The Family Resource Center at Nemours Children’s Hospital, Florida, offers a fresh approach to the traditional family resource center. For starters, it’s run entirely by volunteers who will be future health care providers. These student volunteers work closely with community partners and the hospital’s social work team to share up-to-date resources with families. The goal is to meet both immediate and long-term social needs – like food, clothing, transportation and housing – that directly impact a child’s health and well-being.
Guests:
Laura Chilcutt, MD, Medical Director of Medical-Social Impact, Nemours Children’s Health, Florida
Amrita Singh, Resource Navigator Lead, Family Resource Center, Nemours Children’s Hospital, Florida
Host/Producer: Carol Vassar
TRANSCRIPT
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at Nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
MUSIC:
Well Beyond Medicine
Amrita Singh, Nemours Children’s Health:
I think taking a more holistic approach to medicine and really looking at the causes of illness rather than just treating a patient, that was really interesting to me. So, I really wanted to be a part of a program that focused more on the social elements of health rather than just medicine itself.
Carol Vassar, podcast host/producer:
That’s Amrita Singh, lead resource navigator at the newly created Family Resource Center at Nemours Children’s Hospital, Orlando. The FRC, as it’s known, is the brainchild of pediatrician, attorney and medical director for medical social impact at Nemours, Dr. Laura Chilcutt. Dr. Chilcutt’s vision takes the standard family resource center with reading and resource materials and brings it to the next level, with an all-volunteer staff providing up-to-date resources for families through community partners and the hospital’s social work team to address a family’s immediate and long-term social needs, such as food, clothing, and shelter, all of which we know impacts a child’s health and well-being. So, what was the genesis of Dr. Chilcutt’s vision? Here she is to fill us in.
Dr. Laura Chilcutt, Nemours Children’s Health:
So, this actually came out of a lot of different issues. We see a lot of families that come in with social issues, especially right now, facing a lot of hunger, housing instability, things like that that really affects the children. It affects the whole family. And so, as we’re coming to the hospital, we’re finding that we hear about these issues, and then our care teams are faced with, “So, what do we do about this? Do we send a child home knowing that they don’t have any food at home?” So, really started thinking about how can we respond as a hospital, as a system, both to support our care teams and then also just the patients, the families, kind of the whole community feel. And so, we started with this idea of, what if we recruited some undergrad students who are pre-medical students, they want to go to med school or to nursing school or to do any kind of clinical work and they need a lot of volunteer hours, but they also really want to work with families.
They want to get that exposure and these social issues are things that really matter to young adults right now. And so, we started recruiting some volunteers, a lot of them are coming from the University of Central Florida, which is our partner university here in Orlando. Some of them are also coming from other schools. Some of them have recently graduated, like Amrita here. And so, they’re coming in as basically volunteers doing four-hour shifts every week. We’re open from 10:00 in the morning until 6:00 in the evening, and then we’re trying to do some evening shifts as well. We also now have some Saturday shifts. So, really trying to get a lot of coverage so that parents, whenever they’re available, whether it’s early morning, late at night, they can come in and talk with our volunteers about these social factors affecting their families to try to get some help to address them so they’re not going home to empty cupboards or to concerns about like, “Am I going to have a home when my child’s ready to be discharged?”
Carol Vassar, podcast host/producer:
So, expand a little bit on that description and talk about the services, the resources, the tools. I’m a parent walking in, I’ve been referred by somebody in the hospital perhaps. What are you going to be able to offer to families?
Dr. Laura Chilcutt, Nemours Children’s Health:
So, that’s a constantly growing process. I started talking to different community organizations to realize that all the different social worker teams from our hospital, from the other area hospitals, from just other different organizations in general in the community, we all had our own little lists of community organizations. And so, when someone would come in with a need, we would use that list. And I started thinking, what if we combine that and start to be able to really broaden our ability to respond to needs so that when a patient’s here, they’re not stuck waiting in a hospital room, picking up a hospital bed, but also just waiting and not being able to go home for hours or days because we can’t find a resource for them. So, we’ve gathered different lists together. The volunteers actually came in, now it’s about a year ago, they started taking all those lists and putting them into a big Excel spreadsheet.
