State's high maternal-death rate gets study; pregnancy-related deaths mostly from violence, substance use, anxiety, depression

UK researchers studying the state's high maternal-mortality rate include (front row, left to right) Anna Chamberlain, Ann Coker, Linda Berry, Heather Bush; (back, left to right) John O'Brien, Cynthia Cockerham, Dana Quesinberry and Josh Bush. (Photo by Jeremy Blackburn, UK Research Communications)

Thursday, April 11 is the International Day of Maternal Health and Rights.

By Lindsay Travis
University of Kentucky

A team of health-care providers and researchers at the University of Kentucky is working with community and government leaders across the state to address a pressing issue facing the state: its high rate of death and illness among women who give birth.

“Kentucky has one of the highest maternal mortality rates in the country. Lowering the proportion of women dying during or after childbirth in our state is not just a goal, but a necessity to safeguard the health and futures of both mothers and their children,” said Dr. John O’Brien, director of the Division of Maternal Fetal Medicine at UK HealthCare. O'Brien is also a professor in the Department of Obstetrics and Gynecology in the UK College of Medicine, and the appointed chair of the Kentucky Maternal Morbidity and Mortality Task Force in the state’s Cabinet for Health and Family Services.

The task force is funded by a $5.2 million, five-year grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The state has a Maternal Mortality Review Committee that determines the causes of maternal deaths and identify opportunities for preventing future deaths, through policy or practice. The panel has documented that substance use, injury and behavioral-health conditions are all common contributing factors to maternal death or maternal illness, also called maternal morbidity.

“In Kentucky, the study of severe maternal morbidities reveals a stark reality that these outcomes are deeply intertwined with health-care disparities,” O’Brien said. “Rural communities and people of color bear a disproportionate burden, highlighting the urgent need to address systemic inequalities in maternal healthcare access and quality.”

O'Brien's task force will work with hospitals, other health-care providers, community partners and state agencies to implement and promote best practices to make birth safer, improve maternal health outcomes and, ultimately, save lives.

The task force will work with state agencies to develop a scorecard to track severe maternal-health issues, using hospital records. The team will also create a data surveillance system to monitor maternal deaths and injuries, with a goal of making this information publicly available.

“Our team also wants to be able to provide critically important hands-on learning opportunities for smaller hospitals to be prepared to handle pregnancy-related complications,” said O’Brien. “We also want to extend and assist coordination of telehealth services to birthing facilities throughout the state as we have shown reduction of severe morbidity in rural communities is possible through telehealth availability.”

The federal grant will also fund bystander-informed violence intervention and prevention training specifically for obstetric health-care providers to address maternal health related to violence.

“In Kentucky, the majority of pregnancy-associated maternal deaths stem from partner or family violence, substance use and anxiety or depression,” said Dana Quesinberry, associate director of the Kentucky Injury and Prevention Research Center and an assistant professor of health management and policy in the UK College of Public Health. “Our goal is to leverage our collective expertise to share violence intervention and prevention training models statewide to make a targeted effort to reduce these types of death.”

“The majority of violence-related maternal deaths ARE preventable. We are firm in our belief that this proactive approach will offer hope to mothers in our state and make a measurable difference in health outcomes,” said Ann Coker, one of the team leaders on the project. She is the Verizon Wireless Endowed Chair in the Center for Research on Violence Against Women and a professor of epidemiology in the Department of Obstetrics and Gynecology.

O'Brien said, “This task force is a comprehensive project involving multiple stakeholders and a crucial step for Kentucky moving forward. By uniting expertise, resources and advocacy, our goal is to ensure every mother receives care and support.”

In addition to the grant, HRSA provided $170,233 to be used for Medicaid redetermination and postpartum-care coverage navigation for pregnant and postpartum individuals and their families. “We have utilized these funds to establish a Perinatal Community Health Worker Program . . . to provide culturally and linguistically matched services to pregnant and postpartum persons in the state,” said Cynthia Cockerham, community program and research director for UK HealthCare’s Division of Maternal Fetal Medicine.

The study team also includes Linda Berry, a registered nurse and perinatal substance use coordinator at UK HealthCare; Public Health Dean Heather Bush, an endowed professor in the Center for Research on Violence Against Women; and Dr. Barbara Parilla, medical director of the UK HealthCare Perinatal Assistance and Treatment Home (PATHways) program and a professor in the Department of Obstetrics and Gynecology.

To inquire about the task force, email Kentucky_MMM@uky.edu. For more information about the Perinatal Community Health Worker Program, email PerinatalCHW@uky.edu.

A webinar to discuss how a new Transforming Maternal Health Model provides opportunities to improve rural maternal-health access will be held at 12:30 p.m. ET April 18. This is the newest model from the Centers for Medicare and Medicaid Services.  At 2 p.m. April 23, the Rural Helath Information Hub is hosting a webinar obstetric readiness in rural facilities without birth units.

AppalReD Legal Aid to hold 20th annual Domestic Violence and Elder Abuse Awareness Conference via Zoom on Sept. 15

 

The Appalachian Research and Defense Fund of Kentucky is holding its 20th annual Domestic Violence and Elder Abuse Awareness Conference  Sept. 15 from 8:30 a.m. to 3:15 p.m. ET via Zoom.

The organization, which uses the brand AppalReD Legal Aid, said in a news release that it is using Zoom this year to allow people from all over Kentucky to participate. 

"Domestic violence and elder abuse challenge every community across the commonwealth," the release said.

The sessions will address several topics, including: when to call protective service, how to help survivors in recovery, advocacy for clients without homes, trauma-informed advocacy and communications challenges. 

The free event is open to everyone including legal professionals, health-care workers, social workers, counselors, nursing home administrators, educators, students, and community leaders. 

"By uniting people from various backgrounds, we can collectively make a significant impact on how we combat elder abuse and domestic violence and best serve those affected," said the release.

While attendance is free, pre-registration is required, and spots are limited. Click here to register. The Zoom link will be provided upon registration. For more information about sessions, CEUs, or speakers visit www.ardfky.org/dv23.

'Forensic nursing' idea of online Frontier Nursing University student could help victims of domestic violence in rural areas

Unseen and unspoken, rural victims of domestic violence are more likely to suffer alone because of geographical isolation, lack of medical support networks, and an "everybody knows everybody" small-town culture that can keep victims from asking for help.

Leslie Copp (Photo from The Daily Yonder)

With the help of a Tillman Foundation scholarship, Leslie Copp, a nurse who grew up in a home with domestic violence, aims to change some of that in rural Indiana, reports Liz Carey of The Daily Yonder. "Copp is an online graduate student at Frontier Nursing University, located in Versailles. Her nursing work includes caring for trauma victims and gathering evidence for prosecutors. She wants her graduate education to help her specialize in trauma care and establish trauma care centers in rural communities like her hometown of Odon, Indiana, pop. 1,400."

