Consumer Health Foundation

Several years back, I was sitting around a nondescript conference table in a similarly nondescript office building with a group of funders.  I don’t remember the subject of the meeting; however, I vividly recall an exceptional conversation with one of the participants, a young woman sitting to my left.  What attracted me to her was the tattoo on her arm — not only because she was a funder with a tattoo, but because the tattoo had the mathematical symbol for 'E to the x' — E^x — lodged inside a red heart.  I racked my brain to try and figure it out.  No such luck.  As soon as we had our break I turned to her and asked the obvious question.  What does it mean?

A very personal story enfolded which has much less to do with math than it does with wisdom and experience. 

She told me that she left home in her mid-teens.  Living on her own, she struggled a lot.  At the age of 25, she enrolled in college.  She was passionate about being an economics major; however, to accomplish this she needed to pass calculus.  She failed her first test and immediately went to the professor and asked if, statistically, it was possible with the failure to pass the course.  He said she could, but that it would be tough.  That was all she needed to hear.  She partnered with another woman, a friend, who was in the same situation.  Her friend gave her a pencil (which she now treasures) and for days they feverishly worked the equations from every angle.  At a critical moment, one equation became clear to her:  E^x.  That knowledge and clarity turned out to be the breakthrough she needed to understand calculus and meet her goal of passing the course.  In fact, in her words, “I broke the curve on the last test.” 

Her story and metaphor captured my imagination because it made me think about the nature of breakthrough and the forces that support it.  For the young woman, they included amazing drive, a partner, support, “space” to work creatively, the willingness to risk failure, and the knowledge that success was, indeed, more than a possibility.  Her story also demonstrated how her breakthrough in understanding one equation led to her understanding a whole branch of mathematics, i.e., calculus.  Thus, a single breakthrough has the potential to open up all sorts of possibilities.
  
It’s hard to predict those breakthroughs. It is possible, however, to support innovation and a process that can lead to breakthroughs, whether it be theoretical (like the one in the story), or concrete, like so much of the work in which funders and others are involved. 

A core value of philanthropy is to foster and support innovation.  This speaks to the willingness to take risks and to putting ourselves “out there” to do so.  We all will make mistakes along the way, learn from them, and move forward in a much stronger position.  “We will listen and seek wisdom in familiar and unfamiliar places.  This orientation enables philanthropy to lead and “push the edges” in advancing equitable social change by aligning with our many partners in their work to improve the health of our communities. 
 
The Consumer Health Foundation has created a new section on our website called Innovation. Through it we will share what we have learned from others designing and doing creative and effective work in the community. We also intend to advance new thoughts, new ideas.  We will elicit the help of our multiple partners in bringing this work to us.

Stay tuned and have a wonderful summer.

The District of Columbia’s foster care system is a complex bureaucracy in which foster families, as well as older foster youth and young adults who are about to age out of the system, often face significant challenges in getting the important health and social services they need.  Two local organizations, however, have been tireless champions for these families and young adults.   Each group advocates for policy changes that not only increases access to these services, but also improves the system in ways that better meet the respective health, social and economic needs of foster families and young adults.  And, both employ similar strategies:  empowering and training those living in and affected by the foster care system to become strong and effective leaders in advocating for reforms that enhance the health and life outcomes for foster children, older youth and young adults.

For Foster Parents, One Group Goes to Bat

Becoming a foster or adoptive parent presents a complex set of issues: emotional considerations and juggling requirements of courts, social workers, judges, lawyers, and health and social services agencies.  And then, of course, there is caring for the children themselves. 

A significant challenge is navigating the health care system, which can be particularly daunting.  Foster parents may have to track down medical records, a Medicaid card or prescriptions, and often have to piece together an array of primary, mental health and dental care services for a child.

They often need help, and that’s where the Foster & Adoptive Parent Advocacy Center (FAPAC) comes in.

Over the last decade, FAPAC has worked to improve access to health and social services for foster children by identifying problems and improving communications, and simplifying processes within the District’s child welfare system.  During this time, FAPAC has helped to organize coalitions and task groups, bring various groups together, and serve as a grassroots advocate for change. It’s the only organization in the District whose primary purpose is to advocate for systemic reform of the child welfare system.

