scholarly journals Adding a Seat at the Table: A Case Study of the Provider's Perspective on Integrating Community Health Workers at Provider Practices in California

2021 ◽  
Vol 9 ◽  
Author(s):  
Courtney A. Paulson ◽  
Eva M. Durazo ◽  
Leigh D. Purry ◽  
Arianne E. Covington ◽  
Bruce Alan Bob ◽  
...  

Blue Shield of California's Community Health Advocate Program was created to support whole person-health needs by helping individuals of all socio-economic statuses navigate and access community resources, social services, and medical systems. Blue Shield's Health Reimagined team is partnering with medical providers, community resources centers, and community partners to provide intensive person-centered and technology-enabled care to patients, ensuring social needs are met while promoting health equity. A key aspect of the Health Reimagined initiative embeds Community Health Advocates (CHAs) within physician practices serving patients using a payor-agnostic approach, by which Blue Shield aims to increase access to social services and community resources, improve health outcomes, reduce medical costs, and improve overall patient experience. The purpose of this case study is to understand the provider's perspective of embedding a CHA into the care team and the resulting impact on the practice and patients. Blue Shield also sought to identify best practices and barriers of a CHA program within primary and specialty care practices. As part of an ongoing two-year mixed-methods impact evaluation (2019–2021), 10 semi-structured interviews were conducted with a total of 18 providers and office staff at five primary care and specialty practices where CHAs have been embedded. We also conducted two focus groups with the same five CHAs at different points in time. Several themes emerged from the provider, office staff, and CHA interviews. Provider practices found great value in adding a CHA to their care team as the CHA brings flexibility and continuity to patient care. They also found that having access to a CHA with shared life experiences of the communities they served is a key component to the program's success. Providers and staff reported a new understanding of the social determinants of health that impacts a patient's wellbeing with the embedding of a CHA in the care team. Overall, practitioners expressed high satisfaction with the CHA program. During the COVID-19 pandemic, CHAs have been critically important in care, as social needs have increased, and resources have shifted. The CHA program is constantly adapting to address challenges faced by all stakeholders and applying new knowledge to ensure best practices are implemented within the CHA program.

2020 ◽  
Vol 110 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Ashley M. Kranz ◽  
Ammarah Mahmud ◽  
Denis Agniel ◽  
Cheryl Damberg ◽  
Justin W. Timbie

Objectives. To describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality. Methods. We surveyed CHCs in 12 US states and the District of Columbia during summer 2017 (n = 208) to identify referral to and provision of services to address 8 social needs. Regression models estimated factors associated with the provision of social services by CHCs and the association between providing services and health care quality (an 8-item composite). Results. CHCs most often offered on-site assistance for needs related to food or nutrition (43%), interpersonal violence (32%), and housing (30%). Participation in projects with community-based organizations was associated with providing services on-site (odds ratio = 2.48; P = .018). On-site provision was associated with better performance on measures of health care quality (e.g., each additional social service was associated with a 4.3 percentage point increase in colorectal cancer screenings). Conclusions. Some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality. Public Health Implications. Health care providers are increasingly seeking to identify and address patients’ unmet social needs, and on-site provision of services is 1 strategy to consider.


2020 ◽  
Vol 110 (3) ◽  
pp. 309-316
Author(s):  
Howard K. Koh ◽  
Amy Bantham ◽  
Alan C. Geller ◽  
Mark A. Rukavina ◽  
Karen M. Emmons ◽  
...  

“Anchor Institutions”—universities, hospitals, and other large, place-based organizations—invest in their communities as a way of doing business. Anchor “meds” (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades. Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants. We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hilary Placzek ◽  
Stephanie Cruz ◽  
Michelle Chapdelaine ◽  
Mary Carl ◽  
Sara Levin ◽  
...  

Abstract Background Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic. Methods This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual’s personal life circumstances. Results Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity. Conclusions Respondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.


2014 ◽  
Vol 27 (3) ◽  
pp. 204-223 ◽  
Author(s):  
Mélanie Levasseur ◽  
Nadine Larivière ◽  
Noémie Royer ◽  
Johanne Desrosiers ◽  
Philippe Landreville ◽  
...  

