Community Health and Education

How Early Screening Helps Primary Care Clinicians Uncover Youth Substance Use

Ninety percent of people addicted to substances started drugs before they were 18, and anxiety, depression and even suicide are often linked with addiction. That’s why early detection is crucial, said Caitlyn Johnson and Kim Shuler, licensed social workers with Arkansas Behavioral Health Integration Network.

They presented evidence-based adolescent substance use screening tools such as the SBIRT model (Screening, Brief Intervention and Referral to Treatment) at the UAMS 29th Annual Family Medicine Update Oct. 29, 2025.

The event was sponsored by the UAMS Department of Family and Preventive Medicine’s Community Health and Education division. Arkansas Children’s National Center for Opioid Research and Clinical Effectiveness sponsored the first day, “Opioids and the Young.”

Speakers Caitlyn Johnson and Kim Shuler, both social workers with the Arkansas Behavioral Health Integration Network — *Caitlyn Johnson and Kim Shuler with Arkansas Behavioral Health Integration Network*

Trends in Teen Substance Use: Alcohol Still Leads

The social workers surprised the primary care audience by revealing that alcohol trumps nicotine and THC as adolescents’ most used substance because it is readily accessible and culturally accepted. But the good news is that binge drinking is trending down, according to the National Institute on Drug Abuse, even though it’s still a contributor to 74% of premature deaths among teens.

“Substance use can contribute to feeling more uninhibited and having suicidal thoughts,” said Shuler. “Suicide is something that we need to have in the forefront of our minds.”

How SBIRT Works in Primary Care

“The key is to be as preventative as possible and provide education and tools for these teens,” Johnson added, referring to SBIRT, which stands for screening, brief intervention and referral to treatment. SBIRT screening tools often take five minutes or less to administer. Substance Abuse and Mental Health Services Administration (SAMHSA) recommends starting at age 12, but children as young as 10 are using substances

“Think about using universal screening for substances, meaning at every visit, use a screener. One of the things we know is that sometimes, when we’re asking someone (about their substance use), they may not tell us the first time. So, it’s important to continually bring this up,” said Shuler.

SBIRT - The 35,000 Foot View
Screening, Brief Intervention and Referral to Treatment (SBIRT) is one of the leading ways to reduce the impact of alcohol and substance use. Screening - Identifying adolescents who are at risk of negative consequences due to their substance use, including risk of a substance use disorder.
Brief Intervention - A conversation that is intended to either prevent, stop or reduce substance use disorder.
Referral to Treatment and Follow-up -- Linking the adolescent to substance use disorder treatment and other services, resources and supports and regularly checking in to facilitate sustained access.

The CRAFFT is one of the more common screening tools. There are others such as anxiety screener Generalized Anxiety Disorder, called GAD, and the PHQ-9A which screens for depression.

Whatever tool is chosen, it’s important to let the teen know that the provider is asking everyone about substance use and not singling them out. The provider must establish confidentiality, that the patient can be honest and trust them.

Clinicians should talk with the parent or caregiver first, conveying the importance of the screening and the need for confidentiality. This will settle the parent’s mind when asked if the teen can step out for a few minutes to speak privately.

Once that confidentiality is set, what if the young patient answers “yes” to any of the questions on the screener? Johnson said many providers feel they don’t have the tools to take the next step of intervention. One solution is to hire behavioral health consultants in the clinic, but providers have been hesitant to move to integrated care because of financial, training and space issues. Video on Arkansas providers who are taking the step toward behavioral health integration.

Brief Intervention Steps

teen boy talking to provider in office visit — Chances of developing an addiction are six times higher for teens who began using before age 15 than those who delay use until they’re 21.

Johnson and Shuler walked through the conversational steps for brief intervention when a behavioral health professional isn’t available.

If the CRAFFT screening score is low (0-2), the intervention may require only one to three minutes since the patient is low risk. If moderate to high risk, the intervention will take 15 – 30 minutes. Johnson said to allot enough time to complete the intervention.

“There are barriers to seeing the doctor, such as missing school and insurance being able to pay and things like that. So you want to make sure you give as much as you can in one session,” said Johnson. She added that the intervention can be extended to several sessions with either the provider or medical team. “If you run into an adolescent or young adult that is not ready to make behavior change, that is OK. That’s to be expected. Their brains are still developing, and they are learning how to make those educated decisions,” said Johnson.

The social workers covered a step-by-step example of brief intervention called the Brief Negotiated Interview model, created by the Boston University School of Public Health. It has six stages.

