Women leaders in healthcare – Richard Asinof

by Richard Asinof, ConvergenceRI, contributing writer

[Editor’s Note: The original headline for this story is “Women get shit down” and is taken from a list of takeaways presented by author Beth Macy, during her presentation last week at Hollins University in Roanoke, Virginia, talking about her reporting conducted in her books, Dopesick and Raising Lazarus.

The provocative phrase – edited here – serves as the connective thread for three separate events that occurred last week:

• The public reveal of the results of the fourth annual R.I. Life Index, a partnership between the School of Public Health at Brown University and Blue Cross and Blue Shield of Rhode Island, on Monday afternoon, Nov. 14. The extensive survey of residents took the pulse of how Rhode Islanders viewed the Health of the state. The R.I. Life Index report card was mediocre at best.

• A panel discussion by the R.I. Latino Policy Institute and the Latino Mental Health Network at Rhode Island College, “Addressing the Mental Health Pipeline,” held on Tuesday evening, Nov. 15. The focus of the conversation was about how to build a more inclusive pipeline in the mental health and behavioral health field among Latinos and other historically underserved communities.

• The release of the report by the R.I. Coalition Against Domestic Violence on “Domestic Violence Homicides in Rhode Island, 2016-2020,” on Thursday morning, Nov. 17. The somber ceremony sought to give voice to the victims and to create the momentum to move forward with solutions – a new domestic violence court, and better law enforcement – to save lives.

After attending each event in person as a reporter, ConvergenceRI recognized that there was a common thread to the three events: the critical importance of women in leadership roles who are working to change the outcomes. The astute observation made by author Beth Macy – that “women get shit done” – seemed to be a self-evident truth of our current landscape.

PART One

PROVIDENCE – Less than 24 hours after a judge acquitted an off-duty police officer of assault after he punched a Black women in the face at a public rally at the State House, the R.I. Coalition Against Domestic Violence held a somber program to release the report, “Domestic Violence Homicides in Rhode Island 2016-2020.”

The findings of the report were incontrovertible:

• Between 2016 and 2020, 26 people lost their lives to domestic violence homicides in Rhode Island.

• The majority of homicides, 21, involved perpetrators who killed their intimate partners, or killed bystanders in an incident related to intimate partner violence.

• Some 43 percent of the intimate partner homicides were committed with firearms. The report made clear that “the presence of a firearm can play a significant role in escalating violence to a lethal level.” Women in abusive relationships are five times more likely to be killed if their abusive partners had access to a firearm, according to the report.

• The report also found that 19 percent were killed by being beaten, either with hands or fists or blunt instrument, 19 percent by stabbing, 10 percent by strangulation, and 10 percent were killed using a vehicle.

“It’s not just guns or knives. It’s hands that kill, too,” said Cheryl Silva, the mother of one of the domestic violence murder victims, speaking at the ceremony. Silva’s daughter Jennifer had been thrown out of the third-floor of a building to her death by her abuser, Silva shared at the event. [What Silva had to say was featured in the lede paragraph of The Boston Globe story by Alexa Gagosz.]

What the report said
The compelling 24-page report shared in detail what happened to each of the 26 murder victims. It also made specific recommendations about what to do better:

• Establish a dedicated, high-risk Domestic Violence Court in Rhode Island within the R.I. District Court to promote greater victim safety, informed judicial decision-making and offender accountability in critical misdemeanor domestic abuse cases.

• Fully enforce laws that bar perpetrators and those subject to domestic violence restraining orders from possessing or obtaining firearms.

At the Thursday morning gathering at the field of memorials off South Main Street, the speakers included: Lt. Gov. Sabina Matos, R.I. Deputy Attorney General Adi Goldstein,RI Coalition Against Domestic Violence Executive Director Lucy Rios, and Zaida Hernandez, a member of Sisters Overcoming Abusive Relationships [SOAR].

The messaging from all of the women who spoke was quite clear: better risk assessment of domestic violence threats by law enforcement; better screening to keep guns out of the hands of those previous domestic violence perpetrators with restraining orders; and better listening by the courts and the police to believe women when they say that their lives are in danger. Collectively, the women were saying: “No more!”

