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​Fred Ssewamala, William E. Gordon Distinguished Professor at the Brown School and Proscovia Nabunya, research assistant professor, have received a two-year, $425,000 award from the National Institute of Mental Health to address HIV/AIDS-associated stigma among adolescents in Southwest Uganda.

“Stigma has been identified as one of the main challenges to slowing the spread of HIV/AIDS,” noted Nabunya, a co-principal investigator with Ssewamala. “Fear of discrimination and public blame has prevented individuals from getting tested for HIV and seeking health care, particularly in adolescent populations.”

To address these challenges, this new study will test two evidence-based interventions, Group Cognitive Behavioral Therapy and Multiple Family Group sessions, to see which is more effective in reducing HIV/AIDS-associated stigma among adolescents. The study will target both internal individual and family level stigma and how the interventions impact participant’s trauma, depression, sexual risk, support systems and adherence to medication.

“The ultimate goal is to reduce HIV rates and improve child well-being in Sub-Saharan Africa and this study is an important first step,” Ssewamala said. “It will lay the foundation for a larger study investigating how HIV/AIDS-associated stigma can be reduced to foster healthy child development, especially for children living with HIV as they transition to adolescence.”

The team will also examine the experiences of both participants and facilitators to identify individual, family and institutional-level facilitators and barriers to both interventions in order to inform future implementation and participation. This part of the study will be led by Ozge Sensoy Bahar, research assistant professor at the Brown School.

​Sheretta Butler-Barnes has been awarded a Research Seed Grant from the Washington University Office of the Vice Chancellor for Research (OVCR) to collect preliminary data on how White and Black parents communicate to their children about race and racism. The one-year, $37,500 grant will support the preparation for a larger grant submission.

Butler-Barnes, a developmental psychologist and associate professor at the Brown School, will work on the project with Lori Markson, a developmental psychologist and associate professor with the university’s  Department of Psychological and Brain Sciences.

“The increasing diversity of the United States has brought large cultural shifts in people’s attitudes toward those from different social groups, but progress is slow,” Butler-Barnes said. “Parents of White children might talk about race and racism with their children, but it is seen as an option,  whereas parents of minority children must follow early racial socialization practices to insulate their children from racism.”

“We seek to gather preliminary data that will help us understand the type of messaging parents in the St. Louis region are communicating to their children and how this impacts their child’s own explicit and implicit racial attitudes.”

The OVCR Program provides funds to support interdisciplinary teams collaborating on new and innovative research that has potential for broad scientific or societal impact.

Butler-Barnes’ expertise and scholarly work is on the impact of racism and the use of culturally strength-based assets on the educational and health outcomes of Black American families. She was recently appointed to the Anti-Racism Task Force of the Society of Research on Adolescence and serves as the  co-chair of the Differences & Intersectionalities section of the American Educational Research Association.

She is also a guest editor of “Racial Justice in Learning Contexts,” an upcoming, special issue of the journal Social Sciences that will feature research on transdisciplinary perspectives to dismantle racism and promote racial justice in classrooms. (Manuscripts may be submitted through Sept. 30 – visit their website for more information.) 

Washington University and the Brown School recognize the importance of Medicaid expansion for Missouri. Increasing access to health care is an incredibly important way to advance health equity — one our School’s defining goals. On August 4, 2020, Medicaid expansion, Amendment 2, will be on the primary ballot for a vote.   

The content below provides context on the impact of the expansion as well as information about a series of July discussions on the topic that will be hosted by the Brown School.

Impact on the State Budget 

Brown School faculty members Tim McBride, Bernard Becker Professor, and Abby Barker, research assistant professor, along with many others, are using key data to model the impact of Medicaid expansion, including the impact on the state budget.  

These scholars, affiliated with the Institute for Public Health’s Center for Health and Economic Policy (CHEP) looked at the experience of other states that expanded Medicaid and they built a fiscal model to estimate the impact of expansion on the Missouri Medicaid budget.  

In their most likely, middle-of-the-road scenario, they estimate that the policy would result in $38.9 million in savings in the first year, even after the state allocates its obligations for 10% of the expanded services. They also predict that the savings to the state after five years would be over $1 billion dollars per year. 

Read the full policy brief: Effects of Medicaid Expansion on Coverage, Access, Outcomes, and Costs: Implications for Missouri.

