Jacquelyn Campbell, PhD, RN, FAAN, and Sarah Szanton, PhD, ANP, FAAN—experts from the Johns Hopkins School of Nursing in the respective specialties of violence and aging—are serving as national advisors on a Centers for Medicare & Medicaid (CMS) Technical Expert Panel examining the gap between clinical care and community services.
The team, which consisted of experts in housing, food security, interpersonal violence, transportation, education, employment, and other health-related social needs, met to provide recommendations on how to best implement a screening tool that can be used to better link CMS beneficiaries with social and community services. Campbell was selected for her expertise in violence, and Szanton for her for work in aging, specifically around housing conditions and their implication on health and well-being.
The screening tool is one of the first steps in the new CMS Accountable Health Communities Model that is testing whether increased awareness of and access to health-related social services will decrease health care costs and/or improve quality of health. Over a five-year period, the CMS will look at cost and health outcomes among three different groups—those who receive increased awareness of services, those who are offered navigation of services, and those who are actually aligned with services.
“This could lead to a much more inclusive definition of health,” says Szanton. “Historically, medical care has been about managing diseases and symptoms, but we also know that factors such as exposure to violence or having access to fresh foods impact health. If this model is a success, these screening questions could be used in other areas and lead to further interventions that address social determinants of health.”
Szanton, whose Community Aging in Place—Advancing Better Living for Elders (CAPABLE) program has had prominent focus on housing conditions among older adults, has seen the positive effects of modifying social factors. Preliminary findings of her research show that in addition to visits from a nurse and occupational therapists, minor modifications within the home like adding handrails or lowering cabinets dramatically decrease disability and improve self-care.
Campbell has studied intimate partner violence for more than 30 years. Her Danger Assessment tool helps women determine the likelihood of potentially fatal violence by an intimate partner.
“We need to step in earlier as health professionals,” says Campbell. “We can’t just treat the bruises, we have to intervene and offer services to people who experience violence before it leads to long-term depression or chronic illness. Being part of this committee is critically important to moving more community services forward and leading the change in how we think about health.”