The following people make up The Kraft Center for Community Health's third class of Practitioners.
Project Focus: Primary Care Center and Grocery Store collaboration: An Initiative to Integrate nutrition and lifestyle with health care
Project Overview: Diabetes prevalence in the city of Brockton is 9.4%, significantly above the Massachusetts rate of 7.5% and well above the “Healthy People 2020” goal of 2.5%; the diabetes rate among current health center patients is greater than 12%. In addition, the patient population of BNHC has significant challenges related to poverty and language barriers. This project will focus on developing a primary care practice adjacent to a new ethnic food supermarket that is favored by most of the Cape Verdean, Haitian, Portuguese and other majority and minority populations of Brockton. Co-location and programmatic Integration with the food supermarket will increase patients' access to primary care, provide opportunities for providers to educate patients about nutritious and practical food choices through nutrition classes and counseling, and increase patient engagement in healthy choices behaviors.
Project Focus: Lifestyle Interventions for Weight Loss in Young Adults with Mental Illness
Project Overview: Individuals with serious mental illness (SMI) are at increased risk of obesity and other cardio-metabolic complications. These factors contribute to higher rates of cardiovascular diseases as well as early morbidity and mortality. Weight gain in serious mental illness has a complex etiology. Young adults are especially vulnerable, as younger age of antipsychotic treatment initiation is a significant predictor of increased risk for weight gain. This project will implement lifestyle modification interventions in Massachusetts Mental Health Center’s young adult population to prevent weight gain in normal weight individuals and promote weight loss in those who are overweight or obese. Interventions will be integrated into the multiservice program that helps young adults obtain skills to manage their mental illness, develop satisfying family and social relationships, and resume or begin educational and/or vocational activities.
Project Focus: One Key Question: Improving Reproductive Health Care at Codman Square Health Center
Project Overview: Low-income women of color have the highest rates of unintended pregnancy in the US reflecting inadequate reproductive health care - including lack of effective contraception, pre-conception counseling and pregnancy planning - and resulting in poorer pregnancy outcomes. The goal of this project is to improve multiple aspects of reproductive health care offered at Codman Square through the use of One Key Question: “Do you want to become pregnant in the next year?” By asking this question of all women of reproductive age at each visit, providers will be able to initiate a discussion about pregnancy intentions with their patients and offer effective contraception or preconception counseling.
Project Focus: Increasing Access to the Continuum of Substance Abuse Services
Project Overview: At Community Healthlink, there are several levels of treatment for substance abuse disorders under one roof - an outpatient clinic, an acute detoxification unit, a CSS unit and a TSS unit - allowing for the potential for integrated, continuous treatment for patients with co-occurring disorders. While inpatient capacity has increased, the capacity of the outpatient clinic has not, resulting in referrals of most patients to outside agencies for outpatient treatment of mental health issues including medication-assisted treatment. This project will focus on improving urgent access to outpatient substance abuse treatment at Community Healthlink and increasing the number of patients receiving medication-assisted treatment on an outpatient basis with specific emphasis on integrating care for patients with co-occurring psychiatric and opiate use disorders. The project will use a team-based approach to provide integrated treatment for clients with co-occurring disorders, specifically focusing on those who present initially for substance abuse treatment.
Project Focus: Community-Dwelling Older Adults with Serious Mental Illness : A Clinical Assessment
Project Overview: Individuals with severe mental illness often have associated cognitive deficits that may impair their ability to function and live independently in the community. Literature suggests that cognitive status in geriatric patients with chronic mental illness may be a more important predictor of ability to function in a community setting than level of symptomatology. In addition to age-related increased risks of cardiovascular disease, adverse effects from antipsychotics, and cognitive decline, geriatric patients may suffer from mood disturbance, functional impairment and quality of life issues. Without systematic screening, some of these issues may go unrecognized. This project will utilize the clinic’s system, which screens, monitors, and treats common medical co-morbidities for psychiatric patients, to collect data related to cognition, mood, functional status and sense of well-being in patients over the age of 55.The goals of the project are to identify areas of need for this population and any barriers to intervention, as well as identify areas of strength in community-dwelling older adults who are living with severe mental illness.
