As required by the Affordable Care Act, UChicago Medicine (UCM) is conducting its third Community Health Needs Assessment (ECS), in part through an online survey, uchicagochna.norc.org, to determine how best to provide social support to its South Side coverage area.
The CHNA also includes focus groups, stakeholder interviews and secondary data. It will take about 18 months to complete; the survey is online until the end of October.
The 2019 CHNA included prevention and management of chronic diseases (with areas of risk for asthma and diabetes), building resilience to trauma (recovery from violence and mental health) and reducing inequalities caused by social determinants of health (access to healthcare, food insecurity and employment) as its priority areas.
Previous needs assessments have led UCM to develop community-based programs such as the Violence Recovery Program, the South Side Pediatric Asthma Center, the South Side Health Transformation Project, and other community programs focused on primary and chronic disease care.
“Part of the creation of our trauma center and our hospital violence prevention intervention was a direct response to the needs that we identified from the needs assessment,” said Brenda Battle, vice president of UCM’s Urban Health Initiative and its main diversity, inclusion and equity responsible. “We’re leveraging a lot to help us determine what programs and interventions we’re going to do to meet the needs.”
UCM has learned, for example, that six of the nine worst neighborhoods with the worst asthma outcomes in Chicago are on the South Side, and that 20% of children on the South Side have it.
Thus, the medical system has partnered with health centers approved by the federal government and La Rabida Children’s Hospital, 6501 S. Promontory Drive (which specializes in the treatment of chronic pediatric disease) to launch the South Side Pediatric Asthma Center.
Community health workers were hired to work in the FQHC, the asthma clinic and the UCM emergency department “to initiate the process of involving families in asthma education (and their learn) to manage their asthma on their own, ”said Battle.
Much of this care happens in people’s homes, where assessments can be done to determine existing triggers – things as common as Clorox and other cleaning products.
Workers taught families to make solutions from vinegar and water instead. They brought hypoallergenic sheets and blankets. They taught how to care for asthma conscious pets, or what to do if there is a smoker in the home. During the COVID-19 pandemic halt, when home visits couldn’t take place, patients got iPads and other tablets to have virtual tours with their workers.
“What was needed more than more allergists or more doctors was more information in the hands of patients and their families on what to do with a child with asthma,” said said Battle. “It was more effective in helping to manage asthma.”
All of this has resulted in a 50% drop in the number of children with asthma going to the emergency room and a 50% drop in missed school days, according to Battle. Similar advances have been made in diabetes care thanks to investments spurred by ACHA.
The community health workers who run the programs “are people who come from the community. They are peers, “said Battle.” These are people who may have had similar experiences as people with chronic illnesses or asthma, or people who have been abused, and you connect the community. with their peers, with their neighbors, who are that partner to help them be educated and manage their health, and navigate the health care system and navigate the systems that help them tackle social determinants of health.
When the Trauma Center opened in May 2018, UCM had two violence recovery specialists. Now there are 16 of them to meet with patients and families and provide “psychological first aid,” Battle said, to explain what is going on in the emergency room and, against the backdrop of internal gang struggles, what could be the consequences of further violent reprisals.
The Violence Recovery Program liaises with organizations such as the Centers for new horizons, 4150 S. King Drive. Cleophus J. Lee, director of the centers’ violence prevention and response, said UCM has referred patients for housing, mental health support, employment and vocational training. The partnership started in January.
“We have had individuals who have taken some of our workforce development programs, in which they have received employment assistance,” he said. “We have had people who need housing as well as people who need mental health services, i.e. individual or family counseling because a family member has been shot or other.”
Lee said people who don’t know how to financially get them and their families out of dire straits are able to rebuild their lives because UCM refers them to the centers’ employment or mental health programs.
“The approach is trauma-informed care,” he said. “It’s really just being able to help someone who’s found themselves in need or in a bad situation, to help them get on the road to recovery. It’s been very beneficial.”
Specialists in UCM’s violence recovery program also help with housing and food insecurity. Battle said they had been effective in reducing recidivism: At the University of California Medical Center, less than 2% of the more than 3,000 abuse recovery clients returned to hospital, although the UCM does not know if they go to other hospitals.
Battle frankly said that the needs of the community, as revealed by the three-year CHNA, don’t change much. Violence is still rampant on the South Side, and it is unlikely to be seen as a significant need. But she reiterated that the resource management had an impact on the south side.
“It has taken years to create the disparities that we see in our community,” she said. It will take more than three or nine years to change it. We’re going to have to work longitudinally on these things over a period of time to make sure we’re able to reduce the disparity that we’re seeing in this survey. “