In Your Neighborhood

Pawtucket/Central Falls HEZ celebrates it successes

When community and collaboration and coordination make a difference in the health of neighborhoods

Photo courtesy of LISC Rhode Island's 2017 Report To The Community

One of the goals of the Pawtucket/Central Falls Health Equity Zone is to improve the overall quality of life in the communities.

Photo by Richard Asinof

Central Falls Mayor James Diossa recognizes Blanche Carter, right, a Wilfred Manor resident, and Rogelio Martinez, left, a 9th grade student at St. Patrick’s Academy in Central Falls, who were paired together as part of the snow removal project.

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By Richard Asinof
Posted 10/2/17
The work to create a Health Equity Zone serving Pawtucket and Central Falls celebrated its success in building a healthier community during its first year at a farm-to-table dinner, emphasizing the importance of collaboration and community.

PROVIDENCE – Continuing difficulties at the former sheltered workshop that stood for everything wrong with Rhode Island’s developmental disability system appear to have caused new noncompliance problems for the state in U.S. District Court.

The problems revolve around one private agency, Community Work Services, a program of the New York-based Fedcap Rehabilitation Services. But the state is accountable to the court for the way it manages its service vendors and for ensuring that adults with developmental disabilities receive high-quality supports under provisions of 2013 and 2014 agreements with the U.S. Department of Justice.

In both settlements, Rhode Island agreed to end segregation of adults with developmental disabilities – a violation of the Americans With Disabilities Act – and instead to offer them the choice of supported employment and integrated non-work activities.

Community Work Services was hired in 2013 to correct Americans With Disabilities Act violations at the former sheltered workshop, Training Through Placement, but which itself has operated under one form or another of state supervision for 17 months and nearly lost its license earlier this year.

Missed deadlines
According to the latest report of a federal court monitor, the state has missed two deadlines: one, a July 30, 2017, deadline for improving the quality of individual career plans; and another, a June 30, 2017, deadline for verifying the accuracy of data reported by Community Work Services on its clients’ progress.

Despite the state’s efforts to resolve inconsistencies in the reporting data, “Problems continue to exist with the information provided by [Community Work Services],” according to a Sept. 7 report issued by the court-appointed monitor, Charles Moseley, to U.S. District Court Judge John J. McConnell.

The state, the monitor, and the Department of Justice use that data to determine whether Community Work Services is following the requirements of the Americans With Disabilities Act agreements.

Blueprints, not paperwork
The so-called “career development plans” are not supposed to be just paperwork, but blueprints that allow officials to see in an instant how the services a client currently receives fit into individualized short-term and long-term goals, according to the court agreement.

The plans are supposed to reflect a key principle embodied in the Americans with Disabilities Act: that people with disabilities have choices in how they live their lives.

Unacceptable
In Moseley’s Sept. 7 report, the monitor also said 70 percent of the clients’ career plans were “unacceptable” and had not been improved a month after the judge’s July 30 deadline, despite the state’s efforts.

For most of the 64 individuals who are active Community Work Services clients, the daily activities and yearly individual service plans didn’t line up with the long-range career development plans, according to Moseley.

In other cases, the long-range plans were “well done,” but the plans were “not being implemented in a manner which aligns with the participants’ interests,” Moseley said.

Neither the Department of Justice nor Judge McConnell have responded on the record to Moseley’s latest findings, although McConnell has said in the most recent hearing on the so-called “interim settlement agreement” of 2013 that he considers himself personally responsible for defending the rights of some 125 individuals protected by the agreement.

Connection to Craig Stenning
Community Work Services, a Boston-based agency, came to Rhode Island in 2013 as a program of Fedcap, hired by Craig Stenning, then director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to get a jump start on turning around the state’s developmental disability system in the wake of the interim settlement agreement of 2013 and the broader consent decree of 2014.

Between 2013 and 2014, Fedcap was awarded a total of about $1.7 million in state contracts. In 2015, Stenning, following his departure as director at BHDDH, joined the Fedcap senior management team.

