By Jamie Cetrone | Categories: | Comments Off on West 25th Street Community Transformation
MetroHealth’s mission is a healthier community. In addition to good health care, for individuals and families to become healthier they need affordable and safe housing, access to fresh nourishing food, and employment. MetroHealth is taking steps to revitalize the neighborhood surrounding the hospital campus. As MetroHealth embarks on a multi-million-dollar campus transformation that includes a new hospital, it is focusing on the growth of residential, commercial, and retail development in the area. The five-year goal is to revitalize the neighborhood to attract new residents and commerce by improving public transportation, offering a mix of moderate and market rate housing, and stimulating job growth so current residents can move on up, not out.
The largest concentration of Hispanics in Ohio is in the neighborhoods surrounding MetroHealth Medical Center, and median incomes are close to the federal poverty level for most families. MetroHealth, a primary anchor in the community, is the largest employer on the west side of Cleveland. To accelerate revitalization, MetroHealth is creating the CCH Development Corporation, a nonprofit 501(c)(3), which will secure funding from private and public sources. It will acquire land and other assets, construct residential and commercial buildings, own and manage real estate, and have the authority to form legal partnerships with private and public entities.
Many hospital departments, such as Arts in Medicine, Aamoth Family Wellness Center, and specific specialties will provide programs and care to enhance lives and ensure better health. MetroHealth also is working with private, governmental, and nonprofit partners to promote economic and community development.
The economic and community development activities will contribute to population health. There will be “placemaking” enhancements to improve the quality of life of residents and those who come to work, visit, shop, and play in the West 25th Street neighborhood.
By Jamie Cetrone | Categories: | Comments Off on VIDA!
Recognizing the health disparities present in neighborhoods surrounding The MetroHealth System’s main campus, a community coalition of residents, community organizations, and Latina faith leaders came together to envision a “healthy community.” The VIDA! program resulted from this engagement, with an initial focus on promoting healthy cultural cooking practices in the local Hispanic community. The goal of the program is to train representatives from local Hispanic congregations as Community Health Cooks, who then go forward to educate others within their networks about healthy cooking practices and foundational healthy lifestyle principles.
This is a train-the-trainer program, focused on training Latina women from local Hispanic churches as Community Health Cooks, emphasizing healthy and culturally appropriate meals. MetroHealth works with a local Hispanic female chef and health coach to implement the program. This cadre of trained, lay leaders then extend the lessons of healthy cultural cooking practices to individuals and families throughout their faith community networks. The program emphasizes affordable, accessible, nutritional, and culturally appropriate meals that bring people together around a family table. MetroHealth provides staffing to coordinate the program and covers the costs of training the Community Health Cooks (instructor, food, supplies, curriculum). Participating churches provide food, space, and other in-kind support once the cooks are trained.
In a venture related to VIDA!, MetroHealth began a farm stand on its main campus to provide fresh produce to employees and local residents, working with the same Latina chef that trained the Community Health Cooks. Various internal departments were involved with this effort including Strategy and Nutrition Services. MetroHealth’s Center for Reducing Health Disparities was also integral in the planning and launch of the VIDA! program. Externally, a coalition of residents and community organizations, including the Hispanic Alliance, Cleveland Department of Public Health, Family Ministry Center, and others helped to design the program. Numerous local churches are partners in implementing the program.
Eleven women from four churches have been trained as Community Health Cooks in the initial cohort. Pre- and post-tests were administered to assess health behaviors, consumption of fresh fruits and vegetables, and cooking attitudes and efficacy. Participants reported positive impacts including weight loss, blood pressure and blood glucose control, and adoption of healthier lifestyle practices around eating and active living for themselves and their families.
By Jamie Cetrone | Categories: | Comments Off on School Health Program
Many children in the Cleveland Metropolitan School District (CMSD) lacked easy access to health care. MetroHealth launched the School Health Program (SHP) in November 2013 to bring primary care health services to children at their schools, initially serving two schools. Now, in the fourth year, the mobile unit travels to three high schools and nine elementary schools. The program also serves one CMSD site via an in-school clinic.
The goals are creating healthy schools with wellness programming, improving school attendance, growing the program, and becoming more sustainable with patient-based revenue, all with the aim of population health.
