NACHC’s podcast, Health Centers on the Front Lines, covers pressing public health issues and shares stories about how Community Health Centers deliver affordable, innovative care at the same time they are advancing health equity in their communities. These are the 5 episodes listened to the most in 2022:
Every year the George Washington University Geiger Gibson Program in Community Health recognizes leaders in the Community Health Movement who are quietly making a difference. One such leader, Felix Hernandez, a 2022 Geiger Gibson Emerging Leader, started as a middle school and pre-K teacher. That was just the beginning of his lifelong quest to lead with change in the community health space.
Hernandez works in a ground-breaking program at Mary’s Center in Washington, DC, as the Advocacy and Father Child Attachment Program Manager. The health center receives a grant from the Child and Family Services Agency (CFSA), which aims to reduce child abuse and neglect in the District by building and strengthening family relationships through home visiting programs. As a teacher, Hernandez recognized how a child’s home life might affect their ability to learn in the classroom. When he became part of the home visiting program, Hernandez put his own personal experience and educational skills to work.
Hernandez explains that “more men need to feel comfortable talking to other men about patriarchy and masculinity.” Growing up with machismo culture, Felix relays some of the impacts and how he has done internal work to address the effects. He says, “I knew I did not want to contribute to that culture.”
Parental knowledge of developmental stages is a protective factor and builds resiliency in children. The father child attachment program supports participants with a two-pronged approach toward that end. One prong includes tangible resources such as diapers, housing vouchers (when accessible and possible), insurance enrollment, and general stability like employment.
Once a trusting relationship and rapport is in place, the family support workers broach the second prong. They engage participants in conversations around patriarchy, toxic masculinity, nonverbal communication, father-child attachment, and more. Hernandez emphasizes how it is an opportunity to be self-reflective together. “There is not one right way to parent,” he says, adding that what is more important is “reinforcing parenting strengths.”
“We have seen firsthand how fathers become more involved in parenting when their immediate needs for their families are met. Felix and his team have done an excellent job building a network of support, trust, and strength for them to become the fathers they want to be for their children.”
Joan Yengo, Vice President of Programs, Mary’s Center
One participant’s story demonstrates how the two-pronged approach works. A husband lost his wife while she was pregnant. She primarily handled medical appointments and school for their children. She was also the primary partner in the application for U.S. citizenship. In one fell swoop, this father lost a life partner, a partner in all family matters, and the route for documentation. The family support workers at Mary’s Center were there to help the father coordinate his children’s lives with a representative who spoke his language. The team meets with fathers as much or as little as needed. The goal is to touch base at least once a month.
Hernandez has several goals for the program moving forward. He hopes to grow the team and double the number of family support workers. Hernandez also wants to help establish workforce pathways for fathers to reduce the need for working multiple jobs which can impact their ability to bond and build relationships with their children. The small but mighty fatherhood team at Mary’s Center believe in their approach to accomplish long-term behavior change, but there are daunting challenges: compensation constraints, an administrative burden of documenting and caseload issues and battling certain cultural narratives and social drivers (particularly employment).
Hernandez’s work reminds us that every day there are people like him in the health center world creating a ripple effect of positive change and wellness. NACHC is proud to partner with the Geiger Gibson program and recognize their work as part of the Emerging Leaders program. If you know of a health center leader like Felix Hernandez, nominate them. You can read here for more information and to nominate someone. Deadline for nominations is December 20, 2022.
The White House recently unveiled a COVID-19 Winter Preparedness Plan to make vaccinations, testing and treatment even more widely available as cases surge. One feature of their plan jumpstarts a partnership with the U.S. Postal Service to mail free at-home COVID tests to households. The plan also calls for “additional resources to Community Health Centers and aging and disability networks to support COVID-19 vaccination efforts.”
The Biden Administration is concerned about a notable rise in COVID, flu and respiratory infections as winter sets in. The announcement comes on the heels of $350 million in one-time funding to health centers to boost COVID-19 vaccinations in their communities, with a specific focus on underserved populations. Health centers can use the funds to expand:
The funding will support vaccine administration of the updated COVID-19 vaccine, the COVID-19 primary series and/or other (e.g., influenza) vaccines. The expanded COVID funding allows health centers to continue efforts to form new or strengthen current on-the-ground partnerships with other entities to build vaccine trust and vaccine adherence. It is this particular aspect of health centers’ work that strengthens the public health infrastructure — filling health gaps, meeting people where they are and bringing preventive services to them.
