Publications

Forthcoming
Sullivan MM, Lazowy EE, Roncarati JS, Koh HK, and O'Connell J. Forthcoming. “Training a Clinical Workforce to Improve Healthcare for Homeless Persons. AMA Journal of Ethics [forthcoming]. 2021.” AMA Journal of Ethics.
2021
Margaret M. Sullivan and Mary T. Bassett. 2/22/2021. “Produced by Design: How the Inequities Experienced by Immigrants During the COVID-19 Pandemic were Created.” Harvard Health Policy Review. Publisher's VersionAbstract
Barriers to equitable health for immigrants in the United States are purposefully created by policies. Our long history of legislation restricting access to comprehensive health insurance, labor protections, and economic opportunities for immigrants set the stage for disproportionate morbidity and mortality during COVID-19. This is further exacerbated by anti-immigration policies which erode trust in public institutions and create fear. Attempts to improve access to healthcare, such as the Affordable Care Act, have left behind millions of immigrants and Medicaid still has not been expanded in several states where high shares of immigrants reside. This results in expected and foreseeable health inequities during a global pandemic.
2020
Margaret M. Sullivan. 11/1/2020. “Learning How to Support and Improve Healthcare Delivery to Immigrant Patients at Health Centers in Massachusetts”.Abstract

Immigrant communities are foundational to the social and economic success of the United States. Health is an important factor in the ability to achieve and maintain success, but numerous barriers to equitable health access, quality and outcomes persist for many immigrants in Massachusetts. These longstanding barriers are compounded by restrictive immigration policies, creating new uncertainties about eligibility for health-promoting benefits, hamper individuals’ willingness to seek care, increase mental health concerns, and thwart the ability of healthcare providers to deliver care. Federally Qualified Health Centers (FQHCs) play a vital role in healthcare delivery to immigrants. With their unique mandate to serve all-comers, regardless of ability to pay, insurance, or immigration status, FQHCs disproportionately care for patients with low-income, lack insurance, and who prefer receiving healthcare in a language other than English. This DELTA (Doctoral Engagement in Leadership and Translation for Action) addresses the challenges and needs FQHCs in Massachusetts face in delivering healthcare to immigrant patients. In collaboration with the Massachusetts League of Community Health Centers, this work sought to understand the specific challenges and opportunities health centers face when caring for immigrant patients. The objective was to identify how the League can improve support of health centers experiencing challenges with delivery of services to immigrant patients. Between December 2018 and June 2019, 53 staff members across five FQHCs and the League participated in discussion groups about challenges and opportunities. Responses were analyzed thematically and formulated into recommendations and tools for the League. A second component of this DELTA was the launch of an immigrant-friendly clinic at one FQHC, Boston Health Care for the Homeless. Since March 2019, 23 clinic sessions have taken place, serving 201 unique patients from over 13 countries who speak more than six languages. The process of developing the new clinic has shed light on one health center’s existing challenges in immigrant healthcare delivery, constructive opportunities for improvement, and necessary core organizational components. Improvements at the organizational level of health centers have the potential to facilitate and promote individual staff capacity. However, new uncertainties, confusion and growing fears compound existing barriers and health centers require additional support.

Kelly Anthoula Love, Rachel Gershon, and Margaret Sullivan. 9/29/2020. The Final Public Charge Admissibility Rule: Implications for Massachusetts. Publisher's Version
Jacqueline Bhabha, Margaret M Sullivan, and Mary T Bassett. 3/22/2020. “Protecting Children’s Rights as Schools Close.” Health & Human Rights Journal. Publisher's Version
2019
Kate Festa, Ariel E. Hirsch, Michael R. Cassidy, Lauren Oshry, Kathryn Quinn, Margaret M. Sullivan, and Naomi Ko. 10/17/2019. “Breast cancer treatment delays at an urban safety net hospital among women experiencing homelessness.” Journal of Community Health, 45, Pp. 452-457. Publisher's Version
Margaret Sullivan. 3/8/2019. The Relational Aspect of Primary Care with Immigrant Patients. Global Alliance for Nursing and Midwifery.
2018
D.D. Im, L. Palazuelos, L. Xu, R.L. Molina, D. Palazuelos, and M.M. Sullivan. 2018. “A Community-Based Approach to Cervical Cancer Prevention: Lessons Learned in Rural Guatemala.” Progress in Community Health Partnerships: Research, Education, and Action, 12, 1, Pp. 45-54. Publisher's VersionAbstract

Background: One international and three local organizations developed the Santa Ana Women's Health Partnership (SAWHP) to address cervical cancer in Santa Ana Huista, Huehuetenango, Guatemala. This paper describes the structure, outcomes, and lessons learned from our community partnership and program.

Methods: The community partnership developed a singlevisit approach (SVA) program that guided medically underserved women through screening and treatment of cervical cancer.

