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Development Office A Sampling of Programs Supporting the Mission The Center for Children at Risk is part of BMC's response to a major public health crisis in Boston in the 1990s. From 1990 through 1996, there were 149 homicides, 13 suicides, and 40 accidental deaths among youths aged 10-19 in Boston, and a cluster of 6 suicides among adolescents in South Boston in 1997. Homicides and intentional injuries were concentrated in a north-south band of Boston neighborhoods near BMC. Families faced significant barriers to care and recovery. BMC's emergency child psychiatry service, evaluating an average of 60 children per month, found that services to help children in crisis were under-funded and inadequate. Children who were suicidal, depressed, psychotic, or violent filled Boston's emergency rooms. Families waited hours to be seen by overworked clinicians. Clinicians trying to find children a safe place in close proximity to families' homes too often found beds only outside of Boston. Sometimes, children and families waited for days in pediatric units or emergency rooms until a psychiatric hospital bed could be found. Pediatric units and emergency rooms lacked staffing or training to adequately help, further compounding families' feelings of vulnerability at a time of high need. Stress on all was considerable. In partnership with the Massachusetts Department of Social Services, the Massachusetts Department of Mental Health, the district attorney's office, schools, community and mental health centers, medical schools, and families, the Center began to provide interventions for children in crisis that focused at the source of problems. Three related programs, (1) a Traumatic Stress Program, (2) an Urgent Care Program, and (3) an Intensive Residential Program, form the basis of the Center's interventions for children at risk. But Center leaders realized this was not enough. Recognizing that the struggle to access services for BMC patients was not unique, Center leaders were spurred to action at a larger level. They brought their concerns and data to state legislators with the help of BMC's Family Advocacy Program lawyers in 2000. This advocacy led to a bill establishing a legislative committee to investigate children's mental health services in Massachusetts. Key members of the Center also advised the Massachusetts Citizen's for Children in their landmark 2001 report detailing the failure of state systems to address child abuse, neglect and trauma. The Center and BMC's Family Advocacy Program have just been awarded $50,000 by the Boston Foundation to continue efforts identifying creative solutions to surmount the considerable barriers to care for families with traumatized and seriously troubled children. The grant will facilitate increased advocacy within the educational, social service, criminal justice, and mental health systems. The Center's advocacy and interagency collaborations are an important step in coordinating a different level of care in Massachusetts and developing data that show the efficacy of interventions. MISSION: We will provide CONSISTENTLY ACCESSIBLE health services… The Boston HealthNet and the Boston Medical Center HealthNet Plan and CareNet Plan integrate delivery among community health centers and assist Medicaid recipients and the uninsured in accessing care, ensuring that health care services in Boston are consistently accessible. Access is a key determinant of health care status and is increasingly cited to explain health disparities among blacks and whites in the United States. Three efforts by BMC and its partners aim to reduce barriers to health care in the Boston area. Boston HealthNet is the fastest growing and most influential community health network serving Boston's underserved and working class neighborhoods. The Boston Medical Center HealthNet Plan is an innovative program that provides full medical coverage to those eligible for Mass Health (Medicaid) benefits. A companion plan, the CareNet Plan, is offered at HealthNet sites for those without insurance or the ability to pay for it. Boston HealthNet, formed in 1995, is an essential element to protecting BMC's public health mission. Through partnerships with 15 health centers in a diverse range of neighborhoods throughout Boston and in Quincy, the network provides services and programs to communities, gives health centers greater access to capital resources and improves their fiscal health, and promotes medical education, among other things. BMC provides almost $4 million in operating support to HealthNet centers each year, and dedicates part of its annual budget to health center capital improvements. To date, nearly $40 million from BMC has helped the centers to improve their facilities. "Improving Access" initiatives through the Boston HealthNet seek to improve access to care for new and established patients. Catherine Tantau, an expert in clinical care redesign and Advanced Access, has helped individual practices increase patient access to network services. In addition, BMC specialists from 21 departments provide over 100 sessions each week at health centers. Over 209,000 patients have