Ruth Browne: Credible messengers, critical trust: Community health empowerment

>> Hello everybody and welcome. [ Inaudible Remark ] Thank you so much for joining us this afternoon. >> Thank you so much. >> I'm Susan Collins, the Joan and Sanford Weill Dean here, at the Gerald R. Ford School of Public Policy. And we're thrilled to have you here for what promises to be a terrific Policy Talks. So, welcome to all of you. Our topic of course is, Community Health Empowerment. And I'll say a little bit more about that and about our speaker in just a moment. But, before we begin, I'd like to thank both the Ford School Center for Public Policy in Diverse Societies and also the Gilbert S. and Martha A. Darling Health Policy Fund for helping to make today's event possible. And Martha is with us here today, thanks. We're delighted to have you and welcome. I also would like to thank Judy Rumelhart, who is the daughter of--Judy, are you here, yet? >> She is here. >> Wonderful. We are delighted to have you here with us. Welcome. Judy is the daughter of Dr. Harry and Margaret Towsley. And we are here today to do part of our commemoration for her family's legacy. Named for her parents, the Harry A. and Margaret D. Towsley Foundation Policymaker in Residence Program, was established here at the Ford School in 2002. And it is a phenomenal opportunity for us to bring to the school policy leaders with extensive experience in a variety of different dimensions of policy making to engage with our faculty, with our students to teach and also to do a public event. And we are delighted to be here today with our 2015 Towsley Policymaker in Residence, Ruth Browne, who is today's speaker. Ruth is CEO of the Arthur Ashe Institute for Urban Health. And she is also a graduate of Princeton. She went on to earn a PhD in Public Health at Harvard University. And I'm delighted to make sure that all of you know that she's also a wolverine. In addition to having an MPP, a Master's in Public Policy from the Ford School, she earned an MPH from the School of Public Health here. And so, it's been wonderful to have her bound home and here on campus. She's been here just for three short weeks. I have to say it seems like it's been a lot longer. Our students say that she is not only inspiring but they call her dynamo and I have to agree with her--with them. >> It's the picture. >> So, if you walk outside of her office, there are typically students lined up to engage and talk with her. She has already had a number of different sessions and meetings with faculty and students. She has led a segment of our school's ongoing community conversation around race in the United States. And she has brought speakers in and launched her own course in Health Disparities. All the while, she is leading from afar, the Brooklyn-based Arthur Ashe Institute for Urban Health. So, I probably think she must have cloned herself to be keeping all of these things moving forward. Her topic today addresses a number of the interrelated issues associated with health equity including prevention, issues around health community options, and policies to support investments in health. Her varied experiences mean that she's particularly well-positioned to reflect on these very complex issues, as CEO of the Arthur Ashe Institute. And I note that it's interesting that it's actually located just a few blocks from her home in Flatbush. She is one of the nation's leading health innovators in urban health. Among her many accolades, she has received two Fulbright Awards. And under the second of those, she developed an internship program for high school students at the University of the West Indies in Trinidad and Tobago. That was a very successful project and it's just one of the many examples of the types of programs around community empowerment that Ruth has both led and been engaged with. As one of our alums and as a policy advocate, she will tell you that while health policy--not while, health policy is a terrific profession. But for those who want to make a difference, it's not a short-term instant gratification type of profession. It's something that takes dedication, it takes leadership. And those are skills that we hope she learned in part here at the Ford School in a variety of other ways. I just wanted to give an example of one of the types of programs that she has been engaged with. In 1994, just two years after the Arthur Ashe Institute was founded, Ruth helped to launch one of what is now a signature program. And that is an after school enrichment program designed to inspire more minorities into health and science professions, and return to their own communities to be able to share their skills. Well, in the 20 years--and I have to say I am so inspired and impressed by some of the statistics. Probably 99% of its graduates have gone on to college and 60% of them have entered bachelor's programs in science and health fields. That is really inspiring. Congratulations. [ Applause ] So, before we get started with what I'm very much looking forward to, I wanted to remind our audience that if you have a question, please write it on the question cards that were distributed as you came in. At around 4:30, we will have staff circulating to begin collecting those cards. And with help from Professor Ann Lin of the Ford School, two of our students who are also in Ruth's class, Kiana Shelton and Chanera Pierce will be reading the questions. And if you are watching online, please tweet your questions to us using the #policytalks. And so with no further ado, it is my pleasure to welcome Ruth Browne to the podium. [ Applause ] >> Thank you so much. That was like [inaudible]. Thank you. Good afternoon. That would be a good afternoon. >> [Simultaneous] Good afternoon. >> Thank you. One second here. All right. So, first, I just want to say thank you. And I want to say thank you to the Towsley Foundation for this tremendous opportunity that's been given to the Ford School. And to the Ford School for the tremendous opportunity that they had given to me to come home to my alma mater here at Gerald Ford School for Public Policy. I am delighted to be back and it is--also I'm very grateful for the opportunity that