The Community Health Access Project (CHAP)
CHAP serves as the Nationally Certified Pathways Community HUB for our community and multicounty region of Ohio.
As the local HUB CHAP serves as the central networking center for a team of community care coordination agencies. These local agencies deploy culturally connected community care coordinators which include community health workers (CHWs), nurses and social workers. They reach out to engage individuals who are most at risk. Using specific checklists they identify the specific health social and behavioral health risk factors. Working with nurses, social workers and physicians they assure that identified risk factors are addressed with specific Pathways. The nationally standardized Pathways serve as the outcome tracking and accountability tool that assures each risk factor is addressed.
The work of the CHAP HUB network of local agencies assures focus on our communities most at risk populations and through evidence based and outcome focused steps, we assure individuals connect to primary care and prevention services, behavioral health, housing, food, clothing, adult education and employment. Published research has documented better birth and adult outcomes and reduced cost of care for individuals who are served by this model.
Many of our clients work forward from high risk pregnancy and homelessness to a healthy baby, stable housing and sustainable employment, and improved management of chronic disease.
The Pathways Community HUB Model is now utilized from infancy to adulthood to assure accountable outreach to at risk individuals, documenting reduced risk, improved outcomes and reduced cost.
We are excited about the growing coordinated network of community agencies in our community focused on culturally connected evidence based service. Our Community Care Coordinators are reaching the most at risk and achieving better health, social and economic outcome.