November 2nd Workshop

Medicine and Its Objects presents…

WEDNESDAY, NOVEMBER 2, 4:30-6:00PM

ROSENWALD 329

join

KATIE GIBSON

 (PhD Student, SSA)

to discuss

DEFINING USE AND ABUSE IN THE DEBATE ABOUT PSYCHOTROPIC DRUGS IN THE ILLINOIS CHILD WELFARE SYSTEM

with opening comments by

Julian Thompson
(PhD Candidate, SSA)

 

 

Abstract of the Dissertation Proposal: This ethnographic study will examine the role psychotropic drugs play in shaping bureaucratic practice in a time in which rates of drug use are at once treated as a measure of an organization’s capacity (or incapacity) to care for clients and as an institutionally legitimized form of therapeutic intervention. Children in foster care are prescribed psychotropic drugs at a rate three to five times higher than their non-foster peers on Medicaid, and they are also significantly more likely to be prescribed three or more drugs simultaneously. While this is widely considered problematic, the issue of the child welfare system’s drug dependence has been articulated in various terms, with scholars and advocates alternating between cultural, neurological and bureaucratic formulations of both the problem and its solutions. Some posit that drugs are used too frequently due to a cultural assumption that fixes should be quick, while others believe such poorly researched “fixes” endanger children and don’t necessarily improve their behavioral or mental health. Many see the issue as one of poor systemic integration, asserting that managing psychotropic drug use requires better communication of expertise between various actors involved in case management. In all accounts, however, drugs are treated as objects upon which professionals act rather than actors in their own right. To complement and complicate this perspective, this study will produce (1) a historical discourse analysis of the roles and relationships psychotropic drugs have generated between child welfare and other systems, (2) an ethnographic account of the social life of drugs in child welfare as it relates to professional practices and (3) a “dialogue” between the various actors involved in the debate about the proper uses of psychotropic drugs.

 

 

Please email Camille (roussel@uchicago.edu) for a copy of the paper.

 

For any questions and concerns about the workshop, or if you need assistance in order to attend, please contact Camille Roussel (roussel@uchicago.edu).

 

To subscribe to our listserv, visit: https://lists.uchicago.edu/web/subscribe/medicineanditsobjects

 

We look forward to seeing you soon!

 

Medicine and Its Objects Presents David Meltzer

Medicine and Its Objects presents…

WEDNESDAY, OCTOBER 19, 4:30-6:00PM

ROSENWALD 329

join

DAVID MELTZER

 (Medicine and Economics)

to discuss

THE COMPREHENSIVE CARE, COMMUNITY AND CULTURE PROGRAM (C4P)

with opening comments by

Angelica Velazquillo Franco
(PhD Student, SSA)

 

Abstract: High health care costs and poor health outcomes in the US are concentrated in a small fraction of the population, many of whom have a history of recent hospitalization, and a disproportionate fraction of who are socioeconomically disadvantaged. The Comprehensive Care Physician (CCP) Program we have developed seeks to address the needs of this population by providing patients with the ability to receive care from the same physician in the inpatient and outpatient setting so that they can benefit from the advantages of continuity in the doctor patient relationship. Since 2012, we have developed and tested this model at the University of Chicago in a randomized controlled trial funded by the Center for Medicare and Medicaid Innovation, in which we have enrolled over 1,800 patients, of whom ~90% are African American, with a median income of ~$20,000 per year, and 1-year mortality rate of 15-20%. The results to date are striking with respe ct to patient experience, outcomes, and resource utilization. We think the efficacy of this model comes from the deep connection that our CCP doctors and teams develop with patients, understanding them as individuals and recognizing and beginning to address the deeper social determinants of their health.

 

Nevertheless, even as we have pushed the boundaries of traditional health care, for example, by great efforts from clinic staff to connect with patients and by establishing a home care program, we have seen the limits of traditional health care. Many of CCP patients still do not engage fully in care; 1/3 attend <2 clinic visits in the year after enrollment or miss more than 1/2 of scheduled visits. These patients who do not engage in the program cost  more per year and have worse outcomes than patients who do engage, with differences that grow over time. Thus, there may be great potential for savings and improved outcomes if we can learn how to better engage and serve these patients. Talking to patients in clinic, on the phone, visiting them in their homes and communities with the people in their lives, and discussing their needs with them more formally in focus groups, we have come to believe that to better serve them we need a greater presence in their daily lives to address challenges of life made more difficult by poverty, and to provide emotional, social, and spiritual support. Our proposed Comprehensive Care, Community and Culture Program (C4P) will build on the success of our CCP Program to address social determinants of health and better engage patients at high risk of hospitalization. We will provide C4P patients access to community health workers (CHWs) and to cultural and educational opportunities to help them solve critical challenges of daily life, and provide emotional, social, and spiritual support that can ameliorate social isolation to promote health and well-being.