Dr. Jacquelyn Campbell, National Program Director, RWJF Nurse Faculty Scholars

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Mark Masselli: This is Conversations on Healthcare I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret what a difference a week makes, things have been
evolving rapidly in the wake of more American cases of Ebola. Two healthcare workers
who contracted the virus from the patient have been moved and are now being treated
at a highly specialized facility Emory University in Atlanta and the NIH Facility in
Maryland.

Margaret Flinter: These are just a handful of cases but we know that public concern
and worry of course is mounting.

Mark Masselli: And the administration in CDC are taking a much tougher approach to
the outbreak.

Margaret Flinter: CDC Director Dr. Tom Frieden has issued additional guidelines on the
use of the right kind of protective gear in the clinical environment if the patient have
symptoms. They're recommending additional layers of protective clothing to minimize
the risk of exposure to health workers and it should be noted Mark that while hospitals
and healthcare facilities have protective what we called personal protective equipment.
This is really very specific very protective clothing that has to be put on in a certain way
taken off in a certain way and that requires training. And the nation's largest union that
represents close to 200,000 nurses has issued really a stern rebuke to the healthcare
system saying that, that level of training and protection just hasn’t been made available
to frontline nurses and the entire medical team.

Ma rk Masselli: Margaret you're right on target there the word training is the operative
one and our hospital systems are not quipped. And top officials at Texas Presbyterian
Health took responsibility for their flood initial response to the presence of Ebo la in their
hospital. He admits that mistakes were made but part of this is the lack of a national
strategy around training hospital and healthcare workers.

Margaret Flinter: Well this one is something of a new challenge for the American
healthcare syste m but all medical crisis have in common that there's an opportunity to
learn quickly from mistakes and move to adopt best practices to prevent future breaks
and to improve outcomes. And certainly it's pretty safe to say that we have a very solid
healthcar e delivery infrastructure here in the United States so I don’t think we'll see an
acceleration of outbreaks in this country but we just don't know exactly how this is going
to unfold.

Mark Masselli: Meanwhile there's a epidemic of another kind that work i n this country
Margaret, October is national domestic violence awareness month. It's the second
leading cause of death in women under 50.

Margaret Flinter: W e know as people engage in primary care how complex this issue is.
And we are so pleased today to have a guest who is a global expert on this topic.

Mark Masselli: That she is Dr. Jacquelyn Campbell currently serves as Co - Chair of the
Institute of Medicines form on the prevention of global violence. She's developed a
highly successful diagnostic t ool for clinicians, law enforcement and patients determine
their risk for further violence.

Margaret Flinter: The lethality assessment profile that she has developed is among one
of the most highly regarded in the field Mark, Dr. Campbell has some great i nformation
on how providers as well as law enforcement might be better equipped to address the
issue in their patients and in their communities.

Mark Masselli: And Lori Robertson joins us from FactCheck.org she's always on the
frontline of misstatement sp oken about health policy in the public domain.

Margaret Flinter: And no matter what the topic you can hear all of our shows by going
to CHC Radio.

Mark Masselli: And always if you have comments please email us at chcradio.com or
find us on Facebook or Tw itter we'd love hearing from you.

Margaret Flinter: We'll get to our interview with Dr. J acquelyn Campbell in just a
moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I'm Maria nne O'Hare with these Healthcare Headlines. The
response to Ebola in West Africa and now on American shores has begun to (inaudible
3:49 ) up in the policy sector as well as the healthcare sector. The CDC is rethinking its
approach to how best to contain infection should it become more prevalent in the US.
The initial thinking was every hospital in the nation should be prepared to identify
diagnose isolate and treat anyone suffering from Ebola infection. It may not be the best
approach according to some experts who recently gathered at Johns Hopkins
Bloomberg School of Public Health to discuss the Ebola epidemic. Now the thinking is
there should be dedicated hospitals around the country who have full capacity for

isolation and quarantine as well as adequ ate systems to threat the illness of many if
need be.

Meanwhile the scope of the outbreak in West Africa continues to confound global health
officials. The World Health Organization warns there could be 10,000 new cases per
week. Cuba has the largest nat ional presence on the ground in three West African
countries. Meanwhile there's a shortage of doctors in this country especially in primary
care. The National Health Services Core has been around since the 1970s to address
the shortage of primary care pr actitioners in rural settings and financial support for that
program was increased to about a quarter billion dollars by 2015. But the money isn't
guaranteed beyond 2015 and a number of organizations, the American Academy of
Family Physicians, American Co llege of Physicians and the American Nurses
Association have all signed letters to congress urging them to keep the funding intact
via next year.