Giving Foster and Adoptive Parents a Voice

Change within a city-run system on this scale may sound daunting, but FAPAC Director Margie Chalofsky believes that the best approach is an obvious but often overlooked one: training foster and adoptive parents to advocate for children.  “Their voice is critical and had been missing in the child welfare system,” she says. “I’m proud to see them leading the charge for better health and social services.” 

With support from the Consumer Health Foundation, FAPAC has helped to make sure foster and adoptive parents have the tools and resources they need: a Medicaid card, medical records or even access to emergency mental health services in the middle of the night.

FAPAC holds trainings for parents to help them navigate D.C. agencies on topics such as, “Accessing Services for Health and Mental Health Needs” and “Understanding DC and MD Medicaid.”  Another recent training focused on legal issues in the child welfare system and included individual legal counsel by appointment. 

Other trainings, presented by experts in the field, are chosen to address specific issues, such as “Healing the Invisible Wounds: Children’s Exposure to Violence.” Another training for parents and social workers that Chalofsky believes is critically important teaches participants about the lifelong behaviors and characteristics resulting from fetal alcohol syndrome disorders and how to improve health outcomes for children with those disorders. 

She is encouraged by the progress she has seen, but admits that finding resources is a constant challenge.  For example, Chalofsky would like to hold the training on fetal alcohol syndrome disorders regularly, but lacks the necessary funding to be able to do so.

In addition to lack of funding, another challenge is the inherent contradictions in the system itself.  

Chalofsky notes one such Catch 22 for parents:  Foster parents cannot rely on the stipends they receive from providing foster care and must have their own income in order to be eligible to become foster parents.  At the same time, they are responsible for taking the child to medical appointments, meetings with their birth parents, school and agency meetings, and court hearings during the work day, as well as making sure that even teenagers are not alone in the house after school, when they are suspended, or when they are on school vacations. “How can a foster parent hold down a job and be available to this degree 24-7?” she asks.

Wanted: Advocates for the Whole Family

She would also like to see stronger partnerships among parents and social workers, noting another contradiction in the system:  Social workers – who are sometimes closer to the ages of the children than the foster parents – often identify with the child and view themselves exclusively as the advocate for the child.

Instead, Chalofsky says, they should be advocates for the entire family.  “Children need to be part of the family structure, but the current system polarizes the child and makes it harder for them to be part of the family,” she says. 

And exacerbating the conflict, she adds, is the fact that “the system’s instinct is to move them at the first sign of a problem, but with better training and support for parents, that doesn’t have to be the case. In reality, it creates much less trauma to a child to train and support their foster parents than to move them from home to home.”

Change has been slow, but progress steady.

Eight years ago, parents were not receiving basic information on the physical and mental health needs of the children in their care.  Through FAPAC’s advocacy, parents now almost always receive placement packets that include a medical history for the child, and parents know where to turn when they are missing a Medicaid card.  FAPAC also successfully advocated to get an emergency mobile van that provides mental health services after hours, and is working to establish training guidelines for “therapeutic” foster care providers and to create standard of care for children with significant behavioral or mental health issues.

FAPAC’s success is due in part to significant efforts to gain the trust of everyone involved in a complex system.  Having a staff and board comprised of primarily foster and adoptive parents, FAPAC has significant credibility with and the trust of its constituents as well as its partners, in part because “we rarely present a problem without offering a solution,” she explains.   
When FAPAC started, Chalofsky says, she was naïve in thinking the ultimate approach to “system change” was advocating for changes in child welfare policies, when, “in reality, the critical step is to change the institutional mindset.  But that’s still not enough.  Then you need to change what’s expected, and then you need to make sure it’s happening.” 

For Youth Aging Out of Foster Care, the Young Women’s Project Helps Young Adults at Risk

At Antoine McPherson’s first meeting to discuss his transition from foster care to living on his own, he was told that none of the eight people around the table could help him with job leads because of the recession.  He was also given the name of a homeless shelter as a housing option. 

As a young adult in Washington, D.C.’s foster care system, Antoine lives in an apartment with missing doorknobs and a broken lock.  He lives in a high-crime area without access to metro buses or trains, or grocery stores.  He also has no internet access, which makes job hunting difficult.

