Until this year a Michigan resident looking to register for government assistance would have encountered the longest form in the entire country. 42 pages of scarcely legible type and tiny boxes covered more than 1,000 questions, including reasonable inquiries like family size alongside more invasive and confusing questions like conception dates for each child.
If they successfully navigated the massive form, residents deemed eligible for support were then subject to often confusing access points for different programs. Information, resources and services were scattered across websites, offices, and different departments within the state. The complex layout created a barrier for those in need; the system was overwhelming for anyone, but could essentially be a brick wall for someone struggling with literacy, or juggling multiple minimum wage jobs, someone balancing daily care for their family or dealing with chronicle health concerns.
In 2016, the Michigan Department of Health and Human Services (MDHHS), with support from the Health Fund, kicked off a series of projects aimed at transforming the way they deliver public assistance. They focused on three main components; updating the form that determines eligibility, transforming the way they deliver support programs, and empowering staff to become problem-solvers rather than paperwork navigators.
Project Re:form – Plain language and Friendly Design
Aside from the intimidating length of the application, the original form featured small, difficult to read text. Text that was rife with complicated health terms and uncommon phrases further spurred confusion among native and non-native English speakers alike. Reading levels throughout the document varied widely.
Daily questions poured in from community members struggling to complete the form, leaving employees overworked and wondering if they were really helping people. Assistance for healthcare, food, childcare, and emergency relief services went unclaimed, leaving vast federal funds unutilized each year.
With the help of the design firm Civilla, MDHHS tackled both the design and the content of the form. Using plain language, they were able to ask fewer questions while still gathering all necessary information. Plain language avoids jargon and includes a range of methods, from writing in shorter sentences to breaking up text with bullet points and subheadings, all to create a document that is clear and logical to its intended audience. MDHHS was able to cut the form by more than half, trimming it from 42 pages to just 18. The new form is more inviting and, most notably, easier to read and understand.
The new form, which was tested in Wayne and Eaton counties, will allow staff to go beyond helping people figure out the eligibility paperwork. MDHHS had estimated that a reduction in processing time of just 5 minutes per application could allow the Department to more effectively use 82,000 casework hours each year. The hope is that they’ll be able to spend that time better understanding and helping residents, connecting them to the resources that can improve their health and economic futures.
Integrated Service Delivery Portal – A holistic approach to resource navigation
The redesigned form makes it easier for people to determine their eligibility for assistance, but the next step was to streamline access to resources and services and make them available over a wider range of devices. Nearly 80% of residents have access to a cell phone even if they do not have, or have limited access to computers. With that in mind, MDHHS decided to tackle their web platform, creating the Integrated Service Delivery portal called MI Bridges, that transitions seamlessly to mobile phones. The portal also centralizes a range of support programs and information that was previously scattered around the digital and real worlds.
Three years in the making, the final web interface will take holistic approach with a design focused around positive outcomes. The portal will guide residents through a needs assessment and connect them with support to directly address those needs. Additionally, it will take an in-depth look at underlying causes that often go overlooked during the cursory application process. By providing residents with more in-depth care, the state seeks to reduce the potential of future crisis situations and help set families up for lasting success.
MDHHS launched a pilot program in September 2017, testing the system in Muskegon county. The next phase will start this year, with the rollout of the ISD Portal across the entire state of Michigan this Spring.
From Innovation to Impact: Putting People First
In Michigan, almost 17% of households live below the Federal Poverty Line, nearly 2% more than the national average. And, according to the Michigan Association of United Ways, an additional 24% of households struggle to afford basic necessities like food, housing, child care, transportation and healthcare. With the difficult application process and the complicated landscape of support resources, people were kept at the margins of the system instead of at the center of it.
The system overhaul has been designed, tested and tweaked with the ultimate goal of bringing people into the fold instead of locking them out. By redesigning the paper and technology infrastructure, MDHHS will be able to meaningfully help more people in need, and reduce the burden on staff while empowering them to make a bigger difference.
The next steps are about improving and expanding. With support from the Health Fund and other partnerships, MDHHS will work to gauge residents’ experience with the new form and portal, and further tweak each component to work even better for people. And the public can expect to see this changes within the year. Armed with smarter, more efficient tools, the State of Michigan will be prepared to better the needs of our most vulnerable neighbors while also empowering residents to feel comfortable accessing available resources — putting us on a path toward a healthier state for all.
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A few months ago, Rumsey Street near the southwest end of Grandville Avenue in Grand Rapids looked like any other pocket of disinvestment in cities across the country. Situated in the dynamic neighborhood of Roosevelt Park, the site is surrounded by families, but here they encounter boarded up homes, waist-high thickets of weeds, and disintegrating sidewalks.
The neighborhood sees the potential, though. A small health clinic, Clinica Santa Maria, serves local residents and later this month the church a few blocks down will house entries in the 2017 ArtPrize competition. Together, a committed collation led by Habitat for Humanity of Kent County is working to turn this space into a hub for the neighborhood with housing and amenities that serve its existing residents and promote a healthier community.
