Social Needs Screening and Interventions

By Madeline White | Categories: | Comments Off on Social Needs Screening and Interventions

The Promotora and African American Health Conductor programs were initially birthed at our Bay Point Family Health Center in 2002 and 2005. The initial goal of these programs was to create more effective cultural bridges between Contra Costa Health Services, a county-run health system, and the Latino and African American communities through the utilization of indigenous community representatives in order to assist the populations in better utilizing and navigating the Contra Costa Health Services system of care. The core functions of these two programs included: assisting patients with health navigation, community health education, assisting with group medical visits and conducting community outreach. In July 2016 through a collaboration with Health Leads (a nationally recognized resource linkage organization) some of these staff were trained on the Health Leads REACH tool – a very sophisticated resource linkage software tool which allowed these staff to screen patients for social needs, input patient demographic data, link patients to appropriate resources and agencies, track actions and follow up on each patient assisted, and measure impact.

Contra Costa Health Services partners with a community non -profit, the Center for Human Development to employ and oversee these staff. However, the staff receive direct supervision from two Health Services staff. The contract with the non-profit is primarily funded through the Health Services budget with supplementation from Medicaid revenue generated by the staff, as well as occasional grants. The two programs are housed in five of the 11 Contra Costa Health Services  health centers. They work closely with health center administrative leadership, with medical providers, with our Health Leads advocate partners and with many community based organizations.

From July 11, 2016 – April 14, 2017, The West County Health Center Health Leads pilot program has served over 750 patients with a 86-91% linkage connection success rate – according to Health leads one of the highest in the country. The Promotoras and Health Conductors have assisted over 2,000 households with health navigation, and conducted over 7,791 community outreach encounters.