VII - Columbia University



VII. SERVICE

Criterion VII. The school shall pursue an active service program, consistent with its mission, through which faculty and students contribute to the advancement of public health practice, including continuing education.

Documentation

1. A description of the school’s service program, including policies, procedures and practices that support service. If the school has formal contracts or agreements with external agencies, these should be noted.

2. A list of the school’s current service activities, including identification of the community groups and nature of the activity, over the last three years.

3. A description of the school’s continuing education program, including policies, procedures and practices that support continuing education.

4. A list of the continuing education programs offered by the school, including number of students served, over the last three years.

5. A list of other educational institutions, if any, with which the school collaborates to offer continuing education.

6. Identification of the measures by which the school may evaluate the success of its service program, along with data regarding the school’s performance against those measures over the last three years.

7. A description of student involvement in service.

8. Assessment of the extent to which this criterion is met.

VII.1. A description of the school’s service program, including policies, procedures and practices that support service. If the school has formal contracts or agreements with external agencies, these should be noted.

The Mailman School of Public Health is committed to the importance of public health service as an essential component of its mission. The School has established goals that guide its service activities, which are highlighted in the Mission and Goals statement. These include:

1. Continue to strengthen collaborative preventive health efforts with local community groups interested in health and with health care providers in the Washington Heights/Inwood and Harlem areas of Northern Manhattan.

2. Partner with city, county, and state health departments in New York and New Jersey in the evaluation of both ongoing and new public health projects and programs, by involving both faculty and students in joint projects with these agencies.

3. Provide consultative services to agencies, both public and private, utilizing the wide-ranging expertise of the faculty of the various departments and centers of the School.

4. Support faculty to serve on committees, boards, and councils of organizations involved in improving the health of the public.

5. Develop programs, embodying the goals stated above, that appropriately adapt these goals to the needs of the international community, particularly in the developing world.

Service is an integral component of the Mailman School’s approach to public health education as reflected in the Mission and Goals statement above, sharing priority with teaching and research, and related closely to those two components. The strong commitment to public health service of the School is clearly demonstrated in the collective activities of the School and its departments and centers, in the activities of its individual faculty, and in the explicit focus of many of the School’s research projects on topics that are directly applicable to the delivery of public health services.

Response to 9/11

One example of the School’s service to its community is the School’s important role in responding to the September 11 World Trade Center disaster. In the wake of the disaster, the School has made key contributions in three areas: the short- and long-term mental health effects of the attack; environmental health risks for those exposed at Ground Zero and the surrounding neighborhoods; and infectious disease outbreaks, whether naturally occurring or as acts of bioterrorism.

Focusing first on mental health, on September 12 the Chair of the Department of Epidemiology initiated plans to coordinate the efforts of mental health professionals to respond to the disaster. One of the resulting projects, A Common Ground (ACG), is a unique collaboration between government, labor unions, and the academic community to meet the needs of recovery workers and others who have been living and working in the vicinity of Ground Zero in the months following September 11. The project designed a Central Common Area, a community center for service recipients and their families, with staff and peer counseling available, scheduling of appointments for physical/mental assessment or services, and opportunities to talk with other Ground Zero workers.

Other mental health projects of the faculty include investigations of the degree of post-traumatic stress disorder and depression among residents of Manhattan; surveys conducted in collaboration with the New York City Board of Education on the mental health needs of New York City school children; and assessments of post September 11 psychiatric disorders, functioning, and treatment received at primary care clinics in Washington Heights. Finally, faculty of the School organized the “Year of Recovery,” a program to help residents of the city heal after the disaster.

Turning to environmental health, the School’s Center for Environmental Health in Northern Manhattan collected air samples at Ground Zero from the teamsters who drive truckloads of debris to determine their exposures to pollutants. The School’s Center for Children’s Environmental Health is investigating the impact of exposures to contaminants on pregnant women who live or work in Lower Manhattan, as well as on their unborn children.

In the area of infectious disease, the School’s Center for Public Health Preparedness has worked closely with units of the Health Sciences Campus, Columbia University, New York-Presbyterian Hospital, and other organizations to help formulate responses to the disaster and address constituents’ concerns. The Center, along with partner organizations, offered a special education program, “Recognition and Treatment of Bioterrorism Diseases: A Seminar for Clinicians,” which was repeated six times. The Center works with the New York City Department of Health (NYCDOH) and other agencies to develop curriculum and train frontline public health workers to respond in a coordinated way to emergency situations. Two weeks before September 11, and with funding from the Centers for Disease Control, the Center successfully trained more than 800 public health nurses in emergency preparedness techniques. They were then able to help others after the tragedy. Moreover, under a recent Achelis Foundation grant, Center faculty will reassess hospital and emergency personnel preparedness needs in light of the anthrax attacks, incorporating this information in revised “second generation” preparedness training modules and improved procedures. This work is conducted in cooperation with major New York City area hospitals and the NYCDOH.

Ongoing service activities

As described in II.B.4, the service programs of the School focus primarily on the most vulnerable and underserved populations – the homeless, refugees, communities of color, women, the poor and uninsured, and children. Examples of research and service projects focused on each of these populations are included in II.B.4.

The Mailman School carries out a variety of direct service activities and collaborates with other organizations in the provision of services. The extensive involvement of the School in direct service delivery programs is admittedly unique. Few schools of public health see one of their roles being the provision of health care to populations in need. However, our point of view is that this kind of involvement on the part of schools of public health can be extremely important. In the same way that traditional clinical activities play a crucial role in medical and nursing education, and clinical research is an accepted activity among faculty in medical and nursing schools, one can make an equally strong case for the importance of service delivery programs for teaching in schools of public health and for faculty clinical research. If one of the goals of public health education is to train students who will assume positions as managers of service delivery programs, then service programs run directly by schools of public health can play an essential role in the training of these students by providing opportunities for potentially valuable practical training. Similarly, school-sponsored public health practice or service programs provide a potentially valuable setting for health services-related research that can be carried out by school faculty. Therefore, the Mailman School’s involvement in sponsoring service delivery programs represents a considerable strength.

The Mailman School plays an important and acknowledged role within Columbia University in linking research and scholarship to the urgent problems of communities, to the development of solutions and services to meet those problems, and to the strengthening the interdisciplinary relationships necessary to address the complex issues involved. The President’s Report 2000 “Columbia and New York City” notes: “As much as any other division of the University, the Mailman School exemplifies the degree to which our location provides us with a laboratory for studying urgent problems and developing effective solutions. Research and scholarship are the essential complements to Columbia’s activities in education and community service.” The report cites the following examples:

Northern Manhattan Start Right Program

Harlem Health Promotion and Disease Prevention Center

Columbia Center for Children’s Environmental Health

Urban Air Toxic Exposures of High School Students

Northern Manhattan Adherence Initiative

Northern Manhattan Women and Children HIV Demonstration Project

Metropolitan New York Registry of Breast Cancer Families

Reducing Indoors Allergen Exposures in Northern Manhattan

Women Living with HIV in Two Time Periods

Drug Use and Course of Homelessness Among Single Adults

Health, Wealth, and the City: Records of New York’s Department of Health

and the Nation’s Urban Landscape

Investigation of NYPD Stop and Frisk Practices

Developing Workable Solutions for Improving Health Insurance

Coverage for Working Americans

Finding Common Ground in the Era of Welfare Reform and Managed Care

Policies to Support Low Income Working Families in New York

New York City’s Medicaid Managed Care Initiative

With many of these organizations we have formal contracts and agreements. The list of these contracts and agreements are shown in Table VII.1.

Table VII.1

Agencies That Have Formal Service Project Contracts/Agreements

with the Mailman School

New York-Presbyterian Hospital

Harlem Hospital

New York City Department of Health

New York State Department of Health

New Jersey Department of Health and Social Services

University of Medicine and Dentistry of New Jersey

Centers for Disease Control and Prevention

American Legacy Foundation

National Head Start Program

West Harlem Environmental Action, Inc. (WEACT)

Alianza Dominicana

Harlem Congregations for Community Improvement

State University of New York at Albany School of Public Health

State University of New York at Stony Brook Medical School

Cornell University

City University of New York

Milbank Memorial Fund

New York Academy of Medicine

Planned Parenthood of New York City

American Museum of Natural History

New York City Board of Education

Management Institute for Clinical Chiefs (New York)

World Health Organization

UNICEF

UNFPA

CARE

Save the Children

International Rescue Committee

Federation Internationale de Gynecologie et Obstetrique

Women’s Commission for Refugee Women and Children International

Engender Health

Indian Institute of Management at Ahmedabad

University of Natal

Thusano School of Public Health, South Africa

Family Health International

John Snow International

Asian Network for Cancer Awareness Research and Training (AANCART)

National Medical School of Mali

Uganda Ministry of Health

Makere University, Kampala, Uganda

Ben Gurion University of the Negev

Association of Schools of Public Health

VII.2. A list of the school’s current service activities, including identification of the community groups and nature of the activity, over the last three years.

