Affiliate Spotlight: Dr. Melinda Butsch Kovacic

This week, we had the privilege of speaking with Dr. Melinda Butsch Kovacic about her public health research and work in the community. Dr. Butsch Kovacic is an Associate Dean of the University Of Cincinnati College of Allied Health Sciences and also has an appointment in the Division of Asthma Research at Cincinnati Children’s Hospital Medical Center. 

Inspiring a Change in Focus 

Dr. Butsch Kovacic is a cross trained as a basic scientist and epidemiologist. She started out at the University of Cincinnati in 2006 with a focus on cancer and later asthma. In 2011, she reached out to a Seven Hills Neighborhood Houses (aka the “Nabe”) in Cincinnati’s West End neighborhood to remedy her lack of healthy Black children in her NIH funded study’s control group. She learned that the Nabe had partnered with other UC researchers before but hadn’t received those studies’ results. Rather than focusing on her own study as she had planned, she asked the Nabe if they would consider developing  a longer term, mutually beneficial partnership with her. It wasn’t until later that this traditionally trained researcher realized that she was proposing a “community-based research” partnership.  After building trust with the staff and leadership of the Nabe over several years, the partnership led to the proposal of the We Engage for Health (WE4H) program.  

WeEngage4Health 

WE4H began in 2018, after receiving funding from the NIGMS Science Education Program Award (SEPA). The program is a collaboration between the University of Cincinnati, Cincinnati Children’s Hospital, and with Miami University, and the Nabe. Dr. Susan Hershberger at Miami University is the Co-Principle Investigator. The program’s goal was to improve science and health literacy, reduce chronic disease in the most impacted communities, and involve community members in improving their own and their neighbors’ health. Dr. Butsch Kovacic works closely with the 15-member CCTST West End Community Research Advisory Board to understand the best ways to serve and communicate with their community. The resulting WE4H programs targets middle school students to adults and uses comic-style stories read out loud together and hands-on activities to engage program participants and communicate health-related topics. The stories’ characters and story lines were co-created by community members and have rich back-stories that readers “get to know” throughout the program. While some characters are healthy, others have health conditions such as diabetes, asthma, and high blood pressure that are explored in the stories.  

During the COVID-19 pandemic, affiliated community partners requested the WE4H team create stories to address concerns about COVID-19 restrictions, masking, and vaccinations. Importantly, the community wanted to better understand the science behind restrictions and recommendations. For this reason, the WE4H team created several stories in their COVID Learning Companion which is now offered on their website.  Their “Take Your Best Shot” and  “Vaccine Victory” stories are also being printed as storybooks for use at health fairs and vaccination events. As a result, Dr. Butsch Kovacic and her WE4H is working with the Cincinnati Health Department on a “COVID Literacy Champions Program” which would distribute WE4H COVID stories broadly in the most vulnerable neighborhoods via trained community members and encourage more individuals to get the vaccine. Dr. Butsch Kovacic explained her belief that public health professionals  have to do more than tell people to get the vaccine; we have to be able to tell them why it is important and why it’s safe. Sharing the “why” will help people overcome their mistrust in medicine and science and better consider the costs versus the benefits of vaccination. Her CCTST C5G study with Jack Kues is just completing a series of focus groups to better understand why some people are hesitant about the vaccine, while others are excited. Recently, one of the staff members at the Nabe passed away as a result of COVID. As a result, her family members partnered with the Nabe, the West End Community Research Advisory Board and Cincinnati Children’s Hospital Medical Center to host vaccine events in the West End and more broadly encourage vaccination. Dr. Butsch Kovacic and her WE4H team were at these events too. 

Three teens read "Take Your Best Shot," one of the books distributed by the COVID Literacy Champions Program.

Community Engagement 

WE4H doesn’t just engage the community through health education, but also had developed training and tools for communities to use to ask and answer health related questions themselves through citizen science. Indeed, their Eyewitness Community survey encourages community members to make observations and record them in an online survey tool in order to learn first-hand how the environment that they live in impacts their own health. A partnership with Keep Norwood Cool aims to assess the health impacts of urban heat islands and air pollution throughout Norwood. Citizen scientists will be asked to observe and record the number of trash cans, standing water, and litter, for example, throughout their streets, carry AirBeam sensors on specific routes to measure air temperature, humidity and air pollution levels, and ask adults about their health and quality of life via an online survey. WE4H also supports community health fairs by providing short educational comic style stories for each table and collecting attendee information via their innovative “health passports”. Dr. Butsch Kovacic always shares the resulting data with her community partners in a format that is easily understood and usable by them.  

