ANAHEIM, Calif. - Community Health Centers now are the primary point of care for more than 23 million Americans - with 1,000 clinics in California alone.

Many centers are using an integrated care model that takes into account the person's life as a whole, not just their medical concerns. Some have taken a one-stop shopping approach, where patients can see a doctor but also get help for underlying social problems such as housing issues, poverty, hunger or depression.

Karen McGlinn, chief executive of Share Our Selves, runs five nonprofit clinics in Orange County where case managers look at body, mind and spirit - and connect patients with the right programs.

"We have a food bank, we have financial aid available, legal law clinics, a lot of special programs that deal with care for the homeless, the mentally ill," she said. "So we integrate all those challenges into the delivery of our health-care process."

Health centers started as part of President Lyndon Johnson's war on poverty 50 years ago. These federally qualified health centers are nonprofits that accept Medi-Cal and private insurance, and often raise millions in private donations to cover expenses for those who cannot afford it.

Open Door Community Health Centers serve 80,000 patients in northwest California near the Oregon border. CEO Hermann Spetzler said the clinics include a community garden, a playground, an exercise circuit and hiking trails - all to inspire people to eat more vegetables and get a move on.

"So it is not unusual for a patient to get a prescription that says three times a week we want you to come to the garden and do about 45 minutes worth of gardening, do the exercise routine that we've suggested," he said, "and their vital signs are recorded and added to their chart."

Community health centers are really embracing the concept of wellness - beating back chronic illnesses such as diabetes, obesity and heart disease - one patient at a time.

More information is online at shareourselves.org or opendoorhealth.com.



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Maryland is facing a significant shortage of behavioral health professionals and a new report from the Maryland Health Care Commission offered some suggestions to fix the problem.

All but two counties in Maryland are labeled as a partial or complete mental health shortage area. Years of underinvestment and high rates of burnout for behavioral health specialists has caught up with the state. The report found a 50% shortage in the number of professionals needed to adequately care for Maryland's population.

Tiara Fennell, assistant clinical professor and clinic director of the Center for Healthy Families at the University of Maryland-College Park, said behavioral health professionals have long been undervalued, which can lead to burnout. The COVID-19 pandemic, she added, is also partly to blame.

"A lot of it has nothing to do with their intent or their desire to help people," Fennell explained. "It's because of their desire to want to be able to take care of themselves. One of the major things that is a deterrent is people not getting paid enough."

The report showed 45% of behavioral health professionals currently working in Maryland are expected to either retire, leave the state or exit the profession in the next five years.

To tackle the shortage, the Maryland General Assembly passed a Behavioral Health Workforce Investment Fund in 2023 and commissioned a report on how to spend the money. The report recommended focusing on investments in behavioral health. It suggested implementing more "earn while you learn" programs, with paid apprenticeships, fellowships and stipends to lessen the costs of college. More flexible schedules and mentorship programs were also recommended to address the nonfinancial issues of burnout.

Fennell pointed out many behavioral health internships are unpaid and she believes efforts to increase pay and reduce work loads for these professionals will boost recruitment and retention.

"That would make a huge difference getting people interested in this type of work," Fennell contended. "Also, maintaining that workforce -- and having people want to be there long-term, and spend the majority of their employment history -- however long that will be, working in this space."

The Behavioral Health Workforce Investment Fund will allocate more than $148 million over the next five years.


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The excitement of the holiday season is celebrated with family get-togethers. But for Alzheimer's patients, large groups can produce fear and confusion. The disease causes brain cell deterioration and the ability to rapidly process information diminishes daily.

Macie P. Smith, a licensed social worker and gerontologist, advised paying attention to nonverbal cues when a patient appears agitated.

"If you're going to have a small, intimate gathering, I also recommend doing name tags," Smith suggested. "Go ahead and put the person's name and the relationship to the person on the shirt, so that way they won't have to guess and wonder and try to figure out who this person is. It just helps with the ease of engagement."

Reminiscing over the family photo album is a traditional holiday favorite. Despite the best intentions, Smith explained, asking an Alzheimer's patient to identify a relative can be frustrating. The questions cause them to use brain cells that are severely impacted and could produce combativeness and aggression. She recommended singing or playing music as better choices.

The Alzheimer's Association Illinois chapter reported 311,000 caregivers cook meals, assist with basic hygiene and monitor medication intake. The needs of patients are unpredictable, leaving them with sporadic break times.

Additional stress from gift shopping and work obligations underlines the importance for a caregiver to routinely nurture their physical and mental well-being. Smith advised using a calendar for scheduling enjoyable activities.

"I've asked caregivers, 'So, what do you like to do?' They don't know, or they don't remember, because they have been so engulfed with caring for someone else and depleting everything that they've had, they've lost a sense of self," Smith observed.

For unmanageable situations, Smith recommends contacting a professional respite care service through your local department on aging. The agencies offer vouchers to pay a certified person to sit with your loved one. Another choice is asking for help from a church member, trusted neighbor or a Medicare or Medicaid-funded adult day service.


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A new study found more than 1.4 million children in the U.S., including many in California, have lost a family member to overdose, emphasizing the collateral damage of the drug epidemic.

The study focused on children younger than 18 as of 2019 who had lost one or more parents, siblings, grandparents, aunts or uncles, or cousins to overdose.

Emily Smith-Greenaway, professor of sociology at the University of Southern California-Dornsife and a co-author of the report, explained the effects overdoses have on those left behind.

"Being exposed to drug overdose is a particularly pernicious experience in young kids' lives, because we know drug overdoses are really traumatizing deaths to undergo," Smith-Greenaway explained. "There's probably a lot of hardship leading up to the death. Those deaths are probably very confusing for young kids to process and to understand."

Researchers found most kids who lose family members to drug overdose are between ages 10 and 18. Data show the reach of the problem is getting dramatically worse, because kids younger than 10 are experiencing drug overdoses in their family at younger ages relative to their slightly older peers.

A 2024 study in the Journal of the American Medical Association Psychiatry looked at children who have lost parents to overdose and found the highest rate among non-Hispanic American Indian and Alaska Native families.

Smith-Greenaway pointed out there is currently no system in place to identify, track or monitor children affected by overdose and offer them specialized counseling.

"We need clear supports for identifying this population," Smith-Greenaway urged. "But then also providing them the supports to ensure that there's not a cyclical trauma here that replicates across generations."

Help is out there for parents or caregivers in California looking after a child who is coping with loss due to overdose. Some options include the website of the nonprofit Eluna, or Ronnie's House of Hope, based in Palm Desert.