Originally posted at the Hartford Courant
Johnny Gonzalez-Benitez went to the Hands On Hartford shelter Wednesday looking for a meal. He walked out several hours later with not only a full stomach but also a new jacket and undergarments, toiletries and an appointment to see a dentist for an urgent tooth issue.
As it turned out, Gonzalez-Benitez, a 54-year-old Hartford resident who recently lost his apartment and most of his possessions in a fire, had stumbled upon a mobile clinic held by Hartford HealthCare’s neighborhood health team, which formed last summer in an attempt to meet local residents where they are.
“They found me an appointment for Tuesday,” Gonzalez-Benitez said excitedly. “And they hooked me up with some stuff.”
The COVID-19 pandemic has exposed profound gaps in health care access nationwide, leading to hundreds of thousands of avoidable deaths. There are gaps in Connecticut, too. But hospital officials say it also has inspired them to think creatively about how to fill those gaps.
In the case of Hartford HealthCare’s neighborhood health team, that has meant bringing resources into underserved Connecticut communities, offering not only medical treatment — including physicals, vaccines, screenings and minor procedures — but also legal services, behavioral health resources and help accessing welfare benefits.
“It’s a clinic for the whole person,” said Kelly Toth, an advanced practice registered nurse who leads the neighborhood health team. “Yes, we have medical stuff, but we can treat the whole person, and we bring it to where it’s needed.”
A new template
In a country where trust in medical institutions decreased during the pandemic, where a quarter of people don’t have a primary care physician and where small health issues are often allowed to fester into major ones, those on the neighborhood health team say this model provides an essential service.
“It strips the red tape out of medicine and lets us just do what we intended to do,” Toth said. “Even if a clinic only brings five patients in the door, those five patients are getting very uniquely tailored attention and care to whatever their need is.”
Hartford HealthCare officials say the neighborhood health program grew directly from strategies that worked during the pandemic.
First came mass testing and vaccination sites, then vaccine outreach, including mobile teams who went site to site vaccinating people in their own communities. That effort offered a template for the new neighborhood health team, which visits sites across Connecticut four days a week, often returning to certain locations on a regular schedule.
“Health care is a right,” said Janine Fonfara, Hartford HealthCare’s director of behavioral health integration. “The pandemic has certainly highlighted that we need to be able to bring health care to everyone.”
Members of the eight-person team say they are able, over time, to connect with patients in a way they might not be able to in a more traditional setting. Sometimes that means chatting with them over breakfast or playing cards with them during downtime.
Edwin Smith, a 56-year-old Hartford resident, first met the neighborhood health team at the Open Hearth shelter, where he was staying. Smith had been trying to enter a drug treatment program but said he was struggling to find one that would take him. With help from Priscilla Pandozzi, the team’s clinical social worker, he was admitted to one the next day.
Since completing the 21-day treatment program, Smith has continued to visit Pandozzi during the neighborhood health team’s twice-monthly stops at The Open Hearth.
“It helps me a lot because if I’m struggling, I can depend on them and they can help me,” Smith said. “They help right there, the same day.”
Stephanie Boyce, manager of homeless prevention and outreach for Hands On Hartford, said that when Hartford HealthCare’s neighborhood health team visits, they typically serve a mix of people who show up specifically for medical needs and people who visit for other reasons and then seek care because it’s available on site.
For those worried about what to eat and where to sleep, Boyce said, medical needs can sometimes seem secondary. Having care come to them, therefore, can be essential.
“We know that for folks experiencing homelessness, they’re busy just trying to survive,” Boyce said. “Being able to have those services here when they come is really crucial to having all of their needs met.”
Members of the neighborhood health team say they hope treating minor health issues as they arise will prevent more serious problems — whether physical, mental or behavioral — from developing over time. No patient is turned away for lack of insurance or ability to pay, a Hartford HealthCare spokesperson said.
Matthew Morrett, 36, said he regularly visits Hands On Hartford for meals and made sure to stop by Wednesday so nurses could look at his injured foot. Asked what he would have done about his foot if not for the mobile clinic, he paused and then smiled.
“Let it get worse,” he said. “Let it get to the point where I would’ve been forced to go to the emergency room.”
Building trust
Hartford HealthCare isn’t alone in considering how to better reach patients who can’t or won’t come in for regular visits. Dr. Tom Balcezak, chief clinical officer at Yale New Haven Health, said the system has begun providing acute care in patients’ homes in a way it never did previously.
“We’re doing all kinds of video visits now that we never used to do,” Balcezak said. “All those things are rapidly, rapidly changing.”
Community Health Center Inc. President and CEO Mark Masselli said the organization has increasingly focused on providing care through schools, which he sees as a central hub of community life.
“We have to really embrace a delivery system that aligns with where people go,” Masselli said. “Where’s the best place to deliver [care]? It’s not a health care place.”
According to one survey conducted in early 2021, only 64% of Americans completely or somewhat trust the health care system. Part of CHC’s goal, Masselli said, is to develop trust within a community by meeting people in places they’re already comfortable.
The need to develop trust also helps motivate the Hartford HealthCare neighborhood health team. Toth said some patients are reluctant or intimated at first, only to soften over time. Maybe at first they just want to chat outside. Then they might stop in for coffee. Before long, they’re seeking treatment for a range of issues.
“Seeing the same faces and engaging continually, little by little folks become more comfortable,” Toth said. “If they don’t trust us, they’re not going to come in.”
Dawn Filippa, a registered nurse on the neighborhood health team, tells stories of cutting people’s hair and buying them supplies. When Gonzalez-Benitez, the man who lost his belongings in a fire, mentioned Wednesday that he could use undergarments, a member of the neighborhood health team dashed to a nearby dollar store to buy some.
“The team loves to do that kind of stuff,” Filippa said.
Ultimately, Hartford HealthCare’s neighborhood health initiative consists only of one eight-person team, visiting a handful of sites a week — not nearly enough to change the way health care is delivered statewide. But the people behind the program say it’s here to stay and only likely to grow in the future.
“This is something that certainly has longevity to it,” Toth said. “The needs aren’t going to go away when the pandemic goes away. The needs will still be there.”