Dean Collins has given me, to invite me to come here as a Towsley Policymaker in Residence. I'm having a ball. I have to say you all think of new things for me to do everyday, but I'm enjoying every one of them. So thank you. And I also want to point out the skill that this dean has to get me to come back here in the dead of winter. [ Laughter ] And her tag team, I want to acknowledge Sonia Gill, who she sent ahead to try to lay the ground for me to come back here to the Ford School. So again--and they are both celebrating birthdays this week, so can we say happy birthday. >> [Simultaneous] Happy birthday. >> All right, great. So, it's my pleasure as I said to be here and I want to acknowledge, of course, my team at the Arthur Ashe Institute. I have the pleasure of serving on a board--serving with a board. And the Board Chairman of the Arthur Ashe Institute, Dr. Edgar Mandeville is leading this organization to its next level of accomplishment. And he, along with the other board members, are doing a tremendous job in that regard. And it is my pleasure to serve for them and with them to build the possibilities for the institute. I also have the pleasure of serving with a tremendous leadership team at the Arthur Ashe Institute, my team, Dr. Marilyn Fraser-White, Dr. Mary Valmont, and Mr. Humberto Brown, and those who are working with them everyday to build possibilities in our communities around empowerment, involving people in the work that we're doing to build solutions in their own communities. So thank you. And last but not least, I want to acknowledge the institute's 20-year academic community partnership with our partner SUNY Downstate Medical Center. And specifically, the work that we are doing through the Brooklyn Health Disparities Center and the team of researchers and advocates and community partners there. So, we believe that together we're building a national model for universities in partnership with community. And we have a lot more to do. So, I have a little clicker here, right? All right. Great. So partnership is the core strategy that we use at the Arthur Ashe Institute. And everything that we're doing links community leaders, and activists, and legislators, and providers to address the root causes of health disparities. And we're guided by our founder's simple but profound words, "Start where you are, use what you have, and do what you can." And that's what we're trying to do in Brooklyn. So I hope you'll take copies of the materials outside and read about our methods and our programs and our results. But let me tell you--give you a little background on the Arthur Ashe Institute. So first of all, show of hands if you know who Arthur Ashe was. This is helpful. [ Laughter ] Arthur Ashe, for those who don't know, was the first African-American man to win Wimbledon and the US Open Tennis Championships. And he used his celebrity as a tennis champion for humanitarian causes both here and the United States and abroad, and was known very much for his anti-apartheid work. And so we work everyday in his name and we consider ourselves a legacy-promoting organization. So, founded in 1992 by the tennis champion and humanitarian Arthur Ashe, it's important to note that the Arthur Ashe Institute is an independent 501(c)(3) charity. And we are located in Brooklyn. And we have our main campuses on the campus of SUNY, the State University of New York Downstate Medical Center. It is a partnership. And we use a model of community health empowerment in the work that we do to address conditions that disproportionately affect underserved communities. So, we know we have a lot to work with. And some of the community assets and local heroes who are often overlooked appear on the screen before you. Our approach is really to leverage those community assets. And we truly believe that all communities have assets that can be engaged on behalf of the community's health. So, the assets include the institutions on the left, like businesses and places of worship, of course the local health and social service agencies, libraries and schools, but they also include those personal care establishments. And when I talk about personal care establishments, I mean, the beauty salons, the barbershops, the body piercing and tattoo salons, the Laundromats, even the nail salons that are in the community. So--And at these places in the community, which have become our educational campuses, there are people who can be engaged in community health empowerment. So, community health empowerment is the model that we use in everything that we do at the institute. And what we're really talking about is connecting people to the information and the tools and the resources that will allow them to make better informed decisions about their own health, but also safeguard and engage and at the health of their communities. So we want them to be proactive about their own health and we want them to be proactive about their family's health as well as be advocates for their own communities. It's a model that's designed to increase the options that people have. Increasing their sense of urgency and making it more likely that they have shared their knowledge and their experience with others, sparking the social contagion that's been documented in a--as effective in addressing issues like obesity and smoking cessation, teenage pregnancy and the like. And health messages are tailored, tailored for us so that peeps tailored for the participants so that they can act on them immediately and convey their experience and outcomes to others. So, this is what the institute is doing. The Affordable Healthcare Act also acknowledges and begins to address the underrepresentation of diverse groups of color in the healthcare workforce. And our Health Science Academy, that Dean Collins referenced earlier, was founded in 1994, in response to the underrepresentation of minorities in the health professions. Arthur Ashe believed in academic excellence and that is exactly what the Health Science Academy is about. It's a signature program of the institute and today we have a thousand graduates of the three-year after-school programming that we're doing at the high school level. Now, I will