New Grant for CISWH Executive Director and BU Colleagues Supports Linguistic Interpreters Working with Trauma Patients

Interpreters working with medical patients who have experienced forced displacement are often exposed to their clients’ traumatic experiences, otherwise known as vicarious trauma. Unlike social workers, psychologists, and other clinicians; linguistic interpreters frequently lack the institutional support for managing this indirect trauma and its impact on their mental health. This can lead to poor patient care and decreased work engagement.

The Center for Innovation in Social Work & Health (CISWH) executive director Eleanor Zambrano, in partnership with a team of Boston University faculty and experts at the Boston University School of Medicine (BUSM) and the Immigration and Refugee Health Center (IRHC) at Boston Medical Center (BMC), received a one-year seed grant from the Boston University Center on Forced Displacement (BUCFD). Through the grant, the team will study the experiences of interpreters working with forcibly displaced people to understand how vicarious trauma impacts interpreter well-being and their ability to provide quality care.

“We are committed to building stronger partnerships focused on health equity research,” says Zambrano. “CISWH’s partnerships and research continues to expand the impact of social work within public health in order to improve the health and well-being of vulnerable populations.”

The researchers will interview and gather quantitative data, including demographics and a life events inventory, from 20 participating interpreters currently employed at BMC. With a better understanding of interpreters’ experiences, the team will use the research findings to develop sustainable training programs and other hospital systems of support to meet their unique needs.

Members of the research team include:

  • Resham Gellatly, PhD, assistant professor, Department of Psychiatry at BUSM and clinical psychologist; Boston Center for Refugee Health and Human Rights (BCRHHR) at BMC
  • Sarah Kimball, MD, assistant professor at BUSM; affiliate faculty member at CFD; and director of the BMC IRHC
  • Nuha Alshabani, PhD, postdoctoral fellow at BMC

Learn more about the 2023 CFD grants here.

CISWH Partner, University of Global Health Equity in Rwanda, Launches Community-Based Education Program for International Students

Photo by Paul Kagame, provided under Creative Commons License CC BY-NC-ND 2.0

The University of Global Health Equity (UGHE) in Rwanda, a partner of the Center for Innovation in Social Work & Health (CISWH) at the BU School of Social Work (BUSSW), is now accepting applications for its first Community-Based Education Global Scholars Program (CBE Global).

In this 3-week immersive summer certificate program, students from around the world studying social work, public health, and related fields will travel to Rwanda to learn about the innovative, community-driven work happening in rural communities. Students will work alongside activists and community leaders to tackle inequities in health. By the end of the 3 weeks, participants will be able to:

  • assess and identify community strengths and assets that advance health and wellness
  • remove paternalistic techniques from professional practice and organizational culture
  • co-develop community health programs
  • identify racism, colonialism and other determinants of poor health and act towards dismantling these structures
  • advocate for equity in education and other socio-economic rights
  • effectively collaborate with communities

UGHE will host the first cohort of CBE global students from July 17 to August 3, 2023.

UGHE brings a new approach to recruiting and training health professionals. An initiative of Partners In Health (PIH), which was co-founded by CISWH board member, the late Dr. Paul Farmer, and led by internationally recognized faculty and staff from around the world, UGHE is an independent university that builds on PIH’s three decades of experience in delivering health services to some of the world’s poorest communities.

Learn more about the program.
Apply Here.

Community Connection in Changing Times: CISWH’s Executive Director reflects on her return to Ecuador

by Eleanor Zambrano, CISWH Executive Director

In August 2022, I traveled to Ecuador to visit my family after seven years away. I was overwhelmed with a mix of nerves and anticipation. I was reminded of one of my first experiences in Ecuador in 2002, where I learned to speak Spanish fluently and experienced the collective culture of family and community that has forever influenced my global view of the role of social work in community health and social justice.

