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Community Health Needs Assessment EMMA PENDLETON BRADLEY HOSPITAL

SEPTEMBER 30, 2019

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Table of Contents I. Introduction 3

a. DescriptionofCHNAPurpose&Goalsb. HistoryandMissionofEmmaPendletonBradleyHospitalc. CommitmenttotheCommunityd. EmmaPendletonBradleyHospital–WhatitDoes

II. EmmaPendletonBradleyHospital‐Definingthe

CommunityitServes 9III. Updateon2016CHNAImplementationStrategy 11IV. AssessmentofHealthNeedsoftheEmmaPendletonBradleyHospitalCommunity 18V. IdentificationoftheEmmaPendletonBradleyHospital

Community’sSignificantNeeds 25 VI. Conclusion 30

a. Acknowledgementsb. ContactInformation

Appendices 32

References 39

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I. Introduction

A. Description of CHNA Purpose & Goals

EmmaPendletonBradleyHospital(EPBH),whoseprimary location is inEastProvidence,Rhode Island, is a seventy‐bed non‐profit teaching hospital with university affiliationproviding for thepsychiatric treatmentof adolescentsand children, including somewithseveredevelopmentaldisabilities.EPBHoperatesseveralmajorprogramsincludingacute,partialhospitalization,residential,andoutpatient,aswellasTheBradleySchoolthroughitsnon‐profitsubsidiary,LifespanSchoolSolutions,Inc.(LSS),whichprovidesspecialeducationservices to children from preschool through high school. LSS also operates ten othersecondarysiteswhichfurnishresidentialandspecialeducationservices.Asacomplementtoitsroleinserviceandeducation,EPBHactivelysupportsresearch.EPBHisaccreditedbytheJointCommissiononAccreditationofHealthcareOrganizations.EPBHparticipatesasaproviderinRhodeIslandMedicaid,variousout‐of‐stateMedicaidprograms,andtheStateofRhodeIsland’sDepartmentofChildren,YouthandFamiliesprograms,aswellasprovidingcare for patients covered by private health insurers andmunicipal school departments.EPBHisalsoamemberofVoluntaryHospitalsofAmerica,Inc.

Effective March12, 1996, EPBH entered into an affiliation with Lifespan Corporation, aRhodeIslandnonprofitcorporation.EPBHcontinuestomaintainitsownidentity,aswellasitsowncampusanditsownname.Lifespan,thesolememberofEPBH,hastheresponsibilityforstrategicplanninginitiatives,capitalandoperatingbudgets,andoverallgovernanceoftheconsolidatedorganization.

InadditiontoEPBH,Lifespan'saffiliatedorganizationsalsoincludeRhodeIslandHospital(RIH) and its pediatric division, Hasbro Children’s Hospital (HCH), TheMiriam Hospital(TMH),NewportHospital(NH),GatewayHealthcare,Inc.(Gateway),andLifespanPhysicianGroup,Inc.(LPG),aswellasotherorganizationsinsupportofLifespananditshospitals.

Gateway is one of Rhode Island’s largest non‐profit behavioral health organization’sproviding behavioral health and substance abuse treatment as well as intervention andprevention services. Gateway’s primary purpose is to provide or arrange high quality,comprehensivementalhealthandsubstanceabuseservices.Gatewayprovidesawidearrayof integrated behavioral health care treatments as well as intervention and preventionservicestoadults,children,andfamiliesthroughitsresidential,outpatient,andcommunity‐basedprogramsthatreachmorethan25,000residentsannuallyinthirty‐eightlocations.In2010,thePatientProtectionandAffordableCareAct(PPACA)specifiedrequirementsforhospitals tomaintain recognitionas InternalRevenueCodeSection (IRC)501(c)(3)non‐profit hospital organizations. 1 Among many financial requirements, these regulationsincludearequirementtoconductaCommunityHealthNeedsAssessment(CHNA)atleasteverythreeyearsandtoadoptanimplementationstrategytomeetthecommunityneedsidentified in the CHNA. 2 CHNAs must solicit feedback from certain members of thecommunity to determine themost pressing health needs of the community the hospital

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serves.Thisincludes,amongothers,membersofmedicallyunderserved, low‐income,andminoritypopulations in the community servedby thehospital facility. CHNA regulationsspecifythataCHNAshouldaddressnotonlyfinancialbarrierstocarebutalso“theneedtoprevent illness, to ensure adequate nutrition, or to address social, behavioral, andenvironmentalfactorsthatinfluencehealthinthecommunity.”3EPBHconducteditsfirstCHNA,datedSeptember30,2013,whichcoveredthefiscalperiodfromOctober1,2010throughSeptember30,2013,tobetterunderstandtheindividualandcommunity‐levelhealthconcernsofthepopulationitserves.Thisprocessandtheresultantfindings were achieved through an effort to involve the community in determining thesignificantneedswithinthecommunityofEPBH. TheCHNAencompassedintensivedatacollectionandanalysis,aswellasqualitativeresearch.Thisprocessconsistedofinterviewswith members of the community and surveys of more than 100 internal and externalstakeholders, includinghospital‐basedphysicians,nurses, socialworkers, administrators,otherprofessionals,andcommunity‐basedstakeholdersrepresentingconstituenciesservedby EPBH.4The 2013 report and implementation strategywas distributedwidely amongLifespanstakeholders,communitypartners,andthegeneralpublic.DatacollectedproducedanimplementationstrategytoaddresssignificantneedsspecifictothecommunityservedbyEPBH.Progressontheimplementationisreportedinthe2016CHNA.Lifespan, on behalf of EPBH, conducted its second CHNA, covering the three‐year fiscalperiodfromOctober1,2013throughSeptember30,2016.ThegoalsofthatCHNAwereto:(1)provideareviewofwhatEPBHhadaccomplished inaddressingthesignificantneedsidentifiedinitsimplementationstrategyincludedinEPBH’sinitialCHNA,datedSeptember30,2013;(2)todefinethecommunitythatEPBHserves;(3)toassessthehealthneedsofthatcommunitythroughvariousformsofresearch,communitysolicitation,andfeedback;(4)toidentifywhichofthoseneedsassessedareofmostsignificancetothecommunity;(5)and toprovidean implementationstrategy thatdetailedhowEPBHwouldaddress thosesignificantneeds.ThisreportrepresentsthethirdCHNAconductedbyLifespanonbehalfofEPBH,coveringthefiscalperiodfromOctober1,2016throughSeptember30,2019.ThegoalsofthisCHNAarethesameasthoseoutlinedabovefor2016.TheimplementationstrategytobepresentedasaresultofthisCHNAwillbeusedorganizationallytoguidehospitalstrategicplanningoverthenextthreeyears(October1,2019throughSeptember30,2022).

B. History and Mission of Emma Pendleton Bradley Hospital Asamemberof theLifespanhealthsystem,EPBH iscommitted to itsmission:Deliveringhealth with care. EPBH is the nation’s first psychiatric hospital devoted exclusively tochildren and adolescents. As a Lifespan affiliate and a teaching hospital for TheWarrenAlpertMedicalSchoolofBrownUniversity,EPBHhasestablisheditselfasthenationalcenterfortrainingandresearchinchildandadolescentpsychiatry.EPBHparticipatesintheBrownResidencyProgram inPsychiatry and in theChild andAdolescentPsychiatryFellowship.EPBHwasfoundedin1931byGeorgeandHelenBradley,whohaddesperatelysearchedformentalhealthservicesfortheirdaughter,EmmaPendletonBradleyasshehadbeenleftwith

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neurologicalconditionsaftercontractingencephalitisattheageofseven.Today,EPBHisaseventy‐bed,nonprofitteachinghospitalthatprovidesacuteinpatientcare,outpatientcare,and partial hospitalization for infants, children and adolescents – including treatment ofseveredevelopmentaldisabilities–atitsprimarylocationinEastProvidence,RhodeIsland.EPBHalsooffersresidentialservicesatsevenfacilitieswithinRhodeIsland.AcoreprincipleofEPBHistoprovidearangeoffamily‐focused,highqualitymentalhealthcare to infants, children, adolescents and young adultswith emotional disorders and/ordevelopmentaldisabilities.EPBHiscommittedtoexcellenceintrainingandresearchandtoimprovingthehealthstatusofthecommunityaspartofacomprehensive,integrated,andaccessiblehealthcaresystem.Table1describesEPBHstatisticsduringthefiscalyearendingSeptember30,2018.

EPBHisthesolecorporatememberofLSS.LSSprovides special education services, clinicalcoordination, technical assistance, andadministrative support for special educationclassrooms within Rhode Island andConnecticutschools.In 2017, Lifespan launched its new sharedvalues that define how services are providedacross all affiliates – compassion,accountability,respect,andexcellence–four

wordsthatformtheacronymC.A.R.E.andsuccinctlycapturethesubstanceofitsmission,Delivering healthwith care. This acronym serves as EPBH’s “true‐north” guide, helpingLifespanbecomethebestplacetoobtaincareandthebestplacetowork.Furthermore,Lifespanidentifiedeightcoreprioritiesthathelpfocusitseffortsonstrategiesthatadvanceitscommitmenttoimprovingthehealthandwell‐beingofthepeopleofRhodeIslandandsoutheasternMassachusetts. ADVANCINGACADEMICS&RESEARCH:Advanceclinicaloperationstotrainthenext

generationofclinicians,aswellasadvanceresearchandthescienceofmedicine. COMMITMENT TO THE COMMUNITY: Enhance corporate visibility; improve the

healthandwellnessofthecommunitiesLifespanserves. COST:Continuetoworktoreduceoverallcostofcare. PHILANTHROPY: Cultivate community relationships to enhance charitable

contributionsmadetoLifespantoadvancethemissionandvisionoftheorganization. PHYSICIAN PARTNERSHIP: Achieve outstanding collaboration with the system’s

alignedphysicianpartners. QUALITY AND SAFETY: Achieve and maintain top decile performance in quality,

safety,andpatientexperience. VALUE‐BASEDCARE:Continuallyimprovequalityandcontrolcosttodrivethevalue

imperative. WORKFORCE:Recruit,retain,andengagetoptalentthatisalignedwithLifespan’s

sharedvaluestoprovideanextraordinarypatientexperience.

Table 1‐ EPBH Statistics, FY 20185

Year founded 1931

Employees 814

Affiliated physicians 121

Licensed beds 70

Patient care Patient discharges 1,137

Outpatient visits 3,104

Home health care visits 2,495

Financials ($ in thousands)

Total assets $126,967

Net patient service revenue $64,882

Research funding revenue $6,309

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C. Commitment to the Community AsanationalleaderinchildpsychiatricserviceswithdeepRhodeIslandroots,EPBHiswellpositionedtoidentifyemergingtrendsandneedsthataffectitscommunity.Thecommunity’sneeds are reflected in the experiences of the young people in EPBH’s care and revealedthroughtheclinicalinsightsandresearchoftheacademicphysiciansandotherstaffwhofuelthehospital’swork.EPBHcontinuouslyworkswithcommunityhealthcenters,theRhodeIslandDepartmentofHealth(RIDOH),RhodeIslandDepartmentofChildren,YouthandFamilies(DCYF),RhodeIslandDepartmentofBehavioralHealth,DevelopmentalDisabilitiesandHospitals(BHDDH),RhodeIslandDepartmentofEducation,schools,andtheresearchandadvocacygroupRhodeIslandKidsCounttodeepenitsunderstandingofemergingandexistingneeds.EPBHoffersnumerousservicestothecommunity,including:

24‐houremergencyevaluations; Supportgroupsforparentsandsiblings; Parent,teacher,andchildcareprovidertraining; Consultingservicestoschoolspecialeducationdepartments; Training forprofessionals fromacrossthecountry inchildpsychiatry,psychology,

socialwork,nursingandrelatedfields; Collaborationandsupporttocommunityadvocacyandresourceorganizations; Extensiveresearchprogramsandprojectsinchildren’smentalhealth;and Advocacyforchildrenwithpublicrepresentativesandagencies.

