REACH

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EL CENTRO AIMS TO CLOSE HEALTH AND DIGNITY GAP THROUGH HEALTH CARE NAVIGATION PROGRAM


El Centro, Inc. has a 40-plus year history of providing information and social, educational and economic supports to Latino families primarily in Wyandotte and Johnson counties. The agency was awarded a $26,866 grant to provide health care navigation services for uninsured and medically underserved Latino individuals and families – one of six organizations awarded a REACH Health Care Navigation and Care Coordination grant. In total, REACH has invested $263,806 in the agency’s work in the Latino community. For El Centro’s staff, navigation and assistance are essential services for their clients, who confront health care access challenges and other barriers due to language, culture, economic and other factors.

El Centro’s commitment to client assistance began nine years ago as staff grappled with an increasing caseload of requests for help with health care issues. Early on, the organization adopted a patient navigation model to provide case management and referral services for clients with health needs. El Centro’s health navigators completed training through the Harold P. Freeman Patient Navigation Institute, a nationally recognized model, where they were trained in three key areas of patient navigation: being culturally attuned to clients; understanding the environments in which clients are being served; and forging connections with community entities that affect their clients’ health care.

The Health Navigation Program works primarily with Latino, new immigrant, Spanish-speaking, low-income individuals who are uninsured. More than half of clients were Wyandotte County residents; 45 percent were Johnson County residents; and the remainder from neighboring Missouri and other nearby locations. Ninety-five percent listed Spanish as their primary language. All of El Centro’s staff who provide assistance to clients are bilingual and multicultural.

El Centro’s Health Navigation Program was introduced in 2009 with 257 clients served. By 2016, clients served increased to 1,062 and staff say it continues to grow.

Erica Andrade, the Health Navigation program manager, said that most of the clients were referred through “word of mouth” by other clients, trusted neighborhood and community leaders, safety net health care organizations and community health workers. Andrade says that El Centro has “put a lot of energy” into building a strong and wide network of health partners and local resources to help their clients with an array of health needs – assistance with insurance enrollment, appointment scheduling, securing specialty care, vouchers for eye glasses, prescription medicine assistance, optical care, hearing aids, emergency dental services and diabetes testing supplies and other medical equipment. The agency’s navigators and assisters sit down one-on-one with clients to explain insurance policies, how to make payments for medical services and what information to provide for medical appointments.



On one busy morning at the agency’s main offices in downtown Kansas City, Kansas, a client stopped in for a voucher to obtain glasses. Another needed assistance with scheduling an appointment for specialty care at a local hospital.

“The most common questions we get are about health care costs, and whether the client can afford recommended specialty care,” says Andrade, who notes that many of their clients are unsure of their options when being referred for cancer care, dialysis and treatment for other chronic conditions. “We take time to walk them through the process and explain the steps, and also help them gain confidence so that they can advocate for themselves within these systems.”

Andrade oversees this work along with health navigator Justin Gust and two intake staff. Early on, Andrade was a staff of one – but after Gust joined the team in 2014, they increased the number of clients served over a two-year period by 200 percent. In 2016, El Centro provided navigation services to 1,062 unduplicated clients for more than 1,380 units of work, or services. Andrade and Gust maintain that their growing caseloads and program success are due to supportive health partners in the community and their staffs’ strength in building trust with their clients. They note that the needs of their clients are complex and go beyond just scheduling appointments.

“At El Centro, we bring cultural knowledge and understanding of the questions and concerns our clients have. We know the neighborhoods, and have cultural backgrounds that reflect their own. It is how we have been able to continue to grow this program to serve a population that often is unseen, and underserved,” says Andrade.




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FILLING A NEED FOR ORAL HEALTH
CARE IN CASS COUNTY


Cass County Dental Clinic practice manager Amy Castle takes a quick walk-through of the children’s dental clinic in Harrisonville, Mo. As the first patients arrive, the dental hygienist and dental assistants move them into chairs, take X-rays and talk with the patients and their parents about brushing habits, sugary drinks and how to keep their teeth and mouths safe while playing sports. One elementary age patient admits that he doesn’t brush twice a day – or even every day. The dental hygienist holds up a plaster set of teeth and explains how brushing will not only give him a brighter smile but also keep him in good health. The dentist, Madeline Sloan, DDS, examines the young man’s mouth and visits with his mother about daily brushing and flossing. At the end of the appointment, the smiling patient takes the new toothbrush and floss and promises to do better.

Castle says oral health education is one of the biggest challenges they face and requires continuous reinforcement with families to emphasize the importance of preventive care. According to clinic reports, only 32 percent of new patients had no decay at their first visit in 2016. To address the education issue, clinic staff coach new and expecting parents on oral health topics. Other priorities are developing relationships with specialists and strengthening care coordination so that treatment plans stay on track.

The Harrisonville clinic opened in July 2015 following the opening of the first clinic in Belton in 2011. Operated as a program of the Cass Community Health Foundation, the clinics are the only full-time safety net dental clinics in the county for children up to age 21. Together, they draw the majority of their patients from an array of small communities, including Adrian, Archie, Butler, Drexel, East Lynne, Holden, Midway, Nevada, Pleasant Hill, Raymore-Peculiar and Strasburg in Cass County and Grandview in Jackson County. The majority of appointment referrals come through the state Medicaid carriers and dental screenings conducted at area schools, as well as from school nurses, pediatricians, private dental offices, Head Start programs, the West Central Community Action Agency and other groups.

In 2016, the two clinics served 3,150 patients for a total of 6,817 dental visits.

