Yvorn N. Aswad, MD, MPH is an assistant professor of psychiatry at the Charles R. Drew University in Los Angeles, CA. A native of South Central LA, he earned his doctorate from the Charles R. Drew/UCLA Medical Education Program. Dr. Aswad completed a combined residency in pediatrics, psychiatry, and child and adolescent psychiatry at Brown University, serving as chief resident in his final year. Dr. Aswad aspires to create health systems that deliver care adequately and justly while remaining financially solvent. His research primarily focuses on means of interrupting, preventing, and treating community youth violence. He brings a diasporic lens to his research, having done work at the intersection of violence and mental health in both national and global settings. In 2022 he was named a Donald J. Cohen Fellow of the International Association of Child and Adolescent Psychiatrists and Allied Professionals (IACAPAP) and he continues to remain involved in the organization. Dr. Aswad currently serves in the inpatient children’s unit at Kedren Community Health Center, where he is helping to design and implement the new Kedren Children’s Village.
Yvorn N Aswad, MD
Assistant Professor in Psychiatry, Charles Drew University, Los Angeles, CA
Attending Psychiatrist, Kedren Hospital, Los Angeles, CA
Exploring Methods for Rhode Island to Utilize Medicaid Funding for Violence Prevention Services
Background:
Hospital-affiliated violence intervention programs (HVIPs) have been effective models of reducing the morbidity surrounding community violence. These programs work by leveraging the skillsets and knowledge of social workers, healthcare providers, administrators, and violence prevention professionals (VPP/VIS, a special class of professionals with lived experience of community violence) to build networks that effectively respond to violence and treat its sequelae. Despite the success demonstrated of HVIPs, they are resource intensive and often are reliant on grant funding, which can be unpredictable.
During the previous administration, Medicaid 1115 waivers were allowed to be utilized to fund HVIP program. At present, seven states have approved of this policy, giving the HVIPs in those states more financial sustainability. Determining and preparing readiness for implementing such a policy required engagement from different sectors, including healthcare providers, policymakers, and, most critically, the community based organizations that would host and train the violence prevention professionals.
The EPIS Framework is an evidence-based model for helping organizations work across sectors to build a strategy of implementation for new social services or policies. Occurring in four distinct but iterative phases of Exploration, Preparation, Implementation and Sustainment, the framework helps surface important questions that also can advise on the feasibility and viability of a proposed project. Building on the success of other states utilizing an EPIS framework for approaching the implementation of Medicaid funding for their HVIPs, this model was applied to Rhode Island. Specifically, the first component of the model, Exploration, was heavily leaned upon to best ascertain the feasibility of such a plan in the current moment.
Objectives:
- To identify lessons learned from states that have considered (or even successfully implemented) Medicaid 1115 waivers for HVIP services (specifically CT and PA).
- Engage the EPIS framework for determining the feasibility of using Medicaid 1115 in Rhode Island to fund HVOP services
Methods:
Semi-structured informational interviews were utilized for subject matter experts in states outside of Rhode Island. Resulting domains from those interviews informed were applied to the EPIS framework to generate questions for semi-structured interviews and focus groups in Rhode Island stakeholders.
Results:
Applying the findings from the interviews with leaders in Connecticut and Pennsylvania, an understanding was developed that for the Medicaid 1115 waiver to be applied to HVIP programs requires that organizations have a clear use for their VPPs/VISs, with a means for them to be able to bill and receive reimbursement from Medicaid. Statewide collaboration among academic medical centers and community based organizations as well as a receptive legislature are essential to implementing this policy. Rhode Island at present has some features that satisfy those requirements, but also has other unique features that could be advantageous for it to seek to implement this policy.
Future Directions:
Countenance the Preparation phase of the EPIS framework for Rhode Island, including identifying other potential partner entities, and proposing an ACO model as opposed to traditional fee-for-service which other states have done.
Preceptor:
Olutosin Ojugbele, MD, MPH, Rhode Island Department of Health