Severalclinicalserviceshavebeenlaunchedorexpandedindirectresponsetocommunityneedinrecentyears–fromthetransferofsixbedsfromEPBH’sdevelopmentaldisabilitiesunit(DDU)toitsadolescentunit,inresponsetoincreaseddemandforadolescentservicesandconcomitantreductioninlengthofstayforDDUservices,toincreasingthenumberofphysiciansonstaffinresponsetoheighteneddemandforoutpatientservices.

EPBHisdeeplycommittedtoensuringthatallchildrenandfamiliesinneedhaveaccesstolifesaving and life‐enhancing mental health services, and substantially subsidizes andsupports comprehensive mental health evaluation and treatment in outpatient, daytreatment,home‐based,school‐based,andresidentialprograms.EPBHalsoprovidesmanyother services – including patient advocacy and foreign language translation, andmanyeducationaleventsandsupportservices–atnocharge.

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DuringthefiscalyearendedSeptember30,2018,EPBHprovidedmorethan$8.2millionincharity care and other community benefits for its patients, which accounted forapproximately8.6%of total operatingexpenses.EPBHbillsuninsuredandunderinsuredpatients using the prospectivemethod,whereby patients eligible for financial assistanceunder EPBH’s Financial Assistance Policy are not billed more than “amounts generallybilled”,definedbytheInternalRevenueCodeSection§501(r)astheamountMedicaidwouldreimburseEPBHforbilledcare(includingboththeamountthatwouldbereimbursedbyMedicaid,andtheamountthebeneficiarywouldbepersonallyresponsibleforpayingintheform of co‐payments, co‐insurance, and deductibles) if the patient was a Medicaidbeneficiary.7TheLifespanCommunityHealthInstitute(LCHI),withamissiontoensurethatallpeoplecanachievetheiroptimalstateofhealththroughhealthybehaviors,healthyrelationships,andhealthyenvironments,workswithallLifespanaffiliatestoachievepopulationhealthgoalsand partners extensively with EPBH. For instance, LCHI and EPBH partner to deliverconferencesandworkshopsforparentsandprofessionalsonmentalandbehavioralhealthtopics.Lifespan, through theLCHI andaffiliates, coordinateshundredsofprograms, events, andcommunity service activities that serve between 25,000 and 30,000 southern NewEnglandersannually.Programsareofferedforfreeoratareducedcosttothecommunityandnon‐profitorganizations.8Inpartnershipwithcommunity‐basedagencies,LCHIledthedesignanddevelopmentofthe2019CHNA.Communityandpatientengagementarecriticalcomponents of quality improvement andstrategicplanningforLifespanCorporationandits affiliated hospitals. Lifespan launched awebsite, www.lifespan.org/centers‐services/lifespan‐community‐health‐institute/community‐health‐reports‐and‐resourcesinthespringof2016todescribeandpublicizetheCHNAprocess.Thissite,accessiblefromtheLifespanhomepage,ismaintainedandhouses each hospital’s CHNA report andimplementationstrategy.ThissitealsoservesasaconduittolinkcommunityresidentsandorganizationstoEPBH’shealth‐promotinginitiatives.9

Table 2. Net Cost of Charity Care and Other Community Benefits, FY 20186 ($ in thousands)

Charity care $18

Medical education, net $1,011

Research $785

Subsidized health services $1,272 Community health improvement services and community benefit operations $219

Unreimbursed Medicaid Costs $4,896 Total cost of charity care and other community benefits $8,201

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D. Emma Pendleton Bradley Hospital – Notable Achievements

EPBHoffersuniqueexpertiseinpsychological,developmental,andbehavioralconditionsofchildren and teens, with inpatient, outpatient, residential, partial hospital, in‐home, andcommunity‐basedprograms.NotableachievementsinclinicalservicesduringthereportingperiodsrepresentingthefiscalyearsendedSeptember30,2017‐2019include10,11: During the fiscal year ended September 30, 2017, EPBH established the Pediatric

PsychiatryResourceNetwork(PediPRN),a free telephoneconsultationservice fortheState’spediatricprimarycareproviders.

During the fiscal year ended September 30, 2018, EPBH expanded its residentialprogramfromfivehousestoseven,addingtheCompassHouseforadolescentgirlsand The Bradley Center, which provides services for adolescents dealing withsubstanceuse.

EPBHopenedtheVerrecchiaClinicforAutismandDevelopmentalDisabilitiesduringthe fiscal year ended September 30, 2018 for children who have behavioral oremotional challenges along with a developmental condition such as autism orintellectualdisability.InSeptember2019,theVerrecchiaClinicwasexpandedtoofferservicestoadults,especiallyforindividuals18to21yearsofagetransitioningfromyouthservicestoadult.

EPBHestablishedtheCo‐occurringDisordersProgramduringthefiscalyearendedSeptember30,2018,anintensiveoutpatientservicethatprovidescaretoadolescentswhoarestrugglingwithawidevarietyofmentalhealthandsubstanceuseissues.

NotableachievementsinresearchduringthereportingperiodsrepresentingthefiscalyearsendedSeptember30,2017‐2019include12:

ThePediatricAnxietyResearchCenterattheEPBH/HCHResearchCenterreceiveda$3.4millionawardduringthefiscalyearendedSeptember30,2018fromthePatient‐CenteredOutcomesResearchInstitutetocomparepatient‐centered(in‐home)andprovider‐centered (in‐office) outpatient treatment for children with anxiety andobsessive‐compulsivedisorder.

The EPBH/HCH Research Center bucked the trend of declining federal researchfunding. During the fiscal year ended September 30, 2018, the center saw a fivepercent year‐over‐year increase in federal funding, garnering $25.4 million tosupportseventeennewmulti‐yearprojects.

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Notable achievements in safety, quality, and patient‐centered care during the reportingperiodsrepresentingfiscalyearsendedSeptember30,2017‐2019include,1314:

GatewayandEPBHmergedtheirMentalHealthFirstAideducationprogramsduringthefiscalyearendedSeptember30,2017.

Forthesecondtime,Lifespan’sfourhospitals:RIH,TMH,EPBH,andNH,achievedTopPerformerstatusontheHealthcareEqualityIndex(HEI)duringthefiscalyearendedSeptember30,2018,anationalbenchmarkofhospitals’policiesandpracticesrelatedtoequitableandinclusivetreatmentoftheirLGBTQpatients,visitors,andemployees.

NotablecommunityinvestmentsduringthereportingperiodsrepresentingfiscalyearsendedSeptember30,2017‐2019include15,16:

TheAutismProject,whose sole corporatemember is Gateway, holds its “ImagineWalk&FamilyFunDayforAutism”atGoddardMemorialStateParkannually.Theevent drew more than 8,000 participants each year and raised almost $500,000combinedbetween2017and2018.

DuringtheannualSeasonofGiving,initiativessuchasfoodandtoydrives,collectionsofwarmouterwear,andthegingerbreadhousekitsalewereorganizedtobrightentheholidaysforourneighborsinneed.AnewcollaborationwithOceanStateJobLotinNovember2018yielded50,000poundsoffoodtosupplylocalfoodpantries.

Aftermonthsofplanning,hardwork,andanoutpouringofcommunitygenerosity,EPBHdedicatedtheCarolA.PetersonWelcomeCenterinFebruary2018,theresultofa$2millionrenovationproject.Thepurposeoftherenovationwastomodernizethehospitallobbyareaandhelpimprovepatientprivacy.

II. Emma Pendleton Bradley Hospital– Defining the Community it Serves

EPBHislocatedinthecityofEastProvidence,RhodeIsland,inProvidenceCounty.However,becauseofitsuniqueservices,EPBHservespatientsfromalloverthecountry.FamiliesfromacrosstheregionandthecountryseekconsultationandtreatmentfromEPBHbecauseofitsnational reputation. The largest concentration of EPBH’s patient population comes fromRhodeIsland’surbancorecluster,whichconsistsofProvidence,Cranston,Warwick,CentralFalls,Johnston,NorthProvidence,andPawtucket.17Mentalandphysicalhealthofchildrenandyouthisgreatlyinfluencedbyenvironmentalandsocioeconomic factors, including family household income. In 2018, nearly 20% of allchildreninRhodeIsland,and24.8%ofchildrenundersix,werelivinginpoverty.InthecityofProvidence,39.7%ofchildrenwerelivinginpoverty,and18.8%werelivinginwhatisconsideredextremepoverty.18Childreninpovertyisdefinedasthepercentageofchildrenunderageeighteenwhoarelivinginhouseholdswithincomesbelowthepovertythreshold,asdefinedbytheU.S.CensusBureau.In2014RhodeIslandrankedtheworstamongotherNewEnglandstatesintermsofchildrenlivinginpoverty.19

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Table 3‐ Children Under Age 19 Treated at EPBH

October 1, 2017 – September 30, 2018 (FY 2018)20

# Treated Avg. Length of Stay # Treated Avg. Length of Stay

General Psychiatric Services Developmental Disabilities Program

Inpatient 773 23 days 141 42 days Compass/EPBH Center Residential 188 48 days 35 69 days

Partial‐Hospitalization 727 22 visits 106 22 visits

Home‐Based 0 n/a 20 26 visits

Outpatient 1,363 Data not available 63 Data not available

EPBH utilizes twomain approaches for treating its patients, the first is through generalpsychiatric services, and the other is through its Center for Autism and DevelopmentalDisabilities Program (CADD). The CADD provides clinical services for children andadolescentswhohaveadevelopmentaldisabilitysuchasautism,Asperger’sorintellectualdisability,whoareexperiencingseriousbehavioraloremotionalissues.21EPBH’soutpatientencounters are divided among its partial‐hospitalization program, residential program,home‐basedcare,generaloutpatientcare,andschool‐basedprograms.Duringthefiscalyearended September 30, 2018, EPBH had encounters totaling 1,133 inpatients, 719 partial‐hospitalization,2,139outpatient(AccessCenter),192outpatientresidential,and190home‐basedoutpatient.84%ofallinpatientsduringthefiscalyearendedSeptember30,2018wereresidents of Rhode Island, while 3% were residents of Massachusetts. Among RhodeIslanders,37%livedintheurbancore(19%fromProvidence,9%fromCranston,5%fromPawtucketand4%fromWarwick).22DuringthefiscalyearendedSeptember30,2018,87%ofthepartial‐hospitalizationpatientswereresidentsofRhodeIsland,43%ofwhichresidedintheurbancore.Inthatsameyear,95%oftheresidentialprogrampatientswerefromRhodeIsland,with55%residingintheurbancore.Allhome‐basedpatientsduringthefiscalyearendedSeptember30,2018wereRhodeIslandresidents,54%beingfromtheurbancore.Eighty‐fourpercentofthegeneraloutpatientvisitswerefromRhodeIsland,36%ofwhomcamefromtheurbancoreand19%ofwhomwerefromtheInterstate195CorridorRegion,includingEastProvidence,Lincoln,and Cumberland, Rhode Island, as well as Attleboro Massachusetts. The Bradley SchoolpopulationwaslargelyfromRhodeIslandaswell(73%),withmoststudents(32%)residingintheEastBayRegion,which includesFallRiverandWestport,MassachusettsaswellasNewport,Middletown,andPortsmouth,RhodeIsland.23DuringthefiscalyearendedSeptember30,2018,21%ofinpatientsidentifiedasHispanicorLatino.OfinpatientswhodidnotidentifyasHispanicorLatino,74%identifiedtheirraceasWhiteand15%identifiedtheirraceasBlackorAfricanAmerican.Approximately15%ofalloutpatients identified as Hispanic or Latino. Of the non‐Hispanic or Latino outpatients,approximately80%identifiedasWhite.24

