Dr. Walter Trymbulak knows there’s more to the health and well-being of his patients than what happens in the exam room.
“Patients that come here face challenges outside of just their health care,” said Trymbulak, an obstetrician who sees patients at the Women’s Health Center at Saint Francis Hospital and Medical Center in Hartford, where many patients are low-income and covered by Medicaid.
There’s transportation; even traveling a relatively short distance in Hartford without a car can require taking multiple buses and spending a couple hours in transit.
Securing reliable child care is another challenge that can make it difficult to keep appointments.
So is finding affordable healthy foods in a city with few supermarkets.
Some women struggle with basic needs, such as being unable to pay their heating or electric bills every month.
It’s hardly a secret that these kinds of challenges play a huge role in patients’ health. In wonky terms, they’re known as the social determinants of health. They can seem overwhelming, too big to address in a meaningful way that will make a difference in people’s lives.
Trymbulak and his team at the Women’s Health Center take a different view.
To them, addressing those challenges is critical to delivering the kind of health care their patients deserve – and it’s something they see as possible.
Over the years, they have created what Trymbulak calls an “obstetrical home” in the Women’s Health Center’s office. It’s not a space to live, but a way of operating a medical office to ensure patients can get many of their needs met along with their prenatal care – a home base for their well-being.
“The whole idea behind the obstetrical home is, ‘What services could we provide immediately, within our clinic, within our space, to alleviate or take some of these social determinants out of the equation?’” Trymbulak said.
There’s a fulltime social worker in the clinic who can help with Medicaid enrollment, housing, domestic abuse, and other issues. If a woman has a problem with her heating bill, the social worker, Rossana Spriggs, will call the heating assistance program, fill out the paperwork with her, and fax it back, ensuring that the woman’s heat will stay on.
If a doctor or nurse thinks a patient could use help with a mental health issue, they can refer her to Jessica Clancy, a psychotherapist whose office is in the women’s center. Patients can schedule their visits with her to coincide with their prenatal appointments. The model, developed with funding from the Connecticut Health Foundation, significantly improves access to mental health services, particularly for pregnant women, who face increased risk of depression and other mental health concerns but often struggle to get care.
“I didn’t want the patient to have to leave if there was something more we could do for her,” Trymbulak said.
Pregnant women are also screened for dental health issues during their first prenatal appointment, and the center’s staff help those who need care get an appointment within days – the result of partnerships and processes built as part of a grant from the Connecticut Health Foundation.
Pregnancy-related educational programs like Healthy Start – a federal program run through the state Department of Public Health – have space in the center, so women can learn more about pregnancy and resources without having to go to another office.
The women’s center even helps with access to healthy food. As part of a pilot grant from the Newman’s Own Foundation, a dietician at the center teaches women who will be first-time moms about eating appropriately during pregnancy and nutrition for babies and young children, as well as how to find healthy foods in a city where most neighborhoods lack a full supermarket. After each session, the women receive food from the hospital’s Joan C. Dauber Food Bank.
It grew out of a thought: “There is no grocery store, so why don’t we just figure out a way to get these women some produce?”
What convinced Trymbulak that it was possible to tackle these larger challenges within a doctor’s office?
It was another program that inspired him – the Breastfeeding Heritage and Pride Program, a nationally recognized model created by the Hispanic Health Council in Hartford.
Women who breastfed their own babies receive training to help other new moms, and then provide in-home visits to pregnant women and new moms in their communities to help with breastfeeding and address any problems that arise. It has been shown to increase breastfeeding rates among low-income women, particularly black and Hispanic moms.
The Women’s Health Center now uses the program through a grant from the W.K. Kellogg Foundation.
“What they’ve really shown is that if you figure out and you deal with the social determinants that are affecting their problem, in an evidence-based way, if you overcome those, you can improve anything,” Trymbulak said, noting that the concept has also been shown to be effective for diabetes.
Breastfeeding is “relatively complicated, involved and can be difficult,” Trymbulak noted. He figured: If the Heritage and Pride program could help many more women successfully breastfeed, “I could overcome some of these easier things.”
Social determinants of health remain huge challenges, but tackling them step-by-step can make a difference.