Diversion Options: Voice and Empowerment (DOVE) Delegates is a research and development partnership that will design an alternative response model that meets Louisville’s unique needs, based substantially on input from the city’s residents and those directly impacted.

The need for an alternative response model derives from community concerns about instances in which law enforcement officers engage with individuals experiencing behavioral health crises.

Susan Buchino, an assistant professor in the and assistant director of the , will co-lead UofL’s research effort with Tony Zipple, an executive-in-residence at SPHIS.

“We have the opportunity to create a program that reduces the criminalization of intellectual and behavioral health conditions by using community-care practices and linking people to appropriate health and social services,” Buchino said.

Those involved in the project will assess best practices from other cities, analyze local data and organize community forums. Although similar models have been highlighted nationally, Louisville’s DOVE Delegates planning process is intentional about learning from the work of others while ensuring the model fits the context and climate of Louisville. DOVE Delegates will seek input of invested community members, as well as city leaders, behavioral health and social service providers, and representatives from advocacy organizations.

The will concentrate on organizing focus groups of Louisville residents to learn about their experiences and to integrate their input into planning and decision-making. A community survey launched this month with focus groups to be held throughout the city. School of Social Work Chair Shannon Cambron will lead Spalding’s involvement, and Louisville social worker and community organizer Khalilah Collins will serve as a project manager on the forums, which aim to elevate the voices of those whose lives may have been negatively impacted by current systems and practices.

Experts from Seven Counties Services will contribute insight from the perspective of a mental health services provider, focusing on behavioral health crisis response.

The work of UofL, Seven Counties and Spalding will be combined into a progress report that will be presented this summer to Louisville Metro Government, which is providing support to the DOVE Delegates through funds focused on reimagining public safety, including forfeiture monies from the Louisville Metro Police Department.

Recommendations will be made for implementation of a pilot program in the city’s 2022 fiscal year. The goal of implementing such a model is to create a positive health and economic impact on the community.

The Department of Behavioral Health, Developmental and Intellectual Disabilities is supporting DOVE Delegates through a federal Transformation Transfer Initiative Jail Diversion grant from the National Association of State Mental Health Project Directors.

Key to its community engagement, DOVE Delegates has seated a 20-person accountability/advisory board made up of representatives from around the city and from a range of professional and personal backgrounds. The board was formed to ensure accountability and transparency to the community, and it will provide recommendations and insight into the planning and development process while supporting outreach and engagement efforts of the project.

“Events of 2020 represent a public demand for change, and the process of healing requires re-conceptualizing public safety and emergency response systems in a way that honors the needs and wishes of the community and maximizes use of already limited resources,” said Susan Buchino, assistant professor, . “One such way is to provide social and clinical support services as an alternative or auxiliary to police and EMS.”

Buchino, who also serves as assistant director of the , says the Louisville Metro alternative responder program hopes to reduce incidents of confrontation and demands on the Louisville Metro Police Department, as well as create a positive health impact and fiscal savings. The team will investigate national best practices and analyze local data to create a model designed specifically for Louisville.��

Tony Zipple, SPHIS executive-in-residence, along with other are working with Buchino. The region’s community mental health center, is partnering with the SPHIS team in planning Louisville’s model, offering mental health and substance abuse treatment expertise. The also is collaborating on the project.

The planning process includes seeking the input of community members, as well as leaders from multiple government agencies, behavioral health and social service providers, and representatives from advocacy organizations.

“Transparency and community engagement around the planning process is crucial,” said Buchino. “We are including multiple partners to understand how they perceive this project and how it fits into our community and their organization’s other ongoing work.”

The team is consulting with officials in Eugene, Oregon, who implemented an evidence-based model for deflection called . In this model, the Eugene Police Department partnered with White Bird Clinic, a local Federally Qualified Health Center that offers a full range of medical, dental and behavioral health services, as well as drug and alcohol treatment.

