Long Island Jewish Medical Center

ADDRESSING SUBSTANCE USE AS PART OF USUAL CARE: USING SBIRT AS A FOUNDATIONAL APPROACH IN PEDIATRIC AND SPECIALIZED PATIENT POPULATIONS - NORTHWELL HEALTH WILL IMPLEMENT SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) IN 14 IDENTIFIED CLINICAL SITES TO INCREASE REACH WITHIN UNIQUE POPULATIONS. SITES WILL INCLUDE 3 PEDIATRIC PRIMARY CARE PRACTICES, 3 PEDIATRIC EMERGENCY DEPARTMENTS, 3 PEDIATRIC BEHAVIORAL HEALTH URGENT CARE CENTERS, 3 COMMUNITY-BASED URGENT CARES THAT SERVE ADULTS AND PEDIATRICS, AND TWO ADULT PAIN MANAGEMENT PRACTICES. THESE SITES HAVE BEEN SELECTED BASED ON THE NEEDS OF THE POPULATIONS THEY SERVE, INCLUDING: A) PEDIATRIC PATIENTS IN PRIMARY CARE; B) PEDIATRIC PATIENTS SEEN IN OTHER HEALTHCARE SETTINGS (WHO MAY NOT HAVE A PRIMARY CARE PROVIDER (PCP)); C) ADULT PATIENTS, INCLUDING YOUNG ADULTS, SEEN AT COMMUNITY BASED URGENT CARES (WHO MAY NOT HAVE A PCP); AND D) ADULTS IN PM PRACTICES WHO HAVE A HIGHER PREVALENCE OF SUBSTANCE USE. SETTINGS CHOSEN WILL FACILITATE CONTINUITY OF CARE EFFORTS BY ADDRESSING SUBSTANCE USE AS PART OF USUAL CARE ACROSS THE LIFESPAN, FROM PEDIATRICS TO GERIATRICS, ACCOUNTING FOR DIVERSE HEALTHCARE JOURNEYS PATIENTS TRAVEL, AND WILL SERVE 140,000 IN THE FIVE-YEAR GRANT PERIOD. CLINICAL SETTINGS ARE LOCATED IN DIVERSE, DENSELY POPULATED REGIONS OF METROPOLITAN NEW YORK, INCLUDING NEW YORK CITY, LONG ISLAND, AND WESTCHESTER, AN AREA EARLIEST AND HARDEST HIT BY COVID-19. THE NEED IS GREATER NOW THAN EVER TO IDENTIFY AND ADDRESS SUBSTANCE USE AS PART OF USUAL PATIENT CARE AS STAY-AT-HOME ORDERS, SOCIAL ISOLATION, AND A LACK OF IN-PERSON SCHOOL HAS CONTRIBUTED TO INCREASED SUBSTANCE USE. OUR STRATEGY IS BASED ON A FOUNDATION OF SBIRT, WITH UNIVERSAL SCREENING FOR ALL PATIENTS WHO ENTER THE HEALTHCARE SETTING. OUR IMPLEMENTATION PLAN WILL BE SUPPORT BY INTERDISCIPLINARY CHAMPIONS, WHO WILL DRIVE MOTIVATION AND FOSTER AN ENVIRONMENT FOR PROGRAM SUSTAINABILITY. PATIENTS WITH A POSITIVE SCREENING WILL BE OFFERED A BRIEF INTERVENTION, BRIEF TREATMENT, OR A REFERRAL TO TREATMENT BY A CLINICAL TEAM MEMBER TRAINED TO SERVE AS AN SBIRT HEALTH COACH. INTERPROFESSIONAL TEAM MEMBERS WILL BE OFFERED TRAINING TO SERVE