Delta States Rural Development Network Grant Program

Transcription

1 Delta States Rural Development Network Grant Program IL MO AR LA MS TN AL KY Health Resources and Services Administration 5600 Fishers Lane, Rockville, MD

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3 U.S. Department of Health and Human Services Health Resources and Services Administration Delta States Rural Development Network Grant Program The purpose of the Delta States Rural Development Network Grant Program (Delta) is to fund organizations located in the eight Delta States (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) to address unmet local health care needs and prevalent health disparities through the development of new and innovative projects. The Delta grant program fosters collaborative efforts among rural providers, as many of these disparities could not be solved by single entities working alone. The grantees funded in grant cycle implemented multi-county projects that addressed the following key areas: Delivery of preventative or clinical health services surrounding chronic disease; Increase access to prescription drugs for the medically indigent; Practice management technical assistance services. In addition, grantees focused a portion of their grant activities around one or more of the following priorities: oral health improvement, school-based health services, mental health, and/or teenage pregnancy prevention efforts. Six applicants received supplemental funding through the Delta Innovation Project Fund to provide enhanced focus and development to the Delta Region in several areas. These supplemental funds support projects that focus on one of the following areas: Development of an innovative pilot to improve the quality of care in a rural health care environment, or in one or more participating multi-county networks; Development of a pilot project addressing health information technology in a rural health care environment or in one or more participating multi-county networks; Development of a pharmaceutical pilot project that would support technical assistance, software development and/or purchase to promote pharmaceutical assistance efforts in a rural health care environment or in one or more participating multi-county networks. This Source Book provides a description of eleven initiatives funded under the Delta States Rural Development Network Grant program in the funding cycle. The following information for each grantee is included: Organizational Information, Consortium Partners, Community Characteristics, Program Services, Outcomes, Challenges & Innovative Solutions, Sustainability, and Implications for Other Communities.

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5 Delta States Grant Ricipients (Listed by State) State Grant Organization Name Page Alabama Tombigbee Health Systems 1 Arkansas Health Resources of Arkansas 7 Mid Delta Community Consortium 13 Illinois Board of Trustees Southern Illinois University Center for Rural Health and Social Service Development 19 Kentucky Trover Health System/Baptist Health Madisonville 25 Louisiana The Health Enrichment Network 31 Mississippi Delta Health Alliance 37 Jefferson Comprehensive Health Center 43 Missouri Big Springs Medical Association/Missouri Highlands Health Care 47 Southeast Missouri Health Network 53 Tennessee Paris and Henry County Healthcare Foundation 57

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7 Tombigbee Healthcare Authority Organizational Information Grant Number D60RH08548 Grantee Organization Tombigbee Healthcare Authority Organization Type Hospital Address 105 Highway 80 East, Demopolis, Alabama Project Director Name: Loretta Webb Wilson Title: Project Manager Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $496,630 August 2011 to July 2012: $496,630 August 2012 to July 2013: $496,630 Consortium Partners Partner Organization Location Organizational Type (town/county/state) Cahaba Mental Health Selma/Dallas/Alabama Mental Health East Central Mental Health Troy/Bullock/Alabama Mental Health Health and Wellness Education Center Livingston/Sumter/Alabama Community Based Organization (CBO) Health Resource of West Alabama Butler/Clarke/Alabama Community Based Organization (CBO) Monroe County Hospital Monroeville/Monroe/Alabama Hospital Sowing Seeds of Hope Marion/Perry/Alabama Community Based Organization (CBO) Tuskegee Area Health Education Center Tuskegee/Macon/Alabama Health Education Center/Veteran Hospital Community Characteristics A. Area The Delta Network Development Program, referred to as Delta Rural Access Program (DRAP), services communities are located in the following 18 counties of Alabama: Barbour, Bullock, Butler, Choctaw, Clarke, Conecuh, Dallas, Escambia, Greene, Hale, Macon, Marengo, Monroe, Perry, Pickens, Sumter, Washington, and Wilcox counties. B. Community description Access to health care is the primary factor that influences life in the 18 Alabama Delta Counties served by the Delta States Network Grant Program. According to the 2010 Rural Healthy People, access to health care is one of the 10 leading health indicators. When access to health care is available, it impacts the overall physical, social, and mental health status, prevents disease, disability, and premature death, and improves a person s quality of life. When access to health services is absence, it affects the aforementioned negatively. The Delta Regions of Alabama are rural and sparsely populated with two contiguous counties as far as 30 miles apart; largely minority (83.6% black), (43.2% Caucasian) and (4.1% Hispanic), with 29.9% below the 200% federal poverty line, compared to the state 15.9% and nation 13.2% rates. Counties in Alabama s Delta Regions are medically and dentally underserved. These counties have fewer doctors, primary and specialists, and fewer Federally Qualified Health Clinics, and dentists. Medical students who are becoming doctors are less likely to practice in rural areas because the economy is not promising. In addition, the overall aggregated rate for uninsured persons living the Alabama Delta Regions is 21.3%, per the Alabama Rural Health Association (2010). This rating is higher than the state rate (14%) and the national rate of (15%). According to a report from the Alabama Rural Health Association, the unemployment rate (8.6%) of these counties, 1

