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VENICE FAMILY CLINIC CHILDREN FIRST PROGRAM HEALTH SERVICES PROVE SUCCESSFUL
JoEllen Tullis and Karen Lamp
Venice, California, Early Head Start
The Venice Family Clinic (VFC) provides affordable, accessible, and compassionate comprehensive primary health care for people with no other access to such care. One of the clinic's guiding principles is that clients are partners in their health care, with a focus on the whole person or whole family system and the understanding that health care happens within the context of the cultural, social, physical, emotional, and economic needs of the client. As a result of this commitment, VFC sought and received funds to operate the Children First Early Head Start program. The program's mission is to optimize the quality of life for children prenatal to age 3 by strengthening families and communities. To achieve this, children and families must be healthy. The first steps toward reaching the desired outcome of healthy children and families are to help families access insurance and to connect them to a medical home. The consequences of being uninsured include limited and delayed access to needed services, poorer physical and mental health, premature death, and a diminished capacity to contribute to one's family and community. The Children First Early Head Start program helps all its families determine whether any family members are eligible for any insurance programs. Enrollment is handled on-site at the clinic or, when needed, in the family home. VFC becomes the medical home for families that are not insurable. At VFC, families receive free quality primary health care and can access a variety of services. These services include health education, developmental screening, diagnostic tests, chronic care treatment, medication, nutrition counseling, ophthalmology/optometry (including free glasses), case management, and social work. They also include mental health services, which provide crisis, individual and family counseling, and group support and education programs (for example, parenting, prenatal, battered women). The clinic also has a "warm line" to answer basic child development concerns and provide information on parent/child classes. Because Children First Early Head Start home visitors understand the scope of services at the clinic and (with family permission) have access to their physician and multidisciplinary case conferences, Early Head Start families are more likely to take advantage of these services, seek care in a timely manner, and adhere to treatment plans.
Having Early Head Start as part of the clinic has led to some operational changes at the clinic that provide advantages to all patients. Children First Early Head Start has enhanced the ability of VFC staff to (1) understand the importance of the early years and how those years affect an individual in the future, (2) see patients in the context of their families rather than individuals in a state of disease, and (3) look beyond the medical model and embrace social work services. The relationship has also led VFC to create a literacy program for pediatric patients, to strengthen the Health Education Department with its focus on primary prevention and community outreach, and to infuse resources into behavioral modification/risk reduction and identification of victims of domestic violence. All doctors screen for domestic violence, and the clinic now has a domestic violence specialist-an advocate to help victims through the court system-and an ongoing support group. Substantial quantitative and qualitative data show that this comprehensive approach to health care makes a difference. Compared to county averages, Children First Early Head Start families fare much better.
Medical Home:
Countywide: 31 percent of children have no insurance; seen primarily in emergency rooms for illness.
Children First Early Head Start children: All children receive regular well-child visits. All family members are enrolled in insurance as eligible, and when not eligible, receive free medical care at the clinic.
Immunization Rates:
Countywide: 73 percent of children are fully immunized by age 3.
Children First Early Head Start children: 85 percent of enrolled children are current on immunizations at any given time, and 95 percent of children graduating from the program at age 3 are fully immunized.
Rates for both number of uninsured and incomplete immunizations are even higher among Hispanics and children from immigrant families. Therefore, these improved outcomes for children are impressive, since 85 percent of Children First Early Head Start families are Hispanic and one or both of the parents in 70 percent of Children First Early Head Start families are immigrants.
One family's experience shows how this program has made a difference. When the home visitor noticed the family was not keeping its appointments for well-child and immunization visits, she talked with the mother and learned that the barriers included fear of doctors and fear of using public transportation. She gradually helped the parent assume greater responsibility both in keeping appointments and in figuring out transportation. The home visitor provided photos of the clinic, arranged a phone call with the doctor to help the parent feel more comfortable, and transported the family and remained with them on their first visit. She helped the parent learn about public transportation and accompanied them on their first bus ride. Over time, the parent was able to make and keep appointments and use the bus on her own. The child now receives regular checkups and keeps up-to-date on immunizations. An interesting benefit to the community is that a non-Early Head Start-eligible family with three children that shared living space with the Children First Early Head Start family and previously only received medical care through emergency room visits has, with the help of the Children First Early Head Start mother, obtained insurance for its children, who now receive regular preventive care.
"He who has health, has hope; and he who has hope, has everything." - Arabian proverb
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