Preserving Our Traditions Through Sustainable Nutrition

Cuenca, Ecuador
Plaza de San Francisco, Cuenca, Ecuador

My most recent trip in August re-ignited these feelings of family connection and community, alongside my dedication to social work, health, and building global partnerships. I traveled to Cuenca in the Southern Andes, where I learned about the changes in this region over the last 20 years due to migration and climate change, as well as local efforts to sustain traditional “Cuencano” culture and the environmental health of the region. 

Gustavo José Romero Valencia, a family friend I had the opportunity to visit, is doing this important community work himself, as co-owner of La Chicheria, a restaurant focused on the sustainability of traditional food systems in Ecuador’s South Andes. The restaurant is known for producing Chicha, a traditional Cuencano beer made from fermented corn. La Chicheria partners with community coalitions dedicated to protecting traditional Cuencano practices through agricultural and social research

Learning about this work has inspired my own efforts at CISWH, where we hope to be doing future work with the University of Cuenca to build an environmental health partnership exploring the preservation of indigenous cultures and food systems and how it impacts climate and environmental health and justice. This would be shared, mutual learning between social work and health professionals in both Ecuador and the U.S. Our goal would be to learn about ways to build sustainable, equitable models in our own food systems. Access to nutritional, quality food in underserved communities, in particular, is an important issue, not just abroad, but closer to home as well. 

The Global Impact of Migration on Communities

Southern Andes, Ecuador
The Southern Andes of Ecuador

During my travels in Cuenca, my tour guide introduced me to a small town on the outskirts of the city that was completely populated by families who have relatives living in the US. The town’s economy was fully dependent on migrant workers in the U.S. sending money back to Ecuador to their families. This was a keen reminder of the impact of migration on global communities and the transnational family model.

Through CISWH’s work in Latin America, we know well that people who immigrate to the United States often have attachments to two places at once – their hearts are broken into two pieces. Immigrants often experience feeling like they’re from two different places, which can have health implications. Seeing this firsthand in Ecuador, a country in which I have close familial ties, really drove home the global impact of migration on the community. 

During my stay, many of the conversations with my family were about the collective struggles with staying connected with family between the U.S. and Ecuador. Although we had been apart for several years, the bond and relationships between myself and my family were still strong. We spoke about plans to continue supporting new family members who planned to migrate to the United States, as well as our family’s resilience and commitment to staying engaged and connected while living transnationally.

Reaffirming Our Commitment to Global Health Equity and Social Justice

Ellie in downtown Cuenca
Ellie Zambrano in downtown Cuenca, Ecuador

Fresh from my trip to Ecuador, I am reminded of the complex ways immigration, transnational relationships, and climate change affect Latinx communities both in the United States and globally. I’m energized having reconnected with my own family in Ecuador, as well as having met local communities doing this vital work. In the coming year, CISWH is prioritizing the development of global health partnerships to strengthen global health equity and social justice. Our goal is to be a keystone in social work information sharing, training, and research and policy development in global health.   

11/3: Strengthening Professional Health Education for Global Change: A Conversation with Dr. Vanessa Kerry

Thursday, November 3, 2022

5:00 – 6:00 PM

Zoom; Room 101, The Rajen Kilachand Center for Integrated Life Sciences & Engineering, 610 Commonwealth Avenue

A Hybrid Event Presented by 

The Center for Innovation in Social Work & Health

Featuring Dr. Vanessa Kerry

View the Recording

Join the Center for Innovation in Social Work & Health and Dr. Vanessa Kerry for a conversation on the links between global health and economic growth, community development, and national security.  

As a practicing critical care physician and CEO of Seed Global Health, Dr. Kerry will share a people-centered model for training health professionals in countries with limited resources to improve global health and promote economic and community development worldwide. 


