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Photo: Jessica Portner/California Health Report

By Jessica Portner
California Health Report

It’s early Saturday morning at Serve the People Community Health Center in Santa Ana, and dozens of people have crowded into the cheery waiting room to get their blood pressure or diabetes screenings, mammograms, or follow up appointments for a lingering illness. The clinic, which opened its doors in 2009, offers the gamut of clinic services to 500 patients a month — all for about $15 or less — and the staff regularly haggles with medical specialists for discount rates if the patient needs a referral. The health center’s doors are open to anyone who requires — but can’t afford — medical care.

But free, or low cost health-care services are just part of what this scrappy and dedicated health center does for the Orange County communities it serves. In the parking lot outside of the bustling clinic, things are also humming. Just after dawn, hundreds of people pushing shopping carts have already begun to roll though the line of the food pantry that Dr. Dimitri Sirakoff established in 2008 — before he opened, and became director, of the health clinic. The pantry, which has become a nutritional lifeline for the low-income, homeless, and unemployed residents of Orange County, draws 400 to 800 families two Saturdays a month.

From about 7 a.m. to 9:30 a.m., dozens of volunteers from churches and local colleges usher people under white tents set up in a sprawling parking lot and distribute grocery bags loaded with vegetables, seasonal fruits, and sometimes meats. The rows of huge wooden bins this Saturday in December contain tomatoes on the vine, orange juice, beans, carrots, apples, pasta, and bagels, English muffins, and hefty bags of empanadas. The bounty comes primarily from the Orange County Food Bank. The Food Pantry also receives donations from Trader Joes and Feed the Children, and they buy some food from Second Harvest with funds raised from foundations and local businesses.

“We are selective in what we take. I try to get some forms of protein and juices, something healthy,” said Dr. Sirakoff, who said he was morally compelled to start the food pantry after seeing in his own private medical practice the hunger and poor nutritional habits of local residents. In Santa Ana, a city of 330,000, 17.9 percent of people lived below the poverty level between 2006 and 2010, higher than the state’s average of 13.7 percent, according to the U.S. Census Bureau.

“It’s a safety net,” added Dr. Sirakoff, “Some people have said to me that without this food bank, they don’t know when their next meal will be.”

Across the parking lot, David Martinez, 62 and his wife Maria, 60, both in wheelchairs, zip over to a wall where they wait for their ride home. One of the volunteers follows behind them with a cart brimming with beans, lettuce, potatoes and squash. Maria smiles and says they are food pantry regulars.

“We are so happy they help us out with the food. The food is very good. We have different things every week,” she said. But she added that the other items they give away are valuable, too. The clinic dispenses free articles of clothing, including shoes, socks, baby food, diapers, and toiletries. David, who wears a breathing tube and has significant medical problems, said he picked up a jacket and a pair of shoes recently, items that he couldn’t afford on his fixed Social Security income.

Yvonne Martinez (no relation to David) and her 10-year-old boy, Walter Garcia, stood in the parking lot along with dozens of people waiting to be picked up or to board a free shuttle to their car. “Today is our lucky day,” said Martinez, who spotted the “Free Produce” sign in front of the clinic as she and Walter were riding by on the bus. The pair immediately jumped off at the next stop and took their place in the back of the growing line. Sifting through her packed grocery cart, the single mother on disability was thinking about what dishes she’ll make for her five kids. “It’s a blessing,” she said.

Eighteen-year-old Micaela Sotelo, a student at Santa Ana College, said doling out food is a gift to her as well. “It hit me personally because my dad hasn’t had a job in about nine months, but then a month ago he was able to get a new job,” she said, “Those times were tough…and it feels good to be helping others.”

Jhoanna Katindoy, 22, a volunteer and a nursing student at West Coast University in nearby Anaheim, said it was also worth waking up before dawn to promote healthy eating habits. “This is also primary disease prevention because eating healthy foods builds better immune system, which means less illness,” she said.

That connection between nutritious food and good health is what Dr. Sirakoff had in mind when he started offering quick, mini health screenings while people were standing in line. He’d check for high blood pressure, diabetes, and anemia and see if the people arriving at this doorstep had access to medical evaluation, diagnosis, and treatment. After receiving nearly universal negative response to that question for more than a year, Dr. Sirakoff decided to open Serve the People Community Health Center with a skeleton staff.

