Covering the Spectrum of Community Need
It was a tough day at Union High School for Kim (not her real name). The freshman was coming down with some kind of bug, but didn’t say anything to her mom who, as usual, was racing to get Kim to school before she headed to work. A pediatrician’s appointment would have cost them both the whole day, with offices a long drive from their home in Grand Rapids, Mich. Kim struggled through her morning classes, feeling worse every hour. “Why don’t you go to the school clinic?” her friend asked.
“I didn’t know about the clinic until my friend suggested it,” Kim says. “It was really good to go.” Now a sophomore at Union, she also sees the health center’s dentist, as well as a counselor and a dietitian. “I can ask questions about my health and put the answers to good use,” she says. She is working with the dietitian to eat more healthfully and lose weight, and goes to counseling “to stay positive about school and problems at home. My counselor gives me good advice — and everybody there is easy to talk to.” Kim doesn’t have daily appointments but she pops by the health center every day anyway just to say hello. “I’ve told my friends about the clinic because I think it could help them like it’s helped me,” she says.
There are four such high school health centers in Grand Rapids, run collaboratively by Cherry Health (a federally qualified health center), the Grand Rapids Public Schools and Spectrum Health. The clinics are part of Spectrum’s larger School Health Program, a partnership with seven local school districts providing first aid, medication administration, immunizations, chronic condition management and disease prevention services to 29,000 students. The clinics are funded by the Michigan Department of Health & Human Services, the state department of education and Spectrum Health.
The School Health Program — and Kim’s story — exemplify the everyday victories achieved among the five programs that comprise Spectrum Health’s Healthier Communities Department. The department also operates and/or supports Community Partnership Health Care Programs, which provide free or discounted medical care to vulnerable local urban populations; Community Partnership Programs for Healthy Food; Community Partnership Programs to Create Healthy Lifestyles; and Core Health, a chronic-disease management program for at-risk area residents.
In recognition of Healthier Communities’ two decades of outreach services dedicated to improving the health of underserved Western Michigan residents, Spectrum Health was awarded the 2016 Foster G. McGaw Prize for Excellence in Community Service. As the 31st recipient of the prize, sponsored by the Baxter International Foundation, the American Hospital Association and its nonprofit affiliate, the Health Research & Educational Trust, the not-for-profit integrated health system will receive $100,000 to support and expand upon those efforts.
“Since 1997, Spectrum Health’s Healthier Communities has built the infrastructure, resources, community-based programs and services to reach the people who need care the most,” says John O’Brien, chair of the Foster G. McGaw Prize Committee. “Through impactful alliances with community organizations, Spectrum Health has shown incredible perseverance, patience and a vision to dramatically improve the health of individuals in their community and reduce health care costs.”
“I am so proud of our team and grateful for their collaborative work,” says Tina Freese-Decker, president of the Spectrum Health Hospital Group, which includes 12 hospitals, 180 ambulatory and service sites and more than 3,200 providers. “Everyone is focused on creating a culture of excellence.”
Healthier Communities’ Vice President Ken Fawcett, M.D., believes there are three chief reasons the department has been recognized. “First, we have a comprehensive list of programs that support people throughout life’s journey,” he says. “Second, the community health workers in our maternal-infant health and Core Health programs establish great trust with their clients, often mentoring them through first-hand experience. And finally, we know we can’t do this work alone.” Fawcett sits on four community boards, and meets individually with various stakeholders every week. “I consider other community leaders as friends and partners. In the end, we’re all trying to help those whose voices are not always heard.”
Healthier Communities was launched 20 years ago with a three-pronged focus on reducing infant mortality and disparities in maternal-infant health; improving children’s health; and preventing and managing chronic disease among those living in its 13-county service area. Spectrum Health dedicates $6.8 million each year to the department.
To ensure that budget continues to advance the department’s goals in real time, every Healthier Communities’ program has a data measurement system, regularly comparing results with desired outcomes. “We are unrelentingly data-driven — and we want to make sure we are using every dollar in the best possible way,” Fawcett says.
