A call to the boy's mother provided more information. Although he had dental insurance through the Oregon Health Plan, she could not secure a timely appointment with his dentist.

La Clinica's Happy Smiles staff advised the mother to call her dentist and tell him that her son had been evaluated by the Happy Smiles school dental prevention program and referred for urgent follow-up care. An appointment was set for that afternoon.

Without Happy Smiles, the boy would have suffered in pain for months. His dental pain was affecting his appetite, sleep, ability to concentrate in school and overall health.

Two days after his appointment, the dental assistant saw the boy at school. He smiled and said, "My teeth are all better today."

Some of the problem is due to the poor economy. As people lose their jobs and no longer have health insurance, more of them come to us for care. Our challenge is to treat them without swamping our own boat.

It's imperative that all members of the health care community figure out what they do best - then do it and leave the rest to others. For example, community health centers excel at providing culturally appropriate, team-based care for the most vulnerable of our residents.

We all face a growing struggle to find more budget dollars while operating more efficiently. What we must remember is that the answer doesn't lie only in cutting costs. We have to strike a balance around the "Triple Aim" of health care - cost, quality of service, and population health.

--Vanetta Abdellatif, Director of Clinical Integrated Services
Multnomah County Health Department

Unable to pay for the medications he took to stabilize his blood sugar levels, Patrick lapsed into a diabetic coma that lasted several days.

Patrick finally was discovered by his brother and taken to a local hospital. He was released ten days later, medically stable but heavily in debt. He decided he had no choice but to sell his house to pay for his health care. In the meantime, he again ran low on his medications.

When Patrick was only a few days away from running out of his medications, someone told him about the Virginia Garcia Memorial Health Center in Beaverton.

When the clinic staff told Patrick that they could provide his medications - regardless of his ability to pay - he simply stared at them, speechless with gratitude. He's now able to manage his diabetes while he continues his employment search.

Upon coming to the clinic, Rosie learned that she had preeclampsia. If left untreated, this potentially dangerous condition can lead to eclampsia - a vascular disorder that can cause seizures, coma or even death.

The clinic staff provided her with regular check-ups and treatment. Even though it was difficult, Rosie made regular payments to cover a quarter of her costs, which is what the clinic asks of patients at her income level.

Today, Rosie is the proud mother of a healthy baby boy. She regularly comes to Virginia Garcia for well-child visits.

Working in teams, our staff members leverage their relationships with our clients to provide physical, dental and mental health services in a coordinated way. Teams and patients know and trust one another. That's especially important for our many patients who need behavioral and mental health services. The quality of our integrated primary care has kept patients out of emergency rooms and hospitals.

The team care approach can benefit more than one generation. We've learned that when pregnant women are able to take advantage of our dental services during their first or second trimester, their babies enjoy better health.

The Primary Care Home model is moving our strategic plan from vision to reality.

--Vanetta Abdellatif, Director of Integrated Clinical Services
Multnomah County Health Department

As the county's director of clinical integrated services, I find it especially difficult to attract part-time workers. It's distressing to make patients wait for appointments because I have no one to work a few hours in the evenings. But these part-time positions aren't desirable because they don't include health benefits.

Health care reform can make a difference. As the reform movement gathers momentum and moves toward coverage for all Oregonians, including part-timers, this barrier will disappear. Then I hope to find it easier to recruit the workers we need for the 21st Century.

--Vanetta Abdellatif, Director of Clinical Integrated Services
Multnomah County Health Department

"A counselor I was seeing referred me to Northwest Human Services in West Salem for affordable care. As soon as I arrived, a friendly receptionist welcomed me with a smile and helped me fill out the new patient form. When I met my health care provider, I knew right away that I would receive quality medical care.

"I don't know what would have happened to me without the support and quality care from Northwest Human Services. I'm grateful for this safety net. It holds me up with competent and caring professionals who dedicate themselves to serving vulnerable people in our community - like me."