Betsy Peyton is a community health nurse in Virginia who founded WellAWARE, a program that connects high-tech medicine with clients’ low-tech, high-touch needs—the grassroots, person-to-person program zeroes in on those who might fall through the cracks.
Peyton and two other community health workers regularly visit about 60 clients across central Virginia, focusing on people who frequently use local emergency rooms for low-acuity health problems while avoiding preventative primary care.
During a recent visit with her patient, Dorothy Bishop, Peyton was asked if eating grapefruit would interfere with her medications. Peyton advised avoiding grapefruit because it can hinder the stomach’s natural enzymes and cause too much or too little of her medicines to be absorbed. The discussion then went to Bishop’s foot pain and whether her landlord had resolved a mildew issue in her apartment.
WellAWARE is just shy of its third anniversary and has already shown great results, with clients using the emergency room 48% less often and being hospitalized 30% less frequently for at least six months. Peyton hopes to secure funding to continue and expand the program and sees its value to humans and hospitals’ bottom lines in real-time.
Daily Nurse proudly names Betsy Peyton the Nurse of the Week for using home visits to build relationships with patients and her appreciation of the therapeutic value of listening to people’s stories to help clients overcome entrenched barriers to good health and healthcare.
Peyton and WellAWARE’s staffers are professional problem-solvers who organize medications, offer nutrition counseling, purchase air conditioning units, and intervene with difficult landlords. They also provide rides to food banks and pharmacies, pass out gas and grocery cards, figure out what to do if the electricity or water’s been cut off, and even handle a snake in the house.
As a University of Virginia (UVA) School of Nursing student, Peyton was inspired to pay special attention to the patients who sometimes got overlooked. After becoming a nurse, Peyton worked in group homes with dementia patients in a locked psychiatry unit and found a passion for being with people when they’re “not at their best.”
“I love going on visits and reminding myself of how great and rewarding it is to sit with someone. Sometimes, people who are not at their best bring about healthy outcomes through this. It’s not hanging IV, but you’re talking about important stuff and motivating change. Sometimes you’re strengthening their relationship with the health system,” she says.
Peyton says she respects the dignity of people when they’re struggling.
“Psychiatric nursing is a field where you’re often called to be with people and hear their stories. I’ve always appreciated the therapeutic value of listening to people’s stories,” she says.
For most of 2021, Peyton knocked on doors, chatted on porches, attended neighborhood association meetings, and tuned in. Guided by census-tract maps showing areas where citizens frequently turned to emergency rooms for primary care, Peyton’s approach built trust, giving community members a sense of ownership in the project.
“We want people to trust that the system wants what’s best for them, wants to know their stories, and cares deeply about their situations. And so trust is key to trust. It all comes down to trust,” says Peyton.
What began as a collaboration with the Charlottesville Free Clinic, UVA Primary Care, and Central Virginia Health Services, WellAWARE now offers help that augments the groups’ services and the clients’ needs. Peyton and her colleagues do house calls, the kind of care she was drawn to, which has been demonstrated to save money.
“When the healthcare system saves money, it’s good for everyone. But that’s not what I wake up most excited about,” says Peyton. “The benefits to the community, neighbors, local families, and individuals make this work worthwhile. It really works.”
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The U.S. faces growing and increasingly unsustainable health inequities, and the number of voices calling for substantive healthcare system reforms is growing.
The U.S. is often the first to introduce advanced preventive and therapeutic interventions. Yet, the dominant healthcare delivery models must be equipped to deploy them in communities experiencing harmful SDOH and health inequities.
The recent response to the Mpox epidemic provides valuable insights into future directions for addressing equitable healthcare.
After the first round of Mpox vaccinations showed patterns that were similarly inequitable as past rollouts of necessary prevention modalities (e.g., HIV pre-exposure prophylaxis [PrEP]), the CDC quickly changed its approach to meaningfully engage grass-roots community leaders in the design and implement of local vaccination campaigns.
The resulting approach focused on deploying decentralized, community-based, and culturally and contextually aligned service delivery models that better served those most affected by Mpox.
