MGH Revere HealthCare Center

Roger Pasinski, MD, Medical Director, MGH Revere HealthCare Center
Debra Jacobson, Administrative Director, MGH Revere HealthCare Center
Kitty Bowman, Director, Revere CARES
Eric Weil, MD, Center for Community Health Improvement Liaison

Background: City of Revere and MGH Revere HealthCare Center

Revere is a rapidly changing residential, coastal community of approximately 47,300, located five miles north of Boston.  Revere is home to many immigrants, including natives of Cambodia, Vietnam, the Caribbean Islands and Latin America, as well as Bosnia, and Somalia. The Massachusetts Department of Education reports an increasingly diverse student body in Revere of 51 percent White, (down from 91 percent in 1990), 32 percent Hispanic, eight percent Asian, four percent African-American, one percent Native American, and four percent other. Forty-two percent of Revere students come from homes where the primary language is not English compared to the state average of 15 percent, and 12 percent of Revere school children have limited English proficiency.  Sixty-two-percent of Revere students are eligible for free or reduced price meals.  Revere’s school dropout rate is substantially higher than the state rate (6 percent vs. 3.3 percent).

Revere Community Benefit Goals

Community benefit work in Revere relies on strong and effective collaborations across virtually all sectors, including Revere families and residents, and focuses on youth and supports the MGH Revere HealthCare Center’s goal of creating a comprehensive continuum of adolescent care, from community based prevention efforts to direct patient services.  The priorities include:

1. Reducing and preventing substance abuse among Revere youth and building a healthier community.
2. Increasing access to health care, and promoting health and wellness among Revere adolescents.

Approach to Doing the Work

In Revere, the MGH Revere HealthCare Center (MGH Revere) serves as the base for community benefit work. First opened in 1981, the health center was relocated in 1995 to an expanded 50,000 square foot new facility directly on Revere Beach at 300 Ocean Avenue. MGH Revere offers comprehensive health and mental health care services, and in fiscal year 2006, the health center provided care through more than 109,000 patient visits.

Haven at MGH Revere
Patti Rosell, HAVEN Advocate
Carolyn Vega, HAVEN Advocate

HAVEN at MGH Revere, part of the hospital-wide HAVEN program, works as part of the broader movement to end intimate partner abuse by improving and enhancing our health care response to patients, employees, and community members who have been impacted by abuse. HAVEN’s goal is to reduce the immediate impact of violence on survivors and their families, and to help individuals and families seek lives free of violence and abuse. HAVEN at MGH Revere participates in the Revere community-wide Domestic Violence Task Force, the Advisory Group for the School Based Health Clinic at Revere High School, and the Healthy Relationships Working Group. 

Two HAVEN advocates (one bilingual and bicultural) train healthcare providers to ask patients about partner abuse sensitively and effectively. If a patient discloses abuse, the provider offers the services of a HAVEN advocate, who works to empower survivors to better understand the dynamics and impact of abuse, increase safety, review options, and heal from the abuse in their and their children’s lives. 

2007 Data

• Since its inception in 1997, HAVEN at MGH Revere has provided services to more than 463 clients, 24 percent of whom are Latina and 70 percent of whom have children. 
• 27 percent of their abusers are active users of alcohol or drugs, 17 percent have threatened to kill the patient, 17 percent have threatened the patient with weapons and 7 percent have actually harmed the patient with weapons
• Over 56 Adolescent patients have been seen through the Revere High School Based Health Center or through the Revere Adolescent Health Clinic.
• HAVEN at MGH Revere advocates participated in a statewide training of school based nurse practitioners with staff from the Family Violence Prevention Fund, helping nurses screen and respond to adolescents with more sensitivity and accuracy. 

MGH Revere School-Based Health Center
Anna Berrian, RN, MSN, CPNP, Nurse Practitioner
Emily Wilcox, RN, MSN, CPNP, Nurse Practitioner

The School-Based Health Center, located in Revere High School (RHS) and the Seacoast Academy is entering its fifth year.  It is staffed by: two nurse practitioners, a practice manager, a medical assistant/family planner, two mental health providers, and a patient care coordinator. The SBHC provides comprehensive health care, including management of acute illnesses, chronic disease management, immunizations, confidential care, mental health, and substance abuse counseling. The nurse practitioners also offer consultative services to the city’s school nurses, health, and physical education teachers.  They also offer coverage for RHS home football and hockey games.

A licensed clinical social worker provides counseling to students 20 hours per week and receives referrals from teachers and counselors in the school system.  Annually, Harvard Dental School students visit the SBHC and custom fit mouth guards and teach young people about oral health and dental emergencies. Referrals are made to community-based services.

