Boston Medical Center 2019-2022 Implementation Strategy

Unwavering in our long-standing commitment to address the health needs of our community, Boston Medical Center (BMC) has developed programs and initiatives beyond the traditional medical model. Core to fulfilling our public health mission and vision for health equity, our Community Benefits Programs and Initiatives aim to improve health outcomes among underserved populations in our community.

As the largest safety net hospital in New England, BMC serves a significant number of disadvantaged patients who live in our community. Approximately 57% of our patients are from underserved populations. Our patients are disproportionately and adversely affected by social determinants of health.

Community Health Needs Assessment

In 2019, BMC conducted a comprehensive Community Health Needs Assessment (CHNA) in collaboration with community organizations, Boston residents, health centers, hospitals and the Boston Public Health Commission. The Boston Community Health Needs Assessment-Community Health Improvement Plan Collaborative (the Collaborative) formed to undertake the first Boston-wide CHNA and CHIP. Focusing on the social determinants of health and using a health equity lens, the Collaborative employed a participatory approach that engaged the community in every step of the CHNA.

Prioritization of Community Health Needs

Boston Medical Center, other Collaborative members, community members, and community stakeholders undertook a transparent process to distinguish the most pressing community health needs based on the data collected for the CHNA.

A 100-member work group, comprised of representatives from the health care, public health and social service sectors together with community leaders and residents, selected the following shared values to guide prioritization of the CHNA findings: 1) burden: how much does this issue affect the health of Boston; 2) equity: will addressing this issue substantially benefit those most in need; 3) impact: can working on this issue achieve both short- and long-term change; 4) feasibility: is it possible to address this issue given infrastructure, capacity and political will; and 5) collaboration: are there existing groups across sectors willing to work together on this issue? Guided by these shared values, the work group distilled 19 issues identified by the CHNA into four key issues. BMC has identified six key issues:

. Access to Services . Violence and Trauma

. Housing . Behavioral Health and SUD

. Financial Security and Mobility . Food Insecurity

These shared priorities informed Boston Medical Center’s 2019 Implementation Strategy which serves as our roadmap for Community Benefits Programs and Initiatives for the next three years. We anticipate maintaining our recent level of resource investment over the next three years.

Boston Medical Center 2019-2022 Implementation Strategy Social Determinants of Boston Medical Center Impact Target Population(s) Community Collaborators and BMC Health and Health Needs Programs and Initiatives Teams HOUSING 1. Elders Living at Home 1. ELAHP provides tailored housing 1. Elders and disabled 1. Boston Housing Authority, Program (ELAHP) services including housing stabilization, adults age 55 and Cambridge Housing Authority 2. Good Food Markets agency referrals. older at imminent risk BMC: ELAHP at Bartlett Station 2. Good Food Markets will located at of losing housing 2. Nuestra Comunidad Development 3. Housing Prescriptions Bartlett Station and offer healthy, 2. Residents of Bartlett Corporation 4. Boston Housing affordable groceries and prepared Station and 3. Boston Housing Authority Authority Fund foods. The grocery will hire from the surrounding Dudley BMC: Pediatrics, ELAHP 5. Metro Housing community and engage with the local Square neighborhood 4. Boston Housing Authority Boston Colocation community. 3. Referred homeless 5. Metro Housing Boston, Medical Housing Support 3. A Community Wellness Advocate and housing instable Legal Partnership Boston Services Program situated at BMC liaises with BHA when patients and families BMC: Pediatrics 6. Housing Support patients are in need of services or 4. Elderly and disabled 6. Codman Square Neighborhood Services at the eviction prevention. individuals Development Corporation Waldeck Building 4. Unit upgrades (reasonable 5. Homeless and housing 7. The Community Builders 7. Community Builders accommodations for safety and instable families 8. Madison Park Development Wellness Program at accessibility) allow elderly and disabled 6. Individuals with Corporation New Franklin residents to age in place. mental health issues BMC: ELAHP 8. Wellness Program at 5. A housing case manager employed by and/or disabilities 9. Madison Park Development Dewitt Center Metro Housing Boston, but located at 7. Residents of The Corporation 9. Wellness and BMC, works with patients and enables Community Builder’s BMC: ELAHP Support Services at them to access Metro Housing New Franklin 10. Center for Community Health Smith House resources, such as fair housing Apartments Education Research and Service, 10. Innovative Stable advocacy, housing search, financial 8. Residents (families, Inc., Boston Children’s Hospital, Housing Initiative coaching, and intensive wrap-around seniors, adults, Brigham and Women’s Hospital, (ISHI) case management services. A housing children) in and Health Resources in Action lawyer from Medical Legal Partnership around Madison Park 1-10 BMC: Cross-Functional Housing Boston provides families with legal Village Team, support. 9. Elderly residents of 1-10 BMC’s Housing Community 6. On-site housing support services staff the Smith House, Advisory Committee comprised work with Waldeck residents. Madison Park of community organizations, 7. The co-created Community Life 2.0 with Development Boston Public Health The Community Builders supports the Corporation Commission and Massachusetts wellness needs and housing stability of 10. Boston residents at Department of Public Health New Franklin residents. risk of displacement, 8. Wellness programming support specifically targeting: Madison Park Village residents and families facing community members. eviction; immigrants (undocumented and refugee); People of

