Leading The Way: Rural Advocacy Work In Florida

June 21, 2018 | Featured Articles

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At North Florida Pediatrics (NFP), the care doesn’t stop when you leave one of their six locations.

This facility, which doesn’t specifically employ psychiatrists, social workers or psychologists in their rural Florida locations, is nevertheless dedicated to the behavioral health and overall wellbeing of its community. NFP fights hunger with food drives and backpack programs for kids, fundraises for various childhood causes, and figures out ways to partner with outside services for care coordination NFP itself doesn’t provide, from behavioral health to dentistry.

We got the opportunity to sit down with Dr. Pamela Santelices (or “Dr. Pam,” as she likes to be called), who runs NFP along with her husband and a couple dozen other medical professionals. At the center of the practice’s multiple clinics is a staggering sense of advocacy that in theory could be replicated (at least in part) at any clinic in the country. Here’s what they do, and how.

NFP answers the call for behavioral health and care coordination.

Not satisfied with the vacuum of behavioral health and care coordination resources in the area, NFP took great strides to partner with a local behavioral health organization to offer services, improve patient education, and boost community resources. The pediatrics service highlights the importance of community partnerships to help reduce mental health disparities, and the need for regional doctors to advocate for behavioral health services accessible within primary care.

At the center of these efforts is Dr. Pam, who specializes in pediatric primary care and has vast experience in treating adolescent patients and patients with behavioral health disorders. She has served as a practicing clinician for more than two decades, with more than seven years at NFP.

For NFP, it’s personal.

“I came from the Philippines,” Dr. Pam said. “We both did.” (Dr. Pam and Dr. Samuel Santelices). “In the Philippines, poor is poor. There are no resources, there is just “make do”. The United States is a very rich country. But when we went to work in rural areas, we saw there’s just a different kind of need. There’s isolation . . . there are a lot of single parents. So if you serve a mostly Medicaid population, then you see it. Probably, our very thing is, we want to serve these kids. When we have our clinics, we want it to look like they’re better than the clinics of our friends who have clinics in rich cities.”

“Beyond the structure, you feel like there is much more to reach. And it does also get really close to your heart. We want to empower our patients.”

Partnerships are the product of intense, focused outreach.

Every one of the six NFP clinics are rural, Dr. Pam explained. “We’re regular primary-care providers, it’s like a one-to-one ratio between pediatricians and ARNPs and we have one PA, soon to be two, and around 20 in the group. We deal with a lot of behavioral [issues in] kids, just because there’s not a lot of easy access being in a rural area. About 10 percent of our visits are behavioral…, even before the push for including behavioral health in primary care.

“Basically, we partnered with Meridian—but not financially,” she said, “it’s more to create easy access—they have psychiatrists and psychologists.” Meridian Health is a non-profit with roots in the community mental health movement that last year alone impacted 20,796 lives through 326,431 direct-care treatment visits.

I’m also talking to the University of South Florida,” Dr. Pam said “Our clinic is one of the pilot programs for behavioral psychology, we’re still exploring that. We have private psychiatrists we consult if we need to, but we do see not only ADHD but also autistic children, and children with mood disorders. We encourage nurse practitioners to go into licensing and registration [in that area].”

Partnerships, Dr. Pam said, are the result of persistence and nothing more.

“We tried for a partnership like this before, but it kind of just faded away. I had to actually sit down with the upper-level decision makers; and since then, we were able to get the kids prompt attention. We don’t have a counselor yet—though that’s in the works—but we have also sat down with everybody. If there’s a psychologist, or behavioral therapist, we invite them to the office and ask them to explain their services. We involved our referral department, which is a centralized service, and they know the resources for this area to help.”

“We have two nurse coordinators and they focus on our behavioral and general follow up: ER, labs, and so on. Our more experienced nurses that do that. Basically, all our MD’s are seeing behavioral health. If they’re new, we train them.”

Advocacy takes time. And resources can be few and far between.

“Last year, we attended a summit for Florida behavioral health,” Dr. Pam said. “There’s really a disconnect. And if you don’t actively, proactively seek what’s available, you won’t know. Doctors are really busy in the clinic. And luckily, our size is enough that I would be able to go out and find resources for this work. I can’t imagine being a single practitioner and doing that.”

“Years ago in 2010, we started administering fluoride applications for kids. Now everybody’s doing that. We’ll find access to the dentist also—it’s really, really hard to find a dentist.”

Serving one of Florida’s poorest counties comes with other challenges: like being the only clinic for miles. So NFP was approached to see if the center could provide health care for students during school.

“The hard part of it is the rules and regulations, because we have to work with the department of health and the department of education at the same time,” Dr. Pam said. “So it’s not too fast. The clinic will be at the school, in the school, for services throughout the school year with two exam rooms, I’m kind of excited about it because the population there is 90-percent Medicaid HMO. There’s really a need: a high poverty rate, a high pregnancy rate, so there’s really nothing there. And sometimes they can’t go to our clinic because there’s no transportation.”

“For those kids, school is an unsure environment. It’s their waking hours, and it’s good if you can kind of see them in school also. Also, my background, before joining my husband for almost 10 years, I was medical director for another poor county in Florida’s health department. I’m kind of aware of the services and the needs.”

There’s a lot of legwork involved in boots-on-the-ground advocacy.

“I’m trying to reach out to the schools because I can see… We can be a resource to the school health also, especially in these smaller areas,” Dr. Pam said. “Every time, in our company culture we do volunteer work. If they have something in their church, for example, we gladly sponsor. More or less every month, we sponsor something. Last month we sponsored March of Dimes, at the same time the Hunger Fight was able to donate food… If they have enough sponsors, they want to do a backpack program over the weekend because we do not know if these students are going to eat at all.”

Dr. Pam stays humble about her advocacy work, conveying a sense of bewilderment at how anyone with the resources to help children, wouldn’t do so. She said this sort of support for her community is a welcome respite from what she terms “the pressure of the everyday grind … with all the regulation, lawsuits, and compliance.”