Clinics of Care: Amidst Healthcare Crisis, Widener Serves the Underserved
Melanie Kelner, a senior in the Widener School of Nursing, checks a patient's blood pressure in the Widener Community Nursing Clinic. About 100 students have volunteered n the clinic since it opened in 2011.
By Sam Starnes
On a gray mid-afternoon less than a week before Christmas, men and women line up about twenty deep in a chilly wind and wait on the sidewalk to get inside Cityteam, an aid organization housed in a rehabilitated, red-brick factory building on the corner of Sproul Street and West 7th in the heart of Chester. The crowd is here to pick up fruits and vegetables donated to the needy by local grocery stores and arranged on folding tables in the first-floor hallway.
By 4 p.m., the free food is gone, but another audience begins to appear: Chester residents seeking medical care from the Widener Community Nursing Clinic. The men and women sign their names on a clipboard and take seats in hardback chairs, hoping to get an appointment to see one of two nurse practitioners assisted by registered nurses and Widener nursing students who are on duty to handle non-emergency medical conditions for those without health insurance. Some are residents of the Cityteam shelter, while others walk in off the street.
Mary Franchesi, a Chester resident who will turn 54 only two days after Christmas, sits in a chair outside the triage room where patients have their blood pressure checked and are interviewed and assigned to see a nurse practitioner in one of three rooms upstairs. She says she had health benefits until earlier in the year when a bad back forced her to leave a position working in a local nursing home.
After a few months of being out of work, "My insurance ran out," she says, adding that she has been unable to find another job. Without any income, she can't afford the $78 per month expense of medicine to control her high blood pressure. She is down to a four-day supply. "My birthday is eight days away, and I have nothing."
A friend told her about the Widener clinic. She was happy to learn that the clinic can help her get the blood-pressure medicine she needs either for free or for only $4 per month, depending on her ability to pay. Other services offered by the clinic include diagnosis and treatment of colds, flu, asthma, high blood pressure, diabetes, and other ailments, as well as physicals. "The nursing clinic provides an invaluable service to needy residents of Chester," said Kwinn Tucker, director for Cityteam, which has been working to help the poor in Chester since 1989. "If the clinic didn't exist, most of the people treated here would go without medical care of any kind."
Widener's outreach through clinics encompasses far more than treatment by nursing practitioners. Franchesi is just one of about 2,500 people from Chester and nearby communities who have received a variety of medical and mental health services over the past decade from five Widener clinics that serve the uninsured and underinsured.
The nursing clinic, opened in October 2011, is the newest of the university's clinics; it has treated more than 1,200 people since opening its doors. The other Widener clinics are the Chester Community Physical Therapy Clinic, staffed by faculty and students of the physical therapy doctoral program, and three mental-health-related clinics administered by the Institute of Graduate Clinical Psychology: The Child Therapy Clinic; the Neuropsychology Assessment Center; and the Biofeedback Clinic & Certification Center.
These clinics were inspired in part by the university's Social Work Counseling Services (SWCS), a program founded in 2000 to give Widener social work students counseling experience and serve members of the community. Since its inception, more than 3,000 people have received counseling or participated in programs organized by SWCS, and 200 social work students have served approximately 4,000 people in Chester and surrounding communities. Provost Stephen Wilhite, who served as dean of the School of Human Service Professions during the inception of SWCS and the clinics, said the social work outreach program was very influential on the newer clinics. "It provided an example for us of how clinics could serve the community in a way that would not only benefit residents, but also would provide valuable practical experience for students in professional programs," Wilhite said. "These clinics also present faculty with research opportunities and give them another way to participate in the community through the supervision of students."
All five clinics provide services for either medical or mental health at reduced rates, based on the patients' ability to pay, and the nursing clinic and physical therapy clinic offer free services to those who can't afford any expense. In Chester, where approximately one-third of the city's population lives below the poverty level, Widener healthcare experts said these fill a great need even as the national Affordable Care Act is implemented. "There will always be a need for such clinics," said John Culhane, a Widener Law professor and director of the school's Health Law Institute. "Even if all the pieces of the Affordable Care Act fall into place, there will be a need for community-based services."
A landmark Supreme Court ruling in 2012 upheld the Affordable Care Act, often referred to as Obamacare, but did not require states to extend Medicaid benefits to those below the level eligible for income supplements to pay for the national health insurance. Pennsylvania is one of the states that has not extended its Medicaid benefits, leaving a gap of uninsured in Chester and across the state. "There always has been a misnomer that if you are poor you are eligible for Medicaid," said Dr. Michael Rosko, professor of healthcare management in the School of Business Administration.
