I am going to make my remarks brief because there is so much information to share with you in this newsletter.

First, season's greeting from South Cove to all, we wish everyone a happy and healthy holiday season.

Second, I want to thank all the staff for another banner year with excellent results! I am extremely pleased to share a press release on a study conducted by Stanford University and funded by the Peterson Center on Healthcare where South Cove was named a "provider of America's most valuable care." I cannot be more proud of our staff and their work.

Last but not least, we want to thank our patients for their patronage; our Board of Directrs, partners and friends for their continued support.

See you in 2015!

Sincerely,

South Cove is pleased to announce that its Behavioral Health Department has been awarded a HRSA (Health Resources and Services Administration under the US Department of Health and Human Services) Behavioral Health Integration Grant. It is a two-year grant at $250,000 per year aimed to expand services and increase access.   This funding is much needed and will help tremendously in the department's effort to address some of the pressing issues facing Asian with mental illnesses.

The strong cultural stigma against mental illnesses and lack of understanding of such illnesses in the Western medical context have traditionally shunned Asians from seeking help. The department has taken a proactive stand in outreaching and screening for and identify potential patients. However, the task has proven to be a daunting one due to language and cultural barriers. These barriers lead to under-recognition and under-treatment of mental illnesses among Asians.

What is also alarming is the barrier to services or the availability of services. Numbers at South Cove paint a grim picture, there is one psychologist for every 591 Vietnamese-speaking patients, one counselor for every 17,723 Cantonese-speaking patients, and one counselor for every 8,862 Mandarin-speaking patients, one psychiatrist for every 11,815 Cantonese-speaking patients, one psychiatrist for every 5,908 Mandarin-speaking patients, but 0 psychiatrist for the 591 Vietnamese-speaking patients. Making matters worse, the capacity of the behavioral health services continues to be outpaced by the rapid increase in the influx of immigrants, including those of Asian descent, to the Boston areas. The increasing demand coupled with a shortage in providers resulted in long waiting time (2.3 months on average) for new patients referred to the Behavioral Health Department and even longer for external referrals. Every effort was made to shorten the waiting time, but this is very difficult to accomplish when the demand far exceeds supply.

With the support of this grant, South Cove looks to address this gap and increase the service capacity by hiring a psychiatrist, a social worker or psychologist, and a care manager who are fluent in one or more Asian languages and who are familiar with the Asian culture. The expansion of the behavioral health service capacity will greatly reduce the waiting time for internal and external referrals, allow providers to better meet the patients' needs, and increase the capacity to provide comprehensive services to patients who are currently under-treated. Furthermore, it will give providers more time with patients to ensure that they provide the highest-quality care. The care-manager will help coordinate the patient's care, provide additional behavioral health education, assist in the patient's treatment, and serve as the liaison between the primary care and the behavioral health providers. Ultimately, our goal is to significantly enhance patients' overall behavioral health experience and in turn (hopefully), alter their views about seeking such treatment.

With proper staffing, the department is one step closer to advancing to the higher stage of integration, which is crucial to delivering effective behavioral health care. It has been observed that patients have a higher show rate if the Behavioral Health Department makes the initial face-to-face contact with the primary care providers present. This suggests that a team-based, integrated model of care will help bridge the inter-departmental gap and the patient-to-care gap. Currently, South Cove's Behavioral Health program is between the stages of "basic collaboration on-site" and "close collaboration in a partly integrated system."   The integration effort has been ongoing for over 10 years, it is a long and arduous road but we are excited at the prospect of achieving a "fully integrated" status with the support of this grant.  

The integrated behavioral health project at South Cove will include universal screening of depression, primary care providers providing SBIRT (Screening, Brief Intervention, Referral to Treatment - an evidence-based practice commonly used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and/or illicit drugs. In South Cove's case, PCP will use SBIRT to screen for depression and anxiety), appropriate and timely referral to specialty care for consultation, and continued care by behavioral health service providers for patients with more complex psychiatric conditions. Behavioral Services will be provided in primary care settings, and primary care and behavioral health providers will have regular face-to-face meetings to discuss patient management. At the end of the project, South Cove will have a fully-integrated behavioral health service to meet the great unmet behavioral health needs of the Asian community.

South Cove is proud of the collective effort put forth by all involved in the application of the BHI grant. Work is currently underway to recruit and hire qualified individuals. We are confident that the additional funds will help us make our individual step in advancing the delivery of mental health care to our patients. At the same time, we also hope to make a bigger impact by establishing a best practice model and sharing the learning experience with others looking to break down similar barriers for their targeted populations.