“We must re-think the way healthcare is delivered in this country, especially when, where, and how care is delivered to groups persistently burdened by harmful social determinants of health that perpetuate health inequities,” says Vincente Guilamo-Ramos, Dean of the Duke School of Nursing and lead author. “The financial and human costs of these inequities are already in the danger zone and cannot be sustained for much longer.”
The paper also highlights the need to design healthcare interventions that more comprehensively address harmful social determinants of health, drawing from an innovative framework developed by the Center for Latino and Family Health at Duke University, accessible at www.DUSONtrailblazer.com.
Since March 2020, community health workers (CHWs) have taken on an expansive role as essential workers to help on the frontlines of the COVID-19 pandemic. Now, CHWs in the state of Utah can receive hope and comfort in COVID-19 support sessions through the University of Utah College of Nursing.
The sessions are offered by Caring Connections, the College of Nursing’s not-for-profit bereavement care program, through a unique partnership with the Utah Department of Human Services. Originally funded by CARES Act funds, Caring Connections was asked to develop and implement peer-support groups for CHWs.
“The community health workers are an amazing resource for Utahns, particularly those in underrepresented communities of color,” says Kathie Supiano, Ph.D., director of Caring Connections. “They have themselves been disproportionately impacted by the pandemic. It has been gratifying to encourage their good work.”
COVID-19 support sessions for CHWs through Caring Connections are offered monthly, either virtually or in person, to CHWs across the state of Utah. Caring Connections works in collaboration with Latino Behavioral Health to provide the program in both Spanish and English.
Caring Connections also provides other COVID-19 support groups, including:
COVID-19 Grief Support
This group includes members of the community who may have lost a family member or friend to the coronavirus or who are grieving a death that was disrupted due to the pandemic.
COVID-19 Recovery Support
This group is for individuals who are still dealing with emotional struggles relating to long COVID symptoms. Members of the group can find support from others with similar experiences related to their illness.
All Caring Connections support groups are currently being held virtually. The groups meet once a week and are led by licensed health care professionals. There is no cost for Caring Connections COVID-19 Support groups, though registration is limited. If you are a CHW in Utah, you can register by phone at 801-585-9522.
During the 13-month fellowship, students work to improve the health and well-being of under-resourced populations throughout the state of Alabama.
“As vulnerable populations in our communities face significant obstacles to health and improved quality of life, it is encouraging to see more students rise to the challenge of tackling these issues head-on,” said Executive Director of ASF of Alabama Kristin Boggs. “We are excited to come alongside these students, along with our academic and community site partners, to channel their ideals and grow their commitment to using their knowledge to affect change for under-resourced communities.”
Dorner was inspired to apply for this fellowship following clinical experience at The Foundry’s Changed Lives Mobile Clinic, which serves men at the Changed Lives Christian Center in North Birmingham, a faith-based organization that offers transitional housing in order to break the cycle of homelessness. Through this clinic, CLCC residents can access primary care and resources that aid in overcoming substance misuse.
During his clinical experience, Dorner worked closely with UAB School of Nursing instructors Deborah Bowers, DNP, DMin, MDiv, CRNP, FNP-C and Emily Patton, MSN, CRNP, FNP-C. Bowers will serve as a mentor during this fellowship, and Patton will play an important role through her work at the clinic, Dorner said.
“My decision to apply for this fellowship ties into the passion that Dr. Bowers had in my undergrad classes and community classes,” Dorner said. “I think a lot of students can focus on critical care experience, which is incredible, but it can be easy to overlook community. Those classes spoke to me, however, and provided an opportunity to do a lot of simulations with low-resourced clinics. That really spurred my interest in working with under-resourced populations.”
During the fellowship, Dorner is collaborating with UAB Heersink School of Medicine student Eric Mussell to encourage medication adherence. They will work with residents at CLCC, developing a system to track medication adherence and providing resources between primary care visits. They also will identify barriers and develop interventions that encourage patients to remain diligent while taking medication.
“We want to focus on medications that treat hypertension in order to help improve the health of this patient population,” Dorner said. “Sometimes at the clinic we see patients who have not kept up with their medications and have very high blood pressure. Our goal is to provide an intermittent meeting between primary care appointments in order to encourage medication adherence and hopefully avoid the need for an urgent care visit.”
