Community Health Care Report

Community Health Care Report

Healthcare Alternative Systems
Marco E. Jacome
2755 W. Armitage Avenue
Chicago, IL 60647
773-634-3041 Direct Line
773-252-3100 Main
mjacome@hascares.org

Mission: Healthcare Alternative Systems (HAS) provides a continuum of multicultural and bilingual (English/Spanish) behavioral care and social services that empower individuals, families and communities.

1. Identify the high risk/underserved and/or disadvantaged populations in the community(ies) that you serve and describe specifically the actions you have taken, based on relevant assessment data, to increase their accessibility to health services.

HAS currently serves over 10,000 high risk, underserved, and disadvantaged individuals directly and approximately 20,000 indirectly at eight locations and two hospital co-locations in primarily low-income minority Chicago communities, such as Humboldt Park, Roseland, and Englewood. Ninety-five percent of HAS participants are low income, have no health insurance, are Latino or African American, and earn under $10,000 annually. Many have no income at all, and many are undocumented and thus are ineligible for expanded Medicaid eligibility that has resulted from the Affordable Care Act. The majority of HAS participants are male and has been incarcerated at least once. Approximately 70 percent of male and female program participants suffer from the co-occurring disorders of mental health issues and substance abuse.

These basic demographics have not changed much since HAS was organized in 1974 by two recovering alcoholics to increase this disadvantaged population’s access to health care in the form of substance abuse recovery treatment. Since its inception, HAS has been providing culturally competent, bilingual behavioral health services with a core programming of substance abuse treatment. Over the past 40 years, the agency has grown to serve other disadvantaged populations, such as low-income African Americans who do not need the Spanish language services but do need free or low cost care.

HAS services now encompass a full menu of culturally competent social services, medication assisted treatment (methadone clinic), postpartum depression (the first community-based program of its kind in Illinois), domestic violence services, mental health services, HIV/AIDS testing and counseling, reentry for youth and adults, transitional housing, a residential program, and specialized projects. The recent addition of youth violence prevention programming was designed in response to the growing problems of youth violence, incarceration, and reentry in Chicago’s low-income communities. HAS treats each community and target population as unique and shapes its social service programs through stakeholder input.

In addition to increasing access to health services for disadvantaged populations, HAS has identified and implements opportunities to increase assets of the high risk, underserved, and disadvantaged communities it serves by employing community members as staff in treatment and counseling programs, locating 10 service sites in low-income communities in need, and negotiating purchasing contracts with local businesses for health service-related products, cleaning services, carpeting and flooring, catering, and other products and services needed to operate the organization.

2. Describe specifically the strategies you have used to gather input from high risk, underserved and/or disadvantaged population and their leaders as a basis for program or service development.

HAS was founded by members of the high risk, underserved population that it now serves, on the premise that service recipients must be active in the design and delivery of any successful program. This began in 1972, when two recovering alcoholics in Chicago’s Humboldt Park neighborhood experienced the dearth of substance abuse treatment resources available to their Spanish-speaking neighbors and decided to do something about it. Since HAS’s subsequent inception in 1974, HAS has continued to engage consumers in addressing some of the city’s most crushing health disparities.

Engagement of the disadvantaged target population goes well beyond gathering input; the HAS board of directors includes community leaders and its by-laws require it always has at least one previous service recipient serving as a voting member. HAS leadership has close collaborative relationships with community, faith-based, and other nonprofit leaders. In addition, many frontline program staff are in recovery themselves, contributing to program design and implementation and bringing a peer perspective to their work with participants. Many new programs develop out of a need that becomes apparent through informal and formal feedback from current service recipients, along with community assessment data and the changing demographics of the communities HAS serves.

HAS learns about the health care needs of the communities it serves through ongoing communication with local leadership at other community-based organizations and health care providers, and from elected officials and media reports. HAS also employs a staff Clinical Researcher and Quality Assurance Manager who design surveys and evaluations, collect and analyze direct participant feedback data, and advise on new programs and program design based on data collected and the latest research in the field.

