Funded Projects

Problem:

The south and central Bronx are comprised of predominantly non-white racial and ethnic groups many of whom are foreign born and non-English speaking. Many are undocumented and therefore fearful of becoming known to the healthcare system. The community is young, with more than a quarter younger than 17. One third of families lives in poverty. The 15th Congressional District, which represents this community, is the poorest in the nation. The population has a high rate of dependence on public assistance, including Medicaid, with about 14% having no health coverage at all. The south and central Bronx have also been designated by HRSA as Health Professional Shortage and Medically Underserved Areas with a population experiencing high poverty, limited education and high unemployment. These factors have resulted in the Bronx receiving a ranking of #62 (that is, last) in a Robert Wood Johnson ranking of health by county in New York State. Families are further impacted by histories of trauma related to immigration, violence and other factors. Children in this community may not receive needed health and social services due to family reluctance to access care or providers' lack of awareness about the effect of trauma and social determinant of health on their young patients.

Goals and Objectives:

Following are the program's goals: 1) To improve access to health care and preventive health services for infants, children, youth and families residing in the South and Central Bronx; 2) To utilize the Social Determinants of Health (SDH) and the Adverse Childhood Experiences (ACE) questionnaire to identify those areas that may impact the ability of children, youth and families to achieve optimum health and to refer them for resources and interventions to address these gaps; 3) To educate community partners and other community based organizations regarding the importance of SDH and childhood trauma and how to conduct related evaluations; 4) To include the SDH and ACE in the pediatric residency training curriculum and to assist residents and attending pediatricians to apply these concepts including use of the EMR; 5) To create and distribute a training/operations manual covering the understanding and implementation of SDH and ACE screening for use in community based agencies and at BronxCare; 6) To disseminate findings regarding the impact of patient screening, patient education, patient referral, education to communicate based agencies and to continue collaboration with these partners to assure ongoing ease of mutual referrals and follow-up. Method: Activities to achieve project goals are 1) Screening patients and families in BronxCare Pediatric clinic sites pertaining to the SDH and ACE. Findings will direct referrals to appropriate concrete, supportive and mental health services. Screening tools and follow-up procedures will be shared with other community-based programs to allow them to also screen their client base and refer for assistance; 2) Training community partners and other community-based organizations on the importance of SDH and ACE Study results on health outcomes. leading to more efficient mechanisms for mutual referrals and follow-up; 3) Creating a referral network of medical facilities, social services agencies and other community organizations to streamline referral mechanisms and lead to quicker assistance for clients; 4) Adding the SDH and ACE to the BronxCare pediatric residency training curriculum, including screening tools in the EMR.

Coordination:

The project will have two boards: 1) The Project Advisory Board will consist of the Project Director, other BronxCare personnel, and representatives of project partners, i.e. New Settlement Apartments, BronxWorks, Lehman College, daycare centers, Include NYC, and Health First. New members may join throughout the project. Two representatives of the Community Advisory Board will also join; 2) The Community Advisory Board (CAB) will be comprised of patients/ families of BronxCare Pediatric clinics, including Pediatric Infectious Disease, Sickle Cell Transition Program, and other primary care and specialty clinics. Partner agencies will be asked to recommend representatives as well.

Evaluation:

Process-based evaluation includes number of SDH and ACE screenings done at BronxCare clinics, residents/ attending physicians trained, community-based agencies/staff members trained, advisory meetings and attendees, and referrals made between partners. Outcome measures are completion of a training manual and a resource manual, ongoing inclusion of SDH and ACE training in the residency curriculum, ongoing training at community agencies, training evaluations by participants, patient satisfaction surveys and implementation of a referral system between partners.