This publication was developed by the U.S. Department of Housing and Urban Development to assist in the planning

and development of Neighborhood Networks centers.

The guides in this series offer “how to” information on starting up a center, creating programs and identifying center

partners; center and program profiles and a wealth of resources.

Neighborhood Networks is a community-based initiative established by the U.S. Department of Housing and Urban

Development (HUD) in 1995. Since then, hundreds of centers have opened throughout the United States. These

centers provide residents of HUD-assisted and/or -insured properties with programs, activities and training promoting

economic self-sufficiency. These guides contain examples of successful center initiatives and how you can replicate

them.

To receive copies of this publication or any others in the series, contact:

U.S. Department of Housing and Urban Development

Neighborhood Networks

9300 Lee Highway

Fairfax, VA 22031-1207

Neighborhood Networks Information Center

Toll-free (888) 312-2743

TTY: (703) 934-3230

All publications are available from the Neighborhood Networks website at:

www.neighborhoodnetworks.org
TO GOOD HEALTH!

A GUIDE TO PROVIDING HEALTH CARE AT

NEIGHBORHOOD NETWORKS CENTERS

JUNE 1999
To Good Health! A Guide to Providing Health Care Page i

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TABLE OF CONTENTS

Page

To Good Health! A Guide to Providing Health Care at Neighborhood Networks Centers......................1

Introduction.....................................................................................................................................................................1

Chapter 1: Why Should A Neighborhood Networks Center Have A Health Care Component?.............2

The Difficulties in Transitioning from Welfare to Work.................................................................................................2

Low-Income People Have Greater Health Care Needs...............................................................................................2

Older People Need More Health Care Services ..........................................................................................................2

Better Access to Services Can Mean Better Health ....................................................................................................2

Chapter 2: Selection of Models........................................................................................................................4

Chapter 3: Case Studies ...................................................................................................................................6

Multi-Family Initiatives, Orchard Mews Neighborhood Networks Center, Baltimore, MD..........................................6

Golden West Senior Residence Wellness Program Golden West Neighborhood

 Networks Center, Boulder, Colorado ...........................................................................................................................9

Duquesne University School of Nursing, Nurse Managed Wellness Clinics,

St. Justin Plaza Neighborhood Network Center.........................................................................................................14

West End Medical Center, Inc., Public Housing Primary Care Program, Atlanta, Ga .............................................19

ABC for Health Inc., Health Benefits Counseling Program, Madison, WI.................................................................23

The University of Michigan Comprehensive Cancer Center, Michigan Interactive Health

Kiosk Demonstration Project .......................................................................................................................................27

Chapter 4: Implementation: Adapting Use Ideas for Neighborhood Networks Centers......................31

Role of the Property and Center Staff.........................................................................................................................31

Resident Involvement is Critical ..................................................................................................................................32

Selecting Services........................................................................................................................................................32

Types of Health Care Programs..................................................................................................................................32

Benefits to Health Care Partners ................................................................................................................................33

Key Health Care Partners............................................................................................................................................33

Chapter 5: Resources .....................................................................................................................................36

On-Site Nurse and Addictions Counselor Model (Multi-Family Initiatives)...............................................................36

Service Coordinator Model (Golden West Senior Residence Wellness Program) ..................................................36

University School of Nursing and Public Health Model (Duquesne University) .......................................................36

Community Health Center Model (West End Medical Center)..................................................................................37

Health Benefits Counseling Model (ABC for Health Inc. )........................................................................................37

Telehealth Model (Michigan Interactive Kiosk)...........................................................................................................37

Endnotes ...........................................................................................................................................................39
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To Good Health!

A Guide to Providing Health Care at

Neighborhood Networks Centers

Introduction

In the changing health care environment, access to

care for people with lower incomes remains an issue.

Some people do not qualify for Medicaid; others may

qualify but have not accessed the system. Still other

people live in communities where medical services

are scarce or there is no access to them. Sometimes

transportation is the barrier, sometimes it’s childcare.

The programs described in this guide demonstrate

how six models have met the health care needs of

low-income people by providing programs and

services designed to meet their specific needs. These

programs are models that Neighborhood Networks

centers can apply as they offer health care services.

Neighborhood Networks is a community-based

initiative launched by the U.S. Department of Housing

and Urban Development’s (HUD) Office of Multifamily

Housing in September 1995. This initiative

encourages the development of resource and

computer learning centers in HUD-assisted and/or -

insured properties.

The guide begins with a discussion of why

Neighborhood Networks centers may wish to

incorporate health care programs into their activities.

An explanation follows of the criteria used to select

the case studies that are described in Chapter 2.

Chapter 3 provides strategies for implementing

programs. Finally, useful resources for starting up a

program are identified in Chapter 4.
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Chapter 1

Why Should A Neighborhood Networks Center

Have A Health Care Component?

Good health is at the root of one’s ability to learn,

parent and work.

The goal of the Neighborhood Networks initiative is to

build self-reliant communities by bringing technology

and other resources to HUD-assisted and/or –insured

housing. Computer access and training, job readiness

support and literacy classes will improve prospects for

employability for residents.

However, without addressing health care,

transitioning people from welfare to work will likely

fail. Access to quality health care is important for

seniors living in assisted housing, too. Seniors make

up 47 percent of the households in privately-owned

project-based Section 8-assisted and -insured

properties and for many of them, independent living

requires supportive services. It has been well

documented that greater access to health care

reduces the number of times an individual is

hospitalized and holds off the need for nursing home

care.

The Difficulties in Transitioning from

Welfare to Work

A person’s ability to make the transition from welfare

to work is impacted by several significant barriers,

according to research by the Urban Institute,

including: 1

q Physical disabilities and/or health limitations

q Mental health problems

q Health or behavioral problems of children

q Substance abuse

q Domestic violence

q Involvement with the child welfare system

q Housing instability

q Poor basic skills and learning disabilities.

Most of these barriers can be addressed by a

Neighborhood Networks center that provides health

care programs and services designed to meet the

needs of residents of HUD housing.

Low-Income People Have Greater

Health Care Needs

Research has shown that people with lower incomes

are less healthy than people with higher incomes and

report more limitations in activities due to chronic

health conditions. Furthermore, death rates from

some diseases are two and three times higher in lowincome people. One theory is that low-income people

lack sufficient access to services.

Older People Need More Health Care

Services

Increasing numbers of Americans are living into their

70s, 80s and beyond. Because people are living

longer, their health needs are greater than ever.

The ability to live longer and independently depends

in large part on how well a person can manage his or

her own health. Services, such as classes in nutrition,

medication and self-management of chronic medical

conditions, promote independence, as do health

assessments and screenings that provide frequent

physical checkups.

Better Access to Services Can Mean

Better Health

Low-income people, including seniors, have an

enormous need for health care services. An important

role for Neighborhood Networks centers is to improve

the access to those services for their constituents.
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Health care programming can support seniors in

monitoring and self-managing chronic conditions,

offer counseling to teenage mothers on parenting and

child care, and counsel residents on substance abuse

and HIV/AIDS awareness. The specific needs vary,

but the delivery of health care services is an integral

part of the Neighborhood Networks goal of promoting

self-sufficiency.
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Criteria

These models were selected

because they:

q Used housing as a

delivery vehicle or were

programs easily adapted

to a housing setting

q Required varying levels of

resources

q Met a specific health

need in the community

established through

research, surveys or

experience

q Designed programs with

specific information on

the health care needs of

the residents/constituents

and often included

residents in the design.

Chapter 2

Selection of Models

The models highlighted in this guide are actual

examples of successful programs. They were

selected because of their innovation in providing

access to health care for low-income people. While

only some models reflect practices at actual

Neighborhood Networks centers, all are readily

applicable to Neighborhood Networks centers.

q Orchard Mews

Neighborhood

Networks Center

in Baltimore, MD,

in cooperation

with the nonprofit

Multi-Family

Initiatives,

provides

residents with onsite substance

abuse counseling

and nurse case

management to

facilitate access

to health care

services.

q Golden West

Senior

Residence in

Boulder, CO, created a comprehensive Wellness

Program by facilitating community partnerships

that offer residents a variety of on-site services.

q The Nurse Managed Wellness Clinic operated

by the Duquesne University School of Nursing in

Pittsburgh, PA, provides health promotion and

wellness information to help seniors in remaining

independent.

q The West End Public Housing Primary Care

Program in Atlanta, GA, has adapted the

community health center model and used it at six

public housing sites.

q Advocacy and Benefit Counseling for Health

in Madison, WI, is an initiative organized by a

public interest law firm. It links individuals with

insurance coverage, explains benefits packages

and advocates for consumers in insurance claim

disputes.

q The University of Michigan Kiosk Program in

Ann Arbor, MI, uses telehealth to disseminate

health care information. The use of interactive

computers located in malls, libraries, recreation

centers, work sites, hospitals and other locations

easily accessible to consumers provides tailored

public health information.

These models work with the help of a variety of

partnerships providing on-site health care information

and services. Varying levels of resources are required

in each model. The examples range from a multiproperty program that provides on-site clinic services

performed by an interdisciplinary team to a single-site

program that emphasizes nurse case management to

facilitate access to medical services. All the programs

meet a health care need in low-income communities.

The models can be implemented in properties for

families as well as the elderly.

The models relied on health care statistics of the

organizations that performed needs assessments to

establish needed services. Education about heart

disease, the leading cause of death for all Americans

over 65 and the leading cause of death among

African Americans, is targeted in all models providing

health care information and services. Diabetes,

HIV/AIDS, substance abuse and infant mortality are

also addressed in programs.

All of the models seek to empower residents through

one or more methods:

q Involvement in the delivery of service

q Participation in supervisory committees and

q Assessment of resident needs and interests.
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The following table describes each model.

Name of Program Description

Multifamily Initiatives:

Orchard Mews Neighborhood

Networks Center, Baltimore, Md

Non-profit partner providing on-site services in a family Section 8

property. Staff includes an addictions counselor and a nurse.

Supported by HUD Drug Elimination Grant

Golden West Senior Residence

Wellness Program, Boulder, CO.

Neighborhood Networks center site with a service coordinator on

staff who develops community partnerships to build a

comprehensive Wellness Program.

Duquesne University School of

Nursing, Nurse Managed Wellness

Clinics, Pittsburgh, PA.

University-based training model running on-site clinics in two senior

properties, one of which has a Neighborhood Networks center.

West End Medical Center, Public

Housing Primary Care Program,

Atlanta, GA.

A community health center program providing preventive and

primary care services in six public housing sites. Supported by a

U.S. Department of Health and Human Services, Bureau of Primary

Health Care Services Grant.

ABC for Health,

Advocacy and Health Benefits

Counseling Program, Madison, WI.

Nonprofit public interest law firm dedicated to ensuring access to

health care for families at risk by providing health benefits

counseling to secure insurance coverage, explain benefits and

advocate patients’ reimbursements.

University of Michigan, Michigan

Interactive Health Kiosk

Demonstration Project, Ann Arbor,

MI.

