Breadcrumb
From the Front Row: The Upstream Initiative
Published on February 23, 2023
Rasika and Radha welcome MHA student Emily Molden to discuss the Upstream Initiative, an interdisciplinary group of graduate health professions students, nursing students, and undergraduate students who volunteer in the High-Risk Obstetrics Clinic at University of Iowa Health Care and serve to connect patients with resources in their hometown to combat food insecurity and transportation needs.
Learn more about the Upstream Initiative at medicine.uiowa.edu/md/upstream-initiative
Find our previous episodes on Spotify, Apple Podcasts, and SoundCloud.
Rasika Mukkamala:
Hello, everyone, and welcome back to From the Front Row. Today, we have Emily Molden, a first-year MHA student who is the student administrator for the Upstream Initiative. The Upstream Initiative is an interdisciplinary group of students who volunteer in the High-Risk Obstetrics Clinic at University of Iowa Hospitals & Clinics. Here they connect patients with food and transportation resources in their hometowns. I’m Rasika Mukkamala, co-hosting today’s episode with Radha Velamuri, and if you’re new here, welcome. We’re a student-run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health. Welcome to the show, Emily.
Emily Molden:
Hi. Thank you for having me.
Rasika Mukkamala:
Can you start by telling us how you got involved with Upstream and what your position entails?
Emily Molden:
Yeah, so I was first introduced to Upstream during orientation last semester when I started here at Iowa as a first-year MHA. And after volunteering for a couple of months, I decided I wanted to get more involved, so I applied for the administrator position. And basically, what I do as the administrator is I schedule our board meetings, and I also lead each board meeting, which occurs every single month.
So during these meetings, we talk about some current projects that we are working on, but we also discuss future goals for the organization. Some other things we do during our board meetings is inform our other board members about certain events going on that they can sign up for, just to further educate themselves on social determinants of health and how we can address those things. But most importantly, I also volunteer in the clinic, and this is important because I have the opportunity to not only work with the patients firsthand but I can also work with other volunteers just to get their direct perspective on their experience as a volunteer and how I can improve that experience for them.
Radha Velamuri:
We sort of dived into what the Upstream Initiative is without really addressing anything about it, like the key ideas behind it. So could you give us a brief description of what the Upstream Initiative even is and how it got its name? I heard that this is a new name for it. It used to be called something else before. So could you tell us a little more about that?
Emily Molden:
Yeah, so it was previously known as the Upstream Clinic, and then it was recently changed to the Upstream Initiative. And basically, the reasoning behind the name is that our goal is to systematically understand and address social determinants of health before they have a downstream effect resulting in poor health outcomes. So, basically, we are trying to tackle the root problem before the health of these patients decline. So specifically, in our clinic, we are screening for food insecurity and lack of transportation, and we believe that addressing those things, providing resources for patients to have adequate food and transportation to their appointments will then, in turn, result in better health outcomes for them.
Radha Velamuri:
Yeah, so for people who don’t understand the whole upstream thing you were just talking about, there’s a story that we like to say in public health. So there’s a waterfall, and there’s someone saving, for example. I think the story’s kind of weird where there’s a bunch of babies that are going down a waterfall, and people are saving the babies at the bottom of the waterfall, but then some people go up the hill, and they’re saving the babies before they even go down the waterfall, or they’re preventing the person from putting the babies in the river that go down the waterfall. It’s a little bit crude, but I’m sure there’s a better story. But I remember the baby version.
Emily Molden:
Yeah, so we use that same exact example when we are recruiting our volunteers.
Radha Velamuri:
The baby version?
Emily Molden:
Yes, the baby version. So basically, it starts at the bottom of the stream where babies or individuals are about to fall off the cliff into a steady stream of water, but the goal is to go upstream and prevent the babies from even going into the water. So same thing, same concept. We are providing resources for food or even food supply directly at their appointment that they can take home with them before they even become hungry.
Rasika Mukkamala:
No, that’s super great, and I think one thing that’s interesting is that it impacts so many patients, and it’s student-run. So can you tell us a little bit more about how long the Upstream Initiative has been in operation and how it’s evolved and changed over the years?
Emily Molden:
So Upstream started in January of 2018, so we just hit five years as an organization.
Radha Velamuri:
Woo.
Rasika Mukkamala:
Woo.
Emily Molden:
And then we actually have grown a lot. I am newer to my position, but just from what I’ve seen recently, they started out with screening for food insecurity, but now we have the opportunity to work on many more projects and just try to find other resources to help these patients. So, for example, we had a diaper and period product bank where we took donations for diapers and period products and donated them to local charities and provided them to our patients at the clinic. So that is a small expansion that we have done.
In addition to that, we are working on a medical-legal partnership right now. So we are going to conduct a needs assessment to see how many patients in our high-risk clinic are in need of legal services. And then we’re also working on a disparities grant. And this disparities grant addresses quite a few different things, but we’re looking at innovative ways to connect patients with resources such as WIC and SNAP.
