Public Health Projects, 2008-present

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  A Community Based Approach to a Client- Centered Wellness Program

  Sheridan Finnie, Diane Kim, Prasanna Kumar, Kelly MacPherson, Allyson Miller, Megan Prue, Jacob Weiss, Cathie Buscaglia, Joseph Lasek, and Alison Howe

  Despite health benefits of wellness programs, no such program has been adapted to meet the needs of adult clients receiving services addressing mental health, substance-use, and developmental needs at a community-based mental health organization. We investigated preferred evidence-based diet and exercise wellness programs for potential implementation.

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  Vermont Legislature’s Views on the Reliability and Accessibility of Available Resources Regarding Public Health Concerns of Youth Marijuana Use

  Aram Garewal, Luke Higgins, Jeannie Lin, Kathleen O'Hara, Michelle Oberding, Anna Quinlan, Joseph Teague, Lori Augustyniak, and Karen Lounsbury

  Vermont previously legalized possession and limited cultivation of marijuana. Proposed legislation for 2020 would legalize commercial sale of marijuana. Current knowledge surrounding public health impacts of the legal commercial sale of marijuana on youth is inconsistent, insufficient, and poorly understood by the public. This study investigated legislator utilization and perception of sources contributing to growing knowledge surrounding youth marijuana use.

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  Converting Whole Blood Donors to Apheresis Donors

  Collin Anderson, Racquel DeCastro, Alexa Golden, Sidney Hilker, Flora Liu, Vincent Nocera, Seth Wolf, Jenny Lamping, and Mark Fung

  Donating blood is a noble act with real potential to save lives. Although millions of Americans donate blood each year, supplies of one blood component—platelets—is in chronically short supply. This is in part due to its significantly shorter shelf life (5-7d) vs. red blood cells (28-42d) or plasma cells (1yr). Platelet apheresis donation offers the opportunity to donate platelets more frequently and in higher quantities but accounts for only a small percentage of all donations. Our study aimed to better characterize perceived barriers in conversion to platelet apheresis donation.

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  Assessing Food Insecurity Screening Among Healthcare Providers in Vermont

  Menna Awadalla, Juan Conde Fabela, Annabelle Davey, Jack Dubuque, Jhaimy Fernandez, Ian McClain, Haewon Park, Connor Scagnelli, John Gorton, and Shaden Eldakar-Hein

  What influences primary care providers’ screening for food insecurity and recommending food resources?

  This study examined the barriers primary care providers have to screening for food insecurity and recommending resources to their patients. By analyzing the factors that drive or prevent providers from making recommendations, we can help address food insecurity within the healthcare setting

  • Food security is defined as having access to enough food in order to maintain an active and healthy life

  • An estimated 1 in 8 Americans suffer from food insecurity, which is associated with adverse health outcomes and an increase of $77.5 billion in additional healthcare costs annually

  • Resources exist to ease the burden of food insecurity, but these resources may be underutilized and poorly integrated within the healthcare field

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  Attitudes & Behaviors Surrounding Active Commuting in Chittenden County, VT

  Daniel Bak, Elizabeth Congdon, Doré Grier, Naira Goukasian, Max Silverstein, Georges Tahhan, Katrina Thornburgh, Rebecca Jones, Chester Areson, Dan Quinlan, and Meredith Graves

  Climate Change, Active Commuting, and Health

  • Climate change contributes to 7 million deaths/year globally

  • Negative health outcomes from increased carbon emissions include heat-related illness, mental health issues, and respiratory and allergic disease

  • Active commuting reduces carbon emissions, promotes physical activity, and reduces chronic diseases such as hypertension, diabetes, and obesity

  Active Commuting in Chittenden County

  • Only 8.5% of Vermonters commute actively

  • Burlington has been intensely promoting active commuting through developments in infrastructure and safety

  • Most Burlington residents still commute by car

  Project Goal

  • Compare how active commuters and non-active commuters in Chittenden County differ on attitudes and beliefs on health, vehicle emissions, economics, convenience, and safety.

  • Advise VTCHA on possible targets for the promotion of active commuting.