Besides the BH Integration Grant, the health center received additional support of the same amount ($250,000.00/year) courtesy of an Expanded Services (ES) supplemental funding opportunity for existing health center grantees. The funds are distributed to section 330 funded health centers that "need additional support to increase access to comprehensive primary health care service through expanded service hours, increased number of medical providers and /or increased availability of medical services." The health center will use the funds to increase access by expanding the Adult Medicine Department with the hiring of a new MD and a support team, i.e. one RN, a medical assistant and a secretary.  The increased access in Adult Medicine will work hand in hand with the Behavioral Health expansion. As mentioned earlier, an effective behavioral health delivery model is one that is integrated with primary care, as we expand the former, we could surely benefit from a capacity boost of the latter.      

The Ebola virus outbreak that originated in West Africa is no longer a regional crisis but a global one to which the US was not immune. We learned from lessons here in the US that healthcare workers across the county had to be reminded that this is a dangerous and potentially deadly disease that demands every precaution. As unlikely as the scenario of South Cove receiving an Ebola case may seem, it is nonetheless extremely important that all our staff, especially our healthcare providers, are prepared to not only triage patients in the clinic who may have been exposed to the virus but also to know how to protect themselves from possible exposure to the virus. To make matters worse for diagnosis by healthcare workers is that the Ebola cases in the US are occurring at a time that coincides with the seasonal flu season; and the two viruses may share similar symptoms and signs of illness in those affected. Mary Jo Majors, Director of Nursing and Clinical Operations, and also South Cove's Emergency Preparedness (EP) Coordinator, took on this challenging task and without any delay, hit the ground running.

She immediately established a communication link with the MDPH and the Boston Public Health Commission, as well as other healthcare facilities in our local area. She was given information on the standard policies and procedures to be used in the preparation, triage, and treatment of possible Ebola virus patients and families in our clinics and met with EP Coordinators and medical experts at local healthcare treatment facilities to discuss the processes to be used if South Cove had a possible Ebola virus patient. She attended meetings initially held at BPHC, and now participates in the weekly telephone conferences conducted by MDPH with all healthcare organizations in the state.

Mary Jo provided staff education to all front desk and nursing staff on the use of standardized triage questions and the steps to take for further evaluation, as well as the use of and supply of personal protective equipment in the clinic sites.

Eric Tiberi, our COO, arranged for a web link to the MDPH Ebola Virus page to be added to our internal webpage for constant update to staff.

The other project that Mary Jo has quietly championed is the health center's ongoing effort to maximize seasonal flu vaccination utilization.  

She works with the nurses and our vaccine suppliers to oversee the vaccine supply and use at our clinics in order to ensure that we maintain adequate supplies for all our staff and patients. She has conducted 4 mini-flu clinics for our neighbors in the local area which included the faculty at the local grammar school, 2 local businesses, and our construction staff team.

As health care workers, we have to remember that it is our responsibility to educate and reach out to the public and the community we serve, and to make sure that people have the accurate information before deciding whether or not to receive the vaccination. We will continue to do this and hopefully improve upon the percentage of people receiving a flu shot this year, particularly those classified as being in the high risk groups.

South Cove's Managed Care/Social Services Department is a team of 15 strong that works tirelessly to help every patient apply for state subsidized health coverage. This is a much needed service for tens of thousands of South Cove patients. Since the roll-out of the ObamaCare (officially known as The Patient Protection and Affordable Care Act (PPACA) or the Affordable Care Act (ACA) for short), the department has not seen a slow day and will not likely be able to take a breather until February 15, 2015.

As ACA's Open Enrollment for CY 2015 is underway from November 15, 2014 to February 15, 2015, the department expects to move 6,000+ South Cove patients from their current plan to a new one. Every single one of them needs to reapply online at www.MAhealthconnector.org, the official Massachusetts website for health insurance, or submit a paper form to the Health Connector. This is due to changes implemented by the State in order to be in compliance and to adhere to the new guidelines set forth under ACA. And one of the many changes is the cessation of certain State programs as of January 31, 2015, such as Commonwealth Care, temporary MassHealth and Unemployment Health Insurance, hence the need to move everyone on these plans to a new one.

Washington St. clinic Social Services staff

What this means to the Social Services staff is increased workload, long hours and little rest as they submit applications on the patients' behalf, one at a time. This is a very time consuming process, on average, it takes an hour to submit an online application for one patient, and sometimes as long as two hours for a patient who is a family of four.  

