50 Years of Community Health Center, Inc.: A Special Conversation

CHC 50th Part 1

[ Music ]

Marianne O’Hare : Welcome to Conversations on Health Care . This week we’re the tables
as we mark a half century of the first free community clinic in
Connecticut , Veteran Journalist Thalia Assuras interviews host Mark
Masselli and Margaret Flinter o n their 50 years of transforming
c ommunity c are . FactCheck.org ’s Lori Robertson takes a look at
monkey pox , and we end with a bright idea transforming everyday
lives. Now here's our guest host Thalia Assuras .

Thalia Assuras : Welcome to Conversations on Hea lth Care . Don't worry, your
longtime host s Mark Ma s selli and Margaret Flinter are here for what
th
is a special edition . S pecial because we are marking the 50
anniversary of Community Health Center and also celebrating this
very show that these two created.

As you know, CHC is a nonprofit based in Connecticut has offices in
Colorado and California a nd programs right across the country
through its Weitzman Institute. L et us begin after 50 years already.
Congratulations, Mark, let's start with you. Mark, you f ounded CHC
Inc, in 1972, when you were barely out of your te ens and that's
significant. What motivated you?

Mark Ma s selli : Well, first of all, thanks so much Thalia . It was a great opportunity that
I was presented back in the early 70s an opportunity to wo rk with
other young people. W e were setting up a drop - in center , 24 - hour
crisis hotline for young people who were facing all sorts of problems
and difficulties. They were running away from home, there was issues
around drug us e. I t's a real opportunity to hear people directly talk
about the challenges they faced.

I t turned out that the common theme, whether it was a run away or
someone on the crisis line or somebody who just walked in with a
problem, that access to health care, connected all of them . They
s imply didn't have access to affordable and comprehensive health
care. C ome 1972 , I had heard about a conference that was being held
in Washington D . C . by a group from California from the Haight
Ashbury Free Clinic , hosted by them in Washington in January o f
1972. I made my way there to hear the voices of people who would
become friends , who were thinking about the same thing that I was
thinking about . How do we solve this health care problem for people
who we ’ re engaged with ? W e heard from people who like u s who
were just thinking about setting up a health center to people who are
running free clinics around the country.

I think from that day, to this day, it has animated all the work that I
do , that Margaret does, in terms of trying to build a system. There
were enormous challenges along the way . P retty naive about what it
took to get a free clinic going , b ut we found our way to a second floor

CHC 50th Part 1

walkup in the building that we're in with sort of a ramshackle
apartment building . But we made the best out of a sec ond floor
apartment. Y ou could have been in San Francisco it had a tie dye on
the walls that were beaded curtains that separated the rooms and
that slight scent of incense was in the air.

W e opened up a n d the great news was that we found some local
dentist who said they wanted to volunteer . I reached out to the
Christian Dental Association , t hey donated to chair . F riends at
Wesleyan got their physical plant to install the dental chair . We
converted the bedrooms and two ex am rooms and we opened the
door, and t hat was exhilarating . But back to the naivete , a few months
later got a knock on the door a nd they said we're from the State
Health Department , where's your license? We need a license ?

Thalia Assuras : Right . One of several challenges all along the way, I 'm sure and you
really started chair by chair really , street by street , a nd you talk about
challenges. What do you think are the biggest challenges you faced ,
a nd how you overcame them over the 50 years?

Mark Ma s selli : Yeah , I think the biggest challenge i s trying to find resilience when
crisis’s arise because they're bound to , or being shut down by the
state of Connecticut because our hallways were one inch too narrow.
Most of our volunteers left . D idn't seem like there'd be a possibility of
doing this wor k that they wanted to do , t hat's always been the case.
There's a setback that you have when you're knocked down that you
need to get back up and you need to propel forward . I would just say
to everybody who i s doing anything that you're bound to find that
heady moment when, you know , for us when we open the free clinic
to that moment of despair when we got closed down, you have to
find some equilibrium and not get too high over the excitement of
something or too low in the despair of a setback.

Thalia Assur as : Right equilibrium is a key word there. Margaret, I'd like to bring you in
now to o . I have mentioned the Weitzman Institute, which you
spearheaded, you're also a nurse practitioner and you've expanded
the profession itself through CHC . What inspired you to actually team
up and stay with this CHC for more than 40 years?