Said Barker: “Medicaid expansion also has the obvious benefit of increasing access to healthcare – and in particular preventive healthcare services – which has the potential to save money by keeping low-income Missourians healthier and more able to be productive as taxpaying members of the workforce. None of these benefits was included in our analysis, which focused just on the net impact to the Medicaid budget.”  

Other related reports from CHEP include:  

Three Part Series: Supporting a Healthier Missouri 

During an upcoming three-part discussion series, Supporting a Healthier Missouri, the Brown School will be taking a critical look at the merits of expanding Medicaid, particularly as it relates to racial equity, rural communities, and families with children.  

Opening remarks for all events will be provided by David H. Perlmutter, MD, executive vice chancellor for medical affairs and dean of the School of Medicine.  

Register here for any of the below. 

Moderators for all events will be Gary Parker, Associate Dean for External Affairs at the Brown School and Director of the Clark-Fox Policy Institute; and Cynthia Williams, Assistant Dean for Community Partnerships at the Brown School.

Part 1: Supporting a Healthier Missouri: Medicaid Expansion and Racial Equity 
Co-sponsored by Forward Through Ferguson, CareSTL Health, and the Clark-Fox Policy Institute  
Wednesday, July 15; 12:30-1:30 pm, CT 

The convergence of two public health crises – COVID-19 and racism – is shining a bright light on profound health disparities in our state and coverage gaps that disproportionately impact people of color. Expanding Medicaid in Missouri is a tremendous step toward alleviating the disparate health burdens on poverty-impacted Missourians, and is especially important to tens of thousands of African American and Latino citizens.  

Panelists:

Part 2: Supporting a Healthier Missouri:  Medicaid Expansion and Rural Communities 
Co-sponsored by the Center for Health Economics and Policy, and the Clark-Fox Policy Institute 
Wednesday, July 22, 12:30-1:30 pm, CT

Rural Missourians face unique healthcare challenges such as a larger aging population, lower incomes, higher incidence of chronic illnesses, less access to employer-sponsored insurance, and barriers to healthcare access due to geographic distance and hospital closures. Even healthy, working citizens find themselves caught in the coverage gap and unable to afford private insurance. Throughout the entire state, Medicaid expansion is a matter of access, affordability, quality of life and health equity.  

Panelists:

Part 3: Supporting a Healthier Missouri:  Medicaid Expansion and Family Well-Being 
Co-sponsored by the Clark-Fox Policy Institute 
Wednesday, July 29, 12:30-1:30 pm, CT 

Research supports that expanding Medicaid coverage for adults increases the likelihood that eligible children will be enrolled, have access to preventative healthcare such as well visits, and experience continuity of care. This panel will explore how Medicaid Expansion could mean coverage for some 50,000 parents in Missouri and the implications for family well-being, workforce development, and breaking the cycle of poverty. 

Panelists:

New Associate Dean of Public Health

Professor Rodrigo Reis is taking on the role of Associate Dean for Public Health at the Brown School as of July 1, 2020.

Rodrigo is an exceptionally talented professor, who is deeply committed to student development. He is widely respected in the field for his research on built and community environment and public health, with a focus on promoting physical activity through active transportation and community interventions. 

His projects have a global reach, evidenced by recent work on healthy aging and urban living in Brazil. He is the chair of our Urban Design specialization, and his work with the Brown School’s Prevention Research Center includes the Developing Livable Cities project, a transdisciplinary endeavor that seeks to provide guidance on building socially inclusive, affordable, healthy and safe cities using evidence-based research.

Rodrigo succeeds Associate Professor Lora Iannotti, who will be taking a sabbatical to concentrate on her research and a new R01-level NIH grant to study nutrition and parenting interventions in Haiti. As founder of the E3 Nutrition Lab, she leads teams in Haiti, Ecuador and East Africa focusing on reducing stunted growth and development in children. With Lora’s commitment and leadership over the past several years, our program of Public Health has grown enrollment and faculty, deepened its transdisciplinary focus, and debuted in the U.S. News and World Report ranking at No. 17– the highest ranking for a school of public health, among a field of schools. 

“We are grateful to Lora for her incredible leadership, and we welcome Rodrigo’s talents and energy as he assumes this new role. He is an exceptionally talented professor, who is deeply committed to student development,” said Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School.

New Director of Public Health Sciences Doctoral Program

Associate Professor Patrick Fowler will assume the directorship of the School’s Public Health Sciences Doctoral Program. Patrick is trained in child clinical-community psychology and uses innovative methods that rigorously investigate policies and programs intended to promote housing and family stability.

