2004 Community-Campus Partnerships for Health Award Recipient

Coalition to Care: The Galveston County Community Health Access Program

Represented at the CCPH conference by the following individuals (listed alphabetically):

• Becky Walsdorf, Executive Director for Community Health Promotion, Office of Community Outreach, University of Texas Medical Branch at Galveston
• Ted Hanley, Executive Director, The Jesse Tree
• Dr. Ben Raimer, Vice President for Community Outreach, The University of Texas Medical Branch at Galveston
• Kathy Tiernan, Outcomes Manager, Office of Community Outreach, University of Texas Medical Branch at Galveston

Original members of Galveston's Community Health Access Program Coalition with Dr. Marilyn Gaston

The Coalition to Care: The Galveston County Community Health Access Program (GCHAP) is a 24-member coalition that seeks to reduce health disparities and improve access to health care and quality of life for all Galveston County residents. Established to build a strong and diverse partnership among health and social service providers, much of the work of the 2-year-old coalition, located in Galveston County Texas, has focused on the goal to improve access to health care and related services for the indigent population. The coalition's partnership strategies include service learning, community-based participatory research, and establishing a broad-based community partnership organized around a single goal. Partners include citizens of Galveston County; community health centers and hospitals; the public education, health, and safety departments; social services and faith-based organizations; local government; and The University of Texas Medical Branch at Galveston including an academic teaching hospital, Schools of Medicine, Nursing and Allied Health and Graduate School of Biomedical Sciences.

History

First Galveston CHAP Pacing Event

The genesis of the Galveston County Community Health Access Program came early in 2001 when the Galveston County Medical Society convened a work group to examine the issue of indigent health care and the associated overwhelming costs to the Galveston County community. The work group championed the cause with the Galveston County Commissioners' Court, the governing body responsible for the administration of the county's indigent health care budget. As a result, the Commissioners' Court appointed a 40-member Galveston County Task Force for Indigent Health Care to develop a cost-effective means of providing health care to those in need in Galveston County. At the same time a coalition of Galveston citizens had formed determined to apply for and receive a Community Access Program (CAP) Grant. This community coalition and the Medical Society work group joined forces to implore the Commissioners' Court to provide additional funding for indigent health care. The commissioners did approve a $500,000 increase in the county's budget for indigent health care and the GCHAP received year two funding for the CAP grant in September 2002.

Partnership Goals

Resource coordinators work with CHAP clients

Overall, Galveston County Health Access Program (GCHAP) has a goal of improving the quality of life for all Galveston County residents. GCHAP is designed to bridge gaps in access to healthcare in Galveston County. The GCHAP targets all persons at or below 200% of the federal poverty level who are either uninsured or underinsured. The goal of the program is to meet community needs by increasing access to care and improving health status. By increasing access to community-oriented programs in the areas of health education, prevention and primary care the costs associated with emergency services and long-term or chronic care will be reduced.

In year one, the goals of GCHAP emphasized the need for access to high quality, cost-effective health care for everyone. During that timeframe, the goals of GCHAP focused on access to care issues, including:

• Augmenting existing transportation system, increasing the number of trips to medical appointments and reducing current monthly denials
• Improving and expanding the existing technical infrastructure, effectively creating and interface between social services, religious ministries and medical providers to facilitate and coordinate access to all spectra of service for the uninsured
• Implementing formal, community-based care coordination for the uninsured
• Coordinating and enhancing community-based prevention programs
• Expanding the web-based data collection and reporting system to monitor and evaluate the effectiveness of medical and social service delivery for the uninsured
• Implementing a system of on-going evaluation and assessment, resource coordination, project development and quality assurance

The Planning group of the GCHAP reviews progress on these goals and provides guidance for change. Now on a regular basis, the planning group also invites faculty interested in community research to share their grant opportunities and determine compatible community partners and strategies.

