Retooling for community health partnerships in primary care and prevention.

Abstract

Major changes in medical care challenge health care professionals to discover new ways to address health needs in primary care and prevention (Berkman, 1996). Replacing fragmented systems with coordinated networks of care is one of the greatest challenges. Ensuring that underserved and vulnerable populations have access to comprehensive care is another. Both call for the development of creative partnerships among traditional health care providers, social services professionals, and members of the community. Building and participating in partnerships will require retooling for many professionals. MODELS THAT WORK Recognizing the urgent need for partnerships, the Human Resources and Services Administration's (HRSA, 1996) Bureau of Primary Health Care in the U.S. Department of Health and Human Services is leading a partnership of 36 national foundations, associations, and nonprofit organizations in a Models That Work campaign. The campaign seeks to increase access to primary and preventive health care for underserved and vulnerable populations by encouraging communities to establish comprehensive primary health care programs that are creative, responsive to the community, and transferable to other communities. The following six examples are partnerships that communities have developed to achieve these objectives in a variety of settings. First, the partnerships involve community members in the design and delivery of services. The Cure/Heart, Body and Soul program in Baltimore uses trained neighborhood health workers to carry out prevention efforts in urban African American communities. Workers complement traditional systems of primary care by providing preventive screening, health education, referral, follow-up, advocacy, and community organization. Similarly, the Camp Health Aide Program in Michigan enlists migrant farmworkers to provide culturally appropriate health education, advocacy, outreach, referral, and follow-up services. The Community Health Advisor program in Mississippi uses trained natural helpers who live and work in rural communities to provide health information and advice; organize self-help action projects; and connect neighbors, families, and friends to needed services. This program has reduced infant mortality in one county by 16 percent. Second, the partnerships identify people at risk for health problems during crisis events. In a poverty-stricken neighborhood of St. Paul, Minnesota, HouseCalls identifies families at risk of homelessness through referrals from housing inspectors, outreach workers, and traditional service providers. A staff social worker and the family develop a crisis intervention plan to identify housing priorities as well as health needs related to inadequate prenatal care, delayed immunizations, and overdue well-child checks. Home visits, transportation, and other support services are provided to facilitate access to housing and health services. The Adolescent Community Services project in Binghamton, New York, provides reproductive health services, health education, counseling, and transitional housing supports to pregnant, parenting, and high-risk adolescents and their families. Intervention during this crisis-prone stage of life reduces teenage pregnancy rates, lowers foster care placements, and increases high school completion rates. Third, the partnerships reach out to people by providing coordinated health services in accessible community sites or in the homes of families. For example, Enloe Hospital in Chico, California, offers a wide array of health and social services at a community center for migrant farmworkers and their families. This approach decreases pediatric visits to emergency rooms by increasing access to primary and preventive care. In the Arkansas Delta Community Integrated Service System, a family care coordination team uses a home-visiting model to improve access to services, pregnancy outcomes, and infant health in rural areas. …