HEALTH EQUITY
This is how our Community Health Workers ( CHW ) approach their work : Pauline , a Family Health Centers CHW who works with East and Central African immigrants , was asked to assist a pregnant client , Anna * with transportation concerns . While Anna could walk to her primary care physician , as her pregnancy progressed , she needed to ride the bus downtown for her obstetrics visits , and she had already missed several appointments . When Pauline met Anna , she learned that she initially had taken the bus , but had grown scared after an early morning assault at a bus stop . Furthermore , Anna was fearful of getting lost in the large buildings downtown and did not know how to use the elevators . Pauline spent time establishing trust with Anna , then drove her to a prenatal appointment . On the way there , Pauline followed the bus route and talked with Anna about the various stops , taking time to observe all of the people out and about during the daylight hours . Once at the office building , she gave Anna an “ elevator lesson ,” pointing out the first number as a clue to the floor , and the star button for finding the main level . They discussed asking for help as well . After the prenatal visit , Anna was able to find her way through the building , get to the bus and successfully ride home by herself . Since then , she has been navigating her way to her medical visits on her own . It took a substantial amount of time and effort for Anna to access the care she needed . This is what it takes to remove barriers and move towards equity .
At Family Health Centers , we recognize that to support patients and achieve desired health outcomes , we must look at patients holistically and consider all facets that are contributing to the health issue . We work as an interdisciplinary team of medical care providers , behavioral health providers , social service supports , interpreters and a variety of other helping professionals . We train all our new hires in trauma-informed care principles to give them knowledge to better understand our patients ’ pasts and tools to be resilient caregivers .
In recent years , Family Health Centers has been successful in receiving grants to help support community health workers , patient navigators for HIV care and prevention , and care coordinators for families needing help accessing early childhood development resources . We also have behavioral health assistants , peer support specialists and homeless outreach workers to help patients and clients work through the myriads of issues they face . Other enabling services include on-site kynectors ( through kynect – a program of the Kentucky Cabinet for Health and Family Services ) to help community members obtain Medicaid coverage or other insurance options . The Doctors & Lawyers for Kids group provides pro-bono legal services to families with children for civil issues like landlords who refuse to abate mold , or domestic violence protective orders . We have partnered with Dare to Care Food Pantry since 2018 to offer the Prescription Pantry and the Rx Pantry programs to provide access to healthy options for our many food-insecure patients . Our Health Education department focuses on eating better , exercise , chronic disease management and lactation support . We are grateful to have these additional resources , but they are not guaranteed or reimbursed enough . While some CHW services are now Medicaid reimbursable , the holistic model that supports community-based interventions , as what Pauline provided to Anna , remains dependent on grants . Grants currently run on two-to-three-year cycles and can be population- or service-specific . Language support services costs for Family Health Centers now exceed $ 1.5 million annually . Often , the math does not add up to provide the care we know is needed .
On the face , it appears that we have everything our families need to be successful in their health journeys , but the reality of individual situations is often much more complex , making our efforts feel Sisyphean . When John ,* an 80-year-old , long-time patient was facing eviction , our case management team stepped in to try and help . “ This was an all-hands on deck kind of situation ,” stated Davis . “ We try to pull in other agencies that can help to get evaluations done , legal help , additional case management , but there are a lot of holes in the system where our patients don ’ t meet criteria for assistance , and we are met with radio silence .” Davis ’ team was able to secure housing for John and assisted in his transition , but his situation was similar to many on the precipice of homelessness or other immediate crises . “ If you aren ’ t tech savvy , have trouble speaking the language or have difficulty getting yourself to appointments reliably , you are going to need help .” Our Refugee Care Coordinator at Family Health Centers spends a significant part of her day helping clients navigate Medicaid ’ s nonemergency transportation system . “ Transportation is a benefit under Medicaid but it is only useful if clients can access it ,” said Liz Edghill , Director of Refugee & Immigrant Services . “ The phone-tree is in in English , and there is a specific window of time in which to schedule rides . We offer this assistance because it doesn ’ t benefit anyone if our clients can ’ t get to the specialty appointments we make for them . But it takes ongoing effort .”
Health equity is a foundational principle of the work of community health centers . We have built our sites and services to reach the most vulnerable in our community – the homeless , refugees , those living in poverty . But the reality is that many in our community need support that is far beyond what we are able to do . As of today , Sarah and her family are able to get their specialty appointments and are still working with our case managers to try and find more stable housing . “ I have a stack of charts of kids that need similar help . We do not have the capacity to help them all .” said Dr . Richerson .
* Patient and clients names have been changed . About Family Health Centers
Family Health Centers , Inc . is a not-for-profit community health center whose mission is to provide access to high quality primary and preventive health care services without regard to the ability to pay . We care for the health and wellness of our community through nine locations throughout Louisville Metro-Jefferson County . The Family Health Centers – Phoenix is a federal Health Care for the Homeless grantee , providing a variety of clinical , psychiatric , and social services to the region ’ s homeless . Wayside Respite Care provides acute medical care and support services to homeless individuals who need additional services once they are discharged form hospitals . The Family Health Centers – Americana houses a Refugee Health Program and serves a culturally diverse population of immigrants and refugees . Everyone is welcome here . Learn more at www . fhclouisville . org
Dr . Coole is a family physician and Chief Medical Officer at the Family Health Centers .
Melissa Mather is the Chief Communications Officer at the Family Health Centers . ( non-member )
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