CONCLUSIONES Y RECOMENDACIONES

In the past four years, since the CCHH model was established, the model has increasingly become a realistic and feasible approach to community-centered, prevention-based healthcare. With the new promotion of multi-sector partnerships confronting community conditions that impact health, CCHHs now have a greater chance of being funded. The fact that the CCHH is a model, not just a funding plan, combined with the fact that the CCHH is based in a hospital or clinic makes it stand out compared to other preventive healthcare methods. Despite the CCHH model’s unique traits, in order for the public health field to successfully merge with community agencies and make long-lasting impacts on social determinants of health, the CCHH actors have to overcome many difficult challenges. This paper recognizes the challenges of successfully implementing a CCHH, but also, and more importantly, recognizes solutions to these challenges, indicating that the CCHH model is a feasible setting for community-centered, prevention-based healthcare.

This paper’s comprehensive conceptual model provides steps and concepts that should be addressed to increase the likelihood of successful CCHH implementation. Some key takeaways include the importance of building capacity among staff, developing forums for information sharing and aligning agendas, cultivating and strengthening partnerships, and consistently evaluating the CCHHs processes and outcomes. In addition, external factors like funding and partners’ commitment are crucial to achieving a CCHH’s goals. Without the support of investors, funders, and partners, the CCHH model cannot be executed. More importantly, building trust among community members to encourage community engagement and buy-in is necessary to accomplish changes within the community and changes to the environment that will ultimately be valued and utilized. These internal and external changes contribute to the larger, necessary systems changes and essential cultural shift within the clinic.

In order for the CCHH model to be a true success, many challenges need to be addressed and solved. Funding is a major challenge and the lack of reliable funding is a weakness of this model. Not only do individual clinics need to establish reliable funding, but also, foundations need to have open communication surrounding lessons learned from grants for community-centered, preventive healthcare. This paper’s section on alternative models to community-centered, preventive care and funding opportunities implies that there are multiple initiatives occurring with the same goal. Understandably, each foundation wants to successfully create positive change, but the nation’s health can only improve if information is being shared. Investments

going toward the built environment or the public health sphere can be leveraged if there is collaboration with multiple fields and multiple funders. Maybe this means more communication between foundations with healthy community grants, or maybe this means multiple foundations join efforts to fund larger healthy community grants. Combining grants could support larger environmental changes that would have larger impacts on population health. For instance, by combining grants, a community could have enough funds to develop parks and transportation systems and make long-term improvements toward health equity.

Another challenge is the dynamic between hospitals and clinics. The question remains: is the clinic the best place to focus on implementing the CCHH? What if a hospital manages the operations of a clinic, or of a system of clinics? By concentrating on clinics, is the CCHH movement excluding hospitals and restricting progress? At this point it seems that the process will be determined on a case-by-case basis. If a clinic is a subsection of a hospital, it should be able to transition into a CCHH without the hospital having to also make the transition. In any case, it seems that transitioning into a PCMH is a first step for clinics and hospitals that do not have the funds to become a CCHH but want to begin building capacity for a later implementation of the CCHH model.

Furthermore, if the CCHH model does become the next local healthcare setting, there are immense implications surrounding the roles of and relationships among the clinic, community partners, urban planners, and community agencies. The clinic is not the only actor of change that needs to modify its capacity and culture in order for successful CCHH implementation. The community needs to be willing to change and be open to environmental and behavioral changes and integrative community work. Local agencies must be willing to build their partnerships with health institutions and share their time, data, skills, and funding. The urban planning field, including professionals in housing, transportation, real estate development, economic development, and land use, must collaborate with health professionals. As discussed earlier, comprehensive plans can integrate a health focus, thereby developing an action plan that prioritizes health outcomes and changing the built environment to encourage positive health behavior like physical activity and healthy eating. These efforts need to be made. Siloes need to be broken down and fields must merge.

Addressing these challenges will be difficult, but is not impossible. With additional strategies and tools tailored for clinics and hospitals to implement the CCHH model, these health institutions can be positioned to become CCHHs. With so many actors responsible for

facilitating the merge between clinical work and the community, it is important that the burden does not strictly fall on the clinic. Practitioners of urban planning, education, and policy, as well as a host of other fields, must participate and be involved in the fight for health equity. With their support and additional funding, CCHHs will be the next step in healthcare. By adopting the CCHH model and embracing difficult systemic changes, clinics and hospitals can lead the way in improving public health through community-centered, prevention-based healthcare.