Sisters in Common believes there is a need “To re-integrate/retain cultural values, traditions and history that promote healing and empowerment for our children , youth, families and communities”, that prevent, address and build healthy resiliency/coping skills and remove/decrease SDoH concerns/issues, and the resulting physical/behavioral health issues and challenges that are further exacerbated by cultural and health care disparity/inequity, adverse childhood experiences (ACES) and trauma.

Basic needs (i.e. housing, hunger, mental health and medical health and stability-support needs, juvenile offense behavior, gang involvement and violence).

Cultural and health care disparity/inequity, exacerbated by systemic oppressive “isms” (i.e. racism, sexism), resulting in communities of color being the victims of discrimination and prejudice, and being under-served.

As a culturally competent CBO/licensed Mental Health Agency (MHA) serving African American and East African families and children, Sisters in Common participates in many partnerships, including CBO’s, Managed Care Health Plans (MCOs), and county/state government budgeted agencies (i.e. SKCPH/HCA/DOH, ). Sisters in Common is
in alliances with other Community and Behavior Health Services (BHS) provider. Our
Board/Administration/front-line staff are members of the communities we serve, grounded in their respective community’s cultural and family paradigm

Sisters in Common will use individual and family assessments, evaluations, health consultations/couching, case management, brief intervention, counselings, early child social/mood/emotional learning activities, and “real referral” services, to re-intergrate/retain cultural values, traditions and history, that promote healing and empowerment in our children, youth, families and communities,” to build healthy resiliency/coping skills, while preventing/removing/decreasing SDOH concerns/issues, and behavioral health issues and challenges exacerbated by cultural and health care disparity/inequity, (ACES) and trauma. What We Would Do-and -How We Would Do It- Childcare Health Consultation: Directly provide service, Counseling/advocacy- mental health/emotional support: Directly provide service, Counseling/advocacy- substance use: Provide referrals/navigation services to support access to service, Early child mood/emotional development activities: Directly provide service, Early Support Infant Toddler Mental Health: Directly provide service, Education, advocacy and/or case management related to finances- including budgeting, financial literacy, public benefit enrollment, etc.: Provide referrals/case management/ navigation services to support access to service, Food access- including food banks, soup kitchens, etc.: Provide referrals/navigation services to support access to service, Health screenings and education- including prevention programming, health literacy, etc.: Provide referrals/case management/navigation services to support access to service, Healthcare services-including clinics, primary care, dental services, etc.: Provide referral/navigation services to support access to service, Homelessness prevention: Provide referrals/navigation services to support access to service, job placement and/or job training: Provide referrals/navigation services to support access to service, Legal/justice related- including assistance with legal representation, family law, immigration, etc., Provide referrals/navigation services to support access to service.

The choice in services, goals setting/support, ensure improved outcomes in screening, assessment/evaluation, individualized service planning, referral, linkage, advocacy, coordination, case management, counseling, monitoring, including outreach and in-home/ in-community support, is guided by the client. Sisters in Common periodically requests information from clients about quantity and quality of services from first contact to discharge.Their experience, thoughts and their suggestions on how to improve services, are considered and included as part of services and future planning.

We are a BHA licensed to provide Counseling and Case management to medicaid clients. HCA has approved us as a BHS billing provider. The (MCOs) contract us to provide BHS to its Medicaid covered members. The current status is : Amerigroup: Active – formal (signed MOU, agreement, etc.), Community Health Plan: Active – informal (work together, but no signed/formal agreement), Coordinated Care Active -informal (work together, but no signed/formal agreement) Molina Healthcare: Active – formal (signed MOU, agreement) United Healthcare/Optum: Active -formal (signed MOU, agreement.)

Sisters in Common is culturally competent CBO providing SDoH services to African American, East African children and their families, specifically those with behavioral health conditions, complicated by a history of physical health conditions, i.e. Asthma, COPD,Diabetes, End Stage Renal Failure, Heart Disease, homelessness, and transitioning from the hospital to home. We are licensed to provide BH: Outpatient; Individual mental health treatment services, Brief mental health Intervention/treatment services, Case management BH services and HBS. Sisters in Common have strong and effective partnerships with community stakeholders and continue to develop closer collaborative ties with community service agencies that serve our underserved community’s children/families and add value to each other services/programs. “Synergies created by combining effort and sharing expertise produce benefits greater than those achieved through individual effort”, and will greatly benefit our communities and children, particularly those agencies, are serving our primary population, who are COD and meet the WAC medical necessity criteria for mild, moderate, or sever BHS.

