This story was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

In partnership with the Chicago Public Library (CPL), Amita Health’s Social Worker in the Library (SWIL) Chicago project embeds a Licensed Clinical Social Worker (LCSW) at two library branches, Uptown and Bezazian, to improve the quality of life for individuals who are experiencing homelessness, mental illness and other complex needs in the Uptown community of Chicago. The pilot program was launched in Fall, 2018.

The SWIL program is built upon existing and new community collaborations, with nearly 40 organizations already committed to the effort, including agencies which will serve as community resources and referring partners. AMITA has also worked closely with the Chicago Department of Public Health, Healthy 2.0 office; Chicago’s 46th Ward Alderman Cappleman’s office; and local law enforcement to define the community needs. AMITA has conducted conversations with the American Library Association and other libraries across the U.S to connect with thought-partners and share best practices.

The program's goals are:

• Identify individuals lacking a medical home and provide primary care referrals.
• Assess individuals for behavioral health and substance abuse issues and provide referrals.
• Identify individuals needs around social determinants of health such as housing, food insecurity, employment etc. and provide referrals.
• Reduce staff calls to CPL security and Chicago Police Department and decrease the percent of in-library disturbances and calls for help.

The Process

Amita Health first partnered with CPL in 2017, to provide Mental Health First Aid training for librarians & clerical staff. Though the training was received positively, many identified the need for better referral approaches for behavioral health services and resources. The Social Worker in the Library Chicago project was developed to address this gap in the community. The project also closely aligns with strategic priorities of the health system, as identified in its Community Health Needs Assessment: improving mental health and decreasing substance abuse, increasing access to care and community resources, and addressing social determinants of health.

The library branches selected for the pilot program are located in Chicago neighborhoods with growing needs around mental health and homelessness. According to the Chicago Department of Public Health and CPL incident reports:

• Uptown has the second-highest concentration of homelessness in Chicago, with 9.4 percent of the city’s homeless population living in the community.
• Uptown residents experience high rates of mental and behavioral health hospitalizations.
• Only seven homeless shelters and four homes for those suffering from mental illness exist in Uptown.

Amita Health partnered with librarians to better understand the community. Through focus groups and surveys, librarians shared their interaction with frequent visitors - whether they are homeless or need somewhere to spend time until dinner is served at a local social services agency or need time away from the from either their current homeless shelter or mental disability home. Library staff leveraged these built relationships to encourage patrons to seek help from the social worker, Justine Janis. 

Janis provides specialized care to those in need through multiple approaches, including referrals to health care providers, referrals to community resources related to employment, food and behavioral health services, assistance with applying for benefits and conducting confidential consultants and assessments to identify risk factors and improve the health and well-being of individuals.

In its first year, the program's LSCW, Justine, will have an estimated 600 patron encounters. Each encounter's objective, outcomes and evaluation measures are as follows:

Project Objectives	Outcome	Measurement	Responsible
Identify individuals lacking a medical home and provide primary care referrals	90 percent of individuals with an identified need will be referred to appropriate sources Record percent of individuals needing health care who follow through with referrals	Track and monitor client referrals and referral completion on Aunt Bertha and through client self-reporting	Amita Health Social Worker, clients, partners
Assess individuals for behavioral health and substance abuse issues and provide referrals	90 percent of individuals with an identified need will be referred to appropriate sources Record percent of individuals needing behavioral health and substance abuse assistance who follow through with referrals for baseline metrics.	Track and monitor client referrals and referral completion on Aunt Bertha and through client self-reporting	Amita Health Social Worker, clients, partners
Identify individual needs related to social determinants of health such as housing, food insecurity, and employment needs and provide referrals	90 percent of individuals with an identified need will be referred to appropriate sources Record percent of individuals needing social services who follow through with referrals	Track and monitor client referrals and referral completion on Aunt Bertha and through client self-reporting	Amita Health Social Worker, clients, partners
Reduce calls to CPL security team and the Chicago Police Department for disturbances at the participating library branches by providing crisis intervention and de-escalating situations	Reduce calls to CPL security team and Chicago Police Department by 30 percent	Number of incident reports filed by library staff LCSW case notes regarding crisis interventions	CPL staff, Amita Health Social Worker

Stories of Impact

In the first few months, there have been several success stories. An elderly, homeless, male patron had been coming to Bezazian for the past few months. Due to heavily soiled/foul clothes, he was asked to leave the branch on multiple occasions. The branch manager had alerted Justine to the issue. Luckily Justine had already been speaking to this patron and had established rapport with him.

Justine was able to partner with Heartland Health to bring a new change of clothes to the library so that he would not be asked to leave for the day. Justine also linked him to Thresholds where they were able to take him to the DFSS office to find shelter and go with him to a local soup kitchen. Thresholds assisted him in submitting a Medicaid/SNAP benefits application. Without Justine's unique position at the library, it is unlikely that this patron would have received help. Because of his depression, he was unable to go to various social service agencies or clothing closets.

The program evaluates and measures the success of the program through patron evaluations and library staff training evaluations. Just in the first four months, the program has touched many vulnerable individuals:

SWIL Program Metrics (September, 2018 - March 2019)
Total encounters	441
Encounters at Bezazian	286
Encounters at Uptown	155
Identified as homeless	191
Identified as housed	250
Total time spent with patrons (in minutes)	11,469
Referrals to Medical Home	41
Referrals to behavioral health/substance abuse services	62
Referrals to programs that impact social determinants of health (housing/jobs/food)	258

Justine has networked and built relationships with 32 social services and served as an intermediary between the various social service agencies, to connect patrons in need to valuable resources. Patrons have appreciated Justine's work in many ways:

"Justine was exceptionally kind and non-judgmental. Her suggestions to improve my current situation of being indigent and somewhat isolated were very informative. I plan to follow up with CMAA, JVS and State of Illinois Social Services tomorrow."

"Immensely helpful. A life saver to connect me with Chicago’s CHA housing areas."

"She was very informative and positive."

Justine Janis (second to the left) with Senator Dick Durbin

Next Steps

In 2019, we are planning to expand to the West Side of Chicago to the Austin and West Garfield Park neighborhoods, to improve the quality of life for individuals experiencing homelessness, mental illness, chronic unemployment, and other complex needs. The project will provide individual assessments and linkages to services for primary care, behavioral health services, and social determinants of health. The project will track individual referrals, analyze outcomes, and evaluate program impact.