ESCONDIDO -- Forget cradle-to-grave health care. At a health center that opened here last month, care begins long before the cradle.

That's the concept behind the Pediatrics and Prenatal Health Center, located at 426 Date St. in Escondido.

From the first visit, expecting mothers will be guided during their pregnancy, with checkups, counseling and classes. And when their children are born, the new mothers will return to the same location with their children, from infancy to age 5.

The center is run by Neighborhood Healthcare, a nonprofit organization that operates a growing number of community health clinics in San Diego and Southwest Riverside counties. The clinics bring health care to the people who need it most, those who have no health insurance or who otherwise have trouble paying for it.

Neighborhood Healthcare currently has 10 locations with a professional staff, serving North and East San Diego County, and since 1996, Temecula in Southwest Riverside County. Its annual budget is $25 million, employing 400 and serving 65,000 people a year, including 20,000 children.

A second location will soon be opening in Temecula, said Tracy Ream, the group's chief executive officer.

"We received federal funding to expand services because Southwest Riverside and Temecula has been such a high-growth area, and we're the only community clinic there," Ream said. "So we will be expanding services quite a bit over the next couple of years in Temecula."

Quality care

Community clinics operated by Neighborhood Healthcare and sister groups such as Vista Community Clinic fill a health care void.

These clinics, or health centers as Neighborhood Health calls its sites, help people who, for lack of income or other reasons, aren't getting the health care they need. They operate not only by lowering the cost, but by bringing health care into the communities that need it, staffed by people who understand the cultures and languages of their clients.

Even those who never use the clinics benefit from them. They provide an easy-to-use alternative to hospital emergency rooms, which are the other option for those who don't have health insurance.

Emergency room care is the most expensive care, and, by law, emergency rooms can't turn anyone away for inability to pay. They are loss centers for hospitals, which either have to shut them down eventually or subsidize them. That drives up the costs of everyone else's health care.

Accessible health care catches ailments before they turn into emergencies. That reduces the total cost of health care.

The word "clinic" gives many people the false impression of a shoestring operation with bottom-rung services, said Ream, who has been with the organization for 20 years. But thanks to some large-scale charitable donations, that's not true, she said.

The new pediatrics and prenatal center, for example, was launched with a $2.7 million grant from the First 5 Commission of San Diego County.

"We were running out of room at a couple of our locations," Ream said.

The expansion also allows prenatal and pediatric services to be offered together, she said, and mothers will find it easier to make regular visits a routine part of their lives.

"When a mom gets pregnant, she gets the prenatal care, but she also gets linked with a pediatrician. They're in the same building now," Ream said. "Some of the classes that go on will involve a pediatrician with these moms before a delivery, and afterwards too.

"What we found was a number of our women who were going to deliver said, 'Where's the pediatrician?' and they wouldn't quite make it to that next new building. This way, it's all in the same building," Ream said. "They meet the pediatrician during their pregnancy, and they connect."

Infants who don't get examined early after birth are more likely to be admitted to the emergency room with illnesses such as jaundice that could have been treated during a routine visit, Ream said.

Patient-focused

Neighborhood Healthcare has taken the initiative in adding and improving the services it offers, said Alaina Dall, director of policy and community health at the Council of Community Clinics.

"They're probably one of our more active members," Dall said. For example, Neighborhood Healthcare has been increasing its mental health programs in the last few years.

The money comes from Proposition 63, a 2004 state measure that imposed a 1 percent tax on annual income beyond $1 million. The money funds care for people with serious mental illnesses like schizophrenia and bipolar disorder.

"Neighborhood Healthcare has been actively seeing those patients," Dall said. "They really ramped up quickly, and they're providing great service to the community with that."

Traditionally, counseling has been provided only at the main office of a clinic, which means patients may have to go to two clinics, one nearby for physical care and a more distant one for mental health care. Neighborhood Healthcare has been bringing counseling to other locations.

Patients appreciate the convenience, Dall said, and feel more comfortable.

"I've seen statistics that say in as many as 80 percent of visits, the person has either depression or some type of mental health problem that is not addressed. With this new mental health funding, we're encouraging physicians to work more closely with their counseling departments."

History

Founded 38 years ago, Neighborhood Healthcare started as an all-volunteer neighborhood clinic in Escondido. Ream joined Neighborhood Healthcare in 1987, when, she said, "I barely knew where Escondido was."

