CommuniCare: Treating Yolo County's Indigent

A system of six health care centers are operating in various parts of the county.

For 30 years, CommuniCare Health Centers have offered Yolo County's poorest individuals an alternative to untreated illnesses and emergency room care. Founded by Dr. John H. Jones, this nonprofit organization was originally known as The Davis Free Clinic and operated in a small facility in downtown Davis.

In 1994, as part of a public/private partnership known as the Yolo Health Alliance, CommuniCare Health Centers began providing outpatient services to all of Yolo County's indigent population. Today, CommuniCare operates six facilities in Yolo County: the Davis Community Clinic, Esparto Dental Clinic, John H. Jones Community Clinic and Salud Clinic in West Sacramento, and John H. Jones Community Clinic and Peterson Clinic in Woodland.

More than 80 percent of CommuniCare's clients live at or below the poverty level. The services are affordable because they are provided by a combination of volunteers and paid staff. CommuniCare employs three full-time primary care physicians for the primary care clinics in Davis, West Sacramento and Woodland. Additionally, the clinics are staffed by full-time nurse practitioners, physician assistants, RNs, LVNs, nurse midwives, dentists, and dental hygienists.

Various other primary care and specialty clinics are staffed by a physician workforce of nearly 80 volunteers, primarily in the Davis facility. Medical students from UCDMC also staff the clinic during one of their elective clerkships. We estimate the value of the volunteer time at nearly $355,000 per year.

This extensive volunteer program sets CommuniCare apart from other groups and allows it to sustain high quality health care without turning away patients who can afford to pay little or nothing.

CommuniCare has saved Yolo County several million dollars by providing essential health care services mandated by state and federal laws. Such dramatic savings have been achieved, in our humble opinion, by getting the government out of the business of health care, by our dedicated paid and volunteer staff, and by financial donations from community minded individuals.

Nearly half of our work is in the area of primary medical care. The remainder is in the area of substance abuse treatment, perinatal, dental and community education and outreach. (Figure1)

In the General Medicine clinics, comprehensive non-emergency services are provided for all ages including general health exams, TB testing, hypertension care, and diabetic treatment. Pediatric and perinatal programs place emphasis on nutrition, immunizations and parent education. Women's health care programs include pap tests, mammograms and family planning.

Dental services include acute and preventive care, exams, sealants, x-rays, fillings and root canals. Our Smile Saver program visits schools, daycare centers and health fairs and offers education, supplies, and referrals.

Vision services include routine eye exams from both MDs and ODs with primary emphasis on diabetic eye exams. Outreach programs include home visiting programs with emphasis on education, nutrition and coordination of medical care, tobacco education, and diabetes education. Our HIV program includes prevention education and testing at detention centers, drug treatment centers, and Juvenile Hall.

Teen services include education, birth control and testing in the clinics and at schools in our community. "Kolors," a teen theater group, is formed each year to perform for 5th through 12th grade students focusing on teen issues. The Youth for Recovery program includes outpatient substance abuse treatment for teens. This clinic-based and school-based program includes individual and family counseling.

CommuniCare also offers substance abuse treatment services through its "STAR" program (Steps Toward Active Recovery) for families and individuals. A perinatal day treatment program provides services for pregnant and parenting women with young children. Another program called OSARP (Outpatient Substance Abuse and Recovery Program) helps those who need assistance beginning a clean and sober lifestyle.

Like many rural areas in California, Yolo County has a high concentration of agricultural, low-tech and labor sector jobs that pay poorly and lack benefits. Many residents are illiterate, lack skill required for a living wage, and do not speak English. The ethnicity demographics of patients using CommuniCare facilities are shown in Figure 2. To serve such a diverse population, multilingual staff are employed that speak eight different languages, helping to allow this diverse group of low wage earners to make informed decisions regarding their healthcare.

From a humble beginning 30 years ago as the Davis Free Clinic to its present form, CommuniCare and its volunteers and staff have been meeting the health care needs of the indigent in Yolo County.

Both authors have been privileged to serve as volunteers and now on the Board of Directors. Current efforts are focused on maintaining all programs in the face of dramatic State and Federal deficits.

An Endowment Campaign is currently under way to raise $1 million to help stabilize the roller-coaster funding sources that allow Communicare to operate. Anyone interested in making a financial contribution or wishing to volunteer may contact either of the authors for more information.