A University of Michigan telehealth project funded through Michigan

tobacco tax dollars. Ninety interactive computers provide custom

tailored public health messages at recreation centers, malls,

hospitals, libraries and other locations in Michigan.
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Chapter 3

Case Studies

Multi-Family Initiatives

Orchard Mews Neighborhood Networks Center

Baltimore, MD

Project Address: 514 Orchard Street

Baltimore, MD 21201

Contact : Susan Tuft, President

Multi-Family Initiatives

Phone: (410) 523-2342

Introduction

Orchard Mews is a 101-unit development in the Seton

Hill neighborhood of Baltimore. It receives Section 8

property-based rental assistance and is owned and

managed by NHP/AIMCO. Property manager Angela

Wickham was the inspiration behind the full-service

Neighborhood Networks center established in August

1997.

Ms. Wickham believed that access to health care was

an important component of welfare-to-work efforts.

After visiting a program in Washington, DC,

developed by Multi-Family Initiatives (MFI), she

applied for a Drug Elimination Grant to start an MFI

program at Orchard Mews offering residents on-site

chemical addiction counseling and other services

related to chemical dependency. The center uses a

holistic approach to treatment, therefore addressing

underlying physical and psychological issues. A

secondary objective was to manage the health needs

of the entire community by making home visits,

performing medical assessments and making

appropriate health care referrals.

The program is administered by Susan Tuft of MultiFamily Initiatives whose experience in Washington,

DC, taught her that health care and treatment for

chemical addition among residents of low-income

housing must be addressed first so that they can

maintain employment.

The MFI health care program at Orchard Mews was

recognized as a 1998 John J. Gunther Blue Ribbon

Best Practice by the U.S. Department of Housing and

Urban Development. The award recognizes the very

best community development programs in the

country.

Program Description

MFI started its program in April 1998. It is located in a

two-story townhouse across the street from Orchard

Mews, thereby bringing on-site drug prevention and

treatment services one step closer to residents. Two

staffers serve the health care needs of the 342

residents of the Orchard Mews family property. A fulltime registered nurse holds office hours in the

townhouse and conducts home visits. A certified

chemical addiction counselor works two days a week

providing on-site counseling and door-to-door

community outreach to residents.

Conducting home visits, attending community events

and interacting with residents outside of the health

center is essential to establishing a relationship of

trust.Typically, a resident will see the nurse who

conducts a comprehensive health assessment —

essentially a head-to-toe examination, including the

neurological, cardiovascular, pulmonary, musculo-
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skeletal and psychosocial systems, as well as a

nutritional assessment. Additionally, an assessment

of the home environment can provide a better

understanding of health needs. A course of treatment

is determined and the connections to needed services

begins. This includes linking residents with physician

care and coaching them on how to secure the

services they need.

For chemically dependent individuals, the counselor

and the patient determine appropriate care, which can

include referral to outpatient or inpatient care.

In addition to providing one-on-one health services to

residents, the nurse monitors seniors with

hypertension. Future activities include yoga

instruction and other site-based health resources

made available by partnering. All programs and

services are free.

Program Funding

In 1997, a one-year Drug Elimination Grant of

$102,000 was awarded by HUD to replicate the MultiFamily Initiatives model of treating substance abuse

and related health issues. Monthly expenses of

approximately $8,500 included:

q Full-time nurse

q Part-time (two days) certified substance abuse

counselor

q Rent

q Utilities

q Supplies

q Project management

Implementation

Upon receipt of the Drug Elimination Grant, Orchard

Mews was faced with adapting a successful program

concept to a new setting.

Finding space was the first obstacle. MFI planned to

offer services adjacent to the management office, but

when the management office was relocated, there

was no available space at the new site. MFI rented a

townhouse owned by the neighborhood church and

located across the street from the development.

Identifying partnerships and how much control over

the program they would exercise were obstacles.

MFI had begun developing a partnership with a local

nursing school, but the partnership ended because

the nursing school did not want to practice in a

church-owned site. MFI then established a

partnership with Chase Brexton Community Health

Center, a local community health clinic. The plan was

to contract with Chase Brexton to hire a nurse to work

at Orchard Mews. However, this arrangement left too

much program control with Chase Brexton and too

little with MFI. MFI chose to hire the nurse directly

and Chase Brexton, because of its expertise in the

field, would hire a part-time site-based certified

substance abuse counselor.

Finding a nurse willing to work in the community was

another obstacle. MFI subsequently hired a

community health nurse who knew the public health

resources in Baltimore City, was comfortable in the

neighborhood and willing to make house calls.

Results

In the first five months of operation, there were an

estimated 100 resident requests for services. The

nurse had made many more calls on behalf of

residents to link them to community health services

and conducted more than 61 comprehensive health

assessments and 76 home visits. A group of seniors

was regularly monitored and given support for

hypertension and a 6-week yoga class was well

attended. Additionally, 14 residents sought services

for addiction and 12 remained in case management

after following treatment recommendations.

Lessons Learned

Several lessons have been learned in operating the

health care program at Orchard Mews:

q Health care is a vital supportive service to offer

low-income residents. Other programs will likely

fail when health concerns are not addressed.

q Most residents want to improve their health.
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q Programs must have on-site staff to overcome

the barriers to accessing local community health

centers, a primary care physician and other

available health services.

q Nurses are the most important people to employ

to administer the program. Residents consider a

nurse a primary care provider and medically

qualified to understand and address many of

their health concerns.

q The property management company cannot

operate the program. To disclose health

concerns, residents need to trust the staff and

know that this information will not be used

against them in any way.

q There is very little grant money available for

these kinds of programs.

q Partners are very important. However, be very

cautious in their selection and have a few strong

ones instead of many small ones. Developing a

partnership demands a substantial investment of

time. Partners should offer some resources and

share a similar mission with your center. You

also want to retain enough control over the

program to ensure the original goals of the

program are achieved.
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Golden West Senior Residence Wellness Program

Golden West Neighborhood Networks Center

Boulder, Colorado

Project Address: 1055 Adams Circle

Boulder, CO 80303

Contact : Maureen Dobson

Director of Resident Services

Phone: (303) 444-3967

Executive Director: John Torres

Introduction

The Golden West Senior Residence is a threebuilding complex at the foothills of the Rocky

Mountains in Boulder, CO. It includes 255 senior

housing apartments in two connected high-rise

buildings, one of which houses a Neighborhood

Networks center. The first structure was built 33 years

ago. The high-rises are privately owned Section 202

properties. The third, a four-story building directly

north of the HUD property, was added approximately

nine years ago and provides 56 units of assisted

living for seniors. The Golden West Senior Residence

Wellness Program is a comprehensive program

providing services to seniors living independently and

those needing assistance with activities of daily living.

The complex was built under the sponsorship of the

First Christian Church in Boulder. When the

organization built the facility more than 30 years ago,

part of the mission was to provide on-site services for

seniors. Jeanine Henderson, president of the Golden

West board of directors and a member of the First

Christian Church, comments, “Golden West has over

the years successfully fulfilled its mission in Boulder

by providing affordable housing and services to

people aged 62 years and over. This was the original

intention of the church in building Golden West and it

continues today.”

The Golden West Wellness Program provides 12

services. The objective of The Wellness Program is to

assist seniors in taking responsibility for their own

health by providing a number of on-site resources.

The Wellness Program utilizes community

partnerships to offer this comprehensive array of

services. The staff of Golden West seek out

community resources that can serve the many needs

of seniors. For most services, Golden West has not

been required to provide financial support or

administer these services.

Program Description

Golden West has over the years developed

relationships with government, hospitals, universities,

private practitioners and corporations to build a

meaningful health care program. These partnerships

include Boulder Community Hospital, the University of

Colorado at Boulder Speech and Language Hearing

Center, the Boulder County Health Department,

Dental Aid, the Boulder County Mental Health

Department, a private massage therapist, a private

Tai Chi instructor and Professional Home Health.

These partnerships provide convenient, high-quality

and affordable services to seniors. Programs are

developed and managed by a director of resident

services and a service coordinator.

The complex is well-maintained and has adequate

space for a variety of services. Most of the 320

seniors who live at Golden West are motivated to

keep themselves healthy. Some residents cannot

travel long distances for services. All residents have

Medicare and some have supplemental health

coverage. Residents do have some ability to pay for

services and there is adequate space for service

delivery.

The health care activities are intended to promote not

only the physical well-being of residents but also their

emotional, spiritual and intellectual well-being. The
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services available at Golden West focus on wellness.

This is accomplished by educating seniors about the

symptoms of and predisposition toward certain

conditions. By treating chronic conditions and

receiving checkups while still healthy, residents are

promoting their own good health. They are also

addressing the psychological issues that go along

with aging and managing chronic ailments. The

services available through the Wellness Program

cater to all the needs of seniors and enable them to

stay independent. For example, when a resident

returns from a hospital stay, the program provides two

meals a day, rather than the one meal a day that all

residents receive. To ensure that the necessary offsite services are accessed, the Wellness Program

links residents to the public transportation system that

subsidizes rides for seniors.

Features of the Golden West Wellness

Program

Here are some of the features of the Golden West

Wellness Program:

55+ Wellness Program – This is the longest

operating service of the Golden West Wellness

Program. It has been in existence since the 1970s.

Registered nurses from the nonprofit Boulder

Community Hospital are on site twice a month for six

hours. The nurses perform a variety of procedures

and attend to any health concerns that residents may

have. They take vital signs and monitor chronic

conditions. The program seeks to augment the

services residents receive from their primary care

physicians and specialists. It provides residents with a

convenient way of getting health questions answered

and gaining assistance in maintaining good health.

Residents pay an annual fee of $20 to participate.

The hospital subsidizes the service. For the nonprofit

hospital, it is fulfilling its community service mission.

Fit Feet – Professional Home Health provides a

weekly, eight-hour foot clinic that addresses foot pain

and discomfort. When necessary, the nurse attends

to clients in their homes. This service is available to

residents who are determined not to be homebound

by a medical diagnosis that dictates ongoing foot care

paid for by Medicare. Each clinic visit is $18 and a

home visit is $24.

Boulder County Health Department Flu Clinic –

Each fall, the health department conducts a clinic

where nurses provide flu shots at no charge to

residents with Medicare (non-HMO).

Kaiser Permanente Flu Clinic – Kaiser Permanente

nurses conduct an on-site flu shot clinic. At the

beginning of flu season, residents who selected a

Medicare HMO were not eligible to receive free flu

shots from the county health department because the

service is available through their primary care

physician. Knowing that 100 residents were enrolled

in the Kaiser HMO, the director of resident services

approached Kaiser about providing a free on-site flu

shot clinic for its enrollees. Kaiser Permanente was

very interested in seeing that their senior subscribers

received flu shots.

Dental Screenings by Dental Aid – Dental Aid

provides services to all low-income persons in the

county. For the Golden West Wellness Program,

Dental Aid obtained grants from the City of Boulder

and A.V. Hunter Trust. The grants cover the cost of

quarterly cleanings and x-rays on location. These

services are free; other minor services are available

on a sliding scale fee.

