For Patricia Gerrity, Ph.D., R.N., F.A.A.N., the first step on the road to providing health care to the residents of the public housing projects in the North Philadelphia neighborhood near Drexel University was to ask questions and listen carefully. What she learned, and more important, how she reacted to it, shaped a successful and innovative effort to meet the health care and related needs of low-income residents.
“I started here in 1996,” says Gerrity, associate dean for community programs at Drexel University’s College of Nursing and Health Professions and Director of the 11th Street Family Health Services Center. “We met with the resident councils of the housing projects, and I said we wanted to make a long-term commitment to their health. But by then, they’d been surveyed, assessed and interviewed many times before. In their experience, someone would write a paper on their needs, and then go away. So I told them that wasn’t what we were going to do. We weren’t here just to assess how bad things were; we were here to see what we could do, and what the community wanted us to do.”
Gerrity was surprised by some of the needs identified. She’d expected a focus on diabetes, domestic violence and obesity. “But they were worried about car accidents at an intersection with a missing stop sign, and dog bites from stray dogs,” she says. “They wanted to learn CPR, and they wanted a food cupboard. So we took on all those things.” The effort not only addressed pressing public health needs in the community, it helped build trust.
Setting Down Roots
By 1998, Gerrity had secured federal funding from the Health Resources and Services Administration (HRSA) to open the clinic in a small community center connected to one of the public housing developments. Four years later, another HRSA grant allowed Drexel to build a new 17,000-square-foot facility in partnership with the Philadelphia Housing Authority. The Center is located near four public housing developments. Subsequently, the Center affiliated with a local network of clinics, the Family Practice & Counseling Network.
The Center differs from more traditional clinics in important respects. First, as a nurse-managed clinic, it relies on nurse practitioners to serve as primary care providers. They focus on health maintenance, disease prevention and patient education. “The patients love it,” Gerrity says. “They’d been using the emergency room for most of their health care needs, or waiting days for appointments with the sole doctor in the neighborhood. Now, they call in the morning and we see them the same day.”
Second, the Center relies on a core care team approach that includes a nurse practitioner and a primary behavioral health consultant. Behavioral health services are thus integrated seamlessly into primary care. The behavioral therapists focus on factors that might affect a patient’s current or future health status, including emotional health, quality of life and health habits, and patient behaviors that might create or mitigate health risks. In addition, a social worker joins the team when necessary, helping address patients’ social service needs and connecting them to services available outside the Center. If necessary, a health educator/nutritionist, a physical therapist and a dentist are also available to play roles on the core care team.
Third, the Center continues to innovate and evolve, working to remain responsive to the community’s current and future needs. “We’ve always done a lot of work on diabetes education,” Gerrity explains, “but after a while we concluded that nothing was really changing. So we started to talk to patients about that, and we realized that, for many of them, the problem was that they were so depressed, they couldn’t deal with diabetes. So we started groups for depression, with the goal of helping them become ‘activated’ patients. And we learned something very important from their discussion in the groups. Trauma was a pretty universal problem for them—domestic violence, sexual abuse, or something else. And they all thought they were the only one. Subsequently, we learned more about trauma, and took the entire staff to work with Dr. Sandra Bloom to sensitize them to trauma—and learn a trauma-informed model for care. We think we’re finally getting to the root cause of the problem.”
Promoting Good Health
In addition to clinical services, the Center houses a fitness center, a teaching kitchen and a series of health-promotion activities, including yoga, line dancing, art therapy, smoking cessation, family fitness programs and cooking classes. To meet the community need for a neighborhood grocery store, the Center partners with a food bank to provide free fresh fruit and vegetables to families each week. In addition, it established a small urban farm next to the Center. Some of the harvest is used in cooking classes, and the rest is sold at low cost to patients by teens from the neighborhood who operate the farm as a business. Through all these efforts, the Center has become a hub for community activities that improve residents’ quality of life.
The program has made an impact. Visits to the Center have increased dramatically over the last several years—from 2,200 visits in 2003 to 10,000 in 2007. Visits for behavioral health services provided at the Center have increased sharply as well—from 210 in 2003 to 3,200 in 2007, and dental visits have ballooned from 950 visits in 2005, when services were first offered, to 6,800 in 2007.
Subtler measures of success are apparent too. “I think we’ve helped our patients become activated patients,” she says, “to take initiative in managing chronic illness or maintaining their health. And we’ve seen progress in lowering blood pressure, managing diabetes, and more. We’ve also made headway in getting people back to work. We have a lot of patients who’ve been on disability, and they used to come in periodically to get their forms signed. Now when they come in, they get a full evaluation, and we make a plan, and if they’re working on it, we’ll sign the form. That’s a big change. And it helps make our patients more active participants in their rehabilitation. They’re proud that they’ve gotten back to work. That’s been great.”
Gerrity brings to the job her conviction that the kinds of services the Center provides should be available to all. “My family was very poor when I was a kid growing up in the South Bronx. I remember one time a doctor came to our house to see my sister, who was a little older than I was. We were both very sick at the time, but my mother told me to stay in my room when the doctor came. But I was little, and curious, and I came out, and I remember getting that glare from my mom—I remember it to this day. It wasn’t until I was an adult that I asked my mother about that. She said, ‘Well, you were both sick and I only had enough money to pay for the doctor to see one of you. So I had him see your sister, and then split the medicine.’ That stayed with me. Parents shouldn’t have to make that kind of choice; people deserve access to health care.”
At the 11th Street Center, they have it.
In 2007, Gerrity was named an Edge Runner by the American Academy of Nursing (AAN). The Edge Runner program is a part of Raise the Voice, an initiative funded by RWJF and directed by AAN. The award recognizes nursing professionals who are finding new ways to integrate the mental and physical health of patients. In 2008, the Center was among just 24 “acute care,” “bridge continuum” and “comprehensive care” organizations named national models as part of a research project conducted by Health Workforce Solutions LLC and funded by the Robert Wood Johnson Foundation.