the importance of community in rural health · •• the process can be lengthier due to consensus...
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The Importance of Community in Rural Health
UND College of Nursing & Professional Disciplines
N548 Advanced Public Health Nursing
December 1, 2016
Presented by Brad Gibbens, MPADeputy Director and Assistant Professor
• Establishedin1980,atTheUniversityofNorthDakota(UND)SchoolofMedicineandHealthSciencesinGrandForks,ND
• Oneofthecountry’smostexperiencedstateruralhealthoffices
• UNDCenterofExcellenceinResearch,Scholarship,andCreativeActivity
• Hometosevennationalprograms
• RecipientoftheUNDAwardforDepartmentalExcellenceinResearch
Focuson– EducatingandInforming– Policy– ResearchandEvaluation– WorkingwithCommunities– AmericanIndians– HealthWorkforce– HospitalsandFacilities
ruralhealth.und.edu 2
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Today’sObjectives/Questions
• Whatisruralhealth?• Whataretheruralhealthissuesandconditions?• Howareruralhealthandruralcommunitiesintertwined?
o Strengthsandweaknessesofruralandurbancommunitieso RuralCommunityHealthEquityModelo Buildinghealthiercommunitieso Ahealthcommunityis….o Catalysis’sforahealthycommunityo Resourcesforbuildinghealthycommunities
• Whatiscommunityengagementandhowdowedoit?
OurValuesasaSocietyShapeOurApproachtoHealth
“Itisnotwhatwehavethatwillmakeusagreatnation.Itishowwedecidetouseit.”
TheodoreRoosevelt
“Visionistheartofseeingthingsinvisible”JonathanSwift
“Americanscanalwaysbereliedupontodotherightthing…aftertheyhaveexhausted
alltheotherpossibilities”SirWinstonChurchill
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What is Rural Health
• Rural health focuses on population health and improving health statuso “Health outcomes of a group of individuals, including the distribution of such
outcomes within the group” Dr. David Kindig, What is Population Health?o Rely on social determinants of health and their impact on the population
(Health care system, Health Behaviors, Socio-Economic factors, Physical Environment) – “drivers” of health policy (Better Health, Better Care, and Lowered Cost – Three Aims)
• Historically, rural health has focused more on infrastructure: facilities, providers, services, and programs available to the public (all with quality, access, and cost implications) – In the ACA world more emphasis on population health, but infrastructure is still critical as it is the pathway to achieve better population health. o HRSA (ORHP, SORH, Flex, NHSC) – Federal bureaucracy orientationo Infrastructure improvement- health orgs, systems, payment structureso More and more health networks – independence with collaborationo Delivery systems: CAH, clinics, public health, EMS, nursing homes/aging
services, home health, mental health, dental, pharmacy, and others
Stutsman County
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What is Rural Health?
• Rural health is not urban health in a rural or frontier areao Social determinants of health vary between urban and rural
(economics/income, education, health systems, environmental conditions)o Rural is older, poorer, less insured, and has a higher level of morbidity for a
number of conditionso Rural culture, relationships, how we do things are distinct
• Rural health needs effective health policy, and health policy needs to rely on competent researcho Policy process that is reflective of rural health needso Policy advocacy that tends to be bipartisano Varity of advocacy groupso Rural health research community
What is Rural Health?§Philosophy: rural people have the same right to expect healthy lives and
access to care as do urban people – fairness frame• Access essential services locally or regionally• Access to specialty services through network arrangements• Health outcomes should be comparable• Quality of care on par with urban• Availability of technology
§ Rural health is very community focused – interdependence frame• Integral part of what a community is and how people see themselves• Community engagement – public input is fundamental• Sectors: Economic/business, public/government, education, faith/church, and
health/human services• Direct services provided to the public and secondary impact for other sectors• Major employer
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Whataretheruralhealthissuesandconditions?
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What are Some Important Rural Health Issues? • Access to and availability of care• Financial concerns facing rural hospitals and health systems• Health disparities (inclusive of health conditions and behavioral risks)
• Health workforce• Quality of Care (inclusive of patient safety)• Health Information Technology/ Tele-health• Networks – rural/urban, primary care/public health, acute/public health• Emergency Medical Services – EMS, ambulance, quick response units• Community and Economic Development – community viability• Health Reform (cost, insurance, how we access care, community role)
Sources: 2008 Flex Rural Health Plan, 2009 Environmental Scan, and community presentation feedback surveys 2008-2015
PreliminaryCHNAIssues(2014-2016)• 34CHNAanalyzedoutof45• 151needs(range2to9rankedneeds,most4-5)• Issues
o BehavioralHealth 29outof34o AbilitytoAttractandRecruitaProvider 20o MentalHealth 18o Cost(insuranceandhealthcare) 15o Obesity/overweight 11o ChildCare 10o AvailabilityofResourcestoHelpElderly(stayinhome) 10o JobswithLivingWages 8o Wellness(lifestyle,fitness,exercise) 8o AbilitytoRecruitandRetainYoungFamilies 7o Housing 4o Bullying/Cyber-bullying 2o Poverty 2
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RuralHealthandRuralCommunityareIntertwined
• StrengthsandWeaknessesofRuralandUrbanCommunities
• RuralCommunityHealthEquityModel
• BuildingHealthierRuralCommunities
• AHealthyCommunityis….