Forensic nursing is an emerging field that many students may not know exists. Copp began her medical career as a Certified Nurse Assistant, then earned a bachelor's degree in nursing, but along the way, "realized she enjoyed taking care of trauma victims and helping as a forensic nurse to collect evidence to assist in prosecuting abuse cases. She said she feels born to work as a forensic nurse examiner." She told Carey: "I was raised at the very first of my life in a home where I dealt with watching my mother go through domestic violence. I didn't realize that the trauma that I had been through as a young adult would set the base for something that I would grow to love. I turned my trauma into something that I could do to help others." Carey reports, "She intends to pursue a doctorate in nursing practice and to become a mental health nurse practitioner."

Copp told Carey: "In Indiana alone, there are wide areas where there are no resources or care for victims of trauma or violence. My goal is to start with one (rural trauma care center) and plant it in a place that has the widest area of no coverage so that we can at least start providing medical exams (for trauma victims) and point people in the right direction." Part of the dilemma in gathering prosecutorial evidence from victims is timing and victim bandwidth for the process, Carey writes. By the time a victim is treated at their local hospital, they don't have the energy to go to a metro hospital for another work-up. "Even if a nurse sees them in a metropolitan area, the patients get lost in the system without access to resources like trauma therapy, advocacy services, and support systems."

Frontier Nursing University Assistant Professor Dr. Joshua Faucett told Carey, "Copp's experience as a nurse and violence survivor made her a good candidate for the scholarship. . . . Leslie is a sexual assault nurse examiner and has testified on behalf of sexual assault victims to bring their abusers to justice." Carey adds, "Copp's goal is to create a trauma center in a rural area that could both do medical exams and help victims gain access to social workers, prosecutors, and emergency housing."

UK study finds intimate-partner violence raises risk of developing diabetes, due to stress; Ky. has high rate of domestic violence

A diabetic checks blood sugar. (Photo by AaronAmat, iStock/Getty Images Plus)

By Sarah Ladd

Kentucky Lantern

People who experience intimate-partner violence, or the threat of it. are much more likely to end up with diabetes, due to increased stress. So says a new study published by a University of Kentucky researcher and others.

Experiencing violence, abuse and neglect as adults and children increased the risk of adult-onset diabetes in women and men by 23% to 35%, said the study, published in the American Journal of Preventive Medicine.

Researchers attributed the heightened risk to the elevated cortisol levels and suppressed insulin levels that occur in the human body in response to violence or chronic stress.

Ann Coker
(Photo provided)

UK researcher Ann Coker, who’s also a professor of epidemiology in the Department of Obstetrics and Gynecology in the university’s College of Medicine, said the study is the first of its kind.

“Before this research, we knew that partner violence was associated with diabetes among women, but we did not know that violence preceded diabetes development,” Coker said. “We had no data on this relationship for men or within racial groups.”

 
A recent statewide report on domestic violence showed nearly half of women and more than a third of men in Kentucky experience intimate partner violence or the threat of it.

In 2020, the Centers for Disease Control and Prevention showed 11.4% of Kentuckians had diabetes, a decrease from the two years prior.

Diabetes is a chronic condition that hinders the body’s ability to make enough insulin to properly break down foods, per the CDC. There are several different types of diabetes.

More than 37 million Americans have diabetes, the CDC says, and many don’t know it.

Additionally, Kentuckians experience high rates of child abuse and adverse childhood experiences.

Researchers collected data for the study before the Covid-19 pandemic. The pandemic may have made the risk of diabetes worse by increasing stress, another researcher in the study said.

“Our findings also show an increased risk in a timeframe before the additional social stress of the Covid pandemic,” said Dr. Maureen Sanderson, the study’s lead author and a professor in the Department of Family and Community Medicine at Meharry Medical College in Nashville, said in a statement.

“This strongly suggests the need for helping professionals across disciplines to implement effective violence prevention and intervention strategies to reduce the short and long-term social and health consequences of partner violence and child abuse,” Sanderson added.

Interventions, Sanderson said, can include “strengthening economic supports for families, promoting social norms to protect against adversity and violence, ensuring strong starts for children, teaching skills, connecting youth to caring adults and intervening to lessen harm.”

State's first detailed report on domestic-violence cases has a wealth of data on how courts and law enforcement handle them

The report's court data is by area development district, not by judge or county, but it has data on how individual law-enforcement agencies served emergency protective orders. (Map from report, adapted by KHN; to enlarge, click on it.)

Kentucky Health News

"Kentucky has long had a problem with domestic violence," the Lexington Herald-Leader reports. "A 2012 survey found that 45% of women and 35% of men" in the state have been victims of domestic violence, sexual violence or stalking, "according to a new report released Friday, marking the first time the commonwealth has ever tracked the data. Now the commonwealth will begin to dig into the details with a debut domestic-violence report that will set a baseline for police reports, protective orders issues, court cases and other information."

The 207-page report has a wealth of information about how domestic violence is handled by courts and law-enforcement agencies at regional and local levels. It covers the 14,199 charges and 8,867 arrests related to domestic violence in 2022, and the outome of the 19,986 petitions courts received for emergency protective orders in criminal and civil cases.

For example, it gives the average number of days that it takes individual law-enforcement agencies to serve EPOs on people accused of domestic violence or threats of violence, based on reports by the agencies. Statewide, the average is 2.22 days, but in many counties, especially in Appalachian Kentucky, service is much slower, perhaps putting potential victims at greater risk.

Law-enforcement agencies that averaged 10 days or more (excluding those with fewer than 10 EPOs served) to serve EPOs were: Adair County sheriff (12 days), Bell County sheriff (13), Breckinridge County sheriff (12), Calloway County sheriff (14), Corbin Police Department (19), Garrard County sheriff (15), Laurel County sheriff (10), Lawrence County sheriff (11), Martin County sheriff (11), McCreary County sheriff (15), Perry County sheriff (10), Rockcastle County sheriff (15), Spencer County sheriff (13), Wayne County sheriff (10), Whitley County sheriff (12), Williamsburg Police Department (10); and Wolfe County sheriff (13).

Agencies that averaged 7 days or more (excluding those with fewer than 10 EPOs served) were: Anderson County Sheriff's Department (8 days), Danville Police Department (8), Estill County sheriff (9), Fayette County sheriff (7), Franklin County sheriff (7), Grayson County sheriff (7), Harrison County sheriff (7), Jefferson County sheriff (7), Jessamine County sheriff (7), Knox County sheriff (9), Letcher County sherifff (7), Lincoln County sheriff (7), Marshall County sheriff (7), Pendleton County sheriff (8), Pulaski County sheriff (8), Russell County sheriff (7), and Todd County sheriff (9).

