Promising Practices

New Report Highlights the Health Status of Rural Missourians

i Dec 5th No Comments by

Fifty-five counties in rural Missouri are now without a hospital. Death rates are higher for rural Missourians than urban in each of the top ten causes of death. These and other statistics are included in a new report that looks at the health status of rural Missourians.

Health in Rural Missouri: (Biennial Report 2018-2019) looks at demographic characteristics and other factors, as it has in prior reports. But this year the entire report was done through the lens of social determinants of health (SDOH), according to Kathryn Metzger, Programs Manager at the Missouri State Office of Rural Health (MO SORH), which issued the report.

“In prior years it was mostly done by the numbers—people pulled the numbers and interpreted them,” Metzger said. “This time, we wanted to identify those things most impacted by SDOH, and use that in discussing everything going forward.”  The 2018-2019 report focuses on five of the most important SDOH impacting rural health: economic stability, neighborhoods and built environment, health and healthcare, social and community context, and education.

For example, Metzger said, in the section that discusses education, “We put education levels alongside diabetes rates so you can see that as educational attainment decreased, the diabetes rates increased,” she said. “That’s really important when you’re looking at programming—you start getting into health literacy issues. You want to make sure that people understand the medical advice they are getting, especially with diabetes, which is complex and difficult for everyone to understand.”

Another big change with this year’s report, beyond content, Metzger said, “and one that was important to best serve Missouri’s communities, was to make it easier to read.” In previous years’ reports, she said, “it was a very technical document, written in an academic style, that would have required a pretty high level of health literacy and an understanding of statistics.”

“We want to try to expand the audience,” she continued. “The goal was to use plain language so that the information will be accessible to anyone on the ground doing the work in the community. We also wanted to make sure that when we couldn’t use words that were plain language, we would include a glossary that links to them.” Terms that appear in the glossary are italicized in the report.

Another more visual change is that the new report features award-winning photos from the Missouri Department of Agriculture’s Focus on Missouri Agriculture Photo Contest. “We used photos of people in Missouri taken by people in Missouri,” Metzger said. Rural scenes, including a large photo of a smiling Missouri farmer on the Table of Contents, are used throughout its pages.

Although MO SORH is required by statute to issue the report every two years, Metzger said, “this is much more than we are required to do—it could be done in a five-page overview. But it gives us an opportunity to speak to our lawmakers about our needs and also to share information with our community. I think it keeps Missouri’s finger on the pulse of what is actually happening across the state.” This year’s report is 88 pages.

The report being issued biennially also points out significant changes in health status, Metzger said. “If you have a county that has had a really low rate of something but then, all of a sudden, in a two-year time span, you see it go to a high rate, it draws your focus,” she said.

Metzger said that in recent years the reports have been longer also because their data capacity as a state has changed. “We have a lot more access and we’re using state-specific data sources,” she said. The current report draws on MOPHIMS (Missouri Public Health Information Management System) and the Missouri County-Level Study, she said.

The report was partially funded through SORH funds, Metzger said, with the rest of the funding coming from other state budget sources.

In the coming weeks, Metzger said she hopes to pull together factsheets from the report as well as present webinars that will discuss how to use and interpret the data.“It’s my hope that this year’s report will be easy to understand by everyone at the grassroots level interested in furthering the health of their community—whether it’s a hospital, a non-profit, or a walking club,” Metzger concluded. “I hope that it is used for writing grants, for developing programming, and maybe identifying some opportunities to make an impact in ways people hadn’t previously thought.”

Promising Practice: Sowing the Seeds of Healthy Eating in Rural Indiana

i Nov 1st No Comments by

by Beth Blevins

Thanks in part to the Indiana State Office of Rural Health (Indiana SORH), rural residents in Allen County, Indiana, soon will have the opportunity to take classes on cooking and healthy eating through the HEALing Seeds program.

The Our HEALing Kitchen (OHK) program, which began in 2015 in urban areas of Allen County, in and near Fort Wayne, has been rebranded as HEALing Seeds for its launch in rural, said Laura Dwire, Community Programs Manager for the St. Joseph Community Health Foundation (SJCHF), which manages and is the fiscal agent for HEALing Seeds. OHK is cosponsored by SJCHF and Parkview Health.

Boys and Girls Club participants enjoy their OHK class.

