Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Project HOME

Name of Innovative Program: 
Project HOME’s Approach to Care for Homeless Individuals: A Community-Based Health Home
Sponsoring Organization
Project HOME
Name of Innovative Program Lead: 
Monica McCurdy
E-mail Address of Innovative Program Lead: 
monicamccurdy@projecthome.org
Project Description: 
Project HOME will break ground on the Stephen Klein Wellness Center (SKWC), a community-based health home, in 2014 in Philadelphia’s second poorest neighborhood, and open in January 2015. This 28,000 square foot facility will offer integrated healthcare in a federally designated Medically Underserved Area to individuals who have experienced homelessness, all of whom have special needs, including severe mental illness and/or substance dependence. It will be the only health home in the area to specialize in the care of this population, providing respectful health and wellness services to people that often feel stigmatized when seeking care. Studies indicate that care offered in community-based health homes leads to better outcomes and decreased health costs. SKWC anticipates a patient volume of over 20,000 in the first year of operation and will offer primary medical care, behavioral health services, links to drug treatment, dentistry, physical therapy, a pharmacy, health classes and support groups, a fitness center, with babysitting so parents can keep appointments and utilize the fitness facility. St. Elizabeth’s Wellness Center, our current clinic in operation for 18 years, offers some services on a small scale.  We are taking steps to ramp up our numbers served ahead of the transition to SKWC.
Creativity and Innovation: 
St. Elizabeth’s Wellness Center and the future SKWC specialize in providing health care to people with complex behavioral health, social, and medical needs.  To do this well, we rely on strategic partnerships with Thomas Jefferson University Hospital and several behavioral health agencies, including Women Against Abuse, Einstein Hospital, and Council for Relationships, who all work on-site. This coalition was funded for its third year by the Dept. of Behavioral Health. What we have learned in our work together is that team-based, trauma-informed care delivered by providers who work outside silos and collaborate in real time with consumers and with one another improves the chances for good health outcomes.  By specializing in dignified and respectful care for individuals who have experienced homelessness and partnering strategically, Project HOME can have a significant, positive impact on health in Philadelphia.
Leadership: 
When SKWC reaches full capacity, and outcomes are realized, our process of influencing others (and being influenced) will include:
  1. Making efforts with our academic and funding partners to publish outcomes;
  2. Participating in conferences and “learning collaborative” focusing on the intersection of medical, behavioral health, and community;
  3. Taking advantage of the large, national Federally Qualified Health Center (FQHC) network to disseminate outcomes and find common learning and research interests.
Project HOME’s health home initiative will lead to better health for our clients and neighbors. The Affordable Care Act requires behavioral health care screening and integration as a best primary care practice, and we’ve taken the lead in providing this care to a special needs population. The health home model takes the patient-centered medical home model one step further by addressing social determinants, a critical issue for our clients.
Sustainability: 
St. Elizabeth’s Wellness Center will benefit from receiving Federally Qualified Health Center status (awarded in November 2013), which comes with significant federal funding to help ramp up and sustain services. Revenue from insurance reimbursements (we are finalizing our status as a Medicare/Medicaid biller) and service provision will largely make St. Elizabeth’s and, eventually, Stephen Klein Wellness Center self-sustaining for operations.  St. Elizabeth’s has a patient volume of over 3,000; in the first year of operations at Stephen Klein Wellness Center, we anticipate a patient volume of approximately 20,000 when we are at full capacity. Additionally, we are raising a facilities endowment of $3 million, along with the capital costs of construction, to ensure this initiative is fully sustainable.
Replicability: 
As an innovative and comprehensive model, other cities can learn from the SKWC model and adapt it to fit their specific conditions. The Stephen Klein Wellness Center model is innovative because: (1) it integrates medical, behavioral health, pharmacy, dental, fitness, and wellness under one roof; (2) it is aimed at a vulnerable population that requires well coordinated, personalized, trauma-informed services; (3) it is embedded within Project HOME’ s network of supportive housing, educational and employment programs; (4) it is linked to a nationally-renowned academic medical center; (5) and it locates all these resources in the second poorest ZIP Code in Philadelphia, where it has the promise to be an economic catalyst for the surrounding community in terms of new jobs and economic activity. The U.S. struggles with siloed health care and social service systems, and by committing to a holistic model, SKWC can serve as a replicable solution.
Results/Outcomes: 
As a new FQHC with a state-of-the art facility under construction to support our goals, we are in the process of developing performance indicators.  Metrics include:
  • % of women with Pap tests
  • % of youth with BMI percentile and counseling on nutrition and physical activity
  • % of adults assessed for tobacco use and users receiving cessation advice/medication
  • % of two-year-olds immunized
  • % of hypertensive patients with blood pressure <140/90
  • % of diabetic patients with HbA1c <=9
  • % of patients who are homeless or public housing tenants
These measures appear physical health-related but are strongly driven by behavioral factors–for example, the willingness to adopt new healthy habits/give up unhealthy habits or to address underlying trauma that is a barrier to healthy change. A hallmark of our model is staff skill and ability to motivate patients to take these steps.
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