Solicitation_No._BPM003737_Questionairre_-_Valleywise_Health (2).pdf

Solicitation No.: BPM003737

Attachment 2 – Executive Summary

Valleywise Health’s Administrative office is located at 2601 E. Roosevelt St., Phoenix, Arizona 85008.

We have eight Community Health Centers located in Avondale, North Phoenix, Maryvale, South Central

Phoenix, South Phoenix/Laveen, Guadalupe, Mesa, and Chandler as well as two Comprehensive Health

Centers located in Peoria and adjacent to our hospital and administrative offices. Additionally, Valleywise

Health has three Behavioral Health Centers located in Maryvale, Mesa, and on the main campus in

Phoenix.

Valleywise Health employs 3,793 full-time and part-time employees. We are considered a medium sized hospital with the number of beds between 100-499.

Valleywise Health is the only public teaching hospital and health care system in Arizona providing primary and specialty care services predominantly to underserved, low-income and ethnically diverse populations.

Areas of specialty care include podiatry, psychiatry, endocrinology, ophthalmology, cardiology, pulmonology, dental and eye, ENT (ear, nose, and throat), adolescent care, dermatology, infectious disease, gastroenterology, laboratory, pharmacy, and advanced diagnostic radiology.

Valleywise Health Medical Center (VHMC) is the leading public safety net health care system in Maricopa

County. Since its inception over 150 years ago, its mission has been to serve vulnerable and underserved populations, caring for a high proportion of racial/ethnic minorities and other marginalized communities, including refugees.

The Refugee Health Program at Valleywise Health has an exceptionally skilled and diverse team of providers, nurses, medical assistants, and cultural health navigators (CHNs). They have long-standing experience serving an average of 11,000 refugees over the age of 12 (per year) across the scope of

Women’s Health, Pediatrics, and Primary Care in a culturally, linguistically, and patient-centered care manner. One of the top recent projects the Valleywise Refugee Health Care team has designed, completed, and successfully implemented is the creation of COVID-19 health videos in eleven different languages with content focused on both preventative education and dispelling myths around vaccine hesitancy. This education is delivered in the teaching modalities preferred, acceptable and easily understood by the refugee community.

While the entire team is outstanding, the Refugee Women’s Health Clinic (RWHC) has a history of implementing Refugee Health Promotion programs. The RWHC has been the first to implement the

Refugee Health Screener (RHS-15) in Arizona since 2012.

The Refugee Women’s Health Clinic at VHMC has grown tremendously in the nearly 13 years since its inception, caring for over 9,000 women from 66 countries, representing 68 languages spoken across Sub-

Saharan Africa, South-East Asia, and the Middle East. The predominant refugee communities served are from the Great Lakes Central African region (encompassing the Democratic Republic of Congo, Burundi, and Rwanda), Iraq, Burma (Myanmar), and Somalia.

Arizona consistently ranks among the top U.S. states welcoming newly arrived refugee populations, resettling nearly 83,000 refugees since 1975. In 2008, the Refugee Women’s Health Clinic (RWHC) was founded, and it remains the first and only clinic of its kind in the state of Arizona to provide culturally grounded and linguistically appropriate reproductive and preventive health services to the growing refugee communities in the Phoenix Metropolitan region. The RWHC is nationally recognized, has received numerous awards, and has contributed various peer-reviewed publications including one on the utility of the Refugee Mental Health Screener (RHS-15). The Refugee Pediatric medical home and

Refugee Primary care were expanded and established officially and in 2012 and 2017 respectively, to provide holistic care to the entire refugee family.

Currently, VHMC’s Refugee Registry in our Electronic Health Record (EHR) reports 11,000 patients (over the age of 12,) have received care in the past 12 months.

Employees providing services for the Scope of Work in this proposal will be assigned from our

Comprehensive Health Center (CHC) located on our main Phoenix campus as well as our new West

Maryvale Integrated Behavioral Health Center.

