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Creative Strategies Help Overcome Barriers To Accessing Health Care Services

Reproductive Health

Planned Parenthood Shasta-Diablo (PPSD) is using a three-year, $225,000 TCWF grant to provide medical services to thousands of underserved women in 13 northern counties who live below the national poverty level. Services are offered at 10 health centers, three stand-alone education centers and 22 “Express” sites, nonclinical settings where clients can access reproductive health information and contraceptives. Family planning services at PPSD increased almost 14 percent in 2002 and 16.5 percent in the first nine months of 2003.

“We’re facing considerable cuts in our state funding because of the budget crisis, which could be the rug that’s pulled out from under our clients’ access to services,” said Mitzi Sales, PPSD senior vice president of external affairs.

PPSD is using its grant to expand access to reproductive health services in a variety of ways, such as adding Express sites in its rural counties and on-call clinicians to meet after-hours needs for emergency contraception, and extending hours for drop-ins and appointments.

“At Express sites, low-income women and teens can access hormonal modes of contraception, such as birth control pills, without a pelvic exam,” Sales said. “They also can pick up reproductive health information and condoms and get screenings for sexually transmitted infections and pregnancy tests. We find that 35 percent to 50 percent of our Express clients come to a clinic for follow-ups and other services.

”Express services are available in high schools, drug treatment centers, homeless shelters and other community agencies – places that are easily accessible and nonthreatening to those who need the services.

“With all the challenges rural health providers face, funding continues to be primary,” said Cristina M. Regalado, TCWF vice president of programs. “Our intent is to provide support so they can continue to maximize their resources to meet the health care needs of rural communities.

”PPSD hopes to be able to continue services at the Express sites through creative partnerships. However, sites that serve women in homeless shelters and drug treatment centers – women most in need of services – may be difficult to maintain in the current funding environment.

Mental Health Services

In Redding, the Shasta Community Health Center (SCHC) is using a three-year, $125,000 TCWF grant to provide medical psychiatric care for children and youth from a five-county area reaching to the northern and eastern borders of California.

“Access to mental health services is one of the greatest health care challenges facing rural communities,” said TCWF Program Director Nicole J. Jones. “Services for children and their families are almost nonexistent in these areas.

To address the problem, SCHC has developed a model in which a clinical psychiatrist teams with family physicians to assess and treat patients.

“Many of the children we see have been so damaged,” said Lynne Pappas, M.D., who is one of two pediatric psychiatrists in the six most northern rural counties. “In the area we serve, there are high levels of divorce, physical and drug abuse and domestic violence. Those factors make an impact on the pediatric population. Many children suffer from severe trauma and psychological problems that are manifested in anxiety, depression, attention deficit and social interactions.”

Because of the lack of trained mental health workers, most children’s mental health support falls on pediatricians and family practitioners. So Pappas now works in concert with those physicians, providing more comprehensive care to young patients.

“The model is really amazing,” Pappas said. “Children aren’t just being helped, they’re getting well. They’re beginning to function in school and to develop more normally."

Physicians also benefit from the program, which was established on the premise that primary care clinicians can effectively address the majority of mental illnesses if they have the backup and support resources of mental health professionals.

“Doctors treating medical problems are learning how to evaluate and assess children’s mental problems. And, I’ve picked up useful skills from the medical doctors,” she said.

Pappas spends half a day each week working with patients in remote areas via teleconferences. She also works with developmentally disabled children. Three social workers and a psychiatric nurse provide crisis service and group counseling.

“With our state and federal funding sources so shaky, foundation grants are a tremendous help,” Pappas said. “This program is working. It’s a safety net for clinicians who didn’t have the resources to deal with such severe mental and emotional problems.”