Here is a glimpse into what each application entails and what the department has done to prepare for the transition:

• First, patient needs to sign up online with an email account; it is not uncommon for some patients to not have an email account, in that case, the Social Services staff would help the patient create one and obtain an email address.
• Enter data online to verify an individual's information in the federal system. If verification was successful, we would proceed to the next step. More often than not, a patient's information cannot be verified through the online system, in that case, a paper application submission is required. The paper application, expectantly, takes longer to prepare and to receive a reply from, about one month as opposed to a real-time response if submitted online.
• Once all the information required is entered, the system will determine, based on those information, what plan(s), if any, the applicant may be qualified for.
• Social Services staff then would advise the patient on what plan to enroll that would best fit his/her needs. Enrolling in a plan is a separate process and takes additional time. Most of the South Cove patients would be moved to a new plan called the Qualify Health Plan/Connector Health Plan, such as Neighborhood Health Plan, Tufts Network Health Plan and BMC Health Net Plan to name a few. To be knowledge about ACA and the many different plan options, all staff members went through an online training and passed an exam to be Certified Application Counselors.
• The process is not complete until the patient has successfully enrolled in a plan and received proof of enrollment.
• Besides devoting face-to-face time with each patient, Social Services staff works as a team to disseminate a plethora of information coming from the State, the federal government and commercial insurances to patients. Many of these publications are translated into Chinese and posted on the department's bulletin board. Power point presentation in Cantonese and Mandarin was also prepared and played on TV monitor for patients to watch while waiting to be seen.
• The department also contributed articles to the Sampan newspaper about ACA, the changes it would bring and what people with State subsidized plans should do.   

Quincy clinics Social Services staff

It could be quite a stress going through this process just once for the average person, imagine doing it for 6,000+ patients and about 1/3 of who require submission of paper applications. And very often, Social Services staff deal with more complex cases that call for more time, energy and resourcefulness. It is not a job for the faint of heart as everyone works under tight time constraint trying to see, on average, 200 patients a day at the Washington Street clinic, and about 150 at the two Quincy locations.

As the team of 15 works hard to tackle the task at hand during this stressful period, we want to offer our support and recognition for the tremendous job they have done and continue to do. Social Services department is an integral component of the South Cove experience; it is the bridge that connects the uninsured to affordable health insurances - a benefit and a right that should be afforded every resident.  

The new WIC card

On October 29, 2014, South Cove WIC program rolled out the new WIC Card, featuring the major transition from paper checks to a new electronic benefit card. It is a landmark change that did away with the old paper check system, which was more hassle.

WIC Director, Zhanglin Kong, expects a busy 3-4 months as the program transitions all the clients from paper to electronic. Once this phase is over, she expects to see increased efficiency and reduced workload on the staff in terms of issuing benefits, this would free up time and resources to enhance other aspects of the program such as nutritional counseling and referral services.

So far patients have responded very positively to the new card.   Besides the obvious advantage of being faster, easier and more convenient, the not-so-obvious benefit is that it lessens the stigma placed on the clients receiving the benefits. Kong explained that the traditional paper checks would take a cashier longer to process because one needed to separate the WIC items from the non-WIC items and ring them up separately, signature verification is also required to authenticate the check.  As a result, it often held up lines and put users in a very uncomfortable situation. She had personally heard of customers waiting in line complain about the long wait time. The new card should remove any uneasiness or stigma a client may have, as it works just like a credit/debit card, and greatly reduces the time one needs to spend at the register.

WIC Staff explaining the new card benefits to a client.

We are so glad that the Massachusetts WIC Program managed to come up with the necessary funds and resources to overhaul the ways benefits are delivered. The new card is a vast improvement from the old paper checks and based on the feedback, the South Cove WIC clients couldn't be happier!

# # #  

About South Cove WIC: the program started after 1972, it currently provides services to over 1600 clients and coming from over 400 household. It is the only Chinese speaking program out of the 34 WIC programs across the Commonwealth. It provides nutritional class/support to all eligible clients and provides referral services tailored to the individual's needs and those of the Asian American community in Chinatown and beyond.

About WIC: The Women, Infant and Children Nutrition Program is a free health and nutrition program that provides healthy foods, nutrition education, breastfeeding support and referrals to health care and other services for low-income pregnant, breastfeeding and postpartum women and children under age five. It is a federal program under the Department of Agriculture Food and Nutrition Service (USDA), but each State runs its own WIC program. 