The Partners

• Breast Cancer Awareness Coalition
• Community Action Council
• Coastal Area Health Education Center (AHEC): Coastal AHEC seeks to improve the health of the populations we serve, especially the underserved, by creating partnerships among community and academic organizations. We link health care resources to build and strengthen community-based education programs. Coastal AHEC serves Brazoria, Chambers, Galveston, Hardin, Jefferson, Liberty, Matagorda, and Orange counties.
• Galveston County Health District: The Galveston County Health District focuses on the task of ensuring conditions in which people can be healthy.
• Galveston County Four Cs Clinic: The Galveston County Health District (GCHD), a government entity, provides public and personal health services to residents of Galveston County. Through its 4C's Clinics, medical and dental services are provided to qualified Galveston County residents seeking treatment regardless of their ability to pay.
• Galveston County Immunization Coalition: Established in 1993, the Galveston County Immunization Coalition's mission is to increase immunization rates for all Galveston County residents through collaboration.
• Galveston County Social Services: Galveston County Social Services provides social services including adult and child protective services and confirm eligibility for state welfare programs including temporary aid for needy families, food stamps, and Medicaid.
• Gulf Coast Center: Since opening its doors in 1969, the Gulf Coast Center has been providing mental health and mental retardation (MHMR) services for residents of Brazoria and Galveston counties. The Center also offers substance abuse recovery programs under the sponsorship of the Texas Commission on Alcohol and Drug Abuse.

• Friday Food Fair at the Jesse Tree

  The Jesse Tree: The goal of the Jesse Tree is to help all members of our community locate and utilize available services, to advocate for new or expanded services, and to provide tools, resources, and in-service training to improve existing services. The Jesse Tree helps to coordinate community services through many community faith-based organizations.
• Luke Society Clinic: The Luke Society Medical Mission to the Homeless operates an open-air clinic to help meet the health needs of the homeless in Galveston. Clinic services include screening for medical problems and basic treatment of wounds and infections. There is no fee for clinic services.
• Mainland Medical Center: Since 1992, Mainland Medical Center has been saving lives and improving the quality of life. Each year, over 62,000 outpatient procedures are performed and more than 8,000 persons are admitted to MMC from the Greater Galveston County region.
• St. Vincent's
• Salvation Army
• Social Security: The Social Security Office aids in declaring eligibility for Medicare and supplemental secondary income (SSI), which is welfare for the aged and disabled.
• Texas Department Human Resources: The mission of the Texas Department of Human Services is to provide financial, health, and human services that promote the greatest possible independence and personal responsibility for all clients.
• Teen Clinics, Ball High, Central Middle School, Austin Middle School
• University of Texas Medical Branch: The University of Texas Medical Branch (UTMB) is dedicated to educating health science professionals and researchers, caring for patients, and advancing human health through research.
• UTMB Community Outreach: Community Outreach brings together several outstanding programs that connect UTMB to the many communities it serves. Community Outreach is proud to represent UTMB and to play a vital role in assisting the university realize its core purpose of generating, disseminating and applying knowledge to better the health of society. We envision a Texas in which each person has optimal access to health care.
  

Strong Partner Involvement Strategies

Galveston County Health Fair Student Committee

All members of GCHAP contribute significant resources to the coalition, along with a sincere desire to do what is right and what is best for the Galveston County community.

GCHAP pursues a number of community-campus partnership strategies but they have focused mainly on the development and operation of a broad based coalition. Healing old wounds and forgetting old fights, the partnerships have made major strides to sit with equal power and resolve to make Galveston a better place to live. As they had hoped, the improved communications and planning has opened the door for service learning and research.

