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1
PHPC 101
David Vincent, MSW
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History of PHPC
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In 1990, the Public Health Service Act was amended to include the Disadvantaged Minority Health Improvement Act, which under Section 340A, established the Health Services for Public Housing Residents program, known as the Public Housing Primary Care (PHPC) program.
Authorizing Legislation
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Authorizing Legislation (Continued)
The cornerstone of the PHPC program is the 340A legislative requirement that grantee programs are to be located on the premises of public housing or at locations immediately accessible to residents of public housing.
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In 1996, the Health Centers Consolidation Act replaced Section 340A of the Public Health Service Act and consolidated the Health Care for the Homeless, Migrant Health Centers and Public Housing Primary Care Programs under Section 330 of the Consolidation Act, Public Law 104-299.
Reauthorized in 2006
Health Centers’ Consolidation Act
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Health Centers’ Consolidation (Continued)
This legislation reauthorized the health center programs as: 330(e) All Health Centers 330(g) Migrant Health Centers 330(h) Health Care for the
Homeless 330(i) Public Housing Primary
Care
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PHPC History In 1991, the Department of Health and Human
Services, Health Services and Resources Administration (HRSA) established the Public Housing Primary Care Program and funded the first seven health center grantees.
The first PHPC programs were: Ella Austin Health Center (now known as CommuniCare
Health Care Centers), San Antonio Texas; Family Practice and Counseling Network, Resources for
Human Development, Philadelphia, Pennsylvania; Grace Hill Neighborhood Health Centers, St. Louis,
Missouri; Great Brook Valley Health Center, Worcester, MA; Primary Care Health Services, Pittsburgh, Pennsylvania; The Clinic at Altgeld (now known as TCA Health, Inc.),
Chicago, Illinois; West End Medical Centers, Atlanta, Georgia
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The PHPC Program Today
Today there are 61 PHPC grantees in 24 states and Puerto Rico.
These programs provide high-quality comprehensive, case- managed, and family-based preventive and primary health care services to approximately 187,992 residents at over 711 public housing service delivery sites.
Administration of the PHPC Program
HRSA provides resources to support the PHPC program through a Cooperative Agreement grant to provide technical assistance to PHPC health centers and health centers wishing to provide services to public housing residents.
The National Center for Health and Public Housing Training and in additional to technical
assistance, provides regional and national trainings, newsletters, white papers, listservs and webinars
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Patients Served by PHPC Programs
1111
Total Number of Patient Encounters
2006 2007 2008 2009 2010 20110
200000
400000
600000
800000
500307 508430
614925
738770
809491
884829
1212
Patients Served by PHPC Programs
In 2011, more than 187,992 public housing residents were served.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
50000
100000
150000
200000
Financial Status of PHPC Patients
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
10
20
30
40
50
60
70
80
90
100
150% below poverty 100% below poverty
Per
cen
tag
e
1414
Insurance Status of PHPC Patients
2004 2005 2006 2007 2008 2009 2010 20110%
20%
40%
60%
80%
100%
Uninsured
Commerical
Medicare
MedicaidPe
rce
nta
ge
1515
Age and Gender of PHPC Patients
37% are children ages 0-19 years old
25% of the patients are children ages 0-12
years old
5% are 65 years old and older
Female patients constitute 62% of PHPC
patients
Most Frequent Encounters
Depression and other Mood Disorders
Hypertension Diabetes Vaccinations Oral health exams Health Supervision of infant or child
(ages 0 through 11) Contraceptive Management
Overall Health StatusThe percent of black women self-reporting “fair to poor” health
status18-24 yo: 6% - U.S total 10% - U.S. Black women 26% - Black women in Public Housing
45-64 yo: 15% - U.S total 28% - U.S. Black women 58% - Black women in Public Housing
65+ yo: 22% - U.S total 42% - U.S. Black women 65% - Black women in Public Housing
Presence of Chronic Illness
Arthritis 14% - U.S Black women 29% - Black women in Public HousingAsthma 11% - U.S Black women 23% - Black women in Public HousingObesity 39% - U.S Black women 48% - Black women in Public Housing
Presence of Chronic Illness(Continued)
Depression 7% - U.S Black women 14% - Black women in Public HousingDiabetes 7% - U.S Black women 17% - Black women in Public HousingHypertension 21% - U.S Black women 39% - Black women in Public Housing
Health Status of Residents
Healthy Weight Management Poor nutrition and the unavailability of healthy food
options in some public housing communities have significantly impacted the weight of many residents in public housing.
31% of residents are considered to be obese, compared to 16% of the general population.
