Health Share Partners Show How They Fight Childhood Adversity, Poverty, and Build Resilience

The rollout of the GOP’s plan to reduce Medicaid and Oregon’s own budget shortfall prompted barely a mention as scores of partners in Oregon’s biggest coordinated care organization burrowed into the weeds, seeking to combat challenges Health Share of Oregon’s members face from poverty, inequity and trauma.

As a pediatrician at The Children’s Clinic in 2008, Dr. R.J. Gillespie saw a happy six-month-old baby with a clearly depressed mother. By the time that baby was nine months old, he failed his developmental screening. At age two, the child was standing in a corner screaming.

“These are the effects of social determinants,” Gillespie told participants at Health Share of Oregon’s second Transformation Alignment Summit. Even two adverse childhood experiences, or ACEs, for a parent tend to result in that parent’s child failing a development screening at nine months.

“Troubled health and troubled lives go together,” said Dr. David Labby, Health Share’s health strategy advisor. “Poverty and inequality is the thing that is raising (healthcare) costs, and that is the conversation that is not happening.”

One conversation Labby would like to have, based on his survey of Health Share members, is how “resilience trumps ACES.”

“Twenty-five percent do really well even with terrible childhoods,” Labby said. “What happened? We don’t even have a language (to discuss) resilience. How do we even ask these questions? The literature of resilience is small.”

While Labby admits “we’re not going to solve poverty” he believes “health is a community product” and  “resilience is built mostly in communities.”

Tuesday’s summit gave community partners a chance to tell how they build resilience.

Kaiser uses community health navigators, community health workers and a new screening tool that now captures social needs in easier-to-read EPIC records by asking Kaiser members directly about food security, transportation, housing and stress. Caregivers anywhere in the Kaiser network from Longview to Salem can then make appropriate referrals.

“Navigators call people until their (social) needs are met,” said Kaiser’s Bonnie Pickens. “(We) actively integrate social determinants in a patient’s care.”

Fourteen clinics in Oregon’s Primary Care Association also identify at-risk patients based on factors such as whether they are living in poverty, frequently miss appointments, have recurring mental health or substance abuse issues or just don’t speak English.

“It can feel difficult to do this work without the resources to address the problems,” said the association’s Alicia Atalla-Mei. “But asking can be therapeutic (for the patients).”

OHSU’s Richmond medical clinic now has a legal clinic inside its walls to help patients deal with wrongful termination, housing issues, domestic violence, guardianship, custody, divorce and other such matters. It’s new to Oregon but 42 states already have legal clinics in health clinics. Samaritan Health is considering a second such Oregon legal clinic in Sweet Home.

Providence’s community paramedicine seeks to reduce hospital readmission rates and emergency visits by giving those who don’t qualify for home health but still need a little home health up to four visits over a 30-day period. Paramedics step beyond the emergency culture of “get in and get out” learning to spend time helping patients with everything from medication to tripping dangers at home -- which could be a tent, under a bridge or a drug house.

The summit also featured updates on Project Echo, launched in 2014 to link specialists with primary care providers via video, Project Nurture’s Providence Milwaukie program for pregnant women with substance use disorders, and Photovoice, using photos taken by community members to show health challenges and community strengths.