This is how we do

Pictured are volunteer Artemis Shaw (left), CC '11 and program coordinator Sonia Sekhar (right), BC '08 together on our Thursday shift.

--David Yin, CC'09

New York Site joint Reflection Session 3.24.08

Reflection Session Minutes



Visit from Nell, the COO of Project Health, joined about a year ago.

Project Health is now, after 12 years of growth, a national organization and is thinking about different issues:

--organizational growth

--working with a consulting firm, New Profit?

Apparently we have been growing in ‘exactly the right way’

Project Health is spread into sites in a very organic way, as opposed to an

organization that standardizes a program in a very clearly defined, but inflexible

manner.

Ex. So instead of dictating how Baltimore should launch an FHD program, explain more of ‘this is how we roll’.

“evolve”

--come up with a set of hypotheses to test this summer to help us understand what actually drives the impact in the ways we define success.

--thought of having a series of RS’s and think of what volunteers thing, then prioritize the laundry list into some set of things to test using a PH-wide volunteer poll



In this RS, ask volunteers to brainstorm actions we can take to increase % of clients that…



% of clients who obtain at least 1 of the resources identified as a need in the initial intake w/in 3 months.

+continual follow-up with clients on part of the volunteers, creating the opportunity for the client to communicate with us

+ensuring that client comes away with some tangible resource/info at initial encounter

+volunteer contacting a resource

--resource exists/correct information/reliability of resource

--give them a person/name to look for

--set-up an appointment timeà plan of action

+organized set of handouts/resources (express desk sheets/personal express desk sheets)

--concise good (name, address, phone number)

-one sheet v. packet

-multi-language sheets

+attitude toward clients during interaction: warm, welcoming. Beware of condescension.

--tension between being legitimate v. too legitimate, e.g. looking for-profit

+better communication between volunteers, ex. re: resources

+narrow down resources we can provide

--Problem with housing as a resource we can’t provide. Take it off?

--Housing is a primary attractant to the desk, and gives us an opportunity to implement the flexible/fungible income idea, and try to get clients with housing needs other services that they might qualify for, but that they might not have come to the desk in search of.

--Success is a function of what you are trying to measure. If we just define it differently, we aren’t evaluating the same thing.



% of clients referred to the desk by a provider.

+Continuity Clinic/community lectures

+face-to-face conversations, communication during shift

--constant and courageous contact\

--have a list of doctors with their names/pictures, so we can pretend to know people when we say hello

+e-mailing them updates, interesting stories, data? Communicating success stories

--sending them feedback from clients, blog

--even cases where we tried but failed

--ask clients to tell the doctors about success

+community rotations, physician involvement in desk

+inviting them to speak at RS

+FHD checkbox or flag in the medical charts/electronic records

--referral w/o physically coming to the desk or writing something

--referring as easy as possible

+flyers/posters in the examination room “Ask me about FHD” (for the parents/clients to see); buttons for physicians to wear



% of referred cases which result in some subsequent communication with the referring provider

+success letter/success e-mail to provider

+in person debrief

+interesting blog

+case conferences


--David Yin, CC'09

Reflection Session 2.18.2007

Each week the volunteers of Family Help Desk get together to talk about logistics, program development, planning for finding more resources, and the 'big-picture' issues that effect our program. This semester we have RS on Mondays 8:15-9:15pm, rm 568 Lerner Hall, Columbia University.

Tonight in RS we talked about the presidential candidates' healthcare plans. The Kaiser Family Foundation has an interesting side with a side-by-side comparison of candidates' plans is here:
http://www.health08.org/sidebyside_results.cfm?c=5&c=11&c=16

--One major difference between the candidates is who is required to have healthcare. Under McCain, no one is mandated to have coverage, there are simply more incentives and stuff to get insurance cheaper. Clinton's plan mandates coverage for all Americans, and Obama's mandates coverage for all children (up to age 25).
--A big philosophical difference here is in autonomy. Obama would say that children need healthcare because they cannot make a choice, but adults do not because they have the right to make even unwise choices. On the other hand, for Clinton perhaps, these choices can often impact the entire family, including the children. For McCain, there is a stronger right to self-determination that the government cannot override unless it is very serious.
--One thing mentioned was Obama and his use of Rep. Jim Cooper as a spokesperson/surrogate, and how he may have been instrumental in derailing the [Bill] Clinton healthcare plan, but how specifically is unclear.

