The St. Joseph Health System has nurtured its Sonoma County neighbors for more than 60 years through a wide range of community outreach programs.
The Harvard team’s goal was to quantify the cost savings that accrue when mobile health care is available to prevent unnecessary emergency room visits. While the researchers found the average return on investment was 20:1—or $20 returned for every $1 invested—the St. Joseph Mobile Clinic returned $28 for every $1 invested in operations, one of the highest return rates in the country. (To learn more about the Harvard study, you can visit www.mobilehealthmap.org).
“This study proves what we’ve known for some time: Mobile health clinics play a vital role in supporting health care in the United States and are extremely cost-effective,” says Kathy Ficco, executive director of St. Joseph Health System Community Health Clinics. “As health care costs continue to spiral out of control, preventive actions are clearly one solution.”
Although mobile health clinics may be a nontraditional method of health care delivery in most parts of the country, the St. Joseph Mobile Clinic has been a fixture in the community for nearly 20 years. In 2009, it made more than 3,700 office visits to more than 1,500 individual patients; 80 percent of its patients consider it their regular source of health care in the region. And, as the team from Harvard demonstrated, its value is underscored by the role it plays in reducing the health care disparities between the haves and the have-nots.
Half a century of service
The mobile clinic is just one example of how St. Joseph Health System-Sonoma County (SJHS-SC) is serving as a model for providing community outreach to underserved populations.
Founded by the Sisters of St. Joseph in Orange, Calif., SJHS-SC has been serving the health needs of families in the North Bay for more than 60 years. Part of a statewide network of hospitals and clinics, the Sonoma County ministry operates two hospitals as well as several urgent care and community clinics, hospice care centers, home health services and skilled nursing facilities, as well as community outreach services. Its core facilities are Petaluma Valley Hospital, an 80-bed acute care hospital, and Santa Rosa Memorial Hospital, a full-service, 289-bed acute care hospital that includes a Level II trauma center for the coastal region stretching from San Francisco to the Oregon border.
“What sets us apart from other health systems is our devotion and commitment to community benefits,” says Jo Sandersfeld, vice president of mission integration. “Our mission is to promote health improvement, provide compassionate care and create healthy communities—and that’s what we do, every day.”
Many of its programs have the weight of history behind them. Its mobile dental clinic, for instance, celebrates its 20th anniversary this year; the mobile medical clinic will do the same next year. The Circle of Sisters program, which provides after-school support for girls ages 10 to 14 to promote positive self-esteem, recently celebrated its 10th anniversary. And the popular House Calls program, which provides primary medical care to frail seniors in their homes, dates back to 1996.
“We’ve established a lot of goodwill over the years,” Sandersfeld says. “Many of our programs grew from a single idea into a comprehensive outreach effort that’s now become part of the community, like the mobile dental clinic, which goes to different locations and visits farm workers on the job. It’s not something we created for marketing purposes, but rather comes from a core belief that it’s our responsibility to provide for those in need.”
SJHS-SC dedicates 10 percent of its net income to community-based health programs as part of a tithing system that’s been part of its tradition for centuries. Of that total, 75 percent is used to fund community health programs in Sonoma County, and the remaining 25 percent is set aside for disaster relief at our SJHS Foundation (the St. Joseph Health System, as a whole, and its foundation, together contributed more than $100,000 to aid earthquake victims in Haiti).
“The tithe is important, because it holds each of our ministries responsible for how we go about improving the quality of life in the communities we serve,” Sandersfeld says. “As a Catholic health care organization, we have a social responsibility and moral obligation to make quality health care services accessible to the medically poor. We believe everyone has a right to an adequate level of care, and that no one should delay seeking medical attention because they don’t have insurance or the resources to pay. That’s why we have a financial assistance program that provides free or discounted services to eligible patients.”
Is there a business advantage to be gained from such enlightened generosity? Sandersfeld and her SJHS-SC colleagues believe there is.
“We’re primarily an acute care system, so we understand the costs of accessing health services in the community,” she explains. “By developing ways for people who don’t have normal access to facilities to get them, we help people manage issues without having to resort to extremes. Our House Calls program, for example, helps prevent seniors’ emergency room visits by offering them medical care in their homes—just like an old-fashioned house call. That certainly influences our business and has an impact on the community as a whole. But the real reason we’re involved in the community is to improve access in the first place.”
Creating healthy communities
Taking the pulse of a community’s health care network has as much to do with assessing its political, social and behavioral determinants of health—such as the access to affordable housing and food, or safe neighborhoods—as it does with access to care.
