Connections4Health History & Future
Background & Vision
The social, environmental and financial factors that influence health are increasingly recognized for having a significant, and measurable, impact on mental and physical health status, access to health services and ability to practice a healthy lifestyle. Issues such as the difficulty with medication adherence because someone lacks enough food to take with pills, or treating asthma while a person lives in poor housing conditions exist outside of the exam room. Evidence suggests that addressing these “social determinants of health” in the clinical setting improves health status and helps reach health targets.
Connections4Health began as Birmingham Health Links (BHL), a social services help desk modeled after Health Leads, Inc that trains student volunteers to help patients address the broader social factors that influence health such as employment, food security and housing. BHL co-founders Jennifer Sloan and Mary Herbert recognized that addressing the challenges of access to quality health care and management of chronic disease begins with focusing on patients’ unmet basic needs, those things that have long since been considered outside the realm of direct medical care.
To this end, those involved with C4H today believe that to effectively improve access to health care and address chronic disease, providers must re-define what is encompassed in primary care delivery systems. Connections4Health is designed specifically to be financially accessible to clinics with fewer resources, and serves to educate both future medical professionals and current medical providers on addressing the social determinants of health -- while providing personnel to assist with this goal.
On our patients. Over a 6 month period, 23% of unique clinic patients used Connections4Health, most commonly seeking help with housing, employment and food assistance. A survey of patients found very high patient satisfaction with their C4H experience.
On our student volunteers. Student volunteers note significant personal and professional growth, a new understanding and appreciation for social determinants of health and a shift in their career path to include work with underserved populations as a result of this experience. One student noted:
“In school, they rarely teach you about things like welfare, healthcare, and self-sustenance. This program is a great opportunity to learn directly from the patients themselves, through the members of the clinic, and through the other fellows about how much of an impact a patient’s socioeconomic status has on their health.”
Over the first three years of the program, C4H had been entirely volunteer-run with in-kind time donated by the Birmingham’s Clinical Director, the C4H Director, and technology and administrative supplies donated by the Birmingham Clinic. Annually, student volunteers dedicate over 1,300 volunteer hours to the program, the program director logging 400 indirect service hours, and the BFC Clinical Director contributing 250.
Beginning in 2017, thank you to invaluable grant funding from the Hillman Family Foundation, Connections4Health will have it's first paid staff person. The C4H Director will be responsible for the overall planning, implementation and management of the program. This will also include developing an expansion plan to bring the program to four new locations over three years.
C4H received valuable support from the Allegheny County Health Department/Division of Maternal and Child Health in 2015, when they donated support for a build out of a new database system for Connections4Health, including two years of maintenance. This was vital support for the program, establishing a technological foundation that led to the ability to apply for and be awarded the Hillman Foundation grant.
Another integral aspect of the program's evolution has been the establishment of the program under the regional Area Health Education Center (AHEC) for long-term sustainability. This was a natural union given that the AHEC mission is to: (1) enhance access to quality health care for individuals living in underserved areas of Southwest Pennsylvania by recruiting and retaining primary care providers in these areas; and (2) educate and train emerging providers on issues impacting the care of these populations.
The scope and approach of C4H has also grown out of interviewing key partners in a variety of local health centers/FQHCs to get a sense of how they currently address the social determinants of their patients’ health; if a C4H program at their clinic would aid in providing comprehensive health care and furthering their mission, and thinking through a strategy to ensure this expanded program is effectively adopted to the needs of additional clinics. All clinics surveyed expressed interest in Connections4Health, and indicated that it aligned with their mission to serve the whole person. Most would be interested and able to pay some type of fee annually to support bringing C4H to their facility.
The city of Pittsburgh is replete with medical care, from free and community clinics, to tertiary care systems. However, the CDC estimates that medical care impacts only 25 percent of population health. In order to effectively address and meet those social determinants of health needs, C4H will be looking to develop collaborations to expand the program to other free clinics, CHCs, FQHCs and other location in our region. By the end of 2019, C4H will be connected with and operating in four total clinics or community health programs that address meeting the needs of the underserved.
Part of this expansion will also mean developing new relationships with other local universities. Currently C4H collaborates with the University of Pittsburgh to recruit and train the student volunteers, or Fellows. It's estimated that the program will need 45 Fellows by the end of 2019.