Starting life strong
Healthier Communities’ maternal-infant health initiative became a galvanizing priority for the department, fueled by a grim statistic: In 2003, Grand Rapids had the highest black infant mortality rate of any Michigan city — 22.4 deaths per 1,000 births, versus 6 deaths per 1,000 births among white infants. In 2016, the black infant mortality rate had dropped to 5.6 per 1,000 births — a 75 percent improvement — thanks to Healthier Communities’ Strong Beginnings Program. The partnership’s eight community organizations offer outreach, education, case management, mental health services and a fatherhood program, all part of its ongoing mission to improve maternal-child health and eliminate racial and ethnic disparities in birth outcomes, with a particular focus on the area’s African-American and Latino communities.
Strong Beginnings’ goal is to ensure that all women begin prenatal care during their first trimester of pregnancy and continue regular care throughout their pregnancy and 24 months after delivery. Outreach staff provide breastfeeding education, help with groceries and baby supplies, and coordinate doctors’ appointments, among other services.
“The key to our success has been a combination of community health workers’ efforts and mental- health services,” says Peggy Vander Meulin, program director for Strong Beginnings. “There are multiple stressors in these communities. Being able to go into people’s homes and engage with mothers and fathers has been very important.”
Core Health
Since 2013, Healthier Communities’ Core Health Program has been developing those same personal connections through its chronic disease management program for underserved residents at risk for poor health outcomes. Community health workers and nurses make regular home visits to both urban and rural households, monitoring diabetes and asthma treatment compliance, helping patients manage heart disease and COPD, or following up on a hospital discharge. The program has reached 2,500 community members to date.
“Navigating the health system with a chronic illness is tough for anyone, but add in diminished resources, language barriers and other social determinants of health, and it’s even tougher,” says Bethany Schwartz, Core Health’s program supervisor. “Core Health seeks to walk through life with our clients.” Recognizing the need for more behavioral-health services, the program added a licensed social worker to its staff last year. “Health may be the last thing people think about — food security, housing security, personal safety, transportation take priority,” Schwartz says. “Getting someone to feel safe and secure in their community is so important, because that stress will exacerbate all their other health problems.”
Healthy food in reach
Understanding the vital link between food security and good health, a Healthier Communities pilot program, the Community Food Club of Greater Grand Rapids, has provided healthy food to low-income households in a grocery-store setting for the past three years. Area residents at or below 200 percent of the federal poverty level may be referred by one of seven community organizations, including Spectrum Health, for a 30-day membership to the Food Club, and membership is renewable as they need it for $10 a month. Shoppers use Food Club points to purchase groceries, with fruits and vegetables “costing” the fewest points, encouraging healthy purchases while still allowing for personal choice.
“This has been a really grand experiment — we reached 1,400 households in our first year,” says Holly Anderson, program manager of the Food Club. A member survey conducted six months into the pilot found a 33 percent reduction in members skipping meals, while 29 percent said they had improved their ability to meet their basic needs by shopping at the Food Club. Healthier Communities helps purchase the food, and local wholesalers are used as much as possible for fresh vegetables, fruit, dairy products and meats.
Health and education
Although, as in a large family, it’s impossible to choose a favorite child, Fawcett speaks with particular pride about the achievements — and necessity — of the School Health Program. “Without education, poverty is a near-certainty, and education is key to better health outcomes,” he says.
In the course of offering a mentoring program at a local elementary school 20 years ago, “Our mentors saw the role chronic conditions played in allowing children to be in school,” explains Tracy Zamarron, R.N., director of the School Health Program. Previously, parents of a child with diabetes or asthma, for example, would keep their child home if he or she was having a bad day because they felt responsible for to administering and monitoring their medications. “Now, our services allow kids to participate in school without parents worrying about that, knowing we will make sure students adhere to their medications,” Zamarron says.
Healthier Communities launched a pilot program that sent a school nurse and a community health worker to that first elementary school, where they saw 267 students in 1995. By the 2014-2015 school year, 61 RNs and 28 health aides had provided care to 28,864 students in 58 schools across seven Grand Rapids districts. That year, more than 98 percent of student visits for illness, injury or other problems were resolved without the need for further referrals. Emergency care action plans also have been developed for more than 2,400 children with asthma, diabetes, seizures, life-threatening allergies and other significant health problems. All services are free.
