Online Event Archive Recorded: November ?, 2025
The Affordable Care Act (ACA) creates opportunities for community groups and community-based organizations to engage hospitals and health systems in addressing the interconnected issues of housing, health, and community development. A hospital’s Community Health Improvement Plan (CHIP) guides part of its community benefit activities, much like a bank’s Community Reinvestment Act (CRA) plan directs its community investments. In this session, learn how the ACA establishes incentive structures for engagement nationwide; explore a collaborative model from Philadelphia; and examine the CRA-funded Building Life Opportunities and Options for Mothers (BLOOM) initiative in Nashville, which empowers mothers through a social-enterprise approach that provides stable, affordable housing and creates pathways to family economic mobility.
Speakers
Garrett O’Dwyer, MPH, Policy Director at the Philadelphia Association of CDCs
Rolanda Lister, MD, Founder and CEO of BLOOM (Building Life Opportunities and Options for Mothers), Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Vanderbilt University Medical Center
Kay Bowers, Affordable Housing Consultant, Board of Commissioners, Metropolitan Development and Housing Agency
Greg Wilson, Senior Organizer, NCRC
Transcript:
NCRC video transcripts are produced by a third-party transcription service and may contain errors. They are lightly edited for style and clarity.
Wilson 0:08
Okay, everybody. Thank you very much for joining us today. We’re part of the Better Together webinar, “Better Together: Community Voices, Hospitals and Banks Advancing Housing and Health.” My name is Greg Wilson. I’m a senior organizer for NCRC. We appreciate everyone’s time here today. Next slide. We want to be able to let you know that NCRC is a 700+ member organization. We have folks all over the country that are members of NCRC – CDCs, CDFIs, nonprofit groups, financial literacy shops and we strive to develop a just economy. Next slide. Just for some basic ground rules, we have a code of conduct that you could look at for this webinar today. And when it comes to questions – this is important – when it comes to questions, we look forward to you submitting your questions in the Q and A box. It’s right there at the bottom in your little zoom field. So if you could submit your questions there, and please, for everyone else, please keep on registering for the event. Let us know. Sign on in. We’d like to see who’s on board. Right now, we have 97 folks signed up for this webinar, and we very much appreciate it. So first off, I’d like to introduce each one of the folks that are going to be participating in our webinar today. Garrett, why don’t you go first?
O’Dwyer 1:32
Sure. I am Garret O’Dwyer. I am the policy director at the Philadelphia Association of Community Development Corporations or PSCDA.
Wilson 1:43
All right, and Kay Bowers?
Bowers 1:44
Hi everyone. I’m Kay Bowers, and I live in Nashville, Tennessee. I’m an affordable housing consultant and technical assistance provider. I spent the majority of my career as an affordable housing developer and provider across cities in Tennessee.
Wilson 2:06
And Dr Lister?
Lister 2:09
Hi, I’m Dr Lister. I’m a maternal fetal medicine specialist in Nashville, Tennessee at Vanderbilt University Medical Center. I’m also the founder of Building Life Opportunities and Options for Mothers. I take care of high-risk pregnancies and see the intersection of a failed social safety net with pregnancy complications. So my goal, and my hope that you’ll hear more about today with our organization, is to really understand housing as a part of a critical part of health care, and ultimately, we want to reduce pregnancy complications by addressing social drivers of health.
Wilson 2:55
Great, okay, to kick things off, we’ll have Garrett O’Dwyer speak from PACDC. Garrett, the floor is all yours.