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III. Update on 2016 CHNA Implementation Strategy EPBHconductedaCHNAdatedSeptember30,2016thatresultedinanimplementationplanfortheperiodofOctober1,2016throughSeptember30,2019.Thecommunityhealthneedsassessment findings reflected significant community input garnered through communityforums, surveys, and key informant interviews. In addition, EPBH reviewed hospitalutilization data and public health trends to inform its selection of implementationpriorities.25The2016reportandimplementationstrategycoveringtheperiodsfromOctober1,2016through September 30, 2019 were distributed widely among Lifespan stakeholders,communitypartners,andthegeneralpublic.ProvidedbelowisanupdateonprogressmadeinaddressingeachofthesignificantneedsidentifiedintheSeptember30,2016EPBHCHNA.Access to Services in Clinical and Community SettingsCommunitystakeholdersinProvidenceCountyandstatewidecitedaspectsofaccesstocareasmajorchallengesfacingtheircommunities,particularlyamongpopulationswhoresideoutside of centralRhode Island.EPBHexpandedaccess to clinical and community‐basedservices tomeet demand. This included creating new collaborations to better serve thecommunity,allocatingresourcestohigh‐needservices,andcoordinatingcareacrossexistingprogramsandsettingswhereneeded.BelowareactionsEPBHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofaccesstoservicesinclinicalandcommunitysettings:

A. ExpandEPBH’sPediatricReferralConsultation (PERC) clinic toprovideadditionalpsychiatric consultation and care plans for children with various psychiatricdiagnosesandcomplexclinicalpresentations.

In response to the overwhelming demand for pediatric psychiatricconsultationacrosstheState,andinrecognitionofthelimitedpipelineofnewproviders, EPBH established the Pediatric Psychiatry Resources Network(PediPRN),afreetelephoneconsultationservicesfortheState’spediatriccareproviders,whichcreatedrealtimephoneconsultationservicestaffedbyourchildpsychiatristsforallpediatricprimarycareprovidersintheState.DuringthefiscalyearendedSeptember30,2018,PediPRNrespondedto398requestsforconsultation.

B. EffectiveJune2016,EPBHassumedoperatingresponsibilityfortheCaritasARTsProgramfromGatewayHealthcare.Theprogramisa16‐bedresidentialfacilitythatprovidesshort‐termintensivetreatmentforadolescentsaged12to17.

Clinically, EPBH expanded services in critical areas including co‐occurringdisorders(thosesufferingfromsubstanceuseandpsychiatricdisorders)withthe restructuringofCaritasARTs and the continuationof theCo‐OccurringIntensiveOutpatientProgram.

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InFebruary2017,EPBHopenedanintensiveoutpatientprogramatCaritas

ARTsforyouthwithco‐occurringdisorders.Theexpansionprovidesintensiveprogrammingtopatientsforafewhourseachday.InJune2017,theCaritasARTsprogramwasrenamedTheBradleyCenter.

C. Offer a co‐occurring substance abuse and psychiatric disorders clinic at the

AdolescentHealthcareCenter,locatedintheCoroCenterinProvidence,RhodeIsland. EPBHbeganprovidingservicesthroughtheAdolescentHealthcareCenterin

April2018andhassincetransitionedtheservicesbacktotheEPBHcampusaspartofitsoutpatientclinics.

EPBHopenedaco‐occurringpartialhospitalizationprograminOctober2017andhasexperienced steadygrowth in census.During the fiscalyearendedSeptember30,2018,EPBHservedanaveragedailycensusofthreechildrenandthroughthe firstelevenmonthsof the fiscalyearendedSeptember30,2019,thatfigurehasincreasedtonearlysevenchildrenperday.

D. ConsiderexpandingtheCADDOutpatientClinictoservechildrenagedfivethroughtwenty‐one.

InNovember2016,CADDlaunchedanewclinicforchildrenandyoungadultsagedfivetoeighteenwhohavebehavioraloremotionalchallenges,aswellasa developmental condition such as autism or intellectual disability; theVerrecchia Clinic for Childrenwith Autism and Developmental Disabilities.TheVerrecchiaClinicopenedinNovember2016andprovidestherapytohelpsolve problems related to behavioral health through individual and familytherapy,parenttraininginbehaviormanagement,psychiatricevaluation,andmedicationmanagement.Clinicalstaffincludespsychologists,socialworkers,a psychiatric nurse specialist, and a psychiatrist. In September 2019, theVerrecchiaClinic’sserviceswereexpandedtoalsoincludeadults.

TheCADDisaunique,specialtyprogramthatcaresforchildrenandyouthwithdevelopmental disabilities who have co‐morbid psychiatric problems orbehaviors.ThenewVerrecchiaClinicissignificanttoEPBHbecauseitaddsapreviously missing link of effective outpatient care within the existingcontinuum of services, which increases patients’ likelihood of success andreducesdependenceoninpatientservices.

E. EPBHwillassurethequalityoftheGatewayChildandFamilyTherapeuticOutreach

program,whichprovideseducationtofamilies,schools,teachers,andnursesinbestpracticesaroundtherapeuticoutreach.

In collaboration with HCH and Gateway, EPBH continued to operate anOutpatient Clinic for children, including specialty services in Autism andDevelopmental Disabilities that launched during the fiscal year endedSeptember30,2017.

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EPBHprovidesclinical supervisionandqualityoversightbydoctorate‐levelclinicians including psychologists, a psychiatrist, and social workers. Thisrepresents an effort to streamline care coordination and improve qualityacrossthecontinuumofLifespanservicesandsystems.

TheOutpatientProgramservesover1,400clientsandprovidesover7,200outpatient visits annually. Services include individual and family therapy,parenttraininginbehaviormanagement,andmedicationmanagement.

F. Exploreexpansionofthehome‐basedIntensiveBehavioralTreatment(IBT)program. IBTprovidesinnovativetreatmentservicesforchildrenwithautism,helping

ouryoungpatientstolearnandgrow,andassistingtheirfamiliesinmanagingthemultitudeofstressorsassociatedwiththedisorder.

This program previously served fifteen families per year with intensiveservicesforten‐twentyhoursperweek.EPBHhasdoubledthecapacityoftheprogramtoserveuptothirtyfamiliesperyear.

G. EPBHhasappliedtomanagetwoGatewayresidentialprograms.IfapprovedbytheState ofRhode Island,EPBHwill takeovermanagementofBlackstoneAdolescentCounseling Center and LincolnHouse during the fiscal year ended September 30,2017.

EPBH was approved to manage two Gateway residential programs‐BlackstoneAdolescentCounselingCenterandLincolnHouse.TheBlackstoneAdolescentCounselingCentersubsequentlyclosedandtheLincolnHousewasrenamedTheCompassProgram‐Lincoln.TheCompassProgram‐Lincolnisashort‐term, community‐based residential treatment programwith a censuscapacityofeightadolescentgirlsaged13‐18strugglingwithseriousemotionaldisorders,andalsoincludestheirfamilies.

The Compass Program follows a Dialectical Behavior Therapy‐Adolescent(DBT‐A) empirically validated treatment model.The treatment hasdemonstrated efficacy in caring for a variety of challenging behaviorsincludingself‐harmaswellasproblemswithmoodandanxiety.

This residential program allows patients to receive services in‐state thatpreviouslyrequiredgoingout‐of‐stateforcare.

H. TheAutismProject(TAP),anaffiliateofGateway,haslaunchedProjectIDENTIFY,aprogramdesignedtoimproveRhodeIsland’ssystemofcareintegrationforchildrenand youth who have an Autism Spectrum Disorder (ASD). TAP helps facilitate acollaborationofparents,providers,andcommunitymemberswhoprovidequalitysupport,training,andprogrammingthatisaccessibletochildrenandadultswithanASD.

TAPwasawardeda three‐yeargrant for$1.26million, covering theperiodfromSeptember2016throughAugust2019,fromtheHealthResourcesandServiceAdministrationtolaunchProjectIDENTIFYinpartnershipwithEPBH.ThenameoftheprogramhassincechangedtoCreatingtheConnections,tobemorewelcomingtofamilies.Thegoaloftheprogramistoincreaseparentand

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medical tracking of development; raise awareness of when a child is notdemonstrating typical development; and teach providers how to refer andsupportafamilytogetscreening,evaluation,diagnosis,andappropriatecare.

Through “Creating the Connections”, TAP’s Family Support Specialists andCommunityEngagementstaff,withmultilingualcapacity,havebeenengagedby1,151parents,154grandparents/guardiansand449professionals.TAP’sstaff have provided support to families, met with families one‐on‐one,providedaidinnavigatingresources,andmadeover2,000supportcalls.

The Family Support Team has trained 3,170 parents, professionals, andcaregivers, facilitated parent‐to‐parent training and performed communityoutreach and education to members of the early childhood community,includingstaffatHeadStarts,pre‐schools,daycarecenters,in‐homeproviders,andcommunitymembersonwhattypicalchilddevelopmentlookslikeusingthematerialsfromthe“LearntheSigns,ActEarly”developmentalprogram.

TAPandEPBHcollaborateonevaluationandoutcomereportingfor“CreatingtheConnections”.TAPalsosecuredfundingtoestablishasecondlocationintheEastBayarea,andtosupportincreasedoutreachtofamilies,children,andadultswithautism,viatraining,supportgroups,educationalprograms,andadrop‐incenter.

I. EPBHwillcontinuetopartnerwithLCHItooffereducationalandtrainingprograms

for families, including parent support groups, Temas Familiares, and ParentingMattersconferencesandworkshops.

EPBHandLCHIofferedamultitudeofprograms reachingmore than1,000residentsoftheservicearea,including:o ParentingMattersWorkshoponOctober19,2017,123participantso TemasFamiliaresConferenceonNovember4,2017,42participantso ParentingMattersWorkshoponNovember9,2017,50participantso “UnderstandingtheOpioidEpidemicinRI:TreatmentChallengesand

Strategies”communitylectureonFebruary3,2018o ParentingMattersConferenceonMarch24,2018,240participantso ParentingMattersConferenceonMarch23,2019,196participantso TemasFamiliaresWorkshoponMay4,2019,42participantso “WorkingwithGrievingChildren,Teens,andFamilies”community

lectureonJune11,2019o “CulturalConsiderationswhenWorkingwiththeLatinoPopulation”

communitylectureonJuly9,2019

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J. The Bradley Learning Exchange will continue to provide increasing numbers oftraining opportunities for caregivers and families, health professionals, andcommunitymembers.

TheBradleyLearningExchangemovedintoanexpanded11,000squarefoot.trainingfacilityintheEastProvidencecommunityinMay2018.Thisfacilitysupportedthehiringofadditionalbehavioralhealtheducationstaff,whichhasresultedinanincreaseintrainingopportunitiesforcaregiversandfamilies,professionals,andcommunitymembers.