Build engagement and rapport – Show interest in them as a person, the things they’re putting in their body and the risks. “Would it be OK if we spent a few minutes talking about your alcohol or drug use?” If “yes,” go to question two, but if the answer is “no,” offer to be available to talk if needed.
Pros and Cons – Ask what is enjoyable about using the substance and what’s difficult. “What else comes to mind when you think about how using the drug may impact your life, goals or wellbeing?”
Feedback – Ask if they mind some education or thoughts on the situation. If “yes,” share one or two facts and ask their thoughts. If “no,” emphasize autonomy by saying the patient knows what’s best for them regarding the drug use.
Readiness Ruler – Gauge their motivation for change, whether it’s low on the scale or high, and what can be done about it. “If you were to place yourself on a scale of 1 – 10 regarding how important it feels to make any change in your use of the drug, where would you be?” If the answer is four or above, ask why they chose that number and not a lower one. If the answer is 1 – 3, probe with the question, “What would have to happen to feel like making a change?”
Negotiate Action Plan – Formulate goals with them. “So, now that we’ve had a few minutes to talk, what would you like to do, if anything? Would it be OK if I share some options?” Have them write down their goals and next steps. Focus on one to two short-term goals with specific steps.
Summarize and Thank – They took a chance on being vulnerable with the provider, which can be painful. Ask, “Is this what you agree we went over? How do you feel about these goals that we set?”

Shuler noted that one powerful preface to a question is, “I’m curious,” because curiosity invites openness and doesn’t equal judgment.

When to Refer for Substance Use Treatment

If the brief intervention reveals a need for more intensive care, Johnson said the referral needs to be to a licensed substance use professional at a treatment facility. Cost, insurance, school or parents’ work schedule are some potential barriers.“It’s not going to be the smoothest process,” said Johnson, “but it is worth a try to see if we can overcome those barriers through conversations or connections to resources.”

The Arkansas Department of Human Services Office of Substance Abuse and Mental Health oversees prevention, treatment and recovery programs in the state and can help locate providers by area.

An educational video from Dr. Aaron Weiner on youth substance use and mental health.

Kim Shuler, LCSW, has more than 20 years of experience in clinical practice and leadership within integrated behavioral health. As CEO of ABHIN and project director for several HRSA-funded initiatives, she leads statewide efforts to advance access and quality. She is a certified behavioral health consultant with expertise in workforce training, coalition-building and strategic planning.

Caitlyn Johnson, LCSW, has 10 years of experience in integrated behavioral health, care coordination and medical social work. She earned her bachelor’s and master’s degrees in social work from the University of Arkansas at Little Rock and serves as a project manager on multiple grants for the Arkansas Behavioral Health Integration Network. Johnson specializes in program development, brief intervention, harm/stigma reduction and suicide prevention.

Family Medicine Update Oct. 29 – 31 offers 12 hours of virtual content for primary care

The 29th Annual Family Medicine Update: Fueling the Front Line will offer up to 12 hours of online continuing education Oct. 29 – 31 for primary care physicians, advanced practice registered nurses and registered nurses, pharmacists, physician associates, physical therapists, respiratory therapists, certified health educators, social workers and substance abuse counselors.

The virtual annual conference compiles the latest advances impacting family medicine, with a bonus of flexible, on-demand viewing through November 28, 2025.

The first day – Opioids and the Young – offers four hours of content for only $25. The Thursday and Friday two-hour blocks are $40 each.

To register, visit this link.

Day 1
The first day is Opioids and the Young, sponsored by Arkansas Children’s National Center for Opioid Research and Clinical Effectiveness. The day will include a talk on opioid use disorder in moms and children with Shona Ray-Griffith, M.D., an associate professor in the UAMS Depts. of Psychiatry and Obstetrics and Gynecology, and mandated reporting laws with Jessica Coker, M.D., assistant professor in the UAMS Dept. of Psychiatry. Other topics include behavioral health screening and intervention for adolescents with Kim Shuler, LCSW, and Caitlyn Johnson, LCSW, both with the Arkansas Behavioral Health Integration Network. The last session will be “Opioids Off the Table? Now What?” with Teresa Hudson, Pharm.D., Ph.D., a professor in the UAMS Dept. of Psychiatry.

Caitlyn Johnson and Kim Shuler, social workers — Caitlyn Johnson and Kim Shuler

Day 2
Talks on the second day will feature UAMS providers: sniffles, chills and fever in kids with Rachel Ekdahl, M.D., and Satvika Mikkilineni, D.O.; “Naloxone Know-How for Saving Lives” with Leah Tobey-Moore, DPT, MBA, and Meghan Breckling, Pharm.D.; and a fresh look at hypertension medications with Michelle Hernandez, Pharm.D. Alexis White, M.D., also will speak on menopause.