Care for students is integrated with the MGH Revere Health Center, and includes assistance with enrolling in insurance, and follow-up and referrals to MGH Revere physicians, mental health providers, and the OB/GYN Department. Services are coordinated with the Adolescent Health Center, described below, for reproductive health needs.

SBHC staff conducts classroom and assembly presentations, and collaborate with school guidance counselors and social workers. The MGH Revere domestic violence advocate provides services at the SBHC and at the Adolescent Health Center. A Healthy Relationships Working Group includes the SBHC, Youth Zone, Adolescent Health Center, Revere Public Schools, Revere Police and HarborCOV, the local domestic violence agency. The group conducts outreach to the middle schools, provides professional development at RHS and Seacoast Academy, and offers a relationship support group for girls.

2007 Program Accomplishments

• The SBHC is one of five recipients of grants from the Dept. of Public Health for Mental Health/Substance Abuse services
• The SBHC conducted a 10 week voluntary Stay in Shape program at Revere High School
• Access to health insurance was facilitated by having staff from the MGH Revere Patient Financial department available at the school while immunizations were provided. 

2007 Program Data

• 170 new patients were registered
• 928 active patient charts
• 675 cumulative visits
• 41 students participated in Stay in Shape program, 24 of these students received awards for outstanding performance in the intervention

MGH Revere Adolescent Health Center

The MGH Revere Adolescent Health Center (AHC) is located on Broadway in Revere and provides confidential services to students from all Revere schools, their partners, and families five days a week during after-school hours, from 2:30 to 5:00 p.m. The AHC offers continuity of care for RHS and Seacoast Academy students requiring additional family planning services. The two SBHC nurse practitioners also staff the AHC, assuring coordination and continuity of care across the two sites.

Services at the AHC include family planning counseling and education. The HAVEN domestic violence advocate is on site once a week and meets with all clients, whether or not they are in an abusive relationship, to provide education and support for healthy relationships. 

ROCA, Inc., in partnership with MGH Chelsea, received a five-year grant from the Office of Adolescent Pregnancy Programs (OAPP) to fund the Circle of Care research project.  Home visitation, parenting skills building, access to medical and mental health services, and educational, prevocational and employment support are coordinated for 35 pregnant and parenting teens living in Revere and Chelsea. Currently, the program is entering its 3rd year with Janet Mozes, Nurse Practitioner as the Clinical Manager for this project.  With an interest in demonstrating an overall improvement in health and educational outcomes, the delay of subsequent pregnancy is the key outcome measure for this grant.   

2007 Program Accomplishments

• A 15-year-old mother and infant joined the Circle of Care program. Since joining the      program the mother has cut her connections with gang involvement and is currently      taking GED and ESL classes

• The program supported 16-year-old in violent relationship by meeting with domestic violence advocate at the AHC

MGH Revere Adolescent Health Initiative
Debra Jacobson, Administrative Director, MGH Revere
Kerstin Oh, MD, Medical Director

Revere Cares
Kitty Bowman, Director

Revere CARES (Community Awareness, Resources, and Education to Prevent Substance Abuse), founded in 1997, is a community coalition dedicated to reducing and preventing alcohol and drug use among youth in Revere and to building a healthier community. As described below, Revere CARES has enabled Revere to make measurable gains in reducing youth alcohol and other drug use.

Revere CARES builds on the strengths of the community to increase protective factors for youth and to decrease risk factors.  Revere CARES includes a growing and diverse group including concerned parents and other adults, teens, Revere Public Schools, the Revere Police and Fire Departments, the Chamber of Commerce, community based providers, churches and others from the faith community, and elected and government officials. Revere CARES is changing the community norms within which Revere youth make choices about tobacco, alcohol and drug use.

The Coalition uses research-based strategies and is based on the belief that a community that works together to send clear and consistent messages about substance abuse to teens, offers positive alternative activities, and makes appropriate services available can reduce alcohol and drug use among youth. The Coalition measures its success not only by indicators of substance use, but also in terms of community change that is sustainable for the long term. Revere CARES Coalition focuses on four priorities:

• Advocating for public policy changes and enforcement efforts
• Conducting community awareness campaigns about the harms of substance abuse
• Implementing science-based prevention and early intervention programs for youth
• Building a healthier community by collaborating with others

2007 Program Accomplishments
2007 was a productive year for Revere CARES in all its priority areas. Accomplishments include: 

