On December 29^th, the Providence Community Health Centers began administering its first doses of the Moderna COVID-19 vaccine to frontline workers from its health centers. The vaccine is not yet available at health centers for distribution to the public.

The initial shipment of the vaccine from the Rhode Island Department of Health includes 300 doses which are first being distributed to employees who are in closest contact with patients including members of the dental team, Express Care, and those who work in the COVID testing tent.

At 8:10 a.m. on December 29^th, dental hygienist Carleen Signore became the first PCHC employee to get the vaccine. Carleen, who has been with PCHC for 15 years, was excited to receive the vaccine. “While the process to approve the vaccine was fast-tracked, I feel confident knowing that clinical trials were successfully conducted to ensure safety and effectiveness,” said Carleen. “I will encourage my co-workers and patients to get the vaccine.”

Moderna’s two-dose vaccine has proven to be 94% effective in preventing COVID-19 infections. As more doses of the vaccine become available, PCHC will offer it to its more than 500 employees, utilizing a tiered approach where frontline workers are immunized first.

Providence Community Health Centers has been a statewide leader in responding to COVID, opening the Rhode Island’s first drive-through and walk-up testing sites in April 2020.

Dr. Nadine Hewamudalige has been named Medical Director for the Providence Community Health Centers, the state’s largest health center network.

She joined the organization in 2016 and most recently served as Physician Lead at PCHC’s Central Health Center.

As Medical Director, Dr. Hewamudalige’s responsibilities include guiding teams of physician site leaders, medical specialty chairpersons, and clinicians to ensure the delivery of high quality, safe, and effective healthcare. She will also focus on developing collaboration of clinicians across the PCHC network in the pursuit of excellence in clinical outcomes and patient access.

“In my years here, we have changed the way we provide primary care multiple times over to meet the changing needs of our patients and healthcare system,” said Dr. Hewamudalige. “We will continue to do so, always with an eye on delivering the best possible outcomes with a personal touch.”

“Dr H”, as she is known to many, is a graduate of the medical school at Ross University School of Medicine. She completed a family medicine residency at Penn State University Hershey Medical Center in Hershey, PA where she served as Chief Resident. Born and raised in Vancouver, Canada, she attended the University of British Columbia for her undergraduate studies.

“During her time with us, Dr. Hewamudalige has focused on improving quality metrics, teamwork, and collaboration, while advocating for and supporting providers and care teams,” said Dr. Andrew Saal, Chief Medical Officer at Providence Community Health Centers. “Now, she will help develop those priorities throughout our health centers during a time of transformation and growth.”

The following interview with Dr. Nelly Burdette was featured in the December 21^st issue of Providence Business News.

Dr. Nelly Burdette, associate vice president of integrated behavioral health at The Providence Community Health Centers Inc., was the sole employee in the behavioral health program when PCHC launched it five years ago.

Today, the program is staffed by nearly 20 clinicians. Burdette discusses its growth, the effect of the COVID-19 pandemic on mental health needs and her take on what role telehealth is likely to play in behavioral health treatment in the future.

PBN: How has the behavioral health program at Providence Community Health Centers changed since it was created five years ago with you as the sole doctor?

BURDETTE: When I began the Integrated Behavioral Health Program, it was just me trying to meet with all of the patients who wanted and needed the service, while also trying to create the program from the ground up. With over 60,000 patients and an overwhelming response to the service initially, it quickly became clear that integrated behavioral health was a critical necessity to our growth.

Today, we have 20 staff across our eight largest health centers in a variety of behavioral health disciplines. The past three years, we have been awarded for the National Committee for Quality Assurance’s Behavioral Health Distinction, the gold standard for providing the highest level of integrated behavioral health in the country.

We have created community collaborations that bring new and exciting options into the health centers such as acupuncture, housing services, medical legal partnerships, and both Rhode Island College and University of Rhode Island as student-training sites. Next up is the launch of an innovative multidisciplinary oncology survivorship treatment clinic in partnership with Roger Williams Cancer Center, starting in early 2021.