2 Boston Medical Center 2019-2022 Implementation Strategy 9. An onsite wellness advocate and RN Color; lesbian, gay, provide wellness and support services bisexual, transgender, tailored to elderly residents. and questioning 10. ISHI engages the community in youth; Black men who addressing housing issues and facilitates are single or a single family and resident led grantmaking parent; seniors; and through three funding streams centered persons with a on housing stabilization: flex fund for criminal offender resources to individuals and families to record; and maintain or attain housing; upstream neighborhoods that fund supporting policy and systems are particularly most change efforts; and resident-led fund at risk for democratizing the grantmaking process displacement: East and addressing root causes of housing Boston, Mattapan, instability. North Dorchester, and Roxbury

MENTAL HEALTH AND Mental Health: Mental Health: Mental Health: Mental Health: SUBSTANCE USE 1. TEAM UP 1. TEAM UP builds the capacity of three 1. Children with mental 1. Lowell Community Health Center, (Transforming and local community health centers to illness and their Dimock Community Health Center, Expanding Access to deliver high quality, timely, evidence- clinicians Codman Square Health Center Mental Health Care based integrated behavioral health care 2. Adults, youth and BMC: Child and Adult Psychiatry In Urban Pediatrics): to children and families. children with mental 2. Mental Health Court Criminal The Child Mental 2. BEST provides a 24-hour comprehensive illness who are Justice Diversion Program at Health Initiative and integrated system of crisis experiencing a mental Boston Municipal Court 2. Boston Emergency evaluation, intervention, and treatment. health related crisis Department’s Central Division Services Team (BEST) Substance Use: Substance Use: West Roxbury and Roxbury Substance Use: 1. CATALYST utilizes a developmentally- 1. Youth/teens with sessions BMC: Adult Psychiatry 1. Center for Addiction appropriate Office-Based Addiction substance use Substance Use: Treatment for Treatment model for youth. disorders 1. Stanley Street Treatment and AdoLescent/Young 2. Project RESPECT focuses on the 2. Pregnant women with Resources, Manet Community adults who use treatment of substance use disorders in substance use Health Center, DotHouse Health, SubsTances pregnancy by combining obstetric, disorders CareZone, Bridge Over Troubled (CATALYST) substance use recovery services, peer 3. Individuals with Waters 2. Project RESPECT support, and behavioral health within a substance use 2. Boston Public Health Commission, (Recovery, specialized prenatal clinic. disorders Institute for Health and Recovery, Empowerment, 3. Faster Paths rapidly evaluates, 4. Individuals with Casa Esperanza Social Services, motivates, and refers patients with substance use 3. Boston Public Health Commission Prenatal care, substance use disorders to a disorders in the 4. Casa Esperanza, Dimock, Hope Education, comprehensive care network of Emergency House, Boston Public Health inpatient and outpatient detoxification, Department Commission

