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When the Community is the Patient: Prevention Work in our
Neighborhoods
Jennifer Kelly
Sarah Coughlin
Sylvia Chiang
2007: MGH Changes Mission Statement
Guided by the needs of our patients and
their families, we deliver the very best
health care in a safe, compassionate
environment, we advance that care through
innovative research and education, and we improve the health and well-being of the diverse communities we serve.
Households living below poverty level Limited English Proficiency, Hispanic population
We Serve the Most Vulnerable Communities
20%
30%40%
10%
PhysicalEnvironment
Air & Water QualityHousing & Transit
Clinical Care
Access to CareQuality of Care
Socioeconomic FactorsEducation
EmploymentIncome
Family & Social SupportCommunity Safety
Health BehaviorsTobacco Use
Diet & ExerciseAlcohol & Drug Use
Sexual Activity
Source: adaptation from County Health Rankings model @ 2014 UWPHI, http://countyhealthrankings.org/our-approach
Social Determinants Account for 80% of Health Status
• Enhance access to care and resiliency for vulnerable patients and community members through community health workers, navigators, coaches, etc.
• Promote educational attainment for youth through STEM and prevention of high risk behaviors
• Function as “backbone” organization to 4 multi-sector coalitions working on policy, system and environmental change
CCHI Approaches:Addressing Social Determinants at Three Levels
Individual
Identified Populations
Community -wide
12.2
3.3 5
40.8
74.9
7.24.6
10.6
4.6
22.1
33.1
8.4
31.9
2.3
0
5
10
15
20
25
30
35
40
45
50
BOSTON
Alls
ton/Brig
hton
Bac
k Bay
Cha
rlestow
n
Eas
t Bos
ton
Hyd
e Park
Jamaica
Plain
Mattta
pan
North D
orch
ester
Ros
linda
le
Rox
bury
Sou
th B
oston
Sou
th D
orch
ester
Sou
th E
nd
Wes
t Rox
bury
Ca
lls p
er
10
,00
0 P
op
ula
tio
n
EMS Heroin Overdose Calls by Boston Neighborhood, 2003
Why Coalitions Were Formed
41.453.3
153.4
28.137.6
141.5
113.6
16.9
38.9
0.0
25.0
50.0
75.0
100.0
125.0
150.0
175.0
200.0
Heart Disease Diabetes Stroke
Mortality Indicator
2004-2006 Vital Records
Age
-Ad
just
ed R
ate
per
100
,000
ind
ivid
ual
s
Chelsea
Revere
Massachusetts
0%
20%
40%
60%
80%
100%
1997 1999 2001 2003 2005 2007 2009 2011 2013Revere Mass.
Drank Alcohol in Past 30 Days Revere High School YRBS 1997-2013
• Foundational model & framework for coalitions• SPF• 12 sectors• 7 strategies for community
change• Specific outcome measures
• Helps build coalition capacity
• Technical assistance/ networking
• Partnership
Drug Free Community Support
Coalition Foundation
Staff:
• 1 MGH staff – Coalition Director
• 1 DFC funded staff
• 2 DON funded staff (from CHNA)
Community Involvement & Organization:
• 75 active participants representing 12 sectors of the community focused on 5 bodies of work:
1. Policy, Environmental and Systems Changes
2. Navigation to treatment/overdose prevention
3. Primary Prevention
4. Access to Care for youth and their families / Family Support Circle
5. Trauma Informed Care
DFC: Prevention
24.8%
Philanthropy: Social
Marketing4.0%
CCHI: Coalition Operations
43.1%
DoN: Access & Navigation
28.1%
Funding Sources & Uses
CCHI’s Coalition Structure
Backbone Support
Guide
Vision
&
Strategy
Support Aligned
Activities
Advance Policy
Build
Public
Will
Establish Shared Measurement
Practice
MobilizeFunding
Backbone Functions for Coalitions
Prevention & Harm Reduction• Alternative Activities & Skill Building: Youth
Groups, Parent Coffees
• Education & Social marketing
• Evidence-based curriculum: Botvin LifeSkills
• Policy/system changes: School drug policy and legislative advocacy
• Decrease access: Prescription Take Back Days; Sticker Shock Campaigns
• Overdose Reversal: Narcan distribution
• Navigation/access to treatment: Recovery Coaches / Drug Courts
• Decrease stigma: Community events / vigils
Strategies To Prevent Substance Use
Effective Prevention
INCREASING PROTECTIVE FACTORS
DECREASING RISK FACTORS
Turn It Aroundwww.facebook.com/turnitaroundcharlestown
• Social Marketing Campaigns• Increasing positive perception
of youth• Value of youth voice • Increase protective factors at
individual and community levels
Increasing Youth Protective Factors
Youth as teaching tools
Decreasing Access
• Annual Prescription Take Back Days• Sticker Shock Campaigns • Community Champion Role at SUDS
rounds
Addressing Trauma • Provide education, resources and
support to natural community leaders
• Community Trauma Response team• Creative Community Projects• Connection to City Wide Efforts• Psychological First Aid Trainings• Stop The Bleed
Combating Stigma
• Voices Of Recovery• Educational Workshops• Use of Language • Overdose Vigils
Policy/System Change
Pride and Connection to Community
• Organize pro-social community events
• Convener of key stakeholders• Monthly Newsletters• Community Wide Website• Social Media Connection
Community Health @ MGH
It’s not about the goldfish.
It’s about the water.
~Howard Koh’s Friend
Thank you!
Sarah CoughlinCharlestown Coalition
Jen KellyHealthy Chelsea617-887-4219
Sylvia ChiangRevere CARES781-485-6161