Assessing and Reflecting on Impacts 

In addition to using quantitative surveys, Dr. Butsch Kovacic’s WE4H team works with the UC Evaluation Center to collect data via focus groups and other qualitative methods to evaluate their program. They are finding that people are not only understanding the information better, but also acting on what they learn. During one of her focus groups, one participant said, “People always tell me what to do but they don’t tell me why or how to do it. You guys (WE4H) have made it real for me. I am excited about the changes I have made since doing your program.” Dr. Butsch Kovacic smiled as she remember this, saying that she had never dreamed of that kind of impact. She expected knowledge outcomes, but she did not expect behavioral changes so quickly. Now starting year 4 of the project, she is excited to see how many lives can be impacted by WE4H over the final 2 years of the project. 

Answering Hard Questions: Clinical Ethicist Dr. Elizabeth Lanphier

When a patient’s family, caregivers, or medical providers raise ethical questions about how to best balance a patient’s needs, who helps them navigate those conversations and decisions? At the Cincinnati Children’s Hospital Medical Center, a team comprising of doctors and philosophers that all have special training in ethics is prepared to help guide those conversations, hear concerns of families and health care providers, and prepare nurses and other bedside care providers for caring for diverse patient populations ranging from young kids to legal adults.

Dr. Elizabeth Lanphier is part of this team.

As a clinical ethicist, Lanphier is on call to provide counsel about patient care decisions when ethical concerns arise from patients, family, and physicians. Dr. Lanphier addresses questions from families about why an alternate care choice may not be offered, helps doctors and families weigh risks and benefits of medical options, and may work to rectify miscommunications. Much of the time, there is no single clear answer. Lanphier recognizes that families are their own ”experts on their family“ making decisions alongside medical expertise, and provide different perspectives on the risks and benefits of various choices.

Research

Lanphier also researches and writes about bioethics and social and political philosophy, often as it relates to medical care. In addition to being a clinical assistant professor in the Division of General and Community Pediatrics in the UC College of Medicine, Lanphier is a research assistant professor in the UC philosophy department, and affiliate faculty in the UC women, gender and sexuality studies department. In graduate school at Vanderbilt University, from which she earned her PhD in philosophy, she was interested in the intersection of medicine and philosophy, and sought out experiences related to this intersection with the Vanderbilt University Medical Center and its Center for Biomedical Ethics and Society.

Now, she uses moral philosophy to put bioethics into practice, especially as it relates to healthcare access, justice, and inclusion. Her desire to understand and serve vulnerable populations, especially those who have historically been mistreated or neglected, drives her research.  Currently , Dr. Lanphier is working on the connection between  trauma-informed care and ethics consultation and recently published a paper advocating for a trauma informed approach to ethics consultation with neonatologist Uchenna Anani.

Additionally, her community work during graduate school with people incarcerated on Tennessee’s death row has instilled in her research and advocacy a commitment towards the incarcerated population. Last year Lanphier along with colleauges Takunda Matose and Abu Ali Abdur’raham (who is currently incarcerated on Tennessee’s death row) published a paper in the Public Philosophy Journal. In December she advocated for incarcerated persons to be prioritized higher in Ohio’s COVID-19 vaccine allocation. The resulting opinion piece received positive feedback, including from a senator who acknowledged how much work needs to be done. While some public reactions were critical, she was thrilled that it had such a wide impact, as she always aims to reach as broad an audience as possible. She and a colleague are investigating if and how the incarcerated population can take part in studies such as the COVID-19 vaccine trials without risking the coercion or exploitation this population has historically experienced in the medical research leading to tighter research regulations on incarcerated persons and other vulnerable populations.

Trust in Science

COVID-19 has brought important questions about bioethics, healthcare access, and public confidence in medical research to the forefront.  Lanphier sees medical professionals growing frustrated as the public’s trust in science deteriorates. To her, this means that clear communication and approaching medical research in a way that regains that trust is paramount. Part of this includes increasing representation of persons of color (POC) in biomedical research as researchers and participants to help increase confidence in clinical trial outcomes. As her opinion piece in the Columbus Dispatch shows, she has been considering the problem of who should have access to the COVID-19 vaccine, as it is still a limited resource. For example, healthcare workers should be offered it, because we need them to keep us healthy and they are at risk of virus exposure. Beyond that, it gets more complex. How do you designate other frontline workers? Many groups, including store workers and teachers, are needed, but by the time we include so much of the population, we are well beyond the number of available doses, though this number of available doses continues to increase. With this scarcity and the vaccine currently approved for emergency use, we are also a long way from being able to mandate receiving the vaccine for those who work with the vulnerable. She also posed the question of how to approach undocumented populations, who still play a critical role in their communities but may have limited access to healthcare, and also stressed that vaccine roll out needs to also address hesitancy.

Lanphier’s career path leading to her position on a clinical ethics team combined philosophy with practical experience and post-doctoral training working in healthcare environments.  Her role mixes a theoretical, philosophical approach to broader questions with day-to-day interaction with families and care teams related to ethical concerns that come from a diversity of beliefs and backgrounds. She encourages anyone wanting to follow a similar path to seek out a wide variety of experiences and talk to others who are already established in their field.