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12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community COMMUNITY ENGAGEMENT TAKES TIME, TRUST, TRANSPARENCY, TALK, TEAM, TALENT & TENACITY

Saturday, February 2, 2019, from 8 am to 2 pm UT Health San Antonio C M Y CM MY CY CMY K

Table of Contents

Overview Introduction...... 1 Conference Objectives ...... 1 Welcome Letters...... 2 President’s Higher Education Community Service Honor Roll...... 4 Map ...... 5 Agenda ...... 7 Lunch Instructions...... 8 Poster Session Details...... 8 Judge’s Choice Awards ...... 8 Diving Deep Interprofessional Education (IPE) Award...... 8 Kleberg Scholars...... 8 Into Community Blue Ribbon Awards ...... 9 12TH ANNUAL Presentation Summaries & Presenter Bios COMMUNITY Opening Remarks & Keynote ...... 11 SERVICE LEARNING Forum Theatre: End Stigma, End HIV/AIDS...... 12 (CSL) CONFERENCE Lunch Panel...... 13 Student Poster Abstracts Advocacy/Policy ...... 13 Capacity Building...... 15 Clinical Service...... 25 Education ...... 31 Outreach ...... 61 Kleberg Scholars...... 69

Acknowledgements Planning Committee...... 79 Mentors...... 80 Community Partners...... 81 Sponsors...... Inside Back Cover

Index of Student Poster Abstracts...... 83 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 1

Introduction Community service learning (CSL) is a structured learning experience that combines community service with explicit learning objectives, preparation, mentorship and reflection. Health Science Center students address community-identified needs while learning about the context in which illness develops, connecting their academic coursework to real-life situations and reflecting on their roles as future healthcare professionals. The Annual CSL Conference at the University of Texas Health Science Center at San Antonio originated in 2008 as an opportunity to learn from the CSL experiences of students, faculty, staff and community partners in San Antonio and across Texas. Each year, the conference focuses on a theme relevant to service-learning and hosts experts and guest lecturers, provides skill-building sessions and showcases CSL projects through students' poster presentations. Presented by the Center for Medical Humanities & Ethics in conjunction with an interprofessional planning committee, the conference is free and open to the community.

Conference Objectives To share best practices and scholarship in community service learning with a focus on how to deeply engage with community. To bring together an interprofessional group of University of Texas (UT) Health Science Center students, faculty and staff from across the state with community partners to foster service-learning collaborations. To highlight existing UT Health Science System community service learning projects and future opportunities with community partners. To recognize and reward excellence in community service learning within the UT Health Science System. 2 3 1 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 4 Diving Deep Into Community 3

President's Higher Education Community Service Honor Roll

The University of Texas Health Science Center at San Antonio is committed to engaging our community to improve health. In support of our university's service mission, our students use what they learn both inside and outside of the classroom to empower medically underserved communities in San Antonio, across Texas and around the globe. The Community Service Learning (CSL) Program provides a structure to engage faculty, staff and institutional support of these activities. This university-wide dedication to helping others has earned our institution a place on the United States President's Higher Education Community Service Honor Roll annually since 2009. This is the highest federal recognition that an institution can receive for its commitment to service. Our university is the only health science center in Texas, and one of only ten across the nation, recognized by the Honor Roll. The Honor Roll showcases the U.S. colleges and universities that have best demonstrated their commitment to addressing community needs and engaging students on a lifelong path toward civic engagement. Institutions must demonstrate widespread support and cooperation, as well as meaningful, measureable outcomes in the communities they serve. At the Center for Medical Humanities & Ethics, we believe that CSL is ethics in action. We are proud of the leadership that our students exhibit and the promise that they will become community- connected healthcare providers who work to reduce disparities and enhance access to healthcare throughout their careers. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 5

12TH Anniversary CSL Conference Map 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 6 Diving Deep Into Community

NOTES 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 7

Conference Agenda Saturday, February 2, 2019 UT Health San Antonio

8-8:30 am Academic & Admin Registration Opens / Breakfast with Community Partners Bldg. (AAB) Foyer

8:30-8:45 Welcome / Opening Remarks Ruth Berggren, MD, MACP, Director, Center for Medical Humanities & Ethics, Holly Auditorium UT Health San Antonio

8:45-10:00 Keynote: Building Healthy Communities Together to Reduce Health Disparities: Diving Deep into the Community Using My 8 Ts of Community Engagement Holly Auditorium Loretta Sweet Jemmott, PhD, RN, FAAN, Vice President, Health and Health Equity and Professor, Drexel University, College of Nursing and Health Professions

10:00-10:10 Break

10:10-11:30 End Stigma, End HIV/AIDS: A Forum Theatre Project Facilitator: Roberto Prestigiacomo, MFA, Associate Professor, Human Holly Auditorium Communication & Theatre, Trinity University

Holly Auditorium 11:30-12:00 Networking with Community Partners / Pick up Lunch Foyer

12:00-1:00 Lunch Panel: A Deep Dive into CSL Moderator: Rev. Kenneth Kemp, MD, Senior Pastor at Antioch Missionary Baptist Holly Auditorium Church and Faculty, Pulmonary and Critical Care, Brooke Army Medical Center

Holly Auditorium 1:00-2:00 CSL Poster Session with Dessert Reception Foyer 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 8 Diving Deep Into Community 3

Lunch Instructions Holly Auditorium Foyer, Pick up Lunch 11:30 – 11:55 am Lunch is provided for those who registered by the January 26 deadline. Boxed lunches will be available for pick up in the Holly Auditorium Foyer beginning at 11:30 a.m. For those who registered for a vegetarian lunch, you will have a green dot on your name badge; others will have a red dot. For those who did not register in time, you will be asked to wait and any extra lunches will be made available to you after all of the pre-registered attendees receive their lunches. Enjoy your lunch during the community partner networking session from 11:30-12.00 or while listening to the noon panel presentation. It's up to you!

Poster Session Holly Auditorium Foyer, 1:00-2:00 pm Visit with students presenting their Community Service Learning posters while you enjoy dessert. Posters and abstracts begin on page 13 and an index is at the back of the program.

Judges Choice Award

During the Poster Session, a panel of Hidden Judges will be speaking to the presenters and one poster will be selected for the Judges' Choice Award. This award comes with a monetary prize. The winner will be announced by email following the conference.

Interprofessional Education Award

Also during the Poster Session, the poster featuring the best Interprofessional Education (IPE) project will be selected. This award comes with a monetary prize, due to the New support of UT Health San Antonio's LINC (Linking Interprofessonal Networks for this Collaboration). The winner will be announced by email following the conference. Year!

Kleberg Scholars Poster Section

The Kleberg Scholars program is funded by the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation and creates opportunities for students, residents and fellows to experience working within the community-based clinical settings available through UT Health San Antonio partnerships in South Texas. These are advanced community-based research and clinical projects with CSL attributes.

(Continued on next page.) 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 9

Blue Ribbon Award

Note the 3 posters with large blue ribbons on them – they are the Blue Ribbon Winners! These posters were selected by an interprofessional committee who reviewed all submissions and chose the top 3 outstanding abstracts. The 2019 Blue Ribbon Winners are:

A New Hope: Introducing Comprehensive, Non-Religious Sexual Education to a Christian Secondary School in Masaka, Uganda

Student Team Jaclyn Boozalis, Andrew Jeffery, Avery Kester, Jeremiah Gress, Travis Bishop, Chidimma Amuneke-Nze, Averi White, Prem Menon

Faculty Mentor Jason Rosenfeld, MPH, DrPH(c)

Community Partners Hope Comprehensive School, US2Uganda4Life

Naloxone Accessibility Under Standing Orders from Texas Community Pharmacies and the Efficacy of Brief Academic Detailing on Improved Accessibility

Student Team William Godinez, Ravi Gandhi, Jillian Contreras, Itzel Alfaro, David Giang, Michelle Tran, Judy Chan

Faculty Mentors Lucas Hill, PharmD; Kelly Reveles, PharmD, PhD; Kirk Evoy, PharmD

Community Partner Operation Naloxone

Assessment of the Reproductive Health Needs of Female Afghan and Burmese Refugees in San Antonio, Texas: A Focus Group Approach

Student Team Mikaela Miller, Cameron Holmes, Kinsey Dittmar, Fatima Dollar, Matthew Moran, Matthew Makansi, Andrew Jeffery, Donald Egan

Faculty Mentor Heidi Worabo, DNP, RN

Community Partner Center for Refugee Services 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 10 Diving Deep Into Community

NOTES TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 11 Diving Deep Into Community

Presentation Summaries Opening Remarks Presented by: Ruth Berggren, MD, MACP

Dr. Ruth Berggren directs the Center for Medical Humanities & Ethics at UT Health San Antonio. In this role, she teaches ethics and professionalism, while nurturing empathy and humanitarian values. Dr. Berggren is the Marvin Forland, MD, Distinguished Professor in Medical Ethics, and she holds the James J. Young, PhD, Endowed Chair for Excellence in Medical Education. Dr. Berggren is board-certified in both internal medicine and infectious diseases with significant experience and particular interest in clinical AIDS and viral hepatitis research, as well as in implementing HIV care in resource poor settings.

Keynote: Building Healthy Communities Together to Reduce Health Disparities: Diving Deep into the Community Using My 8 Ts of Community Engagement

Speaker: Loretta Sweet Jemmott, PhD, RN, FAAN

Session description: The purpose of this session is to provide an overview of community engagement and effective community engagement strategies for building true partnerships with community leaders to promote positive health outcomes. At the end of the talk, participants will be able to have an: Increased knowledge about importance of engaging with the community to promote health and reduce health disparities. Increased understanding of the strategies to partner with the community leaders and residents to improve their health outcomes Increased strategies of truly listening to the community voices and responding. Increased knowledge about my successful 8 Ts strategies of community engagement. Increased strategies for doing a Deep Dive in communities, listening to their voices, and responding to promote their health. Dr. Loretta Sweet Jemmott is the Vice President of Drexel University focusing on Health and Health Equity and a Professor in Drexel's College of Nursing and Health Professions. She leads Drexel University's community/civic engagement initiative, "We Here Because We Care: Building Healthy Communities Together," which is designed to partner with the community to identify health and wellness concerns within the 10 West Philadelphia Promise Zone communities and develop health and wellness programs to improve health outcomes by implementing community-driven, sustainable programs based on the community's voices. An outstanding translational researcher, she has transformed her NIH-funded, evidence- based research outcomes for use in real-world settings. To date, nine of her evidenced-based HIV/STD and pregnancy prevention curricula having been designated by the Department of Health and Human Services (DHHS) Office of Adolescent Health and the Centers for Disease Control and Prevention for national and international dissemination. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 12 Diving Deep Into Community

Forum Theatre: End Stigma, End HIV/AIDS Facilitator: Roberto Prestigiacomo, MFA

Session Description: For health care professionals, stigma is the greatest social impediment to combatting the AIDS epidemic. The interactive theatre production, a product of a collaboration between the Mellon Institute for Summer Research at Trinity University and the AtticRep, draws from in-depth interviews with 34 San Antonio residents to depict the lived experiences of stigma related to HIV/AIDS testing and treatment locally. Each production includes a discussion with the audience, during and after a repeat performance that invites the public to participate in the action on the stage. The inclusion of "spect-actors" in the performance is integral to the Forum Theatre method, a tool that has been used successfully for decades to address social problems in numerous countries around the world. Roberto Prestigiacomo is a theater-maker who directs plays, creates original performances, and develops Forum Theatre Projects applying Theatre for Social Change Techniques. A native of Rome, Italy, Roberto is Associate Professor at Trinity University, and the Producing Artistic Director of AtticRep. Recent projects include co-directing Die Fledermaus in Taiwan, participating in MITEM-International Festival in Hungary, FLIPT- Intercultural Festival Laboratory of Theatre Practices in Italy, and creating a Forum Theatre Project on Skin Tones in India. In the past year, Roberto has created Forum Theatre Projects on Immigration, Family Abuse, and HIV/AIDS in San Antonio.

Lunch Panel: A Deep Dive into CSL Moderator: Rev. Kenneth Kemp, MD Session Description: This session will explore the development of a CSL project, the Pride Clinic, from inception of an idea through a comprehensive needs assessment to execution of a fully functioning clinic. The Pride Clinic serves LGBTQ patients who are part of a medically underserved community in San Antonio. The clinic is provided in collaboration with Alamo Area Resource Center (AARC). The panel will be moderated by the Rev. Dr. Kenneth Kemp and will feature key players who helped bring about the success of this project: Christopher Smith, MD, First Year Internal Medicine Resident, University of Maryland Medical Center: Pride Clinic student founder Sean Garcia, MD, FHM, Associate Professor, Division of General Hospital Medicine, Long School of Medicine, UT Health San Antonio: Pride Clinic Medical Faculty Advisor Cindy Sickora, DNP, RN, Vice Dean for Practice and Engagement, School of Nursing, UT Health San Antonio: Pride Clinic Nursing Faculty Advisor Patient Representative of the Pride Clinic Community Partner Representative from AARC Kenneth R. Kemp, MD, is a former Program Director for the Pulmonary and Critical Care Medicine Program at Brook Army Medical Center (BAMC) and previous Chairman of the Institutional Bioethics Committee. He is certified in the areas of Internal Medicine, Pulmonary Medicine and Critical Care Medicine and a fellow of the American College of Physicians and the American College of Chest Physicians. He retired as a Colonel from the Army Medical Corps in September 2009 after 21 years of active service and 25 years of total service in our nation's military. In addition to his life in medicine and the military, Dr. Kemp is an ordained Baptist minister and currently serves as the Senior Pastor of Antioch Baptist Church. TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 13 Diving Deep Into Community

Student Poster Abstracts

Advocacy/Policy

Informed Medical Bill Negotiation

Project Discipline: Medicine Primary Presenter: John-Paul Bonansinga Name of Mentor: Kanapa Kornsawad, MD Community Partner: The Patient Institute Project Location: San Antonio, Texas

Background: Health care costs in the U.S. have outpaced inflation since 2007. High prices are set to allow for bargaining with third parties for reimbursement. Patients incur excess charges resulting in financial hardship. Limited resources are available to empower patients to negotiate these charges. Objectives: The goal was to assess the knowledge of the populace regarding the ability to negotiate medical bills and stress associated with medical bills. I also wished to synthesize a process to negotiate bills. Methods: Impact of unpaid medical bills was researched. A six-question survey was generated to assess the prevalence of unpaid medical bills, stress and willingness to negotiate. Surveys were completed online by 100 participants. Interviews were conducted with an additional 10. Analysis of billing practices and a review of Medicare guidelines conducted. Negotiation stories were reviewed, and an attorney consulted. The intervention begins with education on "fair pricing" and escalation thereafter. Success will be measured by savings. Results: Review showed significant financial burden on the U.S. population resulting from medical bills. Survey results: 64% difficulty paying medical bills, 89% financial arguments, and 98% "highly likely" to negotiate given a resource. A process was generated to approach the negotiations. One trial resulted in a $1,653.28 reduction, another in discovery of a fraudulent bill. Four trials are underway. Conclusion: Most Americans will experience stress or hardships related to medical bills at some point in their lives, a resource outlining negotiation has value. The approach has yet to be tested thoroughly to assess effectiveness, but pre-trials show promise. There is growing public concern over health care pricing transparency. The finished product must be of use to a person who only possesses the motivation to invest time into the negotiation. I have partnered with The Patient Institute to distribute and e-publish the finished project as well as translate it into other languages. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 14 Diving Deep Into Community

Advocacy/Policy

Naloxone Accessibility Under Standing Orders from Texas Community Pharmacies and the Efficacy of Brief Academic Detailing on Improving Accessibility*

Project Discipline: Pharmacy Primary Presenter: William Godinez Other Student Team Members: Ravi Gandhi, Jillian Contreras, Itzel Alfaro, David Giang, Michelle Tran, Judy Chan Name of Mentor: Lucas G. Hill, PharmD, Kelly R. Reveles, PharmD, PhD, Kirk E. Evoy, PharmD Community Partner: Operation Naloxone Project Location: Texas. This study was conducted statewide, with community service intervention targeted in Austin and San Antonio

Background: Enacted in September 2015, Texas' naloxone access law allows pharmacists/pharmacies to develop standing orders in which prescribers may authorize pharmacists to dispense naloxone directly to patients without prescription. Objectives: This two-part study evaluated naloxone accessibility under standing order from Texas chain pharmacies and subsequently assessed whether academic detailing of community pharmacists improved naloxone accessibility. Methods: Trained pharmacy students conducted a telephone audit of all 2,317 CVS, Walgreens, HEB, and Walmart pharmacies in Texas. Utilizing a scripted interview, they spoke to a pharmacist, representing themselves as potential overdose responders seeking to purchase naloxone. Two months after initial audit, pharmacy students traveled to pharmacies in the Austin/San Antonio area that indicated they were not willing to dispense naloxone without prescription and provided brief, in-person academic detailing to inform pharmacists about naloxone standing orders and naloxone use for overdose prevention. Students provided handouts to disseminate to off-duty pharmacists and requested the pharmacies display a provided flyer informing patients about naloxone. An identical telephone audit was conducted of the stores receiving academic detailing 1-2 weeks post-education. Results: Response rate was 100%, with the survey cohort representing 44.3% of all Texas community pharmacies. Among audited pharmacies, 83.7% (95% CI 82.2-85.2) indicated they would dispense naloxone without prescription, and 76.4% (74.1-78.1) currently stocked naloxone. Most (79.9% [78.3-81.6]) would allow purchase of naloxone for someone else, but only 49.7% (47.8-51.9) would bill the purchaser’'D5s insurance for this third-party prescription. Among the 49 pharmacies receiving academic detailing, 37 (76%) responded appropriately that they would dispense naloxone without an outside prescription. Furthermore, more pharmacies stocked naloxone (29/49 (59%) vs. 21/49 (43%), p=0. 0075) after detailing. Conclusion: Among Texas chain pharmacies with standing orders, most stocked naloxone and would dispense it without a prescription, tough barriers to access remain. Results indicate that brief, student-led academic detailing improved naloxone accessibility via standing order.

