Health of Boston Meetings Each year, the Boston Public Health Commission (BPHC) holds meetings with the community to share health data from our Health of Boston report and to listen to residents concerns about their health. The goals of these meetings are to increase awareness of the impact of social and economic factors, like housing, education and racism, on health and to help improve health in our communities through effective partnerships. In November, BPHC held the third of our 2011 community meetings. The meeting was co-sponsored with South Boston CAN Reduce Underage Drinking, South Boston Collaborative Advisory Network, Action for Substance Abuse Prevention, South Boston Collaborative and the South Boston Hope Project. The health topics discussed were chosen by these community partners to address important health issues in South Boston. The meeting highlighted community concerns and exposed participants to the problem of racial and ethnic health inequities, as well as the social factors contributing to these unjust differences in health status and health outcomes. Participants listen to presentations on the Health of Boston Introduction On November 14, 2011, the Boston Public Health Commission, along with South Boston Collaborative Action Network and South Boston CAN Reduce Underage Drinking sponsored a meeting at the Iron Workers Union Hall in South Boston. More than 150 members of the community attended, including a number of young people. The goal of this meeting was to address the issues of substance abuse, suicide and Hepatitis C through familiarizing community members with South Boston s current health outcomes and with useful prevention and coping techniques. 1
How Healthy is South Boston? Dr. Barbara Ferrer, Executive Director of BPHC, with Kay Walsh of South Boston CAN Kay Walsh, of South Boston CAN Reduce Underage Drinking opened the meeting. She presented the MAPP (Mobilizing for Action through Planning and Partnership) Planning Model, on which the meeting was based and explained its comprehensive approach to improving health. Following the introduction, dinner was served and participants were given the opportunity to meet each other, receive materials, and talk with representatives from the sponsoring organizations. This led to the main presentation by Dr. Barbara Ferrer, Executive Director of the Boston Public Health Commission. Dr. Ferrer presented data on demographics and health outcomes for obesity, cancer, and substance abuse, along with community assets and a framework for promoting health equity and addressing the impact of racism on health. According to the latest Health of Boston Report, South Boston has the highest rate of substance abuse mortality of all Boston neighborhoods (51 per 100,000 population), has much higher rates of opiate use than Boston overall, and has the highest incidence rates of Hepatitis A and C. However, South Boston does have one of the lowest rates of reported HIV/AIDS cases at just 2 percent and ranks better than Boston overall in the number of asthma-related hospitalizations among children 5 years old and under. Dr. Ferrer concluded each section of the presentation by addressing how residents can prevent and treat these issues, and obtain additional support. In response to audience questions about support for the problems of substance abuse in South Boston, Jan Quiram, Associate Director of the BPHC Addictions Prevention, Treatment and Recovery Support Services Bureau, presented some of the programs and services that BPHC offers to the South Boston community, including prevention services for young adults to outpatient and residential substance abuse programs. Participants mingle and enjoy dinner at the beginning of the meeting 2
Other questions raised were about the reasons for the high suicide rate in South Boston, and how one contracts Hepatitis C. Dr. Ferrer explained that a combination of critical factors contributes to the distressing suicide rate, including high school dropout rates, substance abuse, mental health issues, joblessness, and street violence. Adam Butler, Project Manager of the Risk Reduction and Overdose Prevention Program at BPHC, explained in detail the blood-borne modes of transmission for Hepatitis C. After this in-depth discussion, participants had the choice to attend one of two breakout sessions. One focused on coping skills and relaxation tools benefiting those who are dealing with the stress of an unexpected death. The other session provided training in overdose prevention. Trauma Healing Session Courtney Grey, Director of Trauma Services at the BPHC, guided 20 participants through the Trauma Healing session, modeling how a self-care coping group could address the issue of exposure to sudden loss and other traumatic events. This activity, based on Psychological First Aid and other models for trauma response and recovery, gave participants an understanding of the typical reactions to and symptoms of post-traumatic stress. Most importantly, participants learned specific, practical techniques to deal with psychological and emotional challenges by boosting resilience, stabilization, and Trauma healing session participants listening to Courtney Grey, BPHC Director of Trauma Services recovery in the aftermath of suicides, homicides, accidents, overdoses, etc. Participants left this session with new and improved skills on how to expand their external support networks. This included strategies on how to utilize community resources and agency referrals, as well as strategies on how to re-establish healthy social supports, how to develop coping techniques, and how to reduce isolation. Overdose Prevention The other session addressed overdose prevention. Adam Butler, introduced participants to the Addicts Health Opportunity Prevention Education (A-HOPE) program through the BPHC s Addictions Bureau, which provides overdose 3