It will address and decrease fear and stigma, in our communities, for those who need BHS treatment, and when they do, services will be culturally competent, sensitive or appropriate. Client complaint that there is “no culturally competent system in place to provide ongoing, routine support to help African American and East African medicaid eligible children/families flourish, be resilient, physically AND emotionally healthy”. Children in our communities will be exposed to culturally competent activities that support integrated health- social/emotional/development. Culture, ethnicity and spirituality is a powerful factor in our medicaid eligible families’ often resulting in long delay in seeking services, and critical years for early whole person health care/ Interventions are lost. African American and East African families, when they choose BHS, will get services from professionals who they know and trust. immigrant families, who want BHS support from members from their own communities, and professionals who are fully engaged within their cultural values, including religion, will get it.

Sisters in Common is serving African American, Eritrean, Ethiopian-Oromo, Somali children, youth, adults and their communities, (specifically, English, Amharic, Tigrinya, Oromo and Somali speakers), who are ages (cradle to grave), undeserved and under-resourced, in King County. Health Plan; =99 percent receive medicaid benefits. Ages; Children( 0-12years of age) =28 percent, Teens (13-18 years of age)= 12 percent, Adults (19-64 Mars of age) =59 percent, Older adults (65+)= 1 percent. Gender/Identity; Women = 70 percent, Men = 29.99, Transgender – Male to Female = .001, Language ; Understand and speak English = 79 percent, Understand and speak Somali = 7 percent, Understand and speak Oromo = .006 percent, understand and speak Spanish = .004.

Because of fear and stigma, eligible families, in our communities, rarely seek out existing BHS treatment and when they do, services are often not culturally competent, sensitive or appropriate. Client complaint that there is ” no culturally competent system in place to provide ongoing, routine support to help African American and East African medicaid eligible children/families flourish, be resilient, physically AND emotionally healthy”. Children in our communities are not exposed to culturally competent activities the support integrated health- social/emotional/mood development. Culture, ethnicity and spirituality is a powerful factor in our medicaid eligible families’ often resulting in long delay in seeking services. Thus, critical years for early whole person health care/Interventions are lost. Many African American and East African families, when they choose BHS, want BHS services from professionals they know and trust. Today, more immigrant parents want BHS support from members from their own communities, and professionals who are fully engaged in there cultural values, including religion.

We have developed and maintain a professional multi-cultural and diverse staff. All services are provided in our client’s primary language. We recruit and train staff that are culturally competent, sensitive and aware of the diverse needs of our clients. Note: Staff are recruited from the community of the clients we served and further trained to provide resources for required trainings. In this way our staff have access to ongoing trainings, information and support to remain in compliance with their DOH licensure/certification training requirements. We also utilize our network of ethnic and culturally diverse relationships and resources in the client’s communities to better serve them.

We, who are fully engaged in the transformation model and process, have to KEEP GETTING THE WORD OUT about THE NEW TO THE OVERWHELMING MAJORITY OF OUR CLIENTS, Washington State Health Care Authority (HCA) medicaid ” whole-person care, integrating physical health and behavioral health services and system – specifically, how and what we can do together in King County.

We have to share strategies on HOW TO GET THE WORD OUT to our health, social and/or human services and networks about HOW TO USE the NEW TO OUR CLIENTS, Washington State Health Care Authority (HCA) medicaid “whole-person care, integrating physical health and behavioral health services and system- specifically how we do it in King County HealthierHere

We, NEED HH help, providing ongoing (routine and repeated) ACTIONS and/or ACTION PLANNING, TO KEEP GETTING THE WORD OUT! Why, Because this works! i.e. – Information Sessions for Community-based Organizations- Continuing to host or sponsor (Under HealthierHere’s Banner), informations sessions where community-based organizations can learn about; THE HOW TO of them getting involved with us and us getting involved with them in creating collaborative innovative efforts to collaboratively improve health and health equity in King County.