Data on how courts handle domestic violence is not given by judge, court or jurisdiction, but by the state's 15 area development districts.

It shows that judges in the Lincoln Trail ADD (Meade, Breckinridge, Grayson, Hardin, LaRue, Marion, Nelson and Washington counties) approved only 40 percent of the petitions for EPOs regarding domestic violence, and 31 percent of those for tempotrary interpersonal protective orders.

Judges in the Northern Kentucky ADD (Boone, Kenton, Campbell, Carroll, Gallatin, Owen, Grant and Pendleton counties) had the next lowest approval rates, 63 and 45 percent. The statewide averages, respectively, were 72 and 60 percent.

In divorce and other civil cases where domestic violence was alleged, judges in the Cumberland Valley ADD (Jackson, Rockcastle, Laurel, Clay, Knox, Whitley, Bell and Harlan counties) had the lowest approval rate, 16.9%. Lincoln Trail was second-lowest at 19.8%, just ahead of the Kentucky River ADD (Wolfe, Owsley, Lee, Breathitt, Leslie, Perry, Knott, and Letcher counties), at 19.9%.

In civil cases where other interpersonal violence was alleged, judges in the Gateway ADD (Bath, Montgomery, Menifee, Rowan and Morgan counties) had the lowest approval rate, 9.1%. The next lowest rate, 12 percent, was in the adjoining Fivco ADD (Boyd, Carter, Elliott, Greenup and Lawrence counties). It was 14.9% in the Cumberland Valley ADD.

Generally, judges in the Bluegrass, Purchase and Green River ADDs were the most likely to issue protective orders.

The report was required by a 2022 law sponsored by state Sen. Whitney Westerfield, a Republican from Christian County. "Before this report, domestic violence advocacy groups had used a newspaper clipping service to keep track of domestic violence homicides," the Herald-Leader reports.

Westerfield, chair of the Senate Judiciary Committee, learned of the lack of centralized reporting from Herald-Leader Opinion Editor Linda Blackford. “It’s just unacceptable,” he told her as the bill mved through the legislature. “We can’t make informed public policy decisions without good information.”

Domestic-violence survivor triumphs, one step at a time, at UK

University of Kentucky video; for captions, click on play, then click the CC icon on the bottom line. If using a mobile device, click on the "thought bubble" in the same area.

April Ballentine uses new equipment to walk.
(University of Kentucky photo by Mark Cornelison)

By Allison Perry
and Steve Shaffer
University of Kentucky
   
   “Deep breaths, April. Deep breaths.”
   April Ballentine nods, steeling herself. As she sits inside the lab of the University of Kentucky’s Sports Medicine Research Institute, her anticipation stirs up an incredible amount of pure nervousness.
   This is the day the Lexington native has been waiting for, working for – for weeks, months, even years.
   A crowd has gathered to witness this moment, including April’s friends and family, UK faculty, and physical therapy students from the UK College of Health Sciences.
   With great trepidation, she shifts her body into position, channeling her mindfulness to conquer this new task. Then, she is asked the million-dollar question.   
   “You ready?”
   April looks up at the physical therapist in front of her, unflinching. “Yes.”
   Today, the 51-year-old will stand and walk for the first time in more than eight years.

•

   In August 2013, April was out with friends at a happy hour when an ex-boyfriend showed up, gun in hand. As he raised it toward her face, she blocked his first shot. But in the chaos, she blacked out and fell to the ground. He then unloaded the chamber on her in front of more than 50 witnesses.
   At some point, April woke up, covered in a white sheet. Her ears were ringing, and all she could utter was one phrase, over and over. “I’ve got to get up.”
   She then heard a voice gently reply, telling her to lie still, followed by sirens. She couldn’t breathe. Then, everything went black again.
   When April woke up for the second time, she was at UK's Albert B. Chandler Hospital. She had survived five gunshots at close range. A trauma team led Dr. Andrew Bernard, the trauma medical director, had stopped the bleeding, saving her life.
   Because she was hooked up to a respirator, April’s medical team gave her a dry-erase board to communicate.
   “I wrote my daughter’s name with a question mark, and they said she was fine,” April said. “Then they asked me if there was anything they could get for me. And I said I was hungry as hell.”
   That fighting spirit kept April going during her stint in the ICU – a time she calls “one of the greatest challenges I’ve had to go through in my life.” After several weeks of intensive care, she was discharged to Cardinal Hill Rehabilitation Hospital.
   “That’s when I learned I was paralyzed,” April said. “I had never heard that word before – or if I did, it just never registered because I was so highly medicated.”
   At Cardinal Hill, April began working with a team of therapists led by physical medicine and rehabilitation physician Sara Salles. She had to learn how to live with her new normal: paralyzed from the chest down due to a T4 spinal-cord injury.
   “Dr. Salles explained everything to me,” April said. “And I said, ‘OK.’ I never asked why. I never cried about it. The pain was more overbearing than anything else I could have imagined because it was constant. [It’s] something I never want anyone to experience.”
   April spent 90 days at the facility. She’d heard of companies that made robotic exoskeletons, which allowed users to stand up and walk again with bracing and support from the upper body. Occasionally during her therapy, April would try to stand, holding herself with her arms.
   It was far harder than she had expected.
   “It was so difficult,” she said. “I recall trying to push myself up, and it almost seemed impossible. That dream was shot really easily. I had to learn that I had to live for today and not tomorrow. Because I lived for walking, I couldn’t live in the moment.”