prevention/narcan training. Narcan (Naxolone) is a drug that reverses the effects of other narcotic medicines (also known as a narcotic blocker), and is particularly useful in the treatment of drug overdoses. Adam described the training and its importance, offering Narcan kits, and introducing his colleagues Berto Sanchez and Sarah Mackin, A-HOPE Public Health Advocates. Berto and Sarah then enrolled 28 willing participants in the process of becoming trained in using Narcan. Enrollees identified themselves as either non-substance users or in recovery and treatment for substance use. They informed the trainers that they would use Narcan to help family, friends, and clients, when necessary. Everyone enrolling had to practice assembling the Narcan demo. Approximately 90 people attended this training (of which half were young adults), which addressed particular concerns and questions participants had. Their questions were mainly focused on where and how they could obtain Narcan. Adam Butler trains meeting participants on the use of Narcan The training team described the needle exchange van, including specific information about the van s site time and location in South Boston. Participants were informed that BPHC offers training and Narcan enrollments within the community, even in people s homes, and were given business cards and Get the Scoop handouts with contact information and more details on the program. Further discussion within the training dealt with rescue breathing. Some participants commented that people don t care about drug users and consequently, there is a lack of interest in providing rescue breathing. The training team reinforced the need for air during an opioid overdose, pointing out that the Narcan kits included breathing masks, which can reduce some of the perceived risks. Next Steps The introduction of MAPP s Health Planning at the Town Hall Neighborhood Health Report event was an effective way to show South Boston residents the value of health planning. Dr. Barbara Ferrer made the charts and numbers real for the lay audience and this had an immediate impact. She clearly and precisely expressed her concerns about the data on South Boston s alcohol addiction, Hepatitis C, and opiate overdoses rates. Dr. Ferrer also noted the trend of attempted or completed 4
suicide among adults ages 21-34, and men ages 45-55. The participants really enjoyed her inclusive presentation and felt reassured knowing that these crucial issues are on her radar. Based on the concerns raised at this meeting, and being mindful of health equity and cultural awareness, the following actions are being taken: An intensive training in Physiological Trauma First Aid is being planned for April 4 th and 5 th to be presented by Dr. Robert Macy. The two day training will be open to anyone who is over 18 years of age and will provide the attendees with basic first responder skills and trauma healing tools. It is expected that 40 to 50 people will be trained which can replenish South Boston s standing response team. Meeting organizers understand that when an incident overwhelms the South Boston community, having sufficient bands of ready and trained responders is necessary. Data are currently being collected to gather core measures on prescription drugs, alcohol, marijuana, and opiates. Twenty schools (public, catholic, charter, and private) have been identified where a diverse sample of zip code 02127 (South Boston) young people attend. For copies of this report and the presentation from the meeting go to: http://www.bphc.org/about/policyandplanning/ Pages/Home.aspx or contact Pam Jones at BPHC, 617-534-7195 or pjones@bphc.org. For more information or to get involved, contact Kay Walsh at 617-269-5160 x126 5
Appendix Overall Evaluation Of the participants who responded to the evaluations, 100% found the Narcan and the Self-Relaxation sessions (whichever one they attended) to be helpful. Trauma Healing: What did you like about this session? Taking my mind off stress. Learning about the reactions our body has and being informed on how to change it. Loved it. Courtney was very informative and fun. He helped with trauma and then took it off everyone s mind by playing. Activities and the incorporation of science that provided insight into why the demonstrated activities work. 6
Natural reflex of stressors. Learning techniques for relaxation. Seeing the young people relaxing, smiling being kids again, no stress. What could we improve about this session? Fine just as is. / No improvement needed. The sharing of stories at the beginning was a bit awkward without having even met the other person. Keep it fun! Have more groups like this. Narcan: What did you like about this session? Learned to help. I like the fact that we/i can save a life. The questions from the crowd coinciding with the slideshow. Adam gave us the big picture in easy to understand terms. Information and stats about overdose. The teacher was very clear and understandable and thorough. The slides were very helpful. People got to ask questions (he answered well) and make comments. How to use Narcan and when. How can we improve the session? Include more people. Hold questions until the end of the session. Too many technical terms needs to be easier for everyday people to understand. Have someone with a mic for questions. 7