CCPH 2010 Annual Award Winner
Center for Community Health Education Research and Service
The Center for Community Health Education Research and Service, Inc. (CCHERS) partnership was established in 1991 with a $6 million grant from the W.K. Kellogg Foundation’s Community Partnerships in Health Professions Education initiative. The goal of the initiative was to “redirect and reorient” health professions education, to make it community-based, primary care focused, interdisciplinary, and serving underserved populations. CCHERS is nationally recognized as a model community-academic partnership, among hospitals, universities, 15 community health centers (CHCs) and the racially and ethnically diverse communities they serve in the central city neighborhoods of Boston. The community health centers are the locus where community health and primary care are “operationalized” and have proven outstanding sites for the education of a variety of health professions students and for conducting clinical and health services research.
Executive Director, Elmer Freeman teaches a class on health disparities
at the Edward M. Kennedy Academy for Health Careers a public charter
school founded by CCHERS at Northeastern University
In 1996, CCHERS was funded in a second initiative by Kellogg, Community Partnerships in Graduate Medical and Nursing Education, for training primary care residents and advanced practice nurses in pediatrics and internal medicine. The new funding coincided with the merger of Boston City Hospital, the public safety-net hospital with a group of affiliated community health centers and Boston University Medical Center, the private academic teaching hospital of Boston University School of Medicine. Along with other funding to the medical school (RWJF – Generalist Physician Initiative) and the college of nursing (Pew – Health Professions Schools in Service to the Nation) CCHERS was positioned at the forefront of transforming medical and nursing education in Boston.
The mission of CCHERS is … to promote the development of “academic community health centers,” that integrate education, research, and service, to influence and change health professions education; improve health care delivery; and promote health systems change to eliminate racial and ethnic disparities in health. The mission was developed by the founding partners of CCHERS in 1991; was amended in 1997 with its incorporation and again in 2007, the result of its strategic planning process. The first change emphasized and modeled the concept of the “academic community health center” and the strategic planning process emphasized a focus on the elimination of racial/ethnic health disparities.
Through formal and informal community/academic partnerships, the goals of CCHERS are to:
CCHERS defines its community as those served by its community health center partners which represent the most racially and ethnically diverse central city neighborhoods of Boston. Like other major cities, Boston since the 2000 census has begun to experience greater and greater diversity with growing minority and new immigrant populations emerging and dramatically changing the demographic composition of the City and its neighborhoods. According to the 2000 census Boston had already become a majority minority city with its minority population reaching 51.2% and its white population at 48.8%. Based on the experiences of how neighborhoods change and are being resettled by immigrant groups the 2010 census is expected to show these dramatic shifts which the community health centers, being on the on the frontline of that change have been experiencing over the past 5-7 years.
Dorchester, the largest community, has the greatest racial and ethnic diversity as well. Whole neighborhoods have changed to become ethnic enclaves for Vietnamese, Cape Verdean and Latino immigrants. Roxbury, the historically African American community, experienced increased numbers of Puerto Rican residents and a significant influx of African immigrants over the same period. Mattapan’s Black population represents many ethnic groups, including African Americans, Jamaicans, Haitians, and Cape Verdean, African, Guyanan and other West Indian immigrants; and Jamaica Plain’s Latino ethnic diversity is just as broad with Puerto Ricans, Dominicans, Cubans, other Caribbean Islanders and Central Americans. The neighborhoods of Roxbury, Dorchester and Mattapan have infant mortality and mortality rates that are consistently above the rates of the City as well as higher rates of visits to emergency departments and childhood hospitalizations from asthma.
CCHERS builds on the community health movement values and founding principles of consumer participation and community empowerment so that “community” is a core value of the organization with representation on the Board of Directors and through out all levels of the organization, including its staff. These values are reflected in the mission and goals of CCHERS as well as the partnerships in which it chooses to participate.
Elmer Freeman talks with Dr. Jack Geiger, founder of the community health center movement about social, political and economic determinants of health
CCHERS has a typical hierarchical organization structure with an Executive Director (ED) accountable to a Board of Directors and a group of program directors reporting to the ED. The chart identifies the major program areas of CCHERS, including health professions education, the community advocacy domestic violence program, community research and evaluation and policy planning and advocacy.