5:00 pm: Opening remarks and introduction by Ellie Zambrano, CISWH executive director

5:07 pm: Dr. Vanessa Kerry presentation

5:30 pm: Q&A with Prof. Margaret Lombe and Dr. Vanessa Kerry

5:40 pm: Q&A with in-person and Zoom audience

5:55 pm: Closing remarks by Ellie Zambrano

Content Level: Intermediate

Continuing Education Credit Info:

The target audience of this lecture and discussion is LICSW, LCSW, LSW, LSWA and other health care professionals. Strengthening Professional Health Education for Global Change  is approved by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program to be offered by the Center for Innovation in Social Work and Health as an individual course. Individual courses, not providers, are approved at the course level. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ACE course approval period: 11/08/2021 – 11/08/2024. Social workers completing this course receive 1.0 continuing education credits. 

1.0 national continuing education credits (free) are available to social workers licensed in the United States after the completion of a brief post-event quiz. The event will provide intermediate-level content and must be attended live in order to receive CE credits. If you would like to receive credits, please provide your license number during registration. The post-event quiz will be sent out at the end of the event and will be a Qualtrics quiz. Applicants will need a score of 70% or higher to receive the CE certificate, which will be sent via email. Questions? Contact [email protected] 

Boston University School of Social Work, 1121, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Boston University School of Social Work maintains responsibility for this course. ACE provider approval period: 11/8/2021 – 11/8/2024.

Learning Objectives:

  • Explain central challenges to training health professionals in resource- limited countries.
  • Examine the links between health and other aspects of society including economy, social cohesion, and national security.
  • Apply a model for training local health professional capacity.


  • Kerry VB, Ahaisibwe B, Malewezi B, Ngoma D, Daoust P, Stuart-Shor E, Mannino CA, Day D, Foradori L, Sayeed SA. Partnering to Build Human Resources for Health Capacity in Africa: A Descriptive Review of the Global Health Service Partnership’s Innovative Model for Health Professional Education and Training From 2013-2018. Int J Health Policy Manag. 2020 Nov 29. PMID: 33300760.
  • Shokoohi H, Raymond A, Fleming K, Scott J, Kerry V, Haile-Mariam T, Sayeed S, Boniface KS. Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda. Ultrasound Med Biol. 2019 06; 45(6):1351-1357. PMID: 30904246.
  • Schriger SH, Binagwaho A, Keetile M, Kerry V, Mubiligi JM, Ramogola-Masire D, Roland M, Barg FK, Cancedda C. Hierarchy of qualities in global health partnerships: a path towards equity and sustainability. BMJ Glob Health. 2021 12; 6(12). PMID: 34969686; PMCID: PMC8718486.
  • Falahee BKerry V. Embracing Social Engagement in Academic Medicine: Ongoing Challenges and How to Move Forward. J Gen Intern Med. 2022 04; 37(5):1254-1257. PMID: 34505236; PMCID: PMC8971209.
  • Bebell LM, Ngonzi J, Meier FA, Carreon CK, Birungi A, Kerry VB, Atwine R, Roberts DJ. Building Perinatal Pathology Research Capacity in Sub-Saharan Africa. Front Med (Lausanne). 2022; 9:958840. PMID: 35872791; PMCID: PMC9304650.


Boston University strives to be accessible, inclusive, and diverse in its facilities, programming, and academic offerings. Your experience in this event is important to us. If you have a disability (including but not limited to learning or attention, mental health, concussion, vision, mobility, hearing, physical or other health-related issues), requiring communication access services for the deaf or hard of hearing, or believe that you require a reasonable accommodation for another reason, please contact the event organizer at [email protected] to discuss your needs.

About Vanessa Kerry, MD, MSc

Vanessa Kerry, CISWH advisory board member, is the CEO of Seed Global Health, director of the Program in Global Public Policy and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School, and an associate professor of medicine at Harvard. Her work has included innovative research in the nexus of national security, crisis response, and health including a two-year project with the North Atlantic Treaty Organization (NATO). She has taught courses on the intersection of health, economy, politics, and security at the Kennedy School of Government and Yale University.