Dorner and Mussell hope to set up this project so that it will continue with one nursing student and one medical student each year to facilitate that connection. Patients also benefit from this interdisciplinary partnership, Dorner said, as he and Mussell are able to learn from each other and offer a balance of perspectives.
“Eric and I are both volunteers at the clinic, and we chose to enter our project as a team in order to bridge the gap between professions and provide the benefit of interdisciplinary care,” Dorner said. “Due to the COVID pandemic, we did not get as much physician/nurse interaction as students, and I think facilitating a project that can continue a bond between our two schools and benefit the community is so important.”
The project is still in its early stages, Dorner said, and they are compiling resources needed to best support patients.
Leaving a lasting mark on the organization they serve is a dream for many, but for one nurse, through her career in the Army Reserve, she’s been able to do just that.
Lt. Col. Kelly Bell, MSN, RN, CEN, USAR, commander of the 7203rd Medical Support Unit in Hobart, Indiana, successfully advocated for accommodations of pregnant Soldiers and new parents, resulting in Army policy change at the highest level.
“Be the change. Advocate for your soldiers.”
Announced and released on April 21, 2022, Bell was an integral contributor and author of the new Parenthood, Pregnancy, and Postpartum Army Directive. The directive features 12 distinct policy changes that pertain to pregnant and postpartum Soldiers as well as new parents. Changes touch on areas ranging from deployment deferments, an extended timeline to take the Army Combat Fitness Test after giving birth, and attending professional military education while pregnant, to convalescent leave after pregnancy loss or miscarriage or stillbirth, and more.
“I just wanted to take care of my pregnant Soldiers the way I wanted to be taken care of,” she said of her collaboration on policy change.
“It’s a change I never thought I’d see in my career, and it’s been needed for many, many years,” said Capt. Jennifer DeMaio, a mobilization officer with Army Reserve Medical Command, who gave birth to her fourth child on April 20, 2022, the day before the directive was published.
DeMaio, who has had all four of her children while serving in the Army, said the attitude towards pregnancy is different now than it was 18 years ago when she had her first child. For example, she only received a four-month deployment deferment after having her first child.
DeMaio also praised the new one-year timeline to prepare and train for the Army Combat Fitness Test after childbirth, mentioning the level of athleticism and healing that is necessary.
“The events are completely different,” DeMaio said of the new test. “And they are harder. This one-year prep time for the ACFT is completely needed.”
DeMaio experienced a complicated pregnancy this time around and delivered a baby girl, Jessah, via C-section at 26 weeks after several weeks of bed rest. DeMaio said she is grateful for her command’s reaction to and support of her pregnancy—a hint that culture change towards the normalization of parenthood has already begun.
“This unit is the most accepting of any unit I’ve been in,” DeMaio said of her pregnancy. “I was scared to tell my leadership because I didn’t have the best reactions (to her pregnancies) in the past. But I can’t imagine it going any better—nothing but positivity.”
Maj. Quentin F. Stewart, a plans officer at Army Reserve Medical Command and father of a newborn, said he believes the policy changes align with the Chief of Staff of the Army’s “People First” initiative and will have an impact on retention.
“This is a really great change for the health and welfare of our Soldiers and Families,” Stewart, currently on paternity leave, said. “The foundation of everything we do in the Army begins with people and I believe the parent and postpartum changes bring the Army on par with the other services when it comes to supporting the important early years of new family additions.”
“I think culture shift takes a lot longer than just writing a directive, but we hope that the directive will give the tools to begin the normalization of parenthood that’s necessary.”
For Bell, advocating for new parents and helping foster change to Army policy isn’t new; she’s been fostering accommodations around this topic for a while.
Bell commissioned into the Army Reserve in 1999 through Marquette University’s Reserve Officer Training Corps program after earning a bachelor’s degree in nursing. Since then, she has worked as a nurse both in the Army, which included a deployment to Afghanistan and a stateside mobilization during the COVID-19 pandemic, and in her civilian career. In her civilian capacity, she now works at a Des Moines, Iowa Veterans Affairs primary care clinic.
