By: Beth Blevins
Residents in rural communities across the Hawaiian Islands have been sharing their “stories of health” in community meetings as part of an effort to build a framework of health derived from community values and practices.
“A common thread in all these meetings is that having a connection to what matters is really what can make good, positive change in the community,” said Gregg Kishaba, Rural Communities Health Coordinator at the Hawaii State Office of Primary Care and Rural Health (HI OPCRH).
The meetings, sponsored by the Hawaii Public Health Institute (HPHI) and supported by HI OPCRH, are part of a larger, long-term strategy for achieving “Pilinahā”—a nonclinical, universal view of health and wellness developed by the communities themselves. The objectives of Pilinaha are: deepening a connection to place, to the past, to others, and to the best parts of one’s self. As part of the initial phase of this strategy, 17 community forums, which included discussions and storytelling sessions, were held on all six islands.
“We had the connections in a lot of rural communities already so they (HPHI) wanted to partner with us,” said Scott Daniels, FLEX Coordinator at the HI OPCRH. “We were part of the original planning committee. We had to do a lot homework beforehand to figure out how many meetings we would be having and who would lead in the community.”
HI OPCRH staff, trained in the THRIVE (Tools for Health Resilience in Vulnerable Environments) method in 2015, helped facilitate the meetings. “THRIVE really does involve the whole community,” Daniels said. “It provides an interactive method for communities to get out there and record and discover their community.”
“THRIVE is a unique tool that focuses on community and the concept of health equity,” Kishaba added. “The process guides communities to assess and identify root causes through a health equity lens. THRIVE allows for multi-sector partnerships to develop, facilitates a deeper understanding of the social determinants of health, and builds a foundation for future action and activities.”
For example, Kishaba explained, “if a community chooses to focus on a particular disease, like diabetes, THRIVE has an online tool that walks you through what kind of questions should be addressed. Or if a community says ‘it’s not all about the disease state, it’s more about where we live, our economy, education’—you can take that path. But that will eventually connect you back to a health issue, like asthma, which can be exacerbated by roaches or dust.”
Most communities chose not to focus “on the disease or on deficit or scarcity, but on the positive side of health,” Kishaba said. “So, we might start off a meeting, by asking: ‘When was the last time you felt good about yourself or you were healthy?’ Many of the seniors at the meetings went back to a time when they were younger and had the freedom to ride bicycles or walk safely in the community.”
“It’s useful getting the community to think of those other factors that contribute to the health of the community,” Daniels said. “It’s getting back to social determinants. The focus is on trying to establish a framework where people live healthy in their environment and the people that they are around so that creating those connections will ultimately improve A1c counts.”
Daniels said that they have found their THRIVE training useful for other efforts, including Community Health Needs Assessments (CHNAs). “It’s another tool and another way to look at health in your community,” he said. “We have been using THRIVE training to help hospitals break out of the hospital-clinic-medical thing and think more about the environment.”
The National Public Health Institute provided funding for the 17 meetings and the statewide forums, and the original THRIVE training was coordinated by the Hawaii Public Health Institute, Kishaba said.
HI OPCRH is supporting the creation of a video that captures what was learned from these community meetings. “Our office understands the importance of storytelling through digital media, so we provided the resources to tell this in a digital format instead of just having a booklet or pdf,” Kishaba said. “We sent film crews to the meetings, based on everyone’s input, to pick and choose unique stories that will captivate audiences.” The film will serve as a roadmap and springboard for future activities, Kishaba said.
“Once the video is developed, we will go back to those 17 communities to show it,” Kishaba said. The video also will be shown at statewide conferences and be available for free on the HI OPCRH website.
Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger at firstname.lastname@example.org to set up a short email or phone interview in which you can tell your story.
With funding from a Centers for Disease Control and Prevention (CDC) Oral Health Infrastructure Grant, the Hawaii SORH has partnered with the Hawaii State Department of Health (DOH), Family Health Services Division to assist in rebuilding its oral public health program. Other partners include staff from the Primary Care Office and Title V Maternal and Child Health Services Block Grant.
“Hawaii’s oral public health program was shut down in 2009 due to lack of funding,” said Gregg Kishaba, Hawaii SORH Rural Health Coordinator. “The need for the program to be restarted was clear when we received two consecutive “F” grades on our PEW Foundation report card for achieving only one of eight key benchmarks.” Some of the indicators used to measure success included fluoridated water systems, school-based dental sealants programs, expanding dental hygienists scope of work, and Medicaid reimbursement.
Implementing the Hawaii Smiles program is the first step in the rebuilding process. Starting in January 2015, Hawaii Smiles will monitor the dental health of Hawaii’s third graders, gathering important data that will be used to develop dental disease prevention programs for children.
“Good oral health care is critical. Dental problems cause children to miss school and have difficulty eating, speaking, socializing and sleeping,” said Kishaba. “We’ll be asking 64 random schools to take part in Hawaii Smiles during the 2015 school year. Our plan is to repeat Hawaii Smiles every 3-5 years.”
With their parent’s consent, third graders will receive a free, non-invasive dental screening at their school. Screenings will be performed by a dentist or dental hygienist and will take about one minute per child. Children who are determined to be in need of dental care will be referred to their own dentist or a local clinic. “Hawaii Smiles will provide basic services that many rural communities are not getting. We are currently building teams so that every island will have equal resources available to them,” Kishaba said.
Data collected from Hawaii Smiles will be analyzed by the Association of State and Territorial Dental Directors (ASTDD). Kishaba said “the baseline data will be shared with our partners to quantify the oral health burden within Hawaii’s school-age population. Findings will be used for public health strategic planning, policy development, and prevention activities.”
With funding in place and the Hawaii Smiles program starting in 2015, Kishaba is confident they are “establishing a solid foundation in which the core team can leverage and build upon other key oral health efforts in the years to come.”
Back to July Branch
Scott Daniels is the director of the Hawaii State Office of Rural Health. He is also currently the Secretary of the NOSORH Board.
You’ve said that management is different than leadership. How?
The simple answer is that, as Peter Drucker said, “Management is doing things right; leadership is doing the right things.” Leaders can bring about culture change. Culture change is doing the right thing but also creating an environment where it’s always the right thing to do. Just following the rules keeps you out of trouble, but it doesn’t necessarily serve the people that you’re supposed to be serving. You need to have someone who can recognize that something is wrong, make waves and get things done. So leadership in a sense always invokes some amount of risk. A leader needs to break molds, go against processes. I think Flex coordinators are consistently put in situations that require creativity and a willingness to go against the grain. We sit right at the nexus of the federal Office of Rural Health Policy and the critical access hospitals of our state and need to represent both to the best of our ability. This often creates a conflict between policies ORHP wishes to push forward and the situation of the CAHs in your state. I
frequently find myself arguing for the policies to the hospitals and the realities to ORHP. I do want improvement as quickly as possible, but that only happens as long as I can keep everyone listening.
What qualities do you think are important in a leader?
Making sure that you train and raise others around you. Be willing to let people grow and do better than you—and eventually replace you! A good leader lets the people they lead become leaders themselves. As this Office grew, I had to realize that I couldn’t be the expert on everything anymore. A good leader learns to let go and let people support them. They have to recognize there’s more involved than everything being under them—they need to learn to delegate.