Since the passage of the Affordable Care Act, community clinics have played an important role in providing primary care for millions of newly covered Americans. In Los Angeles, nonprofit community clinics and health centers have drastically expanded their services to meet this new demand for care, growing from 1.2 million patients in 2010 to 1.5 million in 2015. But as Congress debates the future of the Children’s Health Insurance and programs supporting community health centers, LA’s clinics face an uncertain funding future.
While there have been major gains in access to care, there still remain significant socioeconomic disparities among Los Angeles residents, which in turn impact their health care needs: 16.6 percent of the County’s more than 10 million residents live below the federal poverty level, and households living below poverty in LA are more likely to experience food insecurity (41.1 percent). Nearly 60,000 individuals in LA are currently homeless, a 23 percent increase from 2015 to 2016, while 4.8 percent of county residents report being homeless or not having their own place to live or sleep in the past five years. Over one-fifth of adults in LA report that they have no usual source of health care, and 21.5 percent report their health to be fair or poor, compared to 16.8 percent nationally.
Docs use new tool to track social determinants
To understand how such social determinants are shaping their patients’ health, two LA clinics are piloting a new screening tool that assesses risk factors beyond mere health status. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences tool feeds information on housing, job security, and education into a clinics’ electronic health record system.
Bessie Mathew, program manager at Venice Family Clinic, said the project gives her providers a way to ask patients questions about the social factors driving their health. At her clinic, a patient navigator is currently exploring how to best ask difficult questions. For example, asking questions around stress or topics such as domestic violence or substance use may be difficult, so the navigator would try to frame the questions in a way that would make respondents feel more comfortable answering.
“Identifying and addressing these determinants are part of our strategic plan, as we really want to figure out how to make an impact within our organization and community,” Mathew said.
Venice Family Clinic plans to use the data they gather to figure out which areas to focus on, based on highest need and biggest impact on health. It also helps them connect patients to services, letting patients know, for example, about behavioral health services, health insurance programs, or health education programs.
Clinics find way to provide housing, food, and legal help
Several clinics across Los Angeles County are working to connect their patients with housing. Without affordable, stable and safe housing, individuals are hard pressed to maintain or improve their health status. For example, refrigeration is vital for medicines and access to a clean environment to help wounds heal.
On Skid Row, L.A. Christian Health Center (LACHC) and the Skid Row Housing Trust are collaborating to build a 25,000-square foot state of the art housing and health care complex in the heart of downtown Los Angeles, called the Joshua House Health Center. Homelessness increased 23 percent in L.A. County in 2016, and the 54-block area of Skid Row is the epicenter, with the largest concentration of homeless and highest number of unsheltered homeless.
Focused exclusively on serving people who are homeless or in public housing for over 20 years, L.A. Christian Health Center has developed numerous approaches to addressing social determinants of health. The center focuses on partnerships with social service agencies, including shelters, rehab programs, substance use programs, food and transportation assistance, and job placement services.
Social workers and case managers help patients navigate the obstacles to housing. During the waiting period, LACHC keeps patients as stable as possible by working with shelters, using vouchers, and getting individuals into wellness therapy groups. The work continues once patients get into permanent housing — they stay connected with case managers, ensuring that individuals are engaged in medical, dental, mental health and substance use services. All are vital when it comes to retaining housing and staying connected to the broader community.
Many clinics are also partnering with legal services agencies to help patients address issues of tenant rights, immigrant rights, discrimination, and public benefits. In South LA, St. John’s Well Child and Family Center partnered with Neighborhood Legal Services to provide onsite assistance. In San Pedro, Harbor Community Clinic partnered with Catholic Charities to host a naturalization workshop for patients who want to become U.S. citizens.
Getting patients access to healthy food is another big challenge. In the San Fernando Valley, the San Fernando Community Health Center hosts cooking classes for their patients, as well as for other community partners. Foods prepared in these classes all come from low-cost foods available in the local grocery store. Participants review not only the recipe, but also the receipt. Designed for diabetes wellness and care, the goals of the cooking class program are to help diabetics learn how food choices prevent or treat the disease, and to give useful skills for meal preparation that can be tailored to their cultural preferences.
Dr. Lisa Abdishoo, President and CEO of L.A. Christian Health Center, says such community health centers are in a unique position to help patients deal with the social factors that may be hurting their health.
“As our staff work with patients, they see the outcomes of social inequities that are a part of poverty every day, including housing instability, food insecurity, violence, and educational disparities, so we are already in the heart of these issues right from the start – it’s who we are as organizations.”
[Photo by Ryan Vaarsi via Flickr.]