Recent USF Graduate represents a new generation of health professionals
We explore connections between Glenda's work, trends in healthcare and goal of USF's MSBH program
Powered by expert consensus and the Affordable Care Act, there has been a recent trend in healthcare to integrate behavioral health services into primary care. This trend has resulted in a new generation of healthcare professionals who are trained to engage patients in a full range of physical, psychological, social and preventative care to address the ‘whole person’ rather than isolated aspects of their health. One example is the recent USF graduate Glenda Kith, MSBH’17, who works as a Wellness Analyst for Zuckerberg San Francisco General Hospital’s Community Wellness Program. Glenda is on the front lines of designing and managing programs that promise to cut costs, empower patients, and improve health outcomes, especially for low income and vulnerable populations.
Glenda recently applied for and received a Hearts Grant from the San Francisco General Hospital Foundation for the ‘Train the Trainer Navigation Health Coaching’ program that trains volunteers and health students to help patients find appropriate health resources and increase patient engagement. Inclusive health programs have grown in popularity and accessibility since the passing of the Affordable Care Act, and health care providers have already started realizing their cost-saving potential (1). Conditions such as depression, addiction, and anxiety impact nearly 1 out of 5 Americans (2) and can exacerbate or worsen their other medical conditions, diminishing their ability to manage their own health. The Zuckerberg San Francisco General Hospital’s Community Wellness program is an example of an emerging consensus in healthcare regarding the connection between Behavioral Health and many major diseases and ailments.
The Mission to enhance healthcare delivery, equity and access
A second-generation immigrant, Glenda Kith grew up in a low-income household in Alameda where she was all too familiar with the effects of insufficient health insurance within her family and community. Due to the high cost of care, low income and minority populations are typically associated with a greater lack of health-insurance coverage as compared to other population segments (3). Glenda explained how her mother’s cancer was left untreated, and her condition degraded, as she was uninsured and unable to afford the high costs of care. Kith’s family, like many others in the United States, were forced to treat vital health care as a luxury. Motivated and poised to make a difference, Glenda started pursuing a career in science by earning a full-ride for her Bachelor of Art in Integrative Biology from UC Berkeley. While an undergraduate, Glenda was inspired by the national debate on health care reform, became passionate about healthcare policy, and decided to make her career addressing issues of access and inequity in health care, especially for underserved populations.
When my mother was diagnosed with breast cancer, I more clearly saw health disparities and how broken our healthcare system was. I wanted to work toward helping people restore their health and wellbeing. In order to do that, I knew I needed to view health comprehensively and understand language/cultural barriers, environmental problems, food insecurities, infrastructural inefficiencies, and workplace culture issues from the patient’s, to the provider’s, to public health policy professional’s perspective. I was attracted to USF’s MSBH program’s philosophy and the professors’ human touch.
Glenda was intrigued by USF’s Loading... (MSBH) program as she embraced the program’s premise that health and well-being are shaped by a variety of social, physical and psychological factors. Just before graduating from USF in 2017, Glenda started working as a Wellness Analyst for the Zuckerberg San Francisco General Hospital’s (ZSFG) Community Wellness Program. When asked about her USF education, she cited specific courses such as Public Health Program Planning, Management, and Evaluation - MPH 636, Applied Research Methods - MSBH 603, and MPH 622 - Commuting Healthy Behavior and Social Change, that provide foundation the needs to excel at her current role.
I often go back to my lectures and assignments, because what I learned directly relates to my work. It has helped me a lot as a program analyst, evaluator, planner, and data manager.
Beyond academic preparation, USF’s social justice mission solidified Glenda’s personal mission to be an agent for change in healthcare delivery. We reached out to the MSBH Program Director Dr. Kelly L’Engle to get her to take on the overall goal of the program and how it integrates USF’s mission-driven values into its curriculum:
The focus on behavioral health in the MSBH, Master of Public Health, and other programs in the School of Nursing and Health Professions at USF are designed to educate the next generation of the healthcare workforce with the skills they need right now and in the future to address health for all. Our focus on underserved individuals and communities is paramount in our graduate programs, and we are proud and privileged to educate students like Glenda who have the passion, knowledge, and skills to effect change in the populations and health systems they will work with upon graduating.
DR. KELLY L'ENGLE, PROGRAM DIRECTOR, MASTER OF SCIENCE IN BEHAVIORAL HEALTH (MSBH) AND MASTER OF PUBLIC HEALTH (MPH), SCHOOL OF NURSING AND HEALTH PROFESSIONS, UNIVERSITY OF SAN FRANCISCO
The Community Wellness Program at Zuckerberg San Francisco General Hospital
The Affordable Care Act of 2010 has inspired many new healthcare professionals and laid the legislative groundwork that enables and incentivize care providers to create their own integrated wellness programs. The Community Wellness program at San Francisco General is one such program - patients are offered a variety of holistic health programs and classes- including dance, exercise, cooking, group therapy, and other health regimes that empower them with the knowledge and skills they need to become healthy. The program has already demonstrated high patient satisfaction but faces challenges with low participation rates of the most vulnerable referred patient, as low income, uninsured, or undocumented patients often have a trust deficit with the healthcare system. Hoping to increase engagement, the grant Glenda received secures funding for a program that will train student interns as ‘patient navigators & health coaches’ - healthcare workers tasked with gaining patient trust, and pairing them with appropriate wellness programs that seek to empower them with the knowledge and skills they need to manage their long-term health.