Sisters in Common maintain a quality improvement program to assures continued progress towards effective/efficient, age/gender/culturally competent services and client satisfaction/ outcomes. We monitor/review clients progress, analysis client/member outcome data, Client/member satisfaction surveys, internal work group(s)/ committee(s), File reviews/audits/grievances, and conduct client/member focus groups to identify and correct any deficiencies in services toward improving the quality of services. Note; All are looks at, for incorporating sessions learned into Sisters in Commons’ operations.

Sisters in Common maintain individual client record and backup for clients receiving SDoH and BHS, in accordance with the department of health (DOH) requirements for agencies providing BHS (WAC 246-341-0425, WAC 246-341-0640, WAC 246-809-035). We maintain comprehensive clinical record system that includes policies and procedures that protect an individual’s personal health information; Ensure that the individual’s personal health information is shared or released only in compliance with applicable state and federal law.

Provide/host ongoing (routine) -Community Information Sessions for CBOs, community stakeholders and the client/members themselves – hosted or sponsored (with HealthierHere), where attendees can share and learn about what Community Base/driven (empowerment) health solutions “worked” and are sustainable.

Coor-care needs to be deeply embedded in the communities they serve and have trusted relationships with the patients-clients, community leaders and stakeholders. Service setting; the client’s homes and community: (i.e. Schools, churches, mosque’s, and community centers). “client choice” is paramount, (“good treatment is what the client is willing to accept) in services, goal setting and getting support, ensure improved outcomes. Services need to be designed to be flexible/creative, to fit into the client’s unique life solution. Also, the strategies for providing effective services, keep the focus on service quality-effective- solution and outcome oriented, while promoting client empowerment.

1. Adhere and follow this definition of cultural competence; ” a set of congruent behaviors, attitudes, and policies, (that adheres to standards of equity), that come together in a systemic or organized way, to enable that system of organizations to work effectively in “cross-cultural” ways and situations”.

2. Become a culturally competent system of organizations that acknowledges and incorporates at all levels the importance of language and culture, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural differences , expansion of cultural knowledge and adaptions of services to meet culturally unique needs.”

3. Recruit qualified staff from the community of clients served.

4.Provide further and ongoing training in Cultural Humility and Process of Inclusion and Empowerment.

5.Commit themselves to developing, maintaining a multi-cultural and diverse staff as well a utilizing their network of ethnic and culturally diverse relationships and resources in the client’s communities to better serve them.

Cultural and health care disparity/inequity, exacerbated by systemic oppressive “isms” (i.e. racism, sexism), resulting in communities of color being the victims of discrimination and prejudice, and being under-served. There is no culturally competent system in place to provide ongoing, routine support to help our clients flourish, be resilient and physically AND emotionally healthy. Our communities are not exposed to activities that support integrated health- social/emotional/mood development.

We provide Childcare Health Consultations to family/friends/neighbors (FFN), who watch each other’s children. 25% are grandparents with health conditions, i.e. Diabetes, End Stage Renal Failure, Heart disease, and homelessness. Working with their (PCP), we provide case management (i.e. transportation, housing “real” referrals, doctors appointments support, prescription/med prep/ schedule compliance support, ADL planning, community activity risk assessment, natural support consualtuon, facilitate PCP- family consultations, and crisis prevention/intervention) services.

“Client Choice” is paramount; (“good treatment is what the client is willing to accept), in services, goals setting and support, and will ensure improved outcomes. Services should always be designed to be flexible and creative, to fit into the client’s unique life situation. Always, always, health care should be provided with clients and NEVER “TO” CLIENTS.

First, Adhere/follow this definition of cultural competence; “a set of congruent behaviors/ attitudes, and policies, (that adheres to standards of equity), that come together in a systemic/organized way, to enable that system of organizations to work effectively in “cross-cultural” ways and situations”.
Second; become a culturally competent system of organizations that acknowledge/incorporates at all levels the importance of language, culture, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural differences, expansion of cultural knowledge and adaptation of services to meet culturally unique needs”.
Third; recruit qualified staff from the community of clients served.
Fourth; provide further/ongoing training in Cultural Humility, Inclusion and empowerment.
Fifth; commit themselves to developing/maintaining a multi-cultural and diverse staff as well as utilizing their network of ethnic and culturally diverse relationships and resources in their client’s communities to better serve them. Sisters in Common engages providers who are actually competent, sensitive and aware of the diverse needs of the clients we serve.

