UMC clinic helps children and families navigate foster care

By Amelia Neumeister

As a foster parent, Dr. Brian Gannon knows that children and families in foster care can face challenges navigating medical care, paperwork, state agencies, schools and other aspects of case management. He has eight children—six of which were adopted. And four of those adoptions were through foster placements.

Physicians can legally request information on foster children, says Gannon, an assistant professor of Pediatrics at the College of Community Health Sciences and a pediatrician at University Medical Center, which the College operates. So he wanted to streamline the flow of information, help to gather all of a foster child’s relevant information in one place and provide them access to health care and resources. To do that, he started the FRESH Start Clinic at UMC.

FRESH stands for Fostering Resilience through Education, Support and Healthy choices. Since opening its doors in July 2016 at UMC, the FRESH Start Clinic provides care for children in foster care and for families and professionals who support them. The clinic is held on Thursday afternoons.

The goal of the clinic is to advocate for the specialized needs of children in foster care and to change the way children in foster care are obtaining medical care, says Gannon.

He and his team of nurses, a receptionist and social work students wanted to create a clinic for foster children based off the Patient-Centered Medical Home, a model of health care that is patient-centered, accessible, continuous, comprehensive and coordinated, and that focuses on quality and safety.

The clinic works in partnership with the Tuscaloosa County Department of Human Resources, and includes all members of the foster child’s team in health care decisions as appropriate, including the foster parents, birth parents, DHR caseworkers and investigators, noncustodial family members, residential home staff and mental health providers.

“There are different [foster care clinic] models across the country,” says Gannon. “A lot of the larger cities will have foster care clinics that are much more involved than what we are starting right now. We’d like to work into that. The goal would be to have mental health, development and social work all on-site as part of the process, because these kids are known to have more needs than your average pediatric population.”

Gannon had the idea for the FRESH Start Clinic after studying similar clinics in urban areas where foster care is more commonly found, he says. By partnering with UMC, he hopes the clinic can serve as a state-wide model and can bring access to rural areas where foster homes are less common.

Gannon says he drew from his experiences as a both a doctor and a foster parent to help plan the clinic.

“There are so many little things that make it difficult as a foster parent to get the care   that the child needs,” he says. “So, my goal was to make all that easier.”

Foster parents can call to set up an appointment in the clinic as soon as the child is placed in their care, Gannon says. They can be seen within a week. At the first visit, the child’s medical, social and psychiatric history will be collected and requests will be submitted for any  additional records needed. Gathering this information helps to streamlines the process of medical care for children in the foster system, Gannon says.

Once additional records are obtained, another visit will be scheduled. The clinic will assess the child’s adjustment to his or her foster placement and will look into any behavioral concerns a foster parent might have. A trauma assessment will also be performed to help families address needs of children who have suffered from abuse or neglect.

From there, the FRESH Start Clinic can provide primary care for children in state custody or can serve as a consultant to their chosen doctor. The clinic also stays in touch with DHR and is notified of any changes in the child’s placement or goals.

The FRESH Start Clinic knows how to gather background information and navigate paperwork that many foster parents simply don’t have time for, Gannon says. If the parents are not dealing with paperwork, they will have less difficulty making appointments, he says.

“I’ve gotten a lot of positive feedback from the foster parents that I’ve worked with as well as the caseworkers, because the DHR caseworkers will have dozens of children on their caseload,” Gannon says. “Often they’ve had more negative experiences than foster parents have as far as interacting with doctors’ offices and things being challenging and not running smoothly, and they’ve been very pleased with the efficiency that we’ve been able to provide to them.”

The long-term goal for the clinic is to create an infrastructure to bring the clinic to a wider audience.

“I would love for this to be a model for the state and have interested doctors all over the state who have extra training and special interests,” he says. “And we could have case managers that make sure all these children get what they need. I think over time that would be a really good goal. But we are starting small—starting with one county.”

Sleep problems, adapted athletics topics at Mini Med School

More than 50 percent of adults in the US experience intermittent sleep disturbances, and only 30 percent of adults report regularly getting enough sleep.

Chronically tired individuals face increased risk of illnesses and an overall lower quality of life, says Dr. Katie Gates, assistant professor of Family Medicine at The University of Alabama College of Community Health Sciences.

