Journey to a Lifetime of Helping Others

Dr. Rao attended medical school in India where she met her husband. In 1980, the couple moved to the United States, and Dr. Rao completed her residency at University of Illinois before moving to Texas. She worked at Kaiser for eight years and admitted many patients to Cook Children’s. At the time, most Medicaid patients did not have a primary care physician, so all physicians were on call. 

“When we discharged patients, we didn’t have anywhere to send them for the follow-up care they needed,” Dr. Rao said. “The neighborhood health centers that Cook Children’s started have been a meaningful addition to help us continue caring for children and families close to home.”

In 1996, Dr. Rao worked in the first Cook Children’s neighborhood health center – a 500-square-foot mobile building on a playground. 

“We have come a long way since then with nine neighborhood health centers serving the underserved,” Dr. Rao said.

A Passion for Preventive Care

Dr. Rao was determined to work at the neighborhood health center, ensuring every patient had a primary care home and referrals to specialists. She promoted immunizations, well checkups and other issues like mental health or speech therapy. 

“The neighborhood health centers serve as a patient’s home for treatment of existing conditions and preventive care,” Dr. Rao said. “The goal is to pick up on any problems early on instead of waiting until they have to visit an Emergency Department or Urgent Care.” 

One of the ways Dr. Rao focused on preventive care was taking a special interest in supporting children with obesity. At the time, nutritionists did not work with kids, so Dr. Rao stepped in to fill that gap. One of her patients who struggled with obesity visited the neighborhood health center every two weeks, and she made a personalized meal plan to help him make healthier choices. At 16 years old, it was time for him to transfer to another doctor due to his age. Dr. Rao will never forget the last conversation with his mom. 

“The patient’s mom said she appreciated my effort to personally meet with him so often, and it meant a lot to me,” Dr. Rao said. “It was heartwarming to hear that he benefited from it.”

Advances in Modern Medicine

Throughout her 29-year career at Cook Children’s, Dr. Rao has seen many advancements such as the change from paper to electronic records. Dr. Rao said EPIC is linked to specialists, Emergency Department and Urgent Care visits which allow for continuity of care as pediatricians are able to look up labs and imaging. 

She has also seen a difference in common diagnoses due to immunizations. 
“People don’t realize how much immunizations have helped,” Dr. Rao said. “When I started as a resident, meningitis was the most common reason for hospital admissions. Tetanus, measles and chickenpox were also prevalent childhood diseases. My hope for the future is that the immunization schedule will stay the same.”

Looking to the Future

Dr. Rao is thankful for the Cook Children’s vision to open the neighborhood health centers and sees it as the hospital’s ongoing legacy. She said the training and advancements at the Las Vegas Trail Neighborhood Health Center will have a far-reaching impact.

The Las Vegas Trail Neighborhood Health Center features services such as counselors, social workers, and speech therapists. The new space also allows families to take part in hands-on learning, including kitchen demonstrations where they prepare healthy meals together. 

“Having onsite specialists makes a big difference as there is no delay in treatment,” Dr. Rao said.

A Mother’s Insight

As a mother of two children, Dr. Rao understands that some challenges children face go beyond parenting and require compassionate care to help each child thrive. 

“I was able to pick up on problems with other kids that came from my own experience as a mom,” Dr. Rao said. “It is not just the home situation that makes them who they are. They come with their own personalities and there is no guidebook.” 

Dr. Rao said one of the most rewarding experiences is when former patients bring their own children to see her – a full circle moment. 

A Legacy of Serving the Underserved 

Dr. Rao retired in October. She is looking forward to continuing to serve the underserved through volunteering. 

Above all, Dr. Rao is grateful for her time at the neighborhood health centers and counts it a privilege to have cared for each of her patients. 

“I’m thankful I was able to be part of the legacy at Cook Children’s to care for the underserved.”

“I'm a grandmother raising three children due to their mother's passing, and I feel like I'm just doing what their mother would want most,” McGee said.

This week, Cook Children’s Health Care System opened the Cook Children’s Neighborhood Health Center, provided by The Happy Davis Foundation and the Texas Rangers at 6825 Manhattan Boulevard in east Fort Worth. It is Cook Children’s eighth Neighborhood Health Center (NHC), all of them located in areas throughout Tarrant County where access to care is most needed. These centers provide primary health care, well-being services and more to families living in areas where residents are met with multiple barriers to accessing care, including limited transportation, food insecurity, language or literacy barriers, and a lack of awareness of available resources.