•

   In October 2015, April was speaking about her experience at a church to raise awareness for Domestic Violence Awareness Month. Fayette County Sheriff Kathy Witt heard her story and approached April with a proposition.
   “She said, ‘I want you on my team’,” April said. “She’s been a great advocate for domestic violence awareness for a very long time.”
   April began working with the sheriff’s office, first as a volunteer, then as an employee. She now serves as a victim advocate intake specialist in Amanda’s Center, a 24-hour point of contact for victims of domestic violence located in the Fayette District Courthouse. In this role, she helps ensure victims have access to the resources and help they need.
   April describes the work as “a calling” that has helped her heal, process and understand her own trauma.
   “I understand what it’s like to be a victim, and I understand what it’s like to be afraid and to not be afraid,” she said. “And I believe that I’m a good resource to help someone escape, or to help them understand the extreme behavioral issues they’re experiencing.”
   April also began volunteering at Cardinal Hill, playing a mock “patient” for physical-therapy students to learn how to work with people who have spinal-cord injuries.
   “[I want to show] that for anyone with a spinal-cord injury, life is possible and life can be good,” she said. “And I make it fun, too. I think my personality fits because I break the ice, make them laugh, and say the unexpected.”
   Several years ago, she was contacted by ReWalk Robotics, a company that makes bionic devices to help people with spinal cord injuries. ReWalk’s exoskeleton has been available since 2014 and was the first such device to be cleared for market in the U.S. by the Food and Drug Administration. The company was looking for an opportunity to start a program in Lexington. April passed their information on to her contacts at Cardinal Hill, not really expecting to hear anything further.
   But that contact lit a spark in her. She decided to start focusing on her physical fitness.
   “I started thinking, ‘OK, I’ve got to take better care of myself,’” April said. “And then Covid hits. I said, ‘I’m not going to sit here and do nothing.’”
   April sought out a trainer and got to work, noting playfully that one of her goals was to develop “Angela Bassett arms.” Over the past two years, she’s lost 180 pounds and developed incredible upper-body and core strength. Although April’s spinal-cord injury is at her T4 vertebra – around chest height – she still has some sensation and strength in her core, which helps her do things that many others with her same injury classification can’t do.
   Last August, April began to build strength in another way.
   She bought her own house, regaining the independence she lost that traumatic day in August 2013.
   “Taking on my health and being able to live independently with such a high injury level made me dream,” she said, “and recognize, and remember that I can do anything.”

•

   Denise O’Dell is relatively new to UK, having joined the College of Health Sciences as an associate professor last summer. As a physical therapist, she specializes in working with patients who have neurological impairments, including brain and spinal cord injuries. O’Dell teaches students in UK’s Doctor of Physical Therapy program and works with patients in the Kentucky Neuroscience Institute’s ALS Multidisciplinary Clinic.

   O’Dell took a group of UK students to Cardinal Hill last fall, where April was volunteering again as a mock patient. In addition to the physical therapy techniques students will perform, O’Dell says she often reminds them how important it is to listen to their patients during therapy.
   And listening to April’s story, O’Dell and her students were impressed.

   “I could see the drive that she has to give back to society, to better herself, to stay engaged,” O’Dell said. “Given my background and having worked with a lot of individuals with spinal cord injury, I saw sparks there that I hadn’t seen in others for quite some time.”

   Encouraged by April’s overall strength, O’Dell asked if she’d ever stood up. April had been medically cleared via bone-density screenings for standing – with support – in her power chair, but she had never tried to stand another way. O’Dell brought her to a set of parallel bars.
   “Denise was like, ‘We’re going to do something different’,” April said. “She said, ‘I’m going to have you stand using these parallel bars.’ And I just kind of looked at her and said OK. I’m open to it.”
   With O’Dell supporting her legs, April grabbed the bars and pushed up into a standing position.
   “She literally just popped up into standing,” O’Dell said. “The first time she was up for two or three minutes. That’s pretty unheard of for someone who hasn’t done it for so long.”
   Shortly after, April asked to stand again.
   “Even though we were out of time, we did it again,” O’Dell said. “The students were like, ‘We’ll stay.’ They could see that this was a better learning moment than I think they had expected.”
   In a previous job, O’Dell had been part of a team that helped evaluate and train patients following spinal cord injury, including evaluations for standing and use of exoskeletons. Based on her experience – and what she had just witnessed – she thought April could be an ideal candidate. She made some calls to her colleagues at UK HealthCare and the College of Health Sciences and contacted ReWalk to come up with a plan for April to trial an exoskeleton device.
   “Next thing I knew, I had a phone call with a date,” April said. “So here we are.”

•

   Back in the Sports Medicine Research Institute lab, April’s big moment is here. She’s officially “trialing” the exoskeleton, which will help the ReWalk team determine if she’s an eligible candidate to begin training with the device. From the crowd, a voice calls out: “Use those Angela Bassett arms!”
   April smiles and offers a correction: “These are April Ballentine arms.”
   She swings a set of forearm crutches back, tilts forward, and prepares to use her considerable upper body strength. The exoskeleton beeps and whirs. Guided by therapists from ReWalk, April pushes into the crutches and powers up to a full standing position. Now, she’s standing taller than the therapist in front of her.
   Her audience cheers.
   From there, the team takes April through some of the basic movements she will need to master: holding a neutral standing position, shifting her weight laterally, pivoting, and finally, walking. The machine will move her legs for her, but she will use the forearm crutches to support, balance and guide her body as she moves.
   When it’s time to walk, the therapists clear a path in the room and tell April she’ll be walking toward a man in a blue suit – Bernard, the UK trauma surgeon, who stopped by to show his support. Seeing him, her eyes fill with tears.
   April’s first few steps are big, lurching. The team stops to recalibrate the machine to her gait. Her trainer, David Asbury, comes to stand by her side and coach her through the walk. She grins.
   “Hey, I’m taller than you!” she exclaims to Asbury, and everyone laughs.
   With the machine recalibrated, she tries again. This time, she takes off, walking across the room, only stopping when she reaches a curve that requires a pivot. Sitting down to rest, she’s overcome with emotion as her friends and family hug and congratulate her.
   “I’m just overwhelmed right now,” she says, voice shaking. “It’s been eight and a half years.”

•

   For patients with a spinal cord injury, a ReWalk exoskeleton isn’t just about the chance to walk again. The mobility it offers comes with a number of health benefits that can improve the patient’s overall quality of life – better circulation, muscle spasticity, bowel and bladder function, and even nerve pain.
   “The opportunity to stand and walk is multifaceted,” O’Dell said. “Physiologically, being upright, your gastrointestinal system works better. Your heart, your lungs work better. An individual such as April will rate their quality of life higher from a participation and health standpoint.”
   But April still has more work ahead of her.
   Although insurance will cover the cost of training with the device, it does not cover the cost of the device itself for non-veterans. ReWalk continues to pursue insurance coverage opportunities, but for now, April will need to cover the cost of her own exoskeleton.
   To help fundraise for the device, April is working through a nonprofit organization called I GOT LEGS, which set up a donation page for her. Once she has her down payment, she can begin working with ReWalk-trained physical therapists to become proficient with the exoskeleton, a process that usually takes 20-30 sessions.
   She isn’t deterred by the cost. Where there’s a will, there’s a way, and April Ballentine always finds a way.
   “Throughout the last nine years, there have been people saying, ‘You can’t do this, you can’t do that’ – whatever,” April said. “I’m going to prove you wrong every time.”
   Besides, she has another ambitious goal to meet. In November, April’s daughter is getting married. And she’s determined to walk her daughter down the aisle.
   It’s that determination that makes her such a light and role model for the community, said Bernard. Despite her tragedy, she has persevered.
   “She was a victim, but she’s not a victim anymore,” Bernard said, adding that her situation “was minutes of crisis, and then it’s a lifetime of potential impact.”
   When she woke up under that sheet in 2013, April had only one thought in her mind: I’ve got to get up. Eight and a half years later, she’s done it. And she’s hungry to do it again.
   She just needed that little extra push – one that came in the form of a chance meeting with someone who saw her potential and had the right experience to make it happen.
   Denise “is pretty phenomenal,” April said. “Recently, I told her, thank you for seeing my ability instead of my disability. If it wasn’t for her, I would not be here today.”

