MGH Charlestown HealthCare Center

Lorenzo Lewis, MD, Medical Director, MGH Charlestown
Peggy Carolan-Bolognese, Administrative Director, MGH Charlestown

Background: City of Charlestown and MGH Charlestown HealthCare Center

MGH has a long history of involvement in the Charlestown community. In 1968, MGH worked with the City of Boston’s Department of Health and Hospitals, Harvard Medical School and other community partners to develop one of the first hospital licensed, multidisciplinary community health centers, originally known as the Bunker Hill Health Center.

In 2007, the MGH Charlestown HealthCare Center (MGH Charlestown) offered comprehensive services to 8,900 people in approximately 54,000 visits. Charlestown, with a population of about 16,000 residents has the greatest range in income and socioeconomic status of all Boston neighborhoods, with very wealthy, very poor and middle income residents. Its rates of heart disease and substance abuse are higher than other Boston neighborhoods.

In response to a growing trend of opiate-addicted patients, Mark Eisenberg, MD, Unit Chief of Adult Medicine and William Schmitt, MD, of the Charlestown Health Center and most recently Jim Morrill, MD became certified as Suboxone providers. Suboxone has been a significant addition to the successful chemical treatment of opiate addiction.  Unlike methadone, it can be prescribed by primary care physicians who undergo a special FDA approved training course. Drs. Schmitt and Eisenberg advocated to Congress to expand the number of patients providers were permitted to treat from 30 per practice to 30 per provider (the number has subsequently increased to 100 per provider). The law was enacted in 2005.

 In 2004, the MGH Charlestown Health Center committed a full time substance abuse clinician to complete the team, in association with the MGH West End Clinic. The Suboxone program at the Charlestown Health Center currently provides Suboxone treatment to seventy patients who are also involved in therapy or other supportive services.

MGH committed one million dollars over five years to expand mental health and substance abuse services to Charlestown’s neediest population. The services, including a substance abuse counselor, mental health clinician and referral specialist will be housed in New England’s largest public housing development at the Bunker Hill housing development. “The Center at 76” will provide walk in services to all Charlestown residents. The effort is collaboration between the MGH Charlestown Health Center, The City of Boston and the Boston Housing Authority. Renovation of the site has been underway through 2007 and the site will open in early 2008.

Charlestown Substance Abuse Coalition
Beth Rosenshein, MSW, Director

In response to alarming levels of substance abuse, community leaders, the police, social service agencies, MGH Charlestown, residents and others came together in the winter of 2004 to form the Charlestown Substance Abuse Coalition (CSAC). CSAC was further galvanized to action by the tragic overdose of two prominent youth in April of 2004, one of whom died.

The mission of the Coalition is:
“We are a community-based Coalition of residents businesses, organizations, professionals, and advocates who work together to reduce substance abuse among youth, adults, and families. Through a unified collaborative approach, we utilize existing community resources, organize programs to respond to identified needs and harness the energy and commitment of all to provide a safe, healthy environment in Charlestown.”

CSAC’s guiding principles are as follows:
“The CSAC believes that in order to be successful, it needs to identify, assess, organize and maximize the assets and successes of our community. We value a collaborative approach that is inclusive of everyone who lives/works in Charlestown. We are committed to these values:

• Honesty and integrity in working together towards our mission
• Listening to one another and learning from our successes and failures
• Calling our community to action through outreach, awareness and a commitment to our mission
• Including youth and parents in the entire process
• Being respectful of and accountable to our community”

Partnerships and Activities

CSAC works to achieve its goal through four strategies:

• Changing community norms, attitudes and behaviors about alcohol and other substance abuse.
• Increasing the safety of the neighborhood and quality of life for all by decreasing the supply of drugs, levels of crime, violence and other consequences of substance abuse through collaboration with the law enforcement and judicial systems.
• Increasing access to and resources for successful treatment and recovery from substance abuse for Charlestown residents and families afflicted with addiction.
• Strengthening protective factors and decreasing risk factors for families, youth, and young adults through education, prevention, and intervention strategies.