Researchers expect to complete a final report later this summer which will include:

• Louisville alternative model design, including an operating model for services
• Comprehensive training materials
• Implementation and evaluation plans
• Budget and sustainability plan
• Cost-benefit forecast

, operated by Volunteers of America Mid-States (VOAMID), is a residential treatment program for alcohol and/or drug dependent pregnant women and women with young children.

The research will examine Freedom House and its recent expansion into eastern Kentucky, determining how well and in what ways the urban and rural partners align in terms of purpose, data sharing, financing and governance.

Aligning Systems for Health Program, led by the and supported by the Robert Wood Johnson Foundation, has awarded UofL more than $290,000 to fund the two-year study. UofL is one of seven institutions to receive the competitive funding.

UofL researchers Liza M. Creel, assistant professor, , and co-director, , and ���徱���𳦳ٴǰ�, , Division of Clinical and Translational Research in the Department of Pediatrics, will lead the study.

“We’ll focus on health equity and investigate similarities and differences between settings as it relates to program implementation and success of clients in the Freedom House program. We look forward to sharing data-driven insights around how organizations across sectors can work together to improve outcomes for the people and the communities they serve,” Creel said.

“We are so pleased to collaborate with UofL on this study that will ultimately help pregnant and parenting moms in our Freedom House programs have even better recovery outcomes in both our urban and rural communities,” said Jennifer Hancock, president and chief executive officer of ���Ѿ���-���ٲ��ٱ��.

VOAMID operates three evidence-based residential, licensed clinical treatment programs in Louisville. The Freedom House programs treat mothers’ substance use disorder, promote the birth of healthy babies, reunite families and reinforce positive behavior changes. Annually, the Louisville programs serve approximately 170 women, and more than 200 babies and children.

Earlier this year, the organization expanded into eastern Kentucky with a new site in Clay County, a rural area hit hard by opioid use, with high rates of Neonatal Abstinence Syndrome and out-of-home foster care placements much higher than Kentucky’s overall rate (91 vs. 43 per 1,000 children). This location can serve more than 60 women, 30 newborns, and 50 minor children each year.

The University of Louisville’s and conducted the study, thanks to $50,000 from Louisville Metro. With a transdisciplinary research model that spans beyond traditional academia, CIK and CCTSJR provide infrastructure for researchers to find solutions  to complex social problems, recognizing that problem solving requires expertise from multiple disciplines in partnership with the community.�� 

As a community, Louisville attempts to address homelessness in a coordinated and comprehensive manner, using data to identify gaps in services and streamlining the use of valuable community resources. In the past year, new property developments and attempts to enforce community safety have displaced homeless camps, leaving unsheltered individuals to collect on downtown streets and under overpasses.

In response, Mayor Fischer’s Homeless Encampment Task Force engaged researchers from CIK and CCTSJR to support their work with the following specific aims:

1. To determine national best practices to address street homelessness.
2. To provide an assessment of the existing service system for individuals experiencing homelessness in Louisville.
3. To perform a gap analysis between Louisville’s existing services and best practices, with recommendations on policies, practices and funding, to aid Louisville in progressing toward reducing the number of individuals who remain unsheltered.

The study recommendations are outlined below:

1. Expand and evolve homeless services. Ensure individuals experiencing a housing crisis have access to the single point of entry system at all times. Reinforce the Housing First model and trauma-informed care within the Continuum of Care, such that a centralized case management team provides the accompaniment needed to navigate a complex system, resolve barriers and move into and maintain a home.
2. Revise encampment policies. Expand policies to shift focus from clearing to providing needed services, including hygiene facilities and housing assistance. When clearances are required, ensure that campers not only receive notice of a clearing, but that they are required to be offered and assisted with storage and shelter options.
3. Offer multiple low-barrier shelters in locations throughout Jefferson County. To ensure everyone has access to shelter and feels safe, emergency shelters should be smaller, designed for specific subpopulations, meet Americans with Disabilites Act standards and offer a staff to guest ratio that supports trauma-informed care. Emergency shelters should be used as a touch-point to link guests with wraparound services.
4. Improve collaboration. Resolving homelessness requires the participation of everyone. Communication and collaboration among service providers and across sectors is imperative.
5. Housing and community development. Prioritize affordable housing in Louisville, especially to meet the needs of households with income below 30 percent Area Median Income ($25,100 for a family of four). As needed, revise zoning ordinances to achieve this.
6. Address root causes of homelessness beyond housing. Create policies to raise the minimum wage and revise policies that create barriers to employment and housing for individuals who have been in the criminal justice system.
7. Promote community education and engagement. Develop a comprehensive public awareness campaign that sets achievable goals, involves multi-sector participation and is aimed at multiple audiences (individuals experiencing or at risk of homelessness, advocates and service providers, and the general public).
8. Evaluate the outcomes of new policies and programs.