Day 3
The last morning of the virtual conference will focus on cancer screening in Arkansas, presented by Daniele Ramirez-Aguilar, MPH, with the Arkansas Central Cancer Registry, and “Mending a Child’s Heart: Pediatric Cardiology from a Nurse Practitioner Perspective” with Leslie Lewis, APRN, who works at Children’s Medical Center in Dallas, Texas. The two afternoon sessions will feature Robert Hopkins Jr., M.D., who will update attendees on immunization essentials for the fall. He is the division director for the UAMS Dept. of Internal Medicine. Next will be “Spotlight on LADA: The Hybrid Diabetes of Adulthood” with Hadeel Al Fares, M.D., an endocrinology, diabetes and metabolism fellow at UAMS.

Family Medicine Conference Warns of Trend for Early-Onset Colorectal Cancer and Highlights Topics Important to Family Medicine

Family medicine providers gathered for UAMS’ virtual 2025 Family Medicine Spring Review April 23 -25 and learned that the colorectal cancer death rate in people younger than 55 is climbing one percent each year since the mid-2000s, but that this group is more open to a yearly stool-based screening test such as the fecal immunochemical test (FIT) or Cologuard than other age groups.

The colorectal cancer screenings updates from Whitney Jones, M.D., a gastroenterologist from Kentucky, and Francis Colangelo, M.D., a primary care physician with Allegheny Health Care in Pittsburgh, were part of the first day of the three-day conference.

Francis Colangelo, M.D., primary care physician, speaking on early-onset colorectal cancer.

“Around 41 percent of these (younger patients) had symptoms for at least six months before visiting a provider,” said Colangelo. “And if you see rectal bleeding, always assume it is colorectal cancer in the younger patient.”

The conference was presented by the Department of Family and Preventive Medicine’s Community Health and Education division, which has produced continuing medical education for 47 years.

Amanda Deel, D.O., associate dean of the New York Institute of Technology’s College of Osteopathic Medicine, spoke on compassion in healthcare.

“Following a compassion-centered script with patients may feel artificial, but in a study, patients didn’t sense that. Physicians miss opportunities to practice compassion 70 percent of the time and interrupt patients on average in the first 11 seconds,” said Deel.

Angela Driskill, M.D., is a wound care specialist practicing at Baptist Health. She said there must be a distinction between pressure injuries and skin that fails because pressure injuries imply failure of care or harm.

“If you don’t document a wound 12 to 24 hours after admission, it will throw up a red flag to CMS. Say it’s been 24 hours before anyone does a skin assessment, they are classified as ‘unwounded’ when they came in. Then we document there’s a stage 3 or 4 wound of the sacrum, and CMS begins to recoup the cost of that care, which can be $50,000 to $70,000,” said Driskill.

Sleep medicine physician Caris Fitzgerald, M.D., offered trouble-shooting tips for patients who wear a CPAP, a machine that treats sleep apnea with continuous positive airway pressure. CPAP manufacturers estimate that more than eight million people wear a CPAP each night. One common complaint is dry mouth.

Picture of Caris Fitzgerald, MD — **Caris Fitzgerald, M.D.**

“A leak makes or breaks the experience with a CPAP,” said Fitzgerald, who sees patients at the Central Arkansas Veterans Healthcare System. “If a patient complains of dryness, fix the leak, don’t just increase the humidity. The nose is a humidifier. If your pressure system is sealed well and the patient is nasal breathing, they will not need a humidifier.”

My goal with patients is 10LPM unintended leak. 10LPM is generally a good goal for 95% Unintended Leak. Most under 10LPM can do without a humidifier which means a lot less cleaning and expense. And those with co-occurring good use have almost always resolved the complaints associated with OSA.

In his talk on metabolic issues, James Tucker, M.D., bariatric surgeon with Arkansas Heart Hospital, said bariatric surgery is not a cure for disease of obesity but a treatment. Sleeve gastrectomy is the more common surgery where 50 to 70 percent of the stomach is removed.

“With insulin-dependent patients who’ve had the surgery, 60 percent to 80 percent experience remission from the disease,” said Tucker.

On the third day of the conference, Amy Grooms, M.D., with the UAMS Department of Psychiatry, spoke about using transcranial magnetic stimulation for patients with treatment-resistant depression. She said transcranial magnetic stimulation uses a magnetic pulse that stimulates the dorsolateral prefrontal cortex and rebalances it with the subgenual anterior cingulate cortex. Around 30 percent of patients who use this treatment have a standard response, but 18 percent of patients report that their depression is gone.