*Blue Ribbon Winner 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 4 Diving Deep Into Community 15

Capacity Building

An Interprofessional Collaboration to Improve Patient-Provider Communication for Refugee Patients with Limited English Proficiency

Project Disciplines: Dental, Medicine, Nursing Primary Presenter: Emily Gallagher Other Student Team Members: Jennifer Boswell, Joshua Barrera, Kinsey Dittmar, Taylor Dramberger, Michael Estrada, Mitchel Faulkner, Bao Ha, Andrew Jeffery, Prem Menon, Ronald Minard, Khushboo Pal Mentors: Browning Wayman, MD; Moshtagh Farokhi, DDS, MPH Community Partner: St. Francis Episcopal Church Project Location: San Antonio, Texas

Background: San Antonio Refugee Health Clinic (SARHC) is an interprofessional education (IPE), Student-Faculty Collaborative serving the local refugee population. Previous needs assessments identified medical interpretation for patients with Limited English Proficiency (LEP) as a priority. To address this healthcare access barrier, an IPE team of students and faculty initiated an investigational use of a medical interpreter phone line service. Objectives: The purpose of this initiative was to train University Texas Health San Antonio (UTHSA) IPE student volunteers at SARHC on nine learning objectives pertaining to communicating with patients with LEP (October 2017- January 2019). Another objective was to provide consented SARHC patients with LEP with adequate phone interpretation services (October 2017- January 2019). Methods: The initiative was a quality improvement (QI) project. Pre- and post-training surveys were administered to all student volunteers who completed calibrated phone line training. A summative self-assessment score was calculated for pre and post surveys respectively. Descriptive data was collected on SARHC patient participants receiving the phone line service, and a patient satisfaction questionnaire (PSQ) was administered upon the completion of the appointment. Statistically significant differences in self-assessment scores pre- and post-training were determined using a paired t-test. Results: Of the students who attended the phone line training, 61 students completed both the pre- and post-survey. Student data presented a statistically significant improvement in understanding the learning objectives after attending the training (p<0.00001). Of the refugee patients who utilized the phone line, 35 volunteered to complete the PSQ. Most patients expressed "satisfied" to "very satisfied" for the services rendered (94.3%) and rated provider communication as "good" to "excellent" (95.2%). Conclusion: Both students and refugee patients benefited from this initiative. UTHSA students improved their self-efficacy in communicating with and treating a vulnerable patient population. Refugee patients were enabled to communicate more effectively with their healthcare team at SARHC. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 16 Diving Deep Into Community

Capacity Building

Assessing Access to Healthcare and Medications in Communities in Quetzaltenango, Guatemala

Project Disciplines: Medicine Primary Presenter: Nimmy Thomas Other Student Team Members: Claudina Tami, Glennette Castillo, Carmella DeSerto, Luis Garza Mentor: Mark Nadeau, MD, MBA Community Partner: Hogar Luis Amig Project Location: Quetzaltenango, Guatemala

Background: Vamos Guatemala is a service learning program in which medical students, mentored by faculty physicians, provide primary care to underserved populations in Quetzaltenango, Guatemala. Since the program's inception in 2011, no evaluation has been conducted to assess healthcare access in communities served. Objectives: The purpose of this project is to assess access to healthcare and medications in partner communities in Quetzaltenango. Information on access will be used to evaluate the role of Vamos Guatemala's services in these communities and examine ways to establish longitudinal care. Methods: The study was conducted in three communities which are routinely served by Vamos Guatemala: 1) Women's Center, 2) Xecam and 3) Cuchilla. As part of their medical history, all participants who received care were interviewed about access to and use of medical services and medications in the past year. Results: A total of 178 patients were surveyed. At the Women's Center, 52% visited a physician and 50% accessed medications in the previous year. Of those patients, 20% received care and 12.9% received medications from a previous Vamos Guatemala team. In Xecam, 57% reported visiting a physician in the previous year and 60% accessed medications. Of those patients, 60% and 62.5% of patients reported the regional health center in Xecam as where they received healthcare and medications, respectively. In Cuchilla, 74% of the patients reported visiting a physician and 83% accessed medications in the previous year. Conclusion: Lack of financial resources and limited access remains a problem in these communities to varying degrees. For some, Vamos Guatemala serves as the only form of healthcare due to highly limited access. Regional health centers provide care to a large percentage of the community, suggesting a need for collaboration in future trips to address longitudinal care in the communities with greater access. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 4 Diving Deep Into Community 17

Capacity Building

Development and Implementation of a Standardized Training Program for Frontera de Salud Volunteers

Project Disciplines: Medicine, Nursing, Occupational Therapy, Respiratory Care, Physical Therapy, Physician Assistant, Public Health, Speech Pathology Primary Presenter: Jordan McMaster Other Student Team Members: Nimmy Thomas Mentor: Melanie Stone, MPH, MEd Community Partner: Frontera de Salud Project Location: San Antonio, Texas

Background: Frontera de Salud is a student-run organization at UT Health San Antonio which, under faculty mentorship, provides health screenings, sports physicals, and health education to medically underserved communities throughout South Texas. Prior to each service trip, student leaders provide preparatory training to volunteers. Historically, this training was conducted in large group sessions and varied greatly in the terms of both content and quality depending on the expertise and confidence level of the student trainer. Objectives: The purpose of our quality improvement project is to create a standardized curriculum for Frontera training which can be easily utilized by current and future student leaders. Methods: The curriculum was created in the form of a PowerPoint presentation to be used as a template for pre-trip training for adult health screenings. A corresponding training manual was created with details and protocols about each of the tests administered on the trips, general nutrition and physical activity guidelines for adults and children in the U.S., and information on motivational interviewing. Sessions were conducted to evaluate the curriculum on four pre-trip training sessions in fall 2018. At each session, participants were given pre- and post-surveys to measure changes in knowledge and confidence. A separate session was conducted to train the new 2019 Frontera leadership on leading pre-trip training. Results: Quantitative: Four training sessions were conducted using the newly created standardized curriculum. 38 people completed both pre- and post- surveys. Survey results showed an increase in both knowledge and self-efficacy in technical skills. Qualitative: People found the hands-on practice portions to be most helpful. Conclusion: The new standardized curriculum is effective in improving volunteers' knowledge and self-efficacy. Additionally, we believe this is now a more sustainable training program due to the addition of mechanisms for its monitoring and evaluation and a leadership position specifically in charge of its maintenance. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 18 Diving Deep Into Community 11

Capacity Building

Evaluation of the Use of Collective Impact by Partners in Pink

Project Disciplines: Medicine, Nursing, Public Health, Community Health Worker Primary Presenter: Gayla Ferguson Mentor: Linda Highfield, PhD Community Partner: Breast Health Collaborative of Texas Project Location: Houston, Texas

Background: The Galveston County Coalitions in Action: Partners in Pink (PIP), is a group of 30 breast health and breast cancer organizations serving Galveston County, Texas residents called together by Susan G. Komen for the Cure - Houston®. Their mission is to apply a Collective Impact (CI) framework to address the breast cancer morbidity and mortality disparity among African American women in Galveston County through the discussion, development, and implementation of sustainable interventions for improving breast health continuity of care. Objectives: Assess the implementation of the (CI) framework through an observational phenomenological mixed methods approach using the Consolidated Framework for Implementation Research (CFIR) and the Wilder Collaboration Factors Inventory. Methods: An anonymous cross-sectional survey, derived from the consolidated framework for implementation research (CFIR) and the Wilder Collaboration Factors Inventory, was emailed to all active PIP participants. Observational data (group dynamic field notes) were collected and content analysis conducted for themes and cross-referenced with the quantitative portion of data collected to inform outcomes. The evaluation was conducted over three months at the end of PIP's first year. Results: By the end of the first year, PIP members established mutual respect, informal relationships, and created a Common Agenda for successful coordinated efforts in continuity of care. All performance objectives were met. Each PIP member reported joining to expand their reach in combating breast cancer disparities. PIP members were motivated by the desire to further Komen’'D5s mission, rather than an obligation to secure future funding support. An area of improvement for PIP is to equip members with the skills necessary to feel prepared to achieve the outcomes of the Common Agenda. Conclusion: The CI framework positively impacted continuity of breast health care gaps by combining the efforts of competing breast health organizations in a unified front serving African American women in Galveston County, Texas. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 10 Diving Deep Into Community 19

Capacity Building

Helping the Elderly Avoid the Emergency Department

Project Disciplines: Medicine Primary Presenter: Daniel Glade Mentor: Jeanette Ross, MD Community Partner: South Texas Veterans Healthcare System Project Location: San Antonio, Texas

Background: The aging population is growing rapidly and placing an increased burden on the healthcare system, particularly Emergency Departments (ED). Objective: Describe the characteristics of frequent flyers to the ED from the Geriatric Evaluation and Management (GEM) Clinic in the South Texas Veteran Health Care System and identify areas that can be improved to prevent unnecessary ED visits. Methods: Retrospective chart review of GEM clinic patients who visited the ED between April 2016 through April 2017 using the ED log. Specifically looking at diagnosis (categorized into 10 body system groups), emergency acuity index (1-5 scale, 1 being the most urgent/dying and 5 being the least urgent), assignment of skilled home health services, and use of telecare 48 hours prior. Outcomes examined using Pearson's Chi-Square test for discrete variable and analysis of variance for continuous variable following Tukey-Cramer method for multiple comparisons. Results: A total of 1,020 total ED encounters corresponding to 375 patients were identified. Among those, 131 patients returned to the ED 3 (frequent flyers) making up 610 ED encounters (59.8% of total). Most common reason for ED visit: musculoskeletal pain (16.5%), respiratory (13.8%), cardiovascular (13.8%). Among non-urgent visits (emergency acuity index rating of 4 or 5) musculoskeletal pain was the most common reason (37.3%). Telecare use (48 hours prior) preceded < 1.0% of ED encounters. Skilled home health services did not significantly reduce likelihood of returning to the ED within 30 days (p-value = 0.1627) Conclusion: The leading cause of non-emergent ED visits was musculoskeletal pain, most of which did not lead to hospital admission. The use of the after-hours nursing advice line Telecare was rarely used prior to ED visits. Future interventions geared towards providing non-ED options for care, such as creating new opportunities for same day appointments and increasing awareness of telecare availability, could decrease preventable visits to the ED. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 20 Diving Deep Into Community 11

Capacity Building

Implementing Diabetes Mellitus Data Collection in a Ugandan Clinic

Project Disciplines: Medicine, Public Health Primary Presenter: Emily Henkel Other Student Team Members: Mitchell Katona Mentor: Melissa Valerio, PhD, MPH Community Partner: Kigezi Healthcare Foundation (KIHEFO) Project Location: Kabable, Uganda

Background: The prevalence of type 2 diabetes is rising across the world; in Uganda rates rose from 2.0% in 2014 to 2.8% in 2016. This points to an opportunity for implementation of preventive intervention strategies at the community level. The Kigezi Healthcare Foundation (KIHEFO) developed and launched a mobile screening and data collection program in July 2018 to promote awareness, collect data to inform interventions, and to meet requirements for government funding to purchase a HbA1c testing machine. Objectives: The purpose of this project was to create and implement a data collection tool and train clinical officers to utilize the tool for mobile diabetes screenings. We also set out to incorporate patient education into the program. Methods: Following a literature review, a questionnaire was drafted utilizing KIHEFO's existing data tools to ensure familiarity and drafts were revised with input from clinical officers. Three clinical officers were trained to utilize the data tool. An easily interpreted graph of random blood sugar (RBS) was used to assist with patient education. Officers anonymously rated the efficiency of the tool, comfortability of use, and likelihood to use in clinical setting on a Likert scale. Results: Officers rated the tool as 4.7/5 for efficiency, 5/5 for comfortability of use, and all stated they are "very likely" to utilize the tool. Qualitatively, the patients expressed greater interest and understanding of their disease with use of the graph. Conclusion: Development of this data collection tool provided the groundwork for KIHEFO to expand statistical studies, pursue funding, and educate patients. We anticipate returning in 2020 to perform data analysis that will help KIHEFO receive funding. Integration of training and data collection prior to escalation is important for long-term prevention and to improve health outcomes in communities. Communication and understanding of population needs will help with long-term care management and inform effective organizational practices. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 12 Diving Deep Into Community 21

Capacity Building

Music & Art in Medicine (MAM): The Effectiveness of MAM Events on the Interest and Perception of Geriatrics and Nursing Homes by Medical Students (MSs)

Project Disciplines: Medicine Primary Presenter: Steven Diep Other Student Team Members: Glennette Castillo, Max Feng, Joel Pious Mentor: M. Rosina Finley, MD, CMD Community Partner: Sorrento by Cantexx Project Location: San Antonio, Texas

Background: MAM is a MS interest group which provides community service music and art performances. PALTC events are activities director-coordinated. Music and Art QI projects have revealed a positive response in depression, pain, and cognition. A new QI collaboration was developed. MSs would be surveyed similar to research conducted by Janzen KM, et al. measuring the effect of student-led educational events on geriatric patient and student participant perceptions and in research conducted by Couteur DG and Price DA reflecting MS attitudes toward the elderly and careers in geriatric medicine. This project includes pre- and postmusic and art combined PALTC- event surveys. Objective: Increase PALTC music and art student volunteers and sessions with an aim of measuring music and art- event effectiveness on MS interests and perceptions of Geriatrics and Nursing Home populations that could be utilized in the recruitment and retention of PALTC volunteers. Quality Improvement Methods: An increase in PALTC volunteers and activities was needed. A QI project was developed that included a music and art event-timed outline and survey of MSs. Results: Volunteers and activities increased. A music and art event module was developed. Of 4 events, 8 pre- and post- event surveys were completed using a Likert scale of 1 to 5: 1 equals strongly disagree and 5 equals strongly agree. After careful review of all the surveys, it was noted that there was an overall positive effect on perception of medical students on Geriatrics and nursing homes. Many students felt more comfortable working with the elderly and several students even expressed interest in either pursuing a career in Geriatrics and/or applying music and art therapies in their future practice. Conclusion: Collaborative MS and PALTC projects should continue. Information gained should be utilized in improving PALTC services and quality of life of its residents. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 22 Diving Deep Into Community 13

Capacity Building

Pride Community Clinic: Addressing the Needs of Underinsured LGBTQ+ Patients in San Antonio

Project Disciplines: Medicine, Nursing Primary Presenter: Jessica Hill Other Student Team Members: Delaney Rawson, Michael Estrada,Ronald Minard, Joshua Barrera, Donald Egan, Sushmitha Rames, Ravyn Yoko Middleton, Andrea Grey, Stacy Nguyen Mentor: Sean Garcia, MD Community Partner: Alamo Area Resource Center (AARC) Project Location: San Antonio, Texas

Background: The Pride Community Clinic, an inter-professional clinic under UT Health San Antonio and AARC, was opened to address holistic LGBTQ+ care in areas such as mental counseling, STI screenings, and hormone replacement therapy (HRT) for transgender patients.New patients are self-reporting to be uninsured. Methods: Preliminary analysis of the 38 patients that have been seen at the clinic was performed from monthly clinic nights taking place from October 2017 to November 2018. Demographic information was provided through patient self-reporting on clinic intake forms, while clinical data was collected from electronic medical record review. Results: The mean age of patients was 31.3 years and 53% of patients identified as Latino, with 89.5% identifying as transgender seeking HRT. The sexuality of patients varied, with 31% identifying as straight, 21% identifying as bisexual and 18% identifying as gay or lesbian. Conclusion: Although the clinic is targeted toward LGBTQ+ patients, the greatest need rests with the transgender community. The age and race statistics of the clinic patient population are similar to that of San Antonio as a city, suggesting the need of uninsured patients in San Antonio is universal. This suggests a lack of knowledgeable, sensitive, and cost-effective providers targeting LGBTQI+ health in San Antonio, especially the transgender community. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 23

Capacity Building

Project Saha: Integrating Mental Health Services into the San Antonio Refugee Health Clinic

Project Disciplines: Medicine, Nursing Primary Presenter: Kinsey Dittmar Other Student Team Members: Khushboo Pal, Andrew Jeffery, Andrew Jeffery, Khushboo Pal, Ronald Minard, Jennifer Boswell, Bao Ha, Joshua Barrera, Isabelle Seto, Gina Jamal, Melissa McCarty, Chidinma Glory Mentor: Rebekah Salt, PhD, RN Community Partner: Center for Refugee Services Project Location: San Antonio, Texas

Background: From pre-migration trauma to post-migration stressors, refugees have many factors that predispose them to mental health challenges. This pilot project was designed to facilitate the integration of mental health services into the San Antonio Refugee Health Clinic (SARHC) using the Refugee Health Screener-15 (RHS-15) and Pathways to Wellness (PW). RHS-15 is a validated mental health screening tool for refugee populations. PW was designed to provide support to those who score above threshold by focusing on group discussion and teaching strategies that empower refugees to move toward mental health wellness. Objectives: The purpose of this study was to identify refugees in need of additional mental health services, gain an understanding of different views of mental health, and identify how to best incorporate mental health services into patient care at SARHC. Methods: The pilot project was divided into three sections: 1) Screening, 2) Intervention, and 3) Evaluation. Arabic and Burmese patients were screened with the RHS-15. Those who scored above threshold were invited to PW classes. Each class was moderated by an experienced facilitator and UT Health students. Upon completion of the three classes, the refugees re-took the RHS-15, attended a celebratory event, and received a certificate of completion. Results: Of the 27 patients who were screened, 63% screened above threshold for psychological distress. Pre and post survey analysis was difficult because of a small sample size; however, results showed improvement in knowledge of, and comfort talking about, mental health. During the sessions many themes emerged which included loss, culture shock, and interpreter needs. Conclusion: Integrating the RHS-15 and PW into the standard of care for refugees who access the SARHC is an important first step. This pilot study generated momentum that will be used to expand the services offered at SARHC to include mental health screenings, monthly "psych nights" and PW workshops. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 24 Diving Deep Into Community

Capacity Building

The Most Common Diagnoses at the Travis Park Dermatology Clinic, A Retrospective Chart Review

Project Disciplines: Medicine Primary Presenter: Giselle Castillo Other Student Team Members: Kavina Patel, Caroline Zhu, Pavela Bambekova, Chirag Buch Mentor: John Browning, MD Community Partner: Travis Park United Methodist Church Project Location: San Antonio, Texas

Background: The Travis Park Dermatology Clinic was established November 18, 2009 in an effort to treat dermatologic conditions in the homeless, indigent, and uninsured patient population of San Antonio, Texas. The clinic operates the first and third Wednesday of every month. Among those who are homeless, uninsured, or underinsured, access to proper dermatologic care may be difficult, thus the clinic was established with the goal to reduce barriers to care. Objectives: To identify the most common dermatologic diagnoses among patients seen at the clinic from January 2017 to September 2018 with attention given to age and diagnosis. Data will be used to help identify prevalent dermatologic conditions and trends and will serve as a resource when medications and treatment supplies are ordered for future clinics. Methods: Patient charts from 43 dermatology clinics were reviewed and demographics and diagnosis were recorded. Results: Overall, 724 patients, between the ages of 0-87 (average 51, mode 45), were seen. A total of 417 diagnoses were recorded, with 8% of patients presenting with more than one complaint. The top diagnoses (per total # of patients) were: atopic dermatitis (18.3%), acne (9.2%), seborrheic keratosis (4.9%), epidermal inclusion cyst (4.8%), alopecia areata (4.8%) and with less than 5% frequency: psoriasis, actinic keratosis, tinea infections (body and head), verruca vulgaris, and rosacea. Additionally, the rate of malignancy per total patients seen was 3.31% with patients presenting with lesions suspicious for basal cell carcinoma (13), squamous cell carcinoma (5), melanoma (5) and dysplastic nevus (1). Conclusions: The most common diagnosis at the clinic was atopic dermatitis with 132 out of 724 patients presenting with this condition. A limitation to this study includes diagnosis variability between attending dermatologists. This knowledge will aid in future clinics as new medications and supplies are ordered. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 25

Clinical Service

Analysis of Pain Prevalence and Management in Low-Income Areas of Quetzaltenango, Guatemala

Project Disciplines: Medicine Primary Presenter: Glennette Castillo Other Student Team Members: Nimmy Thomas, Carmella DeSerto, Claudina Tami, Luis Garza Mentor: Mark Nadeau, MD, MBA Community Partner: Hogar Luis Amig Project Location: Quetzaltenango, Guatemala

Background: Vamos Guatemala is a service learning program in which medical students under the supervision of faculty mentors provide primary care to underserved populations in Quetzaltenango, Guatemala. In Spring 2017, Vamos Guatemala discovered that the most frequently prescribed medications on these trips were NSAIDs (nonsteroidal anti-inflammatory drugs) for pain management. In addition, the WHO's Global Burden of Diseases studies indicated that low back and neck pain has steadily increased as a concern in all of Central America, indicating a need to explore this issue further. Objectives: The purpose of this study was to measure the prevalence of painrelated chief complaints and evaluate the patients' current methods of pain management. We analyzed the current methods of pain management in the community to drive future discussions on the possibility for implementation of patient education and physical therapy programming into our annual trips. Methods: A total of four locations were surveyed: a women's center and three community clinics. We performed a qualitative analysis of 178 patient intake forms and analyzed those with pain as their chief complaint or those who had a history of pain. Results: Data showed that pain was either the chief complaint or present in the medical history for 72.1% of patients, and 53.2% of those used medications to manage their pain. Conclusion: Overall, pain was the chief complaint of numerous patients seeking treatment at the clinic. The majority of patients resort to chronic medication use to treat their pain. This indicates a need for alternative pain remedies like physical therapy and more patient education on appropriate pain management. Future trips could incorporate an education and counseling station where patients are taught physical therapy exercises and provided information on the risks of NSAID use for chronic pain management. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 26 Diving Deep Into Community

Clinical Service

Breastfeeding Practices and Needs Assessment Among Indigenous Women in Quetzaltenango, Guatemala

Project Disciplines: Medicine, Public Health Primary Presenter: Sejal Lahoti Other Student Team Members: Maria Benson, Maddie Flores Mentor: Nandini Mandlik, DO Community Partner: Puesto de Salud Project Location: Quetzaltenango, Guatemala

Background: The purpose of this study was to assess breastfeeding practices and prenatal feeding within indigenous women living in Xecam, Guatemala. The study also included a needs assessments to review where women receive their key health services. Objectives: To measure the time of exclusive breast feeding and other foods being introduced to better improve nutrition. Methods: Data was collected using a convenience sample from a puesto (community health center) in Xecam. The research was carried out from May- June 2018. The surveys were IRB approved and administered to the women in Spanish. The study participants were women that came to the puesto for care, and they were given the choice to participate in the survey following the visit. The final sample for the study were 45 women of ages 16-50. A woman was excluded from the study if she had no pregnancies or children. Results: The data analysis showed that 43 of the 45 women exclusively breastfeed for six months. The 2 that did not breastfeed were unable to produce breast milk. The average age to breastfeed a child was 2 years (N=39). The average age of complementary food introduction along with breastfeeding was 9.5 months (N=30),and some surveyed women had babies under the six- month period. The major food groups included fruits/vegetables, grains, and local foods. We also found that the Puesto promotes breastfeeding education with 20 women receiving education at the Puesto (N=39). Conclusions: The major nutrition problems arise when children are weaned from breast milk. Thus, Xecam should make a community garden to help feed children. A better analysis needs to be conducted on the nutritional deficiencies in toddlers ages 2- 6 in the community. A longitudinal study on growth patterns could also be beneficial to analyze how the growth in Xecam community compares to the national average. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 27

Clinical Service

How Does Laredo Feel?