Recently, with the help of donations from businesses and foundations, Dr. Sirakoff was able to hire a new, professional crew — a physician’s assistant, patient navigator, and office manager. The clinic is working towards an ambitious goal of becoming a Patient Centered Medical Home.

California supports implementing models for more comprehensive and coordinated care for the state’s most vulnerable residents to help prepare for the increasing numbers of people who will have access to health care.

Winning the coveted PCMH certification requires clinics to use, for example, an advanced medical records system to keep track of the voluminous piles of essential information, from a patient’s demeanor to their diagnosis and treatment history.

Once certified, the clinic would be in line to receive more patients under the federal Affordable Care Act or health care reform.

The Coalition of Orange County Community Health Centers, a consortium of safety net providers, has singled out Serve the People Health Center as a clinic working to create quality healthcare for vulnerable, underserved communities.

Karen Greenwood of the Santa Ana-based Dhont Family Foundation agrees. The charity, which donates to local charities that serve disadvantaged people with great needs, gave the clinic its first grant of $60,000.

“It’s an affluent community, but behind the scenes there is a lot of poverty, particularly with the economic downturn,” she said. “We know [Dr. Sirakoff] is doing a great job at delivering the health care, but that’s just part of what he does…he doesn’t have a large staff and there’s not a lot of overhead.” (The clinic also runs a legal aid clinic where volunteer lawyers offer advice every other Saturday on everything from immigration to landlord/tenant disputes.)

The sense that the health center, which has an annual operating budget of $623,000, operates a lean, efficient enterprise seems to be spreading. The clinic’s overtures to donors and their bids for grants — which Dr. Sirakoff initially wrote himself with his bookkeeper — have been unusually successful of late. They recently received a $250,000 grant from the Children and Families Commission of Orange County to establish a pediatric dental clinic on site.

The bounty is a welcome gift for the holidays. When the expected 700 families roll their carts into the pre-Christmas food pantry on December 22, they’ll also find presents, courtesy of the California Highway Patrol’s Toys for Tots Program. Though they don’t have them yet, Serve the People’s volunteer organizers are banking that they’ll be able to dole out turkeys, too.

Laundry Love helps the homeless and poor clear the hurdles of laundering their clothes, providing money, access to washing machines and necessities including detergent. Photo: Moses Chiong

By Helen Afrasiabi
California Health Report

Amidst a mostly unpredictable day to day existence, many of Santa Ana’s homeless and immigrant poor have come to count on at least one thing: the chance to get their clothes and other belongings laundered once a month.

Starting at 7:30 p.m. on the third Thursday of each month, up to several dozen of them can be seen outside of the Santa Ana Laundromat, patiently perched next to their carts as they wait their turn to get inside. Assembled inside is the entirely volunteer staff orchestrating this once a month event known as Laundry Love Santa Ana.

Laundry Love helps the homeless and poor clear the hurdles of laundering their clothes, providing money, access to washing machines and necessities including detergent. The volunteers coordinate based on the number of people in line, providing coins, detergent, dryer sheets and helping hands. Up to 200 loads of laundry have been done on some nights.

The project is adopted at the local level by interested parties partnering with local laundromats. With team leader Scott Overpeck at the helm, Laundry Love Santa Ana is currently in its third year. The catalyst for Laundry Love was the basic tenet that laundry is a universal need.

“No matter who we are, we all need to do our laundry,” said Overpeck, who spends his time outside of Laundry Love running his own business, Santa Ana-based consulting group Intersection Creative Strategies. There, he helps non-profits manage their difficulties with fundraising, program development, marketing and strategic planning problems. His experience working with those serving various disenfranchised groups has given him a unique perspective on the problems of the homeless, he said.

He explains, for example, that the general perception is that food is the foremost unmet need affecting the homeless and poor in Santa Ana, but his observations during time out in the community among them has shown him otherwise.

“As a homeless person, you can have nine meals on a Sunday on Civic Center Drive,” Overpeck said.

But laundry is among the needs that typically aren’t met, he said.

Among those coming to Laundry Love Santa Ana for several months is Marta Hernandez. Only months ago, she was a supervisor at nutritional product manufacturer Herbalife. Following a layoff, she has since gone from having her own apartment to being homeless for the past two months.