Health centers have until Sunday, January 8, 2023, to submit information about planned activities and costs that the funding will support. There’s a technical assistance webpage for award submission guidance.
Health centers have played a pivotal role in fighting COVID-19 since the beginning of the pandemic. They have provided services to the nation’s most at-risk, medically underserved communities, administering more than 22 million vaccines, of which 70 percent have gone to patients who are racial and ethnic minorities.
Kristine Cecile Alarcon is the Communications and Storytelling Manager, Gabrielle Peñaranda is the Program Manager, Training and Technical Assistance, and Rosy Chang Weir is the Director of Research at the Association of Asian Pacific Community Health Organizations.
Community Health Centers that serve Asian Americans (AAs), Native Hawaiians, and Pacific Islanders (NH/PIs) provide innovative care for their patients. In an analysis the Association of Asian Pacific Community Health Organizations (AAPCHO) conducted earlier this year of federal data, we found that health centers serving AA and NH/PI communities have a higher proportion of patients with social risk factors than health centers across the nation.
Health centers serving AA and NH/PI communities have a higher proportion of limited English proficient, low-income, and Medicaid and publicly insured patients. AA and NH/PI health centers also provide a higher number of enabling services, which are non-clinical services that alleviate barriers to care of patients, or other non-clinical services that aim to increase access to health care and improve health outcomes. Enabling services allow for culturally and linguistically appropriate whole-person care, which can address the unique health disparities that AA, NH/PI, and other communities served at health centers face.
Asian Americans (AAs), Native Hawaiians, and Pacific Islanders (NH/PIs) have a wide variety of cultures, experiences, rich histories, and languages. People from the AA community have cultural roots from more than 20 countries in East and Southeast Asian and the Indian subcontinent. The NH/PI community are just as diverse with people having origins throughout the Pacific region, also referred to as Oceania, a geographically widespread region populated by people of diverse cultures and ethnicities across 14 countries and a sea of islands grouped into four geopolitical sub-regions. The sub-regions include Australia and New Zealand; Melanesia; Micronesia; and Polynesia. Despite this diversity, AA and NH/PI populations are often aggregated into one racial category, masking meaningful differences in health and social barriers to care between these subgroups.
AAs and NH/PIs are also the fastest growing racial group in the United States, Hawai’i, U.S. Territories, and Compact of Free Association Migrants (COFA) nations. Most AA and NH/PI populations can be found living in California, New York, Washington, Hawai’i, and Massachusetts. Between 2019 and 2020, AA and NH/PI populations had the largest growth (by raw numbers) in Florida, Kentucky, Virginia, Federated States of Micronesia, and Rhode Island. The states with the largest growth rate (by percentage) between 2019 and 2020 were Rhode Island, Florida, Arkansas, Federated States of Micronesia, and Alaska.
According to AAPCHO’s analysis of the 2020 Uniform Data System (UDS), AA and NH/PI-serving health centers provide innovative care for their patients. Key findings show that
The innovative care AA and NH/PI-serving health centers provide, like enabling services, can incorporate culturally and linguistically appropriate whole-person care. With whole-person care, providers can address the unique health disparities that AA, NH/PI, and other communities served at health centers face.
Providing whole-person care is essential in addressing chronic and infectious conditions. Nationally, 36% of adult health center patients live with diabetes, and 21% live with hypertension. According to AAPCHO’s UDS data analysis, 25% of AA, 40% of NH, and 43% of PI patients are living with diabetes while 41% of AA, 45% of NH, and 46% of PI patients are living with hypertension. NH/PI patients have the highest rates of chronic disease, which can be largely attributed to socioeconomic disparities, structural discrimination, and pre-existing conditions.
For tuberculosis rates, NH/PI communities have the highest incidence rate (18.7 cases per 100,000 persons), while AA communities have the second highest rates (13.3 cases per 100,000 persons) across the nation. According to UDS data, the average tuberculosis rate was 3.0 cases per 100,000 persons at health centers across the nation. AA and NHPI-serving health centers also serve higher rates of hepatitis B patients compared to the national average with 3.4 cases per 100,00 persons for AAs and NH/PIs, 2.1 cases per 100,00 for NH/PIs. The average hepatitis B rate at health centers across the nation was 1.7 cases per 100,000 persons. These disparities demonstrate the unique health experiences that AAs and NH/PIs face and the need to provide whole-person care to provide unique and tailored care for AA and NH/PI patients.
