Blue Shield of California
Roots Community Health Center (Roots) is a community clinic licensed by the CA Department of Health Care Services that provides a unique blend of primary care and wraparound services to build empowerment and self-sufficiency for individuals, families and communities. Roots directly addresses social determinants of health disparities, such as unemployment, that are not prioritized by most medical providers. Roots’ whole health approach to wellness engages “hard to reach” individuals living in areas with high levels of violence and entrenched poverty. Roots provides culturally responsive, trauma-informed physical and behavioral healthcare, navigation services, workforce development and housing, and empowerment services tailored to the needs of its primarily low-income African American patients, a number of whom are re-entering society from incarceration. Many Roots clients suffer chronic health conditions like diabetes, hypertension or COPD, and are impacted by substance and mental health issues. Because economic and employment barriers impede whole health, Roots offers barrier removal; “soft skills” and on-the-job training in light manufacturing through its social enterprise, Clean360, a model soap factory; and upon individual readiness, linkage to permanent employment.
Roots implements a number of best-practice violence prevention strategies via programs focusing on: gun/gang violence prevention and intervention, recidivism reduction and fostering pro-social activities, family reunification/healthy relationships and fatherhood support, support for survivors of human trafficking, behavioral health interventions, and neighborhood beautification. While this work is accomplished by working across sectors and braiding funding to achieve broader goals, measurements of program activities and outcomes are driven by disparate funding sources over different time periods for distinct geographies and target populations, and are not necessarily reflective of community input.
ref. Blue Shield of CA Fnd.pdf – June 2018, Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Violence Prevention
Blue Shield of California
Roots Community Health Center is growing in impact as an East Oakland anchor organization. Since 2008, Roots has steadily rectified inequities by identifying and responding to local unmet needs and addressing social determinants of health through education, employment, training, and wraparound services that build self sufficiency and promote community empowerment. Roots honors the “roots” of culture, heritage, and tradition, prioritizes easy access, and fosters longstanding partnerships to strengthen a continuum of care in the community.
ref. Blue Shield of CA Fnd.pdf – June 2018, Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
ASCEND BLO Accelerator
Roots’ Mission is to uplift those impacted by systematic inequities and poverty by providing culturally responsive, comprehensive healthcare, behavioral health, and wraparound services; identifying and addressing root causes of illness and suffering; and emphasizing self-sufficiency and community empowerment. Roots envisions a deep East Oakland that remains predominantly African American with secure and sustained well-being through access to clean air, healthy fresh locally-sourced food, vibrant centers of learning, living-wage jobs, skills for the 21 st century workforce, and culturally responsive primary and behavioral health care services indistinguishable in quality from those available to Oakland’s wealthiest residents. Roots’ Values: We honor the “roots” of culture, heritage, and tradition; we believe in the dignity of each of our members and meet each one where they are at, providing them unprecedented access to services; we remain community-aware and community-responsive; and we establish partnerships to ensure a more efficient continuum of care. We believe in outcome driven, data-informed improvement; we conduct high impact/high value activities; and we leverage our expertise to inform systems-change work.
ref. ASCEND BLO Accelerator Application_FINAL.docx – Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Innovations in Reentry Pilot
The mission of Roots Community Health Center is to uplift those impacted by systematic inequities and poverty by providing culturally competent, comprehensive healthcare, behavioral health, and wraparound services for high risk patients, encouraging their self-sufficiency and empowerment. Initially our medical team provided services to underserved patients including reentry and homeless individuals on-site at various reentry programs, substance abuse facilities, and transitional housing programs, where participants received medical care and the opportunity to sign up for public benefits programs and supportive services. Roots provides full-scope primary care for all ages, while continuing to demonstrate a high success rate with “hard-to-reach” patients who consistently utilize our comprehensive medical and wraparound services, forming meaningful long-term relationships with the Roots care team: over 10,300 patients identify Roots as their medical home, and more than 250 people access our wraparound services each month including case management and behavioral health care.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Innovations in Reentry Pilot
The mission of Roots Community Health Center is to uplift those impacted by systematic inequities and poverty by providing culturally competent, comprehensive healthcare, behavioral health, and wraparound services for high risk patients, encouraging their self-sufficiency and empowerment. Initially our medical team provided services to underserved patients including reentry and homeless individuals on-site at various reentry programs, substance abuse facilities, and transitional housing programs, where participants received medical care and the opportunity to sign up for public benefits programs and supportive services. Roots provides full-scope primary care for all ages, while continuing to demonstrate a high success rate with “hard-to-reach” patients who consistently utilize our comprehensive medical and wraparound services, forming meaningful long-term relationships with the Roots care team: over 10,300 patients identify Roots as their medical home, and more than 250 people access our wraparound services each month including case management and behavioral health.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Expanding East Oakland Access to Primary Care for 911/Emergency Medical Service
Roots Community Health Center was founded in 2008 to address troubling health issues in East Oakland with the vision of improving health through innovative and accessible healthcare delivery. The mission of Roots Community Health Center is to provide the highest quality, culturally competent, comprehensive healthcare and mental health services with the goal of eliminating health disparities in East Oakland. Roots accomplishes its mission by providing state-of-the-art, top quality care while honoring the “roots” of culture, heritage and tradition; by providing unprecedented access to preventive, primary and urgent care; and by maintaining a network of partnerships to ensure a more effective continuum of care in East Oakland. Roots’ innovative leadership team is committed to improving the health of underserved communities through education, advocacy, and innovative care models informed by objective research and collaboration. To that end, we conduct research on pressing health issues and develop innovative strategies to address these issues. We then incubate, test and refine these strategies, with the goal of creating replicable models for use in other communities.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Exploring and Developing
Roots is a 501(c)3 organization licensed as a Community Clinic by the California Department of Health Care Services with a $5 million annual budget. Financial oversight on the annual budget and the contracts and activities cited above are the responsibility of the Roots Board of Directors, Chief Executive Officer and Director of Finance. The agency undergoes an annual independent financial audit. Roots has a successful track record of designing and implementing innovative approaches to serving the community, including developing fiscal processed that are responsive to the needs of the people we serve.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
The Alliance Health Home Pilot
Roots Community Health Center has a proven track record in offering successful care and case management for high needs patients at our four Oakland locations (two fixed clinical sites, one mobile clinical site, and one workforce/case management site), consistent with our Whole Health model upon which Roots was founded. While we serve as a primary care health home for all community members, case management is currently provided for two high-risk primary care populations: medically fragile, chronically homeless individuals; and individuals with chronic illness being released from incarceration. As detailed below, Roots’ care and case management model and infrastructure are designed to prevent avoidable morbidity, overutilization of medical care and inappropriate utilization of acute care facilities for non-medical needs – that is, to prevent transitioning to a medical high-utilizer state. Our model thus has clear application to managing clients who enter our care from a medical high utilizer state.
ref. AAH Response_FINAL_2017 The Alliance Health Home Pilot – 2017, Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
The Alliance Health Home Pilot
Since our formation in 2008, Roots has grown from a small operation of volunteers to a multi-site nonprofit serving nearly 10,000 low-income residents through a primary care clinic, pediatrics clinic, mobile clinic for the homeless, and innovative care/case management and workforce development initiatives. Eighty-seven percent of our adult patients/members are Medi-Cal recipients, 89% are African American and 7% are Latino. Nearly half of our adult patients are men, unlike the majority of primary care medical homes which have historically served mostly women, or women and children.
