Archive for category: Health Care

Madison Hayes presents research into sexually exploited youth, completed as part of Social Welfare's capstone requirement. Photo by Les Dunseith

Graduating Students Seek Solutions Near and Far The capstone research projects that are now part of all UCLA Luskin programs tackle local challenges or examine issues that extend far beyond campus and California

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By Stan Paul

Newly graduated Social Welfare master’s degree recipient Deshika Perera’s research project extended across the United States and as far north as Alaska.

Evan Kreuger helped create a nationwide database as a basis for his research into LGBT health and health outcomes to culminate his Master of Social Welfare (MSW) studies at the UCLA Luskin School of Public Affairs.

Perera and Kreuger are members of the first graduating class of Social Welfare students to complete a capstone research project as a graduation requirement for their MSW degrees. Like their UCLA Luskin counterparts in Urban Planning and Public Policy who must also complete capstones, working individually and in groups to complete research and analysis projects that hone their skills while studying important social issues on behalf of government agencies, nonprofit groups and other clients with a public service focus.

“It’s been fun; it’s been interesting,” said Perera, who worked with Associate Professor Ian Holloway. Her qualitative study examined the relationship between the Violence Against Women Act and nonprofits, focusing on programs that provide services to indigenous survivors of sexual assault and domestic violence on reservations and in remote areas of the U.S.

As a member of the pioneering class for the MSW capstone, Perera said that although the new requirement was rigorous, she enjoyed the flexibility of the program.

“I feel we got to express our own creativity and had more freedom because it was loosely structured,” Perera said, explaining that she and her fellow students got to provide input on their projects and the capstone process. The development of the requirement went both ways. “Because it was new, [faculty] were asking us a lot of questions,” Perera said.

“We strongly believe that this capstone experience combines a lot of the pieces of learning that they’ve been doing, so it really integrates their knowledge of theory, their knowledge of research methods and their knowledge of practice,” said Laura Wray-Lake, associate professor and MSW capstone coordinator. “I think it’s really fun to see research come alive and be infused with real world practice.”

Krueger, who also was completing a Ph.D. in public health at UCLA while concluding his MSW studies, previously worked as a research coordinator for a national survey on LGBT adults through the UCLA School of Law’s Williams Institute. He said he had a substantial amount of data to work with and that he enjoyed the opportunity to combine his research interests.

“I’m really interested in how the social environment influences these public health questions I’m looking at,” said Kreuger who has studied HIV and HIV prevention. “I kind of knew what I wanted to do, but it was a matter of pulling it all together.”

For years, MSW students have completed rigorous coursework and challenging educational field placements during their two-year program of study, and some previous MSW graduates had conducted research in connection with sponsoring agencies. This year’s class included the first MSW recipients to complete a new two-year research sequence, Wray-Lake said.

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Oceana Gilliam shares her team‘s research on juvenile justice in L.A. County. Photo by Les Dunseith

View more photos from Public Policy’s APP presentations.

Applied Policy Projects

In UCLA Luskin Public Policy, 14 teams presented a year’s worth of exacting research during this year’s Applied Policy Project presentations, the capstone for those seeking a Master of Public Policy (MPP) degree.

Public Policy students master the tools to conduct policy analysis during their first year of study. In the second year, they use those tools to create sophisticated policy analyses to benefit government entities and other clients.

The APP research is presented to faculty, peers and curious first-year students over the course of two days. This May’s presentations reflected a broad spectrum of interests.

Like some peers in Social Welfare, a few MPP teams tackled faraway issues, including a study of environmental protection and sustainable tourism in the South Pacific. Closer to home, student researchers counted people experiencing homelessness, looked at ways to reform the juvenile justice system, sought solutions to food insecurity and outlined ideas to protect reproductive health, among other topics.

“Our students are providing solutions to some of the most important local and global problems out there,” said Professor JR DeShazo, chair of UCLA Luskin Public Policy.

