Targeted Social Determinants of Health Interventions

Social Determinants of Health

Social determinants of health interventions for children are essential to advancing health equity. After years of successfully screening for social determinants of health, we’re building on this foundation to further address patients’ adverse social determinants of health. We are launching targeted interventions to address the specific needs of patients. Our goal is to launch an innovative research study in each key social determinant of health domain to create sustainable interventions that resolve patients’ needs.

Little girl eating apple

Social Determinants of Health Intervention Programs for Children

Learn more about our interventions aimed at promoting economic mobility, food security, and transportation security below. 

Do you have an idea for a project that will address adverse social determinants of health?

We would love to hear from you.

Economic Mobility

Background and Significance

Children are the poorest segment of the U.S. population: 2 in 5 American children live in impoverished conditions. Since 2020, for the first time in history, the majority of children in the U.S. are Black, Indigenous, or people of color (BIPOC). Low-income BIPOC children, who represent 70% of all low-income children and 26% of children overall in the U.S., face the catastrophic consequences of experiencing poverty throughout their lives. 

From a public and population health perspective, poverty negatively impacts health from early childhood onward. This leads to worse health in adulthood, thereby reducing the productivity of society’s workforce and resulting in avoidable healthcare utilization and costs.

Innovation

We are working to shift current research and clinical paradigms that reinforce socioeconomic inequities

Approach

We plan to implement a financial wellness intervention across our health system and examine its effectiveness in improving health outcomes, satisfaction, and overall wellness.

Elementary age student boy raised hands up in class.
Little kids playing toys in the playroom
Cute diverse kids playing with hula hoops
Happy baby playing with toy blocks.

Food Insecurity and Malnutrition

Background and Significance

“Food insecurity, malnutrition and obesity, independently, represent three of the most complex conditions threatening the livelihoods of populations in nearly every country, making them leading causes of poor health, globally.”

In Worcester County alone, nearly 70,000 people are experiencing food insecurity. As the leading cause of malnutrition, food insecurity can lead to worse health throughout life. Malnutrition is among the leading risk factors linked to the development or worsening of acute illness and/or chronic diseases.  

Innovation

Our Stepped Nutrition Program is helping us address food insecurity among our patients. The program has four distinct steps, each with its own intervention, and the intervention intensity increases as the steps rise. Higher-need patients will be “stepped up” to higher-intensity interventions. Our goal with this program is to provide the right nutritional support at the right time to the right patient.

The program will be strategically embedded within the broader healthcare system. This allows us to leverage the system’s electronic health record software, Epic, to track progress and evaluate the program. Data on social determinants of health and food insecurity risk are already captured in Epic. By analyzing these data and individual health outcomes data (such as blood pressure), we will be able to ensure the program is promoting optimal health.

Approach

We are currently piloting this program among a small number of at-risk patients. Following completion of the pilot, we hope to expand the program throughout the Children’s Medical Center and UMass Memorial Health system.

Transportation Access

Background and Significance

Access to affordable and reliable transportation is essential to healthcare. Individuals lacking transportation access are more likely to delay preventive care and miss medical appointments. This contributes to the decompensation of medical conditions and poorer health outcomes. In Worcester, Massachusetts, and its surrounding areas, public transportation options are very limited. For patients without access to a personal vehicle or the funds to purchase gasoline, transportation is virtually impossible.

Innovation

Our project provides at-need patients with no-cost transportation to and from medical appointments. 

Approach

We are implementing a ridesharing intervention and examine its effectiveness on improving access to care and decreasing no-show rates. 

Woman took her daughter to pediatrician
Child in wheelchair is playing, learning and exercise in the outdoor city park.

