A System And a City Collaborate To Care For an Immigrant Population
Ms. Bauer is project manager, Southwest Community Health Clinic, Houston.
Summary
The Southwest Community Health Clinic (SCHC) has been providing free preventive healthcare to the poor residents of its Houston neighborhood since June 1991. Sponsored by the Sisters of Charity of the Incarnate Word Health Care System and the city of Houston, the clinic invites healing through hospitality, unlike many free clinics.
The family-focused clinic takes a multidisciplinary team approach to preventive healthcare. The staff of approximately 30 healthcare professionals provides prenatal and pediatric care; immunizations; tuberculosis screenings; and a variety of social services for patients' physical, emotional, and spiritual needs.
SCHC's well-child program screens children from birth through age five for physical and developmental problems. Clinic staff teach and guide parents on their children's health. The program stresses early identification of developmental delays and disabilities, with referral to appropriate services.
SCHC has also implemented a tuberculosis testing program to prevent spread of the disease. Persons who test positive are referred to the City of Houston Department of Health and Human Service's chest clinics for follow-up and treatment.
Community outreach is a major ingredient of SCHC's preventive healthcare program. A community health advocate, who is familiar with the cultures, traditions, and languages of the population being served, identifies families needing care and supports their access and use of healthcare services.
Rosa Molina smiles at her infant son Angel Ariel as they wait for Angel to be immunized at the Southwest Community Health Clinic, sponsored by the Sisters of Charity of the Incarnate Word Health Care System and the city of Houston. Smiles come easily to her now, but not long ago she was afraid and in pain.
When Rosa was five months pregnant, she experienced stomach pains. At a public health clinic located near her Houston home, Rosa spent an uncomfortable 14 hours waiting for medical attention. This was her first pregnancy, and she feared something was terribly wrong with her baby.
"I didn't like the way I was treated," Rosa offers quietly. "I had to wait so long and I was scared and I hurt."
Fortunately, she and her baby were healthy. But she vowed never to repeat the experience.
At Southwest Community Health Clinic, "we get prompt, personal attention," Rosa says. "There are a lot of people living in this area of Houston without resources for good medical care. Now there's a place where they can come."
Since June 1991, poor persons living in southwest Houston have received free preventive healthcare in a place where staff treats them with respect, listening to and understanding each person's needs. That place is Southwest Community Health Clinic (SCHC), sponsored by the Sisters of Charity of the Incarnate Word Health Care System (SCH) and the city of Houston. Unlike many free clinics, SCHC invites healing through hospitality.
Community Needs Assessed
The impetus for the clinic came from thousands of miles away. While working in El Salvador and Guatemala, members of the Sisters of Charity religious institute learned that many persons from these nations were emigrating to southwest Houston. These women religious in Latin America asked congregational members in southwest Houston to complete a needs assessment. SCH then teamed up with the Southwest Houston Task Force, a group of community leaders and volunteers, to assess the needs of the community.
The neighborhood in question is the 3.2 square-mile Gulfton community. The needs assessment determined that during the 1970s and early 1980s young professionals inhabited Gulfton's many apartments. When economic hard times hit Houston, Gulfton residents moved out, leaving a glut of apartment space that became low-income housing and attracted poor immigrants from Mexico, Central America, Africa, and central and eastern Asia. But because previous residents had no need for social services, they were not available. Preventive and primary healthcare were also unavailable.
As a result of the findings of this assessment, SCHC was established. The clinic is located on the site of a former physician office complex. The family-focused clinic takes a multidisciplinary team approach to preventive healthcare. It is staffed by approximately 30 professionals. Many speak Spanish; a few can speak African or Asian languages. Physicians, certified nurse midwives, pediatric nurse practitioners, registered nurses, licensed vocational nurses, a social worker, a nutritionist, a community health advocate, eligibility and intake workers, medical assistants, appointment registration clerks, and medical record clerks staff the clinic.
Services Offered
When SCHC opened, it offered prenatal care to help reduce infant mortality rates among a growing indigent and predominantly minority population. Today SCHC offers pediatric care and provides immunizations; tuberculosis screenings; and a variety of social services for patients' physical, emotional, and spiritual needs.
Between June 1991 and June 1993, SCHC logged in approximately 44,350 patient visits— 32,000 for prenatal and 12,350 for well-child care. SCHC has performed approximately 37,500 immunizations and tuberculosis skin tests.
Unlike many public health clinics, SCHC takes appointments so that patients do not have to wait for hours to see a medical professional. Only immunizations are handled on a walk-in basis. Unfortunately, because SCHC has become so popular, patient waiting times have increased, and it takes longer to get an appointment. For example, expectant mothers now wait about four to six weeks for their first prenatal appointment, while families wait at least six weeks for well-child appointments.
Well-Child Program
Before SCHC opened, there was no well-child program in southwest Houston. Because many low-income children were not routinely screened, problems often were not discovered until children began school.
The clinic's well-child program screens children from birth through age five for physical and developmental problems and provides them with immunizations. Clinic staff teach and guide parents on their children's health. The program stresses early identification of developmental delays and disabilities, with referral for appropriate services.
SCHC has referred children to other community programs for hearing, vision, and speech problems; developmental delays; orthopedic problems; dental problems; failure to thrive; cancer; and many other chronic and acute diseases and conditions.
SCHC's immunization program serves southwest Houston residents of all ages because prevention of vaccine-preventable diseases depends on immunizing the entire population. Southwest Houston experienced an unusually high number of measles cases in 1988-89 partly as a result of the large number of unimmunized preschool children. For this reason, SCHC's well-child health and immunization programs place special emphasis on immunization of preschoolers.