After each presentation, faculty members and others in the audience followed up with questions about data sources, methodologies and explanations for the policy recommendations.

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MURP Jesse Flores talks about his project during the poster session. Newly admitted students to UCLA Luskin Urban Planning are among those invited to CCC each year. Photo by Les Dunseith

View more photos from Urban Planning’s capstone presentations.

Careers, Capstones and Conversations

Recently graduated UCLA Luskin urban planners displayed their culminating projects in April at the annual Careers, Capstones and Conversations networking event, following up with final written reports for sponsoring clients.

Many planning students work individually, but a cohort of 16 Master of Urban and Regional Planning (MURP) students worked together to complete a comprehensive research project related to a $23 million grant recently received by the San Fernando Valley community of Pacoima. The project was the culmination of almost six months of analysis in which the MURP students helped the nonprofit Pacoima Beautiful, other community partners and government agencies prepare a plan seeking to avoid displacement of residents as a result of a pending major redevelopment effort.

“I think our project creates a really amazing starting point for further research, and it provided concrete recommendations for the organizations to think about,” said Jessica Bremner, a doctoral student in urban planning who served as a teaching assistant for the class that conducted the research. Professor Vinit Mukhija, chair of UCLA Luskin Urban Planning, was the course instructor.

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UCLA Luskin faculty, students and guests gather to hear MSW students present their capstone research. Photo by Les Dunseith.

View more photos from Social Welfare’s capstone presentations. 

MSWs Test Research Methods

In Social Welfare, the projects represented a variety of interests and subject matter, said Wray-Lake, pointing out that each student’s approach — quantitative and/or qualitative — helps distinguish individual areas of inquiry. Some students used existing data sets to analyze social problems, she said, whereas others gathered their own data through personal interviews and focus groups. Instructors provided mentoring and training during the research process.

“They each have their own challenges,” said Wray-Lake, noting that several capstones were completed in partnership with a community agency, which often lack the staff or funding for research.

“Agencies are very hungry for research,” she said. “They collect lot of data and they have a lot of research needs, so this is a place where our students can be really useful and have real community impact with the capstones.”

Professor of Social Welfare Todd Franke, who serves as a lead instructor for the capstone projects, said his students worked on issues that impact child welfare. Others studied the relationship between child neglect and involvement with the juvenile justice system. Another capstone focused on predictors of educational aspirations among black and Native American students. The well-being of caregivers and social workers served as another study topic.

Assistant Professor Amy Ritterbusch, who also served as a capstone instructor, said her students focused on topics that included education beyond incarceration, the needs of Central American migrant youth in schools, and the unmet needs of homeless individuals in MacArthur Park. One project was cleverly titled as “I’m Still Here and I Can Go On: Coping Practices of Immigrant Domestic Workers.”

“They all did exceptional work,” Ritterbusch said.

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When Psychiatric Medications Are Abruptly Discontinued, Withdrawal Symptoms May be Mistaken for Relapse UCLA research contributes to assessing the reliability of industry-funded drug trials

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By Stan Paul

Withdrawal symptoms following the practice of discontinuation, or abruptly “coming off,” of psychiatric drugs in randomized clinical trials may be mistaken for relapse and bolster the case for continued use of medication, according to two new studies by UCLA researchers published in the journal Psychotherapy and Psychosomatics.

Principal investigator David Cohen, professor of social welfare in the UCLA Luskin School of Public Affairs, said that clinical trials employing a drug discontinuation procedure had not previously been studied systematically.

“For years, observers have asked whether people getting more symptoms when they came off their medication was their disorder returning or the withdrawal effects from drugs that could be reduced by more gradual, patient-centered discontinuation,” Cohen said.

In light of the difficulties that people have in discontinuing psychiatric medications, Cohen sought to answer that question, joined by co-author Alexander Récalt, a doctoral student in social welfare at UCLA Luskin who is also pursuing a master’s degree at the UCLA Fielding School of Public Health.

