University of Texas at Dallas student Sana Iqbal participated in Baylor Scott & White Health’s Community Advocates Program, which connects hospital patients from underserved communities with much-needed social services.

Baylor Scott & White Health is working hard to address health care inequality across Texas with its Community Advocates Program

by David Buice, Special Contributor | May 2, 2019

When Sana Iqbal enrolled as a freshman at the University of Texas at Dallas, she had no idea what she wanted to major in. The only thing she knew for certain was that after graduation she wanted to be part of some sort of cause — something that went beyond personal ambition. These feelings eventually led her to major in health care management with a minor in public health.

Iqbal then learned about Baylor Scott & White’s Community Advocates Program, which connects hospital patients from underserved communities with much-needed social services available in their communities. Realizing that participation in such a program would complement her academic work, she volunteered and was accepted. Following her initial training, she worked in the Emergency Department at Baylor Scott & White Medical Center – Carrollton. There Iqbal came under the tutelage of Anne Horton, a Primary Care Connect Social Worker at the medical center, and came to learn the complex, daily challenges of providing patient care in a busy Emergency Department.

During the three semesters Iqbal spent at Baylor Scott & White – Carrollton, she encountered situations impossible to duplicate in the classroom. She found that while it’s one thing to study in an academic setting the medical needs of underserved individuals, it’s quite another to actually face a desperate mother who can’t feed her newborn child, or a father in tears because he’s unable to care for his family.

“Serving as a Community Advocate allowed me to experience what it truly means to deliver compassionate and comprehensive care,” Iqbal says. “Helping patients find a way to pay their bills, get a doctor’s appointment that they weren’t able to get before or secure a meal for their families for the next month was the best feeling.”

Iqbal’s experience is the result of a comprehensive, decades-long Baylor Scott & White Health initiative to study existing health care inequalities in North and Central Texas and strengthen these communities by improving health care access, especially among traditionally underserved sectors of the population. To that end, Baylor Scott & White Health has established relationships with 750 organizations in its service area — from McKinney in the north to Austin in the south — fostering collaboration and innovation to best meet the needs of the area’s population.

Baylor Scott & White Health’s ultimate goal is to use this vast array of information to devise innovative new programs aimed at improving the delivery of health care to individual communities. “We want to think globally but act locally to find the health care programs that are right for a particular community and its specific needs,” explains Niki Shah, Baylor Scott & White Health’s Vice President for Community Health.

This nearly 20-year effort has led to the creation of several new Baylor Scott & White Health community impact initiatives, including the multifaceted Community Advocates Program.

The origins of the Community Advocates program

The seeds of the Community Advocates Program were planted in 2016, when Baylor Scott & White Health officials collaborated with a national healthcare organization. The organization had developed a model program to connect hospital patients with an array of social services available in their communities and create improved health care outcomes.

Baylor Scott & White Health adopted this model, tailored it to meet staff needs and became the first hospital system in the nation to implement the revised version of this program in Emergency Departments, among other clinical settings. The Community Advocates Program brings together student volunteers, clinical and front-line staff, university collaborators and key community organizations to meet the basic social needs of a vulnerable patient population and create a pipeline of future professionals to serve in the health care field.

Making community connections

Baylor Scott & White Health’s Community Advocates Program is focused on achieving several outcomes. First, the program seeks to connect patients — especially those in traditionally underserved communities — with the many social and government services available to them outside the hospital, from food banks and homeless shelters to counseling facilities, along with detailed support and instructions on gaining access to these services. Without this critical service, these patients may go hungry, be unable to find shelter in a safe place or otherwise face deprivation or peril. By creating sustainable, high-impact and cost-effective interventions, Baylor Scott & White Health hopes to create a decline in Emergency Room readmission rates.

Additionally, the program serves as a career-building training ground and pipeline for future health care professionals. Ideally, the experience of working as a Community Advocate will lead some student volunteers into careers in health care. Even if they do not become health care professionals, their volunteer experiences will greatly enrich their educational lives and raise their awareness of the most pressing health-related needs of at-risk communities.

Volunteer recruitment and training

Volunteers for the Community Advocates Program are all students attending area universities, including the University of North Texas, the University of Texas at Dallas, Baylor University and the University of Mary Hardin-Baylor.

All volunteers, both undergraduate and graduate students, must be at least 17 years old. They come from a variety of academic backgrounds, from math to theology, but all share a passion for serving their communities. To be accepted into the program, each aspiring Community Advocate must submit an application and resume, undergo a background check and pass a rigorous interview in which he or she is expected to demonstrate a high level of professional acumen. Finally, all volunteers are asked to make a two-semester commitment to the program.

Those who are admitted go through an intense one-day “boot camp” complete with role-playing scenarios that replicate the kinds of encounters they’re most likely to have with patients. Next, program volunteers spend about six weeks shadowing experienced clinicians in Baylor Scott & White Health Emergency Departments in order to gain valuable knowledge about the demands and challenges of patient care while becoming proficient in social needs screening, navigation processes, ongoing patient contact and documentation in the electronic medical record. 

Early successes

26 student volunteers currently participate in the Community Advocates Program, and their work goes beyond typical volunteer activities, such as office or clerical work. Instead, they have direct contact with patients, conducting in-depth social needs screenings and providing detailed information that will help patients secure food, shelter, counseling, access to primary care and other vital services, such as resourcing transportation services, ID card services and working to address the needs of the patient’s household.

Emergency Room patients from underserved areas are often reluctant to talk to clinical staff about their difficult life issues, a phenomenon known as “white coat syndrome.” This is not the case with the Community Advocate student volunteers, however. Approximately 90 percent of patients from underserved communities have willingly interacted with Community Advocates.

Of the almost 800 patients screened by volunteers to date, 80.3 percent had at least one social need, and 56.3 percent accepted assistance from student volunteers to connect them to outside social service organizations. Most impressively, the readmission rate of those receiving assistance through the Community Advocates Program has dropped, with only 19 percent of patients returning to the Emergency Department within 30 days of their initial visits with an advocate.

Looking to the future

In light of the Community Advocates Program’s initial success, Baylor Scott & White Health intends to place Community Advocates in additional Emergency Departments in its system. It will also act collaboratively with other health care organizations throughout the nation to establish programs based on the Baylor Scott & White Health model.

In addition to the Community Advocates Program, Baylor Scott & White Health has pioneered a variety of other community outreach initiatives including an ongoing Community Health Needs Assessment, a Community Health Workers Program and the establishment of a network of Community/Charitable Clinics. All are rooted in Baylor Scott & White Health’s dedication to providing quality care while improving costs in order to invest in its mission and reduce patients’ financial burden.

For more information about the latest advances in patient care and the many services Baylor Scott & White Health provides its patients, subscribe to the Baylor Scott & White Scrubbing In blog.

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