Senate passes its version of state budget with many health items; $100 million would 'support a response to the nursing shortage'

By Melissa Patrick
Kentucky Health News

The state Senate passed its version of a two-year state budget by a 30-6 vote Wednesday, the same day it passed out of committee. The bill will soon head to a House-Senate conference committee that will write the final version.

The Senate-revised House Bill 1 has a number of health provisions, with some variations from the House version and Gov. Andy Beshear's proposals.

The Republican-controlled chambers and the Democratic governor have three different approaches to addressing the nursing shortage, which has been exacerbated by the coronavirus pandemic. 

Photo from American Nurses Association

The Senate allocated $100 million of federal relief money in the first year of the budget, starting July 1, "to support a response to the nursing shortage," without giving any details. The House included no money for the retention and recruitment of nurses.

Beshear, who said Thursday that the focus needs to be on retention, called for $6 million each year from the General Fund for nursing scholarships; and from relief funds, $5 million a year for five years to create a new student loan-forgiveness program and $2 million for a marketing and outreach campaign.

The House budget and Beshear's budget both include $17.7 million in the first fiscal year and $19 million in the second fiscal year to cover the costs of local health departments required services, but the Senate's budget only allocated money for the second fiscal year in the amount of $19 million. 

Randy Gooch, executive director of the Jessamine County Health Department, said the Kentucky Health Department Association isn't sure why the Senate would have left out an allocation for fiscal year 2023 and Sen. Chris McDaniel, R-Ryland Heights, who crafted the Senate budget has not yet returned a call for clarification. 

The Senate budget includes Beshear's wish for for 500 new Michelle P. waiver program slots for people with intellectual or developmental disabilities; the House provided for 100. The Senate added 200 slots to the Supports for community Living waiver program for similar beneficiaries, double what Beshear and the House proposed. Both programs have thousands of Kentuckians on their waiting lists.  

The Senate agreed with the House on extra funding for domestic-violence shelters, rape crisis centers and child-advocacy centers, allocating $500,000 more for each in each fiscal year. Beshear proposed a 36% increase each year for each type of organization: $2.5 million, $1.78 million and $1.3 million, respectively.

And while the Senate and House budgets both would fund 200 more social workers, Beshear's budget proposal would have funded an additional 350. 

To implement the new 988 suicide hotline, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024, the Senate budgeted $3.37 million in the first year and $9.9 million in the second, the amounts Beshear recommended. The House allocated much more: $12.4 million in the first year and $17.6 million in the second, but directed that the money also be used to create more mobile crisis units. 

The Senate allocated $500,000 in each year for the Lung Cancer Screening Program that would be established with the passage of HB 219. The bill passed the House in late January and in the Senate Appropriations and Revenue Committee, which wrote the revised budget. 

The Senate budget also says that each Medicaid managed-care organization that has a participating contract with Kentucky in the next contract renewal will cover lung-cancer screenings.  

Here are some other health-related provisions in the Senate budget. 

From the Tobacco Settlement Fund:

• $500,000 in each fiscal year to support the Kentucky Rural Mental Health, Suicide Prevention and Farm Safety Program, titled the "Raising Hope Initiative."
• $1.4 million each year for substance-abuse prevention and treatment for pregnant women with a history of substance-use disorders;
• $7 million each year for the Health Access Nurturing Development Services Program (HANDS) for poor families with young children;
• $900,000 per year for the Healthy Start initiatives;
• $900,000 a year for early-childhood mental health;
• $900,000 a year for early-childhood oral health;
• $2 million a year for smoking cessation. Advocates have long asked for more smoking cessation funding, asking recently on a Kentucky Educational Television lung-cancer forum that this amount, at minimum, go back to the pre-pandemic level of $3.3 million.
  

From the General Fund:

• $6.25 million in each fiscal year for cancer research and screening to be equally shared by the University of Kentucky and the University of Louisville;
• $500,000 in the first year and $493,500 in the second year for spinal-cord and head-injury research (an amount that was previously taken from the Tobacco Settlement Fund); 
• $93,700 in each year for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma;
• $500,000 each year for the Kentucky Colon Cancer Screening Program;
• $100,000 per year for The Hope Center of Lexington for addiction recovery;
• $900,000 a year for The Healing Place, a Louisville recovery program;
• $1,495,000 a year to support the Lee Specialty Clinic, which provides specialty medical services for individuals with moderate developmental and intellectual disabilities living in residential and community settings. 
• $7.2 million in the first year and $14.48 million in the second fiscal year to expand the senior citizens' meal program. The appropriation will come from federal relief funds. 
• $1 million in the first year to support external performance reviews of substance-use treatment programs administered or funded by the health cabinet. 
• $2.5 million in each year to the Kentucky Pediatric Cancer Research Trust Fund; Beshear's proposal provided $3.75 million in each fiscal year. 
• $750,000 per year for the Kentucky Poison Control Center, unless federal emergency relief funds become available;
• $1 million a year for the Ovarian Cancer Screening Outreach Program at the University of Kentucky; the House budget had $500,000 a year. 
• Federal and state funds are allocated in both years to maintain the pandemic-elevated reimbursement of $29 per day per Medicaid patient in nursing homes.
• Money is provided to support expansion of of a pilot program for Tim's Law to additional locations as a way to ensure statewide access. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door them going in and out of jails and state psychiatric hospitals.

State reveals plan to test every resident and employee in all 286 nursing homes in next 2 months; posts more reopening guidance

As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear and Health Secretary Eric Friedlander announced a plan Friday to test every nursing-home resident and employee in the state for free.

"We are now going to be very targeted in making sure that we know the situation in each of these facilities, especially for the most vulnerable, and are able to take some quick action," Beshear said at his daily briefing. Around 58 percent of the state's covid-19 deaths have been nursing-home residents.

Friedlander said, "With the ability to now test every resident of our long-term care facilities, we can take an even more aggressive approach to our battle against the coronavirus." He said the state, Norton HealthCare and local health departments and emergency management leaders would be testing every resident and every staff member at all 286 skilled nursing homes in Kentucky.