Principal Contact:

Michael D. White, MD, MBA, Executive Vice President and Chief Clinical Officer

Valleywise Health

2601 E Roosevelt Street

Phoenix, AZ 85008

Phone: 602-344-5503

Valleywisehealth.org http://valleywisehealth.org/

Solicitation No.: BPM003737

Attachment 2 – Questionnaire Narrative Scope of Work

1. County for which this organization’s offer is for: Maricopa County

2. Experience providing services to the target population:

Arizona consistently ranks among the top U.S. states welcoming newly arrived refugee populations, resettling nearly 83,000 refugees since 1975. In 2008, the Refugee Women’s Health Clinic (RWHC) was founded at Valleywise Health, and it remains the first and only clinic of its kind in the state of Arizona to provide culturally grounded and linguistically appropriate reproductive and preventive health services to the growing refugee communities in the Phoenix Metropolitan region.

The Valleywise Health RWHC provides locally accessible, and comprehensive reproductive health services encompassing obstetric, gynecologic, and preventive health care, as well as family planning. A unique clinical niche of expertise and a referral base of patient-centered care for refugee families exists across very close partnerships with pediatricians, family medicine, and mental health service providers within and across our health care system. In addition, specialized care and expertise is offered for women with Female Genital Mutilation/Cutting, including surgical defibulation and reconstructive procedures.

Through this multi-disciplinary enterprise, comprehensive, family-centered health care services are anchored in the provision of locally accessible, culturally-grounded and linguistically-appropriate care navigation, while concomitantly nurturing and sustaining trusted, community partnerships and enhancing community capacity.

We employ multi-lingual Cultural Health Navigators (CHNs) who assist in providing health education activities and targeted health outreach to increase health literacy among eligible refugees with the most pressing health needs. CHNs work in each of our refugee service lines including Women’s Health, Internal Medicine, and Pediatrics. They speak up to 18 languages fluently and facilitate an integrated team-based approach to health care delivery which involves intensive care coordination and case management that engenders trust and empowers families towards enhanced health literacy and self-efficacy in navigating the health care system.

In one of the recent publications on the experiences of the patient in a dedicated RWHC, it demonstrated that, “Having trained medical interpreters who work as CHNs at the RWHC was a key driver of utilizing the clinic specifically. The women opined that because CHNs are women like themselves and belong to the same culture, nationality, and language, they are more open to communicate with them regarding their feelings, their health, and their other needs, which makes it easier for them to use prenatal care.”

(Banke-Thomas et al., 2017). In addition, Valleywise Health has been awarded previous DES Inter

Government Agreements contracts and the most recent grant was awarded in 2017. These contracts did allow the provision of community outreach and health literacy in various health care topics that refugee communities needed. More than 35 mental health clinicians mainly from Jewish and Family Children

Services (JFCS) were trained in cultural competency and Refugee Mental Health101. JFCS remains the major behavioral health agency RWHC partners with for eligible referrals. The same contract did allow

RWHC to establish relationship with Afghani refugee communities which resulted in hiring a Farsi CHN, to work closely with that community.

With Mercy Care Value Based Solutions funding support, from 2017 thru 2019 incorporating CHNs at

Valleywise Health which demonstrated improved quality outcomes and a cost-efficient program. Mercy

Care Health Plan (MCHP) members were identified for a baseline period from July 2017 – June 2018, comprising 156 distinct members/1,680 member months, and followed by a performance period from July

2018 – June 2019 comprising 161 distinct members/1,752 member months. Examining the rate of change between the baseline and performance periods, Emergency Department (ED) visits increased by 2.1%, however inpatient admissions decreased by 43.6%. Delivery of low birthweight infants (<2,500g) decreased by 10.6%, and early initiation of prenatal care increased by 26%. Timeliness of postpartum visits and newborn well child visits decreased by 10.9% and 2.4% respectively. Preliminary data among a very diverse subgroup of refugee women has demonstrated this program to yield improved maternal as well as perinatal outcomes, with resultant cost savings and return on investment, advancing health equity for vulnerable and marginalized communities.

In 2012, RWHC partnered with Pathways to Wellness to implement the Refugee Health Screener-15

(RHS-15) across its multi-ethnic refugee population. Details of the process of development and validation of the RHS-15 have been published (Hollifield, et al., 2013).

Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The Refugee Health Screener-15 (RHS-15) is a culturally responsive, efficient, validated screening instrument that detects symptoms of emotional distress across diverse refugee populations and languages (Johnson-Agbakwu et al., 2014).