tell you what we're really trying to do is take young people out of neighborhoods that we want them to come back to. And just because you identify young people from neighborhoods to go through academic preparation doesn't mean that they will want to come back to their own neighborhoods. And so for us, that's key. It's building community commitment to your own community. And so we're giving them not only the technical, the academic enrichment but the attitudinal preparation to get a leg up so that they will not be weeded out of undergraduate science curriculum programs in their first semesters. And now, we have a robust, expanded pipeline that starts even earlier in middle schools. Introducing career exploration and extending forward with programming for the academy alumni, it--at various phases of their academic tenure as well as their professional health practice. The institute takes a pipeline approach to its partnership with SUNY Downstate to--which is by the way Brooklyn's only academic medical center and one of four in the state university system. And our goal is to reach youth of color from middle school to high school. So as Dean Collins said, more than 60% of academy graduates choose to study science at the undergraduate level, and that compares to less than 6% of minority students nationally who make that choice. In terms of our community outreach, we are right in the sweet spot of the Affordable Care Act. And the Affordable Care Act calls for comprehensive medical homes and preventive services and education that occurs outside of clinical settings. It's a vision that shaped our work from the very beginning. So what we're looking at with our programs is what is the health behavior of customers in stylist and barber-delivered--what is the health behavior of customers based on stylist and barber-delivered health messages. So let met just give you a couple of examples. Heart of a Woman is one of our programs that really is our answer to the increasing incidence of heart disease among African American women. Heart of a Woman takes place in beauty salons in Brooklyn and we've probably worked with four--over 400 beauty salons and barbershops in the Borough of Brooklyn. And it's basically about knowing your numbers and linking people to health services. Now, Barbershop Talk with Brothers leverages the work that we've been doing in barbershops but basically is an HIV-risk reduction program for heterosexual African American men. And Barbershop Talk with Brothers is a program that we run in partnership with the Brooklyn Health Disparities Center and a team of researchers that work with us there. We've enrolled more than 300 men in this new HIV-risk reduction program. Now, ACCESS is a program that connects people who are returning to their communities from prisons and jails and links them to health services. And I'm going to talk more about the ACCESS program in a minute. The Brooklyn Health Disparities Center is an NIH-funded Center for Excellence that really leverages community partnership. It is community-informed, it is community-driven, and it is community-engaged. And it basically is a partnership between the three institutions which is a unique community academic and government partnership. So it's the Arthur Ashe Institute, the SUNY Downstate Medical Center, and the Brooklyn Borough President's Office, to use this method of community engagement around policy, advocacy, intervention design, research, as well as training. We believe that to achieve equity you have to acknowledge, document, and monitor inequity. And in order to do that, we have to address the health disparities in a way that engage communities in the documentation, to monitoring the decision making and the problem, and the development of solutions. So to see how this works in action, I'm going to let some of those local heroes speak for themselves, about how they're fulfilling our founder's vision starting where they are, using what they have, and doing what they can. [ Pause ] [ Music ] [ Noise ] [ Inaudible Discussion ] >> When you go in for employment you're going to end up getting more than a haircut. >> Now, you do it safely because the--when you come in, she's not just doing your hair, she's talking about what you've been doing, what should you drink, what should you take, what should you do. [ Inaudible Discussion ] [ Pause ] So, I had the opportunity to participate recently in a fellowship that is sponsored by the Presidio Institute. And it's a year-long program that's intended to develop leaders who will engage across intersectorally. So, across government, across business, and across the not-for-profit sector to solve seemingly intractable problems. And it was important to be involved in that because as the Arthur Ashe Institute considers what is major and new work for itself, and that work is to address health concerns for people returning from prisons and jails to their communities. We often encounter the question, whose responsibility is it to address the needs and rights of the reentry population, people returning to their communities from prisons and jails. And we contend that it is--to be true to an urban health institute, we have to be addressing major social determinants of health. Our mission is really to address the social and cultural issues that affect health and wellness. And so, incarceration and its effects is a major social determinant for us in our work. So the work we've done over the past 20 years is a testament to what barriers can be overcome through openness, persistence, and continuing to talk to people who might oppose you until you find some common ground, some translatable language and experience. So Arthur Ashe said do what you can. And I will say that the three programs I had described guided by our community health empowerment model, really address complex root causes through approaches and activities that are designed to narrow gaps in trust, in motivation, in access, and in representation and in information. And representation is key for us, right? Who is at the table? Who is at the table and how do we find common language that reflects our individual experience in terms that we can understand and work