The Whole Person
“Sometimes there just aren’t words for what a person is feeling,“ says Shari Marchesi, a Eureka Community Health Center (ECHC) patient.
“I know what I’m going through emotionally affects my health overall, and my physical health certainly influences my psychological well-being.” Shari can speak first hand to the success of the team approach to care used at ECHC. “My whole health care team is here. They all communicate with each other and with me as we work to meet my unique needs. I’m a registered nurse and I am constantly impressed with the care I receive here. I’ve experienced serious trauma in my life and together with my care team I’m addressing my physical and emotional needs, and working towards wellness goals.”
According to Elizabeth Drabkin, LCSW, behavioral health specialist at ECHC, “We all feel stressed and overwhelmed at times, but for some, particularly people who experience severe trauma, the psychological and physical needs run deep. We can’t just treat the physical and we can’t just treat the emotional; it requires a comprehensive approach.
Our team approach allows us to do that.” Elizabeth applied to work at Open Door Community Health Centers upon completion of her graduate program. “I knew I wanted to work for this organization, so when I wasn’t hired the first time, I kept trying, and here I am. I enjoy working at ECHC because the organization is so supportive and the work changes minute by minute. My work is diverse. My training as a Licensed Clinical Social Worker helps me empower people. We consider where the person lives, who they live with, how they spend their time, their history, their dreams and goals, all in addition to the primary reason for their visit. Our ultimate goal is to help the person feel better. I work with patients to support their goals for resolving both emotional and physical problems, including grief, depression, post-traumatic stress, diet, hypertension, addiction, fatigue, pain and diabetes. We try to work quickly, and I’m impressed with what we can accomplish in just a few sessions when everyone is on the same team. In many cases I connect with a patient when they are here to see one of our medical providers. I am often invited into the exam room by the patient and provider and we begin discussing a treatment plan that combines medical and emotional support right then. We include the patient as a team member and we talk about everyone’s responsibilities. When you think about it, a patient is seeing a provider for a just a few minutes. What they do outside of the clinic is going to make the real difference.”
Elizabeth explains, “Our resources are limited, so access to these groups, and to our behavioral health services in general, is reserved for established patients of Open Door clinics.” As part of her approach, Elizabeth uses a wide range of resources. “The patient is the one who’s doing the real work. With some patients we incorporate art therapy into their care plan to engage them in the healing process.”
Shari has been active in her health care. She participated in a women’s trauma support group, creating an art therapy project that she refers to as her “spirit doll” based on a comforting and safe memory, and contributing to the clinic’s small garden.
“It’s a peaceful place. I feel grounded when I’m working in the garden,” says Shari. Elizabeth elaborates, “Dozens of our patients are involved in art therapy projects. It’s extraordinary to see what happens. We create the dolls, mosaic tiles, masks and add to the garden. What’s more extraordinary is to watch the transformation in the people.” As Shari explains, “I didn’t want to participate in the project at all at first. Like many trauma patients, I didn’t want to connect. To see the transformation of my doll over time and to see the transformation in myself through these projects has been amazing for my healing process. I’m now proud of what I used to be terrified about.”
“We opened the Eureka Community Health Center in 1991,” says Cheyenne Spetzler, Chief Operations Officer of Open Door Community Health Centers. “We recognized that many Eureka residents were going without health care because of financial or transportation barriers.” Through the generosity and perseverance of Sister Ann McGuinn, St. Joseph Hospital let Open Door use a building they owned on Harrison Avenue and the Sisters of St. Joseph of Orange provided a $35,000 grant. “That was huge money, and with the building, it was enough for us launch the Eureka clinic,” reports Spetzler. “We were able to begin offering a full range of family practice services to a mostly low-income population. We hired two physicians, Ellen Weiss and Nathan Copple, who are still with Open Door, although working at different clinics. We started providing dental services in 1992. We’ve now consolidated our dental services at the Burre Dental Center on Myrtle Avenue in Eureka. It took a few years, but we were able to purchase the current ECHC clinic location on Buhne so that we would further expand access for medical care.
Most health care studies show that if we provide better primary care, the kind of care we provide at ECHC, then the outcomes for our patients will be better across the board, improving long-term health while reducing costs to patients, insurers and government programs
Eureka Community Health Center (ECHC) now provides more than 20,000 medical and behavioral health visits to nearly 5,500 patients each year. Under the leadership of the corporation’s Chief Medical Officer, Dr. Willard “Bill” Hunter, ECHC is transforming health care delivery. “We are making a real shift in how we provide care, and it is a direction that makes sense to our providers, staff and patients here at ECHC. We’re moving from the idea of doctors as ‘all-knowing-experts-in-everything’ to a team approach model. The goal is that we work together – patients included – to coordinate the care that best meets our patients’ health needs. We get the best results through a team approach, and here at ECHC we have fully evolved teams, with physicians, physician assistants, nurse practitioners, behavioral health specialists, nurses and medical assistants all contributing to care. The medical providers organize the teams and order all required health screenings and provide direct treatment. Nurses focus on effective case management and medical assistants maintain the patient flow – and we talk to each other about what we’ve seen and what we think the patient needs. This model is the best way we know to put patient’s needs at the center of health care delivery. We’ve literally rearranged our work stations so that the entire team is in constant communication. We know each other’s patients; we can maintain the continuity of care. We’ve seen a tremendous expansion of access and a positive response from our patients,” explains Dr. Hunter.
