Improving the delivery of services to vulnerable, under-served and high risk populations

Project Connections

Creating Partnerships to Provide Mental Health Services in Vulnerable Communities

Introduction to Project Connections

There is a direct correlation between depression and poverty, but relatively few of those affected are in treatment. There are myriad reasons for this: the apathy resulting from the disease itself, the stigma in the community for those seeking mental health treatment, and the failure to understand the disease and its consequences. These factors are exacerbated by a lack of access to mental health professionals and a corresponding dearth of culturally sensitive resources. While the causes are complex, the consequences are severe and clear: high rates of poverty, unemployment, crime, substance abuse, violence, victimization and abuse. Depression presents a public health crisis of major proportions. The challenge is to identify and treat those suffering and link them into appropriate services as they recover.

MHPILT’s Project Connections aims to meet this challenge in Baltimore City and beyond by placing mental health professionals within grassroots community institutions - from community centers and neighborhood health education sites to neighborhood primary health care clinics and re-entry programs for ex-offenders. The Project provides quality, comprehensive mental health care, education, advocacy, and support services made available to all clients of the community institutions where the project is in operation. In an effort to assure accountability and efficacy of the project, research evaluation of Project Connection’s services and outcomes have been in effect since the project’s first year of operation and are ongoing.

The current project sites are: The Rose Street Community Center and Youth Shelter Sites, Healthy Start of Baltimore – East and West Side Sites, The Men’s Health Center of the Baltimore City Health Department, Dee’s Place 24-hour Substance and Addiction Drop-In Center, and The Harriet Lane Clinic at the Johns Hopkins Hospital Children’s Center.

In addition to having received initial development funds from The Straus Foundation, Project Connections is sponsored by a consortium of four local foundations providing funds since the inception of the project: The Leonard and Helen Stulman Foundation, The Jacob and Hilda Blaustein Foundation, The Abell Foundation, and The Zanvyl Krieger Foundation. Additionally, the Open Society Institute is providing funding to expand the Project by developing a co-occurring treatment service with buprenorphine at one of the sites. Finally, the Maryland State Department of Health and Mental Hygiene – Transformation Office is funding a Phase Two research evaluation.

Project Connections Baltimore City Sites

Rose Street Community Center and Youth Shelter

A community center in the true sense of the word, the Rose Street Center was founded by two residents of East Baltimore in response to high crime and open air drug markets in their neighborhood. The founders wanted to work with the community to fix the community. The neighborhood surrounding Rose Street is one of significant poverty and is marked by boarded up homes and litter-filled alleys. Rose Street Community Center provides support groups for men just released from jail as well as transitional housing for those men and very preliminary job opportunities for people in this neighborhood. In addition to the job crews and the prison transition services, there are also tutoring programs for the children and opportunities to use the Center for other activities for people in the neighborhood. The Center currently serves single men released from prison in its transitional houses as well as about 50 people daily in the job crew plus the children who are served by the tutoring programs. It is a place to congregate, communicate and be safe.

In March of 2009, the Rose Street Community Center opened a 24-hour youth shelter on neighboring East Madison Streetwith funding from the Family and Services Youth Bureau in cooperation with the Baltimore City Mayor’s Office. The shelter is home to four temporary shelter beds for youth ages 12-17 who are homeless, run-away, or who have highly unstable living conditions in the local community. The shelter works with Rose Street’s operating youth outreach program to provide direct care and assistance to local youth by giving them a safe place to stay, and aid in attaining basic health, education, and social services.

Healthy Start – East Side and West Side

Healthy Start in Baltimore is part of a federally funded program to prevent infant mortality and low birth weight through early intervention with pregnant low-income women. Healthy Start provides health care, counseling, and other pre-natal and post-partum services. There are currently two sites in Baltimore, East and West; together they see about 500 women every year. Each site conducts a preliminary screening for depression. This reveals that at least half of the women meet the screening thresholds for depression and need further evaluation. The mental health team is working to build trust in the community through education and community enrichment projects so that the residents will feel comfortable seeking mental health treatment.

Dee’s Place 24-hour Substance and Addiction Drop-In Center

In 2000, a group of former substance users and the Historical East Baltimore Community Action Coalition, Inc. (HEBCAC) created Dee’s Place – a safe haven for those struggling to overcome addiction. The center operates 24 hours a day and 7 days a week with staff, counselors, volunteers, and meetings set up to serve those in the community whenever they are in need. In addition to being open 24/7 and holding multiple support groups per day, the Dee ’s Place team also makes every effort to connect recovering individuals with appropriate drug treatment programs as well as to offer them assistance in securing housing, legal aid, job training, mental health services, and other basic resources.

Project Connections added Dee ’s Place as a mental health treatment site in the fall of 2008. In addition, with funding from the Open Society Institute, MHPILT is preparing to implement an onsite buprenorphine recovery maintenance program at the drop-in center in conjunction with the mental health services. This program, monitored by a psychiatrist and addiction nurse specialist, will add to the ability of Dee ’s Place to provide a continuum of quality behavioral health support to recovering addicts at no-cost. The program is currently in intermediate stages of development, and is set to begin in July of 2009.

The Harriet Lane Clinic at the Johns Hopkins Hospital Children’s Center

The Harriet Lane Clinic was the first specialty clinic in the nation devoted to children. It has been providing primary health care services to the community in East Baltimore for almost a century and is currently located within the David M. Rubenstein Child Health Building of The Johns Hopkins Hospital Children’s Center.

The mission of today’s Harriet Lane Clinic is to improve the health and quality of life of children and adolescents within the context of their families and community and to educate trainees in this model of care. With over 20,000 visits each year, the Clinic serves as a training site for medical students, pediatric residents, and fellows, who provide comprehensive health care services, including check-ups, immunizations, acute illness care, psychosocial support, nutrition support, parenting education, OB-GYN and family planning services, and linkages to school and community programs for approximately 8,000 children and youth up to 21 years of age.

Project Connections is one among many unique programs that the Harriet Lane Clinic offers on behalf of children and their families, including the Fitness Circle for overweight children, the Reach Out and Read and Adolescent Literacy Program, Project HEAL (health, education, advocacy and law), and the Intensive Pediatric Clinic to treat children and adolescents with or affected by HIV.


Goals of MHPILT’s Project Connections

The goals of the MHPILT’s Project Connections are to:

1.     Increase accessibility to mental health services for people living in poverty and suffering from depression, PTSD, anxiety or demoralization

2.     Link these individuals into treatment

3.     Reduce the stigma of mental illness and receipt of treatment

4.     Educate the impacted communities about mental illness and the link between mental illness and troubled children, violence, substance abuse and unemployment

5.     Educate the impacted communities about symptoms and signs of mental illness and ways that they can improve the mental health of their communities

6.     Educate and integrate relevant professionals into these community settings

7.     Improve state and federal funding for these services

8.     Increase the numbers, training and employment of community mental health outreach workers in partnership with mental health professionals

9.     Improve health outcomes, reduce jail recidivism, improve parenting skills and build stronger families and reduce substance abuse

10.  Develop understanding of challenges of servicing this population to facilitate improved models available for replication