And then, we also partnered with the UCF undergrad program that takes students working on their computer science degrees, and they came in and volunteered, this whole team of them, to turn that spreadsheet into a web-based platform for us. So, we now have this web-based page where our volunteers can go in and search by zip code, by type of need and start to come up with different lists. So, if someone comes in and says, “I live at this zip code or in Orange County or Osceola County, I need help with food, I need help with housing,” we can do a cultivated list basically of resources in the area.
That may be things like just a list of food pantries. It may be help with figuring out how do they get to the WIC office or to apply to SNAP. So, that kind of covers the broad range of different things available for food, and then, other organizations that may be available with case management to help with housing and figuring out where can you afford to live and how can we get you there.
Carol Vassar, podcast host/producer:
I’m hearing a lot about partnerships and the strong partnership with UCF, first and foremost, but also community organizations. This is really a matrix of many, many organizations coming together to serve the community. Talk about the importance of those partnerships.
Dr. Laura Chilcutt, Nemours Children’s Health:
That’s a huge part of this. As a hospital, we see a lot of the need, right? A lot of times, families, if they don’t know where to go, they may be just kind of struggling on their own in isolation, but then eventually something happens, and they end up in the hospital, and we start to see it. That’s when we recognize that the kid’s stomach ache or headaches or things like that that are bringing them back to the clinic over and over or back into the hospital could be coming from the fact that they’re stressed or they’re not eating, or something like that that’s related to a social issue. But we can’t fix all of that, right? As a hospital, we are not the experts in housing, and we’re not the experts in maintaining food. So, we do have a partnership with Second Harvest where we actually bring in the Second Harvest food boxes, and those provide enough food for a family of four for a week.
So, those are great resources that the volunteers do bring to the family. So, if a family is recognized as having some food insecurity or concerned about food at home, the volunteers, when they go to meet with them, they will take the box of food, but then also bring other resources. But even beyond that, organizations that work on housing in particular, that’s a really complex need. You have issues of complete homelessness, which is one whole area that goes, it’s a HUD and other things, where you’re looking for actual shelters and how to immediately get someone into housing, either out of their car or off the streets. But then, there’s a long-term plan of you might be living on someone’s couch, but you know that a month or two from now, you’re not going to be able to still be there. So, how do we figure out, do we need to get you SSI or other benefits to make sure that you can pay for that deposit and that first month’s rent, last month’s rent, utilities, all those things that come with that?
And so, that’s where we start to rely on community partners and they’ve been fantastic. We have one organization. When we find a family that we know has no place to go, we call that organization, match them up with their case manager, with our social worker, and that family will work with them to figure out what they can afford. Where can I live? They will identify housing for them, and then give them kind of a list of, “These are things I need you to do as a parent and as a family to figure out what you can do. And then, we’re going to help you with your deposit and maybe first month’s, last month’s rent, and then get you housed.”
Carol Vassar, podcast host/producer:
One key to this is the volunteers, volunteers like Amrita. Get to you in a moment, Amrita. How do you choose the volunteers? What kinds of qualities are you looking for in your volunteers?
Dr. Laura Chilcutt, Nemours Children’s Health:
So, like I said, a lot of these volunteers are already coming to us with a lot of this knowledge and enthusiasm about working not just with families, but working with families on these social needs. I know when I was an undergrad, I mean, I majored in sociology, so I learned about a lot of social factors. But even at that time, social determinants of health or social drivers of health was not a big thing that was being discussed a long time ago. But now, that’s a big part of training that I think even the students going through the BioMed majors, they’re still hearing about these factors and they’re required now to take Intro to Sociology and Anthropology in these classes that will help to let them understand that mix of, it’s not just pure science, right? You can have science and healthcare, but you still need to understand the social factors because so much of the well-being of a person comes from that.
