At a time when the federal government is placing increased emphasis on extending coverage to millions of uninsured Americans, many community-based healthcare programs have found ways to help the underserved with little or no government funding.
Last month, HHS honored six healthcare programs that increase access and eliminate disparities in healthcare as winners of its third HHS Models That Work campaign.
This year's three winners and three special honorees focused on a number of public health issues, including substance abuse, domestic violence, prenatal care, teen pregnancy and injury prevention.
The winners. The Models That Work 1998 winners are:
The Healing Place in Louisville, Ky., which was founded by the Jefferson County Medical Society Outreach Program in 1995. It helps homeless and other needy individuals overcome substance abuse and alcoholism.
The Healing Place includes shelters for men and women; two "healing centers," or clinics for recovery classes; a soup kitchen; and transitional-living facilities. The women's two-building campus will be expanded to include a third building within the year.
Based in part on Alcoholics Anonymous' 12-step program, the Healing Place uses nonmedical detoxification and recovery classes as well as the emotional support of program alumni. People who stay for the long-term program of four to six months are eligible for life-skills training, job placement and subsidized transitional housing, where they can stay as long as two years. All other services are free and are funded by private grants.
The Healing Place said that of the men and women who have completed the program, 64% have maintained continuous abstinence.
Laurel Health System's Service Integration for Quality Improvement, founded in 1994, aims to overcome economic and geographic barriers in the delivery of quality healthcare services for each life cycle.
Wellsboro, Pa.-based Laurel Health, made up of seven health centers in geographically isolated communities, provides prenatal care, mental health services, immunization outreach and teen-age pregnancy prevention information.
One important community health improvement has been the increase of patients entering prenatal care in their first trimester. That figure grew to 92% in 1996 from 31% in 1993.
Laurel Health is affiliated with 103-bed Soldiers and Sailors Memorial Hospital, Wellsboro.
The School Health Outreach Project in Brooklyn, N.Y., provides primary and specialty health services to children and families through 11 school-based health centers.
Since the project began in 1995, 500 previously uninsured children have been enrolled in Child Health Plus, a state managed-care program for uninsured or underinsured children.
The School Health Outreach program provides primary care, such as immunizations and maintenance of asthma and diabetes, as well as mental health services.
The program also works closely with immigrant families, providing translation services to integrate the entire family into the mainstream healthcare system.
The project is part of the Sunset Park Family Health Center Network, a multisite community health center and managed-care network.
The special honorees. Models That Work special honorees are:
B4 Babies and Beyond, based in Grand Junction, Colo., helps women in Mesa County secure financial aid for prenatal-care, labor and delivery services. It also provides access to a continuum of primary care for children from birth through age 18.
Created in 1990, B4 Babies and Beyond rotates assignment of new patients among its network of providers so any single provider is not disproportionately burdened with charity cases.
In 1996 Mesa County reported that the number of women who received prenatal care beginning in their first trimester of pregnancy increased by more than 10% since the mid-1980s.
The program serves approximately 1,500 children and 700 women each year, most of whom do not have insurance. In 1996, 43% of Mesa County births were to clients of B4 Babies and Beyond.
The RADAR Domestic Violence Intervention Training Project, sponsored by the Philadelphia Physicians for Social Responsibility, trains physicians and other healthcare providers to screen patients for domestic violence, document findings and refer victims to sources of help.
Since the program began in 1993, RADAR has conducted more than 140 training sessions and presentations for approximately 5,000 individuals. About 62% of providers trained in the program's first year described changes or improvements in their clinical practice and service delivery in regard to domestic violence intervention, RADAR said.
The project initiated and succeeded in adding domestic violence training to the curricula at the Philadelphia-based School of Medicine, Allegheny University of Health Sciences. RADAR's goal is to make domestic violence training and education an integral part of the curricula in all years of medical school, said Martha Davis, director of training and programs at the PPSR.
RADAR also is working to place questions concerning domestic violence on the National Medical Board exams, she added.
Kids Can't Fly, founded by the Boston Public Health Commission's Childhood Injury Prevention Program in 1993, has helped reduce the number of children falling from windows by 50% between 1993 and 1997.
Health centers and community organizations distribute window guards free to people who cannot afford them. The program directs safety information primarily to low-income Boston residents, many of whom live in public housing projects.
Community problem-solving. The biennial Models That Work campaign identifies innovative local health programs, showcases their efforts and helps other communities facing similar healthcare challenges. The honored programs are expected to provide workshops and on-site training for communities that want to replicate their programs.
"Models That Work multiplies community solutions, overcomes barriers and scores economic dividends," said Regan Crump, the campaign's chairman.
The first five winners of Models That Work were awarded in 1995. Starting in 1996, HHS held the awards program every other year. Since the start of the campaign, 21 new community programs-called access points-have sprouted up based on the previous 10 Models That Work winners, said Crump, who is also chief of the program implementation and coordination branch at HHS' Bureau of Primary Health Care.
"We're hoping to average about 10 new sites a year," he added. "Our goal is, by the year 2003, to add a million people to the well-served, as opposed to underserved, healthcare community. We're on our way." The Models That Work staff is in the process of evaluating the number of people served in the existing sites.
Started in late 1994, Models That Work is a public-private partnership sponsored by the Health Resources and Services Administration, which is part of HHS, and 38 national organizations, foundations and corporations. All the organizations involved help review the programs. Some also serve as advisers or contribute funds to support the campaign.
Programs were eligible if they provided primary care, involved the community in implementation and evaluation of projects, partnered with other organizations and could document measurable outcomes.
Models That Work offers no monetary award or grant. Instead, winners are trained on how to make presentations, talk to the media and provide technical assistance to communities that want to replicate the projects in a two-day orientation taught in part by past winners.
A big reward is being able to help people throughout the country instead of just in their town, said Crump and a number of project officials.
"We find this an honor to spread the program," said Karyn Hascal, director of development at the Healing Place. "It's a good opportunity to share with folks how you can (duplicate the program) in a cost-effective, efficient way without using government funds."