The National Association of Community Health Centers Prioritizes Enabling Services
March 16, 2020 | By Transform Health
CASE STUDIES FROM ALASKA, ARIZONA, CALIFORNIA AND NORTH CAROLINA
In 2019, through support from the Health Resources & Services Administration (HRSA), the National Association of Community Health Centers (NACHC) published four case studies highlighting the critical importance of enabling services provided in our health centers and supported by primary care associations. Each case study focuses on some of the innovative approaches health centers and primary care associations are taking to meet the specific needs of their communities. This blog highlights some of the findings from those case studies written by Transform Health.
Enabling services are defined as “non-clinical services that aim to increase access to healthcare and improve health outcomes,” and include services such as health education, interpretation, and case management. We believe that these types of services remain critical to be supported in order to improve access to primary care, preventive services and ensure patient satisfaction critical for sustainability. However, these services – and the workforce that provides them – are often the first to face budget cuts, as we have seen during this Administration.
Health centers often provide enabling services as a means to address barriers to social determinants of health, including economic and food insecurity, lack of health access and coverage, transportation, health education, and significant language barriers. While enabling services and social determinants of health are not mutually exclusive, providing enabling services allows for health centers to address social determinants of health in their standard clinic workflows. This allows for health centers to serve as a cornerstone in their community and obtain a deeper sense of the specific issues facing by their communities while developing effective strategies to address them.
Each of these case studies, from four different states, focuses on a key issue impacting their community – including behavioral health integration, food insecurity, outreach and enrollment for migrant farmworkers, and workforce apprenticeships. Here are some of the key take-aways:
WellSpace Health in Sacramento, CA
Who They Are: WellSpace Health (WSH) is a Federally Qualified Heath Center (FQHC) that provides health services to the most underserved community members of the Sacramento, California region. WSH operates 22 community health centers in three counties – providing medical, pediatric dental, women’s health, behavioral health, and immediate care services for approximately 80,000 patients annually. Their “blanket of care” approach embraces the whole person and addresses patient needs through a holistic approach.
Enabling Services Provided: Behavioral Health is the bread and butter of WSH. Linkage to behavioral health care is integrated into all of WSH’s services and programs. Some of the enabling services they provide include (but are not limited to):
- Behavioral health screenings: integrated into every department, patients are screened for behavioral health needs at every appointment and are elevated as needed.
- Suicide prevention: staffed by community health workers, WSH operates the regions suicide prevention hotline and act as first responders in 50 CA counties.
- Respite & recuperative care: provides lay-in nursing and case management for patients discharged from the hospital up to 3 months.
- Substance Use Disorder (SUD) treatment: offers a continuum of services for SUD including outpatient, detox, residential treatment, and medication-assisted treatment.
Workforce: WSH has invested in building up their enabling services workforce. They partnered with Los Rios Community College District in Sacramento to create the Community Health Worker (CHW) Certificate of Achievement Program. The program has developed CHW certification standards and curriculum, creating a pipeline of qualified staff for WSH and many other health providers in the Sacramento area that have a need for CHWs. Outside of this pipeline, applicants for enabling service roles such as case managers have a diverse set of qualifications, which can range from Certified Alcohol and Drug Counselors, previous experience as CHWs or case managers, or a bachelor’s degree.
Funding: WSH’s enabling service programming is supported by two HRSA 330 community-based grants. The health center also partners closely with hospital systems and local government, as well as other regional FQHCs and social service agencies. Their partnerships with local, state, and federal stakeholders strengthens enabling service programs and helps legislators understand the human impact of these programs.
Native Health in Phoenix, AZ
Who They Are: Native Health is an FQHC and Urban Indian Health Program based in Arizona that serves more than 8,700 patients annually in Phoenix and its surrounding communities. The health center provides medical, dental, behavioral health, and health and wellness services in four locations for individuals of all ages and cultural backgrounds, with a specialized focus on the urban Native American community. By offering an extensive range of enabling services, Native Health functions as a one-stop community resource center, as well as a health center.
Enabling Services Provided: Native Health’s enabling services are designed to address food insecurity specifically. The foundation of Native Health’s food programming comes from leveraging its partnerships with food banks, benefits agencies, and other community-based organizations. Some of the enabling services they provide include (but are not limited to):
- Co-located Benefits Eligibility Services: State agencies provide onsite eligibility determinations for Medicaid, TANF, and SNAP at Native Health sites, speeding up approvals by weeks.
- Addressing Food Insecurity for Vulnerable Populations: offers multiple innovative food programs specifically targeted for children, including a “dinner program” that provides a daily meal to children and seniors.
- Education to Promote Healthy Food Choices: offers cooking classes to promote food literacy and teach healthy cooking skills to seniors and families with young children.
- Community Gardening Program: generating more than 3,000 pounds of produce a year, Native Health hosts a traditional garden with indigenous, drought-tolerant, protein-rich plants, and a half-acre community garden.
