Grant Partners

East Boston Neighborhood Health Center will target uninsured patients prior to their next scheduled appointment and provide enrollment assistance.  To address churn, it will utilize its electronic medical record to identify individuals whose coverage is about to lapse, and refer them to follow-up assistance. It will develop a health insurance education module that includes low-literacy multilingual materials and a workshop curriculum that helps patients navigate the system.  Ten health insurance literacy information sessions will be held each year. 

Way Finders, Inc. is a community development organization and the largest nonprofit housing provider in Western Massachusetts.  In partnership with Behavioral Health Network (BHN) and Mercy Medical Center (Mercy), the team will provide a consistent Family Care Coordinator who will anchor, coordinate and oversee the clients’ progress from the moment they enter shelter until one year past the attainment of secure, permanent housing.  They will address barriers that lead to housing instability and poor health outcomes, connecting with BHN for behavioral health services and Mercy for medical care, all the while navigating social service systems and providing wraparound services like employment support, financial education, access to nutritious food, and afterschool programs.  The planning phase of this initiative will develop a case management approach that could expand coordinated or joint services to all families in the shelter portfolio. 

To redesign organization’s website, making it more user friendly and accessible to those with visual impairment and literacy issues.

Police Assisted Addiction and Recovery Initiative will strengthen its peer recovery coach and referral program with the Boston Police Department and expand weekly multi-agency collaborations that help identify the highest risk individuals in Boston communities. 

Lahey Health Behavioral Services (LHBS) Emergency Services Program provides rapid assessment and immediate stabilization services to people in need in the greater Lowell area. The grant will help to enhance their urgent care clinic by introducing telemedicine for real-time psychiatric prescribing, using community health workers to assist clients following an emergent or urgent evaluation, and developing an integrated HER to improve crisis treatment and follow-up planning.

Community Action Committee of Cape Cod & Islands will participate in outreach activities in Cape Cod and Nantucket; utilize local and social media to inform clients of updated information on MassHealth and Connector plans; outreach to unemployed populations through a partnership with Career Opportunities Center and to immigrant communities through the Immigration Resource Center; use plain language tools developed for multilingual audiences; and coordinate with Volunteer Income Tax Assistance tax sites in sharing materials with clients as they receive tax preparation assistance.

To purchase an electrocardiography (EKG) machine and cart for the Behavioral Health department.

Health Law Advocates (HLA) will focus on improving health care access for vulnerable populations by providing direct legal services and advocating to state policymakers. Their direct legal service work will inform community outreach efforts, education programs, policy analyses, and legislative proposals. In their advocacy work, HLA will pay particular attention to children with disabilities, immigrants, and transgender individuals, and to issues related to behavioral health care access. Additionally, they will defend MassHealth members against federal Medicaid changes and ensure access to services for ACO-enrolled MassHealth members.

The Massachusetts Organization for Addiction Recovery (MOAR) will work to reduce stigma against addiction and to increase behavioral health care access and integration. Their efforts will center on increasing access to timely treatment to reduce overdose risk, as well as access to long-term treatment; advocating on behalf of populations disproportionately affected by addiction; and integrating peer support services into mainstream care. MOAR will conduct community organizing and outreach, participate in coalitions, and expand peer-oriented educational programs.

University of Massachusetts Medical School Center for Integrated Primary Care will develop an engagement and education curriculum for patients with opioid use disorder (OUD) and their families. The curriculum, which will be available online and through smartphone devices, will aim to provide information about OUD treatment options and promote better primary care.

To purchase nutrition and menu planning software for use by newly hired Dietician.

Boston Public Health Commission will maintain referral systems with community partners; host enrollment sessions throughout the city with a focus on the East Boston and Dorchester communities; leverage social media and local cable access; scale up flyering in census tracts with the highest rates of uninsured, with an emphasis on local businesses and community organization; and develop a multilingual plain language form that outlines when and how a consumer needs to update the state with pertinent information to maintain coverage.                                                                                          

With support from the Foundation, EBNHC will focus on expanding behavioral health services for children and adolescents (ages 5 to 21) who are seen in Pediatrics, Family Medicine and the health center’s School-Based Health Center.  In 2014, the Pediatric and Family Medicine Departments served a total of 15,498 patients up to age 21, and the number of child and adolescent patients served continues to increase.  EBNHC's two newly hired child/adolescent psychiatrists will be able to fully treat and manage, and track and measure, the care of children and adolescents with mild to moderately severe depression and anxiety disorder, and integrate this care with a range of medical conditions.  EBNHC has historically only been able to refer pediatric patients with behavioral health issues to community providers where there are challenges associated with long wait times due to psychiatric provider shortages, as well as geographic and linguistic barriers.  Expanding on-site psychiatric capacity also will help to facilitate care planning for patients following psychiatric hospital discharge.

To upgrade to a new phone system.

Since 2012, Lahey Health Division of Primary Care and Lahey Health Behavioral Services have collaborated to embed behavioral health clinicians in five community primary care practices, sharing medical records, and using the Collaborative Care Model (CCM), a team decision-making model of care.  Through this grant, Lahey Health Behavioral Services proposes a multi-faceted, multi-site expansion of its integrated CCM approach, by adding two community primary care practices (Gloucester and Beverly); introducing CCM in one Lahey Health System obstetrics practice; establishing CCM in one Lahey Health System pediatrics practice; piloting reverse integration at the Lahey Health Behavioral Services community mental health center in Salem; and expanding screenings of primary care patients across all of these sites to identify higher-risk patients and track outcomes.  Lahey Health Behavioral Services will also use tele-psychiatry to enable consulting psychiatrists to serve more patients, particularly for more rural, isolated sites, such as Gloucester, where there is a lack of access to specialty services.