Included among her many honors: she is a Draper Richards Kaplan Foundation Social Entrepreneur, a World Economic Forum Young Global Leader,  a member of the Council on Foreign Relations, and is on the editorial board of New England Journal of Medicine Evidence and Annals of Global Health. She was recently appointed to the President’s Council for International Activities at Yale University, is a Global Advisor to the Wellbeing Foundation Africa, and serves on the board at University of Global Health Equity.

Dr. Kerry graduated from Yale University summa cum laude and Harvard Medical School cum laude, completing her clinical training at Massachusetts General Hospital (MGH). She earned her Master’s in Health Policy, Planning, and Financing from the London Schools of Economics and of Hygiene and Tropical Medicine. She was awarded an honorary doctorate in Public Policy from Northeastern University in 2015.

She is currently a critical care physician at Massachusetts General Hospital and serves as the associate director of Partnerships and Global Initiatives at MGH Global Health. She also directs the Global Public Policy and Social Change program at Harvard Medical School where she has focused on links between security and health. 

Social Work in Nicaragua with CISWH: A BUSSW Student’s Perspective

by Lauren Glaser (BUSSW MSW ’23) 

This past academic year, I worked as a global health research assistant at the Center for Innovation in Social Work & Health (CISWH) under the supervision of Professor Dr. Luz López. In this role, I helped  prepare and deliver mental health trainings to university students in Nicaragua via Zoom. Following that, I was  privileged to be one of two BUSSW MSW students who took part in CISWH’s trip to Nicaragua in April 2022, where I got to meet in person with many of the university students I had worked with virtually. 

Our initial delegation of four — Professor López, CISWH Executive Director Ellie Zambrano, CISWH Administrative Assistant Winnie Chen, and me (the second MSW student, Madelyn Fermin, joined midway through the trip) — flew from Boston to Miami to Managua. Upon landing we left the airport and walked into the warm, sticky Nicaraguan weather that felt quite familiar to me, having worked there for several months before I began my MSW studies.  

We hopped into a pickup truck and, after stopping for our first of many delicious meals, we headed north to the small city of Estelí, where two of our partners, Fundación Superemos and the National Autonomous University of Nicaragua-Estelí (UNAN-FAREM Estelí), are located.  

The Superemos Foundation and Boston University have a truly special relationship that has lasted more than two decades. The relationship began with an annual medical brigade led by Dr. Peter Loewinthan, which now includes BU-affiliated dentists, doctors, nurses, psychologists, and social workers. The group travels to Estelí to deliver healthcare to people in the surrounding areas and to train local providers. This year the training was offered via Zoom due to the pandemic. One of the goals for our visit to Superemos was to provide follow-up in-person trainings for students and professionals, including nurses, physicians, and lawyers working in rural healthcare and domestic violence prevention. 

CISWH in Nicaragua

On our first morning, after breakfast at a family-run B&B, we taxied over to the Superemos site, an oasis of green at the edge of town. The property is tidy with mural-covered buildings where art classes, high school equivalency courses, and other training programs take place. When we got to Superemos that first day, we were greeted with open arms and hearts by Stephen Stefton, who is one of the original founders of the organization and their Intervention, Change, and Education Service (ICES) team. After an introduction to the organization and a tour of the facilities, we shared a delicious homemade lunch of rice, fresh vegetables, and avocado in the outdoor dining area.  

ICES is one of the central programs of Superemos. Created in 2010, it works to address domestic violence in and around Estelí, and utilizes a wraparound team including a lawyer, psychologist, and social worker to support victims of domestic violence and their families. The team travels regularly to rural areas offering prevention education and interactive seminars about unhealthy relationships, and to establish trusting relationships with residents.  

