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Boston Children’s Collaboration for Community Health Reflecting on challenges and opportunities

orange and blue infographic for community health collaboration

 

On December 3, 2020, the Office of Community Health at Boston Children’s Hospital convened (virtually) the funded partners in the Collaboration for Community Health to connect and reflect on the past year. More than 135 participants joined in, representing 47 organizations, which have been funded through Boston Children’s Determination of Need/ Community Health Initiative.

The convening partner Health Resources in Action (HRiA) facilitated the program with an agenda focused on the impact of dual pandemics—COVID-19 and racial injustice—on community organizations and the children and families served over the past several months. It was also an opportunity for the funded partners to discuss their individual and collective work, identify opportunities for continued collaboration, and share resources and lessons learned.

Early in the day, participants were reminded of Boston Children’s community mission: To improve the health and well-being of children and families in the community. “That’s been our goal for more than 30 years,” noted Dr. Shari Nethersole, Executive Director for Community Health at Boston Children’s. Dr. Nethersole views the Collaboration for Community Health as an opportunity for the hospital to further its community mission by addressing the social determinants of health.

To date, more than half of the Collaboration for Community Health’s $53.4 million commitment has been awarded to various community-based organizations. Dr. Nethersole thanked the funded partners “for all your efforts to continue to serve children and families under these extraordinary circumstances. The fact that you’ve been able to do that offers us a lot of hope … we continue to learn from you and know that you are learning from one another too.”

Drew Koleros of Mathematica, the evaluation partner for the Collaboration, led a discussion of the Collaboration’s Theory of Change, a visual of how the funded partners’ activities contribute to improved health and well-being, which is “about being intentional regarding where we want to go [with our programs]. It’s about how we’re going to get there, and what are the steps on the pathway.”

“We are focused on the long-term impacts—healthy children and families as well as equitable communities,” Koleros added. This will be achieved through the projects funded within seven strategic funding areas in the Collaboration.

Boston Children’s goal for the funding is to bring change through policy advocacy and knowledge building, cross-sector coordination, and new programs and services. Through these channels, the hope is that knowledge and skills will increase, policies and access to services will improve, and the community’s strength will grow.

Funded partners were separated into small-groups by initiative for a chance to explore common challenges, experiences, and share tips. These sessions gave participants a welcome opportunity to dig in and compare notes with their peers. For example, the Family Housing Stability and Economic Stability group, in which racial justice discussions were held, noted that health and healthcare are “at the center of many intersecting issues,” and that the pandemic has underscored an already existing crisis in schools.

In the Mental Health Systems group, participants discussed that in Boston, the Mayor’s office declared mental health a public emergency, noting that this recognition has the potential to funnel resources to address the urgent need—which has been made even greater by the pandemic. And in the Community Physical Activity, Recreation and Food Access group, participants said, “COVID has really lifted up the issue of equity, and racial equity in particular…many of us are feeling how important it is to stand up and speak truth to power.”

After lunch, the group reconvened to hear remarks from Dr. Kevin Churchwell, President and Chief Operating Officer at Boston Children’s. Thanking the participants for their dedication, Churchwell noted the hospital’s Declaration on Equity, Diversity and Inclusion, which was formalized in August 2020 in response to nationwide protests and whose “goals are embedded in the work that we are doing and will keep doing in the years ahead. … We need to work together so that all voices are represented and heard.” Churchwell underscored the importance of the hospital’s community mission and that each partner plays a critical role in helping children and families within the communities we serve.

The final small group session allowed for participants to break out by geography. Once again, the funded partners appreciated the chance to swap notes with peers and reflect on how they have continued activities during the pandemic. During these sessions, COVID-related challenges and strategies were explored. For example, the Dorchester, Mattapan, and Hyde Park group agreed that “Since we’re not able to gather [due to COVID], it impacts how we share and connect…but we’ve found different ways to do outreach and keep engagement going.” In the Statewide group, participants shared tips on using software like Slack to connect with their staff, reducing the number of meetings to reflect present conditions, and rotating meeting facilitators to keep things fresh. In Greater Boston it was noted that the lack of in-person contact makes it difficult to verify people’s identities and direct them to the assistance they need.

