Poster Session: Retinal Changes Associated with Football-Related Concussions and Head Impacts.

This pilot study explored the sensitivity of retinal markers to CNS sequelae of concussive and subconcussive head hits. Three groups of college athletes were assessed at pre-season, post-season and 4-months later: Football players with a concussion history (FB+C) (n = 9), players without a concussion history (FB-C) (n = 11), and non-contact athletes (swimmers, track & field; Non-FB) (n = 12). Measures included optical coherence tomography (OCT), OCT angiography, electroretinography, and visual acuity testing. Head impacts during the season were tracked with in-helmet accelerometers. At pre-season, FB+C demonstrated thicker macular central subfields (CSF) (Hedge's g (effect size) = 1.05, p = 0.02) and retinal nerve fiber layers (RNFL) (g = 0.81, p = 0.08), relative to other athletes. Differences in CSF thickness were also observed at post-season and follow-up (gs > 1.00, ps < 0.04), reflecting their non-short-term nature. RNFL was thicker in FB+C at post-season (g = 0.93, p = 0.06) but not later. Total head impacts during the season correlated with increases in CSF thickness from baseline to follow-up only (r = -0.53, p = 0.02). High intensity head impacts in particular correlated with increases in cup-to-disc ratio at post-season and follow-up (rs > 0.53, ps < 0.03). These data suggest that concussion history is associated with retinal changes that are not short-term, and that severe head impacts are associated with acute changes whose duration is not yet known.

A Biopsychosocial and Interprofessional Approach to the Treatment of Family and Intimate Partner Violence: It Takes a Village.

Family and intimate partner violence and abuse (FIPV) is a critical public health problem with repercussions for mental and physical health. FIPV exposure also is associated with social difficulties such as low socioeconomic status, legal issues, poor access to employment and education, housing instability, and difficulty meeting other basic needs. As a biopsychosocial problem, one discipline alone cannot adequately address FIPV. While individuals who experience FIPV traditionally seek respite, care and safety through domestic violence shelters, social services or courts, they also often present to health care settings. Building on the medical-legal partnership model with critical input from a community advisory board of individuals with lived experiences of FIPV, we implemented a person-centered approach in the health care context to cohesively integrate legal, safety, social, psychological and physical health needs and concerns. The purpose of this paper is to describe the Healing through Health, Education, Advocacy and Law (HEAL) Collaborative for individuals who have experienced psychological abuse, physical abuse, sexual abuse, or neglect related to child maltreatment, intimate partner violence, and/or elder abuse, and review our real-world challenges and successes. We describe our interprofessional team collaboration and our pragmatic biopsychosocial framework for bringing together: professional and stakeholder perspectives; psychological, medical, legal, and personal perspectives; and clinical, evidence-based, and educational perspectives. There is no doubt that creating a program with biopsychosocial components like HEAL requires professionals appreciating each other's contributions and the need to begin working from a common goal. Furthermore, such a program could not be successful without the contributions of individuals with the lived experience we seek to treat, coupled with the external health care clinicians' input. We describe lessons learned to date in an effort to ease the burden for those seeking to implement such a program. Lessons include HEAL's more recent clinical adaptions to serve patients both in-person and via telehealth in the wake of COVID-19.

Demonstrated health care cost savings for women: findings from a community health worker intervention designed to address depression and unmet social needs.

To evaluate the impact of a community health worker intervention (CHW) (referred to as Personalized Support for Progress (PSP)) on all-cause health care utilization and cost of care compared with Enhanced Screening and Referral (ESR) among women with depression. A total of 223 patients (111 in PSP and 112 in ESR randomly assigned) from three women's health clinics with elevated depressive symptoms were enrolled in the study. Their electronic health records were queried to extract all-cause health care encounters along with the corresponding billing information 12 months before and after the intervention, as well as during the first 4-month intervention period. The health care encounters were then grouped into three mutually exclusive categories: high-cost (> US$1000 per encounter), medium-cost (US$201-$999), and low-cost (≤ US$200). A difference-in-difference analysis of mean total charge per patient between PSP and ESR was used to assess cost differences between treatment groups. The results suggest the PSP group was associated with a higher total cost of care at the baseline; taking this baseline difference into account, the PSP group was associated with lower mean total charge amounts (p = 0.008) as well as a reduction in the frequency of high-cost encounters (p < 0.001) relative to the ESR group during the post-intervention period. Patient-centered interventions that address unmet social needs in a high-cost population via CHW may be a cost-effective approach to improve quality of care and patient outcomes.

