6/17/2019

1

Seiji Hayashi, MD, MPH, FAAFP

Chief Transformation Officer

Mary's Center

Integrating Healthcare, Social Services, and

Education to Improve Outcomes

The Social Change Model

Overview

• Goals

• Social Determinants of Health & COPC

• Context: Mary's Center

• Solution: Social Change Model

• Discussion

3

What do you want to accomplish for the community you serve?

6/17/2019

2

4

Social Determinants of Health (SDOH)

• Economic Stability: Employment, income, food security, housing

• Education: Early childhood education and development, enrollment in

higher education, high school graduation, language and literacy

• Social and Community Context: Civic participation, discrimination,

incarceration, social cohesion

• Health and Health Care: Access to healthcare/primary care, health literacy

• Neighborhood and Built Environment: Access to healthy foods, crime and

violence, environmental conditions, quality of housing

Source: Healthy People 2020

Health &

Health

Care

SDOH

Neighborhood

&

Built

Environment

Economic

Stability

Education

Social &

Community

Context

5

Community-Oriented Primary Care(COPC) & Health Centers

"A continuous process by which primary health care is

provided to a defined community on the basis of its

assessed health needs by the planned integration of

public health with primary care practice.”

- King's Fund College; Hadassah Medical College

6

COPC: El Salvador

• Geography/History: Mountainous River Valley Site of fierce

battles from 1980-1992

• Population: ~ 2000, 90% of Mayan (Lenca) descent

• Language: Spanish, Lenca

• Economy: Subsistence Farming, 97% live in poverty

• Education: < 5th Grade

"Health as reconciliation"

6/17/2019

3

7

COPC: El Salvador

Priority health issues:• Infant mortality

• Maternal mortality

• Malnutrition

• Infectious Disease

• Violence

• Depression and suicide

• Injuries

• Alcoholism

8

COPC: El Salvador

• Promotoras de salud

• Health care

• Sanitation

• Nutrition

• Sexual and reproductive health

9

COPC: El Salvador

• Potable water

• Sustainable farming

• Transportation

6/17/2019

4

COPC: El Salvador

Kindergartens:

• Early childhood education,

development, and health

• Focus

• Food and nutrition

• Oral health

• Mental health

• Parental involvement required

10

11

Why Education?

Maternal education and child health

• An additional year of maternal secondary education is

associated with a large decline (21% decline) in child mortality.

• Increased education leads to improved health outcomes by

primarily influencing fertility and economic outcomes.

Source: Grepin, et al, J Health Econ, 2015

12

From 1980 to 2015, the size of the Central

American immigrant population in the U.S.

grew nearly tenfold to 3.5 million

Salvadorans, Guatemalans, and

Hondurans accounted for 85% of

Central America immigrants.

Source: Migration Policy Institute, 2017

6/17/2019

5

13

Five metropolitan areas accounted for 52% of Central

Americans in the US.

Migration Policy Institute, 2017

15

Established in 1988 to care for Latin American

immigrants, Mary's Center now serves the

broader community.

• 53,000 participants from 50+ countries

• 5 full-service community health centers

• 19 School-based mental health programs

• 2 Senior Wellness Centers

• Public Charter School co-located at 3 health centers

6/17/2019

6

16

Our Mission

Mary’s Center embraces all communities and provides high-quality

healthcare, education, and social services to build better futures.

• Treating health problems alone is insufficient

• Comprehensive health care

• Dual-generation education

• Social services

• Striving to address all aspects of wellbeing that can impact quality of life and advancement

Our Social Change Model (SCM)

17

• Care for the entire family

• Primary care

• Behavioral health

• Dental health

• Health education

• Nutrition

• Chronic disease management

• Telemedicine

• Health Homes care coordination and

case management

• Sexual health

• Infectious disease

• LGBTQIA health

Comprehensive Health Care

18

6/17/2019

7

• Case Management

• Legal services

• Benefits Enrollment Assistance

• Senior Wellness Centers

• Family Support Programs (Home

Visiting)

• Domestic Violence Support

• Food & Nutrition Assistance

• Energy Assistance

• Insurance & Fees

• Teen Program

Social Services

19

• Parents

• English language

• Digital literacy

• Parenting

• Children

• Early childhood education

• Preschool

• Professional

• High school diploma

• Medical Assistant training

• Child Development Associate

licensing

Education Programs

20

21

Saves Lives

StabilizesFamilies

CreatesStronger Communities

6/17/2019

8

Briya Public Charter School

• Began as an Even Start Program in 1989.

• Became a DC public charter school in 2006.

22

23

Briya Public Charter School

• Maintains a Tier One ranking for its consistent

high academic performance

• Named a Bright Spot in Hispanic Education by

the White House Initiative on Educational

Excellence for Hispanics.

Child Development Associate Program (2007)

Medical Assistant Program (2012)

24

• Co-located at 3 sites to offer

healthcare, social services, and

two-generation education.

• Graduates of the programs are

hired at Mary's Center and Briya.

• Many are supported to further their

education in fields such as nursing.

Our Partnership

6/17/2019

9

• Has a medical home for primary care

• Enrolled in health coverage

• Parents are empowered to be child’s FIRST and BEST teacher

• Parents are helping with homework and getting involved in child’s school and personal life

• Enrolled in programs for job skills training

• Living in safe and affordable housing

• Linked to important resources

• Linked to pro-bono legal counsel

• Moving up the economic ladder

• Happy and secured families looking forward to helping others

SCM: Our Hypothesis

25

Social Change Model

NIH Study

Health Care

Social Services

Two-Gen Education

Mental Health Care

Dental Care

VS.

"Utilizing the Social Change Model is

protective against adverse health

outcomes than utilizing Comprehensive

Team Health only."

26

Health Care

NIH Study: Preliminary Results

• Utility of the Social Change Model was protective

against certain adverse health outcomes than use

of Health Care only

• This appeared to be true for:

• Hypertension

• Obesity

• Diabetes

• High Cholesterol

27

6/17/2019

10

Urban Institute Study

Qualitative study assessing the impact of the Social Change Model on three domains:

Our Community

Our Staff

Our Participants

28

Urban Institute: Preliminary Results

• Participant impact:

• Welcoming environment: "clínica para la familia."

• Community impact:

• Strong community partnerships

• Staff impact

• Strong commitment to mission

• Continuous improvement culture

29

Opportunities & Challenges

• Integration of different services

• Financial sustainability

• Managing growth

• Evaluation

30

6/17/2019

11

Summary

• Our goals are to improve the lives of

the community we serve.

• The Social Change Model is one way

to address the social determinants of

health.

• We would love to work with other

health centers to expand and

improve this model.

31

Seiji Hayashi, MD, MPH, FAAFP

Chief Transformation Officer

Mary's Center

SHayashi@maryscenter.org

www.maryscenter.org

Thank you!

mailto:SHayashi@maryscenter.orghttp://www.maryscenter.org