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A van pulled up at the site, and a mother and her four children got out.
Santa Barbara Neighborhood Clinics was holding a dental fair, and the family had come simply for the routine dental work on offer. However, “during the sign-up period, [staff members] discovered that the van was also the house,” said Dr. Charles Fenzi, the health center’s CEO. “They weren’t sure whether they would eat or where they would eat.”
By the end of the day, thanks to the federally qualified health center’s wellness navigators – health workers whose job is to help patients overcome nonmedical barriers, like the care system and access to community resources – the family had housing and a connection to a local food bank.
It’s a perfect microcosm of the care process at the Neighborhood Clinics: Come in for a minor ailment or routine care, and leave with the weight on your shoulders lifted a little.
The name “Santa Barbara” evokes a breezy, sunny enclave that’s home to the laid-back and privileged. But that picture leaves out the one in three people in south Santa Barbara County who are considered low-income and the one in six who live in poverty, according to the health center’s calculations.
It’s primarily this population that SBNC – with eight primary, dental, or integrative health centers in the City of Santa Barbara and neighboring communities – serves. Ninety percent of their patients are low-income.
The health center was formed when three independent clinics in the Santa Barbara area – each formed during the 1970s to provide care to low-income patients in their neighborhoods – decided to join forces. More locations and services have been added on over the years, but the focus on underserved patients and a close relationship with the community remains.
Taking an X-ray View
“The patients we see…come for healthcare, but they also have a number of other issues that impact their health,” said Dr. Andria Ruth, a pediatrician at SBNC. These other issues include insurance status, homelessness, poverty, lack of access to education, food insecurity, and childhood or domestic abuse.
A diabetes diagnosis is rarely just that. When patients come into one of the health center’s clinics, staff ask a series of questions designed to uncover situational or emotional issues that may take a toll on health. “We call it an x-ray” because it involves looking beyond the obvious illness to find what’s lurking underneath, said Mayra Garcia, a wellness navigator.
That means keeping a close eye out for anxiety, depression, and substance abuse disorder, and integrating behavioral health care into treatment for chronic ailments like heart disease and diabetes. “Depression is exquisitely common,” Dr. Fenzi said. “All of us are stressed to the max.”
It also means that SBNC staff work to remove the stressors that separate their patients from good health.
“We have everybody working up to their license: we have behavioral health specialists, we have [registered nurses], wellness navigators, people from the community. They’re bilingual, bicultural, and they’re trained to understand resources in the community,” including the organizations that provide underserved people with housing, childcare, insurance, and food, among other services, Dr. Fenzi said.
As a wellness navigator, it’s Garcia’s job to help underserved people deal with everything from the food bank to insurance paperwork to preschool applications. “Sometimes they don’t even know that some agencies exist,” she explained.
Garcia, like the health center’s other wellness navigators, doesn’t just help patients. Anyone who walks through the health center’s doors and requests assistance will receive it, and Garcia goes door-to-door distributing flyers and talking to residents in low-income neighborhoods about what’s available to them and how the health center can help.
The goal, she said, is to make SBNC “kind of a one-stop shop.”
She also fills out the applications herself. Most forms, she explained, are in English, and some of her patients aren’t literate anyway.
One day, she’s coordinating Section 8 housing for a senior patient or helping someone diagnosed with cancer get funding for surgery. The next, she’s working with a family to obtain medicine, transportation, housing, and educational services.
Stopping Trauma, Before It Starts
Through a new pilot program with the University of California, Santa Barbara, the health center is also working to keep mental health issues from emerging to begin with.
Adverse childhood experiences, or ACEs – such as physical or verbal abuse, a family member with mental illness, or the loss of a parent, regardless of the circumstance, among others – have received a lot of attention in recent years.
Compelling research suggests that people who are exposed to several of these ACEs are more likely to struggle with mental illness, addiction, and a host of physical conditions. Those with particularly high scores are even likely to live significantly shorter lives than average.
Often, ACE scoring is used retrospectively, to identify the traumas to which adults may have been exposed.
But SBNC actively screens both children and their parents for ACEs, identifying at-risk children and assigning their families some combination of a wellness navigator, a therapist, and home visits.
“We decided to work on the skills of the parent, and the interaction between child and parent, as well as whatever concrete needs we could address,” said Dr. Ruth, the pediatrician, who designed the program. With UC Santa Barbara, the health center is trying to figure out which level of intervention is most appropriate through a formal study.
Far from being offended by the screening, patients are often grateful for the intervention. “Most people want to be a good parent, but some people aren’t sure how to do that because there was no modeling in their household,” Dr. Fenzi said.
Research shows that the potential risks of ACEs can be offset by the presence of a caring, stable adult in a child’s life. The goal of the program is to turn parents – often uncertain of how best to guide their children, or struggling to overcome their own difficult childhoods – into precisely those adults.
A Healthy Community
Walk through the SBNC location in Goleta, a smaller city just north of Santa Barbara, and you’ll find yourself surrounded by soothing blues and smooth glass. The halls are quiet and calm. Providers smile and say hello.
“The delivery system that provides care for low-income folks should not be different in its quality or its presentation” than the health care of those lucky enough to have great PPOs and concierge doctors, Dr. Fenzi said.
The clinicians bring impressive pedigrees to the table. Dr. Ruth, for example, graduated from Harvard Medical School and did her residency at Boston Children’s Hospital. “I wanted to work for a population that I felt might need the most help, where I could make the most impact,” she explained.
SBNC is also supported by local philanthropy efforts – including Direct Relief, which provides medicines and supplies that help defray the health center’s costs. The organization contributed more than $1.2 million worth of medical goods in 2018.
But despite extensive community outreach, including service announcements on local TV and radio, most patients come to the health center through word of mouth. It’s impressive, then, that SBNC treats about 10% of south Santa Barbara county’s residents.
Dr. Fenzi is determined to reach as many people as possible. “You cannot have a healthy community if everybody in your community does not have access to good healthcare,” he said.