PBN: Roughly how many patients are cared for by PCHC’s behavioral health program, and what types of treatment does it offer?

BURDETTE: Integrated behavioral health embedded within primary care is a defining feature of PCHC’s approach to serving our population from a holistic perspective. In the health center setting, this care is a short-term, solutions-based treatment for patients across all ages who have mild to moderate mental health and substance use issues that would benefit from a different approach than specialty mental health therapy.

In 2016 – our first full year – we had more than 3,800 patient visits. We have steadily grown the number of patient visits every year since. In 2019, we had more than 9,000 patient visits and this year, we are already 1,000 visits ahead of that pace. We expect that growth to continue as the need for these services increases.

PBN: What sort of effect have you seen the COVID-19 health crisis have on mental health needs in Rhode Island, and are more patients coming to you for care?

BURDETTE: The COVID pandemic has exposed the underlying mental health and substance use epidemic that has been growing for years in our state. All PCHC patients over the age of 18 are screened for depression, anxiety and substance use. Anxiety in adults has seen the largest clinical increase across all sites since the pandemic began.

For children, needs have arisen around the intersection of this new approach to schooling and their home lives. A number of our school-age patients lack access to computers and the internet, and may have a home life situation that was already unstable prior to the pandemic. There has been a considerable increase in demand for behavioral health services in our integrated primary care settings and we have met that demand largely through our rapid adoption of telehealth.

PBN: Are you and other doctors at the behavioral health center continuing to see patients via telehealth because of the pandemic, or have you begun in-person visits again?

BURDETTE: While we started to see behavioral health patients via telehealth due to the pandemic, we have mostly remained on-site while doing so. We anticipate continuing to provide tele-integrated behavioral health after the pandemic is more under control. Frankly, many patients and providers prefer the telehealth service for the ease and access it opens up. We are now able to easily connect with our patients during their breaks at work or from their homes, without exposing them to heightened risks of in-person visits or struggling to consider how to arrange for and manage transportation and/or requesting time off from work.

We were very fortunate to have also received a grant from the Rhode Island Foundation that allowed us to continue to waive all integrated behavioral telehealth copays for our uninsured patients who use a sliding scale option.

PBN: Have you found telehealth to be just as effective as in-person visits for behavioral and mental health issues?

BURDETTE: For PCHC, integrated behavioral telehealth is often an improvement to an in-person visit, as it allows the patient more flexibility in their schedule. Telehealth also allows providers a glimpse into the homes and lives of patients in a different way than an office visit. However, we have found that for children under the age of 10 and elderly patients over the age of 65, there can be a limited knowledge base and comfort with telehealth that makes an in-person visit preferable.

There have been issues related to telehealth like internet connectivity, technological literacy of providers and patients, and the need for a safe and private location for patients to speak. Much of the research in this field, however, has found telehealth to be as effective for mental health and substance use as in-person care.

Dr. Mansi Kachalia James, a board certified Allergist/Immunologist, has joined the Providence Community Health Centers and will work from our new specialty clinic site at Randall Square, where she hopes to begin offering a wide variety of services including environmental skin testing, drug and food allergy testing and oral challenges.

Dr. James completed a two-year ACGME-accredited Allergy and Immunology Fellowship from Baylor College of Medicine, where she served as co-Chief Fellow. She completed her Pediatric residency at Baystate Medical Center in Springfield, Mass., following her graduation from Lake Erie College of Osteopathic Medicine.

During her fellowship, Dr. James gained in-depth clinical experience in allergic and asthmatic diseases, congenital and acquired immunodeficiency, and systemic inflammatory and immunologic disorders. She has worked on a number of research projects and has several health-related volunteer experiences to her credit from India and Ghana to Florida. Before starting medical school, Dr. James spent two years as a licensed teacher with Teach for America, working with children in low income communities to reduce the education gap.

Are you a recent Family Nurse Practitioner graduate looking to start a career in community health?

The Providence Community Health Centers is one of nine organizations that will be recognized for its efforts to promote and enhance diversity and inclusion in the workplace.