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  Impact of Interactions Between First Responders and Opioid Drug Users

  Rio Beardsley, Pirapon Chaidarun, Kalle Fjeld, Benjamin Grebber, Brian Muchmore, Ellen Seyller, Lauren Struck, Heng Tan, Peter Jacobsen, and Jerry Larrabee

  INTRODUCTION

  In 2017, First Responders (EMS, Police, and Fire Department) in Vermont administered 848 doses of naloxone (Narcan®), an opioid antagonist that can block the effects of opioids in overdose. However, the rate of opioid-related fatalities has continued to rise from 74 in 2015 to 101 in 2017. Vermont CARES, a nonprofit organization, helps address this issue by working “for and with Vermonters affected by HIV/AIDS to promote well-being through a continuum of prevention, support, and advocacy services.” Their syringe service programs throughout the state provide access to clean needles, overdose prevention education, and naloxone.

  AIMS

  1. To better understand the perceived experience of opioid drug users (Vermont CARES clients) when interacting with First Responders following an overdose.

  2. To explore how such interactions of a Vermont CARES client – essentially as positive or negative – affects the likelihood to request such help in the future

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  Legislator Beliefs, Perceptions, and Voting Influences regarding Carbon Pricing: Implications for Climate Change and Health Advocacy

  Joy Benner, Istvan Kanyo, Meri Lackie, Evan Lowry, Shivani Seth, Alan Su, Jill Jemison, Raj Chawla, and Sally Kerschner

  Carbon pricing was proposed to reduce carbon emissions which has been linked with negative health effects such as:

  • Increased incidence of heat stroke

  • Food poisoning

  • Malnutrition via food shortages

  • Vector-borne illnesses

  • Asthma

  • Allergies

  Purpose: To understand factors that affect legislators’ carbon pricing voting, guiding future health educators and advocates.

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  Safe Driving Attitudes and Behaviors Among Vermont Student Drivers

  Samantha Bissonette, Megan Garrido, Nicholas Haslett, Ashton Pike, William Prince, Davina Tolbert, Catherine Westbom, James Lockridge, and Wendy Davis

  Distracted driving contributes to approximately 10% of all driver fatalities and 17% of injuries in the US. Vehicle crashes are the leading cause of death for teens in the US. Drivers aged 16-19 are 3 times more likely to be involved in fatal crashes than those > 20 years. Increased teen risk is related to attachment to technology, limited driving experience, and an illusion of invincibility. Previous National Highway Traffic Safety Administration assessment of distracted driving attitudes and behaviors does not include significant data on teenage drivers. The goal of this project is to assess safe driving attitudes and behaviors among Vermont Student Drivers.

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  Evaluation of Interactive Rhythm Activities on the Engagement Level of Individuals with Memory Impairments

  Jared Bomba, Raghav Goyal, Marc Hammond, Van Hoang, Alexander Karabachev, Laura Nelson, Hanaa Shihadeh, Judith Christensen, and Ellen Meagher

  Alzheimer's dementia can lead to a decreased quality of life in patients through the manifestation of inappropriate behavioral and psychological signs and symptoms. Music therapy has been shown to decrease agitation and disruptive behaviors in patients with dementia, although improvement in overall cognitive function was minimal. However, there is evidence showing an increase in grey matter in those who actively participate in music activities. Our goal in this study is to focus on how participation in rhythm-based activities affects quality of life.

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  The Effect of Food Insecurity Training on Knowledge, Awareness, Screening, and Intervention Practices within Two Pediatric Wards at an Academic Medical Center

  Jonathan Borden, Hillary Danis, Christina Dawson, Max Knapp, Jessica Lyon, Jordan Munger, Nam Trinh, Katy Davis, and Alison Howe

  Background and Introduction

  • Food insecurity is a major driver of preventable disease. Providers can screen to identify patients at risk for food insecurity using a two-question survey tool called “The Hunger Vital Sign”. Screening barriers identified in the literature include lack of provider knowledge, comfort, and capacity for effective intervention. Addressing this provider knowledge gap through training is essential for implementing robust and sustainable clinical food insecurity screening practices.

  • This study aims to evaluate the effect of food insecurity education on providers’ knowledge and awareness of food insecurity and their likelihood to screen and make referrals for at-risk patients, as well as to encourage healthcare providers to foster a culture of food insecurity screening and intervention in their practices.

  Objectives

  1. To determine providers’ knowledge of food insecurity and awareness of referral practices and resources to help patients experiencing food insecurity.

  2. To determine if providers’ participation in formal food insecurity training influences their likelihood of incorporating food insecurity screening into their patient interviews.

  3. To determine if providers’ action following a positive screen is affected by participating in food insecurity training.