Nearly 100 percent of CMSD students are eligible for free or reduced-price lunch. A graduation rate of 64 percent and chronic absenteeism rate of 35 percent are the result of the many challenges students face. By providing services at schools, the SHP eliminates many of the barriers to receiving health care. The SHP has a medical director, behavioral health director, APRNs, physicians, program directors that are medical assistants, and a mobile van driver. It connects students and their families with primary care providers in Patient Centered Medical Homes (PCMHs) across The MetroHealth System. Operating resources are a mix of patient revenue, institutional support, grants, and individual philanthropy.
Our partnerships have resulted in a variety of education and engagement opportunities for our CMSD sites. The SHP collaborates closely with internal MetroHealth departments including the Aamoth Family Pediatric Wellness Center, Trauma Department and Arts in Medicine to provide wellness services to students, staff, and families. Programs and activities include fitness breaks, safety towns, art classes focused on social and emotional learning, and introduction of the #BeWell campaign across sites. Externally, the SHP has partnered with the Cleveland Foodbank to provide health screenings at schools. The SHP also serves as a site to train child health professionals – including students in nursing, public health, community health, social work, and medical residents and students.
The SHP provides valuable care coordination in the management of chronic conditions such as asthma and diabetes. Working with families, school nurses, SHP providers, primary care providers and specialists has produced significant documented improvements in population health outcomes. Care coordination, along with convenient services and proactive outreach, has increased utilization of preventive services and completion of immunizations more successfully when compared to state and national Medicaid populations.
By Jamie Cetrone | Categories: | Comments Off on ARMC’s Breathmobile
Because asthma is one of the leading causes of school absenteeism as well as the number one reason children go to the emergency room, Arrowhead Regional Medical Center (ARMC) and the County of San Bernardino, in association with the Asthma and Allergy Foundation, have implemented a unique approach to pediatric asthma management by establishing the Breathmobile® program that provides care via an “asthma clinic on wheels. The Breathmobile ® provides coordinated case identification, structured mobile office visits, diagnostic testing, physical exams, pharmacological therapy and patient/family education in asthma management. All services are provided at no cost to the patient.
The goals of the program are to deploy two Breathmobiles to provide free asthma and asthma related care to surrounding, underserved schoolchildren who are otherwise unable to receive this type of care.
The Breathmobile® travels to 40 different school sites throughout the County of San Bernardino, rotating to each site every six weeks. During the school hours the Breathmobile® staff sees patients that attend the school site as well as any child referred from the surrounding area. A complete evaluation, examination, care plan and extensive patient family education are completed at the time of the visit. Follow-up visits require a shorter time span than the initial evaluation. The average visit requires less than 30 minutes of the child’s day. Providing care at a familiar, convenient site, often within walking distance for parents without transportation, has greatly improved patient participation and compliance with follow-up care.
The Breathmobile® staff consists of a pediatric specialty practitioner, a licensed vocational nurse and a respiratory therapist who are specially trained in asthma case management. The Breathmobile® team, in collaboration with school nurses and health aides, facilitates initial identification of patients. Ongoing communication with the school nurses and health aides help the patients remain compliant with their asthma management program.
The Breathmobile® healthcare model has proven to be very successful in overcoming the complex social and economic barriers that can prevent successful chronic disease management in children in lower socio-economic areas. Seventy-five percent of the children participating in this program have their asthma symptoms under control by the third follow-up visit, regardless of the severity of their illness. Evaluation studies have demonstrated decreased school absenteeism, fewer emergency room visits, improved pulmonary function and exercise tolerance, and an overall improved quality of life.
Funding for this program is provided by Arrowhead Regional Medical Center with additional financial support from ARMC’s Foundation.
By Jamie Cetrone | Categories: | Comments Off on Harbor Place
Champlain Housing Trust (CHT) created Harbor Place, a motel that provides temporary housing and wrap-around case management services to adults, in the Fall of 2013 to address a significant increase in homelessness in Vermont and to establish a more sensible approach to addressing a housing crisis. CHT had two main goals in mind when developing Harbor Place: reduce the cost of emergency housing and get better outcomes for people in crisis. Realizing that people who are inadequately housed require significant health care resources, The UVM Medical Center provided funding to Harbor Place so that patients experiencing homelessness would have somewhere to go upon their discharge from the hospital.