“Cook Children’s is very specific with where we build NHCs,” said Brian Leird, project manager for Cook Children’s Health Care System. “We conduct market studies to understand where in the Metroplex we can make the biggest impact. We find those health care deserts.”

The Cook Children’s Neighborhood Health Center, provided by the Happy Davis Foundation and Texas Rangers, would not be possible without the support of generous community donors who believe that collaboration builds strong and healthy communities. The new center will showcase this generosity and collaborative spirit with artwork featuring a local legend—Rangers Captain, the Texas Rangers mascot.

“The Texas Rangers and Texas Rangers Baseball Foundation are honored to join The Happy Davis Foundation in supporting Fort Worth’s children and this Cook Children’s Neighborhood Health Center,” said Karin Morris, Senior Vice President, Community Impact & Executive Director, Texas Rangers Baseball Foundation. “We hope that the artwork featuring Rangers Captain brings joy to children who visit the clinic and look forward to hearing about the great work that will be done there.”

Count On Compassion

For years, Monica Goyal, D.O., a Cook Children’s pediatrician, has cared for McGee’s grandchildren at another NHC location. Dr. Goyal is one of two physicians selected to provide care at the new center. Because of their trusted relationship with Dr. Goyal, the McGee family has chosen to follow her there. It will become the family’s new health care home.

“Dr. Goyal just has compassion,” McGee said. “She knows the whole story. She knows where these children came from and what their needs are, and she just goes above and beyond.”

As a child of immigrant parents, Dr. Goyal can relate to many of the challenges her patients face. It’s what compels her to practice medicine in the NHC setting.

“In these clinics, I see real opportunities to make a difference, whether it is by advocating for the child or empowering families to make informed decisions about their child’s care," Dr. Goyal said. “It’s work that keeps me truly engaged and connected to the families we serve.”

Triveni Kallur, M.D., a Cook Children’s pediatrician, also will deliver care at the new center. She speaks fluent English, Kannada, Telugu and Hindi.

“I’m excited to serve a community that often includes vulnerable populations and those who might otherwise fall through the cracks of the health care system,” Dr. Kallur said. “The NHC model allows us to bring care directly to those who need it most and make a lasting impact.”

Better Together

Cook Children’s Neighborhood Health Centers are designed to be a comprehensive health care home where children and families can receive the care they need, all in one location. By offering everything from sick care and injury treatment to well-child visits and vaccinations, to behavioral health and nutrition services, the NHCs connect the health and wellness dots for families, and eliminate the need to travel to multiple locations for various services and resources.

“Pediatric care is not about just seeing the pediatrician,” Dr. Kallur said. “Our typical patient has various needs. Sometimes they need a dietitian. Sometimes their family needs food, diapers, durable medical equipment or complex care. The NHC is a place where they’re able to find these things in one single place, and I think that’s the most important role the NHC is playing.”

The McGee family has accessed all of these services at one time or another. When the care needed goes beyond what can be provided at the center, Dr. Goyal and Dr. Kallur have the full weight of Cook Children’s Health Care System and Cook Children’s Physician Network behind them, allowing them to refer patients to the specialty physician or service they need.

But it’s the feeling that she’s a partner in her grandchildren’s health care that means the most to McGee.

“Dr. Goyal always makes me feel good because she says, ‘You know your grandchildren and you know their needs, and you work really hard to make sure they get all that they need,’” McGee said. “I know that I do, but to hear the doctor tell me makes me feel good.”

Dr. Goyal, Dr. Kallur, and the center’s staff are dedicated to building lasting relationships with the community they serve. Through the new center, they hope to impact the health of children and families, both physically and mentally, for generations to come.

“I’d love to see that we helped create a strong foundation for their future,” Dr. Goyal said. “And that families felt supported, empowered, and truly cared for along the way.

The center is open from 8 a.m. to 5 p.m., Monday through Friday. To schedule an appointment, call 682-303-6825 or visit www.cookchildrens.org/nhc-manhattan.

