The Kauno Project
The Kauno Project Logo
Shortly after the COVID-19 shelter in place order began, the team at Kauno was asked to provide a list of their professional goals for the coming months and years. During that time, COVID-19 cases were rapidly escalating across the country and the impact was astonishing, particularly in minority communities. A study by The Foundation for AIDS Research showed that counties with a higher proportion of black residents accounted for 52% and 58% of COVID-19 cases and deaths, respectively. Pre-existing conditions like diabetes, cardiovascular disease, and social determinants of health increased the health-related vulnerability within communities of color.
With a desire to lessen the influence that social determinants have on young people’s future, I created goals that focus on community service in underserved areas of my community. I want to be an asset to those in need by sharing my own knowledge, skills, and resources. By targeting the youth population, I believe I can create the biggest impact on life-long health trajectories. After sharing my goals with the team at Kauno, I realized that my colleagues shared the same values and wanted to contribute to our community.
As a physical therapist, I believe I can make the largest and most immediate impact using the knowledge and skills I already possess. Socioeconomic status is positively correlated with household income, education level, and insurance coverage. A lower socioeconomic status thus increases the likelihood of experiencing income, education, and insurance barriers that ultimately influence the decision to seek and use physical rehabilitation services. Research shows that physical therapy usage among adults increases by 5% for every year of education a patient has completed, and physicians are more likely to make referrals to Physical Therapy if the patient has a higher education. This can indirectly affect youth who come from families that are socioeconomically disadvantaged. If parents are less likely to use or be referred to Physical Therapy services due to education or socioeconomic status there may also be underutilization and barriers for their children to receive those same rehab services.
Public insurance accounts for a large percentage of coverage for adolescents in the United States who identify as racial or ethnic minorities. 53.5% of black and 51% of Latino children reported to have Medicaid or Children's Health Insurance Program (CHIP) coverage, according to 2018 data. In California, 54.5% of Latino and 47.4% of African American children reported to have Medi-Cal (California’s Medicaid Program) or CHIP coverage compared to 20.4% of white, 22.8% of Asian, and 22.6% of other or multiple race children. This poses a challenge on being able to access care particularly, for specialty services like Physical Therapy, due to a reduction of Medi-Cal coverage acceptance rates among providers because of low Medi-Cal reimbursement rates. As a result, there is a concern that youth with these insurance plans will have a smaller pool of providers to receive services from increasing the risk for underutilization of care when it is needed most.
The Kauno Project is our initiative to support our community in the ways we know how. It was created to help diminish the effect of systemic faults. Initially, this will be achieved through expanding our rehab and training related offerings to the youth population regardless of insurance or socioeconomic status. In addition to these services, we are working to include mentorship, regular workshops, and educational opportunities in this initiative.
As health and fitness professionals, we often prioritize the physical element of health in our work. However, there are countless psychosocial factors that are intertwined into the physical nature of what we do. We are also motivators, listeners, coaches, and advisors giving us a unique ability to influence a person’s wellbeing from many facets. We hope to use these skills to provide a valuable resource to those in need.
Initially, through the use of physical training modalities, we hope to instill a sense of self-efficacy, self-empowerment, and opportunity for the youth. As The Kauno Project grows, we will expand our offerings through volunteerism, partnerships, mentorship, and funding. Our goal is to create a diverse group of healthcare and allied health professionals who are motivated to do their part in building up their community.
By creating an environment that emphasizes health, we aim to have a profound effect on the physical, mental, and emotional dimensions of wellbeing. We believe the interpersonal connections that can be made by being positive role models who are available and willing to assist youth navigating through the stages of personal and professional growth are profound.
At Kauno, we believe quality health is the foundation for a quality life. We are excited to embark on this journey and looking forward to making a positive impact!
““Whatever you do for the purpose of impacting on others, no matter how little you think it to be or how little your audience may seem, it not only grows but it leaves a lifetime effect which sets you up on greater grounds of success more than you ever anticipated.”
Tiara Dunson, PT, DPT
Tiara is a physical therapist at Kauno
References
Sandstrom, Robert, and Alexandria Bruns. 2016. "Disparities In Access To Outpatient Rehabilitation Therapy For African Americans With Arthritis". Journal Of Racial And Ethnic Health Disparities 4 (4): 599-606. doi:10.1007/s40615-016-0263-7.
Carter, Stephanie K, and John A Rizzo. 2007. "Use Of Outpatient Physical Therapy Services By People With Musculoskeletal Conditions". Physical Therapy 87 (5): 497-512. doi:10.2522/ptj.20050218.
Alberto, Cinthya K., Jessie Kemmick Pintor, Ryan M. McKenna, Dylan H. Roby, and Alexander N. Ortega. 2019. "Racial And Ethnic Disparities In Provider-Related Barriers To Health Care For Children In California After The ACA". Global Pediatric Health 6: 2333794X1982835. doi:10.1177/2333794x19828356.
SHADAC analysis of [DATA SOURCE], State Health Compare, SHADAC, University of Minnesota, statehealthcompare.shadac.org, Accessed [July 7, 2020].
Beitsch R. Are Medicaid’s payment rates so low they’re discriminatory? Stateline. http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/22/are-medicaids-payment-rates-so-low-theyre-discriminatory. Published September 22, 2017. Accessed January 22, 2019.
Henry J. Kaiser Foundation. Medicaid Physician Fee Index. State Health Facts 2016. https://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?activeTab=map¤tTimeframe=0&selectedDistributions=all-services&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22asc%22%7D. Accessed January 22, 2019.
Zuckerman S, Skopec L, Epstein M. Medicaid physician fees after the ACA primary care fee bump: 19 states continue the Affordable Care Act’s temporary policy change. https://www.urban.org/research/publication/medicaid-physician-fees-after-aca-primary-care-fee-bump/view/full_report. Published March 5, 2017. Accessed January 22, 2019.
Bindman AB, Yoon J, Grumbach K. Trends in physician participation in Medicaid. The California experience. J Ambul Care Manage. 2003;26:334-343. [PubMed] [Google Scholar]
Polsky D, Candon M, Saloner B, et al. Changes in primary care access between 2012 and 2016 for new patients with Medicaid and private coverage. JAMA Intern Med. 2017;177:585-588. [PubMed] [Google Scholar]
Decker SL. Two-thirds of primary care physicians accepted new Medicaid patients in 2011-12: a baseline to measure future acceptance rates. Health Aff (Millwood). 2013;32:1183-1187.
Machlin, Steven R., Julia Chevan, William W. Yu, and Marc W. Zodet. 2011. "Determinants Of Utilization And Expenditures For Episodes Of Ambulatory Physical Therapy Among Adults". Physical Therapy 91 (7): 1018-1029. doi:10.2522/ptj.20100343.
Constantinescu, Florina, Suzanne Goucher, Arthur Weinstein, and Liana Fraenkel. 2009. "Racial Disparities In Treatment Preferences For Rheumatoid Arthritis". Medical Care 47 (3): 350-355. doi:10.1097/mlr.0b013e31818af829.
"Why African American Communities Are Being Hit Hard By COVID-19". 2020. American Medical Association. https://www.ama-assn.org/delivering-care/population-care/why-african-american-communities-are-being-hit-hard-covid-19#:~:text=Harris%20rhetorically%20asked%20one%20of,impact%20the%20African%20American%20community.