"No Wrong Door:" Establishing a Healthy Living Center in a Vulnerable Area

    • May 21, 2008

The Problem: In September 2002, the Eleventh Street Family Health Services Center opened in an underserved, low-income area in North Philadelphia characterized by public housing, high crime and relatively little trust held by residents toward the academic institutions trying to improve the neighborhood. For six years, Drexel University faculty had worked with local residents to improve the health status of the community. But would residents connect to the new center and use it as more than a bandage in an emergency?

The Proposal: Patricia L. Gerrity, PhD, RN, FAAN, associate dean for community programs at Drexel University's College of Nursing and Health Professions, wanted the center to be similar in concept to the British model of a Healthy Living Centre, which reflects a community's needs by offering services beyond mere diagnosis and treatment—and embraces a holistic approach to health.

During her early research for the Eleventh Street center, Gerrity got to know area residents, and to understand their needs. “There was violence—one woman's son had died in her arms and the emergency medical team couldn't find them—and so they wanted to know CPR. Another issue was dog bites from stray dogs. They wanted a health center that was accessible to them, which meant they would not be judged if they didn't have insurance but were on medical assistance,” Gerrity says. “And they wanted to learn how to be healthier through nutrition, activity and exercise.”As the director, Gerrity wanted to plant the principles of the Healthy Living Centre concept as deeply as possible, but she realized she needed to study the model further to formulate her long-term development plans.

Grantee Results: In 2003, Gerrity used the grant she won in 2002 from the Robert Wood Johnson Executive Nurse Fellows Program to travel to England to see firsthand how Healthy Living Centres operate. Back in Philadelphia, after completing a certificate program in executive administration for non-profits at the University of Pennsylvania, she began to build links at the Eleventh Street center between primary care, public health, behavior health, creative arts therapy, physical therapy, nutrition education (there is a teaching kitchen) and exercise (a fitness center opened, too).

Often, patients know they have a health issue but don't know what type of care to seek. At the center, every health care provider is able to assess and direct any patient to needed services. For instance, a person seeking help for depression may be directed to a behavioral health specialist who, understanding the link between depression and exercise, may guide the patient to the fitness center. “With this transdisciplinary model of care, there are no wrong doors,” Gerrity explains. “No matter where you come in, you can be helped.” Conversely, many who come in with physical complaints turn out to be suffering from depression. “They can't sleep, and they ache all over,” says Gerrity. “In too many cases the body and the mind are separated. We find underlying that is post-traumatic stress, and we are addressing that. Children are seeing people stabbed and shot—it's terrible.”

By 2005, the final year of her fellowship, Gerrity reported that the Eleventh Street center was well-established along the lines of the British model with clinical services including primary care, midwifery, podiatry, psychology, psychiatry, dental and physical therapy, as well as programs focused on fitness, nutrition, family support, sexual decision-making and management of chronic illness.

With funds from the Pew Charitable Trusts, the center added special programs for adolescents and worked with residents of the public housing community to address their desire to be known as the “healthiest development, rather than the most dangerous.” Gerrity believes that the center has had a significant impact on Philadelphia as it serves as a model for comprehensive community-based care.

One of the aspects that make the center unique is its funding structure: Though it is managed by Drexel University, the center partners with the Family Practice & Counseling Network, a group of Federally Qualified Health Centers, which provides financial stability and sustainability by helping the center qualify for reasonable rates of reimbursements. “I'm very biased about public health nurses, but I think we have a different take on things,” Gerrity says. “Historically, we look at a situation and say, ‘It doesn't have to be that way.' That's the hallmark of public health nursing.”

Grantee Perspective: “Be Big”—that's one key lesson Gerrity got from the Fellows program. “Being Big is about thinking big and being big,” she explains. In the past, Gerrity often considered her accomplishments as all in a day's work. “I felt like I was just doing my job, that this was nothing special,” she says. “In the fellowship, they said, ‘No, this is special. Nurses don't always do this.' They helped me have better self-confidence, self-image. The fact that I was chosen was a big thing. And it's never over. Once a RWJ fellow, always a RWJ fellow.”

RWJF perspective: The Robert Wood Johnson Executive Nurse Fellows Program was created in 1997 to capitalize on the profession's strengths and build the leadership capacity of nursing. “Nurses are in a unique position to serve in leadership roles and contribute to transforming our health care system,” says Susan Hassmiller, PhD, RN, RWJF senior program officer. “The Executive Nurse Fellowship Program is part of the Foundation's building human capital strategy to attract, develop and retain diverse and high-quality leaders and a workforce to improve health and health care.”