This chapter encompasses the direct service activities of the Mailman School of Public Health, its collaboration with other organizations in service activities, and activities of individual faculty members of the School, covering the following areas:

• Collaboration with New York City and New York State Departments of Health

• School programs that provide direct services to populations in need

• Collaboration with other organizations and communities: U.S. and international programs

• Service activities of individual faculty

Collaboration with the New York City Department of Health

The School has a long tradition of supporting projects that provide technical assistance to agencies or organizations that provide health services to populations in need. Locally, this tradition has taken the form of strong ties with Departments of Health in both New York City and New York State. Equally strong ties have been developed over the years with organizations in a number of developing countries. Examples of each of these are provided below.

Beginning with the first head of the School in the 1920’s, who also served as Commissioner of Health for New York City, a partnership between the School and the New York City Department of Health (NYCDOH) was strengthened in 1939 by a joint agreement to construct a building on the corner of 168th Street and Broadway to house the School and create a municipal health center for the residents of Washington Heights.

This partnership has grown through the years and is now a model collaboration program between the largest local health department in the U.S. and one of the oldest schools of public health – designated and funded as a formal model program in response to the Institute of Medicine’s recommendation for closer ties between academic public health and public health practice. The collaboration now includes joint appointments, an assessment program to evaluate current models of the community-based outreach, and a violence prevention program initiated as part of the Statewide Violence Prevention effort.

Healthy People 2002 and 2010

The School and the NYCDOH have initiated a series of joint projects aimed at addressing the objectives set forth in the “Healthy People 2010” initiative, among them: Pregnancy outcomes in Hispanic Women in New York City; Expanding Primary Care in New York City DOH Child Health Clinics; Identifying Children at Risk for Learning Problems; Improving Tuberculosis Tracking in Harlem; Assessing Immunization Status among Children in Washington Heights; and Fertility Change and Family Planning in New York City.

NYCDOH and the School of Public Health joined forces earlier on a special project to meet the objectives set forth in the U.S. Department of Health and Human Services “Healthy People 2000.” With multiple-year funding from the Health Resources and Services Administration, the Model Health Department/School of Public Health Collaborative Project represents a mutual effort to strengthen ties in order to meet the nation’s health objectives. The primary goals in the first year were to facilitate the exchange of School faculty and NYCDOH staff for applied projects and teaching activities and to create a joint Steering Committee to oversee shared projects. These included an assessment of health needs in the communities of Harlem and Washington Heights/Inwood, and projects focusing on areas of particular concern to inner-city minority populations, such as infant mortality, child health, tuberculosis control, prenatal care, pediatric ambulatory care services, child immunization status, lead poison prevention, improved tracking of TB patients, family planning, and violence.

Assessment Protocol for Excellence in Public Health Project

In 1992, the School and NYCDOH began an effort to utilize a nationally developed organizational assessment tool for small area planning in two New York City neighborhoods. After pilot testing the model, many practical difficulties were identified with the application this model to a decentralized organization like the NYCDOH. The scope of this project was tailored to fit the structure of NYCDOH and encompassed two distinct elements: investigating the general utility of an organization self-assessment and community-oriented health planning at large metropolitan health departments nationwide, and compiling a community chart-book for one New York City neighborhood for use by NYCDOH health planners and community interest groups.

Center for History and Ethics of Public Health

The Center is presently consulting on a project to detail a historical timeline of the history of disease in New York for the NYCDOH. And in collaboration with Columbia’s Oral History Office, the Center is working with the NYCDOH on an oral history of the Department of Health’s executives and workers regarding their experiences during and following the events of 9/11/2001.

Other collaborative efforts with NYCDOH

Faculty of the Department of Sociomedical Sciences have served on recent task forces of the NYCDOH. One task force on behavioral health resulted in the creation of an Office of Behavioral Health last year. And faculty from the Center for Gender, Sexuality, and Health have provided leadership on a task force on gay men’s health.

The Harlem Center for Health Promotion, with the NYCDOH, is sponsoring a preventive medicine resident to carry out a project with Center and with community organizations.

Faculty of the Departments of Epidemiology and Sociomedical Sciences are collaborating with NYCDOH to prepare frontline public health workers to deal with the special threats posed by

Infectious diseases (both newly emerging infectious diseases, and HIV, TB, and STDs), bioterrorism, and other emergency situations.

Collaboration with the New York State Department of Health

In ongoing collaboration with the New York State Department of Health (NYSDOH), the School has links with a number of projects including:

Healthy Heart Programs

The Heart of Harlem and Washington Heights/Inwood Healthy Heart Programs use multi-targeted approaches to reduce morbidity from cardiovascular disease, including outreach to the community through churches, businesses, schools and radio stations.

Population and Family Health programs

Collaborative projects with the NYSDOH and the School’s Department of Population and Family Health have included: maternal and child health internships, analysis of low birth weight trends and ethnic differences in lifestyle during pregnancy, pregnancy outcomes in native-born and foreign-born Puerto Ricans, prenatal care in Central Harlem, HIV transmission in breast milk, childhood injury problems in New York City, evaluation of family planning, and community-based immunization services.

Tobacco use prevention programs

The Harlem Center for Health Promotion is collaborating with the NYSDOH and NYCDOH on policies to prevent tobacco sales to minors.

School programs that provide direct services to populations in need

Center for Community Health & Education (CCHE)

The Mailman School’s Department of Population and Family Health has a long history of providing direct services to populations in need. For over 25 years, the Department’s Center for Community Health & Education (CCHE) has provided primary health and reproductive health services to women and adolescents in Northern Manhattan. These services, delivered through a network of clinic sites, located in the community and six local public schools, represent a joint effort between the Center, the Mailman School, and the Ambulatory Care Network Corporation of the New York Presbyterian Hospital. CCHE also collaborates with the local public schools, the College of Physicians and Surgeons’ Departments of Pediatrics, Obstetrics & Gynecology, Psychiatry, Family Medicine, and Ophthalmology, and with the School of Dental and Oral Surgery.

In addition to medical, mental health, and health education services at these clinics, CCHE has an extensive parent-education program, HIV prevention, teen pregnancy, and tobacco prevention programs that reach hundreds of participants and are designed with the recognition that a single approach or strategy to good health is unlikely to be successful, given multiple problems confronting a community.

The overall goals of CCHE are to: provide comprehensive women’s health care services; provide primary health care services, including medical and mental health services, as well as HIV-related education, counseling, and testing to prevent early childbearing; delay initiation of first intercourse; increase use of effective contraception among the sexually active; and empower parents to become advocates for themselves and their children.

CCHE’s major service programs are described below:

Family Planning Program

CCHE provides comprehensive women’s health care and counseling through its community health clinic, open to adult women Monday-Thursday; the Young Adult Clinic for adolescent females open two evenings; and the Young Men’s Clinic for adolescent males, open two days a week. In 2001 these clinics provided over 30,000 visits.

These health clinics are often the first entry point and primary source of health care for adult women and adolescents in Washington Heights. These clinics provide counseling and social work services, comprehensive women’s health care, a full range of contraceptives, pregnancy testing, STD screening and treatment, HIV-related services, emergency contraception, and colosposcopy.

In addition, the clinics serve as an entry point into prenatal care. Women who are pregnant and wish to carry to term can apply for Medicaid on-site and get their first prenatal appointment within two to three weeks.

CCHE’s clinics offer a bilingual staff of social workers, nurse practitioners, physician assistants, health educators and doctors trained to provide “whole person” care to assess a patient’s overall physical and mental health status.

Young Adult Clinic and Young Men’s Clinic

Although young women and men can be seen at all times when the Family Planning Clinic is open, the Clinic caters to the needs of young women and men three evenings a week and on Friday afternoons. The clinic staff available to help young people through these volatile years includes physicians specializing in adolescent medicine, nurse practitioners, social workers, health educators, and first-year medical students from the College of Physician and Surgeons.

The Young Adult Clinic for female adolescents operates two afternoon/evening sessions. During these times, the medical and mental health staff offers the same services as in the Adult Family Planning Clinic, but with a particular focus on health needs and concerns of teenage girls.