CSAC includes a wide collaboration of MGH Charlestown, the Boston Police Community Service Office, Charlestown Court House, representatives of elected officials, the Charlestown Boys & Girls Club, the John F. Kennedy Center, Charlestown Community Centers, Charlestown Against Drugs, the Charlestown Recovery House, Youth Service Providers Network, Charlestown MissionSafe, Charlestown Neighborhood Council, Charlestown Neighborhood Watch Coalition, Charlestown Business Association, Student Support Team Leaders and Principals from local Boston Public Schools, property managers from public housing developments, the Boston Housing Authority Residents’ Association, street workers, local parishes, the Dennis McLaughlin House of Charlestown, Charlestown Mother’s Association, Boston Public Health Commission (BPHC), the MA Organization for Addiction and Recovery, the Greater Boston Regional Center for Healthy Communities, and many individual residents.

2007 Program Accomplishments

• CSAC is in its second year of a five year, $500,000 Drug Free Communities grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to focus on youth. 
• CSAC also received funding from Boston Public Health Commission to retain its designation as a NoDrug Coalition for the fourth year.
• CSAC held four community-wide forums which created community dialogue and awareness. Presenters included Dr. Nancy Norman, Acting Director, Boston Public Health Commission and Mary Ann Solberg, former Deputy Director, White Office of National Drug Control Policy.
• Groundbreaking for a new Charlestown Police Station was held on July 3, 2007.
• Boston Police Department Area A-1 received a 40% increase in Police resources for Charlestown, including an additional anti-crime car and a beat cop.
• Charlestown Neighborhood Watch Coalition expanded to fifty-one streets in the community.  
• Groundbreaking for the Charlestown Recovery House, a planned 25 bed transitional housing program for men in recovery, was held on October 1, 2007.
• MGH committed one million dollars over five years to support MGH Charlestown in locating mental health and substance abuse services at the Bunker Hill Housing Development. A Clinical Director/substance abuse counselor, mental health clinician and referral specialist have been hired. Official opening is slated for early 2008.
• CSAC is in its second year of implementing the AllStars program, a science-based substance abuse prevention program at the Warren-Prescott K-8 School. The entire fifth grade class (49) went through the program in the 2006-2007 school year.  The same class is receiving the Booster program in school year 2007-2008, while the current fifth grade class is receiving the Core program.
• CSAC organized the Charlestown Sports Collaborative to coordinate youth sports organizations in expanding outreach to all eligible Charlestown youth and in enhancing adult volunteer participation.  In 2007 the Institute for Sport Coaching conducted a “Successful Youth Coaching Workshop” for twenty-two new and returning local volunteers.
• CSAC partnered with the two public middle schools in Charlestown to create and administer a youth health survey to all students in grades six through eight.  The survey collected data from 392 students on attitudes and behaviors around drug use, violence, and trauma. Although anonymous, the instrument collected zip codes for students, thus allowing Charlestown-specific data to be analyzed.  This data will be gathered every two years.

2007 Program Data:
(All data and statistics were calculated and provided by the Boston Public Health Commission.)

• More Charlestown residents are accessing treatment.  Admission rates to publicly-funded substance abuse treatment programs for Charlestown residents was 25.9 (per 1,000) in fiscal year 2004 and increased to 37.1 (per 1,000) in FY2006.
• Emergency Medical Service responses to heroin overdose calls to Charlestown declined 17.7% between calendar year 2003 and fiscal year 2006.
• While overdoses increased across the City of Boston by 29 percent from FY 2005 to FY 2006, Charlestown’s overdose numbers decreased by 11 percent during the same period.
• Between calendar years 2002 and 2005, Charlestown’s drug abuse mortality rates decreased by 41percent from 63.8 to 37.7 (deaths per 100,000).
  

Mental Health Services in Boston Public Schools (Charlestown)
D. Scott McLeod, PhD, Director of Child and Adolescent Mental Health Services

The Child and Family Team of the Counseling and Behavioral Services Unit of MGH Charlestown provides a range of services to Boston Public Schools in Charlestown, including the Warren Prescott and Harvard Kent Elementary Schools and the Clarence Edwards Middle School, as well as to the Head Start Program, operated by the John F. Kennedy Center.  The team also consults with the staff of the Boys and Girls Club. 