In addition to that, we use this grant to provide onsite food sources that these patients can take home with them. But we’re also talking with patients directly to discuss barriers that they have faced with signing up for WIC and SNAP and then get direct perspective on how we can improve the process for them. And there’s really no better way to do that than get their perspective and their opinion on how the process could have been easier for someone who is actually trying to access these services. So it has really grown a lot, and those are just a few things that we are working on in addition to our initial screening of food insecurity and transportation issues.
Radha Velamuri:
You guys sure like to stay busy.
Emily Molden:
Yes, we do.
Radha Velamuri:
There’s a lot going on.
Emily Molden:
There is a lot going on, and we have no plans to stop anytime soon.
Radha Velamuri:
I love that. What about the initial screening? You told us a lot about your other initiatives. Could you share a little more about that screening you were talking about and how that works?
Emily Molden:
Yeah, so when the patient comes into the clinic, every single patient gets screened every single time. Of course, they have the right to deny the screening if they wish. So we do an initial screening, which means the patient is new to the clinic, they have never been screened before, and we do a subsequent screening, meaning that all of our return patients are screened again because food security is not just a one-time thing, you can become food insecure over time. You can come out of food insecure and go back into it.
So that’s why we screen all of our patients no matter how many times they’ve been to the clinic and basically just ask a series of questions on whether or not they feel they have access to food or adequate food. We’re not just talking about fast food, but we want to make sure that they have access to nutritious meals as well. So if they answer yes to any of those questions, then we would consider them food insecure, and then that’s when we would go into the room with the patient and educate them on resources within the specific county that they live in.
Rasika Mukkamala:
Can you talk a bit more about the WIC and the SNAP resources that you can refer patients to and how that process works? I know WIC and SNAP are a bit complicated. So does Upstream refer them, or is it the hospital or other people within the realm?
Emily Molden:
So we give them information based on the specific county that they live in, and the information sheet it shows them the office that they can go to within their hometown to sign up. So it’ll give them a direct address of the facility that they can go to and sign up for WIC and SNAP benefits. And so that’s kind of how we provide these resources for the patient is, basically showing them how they can do it because it does vary from county to county.
Radha Velamuri:
And you can’t know if they’re SNAP eligible or WIC eligible, right, because you don’t ask those financial questions?
Emily Molden:
Right. We don’t go into any specific finances with them. So we basically give them a location for them to go to in their hometown, where then they can go and figure out whether or not they’re eligible to sign up or not.
Rasika Mukkamala:
And I think that’s super helpful because it helps with patient autonomy too, especially if maybe during this appointment they may just need a little boost. They’re in between jobs or something. But then, at the next one, they’re full-on in a job or something else. So it gives a lot of autonomy and still provides them with the resources, but it also provides them with options if they need it, which I think is super helpful.
Emily Molden:
Yeah, exactly. And when we give them these resources that have these specific addresses on them, they can share that with family members or friends that they also believe have the same need or need the same resources as well.
Radha Velamuri:
So what proportion of patients do you think you refer to these services? Do you see a large need for these services? You screen people for a reason, and it seems like you’re doing a lot of good work, but do you have any numbers you could share with us?
Emily Molden:
Yeah, so there definitely is a very large need, especially for food-insecure patients. During our third quarter of 2022, we screened 227 patients. So that was just one quarter alone in 2022. And of those 227, we had 58 new screens. So 58 new patients come in and get screened, and over 53% of them screened positive for food insecurity.
Radha Velamuri:
Wow.
Emily Molden:
So, all 53% of those patients were educated on the resources that were available to them in their county. We have a much smaller percentage of subsequent screens positive, but that is our hope is that when they come back, they are using these resources and no longer have to classify as food insecure.
Radha Velamuri:
Mm-hmm. Yeah, that’s really valuable.
Rasika Mukkamala:
Yeah, that’s awesome that you’re able to collect the data and continue to improve and change things based on how patients are responding. So with that, what impact do you think the Upstream Initiative has on the local patient population and beyond? Can you tell us a little bit about maybe where patients come from? Are they mostly from the state of Iowa? Do you have that information?
Emily Molden:
Yeah, so we do have patients come from all over. Of course, a large population we serve are from the state of Iowa, but Illinois is very close. We serve patients from Illinois as well. So I do think that the Upstream Initiative impacts our local communities, but we also impact surrounding communities. I also think it’s important to consider the impact that we have on the direct patients that we are serving, but a lot of these patients are pregnant as well. So we have to think about how we’re impacting the babies that are growing inside of them because if they’re food insecure, we have to think about how that affects the baby as well. So we’re impacting our local communities. We’re impacting our surrounding communities. But we’re also impacting our future communities of lives to come.
Radha Velamuri:
Speaking of the future, what do you want? Yeah, good segue, right?
