Beyond the Hospital Walls

January-February 1997


Saint Raphael's Vision of Care Includes Jobs, Home Loans, and a Reading Room

Mr. Collen is president and chief executive officer, Hospital of Saint Raphael, and chief operating officer, Saint Raphael Healthcare System, New Haven, CT.


Saint Raphael Health System is based in inner-city New Haven, CT, an area plagued by poverty, unemployment, and high infant mortality. Its leaders have long realized that healthcare involves more than curing diseases and patching wounds.

Thus, in 1992, they launched Saint Raphael's Neighborhood Plan, which has five main components. The Neighborhood Reading Room, in a police substation, gives children a place to read, do homework, and get off the streets. The Neighborhood Home Ownership program helps Saint Raphael employees buy homes in the neighborhood.

The Neighborhood Scholarships program gives eligible residents an opportunity to study full time at a state university or vocational school. The Neighborhood Career Counseling and Job Skills Assistance program has enabled Saint Raphael to hire 30 neighborhood residents and help others find jobs elsewhere.

Reaching beyond its immediate neighborhood, Saint Raphael also operates school-based health centers, clinics for the elderly, a mobile clinic for pregnant women and new mothers, a parish nurse program in 21 area churches and congregations, and a home care network.

In addition, Saint Raphael is working with the local United Way and other organizations to conduct a community needs assessment; working with Yale University and other organizations to increase neighborhood stability; and operating a program for the early detection of breast and cervical cancer in uninsured and underinsured women.

We who work for the Saint Raphael Health System, based in inner-city New Haven, CT, have long known that healthcare involves much more than curing diseases and patching wounds.

Poverty, crime, and drug abuse plague the once middle-class area surrounding the Hospital of Saint Raphael, our system's 90-year-old flagship. In 1990, the date of the most recent census, nearly 10 percent of our neighborhood's residents were unemployed, compared with about 5 percent statewide. Thirty-five percent of the residents had failed to graduate from high school, a factor which contributed to the joblessness. Infant mortality—a phenomenon whose causes are as much social as medical—was high.

In 1992, after getting input from community residents, we launched what we call our Neighborhood Plan. We also joined other providers in establishing an integrated network of comprehensive services for the greater New Haven region.

Saint Raphael's Neighborhood Plan
The Neighborhood Plan has five main components.

The Neighborhood Reading Room Our neighborhood library has been closed for several years, a victim of city budget cuts. Community residents and city officials—all well aware of the connections between illiteracy, poverty, and crime—said they wished the neighborhood had a place where children could get off the streets, do homework, and develop an appreciation for reading.

In March 1993, in collaboration with the New Haven Police Department, Saint Raphael opened the Neighborhood Reading Room in a police substation a few blocks from the hospital. The room, staffed by volunteers from the hospital and the community, is open four hours a day. It has been a great success. Friends of the project have contributed a computer and 2,600 books to it. The room has been praised by the U.S. Department of Education as a program that encourages family involvement in children's learning. Inspired by Saint Raphael's Neighborhood Reading Room, community groups in other parts of the city have opened similar rooms in police substations and in housing projects.

Neighborhood Home Ownership In 1994 we introduced a program to help Saint Raphael's employees buy homes in the neighborhood. Under this program, an employee is offered a loan of $5,000 toward the home's down payment and closing costs, to be repaid over five years at a low interest rate. Saint Raphael forgives 20 percent of the loan, plus interest, for each year the employee remains in the home; should the employee stay five years, the entire $5,000 is forgiven.

A local agency, Neighborhood Housing Services of New Haven, Inc., counsels our employees through the home-buying process. To date, the partnership between Saint Raphael and the agency has settled five employees in the neighborhood; another 30 employees are seeking homes there now.

We created the loan program because we believe that home ownership—and the sense of pride it induces—lends stability to a neighborhood. To focus on the stability of its immediate community, Saint Raphael does not offer loans to employees who settle in other New Haven neighborhoods.

Neighborhood Scholarships Since 1994, we have offered eligible neighborhood residents an opportunity to study full-time at a Connecticut university or vocational-technical school. This scholarship, awarded annually to an applicant who has shown evidence of both academic achievement and financial need, may be renewed each year for four years if the recipient continues to meet program criteria.

Three persons have thus far been scholarship winners. One received a bachelor's degree from Southern Connecticut State University in 1995 and, last fall, began studies in the physician assistant program at Yale University. Another earned a degree in social work from Southern Connecticut State in 1995 and is now planning a career in bereavement counseling.