“Most health care studies show that if we provide better primary care, the kind of care we provide at ECHC, then the outcomes for our patients will be better across the board, improving long-term health while reducing costs to patients, insurers and government programs,” notes Dr. Hunter.
“The model of the ‘medical home’ is an updated way to promote primary care. As a medical home, we strive to be available to our patients when they need to be seen and get them the care they need when they need it, including coordinating with local and regional specialists. We try to see our patients the day they call.” Dr. Hunter spends half his time seeing his patients at ECHC and the other half as Chief Medical Officer for the organization. “My primary focus is increasing the quality of the care our system provides. The model for ‘medical homes’ isn’t one we created; rather, we are taking the idea and making it our own to best suit the needs of our patients. With our long tradition of collaboration with other providers and specialists in our community and the region we can coordinate the full range of care our patients need,” concludes Dr. Hunter.”
Promoting Community Wellness
David Villasenor, MD, joined the ECHC team in August 2010, right out of his medical residency at the University of California, San Diego’s combined Family Practice/Psychiatry program. He has a unique combination of skills, particularly for a rural community health center and that is just what Dr. Villasenor wanted to offer. He considered his career options carefully and decided ECHC was the place where he could best apply his skills. “This job is what I hoped for,” says Dr. Villasenor. “The clinic has strong leadership, wonderful support staff and a real dedication to the community. My family and I have been here for a year. My wife is in the Masters of Social Work program at HSU. We already feel connected to the area and that we are a part of moving the community forward.”
“My residency program in San Diego is very proud that I am here, that I am serving a community in medical need. I see a great diversity of patients at ECHC. In addition to my family medicine practice, I’m particularly interested in outpatient psychiatric care and substance abuse treatment. I work with a variety of established patients who are referred by their ODCHC primary care providers.”
“We offer a suboxone program at ECHC,” explains Dr. Villasenor. “This is an outpatient, office-based treatment program for dependency on opiates, including heroin, morphine, methadone, Oxycodone, Vicodin and similar drugs. Some of these drugs have real medical value, but if used improperly, they cause real problems. Addiction does not discriminate. Our patients are homeless and unemployed, and professionals with good jobs and families – and everyone else.”
Registered nurse Beverly Bulloch coordinates the ECHC suboxone program, among her many other duties. “I wasn’t sure if I wanted to take on this project, but the first time I walked into the support group,
I knew I wanted to be a part of this work. There was a woman in the room who I had treated many times when I worked at the hospital. In the past, I really doubted whether she would survive, but here she was sitting in the conference room looking great – and alive! She was sober and had reconnected with her family. The opportunity to get clean through this program – and her willingness to stick with it – saved her life. Patients’ lives change so dramatically from week to week and month to month. We are treating the disease of addiction, not just substituting the use of opiates. Beyond the individuals in the program, we are improving the health and quality of the community. This program has become the most rewarding part of my job.”
Beverly has a busy schedule in addition to her suboxone program duties. “I may be a nurse, but I’m also an educator,” she explains. “We work to develop education packets on a whole range of illnesses and conditions. Our patients love it. They get excited about education, about learning how to take control of their health, and they enjoy the one-on-one consultations our nurses provide. Our teams are in communication all day long and I coordinate a lot of that communication, making sure that everyone is doing what needs to be done, including the patients. We let our patients know we are here and they appreciate that they can reach me when they have concerns. They know I’ll be their representative with the team.”
“I have been a nurse for 30 years,” Beverly says with pride. “Before taking my job at ECHC in 2009, I had worked exclusively in hospitals. I started here just as the clinic began the transition to team-based care. While we’re learning more about team care every day, our team is fantastic. The medical leadership is involved and invested in this model and better care for patients. Beyond this clinic, I know that Open Door’s leadership wants to know what I think. This is the only place I’ve ever worked in my whole nursing career where the administration consults with the medical staff on operations. I feel like I am a valued part of the Open Door system, not just a nurse working in an Open Door clinic.” Beverly adds, “The bottom line is that everyone here is always trying to do what is best for patient care.”