The Young Men’s Clinic takes over on Monday nights and Friday afternoons, serving the long-neglected reproductive education and health care needs of males between the ages of 13-24. For the past ten years, the Young Men’s Clinic has offered a unique “male friendly” environment, where male patients come for health exams, STD/HIV testing and counseling, chronic and/or acute medical conditions, or just to talk with social workers either one-on-one or in a peer discussion group.

Despite national efforts and recommendations from the Beijing and Cairo population conferences calling for male involvement in women’s and children’s health, there are surprisingly few health programs designed specifically to teach young men of the risks and responsibilities involved in sexual relations. The Young Men’s Clinic is in fact the only such program in New York City and one of only a few in the United States.

Comprehensive School-Based Clinics

CCHE established the first of its school-based clinics in 1986 to provide primary health care services for inner-city teenagers in Washington Heights, many of who have no other access to such services. Today, the Center operates health clinics in four junior high schools, at George Washington High School, and until October 2001 at the Center for Continued Education’s Program for Pregnant & Parenting Services in Harlem. Altogether, there were over 30,000 visits to these clinics in 2001.

The Center’s day-to-day medical services include immunization, first aid, comprehensive physicals, management of chronic illnesses, trauma response, and laboratory tests. The clinics also provide free dental care, through collaboration with Columbia’s School of Dental and Oral Surgery, and free eye examinations and eyeglasses.

The Center’s social work and health education services include individual and group counseling, on-site psychiatric assessment and treatment, intensive case management and follow-up crisis intervention, classroom intervention, interface with school personnel, and if needed referral to other mental health resources and health clinics. Thirty percent of all visits to the clinics in 2001 were for mental health reasons.

In Your Face Program

In Your Face is a successful school-based program that enrolls junior high and high school students who are either sexually active or at risk, in an intensive health education course that encourages them to use contraception and condoms to protect against pregnancy and STDs including HIV. Although that pregnancy rates among very young teens nationally and in New York City have risen in the 1990s, the school-based clinics in Washington Heights saw their rates cut by a third.

Community-Based Abstinence Pregnancy Prevention Program

The Community-Based Abstinence Pregnancy Prevention Program promotes abstinence at one of CCHE’s junior high schools where over ten percent of the 7th graders admitted to being recently sexually active. Implemented in the 1997 school year, the program is funded by the NYSDOH and reflects a national effort to encourage teenagers to postpone sexual activity as a way to safeguard against unwanted pregnancies and STDs.

Junior high school is a critical time to reach young people with a classroom-based curriculum that stresses risk reduction and human sexuality. The curriculum combines interactive and skill-based coursework with video presentations, role-playing, games, group discussions and even sports and community activities.

HIV/AIDS Prevention Program

The HIV Prevention Program at George Washington High School is a 12-week course on sexuality and HIV incorporated into such mandatory, “non-health” courses as Math and English in order to reach a maximum number of students. Students learn about HIV risk reduction techniques, safe sex, negotiation skills, and prevention. Last school year, the HIV Program pulled together smaller “higher risk” groups for more in-depth discussion; strengthened outreach program to parents; trained peer educators; and brought a pilot version of the course to Special Education students. Having its foundation in a school-based clinic is particularly helpful to the HIV Program as it affords students who think they may have an STD to be tested confidentially in the clinic immediately. Beginning in 2000, the program also introduced “booster” sessions on HIV prevention for graduating 12th graders.

Adult Parent Education Program

A strong parent-child relationship is fundamental to an adolescent’s development. The Adult Parent Education Program focuses on improving communication between children and their parents, working within the different cultures in Washington Heights and involving parents as advocates and educators for their children on a range of issues. From its inception in 1991, over 1,700 parents have been trained, each receiving three-hour sessions over 15 weeks. The parents of elementary and junior high schools participate in discussion topics ranging from adolescent development and sexuality to gender stereotypes and stress management. Many graduates of the program receive additional training in group counseling and teaching skills to conduct parent-to-parent sessions in their own communities. This program has been so successful that there is a waiting list to attend the course.

Tobacco Prevention and Cessation Program

Beginning in July 2001, the Center developed a curriculum-based classroom educational program for tobacco prevention and cessation. The program is based at the school-based clinics and includes a parent education component.

Head Start

The Columbia University Head Start and Early Head Start program, a collaborative program of the School and the Department of Pediatrics, provides home-based services to a high-risk population of young children in Northern Manhattan. The Head Start program, based in the largely Latino community of Washington Heights, serves children and families. Participating families receive individual weekly home visits by a team of bilingual educators, as well as group center-based services. Individual home visits are tailored to the education and social-emotional needs of the child. Teachers model strategies for working with the child, and encourage responsiveness and sensitivity to the child’s needs and developmental stage. Parents are viewed as primary educators of their child, and take an increasingly active role in teaching their child new skills and reinforcing those that have been mastered.

The Early Head Start Program serves children under the age of three and/or pregnant women residing in the neighborhoods of Washington Heights and Hamilton Heights in Northern Manhattan. Bilingual services are provided in conjunction with two community-based outpatient pediatric clinics of New York Presbyterian Hospital and with the Columbia University Head Start program. Services are designed to support parent-child attachment, child health and development, and adult vocational development. An emphasis is placed on normal developmental milestones and each child’s unique temperament and growth.

A main objective of the Columbia University Head Start and Early Head Start program is to support families in achieving economic self-sufficiency. Center-based services include a language enriched socialization group for children and adult development workshops for parents. The program helps parents to identify personal goals and strengths, and to select appropriate training. The following are examples of bilingual training modules offered this year: Computer Skills, Life Skills and Job Readiness, Family Daycare, Child Development Associate, English as a Second Language, Basic Spanish Literacy, and Introduction to Cosmetology. In addition, collaboration with the Ackerman Institute for the Family to support parent transitioning to the workforce is currently underway.

West Harlem Environmental Action Inc. (WE ACT)

The Department of Environmental Health Sciences assists the West Harlem Environmental Action Inc., (WE ACT) a community-based organization whose mission is to improve the quality of life for the underserved communities of Northern Manhattan. This mission is accomplished through a variety of strategies, including collaborative research, community education, and advocacy for policy change. WE ACT’s youth leadership/community service project is investigating whether diesel pollution is linked to the amount of airborne soot and fine particles that penetrate deeply into the lungs. Students collected air-quality data with sampling pumps and counted trucks, buses, cars, and pedestrians at four Harlem intersections. These results, published in the March 2000 issue of Environmental Health Perspectives, documented the influence of diesel exhaust on area residents’ exposure to fine particles.

Children’s Environmental Health Center

Established by the Department of Environmental Health Sciences, this Center is leading an investigation to determine whether prenatal exposure to indoor allergens predisposes some children to asthma, cancer, and neurodevelopment disorders. The long-term, prospective study is following 500 non-smoking, pregnant women. Indoor allergens, including dust mites, cockroaches, and mouse droppings, will be assessed late in their pregnancies. Maternal and infant cord blood, collected during delivery, will be analyzed for sensitivity to allergens and levels of antioxidants. In addition, the Center has launched the “Healthy Home, Healthy Child” community education campaign in Northern Manhattan and the South Bronx, with a focus on air pollution, cigarette smoke, nutrition, and pesticides.

The Harlem Health Promotion Center

In order to more effectively apply research to health services delivery for Harlem residents, the School, in collaboration with the Centers for Disease Control and Prevention (CDC) and Harlem Hospital, established the Harlem Health Promotion Center (HHPC) in 1991. HHPC has become an important community resource, sponsoring programs to reduce morbidity and mortality in Harlem, several of which are highlighted below.

HHPC is working with the Ambulatory Care Network Corporation, the AIDS Center, the Department of Population and Family Health, and the Department of Family Medicine in the Keeping Adolescents and Young Adults Connected (KAYAC) project to bring an adolescent HIV clinic from St. Luke’s Hospital to New York Presbyterian Hospital.

To reduce cardiovascular disease morbidity and mortality, one of the leading causes of death in Harlem, HHPC established the Heart of Harlem program, in concert with community-based organizations. This multifaceted program works with local religious organizations to provide blood pressure screening, CPR training, nutritional counseling, medical referrals, and exercise instruction to thousands of Harlem residents. The Heart of Harlem Community-Based Smoking Cessation Program assists adult smokers with quitting through peer support and positive reinforcement strategies, combined with the use of nicotine replacement therapy. Much of the program’s effectiveness hinges on educating the smoker on the health risks of smoking and modifying behaviors.