“It’s critical to recognize that homelessness is a result of a system that perpetuates discrimination and creates poverty. This study reveals that we must strengthen the connectivity between services and providers, as well as across sectors, and employ an approach of accompaniment, whereby our community meets individuals where they are and walks with them on the journey to stability,” said Susan Buchino, PhD, OTR/L, assistant professor, , and research study lead from UofL’s CIK and CCTSJR.

Other UofL researchers include Catherine (Cate) Fosl, M.S.W., Ph.D., co-director of CCTSJR, director, Anne Braden Institute for Social Justice Research, and professor, Women’s, Gender, and Sexuality Studies; Lora Haynes, Ph.D., associate professor, Department of Psychological and Brain Sciences; Kelly Kinahan, Ph.D., A.I.C.P., assistant professor, Department of Urban and Public Affairs; Diane Zero, M.Ed., CIK graduate research assistant and doctoral student; and Jamie Beard, administrative assistant, Anne Braden Institute.

“We are all aware that we have a homeless crisis in Louisville,” said Natalie Harris, executive director of the Coalition for the Homeless. “This problem will only get worse through the proposed cuts to preventative services that are currently funded by Louisville Metro Government. We need the community to step up and demand that vital resources provided by the Office of Resilience and Community Services, the External Agency Funds and Neighborhood Development Funds are preserved and expanded using the guidance outlined for us in the University of Louisville report released this week.”

“We appreciate the hard work and collaboration among all of our partners, and especially the Coalition for the Homeless and University of Louisville,” said Mayor Greg Fischer.�� “It will take a united community to address the complex issue of homelessness.”

Featured photo courtesy of .��

Susan Buchino, PhD, OTR/L, assistant professor in the Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, is leading a team of researchers from UofL’s and to analyze the situation in the city.

Under a $50,000 contract through the Coalition of the Homeless funded by the city, the UofL team will determine national best practices and provide an assessment of the existing continuum of care for individuals experiencing homelessness in Louisville. This gap analysis between the city’s existing services and best practices can provide direction for strategic planning and next steps toward ensuring individuals without stable shelter in Louisville have access to the services and resources they need to find and maintain housing.

“Homelessness impacts the health and safety of not only those who experience it, but of our entire community,” Buchino said. “We are excited to partner with the Coalition for the Homeless and Louisville Metro to further understand homelessness, and to help identify potential solutions to a pressing problem in our hometown.”

Other UofL researchers include Catherine (Cate) Fosl, MSW, PhD, co-director of CCTSJR, director, Anne Braden Institute for Social Justice Research, and professor, Women’s, Gender, and Sexuality Studies; Lora Haynes, PhD, associate professor, Department of Psychological and Brain Sciences; Kelly Kinahan, PhD, AICP, assistant professor, Department of Urban and Public Affairs; Diane Zero, MEd, CIK graduate research assistant and doctoral student; and Jamie Beard, administrative assistant, Anne Braden Institute.

“Understanding why the number of persons living on the streets and in encampments has increased needs to be the first step in helping people find shelter. This study will be vital as we work together to help our homeless neighbors hopefully transition to a stable home,” said Sherry Duffy, MS, CIK’s Deputy Director.

The project will conclude in June 2019 with a comprehensive report that will include recommendations on policies, practices and funding to aid Louisville in progressing toward a reduction in the number of individuals who remain unsheltered.

