User:Jigmelamo/Community health centers in the United States

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Services
Integration of health care services is a major emphasis of community health centers, in addition to the provision of preventive and comprehensive care. Services provided can vary depending upon the site, but frequently include primary care, dental care, counseling services, women's health services, podiatry, mental and behavioral health services, substance abuse services, and physiotherapy. Often, CHCs are the only local source of dental, mental health, and substance abuse care available to low-income patients.

Most recently, CHCs have played an increasing role in the opioid epidemic by facilitating access to treatment. CHCs have experienced an increase in the number of patients with opioid use disorder (OUD) from 2015 to 2018. As part of the substance use disorders (SUD) component of services provided by CHCs, services have been added and expanded relating to the prevention and treatment of opioid use disorder. The number of CHCs that provide services for SUD has increased from 20% in 2010, to 28% in 2018. There has been a 36% increase in the number of full-time staff at CHCs who are trained to provide SUD services. As of the federal budget for the 2019 fiscal year, over $5 billion has been requested for the Department of Health and Human Services to use over the upcoming five years towards addressing the opioid epidemic. Of that request, $350 million has already been available for grants to be awarded by the start of the 2019 fiscal year.

Because patients can come from a diverse range of socioeconomic, educational, cultural, and linguistic backgrounds, CHCs offer additional public health services unrelated to direct care, such as health promotion and education, advocacy and intervention, translation and interpretation, and case management. CHCs emphasize empowerment, so they also have programs to help eligible patients apply to federally funded health coverage programs, such as Medicaid.

Additionally, CHCs place great emphasis on meeting community needs. To meet this goal, administrative and health care personnel meet regularly to focus on the health care needs of the particular community that they are trying to serve. Individual CHCs will often provide specialized programs tailored to the populations they serve. These populations could include specific minority groups, the elderly, or the homeless. To determine what the community's needs may be, CHC staff may decide to engage in community-based participatory research. The success of community health centers depends on collaborative relationships with community members, industry, government, hospitals and other health care services and providers.

** add following as subsection under "Services"**

Role of community clinics in Medicaid expansion
'''Community Health Centers strongly align with the objectives of the Affordable Care Act (ACA). The ACA aims to establish a healthcare system that prioritizes patients, extends healthcare services to low-income individuals, and places a great emphasis on preventive care. The patients who visit health centers are considered to be among the most vulnerable populations in the country who face numerous barriers to accessing traditional forms of medical care, such as where they live, their cultural identity, language barriers, and complex health needs. Consequently, the patients who visit health centers are often from low-income backgrounds, uninsured or publicly insured, and from minority communities.'''

During the autumn season of 2017, Medicaid accounted for 44% of the revenue generated by Community Health Centers (CHCs) and was regarded as the primary source of primary care for Medicaid patients. '''One example of CHC that advocates for Medicaid expansion is the Brighter Beginnings Clinic, which originated from an organization in Oakland City that provides social services and case management to low-income populations. Brighter Beginnings Clinic is located close to a low-resource neighborhood where predominantly Black Americans reside and provide comprehensive primary care services, which include general medicine, pediatrics, women's health, family planning, preventive care, chronic disease management, health screenings, as well as mental health services.'''

Immigrants and community health centers
The following subsection comes under the Immigrants and community health centers main section

Asian Health Services[edit]
One example of a community health center that serves immigrants is Asian Health Services (AHS) in Oakland, CA. Asian Health Services aims to provide health, social, and advocacy services for the immigrant and refugee Asian community by entailing many of the strategies previously discussed. Additionally, they provide primary care services, including mental health, case management, nutrition, and dental care in English and 14 languages: Korean, ASL, Lao, Burmese, Mandarin, Cantonese, French, Mien, Karen, Mongolian, Karenni, Tagalog, Khmer, and Vietnamese. Their youth program provides services including health education, cultural awareness, job training, and college readiness to East Bay Asian American youth.

