Karen A Hacker

Karen A Hacker
Allegheny County Health Department

MD, MPH

About

109
Publications
19,865
Reads
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4,375
Citations
Additional affiliations
January 2002 - August 2013
Cambridge Health Alliance
Position
  • Managing Director
September 2013 - present
Allegheny County Health Department
Position
  • Managing Director

Publications

Publications (109)
Article
The incidence of unexpected deaths from opioid overdoses sharply increased in Allegheny County, Pennsylvania, in recent years. In 2017 alone, the county’s opioid-related overdose rate was 51.5 per 100 000, more than triple the US rate (14.9 per 100 000). This represented more than 90% of all unintentional overdoses.
Article
Objectives: In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from 17.4 per 100 000 population in 2008 to 23.9 per 100 000 population in 2014. Our objectives were to describe local demographic characteristics of this epidemic, identify public human services targets for intervention, determine temporal rel...
Article
Little is known about how practices reorganize when transitioning from traditional practice organization to team-based care. We compared practice-level (1) configuration as well as practice- and team-level (2) size and (3) composition, before and after establishing teams. We employed a pre-/poststudy using personnel lists of 1571 to 1711 staff (eg,...
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This report, a joint effort of the Allegheny County Department of Human Services (DHS) and the Allegheny County Health Department (ACHD), provides an update to an earlier report that analyzed available data sources on opiate overdoses in the County from 2008 through 2014. This report covers the time period January 1, 2015 through December 31, 2016...
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Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of...
Article
Purpose: When school districts choose not to participate in adolescent health behavior surveys, tracking adolescent health indicators can be challenging. We conducted a countywide youth behavior survey outside of the school system. Our purpose is to describe alternative methods used for gathering these data reliably and ethically. Methods: We im...
Article
Objective: In 2008, Massachusetts Medicaid implemented a pediatric behavioral health (BH) screening mandate. This study conducted a population-level, longitudinal policy analysis to determine the impact of the policy on ambulatory, emergency, and inpatient BH care in comparison with use of these services in California, where no similar policy exis...
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Background: This paper uses a theory from educational research - "the culture of power" - to explore power differentials between academic researchers and community partners in community engaged research partnership programs. Objectives: This paper describes how a capacity-building program illuminated the tensions between academics and community...
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With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health...
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Abstract: Background: Despite universal environmental and policy-focused initiatives that resulted in declines in obesity among children in Cambridge, Massachusetts, disparities persist among racial/ethnic groups. In response, a community coalition formed the Healthy Eating and Living Project (HELP), to investigate and disseminate findings regardi...
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The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupt...
Article
Attention-deficit/hyperactivity disorder (ADHD) affects almost 2.4 million US children. Because American Academy of Pediatrics guidelines for ADHD recommend use of standardized diagnostic instruments, regular follow-up and the chronic care model, this pilot project sought to implement and assess an electronic registry of patients with ADHD combined...
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Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilogra...
Article
Facing recent economic and regulatory pressures, safety-net systems (SNSs) are redesigning their organizations to improve care delivery, remain financially viable, and maintain competitive positions. Aligning physicians with redesign goals is a priority, particularly as many SNSs shift toward patient-centered, population health-focused models. No p...
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To develop and validate a survey instrument designed to measure team dynamics in primary care. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. We developed a conceptual model and administered a cross-sectional sur...
Conference Paper
Background: Since the 2010 Patient Protection and Affordable Care Act, health systems face unique opportunities and challenges in moving toward patient-centered, team-based care delivery models. Central to patient-centered medical homes (PCMHs) is developing effective primary care teams, which better coordinate care, improve quality, and reduce cos...
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Objectives: To determine the relationship of child behavioral health (BH) screening results to receipt of BH services in Massachusetts Medicaid (MassHealth) children. Methods: After a court decision, Massachusetts primary care providers were mandated to conduct BH screening at well-child visits and use a Current Procedural Terminology code along...
Article
Purpose Although mental health screening is recommended for adolescents, little is known about the predictors of referral to mental health services or engagement in treatment. We examined predictors of mental health referral from primary care and service use for commercially insured youth who had been screened using the Pediatric Symptom Checklist...
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Although safety-net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge...
Article
Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supp...
Article
The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public’s health and reducing health disparities, the CTSA Consortium’s Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. T...
Article
Objective: To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. Design and methods: Process outcomes from a three-arm, cluster-randomized trial from 14...
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Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. Our aim was to examine...
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Objectives: To understand mandated behavioral health (BH) screening in Massachusetts Medicaid including characteristics of screened children, predictors of positive screens, and whether screening identifies children without a previous BH history. Methods: Massachusetts mandated BH screening in particularly among underidentified groups. 2008. Pro...
