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Road Scholars

A prestigious program sends doctoral students across the U.S. to counsel community health organizations—and gain real world experience for themselves.

By Brian W. Simpson

Perched at the upper end of Penobscot Bay, the town of Bucksport, Maine, markets itself as the "Jewel at the End of the Bay." The town of 5,000 boasts a small town ambience, a rich history dating back to 1764, employment from a large paper mill in town and major port facilities, and one of the state's biggest tourist attractions: the nearby, historic Fort Knox.

But Bucksport, located in Maine's Down East region, also has its share of public health problems: alcoholism, high rates of chronic disease like diabetes, an elderly population in need of long-term care, and health care access issues (the nearest hospital is 18 miles away).

Since Maine lacks the traditional public health infrastructure of county health departments, town residents can't rely on government-driven solutions. Instead, concerned citizens organized themselves into the Bucksport Community Health Advisory Committee to find the answers themselves. Their efforts got a big boost in 2000, when the group won a two-year $100,000 grant from the Johnson & Johnson Community Health Care Program. But what would happen when the seed money ran out? How would the Bucksport group ensure that the public health programs it launched would be sustained?

Enter Mary Garza, a Johnson & Johnson Scholar who was then a doctoral student in the Department of Health Policy and Management at the School. The Scholar program matches student advisors (see sidebars) from the School with organizations that have won grants from Johnson & Johnson. (The grants program, launched 15 years ago, each year funds the work of three to eight sites of the 1,000 community health centers across the United States—centers that provide an essential safety net for the uninsured and the poor.) The Scholars' role: to help guide community health organizations by performing research, giving informed advice, and assisting the sites in program evaluation. Since the program's inception in 1999, Scholars have been dispatched to assist a Wilmington, Del., project that provides free pregnancy support for immigrants; a nutrition program for HIV-positive individuals in Miami; diabetes prevention initiatives for Latinos in Washington, D.C., and Pennsylvania; an outreach program for at-risk youth in Newark, N.J.; and a Cincinnati effort to help youths with special health care needs.

When Garza rolled into the coastal Maine town in mid-December 2000 (with then-faculty mentor Susan Russell Walters, DrPH '95, MPH '87), the native Californian was ready for everything but the weather. "The temperature was 11 degrees," recalls Garza. "I could not believe how cold it was. I'm from California, remember. I had no idea what 'wind chill' meant." With the help of three layers of thermal underwear and a warm welcome from the Bucksport community, Garza, PhD '02, recovered sufficiently to concentrate on the task at hand: introducing herself to the Committee and explaining how she would provide them with advice and technical assistance over the following two years.

For Garza, the experience expanded her focus from academic theory to immediate, real world health problems. How could the Bucksport public schools improve children's health through curriculum, nutrition, and health care services? How could the town ensure that elderly residents who live alone are checked on daily? What could be done to reduce rates of cardiovascular disease?

Through two annual site visits and weekly contact via phone, e-mail, or fax, Garza was also able to help find answers to the community's pressing health needs. When the group was looking at the issue of long-term care for the elderly, for instance, Garza sought out funding options for them. Garza also helped research evaluation models that could be used by the group to chart their program's success—critical information for any organization looking for future funding.

The evaluation process, a major focus of each Scholar's work, is vital for a community health organization's continued existence. The original Johnson & Johnson grant serves as seed money that makes it possible for a community health organization to initiate a project. But the organization needs a track record of success to attract future grants, according to Rick Martinez, MD, medical director of corporate contributions and community relations at Johnson & Johnson.

"Making a case for those funds requires data collection," says Martinez. "The data generated can be used by the [community health organizations] as a way of communicating what they have accomplished. For grant makers like us at Johnson & Johnson, the challenge is judging an operation at a distance. If you add clarity to an application and to the outcome you've achieved on the ground, that definitely enhances [the application]."

The problem is that many organizations lack the time, knowledge, and skills necessary to carry out thorough evaluations: How can they best track their patients and the difference the program makes in their lives? What database software do they need and how do they operate it? What evaluation model best suits what they're trying to accomplish?

In a 1998 meeting at the School, Johnson & Johnson representatives and School officials hit on a solution to the problem of how to help grantees with evaluation: Pair each site with a PhD or DrPH student from the School. Students from Health Policy and Management, Population and Family Health Sciences, and other departments are only too familiar with evaluation techniques, having studied them in their course work.

Most organizations welcome the students' input. "It's helpful to a site to have an outside perspective in general because they're so close to the issue," says Anita Chandra, MPH, DrPH candidate. "They don't have the distance and perspective to look at it. I think we add that additional voice."

Chandra was one of nine Scholars working this summer. Four students from the 2000–2002 cohort were completing their work, while the rest were midway through their tenure. The newest group of Scholars will be named this September. Fannie Fonseca-Becker, DrPH '00, MPH '89, a senior research and evaluation officer at the School's Center for Communication Programs, has been named the Scholars' new coordinator.

Early in a Scholar's first year, each student visits his or her site for the first time to learn about the project's goals — and reassure the site's staff that they have not been sent by Johnson & Johnson to make sure grant money is spent wisely. "We're not a spy for Johnson & Johnson," says Shelly Atherly Trim, MPH, DrPH candidate. Misunderstandings about what the Scholars do have made for some rough starts for some, but once staff members understand that a Scholar is there solely to help, things go much better. "Then they [understand] this is not as big and scary as they thought it to be. They see we're regular old Joes," says Trim.

Helping an outreach program for at-risk youth in Newark, N.J., Rachel Johnson, an MD/PhD student, embraces her role as a problem solver, helping the staffers organize the site's intake documents, patient logs, and other paperwork. "I don't tell them how to run a support group or how to recruit people," she says. "It's more talking with them, telling them what they can do if they run into barriers… [and] what we can do to facilitate their ability to collect necessary information or to suggest better techniques they can use to analyze the success of their program."

The program has obvious benefits for both the students and the sites with which they're paired. The community health care programs get the Johnson & Johnson seed money (now $150,000 over two years) as well as the assistance of a student advisor. The students earn an annual $3,000 stipend and get the chance to apply academic methods and research in the real world of public health.

"It's a win-win," says Janice Bowie, PhD '97, MPH, assistant professor in the Department of Health Policy and Management, who with Lee Bone, MPH '77, has served as an acting coordinator for the Scholars program. "My anecdotal impression is that [the Scholars] come away with a broader perspective, understanding, and appreciation for what takes place in community organizations, and what challenges or barriers have to be overcome."As Mary Garza, now a newly minted PhD, wrapped up her final year as a Scholar with a last site visit to Bucksport in late June, it wasn't hard for her to measure the success of the Bucksport Community Health Advisory Committee. The group completed a 134-page comprehensive health plan for the town, recruited 140 volunteers for 10 subcommittees to address all aspects of the community's health, exceeded the goals they'd set for the Johnson & Johnson money, and won almost $500,000 in new grants, including a five-year, $325,000 state grant to support a coordinated school health program.

"Mary's been fantastic," says Mary Jane Bush, health planning director for the town of Bucksport. "She was extremely helpful in developing a work plan, in terms of plotting through our program goals and objectives from the beginning of the Johnson & Johnson grant to make sure we systematically addressed each of those areas and demonstrated our accomplishment."

Evaluating her own experience as a Johnson & Johnson Scholar, Garza says she would deem it a success. "This has been an excellent learning experience," says Garza. "I have gained so much. More than I will ever learn from a book."