Growing a World of Wellness through Community Cafes' in Camden, NJ

What if we asked families what they needed to strengthen their relationships with their healthcare providers and what if we acted on it?

Photo of Robin Cogan
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

I am a School Nurse and a J&J School Health Fellow. Our J&J team's initiative was founded on the startling data that the ER is used as primary care more than 85% more in Camden City than in the rest of the county. Our goal was to find out directly from our families why they chose the ER over their provider. Our Cafes have been embraced, families have generously shared their perspective. The Camden Coalition of Healthcare Providers is our champion in this important initiative. More work to do!

Which categories describe you? (the answer will not be public)

  • Black or African American (for example: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian)
  • Hispanic, Latinx, or Spanish origin (for example: Mexican, Puerto Rican, Cuba, Salvadoran, Dominican, Colombian)
  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Location: Where is your organization headquartered? [State]

  • New Jersey

Location: Where is your organization headquartered? [City]

Camden

Location: Where is your project primarily creating impact? [State]

  • New Jersey

Location: Where is your project primarily creating impact? [City]

Camden

Problem: What problem is this project trying to address?

Improving communication and relationships between families and healthcare providers is one of the bridges to "Building a Culture of Health" in our community. From a population health/systems perspective we found that the #1 health need was access to care. The fascinating thing was accessing the care was the real issue. We wanted to why this was so. Our Community Cafes were not only well received, but a great vehicle for family empowerment.

School Nurses are front line, in the trenches, healthcare warriors every day in our nation’s schools. The call from RWJF to “Build a Culture of Health” has given rise to community collaborations that spotlight the impact and importance of School Nursing. The last 15 years of my 31 years in Nursing has been as a School Nurse in Camden, NJ. Camden is usually listed as the #1 or #2 most dangerous city, with more than 50% of the population under age 21. 99% of my students qualify for free breakfast and lunch. Needless to say, my role is often primary care to staff, students and families.

For many years, I struggled to feel supported in my work. The isolation led me to create my own network of like-minded healthcare warriors in other school nurses who were as passionate as I was about caring for our kids. It was not until I was accepted in the Johnson & Johnson School Health Leadership Program in the cohort of 2015 that I found the tools I was so desperately seeking.

As part of the J&J Fellowship, you form a team attend and one week summer Institute in New Brunswick, NJ. My team attended this past summer of 2015. During the Institute, we were immersed in leadership training, exposed to current research in School Nursing practice and are supported in exploring what it means to be a Health Leader in your school community. I felt like somehow my passion to be a School Nurse was reignited during that week. My reset button was pushed and our toolbox was restocked.

The initiative that my team chose was based on the Camden County Health Assessment from 2013. It revealed that Camden residents were using the ER as Primary care at an astronomical rate, but at the same time, it showed that there were more Healthcare providers in the city than anywhere else in the County. That was an intriguing comparison; there were more than enough providers but they were not being accessed. Access to care was not the issue; it was accessing the care that was the problem. Our project took shape based on this one question. Why, in a City with more providers than expected, would residents still be using the ER for primary care?

As School Nurses, we could have given you our top 10 reasons, but as newly minted Health Leaders, we knew we had to find out from the perspective of the families. Culturally informed, patient/family centered care was the foundation in which we began our inquiry. We researched an evidence-based tool to collect our data. We chose to use a “Community Café” model in which to host structured conversations with our parents to find out what barriers to care they were experiencing.

Our findings will be on display in June because our initiative has been accepted as a Poster presentation for NASN’s National Conference in Indiana. Beyond that wonderful privilege the scope of our project is expanding to include the other Nurses in my district. My team collaborated with the Camden Coalition of Healthcare Providers to share our Café findings the themes identified to improve relationships with primary care providers so that our students will have improved health outcomes and improved school attendance. Closing the achievement gap is directly related to school attendance and School Nurses have an important role in supporting school attendance through school health services.

By stepping outside of the Health Office and seeking a collaborative relationship, we were able to partner with the Camden Coalition on a larger pilot project that will share access to health records and school forms with School Nurses and Primary Care Providers. Coordinating care and ensuring continuity of care is a key component in providing the best outcomes for our students. Beth Mattey, President of NASN has been generous in her support of our pilot project along with the Camden Coalition of Healthcare Providers. A similar initiative was successfully implemented with DE School Nurses and Nemours Hospital for Children. The outreach from NASN and J&J School Health Leadership Program has enabled our initial initiative to move to a larger scale pilot project that we hope to begin in the Fall of 2016.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Children who are differently abled
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Community Development and Empowerment
  • Education
  • Mental Health

Year Founded

2015

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

Our model is really based on upstream thinking. When we improve access to healthcare for our families, our children benefit. Healthy children are better learners! The achievement gap can be tackled more successfully when our students are healthy and ready to learn.

The key to successful Community Cafes is having a network in which to share the data. Our team has this ability through our collaboration with the Camden Coalition of Healthcare Providers. One mom who attended a Cafe sought out my help after her employer mistakenly believed her medical excuse note was fraudulent. She asked for help, we contacted both the provider and the employer and the mother's job was saved. Imagine if that mom had not asked for our help!

