Perelman School of Medicine

Perelman School of Medicine's mission is to advance knowledge and improve health through research, patient care, and the education of trainees in an inclusive culture that embraces diversity, fosters innovation, stimulates critical thinking, supports lifelong learning, and sustains our legacy of excellence.

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Now showing 1 - 10 of 140
  • Publication
    Reducing Incarceration in Philadelphia
    (2017-10-01) Shefner, Ruth; Anderson, Evan; Riker, Derek
    Reducing incarceration is an important public health priority. There is now widespread recognition that criminal justice systems are a significant source of public health harm. They sometimes penalize individuals without improving community health, or create improvements that are offset by the considerable individual and communal harms associated with incarceration and with the collateral consequences of criminal convictions. Philadelphia has become a leader in implementing criminal justice reforms. In 2010, the District Attorney’s Office initiated changes to reduce overcharging. In the last seven years, the First Judicial District has created nine specialized diversion programs, with seven specifically aimed at addressing the underlying causes of criminal activity. These programs vary in design but share key features. All attempt to prevent future criminal activity by diverting offenders away from incarceration and into community supervision. Programs also provide access to appropriate social and health services, and utilize a more collaborative approach between prosecutors, defense attorneys, judges and social services staff. This more efficient use of resources allows greater attention to more serious and violent crimes in Philadelphia.
  • Publication
    Precision Prevention and Public Health
    (2017-11-01) McGrath, Colleen; Palmarella, Graceann; Solomon, Sara; Dupuis, Roxanne
    A new trend, “Precision Prevention,” is emerging in public health. This term is borrowed from “Precision Medicine,” a concept in medicine that allows for individualized treatments for patients. Precision prevention utilizes “biologic, behavioral, socioeconomic, and epidemiologic data to devise and implement strategies” tailored to specific individuals or populations. The goal of precision prevention is to target the “right intervention to the right population at the right time.” Much of precision prevention accounts for one’s social determinants of health, tailoring interventions based on a set of individual factors related to where we live, learn, work, and play that impact our health. Precision prevention works to move away from universal approaches to illness and injury prevention. Flaura Koplin Winston, MD, MPH, Chair of the Science and Medical Advisory Committee for Entrepreneurship and Innovation at The Children’s Hospital of Philadelphia (CHOP), applies a precision prevention framework, using a “tiered risk model” (see figure 1) for the Violence Prevention Initiative at CHOP. In the tiered risk model, there are three types of interventions focused around the needs of universal, selected, and indicated populations. At each level, interventions range from meeting the universal needs of the general population, to the select needs of populations at increased or different risk, and finally to interventions tailored for populations with adverse or indicated needs. For example, within the Violence Prevention Initiative, selected interventions that integrate appropriate community support services are tailored to children at greater risk for violence, and indicated interventions tailor the most intensive, direct support to child victims of violence.
  • Publication
    The Opioid Crisis
    (2017-09-01) Stark, Caroline; Solomon, Sara; Cannuscio, Carolyn; Hom, Jeffrey; Meisel, Zachary
    Opioid use and addiction have reached epidemic proportions in Philadelphia, making drug overdose involving opioids a leading cause of death. Both pharmaceutical and illicit opioids contribute to this crisis. Opioid sales in Philadelphia more than doubled between 2000 and 2012, and health care providers continue to prescribe opioid pain medication in greater quantities than medically appropriate. The peak age group for overdoses is 45-54, an older age group than previously seen. Over-prescribing of opioids contributes to the recruitment of adults into drug dependence. While use of opioid pain medications usually does not lead to opioid use disorder, four out of five heroin users nationwide transitioned from original use of prescription medications. Heroin is easy to obtain, potent and cheap compared to prescription pain medications. There are estimated to be at least 70,000 heroin users in Philadelphia.