O’Dwyer 3:04
Sure, and I think you can go to the next slide. So I just wanted to give a little bit of background of us, about us at PACDC. As I said, the Philadelphia Association of Community Development Corporations, and as the name implies, we are based in the city of Philadelphia, in Pennsylvania. We are one of a handful of municipal CDC associations around the country. There aren’t too many. Most are on the state level. But we are, we are really just focused on the city, so not the region, not, you know, the outside of the city boundaries. And we’ve been doing our work since 1992 we were founded by the CDC community. And I know that there are some folks on the call who might be from the public health or hospital background. So I actually just wanted to take a second to make sure we’re all speaking the same language and let you know what we mean by CDC in this context. So we’re talking about community development corporations or neighborhood-based nonprofits that do the work of community revitalization and community stabilization. So everything from building affordable housing to economic development and managing neighborhood commercial corridors, taking care of vacant properties and turning them into green spaces or urban gardens I providing social services, including homeless services. Some have moved into health care by opening up federally qualified health centers, and some have moved into education at PACDC, we support their work through two big baskets of of focus areas. One is our policy and advocacy work, which we do on a federal level with partners like NCRC, we do it on a state level, and primarily a local level, where we try to make sure that the programs are members used to do their work in communities, that they work well, that they’re well funded, and that the policies that impact not just. Star members, but the communities that they serve are well thought out and are able to benefit, particularly lower income communities, communities of color and immigrant communities. And beyond just working with governmental actors, we also work with large institutional stakeholders, like our hospitals and universities and banks. In addition to this policy and advocacy work, we also do capacity-building work. We have a Community Development Leadership Institute where we bring folks in from around the region and the country to share best practices on that full range of work involving community revitalization and community stabilization. We work with small businesses to build their capacity so that they can better serve their communities and thrive. And we work to build the capacity of local residents in areas that don’t have that kind of civic infrastructure of existing strong CDCs. We began the work of community development and health, our work in this area, around 2012, after the ACA was passed, which we’ll be talking about here today and next slide. And before we jump into that, I just wanted to say at the top, just make a note of the current moment. I know that there’s a lot of flux on the federal level with health care policy. Of course, we just had this prolonged shutdown fight over Affordable Care Act subsidies, and it can feel like there’s a lot of uncertainty and and indeed, there is. I would say two things, one is that this should not dissuade you from the work of partnering with health systems. I think that there’s a lot of reasons to do it and a lot of entry points to do it that don’t involve the ACA, even if that were to get completely thrown out, which I don’t think is going to happen. And there are a lot of benefits. And I also think that the timeline of this is is long building relationships like this take time, and there are bound to be political up and downs along the way, and so I would not let that dissuade you. Next slide.
So let’s talk about the ACA. Its full name is the Patient Protection and Affordable Care Act. It was passed in 2010 it’s more commonly known as Obamacare, and it’s the main driver. The main impetus of it was because we had so many uninsured, under and under insured folks, and so many folks that had pre-existing conditions that weren’t able to access health care, and so the ACA made a number of changes that resulted in the number of uninsured being halved, and the quality of the health care plans that the insured Has improving substantially. It did this by expanding Medicaid, by providing subsidies on on private for private insurance, on on state-based exchanges. It banned the denial of I, of excluding people for from care for pre-existing conditions, and it began to switch us from value-based care, or sorry, to value-based care, where the outcomes are what’s important from volume-based care, where the number of times somebody goes into a hospital is what determines how much the hospital gets.
Some of these have been lost over time, not some of the ones I just mentioned, but there were other elements of the ACA when passed like an individual mandate, which was thrown out by the Supreme Court. But these elements have remained, as well as a community benefit requirement for nonprofit hospitals to improve the health outcomes in the communities they serve. And part of the reason for that was that so much of the finances of nonprofit hospitals were impacted by the amount of uninsured folks, and they weren’t able to pay their medical bills. And so what would happen is that that would get passed off as bad debt. So if you expanded the pie of folks that have insurance, suddenly the books of nonprofit hospitals get a whole lot better. And so what the federal government said was, well, hold on, you can’t just take that money and say, you know, give it to your executives or something like that, you have to take that money and reinvest it in improving health outcomes in the community. And why specifically focus on that? Next slide. And it’s because the federal government realized that you can’t really improve health in a community without addressing the social drivers of health, or often also called the social determinants of health, which are the things that define the context in which people live and the quality of lives that they’re able to lead. So that is everything from community conditions to the condition of the housing that they’re living in, the access to food, economic factors like their work, how much money they make, etc. Here’s just an example of some common social drivers of health. If you look up 12 different ways of breaking down social drivers of health, you’ll see 12 different ways of doing it, and so this is just one. And you know, when we talk about health care, we’re generally talking about hospitals. We’re talking about, you know, our relationships with physicians and medical care. But these are the factors that actually play an outsized role in determining health outcomes. And when you think about it, it makes a lot of sense. If you live in unsafe housing, if you have a leak in the roof that is causing mold, the result of that is that you’re going to perhaps develop some respiratory condition and then need to go get medical treatment. If you live in a house that’s unsafe because of some other repair issue, maybe the carpeting is loose or something, you might be more at risk for slip and falls. If you are homeless and don’t have a home at all, you’re exposed to any number of different risks of injury, of violence, and of disease.