Roots addresses social determinants of health disparities that are often not prioritized by traditional medical providers. Our programs increase opportunities that stabilize life for people surviving high levels of trauma – including violence, racism, marginalization, homelessness and poverty. We are a primary care medical home for all underserved patients, prioritizing outreach and linkage-to-care efforts to African American men, including the formerly incarcerated, homeless, and those with substance use and mental health issues. Roots leadership shares a value that for our patients to meaningfully engage in ongoing primary, preventative and mental health care that is effective in reaching high risk groups, patients’ initial experiences upon entering the medical system must build trust based on a partnership between the individual and staff to overcome the multitude of barriers that exist. Engaging these patients at the ground-level when they engage with Roots is crucial to ensuring ongoing care. Thus we have expanded on our early work with reentry men and those with substance abuse and mental health issues, through implementation of our HealthyMeasures Initiative, a strong care/case management model, and OaklandSTOMP, our mobile clinic which targets medically fragile, chronically homeless individuals. Both Healthy Measures and Oakland STOMP utilize Roots Health Navigators who build trust that facilitates their ability to obtain detailed patient information, including family contacts, where they hang out, and what they do when they are under stress. RHNs are assertive in staying connected, via home/encampment visits and active outreach, especially during times of crisis. We frequently receive information from others involved in clients’ lives, such as probation officers, service providers and family members who partner with us to “wrap around” our clients. Roots has worked diligently to create a welcoming medical home that honors the roots of culture, offering unprecedented access to community-responsive services. Our expertise serving the “hardest to serve,” our determination to bring the Whole Health model to Oakland communities vulnerable to marginalization and push- out, and our success providing high quality primary care and whole health initiatives, have resulted in a significant growth trajectory, including several recent key opportunities that are strengthening our path to becoming a hub/anchor organization for deep East Oakland. Among these opportunities are our increasingly strong partnerships with the Alameda County Department of Public Health and the City of Oakland to bolster place-based strategies that improve the health of at-risk Oakland residents, including several focused, coordinated efforts in East Oakland’s Sobrante Park neighborhood. Roots’ place-based approach to this work includes close partnerships with resident leaders, schools, and relevant city and county departments/offices to: improve the built environment by ensuring safe spaces and food access; deploy violence-prevention/ intervention initiatives; implement educational coaching and civic engagement in partnership with local schools for youth at risk of not graduating; and facilitate opportunities for community economic empowerment through fiscal sponsorship, incubation, technical assistance and capacity building for local non-profits and resident groups. This work is serving as a learning laboratory for achieving health equity, focusing simultaneously on upstream approaches and treatment strategies within a defined geographic area that has demonstrated persistent poor health outcomes.
ref. AAH Response_FINAL_2017 The Alliance Health Home Pilot – 2017, Dan Abrahamson
Core Care Model:
Program: Healthy Measures; STOMP
Themes, Keywords & Tags: About; Mission
ACOCAP
Roots’ mission is to address long-standing health inequities by providing culturally competent, comprehensive physical and mental health services; education, employment and training; and wraparound services that build client self-sufficiency and promote community empowerment. Roots addresses social determinants of health disparities – including unemployment – that are often not prioritized by traditional medical providers. Our programs and services honor the “roots” of culture, heritage, and tradition; prioritize easy patient/client access; insure community-aware, responsive programs; and enable long-standing partnerships, resulting in an efficient continuum of care in Oakland. We see our mission and vision as well-aligned with that of AC-OCAP, and welcome this opportunity to introduce our Emancipators Initiative and be considered as a partner. An African American child born in East Oakland can expect to live 15 fewer years than a White child born in the Oakland Hills. Roots is determined to rectify this state of inequity by delivering top-quality primary and behavioral healthcare integrated with wraparound services and workforce development. Programs are designed to engage and empower all members of our community, countering the effects of multi-generational poverty, trauma, incarceration, chronic stress and longstanding lack of health access. In eight years, we have grown from a small operation of volunteers to a multi-site nonprofit serving nearly 10,000 low-income local residents through a primary care clinic, pediatrics clinic, mobile clinic for the homeless, and innovative case management and workforce development initiatives. Over 1200 people have accessed Roots’ wraparound services, including case management and behavioral health care. Our clinics are also a training ground for Oaklanders aiming to serve their home community as health professionals. While we train more than 60 individuals annually in healthcare professions ranging from community health outreach worker to nurse to physician, we recognize that healthcare careers are not a match for everyone, whether due to aptitude, criminal record, or preference. As a result, we strengthened our job training/employment programming over the last three years through the launch of the Emancipators Initiative, providing on-the-job training in the light manufacturing setting; barrier removal, “soft skills” training; and upon individual readiness, linkage to permanent employment. Roots Emancipators Initiative began as a workforce pilot with Alameda County Social Services Agency to transition individuals off of General Assistance, and led to the design and implementation of our social enterprise, Clean360 (www.clean360.org), in which we train at-risk individuals in our model soap factory. Emancipators learn how to make small batch, handcrafted soaps while they receive stipended on-the-job training, barrier removal assistance, and ongoing support. Over its 28-month pilot, 30 of 32 Emancipators (94%) achieved long-term stabilization and permanent, sustainable employment in our Clean360 social enterprise (6) or in outside employment (24).
ref. ACOCAP_RFP_Response.pdf – 2017-2019, Dan Abrahamson
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: About; Mission
ACVPI
Roots Community Health Center’s mission is to eliminate East Oakland’s health disparities by services, resulting in increased capacity for client self-sufficiency and empowerment. Roots implements its programs and services while honoring the “roots” of culture, heritage and tradition; providing unprecedented access to services; remaining community-aware and community-responsive; and establishing partnerships to ensure a more effective, efficient continuum of care in Oakland. Roots addresses social determinants of health disparities that are often not prioritized by traditional medical providers. Our programs increase opportunities that stabilize life for people surviving high levels of trauma – including violence, racism, marginalization, and poverty. We are a primary care medical home for all underserved patients, prioritizing outreach and linkage-to-care efforts to African American men, including the formerly incarcerated, homeless, and those with substance use and mental health issues. Many of these individuals have had no meaningful connection to medical care as a result of entrenched barriers to public benefits and services, particularly prior to the implementation of the Affordable Care Act. Many of our patients have not had medical coverage since childhood, some only received care on an emergency basis, others only in correctional facilities, and some are homeless or without stable housing. In addition to primary care and mental health, Roots’ services include pediatrics; mobile services/street medicine; research/evaluation; and empowerment initiatives offering training and employment, enhanced by barrier removal, case management, and service navigation. Roots maintains two East Oakland sites, home for over 9,000 patients. Since our formation in 2008, staff has grown from 2 volunteers to 45 full-time staff, over 90% of whom are hired from our community. Eighty-seven percent of patients/members are Medi-Cal recipients, 89% are African American and 7% Latino. Nearly half of our adult patients are men, unlike the majority of primary care medical homes which have historically served mostly women, or women and children. For over eight years, Roots has identified and corrected disparities of access that include regular physical/mental health treatment, employment, housing, education, and related obstacles to a stable life. Our activities and services (see Figure 2) continue to expand organically, in response to needs identified through community input, demonstrated through internal and/or external data, and our understanding of the local context within which services are provided.
ref. ACVPI_Roots_Proposal.pdf – November 2016, Dan Abrahamson
Core Care Model:
Program: IMPACT Eastmont
Themes, Keywords & Tags: About; Mission
Innovations in Reentry 2 – Reentry Engagement Framework Project
Founded in 2008, Roots Community Health Center is a primary care medical home that prioritizes health care access serving the whole person, and targets underserved patients, with a focus on African American men, including reentry and homeless populations. Many of our clients have had no previous meaningful connection to medical care as a result of entrenched barriers to public benefits and services, particularly prior to the implementation of the Affordable Care Act. Many of our patients have not had medical coverage since childhood, some only received care on an emergency basis, others only in correctional facilities, and some are homeless or without stable housing. For the past eight years, Roots has identified and corrected disparities of access that include regular physical/mental health treatment, employment, housing, education, and related obstacles to a stable life.