“I left Cuba 17 years ago to find a better life, I never thought one day I would be homeless,” Hernandez says. Still, she is energetic. The look in her eyes is not one of despair, but rather that of focus as she rapidly moves her plastic bag-filled cart back and forth between the washers and dryers.

With one eye on the machines, she emphasizes that rather than feeling sorry for herself, she is grateful for the help Laundry Love provides because it enables her to conquer the bigger goals she has sketched out for her future.

“I am studying Math and English at Santa Ana College to get back on my feet,” Hernandez says optimistically, adding that without the few dollars in coins and detergent provided by Laundry Love, having clean clothes to go to school would be out of the question soon if not immediately.

Like Hernandez, Mariela Gonzales was also laid off. With her two toddler and infant children in tow, she also is there for the much needed assistance in getting her family’s clothes washed.

The former hotel employee says that without work, the cost of laundry stretches her budget too thin at the moment.

“It’s hard. I’m a single mother,” Gonzales says. “Right now I barely have enough money for rent.”

Overpeck sees much of the value of Laundry Love nights as its role in creating community.

“We’re not here to be saviors, that’s not the concept,” Overpeck said, highlighting that everybody is vulnerable to what people like Hernandez and Gonzales are experiencing right now.

Still, there are some for whom Laundry Love is nothing less than being saved. Another visitor who wished to remain anonymous has been homeless off and on for 20 years as a result of drug addictions. She says that Laundry Love is essential to her hygiene and health.

“This helps me keep a clean living environment,” she says of being able to wash her clothing and blankets. “It helps keep the germs and bed bugs off of my body. And I don’t get those horrible spider bites.”

She is currently looking for work as well. If not for Laundry Love, she says, her appearance might possibly cost her a chance at a job also.

“I’d be looking for the closest five gallon bucket. You do what you got to do. But this is a heck of a lot better,” she said.

What makes Laundry Love Santa Ana unique is that the help given to the community is packaged as something more akin to a party. Overpeck and team leaders have provided Hernandez and others something more than the financial assistance and appliances: an atmosphere that lets them get away from their problems for that hour or two that they are there. Bringing in activities for the kids accompanying their parents, juke boxes and dance-offs are just a few things designed to help pass the time while people wait for their clothes. And it makes a noticeable difference.

“There are some people we see for a long time. One of our first success stories was a woman who used to be bitter and angry, but after a year of hanging out at our event, she was a nicer person to be around, and her daughter even let her back in, which was great,” Overpeck said.

Looking at these peoples’ lives from a bird’s-eye view, Overpeck recognizes those coming to the laundromat suffer voids beyond a lack of clean clothes. These include lack of affordable housing, jobs, community, entertainment and leisure time.

“My family has gone through this, I grew up poor and had to go to laundromats most of my life,” Overpeck said. “I know what it’s like having to go without.”

President Clinton at the Health Matters Conference in January 2012. Photo: Clinton Foundation Press Office

By Suzanne Potter
California Health Report

A new health initiative run by former President Bill Clinton’s charitable foundation recently selected Southern California’s Coachella Valley as one of its sites, and local leaders in Coachella Valley will meet with the Clinton Health Matters Initiative staff to start planning tomorrow, December 6.

The new Clinton Health Matters Initiative (CHMI) aims to reduce suffering from preventable disease and close the gaps in health care access that are related to race, income and education.

The planning meeting, which will be held at Cal State San Bernardino’s Palm Desert campus, will bring CHMI staff together with local health care advocates and representatives from schools, businesses and non-profits. They will assess the valley’s needs and work out a blueprint for what can be accomplished over the next five to seven years.

“Our nation’s rising tide of preventable health problems is alarming because it is ruining the quality and length of life for millions and driving up healthcare costs in a way that can’t be sustained,” said former president Bill Clinton in a statement.

The Coachella Valley is about 50 miles long and comprises nine cities, from the wealthier towns like Palm Springs, Rancho Mirage, Palm Desert and Indian Wells, to struggling areas like Desert Hot Springs, Indio and Coachella. The rural east end near the Salton Sea is home to thousands of desperately poor migrant field workers and their families

“We chose the CV because the resources are rich within the community and the commitment is rich, yet the disparities are great, said Ginny Erhlich, CEO of the CHMI. “More than 70 percent of children in the valley are living in poverty. And at the same time there are tremendous resources that can be leveraged and coalesced and built upon to really make a difference.”

