Hopewell Health Centers, Inc.

Hopewell Health Centers (HHC) is the grantee on behalf of the PACS (Partnering to Achieve Compliance and Savings) Consortium in rural, Appalachian Ohio. The PACS was formed in 2019 and brings together the regional FQHC, local health departments, managed care plans, Ohio University, and other stakeholders interested in implementing and sustaining community health workers (CHW's) to address health disparities. One success was the implementation the Pathways HUB model, whereby managed care plans contract with the HUB to complete care pathways, many focused on maternal and child health. In this new project, PACS will work with partners to increase the network's capacity to reduce the incidence and impact of NAS by (1) Creating a NAS subcommittee to the PACS Network that will bring expertise and equip the consortium to address NAS; (2) Better addressing preconception needs of individuals impacted by SUD/OUD by hiring and sustaining a RN Health Navigator to screen, identify, link, and coordinate the care of individuals served by Marietta Health Systems in the ER and/or are being served by the OBGYN; (3) Better address the prenatal and delivery needs of individuals impacted by SUD/OUD through training efforts to OBGYN providers, increasing providers who are able to provide MAT services to this population, reducing barriers to care through implementation of the healthcare navigator, peer recovery support in the community resource center, and stigma reduction aimed at the population through Athens Photographic project–all while leveraging the Pathways HUB/Medicaid managed care relationships to sustain these efforts post grant; and (4) Better address Postpartum Needs of caregivers and children impacted by NAS by leveraging HHC's early intervention team and trauma-informed teams to provide supports in school districts which act as community hubs and the community resource center.