Culture of Health Rural Population Draft Framework Rural Population Group Member List Contact Name Organization Email Loretta Heuer Steering Committee, Group Co-Lead [email protected]Mary Sahl Steering Committee, Group Co-Lead mary.sahl@sanfordhealt h.org Gabrielle Petri Steering Committee Member [email protected]Denise Andress Western North Dakota AHEC denise.andress@mayvill estate.edu Brad Gibbens Center for Rural Health [email protected]du Jody Ward ND CAH Quality Network- [email protected]Susan Mormann Womens Way [email protected]Doris Vigen ND CAH Quality Network doris.vigen@sanfordhea lth.org Pete Antonson Northwood Deaconess Health Center [email protected]Darrold Bertsch Sakakawea Medical Center [email protected]Gretchen Dobervich ND Rural Health Association gretchen.dobervich@nds u.edu Sue Heitkamp CHI Health at Home sueheitkamp@catholiche alth.net Jan Quandt CHI Oakes Hospital janquandt@catholicheal th.net Nikki Johnson NDSU Extension [email protected]du Jane Myers ND Department of Health [email protected]Tracy Evanson University of North Dakota College of Nursing and Professional Disciplines [email protected]Katherine Dean Essentia Insitute of Rural Health [email protected]1
Transcript
Culture of Health Rural Population Draft Framework
Rural Population Group Member List
Contact Name Organization Email Loretta Heuer Steering Committee, Group Co-
Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 1: Mindsets and Expectations: Awareness of how our individual health affects others- and how the health of our communities influences our own- is key to building a culture of Health. Do our policies reflect our communities needs and values? These measures reflect how we as individuals, families and communities, and as a nation- think about health and well-being.
Examples: Value on Health Interdependence, Value on well-being, public discussion on health promotion and well-being.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
BCBSValue based program, blue alliance for quality care and prevention, manage chronic patients. Case managers coordinate community resources.Education and coordination of benefits.Disease management to help members become more engaged and manage diseases at home.
Statewide Private
Social ServicesCare management and support for seniors and families.Counseling services. – SWInclusion Specialists for Behavioral and Mental health – SWEmpowering and capacity building that
Statewide State/Federal
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fills gaps for seniors. Senior companionships.Home visiting support for young families for abuse and neglect - Gambling addiction treatment. Affordable Housing for seniors – SWLong-term Recovery Assistance.Therapeutic foster care. – Minority Youth
USDA Rural DevelopmentGrants to support job training. Technical assistance and financing for local grocery stores. Prove community economic development and financing – telepharmacy, safe housing, rental assistance, utilities, broadband.
Federal
North Dakota Rural Health Association
Advocating on the state and federal level for rural health Access to care.
State State/Federal
Center for Rural Health Community health needs assessment for hospitals and public health.
- Will be focusing on 5-8 communities to help strengthen community based palliative care with CAH network
Statewide Federal/Private.
Local Public Health Units Contribute to filling gaps in resources while providing a bridge to convene partners.
Statewide county/state/federal
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What are ND’s gaps (geographic and programmatic) for this driver?
Reservations Provider gap – Southwest corner of the state Behavioral health and mental well-being Palliative Care (community based) is not covering the entire state at this time
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Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 2: Sense of Community: Residents of socially connected communities are more likely to thrive. Research suggests that individuals who feel a sense of security, belonging, and trust in their environment have better health. People who don’t feel connected to the community are less inclined to engage in health-promoting behaviors or work together for positive change. These measures indicate to what extent people feel a part of their communities.
Examples: Sense of community, social support.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
NDSU ExtensionCommunity health and nutrition.Family Consumer Science Agents.Family Nutrition Program.SNAP referrals.Diabetes Prevention.Community gardens.Capacity building for teachers.Smarter lunch rooms – creating a healthier environment.Health insurance literacy program.Community economic community program.Rural leadership program and Rural Health grants.
State/County State/Federal
Kiwanis, Lions ClubsService/educational clubs that organize volunteer hours and donations to strengthen communities and serve children.
Community based
Community/Private
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Center for Rural HealthBe a resource, increase knowledge and improve the health in ND.Emphasize partnerships with others because no one has enough resources or staff.Building local capacityTry to help communities find solutions.Community Health Needs Assessments Strategic planning with organizations and communities.Grant writing workshops.
