Current Pilot Summaries
There are currently 19 IHN-CCO pilot programs underway in Benton, Lincoln and Linn counties. All pilot programs share the same goal of improving local health and health care access. Each program operates under criteria developed by the Oregon Health Authority and the IHN-CCO Community Health Improvement Plan. Program progress is monitored quarterly.
Breastfeeding Support Services in East Linn County
Linn County 2015 Women Infants and Children (WIC) data show that although 92% of WIC moms start breastfeeding, only 38% exclusively breastfeed for six months. This pilot seek to reduce the barriers new mothers have in being able to successfully breastfeed their children through the placement of a Spanish speaking International Board Certified Lactation Consultant (IBCLC) in the Samaritan Mid-Valley Pediatric office in Lebanon and by expanding breastfeeding support services in Linn County WIC clinics. By the placement of a Lactation Consultant in the clinic setting, evaluation and consultation to the mother-baby dyad can be provided in coordination with the other medical services delivered by primary care staff. An IBCLC's contribution to the care of the new breastfeeding family can meet the American Academy of Pediatrics recommends that breastfed babies be seen within 3 to 5 days of birth.
Linn County WIC
Samaritan Mid-Valley Pediatrics
CHANCE 2nd Chance
Communities Helping Addicts Negotiate Change Effectively (CHANCE)
Community Health Worker in North Lincoln County
This pilot will integrate Community Health Workers (CHWs) within Patient Centered Primary Care Homes and the North Lincoln County Community. CHWs in the clinic will further engage patients in their care and help patients make connections within their own community. The CHWs will help create barrier-free access to healthcare, a closed loop referral system for accessing community resources, and teach healthcare/lifestyle classes. Due to recruitment issues in the region, the pilot would also work to create a training center with other area organizations.
Samaritan North Lincoln Primary Care and Women’s Health Clinic
Albany Fire Department
Eating Disorders Coordinated Specialty Care Teams (EDCSCT)
This pilot will develop Coordinated Specialty Care Teams (CSCTs) for treatment of eating disorders in Linn, Benton, and Lincoln Counties. Best practices in eating disorder treatment include immediate evaluation of diagnosed or suspected cases, prompt initiation of effective treatment, quick resolution of medical and nutritional complications and ongoing treatment by a knowledgeable multidisciplinary team until normalized eating is achieved and psychological health is restored. This proposal is transformational because instead of employing one specialist or having a treatment center, which is not feasible for a community of our size, the pilot would create a multidisciplinary team. Providers within a CSCT would remain in their current offices to see patients from their primary locations.
PCPs throughout Linn, Benton, and Lincoln Counties can refer patients to EDCSCTs
Expanding Health Care Coordination
This pilot will examine and compare the effectiveness of different approaches for using Medical Assistants to extend care coordination to IHN-CCO members. One approach is to use Medical Assistants to proactively engage assigned members to come in for needed follow-up care. The other effort expands the role of Medical Assistants in the exam room by having them work side by side with the provider during visits to attend to documentation and assist with orders. The Medical Assistant will then wrap up the visit and help the patient arrange testing, treatments, and follow-up. Shifting appropriate tasks to the Medical Assistants will ensure better care coordination while freeing up provider time to engage with patients and manage more complex medical care.
Samaritan Family Medicine Resident Clinics in Corvallis, Albany and Lebanon
Family Support Project
The Family Support Project will use Family Support Liaisons (FSLs) from Linn Benton Lincoln Education Service District (LBL ESD) to function as a safety net to catch students who are falling through the cracks. Liaisons, who are Qualified Mental Health Associates, licensed professional counselors, and social workers will provide services and outreach to youth and families in homes, schools, and the community helping them to acquire the basic resources, health and social services, educational supports, positive opportunities and life skills they may need. Liaisons will collaborate with schools to support efforts to ensure students are attending school consistently and making academic progress. The Liaisons will work with each youth and family to develop a culturally appropriate, individualized and coordinated service plan that reduces the likelihood of duplication and maximizes the impact of services.
