As a first-year resident, Ken Ginsburg, MD, MSEd, clearly remembers the advice he received decades ago from Steve Ludwig, MD, an attending physician at The Children’s Hospital of Philadelphia: “If you want things to happen around here, you need to build it yourself.”
So Ginsburg did. He arrived in Philadelphia fresh from Albert Einstein College of Medicine, where he had worked in an outreach program to bring medical care to homeless youth in New York City.
Could CHOP help children living in Philadelphia homeless shelters?
Taking Ludwig’s advice, he gathered four friends — fellow residents Suzie Miller, Chris Forrest and Stacie Walton, and Emergency Department nurse Ellen Marie Whalen — and in 1988 they began to visit shelters in West Philadelphia and make themselves available as the primary care pediatricians for the families.
“The program became a magnet for residents committed to social justice,” says Ginsburg, who has continued his quest for social justice as a CHOP attending in Adolescent Medicine and medical director of Covenant House, a shelter for homeless teens.
Now, 25 years later, the program that this small group began — the Homeless Health Initiative (HHI) — is still helping children and families in Philadelphia and beyond who are experiencing homelessness. See HHI's timeline.
The second year of HHI, attending Mark R. Magnusson, MD, PhD, now medical director of Home Care and Case Management for Children’s Hospital, got behind the project. Joel Fein, MD, MPH, jumped in as a first-year resident, and more people, like ED nurse Sally Poliwoda, BSN, RN, got involved.
Magnusson and Ginsburg secured funding from grateful parents who wanted to thank them for caring for their son. “That’s what gave it legs,” Ginsburg says.
“We started as a group practice. We’d get a call and off we went,” Ginsburg remembers. “We held large health screenings at the shelters, too, with 20 residents and 20 medical students.”
They soon realized being docs-on-call wasn’t the best model and shifted to providing regular medical and dental check-ups during CHOP Nights. Just as important, they also connected families with primary care practices nearby so children would continue to have care once the family left the shelter. Residents also held education sessions for mothers on topics such as fever, nutrition and discipline.
Over the decades, HHI has expanded services and locations and improved the health of thousands of children and families experiencing homelessness. See our programs.
The HHI experience also profoundly affected the careers of many of its founding clinicians, in addition to Ginsburg.
Fein stayed close to those roots and is director for Advocacy and Health Policy for CHOP’s Division of Emergency Medicine and the director of the Philadelphia Collaborative Violence Prevention Center, which promotes community-based participatory research in violence prevention.
Poliwoda leads CHOP’s Community Nursing Advocacy Fellowship program, connecting nurses to unmet needs in West Philadelphia, and she’s also HHI’s nursing director, recruiting nurses and nursing students for CHOP Nights and other roles.
Chris Forrest, MD, PhD, professor of pediatrics at CHOP and the Perelman School of Medicine at the University of Pennsylvania, remembers being struck by the juxtaposition of sophisticated medicine being practiced at CHOP and the brutal experiences of homeless families living a handful of blocks away.
“My own experiences in the HHI led me to a career in health services research,” he says, “dedicating myself to finding ways to transform our delivery system to address the health needs of all children.”
One snapshot from that first year has stayed with Miller, now a primary care pediatrician in the CHOP Care Network. After she diagnosed a little boy with pink eye, the child’s mother thanked her, and Miller casually responded, “You’re welcome.”
“She said 'thank you' again and I heard an urgency in her voice. It got my attention, so I turned around,” Miller recalls. “She had her hand outstretched toward mine, and in that very common gesture I felt her overwhelming gratitude. I will never forget it.
"In that brief moment, I was both humbled by the gravity of her life’s circumstances and elevated by her generosity," he adds. "She was the hero, not me.”
Reviewed by: Karen Hudson, MSW, LSW
Date: May 2013