Summary: Family Service of Rhode Island (FSRI) has created “Best Start RI” to address Social Determinant of Health (SDoH) challenges and mental health/substance use issues for children, adolescents and their families. At least 500 Jenks Park Pediatric (JPP) patients at critical ages of development from Central Falls, Providence and Pawtucket will be screened for SDoH inequities, along with mental health/substance use needs. Additionally, the project staff will mitigate imminent patient needs, collaborate with JPP and community providers, and coordinate appropriate referrals to address follow-up care for both the SDoH and mental health/substance use components.
Population to be served: The pediatric patients of JPP, most residing in low-income minority neighborhoods in Central Falls, Providence and Pawtucket, Rhode Island. In Central Falls, 39% of residents are foreign born, with 25% living in poverty. Those numbers respectively are 31% and 22% in Providence, and 25% and 15% in Pawtucket (Census.gov).
Strategies/Interventions: Best Start RI staff will 1) detect and intervene in Social Determinant of Health barriers; 2) screen, provide intervention, and linkages for children/adolescents experiencing mental health/substance use challenges. Trained staffs will provide systems navigation and coordinate care to mitigate inequities.
Brief Summary of Goals and Objectives
Goal 1: Increase JPP capacity to screen for SDoH challenges. Objectives: By end of October 2023, project staff will be trained in the tool deployed to screen patients, while practice staff will be oriented to project screening and referral workflow. By the end of August 2024, 500 children/adolescents (and their families) will be screened for SDoH challenges.
Goal 2: Increase the capacity of JPP to support families in mitigating SDoH challenges. Objective: By the end of August 2024, 75% of families who screened positive for SDoH challenges will have been connected by staff to an appropriate community resource.
Goal 3: Increase the capacity of JPP to screen patients for mental health/substance use problems. Objectives: By October 2023, project staff will be trained in PSC-17 and CRAFFT2.1+N tool, and practice staff will be oriented to all mental health/substance use project components, and aware of screening and referral workflow. By the end of August 2024, at least 500 children/adolescents will be screened.
Goal 4: Increase the capacity of JPP to refer and connect patients to clinically appropriate mental health/substance use services. Objective: By the end of August 2024, 100% of children or adolescents who screened positive for mental health/substance use problems will have been referred to a clinically appropriate intervention resource.
Goal 5: Decrease child/adolescent mental health problems in the community by implementing evidence-based screening tools into JPP workflow that assess anxiety, depression, and other problematic behaviors. Objective: By the end of August 2024, at least 50% of children/adolescents screened positively for mental health/substance use problems will have engaged with a clinically appropriate intervention or resource.