The M.D./M.P.H. joint degree program at the University of Miami Miller School of Medicine implemented a public health immersion program two years ago to enrich students’ education with hands-on experience. The goal is for students to not only learn about concepts such as population health and the social determinants of health in the classroom, but to understand the broader impact of these concepts in the community.
“We want students to have early exposure to what public health looks like in real-word practice and for them to understand the intersection between the field and other equally important areas, such as clinical medicine, law, housing, syringe service programs, and more,” said Roderick King, M.D., M.P.H., director of the M.D./M.P.H. program at the Miller School. “Part of what is driving the immersion program is the interest of students to learn more about the public health issues that are happening in the community around them.”
This summer, new M.D./M.P.H. students have spent time in Judge Jeri Cohen’s Adult Drug Court at the Richard E. Gerstein Justice Building and have visited the IDEA Exchange, a syringe service program – both within walking distance of the Miller School campus.
The Adult Drug Court in the Eleventh Judicial Circuit of Florida is a volunteer diversion and treatment program for defendants in substance abuse cases. Since 1989, the goal of the program has been to provide people with rehabilitation services for a minimum of one year, while under the supervision of the presiding judge.
“From my perspective, I hope that the M.D./M.P.H. students walked away believing that courts are more than just places where cases are adjudicated in a balls-and-strike, cold-hearted way,” Judge Cohen said. “Besides adjudicating cases, family and criminal courts are also engaged in helping people recover from substance use disorder and untreated mental illness.”
Adult Drug Courts follow a process that sets them apart from other criminal courts. When a defendant finishes a treatment program and their case no longer needs to be supervised, their treatment counselor will recommend that the judge close the case. Their case is then reviewed by the judge and treatment counselor, with the defendant's recovery and progress in academic and vocational activities taken into consideration. The judge then makes the final decision on the outcome of the case.
If the case is closed, the defendant graduates from the program and no longer needs to be under court supervision. For those who qualify, their arrest record is expunged, which benefits their future employment and career prospects.
Sitting in the Adult Drug Court was an eye-opening experience for M.D./M.P.H. students, as they witnessed the extent of Judge Cohen’s interest in the defendants’ well-being.
“The process is definitely more representative of justice,” said William Trevino, a first-year M.D./M.P.H. candidate. “Judge Cohen weighed out each case fairly and was compassionate, but also knew when to be stern. One can see that she's neutral, but also that she's really interested in each person and their recovery as well.”
“I think the use of adult drug courts is an important shift in the frame for the legal system which treats addiction as a disease instead of a legal violation,” added Brianna Mussman, a first-year M.D./M.P.H. candidate. “This allows people who need mental and physical health support, as well as support in working towards sobriety, to be able to access those services instead of simply being penalized for their actions.”
Students also visited the IDEA (Infectious Disease Elimination Act) Exchange, which provides resources for people who inject drugs to prevent and reduce the spread of HIV, Hepatitis C, and other blood-borne diseases. People can exchange their used needles for clean ones, as well as get tested for HIV and Hepatitis C.
“We also have a wound care clinic here on Thursdays,” said Carlos Padron, M.P.H., the site supervisor at the IDEA Exchange. “There is also a mobile unit, which provides the same resources at the main site, but around several areas in Miami-Dade County, like Florida City. When they are ready, we connect them with various rehabilitation and treatment options.”
Padron, who took M.D./M.P.H. students on a tour, said participants are provided with Narcan, which is used for drug overdose reversals, as well as with safe injection packs. They can also learn about overdose prevention, both at the main site and on the mobile unit.
“I was struck by how much the IDEA Exchange was integrated into the surrounding community, and how much they thought about the population they serve in not only the resources that they provide, but even in regard to their spaces,” Mussman said. “The program is housed in trailers, and in discussing this space with those working at the program during the site visit, it was clear that they felt moving to a formal building had the potential to exclude participants — possibly leading to lower use of services. I was glad to see that they think holistically about the whole process.”
Hansel Tookes, M.D., M.P.H., assistant professor of clinical medicine at the Miller School, founded the program, which has been proven to increase proper syringe disposal in Miami-Dade. Recent data from the Florida Department of Law Enforcement also showed that opioid-related deaths decreased by 39 percent in the county in the last six months of 2017.
Because of this success, the Florida Senate and House of Representatives passed a bill that will permit the expansion of syringe service programs throughout the state of Florida.
“The public health immersion program is critical to our understanding of the social determinants of health,” said Samuel Hinks, a first-year M.D./M.P.H. candidate. “We have spent time in inpatient and outpatient facilities. We often forget about the organizations these individuals visit when they can't access a health care institution. That's why it's important to visit these various different sites in the community. It's honestly one of my favorite parts of the program because it puts it all into perspective.”