The three women who make up the ICES team—Maria Félix Castillo, Karen Villareyna, and Sindy Alvarado—led us through a comprehensive and meaningful program during the first few days of our visit. Some of the moments that stick out in my mind include traveling for hours to get to a rural health outpost, where the ICES team delivered a presentation to a group of moms while their children were vaccinated; a meeting  at the Ministry of Family, Adolescence; a meeting at the UNAN-FAREM, university in Estelí, with faculty and administrators we had met during the Zoom trainings earlier in the year; and a visit to a shelter for at-risk pregnant women that Superemos helps run, where we engaged with the soon-to-be mothers. It was heartening for me as a new social worker to see how the ICES team engaged with the women at the shelter in such a dynamic, authentic, and non-hierarchical way.  

The three women who make up ICES went above and beyond to make sure that we felt welcome and supported. For example, when I came down with a stomach illness, they made a trip to the pharmacy for me without being asked, and then sent me WhatsApp messages to check in on me. The ICES social worker, Sindy Alvarado Castro, showed me great patience when I peppered her with questions about why she became a social worker, about social work education in Nicaragua, and the social work profession overall. I learned the ins and outs of the thesis that Sindy co-wrote on rural healthcare delivery, and about what it’s like to be a part of a profession that many Nicaraguans don’t quite understand yet. Towards the end of the week when we had to say goodbye to Superemos and to the ICES team, it was with heavy hearts and much gratitude for both the professional and personal connections we had experienced in Estelí. 

CISWH in NicaraguaNext, we traveled back down towards Managua to learn about La Mariposa, an NGO founded by former social worker Paulette Goudge, an Englishwoman who moved to Nicaragua years ago. The initial idea for La Mariposa was that it would be an eco-hostel and Spanish school to help spur local employment. With Paulette’s energy and passion, however, it transformed into something even bigger. Over the course of a few days we had the chance to visit the projects that La Mariposa funds and runs. These include free physical, mental health, and equine therapy for children with special needs; clean water delivery for a village that doesn’t have access to running water; a reforestation project; an animal sanctuary; a small English school for local children, and more. Just like in Estelí, we were received by people—Paulette herself, her employees, community members, and clients—who patiently shared their stories with us without expectation of anything in return.  

Before the trip, I was honestly a bit nervous to participate since the journey was to take place right in the middle of my MSW program’s final exams and papers. It turns out that my concerns were unnecessary. I was even able to use what I had learned from the ICES team as inspiration for my final Communities and Organizations course assignment. 

What I gained from the trip to Nicaragua was immeasurable. Much more than professional experience, I gained several new friends and a deep appreciation for the work other women are carrying out across borders. I was, and continue to be, inspired and uplifted by the experience, and I remain grateful to Professor López, Ellie Zambrano, and everyone else at CISWH who made my participation in the trip possible.  

The BUSSW Statement: Reproductive Justice

This article was originally published on May 4, 2022. It was updated on June 24, 2022.

The Supreme Court overturned Roe v. Wade today. Our School’s previous statement reaffirms our commitment to fight for reproductive justice:

Nearly 50 years ago, the U.S. Supreme Court ruled on Roe v. Wade, which guaranteed a person’s liberty to have an abortion without excessive government restriction. 

As of today 26 states are likely to pass legislation completely or partially banning abortions. 

Fundamentally abortion is an issue of reproductive justice, racial justice, health care access, class, and gender equity. As a profession, if we are committed to social justice, we must be willing to stop seeing abortion as the shadow “hot button” issue.

Even before this news, our Equity and Inclusion Committee was organizing to form a BUSSW learning community to collectively deepen our knowledge about reproductive justice more broadly, as well as abortion specifically. The SCOTUS opinion propelled us to develop this learning community sooner. In addition to reading books and articles about our past and present reproductive landscape, we will invite speakers and trainers from local reproductive health organizations and abortion fund agencies to support our learning. This work will help us act on the information we learn so we can contribute to reimagining how people access abortion care and other reproductive health-related services in the United States. 

