Maimonides Medical Center in Brooklyn, N.Y., has developed a framework to identify community priorities and guide programmatic investments. The largest hospital in Brooklyn is using consumer feedback to rethink how services are designed and delivered and shift the power dynamic to incorporate the voice of the community in terms of how its resources are deployed.
The Center for Health Care Strategies (CHCS), a nonprofit policy center dedicated to improving the health of low-income Americans, is working to uncover best practices for healthcare systems in establishing effective community partnerships. With support from the Robert Wood Johnson Foundation, it is working to identify examples that can be replicated, including Whole Person Care – Los Angeles: Creating a countywide re-entry health advisory collaborative; and Hennepin Healthcare in Minneapolis: Partnering with the foreign-born Somali population to identify and address barriers to accessing mental health services.
In a recent webinar, supported by the Robert Wood Johnson Foundation and co-sponsored by the Better Care Playbook, one of the examples described was Maimonides Medical Center’s use of a Participatory Action Research framework to engage neighborhood communities in Brooklyn.
Shari Suchoff, vice president of policy and strategy, and Okenfe Lebarty, senior manager of community engagement, described their approach.
Setting the table, Suchoff noted that Brooklyn has 1.2 million Medicaid beneficiaries and 300,000 uninsured residents. Thirty-three percent of New York City’s Medicaid beneficiaries live in Brooklyn and 20 percent of New York State’s (2 percent nationwide). There are many diverse cultures and languages spoken in the borough. Maimonides has a long history of providing services to under-served communities and investing in community health initiatives, and also a long history of leadership in population health, Suchoff said.
A New York State Medicaid redesign effort called “Delivery System Reform Incentive Payment (DSRIP) led Maimonides to work with other healthcare providers and community organizations to come together to form Community Care of Brooklyn (CCB). Members range from Federally Qualified Health Centers to community-based organizations (CBOs), and managed care plans.
The network of Brooklyn health and social service providers, led by Maimonides, includes more than 4,600 practitioners, including 1,600 primary care providers, seven hospitals, 10 FQHCs, behavioral health providers, social service providers and 70 community-based organizations.
To address the needs of each neighborhood, Community Care of Brooklyn team understood that complex social, economic, and environmental problems cannot be addressed through top-down, needs-based development approaches, Lebarty said. “For us, the approach was Participatory Action Research,” he added.
The CCB team realized they had to include residents in research processes that will drive changes in their own communities. “We had to come together to identify community assets and create action plans. They know their neighborhood better than anybody else. This approach acknowledges local stakeholders’ personal experiences as valid and critical in identifying community assets and implementing action plans and shifts the power balance by changing who determines needs and solutions.”
“We started in 2016 in Brownsville and East New York to build a deeper understanding of social determinants of cardiovascular health in two dangerously afflicted communities,” Lebarty said.
Their first published report indicated that successful engagement and organizing efforts “must address head-on the strong lack of trust between the community and the local healthcare system,” he added. The effort has since grown a movement in many Brooklyn neighborhoods, driven by a highly engaged and diverse Community Action and Advocacy Workgroup.
Suchoff said that using the PAR approach, they first convene elected officials and CBOs in the neighborhood. Then they identify high school and college students who want to work on the research projects. They map the neighborhoods, design a survey and spend two to three weeks of summer out surveying the neighborhood . They ask residents what is driving poor health outcomes.
Among the key issues raised by those surveyed:
• Food justice and nutrition
• Physical activity
• Gentrification, sustainable civil infrastructure
• Healthcare system redesign
• Mental health resources
• Affordable housing
• Public safety
CCB has worked to incorporate findings into complex care work. For instance, concerns about food justice and nutrition led to the Healthy Savings Program, which supports access to fresh produce in partnership with the Mayor’s Office of Food Policy.
CCB also is partnering with Teens For Food Justice and Brooklyn Sprout to increase healthy food access and develop community-owned hydroponic businesses.
PAR alumni and students engaged in Maimonides-sponsored school programs are engaging more with their communities and working with local healthcare institutions to improve social determinants, Suchoff said. “Instead of us looking at data and coming up with programs, we use PAR as the driving force on how to work together. We are working hand in hand in designing and implementing these programs.” For instance, a new nonprofit called Brooklyn Communities Collaborative is formally uniting government, health, education, labor, and community-based organizations across Brooklyn, anchored by major Brooklyn institutions, to strengthen health, wealth, and leadership in Brooklyn communities.