Boulder County Mental Health Clinic – For several

years, a geriatric therapist has been on-site once

each week. In 1998, volunteer peer counselors –

seniors trained and supervised by the Boulder County

Mental Health Department — began providing mental

health services. The peer counselors know first hand

the isolation many seniors experience and the

emotions surrounding failing health. The peers play a

short-term assessment and support role and are

trained to identify when to refer a resident for

additional services. They talk with the resident,

assess the situation and offer their support to assist

them in finding ongoing treatment if it is needed. The

peer counselors and an intern working toward her

professional counseling license are also trained to

provide group services. Seniors in need of

psychological support can gather as a group and

work on specific issues.

Hearing Clinic conducted by graduate students of

the University of Colorado Speech and Language

Hearing Center – The relationship with the University
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of Colorado Audiology Department began around

1990 when Dr. Sweetman, an audiologist, performed

free on-site hearing tests. In the mid-1990s, the

student-run clinic developed out of a need for

providing residents with additional services once

hearing loss was diagnosed. Residents are taught lip

reading in a group setting each week. The students

regularly assess the need for hearing aids and

consult with residents about other such devices.

Additionally, students conduct home visits with every

participant in an effort to keep residents

communicating optimally in light of hearing loss.

Telephone amplifiers and lighted doorbells are two

examples of hearing loss aids. The students also

teach residents assertiveness skills so that they can

obtain the necessary aids.

Professional Home Health Consulting Nurse – For

assisted living residents, this service provides a

medical consultation by a registered nurse from the

home health agency at a reduced rate. Golden West

pays the nurse $15 an hour. The nurse is on site for

an hour each day, Monday through Friday. This is not

an emergency service, but the nurse can assist with

many of the medical situations that arise each day.

Unlike other assisted living facilities, Golden West

does not employ health professionals. If a situation

arises that requires immediate medical attention,

Golden West staff must call 911. The on-site nurse

assists staff with medical assessment or advice

before a situation becomes a medical emergency.

Massage Therapy – Once a week for three hours, a

private therapist provides 15-minute chair massages.

The fee is $10 and is paid for by the residents.

Tai Chi – A private instructor provides small group

instruction for eight to 10 weeks to work on balance.

The residents pay $3 per session or approximately

$30 for the course.

Program Funding and Sustainability

Among their other responsibilities, the director of

resident services and the service coordinator support

the Wellness Program. Their role is to determine —

with resident assistance — which services are

needed, to pursue providers who offer the services

and to assist providers in the development of on-site

programs. These positions are allowable expenses of

the project.

Golden West offers its partners space for providing

services. Providers subsidize some of the services for

a variety of reasons. Universities use it as a teaching

site, nonprofit organizations may be fulfilling a mission

to provide services in the community and yet others

may see their work as a way to market the highquality professional services of their organization.

Periodically, providers ask Golden West to pay for

services. Golden West’s approach is to survey

residents to determine interest. Residents are asked

whether they are willing to pay (or pay more, in some

cases) for a service. If they are not, the partnership

ends. The exception is an on-site nurse who

manages non-emergency medical problems among

assisting living residents one hour each day.

Periodically, Golden West makes these decisions as

it considers the need to hire more staff or subsidize a

service.

The sustainability of the Wellness Program’s success

depends upon maintaining the property in good

condition, retaining space for services and continuing

to match resident needs and potential partners’

interests.

Implementation

The information on which services to include in the

Wellness Program is gathered from many sources.

The director of resident services and the service

coordinator participate in monthly networking

meetings of the Colorado Gerontological Society with

the help of Boulder Manor, a local nursing home. The

meetings are held at Golden West and provide

educational information as well as an opportunity to

network. This forum promotes community building

and provides an opportunity to the members to

determine whether seniors’ needs are being well

served community-wide. Golden West has historically

maintained a high profile in the community and

agencies approach them about bringing services

onsite.

There are a number of ways that staff gathers

information from residents about which services to
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provide. Annually, one-hour floor meetings are held,

led by the executive director. It is an opportunity for

residents to discuss their concerns and for staff to

propose ideas to residents. A pre-admission interview

of each resident gives the staff a chance to establish

a baseline of health service needs and available

resources. Throughout the year, there are monthly

resident council meetings. An annual survey

measures resident satisfaction.

With so many partnerships, the logistics of where and

when to offer each service is a challenge. The three

spaces Golden West provides to the Wellness

Program give providers three different types of rooms

from which to choose.

With the opening of a new program, more staff

support is required. There is an initial period where

staff need to foster resident participation even if

residents endorsed the program concept. As

residents become more familiar with the service, the

provider and where and when the service is offered,

less staff involvement is required. Staff has made one

exception to this successful strategy. Due to the need

for privacy in providing mental health services, staff

has never encouraged or facilitated resident

participation. It is important for residents to know that

their privacy is maintained.

Results

In 1998, Golden West established its first partnership

with a managed care plan Kaiser Permanente, which

provided flu shots on-site.

There have been no Wellness Program failures. All of

the programs have been well-attended. This can be

attributed to the advanced research to establish

program appropriateness and plan for staff support.

In the 55+ program, approximately one-quarter of the

residents are members and on each day the nurse is

present, an average of 28 residents receive services.

A satisfaction survey reported a 98 percent

satisfaction rate.

The 55+ program and the Professional Home Health

consulting service make physician medical

appointments more informative and beneficial

because of the education and information provided by

on-site nurses. Additionally, off-site physician

appointments may be unnecessary for monitoring

chronic conditions and checking vital signs. Another

advantage of the Professional Home Health program

is that if a resident develops a need for in-home

health services, the transition is a smooth one

because the resident is already familiar with a nurse

who can provide those services.

Golden West has provided an opportunity for three to

five University of Colorado graduate students in

audiology or speech pathology to receive hands-on

clinical experience each semester. The success of

this program has resulted in the use of a $5,000

donation toward the purchase of assistive listening

devices. This means that more residents can

participate in this program which has served as many

as 40 residents.

Golden West residents are the most frequent users of

the Special Transit Services of Boulder County. The

service helps them keep medical appointments, go

shopping and go on recreational outings.

Lessons Learned

Wellness Program staff have learned many lessons in

their program operations.

q A community-wide network of gerontology

professionals promotes community planning for

services, raises the profile of each of the

participants and educates the professionals on

new information in the field.

q When a service is built on partnerships, it is

important to be adaptable to change. Internal

changes in partner organizations, such as staff

changes, or changes in profitability or mission,

may mean a modification in on-site services.

With each change, staff review the impact on

residents. Some changes may be acceptable and

some may not. There are enough partners and

potential partners that any one service is not

considered indispensable.

q The need for on-site services is growing. The

cutbacks in Medicare and the movement toward

managed care have meant that residents return

from hospital and rehabilitation stays quicker and
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sicker. Additionally, Golden West has been in

existence for 33 years and many residents have

aged in place. The average age in the complex is

82 years. As people grow older, they typically

need more health care services.

q Happy residents are often healthier residents. A

service-rich environment not only addresses

health concerns, but it provides an active

community environment, gives residents

interested and knowledgeable people to

communicate with and shows them that staff

care. On a satisfaction survey, one resident

wrote, “I never dreamed I could feel as happy in

retirement.”

q The benefits of on-site services extend beyond

what is readily apparent. Residents need to

develop trust in a program before they will

access it. Having a service on site that is used by

other residents and encouraged by staff invites

participation. Once a resident uses a service, that

service becomes more important to the resident.

For example, some residents access off-site

dental services because they received cleanings

on-site. Good dental hygiene also encourages

good nutrition. The mental health program is a

service that many residents probably would

never have accessed if it was not available in the

comfortable, supportive environment of Golden

West. Mental health counseling is used for an

ever-expanding list of issues.

These lessons learned can help other Neighborhood

Networks centers in their efforts to offer health care

services to residents.
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Duquesne University School of Nursing

Nurse Managed Wellness Clinics

St. Justin Plaza Neighborhood Network Center

Pittsburgh, PA

Project Addresses: K. Leroy Irvis Towers

715 Mercer Street

Pittsburgh, PA 15219

St. Justin Plaza

120 Boggs Avenue

Pittsburgh, PA 15211

Contact : Lenore K. Resick

Assistant Professor

School of Nursing

Duquesne University

612 College Hall

Pittsburgh, PA 15282

Phone : (412) 396-5228

E-Mail: resick@duq3.cc.duq.edu

Introduction

Lenore Resick, assistant professor of nursing at

Duquesne University, directs two nurse-managed

wellness clinics in Pittsburgh, PA. Both clinics are in

senior properties with Section 8 rental assistance.

In 1994, the first clinic was opened at St. Justin Plaza,

a 97-unit building in the Mt. Washington area. It is

owned by the Christian organization of the same

name and managed by Sister Susanne Watson. St.

Justin Plaza opened its Neighborhood Networks

center in December 1997. The second clinic opened

in 1995 at K. Leroy Irvis Towers, a 190-unit building in

the Hill district of Pittsburgh. It is owned by a

consortium of investors and is managed by Arbors,

under the direction of Edward Quinlin.

The objectives of the clinics are:

q To promote independent living for seniors by

providing health promotion and wellness

programs on site for the residents of two highrise properties.

q To facilitate access to primary care services so

the elderly can live longer and healthier lives and

provide preventive care as a means to avoid

costly medical services.

q To provide a community-based and communityfocused, cross-cultural health care experience for

nursing, pharmacy and health science students.

In the early 1990s, two national health prevention

agendas motivated Duquesne University’s opening of

the first Nurse Managed Wellness Clinic.

By the year 2000, 13 percent of the population will be

over the age of 652. Because chronic health problems

increase with age, the need for supportive services is

increasing. The 1990 U.S. Department of Health and

Human Services Healthy People 2000 campaign

expressed goals to increase the years of healthy life

to age 65 and beyond. One of the strategies

proposed was providing health promotion programs to

seniors. Early in the decade, the American Nurses

Association proposed a health care reform agenda

that emphasized wellness programming, equitable

access to care and a consumer-focused health care

system that encourages more responsibility for selfcare in managing health. Nurse-managed wellness
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clinics staffed by advanced practice nurses, such as

nurse practitioners and clinical nurse specialists, are

vital to this plan. Carol Taylor, a nurse from Duquesne

University, opened the first clinic at St. Justin Plaza in

1994 to accomplish these goals.

In 1993, the University Provost Michael Weber began

a community-wide planning process. He involved

community partners and many schools within the

University. He knew that the university had significant

resources to offer and believed that the community

could teach the faculty and students important

lessons. The University was awarded a $580,000

Community Outreach Partnership Grant from the U.S.

Department of Housing and Urban Development. A

second clinic site at K. Leroy Irvis Towers, modeled

after the success at St. Justin Plaza, opened in 1995,

utilizing some of the HUD funds.

Program Description

The wellness clinics are open an average of two days

per week on Tuesdays and Thursdays from 9 a.m.-3

p.m. An advanced practice nurse who is also a faculty

member is assigned to each site.