The mission of Roots Community Health Center is to eliminate Oakland’s health disparities by providing culturally competent, comprehensive healthcare, behavioral health, and wraparound services for high risk patients, encouraging their self- sufficiency and empowerment. Initially our medical team provided services to underserved patients including reentry and homeless individuals on-site at various reentry programs, substance abuse facilities, and transitional housing programs, where participants received medical care and the opportunity to sign up for public benefits programs and supportive services. Since becoming a state-licensed community health center, Roots now provides full-scope primary care for all ages. Roots has consistently demonstrated a high success rate with “hard-to-reach” patients who routinely utilize our comprehensive medical and wraparound services. By providing these holistic services, Roots’ care teams are able to form meaningful long-term relationships with clients. Over 9,000 patients now identify Roots as their medical home, and more than 1,400 people have accessed our wraparound services including case management and behavioral health care since 2013.
In 2013 Roots implemented its HealthyMeasures Initiative as a best-practice strategy to serve reentry individuals with chronic medical conditions. The Initiative establishes a formal relationship with San Quentin Prison Health and allows inmates to enroll in medical care prior to release, so that they are linked to Roots as their primary care medical home to jump-start their transition upon release. In 2014, Roots expanded HealthyMeasures to recruit and train formerly incarcerated individuals who complete their Community Health Worker Certificate at SF City College and provide navigation/intensive case management to recently released individuals. Roots Health Navigators currently provide case management services to 426 recently released Alameda County residents. Roots’ Health Navigators have formed strong client relationships, providing face-to-face client services at Roots or in the community. Their skills develop through regular team meetings, and ongoing coaching and supervision by the HealthyMeasures Director.
Building on our commitment to serve the formerly incarcerated, and with support from Alameda County Social Services, Roots launched Emancipators Initiative – our workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including reentry individuals. In the first months of implementation, we forged a social enterprise, Clean360 (www.clean360.org), as the platform in which we train at-risk individuals in our model soap factory. Through ongoing support and a best practices curriculum, Emancipators are demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic. In the past two years, 26 participants completed the program – 25 of them reentry individuals. Reentry Emancipators have a 96% success rate with respect to long-term stabilization and employment.
Timelist is a multicultural nonprofit in Union City that empowers reentry community members with effective tools, resources, leadership training and positive influences to guide them on a path to success. Timelist’s mission is to engage with communities to end the cycle of violence, crime, poverty and recidivism through best practices in reintegration services and social programs. Since 2007, Timelist has served over 500 reentry and pre-release individuals in California, including Alameda County residents. Fewer than 1% of Timelist’s released clients return to prison.
Timelist’s founders were previously incarcerated, and have lived experience in the challenges of persons navigating reentry. They have designed a supportive, structured program to prevent recidivism and help those reentering the community create a positive, rewarding environment for themselves and their families. Timelist’s services include apprenticeships, legal assistance, family reunification, housing referrals, emotional recognition and rehabilitation classes, leadership development, general education classes and employment skills assessment.
Core Care Model:
Program: Reentry Engagement
Themes, Keywords & Tags: About; Mission
Innovations in Reentry 2 – Reentry Engagement Framework Project
Roots Community Health Center (Roots) is a community clinic licensed by the CA Department of Health Care Services that provides a unique blend of primary care and wraparound services to build empowerment and self-sufficiency for individuals, families and communities. Roots directly addresses social determinants of health disparities, such as unemployment, that are not prioritized by most medical providers. Roots’ whole health approach to wellness engages “hard to reach” individuals living in areas with high levels of violence and entrenched poverty. Roots provides culturally responsive, trauma-informed physical and behavioral healthcare, navigation services, workforce development and housing, and empowerment services tailored to the needs of its primarily low-income African American patients, a number of whom are re-entering society from incarceration. Many Roots clients suffer chronic health conditions like diabetes, hypertension or COPD, and are impacted by substance and mental health issues. Because economic and employment barriers impede whole health, Roots offers barrier removal; “soft skills” and on-the-job training in light manufacturing through its social enterprise, Clean360, a model soap factory; and upon individual readiness, linkage to permanent employment.
Roots implements a number of best-practice violence prevention strategies via programs focusing on: gun/gang violence prevention and intervention, recidivism reduction and fostering pro-social activities, family reunification/healthy relationships and fatherhood support, support for survivors of human trafficking, behavioral health interventions, and neighborhood beautification. While this work is accomplished by working across sectors and braiding funding to achieve broader goals, measurements of program activities and outcomes are driven by disparate funding sources over different time periods for distinct geographies and target populations, and are not necessarily reflective of community input.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Roots Community Health Center (Roots), with our primary site located in deep East Oakland, is committed to our mission: to address long-standing health inequities by providing culturally competent, comprehensive physical and mental health services; education, employment and training; and wraparound services that build client self-sufficiency and promote community empowerment. Roots addresses social determinants of health disparities that are often not prioritized by traditional medical providers. Our programs and services honor the “roots” of culture, heritage, and tradition; prioritize easy patient/client access; ensure community-aware, responsive programs; and enable long-standing partnerships, resulting in an efficient continuum of care for our clients/patients. At Roots, services are provided within a safe, trustworthy environment enabling the best possible outcomes for so-called “hard to reach” individuals. By demonstrating competency through humility and a desire to meet individuals “where they’re at” each Roots provider establishes him or herself as someone that individuals can trust and with whom they can share their concerns and develop a therapeutic relationship. Such relationships lay a foundation for increased patient/client engagement, empowered attitudes regarding systems of care, and improved standards of health within underserved communities overall.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Reentry
East Oakland Building Healthy Communities
Roots Community Health Center is a community clinic licensed by the California Department of Health Care Services that is growing in impact as an East Oakland anchor organization. Roots provides a unique blend of primary care and complementary services to build empowerment and self-sufficiency through a whole person approach to health. Roots is acting on new opportunities and building organizational capacity as we serve as an Oakland-rooted model that demonstrates integrated, whole health services and programs. Our success has led to the addition of new locations, including our pediatric clinic in the lower Fruitvale neighborhood, our social enterprise – Clean360 – in central Oakland and two new storefronts, including our newest location at our primary care site in East Oakland. We have also added service components in San Jose and the Crenshaw district of Los Angeles.
