Monday, November 6, 2017

Community Health Centers: Centers of Innovation and Best Practices in a Changing Healthcare Landscape

Leslie Chatelain, MPH, Research Associate

Acronyms:
PCH – Partnership for Community Health
CHC – Community Health Center
ICH – Institute for Community Health

The landscape of healthcare in the U.S. has rapidly changed in the last several years. These changes have compelled community health centers (CHCs) to innovate to keep up. One mechanism enabling CHCs to implement innovative projects is grant programs. Some of these grants are funded by foundations which, in 2014 alone, gave away $60 billion (http://data.foundationcenter.org, most current data).  An example of this is the Partnership for Community Health Excellence and Innovation Grant Program (PCH), which has awarded over $17 million to CHCs in Massachusetts since 2014.  This money has helped grantees to develop and implement innovative projects to transform their operations and patient communications. The PCH grant program contracted with ICH to lead the foundation and grantee-level evaluations.  By using a participatory, utilization focused approach to this evaluation (http://instituteforcommunityhealth.blogspot.com/2017/10/the-foundation-to-effective-reporting.html), grantee CHCs have been able to collect meaningful data on the successes and challenges they have encountered while implementing their projects.  To magnify the impact of the foundation’s grant-making activities, ICH helps to strategically disseminate lessons learned so others can replicate and expand upon the grant-supported work.  One way this is done is by convening best practices forums or learning collaboratives.    

A learning collaborative or best practices forum offers an opportunity to grantees to pool and share knowledge with other CHCs who may benefit from such an exchange. PCH held such a forum most recently in September 2017 with 3 panels consisting of some of the current grantees. The panel topics included: addressing social determinants of health through adding new roles to the care team, improving care through telehealth technology, and taking a population health approach to chronic opioid dependence.
Insights from the forum’s panel on telehealth technology include the following:
·         With their small profit margins, community health centers generally cannot implement the kinds of projects presented at the forum without additional resources committed to innovation. Consequently, the investment provided by the funders was critical.
·         For technological projects, there is a need to assess the technology that is currently in place to determine what software or program would fit best with the existing infrastructure.
·         For all of the potential benefits that telehealth projects can have, it is essential that the right staff is in place to manage and harness the potential of the technology.

·         Telehealth projects have advanced thinking about what is possible to achieve with technology. Patient access to specialists is difficult across all health centers in the state and telehealth projects may be able to address that.
o   Example:  One project utilizing telehealth technology to triage dermatological conditions has determined that 75% of referrals to dermatology specialists are unnecessary.  Cutting down on unnecessary referrals frees up the services of dermatologists for patients who really need them.
At the conclusion of the discussion, one forum attendee reported that they “couldn’t wait to head back to their community health center and implement some of the ideas discussed at the forum.” Other attendees spoke similarly. This open sharing of knowledge, best practices, and lessons learned will serve to inform future innovative projects at community health centers and help to improve quality of care, increase patient/staff satisfaction, and reduce costs/increase operational efficiency at CHCs.
If interested, please see the following video to view the presentations and discussions from the forum

Thursday, October 5, 2017

The Foundation to Effective Reporting: A Utilization-focused, Participatory Approach

Eileen Dryden, PhD and Ranjani Paradise, PhD

Foundations gave away over $60 billion in 2014[1].  According to Social Solutions, reporting expectations for these financial distributions have increased over the last five years and are expected to increase even more over the next five years [2]. Driven largely by limited resources, these expectations increasingly focus on impact – evidence that shows what they are funding ‘works.’  However, many deserving grantee agencies that are stellar at providing services don’t necessarily have the experience or skills to know how to evaluate the impact of their work.  Additionally, the foundations themselves may not know quite what to ask.  Foundations often fund an array of agencies and programs whose goals have an implicit, if not explicit, alignment with their own mission. In an attempt to speak to that mission and make it easier to aggregate data in the end, many foundations create one generic reporting template for all grantees to complete.  Unfortunately, this approach is not likely to truly capture the unique contributions and impacts of each grantee.  Grantees get frustrated at trying to shoehorn their data into a report that doesn’t quite fit, and foundations end up with data that is less than compelling.  Technical assistance from experienced evaluators at ICH can help to address this problem. 
 
OUR APPROACH

ICH works with foundations to clarify and focus their grant-making goals and effectively document their own, as well as their grantees’, impact. Our approach includes a number of activities that can be utilized as a comprehensive package or individually, as needed. 



Multi-level Logic Modeling and Evaluation Planning
Collaborating with foundation staff, we develop an overarching, foundation-level logic model, a visual that depicts the underlying theory of how their grant-making activities will accomplish their goals.


