Over the last few decades, there has been an increasing focus on health care reform and bending the cost curve through a combination of new approaches including social determinants of health, trauma-informed treatment, health equity, patient engagement and integrated care. While these elements have clearly found a place in the literature, few attempts to comprehensively address these issues have had significant impact. One program in East New York may soon change all of that and in an unprecedented way.
On Monday, September 24th, the ICL East New York Health Hub opened its doors. This milestone was the culmination of years of planning to bring a wide range of health and behavioral health services under one roof in a way that would be much more than co-locating programs or offer opportunities for sound referrals.
For ICL, this carefully designed, light-filled 45,000 square-foot space was the realization of a long-held dream. And we chose an equally committed and enthusiastic organization – Community Healthcare Network—as our primary healthcare partner.
As the Hub officially opens, we are confident its success will bear out our long-held belief that you cannot separate health from mental health care nor from the social determinants of health. The Hub instead offers a unified model of care to address health and behavioral health and the larger social and economic factors that we know lead to significant health problems and disparities.
Whatever “door” a person enters at the Hub – a medical appointment for a chronic sore throat or a monthly appointment with their therapist for depression – our goal is for that person to leave with what they need from a whole health perspective. The person in therapy might reveal a lethargy from not eating nutritious foods and leave with a bag of fresh vegetables from a local community garden (and Hub partner) or the person seeing their primary care doctor leaves with an appointment at the ICL mental health clinic to explore the still numbing grief they feel after losing a child to violence that may be making them sick.
The plan for the Hub is profoundly different than a simple co-location of services. ICL and CHN are firmly committed to a shared sense of responsibility for everyone who walks through its doors. The Hub offers a reimagining of what a neighborhood health center can and should be.
Throughout its 31-year history, ICL has been committed to serving New York City’s most vulnerable populations. At the core of our 110 programs throughout New York City – counseling, clinics and community and residential support – is a commitment to treating clients with respect for their experiences and engaging them on their terms.
I am proud that ICL was among the first behavioral health agencies to build into mental health treatment planning a specific, targeted consideration of health issues to help clients address their physical and mental health concerns. Thanks to a generous, multi-year SAMHSA grant in 2011, ICL instituted a Healthy Living initiative with a survey of all clients taken at six-month intervals to assess how individuals were doing – were they in fact getting better with us. Each year since starting the survey the answer has been a resounding yes. Over the past three years some 98% have said they feel more in control of their lives and connected to community as a result of their involvement with ICL services.
In 2017, SAMHSA chose ICL from around the entire country as one of only three organizations to receive its Pathways to Wellness award for impacting people with chronic health conditions. The principles guiding the Hub reflect SAMHSA’s contention that the integration of mental health, substance abuse, and primary care services is the most effective approach for people with multiple healthcare needs and that care coordination across providers and disciplines increases efficiency and improves outcomes and satisfaction with care.
Other national policy groups support this shift to a whole health approach. A 2016 report by the Robert Wood Johnson Foundation contended that to promote a culture of health requires “health providers to fully understand the social determinants of health and take these determinants into account in its treatment of patients including collaborating with social services and other systems to provide necessary services outside the purview of the health care system.” RWJF defined the social determinants of health as “factors such as where we live, how much money we have, our education level, and the problems we struggle with that have been clearly linked to our well-being, the quality of our lives, our health, and how long we live.” Research by the Kaiser Family Foundation shows that social determinants of health account for at least 60% of a person’s health.
The problems inherent in a siloed system were underscored in a 2016 report by the Eugene S. Farley Health Policy Center, “Creating a Culture of Whole Health; Recommendations for Integrating Behavioral Health and Primary Care.” Researchers attributed the “fragmentation in healthcare delivery” to “the artificial separation of ‘mental’ health from ‘physical’ health that “almost always comes back to a need for intentional integration at all levels to achieve a foundation for better health.” They argued that “primary care cannot be practiced without addressing mental health concerns, and all attempts to do so result in inferior care.” The research showed that where integrated care was introduced, “it appears to improve health and healthcare and contain costs.”
A Continuing Commitment to Integrated Care
Through more than 30 years working in distressed communities, ICL had come to understand that changing health outcomes is not just about improving medical services or “better doctoring” but a fully ecological approach.
So, guided by the research and our own client outcomes, ICL went to work to develop a physical center – a place where community residents could come to have the complexity of their needs better met. We knew it would not be an easy road but were determined to overcome the bureaucratic and financial hurdles. We felt compelled to do what we knew could significantly impact the lives of the people of East New York, one of the most distressed communities in New York City.