IN THIS ROLE, TO DIVERSIFY THEIR CLINICAL SKILLS AND ASSIST PROGRAM SUSTAINABILITY. REFERRALS TO TREATMENT WILL INCLUDE WARM HAND-OFFS TO LICENSED TREATMENT PROVIDERS, INCLUDING FOR MEDICATION FOR ADDICTION TREATMENT (MAT). MAT REFERRALS WILL BE FACILITATED FOR PATIENTS WHO RECEIVE MAT INDUCTION DURING THEIR HEALTHCARE VISIT, AND FOR PATIENTS WHO ARE NOT YET IN WITHDRAWAL AND NEED A NEXT-DAY INDUCTION. ONGOING BRIEF INTERVENTION AND REFERRAL TO TREATMENT SERVICES WILL CONTINUE IN PARTNERSHIP WITH CENTRAL NASSAU GUIDANCE & COUNSELING THROUGH PROJECT CONNECT. A PROJECT CONNECT NAVIGATOR WILL REACH OUT TO PATIENTS WITHIN 24 HOURS OF THEIR HEALTHCARE VISIT, AND AT DAYS 7, 30, 60, 90, 120, AND 180, TO OFFER ONGOING SERVICES AND SUPPORT. NAVIGATORS WILL ALSO PROVIDE INFORMATION ON SOBER HOUSING, RECOVERY SUPPORT, AA/NA, AND OTHER RESOURCES TO SUPPORT SUSTAINED RECOVERY. THROUGH THIS MODEL, WE WILL COMPLETE ALL REQUIRED GPRA DATA COLLECTION, AND HAVE AN OPPORTUNITY TO ASSESS ADDITIONAL MEASURES OVER TIME. WE WILL ASSESS AOD USE, ENGAGEMENT IN SUBSTANCE USE CARE/TREATMENT, AND CONDUCT ONGOING QUALITY IMPROVEMENT ACTIVITIES TO DRIVE THOSE MEASURES IN THE DIRECTION OF PATIENT RECOVERY.

LEARNING TO LIVE INDEPENDENTLY FOR TOMORROW (LIFT) - SCHIZOPHRENIA AFFECTS 1% OF THE POPULATION, CAUSING ENORMOUS SUFFERING, DISABILITY, AND SUBSTANTIAL SOCIETAL COSTS. TIMELY ENGAGEMENT IN CSC FOR YOUTH WITH FIRST EPISODE PSYCHOSIS (FEP) IS CRITICAL TO IMPROVE OUTCOMES AND SUPPORT FUNCTIONAL AND SYMPTOMATIC RECOVERY. IN NEW YORK STATE (NYS), OTNY HAS ESTABLISHED A UNIFIED APPROACH TO DELIVERING CSC TO ADOLESCENTS AND YOUNG ADULTS WITH FEP. SINCE INCEPTION, 27 OTNY PROGRAMS HAVE BEEN DEVELOPED ACROSS NYS, INCLUDING 13 IN OUR CATCHMENT AREA OF MANHATTAN, QUEENS, BROOKLYN, AND LONG ISLAND, PROVIDING CSC TO OVER 3,000 YOUTH STATEWIDE TO DATE. DIRECTED BY DR. BIRNBAUM, THE OTNY PROGRAM AT ZHH IS THE LARGEST AND MOST ESTABLISHED AND HAS PROVIDED CARE TO OVER 300 YOUTH. HOWEVER, EARLY INTERVENTION SERVICES ARE TIME LIMITED. OTNY PROGRAMS ARE DESIGNED AND RESOURCED TO PROVIDE CSC FOR APPROXIMATELY 2 YEARS, AFTER WHICH, DISCHARGED PATIENTS (75% BETWEEN THE AGES OF 16-25 YEARS) ARE USUALLY REFERRED TO STANDARD