StatewideFederal funds, ND legislature, private foundation funding (e.g. Cargill Foundation)
Amvets, Elks clubsPromote membership from the community to strengthen relationships and serve as meeting places.
Community based
Community/Memberships
NDDOH Cardiac ready communities – educate on CPR, 911, BP screenings, heart healthy lifestyles; go beyond the hospital, community grassroots efforts
State
Boys and Girls clubs on Reservations, youth recreation program
Promote family after school and weekend activities
Opportunities for volunteerism, Parent, Teacher Organizations (PTO), Support Groups (AA,Al Anon, Alzheimers Support Group, Parkinson Support Group)
Promote sense of belonging and community
Parish Nurse/Faith Community Nurse
Provided in home Community
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nursing services, typically, supported by a group of churchesProvide support, lead support groups
Based
What are ND’s gaps (geographic and programmatic) for this driver?
Sense of community in some areas is a gap because the post offices, grocery, and gas stations. Hard to be poor in a rural community. There is a lot of hidden poverty. Won’t use some services such as food bank because they know people. Senior centers can be used as a resource but limitation is in its size and audience. Churches and faith-based communities can also serve as resources- education, financial barriers. Churches and Senior Centers closing - e.g. daily wellness check Not being able to recruit and retain young families and having jobs with good wages Improved bandwidth – would be able to maintain people in their homes
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Making Health a Shared Value: How can individuals, families and communities work to achieve and maintain health?
Driver 3: Civic Engagement- Civic engagement creates healthier communities by developing the knowledge and skills to improve quality of life. Voting and volunteering are among the many measures of an engaged population. In both cases, people’s actions show they care about the outcomes of their community or their nation, and they want to cultivate positive change. These Measures reflect whether individuals feel motivated and able to participate and make a difference.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
North Dakota Public Health Association
This association is planning to do community education on legislative issues.
ND State Governor’s Office
Education Innovation Initiative – schools can seek waiversWorkgroup – examine the nursing shortage in ND.
Dollars for Doer’sGo out and volunteer two days out of the year, can request the donation to be made.
North Dakota Rural Health Association
Advocating on the state and federal level for rural health Access to care.As a legislator – passing legislation that is responsible, ethical, evidence based.American Indian Public Health Resource CenterDevelop public health needs, cultural
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competence, culturally sensitive policy.
What are ND’s gaps (geographic and programmatic) for this driver?
Issue voting vs. Party voting – are we electing people who value health and supporting health? Do North Dakotan’s recognize the importance of health? – How engaged are North Dakotans in
understanding a variety of issues? Communities are not contacting their elected officials to tell them what the health needs are for
the area. Providing Information vs. Lobbying; providing information to citizens of ND and state employees
alike.
Declining population in rural areas limit volunteers; generational differences in the value of volunteering.
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 1: Number and Quality of Partnerships: Research indicates that building relationships among partners is the most challenging aspect of creating change. Measures look at how organizations are working together to improve health and well-being.
Examples: Health department collaboration with community organizations, school districts, workplace health promotion
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
BCBSWorksite Wellness grants, Worksite Wellness tool kit available to employersPhysical Activity Grants
ND Community Foundation Gra Private
NDDOHBuilding Cardiac-Ready communities, building relationships in the community
Community State
NDSUProvides assessment of workplace employee health, assist in collaborating with other entities to address issues/concern areas
Workplaces statewide
State/Federal
Sanford HealthProviding screening opportunities and wellness incentives to employees
Sanford facilities Private
Center for Rural Health Partnership development, creating alliancesWork with statewide organizationsCommunity Health Needs Assessments
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ToolkitDakota Conference of Rural and Public HealthCAH Quality Network
ND Community Foundation Grants
Available to be used for health related activities
What are ND’s gaps (geographic and programmatic) for this driver?
Resources limited to be able to designate employees to go after these wellness and workplace assessment opportunities
Need a resource book listing the available coalitions, grants, foundations, etc.
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 2: Investment in Cross-sector Collaboration: In addition to measuring the quality and quantity of cross-sector collaborations, it is important to track investments that support these partnerships. Corporate and federal contributions have the power to influence our nation’s health, both directly and indirectly. Measures help identify whether there is adequate financial support to enable cross-sector partnerships.
