Family First Health has partnered with Keystone Health since 2011 to provide services through the Agricultural Worker Program. These services, which include primary medical and dental care, behavioral health and substance use support, focus on the needs of migrant and seasonal workers.

Family First Health took some time recently to speak with Melanie Finkenbinder, MD, MPH, who serves as the medical director for the program. Dr. Finkenbinder also provides direct patient care at the Family First Health Gettysburg Center and at her primary care clinic in Gardners, PA.

Can you explain for us how farm workers and seasonal workers learn about the program and access services? 

Yes. Agricultural workers have an exceptionally difficult time accessing health care services and preventative health services.

They are generally very isolated. Many of them come here for just several months of the year. Many don’t know their way around the area.

Many have very little knowledge of the American healthcare system and how it works, and most lack transportation to be able to get themselves to a primary care clinic or even to urgent care or to the emergency room.

The Keystone Health Agricultural Worker Program has outreach teams throughout the state. Their job is to find agricultural workers and agricultural employers, and areas where agricultural workers might be living; to reach out to them at home or at work to inform them about the program; and help them access health care services directly at our clinic or through the program’s contract with Family First Health.

When an individual or family connects with Family First Health, typically for primary medical care, we use a coordinated care approach to address their needs in a comprehensive manner. How does that work with a population that might be transient or seasonal, where you may only see them during a specific time of the year?

Like Family First Health, the goal of Keystone Health is to be a patient-centered medical home, and to facilitate connecting agricultural workers throughout the state with other patient-centered medical homes that can not only provide preventative care and primary care services for them while they’re in the United States or while they’re in the Pennsylvania area, but that can also help to facilitate transfer of care wherever they go when they migrate.

Keystone Health also has a relationship with the Migrant Clinician Network, which works with patients to continue their care, access testing, or find a specialist when they migrate or move from our service area.

Although the Agricultural Worker Program relies on that network to help transfer care, while agricultural workers are here the program depends on organizations like Family First Health, that offers more comprehensive primary care that includes behavioral health, dentistry, and substance use services. Family First Health community health workers or care coordinators can help patients apply for financial assistance, identify other social determinants of health that might prevent them from receiving services, and share with them other community resources – just like we would for any of our other patients. And when a patient needs a specialist visit, Family First Health uses its resources to facilitate appropriate referrals.

Do you have an experience with a particular patient or family that you can share with us that demonstrates how we were able to make a difference in their health care as a result of the program?

Yes, I have a particular patient in mind: a young man who came into our care system several years ago. He was just 22 years old at the time, and was someone who may not have sought care if it had not been for the program’s outreach services.

He came to us because he was experiencing fatigue and pain in his knees. One of the program’s bilingual providers picked up on the fact that this wasn’t the typical case of fatigue or knee pain, did some blood work, and found that this 22 year-old man had end stage renal failure.

Luckily, we were able to find the individual and help him get to the emergency room. He ended up needing dialysis treatment, and being able to afford everything because he had access to emergency medical assistance that’s available to people who are uninsured. He was able to get ongoing dialysis for the remainder of the time that he was here in the United States. And he was able to continue working.

Once he’d been discharged back to the community, he continued to follow up, and the program was able to continue to address his medical needs and to coordinate his care with specialists.

He is on track to live a long life, but if there had not been a program that was able to reach out to him and provide these resources, and if there had not been community health centers like Keystone Health and Family First Health to help coordinate his care and to push it every step of the way to make sure that he got everything he needed, I think there’s a very good chance that he would have had a poor outcome.

The whole safety net really served this patient well because of a patient-centered medical home that was able to put together, and keep together, all the pieces. Community health centers, like Family First Health, that know how to reach out to patients and understand their needs and social determinants of health, provide the “glue” necessary to ensure everything stays together for a good outcome.

To hear the complete story and the inspiring outcome for this health care experience, view below.

 

The Agricultural Worker Program is open to migrant or seasonal farmworkers and dependent family members. Workers must show proof of agricultural employment to register. Once registered, the farmworker will be issued a card that can be used at Family First Health sites to receive services for a small co-pay.

For more information about the program, visit: keystonehealth.org/keystoneagworkerprogram/.