with. So, each of these is equally important to us. But today, I'm going to talk about ACCESS, and how the institute is responding to the Afford--the opportunities in the Affordable Care Act. So, our ACCESS program connects people who are returning to their communities from prisons and jails to health services. And this is an important response to an urgent need in the Borough of Brooklyn where we work. Brooklyn--Central Brooklyn is 80% black, 30% of people residing there live below the poverty level, 29% of the residents are born outside of the United States. But get this, 75% of New York State's prison population comes from seven communities in New York City and three of those communities are in Brooklyn, in the areas that we work in. So to demonstrate the importance of these statistics in our work, the ACCESS program targets people who have been jail-involved in our community. And I want to point you to the work of Eric Cadora, who is the Director of the Justice Mapping Center and has done work that is coined around million-dollar blocks, and how that concept is being applied very specifically to Brooklyn and the neighborhood of Brownsville. So the Brownsville section of New York's Brooklyn Borough has long been considered challenging. It's been considered a dangerous community. And the Brooklyn-based Justice Mapping Center has been tracking the cost of incarcerating residents of neighborhoods like Brownsville, block by block for the last 15 years. The Justice Mapping Center coined the phrase, "Million-dollar blocks," when they were looking not at crime rates but at incarceration rates on those blocks. They mapped where people were going in and out of prisons and jails every year, and started to look at the data at a very local level on the block. They tallied the cost of that imprisonment for each block in Brooklyn and found places for which the state and the city of New York was spending more than a million dollars a year to send the residents to prisons and jails on average between two and three years. So the map on the left shows the cost of incarcerating all residents sent to prison in 2009 from each block in Brooklyn. And the dark red blots represent areas where the state will spend more than a million dollars to incarcerate people. The map on the right shows the cost of incarcerating residents from the individual blocks in and around Brownsville. And as you can see there are several million-dollar blocks in Brownsville. So where is the opportunity? Well, if you look here, we have--this is a map of beauty salons and barbershops in Brownsville. And we've worked with many barbershops and salons in the Brownsville community. The Barbershop Talk with Brothers project that we are currently working on has established relationships with many of the barbers in Brownsville and its surrounding or next door neighbor is New York. So in terms of community empowerment there's opportunity here, right? Looking for the places where people naturally go and looking at the opportunities to engage them on behalf of the community's health. Now, the Affordable Care Act has a potential to build a safety net, wide enough for all who need it, however, almost all. However, in the language of the Affordable Care Act, as practitioners, we're told that it's up to us to work intersectorally to close the access gap. So again, in our programming, information on screening is accompanied with referrals, to culturally-competent providers, and the means to enroll in low-cost or no-cost health coverage. Approximately 10 million people are released from US jails each year. And this population is disproportionately young, male, although increasingly female, minority, low income, and poorly educated. So compared to the general population, these are individuals that have high rates of mental and substance use disorders. So access to much needed health and mental health services as they leave jails could improve health and potentially recidivism. Sixty-three of men and 75% of women entering jails exhibit symptoms of a mental health disorder. Alcohol plays a role in more than 50% of incarcerations than illicit drugs in more than 75%. People in jails experience higher rates of chronic and acute physical mental--physical health conditions compared to the general population. And those conditions include hypertension, and asthma, and cervical cancer, as well as hepatitis among others. Most individuals released from jail have no health insurance, and as many as 90% of people entering county jails are uninsured. Without ongoing physical and mental health care, many released individuals are susceptible to relapse of conditions that may have gotten them arrested in the first place, or may have been contributed to their arrest in the first place. And I--transparency here, I serve on the Board of the Center for Healthcare Strategies and they have released recent data about the opportunities for the Affordable Care Act for jail-involved populations. And for those of you, who don't know what the center is, the center has been focused on diverse and low-income populations but their sweet spot has been Medicaid. Medicaid expansion for low-income adults under the Affordable Care Act, offers the potential to connect more--many former jail-involved, many formerly incarcerated individuals to health insurance coverage for the first time. So, people with mental illness, substance abuse disorders, as well as a history of incarceration, and who may have much more difficulty obtaining stable employment than healthier jail-involved individuals. This is an opportunity for. With Medicaid expansion, eligibility for Americans with incomes up to 138% of the federal poverty level, this should greatly increase coverage for people who have recently been released from jail, and perhaps improve the health outcomes and reduce recidivism in this population. The Affordable Care Act offers many new options and it allows states to expand Medicaid to non-elderly adults up to 138% of the poverty level, but also it offers subsidies to purchase marketplace coverage for those between 100 and 400% of the poverty level. Up to 30% of people released from jails could enroll in Medicaid in states that