Examples: US Corporate Giving, Federal allocations for Health Investments.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Co-ops (USDA?)Providing some loans at zero-rates, or low ratesProvide technical assistance
ND Dept. of CommerceWorkforce Development
Governor BurgumMainstreet Initiative
USDA Rural DevelopmentFinancing loans and grants for healthcare facilities, telehealth, telepharmacyCommunity Facility Loan and Loan Guarantee program
Economic Development Corp./Job Development Corp.
Consensus CouncilThrough the Bush foundation, grants available to pull communities together for discussion/solutions
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Reservations: Small business loans, small loans program, home mortgage programs
Financing available to tribal members backed by the tribe
Tribal Tribal
QSP Workers that collaborate with county social services to travel off-reservation (Spirit Lake) Elders Programs that collaborate with many entities.
Tribal Nations
What are ND’s gaps (geographic and programmatic) for this driver?
Formal cross-sector partnerships seem to be missingo Educatorso Law Enforcemento Community Health Workers
Listed above likely to work together on a case by case basis but are there formal partnerships anywhere?
Difficult to identify US corporate giving and federal allocations that facilitate rural community collaborations. Yes, there are federal dollars and programs operating in communities but most programs seem to be “silos”.
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Fostering Cross-Sector Collaboration to Improve Well-being: Are Individuals, institutions and communities doing all they can to prevent illness and promote health?
Driver 3: Policies that Support Collaboration: Policies play a key role in encouraging and maintaining collaboration across sectors, as well as creating incentives for different sectors to contribute what they can to the cause of improving our nation’s health. Measures highlight some of the policies that have the potential to catalyze widespread improvement in health and overall well-being.
Examples: community relations and policing, youth exposure to TV ads, climate adaption and mitigation, support for working families
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Department of HealthFund marketing campaigns for health-related PSA’s, posters, take-home materials.Manage Vaccine sites in rural communities.Chronic disease, smoke-free communities, and Diabetes projects state-wide.
Policies in place that support flexible work schedules, family friendly environments.
Statewide State/Federal/Grant
USDA Rural DevelopmentFinance- telepharmacy, quality safe housing, rental assistance, all rural utilities, broadband, electricity. Grants to
Communities/State Federal
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support job training.Prove community economic development and financing.
Center for Rural Health
Building local capacity.Try to help communities find solutions.Community Health Needs Assessments for over half the hospitals in ND.Strategic planning with organizations and communities.
Community/State Federal
What are ND’s gaps (geographic and programmatic) for this driver?
Service limited/unknown/lack of understanding in Tribal communities Behavioral and Mental health gaps Workforce limits
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Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 1: Built Environment: Health-promoting environments are safe, affordable and provide access to exercise and nutritious food. Feeling safe in our neighborhoods will also allow us to take full advantage of the space around us. Measures gauge whether our physical environments support well-being.
Examples: housing affordability, access to healthy foods, youth safety
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Lutheran Family ServicesChildcare for employers.Respite care/companion programs.
Community based
Private
ND Coalition for FoodHunger-free ND initiative.Food Pantries.
State
NDSU ExtensionsCommunity health and nutrition instruction.Family Nutrition Program, SNAP referrals.Community Gardens.Health insurance literacy program.
Community locations
State/Fed/Grant
Social ServicesCare management and support for seniors and families.Counseling services.Affordable housing for seniors.
What are ND’s gaps (geographic and programmatic) for this driver?
Lack of resources, income guidelines, limited number of caregivers/volunteers Housing income guidelines are too low for most working families to qualify for.
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Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 2: Social and Economic Environment: Our social environment influences a community’s sense of trust and cohesion. Factors like enduring racial and socioeconomic segregation have an impact on community health. Research points to strong connections between our environment, economic prosperity and health. Measures identify social and communal factors that influence wellness.
Examples: residential segregation, early childhood education, public libraries
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Head StartGives preference to low-income families for early childhood learning opportunities.
Community Based
Federal
ND State HousingGrants available to build housing/apartments in rural communities
State State/Federal
Jeremiah Project Affordable housing Community
Parks and RecreationSports programs for children.Maintenance of green spaces and equipment.
Community based
What are ND’s gaps (geographic and programmatic) for this driver?
Many segregated “poor” neighborhoods exist in rural and urban communities. Housing assistance income guidelines is too low for most working families.