Margaret Flinter: Yeah, I was a few more years out of my teens than Mark but not
much. I think I was probably 27 , when I arrived , a newly minted nurse
practitioner from the Yale School of Nursing. My choice of the health
center was somewhat both pragmatic and fortuitous. I was a National
Health Service Corps scholar, meaning I had a period of service
commitment in exchange for the Federal Government graciously
funding my time at Yale . But I had a choice and I visited around New
England and a number of community health centers .

I say about my first meeting with Mark , my first visit to Middletown, I

CHC 50th Part 1

had found my people , this banner of h ealth c are as a right and not a
privilege, this model of a community health center that made health
care available to people regardless of their finances. N ot just any
health care, but a kind of health care not available to the wealthiest
people in America , fully integrated. Even in that one hallway that
existed after the second floor walkup , we were on the first floor
hallway on Main Street .

But it was really the original idea of a community based patient
centered primary care home there was only one of each of us, a
dentist, a doctor, a nurse practitioner, a med ical assistant, a social
worker and of course, somebody to s ort of take care of the finances
a n d the data. But that model would give rise over the next 50 years to
what has been pretty universally acknowledged as this is the model of
what really good compr ehensive primary care ought to be , not yet
fully realized f or everybody in the United States , but it was the first
step on a long journey that feels like it's just been overnight.

Thalia Assuras : Well, let's backtrack a bit and Mark I’ ll come back to you b ecause the
vision, the mission and who you serve. Can you give us just a quick
overview?

Mark Ma s selli : Sure. I mean, I think the mission , vision , values , have always been that
health care is a right, not a privilege. I think it animates so much of the
con versations that we have . E ven today with young people , it's
something that courses through their veins as well. T he population we
care for were in 243 locations here in Connecticut, we're in 34 farms
that were taking care of farm workers . We’re in 10 homel ess shelters,
taking care of people who simply can't find affordable housing. We're
in 185 school - based health centers, taking care of young people from
elementary school all the way through high school and 16 fixed
primary care sites across the state of C onnecticut.

It's mostly a people who live in poverty, a very diverse population,
and we care for around 150,000 patients . W e run a battered women's
shelter from gender affirming care, all the way over to primary
prenatal care. It's also one where English i s not always the first
language spoken . 50 different languages a month, we've got a great
translation service. W e're seeing from single individuals to large
families .

Thalia Assuras : Enormous . Margaret, not only are you serving the communities, you
are hel ping the people who serve the communities. Why has that
been important , and you've been involved in that very deeply , haven't
you ?

Margaret Flinter: Sure. We need the next generation always of people who will provide
the h ealth c are and we need to support the people who are doing it
today. O ver the years, I think we've recognized that our partnerships

CHC 50th Part 1

with academic universities and training institutions are so important
and we've welcomed in from many universities and colleges . I think at
any given time, we have 300 students and trainees within the
organization. But we also recognize that there are elements that the
service delivery based organization can provide as key educational
learning experiences that can never be provided in the classroom.

W e've taken on not just providing clinical experiences to students, but
we've also developed our own tailored, accredited , rigorous training
programs along the continuum for medical assistants, an idea whose
time had come in terms of a new way of training medical ass istants
who are so creative on the health care team . We develop the model
of postgraduate residency and fellowship training for new nurse
practitioners to ensure that they had a solid period of time, in this
case a year , to be fully embedded in the primary care setting, working
as part of a team , taking on the most complex and challenging
patients that we see b ut with the support and mentorship of expert
clinicians as a way to, if you will , fortify them for long term careers in
community health centers .

In the public's eye, I think sometimes primary care is about the
simple, the easy and the quick . They have the idea of the convenience
clinics or the -- with the walk - in center . But primary care in a
community health center is about a commitment over time to people
who are struggling with challenges that most of us never encounter in
our lives, financial, social and often clinical, when people don't have
resources it's often because of compounding physical and me ntal and
emotional difficulties a nd so they brin g all that to bear into the
setting. W e owe it to that next generation to train them with real
optimism and purpose. T hat gave rise to postdoctoral clinical
psychology residencies to a full pipeline for the behavioral health
professionals of nursing studen ts and much more to come . Dentists
are well represented in that as well.

Thalia Assuras : Well, let me -- you wanted to talk a little bit more about medical
assistants , w hy , j ust very quickly .