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  Opportunities and Barriers to Implementing Tobacco 21 in Vermont

  Audrea Bose, Cameron Burke, Jack Chen, Jenna Dafgek, Kathryn Kurchena, Alexander Miller, Catherine Pratt, Rebecca Ryan, and David Kaminsky

  Introduction

  • Tobacco is the leading cause of preventable disease and death in the U.S. Demographics

  • Approximately 90% of current smokers starting smoking before age 182

  • Earlier age of tobacco use initiation associated with lower rates of smoking cessation

  • The proposed Tobacco 21 bill (T21) would raise the minimum legal age of sales to 21, creating the opportunity to reduce tobacco use initiation

  • Within five years of implementing the nation’s first T21 bill in 2005, the 30-day smoking rate in Needham, MA dropped from 13% to 7%

  • Recently in Vermont, the age of gun sales was raised to 21, the age of marijuana possession was set to 21, and the Burlington City Council resolved to recommend the age of tobacco products sales be raised to 21

  Objectives

  • Understand why T21 has been unable to pass in Vermont to date

  • Understand the current view of T21 held by Vermont legislators

  • Identify opportunities and barriers to implementing T21 in Vermont

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  Understanding and Evaluating Quality of Life for Individuals with Intellectual Disabilities: A Northwestern Vermont Population Study

  Karla Brandao-Viruet, Katherine Callahan, Michael Chmielewski, Samuel Epstein, Elizabeth Lynch, Emily Puleo, Derek Tan, Mike Reilly, and Stephen Everse

  Introduction

  There are 7-8 million individuals with intellectual or developmental disabilities living in the US.

  • 91,795 of this population lives in Vermont

  • Historically marginalized and isolated community

  • Socioeconomic, health-related, and emotional burden

  • Public health-related disparity

  Champlain Community Services (CCS): non-profit service provider and coordinator for 86 persons with intellectual disabilities in Northwestern Vermont

  Objectives:

  • Develop and apply measures to better understand and evaluate quality of life in the population CCS serves.

  • Recommend improvement to CCS data collection and evaluation methods.

  • Provide a basis for future recommendations to CCS services that are aligned to the needs of consumers.

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  Needs Assessment of Winooski Food Shelf Clients

  Susan Campbell, Lexi Churchill, Michael Lawrence, Shae Rowlandson, Kathryn Thomas, Matt Tsai, Timothy Woodin, Linda Howe, and Jan Carney

  Food shelves offer a unique, centralized location to engage with populations with multiple needs. Food shelf clients demonstrate poorer overall health and less access to healthcare and other social services. Winooski has a large refugee and immigrant population, whose needs may differ greatly from clients served by nearby food shelves in Chittenden County. Winooski Food Shelf visits provide opportunities to link clients to other needed health and social services. Previous studies have demonstrated efficacy in resource intervention guided by information gathered from food shelf clients.

  PROJECT GOAL: Assess the greatest health and social needs for clientele of the Winooski Food Shelf and make recommendations based on data gathered.

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  Oral Health and Barriers to Care in Burlington Housing Authority Residents

  Cari Carpenter, Andrew Darling, Reed Hausser, Mary Ann Kelly, Adam Lacayo, Elizabeth Lanata, Scott Olehnik, Molly Moore, and Taylor Puckhaber

  Background

  Oral health affects everyone and serves as a model for the long term benefits of establishing preventative health practices early in life. However, children with significant socioeconomic stress or cultural and language barriers to access may have difficulty obtaining oral hygiene information, or developing and maintaining oral health regimens. The Burlington Housing Authority (BHA) provides housing subsidization to low-income families and services many resettled refugee families in Burlington, VT. We recognize some intervention initiatives are already and place, and will evaluate program efficacy and utilization. Ultimately, we seek to understand barriers to the existing programs and recommend strategies to increase utilization, compliance, and education in our target population.

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  Effects of Nostalgia Directed Music Therapy on Residents with Dementia in Nursing Home

  Garrett Chan, Jack Fitzsimons, Sidika Kajtezovic, Kristen Keene, Marc Kostrubiak, Jessica Sikka, John Vandenberge, Shaden Eldakar-Hein, and Cameron Segal

  Background

  • Studies support a beneficial relationship between music therapy and the management of dementia.

  • Music therapy intended to activate memory may improve apathy and decrease cognitive decline in patients with mild to moderate dementia.

  • Individuals are typically most influenced by music encountered during early adulthood.

  Objective

  To analyze the effect of nostalgia directed music therapy on the quality of life of nursing home residents with moderate to severe dementia.

