Inner-City Health Care Center Provides Essential Health Services
The Ounce of Prevention Fund, a public/private partnership that promotes the well-being of children in Illinois, established a maternal and child health care center at the Robert Taylor Homes, a public housing complex in Chicago.
The health center was part of a larger program called the Center for Successful Child Development (CSCD), which provided home visitors, family support services and early childhood education to young mothers and their children living in isolation and poverty.
Project and clinic staff:
- Established an on-site maternal and child health center at one of the housing complex apartment buildings and served 1,054 women and children.
- Provided prenatal services, pediatric care, laboratory services, patient education on health issues, and referrals for high-risk pregnancies and specialty care. Staff also monitored the health and development of children in CSCD's day care program.
- Conducted prenatal groups for expectant parents and a parenting peer support group.
- Provided health care services to about 3,400 women and children.
- Relocated to new facilities two blocks away and finalized a partnership with the Cook County health system to assume responsibility for the health care center.
- Became self-sufficient through Medicaid reimbursement and other funding.
- Provided expanded mental health services through a full-time social worker, consulting psychologists and childhood development specialists.
- Provided therapeutic early intervention services for children with developmental delays.
The Robert Wood Johnson Foundation (RWJF) supported this project with two grants totaling $2 million from March 1988 to June 2000.
The Robert Taylor Homes are a series of high-rise public housing buildings in Chicago. During the 1980s, the complex was known for gang and drug activity. The area had often been the scene of shootings and other violence; many parents kept their children inside or only allowed them to play on apartment balconies. Single women, many of whom were adolescents, headed three-quarters of the households. Teenagers often did not finish school; one neighborhood high school reported a 60 percent drop out rate.
In 1986, the Center for Successful Child Development (CSCD) was launched by the Ounce of Prevention Fund, a public/private partnership, and the Chicago Urban League, a community-based organization working in the areas of education, economic development and community empowerment for African Americans, other minorities and the poor. With matching funds from the U.S. Department of Health and Human Services, CSCD was intended to serve young mothers and their infants living in poverty and social isolation. The goal was to provide children with the support and facilities that they needed to develop and participate fully in school, and to help their parents build on their strengths as individuals and parents. The project built upon a growing body of research that pointed to the critical role of the first three years of life in the child's development.
The targeted families lived in six of the Robert Taylor buildings. Key components of the project included:
- Home visits by trained staff who provided education in prenatal care, nutrition and infant and child care.
- Center-based family support services, including a drop-in center for pregnant and parenting women.
- Early childhood education.
The project recruited women who lived in the housing complexes to serve as "family advocates." These women received some training and made home visits to encourage pregnant women and mothers to take part in the CSCD services.
While CSCD provided social services, it had no medical services to offer families. Robert Taylor Homes are located within an area that has one of the highest infant mortality rates in the city and state. In addition, 37 percent of all births recorded in the Robert Taylor Homes were to teens, who represent one of the highest risk groups for delivering low-birthweight infants. Many young women did not seek prenatal care, putting their children at risk for complications and developmental delays later in their lives.
In the early 1980s, the Ounce of Prevention Fund received grants from RWJF to set up two of the first school-based health clinics in the country (ID#s 009872, 010355, 010578 and 011238). The clinics were located at high schools serving the Robert Taylor Homes.
These grants from RWJF supported the establishment of a maternal and child health care center at the Robert Taylor Homes.The first grant (ID# 012955) supported the development of a primary care clinic and medical program at the CSCD, which was located in a renovated floor of one apartment building in the housing complex. The primary health care center would provide maternal and child health care services to pregnant and parenting women with children ages six and under, and it would be linked to CSCD's other services, including early childhood education and parent support.
The second grant (ID# 013473) continued funding the primary health care program, with an emphasis on increasing clinic utilization and substance abuse and mental health interventions. Staff had learned that about half of the mothers had substance abuse problems. A number of the mothers and children had mental health issues as well.
CSCD eventually phased out the use of family advocates hired from the housing complexes. Project staff found that the women lacked sufficient training to recognize and address the myriad issues facing the mothers and children in the complex. Instead, the project sent interdisciplinary professionals teams into the homes to talk with mothers and conduct assessments.
The CSCD received $13 million in funding from public sources, including the U.S. Department of Health and Human Services ($5,792,359) and Illinois Department of Children and Family Services ($2,275,495) and $2.4 million from private foundations and companies, including The Harris Foundation ($640,479) and Families with a Future ($224,528).
Results: ID# 012955
- Established an on-site maternal and child medical clinic at one of the Robert Taylor housing complex apartment buildings. During the five-and-a-half year grant period, the clinic served 1,054 women and children.The clinic staff, which included nurse practitioners, midwives, and physicians, provided prenatal services, referrals for high-risk pregnancies, pediatric care, family planning and counseling services, basic laboratory services and health and social services. Nurse practitioners and physicians educated patients about preventive health care and well-baby care for their infants and toddlers. Clinic staff screened all children for developmental delays. More than 30 percent showed some language deficit. Staff referred those with speech problems and other needs to specialty clinics and tertiary hospitals (hospitals that provide highly specialized skills, technology or support services).