Dr. Emily Rothbaum, a doctor in the Pediatrics department at Columbia-Presbyterian Hospital, and our physician mentor, talked about healthcare as well:
--If people are uncovered by health insurance, they will be given care in the Emergency Dept. if they have an 'emergent' (i.e. emergency) problem. This cost is taken up in part by the hospital itself, and in part by the government, which has various 'slush funds' that cover the cost, so ultimately the taxpayer will pay for emergency treatment of people without health insurance. The difference is that once these patients leave the hospital, they cannot get treatment.
--SCHIP/Medicaid/private plans try to get people to save money by signing people up for HMOs. One effect this has is that HMOs determine which hospitals you can attend, because hospitals will only accept certain HMOs.
--People who are most affected by SCHIP (State Children's Health Insurance Program, that provides health coverage to low-income children) don't actually have time to vote/lobby and have a voice in the political process

One question that came up was why the U.S. was different from other countries with similar economic power, but universalized healthcare.
--Some reasons are our population is much higher, Americans like the idea that they can buy their health insurance (and better insurance), and their cultures except much higher tax rates that are levied in those countries in order to pay for health care
--Americans use more technologically advanced tests/treatment --> higher costs
--There is an explanation that American companies need to recoup their R&D costs
--In the U.S., we have much higher administrative costs than other countries.

We also talked about Departments of Health and competing interests that commissioners might have.
--What brings money to the city v. helping people out (commissioners are often MDs, didn't become commissioners for money)
--Two interesting special interests: Businesses (as in employer-based healthcare), AARP (American Assoc. of Retired Persons) which is actually the largest lobby in the U.S. and are very, very invested in keeping Medicare around.


--David Yin, CC '09

City Room

Name: Larry

Family Composition: Currently single male, separated from his wife, with three children and living in an SRO (Single Room Occupancy)

Presenting Issue: Housing

Larry is the quintessential example of a single male in New York, whose doing all he can to get his life back on track, but desperately needs a new apartment and earns too little to afford anything on the market. When I met him, he was enrolled in a job-training program at the Bronx VA hospital and living in an SRO (Single Room Occupancy) that was in such debilitated condition, he wouldn’t let me meet him there to help him fill out an application. But that’s not why he was looking for a new home. Larry recently separated from his wife, and agreements between the two resulted in Larry getting to spend time with his three children on the weekends. His SRO had barely enough space for him to sleep, let alone his kids and the SRO rules prohibited Larry from letting his children sleep over on weekends. He needed to move elsewhere if he wanted to spend time with his kids. The only problem was that Larry was living on SSI disability, which meant his monthly income was only $690.

Larry’s income was insufficient to qualify him for affordable housing lotteries, let alone market value apartments. The first thing I checked out was Public Housing and Section 8 vouchers. Fortunately, the Section 8 voucher program had reopened for a brief period of time and the government was accepting new applications. Larry told me he had applied for Section 8 a long time ago and hadn’t heard anything from them. I went up to the Manhattan Application Office on 125^th street and picked up a Public Housing Application and another Section 8 application for him and offered to meet up with him to fill them out. In the mean time, Larry wanted to look into immediate housing options, since he knew from personal experience that the Public Housing and Section 8 waiting lists were many years long. I turned to supportive housing – organizations that might offer housing to single males on SSI. I obtained a spreadsheet of supportive housing sites in New York and went down the list, making phone calls and leaving messages. I called the Urban League, the Independent Living Center, The Center for Urban Community Services, even the Mayor’s Disability Hotline. Almost everyone was helpful and encouraging but none had open spaces. In the end, Larry lucked out as the Section 8 voucher application he had filled out years ago came through and he was contacted for an interview. Larry’s story shows how hard it can be for low-income persons to find housing, and how daunting the process is. You need a whole lot of patience, a great deal of persistence and good dose of luck to get what you need.