“We knew food deserts were a really big problem in urban areas,” Dwire said. “But rural areas have the same low-access pockets. Some of our areas are 15-20 miles from a grocery store. Because it’s rural and their needs are different, we’ve adjusted the curriculum and rebranded it as HEALing Seeds.” HEAL stands for Healthy Eating and Active Living, she said.

The aim of HEALing Seeds is to provide the seven rural communities of the New Allen Alliance (NAA), a coalition of communities in east Allen County, training and education to encourage healthy cooking, increase access to healthy foods, and ultimately improve health outcomes within the region, Dwire said.

The program uses a “train the trainer” model, Dwire said. “We realized there has to be a trusted individual in the community that facilitates the classes because if I came in and said, ‘Hey we’re having public cooking class,’ the attendance would be low,” she said. HEALing Seeds offers a three-hour training for program facilitators and administrators (which can be the same person), and then facilitators deliver classes in their communities or organizations based on their schedule and timeframe, she said.

The HEALing Seeds curriculum is composed of eight sessions, with four to six recipes taught per session, “but the facilitator can bring in their own recipes if they meet the standard nutritional guidelines, and they can create their own schedules—whatever works,” Dwire said. “In the past some organizations have added exercise classes, yoga instructors, and mindfulness training, and some churches have tied it into Bible study. So HEALing Seeds is just the foundation for the organizations to build a movement.”

Celebrity judge, Indiana Lt. Governor Suzanne Crouch (front row, holding fork), attends the first OHK Champion Cookoff competition.

Seven organizations in the NAA have agreed to hold the classes, including two youth centers, an alternative school, a community center, and a senior living community, Dwire said. “Originally the program was designed only for adults, but then we realized it was impactful to teach life skills to middle schoolers and above because they have the same health issues—obesity, hypertension, diabetes—as the adult population,” she said.

The project is part of the funding NAA received when it was designated an Indiana 2018 Stellar Community, said Joyce Fillenwarth, Indiana SORH Manager. “The purpose of the Stellar program is to encourage and emphasize collaboration among all community stakeholders in planning their vision for future economic and community development.”

“In 2018, our office approached the Indiana Office of Community and Rural Affairs and suggested that the Stellar Designation include a rural health component,” Fillenwarth continued. “Incorporating the community health assessments as a component of community-wide planning will improve the comprehensive nature of the process.” The Indiana SORH grant provides $75,000 (which was split between the two designees the first year) for projects that address health and wellness issues within the respective regions, she said.

Vickie Hadley, a Woodburn resident, facilitates an OHK class at Johnnie Mae Farm,  a partnership between the City of Fort Waynes’ Office of Housing & Neighborhood Services and Purdue Extension.

NAA chose OHK as the health component for their stellar designation application because it was already a success and was ready to go, said Kristi Sturtz, NAA Rural Liaison. According to Dwire, in the past four years, OHK has expanded to over 40 organizations and 1,500 participants.

The hope is that the program will be sustained after funding has ended, Dwire said. “We have chosen organizations that have the capacity to incorporate the curriculum into their programming,” she said. “We give them comprehensive skills to keep moving without our funding.”

As part of the move toward self-sufficiency, the grant agreement requires each class to have a celebration at the end of the program, which is planned, prepared, and served by the participants, Dwire said. “They can invite family, make a theme, whatever they want,” she said. “We ask that they raise funds for its cost so they can be part of the solution. We also suggest that they partner with a farmer or grocery store or local organization to support their class as well. We’re trying to make it theirs, give them the tools so they can go on.”

Dwire said that she would be happy to share the OHK recipe book and curriculum with any interested organizations. The recipes are available on the SJCHF website.

HEALing Seeds train-the-trainer sessions will begin in December, with the rollout of classes planned for 2020, Dwire said.

Promising Practice: Forum on Aging in Rural Oregon Brings Together Innovative Ideas and Programs

i Sep 29th No Comments by

By Beth Blevins

In rural and frontier Oregon, as in many other parts of the country, the aging population is rising, bringing new challenges to healthcare and other services. To address these needs, the Oregon Office of Rural Health (ORH) hosts the annual Forum on Aging in Rural Oregon.

“We bring people together who are working on aging issues, to share best practices and learn from each other,” said Robert Duehmig, ORH Interim Director. “It’s important that Oregon’s rural and frontier communities are supportive of the aging population, so folks don’t have to leave when their care needs increase. There’s not a lot of assisted living or senior homes in rural and frontier communities, so when somebody has to leave their home for care, it usually means going quite a distance.”