So, a lot of them when they come in, they’re already kind of self-selecting. They’re the ones who understand that this stuff is important. They also really want access to families and to be able to work with families and talk with kids, especially. So, when they come in, we actually do have them write a short essay just on why are you interested? And I’ve actually been amazed by the essays that we’ve gotten. They’re all, they either are connecting it back to things that happened to their families and their interaction with the healthcare system when they were younger, or just an understanding in general of, “I’m coming from an underserved population. I get that this can sometimes be hard or scary for families, and I want to help to understand that and to make it better for other families.” And so, that enthusiasm for really making everything safer and more comfortable for the families and for the kids.
Carol Vassar, podcast host/producer:
I’m seeing Amrita nod her head. So, I’m going to turn to you, Amrita. You’re a volunteer. You work here, and you are inspired to volunteer here. Why? What drove you? How did you hear about Family Resource Center?
Amrita Singh, Nemours Children’s Health:
Initially when I was looking for volunteer positions to do my pre-med requirements, I really wanted to volunteer at Nemours because I really loved children. And when I learned about the social program, I was really interested because the social aspects of health were only really things that I learned about towards the end of my degree. So, this really seemed like a new initiative in a hospital that I haven’t seen in other hospitals in Florida. And I think taking a more holistic approach to medicine and really looking at the causes of illness rather than just treating a patient, that was really interesting to me. So, I really wanted to be a part of a program that focused more on the social elements of health rather than just medicine itself.
Carol Vassar, podcast host/producer:
Talk about what your experience has been like. Direct services to the family is not easy sometimes.
Amrita Singh, Nemours Children’s Health:
It’s definitely not easy. Every family is a different case. Every family comes in with unique circumstances and has their own unique struggles. Every day is different at the Family Resource Center, and I’ve been privileged to be able to see so many different struggles that people face every single day. And I realized that a lot of the solutions that people think are really difficult to get connected with, and sometimes people need an extra step or guiding hand to really know what help exists out there, and how do you even get connected to it.
Carol Vassar, podcast host/producer:
Can you cite an example of a family, without going into great detail so we don’t reveal exactly who they are, that has touched your heart and has really stuck with you as you continue on your journey in healthcare?
Amrita Singh, Nemours Children’s Health:
A couple months ago, we got, I think she was a single mother who recently had another child. Her kids were preschool age, so she was looking into how to get them into school. She wasn’t quite sure where to start. She was looking for more daycare options or preschool options that she’d get into, but she was having trouble connecting and knowing what the right options are. So, we ended up seeing her at the Family Resource Center, connecting her with different programs that we thought might be helpful, like VPK. And a couple of weeks after her visit, she was able to come in contact with some VPK services and get her children enrolled.
And that’s just one specific example. But as we followed up with families who have interacted with volunteers at the Family Resource Center, I think the biggest feedback that we’ve gotten is how supported families feel. Sometimes when you come to the doctor’s office you feel like, or to the hospital in general, you feel like they’re only treating that illness at that particular time, and doctors don’t really care about the whole background of a family or of a child, and they feel that the Family Resource Center is a place where people actually care about those bigger issues.
Carol Vassar, podcast host/producer:
Education of families, of parents, even the kids who might be a little bit older is a huge part of what you do, Amrita. Talk about the role that education plays in empowering families to move forward.
Amrita Singh, Nemours Children’s Health:
I think the biggest aspects of education from the Family Resource Center are just learning what’s out there. Some people don’t even know about particular programs or how to apply for them. Even for ones that are as well spread as SNAP or WIC, sometimes people don’t even know where to begin. So, I think the biggest part of education is knowing what resources and systems are already out there.
Carol Vassar, podcast host/producer:
Dr. Chilcutt, how does the center facilitate that education process between the volunteers and the families and the patients?
Dr. Laura Chilcutt, Nemours Children’s Health:
The first we do when the volunteers first come to us, we do some training for them. We’re actually doing one tonight for a new group of volunteers that are coming in. So, this is a chance to really make sure that they understand the idea of social drivers of health, what we’re doing, and this whole role that we have of connecting the families. And then, when the families are admitted to the hospital or coming to one of the clinics, whether it’s the care team or the nurses who are admitting them and they recognize that there’s a social need, they’ll then let them know we have this center downstairs, they’re here to help with these different issues. And then, they’ll either send them downstairs or send a message down to the volunteers and say, “There’s a family in this room and they need some help.” And they’ll give a list of some of the issues.