As we recognize National Gun Violence Awareness Month in June, it’s important for us to reflect upon the data that captures information on the incidences of gun violence in the York community. In 2022, the York County coroner, Pamela Gay, reported on the effects of gun violence in York County, with data on homicides and suicides from gunshot wounds. A total of 59 York County residents died as a result of gun violence during the year, indicating the gun violence is a critical, dangerous issue affecting the health of our community. Below is some data that shows the prevalence of gun violence in York County.

Gunshot wounds resulted in the homicides of 23 York County residents in 2023. Of these, 3 victims were female and 20 were male. The majority of the homicides, 19, occurred in York City; however, homicides also occurred in Shrewsbury, Hanover, Red Lion, and West Manchester Township. The ages of the victims ranged from 17 to 66 years old, with about half of the victims being under the age of 30 years old. In April, four homicides occurred over a two-day period (April 13-14), while there were no homicides reported in the months of October through November.

Gun violence resulting in suicide in York County outpaced homicides with a total of 36 in 2022. Similarly to the homicide rates, suicides affected 3 female victims in the County, while the remaining 33 were male. Compared to the homicides detailed above, suicides represented a much broader geographic diversity of York County, with suicides being reported from Brogue to York Haven and many communities in between. Geographically, 11 of the suicides occurred in York City, while the remaining 25 were outside the city. Outside of York City, the locations reporting three or more suicides over the past year included Dover, Red Lion, and Thomasville. The ages of the suicide victims ranged from 21 to 90 years old. Suicides occurred every month of the year, with June and September resulting in the most deaths, with five each.

The data above, while representative of lives lost in our communities, does not fully capture the effects of gun violence in York. Each of these lives lost left friends and families behind, who struggle to understand how their loved one could fall victim to gun violence. They often have difficult times processing the senselessness of the losses, and suffer both physically and mentally having been a witness or losing a friend or family member. Our providers at Family First Health have seen first-hand the effects of gun violence on our patients. More information about how our patients have been affected can be found here.

Gun violence can affect someone’s health in more ways than just the physical damage, even including those who were not directly involved in the violence. Our providers here at Family First Health have experienced firsthand how gun violence can take a toll on someone from some of their patients.

Those experiences, whether witnessing a murder, being held at gunpoint, or just living on a street where there’s gun violence affect someone’s day to day living and have daily struggles well beyond when the violence took place. After witnessing the murder of a parent, a patient’s struggles of PTSD, depression, and substance dependence became a daily obstacle and is still an obstacle to this day, 15-20 years after it took place. 

Other patients who experienced the death of a loved one or just having gun violence on their block often experience significant clinical depression, feelings of shame and guilt, anxiety, and social isolation which become barriers to addressing their biopsychosocial needs.

One provider has dealt with multiple 15 year old patients who have been caught in the crossfire of gun violence having to remove bullet fragments from a patient’s back and another patient now not being able to see out of one eye after bullets going through their head, arm, and leg.

Gun violence is not just subjected to adults as they have seen teenagers who have been caught up in gun violence. A younger patient, scared about gun violence, reported that they had a gun hidden away in their backpack in case of an intruder breaking into the school.

Hear from some of our providers on how exposure to gun violence increases a patient’s lifelong health issues: 

Dr. Luis Garcia, MD, George Street Center: “Increased levels of exposure to gun violence increase the level of stress which results in high risk of depression, anxiety, cardiovascular disease, diabetes, obesity, and much more.”

Christina Little, LPC, George Street Center: “Exposure to gun violence can shatter a person’s sense of safety which has large rippling effects on how a person goes through and experiences life, trusts in others, and the person’s ability to allow the level of vulnerability needed to ask for help and support.” 

Helen Madea, LCSW, George Street and Lebanon Center: “It keeps their system in fight or flight, making it difficult to regulate their emotions and problem solve basic needs.”

The effects of gun violence are real, and take a heavy toll, physically and mentally, on those affected, either having been a direct victim or witness. Understanding these tolls helps our providers give the best possible care to those affected by gun violence in our communities.

“Don’t ever give up on your dreams. You can do this. You have to take care of yourself, but you can do this.”