Gates gave her talk, “Sleep Problems,” on Jan. 26 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program. On Jan. 19, Dr. Jimmy Robinson, endowed chair of Sports Medicine at CCHS, gave his talk, “Adapted Athletics.”

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Gates broke down sleep disorders into four categories: Those who can’t sleep includes sufferers of insomnia and restless leg syndrome. Those who won’t sleep likely have delayed sleep phase syndrome. Those with excessive daytime sleepiness may suffer from narcolepsy or obstructive sleep apnea. And those with increased movements during sleep include REM sleep behavior disorder sufferers, or those with periodic limb movement.

Three criteria must be met for a diagnosis of insomnia: First, the patient must complain of difficulty sleeping, difficulty staying asleep or waking up too early. Second, the sleep difficulty must occur despite adequate opportunity and circumstances to sleep. And third, the lack of sleep must negatively affect daytime function.

“Insomnia is a very common complaint, and it does increase with age, unfortunately,” Gates said. Women report insomnia 50 percent more often than men. It can be treated with cognitive behavior therapy or with medications.

Delayed sleep phase is a circadian rhythm disorder, meaning “the brain has gotten off its track,” said Gates. It’s characterized by the person going to bed very late and waking up late.

“This can be genetic or socially reinforced,” she said.

Obstructive sleep apnea is the most common sleep breathing disorder, and it affects 20 to 30 percent of males and 10 to 15 percent of females.

“With my patient population, it seems higher than this,” Gates said.

Risk factors for sleep apnea include age, obesity, craniofacial abnormalities and smoking. Continuous positive airway pressure, or a CPAP machine, is recommended treatment.

In some instances of diagnosing a sleep disorder, a physician may order a polysomnography, or a sleep study.

Cognitive behavioral therapy can be a treatment for some sleep disorders, said Gates, and a therapist may focus on changing false beliefs and attitudes about sleep. One of these might be that everyone needs at least eight hours of sleep, she said.

Music therapy can be another way to treat a lack of sleep.

“Choose music you are familiar with,” Gates said.

She said the music should have a slow and stable rhythm with low-frequency tones and relaxing melodies.

“Try out different genres, like classical or acoustic, to find what works for you.”

View a WVUA report on Gates’ lecture here:

Robinson, in his talk about adapted athletics, said the number of adapted athletes is rising. In the 1960 Summer Paralympic Games in Rome, 400 athletes came from 23 countries. In 2016, 4,316 athletes came to Rio from 159 countries.

The International Paralympic Committee assigns points to athletes based on their impairments. The classification systems differ by sport and are developed to govern the sport. Players are allocated points based on an evaluation by the International Paralympic Committee.

A lower score indicates a more severe activity limitation than a higher score. A team is not allowed to have more than a certain maximum sum of points on the field of play at the same time in order to ensure equal competition with the opposing team.

As time progresses, a disability may get worse, so a player can be reviewed again.

“Disabilities are evolving,” said Robinson. “It’s important to have this avenue to challenge their disability, especially if it’s progressive.”

Robinson, also spoke about the Alabama Adapted Athletics Program, which was started in 2003 by husband and wife Brent Hardin and Margaret Stran. Though the program received an initial funding of only $5,000 from the Christopher Reeve Foundation, it now operates off an annual budget of $450,000, offers six full scholarships and supports five sports: women’s and men’s basketball, tennis, rowing and golf.

Repealing without replacing Affordable Care Act will hurt rural hospitals, dean says in news report

As the Senate takes steps to fast track getting rid of the Affordable Care Act, Dr. Richard Streiffer, dean of The Univeristy of Alabama College of Community Health Sciences, says repealing the ACA without replacing it will hurt many rural hospitals struggling to stay open, according to a Fox 6 WBRC report.

Even a small change in coverage could even force some of these rural hospitals to close, Streiffer said in the report.

“I don’t believe that anyone, Republican or Democrat, is opposed to trying to improve it, but the rhetoric of ‘let’s get rid of it’ without knowing where we’re going to go and how we’re going to improve it is concerning,” Streiffer said in the report.

Streiffer says the United States should learn from the rest of the world and focus on regular check-ups and the prevention of illnesses in a WVUA report.

Streiffer says that when people have a primary care physician that they see yearly, chronic illnesses are less expensive to control and potential illnesses are caught and dealt with early, which means patients stay healthier, according to WVUA.