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  Training: Key in Recognizing Potential Trafficking Victims in a Healthcare Setting

  Alexis Dela Cruz, Jennifer Holland, Ibrahim Hussein, Dylan Koundakjian, David Viscido, Candice Wolf, Hannah Woodruff, Edith Kilmoski, and Mariah McNamara

  Background

  • Human Trafficking (HT) is a crime that involves exploiting a person for labor, services, or commercial sex.

  • HT can happen in any industry, to persons of any gender, age, economic status, religion, and nationality.

  • In FY 2018, service agencies in the State of Vermont submitted over 180 reports of HT.

  • HT has a profound negative impact on survivors’ physical and mental health.

  • 25-88% of HT victims interact with a healthcare professional while they are being exploited.

  • Providers have cited a lack of confidence and knowledge on HT as a major barrier to proper care of potential victims, stemming from a lack of adequate training.

  • There is a need to assess healthcare workers’ knowledge in recognizing and providing appropriate care and options to potential victims of HT.

  Objectives

  • Assess awareness of University of Vermont Medical Center (UVMMC) and affiliated primary care staff and providers regarding the recent implementation of a UVMMC policy on providing support to victims of HT.

  • Understand current behaviors of staff and providers when providing care to a patient suspected of being a victim of HT.

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  Vermont Legislators' Opinions Regarding the Opioid Epidemic

  Liam du Preez, Emily Eichner, Jonathan Gau, Ryan Harned, Matthew Lebow, Bridget Moore, Casandra Nowicki, Elizabeth Cote, Charles MacLean, and Jan Carney

  Introduction

  • The VT General Assembly includes 180 legislators: 150 representatives and 30 senators

  • State legislators have substantial power to create opioid-related policies

  • During the 2017-18 VT legislative session 22 opioid related bills were introduced and 9 were passed

  • No data currently exist on how VT legislators gather information and formulate public health decisions regarding opioid policies

  Purpose

  • Examine VT legislators’ understanding of the opioid epidemic

  • Identify what drives legislators to draft legislation, including beliefs, priorities, and voting decisions

  • Inform health and human services professionals to best respond to legislators’ knowledge gaps and continuing education needs

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  Community Awareness and Utilization of School Based Health Centers in Burlington, Vermont

  Sarah French, Cinduja Nathan, Kenneth Palanza, Sienna Searles, Sarah Sherman, Joshua Taylor, Michael Weber, Rebecca McCray, Matthew Saia, and Barbara Frankowski

  Most K-12 students will miss at least one day of school each year due to illness or injury; in 2010, six percent missed 11 days or more. School Based Health Clinics, SBHC, are provider-based health clinics located in schools, supplementing routine nursing care and complementing the role of a pediatrician while the child is in school.

  SBHCs aim to:

  • Reduce the amount of school that students miss

  • Provide quick and convenient care for a variety of routine and acute medical concerns

  Our objective was to:

  • Investigate community awareness and utilization of the SBHCs in the Burlington School District

  • Providing insight regarding how to increase engagement of students and parents with the SBHC’s and thereby reduce avoidable class absenteeism.

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  The Halo Effect: Does In-Hospital Art Intervention Result in Improved Overall Patient Satisfaction?

  Brian Gross, Olivia Harrison, Olivia Larkin, Collin Love, Sean Meagher, Alice Peng, Stephanie Udawatta, Karen Lounsbury, and Rebecca Schwarz

  Introduction

  The positive impact of art therapy on medical patients has been well established in the literature.

  • Association between visual art creation and maintenance / reconstruction of a positive identify throughout cancer treatment

  • Decreased need for narcotic medications and patient length of stay following participation in guided imagery sessions

  Despite an abundance of research on art therapy, few studies have examined impact of in-hospital art intervention on overall patient satisfaction.

  Objectives

  • Examine impact of Art from the Heart (AFTH), an in-hospital art intervention program, on patient interpretation of overall care received during hospital stay—the ‘halo effect’.

  • Assess temporal, institution-level patient satisfaction survey scores following establishment of AFH intervention program

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  Engagement and Disengagement in Art Interventions with Memory Impairment

  Nana Agyepong, Karamatullah Danyal, Lauren Gaffaney, Nicole Jedrqynski, Michael Rodriguez, Matthew Sommers, Andrew Wick, Judith Christensen, and Ellen Meagher

  Introduction. Studies have shown art intervention to be an effective therapy for patients with memory impairments, leading to overall positive behaviors, increased quality of life and decreased caregiver burden. We conducted a preliminary study to evaluate and compare the effect of participation in weekly art appreciation and painting sessions on the behavior of memory impaired residents in an assisted living facility.

