Community Portrait: Dr. Juleigh Nowinski Konchak
This Community Portrait is the fourth in a series highlighting individuals who are championing cross-systems collaboration and data sharing within their jurisdictions to respond to the needs of frequent utilizers of justice, health and human services systems. This interview was edited for brevity.
Juleigh Nowinski Konchak, MD, MPH, has spent her life working at the intersection of equity, health and policy. She is the program director for Public Health/General Preventive Medicine Residency Program with Cook County Health (CCH) and a physician advisor for CCH’s substance use disorder programming. In this role, she sits in the Center for Health Equity and Innovation leading the substance use disorder programing while continuing to work in preventative medicine. Juleigh graduated with honors from The University of Illinois College of Medicine and earned her Master of Public Health and Certificate in Healthcare Quality and Patient Safety from Northwestern University.
Q: How did you get into this work?
I studied social policy in college; after I graduated, I joined the Obama senate campaign. He won, and I took a position in Senator Obama’s D.C. office working on health, education and veterans affairs. I was really drawn to the health side of the job and started to really focus on health policy. My supervisor at the time was a medical doctor, and I had been pre-med in undergrad, so I decided to go to medical school to really understand the inner workings of health care. Not long after I started medical school, I took a leave of absence to go work at the U.S. Department of Health and Human Services for the Obama administration, really diving into the world of policy and how it interacts with public health. I always envisioned that I would return to the policy world, but I find it really rewarding to work on the “little p” policies within Cook County government and at Cook County Health. I didn’t expect to stay clinically active or stay at Cook County Health, but substance use is an area where there are so many inequities. It spoke to me from a public health perspective that there was an opportunity to be involved in building up a system and use data to inform our policies and programs – so, I never left!
Q: How is the health side of the DDJ work structured in Cook County?
Cook County Health is the largest social safety net provider in the Chicago region. We have two hospitals, over a dozen community health centers, the Core Center – an HIV and hepatitis specialty center and CountyCare – one of the largest Medicaid providers in Illinois. We also serve as the public health department for the majority of suburban Cook County and as the health care provider at Cook County jail. We have a very broad reach. Cook County Health has been working in the substance use disorder space for a long time, but within the last decade we have made a more concerted effort to expand access to evidence-based care across all our sites. We coordinate internally between outpatient, inpatient, jail and emergency department settings, and coordinate with other county government partners, including Adult Probation and the Sheriff’s office, and the State’s Attorney’s office on trainings and care for people involved in the justice system.
Q: What is Cook County working on in this space right now?
When we started working through the data from the overdose crisis, it brought newfound energy to the work we do in Cook County. We have started using a lot of qualitative data points to help support the mission. We surveyed patients and presented those stories to clinicians and leadership to encourage patient centeredness and reduce stigma around substance use. We also used patient interviews for advocacy materials to elevate the patient voice internally, with the state’s attorney’s office and the probation department to highlight the complexities of navigating substance use disorder when you are involved with the criminal justice system. That has been powerful and effective. We have also been trying to educate internally to encourage providers to be more patient-centered and use other indicators of success besides the absence of drug use. When we think about diabetes or obesity we don’t think about perfection as the only indicator of success. There is a spectrum of improvement and progress. We are trying to mirror that highlighting other improvements for drug use such as less pain interference or improved ability to engage in social roles and activities.
Through a research grant with Northwestern University and the Agency for Healthcare Research and Quality, we are working to create a regional learning health system around substance use disorder. We are hoping to use data to drive partnership and work to improve how the probation system connects patients to care. We are working with the state to pilot the use of an information system to optimize access to recovery homes for those seeking help. With partners, we will use data integration to build out this regional learning network, with an initial focus on probation and electronic monitoring. As an example, we recently linked data on opioid overdose from the Cook County Medical Examiner with data on engagement in Adult Probation to estimate opioid-related mortality for this population. There is a lack of data and information on the elevated overdose risk from being on probation, and we are hoping that making this information accessible can help drive policy and systems changes to improve SUD care for people involved in the justice system.
Another project we have been working on is “no wrong door” for our health centers. We launched this effort in 2014 to enable all our health centers to provide evidence-based substance use and recovery support services for opioid use disorder. In-depth analysis has allowed us to see gaps in the system, and we have been able to adjust. The tracking of progress helped maintain engagement from key stakeholders and leadership.
Q: Can you describe some of the racial and ethnic disparities work being done?
Cook County has always served a diverse population. While the national conversation around opioid use and misuse has been centered on non-Hispanic white overdoses, the increase in overdoses in Cook County has consistently been among African American males in the 40- to 60-year-old range. One of the things we have been doing to address this racial disparity is looking more concertedly at our patient population to make sure that we are reaching the people that we are trying to serve and that our population reflects the demographics of Cook County. We are trying to make sure that when we do new work, we lift everyone up and allow them to benefit from our programing.
The jail is another place where we see a lot of health racial disparities. Non-Hispanic Black and white individuals use substances at a similar rate, but non-Hispanic Black individuals are incarcerated at a much higher rate. We are doing what we can to address those disparities. Our follow up occurs in neighborhoods that people we are serving can easily access. Now we are trying to review our data with an equity lens to build out equity in every facet of our system.
Q: What keeps you motivated to do this work? What gets you out of bed in the morning?
Still seeing patients keeps their stories and struggles clear in my mind when the bureaucracy and other tasks and difficulties that are part of this job take over. The glaring injustice when it comes to substance use, especially for those involved in the criminal justice system, keeps me motivated. I always want to be making better policies and making sure we, as public servants, are doing all we can. Until inequity is not a problem in our health or criminal justice systems, I will continue to be motivated to do this work and stay working on these systems.
Q: What advice do you have for others looking to start this type of work in their communities?
Whenever it is possible to engage the people who we are hoping to benefit, it is vital that we do, and that we continue to include them at every stage. If you can have the people you are hoping to serve as stakeholders and truly listen to their input, that is invaluable to the work and its impact. They don’t just have great ideas, but ideas that can translate to real impact.
Collaboration in general is also key. Whenever things can be “win-win,” that is when partnerships continue to function and thrive. Incorporating data can drive these partnerships and feelings of “everybody wins,” because everyone has tangible numbers in their hands on how their facet of the system has improved. Approaching collaboration with genuine respect goes a really long way. We all are working in the public sector because we want to improve society and so we all strive to do that more efficiently.
NACo would like to thank Dr. Juleigh Nowinski Konchak for speaking with us about her and Cook County’s efforts. She can be reached at email@example.com.