Project Disciplines: Medicine, Public Health Primary Presenter: Bradley Gustafson Other Student Team Members: Cosme Belmonte Mentor: Glen Medellin, MD Community Partner: Mercy Ministries of Laredo Project Location: Laredo, Texas

Background: Access to healthcare is an ongoing struggle for many individuals living near the Texas-Mexico border. While periodic visits to healthcare providers is supported by the medical community to avoid serious long-term health consequences, in a population with difficulty accessing healthcare many individuals only seek to access care when the care is perceived to be absolutely necessary; by extension periodic maintenance visits to healthcare providers are frequently underused. Objectives: The goal of the Laredo Healthcare Screening Trip was to see if how people felt about their own health correlated with an objective measure of their health status. Methods: A free healthcare event was performed in conjunction with Mercy Ministries of Laredo to offer screening services where an individua's BMI, blood pressure, blood glucose, and Cholesterol/lipid levels were checked and a survey was collected to see how healthy the reporting population perceived they were, how long it had been since their last doctor’'D5s visit, and what were some of the barriers to healthcare experienced by the Laredo community. Basic healthcare counseling was provided. A data analysis was performed; the measured screening-test results were used to assign an objective standardized health score to each individual and the objective health score was then compared with each individual's self-reported health score. Results: Health data and surveys were collected from 72 individuals. In the reporting population it was found that the correlation was weak between how healthy people thought they were and how healthy they actually were based on the standardized health score. Conclusion: These results speak to the necessity of periodic check-ups for health maintenance; qualitative opinions need to be checked with empirical methods to assess patient health status and avoid long-term complications. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 28 Diving Deep Into Community

Clinical Service

Medication Review from a Pop-Up Clinic in Gulu, Uganda: How to Prepare a Pharmacy in a Resource Limited Environment

Project Disciplines: Medicine Primary Presenter: Andrew Jeffery Other Student Team Members: Avery Kester, Jeremiah Gress, Averi White, Travis Bishop, Chidimma Amuneke- Nze, Jaclyn Boozalis, Prem Menon Mentor: Jordan Abel, MD Community Partner: WEND Africa Project Location: Gulu, Uganda

Background: The UTHSA Long School of Medicine Kisoboka Uganda global health team, composed of eight medical students and one physician, implemented a health clinic for the workers and families of WEND Africa, a nonprofit that provides work and support to war-affected mothers in Northern Uganda. We set up a clinic pharmacy by purchasing medications at local pharmacies. We examined the medications dispensed and patient complaints to review the best ways to address treatment needs. Methods: The medications purchased in advance were determined based on subjective observations offered by team members who previously participated in the WEND Clinic. These medications predicted patient complaints such as chronic pain, fungal infections, bacterial infections, allergies, hypertension and acid-reflux. Dispensed medications were tracked on an excel spreadsheet during clinic. Patient complaints and treatment plans were recorded on paper charts and retrospectively abstracted into excel and analyzed. Results: The WEND Clinic served 61 patients and gave 135 prescriptions over two days. The most common complaints were abdominal pain (18), headaches (15), allergies (14), joint pain (10) and cough (10). Patients were most frequently dispensed paracetamol (32), albendazole (23), cetirizine (20), griseofulvin (7), and omeprazole (5). We were unable to accommodate the following treatment plans based on inventory in Gulu: diphenhydramine (2), melatonin (2), saline drops (2), reading glasses (1) and walker (1). Additionally, local pharmacies had low supplies of nifedipine and metformin. Conclusion: In preparation for another clinic with this population, we plan to preemptively stock medications that were identified as scarce in Northern Uganda. Useful non-pharmaceutical items would include pamphlets on chronic pain exercises, reading glasses, and mobility equipment. In general, pop-up clinics would benefit from contacting community partners in advance to obtain common complaints for their population, drafting a medication inventory to address those complaints, and assessing the availability of those medications in country. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 29

Clinical Service

Patient Preferences of a Downtown San Antonio Primary Care Clinic

Project Disciplines: Medicine Primary Presenter: Julia Kirsten Other Student Team Members: Shane Bullock, Charles Huynh Mentor: Stuti Nagpal, MD Community Partner: University Health System: Robert B. Green Family Health Center Project Location: San Antonio, Texas

Background: UT Health's downtown clinic, Robert B. Green, is located in one of the poorest neighborhoods of San Antonio and serves a predominately Hispanic population. Many patients who visit this clinic do not speak any English at all. This vulnerable population is at risk for low health literacy (Sentell et al, 2012) and many disparities in health care (Vega et al, 2009). Objectives: The goal of this project was to identify this unique patient population's preference on how they receive lab results, what they want from their primary care provider, and to understand any differences in preferences between race, age, or gender. Methods: Two medical students handed out a total of 324 surveys (over the course of 10 visits) in both English (n=243) and Spanish (n=81) to patients over the age of 18 in the waiting area of the Robert B. Green Family Health Center. Out of 324 surveys, 234 people identified as Hispanic. Patients were only handed Spanish surveys if the patient couldn't speak, read or understand English. Results: Most people, regardless of race, want to see both abnormal and normal results compared to just abnormal results (p= 1.74075E-32). 68.4 % (n= 52) of the Spanish-only speakers reported that their physicians showed them both normal and abnormal results, which was similar to the English-speakers (68.2% n= 165). 15.7 % (n=12) of Spanish-only speakers and 11.2% (n=27) of the English-speakers reported that they didn't receive any results from their physicians. We also found that younger people (ages 18-50) prefer a more thorough physical exam compared to the elderly (51+) (p=0.02075). Conclusion: Physicians should take the time to go over every patient's labs, regardless of the result and/or any language barrier there may be. Physicians should also be aware that patient preferences differ by age, gender and race. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 30 Diving Deep Into Community

Clinical Service

The Effect of Mindfulness-based Interventions on the Wellness of Patients With Multiple Sclerosis

Project Disciplines: Medicine Primary Presenter: Natalie Dapas Other Student Team Members: Clark Gravell, John Philip Palmer, MD Mentor: Kristy Kosub, MD Community Partner: UT Medicine Medical Arts and Research Center (MARC) Project Location: San Antonio, Texas

Background: Multiple sclerosis (MS) is a debilitating neurologic disease that has chronic physical, mental, and emotional implications. Mindfulness-based interventions (MBI) [e.g. breath and body awareness] show potential benefits for MS patients (Simpson et al., 14-15). Offering MBI where MS patients receive medical care is necessary for access and increased patient awareness. Objectives: We investigated MS patient characteristics including baseline symptoms, functionality, well-being, and mindfulness awareness. We assessed effectiveness of MBI on improving chronic symptoms and quality of life. Methods: Patients completed Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) and Mindful Attention Awareness Scale (MAAS) upon enrollment and project completion, and one mindfulness practice engagement survey. Intervention group participated in MBI including hour-long classes of meditation, yoga, and journaling. Classes occurred at Medical Arts & Research Center for four consecutive Saturdays. At completion, intervention group wrote evaluations. Results: Intervention and control groups each had three women and two men, ages ranging 28-64 years (intervention) and 22-50 years (control). MAAS revealed higher mindfulness scores in intervention group. SF-36 demonstrated improved mental health and emotional role functioning in intervention group after MBI compared to control (p<0.01). Interestingly, there were significant baseline differences between groups (p<0.05). Results: Results suggest intervention group was more self-motivated to participate in our study. There was no statistical difference in perception of general health, bodily pain, physical and social role functioning between groups and within intervention group after MBI. Conclusion: We did not prove our hypothesis that 75% of intervention group will improve on all health measures, which may be due to small sample size and limited class length. MBI participants reported benefit from the shared experience, which supports the improved mental health measure. Challenges included participant communication and accommodation of individual schedules. MBI has potential as a complementary health benefit for UT Health patients with chronic disease. TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 31 Diving Deep Into Community

Education

A New Hope: Introducing Comprehensive, Non-Religious Sexual Education to a Christian Secondary School in Masaka, Uganda*

Project Disciplines: Medicine Primary Presenter: Jaclyn Boozalis Other Student Team Members: Andrew Jeffery, Avery Kester, Jeremiah Gress, Travis Bishop, Chidimma Amuneke-Nze, Averi White, Prem Menon Mentor: Jason Rosenfeld, MPH, DrPH(c) Community Partner: Hope Comprehensive High School and US2UGANDA4LIFE Project Location: Masaka, Uganda

Background: One quarter of Ugandan girls aged 15-19 have become pregnant. Adolescent pregnancies pose health challenges because teenage mothers are constrained in their future pursuit of education and have an increased likelihood of adverse pregnancy outcomes. During summer 2017, the Kisoboka student group from Long School of Medicine identified a need for sexual education at Hope Comprehensive High School in Masaka. In summer 2018, Hope School invited the team to introduce a sexua education curriculum. Objectives: Our goal was to improve student knowledge and attitudes toward sex, relationships, and contraception. Methods: We implemented an abstinence plus reproductive health education curriculum called Big Decisions, authored by Dr. Janet Realini, Founder and Former President of Healthy Futures of Texas (HFT). We trained 15 teachers and cofacilitated the curriculum to a pilot group of 30 students. We used written surveys to measure student demographics and knowledge/attitudes toward sex, relationships, sexually transmitted infections (STIs), and contraception before and after the program. Upon the pilot group's conclusion, the Kisoboka team met with Hope School administrators and created a timeline for the rest of the schools' 300 students to complete the program during the 2018-2019 school year. Results: Thirty surveys were collected. Chi-squared tests show that the percentage of correct responses on the knowledge questions improved significantly from pre to post-survey. The proportion of students who held positive attitudes toward suggesting condom use to a partner increased. Students who reported that the most suitable method of contraception for young people is abstinence increased from 40.0% to 72.4%. Conclusion: Uganda recently lifted a parliamentary ban on sexual education beyond abstinence only; therefore, successful implementation of a secular, comprehensive sexual education curriculum is a significant milestone. Myths on contraceptive education and condoms were significantly debunked. The biggest challenge for the project will be monitoring its sustainability now that we have left Uganda.

*Blue Ribbon Winner 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 32 Diving Deep Into Community

Education

A Sustainable Approach to Skin Cancer Education, Prevention and Management in a High-Risk Homeless Population

Project Disciplines: Medicine Primary Presenter: Tommy Pham Other Student Team Members: Jordan Garcia, Daniel Anderson, Giselle Castillo, Cameron Holmes, Mitch Parma, Kavina Patel, Erin Pickard, Tracey Vuong Mentor: Richard Usatine, MD Community Partner: Haven for Hope Project Location: San Antonio, Texas

Background: Haven for Hope is a nonprofit transformative campus in San Antonio offering housing, food, and transformational services to over 1,300 persons experiencing homelessness. Data shows persons experiencing homelessness spend more time outside and have above average UV exposure, increasing their risk for skin cancer. Objectives: The purpose of this intervention was twofold: 1) to screen and treat Haven for Hope residents for active precancerous and cancerous skin lesions to reduce cancer morbidity and mortality, and 2) to host educational seminars to increase awareness of skin cancer factors and encourage preventative measures. Methods: After taking a pre-survey, residents attended an educational seminar designed around the "slip, slop, slap" method and the ABCDEs of skin cancer. A post-survey was then administered, followed by a rapid skin cancer screening with suspicious lesions referred for free evaluation and treatment. Residents were provided with sunscreen, sunglasses, and hats for tangible methods to reduce their risk UV exposure. Results: 9 of the 10 behavior modification questions demonstrated significant increase in knowledge (p-value < .003). 12 of 274 patients were referred for evaluation. 5 biopsies were performed. 7 patients were diagnosed with actinic keratosis, a precancerous lesion, and treated. Conclusion: This project is designed to serve as a framework for how student run free clinics can sustainably provide skin cancer prevention and screening services to at-risk populations. This model takes advantage of pre-existing clinic infrastructure, and leverages a way to identify and integrate at-risk populations into health care. We aimed to increase early detection of skin cancer and decrease morbidity and mortality in San Antonio's homeless population, increase compliance in behaviors that reduce UV exposure, and increase awareness of the clinic and its services. Thereby, increasing access to healthcare in a vulnerable population. Our results highlight a need for skin cancer education and screening interventions in persons experiencing homelessness. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 33

Education

Addressing Maternal Mortality through Education at the Mommies Program

Project Disciplines: Medicine Primary Presenter: Emily Sendukas Other Student Team Members: William Manning, Nicholas Stansbury, Emily Sherry, Callie Tunnell, Olivia Gensheimer, Johnnie McElroy, Deandra Gonzalez, Audrey Phan Mentor: Ometeotl Acosta, MD, FACOG Community Partner: The Mommies Program - University Hospital System and Center for Health Care Services Project Location: San Antonio, Texas

Background: Drug overdose was the second leading cause of maternal death in Texas between 2011 and 2012 with the majority of maternal overdose involving opioids. The Center for Health Care Services of San Antonio operates a methadone clinic treating those with Opioid Use Disorder (OUD). Pregnant patients with OUD are concurrently enrolled in The Mommies Program and receive prenatal care through University Health System (UHS). We aim to educate women about OUD in pregnancy and provide motivational incentives for sustained abstinence. Objectives: 1) Participants counseled at their prenatal visit will have an improved understanding of the effects of OUD on their pregnancy health 2) Participants will take action in the immediate future to achieve sustained abstinence from illicit opioid use. Methods: Medical students attend Mommies clinic at UHS to discuss methadone use in pregnancy, the health effects of OUD to mother and child, and review resources for sustained peripartum abstinence. Provide motivational incentives, including newborn supplies, for mitigation of stressors related to newborn care and education on caring for an infant. Assess measurable objectives with pre and post intervention surveys. Results: Of the participants (n = 9) surveyed, only 44% of participants felt they understood the effects of opioid use on their health and their fetus prior to the intervention. 66% of participants reported pregnancy made them more motivated to quit illicit drug use and 88% were very willing to stay sober after childbirth. Conclusion: Counseled participants were self-motivated to adhere to methadone treatment and remain abstinent from illicit opioid use in the postpartum period. They were also receptive to learning about the effects of opioid use and methadone on themselves and their newborn. Our greatest challenge was patient follow up in the postpartum period. In the future, we will aim to increase awareness of our project and the benefits of participation. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 34 Diving Deep Into Community

Education

Anaphylaxis, Asthma, and Allergy Awareness in Comal ISD

Project Disciplines: Medicine Primary Presenter: Anastasia Perez Other Student Team Members: Christiane Hennessee, Khady Diack Mentor: Edward Brooks, MD Community Partner: Comal Independent School District Project Location: San Antonio, Texas

Background: Many children attending public schools in the United States suffer from atopic conditions like asthma, allergic rhinitis, and anaphylactic reactions. Although school staff may be required to manage events during the school day (1), parent education is normally undertaken by physicians (2), who may not have time to give comprehensive education to parents about the potential interventions at home that would reduce their children's adverse events. Objectives: As a UT Health Community Service Learning Project, our aim was to increase awareness and provide resources to parents and community schools that could lead to better practices of parent-school communication and interventions at home that can decrease adverse events in schools. In an effort to support parents, school nursing staff, and teachers, a comprehensive presentation was created with the guidance of a certified Allergist-Immunologist and the Health Coordinator for Comal ISD. Methods: Comal ISD in South Texas was identified as an area of need based on rates of atopic illness and relatively limited resources (socioeconomic status, rural population). A presentation on anaphylaxis, asthma, and allergic rhinitis was given to members of Comal ISD’'D5s School Health Advisory Council (SHAC). Members were given a post-presentation survey. Results: Content of presentation, need for better communication between parents and schools, and expected outcome of presentation were components of the survey given to SHAC members. A 5 point system was used for every question and a "need scale" score was created from the averages of the responses of each individual. Post-presentation surveys resulted in a "need scale" score of 0.85/1.00, with 1.00 indicating highest need. Conclusion: The survey results concluded the content of the presentation we constructed increased specific knowledge of atopic disease risk reduction and prevention as well as confidence in ability to communicate important health conditions to school staff. Multiple presentations to parent and faculty groups are to follow. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 35

Education

Art Cart at The Lighthouse Charter School

Project Disciplines: Medicine Primary Presenter: Aaron Frolichstein Other Student Team Members: Hayley Cantway, Matteo Garofalo, Kajal Dalal, Olivia Lopez, Ewelina Migut, Bri Bal Mentor: Glen Medellin, MD Community Partner: Lighthouse Charter School Project Location: San Antonio, Texas

Background: Art Cart was conducted at the lighthouse Charter School, a local public charter school located in the cities west end. According to the Texas Academic Performance Report 2016- 2017 86.8% of students at Lighthouse Charter School were classified as Economically Disadvantaged and 60% were classified as atrisk. Objectives: Our goal was to implement a 5-week program at the Lighthouse Charter school where at-risk students would be exposed to art as a therapeutic tool, positive mentors, and retain the materials necessary to use art as an emotional outlet in the future. In addition, we hoped to immediately improve the mood and mental well-being of the students. Methods: Working with child-life therapists we developed a curriculum of five two-hour activities done weekly, designed to get students to express themselves artistically, think about their future, and develop relationships with their peers and mentors. We evaluated our programs effectiveness by administering a 17 question Likert scale survey at the end of every activity. We also will administer another survey one month after the end of the program to evaluate long term impact of the program. Results: According to our data (N=109) our program made an immediate impact upon the students, with 10 being the highest rating student responses averaged 9.52 on questions involving improvement of mood and an average of 9.73 on questions measuring small group dynamics. Long term impact survey will be administered in early January 2019. Conclusion: We concluded based upon our data and qualitative feedback that the students enrolled in the program benefitted from positive improvements in mood and were exposed to artistic opportunities they otherwise wouldn't have been able to. The small group format along with an older average student seemed to improve the program over the pilot run. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 36 Diving Deep Into Community