The Forum was the vision of Scott Ekblad, former ORH Director, Duehmig said. “His vision was to highlight and share rural organizations’ programs with other communities that have similar resources and geographies.” In this way, he said, “rather then keep that innovative work siloed, the Forum offers a way for other folks to hear about this great work—there are a lot of really cool programs and projects going on in rural and frontier communities.”

To address as many aging-related topics in as many communities as possible, each year the Forum is held in a different region of the state, said Rosalee Locklear, ORH Field Services Program Manager. “We rotate to a different area of the state to highlight communities in and around that specific region,” she said. “And we rotate committee members to bring in folks from that local area, because they know the needs of their community best, and they help us spread the word about the Forum.”

Participants at the third annual Aging in Rural Oregon forum network in the partner room.

The topics chosen for each Forum are based on evaluations from the previous year’s Forum, in conjunction with feedback from the Planning Committee, Locklear said. “After the Forum we ask attendees to fill out evaluations to understand what they liked and what they want to see in the future. Then the Planning Committee and I discuss the data,” she said.

In the evaluations, attendees also share how they will use what they learned at the Forum. After last May’s Forum, which included presentations on loneliness and grief, aging and disability, and clinical considerations for cannabis use, their comments included: “I’m more motivated to work harder against loneliness and social isolation in our community,” and “The pharmacology was helpful, knowing when a client is taking too many medications and who to contact regarding this.”

Tied in with and awarded after the annual aging forums, ORH’s Elder Service Innovation Grants are intended to fund new projects or those building upon existing services. “Through the grants, we’re able to support small organizations that do innovative projects,” Locklear said. “There’s not a lot of funding for those sort of programs.”

The Forum is funded through three sources: paid registrations, organization partnerships, and the Medicare Rural Hospital Flexibility Program, Duehmig said. “We absolutely have to have partners to make it possible,” Locklear said.  “We like to reach out to organizations in communities where we host the Forum to showcase their support of this event.” Partners have included hospital and health systems, health care organizations and foundations, government aging organizations, and education institutions, she said.

Right now, ORH is the only State Office of Rural Health (SORH) that hosts a forum dedicated to aging in rural and frontier communities. “To my knowledge there are not a lot of SORHs that are specifically addressing their aging population this way, but other states are interested in supporting their aging communities,” Locklear said. ”For example, the Washington SORH has done an evaluation of their state’s home health and hospice agencies.”

“I’d be happy to have a conversation about what we do with anyone who is interested, and to help other people do something similar,” she added.

When ORH first began the Forum on Aging in Rural Oregon, Duehmig said, they did not know it would be an annual event. “But as long as the need is out there and we can meet that need through this particular mechanism, we will keep doing it,” he said. “I think the support for it is still strong and the need for that kind of information remains vital.”

Yes There’s an App for That!

Want to know what to expect at an Oregon Office of Rural Health (ORH) conference? Check the ORH app! The app offers information on the ORH-sponsored Oregon Rural Health 

Conference and Forum on Aging in Rural Oregon, including meeting agendas, speaker bios, and sponsor information. The app also includes information on ORH and ORH staff, and instant access to ORH videos and ORH’s Twitter and Instagram accounts.

According to Robert Duehmig, ORH Interim Director, the app was created as part of ORH’s larger goal to become more paperless. “We don’t want to waste paper so we can be environmentally sound,” Duehmig said. “But the other reason is that our conferences are never near the office, so we would have to travel with all that stuff or ship it out.” Additionally, he said, “more and more people don’t want to go to a conference and bring home tons of stuff, so we make it easier for them to view that information on their mobile devices.”

The content of the app changes with each new conference. Since the last conference (as of this writing) was the ORH Rural Aging Forum, it is now featured on the app.

Currently, ORH is the only SORH that offers its own app and it is one of the few apps devoted to “rural health events.” The app is available on both Android and iOS platforms. (Search for “Oregon Office of Rural Health” in either app store).

Promising Practice: NY State Office of Rural Health Leans Into More Efficient Work

i Aug 28th No Comments by

By Beth Blevins

Using Lean, a concept originally developed to eliminate waste in Japanese manufacturing, the New York State Office of Rural Health (NYSORH) recently embarked on a project to find more efficiency in the way its operates. The effort was part of the New York State’s broader Lean Initiative.

The NYSORH utilizes simple, low-tech processes during Lean meetings.

