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.”
by Beth Blevins
Funding from HRSA’s Rural Communities Opioid Response Program (RCORP) program has helped several State Offices of Rural Health (SORHs) recently start—or strengthen—their work related to substance use disorder and opioid use disorder (S/OUD). Those who receive the RCORP Planning grant have a year to create or strengthen a consortium focused on SUD/OUD. (HRSA currently offers an RCORP Implementation grant that some SORH have received as well.)
For example, the South Carolina Office of Rural Health (SCORH) had never focused on S/OUD activities prior to receiving the RCORP Planning grant, according to Lindsey Kilgo, SCORH Director of Network Development. For them the grant was “about how we can understand what’s going on in the state,” Kilgo said. “There’s been a lot of information gathering, a lot of consortium and office conversations, a lot of convening and bringing folks together.”
Forging Stronger Partnerships
While creating their consortium, the Virginia SORH (VA SORH) discovered new partners. “There are additional people at the table who might not have been there because of the consortium,” said Heather Anderson, VA SORH Director. “We added to the conversation and got community health centers and other folks that maybe weren’t involved before. We have stronger partnerships in the region.”
Anderson continued, “Because of our experience with the planning grant, another agency was willing to run with the implementation grant. So we said, ‘Go for it. You’re local, you know all the people. We will support you any way we can, give you technical assistance, and help you convene people.’”
For the Michigan Center for Rural Health (MCRH), the planning grant “has allowed us to really bring everybody to the table and wrap our arms around the importance of the challenges in those counties we are working in,” said Crystal Barter, MCRH Director of Performance Improvement. “I think everyone has really bought into it, whereas before everyone was working in their own silo. And now we are working as a consortium and starting to leverage the resources each organization has.”
Hanneke Van Dyke, former SORH Coordinator at the Texas SORH, also talked about the importance of community outreach. “It was important to use relationships we already had and having an openness to expanding relationships to new project areas,” Van Dyke said. “In both of our (RCORP) project areas, community advisory councils—made up of community members and community leaders who are there for every step of the process—have been central. Making sure we built in a few back routes tied back to the community was very important for us.”
No Prior Expertise Needed
When asked what skills are needed for SORHs to engage with S/OUD work, Kilgo replied, “Having the determination to make things better and to make change—and then not being afraid to ask questions, in an effort to build knowledge, partnerships, and relationships.” Kilgo added, “For folks who work in this particular realm, it requires a level of passion and commitment. And when you have that shared passion and commitment, the relationship and trust come fairly easily. We all have a common vision and common theme. We’re moving forward together in a positive manner.”
The ability to seek out experts was also key for Van Dyke. “None of us on staff had worked on an S/OUD issues or had any particular training or experience with it,” she said. “As project coordinator, I’ve taken it on to educate myself through reading and talking with experts. I’m not an expert but I’m pretty comfortable now, knowing who to go to to get the right information.”
Although the North Dakota Center for Rural Health (NDCRH) has been involved with S/OUD activities for the state for a few years, they had no broad expertise in their office when they started their RCORP work, said Lynette Dickson, NDCRH Director. “Our knowledge has grown and continues to grow,” Dickson said.
“Even if you are not an expert in the field you can still have an impact in this arena,” Dickson explained. “Because what we (SORHs) do is convene people, and reach out and find the resources. You can have more confidence that you can have an active role in this—you can convene and connect like we do with anything else.”
For more information, see the new NOSORH Issue Brief, SORH Response to the National Substance Use Crisis. A full spectrum of NOSORH resources to address rural SUD/OUD are available in the Rural Opioids Educational Resources library on the NOSORH website.
Virginia State Office of Rural Health
Division Director of Primary Care & Rural Health
NOSORH Member Since 2015
What I’m working on right now: The Flex funding extension and hiring a Flex coordinator.
My Top 3 Goals for 2018: Survive my son’s wedding, travel somewhere awesome for my 30th wedding anniversary, and keep a cleaner desk at home and work!
Best advice I ever received: Don’t let the sun go down on your anger.
Favorite thing about working at a SORH: The people. Everyone is so interesting and committed to making their world a better place.
3 great things about rural health in my state: There are pockets of greatness everywhere. Our CAHs are pretty awesome, we have great providers that work hard to make a difference in their communities, and traveling to meet with everyone takes me to breathtakingly beautiful places!
If I weren’t doing this, I would…probably be running an AHEC Program or promoting my husband’s art work full time.
What I’m currently reading: I wish I were reading something. Instead, I am working on projects for my son’s wedding in August. I’m gathering family recipes for a cookbook and putting together a slide show.