Conference Paper
Introduction: Despite some stabilizing of childhood obesity rates, racial/ethnic disparities persist. Because determinants of obesity and weight transition trajectories may differ among racial/ethnic populations, race/ethnic-specific research is needed to guide prevention/intervention efforts. Methods: A longitudinal public school student health su...
Conference Paper
Opioid related deaths in the nation, distinctively in Massachusetts, have risen at a considerable rate. Recent CDC reports confirm that nationally, prescription drug abuse is the fastest growing drug problem. In 2006, the Massachusetts Department of Public Health was awarded a Strategic Prevention Framework State Incentive Grant (SPF-SIG) and ident...
Conference Paper
Background: Adopting public health strategies in the workplace is an important strategy for improving the health of the public here and abroad. A healthy work environment can support healthy lifestyle choices and reduce health care expenditures. Cambridge Health Alliance (CHA), a public self-insured health care system with over 3000 employees, bega...
Article
Universal mental health screening in pediatric primary care is recommended, but studies report slow uptake and low rates of patient follow-through after referral to specialized services. This review examined possible explanations related to the process of screening, focusing on how parents and youth are engaged, and how providers evaluate and use s...
Article
Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care. The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use valid...
Article
Community health centers (CHCs) have great potential to participate in the development of evidence-based primary care but face obstacles to engagement in clinical translational research. To understand factors associated with CHC interest in building research infrastructure, Harvard Catalyst and the Massachusetts League of Community Health Centers c...
Article
Safety-net populations are underrepresented in research and quality improvement (QI) studies despite the fact that safety-net providers are uniquely positioned to engage in translational research. This study aimed to understand the current level of interest in, experience with, predicted career satisfaction associated with, and barriers experienced...
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We assessed the perceptions of community core faculty in academic medical center institutions that received Clinical and Translational Science Awards (CTSA) about how these institutions consider community-engaged scholarship (CES) when tenure, promotion, and retention decisions are made. An assessment tool was adapted to create an 18-item survey th...
Article
Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the...
Article
Objective: The purpose of this quasi-experimental study was to examine the effect of a computerized point-of-care alert with clinical decision support on the rates of diagnosis of childhood obesity in a multisite group practice in Massachusetts; Cambridge Health Alliance (CHA) which implemented an alert, relative to a separate group practice, Harv...
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Background: To help build community capacity to partner in translational research partnerships, new approaches to training that incorporate both adult learning models and community-based participatory research (CBPR) are needed. Objectives: This article describes the educational approach-"community-engaged pedagogy"-used in a capacity-building t...
Article
Community policies and programs can encourage active living and promote physical activity among residents. Somerville MA implemented an Active Living by Design project in 2003-2008 that promoted partnerships and advocacy to encourage physical activity. To evaluate the Active Living by Design project implemented in Somerville. A retrospective design...
Conference Paper
The rate of deaths associated with opioids has increased at a startling rate. In fact recent CDC reports confirm that nationally, prescription drug abuse is the fastest growing drug problem. In 2006, the Massachusetts Department of Public Health was awarded a Strategic Prevention Framework State Incentive Grant (SPF-SIG) and identified reducing uni...
Conference Paper
Background: National data show the proportion of older adults using illicit or non-medical prescription drugs is growing and the number with substance use disorders is projected to double by 2020. Chronic health conditions common to an aging population may coexist with substance use, however few studies have examined associations between health sta...
Conference Paper
Background: Community health centers (CHCs) are instrumental in providing evidenced based care for vulnerable populations. However there is a limited understanding of how they identify and adopt evidence and what factors impede or promote this adoption. Study Aims: In 2011, the Harvard Clinical and Translational Science Center (Harvard Catalyst),...
Article
Background: Comparative effectiveness research (CER) evidence on childhood obesity provides the basis for effective screening and management strategies in pediatric primary care. The uses of health information technology including decision support tools in the electronic health records (EHRs), as well as remote and mobile support to families, offe...
Article
The purpose of the study is to assess the relationship between timing of adolescent development and risk factors for suicide. Nationally representative data from the Add Health survey were used. The relationship of sociodemographic characteristics, known risk factors, and physical developmental timing and cognitive developmental style to suicide at...
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For communities, the value of community-based participatory research (CBPR) is often manifested in the outcomes of increased capacity and sustainable adoption of evidence-based practices for social change. Educational opportunities that promote discourse between community and academic partners can help to advance CBPR and better define these outcom...
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Background: Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes. Methods/principal findings: To determine whether the amount and type of language services received during primary care visits...
Article
To determine the community-based participatory research (CBPR) training interests and needs of researchers interested in CBPR to inform efforts to build infrastructure for conducting community-engaged research. A 20-item survey was completed by 127 academic health researchers at Harvard Medical School, Harvard School of Public Health, and Harvard a...