SPHIS has been awarded two contracts from the Department of Medicaid Services within the Kentucky Cabinet for Health and Family Services. One project seeks to identify high-risk diabetes patients for more aggressive early preventive measures, while the second directly addresses the capacity of providers to be responsive to emerging value-based purchasing incentives. Faculty in the SPHIS proposed these initiatives based on needs specified by the state.��

“We are enthusiastic about the Medicaid initiatives we’ve been asked to work on with our state partners. Both projects are innovative and have the potential to improve the quality and efficiencies of the care provided to Medicaid recipients in Kentucky,” said Craig Blakely, PhD, dean of the School of Public Health and Information Sciences.

“Our collaboration with UofL leverages the breadth of expertise at the university. The analysis that will be conducted through these two contracts will inform our decisions at the state level for delivery of the best, cost-efficient care to our most vulnerable population,” said Gilbert Liu, MD, medical director for the Kentucky Department of Medicaid Services and professor of pediatrics at UofL.

The total value of both contracts over a two-year period is nearly $950,000. The financing is structured as a 50/50 match. Half the funding comes from Kentucky’s allocation of Federal Financial Participation funds – money available to external agencies like universities collaborating on Medicaid-related activities. The remainder of the project cost is paid for through the SPHIS Department of Health Management and Systems Sciences and UofL’s , an entity of SPHIS. The contracts will be administered by the Department of Health Management and Systems Sciences’ , a National Science Foundation-funded center focused on improving patient care and service, efficiency, and maximizing their capabilities while preserving resources.

More about the projects:

• Type 2 Diabetes among Medicaid Beneficiaries in Kentucky

Led by Bert Little, PhD, professor, SPHIS Department of Health Management and Systems Sciences and CIK scholar, this project will perform longitudinal analyses of Kentucky Medicaid claims to develop predictive algorithms. This work will help identify factors that can predict which beneficiaries with type 2 diabetes need more intensive medical intervention. Individuals identified with high probability of need can receive early treatment to delay or prevent severe complications of type 2 diabetes, which include blindness, kidney failure and heart disease. The expected goal is improved quality of life, along with reduced long-term care costs.

• Evaluating Provider Readiness to Implement Core Quality Measures

This study is led by two faculty in the SPHIS Department of Health Management and Systems Sciences – J’Aime Jennings, PhD, assistant professor, and Christopher Johnson, PhD, chair of the department. Jennings and Johnson also are CIK scholars and co-directors of CHOT.

Jennings and Johnson will review a provider readiness survey instrument and assess the state’s capacity for implementing quality measures outlined by Kentucky’s in five key areas: pediatrics, chronic and acute care, preventive health, behavioral health and cost/utilization.

The results of the comprehensive analysis will include a quality improvement proposal that focuses on the development of a strategic plan to accomplish quality measure implementation across Kentucky.

The LEAD program, which first launched in Seattle in 2011, is an innovative pre-booking, community-based program focused on routing individuals suspected of committing low-level drug-related offenses away from jail and prosecution into treatment.

Louisville has been awarded a $400,000 federal grant to fund a pilot project, serving 50 qualifying individuals who come into contact with police in the Portland and Russell neighborhoods over the next 18 months.

“The Opioid crisis remains a vital concern to public safety in this community,” said Mayor Greg Fischer. “But incarceration cannot be the only option for those struggling with addiction. We must find ways to divert people to treatment and stem the tide of drug-related crime. This program is one more option for our community.”

Commonwealth Institute research scholars Liza Creel, PhD, and Susan Buchino, PhD, will conduct the evaluation, ensuring the program is working as it should.

“By following an evidence-based intervention that has shown success in other communities and designing it to meet Louisville’s needs, the Louisville LEAD pilot has great potential to positively impact participant lives and our community,” Creel said.

The research team will look specifically at the impact of LEAD on:

• Recidivism, including arrests and charges
• Use of publically-funded legal and criminal justice services
• Costs to the local criminal justice system
• Use of treatment and other services after LEAD enrollment
• And fidelity to the Seattle-model (the extent to which the Louisville LEAD pilot aligns with the model implemented in Seattle)

“UofL is committed to enhancing the well-being of our city through research and collaboration. We look forward to sharing our evaluation findings over the next two years,” she said.

