Tackling Medical Mistrust among Marginalized Communities: Community Based Organizations
How do we make people believe?
My last post was about the historical legacy of mistreatment of marginalized communities, unsurprisingly resulting in medical mistrust (and mistrust of government institutions more broadly). While the history is clear, what I also hope to bring to light are the organizations that are working to build trust with marginalized communities to ensure utilization of resources.
And most importantly, improve their quality of life.
When trying to get two groups to come together meaningfully, it is always helpful to have a mediator. A group that is trusted by both sides and can deliver the end goal. To that effect, many hospitals/health systems partner with community-based organizations to ensure that they are able to gain the trust of the local community. CBOs can also help with patient health literacy efforts and culturally competent outreach. While data shows that facilitating these connections does not necessarily change inpatient and emergency room services utilization, it can help contribute to patients’ sense of overall well-being and awareness of general services they can access.
Improving Asthma Control in East Harlem: Partnership between Little Sisters of the Assumption Family Health Services and OneCity Health
Childhood asthma prevalence in East Harlem has often been described as a crisis. In 2014, 102 out of every 1,000 children had asthma in East Harlem — compared to 74 out of 1,000 for the entire New York City region. There are ongoing CBO and health system investments in asthma prevention and support, most notably the East Harlem Asthma Center.
OneCity Health is a prospective payment system (PPS) program formed through partnerships across New York City’s public health system (known as NYC H+H). PPS is one of the many financial arrangements that health care organizations can use under the value-based payment (VBP) framework. This framework contends that instead of reimbursing health care organizations for volume of services utilized by patients, payment is made upfront to the health care organization. This requires them to manage costs efficiently and be judicious about what services to recommend to patients.
In this environment, OneCity Health decided to partner with community based organization Little Sisters of the Assumption Family Health Services, which provides health literacy classes and home visits. One of Little Sisters’s core programs is dedicated to environmental health, mitigating the negative effects of childhood asthma through caregiver education, hands-on remediation, and advocacy.
Source: Idealist
Materially, this partnership allowed OneCity Health to get insight into the challenges their patients were facing at home, and also increase awareness among potential patients of the services OneCity Health provides. While this partnership was not without challenges — streamlining clinical and administrative operations, for one — overall, it allowed OneCity clinicians to understand the challenges that patients were facing at home. According to a 2018 paper published by the Greater New York Hospital Association and New York Academy of Medicine, who profiled this partnership, one of the OneCity clinicians said:
“I think it kind of opens the eyes of the clinical team as well, because in the office, it’s all about medication adherence, it’s not really about environment. And opening these channels has really been an eye-opener for the clinical team, as well.”
This realization is critical. In many situations, marginalized communities — like children living in East Harlem — experience very high rates of asthma diagnosis due to environmental factors.
For Little Sisters, they realized the benefits of being able to communicate with physicians, nurses, social workers, and others in a secure environment to better aid patients and their caregivers (especially important in a pediatric population).
Addressing Food Insecurity through Screening: A Partnership between Kaiser Permanente and Hunger Free Colorado
Colorado has recently become a frontier in connecting social determinants of health — non-health factors that play critical roles in health outcomes — and health care delivery. Only a few years ago, Denver — one of Colorado’s largest cities — launched a Housing to Health program. While the program’s results collection is still under way, designing a program that prioritizes providing housing for indigent patients with robust arrest records and involvement with law enforcement to improve their health care demonstrates a recognition of how social factors impact one’s health.
Hunger Free Colorado, a nonprofit dedicated to eradicating food insecurity within the state, partnered with Kaiser Permanente through a larger initiative called the Colorado Blueprint to End Hunger. Blueprint to End Hunger was started by the Colorado Health Foundation in an attempt to bring health care organizations and CBOs together to tackle hunger in the state. While most CBO-health care organization partnerships are more locally focused, the Colorado Health Foundation was strategic in creating an overall vision for how to connect Coloradans to critical resources to prevent hunger.
Source: Health Affairs
Hunger Free Colorado eventually developed a partnership with Kaiser affiliated facility Children’s Hospital Colorado. Through this partnership, the children’s hospital launched a food insecurity screening program through their primary health clinics. The grant funding that the children’s hospital used also went to the hiring of a family navigator through Hunger Free Colorado. This navigator was responsible for ensuring that patients were able to access relevant resources. This partnership also helped to build out the infrastructure for these other resources, including a hospital-wide food security council, nutrition classes for families, and a hospital-based community garden.
Both stakeholders have seen success in this partnership, based on the recognition that access to healthy, nutritious food is critical to overall health. This screening program has destigmatized patients asking for assistance with obtaining food, while also allowing for seamless data sharing to ensure appropriate tracking of outcomes.
Community-based organizations have shown, time and time again, how much they care about and represent the people for whom they are advocating.
When they partner with institutions with historical legacies of exploitation, they can bring patients closer to better care and, more importantly, better outcomes.
It is building and reinforcing these relationships that can be the difference between illness and whole health.
On Thursday, I’ll profile one of the health care institutions that was designed for marginalized communities: the federally qualified health center.
As a doula, this spoke to me because I am often the "middle ground" between provider and families who are receiving perinatal care from the healthcare system. CBO's are so important!