School of Nursing Nurse-Led Models of Care Receive Acclaimed Awards
Projects involving Dean Vincent Guilamo-Ramos and Associate Professor Donna Biederman have been designated as Edge Runners from the American Academy of Nursing.
Two Duke University School of Nursing-affiliated nurse-led models of care have been designated as Edge Runners by the American Academy of Nursing — Families Talking Together (FTT) and the Durham Homeless Care Transitions. They join nine other innovative models of care earning this year’s distinction.
Edge Runners is a signature initiative of the Academy that recognizes innovative, nurse-led models of care and interventions that improve health care quality and outcomes, enhance patient satisfaction, and positively impact cost.
“The Academy is proud to designate these unique and timely programs as Edge Runners. The diverse focus of these models highlights the wide range of services, vital support, and team-based approaches that the nursing profession provides,” said Academy President Kenneth White, PhD, AGACNP, ACHPN, FACHE, FAAN, in a press release. “In particular, these models highlight nurses as leaders in innovation for improving care and equity in our health systems.”
Families Talking Together
FTT is an effective parent-based intervention designed to promote adolescent sexual health. Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN, dean of the Duke University School of Nursing, vice chancellor of nursing affairs, Duke University, and founding director, of DUSON’s Center for Latino Adolescent and Family Health (CLAFH), is the primary developer of FTT.
Adolescent sexual and reproductive health (SRH) continues to be a public health and social welfare priority across the United States. Negative SRH outcomes represent a major source of morbidity among adolescents, both historically and presently, and expenditures associated with teen pregnancies, sexually transmitted infections (STIs), and HIV cost U.S. taxpayers billions of dollars annually.
Although significant progress has been made in reducing teen pregnancy rates in the U.S., the rates remain significantly higher than in other well-resourced countries. Annually, there are approximately 160,000 children born to mothers younger than 20 years old. Though they represent only a quarter of the sexually active population, youth aged 15 to 24 account for nearly half of the more than 26 million annual new cases of STIs; youth aged 13 to 24 account for approximately 20 percent of estimated new HIV infections in the U.S.
Statistics also show a disproportional impact among Latino and Black adolescents, who account for approximately half of reported STI cases and 8 in 10 new HIV diagnoses among adolescents under age 20. These inequities demonstrate a pressing need for innovative and efficacious models of care to promote SRH among adolescents in historically underserved communities.
FTT is specifically designed to address this need. While interventions designed to improve adolescent SRH outcomes have traditionally focused directly on adolescents through school-based curricula, social media campaigns, and community-based programs, FTT focuses on parents as the primary influence in prevention of adolescent sexual risk behavior, unplanned pregnancies, and STIs.
FTT consists of face-to-face intervention sessions focused on supporting parent-adolescent communication about sexual health, parental monitoring and involvement; printed FTT materials for parents and for adolescents; and homework exercises assigned to parents, such as practicing communication about sexual health with their adolescent. Several large-scale randomized controlled trials have shown FTT to be efficacious in promoting positive adolescent sexual health outcomes that reduce the risk of unplanned teen pregnancy, STIs, and HIV, including by delaying sexual debut, increasing adolescent condom use, and reducing the frequency of adolescent sexual activity.
FTT is currently being implemented across the U.S. in a variety of settings, including health clinics, schools, community-based organizations, and households, and can be delivered to parents individually and in group sessions. The FTT Clinic adaptation specifically designed for delivery in adolescent primary care settings formally integrates health care providers (HCPs) into the FTT model, thereby adopting a triadic (HCP-parent-adolescent partnership) approach to SRH promotion. FTT is available in culturally tailored versions for Latino and Black families, including a version in Spanish.
“While the Edge Runners program recognizes Duke and FTT’s innovative work in transforming models of health care, they also collectively recognize the work of all nurses who transform health and improve patient outcomes,” Ramos said.
Durham Homeless Care Transitions
Donna Biederman, DrPH, MN, RN, FAAN, associate professor, along with Julia Gamble, MPH, NP, of Duke Outpatient Clinic, and Sally Wilson, MDiv, of Project Access of Durham County, founded the Durham Homeless Care Transitions (DHCT) program. Biederman serves as the evaluation and education director, with Gamble as the clinical director and Wilson as the administrative director. DHCT, housed within Project Access of Durham County, facilitates transitions and strengthens connections to care for people experiencing homelessness in Durham County in order to decrease or avoid preventable adverse outcomes and improve quality of life.
People experiencing homelessness have high rates of physical and mental illness, increased mortality, and often repeated emergency department visits and hospitalizations. Homelessness exacerbates health problems, complicates treatment, and disrupts continuity of care. Frequently, people experiencing homelessness are discharged from hospitals with care instructions that are difficult to follow while living on the streets or in shelters.
Since hospitals are often reluctant to knowingly release patients into homelessness, some patients remain hospitalized beyond their expected date of discharge, thus increasing costs significantly. The Durham Homeless Care Transitions (DHCT) model addresses the disconnect between health and homelessness systems by providing a place for healing and an opportunity to stabilize housing, health benefits, and relationships with supportive services.
DHCT provides short-term housing to allow individuals to recover from illness or injury in a safe and clean environment. The program also provides health-sustaining services including medication reconciliation, connection to primary and specialty care, connection to mental health substance use disorder treatment, facilitation of community connections and income opportunities, and housing. DHCT is the first health organization in Durham to obtain funding from the local health department for medical respite housing to allow people experiencing homelessness a safe environment for healing and recovery from illness and injury.
The program received 576 referrals between July 1, 2016 (inception) and June 30, 2020, 497 of which were primarily from the Duke University Health System. Of those referrals, 125 participants were enrolled. An analysis found that more than 90 percent of enrollees obtained or maintained primary care medical home and received specialty care when indicated. More than 75 percent had improved access to transportation, had improved their housing situation, and had reestablished connections with family or friends.
Program outcomes did not differ based on having a diagnosed substance use disorder or by race. Program participants had fewer hospital charges the year after referral than those persons who were referred but not enrolled, which indicates cost savings.
After DHCT involvement, more previously homeless people find housing and achieve a number of positive outcomes, which benefits the entire community.
“I am proud to be involved with the DHCT program and to work with such an incredibly passionate team,” Biederman said. “DHCT helps to stabilize health and rebuild lives of some of the most marginalized members of our community. The Edge Runner designation supports the importance of nursing ingenuity in developing practical solutions to real world problems.”