He stressed that to get tests, a facility must have a plan for how to manage whatever the tests reveal. Asked how a facility would remain staffed if it finds many of its employees are infected, he said the state would help.

Friedlander noted the state has sent medical and nursing students to help, is using the National Guard a one facility in Northern Kentucky, and has received staff help from hospitals. He said Norton has sent nurses and certified nursing assistants "to hold facilities together," and the state's nursing home task force is working on way to match up recent graduates and facilities that need staff.

He said the state has provided additional reimbursements, support and guidance to the facilities, but worried a month ago about falling short of test kits and and personal protective equipment, "and frankly, we had a long way to go."

At this point, the state has tested about 10 percent of all residents, and testing all of them would take a couple of months to get all of the testing done, Friedlander said.

He said the state is prioritizing facilities with eight factors, including their current rate of infection and if they are in a county with high rates of positive tests. He said they have tested about a third of the homes that have been placed in the highest category.

The state would also test in assisted-living facilities "when they start to have trouble," Friedlander said, and that would bring them to the top of the list.

Friedlander said one of the best things Kentucky did was be one of the first states to stop visitation at the nursing homes, but he acknowledged that this has been hard of residents and families, and that Mother's Day is approaching. He encouraged facilities to find creative ways to allow visitation, through closed windows, Plexiglas visitation stations or technological assistance, which the state has provided in some cases.

"We know that you miss meeting with your loved ones," he said. "That is a very big sacrifice that you have made, but it is an important sacrifice and as the governor says, you have saved lives."

Beshear said nine more residents and three more employees have tested positive in Kentucky long-term care facilities, bringing the respective totals to 862 residents and 356 staff. In 81 facilities, 174 residents and two staffers have died. Click here for more information.

Reopenings: Beshear said the state had posted the minimum requirements for all businesses and organizations that will open through May 20.

Guidance has been added for government offices and agencies, which can open May 18; funeral homes, which can open May 20; and places of worship and retail under "Healthy At Work" at kycovid19.ky.gov.

Beshear praised the efforts of the faith community in drafting these guidelines, specifically pointing to the Kentucky Baptist Convention and the Kentucky Council of Churches.

The requirements say that houses of worship will need to limit attendance to one-third of occupancy, including clergy; maintain six feet of physical distance between attendees, even in rows; not provide communal food or beverages; avoid handshaking and hugs; wear masks or face coverings; increase sanitization; avoid live choir or singing; consider taking temperatures or asking about symptoms, and not admit those who have them; use greeters and markers to guide social distancing; and allow only one person in a restroom at a time, with adequate hand sanitizer and soap. It adds that youth services should not resume until June 15, the same date child-care facilities are tentatively set to reopen.

Beshear said, “Remember, listen to your faith leader. If they tell you that they're not ready and that they don't think that it's safe, then you should wait.” He added that this should be the case for all businesses.

Testing: Beshear stressed the importance of testing and contact tracing as the state re-opens its economy, and said Kentucky now has the capacity to do about 50,000 tests a week, which would more than meet the federal guidelines for reopening.

He said the next step is to make sure people use that testing capacity, even if they don't have symptoms, since many with the virus are asymptomatic but can still infect others. "Making sure people get tested is our new challenge," Beshear said, adding that is preferable to the challenges of the last two months.

Beshear held up his mask as he asked others to wear theirs.

“We don't have to make excuses anymore,” he said. “We’re not facing the same type of shortages. So let’s make sure as we go back to being healthy at work that we're doing everything we can to take care of those around us.”

Again, Beshear pleaded with Kentuckians to wear masks, especially many places reopen Monday.

Holding up his mask, he said, "Knowing that the decision to wear one of these may be the difference if you are asymptomatic between someone else living and someone else dying. . . . It is just one small thing I can do to live out my faith, that Golden Rule: How I can be a good neighbor, how I can be ethical in this time of the coronavirus?"

At the start of his briefing, Beshear made a different sort of argument: "The healthiest economy coming out of 2019 is the one that’s able to keep the virus contained as they successfully reopen. That is what our plan is designed to do."

In other covid-19 news Thursday: 

• Beshear reported 176 new coronavirus cases, bringing the state's total to 6,288. He said the number continues at a plateau and that the state is working on getting all negative test results from laboratories so it can show more accurate infection rates. Click here for the daily summary. 
• The counties with more than 10 new cases were: Jefferson, 35; Warren, 27; Fayette, 14; Kenton, 13; and Logan, 11. 
• He said 396 Kentuckians are currently hospitalized, 210 of them in intensive care, and 2,266 had recovered, which he said was 36% of the positive cases. He noted that the number of ICU cases has slowly been climbing, and that this is something to watch. The Lexington Herald-Leader reports that this number has been increasing since April 18.
• Four new deaths brought the state's death toll to 298: a 90-year-old woman from Edmonson County, a 90-year-old woman from Hopkins County, a 69-year-old man from Jefferson County and a 75-year-old man from Bullitt County.
• Most child-care centers in Kentucky are closed, but 79 are open as "limited duration" centers for children of essential workers. They have to follow special rules, the most costly of which is that no staffer can be left alone with children, doubling payroll costs, reports Jared Bennett of the Kentucky Center for Investigative Reporting. Jennifer Washburn, executive director of the iKids Childhood Enrichment Center in Marshall County, told him that the rule made sense at first because the state didn’t know who would operate the centers. "As it turns out, most are run by existing child care centers," Bennett reports, so most "are trained professionals who have already passed a background check. At the same time, tuition is down significantly."
• KCIR also reports on a steep decline in domestic-violence orders, coupled with an increase in murders of and by domestic partners in some areas. The pandemic "has created a situation ripe for domestic violence," Eleanor Klibanoff reports. "Victims may be isolated with their perpetrator, and tensions may be running high because of financial insecurity or children being home from school all day. . . .Custody issues are flaring up as co-parents disagree about how to handle social distancing and homeschooling. People are moving back into bad situations after being laid off. And the federal stimulus checks distributed last month have also caused conflict. . . . Advocates worry there are many more of these situations that are not being reported," and Administrative Office of the Courts data shows that between early March and mid-April, the number of protective orders dropped nearly 25% compared to the same time last year. "
• "A new study offers a glimmer of hope in the grim fight against the coronavirus: Nearly everyone who has had the disease — regardless of age, sex or severity of illness — makes antibodies to the virus," The New York Times reports. "The study, posted online on Tuesday but not yet reviewed by experts, also hints that anyone who has recovered from infection may safely return to work — although it is unclear how long the ir protection might last."
• A preprint study in Annals of Internal Medicine analyzes autopsies of patients who died of covid-19, showing that a third had died directly from blood clots in the lung. An Intensive Care Medicine preprint study shows that despite use of standard anti-blood-clotting medications, blood clots are still very common in COVID-19 patients with severe respiratory distress," CovidActNow reports.

