The Institute of Medicine of Chicago will hold a joint program and panel discussion on ‘Integrating and Building Lives – From Homelessness to Self-Sufficiency’ on April 20, 2023, from 8:00 AM-10:00 AM CT at A Safe Haven Foundation. Six organizations are addressing the pathways and a call to action of the homeless and defining supportive and sustainable measures to self-sufficiency again. Pre-registration is preferred- limited seating. More details and to register> 

Some call for reimagining the current model of care for people experiencing homelessness. Others call for solutions to prevent homelessness. Still, others call for attention with substance abuse disorders, opioids, behavioral health issues, job insecurity, and lack of safe housing to prevent or address homelessness. Regardless of its origins, we live in a world where homelessness is a humanitarian crisis that touches most communities. The speakers will share insights on what’s working, why, and its positive human, social and economic impact. 

Join us for an interesting conversation with:

Moderator and Speaker–Dr. Tom Allen, MD, Executive Medical Director, Health Service Corporation, and Chief Psychiatrist, BCBS Medicaid- Illinois and Fellow, IOMC

Mark G. Mulroe, JD, MBA-HM, President, A Safe Haven Foundation 

Raul Garza, MBA, President, Institute of Medicine of Chicago and Billings Fellow, IOMC

Dr. Kiran Joshi, MD, MPH, Senior Medical Officer, Cook County Dept. of Public Health and Fellow, IOMC

Dr. Tariq Butt, MD, Vice President, Health Affairs, Access Community Health Network

Lee Rusch, MA, Director, West Side Heroin/Opioid Task Force

Guest Speaker: Neli Vazquez Rowland, Co-Founder and Immediate Past President of A Safe Haven Foundation, and Billings Fellow, IOMC 

Download agenda here> 

Download flyer here>

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Of more than 580 000 individuals in the US who experience homelessness on a single night, estimates suggest that more than half have a mental illness or substance use disorder and at least 1 in 5 have severe mental illness. 

Limited mental health care for this population forces individuals into emergency departments, where they are frequently boarded or discharged to the street, generating high spending and dismal outcomes. Pandemic-induced closures of social services and psychiatric beds have exacerbated harm. People experiencing homelessness with mental illness face alarming rates of incarceration, discrimination, chronic disease, suicide, and premature death. This is intolerable—and preventable. [JAMA Network]

...provides an urgent opportunity to implement community-based care options, reimagine institutionalization, and finally build a functional continuum of care for those experiencing homelessness and mental illness.

Download PDF of full article here> 

Full article here> 

Attend IOMC's program on Integrating and Building Lives- From Homelessness to Self-Sufficiency on April 20th - 8-10:00 AM CT. More details and to register here> 

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In 2020, in 7.6% of all households, children were food insecure.¹ Childhood food insecurity is associated with adverse outcomes, including anxiety, depression, poorer diet quality, higher rates of diabetes and obesity, and lower academic performance.^2-4 The purpose of this survey study was to compare current trends (2015-2019) in chronic food insecurity with trends from 20 years ago (1999-2003). [JAMA Nework]

Download PDF here.

Results

Figure 1 shows that almost half of the 12.1% of families that ever reported food insecurity from 1999 to 2003 experienced at least 1 additional wave of food insecurity (5.3% of all families). From 2015 to 2019, 4.5% of all families reported food insecurity in all 3 waves, more than doubling the rate from 1999 to 2003 (2.1%). Low-income families with children experienced higher levels of chronic food insecurity compared with other families from 1999 to 2003 (8.8% of low-income families with children vs 2.1% of all families and 3.7% of all families with children). Chronic food insecurity was even higher from 2015 to 2019 (10.9% of low-income families with children vs 4.5% of all families and 4.8% of all families with children).

Of the 31.2% of all families who reported NHFS status in at least 1 wave from 2015 to 2019 (Figure 2), 59.3% reported NHFS status in at least 1 additional wave (18.5% of all families). Among low-income families with children, only 33.1% always reported high food security, with 25.0% of low-income families with children never reporting high food security during the period.

Alhough the PSID has shown lower cross-sectional rates of food insecurity compared with the benchmark Current Population Survey across time, it remains the only nationally representative, longitudinal panel data on food security collected, to our knowledge.⁶ Although the HFSSM is used in both surveys, the PSID-based trends of chronic food insecurity could be underestimated.

