Social Determinants of Health

The initiatives in this domain support high-need patients and assist providers in providing care by addressing SDoH factors. The efforts include advancing health equity by working with sectors on the factors that influence health, including employment, housing, public safety and food access.

Catholic Charities of Steuben / Livingston Access to Healthcare Program

We collaborated with Catholic Charities of Steuben / Livingston to improve healthcare access to vulnerable people in Steuben and Livingston. The agency expanded its outreach and used its mobile van to provide telehealth services and social determinants of health screenings.

Social determinants of health are health-related social needs that have an effect on health outcomes. Examples of social determinants of health include housing, food, transportation, utilities, and personal safety.

As part of this collaboration, we provided technical support to ensure the program met its goals. This support included consultation on data and analytics, and a program evaluation report.

Catholic Charities used these screenings to refer individuals to area providers for primary and behavioral health services. The agency also coordinated and supported these individuals in getting needed healthcare and social services.

Our Community Partners

“For decades Regional Health Reach has been a leader in the community in providing healthcare and support services to those experiencing homelessness. Through our traditional clinic, mobile medical unit, and presence at shelters, our Healthcare for the Homeless program has touched thousands of lives. Health Reach is excited to partner with Finger Lakes Performing Provider System and MC Collaborative to expand our reach to unsheltered individuals, meeting them where they are, to provide the care they need.”

William E. Belecz, Executive Director of Regional Health Reach

“The Finger Lakes IPA, a partnership of the region’s community health centers, six behavioral health organizations, and the S2AY Rural Health Network, is very excited to be a part of this important initiative by FLPPS to support the critical need for access to developmental screenings for young children in our rural communities. This program will give us the ability to provide access to services that are often not available due to geographic and other barriers to care experienced by our patients.”

Mary Zelazny, Chair of Finger Lakes IPA and CEO of Finger Lakes Community Health

“I am excited to see ‘equity in action’ through this partnership with FLPPS, who recognizes the importance of lived experience and elevating the parent and patient voice to bring change across our health and behavioral health systems.”

Sara Taylor, Founder of BIPOC PEEEEEEK

“The key to the success of this menu of services is our ability to have a two-way dialogue with doctors and other medical professionals about both health and social support needs at home. We’ve proven this model can improve patient outcomes and reduce unnecessary ED visits and hospitalizations, and that’s a win for everyone. It also reduces both physician and patient/family caregiver frustrations.”

Ann Marie Cook, President and CEO of Lifespan

“By expanding our Person In Crisis teams to include certified peer specialists, we will be able to assist even more of our residents in need in a humane and compassionate manner. In addition, by assisting residents in this new way, we are expecting that there will be a reduced number of people calling the PIC team because they are getting connected to the services they need.”

Former City of Rochester Mayor Lovely Warren