The screener has been validated in many languages including, Farsi, Karen, Russian, Somali, French, Amharic, Tigrinya, and Swahili, Kinyarwanda, Burmese, Nepal, and Spanish. During the initial implementation of RHS-15, an interdisciplinary partnership was established with Jewish Family and

Children Services (JFCS), a local behavioral health services agency sensitive to the needs of refugee populations. A joint work plan was created to maximize the seamless integration of culturally appropriate evaluation and treatment modalities. Cross-cultural training sessions were held with staff, CHNs, therapists, and clinicians from the RWHC and JFCS, as well as the senior author, representing Pathways to Wellness; to provide orientation to the RHS-15, discuss the logistical process of screening, patient eligibility requirements, and referral processes. In addition, for patients referred for services, mechanisms were in place to ensure that their linguistic and transportation needs were met. This also provided an opportunity for the team to understand the processes that were in place by JFCS to provide mental health evaluation and treatment.

Following are some graphics that depict the services provided using RHS-15:

1) RWHC Updated Refugee Health Screener (RHS-15) Screening data

2) Total Positive Scores for referrals

3) Referrals vs Eligible for services

Total Positive Scores for referrals (2012 - July, 2021)

Number Percent

Eligible (Medicaid) 162 72%

Ineligible (Self-pay, Private insurance) 63 28%

Total 225 100%

The Use of the RHS-15 as a behavioral health screen for all refugees will enhance the understanding of their mental health service needs and facilitate referrals for targeted mental health services and interventions

5 8

22 21

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Yearly RHS-15 Screeners Completed: 2012 - July 31, 2021

Positive Negative Total

3. Describe how your organization will select relevant health topics, identify, and enroll the target population into classes and Mental Health case management Services.

An internal robust interdisciplinary partnership, alongside referral streams from Refugee agencies, and a community partnered approach, will be critical for the sustained success of enrollment and the provision of services to eligible recipients. To further serve those in the community, we will collaborate with Catholic

Charities for referrals to professional clinicians for refugee individuals on Refugee Medical Assistance

(RMA) and Mercy Care Insurance.

For those 60 years and older in the population, Valleywise will partner with the Area agency on Aging, and the Refugee Mosaic Elder Program for cross referrals and the delivery of those services. We have a long-standing relationship with AAA-RMEP, and training of the staff from both entities on the required deliverable will occur before services are delivered.

Prior to the implementation of the services, the RWHC will seek input from its established Refugee

Women’s Health Community Advisory Coalition (RWHCAC), infrastructure of community partnership engagement, and shared community leadership through its 60 individuals from community organizations including local ethnic community based organizations (ECBOs), refugee resettlement and voluntary agencies, mental health and social services agencies, as well as academic partners who serve as co-equal partners in the community outreach and engagement activities of the RWHC, informing the

RWHC’s initiatives, as well as facilitating the coordination of culturally competent care, services, and support.

During our intake process for new refugees, we use the RHS-15 (Refugee Health Screener) in one-on-one meetings to determine the direct services that may be required. Refugee’s will be given the opportunity to enroll into group or one-on-one educational sessions. In addition, the feedback will be continuously collected from participants using pre and post surveys. Subsequent classes will be adapted accordingly.

Referrals vs Eligible for Services (2012-7/2021

Eligible (Medicaid) Ineligible (Self-pay, Private insurance) Total

The Refugee Health Screener-15 (RHS-15) was developed by the Pathways to Wellness: Integrating

Community Health and Well-being project as a culturally responsive, efficient, validated screening instrument that detects symptoms of anxiety, depression, and PTSD across multiple refugee populations

(Hollifield, et al., 2013; Pathways to Wellness, 2011).

We plan to utilize Pathways to Wellness curriculum to choose appropriate health topics based on its adapted and validated curriculum. Mental health case management services will be coordinated through our CHNs who will provide an assessment using the RHS-15 screener. The CHNs will ensure culturally responsive and linguistically compatible mental health providers are identified and referrals are established.

4. Describe how your organization will provide classes and individual mental health case management services in a culturally and linguistically appropriate manner, ensuring that instruction is provided in a language that the clients understand. (Scope of Work, section 5.6).

Valleywise Health has a core team of CHNs who speak the languages of the refugee population in

Arizona (Arabic, Burmese, Chinese, French, Karen, Kiluba, Kikonga, Kinyarwanda, Kirundi, Lingala, Luganda, Maay-Maay,Somali, Swahili and Thai). Assigned CHNs will facilitate classes in participant’s languages. CHNs and an onsite Valleywise Health Licensed Master Social Worker (LMSW) will be trained on the curriculum to enable teaching in a refugee friendly environment. Mental health case management services are already a part of our CHN responsibilities. We plan to also train them in a Mental Health 101 course to be able to respond to needs identified during one-on-one meetings.