Margaret Flinter: T here are a group, I think , that represent the people that maybe Mark
and I have the softest spot for, right . The people who ’ve grown up in
families , who ’ve worked hard, haven't had much in the way of
resources. O ften we could see that very bright and talented people,
maybe the guidance counselors did n't work with them so much .
Medical assisting has long been a first rung , it's a certificate - based
program, it doesn't require an academic degree a nd that's something
sought after by hard working people looking to do good in their
community . T oo often find ing it only available through for - profit
institutions with pretty extreme tuition that then put them in debt for
many years following their education a nd didn't give them clinical

CHC 50th Part 1

experience in that kind of high performing , highly mentored setting
that we just talked about .

We thought we could do better by those individuals who are often
people in our own community . Mark really led the development of
the National Institute for Medical Assistant advancement, which I
think has kind of turned medical assistant education on its ear a bit in
a positive way and now operates nationally around the country. It’s
really on its way to becoming a powerhouse of training often that first
generation and families and a first run g in the h ealth c are professions.

Mark Ma s sell i : I f I can just add some to that, the indebtedness that we see that
happens through this training, so just understand that people pay
between 30 and sometimes $40,000, for seven or eight month s
training, that's a little more than if you annualize it out m aybe for
Harvard or NYU for simply a certificate . We find them 15 years later
still paying off that debt . We needed to find an affordable way of
doing that.

As Margaret said, the classic training program is seven months in an
academic setting and then a mo nth where they have to go and find a
placement. W e really turn that on its head by embedding the student
for the entire eight months in a primary care setting. It's a great job
opportunity interview that extends over a period of time . W e want
people like w e found our people to find their people , b ut we are very
focused in on trying to transform the entire educational system.
We're very concerned about that entry level . We want people to have
a unique experience and opportunity.

Thalia Assuras : T he people wh o come to your various clinics, a question for both of
you . M argaret I guess I'll start with you. Is there one person or one
family who remains seared in your memory and says to you this is
why I'm doing this ?

Margaret Flinter: Not one , really truly thousa nds . I think one of the amazing elements
of being in primary care , and I think this is true of primary care
providers g enerally it's just writ so much larger . I think at the health
center s that you know, people and you know families over time.
T here are th e pivotal moments that are seared , a tough diagnosis, a
family crisis, a great success and then there's just the evolution over
time. Mark, I think you probably have the same experience , some of
that is realized walking down the street when people call out to us
and remember me from years ago, people that I took care of decades
ago who will look you up on Facebook and say , do you remember me ?
You t ook care of me when I was a kid, a teenager, whatever.

But I think there are also the people and the families w ho are seared
in our mind because what happened to them should never have
happened to them. T hey became part of the galvanizing force to

CHC 50th Part 1

create change . I can think of so many of those really that inspire me,
particularly around the areas of women's health, women's rights,
domestic violence, substance use disorder, what happens to people in
the criminal justice system, that was their story. I think for everybody
at the health center they have those experiences that really on the
toughest days propel you forw ard, because we use those to create
lasting systemic change. W e have the opportunity at our size and our
strength to influence policy and practice in the United States.

Thalia Assuras : Mark, a significant memory for you ?

Mark Ma s selli : Yeah, one of the uni que things that we did when we were starting the
health center, we said we're going to organize ourselves at our board
in a different way a nd th at we're going to have the majority of our
board members be patients , that's unique. Oftentimes, we have
people just saying, how's that possible t hese are people who live in
poverty. The reality is they make do with less and they're raising
children, they're going to work and they're problem solvers.

One of the early board members and who was a mentor , to me was
Reb a Moses, born in 1920s in South Carolina, her dad was a
sharecropper. She found her way in the 1940s of the Middletown and
she was a foot soldier in the C ivil R ights and the anti - poverty work
that was going on at that time. S he found me a young upstart, sh e
was probably close to 30 years older than I was, but she became a
friend, a mentor . She served on our board of directors, she is
emblematic of so many people that Margaret and I get to work with
on our board who are patients who come here and then they g uide us
a nd made such a profound impact. T here are many people like that in
the health center. They've made us who we are today.

Margaret Flinter: Yeah, one of the remarkable experiences that's begun to happen
more in recent years, particularly with the tr aining programs, people
tell us that they used either this community health center or a
community health center somewhere in the country as children, often
children in immigrant families that did not speak the language. T hey
speak of how in their family th ey heard their parents saying that the
health center was the place that could trust and that their experience
of getting care in a health center really fueled and propelled them
into the health professions . It's a very special thing to realize the
impact t he experience of receiving care in a health center like this can
have the future life of a child .