SISTERS IN COMMON POLICY AND PROCEDURES MANUAL; Pursuant to state law, client information, we disclose is as follows: Clinical Assessment; pages 12-13, Individual Service Plan; pages 14-15, Mandatory Reporting; page- 23, Medication Protocols; page-24, Client Information, Sharing Information, Confidentiality; pages 25-26.

Client feedback; it is/was our cultural competency (BOD officers, administration/staff is 99% African Americans and East Africans), high staff retention, skills -blend of SDoH and BHA services. “Client Choice and home base delivery model to our Specialty; African American and East Africans, Low income clients with behavioral health conditions, complicated by history of physical health conditions, i.e. Asthma, COPD, Diabetes, End Stage Renal Failure, Heart Disease, homelessness, speaking (English, Amharic, Tigrinya, Oromo and Somali speakers). Introduction.

Share with Sisters in Common their client feedback; as to their cultural competency (BOD officers, administration/staff), staff retention, history, skills and blend of SDoH, PCP and BHA services/integration. Their service delivery modality (Site or home base) and client focus model coupled with their specialty population profile and language proficiencies.

The MAJOR issues is ” misinformation” between community and clinical providers staff and provided to clients, about what each other REALLY do and how we do it.. We, NEED HH help, providing ongoing, (continuing to host or sponsor), (routine and repeated) – Information Sessions for joint Community and Clinical organizations. Information sessions where we can learn about what each other ” Really do, TO KEEP GETTING THE WORD OUT! Because this works!

Sisters in Common mission; “To re-introduce cultural values, traditions and history that promote healing and empowerment for youth, families and communities in crisis”. Our motto is “Cultural empowerment for families in crisis”. We are a 25-yr. old Non-profit CBO and, since 2009, DOH licensed Outpatient BHA- Mental Health. We are recognized as culturally competent in serving African Americans, Eritrean, Ethiopian-Oromo, and Somali children/adults, their families and communities, (English, Amharic, Tigrinya, Oromo and Somali speakers). Specialty; Low income clients with behavioral health conditions, many complicated by a history of trauma and physical health conditions, i.e. Asthma, COPD, Diabetes, End Stage Renal Failure, Heart Disease, homelessness, and transitioning from hospital to home. Our client feedback; it is cultural competency (BOD officers, administration/staff is 99% African American and East African), high staff retention, skills and blend of SDoH and BHA services. “Person centered Care” and our base services delivery model, keep them engaged in their healing and empowerment.

The Sisters in Common part time (FTEs) Certified Agency Affiliated Counselors- Community Health Workers (CAAR-CHW) are the back bone of our clients based on culture and languages spoken. They are teamed with our part time Counselors/ Case Managers, independent contractor Registered Nurse- PhD, Psychologist PhD, LMHC, SUDP, and all but one, is a DBHR/DOH Certified Mental Health Professional, Child Mental Health Specialist, Ethnic Minority Mental Specialist, Disability Mental Health Specialist, who are (specifically, English, Amharic, Tigrinya, Oromo and Somali speakers), communities. Sisters in Common would expand our flexible, person-centered-care services already in place. Similarly, we would add needed hours for Contractor-Specialist on retainer, (e.g. Psychologist, and Nurse for (Co-Occurring disorders (COD) clients), IT- Data and , medicaid billing specialists, and accounting for increase programs-funding-evalutation/reporting/ milage and travel.
BHS Case Managers and Counselors, teamed with our Registered Nurse- PhD and Psychologist LMHC, SUDP, All, but one are either a state qualified Mental Health Professional, Child Mental Health Specialist, Ethnic Minority Mental Health Specialist, Disability Mental Health Professional, or Certified Agency Affiliated Counselors- Community Health Worker, who are members of the (African American, Eritrean, Ethiopian-Oromo, and Somali) culture, and linguistic, (specifically, English, Amharic, Tigrinya, Oromo and Somali speakers), communities we serve. Our BHS part time (FTEs) Certified Agency Affiliated Counselors- Community Health Workers (CARR-CHW) is the backbone of our clients based cultural, language spoken in home, and geographic area. Sisters in Common would expand our flexible, person-centerd-care, home based services already in place. Staff hours would be increased to provide home-based services to more medicaid clients eligible for SHoH and BHS services. Similarly, add needed hours for Contractor-Specialists on retainer, (e.g. Psychologist, and Nurse to support Co-Occurring disorders (COD) client services, IT- Data Specialist on retainer, medicaid billing specialist, and accounting for increased programs-funding-evaluatioion- and reporting. Adequate funding for mileage and travel time will be incorporated into the program budget.