A child’s smile holds enormous potential for fostering emotional well-being, communicating happiness and building connections with others. It can also be a powerful indicator of physical health.

“There is a clear connection between oral health and overall mental and physical health,” said Tonya K. Fuqua, DDS, director of oral health for the Center for Community Health, led by Cook Children’s. “Teeth can be very telling about what is going on in a child’s life, the socioeconomic barriers they face and underlying health issues they may have. That’s why it’s so important for the dental health of children to be as high a priority as their physical health.”

Connecting the dots between oral and physical health to improve a child’s overall wellness is the purpose of a grant awarded by the American Academy of Pediatric Dentistry (AAPD) Foundation to Cook Children’s Health Care System’s Renaissance Neighborhood Health Center and the Center for Community Health’s Save-A-Smile Program. Cook Children’s is one of only two recipients nationwide to receive the grant.

“The AAPD Foundation is dedicated to making dental care accessible to all children by supporting nonprofit clinics providing routine cleanings, advanced treatments and ongoing care that helps kids in need,” said Douglas Keck, DMD, MSHed, AAPD Foundation president, pediatric dentist, and dental director of a Federally Qualified Health Center in Florida. “Our support of Save-A-Smile and its medical dental interface initiative represents a pivotal step in bridging the gap between oral health care providers and primary health care practitioners. By working together, we aim to provide sustainable compassionate care for children in need.”

The grant supports a three-year pilot project aimed at developing best practices for bridging the gaps between pediatric medical and dental care. It makes way for a community health worker (CHW) to be embedded with Renaissance Neighborhood Health Center to educate and support families while identifying and addressing any barriers that keep them from completing care.

Cook Children’s Renaissance Neighborhood Health Center is a primary health care home for children living in southeast Fort Worth. The center has both a dental and medical clinic under one roof, making it the ideal location to conduct the pilot. Many within the center’s patient population are considered financially vulnerable and qualify for government-supported health programs such as Medicaid and Children’s Health Insurance Program (CHIP). They may also face non-medical drivers of health such as food insecurity, housing issues and adverse childhood experiences.

Making Connections

Juanita Valles is the community health worker assigned to this medical/dental integration project at Renaissance.

“Families tell me their problems and I listen,” Valles said. “Right now, everyone is struggling financially. Sometimes they need transportation to appointments, childcare, clothing, diaper assistance, car seats for the kiddos, household items or even dental care for the parents themselves. That’s where I come in.”

When a family has a need, Valles works to clear the path to make it easier for them to follow through with medical and dental care. She even goes so far as to make in-home visits with her trusty stuffed assistant, Leo the Lion, when working to educate a family and overcome barriers.

“I take Leo with me everywhere I go and use him to show kiddos how to brush their teeth the right way,” she said. “We also teach them to drink lots of water and stay away from sugary drinks.”

Children with untreated dental problems often have difficulty with pain, eating, sleeping, self-esteem, school attendance and grades. Cook Children’s 2021 Community Health Needs Assessment revealed that more than 175,000, or 1 in 7, children living in Cook Children’s eight-county service area were not able to get the dental care they needed. This rate is 9 times higher than national estimates and 5 times higher than state estimates. Stated barriers included inadequate dental insurance coverage, difficulty scheduling and lack of education and resources for dental care.

“You really relieve all barriers by addressing the social service component of why families may not get the dental care they need for their kids,” Dr. Fuqua said. “And the pediatrician’s office is the perfect place to start because children often visit their pediatricians more frequently in their first years of life than they do dentists.”

Leveling Up

Results from year one of the pilot, which began in January 2023, have already triggered system-wide change, Dr. Fuqua says. Dental screening questions were implemented across all of Cook Children’s Health Care System for well-child visits ages 0 to 3. Children in the pilot project who screen positive are connected with the community health worker. Other opportunities to scale-up and implement new solutions for year two include streamlining pilot data collection and analysis, refining criteria for patient referrals to the community health worker and examining system-wide dental screening data.

In the first 10 months of the pilot, more than 1,000 patients responded to dental screening questions during a well-child check and subsequently scheduled a dental appointment at Renaissance. Of those, 429 patients completed initial dental appointments at Renaissance. In that same time, Valles attempted or completed contact with families 247 times and provided tailored oral health instruction in person or by phone to 50 families.