Bill Fantegrossi, Ph.D, who works in the UAMS Department of Pharmacology and Toxicology, ended the conference with a talk on emerging drugs of abuse. He said new synthetic opioids grip more tightly to the opioid receptors in the brain. With such a strong bond, reversing an overdose is difficult with standard treatments such as naloxone (Narcan). Naloxone knocks opioids from brain receptors, but it struggles to unbind new synthetic opioids from receptors. This means it can only partially reverse an overdose or may fail.

Synthetics - fentanyls. Lethal doses of heroin, fentanyl and the ultra-potent analog carfentanyl.

Other conference topics included an update on the HPV vaccine with Portia Knowlton, who works with St. Jude’s HPV prevention program, renal cysts and masses with UAMS’ Marcelo Bigarella, M.D., and long-term effects after curative cancer treatments with Viriginia Laliberte, APRN. Ashley Acheson, Ph.D., and Jami Jones, who work with the National Center for Opioid Research & Clinical Effectiveness at Arkansas Children’s Hospital, spoke on the research they are conducting on children and adolescents who have been affected by the opioid crisis and other drug addictions.

Hidradenitis Suppurativa: Three Questions to Diagnose and Five Layers of Treatment

Hidradenitis suppurativa (HS) is a skin disorder that starts with blocked hair follicles, leading to painful nodules, abscesses and scarring. Front-line providers can work with dermatologists to diagnose and treat this often debilitating condition by asking three questions and following a five-tiered approach to treatment.

Dr. Vivian Shi, former UAMS dermatologist and director of the hidradenitis suppurativa clinic, offered tips to family medicine providers at the UAMS 2024 Family Medicine Spring Review last April. She said, “It requires a multidisciplinary approach. An HS team including all of these specialists and dermatology providers are the principal providers, but we really lean on front-line providers … to detect, treat, refer and to collaboratively manage.”

Picture of Vivian Shi, MD — Vivian Shi, M.D.

Most of her HS patients have had it more than 10 years after having seen their providers at least five times, and around 15% are disabled or unable to work because of HS pain. Girls typically show signs in their early teens, and boys start in their mid to late teens. If the teen has severe acne, have the patient lift the arms to check for HS signs. The typical onset is between puberty and age 40, with women being three times more likely to be affected.

Three key diagnostic questions every provider must ask the patient:

1. In the last 12 months, did you repeatedly have big, painful nodules and boils in the armpits or groin?

2. Have you had outbreaks of boils in the last six months?

3. Do you repeatedly have outbreaks of big sores, painful nodules or boils that heal with scars in any of these locations?

If the answer is “yes,” there is a 90 percent chance of HS.

“There’s no reason healthcare providers should be missing this if they ask these questions,” said Dr. Shi.

HS can show up anywhere on the body – behind the ears, outer arms or legs – not just the skin folds and areas with sweat glands. The two exceptions are the palms and soles of the feet. It’s chronic, inflammatory and very painful. Initially, the patient will have inflamed nodules, abscesses, white heads and black heads. The more advanced stage includes draining sinus tracts (narrow channels) and severe scarring, which are especially true in Blacks. Often it is misdiagnosed as cellulitis.

HS is divided into three Hurley Stages. The mildest is Hurley Stage 1: Abscesses that resolve without any trace of scarring, but this is rare. As soon as the patient has any sign of a scar, it’s labeled Hurley Stage 2. This stage includes recurrent abscesses, sinus tracts and scarring, but normal-looking skin will appear between them. The most advanced stage is Hurley 3, characterized by multiple connected sinus tracts and abscesses across the entire area with little to no normal-looking skin between. She describes it as an “over-exaggerated inflammatory response where, over time, the hair follicles connect with each other and form sinus tracts and extensive scarring.”

Dr. Shi recommended a pyramid of treatment. The front-line provider can manage all the treatments except for biologics, the top tier. In early moderate to severe patients (late Hurley 1 to early Hurley 2), Dr. Shi suggested preparing patients for biologic therapy by prescribing oral antibiotics because payors typically require patients to fail 90-plus days of systemic antibiotics to qualify. Regardless of disease stage, providers should refer the patient to a dermatologist for advanced therapy, while collaboratively managing the patient.

The 5 Tiers of Treatment:
Top layer - Biologics
Second layer - Hormonal Treatments
Third layer - Oral Antibiotics
Fourth layer - Topicals
Bottom Layer - Lifestyle Modification

Lifestyle Modification

The first tier of the pyramid is lifestyle modifications where the provider would screen for comorbidities and start treatments. In a recent JAMA Dermatology report, patients with HS said diet changes were the most used non-prescription treatment with the Mediterranean diet and intermittent fasting both being effective. The two exercises that HS patients can tolerate are Pilates and swimming. Weight loss surgery is also a strong consideration if the patient is greater than 35 BMI, and if the patient smokes, encourage them to quit since cigarette smoke has dioxin-like compounds that can cause acne and scarring. Loose-fitting clothing and anti-chaffing products applied in skin folds can reduce friction and pain.