In the coming weeks, members of the Equity & Inclusion Committee will hold space for our community to collectively discuss social workers’ role in this moment. In the meantime, there are three things members of our community can do:

  1. Learn about abortion access in your state. If you live in Massachusetts, abortion will remain legal and accessible but we know our BUSSW community stretches across the country and the communities we live in and serve will be affected differently by this ruling.
  2. Support abortion funds, practical support organizations, and independent people along with Planned Parenthood, so that reproductive justice organizations can continue to strengthen and sustain the power needed to navigate the rapidly shrinking landscape of abortion access. These are the groups that will ensure that all people, especially those living in states hostile to abortion, can access the care they need.
  3. Tell five friends about abortion funds and share our Massachusetts Abortion Funds’ Resource Guide. This guide is not specific to Massachusetts, but rather contains information about donating to funds, how to talk about abortion, and how to access help.

Thanks and credit to doctoral candidate Greer Hamilton for her editorial leadership on this statement, and MSW student Kate Glynn for initiating the discussion to develop reproductive justice programming.

In solidarity,

Dean Jorge Delva
Equity & Inclusion Committee Chairs: Dawn Belkin Martinez & Ellen DeVoe

CISWH Joins Steering Committee for National Advocacy Campaign

The Center for Innovation in Social Work and Health, in partnership with the National Coalition on Social Work in Health, joins a 2-year  campaign that will advocate for social work innovations and policy change, as well as sustainable infrastructure and roles for integrated care settings. The committee was awarded 2-year base funding from the New York Community Trust in June 2022. 

The committee will focus on four key areas: 

  • Develop and distribute materials highlighting social workers’ expertise among diverse audiences
  • Train both social work students and practitioners to advocate for roles in integrated care settings 
  • Advance policy advocacy efforts 
  • Build systems for sustainable funding

The 12 committee members will lead four workgroups focused on these key areas that will include additional members from the National Coalition on Social Work in Health and external partners. CISWH Director Dr. Jorge Delva, alongside Louise Knight, director of patient and family services at Johns Hopkins Kimmel Cancer Center, will lead the Partnership & Sustainability workgroup. 

“I am thrilled that as members of the National Coalition on Social Work in Health we were successful in securing funding to create a campaign that aims to increase the recognition of our professions’ expertise, roles, and values,” says Dr. Delva.

Those Who Remain: Supporting Separated Families in Nicaragua

People migrating from South and Central America to the United States face a harrowing journey, braving some of the world’s most inhospitable environments by foot, often exposed to violence along the way. Those who make it to Mexico and the U.S. border are then faced with further trauma in camps and detention centers that are overburdened and under-resourced. Many of these migrants come to the United States seeking a better life for their families, often leaving family members as they make the costly trek north. Although less documented in the news, these family members suffer their own trauma from separation, often left behind in difficult circumstances. CISWH is providing essential trauma and mental health care services not only to migrants at the U.S. Mexico Border, but to family members waiting in Nicaragua as well.

The role CISWH plays

CISWH and Superemos collaborating in Nicaragua.

Family separation has been on the rise in Nicaragua, especially after the COVID-19 pandemic hit the Central American country hard, shuttering tobacco factories and other key industries leading to lay-offs for thousands of workers. Over 100,000 people have migrated from Nicaragua to neighboring Costa Rica and beyond since 2020. CISWH is working with the Superemos Foundation, a Nicaraguan non-profit providing community development through education, training, a comprehensive domestic violence program and related health and social work programs, to provide separated families with education and mental health support.

Professor Luz López, CISWH Global Health Core director; Ellie Zambrano, CISWH executive director; and Winnie Chen, administrative coordinator, were joined by two MSW students, Madelyn Fermin and Lauren Glaser, for a trip to Nicaragua in April 2022 where they participated in a cultural exchange and interprofessional partnership with the Superemos Foundation and the National Autonomous University of Nicaragua (UNAN-FAREM) in Estelí. Superemos Foundation collaborators included program co-founder Stephen Sefton, social worker, Sindy Alvarado, psychologist Karen Villareyna and lawyer, Maria Felix Castillo.