As part of the state’s arrangement with Fedcap, Community Work Services took over the Training Through Placement [TTP] program, which had used the Birch Academy at Mount Pleasant High School as a feeder for its sheltered workshop. There, adults with developmental disabilities performed repetitive tasks, sometimes for decades, at sub-minimum wages, even when they expressed a desire to do something else.

License in jeopardy?
At a federal court hearing in May of 2017, the monitor, Moseley, told Judge McConnell that the number of former TTP clients who have found regular jobs in the community has remained “essentially flat” for the last four years. Most of the former TTP clients still received services from Community Work Services.

At that point, Community Work Services itself had been operating under one or another form of state supervision since May of 2016, as a result of both programmatic deficiencies and substandard facilities at the former TTP building in North Providence.

In his most recent Sept. 7 report, Moseley disclosed that state officials had notified Community Work Services in early May – about two weeks before the federal court hearing – that they intended to revoke the private agency’s license. But state officials changed their minds after a conference with Community Work Services’ representatives, the monitor said.

Instead of revoking the license, the R.I. Division of Developmental Disabilities decided to give Community Work Services one last chance by continuing the agency’s probationary status from July 1 to Sept. 30, with the possibility of only one more extension, until Dec. 31. The current status of the license is not clear.

Moseley said Community Work Services has brought on new staff, including a deputy director, a job developer and a new position with responsibilities for data and reporting.

According to the Community Work Services’ website, it also has a new executive director, Craig Stenning, Fedcap’s senior vice president for the New England Region and the former BHDDH director.

Extensive oversight
Less than a year after Stenning’s departure in early 2015 as the director at BHDDH – when Gov. Gina Raimondo declined to reappoint him – the Department of Justice and the court-appointed monitor asked the U.S. District Court for judicial assistance in enforcing the companion agreements of 2013 and 2014, citing a lack of progress by the state.

As a result, McConnell took up the combined cases and held the first hearing in January of 2016. Since then, the judge has held periodic reviews from the bench.

Moseley’s Sept. 7, 2017, report described the extensive state supervision dedicated to Community Work Services. Licensing officials make monthly regulatory reviews of Community Work Services. In addition, there are unannounced monthly visits coordinated with the state’s chief quality improvement officer for developmental disabilities. Supplementary phone calls and emails from state officials to Community Work Services occur at least once a week.

Meanwhile, the state’s chief employment officer for developmental disabilities provides on-site technical assistance to Community Work Services’ job developers, reviewing day-to-day activities and observing so-called “person-centered” planning meetings that are designed to put the needs and preferences of the clients first.

In earlier reports, Moseley has said the state simply does not have enough personnel to provide a fully functioning quality assurance program across the board to verify that some three-dozen service providers are complying with the “person-first” principles and practices of the Americans with Disabilities Act. He has required the R.I. Division of Developmental Disabilities to take steps to create one.

Currently, the R.I. Division of Developmental Disabilities has 24 caseworkers and a handful of supervisory personnel and support staff to manage the needs of a total of about 4,350 individuals. [About 3,700 individuals receive day-to-day services.]

After learning that there had been little change at Community Work Services since 2013, McConnell said he was angered on behalf of those who are “years late in terms of getting the services that the state agreed to,” according to a transcript of the hearing on May 23.

Addressing lawyers and state officials before him, McConnell said: “The truth is that we all [have] these hundred-odd people’s rights in our hands.”

McConnell continued. “I don’t take that lightly. I will use whatever powers that I have available to me to ensure that those individuals aren’t forgotten. Dr. Moseley always reminds me that we’re talking about individuals here and not alphabet soups and programs and whatnot. And this time it’s got to stick.”

Praise for the high school, city
McConnell concluded on what he described as an “optimistic note” for Providence city officials, whom he said had made substantial changes at Mount Pleasant High School during the last few years, enabling special education students who otherwise would have been completely segregated to become part of the broader student body and to have school-to-work experiences in the community.

“Keep up the good work,” the judge told school and city officials. “It doesn’t mean you’re at the finish line, but you’ve showed us that it can be done.”

