Community Health Innovators in North Philadelphia
During the last three Leadership Exchanges, we have explored the role of access to quality healthcare in community development. In 2013, we visited CHOP’s new Karabots Center in West Philadelphia, and last year we were impressed by the Whittier Street Health Center, a nationally-recognized facility for health care equity in Boston’s Roxbury neighborhood. This year, we visited two facilities delivering community-specific healthcare to residents of North Philadelphia.
St. Christopher’s Hospital has been in the business of neighborhood-based pediatric care since 1875 when it opened as a one-room dispensary for the children of Kensington’s mill workers. The Center for the Urban Child (CUC) at St. Christopher’s Hospital serves one of the poorest neighborhoods in the city, where 48% of residents live below the poverty line and 30-45% have experienced some combination of abuse, crime, neglect, or mental illness either personally or in the household.
During our visit, Dan Taylor and Hans Kersten, two pediatricians based at the Center, described the challenges their patient population faces and the programs they’ve devised to address them. They tackle childhood obesity and food insecurity through the low-cost Farm to Families and Fresh Rx programs underwritten by the St. Christopher Foundation. The Reach Out and Read program provides a small library with children’s books in the Center’s waiting area and helps parents understand how they can positively influence early brain development through reading and conversation. Through the Newborn Access Program, more mothers are receiving prenatal care, bringing their newborns in for checkups sooner after birth, and breastfeeding. On-site staff from the PhilaKids Medical Legal Partnership provides legal aid to help families with housing issues, powers of attorney, SNAP and SSI benefits, and custody and child support issues.
It’s these wraparound services and interdisciplinary approach that distinguish the CUC among pediatric healthcare providers. Instead of referring patients to services outside the hospital where time and transportation constraints hinder follow-through, the CUC brings services directly to patients and their families. Dr. Lee Pachter, St. Christopher’s Pediatrics Chief, pointed out that before the CUC, there was only a 50% chance that a child would get to her referral appointment. By bringing more services to patients and their families in the Center (often in the same room), more can be accomplished in one visit.
The Stephen and Sandra Sheller 11th Street Family Health Services of Drexel University in North Philadelphia was founded 20 years ago in an apartment building donated by the Philadelphia Housing Authority. At that time, a steady stream of academics were studying conditions in the neighborhood and leaving shortly thereafter. According to founder and current executive director Patricia Gerrity, a permanent partnership needed to be forged, and to that end, a community advisory board was established to help staff understand the social and environmental factors impacting health in the community.
Today, the 11th Street facility offers many of the same one-stop services as the Center for the Urban Child, but with added attention to mind-body programs as a means to treat and prevent disease. The airy, modern building has art, movement, and music therapy rooms in addition to a gym, dental clinic, and medical treatment spaces. The design, like that of the CUC, was informed by the needs of its patients (two-thirds women, one-third children), most of whom have experienced some kind of trauma. Treatment rooms have two doors to prevent patients from feeling trapped or threatened.
For their innovative and holistic approach, 11th Street has been recognized by the Robert Wood Johnson Foundation’s LEAP project (Learning from Effective Ambulatory Practices), the Agency for Healthcare Research and Quality, and the American Academy of Nursing. Drexel University now trains its College of Nursing and Healthcare Profession students at the facility. In 2014, more than 36,000 patients from the neighborhood and across the region were treated by 11th Street staff.
Despite 11th Street’s tenure in the community, staff members acknowledge that it is still a lot of work to get patients in the door and to make sure they return. The 11th Street advisory board plays a role in this effort, but staff members take personal responsibility for community outreach. For example, Community Health and Wellness Director John Kirby leads neighborhood walks to encourage local residents to exercise. The center holds a series of open houses, and, when treating someone with acute needs, staff try to address chronic issues and engage other household members in the conversation about treatment.
The work is paying off in ways beyond patient health. An advisory board member who works with children with behavioral issues described how her mindset had evolved: “I used to get upset when a child would ‘act up.’ But now I wonder ‘what happened to this child that makes him behave this way?’ I approach my work differently.”
Although associated with larger institutions, both the Center for the Urban Child and Stephen and Sandra Sheller 11th Street Family Health Services rely on a large number of partnerships, grants, volunteers, and donations to provide their robust network of services.