View both reports here:

Dean speaks to WVUA, CBS 42 on spike in flu cases

Alabama has seen a spike in the number of flu cases reported, and Dr. Richard Streiffer, dean of The University of Alabama College of Community Health Sciences, says it isn’t too late to get a flu shot, according to reports from CBS 42 WIAT and WVUA.

Alabama joins Arizona and Georgia as the three states in the U.S. with the highest number of flu cases, according to WVUA.

Streiffer encourages anyone who hasn’t had a flu shot to go get one, according to CBS 42.

“Most insurances will pay for it, but if you don’t have insurance … whatever it costs is a pretty good investment as opposed to the risk of an expensive complication and hospitalization and loss of time from work,” Streiffer said to CBS 42.

Streiffer told WVUA that he is unsure why there is an increase in flu cases in Alabama.

“But it doesn’t appear that the flu that is in the community is anymore severe this year than in prior years,” Streiffer said in the report. “The flu vaccine should be protective to the majority of the population.”

Streiffer says it is not too late to get a flu shot, according to the report.

View both reports:

Resident speaks about hypertension at Mini Medical School

One in three adults in America has hypertension, according to the US Centers for Disease Control and Prevention. However, hypertension can be treated with lifestyle modifications and medications, said Dr. Brittney Anderson, a third-year resident physician at The University of Alabama Family Medicine Residency.

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Anderson provided a presentation on hypertension on Nov. 3 as part of the Mini Medical School program conducted by the UA College of Community Health Sciences in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Anderson started her presentation by illustrating hypertension, or high blood pressure.

“Think of it the way you would think of pressure from a water hose. What would alter that pressure? The size of the hose, and what the fluid in the hose is having to overcome,” she said.

Cholesterol buildup, for instance, can inhibit blood from moving at a normal pressure through blood vessels, she said.

Diagnosing hypertension starts with an accurate blood pressure reading, which can sometimes be challenging due to faulty or inaccurate measuring cuffs or other factors with the patient and environment, Anderson said.

She offered tips for an accurate blood pressure reading. First, be at your calmest—don’t worry about engaging in conversation. Second, support your back and feet, and keep your legs uncrossed. Third, empty your bladder so that it doesn’t affect your body’s stress level. And fourth, keep your arm supported at your heart level and make sure the cuff is over your bare arm (and not your clothes).

If patients are using an automated cuff for measuring blood pressure at home, the physician may ask that it be brought in for the exam to compare, Anderson said.

Normal blood pressure less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Prehypertension is between 120-139 mm Hg systolic and 80-89 mm Hg diastolic. When the systolic reads 140-159 mm Hg, and diastolic reads 90-99 mm Hg, the patient may be diagnosed as Hypertension Stage 1. Hypertension Stage 2 is when the systolic is 160 mm Hg or higher, and the diastolic reading is 100 mm Hg or higher. A Hypertensive Crisis, which requires emergency intervention, is when the systolic is read at higher than 180 mm Hg and higher than 110 mm Hg diastolic.

If a patient has an elevated blood pressure reading of greater than or equal to 180/110 mm Hg, then the diagnosis is clearly hypertension, Anderson says.

“But if not, then we have to do some more digging,” she said. It could be that the patient suffers from “white coat hypertension,” which means the patient is nervous simply from being in the doctor’s office. Patients in that case would be asked to wear an ambulatory blood pressure cuff 24 hours a day for a few days for an accurate measurement.

Or, if a patient is diabetic, it causes damage to blood vessels. That means that if a reading is greater than 130/80 mm Hg and the patient is diabetic, then it is a diagnosis of hypertension.

There are risk factors that lead to hypertension, Anderson said. Primary risk factors include age, obesity, family history, race, diet and exercise and alcohol use. Secondary risk factors include medicines (like decongestants, birth control and steroids), illicit drugs, sleep apnea and renal disease.

Hypertension can be treated through lifestyle modifications, like weight loss, adopting an eating plan, adding physical activity and reducing alcohol and sodium intake, Anderson said. There are many medications, too. Thiazides, ACE inhibitors and calcium channel blockers are some of the most common.

In Remembrance: Dr. Ernest Cole Brock, Jr.

Dr. Ernest Cole Brock, Jr., a longtime physician for the Alabama Crimson Tide and the creator of a sports medicine lecture series for the College of Community Health Sciences, passed away on Nov. 5 at his home in Tuscaloosa. He was 91.