The CISWH and Superemos teams conducted interactive seminars on trauma care, violence prevention, and the psycho-social impact of migrant families’ separations for nurses, physicians, lawyers, and community health workers based in the communities of San Nicolas and surrounding rural areas. They also presented seminars for social work, psychology, and medical students at UNAM-FAREM. The Superemos Program works in collaboration with the Nicaragua Ministry of Health (MINSA) and the Ministry of Families. This cultural immersion experience serves to deepen BU social work students’ knowledge, clinical practice, and the cultural adaptations needed to work with migrants in both Central America and the United States.

“We as social workers have a key role in working with migrant families in their country of origin or at the Mexico/U.S.border. I feel so grateful to contribute as part of CISWH during this critical time,” Prof. López says.

A view of the sunset in Esteli, Nicaragua. Part of this work focuses heavily on care for women currently experiencing or surviving domestic abuse. Domestic violence is endemic in Nicaragua, and many women flee the country, with or without their children, to escape it. Working with Superemos, Prof. López and the CISWH team are training local nurses and physicians in preventive measures against domestic abuse. They’re also ensuring that practitioners have the tools they need to identify existing cases of abuse. These doctors and nurses can then connect women and their children with services from the Superemos Foundation and the Ministry of Family, offering protection and connecting women with family members who can keep them safe. This community-centered approach keeps women and their children together, while building strong preventive measures in rural areas in Nicaragua.

“We learn from the families as well – about their resilience. It was a two-way participatory process which was very, very helpful,” Prof. López says.

What’s next

As the federal Title 42 order is extended in the United States, families will remain separated and migrants will continue to be stalled in poor conditions at the U.S. and Mexico border. CISWH offers ongoing support to migrants and their families and continues to provide resources to ensure that nurses and doctors in rural areas can travel to Nicaragua’s capital, Estelí, to receive essential training. CISWH will also continue to train social work and psychology students in Nicaragua via Zoom. Prof. López plans to work with families directly, too, offering virtual consultations and social work support to families experiencing separation.

In the meantime, Prof. López highlights that there is much work to be done stateside as well. She wants to raise awareness about the families traveling to the border in hopes of improving their families’ circumstances. “People need to know these are hardworking families,” Prof. López says. “They don’t want to leave their kids behind. They very much care for their children and want to provide them with economic and educational opportunities.”

CISWH’s Meg Comeau Co-authors Research Recommendations to Improve Health Care Financing for Children and Youth with Special Health Needs

By definition, children and youth with special health care needs (CYSHCN) require more health care services than children typically do to ensure their optimal health, quality of life and well-being.  About 20% of children in the US have special health care needs, and their care comprises about half of all pediatric health care spending. 

Health care spending in the US has historically been based on payment for acute, time-limited health care needs, and payment has not typically been attached to improved outcomes.  However, CYSHCN require a different approach, since their health care needs are ongoing and effective spending on improved health care in childhood pays dividends throughout the life course.

With health care costs spiraling for all populations, increasing attention is being paid to improving the cost-effectiveness of spending through payment reform. To date, the development and testing of payment reform has primarily focused on adults rather than children, who have different health and social needs.  This leaves gaps in knowledge around what kinds of benefits best serve CYSHCN, which payment models are the most cost-effective and how to identify and test new quality measures that ensure what’s being paid for matters to children, families, providers, and payers.

In a new paper from Academic Pediatrics co-authored by Meg Comeau, CISWH senior project director and principal investigator for the Catalyst Center, a team of experts recommend a financing research agenda focused on filling the knowledge gaps around benefits, payment models and quality measures in the care of CYSHCN.