The Belton site maintains a full-time dentist; Harrisonville has a dentist on site two days a week. Both clinics extend their outreach by sending volunteer dental professionals to every school district in their region to complete oral examinations on students. The clinic’s outreach coordinator has compiled a contact list of nearly 300 community groups, including libraries, preschools and child care providers, banks and credit unions, social service agencies and food pantries to get the word out about the dental clinics. An oral health newsletter is sent to school nurses in the multiple districts with a request to share the information with students and families. Other outreach focuses on service and civic groups to serve as community champions for oral health.



The REACH Foundation awarded an initial $21,000 capacity grant in support of this project in 2010. Since then, the foundation has invested more than $790,000 to support operations, staffing, quality improvements and planning. In 2016, REACH awarded a $50,000 core operating grant, which allows the organization to use the resources where needed.

Clinic staff emphasizes the importance of building relationships and enlisting oral health champions to their priority of improving children’s oral health. Castle says their team has achieved success in forging relationships with every school district in the county; working toward timely completion of treatment plans; patient/family satisfaction of services; and achieving high rates of completion on evidence-based practices, such as sealants on molar teeth.

“We’re working to make oral healthcare a priority for everyone we meet,” Castle says. “Placing 95% of sealants recommended to our patients was a top success measure for our team in 2016. There’s still a lot of work to be done in overcoming barriers to care, but we know that by working with our community partners, we will reach our goals.”




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COMMUNITY HEALTH WORKER SCORES HIGH MARKS FOR CONNECTING FAMILIES TO DENTAL, HEALTH CARE


During the school year, Alex Martinez-Munoz can be found several times a week seated at the front desk at Scuola Vita Nuova, a charter elementary school located in the northeast area of Kansas City, MO. The community health worker chose that spot to be visible to families as they arrive at school so that he can become a recognized face and ready resource for parents who have questions about their children’s oral health and other health needs.

Trained locally in community health work, Martinez-Munoz was hired by the Kansas City University of Medicine and Biosciences (KCU) to improve access to oral health care primarily for Latino children and families through its Score 1 for Health® program, which works in 43 elementary schools in the Greater Kansas City area to provide health, dental, vision and other screenings and follow-up referrals and health care navigation for preventive care, dental services and other health needs. The target population for Score 1 for Health is diverse – 35 percent are African American, nearly 40 percent are Latino, and 4 percent are Asian with the remainder identifying as white or of other racial and ethnic background. Martinez-Munoz’ role is to be a liaison between parents and guardians of Latino children who are screened through Score 1 and the health care system, and help families obtain the services children need.

Score 1 program staff often heard from families that information and language challenges were some of the biggest obstacles they faced in accessing care for their children. Families shared that they didn’t know where to go for medical or dental care, how to qualify for health insurance and services, and how to schedule appointments. Data collected through encounters showed that information and assistance and language barriers were some of the biggest obstacles to care. Score 1 employs a Spanish-language interpreter and uses an interpretation service for other languages, but program leaders increasingly recognized that the program’s ability to effectively serve their target population depended upon strengthening cultural competence and the capacity to develop relationships with families in their familiar school settings.

Martinez-Munoz’ charge is to increase oral health access by providing consistent outreach, oral health information and care coordination, focusing on those whose primary language is Spanish. In 2016, he served 588 families. At the pilot school, he connected with 113 – more than half of the student body.

Following Score 1 screenings, Martinez-Munoz contacts the families of children who need a dental referral to provide them information about services, schedule appointments, discuss coverage options and costs, and help children and their parents overcome fears about dental care. Martinez-Munoz works to identify each family’s needs, such as help with making an appointment, securing transportation or selecting a provider that would be a good fit for the child. He provides information about Medicaid benefits, accompanies families to appointments if needed and maintains records of completed services, ongoing concerns or barriers, and follow-up needs.

The REACH Foundation has awarded grants totaling $488,396 to Score 1 for Health over the past several years. In 2016, REACH awarded the program $29,939 grant to support the Latino-family focused health project. The Scuola Vita Nuova school pilot effort introduced in 2016 has been one way to assess the placement of a bilingual community health worker at a school site to see if having a regular, physical presence at school increases access to services, parent receptivity to information and oral health education, and parent satisfaction. On one afternoon, students and parents stopping by the front office chatted with Martinez-Munoz about school, upcoming dental visits and any follow-up needs. The school’s administrative staff members readily share front desk space with the health worker as they recognize the additional value these outreach services bring to their families.



Annette Campbell, director of Score 1 for Health, says her team worked with the school’s principal, vice principal and office staff to develop a plan for integrating Martinez-Munoz into the culture of the school. He attends school events, staff meetings, acts as a greeter during morning drop-off times and makes sure he is at school on parent-teacher conference days, which generate high parent turnout.

“Having Alex on site has helped us create a bridge between our Score 1 screenings and health initiatives and improving access to services for elementary children,” Campbell says. “We have enjoyed watching how he has been welcomed into this school and the success he has had in building strong relationships with school staff and acceptance with the families.”

While this project has enabled Score 1 to test this approach in this one school, Martinez-Munoz coordinates referrals and works with Spanish-speaking families within all of the Score 1 schools. Referrals are generated by the Score 1 outreach nurses, school nurses and social workers with an emphasis on dental referrals, but the work also includes assisting with vision and other health needs. Score 1 program leaders have worked to educate partners about the purpose and function of a community health worker, providing information and making introductions to their network of dental providers, school nurses and safety net clinics. Campbell says the community health worker services are not reimbursable by Medicaid, but the investment in this model has shown early success in helping Score 1 achieve its goal – that is, expanding access to health care.