Health Foundation grants deliver results across Central Mass.

Transportation is a public health issue. If you can't get to a job, to medical visits, to buy groceries or pick up a prescription, it affects your health.

So do clean water, housing, high-quality child care and parenting support, job opportunities, education and access to healthy food.

Social determinants of health, including physical environment and social and economic factors, have a major impact on health status, far more than health care alone, according to research over the past decades.

Twenty-one years ago, a new philanthropic organization, The Health Foundation of Central Massachusetts, came on the scene, backed with $42 million in assets and a long-term plan to make deep and permanent changes in factors affecting health.

Its approach to embedding multiagency collaboration and evaluation from the very start influenced how other funders, charities and even policymakers approach complex problems, according to leaders in the nonprofit field. And its funded programs have demonstrated impressive results.

The Health Foundation of Central Massachusetts was created in 1999 after the sale of Central Massachusetts Health Care, a physician-initiated health maintenance organization. It started making grants in 2000.

With assets now of $75 million, the foundation has disbursed $44 million over 20 years to 202 organizations.

The foundation's grant-making in Central Massachusetts has been identified as leading-edge in addressing social determinants of health, among the nation's health conversion foundations, by researchers at Wake Forest School of Medicine, in a study supported by the Robert Wood Johnson Foundation.

Health conversion foundations are those formed with the assets of a nonprofit health organization that was converted to for-profit status.

"At the end of the day, we wanted to have results," said Janice B. Yost, president and chief executive officer of The Health Foundation of Central Massachusetts.

Yost said that the foundation's creators wanted to take a systemic approach to improving health in the region rather than fund short-term programs.

"We knew that was where the greatest return of investment will come," she said.

Programs funded through the foundation's Synergy Initiative grants, which account for 75% of its grant funding, have created ripple effects of policy change throughout the state, Yost said. That could only happen with solid planning and evaluation built into the multiyear grants, and with the ability of the Health Foundation to lobby legislators about issues.

"That's what makes that model so powerful," Yost said.

Unlike many foundations, which are tax-exempt 501(c)(3) organizations, The Health Foundation of Central Massachusetts retained the 501(c)(4) tax-exempt status of its legacy HMO. The foundation has limits on how much it can lobby.

Models for change

Examples of program impacts abound in the major focus areas the foundation has supported, and Yost has charts and graphs highlighting them in ways it doesn't take a Ph.D. to understand.

Children's mental health has been the target of more than $4 million in Synergy Initiative grants from the foundation, influencing broad changes in educational support from regulators and other funders.

One program, Together For Kids, received $1.8 million from the foundation between 2001 to 2009. It demonstrated that with an average of 24 hours of behavioral health consultation for teachers and parents, children's challenging behaviors and developmental skills significantly improved, compared to those in matched preschools that didn't get outside help. Preschool expulsions were reduced to near zero in schools with behavioral health support.

Based on the project's findings, advocacy efforts resulted in the state providing $19 million for mental health consultation services in preschool settings from 2008 to 2020.

"We were able to make changes on many different levels," said Lynn Hennigan, Community Healthlink's director of services for young children and Together For Kids project director.

More important than the financial return on investment, Hennigan said, was being able to improve the lives of the youngest children and their families.

She said the Together For Kids Coalition is still championing early childhood needs.

Being data-driven and mobilizing the community were key to achieving results, according to Hennigan.

"Feel-good stories are great," she said, "but at the end of the day, it's data that moves the needle."

Hennigan said the Health Foundation's approach was "nothing short of revolutionary in the city of Worcester, the way we thought about doing grants."

She said, Yost always said, "Begin with the end in mind."

Among other focus areas, the three-year recidivism rate among men and women who were formerly incarcerated dropped 47%, compared to a historical comparison group, following a prison re-entry grant program.

The program included access to social and health services, housing placement, employment readiness and job placement. It saved $375,000 per 100 participants, a 59% return on investment based on one-year incarceration rates, and served as a model for state and national criminal justice pilot programs, including those in Worcester and Middlesex counties.

"That's phenomenal return on investment," Yost said about the prison re-entry work.

Yost also pointed to A Better Life, a program to help families achieve economic self-sufficiency and transition out of public housing in Worcester, for which the foundation provided more than $3 million in grants from 2011 through 2017.

As of 2019, 78 families had used their escrow savings, averaging nearly $10,000 per family, to move out of public housing. The employment rate at Great Brook Valley and Curtis Apartments in Worcester grew by 23%, from 39% in 2014 to 62% in 2019.

In 2014, the Legislature approved a provision requiring the state Department of Housing and Community Development to allow the Worcester Housing Authority to operate A Better Life in its state-subsidized housing, which represents 20% of its units. Last year, DHCD awarded nearly $1 million to enable other housing authorities to operate A Better Life.

While public housing serves as an important bridge, Yost said, "If you can move people out of public housing, they can move into a better ZIP code, earn more and be healthier."

Impacts have also been shown in grants addressing oral health, homelessness, child-abuse prevention, hunger and healthy eating, health care access, childhood adversity and community development, according to foundation reports.

