Claude Earl Fox says that before he took over the helm of the Johns Hopkins Urban Health Institute, he knew how great a challenge stood before him. But he couldn't have imagined the complexity of the issues.
"The whole first year was a learning curve," says Fox, who has now headed the two-year-old institute for 18 months.
The institute has the daunting charge of marshaling the resources of the university and health system to improve the health outcomes of the residents of East Baltimore, an area of the city shackled with some of the most alarming health care indicators in the nation. Fox describes it as a community "devastated" by health and social problems, among them crime, unemployment, poverty, substance abuse, diabetes, hypertension and other chronic diseases.
But where to start? For Fox, the answer has been by reaching out to one organization and one faculty member at a time.
The Urban Health Institute has just released its first full progress report and, according to Fox, there is much cause for optimism. Crime, incidents of sexually transmitted diseases and the number of substance abuse-related cases presented to hospital emergency departments are all on the decline. And while these hopeful trends predate the institute's activity, Fox says, the facts speak loudly that an organized, focused effort can have a significant positive impact on the community.
"The expectations for this institute, I think, were very high, and I feel we have delivered, especially considering the fact we've been only in existence a little over two years," Fox says. "We have a number of projects already under way, and I can confidently say that we think they are all working well."
Fox became the institute's first full-time director in June 2001, taking over from Thomas O'Toole, an assistant professor of medicine, who had served as interim executive since its founding in July 2000. O'Toole, who continued on as the institute's associate director, is stepping down from his post this week so he can devote more time to his research, teaching and work in the community.
The role of the institute, Fox says, is to work with existing community organizations and determine their needs. The staff, which now has six full-time and three part-time members, then attempts to match those needs with available resources, whether it be grant funding, supplies, personnel or faculty research. Specifically, the institute seeks to understand how Hopkins' research, teaching and clinical expertise can be better harnessed to tackle serious community health problems in East Baltimore and elsewhere.
In the past year, Fox and O'Toole laid out the institute's four principal goals, which are to provide economic stimulus through training and employment assistance, to strengthen and enhance community-based research partnerships, to enhance the infrastructure of the community and to provide 100 percent access to health care with no disparities.
Fox says that reversing the economic problems of East Baltimore needs to be a top priority. The current unemployment level in the community is disturbingly high, he says, and more jobs need to be created where people live.
"The signs are not encouraging. We have a long way to go on unemployment, and that is why we are focusing so much on the job issue right now," he says. "Basically, there is a lack of opportunities for employment within this community. We feel that if everyone could get a job with a livable wage, the health problems would probably drop by two-thirds overnight. The social determinants of health have as much impact on the community as the number of clinics."
To help remedy the problem, the institute is looking into developing training academies that can provide residents with such skills as computer repair, carpentry and construction. In particular, Fox says, plans are under way to open sometime next year a computer refurbishing training center where residents would be taught to rebuild and rehabilitate computers, which could then be used in the community.
"We need to do a better job of promoting jobs in the community, and this is one way to do that," Fox says. "This will be a technical center that can support the community and help with job readiness. A project like this will also help to reclaim another block from the drug dealers, and that is certainly a step in the right direction."
Fox points to upcoming Hopkins-related construction projects in East Baltimore, such as the development of a biotech park just north of the JHMI campus, as another potential source of employment.
"I thought, wouldn't it be great if we could use area residents on these construction projects?" he says. "So we are working with Jim Davenport from The Door to help them expand their program that trains people to do carpentry and construction."
On the topic of community-university partnerships, Fox says the institute's four funded projects are all progressing well, and results from each will be published by summer 2003.
The projects include:
The Amazing Grandmothers Project -- a partnership between School of Nursing faculty member Laurie Edwards, Tench Tilghman Elementary School and the Amazing Grace Church that targets 10 families in which grandmothers are the primary caregivers to their grandchildren.
A partnership between Brian Poeschla, a faculty member in the School of Medicine's Department of Psychiatry, and the Mattie B. Uzzle Outreach Center to study whether initial substance-abuse screening and direct referral admissions from the community to Psychiatry's Intensive Treatment Unit will result in better outcomes.
A project by Annelle Primm of the School of Medicine's Department of Psychiatry, Rosa Crum of the Johns Hopkins Bloomberg School of Public Health and Zion Baptist Church to examine the role of spirituality and religious practices in the treatment of patients with substance-abuse problems and severe mental illness.
A partnership between School of Nursing faculty member Marion D'Lugoff, the Wald Community Nursing Center and Heart, Body and Soul to expand on LINCS, the Linking Individuals to Need and Continuing Support project. Through this effort, substance-abuse treatment has been included in primary care delivered at the Wald community clinics, and training in substance-abuse screening is now offered to part-time community health workers through the Heart, Body and Soul program.
Fox says that he expects most, if not all, of these projects to continue into next year and beyond. In addition, the institute is currently laying the groundwork for several new partnerships with Hopkins faculty and the community.
"I think many activities that we start will go on after the initial funding period ends," Fox says. "There is not going to be continued funding support from us; we don't have the money for that. What we want to do is get them up and running."
To determine the community's needs, the institute this summer launched a project, conducted by two Johns Hopkins medical students, that mapped out in detail 40 community service organizations. The next step, according to Fox, is to determine what the institute can do to help these groups achieve their missions.
"For instance, we have identified several potential resources to get office equipment at low or no cost. We also might help meet their human resource needs by getting students to do after-school mentoring at these organizations," he says. "There are many resources in Maryland and D.C. that people don't know about, and I see our job as helping the community gain access to them. Another thing I would like to see us do is to provide some in-house experts on grants who can perform grant work pro bono for organizations who can't afford to hire their own."
As for access to health care, Tom O'Toole says that the institute's substance-abuse initiative is "clearly making a difference" and he sees progress on many fronts. The key, O'Toole says, is twofold: pairing up individuals with successful programs, and strengthening efforts that have proven track records.
"The reality is that this institute needs to be there as a facilitator to help those in the health care field do a better job," O'Toole says, "and to make their work relevant to the residents of East Baltimore and such communities."
The institute is currently headquartered downtown in the Candler Building, but Fox says it will move to offices on or near the East Baltimore campus as soon as possible. He says he also expects to expand the number of staff.
"Right now, there is a limit on what we can do, based on the amount of time I have and that of the other staff," he says. " But down the road, it's pretty much unlimited, the amount of good we can do."
For more on the Johns Hopkins Urban Health Institute, go to urbanhealthinstitute.jhu.edu.