We plan to organize a training hosted by a Pathways to Wellness Founder or member for the Refugee Health Care team at Valleywise Health. This training will be extended to representatives from Maricopa County Public Health (MCPH) Refugee health screening, RA’s, community organizations, and Behavioral Health agencies from the main stream communities.

5. Describe your experience utilizing existing, user-tested, and validated curricula and developing curricula for health education activities (Scope of Work, section 5.7).

There is a need for community-partnered, culturally tailored interventions to provide health promotion education, dispel myths and reduce the stigma of mental health, while accentuating asset-based, strength models of resiliency and community social support (Johnson-Agbakwu et al., 2014).

Valleywise Health plans to use the Pathways to Wellness program as our core curriculum, which has been adapted and validated in refugee settings and is also appropriate for health education activities.

This curriculum will be reviewed with our internal Behavioral Health (BH) group to get input and will collaborate if any changes or edits will need to be incorporated. We will employ the use of Pre and Post surveys to be able to determine improvements or additional health education activities.

In 2015, Arizona State University-Global Center Health and Applied Research (ASU-GCHAR) funded the

RWHC to implement, “Aku Anyi Swastha” (Help for Health), an initiative to promote health literacy with the goal of understanding and addressing Burmese and Bhutanese health disparities. As a result, 11

Community Health Advisors (CHAs) were trained to deliver health educational classes. These CHAs also became Certified Applicant Counselors (CACs) enrolling over 318 in health care plans under the

Affordable Care Act (ACA). Although surveys from participants showed knowledge gained, 94% of participants indicated they would like to receive more information from their CHAs particularly in chronic disease management and mental health. Later, through funding from Arizona Department of Health

Services, Refugee Behavioral Health & Social Services program (ADHS-RBH SS), from 2016 thru 2017, RWHC collaborated and partnered with Catholic Charities in the in the provision of Pathways to Wellness support groups to refugees from Congo, Somalia, and Bhutan. As a result, a total of 44 Congolese and

Burundian refugees, 31 Somali women and 45 Bhutanese refugees successfully attended the Pathways

Adjustment Support Group sessions.

The RWHC developed additional health topics and relevant materials which will be handed out to participants in the following topics: Covid-19 prevention and treatment, resources for ethnic grocery stores, healthy eating, free low-cost clinics, and how to navigate the US Health Care System, etc.

6. Describe how your organization will ensure classes are easily accessible to refugees or that refugees have reliable transportation to the classes offered. (Scope of Work, section 5.9)

We plan to deliver classes in the areas close to where many refugees are housed in the following zip codes (85301, 85015, 85017, 85302, 85035). Valleywise Federally Qualified Health Centers (FQHC) clinics are in these communities as are our Integrated Behavioral Health services. Those not able to attend classes at the CHC will be able to attend classes at one of the FQHCs.

We plan to create a calendar of classes with projected venues based on accessible locations either at the

Valleywise Health CHC, where our refugee service lines are located (FQHCs), or within the community.

Coordination of reliable transportation is already incorporated into our case management process. CHN’s are trained to deliver one-on-one education and coaching. The outreach will target collaboration with new apartment complexes that are housing newly arrived refugees, presentations at Resettlement Agencies that receives those refugees, ECBOs and Churches and Mosques that serve the concerned groups.

7. Describe your organizations capabilities and capacity to provide all personnel and train them on the necessary information technology systems to perform the services in this contract.

(Scope of Work, sections 5.12 and 5.13)

Part of the New Employee Orientation classes at Valleywise Health is to train all personnel on the information technology systems used. This includes training on our electronic health system (EHR), and other software necessary to perform the required responsibilities.

All CHNs document encounters and are also equipped with necessary knowledge for scheduling all appointments and follow-up visits.

8. Describe how your organization will develop and implement a clear strategy to ensure outreach is targeted to enroll refugees with the most persistent, pressing or underserved health needs into RHP services, and your organization will provide health education classes based on the refugees needs. (Scope of Work, section 6.2).