• Public policy changes and enforcement efforts:
• Revere CARES and Revere Police Department completed an assessment of gang activity in Revere, and issued a community wide gang violence prevention plan.
• The City of Revere received the Shannon Gang Violence grant award from the Executive Office of Public Safety for the second year in a row, and Revere CARES was awarded a Youth Violence Coalition Expansion grant from the Department of Public Health.
• Revere CARES is organizing public advocacy to roll back bar hours from 2:00 a.m. to 1:00 a.m., concurrent with most neighboring communities. The city experiences a large influx of people at 1:00 a.m. for “last call” at local bars. Neighboring Lynn, the only other city with a 2:00 a.m. closing time, is in final appeals process to roll back bar hours, and city leaders are concerned that this will increase further the volume of bar-related traffic into Revere.

Implementing science-based programs and interventions.

• Recognizing the importance of positive alternative activities for youth in reducing drug and alcohol use and preventing violence, Revere CARES provided technical assistance and staff support to CASTLES, an alumni group that raised $50,000 for after school scholarships and enrichment activities; assisted Revere Public Schools in obtaining a 21st Century Community Learning Center Grant that will provide after school programming for 200 students for three years; and successfully advocated for a Revere Public School  After-school Project Director position to oversee after school program development, funding strategies, and partnerships.
• Revere CARES works with Revere High School to provide substance abuse education for athletes, freshman, and sophomores, and to support the Power of Know Club, a high school peer education program.
• Revere CARES served on the community advisory board for the Strengthening Families Program at North Suffolk Mental Health and the Second Step program in the Revere Public Schools, both science-based programs designed to build protective factors among families and children to delay and reduce substance abuse among youth.

Increasing awareness about substance abuse.

• Revere CARES collaborated with Mother’s Against Drunk Driving, local teen leaders, and alcohol outlets on a Sticker Shock Campaign to place stickers reading, “Hey You! It is ILLEGAL to purchase alcohol for people under age 21”on all multi-packs of beer, wine coolers and alcopops (sweet alcohol drinks marketed to teens).
• Revere CARES conducted the Power of Know, a comprehensive media campaign designed to increase parents’ awareness of their role in reducing underage substance abuse. As part of the campaign, 837 caregivers pledged to ask the “who, what, where, and when questions”; to talk to their children about alcohol, tobacco and drugs; and to model responsible use of alcohol.  The Parents Who Host Lose the Most campaign was designed to inform parents about the civil and criminal penalties associated with hosting teen parties where alcohol is served.
• Revere CARES hosted the First Annual Revere Beach Memorial honoring 104 people who lost their lives to alcohol and drugs at sunset, September 16th at the William G. Reinstein Bandstand on Revere Beach. Over 250 participated in this candle light vigil.

Building a healthier community.

• Approximately 20 businesses participated in an internet-based Summer Job Bank for Revere youth offered in collaboration with the Revere Chamber of Commerce.
• Revere CARES collaborated with Revere High School to establish the RHS Connect Club, a violence prevention club, of thirteen students who conducted a participatory action research project to assess and improve school climate in collaboration with the high school administration. RHS Connect developed, implemented, and analyzed survey data from over 1200 student respondents to identify priority areas for fostering connection among students and faculty.
• Revere CARES conducted its third biennial Community Survey with support from the Revere Public School System, MGH Revere and the Mayor to measure resident perceptions and experiences with youth substance use as well as new information on resident beliefs about their overall health and feelings about their community.  
• The City of Revere, Revere Beach Partnership, Revere First, Revere Beautification Group, MGH Revere HealthCare Center, WIC, and Revere CARES worked together to support a multicultural Farmer’s Market on Revere Beach from July through October. Revere CARES contributions include obtaining funding for promotional activities, facilitating farmers’ market meetings, and coordinating volunteers.
• MGH Center for Community Health Improvement, MGH for Children and Revere CARES are partnering to develop a comprehensive environmental food and fitness initiative.
• With support from MGH and Revere CARES, Revere will expand beach-based activities for youth, career awareness courses and related paid summer service learning opportunities for Revere High School Juniors.

 
Program Data
The following data from Revere’s Youth Risk and Behavior Survey show the gains made from 1999 to 2007 through community substance abuse prevention, intervention and policy efforts.  Following national and local trends, Revere students reported less tobacco, alcohol and marijuana use over time. In addition, Revere high school students have reported an increased difficulty ease in obtaining substances, suggesting policy and community efforts may have contributed to this change. 