The Partners: CCHERS is a community-based organization that is a community/academic partnership among Boston Medical Center, the Boston Public Health Commission, Boston University School of Medicine, Northeastern University Bouvé College of Health Sciences and an established network of fifteen community health centers in Boston. The formal partnership recognizes the following 4 institutions and 15 community health centers as voting partners and members of the Corporation as established in its By-Laws:
Boston Medical Center - The successor institution
resulting from the merger of Boston City Hospital and Boston University
Medical Center, established in 1996 as the City’s non profit safety-net
Boston Public Health Commission - The successor institution to
Department of Health and Hospitals City of Boston after hospital
merger, established as the city public health department in 1996.
Boston University School of Medicine - Medical school was
partner with an orientation toward primary care, underserved
populations and urban health through its affiliation with Boston City
Hospital (Boston Medical Center).
Northeastern University Bouve College of Health Sciences -
Nursing was the founding partner however the merger of the colleges of
nursing, pharmacy and allied health led to the larger Bouvé College of
Health Sciences in 1999.
Bowdoin Street Health Center - Licensed by Beth
Israel Deaconess Medical Center, a member of the Community Care
Alliance network. (7,700 Registered Patients)
Brookside Community Health Center - Licensed by Brigham and
Hospital, a member of Partners Healthcare System. (10,000 Registered
Codman Square Health Center - Licensed by Boston Medical Center,
federally qualified health center, a member of Boston HealthNet.
(17,700 Registered Patients)
Dorchester House Multi Service Center - Licensed by Boston
Center, federally qualified health center, a member of Boston
HealthNet. (21,350 Registered Patients)
East Boston Neighborhood Health Center - Licensed by Boston
Center, federal 330 center, a member of Boston HealthNet. (45,500
Geiger Gibson Community Health Center - Independently licensed,
330 center, a member of Boston HealthNet. (6,700 Registered Patients)
Greater Roslindale Medical and Dental Center - Licensed by
Center, federally qualified health center, a member of Boston
HealthNet. (8,250 Registered Patients)
Harvard Street Neighborhood Health Center - Independently
federally qualified health center, affiliated with Boston Medical
Center, a member of Boston HealthNet. (9,100 Registered Patients)
Neponset Health Center - Independently licensed, federal 330
affiliated with Brigham and Women’s/Faulkner Hospitals, a member of
Partners Healthcare System. (12,000 Registered Patients)
Mattapan Community Health Center - Independently licensed,
center, affiliated with Boston Medical Center, a member of Boston
HealthNet. (6,200 Registered Patients)
South Boston Community Health Center - Licensed by Boston
federally qualified health center, a member of Boston HealthNet.
(13,000 Registered Patients)
Southern Jamaica Plain Health Center - Licensed by Brigham and
Hospital, a member of Partners Healthcare System. (8,000 Registered
The Dimock Center - Independently licensed, federally qualified
center, affiliated with Beth Israel Deaconess Medical Center, a member
of Community Care Alliance network. (12,600 Registered Patients)
Uphams Corner Health Center - Independently licensed, federally
health center, a member of Boston HealthNet. (16,750 Registered
Whittier Street Health Center - Independently licensed, federal 330 center, affiliated with Boston Medical Center, a member of Boston HealthNet. (9,000 Registered Patients)
CCHERS has established less formal partnerships based on collaborations on various projects and programs. These partners are not specifically represented in the corporation or the governance structure but may have formal memorandums of agreement, contracts, or other business ties with CCHERS.
Action for Boston Community Development - Boston’s
agency is a partner in Critical MASS and collaborator with CCHERS on
health disparities grants.
Brigham and Women’s Hospital - Partner in Community Health and
Medicine Partnership with CCHERS and Harvard Medical School.
Kennedy Academy for Health Careers - Founded by CCHERS and a partner in
HRSA funded Comprehensive Health Careers Opportunity Program.
Harvard School of Public Health - Partner on a number of CBPR
Health Care for All - Partner on Disparities Action Network with Critical MASS and CCHERS.
Institute for Community Health - Partner on contract with MA
Public Health to conduct training in the collection of racial, ethnic
and language data at community health centers and other health care
MA Dept of Public Health - Co-founder and member of Critical
contractor with CCHERS.
Tufts Medical Center - Partner in Clinical and Translational
Tufts University - Partner in Clinical and Translational Science Institute, Tufts Community Research Center and a HRSA funded Comprehensive Health Careers Opportunity Program.