For older youth in foster care like Antoine – those ages 15 to 21 – these are the everyday realities of the complex child welfare system,   with particular challenges for young adults about to age out of care.  This year, 170 youth will age out of D.C.’s foster care system.   Despite a system that spends up to $100,000 per child per year, foster teens and young adults often lack vocational skills, face bleak job prospects, and have few housing options as they transition out, putting them at risk for poverty and homelessness. 

In many cases, these youth don’t get services to which they’re entitled, and many don’t even know they’re entitled to certain services.  And allowances for personal expenses don’t cover clothing, transportation and personal supplies.  Antoine receives $580 per month, the same amount he has received since 2001, despite the increased cost of living in D.C.  He spends $350 per month on transportation, leaving $230 for food, clothing and any other expenses. 

To combat these critical issues, the Young Women’s Project (YWP) created its Foster Care Campaign which advocates for older D.C. foster girls and boys and trains 25-35 youth staff each year to be leaders, advocates and peer-to-peer educators.  The program is designed to help teens and young adults in foster care to know their rights, how to navigate the bureaucracy of a variety of city agencies, and to be advocates for better services.

Access to health care is a particular challenge, according to YWP Executive Director Nadia Gold-Moritz, noting that while youth in foster care are covered by Medicaid, they don’t always know how to access reproductive health services, mental health services, or routine care such as eye exams and often don’t practice healthy behaviors.  One third of girls in foster care become mothers before they age out of the system.

And while the needs of older youth in foster care are great, one thing the system doesn’t need is more money.  “There is plenty of money in the system, but it’s not being used effectively,” Gold- Moritz says. 

What specific changes would she like to see?  Getting foster youth into good schools and keeping them there; college prep starting at age 16 for youth who show college potential; improving support for youth aging out of the system; reducing poverty by increasing subsidies; and better data collection to see how progress is occurring.  YWP is empowering foster youth to help ensure these changes happen.

March 23, 2011 marked the one-year anniversary of the Patient Protection and Affordable Care Act, the most significant federal expansion of health care coverage and delivery reform in decades. The law is comprehensive and complex, and cuts across many issue areas: insurance reform, financing and payment systems, workforce development, health information technology and prevention. Millions of federal dollars have come into the region to government and nonprofits as result of this legislation, and significant activity has occurred over the last year to support implementation of health reform at the local level. 

Following are some brief updates from our region:

The District of Columbia became an early adopter of the Medicaid expansion under health care reform in 2010 by petitioning the federal government to move all eligible childless adults with incomes up to 200% of the federal poverty level from the DC Alliance to Medicaid. In the transition, roughly 30,000 people were moved into Medicaid and are now able to receive a fuller benefits package that includes mental health services. Yet this shift also resulted in lost revenue for some safety net health and mental health providers, due to concurrent cuts that were made to Medicaid provider rates through the budgetary process. The mayoral transition in D.C. resulted in leadership and staff changes, creating some delays in the implementation process.  The District has reconstituted its Health Reform Implementation Committee and established three working groups: Eligibility and Medicaid Expansion; Insurance; and Health Delivery System.  It has contracted with Mercer Consulting around the development of the Exchange and is holding several stakeholder meetings to gather input over the summer. There has been some discussion about the creation of a regional exchange with Maryland or Virginia.

Virginia, in spite of its lawsuit contesting the constitutionality of reform, is moving forward with implementation. It has established the Virginia Health Reform Initiative Advisory Council under the Secretary for Health and Human Services. The Council has looked at the potential impact of reform in VA and provided recommendations around implementation in a report released December 2010. Six task forces have been established to discuss key issues related to reform, including: Medicaid Reform, Insurance Reform, Capacity (Workforce), Delivery & Payment Reform, and Technology. In our region, health care consumers in Virginia have the most to gain from reform since the state currently has very limited eligibility for its Medicaid program. Because of its historically low Medicaid coverage rates, Northern Virginia’s primary care capacity is also limited and will require major investments to meet demand.

Maryland has positioned itself as an early adopter in implementing reform. It has developed a Health Reform Coordinating Council with several committees that have engaged in a process to gather community input on reform and develop recommendations for implementation. It is among a handful of states that have already passed health insurance exchange legislation for the state, and the state recently released its list of appointees to the Maryland Health Benefit Exchange board.

