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Associate Professor Department of Maternal and Child Health, Research Fellow Sheps Center For Health Services Research | UNC-Chapel Hill
Chapel Hill, NC, UNITED STATES
Professor in the Gillings School of Public Health, with interests in substance use disorders and chronic health conditions rural populations
I work at the intersection of health and behavioral health for women, children, and families affected by substance use disorders and chronic health conditions amplified by experiences of trauma and poverty and rural access to care barriers. Currently, I am PI for a 3-year AHRQ study looking at barriers for rural primary care providers to offer medication assisted treatment for opioid use disorders. My overall work includes utilization focused evaluation, public health policy research, and efforts to bridge evidence-based research and practice through technical assistance, community collaboration, executive leadership coaching, training, and education. I draw on over 25 years of clinical, leadership, and research experience to address this important public health issue. In 2015, I completed an 8-year federally funded project in eastern North Carolina addressing the role of community substance use disorder treatment, health, child welfare, and family court collaboration to improve family wellbeing. An evaluation of the collaborative impact showed positive treatment and health outcomes and that during the study time period, only 11% of children in the treatment group experienced a recurrence of substantiated or indicated maltreatment, whereas 71% of children in the comparison group experienced maltreatment recurrence. [Pollock MD, Green SL., 2015] My role as an administrator for behavioral health programs in an integrated health setting and my role as PI on various contracts, and university, foundation, and federal grants, have given me the experience necessary to manage effective systems change, project timelines and deliverables, large budgets with contracted services, and to assure positive and effect team leadership.
Areas of Expertise (5)
Maternal and child health
Drug Addiction and Treatment
Public Health Policy Research
Rural Health Care Access
Community Service Award
Robeson County Bridges for Families Coalition, 2014
Innovations in Teaching Award
Maternal and Child Health Care, UNC GIllings School of Global Public Health, 2012
Delta Omega Faculty Member
Honorary Public Health Society, 2011
Warren Wilson College, Swannanoa, NC: BA, Social Work
University of South Carolina, Columbia, South Carolina: MSW, Social Work
Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC: PhD, Maternal and Child Health
North Carolina State University: Certificate, Executive Business Coaching
- North Carolina Society of Acupuncture and Asian Medicine
- American Public Health Association
- National Association of Social Workers
Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis.
Sexually Transmitted Infections, December 2016
Parcesepe AM, L'Engle KL, Martin SL, Green S, Suchindran C, Mwarogo P
AbstractOBJECTIVES:Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.METHODS:In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.RESULTS:FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.CONCLUSIONS:Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.
The impact of an alcohol harm reduction intervention on interpersonal violence and HIV risk behaviors among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial
Drug and Alcohol Dependence
Parcesepe AM, L Engle KL, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N
AbstractAIMS:To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya.DESIGN:Randomized controlled trial.SETTING:HIV prevention drop-in centers in Mombasa, Kenya.PARTICIPANTS:818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively).INTERVENTION:6 session alcohol harm reduction intervention.COMPARATOR:6 session non-alcohol related nutrition intervention.MEASUREMENTS:In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days.FINDINGS:The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention.CONCLUSIONS:The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.
Effects of a rural family drug treatment court collaborative on child welfare outcomes: Comparison using propensity score analysis.
Child Welfare, 2015
Pollock MD, Green SL
AbstractPrevious studies that have examined the impact of family drug treatment courts (FDTCs) on child welfare outcomes have produced mixed results. This study evaluates the impact of a rural, FDTC collaborative on child welfare outcomes using propensity score analysis. Findings from the study show that children in the treatment group had longer stays in child welfare custody but were substantially less likely to experience future incidents of maltreatment than those in families with parental substance use disorders without these services.
“I felt for a long time like everything beautiful in me had been taken out”: Women’s suffering, remembering and survival following the loss of child custody
International Journal of Drug Policy, November 2015
Kenny KS, Barrington C, Green SL
AbstractBACKGROUND:Child Protective Services' (CPS) placements of children in out-of-home care disproportionately impact families marginalized by poverty, racism and criminalization. CPS' mandate to protect children from neglect and abuse is frequently criticized as failing to address the multiple social and structural domains shaping parents' lives, especially mothers.METHODS:We conducted a thematic narrative analysis of in-depth interviews to explore the impact of child custody loss on 19 women who use drugs residing in Toronto, Canada. We also assessed the potential roles of intersectional forms of violence and inequities in power that can both give rise to child custody loss and mediate its consequences.RESULTS:Trauma was identified as a key impact of separation, further exacerbated by women's cumulative trauma histories and ongoing mother-child apartness. Women described this trauma as unbearable and reported persistent symptoms of post-traumatic stress disorder and other mental health conditions. Practices of dissociation through increased use of drugs and alcohol were central in tending to the pain of separation, and were often synergistically reinforced by heightened structural vulnerability observed in increased exposure to housing instability, intimate partner violence, and initiation of injection drug use and sex work. Women's survival hinged largely on hopefulness of reuniting with children, a goal pivotal to their sense of future and day-to-day intentions toward ameliorated life circumstances.CONCLUSION:Findings highlight needs for strategies addressing women's health and structural vulnerability following custody loss and also direct attention to altering institutional processes to support community-based alternatives to parent-child separation.