So, it’s really a matter of just going and walking into that room and basically saying, “We’re here to help. What can we help with?” Sometimes the families don’t even know. And so, letting them talk a little bit about what their experiences are or just kind of saying, “Well, we’ve got a referral. Maybe for this issue, is this something that you need help with?” Or even just offering, “We have food downstairs, we do have some diapers downstairs. What kind of things can we do to help?” But once you start showing that you’re willing to help and showing that you’re interested and really do want to hear, they really do open up. I think that’s just a big part.
Like Amrita said, every family is different. They’ve all had different experiences. Some of them have already gone to many resources, and some have never even tried. And so, really trying to assess that, it’s just something that comes with time, and the volunteers just go in and just have a conversation. Sometimes just listening to the family is enough and sometimes it’s a matter of really trying to walk them through the process of like, “Here’s what we’re going to send you, here’s why,” and hoping that it helps. And if they come back, we do the whole thing again.
Carol Vassar, podcast host/producer:
Do most of the referrals come internally? That is, do Nemours providers refer families over, or do families hear about this in other ways?
Dr. Laura Chilcutt, Nemours Children’s Health:
So far, it’s mostly been internal. So, a lot of it is on the admission process. The nurses who are downstairs in the command center, they will do the admission questions for families. It’s a lot of questions, a long process. And so, they actually ask some basic questions about needs for housing and stability of food at home, domestic violence, things like that. So, really trying to cover some of the big issues that we see with the families. And when they see that, they then do a referral within a resource center as well as to our social work team. And then, we work with the social work team to figure out who should do more of an assessment, who’s the best to go work with the family, making sure that we’re all kind of sharing resources and coordinating our work.
Carol Vassar, podcast host/producer:
This is a relatively new effort. And what’s unique? And this is a question for both of you. I’m going to start with Dr. Chilcutt. What’s unique about this family resource center that maybe you’re not going to find somewhere else?
Dr. Laura Chilcutt, Nemours Children’s Health:
I think there have been a of couple other places in the country where only a few that have tried some of these, kind of using volunteers to help with addressing needs for families. But I think this is just a much more ambitious version of it. So, to have an actual center in the hospital, so not just that volunteers are virtually calling into a room or maybe going into just kind of one unit. This is us trying to address needs for the entire hospital, but also our clinics, our specialty clinics. We’ll send families down or we’ll take resources to them.
We actually have sent some of the volunteers to the clinics. So, they’ll do a whole shift in, say, the diabetes clinic. So, all the patients who are coming in who are seeing not just the physician but also the nutritionist and the social worker, the Family Resource Center volunteer can be there with them as well to provide resources immediately. So, I think a lot of these, having this embedded within all of the work that we’re doing, I think really is unique.
Carol Vassar, podcast host/producer:
Amrita, what do you see as unique about the Family Resource Center?
Amrita Singh, Nemours Children’s Health:
From the volunteer side, I think the most unique part is that you get to work with every single unit in the hospital and all the different departments. So, you’re not just working with doctors, you’re also working with social workers, you’re working with nurses, and you’re working in all the different clinics like Dr. Chilcutt said. So, you do get to see a lot of the inner workings of the hospital, and you also get to be somewhat a part of the discharge process, and social work tends to be some of the last people who see a family. The Family Resource Center also happens to be one of the last people who see a family. So, we really get to be part of that exit process for a family to make sure they can get home to food in their cabinet or be a little more secure in their housing situation.
Carol Vassar, podcast host/producer:
Now, a lot of this has to do with aiming toward whole child health, and part of a child’s health is supporting their parents, their caregivers. How does the Family Resource Center address patients and their families and their emotional and mental health needs, Dr. Chilcutt?