In addition to offering clinical and support services for adults living with mental illness and substance abuse, helping families is a major focus. The Hub will be home to ICL’s Family Resource Center (FRC), giving people access to this highly sought-after family support program; at the same time, FRC’s 500 families have the chance to get their medical care there. And with our understanding of the benefits of intervening early and effectively, we will offer wellness programs, access to healthy food, counseling, and job and housing programs.
Our plans for the Hub better prepare us to fulfill New York State’s five-year plan for Value-Based Payment to improve outcomes, reduce skyrocketing costs, and improve patient experience. The Hub could become a model for moving from fee-for-service to a whole health approach to comply with the state’s plan requiring 80% of Medicaid spending be in a Value-Based arrangement by 2020. We believe the Hub offers one of the most promising ways to help turn around an out-of-control system unprepared to meet basic health care needs, particularly for the high-need, high-cost populations we see every day in our programs.
In recent years we have come to better understand the country’s unsustainable healthcare costs and the need to address causes. One reality is that 5% of the US population spends 40% of health care monies, predominantly in disadvantaged communities like East New York.
The Hub is also in sync with state and city initiatives to combat poverty, violence and poor health in severely underserved and disadvantaged communities by creating a sustainable network of community resources to bring better health care to the people of East New York.
Joining Forces to Enhance Health
ICL was very deliberate in our choice of Community Healthcare Network (CHN) as our medical services partner in the Hub. An outstanding provider of primary and preventive healthcare for adults and children, CHN is a Federally Qualified Health Center (FQHC) with 15 sites throughout New York City and a highly respected leader in comprehensive community medical care for underserved New York City residents.
Early on, we knew this would be a very successful partnership. In talking about the Hub, Bob Hayes, CHN CEO, says that “it is inspiring to work with the ICL team. We share a common vision to bring the finest care to people in distressed communities long ignored by traditional service systems. Our integration of physical and mental health care will make a huge difference for the people of East New York. One day soon we will wonder why there were ever separate systems for health and behavioral healthcare.”
ICL and CHN met regularly prior to the move to explore how we could enhance communication and service delivery. An Altman Foundation grant is allowing us to create a manual of standard operating procedures culturally responsive to the health needs of Black/African American and Hispanic/Latino communities in East New York to be used by both organizations. A grant from the New York Community Trust further supports a shared service framework for a whole-person care approach to health and wellness.
Community at the Core
To make inroads into the seemingly intractable health disparities of the social determinants of health, research continually underscores the importance of patient engagement and patient activation. At ICL we apply these individual constructs to engaging the community as a whole.
From the start, we recognized the importance of working closely with local community organizations, service providers, churches, businesses and schools to offer the most effective services and reach communities of color.
We engaged two leading community development organizations – Local Initiative Support Corporation NYC (LISC NYC) and Hester Street Collaborative – to conduct a comprehensive planning study to identify unmet needs and make the Hub inclusive and inviting. Over a two-year period, virtually every group they met with expressed excitement; the Hub vision clearly resonated with local residents.
Cruz Fuksman, a community outreach worker who has lived in East New York her entire life and is a member of our East New York Health Advisory Council, made a comment at a focus group that has stayed with me. “I’ve lived in this community all my life and we’ve always talked about needing a place like the Hub. The only thing we were missing was ICL.” I took what she said as both a great honor and a profound responsibility. The Advisory Council, which Cruz is an active member of, continues to help us understand the structural and cultural barriers to health and well-being as well as service gaps and program needs.
The Council is helping ICL establish formal linkages with community-based organizations to allow the Hub to make available additional support related to conditions that can cause or exacerbate health concerns, like legal services, domestic violence support, or advising on entitlements and housing.
Central to our community engagement plan is collaborating with clergy. We’re working with faith-based communities and local ministers and religious leaders to address how we can help support church members and how clergy can help us be more responsive to the important role religion plays in the life of the community.
Since the start, the Hub project has been defined by dedication and collaboration. It’s a true team effort—from the funders and tax credit issuers who came up with the complex financing arrangements to the architects and designers who took up the challenge of creating the center that fulfilled our vision. And our committed and talented staff did the heavy lifting to get us to the finish line and continue to do the work of healing and supporting all those who come to us for help.
We are optimistic that the Hub will bring the people of East New York the improved access to care they deserve and better serve a community that has been highly underserved for generations. And it may well be a model that could be replicated around the city, the state and even the country.
Whatever “door” people enter at the Hub, we believe they will find the finest care and in the process experience a sense of improved possibilities for their future and the future of the community.
Come visit the East New York Health Hub and see for yourself how health and behavioral health care can live together – and help people flourish – under one roof.