• Catalysis'sforaHealthyCommunity
• ResourcesforBuildingHealthyCommunities
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RuralandUrbanStrengthsandWeaknesses
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Rural Urban
Weaknesses••Lackofcohesiveness
••Limitedinformalsupport••Competitionamongproviders••Competitionforfundraising••Morecontentious-fractions••Lesssenseof"community"
Strengths••Morestable/diversifiedeconomy
••Availabilityofresources••Availabilityofprofessionals
••Growinganddiversepopulation••Changeisnatural
Weaknesses••Skewedpopulationdemographics
••Fluctuatingeconomy••Resistancetochange
••Shortageofprofessionals••Lackofresources••Over-tappedstaff
Strengths••Stronginformalsupportnetwork
••Fundraising••Cohesive
••Establishedinterdependence••Collaboration
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BuildingHealthierRuralCommunitiesMeansWhat?
• Healthierpopulation/clients/patients• Underlyinggoalwithinhealthreformofthe
deliverysystem• Senseofinterdependencyandequity• Localleadershipfromhealthsectorand
othercommunitysectors– partnershipsandcommunitycoalitions
• Requiressincere communityengagement• Greaterindividualresponsibilitywithin
thecommunityforoneshealthbutwithcommunitystructuresforsupportandguidance
• AhealthycommunityisaØ dynamiccommunityØ changingcommunityØ faircommunityØ engagedcommunity
• Inahealthycommunity,Ø diversityisvaluedØ peoplefeelincluded,respected,and
trustedØ peopleworktogetherØ assetsarevaluedØ thegoalistheoverallhealthofthecommunity
Source:adaptedfromhttp://sarahefrost.blogspot.com/2011/07/what-makes-community-healthy-why-not.html
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WhatCanActasCatalystsforBuildingaHealthyCommunity
• CommunityHealthNeedsAssessment(CHNA)andImplementationPlan• FunctionwithintheACA– understandingcommunityneedsandmeeting
thoseneeds• Fostersalevelofcommunityengagement– needsassessment,key
informant,andfocusgroups,CHNAteam,individualcommittees• Collaborationbetweenhospitalsandpublichealth(required)andother
communitygroups(health,civic,business,school,faith-based)• Opportunityforcommunitycollaborationtodevelopanimplementation
planforcommunityhealthimprovement• Followthroughisimperative• Whatarethegoals,objectives,timeframe,andultimatelyoutcomes(how
tomeasuretheoutcomes)?
ResourcestoAidinBuildingaHealthierRuralCommunity
• CHNA – processandplatformthatcanleadtoaHealthierCommunity
• CommunityHealthImprovementPlan – resultsfromtheCHNAandisaroadmaptobuildahealthiercommunity
• AHealthierCommunitycomesfromthededicationandhardworkofthepeoplewhotakeresponsibilityandprovideleadership
o Workgroupsandcommittees– diversity,buildleadership,buildconfidence
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ResourcestoAidinBuildingaHealthierRuralCommunity
• GeneralAdvice:ThinkTeam– RememberValuesandCommonBeliefso Ateam,acoalitionofcommittedpeopleworkingtogethero Manyhoursofworkovertime(butthinkofeatinganelephantJ )o Compromise– don’texpecttogeteverythingyouwanto Flexibility– listen,adjust,try/fail,andkeepmovingo Bigpicture– whatisneededforthecommunity(commongood)o Methodicalsmallstepstogetthere– goals,objectives,actionsteps
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ResourcestoAidinBuildingaHealthierRuralCommunity
• CDCMakingHealthyLivingEasier(http://www.cdc.gov/nccdphp/dch/programs/index.htm)
• BuildingHealthierCommunitiesKeyResourceList(http://www.muskegonhealth.net/programs/educational/building_healthy_communities_resources.pdf)
• RuralHealthInformationHub(RHIhub)(https://www.ruralhealthinfo.org/)o GrantWritingforRuralHealthcareProjects
(https://www.ruralhealthinfo.org/topics/grantwriting)o HealthcareAccessinRuralCommunities
(https://www.ruralhealthinfo.org/topics/healthcare-access)o ConductingRuralHealthResearch,NeedsAssessment,andProgram
Evaluation(https://ruralhealthinfo.org/topics/rural-health-research-assessment-evaluation )
RuralHealthInformationHub(continued)
o EvidencedBasedToolkitsforRuralCommunityHealth(https://www.ruralhealthinfo.org/community-health/toolkits)
o RuralHealthModelsandInnovations(https://www/ruralhealthinfo.org/community-health/project-examples )
o SupportingRuralCommunityHealth(https://www.ruralhealthinfo.org/community-health/support )
o FindingStatisticsandDataRelatedtoRuralHealth(https://www.ruralhealthinfo.org/topics/statistics-and-data)
o CommunityVitalityandRuralHealthcare(https://www.ruralhealthinfo.org/topics/community-vitality-and-rural-healthcare)
o RuralTribalHealth(https://www.ruralhealthinfo.org/topics/rural-tribal-health)
o SocialDeterminantsofHealthforRuralPeople(https://www.ruralhealthinfo.org/topics/social-determinants-of-health)
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WhatisCommunityEngagementandHowdoWedoit?
