Community Health Resource Centers

State: VA Type: Model Practice Year: 2011

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The recent County Health Rankings released by the Robert Wood Johnson Foundation ranks Richmond City among the bottom five localities in Virginia by almost every major public health indicator. A disproportionate amount of the city’s morbidity exists in five census tract areas that make up the East End, where four of Richmond Redevelopment Housing Authority’s (RRHA) largest public housing developments exist. This concentration of poverty accounts for 14% of the City’s STI burden, 16% of HIV cases, and 18% of both teen pregnancies and infant deaths.

This past year, the Richmond City Health District collaborated with RRHA to create the Community Health Resource Centers in several of the highest risk housing communities in the city. With extensive involvement from residents of these communities, vacant apartments were converted to medical clinics where a wide array of services are now offered, including family planning, GYN and STI services, support groups, health classes, blood pressure and glucose screenings.

The primary goals of the Resource Centers are 1) To function as a community hub for health and wellness, with a particular focus on reproductive health, 2) To serve as a referral point to existing medical homes in the community, and 3) To invest heavily in indigenous leaders, training them to be health educators and health navigators.

The first center opened in Fairfield Court in November of 2009, and the response by the community was so positive, a second site was opened in Whitcomb Court in May 2010. Two more sites are currently under renovation, and are slated to open in February 2011. The first center was initiated with funding from a Title X expansion grant and contributions from RCHD and RRHA, but subsequent sites have relied on a more diverse group of funding streams, including: Bon Secours Health System, VCU School of Nursing, Richmond Behavioral Health Authority, The Community Foundation, and the Richmond Memorial Health Foundation. In addition to financial support, various local organizations and businesses lend their staff members and supplies to provide various education classes and support groups.

The success of the model is due to several factors, but primarily the quality of relationship that has evolved between the Resource Center staff and members of the community. The staff have done a remarkable job of being a consistent, caring presence over the past 12 months, and have earned the trust of the residents of Fairfield and Whitcomb Courts. They regularly seek input from the residents on everything from what classes will be offered to the paint colors on the walls. They have done home visits, helped people get jobs, and been invited to family events. They are doggedly focused on leadership development, and recently were awarded a grant to hire members of these high risk neighborhoods to serve as lay health educators and health navigators. This focus on developing meaningful relationships with indigenous leaders in the neighborhood has laid the foundation for the sustainable transformation of a community.

