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Social impacts on health tended to in new program

  • December 1, 2013

By Stephanie M. Lee
Chronicle Staff Writer

Ashley Cook recently took her 2-month-old daughter to Children's Hospital Oakland, expecting a routine visit with a pediatrician.

But after the appointment, the doctor introduced the new mother to a hospital volunteer, Yolanda Pulido-Lopez, who asked her if she received food stamps, if she was working, where she lived - subjects that doctors don't usually inquire about. Pulido-Lopez understood, however, what research has shown: Socioeconomic and environmental factors can have a significant bearing on a child's health.

To address that, half a dozen Bay Area health care providers, including Children's Hospital, are trying to break from the normal way of doing things. They've trained crews of volunteers to help patients find resources to tackle problems that directly or indirectly make it hard to be healthy.

On a recent afternoon, Pulido-Lopez, a trained social worker, listened as Cook explained that she wanted to move into a home of her own. The 21-year-old Oakland mother also told them she'd been diagnosed with a learning disability years ago.

So Pulido-Lopez told Cook about Through the Looking Glass, a Berkeley nonprofit that helps parents and children with disabilities. "I want you to work with someone who can help you get housing," she told Cook, writing down the number of a friend who works there.

Beyond the clinic

This is the kind of conversation that Dr. Dayna Long, the pediatrician, wants to hear more often. Doctors can only work so much magic when patients lack stable housing, food, health care and opportunities to exercise, she said. The proof is in the thousands of patients who check into hospitals multiple times a year without ever getting healthier.

"The societal and environmental factors that impact health can lead to chronic diseases and can lead families to come to the emergency room over and over again," Long said.

That belief motivated her to co-found the Family Information and Navigation Desk at Children's Hospital last month. The program consists of about 30 "navigators," who aren't to be confused with the navigators who help people sign up for insurance under the Affordable Care Act.

Most are students at UC Berkeley, Mills College, San Francisco State University andSamuel Merritt University's School of Nursing who work in the hospital's emergency department. Four navigators, parents and students, volunteer in primary care, and the hospital wants to recruit 30 more.

During more than 16 hours of training, navigators learn about dozens of nonprofits, civic agencies and programs that are set up to help people with problems ranging from homelessness to asbestos in their homes to a lack of easy access to parks.

Socioeconomic factors

Extensive research shows that external factors can make a big difference in people's physical and mental health. A Columbia University analysis in 2009, for example, found that poverty and high school dropout rates can lead to ill health and shortened lives. Researchers found those factors have a more negative impact on people's well being than smoking or obesity.

Health care leaders are particularly worried about such disadvantages in places like Alameda County, where about 10 percent of the 1.5 million residents reported being uninsured in a 2012 survey. At Children's Hospital, 65 percent of young patients have government insurance.

Even so, "physicians feel like they don't want to ask (about socioeconomic factors) because they feel like there's nothing they can do," said Jessica Peters of Regional Asthma Management and Prevention, which is helping oversee the primary care part of the program at Children's Hospital. "They might not know the right resources."

In addition to Children's Hospital, navigator programs are up and running at San Francisco General Hospital and Highland Hospital in Oakland. Stanford University, Contra Costa County and San Mateo County public hospitals are experimenting with similar programs.

Highland Hospital started its program in March with a small amount of grant funding. Most of its work is done by its two dozen volunteers, who are undergraduate and graduate students at UC Berkeley, Cal State East Bay and Mills College and who have helped nearly 200 patients, according to the hospital.

Since mid-October at San Francisco General Hospital, 38 navigators, all of whom are also students, have been assisting patients in the pediatric primary care and urgent care departments. In addition, social workers and attorneys are on hand to guide those with more complex needs.

Both this operation and the one at Children's Hospital are supported by a donation from the Lisa and John Pritzker Family Fund through at least June 2015.

Smaller efforts

Locally, there have been similar, smaller efforts to help patients navigate complicated medical situations. Under a UCSF program, for instance, student interns work with cancer patients to develop questions for doctors and accompany them to appointments.

But Megan Sandel, medical director of the National Center for Medical Legal Partnership, said the navigator program's wide approach to primary and urgent care at sites throughout the Bay Area may be the first of its kind in the nation.

"It's not a single intervention, but a linked intervention that can address which social and legal issues a patient has, detect them early in the process and be able to deal with them preventively to achieve better health outcomes," said Sandel, who served as an adviser to the program at San Francisco General Hospital and the Children's Hospital program before it started.

But it's one thing to tell a patient to make a call or visit an agency. It's another for him or her to do it.

On a recent morning at Children's Hospital, Pulido-Lopez talked to LaTanya Ross, 34, of Oakland, who was there with two daughters in tow. "It's hard being a parent, but you get used to it when you got a lot," she said with a half-laugh.

Ross said she was out of work at the moment, and her husband, who has epilepsy, was also unemployed. She wasn't expecting to get help with her high utilities bills when she took her newborn to the doctor, but seemed grateful when Pulido-Lopez printed out information onPacific Gas & Electric Co. subsidies.

"They can help me with referrals," she said.

An offer of help

Sensing the mother was overwhelmed, Pulido-Lopez offered to take her to an agency that could refer her to child care services.

Ross agreed to her offer, but only after she ran an errand. Ross never returned. Pulido-Lopez's policy as a navigator is to call patients every two weeks until their issue is resolved, but she still hasn't been able to contact Ross.

On the other hand, Cook has left Pulido-Lopez a series of promising voice mails. The young mother told her she had called Through the Looking Glass, which had in turn helped her sign up for a case manager who would work with her one-on-one. She'd also enrolled her daughter in Early Head Start, a federal child-development program.

It was all very good news.

"When they make the connection and things work for them, we are happy," Pulido-Lopez said. "I am happy."

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