And a missing link found in the quest to find a cure for Alzheimer's researchers at Mass
General in Boston hav e grown disease brain cells being called Alzheimer's in a dish this
cells can be grown quickly in a dish that allows researchers to test compounds quickly
that can combat Alzheimer's its being held as a giant leap forward in the field. I'm
Marianne O'Hare with these Healthcare Headlines.

Mark Masselli: We're speaking today with Dr. Jacquelyn Campbell the Anna D. Wolf
C hair at the Johns Hopkins School of Nursing, she also holds -- she's an international
expert on domestic and intimate partner violence and its impact on public health. Dr.
Campbell is national program director of the Robert Wood Johnson Foundation Nurse
F aculty, scholars she currently serves as Co - Chair on the Institute of Medicines form on
the prevention of global violence. She's won numerous awards including the American
society of criminology Vollmer Award and serves as Chair of the Board of Directors of
Futures Without Violence. She earn her BS in nursing from Duke and her PhD nursing
from the University of Rochester, Dr. Campbell welcome to Conversations on
Healthcare.

Dr. Jacquelyn Campbell: Thank you I'm delighted to be with you.

Mark Masselli: W ell, you know, October is National Domestic of Violence Awareness
Month, an important time to examine the issues and before we dive into the assessment
models you've developed could you give our listeners an analysis of the (inaudible 6:39 )
prevalence of d omestic violence in our culture?

Dr. Jacquelyn Campbell: Well unfortunately at least 30% of women in this country have
experienced physical violence and or sexual assaults or stalking from a husband,
boyfriend, ex - husband, ex - boyfriend or same sex partner or ex same sex partner
sometime in their lifetime, so all too common.

Margaret Flinter: Well Dr. Campbell because it's so common it is critical that in
healthcare people on the frontlines be very tuned to the possibility of intimate partner
violence. Bu t how effective have we been at getting primary care providers to screen
for intimate partner violence to recognize it and what are the science and symptoms
beyond physical manifestations that provider should be alert for and thinking about
whether a women might be at risk or experiencing violence ?

Dr. Jacquelyn Campbell: Well we have found where primary care providers do assess
for domestic violence we get far more disclosure of domestic violence when they
actually ask. We have been successful in increas ing our screen practices in primary
care when first of all the providers are trained and doesn’t have to be a long training but
at least a some sort of a brief training about the importance of doing this, also when the
providers know that there's someone i n their system that they can help get an abuse
women to talk to. So it's very important for them to know who within their system is able
to help them if it's a very difficult kind of a situation which is often is. We also find that is
helpful if there is -- in the well women's visit coverage insurance coverage for the time
that you spend doing some brief counseling with someone who is abused. And you
said, you know, what should we be alert for or we know that abused women are much
more likely to be depre ssed than other women. We know that women who are abuse
have a whole variety of healthcare problems especially things like chronic pain. So we
find it's much more important to ask everyone and then we don’t have to think about oh
should I be asking this person versus that person.

Mark Masselli: Dr. Campbell during your early days working as a nurse you recognize
that the healthcare and law enforcement communities needed a better risk assessment
tool to intervene on behalf of battered partners and especially in determining which
battered domestic partners were more likely to experience future lethal harm. And your
works evolved to the development of the lethality assessment profile and what's
different about this new assessment tool and how much up take has there been in law
enforcement communities around the country?

Dr. Jacquelyn Campbell: Well first I developed the danger assessment which is an
instrument that a women can do herself (inaudible 9:51 ) there's actually an app for that,
that helps he r see for herself how much danger she's in. It's even better done with a
domestic violence advocate at a advocacy organization or by a social worker or a nurse
in the healthcare system then they would go on to have the danger assessment done
with them whi ch is very accurate and helps pinpoint the actual level of danger for each
women. The LAP which is a Lethality Assessment Program was developed by the
Maryland Network against domestic violence along with myself and domestic violence
advocates. And it is a short form of the danger assessment that was meant to be asked
by first responders law enforcement when they are called to a scene of a domestic
violence incident. It's somewhat less detailed than danger assessment itself and so

therefore it's very use r friendly for a first responder a police officer the officer makes the
phone call to the domestic violence advocacy organization and actually helps the victim
get on the phone with that organization right there, right then. What police officers
usually d o is give domestic violence victims a phone number to call and they often times
don’t follow up on that. So we know we have good day to the show that it's much more
effective if the police officer actually gets the victim in touch with that domestic viole nce
advocacy organization right then on the scene. So we have the Maryland Network has
been incredibly successful at getting the LAP in use across the entire state of Maryland.
We've also been very successful in getting it in use in the state of Oklahoma . So now
the Oklahoma legislature has passed a law that the LAP is to be used throughout the
state of Oklahoma.