It is important that community members and nonprofits serving low-income people get involved in local health reform efforts. What can you do?

1. Stay informed. In addition to major media sources, you can also get information from nonprofit organizations that are working on health care reform locally and nationally such as Maryland Citizen’s Health Initiative, the Commonwealth Institute in Virginia, and Kaiser Family Foundation.
2. Join the conversation. Participate in health reform stakeholder meetings and work groups being organized by the D.C., Virginia, or Maryland governments.
3. Engage your colleagues. Discuss the impact that health reform will have on our region and how we can work together to prepare for implementation.
4. Advocate. Recommend policies and programs that serve the interests of the consumers.

Last month The National Prevention, Health Promotion, and Public Health Council released the National Prevention Strategy. The National Prevention Council is made up of 17 heads of departments, agencies, and offices across the Federal government who are committed to promoting prevention and wellness. The National Prevention Strategy focuses on four strategic directions and seven priority areas (see diagram below) to achieve the overall goal of increasing the number of Americans who are healthy at every stage of life. The Strategy is momentous due to its recognition that the health and well-being of all people is affected not just by policies focusing on health care, but policies concerning housing, education, transportation, agriculture, labor and the environment. Recognizing that our health is impacted by these social factors is a vital step in improving the health of Americans across the board.

Why We Care

The Strategy validates what Consumer Health Foundation and its grantees have known for a long time: that preventing disease requires more than just providing people with information about healthy choices.

• While knowledge is critical, we also need to address the Social Determinants of Health, which include the social and economic conditions that shape the health of a community.
• Strong emphasis on the importance of empowerment and equity, particularly underserved and communities of color.

Bringing the National Strategy to the Local Level

For each strategic direction and priority area covered, the National Prevention Strategy includes actions to be taken at all levels of society including the federal government, state governments, insurers, community organizations, individuals and families. Community organizations can utilize the strategy in the following ways:

• Inform new projects and strategies based on the evidence-based research and indicators provided.
• Validate current projects and leverage support by referencing the goals and priorities of the strategy as well as the comprehensive research cited.
• Advocate that local institutions such as employers, healthcare systems, and schools adapt their practices and policies to align with the strategy.

Yanira Cruz has been on the CHF Board of Trustees since 2009 and chairs the Nominations and Governance Committee.  Cruz is the President & CEO of the National Hispanic Council on Aging (NHCOA), is on the board of the American  Society on Aging, and holds an adjunct faculty appointment at The George Washington University School of Public Health. She has led numerous public health research efforts to establish solutions and best practices on key health inequities, and is the author of Barriers to Controlling Diabetes among Adult Older Latinos.  Before joining NHCOA, she served as executive director and chief operating officer of the Hispanic-Serving Health Professions Schools (HSHPS). She joined HSHPS after serving as director of the Institute for Hispanic Health at the National Council of La Raza where she led numerous public health programs to improve the health status of Latinos nationwide.  Cruz received her Bachelor of Science in Biology and holds a Master’s degree in Public Health and a Doctorate in Public Health with a specialty in global health from The George Washington University School of Public Health and Health Services. Her primary focus is to increase policy-maker and public understanding of the needs impacting Hispanics and disenfranchised sectors of our society, and to encourage the adoption of programs and policies that equitably serve everyone. In her leisure time, Cruz loves to run, go on long walks with her family’s Siberian husky, and volunteers at Montgomery County Aquatic Activities where her son Alejandro swims.

Naomi Mezey was appointed to the Board of Trustees in 2007 and chaired the Program Committee.  Mezey is a law professor at Georgetown University Law Center.  She received her J.D. from Stanford Law School where she served as an articles editor for the Stanford Law Review.  She also has a Master’s degree in American Studies from the University of Minnesota.  Her areas of research are law, culture, and the construction of identity. Mezey served as law clerk for Judge Marilyn Hall Patel of the United States District Court for the Northern District of California and prior to law school worked on Capitol Hill as a Legislative Aide to former Senator Alan Cranston.  While Mezey has long had a personal and professional interest in race and inequality, she received a crash course in the inequalities of access, care and health finance when her younger son was terminally ill with acute myeloid leukemia.  Mezey lives in the District with her husband Matt, and their two surviving children, Jake and Lucy.  For pleasure, Mezey swims, cooks, gardens and does Glee karaoke with her kids.  This summer Mezey and her family will be moving to London for a year where she will be directing the Center for Transnational Legal Studies.

