AC CARE Alliance

To provide support for the ACCA project that will deploy a technology solution to coordinate operations, optimize its data collection for value to health systems and health plans, and identify how to market ACCA to those systems and plans. The project will support the long-term viability of our community-based and faith-based care navigation program targeting the needs of those with chronic and advanced illness in underserved and disadvantaged communities of the East Bay.

Through this project, the ACCA will use a community based participatory research approach to identify and refine aspects of existing Advance Care Planning (ACP) programs and materials (and, as needed to develop new tools and materials), assemble an ACP toolkit and evaluate the effectiveness of ACP toolkit and tools from the perspectives of persons needing care, caregivers, Care Navigators, Pastors and clinicians.

This project will focus on refining the advance care planning resources in the ACCA’s community- and faith-based care program. Includes refinement of the care navigators’ advance care planning toolkit developed under a prior project, and field testing and refinement of a discussion guide developed for pastors and faith leaders to be used as a companion to the documentary “Extremis” in opening up the difficult conversation with their congregations and community about end of life care decisions.

The ACCA Illness Care Program will serve 400 Persons needing advanced illness care and their caregivers formally enrolled in the AICP and approximately 2500-3000 community members who are not formally enrolled in the program, but receive a subset of services in Alameda and Contra Costa Counties.

This project will support the dissemination of tools developed under a previous grant, via 3 methods: 1) The optimization, through rapid cycle evaluation, of specific intervention methods and tools previously developed to support the ACCA AICP intervention; 2) The redesign the existing ACCA web site to include pages facing participants, health care system partners, and future dissemination sites; 3) Completion and submission of two manuscripts for peer review documenting ACCA findings to date.

The ACCA AICP will serve 650 Persons Needing Advanced Illness Care (PNAIC)/caregivers and position the program for future scale-up and sustainability by 1) refining the intervention and program infrastructure; 2) augmenting program staff training 3) standardizing the training curricula and protocol and; 4) improving the referral process from local providers.

This project will expand the program to three additional church communities, enrolling an additional 500 congregants, community members, and family caregivers. This project will also be used to train care navigators and volunteer care ministers, to promote the program through community outreach, and to support ongoing data collection that has provided evidence of the program’s success.

This exciting project is a first with Stanford Health Community Partnerships and the AC Care Alliance. For the past 3 months we (ACCA) successfully completed a planning grant that was designed to build new relationships with Communities of Color in both Santa Clara and San Mateo counties. The focus was on building trust and developing relationships with churches, health partners both Stanford and FQHC's in the area as well as CBO's. We exceeded our deliverables for the planning grant, and were therefore awarded the larger grant of $248,000 for 1 year to hire and train a new Care Navigator and Care Team Supervisor for this new region for our AC Care Alliance footprint.