The Los Angeles Mission Community Clinic (LAMCC) was started in 1996 as a department of the Los Angeles Mission (LAM), a faith-based nonprofit agency serving the homeless population of Skid Row for over fifty years. While the main focus of LAM was providing social services such as housing, food, clothing, rehabilitation, and vocational services, they were concerned by the unmet medical needs that they witnessed on a daily basis while they served the community. The LAMCC was started in response to those needs.The clinic grew slowly over the first few years, starting with mainly volunteers and then adding staff positions little by little. By 2003—when the clinic first applied for CCHF funding—our annual budget was about $595,000, made up completely of private foundation grants and individual donor contributions. With this budget, a dedicated ten-member staff, and less than 4,000 square feet of space, we were able to offer full and individual time, comprehensive, adult primary-care services to 2,100 patients (4,000 visits) per year, as well as part-time dental and part-time chiropractic care.Unfortunately, despite modest growth, LAMCC continued to see tremendous unmet needs in the Skid Row homeless community. Most troublesome to us was the fact that nearly every day we turned away more patients than we were able to serve. We yearned to make more of an impact on our community, and knew that we would need to grow significantly if we were to really make a difference in access to care. We would need more providers and nurses. We would need to expand hours to include evenings and Saturdays. Dental services needed to be increased from part-time to full-time to meet the huge need for dental care. We would need to begin serving children, a subpopulation whose numbers were sadly on the rise in Skid Row.To accomplish all of this growth that we envisioned, of course we would need to do a lot of fundraising. But more importantly, we would need to find funding sources that would be sustainable year after year, so that our patients would be able to depend on us over the long term. We began to contemplate the idea of pursuing government funding, and particularly the Federally Qualified Health Center (FQHC) program. As we did so, we immediately faced numerous challenges: (1) We know very little about the program and had received much conflicting information about whether or not a small faith-based clinic such as ours could qualify; (2) Our parent organization had a long history of receiving all of its funding from the private sector, and was open to the idea of the clinic pursuing government funding only if we split off and became a separate 501(c)3 entity; (3) Our very small administrative staff was already overburdened and had limited time to spend researching governance and operation requirements, conducting a readiness assessment, and bringing the clinic into compliance; (4) We had very limited ability to track the types of clinic data that we knew a federally-funded clinic would need to report on, due to our antiquated computers and “homemade” patient database, and we lacked the funding to purchase and implement a new system; and (5) We had no grant-writing staff to write the 200-page-long proposal, and we knew our medical director and administrative director could not do it alone and still conduct their duties of running the clinic. To say that the challenges seemed insurmountable would be an understatement!We started asking CCHF director Jerry Stromberg for advice early on in the process. It was a huge encouragement to hear his stories of other faith-based clinics that became FQHCs and maintained a Christian identity. Hearing about the growth that these clinics underwent and the impact that they were able to make on their communities fueled our desire to move forward on the path.In 2003 we applied for and received a Compassion Capital Fund sub-award from CCHF. We used the funds for two purposes: (1) to purchase and implement a new practice management system, and (2) to hire a consultant who could conduct an readiness assessment, assist us with achieving compliance, guide us through the process of separation into a separate 501(c)3, and help us write the daunting application.The months that followed were a whirlwind of meetings, conference calls, late nights on the computer, and most of all watching God do miracles! While the CCHF funding had addressed all of the barriers we had been anticipating, we encountered numerous challenges along the way that we had not foreseen, ranging from mind-boggling logistic issues to fierce local politics. At every turn, we were humbled beyond description as we watched God solve every problem we faced. Ultimately, in the spring of 2004, we submitted our application, and by fall we had received notification that we were awarded FQHC status, along with a $650,000-per year continuing grant to expand access to care to an additional 2,750 patients annually. Hallelujah!The CCHF funding that we received was obviously a crucial part of our getting to the point of being an FQHC clinic—but CCHF’s role went beyond just the funding. They provided various types of technical assistance that were vital to the process. One example includes the “Strategic Planning Technical Assistance and Coaching” workshop that we (the medical director and administrative director) attended in March 2004. This workshop could not have come at a better time for us. We were just at the threshold of breaking off into a new 501(c)3, but our new governing board had not been put in place yet. As clinic management, we had to determine the vision for the new entity on our own, yet if asked, we would not be able to define values, vision, and mission statements, let alone try to formulate them. At the workshop we learned just what we needed to know about those important concepts, as well as SWOT analysis, goal setting, and action plans. We eagerly returned to the clinic and implemented essentially everything we had heard about. We were able to involve our entire clinic staff in the process, and in the end, we had a finished product to present to both our parent agency board and our new clinic board. This set the tone for the brand new phase that the clinic was entering into.Networking has been another benefit of our experience with CCHF that has contributed significantly to our growth over the past few years. We have had numerous occasions where we needed advice and called clinic administrators that we met at CCHF conferences. We have also recruited key clinic staff members at CCHF workshops.Today LAMCC is a separate nonprofit entity with its own 50l(c)3 status. Our independent governing board is able to focus its attention on achieving the mission and vision of the clinic and maintaining compliance with Federally Qualified Health Center requirements. And although we are now separate, our parent organization continues to give us financial support, and our two boards and management teams work very closely together in order to coordinate services for the population we both serve.Our annual budget has increased to over $3.7 million and is growing continually. The FQHC funding of $650,000 per year has served as leverage and led to significant increases in private grant funding. And the augmented Medicaid reimbursement rate that is given to clinics has greatly increased our patient-generated revenues.We now have a staff of 47, plus more than 50 part-time volunteers working in our clinic space of over 8,000 square feet. Together, they are able to provide nearly 20,000 annual visits to the Skid Row community. The clinic offers full-time medical, full-time dental, and full-time social work services. Chiropractic care, optometry services, and psychiatry services are offered on-site through volunteer professionals. Dietitian and clinical case management staff, as well as masters-level social workers, are now integrated into our clinical team. Pediatric services are available full-time, including well-child care and immunizations.Despite this amazingly rapid growth, access to health care in Skid Row continues to be inadequate, and the clinic still sees the need for growth in many different areas. Our building is bursting at the seams, forcing us to take creative approaches, such as providing many of our visits off-site at shelters and drop-ins. Over the past two years, we’ve found this “country doctor” approach not only alleviates our space constraints, but also brings health care to many service-resistant homeless individuals who would otherwise go without care.Over the past ten years, LAMCC has experienced significant growth and has increased its ability to serve the medically needy in the Skid ROW (and greater) area of Los Angeles. We are grateful to God for this growth and for the partnership of CCHF.
by Lisa Levsen Abdishoo, MD, Medical Director, Los Angeles Mission Community Clinic, Los Angeles, CA