PLNU’s Health Promotion Center (HPC) was founded on a creative idea for compassionate care: operate a clinic rooted in accessibility, mutuality, and a deep belief in our shared humanity.
Under the leadership of Clinic Director Kristen Kellogg, the HPC facilitates internships for graduate students who are studying to be social workers, nurse practitioners, and occupational therapists. In turn, these students provide healthcare to people who otherwise could not afford it.
With this approach, the HPC has faithfully provided free, accessible healthcare to uninsured, under-resourced patients since May of 2000. In recent years, the clinic has expanded to offer the community a food distribution center, social work support, and occupational therapy. These additional resources are not only meeting the dynamic needs of patients; they are also giving graduate students an opportunity to collaborate across disciplines to provide holistic care.
The Value of Trust-based Patient Care
Kara Duetsch, who interns at the HPC as an occupational therapist, appreciates that each shift begins with a team huddle. During these interdisciplinary discussions, the team reviews the day’s schedule and brainstorms how best to meet the unique needs of each patient. From Kara’s perspective, this daily collaboration fosters her own learning and creates personalized support for each of the clinic’s patients.
“One of the biggest things I’ve learned is how important it is to communicate with your team,” Kara reflects. “In a setting like this, learning how to effectively communicate has been super important.”
Kevin Vasquez, who interns as a nurse practitioner, is now in his second rotation at the clinic. With time, he is getting to see how this strong team communication leads to quality care for patients with fewer resources.
Early in his internship, Kevin’s kind demeanor and fluency in Spanish helped him build rapport with a middle-aged, Spanish-speaking female patient. Their bond was solidified when they discovered he shares a name with her son, and she started calling him “doctor” at her appointments.
“One of the biggest things I’ve learned is how important it is to communicate with your team. In a setting like this, learning how to effectively communicate has been super important.”
This patient recently came into the clinic unexpectedly, describing a sudden onset of dizziness and lightheadedness. The patient had felt fine at her routine visit a few weeks prior, so Kevin and his colleagues discussed the best next steps and decided to do an EKG.
“We saw that her heart rate was very slow,” Kevin recalls. “It was very irregular and concerning, given that she had dizziness and symptoms. We told her, ‘We are very concerned for you. We think you should go to the emergency room as soon as you can.’ Because we had already established that rapport, she really trusted what we were saying.”
From the exam room, the patient called her son Kevin and asked him to drive her to the ER. Later that day, she went into emergency surgery to receive a pacemaker — without it, her heart might have stopped. If not for the strong relationships she’d built at the HPC, she might not have brought her dizziness to a medical team at all.
Supporting a patient through an urgent health issue like this one is not unfamiliar to Kevin, who is well accustomed to the intensity of an ICU floor. However, the unique opportunity to care for uninsured and under-resourced patients is what Kevin values most about his experience at the clinic.
For Jennifer Lopez — one of the clinic’s two social work interns — the interactions with unhoused clients have been most significant. The first client she saw is an unhoused veteran who comes in twice per week. Prior to their first appointment together, the staff had given her important context: it would be difficult to connect with him because he has learned not to trust anyone.
A few months into working with this client, he came into his appointment distraught over his housing situation. As he talked, Jennifer and her fellow social work intern listened intently. In response, he smiled and said, “I feel safe coming here because I feel like I can trust you ladies.”
Jennifer reflects on the impact of this comment, saying, “It solidified the reason why I do this. It brings tears to my eyes because it feels like it is worth the time and effort I am putting into this person. It makes me think, ‘If I can help this person, I am actually doing something good.’”
Care Through Creativity
For Kara, an internship at the HPC is reinforcing the value of her career as an occupational therapist.
“This is my first time working with this specific population where there are so many barriers to their access to care,” Kara shares. “These people are really scared right now. A lot of them are undocumented and scared to go out of their house, let alone get care from a bunch of grad students. There are language barriers, insurance barriers, transportation barriers. It has really opened my eyes and made me appreciate my work because I know I can help these people.”
As much as Kara feels confident that the work she is doing at the clinic matters, sometimes a patient comes in with a symptom she isn’t yet licensed to treat. In these moments, she works with her fellow intern to find creative solutions that still offer supportive, proactive care to a patient that likely doesn’t have other options.
“It’s really tested our creativity for being able to adapt,” Kara notes. “We have become very creative people — professional problem solvers.”
Innovative problem solving is also becoming one of Jennifer’s superpowers through her internship at the HPC. She is one of the first two social work students to ever intern at the clinic, and together, they have been building the infrastructure for what social work support will look like for future patients. During the fall semester, Jennifer and her colleague created an intake form and promoted their free services to the nearby community. Currently, they are building out a robust list of local referrals — for necessities like housing, insurance, and transportation, among others — to ensure each patient’s unique needs are taken care of.