Linn Benton and Lincoln Education Service District
Improving Infant and Child Health in Lincoln County
Lincoln County Health and Human Services
Oral Health Equity for Vulnerable Populations
Linn and Benton Counties Oral Health Coalition
Pain Management in the Patient Centered Primary Care Home
This pilot strengthens the Primary Care Home by improving primary care physician and provider knowledge, treatment of, and confidence in treating chronic pain in order to improve patient outcomes, reduce patient harm, and improve utilization of healthcare resources. This is accomplished through a unique educational and interactive program designed by a fellowship trained chronic pain specialist for primary care physicians and providers practicing in a Patient Centered Primary Care Home. In this pilot, twelve Patient Centered Primary Care Homes will receive direct assessment, training and on-going support.
12 Clinics across Linn, Benton, and Lincoln Co.
Pharmacist Prescribing Contraception
This pilot seeks to provide low barrier oral contraceptives to IHN-CCO members through trained pharmacists in pharmacies so that patients can be interviewed, assessed and counseled regarding their choice of hormonal contraceptives in each of our SHS retail pharmacies. This pilot seeks to ensure that each SHS outpatient pharmacies offer this service during normal business hours
Pre-Diabetes Bootcamp in Lincoln County
The goal of this pilot is to establish a sustainable pre-diabetes program in the Lincoln City area that reduces the transition of IHN-CCO members from pre-diabetes to diabetes by include increasing a person’s awareness of their pre-diabetes as well as concrete steps they can take to improve their health. The Pre-Diabetes Boot Camp consists of a 2 hour intense introduction to pre-diabetes and the benefits of taking action to prevent diabetes onset. Participants will be followed and coached through a year-long lifestyle intervention program and given tools to help them make lifestyle changes. Learning and participant feedback will be used to continually improve and sustain the program.
Samaritan North Lincoln Hospital
Depoe Bay Clinic
Samaritan Pacific Communities Hospital
SHS Palliative Care
Palliative care is an interdisciplinary specialty that focuses on preventing and relieving suffering. Palliative care serves patients at any stage of serious illness, concurrent with disease directed therapies, focusing on: improving quality of life, reaching the best possible function, helping with decision-making about end-of-life, and providing emotional support to patients and their families. The pilot’s goals are to improve patient experience, reduce patient suffering and family distress, reduce hospital length of stay, readmissions and emergency room usage, reduce clinician moral distress, improve communication and collaboration between providers caring for patients with serious illness, and increase use of advance directives in order to reflect patient wants and needs.
Available in Benton and Linn Co. and spreading to Lincoln Co.
Social Determinant of Health (SDoH) Screening with a Veggie Rx Intervention
Benton County Health Services
The Warren Project: Nature Therapy
Olalla Center for Children and Families, a mental and behavioral health provider, in collaboration with Community Services Consortium, proposes to pilot The Warren Project: Nature Therapy, an outdoor-based therapeutic care model. This model integrates physical and mental health therapies with experiential learning in a natural setting and offers early intervention strategies for adolescents and families. The program will work through an equity lens and move towards overcoming health obstacles such as poverty and literacy, while utilizing culturally appropriate methods, bilingual and multi-cultural staff and partners with specialized training in family dynamics, adolescent and LGBTQ needs, all in a very rural and underserved county
The Olalla Center for Children and Families
Traditional Health Worker Training Hub
Benton County Health Services
Youth and Child Respite Care
Morrison Child and Family Services will provide planned and crisis respite services in Linn, Lincoln, and Benton Counties to the target population of IHN-CCO member children (ages 3 to 17) identified as needing stabilization through Planned and Crisis Respite Services. This pilot aims to expand upon our existing respite services in Multnomah, Clackamas, and Washington Counties to address the need for respite providers in Linn, Lincoln, and Benton Counties. The overall project aim is to stabilize families at risk of disruption, which we intend to meet by recruiting 15 new respite provider families and of those recruited families, successfully certifying at least 10 providers by the end of the funding period.
Linn, Benton, and Lincoln Counties