The Role of Primary Care Providers in Changing the Culture of Care in Communities

Jun 6, 2014, 7:00 AM

The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting, and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. The first webinar addressed the responsibility of health delivery organizations to strengthen community health and the ways primary care providers can address social determinants of health.  It featured leaders from four primary care sites around the country that the LEAP program has deemed exemplars.

Bringing Change to a Low-Income Community in Philadelphia

Patricia Gerrity, PhD, RN, associate dean for community programs at Drexel University and director of 11th Street Family Health Services at Drexel University, discussed the origins and work of her clinic, which is a partnership with the Philadelphia Housing Authority (PHA) that began in 1996. In response to a letter between the University and the PHA, Gerrity worked to gain mutual trust with the aim of improving the residents’ health status.

Getting started wasn’t easy, Gerrity noted.  To achieve some wins, she assigned a public health nursing faculty member from Drexel to each public housing development. The nurse faculty members asked residents about pressing problems—and then became partners in solving them. For instance, residents said car accidents were an issue, so stop signs were put up. Residents wanted to learn CPR, so training was offered. Residents expressed concerns about dog bites, so they worked with Animal Control to remove stray dogs. “We had to have some short term wins to gain trust,” Gerrity said. 

The model of 11th Street’s health care delivery was driven by the ideas and expressed needs of community members articulated through a Future Search that included members of the University and residents of four public housing developments in North Philadelphia. More than 100 stakeholders met for 16 hours over three days, producing a rich mixture of information and ideas. The group reviewed the past, explored the present and created ideal future scenarios. They identified a shared vision: “A place in our own neighborhood where we can get good health care”—not only access to clinical services but also opportunities for learning about and experiencing healthy behaviors such as nutrition education through cooking classes and a safe place to exercise, like a fitness center. 

Armed with Future Search data, the nursing faculty along with a newly formed community advisory board worked collaboratively to develop plans for a health center while they simultaneously raised funds for a new building. Establishing trust between community and providers was at the heart of the implementation of the center. From the initial meetings in 1996 to the opening of a new building to house the Center in 2002, the College of Nursing & Health Professions engaged in continuous dialog with the community in order to shape the center and its programs.

Today, the 11th Street center is a well-established part of the community that takes an integrated approach to health by offering yoga, movement therapy, health coaching, and more. Its leaders are committed to taking programs outside the center’s walls. For example, they organized a “Gobble Gallop”—a walk around Philly that led participants to health resources around the community, and a “Porch Light Initiative” designed to reduce the stigma of behavioral health.

In partnership with the Philadelphia Housing Authority, 11st Street is expanding its work to support housing for homeless veterans and 3.6-acre health campus that will be a health hub in the community. Read more about Gerrity’s work at 11th Street here.

Improving the Built Environment in Rural Colorado

In rural Colorado, the High Plains Community Health Center is also improving community health, in addition to providing primary care. Jay Brooke, MSW, its executive director, said on the webinar that from 2000 to 2010, the center achieved successful patient health outcomes—but in 2009, its leaders expanded its work by partnering with the city to improve the built environment.

Stage One of this effort involved creating in-house programs that allowed the Center to more comprehensively meet patient needs by providing dental care, primary care, health coaches, chronic disease and weight loss classes, health educators, and more. The goal was to create opportunities to get patients to focus on the psychosocial changes needed to achieve optimal health.

For Stage Two, the Center partnered with community colleges, local hospitals, health centers, a rec center, and others to give patients access to fitness facilities. “We really didn’t have the environment in the community—the trails, the parks—[that give people] the opportunity to make the kind of changes that we, as a community, needed to make,” Brooke said. That changed when High Plains received a $1 million grant from the Colorado Health Foundation to improve the built environment. Now the center is working with the community to create a city master plan for trails and parks, with a focus on neighborhoods with higher rates of obesity. The plan is to connect city parks and transportation, and the center has already engaged the community in rehabilitating a city park.

“We really have a paradigm shift in the community,” Brooke said. It “has been a great realization that we can’t do it all in exam rooms.”  Today, he said, the center’s staff members are embedded in the community. Three hundred residents cleaned up a park in one day. “It’s a matter of asking and encouraging people [so] they can have a say,” he concluded.

Emphasizing Advocacy in an Immigrant San Francisco Community

At Asian Health Services in Oakland, Calif., leaders are doing just that, according to Jennifer Lee, community services director.  Asian Health provides primary care, behavioral care, and community outreach to patients who speak 11 languages. The agency has “a strong, articulated mission of service and advocacy,” Lee said on the webinar.

Many of the residents Asian Health serves in San Francisco’s Chinatown have very little awareness of available health services, Lee said. So the agency made “a deep investment in community health workers ... to help us with language access.” The community health workers serve as language interpreters and helped build a pipeline that now reaches 24,000 patients.

Asian Health convenes meetings about the Affordable Care Act and other issues that matter to the community. The agency established a Patient Leadership Council program, holds leadership training sessions, and organized a 12-part series on health, health care, health disparities, and the importance of advocacy as a tool for change.  All this has helped Asian Health engage a pipeline of community leaders.

Ongoing outreach makes Asian Health a constant presence, and it is now one of the largest employers in the Chinatown community.

Today the agency has a $1 million advocacy endowment.  “We really have a great ear to the ground and [have created] a seat at the table for our stakeholders to give us live-time feedback on what’s relevant, and what changes they’d like to see,” Lee said.

Giving Diverse Community Members in New Mexico a Voice

Hidalgo Medical Services Center for Health Innovation in Silver City, New Mexico, also has transformed its work, according to Executive Director Charlie Alfero, MA. Hidalgo is a community health center serving 35,000 residents. In its early years, the center used its community health workers in traditional ways to provide chronic disease management. Today, the center provides medical, dental, and mental health programs as well as family support, works with people with different health status in different ways, and is aiming to change conditions of the community, Alfero said on the LEAP webinar.

The non-clinical support services the center provides range from garden development to food distribution to workforce development, and more. Through its Forward New Mexico program, the center has reached 25,000 junior high and high school students with math and science programs and summer academies; and works with 70 graduate student medical residents. Through its “DreamMakers” program, the center takes youth on visits to Albuquerque to tour nursing and medical schools.

The center received a REACH (Racial and Ethnic Approaches to Community Health) Grant from the Centers for Disease Control and Prevention to train community health workers to provide culturally appropriate outreach to the community, and to work with community leadership teams as change agents. “We’re developing a process so people from racial and ethnic populations have a better voice in their community development process,” Alfero said. We are “trying to raise the level of input from community organizations to impact local state and national policy change, and developing an evidence base for that.”

The RWJF Human Capital Blog will report on the next LEAP webinars in coming weeks.         

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.