First published on October 20, 2014 in observance of the COPH’s 30^th anniversary celebration.

October is Domestic Violence Awareness Month.

Like many entities directed at the greater public good, the USF College of Public Health’s Harrell Center was the product of a private philanthropist’s gift. James Harrell and his family wanted to do something to help eliminate family violence, and they acted on that desire. The result was a 1997 endowment that set the stage for what has become an international force.

“The intent of the Harrell family was to provide a center that would focus on family violence,” affirmed Dr. Martha Coulter, the center’s founding director, “but they were particularly interested in looking at the prevention of family violence, as well as research that would be directly applicable to prevention and intervention.

“So the mission of the Harrell Center, really, is to be an intermediary between research and practice, to do research that is focused on family violence intervention and prevention across the lifespan.

“The grant was an endowment, so the funding is very limited, because it’s just the interest on the endowment. Now, most of the income is from other grants and contracts,” Coulter said, “but what the Harrell endowment did was provide the base for doing that kind of research.”

Brick sponsored by the Harrell Center in remembrance of James Harrell after his death in 2007.

One of three faculty members at the center full-time, Coulter, whose doctorate is in maternal and child health, teaches three courses: Family and Community Violence, Child Maltreatment, and Child Health, in addition to coordinating the maternal and child health academic concentration at COPH.

“In the very beginning, there was only the grant and the establishment of the center conceptually,” she said. “Over the years, we’ve developed.”

That development recently necessitated alignment into three divisions.

“The specific divisions – the redesigning of the organizational chart – has really been something that I’ve done this year,” Coulter said. “Before that, over the years, we’ve just developed these different projects and all worked together, but it looked like now we were at a place where we really needed to have a little bit more separate organization and to develop some strategic goals and objectives in each of those content areas.”

The result is a children’s services division directed by Dr. Lianne Estefan, an intimate partner violence division directed by Coulter, and an elder mistreatment division directed by Dr. Carla Vandeweerd. Dr. Karen Liller recently joined the center as a regular collaborator focusing her attention on the overlap between child maltreatment and unintentional injury, Coulter said, and “usually about 10” graduate students round out her staff. A community advisory board is among the center’s numerous external extensions.

“The children’s section has been very involved in looking at issues regarding the prevention of violence in the community,” Coulter explained, “and the center has developed a virtual research institute with one of the community agencies, Champions for Children, which is a multi-program unit, so that we can do research that is truly collaborative. We’ve worked very consistently with them over the years.”

Graphic that Harrell Center graduate assistant Natasha Hojati created for the Center’s Facebook page.

Coulter said that much of what her intimate partner violence section does involves the courts, so much so that she has become a regular consultant for the courts and has undertaken the task of evaluating the effectiveness of their intervention programs for batterers. Developing and continually improving guidelines for batterer intervention and responses to the needs of victims have been major off-shoot projects.

Among the section’s more significant research findings is that female batterers are falling through the cracks. While the county’s intervention for male batterers has been “very effective,” Coulter said, it has largely failed to successfully intervene with female batterers, who comprise about 15 percent of all convicted batterers in Hillsborough County.

“The clinical providers of these programs,” she said, “have been saying for a long time that they didn’t think the state-mandated curriculum for men was really the right curriculum to use for women.”

Among many leaders and dignitaries who have visited the Harrell Center over the years was then-Attorney General Janet Reno, who attended an elder abuse conference sponsored by the Center in 2001. The attorney general is pictured above with students Seraphine Pitt (left) and Carol Williams, and below with Dr. Coulter.

The elder mistreatment division concentrates on elders with dementia and the kinds of violence against them, which is, Coulter said, “fairly common, unfortunately, from both spousal caretakers and children taking care of elderly parents. The dynamics of this are very different from other sorts of domestic violence and really have a lot to do with people not understanding how to help people who have dementia.”

Coulter said she considers a new project in the division to be particularly tantalizing and potentially groundbreaking.

Called the Senior Surfers Project, Coulter said it looks at the rapidly expanding but little-known phenomenon of women over 50 seeking relationships online and getting responses from people who wind up physically, emotionally or financially harming them.

All previous research on Internet connections leading to violent encounters has been on adolescents, she said, so Senior Surfers is another project aiming to keep potentially overlooked victims out of the cracks – in this case, the cracks that open at the nexus of society and technology.