Example of foundation level logic model from
the Partnership for Community Health (PCH)  Excellence and Innovation Grant Program. 
 This granting program has distributed over $17 million since 2014.

We also work closely with each grantee to develop a project-specific logic model. Through this process we guide grant recipients to think about what their project can really accomplish and to ensure that their activities link to their anticipated outcomes.

Examples of grantee level logic models from
the Partnership for Community Health Excellence and Innovation Grant Program.

Working in partnership with each grantee, we develop evaluation plans that are meaningful and relevant to them, while simultaneously measuring outcomes that align with the foundation’s overarching goals. Using the grantee- and foundation-level logic models as a guide, we facilitate discussions to prioritize outcomes to measure and create evaluation plans that are focused, feasible, and useful. This process fosters buy-in to evaluation on the part of the grantee.

Layered, Strategic Reporting
We craft a tailored set of evaluation measures for each grantee’s project that is derived directly from their evaluation plan and flows naturally from the work they are doing. This ensures that the reports submitted by grantees capture project-specific outcomes that are connected to the foundation's key goals, making reporting a useful and relevant activity for both the grantee and the foundation. We provide technical assistance to grantees, as needed, to develop data collection tools, and collect and analyze their evaluation data.

We create summary reports at multiple levels of detail to meet the needs of different audiences, ranging from short, visual reports highlighting impact stories to in-depth data summaries for tracking individual grantees’ progress against goals. Comprehensive final reporting at the end of the grant period highlights program impact by rolling up individual grantee accomplishments into the foundations’ overarching goals. 

Collecting and Sharing Lessons Learned
To help document the collective learning that occurs throughout the implementation of each grantee’s project, we conduct qualitative interviews that allow us to gain a deeper understanding of grantees’ experiences. We summarize and share back the qualitative findings to ensure that future grantees can build upon the collective best practices and lessons learned to optimize their work.

Finally, we facilitate learning collaboratives among current and potential future grantees.  At these forums, grantees have an opportunity to share what they have learned and participants can informally network and discuss projects.  In this way, we ensure that lessons learned are disseminated to those who can benefit most.

“I just shaved months off of my project talking to someone I met here today.”

 - Best Practices Forum participant


BENEFITS OF THIS APPROACH

This individualized, participatory approach generates a number of benefits including helping to:

Ensure grant-making success
    Foundations can monitor grantee progress and jump in when needed to help ensure grantee success
    Foundations continually improve their own grant-making process by learning from grantees’ experiences 

Promote sustainability
    Provides grantees with data that they have prioritized as useful.  This data can be leveraged for funding to sustain their work beyond the grant period.
    Builds grantee capacity to ‘think evaluatively’ and participate more effectively in evaluation activities in the future

Demonstrate and expand impact
    Foundations can readily demonstrate to their board and other stakeholders how their grant-making activities support their mission
    Because successes and lessons learned are disseminated strategically, others can replicate and expand upon the grant-supported work, magnifying the impact of the foundation’s grant-making activities.


Given all of these benefits, our clients have found that with the support of experienced evaluators, the typically onerous process of grant reporting becomes a win-win for foundations and grant recipients.
________________________________________________________________________
[1] http://data.foundationcenter.org (most current data)


Wednesday, September 6, 2017

ICH Response to the DACA Program

At ICH, we would like to extend our support to the 800,000 young people affected by the recent decision about the Deferred Action for Childhood Arrivals (DACA) program. The DACA program allows undocumented immigrant youth who were brought into the US by their parents at a young age to obtain legal status to work and go to school. These young people are contributing members to our society and are integral parts of our community.

We would like to share the below statement from one of our partners, Parenting Journey, regarding the recent news about the DACA program:
Today, Parenting Journey reaffirms its commitment to immigrant families. We are disheartened by Attorney General Jeff Sessions' actions today on Deferred Action for Childhood Arrivals (DACA), but we maintain our sincere support of the young people and families affected by Mr. Sessions' announcement.
Parenting Journey unequivocally stands with the 800,000 young people who are DACA beneficiaries and their families. The DACA program allows undocumented immigrant youth to obtain legal status for work or school, and to fully contribute to the fabric of our communities. At Parenting Journey, we believe that families are stronger together. We believe that America is great because of the contributions of immigrant families, and we are firmly opposed to any actions or policies that would deport nearly a million people and tear families apart.
To our partners and friends involved in efforts to protect and support immigrant families, thank you. We stand with you.”

If you would like to show support for the DACA program here are a few things you can do today:
  1. Contact your state senators and local representatives. To find out who your senators and representatives are click here.
  2. Support local organizations that are committed to protecting immigrant rights. You can volunteer, organize, donate, or attend peaceful protest and rallies.
  3. Share your story of how this will affect you or someone you know.

