Framework for Community Clinic Collaboration March

Transcript:Framework for Community Clinic Collaboration March:
Framework for Community Clinic Collaboration March 6, 2018 Prepared for: CCALAC Homeless Housing Committee 1 Agenda WPC-LA Overview Community Health Worker (CHW) – Care Management Model Framework for Collaboration Next Steps Questions and Feedback 2 Meeting Objectives Review WPC-LA’s fundamental understandings relevant to the primary care setting Increase understanding of WPC-LA’s CHW based care management model Discuss the framework for clinic engagement Review next steps for collaboration Discuss questions and feedback 3 WPC-LA Overview 4 WPC-LA Fundamental Understandings That 90% of health outcomes are impacted by something other than access to a clinician. “Social determinants have a significant impact on health outcomes. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care. Based on a meta-analysis of nearly 50 studies, researchers found that social factors, including education, racial segregation, social supports, and poverty accounted for over a third of total deaths in the United States in a year.” https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/ WPC-LA role with individual participants/patients is in providing support in trying to address some of these social determinants and supporting care coordination and system navigation We know that providing patients with non-medical support takes work, time and funding. 5 Vision, Mission, and Principles Vision: To ensure the most vulnerable individuals living in Los Angeles County have the resources and support they need to thrive Mission: Build an integrated health system that delivers seamless, coordinated services to the highest risk LA County residents Principles: Regional deployment with multiple entry points Care coordination during high-risk times in order to deliver seamless, coordinated care for each WPC-LA participant Address whole person needs through a participant-centered approach by optimizing participant engagement 6 WPC-LA Populations of focus Homeless Care Support Service Benefits Advocacy Recuperative Care Sobering Center Tenancy Support Services Re-entry Enhanced Care Coordination Community-based Re-entry Intensive Service Recipients Residential and Bridging Care Engagement, Navigation & Support Transitions of Care *Does not cover housing subsidy Kin Through Peer Juvenile Aftercare Mama’s Neighborhood Medical Legal Partnership Other Services 7 Community Health Worker (CHW) – Care Management Model 8 CHW’s are the primary change agents for WPC-LA What WPC-LA Community Health Workers bring to this work: Expertise from life experience Skills in variety of areas: health education, care planning, motivational interviewing, chronic disease self-management, and community