BY: DAVID J. WARD
Mr. Ward is president and CEO, Daughters of Charity Services of New Orleans.
A Community Health Ministry
Evolves in New Orleans
"When one door closes, another opens." This has certainly been the experience of Daughters of Charity Services of New Orleans (DCS-NO). When in 1992 Daughters of Charity National Health System-West Central Region (DCNHS-WC) sold its Hotel Dieu Hospital in overbedded New Orleans to the state of Louisiana, which used it to replace its "Big Charity Hospital," community members were apprehensive about the loss of a Catholic acute care presence. But now, supported by the funds from the sale, DCS-NO has turned its ministry to community health services—reaching out to people in the most challenged neighborhoods and filling gaps where the current system was not meeting needs. DCS-NO is modeling new approaches to creating healthy communities by working in collaboration with the full community.
An Identity in Transition
After the sale of Hotel Dieu Hospital the Daughters of Charity had to find a way to make a significant difference in the health of the community through ways other than acute care. Sr. Nannette Gentile, DC, visitatrix of the province, delivered a clear, simple charge: "Be concerned about what will most improve the health of the community, especially the poor." After almost a year spent studying community needs and assets, and our own strengths and weaknesses, three areas in which to concentrate our efforts emerged:
- Access Our goal is to improve the availability of services in underserved areas, make services affordable for the poor or uninsured, and break down cultural barriers.
- Prevention We focus on the early detection of disease to reduce high mortality and morbidity rates in underserved areas of New Orleans for cancer, heart disease, diabetes, and sexually transmitted diseases. We work to prevent disease through education and training aimed at helping people move out of poverty.
- Collaboration We extend our resources by supporting others' efforts and act as a catalyst for partnerships that integrate the services of different agencies. We also work to build community, especially among other agencies of the Church.
Organizational Realignments
The second and third fiscal years after the hospital's sale, the organization approved $3,827,000 in grants. Approximately half that amount supported health initiatives of other community organizations; half was invested in renovations to bring health and social services to underserved neighborhoods. In the fourth year, two new organizations replaced the hospital corporation: DCS-NO, which receives priority funding to develop a ministry of community health services; and the Daughters of Charity West Central Region Foundation, which continues to award grants and solicits quarterly grant applications from individual Daughters of Charity affiliates in the 11-state region.
A Community Health Ministry
Two of the initial grants from Hotel Dieu Hospital have grown into ongoing programs of DCS-NO, while two other programs resulted from the assessments of the greatest needs. The programs that constitute the Daughters of Charity's new community health ministry are:
- Daughters of Charity Health Center at Carrollton
- Neighborhood Health Partnership
- Seton Resource Center for Child Development
- Vincentian Ministries
Primary Care for Carrollton
In 1991 a citywide coalition identified the Carrollton area of New Orleans as an area of the city with poor access to primary care. Carrollton includes six neighborhoods, one of which is Gerttown, an impoverished area with a high percentage of substandard or abandoned houses.
At the time of the 1990 census, the median household income for the Carrollton area was $15,218. Forty percent of the 24,000 residents do not have health insurance, and half of the 30 percent eligible for Medicaid are not enrolled. The area has been described as a "back end of town," and has been left out of federally funded initiatives such as Healthy Starts. Residents must take a series of buses to reach medical care.
DCS-NO has leased and renovated an 8,200-square-feet storefront in the Carrollton Plaza Shopping Center, where two national retail chains recently closed stores. Here we opened the Daughters of Charity Health Center at Carrollton in February 1997. The center offers on-site physician services, a licensed retail pharmacy, a laboratory, and x-ray services. The Daughters of Charity Foundation has designated approximately $1 million annually to fund the sliding scale fee system offered to uninsured individuals for clinical and pharmacy services. Clinical protocols encourage each client to visit with our nurse educator and social worker. Management and prevention are priorities.
The health center has become an educational site, as well. Students from seven schools of medicine, nursing, pharmacy, and public health receive part of their training there from the physicians, all of whom are board-certified and hold appointments to the teaching faculty of Louisiana State University School of Medicine.