Given the unique experiences of the widely diverse AA and NH/PI population, AAPCHO recommends:
This blog post is a summary of AAPCHO’s full report. For more information, listen to AAPCHO’s webinar. Stay connected with AAPCHO’s newsletter, Facebook, LinkedIn, Instagram, and Twitter as an analysis of the 2021 UDS data will be released in summer 2023. To learn more about AA and NH/PI-serving health centers, visit www.aapcho.org.
AAPCHO is a national association of community health organizations dedicated to promoting advocacy, collaboration and leadership that improves the health status and access of Asian Americans, Native Hawaiians, and Pacific Islanders in the United States, the U.S. territories, and Freely Associated States.
Access to eye care is out of reach for many Community Health Center patients around the country. The New England College of Optometry (NECO), which is celebrating 50 years of training students and serving patients in health centers throughout Massachusetts, is trying to change that statistic. As the first optometry school to conceive and create such a clinical training model, NECO has influenced thousands of optometrists and optometry itself. NECO has provided over 1 million eye exams in community health centers since 1972.
In our 2022 Chartbook, NACHC reports that, while dental services are offered in 82% of all health centers, only 25% of health centers offer eye care services. This highlights the problem of limited national eye care access for marginalized populations.
“I am so proud of NECO’s legacy in developing new optometrists to provide equitable eye care to the underserved in our communities,” saysDr. Amy Moy, the current Director of NECO’s Health Center Network and Chief Compliance Officer.
“We do not look at our patients as walking sets of eyeballs! We see them as people who need to see to achieve what they need to in their daily lives. Our work is about seeing the whole person. In helping them, we can positively impact our communities.”
– Dr. Amy Moy
Dr. Amy Moy leads the NECO Clinical Network, nurturing and managing partnerships with community health centers and many other community care locations. NECO believes community-based clinical training is essential to developing culturally competent eye care providers and it also fulfills NECO’s commitment to expanding access to eye care.
“It’s the student who has had perpetual headaches and has not found the right doctor to realize that they have eye focusing issues preventing them from performing well in school.
It’s the middle-aged woman who has had headaches for months for which ibuprofen does nothing, and her optometrist listens to her, and does more testing to find a brain tumor.
It’s the elderly man who comes in without money for his next meal, not to mention his glasses, and we are able to provide him with both food and glasses with good old-fashioned health center teamwork.
And it’s the little 4-year-old girl who just arrived from another country, who turns out to have high myopia, and when we put on her glasses, her little face breaks into a giant smile, and your heart just melts.”
In 1972, NECO developed a model of training the next generation of optometrists in the health center setting. The idea was to generate more eye care access and raise future optometrists interested in public health and viewing optometry as a vital part of the interdisciplinary healthcare team.
This new clinical training model moved optometry education beyond refraction and on-campus clinical experiences into a new educational realm: multidisciplinary co-management of patients with other healthcare professionals in a community-based setting.
“NECO chose a wise path: to go to the people, where they lived, and where they sought care and other services,” said Roger Wilson, OD, who spent 33 years at NECO expanding its affiliations with the health centers and working in their communities.
Dr. Moy often says: “NECO goes to the people, instead of the people coming to us. This allows us to serve the community while training our students in diverse populations and with diverse ocular conditions.”
Coincident with NECO’s educational mission was a commitment to provide eye care services to underserved communities. In 1972, NECO established the first formal clinical training agreement with Dorchester House. A year later, it signed agreements with The Dimock Center and South End Community Health Center.
From vision screenings to patient care in community health centers, NECO students start their clinical training within the first few weeks. Relationships with community organizations and health centers make it possible to expand access to care while providing top notch clinical training.
By transforming what traditionally was a micro-focus on the eye into a macro view of the health of the whole patient, the NECO and health center collaborations ensured that students gained mastery not just in fundamental skills, but also in the critical thinking needed to competently diagnose, prescribe, and treat any type of optical patient or condition they encountered, in any type of clinical setting they choose, anywhere in the world.
The opportunity to work alongside other healthcare professionals as peers did more than help change the practice of optometry itself: it raised the level of recognition and respect the profession received.
Today, NECO offers residencies at 14 different community health centers and Veterans Administration (VA) medical centers. NECO students also receive training and externship opportunities through a diverse list of affiliations with teaching hospitals such as Tufts Health Center and Boston Children’s Hospital and with organizations like Perkins School for the Blind, Seamark Vision Clinic at the Cotting School, Pine Street Inn, Army & Navy Health Clinics, and Boston Public Schools.