The UVM Medical Center’s Case Management & Social Work department purchases bed nights at Harbor place so patients can be discharged there when they leave the hospital. The Community Health Centers of Burlington provide medical and onsite case management services, as does Howard Center. The Champlain Valley Office of Economic Opportunity provides management of the case management at Harbor Place and provides direct support staffing. Other community partners and support include:
Vermont Agency of Human Services/DCF: The State’s DCF administers the program that funds motel vouchers and agreed to a long-term contract guaranteeing 30 out of 55 rooms at Harbor Place. The State also helped fund an operating reserve.
Fanny Allen Foundation: contributed a $25,000 grant towards an operating reserve.
Vermont Community Loan Fund: made a $1.7 million loan to finance the purchase of the motel.
Vermont Housing & Conservation Board: provided $265,000 for the acquisition and rehabilitation of the property.
United Way of Northwest Vermont: provided $50,000 in funding towards the operating reserve.
Howard Center: provides onsite mental health and substance abuse counseling services to residents of Harbor Place.
Women Helping Battered Women: provides onsite support and counseling .
Community Health Centers of Burlington: provides case management and medical services.
Champlain Valley Office of Economic Opportunity: provides overall management of the case management at Harbor Place, as well as providing direct support staffing.
Since Harbor Place’s program inception in 2013, the Medical Center has paid for a total of 1,720 nights for 153 patients through 2016 (approximately $51,600). To measure Harbor Place’s impact on patient cost of care, UVM compared utilization and direct costs for a group of 147 patients, both three months prior to and three months after their stay at Harbor Place. The evaluation included inpatient and emergency department encounters. For this group, there was a 73% reduction in direct cost in the three months following their stay at Harbor Place compared to the three months prior.
By Jamie Cetrone | Categories: | Comments Off on TECH/TEACH
The TECH and TEACH programs at Broadlawns Medical Center were developed to provide education, training and awareness for career opportunities that exist in health care. Specifically, the TECH and TEACH programs identify candidates who are at-risk or from the underserved neighboring communities. TECH and TEACH are paid training and education programs, and participants complete the program having earned a CNA degree.
TECH and TEACH are programs for Training and Educating for a Career in Healthcare. TECH is geared for high school students, and TEACH is geared for adults. Both programs provide mentoring, professional development and training for healthcare positions ie: technicians, phlebotomists and patient access representatives. By drawing participants from underserved, neighboring communities, Broadlawns is committed to educating and employing the individuals from the neighborhoods that have the highest concentrations of unemployment and poverty.
The TECH and TEACH programs are a product of cross-department work, including administration, human resources, marketing, the hospital foundation, community outreach, physicians, and nursing staff. Broadlawns has also involved numerous external organizations in the development of the TECH and TEACH programs. Urban Dreams and iJAG have assisted greatly in identifying candidates for participation in the program. United Way of Central Iowa has provided some financial support for the TEACH initiative. Other community partners include Signature Healthcare, Des Moines Public Schools, Wesley Life, Creative Visions, Evelyn K. Davis Center, the Department of Human Services, and the Polk County Health Department.
The first group of TECH students completed their training in April 2017. Seven of the ten TECH high school students were hired by Broadlawns upon completion of the training program.
By Jamie Cetrone | Categories: | Comments Off on Pathways to Housing Program
JPS Health Network in Ft. Worth, Texas, partners with the Salvation Army for the Tarrant County Pathways to Housing program. The program supports medically vulnerable homeless patients by providing permanent housing rental assistance, long-term comprehensive case management, with medical and supportive services in scattered site apartments within Tarrant County. Eligible patients are high utilizers of local emergency rooms who are experiencing homelessness, medical and behavioral health challenges. Care Connections for the Homeless team provides outreach based medical care and medical case management. This medical team works in collaboration with The Salvation Army housing case managers to identify and engage program participants. Amerigroup, as the largest provider of Medicaid services in the Tarrant County area, also serves as a partner in the project to augment behavioral health supportive services and care coordination for clients.