And so if you go to the next slide, what we see here is the impact of different elements on the outcome, the health outcomes of patients. And at the top of the pyramid you have those things that have the smallest impact, and on the bottom of the pyramid you have those things which have the biggest impact. And right there, at the bottom of this pyramid from the CDC, you see socioeconomic factors, and those are those social determinants of health. In contrast, right there, second from the very top, you see clinical interventions. So that’s everything that happens when you go to your doctor’s office, when you go to a hospital. Those are all the clinical interventions, the medications that you take, everything like that. That actually only accounts for between 10% and 20% of your health outcomes. Now, in our medical system, currently, we spend about 17.6% of our gross domestic product on healthcare. It’s about $4.9 trillion per year, and all of that is in that clinical interventions section that only accounts for about 10 to 20% of healthcare outcomes. We don’t spend nearly as much on that bottom socioeconomic rung of the pyramid, despite having a much, much greater, greater impact. And so this is why the Federal Government said, okay, nonprofit health systems need to start addressing some of these issues so that we can really make a change in the health of communities and reduce some of the healthcare utilization by making the communities healthier. Next slide. And the way that they mandated for nonprofit hospitals to do that is through a community health needs assessment process. So this is mandatory for all nonprofit hospitals. It has to be completed every three years, and it’s a measure of the unmet health needs, a wide range of unmet health needs in the surrounding community, usually defined by zip code. There’s a quantitative analysis portion where you’re looking at data from a range of different sources about physical disease and mental disease. And then there’s also a qualitative analysis portion where they have to go and actually engage with the community and get feedback on what are the what are the factors addressing poor health outcomes. This has to be submitted to the federal government, and it has to be made publicly available online. So if you live in an area with a nonprofit hospital, you should be able to find this online. It is not going to be on the homepage of the website. You might have to do some looking, but you should be able to find it. Next slide. And from this community health needs assessment, they then have to develop an implementation plan or an implementation strategy, and this is where they identify which of the unmet health needs they plan to address over the next three years with their community benefit resources, some degree of how they’re going to accomplish it, though, the amount of specificity does vary. I’ve seen ones that offer very, very limited information on how they plan to to tackle whatever issue they want to address, to ones that go really in depth. This portion of it does not require any community input into what they ultimately select, so that there could be something really important that is very clearly at the top of the ACA and that doesn’t necessitate it being in the implementation plan is something they’re going to address. It also does have to be submitted to the federal government, and it also has to be available online. So again, you should be able to to find that, and sometimes they bundle those together, so it’ll be Community Health Needs Assessment and implementation plan, but you should be able to find that for the health system in your area. I will say about both of these that there’s really no guarantees on how in depth they will go or what their overall quality will be. I’ve seen a big range. So I think that while it’s an opportunity, not all hospitals do invest the same amount of attention into this. Next slide. But this does form a key opportunity for engaging with your health systems, and there are a lot of reasons that a health system would want to engage with community groups around this. They could get a higher quality Community Health Needs Assessment and therefore a higher quality implementation strategy, one that is more responsive to community needs. They often don’t have the kind of conduits to the community that many of you do, and so they really appreciate being able to connect with those neighborhood leaders that they don’t have regular correspondence with. And it can also provide essential intelligence about what they’re seeing in their emergency rooms, their emergency departments, and allow them to better prepare and be responsive. And I think of on the community-based organization side by working with hospitals on their community health needs assessments, it can be a way of really building strong relationships with them, engaging key staff people. It can help ensure that the needs that you think should be prioritized are getting prioritized, at least they’re getting recognized in the community health needs assessment, if not also in the implementation plan. And it does provide some accountability. These are public documents. They have to be filed with the federal government and so, and they have to be signed off on by the Board of Trustees of the hospital and hospital leadership, so there is a real commitment that the hospital is making when they do these. And that it can provide the opportunity for meaningful community investment. Oh, thank you.