But Medicaid benefits in Pennsylvania are actually extended only to the "worthy poor"–those with disabilities or dependent children. "Even if you are dirt poor, you may not qualify," Culhane said.
Culhane said that the Widener clinics also help to allay more expensive healthcare costs absorbed by hospitals and state and local governments. "If these people aren't insured, they show up in emergency rooms and we all pay for it," he said. "Clinics really provide a good alternative to that—it's a great public service they are doing."
In some cases, Widener clinics provide services that health insurance might not cover. "It is a challenge to get insurance for mental healthcare," said Dr. Mary Rourke, an assistant professor of clinical psychology who co-founded Widener's Child Therapy Clinic in 2011.
The Child Therapy Clinic saw children from more than forty families in the first half of the 2013-2014 academic year. "Kids come to us often because there is a lot of conflict in the home or fighting and failing at school," she said. "By working with us weekly, we can decrease conflict and increase performance in school."
Families using the Child Therapy Clinic pay on a sliding scale based on their income, ranging from a minimum of $2 per hour to a maximum of $50 per hour. The average market rate for such care is $150 per hour. "The overwhelming majority of people who see us could not afford to get treatment," Rourke said.
The clinics offering neuropsychology assessment and biofeedback are the oldest of Widener's clinics. Both were founded in 2004 and offer their services on a sliding scale based on a client's income. The Neuropsychology Assessment Center, which does mental health evaluations of about 100 people per year —about 60 percent of whom are children—has seen more than 900 clients since its inception. The center also provides school psychology services to students from the Widener Partnership Charter School. The Biofeedback Clinic and Certification Center has served more than 250 clients since it began. It has also trained nearly 100 psychology doctoral students in biofeedback and has worked with 70 professional psychologists for training and mentoring.
Like mental health services, physical therapy treatment is another service that even those with insurance have a hard time accessing. Factors such as high deductibles, co-pays of $70 or more, and restrictions on the number of visits limit access to physical therapy treatment for many. "Having Widener's clinic makes it possible to extend services to local residents who otherwise could not afford it," said Dr. Jill Black, an assistant professor and pro bono services coordinator for Widener's Institute for Physical Therapy Education.
Started in 2009, the physical therapy clinic has grown under the direction of the program's doctoral students to earn respect nationwide. A total of 174 patients made 2,435 visits in the clinic's first four years of operation. Through donations and hard work by the students, the space in Balin Hall is stocked with exercise equipment and compares favorably with professional physical therapy facilities. All students in the doctoral program have volunteered in the clinic under the supervision of licensed physical therapists. "It's completely student-run," said Caitlin Grobaker, a graduate student in the program. "We make our own funding, and we take care of patients. The fact that we have this clinic, and that it's part of a cycle of our program, is just amazing."
The clinic's success is influencing other universities around the country who view Widener's clinic as a model to follow. Students and faculty in the physical therapy doctoral program have made eight conference presentations about the clinic, and faculty have published two articles in the discipline's leading journal. As many as ten schools with physical therapy doctoral programs are planning to launch similar student-run physical therapy clinics, and Widener alumni are directly involved in assisting two universities with establishing pro bono clinics. The doctoral program also hosts a conference each March for physical therapy programs to learn about the Widener program or to discuss issues with their own clinics. Other initiatives include the launch of a national network of pro bono clinics, a national pro bono physical therapy honor society, and plans to host student-run seminars conducted online. Dr. Scott Voshell, a 2008 alumnus of the Widener program who is now director of rehabilitation at Riddle Hospital in Media, Pennsylvania, said he has witnessed the success of the clinic as chair of the American Physical Therapy Association's Global Health Special Interest Group. "I am privy to watching the growth of student-run physical therapy pro bono clinics," he said, "and Widener is leading the way."
Donations from the physical therapy community have been a big part of the program's success, and more than 25 alumni from the program return to Widener to volunteer at the clinic. Volunteers and donations also help to run the nursing clinic, said Ellen Boyda, coordinator of the family nurse practitioner program for the School of Nursing who founded and directs the nursing clinic. Most of the equipment and medicines in the three treatment rooms at the nursing clinic came from donations. The clinic is seeking more donations and volunteers, with its biggest shortage being in the area of nurse practitioner volunteers.
There is no shortage, however, of people to serve. "If we could have more hours, we could have more patients," Boyda said. "I truly believe there will always be a need for clinics like this one. There are people who fall through the cracks. The need is more than the clinic can ever meet. We may not be able to do everything, but at least we can do something."
–Hannah Dinsmore '14 contributed to this article.