Size and Diversity of Inland Empire Requires Creative Approaches to Health Care
 an Bernardino and Riverside counties – often referred to as California’s Inland Empire – account for approximately 10 percent of the state’s population. They cover a vast geographic area that incorporates rapidly growing urban and suburban communities, miles of sparsely populated desert, and isolated rural mountain communities. Fifteen percent of households live below the poverty line and 23 percent have no health insurance. It is also a region where the development of nonprofit health care infrastructure has not kept pace with its rapid population growth.
 These factors combine to create a challenging environment for community-based organizations that offer preventive health services.
“In the Inland Empire, many organizations work hard to overcome barriers to providing access to health care such as geographic isolation or heavy reliance upon jobs in industries that don’t provide health benefits,” said Gary L. Yates, president and CEO of The California Wellness Foundation (TCWF). “With its grantmaking, the Foundation can provide financial resources to support the provision of services that can improve the health of underserved populations in the region.”
TCWF’s core operating support grants have funded organizations throughout the region to provide health care services, build community leadership to address health concerns, and improve organizational capacity to deliver services. The following are several examples of how organizations have used this type of support to provide health services for underserved populations in the Inland Empire.
Preventive Health Screenings for Children
Many Californians know Big Bear Lake as a resort destination high in the San Bernardino Mountains, famous for its skiing in the winter and a variety of other outdoor recreational activities throughout the year. But it is also the year-round home for about 20,000 people, many of whom rely on the resort and tourism industries for employment. Over the course of the year, many families shift among several low-wage, seasonal jobs that lack health insurance benefits for themselves or their families.
The drive to San Bernardino, where many county-provided health services are located, can easily take two hours... and bus service down the mountain is limited. |
Bear Valley Healthy Start is a collaborative effort, staffed by the local school district, that includes health care providers, community-based organizations and local businesses. It is designed to link families to free or low-cost health services and other assistance. Despite declining school enrollment, the district has seen a steady increase in the percentage of children eligible for free or reduced-cost lunches, a key indicator of families at or near the poverty level.
In June 2005, Bear Valley Healthy Start received a three-year core support grant of $150,000 to continue to provide health screenings and medication management for students in the school district and to strengthen its capacity to advocate for improved county services in the community.
A cornerstone of the Healthy Start program is periodic vision, hearing and dental screenings for children attending the district’s elementary schools. Typically offered each fall by health staff and local providers – such as a team of dentists who volunteer their time – the screenings are an opportunity for early detection and diagnosis. District staff then work with parents to help refer them to community-based providers. More than 1,600 students benefit from the Healthy Start screenings each year.
“The buy-in we receive from health professionals and other members of our community is a strength of our collaborative approach,” said Tanya Perry, Healthy Start coordinator. “For example, our partners agree to treat families at the Medi-Cal rate, and our local Lions Club chapter helps supply eyeglasses for children who need them.”
Helping families access services in the community is important in mountainous areas like Big Bear Lake. The drive to San Bernardino, where many county-provided health services are located, can easily take two hours – longer in winter. And for those without access to a car, bus service down the mountain is limited.
To raise awareness of services available in the community, the Healthy Start collaborators stage events such as an annual Community Family Fun Night. Typically scheduled for a Monday afternoon and evening to accommodate resort workers’ schedules, these events include games and activities for children and parents, health information booths, food vendors and other attractions.
“Big Bear Valley Healthy Start’s collaborative approach can have an impact beyond the delivery of health care,” said Sandra Martínez, TCWF program director. “Its collective voice can also help the community advocate with county government for more equitable distribution of its resources to isolated mountain towns.”
Community Voucher Program
 Idyllwild is a small mountain community in Riverside County’s San Jacinto Mountains. Its year-around population of about 3,000 full-time residents relies primarily upon tourism and related service-sector jobs that rarely provide employer-funded health benefits. Many residents juggle several jobs. The area is also seeing an increase in its homeless population, especially in the summer when the climate is more comfortable in the mountains than in the desert below. With no public transportation system or taxi service, low-income residents are isolated from larger population centers where county-funded health services are located.
The Idyllwild Help Center (IHC) was established in 1992 and has since become a lifeline for individuals in need of health care and related services in Idyllwild and in the neighboring mountain communities of Pine Cove, Fern Valley and Mountain Center. The IHC operates a food bank and a thrift store that sells low-cost clothing, and also provides assistance with utility payments and limited emergency housing.
