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Abstract
Meaningfully addressing social risk factors that impact health outcomes is a complex and expensive endeavour. As healthcare systems across the USA pivot their operations to include upstream and downstream social care elements, they struggle with the operationalising screenings, intervention, staffing and sustainability. This paper shares the nearly decade-long experience of Rush Medical Center in Chicago in creating an infrastructure that identifies social needs, escalates patient cases to an interdisciplinary team intervening at different levels of intensity and simultaneously engages local community and medical entities to develop an enduring partnership to support these efforts.
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Author's Biography
Walter Rosenberg , MSW, MHSM, LCSW, is the Director of Social Work and Community Health at Rush University Medical Center and Associate Professor in the Rush University College of Health Sciences. He provides operational and strategic leadership in the Department of Social Work and Community Health. In addition, Walter is the co-director of the Center for Health and Social Care Integration at Rush (CHaSCI), where he directs its strategic planning and national training initiatives. He is the past president of the Illinois Chapter of the Society for Social Work Leadership in Health Care and serves on the advisory boards of the Dominican University Graduate School of Social Work and the Social Work Health Leadership Foundation. Walter is a Hartford Practice Change Leader and is on the 2021 EHR Care Coordination Committee of the National Quality Forum. He received his MSW and BA from the University of Illinois at Chicago and MHSM from Rush University.
Ruth Richman works as a Community Practice Social Worker within the Social Work and Community Health department at Rush University Medical Center. In this role, Ruth partners with two other social workers to provide care management to patients referred by Rush Community Health Workers, Rush clinicians, community event attendees and callers to the department’s 800 Social Care Help Line. The focus of our social work care management is connection to resources for identified needs associated with health outcomes of the people we serve. These fundamental needs include access to housing, food, medical care and mental health services. Ruth holds a Bachelor of Arts degree from Brandeis University, a Master’s Degree in Journalism from Northwestern University and a Master of Arts degree from the University of Chicago’s Crown School of Social Work. Prior to her current role, Ruth provided psychotherapy to children experiencing loss, served on an interdisciplinary hospice team and worked as a reporter/writer for a variety of publications.
Teresa Berumen is the Community Health Worker Supervisor with the Rush University System for Health, a Trainer with the Center for Health and Social Care Integration, and serves as member of the Illinois Kidney Care Alliance CHW Task Force. In her roles at Rush, Teresa was instrumental in developing and implementing a community health worker programme and serves as a co-lead for the team. Teresa’s work includes co-leadership of Rush’s 30-plus member Community Health Worker (CHW) Hub, oversight of her team conducting social determinants of health screenings, primarily in the emergency department, as well as providing guidance for her team in assisting patients to apply for public benefits and connection to community resources. Teresa formally began her career as a Community Health Worker in 2014 at Enlace Chicago, followed by her work as a community resource educator at Saint Anthony Hospital. Additionally, she recently ended her term as the Board Chair for the Illinois Community Health Worker Association. She had also previously served as a member of the Illinois Community Health Worker Advisory Board.
Rachel Smith is a Donor Relations Coordinator at the University of Florida, where she provides communications and project management support to the central Donor Relations team. She collaborates with the team leads to develop and edit content for donor communications pieces, including vice presidential acknowledgments, annual endowment reports, impact reports and other special projects. She also assists with the planning and execution of special initiatives and events. Rachel holds a bachelor’s degree from the University of Florida.
Eugenia Olison , MEd, LPC, serves as the programme manager for the Center to Transform Health and Housing at Rush University Medical Center. Through the Center, Olison works to promote the intersectoral development of strategic collaborations to address inequities in health care and to increase positive health outcomes while advocating for people experiencing homelessness. Previously, Olison served as a member of the Resident-Centered Change Management Team and held the position of senior community life manager at Community Builders, a non-profit housing developer that creates and strengthens affordable housing infrastructure. She has more than 15 years of experience working to provide leadership in partnership with local service providers and community stakeholders to increase opportunities, particularly in the areas of housing stability, health and wellness. In her efforts to decrease food insecurity and improve health outcomes, Olison has enhanced access to and enrolment in public benefits among underserved populations in Chicago Public Schools. She is a licensed professional counsellor in Illinois, holds a bachelor of science degree in human development and family studies from the University of Illinois, and has a master of education degree in family and young child counselling from DePaul University.
Lexi Artman is the System Manager for Community Health Strategy and Programs within the Office of Community Health Equity & Engagement at Rush. In this role, she collaborates to develop and implement strategies that result in improved healthcare services, practices and programmes to effectively address identified needs. Lexi’s work includes grant management, data management and reporting and operational oversight and co-leadership of Rush’s 30-plus member Community Health Worker (CHW) Hub. Lexi holds a Bachelor of Science in Public Health degree from Tulane University and a Master of Science in Health Systems Management degree from Rush University, where she served as an Administrative Project Assistant in the Children’s Hospital at Rush. Prior to assuming her current role, Lexi worked as a Project Manager for the CHW Hub and Contact Tracing programme.
Siqi Wang is a Health Services Researcher at Rush University Medical Center and oversees evaluation of Social Work and Community Health programmes. Her career has spanned educational data management, statistical analysis and academic research. At the State University of New York at Buffalo (SUNY-Buffalo), she led numerous projects related to departmental data-driven decision making on increasing communication efficiency and perfecting data tracking systems. During her graduate years at SUNY-Buffalo, she investigated the health outcomes of older adults in the USA with large-scale longitudinal data sets. Her empirical research on arthritis diagnosis identified health insurance coverage as one of the social determinants of health (SDOH). At Rush, she embeds herself in healthcare settings and conducts end-to-end mixed methods research and evaluation to demonstrate the impact of SDOH and ageing programmes. These experiences provide the content knowledge and research and statistics skills needed for programme evaluation.
Bonnie Ewald is the Managing Director of the Center for Health and Social Care Integration (CHaSCI), an applied think-tank based at Rush University Medical Center in Chicago that advances practices and policies that expand access to social care. In this role, she leads CHaSCI’s strategy and implementation of its workforce development trainings, care model implementation support and policy advocacy initiatives that advance coordinated and comprehensive care. Bonnie is also Manager of Strategic Development and Policy for Rush’s Social Work and Community Health department, assisting with programme development and evaluation, and provides strategic management for Rush’s Community Health Worker and AmeriCorps teams. She serves as Assistant Professor in Rush’s Social Work department and adjunct faculty in the Health Systems Management department. She also serves on the Chicagoland Regional Planning Council for the American Society on Aging, leads the policy core for Rush’s Center for Excellence in Aging and serves as an adjunct instructor for the University of Wisconsin – Whitewater Department of Social Work. Bonnie has her master’s in public policy studies from the University of Chicago, a postgraduate certificate in Sustainable Urban Design from Archeworks, and a bachelor’s in mathematics and geography from the University of Wisconsin – Madison.
Citation
Rosenberg, Walter, Richman, Ruth, Berumen, Teresa, Smith, Rachel, Olison, Eugenia, Artman, Lexi, Wang, Siqi and Ewald, Bonnie (2023, December 1). Organising social care initiatives within an urban academic medical centre. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 7, Issue 2. https://doi.org/10.69554/UVEN1120.Publications LLP