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In pursuit of seamless integration: The East New York Health Hub
The need for integrated care is deeply felt in the Brooklyn, New York neighborhood of East New York, which struggles with high rates of poverty, violence, psychiatric hospitalizations, and chronic disease, exacerbated by long standing racial disparities. The COVID-19 pandemic has increased the urgency of integration and pushed this work toward technology-enabled care, including teleconsultation […]...Read more
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Transform your engagement practices
Through practices like motivational interviewing, harm reduction, and our participant engagement framework COACH, the Camden Coalition’s care planning process has a powerful impact on participant engagement and cross-continuum teaming, and improves patient outcomes. During this webinar, Camden Coalition’s Gladys Antelo, Renee Murray, and Victor Murray discussed traditional and non-traditional care planning, and engagement styles that […]...Read more
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CHWs as community connectors and care team supervisors
Community health workers (CHWs) play an important role in reaching underserved populations in communities with high levels of complex social and medical needs. At Baylor Scott & White Health System (BSWHS) in Texas, CHWs have been addressing the health and social needs of the community since 2017. In that time, BSWHS has developed a workforce […]...Read more
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Building a system of care for children with complex medical and social needs
Children with medical complexities require specialized services and care delivery models across the healthcare continuum – from inpatient, outpatient, transitional, respite, home care, and community support services to physicians, nurses, and other providers with the expertise to care for these children. The care system for this population of children is extensive and fragmented, and seldom […]...Read more
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Anti-racism resource toolkit
This publication was produced by the Pennsylvania Department of Health (DOH) Office of Health Equity as part of the National Center’s 2020 regional complex care convening cohort. The publication describes “Dismantling Systemic Racism in Pennsylvania,” the DOH convening of 200 participants across 26 state agencies. It includes an extensive toolkit of books, articles, videos, podcasts, and […]...Read more
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Strengthening health & housing collaboration in Louisiana
This publication was produced by the Louisiana Public Health Institute, HousingNOLA, and Green and Healthy Homes Initiative as part of the National Center’s 2020 regional complex care convening cohort. The publication synthesizes findings from the New Orleans Healthy Homes Regional Convening focused on enhancing healthy homes interventions to demonstrate the impact of home-based interventions and […]...Read more
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Massachusetts complex care convening and learning community: Project summary July 2021
This publication was produced by The Brookline Center for Community Mental Health as part of the National Center’s 2020 regional complex care convening cohort. Their Massachusetts convening brought together a regional learning community to better navigate siloed systems to improve the care of people with complex health needs. This publication synthesizes the planning process, key […]...Read more
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Addressing social isolation and loneliness in central Iowa
This publication was produced by MercyOne Iowa as part of the National Center’s 2020 regional complex care convening cohort. MercyOne brought a cross-sector team together to plan a regional convening to better understanding of the impact of social isolation and loneliness on the health of their community and to develop a roadmap to collaboratively address […]...Read more
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Path-4CNC (Children’s Complex Care Coalition of North Carolina) Complex Care Convenings 2021: Executive summary
This publication was produced by Duke University and the University of North Carolina at Chapel Hill as part of the National Center’s 2020 regional complex care convening cohort. The publication synthesizes findings from the Path-4CNC conference series focused on improving systems of care for children with complex health needs in North Carolina. It includes actionable […]...Read more
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Building the Value Case for Complex Care Toolkit
This toolkit from the National Center for Complex Health and Social Needs was designed to be a simple and accessible way to learn about one of the least understood and most challenging aspects of complex care: making the mission and margin align. With support from The Commonwealth Fund, we interviewed more than 100 health and […]...Read more
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Compensating consumers and considerations for public benefit recipients
In this memo, Jeremy Spiegel, Esq. and Ashley Maddison, Esq. of the Rutgers Law School/Camden Coalition Medical-Legal Partnership and Evelyne Kane of the Camden Coalition of Healthcare Providers outline ways organizations can fairly compensate lived-experience experts without jeopardizing their eligibility for federal or state benefits. These include working creatively within the current legal confines for […]...Read more
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Rethinking complex care measurement: Using patient- and staff-reported measures
Complex care stakeholders across the nation are committed to finding new ways to measure quality and impact of complex care programs, ways that incorporate the holistic goals of caring for individuals with complex health and social needs. The Blueprint for Complex Care and Measuring Complexity, seminal reports in the complex care field, highlighted the need […]...Read more
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Person-centered implementation of patient-reported outcome measures (PROMS) in complex care programs
This brief from the National Center for Complex Health and Social Needs and the Kaiser Permanente Institute for Health Policy and Care Management Institute examines the factors that support or hinder the implementation of patient-reported outcome measures (PROMs) in complex care programs. The authors found that simply including PROMs in a complex care measurement strategy […]...Read more
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Breaking the homelessness-jail cycle with Housing First: Results from the Denver Supportive Housing Social Impact Bond Initiative
This report by the Urban Institute tracked and evaluated the implementation of the 2016 Denver Supportive Housing Impact Bond Initiative (Denver SIB), an initiative that provides supportive housing through a Housing First approach. This report includes the randomized-control trial and evaluation results of the efficacy of the supportive housing initiative over a five-year period. Read […]...Read more
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Best practices from the field: Using social determinants of health resource and referral data to increase equitable access and connection rates to essential resources
This brief by Health Leads provides guidance for organizations adopting resource databases as a technology solution to support social determinants of health programs, providing examples to demonstrate the ways in which data usage and interpretation can impact equitable access to essential resources and improve connection rates. Read the brief...Read more
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Policy options for integrating health and housing for low-income older adults
This report by the Center for Consumer Engagement in Health Innovation (CCEHI), with support from Arnold Ventures and in partnership with the Leading Age LTSS Center @UMass Boston, describes barriers and solutions to successfully linking low-income older adults to affordable housing and healthcare. Through focus group interviews, CCEHI identified key building blocks for achieving success, […]...Read more