Lori Nieboer has been a physician assistant at the Union High School Health Center for five years. From sports physicals and flu shots to well-child exams and a range of risk assessments, she likes the close-knit coverage the clinic provides. “My patients are in this building all day — we can pull them from class if we’re worried about them,” she says. Parents feel the same way. “We get grateful calls from parents — just our being here is a weight off their shoulders to know their kids are getting good, quality care.” Teens also learn how to navigate health care services, from learning how to make appointments to asking providers questions. “It gives power to teenagers — putting their care decisions in their own hands,” Nieboer says.
As for the social work and counseling services available to teens, she says, “I can’t imagine working without that component now. It’s a gift to me and to the kids. Our students are at high risk for depression, abuse and trauma issues, and our social workers have all been trained to deal with those issues.” Nieboer also can check in with the social workers to see if students need medical attention. “That mental-physical connection is especially important for teens who are at a volatile point in their lives,” she says.
Onsite counseling further “reduces the stigma of seeking behavioral health care,” Freese-Decker adds. “These types of outreach tie into Spectrum Health’s ‘Heal the Whole Person’ initiative to address the social determinants of health care, connecting people to the resources they need.”
Zamarron says absenteeism has dropped markedly since the School Health Program began and graduation rates have gone up. “We believe health care should be used as a tool to keep kids in school and promote the health of all communities,” she says. “Spectrum Health’s support is fantastic, providing access all day where it’s needed most.” The biggest contributor to the program’s success has been the trust the school health staff has built with students and their families, she says. “The kids are open to sharing their issues with us — and this may be their only access to health services.”
Health for life — and maybe a career
Underscoring Fawcett’s belief about the direct correlation between good health, a solid education and economic well-being, Grand Rapids’ Innovation Central High School also offers students the option to pursue one of four post-graduation career paths through its Academies of Business Leadership and Entrepreneurship, Design and Construction, Modern Engineering or Health Sciences and Technology. Students must apply to the four academies, but all who do are accepted. One track in the Health Sciences Academy, in partnership with Spectrum Health, allows students to seek certification to become emergency medical technicians.
“Spectrum Health is the best community partner we could have,” says Innovation Central Principal Mark Frost. “They don’t just provide funds; they provide materials, people and ideas.” He estimates 40 percent of Innovation Central’s students choose the Health Sciences Academy. In addition to videos, patient simulators and other classroom materials, a Spectrum Health paramedic teaches a two-hour EMT class with a certified science teacher.
“These kids take the EMT and first-responders’ certification and can walk out of high school with a job,” Frost says. “And if they become an ambulance driver, for example, they can use that job to help put themselves through college. The school sells itself — it has astonished the district.” Like Union High School and the other two Grand Rapids high schools, Innovation Central also offers a full-service health center, another major recruitment tool. Among families of the school’s 775 students this year, 550 filed consent forms for health services. Dental care is the biggest draw, but medical and behavioral health services are highly valued as well. “If you can’t teach the whole kid, academic performance won’t fly,” Frost adds.
Spectrum Health President and CEO Richard Breon has this advice for health system leaders looking to make a similar positive impact in their communities: “Be bold. Convey a sense of urgency and hold people accountable to a timetable. Whether it’s infant mortality, hospital readmission rates or access for underserved populations, don’t be afraid to tackle a problem that may seem insurmountable. Over time, your message will be heard and your work will make a difference.” — Laurie Larson is a freelance writer in Chicago. •
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2016 Foster G. McGaw Finalists
Three health systems were awarded $10,000 each by the Foster G. McGaw Prize committee in recognition of their outstanding community health programs. They are:
• Children’s Health System of Texas: The Dallas-based system has created a cross-sector coalition that takes a unique approach to improving the health and well-being of children in the community.
• ProMedica: Based in Toledo, Ohio, ProMedica has established a significant number of innovative community health programs to help its low-income residents, from collaborative approaches for eliminating food insecurity to addressing peer abuse.
• White Memorial Medical Center: The Los Angeles medical center has developed several prevention programs for its patient population, including a healthy eating initiative and interventions for pregnant and post-partum women, in addition to promoting a health careers program to help sustain community health.