Our current strategy consists of creating a schedule of outreach events monthly. A flyer is created and shared two weeks prior to community health education classes with ECBOs, RAs, church leaders, and ethnic grocery stores for posting. The outreach targets collaboration with new apartment complexes housing newly arrived refugees, presentations at RAs that receives those refugees, ECBOs and

Churches and Mosques that serve the recognized groups. In addition, each Friday, the CHNs perform outreach within the apartment complexes making contacts and handing out flyers.

As we enroll new refugees a priority will be placed on newly arrived refugees in the top refugee groups resettled such as refugees from the African Great Lakes region (DRC, Rwanda, Burundi) and the Afghani

SIVs and refugees admitted because of current crisis. The assessment tools are already available in the languages spoken by these groups (Farsi and Swahili). We will work to identify Behavioral Health professionals who come from refugee, immigrants, and migrant communities to partner with the provision of services as necessary.

We have a proven intake process performed by our CHNs that identifies the needs of refugees. A manual on the use of RHS-15 will be available for assigned CHNs to use. It explains the process of enrollment and screening and provides a script as a guide to introduce the Provider who will then assess for further behavioral health services before initiating a referral for necessary interventions.

A post screening is conducted by an on-site LMSW for the coordination of other social services needs including housing, employment, legal or immigration needs, intimate partner violence, and other therapeutic services

9. Describe your experience providing mental health navigation and support case management services (Scope of Work 6.5).

From the first time we implemented the use of RHS-15 at the RWHC, community engagement was an essential step in creating a ‘safe space’ for dialogue on mental health. It was important to glean from the community their perceived need for care and the receptivity to accessing mental health services. Hence community outreach and mental health education became a critical component of the implementation of this initiative which enabled the team to understand cultural and logistical challenges in reaching the refugee community. CHNs were an integral part of this process wherein educational seminars were held with key community members, refugee resettlement agencies, providers, and refugee women to discuss issues of distrust of the health care system and provide orientation to the historical background and culture of the various refugee communities.

The RWHC Program Manager has created curricula in different healthcare topics and a resource guide for different social and/or referral needs. These resources will be adapted as necessary and available for use by assigned CHNs.

We have an established intake procedure that includes assessment of Behavioral Health/Mental Health navigation. Routine coordination of care includes a mental health screener, behavioral health assessment, and if found necessary, referral to appropriate mental health providers both internally and externally based on language need and the concerns to be addressed. Our CHNs are coordinating many services including appointment set-up, transportation needs, assisting in enrollment for coverage, coaching and providing education of general health care services.

We currently maintain a database to track which services are being provided to each patient as well as their current goals, progress to goals, status of referrals, utilization of behavioral health services, and outcomes in terms of rate of cases considered graduated, loss of contact, closed, or still in service.

We are working with our Information Technology team to implement this as a charting mechanism built in our EHR. This will allow care teams to have to easy access to this information in order to facilitate comprehensive care coordination.

10. Explain how your organization will manage, utilize, and monitor the funding expenditures detailed in the Itemized Service Budget (Attachment 12) to maximize the services outlined in this Scope of Work. Describe your organization’s strategy to serve the highest volume of eligible participants.

The Grants Program Manager is responsible for aspects of the requirements of the contract. She will manage the components of the budget including collecting expenditures, time and effort sheets, and ensuring the Itemized Service Budget is monitored. Monthly, a finance review meeting is held with Grants

Accounting to review the budget spend-down and that all expenditures are recorded in the general ledger.

The Grants Program Manager will provide oversight of the Scope of Work and will collaborate with the

Refugee Health Clinic Program Manager to ensure outlined services and reporting requirements are met.

As mentioned above, we have a process to track deliverable progress for all enrolled participants. We will review the reporting deliverables in the linked reports and ensure that they are incorporated into our current process ensuring that required data is relayed.

As we deliver these services, the outcomes will be disseminated, shared, and spread throughout the community. As a result, the likelihood of receiving self-referrals will be high. It’s estimated that stablished patients will bring new patients because of the reputation of the services they receive.

Overall services will be monitored through a plan of care for the following outcomes: status of referrals, utilization of BH services, rate of completion of surveys, and classes and level of service completion

(graduated, loss of contact, closed or still in services). Services will be implemented in a culturally and linguistically manner and promoted to all eligible recipients and their respective affiliated community organizations, refugee agencies and refugee health providers.

We will rely on our outreach capabilities as well as our community partners who refer to us to provide culturally responsive care in all aspects of whole health care.