The CHMI’s biggest event is a national conference held in each year in La Quinta, alongside the Humana Challenge Golf Tournament (formerly the Bob Hope Classic). Former President Clinton headlined the first annual conference this past January and is slated to appear on January 15th at the 2nd annual conference, entitled Health Matters: Activating Wellness in Every Generation.

The Health Assessment Resource Center (HARC) in Palm Desert will play a significant role in the initiative. HARC does an extensive survey every three years that explores dozens of health indicators; that data will inform the planning process.

Eileen Packer, Chief Executive Officer of HARC, is optimistic about the possibility of improving health in the region. “In order to change a community you need to have everyone involved,” she said. “I believe the Clinton Foundation will be a catalyst to get everybody working in the same direction.”

“Changes take time, she added. “Nothing happens overnight. The fact that they are committed to stay for a while will facilitate change.”

The CHMI’s partnerships are already producing results. At last year’s Health Matters Conference, the Desert Healthcare District (DHD) gave a $900,000 grant to the Alliance for a Healthier Generation (a spin-off of the Clinton Foundation) to bring the Healthy Schools program to all three local school districts.

The funds will support a full-time position, the Relationship Manager, for four years to work with every public school in the Coachella Valley, says Kathy Greco, CEO of the DHD.

That manager, Hayden Ross, will help to create an action plan to address students’ health issues. “Incrementally we really hope to see changes that create a healthier school environment,” Ross says.

The goals include offering healthier food choices, maintaining or improving PE classes and implementing staff wellness programs.

At Palm Springs Unified, they are going further, eliminating sports drinks, and limiting calories and portions of any foods sold at fundraisers on campus. They also offer a Junior Chef program and feature a fruit and vegetable a month in menus and in the newsletter.

In addition, the Humana Challenge is offering free tickets to kids’ day at the tournament for students who take part in the 9-0-2-1-5 program. Students must show they did one of five things for a week: get 9 hours a sleep a night, drink zero sugary beverages, exercise two hours a day, and/or eat five fruits and vegetables a day.

“Studies have shown that that the model has moved the needle around policies and programs as well as impacted positively students’ body mass index and healthy eating behaviors,” adds Ehrlich.

Wanda Grant, Director of Nutrition Services at PSUSD, is optimistic, “I think we’re on the tipping point here. We have a lot of interest in the valley and a lot of momentum. I think we’re just beginning to break the surface on making a difference with our families.”

One local nonprofit, Hidden Harvest out of Coachella, is featured prominently on the CHMI website. Hidden Harvest feeds about 45,000 families a month by collecting the produce left over after the harvest at local farms and packing houses – then giving it away to the poor.

The group’s founder, Christy Porter, will be writing a blog about Coachella Valley health issues. “Hidden Harvest and the CHMI are partners in the Coachella Valley – our mission overlaps as both of us are public health initiatives at our core, dedicated to our mission of making better health possible for our citizens,” Porter said.

Two of the valley’s major hospitals, Desert Regional Medical Center and Hospital, are getting involved as well. Their parent company, Tenet Healthcare is a title sponsor of the national conference in January.

The CHMI is also working with Verizon. The communications giant will offer wellness programs to its employees and will use their expertise to improve public health. Verizon is working to use video technology to offer “virtual” doctor’s visits to patients who can’t get to the physician’s office. In addition, they have a program that lets rural doctors send x-rays and EKG readings wirelessly to the hospital for analysis.

The CHMI is also building a website that uses crowdsourcing techniques to help people make a difference. For example, the site helps you organize a walking group or run a neighborhood watch program, to keep local parks are safe for kids to run around and play.

The Health Matters website emphasizes simple things people can do to improve their health and thus prevent disease, like eating better, exercising, drinking more water and getting more sleep. The initiative takes that a step further by enlisting companies to fund farmer’s markets, free exercise classes and programs to help people quit smoking.

Children with less serious needs will have to find providers who take Medi-Cal’s lower rates

By Lynn Graebner
California Health Report

Santa Cruz County mental health staff and patient advocates in California predict that many children enrolled in the state’s Healthy Families Program, an insurance program for low-income families that will be phased out in 2013, should actually have better access to mental health services once they start transitioning to Medi-Cal in January.

