Charlestown – a 1-square mile neighborhood in Boston – seemed mired in an opioid crisis in 2003.
Addicts colonized neighborhood parks and fast-food restaurants locked their bathroom doors after finding discarded needles. The signs of the crisis even appeared on a Sunday afternoon at a pizza parlor where Charlestown resident Michael Charbonnier took his two small children.
As they settled into a booth, Charbonnier saw two men at another table take out a stash of heroin and prepare to shoot up. Charbonnier, a Boston police officer, tossed them out.
“This was a family restaurant on a Sunday afternoon and it was like we had reached the point where there was no more denial. There was just acceptance,” says Charbonnier, who is chairman of Charlestown against Drugs, a neighborhood group that counsels youth about drug use. “I said, ‘What has it come to here?’”
To confront the deadly threat, Charbonnier and others in the community rallied around the then newly-formed Charlestown Substance Abuse Coalition and the leadership of Boston’s Massachusetts General Hospital (MGH), recipient of the 2015 Foster G. McGaw Prize for excellence in community service.
“Folks invited us to the table,” recalls Joan Quinlan, director of the hospital’s Center for Community Health Improvement (CCHI). “They said young people are dying in our community and we need your help.”
Through the years, the hospital has contributed several million dollars to the effort, including support for neighborhood health clinics that offer substance abuse counselling and referrals to other resources. It put the substance abuse coalition’s administrative staff on its payroll.
“The hospital is our backbone agency,” says coalition director Sarah Coughlin. “We wouldn’t be where we are without it.”
The coalition brought together disparate efforts around the town to sound the alarm about opioid abuse. Residents started calling one another, as well as police, to report suspected drug dealing – part of a block-by-block campaign to thwart the spread of heroin. Neighbors scattered their children’s plastic toys across a park, symbolic proof that they had reclaimed it from drug users. Residents distributed anti-drug magnets and fliers at neighborhood businesses.
As it supported the anti-drug campaign in the Charlestown neighborhood, MGH also developed a clinical initiative to address the problem – a response to community health needs assessments that identified substance abuse as the area’s top concern.
As part of a “community to bedside” initiative, the hospital created an outpatient recovery program for addicts that works with younger people, ages 14 to 26 and their families. It hired an addiction specialist in the emergency department and recovery coaches – recovering addicts with personal experience and additional training to help young people after they leave the hospital and return to the community.
“We look at addiction as a chronic disease, rather than a personal failing,” CCHI’s Quinlan says. “It has the same course as any other chronically lapsing disease like diabetes and hypertension. It can be managed.”
The counteroffensive in Charlestown showed strong results early on. By 2007, overdoses had plummeted by two-thirds what they were four years earlier. But the problem has grown again in recent years, says Coughlin. “We’re in it for the long-haul,” she says.
But Coughlin draws comfort from those who the initiative has helped to make whole again. “We see folks get better who people never thought would,” she says. “It is inspiring to see the change that can occur when people are given the appropriate access to treatment.”
In addition to its work in combatting substance abuse, the Foster McGaw Prize sponsors – the AHA, the AHA-affiliated Health Research & Educational Trust and The Baxter International Foundation – recognized MGH’s innovative initiatives to promote healthier lifestyles; improve access to care for vulnerable populations; and train disadvantaged youth for jobs in science and engineering.
MGH will receive the award May 3 at the 2016 AHA Annual Membership Meeting in Washington, D.C.
“We see the commitment to community health as being as fundamental to who we are as our commitment to clinical care, research and education,” says Peter Slavin, M.D., CEO of the 1,000-bed teaching hospital. “We talk about having four missions, not three.”
The hospital launched CCHI in 1995 as its springboard into the community. The CCHI team works in Chelsea, Revere and Charlestown, where the hospital has had health centers for more than 40 years, and among vulnerable Boston-area residents – troubled teens, the homeless, seniors, immigrants and refugees. It convenes community organizations, provides staffing, offers evidence-based best practices to guide collaborative action, applies for grants to help fund initiatives, and provides other resources to support a broad range of community health partnerships and initiatives.
“We bring those kinds of things to the table, but we are a partner,” says CCHI’s Quinlan. “Communities know what their issues are and how to tailor solutions to meet their needs much better than we do.”
Following a 2009 MGH needs assessment in Chelsea that showed obesity to be the number one health concern in that community, the MGH-backed Healthy Chelsea coalition helped persuade the city to ban transfats anywhere food is prepared, including restaurants, bakeries, hospitals and nursing homes. Transfats, commonly found in snacks, fried foods and baked goods, have been linked to increases in coronary heart disease and obesity.
In neighboring Revere, a collaboration between the city and Revere CARES, a coalition supported by MGH, created, among other successes, an adopt-a-park program, a district-wide walk-to-school initiative, a farmers market, community playgrounds and gardens and two urban trails.
The hospital’s leadership “understands what it takes to get things done,” says Sylvia Chiang, director of Revere CARES. “And they understand that the community has the answers to how to improve the health of the city.”
Another example of how the hospital leverages community resources is a partnership with the Appalachian Mountain Club (AMC) that gets kids and families outside and walking in local urban parks and trails. The program works with more than 60 MGH physicians to write “Outdoors Rx” prescriptions for children 13 and younger to go on free guided walks in local parks. The program also encourages families to explore the outdoors on their own using the Outdoors Rx website at www.outdoorsrx.org.
More than 4,800 kids and family members so far have participated in Outdoors Rx.
“The hospital is a well-regarded, world class institution,” says Angel Santos Burress, manager of AMC’s Outdoors Rx. “Working with an organization that takes health and wellness so seriously and pairing it with our knowledge is a great way to combine our strengths.”
In a changing health care world, hospitals are becoming less about four walls and more about partnerships that advance the health of individuals and communities. For organizations looking to strengthen their community connections, CEO Slavin advises: “Be serious about it. You have to be in it for the long term … and you need to be willing to build it into the fabric of your organization.”
April 1 is the deadline to apply for the 2016 Foster McGaw Prize. Click here to learn more. MGH’s Slavin talks about what it takes for hospitals to strengthen their community connections in this podcast.