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Internal medicine remained one of the most popular specialties for Illinois medical students pursuing residency. [Health News Illinois]  All students in Rush Medical College’s graduating class matched into residency programs. Thirty-six percent of fourth-year medical students will stay in Illinois for residency. Out of its graduating class of 133, 39 students will work for hospitals in and around Chicago.  Over half of Loyola University Chicago’s Stritch School of Medicine matched students will stay in the Midwest for residency, with 14 percent of matched students working at Loyola University Medical Center. Stritch also celebrated its first Deferred Action for Childhood Arrivals recipient to achieve a joint M.D./Ph.D. Northwestern University’s Feinberg School of Medicine has 32.7 percent of its matched students remaining in Illinois for residency. Specialties that drew the most students included internal medicine, pediatrics, OB-GYN, anesthesiology and general surgery. Thirty-five percent of fourth-year medical students at Chicago Medical School at Rosalind Franklin University matched into Illinois programs. Psychiatry, internal medicine, family medicine and anesthesiology were the top specialties. Illinois is the most popular residency location for University of Illinois College of Medicine students, with 51 staying at the university. Most matches pursued internal medicine, psychiatry, emergency medicine, pediatrics and diagnostic radiology. Roughly 20 percent of matched students at the University of Chicago’s Pritzker School of Medicine will be staying in Illinois. Internal medicine, anesthesiology and psychiatry were the top three specialties. Over 40 percent of Southern Illinois University School of Medicine’s matched students will remain in state. Family medicine was the most popular specialty, followed by emergency medicine. Internal medicine and pediatrics were tied for third. ###

Department of Public Health Director Dr. Sameer Vohra told lawmakers Wednesday the agency is looking to create a “unified vision” for the state’s healthcare system coming out of the COVID-19 pandemic. [Health News Illinois]
 
He told the Senate Appropriations-Health and Human Services Committee that their proposal is a commitment to responding to the lessons learned from the pandemic, including the need for unity among the various health agencies across the state.
 
“(The) budget is an important step in building a unified vision for health that will make the health of every community in Illinois stronger,” Vohra said.
 
The plan includes steps Vohra laid out in an appearance before the House last month, including a $45 million investment in the health data system around infection control and long-term care facilities as well as $7 million to enhance public health communication.
 
The budget also calls for an $8.5 million investment to help the agency identify and quickly prevent the spread of new and emerging illnesses.
 
The plan designates $18 million to ease access to reproductive healthcare, including the creation of a navigation hotline, training to increase the number of abortion providers and a consultation program for high-risk patients.
 
In other business, Vohra said they continue work on the community health worker program, which includes drafting rules and looking at some of the best practices across the country.
 
“One of the many lessons around COVID-19 was that we need to be able to create the community-led and community-built solutions," Vohra said. "They'll be sustainable and they'll be targeted towards what the community's needs are because they know their communities better than than anybody."
 
Finding which solutions will work best in each community remains a challenge, he said, as something that works in Chicago may not work in a downstate community like Effingham.
 
Last year, lawmakers passed long-term care rate reform, and Vohra said the rollout is making "some good progress."
 
“We meet with the industry regularly, we're meeting with our different advisory boards on that issue, to try to deal with the circumstances as best as possible,” he said. “It continues to be an incredible priority for our agency.”

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The Illinois Senate approved various healthcare proposals last week, including one to implement recommendations made earlier this year in the children’s behavioral health blueprint laid out by Gov. JB Pritzker’s administration. [Health News Illinois] The bill by Sen. Sara Feigenholtz, D-Chicago, would establish a centralized intake portal that can provide families guidance and referrals to state and community-based programs for which they are eligible. The plan would create a navigator assistance program and lay the foundation for an effort to provide annual mental health screenings to all K-12 students in the state. “The importance of this roadmap to appropriate treatment cannot be overstated,” Feigenholtz said in a statement after the vote. “This work is transformative and will be a game changer for children's behavioral health in Illinois.” Lawmakers also approved legislation by Sen. Laura Fine, D-Glenview, that would create repercussions for employees found to not have reported incidents of resident abuse or neglect at state-operated mental health facilities. Fine said her plan comes after staff members at Choate Mental Health and Developmental Center in Anna were reported to have abused patients.  “It is the responsibility of the state to protect our most vulnerable from abuse and neglect,” Fine said. “This legislation will be an important tool to deter further atrocities from taking place.” The chamber also passed a bill by Sen. Omar Aquino, D-Chicago, that would make professional licenses for home health, home services and home nursing agencies valid for 240 days, rather than 120 days. It would allow new agencies to receive a provisional license for up to 90 days, with a goal of offering services on demand for thousands of patients who require in-home critical care. “The need we have in Illinois for healthcare professionals that can support families with a loved one in need of in-home care should be addressed, and that’s what this bill does,” Aquino said. And lawmakers approved a bill from Sen. David Koehler, D-Peoria, that would allow individuals to bring legal action against healthcare providers that knowingly or intentionally use their own reproductive cells without the patient’s informed written consent. ###

