New Jersey Health Initiatives - A Better State of Health
A Robert Wood Johnson Foundation Program
A New Tool Builds Partnerships

Underlying drivers of poor health outcomes in Trenton are many and varied — related to poverty, structural racism, behavioral health, childhood trauma, immigration status and other variables that a traditional medical entity is ill-equipped to address alone. 

Trenton Health Team (THT) is building on our track record of collaboration to create new relationships among clinical and community partners and introduce a new way to address social determinants of health (SDOH). 

To better address SDOH affecting our community, THT is providing access to NowPow, a community resource referral platform. NowPow can be used alone, or integrated with our Health Information Exchange (HIE) to enable users to make referrals based on a client’s health and social needs. 

NowPow provides a verified list of local health and social services, so users know what is available to meet clients’ needs. Users can track results and text, email, or print referrals in multiple languages for clients–and send appointment reminders or other follow-ups. 

Since December 2018, THT has hosted five “town hall” meetings introducing NowPow to community partners and currently provides access for 93 users representing 18 partner organizations–with more agencies planning to join in upcoming months. 

In addition to streamlining efforts to address SDOH for clients, the process of introducing NowPow to a new audience of social service providers and working with partners to implement the platform has created new connections among Trenton’s social service and clinical care providers.

Case managers, social workers and others from seven agencies and THT’s care management team collaborated on a social determinant of health screening tool for NowPow users to assess housing, transportation, food insecurity and other social needs. A NowPow Steering Committee also recently agreed on definitions of “urgent” and “non-urgent” referrals and response times for each. 

As new issues arise, THT will continue working with our NowPow partners to co-design solutions that reduce duplication, grow community capacity, and encourage partners to work together on projects. Our Vision for a Healthy Trenton reflects a broad view of health and well-being, and requires new ways to improve outcomes for those calling Trenton home. Partner with us to learn more.


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Project
Author
Michelle Ruess
Organization
Trenton Health Team