CLINICAL CARE WITHIN THE COMMUNITY. CRITICALLY, ACCUMULATING EVIDENCE DEMONSTRATES THAT THE BENEFITS OF EARLY INTERVENTION OBTAINED DURING CSC DO NOT PERSIST POST DISCHARGE AFTER TRANSITIONING TO STANDARD CARE. FURTHER, THE RISK OF DISENGAGEMENT IS HEIGHTENED DURING THE TRANSITION FROM CSC TO STANDARD CARE, INCREASING RISK FOR MEDICATION NON-ADHERENCE, SYMPTOMATIC RELAPSE, SOCIAL ISOLATION, UNEMPLOYMENT, AND SUBSTANCE USE. DATA ALSO SUGGEST THAT MINORITY POPULATIONS MAY BE PARTICULARLY SUSCEPTIBLE TO NEGATIVE OUTCOMES POST-CSC DISCHARGE. MOREOVER, YOUTH GRADUATING OTNY HAVE NEW CLINICAL AND DEVELOPMENTAL NEEDS AS THEY MATURE INTO YOUNG ADULTS (AND GAIN GREATER INDEPENDENCE) THAT REQUIRE DEDICATED SUPPORTS YET RECEIVE INSUFFICIENT ATTENTION IN STANDARD CLINICAL CARE. DESPITE A CLEAR NEED, EFFECTIVE CARE FOR YOUTH GRADUATING OTNY ARE LACKING, RESULTING IN REPEATED CALLS FOR INNOVATIVE SOLUTIONS DESIGNED TO SUSTAIN GAINS AND PROMOTE ONGOING RECOVERY. TO ADDRESS THIS CRITICAL SERVICE GAP, NORTHWELL HEALTH, IN PARTNERSHIP WITH THE NYS OFFICE OF MENTAL HEALTH (OMH), IS PROPOSING TO DEVELOP A CSC STEP-DOWN SERVICE AT ZHH FOR YOUTH AGES 16-25 GRADUATING FROM ZHH’S OTNY SITE AS WELL AS THOSE REFERRED BY OTHER LOCAL OTNY SITES. LEVERAGING OUR ESTABLISHED EXPERTISE IN RECOVERY ORIENTED CARE, THE LIFT TEAM WILL PROVIDE EVIDENCE-BASED AND COORDINATED SUPPORTS, USING THE CRITICAL TIME INTERVENTION (CTI) MODEL DESIGNED TO BE INTEGRATED AND DELIVERED IN CONJUNCTION WITH STANDARD CARE, AIMING TO 1) EXTEND AND ENHANCE THE BENEFITS OF EARLY INTERVENTION, 2) MINIMIZE DISENGAGEMENT DURING A CRITICAL TIME OF TRANSITION (OTNY GRADUATION), AND 3) EQUIP YOUTH WITH THE SKILLS AND RESOURCES THEY NEED TO FOSTER AUTONOMY, INDEPENDENCE, AND TO LEAD PRODUCTIVE AND FULFILLING LIVES.

PROMOTING NEURODIVERSITY IN CHILD SERVICES BY SUPPORTING TRAUMA RECOVERY FOR YOUTH WITH DEVELOPMENTAL DISABILITIES (STRYDD FOR NEURODIVERSITY) - THE STRYDD CENTER AT THE NORTHWELL HEALTH SYSTEM WILL BUILD ON OUR EXPERTISE SUPPORTING TRAUMA RECOVERY FOR YOUTH WITH INTELLECTUAL AND DISABILITIES (IDD). THESE YOUTH, ABOUT 17% OF THE POPULATION, ARE AT INCREASED RISK OF VICTIMIZATION AND CHILD WELFARE INVOLVEMENT BUT THEIR TRAUMA-RELATED