3 Boston Medical Center 2019-2022 Implementation Strategy Community and treatment, and aftercare services 5. Families affected by 5. Parenting Journey Treatment) integrated with mental health and substance use 1-5 BMC: Grayken Center for Addiction 3. Faster Paths medical care. disorder, including Medicine, General Internal Medicine, 4. Project ASSERT 4. Project ASSERT provides greater access substance exposed Pediatrics, Pediatric and Adult (Alcohol & Substance to substance use treatment in the children and parents Psychiatry, OBGYN, Emergency Abuse Services, Emergency Department setting and who use substances Medicine Education, and includes a variety of social and Referral to community health support services. Treatment) 5. SOFAR clinic is a comprehensive 5. SOFAR (Supporting outpatient program for families Our Families through impacted by substance use disorders. Addiction and Recovery) ACCESSING SERVICES 1. Birth Sisters and 1. Birth Sisters, women who are trained to 1. Childbearing women 1. BMC: OBGYN Centering Pregnancy provide social support and education to at risk for poor 2. BMC: Department of Pediatrics, 2. Center for the Urban mothers from their own communities maternal and infant Center Family Advisory Board Child and Healthy during pregnancy, labor, and the outcomes 3. Massachusetts Department of Family postpartum period, help improve health 2. Children and their Public Health, Cradles to Crayons, 3. Grow Clinic outcomes of childbearing women at risk families Massachusetts Early Intervention 4. Immigrant Health for poor maternal and infant outcomes. 3. Children with failure BMC: Family Medicine, Emergency Center 2. Center for the Urban Child and Healthy to thrive Department, NICU, Food Pantry, 5. Pediatric Assessment Family revolutionizes the model of care 4. Immigrant and Children’s HealthWatch of Communication for pediatric patients and their families, refugee populations 4. Massachusetts Department of Clinic standing at the epicenter of clinical 5. Children with a variety Public Health, Irish International 6. Patient Navigation care, research, and the community. of developmental Immigration Center, Greater 7. Pediatric Pain Clinic 3. Grow Clinic is an outpatient issues including Boston Legal Services, Political 8. Transportation subspecialty clinic that provides developmental Asylum/Immigration Refugee Services (Uber comprehensive specialty medical, language delay, ADHD, Services, U.S. Office of Refugee Health) nutritional development, social services learning disabilities, Resettlement, United Nations, 9. Supporting Parents and dietary assistance to children. school failure, autism Physicians for Human Rights and Resilient Kids 4. The Immigrant and Refugee Health spectrum disorder, BMC: Integrated Behavioral Center (SPARK) Program provides comprehensive and anxiety disorder, Health, General Intenral Medicine, culturally appropriate, integrated behavioral problems Psychiatry, Social Work, OBGYN primary care services to immigrant and and more Refugee Women’s Health Group, refugee populations, including those 6. Oncology patients Infectious Diseases, Family seeking asylum, and promotes dignity, with one or more Medicine, Pediatrics, Pediatric social justice, and human rights. barriers to care Infectious Diseases, Emergency 5. Pediatric Assessment of 7. Children from infancy Medicine, Food Pantry, Interpreter Communication Clinic (Autism Program) to 22 with acute, Services offers specialized outreach, training and complex, and chronic 5. Boston Public Schools, Boston advocacy services, forms effective pain Special Education Parent Advisory

4 Boston Medical Center 2019-2022 Implementation Strategy partnerships with schools, collaborates 8. Patients with Council, TILL Autism Support with local support organizations and transportation Center, Family TIES of draws upon a deep knowledge base of insecurity Massachusetts, Special Education social service agencies to facilitate 9. Children with medical, Child Mass, Boston Disability Task linkages to resources. emotional, and Force, Massachusetts Autism 6. Patient Navigation provides advocacy behavioral challenges Commission, Massachusetts Early and case management to oncology Act State Team, Massachusetts patients who have at least one Advocates for Children B-SET identified barrier to care. Career Network, Tufts University 7. Pediatric Pain Clinic manages acute, Child Study & Human complex, and chronic pain in children Development, MIT Pricilla King 8. Uber Health brings patients to/from Gray Center, Harvard University BMC for appointments. Child Advocacy Strand, Boston 9. SPARK gives children skills needed to University Center for Autism succeed in school and develop Research Excellence productive and rewarding adult lives. 6. BMC: Hematology and Medical Oncology 7. Kids Kicking Cancer “Heroes Circle” program, UMass Worcester Mass College of Pharmacy and Health Sciences School of Acupuncture BMC: Departments of Pediatrics, Child Psychiatry, Physical Therapy, Integrative Medicine 8. BMC: Multiple departments 9. Massachusetts Department of Early Education and Care BMC: Pediatrics, Pediatric Infectious Diseases FINANCIAL SECURITY 1. StreetCred 1. StreetCred provides free tax- 1. low- to moderate- 1. Boston Tax Help Coalition, Boston AND ECONOMIC preparation services through well- income pediatric Health Care for the Homeless MOBILITY trained staff and volunteers who work families Program, South End Community with families to prepare their taxes and Health Center, Boston Children’s help them access the EITC and other Hospital tax-based programs. BMC: Pediatrics, Center for the Urban Child and Healthy Family VIOLENCE AND TRAUMA 1. Child Life Program 1. The CLP team helps children express 1. Children and families 1. BMC: Department of Pediatrics (CLP) their feelings through play in a safe and who are experiencing and Domestic Violence Program supportive environment; advocates for stress associated with children; offers support to effectively