With the bulk of her experience in emergency room nursing, Bell has loved taking care of others as a career. She explained that becoming pregnant with her first child while serving as a commander of a medical unit was eye-opening to the challenges faced by military mothers and new parents.
Winning the battle to support lactating mothers in a modern army
Bell encountered vague guidance on the postpartum period for new Army mothers, including in the area of accommodating a time and place for pumping breastmilk for their new infants.
“It’s a huge mental stress on a lactating Soldier if they aren’t provided the services to pump and store breastmilk for their children,” she explained.
And her first foray into advocacy touched on this issue. In 2018, Bell wrote an email to the sergeant major of uniforms branch, asking for provisions be made for lactating Soldiers to wear an alternate nursing t-shirt that would make pumping breastmilk more easily accessible: her request was approved.
This led to a revision to AR 670-1 in 2021 which includes the undershirt authorization and notes that Soldiers are permitted to breastfeed their nursing child anywhere the Soldier and child are authorized to be. Additionally, the updated uniform regulation does not require breastfeeding Soldiers to cover themselves with additional items while doing so.
“This is a really great change for the health and welfare of our Soldiers and Families.”
“I think the most significant thing this time around is the time I’ll have to get back to the standards,” said Spc. Kellie N. Steele from Midland, Michigan, a dental specialist in the 7203rd Medical Support Unit. Steele, who is now pregnant with her fourth child (her second while serving in the Army Reserve), said she is grateful that the new Army directive will give her a year after having her child to take a record Army Combat Fitness Test.
Steele explained that after having her last child in December 2020, she experienced hip and pelvic pain, and it wasn’t safe for her to lift weights until she had fully recovered from childbirth.
“Every woman’s body is different,” Steele said. “The fact that they are extending and accommodating things means a lot.”
Steele said she is also grateful for the lactation accommodations in the new directive, as breastfeeding her children is important to her. The directive clarified and expanded Army Regulation 600-20, Army Command Policy, and now dictates where, how long, and under what conditions commanders will provide lactating Soldiers the opportunity to express breastmilk and discusses its storage.
Bell was instrumental in facilitating the passing of a waiver to Tri-Service Bulletin Medical 530, which discusses food codes. The waiver allows for storage and management of breastmilk in field food establishment refrigerators, making it an option to store breastmilk for nursing Soldiers.
Steele explained that she was able to use this waiver firsthand while on annual training at Fort McCoy, Wisconsin and away from her then eight-month-old daughter for two weeks: she successfully stored her breastmilk and was able to transport it home after her temporary duty, rather than throwing it away.
Bell did not stop her advocacy there, and became active in moderating two popular Facebook groups aimed at giving Army mothers an outlet for discussing pregnancy and childbirth topics.
Normalizing treatment of soldier parents
Bell found in the Facebook groups that Soldiers of all ranks and components pointed out further gaps in policy, education, and empathy on behalf of command teams. Concerns that continued to come up from new mothers included maternity and paternity leave, postpartum body composition testing, being excluded from attending professional military education while pregnant, and leadership education, among others.
Bell, along with 10 other authors, wrote a white paper published in 2021 that addressed these topics and stood as recommended revisions to the Army’s pregnancy and postpartum policies. Bell’s particular area of concentration for the paper was looking at the Army’s current operational and deployment deferment for new parents. Through research, the author group concluded that a one-year deployment deferment is necessary for both the development of the child and the child’s bond to its parent.
“We wanted to keep at least one parent at home with the infant during the child’s first 12 months,” Bell explained.
The white paper had the desired effect: senior leaders listened. Just a year after the white paper was published, the policy has been issued—a speed of action which suggests how seriously the recommendations were taken by Army leadership.
“The Sergeant Major of the Army was an integral part of reading this … and working with us to get the words right from a very early stage,” said Amy Kramer, lead action officer for the policy during a Pentagon press briefing.
Kramer noted that becoming a parent is a healthy, natural part of life, and the Army is committed to de-stigmatizing it.
“I think culture shift takes a lot longer than just writing a directive, but we hope that the directive will give the tools to begin the normalization of parenthood that’s necessary,” Kramer said.
