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.

Food Bank of the Southern Tier and C.I.D.S Maternal Home Delivery Program

Food insecurity is a social determinant of health and a driving force of health inequities. The COVID-19 pandemic has exacerbated the crisis of food insecurity, disproportionally affecting women and racial and ethnic minorities.

A partnership was formed with the Food Bank of the Southern Tier and Comprehensive Interdisciplinary Developmental Services, Inc. (C.I.D.S) to launch an innovative program addressing food insecurity and maternal health needs.

This innovative program offered home delivery of nutritious food along with virtual cooking classes during pregnancy and the postpartum period. Cooking kits, including kitchen utensils, pots, pans, oils, and spices, were also provided.

Technical support was given as part of this collaboration to ensure the program’s goals were met. This support encompassed consultation on data and analytics, as well as a program evaluation report.

The Food Bank of the Southern Tier and C.I.D.S collaborated with Arnot Health and Meals on Wheels of Chemung County, Inc. on the program, known as “Kitchen Stork,” which aimed to serve up to 50 expectant mothers in Chemung County. Community Health Workers from C.I.D.S provided support to participants throughout the duration of the program.

Our Community Partners

“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

“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

“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

“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