Roots’ mission is to address Oakland’s long-standing health inequities by providing culturally competent, comprehensive physical and mental healthcare, education, employment and training, and wraparound services that build individual self-sufficiency and promote community empowerment. Roots implements our mission by addressing major social determinants of health disparities – including unemployment and marginalization from the workforce – that are often not prioritized by traditional medical providers. Our programs and services honor the roots of culture, heritage, and tradition; prioritize easy access, particularly during critical life transitions; ensure community-aware, responsive service delivery; and engage in long-standing partnerships: organizational drivers that lead to our empowering and efficient continuum of care in Oakland.
Core Care Model:
Program: East Oakland Building Healthy Communities
Themes, Keywords & Tags: About; Mission
On the Frontlines of Communities Hub Host Proposal
Roots Community Health Center (“Roots Clinic”) is a 501(c)3, licensed community health center dedicated to improving the health status of East Bay residents. Roots Clinic accomplishes its mission not only by providing direct service to low-income individuals, but also by establishing partnerships to ensure a more efficient continuum of care for its population. To that end, Roots Clinic leadership spearheaded a collaborative of similarly mission-driven independent clinics and private practices, including primary and specialty care, which serve low-income people of color in Alameda and Contra Costa Counties. This collaborative, Roots Community Health Alliance (“Roots Alliance”), is a 501(c)6 non-profit professional association dedicated to the preservation and advancement of independent Safety Net practices—those institutions which have tremendous impact on the health of their patients through long-standing relationships and a high degree of trust.
Core Care Model:
Program: HealthSTATS
Themes, Keywords & Tags: About; Mission
West Oakland Street Outreach
Roots Community Health Center, an East-Oakland based full-scope state-licensed health center, brings equity in healthcare and supportive services to low-income community members living with high levels of unemployment, violence and entrenched poverty. Roots offers a welcoming medical home with an innovative, integrated resource menu including primary and behavioral care and complementary services shaped by cultural competence and respect. Formed in 2008, a staff of 34 and board of 7 implement Roots’ mission to eliminate Oakland’s health disparities by providing comprehensive healthcare and related services that encourage patient self-sufficiency and empowerment. We define health broadly and work to increase opportunities for those who have lived with high levels of trauma – including violence, racism, marginalization and poverty. Our strong service delivery model includes hiring from the community and prioritizing service to African American men, formerly incarcerated, homeless, and those with substance use and mental health issues. In 2013, we implemented our Healthy Measures Initiative, through which formerly incarcerated “Roots Health Navigators” become certified Community Health Outreach Workers, provide case management/wraparound services to reentry individuals, facilitating successful reintegration into their families/ communities. Our primary care patient base is >8,000, with 1,200+ accessing wraparound service.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal – April 2018, Dan Abrahamson
Core Care Model:
Program: West Oakland’s Assembly a Family of Churches (WAFC)
Themes, Keywords & Tags: About; Mission
Building Medical Home Capacity for Pediatric Early Identification and Linkage
Roots Community Health Center is a community clinic licensed by the California Department of Health Care Services that is growing in impact as an East Oakland anchor organization providing a unique blend of primary care and complementary services to build empowerment and self-sufficiency through a whole person approach to health. In conjunction with the Alameda County Public Health Department, First 5, and our collaborative partner, Health Leads, Roots Community Health Center proposes to build upon existing infrastructure to improve screening, early identification and linkage to care; identify unmet need among children and families; and build the capacity of pediatric medical homes across the county to address social, emotional and developmental needs.
Roots is committed to expanding our Whole Health model which integrates empowerment, self- advocacy and participation with Roots as a primary health care home – with a goal to build a replicable model of Whole Health to serve communities traditionally without culturally responsive healthcare services, where barriers to healthcare intersect with lack of access to opportunity. Roots’ approach combines physical and mental healthcare with complementary services inspired by our commitment to culturally responsive care and empowerment for individuals and families, and enhanced by health navigation services to access benefits and build linkages to appropriate services.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Prop 47
Roots Community Health Center, located in East Oakland, provides health resources, broadly defined, to low income, underserved people and families, prioritizing the needs of vulnerable community members who live in neighborhoods with high levels of violence and entrenched poverty. Roots’ approach combines physical and mental healthcare with complementary services inspired by our commitment to culturally responsive care, grounded by a commitment to empowerment for individuals, families and workforce participants, and enhanced by health navigation services to access benefits and build linkages to appropriate services.
Roots’ mission is to uplift those impacted by systemic inequities and poverty by providing culturally responsive, comprehensive physical and behavioral healthcare, and wraparound services, encouraging self-sufficiency and economic empowerment. Roots’ expertise providing culturally competent and situationally appropriate services is demonstrated through authentic engagement with the most vulnerable and most marginalized among us: those reentering society from incarceration, unsheltered individuals, and those with mental health and substance use issues – the very individuals this opportunity seeks to serve. Specific programs and services, designed to assess, prioritize and meet the needs of these priority populations, are delineated below.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Mental Health Prevention and Early Intervention
Since its inception, Roots has steadily rectified inequities by removing barriers to access (as evidenced, in part, by a steady stream of patients transferring their care to Roots), identifying and responding to local unmet needs, delivering responsive services that meet people where they are, and promoting self-efficacy of marginalized individuals so they have access to a healthy life. Roots seeks to intervene in ways we know to be effective, test new approaches we believe hold promise, and forge and strengthen partnerships with a broad range of other organizations that are critical to protecting and sustaining low-resource neighborhoods in East Oakland.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Mental Health Prevention and Early Intervention
Roots’ mission is to address long-standing health inequities by providing culturally responsive, comprehensive physical and mental health services; education, employment and training; and wraparound services that build self-sufficiency and promote community empowerment. Roots provides health resources, broadly defined, to low income individuals and families, prioritizing the needs of vulnerable community members who live in neighborhoods with high levels of violence and entrenched poverty. Roots combines culturally responsive physical and mental healthcare grounded in a commitment to empowering individuals, families and communities. To this, Roots adds health navigation services to enhance persons’ access to benefits and linkages to appropriate programs and opportunities.
Given the unprecedented needs of East Oakland residents and low-income communities of color, Roots works to promulgate, deepen and expand its commitment to whole health. We continuously refine our methodology that integrates empowerment, self-advocacy and participation with Roots as a health home in East Oakland with an eye towards creating a replicable model for whole health that can benefit even distant communities that traditionally lack culturally responsive healthcare services and access to economic, educational and cultural opportunity. Individuals who come to Roots initially for basic primary medical treatment, establish relationships with Roots staff and through those relationships become empowered to self-advocate for their wellbeing and are introduced to the tools necessary to pursue greater opportunity. Some Roots members participate in Roots training programs to become health professionals (approximately 60 individuals annually); other members become Roots Health Navigators who, in turn, use their skills and lived experience to care for new clients, thereby perpetuating a cycle of whole health.