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Increasing Immigration and Customs Enforcement (ICE) activities such as raids, detention, and deportation may be affecting the health and well-being of immigrants. This study sought to understand the impact of ICE activities on immigrant health from the perspective of health care providers. An online survey of primary care and emergency medicine pr...
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The objective was to determine whether transitioning from paper to electronic health records affected behavioral health screening rates in a large Northeastern pediatric practice. The study setting was a pediatric practice with seven pediatricians, serving about 6,000 patients. The patient population was diverse (54% nonwhite, 40% publicly insured...
Article
To examine the effectiveness of current community-based participatory research (CBPR) clinical trials involving racial and ethnic minorities. All published peer-reviewed CBPR intervention articles in PubMed and CINAHL databases from January 2003 to May 2010. We performed a systematic literature review. Data were extracted on each study's characteri...
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Despite the availability of national evidenced-based guidelines related to pediatric obesity screening and prevention, multiple studies have shown that primary care physicians find it difficult to adhere to them or are unfamiliar with them altogether. This article presents physicians' perspectives on the use of electronic decision support tools, an...
Conference Paper
Background: A strong primary care system that provides evidence-based, patient-centered care is critical to the US health care system. Safety net providers require a robust base of research to achieve their potential as high performing systems of care. This is especially true following the implementation of the Affordable Care Act and the transform...
Conference Paper
There is a rising demand for courses that train students in community-based participatory action research (CBPAR). Students are eager to embark on projects that make a difference and lead to action in local communities. In 2009, students from the Harvard School of Public Health approached members of the Harvard Catalyst to develop a new CBPAR cours...
Conference Paper
Background: Capacity building and sustainability of community health improvement efforts are important concepts for Community based participatory research (CBPR). However, community partners and investigators have few opportunities to come together to develop shared definitions and strategies for enhancing capacity building and creating sustainable...
Conference Paper
Background: Building practice-based research networks (PBRNs) may enhance patient care by improving generalizability of findings derived within a practice-based setting and facilitating the translation of research into clinical practice. The development of these networks necessitates increased provider research capacity, particularly in settings th...
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The availability of language services for patients with limited English proficiency has become a standard of care in the United States. Finding the resources to pay for language programs is challenging for providers, payers, and policymakers. There is no federal payment policy and states are developing policies using different methodologies for det...
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There are inconsistent findings about depression in Asians. This study examined risk factors for depression in Asian and Caucasian adolescents. Stratified bivariate secondary analyses of risk indicators and depressed mood were performed in this cross-sectional study of high school survey data (9th to 12th grades) from 2,542 students (198 Asian). As...
Article
U.S. immigrants have faced a changing landscape with regard to immigration enforcement over the last two decades. Following the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, and the creation of the Immigration and Customs Enforcement (ICE) agency after the attacks of September 11, 2001, detention and deportatio...
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The National Institutes of Health-funded Clinical and Translational Science Awards (CTSA) have increasingly focused on community-engaged research and funded investigators for community-based participatory research (CBPR). However, because CBPR is a collaborative process focused on community-identified research topics, the Harvard CTSA and its Commu...
Article
Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that...
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The objective of this study was to evaluate the impact of electronic technologies on the completion of a standardized rating form in an outpatient child psychiatry clinic, and the feasibility of adding a parent-report measure to the form. An electronic Outcomes Rating Form (e-ORF) was used in conjunction with a web-based patient tracking system and...
Article
There is growing recognition of the importance of recreational space utilization for promoting physical activity (PA) among youth. A cross-sectional study was conducted with a sample of 926 diverse 6th-8th grade students in Somerville, MA. Participants completed the 2007 Youth Risk Surveillance Survey (YRBS). Chi-square testing and logistical regre...
Conference Paper
Integrating behavioral and physical care for children is one of the foundations of the medical home model. This comprehensive patient centered approach is challenging to implement but has great promise to enhance health care. In 2001, The Institute for Community Health, along with the Cambridge Health Alliance (CHA) department of pediatrics and div...
Conference Paper
Background: In Cambridge, MA, as nationally, obesity among African American and Black (Black) youth is disproportionately high compared with other racial/ethnic groups. After universal school-based interventions in Cambridge (2004-2007), obesity among children grades kindergarten-8th declined significantly (20.2% to 18.0%), but disparities in obesi...
Conference Paper
Following rapid growth and diversification of US immigrant populations over the last two decades, cities have witnessed increasing racial and ethnic diversity. Concurrently, there has been a significant intensification of Immigration and Customs Enforcement (ICE) efforts as evidenced by a five-fold increase in deportees in 2008 compared to 1996. Th...