An advanced practice nurse is a nurse who is a

licensed, registered nurse prepared at the graduate

level as a clinical specialist, nurse practitioner, nurse

anesthetist or nurse midwife. At the clinics, the

advanced practice nurses are nurse practitioners.

They develop clinic operations, manage clinic

activities, provide direct care and plan and supervise

student activities. The advanced practice nurse

provides the program continuity that might otherwise

be lost as the students change from semester to

semester. On any day, one, two or three students

from the schools of nursing, occupational therapy and

pharmacy staff the clinics. The goal of all the activities

derived from the three disciplines is to keep the

seniors well through exercise, monitoring chronic

conditions and providing health information on issues

that impact their lives. Managing medication and

preventing unnecessary hospitalization and

premature institutionalization are important issues, as

the average age in both facilities is 75 years.

The clinics have examination spaces but look more

like apartments. Each clinic has chairs, tables,

curtains, carpeting and other features that make the

physical space inviting. Clinic activities vary

depending on the needs of the residents. Activities

may include discussions about a future surgery and

post-hospitalization plans. The advanced practice

nurse or students under APN direction may review a

visit made to a physician’s office or discuss chronic

conditions. Blood pressure is checked and weight

measured. Occupational therapists frequently perform

functional assessments and nursing students lead

exercise classes.

The wellness clinics are designed to teach students

how to render “culturally-competent” care, defined as

care that is sensitive to a resident’s culture, race,

gender and sexual orientation. The students regularly

facilitate workshops.

The relationship between the students and the

seniors is mutually beneficial.

The seniors educate the students about the selfmanagement of chronic conditions. The seniors also

have a wealth of experience with the medical system

so they provide the students with a better

understanding of why some medically- recommended

practices may have failed.

The service to seniors is unique not only because of

its focus on wellness and not illness, but because it is

frequently delivered by an interdisciplinary team.

Information is often provided from multiple

perspectives. For example, a student nurse may give

a diabetic nutrition information and an assessment of

weight and other symptoms of the disease. An

occupational therapy student may work with the

patient on performing exercises to promote greater

blood circulation and overall mobility. A pharmacy

student may ensure that the resident is administering

the correct insulin dosage and is not taking other

contraindicated medications.

The advanced practice nurse may perform a physical

assessment if a client has a specific complaint. The

wellness clinic is not designed to provide medical

treatment but to augment medical care by offering

health promotion and wellness services and by

encouraging appropriate use of the health care

system. If medical treatment is indicated, the patient
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is encouraged to call his or her physician. Often, a

client calls the physician from the clinic and both the

client and nurse speak with the physician. The nurse

can provide to the physician records on blood

pressure readings and other assessment information

gathered during clinic visits.

Graduate nursing students perform an annual chart

audit and client satisfaction survey. The audit and

survey usually result in program modifications the

following year. All students are asked to complete a

satisfaction survey of their clinic experiences.

Program Funding

The clinic at K. Leroy Irvis Towers opened with

$58,301 that Duquesne University received in the

form of grant from the HUD Community Outreach

Partnership. It covered the salary of the managing

nurse and administrative support, as well as some

supplies and equipment. The second year of the K.

Leroy Irvis Tower’s Nurse Managed Wellness Clinic

was supported by a $25,000 continuation grant from

HUD.

Duquesne University has always provided financial

support to St. Justin Plaza. Since January 1998, the

university has been the primary funder for K. Leroy

Irvis Towers. Duquesne University supports the

wellness clinics in order to train students in a crosscultural community setting while providing advanced

practical nurse faculty a clinical practice site. The

university pays for the salaries of the two advanced

practice and nurse practitioner faculty members who

manage the clinics. In addition to managing clinic

services, providing direct care and planning and

supervising student experiences, these faculty have

other university responsibilities. The student

involvement in the clinics is free. For students, this

experience partially fulfills a requirement to practice in

a community setting.

HUD no longer funds the program. Grants of $1,000

each year for the next five years have been awarded

by the Alumni Association of Presbyterian-University

Hospital School of Nursing. The award funds supplies

and the cost of a part-time administrative assistant.

The supply expense and administrative support for St.

Justin Plaza were approximately $12,600 in 1996 and

1997, which is paid for by Duquesne University. The

property owners provided the physical space for the

clinic and some of the furnishings.

Implementation

The first clinic opened after Duquesne University

nurse Carol Taylor considered the following factors:

the experience of other nurse-run clinics, results of a

survey that revealed that residents had health

insurance and primary care providers, and the limited

funding available. A duplication of primary care

services was not necessary. The experience of other

nurse-managed clinics and a survey done of the

community’s existing medical services suggested that

health promotion activities for seniors were scarce

services. The nurse managed wellness clinics are

designed to augment the health services already

available to seniors.

One of the challenges to a successful health

promotion and wellness clinic is distinguishing it from

a medical service. Typically, people access health

professionals when they are ill. A successful health

promotion and wellness clinic serves clients before

this stage. Determining additional services residents

value requires gathering information about the health

issues being managed day to day. This is a needs

assessment, of which there are two aspects; residentperceived needs and needs defined by trained health

professionals. The latter can be determined by a

health assessment or chart audit.

Another factor in the success of a wellness clinic is

that each resident may have a different definition of

wellness. Ms. Resick and staff see their roles as

facilitators. “We assist residents in defining and

achieving wellness”, Ms. Resick explained.

Succeeding in this effort requires expert listening

skills. In order to obtain credibility with residents of K.

Leroy Irvis Towers, the help of the on-site social

worker who had successfully served the residents for

years was enlisted. The social worker became Ms.

Resick’s liaison until she built her own relationship

with residents. “Unlike the process at St. Justin Plaza,

the needs assessment at K. Leroy Irvis Towers

transpired through informal communication with

residents,” she said. At St. Justin Plaza, the residents
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at Neighborhood Networks Centers June 1999

tend to be very active in resident council meetings.

About 90 percent participated in a council meeting

that served as a focus group to determine clinic

activities. Residents were urged to visit the clinic for

an initial health assessment to establish a baseline of

data on their health. In both cases, residents

responded.

The experience at K. Leroy Irvis Towers was very

different. Residents were suspicious of the need for a

formal baseline health assessment since they were

already under physician care. Clinic staff had to

develop a trusting social relationship with clients

before clients would begin to divulge information

regarding their health concerns. This relationship

developed by taking time to get to know the residents

and giving them time to get to know the nurse. This

happened by having one nurse regularly at the site,

keeping consistent hours, attending many community

events and explaining the need for baseline

information.

Residents feared being studied for research

purposes. Although they willingly participated in clinic

activities, many residents still considered the formal

health assessment too time-consuming and

unnecessary. As a result, a baseline of health

information for the population was established — not

by doing a formal health assessment, but by

performing a chart audit of the medical records

maintained by the clinic.

Although the process for obtaining information

regarding the needs of the residents varied greatly

between the site at K. Leroy Irvis Towers and St.

Justin Plaza, the primary health issues are the same.

Three main areas of concern for seniors at both sites

include hypertension and the need for blood pressure

monitoring, nutrition and maintaining optimal weight,

and managing multiple medications.

Results

By 1998, there were nearly 4,000 visits to the Nurse

Managed Wellness Clinic at St. Justin Plaza and

more than 1,732 visits to the clinic at K. Leroy Irvis

Towers. More than 70 percent of seniors at the two

sites participate in program activities.

Residents are able to live independently longer and

the centers have improved the quality of life at St.

Justin Plaza and at K. Leroy Irvis Towers. The social

interaction surrounding clinic activities reduces the

isolation residents often experience when moving

away from family and friends and into a senior facility.

Furthermore, teaching students about chronic

illnesses and their experiences with the medical

system bolsters their self-esteem.

Each year, more than 100 students gain experience

at the two clinics, often changing their opinions of the

capabilities of seniors as a result, students say.

Surveys of students’ satisfaction generally rate the

experience high and include that it has taught them

about culture, healthy aging and health care in the

context of community.

For these and other contributions the nurse managed

wellness clinics received international recognition by

being awarded a 1996 International Archon Award by

Sigma Theta Tau International Nursing Honor

Society. In 1997, the clinics were awarded a

Certificate of Honor by the Hospital Council of

Western Pennsylvania in recognition of “their

excellence and impact in improving community

health.” Additionally, the Butler Pennsylvania Visiting

Nurse Association replicated the clinic model and four

local agencies expressed interest in doing the same.

Sustainability

The nurse managed wellness clinics are teaching

sites and funded in large part by Duquesne

University. To ensure that the university continues to

fund the projects, strategies have been implemented

to keep administration informed of how the clinic

supports the university’s mission.

Alternative funding sources for the entire program are

unknown. However, small sums for supplies have

been obtained. Also, exploring relationships with

alumni organizations, local foundations, hospitals,

visiting nurse associations, churches and health

departments was considered.
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Lessons Learned

Know the Requirements of a Community Health

Nurse

The role of the nurse manager in a community

wellness clinic requires:

q Advanced clinical expertise as well as knowledge

of Occupational Safety and Health Administration

and local health department regulations, which

dictate what can and cannot be performed at the

site;

q Communication skills;

q Sensitivity to individual needs;

q Good clinical skills;

q An intuitive sense for identifying influential

community leaders; and

q The ability to be open and honest.

Many nurses who work in community wellness

settings need to make adjustments from acute care

settings. For example, the pace of activity is different

and the environment is more like a home than a

hospital.

Gather Information on Health Needs of Residents

Information regarding what services are needed

should be obtained by identifying the residents’

perceived needs and objectively establishing the

health status of the residents. “The processes for

gathering both sets of information can vary greatly

from location to location,” Ms. Resick said, because

each community has a unique culture. “In order to be

successful in this endeavor, the services must be

community-focused and not just community-based,”

she said. This means understanding individuals’

beliefs about health and providing services that are

valued and delivered in a manner acceptable by the

community.

Evaluate Provided Services and Measure Health

Improvement

Measuring outcomes of senior wellness programs is

challenging. The classification systems that exist for

documenting health issues are built around the

identification of a health problem. Clients do not

always come to the wellness clinic because of a

medical problem. Charting in a community-based

setting where wellness activities occur requires much

broader categories for classifying why residents are

participating and what plans are in place for achieving

wellness. Without uniformly collecting data on the

clients, improvements in health across the population

are impossible to measure.
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West End Medical Center, Inc.

Public Housing Primary Care Program

Atlanta, GA

Address: 34 Peachtree Street, NW

One Park Tower, Room 708

Atlanta, GA 30303

Contact : Karen Williams

Program Director

Phone: (404) 371-1122

Executive Director: Daisy Harris

Introduction

According to Karen Williams, program director at the

West End Public Housing Primary Care Program, it

was well recognized at the Atlanta (GA) Public

Housing Authority that access to health care is an

important link to resident self-sufficiency. Daisy

Harris, the long-time executive director of West End

Medical Center (West End), saw that West End

provided a very valuable service in low-income

communities, but also knew that there were many

community residents who were not accessing

services. Atlanta health statistics on infant mortality,

teenage pregnancy and child immunization showed

that the community health centers still had much work

to do. Mrs. Harris considered whether there was

another model of health care that would serve the

disenfranchised population. Together with the Atlanta

Public Housing Authority, Mrs. Harris, staff and board

of West End Medical Center began to adapt the

community health center model to locations within

public housing.

