April 13, 2022
To move the needle on our country’s Wicked Problems, a new approach to leadership from and with communities is needed.
A Wicked Problem has no defined rules of play or clear end points; rather it is an ever-evolving, ever-lasting challenge. Despite major advances in medicine and healthcare, Wicked Problems persist and particularly for marginalized groups. Clinical Scholars Fellows work in interdisciplinary teams to tackle complex issues through applying equity centered leadership. From Asheville to Seattle, there are 34 healthcare providers across 8 teams in the 2020-2023 Cohort. These counselors, nurses and nurse midwives, pharmacists, physicians, psychologists, social workers, and veterinarians and veterinary nurses are leading the way to a Culture of Health.
- Community-Based Doulas – Lavish to Essential Support
- Community to Fight Diabetes Among Latinos
- Harnessing the Human-Animal Bond to Improve Health
- emPOWER NOLA School & Cultural Leaders to Address Childhood Trauma
- Breaking Silences in the Model Minority
- Cross-Sector Collaboration for Patients Living Unhoused
- Improving Mental Health in Veterinary Workers
- Wake County Familiar Faces
Wicked Problem: Highest Maternal Mortality Rates in Industrialized World
The US now claims the highest maternal mortality rates (MMR) in the industrialized world, with African American women having MMRs 3-4x higher than their White peers regardless of education, income, or other socioeconomic indicators. As clinical practitioners providing safety-net obstetrical and well-woman healthcare to the women of Western North Carolina, we acknowledge structural and institutional racism as the root cause for inequities in maternal and infant mortality rates.
Our Wicked Problem Impact Project seeks to eliminate these infant and maternal mortality inequities in our region, across the state, and beyond by solidifying a framework for racial health equity, supporting Sistas Caring 4 Sistas, an already established community-based doula program, and through replicating these services in other interested and engaged communities eager to address health disparities and improve maternal and infant outcomes.
Wicked Problem: Diabetes Affects 1 in 2 Latinx Individuals
Diabetes will affect 1 in 2 Latinx individuals in their lifetime and is the #1 cause of kidney disease among Latinx communities in the US. Latinx adults with diabetes experience a 1.3-fold faster progression of chronic kidney disease to kidney failure compared to non-Latinx white individuals. To address the “wicked problem” of diabetic kidney disease in Latinx adults, the Denver team aims to:
- Strengthen community resources and community-health system ties
- Increase awareness of diabetic kidney disease
Their project utilizes evidence-based strategies including clinically recommended screening tests for kidney disease, a community-based diabetes self-management education (DSME) program, and a wide-reaching culturally tailored health awareness campaign. The interdisciplinary team is composed of experts in diabetes and kidney disease at Denver Health who share a commitment to culturally responsive care, working in partnership with the Latinx-serving community organization Vuela for Health and the National Kidney Foundation. This project will establish the foundational partnerships and infrastructure needed to sustain improved care for the Latinx community and others with diabetes.
Wicked Problem: Growing Unhoused Population’s Poor Health
Unsheltered individuals face significant barriers to accessing healthcare which leaves them vulnerable to poor outcomes including increased morbidity and mortality. Seattle and King County have relatively high rates of individuals living homeless compared to other major cities, and these rates of homelessness have significantly increased as a result of the COVID pandemic.
Seattle Veterinary Outreach aims to create a culture of health by:
- Providing basic healthcare in locations convenient for the unsheltered and low-income
- Building trust by providing care for not only people but their beloved pets
- Partnering with individuals with whom individuals living homeless already have relationships of trust
Care is delivered from the back of a refurbished ambulance and in an outreach backpack model, allowing a nimble, boots-on-the-ground approach to improving the culture of health for our unhoused neighbors.
Wicked Problem: 1 in 5 Kids Have Experienced Trauma
The City of New Orleans surveyed 5,000 youth between 2012 and 2018 and found a startling prevalence of youth living through profoundly traumatic events. This reality calls for the development of interventions that will heal and partnerships that promote trauma-informed spaces. Strongly cohesive naturally occurring social networks (NOSN), that have decades of history in the various communities of Orleans Parish (Metro New Orleans), serve a strong healing purpose for people historically disenfranchised from traditional mental health and social supports.
emPOWER NOLA seeks to address the “wicked problem” through the theory of change that a larger percentage of children living with profound trauma will access services through bridging two needs: increasing the cultural competence of our fragmented mental health treatment network, and empowering communities to more effectively access resources to support its children. The dyad of NOSNs and school-based nursing/social work resources will then have a vehicle to make a tremendous difference in the lives of children suffering from trauma.
Wicked Problem: Higher Rates of Suicide in Asian American Youth
The so-called “model minority” is suffering – and dying – in silence. Despite being stereotyped as uniformly well-educated and successful, Asian American youths actually have higher rates of suicidal thoughts and attempts compared to most other racial/ethnic groups. They also have more internalizing symptoms, more peer victimization, and lower self-esteem compared to their White counterparts. Yet Asian Americans are among the least likely of all racial groups to utilize mental health services.