This summer the state legislature approved Governor Jerry Brown’s plan to cut the Healthy Families Program, saving the state $129 million in the next two years and $71 million annually after that. Healthy Families enrolls families whose incomes are low, but not low enough to qualify for Medi-Cal, as Medicaid is known in California. Many fear that with this transition to Medi-Cal, former Healthy Families enrollees will have difficulty finding health providers, since Medi-Cal pays providers less.

Many county health departments in California, however, welcome the state’s 2011 decision to give their departments responsibility for managing the money that will help them provide the specific mental health services needed locally.

But they are concerned about the state’s recent decision to switch from funding Medi-Cal mental health services with state general funds to giving counties a set amount of sales tax revenues. That funding will be based on estimated mental health care needs, but counties say that funding may not keep pace with the growing need for services.

“Counties certainly want to move forward. We think we can do it, [but] it comes down to the financial support,” said Suzanne Tavano, Director of Mental Health and Substance Abuse Services for the Santa Cruz County Health Services Agency.

The state is estimating counties’ funding needs for mental health services based on historical use plus the expected increased use of county services as Healthy Families enrollees come into the Medi-Cal system.

Based on that estimate the state is depositing a portion of its sales tax revenues into a behavioral health account, which will pay for adult treatment programs as well as youth screenings and services.

“To have counties responsible for providing care for their residents seems to make sense,” said Carmella Gutierrez, president of Californians for Patient Care, a nonprofit patient advocacy organization based in Sacramento. “The concern is with the funding.”

The Healthy Families Program gave parents seeking mental health care for their children more access to physicians in private practice because Healthy Families provider rates are higher than Medi-Cal’s.

After the transition, children suffering from mental health disorders serious enough to require a specialist, such as conduct disorders or early diagnosis of bipolar disorder, will continue to seek treatment from the county. Children with milder needs – for instance, depression resulting from divorce – will need to find therapists who accept Medi-Cal.

The county already has the infrastructure in place to support children with serious mental health care needs, so the transition away from Healthy Families to Medi-Cal should benefit them.

Participants in Healthy Families actually seem to underuse their mental health care services, compared to Medi-Cal participants. No one is sure why that is. “The state has been trying to get to the bottom of that for quite a few years,” said Patricia Ryan, Executive Director of the California Mental Health Director’s Association.

“I don’t think it was due to any problems per se on the part of Healthy Families,” said Dane Cervine, Program Chief of Child and Adolescent Mental Health Services for the Santa Cruz County Health Services Agency. He said it could have been that families just weren’t aware of the services. Medi-Cal has a much longer history of providing mental health services.

That’s one reason why counties are concerned about the current funding estimates – they expect to see an increase in specialty treatment services as Healthy Families enrollees transfer to Medi-Cal.

Only about 1 percent of Healthy Families beneficiaries in Santa Cruz County, for instance, are getting mental health services, Cervine said. In comparison, usually 5 to 10 percent of children with Medi-Cal are getting some sort of treatment. In Santa Cruz County 10.71 percent of children with Medi-Cal received mental health services in 2010, he said.

Ryan estimates that about 43,000 children transferring from Healthy Families may require these higher-level specialty services at the county or through county-contracted providers.

They will be eligible for a wide variety of services with their Medi-Cal coverage, including screening and assessments, therapeutic behavioral services and wrap around services including family teams and in-home visiting.

Paying for this level of services based on state estimates of current use is a concern, Ryan said at an Oct. 16 Senate Budget Committee hearing.

In an interview, Ryan said counties question the state’s funding estimates for serving these additional children.

“We fear they low-balled it,” she said.

If counties come up short, they may need to redirect county funds from other programs for indigent individuals or for child welfare services or adult protective services, Ryan said.

But the state believes the funding is adequate, said Norman Williams, Deputy Director of the Office of Public Affairs at the California Department of Health Care Services.

“The state will monitor expenditures in this funding category to determine if adjustments are needed on a prospective basis,” he said in an e-mail response to questions.

Healthy Families enrollees with less serious needs, such as attention deficit disorder or mild depression, will be able to continue treatment through their primary care providers.

Children with mid-level needs, such as a child suffering from anxiety about a divorce, who may currently be seeing a private psychiatrist, psychologist or an agency contracting with Healthy Families, could continue to see those providers if the providers agree to take Medi-Cal reimbursements and enroll in the state’s fee-for-service Medi-Cal network.