A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral.

Background: Despite recent widespread acceptance that unmet social needs are critically relevant to health, limited guidance exists about how best to address them in the context of women's health care delivery. We aimed to evaluate two interventions: enhanced screening and referral (ESR), a screening intervention with facilitated referral and follow-up calls, and personalized support for progress (PSP), a community health worker intervention tailored to women's priorities. Materials and Methods: Women >18 years were screened for presence of elevated depressive symptoms in three women's health clinics serving primarily Medicaid-eligible patients. If eligible and interested, we enrolled and randomized women to ESR or PSP. Pre- and postintervention assessments were conducted. Primary outcomes were satisfaction, depression, and quality of life (QOL). Planned analyses of subgroup differences were also explored. Results: A total of 235 participants were randomized; 54% identified as African American, 19% as White, and 15% as Latina. Participant mean age was 30 years; 77% reported annual incomes below US $20,000/year; and 30% were pregnant at enrollment. Participants in both arms found the interventions satisfactory and improved for depression (p < 0.001). There were no differences between groups for the primary outcomes. Subgroups reporting greater improvement in QOL in PSP compared with ESR included participants who at baseline reported anxiety (p = 0.05), lack of access to depression treatment (p = 0.02), pain (p = 0.04), and intimate partner violence (p = 0.02). Conclusions: Clinics serving women with unmet social needs may benefit from offering PSP or ESR. Distinguishing how best to use these interventions in practice is the next step.

Resilience in the midst of chaos: Socioecological model applied to women with depressive symptoms and socioeconomic disadvantage.

Socioeconomic disadvantage is extremely common among women with depressive symptoms presenting for women's health care. While social stressors related to socioeconomic disadvantage can contribute to depression, health care tends to focus on patients' symptoms in isolation of context. Health care providers may be more effective by addressing issues related to socioeconomic disadvantage. It is imperative to identify common challenges related to socioeconomic disadvantage, as well as sources of resilience. In this qualitative study, we interviewed 20 women's health patients experiencing depressive symptoms and socioeconomic disadvantage about their views of their mental health, the impact of social stressors, and their resources and skills. A Consensual Qualitative Research approach was used to identify domains consisting of challenges and resiliencies. We applied the socioecological model when coding the data and identified cross-cutting themes of chaos and distress, as well as resilience. These findings suggest the importance of incorporating context in the health care of women with depression and socioeconomic disadvantage.

Using patient engagement in the design and rationale of a trial for women with depression in obstetrics and gynecology practices.

INTRODUCTION: Significant health disparities exist among socioeconomically disadvantaged women, who experience elevated rates of depression and increased risk for poor depression treatment engagement and outcomes. We aimed to use stakeholder input to develop innovative methods for a comparative effectiveness trial to address the needs of socioeconomically disadvantaged women with depression in women's health practices. METHODS: Using a community advisory board, focus groups, and individual patient input, we determined the feasibility and acceptability of an electronic psychosocial screening and referral tool; developed and finalized a prioritization tool for women with depression; and piloted the prioritization tool. Two intervention approaches, enhanced screening and referral using an electronic psychosocial screening, and mentoring using the prioritization tool, were developed as intervention options for socioeconomically disadvantaged women attending women's health practices. We describe the developmental steps and the final design for the comparative effectiveness trial evaluating both intervention approaches. CONCLUSIONS: Stakeholder input allowed us to develop an acceptable clinical trial of two patient-centered interventions with patient-driven outcomes.