Thursday, August 17, 2017

ICH Response to Charlottesville

At ICH, we have witnessed the increasing visibility of racist hate groups in the U.S. with extreme concern. As leaders and followers of these groups emerge, they pose significant danger to the safety, health and well-being of vulnerable minorities and people of color, as we saw this weekend in Charlottesville. As with all terrorism, the fear stoked by this violent ideology reaches far beyond the actual victims of violence, impacting the well-being of people in widespread communities. Remaining silent, or making only general statements that fail to specifically condemn racism and hatred, encourages and validates these groups.
At ICH we have a deep appreciation for the experiences and perspectives of diverse communities and believe that racial equity is essential to community health. These hate groups stand in direct opposition to these values. We condemn these hate groups, their racist ideologies, and their terrorist violence in the strongest possible terms. We call upon all our leaders to do the same, and to use all available resources to protect the health and safety of our communities.

Friday, May 19, 2017

Bike to Work Week at ICH


by Carolyn F Fisher, PhD,  Research and Evaluation Project Manager

This week is the Bay State Bike Week, and ICH is participating in the MassCommute Bicycle Challenge on a team together with Cambridge Health Alliance. 



Martina Todaro, ICH RA
Biking taps in to the mission and values of ICH in multiple ways. Exercise we get from biking is an important component of promoting health. Biking, and robust pedestrian and bike infrastructure, promotes social justice and the environmental health of our communities.  And bicycling promotes community development, providing economic and social benefits to local communities. We at ICH are proud to be living our values!

Martina Todaro says she arrives at work in a better mood when she bikes

We’re lucky to be located in the Greater Boston area, where there is a significant amount of bicycle infrastructure, including dedicated bike lanes, and some off-road bike trails. Perhaps most importantly, too, there are lots of other bicyclists on the roads. There is safety in numbers – drivers, seeing one bicyclist, will be more attuned to looking for others, and in general, drivers are not surprised to see bikes on the road.

Exercise and individual health

Cycling to work has the major advantage of building exercise into the start and end of our days. This way, even when our schedules are packed, we are guaranteed to fit in some exercise. And exercise is extremely important to health, as ICH RA Abby Tapper writes. Some even argue that biking, specifically, is good for mental health and for promoting happiness.

Jeff Desmarais says "Even if biking to work didn't make me healthier and shave 15 minutes off my commute, I would still do it. In the morning it helps me get ready for my day and in the evening it helps me unwind."
Jeff Desmarais, ICH PM

Environmental Health and Social Justice
Further, the environmental benefits of biking are important to the communities in which we live. When we bike, we both avoid putting greenhouse gases into the atmosphere, with broad implications for climate change, and also avoid putting ingredients of smog into the air in our local communities. While climate change affects all of us, smog and its negative health impacts such as asthma particularly and disproportionately affect our urban communities which tend to be poorer and lived in by more people of color.
The Pedestrian and Bicycle Information Center points out that prioritizing bike-ability and walk-ability in planning has important social justice implications.  They write:
“If automobile travel is the only feasible mode of transportation in a community, low-income families are placed at a large disadvantage with very limited mobility. By providing safe and convenient pedestrian and bicycle facilities, the community can ensure that all citizens have access to a viable mode of transportation.”


Carrie Fisher, ICH PM, drops the kids at school before heading to work
Community benefits: Bicycling is good for the economic health of our communities:  building bike infrastructure promotes job creation, and bicycle-related businesses such as bike stores and repair shops are a source of revenue for our communities. There is also evidence that people who bike are more likely to patronize local businesses they pass than people in cars.

In addition to the economic, health and environmental benefits for our communities, there are less tangible benefits for our communities.  Noise will decrease, because bikes are quieter than cars, and the “livability” of the communities will increase. Biking also promotes social interaction more than traveling in cars does.

Abby Tapper, ICH RA, bikes with her dad
Links to biking resources
Boston Bikes is a City of Boston initiative that promotes cycling in the city, and has links to numerous programs including (among many other things) How-Tos for beginning bicyclists, special programs for women bicyclists, and information about Hubway, the Greater Boston bike sharing program (which has $5 annual membership available for low-income residents).
Bike lane and trail maps Google Maps isn’t always the best source for biking map information. Try this map instead!
Hubway is a bike share system in Boston, Cambridge, Somerville and Brookline. You can bike without having to own a bike!
Safety tips  and information from the National Highway Traffic Safety Administration and the CDC.

