Testing a Shared Decision -Making Model for Health and...

Strategies to Achieve Alignment, Collaboration, and Synergy across Delivery and Financing Systems

Testing a Shared Decision-Making Model for Health and Social Service Delivery in East Harlem

Research In Progress WebinarWednesday, April 25, 2018

12:00-1:00 pm ET/ 9:00 am-10:00 am PT

Funded by the Robert Wood Johnson Foundation

AgendaModerator: CBMamaril,PhD

ResearchFaculty,RWJFSystemsforAction NationalCoordinatingCenterUniversityofKentuckyCollegeofPublicHealthanna.hoover@uky.edu

Presenters: CarlLetamendi,PhD,MBA,GStat RachelDannefer,MPH,MIADirectorofEvaluation&DivisionalSupport DirectorofResearchandEvaluationDivisionManagement HarlemNeighborhoodHealthActionCenterCenterforHealthEquity rdannefe@health.nyc.govcletamendi@health.nyc.gov

CommentarySpeaker: Padmore John,MS

ManagerEastandCentralHarlemNeighborhoodHealthActionCenters

Q&A: ModeratedbyDr.CBMamaril

Presenter

CarlLetamendi,PhD,MBA,GStatDirectorofEvaluation&DivisionalSupportDivisionManagement

Presenter

RachelDannefer,MPH,MIADirectorofResearchandEvaluationHarlemNeighborhoodHealthActionCenter

Commentary Speaker

Padmore John,MSManagerEastandCentralHarlemNeighborhoodHealthActionCenters

TestingaSharedDecision-MakingModelforHealthandSocialServiceDeliveryinEastHarlem

ResearchinProgressWebinarApril25,2018

RachelDannefer,MPH,MIADirectorofResearchandEvaluationHarlemNeighborhoodHealthActionCenter

CarlLetamendi,PhD,MBA,GStatDirectorofEvaluation&DivisionalSupportDivisionManagement

PEACH: PurposeandGoal

PartnershipstoEncourageActionableCulturesofHealth

2

Purpose:Theprimaryaimofthismixed-methodsstudyistoprovidenewevidenceonhowaligningacityhealthdepartmentwithcross-sectorcommunitystakeholdersunderaplace-basedmodelcanimprovehealthandreduceinequitiesacrossneighborhoods.ThePEACHstudyfocusesprimarilyontheEastHarlemNeighborhoodHealthActionCenter.

Goal:Weexpecttocriticallyevaluatetheimpactofthesystemontheneighborhood,anddetailhowthisalignmentmaybescaledupinNewYorkCity(NYC)andreplicatedinotherU.S.cities.

BuildingaCultureofHealthinEastHarlem

ActionArea2:Fosteringcross-sectorcollaborationtoimprovewell-being

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PEACHResearchTeam

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CarlLetamendi,PhD,MBA,GStatDirectorofEvaluation&DivisionalSupportDivisionManagement

RachelDannefer,MPH,MIADirectorofResearchandEvaluationHarlemNeighborhoodHealthActionCenter

JenniferPierre,DrPH,MPHDirectorofQualitativeResearchCenterforHealthEquity

LukeSleiter,MPHAssistantProjectDirector,PEACHCenterforHealthEquity

Presenter

NeighborhoodSnapshot:EastHarlem

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NeighborhoodHealth:EastHarlem

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NeighborhoodHealth:EastHarlem

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NeighborhoodHealth:EastHarlem

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CausesofInequities

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PoliciesthatcreatedalltypesofsystemsofunbalancedpowerandprivilegeCausedbyhistoricalpracticeofexclusionanddiscriminationacrossthelifecourseLedtogeographicconcentrationofpovertyandhyper-segregation

Rootcausesofinequities

RespondingtoInequities

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Aneighborhood’shealthresultsfromthehistorical,political,socialandphysicalforcesthataffectit.CertainNYCNeighborhoodshavebeendeprivedofsufficient

resourcesandattention.Inorderto“right”thisinjustice,wehaveneighborhoodofficesinareasthat

bearthehighestdiseaseburden.