Margaret Flinter: Well Dr. Campbell, Mark and I have the pleasure of leading a
statewide community health center one of the very few in the co untry I think that also
operates a domestic violence shelter and full community intervention program so I want
to give a shout out to our director Michelle Walder [PH] who I know is been working
hard in Connecticut to get the lethality assessment profile a dopted here. But I like to
ask you about another dimension of this issue the issue of reporting or mandated
reporting I'd be so interested in your perspective on this what sort of the state of the
country in terms of mandated reporting and some of the arg uments against that or for
that as a case maybe.

Dr. Jacquelyn Campbell: Part of the issue with that and we did a whole series of
research studies both to see what abused women thought about that. And actually the
majority of abused women said this, I wo uld prefer that the healthcare provider offered
to call the police but that it should be up to me and whether or not the police get called
in on a case because only I know if this could be harmful to me. A lot of women of color
know that their partner for instance has had some other legal action against them and if
they have one more arrest for something this is going to mean significant jail time for
them. She wants the abuse to end but not necessarily this abuser go to jail, so it's a
complicated decisi on for her to make now on the other hand obviously as providers we
have to obey the law. So if it is an assault with a weapon or where someone has for
instance been choked or strangled to unconsciousness in those kinds of cases the
police have to be calle d. But for other kinds of abuse in most states as you said
California been the big exception also Kentucky where healthcare providers are not
mandatory reporters of the whole range of abuse of tactics. As providers we need to do
two things, we need to re member to offer to her to call the police for her because often
times when the emergency department and the police can be brought in to talk to her in
privacy. We also as providers use something like the danger assessment to see, you
know, if she's at hig h risk for lethality then I as a clinician would be a lot more assertive.

Mark Masselli: We're speaking today with Dr. Jacquelyn Campbell the Anna D. Wolf
Chair at the Johns Hopkins School of Nursing. She's an international expert on
domestic and intimat e partner violence and develop the lethality assessment profile use
to predict ongoing risk for intimate partner violence. You know, Dr. Campbell talk to us
a little bit about politics of this of how this is grabbing on, it's really about making sure as
y ou say that the three pillars that you want to do is to improve safety health and
wellbeing are all taking place.

Dr. Jacquelyn Campbell: When we look at from a national perspective for those that
think that the best way to address domestic violence is t hrough the criminal justice
system. The LAP gives those locals a really good way to make sure that the criminal
justice part is collaborating with the domestic violence services organization. Those two
sides need to work together with the healthcare syst em been the third pillar. The one
place where we find issues that often times do get politically driven, guns being so often
the domestic violence fatality means especially the homicide suicides and when a child
is also killed those are almost always with guns. So trying to address that gun removal
from known abusers, abusers who have been convicted of a domestic violence offence
or who have an order of protection out against them, how that can really save lives.
That's a place that politics does sometim es get in the way. One of the reason that I see
like the LAP has been a really important and I can't credit Maryland Network against
domestic violence enough that it is a means of brining all of the sectors together through
a coordinated use. And Connect icut has done a really terrific job of implementing the
use principles of risk assessment throughout the various parts of the systems, so that
now child protective services is involved. The family court is involve and your health
department as you say so Connecticut is an excellent example of a statewide initiative
and Maryland is trying to be -- and even Oklahoma is now with this risk assessment
strategy the LAP's strategy that it also brings together their health department and their
domestic violence se rvices organizations.

Margaret Flinter: Dr. Campbell I'm sure it will come as no surprise to you that we are
always searching for the opportunity to be further up stream in our prevention efforts.
And it seems that to do that we need so much for the next generation of healthcare
professionals to have as part of their education and curriculum and understanding of
intimate partner violence and you play such a prominent leadership role in the country in
your position as the national program director for the RWJ Foundation nurse faculty
scholars. What's the state of the art around training of the next generation of healthcare
professionals around this critical issue?

