School nurses and pediatricians team up for better care in Camden
Adults with complex health and social needs are not the only ones in Camden who often visit the emergency department (ED) instead of their primary care providers. Robin Cogan, a school nurse who works at four Camden-area preschools, noticed that when she asked parents to get medical clearance from a doctor to allow their child back in school, parents would often take their children to the ED instead of to their pediatricians. “What I wanted to know was, why the ER instead of their provider?” she said. “I wanted to know what the barriers are.”
Through the Johnson and Johnson School Health Leadership Program, Robin and a team of two other school nurses and two family workers learned the answer to that question directly from the source: the parents. Robin’s team convened a series of six “community cafés,” using an innovative research method based on the World Café method. In these focus group-like meetings, parents, school nurses, and family workers talked about parents’ experiences with the health care system.
Robin said she was surprised by what she learned from parents. “Continuity of care, or the lack of continuity of care, was the number one reason parents gave for why they go to the ER,” she said. Parents described the frustration and difficulty they faced making appointments with their children’s pediatricians. “One dad said, ‘If I can’t see my child’s pediatrician and I have to see a stranger in the office, I may as well go to the ER and see a stranger there.’”
Language and cultural competence was another major theme.
“Our population is mostly undocumented immigrants,” said Candida Rodriguez, a family worker at Mi Casita day care and part of the community café team. “People assume that they’re all Mexican, but they’re not. People assume they all speak Spanish, but they don’t. And even when staff do speak to them in Spanish, it’s not the same Spanish that they speak.”
Other barriers included lack of transportation and parents’ inability to get off of work to take their child to the pediatrician’s office.
The next step was taking these findings to the city’s pediatric practices. That’s where the Camden Coalition was able to help: we convened a meeting between the school nurses and family workers who led the community café project and the pediatric practices that are part of our Accountable Care Organization. The meeting has since turned into a quarterly roundtable focused on brainstorming shared solutions to improve care for vulnerable Camden families.
The city’s school nurses and pediatric providers didn’t necessarily understand each other’s roles, said Kaiya Harris, Program Manager for Community Engagement at the Camden Coalition. That lack of understanding was contributing to the breakdown in care. “The thinking was to get them in a room and get them on the same page,” she said.
The relationship-building seems to be working. “I love the openness and willingness of the [pediatric] providers and nurses to be so positive and proactive in finding solutions that work for everyone,” said Candida.
“Ultimately everyone wants the same thing,” said Robin: “to provide good care to kids and families.”
Camden pediatric providers aren’t the only ones listening. In May, Robin, Candida, and family worker Laura Jimenez went to Boston to present their findings at the Lown Institute’s national conference and to lead a workshop in the community café model. In June their team won a Population Health Hero award from the New Jersey Department of Health.
Robin said she has been grateful but a little surprised at the strong positive feedback. “Talking with patients should not be a novel idea,” she said. “They are the experts.”
Candida agrees. “I could sit here and think of reasons I think care may need to be improved, but that’s my experience, not their experience,” she said. “They’re the ones sitting in the waiting rooms, they’re the ones speaking to the providers. It’s important that it’s their voice [being heard], that they’re advocating for themselves, that they’re getting the right tools. Otherwise it’s not going to change.”