But some providers and families don’t want to make the switch.

Vivian Gratton, president of the Santa Cruz Chapter of the California Association of Marriage & Family Therapists, treats a child with Healthy Families coverage. The family was told they now have to seek services at the county.

They opted not to. They are comfortable with Gratton and her skill set, she said. They pay Gratton on a sliding scale out of pocket, which is a stretch for them.

Sylvia Yee, another marriage and family therapist in Santa Cruz County, has treated children in the Healthy Families Program even though the reimbursement didn’t completely cover her fees. But she said she probably won’t become a Medi-Cal provider.

She’s not alone. California ranks 46th nationally for Medicaid reimbursement levels to providers, according to Williams.

He indicated his agency is working on equipping counties with lists of current Healthy Family mental health providers who could possibly be resources for counties.

Margarita, a patient at Clinica de Salud del Valle de Salinas, has Medi-Cal and Medicare. She came to the clinic because she didn’t like her private practice physician. Photo: Lynn Graebner

By Lynn Graebner
California Health Report

The Affordable Care Act excludes undocumented immigrants from buying health insurance on state health benefit exchanges. But healthcare providers in the Salinas Valley are weaving safety nets of their own for medically vulnerable farm and migrant workers who are part of the community and essential to the country’s food production.

Seventy thousand people on California’s Central Coast will remain ineligible for health insurance under the ACA in 2019 because of their immigration status, estimated the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research in a September report.

But healthcare providers in Salinas are attempting to create an alternative form of insurance for farm workers and migrant workers and are expanding services to care for those who will remain uninsured for financial or other reasons.

One of the largest networks of safety-net clinics in the Salinas Valley, Clinica de Salud del Valle de Salinas, is working with five other community health centers from Santa Clara to Ventura counties to develop a privately-funded health plan for farm workers.

They cooperate through the Central Coast Health Network. Last November the California Endowment granted them $175,000 to research solutions for insuring farm workers and to keep the legislature informed about farm worker health, said Arnoldo Torres, a policy consultant to the Health Network. A final report is due out before the end of the year.

The group is engaging agricultural employers and farm labor contractors to see what they would be willing to pay to ensure health coverage for their workers, Torres said. There is an initiative under way already to create an HMO operated by one of the nonprofit community healthcare centers and licensed by the state to provide care to various populations including farm workers, he said.

“The best way to provide health coverage to this population is through community health centers for the simple reason that they are non profits and they were created for the purpose of providing care for that population historically,” Torres said.

He said the group is organizing discussions with growers in Monterey, Santa Cruz and Ventura counties who have already expressed a willingness to work on a form of coverage for this population.

It’s a tricky group to insure, since farm workers and other migrant workers may only work for an employer for a few days before migrating to other jobs based on the seasons and differing pay rates, said Guadalupe Sandoval, Managing Director of the California Farm Labor Contractors Association, in an e-mail response to questions.

“Employers of farm workers, growers and farm labor contractors are hopeful that some viable, affordable health care plans will be made available for their labor force,” he wrote.

The cost of insuring undocumented workers is only one of the barriers preventing them from accessing healthcare. They may also fear having to divulge too much about their immigration status, or have difficulty getting time off work or transportation to a clinic or managing a co-pay, said Virginia Ruiz, Director of Occupational and Environmental Health for Farmworker Justice, a Washington D.C.-based national nonprofit advocacy organization.

“This population is mostly out of Mexico, and when people buy health care in Mexico it is urgent care. Not everybody can afford to see a doctor,” said Dr. Max Cuevas, Chief Executive Officer of Clinica de Salud.

Ms. Garcia, a 57-year-old Salinas resident who declined to give her first name, works as a janitor. She doesn’t have health insurance, and knows of her options for healthcare at the community clinics. As she ages, she said, she is considering getting preventative care, but she works double shifts daily and doesn’t have time.

Margarita, an elderly patient at Clinica de Salud in Salinas who declined to give her last name, has Medi-Cal and Medicare. She came to the clinic because she didn’t like her private practice physician. She has high blood pressure and kidney problems and comes in every two weeks. She is happy now, she says, because she has a female doctor at Clinica de Salud.