“This seemed very bureaucratic when we first began and we were not entirely enthusiastic about it,” said Karen Madden, NYSORH Director, “but we knew that it was something that we needed to do. So we decided to have open minds about it. We took a lot of time to be prepared and reviewed all of our data prior to our first Lean meeting, which allowed us to hit the process running.”

Although the New York State government (NYS) began its Lean efforts in 2013, it was the first time that NYSORH had used Lean. “It hadn’t gotten to us yet,” Madden explained. “Some of the projects they did were high profile and larger scale, and things that had very long processing times. But the eventual goal is to have every person who works in the NYS Department of Health trained on Lean or have them do at least one Lean project.”

For its first effort, NYSORH applied Lean principles to how it develops amended contracts, with the goal of eliminating excessive back and forth with contractors on contract requirements, Madden said. “It ended up improving our process, which we initially didn’t think needed improving, and was a great team building exercise,” she said.

Although completed last summer, NYSORH continues to apply Lean principles to its contract work, Madden said.  “We continue to monitor each step of the process and compare actual times with targets that we established as part of our Lean process,” she said. “We identify outliers and discuss the issues that are causing delayed processing. Additionally, we periodically review our guidance to our grantees because that was something that we improved and that helped improve the timeliness of our approvals.”

The NYS Lean project began with four pilot agencies and has now grown to include over 41 agencies and authorities across the state. Madden said that some examples of processes that have been “leaned” in NYS include processing times for contract review and approval, voucher review and approval, application reviews, and site surveys.

Lean also has been used in other state government agencies, including Iowa and Colorado, and federal agencies including the U.S. Environmental Protection Agency.

Although NYSORH has received no additional funding for its Lean work, Madden said, “Lean has become part of how we operate now.”

When asked if other SORHs should use Lean principles, Madden answered, “We all have processes that we need to follow that we don’t necessarily have much control over, but there are likely ways that the process can run more smoothly if you take the time to break it down and find out where things slow down and why.”

“It doesn’t take a formal process or facilitator to do that,” Madden added. “It just takes a little time and an open mind to maybe do things differently and get out of the ‘that’s the way we’ve always done it’ mindset.”

“We are all part of larger organizations and need to do things that we don’t necessarily want to do, but very often something that seemed negative can be very positive if you are fully present,” Madden concluded.

Promising Practice: Educational Partnership Reaches Rural California Communities

i Aug 5th No Comments by

By Beth Blevins

Rural migrants and other immigrant Latinos in California are becoming better informed on issues that affect their health thanks to a partnership between the California State Office of Rural Health (CalSORH) and the California Department of Public Health’s Office of Binational Border Health (OBBH).

Since the partnership offered its first workshop in March 2015, community health workers (CHWs), also known as promotores, have been trained on emerging health issues that impact migrant, seasonal, and agricultural workers.

“Each year, we look at emerging health issues, listen to what the CHWs/promotores are hearing in their communities, and tailor our training with up-to-the-moment information,” said Jalaunda Granville*, former Rural Health Project Coordinator at CalSORH. “The goals of the training vary from year to year.”

Statewide Promotores Trainings on Pesticide Illness and Safety poster. Click for more information and evaluation results.

The project uses a “train-the-trainer model”—trainings are held for the CHWs/promotores who then spread the information to the community, said Corinne Chavez, CalSORH Health Program Manager. “The goal of all of these trainings is to provide education and tools for participants to share in their communities. It’s an outreach and education model that offers relevant and reliable health education and resources to California’s rural population.”  Chavez added, “OBBH has utilized this model for over a decade.”

Past trainings have been on pesticide illness and safety, Zika awareness and prevention, and mental health and opioid use disorder (OUD). Trainings take place in four regions of the state, with participants drawn from rural parts of those areas, Granville said. More than 300 CHWs/promotores have been trained so far, Chavez said.

“The CHWs/promotores are carefully selected,” Chavez said. “And OBBH’s strong relationships with community-based organizations and community leaders aid in their selection.” A workgroup, composed of OBBH staff, medical professionals, and community leaders and members, develop culturally appropriate curriculum and implement trainings, she said.

After each workshop, participants are given educational manuals and materials, copies of presentations, resource links, and/or contact information for the local resources involved in the workshops, Chavez said.