In 1991, West End started the first two on-site clinics

in public housing developments in Atlanta, GA. The

objective of the now six on-site clinics is to increase

health services access to people in great need by

providing a convenient and targeted health program.

Teen pregnancy, infant mortality, hypertension, ontime immunizations and substance abuse are public

health issues that have been targeted.

Program Description

The clinics are in various public housing communities

throughout Atlanta. The smallest property is a 250-

unit high-rise senior development. The other five are

low-rise family properties, the largest of which has

740 units. At the senior property, West End converted

a one-bedroom apartment into clinic space; at the

largest development, it converted three two-bedroom

units. Similar services are provided at all six sites.

However, the frequency of services, hours they are

offered and the providers vary depending on the

physical space and residents’ needs. All clinics are

open Monday through Friday, 8 a.m.-5 p.m., except

for the smallest clinic which is open once a week.

Clinics based at family properties provide a Women,

Infant and Children (WIC) nutrition program which

includes nutrition counseling and food vouchers that

residents can use at authorized food stores. These

sites provide obstetrics and gynecology, pediatric

services, adult medicine and some laboratory testing.

Social workers provide case management services

designed to connect residents to other social and

medical services in the community. An important

component of the on-site services is health education

activities, including information on family planning,

violence prevention and substance abuse. A health

educator rotates through all six sites, providing health

education information and arranging for experts to

deliver on-site information sessions. Some health

education is offered on the weekends in order to take

advantage of scheduled community events.
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Each site has an office manager, two licensed

practical nurses, a part-time nutritionist, a part-time

nurse midwife and a full-time physician’s assistant. In

Georgia, under physician supervision, a physician’s

assistant can write prescriptions and bill insurance

plans for services. Additionally, each site has a

physician on-site part-time who provides full-time

backup for all health professionals. The physicians

are board certified in pediatrics, internal medicine,

family practice or obstetrics and gynecology. One

registered nurse supervises the licensed practical

nurses by rotating throughout all of the sites.

An important aspect of the success of the on-site

clinics is the outreach by resident workers who are

employed at each location. They do not diagnose or

treat patients; instead, they make in-home health

assessments, including blood pressure monitoring. By

making home visits, these outreach workers help

break down the psychological barriers patients have

to obtaining care by building a trusting relationship. In

addition, they educate residents in the safety and

security of their own home about their need for

services. Outreach workers have a high school

diploma or equivalent.

Program Funding

In 1990, the Public Health Service Act was amended

to authorize the targeting of primary care services to

residents of public housing. The U.S. Department of

Health and Human Services (HHS), Health

Resources and Services Administration’s Bureau of

Primary Health Care established the Public Housing

Primary Care Program. In 1991, West End was

awarded a $500,000 grant to provide on-site services

to public housing residents. The grant has been

renewed annually and increased to $675,000 in 1997.

The grant can be used for West End’s so-called “soft”

costs, including staff, medication, equipment and

supplies. It cannot be used to rent and/or prepare the

clinic space. The Atlanta Public Housing Authority

provides the space and makes modifications to it for

use as a clinic.

The total budget for the West End Public Housing

Primary Care Program in 1997 was approximately

$1.2 million. The difference between operating costs

and the Health and Human Services grant comes

principally from three sources: Medicaid

reimbursement, fees from residents who do not

qualify for Medicaid and small grants of $20,000-

$50,000 from a variety of sources.

“It is a struggle every year to make ends meet,” said

Program Director Karen Williams. Many services not

covered by Medicaid are considered important,

including case management, nutrition and other

education services. Even if a service does qualify for

reimbursement, limits have been placed on the

number of allowable visits for that service. Residents

frequently run out of Medicaid-authorized visits before

the need has been satisfied. Despite the challenges,

Ms. Williams maintains a positive outlook. “The

program is part of a larger medical community and

has citywide supporters so even though it is a

challenge each year to meet the budget, there are

many committed individuals supporting the effort,”

she said.

Implementation

Once West End received the first Public Housing

Primary Care grant, a program director was hired and

provided the citywide health information, including the

need for services. However, the public housing units

to target and services to provide remained in

question.

Of the 42 public housing buildings in Atlanta, the

program was targeted to sites where resident councils

were very strong. Without strong resident interest and

involvement, they did not expect to succeed where

off-site community health centers had failed. In

addition to planning the program with the resident

councils, West End went door to door to conduct

health surveys. Not only did this result in increased

awareness of the program, but it provided a complete

health profile of the residents. At this point, it was

decided which services to offer.

An early challenge was the modification of public

housing units into adequate clinic space. This is the

responsibility of the public housing authority. Clinic

openings have been delayed because space was not

ready for occupancy and clinic staff has had to devise

ways to provide services without space. Services

have been delivered from alternative spaces, such as
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at Neighborhood Networks Centers June 1999

a van, the management office and often at community

events. These efforts were at one time only reactions

to unfinished clinic space but have become

successful strategies for building public awareness

prior to a new on-site clinic.

As part of a larger community health center, the

Public Housing Primary Care Program has been able

to share staff with other programs when a full-time

person was not needed. Now with six sites, the

program supports most of the staff full-time by

rotating them between the sites. A few of the

physicians split their time between the community

health center and the Public Housing Primary Care

Program.

Results

Of the 8,000 residents living in the six public housing

sites, 86 percent have used the services of the clinics.

Of the 14 percent who have not, some have

relationships with other health care providers. Staff at

the senior center clinic performed 1,500 services last

year. Throughout the six sites, staff of the Public

Housing Primary Care program performed 12,000

health services, including case management.

Sustainability

To a large degree, the program is dependent on the

HHS grant. No other major source of funding for this

program has been identified. One strategy to

decrease the dependency on this grant has been the

development of a for-profit umbrella corporation that

delivers health care services to privately insured

patients. Profits from this corporation are used to

subsidize designated programs of West End Medical

Center.

The Public Housing Primary Care Program is looking

very closely at how efficiently each site is run and

how to bill insurers for more of the services.

Historically, only one set of financial records has been

maintained for all the sites. The importance of

knowing how efficiently each site is operated has

become apparent. Therefore, separate financial

records are being set up for each site.

Ms. Williams hopes that two recent developments will

positively impact the program. The Children’s Health

Insurance Program (CHIP) has been enacted by

Congress to allow states to cover more health

services for children by providing federal matching

grants. This program may cover more of the services

already provided by the Public Housing Primary Care

program. Also, the Atlanta Public Housing Authority

has turned some of the developments served by the

Public Housing Primary Care Program into mixedincome facilities. Both low-income and middle-income

residents now occupy the converted sites. With

middle-income residents accessing the on-site

services, the Public Housing Primary Care program

will be able to bill third-party payers.

Lessons Learned

Several important lessons have been learned in the

establishment of the West End Medical Center’s

Public Housing Primary Care Program. These

lessons are:

q Create a structure that will give the program

resident input in program implementation as well

as throughout the life of the program.

Although West End and the staff of the Public

Housing Primary Care Program chose sites and

selected services by assessing resident interest and

needs, a structure to continually receive feedback

was not in place. Now, each public housing site has

an advisory committee of 10 clinic users who meet

quarterly. Their task is to advise the management on

the quality of the clinic operations. For example, if

waiting time for services is too long or if staff behave

unprofessionally, the committee will inform

management. Additionally, a President’s Council

represented by the presidents of individual resident

councils, monitors programming in all locations.

Karen Williams, the program director, also sits on this

committee.

q Resident outreach coordinators are essential to

the success of the program, but how much

information about other residents they acquire

and which residents to hire for the job needs to

be carefully considered.
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An outreach coordinator’s primary responsibility is to

connect people to available services. Details of a

patient’s health or specific condition need not be

known in order to refer a resident for services.

Outreach coordinators need to be flexible in their

approach to residents. How a coordinator

successfully encourages compliance with medical

regimens requires creativity.

q To encourage compliance with care routines, it is

important to reduce the need to seek off-site

services.

With seven years’ experience, the West End Public

Housing Primary Care Program remains committed to

creating a continuous care system that treats all of a

patient’s health care needs. The program is working

toward adding an on-site addiction’s counselor.

q Community partnerships are essential to the

success of the program.

Even though it may be desirable, it is fiscally

impossible to bring on-site all services residents

need. Linking to existing programs facilitates access

to off-site services. Additionally, the partnership with

the West End Medical Center, a longtime community

health center, not only raises most of the program’s

funding, but also allows the PHPC program to take

advantage of the partnerships between West End and

local hospitals and health plans.
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ABC for Health Inc.

Health Benefits Counseling Program

Madison, WI

Name: Advocacy and Benefits Counseling for Health Inc.

(ABC for Health Inc.)

Address: 52 West Johnson Street, Suite 206

Madison, WI 53703-2213

Contact: Robert A. Peterson

Executive Director

Phone: (608) 261-6939

Fax: (608) 2616938

Website: www.safetyweb.org

Introduction

ABC for Health Inc. is a nonprofit public interest law

firm dedicated to ensuring health care access for

children and families, particularly those with special

needs or at risk. Since 1990, the Health Benefits

Counseling program of ABC for Health has assisted

families in qualifying for Medicaid and Medicare and

assisted in dispute resolution with insurance

companies regarding payment of claims. The

program is a marriage of community-based advocacy

and public interest law. It exists because public health

insurance programs that many low-income people

rely on are complicated. Who qualifies? Which

managed care plan is optimal? What services are

eligible for payment? These are a few of the

questions ABC for Health helps families answer.

There is little accessible and understandable

information to help individuals answer these

questions on their own. Medicaid and managed care

plans have limited staff to help navigate the complex

health care system.

ABC for Health employs health benefit counselors

who teach consumers and train consumer advocates

on how to qualify for medical assistance. They

educate consumers about the nuances of the benefit

plan and advocate on their behalf if reimbursement

issues arise with a third-party payer. ABC for Health

has developed a cadre of community advocates who

are trained as health benefits counselors.

Founder Robert Peterson based the idea for the

program on a similar program that provided health

benefits counseling services to senior citizens. While

working at the Seniors Benefit Program in the early

1970s, he was frequently asked to assist non-seniors

with health insurance problems. He realized that no

equivalent program existed for other segments of the

population. With the advent of managed care and an

industry-wide effort to cut costs, health insurance

regulations have become increasingly complex. The

need for health benefits counseling for all patients has

become more pressing. Mr. Peterson decided to

replicate the successful Senior Benefit Program but to

add additional information that addressed the needs

of all health care consumers regardless of age,

thereby establishing the ABC for Health program.

Project Description

ABC for Health’s work reduces the vulnerability of the

poor and medically needy to economic hardship and

neglected health needs. It does this by reducing the

confusion and frustration in accessing the health care

system, by easing the financial burden of seeking

care and allows families to focus on their health

needs. The program benefits residents throughout

Wisconsin. Six instructors train an average of 200

persons a year in Health Benefits Counseling, using a

variety of training formats. Individualized advocate

training sessions take place over one to two weeks,

followed by an apprenticeship. After that, as

regulations and programs rules are modified,
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meetings are scheduled for an update of information.

