CIVIC ENGAGEMENT WITH FREE CLINICS: ASSESSING SOCIAL DETERMINANTS OF HEALTH Kate Ksobiech, ph.d. Nick Surita Special Thanks to: Dr. Christina Jones, Yolanda Pena, Rock River Free Clinic, Open Arms Free Clinic and UW-Whitewater Undergraduate Research Program.

Free clinics in Wisconsin 70 Free & Charitable Health Care Clinics in Wisconsin in 52 counties. Post Affordable Care Act, close to 9% of Wisconsin residents have no health insurance with many counties still in the double digits for uninsured Dr. Ksobiech and Dr. Jones were approached by Rock River Free Clinic & Open Arms Free Clinic to study and analyze the clinics utilization and client satisfaction.

Surf Research project Summer 2016: Received a Summer Undergraduate Research Fellowship (SURF) through UW-Whitewater Undergraduate Research Program. Summary: “This research project qualitatively explored the experiences of 44 clients and patients affiliated with Open Arms Free Clinic in Elkhorn, Wisconsin and Rock River Free Clinic in Fort Atkinson, Wisconsin. Through analysis of the data collected, reoccurring themes for the lack of utilization and potential outreach opportunities emerged. An interview and questionnaire allowed insight into the social determinants of health of impacting the clients. “

Interview process Rock River Free Clinic Open Arms Free Clinic Recruitment was done by Executive Director Conducted after client was seen by doctor Sporadic – When free time was available Recruitment was done by Translator and Researcher. Conducted before client was seen by doctor Set schedule for times to be interviews

The Sample - Gender 9 males – 10 females 11 males – 14 females

The sample – race / ethnicity 14 White Americans, 3 Hispanic Americans, 2 African Americans 8 White Americans, 17 Hispanic Americans

The sample – education level

Thematic analysis findings Patient Perceptions of Clinic and Staff Addressing Stigmatization Challenges & Barriers Outreach Moving Forward

Patient Perceptions of Clinic anD Staff Rock River Free Clinic Open Arms Free Clinic “I feel like everyone when I called they were very helpful with how I take my first step in coming in and signing up and stuff like that. Everyone here was really nice.” “It’s a great place, I have not had any issues, you guys have been very accommodating… It’s very non- stressful when you come in here.” “Personally I am so happy and thankful with this clinic. The people here are super, super nice. Every single person is very helpful and they treat us super good!” “I have had really good experiences here, I feel very informed about the process and the entire staff here are very nice.”

Addressing stigmatization Rock River Free Clinic Open Arms Free Clinic “I think it’s kind of a pride thing, I guess you could say. Some people feel like this is a handout to certain people.” “I think one thing is to some people it’s embarrassing. They don’t want to be freeloaders, so to speak. I think for other people they just don’t know, and I don’t know.” “People may not use the clinic because it may be a pride thing. They don’t want to be seen as a charity case and getting free stuff from the government.” “I think some people are too proud to be seen getting help and treatment from a free clinic.” “Probably because they feel down using free services and they preferred being sick rather than use free services.”

Challenges & Barriers – Language Rock River Free Clinic Open Arms Free Clinic “I think they are scared. My husband is Hispanic, my children are Hispanic. Some of the other family of mine do not speak Spanish so I think they are afraid of that, Nobody here is going to be able to understand them or know that their problem is. “ “I really appreciate that the volunteers try and speak Spanish for us. First we had just one volunteer but now we have more Spanish speakers and it is very helpful especially for my mom that don’t understand English at all.”

Outreach Opportunities identified Media outreach Radio Newspapers Online (website/social media) Creative locations Schools, daycares Churches Hispanic grocery stores Job Fairs

Moving forward Clarifying mission and vision with potential clients and community members Many patients indicated they fall within the “Affordable Care Gap.” Expanding the message regarding preventative care vs. illness care, treatment of the temporarily in-need compared to the persistently dependent.

“I’m so happy with this clinic, and I want to say thanks for their help. I am very emotional because I had not been to a doctor in 10 years and they found, I had diabetes. Thanks to god that I found this clinic, they saved my life.”