Friday, November 22, 2024
11/22/2024
Terros Health CCBHC-Improvement and Enhancement (CCBHC-IA) project in Phoenix, Arizona will bring equitable care to all populations, regardless of the ability to pay for services, using the CCBHC Certification Criteria for Service Delivery. Our focus population will be children, youth, families, and adults newly accessing Terros Health’s CCBHC, who will receive person- and family-centered mental health, substance use disorder (SUD), and primary care services. As the only integrated care facility in our catchment area, our CCBHC will increase access to care and improve our ability to meet the needs of the whole person including health equity and social determinants of health (SDoH) support. Our evaluation tools and communication with participants are culturally appropriate, accessible, and provided in plain language. We hire and train our employees to interact with our participants with cultural sensitivity and we strive to have our staff be a representation of those we serve. In Phoenix, 42.7% of individuals identify as Hispanic and 36.9% of individuals ages five and older speak a language other than English at home.1 In our 2019 Terros Health needs assessment, 83% of participants were Medicaid-eligible – almost double the average for Federally Qualified Health Centers (FQHC’s) in Arizona – with 13% identifying as black and 32% identifying as Hispanic. Using our long-standing experiences providing services for those who identify as LGBTQ+, we will continue to provide equitable care and access to preventive screenings, assessments, and services for this population. With 42.8% of children (under age five) in 85017 living in poverty, our CCBHC expands our ability to serve the physical and behavioral health needs of participants. Individuals served will be 900 in year 1, 1000 in year 2, and 1100 in years 3 and 4, for a total of 4,100 individuals served during the lifetime of the grant. The project goals and accompanying objectives are: Goal 1) Improve participant health outcomes through timely access to critical care, availability of evidence-based interventions, and ongoing participant engagement with integrated, comprehensive health care. We will meet this goal by a) demonstrating a 10% improvement in participants that receive a follow-up visit within 7-days and within 30-days after a hospitalization or emergency department use (as indicated by Health Information Exchange [HIE] data), b) 75% of participants, who have been enrolled in the program for at least 90 days, will be engaged in at least 3 services – one of which will include treatment planning, c), 85% of the number of participants with active Opioid Use Disorder (OUD) will receive education about or a recommendation for Medications for Opioid Use Disorder (MOUD) services, d) 75% of participants who required a mobile crisis intervention will receive a coordinated, follow-up outreach attempt within 24-hours, and e) 85% of CCBHC participants will be offered required screenings, vaccines, or testing including HIV and viral hepatitis screens. Goal 2) Increase the number of participants who receive social SDoH resources and support by a) 60% of participants who identify housing needs on their National Outcomes Measures will receive support from case management (such as our Housing Specialist) or are engaged with housing coordinated entry, and b) 60% of participants who identify employment needs on their NOMS will receive support from case management (such as our Rehabilitation Specialist). Goal 3) Outreach and provide education to individuals and community partners by a) Providing 10 health literacy education outreach events each year of the grant (such as tobacco cessation, diabetes management, and how to access SDoH resources) to individuals who are justice involved, and b) Provide six Narcan education and distribution events in the community each year (to reduce accidental overdose) with three targeted to the Hispanic/Latino/a population.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
