Week 6: Strengthening the Commonwealth through Cross-Municipal Collaboration

Co-authors:

Jan Mutchler, Nidya Velasco Roldan, Sarah Concannon

The services that local governments provide to residents vary depending on the demographics of their populations. While municipalities generally have a decent handle on how changes in the population of families with children will impact a municipality’s school system needs, there is much less discussion and analysis into how aging populations may impact municipal service provision and finances. Focusing on emergency medical services (EMS) and using Massachusetts statewide data and municipal case studies, we have attempted to begin closing this gap. In particular, this project is the first part of a research agenda that begins to address the following questions: (a) How do changes in the size of the senior population correlate with changes in EMS calls? (b) How do aging populations impact municipal costs, particularly related to EMS? (c) How do aging populations impact revenues? (d) What policy options or models have emerged to manage the impact of aging populations on costs? Our research indicates that if growth in the older population occurs as projected, and if the age-related patterns of 911 responses remain stable, demand on the EMS system will grow considerably in coming decades. This has multiple direct and indirect impacts on the municipal EMS service provision and finances. The impact on municipal costs and revenues is likely to be significant. The most direct impact will arise due to the low reimbursement rates from Medicare (and Medicaid), which (as the demand from seniors rises) will force more costs of service onto municipalities. Indirectly, the changing nature of the work of Fire Departments may hurt recruitment and retention of firefighter/paramedics, indirectly increasing costs in numerous and important ways. Strengthening skills training to better prepare EMS staff to meet the needs of older populations may promote retention. Although few policy responses have been developed to address the evolving landscape of EMS, some Massachusetts municipalities have begun to address these problems through changes like the creation of cross-departmental teams and social worker positions.

Co-authors:

Stacy Carruth, Community Health Network Area 17

Nationally and in our communities around Boston, African Americans have long experienced systemic and structural racism in systems that have resulted in decreased access to health, educational, social, and economic resources. Research shows historical trauma, the effects of diminished opportunities, and present-day experiences of racism have negative effects on the mental health of African Americans (Williams DR and Mohammed SA, 2009). Research also shows that African American adults with mental illness are less likely to receive treatment and counseling than white adults with mental illness (National Center for Health Statistics, 2017).

Community Health Network Area 17 (CHNA 17) is a community health coalition serving Arlington, Belmont, Cambridge, Somerville, Waltham, and Watertown. Its mission is to promote healthier people and communities by fostering community engagement, elevating innovative and best practices, advancing racial equity, and supporting reciprocal learning opportunities to address the needs of the most marginaLiz Hessed members of our communities. Based on recent community health needs assessments, the coalition identified racial equity and mental health of American-born Blacks as its priority area of focus. As such, CHNA 17’s activities aim to foster community engagement and build community leadership to address these issues.

The coalition has a robust internal evaluation plan. Evaluation efforts in recent years have demonstrated strong outcomes around training and capacity building of organizations and local health institutions to identify and address barriers to access for American-born Blacks. However, coalition leadership lacked a clear picture of outcomes in promoting cross-institutional learning and collaboration. In order to bridge this gap, the coalition launched a social network analysis among its active members in 2018.

The social network analysis mapped 248 connections between 71 agencies. Nearly a third (29%) of the relationships mapped involve collaboration on mental health and racial equity at least once a month, and an additional 11% of the relationships do so at least once a quarter. Looking at levels of collaboration, one third (33%) of the relationships mapped are integrated partnerships in which agencies share funding, refer clients, or co-sponsor community events. 29% are coordinated relationships in which agencies coordinate their activities, and 32% are collaborative relationships in which agencies share information and inform one another of funding opportunities. Nearly half (47%) of relationships were developed or strengthened because of their involvement in CHNA 17. These findings suggest positive outcomes in terms of coalition building efforts. The analysis also yielded some surprises. For example, one community that was assumed to be well-connected showed relatively sparse connections among key service providers. Coalition leadership has used the network map to discuss how strategic engagement with members will allow it to build on its mission and contribute to its sustainability goals. A second network survey is currently being conducted with results coming out in Spring 2020. This second round will serve to validate the baseline, and hopefully reflect outcomes of coalition building efforts adopted in recent years.

Co-authors:

Prof. David Glick, Boston University

Co-creating the society we want requires consistent engagement from academic researchers, community leaders, and government partners. It is in our best interest as a region to encourage college students – who will soon step into academic and government leadership roles themselves – to become more civically engaged.

Project-based teaching and learning is one approach to achieving this mission. Many higher education institutions in the Greater Boston area offer programs providing students with exposure to real-world projects for government partners. Whether it’s conducting policy scans, analyzing data, or researching evidence-based best practices, these programs are achieving the dual mission of improving cities and teaching students how their skills and experience are valued in the policymaking process.