If the patient has draining sinus tracts, bathing helps to rinse out the tunnels. Dr. Shi recommends alternating daily with 10-minute baths of Epsom salt, CBD oil and ¼ cup 6% commercial bleach which help with pain, itch, relaxation and decrease biofilm.

Topicals

The next level is topical treatments. She typically uses clindamycin 1%; however, resorcinol 15% elicits a better response in mild to moderate HS. Resorcinol is especially helpful because it breaks down the outer layers of the skin and unplugs the hair follicles. There are also washes such as benzoyl peroxide, chlorhexidine or dapsone. Dr. Shi cautioned against benzoyl peroxide wash used together with topical dapsone because they’ll have reversible yellowing of the hair follicles.

Oral Antibiotics

Dr. Shi’s office typically starts with the tetracycline family because it’s better at reducing inflammation in the hair follicle and less costly. She recommends 100 milligrams of doxycycline or minocycline twice daily or extended release minocycline at a weight-adjusted dose once a day for eight to 12 weeks. Dr. Shi cautioned that dosage may need to exceed 100 milligrams for it to work, so ensure the patient doesn’t have anemia. She uses this for flare-ups or to bridge to biologic therapy.

Rotating through combined systemic antibiotics also works, being careful not to extend beyond three months. One combination is clindamycin with rifampin. A second choice is rifampin with moxifloxacin and metronidazole, which is especially helpful for drainage. And one thing providers want to consider is to stop the metronidazole after six weeks because longer use can cause reversible peripheral neuropathy.

Certain supplements also should be considered. Persons with HS typically have lower serum zinc levels. Prescribing 100 – 200 milligrams of daily zinc (with copper included after two months) has shown to reduce HS severity in 80% of patients. Another supplement to consider is Vitamin D since most patients with HS are deficient. Vitamin D regulates hair cycle and skin cell activity.

Hormonal Treatments

Dr. Shi recommends these hormonal / metabolic therapies:

Hormonal and Metabolic Therapies
For Women - Spironolactone 50 - 150 mg daily. Monophasic OCP (with increased estrogen and with anti-androgenic progestin such as drospirenone)
For Men -- Finasteride 5-10 mg daily
For Both - Metformin 500 mg - 1500 mg daily (for patients who are obese or have diabetes). Also Metformin XR.

Biologics
Biologics is the last step of treatment. Dr. Shi said providers should learn the basics of biologics so they can explain how it works before they refer to a dermatologist. The patient must be on at least 90 days of an oral antibiotic before most insurance will allow biologics.

Dr. Shi’s takeaways:

Ask the three questions to have a high confidence of diagnosing HS.

Refer to dermatology once diagnosed.

Screen for metabolic syndromes, inflammatory bowel disease, hormonal and mental health abnormalities.

Reverse screen for HS if the patient has Down syndrome.

Start antibiotics if the patient has any scarring because biologics is the next step. Most insurance requires 90 days to four months of oral antibiotic to be eligible for biologic treatment, so this is the referral window.

More information on HS can be found at hs-foundation.org

If you’re interested in more of UAMS’ primary care CME/CE, check out our list of upcoming CME/CE here.

Physician Wins Award for High Colorectal Cancer Screening Rate

Dr. Clinton Smith with 1^st Choice Healthcare was named the Arkansas Cancer Coalition Healthcare Provider of the Year at the Arkansas Cancer Summit March 7 for his 75 percent rate of colorectal cancer screening with his patients.

The family physician has participated in the UAMS Partnerships in Colorectal Cancer Screening for Arkansas (PiCS-AR!) since 2020, a Centers for Disease Control and Prevention grant that seeks to raise colorectal cancer screening rates in the state. His 75 percent rate is closing in on the national goal of 80 percent set by the National Colorectal Cancer Roundtable.

Clinton Smith, DO, physician with 1st Choice Healthcare in Corning, Arkansas

Smith’s first year with the PiCS-AR! grant showed a screening rate of 65 percent. His rate grew to 70 percent in 2021 and has escalated in one year to 75 percent. He said the reasons for his higher screening rate stem from frequently reminding the patients of screening, making it easy for them to screen, and relaying the facts.

