Unfortunately, increasing funding alone would not have been enough to keep LOC open.
The program would have required significant changes to its care model, staffing, and services to meet the increasing clinical complexity in this population. To sustain these changes, state regulations would also need to be redesigned to create a programming designation that adequately funds a treatment model tailored to the needs of high-acuity pregnant and parenting women. In addition, broad overhauls are needed to the child welfare network to improve partnership and support for child outcomes.
Over time, LOC has taken on responsibilities that extend beyond its original scope, including parenting education and skills development, transportation, care coordination of both parents and children, and child welfare-related services. Furthermore, the responsibility of caring for the children as “patients” has increasingly become a requirement for this service model. As a Federally Qualified Health Center System, CCC is unable to add the scope of pediatric care for a single site without expanding that care across all our health centers. We are simply unable to make that significant of a shift in our scope and operationalize caring for children. In parallel, because most other health centers in the region (those which are not Healthcare for the Homeless centers) care for children in their scope, the probability of an FQHC scope expansion being approved is low. Even if an FQHC scope expansion was approved, the effort to operationalize this change would require a large investment of resources.
Without these major changes both inside and outside the program, LOC would have continued to face challenges related to funding, quality of care, client outcomes, and safety.