The center works closely with the Breast Health Cooperative, which is funded by Hotel Dieu Hospital, the National Cancer Institute, and the state office of public health. In this program, lay community outreach workers teach breast self-examination and risk-reduction behaviors throughout the Carrollton area. The health center provides clinical services, including on-site mobile mammography arranged with a local hospital.
An Emphasis on Holistic Care
Given the space constraints of the health center's storefront location, DCS-NO sought a sister site nearby to provide social services. At a former Catholic school a mile away, the Archdiocese Office of Social Apostolate (OSA) operates a Head Start program for 70 children and a social/meal club for 75 senior citizens, distributes food for 2,000 area families, and provides emergency assistance.
In October the Vincentian Ministries joined this site, where 4,000 square feet of renovated space on the second floor of the former school now house a counseling center and a learning center. Individual and group counseling are done in collaboration with Family Services of Greater New Orleans and the Children's Bureau. Vincentian Ministries also offers training in computer skills, a youth program, and programs to help people make the transition from welfare to work. As with our other collaborative programs, a cosponsors' council meets periodically to update the strategic plan, devise ways to improve client access, write grants, leverage collective budgets, and support one another's ministries.
Neighborhood Health Partnership
The Neighborhood Health Partnership (NHP) evolved from a collaboration with Catholic Charities of the Archdiocese of New Orleans to better integrate health and social services in underserved areas of New Orleans. Our goal was to implement the principles that the Catholic Health Association and Catholic Charities USA had articulated for an integrated delivery system. We invited the OSA to be the third partner. Each agency brought key assets. Catholic Charities and OSA operated eight neighborhood social service centers, and Catholic Charities offered the services of its health education department. DCS-NO contributed its healthcare expertise.
The NHP provides health screening, health risk appraisal, immunizations, health education and counseling, case management, and wellness programs for the neighborhood centers' 15,000 clients. We have expanded these outreach services to 10 other schools, churches, shelters, and social service centers near the archdiocese's centers. The annual budget is approximately $500,000.
Recently the NHP was named a corecipient of a $450,000 grant for an integrated mobile assessment and treatment team to serve homeless individuals. The partnership is a participant in the CHA and Catholic Charities USA Neighborhood-Based Senior Care National Initiative, funded by the Retirement Research Foundation (see Health Progress, July-August 1997). The NHP was also included in the U.S. Public Health Services' 1996 compendium, Models That Work.
School-Linked Health Services
Seton Resource Center has implemented child development services at Catholic elementary schools. The program is cosponsored by the Sisters of Mercy Health System-St. Louis, the Sisters of Charity Health System-Houston, the Vincentian Fathers, DCNHS-WC, and the Archdiocese School System.
This behavioral health program includes behavioral screening, individual and group counseling, personal safety training, and self-esteem and leadership skills development. The Seton Resource Center administers the program in four Catholic schools, while Mercy Family Center administers it in four others. Three schools of social work place their students at the schools, and graduate students extend the capabilities of full-time staff.
Another school-linked service was originally funded by Hotel Dieu Hospital, which awarded the Louisiana State University School of Nursing a grant to implement a pilot employee health program at a Catholic elementary school. The District Nurses Association also provided funds. Nursing students and faculty members at the school conducted health risk assessments, health screenings, health education programs, school safety inspections, and wellness classes. The YWCA conducted exercise classes as part of a weight-control program.
The Daughters of Charity Foundation has renewed this grant, and DCS-NO is working with LSU to expand these preventive health services to three of the schools where Seton Resource Center has implemented its behavioral health program. Hotel Dieu Hospital also awarded a grant to the Redemptorist Fathers to expand their peer mentoring program to two high schools in New Orleans.
A Promising Beginning
The sale of a hospital does not have to mean the death of a ministry—it can be the moment of its rebirth. Urged by the charity of Christ, the Daughters of Charity and their collaborators will continue to work to meet the needs of the poor.