Project Focus: Universal Substance Use Disorder Screening and Improving Brief Interventions
Project Overview: The Lynn Community Health Center needs assessment identifies substance abuse, including alcohol, as a community priority. While the SBIRT model (Screening, Brief Intervention and Referral to Treatment) has been shown to be effective in the treatment of alcohol use disorders, it can only be effective if the patient's disorder is recognized and the provider has the knowledge and tools to intervene. Lack of provider knowledge, comfort and perceived time to intervene may all be barriers to effective recognition of alcohol and substance use disorders and appropriate treatment. This project will introduce universal screening for substance use disorders and referral treat using the SBIRT program into one integrated primary care team at Lynn Community Health Center. In addition, providers will receive longitudinal practice and training in brief interventions and motivational interviewing.
Project Focus: Fatherhood Initiative
Project Overview: There is a lot of support for maternal child health, but very little in terms of paternal child health. While there are many regimented programs that are geared toward fathering and nurturing, these programs tend to be somewhat intense, multi-week long programs that do not have a rolling admission, are geared only to expectant fathers, and often charge a fee. By contrast, his project will create a Fatherhood Initiative at Family Health Center of Worcester that will function as a learning center and support group for fathers and enlist both expectant fathers as well as current fathers that want to be part of a discussion about fatherhood.
Project Focus: Concentric Circles: Improving Utilization of Psychiatric Services in a Community Health Center Setting
Project Overview: There is a dearth of psychiatric services and great need in most community health centers, and that is certainly the case at Codman Square Health Center in Dorchester, MA. While most people with mental health issues first present to primary care, many pediatricians, internists, and family practice physicians do not have the time or training to adequately address these issues in a primary care visit and do not have easy access to mental health professionals, particularly psychiatrists. The coexistence of psychiatry in a community health center has the potential of improving patient outcomes and the satisfaction of their providers by providing better, more coordinated care and mutual support. The aim of this project is to better match psychiatric services to population need by operating on several levels: understanding the prevalence of psychiatric conditions in the clinic population at large, establishing which conditions are currently seen by psychiatry, creating a referral system that would better match availability to complexity of presentation, and better assisting primary care providers to manage certain conditions in primary care.
Project Focus: Improving Overall Patient Experience in a Community Health Center Setting
Project Overview: In the past two years, North Shore Community Health Center has undergone a rapid expansion in the number of patients and clinicians, as well as welcomed a new leadership team. Additionally, all three health center locations have recently achieved PCMH certification. With this significant transformation in the organization, a positive patient experience and the provision of consistent quality care are critical. This project will identify the drivers of patient experience from both patient and organizational perspectives, and then develop and implement recommendations to improve the relationship between the medical team and the patient. Incorporating patient experience as a critical measure/metric for the organization will ensure that it is explicitly considered in decision making processes focused on the delivery of care.
Project Focus: Opiate Prescribing: The Impact of an Evidence-based Policy Change on Boston Healthcare for the Homeless Program’s Practice
Project Overview: Boston Healthcare for the Homeless Program’s clients have a high prevalence of chronic pain for which they seek treatment. There is also a high prevalence of substance use disorder in this population. In 2012, a mortality study of patients revealed that drug overdose had become the leading cause of death, accounting for a third of all deaths in patients under age 45; an opiate was implicated in 81% of the overdoses. The health center has developed a comprehensive plan to address the opiate epidemic and overdose prevention. One area of focus is to improve quality of opioid prescribing for chronic non-cancer pain by developing a guideline that was widely disseminated and included in the EMR. This project will evaluate whether this policy change resulted in a change in prescribing habits for opioids in the treatment of chronic non-cancer pain.
Project Focus: Money Matters - Incorporating Financial Literacy into Centering Pregnancy Group Prenatal Care
Project Overview: A major barrier to improving one's socioeconomic status is a lack of basic financial planning skills, a difficulty that is compounded by the limited opportunities for low-income individuals to access basic financial education. This project will incorporate financial literacy into the “Centering Pregnancy” model of group prenatal care, enhancing family planning and inter-conception care by helping women to see the financial implication of having closely spaced unplanned pregnancies.