Every day, the health of individuals is impacted by their social status, stress, early life, economic opportunities, safety of community and workplace, and availability of quality schooling, food and transportation.

These social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status.

Our Community Health Advocate (CHA) team has worked aggressively to help patients address these issues. Most recently, our CHA’s have partnered with RIHousing and ONE Neighborhood builders to place patients in long-term living situations, recently enrolling the sixth patient in permanent housing. Over the summer, the partnership enrolled its first family in housing, a mother and her three children who had been homeless for the past four years.

The CHA’s role is to support the patient in their transition from homelessness to ensure they stay housed and engaged with their primary care team. The CHA assists with the lease signing, utilities set up, finding furniture/donations, checking in on rent payments, applying for SSI and SNAP, finding employment and transportation. They do this through weekly follow-up visits with the patients. Thank you to our CHA team for partnering with others to change the lives of people in the community.

Businesses and schools everywhere had to adjust how they operate over the last several months as the COVID-19 pandemic swept the country. For a group of interns – and their supervisors -- at The Providence Community Health Centers, it meant finding new, mostly virtual, ways to contribute.

Many of the interns were originally going to work at a second COVID-19 testing site. When that site did not come to fruition, new duties were designated to the 12 interns, whose work was coordinated and supervised by a variety of PCHC staff including Dr. Andrew Saal, Chief Medical Officer, and various members of the clinical, administrative, and human resources team.

“Internships are invaluable to young people looking to gain hands-on experience,” said Cheryl Perry, Vice President, Chief Marketing & Human Resources Officer at PCHC. “Their contributions help us advance our cause of creating a healthier community. This group of interns was impressive and enthusiastic and we look forward to seeing what they will do next.”

Kathryn Sullivan, who just started her senior year at North Carolina State University, was originally slated to work in the second COVID testing tent. Instead, she went to work with Dr. Jonathon Gates, Chief Medical Officer for Accountable Care, and Daniel McGuire, Director of Population Health. Here, she learned about the care gap that exists locally and nationally. She helped outreach to patients, particularly those who needed colorectal cancer screening.

Kathryn, who is originally from North Kingstown, is now applying to Physician Assistant programs as the next step in her educational journey.

Katelyn Loyo, a Providence native who graduated from E-Cubed Academy, worked directly with Graciela Morales, patient engagement coordinator, as well as other staff members. Graciela taught Katelyn how to work with patients to best direct them to resources inside and outside of PCHC.

“While speaking to patients, they talked about how happy they are with the services PCHC offers,” said Katelyn. “That’s very important for patients to feel like they’re in great hands.”

Katelyn wants to pursue a career in nursing, following in the footsteps of her grandmother who is a nurse in Guatemala.

Benjamin Coleman from North Kingstown also worked in the Accountable Care Organization with Dr. Gates, Dan McGuire, and Graciela Morales. There, his eyes were opened to PCHC’s efforts to address a patient’s health before they get sick. “Working on the ACO team taught me a lot about preventive health care and the importance of prioritizing one’s health year-round through recommended screenings, a proper diet, and an active lifestyle,” he said.

As part of the colorectal screening effort at PCHC, Ben spent time on the phone with patients, learning more about their specific challenges and he says, “the barriers that often impede Americans from receiving access to medical care.” Ben is interested in attending medical school after graduating from the University of Miami.

Amy Burt, a junior at Unity College in Maine, served her internship updating policies and performing data entry. She worked in a variety of roles and was supervised by several PCHC staff members. No matter the assignment, she said there was one consistent theme.

“The mission statement of PCHC shined through in all the tasks I was assigned,” she said. “Three core values stood out to me throughout my experience: cultural competency, compassion, and respect. All of these actions promoted a productive and safe environment.”

Amy plans on becoming a licensed clinical social worker but is still open to other career options. “I know whatever I do,” she said, “I will stay true to my goal of helping others.”

A brother and sister from North Kingstown -- Nicolette and Maximino Naya -- spent the summer interning at PCHC.