Roots’ decision to locate in “deep East” Oakland (12 blocks from Sobrante Park) was intentional. Roots desires to reside in the midst of the city’s and county’s greatest and most persistent health disparities, to work in the community that has the greatest concentration of supervised individuals (probation/parole)1; to offer healing in a place plagued by 7 of the top 10 “stressor beats” in Oakland (indicators of higher rates of violent crime)2; and to educate and empower in a community in which more than one in four residents over age 17 lack even a high school diploma.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Sobrante Park Narrative
Roots’ mission is to address long-standing health inequities by providing culturally responsive, comprehensive physical and mental health services; education, employment and training; and wraparound services that build self-sufficiency and promote community empowerment. Roots provides health resources, broadly defined, to low income individuals and families, prioritizing the needs of vulnerable community members who live in neighborhoods with high levels of violence and entrenched poverty. Roots combines culturally responsive physical and mental healthcare grounded in a commitment to empowering individuals, families and communities. To this, Roots adds health navigation services to enhance persons’ access to benefits and linkages to appropriate programs and opportunities.
Given the unprecedented needs of East Oakland residents and low-income communities of color, Roots works to promulgate, deepen and expand its commitment to whole health. We continuously refine our methodology that integrates empowerment, self-advocacy and participation with Roots as a health home in East Oakland with an eye towards creating a replicable model for whole health that can benefit even distant communities that traditionally lack culturally responsive healthcare services and access to economic, educational and cultural opportunity. Individuals who come to Roots initially for basic primary medical treatment, establish relationships with Roots staff and through those relationships become empowered to self-advocate for their wellbeing and are introduced to the tools necessary to pursue greater opportunity. Some Roots members participate in Roots training programs to become health professionals (approximately 60 individuals annually); other members become Roots Health Navigators who, in turn, use their skills and lived experience to care for new clients, thereby perpetuating a cycle of whole health.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf – March 2018, Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Healthy Measures: Health Care Connection Services for Formerly Incercerated
Since 2011, Roots Community Health Center, located in East Oakland, has been dedicated to meeting the needs of low-income, underserved individuals and families who experience the multigenerational impacts of poverty, violence, and incarceration. While Roots established itself as a primary care medical home for all underserved patients, leadership shared a specific mission to provide comprehensive care to African American men, many of whom have never engaged meaningfully in medical care as a result of the many barriers to public benefits and services programs that existed. Our patients are a high health need population, the majority of whom live with chronic illnesses and also suffer from trauma-related behavioral health conditions including substance abuse disorders and the mental health impacts of institutionalization. Roots staff and clinicians are trained to provide culturally-competent, trauma-informed care that addresses the symptoms as well as the causes of trauma, making us ideal candidates to serve newly-released, chronically ill patients.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: About; Mission; Incarceration
Healthy Measures: Health Care Connection Services for Formerly Incarcerated
Roots Community Health Center has been an important link to a primary care medical home for men released to the East Bay since October 2013 through an existing relationship with San Quentin Prison Health. Through this relationship, inmates are able to make an appointment to sign up for benefits and medical care prior to release, so that upon release, they are immediately linked to a culturally competent primary medical home as they navigate the transition. All of these patients suffer from chronic illnesses, including mental health disorders, and also need additional support services upon release, such as housing, employment training, and counseling. Because transitioning individuals who have experienced chronic and/or long-term incarceration are more likely to require support services post-release and due to the fact that the two-week period after release is critical (provide note), swift and efficacious linkage to a primary care medical home that offers wraparound services is fundamental component of stabilization. At Roots, reentry patients receive culturally competent, trauma- aware services which support acute medical needs and long-term stabilization.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: About; Mission; Medical Care
Uplift Initiative
An African American child born in East Oakland can expect to live 15 fewer years than a White child born in the Oakland Hills. Roots is determined to rectify this state of inequity by delivering top quality primary and behavioral healthcare integrated with wraparound services, education, training and workforce development. Our programs are designed to engage and empower all members of our community, countering the effects of multi-generational poverty, trauma, incarceration, chronic stress and longstanding lack of health access.
Roots’ mission is to address long-standing health inequities by providing culturally competent, comprehensive physical and mental health services; education, employment and training; and wraparound services that build individual self-sufficiency and promote community empowerment. Roots addresses social determinants of health disparities – including lack of educational attainment – that are often not prioritized by traditional medical providers. Our programs and services honor the “roots” of culture, heritage, and tradition; prioritize easy community access; ensure community-aware, responsive programs; and enable long-standing partnerships, resulting in an efficient continuum of care in Oakland. We see our mission and vision as well-aligned with that of the Community Health Services Division of the Alameda County Department of Public Health, and welcome this opportunity to present our Uplift Initiative and be considered as a partner.
ref. Roots Care Coaching_narr.pdf Uplift Initiative Bid Response – April 2018, Dan Abrahamson
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
East Oakland Building Healthy Communities
Roots Community Health Center is a community clinic licensed by the California Department of Health Care Services that is growing in impact as an East Oakland anchor organization. Roots provides a unique blend of primary care and complementary services to build empowerment and self-sufficiency through a whole person approach to health. Roots is acting on new opportunities and building organizational capacity as we serve as an Oakland-rooted model that demonstrates integrated, whole health services and programs. Our success has led to the addition of new locations, including our pediatric clinic in the lower Fruitvale neighborhood, our social enterprise – Clean360 – in central Oakland and two new storefronts, including our newest location at our primary care site in East Oakland. We have also added service components in San Jose and the Crenshaw district of Los Angeles.
Roots’ mission is to address Oakland’s long-standing health inequities by providing culturally competent, comprehensive physical and mental healthcare, education, employment and training, and wraparound services that build individual self-sufficiency and promote community empowerment. Roots implements our mission by addressing major social determinants of health disparities – including unemployment and marginalization from the workforce – that are often not prioritized by traditional medical providers. Our programs and services honor the roots of culture, heritage, and tradition; prioritize easy access, particularly during critical life transitions; ensure community-aware, responsive service delivery; and engage in long-standing partnerships: organizational drivers that lead to our empowering and efficient continuum of care in Oakland.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Alameda Alliance for Health
Roots Community Health Center’s mission is to eliminate Oakland’s health disparities by providing culturally competent, comprehensive healthcare, mental health, and wraparound services, and by building capacity for self-sufficiency and community empowerment. Roots implements its programs and services while honoring the “roots” of culture, heritage and tradition; by providing unprecedented access to services; by remaining community-aware and community-responsive; and by establishing partnerships to ensure a more efficient continuum of care in Oakland.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
AB 109 – Reentry and SSI Advocacy Population Case and Care Management Services
oots Community Health Center, located in East Oakland, provides health resources, broadly defined, to low income, underserved people and families, prioritizing the needs of vulnerable community members who live in neighborhoods with high levels of violence and entrenched poverty. Over the past seven years, we have maintained our commitment to attract and serve the reentry population from our community, particularly men of color and African Americans from East Oakland who don’t trust institutions or the medical profession, living for generations with no regular healthcare. Roots’ mission is to eliminate Oakland’s health disparities by providing respectful, culturally competent, comprehensive healthcare, mental health, and wraparound services for high risk patients, encouraging their self-sufficiency and empowerment.
Since our formation in 2008, Roots has introduced the formerly incarcerated, including men with mental health and substance abuse issues, to health and stabilization resources by building partnerships in which they become strong spokespersons for their own health, encouraged by Roots’ care team which nurtures trusting relationships and supports healthy choices that improve their own and their family’s lives. Early on, our medical team provided mobile services to this population in partnership with re-entry programs, substance abuse facilities, and fatherhood programs, where patients received medical care and the opportunity to sign up for public benefits and supportive services. Since becoming a full-scope, state licensed community health center, we have successfully retained these “hard-to-reach” patients: our facility is now a one-stop entry point for comprehensive medical care and appropriate wraparound services shaped by culturally-competent, trauma-informed care that addresses the symptoms as well as the causes of trauma, making us ideal candidates to serve newly-released, chronically ill patients.
