The Membership Organization of State Offices of Rural Health
Often the best ideas on community healthcare come from community members themselves—especially when they are engaging in active discussions with healthcare providers and others.
That’s the idea behind community cafes, sponsored by the Alaska State Office of Rural Health (AK-SORH), which are being held in small towns in the state.
“Last spring we told all our Critical Access Hospitals (CAHs) that we can come to their communities to facilitate a conversation on whatever topics they want,” said Heidi Hedberg, AK-SORH Director.
The community cafes are set up to last an hour, with the first 25 minutes devoted to a presentation on a chosen topic. Attendees then break into smaller groups for discussion. “We have a facilitator in each small group and a scribe,” Hedberg said. “This is where we are looking for the community to provide feedback on the topic they were just educated on.”
Petersburg Medical Center (PMC) in Petersburg, a small town on an island in southeastern Alaska, was the first to sponsor a community cafe last November at the Petersburg Public Library. Jeannie Monk, Vice President of the Alaska State Hospital and Nursing Home Association, spoke on the changing landscape of healthcare in rural communities and how communities must pivot to accept these changes. Phil Hofstetter, PMC CEO, added his perspective following Monk’s presentation, Hedberg said.
“When we broke into small groups after their presentation, one of the questions we asked was, ‘As a community member, what healthcare services will keep you in your community?’” Hedberg said. “It was fascinating to hear what they want and what they perceive, and their thoughts on healthcare.”
AK-SORH held community cafes twice that day at PMC on the same topic. The morning cafe had 50 to 60 people, and the afternoon cafe had around 30 people participating, Hedberg said. “It’s important that the cafes have a limited number of participants, because in a smaller group, it’s easier to draw out the quiet voices,” she explained. “You could have a town hall meeting, but it would be harder to have one-on-one conversations. In rural communities, the smaller the group, the more information you can draw out of them.”
Hedberg called the first community cafes “a fantastic start,” especially since they included a wide swath of community members. “It enabled us to see where their knowledge base was so that we can target our education and further that conversation,” she said.
PMC, which is Petersburg’s only hospital, is a CAH built in 1917 that was last remodeled 30 years ago, Hedberg said. “One thing we all realized is if Petersburg wants a new hospital it needs to be community-driven,” she said. “And we need to know what services they want so we can build it into that plan.”
The first cafes were such a success that AK-SORH was invited back to PMC in February to do another, this time on the promise of new telehealth offerings. The group experienced a tele-psychiatry visit through a camera, Hedberg said, then broke into smaller groups to answer questions including “what types of services are you looking for?” and “how much would you be willing to pay for these services?” Since then, PMC has launched tele-psychiatry services.
PMC helped advertise the cafes by making posters and putting them in local venues and promoted them on their weekly radio session and their website, which helped lead to their success, Hedberg said.
The idea for AK-SORH’s community cafes sprang from those sponsored by the state’s Office of Substance Misuse and Addiction Prevention (OSMAP), which visited more than 20 Alaskan communities “to educate them on opioids and to hold conversations on how to resolve the issue,” Hedberg said. “From that, a lot of communities formed their own coalitions and OSMAP created a statewide strategy plan drawn out of the responses from those communities.”
“This is not a new idea—it’s just how you organize it,” Hedberg added. “Consensus meetings, listening sessions, community cafes— there’s all different types of them, but for small rural communities, the cafes are a great way to have a structured format to both educate and receive feedback on any topic.” AK-SORH funds its community cafe work through Flex money for travel, and SORH money for staffing time, she said.
Since the cafes that were held in Petersburg, other communities have expressed interest in them, she said.
“It’s exciting when you bring a community together and through that relationship comes feedback, and out of that comes these new service delivery models,” Hedberg concluded. “We’ll continue to do these as long as communities ask us to facilitate these conversations on healthcare topics that are impacting the community—we hope to do these forever!”
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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.
