Next steps

Children’s Access Summit begins planning route toward better health in Metro counties

By the end of 2010, 80,000 additional Oregonians will have access to health care insurance.

But will that be enough?

David Wills, MD
President, Oregon Pediatric Society

Photos by Jeanie Lunsford

In Portland, health care advocates gathered Oct. 13 to discuss the issue of access to health care for children in Clackamas, Multnomah and Washington counties.

The event was organized by Children First for Oregon, Oregon Health Action Campaign, Oregon Nurses Association, the state Office of Family Health, Oregon Pediatric Society, Oregon Primary Care Association, Oregon School-Based Health Care Network and CareOregon. It included representatives from these and other representatives of advocacy groups and providers, as well as families affected by the health care system.

“We want to make sure the community is doing the best job possible to promote health,” said Pam Mariea-Nason, Health Policy and Community Engagement Director for CareOregon. “We’re trying to promote health, which is why it’s not just doctors and nurses who came. Children’s health is all of our responsibility. Each of us has a role to play. The Legislature and the governor made it possible to step up to the challenge by insuring kids. It’s now up to us to follow through.”

The obstacles

Why would a judge kick off a planning session for health care? Keynote speaker Judge Nan Waller, Multnomah County Circuit Court’s chief family law judge explained that children’s different needs—whether in the educational, judicial or health care systems—all interact with each other.

“They don’t come in silos, nicely separated in terms of their needs,” she said. “It’s clear to me that access to justice is not only about what goes on in a court, but it’s also about access to support in the community, including health care.”

Judge Waller said that she has seen the results when children have complex issues and many needs, and their families get burned out dealing with duplicative, complicated plans for different systems: education, mental health, justice, health care and more.

“We are putting a tremendous amount of money into some of these youths,” she said. “It’s worth the money if there are good results; but it’s not worth it if there aren’t good results.”

Families set the stage

The complexity of health and social services was a common theme throughout the day-long discussion, including in the comments of three community members whose families have encountered the difficulty of the health system.

• One of Robin Van Houten’s children has health issues that include epilepsy and a form of cerebral palsy. Finding and coordinating health care is very difficult, she said. “The paperwork is very intensive,” she said. “I’ve had higher education and I still find it challenging.”


• Carol Criswell has two children. Her daughter, the oldest, has asthma, allergies and autism. The family has health insurance, but are self-employed so the premiums are “astronomical,” she said. Copayments are huge. Therapies that work are covered one year, then dropped the next. Formularies change without reference to physician-documented evidence that certain medications do not work for her child.


• Emily Ryan has had private insurance, the Oregon Health Plan (with copayments and without), employer-paid insurance and employment with no insurance. She was also homeless at 16. Considering how difficult it is to navigate the system if you are an employed, educated adult, imagine how hard it is to get the care you need as a homeless teen without a parent or other adult to advocate for you.

Providers agree

“These are central issues,” said Art Jaffe, MD, pediatrician at Oregon Health & Science University. “You really paint a picture of what all of us know we should be doing.”

Janine Tebeau-Jemerson, RN, and Art Jaffe, MD

Connecting to care is too complicated, said Pam Hiller, of Multnomah County Health Department. “I know a family who had to go back to the Department of Human Services office five or six times to complete the application process.”

Teri Bunker is a family nurse practitioner at Bridge City Family Medical Clinic in Northeast Portland. Her patients include many who are insured by Medicare or Medicaid. A particular difficulty is when families are assigned to providers who are so booked up they can’t see them.

Janine Tebeau-Jemerson, RN, Jefferson High School Health Clinic, said a big challenge for school nurses is to get access to the right care for the students who have medical concerns that require specialists.

It’s not just access to a doctor that affects health, noted David Willis, MD, president of Oregon Pediatrics Society. Medical services rank below genetics, environment and health behaviors as a determinant of health. It makes sense to integrate medical care with other services affecting the determinants with greater impact on health.

The common theme

The strongest of several threads connecting the speakers’ comments was the fragmented nature of the health care system and the disconnection of the various systems of assistance from each other.

The summit’s afternoon session was devoted to brainstorming concrete steps to overcome the obstacles to children’s health in the three Metro counties. Several ideas were generated from small-group discussions. The most consistent theme was to develop some kind of community-wide umbrella, or “hub,” that would inventory services, educate agencies, providers and families about these services, and simplify, coordinate and reduce duplication of service management.

Technology—creating a way for electronic health records to be exchanged between practices using different systems—can help, and is being worked on. But there is also a need for some organization, agency or other entity to provide the multi-system coordination of care and services that’s now missing.

Next steps promised

“A great meeting. A lot of good ideas. A lot of people committed to seeing something happen,” Teri Bunker said following the conclusion of the meeting. “I’d like to see health plans and providers be partners in delivering care to this group, instead of being polarized financially.”

With Katherine Bradley, administrator of the Oregon Office of Family Health promising to be a willing partner, participants committed to making sure that the ideas generated at the summit won’t gather dust.

The Northwest Health Foundation will coordinate these ongoing efforts.

Chris DeMars, health care reform policy program officer for the foundation, said a second meeting in the next few weeks will bring together those who committed to working on the initiative.

“We’re still in the formative stage to figure out if this is a part of a larger effort,” she said. “What the foundation has committed to do is convene the continuing conversation about how to move forward.”

“It’s clear to me that access to justice is not only about what goes on in a court, but is also about access to support in the community, including health care.”

—Nan Waller
Multnomah County Circuit Court Judge, chief family law judge

“It was amazing how many commonalities there were. Even working across different points of view, the group came up with central themes. I also liked the fact that in the end we made commitments about moving forward. Thanks for bringing the challenge to the community and the providers and for putting families first.”

—Katherine Bradley
Administrator, Oregon Office of Family Health

“A great meeting. A lot of good ideas. A lot of people committed to seeing something happen.”

—Teri Bunker, FNP
Bridge City Family Medical Clinic

“The Legislature and the governor made it possible to step up to the challenge by insuring kids. It’s now up to us to follow through.”

—Pam Mariea-Nason
CareOregon Public Policy and Community Affairs Director