This diverse, somewhat seemingly incongruous partnership stretching across sectors is working to transform the site. Last week Habitat Kent and eight partners announced their plans for Plaza Roosevelt, a new development set to include affordable housing, storefronts, public spaces, a new public high school, and an updated and expanded Clinica Santa Maria.
These changes are all key ingredients for creating a healthier, more successful neighborhood. We know lack of access to affordable housing can put families in the position of choosing between paying rent and paying for other essentials like food, heating and medical care. Transportation to school and other services can be a challenge for households without a car. By building housing that meets the needs of the community, families will be empowered to improve not only their financial stability, but their health, education and overall wellness.
Find more information about the importance of housing on communities in the MacArthur Foundation’s How Housing Matters report.
Plaza Roosevelt, as envisioned, will be more than the sum of its parts. Each element is an important aspect of a strong community, but together in close proximity they can transform the neighborhood’s function. Instead of walking past a blighted lot, residents can now choose from more housing options, walk to a public school, access health services, do some shopping, and enjoy new green spaces.
Just as the planning team considered health impacts at every stage of the project, collaboration was a critical cornerstone of the process. Habitat Kent went beyond merely consulting local community members, instead forging a meaningful partnership throughout the planning process. Along with health officials, funders, and universities, the neighborhood’s residents helped shape and drive the vision.
The focus on urban revitalization sometimes prioritizes profitable development over the people who already live in a place. Affordable housing is often an afterthought or concession made by developers in order to secure public financing or approval. In contrast, Habitat Kent’s approach to Plaza Roosevelt is not just responsive to community needs—it is rooted in them.
As Habitat Kent Executive Director BriAnne McKee remarked at last week’s announcement, “if you want to go fast, go alone. If you want to go farther, go together.” This approach, cross-sector partnerships invested in a community-driven process and focused on holistic community health, represents a possible path forward for neighborhood revitalization projects.
Because the Plaza Roosevelt model requires significant partnership from multiple entities, part of the Health Fund’s support includes evaluation of the convener’s role and effectiveness, as well as the project’s health outcomes. Our hope, shared by all project partners and by the community, is that Plaza Roosevelt can not only have an impact on direct health outcomes but also on the social determinants of health. We know making housing available to community members and increasing ease at which they access health care creates positive impacts that ripple across the neighborhood. Together, we can strive to create communities where people work, live comfortably, enjoy the arts and ultimately settle roots to foster future of generations healthy, successful Michigan residents.
We’re pleased to announce more than $6 million dollars awarded through our 2017 Behavioral Health Initiative, including several grants aimed at addressing opioid addiction. The 16 grantee organizations serve communities in every region of Michigan, from Detroit to Houghton, reflecting a statewide effort to improve access to care and combat the growing opioid crisis.
“The opioid crisis is a statewide challenge in Michigan,” said Health Fund Senior Program Officer Becky Cienki, who oversees the Behavioral Health Initiative. “No community or demographic is immune—Upper or Lower Peninsula, urban or rural, wealthy or economically struggling. We must develop evidence-based solutions that work across boundaries.”
In addition to focusing on children or older adults, each of the awarded projects advances integrated care or workforce development. By threading these two goals throughout our grantmaking, we can work with grantees to improve the quality and efficiency of care for all Michigan residents.
Here is the full list of 2017 Behavioral Health Awardees:
Catholic Human Services, Inc., Integrated Intervention For Parents With Addictions In The Child Welfare System | $449,411
- This project will develop and implement an integrated intervention model to address substance abuse. An interdisciplinary care coordination team will help parents who are struggling with addiction and have children within the child welfare system in Alpena and Montmorency counties.
- Areas served: Alpena and Montmorency
Cherry Health, Elevate Senior Health: Behavioral and Physical Health Annual Screening | $480,678
- The project will improve early detection and treatment of behavioral health issues in seniors aged 65 and older. It will increase utilization of annual wellness exams at three Cherry Health sites in Grand Rapids as well as integrate care management, wellness coaching, referral coordination, and follow up for improved senior health and wellness.
- Areas served: Kent County
Communities in Schools of Kalamazoo, Integrated Behavioral Health in School | $498,204
- This project will expand students’ access to behavioral health services by integrating clinicians into five high poverty schools in year one, followed by the addition of five more schools in year two.
- Areas served: The townships of Kalamazoo, Oshtemo, and Texas
The Corner Health Center, Psychiatric Services for Youth through Community Healthcare (PSYCH) | $282,913
- (PSYCH) is a collaboration to increase access to integrated psychiatric services for children. The project adds psychiatric capacity to the Corner Health Center and provides training to residents and other clinicians to provide care for stabilized patients or lower acuity patients without the presence of a psychiatrist.
- Area served: Washtenaw County
D. A. Blodgett-St. John, The Safe Passages Mentoring Program | $287,327
- To improve reunification rates of children in foster care, this project connects biological parents dealing with substance use disorders to recovery support services through certified recovery coaches.