--Iman Hassan, CC '10

The French Connection

i. [Fake] Names, Family Composition, Language

Ava K. Family of 3. From Mali. Language of communication with volunteer: French

ii. Case Concerns/Presenting Issues

* Needed someone to accompany her to NYCHA (New York City Housing Agency) to help her speak with the case worker in charge of her public housing application, whom she had had trouble communicating with in the past.
* Job training/ Placement

iii. Medical Info

1. What brings them to the clinic?

medical checkup for her newborn child

2. How does their present living/family situation affecting their health?

family lives in a basement 1 bedroom apartment, had to move temporarily to her brother in law's after the child's birth because of sanitation issues, but have now moved back in because they do not want to burden her brother any longer.

iv. Social/Work history

Does not have a valid visa (overstayed her tourist visa). Has applied for a working permit, will have a hearing in mid-December. Until then, is barred from many job-training programs and job offers.

vi. Story

I accompanied my client to NYCHA, where we lined up for two and a half hours before being called. Despite the fact that my client had brought all the various documents she was asked to bring, the case worker was still unwilling to approve her application, allegating that a document was still missing. After a frustrating discussion with the case worker, I asked to speak with the supervisor, who declared that all was in order, and told the case worker the application. My client is currently waiting for an answer on whether or not her request for public housing has been granted.

My client has also enrolled in a free home attendant training program, which will be starting in January. This program takes place in the afternoon, which allows her to continue attending her morning ESL classes.

v. Action Plan

Continue calling the client regularly to see progress on her housing application. Call her in January to remind her of the start of the home attendant training program. In the meanwhile, look for temporary, part-time jobs for my client (client is undocumented)

--Anna Law, BC '10

Untitled

Case Summary:

1. Basic Information
1. Client Pseudonym: Kimberly Johnson, 55 year-old single mother
2. Family Composition: Kimberly, and her 18 year old daughter Tania
3. Primary Language: English
2. Case Concerns/Presenting Issues
1. Housing Status
2. Food Status
3. Immigration Status
3. Medical Issues
1. The daughter’s visit to the clinic was for a routine check-up, so there are no pressing medical issues that directly connect to this case.
4. Social/Work History
1. Kimberly immigrated to New York about 20 years ago from Africa, and is currently a green-card holder.
2. She has a job as a cook, but it doesn’t pay very much.
3. She currently lives in her sister’s apartment, and her daughter has just started college.
5. Action Plan
1. Housing: See if her position on the waitlist is high enough so that she can receive Section 8 Housing, enter her in housing lotteries, and search independently for affordable housing.
2. Food: Try to get her back on to food stamps, and give information regarding nearby food pantries and soup kitchens in the meantime.
3. Immigration: Wait until more progress has been made in regards to housing and food, but will search for the protocol and procedures for becoming a US citizen in the meantime.

Narrative:

Kimberly is a 55-year old single mother with an 18-year old daughter who is about to start college. As her daughter was having a routine check up, she approached me at the Help Desk, and said that she wanted help with issues concerning her housing, food, and immigration. She lives in Section 8 Housing that is under her sister’s name, and she has been notified that she will have to leave this housing soon because they cannot put the apartment in her name. For this issue, she will continue to live in her sister’s apartment as long as she can. Additionally, she is on the Wait List for Section 8 Housing, so we are in the process of investigating as to whether she can get a different apartment. We are also working to get her enrolled in the housing lottery, and searching for low-cost quality apartments independently. In terms of food, she says that she cannot afford to keep a decent amount of food in her house, but she was rejected when she applied for food stamps. In response to this problem, we are working to see if she can actually be placed on food stamps, and I have given her information regarding soup kitchens and food pantries in her area for the meantime. Currently, Kimberly is a green card holder, and she wants to become a United States citizen, yet doesn’t know the process. We have agreed that this issue will wait until after substantive progress has been made in relation to her housing and food, but I am currently researching the protocol for becoming a full-fledged citizen. This case is still active, but I am optimistic that we will make progress in the coming weeks.

--Elizabeth Lamoste, CC '10

A Bronx Tale

Family Composition:

Ms. Jones* is a 67 year old female who lives with her 21 year old son, Billy Roberts*, and her four grandchildren. The granddaughters’ ages are 16 and 8 and the grandsons’ ages are 6 and 1. All family members speak English and are American citizens. All six family members live in an apartment together.