Dr. Ernest Cole Brock, Jr., with his wife, Hannah Brock

Dr. Ernest Cole Brock, Jr., with his wife, Hannah Brock

Brock was an orthopedic surgeon who practiced in Tuscaloosa for many years, in addition to serving as a physician for the Alabama football team.

He and his wife, Hannah Brock, created The Ernest Cole Brock III Endowment for Continuing Medical Education at the College to support a lecture series on treating concussions and other athletic injuries. They created the fund to honor the memory of their son Ernest Cole Brock III who died in 1999 at the age of 36. The inaugural lecture was held in January 2013.

Brock grew up in Fairfield, Alabama. In 1943, at age 18, he entered the United States Air Force and fought as a gunner in 32 combat missions in Guam and Japan. After he returned to the US, he accepted a scholarship to play football at Wake Forest University in North Carolina.

Brock had plans to be a football coach and a science teacher, but after he suffered a career-ending leg injury during his second year of college, he decided to pursue medical school. He received his medical degree from Wake Forest University and then completed his residency in orthopedic surgery at University Hospital in Birmingham (now UAB Hospital).

After residency, he joined the hospital’s staff and served as the physician for high school football players at Legion Field.

“[Orthopedic surgery] is a good field to be in,” Brock said to the College in a 2014 interview. “Most of the patients are young and can heal.”

Brock later formed an orthopedic surgery and sports medicine practice in Tuscaloosa and began traveling as a surgeon with the Crimson Tide and head coach Paul “Bear” Bryant.

“I enjoyed working for the team, and Coach Bryant was nice to work for,” Brock said.

For 25 years, Brock was the team orthopedist for Alabama. He also served as an orthopedic preceptor for the College, training residents and medical students on the diagnosis and treatment of musculoskeletal conditions. He practiced in Tuscaloosa until he retired in 1992.

Dr. James Robinson, chair of Sports Medicine, team physician for Alabama and an alumnus of the College’s Residency, said Brock was a mentor to him when he was training.

“Dr. Brock’s legacy to CCHS will be maintained by the annual lecture series that bears his name and by the continuation of the physician care of the athletic department through the deShazo Sports Medicine Clinic,” he said.

Brock’s funeral was held Nov. 9 at Calvary Baptist Church in Tuscaloosa.

CCHS hosts two Cuban physicians, discusses health care topics as part of UA Cuba Week

Parkinsonism, ADHD in Grandchildren and Geriatric Depression topics in fall semester of Mini Med School

Mini Medical School is back in session this fall semester. The University of Alabama College of Community Health Sciences kicked off its second semester of the lecture series for UA’s OLLI program that has been put on by faculty and resident physicians at CCHS.

Mini Medical School lets adults and community  learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Parkinsonism — Dr. Catherine Ikard

Many people think of Parkinson’s disease as a single disorder, but it is actually more complicated than that, said Dr. Catherine Ikard, a neurologist at University Medical Center and assistant professor of Internal Medicine and Psychiatry and Behavioral Health for the College.

Parkinsonism is a syndrome characterized by decreased movement and is associated with tremors and a loss of balance, Ikard said at her lecture, titled “Parkinsonism and Parkinson’s Disease,” which she presented as part of the Mini Medical School series on Sept. 15.

Parkinsonism can appear in an array of disorders, some even as a result of repeated head trauma or medication, but the most common one—the one most people refer to when they think of Parkinson’s Disease—is Idiopathic Parkinson’s Disease.

Idiopathic Parkinson’s Disease is the progressive loss of dopamine-producing cells in the brain. The disease is slow and degenerative. “We don’t know why this happens,” Ikard said.

There are motor symptoms, which include shaking, smaller and slower movements, becoming stiff and losing balance more easily. Motor symptoms usually start on one side of the body. Tremors can worsen when the patient is at rest, and they are suppressible by concentration.

Non-motor symptoms include affective disorders, such as depression, orthostatic hypotension (when blood pressure falls significantly when standing up too quickly), memory impairment, fatigue, constipation and sleep disturbances.

There is no test for Idiopathic Parkinson’s Disease, Ikard said. The diagnosis is clinical. “We often have to watch a tremor over time—months, sometimes years,” Ikard said.

Medication and therapy can help treat symptoms, Ikard said. The most common medication is Levodopa, and physical and speech therapy can help improve lifestyle. “I cannot emphasize enough how important therapy is for patients with Parkinsonism,” said Ikard. Exercise improves symptoms, too, she said.