HHPC initiated the Prostate Cancer Early Detection Project to improve the odds of survival for black men. Researchers surveyed Harlem residents and local physicians to determine their attitudes toward prostate cancer screening, prevention, and treatment. The survey revealed that only 16 percent of the eligible community had been screened for prostate cancer, and that most at-risk men knew little about the disease or its prevention. HHPC is now implementing a health education program to promote regular screening and reduce risk factors for prostate cancer.

Other major HHPC projects include: research on reducing health disparities, studies of ways to reduce smoking, and research on promising complementary and alternative treatments for chronic diseases. In addition, the Center is playing a national leadership role in implementing strategies to strengthen linkages between academic research and community partners.

Center for Environmental Health in Northern Manhattan

Established by the Department of Environmental Health Sciences, the Center carries out basic and applied research on the role of environmental exposures on development of cancer and respiratory and neurodegenerative diseases. A specific focus is on exposures relevant to the communities in Northern Manhattan as well as the interaction between these exposures and genetic susceptibility. A Community Outreach and Education Program has formed partnerships with community groups, in particular West Harlem Environmental Action, Inc. (WEACT), to promote education of local communities and to foster awareness of the research efforts and their public health significance.

Northern Manhattan Women and Children HIV Project

Women, children, and adolescents in Upper Manhattan’s poorest neighborhoods account for nearly half of the AIDS cases in New York City. The Northern Manhattan Women and Children HIV Project teaches prevention and provides community-based, culturally sensitive care to families affected by HIV. One of the largest pediatric AIDS programs in the country, the program has already reduced HIV transmission from pregnant mothers to newborns, expanded access to clinical trials, and improved comprehensive health services for HIV-infected women and children.

Northern Manhattan Adherence Initiative

Antiretroviral therapy for HIV/AIDS often involves complicated regimens that are especially difficult for children and adolescents, as well as for single parent women who often neglect their own health to care for their children. The Northern Manhattan Adherence Initiative helps pregnant women, adolescents, and their caregivers adhere to therapy.

Northern Manhattan Start Right Coalition

The Northern Manhattan Start Right Coalition, launched in 2000 in partnership with Alianza Dominicana and the Harlem Congregations for Community Improvement, is identifying strategies to improve the on-time immunizations for children in Northern Manhattan.

Collaboration with other organizations and communities: U.S. programs

Residency programs in public health and preventive medicine

The Department of Health Policy and Management manages the School’s collaboration in medical residency programs in public health and preventive medicine, with the NYCDOH, with the State University of New York at Stony Brook, and with Cornell University. Residents in these programs, and in several other residency programs in the New York area complete their MPH studies at the Mailman School.

City University of New York (CUNY)

The Center for the History and Ethics of Public Health works with the City University on a variety of projects regarding occupational and environmental disease.

Milbank Memorial Fund

With support from the Milbank Memorial Fund, the Center for the History and Ethics of Public Health is involved in two projects. The first is a project to detail the history of occupational and environmental health. This will result in a book, to be published in Fall 2002, by the Fund and the University of California Press. The second project is a contribution on the history of labor and health that will appear in another Milbank publication.

Other community organizations

The Harlem Health Promotion Center is working with many community-based organizations in Northern Manhattan to provide high-risk adolescents with primary care and treatment of HIV and sexually transmitted diseases. One effort, the Gonorrhea Community Action Project (GCAP) is a collaborative effort to encourage adolescents and young adults to seek regular health care, and to improve the delivery of that care. The project works with community organizations and leaders of Central Harlem to incorporate important adolescent issues into a more comprehensive approach to health care. GCAP also works to: enroll adolescents and young adults into an intensive skill building workshop to help navigate the health care system; train providers in Central Harlem to work more effectively with adolescents, specifically around areas of sexual history taking; develop and implement a community-wide media campaign to reinforce the importance of regular health care; and increase the services available to teens at local STD clinics.

U.S. government and other organizations working on issues of child poverty

The National Center for Children in Poverty consults with and works closely with a wide variety of policymaking organizations in its efforts to identify and promote strategies to reduce child poverty and to improve the life chances of the millions of U.S. children who remain in poverty. These include:

Federal Level: The U.S. Department of Health and Human Services (Assistant Secretary for Children and Families; Assistant Secretary for Planning and Evaluation; Head Start Bureau, Child Care Bureau); the National Institutes of Health, and the Center for Disease Control and Prevention.

State Level: The National Governor’s Association, American Public Human Service Associations, Welfare Information Network, and officials in the executive and legislative branches of dozens of individual state governments. Let’s Invest in Families Today (LIFT), a major new NCCP initiative, integrates communications research and policy research in support of state-level efforts to reduce child poverty and improve family economic well being. NCCP is collaborating with a growing network of state-based organizations to develop a web-based “tool box” that will facilitate and accelerate cross-state learning about effective strategies to identify and promote sound investments in low-income families.

In addition, NCCP works closely with both research and advocacy groups such as the National Academy of Sciences, the Social Science Research Council, the joint Center for Poverty Research (at the University of Chicago/Northwestern University), the Institute for Poverty Research (University of Wisconsin) and the National Association of Child Advocates, to design and effectively disseminate policy-relevant research on child poverty and family economic security. The Center has also become an informal advisor to groups in other countries, (e.g. Ireland, Israel, South Africa) who wish to develop university-based child policy research centers.

Collaboration with other organizations and communities: international programs

Preventing Maternal-to-Child-Transmission Plus (MTCT Plus) HIV/AIDS Initiative

The Mailman School is leading a major international effort, supported by an unprecedented collaboration of private foundations, to coordinate a global effort to expand HIV/AIDS care in resource-poor areas in Africa, Asia and Latin America. Total funding for the initiative, over the course of the five-year project, is expected to be $100 million.

The Dean and leaders of the private foundations met with the UN Secretary General in December 2001 to announce the initiative, which is in direct response to the Secretary General’s call, issued in 2001, for a Global Fund to Fight AIDS, Tuberculosis and Malaria. Although groundbreaking progress is being made in preventing mother-to-child-transmission (MTCT) of HIV, the absence of care for mothers has been identified both as a moral dilemma and as a disincentive to participation. MTCT-Plus seeks to extend HIV treatment to women so they will have the possibility of surviving their own HIV infections for a substantially extended period.

The Mailman School team will manage the technical and operational aspects of the program, and will lead a broad coalition ranging from technical and service organizations in developing countries to international institutions and non-governmental organizations (NGOs). The program builds on ongoing work in mother-to-child-transmission prevention, including programs administered by UNICEF, the Elizabeth Glaser Pediatric AIDS Foundation, Medecins Sans Frontieres, ministries of health, and national NGOs.

Averting Maternal Death and Disability Program (AMDD)

The Averting Maternal Death and Disability (AMDD) Program in the Department of Population and Family Health is a five-year, $50 million project funded by the Gates Foundation to increase the availability and quality of emergency obstetric care in developing countries. The project is utilizing a collaborative approach whereby a small New York based staff works with major international agencies utilizing their networks and staff to implement projects to prevent maternal deaths. AMDD is collaborating with UNICEF, UNFPA, CARE, the Regional Prevention of Maternal Mortality (RPMM) Program, and Save the Children to work in countries in South Asia, Africa, and Latin America.

In addition to the relatively small New York based technical team, AMDD has partnerships with Family Health International, John Snow International, and the Indian Institute of Management for technical assistance with needs assessment, project design, and monitoring/evaluation activities.

Program on Forced Migration and Health

The Program on Forced Migration and Health in the Department of Population and Family Health was developed in response to the need for technically sound approaches to issues faced by health professionals who provide human assistance in complex emergencies. The program has three main areas of activity: post-graduate training in public health in preparation for careers in international assistance; short-term training for public health professionals currently working in the field; and research into the relationship between public health and migration. The continuing education activities in the program are described in detail in the following section.

Two of the major activities of the program are the management training program undertaken in collaboration with the International Rescue Committee (IRC) and a training program for health professionals working with complex emergencies:

Improving Skills in Program Design, Monitoring, and Evaluation in Forced Migration Settings

The program is working closely with the IRC to introduce and expand its reproductive health services and to improve its programs in its other technical fields as well. The program is working with the IRC to develop and test a training curriculum and field manual on sound programs in primary health care, water and sanitation, construction, agriculture, microenterprise, and women in development. Regional workshops have been held for IRC staff around the world.

Training for Personnel in Complex Humanitarian Emergencies

The program is developing short-term, intensive training courses for health professionals working with complex humanitarian emergencies. Between 2001-2004, ten two-week training sessions will be offered in the U.S., Europe, Africa, and Asia. Trainees will include key staff of government and non-government organizations that are involved in humanitarian relief. The IRC will coordinate the participation of non-governmental and private volunteer organizations.