NEEDS ARE OFTEN IGNORED. WE WILL CALL ATTENTION TO THIS NEED THROUGHOUT NCTSN AND THE COMMUNITY AND ENHANCE THE CAPACITY OF EXISTING TREATMENT PROVIDERS TO ADDRESS IT. WE WILL PARTNER WITH OTHER NCTSN CENTERS TO RAISE AWARENESS IN THEIR COMMUNITIES USING TRAINING TOOLS SUCH AS NCTSN’S ROAD TO RECOVERY TOOLKIT AND CORE CURRICULUM ON CHILDHOOD TRAUMA WITH IDD-RELATED LEARNING CASES CURRENTLY UNDER DEVELOPMENT BY OUR TEAM. WE WILL INCREASE TRAUMA TREATMENT CAPACITY FOR THESE YOUTH BY DISSEMINATING OUR ADVANCED TRAINING FOR TAILORING TF-CBT TO YOUTH WITH IDD, WHICH HAS ALREADY BEEN CREATED WITH CONSULTATION FROM A TF-CBT DEVELOPER AND SUCCESSFULLY PILOTED. WE WILL FURTHER DEVELOP SUPPORTING MATERIALS AND A TRAINING MANUAL. WE WILL ALSO DEVELOP AND DISSEMINATE A MORE UNIVERSAL TRAINING, WHICH WILL SHOW HOW TO APPLY UNDERLYING PRINCIPLES AND STRATEGIES TO OTHER EVIDENCE-BASED TRAUMA TREATMENTS FOR YOUTH WITH IDD. APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES ARE OFTEN USED WITH YOUTH WITH AUTISM SPECTRUM DISORDER TO ADDRESS BEHAVIOR DYSREGULATION THAT AT TIMES IS A TRAUMA SYMPTOM. WITH COLLABORATORS WHO ARE ABA PROVIDERS, WE WILL DEVELOP TRAINING ON TRAUMA-INFORMED ABA SERVICES AND FACILITATE COMMUNICATION BETWEEN ABA PROVIDERS AND TRAUMA TREATMENT THERAPISTS. WE WILL PARTNER WITH OTHER CAT II SITES TO DEVELOP BRIEF EDUCATIONAL MATERIALS REGARDING TRAUMA AND IDD FOR SPECIFIC IMPORTANT PROVIDER GROUPS SUCH AS PEDIATRICIANS, PROFESSIONALS WORKING WITH YOUNG CHILDREN IN THE CHILD WELFARE SYSTEM AND/OR THOSE WORKING WITH YOUTH IN THE JUVENILE JUSTICE SYSTEM. IN RESPONSE TO COVID-19, WE HAVE FACILITATED USE OF A SELF-CARE AND PEER SUPPORT MODEL, STRESS FIRST AID IN OUR HEALTH SYSTEM. WE WILL EXPLORE THE UTILITY OF THIS MODEL FOR SUPPORTING SCHOOLS AND FAMILIES IN OUR COMMUNITY WITH EMPHASIS ON SPECIAL NEEDS STUDENTS BECAUSE THIS POPULATION IS OFTEN OVERLOOKED WHEN RESOURCES ARE STRAINED. THIS INITIATIVE IS EXPECTED TO REACH 1,630 SERVICE PROVIDERS DIRECTLY THROUGH LIVE TRAININGS, WITH AN ADDITIONAL 1000 PROVIDERS THROUGH WEB-BASED CONSULTATIONS, RECORDED WEBINARS AND RESOURCE DISSEMINATIONS. TOGETHER, THIS INITIATIVE WILL IMPACT MORE THAN 5,000 YOUTH WITH IDD AND THEIR CAREGIVERS.