So common community benefit resource allegations, social determinants of health are one of them, but there are many others. Unreimbursed medical care is still a huge one. There’s still a lot of uninsured people. Education and training of staff is another big line item that we see, and then community health investments, like community education, health screening and health access, like helping seniors get to their doctor’s appointments and so forth. And social determinants of health is one of these, but it’s not the only one, and that means that they have a lot of flexibility in how they spend these resources. And so if you want them to be investing in things that you think are important, you really need to be engaged in the process. Next slide. So there’s a lot of talk about how the CRA and the ACA are similar in some respects. They both do have determined processes and some public engagement, I’d say on the CRA front, that’s way more formalized. The ACA is much looser in what hospitals have to do, and it can allow for much more kind of box checking. The federal government review is also very different for the ACA. This is actually part of the tax code that allows nonprofit hospitals to keep their 501 c3 certificates, and so these public health documents are reviewed by the IRS, which is not a notable public health body, and so that is what allows for some of the box checking that I was talking about earlier, whether they’re just basically meeting a minimum. And the obligations and consequences are different. And I think that a lot of this just comes from why we have these two the CRA was put in place to hold banks accountable and ensure investment in community the ACA community benefit requirements were put in place to really just incentivize hospitals to view Community Health differently and to take a more active role in addressing unmet health needs. Next slide So just a landscape view of the ACA. It does provide real opportunities for collaboration. We’ve seen it in Philadelphia, which I’ll I’ll talk a little bit about now. But there are no guarantees. It can be heavily dependent on external factors. Hospital finances can change in ways that can affect what they’re going to be investing in. Insurance participation rates, that means that if people are uninsured, then you’re going to see a spike in unreinvested, unreimbursed medical care, and that’s going to take up a larger portion of resources that could go to addressing social determinants of health. We’ve already talked about some of the political challenges and legal challenges. And then there’s just the overall healthcare reality in Philadelphia in 2019 we had a lot of hopes for what was going to happen in 2020 with hospitals investing in communities. Obviously, COVID had had different ideas. Next slide.
And so I just want to quickly talk about COACH – the collaborative opportunities for advancing community health. So this is what we’ve done in Philadelphia. Next slide. And this came from us approaching the department, the local office, regional office of the Department of Health and saying, Hey, with the ACA and community health needs assessments and this implementation planning process, we really see there that there’s an opportunity to look at the work of community development through the lens of health, because what our Community Development Corporation members are doing are really addressing social determinants of health. The HHS put together a working group with us, with some other nonprofit intermediaries, a representative from public health bodies and hospitals, to figure out a way, how do we, one, foster collaboration between health systems? How do we foster collaboration between health systems and community-based organizations, and how do we get hospitals to do more to address social determinants of health? Next slide. And this is really important in Philadelphia, because Philadelphia has so many overlapping boundaries of hospitals. And so here’s a map where you can see the different overlapping boundaries and as well as some of our CDC member headquarters and where they are. And so you might have three hospitals that are serving the same geography, trying to do the same thing, and we’re neither coordinating with each other or with the CDCs. And so that was one of the things that really got us motivated to try to build this. Next slide. And so this working group led to us making a presentation to leadership of all the nonprofit hospitals. And that led to the hospitals going into their own kind of conclave to figure out how they might be able to do something better. And it was ultimately from that that gave rise to COACH. And what I’ll say is that when COACH first started, and the hospitals all had their initial meeting, which none of us in intermediaries were invested or invited to, there was a huge deficit of trust, and they were not. They did not show up just with the representatives open to talk. They showed up with their attorneys, and it was very much like a hostile deposition, where when a question would be asked, they’d cover up the microphone and they consult with their attorneys before even answering the question. That’s how little faith people had in one another. Next slide.