The CalSORH/OBBH partnership also utilizes additional partnerships with other state and federal agencies. For its workshop on pesticides, OBBH collaborated with CalSORH, the U.S. Environmental Protection Agency, and the California Department of Pesticide Regulation, Chavez said. OBBH and Vision y Compromiso, a leading promotores organization, facilitated its four Zika Awareness workshops in targeted regions of California in 2017, she said.

The partnership provided training and outreach mental health on the dangers of OUD in 2018. It targeted rural areas of the state based on the number of opioid-related deaths found on the California Opioid Overdose Surveillance Dashboard, Chavez said. “California rural communities have the highest rates of OUD in the State,” she said.  “OBBH wanted to provide training in a culturally and linguistically appropriate setting because they believe CHWs are uniquely positioned for early intervention and to assist in increasing access to services.”

This year, the partnership is offering training on increasing awareness of antibiotic overuse and misuse in rural communities, with the goal of training 120 promotores/CHWs by 2020. That topic was chosen, Chavez said, “because of the current public health threat it poses throughout the world—we want to provide these trainings as a tool to expand access to healthy practices and services.”  If each CHW who is trained on this topic delivers a short presentation to at least 20 community members, she said, the hope is that it will eventually reach at least 500 people in the state.

CalSORH currently is in a five-year intragovernmental agency agreement with OBBH for their services through CalSORH funds, Granville said, “but they also provide services above and beyond their agreement amount.” Funding for the partnership comes from CalSORH’s Federal Office of Rural Healthy Policy SORH grant.

The partnership has allowed CalSORH to reach communities and populations they might not otherwise have, Chavez concluded.

“Early on we recognized that partnering with OBBH was the best way to deliver information and services,” she said. “Working with OBBH was a natural choice in terms of trying to address our rural migrants and Latino populations that may or may not be exposed to this information. We identified their expertise, and knew that they have access to communities and resources. It was a natural link for us to partner with them.”


* Granville has recently accepted a promotion in the Office of Statewide Health Planning and Development, California’s federally designated Primary Care Office

Promising Practice: Iowa Project Promotes Healthcare Careers Early

i Jun 4th No Comments by

By Beth Blevins

With an increasing shortage of rural healthcare workers, Iowa needs to recruit locally and early. That’s the idea behind the Opportunities in Health Sciences: Iowa Career Pathways, which helps high school students (and adult workers who are looking for a career change) navigate toward healthcare careers.

The Opportunities in Health Sciences project came about through the efforts of the Iowa State Office of Rural Health (IA SORH), which saw the need to recruit rural students to work in rural areas. The impetus for the project was a one-day workforce summit Iowa SORH held two years ago to gather information about the shortages and needs of the healthcare workforce in Iowa.

“Some of the recommendations at the summit came from people working at hospitals and clinics,” said Megan Hartwig, Iowa SORH Director. “Their concern was that we recruit students in healthcare careers but they end up leaving rural communities to work in urban centers. Or some rural schools don’t have the capacity to provide the curricula or experiences the kids need to help them consider further training and education in the health field.”

The “Opportunities in Health Sciences: Iowa Career Pathways” guide

What followed was a discussion on how to do a better job of communicating with Iowa high school students, how to provide resources to counselors so they can help steer those who show aptitude and interest into health sciences careers, Hartwig said.

“We wanted to provide a guide that helps students realize they don’t often have to go to school for more than two years to complete training for a successful career in healthcare,” she said. “We also wanted them to understand there are healthcare employment opportunities in their own communities, and that they don’t have to just be a doctor or nurse to work in healthcare.”

The Future Ready Iowa initiative had already been set up through the governor’s office, with the Iowa Department of Education (DOE) and Iowa Workforce Development as the main partners on the project, Hartwig said. “The Iowa DOE had put together an Iowa Pathways website and guide for a few career sectors, like energy and manufacturing, but healthcare hadn’t been developed,” she said.

To get momentum behind the ideas discussed in the workforce summit, Iowa SORH applied for special project funds through the Department of Public Health’s CDC Block Grant, Hartwig said. “Our intent was to develop resources for students who might be interested in health sciences, as well as to develop marketing material around healthcare careers, specifically more of those entry-level careers,” she said.

Hartwig worked on the project with the Iowa DOE and other health industry partners. Her time on the project was funded by IA SORH, but the project itself was funded through the CDC Block Grant, she said. The project was done in tandem with Future Ready Iowa. “The work we’re doing dovetails with Future Ready Iowa and can be used in conjunction with the Health Sciences section on its website,” she said.

