This is the first of a two-part webinar series on implications of the Camden Coalition’s RCT results.

In 2020, a major article on “healthcare hotspotting” may have caught your eye. It did ours! The article described findings from a four-year, prospective, 800-person randomized evaluation of the Camden Coalition’s Camden Core Model, an innovative and comprehensive approach to care coordination for patients with very high use of healthcare services. The study found no differences in hospital utilization between patients randomly assigned to the Camden Core Model and those who received usual care. In 2023, the Camden Coalition published two secondary analyses looking at intervention dosage and engagement, and they teamed back up with MIT’s J-PAL to publish a new analysis looking at more intermediate measures of care coordination. These studies help to explain the original RCT’s primary outcomes findings.

On April 5, 9-10am PT, participants joined us for a moderated panel discussion with Kathleen Noonan (Camden Coalition), Kedar Mate (Institute for Healthcare Improvement), and Damon Francis (Alameda Health System) about study implications. Prior to the panel conversation, Amy Finkelstein (MIT) and Aaron Truchil (Camden Coalition) briefly presented study findings.

Want to jump into the conversation? Join us at the Feb 2025 SIREN National Research Meeting: Advancing the Science of Social Care. Learn more at: https://sirenetwork.ucsf.edu/2025-national-research-meeting.

This season of the SIREN Podcast is supported by Kaiser Permanente.

On March 29, 2024, the Harvard Medical School Center for Bioethics convened a session of the Organizational Ethics Consortia Series on social care. Addressing health inequity generally requires attention to the most marginalized patients, whose health is often undermined by social, legal and financial challenges. In response, many health care delivery organizations have begun to collect data about health-related social needs and build organizational capacity to address these needs, either “in-house” or through partnerships with community-based organizations. This gives rise to challenging ethical questions:

• How do we weigh the potential benefits and harms of screening for social needs? And what responsibilities do health care delivery organizations have once they have health-related social need information?
• How should health care delivery organizations allocate their resources between addressing specific patient needs versus thinking more broadly about community-level social determinants?

Presenters:

Monica E. Peek, MD, MPH, MSc, Ellen H. Block Professor of Health Justice, Section of General Internal Medicine; Associate Vice-Chair for Research Faculty Development, Dept of Medicine; Associate Director, Chicago Center for Diabetes Translation Research; Dir. of Research (Assoc. Director), MacLean Center for Clinical Medical Ethics; Executive Medical Director, Community Health Innovation

Marshall Chin, MD, MPH, Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics in the Department of Medicine, University of Chicago; Associate Director, MacLean Center for Clinical Medical Ethics; Co-Director, Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation National Program Office; Co-Chair, CMS Health Care Payment Learning and Action Network Health Equity Advisory Team

Laura Gottlieb, MD, MPH, Co-director, Social Interventions Research and Evaluation Network (SIREN); Professor, Department of Family and Community Medicine, University of California, San Francisco

Moderator:

Lauren A Taylor, PhD, MDiv, Assistant Professor, NYU Grossman School of Medicine

Consortium Co-Chair:

Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Co-Chair, Organizational Ethics Consortium, Harvard Medical School Center for Bioethics; Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital

This consortia series provides a forum for local, national, and international discussion of organizational-level ethical issues and processes to address them, with the aim of cultivating a learning community of practitioners and scholars in this evolving field. We are grateful to the Harvard Medical School Center for Bioethics for making this recording available to the SIREN Podcast audience. To learn more, visit https://bioethics.hms.harvard.edu/

On Monday March 11th participants joined us for a conversation about the new SIREN Social Care Conceptual Model! Emerging evidence suggests that social care programs do not affect health solely by connecting patients with social services and reducing socioeconomic barriers. In a recent paperwe used this evidence to develop a model that depicts the multiple pathways through which social care interventions appear to operate. SIREN co-directors Laura Gottlieb, Danielle Hessler, and Caroline Fichtenberg discussed the new model and its implications for future program investments and evaluations.

Want to jump into the conversation? Join us at the Feb 2025 SIREN National Research Meeting: Advancing the Science of Social Care. Learn more at: https://sirenetwork.ucsf.edu/2025-national-research-meeting.

This season of the SIREN Podcast is supported by Kaiser Permanente.

Although there is no question that adverse social circumstances negatively impact health and healthcare outcomes, it is not clear what the healthcare sector’s role should be in addressing these adverse social factors. On February 28, 2024, SIREN Co-Director Caroline Fichtenberg moderated a lively discussion with three thought-leaders on their perspectives on this important question:

• Seth Berkowitz, MD, MPH, Associate Professor of Medicine, UNC School of Medicine
• Sherry Glied, PhD, MA, Dean and Professor of Public Service, NYU Wagner School of Public Service
• Stacy Lindau, MD, MA, Catherine Lindsay Dobson Professor of Obstetrics and Gynecology and Professor of Medicine, University of Chicago School of Medicine

Want to jump into the conversation? Join us at the Feb 2025 SIREN National Research Meeting: Advancing the Science of Social Care. Learn more at: https://sirenetwork.ucsf.edu/2025-national-research-meeting.

