Care where the people are
La Clinica's growing field-based team serves a community need
On a chilly morning when the Rogue Valley is dusted with snow, people who live on the streets crowd into the Medford library’s lobby to get a hot cup of coffee, a bagel, some fruit, and connections to health care and social services. Each Wednesday for 90 minutes before the doors open to readers of all ages, the library hosts this outreach event for people without homes.
Since January 2022, benefit enrollment and behavioral health support specialist Michelle Maestro has represented La Clinica each week. At no cost to the people who attend, she helps people sign up for the Oregon Health Plan, schedule appointments, and find transportation, all small steps to building the relationships and connections that can change lives.
This is the kind of outreach work La Clinica’s field-based team does in homes, schools, orchards, and shelters across the valley with support from the state, community organizations, and foundations. The team grew in size and scope in 2022, greatly extending the organization’s reach and its ability to connect Jackson County residents to the care they need.
“Our team meets the patients where they are and helps them access the resources they need,” explained Zulma Larios, field-based care manager. This added layer of listening and advocacy helps address basic needs—food, shelter, transportation, and more—that don’t always come up in conventional health care but have a proven effect on well-being.
Dave Vaux, a bearded man who has lived without a home for 10 years, lost his sleeping bag, his medication, and nearly everything he owns the previous night when his backpack was stolen. Michelle reaches out to team member Alex Alvarado to connect him with a tent, sleeping bag, and some donated clothing, while also making sure Dave has information about more permanent options.
“These guys are awesome,” Dave said. “They’ve helped me again and again.”
Michelle spots another patient she knows. Richard Harris relies on care from La Clinica’s Mobile Health Center. In 1995 his lower leg was amputated after a car crash on backroads around Merlin. Recently, he’s struggled with sores that won’t heal on that limb and has used a wheelchair for more than a year.
Knowing that getting to the Mobile Health Center on any given day can be a challenge for Richard, Michelle summons team member Carlos Grimaldo-Magallon to provide wound care. As Carlos cleans and bandages Richard’s leg, Richard talks about his hope for healing so he can wear a new prosthetic and the help he’s gotten from La Clinica.
“They are the best thing that’s happened to me in 20 years,” he said.
The library staff, who called on La Clinica and other partners to help serve growing numbers of people without homes spending their days at local libraries, appreciate the partnerships that have developed in the last few years.
Hailie Courtney, a social worker with Jackson County Library Services, notes that libraries work to be safe and welcoming to all—families coming for story times, people checking out books and using public computers, and people seeking shelter during the day and needing resources.
“We want to have a healthy balance between social services and other services,” she said. “La Clinica has been awesome for helping with this.”
Field-based care teams by the numbers
Mobile health | Community resources | Health outreach | Happy Smiles
Mobile Health Center team
Care in a 40-foot mobile center that travels the community
In 2022: 549 patients, 915 visits, and 821 care steps*
*A care step is a phone call, connection to a resource, or group education.
Community resource team
Connecting people to resources by phone or at community events
In 2022: 2,302 patients and 5,610 care steps*. Also met with 2,367 community members at 43 events.
*A care step is a phone call, connection to a resource, or group education.
Health outreach team
Managing medication and coordinating care in patients’ homes
In 2022: 170 patients and 760 care steps*
*A care step is a phone call, connection to a resource, or group education.
Happy Smiles dental outreach
Interacting at community sites and schools
In 2022: Interacted with about 6,000 community members at 23 community events. In schools: dental education to 4,000; dental screenings to 1,270; fluoride application or sealant placement to 1,437.
Help for our mental health
La Clinica school therapist David Minter helps Lex Caldwell repair a bike's flat tire.
Demand grows nearly 40% in 2022 at schools and community health centers
The red bike sits atop a foldable bike repair stand, one of its tire tubes flat and flung to the side. As raindrops hit the sidewalk nearby, La Clinica school-based therapist David Minter and Central Point Elementary fourth-grader Lex Caldwell focus on fixing a flat on the bike Lex got through a program at the school.
