, because we have some pockets of multicultural communities that do come to our hospital that sit outside of Newark. So right now we're developing strategies, specifically a lot of those populations around the Haitian descent, certain African descent, and other different Latin communities, specifically some of the migrant communities coming in now. How do we get our tentacles out into those groups as well?
Jodi
Okay.
Courtney
So there's no I in team, and I'm very thankful for the level of collaboration between myself and different community stakeholders, in addition to health care providers. And the clinical team, I feel that our level of collaboration within a community has always been a tremendous value, and this is something that we look forward to in the future.
Colette
We cannot overstate the value of boots on the ground, and that boots on the ground approach of going to the local houses of worship, going to the senior centers, going to the community centers, and removing any sort of challenges a person may have as to why they are not able to come and do this in person. And so imagine you are at your house of worship, whether it's the mosque or the church, and then when you come out, someone is there and beginning to provide you with education. In that moment, because your congregation leader is encouraging you to do that, you're more likely to actually sit and get screened. And that screening is a connection to University Hospital or the care that you would receive. This is the last thing I'll share. The Department of New Jersey Hospital Association and the Center for Health Analytics Research and Transformation, they did this analysis across the state and they looked at the 35 zip codes with the best health outcomes and the 35 zip codes with the worst health outcomes. Three of the zip codes in Newark were among the worst or the most vulnerable zip codes. And so these zip codes were primarily communities of color. And these are individuals that are going to the ED for preventable causes, many of it chronic conditions. And so this data and what we hear in community really continues to fuel our fire and to come up with even more creative ways into how can we get care to people who need it. And so thank you for allowing me to share that bit of information.
Jodi
No, it's all very, very critical, very important. And really appreciate you sharing that. Sounds like you have a lot of good work yet to do. And I wish you the best in completing that project. And I want to thank you all, Franklin, Colette and Courtney, so much for taking the time for joining us for this episode of The Huddle and for sharing your knowledge and experience.
Franklin
Jodi, I want to thank you and ADCES for this invitation and allowing us to share our work and be a part of this podcast. It has truly been a great time talking to you and sharing our passion about our work.
Colette
Yes. And I'll echo that sentiment. Thank you so much for including us. Our hope is that other people will hear this story and that they would see the value on boots on the ground and doing that community work to make such a great and lasting impact.
Courtney
And I'll second that as well. And I really, really hope that the audience also understands that there's power in prevention. And I'm very blessed that University Hospital has the program to promote it.
Jodi
All right. And thank you again so much. All three of you. We wish you the best.
Thank you for listening to this week's episode of The Huddle. Make sure to download the resources discussed in today's episode. You can find them linked in the show notes. And remember, ADCES membership gets you free access to resources, education, and networking that improve your practice and optimize outcomes for your clients. Learn more about what ADCES can do for you at adces.org/about-us/membership. The information in this podcast is for informational purposes only and may not be appropriate or applicable to your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a health care professional. Please consult your health care professional for any medical questions.