5 Boston Medical Center 2019-2022 Implementation Strategy 2. Child Witness to work through pain management; offers hospitalization and 2. BMC: Departments of Pediatrics, Violence Project children developmentally appropriate illness Emergency Medicine and (CWVP) choices that increase feelings of 2. very young children Radiology 3. Community Violence independence, self-esteem, and trust; who have been 3. Cambridge Center for Homicide Response Team and assists with implementation of bystanders to Bereavement, Louis D. Brown (CVRT) coping techniques during stressful domestic or Peace Institute, Beth Israel’s 4. Domestic Violence situations. community violence Homicide Support Services Program (DVP) 2. The CWVP team provides short- and 3. victims of community Program, Suffolk County DA’s 5. Violence Intervention long-term evidence based mental health violence and their Office, Justice Resource Institute Advocacy Program counseling, outreach and consultation families, as well as SMART Team, Boston Police (VIAP) 3. culturally sensitive and family-focused family survivors of Department, Massachusetts Office clinical services provided by the CVRT homicide victims from of Victims Assistance, Serving include crisis intervention, advocacy, the Greater Boston Survivors of Homicide Victims case management, and trauma-focused area Providers Network. counseling for adults, adolescents, and 4. Community members BMC: VIAP, the Domestic Violence children (with a focus on age eight and and community Program, the Emergency over) groups; BMC Department, Trauma Surgery, and 4. DVP Safety and Support Advocates employees, patients, Child Witness to Violence Program provide victims and survivors with crisis staff and students 4. Boston Area Rape Crisis Center, intervention/counseling; risk community groups Jane Doe Inc., Casa Myrna assessment and safety planning; 5. Victims of violence Vazquez assistance with accessing protective and their families BMC: Emergency Department, orders and victim compensation; Family Medicine, Pediatrics, accompaniment to court, legal, medical, Community Violence Response housing and other appointments; Team, Child Witness to Violence referral to community-based DV Project advocacy/rape crisis counseling, 5. Boston Police Department, Boston medical/mental health services; Center for Youth and Families, emergency financial assistance; and Boston Public Health Commission, other support as needed; DVP staff Boston Public Schools, Youth provide training and education for staff, Connect, Lois D. Brown Peace students, and community groups for Institute, Mothers for Justice and those interested in learning more about Equality, the Roxbury Presbyterian domestic violence and the role we all Church/Social Impact Center, can play in addressing it. ROCA Boston, HiSet Programs, 5. A Violence Intervention Advocate helps Boston Housing Authority, victims of violence avoid future violence HomeStart, Safe and Successful and build a positive future by providing Youth Initiative case management, safety planning, BMC: Emergency Department, counseling, job and educational training Community Violence Response Team

6 Boston Medical Center 2019-2022 Implementation Strategy and connecting them to mental health and family support services. FOOD INSECURITY 1. Rooftop Farm 1. The Rooftop Farm provides patients 1. BMC patients who 1. Recover Green Roofs, Higher 2. Preventive Food with fresh produce grown on the BMC have limited access to Ground Farm Pantry rooftop farm, the largest in Boston. fresh produce BMC: Support Services, 3. Teaching Kitchen 2. The Preventive Food Pantry addresses 2. BMC patients who Preventative Food Pantry, nutrition-related illness and under- have hunger-related Teaching Kitchen, General Internal nutrition for low-income patients by illness or malnutrition Medicine, Family Medicine providing them prescriptions for and their families 2. Greater Boston Food Bank, Ocean supplemental foods that best promote 3. BMC patients who State Job Lot, Lovin’ Spoonfuls, physical health. require special diets Whole Foods 3. The Teaching Kitchen offers free that support their BMC: multiple BMC departments cooking classes to promote a healthier health refer patients lifestyle and better manage health. 3. Greater Boston Food Bank, Ocean State Job Lot, Lovin’ Spoonfuls, Whole Foods BMC: Multiple BMC departments refer patients

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