Tags: redesigning care , creating jobs

Dr. Hobbs-Knutson

The Kraft Center Fellows

At Partners HealthCare, our vision is to nurture the next generation of health care providers. Through the Kraft Center for Community Health, we are investing in some of the brightest young leaders who will be there to deliver high quality, affordable, community-based care today, tomorrow and for years to come.

A year and a half ago, the Kraft Center welcomed its inaugural class of program participants. Yet, in that short time, these 18 talented and compassionate physicians and nurses have demonstrated leadership and a dedication to providing the best health care possible for the low-income communities they have chosen to serve.

Over the next few months, we will be presenting a series of profiles designed to help our readers get to know some of our program participants a little bit better.

Meet Dr. Hobbs-Knutson

Kate Hobbs-Knutson always knew she was interested in medicine. But somewhere along the line, she became fascinated by health care services and the profound impact they can have on people's lives, as well.

"What really caught me was the multidisciplinary aspect of the work," explained Dr. Hobbs-Knutson, who became a child and adolescent psychiatrist in part because she enjoyed figuring out the very many systems that inevitably play a role in young people's care.

Her journey began in rural North Carolina, where firsthand experience with limited access to health care led to an early awareness of its importance. Her next stop, at Duke University, equipped her with a major in biology, a minor in chemistry and volunteer experience both internationally and in local underserved communities.

After a brief stint teaching at an urban middle school and pursuing research, Dr. Hobbs-Knutson eventually landed in medical school at the University of North Carolina at Chapel Hill. She racked up a slew of academic honors there, including acceptance into the Howard Hughes Medical Institute Research Scholars Program and membership in the Alpha Omega Alpha Honor Society – but, looking back at that time, she said that it is her work at a local free health clinic that stands out the most.

"I was so busy, but I felt like I was making a difference," she recalled.  She added: "I really got the feeling that the patients we saw at the clinic wouldn't have gotten health care otherwise."

A residency in adult psychiatry and a fellowship in child and adolescent psychiatry, both at Massachusetts General Hospital and McLean Hospital, followed. Dr. Hobbs-Knutson had always gravitated towards policy, so she knew that a Masters of Public Health degree was somewhere in her future. But it wasn't until a perfectly timed e-mail about a new program called the Kraft Fellowship in Community Health turned up in her in-box that all the pieces finally came together.

"I said to myself: 'That is exactly what I want to do!'" she remembered, with a wide smile.

Improving Community Health in South Boston 

For their part, the community health centers engaged with the Kraft Center were absolutely delighted that Dr. Hobbs-Knutson had decided to go the community health route.

"There are simply not enough child psychiatrists in the entire country, let alone in community health centers," explained Nisha Thakrar, the Medical Director at South Boston Community Health Center, which will serve as Dr. Hobbs-Knutson's clinical practice base throughout the two-year Kraft Fellowship.

Indeed, Dr. Thakrar continued, her main worry when Dr. Hobbs-Knutson first came on board was how to best integrate her into the health center's practice without leaving the young doctor completely overwhelmed.

Interestingly, it was a dilemma that hit right at the sweet spot of Dr. Hobbs-Knutson's own professional preoccupation with the organization of health care services. And it led directly to the issue she elected to tackle in the community health project required by the Kraft Fellowship – figuring out a way to improve the identification of kids with serious mental illness at the primary care level so that clinicians can do a better job making use of the extremely limited child and adolescent mental health care that is typically available.

If the demonstration project she is setting up at South Boston Community Health Center works out, it is something that could benefit the countless other health centers struggling to fill the mental health needs of their child and adolescent patients.

A Unique Learning Opportunity

Dr. Hobbs-Knutson is also pursuing a Masters of Public Health at the Harvard School of Public Health, which the Kraft Fellowship offers for participants who have not earned this advanced degree already. Yet it is her work with her young patients from South Boston, a community plagued by high levels of substance abuse, poverty and trauma, which has so far proved to be the most intense part of the Kraft Fellowship experience for this empathetic and talented provider.

"A lot of the kids carry serious emotional wounds from repeated traumatic experiences," she explained.

She added: "I've repeatedly found myself humbled by their resiliency – and I've often had to consciously remind myself to remain objective so that I can actually be helpful."

The Kraft Fellowship has been important, she said, in that it has given her time and space that she might never have had otherwise to explore the topics she finds so fascinating: how health and community services are provided for kids; how the health care system works in general; and how to think about the "social determinants of health," which she has frequently been challenged by in individual patients, but never before had the vocabulary to describe on a larger level.

Looking forward, once the Kraft Fellowship is finished, Dr. Hobbs-Knutson hopes to continue her clinical practice in a community setting – and to keep working to improve the mental health system for her young patients.

It's a system that is poorly coordinated and chronically underfunded, she acknowledged, with a self-deprecating shrug.

"But I can't help but wonder," she mused.  "If we could just get better organized, could we get a lot more kids the help that they desperately need?"

Read our profile of Kraft Fellow Dr. Genevieve Daftary's work with Boston public schools.

Pictured above at the South Boston Community Health Center, from left to right: Lars Reinhold, MD; Virginia Fitzgerald, MD, MPH; Nisha Thakrar, MD, Chief Medical Officer; Kate Hobbs-Knutson, MD.