Codman Square Health Center

Codman Square Health Center (CSHC) is a community-based, multi-service outpatient healthcare centre located at 637 Washington Street, Dorchester, Boston, Massachusetts, 02124.^[1] CSHC was opened in 1979 and continues to be open to the community.^[2]

Mission

CSHQ’s mission is to ‘serve as a resource for improving the physical, mental, and social wellbeing of the community’, empowering ‘individuals to lead healthy lives and build thriving communities.^[3] CSHC’s guiding values are centring the patient, connecting to the health of the community, engaging a diverse and empowered workforce, advocating for resources to tackle health inequalities, innovating, and building partnerships.^[4]

Patients or Clients Served

CSHC serves the community of the Greater Dorchester area. In 2022, 77.8% of CSHC patients were from 10 postcodes in Dorchester (02121, 02122, 02124, 02125), Mattapan (02126), Hyde Park (02136), Randolph (02368), Roxbury (02119), and Brockton (02301, 02302).^[4] In total, CSHC serves more than 23,000 patients each year.^[5] In 2022, there was a total of 110,188 patient visits, with 76% of these visits being in-person.^[6] Considering that the Dorchester area has a population of approximately 123,000, CSHC serves around one-fifth of the Dorchester population.^[7]

CSHC serves a poor, largely Black, Hispanic and Latino community: in 2022, 81.5% of patients were Black and 11% were Hispanic/Latino.^[6] In 2022, 96.1% of patients lived at or below the federal poverty line^[6]; this is a steady increase in the proportion of patients in (federally defined) poverty from 74% in 2014^[4] , 81% in 2016^[8], and 86% in 2020.^[6]

CSHC accepts a variety of forms of insurance, including BMCHP Community Alliance and other forms of Medicaid.^[9] CSHC is aware of the complexity of the healthcare insurance system and supports individuals who do not have access to health insurance; for example, in 2014, the Enrolment and Insurance Services Team supported over 6500 individuals to enrol in a health insurance plan.^[4] In 2022, 7.8% of patients were uninsured, 27.5% had private insurance and 54.5% were on public insurance - 54.5% of all patients were on Medicaid and 9.3% were on Medicare.^[10]

The center is funded by a combination of federal Medicaid payments, private foundation donations, and patient fees which operate on a sliding scale based on income. In a strategy that captures the community-orientated nature of the Center, emissaries are sent around the neighbourhood to make residents aware of their entitlement to health care services in the center.^[11]

History

During the mid-1970s, community and neighbourhood activists involved in the Codman Square Neighbourhood Association called for the former Boston Public Library building in the Square to be converted into a health center.^[12] The Codman Square area in the 1970s had experienced issues of disinvestment, building abandonment, rising poverty, and dereliction.^[13] Bill Walczak – one of the founders of CSHC - recalled in a 1999 Boston Globe article the imperative of saving the building as “this was a time when everything was burning. We were afraid it was going to be another abandoned building in Codman Square.”^[14] The community was also facing related medical issues, such as, disproportionality high rates of infant mortality.^[15]

However, Mayor Kevin White did not respond to community requests at the time, and during a re-election cycle residents held a press conference to embarrass the mayor.^[11] White eventually capitulated and in 1979 CSHC was founded^[16] in a 2000-sqaure-foot corner of the repurposed library basement with an annual budget of $100,000.^[17]

The health center was founded around the notion that a ‘true “culture of health” is more complex’ than just alleviating sickness, recognising the importance of jobs, housing, and empowerment to the health of individuals and a community.^[3] The center started with only two physicians, and today has a staff of more than 300 employees^[18], including nurses, social workers, and community health workers.^[5] Further, the health center is the largest employer in Central Dorchester.^[19]

Throughout its history, CSHC has considered itself not just a medical provider, but a catalyst for community change: the health center has been described as the “soul” of Codman Square.^[11] This has involved developing and enhancing partnerships to provide services to the community with programs holding expansive understandings of health and care^[20], focusing on housing, nutrition, financial literary, cooking skills, tax clinics, and food pantries.^[21] Examples include the Raising Our Children’s Children group which was founded by Harriet Jackson-Lyons, a receptionist at the center in the 1990s. Jackson-Lyons wanted to form a support group for grandmothers raising their grandchildren. The center received a grant for the program, and by 1997 the group had 165 members.^[22]

Perhaps one of the most significant developments in the history of CSHC was their partnership in the founding of the Codman Academy charter school in 2001.^[23] The underlying idea behind the partnership is that ‘prevention is the best medicine, and education is the best means of prevention’.^[23] Students are given internship and employment opportunities in CSHC and receive on-site mental and behavioural health support. As of 2023, 100% of graduates from the Academy have been accepted to college, nearly double that of the Boston average.^[24]

A more recent development that underscores CSHC’s commitment to community care is their work in food access and justice. In 2012, when the new 34,000 square feet building - the William J Walczak Health and Education Center - was completed, CSHC hosted the first Winter Farmers Market in Boston in partnership with the Dorchester Community Food Co-op.^[25] Every year between January and March, CSHC becomes a ‘lively farmers’ market’ where residents can purchase fresh and affordable produce, with vendors accepting SNAP/HIP/EBT.^[26]

CSHC has continually worked to transform its model of care delivery, responding to the needs of the community. For example, in 1996, following the first annual ‘Men of Boston Cook for Women’s Health’, which continues to this day, CSHC established targeted womens’ health services.^[27] In the last decade CHSC has worked to improve patient contact with health professionals, introducing group visits for patients with special and shared conditions, such as, pregnant teenagers.^[16] Group visits hope to facilitate social connectedness and community support, using a ‘medical model for social means’.^[13]

Notes