Beyond the Hospital Walls

October 31, 2014

Aide Silva’s third-grade class at Gulf Avenue Elementary in Wilmington hits the playground as if school had just let out for summer. It hasn’t, of course. It’s a Tuesday morning in May, and many more weeks of reading and writing remain.

But the skipping and laughing boys and girls are elated. Today is their twice-monthly COPA (Creating Opportunities for Physical Activity) class, a teacher- training program launched by Providence Health & Services, Southern California, to impart a love of movement and physical fitness in children who reside in economically disadvantaged neighborhoods.

“They love this,” Silva says, after instructing her class in a game of straddle ball. “If we don’t have the class, they are so disappointed. For any child, this type of program would be valuable. But in our area, parks are so limited. Children don’t get the physical activity they need.”

“Creating healthier communities together” is the Providence core strategy, and programs such as COPA turn those words into action. The program is one of dozens designed to reach beyond the walls of the hospitals.

By collaborating with government agencies, local churches and schools, charitable foundations, and research organizations, the Community Benefit programs focus on preventive health needs and fill gaps in community health care services. Since 2010 Providence Health & Services, Southern California, has funneled more than $578 million into the programs (which also includes charity health care and the unpaid costs of Medi-Cal).

“It’s a huge piece of who we are,” says Sister Colleen Settles, OP, chief mission integration officer for Providence Saint John’s Health Center. “We know in this day and age that not everyone is going to be able to access the health care they need— except when they need an emergency room visit. There are people who would not have access to our care unless we went out to them where they reside.”

The programs include mobile health vans that travel to underserved communities to provide checkups for people with chronic conditions, putting school nurses in select schools, community health fairs and outreach to sign up the previously uninsured who can now access coverage under the Affordable Care Act.

Funding for the Community Benefit programs comes from grants and hospital revenue. Programs are funded based on a meticulous selection
process. Every three years the two directors of the service area programs conduct a community needs assessment, seeking input from the community on its most pressing needs.

“Our programs are developed in such a way that they can morph with the health needs of the community,” Settles says. “If we find hypertension or diabetes in a certain area, we can address that.” They do so with programs such as the mobile health van.

Partnering with community members is a key to the programs’ success. Recently the assessment showed a growing need for mental health care. The Community Outreach program partnered with Tarzana Treatment Center, a behavioral health care and addiction treatment facility, which applied for a grant to train community health care workers on how to conduct basic mental health screenings. The screenings help identify individuals who should be referred for treatment and links people with mental health resources.

“We also found that children are witnessing a lot of violence that’s exacerbating their mental health needs,” Settles adds. “We partnered with California State University Northridge and Los Angeles and their schools of social work and counseling for students to do their residencies in the schools. It’s a wonderful, creative way to address that need.”

One of the longest-running projects is the Latino Health Promoter Program, launched in 1993 in the San Fernando Valley. The program aims to bring health care education and services to people who are not connected to a doctor’s office or clinic.

Program staff identify and train community members—health promoters or, in Spanish, promotoras—who have an interest in health and wellness. During the six-month training process, the promoters learn how to conduct educational seminars and steer people to services they may need, says Ronald Sorensen, director of the Providence Center for Community Health Improvement for the San Fernando Valley.

The promoters lead diabetes support groups, organize health fairs and assist with various health screening events. Some of the promoters are paid workers, while many are volunteers.

“Because we recruit people from the local com- munities, they are culturally sensitive and speak the same language,” Sorensen explains. “People have a strong trust and bond with individuals who live in the local community.”

Over the years, the program has identified people with serious disease and connected them medical care. “When we do health fairs, we see people who come back year after year and say, ‘I look forward to this because this is when I get my screenings done,’” Sorensen says. “We know it’s providing an important service to people who can’t otherwise get their cholesterol or bone density checked.”

The Latino Health Promoters Program has emerged as a model for the concept of population health—the idea that the American medical system must focus on the health of entire communities with aggressive preventive care strategies, rather than just focus on treating individuals once they become ill.

“I’m excited about the Latino Health Promoter Program. I think it’s a forerunner of a new professional caregiver,” Settles says. “They are the caregivers who will
help people stay healthy at home. They can check on the patients to make sure they’re doing okay.”
Enlisting the help of devoted people who care about their communities is what makes the program a success, she adds. “A lot of this would not happen if not for the volunteerism of people.”
“This is not the same old exercises we learned when we went to school, like jump- ing jacks,” she notes. “The kids don’t think about how much they’re sweating or how much their hearts are racing. They’re just having fun. I participate as well. If they see me doing the activity, they want to do it.”

COPA is designed to teach the teach- ers about physical activity. At the start of the school year, teachers are trained on the curriculum, which is based on the state public school standards for physical education instruction. COPA’s physical education specialists come to the schools to assist the teachers.

But over time the teachers conduct greater portions of each lesson. At the end of the three-year program, the COPA in- structors will leave, but the equipment and instructional manuals remain at the school, says James Tehan, director of community partnerships who oversees programs in the South Bay.
“The goal of the peer coach model is to help teachers gain the confidence to be independent in physical education for their grade levels,” Tehan says. “This is accomplished by providing them the COPA Teacher Guide, and together the Providence PE specialist and teacher partner to achieve the goal. As an ever-larger group of teachers at a school gains independence, they collectively begin to organize school-wide events, projects and pilot projects designed to increase daily physical activity.”

At Gulf Avenue Elementary, child obesity rates are high, and many kids suffer from asthma that is worsened by the proximity of smoke-belching oil refineries. Families are grateful for the efforts to keep their children healthier, says Freddie De Leon, a COPA physical education specialist who is assisting Silva this day.

“I hear from parents that their children are beginning to lose weight,” he says. “This program is so important because the kids are sitting for hours in school and may not even move around enough at recess.”

Teachers could opt in or out of the COPA program, but almost every one of them chooses to participate, says Gulf Avenue elementary principal David Kooper. “This has created a commitment from our teachers to make physical education a priority. This is not about throwing out a kickball and standing back. This is fun, and it’s creating a culture of fitness.”

Ultimately the aim of all of the Community Benefit programs is to leave positive footprints behind, says Sorensen. “We are out there on the front lines and know that what we’re doing in the community is in direct relationship to our mission statement and what the Sisters of Providence intended when they started our system in the mid-1800s.”

He continues, “It’s about being in the community, looking at what the needs are and then responding to those needs as best we can.”