Abstract
Community health centers (CHCs) provide affordable, accessible care to patients in urban and rural areas across the nation. Health centers must be located in underserved locales, governed by a community-majority board, provide a core set of primary care services, and offer a sliding fee scale to patients under 200% of the federal poverty level (National Associations of Community Health Centers, 2017a). Based on most recent figures, health centers serve more than 25 million patients (1 out of every 15 Americans), 71% of whom are at the 100% federal poverty level and below and 83% are uninsured or publicly insured (NACHC, 2017a). Health centers employ over 8400 mental health and substance abuse staff and provide access to these services in the most underserved communities in the nation. In 2015, over 8.3 million clinic visits were provided for mental health or substance abuse issues; this represents a 56% growth in behavioral health visits since 2010 (NACHC, 2017b).
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Additional Resources
Literature
Engel, J. (2006). Poor people’s medicine: Medicaid and American charity care since 1965. Durham, NC: Duke University Press.
Hoffman, B. (2012). Health care for some: Rights and rationing in the United States since 1930. Chicago, IL: University of Chicago Press.
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Minkler, M., & Wallerstein, N. (Eds.). (2011). Community-based participatory research for health: From process to outcomes. San Francisco, CA: Wiley.
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Electronic Resources
Agency for Healthcare Research and Quality: The Role of Community-Based Participatory Research. https://archive.ahrq.gov/research/cbprrole.htm
Community-Campus Partnerships for Health: Community-Based Participatory Research. https://depts.washington.edu/ccph/commbas.html
Health Resources Services Administration: Federal Office of Rural Health Policy. https://www.hrsa.gov/ruralhealth
Measures/Instruments
Alcohol Use Disorders Identification Test (AUDIT). https://www.drugabuse.gov/sites/default/files/files/AUDIT.pdf
Anxiety: Generalized Anxiety Disorder 7-Item Scale (GAD-7). http://www.phqscreeners.com/sites/g/files/g10016261/f/201412/GAD-7_English.pdf
CAGE AID Questionnaire. http://www.integration.samhsa.gov/images/res/CAGEAID.pdf
Depression: Patient Health Questionnaire 9 (PHQ-9). http://www.phqscreeners.com/sites/g/files/g10016261/f/201412/PHQ-9_English.pdf
Drug Abuse Screen Test (DAST—10). https://www.drugabuse.gov/sites/default/files/dast-10.pdf
Duke Population Health Profile (Duke-PH). http://www.integration.samhsa.gov/clinical-practice/DukeForm.pdf
Social Determinants of Health/Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE). http://www.nachc.org/research-and-data/prapare/
Suicide Risk: Columbia-Suicide Severity Rating Scale (C-SSRS). http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/, http://www.integration.samhsa.gov/clinical-practice/Columbia_Suicide_Severity_Rating_Scale.pdf
Trauma: PTSD Checklist—Civilian version (PCL-C). https://www.mirecc.va.gov/docs/visn6/3_PTSD_CheckList_and_Scoring.pdf
Organizations/Associations
Health Resources Services Administration: Health Center Program. https://bphc.hrsa.gov
National Association of Community Health Centers. www.nachc.org
National Institute on Minority Health and Health Disparities. https://www.nimhd.nih.gov
RCHN Community Health Foundation. http://www.rchnfoundation.org
The Community Health Center Story. http://www.chcchronicles.org
Glossary of Important Terms for Care in Community Health Centers
- Collaborative care
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The process of working with healthcare providers across disciplines to discuss patient’s diagnoses, treatment options, and interventions and to develop a treatment plan.
- Cost report
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Often used for Medicaid and Medicare reimbursements , a report that includes information about the provider system (e.g., an FQHC), including utilization of services, charges to patients, and cost of services.
- Encounters
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A face-to-face visit between a patient and healthcare provider that must include a treatment intervention and proper documentation.
- Encounter rate
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A facility-specific rate that is paid to an FQHC to cover the cost of services for each valid encounter.
- Federally Qualified Health Center (FQHC)
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A comprehensive healthcare center designed to service underserved populations, typically in areas with limited health resources. FQHCs must offer a sliding fee option to patients without insurance and are eligible for enhanced reimbursement from Medicare and Medicaid.
- Health behaviors
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Practices, habits, and knowledge that can improve a patient’s health.
- Health disparities
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The differences in health status that socially disadvantaged populations experience. Factors that contribute to health disparities include access to healthcare, socioeconomic status, geographic location, race/ethnicity, and gender.
- Population health
-
Factors contributing to the health of (and the health outcomes of) a group of individuals who share a common illness, environment, or social identity.
- Promotora
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A Hispanic/Latino community member who provides basic health education to the population as a trained lay person (not as a professional healthcare worker).
- Rural health clinics
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Public, profit, or nonprofit clinics located in rural, underserved areas to provide primary care services to rural populations .
- Social determinants of health
-
The social, cultural, economic, and environmental factors that contribute to an individual’s health status, including marital status, education, socioeconomic status, and immigration (see PRAPARE in Resources for more details).
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Hodgson, J., Lamson, A., Aamar, R., Limon, F. (2018). Medical Family Therapy in Community Health Centers. In: Mendenhall, T., Lamson, A., Hodgson, J., Baird, M. (eds) Clinical Methods in Medical Family Therapy. Focused Issues in Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-68834-3_13
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