Education

Asian American Breast and Colorectal Cancer Screening Promotion in South Texas

Project Disciplines: Medicine, Nursing Primary Presenter: Rachel Zimmerman Other Student Team Members: Cindy Wu, Shinyeong Jeong, Christina Nguyen, Jay Jeon, Allyn Gatchalian, Thien Kim Thanh Lam Mentor: M. Danet Lapiz-Bluhm, PhD, RN, MSCI Community Partner: Aguman Capampangan of San Antonio (ACOSA) Project Location: Schertz and San Antonio, Texas

Background: Routine cancer screenings are associated with early cancer detection and improved prognosis. Among Asian Pacific Americans (APA), cancer has remained the leading cause of death. The incidence of colorectal cancer (CRC) and breast cancer (BC) has increased among APAs, which is associated with reduced screening rates compared to other populations. This project promoted cancer screening among APAs through our continued partnership with Aguman Capampangan of San Antonio at an annual Filipino Fiesta that draws APA and other minority populations around South Texas, as well as the Korean Grace Baptist Church. Objectives: This project determined the knowledge and attitudes of APAs towards BC and CRC screening and identified barriers for cancer screening as basis for cancer screening promotion among APAs. Methods: Participants (N=45) completed a pre-survey about their knowledge and attitudes towards breast and colorectal cancer screening. This was followed by an educational presentation using infographics depicting American Cancer Society guidelines to screening, as well as the benefits of routine cancer screening. Participants then rated their understanding of cancer screenings by completing a post-survey. Data were subsequently analyzed. Results: Most participants were APAs (75%), female (62%), and over the age of 35 (82%). Participants had increased understanding of cancer screening methods (CRC=31%; BC=9%), cancer screening timing (CRC=52%; BC=44%), and importance of early cancer detection (CRC=8.6%; BC=7.6%). They increased their intention to get cancer screening (CRC=10.2%; BC=10%) and to advocate for screening (CRC=7.2%; BC=7.6%). Conclusion: This project improved knowledge on breast and colorectal cancer screening among participants, which was associated with increased willingness to receive cancer screening and to advocate for appropriate screening to family members and friends. Whether this increase in knowledge and willingness to be screened eventually translates into actual screening behavior is yet to be determined. Further studies that consider the translation of knowledge to action need to be done. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 37

Education

Be Sun Safe: Protect Yourself from the Sun

Project Disciplines: Medicine Primary Presenter: Anisha Guda Mentor: Sandra Osswald, MD Community Partner: Rhodes Elementary School and Benjamin Franklin Elementary School Project Location: San Antonio, Texas

Background: One in five Americans will develop skin cancer in their lifetime but 80% of skin cancer is preventable. According to the World Health Organization, the majority of sun exposure occurs before the age of 18. Many schools in San Antonio are not educating students on this topic. Be Sun Safe is an innovative curriculum that addresses this problem by providing a short powerpoint presentation to students, teachers, and parents. Objectives: The goals of Be Sun Safe are to provide children, parents, and teachers in San Antonio with adequate knowledge to protect themselves from sun exposure and damage. Methods: A powerpoint presentation regarding sun damage and protection was created and evaluated by local educators. Two presentations were given to elementary school students, parents, and teachers at Rhodes Elementary and to Kindergarten, 3rd, and 5th grade students at Benjamin Franklin Elementary. 3rd and 5th graders at Benjamin Franklin Elementary School took a pre and posttest that assessed their knowledge on sun protection and whether they use sunscreen. Results: 66 students in 3rd grade and 55 students in 5th grade took the pre- and post-test. Both classes improved their score from the pre to the posttest. 3rd grade missed an average of 2.454 questions on the pretest and 2.121 questions on the posttest. 5th grade missed an average of 3.290 questions on the pretest and 1.210 questions on the posttest. Additionally, only 36% of 3rd grade and 16% of 5th grade claimed that they always use sunscreen. Conclusion: Students improved their knowledge regarding sun damage and protection by listening to the presentation. Moreover, many students are not using sunscreen to protect themselves from the sun. It is imperative that children, parents, and teachers continue to be educated in San Antonio so that the next generation can protect themselves from the sun. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 38 Diving Deep Into Community

Education

Breastfeeding Education and Support for Teenage Mothers: Assessing Curriculum Effectiveness

Project Disciplines: Medicine Primary Presenter: Alia Yaghi Other Student Team Members: Chelsea Mendonca, Amanda McDonald Mentor: Alice Gong, MD Community Partner: Seton Home Project Location: San Antonio, Texas

Background: BEST partnered with Seton Home to help provide breastfeeding education and support. Seton home houses pregnant or parenting teenage girls who have been removed from their families by CPS due to abuse and neglect. Many residents have an interest in breastfeeding but lack knowledge about the benefits of breast milk or struggle due to early painful experiences. Objectives: BEST aimed to equip new moms with the knowledge, skills, and tools to successfully breastfeed. Specific aims included educating moms about the benefits of breastfeeding for mothers and children; teaching moms how to breastfeed and pump; and providing resources to aid moms in overcoming common barriers. Methods: The BEST course consisted of 6 meetings held from September 2017 to February 2018. Handouts generated from WIC Partner Training videos were the primary resource and included benefits of breastfeeding; how to breastfeed, pump, and wean; and overcoming barriers. Other educational tools included breastfeeding dolls and supplies, crafts, and interactive discussions. Pre- and post-course surveys were administered at the September and February meetings respectively, evaluating knowledge about and attitudes toward breastfeeding. Results: Data collected from seven Seton Home residents suggests that current curriculum strategies are successful in building mothers' knowledge about breastfeeding. Mothers demonstrated increased understanding of general principles, such as how to breastfeed. Mothers also showed increased knowledge of specific learning points like the health benefits of breastfeeding. With regards to attitudes, data shows an increasing trend, representing greater beliefs in personal benefits of breastfeeding, benefits to child, and confidence in teaching others. Conclusion: The current curriculum that BEST members use to educate Seton Home mothers is successful in increasing mothers' knowledge of breastfeeding, as well as increasing positive attitudes toward breastfeeding. Study limitations include a lack of data on total BEST sessions attended by each mother. BEST leaders should continue refining the curriculum to address cohort-specific needs. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 39

Education

Breastfeeding Education and Support for Teen Moms

Project Disciplines: Medicine, Occupational Therapy Primary Presenter: Alia Hemeida Other Student Team Members: Mirka Trejo, Sarah Molina, Matt Phillips, Sarah Bevins Mentor: Ruth Berggren, MD, MACP Community Partner: Seton Home Project Location: San Antonio, Texas

Background: Seton Home, a facility located in San Antonio, Texas, serves pregnant teenagers that have been removed from their families by Child Protective Services due to abuse and neglect. Many of these mothers choose not to breastfeed due to their limited knowledge about how to breastfeed, the benefits of breastfeeding and science on how to overcome the barriers to breastfeeding. Objectives: The purpose of BEST was to instruct Seton Home residents on the health benefits of breastfeeding, the techniques to utilize and improve self-confidence. Additionally, BEST sought to increase the number of breastfeeding residents. Methods: Based on Womens, Infants, and Children (WIC) Breastfeeding Support, a breastfeeding training curriculum was developed and presented to residents of Seton Home in five one-hour sessions. The interactive curriculum has been proven efficacious by BEST leaders in previous years. Notably, the team this year consisted of both medical and occupational therapy students and a lactation nurse. In addition, approximately $1,600 in breastfeeding tools were given to residents in an effort to remove barriers. To assess changes made to the BEST program, a pre- and post- survey were conducted to measure baseline knowledge and changes in attitudes of neonatal care throughout the workshop. Results: A total of 20 residents were exposed to our curriculum. Participants who answered both surveys demonstrated general improvement in breastfeeding technique, baby cue interpretation, and future family planning, with 83% of responses indicating future plans of breastfeeding. Additionally, the girls verbalized their appreciation for the addition of Occupational Therapy students and commonly requested more frequent sessions. Conclusion: Residents felt BEST improved their understanding of the practice and benefits of breastfeeding as well as their ability to overcome barriers. Still, feedback and a high turnover rate at Seton Home suggest future organizations should consider hosting sessions more frequently than once a month. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 40 Diving Deep Into Community

Education

Can a Smartphone App Improve Health Insurance Literacy?

Project Disciplines: Medicine, Pharmacy, Physician Assistant Primary Presenter: Ana Diaz Other Student Team Members: Erica Giordano, Diana Olivares, Hannah Galvan, Ewelina Migut, Aparna Yarram, Maria Mosso, Chris Kvapil, Dioscar Delgado, Evelyn Oliva Mentor: Melanie Stone, MPH, MEd Community Partner: Bexar County Community Health Collaborative (BCCHC) Project Location: San Antonio, Texas

Background: SA Access (www.saaccess.com) is a free English/Spanish smartphone app developed to improve health insurance literacy and empower San Antonio community members to access and use health coverage plans. Health insurance literacy (HIL) affects one’'D5s ability to navigate the healthcare system and engage in self-care. San Antonio continues to rank poorly (76th of 82) in health literacy among the nation's largest cities. Access Care Texas (ACT), a community service learning organization at UT Health San Antonio, partnered with Bexar County Community Health Collaborative (BCCHC), to create SA Access as a novel way to approach this health literacy deficiency. Objectives: ACT is conducting a study within University Health System (UHS) to validate the effectiveness of SA Access and measure the impact of the app on the HIL of UHS patients. Methods: To evaluate the impact of the app, two research groups (an experimental group of patients trained on how to use the app and a control group of patients not trained on the app), each with a sample size of n=137, was created. Study participants are recruited from UHS ambulatory care and urgent care clinics. The validated surveys REALM-SF (Rapid Estimate of Adult Literacy in Medicine - Short Form) and HILM (Health Insurance Literacy Measure) are used to assess health literacy and HIL self-confidence levels. A one-month follow-up survey will assess outcomes on app usage, as well as HIL self-confidence. Results: Data collection is ongoing through February 28, 2019 and full analysis will be completed by April. Preliminary results will be shared at the 2019 CSL Conference. Conclusion: SA Access is an educational tool that can be widely disseminated to promote HIL in community and clinical settings. This study will yield data on whether the app improves HIL in a sustained way. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 41

Education

Correlation Between Nutritional Knowledge and Obesity in McAllen Texas to improve Frontera De Salud Counseling

Project Disciplines: Medicine Primary Presenter: Oluwadunsin Bakare Other Student Team Members: Jomari Guerrero Mentor: Glen Medellin, MD Community Partner: La Union del Pueblo Entero Project Location: McAllen, Texas

Background: Obesity is a risk factor for worsening health outcomes in numerous low socioeconomic communities around the United States. This is especially prevalent in the McAllen community as Hidalgo county has been listed as a "whole county MUA (medically underserved area)." Objectives: The purpose of this study is to investigate if there is a correlation between nutritional knowledge and obesity in the McAllen area. The goal is to determine if lack of proper nutritional knowledge is a contributing factor to obesity, measured using BMI, in the McAllen area in hopes of improving the counseling portion of our health screenings to focus on proper nutrition. Methods: Health screenings involving taking glucose, lipid, body mass index, and blood pressure measurements were conducted. During the screenings, patients were given a survey to assess their nutritional knowledge. Using the completed survey, the patients were stratified into a low nutrition score (LNS) and high nutrition score (HNS). The health screening was provided to a total of 200 McAllen community members with 51 surveys being completed. Results: For the LNS group (M = 32.78, SD = 7.77, N = 32) and the HNS group (M= 29.04, SD= 4.69, N = 11). Analysis of the data via a two-tailed test showed no significant difference between the BMI of the LNS and HNS group (P = 0.07). Furthermore, A linear regression between BMI values and nutrition score showed no correlation (R = 0.13). Conclusion: Frontera De Salud nutritional counseling focuses on proper nutritional knowledge, but results from this study indicate that a lack of nutritional knowledge is not a huge factor for obesity. Since obesity could be impacted by social determinants of health as well as exercise, we propose to add those components to the counseling. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 42 Diving Deep Into Community

Education

Don't Sugarcoat Diabetes (DSD): Outcomes of A Diabetes Awareness and Advocacy Program Among Texas High School Students

Project Disciplines: Dental, Medicine, Nursing Primary Presenter: Max Feng Other Student Team Members: Elisha Lalani, Nicholas Shaffer, Christiane Hennesse, Linnea Moran, Stephanie Tran Mentor: M. Danet Lapiz-Bluhm, PhD, RN, MSCI Community Partner: UT Health San Antonio Office of Recruitment and Science Outreach (ORSO) Project Location: San Antonio, Texas

Background: Diabetes is a preventable condition associated with significant morbidity and mortality. Minors can potentially play a significant role in diabetes prevention and advocacy in the community. Don’'D5t Sugarcoat Diabetes (DSD) is an interactive diabetes prevention-focused educational program designed to increase knowledge, prevention, and advocacy towards healthy lifestyles among South Texas high school students. Objectives: The DSD program aimed to increase knowledge of diabetes and its prevention, as well as encourage healthy lifestyles in high schoolers by improving their confidence in their ability to share their knowledge of diabetes with others. Among health professions students who volunteered to conduct the DSD program, it aimed to increase the confidence in their ability to communicate healthcare knowledge with the general population. Methods: South Texas high school students (n=167) completed the pre-program and postprogram surveys in Likert scale format which measured confidence and knowledge in diabetes and diabetes risk reduction and intended change in behavior and advocacy. Follow-up surveys are on-going. Student volunteers (n=15) completed a questionnaire measuring their confidence of diabetes knowledge and communicating this information as a team. All data was analyzed for differences. Results: The high school students showed a significant improvement in their confidence in diabetes knowledge, risk reduction, and ability to share diabetes knowledge with others (mean increase=57.5%), knowledge of diabetes and its risk reduction (mean increase=16.8%), and intent to adopt healthy lifestyle changes (mean increase=53.4%) after the program. Student volunteers showed significant improvement in their knowledge of diabetes (mean increase=20.9%) and confidence in communicating diabetes and healthcare information to patients (mean increase=31.6%). Conclusion: The DSD program significantly improved high school students' confidence and knowledge of diabetes and its risk reduction, as well as encouraging healthy lifestyle changes. It also improved student volunteers' confidence in their knowledge of diabetes and the ability to communicate diabetes information to high schoolers and patients 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 43

Education

Effect of Oral Health Campaign on Children of Refugees' Families

Project Disciplines: Dental, Public Health Primary Presenter: Murad Alrashdi Other Student Team Members: Samin Javanmardi, Ahmed Hamred Mentors: Maria Jose Cervantes Mendez, DDS, MS; Moshtagh Farokhi, DDS, MPH, FAGD Community Partner: Center for Refugee Services Project Location: San Antonio, Texas

Objectives: The purpose of this study was to assess the effectiveness of oral health campaign in improving oral health and related quality of life in children of refugee's family before and after the educational program. Methods: The study design was a longitudinal randomized clinical trial, where at baseline, children's oral health assessed by using WHO oral health assessment form (DMFT index), Michigan Oral Health-related Quality of Life Scale, and caregivers' knowledge, attitude, and behavior (KAB). Then, the participants were educated through hands-on demonstrations regarding their oral health. Right after the educational program, three months, and six months after, oral health and related quality of life, and KAB assessed using the same scale. Results: Of 66 families enrolled in the program, 52 (72%) completed the six-month follow up. In comparing case and control group, there were no significant different to child's oral health related quality of life pre- and six-month post educational program (P>.05). DMFT score didn't differ significantly between the families that had the educational program and the one who had not. However, knowledge and behavior has improved only in families with higher education and socio-economic status (P = 0.033) and (P =0.032), respectively. Conclusion: Six-month follow up of oral health campaign through education program is not effective in reducing caries risk, improving oral health related quality of life of children of refugee’'D5s families, or advancing oral health knowledge, attitude, and behavior of parent of refugees' children. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 44 Diving Deep Into Community

Education

Elementary Nutrition: Teach Back, Give Back

Project Disciplines: Medicine, Public Health Primary Presenter: Laura Zabalgoitia Other Student Team Members: Emily Sendukas Mentor: Kenneth Stone, MD Community Partner: Walzem Elementary School Project Location: San Antonio, Texas

Background: In the shadow of the childhood obesity epidemic, elementary school teachers as a population are largely overlooked as a target for nutritional education and health literacy interventions, despite obesity rates being more than twice the national average. As a collaboration with "Elementary Nutrition," "Elementary Nutrition: Teach Back, Give Back" will be a six-week nutrition and health literacy intervention for WES teachers and staff, taught by medical students. Objectives: The goals of this course are to 1) improve the nutritional knowledge basis of WES teachers and staff regarding the Mediterranean diet; 2) develop skills in basic food preparation and cooking, reading nutrition labels, and constructing nutritionally balanced meals and snacks; 3) foster self-efficacy to utilize knowledge and skill set. Methods: "Elementary Nutrition: Teach Back, Give Back" will utilize a pre-developed curriculum created by the Goldring Center for Culinary Medicine at Tulane University. A community needs assessment will be conducted prior to the intervention to inform adjustments, if needed. Pre-/post- Intervention assessments will survey for change in both knowledge and self-efficacy in cooking and nutrition gained during the course. A two-tailed, paired t-test will be used to assess whether a significant increase in knowledge basis and confidence is achieved. Results: None Conclusion: This curriculum will be intended to meet the health needs of the teachers directly, as well as stand as an instructional tool to help teachers learn how to share and instruct these concepts to their students. We hope to reflect the findings of previous studies, which suggest that nutrition-related professional development for teachers increases not only the likelihood of teaching nutrition to their students, but also the self-efficacy to do so. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 45

Education

Elevate Your Mood; Eat Good Food: Implementing Elementary Nutrition Education through the ESNACs Program

Project Disciplines: Medicine Primary Presenter: Meredith Furst Other Student Team Members: Jessica Mondshine, Chandler Morrow, Emily Sendukas, Abby Souryal, William Tang, Megan Thomson, Alexander Wellford Mentor: Kenneth Stone, MD Community Partner: Walzem Elementary School Project Location: San Antonio, Texas

Background: Despite Texas having the seventh highest obesity rate for ages 10 to 17 in the nation, nutrition education is not emphasized in elementary schools. After the success of the Elementary Nutrition program, the Elementary School Nutrition and Activity Club (ESNAC) was created to address the issue of childhood obesity by utilizing an after school club to teach a curriculum emphasizing nutrition and exercise. For the 2018 year, ESNAC expanded to include an additional elementary school in San Antonio (Regency Place Elementary) while still improving the nutritional knowledge of participating students at Walzem Elementary. Objectives: ESNAC participants will have increased nutritional knowledge as measured by an improvement in pre and post surveys and weekly food frequency logs. The participants will incorporate more exercise and nutritious foods into their daily habits outside of school as measured by a post-intervention survey. Methods: Five medical students visited two different elementary school fourth and fifth grade classes. The medical students led a short exercise, followed by a discussion on good health practices and an interactive lesson on making healthy snacks. Surveys were administered to assess baseline nutritional competency and eating habits. In addition, a "Food Frequency" worksheet was provided each week to evaluate recent changes in food choices. Results: For the students that were present for the first and last week, there was an average improvement of 22.91% as measured by the Food Frequency worksheet (SD = 27.61%), which proved to be a significant increase (p = 0.015). Conclusion: Our results suggest the ESNAC curriculum can be successful in improving nutritional knowledge and habits in an elementary-aged population. Our findings may be used to support larger efforts to increase the education of nutrition at younger ages, decreasing the risk of childhood obesity and the development of future, chronic medical conditions. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 46 Diving Deep Into Community

