MCH Student:
Paola Schnabel
Date of Defense:
February 15, 2019
Abstract:
Introduction: For my field experience, the public health issue I focused on was increasing utilization of parental support and early childhood development resources by families living with low incomes. This is a public health priority because many families living with low incomes, especially children, are at risk for experiencing adverse health outcomes and utilizing these resources can help reduce this risk, as well as allowing children to experience healthy stages of childhood development (Ryan et al. 2009). My field experience was conducted at the Community University Health Care Center (CUHCC) which predominantly serves low-income patients, many of whom are families with children. Studies have shown that families of lower socioeconomic status tend to experience more stress, pressure and other risk factors, which can negatively impact a child’s development. Families who experience difficulty providing food, shelter, emotional support, and/or meet other critical needs for their children due to financial constrains or other stressors, can inadvertently affect their child’s growth and development (Ryan et al. 2009). In addition, low-income parents who have limited time to care for their children, e.g. due to working multiple jobs, combined with the stressors described above, can experience difficulty nurturing the development of appropriate parent-child interactions. Community-based parenting support programs are designed to support and strengthen existing parenting abilities and promote the development of new competencies, so that parents have the knowledge and skills needed to carry out child-rearing responsibilities and enhance the growth and development of young children (Trivette & Dunst, 2014). The availability of these services which provide social, emotional, and educational support and early childhood development interventions can be highly beneficial for this population.
Families living with low incomes face many barriers when accessing services. Limited financial means, transportation and time off of work are the main barriers cited by families when accessing care and support for their child (Lewis et al. 2017). Another barrier is the mistrust of healthcare and social service providers (Heath, 2017). In particular for low-income and patients of color, the majority of patients seen at CUHCC, this perception of mistrust may be due to systemic oppression and generational trauma. The idea underlying this field experience is that by improving provider-patient relationships, and practicing culturally appropriate care, this can lead to an increase in the utilization of community and government based parental support services by this population.
Organization: My field experience was conducted at the Community University Health Care Center (CUHCC), which is a federally Qualified Community Health Center, Rule 29 Mental Health Clinic and a department of the University of Minnesota. It is also a safety net clinic, meaning that CUHCC provides services to individuals no matter their socioeconomic status or insurance coverage. Of the patients seen at this clinic, 70% live at or below federal poverty guidelines, 53% rely on Medicaid, CHIP or other public insurance, and ¼ are uninsured and utilize a sliding fee scale. CUHCC patients represent at least 12 different racial/ethnic groups and 42% of patients prefer a language other than English. The following is the racial breakdown of patients; 27% identify as African, 22% Latino/Hispanic, 19% European American, 13% African American, 11% Asian, 4% Native American, and 4% other. Due to the high-volume of immigrants served, services are available in 6 different languages – Spanish, Somali, Loa, Vietnamese, Hmong and English. With regards to families seen at the clinic, 30% of patients are children between the ages of 0-17, and 50% of the children who receive care are fully immunized by 2 years of age.
The mission of the clinic is to transform care and education to advance health equity, which aligns with their status as a community health center. The following services are provided at CUHCC; medical, dental, mental health, advocacy, legal services, case management, care coordination, and Adult Rehabilitative Mental Health Services (ARMHS). CUHCC is also a learning clinic which hosts residents from all areas of medicine and interns from several local graduate school programs. The vision of the clinic is to be a premier education site which leads in team-based care, and centers on person-family-community experiences. CUHCC clinic staff are also representative of patients served. Over 50% of CUHCC staff are immigrants, refugees and people of color. Many staff members speak more than one language and when needed, interpreters are available on site.
Experience: At CUHCC, my internship role was as a Health & Wellness Care Coordinator. I met with patients to address immediate needs and provide on-going care coordination when necessary. For the purpose of the Public Health field experience, I developed a project to assess whether the families and children seen at the clinic experienced any gaps in service utilization or if there were certain needs discussed during appointments with their providers that were not being met. My goal was to create an educational maternal & child health (focus on family practice) resource guide for patient needs. The learning objectives were as follows; determine patient needs, research patient needs to gather best practice methods, and create a resource guide which providers can distribute to patients at the clinic
I started by meeting with pediatric providers to discuss their patient’s needs. Since pediatricians meet with children and their families daily, I believed they would be able to provide me with in-depth information. Pediatricians indicated that patients expressed needing additional parent support such as parenting classes, home visiting programs, and also noted a lack of parental education on early childhood development (i.e. social and emotional health of a child). This was particularly true for families with children under the ages of 5 and 10. Access to mental health services for 6-12 year-olds was also discussed as an urgent need for families. With regards to adolescent health, providers mentioned a need for more education around sexual health, mental health and substance use.
Based on these findings, I researched resources for families with children under the age of 10. Given the demographic characteristics of the clinic’s patients, I specifically looked for services available through Hennepin and Ramsey Counties. Since the majority of our patients are of lower socioeconomic status, social services via the county are more accessible for this population. I created a pamphlet which specifically lists parental support groups, home visiting programs and early childhood development services for families living with low incomes. This pamphlet will be made available in other languages. I also created a document with culturally-specific parental support services within the Somali, Latino and Hmong communities.
Recommendations: Based on my experience at CUHCC, a key recommendation I have is for the clinic to establish their own parental support initiative for patients. In my meeting with providers, they mentioned an interest in developing an on-site parent support group. Due to the patients’ needs they mentioned, this group could greatly benefit their patients. CUHCC is a wrap-around clinic which provides an array of services so that patients are able to receive their care all in one place. Due to the barriers in accessing care many of these patients experience, having their medical, mental health and other support services available in one building is helpful. This would allow patients to utilize a service through a clinic they already have established rapport with. Continuing to provide external referrals is still necessary since the clinic does not currently provide this resource.
Lessons Learned & Conclusion: Upon completion of my field experience at CUHCC, I realized that while this clinic provides an array of services to individuals in need, there are still barriers and limitations individuals experience in accessing certain services such as parental education and support. This is particularly true for communities of color and since there is a large immigrant population in Minneapolis, developing more parental support services for these communities is necessary.
References:
Heath, S. (2017). Low-income patients cite financial, cultural barriers to care. Patient Care Access News- Patient Engagement HIT. Retrieved from
https://patientengagementhit.com/news/low-income-patients-cite-financial-cultural- barriers-to-care
Lewsi, C., Abrams, K.M., & Seervai, S. (2017). Listening to low-income patients: Obstacles to the care we need, when we need it. The Commonwealth Fund. Retrieved from
Ryan, M.R., Kalil, A., & Leininger, L. (2009). Low-income mothers’ private safety nets and children’s socioemotional well-being. Journal of Marriage and Family, 71, 278-297.
Trivette, M.C. & Dunst, J.C. (2014). Community-Based parent support programs. Encyclopedia
on Early Childhood Development. Retrieved from http://www.child-encyclopedia.com/sites/default/files/textes-experts/en/654/community-based-parent-support-programs.pdf