Who talks, who listens, who hears, who acts?
Later that same day, driving back from a physical therapy appointment, ConvergenceRI had been listening to the radio, taking the temperature of the “intemperate” on WPRO. The 4 p.m. news, delivered by WPRO’s anchor, Steve Klamkin, featured the “Domestic Violence Homicides in Rhode Island 2016-2020” report as one of the top local stories.

However, that news being reported by his own station fell upon the apparently deaf ears of radio talk show host Dan Yorke, who did not mention the report. Instead, Yorke spent most of his airtime discussing the pros and cons of the acquittal of the off-duty police officer, for the second day in a row.

The question is: Why was it so difficult to recognize the connection between what the R.I. Coalition Against Domestic Violence study had found about 26 domestic violence murders and the violence that occurred at a public rally, protesting the U.S. Supreme Court decision overturning Roe vs. Wade?

State Senate Candidate Jennifer Rourke, who had been the victim punched by the off-duty Providence police officer, had issued a statement following the ruling by R.I. District Court Judge Joseph Houlihan.

“As a Black woman and a victim of physical assault from a police officer, I stand where many survivors have stood before – with our voices silenced and stories dismissed, abandoned by the state structures that were sworn to protect us and keep us safe,” Rourke said, as reported in a story published by UpriseRI.

“This verdict makes it clear that these structures are not intended to keep us safe, they are only intended to protect their own,” Rourke continued.

“It was not safe for me to stand on the State House steps at a peaceful protest for our reproductive rights,” Rourke said further. “It was not safe for me to seek healthcare after an alleged assault without it bringing financial harm to my family”.

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Part 2

The front row of prominent women leaders in health care who had gathered on the fourth floor of South Street Landing on Monday afternoon, Nov. 14, to share and to analyze the results of the fourth annual R.I. Life Index represented proof positive of author Beth Macy’s astute, provocative observation that “women get shit done” – though they would have certainly chosen much different language to articulate and give voice to that sentiment.

They were:

• Dr. Megan Ranney, MD, MPH, the Deputy Dean of the School of Public Health at Brown University, the director of Brown Digital Health, and an ER physician in emergency medicine at Lifespan, who has become well-known for her appearances on cable news TV speaking about firearm violence and the COVID 19 pandemic.

“I am quite optimistic,” Ranney said, introducing the afternoon’s activities. “My optimism flows from the knowledge that everyone in this room, and everyone attending virtually, are committed to addressing the inequities in our health care, public health, and community in Rhode Island.”

The results from the 2022 R.I. Index were “mediocre” at best, with the overall data trend for “affordable housing” showing a seven-point drop, from 40 to 33, from 2021 to 2022. In the handout summarizing the findings from the 2022 R.I. Life Index, it framed the steep decline in perceptions as follows: “The housing market here and nationally continued to heat up, resulting in soaring prices and rents and decreased availability.”

In her opening remarks, Ranney put a positive reframe on the data. “We believe that this work and our partnerships will help us build healthier communities across Rhode Island,” she said. “Our 2022 results show increasing layers of instability.” But, she continued, they also show a number of areas that “deserve our attention and our commitment” as we work to address the challenges that we are facing in today’s public health and health care landscape.

“We know that collecting data is just the first step toward eliminating the barriers that people face every day in accessing good Health,” Ranney said, accentuating the positive. “We understand that this data can also shine a light on the steps that are most likely to be impactful.”

• Martha Wofford, president and CEO of Blue Cross and Blue Shield of Rhode Island, the state’s leading health insurance firm. Since its inception, Blue Cross and Blue Shield of RI has been a co-sponsor of the R.I. Life Index. The Index has become a signature initiative for the health insurance company, with the data trends serving as a guiding light to show where the health insurer should prioritize its philanthropic investments in the community.

“Why are we here? And, why is the R.I. Life Index important?” Wofford asked rhetorically, to begin her introductory remarks. She answered: “I believe that it is important to measure and publicly [access] data so that we can have a shared understanding, and a shared agenda, and a shared commitment to address the issues.”

Wofford thanked the community-based partner organizations that she said had done the very hard work of conducting the interviews in 14 different languages, “to make sure that voices that often are muted are actually heard and part of the Index.”

The R.I. Life Index, Wofford continued, “is being held up as a model by some of the national policy organizations on how to measure the social determinants of health.”

“To me, it’s really important that these social determinants of Health do not become deterministic of one’s Health outcomes,” Wofford said.