Case Concerns:

Main concern is finding enough food. Second concern is finding employment.

Medical Information:

All family members are healthy and have no chronic illnesses or health problems that affect work. The son, Billy, does have an anger management problem, but is working to control the issue. She is in the clinic for an annual check-up for a grandchild.

Action Plan:

In order to get food immediately, Ms. Jones was going to go to some local food pantries and get food for the next week. While waiting for the doctor’s appointment, she filled out a food stamp application and she was going to go to apply sometime within the week. She was also sent a job resource sheet and she was going to go to the Citizen’s Advice Bureau: Bronx Works to see if they could assist her in her employment search. A follow-up call revealed that the food stamp application process had been slowed, but she was put in touch with a man who could interview for food stamps over the phone. She was then unable to show up for a scheduled meeting for food stamps. Further steps will be taken to reschedule the meeting.

Social/Work History:

Ms. Jones has had some college education as well as many jobs in various fields such as secretarial work and care giving. However, now she is the primary caregiver for her grandchildren. Although she is healthy, she does get tired because she “running around” for her grandchildren. The living situation is suitable and Ms. Jones does not have a problem with their apartment. Ms. Jones desperately wants to obtain a job and hopes to do so in an area in which she has experience.

Story:

Ms. Jones and her son live with four children. They are both unemployed and they are not able to afford enough food to adequately feed everyone in the household. As the month goes on, the finances get tighter and food gets scarcer. Because both Ms. Jones and her son are unemployed, there is no steady income for the family. She is willing to travel for her job and/or receive specialized training. Her son is also willing to do the same in order to find a job. The first guardian to gain employment would keep his or her job and the one remaining unemployed would provide care for the children of the home. The main issue is the one concerning food. Ms. Jones was able to get food from food pantries and the food stamp application is still pending. The job application is still pending, but she has been put in contact with various resources. When Ms. Jones was last contacted, she was having trouble obtaining specific medical records for her grandson. She was helped with that and has since been out of contact. However, when further contact is established, a follow up on all issues will be made.

--Kathryn McCaleb, CC '11

Lost in Resource Translation

I. Client Name: A.C.*

This is a young West African immigrant mother of six (all 8 years old
and under) who does not speak English. She, her husband (who does
speak English), and her 6 children make up 8 of the 22 people living
in her 3 bedroom apartment. She and her husband both have Social
Security cards, and 5 of her 6 children were born in the US.

II. Case Concerns/Presenting Issues:

- Adequate housing
- Child's medical conditions exacerbated by living situation

III. Medical Info:

One of her children's asthma is aggravated by overcrowded apartment,
to a critical point.
All children testing positive for lead in their blood due to outdated
paint on walls.

IV. Social/Work History:

A.C. and her husband have been in the US for nine years and are
documented immigrants. A.C.'s husband has a steady job, but she
herself stays home to look after all the children. They receive WIC,
ACD subsidized childcare, and Medicaid, but no other public benefits.

V. Action Plan:

- A meeting with PATH office was arranged, but temporary home was
turned down by A.C.'s husband.
- Follow up with apartment A.C.'s husband knows about
- Search housing lotteries, add A.C.'s name to list, organize
appointments with landowners where appropriate.
- Get A.C. and her family set up with Food Stamps so that the part of
their income that usually goes to feeding 8 people can now be used for
other things, especially a cleaner apartment that would fit their
whole family in a healthy way.

VI. Story:

Although the situation is urgent, due to her children's medical
concerns (asthma and lead toxins), A.C.'s husband turned down the
temporary home the PATH office offered because he did not want to
"live with the homeless people." Following this, A.C. called, saying
desperately (through a translator) that she needed to move out, she
needed that apartment. She asked me to talk to her husband. When I
called her husband to talk about the issue, he said that he would be
meeting up with a man his boss connected him with, who was going to
rent him an apartment for just over what he could pay. The meeting
was rescheduled, however, and further follow up is needed. In the
meantime, I have been calling and checking up with A.C. to make sure
everything is okay. I am also setting up an appointment for them to
apply for Food Stamps so that if her husband is able to secure this
other apartment, they can use money that is now going for food toward
rent.

--Alexandra Woodward, BC '10