Pat Carr is the Director of the Alaska Office of Rural Health in Juneau. She is also the Section Chief for Health Planning and Systems Development. Pat moved to Alaska from North Carolina in 1993 and started working with the state office three years later. She is on the Frontier and Rural Expert Panel of the National Center for Frontier Communities and the Advisory Committee for the University of Alaska Anchorage master’s in Public Health program. In her free time, Pat enjoys cross country skiing, hiking, snowshoeing, fly fishing and tennis.
As Director, what are your two biggest challenges and how do you meet them?
There are competing priorities and shifts in funding levels. It takes diligence to stay focused on our goal of improving health and access to health care. Strategic planning and maintaining partnerships with others who share the same goal are ways that I meet these challenges.
What makes your SORH different than those in the “lower 48”?
Alaska is a big state geographically but we have a smaller population and in many ways, less complex organizations. We are able to get to know and work with lead staff of these organizations easily. No matter the rural health issues we are working on, the same people are around the table. The richness of our Alaska Native cultures is a special resource.
You mentioned that most areas in Alaska are considered frontier and are connected by water rather than roads. Tell us about the unique challenge of travelling through your state.
Most of my staff members are in Juneau, however I have some staff members in Anchorage, 500 miles away, and I have to fly to meet with them face to face. I have traveled to communities by jet, float plane, small wheeled planes, and ferry. I have been picked up at local airports by four-wheelers and by pick-up trucks where my seat was in the back. The communities are so different. I love traveling throughout Alaska and I never stop learning!
Through a federal grant program, the Alaska State Office of Rural Health (AK SORH) is expanding telehealth technology and mental health services for veterans in the state. Alaska is one of three states (including Montana and Maine) awarded $300,000 for the second three-year cycle of the Flex Rural Veterans Health Access Program; (it was awarded funds in the first program cycle as well). The program is part of an ongoing collaboration between HHS and the Department of Veterans Affairs (VA) towards implementing an information infrastructure for rural health. “The federal mandate is to provide access of care closer to home and develop increased collaboration between the VA and local providers,” according to Tracy Speier, Health and Social Service Planner and RVHAP Director at the AK SORH.
Speier said that the focus on veterans is important in Alaska because the state has the number one veterans population, per capita, in the country. And telehealth is essential in a frontier area like Alaska, Speier said, because there is no road system in much of the state–most of its towns are accessible only by boat or small aircraft or, in the winter, snowmobile or dogsled. Speier gave an example of a veteran in a rural community in Southeast Alaska who has been getting care at a VA clinic in Anchorage. A one-hour visit there required three days of travel due to airline schedules-one day to travel to Anchorage, one day for her appointment, and one day to travel back. “I don’t think people realize how vast Alaska is,” Speier said. “Now through telehealth, she can meet with her counselor through video conferencing technology.”
In the last year and a half, the AK SORH has developed a telehealth network from the ground up in seven rural, remote communities in Southeast Alaska; trained 150 community-based providers on military culture PTSD, TBI and military sexual trauma in Juneau, Anchorage and Fairbanks; sponsored VA-approved PTSD treatment training to 19 behavioral health providers; and trained health administrators from non-tribal community health centers, Community CAH, and CMHC state-wide on how to do business with the VA. “This develops an increased collaboration between the VA and rural clinics in order to increase access to and quality of care for veterans in rural communities,” Speier said. “This could be duplicated in other areas with a commitment by the VA to work with non-VA clinics.”
Over the next three years, the AK SORH plans to work to identify veterans who are enrolled in public assistance programs in the state, to help them access VA and other benefits. “It has been challenging to identify veterans in need of services,” said Pat Carr, AK SORH director. “Many providers don’t ask people if they are veterans.” The AK SORH plans to use the PARIS (Public Assistance Reporting Information System) system in this effort. Carr said that other states that have worked with their public assistance agencies to implement this model “have saved significant funding.”
NOSORH hosted a Learning Community Call on Working with Rural Veterans on September 26th (in which Speiers described the Alaska program). Click here for a recording.
NRHA Development and the Future of Rural Health (T. Barnhart)
Alaska State Office Widens Outreach to Rural Veterans – The Branch: November 2013