Don't expect underserved to come to you
Solicit aid of community agencies, business leaders
Questions: How do you identify the underserved members of your community? What steps do you take to determine the most effective way to reach them? How do you access these patient groups? What education efforts have you found to be effective?
Answer: The best way to identify the underserved members of your community and determine how to reach them is to take the "plunge," says Philip A. Newbold, MS, MBA, president and CEO of Memorial Health System in South Bend, IN. The community plunge is a way to become immersed in an issue such as homelessness, child abuse, or violence.
The technique is simple. Select an organization or community group interested in a certain topic and organize a half-day gathering to tackle the issue at a site that serves the target population. Both Memorial and the plunge partnering organization invite board members, community leaders, and interested parties. Around 100 invitations are sent and usually about 40 people are able to set aside the time to attend. (To order a free Community Plunge Action Kit, see the resource list at the end of this article.)
In a recent community plunge, Memorial Health System partnered with the Center for the Homeless in South Bend. They met at the shelter so the group could speak with people who are homeless or have been homeless.
"When you put different combinations of people together, initiatives and opportunities emerge. Opportunities crop up that you would never figure out around a conference table," says Newbold. For example, one participant noticed there were many families with children at the center. From this observation, a screening for neurological and emotional disorders was organized.
Neighborhood clinics that are either run by your health care facility or another organization can put you in touch with the underserved members of your community, says Nancy Walch, BSN, MPH, CDE, coordinator of the health education and wellness department at Queen's Medical Center in Honolulu. Walch uses the clinic at Queen's to connect with homeless diabetics.
Immediate needs must come first
Once patients are identified, they are plugged into services that will help meet their immediate needs such as housing and food. Once patients' basic needs are met, they return to the clinic for treatment.
"People say this population is hopeless because they are homeless. However, the biggest mistake we health care professionals make is not applying what we have learned before, which is to take care of a patient's basic needs before talking about education,"says Walch. If you don't take care of basic needs, the patient won't listen, she says.
Management at Johnson Memorial Hospital in Franklin, IN, have found that monthly luncheons with staff from social service agencies and business leaders are a good way to identify the underserved members of the community and their needs. These meetings have resulted in a countywide partnership, says Janette Helm, MA, RN, CHES, director of education and training at the hospital. (For more information on this partnership, see Patient Education Management, March 1997, pp. 33-35.)
One committee from this partnership purchased a van to use for wellness screenings and education projects. They plan to travel in the van to specific communities on a weekly basis. The committee selected a mobile home park as a pilot project. "The most effective way to reach people is where they are, and that takes planning and sometimes money. Transportation can be a big problem for some populations," says Helm.
Another committee in the partnership decided to provide mammograms to women who could not afford them, so they contacted the county welfare and health departments to determine how to reach this patient group. As a result, they distributed flyers at locations the women might frequent, such as the office for the local Women, Infant, and Children supplemental voucher program, the Johnson County Health Department's site for child immunizations, and a free clinic in Franklin, IN.
They spoke to the people who worked at each location first so the staff would have the information needed to answer the women's questions. They also made the flyers simple with bulleted points and one telephone number for registration. "We didn't want the women to have to go through a lot of steps because we were afraid that would be a barrier and they would say it was too difficult," says Helm.
Tailoring the project to the needs of the individual is extremely important, agrees Walch. Queen's Medical Center has organized a six-week class for the homeless diabetics identified at the clinic. Because patients in the group have low literacy levels and often have multiple psychosocial problems, they are taught in a variety of experiential learning methods including demonstrations and big posters. Transportation is arranged for those who don't have it.
Often it is difficult to evaluate the effectiveness of an underserved patient group. That's one reason the committee that designed the van outreach project selected a mobile home park as its pilot neighborhood, says Helm. Each time the van returns to the neighborhood, staff conduct a follow-up screening on the people who were seen the week before.
"I think the way we have traditionally measured our success is by the number of people who have participated. Now we are trying to take that next step and do some of the long-term follow-up," says Helm.
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