PRIMARY CARE TRAINING AND ENHANCEMENT - LANGUAGE AND DISABILITY ACCESS - ADDRESS: LONG ISLAND JEWISH MEDICAL CENTER OF NORTHWELL HEALTH, 270-05 76TH AVE, QUEENS, NY PROJECT DIRECTOR NAME: PRATICHI GOENKA MD & SOPHIA JAN MD MSHP CONTACT PHONE NUMBERS (VOICE): 718-470-3396 EMAIL ADDRESS: PGOENKA@NORTHWELL.EDU GRANT PROGRAM FUNDS: $2,952,366 ($2,742,007 DIRECT; $210,359 INDIRECT) THE PROPOSED PROGRAM AIMS TO DEVELOP AND IMPLEMENT A COMPREHENSIVE AND INNOVATIVE CURRICULUM TO EDUCATE PEDIATRIC, INTERNAL MEDICINE, AND FAMILY MEDICINE RESIDENTS ON CULTURALLY COMPETENT AND LINGUISTICALLY APPROPRIATE CARE FOR INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY (LEP), PHYSICAL DISABILITIES (PD) AND/OR INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD). OUR PATHWAYS TO CARE: CULTURALLY APPROPRIATE RESIDENCY EDUCATION FOR PATIENTS WITH LIMITED ENGLISH PROFICIENCY AND/OR DISABILITY (LEAD) (“PATHWAYS TO CARE”) PROGRAM WILL BE COMPRISED OF (1) AMBULATORY CURRICULUM WITH LEAD FOCUS, (2) PRIMARY CARE CONTINUITY CLINIC WITH LEAD FOCUS, (3) COMMUNITY-BASED CLINICAL EXPERIENCES, AND (4) OPPORTUNITIES FOR ENHANCED COMMUNITY IMMERSION EXPERIENCES. THIS INNOVATIVE TRAINING PROGRAM ADDRESS THE URGENT NEED FOR ENHANCED SKILLS TRAINING FOR HEALTHCARE PROVIDERS SERVING PATIENTS WITH LIMITED ENGLISH PROFICIENCY (LEP) AND/OR DISABILITIES. INDIVIDUALS THESE POPULATIONS FACE SIGNIFICANT CHALLENGES IN THE HEALTHCARE SETTING, INCLUDING MORE ADVERSE EVENTS DURING HOSPITALIZATIONS, HEALTH INSURANCE DIFFICULTIES, AND DISRUPTIONS IN SHARED DECISION-MAKING. THE PROVISION AND DELIVERY OF COMPREHENSIVE AND CULTURALLY RESPONSIVE HEALTHCARE SERVICES CAN MEET THESE NEEDS. THIS TRAINING PROGRAM WILL TARGET 575 RESIDENTS ACROSS FIVE RESIDENCY PROGRAMS IN PEDIATRICS, INTERNAL MEDICINE, AND FAMILY MEDICINE LOCATED AT NORTHWELL HEALTH IN METROPOLITAN NEW YORK CITY, ONE OF THE MOST DIVERSE REGIONS OF THE UNITED STATES. IN ADDITION, RESIDENTS WILL PARTICIPATE IN ENHANCED COMMUNITY IMMERSION EXPERIENCES. WE BELIEVE THAT THIS PROGRAM WILL PROVIDE SUPPORT FOR DIVERSE PATIENT POPULATIONS IN OUR COMMUNITIES AND CREATE A PIPELINE OF PRIMARY CARE PROVIDERS PASSIONATE ABOUT AND EQUIPPED TO CARE FOR DIVERSE PATIENT POPULATIONS. OUR TEAM IS UNIQUELY QUALIFIED TO CARRY FORTH THE PROGRAM VISION AND OBJECTIVES OF THIS PROPOSAL GIVEN: (1) THE CLINICAL, RESEARCH AND TEACHING EXPERTISE OF THE TEAM; (2) THE MULTIPLE DISCIPLINES OF THE TEAM, WHICH INCLUDES PHYSICIANS, SOCIAL WORK, AND EDUCATORS; AND (3) THE TEACHING AND OPERATIONAL LEADERSHIP POSITIONS THAT THE TEAM HOLDS, WHICH GUARANTEE THE SUCCESS OF THE TRAINING PROGRAM. FURTHER, WE HAVE A PROVEN TRACK RECORD WITH HEALTH-SYSTEM AFFILIATED AND EXTERNAL COMMUNITY-BASED ORGANIZATIONS THAT PROVIDE CARE TO PATIENTS WITH LEP AND/OR DISABILITIES. THROUGH THE PATHWAYS TO CARE PROGRAM, WE WILL INTEGRATE IMPACTFUL DIDACTIC AND EXPERIENTIAL LEARNING, COMPLEMENTED BY MEANINGFUL COMMUNITY ENGAGEMENT WITH INTERNAL COMMUNITY-BASED PROGRAMS (DOLAN FAMILY HEALTH CENTER, HEALTH HOME MEDICAID CASE MANAGEMENT PROGRAM, NORTHWELL