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In January 2021 Community Medical Centers, Inc., celebrated a landmark event: the opening of its new Respite Center in downtown Stockton. The structure on North Stanislaus Street will shelter people coming out of substance abuse who don’t have a place to stay. Patients will stay for as long as 14 days in one of 17 beds on site: 8 female beds, 8 male beds, and 1 bed for special cases. 

Other expansion projects are on the horizon.

What’s driving all these developments, at least in part, is the growing need for behavioral health and substance abuse treatment in the Central Valley. 

The behavioral health needs “have always been there,” said Christine Noguera, chief executive officer of CMC, but they haven’t always been recognized or addressed. 

What’s different now is “we are asking questions, we are doing assessments. We are finding out what was always there.” Before, the health centers “just didn’t ask the questions, because the resources weren’t there. We didn’t have the mental health programs. But now we do.” 

Of course the main triggering factor has been COVID-19.  The recession of 2008 created a lot of anxiety and depression in the Stockton community that went untreated. The pandemic is “creating additional stresses for families and adolescents, in terms of isolation, lack of jobs,” Noguera said. “It’s a perfect storm with COVID.” 
Traditionally directed toward medical services for migrant workers, from Tracy to Stockton to Solano, CMC has in recent years expanded its portfolio to include a wide array of services to low-income or unsettled patient populations. Today it’s the largest FQHC in Stockton, with 23 sites of care, and more on the way. CMC still reaches out to farm workers and homeless patients, but today it has the financial capability to be more ambitious.  

Take the recently opened Waterloo Clinic, in a shopping center near North Wilson Way, for example. It’s in a rough part of town, where alcoholism and drug addiction are commonplace. This structure, built to order for CMC, includes the standard medical, dental and pediatric services, but also a sobering center, recovery center, and substance use disorder facilities -- in other words, a full array of services to people needing behavioral and substance abuse care. Where five years ago it had 3 behavioral health staffers, now it has 26. In 2019 the clinic was able to screen 50,000 people for depression. The staff here practices a “warm handoff”—a medical assistant walks the patient down the hall to the behavioral treatment rooms. 

“Our physical presence in this location is important,” said Dana Maulit, a licensed vocational nurse at the clinic. “Patients don’t have to travel to get services. Many of our clients don’t have housing or phones.”

The clinic is designed to maximize patient privacy and discretion. The layout of the substance use disorders clinic helps staffers live up to the requirements of CFR 42, the federal regulation governing privacy for patients with SUDs. 

Patients are using their substances more since COVID-19 became prevalent, Maulit said. “Because we’re here, they can come in and see us even without an appointment. It has helped clients a lot more that we are here.” There are six sobering chairs for people who need to dry out. 

“We do an assessment,” said Delani Gunawardena, MD, an internist known affectionately as Dr. G. “Do they have to go to the ER?” Or can they sober up here on site? The behavioral health clinic takes a holistic view of what patients need, she said. “Social determinants of health are especially important for SUD patients.” 

“We have gotten 600 referrals for SUD in the last two years,” Dr. G said, of whom 380 received services. More than 80 of them got MAT – medication assisted treatment. She writes prescriptions for drugs such as Vivitrol (Naltrexone) and Suboxone, to reduce physical cravings from opioid addiction. 

“As a pipeline, it kinda works,” she said. “They get stabilized here.”  

A mile or so away, another CMC facility, the Channel Center, houses a family practice residency program. A few years ago the program started with six residents. Now it has 18. “That poor building is bursting at the seams,” Noguera said. CMC is constructing an expansion next door. 

Across Stanislaus Street, the new Respite Center will house both a behavioral health and substance abuse disorders assessment center. The other two-thirds of the building will be dedicated to 24/7 housing and support for people who have gone through detox. “You come down from your high, you’re ready to work on your addiction, but there is not a place for you yet,” Noguera said. “This gives them an alternate place to stay for up to two weeks.”

Kitty-corner across the street from the Respite Center, CMC has acquired the square block once anchored by the Ebenezer AME Church, a pillar of the Black community in Stockton, where it plans to develop a new administrative and medical center. 

“We are running out of room here,” said Alfonso Apu, director of behavioral health at CMC. He wants more beds for behavioral health, preferably for longer stays. The homeless population needs more time to get back on their feet. “Here in Stockton the issue is beds -- not enough beds,” Apu said. 

Stockton and San Joaquin County generally have a huge Med-Cal population. CMC’s growth has been driven in large part simply because people need services. Until recently there has not been enough capacity for people served under Medi-Cal, and the private provider networks don’t get reimbursed enough to treat these patients profitably. 
How does CMC finance all this expansion? Partly through 
grants from the US Health Resources and Services Administration. But most of its funding comes from regular operating revenue. 

“We are reimbursed at our cost,” Noguera said. “You have to be strategic about your prospective payment rate. As you grow, you add certain types of services, so you can apply for an improved rate, so your cash flow stays strong. It’s called triggering.” 

And it doesn’t hurt that the practices that CMC is acquiring bring with them a strong patient base and good finances. “The two pediatric practices, they came with a nice chunk of patients and staff already very productive,” Noguera said. “From Day One, we had revenue flow. We did not have to start from zero and move up. You just have to have revenue. We do not have deep pockets.”

Across all entities, there is a growing acknowledgement that behavioral health should be offered in an integrated setting, with an emphasis on prevention. The majority of people who need behavioral health treatment have problems of low or moderate intensity, for issues like anxiety or depression. 

“We don’t want them to escalate into severe mental illness,” Noguera said. “Building a base of easily accessible mental health services is very important in avoiding and preventing people needing more advanced, severe mental health care.”

The Respite Center is only the latest in a spate of building projects and service expansions CMC has undertaken over the past two years. They include:

  • A new substance abuse treatment center and a medical office, both in Tracy.
  • A 20,000-square-foot medical center in a large shopping mall in Stockton, renovated for $3.5 million, including $1 million from the federal government.
  • Taking over two large private pediatric practices serving very low-income children. 
  • Assuming control of two smaller clinics in Lodi run by Adventist Health. The clientele were mostly Medi-Cal patients needing behavioral health services.
  • Developing a new student health center at San Joaquin Delta College. 
  • Starting a small health center for the Stockton Unified School District that can offer vaccinations and health screenings for underserved or uninsured children.