San Antonio’s Eastside Promise Neighborhood (EPN) is a community of about 18,000 residents (67.5% Latino) who face many health disparities driven by socioeconomic inequities in income, education and access to health care. Noemi Villarreal and others at EPN sought ways to improve health care and health equity in the area. To do that, they looked for ways to promote the idea of the “medical home,” in which the patient/family is the center of partnerships with primary care providers, specialists, educational resources, and the entire community. They formed a group of dedicated “Community Connectors” to travel the neighborhood and do whatever was necessary to promote development of a medical home for every home.
Awareness: Noemi Villarreal, health and wellness manager for EPN, knows that residents in Eastside San Antonio face health disparities, including high rates of childhood obesity, diabetes, and asthma.
The reasons stem from socioeconomic barriers. The Eastside’s poverty rate tops 70%. Fewer than 40% of residents have a high school diploma. Many lack health insurance and face language barriers.
The EPN is all about helping residents “overcome some of these barriers,” Villarreal said.
One particular issue that began to stand out, Villarreal said, was the lack of timely preventative care for the children of the neighborhood, which leads to health issues and significant amounts of missed school.
“A lot of times, these families don’t practice wellness checks or regularly visit the pediatrician,” she said. “Usually, when you ask them how often they take their kids to the doctor, they will tell you they take them to the emergency room if they’re sick.”
Learn/Frame Issue: EPN first formed in 2010 with a federal Promise Neighborhood planning grant for the United Way of San Antonio and Bexar County. In 2011, EPN leaders applied for and received a five-year implementation grant, one of five implementation sites in the nation.
As part of their planning process, EPN leaders set health and wellness goals.
One was to set up a “medical home”—where families regularly visit and have a relationship with a physician who provides continuous and comprehensive care. This care is also coordinated and integrated into other services, such as education.
Medical homes ensure that parents of children ages 0-5 regularly take their children to primary care doctors.
“It’s important for [families] to feel comfortable with [having a regular pediatrician and community support] instead of waiting to go to the emergency room when their child has a bad cough,” Villarreal said.
EPN leaders identified “parent facilitators” as a key component to promote medical homes.
The parent facilitator would raise awareness in the community about the importance of a medical home, specifically targeting those with children ages 0-5. The program is designed to use a peer-to-peer network to help community residents in connecting to available resources.
“We wanted to create a position in which we had someone go into the neighborhood and visit the families in their homes and see what was going on with them,” said Roxanne Acosta, a neighborhood parent who later became a parent facilitator.
Education/Mobilization: EPN studied the area and identified nearly 2,000 children between ages 0-5.
To provide a parent facilitator to engage neighborhood parents toward a medical home, EPN partnered with the Family Service Association (FSA), a local nonprofit that supports community assistance initiatives.
“We knew creating a medical home was important but there wasn’t anything like the parent facilitator program anywhere that we could model ourselves after,” said Villarreal.
EPN also contracted with 14 peer home visitors to engage local residents to assess their health habits and their willingness to be a part of the parent facilitator program. There was significant reticence on the part of many residents to take part in what they felt was yet another survey in the area.
“This community has been overly surveyed at this point and we didn’t want to give them the impression that that is what this would be,” said Villarreal. “We’re collecting demographic information and asking them if their family has any health issues. We just want to see what their needs are.”
Using the data, parent facilitators began developing the curriculum they would use to engage the community.
Debate: Engaging the community and bridging the issues of mistrust and a lack of knowledge was going to be critical to the success of the parent facilitator program.
“The parent facilitator job, it has you in the community, going to the homes, and getting to know the families,” Acosta said. “It’s very hands-on, which helps us build trust.”
Activation: Parent facilitators started to plan how they would engage residents.
The first step would ask each parent two simple questions: Who is your child’s pediatrician? When was the last time you saw them?
“If they can’t answer those, we can then begin the conversation,” Villarreal said.
The parent facilitators then would help connect parents and families in the neighborhood to the available health resources and reduce potential barriers to care.
“[And] if the parents continue working with us, we follow up with them to see where things are at,” Acosta said.
Change: The Community Connector program launched in 2016 in the neighborhood served by EPN. The program started out with three Connectors and hopes to expand ultimately to upwards of 15. All the Connectors were trained in house.
The Community Connectors work directly with family members to eliminate barriers that prevent them from becoming a medical home.
Implementation: The program has met with resounding success to date. The community has been receptive to the help and are encouraged by what the Community Connectors can offer.
“They are trained to answer and address any concerns that come up during the course of these conversations,” said Acosta. “If a child hasn’t been able to receive their immunizations, for example, because a parent doesn’t have after-school care, we have a full referral packet that we can hand them. Every need that they might have, we have a way to help them.”
Community Connectors go beyond the referral process; they can even make the connection for the family.
“We tell them this is where you can go, this is what you need, and we can even call them for them,” she said. “I can schedule their appointments for them. We don’t want them to feel like they have to do something extra. We want their needs addressed right then and there.”
Community Connectors also are working with service providers and helping them connect to health care opportunities among local families.
Two programs impacted by this are the Nurse Family Partnership (NFP) and Home Instruction for Parents of Preschool Youngsters (HIPPY).
NFP aims to serve at least 25 families, and HIPPY aims to serve at least 50 families per year through 2016.
“There are also clinics in the area that we have partnerships that we can help the parents connect to,” Villlarreal said. “Once we educate them on why they need to have these regular visits [to the doctor], we can help them set up the appointments.
“These are the first steps into them having a medical home.”
Equity: As the Community Connector program expands, the goal is to hire more to serve the community.
“We have goals for the community that we want to achieve,” said Monica Saucedo, Community Connectors Coordinator for EPN. “To reach these goals fully, we’ll need to have more Community Connectors. This will happen somewhere down the line though.”
Sustainability: The EPN is committed to the success of the Community Connector program and to ensuring that medical homes become the norm for the area. This is one of the core principles of the EPN.
“Making sure that kids are healthy is what this is all about” Villarreal said. “Our Health & Wellness Committee, which is made up of parents, educators, and health professionals in this community, they know that this is a need here. As a whole, they knew this was a concern and they want this to succeed.”
This success story was produced by Salud America! with support from the Robert Wood Johnson Foundation.
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