Rani Jones, BS (She/Her)

Project Coordinator

Rani Jones is the current Project Coordinator for the Child Health Equity Center. She graduated from Rensselaer Polytechnic Institute (RPI) in 2023 with her B.S. in Biochemistry and Biophysics, and a minor in Behavioral and Cognitive Neuroscience. During her time as an undergraduate, she spent a lot of time volunteering with children in the New York capital region. She is very interested in public health and plans to continue her education at RPI to pursue her Ph.D. in Biochemistry and Biophysics in the Fall.
Rani_headshot

Rani Jones, BS (She/Her)

Project Coordinator

Rani Jones is the current Project Coordinator for the Child Health Equity Center. She graduated from Rensselaer Polytechnic Institute (RPI) in 2023 with her B.S. in Biochemistry and Biophysics, and a minor in Behavioral and Cognitive Neuroscience. During her time as an undergraduate, she spent a lot of time volunteering with children in the New York capital region. She is very interested in public health and plans to continue her education at RPI to pursue her Ph.D. in Biochemistry and Biophysics in the Fall.

Maia Archer, BA (She/Her)

Career path intern

Maia Archer graduated from Boston University with her B.A. in Biology, double minoring in French and Public Health. She is an intern for the Child Health Equity Center primarily assisting with the Pilot Lyft Transportation Program and Food is Medicine Program. Maia will be continuing her academic journey at George Washington University to receive her Masters in Public Health with a concentration in Health Promotion.

Child Health Equity Center

Maia Archer, BA (She/Her)

Career PATH Intern

Maia Archer graduated from Boston University with her B.A. in Biology, double minoring in French and Public Health. She is an intern for the Child Health Equity Center primarily assisting with the Pilot Lyft Transportation Program and Food is Medicine Program. Maia will be continuing her academic journey at George Washington University to receive her Masters in Public Health with a concentration in Health Promotion.

Monick Powell, C-TAGME (She/Her)

Fellowship Coordinator

Monick Powell, C-TAGME, is the Pediatric Training Program Coordinator at UMass Chan Medical School and UMass Memorial Children’s Medical Center. She acts as Coordinator for the Program to Advance Training in Child Health Equity (PATH) Fellowship. She was born in Puerto Rico, grew up in New York, and has been working at UMass since 2004 in various positions in Pediatrics. Ms. Powell established and leads the institutional Training Programs Coordinator Advisory Committee.

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Monick Powell, C-TAGME (She/Her)

Fellowship Coordinator

Monick Powell, C-TAGME, is the Pediatric Training Program Coordinator at UMass Chan Medical School and UMass Memorial Children’s Medical Center. She acts as Coordinator for the Program to Advance Training in Child Health Equity (PATH) Fellowship. She was born in Puerto Rico, grew up in New York, and has been working at UMass since 2004 in various positions in Pediatrics. Ms. Powell established and leads the institutional Training Programs Coordinator Advisory Committee.

Larry Rhein, MD, MPH (He/Him)

Advisor

Larry Rhein, MD, MPH, joined the faculty at UMass Chan Medical School in June 2016. He is an Associate Professor of Pediatrics and Chair of the Department of Pediatrics. Dr. Rhein is board-certified in both pediatric pulmonology and neonatology. He is a health services researcher with a focus on respiratory outcomes of neonatal lung disease and is a national expert on lung disease of prematurity. Dr. Rhein runs a research program focused on optimizing respiratory status in infants with severe lung diseases, particularly infants who are technology- or oxygen-dependent. He has pioneered several protocols for safe outpatient oxygen weaning, which allows infants to be discharged from the neonatal intensive care unit much earlier. Through clinical trials and analysis of physiological data, Dr. Rhein hopes to develop new strategies to prevent and treat neonatal and pediatric lung disease.

Photo of Dr. Larry Rhein, MD, MPH

Larry Rhein, MD, MPH (He/Him)

Advisor

Larry Rhein, MD, MPH, joined the faculty at UMass Chan Medical School in June 2016. He is an Associate Professor of Pediatrics and Chair of the Department of Pediatrics. Dr. Rhein is board-certified in both pediatric pulmonology and neonatology. He is a health services researcher with a focus on respiratory outcomes of neonatal lung disease and is a national expert on lung disease of prematurity. Dr. Rhein runs a research program focused on optimizing respiratory status in infants with severe lung diseases, particularly infants who are technology- or oxygen-dependent. He has pioneered several protocols for safe outpatient oxygen weaning, which allows infants to be discharged from the neonatal intensive care unit much earlier. Through clinical trials and analysis of physiological data, Dr. Rhein hopes to develop new strategies to prevent and treat neonatal and pediatric lung disease.

