1

PHPC 101

David Vincent, MSW

2

History of PHPC

3

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

4

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.

5

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

6

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 

7

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

8

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

9

10

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

24

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

25

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

26

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.

27

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?

28

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

29

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)

30

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.

31

32

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 kbates@hrsa.gov, (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