“We know that just having access to services doesn’t mean that our clients will be healthier,” says Dory Escobar, director of healthy communities for SJHS-SC. “They also need to be in an environment that supports healthy choices. Are their neighborhoods safe? What are the literacy levels of their children? What are the graduation rates from high school? All of those things tie into the health of the community.”
The Healthy Communities programs are designed to build the community’s capacity to affect positive change in Sonoma County’s disenfranchised neighborhoods through community organizing and grassroots leadership development. More than a dozen groups across the county are currently engaged in related projects, ranging from establishing and maintaining community gardens to replacing graffiti-strewn walls with colorful murals. The successes are measured in safer streets, cleaner parks and residents who are able to manage or, better yet, prevent health problems.
“Partnering with the community is a very fluid process that can take years,” Escobar says. “We literally start by going into the neighborhood and knocking on doors. The people we talk to face obstacles like poverty, immigration status and lack of education to make healthy lifestyle choices. After a few visits, we start to connect with people, and the relationships start to build. Through that process, we discover who the natural leaders are in the community and work on bringing them together and mentoring their abilities.”
The mentoring muscle comes from SJHS-SC’s Neighborhood Care Staff (NCS). In 2009, its Agents of Change Training in our Neighborhoods (ACTION) program trained 12 new community leaders in low-income neighborhoods in Santa Rosa as part of the Community Activity & Nutrition Coalition’s Healthy Eating/Active Living Project. Overall for the year, the NCS was the catalyst behind mentoring more than 140 community leaders who engaged their neighbors on issues ranging from substance abuse to gang prevention.
“We help them with leadership training and mentoring, but the real focus is on what they can do as residents of their local communities to make a difference in the lives of their neighbors,” Escobar points out.
For example, the residents of one Sonoma Valley school district were concerned about the nutritional value of what their children were eating for lunch at school. Because of their low socio-economic status, however, they didn’t feel empowered to express their opinion. With the help of community leaders organized by SJHS-SC, they formed a group and approached one of the schools. Eventually, they contacted the food services director of the school district and talked about their concerns—and within six weeks, the district office changed its policies, resulting in improved food that affected the health of thousands of school children.
“People can make a difference,” Escobar says. “We help them develop the long-term skills to build consensus with stakeholders, but also those they need to work with institutional partners to make changes in their neighborhood. They can start to make connections between the conditions of their sidewalks, how safe it is to walk to school in their neighborhoods and the health of their children.”
Sometimes it just takes a garden (and not an entire village) to sow the seeds of change. For a number of years, SJHS-SC has worked with an organization called Nuestra Voz to spearhead its efforts to develop leadership within the Latino community to improve its health and quality of life. Earlier this year, the group invited other organizations to help it start a community garden to serve as a source of fresh, healthy food and an educational tool at the same time. To date, 12 organizations have joined the Sonoma Valley Community Garden Coalition and—in a first—the Sonoma County Parks Commission has agreed to set aside land in Larsen Park for the garden.
Another bright spot in the community that’s blossomed under the tutelage of SJHS-SC is Concerned Citizens of Rohnert Park (C-CORP), a group of residents living in the city’s older southern neighborhoods. Through the mentoring of the Healthy Communities organizing team, C-CORP started neighborhood beautification projects and rallied for traffic improvement measures on busy Adrian Drive, including speed bumps, a bicycle lane and new signage. After several years of C-CORP’s advocacy, including reporting code violations in their neighborhoods, Rohnert Park city officials earlier this year reviewed, updated and republished its municipal codes, crediting C-CORP and SJHS-SC’s Neighborhood Care Staff as partners in the revision.
Calling on community partners
SJHS-SC doesn’t accomplish all this work on its own. In fact, the organization has a vast network of community partners that cross social, ethnic and economic classes.
For example, in its efforts to improve children’s oral health—one of Sonoma County’s greatest unmet needs, with nearly 40 percent of the county’s children in Title I schools afflicted with untreated dental disease—SJHS-SC has teamed up with a number of local, state and federal agencies, including the California Oral Health Access Council, Redwood Community Health Coalition, the Redwood Empire Dental Society, Santa Rosa Junior College and the California State Schools of Dentistry at the University of California-San Francisco and University of the Pacific.
Partners like these have helped immensely in recent years as the economy has crumbled and the state has cut back its budget, plunging more people into hard times and placing even more demand on SJHS-SC services.
