Dr. Elisa Nicholas touring one of the eight TCC clinics. Photos by Greggory Moore.
Its origins pre-date the Truman presidency and involve some of Long Beach’s most historic names, but The Children’s Clinic provides a thoroughly modern, holistic approach to wellness, and its mission has exceeded the bounds implied by its name.
The Children’s Clinic (full name: The Children’s Clinic, Serving Children & Their Families; abbreviated as TCC) was founded in 1939 by a group of physicians and community leaders (such as the Bixby family), with an aim to provide health services to children in need. But an increasing number of governmental programs altered the social landscape, to the point that today there are more uninsured adults than children. So about 15 years ago TCC decided to broaden its mission.
“Our vision is very clear: it’s bringing quality, innovative healthcare to children and families in the community,” says TCC CEO Dr. Elisa Nicholas. “[…] A lot of times the family members [of children TCC was helping] were saying, ‘Can you help me, too?'”
Under Nicholas’ guidance, that help goes well beyond strictly medical bounds.
“It’s not just looking at ears; it’s looking at healthy lifestyles, mental health issues,” she says. “I think we realize the social determinants of health. […] You look at what actual medical care does, and it’s really quite small. Obviously there are situations where you’ve got cancer or a festering wound that requires antibiotics, [but often] it’s more all these other [lifestyle] things.”
Nicholas’ background set her up perfectly for such an approach. A pediatrician who trained in public health and preventive medicine, Nicholas did public-health work in Africa and Haiti before moving on to the faculty of Harbor-UCLA Medical Center.
But when she came on board TCC a quarter-century ago, TCC was a single clinic in the basement of Long Beach Memorial Medical Center, even though most of its patients came from other—read: poorer—parts of Long Beach.
“The Health Department did their needs assessment for health,” Nicholas says, “and—not surprisingly—everything kind of overlays the areas where there’s poverty. […] Most of our patients come from 90813, 90805, and 90810 ZIP codes.”
Nicholas found inspiration in her experience with the Teen Mom Program at Reid Continuation High School, where she created a group-well childcare, which she headed for a year. In her work with that program she met a nurse who queried about whether Nicholas might be interested in bringing group-well childcare to the community at large.
“I’d see where the kids were from, I’d see their ZIP codes, and I’d see their diagnoses,” Nicholas says. “So I started trying to create programs to address the issues I was seeing. […] The idea was to go where the patients were, and the school was a natural place where children and families gathered. So our first [branch] clinic was at an elementary school. But it was not just serving those students.”
That first TCC branch clinic, at International Elementary School, opened in the mid 1990s.
“With our original one [branch clinic], we really wanted to have a comprehensive school-based program for the younger kids,” Nicholas relates. “[…] Originally it was a very comprehensive program that brought in mental health, public health, the YMCA—it was a collaborative program. […] It was probably the first clinic on a school site in L.A. County. […] It was wonderful. We did health education, we integrated it into the classroom; we trained parents in things like how to care for a sick child; we trained them in child safety; we developed a curriculum. We had the YMCA doing drowning prevention. We didn’t think we could do swimming completely, but we thought we could keep kids from drowning—because a lot of the kids lived near the ocean but they didn’t know how to swim. We did walk-in immunizations. It was a very elaborate program. […] We asked parents and teachers what they wanted in their school and in their community, and we designed the program.”
Dr. Nicholas’s office is just about as busy as she is.
But Nicholas says it would never have happened without the right partners, starting with International’s principal at the time.
“I always feel that to have a program thrive, you have to plant the seed on fertile soil,” Nicholas says. “It’s not like we go and say, ‘I think we should have a clinic here’; it’s more like, ‘Wow, there’s this visionary principal that wants to do more things and bring more resources into his school. I think you should meet him.'”
More clinics followed, all of which almost immediately grew beyond their original conception. As an example Nicholas points to the clinic at Hamilton Elementary School, TCC’s first clinic in North Long Beach, which has doubled in size since its origin and in June will be augmented to include a family resource center.