HEALTH SCHOOL-BASED HEALTH CENTERS) AND EXTERNAL COMMUNITY-BASED ORGANIZATIONS (THE CENTER FOR DISCOVERY, HARMONY HEALTHCARE LONG ISLAND, LONG ISLAND SELECT HEALTHCARE, ST. MARY’S HEALTHCARE SYSTEM FOR CHILDREN). CURRICULUM WILL BE DEVELOPED IN PARTNERSHIP WITH STAKEHOLDERS, INCLUDING PATIENTS AND COMMUNITY-MEMBERS, AND WILL UTILIZE KERN’S 6-STEP APPROACH. PROGRAM EVALUATION WILL BE ONGOING AND MIXED METHODS, INCLUDING FEEDBACK FROM CLINICAL SITES, COMMUNITY SITES, AND TRAINEES. BY FOSTERING STRONG PARTNERSHIPS WITH LOCAL COMMUNITIES AND USING ESTABLISHED METHODS FOR CURRICULAR DEVELOPMENT AND EVALUATION, WE CREATE A DYNAMIC CLINICAL LEARNING ENVIRONMENT THAT EMPOWERS PRIMARY CARE RESIDENTS TO BECOME LEADERS IN PROMOTING HEALTH EQUITY AND ADDRESSING DISPARITIES AMONG PATIENTS WITH LIMITED ENGLISH PROFICIENCY (LEP), PHYSICAL DISABILITIES (PD), AND INTELLECTUAL OR DEVELOPMENTAL DISABILITIES (IDD).

ADVANCING THE ADAPTATION AND APPLICATION OF TRAUMA INFORMED EVIDENCE-BASED INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES

ADVANCING THE ADAPTATION AND APPLICATION OF TRAUMA INFORMED EVIDENCE-BASED INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - AS LONG ISLAND JEWISH FOREST HILLS STRIVES TO PROVIDE EXCELLENT NEUROLOGIC/ORTHOPEDIC CARE FOR OUR COMMUNITY, WE RECOGNIZE OUR NEED FOR UPGRADING AND ENHANCING OUR CURRENT PROCESSES, TOOLS, AND EQUIPMENT. TO ACHIEVE THE BEST OUTCOMES FOR OUR PATIENTS WE WILL BE INVESTING IN ADVANCED NEUROLOGICAL EQUIPMENT THAT WILL BE USED BY OUR SKILLED NEUROLOGICAL AND ORTHOPEDIC SPINE SURGEONS AS WELL AS PURCHASING UPDATED INSTRUMENTATION FOR OUR ORTHOPEDIC SURGEONS. THE NEUROLOGICAL NAVIGATION SYSTEM IN COMBINATION WITH THE ZIEHM IMAGING SYSTEM IS A TOOL DESIGNED TO IMPROVE PRECISION, SAFETY, FEEDBACK, AND PATIENT OUTCOMES. PRECISION IS EXEMPLIFIED THRU REAL TIME NAVIGATION OF THE SPINE BY OBTAINING INTRAOPERATIVE CT SCAN QUALITY IMAGES ALLOWING SUB-MILLIMETER ACCURACY IN REAL TIME. THIS IMPROVES SAFETY BY IDENTIFYING THE CORRECT LOCALIZATION OF SPINAL LEVELS AND EXACT PLACEMENT OF SPINAL INSTRUMENTATION THUS AVOIDING CRUCIAL NEURAL AND VASCULAR STRUCTURES. THE PATIENT OUTCOMES ARE IMPROVED BOTH IN THE ACCURACY, SAFETY, AND ABILITY TO USE SMALL INCISIONS. IN ADDITION, THE SPINAL NAVIGATION SYSTEM GIVES THE ABILITY TO PERFORM MINIMALLY INVASIVE SPINE SURGERY OBTAINING IMMEDIATE FEEDBACK WITH INTRAOPERATIVE POST PROCEDURE CT SCAN QUALITY IMAGES. ADDING BOTH HIP AND SHOULDER INSTRUMENTATION TO OUR CURRENT SUPPLY ASSISTS US IN BUILDING OUR ORTHOPEDIC PROGRAM WHICH ALLOWS OUR RESIDENTS TO RECEIVE THE MOST EXACT AND ADVANCED CARE. WE CONTINUE TO BUILD OUR ORTHOPEDIC ROBOTIC PROGRAM TO ACHIEVE PERSONALIZED SURGICAL PLANS FOR OUR PATIENTS AS WELL AS PROVIDE A MORE ACCURATE, PRECISE PROCEDURE WHICH IN TURN LENDS ITSELF TO A BETTER RECOVERY AND SHORTER HOSPITAL STAY. THESE STATE-OF-THE-ART ADVANCEMENTS WILL AFFORD QUEENS RESIDENTS THE ABILITY TO STAY IN QUEENS, ALLOW FOR MORE FAMILY AND SOCIAL SUPPORTS DURING THE CONTINUUM OF CARE AND THROUGHOUT THEIR RECOVERY.