- Monitored the health and development of children in the CSCD's day care program. Center staff trained day care staff and family advocates on health issues related to pregnancy, childhood development and parenting, including: prevention of birth defects, nutrition and cooking, child abuse and neglect and safety. The day care program was located on the same floor as the health center.
- Conducted continuous eight-week prenatal educational groups for pregnant women. These sessions provided information about nutrition during pregnancy, anemia, effects of alcohol and substance abuse on the fetus, pre-term labor, breast feeding, infant care and family planning.
- Facilitated a "Knowing Your Child" peer support group which met every other week, for parents of pre-kindergarten children. Staff held other peer support sessions for parents of Head Start children and parents of students at a local elementary school.
Results: ID# 013473
- Relocated the health clinic and other services to new and renovated facilities. Staff decided to relocate in part because any patients coming to the clinic had to cross gang territory, putting them in jeopardy. In addition, the Chicago Housing Authority announced plans to eventually demolish the Robert Taylor Homes. The health center, now named the Hayes Family Center, is located two blocks away in a renovated building in a gang-neutral area. During the six-and-a-half year grant period, 860 women and 2,578 children received services at the clinic.
- Finalized a partnership with the Cook County health system to become the medical provider for CSCD's health center. Cook County provided physicians, nurse practitioners, nurses, medical assistants, and part-time nurse midwives, social workers and child/adolescent psychologists. The Hayes Family Center became self-sufficient through Medicaid reimbursement and other funding, including some continued funding from the Ounce of Prevention Fund.
- Provided expanded mental health services through a full time social worker, consulting psychologists and childhood development specialists. The program started Early Childhood Group Therapy, which works with children between the ages of three and six. Children who were depressed, inhibited and acting out took part in a small group play therapy for about one hour, twice a week. A full-time social worker provided direct counseling and services to children and their families.
- Provided substance abuse training to staff. Working with a nonprofit treatment organization, the clinic also identified parents with potential substance abuse issues and developed treatment plans for them.
- Began providing therapeutic early intervention services for children with developmental delays so that their parents would not have to travel for such services. Project staff had learned that parents were much less likely to follow through on treatment referrals if they had to travel outside their community. The project and Cook County established a developmental assessment clinic at the health center, which was offered twice a month. A speech therapist provided therapy to children diagnosed with speech and language delays or problems.
According to project personnel, the stability afforded by RWJF's extended support over more than a decade allowed CSCD to augment its programs beyond the health center created under the grants reported here. During the period of RWJF support, CSCD also:
- Expanded its child-care programs, opening an Infant-Toddler Center in 1989, a full day Head Start program in 1991 and a new federal Early Head Start program in 1995. The Early Head Start program provided funding to work with pregnant women and families with children younger than three years of age.
- In 2000, CSCD opened an Educare Center that provides full-day, full-year developmental child-care to infants and toddlers and their families from three months to five years of age. The new center, located at a renovated school a few blocks away from the Robert Taylor Homes, brought together all of CSCD's child-care programs in one place by combining several funding streams, including Head Start, Early Head Start and state and private funds.
CSCD and the primary health care center were featured in articles in the New York Times and the Chicago Tribune. Project staff made presentations to national conferences including the 1997 White House Conference on Early Learning.
- To work with children effectively, you have to work with parents and give them a sense of hope and opportunity. The schools or the department of children's services cannot be a surrogate for parents. In addition, a rebellious 16 or 17 year-old with children who has had a tough life is not interested in having someone instruct her. However, giving her hope can work. Helping her understand that she can complete high school—that it's within her capacity—may be difficult to impart, but it is absolutely critical if the program is going to help the children. (RWJF Program Officer)
- In funding the broad area of family development, it is critical to bring together all of the responsible parties in the public sector, such as the welfare department, the department of health and the education department as this grantee did. These organizations need to talk to each other if any lasting change is to occur. (RWJF Program Officer)
AFTER THE GRANT
The Hayes Family Center health clinic is now run by the Cook County health system. The clinic continues to see patients from the surrounding community and the Robert Taylor Homes, which are in the process of being demolished. CSCD's other activities continue through the Educare center, which is located about a block and a half away. The Educare Center model is being replicated at sites in Omaha, Neb., Milwaukee, Wis., and Atlanta.
The Ounce of Prevention Fund has received an additional RWJF grant (see Grant Results on ID# 038175) to conduct a statewide initiative to improve coordination of disparate preventive care services available to children ages three and younger and their families. Under the project, countywide networks of health and family service agencies will identify, assess and enroll target families in programs to ensure that children receive comprehensive services, including immunizations, nutrition and developmental services.
GRANT DETAILS & CONTACT INFORMATION
Health Component of a Project for Children in Deprived Communities
Ounce of Prevention Fund (Chicago, IL)
- Health Component of a Project for Children in Deprived Communities
Amount: $ 1,000,000
Dates: March 1988 to October 1993
- Health Component of a Support Services Program for Inner-City Families
Amount: $ 1,000,000
Dates: November 1993 to June 2000
Report prepared by: Susan G. Parker
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Terrance Keenan