“Each time I have a checkup with a patient (not even necessarily a wellness checkup), I try to mention (screening) and see if they’re due for anything. And if they are, we try to go ahead and facilitate that and get it set up,” said Smith. “The best time to (mention) it, in my opinion, is when you see them. Sometimes people are non-compliant and you may not see them for a while. Now, it does take extra time, and sometimes I get behind, but I feel that prevention is the key. It’s better to prevent a problem than to have to treat it later.”

Smith gives his patients several screening options: stool-based tests and a colonoscopy. The stool-based tests (FIT or Cologuard) require that the patient send a sample of their stool in the mail, which takes minutes and is not invasive and requires no dieting, fasting or anesthesia. The colonoscopy is considered the most accurate for colorectal cancer screening, but with his rural patient population in northeast Arkansas, arranging a colonoscopy can be cost- and time-prohibitive.

“I tell them about the options and let them decide. I think the FIT tests have helped a lot. We’re rural, so to get a colonoscopy, you not only have to take a day off of work, you have to drive 30 miles outside of town,” said Smith.

Colorectal cancer is the second deadliest cancer for Americans, and it’s on the rise with younger age groups, according to the American Cancer Society. The rate of new colorectal cancer cases among Americans younger than 55 increased from 11 percent of all cases in 1995 to 20 percent in 2019. The recommended screening age for those with average risk is 45, which the U.S. Preventive Services Task Force lowered from age 50 two years ago because of this new trend. Screening at an earlier age means cancer will be caught in its first stage and is highly treatable if detected early.

Smith also credits his employer, 1^st Choice Healthcare, for allowing him to spend more time with his patients who are often chronically ill and require more than the suggested 15 minutes many physicians are tethered to. 1^st Choice is one of two healthcare partners working with the PiCS-AR! five-year grant. Mid-Delta Healthcare System in eastern Arkansas is the latest system to join.

In Memoriam: Kent McKelvey, M.D., CHE Medical Director and Leader in Genetics Research

February 1, 2022 – Kent McKelvey, M.D., 52, of Little Rock died Monday, Jan. 17. He was an Associate Professor in the Division of Genetics and served as Director of Cancer Genetics Services in the UAMS Winthrop P. Rockefeller Cancer Institute. He was also a long-time medical director for the Department of Family and Preventive Medicine’s Community Health and Education division.

Dr. McKelvey had been battling acute myeloid leukemia for the past five years. His devotion to his patients, his mission in his field and his love of life sustained him through three stem cell transplants, the most recent in July 2021.

A faculty member since 2003, Dr. McKelvey was a founding member of the Division of Genetics and served as Director of Cancer Genetics Services in the Winthrop P. Rockefeller Cancer Institute. He was a champion for Arkansans with Down syndrome and other genetic conditions and was instrumental in establishing the Adult Genetics Clinic at UAMS. He was invested as the inaugural recipient of the Winthrop P. Rockefeller Chair in Clinical Genetics in 2009.

Dr. McKelvey was a nationally recognized leader on the ethical use of predictive genetic testing in clinical medicine and was on the forefront of teaching the responsible use of molecular genetics in preventive medicine. Between his own stem-cell transplants, he tenaciously continued his career seeing patients and families via telemedicine and working closely with the Arkansas Down Syndrome Association on their behalf. After many years of research, despite his ongoing battle with AML, he published definitive guidelines for treatment of adults with Down syndrome in JAMA in October 2020, and continued his collaboration with fellow members on the American College of Medical Genetics Secondary Findings Committee, which resulted in authorship of his final publication on genome sequencing in Nature Genetics in Medicine in May 2021.

Dr. McKelvey is one of six doctors from three generations of his family to practice in the state of Arkansas. He received his medical degree from UAMS in 1996 and completed his residency at the UAMS Family Medicine program in Texarkana. After working in emergency departments in DeQueen and Nashville, Arkansas, and two years in private practice in Mountain Home, he completed a fellowship in medical genetics at his college alma mater, the University of North Carolina at Chapel Hill. In 2003, he returned to Arkansas to raise a family and rejoined UAMS as Director of the Family Medicine Pre-doctoral Program in the Department of Family and Preventive Medicine. Dr. McKelvey served in the Division of Genetics following its establishment in 2008, and continued to hold an additional appointment in Family Medicine. He directed the Medical Genetics Course in the College of Medicine, and was elected by his students for numerous teaching awards.

Dr. McKelvey brought his gift of strength and determination to the diverse roles he served at UAMS throughout his life. He was an intense person with a good sense of humor and a force of vitality wherever he went. Although his career goal was to give back to those around him, he spent much of his final years at UAMS as a patient rather than a physician, and he found himself overwhelmed with gratitude for the physicians, colleagues, nurses and staff who would treat him like family at the only hospital that would ever feel like home. He considered these final years to be the happiest of his life. Dr. McKelvey’s family would like to extend their thanks to all those who cared for him.