Weinvestinkeyneighborhoods(place-based).

NYCDOHMHCenterforHealthEquity

OurVision

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Acrossourcity,everyNewYorkerlivesinathrivingneighborhood,whereresourcesworkwellandsystemsareequitableinordertonurtureandsustainhealthyindividualsandcommunities.

OurMissionTostrengthenandamplifytheHealth

Department'sworktoeliminatehealthinequities,whicharerootedinhistoricalandcontemporaryinjusticesanddiscrimination,includingracism.

NeighborhoodHealthActionCenters

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ActionCenters:BriefHistoryandOverview

13DistrictHealthCenters

1920s

DistrictPublicHealthOffices(DPHOs)

2003

NeighborhoodHealthActionCenters

2017

ActionCenterLocations

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NewYorkState

NewYorkCity

ActionCenterStrategies

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CollectiveActionandImpact

InnovationinPrograms&Policy

Co-locationandReferrals

Clinicalandprogrammaticproviders

Kitchensandgardens

Navigatorsandreferral

specialists

Neighborhoodconveningspace

TheFamilyWellnessSuite

Amultipurposeroomprovidesa

spaceforneighborhoodpartnersandresidents,and

spaceforphysicalactivity andevents

Co-locatedservicesprovidedirectclinicalandsocialservices,

whileallowingforplace-basedplanningandcoordination

TheFamilyWellnessSuiteprovidesa

lactationlounge,children’snookandtargetedprogramming

Somewillfeatureateaching

kitchenaswellasagardenforgrowingfruitsandvegetables

Throughreferralsystems,

residentsaresupportedingettingtheservicesthey

need

ActionCenters:WhatWeOffer

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ActionCenterCo-LocatedPartnersinEastHarlem

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v HarlemHealthAdvocacyPartners

v EastHarlemAsthmaCenterofExcellence

v NewbornHomeVisitingv EHACEChefsv FreshFoodBoxv ShapeUpv EastHarlemCommunity

WalkingTrailv FamilyWellnessSuite

PEACH Objectives

Determinehowaligningthecityhealthdepartment,clinicalandnonclinicalpartners,internalandexternalfrontlinestaffinacollectivegovernancestructure withintheEastHarlemActionCenterbuildsacultureofhealth.

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Theobjectives guidingthestudyseekto:

DeterminewhethertheuseofNowPowbyActionCenterstakeholdersfostersacross-sectorcollaborationtoimprovehealth&well-beingintheneighborhood.

EvaluatetheimpactthattheActionCenterhasonthehealthoftheEastHarlemcommunity.

TodevelopafinalreportwhichdetailshowthisalignmentmaybescaledupinNewYorkCityandreplicatedinotherU.S.cities.

PEACHDataSources

• GovernanceCouncilInterviews

• EastHarlemActionCenterStaffInterviews

• NowPowreferralandtrackingsystem

• VisitorSatisfactionSurveys

• ActionCenterMonitoring&TrackingData

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GovernanceCouncilInterviewsGovernanceCouncilPurpose• Promotetransparency• Supportcohesionandcollaboration• Addressbuildingmanagementissues• Ensurecustomerrelationsareofthehighestpossiblestandardsandrespondtocommunityneeds• Strategicplanning

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MonthlyGovernanceCouncilMeeting• Includesrepresentativesfromeachco-locatedpartner

• Supportscoordinationofservicesandplanningatthebuildinglevel

GovernanceCouncilBaselineInterviewsAnticipatedbenefitstoorganizationsforbeingpartoftheActionCenter

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Membersdescribedexpectationsandoutlinedgoalsforthecouncilitself,fortheirorganizations,andfortheActionCenter.