Education

Evaluating an Over-the-Counter Model for Contraception in a San Antonio STD Clinic

Project Disciplines: Medicine Primary Presenter: Jennifer Nordhauser Other Student Team Members: Avery Kester (MS2), Danielle Ellis (MS2) Mentor: Ometeotl Acosta, MD Community Partner: San Antonio Metropolitan Health District (SAMHD) Project Location: San Antonio, Texas

Background: Over 54% of pregnancies in Texas in 2010 were reported as unplanned. In 2014, Texas reported 97,695 chlamydia diagnoses, 17,962 gonorrhea diagnoses, 1,808 syphilis diagnoses, and 773 HIV diagnoses among the female population. Increased access to effective contraception for women with sexually transmitted infections (STIs) may prevent unintended, high-risk pregnancies. Providing contraception education and administering free progestin-only hormonal pills (POPs), which have few contraindications, lower cost than other contraceptives, and can easily be discontinued without adverse effects, to uninsured female patients at the San Antonio MetroHealth STD Clinic. POPs are also the form of medical contraception closest to over the counter status (OTC). We are emulating this OTC model through the STD clinic to compare to provider-based administration of POPs, which is currently required in Texas. Objectives: This pilot project aims to address the need for contraception and decrease perceived barriers to acquiring contraception: namely cost and provider access. We will measure the pregnancy rate, POP discontinuation rate, attitudes toward POPs, and sexual health knowledge. Methods: This cohort study emulates an OTC model through the MetroHealth STD Clinic in San Antonio, Texas. 200 non-pregnant, uninsured women who present for STD treatment will be recruited, consented and followed for twelve months through REDCAP. At enrollment, subjects will receive contraception education and a three- month supply of POPs. At each follow up, subjects will take a pregnancy test, receive another three-month supply of POPs and take a survey to assess retention of educational content, POP adherence and attitudes toward POPs. Results: Currently under IRB review. Surveys and education materials have been developed. CSL grant received to fund supplies. Conclusion: After one year of enrollment, our goal is a lower rate of pregnancies than the Texas unintended pregnancy rate of 54%, and a lower rate of POP discontinuation than the national rate of 56.7%. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 47

Education

Healthy Children, Healthy Citizens: Assessing the Effectiveness of Promoting Healthy Habits Amongst 4th and 5th Graders

Project Disciplines: Medicine, Nursing Primary Presenter: Samuel Wang Other Student Team Members: Blake Brandon, Sergio Gomez Mentor: Laura Sisk, DNP, RN Community Partner: Castroville Elementary Project Location: Castroville, Texas

Background: Castroville Elementary is a Title One school located in a rural south Texas community. As part of a medically underserved area, there is a great need for health education at an early age. The school has previously expressed the desire for outreach to promote and instill healthy habits based on the needs of the students. Objectives: The purpose of the Healthy Children, Healthy Citizens project is to teach lessons on personal health and wellness to 4th and 5th graders at Castroville Elementary. Nursing and medical students developed a curriculum that incorporated PowerPoint presentations and interactive activities focusing on health literacy and health promotion. Methods: Three one-hour workshops have been held at Castroville Elementary, each discussing a different health topic: hand hygiene, sun safety, and flu/cold prevention. Knowledge assessments were administered before and after each lesson to evaluate the efficacy of these sessions. The hand-washing lesson was given to the entire grade, while the other two lessons were taught to select classes during their computer time. Additional topics will be presented during the spring semester. Results: Based on results from the knowledge assessments, students demonstrated improvement of understanding after all the lessons. However, varying degrees of improvement were seen between lessons (Hand Hygiene - 5.31% increase, Flu/Cold Prevention - 3.95% increase), with the most marked improvement being from the Sun Safety lesson (43.54% increase). Conclusion: The lessons were well-received by students, and they showed motivation in improving in the areas discussed. They were further encouraged to practice these health behaviors at home by providing homework assignments and tangible resources (such as sunscreen and hand sanitizer) after each lesson. Since there are few evidence-based health literacy assessment tools for children, we developed our own assessments; therefore, there are some limitations in evaluating outcomes. Nevertheless, continuing to teach healthy habits early is important for a healthier community. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 48 Diving Deep Into Community

Education

Healthy Moms and Babies Equal Happy Moms and Babies

Project Disciplines: Medicine, Nursing Primary Presenter: Jennifer Kim Other Student Team Members: Dawn Janysek, Rebecca Omorodion, Ana Ojeda-Prias, Maria Hernandez Mentor: Laura Sisk, DNP, RN Community Partner: Healy Murphy Center Project Location: San Antonio, Texas

Background: The Healy Murphy Center is a non-profit organization aiming to educate at-risk youth of San Antonio. For the past several years, the UTHSCSA School of Nursing has taught a parenting course to mothers at the center, addressing maternal-newborn skills. Students in the class displayed concerns about substance use, and based on data collected in 2017 by the school's nurse, 33% of all students at the center abuse substances. Therefore, we decided to extend a lecture over substance abuse to the whole school. Objectives: The goal of this project is to educate teenagers and expecting mothers about the dangers of substance abuse and to stimulate a change in attitude about those substances. Methods: A workshop about the health effects of marijuana, tobacco, alcohol and opioids was presented to 64 freshmen and sophomore students, 13 of which were also enrolled in the parenting class. Pre-surveys were given at the time of the session and post-surveys were administered 30 days after. Students were also given brochures at the end of the presentation to summarize important points discussed. Results: Based on pre-survey data, marijuana was found to be the most widely-used substance amongst this population, with 76.56% admitting ever using it. Based on post-survey data, a large proportion of students reported being less likely to use all four of the substances. Additionally, we noted that of the 13 students from the parenting class in attendance, 31% of them reported ever using opioids; however, this population displayed less knowledge about the harmful effects of opioids compared to the rest of the students in attendance. Conclusion: Based on the results above, more emphasis should be placed on educating students in the parenting class about the dangers of opioid abuse. Given the widespread use of marijuana, additional efforts should be pursued to educate the students about its risks and harmful effects. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 49 Diving Deep Into Community

Education

Healthy Skin for Everyone: Evaluating Educational Impact on Individuals Experiencing Homelessness

Project Disciplines: Medicine Primary Presenter: Giselle Castillo Other Student Team Members: Kavina Patel, Farhan Ahmad Mentor: John Browning, MD Community Partner: Travis Park United Methodist Church Project Location: San Antonio, Texas

Background: About one in five Americans will develop skin cancer, with higher rates among the homeless, indigent, and uninsured population. "Healthy Skin for Everyone" is based at Corazon Clinic, a clinic that provides free access to primary medical care to those experiencing homelessness in San Antonio. The clinic is located at the Travis Park United Methodist Church and operates every Sunday morning. A needs assessment was performed at the clinic identifying gaps in knowledge regarding skin cancer and sun protection and unveiled the need for patient education. Objectives: The objectives included weekly bilingual education sessions on skin cancer, specifically melanoma, to local homeless individuals and raising awareness about the free dermatology clinic located at the church. Methods: The results of the needs assessment were used to create a bilingual educational session and pre and post survey questions. The educational session targeted risk factors of melanoma skin cancer, prevention, and recognition of its signs and symptoms. Each participant was asked to fill out a pre-survey before taking part of the session and filled out a post survey to assess what knowledge was retained from the experience. Each participant was also given a cap and sunscreen to practice proper sun protection. Results: The needs assessment revealed that only 18% of individuals were confident in their ability to identify skin cancer and 39% of individuals believed that people with darker skin don’'t have to wear sunscreen to protect themselves. Following the session, correctly identifying melanoma increased by 40%, correctly identifying risk factors increased 19%, and 59% of people identified themselves as having an average to higher than average risk of developing melanoma, compared to only 20% before. Conclusion: Our project successfully increased the participants' baseline knowledge of melanoma. Future efforts include expanding the project to reach more participants and continuing to increase awareness about the local dermatology clinic. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 50 Diving Deep Into Community

Education

HELP for Better Health, 2018-2019: Use of Small Group Discussions and Interactive Learning in Health Literacy Curriculum

Project Disciplines: Medicine, Occupational Therapy Primary Presenter: Maricarmen Romero-Mondragon Other Student Team Members: Maricarmen Romero-Mondragon, Anita Rahim, Fatima Dollar, Margaret Upchurch, Blake Brandon, Brady Burks Mentor: Melanie Stone, MPH, MEd Community Partner: Providence Place Project Location: San Antonio, Texas

Background: Learning personal hygiene skills, nutritional values, and the importance of self care are essential to living independently. For individuals with intellectual disabilities, these skills can be confusing and easily neglected. The Health Education and Literacy Program (HELP), a community service learning project at UT Health San Antonio, has been partnering with Providence Place since 2012 to teach health education and health literacy to their young adult clients with disabilities. Objectives: The goal of HELP is to promote independence and quality of life for the participants by increasing their knowledge of health-related topics and their adoption of healthy lifestyle choices. Methods: The HELP curriculum includes nutrition, personal hygiene, and life skills. Lessons are taught utilizing small groups and interactive activities. The efficacy of this curriculum was evaluated using both self-developed assessments and the validated health literacy assessment The Newest Vital Sign (NVS). Knowledge retention and changes in health-related behaviors (nutrition, hygiene, and overall health literacy) were evaluated through pre/post tests. Results: The nutrition assessment average increased from 2.25 (pre-assessment score) to 3.125 (post assessment score). The NVS assessment average score increased from 2.5 (pre-curriculum) to 3.125 (post curriculum). Post-test results of this health literacy assessment showed an increase in scores, but the participants' overall health literacy still remained in the category of possibility of limited literacy. Post-test results for the hygiene unit are pending and further data will be taken mid January through a focus group. Conclusion: Majority of participants showed an increase in knowledge and ability to make better lifestyle choices. However, there still seems to be a lack of understanding on why certain life choices are healthier than others. Improving the understanding of health-related issues, while overcoming the intellectual barriers that the Providence Place participants have, are future directions for the HELP program. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 51

Education

Mental Health First Aid Training Increases Capacity to Handle Mental Health Crises

Project Disciplines: Pharmacy Primary Presenter: David Giang Other Student Team Members: Alyeshka Jusino-Acosta, Hannah Mucha, Taylor Patek, Sarvnaz Sadrameli, Alex Yap Mentor: Stephen Saklad, Pharm.D, BCPP Community Partner: Mental Health First Aid USA Project Location: San Antonio, Texas

Background: Mental Health First Aid (MHFA) training not only provides education but also provides techniques to identify and address a potential mental health crisis. Studies show that training reduced the stigma surrounding mental illnesses; therefore, we identified the need for training students and trained healthcare providers from all fields. Objectives: We aim to improve the knowledge and comfort level of attendees with patients experiencing a mental health crisis. We have an ongoing follow-up system to track mental health interventions and how many referrals were made to mental health services at UT Austin, UTHSA, and in the wider community. Methods: An eight-hour MHFA training was held in October of 2018 for interested participants in San Antonio, Texas. Each participant received a pre- and postsurvey in order to measure their knowledge, confidence, and perception of mental illness at baseline and post-training. Individuals will be surveyed six months after completion and were asked to report any interventions made. Results: Fourteen individuals were trained from various health professional fields. Thirteen pre- surveys, nine post-surveys, and one intervention report were collected. Before training, participants felt that it was important to be trained in MHFA with an average score of 9 out of 10. They also were only partially confident in their ability to offer aid during a mental health crisis with an average score of 5.8 out of 10. After training, attendees found the MHFA training beneficial with an average score of 8.8 out of 10 as well as one report of intervention for a patient with depression. Conclusion: Participants appreciated the training and requested another session focusing on the adolescent population. A major challenge is getting participants due to the eight-hour time commitment. Additional MHFA trainings plan to be held for other disciplines such as students of medicine, dentistry, and more to further raise awareness of the importance of MHFA. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 52 Diving Deep Into Community

Education

Naloxone Training for the Student-Faculty Collaborative Practice at UT Health San Antonio

Project Disciplines: Medicine, Nursing, Pharmacy Primary Presenter: Cameron Holmes Other Student Team Members: Tracey Vuong, Delaney Rawson Mentor: Richard Usatine, MD Community Partner: Operation Naloxone Project Location: San Antonio, Texas

Background: Since 1990, the number of Americans who have died ever year from drug overdoses has escalated by more than 650 percent (1). In 2015, Bexar county saw over 108 deaths from opioid overdoses, one of the highest rates in the state of Texas. Naloxone is a competitive opiate antagonist that can treat opioid overdose and decrease the likelihood of death. Objectives: The goal is to ensure that every healthcare provider and every interdisciplinary student volunteer that is serving at any of the 6 Student-Faculty Collaborative Practice (SFCP) clinics is trained on how to respond to a possible opioid overdose. Trainings will include education on opioids, national overdose trends, naloxone access laws, how to identify an opioid overdose, and how to administer naloxone. Methods: After providing separate trainings for the student leaders of the SFCP, student volunteers, and residents at Alpha Home, a transitional facility for women recovering from substance abuse, we assessed the efficacy of the trainings using pre and post surveys collected by all participants. The survey collected data on opioid knowledge, self-assessment of naloxone administration, and the attitude of opioid overdoses and naloxone utilizing multiple choice answers. Results: A total of 76 people were trained at three separate trainings. On average, participant knowledge increased 13.67%. Participant self-efficacy increased by an average 1.44 points (28.87%). Participant attitude increased an average 0.42 points (8.45%). Participants at all three trainings seemed very interested in the trainings. Conclusion: There was an average increase amongst all participants in knowledge, self-efficacy, and attitudes. We are continuing to provide trainings to the women at Alpha Home because of interest. We are also training the upcoming SFCP leadership team to continue the Naloxone trainings for future student volunteers, leaders and attendings. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 53

Education

Operation Naloxone: Interprofessional Overdose Prevention Service Learning Expanded

Project Disciplines: Medicine, Nursing, Pharmacy Primary Presenter: Kimberly Nguyen Other Student Team Members: Lindsey Groff, Robert Moton, Israel Rodriguez Mentor: Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS Community Partner: Operation Naloxone, La Hacienda Treatment Center, Medina County Sheriff's Office, Lytle Volunteer Fire Department Project Location: Hunt, Hondo and Lytle, Texas

Background: Opioid overdose is the fastest growing cause of death in the United States. Operation Naloxone is an overdose prevention program in which students are trained to lead community trainings regarding opioid overdose response, including the proper use of the opioid reversal agent naloxone, and to increase access to naloxone within the community. Objectives: The goals of this project were to: (1) conduct a train-the-trainer session open to all University of Texas Health San Antonio (UTHSA) students; (2) provide trainings and naloxone supply for vulnerable populations outside of Bexar County; and (3) assess training efficacy. Methods: UT Austin College of Pharmacy faculty led a training for UTHSA students. Trained students led three interprofessional overdose prevention trainings for drug rehab center staff, firefighters, and police in rural counties surrounding Bexar County. Naloxone was also provided. Pre- and posttraining surveys were administered to attendees to evaluate the impact on knowledge, self-efficacy and attitudes regarding naloxone use and the interprofessional learning experience (students only). Results: Thirteen UTHSA students were trained to provide naloxone education. Student-led trainings reached 46 community members including police officers, fire fighters, nurses, EMTs and social workers. Results displayed a significant increase in knowledge [(median (IQR)) 37.5% (37.5-62.5) vs. 62.5% (50%-75%), p<0.0001], selfefficacy (median 3.5 (3-4) vs. 4.75 (4-5), p<0.0001) and attitude on harm reduction scores (3.1 (2.7-4.25) vs. 4 (3.5-5), p<0.0001). Seventy-two doses of naloxone were distributed to the sites being trained. Conclusion: UTHSA students were trained to provide opioid education and subsequently led trainings for community members likely to work with vulnerable populations (rehab staff, police, and firefighters) for rural counties surrounding Bexar County. The results of this study indicate that this train-the-trainer approach to opioid overdose education was valuable for the community and participating healthcare students. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 54 Diving Deep Into Community

Education

Oral Care Skills for Dementia Care Workforce

Project Disciplines: Dental, Public Health Primary Presenter: Ola Ukaoma Other Student Team Members: Olivia Britton, Elio Male, Kristina Orquiz Mentor: Carolyn Pickering, PhD, RN Community Partner: San Antonio Alzheimer's Association Project Location: San Antonio, Texas

Background: Oral health is an integral part of successful aging with the control of oral disease improving the overall health of older adults. Frontline geriatric providers, such as nurses and social workers, can help achieve these positive oral health outcomes. As such, the goal of this project is to describe the level of knowledge and confidence in skills on how to provide oral care to older adults and those with dementia among a sample of geriatric nurses and social workers and identify methods of improvement through evidence-based trainings. Objectives: (1) understand the importance of adequate oral care, (2) recognize oral health products available, (3) demonstrate techniques for cleaning teeth and dentures including managing behavioral symptoms and modifying for function of the client, and (4) recognize when to seek help from a professional dental care provider. Methods: First, a survey assessing level of confidence with providing oral care was completed by N=59 geriatric nurses and social workers. Then, the training was delivered through interactive discussions and hands-on demonstrations of proper brushing technique, use of products, and signs of disease. Following the training, a follow-up survey was administered to all participants to evaluate the intervention in improving knowledge and confidence with oral care skills. Results: The skills training evaluation surveys showed geriatric nurses and social workers increased their knowledge of oral care and recognition of available oral health products. As a group, the geriatric nurses and social workers demonstrated an increased understanding of denture care. Conclusion: This preliminary oral health skills training offered an opportunity to meet the needs of both geriatric nurses and social workers as well as those they care for by providing hands-on skills training to promote proper oral health. Feedback provided during this pilot will inform intervention refinement and future trials. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 55

Education

SA Access: An Interactive Health Insurance Literacy Toolkit

Project Disciplines: Medicine, Physician Assistant Primary Presenter: Ewelina Migut Other Student Team Members: Aparna Yarram, Ana Diaz Mentor: Melanie Stone, MPH, MEd Community Partner: Bexar County Community Health Collaborative Project Location: San Antonio, Texas

Background: Access Care Texas (ACT) is a community service learning project at UT Health San Antonio aimed at improving health insurance literacy in South Texas. ACT identified barriers to health literacy and recognized the growing prevalence of smartphones as an opportunity to overcome these barriers. In collaboration with The Bexar County Community Health Collaborative, ACT developed SA Access, a mobile application (app) designed to facilitate health insurance enrollment and effective use of health insurance. SA Access presents health insurance information in a visually appealing and easily navigable format by incorporating interactive features and limiting text-based explanations and jargon. Objectives: Increase awareness of the SA Access app by holding free train-the-trainer sessions for health care workers. Evaluate participants' perceptions of SA Access as an educational tool posttraining. Methods: Surveys are administered at the end of each SA Access train-thetrainer session to assess the participants' perceptions of the app and its potential value in their health care practices. Results: Of the 38 health care workers who completed the post-training survey, 97% said they will recommend SA Access to others; 78% agreed or strongly agreed they will use the app in the future and that the app will impact their practices. Conclusion: Based on the positive results from train-the trainer sessions, SA Access is a potential tool to be used widely by health care professionals and community members in order to increase health insurance literacy. Future direction include wider dissemination and marketing of the app, including hosting additional train-the-trainer sessions for health care workers. ACT will also implement revised post-exposure surveys to assess the impact of the app in healthcare practices over time. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 56 Diving Deep Into Community