  Methods. Residents’ behaviors were observed during art appreciation and active painting sessions over a six-week period. Each session consisted of either viewing and discussing artwork or actively painting in the style of the artist discussed. Positive and negative behaviors were recorded and tallied throughout the sessions. Over the course of 12 sessions, the 7 observers made a total of 1957 observations of a variable patient population. The total number of both positive and negative behaviors was compared between activities, over time within sessions, as well as over the six weeks. Each session was percent normalized to the time interval with the highest occurrence of select behaviors.

  Results. Upward trends for positive and negative behaviors were noticed in ap- preciation and painting sessions respectively. The negative to positive engagements ratios for each painting session showed an increase in negative behaviors. Disengagement increased as the appreciation sessions progressed and decreased as painting sessions progressed. Overall, positive engagement increased in both appreciation and painting sessions.

  Conclusions. Despite several confounding variables encountered in this study, we demonstrated art appreciation and active painting to be a viable non- pharmacological therapeutic approach for individuals with memory impairments.

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  Impact of Deferral for Low Hemoglobin on Donor Return

  Ashley Aiken, Alexander Disciullo, Cyrus Jalai, Nektarios Konstantinopoulos, Tyler Oe, Mark Fung, Jan Carney, and Jenny Lamping

  Introduction. A consistent blood supply to support life-saving transfusions relies on regular and repeat volunteer blood donations. In this study, we focused on donors previously deferred for low-hemoglobin (Hb) levels to better understand the value of supplying post-deferral educational information, and the actions donors took based on their deferral.

  Methods. An anonymous national survey of active and inactive donor groups (10,000 each) was conducted. The survey questions assessed post-deferral donor actions, preferences regarding post deferral education, understanding of their deferral, and demographic information. Chi-square analysis was performed to compare categorical survey results between donor groups with p < 0.05 denoting statistical significance.

  Results. The survey resulted in 722 and 103 active and inactive donor respons- es, respectively. Active donors were more likely to recall receiving educational materials post-deferral (52% vs. 35%, p=003), take iron and vitamin supplements (54% vs. 39%, p=0.009), lived within 30 min of a donor site (94% vs. 84%, p=0.006), and more likely to be older than 45 yr (62% vs. 42%, p=0.002) than their inactive donor counter- parts. Active and inactive donors were similar (p>0.05) with anemia history frequency, female-gender predominance, low-prevalence of vegans, and mixed interest in receiving information about raising hemoglobin levels.

  Conclusion. While active donors more frequently recalled receiving educational materials for their low hemoglobin deferral, and were more likely to take action to improve their hemoglobin, an alternative method of post-deferral recruitment should be considered given the uncertain value of post-deferral information when comparing active vs. inactive donors.

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  Role of the Dental Community in HPV Vaccination Promotion

  Thomas Luke Arnell, Maeve Donnelly, Alexis Nadeau, Laura Till, Collin York, Pedram Zargari, Alan Howard, Wendy Davis, and Christine Finley

  Introduction. With increasing awareness that human papillomavirus (HPV) can cause oropharyngeal cancer (OPC), dental providers may play an important role in promoting HPV vaccination and preventing cancer. Our goal was to assess knowledge and current HPV vaccine counseling practices among Vermont dentists and dental hygienists to identify potential targets for state-level interventions to increase vaccine coverage.

  Methods. We developed a survey to assess knowledge, beliefs, practices and barriers regarding HPV vaccination, and distributed it via email to practicing Vermont dentists and dental hygienists. Free responses were analyzed using a coding framework generated from three key informant interviews.

  Results. 90% of providers believe it is important for them to play an “active role” in their patients’ general medical care, yet only 50% believe it is their responsibility to recommend HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. When asked to name the biggest barrier against recommending vaccination, providers named the following factors most frequently: “not responsibility of dental provider” (27%); lack of confidence in knowledge (19%); time constraints (14%); and parent philosophical/religious opposition (11%).

  Discussion. Because dentists and dental hygienists care for a broad pediatric population across the state, dental communities may be poised to play an expanded role in Vermont’s efforts to improve its HPV vaccination coverage. Our study identifies several potential areas for provider-focused interventions, which include educating providers about the HPV vaccine and reducing significant barriers against recommending.