• CollaborationwithActionCenterstaffandpartners• Connectprogramsforcollaborativeinitiatives• Acceptreferralsandwarmhandoffsfrompartners• Sharestaffandresources• Increasedcapacityandabilitytooffernewservices• Expandedprogramreach

CollaborationandReach • Goodlocation• Morespace• Attractivespacewithartdisplaysinbuilding

Building

• Fillservicegaps• Raiseawarenessofhealthissuesinthecommunity• Promoteawarenessofprograms• Improvehealthoutcomesintheneighborhood

Community

ActionCenter KeyPlayerInterviews

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NavigatorWelcomesneighborhoodresidents,orientsvisitorstotheActionCenterservices,andfacilitatescoordinationofservicedelivery.

ReferralSpecialistConnectsneighborhoodresidentswithserviceprovidersinsideandoutsidethebuildingtopreventgapsinaccesstocare.

HealthPromoterIdentifiesanddevelopsrelationshipswithneighborhoodassetsandfacilitateshealthpromotionactivities.

NowPow

thatallowscommunitymemberstofindhealthcare,socialservices,andpublichealthprograms,whileconnectingtheprovidernetworktofacilitatereferrals.

Coresystemfunctionsinclude• Acomprehensiveandregularlyupdatedresourcedirectory• Socialneedsscreening• Bi-directionalreferralmanagement• Aclient-centeredactionplanwithremindertools• Populationmanagementdashboardsforeachorganization

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NowPow isaresourcedirectoryandreferralsystem

NowPow Cont’d

Benefits&Opportunities• Numberofsuccessfulreferrals• Identificationofservicegaps• Facilitateswithneedsanalyses• Helpsidentifysocialdeterminants

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VisitorSatisfactionSurveys

• Visitorswillbesurveyedtoassessperceptionsandexperiencesaround:• Physicalspace• Customerserviceandoverallexperience• Qualityofcare• AbilityofActionCentertomeetneeds• Socialcohesion

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EastHarlemActionCenterVisitors

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1065

1301

15371397

1212 1239 1252

1514 1474

1673 1720

1178

1336

1101

0

200

400

600

800

1000

1200

1400

1600

1800

2000

NUMBE

ROFVISITO

RS

TotalNumberofVisitorsEnteringEastHarlemActionCenterbyMonth

2017 2018

EastHarlemActionCenterReferrals

27

4337

49 51

31

74

53

76

51

34 34 34

15

36

0

10

20

30

40

50

60

70

80

90

100

NUMBE

ROFRE

FERR

ALS

TotalNumberofReferralsMadebyMonth

2017 2018

EastHarlemActionCenterReferrals,Cont’d

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TopReferralCategories

1. Sexualhealthservices2. ESLclasses3. Completephysical

82

270

261

Co-located

External

DOHMH

0 50 100 150 200 250 300

TypesofReferrals(January2017– February2018)

NextSteps

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Activity Phase StartTimeGovernanceCouncilMemberInterviews Follow-Up Spring2018

Dôr FootTrafficCounters Implementation Spring2018

NowPow Utilization Implementation Spring2018

EastHarlemKeyPlayerInterviews Baseline Summer2018

EastHarlemVisitorSatisfactionSurveys Follow-Up/RoundTwo Summer2018

EvaluateActionCenterImpactonEastHarlemCommunity

Baseline Fall2018

ThankYou!

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Questions?Comments?Conversation?

CarlLetamendicletamendi@health.nyc.gov

RachelDanneferrdannefe@health.nyc.gov

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Wednesday, May 23, 2018 12-1pm ET/ 9-10am PTINTEGRATING CROSS-SECTORAL HEALTH AND SOCIAL SERVICES FOR THE HOMELESSUniversity of Utah and University of North TexasPrincipal Investigators: Jesus Valero, PhD, and Hee Soun Jang, PhD

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Acknowledgements

Systems for Action is a National Program Office of the Robert WoodJohnson Foundation and a collaborative effort of the Center for Public HealthSystems and Services Research in the College of Public Health, and theCenter for Poverty Research in the Gatton College of Business and Economics,administered by the University of Kentucky, Lexington, Ky.

and

Questions?

www.systemsforaction.org