Families enter Santa Barbara Neighborhood Clinics’ “Circle of Care” from a variety of different avenues, ranging from standard pediatric visits and annual physical exams to treatment for diabetes or a toothache and more.
Executive director Cynder Sinclair’s path to the helm of this dynamic and vital organization follows a long history of involvement with nonprofit organizations that serve the poor and disadvantaged. But that road is far from over. Here she sits down with Noozhawk’s Leslie Dinaberg to talk about her work, her life and the challenges ahead.
Leslie Dinaberg: Can you explain a little about the Santa Barbara Neighborhood Clinics’ “Circle of Care?”
Cynder Sinclair: The idea is that we have to look at the whole individual, as well as the whole target population and the whole community, and how does that all fit together. What can we do to remove barriers to access to health care for the whole community and for the population that we serve?
... It’s common sense, but it’s considered state-of-the-art to combine prevention with treatment and to combine mental health with physical health, and to do so with the prevention and also the dental. To combine all of those things with a comprehensive wholeness kind of approach, of course, makes sense to lay people like us, but from what I read, it’s state-of-the-art.
LD: Speaking of state-of-the-art, I understand you are working on the federal mandate to convert the clinics to electronic health records.
CS: We are converting a 40-year-old organization from paper to electronics, so it’s an enormous undertaking that will cost a couple of million dollars.
CS: There are government incentives on the back end that may cover half of the cost over a five-year period. ... The big benefit for the organization is that it puts us on a path to true sustainability.
LD: You must be doing additional fundraising.
CS: Well, because for the first time in 40 years we have this wonderful opportunity to become sustainable for the long-term, we are. On the one hand you could say, “Are you guys crazy? You’re having enough trouble just keeping the doors open. The state is not going to pay you for quite a long time. You’re going to have to take care of this cash flow yourselves and, not only that, they are threatening cuts and you’re already down to the bone. How could you think at a time like this of embarking upon these two really large projects?” But we are determined that we are not going to let this opportunity to become sustainable pass us by.
There is the electronic health records project and there is another project called federally qualified health center status, FQHC, which leads to a federal grant called the 330 grant. We are in the process of applying for that, which is a big deal. ... Both of them together will cost us lots of hours, lots of dollars, well over $2 million.
We are going out to a few donors who have shown that they understand the importance of our safety net and have the capacity and generosity to contribute significant gifts.
LD: How is it going?
CS: Our first lead partner in this project has been Cottage Health System. They have given us the seed funding to be able to hire the consultants, to be able to pursue the FQHC 330 grant, and to help us start raising the money with a gift to build on toward the conversion to EHR. They are our lead sponsor right now but we are hoping that they will be in a crowded room soon. (Laughs)
LD: When did this project start?
CS: We’ve been working on this about a year and a half ... and we’re just getting to the point where we’re going to spend some big bucks. It’s time to start buying stuff.
LD: That makes sense.
CS: While we are doing all of these things and have all of these challenges, we are also seeing more patients than ever before — and we just see that growing in the future. We are seeing, for example, more than 400 new patients every month for our clinics. Every month, we see a little over 1,000 patients at each one of our four clinics (Isla Vista Neighborhood Clinic, 970 Embarcadero del Mar; Westside Neighborhood Clinic, 628 W. Micheltorena St.; Eastside Neighborhood Clinic, 915 N. Milpas St.; and Eastside Family Dental Clinic, 923 N. Milpas St.).
The reason we’re having so many more patients is, of course, the people who are losing their jobs or have lost their jobs, the people who are still employed but maybe their family isn’t covered, or maybe there has been a reduction and the employer can’t pay as much as they did before.
... The trend now is that the amount the employer has to pay the insurance company is increasing, and because the businesses are so pushed financially because of the economy they can’t pick that up. So what they are doing is passing that on to the employees. At a time when the employees are making less and less, they are having to pay more and more for health care.
We have found that true (as an employer), as well, because our health coverage for our employees was going to increase 17 percent and we had to, for the first time ever, pass on 10 percent of the health insurance premium to the employees. Now they, for the first time, have to pay. For some people, that’s a lot of money.
We are seeing, and I think we are going to continue to see for a while, more patients because there are more people who either don’t have insurance or their employers are going to the high deductible or something like that, so it’s essentially no day-to-day insurance.
... We think we are going to see more patients once health-care reform is really in place because they are going to raise the level of eligibility, so more people will be eligible for Medi-Cal, for example, which means we’ll be able to see more people. It’s good, because people who don’t have insurance will now have it, but it’s going to mean more and more people for us to see.
LD: What determines eligibility for people to come here?
CS: I would say about 95 percent of all of our patients, dental and medical, are living below the federal poverty level, below 200 percent.
... We have A, B, C, D scales, and D is people who don’t qualify, people who are 200 percent or above the poverty level ... so the D level pays the highest amount. Our highest amount is still pretty low, but the other people have a sliding fee, depending on their income.
LD: I understand you have great partnerships with Sansum Clinic if people need to a specialist service you can’t provide, and that the St. Cecilia Society helps out with people who can’t pay their bills.
CS: Yes, these relationships with the other organizations in town really take our ability to treat somebody so much further than well child or sore throats or anything like that. It’s pretty exciting.