There are also small, three- to five-day group

trainings and ongoing workshops on a specific topic.

The training topics include:

q Medicaid eligibility and benefits

q Social Security Income and Disability

determination

q Health insurance denial negotiations

q Appeals procedures and strategies

q Programs for children with special needs

q Other financing resources

q Counseling and advocacy techniques

Counselors gain comprehensive knowledge of how

health systems actually work and affect families. The

audience of a training program not only includes

health care consumers and consumer advocates, but

social workers, patient account staff, managers of

health care facilities and government representatives.

The topics of the health benefits counseling

curriculum are based on an examination of the daily

health insurance issues of citizens. The curriculum is

modified as new changes to insurance laws and

regulations take effect.

The success of the program lead to the opening of a

1,000-sq. ft. training site.

Program Funding

Program operations are supported by a Rural Health

Outreach Grant from the Health Resources and

Services Administration, state grants for health care

training, Maternal and Child Health Block Grant funds,

Older Americans Act funding and a grant from the

Otto C. Bremer Foundation. In addition, in-kind

volunteer services are valued at approximately

$40,000 annually. Furthermore, the subsidized legal

fees ABC for Health charges consumers generate

another $60,000 annually. Law students from the

University of Wisconsin Law School do legal work for

ABC for Health and 60 percent of their salary is paid

by the university through the federal government’s

work-study program. The program provides part-time

jobs for eligible students who demonstrate financial

need. Students who hold jobs off-campus must work

in positions that promote the public interest. Finally,

fee income is generated from individuals who take the

training courses.

Implementation

Convincing people throughout the state that there

was a need for health benefits counseling was a

tremendous challenge. Most consumers assumed

that government and insurance companies were

telling them everything they needed to know to

protect their rights. However, many consumers

experienced a number of obstacles to understanding

medical bills and resolving disputed claims but their

difficulties had not been well publicized. Mr. Peterson

identified program stakeholders by contacting his

colleagues in the Wisconsin Bar Association;

establishing partnerships with grassroots communitybased health organizations and local hospitals and by

using the resources of state and local governments.

The law firms that became program participants

provided legal services pro bono or at a dramatically

reduced cost to consumers. Mr. Peterson

successfully recruited local law school clinical

programs, convincing them to allow students to do

legal research on behalf of consumers under the

supervision of an attorney.

The health care institutions became stakeholders

because they saw the financial benefits of having

well-trained health benefits counselors identify

alternative funding sources for persons with no health

insurance coverage. Advocacy organizations were

supportive because they realized they were gaining

the knowledge and skills needed to negotiate medical

claims with health insurers on behalf of consumers.

Results

In the decade since the staff of ABC for Health began

providing health benefits counseling services in

Wisconsin, more than 7,000 families, health care

professionals and providers have benefited from

information and counseling about health care

financing programs, coverage options and insurance

claim disputes.
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One provider, the Dean Medical Center, seized on the

concept of health benefits counseling and adapted

the curriculum to its own private setting. Dean has a

large clinic in Madison and several satellite clinics in

surrounding southern Wisconsin counties. Partnering

with ABC for Health for training counselors, Dean set

up an Advocacy and Community Services program,

which reviewed all requests for care assistance from

the Dean Foundation. From September 1992 to

September 1996, Dean recovered $1,358,800 on

behalf of more than 1,000 families. This is similar to

the experience of benefits counselors in northwest

Wisconsin. A review of cases in Polk and Barron

counties from as early as 1990 documented the

recovery of nearly $1 million, mostly from private

insurance. In these counties, the use of benefits

counselors also helped increase enrollment of

uninsured children in Medicaid.

The health benefits counselors and attorneys at ABC

for Health have together advocated for families in

coverage and claim disputes with insurance

companies, health maintenance organizations and

government programs. In doing so, they helped

recover hundreds of thousands of dollars for health

care consumers and providers in “lost” third- party

reimbursements from public and private sources. In

fact, their research indicates that each dollar spent on

health benefits counseling generates more than $10

in third- party payments.

In addition, counselors have been successful in

reversing the decisions of health insurance

companies that would have denied consumers

access to durable medical goods, such as

wheelchairs and walkers, and specialty services, such

as occupational therapy and speech therapy for

children.

Sustainability

Since 1987, ABC for Health has leveraged funding

from the government, foundations, universities and

the health care industry to develop consumer

advocacy training programs in partnership with a

highly respected, public interest, nonprofit law firm.

These funding sources contribute toward program

operating costs. In fall 1998, ABC for Health opened a

new on-site training center. The number of firms and

individuals requesting training services was at an alltime high. Each year, ABC for Health generates

income from their training programs. Funding is stable

and the biggest challenge is meeting the demand for

counseling services.

Lessons Learned

Robert Peterson, the founder of ABC for Health, has

provided health care benefits counseling services to

the citizens of Wisconsin for more than a decade. His

experience has taught him the following:

q Establish local partners and get support for your

program from the key people in national, state

and local government agencies and health care

institutions. Their support for the training program

is important for fundraising and obtaining

program information. Many of these institutions

enroll their employees in benefits counseling

training with ABC for Health.

q Obtain enough funding so that the program can

be offered on a continuous basis. If the service is

not ongoing, class participation drops, funding

sources become scarcer and the overall

momentum of the program declines.

q Invest the resources in staff and training

materials that convey professionalism.

Community members will support you if they

believe you provide high-quality products and

services.
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q Train key people in the operation of your entire

organization. At a later date, if another firm hires

those individuals, they will take with them a

strong foundation of how to conduct health

benefits counseling. The entire community will

benefit from their knowledge.

q Take advantage of all of the free information

government agencies and corporations offer on

the Internet. Immediate access to health program

rules and regulations will significantly reduce the

time you will spend on the phone requesting the

information.
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The University of Michigan

Comprehensive Cancer Center

Michigan Interactive Health

Kiosk Demonstration Project

Address: Health Media Research Lab

300 N. Ingalls, Room 5D-04 (0471)

Ann Arbor, MI 48109-0471

Name: Amy Parlove

Project Coordinator

Phone: (734) 647-9576

Project Director: Victor Strecher, PhD

E-mail: Aparlove@umich.edu

Introduction

The Michigan Interactive Health Kiosk Demonstration

Project is a network of computer-based interactive

health programs located in kiosks throughout

Michigan. The kiosks provide public health

information targeting underserved populations. They

are in places highly accessible to the public, including

libraries, work sites, recreation centers, churches,

grocery stores, malls, health departments and

hospitals. This telehealth project aims to inform

people in Michigan about disease prevention and

good health.

The idea was the brainchild of Dr. Victor Strecher, a

professor at the School of Public Health at the

University of Michigan. He is also director of cancer

prevention and control at the Comprehensive Cancer

Center and director of the Health Media Research

Laboratory at the University of Michigan.

Dr. Strecher’s research indicated that public health

campaign information tailored to the recipient is more

likely to be understood and acted upon. Ideally, this

type of tailored information will take into account an

individual’s background, needs, interests, motives

and any barriers to making a health behavior change.

Printed materials, such as pamphlets, are massproduced and, therefore, generically written. They are

also widely and often indiscriminately disseminated.

For these reasons, they are not effective as

communications devices. On the other hand,

interactive computer technology that closely

resembles television that is familiar to almost

everyone is a more successful communication tool.

Users can navigate through channels and receive

health information on specific and it can be personally

tailored to their individual health risks.

Dr. Stretcher proposed the project to Michigan State

Sen. Joseph Schwarz, vice-chairman of the senate

appropriations sub-committee on community health.

Tobacco tax dollars from the Michigan Department of

Community Health funded the program for two years.

The Health Media Research Laboratory was awarded

$2 million and received half in October 1996.

Project Description

“The kiosks are television-like and employ touchactivated screens that allow users to explore health

information with a press of their finger,” says Dr.

Strecher. Audio imager domes that localize sound

around the user are suspended above the kiosk. The

rich stereo sound connects the user with on-screen

visual imagery, creating a vivid, personal and private

experience. Five health “channels,” collectively

identified as the “Health-O-Vision” program include

Smoking Cessation and Prevention, Childhood

Immunization, Breast Cancer, Prostate Cancer and

Child Bicycle Helmet Safety. The channel topics are

relevant to a broad range of people. Future channels

include Cardiovascular Disease and Risk Prevention,
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Cancer Risk Prevention, Physical Activity, Nutrition

and Sexually Transmitted Diseases. The topics were

selected based on the Michigan Department of

Community Health’s Critical Health Indicators which

provide an overview of the health of state residents

and the health system that serves them.

The Michigan Interactive Health Kiosk Demonstration

Project’s health messages speak to a person’s beliefs

about perceived risks of the target behavior,

perceived benefits of changing the target behavior

and the barriers to changing it. This approach can be

seen in the main menu selections of the Smoking

Cessation and Prevention Channel, which offer the

following as entry points to users:

q “Is Smoking Really That Bad For Me?”

(Perceived Risk)

q “Will Quitting Do Me Any Good?” (Perceived

Benefit)

q “How Do I Quit?” (Barriers to Change)

The essence of the interactive experience is that the

health messages can be tailored to the recipient.

Tailored information happens in two ways: through

interactive choices that allow users to create their

own education experience; and through three

programs that solicit information from the user and

tailor the response. According to Dr. Strecher, people

are more often motivated to change a behavior or

take other action if the message specifically

addresses their needs.

The 12-person project staff includes multimedia

programmers, public health specialists, health

educators, graphic designers and administrative staff.

University of Michigan graduate students also support

the project. Health educators on staff write the public

health messages for the channels and a scientific

advisory group University of Michigan physicians

reviews the content. The final approval comes from

the Michigan Department of Community Health. The

kiosks are continually updated with new programming

via a connection to a central computer server at the

University of Michigan.

In 1998, there were 90 kiosks throughout the state.

For the first year of the program, the process for

distributing the kiosks was by requesting proposals

from interested organizations. A statewide media

campaign resulted in applications for kiosks.

The criteria to select sites included answers to the

following:

q How populated is the area?

q What is the socioeconomic status of the local

population?

q What is the minority representation in the area?

q What does the physical location look like?

In the second year, in addition to receiving

applications, staff sought out specific locations for

new sites. The more proactive approach to finding

new sites resulted in higher utilization of the kiosks.

In high-density locations where there are multiple

kiosks, members of the Community Advisory Board

with statewide representation oversee the promotion

and utilization of the kiosks. The board is made up of

representatives from local health departments, local

health organizations and kiosk sites. Its role is to

provide feedback to the staff on existing channel

programming and new programming ideas, organize

consumer focus groups and facilitate relationships

with potential funding sources. This formal process

was needed to gather ongoing feedback from users

and non-users.