~ Melissa Ensminger, Registered Nurse

Melissa “Missi” Ensminger has served her community for almost 40 years working in various roles at Family First Health. Most notably, Missi worked as a Registered Nurse in our Nurse-Family Partnership (NFP) program working with first time mothers for 20 years. She joined FFH in 1983, which was when FFH was known as York Health Corporation. Not only did Missi see a name change during her tenure, but also she saw the additions of new centers being opened, more medical services being offered such as Integrated Substance Use Services and Integrated Behavioral Health Services, and community health programs being offered including NFP and Caring Together. Missi was initially drawn to FFH because it was a better fit for her family life at the time and the ability to continue serving low-income clients. She stayed because she fell in love with what FFH is about, the mission, vision, and values. In particular, Missi loved that nobody got turned away due to their inability to pay or insurance status.

 

As a NFP nurse, she worked with lots of first time mothers over the year but with each baby, she always asked the same two questions; “Are you going to be a president one day? What’s your life going to look like?” She did that with each baby she has worked with because Missi believed that the sky is the limit for them. Working with these mothers, it felt like reading a book on their lives to Missi, even if it was just a snippet of their life. “You’re opening the first chapter of their story and each visit you’re flipping the page for the next chapter and you try to prepare for what’s next, but the story could have taken twists and turns along the way until we graduate them from the program and close that piece of the story in the book of their life.” After the mothers graduate from the program, Missi always thanks the families for allowing her to be part of their journey and being a piece of their story.

One story that will always stick out to Missi from her time as a NFP nurse was of a young mother who had a tough upbringing.  When they first met, Missi told the mom, “It’s going to be hard. I will be your cheerleader. I am here for you. You’re going to have to do the work, but I’ll be here for you.” Those words stuck with the young mom as it was the first time hearing those words from anyone. The young mother went on to graduate from high school with honors and invited Missi to the graduation because of the influence Missi had on her life. The mother worked at McDonald’s, went on to get her driver’s license, was able to get her own car, and get her own housing. She then invited Missi to see the house and all of the things they got in their house such as items like shower curtains. To some people these things are little baby steps, but for her they were huge things and she was proud of them. Right before the mother was about to graduate from NFP, she invited Missi over to her house for an unscheduled visit. She wanted Missi to be the first person to see her wedding gown. A year had passed since the mother graduated from the program but she called Missi letting her know that the little girl turned 3 years old that day and to let Missi know that they loved her. The last time Missi saw the mom was when the mother was climbing into her limo in her wedding dress yelling out at Missi, “I love you, Nurse Missi!”

Missi did not see herself as a cheerleader to just the first time mothers she was working with, but she also tried to be a cheerleader to her fellow colleagues over the years. Through all the years of serving her community, Missi is thankful for the opportunity to have been part of all of the adventures and journeys of all who she came across while working at FFH.

Missi, from all of Family First Health, we wish you the best in your journey of retirement and we love you!

Recently, Family First Health received a major gift from a donor in the Gettysburg area. The donor, who never had any interaction with FFH in the past, came to us on the recommendation of his own primary care provider, and personal friend. The doctor, who practices at a group practice and at the local emergency department, shared why he directed the donor to us. He said that he had recently asked him “Where can my money do some good in healthcare this year?” Without hesitation, the doctor told him that he should consider Family First Health. “I truly appreciate the work you do. I don’t know where we’d be without you and so I suggested to him that’s somewhere his money could really do some good.” He continued, “I know some of your providers and we all really appreciate the work you do.”

After this recommendation, the donor contacted us and asked for more information about who we are and what we do in the community. We invited him to our Gettysburg practice for a tour and to share more about our mission and how we provide medical and dental care to residents of Adams County who might otherwise struggle to access quality healthcare. On the tour, he was able to ask questions of two of our dentists, as well as other members of our care team. We had a conversation about why patients come to us, especially those without health insurance.

The question was posed: given all of the options, especially with the Affordable Care Act, why were some community members still without insurance? There are a few reasons, including challenges for patients who are undocumented and ineligible to receive health insurance, working families who can’t afford the premiums available to them through the insurance exchange, or patients who have barriers that prevent them from getting insurance such as not having access to the Internet or not understanding the process. While there are some reasons we cannot change, our team does work with uninsured patients to sign up for insurance that they can afford and they are eligible to receive. They also educate the patients about our sliding fee scale that makes their visits affordable, regardless of their insurance status.

