eScholarship@UMassChan
eScholarship@UMassChan is a digital archive for UMass Chan Medical School's research and scholarship, including journal articles, theses, datasets and more. We welcome submissions from our faculty, staff, and students. eScholarship@UMassChan is a service of the Lamar Soutter Library, Worcester, MA, USA. See also our open access journal publishing services.
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Recent Publications
Publication Metadata only Bridging Systems of Care: Experiences of Faith Leaders Supporting Community Mental Health in Worcester, Massachusetts(2026-04-11)Amid ongoing workforce shortages in primary and mental healthcare, faith leaders play an important role in supporting individuals with mental health concerns, particularly in culturally diverse urban settings. We conducted semi-structured interviews with 13 faith leaders from diverse religious backgrounds in Worcester, Massachusetts. Interviews explored understandings of mental health, approaches to supporting congregants, and interactions with the healthcare system. Data was analyzed using thematic analysis. Four major themes emerged: (1) faith leaders are approached for a breadth of mental health concerns which are understood to be multifactorial; (2) faith leaders are accessible and complementary resources; (3) faith leaders are vulnerable to burnout; and (4) collaboration with the health system is limited and inconsistent. Ulti- mately, we describe that faith leaders offer accessible, comprehensive, longitudinal, and coordinated mental health support, though encounter significant challenges including outdated referral resources, lack of formal training, emotional burden, and inconsistent engagement from healthcare systems. Strengthening collaboration through faith leader training programs, updated referral pathways, shared dialogue spaces, and improved cultural and religious competency among clinicians has the potential to improve community mental health by targeting specific, modifiable barriers identified by faith leaders.Publication Open Access A lifeline on wheels: perspectives of stakeholders on the implementation and impact of a mobile medications for opioid use disorder unit(2026-04-11)INTRODUCTION: Mobile health units (MHUs) providing medications for opioid use disorder (MOUD) have emerged as a critical strategy to address gaps in opioid treatment access, particularly for marginalized populations. Research has yet to explore stakeholder perspectives on MHUs' implementation, challenges, and long-term sustainability. METHODS: We conducted semi-structured interviews with 15 stakeholders, including MHU staff, administrators, community partners, and policymakers. Interviews explored experiences with the MHU, barriers and facilitators to patient engagement, and operational challenges. Data were transcribed, coded, and analyzed using a template thematic approach to identify key themes related to implementation and sustainability. RESULTS: Stakeholders endorsed the MHU as a highly accessible and flexible intervention that reduces barriers for people experiencing homelessness, economic instability, and transportation limitations. The MHU facilitated strong patient-provider relationships and access to harm reduction, primary care, and social services. Challenges included staffing shortages, inconsistent funding, limited clinical space, and environmental barriers. Additionally, stigma, political resistance, and law enforcement interactions affected service delivery and patient engagement. DISCUSSION: Findings highlight the importance of policy and funding mechanisms to ensure the long-term viability of MHUs. Stakeholders recommended expanding outreach, increasing staffing, and integrating additional services. Addressing these challenges is essential to sustaining MHUs as an effective public health intervention for opioid use disorder.Publication Open Access New approaches to discovering epigenetic rules of homeostasis in diverse mammal species(2026-04-10)Background: While the cells of some mammals, such as humans, maintain their internal5 temperature within tightly controlled ranges, the cells of others, such as dromedary camels,6 experience wide ranges of temperature variation. In order to understand these differences, it7 is critical to identify differentially expressed genes (DEGs) and their interactions; however,8 the data available are often insufficient to obtain statistically significant results.9 Results: We develop an explanatory model to understand the mechanisms of response of10 mammalian species to environmental perturbation on the basis of empirical gene expression11 data. Our approach is motivated by the novel idea that approximately preserved or reduced12 inter-individual variability of expression levels upon environmental change is an indicator13 that a given gene contributes to a homeostasis-preserving mechanism for the species. To14 identify such genes, we use a simple non-statistical criterion that is suitable even when the15 number of replicates is limited. We then identify four extreme subgroups of the DEGs,16 and from these construct an intuitive neural network architecture that best interpolates17 the data and describes the principal response rules of the considered species. Finally, we18 propose measures of the robustness of homeostasis (well-being) from these networks based19 on perturbation analysis and entropy computations. The data used to develop the model20 were collected from homogeneous cell cultures of skin fibroblasts.21 Conclusions: Even with data available for just a few individuals, our model identi-22 fies extreme response sets of genes, using inter-individual variability to provide a faithful23 representation of the response of the species to environmental perturbations. Sets of genes24 identified as relevant in individual species are useful for comparing responses across species.25 All the measures of cellular well-being introduced in this work rank camels higher than26 humans for both the 32° and 41° treatments.Publication Metadata only Use of a Process Map to Evaluate the Implementation of a Community-Clinical Linked Pediatric Asthma Intervention(2026-04-08)PurposeTo use a process map to evaluate implementation of a community-clinical linked asthma intervention.DesignFollowing the CDC Logic Model, we created a process map that outlined: (1) training community partners, (2) pediatric providers enrolling children and prescribing a second preventive inhaler, (3) families delivering the inhaler to school, (4) children visiting the school health office for daily supervised inhaler administration, and (5) ongoing communication.SettingThe trial which the present data comes from was conducted within 4 pediatric primary care practices.SampleThe study sample included pediatric providers/staff ( = 14), children ( = 31), parents ( = 31), and school health staff ( = 18).MeasuresAdherence measures were defined for each process step, using surveys and tracking data.AnalysisDescriptive and frequency statistics were calculated.ResultsAll recruited pediatric practices ( = 2) and schools ( = 46) completed training (100%, = 48). Although delays occurred in sending medication orders from practice staff to schools, all orders were received within 6 weeks of enrollment. Children attended school health offices 92% of scheduled medication days. Providers and families reported high satisfaction with communication, though challenges existed between providers and school health staff.ConclusionUsing a process map, we were able to evaluate adherence to intended process steps and inform future adaptations to improve implementation. Process maps can be practical tools for guiding implementation evaluations and intervention adaptations.Publication Metadata only Massachusetts Medicaid Housing Supports Reduced Health Care Costs Among Adults With Behavioral Health Conditions(2026-04-06)In 2020, Massachusetts Medicaid launched the Flexible Services Program (FSP) to fund housing and nutrition assistance services for beneficiaries in accountable care organizations. To evaluate the program's impact on health outcomes for beneficiaries with behavioral health conditions, we compared changes in total health care costs, hospitalizations, emergency department (ED) visits, primary care visits, and hospital readmissions among 6,575 FSP participants enrolled during the period 2020-23 with those of a comparison group of people who were eligible for but did not receive FSP services. We also conducted the analysis with a secondary comparison group of 6,419 similar beneficiaries enrolled in Medicaid managed care organizations that did not offer FSP services. Relative to the primary comparison group, per person health care costs for FSP participants were $2,117 lower six months after beginning the program and $3,260 lower at twelve months. ED visits were 5 percent lower and readmissions were 36 percent lower at twelve months among FSP participants compared with the primary comparison group. Analyses using the secondary comparison group found similar reductions in costs at six months after FSP initiation, larger cost reductions at twelve months, and similar twelve-month declines in readmissions. These findings support the continuation of housing assistance programs for Medicaid beneficiaries with behavioral health conditions.