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Dignity Health's Beyond the Walls reaches areas of concentrated poverty

BAKERSFIELD, Calif. — To find the common thread linking the 45 diverse programs and services run by Dignity Health's Mercy and Memorial Hospitals' Department of Special Needs and Community Outreach, one need only watch staff and volunteers interact with clients. Every encounter — be it between a nutrition educator and the mother of a pre-diabetic preschooler or between an insurance enrollment counselor and a man whose distrust of government makes him reluctant to apply for Medicaid — respectfully affirms the individual seeking guidance as a person of worth.

Four times weekly, the poor and the hungry line up for free hot meals at Beyond the Walls' Outreach Center in southeast Bakersfield, Calif. Dishing up breakfast are, from left, Debbie Hull, who founded and directs Beyond the Walls; Freddy Hernandez, supervisor of two of the program's Bakersfield community centers; Yolanda Leon, a program secretary; and Archie Barefield, a community philanthropist.
Photo credit: Judith VandeWater/© CHA

Every exchange is approached as an opportunity to advance Christ's mission of compassion and healing. That eagerness to walk humbly with the poor and vulnerable has merited the 2015 Achievement Citation for Beyond the Walls, the joint community benefit offerings of Mercy Hospital Downtown, Mercy Hospital Southwest and Memorial Hospital, all located in Bakersfield. The Achievement Citation is CHA's annual award for an original, bold, innovative program that delivers measurable results for communities served.

Beyond the Walls is ambitious in both its programmatic and its geographic reach. Debbie Hull, regional director of the department of special needs, says Beyond the Walls "fundamentally alters the health care dynamics for high-risk, underserved populations" through health education including comprehensive classes in disease self-management. Its antipoverty programs advance population health by positively impacting social determinants of health including educational attainment, food security, economic opportunities and the fabric of neighborhoods.

Hull, who started the department of special needs and has built its programming for 24 years, says Beyond the Walls is a very important piece of the puzzle in the region's health care.

The program's portfolio includes homemaker services for frail elderly residents, and subsidies for those who can't afford the service; community wellness programs; insurance enrollment initiatives; homework clubs for disadvantaged kids; and even job training for parolees and other hard-to-employ individuals.

Big reach
Beyond the Walls dispatches bilingual health screeners and chronic disease self-management educators to medically underserved rural and urban areas of Kern County, one of California's largest jurisdictions. The program's health education specialists teach sedentary third, fourth and fifth graders principles of good nutrition, portion control and the joys of active play. Luz Torres, a program coordinator, said some young children are stiff from lack of movement when they start the Healthy Kids program. "By the end of the third session, they are anxious to go out and play," she says.

Beyond the Walls staff include culturally cued-in bilingual health educators like Tillie Perez, who visit homes where children have been identified by Medicaid managed care programs as having diabetes, or being at risk for developing it. Many of the households are Hispanic, as is 51 percent of the Kern County populace. Hispanics have a disproportionately high incidence of diabetes. Perez and her colleagues combat high fat, high calorie, fast-food-heavy diets. As they teach parents and children about healthy eating and exercise, they gently repudiate what they say is a widely accepted notion among low-income Latino families — particularly those with adults who have suffered hunger — that a chubby child is a healthy child.

Debbie Hull, at podium, and Stephanie Weber, vice president of philanthropy for the Friends of Mercy Foundation of Bakersfield, accept the award at the Catholic Health Assembly.
Photo credit: Evelyn Hockstein/© CHA

On a recent home visit, Perez told the mother of a clinically obese four-year-old that good parenting requires setting limits. "You need to be assertive for his own good, otherwise, maybe by 10 years old, he'll have diabetes," Perez says she told the mother.

Hard living
Kern County lies at the southern tip of the central San Joaquin Valley, California's agricultural heartland. Bakersfield, a rapid growth city of about 364,000, is the Kern County seat and home to Beyond the Walls' three community outreach centers.

One in five residents of Kern County live in poverty and one in four didn't finish high school, according to the most recent community health needs assessments published by Mercy and Memorial hospitals.

The hospitals found that homelessness; chronic substance abuse; language and transportation barriers; a distrust of institutions, especially by undocumented workers fearing deportation; and a shortage of health services in rural areas make health access a continuing challenge. Beyond the Walls has been chipping away at these intractable obstacles since its founding.

Perfect fit
Hull, who was a Sister of Mercy for 34 years, began the community benefit department in 1991. At that time, the department's budget allowed for two fulltime and one half-time employees, counting her. Today, it has 36 employees and logs an average of 536 volunteer hours each month. Its annual operating budget of $2.75 million is supported by the three hospitals, government grants and employee and public philanthropy.

"I never imagined it would grow this big," says Hull. "The reason it has grown is we are responding to people's needs. When there is a need and we can fill it, more people come."

Among the poor
Hull opened the first two Beyond the Walls outreach community centers in southeast Bakersfield, an area of concentrated poverty. "We feel the best way we can help the people is to be among them," Hull explains. A third office in downtown Bakersfield is the seat of health and wellness programming.

Much of the street-level work of Beyond the Walls is done in partnership with community organizations and with neighborhood activists like Archie Barefield. In 1989, Barefield and four friends formed Kenya Enterprise and bought a building in a poor African-American enclave in southeast Bakersfield. The friends wanted to do something for children who weren't doing well in school and for "broken adults" whom society had written off. "There were a lot of teenage mothers and a big dope problem," Barefield says.