At Family First Health we pride ourselves on being the accessible healthcare provider in the community to anyone who needs our care. Our mission sums up why we do what we do every day: “We improve lives: in big and small ways. From high quality health services and innovative partnerships to daily acts of compassion. In all ways, we work together to improve lives.” We are proud that other healthcare providers in the community recognize the importance of our mission, and the work that we do to support the health needs of the community. We are grateful that the donor decided to make a gift to Family First Health, and that he made the gift in honor of his friend who guided him to us.

As part of the celebration of our 25^th anniversary of our Hannah Penn Center, we would also like to celebrate Brooke Lasher, PA-C, who has hit 10 years being with our Student Based Health Center at our Hannah Penn Center. Lasher joined Family First Health in 2012 after receiving her Masters of Science in Physician’s Assistant Studies at the University of Saint Francis. We hope you enjoy learning about Brooke and her perspective on student based health.

Q: Why have you remained committed to working in student based health for 10 years now?

A: When I first joined Family First, it was more about scheduling; it just worked for my family’s schedule. But as I got here and became more engaged with the students at the school, the way we’re set up here is so that I’m through the school nurse’s station and it gives me a way to impact the youth who are here even if it wasn’t through our visits. I just love that the school nurse was working with me who’s also working with the school’s social worker, the school based counseling, and all of them coming together. I like to engage a lot with my patients and their families, and because we’re small, I am able to do that and practice the way I want to. I have patients who bring me birthday gifts, there’s one patient who says “I love you. I’ll see you later” as she’s leaving the office. I love that. I was put in this position and I fell in love with it.

Q: Why do you think school based health centers are important?

A: They’re important because the school is the hub of the community. The kids are required by law to be at the school and so by tying health care to a place that requires kids to be there, we’re making it more accessible. A lot of the kids who are at the school, their parents’ lives are so hectic, maybe they’re working two jobs, or maybe it’s a single mom who is working and has four kids, but by being here in the school, we take some of the stress away and for patients who may have social or other medical issues, there’s other resources within the school.

Q: What is some of the growth you have seen at Hannah Penn over the past 10 years?

A: The presence of behavioral health here has been huge. Just being able to meet the needs of patients beyond just a doctor visit, adding health coaching has been really cool in the last six months. It adds another layer to help meet the needs of patients. Within the past few years we’ve added community health workers who are actually able to go out into the community and there’s constant growth of each of those different units.

Q: What role do you see the Hannah Penn Center having amongst the students and community overall?

A: My hope is that through the Hannah Penn Center, we are able to provide all the same benefits that upper middle class receives with medical care and be able to bring that to a community where the financial resources are more limited. But also to provide them with health equity. We exist not only to serve the students but also for the families of the students as well.

Q: What are some success stories you’ve seen?

A: There are numerous success stories, but there’s one that comes to mind. Hannah Penn does a lot of the autistic support for the city, and there’s a good number of autistic students here. The school nurse identified one and became concerned because she saw some markings on the back of the patient’s neck and noticed some weight gain. With a lot of autistic students, they respond to using food as an incentive. Once he came in, there were some bumps in the road but we managed to find out he was pre-diabetic, and were able to get him initiated on treatment. Not only were we educating the student and the parents, but we were also educating the teachers and the support staff that we’re working with the student about what kinds of foods to have and ways to move away from food based rewards for him. In the next follow up, the student had lost like 10 pounds and the sugar numbers were normalized. The student was doing really well and the parents were excited and very pleased with the results.

Q: What is your vision for the Hannah Penn Center as a health hub for the school and for the community?

A: By developing a relationship with the students, this allows us to reach their families so then the goal is to raise up a new generation of health conscious individuals. To help raise awareness of health, healthy eating, healthy living, and healthy choices and making that the new norm.

Q: What would your message be to the families and to the students of Hannah Penn?

A: We care about you. I want them to know that we do what we do because we care and we’re here. There are different stages of engagement and health, and we understand and are willing to meet you where you’re at. If you got one part of your health you’re willing to work on but don’t want to work another, or don’t feel like you have the bandwidth to do that, that’s fine, we’re here, and we’re not going anywhere. When you’re ready to work on something else, we’re still going to be here because we care about you.