HSHS St. John's teams up with rival to improve health access

June 15, 2016


SPRINGFIELD, Ill. — Within a few blocks of the Abraham Lincoln Presidential Museum and the Illinois Statehouse lies the Enos Park neighborhood, which long ago fell into sad decline. Although the historic area is home to affluent Springfield community leaders, many of the once-stately homes were long ago subdivided into 10 or 12 low-rent apartments. Some residents are so poor they have no beds. Evictions and homelessness run high.

Photo credit: Jason Johnson SIU School of Medicine
Tracey Smith, project director of the Enos Park Access to Care Collaborative in Springfield, Ill., shares a moment with Jim Schwartz at his home before sitting down to talk about his concerns. Smith, who holds a doctorate in nursing, visits with clients and oversees the collaborative's staff of three community health workers.

Built around a jewel of a park that's more than a century old, Springfield's Enos Park has a storied past but a challenging present that includes a poverty rate of about 53 percent, drug abuse and a large transient population. There are numerous unmet chronic health needs even though the neighborhood has a nearby federally qualified health center to deliver primary care. Many residents use hospital emergency departments or go without health care.

HSHS St. John's Hospital — a regional medical center in downtown — sits at one end of the neighborhood, and its chief competitor, Memorial Medical Center, is less than a mile away at the other end. When the hospitals' leadership collaborated with the Sangamon County Department of Public Health on a comprehensive community health needs assessment in 2014-15, they saw a profound opportunity to make a difference in Enos Park.


The community health needs assessment showed many residents were not receiving primary care. "From a providers' standpoint, it might look like they have access to care, but the data said otherwise," said Kim Luz, St. John's divisional director of community outreach with Hospital Sisters Health System.

Power of two
Now, the two rival hospitals are joined in an unprecedented union to try to address health care access and other ills in this 36-square-block area. That effort, a three-year, $500,000 initiative called the Enos Park Access to Care Collaborative, has set out to improve access to health care for long-term Enos Park residents and for the difficult-to-reach transient and homeless population, said Luz.

Another goal is to address overuse of both hospitals' emergency departments, which have high rates of visits for routine and chronic health issues that should be handled in primary care settings, Luz said. Many residents use only hospital emergency departments or go without health care.

"If this program helps patients access care in the right setting, that will improve individual health outcomes and reduce overall health care costs," Luz said.

To determine how to proceed, St. John's and Memorial engaged in extensive planning and sought insight from focus groups comprised of seniors, young people, working professionals and women from a homeless shelter.

"A lot of the time access to care is a transportation issue, but the residents were in walking distance," Luz said. "So we asked, 'What are the true barriers?' We asked 'What do we need to be doing?'"

Boots on the ground
Education was part of the answer; trust building was another. St. John's and Memorial are paying the salaries of three part-time community health workers and a project director, assigned to the Enos Park Access to Care Collaborative. Tracey Smith, the project director, holds an administrative position with the neighborhood's federally qualified health center, the SIU Center for Family Medicine at Southern Illinois University School of Medicine.

She assembled the staff of three community health workers who focus on the health needs of clients who include, among others, impoverished mothers with children, new parolees, seniors who may feel isolated and others who have been marginalized.

Although there are many primary care health resources in Springfield, some residents don't know how to access them without help.

"They may not understand insurance or know how to find a primary care doctor," Luz said.

Hierarchy of needs
The community workers take into account the clients' other challenges of daily living and can connect them with housing or utility assistance programs, social services and programs that provide clothing or household furnishings. Sometimes they help them find jobs.

"As health care providers, we talk about access to health care," Luz said. "We don't always ask, 'Are basic needs being met?' If I don't have food for my child, I'm not worrying about health care."

Smith said: "The great thing about having community health workers is that there's someone who will listen to the patients' stories, who they are and what they need. Too often we want a Band-Aid, a quick fix, but that's not what the patients need, not the way life works. A lot of making this work is creating relationships that are personal."

Luz said: "We've uncovered that we have entire families living in homes with no beds. We're uncovering children with chronic absenteeism from school due to chronic lice, and we've identified individuals who receive government assistance for food dollars and run out of money after the first two weeks of the month.

Shelly Weatherholt, a community health worker for the Enos Park Access to Care Collaborative, meets with LaShawn Wilson, left, and Glenn Hargis at a boarding house in Springfield, Ill. She is helping the men sign up for Medicaid, enroll as patients of a health care clinic and she is conducting needs assessments for each.

"There are problems of homelessness," Luz said. "People need jobs. People need to get established … on disability. All of these basic things. There are children who don't have appropriate vaccinations."

The community health workers help the clients tap into community resources to address these needs. They help clients find a medical home for themselves and their children and even accompany clients to doctors' appointments.