By Jamie Cetrone | Categories: | Comments Off on Better Health Through Housing
The Better Health Through Housing pilot grew out of an awareness by UI Health leadership that in order to realize its Health Equity mission, they need to take on the challenge of improving the health of whole communities on the west and south sides of Chicago. UI Health is located about 2 miles from downtown Chicago on the near Westside, in the Illinois Medical District, in one of the highest concentrations of city homelessness. With six other nearby hospitals, the chronically homeless hop from one Emergency Department (ED) to another. The goals of their program are: to create a healthcare-to-housing pilot using the Housing First model; to evaluate the effect of housing on health outcomes, cost, and utilization (this includes studying homelessness as a heath condition); and to promote and advocate for more healthcare-to-housing programs in the Chicago area using a collective impact approach
UI Health pays their partner, the Center for Housing & Health (CHH) $1,000 per member per month. CHH created a housing collaborative consisting of over twenty housing agencies that manage 125-150 one-bedroom apartments scattered throughout the city, as well as three single room occupancy (SRO) facilities that serve as bridge units until permanent supportive housing is located. The agencies work with individual landlords that accept and tolerate patients with mental illness and/or substance abuse. There are two program staff: The Program Director and a Care Coordinator, a licensed clinical social worker who specializes working with the homeless. UI forecasts this will provide housing for between 20-30 chronically homeless patients for a year (last year’s program referred 27 homeless individuals). Identification and referral of homeless patients takes a considerable amount of care coordination, not only internally but with community-based partners. In order to strike a balance between healthcare utilization and medical vulnerability, the program utilizes a “Tumor Board” multidisciplinary team consisting of ED, oncology and psychiatry social workers, ED and psychiatry attending physicians, as well as a CHH program coordinator and an Outreach Worker who locates the patients on the street once they are referred into the program. The program consists of $250,000 of internal annual funding (a combination of both operational and philanthropic dollars).
As a result of the program internal healthcare costs have come down 21% (removing one patient in end-of-life care and the reduction is 67%), ED utilization is down 45% and inpatient admissions have been reduced by 55%. UI Health has also begun identifying the homeless in their patient population, and since 2008 have found over 1,300 homeless patients.
By Jamie Cetrone | Categories: | Comments Off on Mobile Palliative Care Homeless Outreach Program
Harborview Medical Center joined with the Seattle/King County Health Care for the Homeless Network to pilot the Mobile Palliative Care Homeless Outreach Program beginning in 2014, to address the needs of homeless people with life-limiting illnesses. The program’s primary goals are: 1) provide end-of-life care and pain management to a population that is poorly served by traditional palliative care programs; 2) empower people who are homeless by giving them more control to make decisions about life management and dying as their illness progresses; 3) prevent unnecessary emergency department visits and prolonged hospital admissions; and 4) eliminate barriers to accessing healthcare by traveling to patients and meeting them on the streets, in shelters, at meal programs or wherever they are living.
By Jamie Cetrone | Categories: | Comments Off on Healthy Youth Transitions
Memorial Healthcare System in Hollywood Florida started the Healthy Youth Transitions (HYT) Program 7 years ago as a result of an investigation of the child welfare system which identified gaps in services when youth unsuccessfully transitioned to adulthood with little support, skills or preparation. HYT helps youth and young adults age 15 to 22 who are aging out of foster care make the transition to independent living.
The program structure is provided by Memorial Life Coaches, who develop rapport and engage youth in an open, honest professional relationship in order to assist them with successful transition to an acceptable, responsible, productive adulthood. Typically, the youth distrust the very systems they have relied on as they have been disappointed frequently by foster care agency staff turnover, lack of services, frequent group home relocations (several youth served have been in over 20 homes in the 10-12 years they have been in foster care) and being separated with the siblings. By building a safe and nurturing relationship, HYT youth being to realize that the Memorial staff are here to help them grow, mature and develop into the adults they desire to become but did not have the role models or consistent caring adults in their lives. The Life Coach aims to help each participant gain skills and self-sufficiency to navigate the logistics of daily living, health management, social relationships, education, employment and money management, and other aspects of young adulthood.
All of Memorial Healthcare System’s Community programs and initiatives are rooted in collaborative partnerships that work to strengthen families and communities. HYT involves internal collaboration, with partnership from the primary care, specialty services, and behavioral health departments. External community partners include local universities, food banks, legal service providers, and the sheriff’s office.
Current outcome measures of the program found that 96% of the females have had no new pregnancies, 98% of all youth have had no new law violations, 98% demonstrated proficiency in employability and/or job retention skills, 86% made progress in school, were promoted, graduated, or obtained a GED, and 89% have obtained stable housing.