8 aggregated, is higher than that of the State rate (5.8%), resulting in two-thirds of the people being poor and without health insurance coverage. These factors and other provide insurmountable barriers to accessing health care in this region of Alabama. C. Need Chronic diseases are a significant problem in the United States, accounting for many of the most prevalent and costly illnesses that affect Americans. More than 133 million Americans, or 45 percent of the population, per the Centers for Disease Control and Prevention (CDC), have at least one chronic condition. To begin addressing the growing concerns of chronic diseases in rural Alabama, Tombigbee Healthcare Authority, through its Delta Rural Access Program (DRAP) grant cycle, provided access to health care services to nearly 14,000 people residing in the Alabama Delta Region through the provision of prescription drugs assistance and health screenings, health fairs, and chronic disease education programs and trainings in basic first-aid and CPR. Although a lot was accomplished during that grant cycle, we continued to see an increase in deaths related to preventable chronic illnesses and determined that during the grant cycle, we could have a greater impact on the health of our communities by intensely focusing our efforts on chronic health diseases more prevalent among our target populations. Recognizing that diabetes in the Delta counties was progressively increasing at an alarming rate, the DRAP Partners united in their desire and began addressing diabetes with an emphasis on prevention of type 2 diabetes by utilizing the evidence-based curriculum Power to Prevent Diabetes:, A Family Lifestyle Approach to Diabetes Prevention. The overarching goal was to reduce the disease and economic burden of diabetes, and improve the quality of life for all persons who have or are at risk for developing type 2 diabetes. Within this goal, the objectives were to support individuals in making life-style changes to prevent or reduce the impact of diabetes through education, and pharmacy assistance. About 90-95% of persons with diabetes have type 2 diabetes (CDC). Those at an increased risk in the Delta States Counties of Alabama include African Americans, American Indians, Hispanics, the elderly, and those with a family history of diabetes along with those who are overweight/obese, are physically inactive, and those with poor dietary habits. The incidence (prevalence) of diabetes, especially type 2 diabetes, has increased over the past years in Alabama. According to the Behavioral Risk Factor Surveillance System (BRFSS), a data collection system supported by the Centers for Disease Control and Prevention, the prevalence of diabetes in Alabama increased from 8.9% in 2004 to 10.5% in 2007 to its current (last reported rate) of 10.8% in In 2008 in Alabama, diabetes accounted for 8,500 hospital stays, 44,125 hospital patient days, 34,000 emergency room visits, and 38,000 outpatient visits. If this trend continues without structured intervention, the number of Alabamians diagnosed with diabetes (currently 379,000 per BRFSS/CDC, 2010) will increase significantly. Per the Kaiser Facts, when rural residents, receive early treatment, education, and preventative services, lives are saved and the prevalence of catastrophic illnesses are decreased. Focus Areas Access: Primary Care Chronic Disease Management: Diabetes Health Education and Promotion Pharmacy Assistance Program Services Target Population Adults Elderly Caucasians African Americans Latinos Uninsured Underinsured A. Description Tombigbee Healthcare Authority Delta Rural Access Program (DRAP) coordinated activities designed to reach its goal of reducing the disease and economic burden of diabetes and improve the quality of life for all persons who have or are at-risk for developing type 2 diabetes. Within this goal, the objectives were to support these individuals in making life-style changes to prevent or reduce the impact of diabetes through education and access to prescription drugs. To achieve its goal and objectives, Tombigbee Healthcare Authority partnered with several key organizations and developed an innovative plan relevant to addressing type 2 diabetes and pharmacy assistance. During the grant period, key partners implemented the following strategies/activities: 2