TRANSITION FOR YOUTH WITH AUTISM AND/OR EPILEPSY DEMONSTRATION PROJECTS - TRANSITION OF AUTISM CARE IN METROPOLITAN NEW YORK CITY (TRAC NYC) LONG ISLAND JEWISH MEDICAL CENTER, 270-05 76TH AVENUE, NEW HYDE PARK, NY 11040 PD/PI: SOPHIA JAN, MD MSHP; CO-PD/PI: CAREN STEINWAY LMSW, MPH CONTACT PHONE: 516-316-2530; EMAIL: SJAN1@NORTHWELL.EDU TOTAL FUNDS REQUESTED: $2,248,153 (DIRECT: $$1,857,978; INDIRECT: $390,175) THE TRANSITION OF AUTISM CARE IN METROPOLITAN NEW YORK CITY (TRAC NYC) PROGRAM AIMS TO IMPROVE THE TRANSITION OF AUTISTIC YOUTH AND YOUNG ADULTS FROM CHILD SERVING SYSTEMS TO ADULT SERVICING SYSTEMS AND LIFE. THIS PROGRAM IS A RESPONSE TO THE CRITICAL NEED FOR COMPREHENSIVE AND CULTURALLY SENSITIVE TRANSITION SERVICES FOR AUTISTIC INDIVIDUALS, PARTICULARLY THOSE FROM LINGUISTICALLY AND CULTURALLY DIVERSE BACKGROUNDS. LED BY A MULTIDISCIPLINARY TEAM, INCLUDING DR. JAN AND MS. STEINWAY, TRAC NYC WILL LEVERAGE EXISTING PARTNERSHIPS, RESOURCES, AND TRAINING MECHANISMS WITHIN NORTHWELL HEALTH TO ENHANCE CARE COORDINATION, IMPROVE ACCESS TO SERVICES, AND PROMOTE SUCCESSFUL TRANSITIONS FOR THIS POPULATION. THE PROGRAM WILL BE IMPLEMENTED IN TWO PHASES OVER FIVE YEARS. PHASE I, PLANNING (YEAR 1), FOCUSES ON ESTABLISHING THE FOUNDATION FOR SUCCESSFUL IMPLEMENTATION. KEY ACTIVITIES INCLUDE FINALIZING THE POPULATION AND BASELINE NUMBER OF AUTISTIC YOUTH AND YOUNG ADULTS, HIRING AND TRAINING THE AUTISM TRANSITION TEAM, IDENTIFYING TRANSITION CLINICAL CHAMPIONS, CONVENING THE ADVISORY COUNCIL, DEVELOPING PARTNERSHIPS, CONDUCTING A LANDSCAPE ANALYSIS, IDENTIFYING BARRIERS AND OPPORTUNITIES, DEVELOPING CLINICAL GUIDELINES, CREATING AUTISM-SPECIFIC TRANSITION-RELATED TRAINING, AND ADAPTING THE MAP OUR LIFE PLATFORM. THESE ACTIVITIES ARE INFORMED BY THE CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH (CFIR) AND ARE DESIGNED TO ADDRESS THE UNIQUE NEEDS OF AUTISTIC INDIVIDUALS AND THEIR FAMILIES. PHASE II, IMPLEMENTATION (YEARS 2-5), WILL INVOLVE ADOPTING AND IMPLEMENTING A COMPREHENSIVE FRAMEWORK FOR TRANSITIONING AUTISTIC YOUNG ADULTS, REFINING