In 2000, IHC was asked by the Idyllwild Community Fund to administer a small grant it had received for health care for those in need. IHC established an innovative voucher program for low-income families that subsidizes the cost of health care services provided in local communities. IHC negotiated with community-based providers to secure reduced rates for treating clients referred through the program. Clients receive the vouchers from IHC and submit them to the health care provider in lieu of payment. The provider then bills IHC directly for reimbursement. Vouchers can also be used to purchase prescription drugs prescribed during the medical visits. IHC also provides vouchers for dental and vision care and other health care needs.
The organization depends upon volunteers to help staff its front desk, saving as much of its funding as possible to provide services. |
For more complicated medical needs that can’t be treated locally, IHC provides gas vouchers to help cover the cost of transit to county-funded community health centers in Hemet or Riverside.
In September 2004, IHC was awarded a three-year core support grant of $100,000 to continue to provide its voucher program that serves almost 200 individuals each year.
“IHC effectively built upon the strengths of its close-knit community to provide access to health care that is free or low-cost, as well as convenient,” said TCWF’s Martínez. “Working adults don’t have to miss a full day of work to travel long distances for routine health care.”
The organization has successfully mobilized the community to help make the voucher program a success. For example, school nurses identify families that may have unmet health needs and refer them to IHC for assistance. And the organization depends upon volunteers to help staff its front desk and the thrift store, saving as much of its funding as possible to provide services. IHC also sponsors periodic health fairs that draw more than 100 visitors.
“We have a strong sense of community here,” said Sandy DeMann, coordinator of the voucher program. “We work together to support people in need.”
Early Detection of Breast and Cervical Cancer
 For Moreno Valley-based Quinn Community Outreach Corporation (QCOC), geographic isolation isn’t typically a factor. The organization provides services throughout San Bernardino and Riverside counties, frequently through religious congregations. But because social and cultural barriers are frequent obstacles in programs designed to increase awareness regarding breast and cervical cancer among African-American women and Latinas, the corporation’s Southern California Witness Project (SCWP) is designed to meet this need.
In church, we witness to save souls. In the Witness Project, we witness to save lives. |
“The mainstream breast cancer field has experienced significant challenges in educating women of color about preventive breast health,” said TCWF Program Director Saba Brelvi. “This is in spite of research that indicates that African-American women and Latinas have later detection and higher mortality rates from breast and cervical cancer than their Caucasian peers.”
 In December 2004, QCOC received a three-year, $95,000 core support grant from TCWF to continue to provide the SCWP program and to develop a plan to diversify the program’s funding.
The SCWP builds on a national model developed at the University of Arkansas and implemented throughout the country in conjunction with the African Methodist Episcopal Church. At SCWP’s group sessions, Witness Role Models – women with cancer or cancer survivors who have received training in telling their stories – share their experiences with cancer. By sharing how they navigated the health care system and proving that cancer isn’t an automatic death sentence, they are powerful role models for women, encouraging them to take steps to protect their own health. More than 100 of the group sessions are held throughout the region each year.
“In church, we witness to save souls,” said Eudora Mitchell, president of QCOC. “In the Witness Project, we witness to save lives.”
At each session the role models are paired with Lay Health Advisors who discuss facts and myths about cancer and demonstrate breast self-exams using ethnic breast models. Participants are able to feel what different types of tumors feel like.
Follow-up attention is given to each workshop participant. The program coordinator telephones all women to answer any remaining questions or concerns and to offer referrals to mammogram services. SCWP also sponsors periodic One Stop Health Workshops at locations throughout the Inland Empire where women can receive both clinical breast exams and mammograms free of charge.
The national Witness Project model was designed to serve African-American women; however, recognizing that early detection rates among Latinas are also low, SCWP is piloting a new program model for that community – Esperanza Y Vida (Hope and Life).
Both programs depend on a base of committed volunteers, many of whom have been with the program since its inception, according to Mitchell. In addition to the personal benefits many women experience by sharing their stories with others, they develop important leadership and advocacy skills.
For information about the organizations in this article, please contact:
Bear Valley Healthy Start
www.bigbear.k12.ca.us
Idyllwild HELP Center
(909) 659-2110
Quinn Community Outreach Corporation
(951) 485-9334 |
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