Associação Brasileira Interdisciplinar de AIDS (ABIA)

The Chair of the Department of Sociomedical Sciences is also President of ABIA, the first Brazilian national NGO to focus on HIV/AIDS. ABIA has sought to advance the civic discourse on HIV/AIDS through research, policy analysis, advocacy, and public education. Much of its early work centered on providing legal assistance to people living with HIV, setting important case law precedents that helped curb discrimination in the workplace and human rights violations in the health care system.

Global Fund to Fight AIDS, TB, and Malaria

The Global Fund to Fight AIDS, TB and Malaria, was initiated through the United Nations, but set up this year as a fund independent from the U.N., with $2 billion committed by governments and other donors. The School hosted the second international meeting of the Fund on the Columbia campus in April 2002.

Nelson R. Mandela School of Medicine of the University of Natal

In a formalization of collaboration between the School and the Nelson R. Mandela School of Medicine of the University of Natal in Durban, South Africa, the School is assisting in expanding the public health curriculum of the Mandela School, and working to develop an exchange program for students and faculty of the two schools.

National Medical School of Mali

In September 1997, the Department of Population and Family Health collaborated with the National Medical School of Mali and University of Rochester to organize the International Conference on the Promotion of Immunizations in West Africa. Participants from six Sahelian countries presented their innovative immunization strategies, which were critiqued and synthesized by the group of assembled international experts. The conference highlighted the findings from a five-year collaborative study, conducted by the Department of Population and Family Health, the National Medical School of Mali, and the University of Rochester, which documented the importance of tracking and recall efforts, both in New York and in Mali.

Collaborative HIV/AIDS Project in Uganda

A collaborative research project with the Makere University in Kampala, Uganda, provides medical care for people with HIV/AIDS and other sexually transmitted diseases, as well as community-based health education designed to curtail the spread of HIV.

Asian American Network for Cancer Awareness Research and Training (AANCART)

The Department of Sociomedical Sciences participates in the newly funded Asian American Network for Cancer Awareness Research and Training, in collaboration with Ohio State University, Weill Medical College of Cornell University, Dana Farber Cancer Institute, the University of Hawaii, the California Department of Health, the Fred Hutchinson Cancer Research Center, UCLA, and the University of California at San Francisco. The goal of AANCART is to increase awareness of cancer risks, to stress the value of early detection in reducing mortality, to conduct research of factors influencing risk, and to identify avenues required for quality end-of-life care among Asian American cancer patients.

VII.3. A description of the school’s continuing education program, including policies, procedures and practices that support continuing education.

The need for a well-trained public health workforce to face the major challenges of this century is well documented. (Institute of Medicine, 1988, The Future of Public Health; CDC/ATSDR, 1999, Toward a Life Long Learning System for Public Health Practitioners; CDC, 2000 Report of the Task Force on Public Health Workforce Development).

The CDC 2000 Report notes that “an estimated 80% of the workforce has no formal training in public health and are not prepared to deal with the challenges of 21st century practice.” The Mailman School is well positioned in the New York metropolitan area to provide continuing education to the large public health workforce in New York City, New York State, and the tri-state area. Our primary continuing education activities are carried out in collaboration with the NYCDOH, the NYSDOH, and a number of local provider and community organizations.

The policies of the School in support of continuing education are based on the need to provide health professionals with appropriate learning opportunities to update and enhance their knowledge and skills in priority areas of public health practice, under the following guidelines:

a. The development of educational programs to meet current needs of public health practitioners at local, state, and national levels.

b. Given the strengths of the School’s international programs, it is also appropriate to incorporate education and training in the global research and service activities of the School.

c. The development of partnerships with practice organizations and other educational institutions, to insure the relevance of continuing education activities and to increase the opportunities for practice organizations to develop ongoing educational resources.

d. The establishment of programs and organizational arrangements to aggressively seek external support for activities and by encouraging service programs to cover costs in order to avoid adding financial burdens to trainees:

1) by seeking funding from federal, state, and local agencies, and from international agencies, responsible for supporting public health programs (e.g. NIH, NIOSH, NYSDOH, NYCDOH, WHO, etc.)

2) by establishing registration fees for continuing education programs and working to see that funding to cover these fees is included in the budgets of practice organizations and donor agencies

3) by educating policymakers at all levels regarding the importance of providing resources for the continuing education of public health workers, and working to see that the need and funding for continuing education are routinely included in program guidelines and budgets.

VII.4. A list of the continuing education programs offered by the school, including number of students served, over the last three years.

Important examples of the School’s continuing education initiatives include:

AIDS education

The School, through the Department of Sociomedical Sciences, is the recipient of a $6.5 million HRSA grant to provide continuing AIDS education to New York State and U.S. Virgin Islands. This program, the New York/Virgin Islands AIDS Education Training Program (NY/VI AETC), contracts with ten academic medical centers throughout New York State to provide regionally based training to a broad spectrum of health professionals. In keeping with the U.S. Department of Health and Human Services focus on prevention, the NY/VI AETC has developed a wide range of prevention-oriented programs for health professionals.

In the budget year July 1, 1999-June 30, 2000, the AETC carried out 658 training programs, serving more than 13,000 participants, and many of the providers participating attended more than one training session. Participants are drawn primarily from providers—physicians, nurses, dentists, and other clinicians. Priority is given to providers of color and providers who serve marginalized, rural, and minority populations. The Logistics and Training Core of the AETC accounts for approximately 60% of the training programs. Other training centers include the Albany Medical Center, the State University at Stony Brook, and the Adolescent AIDS Program.

Center for Public Health Preparedness

The Center for Public Health Preparedness was established in October 2000 with funding from the Centers for Disease Control and Prevention, through a cooperative agreement with the Association of Schools of Public Health. One of the first four academic centers to be funded, the Center’s general purpose is to link public health practice and academe, and develop and deliver competency-based curricula in public health that address local needs and could also serve as models for national replication. It is also a goal to develop and provide materials through technology-supported learning, such as via the internet, so that public health professionals can receive training to best meet their needs.

The Center at the Mailman School is partnering with the NYCDOH to focus on emergency preparedness, including preparedness for bioterrorism and infectious diseases. In addition to training and evaluation, the Center has also been working with the NYCDOH on reviewing and refining preparedness plans. Emergency preparedness competencies for public health, based on compentency-based training, has been developed by the Center in collaboration with colleagues at the School of Nursing.

The first training program was designed for school health nurses. New York City’s 900 school nurses represent a large pool of professional, clinically trained people that could assist in an emergency. Their primary emergency role is opening and staffing shelters. In fact, this is exactly what happened after September 11. After a pilot run in June, the basic emergency preparedness training program (given in conjunction with the American Red Cross) was completed by 800 school nurses in late August. On September 11, a number of the nurses who participated in the training were called in to staff shelters or volunteer in other capacities. Because they had received this type of training, they said they were able to hit the ground running.

Since September 11, the Center has continued to work closely with NYCDOH and other city agencies to identify continuing preparedness and education needs and, in response to their requests, help to evaluate the city’s response to the disaster. During the emergency, the Center helped to coordinate the School’s response, for example by providing the city (as well as CDC) with a database of qualified volunteers from the School’s faculty who could help to provide emergency surge capacity if needed. The Center has also been working with the New York-Presbyterian Hospital system, which covers about one-quarter of the patients in the greater New York City area, to develop improved surveillance and plans for enhancing the interface between public health and the hospital system. Recognizing that public and provider education is a key need, the Center developed and provided training programs on bioterrorism response for clinicians, in partnership with the New York Academy of Medicine, New York State Medical Society, and other organizations, and provided lay language information through community forum presentations and the School’s website. In the wake of September 11 and the anthrax events, Center members gave over two dozen presentations at community forums, seminars, and clinical rounds, and over 100 press interviews. There are ongoing needs in these areas, as well as in the closely related area of emergency department preparedness, which the Center is continuing to address.

An Advisory Committee of national experts and representatives from the practice community guides the work of the Center. The Advisory Committee met in January 2002. Committee members represent: University of Pittsburgh School of Public Health, USAMRIID, CDC/PHPPO, White House Office of Science & Technology Policy, FBI, local health departments, CDC/NCID, DHHS, and The Rockefeller University.

