Addressing Social Needs
Addressing Social Needs
SUSTAIN: Promoting sustained behavior change and nutrition security in Medicaid-enrolled individuals with Stage 2 Cardiovascular-Kidney-Metabolic Syndrome
SUSTAIN is a health system to community-based intervention intended to improve nutrition security and cardiovascular health through a Food is Medicine (FIM) intervention among people who are enrolled in Medicaid and have Stage 2 cardiovascular-kidney-metabolic syndrome (CKMS). People in this population are disproportionately impacted by poor dietary intake, leading to a high prevalence of CKMS compared to privately insured populations. SUSTAIN hypothesizes that a comprehensive FIM intervention – including medically tailored groceries, intensive behavioral nutrition therapy and addressing social needs – will improve nutrition security and Life’s Essential 8 (LE8) measures.
The Center for Accelerating Suicide Prevention in Real-world Settings (ASPIRES)
This center will hasten the implementation of effective and scalable evidence-based interventions to reduce youth suicide. ASPIRES is focused on integrated programs of research that span the continuum of care from early identification in primary and specialty health care settings, to acute and transitional care, and back into the community as part of routine health care practice. The target population is youth at elevated risk for suicide, the majority of whom are from lower socio-economic bracket households experiencing significant health disparities.
Linking education, produce provision, and community referrals to improve diabetes care (LINK)
People with food insecurity may experience other non-medical, health-related social needs (such as transportation barriers, housing instability, and job insecurity) that decrease their ability to attain glucose control and that affect other health outcomes. Leveraging existing programs and relationships, LINK will test the combined effects of several interventions – a food referral program, a diabetes education intervention, and referrals to address other social needs – on hemoglobin A1c levels in a population of racially and ethnically diverse participants with food insecurity and uncontrolled Type 2 diabetes. Innovative solutions are warranted to combat the long-term sequelae of uncontrolled T2D combined with food insecurity that contribute to the two-fold higher all-cause mortality in T2D that disproportionality impacts people experiencing lower socioeconomic status and who are part of racial and ethnic minority populations.
An Evaluation of the Mid-Ohio Farmacy Project on Hypertension and Related Comorbidities
Using a mixed-methods design, this study seeks to build a multi-stakeholder understanding of the patient, provider, and community factors that support the implementation and use of the Mid-Ohio Farmacy, a primary care clinic-based food referral program, for patients with hypertension, diabetes, and obesity.