• Healthcareprovidersandorganizationscannotoperateinisolation• CommunityengagementisevenmoreimportantnowasweredesigntheU.S.
healthdeliverysystem – re-focusonpopulationhealth,providersaretobeassessedandreimbursedonoutcomesandpatientsatisfaction,re-designingthedeliverysystemwithalternativepaymentoptions(e.g.,ACO)
• Communityownership– identifyneedsandworkforsolutions- communityfocused
• Buildinglocalcapacityandleadership– thinkofthenextgenerationofcommunityleadership
• Communicationandsharedunderstanding,sharedvalues
• SIMPLEANSWER:YouNeedtobeEngagedBecauseYouNeedtoSurvive
WhyisCommunityEngagementImportanttoRuralHealth?
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CommunityEngagementToolkit!
Ø OriginalconceptoutoftheCommunityTransformationGrant(end9/2014)
Ø UND– CenterforRuralHealthbelievedinthepotential,soithasbeenfinishedand“branded”.
Ø It’ssetupin5Modules,andmeantfortheusertogofromthebeginningtotheend.– Module1:FindingaCommonMission– Module2:Assessment(DefiningtheProblem)– Module3:Planning– Module4:Implementation&Evaluation– Module5:Sustainability
Ø Includesavarietyoftools,tips,andtricks,tohelpanycommunityorgroupthroughtheprocess.
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CommunityCoercion-----------
Activities/outreachoccur"to"and"for"targetpopulation
-----------
Externalownership
Consultation
CoalitionsandPartnerships
CommunityEngagement
-----------
Activities/outreachoccur"with"target
population-----------
Communityownership=sustainability
CommunityEngagementContinuum
ThingstothinkaboutwhenconsideringaCommunityEngagementprocess…
Considerations:
•• Theprocesscanbelengthierduetoconsensusbuilding.•• Maintainingexcitementcanbedifficultiftheprocessistooslow.•• Gainingtheinvolvementofthekeyplayersorunusualsuspectsis
important,butattimesdifficult.•• Overcomingdifferencestofindacommonvisionorgoal.
Results:
•• Theresultswillbelongerlastingduetoalargerinvestedinterest.
•• Small,easywinscanbuildagreatamountofmomentum.
•• Connectionsandtrustisbuiltamongorganizations/individuals.
•• Newleaderscanbedeveloped.•• Changeisstrongerandmorepowerfulwith
investedinterestfromthecommunity.
Source: BradGibbens,DeputyDirector,CenterforRuralHealth,UNDSchoolofMedicineandHealthSciences
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Step1:OrganizeyourCommunityEngagementProcess
Step2:AssessandDevelopyourPartnershipNetwork
Step3:Firstfullgroupmeeting
Step4:SettingGoalsandCreatingVision
Step5:AssessResourceNeeds
Step6:Goingpublic!
Module 1: Finding a Common Mission The Foundation
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Step1:GapsinAnalysisand/orKnowledge
Step2:DefiningtheProblem/Need
Module 2: Assessment and Data Collection
Module 2: Tools and Samples
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Step1:DifferentTypesofPlans
Step2:UnderstandingtheCHIP
Step3:HowtoRunaPlanningMeeting
Step4:Resources
Step5:Budget,TimelineandDelegation
Module 3: Community Planning
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Module 3: Tools and Samples
Step1:WhoisResponsible?
Step2:Wheretobegin?
Step3:TheSTARTbutton!
Step4:TrackingEvaluation
Module 4: Implementation and Evaluation
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Step1:WhatdoesSustainabilityreallymean?
Step2:WhydoesSustainabilitymatter?
Step3:Whoshouldbeinvolved?
Step4:DevelopingyourSustainabilityPlan
Module 5: Sustainability
Let’srecap!Sustainability
Evaluation
Implementation
Planning
Assessment
Foundation
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CustomizedAssistance 1-800-270-1898
TailoredSearchesofFundingSourcesforYour
Project
FoundationDirectorySearch
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TheRuralHealthResearchGatewayprovidesaccesstoallpublicationsandprojectsfromsevendifferentresearchcenters.Visitourwebsiteformoreinformation.www.ruralhealthresearch.org
SignupforouremailorRSSalerts!www.ruralhealthresearch.org/alerts
ShawndaSchroeder,PhDPrincipalInvestigator701-777-0787•[email protected]
CenterforRuralHealthUniversityofNorthDakota501N.ColumbiaRoadStop9037GrandForks,ND58202
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CenterforRuralHealthUNDSchoolofMedicineandHealthSciencesNorthColumbiaRoad,Stop9037GrandForks,NorthDakota58202-9037
701.777.2569(Brad’sphone)701.777.3848(CRH)
ruralhealth.und.edu
Contact us for more information!
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