New York/New Jersey Public Health Training Center

In an exciting new collaboration, the Mailman School of Public Health is a partner in a regional continuing education program for New York and New Jersey public health workers, a comprehensive public health program covering a full range of public health competencies. The School is collaborating with the NYCDOH, the NYSDOH, the State University of New York at Albany School of Public Health, the New Jersey Department of Health and Social Services, and the University of Medicine and Dentistry of New Jersey School of Public Health, to develop curricula for critical areas of public health.

The NYCDOH workforce typifies the public health workforce nationwide in comprising a heterogeneous array of professional and non-professional titles. Included in the NYCDOH workforce are 990 clinicians (850 nurses and 140 physicians); 1,065 administrative staff; 900 outreach staff (public health advisors); and 255 staff involved in epidemiology and evaluation (160 epidemiologists and 95 research scientists) for a total of 3,210 full-time workers. And during summer school sessions, the number of NYCDOH workers increases to close to 5,000 employees.

In addition to the NYCDOH workforce described above, New York State’s public health workforce includes the NYSDOH and 57 local county health departments. NYSDOH employs 5,525 full-time staff. The majority (3,345) are assigned to Albany and the Capital Region. The State also staffs regional offices in the Metropolitan Region (New York City), Central Region (Rochester) and Western Region (Buffalo and Rochester). There are another nine state district offices offering environmental services in 20 counties.

New Jersey has 115 local health departments that provide services to over 8 million people in the state. Most local health departments in New Jersey serve populations of less than 100,000. According to a survey completed by the New Jersey’s Health Officer’s Association, the percentage of types of staff employed in the public health workforce in New Jersey includes health officers (4.8%), public health nurses (20.3%), registered environmental specialists (14.7%), animal control officers (4.8%), and environmental specialists (3.0%). Another study identified several areas in which local health departments needed increased capacity, including planning, epidemiology, and communicable disease prevention. The New Jersey Department of Health and Social Services (NJDHSS) has had a licensure program for local health officers and registered environmental health specialists for nearly 100 years. In 1998, the NJDHSS established requirements for continuing education of these public health practitioners as a condition of annual license renewal.

The Center will focus its continuing education activities for the public health workforce on ten essential services of public health, with all learning directed at improving performance in these services:

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Enforce laws and regulations that protect health and ensure safety

• Inform, educate and empower people about health issues

• Mobilize community partnerships to identify and solve health problems

• Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Assure a competent public health and personal health care workforce

• Develop policies and plans that support individual and community health efforts

• Research for new insights and innovative solutions to health programs

Crosscutting core competencies for the training programs include the following skills:

• Analytic/assessment

• Cultural competency

• Community dimension

• Leadership and systems thinking

• Policy development/program planning

• Financial planning and management

• Communication

• Basic public health sciences

Public Health in Complex Emergencies Training Program

The Training Program for Public Health in Complex Emergencies is a project of the Program on Forced Migration and Refugees in the Department of Population and Family Health, in partnership with International Rescue Committee and World Education, Inc. The training program is a two-week course that focuses on critical public health issues faced by NGO/PVO personnel working in complex emergencies such as Sudan, Uganda, Kosovo, Indonesia, Sierra Leone, and Afghanistan. The course combines what is scientifically optimal with what is operationally feasible in emergencies, covering key technical competencies in epidemiology, communicable disease, environmental health, nutrition, reproductive health, psychosocial issues, ethics, violence, weapons and trauma, and coordination. Since June 1999, there have been six courses implemented on four continents. The program, partially funded by USAID/Office of Foreign Disaster Assistance, has trained 170 health professionals representing over thirty humanitarian organizations.

Training Program in Reproductive Health for Consortium on Refugees

The Department of Population and Family Health, with funding from the David and Lucile Packard Foundation and the Bill and Melinda Gates Foundation, has undertaken a program in reproductive health for forced migration and refugee communities.

There are an estimated 40 million forced migrants in the world. They suffer death and illness at rates two to three times higher than those in stable populations. There is a clear gender inequity in access to basic needs such as food, shelter, and health care. Violence is a routine fact of life, and sexual violence, including rape, forced marriage, and sexual coercion, may be overt. Yet prior to 1994, there were virtually no family planning or safe abortion services and few reproductive health services of any kind available to refugees and the displaced around the world. The shortage of program and institutional experience is a constraint to planning effective programs.

The Department supports the establishment of programs to improve access to and use of quality services in forced migration settings. Projects are facilitated by member agencies of the Reproductive Health for Refugees Consortium, of which the Department of Population and Family Health is part, and incorporate the expertise of indigenous NGO’s in the field. The Consortium, formed in 1994, includes the American Refugee Committee, Care, International Rescue Committee, the Women’s Commission for Refugee Women and Children, John Snow Research and Training Institute, Marie Stopes International, and the Department of Population and Family Health.

A particular focus of the Department’s work with the Consortium member agencies is a network of ten field projects that aim to introduce or expand high-quality reproductive health services provided by Consortium agencies and their partners. Department faculty provide high-quality technical assistance to these service projects and to the field in general, focusing on reproductive health project design, monitoring and evaluation, and using the results to further improve the programs. They also assist in documenting and disseminating results to the international relief, reproductive health, and development communities, including multinational and government agencies, donors, international, and local NGO’s and community groups.

To assist the projects in the field and the Consortium member agencies, the Department holds

two workshops per year for staff from the 10 field projects and from headquarters, provides technical assistance during field visits to the 10 sites, and provides substantial additional assistance through email and other contacts. The first three workshops for project staff, during 2000 and 2001, with 30-35 participants each, were held in Hungary, Washington and Entebbe. New programs are underway in Afghanistan.

Center for Community Health & Education (CCHE)

The previous section (VIII.2) described the Center for Community Health & Education’s current service activities in considerable detail, so the all of the continuing education components of the Center’s programs will not be repeated here.

Adult Parent Education Program

A strong parent-child relationship is fundamental to an adolescent’s development. The Adult Parent Education Program focuses on improving communication between children and their parents, working within the different cultures in Washington Heights and involving parents as advocates and educators for their children on a range of issues. From its inception in 1991, over 1,700 parents have been trained through a program of 15 three-hour weekly sessions. The parents of elementary and junior high schools participate in discussion topics ranging from adolescent development and sexuality to gender stereotypes and stress management. Many graduates of the program receive additional training in group counseling and teaching skills to conduct parent-to-parent sessions in their own communities. This program has been so successful that there is a waiting list to attend the course.

Averting Maternal Death and Disability Program (AMDD)

The goal of the Averting Maternal Death and Disability Program (AMDD) in the Department of Population and Family Health, supported by the Bill and Melinda Gates Foundation, is to improve the availability, quality, and utilization of emergency obstetric care in developing countries. To accomplish this goal, the program has established project and technical partnerships. Project partners include UNICEF, UNFPA, CARE, Regional Prevention of Maternal Mortality Network, Save the Children, Federation Internationale de Gynecologie et Obsterique, and Women’s Commission for Refugee Women and Children. Technical partners include Family Health International, Engender Health (formerly AVSC), John Snow International Research and Training/UK, and the Indian Institute of Management at Ahmedabad.

Continuing education in the program occurs in several forms including formal workshops, dissemination of information, informal meetings, and small group programs. A training program on “Guidelines for Organizing and Managing Emergency Obstetric Care” was offered by Center faculty in Fall 2000 at several sites in Bangladesh and Pakistan. A total of 380 professionals attended the sessions in Bangladesh and 185 in Pakistan. Topics included technical, management, and human rights issues. Team training (consisting of a doctor in OB/GYN and in anesthesia and at least two nurses), team building, management of facilities, as well as supervision and monitoring were also covered.

The AMDD program also provides financial support, through a subcontract, to the Regional Prevention of Maternal Mortality Network, which consists of multidisciplinary teams in sub-Saharan Africa working in partnership with governments, communities, and other stakeholders to prevent maternal deaths especially in rural and poor urban communities. Participating countries include: Ghana, Nigeria, Sierra Leone, Kenya, Tanzania, Uganda, Benin, Burkina Faso, Guinea, Mali, Togo, Liberia, Botswana, Malawi, and Zimbabwe. One workshop of this group, “Mobilization of Local Resources to Promote Program Sustainability,” was held in Zimbabwe in April 2001, with 190 participants, comprised of ten person multidisciplinary teams from 19 countries. Another training course, a ten-day program on “Design and Evaluation of Projects” is held twice each year for approximately 25 participants

In AMDD’s first annual workshop, held in Morocco in February 2001, 120 participants from Bangladesh, Benin, Bhutan, Ethiopia, Ghana, India, Liberia, Kenya, Mali, Morocco, Mozambique, Nepal, Nicaragua, Pakistan, Peru, Rwanda, Sri Lanka, Tanzania, Tajikistan, Togo, Vietnam and Zimbabwe met to share experiences and learn from colleagues. Workshop participants were a diverse group, including project officers and managers in development organizations, health officials, managers, project officers in health ministries, members of university faculties, obstetricians, gynecologists and midwives, directors of hospital departments, evaluation specialists, and management experts.