And, of course, with Cottage Health System being one of our large partners, they know that the work we do keeps people out of their emergency department and that relationship is a win-win. They win because they are reducing their costs of the uninsured waiting until they are too sick and they have to use the hospital, and we provide their primary regular care.
(Bonnie Campbell, Santa Barbara Neighborhood Clinics’ deputy director, joins in to elaborate on the clinics’ challenges.)
Bonnie Campbell: We can’t keep our doors open in our clinics without community support, and that means donations. ... Keep in mind we have from 68,000 up to 75,000 visits a year. Each visit costs us $154 to see that person. We only get $65 when you average reimbursement that we get from the state, the feds and the sliding-fee scale, and nothing from homeless. When you average all that together that is $65 per patient, so that’s an $89 gap. That’s why we depend on the community to fill that gap by fundraising.
LD: That’s amazing, isn’t it?
CS: It is amazing. I want everybody in this community to feel proud of the fact that because of the work that Santa Barbara Neighborhood Clinics does, every single person in our community has access to excellent medical care.
LD: That’s great.
CS: Everybody is welcome here regardless of their ability to pay. That’s key. Because I don’t want to give the impression that anybody can walk in and get mental health services. They can, but they’ve got to be a patient here first. Or that they can walk into the dental clinic; well, if they’ve got pain and swelling and they’re an adult, yes, we’ll see them but not ongoing. But if you’re a kid, yes, you will. If you’re homeless, fine, come on Thursday morning. For medical, anybody and everybody regardless.
The dental clinic has five chairs and the average five-chair dental clinic sees about 350 visits a month. This clinic sees more than 1,000 visits every month just because we are so efficient. ... Our dental director is an engineer at heart so she makes everything run very smoothly.
LD: This is an impressive operation. Cynder, how did you decide to get into this kind of work?
CS: My professional background is really running nonprofit organizations. After 12 years at Girl Scouts and after more than 30 years of leading nonprofit organizations and never having worked in the for-profit world, I went to work at Santa Barbara Bank & Trust in their wealth management department. It was a great place to work and I worked with a lot of nonprofits.
In that year and a half at the bank, I had an opportunity to objectively look at my professional time. For the first time, I realized that leading a nonprofit is not just something that I do, it’s something that I must do to feel that sense of fulfillment that we all hope to feel.
LD: When did you come aboard?
CS: April 1, 2008. (Laughs) April Fools’ Day.
LD: How long have you been in Santa Barbara?
CS: About 15 years. I came here to take the job with Girl Scouts in 1995. Before that I was in Stockton with the Child Abuse Prevention Council and Fresno before that. I was raising kids and founding nonprofit organizations (including the Christian Community Development Association) that served the farmworker families in the San Joaquin Valley.
LD: I would imagine that health care is very complicated.
CS: It is. This is the most complex organization I’ve been involved with. In 2008, I finished my doctorate in organizational management and leadership, and that’s been really helpful in all the systems designing and infrastructure and all that we put together here.
LD: What do you do when you’re not working?
CS: I’m a cyclist so I ride my bike a lot. I ride in century bike rides, which is 100 miles, and I’ve got one coming up. I live in Carpinteria and I have this very cool trailer that I put on the back of my bicycle; I put my kayak on it and pedal myself over to Santa Claus Beach and then take my kayak out there. I also snow ski, and like hiking and anything outdoors. I have 11, soon to be 12, grandchildren and five kids, and so I see them as much as I can.
BC: Cynder works out every day. She has two different trainers — one for the endurance and one for the strength building because the cycling is different than the other stuff.
LD: It sounds like you’re a good example of health. If you could pick three adjectives to describe yourself, what would they be?
CS: Oh, my gosh. I would say energetic or high energy, that sort of thing. I would say optimistic and I would say focused. ... When I have a goal I don’t care what’s in my way. (Laughs)
Vital Stats: Cynder Sinclair
Born: March 9 in Selma, Ala.
Family: Five grown children, 11 grandchildren and expecting another in November
Civic Involvement: Member, Rotary Club of Santa Barbara; board member, Santa Barbara Region Chamber of Commerce and Council on Alcoholism and Drug Abuse; and involved in a new arm of the Santa Barbara Foundation called Corporate Philanthropic Roundtable
Professional Accomplishments: “I would say the founding of three organizations that really serve the poor; I feel really good about that accomplishment. Then at all of the other organizations I would say bringing stability and improved systems and infrastructure, and really relationship building, connection to the community and between the community and the organization to all of the organizations. That’s what I guess they have in common.”
Best Book You’ve Read Recently: The Girl With the Dragon Tattoo Trilogy by Stieg Larsson and Grace Matters by Chris P. Rice
Favorite Local Spot: My favorite local spots in Carpinteria are Corktree Cellars and Giannfranco’s.
Little-Known Fact: When her children were young, Sinclair would make 50 TV dinners each weekend. “This was back before microwaves. I had a neighbor who ate TV dinners and she would save me the trays. Because I had all these kids and they were coming and going at all these different times, I would cook all this food and put them in little TV dinner trays, cover them up, label them and put them in the freezer so when they were hungry I would know they were eating healthy food. Fifty a weekend. That was my routine.”