  • Publication
    Supervised Injection Facilities
    (2018-01-01) Shefner, Ruth; McGrath, Colleen; Sharma, Meghana; Anderson, Evan; Cocchiaro, Benjamin
    Injection drug use once accounted for half of the new HIV cases each year in Philadelphia. Today, it accounts for less than 6%. This achievement is the result, in large part, of increased access to sterile syringes through needle exchange at Prevention Point Philadelphia. But while tremendous strides have been made in reducing the HIV risk for people who inject drugs (PWID), the story with respect to skin and soft tissue infection (SSTI) and overdose is grim. SSTIs are life-threatening, painful, and remain common among PWID. Rates of fatal overdose, meanwhile, have skyrocketed in recent years, resulting in 907 deaths in 2016 and over 1200 in 2017. Trends for injection-related HIV and injection-related infection and overdose have taken different trajectories because access to sterile injection materials only addresses a portion of the risk environment for injection drug use. Avoiding SSTIs is hard, even with a sterile syringe, when injecting in poorly lit, cold, dirty or otherwise unhygienic spaces. Reversing an overdose is possible with naloxone, but there has to be someone to administer it, and PWID often inject in secluded spaces. Some evidence also suggests that overdose is more likely when PWID inject hurriedly – from fear of assault or arrest – and without the opportunity to taste and control dosing.
  • Publication
    Advances in Digital Health Research
    (2018-02-01) Palmarella, Graceann; McGrath, Colleen; Solomon, Sara; Dupuis, Roxanne; Cannuscio, Carolyn
    Social media and emerging mobile technologies have sparked radical shifts in human behavior, with people worldwide spending an average of 2 hours and 15 minutes daily on social networks. Facebook, Instagram, and Twitter have more than 2 billion users globally. Social networking site use has risen dramatically by all age groups, with the highest use among 18-29 year olds (see Figure below). Every second, Twitter users send 6,000 tweets, amounting to 500 million tweets per day. Instagram users post approximately 95 million photos, generating 4.2 billion likes, each day. A newer platform, Snapchat, has 178 million daily users, 60% of whom are under 25 years of age. They share an average of 3 billion snaps, or rapidly vanishing photos, every day. Researchers at Penn are turning these Tweets, posts, and snaps into innovative data sources that hold vital clues about behaviors, emotions, preferences, opinions, and social networks—all with potential implications for population health. Through the analysis of keywords, images, phrases, emoticons, likes, and hashtags, Penn teams are turning troves of digital information into human-centered health interventions and educational initiatives.
  • Publication
    2014-2015 Annual Report
    (2015-01-01) Center for Public Health Initiatives
  • Publication
    15 Years of Public Health
    (2017-01-01) Center for Public Health Initiatives
  • Publication
    Relationships between Clinician-Level Attributes and Fidelity-Consistent and Fidelity-Inconsistent Modifications to an Evidence-Based Psychotherapy
    (2015-01-01) Crits-Christoph, Paul F; Stirman, Shannon W; Gutner, Cassidy A; Evans, Arthur C; Beidas, Rinad S; Edmunds, Julie
    Background: Clinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults. Methods: Survey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables. Results: Successful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications. Conclusions: Implications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research.
  • Publication
    Predictors of Community Therapists' Use of Therapy Techniques in a Large Public Mental Health System
    (2015-04-01) Beidas, Rinad S; Marcus, Steven C; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Aarons, Gregory; Hoagwood, Kimberly; Schoenwald, Sonja; Mandell, David S; Walsh, Lucia M; Adams, Danielle R
    Importance Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. Objective To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. Design, Setting, and Participants In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Main Outcomes and Measures Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist–Family Revised. Results Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. Conclusions and Relevance This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.
  • Publication
    Contextual Influences and Strategies for Dissemination and Implementation in Mental Health
    (2015-01-01) Wolk, Courtney L B; Powell, Byron J; Beidas, Rinad S
    Implementation science has emerged to bridge the gap between research and practice. A number of conceptual frameworks have been developed to advance implementation research and illuminate the contextual influences that can facilitate or impede the implementation of evidence-based practices. Contextual factors that may be important in the dissemination and implementation of evidence-based practice may occur at the system-, organizational-, and provider-levels. System-level barriers may include external policies, incentives, and peer pressure. Organizational-level factors that are important in implementation include organizational culture and climate and implementation climate. At the individual provider-level, barriers may occur around provider attitudes, knowledge, and self-efficacy. Finally, additional barriers such as client-level that can be used to overcome contextual barriers when attempting to implement evidence-based practices into new settings. Several exemplar implementation strategies are discussed, including the Availability, Responsiveness, and Continuity intervention, Community Development Team model, and Interagency Collaborative Team Model.