CLINICAL GUIDELINES AND TRAINING PROGRAMS BASED ON FEEDBACK, EXPANDING THE BEE MINDFUL™ PROGRAM TO ADULT HOSPITALS IN THE CATCHMENT AREA, IMPLEMENTING AND REFINING THE MAP OUR LIFE PLATFORM, COLLECTING AND REPORTING DATA, PARTICIPATING IN THE NATIONAL COORDINATING CENTER FOR TRANSITION (NCCT)-LED DEVELOPMENT OF A SUCCESSFUL TRANSITION MEASURE, PARTICIPATING IN NCCT-LED DATA COLLECTION AND REPORTING, DEVELOPING A SUSTAINABILITY PLAN, AND DISSEMINATING RELEVANT RESOURCES. THE PROGRAM WILL LEVERAGE NORTHWELL HEALTH'S ORGANIZATIONAL RESOURCES, INCLUDING LONG ISLAND JEWISH MEDICAL CENTER, NORTH SHORE UNIVERSITY HOSPITAL, COHEN CHILDREN'S MEDICAL CENTER, THE OFFICE OF PATIENT AND CUSTOMER EXPERIENCE, BUSINESS EMPLOYEE RESOURCE GROUPS, THE DEPARTMENT OF COMMUNITY AND POPULATION HEALTH, AND THE QUANTITATIVE INTELLIGENCE GROUP, AMONG OTHERS. IT WILL ALSO LEVERAGE A ROBUST NETWORK OF SOCIAL SERVICE, CARE MANAGEMENT, AND PROFESSIONAL ORGANIZATIONS, AND AUTISTIC INDIVIDUALS AND THEIR FAMILIES, FOR WHICH DR. JAN AND MS. STEINWAY HAVE DEVELOPED THOUGH THE PATHWAYS TO CARE PROGRAM, PCORI-FUNDED FUTURE PLANNING AND WELL-BEING FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES AND FAMILY CAREGIVERS, AND THE SCANS PROJECT. THESE RESOURCES PROVIDE ESSENTIAL SUPPORT FOR PROGRAM ACTIVITIES AND ENSURE THE SUSTAINABILITY OF OUTCOMES BEYOND THE GRANT PERIOD. TRAC NYC'S INNOVATIVE APPROACH TO TRANSITION CARE FOR AUTISTIC INDIVIDUALS EMPHASIZES COLLABORATION, CULTURAL COMPETENCE, AND PATIENT-CENTERED CARE. BY ADDRESSING THE UNIQUE NEEDS OF THIS POPULATION AND LEVERAGING EXISTING RESOURCES AND PARTNERSHIPS, TRAC NYC AIMS TO IMPROVE HEALTH OUTCOMES, ENHANCE QUALITY OF LIFE, AND PROMOTE INDEPENDENCE FOR AUTISTIC INDIVIDUALS IN THE METROPOLITAN NEW YORK CITY AREA AND BEYOND.

AWARENESS AND ACCESS TO CARE FOR CHILDREN AND YOUTH WITH EPILEPSY

HEALTH CARE AND OTHER FACILITIES

DENTAL REIMBURSEMENT PROGRAM

DENTAL REIMBURSEMENT PROGRAM

DENTAL REIMBURSEMENT PROGRAM

DENTAL REIMBURSEMENT PROGRAM

AWARENESS AND ACCESS TO CARE FOR CHILDREN AND YOUTH WITH EPILEPSY