While HAS provides a wide variety of services, it upholds a high standard of care across all programmatic offerings, maintained by applying a formal Continuous Quality Improvement Program (CQIP) to all programs. This ensures programs are defined by community need and response to treatment through formal procedures for gathering input from populations served. This QIP process includes:

• Participant Satisfaction Surveys. Participants are frequently canvassed to assess their satisfaction with HAS services. Based on their feedback, HAS then modifies programs to better suit their needs.

• Outcome Studies. HAS understands that long-term outcomes are the best indicator of a program’s success and so follows up with former participants and consistently participates in outcome studies to measure the effectiveness of treatments.

• Performance Standards. HAS regularly monitors its treatment standards against national and local benchmarks to ensure that HAS programs meet or exceed them.

• Clinical Oversight. Each counselor’s caseload is closely supervised by his or her program supervisor or manager. In addition to individual clinical supervision, HAS’s clinical team of medical personnel, support specialists, and program managers reviews the progress of each client at frequent clinical staff meetings.

• Effective Treatment Planning. HAS drives successful outcomes and ensures cost-effectiveness by carefully evaluating new participants at intake and addressing their needs with the least-restrictive level of appropriate care.

The CQIP allows HAS to engage service recipients in monitoring the quality of services, identifying where changes need to be made, and assessing those changes to ensure that services have improved.

3. Describe specific partnerships with other providers and community-based organizations to promote continuity of health care for high risk/underserved and/or disadvantaged populations.

HAS partners with and maintains formal linkage agreements with more than 125 other providers and community-based organizations to promote continuity of health care and access to supportive services for high risk, underserved, and disadvantaged individuals. Partnering clinics and primary health care providers that make referrals to and accept them from HAS include Alivio Medical Center, DuPage Community Clinic, Erie Family Health Center, Elmhurst Memorial Healthcare, Linden Oaks Hospital, Michael Reese Hospital, and Norwegian American Hospital. Participants who need more extensive mental health services, beyond HAS treatment, may be referred to Gateway Foundation, New Age Services Corporation, Association House of Chicago, Haymarket Center, Loretto Hospital Addiction Center, TASC, or others. Key partners that provide assistance to victims of domestic violence include Chicago Metropolitan Battered Women’s Network, Community Counseling Centers of Chicago, Erie Family Health Center, Family Focus, La Casa Norte, Metropolitan Family Services, and Mujeres Latinas en Acción. Participants in need of HIV/AIDS-related services may be connected to the AIDS Foundation of Chicago, or CCHHS/Core Center. Those in need of housing are referred to A Safe Haven, Association House of Chicago, La Casa Norte, or the Center for Changing Lives. HAS also partners with local child care providers, educational institutions, youth service providers, and others.

4. Provide two examples of how you have used the community-oriented approach to program development specified in the attached principles to develop a program of service for high risk/underserved and/or disadvantaged populations specified in the guidelines.

All HAS programs are identified and designed using a community-oriented approach consistent with the Principles for Community Health Care developed by Chicago area foundations and health care providers so HAS may best serve the needs of high risk, underserved, and disadvantaged populations. Two examples are Substance Abuse Outpatient and Intensive Outpatient programming, and the Postpartum Depression treatment program.

HAS Substance Abuse Treatment programming – Outpatient and Intensive Outpatient – is at the core of the HAS mission and the first program offered by HAS at its founding in the early 1970s. This program embodies the model of a community-oriented approach to program development. This program was initially designed by two recovering alcoholics who saw the need for culturally competent recovery services tailored to their own Latino community. They formed Spanish-language programming and founded HAS. Over the years, HAS programs have evolved to meet the changing needs of the population HAS serves. In early years, HAS listened and responded to participant needs as expressed in groups and counseling. In more recent years, HAS has applied its formal Continuous Quality Improvement Plan to refine and expand programming based on results of surveys, assessments, extensive post-discharge tracking, and the latest thinking in the field.