Education

SAMMinistries Health Fair, Screening, and Health Education

Project Disciplines: Dental, Medicine, Nursing, Pharmacy, Optometry Primary Presenter: Mitchell Parma Other Student Team Members: Cameron Holmes, Veronica Phenix, Lindsey Stephens, Michelle Tran, Taylor Patek, Brandon Key, Mahmoud Irannezhad Mentor: Joy Emko, MD Community Partner: SAMMinistries Transitional Living and Learning Center Project Location: San Antonio, Texas

Background: The SAMM Transitional Living and Learning Center (TLLC) provides housing, support, and resources to families experiencing homelessness in San Antonio who show a commitment to gaining self-sufficiency. Working with this population is of utmost importance as it intervenes in a vulnerable population that lacks proper medical and social resources. Objectives: The goals are to provide an interdisciplinary health screening for the residents at SAMM to identify those in need of further medical intervention and to collect health data to implement an education curriculum. Furthermore, we want to increase health literacy and encourage healthier lifestyles through the education curriculum. Methods: We had a health fair for 41 residents and collected 23 adult screening forms to determine what medical problems were most prevalent amongst this community and what medical problems were of interest to the community. From this data, we chose 5 topics to discuss at separate education classes: smoking cessation, vaccinations, dental health, mental health, and heart health. An interdisciplinary education curriculum was created and the residents' health literacy improvement was measured by pre and post surveys. Results: Of the five classes taught, four showed marked improvement in health literacy. The dental health class showed a 6% average increase in the total score (n=6), the smoking cessation showed an 11.6% average increase (n=5), and the heart health class showed a 19% average increase (n=5). The mental health class utilized a different scale and showed a 30% average increase in participant knowledge of mental health (n=6). Conclusion: The screening helped identify residents in need of follow up for the medical, dental, and optometry care. It also helped give the faculty and social workers at SAMM an overarching snapshot on the residents' health status. The interventional education classes revealed a curriculum that helped markedly increase health literacy over a range of health topics. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 57

Education

The Impact of Income and Lifestyle on Diabetes Outcomes: A San Antonio Study

Project Disciplines: Medicine Primary Presenter: Edward Visnaw Mentor: Inez Cruz, PhD, LMSW Community Partner: Medical Arts & Research Center (MARC) Project Location: San Antonio, Texas

Background: Patient outcomes in diabetes mellitus care are an invaluable topic in the medical community. This study explores the relationship in our community between the social determinants of health of living situations and income security and diabetes management regarding diabetes quality of life and diabetes distress in terms of burden. The goal of this study is to determine San Antonio's social determinants of health that impact diabetic patient outcomes, in order to better target and direct care, especially in a community where diabetes is so prevalent and management is so important. Objectives: (1) Measure the correlation among income and living situations with diabetes management, distress, and quality of life in San Antonio. (2) Determine the most clinically significant social determinants of health and adverse diabetic outcomes in San Antonio. Methods: Research is conducted at a family medicine clinic in San Antonio, Texas. The subjects of the study are patients at least 18 years old with type I or II diabetes. The 69-item patient survey measures social determinants of health, diabetes quality of life, and diabetes distress related to diabetes management. Results: This project is expected to: (1) Specifically determine the scope of how different levels of income security and living situations impact diabetic patient outcomes in the community. (2) Help to better train future healthcare professionals, including medical students, residents, physicians, and all other faculty and staff. Conclusion: The patient survey is inherently subject to response bias. Sometimes during the survey, the patients feel the need to tell us "what we want to hear." It was stressed that their responses would not affect their healthcare decisions or relationship with the physicians. Although this challenge was accounted for, there seems to be a continued need to emphasize to patients that their healthcare is always unbiased and equal, which is something that can be improved. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 58 Diving Deep Into Community

Education

Understanding the Impacts of Socioeconomic and Psychosocial Factors on Diabetes Management

Project Disciplines: Medicine Primary Presenter: My Hanh Nguyen Mentor: Inez Cruz, PhD, LMSW Community Partner: The Residency Research Network Project Location: San Antonio, Texas

Background: Diabetes is a growing epidemic and a chronic illness with significant long-term health complications. Previously manifested in the elderly, but with the increase in the prevalence of type 2 diabetes in younger adults, more people are having to manage these complications earlier. This project is a cross-sectional, questionnaire based study carried out at various primary healthcare clinics across Texas. Objectives: The study aims to determine the associations of social determinants of health, particularly the socioeconomic and psychosocial factors, on the development of long term complications such as chronic kidney disease, myocardial infarctions, limb amputations, and dialysis. The level of socioeconomic factors and psychosocial factors are determine based on proxy questions surveying social connectedness, social support, income and education; and diabetes self-care and level of diabetes distress, respectively. Additionally, to determine the associations between the management of Hb1ac and these various factors. Methods: Respondents will be 18 years or older living with type 2 diabetes who present for a routine visit during the summer of 2018. The questionnaire are administered by medical students with help from local physicians. No intervention implemented. Results: There is no significant difference among the socioeconomic and psychosocial factors between patients who develop diabetes complications and those who did not, (p-value >0.05). There is a positive association between social support and control of Hba1c (pvalue 0.04 <0.05). People with higher self-care and lower level of diabetes distress have better control of their Hba1c (p-value ~0 <0.05). Conclusion: Some of the data had to be excluded from the analysis due to incomplete responses, which lowers the sample size, particularly when analyzing the development of complications. I learned how to use statistics to analyze data and derive at conclusions. More research is needed to explore the psychosocial factors in order to develop interventions for better Hba1c control. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 59

Education

UT Health and Elementary Nutrition "A Great Pear" for Tackling Childhood Obesity

Project Disciplines: Medicine Primary Presenter: Jordan Barton-Garcia Other Student Team Members: Nathanael Franks, Luke Lehman, Olivia Lopez, Ana Ojeda Prias, Margaret Upchurch, Maria Leon-Camarena, Emily Sendukas, Laura Zabalgoitia Mentor: Kenneth Stone, MD Community Partner: Walzem Elementary School Project Location: San Antonio, Texas

Background: As of 2016, 44% of Texas fourth graders were obese or overweight. The consequences of childhood obesity are vast, with 75% of affected youth suffering from adult obesity and its associated risks. The high prevalence of childhood obesity is a crisis and an urgent call to action. Elementary Nutrition (EN) is a project to bring nutrition education to 4th grade students at Walzem Elementary School (WES) in San Antonio, Texas. Objectives: The goal of EN was to provide nutritional education to students by validating a 4th grade curriculum first implemented in 2016 by UT Health second-year medical students at WES. The 2018 iteration of EN had a goal to further validate the EN curriculum, as measured by improvement in post-intervention scores. Methods: Over eight weeks, six second-year UT Health medical students each taught one-hour sessions in two fourth grade classrooms at WES – one monolingual, and one bilingual. The curriculum consisted of basic nutrition education and hands-on cooking opportunities. Pre- and post- intervention assessments of nutrition knowledge (reported as percent of questions correctly-answered) were administered on the first and last sessions, respectively. Results: Thirty students participated. Nutritional knowledge assessments for the monolingual class, bilingual class, and the mean of the two were 29%, 39%, and 34% respectively. Post-intervention means were 63%, 58%, and 60%, respectively. A two-tailed paired t-test demonstrated results were significant (p-value <.001). Preintervention scores were identical to previous years, but the post-intervention scores (49% previously) increased by 23%, demonstrating improvement in project execution. Conclusion: Our results indicate the EN curriculum significantly improves nutritional knowledge in a 4th grade student population, validating EN as an effective teaching tool. We hope these findings will lead to increased interest and resources allocated to the project. We believe the expansion of EN is a way to reverse the problem of childhood obesity in our community. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 60 Diving Deep Into Community

Education

Walk it Off: Moving for Mental Health

Project Disciplines: Occupational Therapy Primary Presenter: Aleera Barrera Other Student Team Members: Amy Honeck, Sarah Purcell, Aleera Barrera, Victoria Alejandro, Vanessa Arroyoarroyo Mentor: Bridgett Piernik-Yoder, PhD, OTR Community Partner: San Antonio Clubhouse Project Location: San Antonio, Texas

Background: San Antonio Clubhouse is an organization that empowers those with mental illness through meaningful relationships and a safe, judgment free environment for members. A needs assessment identified that the S.A. Clubhouse needed assistance with their wellness initiative, member participation in wellness walks, and outreach to improve awareness of the resources S.A. Clubhouse provides. Objectives: The purpose of this project was to increase S.A. Clubhouse members' understanding of the connection between physical wellness and mental wellness. Methods: Starting in January of 2018 occupational therapy (OT) students spent one to two days a week facilitating wellness walks by creating a map that correlates miles walked by members, encouraging members to participate and meet personal goals, participating in daily wellness walks, and hosting a 5K with S.A. Clubhouse in May 2018. Students provided educational information regarding diet, exercise, sleep habits, and other areas of physical wellness to increase the health literacy related to physical wellness of the S.A. Clubhouse members. Results: Baseline data collected from December 2017 showed an average of five member participants in daily wellness walks. Increase in member engagement was noted in wellness walks held January 2018-May 2018, with monthly averages of 9-13 members participating. The goal of 50 community attendees was not met with only 25 community participants attending the 5K on May 2018. Conclusion: Increase in member participation was noted on days OT students participated during January and February. During March-May, this increase did not correlate to specific days students were present. This leads to the assumption that members became more self-sufficient in wellness walk participation. To continue increased member participation, health literacy information should be provided across several dates and alternative physical activity options should be provided. Attendance of the 5k is assumed to be due to limited and late event promotion. It is suggested to advertise early for future events. TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 61 Diving Deep Into Community

Outreach

Assessing Access to Care in the Texas-Mexico Border City of Eagle Pass Graduate School-Biomedical Science

Project Disciplines: Medicine, Nursing, Respiratory Care, Physical Therapy, Physician Assistant Primary Presenter: Alejandra Rodriguez Mentor: Fred Campbell, MD Community Partners: Mexican Consulate, Mission: Border Hope Project Location: Eagle Pass, Texas

Background: Border communities are home to some of the greatest health disparities due to genetic, environmental, and socioeconomic factors. Frontera de Salud is a health outreach and education organization that engages student volunteers and faculty mentors to improve the health of medically underserved people in South Texas including residents of the Texas-Mexico border city of Eagle Pass. According to the 2010 U.S. Census data for Maverick County, 27.5% of individuals under age 65 did not have health insurance. Objectives: The objectives of this project were to assess access to care among participants based on health insurance coverage, primary location of healthcare delivery, and most common self- reported barriers to receiving care. Methods: The Frontera De Salud team traveled to Eagle Pass on three separate occasions in 2018 to provide free health screenings at community partner locations. A multiple-choice survey was created to assess medical insurance status, major barriers care, and connection to a primary care physician. Surveys were collected during the screening events and data was analyzed using Microsoft Excel. Results: A total of 69 surveys were collected. 50 patients were females and 19 were males. 30% were over 65 years old, 36% were 51-64 years old, and 33% were less than 50 years old. 45% of all participants were medically uninsured. 56% of people under 65 years old were uninsured. 30% of all participants sought care primarily across the border, in Mexico. The most commonly reported barriers were cost of medical care followed by lack of medical insurance. Conclusion: A large majority of Eagle Pass residents under 65 do not have realistic access to healthcare in the US primarily due to financial limitations. Health outreach organizations like Frontera De Salud must take this into consideration when providing medical counseling and referrals to patients living in low socioeconomic border areas. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 62 Diving Deep Into Community

Outreach

Assessing the Multicultural Health Needs of El Bari Community Health Center Patients

Project Disciplines: Medicine, Public Health, Community Health Primary Presenter: William De Muth Mentor: Fozia Ali, MD Community Partner: El Bari Community Health Center Project Location: San Antonio, Texas

Background: This project's setting takes place at El Bari Community Health Clinic and seeks to discover the needs of the community by implementing, member-checking, and analyzing the data obtained from a community needs assessment conducted at this free clinic's health fair in April of 2018. Objectives: This in an ongoing project that began over a year ago. At this phase, having developed the survey and gathered data, our most relevant objectives are related to data analysis and reporting. On January 11 2019, 8:00 p.m., we seek to feed the data back to the community to answer two main questions about this population: (1) what are the top three health priorities in the community, and (2) what are the top three personal barriers to health? Methods: Data for the community health needs assessment were collected through one-on-one interviews. Answers were recorded on an index card for anonymity. Each participant was asked about basic demographics, her/his top three health priorities, and top three barriers in community to achieving health. After identifying health priorities and barriers, staff members recorded their answers on a poster-sized survey. Male and female answers were distinguished by blue and red stickers, respectively. Results: Though these results are preliminary as we are completing the memberchecking process, we have identified the preliminary top three health priorities perceived in the community: (1) nutrition/diet/malnutrition, (2) weight problems, and (3) high blood pressure. As well as the top three personal barriers to health: (1) time, (2) limited access to health food, and (3) No insurance. Conclusions: The results from this assessment will help to identify the health concerns and barriers that El Bari CHC seeks to address. With the insights and knowledge gained from this experience, Bexar County Translational Advisory Board and El Bari Community Health Center can be better equipped with tools to adequately address the community needs. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 63

Outreach

Assessment of the Reproductive Health Needs of Female Afghan and Burmese Refugees in San Antonio, Texas: A Focus Group Approach*

Project Disciplines: Medicine, Nursing, Public Health Primary Presenter: Mikaela Miller Other Student Team Members: Cameron Holmes, Kinsey Dittmar, Fatima Dollar, Matthew Moran, Matthew Makansi, Andrew Jeffery, Donald Egan Mentor: Heidi Worabo, DNP, RN, FNP-BC Community Partners: Center for Refugee Services (CRS), San Antonio Refugee Health Clinic (SARHC) Project Location: San Antonio, Texas

Background: Key informants at CRS and SARHC expressed a need for improved women's health services. A literature review revealed several barriers to providing reproductive healthcare to refugees. In addition, a major gap in the literature was a shortage of studies conducted in the United States. Family planning views and desires adapt throughout the refugee experience. Therefore, it is advantageous to design evidence-based interventions directed toward the family planning needs of refugees residing in the United States. Objectives: To develop an understanding of family planning knowledge and preferences of female refugees in San Antonio by conducting a focus groupbased needs assessment. Methods: Two focus groups were conducted, one with Afghan (n=7) and one with Burmese (n=13) women. Each participant was a female refugee, married, of reproductive age (18-49 years), and had at least one child. The facilitators and transcribers analyzed the transcripts individually then participated in 10 hours of in-person discussion to identify the common themes and patterns. Results: There is a strong preference for natural methods of family planning. Some reproductive health views and desires adapted throughout the process of resettlement. Access to healthcare is a major barrier to receiving women's healthcare. The participants had varying levels of knowledge on reproduction as well as several questions and misunderstandings. Although these themes demonstrate the consensus that was reached in the groups, refugee women are individuals with diverse, personal preferences regarding family planning. Conclusion: We now have an increased understanding of the family planning knowledge and preferences of Afghan and Burmese refugee women residing in San Antonio. Next steps include focus groups with Afghan and Burmese men, education for Afghan and Burmese men and women, and improved women's healthcare services through SARHC.

*Blue Ribbon Winner 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 64 Diving Deep Into Community

Outreach

Development and Implementation of Art Therapy Curriculum in Elementary-Aged Children at the Madonna Neighborhood Center

Project Disciplines: Graduate School-Biomedical Science, Public Health, Undergraduate Students Primary Presenter: Brianna Bal Other Student Team Members: Aaron Frolichstein, Hayley Cantway Mentors: Glen Medellin, MD, MPH Community Partner: Madonna Neighborhood Center Project Location: San Antonio, Texas

Background: Art Cart, a therapy-based art program for youth, first began with cancer patients at University Hospital. After showing success, it was later expanded to at-risk youth in the community through partnerships with community centers in San Antonio. In 2018, the project partnered with the Madonna Neighborhood Center, a center located on the West Side of San Antonio, and worked with the center’'D5s elementary afterschool program. Objectives: Since its inception, Art Cart did not have a specific curriculum grounded in the principles of art therapy. The purpose of this project was to develop a science-based curriculum that could truly be considered art therapy, and then implement it at the center. By the end of implementation, it was our goal that at least 50% of 25 target children who participated for 6 weeks in Art Cart activities would display improvement in overall behavior and mood at least once, as measured by differences in pre-/post-activity surveys, as well as in pre-/post-activity feedback from teachers. Methods: Before implementation, volunteers received curriculum orientation. They were provided with copies of the curriculum and encouraged to review before beginning. The project occurred over a six-week period. Pre-/post-activity surveys were provided to both children and volunteers, and a pre-/postimplementation meeting was held with staff. At the end of the six weeks, the participants were allowed to take art kits home and encouraged to continue the process. Results: Results collected showed that 80% of children reported improvement in mood by the implementation. Center staff reported qualitatively that overall behavior had improved, notably on days when therapy occurred. They stated that on these days, rates of behavioral outbursts and punishment decreased. Conclusion: Although data collected was overwhelmingly positive, implementation proved difficult with this age group. In the future, the curriculum will need to tested with older youth, and data collection methods revised. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 65

Outreach

Frontera de Salud - Establishing a Medical Referral Network for the Migrating Underserved

Project Disciplines: Medicine, Public Health Primary Presenter: Olivia Lopez Other Student Team Members: Nathanael Franks, Hayley Cantway Mentor: Fred Campbell, MD Community Partner: Refugee and Immigrant Center for Education and Legal Services (RAICES) Project Location: San Antonio, Texas

Background: The Greyhound bus station in San Antonio is a major transportation hub for asylum- seeking families. The Refugee and Immigrant Center for Education and Legal Services (RAICES) operates a legal referral program at the bus station; no medical referral network exists. Objectives: The primary goal is to provide asylum-seeking families with information about pertinent health care services and secondarily to educate University of Texas Health San Antonio (UTHSA) students about the asylumseeking process and migrant health barriers. Methods: Frontera de Salud (Frontera) leaders volunteered five times in Fall 2018 with RAICES. Students were trained on the basics of the asylum process and subsequently led legal orientations. RAICES and Frontera also co-hosted a presentation about migrant health for UTHSA students. Pre- and post-session surveys were administered to gauge attitudes and knowledge about the topic. Results: Frontera leaders provided personalized legal orientations to over 25 families. Data collected by RAICES indicates top relocation cities are Houston, Dallas, Los Angeles, Miami, and New Orleans. Thirty-six students attended the Frontera-RAICES presentation. Pre-survey results demonstrate low baseline knowledge and confidence of the asylum process. Post-surveys indicate that 98% of respondents agreed or strongly agreed that (1) a person's legal status can have a significant impact on health outcomes and (2) healthcare professionals should be educated on the basics of immigration law. Asylum knowledge increased by 40%. Conclusion: Frontera and RAICES identified priority destinations for the referral network, implementation of which began in January 2019. Difficulties to project implementation are that families (1) arrive at the bus station in sporadic influxes, (2) only stay in SA for hours, (3) only speak Spanish, and (4) have no contact information for follow-up. Regardless, in consistence with Frontera's mission, it is important to educate future health professionals on this topic and to advocate for the health of asylum-seekers - undoubtedly an underserved population. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 66 Diving Deep Into Community