Hartwig said it is important that the resulting publication is available both online and as a printed document, which is being distributed to community college and high school counselors. “Not every kid has access to a computer,” she explained.

The Opportunities in Health Sciences publication includes career sections arranged by topics like Direct Patient and Therapeutic Care (“The Caregivers”), Community and Behavioral Health (“The Supporters”), and Biotechnology Research and Development (“The Innovators”), as well as information on work environment options, and career interests based on personality types.

The project also included the creation of a video by Iowa Workforce Development that discusses apprenticeship programs for healthcare careers, Hartwig said. “We are also developing a toolkit with the DOE for schools to use with local healthcare employers, to create opportunities for students to shadow them to see if they want to pursue an education and career in health sciences,” she said.

It is not just future employees and employers who have benefited from the project. Hartwig said that it has fostered greater collaboration between IA SORH and other departments in the Iowa state government. “We now have connections across three departments—IDPH, DOE, and Iowa Workforce Development,” she said. “We pick up the phone and talk to each other now, which has opened doors for more coordination.”

Hartwig concluded, “We recognize that many students love their hometowns and want to stay in their communities, but they don’t think they can make a living there, or they think they have to go away for years and years of training. We hope this project will help students understand they have options— they can go through an Associate’s Degree or certificate program in two years or less and then have a great job helping people in their own communities.”

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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.

 


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Promising Practice: Innovative Program Teaches Colorado Providers to Be Rural Leaders

i May 1st No Comments by

By Beth Blevins

Teaching rural providers to be better advocates for their patients and their communities was the goal of an innovative program conducted recently by the Colorado Rural Health Center (CRHC) in partnership with the Center for Creative Leadership (CCL).

“Through the Rural Colorado Primary Care Leaders (RCPCL) program, we worked to educate 48 rural primary care providers on how to create grassroots advocacy efforts in their community,” said Michelle Mills, CEO of CRHC. “The ultimate goal of the program was to create a peer network of rural providers in the state.”

“CCL approached us after they received a grant from the Colorado Health Foundation (CHF),” said Sara Leahy, CRHC Director of Business Development. “Some of CCL’s staff members had worked with another State Office of Rural Health, and one of CCL’s headquarters is in Colorado Springs,” Leahy explained. “With this program, their goal was to work with primary care providers—MDs, DOs, advanced practice nurses, physician assistants, dentists, and dental hygienists—who practice in rural areas of Colorado.”

The CHF grant covered the $10,000 tuition for each participant, as well as travel expenses, lodging, and meals, Leahy said.

CRHC helped find the program participants. “We started off with targeted marketing to clinics and practices that were engaged with CRHC, then expanded our marketing to a broader outreach to all our membership,” Leahy said.

The participants met in three different learning sessions over the course of a year, Leahy said. “Each session was divided into two cohorts, so that two providers from the same practice could participate.”

The first session, held July 2018, focused on participants’ communication styles, teaching them practice tools like giving and receiving feedback, Leahy said. The second session, held November 2018, worked to improve their ability to lead others and to work collaboratively, she said. The third session, which took place over two days in March, helped the providers develop policies to lead their community, she said.

At that last session, Kelly Erb, CRHC Policy Analyst, spoke about public policy in Colorado. “We discussed the budget and the big bills that are currently moving through the legislature,” Erb said. “Then we discussed how providers can actually participate—whether through developing grassroots activities, writing letters to the editor, hosting community meetings, or testifying at the capital. We explored all the opportunities they have to interact with the political system both locally and on a state level.”

By the third session, participants also had completed a Capstone project, Leahy said. “The aim of the Capstone project was for them to make an impact on policy that affected their own local town and community—something that would affect not just themselves, not just their practice, but everyone that they touched base with.” Each participant had a coach who worked with him or her a few times a month on those projects, Leahy said.

Colorado providers who participated in the RCPCL program gather at the state capital in March to meet with their legislators.

On the second day of the third session, participants were able to put their Capstone projects—and all they had learned in the RCPCL program—into action. “We brought all the providers to the state capital, where we set up meetings with their local representatives and with the state health committee,” Mills said. “It really gave them an opportunity to use those leadership skills they had learned in the program.”