University of Massachusetts – Boston - Partner on HRSA funded Comprehensive Health Careers Opportunity Program.
The CCHERS partnership incorporated in 1997, as an independent 501(c)(3) non-profit corporation as the institutions, community health centers and community partners determined it to be the most equitable way of sharing power and acquiring resources for the work and sustainability of the partnership. The partnership would no longer be dependent on one of the institutions or health centers to serve as its fiscal agent and could seek funding independently. The Board of Directors is composed of representatives of the universities, hospitals, health centers and the communities they serve. Through shared power and decision making they provide governance, make policy and determine strategic direction for the organization. When initially established the principle was that each partner would get 2 seats on the Board with the health centers identifying a community member as their second seat. With the continued growth in the number of partners the size quickly became unwieldy.
In 1997 there was an effort to decrease the Board size and to also have community members that were not necessarily associated with the health centers. The process actually resulted in an increase in the size of the Board and disassociated the community member category from the health centers. It also added a new category of membership, “unaffiliated” for other interested stakeholders and collaborators, including community organizations and institutions. They also moved to an 11 member Executive Committee model where the Board only met quarterly and the while the Executive Committee met monthly except for the months in which there was a Board meeting.
Board decisions are made by consensus and a vote in cases where one is required. The Executive Director is charged with implementing the strategic plan objectives and provides the leadership required for achieving them.
In 2009, following a yearlong strategic planning process the Board was reorganized and its membership cut from 35 to 20, while maintaining the commitment to representation of the partner institutions and health centers, community members, and other interested stakeholders. The Board now meets bimonthly using more of a policy governance model. The number of institutional seats was limited to one per institution; the health center representation was limited to 5 instead of 10 and the same was true for the community seats; and the unaffiliated was cut from 6 to 5.
The Board has three standing committees, Executive, Nominating and Finance with ad hoc committees appointed as necessary. The seven (7) member Executive Committee is elected by the Board of Directors and consists of the four (4) officers of the Board of Directors, two (2) additional directors representing any of the three classes of members that is underrepresented among the officers, and the Executive Director. The Executive Committee exercises the full power of the Board of Directors however any action taken by the Executive Committee may be amended or repealed by subsequent vote of the Board of Directors. The Nominating Committee consists of three (3) members of the Board of Directors and presents to the Board of Directors a slate of candidates for election to the Board at the Annual Meeting of the Corporation in December, and a slate of Officers for election at the January meeting of the Board of Directors. The Finance Committee is appointed by the Chairman and includes three (3) members of the Board of Directors, one of which is the Treasurer who serves as its chair; and other non Board members with financial expertise.
Ad hoc committees have included the Strategic Planning Committee, March 2007 – December 2007, which developed the 4 year strategic plan for the organization and included board members as well as external stakeholders. As a result of the strategic planning process, the CCHERS Board of Directors has committed to build on the success of its eighteen years of forging community/academic partnerships for the further development of its model of academic community health centers with a focus on developing community derived and directed health services and clinical research to impact persistent racial and ethnic health disparities among their diverse urban populations.
Beverley Russell, Director of Research and Evaluation at CCHERS and
Elmer Freeman talk with Peg AtKisson, Director of Proposal Development
in the Office of the Vice Provost at Tufts University’s “Speed Dating
for Researchers and Communities”
In January 2010 the Community Research and Investigations Review Committee (CRIRC) was established as an ad hoc committee with the intent of it becoming a permanent standing committee of the Board with the powers of a community based IRB for research being vetted in and by the community. The CRIRC will be composed of 15-18 members including representatives of community health centers, other community-based organizations, academic researchers, clinical providers, and community residents.
CCHERS is a self sustaining community based organization and by agreement, Northeastern University (NU) serves as its host institution and sustaining partner. NU provides CCHERS with space, payroll processing, human resources services, telecommunications, library, and IT support. Other funding comes from grants and contracts with foundations, government, corporations and private donors directly to CCHERS. The Executive Director and Senior staff decides which grants to pursue that are in concordance with the organization’s mission and strategic plan. In the beginning of our partnership the first Kellogg grant went through the Department of Health and Hospitals and the second through Northeastern University as fiscal agents for the partnership. Since its incorporation and tax determination, CCHERS receives funds directly. Funds are allocated to partners based on the nature and level of participation in a given program or project. In other instances such as the Community Advocacy Program, which targets a geographic neighborhood, the decision for funding support is based on the health center being located in Dorchester, where 5 of those 7 health centers participate in the program. In other situations CCHERS may issue an RFP to the community health centers to apply for participation in various initiatives and programs.