People would be surprised if they knew: I used to sing in a quartet and sang the national anthem at a baseball game on the 4th of July.
by Beth Blevins
Through lay rescuer training and the distribution of lifesaving kits, Virginia is taking aim at opioid overdoses in the state. Now it is increasing its outreach into rural parts of the state through the Virginia State Office of Rural Health (VA SORH).
Between 1999 and 2013, the number of deaths from opioid overdoses in Virginia . “When we looked at the data we found that the opioid epidemic was hitting our bigger cities and our rural areas—especially in Appalachia (the southwestern part of the state) and the Shenandoah Valley,” said Michael Mallon, Assistant SORH Director at the VA SORH. In the Shenandoah Valley, the opioid epidemic is defined primarily by heroin and other illicit drugs, while in the Appalachia region, it’s prescription opioids, Mallon said.
The state’s project trains professionals and others (including family members of addicts) to recognize and respond to an opioid overdose with the administration of naloxone, a drug that can save lives if given in the first few minutes after an overdose. The lay rescuers who take the training also receive a kit that contains gloves and directions—but, until recently, no naloxone.
Mallon said that it has been difficult to provide naloxone both because its cost has in recent years (the cost of the injectable version has risen 600 percent), and because of existing state policy—prior to last November, obtaining it required a prescription from a physician. Since then, Mallon said, the Virginia Commissioner of Health has issued a statewide standing order declaring opioid overdoses a public health emergency, making it possible for anyone to go to a pharmacy to get it, with counseling on its use, from the pharmacist.
“But the cost issue hasn’t gone away,” Mallon said. So, he said, the VA SORH requested authorization to use its state funds for one year to buy naloxone for those who take its REVIVE! training. “We’re hoping we can use this as a catalyst to find someone else to fund it in the future,” he said.
Even with this temporary funding, there is still some difficulty in providing the drug from a logistic standpoint, Mallon said. “A lot of states are allowed to find funding, buy naloxone, and distribute it,” he said. “In Virginia, nonprofits cannot access it directly, but still must get it from a pharmacy, and only the pharmacies can distribute it.” Fortunately, Mallon said, REVIVE! has found a mail-order pharmacy that offers discounts to government agencies for the nasal spray version of naloxone, and it can ship the drug directly to those who have received the trainings.
After July 1st, the VA SORH and its partners will be able to dispense naloxone directly to the lay rescuers at the trainings themselves because the Virginia General Assembly has passed a law allowing coalitions and nonprofits to dispense it. “This will provide another access point,” Mallon said.
“This has been an important and developing issue to curb the effects of the opioid epidemic,” Mallon added. “It’s a matter of reviewing the framework of policies, trainings, and partners in your state and piecing together a plan to increase access.”
The VA SORH is planning to offer 10 REVIVE! trainings in rural areas this year. Each session will train up to 25 lay rescuers, Mallon said.
“We believe addiction is a chronic disease, and one that is treatable,” Mallon said. “We have to do more to expand treatment and, while we figure out the methods to do that, we owe it to our citizens to do as much as we can to prevent overdose deaths. Naloxone doesn’t cure addiction, but it prevents people from dying.”
Adrienne McFadden, MD, JD
Director of the Virginia Office of Minority Health & Health Equity (since January 2014)
How did you get to where you are now?
I was a clinically practicing emergency physician who had additional skill sets from a legal education, in addition to my medical education. I was looking for opportunities within the health realm and happened upon a job in Richmond that would allow me to utilize my additional skill set and pursue my passion in health policy. We are the only state that has all three state-designated offices (SORH, Primary Care and Minority Health) under one roof.
What inspires/excites you most about working at the Virginia Office of Minority Health & Health Equity?
Working among passionate people and knowing at the end of the day we do make a difference in multiple communities and individuals’ lives.
What is the most important thing you are working on right now?
Making sure health equity is always at the forefront of our decision makers’ and leadership’s minds. This goes for rural health equity as well as health equity with regard to racial and ethnic groups, socioeconomic groups, and other underserved groups in the Commonwealth.
What are you doing to ensure you continue to grow and develop as a SORH leader?
Maintaining humility and making sure you hire really great people you can continue to learn from as well. We are always looking at what’s going on not only in this state, but with our colleagues in other states and at a national level to see if we can learn best practices or learn from missteps or other things that are happening elsewhere.
What is the biggest challenge facing SORH leaders today?
Maintaining focus on the issues that impact rural health because the number of individuals that reside in rural Virginia communities is shrinking, but that doesn’t make their challenges any less important.