The State of Research on Healthcare Financing for CYSHCN

To inform their research recommendations, the authors highlight three existing observations on current health care financing for CYSHCN, including:

  • Underinsurance is a common problem for privately-insured families raising CYSHCN, and results in financial hardship for many.
  • Almost half of all CYSHCN are enrolled in Medicaid coverage, along with most children with medically complex conditions.  Medicaid managed care may include capitation (a set amount of money per enrollee) and an emphasis on care coordination as a way of increasing value.
  • Most of the existing research on increasing value in health care financing for CYSHCN focuses on models tested in specific environments (hospital-based outpatient clinics, for example) with limited numbers of participants, making it difficult to generalize findings to different settings and larger populations.

Recommendations for Future Research

Based on the current landscape of healthcare financing for CYSHCN, the authors identified three topic areas for research that addresses the specific needs of CYSHCN, their families, and their healthcare providers:

  1. Assess value by evaluating the fit between benefit packages and the needs of CYSHCN through comparison of different payment models with typical patterns of need.
  2. Develop models to measure return-on-investment for care coordination activities.
  3. Use a multistakeholder process to identify and rank health care value outcomes for CYSHCN, as a precursor to developing and testing new quality measures.  Included in this process should be families raising CYSHCN, pediatric health care providers, and both public and private payers.

Using this agenda, researchers can begin to build a robust body of evidence that can lead to innovative financing that addresses the unique needs of CYSHCN and moves the focus from spending on health care to investment in children’s overall health and well-being.


Read the full article here.

Elevating Social Work in Health in Nicaragua

A team from The Center for Innovation in Social Work & Health’s (CISWH) Global Health Core completed a productive trip to Nicaragua this past month as part of an ongoing partnership between CISWH, the Superemos Foundation, the National Autonomous University of Nicaragua FAREM-Estelí (UNAN-FAREM), and La Mariposa Spanish School and Eco-hotel. CISWH Global Health Core Director Luz M. López, along with Executive Director Eleanor Zambrano, Administrative Coordinator Winnie Chen, and MSW students Lauren Glaser and Madelyn Fermin made the trip to Nicaragua. 

CISWH and Superemos collaborating in Nicargua.
Superemos Foundation and the CISWH team in conversation in Estelí.

The trip began in Estelí, where psychosocial seminars were provided by a multidisciplinary team of CISWH and UNAN-FAREM social work and psychology faculty. The training was conducted in partnership with the  the Superemos Foundation, a Nicaraguan non-profit providing community development through education, training, a comprehensive domestic violence program and related health and social work programs. Two psychologists, Lyn Stycznski & Leonard Greenberg from Massachusetts, also led some of the seminars by Zoom. 

These interactive seminars offered trauma focused and mental health capacity building for lawyers from the Estelí Department of Public Defense, nurses and doctors from the community of San Nicolás, and social work, psychology and medical students at UNAN-FAREM. The goal was to reduce stigma about mental health and trauma care to better serve families affected by intimate partner violence and family separations due to the recent immigration crisis. The team also visited and worked in collaboration with the Estelí Ministry of Family and the Ministry of Health. 

CISWH with La Mariposa in Nicaragua
The CISWH team meets with the leader of La Mariposa, Paulette Goudge.

The CISWH team then traveled to San Juan de Concepción to La Mariposa, a Spanish language school and eco-hotel that uses its profits to fund community development projects in rural areas. They met with founder Paulette Goudge and other community leaders and learned about water projects in the nearby La Concha area, where La Mariposa is working to improve access to clean water. They also visited ‘La Chispa de Vida’, an equine therapy and physical therapy project for more than 40 differently-abled children, several adults, and their families. La Mariposa also leads a reforestation effort in the region and other environmental health projects. 

In the coming months, CISWH will continue to train UNAN-FAREM social work and psychology students remotely, and the three organizations will focus on developing a long term plan for research opportunities to elevate social work in health and offer cultural immersion programming for BUSSW students.