They looked at how and why antidepressants, antipsychotics and stimulants were deliberately discontinued from trial subjects in more than 80 randomized controlled trials from 2000–2017. The study also included benzodiazepines, a class of drugs such as Valium, upon which long-term users may become dependent and experience withdrawal symptoms.

In the first study, the researchers found:

  • In 67 percent of studies, no justification was given for a particular discontinuation strategy, which was abrupt or lasted less than two weeks in most cases (60 percent).
  • In 44 percent of studies that related to antidepressants, stimulants and antipsychotics, researchers used mainly abrupt discontinuation to test whether the drugs prevented relapse. Yet, researchers in most studies did not indicate that misclassifying a withdrawal reaction could occur.
  • Most studies incorporating benzodiazepines used discontinuation differently. These studies recognized that withdrawal symptoms were common, and they employed longer drug-tapering periods (more than eight weeks in most cases) to help people successfully come off and stay off these drugs.

The pharmaceutical industry was involved in 70 percent of the 80 studies; in most of the relapse-prevention studies; but in few of the benzodiazepines studies with longer tapering periods, according to the researchers.

Cohen, who also serves as associate dean for research and faculty development at UCLA Luskin, observed across the 80 studies that, in addition to testing relapse prevention, drug discontinuation was employed to chart withdrawal effects and to compare different methods of managing older and frail residents in institutions, given the known damaging effects of drugs taken over the long term.

But only a single study out of the 80 actually employed the discontinuation procedure in order to distinguish clearly between “relapse” and “withdrawal symptoms,” the researchers noted.

“This suggests to us that sponsors or researchers of discontinuation studies are really uninterested in exploring this crucial question,” Cohen said.

“Distinguishing between them requires careful history taking, an open mindset from the clinician and a degree of suspicion that the discontinuation process itself may be contributing.”

In many first-person accounts, patients have complained that they were not warned about these effects or told how slowly they should come off, Cohen said. Instead, their prescriber told them that the effects confirmed that the patients were better off taking the medication and therefore should continue to take it.

“The disconnect continues to drive a wedge between patients and their prescribers and is increasingly discussed in the media, as about one in six adult Americans take — increasingly for years — psychiatric drugs,” Cohen said.

“Our findings, if confirmed by other researchers looking at this literature, contribute to helping decide whether industry-funded drug trials in psychiatry are — as critics have maintained for years — infomercials for drugs or credible scientific investigations,” he said.

In their second study, Cohen and Récalt focused on whether they could detect evidence in the relapse-prevention randomized control trials that an actual misclassification — a confound — of relapse with withdrawal was occurring.

“Most publications do not raise the issue openly, so they do not provide the data to examine this issue directly,” said Cohen, explaining that an indirect method to test their hunch was used. Because withdrawal symptoms are known to begin to occur within an interval of time after drug discontinuation, the researchers focused on the timing of symptoms for drug-continued vs. drug-discontinued participants. They looked for evidence that end-of-study symptoms might already have been present during the study at set discontinuation times. A 50 percent rate of occurrence was chosen to indicate a substantial, non-trivial possible misclassification, Cohen said.

Few studies provided the data to actually test the hypothesis, even indirectly. Among the 14 studies that did provide the necessary data, about three-quarters showed evidence that withdrawal may be mistaken for relapse.

Relapse prevention trials that use psychiatric drug discontinuation commonly conclude that drugs work because they help prevent relapse, Cohen pointed out.

In line with a stream of previous warnings in the literature, the two studies show that more justifications are needed for why and how these discontinuation trials are conducted. Clinicians and consumers should not accept conventional interpretations of what is actually occurring to deliberately drug-discontinued participants in the trials, Cohen said, “and what this could mean for long-term use of psychiatric medications by ordinary people around the world.”