The program is expected to fully launch by Oct. 1.

Here’s how it will work:

• LMPD officers working in the targeted beats in the Russell and Portland neighborhoods will use discretionary authority at the point of contact to divert eligible candidates into intervention for offenses driven by substance use disorder.
• The LMPD officer will determine eligibility for the LEAD program based on established offense criteria and criminal history exclusions. Eligible crimes will include felony possession of an opiate and possession of heroin under two grams, as well as low-level property crime stemming from opiate addiction.
• Instead of taking them to jail, officers will take those volunteering to participate to the Volunteers of America Mid-States triage location on West Broadway to be connected with a case manager.
• Within 72-hours a potential participant must complete an in-depth assessment before becoming one of the 50 pilot project participants to receive treatment and wrap-around services.
• Volunteers of America Mid-States will assume responsibility for the case management of the individuals.
• UofL’s Commonwealth Institute of Kentucky will conduct the evaluation of the program.

“So often, officers come into contact with members of our community who are committing crime as part of their addiction to opioids and other drugs,” said Col. Michael Sullivan, deputy chief for Louisville Metro Police. “This gives officers a tool to divert people into treatment, rather than taking them to jail, where they may or may not get to address the underlying issue leading them to crime.”

Volunteers of America Mid-States will work with pilot program participants to coordinate services they need to get themselves back to a healthy and productive lifestyle.

“We know that we can change people’s lives when we surround them with professional care and treatment and access to comprehensive support and services,” said Jennifer Hancock, President and CEO of Volunteers of America Mid-States. “Opioid use and addiction is a public health crisis and LEAD will be successful because it offers a public health solution.” 

“If you know your HIV status, you can protect yourself and others,” said Ryan Combs, PhD, MA, assistant professor, University of Louisville School of Public Health & Information Sciences and Commonwealth Institute of Kentucky scholar. “Everyone between the ages of 13 and 64 should get tested for HIV at least once. If you are HIV positive, there are treatments that can help you live a long and healthy life.”

Combs, along with other public health faculty and students, community members, and health care and public health professionals, developed the ‘We’re in Control Now’ campaign, utilizing community-based participatory research. Residents are invited to join the conversation on social media using #CTRLNow.

The messages, communicated through radio ads, posters in West Louisville bus shelters and social media, encourages members of the African American community to seek out free HIV testing through the Louisville Metro Department of Public Health and Wellness, 502-574-5600, or Volunteers of America, 502-635-4505.

“People living with HIV are valued members of the community. In some ways, HIV stigma can be worse than the disease itself,” Combs said.

The Centers for Disease Control and Prevention estimates 1 in 20 African American men will be affected by HIV compared to 1 in 132 White men, and an estimated 1 in 48 African American women will experience HIV compared to 1 in 880 White women.

HIV is one of several topics Combs and his research team have explored since 2017 as part of the health literacy research project funded through the Jewish Heritage Fund for Excellence. Other topics include .��

The HIV campaign continues through Feb. 7, National African American HIV/AIDS Awareness Day. It also coincides with various events throughout Louisville, including the HIV Monologues on Feb. 9 at Hotel Louisville. The event is an outgrowth of UofL’s Cooperative Consortium for Transdisciplinary Social Justice Research initiative that worked with actors and a group of older HIV positive African Americans to develop monologues focusing on the experiences of the HIV positive. For more information, .

From the ecology of the rainforest canopy to the promise of astrosurgery to an arts-based approach to improving community health, UofL projects are among the highlights of the first ACCelerate: ACC Smithsonian Creativity and Innovation Festival in the Washington, D.C. museum’s west wing Oct. 13-15. Virginia Tech is presenting the festival with the Smithsonian.            

The festival showcases “creative exploration and research at the nexus of science, engineering, arts and design” among the 15 participating ACC schools, according to the festival . Organizers project as many as 30,000 visitors could attend during the weekend.