expand the program. An additional 20% could enroll in a marketplace plan, but that's going to be more difficult for people who have mental health and substance abuse disorders. So that might result in a relatively higher Medicaid enrollment and lower marketplace enrollment for that subset of the population. But the benefit plans offered to the Medicaid population have to be--and through the marketplaces must include mental health and substance use services at parity with comparable medical benefits. So given these requirements, most states expanding Medicaid are increasing covered mental health and substance use treatment options. So again, this is about improving access, right, which requires the implementation of this legislation in ways that reach the jail-involved population. But we have to reach this population in ways that are socially and culturally relevant. So again, I want to thank, acknowledge the Center for Health Care Strategies for their work that they're doing on ACCESS for jail-involved populations. So in the work--in the words of our founder, which we hear everyday, right? "As we try to work to eliminate health disparities and achieve health equity, it's really about starting where you are, using what you have and doing what you can." So what do we have that we can use? We have the ability to identify community assets and develop people in the community. And the institute recently received funding from the Langeloth Foundation to develop an intervention that would increase health access for formerly incarcerated individuals, people returning to their communities from prisons and jails. And that is our program, the ACCESS project. The formative work confirmed that over 80% of the barbers that we were working with had had an incarceration experience, 80% of the barbers. So because the barbers that were working with us had had experienced with incarceration, we felt that they could be very credible messengers for the work that we were trying to do. And they indicated their willingness to begin to identify strategies that would help people really reenter the community and access services. And so they are engaged with us in very meaningful ways in both identifying people who need services and also facilitating, getting people linked to services. One of the challenges for us is sharing the work that we're doing with prison discharge planners and that represents new work that we are engaged in. And this programming specifically for jail-involved members of our communities as it represents new work for us is ongoing but it does represent a future direction for our organization. Again, to be true to an urban health mission, you have to deal with the social determinants of health and then the communities we are working in, incarceration is a huge one. So we have the CHE model in our programming, our history of implementing successful programs. And we believe that people can't fully accept responsibility for their health without an expanded range of options. From personal care establishments like the beauty salons and barbershops, to under-resourced middle and high schools, the institute supports indigenous community leaders. We're trying to grow them and engage them in their own community's health. At the institute we navigate worlds that don't necessarily talk to each other much, and when I say that I mean, the world of academic medicine and life on the block. So we have many community partners, other community organizations that we work with and we are trying to address what are pretty shocking disparities in the communities that we work in. In our work, we partner with people and organizations that are working to provide the services, address the social determinants of health and address the social determinants of equity. So again, starting where we are, using what we have, and doing what we can. And I thank you for this opportunity. [ Applause ] [ Pause ] >> Good afternoon. >> Good afternoon. >> My name is Chanera Pierce. I am a second year MPP here at the Ford School and I'm currently enrolled in Dr. Browne's course. >> Hi. I'm Kiana Shelton. I'm also a second year MPP, a graduating one at that. And I'm also very excited to be here today. I'm also taking Dr. Browne's course and it has been extremely illuminating. I'm also super-duper privileged and excited to say that I got to spend my summer internship time at the Arthur Ashe Institute for Urban Health as an intern there working on really important issues for the institute and for myself. So, I'm super-duper excited. We have some questions for you today, so we're going to kick it off. We're going to try to get in as many as possible. And we'd have some great inquiries. So, I think Chanera is going to ask you a question. >> This will be a two-part question. One is, what motivated you to pursue work in health policy and how do you go about inspiring students who want to return to their communities? >> So, I would say that there is nothing like experience in your communities. When Dean Collins referenced the work that I was doing in Trinidad, it represents a replication of work that we do at the Arthur Ashe Institute. And so in Brooklyn, we have young people who not only are being academically prepared but they participate in community-based participatory research experiences that get them working with community-based organizations in their own communities around social determinants of health. So part of the goal is really to get young people engaged in understanding, identifying, and coming up with the solutions for the challenges in their own communities. That's at the pre-collegiate level. In terms of students who are interested in public policy, I would say that, you know, while the institute is doing grassroots programming, we're a hybrid organization that is working across intervention, as well as service, as well as education and training, and research. And so the active community-based research has a lot of implications for policy. And we try to use that opportunity to educate legislators and those who serve legislators about the problems that we're seeing on the block, and so that those things get considered as policies being developed. So the