In the schools, psychologists, social workers, and fellows provide therapeutic and consultative services.  Specifically, they consult with teachers, administrative staff and Student Support teams and provide direct therapeutic services to students and their families.  Clinicians regularly attend Individualized Educational Plan meetings. 
The Team provides school-based services for multiple reasons: to reach out to children and families who are less likely to seek services at the Health Center for fear of stigma; to accommodate parents and guardians who have difficulty getting children to clinics at all; and to help children whose primary problems are school-based.  When school is not in session, students and their families are offered services at MGH Charlestown, or, if necessary, in their homes.  For the second consecutive year, providers have added eight time-limited psycho educational groups at the Edwards Middle school.  These groups are intended for students who are at risk for engaging in violence and other risky behaviors. 

This year, the new principal at the Charlestown High School has initiated discussions to have mental health services at the high school as well.  The unit is committed to making this happen and meetings are in progress.  The Team has also increased its capacity to serve students whose primary language is Spanish. 

Program Data

• Over the course of the last school year, clinicians provided an average of approximately 100 therapy visits per month with students in the schools.  In addition, the psychologists and social workers provided approximately 25 consultative hours in the schools each month.

YouthCare
Scott McLeod, PhD, Executive Director

YouthCare was founded more than 30 years ago when an MGH clinician began taking disadvantaged urban children with behavioral and learning disabilities to the country for weekend wilderness excursions. Through these brief adventures, youngsters discovered that they were capable of overcoming obstacles, taking risks, and developing group trust and cohesiveness. These excursions became Camp Bunker Hill, now called YouthCare.  Today, YouthCare serves children ages 5-17 with social-cognitive deficits including Asperger's Syndrome, Nonverbal Learning Disorders, High Functioning Autism and related challenges. YouthCare’s goal is to help these children to develop the social skills necessary for success at home, in school, and beyond.

YouthCare works to improve the lives of 125 children through its therapeutic after school program, summer day camp programs, teen program, social skill groups, parenting support, as well as additional children through its school-based trainings and consultations. YouthCare offers therapeutic support through group participation in recreational, social and educational activities. Its services focus on children's educational and behavioral needs. YouthCare believes that children are best able to learn social skills within natural group settings.  It also recognizes and values the need to collaborate with community service providers such as teachers, professionals and parents. 

2007 Program Accomplishments

• YouthCare staff conducted pro-bono consultation and training services to three Boston Public Schools during 2007.  For 2008, YouthCare has designated 20 percent of one full-time staff’s time to provide pro-bono services at BPS.  These services include, individual case monitoring of children with autism spectrum disorders, inclusion of students with autism spectrum disorders, staff training and developing internal school structures for school administrators to improve the coordination of services for these students.
• Using the model created last year to conduct a district-wide analysis of the Newton Public Schools’ service delivery to students with autism spectrum disorders, YouthCare offered a substantially reduced rate to provide similar services to the Middleborough School District.
• YouthCare conducted staff training for Camp Joy’s (Boston Public Schools) summer counselors at a significant reduced cost.  Of the thirty slots available at YouthCare's summer camp based in Charlestown, eleven are slotted for low income children from Charlestown and surrounding communities who receive substantial financial aid.
• At YouthCare's after school and social skill group programs 50 percent of the children receive substantial financial aid.

2007 Program Data

• YouthCare’s summer program received a 4.7 average (on a five-point scale) from parents on the program’s effectiveness at meeting their children’s behavioral goals and a 5.0 average response on their child’s overall camp experience.
• Based on YouthCare's Summer Progress Reports, over 75 percent of the children at its summer camp achieved at least 1 of the 2 social goals set by parents and staff at the start of the program.  Almost 60 percent achieved both social goals set for the summer, and several children achieved goals beyond the original two that were set. 
  
  Some sample goals include:
  
  
• To engage in a reciprocal (back-and-forth) conversation for at least two exchanges
• To talk about interests of his peers, even if they are not his interests
• To take a break when prompted as a way of dealing with anger.
• To make positive comments about his role in the camp group (e.g., to gain self-confidence)
• To use a friendly tone of voice (e.g., to not use a monotonous tone of voice typical of children with autism spectrum disorders)