Addressing Basic Needs to Help Patients Lead Healthier Lives


Every year in our annual report I have the opportunity to update our friends and supporters on new initiatives at the Clinic. Through a partnership with Northern Virginia Family Service (NVFS), we have been able to add case management – a critical component in addressing the social determinants of health.

Case management is essentially a service that helps our patients make the most of available community resources within the health and human services field. Case managers support and coordinate this interaction, with the overall goal of helping patients reach their optimal level of wellness, autonomy and functional capability.

AFC is grateful for our longstanding partnership with NVFS, a well-respected local non-profit that provides a wide range of social services for vulnerable individuals and families. As of April, NVFS has placed a case manager at AFC one afternoon a week to assess our patients’ needs for community resources and to support them in the application process for needed services. The case manager has made a significant impact on our ability to educate patients on a range of social factors that impact overall health and well-being. Our patients have vast and varied needs including access to reliable and affordable transportation (especially for those who make frequent trips for medical treatment); emergency financial support when jobs are lost or illness interferes with the ability to work; safe, stable housing; employment training; healthy food; and English language classes. Our case manager follows up with phone calls to patients to be sure they understand instructions, keep appointments, and complete paperwork.

Between April and September, 71 patients have been scheduled for a 60 minute appointment with the case manager. When time permits, she also sees walk-in patients and provides services for immediate referrals from our Nurse Practitioner. As a result of this support, our Nurse Managers are better able to focus their efforts on our patients’ medical issues. When basic needs are being met, patients lead healthier lives. Recognizing the many benefits the pilot program has provided in just five short months has prompted us to seek grant funding to expand the program in the year ahead.

Please join us in thanking NVFS for ensuring that AFC patients receive valuable case management services that will help them move toward physical, emotional, social and financial wellness – and allow AFC to meet its goal of providing the highest quality of care for the whole person. From the very beginning, AFC has been committed to creating a healthier Arlington, and we continue to put programs in place to ensure we never lose sight of this goal and what it takes to meet it.

— Joan Bowes Ritter, MD
Medical Director

Read our complete 2016 Annual Report.