This is not one of the sit-down sessions where the pair talk about how to deal with the frustration Lex has sometimes felt at school. But it is an opportunity to build a relationship while learning life skills and being active outside, two of the mental health priorities “Mr. David,” as Minter is often called at the schools where he practices, brings to his work regularly.
“Motion and exercise are evidence-based tools to reduce anxiety, depression, and anger,” said the therapist, who serves kids at Central Point and Mae Richardson elementary schools. “There are health benefits, and kids learn problem-solving skills by fixing their own bikes. Getting kids off technology is my biggest goal.”
Minter’s approach is just one of many ways La Clinica is addressing the community’s mental health needs as the organization experiences exploding demand for these services. In 2022, La Clinica served 5,438 patients in 34,546 interactions, an increase of nearly 40% in each category over 2021. The services are funded through state grants, insurance billing, foundation grants, and community giving.
Therapists such as David Minter are based at La Clinica’s 19 school health centers, conducting as many as three dozen visits a week with kids for issues as simple as learning to handle emotions or as serious as neglect, severe trauma, grief, or parents who are struggling with substance use or in jail. At La Clinica’s community health centers, therapists, a child psychiatrist, and support specialists provide rapid access to care that includes coaching, goal setting, and support for navigating the healthcare system.
Lex, now 9, has seen Mr. David as a therapist off and on for several years, said his mom, Danielle Caldwell. In addition to school visits, the boy takes part in the district’s after-school snowboarding program and has worked in a school garden, both at the suggestion of his therapist. He credits Mr. David with helping him through some tough times.
His mother said her son’s interactions with a therapist have made a big difference in his life and that she appreciates the relationship, too. “I feel like he’s always looking out for” Lex, she said.
La Clinica school therapist David Minter helps Lex Caldwell repair a bike's flat tire.
La Clinica school therapist David Minter helps Lex Caldwell repair a bike's flat tire.
'Dr. Wheels' makes connections for remote care
When La Clinica’s healthcare providers are at one location and the children they serve are at another and a personal interaction is helpful, enter a new tool that can make the connection: Dr. Wheels.
That’s the name employees have given to four wheeled carts decked out with computers, video connections, and all sorts of medical instrumentation. La Clinica is using the carts at rural schools where nurses who see the children can use technology to get quick access to a medical provider.
School nurses can sit with kids at school and make connections to a medical provider or a therapist or even La Clinica’s child psychiatrist at another location, then the visits can continue as though everyone was in the same room. In the case of medical visits, the cart’s equipment allows providers to view vital signs, look into ear canals, and examine rashes, for example.
La Clinica is one of three organizations that received state funding in 2022 to test the carts. After setup and training for staff, they should be ready for use with kids this spring.
Building a workforce from the inside out
Jenny Caudillo
Using a state grant, La Clinica invests in developing healthcare employees for itself and others
Jenny Caudillo came to La Clinica with no healthcare background and started as a medical receptionist in April 2019. She became the first employee to complete La Clinica’s medical assistant apprenticeship program in February 2022 and is now a certified clinical medical assistant.
“La Clinica gave me an opportunity to start my own career in health care,” Jenny says. “I never thought I’d end up in the medical field.”
With $1 million in workforce development funding from the Healthy Oregon Workforce Training Opportunity Grant, La Clinica in 2022 began investing in training and development to build its own staff and address the larger shortage of healthcare workers in Southern Oregon. The initiative is part of The Learning Well, a new education and support service aimed at improving not just careers but all parts of wellness.
One part of the workforce development initiative is the creation of structured career paths for employees interested in professional growth. "From the moment we interviewed Jenny, we saw something different in her,” says Jillian Robinette, who served as the Wellness Center’s practice manager when Jenny joined the team and today has a new role directing The Learning Well. “Jenny told us she wanted a career to make her grandma proud. We saw her potential during her first year working at La Clinica.”