Advocates worry Medicaid plan will cause the most vulnerable to be kicked off rolls, say 'medically frail' designation is inconsistent

By Melissa Patrick

Kentucky Health News

As Kentucky moves toward implementing a stricter Medicaid plan, a group of providers, consumers and health advocates say they worry that its penalties, work rules and "onerous reporting requirements" will cause people to lose their coverage, especially those in the state's most vulnerable populations.

The group participated in a Dec. 5 Insure Kentucky news conference. Insure Kentucky, led by Kentucky Voices for Health, is a coalition of nonprofits that promote policies to improve access to care for all Kentuckians.

The state calls its new Medicaid plan Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." It is also referred to as the "waiver," since it is implemented through a waiver of normal Medicaid rules.

Among other things, the plan will require "able-bodied" beneficiaries to work, volunteer, participate in job training or go to drug treatment at least 80 hours a month, and then report the hours. Failure to report would result in loss of coverage, though it could be regained by taking a course in financial or health literacy.

The original version of the plan was vacated in late June just days before it was set to roll out. U.S. District Judge James Boasberg of Washington, D.C., ruled that, among other things, Health and Human Services Secretary Alex Azar had not fully considered the state's projection that in five years under the plan the state's Medicaid rolls would have 95,000 fewer people than without the plan.

Federal officials re-approved the plan Nov. 20. It is tentatively set to start April 1, with the work and community engagement requirements to be phased in regionally, but more legal action is expected.

Kentucky HEALTH has a long list of exemptions for "medically frail" people, including those who are chronically homeless, have a severe mental-health diagnosis or are victims of domestic violence. But advocates on the press call said the "medically frail" designation process has been inconsistent.

Krista Seymour, a freelance television producer, said that while she was able to work and had steady employment, her work schedule varies each month, often because a medication she takes for thyroid cancer makes her too sick to work. She said she must take the medicine for the rest of her life, or die.

Seymour said she has applied for medically frail status, but has been denied twice because the state says she's not frail enough to qualify. But Seymour says: "I cannot get anybody to actually give me a name or a criteria of what actually meets a medically frail designation."

Until Kentucky HEALTH is implemented, there is no official "medically frail" status.

Ramona Johnson, president and CEO of Bridgehaven Mental Health Services, said her organization has experienced similar difficulties in getting some of their members a "medically frail" designation.

“We’ve been advised on more than one occasion that anyone who is diagnosed with a severe and persistent mental illness will automatically be considered medically frail and therefore exempt from the work or community engagement requirements, but we really have not found this to be true with any consistency, and we’ve been submitting information on our members for several months," she said. "The managed-care organizations that we work with are receiving denials of medically frail status on some of our members, all of whom have a severe and persistent mental illness."

Johnson said her organization supports work programs for their members, but would like to see the requirements be based on a person's capacity to work, not a set number of hours. She said many of their members work in jobs that are tailored to their abilities, and they simply can't manage a 20-hour work week. In addition, she said the reporting requirements would be an issue for her members.

“For those of our members who can and do work, the 20 hours a week or the 80 hours a month expectation is really very arbitrary and quite unrealistic," she said. "When they lose Medicaid coverage as a result of this, then we have a group of very vulnerable people who are at risk of becoming symptomatic without treatment." She added that research shows that when this happens, people with severe mental illness often end up in the emergency room or jail, or homeless.

Andrea Miller of the Kentucky Coalition Against Domestic Violence voiced concern that victims of domestic abuse will have to self-report and identify as a victim to get a medically frail designation.

Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail that there is an appeals process for people who believe they are inappropriately denied a medically frail designation.

Hogan said there are three ways to be designated as medically frail: through an automated tool based on claims data; a provider's attestation for medical or mental-health conditions that don't have adequate claims data; or through self-attestation if the person is chronically homeless, a victim of domestic violence or if they have difficulty completing one of the "activities of daily living."

He added that providers have access to an online guidance for filling out the attestation forms, which  includes a long list of conditions that would qualify as medically frail.

"To be clear," he said, "Medicaid sets the state policy, and the MCOs [managed care organizations] administer according to policy, so that practices are consistent across the state."

The three organizations that filed suit against the waiver are expected to file an amendment to their case soon. Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the lawsuit on behalf of 16 Kentucky Medicaid recipients, said last week that they were working on amending their complaint, but first had to check with all of the plaintiffs since some of their circumstances had changed since the suit was filed.

Stewart is hopeful the plan can be blocked again. "It's hard to expect a different result with everything the same," she said.

Emily Beauregard, executive director of Kentucky Voices for Health, said "This waiver is nearly identical to the original plan with the same types of barriers and red tape, and completely ignores new evidence that reporting requirements only work to reduce coverage."

Beauregard was referring to the more than 12,000 people who have fallen off the Arkansas Medicaid rolls since the state implemented its work and reporting requirements, as well as a recent report that shows 10,000 Supplemental Nutrition Assistance Program (formerly food-stamp) recipients in Kentucky have lost this benefit since the state implemented similar work and reporting requirements.

Kentucky swears in 325 AmeriCorps service members, state has around 900; they largely work on 'social determinants of health'

By Melissa Patrick
Kentucky Health News

More than 325 new and returning AmeriCorps members were recently sworn in and have committed themselves to a year of service with one of the 20 different AmeriCorps groups across Kentucky.

More than 325 AmeriCorps members were sworn into service
Sept. 25 at the Capitol. (Commonwealth of Kentucky photo)

AmeriCorps is a national service program administered by the bipartisan, governor-appointed group Serve Kentucky, formerly the Kentucky Commission on Community Volunteerism and Service. Serve Kentucky is part of the Cabinet for Health and Family Services and the federal Corporation for National and Community Service.

In all, Kentucky has about 900 AmeriCorps members in 105 of the state's 120 counties. The program is funded by nearly $6.7 million in federal grants and varying local matches.

The 20 Kentucky programs are dedicated to efforts such as providing drug-resistance education, teaching and tutoring children, combating homelessness, empowering victims of domestic violence, promoting post-secondary education opportunities, offering financial-literacy resources and assisting low-income elderly.

Health experts often refer to these unmet social needs as "social determinants of health," and it's been proven that they often have more to do with a person's or a community's health than health care itself.

For example, many of the Kentucky AmeriCorps programs focus on education, which is known to improve a person's social and economic opportunities, factors that ultimately impact health.

"Poverty limits access to healthy foods and safe neighborhoods, and more education is a predictor of better health," says the U.S. Centers for Disease Control and Prevention.