Program Funding

The sole source of funding for the project is the

cancer section of the Michigan Department of

Community Health. The proceeds from Michigan’s tax

on tobacco products fund health care projects. The

Michigan Interactive Kiosk Demonstration Project was

awarded a two-year grant of $2 million in 1996 and

grants from federal agencies have been pursued.

Implementing the Program

Once funding was received from the state, the

development of five multimedia health channels

became an intensive 12-month effort requiring more

than 20,000 cumulative person-hours. The project

was divided into five stages:
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q Analysis – In this stage, it was determined which

health and screening behaviors should be

addressed. The challenges of effectively

communicating each chosen message were

defined by considering the specific health risks,

barriers to good health behaviors and the

benefits of changing behavior.

q Design – This phase involved planning the

communication materials, testing the design

concepts with users (both text and media) and

settling up the major features of the software and

hardware.

q Development – Flow charts for the contents of

each health channel were created. Scripts were

produced, creating many separate health

messages, and storyboards were designed for

each screen. The scientific accuracy of the health

messages was verified and the scripts were

edited. The software was programmed and

tested for bugs and a critical review of the design

took place.

q Deployment – The program was piloted in three

communities with several kiosks in each location.

Users were surveyed for their feedback and the

software was debugged. Following this test, final

versions of the kiosks were deployed to locations

throughout the state.

q Production – Project promotion and

partnerships for establishing a strong network

were the focus. Maintaining and upgrading the

software was also a priority.

Results

Usage of the kiosks was determined by analyzing two

different types of data: on-screen user surveys and

touch screen usage data. Both sources were

collected by the kiosks and then uploaded daily by

modem for analysis at the University of Michigan’s

Health Media Research Laboratory. Touch screen

usage data was analyzed to determine the number of

people who used the kiosk, which channel each user

accessed, the amount of time the user spent looking

at the channel and the path the user took through the

information.

Statistics from the usage of the first 30 kiosks found:

q 16,987 users accessed information during an

average 35-day period

q An average of 468 users per day

q An average of 15.6 users per day per kiosk

q An average of 3.4 minutes spent per user

Based on results from the first year of operation, the

relative success of each channel can be seen. Of the

channels selected, the most popular was the Bike

Safety Channel, with 28 percent of users choosing it.

The percentage of users who watched each channel

is shown below.

Based on total users of the kiosks, the information

shows the most popular channels or the frequency of

its selection:

q Bike Safety Channel 28%

q Smoking Cessation Channel 27%

q Immunization Channel 23%

q Breast Cancer Channel 19%

q Prostate Cancer Channel 17%

(Fourteen percent of users chose more than one

channel.)

Thirty-seven percent (6,300) users completed an onscreen satisfaction survey. The responses included:

q Of the on-screen survey respondents, one

quarter reported having little or no computer

experience.

q Nearly 59 percent of respondents identified

themselves as minority, compared with the 16.5

percent of Michigan’s population.

q Girls ranging in age from 10-19 years were the

most frequent users among survey respondents.

q Males under age 50 were those most satisfied

with the experience.

q More than 63 percent of the respondents said

they would recommend Health-O-Vision to

others.
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q Malls, multi-merchandise stores and community

colleges were seeing the greatest number of

users.

Sustainability

At present, funding is secure. Future funding sources

have been identified and some grant applications

have been submitted. One grant from the Alzheimer’s

Association to produce an Alzheimer channel has

been awarded. The following activities are essential

for sustaining the success of the project:

q Development of future health channels.

Categorical funding for individual health topics,

such as the funding provided by the Alzheimer’s

Association, is an opportunity.

q Acquisition and deployment of additional kiosks.

q Maintenance, repair and upgrade of kiosks and

software.

q Installment of telephone lines for optimal sites

that cannot afford installation.

q Regular updating of local health resources for

kiosk locations.

q Continued data collection and analysis of the

success of specific channels and health

messages, as well as kiosk locations, to

maximize the dissemination of needed health

information.

Lessons Learned

During the implementation and operation of the

Michigan Interactive Health Kiosk Demonstration

Project, staff learned many important lessons about

how to improve delivery of the health messages:

q Improve signage around the sites to attract more

attention.

q Instruct the user immediately on how to interact

with computer.

q Publicize that health information is free.

q Make health channels available on CD-ROM and

the Internet.

q Give the user the option to take away printed

material from an interactive session.

q Give the user information on local health

resources.

Additional lessons about the implementation of the

project:

q Over extension of staff time and energy is a

hazard.

q Public health delivered through interactive

advanced technology requires the collaboration

of many different disciplines. Large diverse group

interaction needs a concrete supportive process.

q A formal process with a large funding agency,

like the Michigan Department of Community

Health, is required to ensure that communication

is frequent and the contributions of the

department are fully maximized.

q A statewide network of supporting organizations

must be developed for multiple purposes,

including promoting the project, receiving

consumer feedback, monitoring kiosks and

identifying funding sources.

The lessons learned are an important byproduct of

the success of the Michigan Interactive Kiosk

Demonstration Project. In 1995, Dr. Strecher chaired

a conference entitled “Consumer Health Informatics:

Issues and Challenges” attended by researchers and

commercial developers of health-related advanced

communication technologies. These experts agreed

that by 2007, interactive television would reach many

individuals who have never owned or used a

computer. The Michigan Interactive Kiosk

Demonstration Project has begun to develop the

infrastructure for the age of interactive television. It is

a bridge between public health and modern

communication.
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Chapter 4

Implementation: Adapting Use Ideas

for Neighborhood Networks Centers

For the individual Neighborhood Networks center,

implementing the practices described in these model

programs may seem daunting because of their cost,

size and complexity. Most Neighborhood Networks

centers are not expected to replicate these models on

the same scale as they are presented. The goal is to

present a range of approaches to providing on-site

health care that a Neighborhood Networks center can

modify to meet the needs of its own community within

existing constraints. At the same time, an ambitious

center with the right partners can indeed create a

robust program that rivals these models.

Most centers that decide to include or enhance health

information and on-site services will begin with a

more modest approach. For example, if resources

are not available to have an on-site nurse on a fulltime basis, a center could work with a partner and

have an on-site nurse one day a week.

Golden West, Multi-Family Initiatives, Duquesne

University and West End Medical Center illustrate

health care programs located at low-income housing

sites. They are presented so Neighborhood Networks

centers can replicate these models in whole or in part

with the collaboration of health care partners.

ABC for Health and the Michigan Interactive Kiosk

illustrate programs and organizations that provide

services that could be located at low-income housing

sites. These models show the kinds of advocacy and

telehealth activities that would be excellent

components of a Neighborhood Networks center.

Centers can develop elements of these programs,

again in collaboration with health care partners.

Neighborhood Networks centers have a unique

opportunity to significantly improve the health of

residents. The ability to locate services where people

live can make a huge difference in increasing

residents’ access to health information and services.

This is particularly powerful when relationships

develop between the residents and regularly available

health care professionals, especially nurses. A nurse

can play two extremely significant roles: develop a

relationship of trust with residents so that prevention

and treatment are sought; and assist residents in

navigating the increasingly complex health care world

to obtain access to appropriate care.

Role of the Property and Center Staff

Staff members of the property and the Neighborhood

Networks center do not need to become experts in

health care. Their role embraces these important

responsibilities:

q Developing partnerships with health care

organizations.

q Involving residents in planning health care

activities.

q Serving as liaison between health care partners

and residents.

q Making appropriate space available for health

care activities.

q Ensuring that health care activities are

coordinated with other center activities.

q Collaborating with health care partners in

obtaining additional funding and resources.

In this capacity, staff can enhance the benefits to

residents of the Neighborhood Networks center and

maximize access to health care and health care

information by center participants.
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Resident Involvement is Critical

As with all components of Neighborhood Networks

centers, resident involvement is critical to the success

of health care activities. Each center can involve

residents in particular ways, depending on the

characteristics of the center and property. Some

important ways to involve residents in the health care

component are:

q Include residents in initial discussions about

creating the health care component and in

subsequent planning groups.

q Assess resident health care needs, perhaps

through a survey or focus groups.

q Conduct outreach to the local community to

encourage participation in health care activities.

q Recruit residents to monitor health care

programs of the Neighborhood Networks center

and provide feedback on health care activities.

Selecting Services

The health care needs of different communities vary

depending on the residents of the community and the

existing health care resources. The process for

establishing what services would be useful to a

particular group of people is called a needs

assessment. The needs assessment establishes the

information and services that are needed and would

be utilized.

It may be advisable to have your health care partner

conduct the needs assessment. Your health care

partner has the knowledge and expertise that will

allow them to effectively gather and analyze

information. Additionally, this resolves any privacy

issues that may be of concern. Your health care

partner’s involvement at the beginning stages of

planning health care activities will increase their

sense of ownership of the activities.

There are two components of a needs assessment.

The first is objective information regarding the health

needs of a community. The second is residentperceived needs.

Objective information about the health needs of a

particular community can be obtained from statistical

information about the community from government

sources, such as the local health department. Health

assessments of community residents are another

source of objective information. This information

establishes a baseline of health for the community. All

the programs providing on-site health services (West

End, Duquesne University, MFI and Golden West)

objectively assessed residents’ health. West End

performed door-to-door health assessments at

chosen sites prior to the start of the program.

Duquesne University performed health examinations

at one site but conducted chart audits at another. MFI

based the decision of which services to offer initially

on their experience at another property with similar

demographics, but since opening have concentrated

on performing comprehensive health assessments.

The Golden West Director of Resident Services

performs a pre-admission assessment of a resident’s

health. The baseline health information is not always

easy to obtain before the opening of a program, so

staff must remain flexible to make changes in

services provided as needs are identified.

Ongoing communication with residents is the source

of information about resident-perceived needs. Before

the start of a program, focus groups may be

warranted. Giving program staff high visibility at

community events may encourage resident opinions

of the planned activities. Resident feedback is

essential at the start of the program and throughout

the program’s life.

Types of Health Care Programs

Numerous Neighborhood Networks centers have

health care programs at their properties. Those

programs fall into four main categories. The models in

this guide also illustrate these four types of

programming:

q On-site Health Care Services – Some

properties have arranged for physicians and/or

nurses to conduct on-site medical assessments,

case management and wellness programs

through partnerships with schools of nursing,

local hospitals and private practitioners and

health care companies.
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q Wellness: Health Information and Health

Screenings – Many properties provide residents

with health information and health screenings.

For example, some senior properties have

screened residents for hypertension, hearing and

vision loss. Some family properties provide

residents with information on child immunization,

substance abuse and teen parenting. Centers

offer these services in partnership with local

health departments, Area Agencies on Aging,

chapters of disease-specific organizations,

community health centers and local hospitals.

q Patient Advocacy – As the Medicaid population

has shifted into managed care, Neighborhood

Networks centers and their health care partners

are helping residents successfully navigate their

health plans and providers. Center training

programs teach residents how to become more

responsible for their own health care.

Neighborhood Networks centers are also helping

enroll children in the Children’s Health Insurance

Program (CHIP), which is open to families who

earn too much to qualify them for Medicaid.

q Telehealth — Many centers are using the

Internet to access health care information on a

range of topics including diabetes, asthma and

Medicare. Some centers have joined online

disease support groups and formed on-site

groups to address residents’ health concerns.