Oral Health Care The impact of poor oral health care has devastated
many residents of public housing. 23% of residents are missing six or more permanent teeth compared to 12% of the general population.
Health Status of Residents (Continued)
Chronic Disease Prevalence Smoking can have significant health care
effects for many, especially those with chronic health conditions. 28% of residents smoke compared to 17% of the general population.
The percent of residents with diabetes is 12%, compared to 5% of the general population.
32% of residents have hypertension, compared to 19% of the general population.
Residents Characteristics
General Information Across the nation there are over 2.2 million residents
living in public housing, and another 6.5 million residents living in Section 8 and Housing Choice Voucher Housing.
Over 21% of residents remain in public housing more than 5 years and nearly 17% of residents also remain in Section 8 housing for more than 5 years.
People with Disabilities 19% of public housing, 17% of Section 8 and 18% and
Housing Choice Voucher households include a family member who is disabled.
Residents Characteristics (Continued)
Families with Children There are approximately 1 million children who live in
public housing. They represent 40% of the total population of residents who live in public housing. Approximately 2.3 million children live in Section 8 housing, representing 47% of residents who live in Section 8 housing.
37% of public housing, 22% of Section 8 housing and 48% of Housing Choice Voucher households are headed by single female with children.
Seniors Nearly 330,000 or 15% of residents in public housing
are seniors (age 62 and above), and approximately 400,000 or 8% of residents of Section 8 housing are seniors.
Outreach to Residents in Public Housing
Developing an Outreach Plan Identify the Need Determine the Goals and Objectives
Making sure they are measureable Identify Community Partners Figure out logistics
Outreach Schedule Develop a training module Recruit staff
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Outreach to Residents in Public Housing
Use of Community Members as Outreach Workers Identifying Community Leaders
Issues Effectively using Partnership with Housing
Authority Tenant Advisory Boards Floor Captains Attending Community Meetings
Hosting and Tabling at Community Events Challenges and Barriers
Hard to reach areas Scattered sites Safety Concerns
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Becoming a PHPC Grantee
In general, PHPC grantees must demonstrate compliance with all Section 330(e) and Section 330(i) requirements, as well as all applicable HRSA guidelines.
Specific Section 330 (i) requirement includes a Formal agreement with the local Public Housing Authority. The application must include a copy of the MOU. Sample available through the National Center for
Health and Public Housing. Grant announcements can be found on
grants.gov
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Preparing for your PHPC application
PHPC programs have established highly effective partnerships with public housing authorities and resident/tenant organizations to facilitate the delivery of services.
Residents are actively involved in the design of services and program governance, and are routinely trained or employed as outreach workers and case managers.
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Preparing for your PHPC application
(Continued) A Needs Assessment must be conducted
The National Center has a toolkit on their website (www.nchph.org) specifically on developing a needs assessment for residents in public housing.
Needs Assessment must include local and state statistics Identify your service area’s public housing
developments, as per HRSA guidelines, e.g., Urban, Rural & High Poverty)
Determine how many residents and the local demographics associated with the Housing Authority
Determine how many of those residents access your clinic(s) primary health care services
Describe the public housing residents’ health disparities, e.g. hypertension, asthma, etc.
List, in your service area, other primary health care providers?
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Preparing for your PHPC application
(Continued) What are the other community agencies
located near the target public housing community
How are they currently working with these residents
How are you partnering with these agencies currently.
What type of partnership opportunities might be available.
Community Partnerships are critical to the success of the PHPC program
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PHPC Application
Program Design What will the service delivery model be?
Onsite, Close by, Mobile Medical Units What factors influence this decision?
Lack of transportation of residents In ability to build onsite Units are spread out
What will staffing look like Must meet the needs of target community (seniors,
children, adolescents) Will your model include residents
Successful applications should answer the 5 W’s and H (Who, What, When, Where, Why and How)
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PHPC ApplicationLetters of Support
Must include a letter of support from your State Primary Care Association.
You must have a letter of support from your local housing authority (and preferably a copy of your MOU – a sample MOU can be found at www.nchph.org).
A letter of support from the resident council, noting how they were included in the drafting of the proposal and how they will continue to work after funding, is recommended.
If your target public housing community is in the same area as another health center, it is strongly recommended that you have a letter of support from that health center.
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Administration of the PHPC Program: Contact Information
For more information, contact: Contact: Lieutenant Commander Kevin
Bates, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Minority and Special Populations [email protected], (301) 443-7340.
Astril Webb, MD, North American Management/National Center for Health and Public Housing, Project Director, HRSA Cooperative Agreement (703) 812-8822.
Health and Human Services, Bureau of Primary Health Services (HHS): http://bphc.hrsa.gov
PHPC website: www.nchph.org