Lessons Learned: The program promoted acceptability of SVA among rural women by engaging local female leaders and improving access to screening services. The program's approach focused on maximizing access and generated interest beyond the coverage area. Distrust among the community partners and weak financial management contributed to the program's cessation after 4 years.

Conclusions: The SAWHP design may guide future implementation of cervical cancer screening programs to reach medically underserved women. Open, ongoing dialogue among leaders in each partner institution is paramount to success.

2017
Karen Feldscher. 1/24/2017. “Student project aims to boost health, decrease hospitalization among homeless.” Harvard School of Public Health-Featured News Stories. Publisher's Version
2016
Margaret M. Sullivan, Lena J.P. Cardoso, Casey Leon, Denise De Las Nueces, and Jessie M. Gaeta. 10/2016. “Spanish-speaking and Homeless: Health Status of a Highly-Marginalized Community in Boston.” In 10th Annual UCSF Health Disparities Research Symposium. San Francisco, California. bhchp_poster_10.2016_final.pdf
2015
Maggie Sullivan. 3/12/2015. “Trauma-Informed Care and Global Health.” Global Nursing Caucus: Engaging Nurses to Advance Global Health.
Margaret M. Sullivan, Dana DaEun Im, Lindsay Palazuelos, Daniel Palazuelos, and Rose Leonard Molina. 3/2015. “The Importance of Clinical Accompaniment for VIA/Cryotherapy in Low and Middle Income Countries.” In Consortium of Universities for Global Health - Annual Conference. Boston, Massachusetts. clinicial_accompaniment_for_via_-_cugh_poster.pdf abstract_cugh_2015-the_importance_of_clinical_accompaniment_for_via.pdf
Naira Arellano, Sheila Davis, Lynda Tyer-Viola, Margaret M. Sullivan, Mary E. Mihovan, Katie Costa, Jafet Arrieta, Hugo Flores, Lindsay Palazuelos, and Daniel Palazuelos. 2015. “Towards la clínica de mis sueños: Findings from a needs and assets assessment among rural nurses in Chiapas, Mexico.” Journal of Nursing Education and Practice, 5, 3, Pp. 90-93. Publisher's VersionAbstract
Mexican nurses can face important challenges such as difficulty finding employment, wide  ranges of salaries and strained interprofessional relationships. Additionally, many nurses in Mexico care for a marginalized and underserved patient population. In Chiapas, one of the poorest states in the country, six government-sponsored clinics have partnered with the non-profit organization Partners In Health (PIH) to deliver healthcare. The goal of this study was to explore the perceptions of the nurses employed in these clinics about their role, professional relationship with clinic doctors and about the needs and assets that characterize their work. In March of 2013, with approval from an ethical research review board, we conducted semi-structured in-depth interviews with the eight clinic nurses and six doctors working alongside them. The qualitative data analysis showed that nurses
highlighted their role in disease prevention, reported highly valuing collaboration with clinic doctors and wanted opportunities to expand their clinical knowledge. Nurses identified the burden of documentation and lack of preparation for medical emergencies among their biggest professional challenges. These findings will serve as the foundation for the strategy to be used to support the work of nurses in the PIH-supported clinics. Key Words: Nursing, Rural health services, Mexico, Needs assessment
2014
Elizabeth Glaser, Eileen Stuart-Shor, and Maggie Sullivan. 2014. “Redefining global health-care delivery: Commentary.” The Lancet, 383, 9918, Pp. 694-695. Publisher's Version
2013
Maggie Sullivan. 9/30/2013. “Nursing in Chiapas and Guatemala.” Global Nursing Caucus: Engaging Nurses to Advance Global Health.
Jennifer Sargent. 4/4/2013. “Achieving Health Equity: Exemplars from the Field.” Medical Nursing's Albert H. Brown Visiting Scholar Program. Massachusetts General Hospital. Publisher's Version
Naira Arellano, Margaret Sullivan, and Sheila Davis. 2013. “Patient Advocacy as a Tool to Reduce Disparities Affecting the Spanish-Speaking Homeless.” In NIH-Science of Eliminating Health Disparities. Washington D.C. patient_advocacy_-nih_poster_the_science_of_eliminating_health_disparities.pdf
2012
Maggie Sullivan. 12/2012. “Even When I Speak English.” Massachusetts Report on Nursing, 10, 4, Pp. 11.
Maggie Sullivan. 5/30/2012. “The Essential Role of Clinical Mentorship.” Partners In Health. Publisher's Version
Margaret M. Sullivan, Dana D. Im, Lindsay Palazuelos, and Dan Palazuelos. 2012. “Cervical Cancer Screening in Guatemala: Implementing a high-quality and sustainable program.” In Global Nursing Caucus - Annual Conference. Boston, Massachusetts. global_nursing_caucus_2012.pdf

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