The Community Research Core leadership team meets regularly to formulate ways to expand and develop Yale’s translational research efforts internally at the university and externally in the community.
Margaret Grey, DrPH, RN, FAAN
Director, Community Research Core
As a pediatric nurse practitioner, Margaret Grey, DrPH, RN, FAAN, is well aware of the toll that chronic illness takes on young patients. That’s why she has pursued research that aims to improve the lives of children with type 1 diabetes and prevent type 2 diabetes in high-risk children and adolescents.
Dr. Grey’s research on coping skills training for teenagers with type 1 diabetes showed that it helps these young patients better control their blood sugar, which translates into reduced long-term complications. Leveraging teenagers’ interest in technology, she adapted this innovative program for the Internet and has also used it to study prevention of Type 2 diabetes in teens. She envisions a growing role for mobile technologies in helping patients manage and prevent other chronic diseases as well.
Combined with her role in the development of practice-based research networks in nursing, Dr. Grey’s experience in community-engaged research makes her ideally suited for her role as Deputy Director of YCCI and Director of the Community Research Core. “All research ought to have a piece of community engagement,” she said, adding that community-engaged research may not necessarily happen in the community.
It should, however, involve the community and address the concerns of its members. Dr. Grey and her team work closely with members of the New Haven community through the Cultural Ambassadors program, a group whose participation she considers to be integral to boosting community-engaged research and translation of findings within the community. She has also established ties with New Haven’s Mayor’s office and has created working groups with basic and clinical scientists, clinicians in the community, and community members to strategize research opportunities in areas that matter to New Haven’s residents.
Her commitment to strengthening Yale’s community-engaged research activities is evident in her emphasis to train young investigators in this type of research. As director of the Community Research Core, she has provided opportunities for them to develop projects and obtain pilot funding. She believes that mentoring junior faculty members “assures the future of science,” and has mentored more than 100 trainees during her academic career.
Dr. Grey notes that community-engaged research is interdisciplinary in nature and she has sought to leverage the expertise available at Yale by including leadership for the Community Research Core from across the medical campus. “I believe that by bringing together scientists from a multitude of disciplines with clinicians in our community health centers and community members, we can adapt innovative approaches,” she said. “Ultimately the collaborative work between the community and YCCI changes health in the area.”
For more on Dr. Grey, click here.
Marcella Nunez-Smith, MD, MHS
Growing up in St. Thomas, U.S. Virgin Islands, a health professional shortage area, Marcella Nunez-Smith, MD, MHS, remembers countless stories of loved ones and members of her community who struggled with their health or died prematurely. That experience led her to pursue a career in medicine and conduct research that focuses on vulnerable populations and their interactions with healthcare systems.
Ever since her arrival at Yale as a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program (CSP), Dr. Nunez-Smith has been on a mission to develop ways of addressing health and healthcare inequities wherever they are found: in patient settings, in the healthcare workforce, and in medical education. As a 2006 YCCI Scholar, she gathered preliminary data for what is now known as PreDict (Patient-Reported Experiences of Discrimination in Care Tool). PreDict is a tool that assesses the patient care experience and measures hospital performance with the goal of improving the quality of care delivery. “The Scholar award was tremendously helpful because it allowed me to launch a line of inquiry that was new and then provided me with the resources to complete the preliminary work that allowed us to be competitive for major NIH grants,” she said.
Dr. Nunez-Smith went on to develop the Eastern Caribbean Health Outcomes Research Network (ECHORN), a collaborative multi-million dollar research study funded by the National Institute for Minority Health Disparities (NIMHD). ECHORN examines the risk factors and prevalence of cancer, diabetes, and heart disease in the Eastern Caribbean, a region for which such data are lacking.
Both ECHORN and PreDict – which has spurred several related projects undertaken by her mentees – are now incorporated into the Equity Research and Innovation Center (ERIC), for which Dr. Nunez-Smith serves as director. ERIC builds on the local, national, and global experience of Dr. Nunez-Smith and 60 team members that are involved in research aimed at narrowing health and healthcare inequities, as well as disparities in the healthcare workforce and medical education.
As a former YCCI Scholar, Dr. Nunez-Smith appreciates the benefits of mentorship and serves as academic advisor to Yale School of Medicine students. She also continues her involvement with the CSP as a core faculty member of the Scholars Program and co-director of Community Research Initiatives. “I’m working towards synergy across all of these programs so they’re not siloed,” she said. “The idea is to think about core elements of knowledge for our faculty for population health and health equity and engage stakeholders in our work.”