Friday, May 12, 2017

May National Physical Fitness and Sports Month

By Abigail Tapper, MPH, Research Associate


                May is National Physical Fitness and Sports Month.  While most people are aware that exercise has health benefits, we don’t always realize how many benefits there are, and there are often barriers in the way.  These barriers can be things like lack of transportation, low levels of knowledge, and lack of resources.  Later in this post, we will highlight a program that is addressing such barriers.  Among youth, physical fitness can lead not only to good cardiovascular health, but improved bone and muscle health.[1]  If a child is not physically fit, they are more likely to have high blood pressure, be overweight or obese, and are more likely to have diabetes.  Increases in exercise and other activities can lead to lower rates of depression among young people.[2]



Participation in team sports has numerous benefits as well.  There are the obvious physical benefits as previously outlined and others pertaining to risk-taking and emotional health: for example, studies have found that participation in team sports leads to an older initial sexual intercourse age, lower risky sexual behavior and, especially for adolescent girls, lower cigarette and drug use.[3]  Other studies have found that being part of a sports team leads to improved psychosocial health.[4]


 
                In adults, higher rates of physical activity have been shown to lower the risk of heart disease, type 2 diabetes and some types of cancer.  Like in youth, regular physical activity has been shown to lower rates of depressive symptoms in adults.  While exercise may not prevent anxiety and depression, research tells us that it alleviates symptoms of both and the benefits are akin to those received from meditation or other forms of relaxation.[5] Several studies have found that exercise can act as a kind of antidepressant, improving mood and lowering neuroticism.[6],[7],[8]  Other research suggests that when those who are addicted to drugs or alcohol engage in some kind of physical activity in addition to regular substance use treatment, it can act as an “adjunct”, aka a substitute, to the high achieved from those substances. [9]
                For the older population, exercise shows numerous benefits.  Physical fitness can lower the risk for falls in older adults as well as improving cognitive function.  Adults age 65 and above can lower their risk for osteoporosis and other bone health disorders.  Mentally, it improves the feeling of self control and efficacy.[10]  Research goes even further to say that adults who exercise more, especially into their 80s and 90s, can expect to live longer.[11] 
 
                A program that we would especially like to highlight is one we at ICH have in our proverbial backyard.  Shape Up Somerville is a 15 year old initiative aimed at improving the health of all residents of Somerville, as well as visitors and people who work within the city.  They do this by increasing access to healthy activities and food, engaging high risk, low income and minority participants, and working to affect systemic change in the actual civic structures within Somerville.  Some of the resources they offer are interactive maps of bike routes and walking paths (like those found here and here), and mobile farmers markets that actually meet residents where they are.  These markets come to public spaces and allow residents to shop where and when it’s convenient for them.   They also work with restaurants in the area to promote healthy eating.  They developed a resource guide that outlines several healthy options at area restaurants.  You can look at the guide here.   Since the program’s inception, Somerville has seen a drop in unhealthy snacking among adolescents, a significant increase in the students meeting physical activity goals, and more students reporting that they walk to school.  Read more about Shape Up Somerville here. 
 
 
 
 
 
 
 
 
                Another initiative that ICH has worked with is Cambridge Health Alliance’s Wellness Program.  CHA’s Wellness program revolves around 4 pillars: Self-care, rest and recovery, movement and nutrition.  Each pillar is associated with one of the fiscal quarters, so there is always new wellness programming happening.   Each department has their very own wellness champion that staff can go to for advice and resources.  These staff are the ones usually implementing the wellness curriculum as well as keeping staff motivated. 
                ICH worked with CHA to evaluate the success of their wellness program, especially looking at participation rates in the various wellness programs.  ICH then gave this feedback to the CHA Wellness team to use to inform their programs for the next year.  Overall, participants were satisfied with the various wellness initiatives they participated in.  To read more about wellness at CHA, click here.

               
 
 
 
 
                 For more resources, check out the CDC’s healthy month toolkit here.
Happy moving!





[1] https://healthfinder.gov/NHO/MayToolkit.aspx


[2] https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-7-40


[3] Kulig, Kimary, Nancy D. Brener, and Tim McManus. "Sexual activity and substance use among adolescents by category of physical activity plus team sports participation." Archives of pediatrics & adolescent medicine 157.9 (2003): 905-912.


[4] https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-10-98


[5] https://link.springer.com/article/10.2165/00007256-200029030-00003


[6] https://academic.oup.com/eurpub/article/16/2/179/505757/Effects-of-physical-exercise-on-depression


[7] http://www.sciencedirect.com/science/article/pii/S0091743505002331


[8] http://bjsm.bmj.com/content/35/2/114.short


[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424736/


[10] https://uic.pure.elsevier.com/en/publications/exercise-and-physical-activity-for-older-adults


[11] https://uic.pure.elsevier.com/en/publications/exercise-and-physical-activity-for-older-adults