logo

Back

Featured Programs 

Clinic to Community Linkage 

2-1-1 Partnering with Better Health Partnership (BHP) to connect patients to community resources. 

United Way 211 and BHP join forces to build a scalable model to bridge the divide between individuals' needs and community resources to abate them. The program enables primary care practices to refer patients to 211 for help and establish two-way communications between clinics and 211 navigators, facilitating follow-up. 

The Clinic to Community Linkage (CCL) program is a new way to connect patients with chronic diseases to community resources via United Way 2-1-1. CCL for adult patients focuses on individuals with hypertension and elevated blood pressure (≥140/90mmHg) seen at participating clinics (initially MetroHealth J Glen Clinic) CCL for pediatric patients focuses on children ages 2-18 with the body mass index (BMI) ≥ 85th percentile and/or children with an asthma diagnosis at three different health centers (Care Alliance, University Hospitals Rainbow Babies and Children, and MetroHealth Buckeye Health Center). 

The goals of CCL are to:

1) Help patients lower their BMI percentile, gain control of their asthma, and improve their overall health

2) Address social determinants of health that impact health and well-being

CCL will achieve these outcomes by connecting patients to community resources for healthy eating, active living (HEAL), disease self-management, and other resources for social and economic needs.

How it Works

CCL begins with an electronic referral that is sent securely from a patient’s primary care provider to United Way of Greater Cleveland.  Once the referral is received by United Way, a specially trained Navigation Specialist will contact the patient or parent/guardian (P/G) of the patient within 2 business days about community resources that will assist the patients with free or low-cost resources for healthy eating, physical activity, and/or asthma management.  The Navigation Specialist will also identify other social or economic needs (housing, utilities, or transportation, for example) and refer the patient or P/G to appropriate community resources.  After the patient or P/G is referred to community resources, the Navigator will follow-up with the patient on those referrals and determine if the patient’s needs were met.  If the need has not been met, the Navigator will continue to work with patient or P/G until the need is either met or is determined to be unresolvable by both parties.