- Area served: Kent County
Eastern Michigan University, EMU Geropsychology Training: Advancing Late-Life Neurobehavioral Health | $391,097.98
- This project will establish specialty training in geropsychology in Eastern Michigan University’s Clinical Psychology Doctoral Program, providing older adults with cognitive loss in Southeast Michigan with integrated behavioral health services delivered by doctoral students. Faculty with expertise in geropsychology will model the service delivery and create a training package to sustain the training in the future.
- Areas served: Washtenaw, Monroe, Lenawee, Jackson, Livingston, Oakland, and Wayne counties
Henry Ford Health System, Opioid Epidemic: Prevention, Diagnosis, and Treatment in and Office-Based Integrated Care Model | $500,000
- Outpatient clinics in metro Detroit will utilize an integrated behavioral health care model to provide education, diagnosis, and treatment to those afflicted with opioid use disorders. In addition, this program will train physicians and other clinical staff in appropriate prescribing of opiates.
- Areas served: Wayne, Oakland, and Macomb counties
Michigan Public Health Institute, A Systems-Level Approach to Neonatal Abstinence Syndrome | $412,347
- This project will address integration of care and services for pregnant women and infants impacted by NAS, caused when a newborn infant experiences withdrawal from a substance in the mother’s system during pregnancy. Focusing on prevention, screening and coordinating care, MPHI will develop the program in Saginaw and Marquette counties, utilizing initial results to develop a replication guide that can be used in other communities.
- Areas served: Saginaw and Marquette counties
M.P.A. Group, Washington Elementary School Family Health Initiative | $157,166
- This project will create a school-based system that integrates behavioral health services, serving family and child needs and enhancing educational achievement. The initiative will educate staff on the impact of childhood traumas, train staff to identify and assist with behavioral interventions, and design educational strategies for students with behavioral health challenges.
- Area served: Bay County
Northern Lakes Community Mental Health Authority, Family Assessment & Safety Team (F.A.S.T.) | $499,790.95
- To address the fragmentation of service delivery for children in crisis and the shortage of child psychiatrists in the state and region, this project will standardize a response and resources available to children in crisis. Mobile FAST members will immediately respond to calls for assistance with an integrated assessment, evaluation, and crisis interventions suitable to the child and family needs. This model also has the potential to reduce emergency room visits and inpatient hospital stays.
- Areas served: Grand Traverse, Crawford, Leelanau, Missaukee, Roscommon, and Wexford counties
Pine Rest Christian Mental Health Services, Reducing Psychiatric Boarding of Pediatric Patients to Assist Families in Crisis | $446,320
- In partnership with five hospital emergency departments, this project will address the issue of children being boarded in an emergency room while awaiting an inpatient bed or assessment. On-call psychiatric consultation, staff education, and additional care integration will reduce emergency department board times and inpatient stays, helping children and families in crisis.
- Areas served: West Michigan, Traverse City, and Indiana counties
The Regents of University of Michigan, Establishing a Michigan Collaborative Care Implementation Support Team to Enhance Access to Quality Mental Health Treatment in Primary Care for Seniors and Low-Income Adults | $499,342
- This project’s goal is to increase primary care workforce capacity to treat seniors’ behavioral health conditions by supporting implementation of the Collaborative Care Model. This technical assistance project will develop infrastructure for a Michigan Collaborative Care Implementation Support Team (MCCIST) that will support efforts by primary care clinics to implement the care model.
- Area served: Statewide
The Regents of the University of Michigan, TRAILS to Behavioral Health: Translating Research into Action to Improve the Lives of Students (TRAILS) | $353,289
- TRAILS aims increase access to evidence-based mental health practices by training school professionals in cognitive behavioral therapy (CBT) and mindfulness. TRAILS has two phases: (1) development of a statewide coaching infrastructure, drawing on existing community-based mental health providers to serve as local coaches; and (2) clinical training to school professionals in every county in Michigan, followed by assignment of a local coach to each participating school.
- Area served: Statewide
The Ruth Ellis Center, Ruth Ellis Integrated Health & Wellness Center | $261,132
- This grant supports the continued development of an integrated primary and behavioral health center co-located within a comprehensive drop-in center for homeless, runaway, and at-risk lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. It also includes training for integrated care organizations and providers focused on LGBTQ-competent care, including harm reduction and trauma-informed care principles and communication skills.
- Area served: Metro Detroit
Upper Great Lakes Family Health Center, Integrating Michigan’s U.P Behavioral Health & Primary Care Services | $438,562
- The project will combine resources of two organizations to provide comprehensive care to individuals in need of substance use treatment. Funding will support new service delivery, training, education, and medical leadership development to create fully integrated health home services and increase the number of addiction-trained physicians in the Upper Peninsula.
- Area served: Marquette and Houghton counties
Wayne State University, High Touch – High Tech (HT2) | $499,502
- The project will increase diagnosis and integrate treatment services for pregnant women struggling with addiction and depression. The project combines interactive mobile technology with infant mental health specialists within two prenatal practices in northern Michigan.
- Area served: Grayling and Alpena
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