Promising Practices


NCI Awards Promising Practice Funds to Five North Country Organizations
Funding for Projects to Address Unmet Healthcare Needs in Tri-County Region

Watertown, NY, June 28, 2021 —– Five organizations in the region were recently awarded grant funding to implement promising strategies to fill physical, social, and behavioral healthcare needs in the community. North Country Initiative (NCI) utilized $175,000 in remaining funding from the New York State Delivery System Reform Incentive Payment (DSRIP) program to strategically invest in Promising Practices that continue the impactful projects implemented as part of the program before it ended in March 2020.

Criteria for the awards were driven by a Summer 2020 poll of regional healthcare providers who were asked their feedback on the most pressing health issues in the tri-county area. Of the 60 issues identified, 14 were earmarked for Promising Practices funding within six categories, including: prevent and manage chronic disease; promote mental and behavioral well-being; prevent communicable diseases; promote healthy infants and children; promote geriatric and end-of-life care; and strengthen healthcare infrastructure and delivery.

In April 2021, NCI issued a request for proposals (RFP) to its partner organizations. Proposals were received and reviewed by a Community Review Committee comprised of healthcare stakeholders including a Medicaid recipient. Grant applications were evaluated based on project feasibility and impact, primarily on the Medicaid/Medicare/uninsured population; focus on social determinants of health; community need; project management; and long-term sustainability. “Involving multiple stakeholder perspectives in the review process was critical, as they each thoughtfully evaluated the strength of each application through their respective lenses,” explains Joanna Loomis, NCI Deputy Director. “Further, the Medicaid recipient, who is a graduate of the ‘Getting Ahead in a Just-Gettin’-by World’ workshop series, helped us see the impact that these programs would have on our Medicaid population and which were most pressing. This changed the course of the conversation and was an invaluable contribution to the process.”

Five projects were selected for funding. The awardees and their respective projects are as follows:

  • The ARC Jefferson-St. Lawrence – “Strengthening Access to Physical & Behavioral Healthcare for People with Intellectual & Developmental Disabilities (IDD) through Remote Technology” will use remote technology for nurses to provide more frequent physical and behavioral health services to people with IDD in supportive housing. This technology greatly reduces nurses’ travel time across Jefferson and St. Lawrence counties, thereby maximizing their services for these individuals in both quantity and frequency.
  • Complete Family Care & Laser Center– “Bridging the Care Management Gap for Medicaid Patients” will make it possible for an independently-owned primary care practice in Jefferson County to hire additional care management staff who will provide clinical and social care management support for identified high-risk Medicaid patients.
  • Northern Regional Center for Independent Living (NCRIL) – “Community Health Workers (CHW) & Primary Care” will deploy a CHW to conduct outreach to low-income and other vulnerable populations in community “hotspots” (such as laundromats, community organizations, and other gathering places) in St. Lawrence County. The CHW will facilitate linking people to primary care.
  • Lawrence County Addictions and Mental Health Clinics – “Incorporating Virtual Reality into Mental Health & Substance Use Treatment” will make it possible to purchase three virtual reality headsets, which utilize software modules to simulate environmental and other triggers, to use in combination with other types of therapy to prepare individuals to respond in healthy ways to substance use and/or mental health triggers in real life.
  • Samaritan Medical Center – “Intensive Outpatient Management for Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and Pneumonia Patients at High Risk for Hospital Readmission” will provide remote patient monitoring devices, intensive outpatient care management, home health as appropriate, and a life coach to link the patient with other services and social assistance. This program will focus on CHF, COPD, and pneumonia patients who have experienced four or more unscheduled hospital admissions or emergency department visits in the past 12 months.

One of the recipients, St. Lawrence County Addictions and Mental Health Clinics, outlined a unique and innovative approach to helping people with substance use and mental health disorders recognize and respond in healthy ways to situations that may trigger their conditions.

“Community Services would like to thank NCI for the opportunity to offer virtual reality as an evidence-based therapy tool for our clients,” stated Sheena Smith, CTRS, Master CASAC, Director of St. Lawrence County Addiction Services Program. “Since the start of COVID-19, the mental health and addiction crisis has become more severe nationwide. We at Community Services have embraced technology throughout this difficult time, and we are excited to add this innovative practice to better meet the needs of our clientele.”

The nine-month performance period for the grant-funded projects is June 14, 2021 through March 18, 2022. Each organization will submit quarterly progress reports and a final report by April 29, 2022. Each project’s impact will be measured throughout the performance period and shared at its conclusion.

“We were so impressed with the quality of the applications and the unique and impactful projects they entailed,” explained Joanna Loomis, NCI Deputy Director. “The Community Review Committee was able to select projects representing multiple sectors of the healthcare continuum and inclusive of organizations throughout the tri-county region. These funds will enable the implementation of much-needed, impactful programs that otherwise may not be possible. We are excited to see these projects come to life.”