From the beginning, the community center offered after-school tutoring and a safe place for kids to congregate. Barefield said when Hull came along in 1995 with an offer to partner with the center, "she helped us take it to a higher level. Without her we wouldn't have flourished."

Beyond the Walls spruced up the building, rechristening it as the Outreach Center and added to the programming. "Neighbors are grateful for what we are doing," Barefield says. "I know, because they let me know." In the spring, when vandals tagged nearby buildings with graffiti, they left the Outreach Center unmarred.

Luz Torres, coordinator of Beyond the Walls' Healthy Kids program, teaches third and fourth graders at Palm Avenue Elementary School in Wasco, Calif., about exercise and nutrition.
Photo credit: Chris Ryan/© CHA

Beyond the Walls serves free hot breakfasts and suppers on alternating days, four days a week at the Outreach Center. Servers greet the regular patrons by name. "People would go without eating if there weren't places like this," says Joy Leon, a regular volunteer.

Leon's family has lived on the economic edge since a medical disability forced her to leave her job four years ago. She says she and her husband occasionally rely on community charity to supplement food and clothing for their six kids. "When you are in that position and wait to get services, you really feel like you are being judged; you feel horrible that you have to ask," she says. When she signs a family up for Beyond the Walls services, she takes care to protect their dignity and privacy. "We want to make sure they get the best services that they can and that they get them in the quickest possible way," she says.

Head of class
A few miles away at Beyond the Walls' Learning Center, staff spend mornings filling requests for emergency food baskets and providing referrals for social services, clothing vouchers and the popular discount coupons that save bearers $20 on California government identification cards. The building belongs to the Diocese of Fresno, which rents it to Beyond the Walls for $1 a year.

Midafternoon, the Learning Center becomes a classroom for 35 children, from kindergarten through sixth grade. All of the students enrolled in the Homework Club come from poor households. All but one of the current crop speak Spanish as a first language. (The tutoring is done in English because schools test in English.)

Freddy Hernandez — Mr. Freddy, to the students — supervises the tutoring program and manages the Learning and Outreach Centers. He said all of the children were struggling in school when they entered the year-round tutoring program. Hernandez and the contracted tutors who teach here and at the Outreach Center use standardized tests to evaluate students' grade level aptitudes. They set clear expectations and a path for scholastic improvement. Those who do the work get rewarded with an amusement park outing at the end of the school year; those who underperform get left behind. No exceptions. Hernandez says kids who fail to earn the trip work harder the next year.

The majority of students advance to earn As and Bs. "Some of the kids who come out of here might go on to higher education," says Hernandez, who credits educational achievement for lifting him and his siblings out of poverty. "Providing education to the low-income community can one day bring prosperity."

Leading in insurance enrollment
Beyond the Walls spearheads a countywide Affordable Care Act health insurance enrollment initiative that links over 50 groups, agencies and organizations working in Kern County. And once people get a Medicaid card or Covered California insurance, bilingual Beyond the Walls certified enrollment counselors make sure the newly insured can find a doctor and access other health services.

"If somebody needs care, (the counselors) keep working," said Edgar Aguilar, program manager of the grant-funded insurance enrollment effort.

Aguilar said that for the 2015 open enrollment period, his office has partnered with the Service Employees International Union. SEIU canvassers will go door to door to find people who haven't yet heard of insurance expansion opportunities under the Affordable Care Act, or haven't made insurance a priority. "We need to find a way to reach those families," Aguilar said. "Our goal has always been to build a healthier community."

Kern County economy leaves many behind BAKERSFIELD, Calif. — The San Joaquin Valley of California gets compared to Appalachia for its pockets of abject poverty. At its southern tip lies Kern County and its 8,161 square miles of barren high desert, brush-spotted mountains and agricultural flatlands that yield almonds, grapes, carrots and cotton, among other crops. A farmer inspects a grape arbor in Kern County. Photo credit: Chris Ryan/© CHA In addition to agriculture, the oil industry is a large employer. Two military bases and the aerospace industry provide 20,000 high paying jobs in Eastern Kern County, according to the Kern County Economic Development Corp. But jobs in the agriculture and oil industry are less dependable. According to a 2013 community needs assessment by Dignity Health in Bakersfield, fluctuations in employment in those sectors keep the county's unemployment rate "consistently well above the state average." Recently, low petroleum prices have led to widespread layoffs in the oil industry. At 10.3 percent in April, unemployment in Kern County was nearly double the national rate of 5.4 percent. And California's historic drought may impact employment in the agricultural sector going forward. There is a long, gritty history of economic hardship in this valley. Okies and Texans fleeing the ravages of the Dust Bowl in the 1930s arrived here hoping for prosperity, but settling into a hardscrabble life. Cesar Chavez launched the United Farm Workers' five-year-long table grape boycott in Kern County in 1965. Fifty years later, farmworkers still earn poverty-level wages. Hard working families of field laborers rely on assistance from Dignity Health's Mercy and Memorial Hospitals' Department of Special Needs and Community Outreach in lean times. Bakersfield, the Kern County seat, has quadrupled in population since the late 1970s. Much of the growth has been driven by a cost of living that is attractive by California's high priced standards. Minutes away from newer middle class subdivisions in Bakersfield are enclaves of dire poverty where Dignity Health concentrates much of its anti-poverty programming.

Copyright © 2015 by the Catholic Health Association of the United States
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