From January 2018 through August 2019, the Bradley Learning Exchangeprovided over 20,000 hours of educational experiences to clinicians,educators,careproviders,firstresponders,andmembersofthecommunityatlarge.TheBradleyLearningExchangeofferedthefollowingprogramming:

o BradleyConference;o DepartmentofBehavioralEducation;o TheBradley/GatewayMental‐HealthFirstAid;o TheCenterforEvidence‐BasedPractice;ando BradleyOnlineLearning

“Bradley Conference” educational presentations for clinicians includingpsychologists, social workers, physicians, nurses, certified counselors,speech/languageandoccupationaltherapists,andteachers.Duringthefiscalyear ended September 30, 2018, eight conferences were held, with 402participantsfromRhodeIslandandfiveotherstates.

MentalHealthFirstAid(MHFA)consistentlyexpandedthecoursesofferedandparticipants served during the reporting period. Classes increased fromtwenty‐one (302 participants) during the fiscal year ended September 30,2017, to thirty‐three (511 participants) during the fiscal year endedSeptember30,2018,andthendoubledtosixty‐sixclasses(1,062participants)heldduringthefiscalyearendedSeptember30,2019.

TheCenterforEvidence‐BasedPracticecontinuestofocusontrainingchildprovidersandparentsbymakingthevariouscurriculaoftheevidence‐basedIncredibleYearsmodelavailableinthecommunity.

Emergency Department Evaluation BelowareactionsEPBHtookbetweenOctober1,2016andSeptember30,2019toaddresstheidentifiedsignificantneedofEmergencyDepartmentevaluation:

A. ContinuetoofferCrisisServiceatEPBHtoevaluatechildrenwithinforty‐eighthoursofcontactingthehospital.

EPBHcontinuestoevaluatechildrenwithin48hoursofcontactingthehospitalthrough its Access Center. This service helps to stabilize crises and referschildrenandtheirfamiliestoappropriate,lessintensiveservices.Childrenandtheir families are seen by a multidisciplinary team, which includes achild/adolescent psychiatrist, a senior clinical psychologist, and severaltrainees.Outpatientevaluationandtreatmentforyoutharealsoavailablefor

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familieswhohavetransitionedfromamoreintensiveserviceatEPBH.FortheperiodbetweenOctober1,2016andSeptember30,2019,theAccessCenteraveraged150evaluationspermonth.

B. ContinuetoprovidetheKids’LinkRIhotline.

In2016,Kids’LinkRIbecameavailable24hoursaday,sevendaysaweek,forchildrensufferingfrombehavioralproblemsorpsychiatricillness.Thehotlineconnectsparentsandcaregiverstochildren’smentalhealthservicesinRhodeIslandandhelpsfamiliesdeterminethebestplacetogofortreatment.Withthis free, confidential hotline, parents and caregivers can dial a toll‐freenumber,andconnectwithemergencyservicecliniciansorreceivedirectionabout the appropriate next step for managing their crisis. Kids’ Link RIincreasestheaccessibilityofreal‐timepsychiatricconsultationforcaregivers,families, and medical professionals, reducing unnecessary wait times andimprovingcontinuityofcare.

EPBHcontinued toprovide theKids’LinkRIhotlineduring the fiscalyearsended September 30, 2017 through September 30, 2019 and promoted itwithin schools and pediatric practices, as well as using general marketingstrategies.

DuringthefiscalyearendedSeptember30,2018observeda100%increasefromthepreviousyearinKids’Linkurgentphonecontactsto5,574calls.

C. ProvidePsychiatricEmergencyServices(PES)atHCH.

Since the 2013 CHNA, EPBH has worked with emergency departments toimprove the coordinationof emergencydepartment evaluations andbettermanage mental and behavioral care for pediatric emergency departmentpatients.EPBHprovidesclinicalstaffing,includingapsychiatristwhoservesas theMedical Director of HCH’s pediatric psychiatric emergency services.TheEPBHKidsLinkprogramhasbeenworkingwiththeHCHBridgeClinictofostercontinuityofcare.InearlyNovember2019,EPBHwillcontinuetoworkwithHCHonthenewPACE(Psychiatry,Access,Continuity,andEvaluation)Clinic at HCH, to divert children from higher levels of carewhile initiatingtimelyandappropriatelevelsoftreatment.ThePACEClinicwillreplacetheBridgeClinicandwillexpandservices.

EPBHcontinuedtoprovideemergencypsychiatricevaluationsintheAccessCenterandatHCH,withlinkagestotreatmentprogramsforneededfollow‐upcare.

o DuringthefiscalyearendedSeptember30,2017:2,017evaluationsbytheAccessCenterand645atHCH;

o DuringthefiscalyearendedSeptember30,2018:1,814evaluationsbytheAccessCenterand709atHCH;and

o ThroughAugust31ofthefiscalyearendingSeptember30,2019:1,431evaluationsbytheAccessCenterand648atHCH;

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The HCH PESworks closelywith EPBH and Gateway to create linkages tocommunity‐basedtreatment,strivingtoprovideefficient,qualitycareintheleastrestrictiveenvironmentpossible.

D. Offer the SafeQuest program as a practical alternative to hospitalization and

traditionaloutpatientservices. SafeQuest is an intensive afterschool program to prevent recurring suicide

attempts and other unsafe behaviors among adolescents. The goals of theprogramaretoprovideanalternativetohospitalization,shortenthelengthofstay for hospitalized adolescents, and prepare adolescents for long‐termoutpatientservices.

o During the fiscal year ended September 30, 2018, 108 individualsreceivedservicesthroughtheSafeQuestprogram.

E. Explore the potential to provide services to rural communities in Rhode Island

throughtelemedicine. EPBHoutpatientserviceshavegrowntoaccommodateincreasedrequestsfor

services,whichnowsurpass45,000peryear.EPBH’spsychiatricoutpatientservices for children are available at RIH and NH from amultidisciplinarygroupofboard‐certifiedpsychiatrists,psychologists,clinicalnursespecialists,andsocialworkers.

Despite EPBH’s growth in capacity, there was still unmet demand foroutpatientservices,soLifespanlaunchedatelemedicineserviceforpediatricpsychiatryinCharlestownandWashingtonCountyinApril2018.PsychiatristsbasedinNewport,RhodeIslandareaccessiblethroughaGatewayoutpatientbuildinginWashingtonCounty.

EPBHintendstousetelemedicinetoprovideaccesstochildpsychiatrytoTMHandNHEmergencyDepartments,whichcurrentlydonothavethisresourceavailable.

Transition Services for Children Who Age Out of Pediatric Care BelowareactionsEPBHtookbetweenOctober1,2016andSeptember30,2019toaddressthe identifiedsignificantneedof transitionservices forchildrenwhoageoutofpediatriccare:

A. EPBHwillcontinuetoincreasecommunityandpatientoutreachrelatedtoresourcesavailabletofamilieswhoaretransitioningfrompediatrictoadultcare.EPBHwillalsoensurethatavailableresourcesarecurrentandaccessible.

In September 2016, EPBH established the Pediatric Psychiatry ResourcesNetwork (PediPRN), a free telephone consultation services for the state’spediatric care providers, creation of real‐time phone consultation servicestaffedbyourchildpsychiatristsforallthepediatricprimarycareprovidersin the State. During the fiscal year ended September 30, 2018, PediPRNrespondedto398requestsforconsultation.

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B. EPBHwill continue toworkwith RIH and the Department of Child Psychiatry toprovideclinicalservicestoresidentsoftheRhodeIslandTrainingSchool.

Clinical work to residents of the Rhode Island Training School is handledthroughRIHandtheHCHDepartmentofChildPsychiatrywhichincludessomeEPBHphysicians.

C. EPBH will promote resources from state agencies such as the Office of SpecialHealthcareNeedsat theRIDOH,and theGovernor’sCouncilonBehavioralHealth,YouthTransitionSubcommittee.

EPBHmaintainsaresourcelibraryatthehospitalandprovidesorpromoteseducational sessions through the bulletin board in lobby, parent supportgroups,parentadvisorygroups,andtheparentresourceroom.

EPBH is represented on state agencies through the Olmstead PlanningCommittee (related to disability and restricted access to treatment), asubcommittee of Governor’s Council on Mental Health; Rhode IslandCommunity Academic Partnership based at Brown SPH, Mental HealthAssociation of RI (working on a public service campaign on educating thepubliconmentalhealthparityandtheirrights),andtheSubstanceAbuseandBehavioralHealthLeadershipCouncil(topooladvocacyefforts).

IV. Assessment of Health Needs of the EPBH Community

TheCHNAprocessinvolvedtheintegrationofinformationfromarangeofdatasourcestoidentify the significant health needs of the community served by EPBH, prioritize thoseneeds,andidentifyresources,facilities,andprogramstoaddresstheprioritizedneeds.Bothqualitative primary data and secondary quantitative data were gathered to identify thesignificanthealthneedsofthecommunity.Theprimarydatasourcesincludecommunityhealthforums,keyinformantinterviews,andindividualsurveys.Secondarydatasourcesincludenationalandlocalpublicationsofstate‐specificdata.Thesesourcesvary insamplesize,methodofdatacollection,andmeasuresreportedbutall arepubliclyavailable sourcesand ineachcase, themost recentpubliclyaccessibledataispresented.Thedatasourcesaredescribedinmoredetailbelow.CommunityHealthForumsQualitativedatawascollected throughCommunityHealthForums (CHFs) to solicit inputfrom individuals representing the broad interests and perspectives of the community.ParticipantsintheCHFsincludedmembersofthemedicallyunderserved,low‐income,andminoritypopulationsintheEPBHservicearea.

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Communityforumsareastandardqualitativesocialsciencedatacollectionmethod,usedincommunity‐basedorparticipatoryactionresearch.AccordingtoBerg,etal.,thisapproach“endorses consensual, democratic and participatory strategies to encourage people toexamine reflectively their problems or particular issues affecting them or theircommunity.”26SixCHFswereheldbetweenMay22andJune14,2019acrosstheEPBHservicearea,with39 participants. Participantswere recruited using socialmedia, posted flyers, email, andwordofmouth.Locationswereselectedtobeeasilyaccessibleto thepublicandhospitalpatients,andforumswereheldonweekdaysandweekends.EPBHforumswereheldatacommunity health center, a senior center, an elementary school, a parent supportorganization,apubliclibrary,andatEPBH.Ateachforum,amealwasprovided,alongwithchildcareandinterpreterservicesifrequestedinadvance.AllCHFswereopentothepublicandparticipantswerefullyengagedthroughoutthe90‐minutediscussions.SeeAppendixA.ArepresentativeofEPBHservedasahospital liaisontohelpplanandfacilitatetheCHFs.The hospital liaison was a critical link between the LCHI as the coordinating body, theexpertiseandresourceswithinthehospital,andtheCommunityLiaisonsdescribedbelow.An important and unique component of the CHFs was the involvement of CommunityLiaisons.ThreepeoplerepresentingthediversepopulationsservedbyEPBHwerehiredasconsultants to assist with the CHNA. These Community Liaisons helped plan the CHFs,recruitedparticipants,andco‐facilitatedtheforums.AppendixBcontainsabio‐sketchforeach of the EPBH Community Liaisons. All Community Liaisons were chosen through acompetitiveselectionprocessandcompletedatwo‐hourtrainingpriortoleadingtheCHFs.Thetrainingincludedprojectplanningtips,role‐playingactivities,conflictmanagementtips,and logistical expectations. Community Liaisons were responsible for identifying anaccessiblecommunityvenueforeachforum,selectingafoodvendorandmenuthatwouldbeappealingtothetargetaudience,andco‐facilitatingthediscussionattheCHFwiththeirhospitalliaison.EachCHFwastwohoursindurationandfollowedasimilarformatthatbeganwithamealfollowedbya90‐minutediscussionco‐facilitatedbythehospitalandtheCommunityLiaisonthatgeneratedconsensusontheparticipants’healthconcerns,theirprioritizationofthoseconcerns,andtheirideasonhowEPBHcouldrespondtothoseconcerns.Discussionbeganwith a brief presentation of EPBH’s 2016CHNApriorities and examples of activities thehospitalhasperformed in response.Participantswere invited to share their reactions towhatwaspresentedaswellastheircurrenthealthconcerns.SeeAppendixCforasampleCHF agenda. The input gathered during the CHFs was assessed qualitatively to extractthemesandquantitativelytodeterminethefrequencywithwhichthosethemeswerecited.CommunityLiaisonsalsometwiththeLCHIandthehospitalliaisontodebrieftheforumsand offer their interpretation of the findings to ensure all input was captured and thatprioritieswereappropriatelyaligned.