Clinica de Salud is already caring for 36,000 patients at its 10 clinics in Monterey County. 40 percent of patients have no health insurance, Cuevas said. They may not qualify for Medi-Cal or Medicare or may be undocumented immigrants so they pay on a sliding scale.

Because each of the clinics is a Federally Qualified Health Center, serving people regardless of their ability to pay or their health insurance status, Clinica de Salud gets higher reimbursement rates for Medicaid patients than private practitioners. The clinics then use part of that money to subsidize the patients with no insurance.

While the ACA has excluded undocumented immigrants from buying insurance on the state healthcare exchanges, the act has provided $11 billion in funding over five years for operating, expanding and constructing community health centers across the country.

Clinica de Salud has received $1.1 million in ACA funds for ongoing operations, reported the U.S. Health Resources and Services Administration. And the organization is currently working on opening two more clinics in Gonzales and the Seaside/Marina area, Cuevas said.

The Monterey County Health Department operates seven clinics that provide internal medicine, family practice, pediatrics and women’s’ health serving low income and uninsured patients.

The county also owns Natividad Medical Center, a safety net hospital. One of the biggest moves the county is making to increase services to the underinsured and uninsured is doubling its family practice center at Natividad from 15 rooms to 28 by mid 2013, said Dr. Steve Harrison, Program Director for the hospital’s Family Medicine Residents Program.

Last year the county clinics saw 37,494 individuals, 5,149 of whom were farm
workers and migrant workers, said Anel Mojica, Manager of Alisal Health Center one of the county’s seven safety net clinics. She estimates Alisal is seeing 60 percent more farm workers than a year ago. She thinks there’s more word of mouth in the fields about the clinics.

She credits the county’s transition to electronic health records in 2010 with helping to improve the clinics’ ability to track information like farm workers’ immunizations, women’s annual health checks and diabetic and asthmatic treatments. Reminders via mail and, more importantly, cell phones are getting patients in more regularly, Mojica said.

“Sometimes I have 30 to 40 walk-ins a day,” she said.

“If you can get people preventive care, assuming you can do it right, they’re not going to get as sick. In the long run it should save the healthcare system money,” said Julie Edgcomb, Bureau Chief of Clinic Services for the Monterey County Health Department.

A group gathers as city gardener Lisa Graves explains proper tree planting technique. Photo: Daniel McGlynn

By Daniel McGlynn
California Health Report

On a recent Saturday morning, the 600 block of 35th street in Richmond was closed to traffic. A small crowd gathered in front of number 634. The knot of people was mostly residents from the surrounding neighborhood, the North & East, in central Richmond, and an assortment of teenage volunteers from various community groups.

The crowd’s focus was directed toward Richmond’s city gardener, Lisa Graves, who was working on behalf of the organization Richmond Trees, and the Chinese Pistache tree she was planting in the thin band of grass that separated the road from the sidewalk.

Since Richmond Trees formed a year ago they have canvassed, educated, fundraised and physically planted more than 150 trees. They are on track to do even more this year. Richmond has roughly 28,000 trees that cover an estimated 10 percent of the streets and neighborhoods in a canopy. That’s low compared to other Bay Area cities. For improving the canopy cover, 40 percent is considered optimal, and that level has benefits ranging from better air quality, reduced crime, increased property values and more community engagement.

Graves explained to the watchful audience that you couldn’t just pull the tree, which was taller than she was, out of the pot and stick it in the ground. She demonstrated the steps that will help these trees survive the critical first few years in a harsh city environment: loosen the root ball, make sure the elevation was just right to ensure proper drainage, and stake the tree properly for good support.

The group of about 65 new urban foresters was then let loose in the neighborhood, under the guidance of a team leader, a member of the group Richmond Trees, to repeat the careful process and plant 28 more trees.

“This started because I wanted to plant some street trees in front of my house,” says Teri Katz, one of the founders and the coordinator of Richmond Trees. “But the city told me the [Adopt-a-Tree] program was on hold, so I thought I’ll volunteer. I really had no idea it would morph into what it has become today.” It helped that the neighborhood already had engaged residents and a chatty Yahoo Group. When checking the listserv one day, Katz noticed that other neighbors were interested in organizing a tree plantings.

