Oakland Site Visit October 2001

About Asian Health Services and La Clinica de la Raza

The committee visited the Oakland Community Voices for Immigrant Health project site in October 2001. The Community Voices project in the city of Oakland, California, is administered by the Asian Health Services and La Clinica de la Raza, two multisite, nonprofit, community-based, federally funded clinics in Oakland. The partnership among these two health care services providers, the Alameda County Health Department, and other community organizations like the Alameda Health Consortium has been fruitful and effective in addressing several of the complex and interrelated issues facing area communities, ranging from a lack of health insurance to tobacco use among minority, disadvantaged populations.

Both La Clinica and Asian Health Services have an impressive history of community engagement. La Clinica de la Raza was founded in 1971 by a group of students, health professionals, and community activists and was organized under a board consisting of patients, community members, and professionals elected in annual elections. La Clinica employs approximately 350 staff at four locations in Alameda County and at a medical and dental clinic in a neighboring county. The services provided include primary medical care; dental, mental, and eye care; clinic- and community-based health education; nutrition services; social services; and off-site inpatient care. Asian Health Services has been serving the community since 1974 at three locations and with 120 staff. Its services include clinical services like maternal and child health; HIV testing, counseling, and care; adolescent, adult, and elderly care; and urgent care. It provides health education services on topics ranging from family planning to disease prevention (cancer and HIV/ AIDS) and women's health.

Mission, Values/Principles, and Goals of the Oakland Community Voices Project

In 1998, Oakland became 1 of 13 sites in the nation funded by the W. K. Kellogg Foundation's Community Voices initiative to address the problem of uninsurance in local communities. The Community Voices project has been advocating on behalf of Alameda County's 130,000 to 140,000 uninsured individuals and aiming to develop policy, organize the community to support policy change, inform the community about access to health care, and develop a new insurance model. The project's primary goal is to create "an integrated community health system of care for the working poor and uninsured immigrants." Its objectives include:

• educating and informing immigrant communities about insurance and health coverage;

• expanding immigrants' eligibility for health programs;

• facilitating the inclusion of social services in health coverage;

• developing alternative models for financing affordable health coverage;

• documenting effective strategies for outreach and health coverage enrollment in immigrant communities; and

• collecting in-depth information about uninsured immigrants for continuing advocacy.

Activities and Accomplishments of Oakland Community Voices

Noteworthy features of the project include a profound level of community involvement and representation in the process; a partnership among community clinics, community organizations, and the local health department; and exceptional attentiveness to cultural competency. Providing health promotion and health care services in a culturally and linguistically appropriate manner is a routine part of "doing business" among these Oakland partners rather than a minor "tag-on" to the services that they provide. Asian Health Services even includes a Language and Cultural Access Program that provides translation services and interpreter training in a total of seven languages. Another aspect of the relationship with the community is both La Clinica's and Asian Health Services' use of community outreach workers as well as promotoras (female health promoters) to serve as links to the community, in addition to conducting community-based health education and health promotion. La Clinica has also developed a curriculum for training promotoras on a range of health topics. The promotoras are paid through stipends and gift certificates.

Asian Health Services conducts specialized, strategic outreach to the various populations that it serves, for instance, to Korean groups at churches and to Vietnamese groups at street festivals. Outreach to diverse audiences also implies a need for awareness of and sensitivity to the sociocultural issues of new immigrants and other underserved populations.

The County of Alameda Uninsured Survey was conducted by Community Voices in 2000 (Ponce et al., 2001). The random-probability telephone survey of more than 11,000 households resulted in 1,673 core questionnaires completed by adults 18 and older in English and six other languages (over 40 percent of respondents). The main findings were as follows:

• More than 70 percent of uninsured adults in the county are people of color.

• More than half of the uninsured adults in the county are immigrants.

• The county's uninsured rate of 16 percent is lower than California's rate of 25 percent.

The objectives of the Oakland Community Voices program are implemented in part through the linked enrollment and outreach activities of community health specialists and community outreach workers based at La Clinica and Asian Health Services. In addition to their educational and health promotion activities, these community workers have made it a priority to discuss issues of health access and health insurance with their communities and to help facilitate linkage to medical homes for any families and individuals who lack coverage.

Through the efforts of a strategic collaborative, Oakland Community Voices has participated in the creation of a new health insurance product called Family Care, administered by Alameda Alliance for Health, the local nonprofit managed care plan

The Alameda County Health Department has transformed its goals and services to become more community based and has increased staff capacity to work with the community. For instance, field staff have been organized into 11 community health teams to strengthen the relationship with the public, increase responsiveness and visibility, and decrease duplication of effort through expanded collaboration with community organizations, such as the Asian Health Services. The health department has also developed a 5-year strategic plan based on the 10 essential public health services. The department's collaborative efforts include sharing the California tobacco settlement money with community partners.

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