Moving healthcare upstream: Smoketown Family Wellness Center aims to improve health at the community level

Smoketown Family Wellness Center (SFWC), a cross between a pediatric office and a community center, is set to open on March 24 in the historic Presbyterian Community Center in Smoketown, one of the poorest neighborhoods in Louisville, Ky.

Smoketown Family Wellness Center (SFWC), a cross between a pediatric office and a community center, is set to open on March 24 in the historic Presbyterian Community Center in Smoketown

SFWC will work to establish healthy lifestyles from the beginning of life, supporting parents with the tools needed to raise their children to be healthy in mind, body and spirit. They will provide clinical care for children, as well as address social determinants of health in a supportive community-based setting.

Location, Location

Smoketown has the highest rate of death due to diabetes in Louisville. Life expectancy is 69 years, 10 years below the Louisville average, according to the 2014 Health Equity Report created by the Center for Health Equity.

Dr. Charlotte Stites

This statistic bothered Dr. Charlotte Stites, a pediatrician who has worked in private practice in the east end. As a result, she conceptualized a wellness center that focused on comprehensive care and healthy lifestyles–addressing social determinants of health. After developing the concepts, she participated in the 2016 Bingham Fellows Program–the focus for the class of fellows was “empowering citizens to live healthier lives.” Stites pitched her idea of the Smoketown Family Wellness Center and recruited a strong team to further develop the idea.

Magic Window

Stites believes there is a magic window—a period of time after birth where parents are motivated to learn. Stites said, “Birth offers a new beginning for parents. They want what is best for their children and are willing to make changes to improve themselves.” Babies are clean slates; it is easier to establish healthy habits from the beginning of life than to fight to change well-established bad habits later in life.

According to Stites, “There is research out of the University of Denver showing that there is a period of brain plasticity around the time of a birth—greater for the mother, but also for the father.”

There is research out of the University of Denver showing that there is a period of brain plasticity around the time of a birth—greater for the mother, but also for the father.

Parents can be healthcare experts themselves, spreading their knowledge to family, friends and neighbors, thus creating a positive culture of health and wellness.

Looking Upstream

The SFWC model of healthcare delivery will move care upstream to provide primary prevention of diseases that begin in childhood. Diseases like diabetes, cancer and stroke fundamentally begin in childhood with how we eat and exercise, how successful we are in school and whether we are exposed to Adverse Childhood Experiences (ACEs). Stites believes it’s “common sense to look upstream to provide primary prevention of chronic diseases.”

According to the CDC, 75 percent of all healthcare costs are spent on treatment of preventable chronic diseases.

A growing body of evidence shows that healthcare providers can play an important role in collaborating with other community-based organizations to help children, patients and families access new resources and influence those factors that play an important role in determining their health.

It means focusing efforts on the early years when the foundations of life-long health are established and the return on investment in prevention is greatest.

Social Determinants of Health

According to Stites, overall health and well-being for individuals is determined by clinical care (about 20 percent), lifestyle (about 30 percent) and physical environment (about 10 percent). The remaining 40 percent is a product of social determinants of health.

Social determinants of health are the structural determinants and conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, housing, transportation, access to food, employment, and social support networks.

Integrating Research

SFWC will collaborate with Spalding University, the recipient of a $1.15 million grant from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) to bring in fourth-year psychology Ph.D. candidates and social work students into SFWC as an integrated care model. It will allow SFWC to provide behavioral health services upfront.

Research will be collected concerning needs for the family and health outcomes–to include educational measures—quantitative and qualitative research. Programming will be data-driven and modified accordingly, but overall, the needs of the families served at SFWC will drive the programming offered in the Center.

ACE Scores Addressed

According to Stites, SFWC will serve as a model to incorporate all components of wellbeing by integrating needs of families with access to clinical care.

Research has shown that individuals with high ACE scores have higher risk for chronic diseases and shortened life expectancy. They often become high healthcare utilizers.

Adverse childhood experiences (ACEs) are stressful or traumatic events, including abuse and neglect. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your risk for later health problems.

Reimbursement Challenges

Stites believes that by providing comprehensive healthcare (i.e., clinical care, healthy living and addressing social determinants of health) they can reach improved health outcomes, prevent more disease and fundamentally save money in healthcare costs, prison systems and social services.

Stites said, “The trick is finding investors to support the model, and to begin to invest in maintaining health rather than paying for the management of disease.” She continued, “A high ACE score is a risk factor for poor outcomes, but not a death sentence. Individuals with high ACE scores need more support to attenuate these risks. We believe that providing this integrated care and tracking outcomes, we will help effect change in the reimbursement policies.”

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