used a shuttle bus between BMC and health centers since early 2000. For patients with little income and less flexibility to take time off work, these initiatives facilitate access to comprehensive services in a timely fashion and promote the early detection of health issues. The Boston Medical Center HealthNet Plan and the CareNet Plan are enhanced MassHealth and free care programs that have brought managed health plan coverage to over 147,000 people. Outreach workers at BMC and Boston HealthNet centers assist people to fill out the MassHealth (Medicaid) and CareNet applications. Most outreach workers live in the same neighborhoods as our patient population, sharing ethnic background and languages. This form of outreach is reassuring to some cultural minorities (such as immigrants) who may be wary of entering the health care system or handing personal information over to the government. Boston HealthNet has grown from 8 center partners to 15 in 6 years. HealthNet patients account for approximately 27% of BMC admissions and over a million patient visits across the system. Fiscal year 2001 operating costs for the Boston HealthNet were $4,664,739, paid for by BMC. The Boston Medical Center HealthNet Plan and the CareNet Plan, respectively, have 70,548 and 77,292 members. FY2001 operating costs were $140 million, supported by state and federal Medicaid funds. A separate federal Community Access Project grant of nearly $1 million dollars supplements efforts to improve the coordination and quality of services to CareNet enrollees and gather data to evaluate the efficacy of a capitated managed care system for the uninsured in Boston. MISSION: We will SERVE ALL IN NEED OF CARE… The Elders Living at Home Program, which assists homeless elderly patients discharged from BMC to access housing where they can recuperate, reflects our commitment to serving all in need of care. Old, alone, homeless, hurting - these are words to describe some of the most vulnerable elderly patients discharged from a hospital. Without social supports, exposed to the elements and psychological trauma of being on the street, homeless patients are unlikely to recover from surgery or to benefit from treatments given in a hospital. Discharging such patients was a defeating action for physicians at BMC. In 1986, they decided to do something about it. The Elders Living at Home Program (ELAHP) responds to physicians' frustrations over the failure of the health care system to serve elderly homeless patients adequately after discharge. Rather than losing patients to the streets, ELAHP establishes a sanctuary for low-income, health-impaired elders by giving them access to safe transitional housing during recovery. Eileen O'Brien, director of ELAHP since 1988, is dedicated to repairing a critical rift in the safety net for some of our city's most needy souls. She and ELAHP staff connect patients referred from BMC, shelters, outreach programs, meal sites and community agencies to transitional housing in vacant units at Boston Housing Authority elderly/disabled developments. Currently, ELAHP maintains 40 temporary units in 4 sites in the Boston neighborhoods of Dorchester, Roxbury and the South End. Intensive housing casework and advocacy promote clients' long-term stability. The efforts of staff have resulted in 77% of participants moving into permanent housing and only 5% becoming homeless again. In 1998, ELAHP added disease prevention, health promotion and education services as program components of those living in the transitional units. The Boston Housing Authority and University of Massachusetts-Boston College of Nursing collaborate with ELAHP in this effort. In 2001, 700 elders benefited from these "community clinics" at 12 housing sites throughout the city. ELAHP handled 165 referrals in 2001. They placed 56 people in transitional housing and provided emergency housing to 73. Statistics on these clients paint a disturbing picture of elderly homelessness and gaps in the safety net:
The Center for Nourishing the Future, a group of programs that address nutritional issues, exemplifies our pledge to deliver services that meet our patients needs, regardless of status. Tucked away on the top floor of one of the oldest buildings on BMC's campus is a special haven for some of Boston's most vulnerable residents: children whose parents cannot afford to provide them with adequate food. Called The Grow Clinic, this sanctuary for children with a condition called Failure to Thrive, is part of the hospital's Center for Nourishing the Future (CNF), a collection of clinical, educational and service programs to address serious poverty and nutrition-related health and development issues in Boston. Poor nutrition - whether from too few calories or the wrong kind of calories - can jeopardize children's health and impair their development, decreasing their chances of ever reaching full potential. Some children may be hungry as they go to bed at night; others cannot concentrate at school. In extreme cases, they develop rickets or a condition called Failure to Thrive (FTT) where they stop growing normally and are at risk of death. Physicians in BMC's emergency department and primary