Thalia Assuras : I'd like to talk about the advances in caring for the underserved. But
where have the re been failures to ?

Margaret Flinter: Good news, the Aff ordable Care Act came along in 2010 . The
Affordable Care Act did some very powerful, significant and sustained
improvements. T here are a whole lot of people who had not had

CHC 50th Part 1

health insurance in decades who received health insurance and a
whole lot of famili es , a nd we need to continue to build upon that. I
think the biggest shortcoming is the failure to have absolutely
universal access to health care to control the prices downstream. But
the third has been around the model of care, it's hard to say thanks to
COVID. But thanks to COVID, one of the big ones that a 15 , 20 - year
overdue major addition of virtual care to the armamentarium of
people a nd h ealth c are actually came to pass , a nd we all did it kind of
overnight. N ow we have to do the hard work of research and
evaluation and testing to see what really works best , b ut that's been a
huge plus .

What hasn't happened is we haven't recognized that as long as we're
locked in this fee for service system, there will always be a bit of the
rabbit wheel of running to do more visits, more visits, which means
less time with patients and more focus on the episodes. There's
certainly a lot of people thinking about it, studying it full a 100 %
access more for the people who need more . A s we say in our health
equity work , i t' s not about providing the same thing to everybody i t's
providing what people need, which may be much more in some cases,
removing those financial barriers. But then really making sure that we
have the time in the model of care with full integration of beha vioral
health, oral health, as well as medical services into primary care , t hat
would be a good start.

Thalia Assuras : Yeah, and Mark if you would pick up on that. It's impossible to
separate h ealth c are in this country from how we actually pay for
h ealth c are . Y ou've been through those budget battles in Washington
for trying to help your construct and what are called and maybe
people that don't know this they’re called Federally Qualified Health
Centers . What have you learned , a nd what are you looking for
further?

Mark Ma s selli : This is a white system, I think we've maybe evolved a little but it is
very much focused in on -- not on the population that we care for .
No ne of the research has been done in terms of health outcomes until
very recently and in only in very small steps h ave we researched the
health conditions of African - Americans or Hispanics of native people
and this is to the detriment of the health and wellbeing of tens of
millions , hundred million Americans who've been left out of the entire
Heal th Care system. It is been designed to limit the opportunities that
the rest of us h ave, a nd so I think that's an enormous shortcoming.
We do not have until very recently an equity lens on the health care
system. W hen we put that lens on we see how far it has fallen short,
in terms of delivering on the promise of that we articulated that
h ealth c are is a right not a privilege .

We often say there's access, but what is the re access to , right . I t's care

CHC 50th Part 1

that has been designed for populations that really not th e population
that we're seeing , a nd so I really worry, we're making progress b ut it's
too slow. We simply haven't done all the research . If you think about
all the research that has been done in health care has been done on
sort of a white male population , b ut really no diversity at all. I think
that's the biggest challenge.

I will add to that the paucity of African - American providers, Latino
providers that really need to be front and center in the movement,
federally qualified health centers who all have b een fighting this
battle to make sure that there's equity across the spectrum. I think
the one thing I come away with it and I think one of the brilliant things
a n d I give a shout out to Ted Kennedy, and maybe somebody like an
Orrin Hatch, who just passed away, health centers found common
ground on both sides of the aisle. That is the only way we can move
forward.

Health centers back in the late 60s and early 70s realized that we
needed to define this common ground , a nd so we had leaders like Ted
Kennedy an d Orrin Hatch who stood together , who were ideologically
so far apart. But they said funding community health centers make
sense. They have this sense of local community control where
patients are engaged in that . They are serving these neighborhoods
for w hom no one else would go to , a nd whether you're in Kentucky or
whether you're in Boston, Massachusetts, they're making a profound
difference. W hile there are enormous struggles, there's enormous
hope that this model has built this incredible network all ac ross
America. 1 , 400 community health centers, tens of billions of dollars
invested in them , a nd that all comes about because there was
common ground.

[ Music ]

M arianne O’Hare : That was part one of our interview with C onversations on H ealth C are
hosts Mark M as s elli and Margaret Flinter. Next week in part two, our
special guest host Thalia Assuras continues the conversation ,
exploring Mark and Margaret's vision on the quest to see equity
driven transformation of h ealth c are in America.