“North Long Beach is very underserved, so we’re reaching out to that surrounding community and building some health programs,” she says. “Eventually we’ll have more mental-health services out there.”
The aid TCC provides to underserved communities ranges well beyond the medical and into the legal and social realms, under the guiding principle that you can’t neatly separate medical needs from general lifestyle factors.
“So many of the issues that our families face are psychosocial and legal,” Nicholas says. “[…] If you see a patient who’s having housing problems, immigration problems, they’re a victim of domestic violence, their children have learning disabilities, they’re not getting what they need—what we do is give them a resource that can help them solve some of these problems from a legal perspective. Because we can’t solve all these problems—and a social worker can’t. We have very meaningful relationships with our patients here. Most of us work here because we care about more than just looking in ears and getting [patients] in and out of the office. And so we really know the conditions they live in, and that the things going on in their lives influence their health as much as us giving them an immunization. So we identify things like domestic violence and mothers not knowing where to turn. We identify things like mushrooms growing on the ceiling of their rented house and their landlord not responding.”
{loadposition latestnews}As much as TCC does, Nicholas wants them to do more, and she puts it in my ear that the organization is actively recruiting Spanish-speaking social workers so as to more effectively provide social services to the community. And that’s a small part of what’s in the works.
“We’re trying to design a program right now to improve parent attachment and identification of stressors in parents of young children,” she says. “Because there’s this whole new set of data—which we could do a whole other article on—about adverse childhood events and toxic stress and protective factors and all that stuff. So we’re trying to integrate and partner with different groups to complement, and not duplicate, what’s going on in the community.”
It’s a lot of ground to cover, but TCC has a big staff—around 250, including a practitioner to go out under the city’s bridges to provide medical care to the homeless, as well as staffers whose only job is to provide home visits for children suffering from obesity, diabetes, etc.—which it needs to see the 30,000 patients per year. And that will grow with the opening of a new clinic at Roosevelt Elementary School, made possible by $500,000 grant from the Department of Health and Human Services through the Affordable Care Act Grants for School-Based Health Centers Capital Program. The Roosevelt clinic will be TCC’s ninth.
If that clinic even resembles the S. Mark Taper Foundation Children’s Clinic Family Health Center (TCC’s strong point is decidedly not coming up with clinic names that slide easily off the tongue), which is located across the street from Miller Children’s Hospital, it will be pretty damn impressive. Teeming with patients at 4PM on a Friday, the SMTFCCFHC (yikes!) features multiple examination rooms in both the adults’ and children’s wings, along with an array of educational material and a staff so varied that it includes no less than four community health workers who work specifically with asthma patients. There’s even a sort of book dispensary on-site, so that every child between the ages of 6 months. and 5 years who comes in for a well-child visit gets an age-appropriate book.
As we tour, Nicholas tell me about how TCC constantly strives to improve from within. “What we try to do is look at what people are doing across the country that’s innovative and try to bring it in,” she explains. As an example, she tells me about ongoing in-house work on doctor-patient communication, such as a methodology developed by a doctor at Kaiser-Permanente for working with patients and parents to curb the obesity that she labels “a major issue in the population we serve.”
That there’s so much more than medicine practiced at TCC is to be expected from a doctor-cum-CEO who considers herself “a therapeutic nihilist.”
“I try not to use medicines for every little thing,” Nicholas says. “I mean, every time you sniffle, you don’t have to take a drug. There are things you can do. Leading a healthy lifestyle, learning to reduce your stress, eating fresh fruits and vegetables, smiling and laughing…There are all these things that can help improve your immune system that are not just giving someone a pill. […] The more educated you are, the healthier you are. I mean, every study shows that, all over the world
There is a place for medical treatment. But as Elisa Nicholas well knows and preaches, wellness is a far broader concept. Fortunately, Long Beach has TCC to supply such social medicine, more broadly all the time.
The Children’s Clinic, Serving Children & Their Families, is a nonprofit organization that not only provides help, but also can always use some financial help of its own. To learn more about TCC services, fundraisers, and how you might be involved on either side, visit www.thechildrensclinic.org.