Katherine (Heflin) Hefcart

All Publications

• Psychiatric Boarding in Emergency Departments and the COVID-19 First Wave: The New Hampshire Response HEALTH SECURITY Heflin, K., Rosen, B. J., Costanzo, R., Ballard, J., Fetter, J. C. 2023; 21 (3): 214-221

  Abstract

  The COVID-19 pandemic forced unprecedented challenges for emergency department operations during the spring of 2020. Before the COVID-19 pandemic, psychiatric boarding in emergency departments required a substantial amount of staffing and administrative resources. This case study describes one state's efforts to rapidly decrease psychiatric boarding by 93% in 2 weeks with a multipronged approach, and simultaneously minimal effects observed on outcome measures of psychiatric hospital readmissions and suicide rates. Lessons learned are discussed regarding workflow adaptations and leadership implications.

  View details for DOI 10.1089/hs.2022.0127

  View details for Web of Science ID 000987719100001

  View details for PubMedID 37184664

• Lessons from a Free Clinic During Covid-19: Medical Students Serving Individuals Experiencing Homelessness Using Tele-Health JOURNAL OF AMBULATORY CARE MANAGEMENT Heflin, K. J., Gillett, L., Alexander, A. 2020; 43 (4): 308-311

  View details for DOI 10.1097/JAC.0000000000000352

  View details for Web of Science ID 000570142700009

  View details for PubMedID 32858731

• Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts JOURNAL OF SCHOOL HEALTH Hughto, J., Biello, K. B., Reisner, S. L., Perez-Brumer, A., Heflin, K. J., Mimiaga, M. J. 2016; 86 (1): 61-71

  Abstract

  Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents.Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity.Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05).Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.

  View details for DOI 10.1111/josh.12353

  View details for Web of Science ID 000366416300008

  View details for PubMedID 26645422

  View details for PubMedCentralID PMC4675046

• Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender-Nonconforming People MILBANK QUARTERLY Reisner, S. L., Hughto, J., Dunham, E. E., Heflin, K. J., Begenyi, J., Coffey-Esquivel, J., Cahill, S. 2015; 93 (3): 484-515

  Abstract

  Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not protect against discrimination based on gender identity in public accommodations settings such as transportation, retail stores, restaurants, health care facilities, and bathrooms. A 2013 survey of Massachusetts transgender and other gender minority adults found that in the past 12 months, 65% had experienced public accommodations discrimination since the law was passed. This discrimination was associated with a greater risk of adverse emotional and physical symptoms in the past 30 days. Nondiscrimination laws inclusive of gender identity should protect against discrimination in public accommodations settings to support transgender people's health and their ability to access health care.Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, Massachusetts law has provided protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not, however, protect against discrimination in public accommodations (eg, hospitals, health centers, transportation, nursing homes, supermarkets, retail establishments). For this article, we examined the frequency and health correlates of public accommodations discrimination among gender minority adults in Massachusetts, with attention to discrimination in health care settings.In 2013, we recruited a community-based sample (n = 452) both online and in person. The respondents completed a 1-time, electronic survey assessing demographics, health, health care utilization, and discrimination in public accommodations venues in the past 12 months. Using adjusted multivariable logistic regression models, we examined whether experiencing public accommodations discrimination in health care was independently associated with adverse self-reported health, adjusting for discrimination in other public accommodations settings.Overall, 65% of respondents reported public accommodations discrimination in the past 12 months. The 5 most prevalent discrimination settings were transportation (36%), retail (28%), restaurants (26%), public gatherings (25%), and health care (24%). Public accommodations discrimination in the past 12 months in health care settings was independently associated with a 31% to 81% increased risk of adverse emotional and physical symptoms and a 2-fold to 3-fold increased risk of postponement of needed care when sick or injured and of preventive or routine health care, adjusting for discrimination in other public accommodations settings (which also conferred an additional 20% to 77% risk per discrimination setting endorsed).Discrimination in public accommodations is common and is associated with adverse health outcomes among transgender and gender-nonconforming adults in Massachusetts. Discrimination in health care settings creates a unique health risk for gender minority people. The passage and enforcement of transgender rights laws that include protections against discrimination in public accommodations-inclusive of health care-are a public health policy approach critically needed to address transgender health inequities.

  View details for DOI 10.1111/1468-0009.12127

  View details for Web of Science ID 000361216700009

  View details for PubMedID 26219197

  View details for PubMedCentralID PMC4567851