New round of grants

Directors of The Health Foundation of Central Massachusetts approved a new round of Synergy Initiative projects in December, providing one-year planning grants totaling $761,833. The foundation expects to follow successful planning grants with pilot and then implementation grants.

The new projects are Central Massachusetts Private Well Program, led by Resources for Communities and People, to address contamination of private wells in Central Massachusetts; Early Education and Care/Head Start Workforce Development, led by Massachusetts Association for Community Action, to ensure early childhood educators receive training in adverse childhood experiences and trauma-informed learning environments; Foster Parents Supports in Worcester, led by the Massachusetts Society for Prevention of Cruelty to Children, to develop parental supports to improve the recruitment and retention of foster parents; and Quaboag Connector, led by Quaboag Valley Community Development Corp., to develop a sustainable, scalable model for rural transportation.

Gail Farnsworth French, project director at Quaboag CDC in Ware, said the problem of reliable transportation in the region is "huge."

With low population density and a large geographic area, "there's no way to do this profitably," she said. Tucked at the fringe of three counties, Ware and surrounding towns aren't on any transit trunk line.

Local businesses have said they couldn't find or keep qualified employees because people didn't have transportation to get to work.

Area residents often rely on getting a ride from someone else or driving an unreliable vehicle, leading to a vicious cycle of higher unemployment, lower education levels and poverty "because people are stuck," French said.

Three years ago Ware started a weekday, curb-to-curb transit service called the Quaboag Connector. Riders need to make a reservation at least two days in advance. The fare is $2 each way.

French said it's made a difference to local employers, who have told her that now they can count on employees to show up every day, on time.

Workers have said, "If it were not for the Quaboag Connector, I would not be working. I would not be able to afford my rent," according to French.

Four vans are on the road in nine towns, but French said that demand has outstripped capacity.

"This is a pivotal moment for the foundation to get involved," she said.

A group of 10 project members from eight organizations is working on how to build a sustainable rural transit model that can be increased in scale and applied in other regions.

Built-in metrics

Mary Brolin, a scientist at the Heller School for Social Policy and Management at Brandeis University, has been working with the Quaboag team since the beginning, last fall, as its program evaluator.

After potential grant projects have submitted a letter of intent with the foundation, before a formal proposal is written, the foundation brings together evaluators with whom it contracts and project applicants in one session, to find a good working match.

"We essentially speed-date," Brolin said.

Evaluators start working with project applicants right away on the proposal, Brolin said, "So you're not trying to go back and see if it worked."

Brolin, who has worked with Health Foundation projects on prison re-entry, childhood adversity in Worcester schools and community development in Fitchburg, said the foundation emphasizes evidence of projects' outcomes so that successful programs can find sustained funding.

Project participants are sometimes afraid to be measured, said Brolin, but she talks to them about shorter-term and longer-term outcomes.

"Usually after the first six months, they see it's not a 'gotcha' thing," she said. "They're improving what they're trying to do."

Incorporating evaluation at each step in Synergy Initiative grants was "a new understanding," said Francis M. Saba, chairman of The Health Foundation of Central Massachusetts and former chief executive of Milford Regional Medical Center. "My gosh, that makes a big difference."

He also attributed the foundation's success in making inroads in social determinants of health to the diverse, skilled board of directors and meticulous planning and follow-through led by Yost and foundation staff.

New approach to health

Setting up The Health Foundation of Central Massachusetts, the state's first health conversion foundation from an HMO, was an exciting time, recalled Johanna Soris, a retired assistant attorney general in the state Public Charities Division.

Soris said there was concern at the time, based on other states' experience, that assets would be spread thin among a range of interests.

"We were worried that a health care foundation can be so much to so many people," she said. With no strategic grant-making approach, including needs assessment and evaluation, they would "just not be as much as they could be."

Over four years, consultants and community representatives were brought in, bylaws were drafted, boards were formed and a national executive search found Yost, who was with a health conversion foundation in South Carolina.

"In my 31 years of working there, it's the best thing I was ever involved in," Soris said. "It was health care broadly defined."

The foundation's approach and impact have been felt throughout the local philanthropic community, too.

Elizabeth L.B. Greene, a partner at Mirick O'Connell law firm in Worcester, serves on the Reliant Foundation board and the American Heart Association/American Stroke Association board. She said she was "really impressed by her (Yost's) leadership and her scholarship in the philanthropic arena."

She said the foundation's board was "tremendous."

Greene said that Reliant, like other health foundations, now includes evaluation early in a grant project's process and incorporates close communication between foundation leaders and project staff.

She became aware of the Health Foundation of Central Massachusetts when it was funding some of the same projects, particularly in Reliant's focus on children's mental health and the opioid crisis.

"The breadth and reach of the issues they're addressing is impressive," Greene said. "And their length of time in the space: They've been able to deal with some of these complex issues."

Yost said the problem-solving model the Health Foundation uses succeeds because it can be adapted to whatever problem the community identifies as a priority.

"I just think we have to look at it 20 years from now, not today," Yost said. "What I think is important is, the work that this foundation funds ends up being sustained."

___

(c)2020 Telegram & Gazette, Worcester, Mass.

Visit Telegram & Gazette, Worcester, Mass. at www.telegram.com

Distributed by Tribune Content Agency, LLC.