Roots has set a high standard in demonstrating effective, culturally-congruent and trauma-aware reentry services in Oakland. Early on, we implemented the Emancipator’s Initiative, using a care and case management model to facilitate reentry after incarceration via a short-term transition and overall stabilization at our primary care facility. This successful program demonstrates that individuals in transition not only need a primary care medical home coupled with mental/behavioral health diagnosis and treatment, but they also require additional stabilizers: public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and dedicated, peer-centered mentoring. We have enhanced this approach by employing peer case managers, all of whom are formerly incarcerated, and who complete their Community Health Worker Certificate at SF City College and provide navigation/intensive case management to recently released individuals. Our experience working with the reentry population has shown that identifying and dismantling barriers to social, emotional, and financial stability is a fundamental first step in a successful transition. Our approach to client-centered, culturally congruent case management assists clients in addressing physical and mental health barriers along with legal and psychosocial issues, through case management that supports long-term stabilization.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Population
Mental Health Prevention and Early Intervention (PEI) Services in Sobrante Park
Roots Community Health Center (Roots), with our primary site located in deep East Oakland, is committed to our mission: to address long-standing health inequities by providing culturally competent, comprehensive physical and mental health services; education, employment and training; and wraparound services that build client self- sufficiency and promote community empowerment. Roots addresses social determinants of health disparities that are often not prioritized by traditional medical providers. Our programs and services honor the “roots” of culture, heritage, and tradition; prioritize easy patient/client access; ensure community-aware, responsive programs; and enable long-standing partnerships, resulting in an efficient continuum of care for our clients/patients.
Since our formation in 2008, Roots has maintained our primary care home in deep East Oakland, with the majority of our patients coming from the immediate East Oakland community. We have developed a range of services that complement health and behavioral health care and correct disparities of access including access to employment, housing, education, and related obstacles to a stable life. Our activities and services continue to expand organically, in response to needs identified through community input, demonstrated through internal and/or external data, and our understanding of the local context within which services are provided.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Mental Health Prevention and Early Intervention (PEI) Services in Sobrante Park
Roots’ mission is to address long-standing health inequities by providing culturally responsive, comprehensive physical and mental health services; education, employment and training; and wraparound services that build self-sufficiency and promote community empowerment. Roots provides health resources, broadly defined, to low income individuals and families, prioritizing the needs of vulnerable community members who live in neighborhoods with high levels of violence and entrenched poverty. Roots combines culturally responsive physical and mental healthcare grounded in a commitment to empowering individuals, families and communities. To this, Roots adds health navigation services to enhance persons’ access to benefits and linkages to appropriate programs and opportunities.
Given the unprecedented needs of East Oakland residents and low-income communities of color, Roots works to promulgate, deepen and expand its commitment to whole health. We continuously refine our methodology that integrates empowerment, self-advocacy and participation with Roots as a health home in East Oakland with an eye towards creating a replicable model for whole health that can benefit even distant communities that traditionally lack culturally responsive healthcare services and access to economic, educational and cultural opportunity. Individuals who come to Roots initially for basic primary medical treatment, establish relationships with Roots staff and through those relationships become empowered to self-advocate for their wellbeing and are introduced to the tools necessary to pursue greater opportunity. Some Roots members participate in Roots training programs to become health professionals (approximately 60 individuals annually); other members become Roots Health Navigators who, in turn, use their skills and lived experience to care for new clients, thereby perpetuating a cycle of whole health.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Cultural Competency; Population; Location
Tobacco Control Policy Leadership Institute
Roots Community Health Center (Roots), located in East Oakland, brings equity in health care and resources to low-income, underserved community members who live with high levels of unemployment, violence and entrenched poverty. Through innovative, integrated approaches to service delivery, emphasizing culturally competent, affordable primary and behavioral care, easy and timely access, participation in community-based research and an array of complementary services, Roots reduces health disparities defined by broad social determinants of health that are often not prioritized by traditional medical providers. Roots’ mission is to eliminate Oakland’s health disparities by providing respectful, culturally competent, comprehensive primary care, mental health, and wraparound services for high risk patients, encouraging their self-advocacy and empowerment. Roots implements its programs and services by ensuring that all staff honor the “roots” of the diverse cultures living in our service areas by providing unprecedented access to services; by remaining community-aware and community-responsive; and by maintaining partnerships to expand the network of care across Oakland.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Tobacco
First5 Emerging Issues
Since its inception, Roots Community Health Center (Roots) has identified and addressed conditions which lead to underdevelopment of potential in our children 0-5 years old. While Roots established itself as a health home for all underserved patients, leadership shared a specific mission to provide comprehensive care to African American men, many of whom had never engaged meaningfully in health care as a result of the many barriers to public benefits and services programs – particularly prior to the implementation of the Affordable Care Act. These issues, along with a destabilizing tradition of making supportive services (WIC, Section 8, “Welfare to Work”) more readily available to women with children, have erected barriers that are especially difficult for men to overcome in the absence of culturally appropriate outreach and retention strategies designed to address current concerns, historical conditioning, and debilitating habits of self-neglect. Roots has developed skill and expertise in connecting men to care – particularly those with significant barriers such as a history of incarceration, marginalization from the workforce, and unstable housing. We have discovered that for these men who are also fathers, a key component of achieving overall stabilization includes reunification and/or strengthening their relationship with their children.
ref. First 5 Emerging Issues Concept Paper Submission Form_FINAL.doc
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; WIC; A/A; ACA
IRUSA Narrative
Roots’ mission is to address Oakland’s long-standing health inequities by providing culturally competent, comprehensive physical and mental healthcare, education, employment and training, and wraparound services that build individual self-sufficiency, promote community empowerment and address major social determinants of health. Our programs and services honor the roots of culture, heritage, and tradition; prioritize easy access, particularly during critical life transitions; ensure community-aware, responsive service delivery; and engage in long-standing partnerships: organizational drivers that lead to our empowering and efficient continuum of care in Oakland.
Roots is committed to continued development of our approach to whole health, especially critical given the unprecedented needs of East Oakland residents and low-income communities of color. We are refining a methodology that integrates empowerment, self-advocacy and participation grounded by Roots as a primary health care home in East Oakland, resulting in a replicable model for whole health designed to serve communities traditionally without culturally responsive healthcare, and where barriers to healthcare intersect with lack of access to opportunity.