The strategies CCHERS uses engage community and academy include education and outreach, service learning and community based research. These strategies have their roots in the work and commitment of the 4 community health centers (CHCs) that were among the original founding partners in 1991. It was institutionalized as part of the community based education model and curriculum for the medical and nursing students in the CCHERS track at their respective universities.
Voices student, Alexandra Puckerine testifies at the Lobby Day of the
Disparities Action Network at the Massachusetts State House along with
Dr. Deborah Prothow Stith of Harvard School of Public Health and April
Taylor of Health Care for All
Students were assigned to the health centers as their community hub and did community outreach and education as a major part of their educational experience in community based organizations such as schools, daycare and Headstart centers, youth and family centers, churches, elderly housing developments, and nutrition sites. Activities included educational workshops, immunization clinics, nutrition demonstrations, etc. Northeastern University was funded with a US Department of Housing and Urban Development grant for a Community Outreach Partnership Center which allowed CCHERS to have a broader impact in the community and created a community presence and identity.
Alexandra Puckerine meets Governor Deval Patrick, Senator Susan Fargo and Representative Byron Rushing at the State House
CCHERS was one of the early funded organizations by the Corporation for National Service (CNS) for a community service learning program under the Americorps Program developed around the model of Co-Operative Education at NU. This made health center based co-op experiences affordable for the health centers and added to their workforce. It also was valuable experience for all students. Subsequently, CCHERS received a Learn and Serve grant from CNS for incorporating service learning into its then pilot high school, the Health Careers Academy.
CCHERS promotes community-based participatory research as the preferred model for conducting research with disenfranchised communities and underserved populations. Experience and evidence have shown that as a model CBPR improves the quality of the research being conducted, builds capacity in the community, and improves health outcomes. CCHERS has 6 active research projects being conducted in partnership with academic researchers and being implemented in its practice based research network of CHCs.
Having started as part of a major national initiative of the Kellogg Foundation, the CCHERS partnership is used to assessing and reflecting on its progress and evaluating its performance to plan. Evaluation was not only of the outcomes of the educational programming but also the process by which the partnership developed. There is an evaluation of the partnership that occurs about every 2-3 years.
As part of the strategic planning process in 2007 there was a reassessment of the partnership and all of the partners were interviewed about their continuing commitment to the partnership and their assessment of the impact on their organization, the institutions and the community. There is also a bi-annual assessment of the Board functioning and member participation conducted by the Nominating Committee. Annually, one Board meeting is dedicated to review of the organization’s activities as compared to the objectives outlined in the strategic plan.
A brief synopsis of the outcomes and results by the various CCHERS program areas is outlined below, followed by a list of key accomplishments.
from the Kennedy Academy talk with Dr. Geiger about his career in
medicine and community health and the community health center movement
Health Professions Education/Workforce Development:
Community Based Research:
from Edward M. Kennedy Academy for Health Careers pose for Community
Voices photovoice project on racial and ethnic disparities in health
and health care
Health Disparities/Critical MASS:
Critical MASS toolkit Taking ACTION on Health Disparities in its second printing of 5,000 copies thanks to the Blue Cross Blue Shield of Massachusetts Foundation
Community Advocacy Program:
All partnerships are transformative for the individual partners and the venture they create as a result of the partnership. CCHERS is no exception resulting in a major change in how medical students from Boston University and nursing students from Northeastern University were educated. Northeastern University’s College of Nursing developed a entire curriculum based on the CCHERS network of CHCs and became nationally recognized for its model of community based nursing education as detailed in their book, Teaching Nursing in the Neighborhoods: The Northeastern University Model. The faculty developed a summer learning institute for other faculty from schools of nursing interested in adopting the NU model that resulted a second book, Community Based Nursing Education: The Experience of Eight Nursing Schools.