Dr. Coulter chats with Judge Dennis Alvarez (left) and James Harrell at a 1997 function.

With so much involvement in the local community, including working closely with the Spring and, until its recent demise thanks to funding shortfalls, the Family Justice Center, the Harrell Center’s global impact might be surprising to some, but global involvement has proven beneficial on numerous fronts.

Dr. Pnina S. Klein, a clinical and developmental psychologist and professor of education at Bar-Ilan University in Israel, recently led a Mediational Intervention for Sensitizing Caregivers workshop on campus to promote cognitive functioning and attachment by improving parent-caregiver interactions with infants and young children.

Attendees included community professionals, physicians and COPH students, faculty and staff.  Dr. Robert Nelson, a joint professor in COPH and the Morsani College of Medicine, sponsored attendance by a visiting group of physicians and clinicians from Ecuador.

“It’s been used all over the world,” Coulter said of MISC. “The outcomes internationally of this program have shown that it’s very effective in strengthening attachment and reducing child maltreatment, so we brought Dr. Klein here from Israel this year to do a training for community people and staff here, as well as faculty and students.”

Dr. Martha Coulter, Harrell Center founding director (right in both photos), in Ecuador in 2007.

Elsewhere on the international front, Coulter is working with the medical school in Panama to begin collecting information and developing guidelines for Panamanian health providers to improve their responses to intimate partner violence. She’s also working in Quito, Ecuador, to develop a program that will provide fundamental intervention services for indigenous populations.

Children in a remote Himalayan village in India read books sent to them by the Harrell Center.

Coulter went to India in 2012 with a group that collected data on maternal/child health and family violence among the 26 indigenous tribes in the Himalayas as a response to one tribal leader’s interest in addressing those issues. Progress has been slow, she said, because the tribes are not formally centralized in any way, and the terrain is difficult and isolating. The center recently collected books to send to children there. A librarian navigates dirt paths on a bicycle to deliver them.

Not surprisingly, Coulter’s five-year vision for the Harrell Center is about more expansion, mostly ideological, and lots of it.

“I would like to expand our depth in looking at female offenders and the way the courts respond to them,” she said.

“We’ve applied for some grants to look with a lot more depth at issues related to fathers. This is an area that has been somewhat neglected and needs a lot of attention. What are the ways that we can help fathers from the very beginning develop the kinds of skills that will be more nurturing and less likely to produce problems?

“As far as the center itself,” she said, “I think the area that we really need to expand the most is our capacity for doing community training and education and technical assistance.”

“I’d also like to see us focus on more primary intervention in a public health direction.   A lot of what we’ve done has been secondary response intervention, but I would like to see us working with primary situations – families, parent-child relationships.”

Coulter said an example of the center’s involvement in this area is its participation in the Hillsborough County Violence Prevention Collaborative, a plan for reducing violence throughout the county.

Community events also make Coulter’s expansion list. Recent ones have included fundraisers with artists and bands, and even a biker run.

“I would like to see us expand these community events, because they have been very helpful. The center doesn’t have much funding,” she said, “and the funding that we get is almost always research funding, so if we want to do things that are outside the research arena, we have to raise the money ourselves.”

Story by David Brothers, College of Public Health. Photos courtesy of Dr. Martha Coulter, Eric Younghans, Dr. Robert Nelson, USF Health and the Harrell Center.

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With an aging population, more of us help care for our parents — most of whom would prefer to live independently in their own homes.  New technology is helping adult children and other caregivers help seniors live safely and happily.

HOME OUTFITTED WITH SENSORS

At 80, Mary Taylor believes there’s a new way to live independently, with dozens of sensors in the home.  They monitor and chart virtually all of her movements within the home.

The sensors can tell if she’s fallen in the bathroom, if her kitchen range is left on too long, even if she’s spending too much time in bed or on the couch.

Examples of sensors and devices used to help keep seniors safe at home.

“It seemed to me that this kind of monitoring is a healthy thing to do,” said Taylor, who lives alone in her home.

There are no cameras, but the sensors will automatically alert caregivers if something goes wrong.

BRINGING HEALTH AND TECHNOLOGY TOGETHER

The system is called Always Near.  It’s being developed by USF researchers through a corporate partnership and a grant from a regional technology organization.