“I know this community needs a lot of resources,” Jennifer shares. “Especially when it comes to food insecurity, [and] especially with Medi-Cal being changed. So I enjoy being someone who can lead them somewhere that could help or connect them directly to those resources they need. Bringing some light into people’s lives.”
Kevin’s creativity is also being tested in a way he didn’t expect. As a nurse, it’s routine to identify medications that can help treat a patient’s symptoms or support their long-term health. But at the HPC, he is being confronted with a new type of problem solving.
“We have to not only learn what medications work best to treat what this patient has, but also what medications they can actually afford and continue to buy to maintain their own health,” Kevin explains. “It’s a lot of learning what would work best in terms of the lifestyle of these patients.”
Interns Provide Care, Patients Provide Education
From an occupational therapy perspective, Kara is also learning the importance of providing care that uniquely supports the population she is treating. One of her first patients at the HPC came in describing some mental health challenges, but she was hesitant about trying occupational therapy — she didn’t know what it was. But as Kara and her colleague started evaluating her symptoms and lifestyle to prescribe improvements, the patient’s reservations softened into relief.
“She just really needed somebody to talk to,” Kara remembers. “She was crying and she was so relieved that somebody was listening to her and wanting to help her with her problems. A lot of the people in this underserved community don’t necessarily have the opportunity to seek services when they need it.”
Through his own experiences treating patients at the HPC, Kevin has seen the social determinants of health play out in real time.
“[I’ve learned] how much of a factor somebody’s background is in their overall quality of care and lifestyle,” Kevin explains. “At the HPC, I’ve heard so many patients say, ‘because of the recent political climate, I am anxious to go outside. I fear that I am going to be taken.’ Besides it causing them anxiety, it is also affecting their chronic diseases, because they aren’t going out to walk as much because they fear going out into the streets.”
Kevin admits that his internship has both provided him with great work experience and confronted him with the reality that not all patients can access the care they need.
The clinic focuses on providing primary care, so if a patient has a specialized medical need — like oncology — they will receive a referral. In Kevin’s experience, there are often few accessible resources to refer out to, and the patients themselves can be afraid to follow up on a referral due to their immigration status. Even with reassurance that they are protected within a healthcare setting, patients will sometimes choose not to pursue the needed care out of fear or a lack of resources. Kevin said it can be discouraging to watch a patient suffer due to circumstances outside their control.
Jennifer, too, is discovering how much a person’s background can determine their current situation. She’s been surprised by how her interactions with clients have nudged her to get curious about some long-held beliefs, especially about the unhoused.
“I used to have opinions about why people ended up unhoused,” Jennifer shares. “But being exposed to their backstories has made me take a step back and re-evaluate my thoughts, my opinions. I thought I had an open mind, but it’s helped me be more self-aware that the things I am thinking aren’t always correct. It has given me the opportunity to just bewith people I didn’t think I could have a relationship with.”
Kara, Kevin, and Jennifer are enjoying the hands-on experience of the HPC. They appreciate how it’s stretching them to provide holistic care to people with unique needs and backgrounds.
“We see a lot of patients that come back even once they get insurance,” Kevin shares. “They know us and they know we truly care for them.”
“We see a lot of patients that come back even once they get insurance. They know us and they know we truly care for them.”
Care As a Culture
Beyond the impactful interactions with patients, graduate students are often struck by the kindness of the PLNU staff at the HPC. Kara, in particular, shares that the staff and team culture are the highlight of her internship experience so far.
“Kristen makes everyone feel so welcomed and important,” Kara says. “She cares about occupational therapy and she wants to know more. Not a lot of people know what occupational therapy is, but only so many people take the time to ask questions, and I feel really respected by her. If I could work here I would because it’s just so friendly and the staff alone make it such an enjoyable place to work.”
For Jennifer, the clinic has played an important role in expanding her vision of what she can do as a social worker.
“When coming into social work, I was thinking of working at a school, but being here at the HPC has shown me there are other things I can do with social work,” Jennifer shares. “So now my new goal is to work for a hospital. I am having a lot of fun here and I’m really enjoying it. I still love kids, so I’m thinking of working at something like Rady’s. The best of both worlds.”
For 25 years, the Health Promotion Center has been faithfully operating an innovative healthcare model to serve those who don’t have access to health insurance. From the very beginning, graduate students have been central to its ability to offer these free services to its patients. Through internships at the HPC, graduate students across decades have gained a vital, out-of-classroom education in what it means to provide creative, compassionate care to an underserved population. And from the perspectives of Kara, Kevin, and Jennifer, those who walk through the front doors of the clinic often prove to be both the patient and the teacher.