experiential opportunities around going into health policy are important so that you have some grounding in policy advocacy work that you might engage in. What was that--there might have been a second part of your question? >> It's what motivated--If I recall correctly. What motivated you to pursue work in health policy and how do you encourage students who want to-- >> OK. >> Yeah. >> Right. >> How do you measure the results of your community empowerment initiatives? >> So, much, you know, we are an institute and a lot of what we're doing is incubation, testing the effectiveness of the models that we're developing and we've had some opportunities to replicate. The work that we do for example in the communities, in the barbershops, and the beauty salons, as I said what we're looking at is, what is the health behavior of customers based on a stylist-delivered health message. So we are developing curriculum, to--curriculum to teach the barbers and the stylists how to coach their customers towards better health. And stages of change, has traditionally been our model, a continuum that we're trying to get people across. But what we're doing is using the trusted relationships at the level of the barber and their customer to get the barbers and the stylist to actually engage their customers in moving across that continuum. We use focus groups. We use in-depth interviews. Our--We have NIH fundings. Our methods are pretty rigorous in terms of the process as well as the outcomes. Much of what we were doing early on was really looking at the feasibility of using these kinds of approaches in the community, and now having proven that it's feasible, acceptable. We are actually measuring the results of the work that we're doing. And for us it doesn't matter whether it's heart disease or cancer or smoking cessation. It's really about breadth and depth, right? So how do you use the model to reach people and get them to change their behaviors across this continuum, but also how do you expand the opportunities beyond, let's say the African-American community that we're working to extend to Latina beauty salons for example, or in this case, the ACCESS project to formerly incarcerated populations. >> Concerning the Health Science Academy, what is the selection criteria for the students? And besides academic supports, are there other types of services to complement scholastic enhancement? >> So, the students come from 12 high schools at the high school part of the academy. The students come from 12 high schools in Brooklyn. And the high schools vary across the--some are--I would say that probably out of the 12, 10 are public schools and two are parochial schools. The students have to get 85 and above in math and science in order to get in the program and they have to keep that average to stay in the program. What's the last part of your question? That was a criteria. >> What--Are there any other types of services to-- >> Yeah. >> --complement scholastic enhancement? >> Right. So, our students are getting support on my own learning styles. They are learning about health disparities research. They are participating in financial aid workshops. We engage their parents as well. We have a prep for them for SATs, PSATs. It's a lot of things they're getting. Anything else Kiana? You worked with them this summer. That's a lot. Yeah. And guidance in terms of the--both the college application process and--but most importantly, I think what the students are getting is an opportunity to be on the campus of a major medical center and the familiarity with engaging with the professors and the graduate students who are there. I think the other piece I would have to say and I would definitely be remiss not to say, is that the acknowledgement of the difficulty that many minority students have in navigating the process of both going to college and staying in college and advancing in the health professions. And I think that the institute's approach has been to really lay those challenges out so that people know what to confront and how to navigate as they're moving along that path. >> Individuals who leave jail or prison may spread diseases such as hepatitis, antibiotic-resistant TB or HIV after they are released. Are there any screening or education programs to prevent these problems in prison or that your foundation or institute does? >> I don't know about prevention in prison. I know that there is correctional health which is supposed to deal with those issues once people have been identified as having them. I think what is the challenge is that upon release, many people are just sort of released. And whatever they were getting and for some people whatever healthcare they got in prison is the only healthcare they've ever gotten. When they're released they're not linked to services and so if they were making progress in terms of disease management in prison, there's no reason to believe that they'll make a progress--continue to make progress having been released because they're not linked. And so that is the--that's really where the challenges in terms of linkage to service and facilitation of a seamless pipeline from correctional health to health services in the community. >> We have a question from Twitter. How do you sustain the work of the institute? >> With great difficulty. [ Laughter ] This bridge called our back. So, the institute's work is supported by a range of funding opportunities. We have both government grants as well as private and corporate foundation grants, and grants from individuals. I would say the individual grants are probably the smallest of our grants, but we are looking to--constantly looking at ways to actually engage the people who work with us in the fundraising on behalf of the institute. And I think the sustainability also comes from the fact that I've had the benefit of having--the institute has really benefited from long-term staff and how you engage and develop that staff I think makes a difference in terms of, you know, a not-for-profit, you work miracles without--very little. And so, we're constantly thinking about ways to diversify our founding base. And then we do traditional things like annual events. >> What are some