The day wrapped up with one final re-convening of the larger group, during which a visual representation of the day’s journey was shared (see illustration). An illustrator who had participated in the whole day created a visual based on real time observations and listening to the day’s conversation—including elements such as the Collaboration’s goals and mission, the Theory of Change, key notes from breakout meetings, and much more. There was universal agreement that while the pandemic has made things more challenging, it has also led to opportunities for many to refocus and become more determined to bring about long-term impacts for children and families.

child drawing stick figures on a piece of paperBoston Children’s Hospital has a long-standing commitment to children’s behavioral health.

The hospital is focused on increasing access to care, expanding resources, and improving public policy both locally and nationally. “There’s more awareness today and improvements have been made, but there’s more to do,” says Josh Greenberg, vice president for Government Relations at Boston Children’s.

Clinicians can play a vital role in informing legislators about needed policy changes by sharing their experiences.

“We help bring the issues to life,” says Dr. David R. DeMaso, psychiatrist-in-chief at Boston Children’s. “We share examples of how policy affects children and their families and shed light on how legislative and regulatory changes could improve outcomes for children.”

Campaigning for change

The Children’s Mental Health Campaign (CMHC) is a coalition of families, advocates, health care providers, educators, and consumers from across Massachusetts. Together, they advocate for children to have access to resources that prevent, diagnose, and treat behavioral health issues.

The campaign was created after the Massachusetts Society for the Prevention of Cruelty to Children asked Greenberg and DeMaso if Boston Children’s would partner to write a whitepaper examining the state’s children’s mental health system.

The hospital agreed, but only if they also developed companion legislation, launched the campaign, found the right partners and worked to change policy.

That’s exactly what they did.

The 2006 whitepaper led to legislation being passed and a broader coalition coming together to form the CMHC. Boston Children’s committed to raising money to fund the campaign for the first five years.

The campaign also worked to reduce the practice of pediatric behavioral health boarding (where patients are held in the emergency department or medical unit until an inpatient bed becomes available in a psychiatric facility).

Working with campaign partner Health Law Advocates, Boston Children’s helped create a program in family resource centers to provide legal assistance to ensure a child with behavioral health needs gets access to health and education services.

Today, the campaign continues to promote and advocate for a comprehensive and coordinated system that is accessible to all children and families.

Advancing access

Boston Children’s also has made advances by integrating behavioral health services into primary care settings with a program that places licensed clinical social workers in pediatrician offices. Psychiatrists are available to consult with the social workers to determine whether a child requires referral to a psychiatrist.

“There is evidence about the benefits of behavioral health screenings for young children”, says Greenberg. “We have an opportunity to help address behavioral health issues early on and avoid more acute problems later on in a child’s life.”

Schools are another key to access.

The CMHC recently received a grant from the C.F. Adams Charitable Trust to develop a policy and advocacy agenda to ensure that children in schools are getting access to prevention and intervention. Boston Children's Hospital Neighborhood Partnerships Program, which has been a leader in providing school-based and community efforts for more than a decade, is helping to develop the advocacy agenda.

Policy Matters

CMHC helps ensure that when a policy is being made—the concerns of children are at the forefront.

“We have seen progress in how our public policy has been able to address the behavioral health needs of kids,” says Greenberg.

For example, it’s been a challenge for families to find mental health clinicians through insurance providers’ directories as information was not regularly updated. Massachusetts recently passed legislation requiring insurers and providers to work together on the directories and ensure that in-network providers and specialists are listed accurately.

Boston Children’s and its partners are involved in other policy issues, such as mental health parity, which requires that mental health conditions and substance use disorders are treated the same as physical health conditions. Members of the CMHC were proud to stand with the Massachusetts State Senate in February 2020 as it approved the Mental Health ABC Act, which could lead to significant changes in the system.

Greenberg says there is still much to do.

“You can’t take your foot off the gas pedal because if you do, people will stop paying attention,” says Greenberg, “So we keep pushing.”  

For more information, visit The Children’s Mental Health Campaign or Boston Children’s Office of Government Relations

The commitment and compassion with which we care for all children and families is matched only by the pioneering spirit of discovery and innovation that drives us to think differently, to find answers, and to build a better tomorrow for children everywhere.

Kevin B. Churchwell, President and CEO

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