Providence Holy Cross Medical Center (PHCMC) has received $300,000 in grant funding from the Wellbeing Institute to help fulfill the vision of the California Mental Health and Wellness Initiative through piloting the Safety Net Integration Program (SNIP). In collaboration with San Fernando Community Health Center (SFCHC), a Federally-Qualified Health Clinic (FQHC) located 3.1 miles from PHCMC in the City of San Fernando, the clinic will be the service site for an integration model that intends to support community clinic integration, build community health capacity and engagement that will address the social determinants of health, specifically among disadvantaged and vulnerable populations. SNIP will make accessible specific safety net services in a medical home model through linkage to a primary care physician, neonatal and pediatric services, mental health counseling and intervention, telepsychiatry, dental care, and diabetes/food education kitchen. This pilot program is focusing on the linkage of frequent users of emergency services to a medical home in the community that has integrated services. A Service Navigator, Patient Case Manager, and Community Health Worker will link, assess, and follow discharged E.D. cases to the FQHC as their medical home by scheduling post-discharge visits within 1-3 business days at the FQHC, assessing a clients’ full health/mental health spectrum of needs, and maintaining close follow-up contact with a client to improve that individual’s health outcomes. By sharing E.H.R. systems (EPIC, eClinicalWorks), both PHCMC and SFCHC can seamlessly address and coordinate health/mental health needs of clients to make navigation, follow-up, outreach, and care planning more individualized, with the FQHC becoming their primary care provider. Another component of the SNIP is the development of a mental health care delivery model at the FQHC as well as their Recuperative Care Center location, Hope of the Valley, incorporating telepsychiatry services as adjunctive support to the advance practice nursing currently provided by SFCHC at that location. For detailed information or questions regarding PHCMC’s Safety Net Integration Program and San Fernando Community Health Center, please contact Heidi.Lennartz@providence.org or call 818/496-4788.