It was developed by public health professor Carla Vanderweerd and engineering professor Ali Yalcin.

Carla VandeWeerd, PhD

“It seemed like a perfect fit in terms of bringing health and technology together,” offered Vanderweerd.

It’s being tested at John Knox Village in Tampa, and final tests are scheduled this summer at The Villages in Lake County.

A WATCHFUL EYE

In addition to delivering alerts to caregivers via text or e-mail, the Always Near system allows the patient’s movements to be monitored by case workers. Developers envision a subscription-based service to consumers.

For the full story and video, visit My Fox Orlando.

Dr. Carla VandeWeerd is an assistant professor in the USF College of Public Health and associate director of The Harrell Center.

Related story:
USF professors lend interdisciplinary expertise to cutting-edge medical alert system

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A pair of USF professors from seemingly disparate disciplines are helping to further develop and refine a new medical alert system with state-of-the-art potential.

Examples of sensors and devices used to help keep seniors safe at home.

“We were approached by a company that’s developing technology to monitor seniors at home,” said Dr. Carla VandeWeerd, assistant professor in the Department of Community and Family Health at the USF College of Public Health. “What’s a little bit different about the technology that they’re developing compared to what’s already on the market is that, instead of having a system that responds to a person pushing a button to indicate there’s a problem, multiple sensors will be in the house providing information about the person’s wellbeing around the clock.

Carla VandeWeerd, PhD

“Additionally,” she said, “the system includes comprehensive case management that uses information collected by the home sensors to improve care coordination between patients and health care providers.”

VandeWeerd’s co-principal investigator is Dr. Ali Yalcin, who will evaluate the wireless monitoring system. Yalcin is an associate professor in the USF College of Engineering, Department of Industrial and Management Systems Engineering.He co-authored the Design for Industrial Information Systems textbook, which won the 2007 IIE/Joint Publishers Book-of-the-Year Award.

Ali Yalcin, PhD

The project is jointly funded by a grant from the Florida High-Tech Corridor and corporate sponsor Always Near Inc. VandeWeerd noted its broad interdisciplinary nature as a natural by-product of its universal human appeal.

“We have students from the College of Public Health, the College of Engineering and the Department of Anthropology who are working with us on a health problem that almost all of us are going to have to face at some point,” she said, “because almost all of us have parents and grandparents or at some point will be older adults ourselves. And even though we don’t really like to think about that, figuring how we can age in place successfully will be very important for most of us.”

“Taking care of the older population – it touches everybody,” Yalcin concurred.

“Another one of the benefits of this type of project is the emphasis it places on student education and training,” VandeWeerd added, “which not only fosters interdisciplinary collaboration and student learning, but also helps to further develop the workforce for high-tech industries in the region.

“Ultimately,” Yalcin said, “technology like this offers the potential to positively influence health and wellness in powerful ways, and the better prepared we are to harness it, the better off many seniors may be.”

The sensors are set up to monitor the person’s activity and automatically send out alerts as necessary. For example, if a monitored person has gotten out of bed but not shown up in another part of the house, the sensors will send an alert that he or she may have fallen.

Some of the various sensors at work in the project’s living lab: bathroom sensors, door sensors (above), kitchen sensors (including motion sensor left of coffee maker), motion sensor in shower (below).

The included case management feature tailors the system to the individual’s health conditions and expectations. No alert is sent, for example, if a person expected to spend 12 hours a day in bed has been in bed for 10 hours, while one will be sent after 10 hours for a client expected to spend eight hours in bed.

A local man believes the system saved his elderly father’s life in October. Ron Bartley received an alert about his father, Ray, who is 80 and has suffered from idiopathic neuropathy for 35 years. Walking is a challenge for the elder Bartley, who has little sensation below his knees.

Ron Bartley already had been visiting his father more often in the preceding weeks, because the system had told him of a dramatic increase in the time he was spending in bed, from 13-14 hours to more than 20 hours a day. One day, while checking his father’s activity, Bartley noticed that it had taken him an unusually long time to make it back to bed from the kitchen.

“I also noticed,” Bartley wrote, “that the display of the bed sensor was different in that it was an intermittent signal with several gaps of no signal, which indicated to me that either he wasn’t in bed all the way or was moving around much more than normal.”