Purpose – This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care. Design/methodology/approach – A qualitative multiple case study was conducted with 11 triads each involving an elder, a caregiver and a healthcare provider working in a Health and Social Services Centers (HSSCs). Findings – Although HSSCs in Québec are supposed to promote social integration and participation of older adults, services provided to the older adults in this study focused mainly on safety and independence in personal care, dressing, mobility and nutrition, without fully meeting older adults’ needs in these areas. Discrepancies between needs and services may be attributable to the assessment not covering all the dimensions of social participation or accurately identifying older adults’ complex needs; older adults’ and their caregivers’ difficulties identifying their needs and accepting their limitations and the assistance offered; healthcare providers’ limited knowledge and time to comprehensively assess needs and provide services; guidelines restricting the types and quantity of services to be supplied; and limited knowledge of older adults, caregivers and healthcare providers about services and resources available in the community. Originality/value – To improve and maintain older adults’ participation, a more thorough assessment of their participation, especially in social activities, is required, as is greater support for older adults and their families in using available community resources. It is also important to review the services provided by HSSCs and to optimize partnerships with community organizations.


Criminologie ◽  
2005 ◽  
Vol 21 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Josette Leroux ◽  
Gaétan Larrivée

The probation officer in a correctional milieu is confronted more and more by a clientele with various psycho-social pro b -lems, one of them psychiatric. By means of a case study, the authors examined the role of the probation officer in pre-sen-tence evaluation and post-sentence intervention vis-à-vis offenders and referrals to community resources The first objective of the probation officer is to help in some way resolve the social conflict engendered by the offence and keep this in mind when dealing with the offender social services.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sudha Panda ◽  
Soumyendu Shankar Ray

PurposeThe research aims to explore the wisdom, knowledge and practices in vernacular housing settlements with their sustainability underpinnings as tools for modelling rural affordable housing in tropical regions. The study is based on a weaving settlement in Bargarh district of Odisha, which is globally acclaimed for its Ikkat style of weaving.Design/methodology/approachA hierarchical framework of sustainability resting on the three pillars of ecological, economical and environmental dimensions is derived from existing theoretical research. This framework of 22 indicators is subsequently assigned to assess the sustainability of the vernacular weavers' settlement through quantitative evaluation. A qualitative assessment through observation and deduction also verifies the result.FindingsSince the vernacular weavers settlement performs very well on the sustainability scorecard, the paper suggests that its best practices can be incorporated while designing affordable housing so that social, cultural and heritage values are retained and a climate conscious, energy-efficient sustainable approach is ensured.Practical implicationsThe recommendations from the assessment has many lessons while framing policies for rural affordable housing as it cannot have one size that fits all settlement typology irrespective of the occupational, climatic and social needs.Originality/valueThe sustainable design and planning principles embedded in this vernacular settlement offers a valuable blueprint to re-imagine the affordable housing in rural areas which can be myopic if it does not take into account the occupational needs and life style of craftsmen dwellers.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S251-S252
Author(s):  
Geraldine E Kanne ◽  
Melissa Black ◽  
Marilyn Disco ◽  
Rhonda Mack-Minniefield ◽  
David Halpern ◽  
...  

Abstract The Duke Geriatric Workforce Enhancement Program aims to improve linkages between primary care practices (PCP’s) and community-based organizations by developing an interdisciplinary, community-based team to consult with PCPs, identifying resources to help vulnerable older adults. The Inter-agency Care Team (ICT) includes a nurse practitioner, pharmacists, community resource specialists, geriatricians and geriatrics and advanced practice nursing fellows. PCP’s refer older adults with complex care needs through the EHR for virtual consultation by the ICT. Team members review medical records and call participants and caregivers to obtain permission for the consult, gather information on function, social factors, medical problems, and their perceived needs. The ICT meets to review each case and sends written recommendations to the PCP and patient. To date, the ICT performed consultations for 73 older adults with a mean age of 76 years. 69% were female. 71% were black and 26% white. Frequently identified needs included personal/home safety (74%), medication management (64.3%), food security (63.0%), cognition (49.3%), transportation (38.4%) and advance care planning (31.5%). In the 90 days before consultation, 32.9% of patients had ED visits and 21.9% were hospitalized. In the 90 days after, 24.7% had ED visits and 13.7% were hospitalized. (Differences were not statistically significant.) ICT provided virtual consultation for complex older adults with prevalent social needs and high rates of ED visits and hospitalization. The team worked with PCP’s to connect these patients more directly to community resources. Further study is needed to know rates of adherence with recommendations and true impact on health outcomes.


2021 ◽  
Author(s):  
Hilary Placzek ◽  
Stephanie Cruz ◽  
Michelle Chapdelaine ◽  
Mary Carl ◽  
Sara Levin ◽  
...  

Abstract Background. Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks.Methods. This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual's personal life circumstances.Results. Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity.Conclusions. Respondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.


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