How was her night?” or “What questions or concerns do you have?” These common open-ended questions are often directed to caregivers (parents, family members, or guardians) of hospitalized children at the start of family-centered rounds. While these questions meet a lot of best practices for family-centered rounds, such as being open ended and starting with caregiver input, the level of caregiver engagement following these questions varies greatly. For example, while one parent might answer “fine,” another might describe symptoms and events in detail, including their opinions and preferences on their child’s care. This variability in participation is important given the critical role of caregivers in preventing medical errors, aligning goals of care, and optimizing pediatric hospital outcomes. [JAMA Network]

The current approach to communication during family-centered rounds operates under the assumption that patients and families will feel safe and empowered to participate when given the opportunity. However, this pretense fails to address how systemic inequities and lived experiences of individuals may influence interactions with health care systems. Several recent studies have demonstrated Black, Latinx, and other racial and ethnic minoritized groups feel less comfortable and empowered speaking up on family-centered rounds.¹ While individual clinician biases and differences in communication likely contribute to this inequity, factors beyond that single encounter may also play a role. Indeed, factors both within the health care system (eg, past discrimination by clinicians, lack of language accessibility in the form of interpreters or signage, lack of diverse representation of clinicians and staff) and outside of the system (eg, racism, stigma, acculturative stress, social needs) can influence caregiver-clinician communication. Thus, even if medical teams use standardized and bias-free communication, family engagement and participation may not be equal across patients from different backgrounds.² Without awareness of the structural factors that influence such communication, clinicians may interpret caregiver differences in communication in ways that reinforce stigma and stereotypes.

More> 

Download PDF of article here>

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The US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children’s Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children’s rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children’s rights. [JAMA Network] 

Observations  Seven findings about advancing children’s rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children’s rights. High-potential strategies for catalyzing advancement of children’s rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children’s movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.

Conclusions and Relevance  Children’s rights provide a powerful, synergistic framework for child health professionals—in partnership with youth and other leaders—to increase equity and protect the rights and well-being of all children in the US.

More> 

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The US Food and Drug Administration (FDA) has approved over-the-counter sales of the overdose reversal agent Narcan (naloxone, Emergent BioSolutions). Greater access to the drug should mean more lives saved. However, it's unclear how much the nasal spray will cost and whether pharmacies will stock the product openly on shelves. [Medscape]

Currently, major pharmacy chains such as CVS and Walgreens make naloxone available without prescription, but consumers have to ask a pharmacist to dispense the drug.

"The major question is what is it going to cost," said Brian Hurley, MD, MBA, president-elect of the American Society of Addiction Medicine. "In order for people to access it they have to be able to afford it," he told Medscape.

"We won’t accomplish much if people can't afford to buy Narcan," said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing, in a statement. Still, he applauded the FDA.

More> 

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The recent study by Hoffmann et al¹ and accompanying editorial by Carroll and Hayes² paint a sobering picture of the mental health system and access to care. We would like to make a few comments in response. [JAMA Network]

First, it is important to note that the while the study by Hoffmann et al focused on mental health conditions and the suicide rate, many adolescents and even younger children may require care for primary or co-occurring substance use disorders, developmental disabilities, and physical health conditions.³ Co-occurring conditions may exacerbate access to care challenges.

Second, it is important to note efforts to implement needed changes, such as the 988 Suicide & Crisis Lifeline and recently released National Guidelines for Child and Youth Behavioral Health Crisis Care. These efforts are directly relevant to some of the challenges noted by the above authors.

Third, while money cannot be the sole metric by which to judge the nation’s commitment to supporting those with behavioral health conditions and their families or caregivers, nor serve alone as a panacea for every conceivable challenge, the importance of sustainable, ongoing, and adequate funding at the federal, state, local, tribal, and territorial levels should not be dismissed or neglected. Together, mental health and substance use account have historically accounted for 6% to 7% of total health spending, which likely does not reflect overall needs for care as identified by Hoffmann et al¹ and many others.⁴

More> https://jamanetwork.com/journals/jamapediatrics/fullarticle/2802515?guestAccessKey=9d9bbe50-435b-423a-8577-56c0e544907c&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamapediatrics&utm_content=olf&utm_term=032723

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