Michelle Trivedi, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Michelle Trivedi, MD, MPH, is a pediatric pulmonologist and clinician-scientist who studies sustainable community-based interventions that seek to improve asthma health for children. She is an Associate Professor of Pediatrics and Population Quantitative Health Sciences at UMass Chan Medical School. Dr. Trivedi is Principal Investigator on a National Institutes of Health (NIH)-funded clinical trial of Asthma Link, a clinic-school partnership that delivers school-supervised asthma therapy to children with poorly controlled asthma in 52 schools across Massachusetts. 

 

With a focus on sustainable, pragmatic interventions, she has developed a novel methodology for stakeholder engagement, grounded in implementation science, that elicits input from children, parents, pediatricians, community and systems-level stakeholders (payors, legislators, and public health officials) in order to adapt evidence-based interventions to real-world settings. The ultimate goal of this methodology and her work is to develop interventions that produce positive public and population health impact, particularly for historically marginalized populations.

Photo of Dr. Michelle Trivedi

Michelle Trivedi, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Michelle Trivedi, MD, MPH, is a pediatric pulmonologist and clinician-scientist who studies sustainable community-based interventions that seek to improve asthma health for children. She is an Associate Professor of Pediatrics and Population Quantitative Health Sciences at UMass Chan Medical School. Dr. Trivedi is Principal Investigator on a National Institutes of Health (NIH)-funded clinical trial of Asthma Link, a clinic-school partnership that delivers school-supervised asthma therapy to children with poorly controlled asthma in 52 schools across Massachusetts. 

With a focus on sustainable, pragmatic interventions, she has developed a novel methodology for stakeholder engagement, grounded in implementation science, that elicits input from children, parents, pediatricians, community and systems-level stakeholders (payors, legislators, and public health officials) in order to adapt evidence-based interventions to real-world settings. The ultimate goal of this methodology and her work is to develop interventions that produce positive public and population health impact, particularly for historically marginalized populations.

Meg Parker, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Meg Parker, MD, MPH, is an Associate Professor of Pediatrics and Chief of the Division of Neonatology at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Parker is a neonatal health services researcher and holds several federal and foundation grants in the area of social disparities in preterm birth outcomes; she has a particular interest in safe sleep and breastfeeding. 

Dr. Parker is also an expert in multi-site implementation science and is the Co-Chair of the Neonatal Quality Improvement Collaborative of Massachusetts and an Improvement Advisor from the Institute of Healthcare Improvement. She has led multi-site NICU quality improvements focused on breastfeeding and family engagement. Dr. Parker applies a health equity lens to her local and multisite quality improvement projects.

Photo of Dr. Meg Parker

Meg Parker, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Meg Parker, MD, MPH, is an Associate Professor of Pediatrics and Chief of the Division of Neonatology at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Parker is a neonatal health services researcher and holds several federal and foundation grants in the area of social disparities in preterm birth outcomes; she has a particular interest in safe sleep and breastfeeding. 

Dr. Parker is also an expert in multi-site implementation science and is the Co-Chair of the Neonatal Quality Improvement Collaborative of Massachusetts and an Improvement Advisor from the Institute of Healthcare Improvement. She has led multi-site NICU quality improvements focused on breastfeeding and family engagement. Dr. Parker applies a health equity lens to her local and multisite quality improvement projects.

Heather Forkey, MD (She/Her)

Child Health Equity Center CORE FACULTY

Heather Forkey, MD, is a pediatrician and a Professor of Pediatrics at the UMass Chan Medical School. She also directs the Child Protection Program and Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center. Dr. Forkey is particularly interested in meeting the health and developmental needs of children who have experienced trauma. In collaboration with colleagues, she has trained thousands of professionals and parents about the impacts of childhood trauma and has developed innovative resources to make that work easier. She published the first textbook on trauma-informed care for pediatrics and presents nationally and internationally on the topic. Dr. Forkey also serves in leadership roles for the National Child Traumatic Stress Network and the American Academy of Pediatrics.

