Even back when most doctors made house calls, they weren’t expected to treat the entire neighborhood. Boston Children’s Hospital is in the midst of an effort to support community organizations that work on increasing access to housing and food and reducing economic inequality — basics that can shape health and determine a child’s future.
Between 2018 and 2027, Boston Children’s will allocate $53.4 million in grants to Boston-area and statewide organizations that address racial, ethnic, and socioeconomic inequities in low-income communities. The grants stem from the hospital’s billion-dollar-plus project to build new facilities and renovate its existing buildings. The Massachusetts Department of Public Health requires health care organizations engaged in construction projects of $50 million or more to put 5 percent of their projected construction costs toward community investment.
The Boston Children’s building project, the largest of its kind in state history, has already expanded the types of organizations the hospital works with. “We never got any funding from the hospital before,” says Sandra McCroom, president and CEO of Children’s Services of Roxbury, who says she is looking forward to partnering with the hospital. Children’s Services has a three-year grant of $300,000 that started in May. In addition to running youth development programs, Children’s Services works to house homeless families, find foster care for abused children, and improve access to affordable child care and mental health counseling. The organization is using its grant to bolster a program that helps children who’ve had to deal with trauma gain access to mental health services.
Community health has always been part of the mission at Boston Children’s, says Dr. Shari Nethersole, executive director for the hospital’s community health efforts. In its first decades, Children’s Hospital of Boston, as it was known at its founding in 1869, provided free care to orphans and the children of indigent families. That was easier to do when the average hospital visit cost $1.50, as was true through the 1930s. By the hospital’s 1969 centennial, however, regular deficits driven in part by innovation, plus the advent of Medicaid, altered the way the hospital would offer care to low-income patients.
Such care takes a variety of forms. Boston Children’s operates eight satellite clinics in underserved neighborhoods, such as the Martha Eliot Health Center in Jamaica Plain. The hospital also spends about $4 million a year on community health, in line with voluntary guidelines for hospitals set by the Massachusetts attorney general’s office. That funding goes to preventive and follow-up care programs for kids from low-income families, such as providing public schools with psychologists and social workers, and training teachers to address student trauma, learning disabilities, and mental illness.
Boston Children’s also sponsors exercise and healthy eating programs, and sends health aides to the homes of kids with severe asthma to help them learn to manage the condition. It provides home environmental assessments, hypoallergenic bedding, special vacuum cleaners, and bins to store items away from dust.
What’s exciting for Nethersole is that the Collaboration for Community Health “allows us to step up our game, and fund things we haven’t funded before.” The hospital is now supporting organizations like the Roxbury-based Sociedad Latina, the Boston Chinatown Neighborhood Center, and HopeWell, the largest non-profit provider of foster care in Massachusetts.
In 2018, HopeWell received a three-year $75,000 grant to boost its My First Place housing program. When teenagers get too old for foster care, they don’t have family to help them navigate young adulthood, says Shaheer Mustafa, HopeWell’s CEO and president. Typically, 40 percent of foster care youth end up on the street in the first year after they’ve aged out of the foster-care system. “We’re trying to disrupt all that by providing stable housing, first of all,” Mustafa says. “And the second piece is engaging these young people in a way that supports them.” It will use its new funding from Boston Children’s to provide up to two years of rent-free apartments to allow the young people it supports to focus on education and employment.
Some of the dozens of organizations Boston Children’s has supported to date show the hospital’s willingness to go beyond traditional definitions of social or health services. For example, it gave $225,000 over three years to Project RIGHT, which supports people who have endured violence and trauma. Events and activities include collaborating with MassArt to host paint nights for families in the Grove Hall neighborhood, and with the Roxbury YMCA to offer Friday teen nights.
Such a mix doesn’t fit the parameters of many funders, says Michael Kozu, co-director of the 28-year-old nonprofit. “BCH is giving us money for what we actually do. It really allows us to address some of the issues that are here.” Its new grant lets it expand its trauma support for teens and young adults, including hiring a bilingual outreach coordinator to work with the Cape Verdean community.
Project RIGHT had previously received at least one large grant from Boston Children’s. This new grant will allow it to provide more individualized interactions with Grove Hall community members, among other services.
Boston Children’s is monitoring the grants to see how they play out, and will measure outcomes over time. “It’s a bit of an experiment,” Nethersole says. “Some organizations will probably be successful and some won’t be. It’s a lot like clinical research: You try a medicine on patients to see if it works.”
Meanwhile, staff members from the hospital’s Office of Community Health continue established traditions of meeting with residents for feedback and ideas related to neighborhood health needs.
On an evening in August, for example, Nethersole, along with Tara Agrawal, the hospital’s director of community investment, and Ayesha Cammaerts, its manager of programs and population health, visited Roxbury’s Hibernian Hall for a meeting the hospital holds every three years, to help Nethersole’s team better plan how to meet the community’s heath needs.
Cammaerts sees meetings like these as an opportunity to help her be more effective. “In my work, it’s easy to get lost in data. But I didn’t get into public health to just sit in an office behind a desk. Here, we can’t just stand in front of the room lecturing at them,” she says, gesturing at the people seated around her. “We have to think about how to engage with the community.”
Nethersole hopes to find ways to sustain the momentum that develops between now and 2027. “The hospital,” she says, “is not just going to pick up and leave.”