“I think it certainly shows that we have work going on here that has huge public impact,” said Paul DeMarco, associate dean of UofL’s School of Interdisciplinary and Graduate Studies and a professor of psychological and brain sciences. DeMarco, who plans to attend, organized UofL’s involvement and oversaw the proposal process for the student-faculty teams involved.

Although the ACC is known widely for athletic achievements, “the intent here is to show these schools have research and work that’s being done by faculty, staff and students,” DeMarco said. “It was important for us to get the students involved.”

The festival will offer 15 dramatic and musical performances, including the 4 p.m. Oct. 14 performance about the intersection of art and public health by . The project leader is graduate student Tasha Golden, a former touring songwriter who directs the Center for Art + Health Innovation within the Commonwealth Institute of Kentucky, an entity of UofL’s School of Public Health and Information Sciences. The multidisciplinary presentation of works that reveal how arts address environmental and social toxins will include Smoketown poet Hannah Drake and Justin Golden.

Biologist Steve Yanoviak from the College of Arts and Sciences and George Pantalos, bioengineering and surgery professor with UofL’s Cardiovascular Innovation Institute, will be featured with their students in interactive exhibits and also as Oct. 14 panelists on the general theme of “Interdisciplinary Thinking and Collaboration.” There are 48 total exhibits.

Pantalos and students Audrey Riggs and Justin Heidel will exhibit two projects: the pediatric cardiovascular simulator designed to train critical care pediatric hospital staff and a joint UofL and Carnegie Mellon project intended to help treat trauma and other disorders surgically in reduced gravity during space missions. Pantalos’ Oct. 14 talk (12:30 p.m. panel on health and body) will focus on the KardioKid.

Yanoviak, whose panel on environment and sustainability begins at 4 p.m., will exhibit with students Max Adams and Evan Gora about their work on the examining forest structure, lightning and insect diversity. The collaboration with other scientists from various disciplines is done primarily at the Barro Colorado Island field station in Panama administered by the Smithsonian Tropical Research Institute.  

The museum site for the ACCelerate Festival is on the National Mall on Constitution Avenue between Twelfth and Fourteenth streets NW. Festival hours are 10 a.m. to 5:30 p.m. Friday-Sunday.

The two entities are working together to design, create and implement a Center for Art + Health Innovation within the CIK to help Louisville become a national thought leader and training site for the improvement of community health through art.

“One of the greatest challenges in public health is authentically connecting with communities, as well as communicating effectively,” said Monica Wendel, DrPH, MA, director of the Commonwealth Institute of Kentucky and associate dean for Public Health Practice at the UofL School of Public Health and Information Sciences. “Our best science is relatively useless if we can’t make it accessible and actionable for people. Arts and culture provide us with the language necessary to foster mutual understanding.”

“We believe artists are a catalytic force who shape and influence our cultural, political and economic environments,” said Theo Edmonds, co-founder of IDEAS xLab. “They have the ability to make new options visible, and with the right training and support, can (re)introduce humanity into policy discussions and shift how community members define and advocate for their health and well-being.”

is IDEAS xLab’s signature project, and uses arts and cultural engagement to help communities discover creative ways to identify their health priorities and develop a health equity action plan for sustainable impact.

Edmonds says although data suggests that arts and culture influence population health, an evidence-based model is needed, and CIK researchers will be important collaborators in the process.

Last year, the CIK and IDEAS xLab partnered to launch a photovoice exhibit at the

. The project featured photographs and written observations of West Louisville residents, and set the stage for community conversations on ways to reduce violence in their neighborhoods. CIK and IDEAS xLab hope to bring more of these initiatives to life under the Center for Art + Health Innovation.

“CIK and IDEAS xLab have our eyes on the same goal –social justice and health equity. We are bringing our unique skill sets together to advance that goal in a creative way,” Wendel said.

CIK is part of the with a mission of informing policy and practice that will improve the health of populations in Kentucky and beyond. IDEAS xLab is a Louisville-based artist innovation company that trains artists as social entrepreneurs to help create equitable places and nurture healthy communities.