Social Work and Public Health:
A Natural Alliance
Amy DeGroff, PhD, MPH
Division of Cancer Prevention and Control
Centers for Disease Control & Prevention
National Association of Deans and Directors School of
Social Work Conference
October 26, 2011
Ida Cannon
CDC applies a Public Health
Approach to Cancer
 Monitoring and surveillance
 Applied Research and Evaluation
 Underserved populations
 Education and outreach
 Improving infrastructure
 Quality of life for cancer survivors
CDC’s Role in Cancer Prevention and
Control
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Provide national leadership in comprehensive public
health approaches to cancer issues, including:
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Monitoring and surveillance
Policy, systems, environmental change strategies
Underserved and disparate populations
Public education and outreach
Clinical preventive services
Improving infrastructure
Improving quality of life for cancer survivors
CDC’s Vital Signs
Inaugural Issue Focus: Cancer Screening
Evidence-Based Clinical
Preventive Services for Cancer
Screen for Life
 Aims to educate persons aged
50+ about the importance of
regular CRC screening
 Targeted to Medicare
recipients, African Americans,
Hispanics and Health
Professionals
 SFL materials adaptable to
State and Local needs
Inside Knowledge:
Get the Facts About Gynecologic Cancer
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CDC conducted formative research, concept and
material testing
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Campaign features ‘real’ women
 Emphasis on women who have survived or had a personal
connection to gynecological cancer
Prevention Research Centers Program
Thematic Networks
Cancer Prevention and Control Research Network
(CPCRN)
 Mission: Accelerate the adoption of evidencebased cancer prevention and control in
communities
 Funded by CDC and National Cancer Institute
CPCRN Strengths
 Advancing public health science for implementation and
translation research
 Building strong community partnerships
 Focusing on underserved populations
 geographic outreach
 Research focus that complements NCI & CDC priorities
 Infrastructure funding provides impetus to focus beyond
discovery and be opportunistic
PI’s
Michelle Kegler, DrPH
Jennifer Allen, ScD, MPH, RN
Marcia Ory, PhD, MPH
Betsy Risendahl, PhD
Roshan Bastani, PhD
James Hebert, ScD, MSPH
Cathy Melvin, PhD
Kurt Ribisl, PhD (Coord Ctr)
Maria Fernandez, PhD
Vicky Taylor, MD, MPH
Matthew Kreuter, PhD, MPH
CPCRN Map
Patient Navigation Study for
Colonoscopy Screening
Defining Patient Navigation
Across Cancer Continuum
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Patient-focused intervention intended to eliminate
barriers to cancer screening, timely diagnosis, treatment,
and survivorship
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Emphasis on reducing health disparities through
improved health care access and quality for medically
underserved populations
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PN used in other areas of public health, including other
chronic diseases
Some Principles of Patient Navigation
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Patient-centric healthcare service delivery model
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Core function to eliminate barriers to timely care across
cancer continuum
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PN serves to integrate a fragmented healthcare system for
the individual patient
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PN often involves navigating patients across disconnected
systems of care including primary care, specialty care, and
tertiary care sites
Freeman, HP, Rodriguez, RL. History and principles of patient navigation. Cancer. 2011;117(15 suppl):35393542
Momentum!
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Harold P. Freeman – Harlem Hospital (1990)
2005 Patient Navigation Outreach and Chronic Disease
Prevention Act (reauthorized in ACA)
2010 Patient Protection and Affordable Care Act (ACA)
2011 National Prevention and Health Promotion Strategy
(required by ACA)
2011 American College of Surgeon’s Commission on
Cancer
2010 National Patient Navigation Leadership Summit,
American Cancer Society
CDC Partners Working in Cancer-Related
Patient Navigation
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American Cancer Society (ACS)
Centers for Medicare and Medicaid Services (CMS)
Health Resource & Service Administration (HRSA)
National Cancer Institute (NCI)
Academic and non-profit partners
Cancer, Supplement to Cancer, National Patient Navigation Leadership Summit, Vol. 117,
Issue 15, August 1, 2011
Colorectal Cancer Screening
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National colorectal cancer screening rates low –
65.4% (all screening tests combined)*
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Extensive barriers to screening documented
Colonoscopy is a complex screening procedure
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*Richardson LC, Tai E, Rim SH, Joseph D, Plescia M. Vital signs: Colorectal cancer screening, incidence, and mortality – United States,
2002-2010. Morbidity and Mortality Weekly Report. 2011;60(26):884-889.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a4.htm?s_cid=mm6026a4_w. Accessed 10/20/11.
Patient Navigation Models
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Emerging evidence-base for PN in cancer*
PN models vary
Multi-disciplinary team developed intervention
model
 Public health
 Oncology social work
 Clinical oncology
 Evaluation
 Behavioral health research
*Paskett, et al. 2011. Patient Navigation: An Update on the State of the Science. CA: Cancer J Clin.
Patient Navigation
Research Intervention Model
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Patient-focused, barrier-focused
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Theory-based
 Socio-ecological approach
 Individual-level behavioral theories
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Removing cultural, environmental/structural, and health
care system barriers will support colorectal cancer
screening adherence
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Theories suggest that changes in knowledge, attitudes,
beliefs, intentions, and self-efficacy precede individuallevel behavior change
Primary Outcomes of Interest
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Individual/Intrapersonal-level outcomes
 Improved adherence to colonoscopy screening
 Improved quality of bowel prep
 Patient satisfaction
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Systems-level outcomes
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Increased screening rate for referring primary care clinic
Reduced number of “no-shows” for colonoscopy appointments
Reduced time from screening referral to completion
Provider satisfaction
Patient Navigation Study
Design and Setting
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RCT (825 patients)
 Treatment group – patient navigation
 Control – usual care
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Boston Medical Center (BMC)
 Teaching hospital for BU Medical School
 Largest safety net hospital in New England
 Patients recruited from Internal Medicine (referred for
colonoscopy)
Opportunities for Evaluators at CDC
 Evaluation is a multidisciplinary field
 Social scientists with strong methodological skills
(quantitative, qualitative, mixed methods)
 New CDC fellowship program for PhD-level
evaluators
 Practicum or Internships??
Social Work and Public Health:
A Natural Alliance
 Shared commitment to social justice and
reduced disparities
 Social determinants of health ≈ The personin-environment
 Work within social ecological models
 Work in community and clinic settings
 Theoretical complementarity
Contact Information
Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and
Health Promotion
CDC
Amy DeGroff, PhD, MPH
adegroff@cdc.gov
The findings and conclusions in this presentation are those of the author and do not necessarily
represent the official position of CDC or ATSDR
Thank You!