Daycares are limited, many family have to start paying for daycare before the child is born in order to secure the spot. Very high daycare costs, the income guidelines for daycare assistance is too low for most working families.
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Lack of fully funded initiatives to create safe areas for activity, e.g. sidewalks, bike paths, new parks
School consolidation, some children may have to quit their respective after school activities
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Creating Heathier, More Equitable Communities: The places where we live, learn, work and play contribute to our ability to become and stay healthy.
Driver 3: Policy and Governance: Do our policies support us in living our healthiest lives? Too often, we see health-promoting initiatives fall short without the policy structures in place to sustain them. Measures spotlight the role of policy in creating health environments, with an emphasis on collaboration between community members, government and large institutions.
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
NDBON Monitors policy
NDCFN Promote nursing entrance into legislation
What are ND’s gaps (geographic and programmatic) for this driver?
Are we electing officials that are making policies based on the community’s needs? Why do we have the lowest CMS reimbursement of all the states with the exception of
Puerto Rico, why aren’t the policy makers going after better reimbursement, do they understand the resources needed to carry out care in rural communities?
Lack of healthcare representation at the state-level.
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Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 1: Access to Care: Access goes beyond simply having insurance. Access must be defined more broadly as ensuring that all people have continuous, comprehensive care, as well as the opportunity and tools to make heathier choices. Measures help us to see whether care is available to those who need it, when and how they need it.
Examples: access to public health, access to stable health insurance, access to mental health services, routine dental care
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Public Health UnitsCounty NursingPreventative care and educationVaccinations.Child fluoride treatments.
Counties
Critical Access HospitalsManage stable patients in the community
Social ServicesSliding scale fee schedules for mental health care, treatment.
What are ND’s gaps (geographic and programmatic) for this driver?
Oral Health Care not provided in all communities, many services are referred out, oral surgery requires payment up front. Also, mental health services most likely to be referred to a larger or urban community. Distance can be staggering, lack of transportation, resources to get to appts.
Access to health care – 8% of ND do not have health insurance, because the ACA plans are too expensive and the employer is too small to be required to provide insurance
Cost of health care for family plans, ACA and through employers, is very expensive in comparison to the average wages of a working families.
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Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 2: Consumer Experience and Quality: Patients thrive through quality care that is safe, equitable, accessible, efficient and timely. Consumer experience can influence whether people delay or seek care. In a Culture of Health, patients are actively engaged in decision-making, and providers are responsive to cultural and linguistic needs. Measures illuminate how patients feel about their health care and outcomes.
Examples: positive patient experiences, population covered by an accountable care organization
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Sanford, CHI, AltruMajor hospital corporations branching out into small communities to provide care.EBP cares implemented.Highly regulated.
Statewide, based in communities
Private
Critical access hospitalsStabilize trauma patients, coordinate delivery of care
EMSCommunity members providing cares in community, trusted
Community based
What are ND’s gaps (geographic and programmatic) for this driver?
Cultural gaps, perceived cultural insensitivities Even critical access hospitals can be a long distance (1+ hours) for rural dwellers
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Strengthening Integration of Health Services and Systems: Integrated care empowers patients and providers.
Driver 3: Balance and Integration: When our systems work together, more people will get the timely, quality services they need. A Culture of Health calls for better balance between prevention and acute care services. This can lead to greater efficiency, fewer hospital readmissions and decreased health costs. Measures reflect whether our public health, social service and health care systems are intentionally balanced and integrated.
Examples: electronic medical record linkages, hospital partnerships, practice laws for nurse practitioners, social spending relative to health expenditure
What is happening in North Dakota for this driver? Is there work being done in this area now? Use Asset map information and expertise of group members to fill in framework. Add additional rows as needed.
Entity/Organization Brief description of Action
Location Funding Source
Case Management/ Social Work
Coordinates care with home and community based services for discharged patients
Hospitals Private
Home Health Care Agencies
Working to keep people in their homes longer, healthier, prevent readmissions
What are ND’s gaps (geographic and programmatic) for this driver?
Disconnect between hospitals and community based programs Accredited Home Health agencies not reaching all rural communities, strong in urban
areas
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Ideas on How to Fill Gaps for your Entire Framework
For the group’s entire framework: What could be done to fill in the gaps for ND for your topic?
This list will be used along with the group’s finished framework to develop cross-cutting
recommendations at the May 2018 in-person meeting.
