Dying and Living in the Neighborhood by Prabhjot Singh

Author:Prabhjot Singh
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2016-02-27T05:00:00+00:00

NEIGHBORHOOD CHANGE AGENTS

Insights from the Wednesday morning meetings yield other, previously undetected avenues for neighborhood advocacy. When City Health Works coach Leny Rivera heard about a movie theater that had called police on a diabetic man who’d brought strawberries to the film to keep his blood sugar levels in check, she was incensed.23 She and her fellow coaches complained about the theater’s policy. The theater yielded. Multiply this degree of change by a hundred small improvements, and not only does the neighborhood become an incrementally healthier place to be, but neighbors also begin to recognize that their collective efforts are meaningful. These small victories, in Renée Canady’s words, get people ready for being ready, for a time when more complex challenges inevitably fall upon them.

By design, City Health Works expands its service area in the shape of the congressional district, in recognition that many issues that affect the neighborhood require political leadership.24 The coaches hope that successors to Congressman Rangel will recognize that improving the health of the neighborhood isn’t just a matter of breaking new ground on healthcare facilities or supporting a legislative priority. Equally important is the problem solving that emerges from the process of engaging people at the street level.

The unique challenges each client presents constitute fresh opportunities for City Health Works to recognize patterns that can be translated into organizational-level goals. For example, because of the strong rapport that coaches build with clients, details of personal traumas often surface, revealing much higher levels of depression and anxiety than originally anticipated. This has led the organization to integrate “trauma-informed care” and a “collaborative care model”25 for mental health as part of its system of engagement.

Although the coaching approach differs substantially from the 1:1 organizing methods that ISAIAH employs, both interactive methods enable the entire organization or movement to change its focus to meet the most pressing needs of its constituents. Doing so builds greater trust and solidarity both between community members and between clients and coaches. Clients, in turn, are more inclined to improve upon their own coping systems when they are able to access a coach they trust to guide them.

Consequently, among City Health Works’s first 200 clients, coaches helped avert 30 unnecessary ED visits,26 all because clients called their coach first, who then urgently informed their clinical care team, who then arranged for the clients to be seen in a primary care setting instead. The results were beneficial for all involved, in terms of cost, quality of patient experience, and health outcomes.27

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