In March 2011, CHF’s Advocacy grantee partners participated in a two half-day training on Structural Racism and Racial Equity in Health facilitated by OpenSource Leadership Strategies, Inc.  The training was designed to advance our grantee partners’ understanding of how structural racism produces racial health disparities and inequities, and how having a racial equity framework could help strengthen their approaches to health advocacy.  CHF offered this learning opportunity as part of our overall Health Justice programmatic and capacity-building strategy, as outlined in one of our Logic Model goals:  Communities have more policies, programs and initiatives that address the social, environmental and economic conditions that affect health, including structural racism. 

The response to the training was overwhelming positive.  Participants felt the training was informative and provided a fresh perspective on thinking about complex issues in concrete ways.  Comments included: 

“The training gave context around why disparities exist, the exercises helped us think about different ways to address those challenges, accounting for historical issues and barriers that exist.”

“The presentation on the various causes of racial health disparities was very valuable. We have been approaching our health policy advocacy with a primary emphasis on poverty. The racial disparity data was useful and will be helpful in future advocacy.”

Next, CHF plans to offer a racial equity communications and messaging training, as well as a workshop on increasing racial and gender diversity on nonprofit boards.

CHF Hires New Program Officer:  Edna “Ria” Pugeda
Ria Pugeda joined the Consumer Health Foundation staff this month as a program officer.  Prior to CHF, Ria was a program officer at Public Welfare, where she focused on their Health Reform Program and their  Reproductive and Sexual Health Program.  At CHF, she will help manage its grants portfolio which targets advocacy for health care access and health justice.  She will additionally be engaged in CHF’s strategic alliances and other work.

CHF Welcomes 2011 MPH Fellow Allison O’Donnell! 
Allison attends the University of Michigan, School of Public Health where she is pursuing a master degree in Health Management & Policy. After graduation in April 2012, Allison hopes to continue her studies to earn a doctoral degree in Public Health. She is interested in studying the intersection between the social determinants of health and personal transformation. A former Peace Corps volunteer, Allison practices and teaches yoga and meditation, and loves Latin dancing.

CHF’s New Articles of Amendment
The votes are in and the members of the Consumer Health Foundation (CHF) voted overwhelmingly to amend CHF’s Articles of Amendment, which changes our status as a membership organization to a non-membership organization and, thus, the manner in which it chooses its Board of Trustees.  Under the new structure, all Trustees will be elected by the full Board to serve limited terms.  The CHF Board also amended the Foundation’s bylaws in order to strengthen our ongoing commitment to community accountability and participation.  Most importantly, the amendments include a provision to assure that the community remains involved in the Foundation’s process for appointing Trustees through an annual “Community Call” for nominations.  CHF will also continue to operate transparently by publishing its annual report, holding annual meetings that are open to the public, and posting its annual tax return on our website, among other things. Thanks to everyone who participated in our voting process.

Washington Regional Association of Grantmakers’ President Tamara Lucas Copeland writes about being arrested at a recent DC Vote protest on Capitol Hill.

Maryland Passes Two New Laws that will improve and support the health and social well-being of its residents:

• The Maryland Alcohol Tax which will raise the revenue needed to fund critical health care and community services, including health care coverage services for people with developmental disabilities and mental health needs; tobacco, drug, and alcohol prevention and treatment; and health care worker training.
• The Maryland Dream Act which grants in-state tuition rates to immigrant students, thereby removing financial barriers to accessing higher education for all Marylanders.

White House Supports DC Voting Rights and Home Rule: DC Vote reports that President Barack Obama recently stated his support for DC voting rights and home rule during an NBC interview, and in a release of a Statement of Administrative Policy, which announced White House opposition to House Appropriators effort to restrict DC's local needle exchange and abortion programs.

CHF Releases its 2010 Annual Report, Connections:  Building the Case for Regionalism
Our 2010 report features interviews with eight local thought and action leaders in the public, private, and nonprofit sectors on how working together across jurisdictions to address health care, HIV/AIDS, job creation, social services, and transportation benefits our region.

Grants Update: The Consumer Health Foundation makes its second-quarter grants.