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Hiring,training,andempoweringcommunitymemberstoserveasCommunityLiaisonsintheCHNAprocess enriched thequantity andqualityof community input. It also allowedEPBHtobuildrelationshipswithcommunitiesthatmightnototherwisehavebecomeawareoforengagedintheneedsassessmentprocess.IndividualSurveysTobroadenthereachofcommunityinput,surveysweredistributedandcollectedbyLCHIstaffateventstheyattendedinMayandJune2019,suchastheannualPrideFestival.ThesurveysaddressedthesamequestionsastheCHFs(SeeAppendixDforthesurvey).TwoindividualsurveyswerereceivedforEPBH.KeyInformant InterviewsThedirectoroftheLCHIidentifiedpublichealthandhealthpolicyleaderswhocouldinformthe 2019 CHNA process and who had knowledge, information, or expertise about thecommunitythatEPBHserves.KeyinformantinterviewswereconductedwithStateleaderstosupplementtheotherquantitativeandqualitativedatacollected.Keyinformantsincludethe:

• ActingChiefofStaff,ExecutiveOfficeofHealthandHumanServices,StateofRhodeIsland,andPolicyDirector,RhodeIslandChildren’sCabinet

• Director of Policy, Planning, and Research, Executive Office of Health andHumanServices,StateofRhodeIsland

• Director, Health Equity Institute and Special Needs Director, Rhode IslandDepartmentofHealth

• PhysicianLead,HealthEquityInstitute,RhodeIslandDepartmentofHealthWhencraftingtheEPBHimplementationstrategy,EPBHreflecteduponthekeythemesthatemerged fromtheseconversations.Thestatewideprioritiesandrecommendationsof thekeyinformantsincluded:incorporatehealthequitytargets;generateandmonitordataonhealthdisparities,especiallybyrace,ethnicity,andincome;buildstrategiesthatincorporatethesocialdeterminantsofhealth;gobeyondindividualinterventionstofamily/householdlevel interventions; make investments in early childhood; consider co‐morbidities,especially between behavioral health and chronic diseases; confront racism and bias toimprovecare;providepersonalizedcare;besensitivetomisalignmentswithinhealthcare;andcontinuetoaddresssubstancemisuseandbehavioralhealthconditions.EPBHPatientData,2016‐2018Lifespan’sPlanningDepartmentanalyzedEPBHdataonpatients,discharges,andencountersdisaggregatedbytownofresidence,age,race,ethnicity,andlanguagespokenforthefiscalyearsendedSeptember30,2016throughSeptember30,2018.Thisinpatient,outpatientandEmergencyDepartmentdataisimportantinunderstandingtrendsinutilizationofhospitalservices.

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TheCommonwealthFund 2019ScorecardonStateHealthSystemPerformance–RhodeIsland,201927TheCommonwealthFundScorecardonStateHealthSystemPerformanceidentifiesplaceswhere health care policies are on track and areas that need improvement. Using theScorecard,statescancomparehowtheirperformancestacksupagainstallothers. In themostrecentedition,releasedinJune2019,RhodeIslandwasthestatethat improvedthemost on the health system performance indicators tracked over time; Rhode Islandimprovedon21 indicators,worsenedonseven,andhad littleornochangeon15.Whilechildren’shealthindicatorsweremixed,RhodeIslandparticularlymadestridesintheareasofcoverageandbehavioralhealth.RhodeIslandranked#2(lowerisbetter)inthecountryfor uninsured children at 2%. At the same time, Rhode Island ranked #32 for childrenwithoutamedicalhome.Still,RhodeIslandimprovedto#1forchildrenwhodidnotreceiveneededmentalhealthcareatlessthanone‐fifthofthenationalrate(4vs.22).At#41,RhodeIslandwasalsoamongthebottom‐rankedstatesfordrugpoisoningdeaths.RhodeIslandKidsCountFactbook,201928Published annually since 1995, The Rhode Island Kids Count Factbook is the primarypublicationofRhodeIslandKidsCount.TheFactbookprovidesastatisticalportraitofthestatusofRhodeIsland'schildrenandfamilies,incorporatingthebestavailableresearchanddata. Information is presented for the state of Rhode Island, each city and town, and anaggregate of the four core cities (cities in whichmore than 25% of the children live inpoverty),Providence,CentralFalls,PawtucketandWoonsocket.Ofnote,threeofthefourcorecitiesare in theEPBHprimaryservicearea.TheFactbooktracks theprogressof71indicatorsacrossfiveareasofchildwellbeing:Family&Community,EconomicWellbeing,Health,Safety,andEducation.GovernorGinaRaimondo’sOverdosePreventionActionPlan29In2015,RhodeIslandGovernorGinaRaimondoissuedExecutiveOrder15‐14toestablishtheOverdosePreventionandInterventionTaskForceinresponsetothesignificanttollthattheopioidepidemicwas takingonRhode Islanders. Initially, the task force’s goalwas toreduceopioidoverdosedeathsbyone‐thirdwithinthreeyears.Thetaskforcedevelopedastrategicplanwithfourpillars:prevention,treatment,rescue,andrecovery.In2019,thetaskforceissuedanupdatetoitsstrategicplanthatretainedtheoriginalfourstrategypillarsandaddedfivenewcoreprinciplesthatbridgethepillarswhileplacingadditionalemphasisonpreventionandrecovery.Thefivecross‐cuttingpillarsare:(1)IntegratingDatatoInformCrisis Response; (2)Meeting, Engaging, and Serving Diverse Communities; (3) ChangingNegativePublicAttitudesonAddictionandRecovery;(4)UniversalIncorporationofHarm‐Reduction; and (5) Confronting the Social Determinants of Health. 30 Rhode Islandexperiencedadeclineinoveralloverdosedeaths,from336in2016to314in2018.31RhodeIslandStateInnovationModel(SIM)TestGrant, 2015‐201932RhodeIslandwasselectedtoparticipateinamulti‐yearStateInnovationModel(SIM)grantintended to “improve health system performance, increase quality of care, and decreasecosts for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP)beneficiaries...” Rhode Island received a $20 million award in the fiscal year endedSeptember30,2015totestitshealthcarepaymentandservicedeliveryreformmodelover

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fouryears.Theultimategoalof theprojectwastoachievethe“tripleaim”ofbettercare,healthierpeople,andsmarterspending, throughavalue‐basedcare lens.GovernedbyaninteragencyteamandasteeringcommitteeonwhichLifespanwasrepresented,theRhodeIslandSIMproject developed a theoryof change that focusesmoreon value and less onvolume.IfRhodeIslandSIMmakesinvestmentstosupportprovidersandempowerpatientstoadapt to thesechanges, andweaddress thesocialandenvironmentaldeterminantsofhealth,thenwewillimproveourpopulationhealthandmovetowardourvisionofthe“TripleAim”.RhodeIslandDepartment ofHealth Strategic Framework33In 2015, Dr. Nicole Alexander‐Scott, Director of the Rhode Island Health Department(RIDOH),issuedtheRIDOHStrategicFramework,theDepartment’sblueprintforreducinghealthdisparitiesandachievinghealthequityinRhodeIsland.Thethreeleadingprioritiesintheframeworkare:(1)AddressthesocialandenvironmentaldeterminantsofhealthinRhode Island; (2)Eliminate thedisparitiesofhealth inRhode Islandandpromotehealthequity;and(3)EnsureaccesstoqualityhealthservicesforRhodeIslanders,includingourvulnerable population. Twenty‐three population health goals are distributed across fivestrategies. The third strategy relates to health care: “Promote a comprehensive healthsystemthatapersoncannavigate,access,andafford”.RIDOH’spopulationhealthgoalsforthisstrategyaretoimproveaccesstocare, includingphysical,oral,andbehavioralhealthsystems;improvehealthcarelicensingandcomplaintinvestigations;expandmodelsofcaredelivery and healthcare payment focused on improved outcomes; build a well‐trained,culturallycompetent,anddiversehealthsystemworkforcetomeetRhodeIsland’sneeds;andincreasepatients’andcaregivers’engagementwithinthecaresystem.RIDOH HealthEquity ZonesTheRIDOHStrategicFrameworkhighlightstheState’sHealthEquityZones(HEZ),whicharegeographicareasdesignedtoachievehealthequitybyeliminatinghealthdisparitiesusingplace‐basedstrategiestopromotehealthycommunities.34TheRIDOHselectedafirstcohortof11HEZinApril2015(twosubsequentlyceasedthecontractwiththeRIDOHbeforethefirstprojectperiodconcluded)andasecondcohortofthreenewHEZinMay2019.TheHEZare charged with forming community‐led collaboratives, conducting baseline needsassessments,creatingplansofaction,andimplementingandevaluatingthoseplansofaction.TheRIDOHexpectshospitalsandHEZtopartneronclinical‐communitylinkagestoimprovepopulationhealthatlocallevels.35Behavioral RiskFactorSurveillanceSystem –RhodeIsland,2018TheBehavioralRiskFactorSurveillanceSystem(BRFSS)isthenation’spremiersystemofhealth‐relatedtelephonesurveysthatcollectstatedataaboutU.S.adultresidentsregardingtheir health‐related risk behaviors, chronic health conditions, and use of preventiveservices.ApartnershipbetweentheCentersforDiseaseControlandPreventionandeachstate’sdepartmentofpublichealth,thesurveyisconductedannuallybyphonetolandlinesandcellphones.36RhodeIsland’sgoalistointerview5,830respondentswith55%ofthoseinterviewedonacellphone.37TheBRFSScollectsinformationfromRhodeIslandadults(18+years) as part of an effort to address key national health indicators and state priorities.