In addition, Leahy said, the group was split into house districts, and within those small groups they brought forward three to five talking points to discuss with their policymakers. “They did a great job of planning who would talk, and making sure they went in there with ideas and objectives,” Leahy said. The topics they discussed that day included increasing access to quality broadband in rural areas, support of more equitable and adequate payment to rural facilities from Medicaid, and integrated care barriers with telehealth, Leahy said.

“Ultimately we prepped them to say, ‘this is the beginning of a relationship, and we’re going to be resources for one another,’” Leahy said. One provider was so comfortable with the visit that he ended up taking his state senator out to lunch, Leahy added.

Though the RCPCL sessions are over, Leahy said the effects of the program will continue. “That last day, even though the program had wrapped up, folks talked about how they can continue to work collaboratively with one another,” she said. “They want to stay engaged.”

“The providers have created a relationship with their local policymakers and are now empowered to use that relationship in advocating for issues important to them,” Leahy continued. They also can use those skills locally, with their own colleagues, she said, “in activities like building short-term and long-term strategic plans for their clinics.”

“This program was super helpful in engaging the providers, and I think that it will trickle down to the community level, giving them more of a presence within their communities,” Mills concluded.

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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.


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Promising Practice: Community Cafes in Alaska Give People a Say in Their Health Care

i Apr 1st No Comments by

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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Promising Practice: Pennsylvania Office of Rural Health Puts Focus on Rural Human Trafficking

i Mar 4th No Comments by

By Beth Blevins

Human trafficking doesn’t just happen in big cities in the United States—it happens in rural areas as well. Lisa Davis, Director of the Pennsylvania Office of Rural Health (PORH), is working to bring more attention to this issue.

Davis said her interest in human trafficking came unexpectedly, at a presentation given at a Pennsylvania Critical Access Hospital Consortium meeting in November 2017. It was unclear if the topic resonated with the hospital leadership in the audience, she said. “But hospital CEOs came up to me after the meeting and told me they never knew that human trafficking was an issue in rural Pennsylvania or was something they should think about.”

Davis added, “It was clear that their facilities needed to be prepared to identify potential victims and to have systems in place to refer them for the services they would need.”

The administrators then asked if PORH could develop training programs for them. “PORH staff made a deliberate choice to train rural providers on the threat of human trafficking,” Davis said. “We know that we can be a resource for rural hospitals and other providers.”

Since the beginning of 2018, PORH has worked to address the issue in rural Pennsylvania. As a first step, a statewide committee of government, academic, community, and hospital representatives was organized. In November 2018, the group launched the Rural Human Trafficking Initiative with an introductory webinar targeting small rural hospitals, community-based organizations, and others interested in serving potential victims.

Since then, Davis said, “We continue to keep the hospitals informed—we’ve gotten a lot of interest from them.”

Davis also is reaching beyond Pennsylvania to raise awareness of rural human trafficking in other states. She gave a presentation in October 2018 at the Annual Meeting of the National Organization of State Offices of Rural Health (NOSORH) in Cheyenne, Wyoming. “It was the first time anyone had talked about that topic at NOSORH,” Davis said.

“I wanted to have NOSORH begin to think about how State Offices of Rural Health (SORHs) could address human trafficking with the Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Clinics with which they work,” she said.

This summer, PORH and its partners will host a summit on rural human trafficking (June 26-27) in State College, Pennsylvania. “We are beginning to put in place some of the training programs that the hospitals can implement to identify point persons in their facilities, and the programs and connections that they need to address human trafficking,” Davis said.

Davis observed, “Human trafficking is often thought of as sexual exploitation but it’s also labor exploitation, which can occur essentially anywhere: in restaurants, domestic service, agricultural production, and more.”

Human trafficking is of special concern in Pennsylvania, Davis said, “because we are a state with two main cities and a number of interstate systems that traverse rural areas. With lots of travel routes into, out of, and through the state, it’s much easier to transport victims from one place to another.” According to the National Human Trafficking Hotline, there were 127 cases of human trafficking in Pennsylvania in 2018, with the majority of those cases sex trafficking.

As PORH staff became more informed about human trafficking, Davis said, they found a large network of individuals and organizations that have been focusing on the issue for a long time.

“We’ve made excellent contacts,” she said. “We’ve connected with Villanova University’s Commercial Sexual Exploitation Institute. We’ve been learning about coordinated efforts between the FBI and other law enforcement agencies to address human trafficking. And we’re working with the Region III offices of HHS and HRSA, which have an intergovernmental task force focused on human trafficking.”