Just out of graduate school at San Diego State University, Ream was looking for a career goal.

"I thought back, and what I had really enjoyed was my work at a community clinic in Seattle," Ream said. "When a position came open for Escondido, I drove up here, and was delighted by the board of directors, and went to work. I never thought I'd stay 20 years."

At that time, the organization was called the Escondido Community Health Center. It had a $200,000 annual budget and a staff of seven.

"We're doing some of the things that really make a difference in someone's life," Ream said. "Our physicians and medical support staff are seeing patients every day who really wouldn't have another place to go. And I can be one of the behind-the-scenes people making it all happen for them. They provide great care, and I'm there to make sure that we have the funding and resources to be able to keep going. It's a great partnership, and I love it."

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

Neighborhood Healthcare Locations

1. Neighborhood Healthcare -- Women's Center

401 E. Valley Parkway, Escondido (760) 737-2020

Services: Women's Health, Prenatal and Family Planning

Hours: 8 a.m. to 5 p.m. weekdays

2. Neighborhood Healthcare -- Pennsylvania Ave.

641 E. Pennsylvania Ave, #102, Escondido (760) 520-8200

Services: All ages, Primary, Preventive and Chronic Health Care

Hours: 8:30 a.m. to 5 p.m. weekdays. Closed for lunch from 12:15 to 1:15 p.m.

3. Ray M. Dickinson Wellness Center

425 N. Date St., Escondido (760) 520-8300

Services/Contact numbers: Healthy Families/Medi-Cal Application Assistance (760) 520-8333, CMS (760) 489-1834, Dental (760) 520-8330, Community Health (760) 520-8313, Behavioral Health/Counseling (760) 746-5857 & Administration (760) 520-8300

Hours: M-F 8 a.m. to 6:30 p.m. weekdays, 8 a.m. to 2 p.m. Saturday

Dental Hours: Hours: Mon & Wed: 8 a.m. to 7 p.m. Monday and Wednesday; 8 a.m.to 5 p.m. Tuesday, Thursday, Friday; 8 a.m. to 2 p.m. Saturday; closed 1 to 2 p.m. for lunch

Behavioral Health Hours: Hours: Mon - Fri: 8 a.m. to 5 p.m.

4. Neighborhood Healthcare -- Escondido

460 N. Elm St, Escondido (760) 520-8100

Services: All ages, Pediatrics, Primary, Preventive and Urgent Health Care

Hours: 8 a.m. to 8 p.m. Monday through Wednesday, 8 a.m. to 5 p.m. Thursday and Friday, 8 a.m. to 2 p.m. Saturday

5. Neighborhood Healthcare -- Temecula

41002 County Center Drive, Suite 310, Temecula (951) 600-6300

Services: All ages, Primary & Preventive Health Care, Pediatrics, Women's Health, Prenatal, Family Planning and Healthy Families/Medi-Cal Application Assistance

Hours: 7 a.m. to 7:30 p.m. Monday through Wednesday, 7 a.m. to 4:30 p.m. Thursday and Friday

6. Neighborhood Healthcare -- Pauma Valley

16650 Highway 76, P.O. Box 655, Pauma Valley (760) 742-9919

Services: All ages, Primary and Preventive Health Care, Pediatrics, Women's Health, Prenatal, Family Planning and Healthy Families/Medi-Cal Application Assistance

Hours: Mon, Tue, Wed, Fri 8 a.m. to 4:30 p.m. Monday through Wednesday, Friday. Closed for lunch noon to 1 p.m.; 8 a.m. to 7:30 p.m. Thursday; closed for lunch from noon to 1:30 p.m.

7. Neighborhood Healthcare -- Pediatrics and Prenatal

426 N. Date Street, Escondido (760) 690-5900

Services: Pediatrics, Prenatal and Healthy Fa.m.ilies/Medi-Cal Application Assistance

Hours: 8 a.m. to 5 p.m. weekdays

Neighborhood Healthcare also has two clinics in Lakeside and one in El Cajon. Neighborhood Healthcare is open to everyone. Insurance information: Neighborhood Healthcare accepts MediCal, CHDP, MISP, IEHP, and CMS. It is a provider for CHG, Universal Care, Sharp, Blue Cross, Health Net, Cal Optima Direct, and Molina Exclusive Care. Cash is also accepted on a sliding scale fee.