The Breaking Silences project tackles the problem of mental health and suicide in Chinese immigrant families. Although Asian American youth are often stereotyped as a uniformly well-educated and successful “model minority,” they are at high risk of depression and suicide. Parents often want to help, but face barriers including communication and language challenges, lack of awareness, and stigma of mental health issues and treatment. The team will develop and disseminate culturally tailored, evidence-informed, and scalable programs and tools focused on mental health awareness, stigma reduction, and help-seeking that decrease suicide risk and directly empower Asian immigrant families to live their healthiest lives. Strategies at the individual level will focus on destigmatization and education. Strategies at the family level will focus on improving parenting skills and practices, including parent-child communication. Community-level strategies will focus on building youth/parent ambassador programs to further influence and promote the culture of change. While the primary focus is Chinese immigrant families, they anticipate the programs, tools, and models developed can be adapted for other Asian and minority communities.
Wicked Problem: Mental Health Stigma in Veterinary Medicine
Veterinarian deaths by suicide occur at rates far above the national average, and suicidal ideation has been reported as being up to 5.5 times more likely in veterinarians compared to the general population. Between 1/3 and 2/3 report history of depression, and 80% describe their occupation as stressful or very stressful.
This team has identified specific types of client interactions that predict veterinarian stress and burnout, with veterinarian reaction to these interactions being a more important predictor of negative outcomes than frequency of such interactions alone. They have developed an Acceptance and Commitment Training (ACT)-based educational program tailored to reduce reactivity during these veterinarian-client interactions. They plan to implement the program in veterinary clinics throughout their community, assessing program feasibility and acceptability, and monitoring use of techniques taught.
Formal measures of burden transfer, stress, burnout, and mental health stigma are being measured using an online survey format at baseline (prior to ACT training) and follow-up (upon completion and 1 month later). Individuals wishing to contribute to research are randomized to either participate in the program upon registration (“program”) or after data collection (control”). Data will be analyzed by comparing baseline data to follow-up, as well as program versus control conditions. Using feedback from program participants and community stakeholders, they will alter the program as needed and develop an asynchronous training module for broad dissemination through veterinary learning management systems to make this program sustainable beyond the funding period.
Wicked Problem: Medically Complex Chronically Homeless Patients
In Buffalo, 1/3 of the population lives below the poverty level and there are high rates of eviction, job scarcity, and minimal municipal infrastructure for housing security. As a result, homelessness is a devastating reality for thousands of residents each year.
This program sought to establish the only medical respite unit in the region, supported by relational, evidence-based care transitions partnerships between interdisciplinary providers from the Buffalo City Mission, University at Buffalo School of Nursing, Erie County Medical Center, and regional health and social providers engaged in delivering care to the region’s high-need, high-cost patients.
With an established medical unit in place, project stakeholders now aim to launch a regional cross-sector network to foster collaboration, trust, and professional development. Through this forum, they aim to better target services toward the improvement of health and social outcomes of high-need, high-cost patients in our city and beyond. By fostering a collaborative team across sectors of care, they hope to engage providers in the regional effort to reduce health care recidivism, increase transition to housing and self-management of chronic disease, and establish innovative, non-duplicative service delivery models that serve Buffalo’s most vulnerable citizens.
Wicked Problem: Gaps in Care for Individuals with Complex Needs
In 2018, 50% of health care costs were spent on 5% of the U.S. population. The “Wicked Problem” in Wake County, like many communities across the country, is related to the lack of integrated health services and supports to vulnerable individuals with complex needs and who have frequent interaction with a combination of criminal justice and correctional systems, emergency medical services (EMS), homelessness services, physical and mental health services, substance use detox and treatment services.
This project involves engaging and coordinating community stakeholders to provide integrated health services to vulnerable individuals with complex needs and who have frequent interaction with crisis systems because current systems are unable to meet their needs. The Clinical Scholars team members all work for organizations (Wake County Government, WakeMed Health & Hospitals, Duke University Health System, and UNC Health) with deep roots in the community. Individually and collectively, they work with and among networks of community stakeholders and service providers who have a substantive understanding of institutional strengths and gaps related to services for the target population.
The team seeks to engage vulnerable community members and front-line service providers to understand barriers and challenges associated with service delivery and support systems for this population. Utilizing existing data sources within the community, the team seeks to understand what it takes to partner, integrate, and deliver a holistic care model to familiar faces, vulnerable individuals who have frequent interactions with crisis safety-net systems. This information will provide valuable insight to improve upon existing strategies to develop an empathetic human-centered design that addresses systemic problems to improve services and health outcomes. The efforts will include utilizing continuous quality improvement practices to allow for ongoing improvement efforts and broad community adoption.
What questions come up for you for each approach to a wicked problem? Let us know in the comments.