His work applies a complex systems perspective to inform developmentally and culturally tailored responses to family and youth homelessness.

Patrick’s federally funded research has been supported by the National Institute of Child Health and Human Development, the U.S. Administration for Children and Families, and the U.S. Department of Housing and Urban Development. 

He succeeds Professor Doug Luke, who has served as the inaugural director of the program and who will be on sabbatical next year. Doug is a leading researcher in areas of public health policy, systems science and tobacco control. He serves as director for the Center for Public Health Systems Science at the Brown School (CPHSS), and recently helped to establish the Systems Science for Social Impact Summer training institute at the Brown School, with the goal of training the next generation of scholars in methods most useful for enhancing the social impact of health and social science research.

Said Dean McKay: “We are grateful for Doug’s work to grow our program and his mentorship of our doctoral students, as we also look forward to the talents that Patrick will bring to the PhD program.”

While COVID-19 has impacted all individuals, the impact has not been equal. In a new national Socioeconomic Impact of COVID-19 survey, the Social Policy Institute (SPI) at Washington University in St. Louis found that liquid assets increased the likelihood that an individual could practice social distancing.

Grinstein-Weiss

“Social distancing is a privilege that comes with resources and wealth, but wealth is not distributed equally in America,” said Michal Grinstein-Weiss, the Shanti K. Khinduka Distinguished Professor and director of the SPI. “Wealth gives individuals agency to make choices, like social distancing, that keep themselves and their families healthy.”

The SPI interviewed approximately 5,500 respondents from all 50 U.S. states from April 27 to May 12.

“Lower liquid assets leave people in a position of choosing income over social distance safety,” Grinstein-Weiss said. “As money increases, affordability to social distance increases.”

Survey respondents also revealed other significant loss and hardships as a result of the pandemic. The survey found that:

“While it’s too early to draw conclusions about long-term impacts of the virus, we know that it’s exacerbating situations for households already experiencing financial vulnerability, wealth inequalities and health inequities,” Grinstein-Weiss said.

The data was presented during a virtual event titled “The Impact of COVID-19 on the Racial, Gender, and Generational Wealth Gaps,” co-hosted with the Center for Household Financial Stability at the Federal Reserve Bank of St. Louis.

Data suggest that the pandemic may exacerbate underlying inequalities, Grinstein-Weiss said.

“Understanding the wealth gap is important, but more critically we need to design policies that enable people to build wealth as the economy recovers,” she said.

In late February 2020, Madisen Janssen, MSW ’20, began her work for the city of St. Louis, just a few months shy of her graduation from the Brown School. Little did she know the transformative experience that awaited her.
Janssen works in the office of Mayor Lyda Krewson, as the mayor’s liaison to the Board of Aldermen. She had worked in the job before as a fill-in, part of her Gephardt Public Service Fellowship, and a good fit for her concentration at the Brown School: domestic social and economic development, with a policy specialization. But her experience and classroom work could not have prepared her for the pandemic explosion that would rock St. Louis and nation only two weeks after she was sworn in.

“Everything happened very quickly,” she said. The first case of COVID-19 in St. Louis was reported March 16, and Mayor Krewson issued executive orders banning gatherings, at first of more than 1,000 people, then 50, then 10 to halt the spread of the virus.
Now her role is permanent one, and her duties include tracking virus data, aldermanic committee hearings, following the legislative process, and communicating updates to the mayor and her chief of staff. Providing information to aldermen on best practices and virus numbers as new developments occurred during the first stages of the crisis was a challenge.
“The aldermen had a lot of questions from businesses and other constituents,” she said. “It was amazing how quickly the situation could change,” Janssen said. “Communication has really been key.”

Janssen also assisted with the city’s spring budgeting process. The pandemic and its economic consequences have had a big impact on that budget.
“It’s a very good learning experience, and there’s always something new.”

Janssen says the Brown School prepared her for many of the skills she would need in the dynamic world of city politics, from policy classes to state-level lobbying experience in the field.
Janssen was a special education teacher before resuming her education, and while she had always been interested in politics and policy, never imagined it as a career path. That has changed.
“Ours is a unique city-government structure, and I like working in the legislative world,” she explained. “One of biggest surprises for me has been how many services city government provides every day,” she said. “The scope of city government and how it impacts our daily lives is much bigger than I realized before I began working in the Mayor’s office.”