Today, HAS is Chicago’s major provider of Spanish-language behavioral health care. Substance Abuse Treatment remains a core service at HAS. Outpatient and Intensive Outpatient treatment services are designed for adults who have developed symptoms of dependency or abuse, are medically stable, and do not need detoxification or residential services. During treatment, participants work closely with staff to create their own individualized recovery plan; to learn about the disease process of dependency; to understand and accept their own chemical dependence; and to explore healthy lifestyles. Group, individual, and family counseling are incorporated based on an individual’s treatment plan. Counselors integrate proven and effective evidence-based treatment approaches such as Motivational Interviewing techniques, Cognitive Behavioral Therapy, and 12-Step Facilitation. Substance Abuse Treatment is participant-centered, bilingual, culturally competent, and gender specific. HAS offers all services on a sliding fee scale; no one is ever turned away due to inability to pay.

HAS Outpatient and Intensive Outpatient serves 6,800 participants (clients) per year at five locations with an annual program budget of $5,517,558, which is 69% of HAS’s annual budget. Of these funds, 11 percent comes from reimbursement by third party payers and 85 percent from public grants/contracts.

HAS’s Postpartum Depression treatment program (PPD) is another example of a program HAS developed using a community-oriented approach and HAS’s Continuous Quality Improvement Plan. In the late 1990s, HAS was providing programming to address high infant mortality rates in Chicago’s Humboldt Park community. Through extended contact with new mothers, HAS case managers became acutely aware of the problem of postpartum depression, especially among the vulnerable HAS target population – women who do not speak English, cannot afford to pay for care, and are often undocumented. Because HAS has a niche within the Latino community and provides all of its services in both English and Spanish, HAS is able to provide treatment services to this traditionally marginalized segment of the community. These women would otherwise fall through the cracks of the community treatment and support infrastructure. At HAS, no woman is ever turned away because of her immigration status, limited English language skills, or an inability to pay for services.

HAS applied its Continuous Quality Improvement Plan to understanding this issue better and developed programming that was first funded in 2004 for two Humboldt Park locations. The suburban Westchester site was added in 2013, in response to a specific request by the Jennifer Mudd Houghtaling Postpartum Depression Foundation. This Foundation was established in memory of Jennifer Mudd Houghtaling, a young Westchester mother who committed suicide as result of untreated postpartum depression.

HAS’s PPD is the only community-based PPD program in the entire state of Illinois. Serving 1,425 women annually at three different locations, this model program provides clinical assessments, individual and family based psychotherapy, support group treatment, psychiatric evaluations, medication monitoring, health education, and case management services to pregnant and postpartum women experiencing or at risk for developing postpartum depression.

In addition to prevalence of depression and anxiety within the postpartum population, approximately 10 to 15 percent of all women will experience depression or anxiety during pregnancy. In response, HAS decided that, in order for the PPD to be as comprehensive and as effective as possible, it would be critical to provide services to both women suffering from mood disorders during the entire perinatal period, as well as the post-partum period.

HAS also provides educational workshops/in-service trainings on postpartum depression for case managers, social workers, counselors, nurses, midwives, and other health and mental health professionals seeking to better understand and screen for this and other perinatal mood disorders. All services are provided in English and Spanish and are completely confidential. HAS’s PPD program receives referrals from a wide variety of health care professionals including OB/GYNs, nurses, pediatricians, midwives, social workers, etc., and it maintains partnerships with numerous hospitals, outpatient clinics, community health centers, and social service organizations.

The total amount budgeted by HAS for the program is $445,439, which is 5 percent of the total agency budget. Two percent of the program budget is directly reimbursed by third party payers, 73 percent comes from public grants/contracts, and 25 percent from private grants.