--DPY
Tuesday, March 31, 2009
Sunday, April 6, 2008
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
Monday, February 18, 2008
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
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 125th 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 '10The 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
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
Monday, February 4, 2008
Untitled
Case Summary:
- Basic Information
- Client Pseudonym: Kimberly Johnson, 55 year-old single mother
- Family Composition: Kimberly, and her 18 year old daughter Tania
- Primary Language: English
- Case Concerns/Presenting Issues
- Housing Status
- Food Status
- Immigration Status
- Medical Issues
- 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.
- Social/Work History
- Kimberly immigrated to New York about 20 years ago from Africa, and is currently a green-card holder.
- She has a job as a cook, but it doesn’t pay very much.
- She currently lives in her sister’s apartment, and her daughter has just started college.
- Action Plan
- 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.
- Food: Try to get her back on to food stamps, and give information regarding nearby food pantries and soup kitchens in the meantime.
- 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:
--Elizabeth Lamoste, CC '10
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