This season of the SIREN Podcast is supported by Kaiser Permanente.

Social care practice and research are often inspired by intentions to advance health equity. However, social care is often planned and executed without a clear recognition of and confrontation with the racism, particularly anti-Black racism, that has led to existing inequities. While the legally-sanctioned enslavement of Black people in the United States was abolished in 1865, many of its aims have been perpetuated through residential segregation, the War on Drugs, and the school-to-prison pipeline, to name a few examples. The SIREN National Research Meeting kicked off on September 15, 2022 with a challenge to our moral imagination: In what ways would social care benefit from the contemporary theory and practice of abolition movements in other sectors?

In this opening plenary session, physician, scholar, and thought leader Rhea Boyd facilitated a discussion with legal professor and ethicist Osagie Obasogie and education scholar Darion Wallace. Discussants explored how abolitionist thinking has been applied in other fields, including the legal system and school-based education and ways to re-imagine types of social care that cultivate healing and racial health equity.

Publications mentioned in this session:

• Becoming Abolitionists, by Derecka Purnell
• Torn Apart, by Dorothy Roberts
• The End of Policing, by Alex Vitale
• Pushout, by Monique W. Morris
• “Just what is afropessimism and what’s it doing in a nice field like education?: Unpacking new contributions to Black educational thought”, by C. Darius Gordon

Health research remains ensconced in a heavily positivist, reductionist, settler-colonial, racial-capitalist “ritual” of knowledge extractivism and expropriation wherein credentialed researchers mine marginalized communities for data to (re)package and (re)distribute as their (our) own knowledge. Much of this work has focused on racial health inequities while, curiously, leaving unexamined matters of positionality, epistemic equity, and procedural justice in the production and curation of knowledges/narratives about racialized subjects (here, perhaps better described as “objects”). In the US, this production is dominated and curated mostly by White scholars—from tenure-track faculty positions, to funding review panels, to editorial boards, to peer-review bodies. In short, the public/medical health knowledge production and curation enterprise is structurally racist, and it is time that we confront the inherent contradictions of a health equity discourse that fails to interrogate the racialized power dynamics that animate it. Moreover, it is time that we remix the canon and forge a future health research capable of doing our health narratives epistemic—and poetic—justice.

In this spirit, social epidemiologist and poet Professor Ryan Petteway draws from social epidemiology, critical, critical race, Black feminist, and decolonizing theory literatures to engage poetry as a site of “radical openness and possibility” (hooks)—an inclusive space of resistance for the production of counternarratives within discourse of health (in)equity.

Dr. Petteway presented two poems at the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care. “Something, Something, Something by Race, 2021” and “RELATIVES//Risks” enact public health critical race praxis (Ford & Airhihenbuwa) principles of “voice” and “disciplinary self-critique” as mode of resistance to counter the epistemic violence of our structurally racist and racial-capitalist health inequities research enterprise. In each poem, Petteway foregrounds considerations of epistemic justice/oppression, data (in)justice, and narrative power—illustrating poetry as praxis to challenge public health’s history of violence against our bodies, its (re)colonization of our lives, and its (a)political silence on matters of epistemic and social injustice. These works suggest the epistemological, ethical, and material imperative of remixing/reimagining health knowledge production, expression, and curation practices to more fully—and unapologetically—"center the margins,” with poetry a necessary format of health equity discourse for resistance and healing.

Poems:

"something something something by race, 2021" Available here.

"RELATIVES//Risks" Available here.

Each year an increasing number of original research articles are published about healthcare-based social care programs and policies. However, relatively few of these studies measure the impact of social care interventions on different racial or ethnic minority groups. More information about differential impacts could help to improve the implementation – and ideally the impacts – of social care. During the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care, physician scientists Crystal Cené and Monica Peek briefly shared findings from a recent review they co-led, funded by the Patient Centered Outcomes Research Institute (PCORI), which involved a collaboration with researchers from both RTI and SIREN. Drs. Peek and Cené in this fireside chat explored what counts as measuring racial health equity (including how they developed a novel framework on “thoughtfulness” and “informativeness”), how much (or little) racial health equity has been explicitly described or measured in the social care interventions evidence base to date, and concrete next steps for researchers and practitioners that can strengthen the racial health equity implications of their work.

Reference:

Cené CW, Viswanathan M, Fichtenberg CM, et al. Racial health equity and social needs interventions: a review of a scoping review. JAMA Netw Open. 2023;6(1):e2250654. doi:10.1001/jamanetworkopen.2022.50654

The final panel at the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care featured four Experts by Experience (Lisa Hamlett, Mike McNear, Ann Reynoso, and Stephanie Walker) as they reflected on their takeaways from the meeting, expressed what was most important to them, and pointed out opportunities for more research and action. The goal of this session was for participants to leave the SIREN National Research Meeting feeling grounded in what mattered to patients with lived experience of racism and socioeconomic challenges, fired up about working in ways that actively promote racial health equity, and focused on what comes next. The panel was moderated by Tanissha Harrell and Rebekah Angove.