Benefits to Health Care Partners

One of the most critical aspects of developing on-site

health care is the establishment of partnerships with

appropriate organizations.

When looking for partners, it is important to identify

the potential partner’s mission. Entities that have

similar missions, such as those wanting to serve lowincome persons, or symbiotic missions, such as a

need for large training sites, are good candidates for

partnership. Developing a successful partnership

requires knowing an organization’s mission as well as

its decision-makers. It may be necessary to convince

them of the mutual benefits of partnering.

Neighborhood Networks centers offer health care

partners key resources and benefits, such as:

q Access to a medically underserved

community right where the residents live.

The on-site location overcomes barriers to

accessing health care, such as child care and

transportation. Partners meet their goals of

increasing availability and the use of their

services by low-income persons.

q Improved relations with the community and

positive public perception. A positive public

opinion has many benefits. It can potentially

attract customers for other services.

q Strengthened grant applications. Funders want

to see linkages with community-based groups,

such as Neighborhood Networks centers, as well

as innovative approaches, such as housingbased services and telehealth.

q Space at the housing development. For

partner organizations, an office for individual

consultations, as well as meeting rooms for

education and information sessions that a

Neighborhood Networks center can offer, are

often hard to come by.

q Computer resource centers with Internet

access. Technology is expensive and not always

widely available at partner organizations.

q Neighborhood Networks center professional

staff. Center staff who have positive

relationships with the resident community and its

leaders can provide a key link for outreach.

q Computer-trained residents. Partners can work

with residents who are already comfortable with

the technology.

Key Health Care Partners

Several types of organizations lend themselves as

potential Neighborhood Networks center partners.

These include university-based programs, such as

schools of nursing and public health, state and local
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health departments, hospitals, community health

centers, Special Supplemental Nutrition Program for

Women, Infants and Children (WIC) sites, Area

Agencies on Aging and home health agencies.

Schools of Nursing and of Public Health

To fulfill their requirements, most nursing and public

health students must have supervised, practical

experience in the community. Neighborhood

Networks centers can provide an excellent training

ground for students to gain experience in working with

people from diverse racial, ethnic and economic

groups. Community nursing is an increasingly

important discipline, and home health care is an

expanding field. Public health students may focus on

such concerns as nutrition, drugs and alcohol,

sexually transmitted diseases or maternal and child

health.

State and Local Health Departments

The basic focus of state and local health departments

is on preventive and protective health and health

promotion. The purpose of health promotion activities

is to inform, educate and empower people. Health

departments mobilize community partnerships to

identify and solve health problems. They focus on

improving access to services needed by the medically

underserved.

Hospitals

Hospitals are increasingly interested in balancing their

traditional emphasis on illness with activities that

focus on prevention and education and decreasing

reliance on emergency rooms for non-emergency

needs. They are also interested in improving

relations with the communities in which they are

located.

Community Health Centers

Community health centers provide access to casemanaged, family-oriented, culturally-sensitive

preventive and primary health care services for

people living in rural and urban medicallyunderserved communities. Their services are

prevention oriented and include such children’s

services as immunizations, well baby care and

developmental screenings. Many centers provide

health education, nutrition and counseling services.

Case management — the coordination of the center’s

services with community services appropriate to the

social, medical and economic needs of the patient —

is emphasized.

Special Supplemental Nutrition Program for

Women, Infants and Children

The Special Supplemental Nutrition Program for

Women, Infants and Children, known as WIC,

provides supplemental food, health care referrals and

nutrition education for low-income pregnant and

postpartum women and to infants and children up to

age five who are identified at nutritional risk. WIC

recipients access these services at WIC sites.

Area Agencies on Aging

Area Agencies on Aging coordinate low-cost,

comprehensive quality care to millions of elderly

people nationwide by helping older persons and their

families navigate the complex systems of community

services.

Home Health Agencies

As the health care system de-emphasizes

institutionalization and as seniors live longer and

more independently, there is a greater role for

companies providing home health services. Building a

clientele through efforts that provide good marketing

opportunities may interest a home health agency.

Ensuring Success

To develop the health care component of your

Neighborhood Networks center, don’t forget to:

q Discuss the idea with all stakeholders: residents,

resident leaders, center staff, management and

owner representatives.

q Contact other Neighborhood Networks centers

that have a health care component and learn

from them.

q Identify potential health care partners in your

community.
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at Neighborhood Networks Centers June 1999

q Meet with potential partners to discuss possible

health care activities at your center.

By taking these steps, your Neighborhood Networks

center will be well on its way to providing residents

with some of the basic services that can address

important community needs.
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at Neighborhood Networks Centers June 1999

Chapter 5

Resources

This section provides important resources on how to

establish a health care component of your

Neighborhood Networks center. Resources are

organized by the types of models featured in this

document. These resources represent a sample of

those available. The Neighborhood Networks website

(www.neighborhoodnetworks.org) lists additional

resources.

On-Site Nurse and Addictions

Counselor Model (Multi-Family

Initiatives)

Local health departments. Information about local

health departments can be obtained from the

American Public Health Association at

www.apha.org/secafcauc/affiliates/basic.html

American Hospital Association (AHA). AHA is the

national trade association of hospitals and health care

networks Website is www.aha.org.

National Association of Public Hospitals and

Health Systems (NAPH). NAPH represents more

than 100 hospitals and health systems which

comprise the essential infrastructure of many of

America’s metropolitan health systems. These

systems provide almost 90 percent of their services to

Medicare, Medicaid and low-income uninsured

patients. Often, they have clinics located in the

community. Website is www.naph.org.

Also see Community Health Center and University

models.

Service Coordinator Model

(Golden West Senior Residence

Wellness Program)

A How-To Guide: Service Coordination, Elderly

Persons and People with Disabilities. This manual

provides excellent information on the role of service

coordinators, including practical steps in Getting

Started, Community Building, Working with Partners

and Bringing More Resources into the Development.

It is available from HUD’s Multi-Family Housing

Clearinghouse at 1-800-MULTI70. Check with your

local HUD office to see if your property qualifies for

grants or can use project funds for a service

coordinator.

University School of Nursing and

Public Health Model

(Duquesne University)

American Association of Colleges of Nursing

(AACN). AACN is the national voice for America’s

baccalaureate and higher degree nursing education

programs. The membership list of 562 schools of

nursing is located at website www.aacn.nche.edu/

Association of Schools of Public Health (ASPH).

ASPH is the national organization that represents

schools of public health throughout the country.

Website: www.asph.org.

National Black Nurses Association. This 25-yearold professional nursing association seeks to improve

the health status of African Americans. It has

implemented hundreds of community-based

programs. Health screening, promotion and education

activities of community-based programs focus on a

variety of issues. Prevention of cardiovascular

disease and infant mortality, the early detection of

cancer and strategies to reduce violence and

substance abuse are examples. Website:

www.bronzeville.com/nbna/index.html.

Community Campus Partnership for Health. Based

at the Center for Health Professions at the University

of California, San Francisco, this nonprofit

organization was founded in 1996 to foster healthpromoting partnerships between communities and
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educational institutions. Website:

http://futurehealth.ucsf.edu/ccph.html.

Coalition for Healthier Cities and Communities.

This 10-year-old nonprofit organization is affiliated

with the National Civic League. The coalition is a

partnership of entities from the public, private and

nonprofit sectors to focus attention and resources on

improving the health and quality of life of communities

through community-based development. A primary

focus is to promote the initiation, development and

sustainability of initiatives that result in healthy people

and healthy communities. Website:

www.healthycommunities.org.

Community Health Center Model (West

End Medical Center)

National Association of Community Health

Centers (NACHC). NACHC is a membership

organization representing the nation’s network of

frontline community health care centers. Its mission

is to promote high-quality, comprehensive health care

that is accessible, coordinated, culturally and

linguistically competent and community directed for all

medically underserved populations. Website:

www.nachc.com.

Bureau of Primary Health Care. This federal agency

provides significant funding and oversight to

community health centers nationwide. Website:

www.bphc.hrsa.dhhs.gov/chc/chc1.htm.

Health Benefits Counseling Model

(ABC for Health Inc. )

Families USA. Families USA, a national, nonpartisan

nonprofit organization dedicated to the achievement

of high-quality, affordable health and long-term care

for all Americans, has given health care consumers a

voice through its national advocacy. Members who

advocate on behalf of patients are located throughout

the country. Website: www.familiesusa.org/.

Health Care Financing Administration (HCFA).

This federal agency manages Medicare, Medicaid

and the Children’s Health Insurance Program (CHIP).

It has insurance counseling staff in each state to

provide information about HCFA programs. HCFA’s

website is located at www.hcfa.gov. Comparisons

between each state’s Medicare-managed care plans

are provided at www.medicare.gov/comparison/.

Children’s Defense Fund (CDF). The mission of this

private, nonprofit organization is to educate the nation

about the needs of children. It promotes preventive

investments in children before they get sick, drop out

of school, suffer family breakdown or get into trouble.

Website: www.childrensdefense.org/.

American Association of Retired Persons (AARP).

A nonprofit, nonpartisan advocacy organization,

AARP is dedicated to helping older Americans

achieve independence and live with dignity and

purpose. Website: www.aarp.org.

Telehealth Model (Michigan Interactive

Kiosk)

Telecommunications and Information

Infrastructure Assistance Program. The U.S.

Department of Commerce is a funding source for

advanced technology projects, including telehealth

and telemedicine. The program is called the

Telecommunications and Information Infrastructure

Assistance Program (TIIAP). It provides matching

grants to nonprofit organizations, such as schools,

libraries and hospitals; public safety entities and state

and local governments. Grants fund projects that

improve the quality of and the access to health care,

education, public safety and other community-based

services. The website

(www.ntia.doc.gov/otiahome/tiiap/index.html) contains

information about the grant funding process, lists the

recipients of past grants and provides information

about grantee projects.

Federal Telehealth Funding Guide. This website

(www.nal.usda.gov/orhp/teleheal.htm) provides

information and contacts for telehealth and

telemedicine funding from federal agencies, including

the National Library of Medicine, Rural Utilities

Service, Office of Rural Health Policy, National

Cancer Institute and National Science Foundation.

California Telehealth and Telemedicine Center.

The center’s mission is to improve and expand

telehealth and telemedicine programs in rural and
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underserved communities. The center helps health

care providers launch telehealth and telemedicine

projects to benefit these communities. Website:

www.catelehealth.org.
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ENDNOTES

 

1 Olson, Krista and Pavetti, LaDonna. 1996. Personal and Family Challenges to the Successful Transition from

Welfare to Work. Washington D.C: The Urban Institute

2

 Carol A. Taylor, Lenore Resick, Joyce D’Antonio and Theresa Carroll. Advance Practice Nurse Quarterly, 1997,

3(2), 36-45, The Advanced Practice Nurse Role in Implementing and Evaluating Two Nurse Managed Wellness

Clinics: Lessons Learned about Structure, Process and Outcomes.