That prompted a call and the subsequent discovery that Ray Bartley had fallen in his kitchen and had crawled back to bed, which explained the long interval. Unable to get back into bed, he instead was hanging onto the side of the bed, which caused the intermittent signal from the bed sensors.

Ron Bartley called for an ambulance that rushed his father to a hospital, where tests revealed severe dehydration and other conditions that suggested he may not have survived more than another few hours without medical help.

The system is slated for a larger community-based trial this spring in The Villages, Florida’s largest planned senior community, after more extensive testing in the research group’s living lab near the USF Tampa campus. Preliminary limited test runs have proven successful and beneficial, and in the Bartley case, possibly lifesaving.

“We have a living lab set up in and donated by the John Knox Village for the project,” VandeWeerd said, “so we actually have put all the sensors into an apartment to make sure that they work the way they should and that the alerts are working the way they should before we put them in more homes for community-based testing. We anticipate putting them in the homes of 60 older adults in the spring.”

Yalcin compared the system’s technology with a home equipped to turn lights and heating or cooling on and off automatically by anticipating its owner’s needs and preferences.

“It’s the difference between having to tell the environment what you want vs. the environment learning and knowing what you want,” he said.

“It’s supposed to learn your patterns of behavior and be able to pick up when there are changes that should be brought to someone’s attention,” VandeWeerd said, “and alerts are designed to be automatic instead of relying on users to notify supports that they are experiencing a challenge. For people who have, for example, dementia, being able to remember to push a button to let someone know that they have a problem can be difficult.

“The great thing about this kind of technology,” she continued, “is that it’s designed to send alerts for certain conditions. So if you’ve had a fall and there’s no movement – you were recently in a chair but now there’s no movement in the house – it will send an alert right away.

“If you’re getting up more to go to the bathroom, that might be an indication of a bladder infection. It notices those things right away and notifies caregivers and case managers, so instead of ending up in a hospital with a kidney infection, you can be treated as an outpatient for a simple bladder infection.”

While “He may have fallen and can’t get up” sounds expensive compared with “I’ve fallen and can’t get up,” VandeWeerd said cost projections are reasonable. She also emphasized the potential health care savings, reiterating her example of early home treatment vs. hospitalization.

Yalcin said that the cost also is affected, interestingly enough, by privacy issues.

“To circumvent that,” he said, “this whole system is using basic, inexpensive sensors that have been around since automation in factories – contact sensors, proximity sensors, motion sensors.

Caregivers can easily observe a patient’s daily activities.

An overview of the in-home monitoring system.

“So from that perspective, the hardware part isn’t prohibitively expensive, but a lot of the sensors that could be used to capture these data you’re carrying with yourself now – your cell phone,” he said. “It would be next to nothing if people would just let us use their cell phones so that we can monitor everything, but most people aren’t comfortable with that. The real value in the cost of the service is the intelligence software, the brains of it.”

“It has a user interface that’s available online,” VandeWeerd added, “so if you live in Idaho and your mom lives in Florida, and you’re wondering how your mom’s doing – if she’s showering, if she’s getting out, if her therapist is really coming to the house three days a week to work with her – you can easily look at the system and actually see the activities that have occurred. It’s not invading her privacy the way that video cameras might or that RFID, that constantly tracks where she is at every second, might. Older adults have clearly expressed that they’re comfortable with it.”

VandeWeerd and Yalcin both expressed enthusiasm for the project for its potential for humanity, as well as its place in the university’s and their respective colleges’ missions.

“With the looming aging and health care crisis on the horizon, this type of technology may be crucial in finding solutions that cut costs and improve health and well-being for seniors,” Yalcin said.

“In terms of how we do research that fundamentally has the power to really change people’s lives, and to do it in a way that’s quickly translational and that’s highly applied and interdisciplinary, this is a really good example,” VandeWeerd said, “and it’s a fabulous learning opportunity for our students.”

Story by David Brothers, College of Public Health. Photos courtesy of Dr. Carla VandeWeerd.

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Preliminary analysis of a Hillsborough County youth survey identifies a range of risk factors for violence, but also indicates that schools may be well positioned to help implement programs and strategies to prevent child abuse, substance abuse, crime and other types of violence.