Photo of Dr. Heather Forkey

Heather Forkey, MD (She/Her)

Child Health Equity Center CORE FACULTY

Heather Forkey, MD, is a pediatrician and a Professor of Pediatrics at the UMass Chan Medical School. She also directs the Child Protection Program and Foster Children Evaluation Service (FaCES) of the UMass Memorial Children’s Medical Center. Dr. Forkey is particularly interested in meeting the health and developmental needs of children who have experienced trauma. In collaboration with colleagues, she has trained thousands of professionals and parents about the impacts of childhood trauma and has developed innovative resources to make that work easier. She published the first textbook on trauma-informed care for pediatrics and presents nationally and internationally on the topic. Dr. Forkey also serves in leadership roles for the National Child Traumatic Stress Network and the American Academy of Pediatrics.

Nisha Fahey, DO, MSc (She/Her)

Child Health Equity Center CORE FACULTY

Nisha Fahey, DO, MSc, is an Assistant Professor at UMass Chan Medical School in the Division of General Pediatrics and a faculty member in the Child Health Equity Center with a focus on global health. Dr. Fahey leads an institutional collaboration with an academic tertiary care center in rural western India focused on research capacity building and community engagement to identify and address barriers to care and health inequities in rural community settings. Through this collaboration, she has led the implementation of several research projects in India; recent projects have focused on maternal-child health and social determinants of health. In addition, she is passionate about exploring how digital technologies can be used to reduce health inequities. Her current research focuses on developing ways to promote the practice of Kangaroo Mother Care among mother-neonate dyads across a variety of settings.

Photo of Dr. Nisha Fahey

Nisha Fahey, DO, MSc (She/Her)

Child Health Equity Center CORE FACULTY

Nisha Fahey, DO, MSc, is an Assistant Professor at UMass Chan Medical School in the Division of General Pediatrics and a faculty member in the Child Health Equity Center with a focus on global health. Dr. Fahey leads an institutional collaboration with an academic tertiary care center in rural western India focused on research capacity building and community engagement to identify and address barriers to care and health inequities in rural community settings. Through this collaboration, she has led the implementation of several research projects in India; recent projects have focused on maternal-child health and social determinants of health. In addition, she is passionate about exploring how digital technologies can be used to reduce health inequities. Her current research focuses on developing ways to promote the practice of Kangaroo Mother Care among mother-neonate dyads across a variety of settings.

Sarabeth Broder-Fingert, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Sarabeth Broder-Fingert, MD, MPH, is a pediatrician and implementation scientist who studies early diagnosis and treatment for autistic children and children with other developmental, behavioral, and/or mental health disorders. She is Vice Chair for Clinical Research in Pediatrics and Associate Director for Research at the Eunice Kennedy Shriver Center at UMass Chan Medical School. Dr. Broder-Fingert is Principal Investigator on multiple National Institutes of Health (NIH)-funded awards focused on testing and/or evaluating the implementation of autism interventions. Dr. Broder-Fingert has published more than 60 peer-reviewed manuscripts and serves as an editor for the Autism and Hospital Pediatrics journals.

Photo of Dr. Sarabeth Broder-Fingert

Sarabeth Broder-Fingert, MD, MPH (She/Her)

Child Health Equity Center CORE FACULTY

Sarabeth Broder-Fingert, MD, MPH, is a pediatrician and implementation scientist who studies early diagnosis and treatment for autistic children and children with other developmental, behavioral, and/or mental health disorders. She is Vice Chair for Clinical Research in Pediatrics and Associate Director for Research at the Eunice Kennedy Shriver Center at UMass Chan Medical School. Dr. Broder-Fingert is Principal Investigator on multiple National Institutes of Health (NIH)-funded awards focused on testing and/or evaluating the implementation of autism interventions. Dr. Broder-Fingert has published more than 60 peer-reviewed manuscripts and serves as an editor for the Autism and Hospital Pediatrics journals.