Workforce: Enabling services are integrated into every position at Native Health. They believe linking patients to all available resources is every staff member’s responsibility. From primary care providers to front-desk staff to executive leadership, all staff are trained to be ready to connect a patient to needed services and supports, be it food for their family, a dental appointment, or community camaraderie through a beading class.
Funding: Native Health supports enabling services with HRSA funding and other grants, which make up 50% of the health center’s total funding. Other funders include government agencies such as Indian Health Services (IHS), which support specific programs targeted to Native community members, and local community-based organizations and foundations. In addition, allowing agencies to co-locate services within Native Health clinic locations sparked conversations about unmet needs. Ultimately, this led to partnerships with outside agencies providing funds, resources, and even embedded staffing and services.
North Carolina Farmworker Health Program
Who They Are: North Carolina Farmworker Health Program (NCFHP) provides a wide range of enabling services to migrant and seasonal farmworkers and their families. As a statewide Migrant Health Voucher Program, NCFHP supports access to primary and preventive care, dental services, and behavioral health services for this vulnerable population. The program is administered by the North Carolina Office of Rural Health within the North Carolina Department of Health and Human Services (NC DHH).
Enabling Services Provided: Enabling services such as case management, outreach, enrollment and health education are core to NCFHP, since these services have proven to be essential in linking farmworkers to care and contributing to positive health outcomes. A common component for all eight sites is deployment of an Outreach Team comprised of outreach workers and an outreach coordinator who provide field-based services. Core enabling services for field based teams include home and migrant camp visits, health assessments and screenings, case management and care coordination, linkage to community resources and benefits, transportation, interpretation, referrals and health education. In addition, farmworker health teams, led by enabling staff, coordinate and facilitate evening and weekend clinics during peak season, as well as mobile medical clinics, including physical therapy and behavioral health telemedicine services.
Workforce: NCFHP provides training, technical assistance, dissemination of best practices, and professional development opportunities for contract site staff. Site staff attend annual conferences and training where they can share best practices and lessons learned, provide peer support, and strengthen involvement of site leadership and direct service staff. NCFHP also partners with several universities to provide learning opportunities and field experiences for students from a variety of fields.
Funding: NCFHP is fully funded by HRSA through their migrant health center 330(g) funding. As one of HRSA’s sixteen Migrant Health Voucher Programs nationwide the program has the flexibility to develop and change services as the needs in the service area or the farmworker population change. Partner agencies apply for grants annually, which provides the opportunity and flexibility to maintain responsiveness to local needs.
Alaska Primary Care Association Apprenticeship Model
Who They Are: Alaska Primary Care Association (APCA) is a statewide consortium serving 27 community health centers working to increase access to critical safety net services for vulnerable populations throughout the state. Each year, more than 113,000 patients receive affordable and accessible medical, dental, behavioral health, substance use disorder, and vision care from health centers in Alaska.
Enabling Services Provided: Alaska faces a shortage of trained, skilled health care professionals. Health centers located in remote regions are particularly challenged in finding and recruiting qualified enabling services staff that are needed to connect underserved populations to care and support critical health center operations. To address the workforce shortage, APCA partnered with the Alaska Department of Labor and Workforce Development (DOLWD) to launch the Health Care Registered Apprenticeship program. Supported by U.S. Department of Labor (DOL) funding, APCA served as DOLWD’s main partner in expanding health care apprenticeships throughout the state.
There are of the five career tracks offered by APCA – including Community Health Worker, Electronic Health Records (EHR) Specialist, Billing and Coding Specialist, Medical Administrative Assistant, and Clinical Medical Assistant. Curriculum for each career track is designed to support learning in core competencies, supplement the skills learned during on-the-job training, and prepare apprentices to become nationally certified (in all but the CHW occupation). Examples of CHW curriculum and training topics include “The Role of the CHW, “Defining Public Health,” “Client Interviews and Confidentiality,” and “Conflict Management.” Supplemental trainings tailored for each career track are also provided. For example, CHWs can receive supplemental training on hypertension and diabetes.
Since January 2017, APCA has trained more than 100 individuals through the program, including 42 apprentices who are currently enrolled and 64 graduates. These apprentices work in a wide variety of settings beyond health centers, including tribal organizations, dialysis clinics and even a chiropractor practice.
Funding: U.S. DOL apprenticeship grant funds administered by DOLWD support APCA’s annual budget for the program. Administrative costs are about $3,000-$5,000 per apprenticeship, which includes hosting curriculum and tracking on-the-job-learning and milestones. Employer resources to support participation in the program is provided in-kind. Currently, neither employers or apprentices are charged to participate in the program. However, employers participating in the program have found it to be a valuable asset, with more than half reporting that they would consider covering programs costs for the service on an ongoing basis.
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