Soon after, on a Sunday afternoon, Katz invited some interested neighbors over to her house. She also invited another of the city’s gardeners to explain Richmond’s Adopt-a-Tree program and the group took a walk around the neighborhood to identify common street tree species and some of the problems associated with urban trees, such as planting the wrong size tree in the wrong locations, like too close to sidewalks or under power lines.

Katz and the other volunteers started to canvas their blocks and talked to people about the benefits of trees. Jan Mignone, the president of the North & East neighborhood council, longtime resident, and another early member of Richmond Trees remembers, years ago, when the neighborhood did have some big trees. “I lived on a street that had a lot of trees, but they got cut down because they were the wrong kind of trees. We had a lot of flowering plums and magnolia, which are not particularly good street trees,” she says. Over the years problematic trees were removed and not replaced. The pattern continued in other parts of the city, until sections of Richmond started resembling a clear-cut capped in concrete, with no shade or dappled light coming through leaves, and almost no canopy.

“Richmond has a major oil refinery, Chevron, as well as a commercial shipping port, railroad yards, and two interstate highways traversing the city,” Katz says, “There’s higher than normal incidences of pollution-related problems in Richmond like asthma, cancer, immune diseases and allergies. Richmond is rated as an impacted community by the Bay Area Air Quality Management District.”

That’s why Richmond trees frequently frames the benefits of more street trees in terms of the ecological services trees provide. Besides exchanging climate change inducing greenhouse gasses for oxygen, trees also filter out other human health damaging pollutants like particulates, volatile organic compounds and nitrogen oxides, all of which are products of heavy industrialization. Trees work like other types of sponges, the closer they are to the source of the pollution, the more effective they are at filtering.

Due to the legacy of heaved sidewalks, broken sewer pipes, and messy leaf litter of the city’s previous plantings, Richmond Trees volunteers often need to make a strong case for the benefits of trees when they go door to door looking for new adopters. “It’s hard canvassing,” says Kaci Smith, another North & East resident and tree planter. “We go through a whole list of benefits. At first people are usually pretty closed off, but after you get past that and they hear that we are a neighbor, then people are pretty receptive.”

Besides the environmental aspects of cleaner air and softening the sights and sounds of an urban environment, trees also have public health benefits like slowing traffic, encouraging residents to spend more time outdoors, and reducing crime. A 2012 study from Baltimore, another city with a large urban forest planting effort, found that a 10 percent increase in canopy cover can reduce crime by 12 percent. The study controlled for the fact that most pre-existing tree lined streets are in more affluent neighborhoods with lower crime rates to begin with. In Richmond, police chief Chris Magnus, who lives in the North & East is a supporter of Richmond Trees, and even planted a tree in his own yard.

If residents are interested, they pick from a list of city approved street trees and then one of the city’s arborists will visit the site and check for utility lines above and below, and either sign off on the selection as appropriate for the spot, or recommend a different species. Then, in order to officially adopt a tree, the adopters have to agree to water the tree regularly until it can fend for itself. “The single biggest challenge we face is getting water to the forest for the first two years,” says Chris Chamberlain, Richmond’s Parks and Landscaping Superintendent.

The city’s Adopt-a-Tree program is a three or four years old, Chamberlain says, but is only in the past year, with the involvement of Richmond Trees, that it has really started to flourish. In addition to the legwork of finding tree adopters, Richmond Trees has also raised money to buy saplings. Last year they received grants from PG&E, CAL FIRE, and Veolia Water to help purchase trees. “We had the equipment to plant trees,” Chamberlain says about the city’s Adopt-a-Tree program, “we just didn’t have the people or resources.”

Richmond Trees recently received a $10,000 grant from the Sacramento-based California ReLeaf, an urban forest advocacy group, to publish more educational materials, and to buy additional trees and a concrete saw to open additional places for planting. As part of the grant they have to plant 100 trees by March 2013.

Now a full-fledged organization capable of mobilizing large numbers of planters and partnering with other local environmental groups such as Groundwork Richmond and the Watershed Project, Richmond Trees is trying export their model of community engagement and education to other neighborhoods in Richmond, like the Iron Triangle, Coronado and Santa Fe. “We are all collaborating on materials and sharing lessons learned and comparing notes because there is a lot of effort in Richmond going to improving the neighborhood tree canopy,” says Nancy Baer, the board chair for Richmond Groundwork. “Within a few years, I think we will have a pretty substantial tree growing effort throughout Richmond.”