Outreach

Inpatient Pediatric Transplant Patients: Caring for the Caretakers

Project Disciplines: Medicine Primary Presenter: Victoria Arnold Other Student Team Members: Cassandra Jones Mentor: Mittal Naveen, MD Community Partner: Transplants for Children Project Location: San Antonio, Texas

Background: Children who are in need of, or have had, an organ transplant are frequently admitted for related complications, which translates to unexpected hospital stays for their caretakers. While there is a focus on care of the child while admitted, parents are also uncomfortable on many levels. Since the link between quality of parental care and child outcomes is well known, it is imperative to also focus on the wellness of caretakers(Simons, et al. 2007). Tools currently promoting parent wellness during child admission at UHS are few. Our avenue of filling this void is the provision of care-packages containing comfort items, social support and self-care informationals, journaling tools, and a children's book. Objectives: The primary objective was that 70% of package recipients report improved wellness directly related to package contents. Our secondary objective was to acquire a total of 15 encouraging messages from transplant parents in order to create a booklet for eventual project expansion. Methods: Effectiveness of the packages was measured by a likert scale survey assessing sense of support, likelihood of connecting with their child through reading, as well as wellness related to increased introspective journaling, improved sleep comfort, and overall improved quality of hospital stay. This, and a free response section included in the survey, will guide the improvement of packages in the future. This section was also used to gather encouraging messages from caretakers to be distributed to others. Results: Packages are still being distributed and several surveys will be collected in the next two weeks. Thus far, over 70% of recipients have reported improved wellness and sense of social support. Conclusion: Ultimately, this is projected to improve the parent's capacity to care for the child, and data related to these care packages supports the notion that this is a step in the right direction. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 67

Outreach

Transitioning Health Needs in Rural Panamanian Communities

Project Disciplines: Medicine Primary Presenter: Dawn Janysek Other Student Team Members: Anisha Guda, Matthew Milam, Amr Arar, Sammira Rouhani Mentor: Richard Usatine, MD Community Partner: Universidad de Panama Project Location: Ca azas, Panama

Background: This project assessed the current state of health of three rural Panamanian communities and evaluated the effectiveness of care provided by annual global health trips. Data collected from prior trips determined that the incidence of Sarcoptes scabiei (scabies) in these communities had significantly decreased and the incidence of Pediculus humanus capitis (head lice) increased from 2016 to 2017. We hypothesized that we would observe a similar pattern in 2018. Objectives: The goals of our project were to assess the change in incidence of scabies and lice in these communities and provide future global health teams with the tools to initiate public health interventions. Methods: A global health team consisting of five medical students and one dermatologist provided health care services to the rural Panamanian villages of Cerro de Plata, Los Valles, and Ca azas over a course of five days. Clinic patients and children from local schools were screened for evidence of dermatologic pathology. Each diagnosis was confirmed by the attending physician and medical information was documented by the students. Results: We observed a dramatic decrease in the incidence of scabies in Ca azas and neighboring communities. In 2016, 12% of all cases seen were scabies. In 2018, 2% of all cases seen were scabies. Additionally, the incidence of lice is decreasing but continues to be an issue. In 2017, 13% of all cases seen were lice in comparison with 10% seen in 2018. Conclusions: The incidence of scabies dramatically decreased due to several factors including continued community education of scabies prevention by annual global health trips, increased medications for local healthcare providers, and empowered healthcare workers that provided appropriate health care. Further investigation of the cause of scabies decrease with local providers is warranted. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 68 Diving Deep Into Community 11

NOTES TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 69 Diving Deep Into Community

Kleberg Scholar

Assessing HIV Risk and Knowledge of Pre-exposure Prophylaxis (PrEP) Among Minorities Recently Diagnosed with HIV in South Texas

Project Disciplines: Public Health Primary Presenter: Taibat Salami Other Student Team Members: Oluyinka Olutoye Mentor: Waridibo Allison, MD, PhD Community Partner: Valley AIDS Council (VAC), San Antonio AIDS Foundation (SAAF), Family Focused AIDS Clinical Treatment Services (FFACTS) Project Location: Harlingen, McAllen and San Antonio, Texas

Background: Although the overall incidence of HIV in the United States is declining annually, southern United States has the greatest burden of HIV infection, illness, and deaths of any U.S. region, and lags far behind in providing quality HIV prevention and care. Texas, with a large minority population, has one of the highest HIV prevalence in the country. VAC, FFACTS, and SAAF are Ryan White HIV/AIDS Program funded clinics serving people living with HIV in the Rio Grande Valley and San Antonio metropolitan area. Objectives: The objective of this study was to understand the social, cultural, and economic factors that influence sexual behaviors, perception of HIV risk, as well as utilization of HIV prevention tools such as pre-exposure prophylaxis (PrEP) among recently diagnosed minority adults. Methods: A 70-question survey, which was modified from a validated CDC risk assessment questionnaire, was administered via semi-structured interviews to qualified clients. To qualify for this study, clients had to be 18-30y/o; diagnosed with HIV within the past 3 years; and be currently established in their treatment routine. Clients were given $10 HEB gift card as an incentive to participate in the study. Results: Data collection is still ongoing. Currently, about 100 surveys have been completed across all 2 sites: 60 in VAC and 38 in SAAF. FFACTS began collecting data about 3 weeks ago. We hope to focus our efforts in collecting data at FFACTS in the coming weeks. Conclusion: The majority of currently published literature about HIV risk perception is obtained from HIV negative individuals. Our study aims to broaden our knowledge about HIV risk perception by seeking the perspective of individuals recently diagnosed with HIV. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 70 Diving Deep Into Community

Kleberg Scholar

Cooking Up Convivencia: Adaptation of a Culturally-Relevant Nutrition and Physical Activity Curriculum for Community Health Clubs in the Lower Rio Grande Valley

Project Disciplines: Public Health Primary Presenter: Jordan McMaster Mentor: Jason Rosenfeld, MPH, DrPH(c) Community Partner: La Union del Pueblo Entero, the Lower Rio Grande Valley Area Health Education Center, and H-E-B Project Location: Hidalgo and Cameron Counties, Texas

Background: The Lower Rio Grande Valley (LRGV) is home to thousands of residents living in colonias – low-income neighborhoods built on unincorporated land. The Community Health Club (CHC) is a community-based health promotion model where peer groups are formed to improve individual and collective well-being. The first clubs in the LRGV were formed in February 2018 by trained promotoras working with La Union del Pueblo Entero and the LRGV Area Health Education Center. These partners identified a need for a curriculum focused on nutrition and physical activity to improve health in the colonias. Objectives: Improve program participant's knowledge about nutrition and physical activity and stimulate behavioral changes around eating, cooking, and exercise through a curriculum designed for CHCs in the LRGV. Methods: Salud con Sabor Latino, which we modified for CHCs, is a curriculum developed by the Esperanca organization which mixes basic theory with hands-on cooking and exercise sessions. After completing a two-day training, 17 promotoras implemented the 10-week curriculum among 10 LRGV clubs. Participant knowledge, behaviors, and anthropometric data were captured via pre- and post-questionnaire given during the first and last course sessions. Focus group discussions were also conducted with club members during the ninth week. Results: Of 122 registered club members, around 50% completed the course in December 2018. Participants reported a strong sense of "convivencia" with their fellow club members and reported implementing the things they learned with their own families. Survey data are still being aggregated and will be analyzed using appropriate statistical methods. Changes in knowledge, behaviors, and anthropometric measurements from pre- to post-intervention will be reported. Conclusions: The CHC is an effective model for helping residents of the LRGV learn and improve their health together. The well-being of club members is improved in both quantitative and qualitative measures, and these benefits will likely be extended to families and communities. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 71

Kleberg Scholar

Creating Learning Communities in the Texas Border Region to Treat Post-traumatic Stress Disorder (PTSD) Using Cognitive Processing Therapy (CPT)

Project Disciplines: Psychology Primary Presenter: Feiyu Li Mentors: David Roberts, PhD, Katherine Dondanville, PsyD, ABPP Community Partner: Border Region Behavioral Health Center Project Location: Laredo and Weslaco, Texas

Background: Mental health repercussions from exposure to traumatic events remain an under- addressed health care challenge facing U.S./Mexico border region. While the lifetime prevalence of PTSD among U.S. adults ranges from 14.5% to 48.8%, Latinos are more likely to develop PTSD and experience more severe symptoms (Alcá'87ntara et al., 2013). Despite the need for treatment, Latinos in the border region experience profound challenges with accessing care; one challenge pertains to lack of access to effective PTSD treatment and shortage of providers. Objectives: This project aimed to increase community-level access to Evidence-based Treatments (EBT) for PTSD in border regions of Texas through an intensive training program to develop provider expertise in EBT for PTSD and engaging community stakeholders at the organizational level. This poster presents interim findings. Methods: The team conducted outreach in border counties to build a Learning Community for Cognitive Processing Therapy (CPT). The Learning Community consists of in-person workshops and weekly case consultation for seven months following the training. The goal is to assist clinicians to achieve CPT provider status. Results: The project team has established community relationships with stakeholders in Webb and Hidalgo counties and assessed local needs for PTSD treatment and resources. During relationship building with stakeholders, local agencies agreed to collaborate on organizing workshops in two locations. As the team continues recruitment, 38 applicants have been approved for the training. The 38 include Licensed Professional Counselors, Social Workers, and Psychologists representing 11 cities in the Texas border region. Conclusion: Interviews with key informants confirmed literature findings of insufficient availability of psychotherapy resources for people with PTSD and the scarcity of training opportunities for providers. Participating providers will complete pre- and post-workshop assessment on their knowledge and utilization of Cognitive Processing Therapy. We aim to improve patient education and EBT for PTSD research in the Texas border region. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 72 Diving Deep Into Community

Kleberg Scholar

Early Recognition and Reporting of Child Maltreatment: An Educational Program for School Personnel in the Lower Rio Grande Valley

Project Disciplines: Medicine, Nursing, Public Health Primary Presenter: Bradley Norat Other Student Team Members: Melody Bahrampour Mentors: Natalie Kissoon, MD, FAAP; Judith Livingston, PhD, MCHES Community Partners: Harlingen Consolidated Independent School District and Texas Education Agency Region 1 Education Service Center Project Location: Harlingen, Texas

Background: In 2017, in Cameron County in the Lower Rio Grande Valley, there were 7,165 suspected cases of child maltreatment with 1,368 confirmed cases (Texas DFPS, 2018). As mandated reporters, school personnel, including those in Cameron County's Harlingen Consolidated Independent School District (HCISD), are required to report suspected child maltreatment. Several factors impact reporting, including knowledge and skills to recognize child maltreatment. Objectives: Through child maltreatment education of HCISD school counselors, school nurses, and parent involvement personnel, as measured by pre/postsurvey, there will be a: 1. 30% increase in endorsement of support for teachers and other school personnel making reports of suspected abuse/neglect directly to Child Protective Services (CPS) 2. 30% increase in willingness to report a suspected case of sexual abuse directly to CPS in an otherwise uninjured healthy child 3. 30% increase in knowledge to correctly identify concerning injuries for physical abuse. Methods: A series of 3-hour, interactive trainings, using evidence-based medicine from Child Abuse Pediatrics, was implemented between September-November 2018. Pre- and post-surveys were administered at the trainings. The test instrument was adapted from validated survey instruments (Walsh, et al; 2010, 2012; Feng, 2005). RedCap was used for data analysis. Results: A total of 122 school counselors, nurses, teachers and parent involvement personnel completed the training. Prior to educational intervention, 84.4% of personnel strongly endorsed reporting suspicions of maltreatment directly to CPS and 88% would report sexual abuse in an otherwise healthy child. Strong endorsement of reporting suspicions directly to CPS increased to 97.5% post-education (p=0.003). Correct identification of a burn concerning for neglect was unchanged with high correct pre-education identification of 90.2% Correct identification of bruising concerning for physical abuse increased by 22.1% (p<0.001). Conclusion: Educational intervention improved knowledge with statistical significance in identification of abusive bruises, and endorsement of reporting suspicions of child maltreatment directly to CPS. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 73

Kleberg Scholar

Hemophilia Education: A Quality Improvement and Outreach Initiative for South Texas

Project Disciplines: Medicine Primary Presenter: Deanna Maida Mentor: Gail Tomlinson, MD, PhD Community Partner: University of Texas Rio Grande Valley School of Medicine, Department of Pediatrics Project Location: San Antonio, Texas

Background: Patients and carriers with hemophilia A and B, an X-linked recessive bleeding disorder, do not understand disease inheritance and the importance of early diagnosis and treatment, leading to affected offspring, late diagnoses in at-risk individuals and increasing morbidity. Access to genetic services in South Texas is limited. Objectives: To increase patient, caregiver, carrier and community knowledge of hemophilia genetics and disease management among South Texas families affected by hemophilia. Methods: A pre- and post-intervention survey study was performed in the South Texas Hemophilia Treatment Center (HTC) outreach clinic at Valley Baptist Medical Center in Harlingen, TX. The intervention consisted of genetic counseling and hemophilia education using toolkits to reinforce learning. Knowledge and satisfaction with genetic counseling was assessed using a 5-point Likert- scale pre/post-test administered on the day of the intervention and three months later. Genetic testing was offered. Community education was provided through local events. Results: Three education and genetic counseling sessions were performed with 23 families, with 13 patients and 11 caregivers participating. Those under the age of 18 years had a survey filled out by a parent/guardian. A caregiver only filled out a survey once, regardless of number of children under the age of 18 years. Pre-tests were completed by 24, post-tests by 22, and genetic satisfaction survey by 21 participants. Three month post-testing is ongoing. Survey results found improved knowledge in the following topics after the intervention: genetics/inheritance (p=0.019), types of bleeding (p=0.04), inhibitors (p=0.006), differences among recombinants (p=0.013), and how new products compare to traditional factor products (p=0.013). The genetic satisfaction survey yielded consistently high results, with averages above 4.7/5 for six questions with standard deviations ranging from 0 to 0.62. Conclusion: This project demonstrates educational interventions are effective for increasing patient and caregiver disease-specific knowledge, and genetic counseling is well-accepted in this population. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 74 Diving Deep Into Community

Kleberg Scholar

Operation Naloxone: Medical Student-led Opioid Overdose Prevention Training

Project Disciplines: Medicine, Public Health Primary Presenter: Delaney Rawson Other Student Team Members: Alejandra Rodriguez Mentor: Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS Community Partner: South Coastal Area Health Education Center Project Location: Corpus Christi, Texas

Background: In 2016, 63,600 Americans died of drug overdose, almost double the number who died in motor vehicle crashes (37,757). Operation Naloxone (ON) uses a "train the trainer" model, educating healthcare students to lead opioid overdose prevention trainings for community groups, healthcare providers, and other students. This project expanded ON to collaborate with the College of Pharmacy and the South Coastal Area Health Education Center (AHEC) to lead opioid overdose trainings in South Texas. In similar community education programs, 7-20% of participants went on to reverse an overdose using naloxone provided to them at their training. Objectives: Train 100 community members and 100 healthcare professionals in South Texas. Assess knowledge, self-efficacy, and harm reduction attitudes through participant pre-/post-surveys. Successfully expand ON to implement a sustainable program in South Texas through AHEC. Distribute 33 boxes of naloxone. Methods: Training sessions involved initial assessment, 90-minute seminar, and immediate follow- up assessment. The seminar included opioid overdose epidemiology, symptoms, naloxone access, overdose response training, and case scenarios. Assessment content included knowledge, self- efficacy, and attitudes. Three trainings were conducted in Corpus Christi and thress in San Antonio, where the participants traveled from throughout South Texas. Results: Community members, medical and nursing students, and healthcare professionals all showed statistically significant pre/post increases for all three metrics. The students had the largest increase in knowledge and self-efficacy whereas the community members had the largest increase in harm reduction attitudes. 139 boxes of Narcan were distributed. Conclusion: It was challenging to promote our first trainings because we heavily relied on our community partner to encourage attendance. Students and community members, such as the Student-Faculty Collaborative Practices at UT Health San Antonio and the new Scholars Program at the Health Professions School in Corpus Christi, participated in the training and are now using our educational materials to lead their own trainings. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 75

Kleberg Scholar

Stop the Bleed South Texas: Interprofessional, Student-led School Trainings

Project Disciplines: Medicine, Pharmacy, Public Health Primary Presenter: Katherine Kazen Other Student Team Members: Courtney Baus, Claire Brandt, Alana Coleman, Kaitlin Kennedy, Robert Moton, Steven Swank, Michelle Tran Mentors: Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS; Rebecca Moote, PharmD, MSc, BCPS; Lillian Liao, MD, MPH Community Partners: Area Health Education Center of the Mid Rio Grande Border Area, Laredo ISD, United ISD, Brownsville ISD, UT Health San Antonio Regional Campus Laredo Project Location: Laredo and Brownsville, Texas

Background: Rates of gun violence are significantly higher in the U.S. than in any other developed country and school shooting events are on the rise. In the last 19 years, 215,000 children have experienced gun violence due to a school shooting, and approximately 300 have lost their lives. Stop the Bleed was launched in 2015 to train bystanders regarding appropriate first-response in a bleeding emergency, such as a school shooting. This project will provide Stop the Bleed trainings to teachers and administrators in three south Texas school districts: Laredo, United, and Brownsville. Objectives: By April 2019, 1,400 teachers, administrators, and student representatives from elementary, middle, and high schools in Brownsville, Laredo, and United ISD will complete a one- hour Stop the Bleed training session resulting in a 75% increase from baseline knowledge and self- efficacy as measured by pre- and post-session surveys. Methods: UTHSA medical and pharmacy students and faculty completed Stop the Bleed trainings locally and will travel to three south Texas school districts to lead fourteen Stop the Bleed trainings over a two-day span. The training includes a brief lecture followed by hands-on tourniquet and woundpacking practice. School districts will also be provided kits containing necessary supplies for optimal bleeding response. Training efficacy will be assessed through pre- and post-training surveys with questions meant to test participant knowledge, self-efficacy and comfort level regarding bleeding control measures. Results: These trainings will be completed in January 2019. Additionally, more than 300 bleeding control kits will be distributed to the school districts. Stop the Bleed training is a proven and effective form of community-based education. We hypothesize that our trainings will result in statistically significant improvement in knowledge, self-efficacy, and comfort level regarding bleeding control. Conclusion: This project will provide potentially life-saving bleeding control training to an estimated 1,400 teachers/administrators in South Texas. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 76 Diving Deep Into Community

Kleberg Scholar

Subclinical Atherosclerosis in a Mexican-American Cohort

Project Disciplines: Medicine Primary Presenter: Marlene Garcia Mentor: Anand Prasad, MD, FACC, FSCAI, RPVI Community Partner: Hispanic Health Research Center Project Location: Brownsville, Texas

Background: The Cameron County Hispanic Cohort (CCHC) was established to study the risk factors for metabolic and cardiovascular disease in Mexican Americans living in the Lower Rio Grande Valley. The CCHC is a "Framingham-like" cohort of Mexican-Americans randomly selected from households in Cameron, Hidalgo, and Webb counties. The CCHC includes 4,600 individuals that have detailed medical histories, biochemical data, and cardiovascular ultrasound imaging. Specifically, the subjects undergo a carotid ultrasound, which is utilized to asses for intimal thickness (cIMT) and plaque. Objectives: The purpose of this project was to analyze the carotid ultrasounds in the cohort for the presence of plaque and cIMT, to assess baseline clinical and demographic variables of those individuals, and to determine how many individuals are on statin therapy. Methods: Carotid ultrasound studies were analyzed for carotid plaque utilizing the Carotid Analyzer software (Medical Imaging Applications, Coralville, Iowa). cIMT was measured in a semi-automative fashion during diastole. The presence of plaque was defined as an area of wall thickening that was >50% of the thickness of the surrounding wall. Results: Interim results of 28 subjects are presented. Mean age was 48.9 17 years and 16 were female (57%). Five had diabetes (2 undiagnosed), 7 had hypertension, and 9 hyperlipidemia. None had established CVD. Sixteen (57%) did not have health insurance. The mean cIMT for the subjects was 0.70 0.12 mm. 9/28 (32%) had presence of plaque on carotid U.S. Patients with plaque were older than those without plaque (64 12 vs 42 15 years, P=0.0003). One individual with plaque was on statin therapy. Conclusion: A third of subjects had carotid artery plaque and the majority of individuals were not on statin therapy. Ongoing analyses will classify the cohort cIMT distribution, explore the appropriateness of statin therapy, and establish the risk factor associations for carotid atherosclerosis. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 77