Scene from a previous political event at UCLA. Photo by Christelle Snow/UCLA

UCLA and Human Rights Campaign to Host 2020 Presidential Candidates Forum Democratic contenders will be on UCLA campus to discuss LGBTQ platforms and plans for equality on eve of National Coming Out Day

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The UCLA Luskin School of Public Affairs and the Human Rights Campaign Foundation, the educational arm of the nation’s largest lesbian, gay, bisexual, transgender and queer civil rights organization, will co-host a forum for 2020 Democratic presidential candidates this fall.

The conversation will take place on Oct. 10, 2019, — the eve of National Coming Out Day — at UCLA, and it will give candidates an opportunity to speak about their policy platforms and plans to move LGBTQ equality forward.

The forum will be part of UCLA’s Luskin Lecture Series, which enhances public discourse on topics relevant to the betterment of society. The series demonstrates UCLA Luskin’s commitment to encouraging innovative breakthroughs and creative solutions to formidable public policy challenges. Details regarding the RSVP process will be made available later on the UCLA Luskin website.

As in other presidential candidate forums, Democratic candidates can qualify for the event by receiving 1 percent or more of the vote in three separate national polls or by receiving donations from 65,000 different people in 20 different states.

Today, in 30 states, LGBTQ people remain at risk of being fired, evicted or denied services because of who they are. Thirty-five states have yet to outlaw the dangerous and debunked practice known as “conversion therapy.” LGBTQ youth continue to face elevated levels of bullying and rejection, and many associated physical and mental health challenges. According to FBI hate crimes statistics from 2017, the most recently available data, the bureau reported a surge in hate crimes disproportionately affecting LGBTQ people, black people and religious minorities, especially those living at the intersection of multiple identities. And at least 100 transgender people — most of whom are transgender women of color — have been murdered in the United States since the beginning of 2015.

“If any LGBTQ person were to take a cross-country drive from HRC headquarters in Washington, D.C., to UCLA’s campus, their rights and protections under the law would change dozens of times at every city line and state border,” said HRC President Chad Griffin. “That’s why we’ve fought to elect a pro-equality majority in Congress that would pass the Equality Act — and it’s why we’ve got to make sure the next president will fight for our community and establish full federal equality once and for all. HRC’s 3 million members and millions of LGBTQ voters across America will be key to victory in the 2020 election, and we’re excited to create an opportunity to hear candidates’ agendas for moving equality forward.”

The forum will be held in the midst of UCLA’s centennial year, when the campus will recognize its many contributions to Los Angeles, the nation and the world since its founding in 1919, as well as looking ahead to another century of discovery and achievement.

“The Luskin School of Public Affairs is dedicated to enhancing the well-being of all Americans through an informed electorate and educated social leaders,” said Gary Segura, dean of UCLA Luskin. “We are beyond excited to partner with the Human Rights Campaign in raising LBGTQ issues and the policy stances of candidates to greater public attention in this cycle. UCLA is the perfect host for this conversation.”

HRC worked to mobilize the powerful LGBTQ voting bloc in the 2018 midterms, endorsing more than 480 pro-equality candidates nationwide, and deploying 150 staff to organize and mobilize voters in more than 70 congressional, targeted U.S. Senate and other key races across 23 states. On Election Day, exit polling showed that more than 7 million LGBTQ voters — 6 percent of total turnout — cast ballots, making the difference in key races from coast to coast. Electing a pro-equality majority in the U.S. House of Representatives has already made a huge impact; Speaker Nancy Pelosi has made it a top priority to pass the Equality Act, a federal LGBTQ civil rights bill that will provide consistent and explicit non-discrimination protections for LGBTQ people from coast to coast. This legislation is expected to be introduced soon amid an unprecedented level of support from members of Congress, national advocacy organizations and leading U.S. companies.

HRC last hosted presidential forums in 2004 and 2007. In 2004, HRC’s forum included Sen. John Kerry, Rep. Dennis Kucinich, Sen. Carol Moseley Braun, Gov. Howard Dean, Sen. Joe Lieberman, Rev. Al Sharpton and Rep. Richard Gephardt. In 2007, HRC’s forum included then-Senator Hillary Clinton, then-Senator Barack Obama, Sen. Mike Gravel, Rep. Dennis Kucinich, former Sen. John Edwards and Gov. Bill Richardson.