State Health Commissioner and AmeriCorps alumnus Dr. Jeffrey Howard told the members at the kickoff event about the impact service had had on his life and career.

“AmeriCorps gave me the opportunity for experiences and relationships that helped shape my path toward public health services and administration,” Howard said. “Through their service, AmeriCorps members can clearly see the needs of a community and get the chance to fill those needs. Being a part of the Kentucky Department for Public Health is the next step in my service, and I’m so glad AmeriCorps taught me -- as members of this year’s pledge class will learn -- that a commitment to serve can come in many forms.”

Since 1994, more than 12,000 Kentuckians have served approximately 19 million hours and nationally, more than one million men and women have served in AmeriCorps, providing more than 1.4 billion service hours, a news release said.

Serve Kentucky Executive Director Joe Bringardner said, "AmeriCorps members do more than just fulfill a service assignment; they make communities stronger and better prepared for the future.”

Domestic abuse is about as common in male couples as in heterosexual couples, study in three major cities finds

Pride photo

Around half of American men in a three-city survey said they experienced abuse in their same-sex relationships -- about the same percentage reported by women, a new study shows.

The study at the University of Michigan surveyed 160 male couples in Atlanta, Boston and Chicago. It found that 46 percent said they experienced physical, emotional, sexual, or control abuse from a partner. Research on domestic violence usually only surveys the assumed victims (usually women in opposite-sex couples), this researched surveyed both perpetrators and victims.

"We're stuck in this mental representation of domestic violence as a female victim and a male perpetrator, and while that is very important, there are other forms of domestic violence in all types of relationships," said Rob Stephenson, a UM professor. He said about 25 to 30 percent of male-only relationships include violence, around the same as female victims in heterosexual relationships.

The study found that male couples, while facing many of the same challenges that heterosexual couples face such as financial problems or drug abuse, also face homophobia, a challenge unique to same-sex couples. Sometimes, the homophobia comes from within, when one member of the couple is struggling with his identity, Stephenson said. Such a man "might lash out at his partner with physical or emotional abuse as a stress response behavior—similar to heterosexual couples, where an unemployed man lashes out at his female partner because he feels inadequate," a UM press release said.

The research also shows a correlation between HIV prevention and abuse, said Stephenson, because men who are in abusive relationships may not be able to negotiate for condom use, when or how they have sex, or communicate their HIV status.

#MeToo reminds health-care providers: trauma survivors carry experiences with them and need 'trauma informed care'

As millions of men and women joined the #MeToo social medial campaign to tell their stories of sexual abuse, harassment or domestic violence, Elizabeth Starr, a licensed clinical social worker, reminded caregivers that people who have had these experiences carry them with them into their health care settings.

In an opinion piece for the Louisville Courier Journal, Starr, who is also WellCare of Kentucky's manager of advocacy and community based programs, wrote: "Most of us know that if someone is in a bad accident, they may be scared to drive. And soldiers who experienced battleground trauma may be anxious during fireworks celebrations. But have you thought about the anxiety a rape victim may feel even years later, sitting alone, in a paper gown, in an exam room – or during the exam itself."

Star noted that health-care providers and others who attended a recent WellCare-sponsored conference learned how to create an environment where everyone is as comfortable as they can be when seeking care.

She used the term "trauma informed care," a phrase she said is used by those who work in mental health care to talk about ways doctors' offices, health clinics and hospitals can learn to recognize the signs of past trauma, understand that those traumas affect current mental and physical health, and to find ways to create a safe environment for everyone who seeks care .

For example, she notes the importance of making sure trauma survivors are comfortable enough to get the routine care everyone needs, like mammograms, pap smears and blood pressure checks: "We must eliminate all the barriers that keep people from these types of screenings - including the discomfort and fear that trauma survivors may feel."

Feds give UK $4.5 million to identify, address social determinants of health in 27 Appalachian counties and parts of Louisville Metro

University of Kentucky researchers have been awarded $4.5 million to support local communities in identifying and addressing the health-related social needs of their most vulnerable patients.

These unmet social needs are often called social determinants of health and include factors that contribute to poor health outcomes. They include housing instability, food insecurity, interpersonal violence and lack of transportation.

And while needs in these areas are often met by existing community programs, many patients have difficulty accessing them, "including lack of awareness and resources to locate appropriate services, low health literacy, and even geographic and distance barriers in the Appalachian region of Kentucky," Olivia Ramirez reports in a UK news release.

"This award – and the research being done with it – will allow physicians to better address the health and social needs of the patients they serve," Mark D. Birdwhistell, vice president for administration and external affairs for UK HealthCare, said in the release. "Addressing those needs on the front lines of care will be critical for reducing the burden of health disparities, especially confronted by patients in Eastern Kentucky and Appalachia."

The $4.5 million award from the federal Centers for Medicare and Medicaid Services goes to the UK Center for Health Services Research to establish the Kentucky Consortium for Accountable Health Communities. UK is one of 32 organizations selected to participate in this five-year pilot project.

UK was chosen for the highest level of participation, which requires an emphasis on "community participation, including assistance from community members in identifying social services available in the region and training navigators who can assist patients in accessing services," says the release.

The project will partner with the Kentucky Primary Care Association, Norton Healthcare, Appalachian Regional Health and Kentucky HomePlace.

The Kentucky Consortium of Accountable Health Communities will research social determinants of
health in the areas colored blue: 27 Appalachian counties and parts of Jefferson County. (UK map)

This collaboration will work across 27 Appalachian counties and part of Jefferson County to screen Medicare and Medicaid patients for unmet social needs that impact their health, provide service referrals and offer navigation services to help patients with their identified needs – with the goal of reducing the use of healthcare services for issues that can be addressed by existing social programs.

Appalachian counties in the study include: Adair, Bell, Casey, Clay, Clinton, Cumberland, Estill, Floyd, Green, Hart, Harlan, Jackson, Knox, Lee, Leslie, Letcher, Madison, Magoffin, Martin, McCreary, Monroe, Owsley, Perry, Pike, Russell, Wayne and Whitley.

A key aspect of this pilot project is to "examine whether clinical and community service alignment at the systems level impacts health care costs, care utilization, and patient outcomes," says the release.

"Our researchers will have the opportunity to identify where gaps exist in the care that residents of Appalachia may be experiencing," Dr. Michael Karpf, UK's outgoing executive vice president for health affairs, said in the release.

Another important aspect of the project is ensuring that these communities can continue to identify social needs and link patients to appropriate services after the funding has ended.

Dr. Mark V. Williams, lead researcher and director of the consortium, said, “This isn’t money being spent solely on a research project. We want to integrate these efforts into the health care of the community and ensure sustainability,"

To learn more about the Accountable Health Communities Project, click here.

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.