CHD’s Outpatient Behavioral Health Clinic in Greenfield recently received $35,000 in federal Community Development Block Grant funding for its Elder Wellness Program to launch a Chronic Disease Self-Management Program (CDSMP). The program is designed to help individuals with chronic conditions learn how to manage and improve their health.
Between October 2024 and September 2025, the grant will provide seniors with technological tools and expertise for self-management of chronic conditions such as persistent pain, diabetes, and cardio-metabolic disorders.
The CDSMP aims to reduce the burden of chronic disease and increase social connections among older adults in Greenfield through awareness, education, and connections to care by focusing on pain management, nutrition, exercise, medication use, emotions, and communication with doctors.
The program will address social determinants to increase positive health outcomes, and also improve community connections between vulnerable clients. With the grant, which was secured by the CHD Grants Team, the CDSMP will target older, low-income, homeless, or housing-insecure, and under- or uninsured residents who have been affected in an inequitable way by chronic health conditions.
“It is commonly understood in our field that people with complex behavioral health diagnoses die 15-20 years sooner than the general population as a result of manageable diseases,” said CHD Vice President of Clinical Services Lindsay Ciepiela. “Our team is excited to gain tools that support interdisciplinary care that will enhance the health and quality of life for our elders and ultimately their loved ones.”
CHD is “proud of the increased use of evidence based tools such as CDSMP that allow providers to feel best equipped to provide optimal care,” said Ciepiela.
Through the first six months of the program, participants will meet regularly with a wellness clinician and clinic nurse to track their progress, and the nurse will provide connections to CHD’s wraparound services focused on mental and behavioral health and substance use prevention. Following that six-month period, an internal assessment will be undertaken, and a second cohort of residents will be welcomed into the CDSMP.
CHD will also purchase take-home medical equipment for participants to use to track and manage their health, and there will be in-home visits by program staff—especially important considering the “transportation insecure” status of many Greenfield residents.
The program will be accessible to people with hearing and speech difficulties, speaking a primary language other than English, and to people with specific physical restrictions, such as individuals in wheelchairs or who have sensory processing disorder.
At the one-year mark, in September 2025, a full assessment of the program’s efficacy, and a plan will be formed for the future of the program and funding.