For more on Dr. Nunez-Smith, click here.
Patrick O’Connor, MD, MPH
The HIV epidemic was exploding among intravenous drug users when Patrick O’Connor, M.D., M.P.H., came to Yale in the late 1980s. At the same time, patients were literally dying while waiting to enter addiction treatment programs due to long waiting lists for methadone maintenance. As a Robert Wood Johnson Clinical Scholar, Dr. O’Connor undertook research to help this community, focusing on finding ways of expanding access to highly effective treatment for addiction by investigating innovative new treatment approaches that could be provided in new and much more widely accessible settings: primary care and general medical health care facilities.
“People with addictions are much more likely to walk into primary care offices or emergency departments than treatment programs,” he said. Over the last 30 years, he has devoted his efforts to identifying and providing effective treatment for addiction when people present to these general medicine settings.
“This research has a major community-based focus in that subjects are recruited from the community and we’ve been able to translate the results of this research into expanded treatment options for the community,” he said. One example is his work on buprenorphine, a medication used to treat opioid addiction, which has moved from experimental treatment through policy review, FDA approval, then into widespread use. This research and health policy efforts that followed led to the development of suboxone, a combination of buprenorphine and the opioid antagonist naloxone, that is currently used to treat addiction. In fact, this new treatment is now provided to more patients than is methadone maintenance. His research has meant that people not just in New Haven, but around the country have greater access to highly effective addiction treatment.
Dr. O’Connor’s research expertise and experience make him a valuable member of the Community Research Core leadership team. He feels strongly that the School of Medicine should be involved in conversations with the community on issues surrounding research. “We need to be engaged with the community as full partners when research is conceptualized so that there is input as to how projects are designed and carried out,” he said. As a natural extension of that concept, he believes that Yale’s research projects should include an emphasis on community health priorities.
His efforts with the Community Research Core include finding ways to connect with community members early in the research process and collaborating with other investigators on broader issues that are central to the community, such as health disparities, re-engagement with healthcare for ex-prisoners, cardiovascular disease, and cancer. “We have a world class group of clinical investigators at Yale who are committed to collaborating effectively with our community and I am working hard to facilitate those connections,” he said. “It’s a win-win on both sides.”
For more on Dr. O’Connor, click here.
Rafael Perez-Escamilla, PhD
When he came to Connecticut in the early ‘90s, Rafael Perez-Escamilla PhD, was surprised to find the same major health inequities affecting Latinos in America’s wealthiest state as he found in developing countries. For the past two decades, he has devoted himself to community-engaged research designed to mitigate these disparities.
“It’s important to encourage minorities to participate in clinical research but the work I do with my community partners goes beyond that to find solutions to address health disparities and health inequities in affected communities in Connecticut,” he said.
For over two decades he has worked with a community-based organization in Hartford to determine and address challenges Latinos face in terms of food insecurity and malnutrition. That partnership has led to major ongoing initiatives involving nutrition education for families and innovative community-based programs to increase food access.
In 2005, he established the NIH-funded Center for Eliminating Health Disparities Among Latinos, a project that involved community health workers who were fully integrated into the healthcare team to help Latinos with Type 2 diabetes better manage the condition. A randomized controlled study on the impact of this structured intervention showed significant improvement in blood glucose levels in those working with community health workers compared to those in the control group.
His ongoing study, LATCH (Lactation Advice thru Texting Can Help), at Yale-New Haven Hospital and Fair Haven Community Health Center, provides WIC program peer counselors with a text messaging platform that allows them to provide timely encouragement, outside resources, and direct assistance to new mothers. LATCH is believed to be the first breastfeeding peer counseling intervention to utilize a two-way communication text messaging platform.
Dr. Perez-Escamilla is also very involved in the translation of science into policy. He was appointed to the Federal Dietary Guidelines Advisory Committee in 2010 and 2015, is a member of the Food and Nutrition Board of the Institute of Medicine, and is an expert external advisor on breastfeeding for the World Health Organization.
His work in community-engaged research to develop interventions and then to actually package, deliver, and test them in randomized controlled community trials makes Dr. Perez-Escamilla uniquely suited to serve on the leadership team of YCCI’s Community Research Core. His vision for the Core focuses on developing training for faculty and students to understand and conduct community-engaged research and fostering equitable partnerships with community-based organizations that are crucial for these models to work well.
For more on Dr. Perez-Escamilla, click here.