Healthcare apprenticeship is an “earn and learn” model that includes paid on-the-job training combined with related instruction. In April 2018 the Oregon State Apprenticeship & Training Council approved the registered apprenticeship program that La Clinica adopted, offering an additional avenue for workers to become trained and eligible to sit for the state’s certified medical assistant exam. The program can be completed in half the time of traditional programs, allowing students to work as they learn.
La Clinica’s MA apprenticeship program is just one example of how leaders are using the $1 million grant to develop workforce training programs. The Learning Well, La Clinica’s education service, is geared to assist patients, staff, and the community in exploring personal and professional growth, and exists “to address our larger community’s shortage of healthcare workers and lack of diversity within the healthcare workforce,” says Jillian.
The new service “complements other local initiatives,” says Heather Stafford, executive director of the nonprofit career-development agency Rogue Workforce Partnership. “The Learning Well is an incredible resource for people at all levels of their career to learn essential employability skills that can help inform and evolve their own personal effectiveness. We see this kind of personal development as a primary prerequisite to any industry-specific skills training we might support.”
Jenny attributes her career growth to supportive healthcare providers and managers at La Clinica. “I had many mentors help me throughout my apprenticeship,” says Jenny. “The leaders I worked with would take the time to answer any questions related to patient care and tell me I was doing amazing.”
Jillian says that she gets excited to have the chance to help guide someone’s career. “It is so rewarding to be able to tell a team member– you have excelled in your role,” says Jillian. “We want to invest in you and your career here. Here is a pathway to get there.”
Jenny Caudillo
Jenny Caudillo
Our work on education in 2022
- Established The Learning Well, an education and support service for patients, community members, and staff, and built a website at https://thelearningwell.org
- Hired a staff of 21 to focus on education and support, including workforce development
- Began in-house technical training for medical, behavioral health, and dental employees
- Developed structured "career pathways" for employees interested in professional growth
- Developed staff coaches who coached 46 employees and conducted 167 group visits
- Conducted organizational equity trainings for 120 community members
- Conducted leadership training for 70 employees and community members
WinterSpring grief programs return
Sugar Mejia holds a photo of her son, Trevor, who died last year of cancer. She now volunteers for WinterSpring. (Photo courtesy of Jim Craven)
Sugar Mejia holds a photo of her son, Trevor, who died last year of cancer. She now volunteers for WinterSpring. (Photo courtesy of Jim Craven)
Sugar Mejia holds a photo of her son, Trevor, who died last year of cancer. She now volunteers for WinterSpring. (Photo courtesy of Jim Craven)
Longtime community grief program returns, now as part of La Clinica
While Sugar Mejia’s 24-year-old son Trevor battled a rare and aggressive cancer at Oregon Health & Science University Hospital last year, she struggled to find support, even in Portland where she expected ample resources for people facing terminal illnesses and their grieving families.
When she came home to Ashland, heartbroken after Trevor’s death in September, she knew where to turn—WinterSpring.
The organization that has provided grief support and education in the Rogue Valley since 1989 became part of La Clinica in 2022. When Sugar called last fall, WinterSpring had just resumed in-person groups after a pandemic pause. Through La Clinica’s education and support service The Learning Well, it was spreading its expertise and strengthening its programs, including support groups for children and adults, training for community members who want to guide people in grief, and teams sent into schools where a teacher or student has died.
Sugar first connected with WinterSpring in 2013 when she was working in schools through a nonprofit that aimed to stop bullying. She saw grief and loss among the challenges kids faced. Knowing that building coping skills can help set children on a path to lifelong success, she completed WinterSpring’s volunteer training and facilitated grief circles for students. Although her career led away from the small nonprofit working in schools, she knew the value of coming together in grief.
“As one heals, we all heal,” Sugar said. “It’s about the wellness of our community.”
She found that healing herself when she joined WinterSpring’s bereaved parents group in October. The group helped her know she wasn’t alone, that what she was feeling was normal.