Nicolette, who just started her senior year at the University of Connecticut, thought she was returning to an internship she held previously at Tiffany & Co. When that was cancelled due to the pandemic, she took on an internship at PCHC, learning about Electronic Health Records under the guidance of Sharon Joseph, Director of Health Information and HIPPA Compliance. While Nicolette said she is not considering a career in healthcare, she learned a lot over the summer and grew appreciative of the work that goes on every day at PCHC.

Max, a student at Stetson University in Florida, intended to spend the summer studying overseas but his plan was derailed because of COVID-19. Instead, he interned at PCHC, assisting with the organization’s marketing and social media efforts, working closely with Susana Conklin, Chief of Staff. As Max is considering a career in marketing or sales, it was a perfect fit at an organization where he could feel good about contributing. “I saw firsthand that PCHC is always actively trying to better itself to be able to best serve their community,” said Max.

Elizabeth Pekar from North Kingstown is a senior at The George Washington University. She worked with clinical pharmacist Lillian Nieves, who she describes as “extremely knowledgeable, kind, and a great teacher,” during her internship. Elizabeth, who wants to become a Physician Assistant, said she learned a lot during her time in the pharmacy including “common practices and protocols to detailed population health projects that Lillian is working on to better the PCHC community. I have also learned about the amazing work that PCHC is doing to provide equal access to healthcare, which is not only extremely encouraging, but inspiring.”

Elizabeth is pictured on the right, along with (from left to right) Lea Diaz, PCHC Certified Technician II, Gabrielle Davis, Pharmacy Summer Intern, and clinical pharmacist Lillian Nieves.

Kristina Krashovats, who is originally from Russia and attends Truman State University in Missouri, learned about the multiple factors that can influence health care finances. She was not one of the summer interns originally targeted to work in the COVID tent; instead, she applied for a competitive internship slot at PCHC and was chosen because of her background and interest in finance.

While she has focused on banking and other industries as a finance major, it was her first time working in health care. “Before the internship, I prepared by reading “accounting for healthcare” textbooks,” said Kristina. “All the numbers were given to me. For example, revenue was simply the product of charge per visit and total number of visits.”

Her real life experience was different as Kristina learned much more about analyzing statistics, profitability, and even anatomy to more deeply understand the world of healthcare finance.

“I had to figure out all the potential cost sources and activities involved in the process of treatment, and collaborate with specialists like an opthalmologist to ensure my assumptions and research conclusions were valid,” said Kristina. “This was definitely a new and exciting experience for me.”

Anastasia Paraliticci, a North Kingstown native who is a student at the University of Rhode Island, worked over the summer as an intern in community outreach. She helped “inform the public about how to access health care, services which many people were not aware of”, while working with Adriana Vargas, Director of Community Outreach. Anastasia enjoyed speaking Spanish with Adriana (which she says is “something I don’t get to do very often outside of my household.”) She also saw the importance of relationships in community outreach, noting that Adriana “is very outgoing and knows everyone in Providence and all surrounding communities.”

“Student interns always bring a fresh perspective,” said Adriana of her time mentoring Anastasia and other interns. “Their analytical, writing, research, project and interpersonal skills make a great difference in the work being done here. This has been the case with Anastasia who brought many skills, and most important, a wiliness and readiness to support the advancement of many projects.”

On November 12th, the Providence Community Health Centers will be recognized with the 2020 Meritorious Program Award at the 23rd annual meeting of the Rhode Island Public Health Association. This award is presented to a group that has made significant contributions to the advancement of public health in Rhode Island at the federal, state, or local level. Criteria is based upon recognition by a group of public health peers familiar with the development and advancement of public health in Rhode Island.

PCHC is being honored for our outstanding response during the early COVID-19 outbreak including leadership, community advocacy focused on housing and domestic violence, and using data to identify health disparities. Accepting on behalf of PCHC at this virtual event will be Dr. Andrew Saal, Chief Medical Officer, Chelsea De Paula, MPH, Manager of Community Integration & Social Determinant of Health Strategy, and Daniel C. McGuire, Director of Population Health. Congratulations to everyone involved for helping PCHC achieve this recognition.