However, she noted, “PORH is still very early in the learning stage and is committed to becoming a trusted resource for rural health care providers.”

Davis concluded, “Every story is heartbreaking and if we can make a difference in even one life, this effort will be well worth it.”

If you see someone who you think might be a human trafficking victim, contact the National Human Trafficking Hotline at 1-888-373-7888 (text to: 233733).

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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.


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Promising Practice: NC Office of Rural Health Helps Rural Providers Get Connected to HIT

i Feb 4th No Comments by

By Beth Blevins

Behavioral and other healthcare providers in rural North Carolina are getting connected to the statewide health information exchange thanks to the state’s Office of Rural Health Information Technology (ORH HIT) program.

The ORH HIT program evolved from the North Carolina 2015 Health Information Exchange Act (HIE Act), which mandates that healthcare providers that bill for Medicaid or receive state funds for services must connect to NC HealthConnex, the statewide HIE, by June 1, 2019, to continue to receive payments.

“The ORH already saw a need for more HIT support, but the HIE Act made a compelling case for a team to help smaller, rural providers with HIT needs,” said Lakeisha Moore, HIT Program Manager at the NC ORH since August 2017. “We work closely with the NC HealthConnex team to support all healthcare providers, especially rural/safety net providers.”

While the NC HealthConnex team can pay for providers to get connected to the HIE, it lacks specific funding for healthcare providers to purchase an Electronic Health Record system (EHR), Moore said.  “So, our team worked with the NC HealthConnex team and other stakeholders to design a complementary program to assist certain providers with funds to procure an EHR to get them connected.”

NC ORH HIT Program Details

Last year, the HIT program offered the Behavioral Health EHR Funding Program, and 243 providers applied to get financial as well technical assistance to purchase an EHR and get connected to the state’s HIE, according to Allison Owen, NC ORH Deputy Director.

The grant offered three tiers of funding, from small to large providers, Moore said. Of the 243 behavioral health providers that applied, 178 were awarded. “The majority of this funding was awarded to organizations with 11 or fewer providers, which was encouraging for us, because it showed that we were helping a lot of those smaller provider practices that might not be able to invest in EHR technology.”

In the future, the HIT program hopes to offer grants to providers that were excluded from Meaningful Use funds such as Long Term Post-Acute Care Providers and Home Health Care Providers, Moore said. “We still find providers whose patient records are still on paper and we have to meet them where they are.” Other providers have implemented an EHR but need additional help in making the switch from fee-for-service to a (CMS) value-based care model, she said.

Grantee Map

Moore attributes the HIT program’s success to the many partnerships it has forged. For example, her office reaches out to rural physicians through partnerships including the state’s Primary Care Advisory Committee, Medicaid listservs, Medical Society, and Area Health Education Centers (AHECs), as well as via social media channels and marketing tools. The Rural HIT Team meets regularly with members of the HIE Authority, along with the state’s AHEC staff, to share information and update one another on the status of key joint initiatives, Moore said.

“We have a really good relationship with the NC AHEC and their technical team,” Owen added. “We look at how we complement each another with our strengths and our skill sets. We come together to talk about challenges and successes, and we’ve had many brainstorming sessions. I would recommend that other states look to AHECs because often they are really strong for technical expertise.”

NC ORH HIT receives 90/10 funding—90% CMS dollars with a 10% state match, distributed through the state’s Medicaid HIT plan, Moore said. The program is in its second two-year funding cycle and will work with the Medicaid HIT team managers to update performance measures in July, the middle of the current cycle, Moore said.

“I’m excited that our Medicaid HIT team reached out to ORH and thought this was a program worth investing in,” Moore said. “I feel that other states may want to collaborate with their Medicaid team because that’s exactly how we received our funding and continue to receive our funding.”

Moore concluded, “Our program has been primed for more opportunities to support rural healthcare providers with Health IT, with a lot of the changes in our state and nationally. Providers need to utilize EHRs and HIT to help better take care of their patients and for population health management.”

Owen agreed, saying that telehealth will become more and more important, especially in rural areas. “Our state didn’t expand Medicaid, but we have transitioned to a managed care framework—we’re right in the heart of that,” Owen said. “One thing managed care organizations (MCOs) have to do is demonstrate that they can provide a broader range of care for their Medicaid population. Telehealth, we think, will be key in helping MCOs demonstrate that they can provide that access. Great opportunities abound!”

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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.


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