Point person
A key step in getting the Enos Park Access to Care Collaborative off the ground was hiring Smith as director. "She is the mastermind," Luz said. Smith, who holds a doctorate in nursing, developed and runs the programming. Smith herself makes home visits. She coordinates with Luz and Paula Gramley who is community benefits program manager of Memorial Medical Center, and Luz's counterpart in overseeing the Enos Park collaborative.

Said Luz: "Tracey Smith has been studying community health work programs around the nation and has created a hybrid of best practices. That's what we're implementing."

Smith set up a system based on population health models but also tailored the plans to be responsive to each individual. She said that it's hard to identify the reasons for all the problems that residents face.

People may be "hitting rough times, or it's something in their childhood experience," she said. "It's multifaceted why someone is where they are in their life."

Initially, referrals poured in from agencies, churches, hospitals and schools, and soon people in the neighborhood spread the message by word of mouth.

"We are really building good relations," Smith said.

Photo credit: Jason Johnson SIU School of Medicine
Tracey Smith, director of the Enos Park Access to Care Collaborative, calls on Roy Bellamy in his apartment while he's home ill.

The community health workers in the field are Shelly Weatherholt, who has an undergraduate degree in social work, Shirley Thompson, who has an undergraduate degree in psychology and prior experience helping the homeless and people with disabilities, and neighborhood resident Dawn Mobley. She is knowledgeable about youth ministry, and was hired to be the Enos Park collaborative in May to do outreach work.

Building connections
In February, the collaborative started a Providers Council to foster coordination and communication among the many social service agencies and health providers servicing Enos Park. Among the largest is Catholic Charities. Its St. John's Breadline provides hot, nutritious meals.

"Everything we do we try to do in a collaborative effort with other agencies," Smith said.

 The Enos Park Access to Care Collaborative program is scheduled to end in the fall of 2018, but one of its goals is to build awareness and a framework that will perpetuate the work.

"Our goal is to be sustainable and cost effective," Smith said. "We hope that at the time we have to exit we've created a network in the neighborhood that can self-sustain and keep people connected to the health system."

Beyond that, if the project succeeds by measurable standards, the hospital sponsor would like to see it replicated in other neighborhoods with vulnerable populations, said St. John's Luz.

St. John's invests in pediatric mental health in Enos Park

SPRINGFIELD, Ill.  — Poverty, homelessness and instability take an emotional toll on young children. That's why, as part of their joint initiative in the Enos Park neighborhood, HSHS St. John's Hospital has joined with Memorial Medical Center to try to help children with mental health issues.

The two hospitals are paying for a mental health clinician to work on-site for three years in McClernand Elementary School in Enos Park, which educates children in kindergarten through fifth grade. The clinician's task is to screen children to detect social and emotional difficulties and to provide treatment to children with mental health problems.

The hospitals are working through The Children's MOSAIC Project, a collaborative initiative which brings mental health services to select Springfield neighborhoods. MOSAIC is an acronym for Meaningful Opportunities for Success & Achievement through Service Integration for Children. 

Mental health professionals embedded in primary care offices and schools provide screenings, treatment, referrals and family advocacy services. Bethann Whitford, the clinician at McClernand, works for Memorial Behavioral Health, the lead agency for the MOSAIC project.

Heather Sweet manages the collaborative MOSAIC project citywide. "What's unique here is that the clinician at McClernand is housed full-time to provide service to students at the school and also children in the neighborhood who may not go to school," she said. "That's a really great model that we're excited to work with."

The 2015 Illinois Report Card identified that 93 percent of students' families at McClernand last year received public aid or were eligible for government-provided free or reduced pay lunches.  More than a quarter of the children had disabilities and received special education. Thirty-five percent would leave before finishing the school year and 11 percent were homeless.

Screening last fall determined that almost one-quarter of the children at McClernand were struggling with mental health concerns to some degree. Of the 253 children who were screened, about 20 students demonstrated behaviors that are indicators for mental health challenges. They were referred to Whitford for MOSAIC's intensive intervention; however, not every family accepted these services.

Another 42 students were only starting to show those behaviors, and they were referred to the appropriate school support services. Currently, Whitford has 22 children in her caseload.

Angela Hall, director of mission integration, Franciscan formation and community benefit for Hospital Sisters Health System, said the need for more pediatric mental health care was identified in St. John's Hospital's community health needs assessment conducted in 2014-15.

"There is a higher than average emergency department use and hospitalization rate for pediatric mental health in Sangamon County, so the hospital is specifically focusing on pediatric mental health," Hall said. "Placing a behavioral health specialist in McClernand Elementary School as part of the Enos Park Access (to Care) Collaborative addressed two identified health focus areas — pediatric mental health and access to care."

 While the hospitals are covering the costs in Enos Park, many partners in the Springfield area including local school systems and univ

ersities support MOSAIC citywide. In addition to Memorial Behavioral Health, others include Southern Illinois University School of Medicine, Springfield Public Schools, The Springfield Project and University of Illinois-Springfield.

— Margaret Gillerman


Copyright © 2016 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2016 by the Catholic Health Association of the United States

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