Community Health Programs

Community health program support for FQHCs and health centers.

Start a conversation Or call (718) 540-8268

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We work with Federally Qualified Health Centers (FQHCs), community health centers, and public health organizations to expand access in underserved communities. Our work covers primary care, behavioral health integration, preventive care, and outreach. We help design programs, strengthen compliance, and build local partnerships so care is easier to reach and to sustain.

Program support for community health centers

FQHCs and community health centers serve as safety nets for vulnerable populations. They benefit from targeted support in program design, compliance, and day-to-day operations, so services remain high-quality and sustainable. We work with the community, in a culturally responsive way, and focus on access, health equity, and population health.

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Program design, compliance, and outreach for community health

Our team helps develop practical, sustainable programs that address health disparities and improve care coordination across primary care, behavioral health, and prevention.

FQHC program development and compliance support, including policies, required reporting, and operational reviews: We review how a health center runs day to day, draft or update its policies, and set up a routine for the reports it is required to file.
Behavioral health integration within primary care, including screening workflows and warm handoffs: Care teams get a written screening and referral protocol, a team-based care design, and staff training so a patient can be introduced to a counselor during the same visit.
Preventive care and chronic-disease program design: immunizations, screenings, and health promotion: We write a design for each program covering who it is for, which services it offers, how it is staffed, and how it fits the center's daily operations.
Community outreach strategy and health education initiatives: Outreach is planned together with local partners, using culturally responsive education materials and support for community health worker programs.
Population health assessment and planning, including social determinants of health and data use for decision-making: An assessment gathers what is known about a community's health needs and living conditions, then turns it into priorities that leadership can plan around.
Care coordination workflows and referral network development: Staff end up with mapped steps for moving a patient between primary care, behavioral health, and prevention services, plus a working list of referral partners.

Who it’s for

FQHCs
Community health organizations
Public health departments
Providers expanding into underserved areas

How an engagement works

Pick any part of the sentence to see the detail.

First, expand access. Then reduce disparities. Next, strengthen community delivery. Finally, build sustainable models.

We design programs that bring primary care, behavioral health, and preventive care within reach of underserved communities.

Common questions

What support do you provide for FQHC compliance and operations?

We assist with compliance monitoring, operational assessments, quality-improvement projects, and strategic planning. This includes alignment with the program requirements, required reporting, and performance standards health centers are held to, while strengthening clinical operations and financial sustainability.

How do you integrate mental health services into primary care?

We implement integrated behavioral health models: team-based care design, screening and referral protocols, technology and workflow integration, and staff training, so patients receive coordinated care within the primary care setting.

What approaches do you use for community outreach and engagement?

We co-design outreach with local partners, use culturally responsive education, and support community health worker programs. Efforts focus on trust-building and addressing social determinants of health through community-driven activities.

Still have a question? Call (718) 540-8268, or see the healthcare overview.

If the program needs to grow and you cannot add staff

We screen for social needs, then have nowhere reliable to send people.: Screening is the easier part. The harder part is a referral list that someone owns, with a named contact at each partner and a way to learn whether the patient got there. We help map the referral network and the handoff steps so a positive screen leads to a referral.
Behavioral health is down the hall, but it still runs like a separate clinic.: Sharing a building does not make the services integrated. What is usually missing is the agreed workflow: who screens, what triggers a same-day handoff, where the note lives and who follows up. We work through those steps with your care team and write them down so they outlast staff turnover.
Required reporting and the next operational review land on the same three people.: Start with one calendar of what is due, who owns each item and where the evidence lives. That alone shows which pieces can be handed off. If a report or review is coming up, call with the date and we can talk through where outside support would take load off your staff.

Have this ready when you call

The report or operational review coming up, and its date
Programs you run now, and the one you want to add or fix
Funding source for the work and any conditions on it
Referral partners you rely on today
Who would sponsor the work internally

You can call without all of these. We will work out the rest with you.

Call (718) 540-8268 Or pick a time for us to call you

Monday – Friday, 9:00 AM – 6:00 PM Eastern

Tell us about your community health program.

Contact us to discuss how our community health work can help your organization expand access to care, improve population health outcomes, and strengthen community-based care for underserved populations.

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