There are clues that the disorder might not be traditional Idiopathic Parkinson’s Disease, Ikard said.

Some of these include: rapid progression of the disease, absence of tremors, frequent falls early in the disease, abnormal eye movement and poor response to Levodopa. If that is the case, the Parkinsonism could be tied to another disorder.

Grandchildren and ADHD — Dr. Brian Gannon

Children are very active from the ages of 2 to 5, but that busyness should decrease over time, said Dr. Brian Gannon, a pediatrician at University Medical Center and an assistant professor of Pediatrics for the College.

But as children get older and if they are easily distracted, can’t stick with a task for a reasonable amount of time and their activity level is not appropriate for their age, they could suffer from ADHD, or attention deficit hyperactivity disorder.

“ADHD is defined as an activity level that is inappropriate for age, that interferes with school work, that causes trouble in dealing with adults,” Gannon said during a lecture on Sept. 22, titled “Grandparents and ADHD.”

Gannon said about 5 percent of the general population in the US qualifies for an ADHD diagnosis. He said sometimes the markers of what appears to be ADHD are actually caused by other medical issues. He said hearing, vision and speech problems can cause some of the same symptoms of ADHD, as can developmental delays, autism and sensory processing disorder.

“We want to look at medical issues because they may cause similar issues to ADHD,” Gannon said.

A child’s living situation – unstable home environment, varying and inconsistent rules and food insecurity – is also a factor. “My job as a physician is to advocate for the child and help parents problem solve. We don’t want to just throw medicine at a child.”

Gannon said medication can help and should be part of efforts to manage ADHD, but is only part of the answer. “Children still need to follow the rules, and do their work. With medication, they can do it without your help.”

Geriatric Depression — Dr. John Burkhardt

Older adults are at risk for depression. One reason: The more medical burdens one has, the higher the risk of depression, said Dr. John Burkhardt, a clinical psychologist with University Medical Center-Northport.

“Chronic pain conditions can be managed, but you never get a break from them. Heart problems can precipitate depressive episodes, and then you have to eat differently, go to physical therapy and deal with a chronic condition. What does that do to your mood?” said Burkhardt, also an assistant professor of Psychiatry and Behavioral medicine for UA’s College of Community Health Sciences, which operates UMC-Northport.

His remarks came in a lecture titled “Geriatric Depression” that he provided on Sept. 29 as part of the Mini Medical School lecture series.

Burkhardt said changes in previous functioning, pain and sleep disruption, significant weight gain or loss, a loss of interest in activities, a sad and depressed mood, a feeling of being a burden – and if those conditions and feelings go on for two weeks or more – could signal possible depression. “A lot of people go through sad times. But when it starts to impact your functioning, that could be depression.”

With older couples, depression can also be “contagious,” Burkhardt said. “If one spouse is depressed, the other spouse is at an increased risk of depression.”

Late-life depression, which happens after the age of 60, can carry added risk because it can transition to dementia, Burkhardt said.

He stressed that depression needs to be treated, particularly in the elderly, who might not seek care because of an associated perceived stigma. He noted that suicide is the 17th leading cause of death in those aged 65 and older.

“When you’re depressed, you’re not good at coping with your physical conditions. Depression impacts the person who is experiencing it, and their families. Who wants to visit people when they aren’t happy? Then they’re alone.”

Burkhardt recommended that people watch for changes in behavior, thoughts, appetite, sleep and whether they lose interest in activities once important to them. “See a provider if you suspect depression. Don’t let stigma keep you from getting help. Don’t isolate yourself. Be social, stay active and have a daily structure.”

 

Flu Shot Campaign Begins

The annual University of Alabama flu shot campaign, an effort by the University to protect students, faculty and staff from the flu, kicked off Sept. 7. Flu shots will be provided during the months of September, October and November at locations across campus, including the Quad, University buildings and student residence halls. The shots are free and no insurance is required. The goal of the flu shot campaign, which is led by UA’s College of Community Health Sciences, is to make getting a flu shot as easy and convenient as possible. Last year, more than 8,000 vaccinations were given.

U.S. News: 10 Gross Things You Should Stop Doing in College

Take a look at this U.S. News slideshow with several quotes from Dr. Thomas Weida, Associate Dean of Clinical Affairs at CCHS.