In addition to our answer to question 37 and 46; 1. developing a share-cared plan, 2. improving access to translation and interpreter services for non-cultural and linguistic-embedded providers, 3. expanding the use of traditional healing and 4. culturally-centered care, where possible, 5. chronic condition prevention and case management support programs that target early child, youth and the elderly, 6. improving health literacy, targeting family, friends, and neighbors (FFN) childcare providers 7. Community engagement ROLL-OUT informational session, on (a) the NEW medicaid system and (b) HOW the (FIVE) different Manage Care Health Plans (MCO)”REALLY” work, to maximizing prevention care which has been proven to minimizing high health care cost, 8. increase the number of cultural competent community health workers, to supercharge the cultural community “deep -dive” to achieve better health outcomes and reduce fear and stigma.

Due to funding and resource limitation, most of Sisters in Common management team, (specifically; (1) administrator, (2) Part time Administrative Assistants and (2) Part time Clinical Supervisors), in addition to their WAC required Administrative, Quality Assurance, and Management duties, ALSO, provide “direct” SDoH and BHS Counseling and Case Management services to our clients. ” WE work double duty. We would need funding for added FTE hours to ensure to enable Sisters in Common organization to participate in the design of these systems wide process improvement.

Because “Social Justice” Lawyers -are- Counselors, make them an integral part of our SDoH/BHS teams (CBO_BHS routinely pro-bono vice from attorneys and firms), for purpose of collectively affecting a education in the “Coping Ugly” behavioral, stress levels and trauma symptoms, in/of our medicaid clients members, (in the African American, Eritrean, Ethiopian-Oromo, and Somali culture and linguistic, specifically English, Amharic, Tigrinya, Oromo and Somali speaking communities.) They would provide ” direct resolution-medication-mitigating ADVICE support- ONLY”, to support the client as they navigate and deal with issues of health disparity/inequity, toward increasing client empowerment, which can reduce their incidents of stress/trauma symptoms responses.

Meeting Laurel A. Lee, MHW VP. Member & Community Engagement, at HH 6/2019- “Building…For Successful Community Partnerships, Their leadership approved Sisters in Common to join their network. To date, used HH funds to pay the cost of; MCO credentialing processing/ follow through (Two MCOs still pend funding time.) Search-MCO medicaid billing specialist (full system setup pending funding. Search/ licensing, IT/ EMR (not EHR) system (fully develop/ implementing pending funding), and specialist search/system set up support client’s physical health-COD screening (i.e. RN PhD Nurse).

Help, with start up infrastructures/workflow-capacity funding, while providing ongoing KEEP GETTING THE WORD OUT! by continuing to host and/or sponsor COB-PCP- (Under Healthier’s Banner), information sessions where CBO-PCP-MCO can partner and learn with and from each other about; THE HOW TOs…. while creating innovative efforts to collaboratively improve health and health equity in King County.

Sisters in Common (SIC) is requesting GRAT funding to support two (2) culturally embedded “Person Centered Care” Geriatric Regional Assessment Teams (GRAT). The home-visiting teams will provide intergrated Behavior Health (BH) and Social Determinants of Health (SDoH) services, to (55+) seniors who meet ALL the following criteria:

*African American, or Eritreans, or Ethiopian-Oromo, or Somali
*Low income eligible
*have challenges or acute or chronic behavioral health condition (mental health) and
*have challenges of acute or chronic physical health conditions (medical).

