Parenting program overcomes distrust to bring men into the health care system

February 15, 2013

Corey Timmons suffered debilitating pain from spinal stenosis in his neck. He has no medical insurance. He has four children.

Timmons, 35, said he had stopped bothering to find a doctor whose services he could afford. He said there was no point.

"If you don't have insurance, the door gets shut," said Timmons, of Columbia, S.C.

Ultimately though Timmons underwent surgery to relieve his pain. He credits Dawn Pender, a nurse practitioner who practices at the South Carolina Center for Fathers and Families, for making that intervention possible two years ago.

"She's been my angel," Timmons said. "She opened those doors. I've never had anyone help like that before."

The Sisters of Charity Foundation of South Carolina got the Center for Fathers and Families going 10 years ago and remains its single biggest backer. The center's goal is to help men who don't have custody of their children to become better fathers. About 40 percent of the men take part under the direction of family court judges, usually because of failure to pay child support. The rest attend voluntarily, some to bolster their bids for expanded visitation rights.

Most of the center's participants are unmarried, jobless or among the working poor. Many also have health problems. Few have much contact with the health care system.

The center hired Pender five years ago through a program it calls Access to Healthcare. She meets with the men in the program to assess their health status, address their health concerns; and, when appropriate, to point them toward health care providers willing to meet complex or chronic health needs. Pender's bosses warned that her biggest challenge would be a widespread lack of trust in health care workers and the health care system. That was obvious during her first visits to the center's locations in four South Carolina counties.

"Our men don't trust systems," Pender said. "They have been scorned by judges, the family courts. … Then you get to medicine. Maybe their only memory of a medical person is the time they got a needle stuck in their arm."

Pender's icebreaker of choice became the blood-pressure cuff. She takes the blood pressures of every participant during each of her biweekly visits to the fathers' meetings.

"It's not invasive, but it brings me into their personal physical bubbles," Pender said. "We have to make direct contact at eye level. That gives me time to make conversation and ask questions: Do you have any troubles? Do you smoke? They discover I'm not there to harm them, and it becomes the bridge to trust."

It also gives her some insight into the participants' health and, in Pender's view, smooths the way for the more comprehensive health screening she gives each man during his enrollment in what is normally a six-month program. (Some stay longer, and may get a second six-month screening if they do.)

"And I always wear a white coat over my regular clothes," she said. "Someday, they are going to deal with people in white coats," and she hopes the trust the fathers have with her transfers to the new providers.

Poverty's front line
Pat Littlejohn, executive director of the Center for Fathers and Families, praised Pender for serving on the "front lines" of the Sisters of Charity Foundation's mission to advocate for the poor and promote healthy family life. Littlejohn said Pender and Access to Healthcare help men to understand and deal with health issues and to serve as better role models for their children.

Littlejohn also called Pender "a relentless advocate" for the participants. "Dawn is incredibly resourceful and scours the community until she finds the help a father needs and at a price that he can afford," Littlejohn said. "She never gives up."

During Pender's visits to the fatherhood meetings, she frequently gives talks on health care topics, such as colon cancer.

She also arrives an hour or so before a session to handle individual medical issues, from an ailment to a physical for a new job.

Those encounters occasionally uncover more serious health concerns, which leads to the program's other function — making alliances with local hospitals, federally assisted clinics, doctors' offices and county health agencies that provide clinical care. Among the community partners that Access to Healthcare has established is a federally funded clinic that referred Corey Timmons for surgery at a Palmetto Health system hospital in Columbia.

Pender negotiated a reduced surgery fee that was covered in total by financial assistance from the hospital and fund-raising by the Center for Fathers and Families. Littlejohn said Providence Hospital in Columbia, sponsored by the Sisters of Charity Health System, serves as the "go-to" medical provider for the fathers program. Two Providence doctors are Pender's medical preceptors, and Providence provides some physician visits, diagnostic scans and medical supplies in support of Access to Healthcare.

"We appreciate the compassion and generosity of all of our medical partners," Littlejohn said.

From 2008 through 2011, Pender has met at least once with 1,103 men in the fathers program and provided them with 4,355 services, ranging from the standard blood-pressure checks to flu shots to referrals for serious medical conditions. Access to Healthcare made 215 referrals in order to secure medical homes for participants with chronic conditions, such as hypertension and diabetes. Pender said most of the men being referred have no medical insurance.

Pender said one unemployed and uninsured man in his late 30s with chronic health problems developed a large benign growth on his shoulder that was inhibiting use of his arm. Access to Healthcare found a surgeon willing to help pro bono and arranged lab work and other assistance through Providence charity care. After successful surgery, Pender said, the man was able to find a job.

Going the distance
In spring 2012, she gave health screenings to 63 men. Ten had high blood pressure, six had elevated blood sugar and almost half were overweight.

Given the near-constant need for services, Pender is always striving to build a bigger health care provider network. She "knocks on doors" to find community doctors who will see Access to Healthcare clients at no charge or at discounted rates. (Center staff provide rides to medical appointments.)

She said establishing the community partnerships took more time than she expected, in part because she encountered scattered resistance. "Some people wanted to know what the sisters (of Charity) were up to," Pender said. She said Access to Healthcare and the Center for Fathers and Families eased those concerns by inviting potential partners to visit and observe their meetings, and by demonstrating staying power in their communities.

"They've gotten used to us," she said.


Copyright © 2013 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2013 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.