A collaborative project among the four Outer Cape health depts. going by the name of “OC Wellness” has won $381,375 in American Rescue Plan Act (ARPA) funding from Barnstable County.

The new title, Eastham Health Director Hillary Greenberg-Lemos said, is a way to publicize an ongoing regional effort to help as many Outer Cape residents as possible to access “wraparound care” — a term that includes not just direct medical care but also other supports for social, physical, and behavioral health.

“We wanted a way to get people interested and reinvigorated about municipal programming, while also acknowledging that just because a program’s in Truro doesn’t mean you can’t go if you’re in Eastham,” Greenberg-Lemos said. “We want to break down that boundary.”

This is the second-largest sum awarded in a $5-million round of county grants (see story on page A7).

The most important budget item is two new direct-service providers on the Outer Cape: one registered nurse and one mental health clinician. These positions will technically report to the town of Eastham, which is the fiduciary sponsor for the project.

The four health depts. are in the process of putting together a Request For Proposals to fill the two roles; they’ll function similarly to the Community Navigator program at Outer Cape Health Services, which takes referrals from both municipal agencies and nonprofits and can meet people at their homes to help coordinate care and services.

“Hopefully, we’ll be able to eliminate an ambulance ride and provide services directly where people need them,” Greenberg-Lemos said. “We want these providers to be able to go out and meet patients where they need to be seen, whether that’s a space in the library or the community center or at their home.”

The initial proposal had requested $500,000 and included a certified nursing assistant as part of a three-person “multidisciplinary support team.” But the health depts. scaled the staffing plan down to two positions once the funding decision was announced. The contracts for those positions can be funded under the ARPA grant for up to 18 months.

The grant will also help hire a facilitator for “asset mapping” sessions, which coordinate programming and resources between the many municipal departments that play a role in the social determinants of health, including recreation, councils on aging, and libraries in all four towns.

A third bucket of funding is earmarked for additional wellness clinics — an estimated two sessions per month on the Outer Cape for 12 months, as well as $1,250 per town for free transportation to the clinics.

Greenberg-Lemos said that the four-town expansion of the popular Winter Wednesdays program, which was started by former Provincetown Health Director Morgan Clark in 2017 to combat off-season loneliness and isolation, had been an important first step toward regionalizing public health work.

In October 2022, the directors signed an agreement with Outer Cape Community Solutions, formalizing a partnership. OCCS is a rural health network that connects health and human service providers across the four towns. It was first funded by a federal grant and now by the state Office of Rural Health. It’s led by a steering committee of the Barnstable County Dept. of Human Services, Helping Our Women, the Lower Cape Outreach Council, NAMI Cape & Islands, and Outer Cape Health Services.

“The world of health and human services exists in the same world with these municipal departments,” said OCCS coordinator Alex Nelson. “My role is to bridge that gap and help build and strengthen relationships between these two groups.”

In a presentation on April 24, Nelson told Provincetown’s select board that, since their agreement, “things are snowballing in a beautiful and exciting way.”

“I’m really thrilled to have access to [Nelson’s] energy,” said Provincetown’s Lezli Rowell. “Our ordinary workloads in health offices are stiff.”

On the Outer Cape, health directors are responsible for business and food service licensing and inspections, sewage and waste disposal, water quality monitoring, and housing regulations, among other things. In Truro and Wellfleet, the health agent is also the conservation agent.

Nelson said she was “particularly excited” about the asset mapping component of the project, which will expand the OCCS regional coordination model from health care and human service agencies to town governments.

“For rural communities, it’s all about relationships,” Nelson said. “By having conversations among all the different people who are providing face time and services in every community across the four towns, folks will be able to see what gaps are available, and then everyone will be able to do their job a little better,” she added.

In the coming months, Nelson, the four health directors, and additional staff from the town of Eastham will be responsible for selecting the individuals or agencies to fill the two new clinical positions. Housing, which has posed a serious staff retention problem in the past few years, is not included in the proposal.