“We’re seeing more people with chronic medical problems, who’ve lost their jobs or their homes and need prescriptions and ongoing care,” says Sandy vonRaesfeld, who manages the medical programs for the SJHS-SC Community Health team. “To meet their needs, we’re now taking our mobile clinic to places like the Mary Isaak Center in Petaluma. We’ve found that when the mobile clinic started out, it was mostly a pediatric van that saw children and the moms with them. Now we’re seeing more and more adults and seniors.
“Where are the locations and who are the populations that are missing out?” she asks. “Those are the places where we can make a difference.”
Despite the lingering financial crisis, SJHS-SC actually increased its investments in the community between 2008 and 2009. Both Santa Rosa Memorial and Petaluma Valley hospitals elevated their spending during that period on prevention activities. Santa Rosa Memorial invested approximately $2 million in community services for low-income community members, while Petaluma Valley invested $66,000 in community services.
The passage of health care reform is also expected to have a major impact on the demand for SJHS-SC’s community-based initiatives in the future. “Health care reform will create the access that some of the people we serve don’t have now, so in some respects, that’s a good thing,” Sandersfeld says. “People will be more likely to check out the health problems they may have ignored in the past. But I think we’re all waiting to see how it plays out in the real world. We’ve already started to plan how to reach the people who will fall through the gaps and not get the care they need. We may need to realign where we situate our programs and how we deliver our services, but we’ll be ready to respond.”
Sandersfeld predicts that the future will bring more empowerment-based initiatives, more capacity building and more involvement with community partners. “We’ll see our community-based networks continue to grow, and that’s a great thing, because none of us can do this by ourselves. Health care is a very competitive business, so we need to find ways to collaborate to creatively provide all these services to our patients.”
As an example, SJHS-SC and its partners will begin piloting a childhood obesity program with two schools in Sonoma Valley this year. In Sonoma County, more than one-third of all children are overweight or obese, presenting a problem that won’t be solved quickly or easily. In typical fashion, SJHS-SC is confronting the crisis on multiple, integrated levels, illustrating why it’s garnered national attention for its health care initiatives. For instance, it served as one of the founding members of Sonoma County Health Action, a high-level community health council convened by the Board of Supervisors. The group’s first initiatives, iWALK and iGROW, are designed to engage local residents in walking groups and community gardens.
“These activities are designed the build the capacity of the most vulnerable individuals to serve as health advocates for their own families and communities,” Escobar says. “They help to remind us that, when we care for ourselves and others, our entire community is the better for it.”
St. Joseph Health System Sonoma County Resources
Agents of Change Training in our Neighborhoods (ACTION) provides leadership and advocacy training to Spanish-speaking community leaders vulnerable Sonoma County neighborhoods as well as to members of the 41st Avenue Community Center in Sacramento. (707) 525-5300 x3216.
The St. Joseph Mobile Health Clinic serves children and adults from low-income families who are uninsured or underinsured countywide. (707) 547-4612.
Cultivando la Salud (“Cultivating Health”) Mobile Dental Clinic provides dental care visits to agricultural workers, low-income families and special needs patients. (707) 547-4649.
Mighty Mouth Dental Disease Prevention Program provides school-based dental education and oral health care for children. (707) 547-4615.
The House Calls Program tends to the physical, spiritual and emotional needs of elderly seniors and adults by providing primary medical care in the home. (707) 547-4684.
Promotores de Salud (“Promoters of Health”) is a community-based health and wellness organization that connects people with resources such as MiVIA, an electronic personal health record system. (707) 547-4602.
Circle of Sisters is a free violence-prevention, after-school program for girls ages 10 to 14. (707) 525-5300 x5311.
To learn more about St Joseph Health System’s Community Benefit programs, visit www.stjhs.org.
Promotores de Salud
The promotores accompany the mobile clinics to assist patients in completing their intake forms and, while patients wait for services, they reinforce positive health messages. You might find them advocating for wellness at churches, health fairs and community group meetings. In existence since 2002, the group has been instrumental in linking immigrant community residents to available health resources.
Nuestra Voz
SJHS-SC continues to provide advice, funding and training to Nuestra Voz through its Agents of Change Training in our Neighborhoods (ACTION) program. From its community center in Sonoma, it offers healthy cooking classes; martial arts for children, teens and adults; music and art classes; yoga; and Zumba.
Under the ACTION team’s guidance, Nuestra Voz has grown from a loosely organized group to a formal nonprofit organization with more than 400 volunteers.