On September 17, 2014, South Cove hosted an Art Exhibition/Reception putting on displaying over 150 pieces of artwork at its Quincy clinics on 435 Hancock Street and 88 Holmes Street. Hundreds of people beat the rush hour traffic to attend, including MA State Representative Tackey Chan, Malden Mayor Gary Christenson, James W. Hunt, Jr., President & CEO of the Massachusetts League of Community Health Centers, and Susie Sands, Vice President of the The Coulter Foundation.  Many community organizations, business partners and artists were also represented, as well as the South Cove Board of Directors and health center staff.  

Eugene Welch, April Tang, Harry Lee, Mai Du and Diana Jeong of the Asian Spectrum pose with Malden Mayor Gary Christenson.

Executive Director Eugene Welch and South Cove Board President April Tang talked about how the collection was put together by a committee that worked the L'Attitude Gallery's Betty Bothereau, who was handed the task of seeking talents from Asian artists regardless geographic locations. The collection featured work procured locally in Quincy and Boston by Chinese and Vietnamese artists as well as from artists abroad, such as Canada, Vietnam and China.

The collection showcased art in an impressive range of styles and mediums, including photography, oil and watercolor paintings, cotton textiles, quilts, yarn weaving and ceramic products. But to be selected, they all shared one common trait: engaging and the ability to capture the attention of visiting patients. The collection is a combination of traditional and contemporary Asian art with some western influence as many artists were born in their native country before making the US or Canada their adopted home. We also feel that it reflects the patient base of the health center: one that retained their Asian values but also assimilated to the American way of living. Some artists are part of the North America Art Association and a couple are of South Cove's very own: Dr. Minping Liu and Cai Lianzhen!

Everyone enjoyed the collection and many took the time to read the description of each artwork (there is signage with a description of each art piece in English, Chinese and Vietnamese). But the one that stood out the most and perhaps also the most eye-catching was the photograph of the Boston Chinatown Gate done by Eaden Huang, a local professional photographer specializing in wedding and landscape photography. It is the big center piece of the 435 Hancock Street clinic pharmacy area; the imposing photograph covers an entire wall and gives the spectacular illusion that one is right in Chinatown.   As a little souvenir, anyone interested could have his/her photo taken in front of the "gate" and take home the printed photo with them! 

Betty Bothereau, Photographer Huang, Eric Tiberi pose with the gate.

The purpose of the artwork is to provide warmth and comfort to those who seek services by surrounding them in a welcoming and peaceful environment. They are also tailored to the different patient population that we serve. For instance, the Pediatrics Department has artwork that are colorful, playful and engaging for both young and adolescent aged. Other departments have art pieces that alleviate stress, nervousness and provide engagement for the viewers.

It is our hope that everyone, patients, staff or casual visitors, will find the collection inviting and engaging and will enjoy it for many years to come! 

A strong community is built on strong partnerships; as a member of the Chinatown community, South cove values its relationship with its fellow CBOs (community based organizations). The health center supports the mission and cause of many organizations that share the common goal of enriching and enhancing the lives of our community members and their families.    

South Cove/South Cove WIC booth at the Oak Street Fair

Boston Chinatown Neighborhood Center (BCNC) Oak Street Fair: the fair was held on Saturday, September 27, 2014.  It is a staple among Chinatown family events. South Cove has been a long time sponsor of this great event designed to draw families and community members together. South Cove was the Watermelon Contest sponsor; the contest had 10 school-aged entrants eating watermelon as if it was their favorite food, and fittingly, the winner was awarded a giant watermelon!

South Cove staff at the Health & Wellness Fair

Thomas Crane Library in Quincy: on Saturday October 18, 2014, the library hosted a Health Matters at your Library:  Wellness Fair.  South Cove was among the many local health and wellness organizations that participated in this event, including the Greater Boston Chinese Golden Age Center, Manet Community Health Center, Quincy Asian Resources, Quincy Medical Center, South Shore Elder Services and many others.

Asian Task Force Against Domestic Violence (ATASK) Silk Road Gala: the only organization dedicated to preventing domestic violence in Asian families and communities hosted its annual Silk Road Gala on Saturday, November 1, 2014, South Cove was there to support their incredible work and those who are victims of domestic abuse.

Eugene Welch and friends at the Silk Road Gala

The Wang YMCA of Chinatown Legacy Gala: the Wang YMCA celebrated its 100th Anniversary on Saturday, November 8, 2014. For any organization, celebrating a centennial is an incredible accomplishment; it speaks volume to its mission, the staff and the community it serves. Like South Cove, the Wang Y has relocated (it had its first home on Tyler Street that was the first indoor recreation space for Chinatown),

Wang YMCA presented supporters with a plaque

640 Washington Street, Brighton, MA 02135