Emily Molden:
Yes.
Radha Velamuri:
Speaking of the future, what is your hope for the future for the Upstream Initiative? Where do you want this organization to go, or not really organization, but initiative, to go?
Emily Molden:
So we have already grown so much, and my hope is that it can only continue to grow. So right now, we are at the High-Risk OB Clinic at the main hospital, but we also have gynecology services at the North Dodge Clinic. We have gynecology services at the Iowa River Landing. So I would love to be able to expand to those clinics as well just to see if we can reach a larger patient population. But even that, if we were able to expand outside of maybe just gynecology and look into other services as well, that may have a large patient population that are food insecure or struggle with transportation to their appointments.
Radha Velamuri:
How about collaborations? Have you thought about collaborating with other organizations on campus?
Emily Molden:
Oh, absolutely. And right now, we are working on the medical-legal partnership, so we are working with the law students on that. And so, definitely expanding the collaborations that we’re having, the organizations that we are working with, I think that it is a great way to continue to grow our initiative and to find other resources that we can use to help these patients.
Rasika Mukkamala:
Yeah. So how can students get involved either volunteering or on the board for this initiative, and how can they feel like they’re making an impact just like you are?
Emily Molden:
So we do two orientation sessions each semester. We actually just finished up our orientation for the spring semester, but we will hold two more in the fall. We usually send those out via email, but when you go through your orientation and stuff, a lot of times, people are presenting on it. So keep your eye out for that. You can also email me directly, and I would be happy to help you get started as a volunteer.
I would highly recommend volunteering for this organization. It has had a great impact on me thus far. And if you are interested in even being a board member, we will do elections every single fall for new board members. So if you become a volunteer and you decide you want to get more involved, absolutely apply for one of those positions, and we’ll give you an opportunity to attend the monthly board meetings and learn about the additional projects that we’re working on.
Radha Velamuri:
Yeah, we can link the contact information for the organization in the podcast description for anyone interested.
Emily Molden:
Yeah. That’d be awesome.
Rasika Mukkamala:
Yeah. You can also email volunteers.upstream@gmail.com if you have comments.
Radha Velamuri:
We’ll also link that. The audio thing doesn’t work for me. I need to see it somewhere.
Emily Molden:
Yeah.
Radha Velamuri:
Do you know what I mean?
Okay. So we have one more question that we like to add. This was pretty quick, so we really ran through all the questions that we wanted to ask you. So we have one more that we like to ask all of our guests, and it’s something you can answer in any way you want. It’s basically, what is something that you thought you knew that you were later wrong about? It could be with the initiative. It could be as an MHA student. It could be as a human being living on planet Earth in 2023. So yeah, what’s your answer to that question?
Emily Molden:
I think related to the initiative directly, I thought a lot of patients who were food insecure or had lack of transportation were more familiar with the resources available than they actually are. I have found that a lot of patients actually are familiar with SNAP and WIC, but then they are not familiar with the free dietician services that Hy-Vee offers. That is something that I just learned about. I had no idea about that before, in addition to the non-emergency medical transportation service offered through patients with Medicaid.
So I think I had this idea that these resources are well known, people are aware of them, but that’s actually not true, especially for the smaller resources that are not used as much, such as the dietician services or even the food pantries around town. So going into this organization as a volunteer, I was like, “Yep. I’ll provide them with the resources and show them the address,” and then next thing you know, it’s like, “Well, I had no idea that we had a local food pantry,” or “I had no idea that I could schedule a ride and have my insurance cover it.” So that was a really big learning curve for me that I had no idea was a real problem.
Radha Velamuri:
Yeah. I don’t know about some of those things. Is there a place people could look this up, or do they have to come to the Upstream Initiative to find out about it?
Emily Molden:
So that’s the thing is, most of these patients do find out about these smaller resources when they come to the Upstream Initiative. But within the grant that we are working on for one of our additional projects, we are looking for a more innovative way to spread this information and educate people without actually having to sit down in a doctor’s office and talk with one of us volunteers. But I think that is actually a great goal for the future to figure out other ways that we can spread the word and get those things out there because WIC and SNAP are often talked about, but these other small resources can be so beneficial, and they’re not talked about as much.
Radha Velamuri:
Absolutely. Thank you so much for coming on today. And if anyone has any questions about the Upstream Initiative, I’m sure you’d be happy to take any questions or comments or anything.
Emily Molden:
Yes, please feel free to reach out to me, and I’m happy to discuss the topic further.
Anya Morozov:
And that’s it for our episode this week. Big thanks to Emily Molden for joining us today. This episode was hosted and written by Rasika Mukkamala and Radha Velamuri and edited and produced by Anya Morozov. You can learn more about the University of Iowa College of Public Health on Facebook, and our podcast is available on Spotify, Apple Podcasts, and SoundCloud.
If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.