Neighborhood Clinics Provide Medical Home For Underserved

Melanie Espinos walks through Cook Children's Miller Avenue Neighborhood Clinic like the place belongs to her. The 3 year old knows the staff, takes imaginary pictures with her toy princess camera, and greets her physician with a high five.

After all, this is home for Melanie – her medical home.

Shortly after being born 24 weeks premature, Melanie was taken to the Cook Children's Neonatal Intensive Care Unit. Doctors treated her for asthma and placed a gastrostomy button (G-button) in her stomach to enable her underdeveloped digestive system to cope with feedings and medications.

Today, Melanie continues to be treated at the Miller Clinic, where she is seen by staff physicians as well as nutritionists and psychologists. She also receives special training to help her make the transition to solid foods at Cook Children's Medical Center.

Evangelina Espinos, Melanie's mother, said the neighborhood clinics have been important to her and her children. "We have always been treated well," Espinos said. "The kids are treated well. The doctors and the staff are great, and I am learning how to take care of my family. We benefit greatly from having the clinic in the area where we live."

Education and treatment go hand-in-hand at the neighborhood clinics, which were founded to provide medical homes, defined as primary health care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. Cook Children's medical homes serve  areas with large numbers of children whose families qualify for Medicaid or TexCare Partnership (CHIP) insurance programs.

Cook Children's Medical Center has embraced children like Melanie by offering medical care accompanied by comprehensive case management services for their families.

Maria del Pilar Levy, M.D., serves as the medical director of the Neighborhood Clinics. She supervises the clinical practice and helps develop educational programs for parents.

"When families bring in a brand-new patient with a fever and sore throat, we are not only going to treat the child's problem, we are going to provide a medical home where we can address a whole range of issues the family may face," Dr. Levy says. "We can take a more proactive approach and give the family anticipatory guidance."

Cook Children's supports four neighborhood clinics. Those on Northside (on Jacksboro Highway) and Miller Avenue were established 10 years ago. The other two – at McCart Avenue in Fort Worth and Cooper Street in Arlington – are new, thanks to a generous grant from Bank of America.

 The clinics also offer obesity classes and newborn classes, supervised by Develle Williams, a registered nurse. Williams leads classes on basic baby feeding and bathing and offers new parents a community resource that is unavailable elsewhere.

Clay Cessna, D.O, a physician in the Northside Clinic, said the neighborhood clinics establish a medical home, where patients are seen for illness and to attend well-child exams for follow-up.

"It's nice because when families come to the neighborhood clinics they are provided normal daily care and have access to the whole system of Cook Children's," said Clay Cessna, D.O., said.

The educational aspect of the neighborhood clinics gives them an advantage over the average pediatric practice or a retail health clinic. According to Dr. Levy, the patient's family often knows little more than how to provide "very basic care." The clinics teach parents how to go beyond that basic level.

Dr. Levy says the clinics clearly fit into Cook Children's "Promise" to children – to improve the health of every child in our region through the prevention and treatment of illness, disease, and injury.  On a recent visit to the Miller Clinic, when  little Melanie spied the Cook Children's logo with its prominent green peaks signifying home, she pointed to it and said, "Hospital."

"The goal is to have healthier kids who will become healthier adults," Dr. Levy says. "The best way to keep kids healthy is to educate the parents. Many of them don't have the knowledge they need. We offer them that education."

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