by Beth Blevins
“Come to supper!” is the invitation extended recently by the Virginia State Office of Rural Health (VA SORH). As a result, folks across rural Virginia have gathered to eat barbecue and discuss what is going on in their communities.
“We figure that people relax when they are eating, and that the conversation will flow a little freer than it would if someone is standing up in front of the room and asking questions,” said Heather Anderson, VA SORH Director.
The community suppers, based on the World Cafe method, sprang out of the SORH’s efforts to update the Virginia Rural Health Plan (VRHP), Anderson said. “We know what the data says, but we don’t know what is working in a community necessarily,” she said. “We wanted to hear from people we don’t always hear from—and who typically don’t get to hear from one another.”
“We already have access to people in the healthcare system since we work with hospitals and providers,” she continued. This time, she said, they wanted to hear from school district personnel, mental health professionals, business owners, and patients.
“We are trying to get beyond our typical healthcare sphere to make this a community-driven project,” she said. “We want to spark community involvement, collaborate where we are needed, and ultimately empower the communities to improve their health status.”
The suppers have been held “in places that reduce barriers,” Anderson said. “We don’t want it to be at the hospital necessarily but at the VFW or the library or a church, if that’s where the community gathers.”
They use local food, served by a community group, as a way of giving back to the community. “Since the first meetings have been held in Southwest Virginia, the local food has been barbecue,” she said. “Maybe by the time we get to Accomack (on the Eastern Shore) it will be seafood!”
The counties where the suppers are held (seen in purple on the state map, right) were chosen by using several data points, including Appalachian Regional Commission’s distressed county index, the Robert Wood Johnson Foundation’s County Health Rankings, and the Virginia Health Opportunity Index (HOI). “We felt like that gave us a state, national, and regional look at Virginia,” she explained.
Then they took the data, ranked the areas where they knew they wanted to go, and asked themselves, “where are we missing?” and “how can we engage the small business owner on Main Street and get their perspective?” Anderson said. “As the SORH, we want to learn what is working for the community, the hidden gems, not just what isn’t working, which is what the traditional data looks at. That’s how we could include a place like Amelia County, which is in the shadows of Richmond, but is still very rural. There are areas that get overlooked because they may not meet the federal definition of rural, but we consider them rural.”
As community members gather for supper, they are given the same three questions to discuss among themselves at each table: “Name one to two things that will improve the health of your community; what are the good things about your community; and what is wellness and what does it look like here,” Anderson said. “At the end we bring it all together with a local facilitator. The expectation is that we want to hear local things we might not have heard before.”
The community suppers so far have had an average of 30 people in the room, with a total of 120 participants. The conversations are being funded with Flex carry-forward funds, with SORH funds likely picking up some of the sustainability going forward, such as printing resource documents to distribute.
Anderson said that one thing they have learned already from the suppers is how faith communities are filling in service gaps in rural Virginia. “In Wythe County, we learned there’s a very strong food bank that’s been around for 20 some years that has blossomed into clothing and social services for people,” she said. “I don’t know that we would have found that out if we hadn’t had the opportunity to have these conversations.”
VA SORH is gathering so much information from the suppers that they will be using it beyond the creation of the VRHP, by sharing information about best practices and community champions in the areas they have visited, Anderson said. “Our SORH will take the qualitative information and promote a champion, either a person or an agency, on a monthly basis on our website,” she said.
“We’re hearing really wonderful things about the communities,” Anderson said. “We know they are lacking transportation, there’s an opioid epidemic, there aren’t enough providers. But we don’t always know what is working well—we are trying to get that out of these conversations. We’re trying to get people in the room that need to talk to each other. Sometimes we make things too complicated, and miss the boat by not talking to people.”
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.
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!”
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.