• Broad-based community partnerships: One of the most significant accomplishments of the GCHAP coalition has been to bring the right people and organizations to the table to organize around a single goal. Included in the coalition are a major academic medical center and a private, for-profit hospital that used to be in direct competition with each other but now work hand-in had to address the issue of health care for the indigent. Churches and religious-based organizations have joined hands with politicians and political activists to further the cause of cost-effective and accessible health care. Also included in the coalition are concerned individuals and volunteers; providers of social services like the Salvation and the United Way of Galveston; and individual providers and agencies who know first-hand the high costs to society of untreated health concerns.
• Service learning in health professional education: The School of Allied Health Sciences at UTMB has initiated a new service learning curricula. Over a three-year period, occupational therapy (OT) and clinical psychology (CP) students will participate in service learning activities that include web-based cultural competence module, in community service agencies located in the city of Galveston and throughout Galveston and Brazoria counties. The Partnerships Project will also develop and implement a joint OT and CP internship to provide community-based mental health services. In addition, four community-based clinical training sites will be expanded to provide collaborative OT and CP mental health services, including those that focus on alcohol and drug recovery, health promotion, prevocational and vocational skill development, peer resistance and skill-building for youth at risk, and life skills coaching.
  
  In addition, Galveston County Health Fair is an annual event coordinated by 50 student volunteers from UTMB's schools of medicine, nursing, allied health and graduate biomedical research. The students work with GCHAP coalition members to provide free health screenings and patient education opportunities to all residents of Galveston County, with an emphasis on the uninsured and under-insured. Approximately 1,000 individuals have taken part in the 2001, 2002, and 2003.

• Community-based participatory research: The addition of an outcomes research specialist to the GCHAP team will allow GCHAP to build its community-based, participatory research programs. During the first year, GCHAP did initiate one research project to determine the health status of the Galveston County community. The telephone survey provided the Coalition with helpful information. In the past two years researchers interested community research have included: Department of Occupational Therapy; Dept of Ob/Gyn; Center for Addiction Research, Department of Preventive Medicine and the Department of Family Medicine. In year two, The Health District received a Robert Wood Johnson grant to further their diabetes education program and UTMB secured a Dell grant to enroll kids into CHIP through schools.
  

Achieving Tangible Results

Former Galveston Mayor Bo Quiroga receiving his flu shot

The GCHAP mission has been to eliminate administrative barriers inhibiting access to health care. Some of the activities and outcomes toward this mission are described below.

Increased Access: In year two, almost 6,000 residents were newly enrolled into health care at the 4C's clinic. Many of these were cased managed through an innovative mini-registration process with process from the Mainland Medical Center and UTMB Emergency Rooms to the Health District. Both programs expanded staffing to include social service and mental health referrals. Our 'for profit' hospital received a HCA award for innovative programs that demonstrate cost savings. Partnering with the Jesse Tree, the network expanded to provide 3722 social services for 3548 clients. Over 200 clients were referred for mental health and another 108 for substance abuse treatment.

Assessment and Comprehensive Reports have Improved Services: The Galveston County health district has used the results of a self study to conduct clinic redesign and realign staff into high priority needs. Jesse Tree made serious improvements in their Web Care program. Comprehensive reports have helped their fundraising and accountability with churches making contributions. The Galveston County Medical Society has used the information and its influence with the Texas Medical Society to help bring the issue of indigent health care to the attention of key policy-makers within the state

Improved Health Professions Education: The School of Allied Health Sciences within UTMB has built on its interest in service learning to implement the Partnerships for Healthier Communities Project with goal of increasing the number of occupational therapists and clinical psychologists practicing in underserved areas of Texas. The Coastal Area Health Education Center has provided personnel, staff, and funding to support GCHAP's patient education programs, as well as develop an asset map for Galveston County that includes both health care and social services resources. They also trained 31 community health workers who last year reached 5772 school aged children in impoverished school systems with the 'Tooth Fairy' decay prevention program.

Leveraged funding and collaboration: The Jesse Tree was able to successfully leverage CAP Grant funding received by the coalition to secure financial support from VISTA to fund nine VISTA volunteers whose efforts are focused on mental health, a health equipment loan program, community asset mapping, patient education, congregational nursing, services for the homeless, financial screening, nutrition, and senior outreach programs. Mainland Medical Center provided funding to expand the scope of The Jesse Tree by opening a site to serve the mainland residents of Galveston County.

For more information on the Galveston County Health Access Program (GCHAP), contact Becky Walsdorf at bwalsdor@utmb.edu or 409-747-4899.

Partnership Website: www.galvestonchap.org