[Music]

Mark Masselli: A t Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consume r advocate
for voters that aim to reduce the level of deception in US politics. Lori,
what have you got for us this week?

Lori Robertson: In the midst of the ongoing COVID - 19 pandemic , a viral outbreak once

CHC 50th Part 1

again has health officials concerned . This time i t's monkey pox, a
much less dangerous relative of smallpox. Monkey pox is endemic in
central and W est Africa. But in early May cases of the disease began
cropping up in Europe and other places, including the US . W ith
hundreds of confirmed or suspected monk ey pox cases reported
before the end of the month, the outbreak is abnormally large , b ut
experts say the risk to most individuals is very low.

Monkey pox is a zoonosis , meaning that the virus is transmitted to
people from animals. People typically become i nfected sporadically in
the forested parts of Central and West Africa after an interaction with
an infected animal. Once infected , people can spread the virus to
others but that requires close contact.

The recent outbreak was first recognized in the United Kingdom in
May . T he CDC is conducting contact tracing to limit further
transmission and it has offered smallpox vaccines that can help
prevent monkey pox to those who had been exposed to the virus.
Symptoms of monkey pox typically begin with fever, headac he,
muscle aches, back pain, swollen lymph nodes , chills and exhaustion .
T he CDC says a few days later, patients develop a distinctive and
frequently painful rash.

Patients who have symptoms can pass the virus on to others through
close physical contact. T he rash and the scabs and fluids from the skin
lesions are especially infectious , which means contaminated clothing
or bedding can spread the virus. Monkey pox is also spread through
large respiratory droplets. But because these larger droplets don't
trave l more than a few feet, it takes a lot of face - to - face contact to
spread the virus.

A large number of the cases worldwide in the recent outbreak have
been in men who have sex with men. Experts are in general
agreement that the monkey pox outbreak is someth ing to be aware of
and take seriously but not something that people need to worry that
much about. And some vaccines and treatments already exist. T hat's
my f act c heck for this week. I'm Lori Robertson, Managing Editor of
FactCheck.org .

Margaret Flinter: F actCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’d
like check, e - mail us at www.chc.radio.com w e’ll have FactCheck.org’s
Lori Robertson check it out for you here on Conversations on Health Care.

[Music]

Margaret Flinter: Each week Conversations highlights a bright idea about how to make

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wellness a part of our co mmunities and everyday lives. It's no secret
that baby boomers are aging in large numbers , a nd that means that
those suffering from age related dementia are on the rise as well.
Four million Americans live with Alzheimer's disease and we know
that number w ill double by 2025 .

Daniel Cohen has devised a tool that is improving the experience for
these patients whose quality of life declines along with the loss of
brain function. He wondered what happened if you provide iP ods for
patients in nursing homes that are loaded with their own personal
playlist of the songs they loved when they were younger. In his first
pilot program called Music & Memory , patients in a nursing home
were given the iP o ds with their own personalized song list. T he results
patients went f rom being no n communicative and disengaged to
being animated and engaged. Patients like Henry featured in t his
documentary on the program called Alive In side.

Daniel Cohen : Do you like music?

Henry : Yeah, I'm crazy about music , you played beautiful music.

Daniel Cohen : What was your favorite music when you were young?

Henry : I guess, Cab Calloway w as number one band .

Daniel Cohen : What's your favorite Cab Calloway song?

Henry : I’ll be home there for Christmas. You can come -- -

Margaret Flinter: Cohen explai ns one of the theories as to why this program works so
well.

Daniel Cohen : The reality is because our memories of music are co - located in the
brain with our autobiographical memories. When you play a song, it's
familiar y ou're kicking off memories that you had.

Margaret Flinter: The results from the Music & Memory program were so impressive
that Cohen's personalized iP od program is now being used in 50
nursing homes throughout North America and many more are lining
up.

Daniel Cohen : We've done some research and the feedback from the frontline from
the nursing homes is that their ability to provide care is facilitated ,
a nd so that allows them to get their job done to pay attention to all
the residents as much as possible. T hat's been a big win as well.

Margar et Flinter: A simple, personalized application for a readily available piece of
technology that could dramatically impact the quality of dementia
patients lives. Now that's a bright idea.

[Music]

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Mark Masselli: You've been listening to Conversations on Hea lth Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and h ealth .

[Music]

Marianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. Th e show is brou ght to you by the Community
Health Center .