Neighborhood Career Counseling and Job Skills Assistance In 1992, having discovered that a high percentage of neighborhood residents had few skills, no high school diploma, and therefore no job, we started a career counseling program, which has led to the hiring of some of our neighbors. Our Community Relations Department, working with other human resources staff, helps such persons through the application process. So far, 30 neighborhood residents have been hired. Another 300 neighbors have taken advantage of various aspects of the program. We know we cannot hire every unemployed neighborhood resident; however, we can at least help prepare them to seek work elsewhere.

Of course, participants come to this program with various strengths and weaknesses. Some we offer free training at Saint Raphael's Educational Resources Center, the system's own skill-development program. To neighbors interested in training not offered by the center, we offer financial assistance—as much as $1,000 per applicant—enabling them to study at a community-based school or vocational program. Those who need more help with tuition are urged to apply for a Neighborhood Scholarship.

Last year we started a new job-preparation program, H.O.P.E. (which stands for "Having an Opportunity to Prepare for Employment"). H.O.P.E. was the idea of a Saint Raphael employee who, as a single parent, had struggled to stay off welfare and find a job. Applicants are screened by Connecticut's Department of Social Services. In a 16-week series of workshops, participants learn resume writing, communications skills, and basic computer skills. They enhance these skills each week by performing six hours of relevant volunteer work at Saint Raphael. Participants also meet once a week with system employees who have agreed to act as their mentors. The mentors help interested participants without high school diplomas to earn GEDs. H.O.P.E. has become so popular that it has a waiting list.

Other Efforts Our Neighborhood Plan has other elements, including the annual Neighborhood Beautification Project, in which Saint Raphael gives residents grass seed and shrubs and demonstrates how to plant them. We also mail to 6,000 residents a quarterly newsletter that celebrates neighbors' achievements, lists neighborhood events and job opportunities, advertises neighborhood businesses, updates job skills training programs, and describes new programs at the hospital. These efforts, like other parts of the plan, help make the neighborhood more solid.

Beyond the Neighborhood
Just as Saint Raphael employees understand that healthcare is more than medicine, we know also that the community is bigger than our immediate neighborhood. Since many of the New Haven area's poor, elderly, and underserved are unable to come to us, we are always seeking new ways to reach out to them.

School-based Health Centers We began this program in 1993 by sending some of our healthcare professionals to work at a local school several mornings a week. The program now serves more than 1,200 children in three schools:

  • At the Troup Magnet Academy of Sciences, a middle school in our neighborhood, we collaborate with the Yale Child Study Center Outpatient Clinic and the New Haven Board of Education in operating a full-time, comprehensive health center. Physicians, nurse practitioners, and physician assistants give students acute care, routine physical examinations, immunizations, health screenings, and counseling. Eighty percent of the school's students come from low-income homes headed by a single parent. Among its many services, the health center offers a program that helps students deal with such traumatic events as violence, divorce, and teen pregnancy. The clinic is supported by an $80,000 annual grant from the Connecticut Department of Education.
  • At the Timothy Dwight Elementary School, Saint Raphael and the New Haven school board operate a clinic on the two days a week when, because of budget cuts, no school nurse is on duty. In addition to examinations, immunizations, and screenings, Saint Raphael staff offer individual and group counseling.
  • At the Branford Intermediate School, in a New Haven suburb, we operate a part-time clinic with services similar to those at the Troup school.

Project ElderCare Since 1992 Saint Raphael's geriatrics section, in conjunction with New Haven's housing authority and health department, has operated clinics in two senior centers and four housing complexes for the elderly. The Project ElderCare clinics serve more than 1,200 persons aged 65 and older, many of whom, for a variety of reasons—disabilities, lack of insurance or transportation, fear of leaving the immediate neighborhood—cannot travel to a physician's office or hospital. The clinics, open either one full day or two half-days a week, are staffed by geriatric physicians, physician assistants, and social workers. They provide the elderly with primary care, health screenings, health education, and social services. Clinic patients are not currently charged for these services; in the future, Saint Raphael plans to bill Medicare and Medicaid.

Project MotherCare Infant mortality has long been a concern in New Haven. In 1989 the city's death rate for babies was 18.5 per 1,000. The rate was high primarily because many pregnant women were not getting the prenatal care they needed; often, they would not even seek care until it was time to deliver.

