La Maestra’s Circle of Care - Addressing Social Determinants of Health through Integration of Services Presented by Zara Marselian, FACHE - President & CEO & Carmen Kcomt - Director, Legal Advocacy & Social Services About La Maestra

Mission: “To provide quality healthcare and education, improve the overall well-being of the family, bringing the underserved, ethnically diverse communities into the mainstream of our society, through a caring, effective, culturally and linguistically competent manner, respecting the dignity of all patients.”

First Clinic, opened 1990 LEED Certified Gold Health Center, opened 2010 2 La Maestra Health Services o Clinic formed in 1990 under La Maestra Amnesty Center. Need for culturally competent healthcare identified by council representing over 12,000 students o Now 5 Medical & 8 Dental Centers in San Diego County o Hope Clinic, an Access Point for Homeless o 4 school-based medical/dental clinics o Mobile Clinic – medical, dental, optometry, telehealth o Imaging Services and new Mobile Mammo Coach o Mental Health services at main clinic, high school clinic, and through telemedicine. o All services/programs focus on education, case management and social services – Integrated Approach 3

Serving the Culturally Diverse Community o More than 40,000 patients served per year o 80% of patients indicated they prefer to communicate in a language other than English o Over 28 languages and dialects spoken by the 350+ employees. o Staff represents (is hired from) the cultures served, ensuring cultural and linguistic competency. o Medically Trained Cultural Liaisons provide valuable, ongoing support, education to local residents and identify new needs – two-way communication.

La Maestra’s Circle of Care Physical Health Issues o Obesity/Overweight o Diabetes o Cardiovascular Disease & Hypertension o Liver Disease (Hepatitis B and C) o Increased risk of stroke and cancer and lower screening rates (esp. Breast, Cervical, Colon cancers) o Tooth decay and gum disease o Asthma and Lead Poisoning (children) o Pulmonary conditions o Osteoporosis (seniors) o Co-morbidities Mental Health o / o Isolation o Influence of Chronic o Alzheimer's, o Unemployment/Under- o Caregivers’ Stress employment o Domestic Violence o Lack of financial resources o Family Violence (Child & o Overcrowded Households Elder Abuse) o Living in high crime o Victims of Trafficking communities o Low self-esteem o Post traumatic stress o Cultural Diversity Issues o Ulysses syndrome o

Environmental and Cultural Factors o Food deserts - lack of access to affordable nutritious food o Urban environment and housing with no outdoor space o Unhealthy/unsafe living condition (crime, unmaintained housing) o Stigmas, myths and cultural beliefs about health and treatment o Lack of healthcare services in country of origin/refugee camps o Forego preventive care due to cost o Changing generational roles and social order within immigrant families o Grandparents raising grandchildren o Isolation of seniors and people with disabilities Other Barriers to Health and Wellbeing

o High cost of doctor visits

o High cost of medication, glucose strips, etc.

o Linguistic and cultural barriers

o Lack of health literacy

o Lower screening rates

o Misunderstanding of health coverage programs

o Lack of transportation

o Managed Care default

9 La Maestra’s Circle of Care Wellbeing in the Circle of Care

Network goes beyond the field of medicine, bringing greater resources to our patients in the Circle of Care New Skills, Independence, Self-Esteem, Helping and Teaching Others, Working in Healing Environments

o Healthy Choices Food Pantry with nutrition education plus eligibility assistance for CalFRESH (SNAP), Medi-Cal, Energy Bill Discounts, etc.

o Urban Community Gardens

o Exercise – Zumba

Zumba

Food Pantry Community Garden & Healthy Recipe Potlucks Wellbeing in the Circle of Care o Microcredit Program for Women & Blossoms Florist Social Enterprise o Microenterprise Assistance o Supportive Housing I Choose Recovery (Housing) o Help with Affordable Housing o Job Training and Placement o Generations - Youth and Intergenerational o “Culture and Healing through Art” Program Generations

Healing Arts Class Senior Job Trainee Microcredit Entreprenuer Microcredit Weekly Group Legal Advocacy & Social Services o Legal Advocacy launched in 2011 to provide assistance and support to survivors of crimes: Human Trafficking, Domestic Violence, Violent Crime, Political Torture o National Human Trafficking Victim Assistance Program o Immigration Services added in 2015 o Legal advocates do not act as attorneys, but give information to help patients understand their rights and options o Referrals to Network of attorneys for Free / Low-Cost Services o Assistance with application for Restraining Orders, Safe Housing, Victims Compensation Program, Family Law Forms o Community Education and Training for Service Providers Legal Advocacy & Social Services Contact Information

Zara Marselian, President & CEO

Phone: 619-584-1612 ext 3018 / Email: [email protected]

Call Center for Appointments/Info about Services: (619) 779-7900

Website: www.lamaestra.org facebook.com/LaMaestraCHC