The National Debate on healthcare
While healthcare in the United States faces profound challenges of rising costs and changing demographics - technological progress, academic research, and intelligent policy (4) continue to offer insights and solutions that provide great hope for the future. Firstly, one of the key goals of the Affordable Care Act of 2010 is to reduce the catastrophic costs associated with healthcare by reducing out of pocket spending and offering coverage options based on income levels, thereby increasing healthcare coverage among low-income populations (5). Secondly, by integrating behavioral health services, the ACA promises to cut long-term care costs associated with populations with mental health disorders. According to the CDC, the uninsured rate for those with serious mental health disorders fell from 28.1% in 2012 to 19.5% in 2015 (6). Finally, the integration of ‘value-based care’ models promises that health programs are held accountable in terms of their outcomes for patients, prompting the emergence of an array of preventative services, educational programs, that weighs healthcare costs against the long-term success of patients, especially those with mental illness (7). By expanding coverage to these target populations, the ACA promises to get patients the care they need before symptoms worsen and drive up costs for the care providers, patients, and taxpayers.
Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions.
DAVID MECHANIC, HEALTH AFFAIRS MAGAZINE (4)
Care providers and patients already have started realizing the benefits of increased coverage and wellness programs to improve patient outcomes and drive down costs. For example, according to the National Health Interview Survey, the ACA has already decreased the number of uninsured from 16% of the population in 2010 to 9% in 2016. Despite early signs of progress, the ACA faces significant backlash from powerful players with vested interests in the current system. While the national debate on health care continues, care providers and hospitals such as Zuckerberg San Francisco Hospital are increasingly mobilizing resources to provide integrated care services that address the long-term care needs of underserved populations. This is especially promising for the career prospects of Graduate students of Public and Behavioral Health, such as Glenda, who are trained to manage these types of programs and realize their medical and social benefits for long-term improvement of healthcare outcomes.
The connection between mental and physical health is increasingly emphasized in scholarly work - as mounting research and data reveals that addressing mental health will help increase the overall value of care by bringing down long-term costs, empowering patients, and improving the value of care. The Affordable Care act of 2010 helps facilitate the integration of mental health services into primary care, encouraging the creation of new holistic health programs that seek to empower, educate patients and most importantly, track and measure their progress. The focus on behavioral health in the MSBH, Master of Public Health, and other programs in the School of Nursing and Health Professions at USF are designed to educate the next generation of the health care workforce with the skills they need right now and in the future to succeed in this new arena. Trained to understand the social, psychological and environmental factors that shape mental and physical health, our students are are equipped with the skills and the mission to advocate “care for the whole person” and fight for healthcare equity. Our focus on underserved individuals and communities is paramount in our graduate programs, and we are proud and privileged to educate students like Glenda who have the passion, knowledge, and skills to effect change in the populations and health systems they will join upon graduating.
Sources and Notes
- Kaile M Ross, Emma C Gilchrist, Stephen P Melek, Patrick D Gordon, Sandra L Ruland, Benjamin F Miller; Cost savings associated with an alternative payment model for integrating behavioral health in primary care, Translational Behavioral Medicine, , iby054, https://academic.oup.com/tbm/article/9/2/274/5001714
- "Any Anxiety Disorder". U.S. Department of Health and Human Services. Retrieved 29 October 2018, from: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
- Gerald F Kominski, Narissa J Nonzee, Andrea Sorensen; The Affordable Care Act's Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review of Public Health. Vol. 38:489-505, https://doi.org/10.1146/annurev-publhealth-031816-044555
- David Mechanic; Seizing Opportunities Under The Affordable Care Act For Transforming The Mental And Behavioral Health System. Health Affairs https://doi.org/10.1377/hlthaff.2011.0623
- Sarah A. Nowak, Christine Eibner, David M. Adamson, Evan Saltzman; Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs. RAND Corporation 2013. https://www.rand.org/pubs/research_reports/RR383.html.
- Sherifa Iqbal; How would repeal of the Affordable Care Act affect mental health care. Current Psychiatry. https://www.mdedge.com/sites/default/files/cp01604021.pdf
- Melinda K. Abrams, Rachel Nuzum, Mark A. Zezza, Jamie Ryan, Jordan Kiszla, Stuart Guterman; The Affordable Care Act's Payment and Delivery System Reforms: A Progress Report at Five Years. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2015/may/affo...
- “Medicaid Benefits: Home and Community-Based Services Waiver” Henry J Kaiser Family Foundation. Retrieved 29 October 2018.
- Integrating behavioral and medical health. Cigna. https://www.cigna.com/assets/docs/about-cigna/thn-white-papers/behaviora...
- Robin A. Cohen, Michael E. Martinez, and Emily P. Zammitti; Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2016. National Center for Health Statistics.