The second annual workshop, held in Bangkok, Thailand in February 2002, brought together participants from 26 countries—project partners, technical partners, service providers, policymakers, and the core AMDD team. The workshop’s overarching theme was implementation and many sessions addressed the activities necessary to ensure that emergency obstetrical care is available, accessible, and used. Other sessions focused on the implementation of human rights principles—a key area of the AMDD framework—into emergency obstetrical care projects. Tools and resources were disseminated to assist programs in implementing and assessing their work.

AIDS International Training and Research Program (AITRP)

The School and the South African Medical Research Council have been involved in collaborative research since 1993. Through the support of the Fogarty International Center, this collaboration has selected, trained and nurtured more than 18 long-term and 22 short-term fellows. The fellows are South African AIDS researchers, some have trained at the Mailman School of Public Health and others have trained in southern Africa. The long-term fellows have received masters and doctoral degrees in epidemiology, while the short-term fellows participate in continuing education, including formal courses in the Mailman School taken as non-degree students. Researchers in this collaboration have secured five NIH grants (the Fogarty tuberculosis training grant, the HIV vaccine trials unit, the Medical Research Council HIV prevention trials unit, the Columbia University HIV prevention trials unit, and a grant for research on adolescent sexual behavior).

The project was initiated in 1993, a critical time for South Africa as it was entering a new political era and facing the worsening AIDS epidemic. The years of isolation during apartheid and specific apartheid policies suppressed the development of a strong cadre of scientists in public health. The Mailman School Fogarty AITRP sought to fill this gap by providing training for a first cadre of South African scientists to help lead the country’s HIV/AIDS prevention efforts.

In addition to the continuing education courses provided, AITRP is helping to build the institutional capacity in southern Africa for training additional epidemiologists to deal with HIV/AIDS. South Africa is in the process of developing its schools of public health, and AITRP is helping in this endeavor. Many of the short courses offered through the program have formed the launching pad for longer, more comprehensive courses at these nascent schools of public health. For example, at the invitation of the Thusano School of Public Health, an HIV/AIDS module for researchers and program managers was developed and piloted. This module will initially be a component of the short-term courses to be offered by this emerging school of public health and, once the MPH Program has been established, it will form one of the school’s core courses.

Management Institute for Clinical Chiefs

The Management Institute for Clinical Chiefs in the Department of Health Policy and Management provides a problem-based learning program for the changing health care environment of academic medicine. Offered in 1998 and 1999, it was designed specifically for a limited number of physician executives who provide leadership for clinical departments of teaching hospitals and academic medical centers. Fifteen physician executives participated in the Institute in 1998 and thirteen in 1999. The Institute, composed of two intensive four-day residence workshops, allowed participants to explore critical issues relevant to the unique circumstances of their departments in a relaxed, confidential, and supportive environment. Major issues explored included establishing and managing effective alliances and partnerships, providing quality tertiary and quaternary care within the constraints of deepening cost- and treatment-control pressures, financing of clinical research and education, negotiating for resources, maintaining productive relationships with primary care physicians and other “gatekeepers” in the face of growing competition, and merging and coordinating organizational forms and roles.

Between the two four-day workshops, held six weeks apart, participants carried out a strategic project, giving them a structured, guided opportunity to apply the concepts of the Institute directly to the current needs and challenges facing their departments. Projects were critiqued in small peer groups, each with an experienced faculty advisor.

This Institute was designated under the Accreditation Council for Continuing Medical Education (ACCME) for up to 52 hours in Category 1 credit towards the AMA Physician’s Recognition Award.

Women’s Health Management Institute

The Women’s Health Management Institute, “Problem-based Learning for Professionals in Women’s Health,” offered March 2-6, 2001 through the Department of Health Policy and Management, was designed specifically for senior-level professionals in women’s health across the health care industry, including medical directors, administrators, service line managers, and professionals involved in policy and program development of women’s health services.

Thirteen senior-level professionals participated in the Institute. Major issues explored included:

redesigning marketing and management strategies for women’s health programs; defining the rules of evidence-based practice for women; responding to changing demographics/a growing midlife and older female population and decline in births; promoting interdepartmental participation and coordination of care across sites; managed care insurance risk sharing practices; making a business case for women’s health; systems integration of women’s health services; and, quality management in women’s health.

This Institute was designated under the ACCME for up to 30 hours in Category 1 credit towards AMA Physician’s Recognition Award, and has been submitted to the New York State Nurse’s Association’s Commission on Accreditation for approval of contact hours.

Free to Grow: Head Start partnership to promote substance-free communities

In a new program, begun in June 2001, The Robert Wood Johnson Foundation, in partnership with the Doris Duke Charitable Foundation, the Mailman School of Public Health and the National Head Start program, launched the four-year $14.4 million Free to Grow national demonstration project. The Free to Grow National Program Office, based at the Mailman School, works with eighteen diverse Head Start communities throughout the country that have been selected as demonstration sites. The program is designed to assist Head Start agencies and their community partners to adapt and evaluate integrated family and community strengthening approaches to reduce children’s vulnerability to substance abuse and other high-risk behaviors as they grow older. One aspect of the project will be a leadership development program to provide continuing education to professionals serving young children.

The Injury Free Coalition for Kids: Building safe communities

With support from the Robert Wood Johnson Foundation, the Injury Free Coalition for Kids National Program Office was established at the Mailman School in 2001. The Injury Free program model—which features educating the community using local injury data, developing a broad-based coalition to address community hazards, building safe play areas, and providing and supporting safe activities with strong adult mentors—is based on the Northern Manhattan Injury Surveillance System (NMISS), created in 1984, which achieved remarkable reductions in childhood injury rates among children in Central Harlem. The Injury Free Coalition approaches its mission of preventing injury to children through its community-oriented program of research, education, and advocacy. By offering grant support, training, and technical assistance, the Coalition will work with over forty pediatric trauma centers across the country to expand its injury prevention program model.

Seminar for reproductive health professionals

In 1998 and 1999, the Department of Population and Family Health held summer seminars in design, monitoring, and evaluation of reproductive health programs. This one-week course was provided to reproductive health professionals at all levels who wished to improve their skills in systematic design and evaluation in real world situations. The Department offered the seminar jointly with Planned Parenthood of New York City. PPNYC senor staff, who are adjunct professors at the School, co-facilitated the seminar with Department faculty. Twenty participants attended each seminar.

American Museum of Natural History

The Center for the History and Ethics of Public Health is collaborating with the American Museum of Natural History on the planning of a volume to accompany a Museum exhibit on human genetics. The Center is also in discussion with the Museum about collaborating on a joint history, ethics, and human genomics training program that would bring together faculty from Columbia and research scientists from the Museum.

New York City Board of Education

The Harlem Health Promotion Center is collaborating with the New York City Board of Education and St. Luke’s Roosevelt Hospital on a project to provide high school students with skills for health seeking behavior and better utilization of school-based health clinic resource.

Alianza Dominicana

In collaboration with Alianza Dominicana, a multi-service community-based organization that provides integrated services for children, youth, and families, the Department of Population and Family Health is developing a program through Northern Manhattan Community Voices to train Northern Manhattan residents in community health outreach and advocacy.

Ben Gurion University of the Negev

The School is collaborating with Columbia’s Institute of Human Nutrition and schools of the Health Sciences on a new MD Program in International Health and Medicine at the Ben Gurion University of the Negev. The program, which trains doctors for the practice of international health and cross-cultural, community and preventive medicine, includes coursework on international health, cross-cultural medicine, community and family medicine, preventive medicine, epidemiology, nutrition, and health care economics; and offers fourth year clinical electives in Israel and at Columbia.

Collaborative training for HIV/AIDS program in Uganda

The Mailman School is conducting a number of studies and service projects in collaboration with the Uganda Ministry of Health, Makere University in Kampala, the Johns Hopkins University Bloomberg School of Hygiene and Public Health, the University of Pittsburgh School of Medicine, and University of Illinois. One intervention trial involves the training of village opinion leaders in a Ugandan district to promote behavioral change related to safer sex practices for HIV/STD prevention.

VII.5. A list of other educational institutions, if any, with which the school collaborates to offer continuing education.