Martha Coulter, DrPH, professor and director of the Harrell Center at the USF College of Public Health, reported the survey’s preliminary results Aug. 25 at a press conference announcing a groundbreaking long-term plan to prevent violence in Hillsborough County.

Martha Coulter, DrPH, director of the Harrell Center at the USF College of Public Health, reports on preliminary findings from the Violence Prevention Collaborative’s youth outreach survey.

The strategic plan will be driven in large part by the complete data analysis performed by Harrell Center researchers – the first step in a five-year pilot project by the county’s Violence Prevention Collaborative.

The collaborative, chaired by Hillsborough County commissioner Kevin Beckner, was launched in the aftermath of the elementary school mass shooting in Newtown, Conn. in 2012. It includes representatives from law enforcement, city and county governments, the 13^th Judicial Circuit Court, the Hillsborough County School Board, the State Attorney’s Office, the Public Defender’s Office and USF.

While the county’s violent crime rate has fallen, violence remains a problem that continues to plague our communities and must be addressed at its root causes, Beckner said.

“We cannot arrest our way out of this problem,” he said. “Our plan is based on the understanding that violence can be prevented when all parts of a community come together to pursue data-drive, evidence-based strategies that address violence as a public health issue.”

To help lay the groundwork for the prevention plan, the collaborative conducted an outreach survey of more than 3,500 youngsters, ages 14 to 19, to assess their perspectives on violence as well as risk factors that threaten well-being and resilience factors that may protect and support individuals.   More than 2,000 surveys were returned from participants in the county’s schools, court diversion and detention programs, and adult education programs. Approximately 58 percent of the respondents were female, and roughly 41 percent reported that they were of Hispanic or Latino decent.

Hillsborough County Commissioner Kevin Beckner (second from right), chair of the Violence Prevention Collaborative, was joined by a diverse group of community leaders, including USF Health’s Dr. Coulter, at a press conference announcing the long-term plan to prevent violence across the county.

While much more analysis of the data will be done by the Harrell Center over the next several months, some emerging trends reported by Dr. Coulter include:

–          Many youth surveyed reported challenges in their communities related to sense of belonging and social cohesion.

–          More than a third of survey participants indicated that they do not feel that adults in their neighborhood can be counted on to ensure that children are safe and stay out of trouble.

–          About the same number do not feel that people in their neighborhoods have the opportunities they need to meet and work together to solve community problems.

–          Twenty-eight percent felt that gunshots and shootings were a problem in their communities, and many youth reported living in neighborhoods where drug sales, graffiti, deserted homes and storefronts, and trash in public areas were problems. A majority said they would spend more time outside if their neighborhoods were safer.

–          More than half of the respondents reported using alcohol or drugs more than 40 times in their lives.

Among the early positive findings:

–          Most respondents said they had a parent or adult they could talk to about their problems and who took an interest in their school work.

–          Ninety-eight percent of children reported feeling a sense of belonging at their school, and the majority mostly or always feel safe in their school building.

“This is what we call a protective factor,” Dr. Coulter said. “It positions the schools to be a central part of implementing prevention programs, and suggests that programs that build on or are based in the schools are likely to be trusted by our children.”

Carla Vandeweerd, PhD, associate director of The Harrell Center (left) and Dr. Coulter stand in front of one of several color-coded maps showing zip code areas in Hillsborough County most impacted by poverty, truancy, child abuse, domestic abuse and other indicators of violence.

Moving forward, the collaborative will hire a coordinator and seek county approval for $1.7 million in funding. The ambitious project seeks to unite and build upon the strength of collective community resources to tackle the causes of violence on multiple fronts. The group’s report recommends strategies to support the health and well-being of families, foster quality education and social connections, and improve conditions in neighborhoods most impacted by violence.

“We believe that prevention efforts need to be grounded in good data and based on evidence, and this collaborative has based its work precisely on that philosophy,” Dr. Coulter said “We are excited to be part of this project to help make our community a safer place.”

Dr. Coulter co-chairs the Violence Prevention Collaborative education committee and is a member of the group’s steering committee.  Carla Vandeweerd, PhD, assistant professor of community and family health and associate director of the Harrell Center, is analyzing the youth outreach survey data.