Tuberculosis Testing
Compared with the population countywide, residents of southwest Houston have a lower socioeconomic status and hence crowded living conditions, less access to healthcare, and lack of nutritional knowledge. In general, this population has a higher incidence of positive tuberculosis tests than other groups in the county.
To prevent spread of the disease, SCHC has implemented a tuberculosis testing program that identifies the incidence and refers for treatment. Persons who test positive are referred to the City of Houston Department of Health and Human Service's chest clinics for follow-up and treatment.
Before SCHC opened, Houston's mobile immunization van served as a full-time site for tuberculosis testing for southwest Houston, but there was no permanent, full-time site for immunizations and tuberculosis testing.
Community Outreach
Community outreach is a major ingredient of SCHC's preventive healthcare program. A community health advocate, who is familiar with the cultures, traditions, and languages of the population being served, identifies families needing care and supports their access and use of healthcare services.
Posters, flyers, and community-wide advertising help inform the southwest community that the clinic exists and what services it provides.
In addition, the Southwest Community Health Clinic Advisory Board meets bimonthly to provide input on community needs and affairs. It consists of 12 to 15 area residents who are involved with the clinic, are community leaders, or have some knowledge of the community. Members include representatives from area schools, churches, agencies, the health department, and the clinic, as well as three clinic patients.
Collaboration
To finance the start-up of SCHC, the city of Houston awarded a fee-for-service contract, which amounted to approximately $662,000. The Sisters of Charity religious institute supplied an additional $756,000 grant. The city's contract is renewed each year, and the Sisters of Charity annually commits approximately $645,000 for the clinic's operation.
The successful collaboration between the Sisters of Charity and the city of Houston already is apparent primarily because the facility is meeting needs that were not addressed in the area before 1991. SCHC's staff and the city of Houston's staff share information and resources to facilitate the delivery of healthcare services. Jointly, the two conduct special events to promote public health services. This is the first public-private joint preventive health venture in Houston.
The clinic's success can also be attributed to sincere and comprehensive collaboration with other organizations. For example, an essential element is the clinic's cooperation with the Harris County Hospital District whose hospitals, Ben Taub and LBJ, deliver a majority of babies born to SCHC patients.
The hospital district supports the clinic by providing diagnostic ultrasound services and obstetric care for SCHC's high-risk patients. The clinic also contracts with Baylor College of Medicine's Midwifery Program, which provides midwives who deliver prenatal care and consulting physicians who supervise the midwives.
Cooperation with the Texas Gulf Coast Chapter March of Dimes resulted in a grant to help implement the Baby Buddy program, a support group of expectant mothers. The women who participate in the program take classes, form friendships, and establish relationsips with other community assistance agencies.
The clinic also collaborates with:
- The Child Abuse Prevention Network, which provides education to the public regarding the relationsip between drug abuse and child abuse
- The Houston Area Women's Center, which provides a family violence counselor
- The Texas Department of Human Services, which provides a full-time Medicaid eligibility worker
- The Harris County Hospital District, which provides two full-time eligibility workers to help patients obtain access to the hospital district's services.
SCHC's Future
Word of SCHC has spread quickly throughout the southwest Houston community. The combination of successful community marketing and a satisfied client base are now straining existing clinic capacity, increasing the amount of time clients must wait for appointments and for care once they have an appointment.
SCHC has asked the city of Houston to expand the preventive healthcare facility to accommodate more patients and provide additional needed services, such as prenatal and well-baby care.
Until the facilities can be expanded, SCHC staff will strive to provide high-quality care with hospitality and concern for meeting the specific needs of the patient population it serves.
Project Access
Houston's underserved are not taking full advantage of the city's free or discounted healthcare services, according to a recent community needs assessment by St. Joseph Hospital, a member of the Sisters of Charity of the Incarnate Word Health Care System.
In interviews with community leaders, social workers, healthcare providers, and residents of low-income neighborhoods, the assessment team identified many barriers to healthcare, including lack of transportation, language barriers, fees for services, lack of information about services available, and eligibility requirements.
As a result, the underserved frequently have a higher incidence of disease. Many of these diseases can be prevented through immunizations or healthier life-styles.
St. Joseph Hospital has created a program to bridge the gap between the underserved and those who serve them. Project Access is being piloted in Port Houston, a neighborhood on the city's east side. Port Houston is a good pilot site for the program. It is miles from the nearest healthcare facility. Many residents do not speak English and rarely venture out of the neighborhood.
St. Joseph's Community Outreach Coordinator Esmeralda Cervantes says Project Access is a collaborative effort involving nearly 20 not-for-profit organizations and neighborhood residents.
"We've trained nine residents to serve as 'health information extenders,'" says Cervantes. "They're serving as liaisons between their neighbors and the participating healthcare agencies."
Since it began in October 1992, Project Access has already made a difference in Port Houston. Its health information extenders arranged for the inoculation of 300 youngsters, signed up 24 people for English-as-a-second-language classes, and gave 120 parents the latest information on preventive medicine.
Cervantes says much of the health information extenders' time is spent answering questions. "Maybe someone heard about the Women, Infants, and Children's program but isn't sure how it works. The health information extenders can help them access this service."
Project Access is St. Joseph Hospital's annual mission project for the underserved. Whereas past projects provided services for the needy, Project Access is a collaborative program involving the people being helped. Rather than managing the care for them, Project Access teaches the underserved how to manage their own healthcare needs.
Robert Cahill
Public Relations Writer
St. Joseph Hospital
Houston