Service arrangements are on hold due to the recent pandemic surge, but a celebration of life is being tentatively planned both in Memphis and in Little Rock, and dates will be forthcoming.

He is survived by his wife, Elise; his children, Caroline and Kent David McKelvey III; his stepdaughters, Anna Douglas Piper and Mary Catherine Piper; his sister and fellow UAMS faculty member Dr. Samantha McKelvey; his sister and Neonatal Intensive Care CNP, APRN at ACH, Betsy McKelvey Peeler, and their entire family in your thoughts during this difficult time. He is also survived by his mother and stepfather, Don Varner and Josephine Charlotte Egner Varner, and half-brothers Michael Varner and Matthew McKelvey. He was pre-deceased by father Dr. K. David McKelvey Sr.

UAMS Receives $2.5 Million CDC Grant to Increase Colorectal Cancer Screening in Arkansas

July 27, 2020 | The UAMS Department of Family and Preventive Medicine has received $2.5 million from the Centers for Disease Control and Prevention (CDC) for a five-year project to increase colorectal cancer screening in Arkansas.

Partnerships in Colorectal Cancer Screening in Arkansas is a project of the Department of Family and Preventive Medicine’s Community Health and Education Division. Alysia Dubriske, director of Community Health and Education at UAMS, is leading the program and managing the grant.

Arkansas ranks near the bottom of the list at 34th in the nation for the number of people per capita who are screened annually for colorectal cancer. Nationwide, colorectal cancer is the second leading cause of cancer-related deaths when men and women are combined.

The American Cancer Society predicts 1,540 Arkansans will be diagnosed with colorectal cancer in 2020 and 610 will die of the disease. According to CDC guidelines, people over the age of 50 should be screened annually for colorectal cancer, and people with a family history of the disease should start at a younger age.

Alysia Dubriske

“This grant allows us to address these disparities in Arkansas by working with both health care providers and the public,” Dubriske said. “We will educate providers on evidence-based approaches for increasing colorectal cancer screening and then partner with them to implement those interventions. This will be supported by a communication campaign directed at the public so they better understand the importance of screening.”

The approaches include automatic reminders for health care providers to touch base with patients who are overdue for screenings, increasing public awareness about screening though media and communication efforts, and reducing structural barriers that allow Arkansans in rural areas access to prevention, early stage diagnosis, and treatment.

The program will target primary care clinics, especially in counties with low screening rates and low average household incomes. The program will work directly with providers to teach them best practices and help them implement the techniques in their clinics.

“Ultimately, our goal is to reduce the amount of late-stage colorectal cancer in Arkansas and the number of colorectal cancer deaths in Arkansas,” Dubriske said. “Colorectal cancer is a highly treatable disease, especially if caught early, and we know that screening saves lives. We’re looking forward to partnering with clinics to make a difference.”

UAMS will work with Federally Qualified Health Centers and Arkansas’ Quality Improvement Organization to implement the project.

CHE Staff Secures Large Donation for Prison Breastfeeding Program

March 2, 2020 | Incarcerated women who are new breastfeeding moms at the J. Aaron Hawkins Sr. Center in Wrightsville, Arkansas, will have access to over 200 pounds of breastfeeding supplies recently donated by Medela, a leading manufacturer of breast pumps in the United States.

The donation came about through UAMS’ partnership with the Hawkins’ Growing Together program. Growing Together was formed to support the needs of incarcerated pregnant and postpartum women in Arkansas. It includes a lactation program, prenatal education classes, and a mental health support group. Childbirth support will launch soon as part of a pilot grant provided by UAMS’ Translational Research Institute.

Melissa Zelinski, Ph.D. with donated boxes from Medela.

Marybeth Curtis, B.S.N., a nurse educator in the UAMS College of Medicine Department of Family and Preventive Medicine, saw the need for breastfeeding supplies and contacted Medela.

Medela gave hospital-grade breast pumps, storage bags, maternity and nursing shirts, lanolin, and other products to the new breastfeeding initiative. The items were donated through Hope Rises, a Little Rock non-profit that offers services to women impacted by addiction, trauma and incarceration.

Annemarie McGahagan, SPAN nutrition coordinator at UAMS, is breastfeeding coordinator for the CDC State Physical Activity and Nutrition grant that helps support Growing Together.

“When Annemarie shared with me the need for breast pumps and supplies for the Growing Together program, my first response was to reach out to Medela,” said Curtis. “I have always been amazed at their generosity. I have learned that acts of charity are waiting all around us once you make the need known.”