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Survey topics include self‐reported health status, health care access, fruit and vegetableconsumption,riskbehaviors,chronicdiseaseburden,andphysicalactivity,amongothers.38YouthRiskBehaviorSurveillanceSystem –RhodeIsland,2017InRhodeIsland,theYouthRiskBehaviorSurveillanceSystem(YRBSS)assessesadolescentbehavioralhealth risksofpublic school students ingrades6 through12.39Thebi‐annualYouthRiskBehaviorSurvey(YRBS)monitorssixcategoriesofhealth‐relatedbehaviorsthatcontributetotheleadingcausesofdeathanddisabilityamongyouthandadults,including:(1)behaviors thatcontribute tounintentional injuriesandviolence; (2)sexualbehaviorsrelatedtounintendedpregnancyandsexuallytransmitteddiseasesincludingHIVinfection;(3)alcoholandotherdruguse;(4) tobaccouse;(5)unhealthydietarybehaviors;and(6)inadequatephysicalactivity.40TheYRBSalsomeasurestheprevalenceofobesityandasthmaandotherhealth‐relatedbehaviorsplussexualidentityandsexualcontacts.Theresultsarereportedstatewide,notbydistricts,towns,norindividualstudent.Duringthespringof2017,the 98‐question Rhode Island high school YRBSwas completed by 2,221 students in 19public,charter,specialeducation,alternative,andvocationalhighschools.The48‐questionmiddle school YRBS was completed by 1,484 students in 19 public, charter, specialeducation,alternative,andvocationalmiddleschools.41KaiserFamilyFoundationStateHealthFacts–RhodeIsland,201942StateHealthFactsisaprojectoftheHenryJ.KaiserFamilyFoundationandprovidesfree,up‐to‐date,andeasy‐to‐usehealthdataforall50states,theDistrictofColumbia,andtheUnitedStates.StateHealthFactsiscomprisedofmorethan800healthindicatorsfromavarietyofpublic and private sources, includingKaiser Family Foundation reports, publicwebsites,governmentsurveysandreports,andprivateorganizations.DatapresentedonStateHealthFactsareupdatedoraddedasnewdatabecomeavailable.Theupdateschedulevariesfromindicatortoindicator.County HealthRankings–ProvidenceCountyandRI, 201943TheCountyHealthRankings&Roadmapsprogram is a collaboration between theRobertWoodJohnsonFoundationandtheUniversityofWisconsinPopulationHealthInstitute.TheannualCountyHealthRankingsprovidearevealingsnapshotofhowhealthisinfluencedbywherewelive, learn,workandplay.Therankingscomparecountieswithineachstateonmorethanthirtyhealth‐influencingfactorssuchashousing,education,jobs,andaccesstoqualityhealthcare.RhodeIslandDepartment ofHealth StatewideHealthInventory,201544TheStatewideHealthInventorystudywasdesignedtoevaluatetheaccessandbarrierstomedical services in the State. The Hospital Survey included information about patients’primaryresidencelocation,insurancesourcesforpatients,censusandvisitdataforfiscalyear 2014, demographics about patients, interpreter services, staffing by specialty andservice category, outpatient specialty clinics and services for calendar year 2014, andinformationtechnology,inadditiontootherdataelements.ThesurveywasinformedbytheCenters for Disease Control and Prevention’s “National Hospital Care Survey FacilityQuestionnaire”andtheAmericanHospitalAssociation’s“AHAAnnualSurveyofHospitals.”Findings were reported in the categories of Outpatient Care, Hospitals, Long‐term Care,

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Facilities&Centers,andPatients&Community.TheRIDOHexpectstocompleteanupdatetotheinventoryin2020.RhodeIslandBehavioralHealthProjectReport, 2015 (TruvenAnalytics)45This report was prepared for the Rhode Island Executive Office of Health and HumanServices, Department of Health, Department of Behavioral Health, DevelopmentalDisabilities,andHospitals,andtheOfficeoftheHealthInsuranceCommissionerbyTruvenAnalyticswhichpublishedfindingsandrecommendationsforimprovingbehavioralhealthinRhodeIslandthroughapublichealthapproach.CriticalNeedIdentificationandPriorityRankingTheCHNAprocess requiredEPBH to synthesize, interpret andprioritize the varieddatacollected.ExistingEPBHandLifespan‐specificservicelineexpertisealsofactoredintotheselectionandprioritizationprocess.InterpretingandprioritizingallrelevantdatawastheresponsibilityofasteeringcommitteecomprisedoftheCommunityLiaisons,EPBHLiaison,LCHIleadership,EPBHleadership,andLifespan leadership. Representatives of these stakeholder groups met multiple times toanalyzethedata,prioritizethesignificanthealthneeds,andcraftresponsivestrategiesinorder for EPBH to effectively allocate its resources to improve the health status of thecommunities it serves. During the discussions, the needs were prioritized based on theimportance identified by the community; the scope, severity, or urgency of the need asidentified by the community and the data; and the estimated ability of EPBH to provideeffectiveinterventions.Other health concerns identified during this processwill continue to be considered andevaluatedasopportunities to sharewithotherorganizations thatarebetterequipped torespondtothoseneedsorforfutureEPBHstrategies.Theprioritized,significanthealthneedsresultingfromtheEPBH2019CHNAprocessare:

Priority1:AccesstoServicesPriority2:SystemsofCarePriority3:OutreachandEducationPriority4:SubstanceAbusePrevention

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V. Identification of the Emma Pendleton Bradley Hospital Community’s Significant Needs

Basedontheextensivereview,evaluation,anddiscussionofthequalitativeandquantitativedata collected through the CHNA process conducted on behalf of EPBH, four significanthealthneedsfacingthecommunityservedbyEPBHhavebeenidentified.Themethodologyusedtodeterminewhichhealthneedsfacingthecommunityhavebeendeterminedtobesignificant and the process of prioritizing by order of significance to the community isdescribedinSectionIVofthisreport. SectionVfocusesonEPBH’sprioritizedsignificanthealth needs in further detail and identifies specific resources, facilities, and programswithin the community, including those atEPBH, that arepotentially available to addressthesesignificanthealthneeds.1. AccesstoServices

EPBH is the only hospital in Rhode Island dedicated to children’s mental health and isconstantlyexploringopportunitiestoexpandservices.ButlerHospitalinRhodeIslandhasinpatientandsomeoutpatienttreatmentprogramsforadolescentsbutnoneforchildren.TheProvidenceCenterandothercommunitymentalhealthcentersinRhodeIslandprovidebehavioral health services, including substance use disorder treatment, for children andfamiliesbuttheydonotofferthedepthofservicesprovidedbyEPBH.In2018therewere465RhodeIslandchildrenandyouthawaitingpsychiatricinpatientadmissiontoEPBH,afiguresimilarto2017.Theaveragewaittimein2018was1.4days,whichhasbeengreatlyimprovedwhencomparedtoanaveragewaittimeof3.6daysin2017.46ObstaclesofaccesstolocalmentalhealthservicesforchildrenandadolescentswasamajorthemeduringCHFdiscussionsandkeyinformantinterviews.Theseobstaclesareevenmoreprevalentwhen specialized child and adolescentbehavioral health services are involved.Overall,thereareaninsufficientnumberofprovidersinRhodeIslandwhospecializeintheseserviceareasandthepracticesthatdooperatewithintheStatetypicallyhavelongwaitlists.CHFparticipantsoverwhelminglypraisedtheservicesprovidedbyEPBHandexpressedadesire to replicate the hospital’s services in other parts of the state. Memorably, oneparticipantsummarizedthatsentimentinaCHFbysaying,“IwishtherecouldbeaBradleyHospital–South County”. CHF participants specifically noted access limitations in thesouthernregionofRhodeIsland.TogetherwithEPBH,HCHprovidesinpatientandpartialhospitalizationmedicalpsychiatrictreatmenttochildrenandadolescents.AdescriptionofthevariousprogramsrelatedtotheseissuesthatareofferedbyEPBHarehighlightedinSectionIII.Despitetheseprograms,CHFparticipants identified difficulty in accessing child psychiatric services on demand. CHFparticipants also identified difficulty in accessing adolescent partial hospitalizationprogramsandsubstanceusedisordertreatmentforadolescents.

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Beyondageneralshortageofchildpsychiatryproviders,especiallyforproviderswhospeakalanguageotherthanEnglish,CHFparticipantsidentifiedthefollowingadditionalbarrierstoaccess.EPBHwillcontinuetofocusonopportunitiestodiminishthesebarrierssothatmorepatientsandfamiliesareabletoobtainthecaretheyneed. Limitedunderstandingamongpatientsandtheirfamiliesofservicesavailableandhow

toaccessthem.EPBH’sAccessCenterevaluateschildrenwithinforty‐eighthoursandhelpsfamiliesdetermineoptimalnextsteps.In2018theAccessCenterreceivedpatientreferralsfromacrossRhodeIsland47.Sincethisisstillreportedasahealthconcern,itcouldbethatexistingresourcesneedtobebetterpublicized.EPBHhasacomprehensiveParent’sGuidetoChildren’sMentalHealthServicesavailabletohelpparentsnavigatechild and adolescent behavioral health resources and maintains its KidsLink RItelephonicnavigation service24hours aday, sevendays aweek tohelp respond tofamiliesincrisis.

FamilieslocatedinareasoutsideoftheProvidencemetroarea,especiallythosewhorelyon public transportation, reported that EPBH is not easily accessible. EPBH drawspatientsfromacrossRhodeIslandinitsInpatient,Partial,Residential,andAccessCenterprograms,whereas itsoutpatientprogramshavemorepatients fromtownsclosertoProvidence. 48 In response, EPBH is assessing opportunities to provide parent andprofessional training services to the residents of those areas, as well as offeringtelemedicine alternatives and an increased promotion of the existing telephonicconsultationservices(KidsLinkRIandPediPRN).

CHF participants reported long wait times for patients seen in hospital emergencydepartments,combinedwithaperceivedlackofcompassionandsensitivityformentalillness and behavioral health challenges. During 2017, there were 3,168 emergencydepartmentvisitsand2,458hospitalizationsofRhodeIslandchildrenwithaprimarydiagnosisofmentaldisorder.Between2007and2017,pediatricemergencydepartmentvisitsincreased18%andhospitalizationsby37%.49Inanattempttokeeppacewiththedemand,EPBHnowprovidespsychiatricconsultationservicesattheHCHemergencydepartment.

Culturalandlanguagebarrierstoappropriatetreatmentorunderstandingoftreatmentoptions.WhilethereareseveralEPBHstaffcertifiedtoprovidecareinalanguageotherthan English, CHF participants noted the lack of bilingual/bicultural clinicians,especially for Latinos, the largest minority community in the state. EPBH has aninterpretercoordinatorwhoworkswithLifespantocoordinatesystemwideresourceswheneverpossible.EPBHutilizesthe“InterpreteronWheels”videoremoteinterpretingprogramandacontractedphoneinterpretationvendor.EPBHexperienced196callstoitscontractedphoneinterpreterservicebetweenMarchandJune2019and41VideoRemoteInterpretingcallsduringthatsametime.ThegreatestneedisforASL(AmericanSignLanguage)andgenerally forextensiveperiodsof time(8‐10hourspersession).TheASLneedismetprimarilythroughoutsidecontractors.EPBHdoesnotleaveanychildunservedduetolanguagebarriers.

Limitationstoinsurancecoverage.CHFparticipantsexpressedfrustrationthatthereisnotcompleteinsuranceparitybetweenphysicalhealthandmentalhealthservices.Theynotedpriorauthorizationrequirementsformentalhealthservicesthatarenotrequiredfor comparable physical health services, resulting in delayed and missed care. CHF

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participantsrequestedadvocacyfromEPBHtoprecipitatechangestoStateandotherinsuranceprogramstoachievefullparity.

Insufficientstep‐downservicesforchildrenwhoaredischargedhomeafteraninpatientcourse of treatment. CHF participants reported that although discharge plans are inplacefortheirchildrenupondischargefromaninpatienttreatmentservice,thefamiliesdidnotfeelequippedtomanagetheirchildren’scareathome.Instead,theywantedamoregradualtransitionofsupportthroughadditionalhomevisitsandoutpatientcaretoreintegratethechildintothehome/communitywhilereinforcingtheskillslearnedatthehospital,therebyreducingthelikelihoodofasubsequenthospitalization.