NECO now requires students to complete at least one rotation at a community health center and one VA center to graduate. Students embark on their optometric careers knowing what it’s like to be part of the community and to provide vital eye care services to its members. They learn critical skills in diversity, social determinants of health, and cultural humility and competence. Many change their career aspirations toward multidisciplinary, medical-based optometry or even decide to practice at community health centers.
The impact on neighborhood residents has been just as positive. NECO clinics in CHCs enhance access to vital eye care services for thousands of patients every year – at lower cost and closer to where they live and work.
What NECO started 50 years ago has changed optometry education today:
“We have the ideal stage in our health centers to teach NECO’s students about culturally competent eye care and social determinants of health, as well as how to advocate for equitable healthcare for all,” says Dr. Moy. “I look forward to working with NACHC and other organizations to further develop eye care access across the country, and to train more optometrists to seek community health careers in the future.”
While Community Health Centers are valued as the nation’s largest primary care network, little is known about the ways they are often a major source of innovation in healthcare and support services. At NACHC, we lift up their innovations through initiatives like the Center for Community Health Innovation and our new Clinical Innovation Showcase.
For our first Showcase event this fall, 28 health centers, Primary Care Associations (PCAs), and Health Center Controlled Networks (HCCNs) submitted applications. We sponsored this Clinical Innovation Showcase with Community Health Ventures as a platform for clinical care teams to share unique and impactful initiatives designed to reach Quintuple Aim goals: improved health outcomes, improved staff and provider experiences, lower costs, and health equity.
With so many impressive programs to choose from, we are pleased to highlight our top three winners: AllianceChicago, AltaMed, and Oak Orchard Health. Each received complimentary travel and conference fees to the Financial, Operations Management/Information Technology (FOM/IT) conference in October 2022 and were acknowledged with an award during the Clinical Innovation Showcase ceremony. As a first-place award, AllianceChicago received $10,000 to support their award-winning clinical innovation.
View all the competition submissions targeting improvements in data, technology, informatics, care teams and the workforce, health equity, partnerships, virtual and curbside care. Keep an eye out for next year’s application opportunity.
We also want to thank Baxter Health, BlueStar Telehealth, and McKesson Medical for their sponsorship.
Child Health Engagement and Coaching Using Patient Centered Innovation (CHEC-UP)
AllianceChicago partnered with Tapestry 360 Health and QliqSOFT to pilot a project that used chatbot technology to optimize and deliver messages to families about the importance of well child visits and up-to-date vaccinations to increase the completion rate of these services. Using QliqSOFT’s customizable AI chatbot platform, “Quincy”, texts and emails in either English or Spanish launched a chatbot dialogue with nearly 250 parents through Tapestry 360 Health. Parents were reminded of well child visits and immunizations that were due, were engaged with evidenced-based child health educational resources prior to appointments, could ask questions, and could schedule appointments online or by phone.
As with many preventative screenings the COVID-19 pandemic led to a decrease in CRC screenings. This was already a challenge for many AltaMed’s Latino/a patients due to a lack of transportation and rigid shift work schedules. In response, AltaMed designed an innovative end-to-end workflow and CRC screening outreach strategy that enabled the health center to directly communicate with patients to encourage colorectal cancer screenings. The health centered distributed 7500 free home colorectal screening tests and supported the distribution with a multi-channel texting and video campaign that included educational animated fotonovelas, and high-touch patient navigation strategies to increase rates of CRC screenings and abnormal test follow up among Latino/a patients, age 46-69.
Mommy and Me Healthy We Will Be
Oak Orchard Health’s behavioral health team created its Mommy and Me Healthy We Will Be program to support new moms and babies as a team. Their aim was to help achieve optimal maternal and child health and normalize conversations around postpartum depression and anxiety. This program integrates behavioral health care managers into the pediatric care team. Each care manager attends well child visits starting with the first visit after delivery through age five. During child well visits, care managers screen moms for depression, anxiety, substance use, and social determinants of health barriers. They also conduct developmental screenings using the Ages and Stages screening tool, and track adherence to immunization schedules and well child visits. Assessments inform needs for other health center services, or services from external partners. Parents can also access a diaper bank and early childhood literacy resources. Mommy and Me Healthy We Will Be is designed to be sustainable and replicable by incorporating several revenue streams, including billable evidenced-based assessments and increased referrals to other in-service lines.