of the findings of your research in communities? Do you set--Do you see trends and lack of access or racial disparity, for example? >> To my whole presentation? That's right. It was about that, absolutely. Do we see trends and lack of access and--yeah. Next. >> As in--I imagine are there any notable trends that you're seeing apart from the ones that you spoke to us today about with-- >> I think that--So, I work in mostly underserved communities. And I think the challenge in working with underserved communities is that you're constantly having assaults from various different things, right? So it could be, you know, a lot of attention paid to HIV this year, and we've moved on to hepatitis C next year, and we're talking about Ebola, and we're talking about, you know, enrolling people in the ACA. I think what the challenge is, for us is that there's so much fragmentation in the system and there's so much diversity at the community level that the linking people to a scene was pipeline of services becomes the real challenge for the organization. And so when I said earlier that we're--it's the model that we're trying to promote, it really is about giving people the tools so they can navigate across a range of issues. In terms of services, I would say that one of the things that we are seeing in our work is this--is progress with people knowing their numbers. So when I talked about the heart disease program that we're doing in beauty salons, we are seeing that people are much more conscious about their--you know, we actually have salon--blood pressure monitors, body mass index monitors in the salons and shops that people are much more aware of what their numbers are. It's the linkage to care piece that continues to be the challenge. >> So--Excuse me. So much of your work with Arthur Ashe is about place-based health strategies. How difficult is it--has it been to reach a subset of the population that is barred from so many traditional institutions? How can strategies begin within prisons and once individuals reenter society at large? >> It's a million-dollar question. I think with careful navigation and with culturally competent navigation. So, I think, you know, when you are talking about a population in our work, we've been working with beauty salons and barbershops since 1995, '96. And when--it was shocking to us to find out the levels of incarceration experiences that barbers had. But when you begin to engage those indigenous leaders in the community on behalf of the community's health, you get homegrown information that you really can't pay for. And their ability to guide people along the process and navigate linkage to care is priceless. [ Pause ] >> I'm part of a team evaluating Michigan's Medicaid expansion, including the impact of enrollees on their families and communities. For the reentry population, what would you ask them or what would you measure to examine the impact of enrolling in Medicaid? >> What would I ask them? OK. I'm not sure I understand the question. >> For the reentry population-- >> I imagine-- >> --what would you ask people who enter the community--who reenter the community? >> Yes. Yeah. >> Certainly, I think it's important to ask people what they need. >> Yeah. >> Right? And they don't necessarily articulate health services as being their primary need. So, you can imagine that people are reentering the community from prisons and jails are concerned about how am I going to support myself, right, so employment, and where am I going to live. And I think that one of the challenges that we have is how you integrate employment and housing and health, all of those social determinants that make people whole, right, in linking people to services. So I definitely think, you know, our model is based on asking people what they need and what they think are the solutions for those needs. And so, asking people who are returning to their communities would be--would really be about prioritizing. >> Does the student pipeline program also provide you an opportunity to engage family members to improve their health? More generally, are there connections across your programs? >> Yes. So that's a great question there. There are many connections across our programs. There are some of our students actually have parents who are in the health professions and many of them have taught in the program. We have folk--so we--engagement of parents is absolutely--and guardians is absolutely important in our work. And people giving their professions have added value in a voluntary basis to what we offer in terms of our student programming. >> All right. [ Pause ] >> Yes. >> Was it hard to transition from on the groundwork to your current position of CEO? Asking a little bit more about you, I suppose. >> I don't know that I have transitions. And I don't say that as a good thing necessarily. But because of the hybrid nature of the institute, my hands are in a lot of things. So I do pride myself on learning not-for-profit management. And I also pride myself on translating the on-the-ground work to its policy implications. But I would say that in terms of being involved in research as well as design of program, I've tried to mentor and support people who work with me to take on more responsibility in that regard. And I definitely think that they do and are leading in their own right. But we're small organizations so I continue to be involved in the many aspects of the institute. [ Pause ] >> For medical students who are interested in policy, what kind of training opportunities are available? For instance, residency programs with policy components. Do they exist? >> Usually those come in the form of joint degrees in public health. At the institute we've had a number of people who have done not formal residencies but informal residencies with us, internships, graduate fellowships. And we try to involve many of them in the--in building the policy arm of the work that we do. So--And we do that at the student level too. So, an example of that is we work with a partner called Make the Road New York. And Make the Road New York was very interested in--Make the Road New York was known for the class-action suit that they launched against the