But what we found in creating COACH was that it really did create that environment that was able to build trust and meaningful collaboration, and it focuses on those same three things as a working group. How do you break down silos between hospitals? How do you break down silos between hospitals and community-based orgs? And how do you address social determinants of health? Next slide. So there are eight health systems in COACH at the moment, as well as 18 community partners, including mine, PACDC. You’ll notice a lot of the departments of public health are also a part of it, and they have been really important partners, both inside COACH and allowing some of the things that have occurred in COACH to take place, but also outside and in fostering work around social determinants of health. Next slide, the core activities that COACH has been focused on are training and education, shared learning, which is really a having those silos start to break down and that trust-build was really important for the shared learning, implementation, planning and collaboration building. Next slide. And we’ve had a couple big focus areas. One was on food access, where all the hospitals got together and worked collaboratively to figure out how to similarly code within EPI – this is medical records coding – food insecurity issues, and refer people to resources. We’ve also seen ongoing work with trauma-informed practices and improving trauma-informed practices, both within the hospital and in the hospital’s interactions outside of their walls. They worked closely with two of our members, New Kensington CDC and impact services, who had developed a trauma-informed model of community development that the hospitals were able to implement. And so we’ve seen that really successful. But there have also been, next slide, outside of COACH, some notable collaborations. We put on a health and housing summit a few years ago, and that brought in folks from around the country to share best practices on how health systems can work with community-based organizations and local government to address a range of unmet health housing needs. The hospitals are really involved in this effort, and it really succeeded in elevating the dialog. Next slide. Locally, we’ve seen in the last few years, low-income housing tax credit developments that have been funded by hospitals. In Philadelphia, we’ve seen home repair programs get created, including Children’s Hospital, which created one for pediatric asthma. Child shows up with pediatric asthma, they’ll send a case worker out, and if there are home repair issues contributing to that asthma, they’ll get them fixed. Homelessness prevention as well as medical legal partnerships, and I should also mention that the Department of Public Health also formed their own health and housing working group that has hospitals, insurance companies and groups like mine around the table looking at better ways of addressing homelessness. Next slide. And we also did eventually end up creating a collaborative process for our own community health needs assessments. And so all of the hospitals in Philadelphia joined together to do one assessment. This is now we just did this year, did the third iteration of it, and this time it actually was an even broader group of hospitals, including those outside of Philadelphia and the surrounding counties. Next slide. Here, you can see all the different areas that were included in this CHNA, and it’s really a recognition that health doesn’t care about political boundaries, like what the boundaries of a city are, and so the health needs of hospital constituents aren’t constrained by ZIP codes or city boundaries. And we were brought on, next slide, we were actually brought on as leadership in this process, particularly for the qualitative needs assessment, and we’re able to set up all of the community feedback sessions and key stakeholder interviews, which allowed us to ensure that social determinants of health were an important part of the feedback hospitals were getting. As a result, we saw the social determinants of health for the last three cycles play a big role in the community health needs assessment and also in the implementation plans of the individual hospitals that resulted from it.
Key takeaways. Next slide. I think I’m – wait, was there another slide there? Oh, yeah, I am. I know I’m a little over time, but almost done. Key takeaways, so it is, it is possible to increase trust between hospitals, but between that with between them themselves, and also with community groups, and it’s possible to increase their collaboration and investment in community groups, their role in addressing social determinants of health, and to have more efficient CHNA processes that yield better results. I will say that, you know, the pace of this stuff can move slowly. The representatives that are involved in COACH are not always the decision makers. They’re not always the C-suite folks at the hospitals. In fact, they’re rarely the C-suite folks. And it can also be personality-driven, so you can have somebody at a hospital who’s super engaged in the community efforts, and then they leave, maybe they retire, they go do something else, and then the hospital participation completely falls off. So those are things to keep in mind. Next and final slide. So this is really about reimagining how these important sectors relate and how we view each other. It does take time. Hospitals are multi-billion dollar institutions. I liken them to big ships that you know, turn very, very, very slowly, but when they do, they turn for a long time. And I think that it’s also necessary, as I said, we currently spend 17.6% of our GDP on health care, highest in the in the developed world, way higher than peer countries and and that’s really unsustainable, and part of that is because we under invest in addressing social determinants of health and this is one way of starting to write that. And the current system is really unsustainable and and doing this unlocks potentialities that can really have transformative impact on communities and on the lives of patients and residents, and I think that one great example is in maternal and child health care, and that’s why I’m so excited to join all of you to listen to Dr. Lister. Thank you.
Wilson 31:22
Thank you, Garrett. Our next speaker will be Kay Bowers in Nashville.
Bowers 31:26
Well, hello everyone. It’s great to be with you today. I’m excited to to bring Dr. Lister to you to speak about the work she’s doing in the connection between moms and healthy babies and housing and support services. I learned a long time ago in my work. I’ve been at this work for decades, I was faced with directly, with seeing the connection between toddlers’ asthmatic conditions and the homes that they lived in, and then what happened within six months after moving out of those substandard homes with mold and heating problems, the dramatic change in their health. And that’s just one example. I have a number of them in my mental file, so the connection between social determinants of health and housing has been in my wheelhouse for decades. So I was introduced to Dr. Lister the last few months and I got excited about the program that she was working on, and I have provided some consulting technical assistance to help her add her second home to her portfolio for moms to be or moms who now have infants, and I’ll tell you a little bit about her. She is a maternal-fetal medicine physician and associate professor at Vanderbilt University Medical Center. She’s a national leader in community-centric solutions to the maternal health crisis, and in Tennessee, she serves as the officer of health excellence for the Tennessee initiative for perinatal quality care. And most importantly, she’s the founder and executive director of BLOOM, Building Life Opportunities and Options for Moms. It’s a nonprofit organization whose mission is providing supportive housing, pathways to economic mobility and economic employment opportunities for pregnant and postpartum moms experiencing homelessness through flowers. It’s a floral social enterprise. If you want to go to her farm, let us know. We’ll make it happen. She’s an alumni of Meharry Medical College for medical school, Loma Linda University for residency, and then Albert Einstein for her fellowship training. And I think her life’s mission is to serve holistic, peripartum needs of women and their families in Tennessee. And so with that, I’ll turn it over to you, Dr Lister.
