The document discusses social determinants of health and how they affect patients at The Care Center, a pediatric therapy clinic. It describes how factors like access to healthcare, availability of specialized clinics, medical insurance coverage, and emphasis on disease prevention can influence patients' health outcomes. It also discusses organizational behavior at The Care Center, highlighting their dedicated staff, focus on customized care, and efforts to ensure patients receive needed treatment regardless of insurance barriers. Professionalism in healthcare is also addressed, with an example of how a physical therapist effectively handled a difficult patient situation.

1. Tori Gar
HLTH 4200
April 2016
Public Health Determinants and Trends
Social Determinants in Health
Social determinants of health are factors that influence and shape an individuals
health status. Examples of this can range from being as broad as the house people live in,
the type of work that they do, and the access to medical care that they have, to being as
specific as the cost of food in their neighborhood market or the number of available parks
and sidewalks. While interning at a pediatric physical therapy clinic I was able to see how
certain social health determinants affect the need for therapy treatment. Access to medical
care is a huge determinant that affects a large number of individuals. The presence of
available and accessible therapy clinics, implementation of health promotion and disease
prevention plans, along with insurance coverage all play a role in the overall health of
patients at The Care Center.
The Care Center is a unique therapy clinic in the fact that it is privately owned and
treats a very specific demographic of children with developmental disabilities in need of
either physical, occupational, or speech therapy. This specialized type of facility is not very
common and available openings can be hard to find. The number of children in need far
outweighs the number of therapists and their availability. This is a social health
determinant that can sometimes makes it hard for children to improve their health by
receiving the treatment they need. Another factor that affects the number of patients that
need therapy treatment is our medical system and its lack of emphasis on disease
prevention and health promotion. Early interventions such as prenatal care and counseling
could help to lower the number of children being born with disabilities. Premature births
along with drug and alcohol use while pregnant are two causes of children being born with
the immediate or eventual need for therapeutic intervention. If effective programs were
more readily put in place it would prevent such a high need for pediatric therapy. The final
determinant that affects patients at The Care Center is the availability of medical insurance.
Therapy is a time consuming treatment that can last for months and even years. This
becomes extremely expensive and the average individual cannot afford to pay for it out of
pocket. It is crucial that each patient be covered under some form of medical insurance that
is able to help pay for the treatment they need to better their health. Without this option
their health will most likely become worse and worse. In order to prevent this from
happening and to provide each patient with the care they deserve, a great number of social
health determinants must work together cohesively.

2. Organizational Behavior and Governance
There are many crucial aspects that go into The Care Center being a successful
pediatric therapy clinic; with quality service being one of the biggest contributors. The Care
Centers dedicated staff provides this high level of quality service, by working together to
focus on the patients and their families. When working with children it is critical to
customize their therapy program especially to them and to involve the whole family in the
therapy process. The Care Center understands this fully and is devoted to providing each
patient exactly what he or she needs. They do this by providing multiple types of therapy
all in the same building, having fun and functioning therapy equipment, staffing a
passionate and educated group of therapists, and putting the child’s needs before anything
else. The down side to this is that some patients do not get to experience this quality
service like they should due to insurance policies.
The insurance barrier is one that the majority of therapy patients face, due to the
fact that they rely on insurance to pay for their treatment. Insurance companies get full
reign over deciding if you are eligible for therapy at all and if so, how many sessions per
year. If a patient does not qualify for insurance due to lack of an official diagnosis or other
varying reasons, or runs out of yearly sessions, it can become a large struggle to get that
patient the treatment they need without the family having to pay out of pocket. The Care
Center works extremely hard to ensure that each patient gets the treatment they need no
matter the insurance situation.
If I could change the policy behind insurance distribution and coverage, I would
make it to where the insurance companies were required to work more closely with the
patients, their families, their therapists and their other physicians. These are the people
who truly know what services these children require and how often. This would allow for
the child to make the developmental progress they deserve in a more hassle free manner. If
the insurance companies could see the patients as real people and not just dollar signs it
would greatly benefit everyone involved, and would allow more children to receive the
quality therapy services they need.
Preprofessional Health Concentration
No matter your field of employment, professionalism is a critical skill to possess.
The medical field in particular requires a special level of professionalism due to the fact
that you are most often working closely with individuals regarding private or sensitive
information. Good decision-making, maturity, responsibility, and communication skills are
all aspects that go into being professional. The staff at The Care Center is a wonderful
example of professionalism in every aspect, but especially in regard to working with
children and their families.
My preceptor, DeeAnn Wright, has been in the field of pediatric physical therapy for
over 30 years. During this time she has gained a vast amount of experience and knowledge
that allows her to know just how to handle every situation in the best way possible. When

3. working with children it is not uncommon for them to become upset or angry for any
number of reasons. While working with DeeAnn I quickly realized there is a right and
wrong way to handle these types of situations. One incident in particular is a wonderful
example of how to professionally handle a tough situation, and lead it to a positive
outcome. A new patient with known behavioral problems came in for a physical therapy
session. It wasn’t long into him being there that he began to break down and become very
upset and uncooperative. DeeAnn did not miss a step and knew just what to do. She began
by speaking with the patient one on one in a way that would not intimidate him, but would
also let him know what was expected of him. She remained calm and firm while explaining
to him how he should act and what needed to be done. After patiently waiting for him to
respond in the proper way, with no prevail, DeeAnn decided to speak with his mother and
move to a different plan of action. By being open and accepting with each other, they
worked out a behavior point system plan to be put in place. After seeing the cooperation
and teamwork between DeeAnn and his mom, the patient became much more willing to
work and behave. It would have been very easy to become frustrated and not want to work
with such a difficult patient, but everyone deserves the same opportunity at treatment no
matter his or her background or behavior. Though DeeAnn is firm with her patients there is
no denying how much she loves and cares for each and every one of them. This is evident to
them and to everyone who witnesses their interaction. This mutual love and respect
between patient and provider results in tremendous progress on every level. Learning that
there is a fine line where you must balance kindness and discipline will take years to fully
figure out and perfect, but I am grateful to have gotten to see this wonderful quality in the
staff at The Care Center. I believe my own professionalism has greatly improved from my
time as an intern.