Sisters in Common has a unique model, specifically designed and delivered by and for the African American and East African communities specified above. As a licensed mental health agency, we provide the full range of assessment, mental health treatment, case management and referral services. We also provide integrated services regarding the Social Determinants of Health, addressing presenting client issues related to: economic stability, neighborhood and physical environment, education, food, community and social context and health care system access, with eligible clients.
The Sisters in Common GRATs will focus on isolated eligible clients to prevent inappropriate or avoidable institutionalization. In addition tour core mental health/case management GRAT team, Sisters in Common has a nurse and psychologist on contract for consultation.

multi-lingual/multi-cultural service- All GRAT senior services will be provided in the client’s primary language, (English, Amharic, Tigrinya, Oromo and Somali). We recruit and train BH staff that are culturally competent, sensitive and aware of the diverse needs of our BH clients. Note: GRAT Staff are recruited from the cultural community of the clients we serve, and further training is provided with resources for required professional growth. In this way, we ensure that our GRAT staff bring their cultural knowledge and sensibilities to service delivery, and have access to on going training and support. This results in high quality GRAT client service, in compliance with their DOH requirements. In our collaborative, community approach we access the GRAT client’s networks of ethnic and culturally diverse relationships and resources in the GRAT client’s communities to better serve them.

Referral- Sisters in Common already gets senior referrals from 5 managed care organizations, and our HealthierHere collaborative partners. Legally mandated, mental health services can only be provided with the permission and request of the client over the age of 12. However, doctor tell there patients to make the call. Referrals can be supported by referring agencies, with client permission. The GRAT senior clients can set-referral, and community/family members can refer with client permission. The referral process can be extended to GRAT partners. Through our extensive, multidisciplinary, GRAT clients will have access to all specialty services needed, including substance abuse, psychiatry and others.

Assessment-Eligibility for BH assessment is determined through a telephone request, followed by an in come screening process. In appropriate. Sisters in Common staff conduct a psychosocial assessment and Individual services plan (ISP). The psychosocial assessment is provided in a manner that respects and includes consideration of the client’s, culture, and is conducted, with an embedded understanding of the BH client’s cultural context.

The BH assessment is comprehensive and includes sufficient data to determine a DSM-5 diagnosis (includes cognitive impairments, dementia and substance use). The BH assessment determines and is built on the GRAT clients strengths and needs and will list client goals and desired outcomes in their own words as much as possible. The assessment may also include strengths and desired outcomes of significant others in client’s life. The assessment is flexible and creative to fit into the client’s unique life situation and meets the unique needs of the client. As part of the GRAT senior’s BH assessment they are informed about the importance of their active participation in services, and are asked to sign an informed consent before services are provided.

Case management: It is the practice of Sisters in Common to assist clients in obtaining needed services that are not available at Sisters in Common and to plan for discharge from services. GRAT senior clients will be actively involved in their planning and discharge process. At the GRAT senior clients request, Sisters in Common will continue its services until such time that the referral has successfully taken place, unless requested otherwise by the client.

Interventions: Sisters in Common provides Individual mental health counseling services, Brief mental health Intervention- treatment services, and case management mental health services. The service design; 1. Assist an individual in attaining the goals identified in their individual service plan, (ISP), 2. Are solution focused and outcome-oriented cognitive and behavioral interventions, and 3. Are intended to resolve situational disturbances and meet the ongoing assessment, facilitation, care coordination and advocacy for options and services to meet an individual’s needs through communication and available resources, while promoting quality and effective outcomes. Rehabilitative case management services support individual employment, education, and participation in other daily activities appropriate to the individual’s age, gender, and culture, and assist individuals in resolving crises in the least restrictive setting.

Consultation- In collaboration and coordination with other agencies partnerships, (e.g. Substance Use Disorder, or psychiatric services) that we have developed through our HealthierHere of King County community-clinical partnerships and linkages, for appropriate recommendations, guidance and education, to improve health outcomes. Sisters in Common have strong partnerships with our community stakeholders and collaborative ties with community service agencies. Sisters in Common Psychologist and Nursing consultant’s recommendations may be incorporated into GRAT client’s Individual Service Plan.

Timely manner: Phone calls are returned no later than 24 hours of receiving them. Messages received from clients are forwarded to identified staff immediately. Whenever a client enrolled in the Sisters in Common BHS contracts “crisis response services” Sisters in Common BHS staff will make a face to face contract with this client within 24 hours of being notified that such a contract occurred. Clients are scheduled for set appointment times to eliminate any unnecessary waiting times for the GRAT clients (48 hours).