Conference Paper
Efforts are underway around the country to find meaningful ways to engage communities in the research enterprise. Leaders in community-based organizations have voiced their intention to do more than merely help academic investigators recruit for research studies in their communities without community input. Instead, community-based leaders want the...
Conference Paper
Along with the rapid growth and diversification of the US immigrant population which occurred over the last two decades, there has been a concurrent rise in Immigration and Customs Enforcement (ICE) efforts. This activity has fueled deportation fears and left many immigrants living in a state of hypervigilance. The resulting fear may be increasing...
Conference Paper
In the U.S. 17% of children age 12-17 witness and 39% are victims of violence, while 1% experience intrauterine cocaine exposure (IUCE). Although exposure to violence (EV) has been shown retrospectively to be a risk factor for earlier age of substance initiation, prospective data are limited, particularly in the context of intrauterine exposures. 1...
Article
To determine the type of subsequent care received by children nonadherent with their next preventive visit and whether behavioral factors predict use of emergency or acute care in this population. Data on 1703 children (4-16 years) screened at a preventive visit with the Pediatric Symptom Checklist (PSC)/Youth-PSC were examined to determine subsequ...
Article
How do parents of children with psychiatric co-morbidities perceive their children’s use of psychiatric medications? To learn more, the Parent/Professional Advocacy League of Massachusetts (PAL), representing families of children with mental health needs, collaborated with researchers on a community-based participatory research (CBPR) study. A ques...
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The objective of this study was to assess the impact of a community-based healthy weight intervention on child weight and fitness. Cambridge Public Schools (CPS) have monitored BMI and fitness annually since 2000. Annual increases of overweight and obesity from 2000 (37.0%) to 2004 (39.1%), triggered a multidisciplinary team of researchers, educato...
Conference Paper
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Background: The importance of interpreters in the delivery of health services has been established. While a number of studies have examined the relationship between delivery of interpreter services and health care quality, few have examined the costs and benefits of professional trained medical interpreters. To identify outcomes related to both the...
Conference Paper
While integrating behavioral and physical health care is considered an important goal in the effective delivery of child mental health services, few models of integrated care have been studied. Most importantly, little is known about how parents experience the benefits of such care. In 2005, in order to ease access to and increase satisfaction with...
Conference Paper
Community-based Participatory Research (CBPR) is an approach that involves community members and stakeholders in the full continuum of the research process. This includes steps from conceptualization through data analysis and dissemination. The application of CBPR methodologies however, requires community partners to be ready to participate in the...
Conference Paper
The use of behavioral health screening tools at the annual pediatric visit has been recommended and mandated in some states. In order to be screened, patients need to show up for preventive care. We explored the follow-up of 2129 children screened for mental health using the Pediatric Symptom Checklist (PSC) in an urban pediatric practice to determ...
Conference Paper
Background: Promoting fruit and vegetable consumption among children through farm-to-school activities may promote access to and acceptability of produce for supporting healthy eating among children and families. Methods: A community-based participatory research-informed three-year intervention was implemented in Somerville and Cambridge, MA, div...
Conference Paper
Background: Nationally, the percentage of overweight children ages 6-19 has increased threefold in the last 25 years. In response to this trend, policymakers and communities have considered how physical environments can facilitate active living. Over the past 5-years, community-wide initiatives in Somerville, Massachusetts have worked to promote ac...
Conference Paper
Background: In April 2009, the Community Engagement Program of the Harvard Catalyst Clinical Translational Science Center, a National Institutes of Health funded initiative which promotes the translation of scientific research to the community, launched the Community ConnectToResearch website (www.connecttoresearch.org). This site provides the gene...
Article
There are many studies of the Pediatric Symptom Checklist (PSC), but none has followed a naturalistic sample longitudinally. We aimed to examine persistence and change in PSC scores over time in children seen in an ambulatory pediatric setting. The sample of 1033 patients was PSC screened at 2 consecutive preventive care visits (10 to 18 months apa...
Article
To determine relationships between physical fitness and academic achievement in diverse, urban public school children. This cross-sectional study used public school data from 2004 to 2005. Academic achievement was assessed as a passing score on Massachusetts Comprehensive Assessment System (MCAS) achievement tests in Mathematics (fourth, sixth, and...
Conference Paper
The continuum of behavioral health screening, referral, assessment, and care is a community responsibility that no one sector can achieve independently. This presentation will discuss the challenges and benefits to a system when statewide policy meets local practice and its unexpected outcomes. The Cambridge Health Alliance, an integrated public...
Conference Paper
From the average parent's perspective, to navigate the pediatric behavioral health system is challenging. Coverage for mental health and substance abuse services is often based on strict and diverse eligibility categories that are not easily understood; furthermore, services may be scarce. For immigrant families, limited language capacity and syste...