Dr. Laura Chilcutt, Nemours Children’s Health:
I think, just like all of the needs, we just provided the resources. So, we actually share resources, not only, like I said, we have them from social work and other teams and other hospitals, but our care coordinators and primary care also have pretty extensive lists, and they work very closely with our primary care patients. And we share a list with them, too. So, they have an extensive list of mental health providers, not just for children but for adults. And so, that’s a place where we may call on them and say, “We have a family from X County and the mom is needing some help,” especially often postpartum, right, that can have maternal depression or even maternal depression.
So, calling them and saying, “Who do you have in this area that we can refer them to?” So, we use all the resources that we have within the hospital as well as in the partnerships. So, I think that really is, mental health is there with everything else. Therapies like ABA, physical therapy, especially in the rural counties, those can be really hard to find. And so, building up those lists has been a big priority for us.
Carol Vassar, podcast host/producer:
Amrita, are there needs that you see that are not being fulfilled?
Amrita Singh, Nemours Children’s Health:
Well, to be honest, it’s a bit of everything that isn’t being fulfilled. There’s always room for more resources in the community. There’s obviously big programs like SNAP and WIC for food, and there’s HUD for housing. But in terms of smaller programs and community-based programs, there can always be more. Funding for these types of programs is hit or miss. A program that exists today might not exist a few months from now. So, it’s always good to keep track of who still exists and any new and up-and-coming resources. The more that we have, I think is the better for now.
Carol Vassar, podcast host/producer:
It’s interesting that you say a program that existed a few months ago might not exist. Is that a funding issue, Dr. Chilcutt, or is that just a resources issue in some other way?
Dr. Laura Chilcutt, Nemours Children’s Health:
I think it’s both. A lot of it just has to do with grants. A lot of what we’re looking at in the partnerships that we’re working with, they’re all nonprofits and they’re all grant-dependent. So, some of them may have a somewhat permanent cash flow through the government, so those are going to be your more permanent organizations that you might be able to rely on a little bit better. But small nonprofits, which often provide really important niche services, those tend to rely on grants. And those grants may come in today, and they may be set for six months, but then six months from now, if they don’t get a new grant, that may be it. So, it is very hard to keep track of what the current resources are. So, this is one of the jobs of the volunteers to constantly be updating that list.
They call organizations frequently to say, “If we send them over, are you still going to be able to help them? If your hours change?” So, that also is something that you could have. They may be open only for intake on Tuesday afternoons, and then that might change till Thursday mornings. And so, you don’t want to send someone across town to an organization that isn’t going to be able to help them today, but maybe they can help them next week. So, it’s a lot of that kind of coordinating and keeping track. It’s just lot of logistics.
Carol Vassar, podcast host/producer:
Amrita, you sound like you have to be really, really organized to be a volunteer at the Family Resource Center at Nemours. Talk about that.
Amrita Singh, Nemours Children’s Health:
We have a couple of organization methods in terms of our physical storage and also our digital storage. We have to keep track of changing inventory pretty consistently as we receive donations of different items. Recently, we’ve gotten a big donation of diapers, baby wipes, and things of the sort. So, we are having a big inventory system to keep track of all of that. But we also have an online database that we are currently using to keep track of all of our resources. Before, like Dr. Chilcutt mentioned, it was a huge Excel spreadsheet, but we ended up partnering with some students from UCF to turn it into more intuitive, searchable database. So, it helps us keep all of our ducks in a row a little better.
Carol Vassar, podcast host/producer:
That sounds like it’s a great tool. You’re leveraging the technology of today. Are there other ways you’re leveraging technology to enhance the work that you’re doing?
Amrita Singh, Nemours Children’s Health:
It’s mostly through follow-ups with families, through email and through phone call, mostly for phone call to follow up, and then if they would like any additional resources after their visit. Maybe the initial ones we provided them they weren’t eligible for, or their needs have changed over time, we were able to send them more resources via email.
Dr. Laura Chilcutt, Nemours Children’s Health:
We do have a computer lab. We built a computer lab in the back of the Family Resource Center space as a way of providing internet access for families. It’s one of the things that we know families may not have high-speed internet at home, so if they need to apply for Social Security or SNAP or any of those federal benefits, that is something that we offer for them. We also have electronic interpreter services, so we have the tablet on wheels so that we can always make sure that we have access to whatever language we need to make sure we can communicate properly with the families.