Alison LeBlanc, MS, PMP (She/Her)

Child Health Equity Center EXECUTIVE DIRECTOR

Alison LeBlanc, MS, PMP, is an experienced development strategist and child health equity advocate with over a decade of experience designing and implementing initiatives to address adverse social determinants of health. Ms. LeBlanc subscribes to the philosophy “nothing about us without us.” To this end, she has extensive experience fostering bidirectional community partnerships and coalition building. She also has a strong track record of building sustainable centers of excellence in safety-net healthcare systems. 

As a disability and chronic disease self-advocate, Ms. LeBlanc has spent years redefining what it means to promote inclusivity and belonging and is dedicated to continually raising the bar for herself and her colleagues. Ms. LeBlanc completed her undergraduate degree at Wesleyan University and completed her master’s in communications at the S.I. Newhouse School of Public Communications at Syracuse University.

Photo of Alison LeBlanc, MS, PMP

Alison LeBlanc, MS, PMP (She/Her)

Child Health Equity Center EXECUTIVE DIRECTOR

Alison LeBlanc, MS, PMP, is an experienced development strategist and child health equity advocate with over a decade of experience designing and implementing initiatives to address adverse social determinants of health. Ms. LeBlanc subscribes to the philosophy “nothing about us without us.” To this end, she has extensive experience fostering bidirectional community partnerships and coalition building. She also has a strong track record of building sustainable centers of excellence in safety-net healthcare systems. 

As a disability and chronic disease self-advocate, Ms. LeBlanc has spent years redefining what it means to promote inclusivity and belonging and is dedicated to continually raising the bar for herself and her colleagues. Ms. LeBlanc completed her undergraduate degree at Wesleyan University and completed her master’s in communications at the S.I. Newhouse School of Public Communications at Syracuse University.

Arvin Garg, MD, MPH (He/Him)

Child Health Equity Center FOUNDING DIRECTOR

Arvin Garg, MD, MPH, is a general pediatrician and clinician-scientist who studies addressing unmet social needs through family-centered healthcare system-based interventions. He is the Founding Director of the Child Health Equity Center and the Founding Program Director of the Program to Advance Training in Child Health Equity (PATH) Fellowship. He is currently a Professor of Pediatrics and Vice Chair of Health Equity at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Garg is also Associate Chief Quality Officer for Health Equity for UMass Memorial Health

Since 2009, Dr. Garg has been continuously funded by the National Institutes of Health (NIH) and has received extramural funding from private foundations. He is Principal Investigator or Co-Investigator on multiple NIH-funded awards focused on testing and/or evaluating the implementation of interventions addressing social needs. He has published over 80 peer-reviewed manuscripts and serves as Associate Editor for the Journal of Developmental & Behavioral Pediatrics. He was recently the Chair of the Health Care Delivery Committee for the Academic Pediatric Association.

Photo of Dr. Arvin Garg

Arvin Garg, MD, MPH (He/Him)

Child Health Equity Center FOUNDING DIRECTOR

Arvin Garg, MD, MPH, is a general pediatrician and clinician-scientist who studies addressing unmet social needs through family-centered healthcare system-based interventions. He is the Founding Director of the Child Health Equity Center and the Founding Program Director of the Program to Advance Training in Child Health Equity (PATH) Fellowship. He is currently a Professor of Pediatrics and Vice Chair of Health Equity at UMass Chan Medical School and UMass Memorial Children’s Medical Center. Dr. Garg is also Associate Chief Quality Officer for Health Equity for UMass Memorial Health. 

Since 2009, Dr. Garg has been continuously funded by the National Institutes of Health (NIH) and has received extramural funding from private foundations. He is Principal Investigator or Co-Investigator on multiple NIH-funded awards focused on testing and/or evaluating the implementation of interventions addressing social needs. He has published over 80 peer-reviewed manuscripts and serves as Associate Editor for the Journal of Developmental & Behavioral Pediatrics. He was recently the Chair of the Health Care Delivery Committee for the Academic Pediatric Association.