Lister 34:38
Thank you so much. Miss Bowers, for that wonderful introduction and for your commitment to this space for the decades that you have. It truly takes a village and BlOOM’s mission is to provide a pathway to home ownership for pregnant and postpartum women experiencing homelessness. Next slide. So, as was mentioned earlier in the previous presentation by Mr. O’Dwyer, there is a connection, a through line, between housing insecurity and pregnancy complications. I myself have experienced this firsthand. I take care of a lot of high-risk patients. One particular patient comes to mind as I reflect on how housing directly impacted her pregnancy outcome. So this was a lady that was touched by addiction and homelessness. She was admitted with preterm labor. Her baby had to go to the neonatal intensive care unit due to complications related to prematurity. But this was not just one, you know, just kind of your garden variety, premature labor case. This patient had been admitted weeks prior with abscess on her inner thigh, and although she had gotten antibiotics appropriately, ultimately, when she was discharged, she really had nowhere to go. She ended up living underneath a bridge in the not most sanitary conditions, and therefore her infection really could not heal as well as it should have. So ultimately, her readmission was related to her infection, which led to the preterm birth of her infant. Pregnancy, that’s fraught with homelessness are more likely to result in not only preterm birth, but low birth weight babies that require neonatal intensive care, as was the case with our patient. They’re also more likely to experience severe maternal morbidity, such as preeclampsia, special hypertension and pregnancy that can result in organ failure, cardiovascular collapse and eclampsia. They’re also more likely to have increased risk of chronic health conditions such as diabetes, hypertension, heart disease, asthma, mental illness and substance use disorders. These mothers are less likely to receive pregnant prenatal care and more likely to use the emergency health services as a first line. They’re more likely to suffer from intimate partner violence and this constellation of pregnancy-related complications are directly related to issues with homelessness. Not only is the mother more likely to have complications, but when there are unsafe sleeping conditions, infants are two to three times more likely to die in their first year of life without safe sleep due to overcrowding or unsafe sleeping arrangements for the new newborn baby. Next slide. So one of the solutions, as was so eloquently stated by our previous speakers was the role of housing as a mitigation to some of these complications that we see. So BLOOM’s mission is really to provide not only housing but the supportive services that a new mother and family would need so they could not only thrive, but bloom into their biggest and largest potential. So we have outlined our phased program to be analogous to a seed that a flower that starts from seed and is cultivated to a beautiful bloom. So phase one is really admission and orientation, where our aim is to establish stability and growth, making sure that a mother has emergency housing. And during this initial phase, we want to really hear about the mothers. What are their personal goals for themselves? How can we build trust? How can we establish them with prenatal care, high-quality prenatal care? Phase two is really stabilization or cultivating the soil, really building that structure that’s important for the mother to thrive. Programs like pregnancy, nutrition, financial literacy are will go a long way in terms of her long goals. Phase three is really skill building. So we actually teach mothers how to grow food and flowers, as well as practical hands on training and floristry, we also provide parenting workshops, mental health support and life skill building. Phase four is really removing barriers that would thwart their goals. So a lot of individuals as they’re forging their financial future, may have issues with understanding budgeting, credit barriers, transportation and really getting into that mindset that overcoming financial barriers is something that’s plausible and possible for them to do. And then we want to really help them to, you know, understand that it is possible, and really map out the direction. So that means coordinating with other entities, such as banks that have first-time home buying programs help with credit repair and rebuilding, making sure that they have adequate employment so that they can earn living wages to fund the lifestyle for themselves and their family. For many, homeownership is a pathway to building legacy wealth, not only for themselves, but for generations to come. And ultimately, we want to support moms as they go through the program and once culminating in a graduation where they are ultimate goal is for them to be able to either purchase a home of their own, if that’s the desire or to have long, long term housing solution for them. Next slide, please. So you heard a little bit about me, how you heard about my story, about and my training of how I got interested into maternal fetal medicine, and my day job is really taking care of high risk pregnancies, and really, you know, as I continued my practice, it became relevant, and a lot of studies will show that health is really – what happens within the four walls of our clinic space – is really just a minority what happens in health really investing in those social determinants of health that built environment if we really want to make the impact that we do is really key to achieving the health outcomes that we desire. So as far as my farmer, florist story. This was a hobby that I cultivated during the COVID-19 pandemic, and I would arrange flowers on a weekly basis to kind of cope with lockdowns and other, you know, stress outside of the pandemic. So I started sharing my joy of flowers with the Nashville community, and found it to be very lucrative, and wanted to see if we could establish a social enterprise using a market-driven solution to address the social determinants of health. So really BLOOM unites my two passions, safe entry into motherhood and floriculture. So this is a picture of one of the gardens. We are able to – residents at the BLOOM program develop skills in growing and arranging selling flowers. They are able to earn a living wage with employment opportunities on the farm. And then the flower farm generates income for the mission by contracting with other entities throughout the city who desire flowers for their special events, and, you know, personal needs, and we use that revenue to go back into the mission. Next slide, please.