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Richmond City Health Department
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Community Health Resource Centers
The recent County Health Rankings released by the Robert Wood Johnson Foundation ranks Richmond City among the bottom five localities in Virginia by almost every major public health indicator. A disproportionate amount of the city’s morbidity exists in five census tract areas that make up the East End, where four of Richmond Redevelopment Housing Authority’s (RRHA) largest public housing developments exist. This concentration of poverty accounts for 14% of the City’s STI burden, 16% of HIV cases, and 18% of both teen pregnancies and infant deaths. This past year, the Richmond City Health District collaborated with RRHA to create the Community Health Resource Centers in several of the highest risk housing communities in the city. With extensive involvement from residents of these communities, vacant apartments were converted to medical clinics where a wide array of services are now offered, including family planning, GYN and STI services, support groups, health classes, blood pressure and glucose screenings. The primary goals of the Resource Centers are 1) To function as a community hub for health and wellness, with a particular focus on reproductive health, 2) To serve as a referral point to existing medical homes in the community, and 3) To invest heavily in indigenous leaders, training them to be health educators and health navigators. The first center opened in Fairfield Court in November of 2009, and the response by the community was so positive, a second site was opened in Whitcomb Court in May 2010. Two more sites are currently under renovation, and are slated to open in February 2011. The first center was initiated with funding from a Title X expansion grant and contributions from RCHD and RRHA, but subsequent sites have relied on a more diverse group of funding streams, including: Bon Secours Health System, VCU School of Nursing, Richmond Behavioral Health Authority, The Community Foundation, and the Richmond Memorial Health Foundation. In addition to financial support, various local organizations and businesses lend their staff members and supplies to provide various education classes and support groups. The success of the model is due to several factors, but primarily the quality of relationship that has evolved between the Resource Center staff and members of the community. The staff have done a remarkable job of being a consistent, caring presence over the past 12 months, and have earned the trust of the residents of Fairfield and Whitcomb Courts. They regularly seek input from the residents on everything from what classes will be offered to the paint colors on the walls. They have done home visits, helped people get jobs, and been invited to family events. They are doggedly focused on leadership development, and recently were awarded a grant to hire members of these high risk neighborhoods to serve as lay health educators and health navigators. This focus on developing meaningful relationships with indigenous leaders in the neighborhood has laid the foundation for the sustainable transformation of a community.
The Community Health Resource Centers focus on four major public health issues: 1. Removing two major barriers to care: transportation (access) and trust. 2. Providing greatly needed family planning and reproductive health services in communities that have the highest burden of STI, HIV, Teen Pregnancy, and Infant Mortality in the city. 3. Connecting individuals with a patient-centered medical homes, and providing health navigation and support to understand how to use our health care system appropriately. 4. Developing local health "experts," peer health educators and leaders who can provide ongoing care and support to members of the community.
Agency Community RolesIn accordance with its mission statement to promote healthy living, protect the environment, prevent disease, and prepare the community for disasters, the local health district, the Richmond City Health District (RCHD), developed the concept, initiated partnerships, and established the first Resource Centers The Resource Center staff are RCHD employees, and RCHD continues to provide oversight to operations, expansion, and partnership development. Costs and ExpendituresThe recent County Health Rankings released by the Robert Wood Johnson Foundation ranks Richmond City among the bottom five localities in Virginia by almost every major public health indicator. A disproportionate amount of the city’s morbidity exists in five census tract areas that make up the East End, where four of Richmond Redevelopment Housing Authority’s (RRHA) largest public housing developments exist. This concentration of poverty accounts for 14% of the City’s STI burden, 16% of HIV cases, and 18% of both teen pregnancies and infant deaths. This past year, the Richmond City Health District collaborated with RRHA to create the Community Health Resource Centers in several of the highest risk housing communities in the city. With extensive involvement from residents of these communities, vacant apartments were converted to medical clinics where a wide array of services are now offered, including family planning, GYN and STI services, support groups, health classes, blood pressure and glucose screenings. The primary goals of the Resource Centers are 1) To function as a community hub for health and wellness, with a particular focus on reproductive health, 2) To serve as a referral point to existing medical homes in the community, and 3) To invest heavily in indigenous leaders, training them to be health educators and health navigators. The first center opened in Fairfield Court in November of 2009, and the response by the community was so positive, a second site was opened in Whitcomb Court in May 2010. Two more sites are currently under renovation, and are slated to open in February 2011. The first center was initiated with funding from a Title X expansion grant and contributions from RCHD and RRHA, but subsequent sites have relied on a more diverse group of funding streams, including: Bon Secours Health System, VCU School of Nursing, Richmond Behavioral Health Authority, The Community Foundation, and the Richmond Memorial Health Foundation. In addition to financial support, various local organizations and businesses lend their staff members and supplies to provide various education classes and support groups. The success of the model is due to several factors, but primarily the quality of relationship that has evolved between the Resource Center staff and members of the community. The staff have done a remarkable job of being a consistent, caring presence over the past 12 months, and have earned the trust of the residents of Fairfield and Whitcomb Courts. They regularly seek input from the residents on everything from what classes will be offered to the paint colors on the walls. They have done home visits, helped people get jobs, and been invited to family events. They are doggedly focused on leadership development, and recently were awarded a grant to hire members of these high risk neighborhoods to serve as lay health educators and health navigators. This focus on developing meaningful relationships with indigenous leaders in the neighborhood has laid