“We all walked in so broken,” she said. “But you know everyone here has the same shattered heart. These are my people.”
Wanting to make sure more people could get the support that sustained her, Sugar jumped back into volunteer training. In early 2023, she launched a Journaling Through Grief group that guides people in processing loss through writing.
“I wanted to be there for others, as people have been there for me,” she said. “WinterSpring has offered the support to make that possible."
“I’m so grateful to La Clinica for its commitment to grief support and mental health and personal development.”
WinterSpring by the numbers in 2022
- 13 children served in 2 youth grief groups
- 64 people from schools and partner organizations educated in 5 community trainings
- 110 youth served by staff teams responding to sudden deaths at 2 Jackson County schools
- 171 people served in 12 adult grief groups
WinterSpring relies on community support and volunteer time to provide its groups and education at no cost. To learn about volunteering, call
541-552-0620.
New support to change lives
New recovery network approach similar to
Birch Grove collaborative's successful model
Ariel Albright first connected with La Clinica in 2018 while she was in inpatient treatment for opioid use disorder at Addictions Recovery Center. She had never had a primary care provider, relying on the emergency room for all her care, including treatment of a reoccurring skin infection that made her ankles swell painfully.
As she finished inpatient treatment, started medication-assisted treatment with a prescription that helps stop cravings and prevent relapse, and got a job with health insurance, the team at La Clinica’s Birch Grove Health Center was with her at every step, part of a network of support that helped her succeed.
That same comprehensive approach to caring for people navigating the path to sobriety and stability is behind work started in 2022 by La Clinica and 17 other area organizations that have come together as the Jackson County Recovery Network. They are sharing $17.5 million in state funds because of a first-in-the-nation Oregon law that decriminalizes small amounts of drugs while funding recovery programs with revenue from marijuana taxes.
Ariel, now 31 and working as a case manager at the temporary housing agency Rogue Retreat, knows the importance of the recovery network’s services—health screening and care, treatment, guidance navigating the recovery process, mentoring, and help finding housing and jobs.
“When I got out of treatment, I was overwhelmed,” she said. “I thought when I was sober, my life would change, but I had never been an adult.”
At Birch Grove Health Center, Family Nurse Practitioner Kelly Church met every medical need as she helped manage medication. Behavioral Health Support Specialist Shelie Hunt called to check in between appointments, providing “that one-on-one connection that makes me feel valued,” Ariel said. When Ariel got a peer support job at Rogue Retreat at the beginning of 2022, the whole Birch Grove team signed a congratulatory card to her.
Birch Grove’s collaborative connections between La Clinica and partners including county departments, mental health providers, drug treatment providers, and coordinated care organizations, deliver success for patients and cut overall healthcare costs, according to a recent study. The study showed that costs decreased on 12 of 16 measures—including substance use and mental health treatment costs, emergency room visits, and ambulance services—after patients started care at Birch Grove.
“We know a team approach works,” said Stephanie Lyon, director of the Birch Grove Collaboration. “We’ve heard the stories from our patients and now can see the positive overall impact in the data.”
Birch Grove will continue to be the center of La Clinica’s efforts in the Jackson County Recovery Network. It will share and build on its expertise engaging patients with substance use and mental illness diagnoses and connect them with a wide range of resources: naloxone to help prevent overdose deaths; substance use treatment, including medication assisted treatment; mental health treatment; and community partners who can help with coordination on food, housing, transportation, child care, and other building blocks of a stable life.
“Imagining the magnitude of what that will mean to the community is magnificent,” Stephanie said.
What is the Birch Grove Collaboration?
La Clinica and eight community partners provide comprehensive healthcare services for people with mental health issues or substance use disorder at Birch Grove Health Center at 910 S. Central Ave., Medford.
This center served 1,514 patients in 6,741 visits in 2022.
Birch Grove Health Center
Birch Grove Health Center
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