The Mailman School participates in a number of partnerships and collaborations in its research, service, and continuing education programs, and has been successful in obtaining funding to serve as the coordinating organization to establish some of these partnerships and networks, including several important networks for providing continuing education in public health. Many of the organizational relations in the School’s collaborative continuing education activities, as noted above, are with provider, relief and development, and donor organizations. The educational institutions with which the School collaborates, and the collaborative settings, are listed below:

AIDS education – (NY/VI) AIDS Education Training Program

State University of New York at Stony Brook

Montefiore Medical Center/ Einstein College of Medicine

State University of New York at Albany, Health Sciences Center

New York/New Jersey Public Health Training Center

State University of New York at Albany, School of Public Health

University of Medicine and Dentistry of New Jersey, School of Public Health

International agencies working on refugee and forced migration problems

UNICEF

WHO

International Rescue Committee (IRC)

Doctors without Borders

Reproductive Health for Refugees Consortium

International Center for Migration and Health

Averting Maternal Death and Disability Program

Indian Institute of Management at Ahmedabad

UNICEF

UNFPA

CARE

John Snow International

Family Health International

Regional Prevention of Maternal Mortality Program

Save the Children

AIDS International Training and Research Program (AITRP)

Cornell University Medical College

Rockefeller University

University of Natal, South Africa

Thusano School of Public Health, South Africa

Public Health Complex Emergencies Training Program

Makere University, Kampala, Uganda

Catholic University

Collaborative training for HIV/AIDS program in Uganda

Makere University

Johns Hopkins University Bloomberg School of Hygiene and Public Health

University of Pittsburgh School of Medicine

University of Illinois

Collaborative medical and nutrition program

Ben Gurion University of the Negev

VII. 6. Identification of the measures by which the school may evaluate the success of its service program, along with data regarding the school’s performance against those measures over the last three years.

The School carries out regular reviews of its departments, including service programs. In addition, in October 2000 the School completed a formal review mandated by the Provost of all activities. One of Columbia University’s priority goals is responsible partnership with and service to the community. The Mailman School of Public Health is recognized as a leader in Columbia’s direct service programs and in fostering interdisciplinary and interorganizational collaboration in service and research activities.

The School evaluates the success of its service program according to the following measures:

a. The degree to which the established goals of its service program are met:

(1) Continue to strengthen collaborative preventive health efforts with local community groups interested in health and with health care providers in the Washington Heights/Inwood and Harlem areas of Northern Manhattan

• The work of the Harlem Health Promotion Center, the Center for Community Health and Education, and the partnership with WE ACT are some illustrations of the School’s strong partnerships with community-based organizations and health care providers.

2) Partner with city, county, and state health departments in New York and New Jersey in the evaluation of both ongoing and new public health projects and programs, by involving both faculty and students in joint projects with these agencies.

• The School continues to work in close collaboration with city, county, and state health departments in New York and New Jersey, as evidenced by its activities following the September 11 World Trade Center attack and the establishment of the New York/New Jersey Public Health Training Center.

3) Provide consultative services to agencies, both public and private, utilizing the wide-ranging expertise of the faculty of the various departments and centers of the School.

• The National Center for Children in Poverty’s work with a wide range of policymaking organizations, both public and private, and the dissemination of innovative program models through the Free to Grow and Injury Free Coalition national demonstration projects, are examples of the ways that external groups and agencies utilize the faculty’s expertise.

4) Support faculty to serve on committees, boards, and councils of organizations involved in improving the health of public.

• The exceptional faculty involvement and service on committees, board, and councils concerned with public health is shown in the on-site Resource File.

5) Develop programs, embodying the goals stated above, that appropriately adapt these goals to the needs of the international community, particularly in the developing world.

• The School has made enormous progress in expanding its global health programs, initiating over $100 million of support for the Averting Maternal Disability and Death, MTCT-Plus, Forced Migration, and Fogarty Fellows programs.

b. Success in obtaining funding for service activities in priority areas.

c. Success in obtaining external support for continuing education programs and in encouraging service programs to cover the costs of educational activities.

d. The degree of involvement of the School’s faculty and students in service programs.

e. Success in developing strong links between service activities and the research and educational activities of the School.

• The School is proud of its strong track record, and continued progress, in obtaining funding and external support, involving faculty and students in service programs, and developing strong connections among its service, research, and education activities.

The School’s service programs have been very successful, with significant growth in many programs—both domestic and international—in the last three years, as described in this chapter and in Chapter IV, “Resources.” More generally, there are certain values that have guided the School’s development of its service programs:

Our involvement in direct service is a long-term commitment, leading to self-sufficient programs

It is clear that the School’s commitment is for the long term and has led to service programs that are integral parts of Columbia’s Medical Center and community service networks. The reproductive health clinics initiated by the School more than two decades ago are an important element in the services of the Medical Center. The School-based service programs in Northern Manhattan are in their 16th year, and have grown to include participation by other schools in the Health Sciences Campus. And the University-based Head Start Program has been in place for nine years.

Our services respond to national and international needs

Examples are the rapid and extensive response to needs arising from the September 11 World Trade Center disaster; the Program on Forced Migration and Health, developed in response to the growing needs of international refugees; and, the MTCT-Plus program that is responding to the expanding need for HIV/AIDS care and treatment in resource-poor areas in Africa, Asia, and Latin America.

Our service programs show evidence of appropriate and long-term partnerships

One of the School’s strengths throughout its history has been its close collaboration with other organizations and community groups. Examples include the many programs with the New York City and New York State Departments of Health, the Harlem Health Promotion Center, in partnership with Harlem Hospital, and the New York Board of Education for the School-based Program.

Our students are involved in service programs

Students are actively involved in the School’s service programs, as described in Documentation VII.7 below, and many are attracted to the School by the wide variety of opportunities for involvement in service programs. In one example, most of the students with a domestic focus in the Department of Population and Family Health, carry out practicums in one of the School’s service programs.

We are successful in obtaining resources to initiate and carry out service programs

As described in Chapter IV, “Resources” there has been a dramatic growth in support for the School’s service programs in recent years, often initiated by governmental organizations and foundations on the basis of our previous work in priority areas of public health.

We strive to establish mutually beneficial links among service, research and educational programs

The location of the School in the New York City Metropolitan area, and its long-standing partnerships with the major service providers in the area, present an opportunity to develop appropriate links among its service, research, and educational programs. The School considers this an important and challenging opportunity, and gives serious attention to the development of appropriate links. Among the numerous examples, research in Environmental Health Sciences has led to many community education activities and the establishment of several new centers with close ties to community organizations. The many AIDS research projects in Sociomedical Sciences, including the longest-running cohort study of gay men and AIDS, inform a variety of AIDS service programs and student opportunities for classroom education and experience in service and research activities.

VII.7. A description of student involvement in service

Students in the Mailman School of Public Health are involved in many of the service programs of the School and, through the School’s practicum program, in a very large number of service programs carried out by other organizations in the metropolitan area and beyond.

Students are involved in 24 of the 31 major service programs described in this chapter. Students have carried out needs assessments and developed curriculum modules in school clinic programs and the Head Start Program in Washington Heights. They have designed evaluation materials, developed educational materials for clients, trained and supervised HIV education group facilitators, carried out quality assurance assessments of educational materials used by clinics in a wide range of service programs, and played a major role in the collaborative work of the School with local public health agencies, especially in work with the New York City and New York State Departments of Health.

Other examples of the service programs in which students are involved include service with the Harlem Health Promotion Center, the Healthy Start Program, Human Rights Watch, the Breast Exam Center of Harlem, several Planned Parenthood affiliates, the Children’s Aid Society, the New York Blood Center, the American Cancer Society, the PS128 Health Partnership, the Atkinson Center for Diabetic Education, and the Harlem School for Pregnant Teens. International service sites in which students have worked include: the International Rescue Committee in Somaliland and in Guinea, Project Concern in Port-au-Prince, Haiti, the Refugee and Immigrant Program in Toronto, Save the Children in Malawi, the United Nations Development Program in Tblisi, Georgia, the United Nations Fund for Population Activities (UNFPA) in Eritrea, and the Pan American Health Organization in Costa Rica.

In a required practical experience component of their MPH program, students carry out practicums, practical experience assignments, usually for one semester, in a wide variety of programs throughout the greater New York area and beyond. Organizations range from departments of health to consulting firms and include hospitals, insurance companies, non-profit service agencies and community programs. A list of field practicum sites is presented in Appendix V.B.3.

VII.8. Assessment of the extent to which this criterion is met.

The School perceives that this criterion is fully met.

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