So this is an example of the partnership that we have forged with Mending Hearts. Mending Hearts is a drug treatment facility, the largest one in Tennessee, to my understanding, and they have a Moms and Babies Program for pregnant and postpartum women touched with addiction. We conduct weekly group sessions with the mothers there and go over the activities that we had discussed previously, and the mothers grew and arranged centerpieces for their annual fun fall fundraiser. This model enabled additional streams of income for their mission and ours. Next slide. And you can see, um, these are the arrangements. This is one example of, you know, one of the events that we’ve done, and we do several throughout the year using this model. Next slide, please. So in addition to the programming activities that BLOOM offers, we also offer residential housing. So this is a picture of our first home situated in the left corner. It’s a three bedroom, two and a half bathroom home. We’re able to support up to three moms at one time and their families. And you can see to the right that is the flower farm and the farm stand, the future farm stand of BLOOM, where we’ll sell flowers from the you know, on-site sales as well.
Next slide please. So we opened our first home in February of this year, and we’ve been able to – next slide, please – residentially, we’ve been able to support six mothers in the home since our start. And we support approximately we’ve supported over 20 women in collaboration with the Mending Hearts collaboration program. Pinnacle Bank has been a strategic and an important partner for BLOOM. They not only provided how lending support for our first house and gap funding for our second plan development. We also partner with them to help us with the literate financial literacy classes and the, you know, future mortgages of our moms that will come through our program, so they have been valuable on the ground. In the picture here, while we were kind of setting up the farm, these are two of the bankers, Miss Casey and Miss Candace, and you can see Casey in the left hand on the right-hand corner that’s leading the financial literacy class, and some of the pictures of our moms that have participated in their babies. So I, I just am so thrilled with the partnership. It’s been truly a benefit to partner with local banks that are passionate about the mission and want to clear the financial barriers. Yes. Dale Mitchell is on from Pinnacle. I’m so, so grateful for the partnership that they have lent to BLOOM and for believing in us. So with that, I will conclude. We are really excited about this is a case study we’re looking forward to expand, and ultimately want to solve the problem of homelessness for pregnant and postpartum women, so that no child has to be born without a home and a mother has a brighter outlook for her future. Thank you so much for your attention.