At Boston University School of Medicine the existence of the CCHERS partnership led to the receipt of a Robert Wood Johnson Foundation grant under the Generalist Physician Initiative and the creation of the Center for Primary Care. The second Kellogg initiative, Community Partnerships in Graduate Medical and Nursing Education coincided with the RWJ grant and the merger of Boston City Hospital and Boston University Medical Center, CCHERS was written into the merger document, consolidation agreement, with a cash commitment of $1.3 million to be used as match for the new Kellogg grant. It also positioned CCHERS to negotiate for the creation of a new residency program in Family Medicine when residency programs were capped and a reallocation of existing slots from specialty programs such as surgery, cardiology, etc had to be cut to accommodate the new program. CCHERS was recognized as a best practice model by the Council on Graduate Medical Education. CCHERS also took the lead with the late Senator Kennedy to establish reimbursement for “out of hospital” residency training programs through Medicare GME like teaching hospitals, as a member of the Medicare Payment Advisory Commission.
in the Community Voices Program meet with Representative Gloria Fox at
State House to discuss her bill for the certification and recognition
of community health workers by the State Department of Public Health
For the community health centers who came to this with little interest in education of students, and even less in research but because they saw it as more of a workforce development opportunity it was transformative. They evolved from community health centers to “academic community health centers” a term they introduced as they sought to replicate all that they knew of academic medicine in Boston, by integrating teaching and research into their historic missions of service to the underserved. The CCHERS network of community health centers is unique in this way.
Today community based research to impact racial racial and ethnic disparities in health and health care is the primary focus of the CCHERS partnership. It is leading the move among community based organizations, groups and residents to increase the role of the public in research to make it more relevant to public needs and community concerns. Circumstances have presented CCHERS’ leadership with the opportunity to help transform the NIH and how biomedical research is conducted in this country with the CCHERS Executive Director’s appointment to the Director’s Council of Public Representatives.
Several factors contribute to the success of the CCHERS partnership. In the initial application process with the Kellogg Foundation, there was a one year planning grant given to fifteen groups who competed for one of seven final grants of $6 million. The planning process allowed the proposed partners to engage in the kind of open discussions and afforded them the time essential to the development of trust and relationships between the members of the founding group. The cultural divide that existed was bridged over the year of planning. The Foundation meetings resulted in frank discussions of the issues, challenges and barriers to partnership. We also focused on the potential benefits and rewards.
Another factor contributing to CCHERS’ success is its having benefitted from the boundary spanning leadership of the two individuals who have served in the role as Executive Director. Coming from the two arenas, the first was a faculty member of the College of Nursing and the second was a health center director coming from the community. They led the organization at different stages of its development and had the vision needed to take CCHERS to the next level.
There have been significant lessons learned over our years of developing and growing this partnership. The following are some of those lessons:
Meservey, PM and Richards, RW. (1996). Creating New Organizational Structures. In Richards, RW. (Ed). Building Partnerships: Educating Health Professionals for the Communities They Serve. San Francisco, CA: Jossey-Bass Publishers
Matteson, PS. (Ed). (1995). Teaching Nursing in the Neighborhoods: The Northeastern University Model. New York, NY: Springer Publishing Company
Matteson, PS. (Ed). (2000). Community Based Nursing Education: The Experience of Eight Nursing Schools. New York, NY: Springer Publishing Company
Freeman E, Gust S, Aloshen D. (2009) “Why Faculty Promotion and Tenure Matters to Community Partners,” Metropolitan Universities Journal. August, 20(2) pp.87-103
Freeman, E.R., Brugge, D., Bennett-Bradley, W.M., Levy, J.I., and Carrasco, E. (2006). “Challenges of Conducting Community-Based Participatory Research in Boston’s Neighborhoods to Reduce Disparities in Asthma.” Journal of Urban Health, November/December, 4(6) pp. 1013-1021
Fitzpatrick, D, Golub-Victor, A, Lowe, S and Freeman, E. (2006) “Partnership Perspectives: Changing the Image of Physical Therapy in Urban Neighborhoods Through Community Service Learning.” Journal of Physical Therapy Education, Winter, 20(3) pp. 33-40.
Freeman, E. (2000). “Engaging a University: The CCHERS Experience.” Metropolitan Universities Journal, Fall, 11(2) pp.20-27.
Meservey, PM. (1995). Fostering Collaboration in a Boundaryless Organization. Nursing and Health Care: Perspectives on Community, 16(4) pp. 234-236.