For Bell, she’s leaving behind a legacy of perhaps enabling pregnant Soldiers and new parents to be both phenomenal troops and caregivers at the same time—to be able to better balance both worlds without having to choose to compromise one.
“None of these policies are now going to help me personally, but they will give me the tools needed to be a better leader,” Bell explained, and said she won’t be having any more children herself, but wanted to help usher change to help future generations of Soldiers.
“Be the change,” she said. “Advocate for your Soldiers.”
And Bell has done just that.
To access the full directive, visit: https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1024798
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The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.
When The University of Texas at Austin School of Nursing partnered with the Division of Diversity and Community Engagement (DDCE), the City of Austin, and Mt. Zion and Rehoboth Baptist Churches to launch the African American Mental Health and Wellness (AMEN) program in 2019, they never envisioned how vital the program would become, especially after the COVID-19 pandemic hit. Designed to support the mental and physical health of African American residents in the Austin area, the program has become a lifeline to many in the largely east Austin community.
“In the early days of the pandemic, members of the AMEN team worked with pastors and lay health workers within churches to conduct a community assessment to determine the needs of congregants,” said Jacki Hecht, RN, MSN, managing director of the AMEN Program. “We assessed their need for more information about COVID, access to medical care and supplies, and feelings of loneliness. We also asked about what they were doing to cope with the uncertainty and hardships caused by the pandemic.”
The team offered a six-week faith-based, holistic mental health and wellness program using Zoom to encourage participants to engage in the five behaviors known to improve mental wellness: mindfulness, healthy eating, physical activity, sleep, and social connectedness. A monthly mental health dialogue focused on topics such as grief, loss, and loneliness; self-care; the impact of racism on health; COVID vaccine safety; heart disease prevention; advanced care planning; and mindfulness.
Team advisor Shannon Jones, BSN, RN and Hecht also host a radio show twice a month during which they welcome community organization leaders and people with lived experience to talk about mental health and wellness.
In addition to providing on-site clinical services, mental health education programs and mental health training for pastors, the AMEN team joined forces with the UT Austin School of Nursing to assist with the School’s Vaccination Administration Mobile Operations (VAMOS), the drive-through COVID vaccination clinics set up at area churches and other local community sites. The mobile clinics were launched to ensure that Austin-area residents who have limited access to requesting online appointments or are unable to travel to large vaccination sites can receive vaccinations.
One such site is Mt. Zion Baptist Church, where Angela Robertson-Bigham, a certified community health worker and wellness coordinator for church community outreach efforts, serves as the VAMOS communications coordinator. Robertson-Bigham oversaw one of the first church-based mobile vaccine clinics at her church, Rehoboth Baptist Church, and continues to assist with other mobile vaccine clinics and homebound visits.
Before the VAMOS clinics were established, she explained, members of her church were hesitant to take the vaccine due to misinformation.
“Many people who come to be vaccinated are anxious and worried,” Robertson-Bigham said. “I try to put them at ease, answer their questions and let them know we will provide really good care to keep them safe. I share my own experience of being anxious about needles and assure them the needles are small, the shot will go super fast, and they can take some pain relief medicine afterward, if they need it.”
For these efforts, the AMEN program has received a “Together We Will Heal” Hero Award, a new award created in direct response to the COVID-19 pandemic and its impact on the African American community, particularly on people living with mental health challenges, substance use disorders, and intellectual and developmental disabilities. The group recognizes the untold hardships that frontline workers are experiencing during this challenging time. The presentation was made at the annual Central Texas African American Family Support Conference on Wednesday, February 9, 2022.
In addition to the team award, Robertson-Bigham also received a Hero Award for her work coordinating the mobile vaccination clinics and managing a community garden where the community can learn about the important intersection of mind-body-spirit in overall well-being.
“There are so many quiet heroes working in the community, sharing important health care information and helping people address the chronic conditions they deal with every day,” Hecht said. “We’re grateful to all these helpers, including School of Nursing students and faculty, and AMEN health workers like Angela, who volunteer at these public events, providing health-related resources and helping people learn how to strengthen their immune systems. Our community is safer and stronger as a result of this collaboration.”