Reposted from USF Health News

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Aimee Eden, PhD, MPH, is a qualitative researcher at the American Board of Family Medicine in Lexington, KY. Her focus areas include: various aspects of family medicine, including quality of care, patient- and family-centered care, professionalism, inter-professional collaboration, physician experience, and much more.

As the mother of two young children, family medicine hits close to home.

“Understanding how family physicians, as primary care providers, function within the broader health care system during this time of transition is an important piece of improving population health, and in addressing health disparities and inequity in health care,” Dr. Eden said.

“Busy and supportive” is one way she describes her time in the College of Public Health.

“I started the program with a 1-year old and graduated with an 8-year old and a 6-year old. It was a long process and I rarely got enough sleep, but with the support of faculty and other students, it was always a pleasure!”

As a student at USF, Dr. Eden was not one to sit idle. She became involved in advocacy, working as a parent member of the Florida Covering Kids and Families Coalition. She also served on the board of directors of The Family Healthcare Foundation (formerly The Kids Healthcare Foundation). In addition, Dr. Eden was an active member of the Hillsborough County Breastfeeding Taskforce.

“These activities supplemented my education as a student of public health, giving me real-world experience and training,” Eden said. The qualitative and mixed methods research skills she learned as a student and research assistant are utilized every day in her role with the ABFM.

“I am so thankful for the opportunities the college provided—SHARP awards, research assistantships, the MCH Traineeship, teaching undergraduate courses, and mentorship from amazing faculty like Drs. Carol Bryant, Martha Coulter, and Carla VandeWeerd.”

Erie, Pennsylvania; Athens, Ohio; and, Washington, DC, are just a few of the places she’s called home. She even spent two years living in Kazakhstan as a Peace Corps volunteer.

In between her travels, Eden managed to complete her undergraduate studies in anthropology and English, as well as a master’s degree in international affairs from Ohio University.

“The dual degree program (PhD in anthropology/MPH) at USF provided me with so many academic, research, and professional opportunities,” Eden shared.  “I got to work with some amazing faculty in both departments and do true interdisciplinary work.”

As for her dream job, “I have it—I get paid to do research all day long!”

When Dr. Eden isn’t living out her research dream, she enjoys spending time with her two children, traveling, and watching documentaries.

In the COPH, the Department of Community and Family Health served as her academic home. The department offers more than 10 concentrations that lead to MPH, MSPH, DrPH, and PhD degrees, as well as dual degrees, special programs, and graduate certificates.

Story by Christi Owiye and Natalie D. Preston, USF College of Public Health. Photo courtesy of Dr. Aimee Eden.

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Lynea E. Bach is lead author and was a graduate student in the college at the time of submission.  Her mentor James A. Mortimer, PhD, professor of epidemiology, Carla VandeWeerd, PhD, assistant professor of community and family health, and Jaime Corvin, PhD, assistant professor of global health, are co-authors on the article. Drs. VandeWeerd and Corvin also serve as the college’s two lead faculty on The Villages project.

Part of a unique partnership between USF Health and The Villages, the assessment included the largest survey ever completed by a population of active older adults. “An incredible team of faculty worked on this effort and many students have benefited from the learning experience,” said Donna J. Petersen, ScD, dean of the USF College of Public Health and interim senior vice president of USF Health.

“While this is the first paper published, many more are in process and will be emerging over the next few months.”

One of the first presentations on the survey earned the College of Public Health team the Erickson Award from the American Public Health Association, Section on Aging.

The College of Public Health’s five-year strategic plan includes a commitment to greatly increase the number of papers co-authored with students. To this end, whenever appropriate students are encouraged to take the lead and to earn the primary author spot.

“Ms. Bach has set a great standard which all of us can work to achieve,” Petersen said.

Lynea Bach earned a master of public health degree with a dual concentration in epidemiology and global communicable diseases. The USF College of Public Health, Departments of Epidemiology and Biostatistics and Global Health served as her academic home. The college offers more than 10 concentrations that lead to MHA, MPH, MSPH, DrPH, and PhD degrees, as well several dual degrees, graduate certificates, and special programs. Most recently, the college launched an online master of public health degree in epidemiology.

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Work begins on USF Health Specialty Care Center in The Villages
Dr. Petersen shares preliminary results of The Villages community health survey

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