“That's the beauty of this program and having a community health worker,” Dr. Fuqua said. “It's not as simple as just saying, ‘Oh, your kid needs help and here's where to go.’ These families have so many barriers and so many reasons why they haven't gotten a child to the dentist, but Juanita and this program make a way for them.”

About Cook Children's Neighborhood Clinic Renaissance

At Cook Children's Neighborhood Clinic Renaissance, we're here to help you raise a healthy child from infancy through the transition to adulthood. We offer well checks, immunizations, school and sports physicals, injury treatment, and care for both short-term illnesses and longer-lasting conditions.

If your child needs additional help, we can connect you with more than 60 Cook Children's specialty clinics. We're always ready to answer questions and share resources. Feel free to reach out. We're looking forward to your visit with us in Fort Worth. Learn more about our pediatricians, services and support here.

About Save-A-Smile – Cook Children's Center For Community Health

Save a Smile was founded in 2003 by Cook Children’s to address a gap in oral health services for underserved children. Save a Smile is an innovative, nationally recognized, collaborative program dedicated to providing restorative and preventive dental care to children from low-income families in the community through volunteer dentists. Children eligible for the program are pre-kindergarten through sixth grade at high risk for dental disease from schools pre-selected by the Save a Smile program and participating school districts. 

It’s not that my own pediatrician didn’t ask how my then 15-month-old daughter was sleeping. She did. I answered truthfully when I said that she slept well. She fell asleep promptly after her bath each night, or occasionally she’d fall asleep after our evening meal which was often late in the evening. It was our Parents as Teachers educator who sat on our living room floor with us and calculated that our toddler was not getting the recommended 12-14 hours of sleep recommended for her, even when we included her afternoon nap. 

I knew about sleep deprivation. I was in the middle of my pediatric residency training before there was an 80-hour per week work limit.

Lack of sleep makes it difficult to:

• Concentrate. 
• Retain what you have recently learned.
• Deal with stress.

Sleep deprivation may increase an appetite for less-than-healthy high fat and high carbohydrate foods as well. Sleep is not just for the weak. It is important to our health and survival. Our nervous, immune and hormone systems are maintained when we are deeply asleep. We had to change bed time to a reasonable hour.

Fortunately, we had many good sleep habits already established. We just needed to start our bed time routine earlier in the evening. That time of day after dinner when my children wind down and go to bed is now one of my favorite times of day. It is a time to reconnect and put away the business of the day. Different families will do different things, but usually a bath and two or three quiet, soothing activities will do the trick. Most often, families stick with the same activities, but these may change as a child gets older and has new skills like being able to write.

Some families I know like to:

• Read a story together. (Babies and toddlers may chew on the books. Short, sturdy board books are great!)
• Sing a special song.
• Listen to music.
• Say a prayer.
• Write in a journal.
• Do a math puzzle together. (Check out bedtimemath.org).

Though it is not always easy, it is important to create good sleep habits. Some other great ways to help your child sleep well include:

• Be active with your child and play outside when possible. Just keep it quiet one hour prior to bed. 
• Keep the television and other electronic devices (smart phones, tablets, etc.) out of the bedroom. The light from the screens actually makes it difficult to fall asleep.  It is also more difficult to regulate what and when things are viewed. 
• Be consistent. Try to stay within one hour of bedtime, even on the weekends. This also makes staying up on an occasional holiday for watching fireworks much more exciting.
• Don’t send a child to his or her room for punishment. Pick another location for “time out” to occur.
• Do let your children know that sleep is important to keep them healthy and ready to learn.
• A special toy, blanket or pillow may provide comfort to a child, especially if they need to travel or spend time in different homes.

Sleep difficulties are common, occurring in about 20 to 30 percent of all children. These difficulties are even more common in children with chronic conditions such asthma, eczema, autism, anxiety and depression.  Sometimes, waking at night and needing additional attention to get back to sleep are normal parts of development, too. As pediatricians, we want to hear from families when children have difficulty sleeping. We want to make sure that they are healthy and ready to tackle whatever comes their way. 

Kara L. Stewart, M.D., is a Cook Children's pediatrician, located at 6421 McCart Ave. in Fort Worth, Texas. The location is one of Cook Children's Neighborhood Clinics.