This story was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Saint Anthony Hospital (SAH) is an independent nonprofit community hospital serving the city of Chicago’s west and southwest sides. SAH plays a vital role in facilitating access to medical care for marginalized community residents. Only 1% of the hospital’s inpatient stays are funded through commercial insurance, while slightly over half are covered through Medicaid. An additional quarter are covered through Medicare, and almost 15% are covered through self-pay and charity care. 

These statistics provide a snapshot of the level of need within the communities that SAH serves. Community residents of Chicago’s west and southwest sides are disproportionately impacted by poverty, unemployment and underemployment, challenges with attaining affordable housing, community violence, and limited access to social services within close geographic proximity.

Therefore, SAH strives to both facilitate access to high-quality medical care for underserved community residents, and to address the psychosocial and emotional needs of individuals and families whose options for accessing these supports within their home communities is severely limited. For more than two decades, SAH has demonstrated its commitment to promoting the holistic wellness of community residents through its creation of and continued investment in the Community Wellness Program.

Funding Sources for Inpatient Stays

Recognizing the demand for emotional and psychosocial supportive services among community residents in the hospital’s catchment areas in the late 1990s, SAH developed a small, community resource center in the Little Village neighborhood. Little Village, the southwest side neighborhood where SAH is located, is home to a predominantly Mexican immigrant population. Prior to the opening of the community resource center, community residents had little to no options for accessing services that addressed their emotional and psychosocial needs.

The opening of the community resource center in Little Village marked the beginning of SAH’s investment in its Community Wellness Program (CWP). The CWP is a fully funded department of the hospital and has expanded to include two community centers in the Little Village and North Lawndale neighborhoods, as well as two satellite locations, one in Brighton Park and Gage Park, staffed by over 20 full-time professionals. Through these community-based locations, the CWP offers a range of free social services to residents on Chicago’s west and southwest sides. Programming at the CWP is informed by ongoing community assessments and is intentionally designed to address the context-specific service needs of community residents. Programming focuses on four primary areas: mental health service delivery; parenting support; health care access and navigation; and health education.

Services are culturally affirming and aligned with program participants’ service needs in the context of the local community and larger sociopolitical environments in which they are situated. The North Lawndale community center, for example, is located in the Dr. King Legacy Apartments built on the site where Dr. Martin Luther King lived with his family in 1966 when he was campaigning for racial justice as part of the Chicago Freedom Movement. Services at the Little Village community center are tailored to address the needs of the predominantly Mexican immigrant population whom it serves.

Among other services, the center provides free mental health services to uninsured Latino immigrant adults. The mental health services are culturally attuned, trauma-focused and long-term. Providers recognize the importance of providing bilingual and culturally affirming services, a fact that is clear from the moment that community residents enter the center’s waiting area and are greeted with a vibrant mural of Our Lady of Guadalupe.

In addition, the range of services that are offered on-site reflects the understanding that community residents’ emotional, psychosocial and medical needs are integrally connected.

Outcomes

Qualitative research exploring mental health program participants’ experiences of service delivery at the Little Village community resource center has documented that program services promote holistic wellness among individuals, families and the community as a whole. Program participants described how they observed positive changes across all aspects of their lives as a result of participating in services through the Community Wellness Program:

Furthermore, mental health service participants identified that the range of services offered through the Community Wellness Program allowed them to address a range of psychosocial and medical needs that are connected to their emotional wellness.

Community residents identify SAH’s Community Wellness Program as providing an invaluable source of support in addressing their holistic service needs.

As the Community Wellness Program expanded beyond its original location in the Little Village community resource center, it demonstrated the same commitment to delivering services aligned with the experiences of community residents. An evolving understanding of the lived realities of the predominantly African-American population in Chicago’s west side neighborhoods continues to inform service delivery at the community center in the North Lawndale neighborhood since it opened in 2013. Upon establishing mental health services at the center in 2014, a community mental health needs assessment was conducted to shape the mental health services provided. The community mental health needs assessment explored residents’ experiences with mental health service providers, as well as mental health overall. Through discussions with community residents and providers, one of the primary concerns that emerged was the importance of family members’ emotional wellness and of intergenerational health needs. More importantly, residents identified a long-standing, complex mistrust of the mental health industry as a response to the history of harm by intrusive, pathologizing services. In response to these kinds of stories from community residents, the North Lawndale community center makes developing trusting relationships central to its model of service delivery.

Responding to Continued Need

Saint Anthony Hospital’s 2015 Community Health Needs Assessment (CHNA) served as another opportunity to revisit community needs in an intentional way. In the true spirit of our community-oriented approach, after survey findings were shared with the hospital leadership, we invited partner organizations and key stakeholders to the table to define the key priority areas of investment of the Community Wellness Program based on the data. Over 120 representatives from organizations throughout the city packed the gymnasium at Arturo Velazquez Westside Technical Institute where the findings of the CHNA were shared with partners. 

At the end of the presentation, participants were asked to rate the “scope and severity” and “ability to impact” for each of the identified health issues. After the analysis was completed, the following six issues rated above eight on a 10-point scale: diabetes; mental health; nutrition, physical activity, and weight; access to health care services; infant health; and injury and violence. Of these six areas, the Community Wellness Program already had programming to support community residents in all areas except one, injury and violence.

Chicago’s west and southwest sides unfortunately have been plagued by violence, and the response to those who have been affected is dismal. Building upon the success of our service delivery model in 2017, the Community Wellness Program applied for and was awarded a million-dollar federal grant to add additional capacity.

This funding will allow us to hire 13 additional mental health clinicians, case workers, supervisors and community organizers to develop community-based healing spaces with community partners, in order to serve individuals and families that have been impacted by community violence. We seek to build these supports embedded in the communities hardest hit by community violence, in neighborhoods where socio-emotional supports are limited, and firearms are easily accessible.

Implications for Hospitals Nationwide

Recognizing that community residents in the hospital’s catchment areas face multiple barriers to accessing medical, emotional and psychosocial support services in the local community and broader sociopolitical contexts where they live, Saint Anthony Hospital has invested in a broad-based community health initiative to facilitate service access to marginalized and underserved populations. The model of service delivery implemented through this program can be translated to hospitals across the nation. By engaging in ongoing assessment and investing in free supportive services aligned with community residents’ context-specific needs, hospitals can play an invaluable role in promoting holistic wellness and health equity within marginalized and underserved communities. Leading the way locally, Saint Anthony Hospital maintains a high-priority investment in the Community Wellness Program model by maintaining it as a continued part of its operating budget, with $1.7 million invested annually in providing free socio-emotional resources to those in highest need on Chicago’s west and southwest sides.