Health Home -- Aurora Mental Health Center - AuMHC proposes to serve its over 8,000 adult patients with serious mental illness (SMI), with additional outreach efforts to serve the Aurora refugee population with serious mental illness. AuMHC's adult patients with SMI are on average 39.6 years of age, 65.3% are female, 69.1% Caucasian, 23% Black/African American, and 15.8% Latino. Almost half are below the federal poverty level and receive public insurance. Thirty-nine percent of adults with SMI at AuMHC have diagnosed chronic diseases including hypertension, diabetes, asthma, arthritis, and hypercholesterolemia. Many refugees in Aurora have high unmet physical and mental health needs and AuMHC will be utilizing its expertise with this population to serve them in the Health Home. AuMHC will be providing quality primary care services by partnering with Metro Community Provider Network (MCPN), an FQHC. MCPN is dedicated to providing medical care to the underserved, including uninsured and indigent individuals. The Health Home team will consist of a primary care provider, medical assistant, financial screener, wellness coordinator, health navigator, referral coordinator, consulting psychiatrist, registered nurse, and peer health advocates. Together, the Health Home team will provide patients and their families with a positive health care experience under the evidence-based Chronic Care Model, as well as utilizing existing and new collaborations with community health promotion and intervention resources. Based on the proposed population's size, it is expected that the Health Home will serve over 1,000 patients by the end of the grant fund (over 200 patients by year 1, over 375 by year 2, over 475 by year 3 and over 600 by year 4).