And then, another project that we’re currently working on is trying to figure out how do we develop some kind of an app version of this database that we’re using and maybe something else that can help us to track, as families get to organizations that we refer them to, can we have a check-in process? Can we have a way of getting some kind of feedback back to us to say, “Yes, they got there. No, they didn’t.” And so, it’s a separate UCF team that we’re working with, trying to figure out now how to integrate maybe this little bit of AI, a little bit of app technology. So, that’s kind of in process right now.
Carol Vassar, podcast host/producer:
Dr. Chilcutt, I’m curious how you see this as fitting the Nemours mission statement of going well beyond medicine.
Dr. Laura Chilcutt, Nemours Children’s Health:
I think this is well beyond medicine, right? This is, we are here in the hospital, so it is absolutely connected to that medicine. But it is all those little things that get people caught up with those little details that don’t quite fit as cleanly into the black and white diagnosis of this versus this, or treatment with this medication or this medication. The social things are so much grayer and so much, a little bit fuzzier to work with. But this is, I think, a really solid team of volunteers and a great program that’s going to allow us to respond to some of those things.
And it’s just being built out every day. We actually have another physician who’s looking at adding in some more programming. We have legal aid classes, different topics that are important to the families. We’ve got our head of our school program who wants to start doing some early childhood education things here in the hospital. So, adding a lot of programming, and just all those things that never fit anywhere, they all fit here. And so, this is a way to really expand what we can offer as a hospital to the community.
Carol Vassar, podcast host/producer:
It sounds like tremendous growth has already happened. Where do you see this in six months, a year, two years?
Dr. Laura Chilcutt, Nemours Children’s Health:
I think the big focus now is how do we get these resources out into more of our community sites? So, we have it here in the hospital. We did actually have one small pilot where we had some second harvest food boxes taken to our downtown clinic. So, we had those available to our primary care office there. So, our residents, as they were seeing families, would need some food right there in the minute, they were able to hand that food to the family. That went over really well, and we actually are now trying to decide how do we expand this? Do we find a way to get this into all of our primary care offices? We’d get our resources there and what is the kind of satellite version of an FRC office? What needs to be there? What do we do centralized, here in the hospital? So, that’s kind of the next phase that we’re working on.
Carol Vassar, podcast host/producer:
Amrita, you are one of many volunteers. Where would you like to see this go in the future. When you come back after you’ve earned your medical degree, how would you like to have this manifest?
Amrita Singh, Nemours Children’s Health:
I would like to see it as a more robust and more organized system. We are just starting off at the FRC, so we obviously have a lot of growth and learning to do. But I would love to see us have stronger connections with different organizations in the community. Really building relationships with organizations that we know work and are helpful.
Carol Vassar, podcast host/producer:
Well, Amrita Singh, Dr. Laura Chilcutt, thank you so much for being here with us today. To talk about this Family Resource Center, we’re going to have to check in with you again in the future to find out where this stands and how it’s grown over time, because it looks like it’s going to have tremendous growth. Thank you both for being here.
MUSIC:
Well Beyond Medicine
Carol Vassar, podcast host/producer:
Addressing the 85% of what happens outside the doctor’s office that affects children’s health is what we’re all about on the Nemours Well Beyond Medicine podcast. And we’re grateful for the time Amrita and Dr. Chilcutt have shared to explore this new vision of the Family Resource Center and how it can function to address the social determinants of health. If you or someone you know is doing work like this, we want to know about it. Send your podcast ideas to [email protected] or leave us a voicemail on our podcast website, NemoursWellBeyond.org. That once again is NemoursWellBeyond.org.
Thanks to our production team for their work on this episode, Susan Masucci, Cheryl Munn, Lauren Teta and Steve Savino. Join us next time as we learn what whole child health means to the man leading the charge to bring it to fruition. Nemours President and CEO, Dr. Larry Moss. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