Tobacco use is steadily declining:

• Among High School Students, the percent of youth ever having smoked steadily declined from 69 percent to 54 percent (22 percent decrease).  The percent currently smoking steadily declined from 37 percent to 25 percent (32 percent decrease).
• Among Middle School Students, the percent of youth ever having smoked has steadily declined from 51 percent to 28 percent representing a 45 percent decrease and the percent of youth who reported smoking in the past 30 days has steadily declined since 2001 from 20 percent to 8 percent in 2007 representing a 60 percent decrease.

Some alcohol indicators are declining:

• Among High School Students:  Following national and local trends, the percent of students who reported ever drinking alcohol, past 30 day use and binge drinking have all decreased since 1999, however in some cases these decreases have not been steady over time. The percent of youth who reported ever having been drunk has steadily declined from 66 percent to 53 percent (20 percent decrease) and the percent of youth who reported frequent binge drinking (5 or more drinks in a row on 6 or more occasions in the past month) has steadily dropped from 14 percent in 1999 to 7 percent in 2007 (50 percent decrease).
• Among Middle School Students: The percent of youth who have ever drunk alcohol declined from 58 percent to 42 percent with a slight increase in 2005 before declining in 2007. This represents a 28 percent decrease between 1999 and 2005. 

Marijuana use is declining:

• Among High School Students, the percent of youth ever having used marijuana steadily declined from 54 percent to 44 percent (19 percent decrease). The percent of past 30 day use of marijuana steadily declined from 35 percent to 26 percent (26 percent decrease).
• Among Middle School Students, the percent of youth ever having used marijuana has fluctuated between 22 percent and 21 percent over the past six years; however, this change drastically declined from 21 percent in 2005 to 14 percent in 2007 representing a 33 percent decrease between these two years.

Additional indicators:

• Among High School Students, since 2001, rates of perception of ease of obtaining tobacco (86 percent in 1999 to 67 percent in 2007), alcohol (83 percent in 1999 to 67 percent in 2007) and marijuana (83 percent in 2001 to 64 percent in 2007) have steadily decreased over time.

The Youth Zone -- After-School Youth Development Program
Linda Jeffrey, Program Director

The mission of the Youth Zone is to provide a safe place for youth to develop life skills, within the context of a caring community, which will better prepare them to deal with challenges of adolescence.  The Youth Zone provides a wide variety of preventive, educational, recreational and vocational planning, programs and resources that facilitate the development of the innate strengths found in all youth, with a focus on younger adolescents ages 10 to17.  The Youth Zone is based on building family and community networks through a strong, supportive environment, where youth can explore and lay the foundation for positive changes in all areas of their lives.

The Youth Zone is located close to Revere High School and is open four afternoons a week. Most Youth Zone participants are from low-income single parent families where parents often work long hours to meet the needs of their families. Many face the complex constraints of poverty, substance abuse and domestic violence in their homes and neighborhoods. Outreach to uninvolved youth and families is a core component of the Youth Zone, which also serves as a point of access to medical, mental health, and social services provided at the SBHC and MGH Revere. A partnership with the Chelsea Boys and Girls Club provides access to the Club for Revere youth.

Services at the Youth Zone include health education, a six-week sports program, homework support, a six-week poetry/journal writing program, arts and crafts, exercise, music, as well as, peer leadership, community service and a variety of social skills enhancement activities.   Staff support youth with concerns regarding family, school and other social issues by working with them on how to approach certain topics, how to handle stress and anger, as well as offering them outside services within the community. 

2007 Program Accomplishments

• The Youth Zone continues to participate in MGH's Jobs 4 Youth program by hiring three RHS students as junior counselors for its six-week summer program. These students are also former members of the Youth Zone program
• Scholarships were given to four families to have children attend a six-week summer program, which was made possible through fundraising efforts by the Youth Zone staff and children
• The Youth Zone has sustained a journal-writing group for girls as an avenue for discussion about relationships, families and other topics affecting youth.
• The Youth Zone established a Sports program for youth to participate in with others of the same gender.  As a reward, the staff was able to secure 27 Free tickets to a Celtics game in 2008 for the participants to attend
• Relationship with the local Boys & Girls Club in Chelsea allowed YouthZone members to join the Club free of the usual $25 charge.
• Peer Leader program participated with intergenerational activities by connecting with pediatric patients and the Senior Wellness program at the Revere Health Center
• Membership has expanded to the Asian community with six children from the Shirley Ave area in Revere
  
  2007 Program Data
  
  
• Average daily attendance at the Youth Zone is 35–40 youth for recreational activities
• The Youth Zone has a total active membership of over 190 youth
• The Youth Zone serves a diverse group of teens, which are 40 percent White, 24 percent Latino, 34 percent African American, and two percent other