2. SystemsofCare

Thetransitionfrompediatrictoadulthealthcare,whiledifficultforanyteen,isespeciallychallengingforteenswithmentalhealthchallenges.CHFparticipantsstressedtheneedforservicesthatbridgethistransitionandimprovecoordinationbetweenpediatricandadulthealthcareservices.Theseindividualsmaybetransitioningtoindependentlivingsituations,employment,orotherindependentlifeexperiences,andneedsupporttodosoinordertoensuresuccessintheirlateryears.TheCHFparticipantsalsoidentifiedinsufficientoptionsfor people aged eighteen to twenty‐one with autism and developmental disabilities incongregatedcaresettings. InRhodeIsland, theagencythatoverseesadultdevelopmentaldisabilitiesistheBHDDH.EPBHintendstosharethishealthconcernwiththeleadershipofBHDDH. EPBH works closely with DCYF on transitioning youth to adult services,Additionally,theexpansionoftheVerrecchiaClinictoaddressthecaregapforthoseagedeighteentotwenty‐oneyearsoldwascompletedtoassistinmeetingthisneed.Anothercriticaltransitionpointinbehavioralhealthcareisattheconclusionofaninpatientstay,whenthepatientneeds toreturn toschoolandhome. In2018,anaverageofsevenchildrenperdaywerereadytoleaveEPBHbutwereunabletodosoduetoalackofstep‐downavailabilityor therebeingnoother safeplacement, evenat theirhomes.50EPBH isworking collaboratively with the State of Rhode Island to continue efforts to improvetransitionsbackintothehomeand/orschoolsetting.CHFparticipantsalsoindicatedthattherearenotadequateresourcesforpatients,families,andschoolstoensureasmoothtransitionandpromotehealing.Suggestionsincluded: Train schoolpersonnel, teachers, coaches, andother staff toworkwith childrenwith

specialneeds. Provide educational materials to schools to help reduce the stigma associated with

mentalhealthdisordersamongstudentsandstaff. Educateparentsonthesystemsthatneedtobeinplacetosupporttheirchildreninthe

home;providementorsorpeerfamilysupportcoaches.

TheTruvenreportandtheRIDOHStatewideHealthInventorybothcitecarecoordinationasan essential component of access to care, particularly in complicated behavioral healthsettings.51OneofthePopulationHealthgoalsoftheState(throughtheSIM)highlightsthecriticalneedtoalignphysicalandbehavioralhealthintreatment.52Asakeyinformantfrom

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theRhode IslandEOHHSnoted, there is a disconnect between systems like hospital andcommunity‐basedmentalhealthcareproviders.EPBHmaybeabletoprovideleadershipindesigning amore coordinated system of carewith the infrastructure needed to supporttransitionsbetweensettingsorstagesofcare.EPBHwillcontinuetoincreaseitsongoingcommunityandpatientoutreachtotransitioningfamiliesinanefforttooptimizedischargeplanningforhomeandschool‐basedservices.Aspartofthiseffort,EPBHwillprovideeducationtoparentsonaccessingneededbehavioralhealthservicesandwilltrainschoolsoneffectivestrategiesforworkingwithchildrenwithspecialneeds.Inaddition,EPBHwillcontinuetocollaboratewiththeRIDOHandBHDDHondevelopingpoliciesandpracticestofacilitatesmoothtransitionsfromhospitaltohomeandcommunity‐basedcare,aswellasfrompediatrictoadultservices.3. OutreachandEducation

Althoughstrideshavebeenmadeinrecentyearstoreducethestigmaassociatedwithmentalhealth disorders, there is still more work to be done before mental health services arepromoted and encouraged in the same manner as physical health care. This involvesoutreach and education to families, communities, health care providers, schools, andpatientsthemselves.OneoftheRIDOH’spopulationhealthgoalsistopromotebehavioralhealthandwellnessamongallRhodeIslanders.53CHFparticipantsidentifiedthefollowingresourceneedstoexpandawarenessofbehavioralhealthcare: Provideliaisonstoassistschoolnurseswholacksufficientresourcesandtrainingtohelp

identify students with mental health disorders and refer them into appropriatetreatment.

Provide cultural competency training for schools on the treatment and language ofmentalhealthdisease.

Offer anti‐bullying programs to schools. Exposure to bullying is a risk factor forbehavioralhealthandsubstancemisusedisease.

Educatethefullcontinuumofthemedicalcommunityonbestpracticesforworkingwithpatientswithmentalhealthdisorders.

Educate pediatricians on key factors contributing to mental health disorders andindicatorsforearlydetection.

Train emergency department staff on best practices for working with patients withmentalandbehavioralhealthconditions.

Increasehealthliteracyamongfamiliesonmentalhealthcaresothattheyunderstandwhatservicesareavailableaswellaswhereandhowtoaccessthem.EPBHshouldalsoincreaseawarenessofitsrangeofcommunity‐basedservices.

Educateparentsontopicssuchasanxiety,attentiondeficithyperactivitydisorder,self‐injuriousbehavior,suicideprevention,autism,sexandgenderdiversity,andsubstanceabuseprevention.

Usepeermentorstoteachparentshowtotalkwithandsupporttheirchildren.

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CHFparticipantsrequestedthatprogramsbeheldatplacesthatyouthandparentsfrequentsuch as community locations, sporting events, and schools, and that they be conductedduringvarioustimesofdayonweekdaysandweekends.EPBHcurrentlyoffersevidence‐based,highlyenrollededucationalandtrainingprogramsforparentsandprofessionalsthroughitsBradleyLearningExchangeandLCHI.EPBHwillcontinuetoraiseawarenessofthoseprograms,whilealsodevelopingprogramsforayouthandadolescentaudience.Thecontentoftheeducationalprogramsforyouth,parents,andprofessionalswillbebasedonthefeedbackfromCHFs.Theseprogramswilllooktoexpandoutreachthroughweb‐basedanddistancelearningoptions.4. SubstanceAbusePrevention

Theriseofopioidandothersubstanceabusehasbeendocumentednationally.Substanceabusecanbeparticularlyharmful to thedevelopingadolescentbrainandbody.Druguseimpactsperceptionandcanfracturedevelopingneuro‐pathwaysintheadolescentbrain.Ifthese pathways include addiction, the impact may lead to lifelong challenges. 54 CHFparticipantsvoicedconcernsabouttheincreasingprevalenceofadolescentsubstanceabuse.Participants also reported a lack of available options throughout Rhode Island to treatadolescent substance misuse and noted difficulty with accessing partial hospitalizationprograms.TheTruvenreportconcludedthatchildreninRhodeIslandfacegreatereconomic,social,andfamilialriskforthedevelopmentofmentalhealthandsubstanceusedisordersthanchildreninotherNewEnglandstatesandthenation.55RhodeIsland,therefore,needstoplacegreateremphasisonandresourcesinproven,effectiveservicesforchildrenandtheirfamilies.56TheTruvenreportalsonotedarangeoffactorsamongRhodeIslandchildrenthatcanleadtoadoptionofriskybehaviors. Since2009,RhodeIslandhighschoolstudentscontinuetofareworsethanthenationin

attemptedandinjuriousattemptedsuicideinthepastyear. In2017,23%ofRhodeIslandhighschoolstudentsreportedalcoholuseinthepastmonth

and11%reportedbingedrinking,asdefinedbyfiveormoredrinksinarowwithinacoupleofhoursinthepastmonth.Theserates,whilehigh,arelowerthantheUSat32%and14%,respectively.57

ChildrenandadolescentsinRhodeIslandhadhigherratesofattentiondeficitdisorderthanmostotherNewEnglandstatesandnationalaverages.58

AdolescentsinRhodeIslandweremorelikelytohavemajordepressiveepisodes.59 ThenumberofchildreninfamiliesthatreceivepublicassistanceishigherinRhodeIsland

(28%)comparedtotheUS(25%).60 Rhode Island is6thamongNewEnglandstateswithchildren in singleparent families

(35%)andranks29thnationwide.61

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ThesefactorsappeartobeimpactingRhodeIslandadolescents,sinceahigherpercentageofthem(5%)reportedillicitdruguseordependencecomparedtootherNewEnglandstates(3.3%‐4.4%)andthenation(3.8%).62SAMHSAdatashowsthat,nationwide,approximately4%ofteensarenotreceivingtreatmentfortheirillicitdruguse.63EPBH will enhance its existing array of initiatives by adding programs for youth andadolescentscenteredonincreasingprotectivefactorsandreducingriskfactorsforsubstanceuse. Thiswill include educational programs focused on reducing stigma associatedwithbehavioralhealth,anti‐bullying,andbullyingreductionprograms.

VI. Conclusion

TheCHNAisatoolthatEPBHwillusetoaddressthesignificanthealthneedsidentifiedinthisreport.TheresultsoftheCHNAwillguidethedevelopmentofEPBH’scommunitybenefitprograms and implementation strategy. EPBH’s leadership team, including its Board ofTrustees, members of executive management, and other individuals critical to theorganizational planning process are currently devising EPBH’s implementation strategywhichwill detail action itemplans to covering theperiod fromOctober1, 2019 throughSeptember30,2022.ThisimplementationstrategywillbecompletedandauthorizedbytheEPBHBoardofTrusteesconsistentwithIRSrulesandregulations.

A. Acknowledgements DataandInformationContributorsAdaAmobi,MD,MPH,PhysicianLead,HealthEquityInstitute,RhodeIslandDepartmentofHealthChristineF.Brown,MHA,FamilyandCommunityLiaisonProgram,BradleyHospitalCancerOversightCommittee,TheLifespanCancerInstituteatRhodeIslandHospital,TheMiriamHospital,andNewportHospitalDeborahGarneau,MA,Director,HealthEquityInstituteandSpecialNeedsDirector,RhodeIslandDepartmentofHealthCommunityHealthInstitute,LifespanMarketingandCommunicationsDepartment,LifespanRhodeIslandKIDSCOUNTKaylaRosen,ActingChiefofStaff,ExecutiveOfficeofHealthandHumanServicesandPolicyDirector,RhodeIslandChildren’sCabinetPamelaMcLaughlin,DirectorofPatientExperience,NewportHospitalJessicaGelinas,Manager,PlanningandAnalysis,LifespanTheresaE.Jenner,MSW,LICSW,CCM,DirectorofClinicalSocialWork,LifespanMartiRosenberg,DirectorofPolicy,Planning,andResearch,ExecutiveOfficeofHealthandHumanServices,StateofRhodeIslandEPBHCommunityLiaisonsEveWartenbergCondonFeliciaDelgadoShavonFreeman

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EPBHCommunityForumHostSitesBlackstoneValleyNeighborhoodHealthStation,CentralFalls,RhodeIslandParkHolmSeniorCenter,Newport,RhodeIslandBradleyHospital,Riverside,RhodeIslandParentSupportNetworkofRI,Warwick,RhodeIslandWoonsocketHarrisPublicLibrary,Woonsocket,RhodeIsland

B. Contact Information Forinformationregardingthe2019EPBHCHNAprocessorfindings,orforinformationonanyoftheservicesorstrategiesmentioned,pleasecontacttheLifespanCommunityHealthInstitute.LifespanCommunityHealthInstitute335RPrairieAvenue,Suite2BProvidence,RI02905Phone:401‐444‐8009http://www.lifespan.org

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AppendixAEmmaPendletonBradleyHospitalCommunityHealthForumScheduleWednesday,May22,20196:00–8:00PMBlackstoneValleyNeighborhoodHealthStation1000BroadStreet,CentralFalls,RI02863Thursday,May23,20196:00–8:00PMParkHolmSeniorCenter1ParkHolm,Newport,RI02840Monday,June10,20196:00–8:00PMEmmaPendletonBradleyHospital1011VeteransMemorialParkway,Riverside,RI02915Tuesday,June11,20196:00–8:00PMParentSupportNetworkofRI535CentervilleRoad,Suite202,Warwick,RI02886Wednesday,June12,20196:00–8:00PMBradleySchoolSouthCounty4781TowerHillRoad,SouthKingstown,RI02879Friday,June14,20199:00–11:00AMWoonsocketHarrisPublicLibrary303ClintonStreet,Woonsocket,RI02895