Even though the State Innovation Model project has targeted the integration of Health Equity Zones as a priority, why have the business summits on health failed to include them as part of their agenda? As population health management increases, with an improvement in health outcomes and a decrease in unnecessary hospitalizations, how will financial rating institutions respond to the changeover in the value proposition from fee-for-service revenue metrics as the bottom line? When will the Warren Alpert Medical School at Brown University convene a gathering that brings together proponents of health equity zones, neighborhood health stations and community health centers as a different way to deliver health care?
WPRI's Dan McGowan reported recently that chronic absenteeism soared nearly 38 percent during the 2016-2017 school year, with more than 3,800 students missing at least 30 days of school. Superintendent Chris Maher responded to McGowan’s questions by saying: “We know that students that are chronically absent are much less likely than their peers to graduate from high school and be successful.”
Maher noted that Providence’s chronic asthma rates are higher than average, but no mention was made of the issue of childhood lead poisoning in Providence and its impact on school absenteeism. In 2016, nearly 1,000 children in Rhode Island were found be newly poisoned by lead, despite the efforts by advocacy groups such as the Childhood Lead Action Project. DataSparkRI has tracked the incidence of chronic absenteeism in schools. And, Anna Aizer has conducted research correlating lead poisoning of children with diminished third-grade reading levels as well as behavioral problems when children who have been poisoned become teenagers.
Perhaps it is time to make the connections between lead poisoning of children and poor academic performance, including chronic absenteeism, and make lead removal in housing and in water a top priority.

PAWTUCKET – Talk about a truly “good news” story. To celebrate its report to the community and to highlight the successes of the past year, the Pawtucket/Central Falls Health Equity Zone held a farm to table dinner at the Hope Artiste Village on Sept. 26.

The dinner was prepared by cooks at Harvest Kitchen, featuring local produce grown in part by the Southside Community Land Trust, which had helped to construct 76 community garden beds at Gallego Court in Pawtucket as part of the HEZ.

The gathering was hosted by LISC Rhode Island, the backbone agency that has helped to coordinate some 40 different community entities from the two cities in a collaborative effort to improve the health and well being of the community.

The creation of the Health Equity Zone, one of 10 in Rhode Island, was seeded by a grant in 2014 from the R.I. Department of Health with support from the Centers for Disease Control and Prevention.

The goal of the Pawtucket/Central Falls HEZ is to reduce health disparities for residents in these two communities, putting the emphasis on access to social and economic opportunities, the safety of neighborhoods and housing, the ability to access healthy food and equitable health care.

The work plan for the HEZ, created as part of a collaborative process, was presented to the community in 2016 in a presentation at Slater Mill. The celebration on Sept. 26 featured a number of success stories, as told by the participants, many of which were highlighted in the 2017 Report To The Community:

Creation of walking paths in both Central Falls and Pawtucket

Improvements in diabetes prevention and management programs

Increased opportunities for jobs and income, initially pairing 20 students with 32 senior households to help with snow removal, then expanding the program to include as many as 50 senior households.

Both Pawtucket Mayor Donald Grebien and Central Falls Mayor James Diossa spoke, with Jeanne Cola, the executive director of LISC RI calling them her favorite mayors.

But a number of participants stole the show when it came to telling their stories:

Johny Ramos, 20, a Pawtucket resident, currently a CCRI student and a Southside Community Land Trust volunteer, has been working with gardening as a volunteer at Southside Community Land Trust for 12 years, since he was 8, when he helped to water the beds.

Blanche Carter, a Wilfred Manor resident, and Rogelio Martinez, a 9th grade student at St. Patrick’s Academy in Central Falls, who were paired together as part of the snow removal project.

Mirna Rivera, a participant in the Diabetes Self-Management Education program, who had lost 40 pounds as a result of her participation. Her brief talk was given in Spanish, which was translated into English by her daughter. Her granddaughter then proudly posed for photographs with the page from the 2017 Report To The Community that featured her grandmother. Call it a family in action.

The really big news
The really big news of the evening was the announcement by LISC Rhode Island that it had closed on a $5 million investment to help fund the construction of the Neighborhood Health Station facility in Central Falls. The new facility, at the site of the former Notre Dame urgent care facility at 1000 Broad St., is scheduled to open in the fall of 2018. A groundbreaking ceremony was held a year ago featuring Central Falls native Viola Davis.

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