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Achieving Health Equity through Enabling Services – You do it. Now prove it!

Monday, February 13, 2017   (0 Comments)
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Juli Hishida, National Health Care for the Homeless Council


Editor's note:  Tuyen Tran of AAPCHO  and Kristen Stoimenoff of HOP will be presenting on this topic at the Western Forum for Migrant and Community Health in San Francisco




As community health centers, we play a critical role in the delivery of primary care for some of society’s most marginalized individuals, and I like to believe we are the most innovative providers in the health care industry. One instance, and the underlying theme of this article, is acknowledging social determinants of health (SDOH), which include factors such as socioeconomic status, access to health care, and the physical environment or neighborhood where one resides. In our day-to-day operations we see how these circumstances affect patients’ health and wellness, since our patients are among the most vulnerable and historically disenfranchised populations (more specifically, racial and ethnic minorities and people living in poverty). It’s not surprising that our health centers have been ahead of the game as far as recognizing the relationship between health and social issues. The objective is to address these external social and economic conditions so we can achieve health equity for all populations.


As a practical response to SDOH, community health centers provide enabling services - non-clinical services such as transportation, interpretation, outreach, and health education. Undoubtedly, enabling services increase access and utilization of primary care, so essentially, we’re achieving health equity through these services. This practical response is run of the mill for our health centers.


Several years before Health Care for the Homeless programs consolidated with what is now the federal health center program, there were only a handful of clinics across the country intended to served people experiencing homelessness. When they opened up shop they noticed people who were living on the streets and in shelters were not coming to the brick-and-mortar clinics. Clinicians soon realized they needed to meet clients where they were- at the park, day shelter, or soup kitchen. And that’s what they did. Thirty years later, outreach, in its varying forms, is a standard for health care for the homeless and a required enabling service for federally-funded health center programs[1]. This is one example of how community health centers provide primary care while concurrently addressing social, environmental, and economic factors that impact access and health outcomes. In this sense, I like to think of us as health care trendsetters.


But as the health care industry catches up and moves toward a better understanding of the relationship between SDOH and health outcomes, there is more pressure to provide data to back up our claims; that yes indeed, health education improves treatment adherence, or providing access to nutrient-dense meals affects immune system functioning and cognitive development. In fact, research conducted by the Association of Asian Pacific Community Health Organizations (AAPCHO) demonstrates a positive relationship between enabling services utilization and HbA1c levels and child immunizations[2]. Even without hard data, at the individual and community level we know these models of care are effective. We’re also aware our work doesn’t stop at the provision of care.


In addition to providing quality primary care and enabling services, more and more health centers are encouraged to track data, measure impact, and demonstrate value. Fortunately, there are national organizations and networks that exist solely to support health centers in their work. Through developing educational and practical resources, conducting research, addressing policy and advocacy issues, and providing training and technical assistance, these organizations support the needs of health centers in meeting federal guidelines and requirements, including responding to demands for more proof that our work is valuable and services effective.


As such, AAPCHO developed a nationally-recognized and standardized model specifically for collecting and analyzing enabling services (ES) data. And for the past several years, Health Outreach Partners (HOP) and the National Health Care for the Homeless Council have partnered up with AAPCHO to further develop and promote this tool. If you’re interested in learning more about how health centers are tracking, recording, and utilizing ES data, we encourage you to join us for the upcoming Western Forum for Migrant and Community Health. Tuyen Tran of AAPCHO  and Kristen Stoimenoff of HOP will present the tool and standardized protocol for documenting enabling services, walk through real-life scenarios, and facilitate discussion among workshop attendees. We hope to see you there!

[2] http://www.aapcho.org/resources_db/impact-of-enabling-services-utilization-on-health-outcomes/



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