The chairperson of Saint Raphael's obstetrics department decided that a mobile clinic might be one answer to the problem. In 1990 we launched Project MotherCare, a 58-foot tractor-trailer used to deliver prenatal, primary, and pediatric care to six low-income neighborhoods in New Haven and West Haven, CT.

The clinic is staffed by a full range of professionals, including physicians; physician assistants; nurse practitioners; a phlebotomist; an HIV and substance abuse counselor; a bilingual receptionist; and two prenatal care assistants, who are also the drivers. The customized trailer contains a waiting room, two examination rooms, four offices, and three wheelchair-accessible restrooms. Project MotherCare bills Medicaid or patients' insurance for these services, when they have coverage; patients themselves are not charged.

In the six years since Project MotherCare began, its staff has brought medical care, social services, education, and counseling to more than 19,000 New Haven area residents. Partly because of this work, by 1992 (the date of the most recent statistics) infant mortality in the city had fallen to 14.4 out of 1,000. In 1995 the Catholic Health Association awarded the clinic its annual Achievement Citation.

Parish Nurse Program We started this program in 1992 and so far have recruited nurses in 21 churches and congregations in the greater New Haven area. Prevention of illness is the program's key goal; identifying parishioners' wellness needs is the parish nurses' key task. The nurses first poll parishioners about their particular health concerns, and then tailor health screenings or educational programs to meet those needs.

For example, one Episcopal church in New Haven operates a soup kitchen for homeless people, among other activities. The parish nurse has arranged two monthly blood pressure screenings, to serve both parishioners and patrons of the soup kitchen.

The Parish Nurse Program, whose coordinator is both a nurse and a Sister of Charity of Saint Elizabeth, now includes more than 40 nurses. Saint Raphael provides ongoing support as needed. The program is funded through the system's budget for community outreach; clients are not charged for the program's services.

Home Care Network In its effort to bring healthcare to those who need it, Saint Raphael has formed the Home Care Network in partnership with the Regional Visiting Nurse Agency and eight other agencies. Membership in the network has allowed us, through the development of clinical pathways, to improve the continuity of patient care.

A Continuing Commitment
Meanwhile, Saint Raphael is involved in other healthcare projects in the region.

In collaboration with the United Way of Greater New Haven and other organizations, Saint Raphael is conducting a community needs assessment. On its completion, we and our partners will develop targeted programs and services to respond to those needs. We also hope the assessment will show, in some detail, what impact Saint Raphael's many programs have had on the community.

Because of our interest in neighborhood stability, we are also participating in a three-year program, spearheaded by Yale University, to finance small-business ventures, improve neighborhood security, renovate abandoned and neglected buildings, help youth, conduct job training, and promote home ownership and investment. The program is being funded by Yale, the U.S. Department of Housing and Urban Development, and other organizations.

In addition, the state's Department of Public Health and Addiction Services has given Saint Raphael a grant to establish a New Haven program for the early detection of breast and cervical cancer. In this program, the Hospital of Saint Raphael provides free screening and diagnostic testing to uninsured and underinsured women who are 40 or over and meet certain income guidelines.

The program focuses on African-American women, who suffer disproportionately from breast cancer. Because low-income black women often lack insurance, access to healthcare, and trust in "white" institutions, they are less likely than other women to get preventive care. We have worked with WNHC, a local radio station whose main audience is African-American women, to regularly publicize the program.

Like the others described here, the cancer detection program illustrates Saint Raphael's mission: caring for the poor, the elderly, the vulnerable, and the underserved—those who otherwise might fall through the cracks.

For more information, call James J. Cullen, 203-789-3020.


The Saint Raphael Healthcare System, founded in 1984, is sponsored by the Sisters of Charity of Saint Elizabeth, Convent Station, NJ. The system comprises the following facilities and agencies:

  • The Hospital of Saint Raphael, a 511-bed acute care hospital affiliated with the Yale University School of Medicine
  • Saint Regis Health Center, a 125-bed long-term care facility
  • The Saint Raphael Foundation, an entity that fosters philanthropic support for the system
  • DePaul Health Services Corporation, a not-for-profit entity that oversees the system's magnetic resonance imaging center and dialysis program
  • Seton Real Estate, a not-for-profit, tax-exempt entity that manages, develops, or disposes of property acquired by the system
  • Xavier Services Corporation, an entity that manages the system's for-profit activities


Copyright © 1997 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Beyond the Hospital Walls

Copyright © 1997 by the Catholic Health Association of the United States

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