care clinics, as well as at other institutions, refer young patients to The Grow Clinic for its intensive services. The worst part of it is that, in Boston, crises of this sort should be preventable. For Dr. Deborah Frank, who founded CNF's Grow Clinic in 1984, poverty means having to choose between buying a new package of diapers and baby food, or between paying bus fare for the family to visit the doctor and serving complete meals to two toddlers. She is impassioned about reversing the effects of malnutrition in individual children and spreading the word - locally and nationally - that hunger is too damaging to small bodies and minds not to be prevented. CNF services include home health education, family advocacy services and a Preventive Food Pantry and Demonstration Kitchen that serves 1,500 families a month. Its Breastfeeding Center promotes breastfeeding as the optimal form of infant nutrition, especially when a mother may be struggling with food security. Most of these services fall outside the traditional medical model and are not covered by insurance or government programs. Remarkably, the history of support for CNF programs is a wonderful example of community service fostering further community service. In an affluent metropolitan area like greater Boston, hunger is mostly hidden from view. However, the extent to which local hunger issues, when revealed, have galvanized churches, temples, celebrities, families, and store owners in the area to get involved in the provision of food and services to families in need is powerful. Donated clothing, food, and taxicab and supermarket vouchers help Grow Clinic families as they work intensively with the clinic to help their child recover. A loyal group of community leaders holds a "Food for Thought" dinner each year, raising $450,000 for CNF programs in a single night. Former Boston Bruin Ray Bourque hosts a celebrity golf tournament for the Grow Clinic kids, raising $600,000 in the past six years. MISSION: We will SERVE ALL REGARDLESS OF ABILITY TO PAY. The Prostate Cancer Screening Initiative (PCSI), which unites BMC with local businesses and health centers to spread the word in communities of color about the risk of prostate cancer, is symbolic of our efforts to extend services to all, regardless of ability to pay. Prostate cancer is a killer for black men. Those living in the United States have the highest risk for prostate cancer of any population group in the world, tend to be diagnosed at later stages, and are more likely to die from it than white men. In Boston, these statistics are borne out locally. Prostate cancer death rates for men living in the predominantly black neighborhood of Mattapan in 2000 were twice as high as the citywide rate. Yet, for a variety of reasons that include a historical lack of access to and distrust of the medical community, many black men do not seek primary care services. For Valerie Navy-Daniels, BMC Community Relations Director, fostering community health means bringing the message of early detection into the community and reaching those who are not otherwise accessing care. "When I arrange a screening event with a local organization, I enroll that community leader in the fight for a healthier community. Most often, black leaders are already concerned about healthcare disparities; my outreach gives them a way to do something about it." BMC's partners in the prostate screening effort include churches, the subway authority, parking garage owners, restaurants, law enforcement officer associations, taxicab operator associations, eight neighborhood health centers and the Boston Public Health Commission. Local community papers, like the Bay State Banner, help our cause with editorials and publicity. Boston HealthNet, the American Cancer Society and the City of Boston also support the effort. Using a Boston Public Health Commission medical van, BMC brings a mobile examination room to neighborhood sites and other areas where black men are working, worshipping, or relaxing. Since August 2000, 601 men have participated in 33 PCSI events. Many men lacked any form of insurance. Free tests (digital rectal exams and prostate specific antigen analysis) have revealed abnormalities among 4% of men tested. Men with abnormal test results are urged to seek further treatment and told about free care options. Darryl Settles, owner of Bob the Chef's Restaurant and Jazz Café in the South End, recently provided music and a dinner buffet for men and women who brought their husbands, fathers, brothers or friends to the screening event. For him, helping increase the number of men who are screened is simple: "The program opens the door to care in time to save men's lives. If meals from Bob's help encourage people to seek care, that's a great role for me to play in my community." The PCSI is one of several BMC off-site outreach efforts. Other van programs include the state-funded Women's Health Network (breast cancer screening for low-income women) and the Family Medicine Department's Outreach Van, which travels into neighborhoods each week to deliver food, blankets and medical assistance to the homeless. |
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