public hospital system around language access and translation. And we actually had students work with them and the project that they worked on was actually focused on pharmacies and looking at pharmacies, making available translation and interpretation, and signage that people could really benefit from in terms of using their medications. And so, it's a great example of how policies can get informed by local on-the-ground community work. So that's just an example I would share for someone who might be interested in doing work around translating grounded community work to its policy implications. >> In looking at incubation and scale of your programs, when building community health advocates, what is the greatest obstacle? >> I think the greatest obstacle would be-- [ Pause ] --we work with a lot of people who have been voiceless. And coming to the table doesn't necessarily mean that everybody is ready to come to the table. And so a lot of our work is it's a long or pretty long time continuum. We have to get people prepared and ready to be advocates and that often means that we have to do skills building in the course of building those advocates. And I would say that that's probably our biggest challenge because the time from skills building to advocacy can sometimes take a while. [ Pause ] >> We have another question from Twitter. Was your work in Trinidad, part of your work for the Arthur Ashe Institute? How does your interest in Brooklyn and on the West Indies fit together? >> So--Well, so, just on a personal level, my parents are--my dad was from the Caribbean. My mom was African-American from Ohio. And I spent time as an undergraduate at University of the West Indies. So I had the opportunity to do a Fulbright. And when I was trying to think about my project, I said, "Well, I have to take time from work," so it might as well work for work. And we were doing the program in Brooklyn with Brooklyn students, many of whom hail from the Caribbean. And I said, "Why couldn't we replicate this program in Trinidad and Tobago?" And so that was actually the impetus for that work. And it's very much part of the institute and we've been very successful in being able to sustain that work for the last three summers. This will be our fourth coming up. [ Pause ] >> Do your HSA students come back to their communities? Do they engage with your summer school students? >> Yes. We have an active core of alums mostly who live in Brooklyn. But those who come for the summer are actively engaged in the work they do. They teach in the program. They mentor in the program. They service group leaders for those students who are working in the summer on community-based and participatory health projects. They help to guide students who are going through the application process and they do internships. And then through the Brooklyn Health Disparities Center we're able to offer them opportunities to do research themselves, get published, participate in professional conferences, et cetera. >> How do you encourage and incentivize the barbers and the beauticians to be those community health advocates? Or is there any type? >> So in terms of the monetary incentives, you know, the barbers we ask them to host things in their salon and we'll give them a stipend for hosting and they can use it for refreshments and that kind of thing. But, you know, if you think about it, it's really mind, body, spirit, right? So how do you encourage people to give back to their communities I think is really at the root of that question. And in our case, we have found that people are not only willing to do it. They're asking us when we're coming back. I think the sustainability issue is on our part of how--you know, we can't sustain active participation in 400 barbershops all at once, barbershops and beauty salons. But we are constantly going back to those that have worked with us with new programs, to test new models et cetera. And I think the challenge for us has been really, in realm, boostering, not incentivizing. But boostering meaning going back and making sure that people keep talking, that we're giving them more information to disseminate in the community, more information to share with their customers. And so, when we booster, we get results. Yeah. [ Pause ] >> Is there a possibility to engage staff in prison in your strategy development for connecting people returning to the community with health services and health information? If this is already happening, what does it look like? >> So, it isn't already happening. It's a process of engagement, and trust, and motivation, and political will and all of those things. And so, our--we are in the process of relationship building with those who are in corrections so that we can create the seamless pipeline and really take advantage of the Affordable Care Act. But yes, that opportunity is absolutely there and is absolutely essential. And some of the students in my class are designing that, so. Yeah. >> As a concluding question, we would like to know what is next for the Arthur Ashe Institute? >> So the institute is--was founded to develop models, test their effectiveness and replicate that. And we've had some opportunities for replication. I think for us it's really building the business model for replication. But the process that we use is really around training other like-minded community-based organizations to do the work that we want in their settings. And so, the business model for that is definitely forthcoming and I think that the opportunity to do multi-site studies and using the models that we have developed would represent future work. >> All right. >> Thank you. >> Thank you very much and welcome. [ Applause ] >> Not sure if this--it is working, wonderful. I just wanted to say thank you very much to Ruth Browne for-- >> Thank you. >> --her presentation and engaging in so many questions. I'd like to thank all of you for joining us this afternoon and for all of your engagement in this important topic as well. I hope you will stay and continue the conversation. We have the reception just outside in our Great Hall. And so, please join me in a final round of applause to thank Ruth Browne. >> Thank you. [ Applause ]