From left, AltaMed's Berenice Núñez Constant, vice president, government relations, and Sonja Diaz, executive director of LPPI. Photos by Gabriela Solis

Briefing Seeks Solutions to Latino Doctor Shortfall UCLA Latino Policy and Politics Initiative’s gathering of medical professionals, policy analysts and advocates looks at underlying causes and why the impact is keenly felt in California

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By Gabriela Solis

Although Latinos comprise the largest ethnic group in California, Latino doctors in the state are in short supply, according to recent research from the UCLA Latino Policy and Politics Initiative (LPPI).

On Jan. 15, 2019, the UCLA Luskin-based think tank co-hosted a discussion in Oakland that brought together doctors, medical practitioners, academics and advocates to discuss California’s Latino physician shortage.

“California has an alarmingly low rate of Latino doctors. There are 46 Latino doctors for every 100,000 Latino Californians,” said LPPI Executive Director Sonja Diaz, citing data derived from the U.S. Census Bureau’s 2015 American Community Survey. “In contrast, there are 405.7 non-Hispanic white physicians for every 100,000 non-Hispanic white Californians.”

Diaz led the discussion co-hosted by the Latino Coalition for a Healthy California (LCHC) and the Greenlining Institute, which is based in Oakland.

“We graduate about 110 Latino medical doctors every year. If we continue forward, it will take almost five centuries to close the gap,” noted Diaz. That data from the Association of American Medical Colleges is included in the LPPI report, “5 Centuries to Reach Parity: An Analysis of How Long It Will Take to Address California’s Latino Physician Shortage,” which was produced under the guidance of LPPI faculty expert David Hayes Bautista, a distinguished professor at the UCLA David Geffen School of Medicine.

Joining Diaz in debate and discussion were Jeffrey Reynoso, executive director, Latino Coalition for a Healthy California; Arturo Vargas Bustamante, associate professor of health policy and management at the UCLA Fielding School of Public Health and public policy at UCLA Luskin; Carmela Castellano-Garcia, president and chief executive officer, California Primary Care Association; Berenice Núñez Constant, vice president, government relations, AltaMed Health Services Corporation; and Carmen Estrada, MD candidate at the UC Davis School of Medicine.

The wide-reaching conversation focused on the shortage’s effects on California’s economy, the needs of medical providers and the shortcomings within higher education that contribute to the shortfall.

Medical student Carmen Estrada of UC Davis

Estrada spoke about her personal experience of being one of the limited number of Latinos currently pursuing a medical degree. Estrada’s first-hand experiences traced her personal journey to medical school from a California State University and the lack of outreach that she said created unnecessary challenges in her career choice.

Núñez Constant shared that although her organization, AltaMed, is constantly looking for Latino physicians, “The supply is just not there.” She also highlighted the difficulty of retaining a Latino physician in such a competitive job market.

Vargas Bustamante’s research supported Núñez Constant’s comments on workforce recruitment. Bustamante said he has found a substantial pipeline problem for Latinos in their transition from high school to college and their transition from college to medical school. Based on his interviews with Latino pre-med students, medical school applicants, Latino medical students and recently graduated Latino physicians, Vargas Bustamante said students who may have an interest in the field often feel discouraged by the lack of investment to recruit and retain Latino students. Many then choose another career.

The panel agreed that this complex issue requires a strategic collaboration of California policymakers, medical providers and academia to form solutions.

But, said California State Assemblyman Robert “Rob” Bonta, expressing his support, “I think we have some wonderful opportunities.” Bonta, a Democrat whose California District 18 includes Oakland, Alameda and San Leandro, serves on a number of legislative committees, including the Health Committee. “Your timing couldn’t be better in terms of uplifting and raising the issue. This is something I’d be proud to work on, and I think it needs to be worked on.”

To learn about California’s Latino physician shortage, visit latino.ucla.edu/health.