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AppendixBEmmaPendletonBradleyHospitalCHNACommunityLiaisonProfilesEveWartenbergCondonisamentalhealthadvocateworkingtowardsherPeerRecoverySpecialistcertification.Shehascreatedandtaughtclassesandworkshopsonmentalhealthandgivenpresentationsaboutherexperiencewithmentalillnesstohighschoolandcollegestudents.Ms. Condon facilitates support groups and teaches for theNationalAlliance onMentalIllness(NAMI)RhodeIslandaffiliate,whichprovidesadvocacy,education,andpeersupport services topeople livingwithmental illness and their familymembers. She alsoworksasamedicalsecretaryinButlerHospital’sintensiveoutpatientprogramsforcollegestudentsandLGBTQyoungadults.Ms.CondonispassionateaboutbehavioralhealthcareandlooksforwardtofacilitatingcommunitydiscussionsthatwillinformLifespan’sdevelopmentanddeliveryoftheseandothervitalservices.FeliciaDelgado is a Community HealthWorker who was transformed by her previousexperienceinthesex‐for‐payindustry.Tohelpwomenandmencompelledbypovertytosell their bodies, Ms. Delgado founded Esther’s Well in 2013, to direct them towardhealthcareandcommunityresources.Ms.Delgado’sstrategytohelphertargetpopulationisdifferentfrommostcommunityhealthworkers.Sheisaone‐womanenterprise:seekingout,providingservicesfor,andsecuringhealthcareaccess for, individuals inthesex industry.Shealsobattleshealthinequitiesatthesystemiclevelincludingunderemployment,lackofaffordableapartmentrentalsinRhodeIsland,poorwages,andalegalsystemthatimposesmorebarriersthansupportsforpeoplewhosellsex.Also,functionallyilliterate,Ms.Delgadostates, “Mydreamasasurvivorof sexualexploitationand functional illiteracy is toteachothershowtoovercomeobstacles.Obstaclesareonlyopportunitiesforgreatness.”ShavonFreemanhasbeeninthemedicalfieldforalmostadecadeasaMedicalAssistantand CNA. In that time, she has developed a passion formaternal health and is pursuingfurthereducationinthatarea.Ms.Freemanenjoyspatientadvocacyandteachesotherstochampionforthemselves.HernewpositionasEPBHCommunityLiaisonisaperfectsegueaftermanyyearsofworkingwithindividualswithbehavioralandintellectualdisabilities.SheisanactivepartofSistaFire,anetworkthatempowerswomenofcolor.

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AppendixB(cont.)

EmmaPendletonBradleyHospitalCHNACommunityLiaisonPositionDescription

LifespanCommunityHealthInstitute

CommunityHealthNeedsAssessment–CommunityLiaison

PositionDescription

PositionSummary

Whileexcellentcareisourtoppriority,Lifespanalsorecognizesthathealthandwell‐beingismorethantheabsenceofdisease.Wepromoteacultureofwell‐being,inpartachievedbyextendingourexpertiseandservicesintocommunitieswherepeoplelive,learn,work,playandpray.Putsimply,weembraceourmissionofDeliveringhealthwithcare.A demonstration of Lifespan’s mission, the Lifespan Community Health Institute (LCHI)workstoensurethatallpeoplehavetheopportunitiestoachievetheiroptimalstateofhealththrough healthy behaviors, healthy relationships, and healthy environments. The LCHI,often in collaboration with Lifespan affiliates and/or community partners, addresses aspectrumofconditionsthataffecthealth. Oneofourmajorinitiativesin2019istoassisteach of the Lifespan hospitals: Rhode Island Hospital/Hasbro Children’s Hospital, TheMiriamHospital,EmmaPendletonBradleyHospital,andNewportHospital,inperformingaCommunityHealthNeedsAssessmentanddevelopingstrategiestorespondtotheidentifiedneedsoverthenextseveralyears.TheLCHIisrecruiting20‐30individualswhowillserveasCommunityLiaisons,helpingtoinfuse community input in the community health needs assessment process. TheCommunityLiaisonisatemporary,part‐timepositionthroughJune2019.Anestimated30‐50hourswillbedistributedoverthecourseof3‐4months.TheCommunityLiaisonreportstotheDirectoroftheCommunityHealthInstituteatLifespan.ThispositionisnotopentocurrentLifespanemployeesanddoesnotconferbenefits.CommunityLiaisonswillbehiredasconsultantsandpaiduponcompletionoftheproject.

Responsibilities

TheCommunityLiaisonwillassistLifespanstaffwithplanningandexecutionofatleasttwocommunity forumsaspartof thecommunityhealthneedsassessmentprocess forRhodeIsland Hospital/Hasbro Children’s Hospital, The Miriam Hospital, Bradley Hospital, andNewportHospital.Thegoalofeachforumistoidentifyandprioritizelocalcommunityhealthneeds. The Community Liaison will be responsible for identifying localorganizations/institutions(e.g.neighborhoodassociations,non‐profits,churches,etc.)thatwillbewillingtohostacommunityforum.Further,theCommunityLiaisonwillassistwith

35

recruitment,logistics,facilitation,andinterpretationofeachforum.TheCommunityLiaisonwillbetrainedonexpectedtasksandrelevantdata.Primaryresponsibilitiesinclude:

TeamwithLifespanstaffandotherCommunityLiaisonstocompletetasks. Perform community outreach and recruit strategic partners to participate in the

needsassessmentprocess. Developandmaintainproductiverelationshipswithstakeholders, tocreatebuy‐in

forthecommunityhealthneedsassessmentprocess. Assist with the planning and execution of presentations for small groups and

communityorganizations,includinglogisticsandfollow‐up. Coordinateandsupportotheroutreachactivities,includingpresentationsortabling

atlargepublicevents,listeningsessionsorneighborhoodmeetings. Practiceeffectivecommunicationandreliablefollow‐upwithLifespancontactsand

communitypartners. Trackandcommunicatedetailedinformationregardingsuppliesorothersupports

neededtocompletetasks. Attendallrequiredorientationandcheck‐inmeetings.

QualificationsandCompetencies

The selected Community Liaison must demonstrate the following qualifications andcompetencies:

Trustedcommunitybrokerwithdemonstratedsuccessorganizingcommunityefforts Commitmenttoandinterestincommunityhealth Willingnesstoworkinateamenvironment,aswellastheabilitytocompletetasks

independently Thorough,timely,andreliablecommunicationskills Excellentoralcommunicationaswellasactivelisteningskills Comfortablecommunicatingbyemailaswellasinperson Experienceinandconfidencewithpublicspeaking Effectivemeetingfacilitator Stronginterpersonalskillsandexperienceworkingwithdiverseaudiences Abilitytoorganizeandleadgroups Willingnesstoshareandleveragepersonalandprofessionalnetworks Detail‐oriented,withexcellenttime‐managementskills Accesstoreliabletransportation Abilitytoworkeveningorweekendhours WorkingknowledgeofMicrosoftOfficesoftware,especiallyWordandPowerPoint

DesiredSkills

Thefollowingskillsarepreferred,butnotrequired: Personal or professional experience in a public health or related field (e.g.,

community outreach or organizing, health care, public policy, or communitydevelopment)

Experienceinterpretingandexplainingdata Bilingual/BiculturalinSpanishorotherlanguagesspokeninRhodeIsland

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AppendixCEmmaPendletonBradleyHospitalCHNASampleCommunityHealthForumAgenda

EMMAPENDLETONBRADLEYHOSPITAL‐2019COMMUNITYHEALTHNEEDSASSESSMENTCommunityForumThursday,May16,2019

HostedbytheUnitedWayofRhodeIsland 6:00PM Eat&VisitInformationTable

6:30PM Introductions

6:40PM OverviewofCHNAandprogresssince2016

6:50PM CurrentHealthData

7:00PM Question#1:Doesthisreflectyourhealthconcerns?

What’smissing?

7:20PM Question#2:Howwouldyouprioritizeamongthese

healthconcerns?

7:40PM Question#3:Whatwouldyoulikeforthehospitaltodo

tohelpaddressthesepriorities?

7:55PM Wrap‐Up&Evaluation

Notes:

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AppendixDEmmaPendletonBradleyHospitalCHNACommunityInputForm

2019CommunityHealthNeedsAssessment‐CommunityInputForm

Lifespanseekstounderstand your health concernsand howourhospitalscanhelprespondto thoseconcerns. The information yousharewillhelpustocompleteaCommunityHealth Needs Assessmentand create anactionplan.Wevalueyourinput! 1. Towhichhospitalserviceareashouldthesecommentsbeattributed?

EmmaPendletonBradleyHospital RhodeIslandHospital/Hasbro

Children’sHospital

NewportHospital TheMiriamHospital

2. Pleasedescribeyoursignificanthealthconcerns.

3. Whatwouldyoulikethehospitaltodoinresponsetoyourconcerns?4. Pleasecommentontheprogressmadeinaddressingthe2016priorities(detailsonreverse).

5. Anyadditionalcommentsorsuggestions?

6. Pleaseshareyourcontactinformationifyouwouldliketoprovideadditionalinformation.Name:____________________________________________________________________________Email:__________________________________________Telephone:________________________

PleasevisitLifespan’sLearningfromourCommunitypage(lifespan.org/our‐community)tolearnmoreaboutthe2019CommunityHealthNeedsAssessments.Thankyouforyourinput!

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2016CommunityHealthNeedsAssessment

ThePatientProtectionandAffordableCareAct(PPACA)requiresnon‐profithospitalstoconductaCommunityHealthNeedsAssessment(CHNA)everythreeyears.CHNAssolicitfeedbackfrommembersofthecommunitytodeterminethemostpressinghealthneedsinthecommunitythehospitalserves.CHNAsaimtoaddressbarrierstocare,theneedtopreventillness,andthesocial,behavioralandenvironmentalfactorsthatinfluencehealthinthecommunity.Basedontheneedsidentified,eachhospitaldevelopsimplementationstrategiesthatrespondtotheprioritizedneeds.In2016,LifespancompleteditssecondCHNAforeachofitshospitals.

The2016CHNAprocessforeachhospitalidentifiedthefollowingsignificantneeds:

TheMiriamHospital

1.AccesstoCareandHealthLiteracy2.CardiacHealth3.Cancer4.HealthyFoodAccess5.SubstanceUseDisorders

NewportHospital

1.AccesstoCareandHealthLiteracy2.MentalandBehavioralHealth3.SubstanceUseDisorders4.Cancer5.HealthierWeight

RhodeIslandHospital

1.AccesstoCareandHealthLiteracy2.HealthyWeightandNutrition3.SubstanceUseDisorders4.CardiacHealth5.Cancer

BradleyHospital

1.AccesstoServices2.EmergencyDepartmentEvaluation3.Transitionservicesforchildrenwhoageoutofpediatriccare

Foreachhospital,andforeachneed,animplementationplanisincludedintheCHNAreport.Thatimplementationplandescribestheactionstepsthateachhospitalwilltaketomitigatethestatedneedoverthe2017to2020fiscalyears.Pleaserefertothereportsfordetailedimplementationstrategies.

FormoreinformationregardingtheCHNAprocessorfindings,pleasecontactCarrieBridgesFeliz,DirectoroftheLifespanCommunityHealthInstitute,atcbridgesfeliz@lifespan.orgor401‐444‐8009.

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