As a key component to whole health, and because economic and employment barriers are primary deterrents to a healthy life, Roots strengthened our job training/employment programming through the launch of the Emancipators Initiative, providing on-the-job training in light manufacturing at our social enterprise Clean 360; barrier removal and “soft skills” training; and upon individual readiness, linkage to permanent employment. Our social enterprise promotes individual empowerment and is a critical component of the program’s own sustainability model: all revenues go directly to fund more jobs.
ref. IRUSA Narrative_FINAL.doc
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
Medi-Cal and CalFresh Renewal Assistance and Enrollment Project
Since our inception in 2008, Roots staff and board have included outreach, Medi-Cal and ACA enrollment as critical in stabilizing under-served Oakland residents who have less access to insurance and public benefits, including CalFresh. Because 94% of our patients are on Medi-Cal, and because we are implementing a community-centered approach to improving health for people historically without a primary care medical home, we see it as vital to integrate outreach and enrollment into all patient activity. As a result, we have eight years’ experience in successfully signing up the so-called “hard to reach” in Oakland’s low-income neighborhoods. As detailed below, Roots is well positioned to successfully complete deliverables in this RFP: we have demonstrated experience in carrying out the activities to re-enroll Medi-Cal qualified individuals and sign up these clients simultaneously with CalFresh, and track all required reporting data; we are knowledgeable regarding the requirements to gain resources for the undocumented; our previous outreach and enrollment contract with ACSSA resulted in 749 submitted applications over 11 months; thus far, 474 Medi-Cal applications and 430 CalFresh applications have a legitimate CalWin status. Roots has all required permits, licenses and professional credentials in place.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Medi-Cal; CalFresh
General Brief Description of Roots
Roots Community Health Center is a community clinic licensed by the California Department of Health Care Services that is growing in impact as an East Oakland anchor organization providing a unique blend of primary care and complementary services to build empowerment and self-sufficiency through a whole person approach to health. Roots is acting on new opportunities and building organizational capacity to serve as an Oakland-rooted, Oakland-committed model demonstrating integrated, whole health methods. Our success has led to the addition of new locations, including our pediatric clinic in the lower Fruitvale neighborhood, our social enterprise – Clean360 – in central Oakland, and recently adding service components in San Jose and South Los Angeles. Roots’ mission is to uplift those impacted by systemic inequities and poverty by providing culturally competent, comprehensive physical and mental healthcare, education, employment and training, and wraparound services that build individual self-sufficiency and promote community empowerment. Roots implements our mission by addressing major social determinants of health disparities – including unemployment, low educational attainment, and marginalization from the workforce – that are often not prioritized by traditional medical providers. Our programs and services honor the roots of culture, heritage, and tradition; prioritize easy access, particularly during critical life transitions; ensure community-aware, responsive service delivery; and engage in long-standing partnerships: organizational drivers that lead to our empowering and efficient continuum of care in Oakland.
While Roots established itself as a primary care medical home for all underserved patients, leadership shared a specific mission to provide comprehensive care to those who have been most marginalized and those who have never engaged meaningfully in medical care. Services and programs are designed to reduce barriers for individuals living with the effects of multi-generational poverty, trauma, incarceration, chronic stress and longstanding lack of health access. In eight years, we have grown from a small operation of volunteers to a multi-site nonprofit serving nearly 10,000 low-income residents through a primary care clinic, pediatrics clinic, mobile clinic for the homeless, street outreach and benefits enrollment, and innovative care management and workforce development initiatives, including our social enterprise formed in 2013 (Clean360). Our clinics also serve as a training ground for Oaklanders aiming to serve their home community as health professionals. Roots’ adult patients are 82% African-American, 8% Latino/a, and 87% receive Medi-Cal.
While we train more than 60 individuals annually in healthcare professions ranging from community health outreach worker to nurse to physician, we recognize that healthcare careers are not a match for everyone, whether due to aptitude, criminal record, or preference. As a result, we strengthened our job training/employment programming over the last three years through the launch of the Emancipators Initiative, providing on-the-job training in the light manufacturing setting; barrier removal, “soft skills” training; and upon individual readiness, linkage to permanent employment. Roots Emancipators Initiative began as a workforce pilot with Alameda County Social Services Agency to transition individuals off of General Assistance, and led to the design and implementation of our social enterprise, Clean360 (www.clean360.org), in which we train at-risk individuals in our model soap factory. Emancipators learn how to make small batch, handcrafted soaps while they receive paid on-the-job training, barrier removal assistance, and ongoing support. Our Social Enterprise is a vehicle for individual empowerment as well as a critical component of the program’s own sustainability model, as all revenue generated goes directly to fund more jobs.
Given the unprecedented needs of East Oakland residents and in low-income communities of color, Roots is committed to continued development of our approach to whole health. We are refining a methodology that integrates empowerment, self-advocacy and participation with Roots as a primary health care home in East Oakland – with a goal to build a replicable model for whole health to serve communities traditionally without culturally responsive healthcare services, and where barriers to healthcare intersect with lack of access to opportunity. Roots’ approach combines physical and mental healthcare with complementary services inspired by our commitment to culturally responsive care, grounded by a commitment to empowerment for individuals, families and workforce participants, and enhanced by health navigation services to access benefits and build linkages to appropriate services. Roots Health Navigators are Oakland residents with a shared, lived experience that resonates with our patient/client community, and who obtain a Community Health Worker (CHW) Certification and/or Health Coaching Certification. Roots Navigators specialize in working with different focus populations, and are qualified in-part based on their life experience. Through one-on-one coaching and peer support, multi-disciplinary teamwork, leadership development, and, most importantly, authentic relationships with community members, their families, and other service providers, Navigators model and encourage positive, pro-social community and family engagement. Roots’ theory of change guides the Navigators’ work: “empowering those who have been marginalized with skills that enable them to engage positively on behalf of themselves and with their communities via wraparound services delivered in the context of a safe and therapeutic relationship, improves morale and self-efficacy, ensures successful integration/reintegration into society, and improves overall community health and well-being.”
ref. Roots Brief Description_7.2017 – 2017
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission
General Brief Description of Roots
ref. Roots Brief Description_w.goals
Core Care Model:
Program:
Themes, Keywords & Tags: About; Mission; Property
Service Area Completion
Roots Community Health Center is a primary care clinic that provides the full scope of primary care services. We see community members of all ages, from childhood, to the elderly. We also provide dental care, mental health counseling, substance abuse, case management and supportive services, and contract and non-contract referrals for a range of patient needs. With an emphasis on providing culturally competent treatment and prevention of the diseases confronting residents of the service area, including their chronic or acute health needs, Roots also focuses its efforts on reaching the so called “hard to reach” segments of the population. While most services are directly provided by Roots staff, some services are by contract or through documented cooperative arrangements.
Services offered on-site at Roots include:
- Preventive health screenings and health care maintenance
- Continuity care, chronic disease management
- Mental health assessment, management and referrals as appropriate
- Group visits, including acupuncture
- Timely access to same day and same week appointments for urgent conditions via RapidCare.