“Rhode Islanders are struggling with issues that affect their lives and their health – like the cost of living and housing. So, we at Blue Cross, like other coalition members, are using this Index to guide our work on health equity,” Wofford said.

Used and useful
The numbers and data derived from the 2022 R.I. Life Index are viewed as a tool to address health inequities under the rubric that “health is much more than what happens within the health care system.”

The R.I. Life Index was first launched in 2019, in order “to capture Rhode Islanders’ perceptions of the social determinants of Health” – with survey questions focused on affordable housing, jobs and the economic situation, medical care, food security, the cost of living, and access to programs for children and seniors.

The working group has expanded into what is known as the R.I. Life Index Coalition, which has defined its mission as follows: “To seek to provide thought leadership on viable solutions to health inequities through its annual survey.”

Translated, the goal is to take the data trends and apply them to policy directives across a broad spectrum of community organizations.

In addition to Blue Cross and Blue Shield of Rhode Island, the R.I. Life Index’s two primary co-sponsors, the list of coalition members reads much like a who’s who of community agencies, many led by women. They include: AARP Rhode Island, Community Provider Network of Rhode Island, the Economic Progress Institute, HousingWorks RI, Latino Policy Institute, Lifespan Community Health Institute, MLPB, the Rhode Island Community Food Bank, the R.I. Department of Health, Rhode Island Kids Count, the Rhode Island Foundation, and United Way of Rhode Island.

Back to the women leaders:

• Carrie Bridges Feliz, MPH, vice president of Community Health and Equity at Lifespan. Bridges Feliz also serves as a member of the board of directors at the Rhode Island Foundation and at the Rhode Island Free Clinic. She is also chair of the Opioid Settlement Advisory Committee, which is charged with overseeing the distribution of 80 percent of approximately $114 million in legal settlements over the next 18 years.

Bridges Feliz served as the moderator for the panel discussion from respondents from a number of the community agency partners, attempting to provide a context for the data trends.

The process of engagement through the R.I. Life Index, Bridges Feliz said, was “a part of bringing a voice to those who don’t have enough power.”

“The R.I. Life Index is reflecting on folks’ actual lived experiences,” Bridges Feliz said, emphasizing the power of the actual voices beyond the data trends. “That’s really important,” she continued. “We try to hear that and then apply their expertise in our responsive programs and activities.”

• Melissa Clark, Ph.D., director of the School of Public Health Survey Research Center and Professor of Health Services Policies and Practice at Brown University, with the overall responsibility for the coordination of nearly 2,100 interview with randomly selected respondents conducted by telephone or online – and an additional 493 interviews conducted by community-based organizations in 14 different languages that comprised the basis of the 2022 R.I. Life Index.

The granular nature of the surveys conducted were further delineated by identifying where the respondents lived – whether they resided in the core urban areas of Central Falls, Pawtucket, Providence, and Woonsocket or the non-core areas of the state. The respondents were further identified by race – White, Latinx, and Black – and by age – older than 55, or younger than 55.

As much as the strength of the R.I. Life Index is in the continuity of repeating the same questions every year, there is also a value to adding new questions to the annual survey, as trends change and new trends emerge. “We are adding a question next year to the Index, about adults as well as children in the household, in accessing mental and behavioral health services, so stay tuned,” Clark said.

Call and response
The panel discussion of respondents talking about the data trends identified in the 2022 R.I. Life Index featured an equally impressive group of community leaders, almost all of them women, representing the members of the R.I. Life Index Coalition.

The included:

• Brenda Clement, executive director of HousingWorks RI.

“There’s a lot of challenges still ahead, but we learned a lot of lessons [in 2021] about what is useful, and how and where you put money in, at what time, can prevent people from sliding down a rabbit hole [with regards to affordable housing],” Clement said.

• Weayonnoh Nelson Davies, executive director, Economic Progress Institute of RI.

“Even though the data is daunting, it is good that we have it,” Nelson Davies said. “We are able to celebrate some ‘wins’ when it comes to children and families,” pointing to the legislative changes in Medicaid regulations enacted by the R.I. General Assembly, which enabled parents postpartum to access health care for 12 months, instead of only 60 days. “This is a huge win to celebrate,” she said.