Melissa Zielinski, Ph.D., a clinical psychologist in the UAMS College of Medicine’s Department of Psychiatry and Behavioral Sciences, spearheads UAMS’ involvement with Growing Together.

Board members of Little Rock non-profit, Hope Rises.

“Gender-responsive programs like Growing Together are critical. Many people don’t realize that over 75% of incarcerated women are of childbearing age and about 4% are pregnant at intake to prison. Few prisons have specialty services available to meet incarcerated pregnant women’s needs. It will take time, but we are working toward that goal,” said Zielinski.

All pregnant women at the Hawkins Unit receive their routine pre- and postnatal care and deliver their babies at UAMS.

Other groups have joined in the Growing Together initiative: UAMS lactation specialists, the Department of Family and Preventive Medicine, doctoral-level psychology student interns from UAMS and the University of Central Arkansas who co-lead mental health support groups, retired RNs with the Presbyterian Women USA who teach prenatal classes for the women, and one volunteer who offered to sew lactation capes for the women who would like to use them when breastfeeding during visitation.

For more information, contact Zielinski at mjzielinski@uams.edu.

Family and Preventive Medicine Receives 5-Year $3.29 Million Grant from CDC to Reduce Obesity

By Amy Widner

The Department of Family and Preventive Medicine at the University of Arkansas for Medical Sciences (UAMS) has received $3.29 million from the Centers for Disease Control and Prevention (CDC) for a five-year project to reduce obesity, increase physical activity and improve nutrition in Arkansas, especially in the Delta.

The State Physical Activity and Nutrition (SPAN) project funding began Oct. 1 and was awarded to the Department of Family and Preventive Medicine’s Community Health and Education Division. Alysia Dubriske, director of Community Health and Education at UAMS, is leading the grant.

“The whole premise of this grant is to try to reduce obesity rates. The CDC has identified target areas, including access to better nutrition, increasing breastfeeding, encouraging healthier foods and physical activity in early childcare centers, and improving activity-friendly communities,” Dubriske said. “At UAMS’ Department of Family and Preventive Medicine, we already have many projects in these areas, so we are looking forward to combining the progress we’ve already made with the CDC’s support to show measurable improvement on this important health issue.”

UAMS staff will be working in partnership with local leadership and stakeholders across the state, but especially in counties where life expectancy is lower than national and state averages. Many rural counties in the eastern Arkansas Delta fall into this category. Obesity, diabetes, high blood pressure, low physical activity, poverty and lack of access to health care are factors.

The project aims to:

Develop and implement food service guidelines for food pantries, early childhood education centers, developmental disability day centers and local parks.
Support breastfeeding by partnering with family practice clinics, early childhood education centers and developmental disability day centers and by offering continuing medical education hours and early childhood center and developmental disability center professional development training.
Partner with communities to create activity-friendly routes to connect everyday destinations by implementing local policies to include bike routes, sidewalks and trails that increase safety and access for all abilities.
Implement nutrition standards and physical activity standards into early childhood education centers across the state by changing the Quality and Improvement Rating System in Arkansas to increase physical activity, increase nutrition and physical activity education to staff, and decrease screen time.

Assisting Dubriske with the project are Christopher Long, Ph.D., senior director of Research and Evaluation at the UAMS Northwest Regional Campus; and Leanne Whiteside-Mansell, Ed.D., director of the Research and Evaluation Division in the UAMS Department of Family and Preventive Medicine, which is part of the UAMS College of Medicine. Bettie Cook, senior research administrator at UAMS, assisted with the successful grant application.

Three Tests for Carpal Tunnel Syndrome

John Bracey, M.D., hand surgeon with the UAMS Department of Orthopaedic Surgery, said that carpal tunnel syndrome affects 2.7 percent of the population and nets 500,000 surgeries a year in the United States, estimated to be a $2 billion annual impact.

Bracey spoke to family medicine providers at the 40^th Annual Family Medicine Intensive Review Course last May, covering how providers can test for carpal tunnel and how to manage it.

A few tests he recommended were:

Tinel’s sign (lightly tapping over the nerve to see if it generates a tingling sensation)

Phalen’s test (pushing the dorsal surface of hands together and holding 30 – 60 seconds)

Carpal Compression Test (Apply pressure with thumbs over the median nerve within the carpal tunnel, located just distal to the wrist crease. The test is positive if the patient responds with numbness and tingling within 30 seconds.)

If the patient shows signs of carpal tunnel syndrome, the provider can conservatively manage with a neutral wrist brace (helpful during sleep), stretching and exercises, ergonomic interventions or steroid injection.