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Using data strategies to advance health and racial equity
This set of resources from the National Academy for State Health Policy (NASHP) illustrates how convergent analysis — which helps to depict the extent that different health conditions coexist at their worst level — can be applied to publicly available data sets to advance health and racial equity. The toolkit includes examples of convergent analysis […]...Read more
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Introducing a toolkit of resources for new and developing complex care teams
The National Center for Complex Health and Social Needs recently released the Complex Care Startup Toolkit. This toolkit contains over 200 tools, templates, and guides to support new and developing complex care teams. The toolkit contains resources from the Camden Coalition of Healthcare Providers and dozens of partner organizations to help new and growing programs […]...Read more
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Open meeting on the National Center’s evaluation and next five years
Ahead of its five year anniversary, the Camden Coalition’s National Center for Complex Health and Social Needs partnered with Mathematica to assess how well its programming delivers on its mission. Funded by the Robert Wood Johnson Foundation, the evaluation, and the conversations that flow from it, will inform the next phase of the National Center’s […]...Read more
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Interventions to address social isolation and loneliness: Lessons learned from programs around the globe
This brief from the Social Interventions Research and Evaluation Network (SIREN) provides a deep dive into what interventions are needed to address social isolation and loneliness. The brief includes literature review, surveys, and case studies help to highlight the rapidly evolving global effort to develop, implement, and scale necessary interventions, as well as key lessons […]...Read more
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Targeted text message outreach can increase WIC enrollment, pilots show
This report by Benefits Data Trust and the Center on Budget and Policy Priorities draws on lessons learned from individual state Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) outreach pilots and discusses: The effectiveness of text message outreach to families who are adjunctively eligible for WIC at reaching families, engaging them, and […]...Read more
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Do no harm guide: Applying equity awareness in data visualization
This guide for researchers and analysts, constructed by the Urban Institute, focuses on how data practitioners can approach their work through a lens of diversity, equity, and inclusion, and aims to encourage thoughtfulness in how analysts work with and present their data rather than prescribe what to do or not to do. Read the report...Read more
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Complex Care Startup Toolkit
Starting or growing a new complex care program can be overwhelming. With the goal of providing person-centered care that bridges organizations and sectors, complex care programs are often structured differently than traditional healthcare or social service programs. Our Complex Care Startup Toolkit is a practical collection of guides, templates, and other tools to help you launch and […]...Read more
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Addressing health equity in HIV care delivery
Linking young HIV-positive African American and Latino men who have sex with men to medical care, supportive services, and antiretroviral treatment is essential to improving their health outcomes, their quality of life, and their ability to achieve viral suppression. Unfortunately, due to persistent structural and societal inequities, these populations generally fare worse in linkage to […]...Read more
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Inverting the burden: A health equity strategy for delivering complex care
“Inverting the burden” is an operational approach to achieving health equity by placing the burden of addressing racism and other inequities on institutions rather than individuals. It includes techniques for addressing the “downstream” immediate needs of complex care patients, the “midstream” supply of affordable housing, quality jobs, and insurance coverage, and the “upstream” root causes […]...Read more
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Shared measurement: Collaborating with communities toward equitable health outcomes
The various systems within communities — including medical care, public health, housing, education, transportation, justice, and human services — directly influence the health and well-being of community members. Yet often, these systems’ policies and practices have excluded, marginalized, and disadvantaged some communities of people — especially people of color — creating long-standing inequities in health […]...Read more
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Building trust through community health workers in a rural environment
Supporting health-related social needs is increasingly recognized as important in addressing health disparities among vulnerable patients, but a patient’s willingness to engage in social needs screening and support requires trust in their care team. Rural communities’ emphasis on self-reliance and general distrust of institutions are barriers providers often face when seeking to develop trust with […]...Read more
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Collaboratively addressing food insecurity during COVID-19 in urban environments
In the absence of comprehensive economic and antihunger policies, emergency food systems and healthcare organizations have organized to meet increasing demand during the COVID-19 pandemic. In this webinar, we heard from two collaboratives about their strategies to address acute food insecurity in urban environments. We heard how their strategies were tailored to their specific populations […]...Read more
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Information session: National Consumer Scholars 2021-2022 cohort
This virtual informational session was hosted by Evelyne Kane, the National Consumer Scholars Program Manager, as well as Alayna Tillman and Stephanie Burdick, two of our Consumer Scholar alumni. We welcomed people with lived experience who may be interested in applying to be a Consumer Scholar, as well as staff/providers of complex care organizations who […]...Read more
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Building partnerships to care for immigrant communities during COVID-19
COVID-19 has compounded long-standing economic and health disparities, disproportionately affecting Latinos and other people of color. The CARES Act did not confer equal access to stimulus relief or Medicaid to immigrants who are more vulnerable due to roles in essential jobs. To address these structural inequities, organizations like La Clínica del Pueblo in Washington, D.C. […]...Read more
Events & Webinars
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Recent News
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Bridging margin and mission: Making the value case for complex care
By Lauran Hardin MSN, CNL, FNAP, FAAN, and Mark Humowiecki, JD For those of us working in the field ...
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Student Hotspotting: A commitment to community engaged learning at Southern Illinois University School of Medicine
By Meghan Golden, DSW, LCSW, Director of Community Health, Director of Survivor Recovery Center; Jan...
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Trust, trauma, and healing: Putting Care at the Center 2021 conference recap
By Hannah Mogul-Adlin, Senior Communications Manager The COVID-19 pandemic and its disproportionate ...
The National Center for Complex Health and Social Needs is an initiative of the Camden Coalition.