View additional photos on Flickr.

Latino Physician Briefing

Anouchka / iStock

UCLA Report Provides Strategies for Making Covered California More Affordable Public Policy's Wes Yin helps develop policy options to keep insurance costs down

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By Mary Braswell

With California taking steps to revamp its health care system, research by the UCLA Luskin School of Public Affairs is guiding the conversation.

The report, published Feb. 1, details strategies to improve the affordability of Covered California, the state’s health insurance marketplace. It was co-authored by economist Wes Yin, associate professor of public policy at UCLA Luskin.

Affordability is “the top challenge for individuals who are insured as well as those who remain uninsured,” according to the report (PDF), which lays out a wide array of proposals to meet that challenge, including:

  • capping out-of-pocket premiums for all eligible Californians;
  • offering expanded cost-sharing benefits, which would lower deductibles and the cost of office visits; and
  • creating a California-only penalty for those who opt out of coverage, to replace the penalty that was phased out by the federal government.

“This will help push the conversation forward, now with policy options that we know will improve affordability and market stability,” said Yin, who wrote the report with economist Nicholas Tilipman of the University of Illinois, Chicago, and Covered California’s policy and research division.

Commissioned under a state law, the report was presented to the governor’s office and state Legislature. It was developed amid a shifting landscape for health care in California.

On Jan. 30, Covered California reported mixed figures for 2019 enrollment. Although the number of Californians held steady from 2018 to 2019, the number of new enrollees dropped by 23.7 percent. In addition, on the first day of his term, Gov. Gavin Newsom unveiled his own far-reaching health care plan, calling for increased premium subsidies and Medicaid coverage for undocumented youths up to age 26, among other reforms.

“Our analysis gives policymakers a sense for how different approaches benefit Californians and at what cost,” Yin said. “So this report bolsters the governor’s effort to improve health care access.”

The dialogue, he said, will include a debate over the state’s funding priorities.

“From a wider lens, it’s helpful to think about how we can best spend that next public dollar,” Yin said. “It could be health care, it could be pre-K programs, it could be public education or parental leave benefits. These are all important. And there is a strong argument for improving the affordability of health care coverage and reducing cost-sharing burdens. Coverage improves health — especially mental health — it improves chronic disease management and it drastically reduces the risk of catastrophic spending and debt incurred by consumers.”

The report includes proposals to address the divisive issue of penalties for Californians who choose not to buy health insurance. Covered California attributes the decline in new enrollments to removal of the federal individual mandate penalty beginning this year. A statewide penalty would create a fresh incentive to opt in.

“The penalty appears to be quite impactful,” Yin said. “What we’re seeing in Covered California the past year shows that, and our modeling also shows that. Zeroing out the penalty has directly caused premiums to increase and enrollment to drop. Including a penalty while making plans more affordable can be both an effective and fair way of expanding coverage and lowering premiums.”

The report also notes that premium costs can vary widely for consumers based on their age and geographic location. “For consumers nearing retirement age living in high-cost regions, premium costs can exceed 30 percent of income for the most common benefit package,” it said.

To make health insurance more affordable for those consumers, California could use subsidies to cap all premium payments at 15 percent of annual income. Currently, subsidies are offered only to people who earn up to 400 percent of the federal poverty level, or $103,000 for a family of four. Consumers who earn just over the 400 percent threshold would not qualify for federal premium subsidies, Yin said. A 15 percent cap would also eliminate this so-called tax-credit cliff.

The report’s policy options are based on a model developed by Yin and Tilipman that shows the potential effects that various policy proposals would have on health care enrollment, consumer health spending and public spending.

As elected officials and consumers debate competing visions of health care reform — from repealing the federal Affordable Care Act to moving to a state-run single-payer system — Yin said the proposals are aimed at expanding coverage and increasing affordability as much as possible.

“Let’s find ways to build on the successes of the Affordable Care Act and make it work better,” Yin said. “These are models for improvement.”