the foundation for the sustainable transformation of a community. ImplementationPerformed needs assessment: - Analyzed demographic data - Conducted focus groups with community residents - Sought input from Tenant Councils Cultivated Community Buy-in - Formed relationships with community residents, used tenant council members to advertise and advocate for the development of the Resource Centers - Involved residents in decision making process: allowed them to choose paint colors on the walls, provide input on interior decor, and determine which services we would pursue on their behalf Partnership Development - Identified public and private sector partners that could provide the various services requested during the focus groups - Connected with local health care providers and developed a referral network, as well as communication procedures for scheduling appointments. Developed MOUs for these processes. - Sought funding from local foundations and local health care systems to expand model to new neighborhoods Implemented Resource Center Model - Identified vacant housing units to be used - Designed space adaptations and renovated space - Hired clinical staff and outreach workers - Continue to add new programs and services as residents request, and partners come into the fold who are able to meet those requests April 2008-April 2009: Planning, relationship building, partnership development, focus groups April 2009- October 2009: Pursued grant funding, developed clinic model and process, began hiring staff July 2009- Nov 2009: Renovations on Fairfield Resource Center November 2009: Fairfield Court Resource Center opened January 2010- April 2010: Renovations on Whitcomb Resource Center May 2010: Whitcomb Court Resource Center opened June 2010- Dec 2010: Pursued grant funding, established partnerships with local health care systems who had an interest in supporting the Resource Center concept, and expanded staff Dec 2010-April 2010: Renovations on 2 new centers Mar 2011: Creighton Court Resource Center opened April 2011: Mosby Court Resource Center opened
Our primary objectives are to provide health screenings for women's health, STI, breast cancer, BP, and blood sugar, and connect patients to medical homes and community resources. The performance measures for these objectives can be measured by the number of attendees at events and meetings, number of contraceptives provided, the number of positive STI results, vaccines administered, and referrals to community resources. For health screenings, the staff simply tallies the number of people that come for a screening and records the results of abnormal pap smears, positive HIV/STI tests, and BP and blood sugar screenings. The Resource Centers staff records patient encounters and attendance at community events using VDH's patient encounter database, Webvision. Our success in connecting patients to medical homes and community resources can be assessed by the number of referrals to community resources and clinics, and the number of patients that successfulyy followed up with medical homes. Since the Resource Centers are relatively new, outcomes data has not been collected, but patient surveys, monthly reports, and medical records show a high level of participation and satisfaction from residents. The monthly reports include standard information on the number of screenings and attendees to meetings, but also highlight anecdotal successes of individual community residents. For example, in January 2010, the Fairfield Resource Center had 19 residents come in for family planning information sessions; by September, that number had more than tripled, with 79 residents coming in for family planning information. A formal evaluation process happens through Title X reporting and accountability from local foundations; the six-month evaluations for both concluded that we were on target for numbers of patients seen and number of contraception distributed. The outcomes of our objectives will be seen through decreased percentiles of STD, teen pregnancy, and infant mortality rates. Although a more formal evaluation processes may be necessary, the patient satisfaction surveys we perform help us customize our needs for the community and factor well with our relationship-centered approach. Because of the surveys, modifications to the practice can be made with increased precision, flexibility and speed than evaluations that are more formal would allow.
Currently, we have the ongoing commitment of cooperative budget dollars from the Richmond City Health District, and a ten year commitment from the Richmond Redevelopment & Housing Authority (RRHA) to provide rent and utility costs in-kind. We also have grant funding from three different local foundations which will ensure operations at two centers for three years. VCU School of Nursing has committed funds for a third center for three years, and Bon Secours Health Systems have committed funds for a fourth center for three years. After the three year period, our major funders will have the opportunity to re-evaluate and renew their Memorandums of Agreement. We hope to achieve long-term sustainability through the following measures: • Medicaid and Plan First Revenues: The expanded eligibility provisions of the current health care reform bill should result in nearly 100% of our population qualifying for Medicaid in the next 2-4 years, providing a previously unavailable revenue stream • Increased Federal Family Planning Dollars: The allocation of Federal Family Planning Funds (Title X) is dependent on the total number of patients seen for family planning services. The increased number of visits afforded by the Resource Centers will translate to an increased allocation of approximately $5000 annually. • VCU School of Nursing: The VCU School of Nursing has committed $25,000 per year for the next 3 years. Initially, the bulk of that funding will go towards renovation and adaptation costs, but in future years, these funds can be committed to operational costs. • City of Richmond: The City of Richmond has shown considerable interest in this project, with strong support by several members of City Council. As the Resource Centers continue to provide valuable care to many of our city’s high risk population, help patients establish relationships with medical homes, and affect health outcomes, our hope is that there will eventually be a line item in the City’s budget to support the operation of these centers. • Increased HUD Funding: RRHA relies heavily on the Department of Housing and Urban Development (HUD) funding. In June 2010, HUD announced new funding priorities which include programs connecting HUD assistance to other agencies’ programs functioning to improve health and economic outcomes of target populations. HUD also specifically outlines co-location with health services as one of their funding criteria. Building the capacity of the Resource Centers in our communities will make RRHA more competitive for these funds, which can be used to sustain operations. • Community Partners: As our network of partners expands and new services are provided through the Resource Centers on the days of the week that are not being used for clinic, there will be an opportunity for other community non-profit organizations to support the operating costs of the Resource Centers.
 
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