- Health education, medication reconciliation, nutrition counseling
In addition to direct primary care, preventive health services include, screening for prostate, breast, and cervical cancer; well-child services; immunizations against vaccine-preventable diseases; screenings for elevated blood sugar levels, hypertension, communicable disease, cholesterol, and prophylaxis; dental care; and voluntary family planning services. Roots also provides RapidCare, an urgent care program designed to address this significant barrier to care in our community by making same or next-day appointments with a health care provider available. Primary care services are provided on-site, and RapidCare patients are advised to follow up as directed by the health care provider. This facilitates appropriate follow-up as needed into chronic or ongoing episodic care.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Services; Rapidcare
The Healthier California Fund
Given the unprecedented needs of East Oakland residents and in low-income communities of color, Roots is committed to continued development of our approach to whole health. We are refining a methodology that integrates empowerment, self-advocacy and participation with Roots as a primary health care home in East Oakland – with a goal to build a replicable model for whole health to serve communities traditionally without culturally responsive healthcare services, and where barriers to healthcare intersect with lack of access to opportunity. Roots’ approach combines physical and mental healthcare with complementary services inspired by our commitment to culturally responsive care, grounded by a commitment to empowerment for individuals, families and workforce participants, and enhanced by health navigation services to access benefits and build linkages to appropriate services. Roots Health Navigators are Oakland residents with a shared, lived experience that resonates with our patient/client community, and who obtain a Community Health Worker (CHW) Certification and/or Health Coaching Certification and specialize in services for homeless individuals and those reentering society from incarceration. Overall, community members first come to Roots for care, and become empowered to self-advocate and equipped to pursue opportunity. Some then pursue training with Roots to become health professionals (approximately 60 individuals annually); others become Roots Health Navigators who, in turn, care for new clients, thereby perpetuating the cycle of whole health for individuals, their families and the entire community.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Whole Health; Navigators
Establishing a Community Rooted Provider Network
Roots Community Consulting team has extensive experience in a broad range of medical practice models, from private practice to federally qualified health centers, and has a particular interest in ensuring access to quality care, health education and behavioral health services for low-income patients. To that end, the team founded Roots Community Health Center, a 501(c)3 organization dedicated to reducing health disparities in East Oakland, California. Roots Community Health Center is designed as a competency model for providing high-quality, culturally competent, community-responsive care, and as a sustainability model for providing cost-effective, comprehensive care in a low-reimbursement environment. As part of this model, Roots seeks to form partnerships with other community providers to create a more efficient continuum of care for its patients. Roots’ team of professionals is specifically interested in ensuring the present and future sustainability of culturally competent, quality medical practices, particularly in low-income communities of color. With that goal in mind, Roots proposes to lead a planning process to engage Community-Rooted Providers in the formation of a network designed to build resiliency and ensure the perseverance of their practices.
ref. CHCF Concept paper 3-13 Establishing a Community-Rooted Provider Network Planning Proposal
Core Care Model:
Program: Roots Community Consulting
Themes, Keywords & Tags: About; Consulting; Cultural Competency
Systems and Services Research Build a Culture of Health
Since their inception Roots has taken a different path, designing a blend of primary care and complementary services through a whole person approach to community health that challenges entrenched social determinants, including poverty and dependency. Their Whole Health approach is at the heart of all clinical and programmatic work, including case management and service navigation led by peers with shared lived experience. The critical work of the Navigators (patient case manager and primary support person) is strengthened by an interdisciplinary care team including a Patient Care Coordinator and clinicians, and enhanced by stabilizers including public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and peer-centered mentoring. Roots trains more than 60 individuals annually in healthcare professions, many of whom are from East Oakland, ranging from community health outreach worker to nurse to physician. Over the last three years Roots has provided on-the-job training in the light manufacturing setting, barrier removal, “soft skills” training, and upon individual readiness, linkage to permanent employment(Emancipators initiative). Roots’ Emancipators Initiative began as a workforce pilot with Alameda County Social Services Agency to transition individuals off of General Assistance, and led to the design and implementation of their social enterprise, Clean360 (www.clean360.org), in which they train at-risk individuals in their model soap factory. Emancipators learn how to make small batch, handcrafted soaps while they receive stipended on-the-job training, barrier removal assistance, and ongoing support.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Innovation; Clean360; Whole Health
Noha Aboelata, MD
Dr. Noha Aboelata, founder and CEO of Roots Community Health Center in East Oakland, operates a community clinic devoted to delivering top-quality primary and pediatric care and wrap-around legal, social and job training and placement services, to everyone, including low-income persons, the currently and formerly incarcerated, those suffering from mental health and substance abuse disorders, and, with a mobile medical team, the homeless. Promoting holistic health, multi-sector collaborations and research, while empowering clients, training and employing community members, and educating fellow clinicians, Dr. Aboelata is transforming the shape and accessibility of health care in Oakland and beyond.
ref. Irvine Leadership Nomination 2017 – FINAL – 2017
Core Care Model:
Program:
Themes, Keywords & Tags: About; Noha Aboelata, MD
Emancipators Initiative
Roots Community Health Center, located in East Oakland, appreciates the opportunity to submit this proposal for our Emancipators Initiative. The Emancipators Initiative is Roots’ workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including reentry individuals. Over the past year, with support from Alameda County Social Services, Roots piloted the Emancipators Initiative with 19 participants, demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic that has led to long-term employment. In 2016, our goal is to raise funding that will help us train and employ a minimum of 24 traditionally difficult-to-employ individuals, including those with criminal records.
The Emancipators Initiative was designed to expand our impact as part of Roots’ mission to address long-standing health inequities by providing culturally competent, comprehensive healthcare, mental health, and wraparound services that emphasize patient/client self-sufficiency and community empowerment. Roots implements its programs and services while honoring the “roots” of culture, heritage, and tradition by providing unprecedented access to services; by remaining community-aware and community-responsive; and by establishing partnerships to ensure a more efficient continuum of care in Oakland.
Roots Community Health Center implemented the Emancipators Initiative as part of a public-private partnership to provide new opportunities for General Assistance (welfare) recipients, many of whom have been recently released from incarceration. In the first months of implementation, we forged a social enterprise, Clean360 (www.clean360.org), as the platform in which we train at-risk individuals in our model soap factory. In our first year, 19 participants completed the program – 18 of them reentry individuals – with 11 employed in outside businesses and six employed through Roots. Of note, four Emancipators have gone on to further their education in the Health and Human Services professions, obtaining their Community Health Worker and Health Coaching Certifications.
In just one short year, the Emancipators Initiative has evolved into an effective program for job creation, barrier removal and long-term alternatives to incarceration. By preventing recidivism and eliminating reliance upon public benefits, the Emancipators Initiative is not only transforming individual lives and families, but is resulting in measurable cost savings to city and county systems.
ref. REI_AASC_funding request_6 month Emancipators Initiative: Education, Empowerment, Enterprise
Core Care Model: Empowerment
Program: Emancipators Initiative
Themes, Keywords & Tags: About; Emancipators; Reentry; Employment; Barrier Removal
Noha Aboelata, MD
Noha Aboelata, MD is nationally recognized for her work to expand access to health care underserved communities. Committed to a vision of community-rooted health care that addresses each person’s “whole health,” Dr. Noha founded Roots Community Health Center in Oakland, California, where she was born and raised. Dr. Noha has extensive experience leading research and evaluation projects for county agencies such as Department of Public Health, Health Care Services Agency, Social Services Agency, as well as community-based organizations and Safety Net healthcare practices. Dr. Noha has placed an emphasis on translating findings into practice, and her evaluation recommendations have been utilized by multiple agencies as blueprints for change. For this scope of work Dr. Noha will assist in planning and implementation across all phases of work, will support the project team, and lead collaborative efforts with Health Leads (Contractor), supporters and funders. Dr. Noha will lead sustainability planning efforts, including synthesizing and integrating learnings for this scope of work.
Core Care Model:
Program:
Themes, Keywords & Tags: About; Noha Aboelata, MD