• Marcela Betancur, executive director of the Latino Policy Institute at Roger Williams University

“There are going to be children that can now access a doctor. They can get a physical, They can prevent long-term illnesses,” Betancur said, pointing to another legislative victory, the Cover All Kids expansion of Medicaid health insurance for children who were undocumented.

• Larry Warner, chief impact and equity officer at United Way of Rhode Island.

“The data is sobering, but it is also a call to action,” Warner said. “Housing has stayed number-one in our top five needs for well over a year.,” saying that United Way of Rhode Island had received some 109,000 calls from Rhode Islanders regarding housing needs on its assistance line.

What was missing?
At the end of the panel discussion, ConvergenceRI asked a question of the panel about whether there needed to be a question that would become part of future R.I.. Life Index surveys, related to the way that the opioid epidemic and substance use disorders had disrupted and reconfigured just about every segment of society – from lack of access to affordable housing to homelessness, from lack of access to health care to the current mental and behavioral health crisis.

Was it not, ConvergenceRI asked, a common thread that ran throughout all of the social determinants of health?

A second important context, not covered by the 2022 R.I. Life Index, in ConvergenceRI’s opinion, was the ways in which Medicaid had become both a lifeline for those living in poverty to access health care, and, at the same time, a huge barrier, creating a permanent underclass of Rhode Islanders, with more than one-third of the state – roughly 350,000 residents – now enrolled in Medicaid for their health care insurance.

While the General Assembly is moving ahead with its plans to look at how to increase Medicaid rates as part of the proposed FY 2024 state budget, the failure to increase Medicaid rates in the last decade has served as a prominent barrier, a barrier that was discussed by participants at the “Mental Health in RI: Addressing the Mental Health Pipeline,” held the next evening, on Tuesday, Nov. 15, at Rhode Island College.

The panel discussion was moderated by: Jennifer Gaviria, MSW, a behavioral health clinician; and Sandra Victorino, the director of Workforce Development, Diversity, Inclusion and Community Relations at Care New England.

The panel participants included:

• Dr. Kalina Brabeck, Ph.D., a Professor of Clinical Mental Helath Counseling at Rhode Island College, where she is also serving as Interim Clinical Field Director. Her research has focused on how sociopolitical oppression contributes to mental health disorders and trauma exposure for Latino immigrant individuals and families.

• Randia M. Dickerson, MSW, LICSW, a senior Clinical Social Work Educator at Lifespan. Dickerson facilitates two groups on campus at Brown University – Redefining Recovery, a group fro students of color that identify somewhere on their sobriety journey and, and a trauma group for survivors of sexual assault and intimate partner violence.

• Senator Alan Di Mario, representing District 36 in the Rhode Island Senate. She was co-sponsor of the RI Child Care Is Essential Act. Outside of the Senate, she is a Licensed Mental Health Counselor in private practice.

• Dr. Jayashree Nimmagadda, Ph.D., MSW, M.Phil, LICSW, the interim dean of the School of Social Work at Rhode Island College for the past five years.

• Lisa Peterson, LMHC/LCOP/LCOS/MAC, is the Chief Operating Officer at VICTA, an agency providing integrated substan e use, mental halth, and ambulatory medical services in Providence.

• Julio Tavarez is a Sr. Clinical Therapist with a research project called “Invita,” that focuses on working with Latinx adolescents who have had a recent suicide attempt. He works for Gateway Healthcare.

The problems related to low Medicaid rates and low rates paid to providers of mental health and behavioral health services in Rhode Island, are seen as a major factor in the ongoing mental health and behavioral health crisis in the state.

Further, the increasing number of Rhode Islanders who are “unhoused,” living in the open, continues to growl they often lack the wrap-around services. As of last week, according to reporting by Uprise RI, there were approximately 392 households living outside that were on the Coordinated Entry System waitlist, which oversees nearly all the shelter beds in the state. “In total, [a count that includes people living ‘doubled- up’ situations, people facing evictions, and others without stable housing], there were 1,101 individual people on the waitlist, but there were less than 850 shelter beds in the entire state,” Uprise RI reported.

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To read more articles in RINewsToday by Richard Asinof, go to: https://rinewstoday.com/richard-asinof/

Richard Asinof is the founder and editor of ConvergenceRI, an online subscription newsletter offering news and analysis at the convergence of health, science, technology and innovation in Rhode Island.