Program Director of the Household Centered Care Program Bernice Hernandez Becerra discussing Healthy Connections/Conexiones Saludables, a component of the HCC program, with a community member. | Courtesy of UH College of Medicine
UH College of Medicine has gotten the ball rolling on it’s Household Centered Care Program, a component of their community health commitment, despite setbacks from the pandemic.
The purpose and impacts
The program is meant to identify social determinants of health within the community, and through an interprofessional health care team, find resources for participants to better their quality of life and in turn their health.
The way these teams approach this is by visiting participants in their home to get an up close and personal experience as to how these participants are living day to day.
“Having that experience of being in someone’s home or in their community sheds a whole new light on them and their health, than if you only see them in a clinic for hospitals,” said Household Centered Care Program academic director Dr. Claudine Johnson.
“Our hope is that as the community accepts us as people who can help them address their social needs, that what we do with the community creates a trustful relationship between us and that UH College of Medicine and our affiliated schools become resources for the communities to address what they need, not what you decide they need,” Johnson continued.
As a second year medical student, Cenk Cengiz said the program really showed there was a story to unpack with each patient, and that as practitioners it’s important to understand how parts of that story can impact the health of community members.
“Seeing patients for 15 minutes in an exam room can only give you so much,” Cengiz said. “Going forward, I will always remember where patients are coming from and then also take into consideration where they live, who they interact (with), and where they work can affect their health.”
The program also hosts workshops for allied health care students, one of them was a “poverty simulation” where Cengiz said students were assorted into families. Each family was given a set amount of money and were given tasks such as finding childcare, paying rent and attending work all within a time constraint.
“What I’ve learned is it’s real, it’s really hard when you’re poor, and that’s kind of like an understatement,” Cengiz said. “But the thing is, it’s really hard to pull yourself from poverty. I do think that people who are born into opportunity, and there’s nothing wrong with it, but I think they do have a leg up compared to people who are not as fortunate. I think that kind of experience solidified that for me.”
The team and their roadmap
The colleges participating in the Household Centered Care Program include the College of Medicine, College of Nursing and the Graduate College of Social Work, each contributing different perspectives and goals for the same outcome.
Students from these colleges as well as community health workers comprise this interprofessional team that goes out into the community and interacts with participants to evaluate their needs and connect them to resources that match through a program called “Unite Us.“
Each student from the different colleges is evaluated based on their course requirements for their respective programs, but all work toward the same goal of understanding how to address disparities in the community they serve.
“We need to honor the different perspectives and we need to also honor the outcome,” said Graduate College of Social Work assistant professor Chiara Acquati. “We’ve been really kind of (getting to) know each other, thinking about what are the goals, the outcomes and the outputs that we want to have from the program and how they each match the expectation, the standards or the competencies that are mapped in the different disciplines.”
Acquati said the process of developing the program with other colleges was an amazing opportunity.
“The training of a future professional involves many components,” Acquati said. “There is a curriculum, but it is mostly also a vision, a perspective, a system of values that they’re going to bring with them. So for me, this aspect of having the opportunity to work together has been extremely rewarding.”
Building trust
Not only are these interprofessional teams addressing outside factors contributing to health, but community health worker Joshua Lopez-Barrios said he aims to build lasting trust in communities in not only the program but themselves.
“They’re not helpless,” Lopez-Barrios said. “A lot of the time they have many strengths and as a community health worker, I just try showing them that they can do a lot of things. And with guidance, then they can focus on their strength.”
Lopez-Barrios said many times participants step into the program reserved and in a “defensive” state of mind, but said keeping things honest and open with communication helps them open up.
“What we’ve seen before is that the community doesn’t always trust big organizations, hospitals, doctors, big colleges,” Lopez-Barrios said. “If you go out to the community, their mindset is ‘they’re trying to take my money’, either that or ‘we’re going and they’re just giving us prescriptions and sending us away.’ So my role per se, would be gaining their trust.”
Participants are aware of the good intentions put out by the program, and Lopez-Barrios said it helped that the community health workers on the team are from the community being served and are giving back.
The setbacks
COVID-19 has made the process of getting out into communities a tumultuous one, Lopez-Barrios said the ups and downs of case trends halted progress but doing so was to keep participants and team members safe.
“It has been crazy,” Lopez-Barrios said. “There’s times that we’re like, we’re going out and we’re gonna meet everyone and then we get the red alert. COVID cases are increasing a lot, and so we take a step back, and then it goes down and we’re ready again, and then the new increase.”
Johnson said the pandemic had the Household Centered Care Program needing to adjust, changing the initial experience for students. And instead of having home visits earlier, in-person visits rolled out in November instead.
Some of these initial visits were virtual or not in a home but at a nearby park as to not put either party at risk for contracting the virus.
“I attended one recently where we sat outside on the porch, in masks as well,” Johnson said. “So we’re still being cautious about COVID, but doing our best to introduce students to that experience, because even sitting out on the porch, we’re able to get a bird’s eye view of the neighborhood and how the participant explained to us, how our neighborhood has changed over time and she can point things out in real time while we’re there.”
Despite pushing back the start date of these visits, Johnson said the program had interprofessional team members participate in seminars to work together beforehand.
The series of seminars were a way to instill skills in students participating in the program regarding various aspects of special determinants of health and disparities, communication and value based care.
“I think the number one challenge that we faced this last two years has been clearly COVID,” Acquati said. “The plan that we have about the visits have to be put on hold, and we are still in a situation (where) things are unfolding.”