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

The following themes were identified during our 3 Community Cafes:
Continuity of Care: 67% of parents went to the ER if they could not see their doctor. One father qualified his decision to go the ER for primary care by explaining that if he was not able to see the doctor of his choosing and would have to explain his history to a new person anyway, why not go to the ER.

Front Desk Dysfunction : 55% of parents make appointments in person vs. by phone. The majority of the participants said that either no one picked up or that they did not speak their language (primarily Spanish). The frustration led them to going in person to make future appointments.

 Communication with School Nurse: 100% of parents agreed school forms should be digitally sent to the School Nurses. Providers rely on the parents to bring school forms that should be available electronically. Great solution!

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $1k - $10k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Our need for funding is very limited. We have been giving out $20.00 gift card to our participants, but that is not a necessity. We also have been providing healthy snacks, which are always appreciated. The beauty of the project is that it can be run with very little funding. Our initial mini-grant was $1200.00 and we still have some leftover after running 3 Cafes.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

The Community Cafe Initiative is an empowerment tool to build capacity within a group. It is an evidence-based intervention that is used in many communities. What makes our specific contribution unique is that our focus is on improving relationships between families and providers. We are then taking the data and sharing it with the providers directly through the Camden Coalition of Healthcare Providers. That step is probably what makes our initiative so unique. The data is used to inform the providers how their patients, our families are making decisions about their healthcare.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

Improving relationships between families and healthcare providers will create a bridge to family centered healthcare collaborative approach to wellness. Population Health is viewed from a systems approach. Clearly the healthcare system is in need of reframing from the family/community perspective. Our families are experts in what works and what does not work for them. Being culturally informed, asking the families to share in the redesign process, is an enriching experience for all parties involved. Inevitably the children will benefit because healthy children are better learners.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Twitter

Referral: If you discovered the Challenge thanks to an organization or person other than Ashoka, who was it? (the answer will not be public)

Beth Mattey, the President of NASN tweeted about this challenge!

Evaluation results

5 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 0%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 20%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 80%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 0%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 80%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 20%

2 - It’s a good project, but I’ve seen others like it before. - 0%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 0%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 0%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 80%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 20%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 0%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 0%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 20%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 60%

2 - I liked it fine but preferred others. - 20%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 66.7%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 100%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 33.3%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 100%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 0%

Nothing stands out! I thought it was great. - 0%

4 comments

Join the conversation:

Comment
Photo of Andre
Team

Robin, noble work you are doing in Camden.  I recently led the effort in Spokane, WA for a Promise Zone designation, in which we were named a finalist but ultimately were not chosen.  I do know that Camden was selected as a PZ in the second round, and I have a colleague who just visited Camden last week.  It sounds like the ball is finally starting to roll in the right direction there.  Being that Camden was selected as a PZ you must have a number of opportunities for funding, and preference for that funding given your status as a PZ.  Is your organization (school district?) an implementation partner?

Andre Wicks 

Photo of Meghan
Team

This is a truly great effort you've made, and congratulations on your abstract's acceptance for poster presentation at the NASN meeting. I would suggest also looking into Eastern Society for Pediatric Research Annual Meeting in Philadelphia, PA in March (https://www.aps-spr.org/regions/ESPR/). The fact that you conducted this project with patients/caregivers as partners is powerful, and this meeting can help give your work a bigger audience in the medical community (this is of interest to ER and primary care docs, and others too). As Maud suggested below, maybe some medical or MPH students can help collect more data and work up another abstract. The ESPR meeting is a really great starting point as it is full of medical students, residents, and other trainees who don't have a ton of experience presenting at national meetings. 

Photo of Maud Schaafsma
Team

Robin,
This is a wonderful grassroots effort to solve a complicated social/medical problem. You have done a great job in bringing parents together to uncover a deeper understanding of why individual physicians do not meet their families' medical needs.  And you are doing the right things in creating a strong social network of organizations that can work together on these problems in Camden.  You should be proud of what you have accomplished.

The next challenge is to communicate this information about cultural obstacles to obtaining medical care from "medial home physicians" to the physicians in a way that they can absorb information about how they contribute to families seeking ER care. It would be interesting to know something about the response you hear from the Camden Coalition of Healthcare Providers. Are they responsive to changing their habits in building patient relationships and scheduling appointments?  This could be a big cultural divide.  Would medical care for children improve if you can persuade a group of pediatricians to establish in-school clinics - that would be accessible to parents and children?  You might need additional data on urban health problems of the population of children you want to serve - asthma, diabetes, depression, weight problems.  And show how children with these diseases/ illnesses  have better outcomes when they have immediate and consistent health care. In-school health care could be delivered at a lower cost - with better preventive care - than visits to the ER. 

Maybe there is a medical school or school of Public Health where you can find a couple of med students, MA or PhD students who can work with you to collect this data and help you report it to the Camden medical community. See Cooper Medical School in Camden: Dean Annette C. Reboli, MD
Reboli@rowan.edu, phone:
 (856) 361-2800 
 

Photo of Ivette
Team

Robin, I appreciate that you   describe your personal journey, the struggles you faced, I can sense your resilience and persistence in finding an opening for your vision, and most importantly your genuine caring for others. I believe that this is what matters the most.