Kleberg Scholar

Systematic Qualitative Evaluation of the Breathe Easy South Texas Program: A Community-centered Approach to Latent Tuberculosis Screening and Treatment

Project Disciplines: Medicine, Public Health Primary Presenter: Soraya Naqvi Mentor: Barbara Taylor, MD, MS Community Partners: Texas Department of State Health Services Region 8, Metropolitan Health District, University Health System, United Medical Centers, Raphael Community Clinic, New Braunfels Rural Health Clinic, Vida y Salud Health Systems, Uvalde Memorial Hospital, Peterson Regional Medical Center, Hill Country Memorial Hospital, Community Health Development, Arthur Nagel Community Clinic Project Location: San Antonio, Texas and neighboring counties

Background: South Texas has one of the highest incidence rates of tuberculosis in the U.S. The Breathe Easy South Texas (BEST) program is a latent tuberculosis infection (LTBI) screening and treatment program which supports IGRA-based testing and shortened treatment for LTBI in high risk populations throughout South Texas. Objectives: A project evaluation of BEST was conducted to identify barriers and facilitators to successful LTBI screening and treatment. Methods: Semi-structured patient interviews and site-based focus groups with staff including providers, nurses and administrators were conducted. Patients were stratified based on presence or absence of LTBI and treatment completion. Focus groups were stratified based on optimally performing versus sub-optimally performing sites using a metric incorporating number of individuals screened and percentage of those who entered and completed treatment. Qualitative analysis using grounded theory identified themes associated with successful outcomes for patients and sites. Results: Sixteen semi-structured patient interviews and 10 site-based focused groups with ~5 participants/site were completed. The primary barriers to treatment completion noted by patients included lack of knowledge of LTBI and treatment toxicities. Patient perceptions of LTBI and LTBI treatment played a role in initiation and completion of treatment. Clinic staff concurred that the primary patient-related barrier to treatment completion was treatment toxicity (4 of 10 sites). The primary barrier to program implementation expressed by 9 out of 10 sites was the challenge of adding new processes to clinical sites with limited resources. Conclusion: Our program evaluation findings suggest that: (1) additional low literacy patient education on LTBI and treatment, including toxicities and (2) expanded support for the clinics in terms of process implementation, data reporting and provider training, would be helpful additions to the program. We are currently meeting with our community partners to disseminate our results and to gather feedback on our findings. 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 78 Diving Deep Into Community

NOTES TH 2019: 12 ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 79 Diving Deep Into Community

12TH Annual CSL Conference Planning Committee

Le'Keisha Johnson, MBA, Director, Office of Chair Student Life, UT Health San Antonio Melanie Stone, MPH, Nancy Maebius, PhD, RN, Community MEd, Assistant Director of Relations Liaison, Galen College of Nursing Community Service Learning, Center for Paulina Mazurek, MA, Director of Wellness & Medical Humanities & Professional Formation, Long School of Medicine, Ethics, UT Health UT Health San Antonio San Antonio Carol Nguyen, RDH, MSDH, Associate Professor and Dental Hygiene BS Completion Bonny Amador-Lopez, former Program Program Director, Division of Dental Hygiene, Coordinator, Community Service Learning, School of Dentistry, UT Health San Antonio Center for Medical Humanities & Ethics, UT Health San Antonio Pegeen Seger, MA, MLIS, Head of Campus & Community Engagement, UT Health San Antonio Ruth Berggren, MD, MACP, Professor of Libraries Medicine, Director, Center for Medical Humanities & Ethics, UT Health San Antonio Jennifer Seltzer, PharmD, Director, Office of Evidence-Based Practice, UT Health San Antonio Leticia Bland, MPAS, PA-C, Assistant Professor, and Clinical Associate Professor, UT Austin Associate Clinical Coordinator, Physician Assistant College of Pharmacy Studies, School of Health Professions, UT Health San Antonio Cindy Sickora, DNP, RN, Vice Dean for Practice and Engagement, School of Nursing, UT Health Carrie Braden, PhD, RN, FAAN, Associate San Antonio Dean for Research, School of Nursing, UT Health San Antonio Melanie Taverna, RDH, MSDH, Assistant Professor and Director of Dental Hygiene Online Moshtagh Farokhi, DDS, MPH, FAGD, Clinical Associate Professor, School of Dentistry, UT Graduate Programs, Division of Dental Hygiene, Health San Antonio School of Dentistry, UT Health San Antonio

Christine Gaspard, MSLS, Librarian-Senior, Barbara Saatkamp Taylor, MD, MS, Associate Liaison to the School of Medicine, UT Health Professor of Infectious Diseases and Assistant San Antonio Briscoe Library Dean for the MD/MPH Program, School of Medicine, UT Health San Antonio Ruth Grubesic, RN, DrPH, PHCNS-BC, Associate Professor for Nursing and Public Health, Rajia Tobia, AMLS, former Executive Director Schreiner University of Libraries, UT Health San Antonio

Stephanie Gutierrez, Senior Program Jacqueline Tovar, Program Coordinator, Coordinator, MD/MPH Program, UT Health Community Service Learning, Center for Medical San Antonio Humanities & Ethics, UT Health San Antonio

Sheila Hotchkin, Assistant Director of Jing Wang, PhD, MPH, RN, FAAN, Professor Administration, Center for Medical Humanities and Vice Dean for Research, School of Nursing, & Ethics, UT Health San Antonio UT Health San Antonio 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 80 Diving Deep Into Community

Mentors Thank you to the mentors who have provided critical guidance for the students' projects.

Jordan Abel, MD Martha Martinez, MSN, RN, WHNP Ometeotl Acosta, MD Glen Medellin, MD Fozia Ali, MD Maria Jose Cervantes Mendez, DDS, MS Waridibo Allison, MD, PhD Naveen Mittal, MD Jack Badawy, MD Priti Mody-Bailey, MD Ruth Berggren, MD, MACP Rebecca Moote, PharmD, MSc, BCPS Elizabeth Bowhay, MD Andrew Muck, MD Edward Brooks, MD Maria de Jesus Munoz, MD John Browning, MD Mark Nadeau, MD Delia Bullock, MD Stuti Nagpal, MD Fred Campbell, MD Carisse Orsi, MD Adelita Cantu, PhD, RN Manuel Oscos-Sanchez, MD Inez Cruz, PhD, LMSW Sandra Osswald, MD Katherine Dondanville, PsyD Tracy Smith Page, DNP, RN, FNP-BC Joy Emko, MD Carolyn Pickering, PhD, RN Elizabeth Casiano Evans, MD Bridgett Piernik-Yoder, PhD, OTR Kirk Evoy, PharmD, BCPS Anand Prasad, MD Moshtagh Farokhi, DDS, MPH Tharani Ravi, MD M. Rosina Finley, MD, CMD Kelly Reveles, PharmD, PhD, BCPS Sean Garcia, MD David Roberts, PhD Michael Geelhoed, PT, DPT, OCS, MTC Jason Rosenfeld, MPH, DrPH(c) Alice Gong, MD Jeanette Ross, MD Adriana Vargas Green, DDS, MPH Stephen Saklad, PharmD, BCPP Ruth Grubesic, RN, DrPH, PHCNS-BC Rebekah Salt, PhD, RN Peter Guarnero, RN, PhD, MSc Linda Highfield, PhD Alexander Shepherd, MD Lucas Hill, PharmD Cindy Sickora, DNP, RN Anthony Infante, MD, PhD Laura Sisk, DNP, RN Nurani Kester, MD Kenneth Stone, MD Natalie Kissoon, MD Melanie Stone, MPH, MEd Kanapa Kornsawad, MD Barbara Taylor, MD, MS Kristy Kosub, MD Gail Tomlinson, MD, PhD M. Danet Lapiz-Bluhm, PhD, RN Richard Usatine, MD Wendy Lee, DNP, RN, FNP-BC Melissa Valerio, PhD, MPH Lillian Liao, MD, MPH Maria del Pilar Montanez Villacampa, MD Judith Livingston, PhD Browning Wayman, MD Phyllis MacGilvray, MD Wendi Wohltmann, MD Nandini Mandlik, DO Heidi Worabo, DNP 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community 81

Community Partners Thank you to our many partners who make Community Service Learning possible.

Aguman Capampangan of San Antonio (ACOSA) Laredo Independent School District Alamo Area Resource Center (AARC) Lighthouse Charter School Alpha Home Lower Rio Grande Valley Area Health Education Area Health Education Center of the Mid Rio Grande Center Border Area Lytle Volunteer Fire Department Arthur Nagel Community Clinic Madonna Neighborhood Center Avance Medina County Sheriff’s Office Benjamin Franklin Elementary School Mental Health First AID USA Bexar County Community Health Collaborative Mercy Ministries of Laredo Border Region Behavioral Health Center Methodist Healthcare Ministries of South Texas Breast Health Collaborative of Texas Mission: Border Hope Brownsville Independent School District The Mommies Program Castroville Elementary New Braunfels Rural Health Clinic Center for Health Care Services Office of State Representative Diego Bernal (TX District 123) Center for Refugee Services Operation Naloxone Children's Center Nurse Family Partnership The Patient Institute Chromosome 18 Peterson Regional Medical Center Comal Independent School District Puesto de Salud Community Health Development Pride Center The Ecumenical Center Providence Place El Bari Community Health Center Raphael Community Clinic FFACTS (Family Focused AIDS Clinical Treatment Services) Clinic RAICES (Refugee and Immigrant Center for Education and Legal Services) Harlandale Consolidated Independent School District ReACH (Center for Research to Advance Community Haven for Hope Health) H-E-B Regency Place Elementary School Healthy Futures of Texas The Residency Research Network Healy Murphy Center Rhodes Elementary School Hidalgo County Health and Human Services SATX Social Ride Department San Antonio AIDS Foundation (SAAF) Hill Country Memorial Hospital San Antonio Alzheimer's Association Hispanic Health Research Center San Antonio Clubhouse Hogar Luis Amigo San Antonio Metropolitan Health District (SAMHD) Hope Comprehensive High School San Antonio Metropolitan Ministries (SAMM) House of Neighborly Services Transitional Living and Learning Center Kigezi Healthcare Foundation (KIHEFO) Seton Home La Hacienda Treatment Center Sorrento Post Acute and Long Term Care Facility La Union del Pueblo Entero (LUPE) South Central Area Health Education Center (AHEC)

(continued next page) 82 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community

Community Partners (continued)

South Coastal Area Health Education Center US2Uganda4Life (AHEC) UT Health San Antonio Office of Recruitment South Texas Veterans Healthcare System and Science Outreach St. Francis Episcopal Church UT Medicine Medical Arts and Research Center (MARC) Texas Department of State Health Services, Region 8 UT Rio Grande Valley Medical School Uvalde Memorial Hospital Texas Education Agency Region 1 Education Service Center Valley AIDS Council Transplants for Children Valley Baptist Health System Travis Park United Methodist Church Ventanilla de Salud Vida y Salud Health System United Independent School District Walzem Elementary School United Medical Centers WEND (Women Empowerment Universidad de Panama Network Design) Africa University Health System Wood Middle School 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE 83 Diving Deep Into Community

Index of Student Poster Abstracts

Advocacy/ 1. Informed Medical Bill Negotiation ...... 13 Policy 2. Naloxone Accessibility Under Standing Orders from Texas Community Pharmacies and the Efficacy of Brief Academic Detailing on Improving Accessibility*...... 14

Capacity 3. An Interprofessional Collaboration to Improve Patient-Provider Communication Building for Refugee Patients with Limited English Proficiency ...... 15 4. Assessing Access to Healthcare and Medications in Communities in Questzaltenango, Guatemala ...... 16 5. Development and Implementation of a Standardized Training Program for Frontera de Salud Volunteers...... 17 6. Evaluation of the Use of Collective Impact by Parners in Pink...... 18 7. Helping the Elderly Avoid the Emergency Department...... 19 8. Implementing Diabetes Mellitus Data Collection in a Ugandan Clinic...... 20 9. Music & Art in Medicine (MAM): The Effectiveness of MAM Events on the Interest and Perception of Geriatrics and Nursing Homes by Medical Students (MSs) ...... 21 10. Pride Community Clinic: Addressing the Needs of Underinsured LGBTQ+ Patients in San Antonio ...... 22 11. Project Saha: Integrating Mental Health Services into the San Antonio Refugee Health Clinic...... 23 12. The Most Common Diagnoses at the Travis Park Dermatology Clinic, A Retrospective Chart Review ...... 24

Clinical 13. Analysis of Pain Prevalence and Management Service in Low-Income Areas of Quetzaltenango, Guatemala...... 25 14. Breastfeeding Practices and Needs Assessment Among Indigenous Women in Quetzaltenango, Guatemala ...... 26 15. How Does Laredo Feel? ...... 27 16. Medication Review from a Pop-Up Clinic in Gulu, Uganda: How to Prepare a Pharmacy in a Resource Limited Environment ...... 28 17. Patient Preferences of a Downtown San Antonio Primary Care Clinic ...... 29 18. The Effect of Mindfulness-based Interventions on the Wellness of Patients With Multiple Sclerosis ...... 30

Education 19. A New Hope: Introducing Comprehensive, Non-Religious Sexual Education to a Christian Secondary School in Masaka, Uganda* ...... 31 20. A Sustainable Approach to Skin Cancer Education, Prevention and Management in a High-Risk Homeless Population ...... 32 21. Addressing Maternal Mortality through Education at the Mommies Program ...... 33 22. Anaphylaxis, Asthma, and Allergy Awareness in Comal ISD...... 34 23. Art Cart at The Lighthouse Charter School ...... 35 24. Asian American Breast and Colorectal Cancer Screening Promotion in South Texas...... 36 25. Be Sun Safe: Protect Yourself from the Sun...... 37 26. Breastfeeding Education and Support for Teenage Mothers: Assessing Curriculum Effectiveness ...... 38 27. Breastfeeding Education and Supprt for Teen Moms ...... 39 28. Can a Smartphone App Improve Health Insurance Literacy? ...... 40 29. Correlation Between Nutritional Knowledge and Obesity in McAllen Texas to improve Frontera De Salud Counseling...... 41 30. Don't Sugarcoat Diabetes (DSD): Outcomes of A Diabetes Awareness and Advocacy Program Among Texas High School Students ...... 42

*Blue Ribbon Winner (Continued on next page.) 84 2019: 12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE Diving Deep Into Community

Index of Student Poster Abstracts

Education 31. Effect of Oral Health Campaign on Children of Refugees' Families ...... 43 (continued) 32. Elementary Nutrition: Teach Back, Give Back...... 44 33. Elevate Your Mood; Eat Good Food: Implementing Elementary Nutrition Education through the ESNACs Program ...... 45 34. Evaluating an Over-the-Counter Model for Contraception in a San Antonio STD Clinic...... 46 35. Healthy Children, Healthy Citizens: Assessing the Effectiveness of Promoting Healthy Habits Amongst 4th and 5th Graders ...... 47 36. Healthy Moms and Babies Equal Happy Moms and Babies ...... 48 37. Healthy Skin for Everyone: Evaluating Educational Impact on Individuals Experiencing Homelessness ...... 49 38. HELP for Better Health, 2018-2019: Use of Small Group Discussions and Interactive Learning in Health Literacy Curriculum ...... 50 39. Mental Health First Aid Training Increases Capacity to Handle Mental Health Crises ...... 51 40. Naloxone Training for the Student-Faculty Collaborative Practice at UT Health San Antonio ...... 52 41. Operation Naloxone: Interprofessional Overdose Prevention Service Learning Expanded ...... 53 42. Oral Care Skills for Dementia Care Workforce ...... 54 43. SA Access: An Interactive Health Insurance Literacy Toolkit ...... 55 44. SAMMinistries Health Fair, Screening, and Health Education ...... 56 45. The Impact of Income and Lifestyle on Diabetes Outcomes:A San Antonio Study ...... 57 46. Understanding the Impacts of Socioeconomic and Psychosocial Factors on Diabetes Management...... 58 47. UT Health and Elementary Nutrition –"A Great Pear" for Tackling Childhood Obesity ...... 59 48. Walk it Off: Moving for Mental Health ...... 60 49. Assessing Access to Care in the Texas-Mexico Border City of Eagle Pass Graduate School-Biomedical Science ...... 61

Outreach 50. Assessing the Multicultural Health Needs of El Bari Community Health Center Patients ...... 62 51. Assessment of the Reproductive Health Needs of Female Afghan and Burmese Refugees in San Antonio, Texas: A Focus Group Approach*...... 63 52. Development and Implementation of Art Therapy Curriculum in Elementary-Aged Children at the Madonna Neighborhood Center ...... 64 53. Frontera de Salud - Establishing a Medical Referral Network for the Migrating Underserved ...... 65 54. Inpatient Pediatric Transplant Patients: Caring for the Caretakers ...... 66 55. Transitioning Health Needs in Rural Panamanian Communities...... 67

Kleberg 56. Assessing HIV Risk and Knowledge of Pre-exposure Prophylaxis (PrEP) Among Minorities Scholars Recently Diagnosed with HIV in South Texas ...... 69 57. Cooking Up Convivencia: Adaptation of a Culturally-Relevant Nutrition and Physical Activity Curriculum for Community Health Clubs in the Lower Rio Grande Valley ...... 70 58. Creating Learning Communities in the Texas Border Region to Treat Post-traumatic Stress Disorder (PTSD) Using Cognitive Processing Therapy (CPT)...... 71 59. Early Recognition and Reporting of Child Maltreatment: An Educational Program or School Personnel in the Lower Rio Grande Valley ...... 72 60. Hemophilia Education: A Quality Improvement and Outreach Initiative for South Texas...... 73 61. Operation Naloxone: Medical Student-Led Opioid Overdose Prevention Training ...... 74 62. Stop the Bleed South Texas: Interprofessional, Student-led School Trainings...... 75 63. Subclinical Atherosclerosis in a Mexican-American Cohort...... 76 64. Systematic Qualitative Evaluation of the Breathe Easy South Texas Program: A Community-centered Approach to Latent Tuberculosis Screening and Treatment ...... 77

*Blue Ribbon Winner C M Y CM MY CY CMY K

Sponsors

We recognize this year’s sponsors for helping make this conference possible.

Center for Medical Humanities & Ethics LINC (Linking Interprofessional Networks for Collaboration) Office of the President School of Dentistry School of Health Professions School of Medicine Student Services Fee Committee

We thank the following sponsors for supporting the Center for Medical Humanities & Ethics Community Service Learning program.

Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation

St. Luke's Lutheran Health Ministries, Inc. C M Y CM MY CY CMY K

Diving Deep Into Community

12TH ANNUAL COMMUNITY SERVICE LEARNING (CSL) CONFERENCE

For more information about the Annual Community Service Learning (CSL) Conference or PDFs of this handout, go to texashumanities.org/cslconference.

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