Youth Program[edit]
In addition to their main clinic they also have a youth program that attempts to address the stigma about mental and sexual health in Asian culture by recruiting local Asian American youth to get involved with advocacy and create educational resources/workshops surrounding these topics. Many Asian Americans, though a very diverse group, have historically felt discouraged from seeking help for mental health concerns due to stigma and pressure to focus on academic and professional success. Additionally, the “model minority” myth plays a role in Asian Americans not seeking support for mental health.

Asian Health Services Youth Program (AHSYP) attempts to address these concerns using methods that Asian American immigrant youth claim would help. In a study on school-based mental health for Asian American immigrant youth, students suggested engaging students and parents, using peers to share their experiences to reduce stigma, and providing educational videos and materials. AHSYP also provides educational material through its social media outlets and workshops. Revive Chinatown! Crosswalk improvements

Project: Revive Chinatown![edit]
In the early 2000s, Asian Health Services envisioned a project called Revive Chinatown! that would create a safer pedestrian environment, while also transforming Oakland, California Chinatown's commercial district into a regional shopping destination. The key to securing the funding and support for this project was in re-defining the issue from one of public health into one of environmental justice. In doing so, Asian Health Services hoped to address the issue of pedestrian safety by simultaneously working on a long-term solution for increased quality of life. The Revive Chinatown! movement has gained traction and is cited as a success story of a CHC being able to successfully create a more public health-friendly environment, which bolsters their case and contributes to the trend towards further healthcare accessibility by means of CHCs.

Brighter Beginnings

'''One example of CHC that advocates for Medicaid expansion is the Brighter Beginnings Clinic located in Richmond City, which originated from an organization in Oakland City that provides social services and case management to low-income populations. Brighter Beginnings Clinic is located close to a low-resource neighborhood where predominantly Black Americans reside and provide comprehensive primary care services, which include general medicine, pediatrics, women's health, family planning, preventive care, chronic disease management, health screenings, as well as mental health services.'''

Quality of care
Quality of care at CHCs can be assessed through many measurements and indices, including the availability of preventative services, treatment and management of chronic diseases, other health outcomes, cost effectiveness, and patient satisfaction. According to several studies, the quality of care at community health centers is comparable to the quality of care provided by private physicians. However, one major challenge that community health centers face is that the population that they serve is usually dealing with many other factors that can also detrimentally affect their health. As CHCs primarily treat the low-income and uninsured, many of their patients do not regularly see a primary care physician, which can lead to poorer health outcomes. Additionally, there is research to indicate that many CHC patients delay seeking health care because they hold a negative view of the health care safety net and expect discrimination from CHCs.

It is crucial for CHCs to evaluate the quality of care they provide in order to meet federal requirements and to fulfill their mission of eliminating health disparities based on socio-economic and insurance status.

Only recently has an evaluation program been instituted for CHCs. Such a program did exist briefly from 2002 to 2004; the Agency for Healthcare Research and Quality (AHRQ) and HRSA jointly monitored CHC providers. As of 2016, the HRSA utilizes the Uniform Data System to gather performance data from all health center grantees (FQHCs) and their look-alikes, which would include CHCs as well. Reporting instructions for the annual UDS report include information on patient demographics, clinical processes and outcomes, services, costs, and more. UDS data has been used to provide a health center adjusted quartile, which ranks the clinical performance of a health center in comparison to other health centers with similar characteristics such as minorities served, etc. In addition, external organizations such as The Center for Health Design, Kaiser Permanente, and the CDC also offer evaluation tools for CHCs.

It is becoming more difficult for Community Health Centers (CHCs)  to find and retain enough primary care physicians. '''  Many CHCs are already operating at capacity and are unable to accept new patients. CHCs could gain by expanding their non-physician primary care personnel by establishing community outreach clinics in order to satisfy this need and by doing so, CHCs might effectively serve a lot more Medicaid patients. However, physicians and non-physician health professionals were trained to treat varying complexity levels of diseases and do not share the same scope of practice, therefore, federal governments have to provide more funds to CHCs to hire enough physicians to accommodate an increasing number of patients. For example, a CHC located in Richmond city in California Brighter Beginnings Clinic, is facing shortages of healthcare professionals and therefore could not accept new patients until they are able to hire enough healthcare professionals.'''