By JULIE MINDA
WASHINGTON, D.C. — Many clinicians have adopted a "don't ask, don't tell" approach when it comes to patients' fundamental needs, such as food security, safe housing and affordable transportation in part because many clinicians find it overwhelming to address those needs, according to Health Leads Chief Executive Rebecca Onie. But, she told attendees at a pre-assembly forum, these elemental components of daily life are inextricably linked to health and health care outcomes and should not be ignored.
Rebecca Onie
Photo credit: Evelyn Hockstein/© CHA
During the June 7 "Pre-Assembly Sponsor Forum: Catholic Health Ministry: Charting a Path for a New Century," Onie explained how Boston-based Health Leads places navigators in public health clinics to help patients tackle socioeconomic barriers to health. The ministry is ideally positioned to replicate the approach, she said. "We need to ensure the most creative and mission-driven people in health care are coming up with the big ideas" to address the socioeconomic factors that are hurting people's health, said Onie, who was a MacArthur Foundation fellow. "And, these big ideas may be so radical that they just might work."
Onie's presentation centered on socioeconomic determinants of health. The Centers for Disease Control and Prevention defines social determinants in part as the circumstances in which people are born, grow up, live, work and age. Onie also spoke of the socioeconomic barriers that hold back people in need. She told the approximately 100 session attendees that while most doctors recognize that many of their low-income patients have challenges related to their socioeconomic status that may be impinging on their health, time-pressured physicians tend to avoid asking about needs they lack the resources to address.
Onie found her inspiration to tackle socioeconomic detriments to health when, as a law office intern nearly two decades ago, she was assigned to help low-income people resolve housing challenges. She learned the clients had numerous interconnected and complex problems in addition to their housing issues. Later, she convinced a Boston Medical Center department chair to allow her to talk with clinicians about their care for low-income patients. The conversations taught her about physicians' feelings of inadequacy when it comes to helping poor patients address concerns they faced around food, transportation, housing and other necessities.
She later connected with public health clinic trailblazer Dr. Jack Geiger — he is credited with helping to found the U.S.'s first community health centers — to establish her Health Leads approach, which places trained college student volunteers in the waiting rooms of public health centers. Clinic clinicians write "prescriptions" for food, heat and other basic resources, and patients take those scripts to the Health Leads volunteers, who direct them to community resources and help them apply for public benefits. Last year, nearly 900 of the navigators, called Health Leads Advocates, worked with 13,000 patients in seven cities nationwide.
Onie said the ministry can — and should — support clinicians in a similar way. To do this, she recommends integrating clinical and social service providers either by putting them in the same physical space or by establishing lines of communications between them, designating team members as social service navigators, putting in place technology systems to provide those navigators with the information they need, equipping them to follow up thoroughly with patients and using data and metrics to track progress.
Onie praised the assembled ministry leaders for Catholic health care's long tradition of addressing social determinants of health. She said by deepening their work in this area, they can continue that tradition and also prepare for the new demands of population health delivery models.
"This is deeply aligned with the values of Catholic health care," she said.