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  Health and Housing Trends of Single Homeless Adults in Chittenden County, Vermont

  Alexa Arvidson, Harshal Athalye, Pamela Derickson, Gregory Johnston, Elizabeth McLeod, Elizabeth O'Neill, Andrew Pham, Christopher Brzovic, and Virginia Hood

  Introduction. Homeless individuals are at an increased risk for both physical and mental health comorbidities compared to those with stable housing. Prior studies have demonstrated that many of these individuals do not seek or receive proper medical care. This study provides a landscape analysis of health characteristics in the single adult homeless population in Chittenden County, Vermont.

  Methods. Interviews were conducted using a modified version of the Vulnerability Index – Service Prioritization Decision Assistance Tool to determine vulnerability indices across a range of different health and social wellness domains. Single home- less adults were sampled from community self-help clinics and transitional living and homeless shelters from September to November 2017.

  Results. 56 in-person surveys were conducted. Mean age of participants was 45.3 years and over half were male (63%). Extended periods or multiple episodes of homelessness were experienced most by those who reported sleeping outdoors (89%); this group also reported the highest use of emergency services (47%). The highest incidence of abuse/trauma as a contributing factor for homelessness was reported most in the 18-30 age group (71%) and least in the above 51 age group (35%). Nearly all participants owned a cell phone (86%).

  Conclusions. Single homeless adults self-reported a variety of health and social is- sues, including substance abuse, increased emergency department use, and in- creased abuse, trauma, and deteriorated social relationships. This study highlights different risk factors that contribute to homelessness in this select population. Future research should evaluate how to individually address these vulnerabilities to optimize health care and well-being.

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  Farm to Early Care and Education in Vermont

  Ramin Badiyan, Nicole Becher, Nicholas Bompastore, Stephen Daniels, Katherine Price, James Rohwer, Heather Link, and Cynthia Greene

  Introduction. Farm to Early Care and Education (ECE) is a program of the Nation- al Farm to School Network that aims to extend the core elements of Farm to School into ECE settings with the goal of improving the health of children ages zero to five and enhancing their educational experience with food and nutrition. The purpose of this project was to gather baseline Farm to ECE data for Vermont.

  Methods. The 2015 National Survey of Early Care and Education Provider was used to create a 23-question survey. The survey was built with SurveyMonkey and distribut- ed through the Child Development Division.

  Results. 600 providers received the survey with 73 respondents. Minimum one meal is served daily at 93% of programs surveyed, and most serve local foods (84%). Most food is purchased from grocery stores (97%), followed by wholesale provid- ers (64%) and farmers markets (43%). Cost and food quality were the most important factors when determining where to buy food. 80% respondents reported they don’t currently engage in Farm to ECE activities; however, when polled on activities at their center 96% of participants who originally answered no, marked at least one activity that qualifies as a Farm to ECE event.

  Discussion/Recommendations. Vermont would like to extend the Farm to School Program to 75% of Vermont schools by 2025. Based on the results of this project, we suggest that a similar goal be established for Vermont-based early care programs targeting improved nutrition for Vermont’s youngest children and while supporting local farms and markets.

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  Barriers Encountered by Syringe Exchange Clients in Vermont

  Ava Bakhtyari, Jennifer Boccia, Pooja Desai, Zachary Ehret, Jacob Lehman, Benjamin Lin, Caroline Vines, Peter Jacobsen, and Jerry Larrabee

  Introduction and Aims. Vermont CARES is a nonprofit HIV prevention and advocacy organization which provides a needle exchange program for intravenous drug users. Services are focused on education, prevention, testing, and harm reduction. The Syringe Support Program (SSP) offers clients clean syringes to reduce intravenous transmission of disease.

  Although SSP are proven avenues for harm reduction, barriers prevent users from utilizing services. Clients are limited by social, economic, and personal obstacles de- scribed in similar populations across the country. This project seeks to identify the barriers Vermont CARES clients face in accessing the SSP, determine needs, and evaluate interest in additional services.

  Methods. Our team and Vermont CARES staff held a focus group with St. Johnsbury clients to discuss services and barriers. A 39 question paper survey was distributed to three Vermont CARES sites during October, 2017 by Vermont CARES. Participation was voluntary and uncompensated. Sixty-three clients completed the survey.

  Results and Discussion. Of the 63 respondents, 61.9% stated that lack of ade- quate income contributed most to their inability to meet basic needs. These same clients faced the most barriers to access with economic hardship precipitated by sub- stance abuse, disability, and family commitments. In assessing additional services, clients sought food pantries, hygiene kits, and dental clinics. 56.4% of respondents would use safe injection facilities if provided. Those without income to meet basic needs expressed most interest in safe injection facilities (p=0.022). With barriers recognized, our future aim is to track efficacy of new services in impacting care and quality of life.