Wilson 48:34
Thank you so much. Thank you so much, Dr Lister, that was great. That was very inspiring. We appreciate all the work that Pinnacle Bank has been able to help you all with. That’s part of sort of their CRA agenda. So NCRC works with a lot of banks around the country when it comes to community reinvestment, and to see that Pinnacle Bank is helping out your women in this time of need is really inspiring on the CRA front, and it was really helpful to hear from Garrett on the role that NCRC member PACDC is working with local nonprofit hospitals and community groups to better serve the community when it comes to addressing social determinants of health. I want to ask Garrett a question, and we’ll try to get a question or two into each speaker before we conclude. And when I was just chatting with Garrett earlier, I was curious to find out. Can you tell us a little more about the structure of COACH? And I’ll be for everyone watching this, I’ll be putting up some links that are regarding Garrett’s work with COACH. So go ahead. Garrett,
O’Dwyer 49:41
Yeah, sure. So the on a funding level, the resources come from the Healthcare and Hospital Association of Pennsylvania and all of the hospital participants. And over the years, for the first, I guess, 10 years or more, actually, of COACH, it was facilitated by the Healthcare Improvement Foundation, which is a local Health Foundation in Philadelphia. They have discontinued operations, actually, just this past June, after the most recent CHNA and so they’re no longer facilitating it. It’s now being facilitated directly by the Healthcare and Hospital Association of Pennsylvania, and so I it is organized by the facilitators. They schedule and conduct regular meetings where not only are people informed about the activities of the respective health systems and community partners, but we decide which issue area we might want to focus on. So I had mentioned that we focused on food insecurity. That was actually the first one, because it was seen as a really low hanging fruit in the sense that it was something that impacted all of the hospitals addressing it, didn’t require anything that might, you know, threaten their underlying business models and and the ways that hospitals could really play a big part was by changing internal protocols and systems, particularly as it pertained to medical records and referrals. And so the team of facilitators then convened the hospitals individually, convened the hospitals with community partners to gain better understanding of the issue and to drill down into it. And it was through this kind of Open Table collaboration that that eventually also led to the decision when the next round of Community Health Needs Assessments came up to do it as a joint enterprise, so rather than individual hospitals doing it separately, to do it jointly and to do it in collaboration with community-based organizations like mine, on the qualitative front. And so that structure has maintained and is still how it operates now.
Wilson 52:05
Garrett, I included the three links that you wanted us to drop in the chat. Can you just real quickly and then I’ll get to Dr Lister. Can you share what each link pertains to?
O’Dwyer 52:14
Yeah, sure. So I think the first one is an addition of the PACDC magazine. This is from a few years ago, and it was really focused on health and community development, and so it has a number of articles in there around health and housing, health equity and a number of different issues areas. I won’t go through it all, but the content is still very relevant, and I think folks could get a lot out of it. The second one is a report that we did about how hospitals could play a bigger role in not just investing in low-income housing tax credits, but particularly the 4% credits, which provide less equity. Those were historically undersubscribed in Pennsylvania, and we saw hospitals as really being able to play a role in providing resources to get those deals over the finish line. And then the third link is to this most recent Joint Regional community health needs assessment that we did. It’s a huge document, but there might be some interesting places for you to look for either information or for to get a better sense of our approach.
Wilson 53:31
Thanks, Garrett and we will be real quick. Dr Lister, can you share a little bit more about your partnership with Pinnacle Bank? Because it sounds like a really good collaborative effort.
Lister 53:46
Yes, so before I answer that question, there was a previous question about how long the mothers can stay. They can stay up to two and a half years or sooner, once they have secured permanent housing. Elaborating on the Pinnacle financial partnership, primarily, they lead out the financial literacy classes, and then they have relationships with the like the financial empowerment program, which is a local organization in Tennessee that offers one on one coaching so that beyond the series of classes, mothers can goal set and work one on one with financial coaches. They sponsor us, they offer volunteer support and just a variety of different ways. They make sure that we are known in the community. They’ve given us media opportunities to highlight the work that we’re doing. So they are connectors. They have a wealth of knowledge about other nonprofits that could enhance Bloom’s visibility, so they have served not only as financial partners, but strategic, helped us with developing and forging relationships with other people in the nonprofit space.
Wilson 55:19
Great, and just so everybody knows, this webinar is going to be recorded, and we’ll share it with everybody who signed up. We’ll include the links that Garrett dropped into the chat or that we dropped into the chat, and we also would really very much appreciate you filling out our little survey about this webinar. These are new. We’re trying to do what we can to serve our member organizations better, and we saw this as a unique opportunity to leverage Garrett’s work there at PACDC in Philly and the work of NCRC member Kay Bowers and her colleague, Dr Lister in Nashville, to help folks understand the synergies, or at least the ways that folks can cooperate more in their communities, leverage resources and be more impactful when it comes to social determinants of health. We hope you all enjoyed it, and we’ll probably have more webinars in the future. We do have our annual conference in the spring, in April. We’ll include that link when it comes to our outreach to you all post event. We do hope to see you in DC in the spring, and I can’t thank Dr Lister enough for her leadership in Nashville, for Garrett for his collaborative efforts in Philly, and for Kay Bowers for bringing this to our attention after our Nashville Summit in September. I also want to thank Kaylee for all of her work behind the scenes. She’s the woman that makes it all work for us, and Caitie Roundtree for letting this all come to pass. So everybody. Thank you very much. Have a good weekend. Thank you.