Dr. Jacquelyn Campbell: We've been very fortunate in the Robert Wood Johnson
Foundation funding of nurse faculty scholars. We've had a number of nurse faculty
scholars who are doing research on various aspects of domestic violence, children's
exposure etcetera. So that's a real ly important piece of the nurse faculty scholar

program. And the Robert Wood Johnson Foundation is working their new initiatives are
around a culture of health. They've identified addressing violence as one way of
providing this culture of health for the country. I work with a number of organizations
that were all interested in increasing that training making it part of every curriculum, you
know, we had in the 70s and 80s some real initiatives that way. We got it into most of
the nursing curricular by early 90s then that was sort of like things (inaudible 19:22 )
even in my own school of nursing I suspect right now with all of the national attentions
that domestic violence will have another upsurge and people making sure it's in the
curriculum. But it's one of those things that you have to get systematized the same
thing with screening for domestic violence, you have to get it in the healthcare records,
in the electronic medical records. You know, a permanent place in the curriculum.

Mark Masselli: We' ve been speaking with Dr. Jacquelyn Campbell the Anna D. Wolf
Chair at the Johns Hopkins School of Nursing. You can learn more about her work
going to dangerassessment.org, Dr. Campbell thank you so much for joining us on
Conversations on Healthcare today .

Dr. Jacquelyn Campbell: You're welcome it was my pleasure.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winn ing journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics, Lori what have you got for us this week?

Lori Robertson: We write a lot about seniors care efforts by politicians who scare
seniors to get their votes. And this midterm election has included plenty of that. Nearly
$50 million has been spent on television advertising in the first nine months of the year
on ads mentioning Medicare with democrats outspending republicans nearly two to one.
That's according to Kantar Media Intelligence Campaign Media Analysis Group. The
spending maybe new but the claims are old, for instance democratic ads and several
senath in - house races claim that republicans w ould "end the Medicare guarantee" a
reference to their support of representative Paul Ryan's Medicare Plan. But Ryan's plan
wouldn’t ends the guarantee of Medicare benefits instead it proposes phasing in a
government subsidy program in which future benefi ciary from private plans or traditional
Medicare. And it wouldn’t take away any guaranteed benefits either it would require
private plans to i nclude the same minimum benefits as traditional Medicare. These
claims about Ryan's plan and in Medicare first b egan in 2011 when he released a
budget proposal that included a transition to a premium support system. We called the
claim a (inaudible 21:49 ) of the year then. Three years later democrats have modified

the claim to say the plan would ends the Medicare guarantee that doesn’t make it any
more accurate.

And many ads feature seniors who are already on Medicare or in one case a man who
says Medicare is " around the corner for him" the republican plan wouldn’t kick in until
those under age 55 reached Medicare eligibility, and that's my fact check for this week.
I'm Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Pub lic Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health c are.

Margaret Flinter: E ach week Conversations highlights a bright idea about to how make
wellness a part of our communities and to everyday lives. One in six people in the
world lacks access to drinking water or basic sanitation. And statistic show that
diarrhea is the leading cause of death for these populations but access to clean and
portable water continues to present a real challenge. In African the numbers are
staggering with 46% of the residence of Sub - Saharan African having no direct access to
clean water.

In 2005 arti st Tracy Hawkins went to Tanzania to see what she could do about it. Clay
pot water filtration has been around for several hundred years where simple clay pots
lying in the bottom of silver oxide can remove up to 99% of the impurities for most water
sourc es. But no one had undertaken a dedicated program to produce and distribute
these pots. Tracy founded that the Sing'isi Pottery Project with a local activist and
began making the pots with local artisans in this region of Tanzania. By 2008 she and
her t eam were able to get a factory built so that they could increase production. The
project has served multiple communities and continues to expand. Independent
researchers have determine the system to be safe effective and the best part the health
of entir e communities has been improved significantly once each village resident is
provided with a clay filtration system. The pots are inexpensive to produce, easy to
handle and the factory has also created jobs for local residence. They have since
change the name of the organization to Safe Water Ceramics of East Africa and have
continued plans to replicate the successful model across the region. A simple easily
manufactured solution that improves access to portable water for a community that
previously had f ew options, one that improves health, wellbeing and economic
conditions at the same time now that's a bright idea.

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Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health .

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.