9 Diabetes Prevention Classes: Partners conducted diabetes prevention classes throughout the Delta Region utilizing the National Diabetes Education Program (NDEP) curriculum, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention developed to help bring diabetes prevention and control to African American communities. The curriculum was modified to include all race and ethnicities who were identified as being at-risk of developing type 2 diabetes and who were between the ages of To assure accurate implementation of the Power-to-Prevent curriculum, Partners received training from the George Health Policy Center. Partners were required to implemented 4 classes (12 sessions per class), per county, per year (4 classes x 18 counties x 3 years = 216 classes) with a minimum of 15 participants constituting a class. During the grant period, nearly 800 people who attended the Power to Prevent classes were administered pre- and post-knowledge tests. Of those participants, at least 300 walked away with the knowledge necessary to take control of their eating habits and be more physically active. Additionally, participants, on average, decreased their overall blood sugar level by 15%, blood pressure by 28% and cholesterol level by 12%. Health Education Campaigns: During the grant period, Partners were also required to coordinate and conduct two education campaigns per year. These campaigns were to be conducted in the form of health screenings, health fairs, benefit fairs, and health education presentations in outlets such as churches, community health centers, schools, and health care providers offices. During the grant period, Partners coordinate and/or participated in a nearly 200 health and education campaigns and nearly 5,000 residents were reached throughout Alabama Delta Regions.. Pharmacy Assistance: During the grant period, Partners assisted their communities with access to prescription drugs utilizing the electronic mechanism (Rx Assist Plus), a tool designed to effectively manage, track, and locate medication at little to no cost. Partners were able to assist nearly 3000 individuals, including the medically indigent, Medicare, and Medicaid recipients in locating prescription drugs. DRAP Database: During year 2 of the grant period, DRAP developed a patient registry database designed to record, track, and monitor data retrieved from the Partners effectively. The database is user friendly and has been a good tool for evaluation of program activities. Innovation Project: During the grant year, Tombigbee Healthcare Authority innovatively connected local healthcare providers to the hospital for effective patient care. A patient medical record now travels with them electronically when seen at the emergency room or admitted to the hospital. Currently, two local healthcare provides have this capability. The Innovation Project was funded as part of the DRAP program. B. Role of Consortium Partners During implementation of the Delta Rural Access Program (DRAP), the consortium members had the reasonability of 1) encouraging a creative and lasting collaborative relationships among Partners, the lead agency and themselves; 2) ensure that the Tombigbee Healthcare Authority carryout grant guideline as required by the funding agency, and 3) to ensure that the grant-funded project addresses the health needs of the identified service region. During the planning and implementation of DRAP, the consortium members assisted with the recruitment and retention of Partnering agencies to implement DRAP in the Delta Regions, assisted with the development of program modules, curriculums and data collection tools; assisted with the establish of a prevention health coalition designed to address health problems identified by the community and statistical data on an ongoing bases; and attended regularly scheduled meetings as outlined in the policy and procedures. The effectiveness of the lead agency, consortium, and partners has been measured by communication, dedication/feedback, and impact on the target counties. Consortium members for the past grant year were: The Center for Business and Economic Services (CBES) at the University of West Alabama. Marengo County Health Department Marengo County Extension Office Dr. Maurice. J. Fitzgerald practicing Family Practitioners (DRAP Medical Director) 3

10 Outcomes Project evaluation is being compiled by the Program Evaluator for DRAP. Outcomes for selected activities conducted during the first two program years are summarized below: Diabetes Prevention Classes: During the first two years of the grant period, nearly 800 residents of the Alabama Delta Region attended Power to Prevent classes. According to pre-and post-knowledge testing, at least 300 walked away with the knowledge necessary to take control of their eating habits and be more physically active. Additionally, participants received pre- and post-screenings for selected health indicators. Following their participation in the Power to Prevent classes: 25% lost 5 to 10 pounds 15% of newly diagnosed diabetics controlled their blood sugar and 8% had an Alc of 7. 28% lowered their blood pressure 12% lowered their cholesterol 30% began a walking regime or joined an exercise program 35% starting eating and cooking healthy Pharmacy Assistance Program: During the grant period, Partners assisted their communities with access to prescription drugs utilizing the electronic mechanism (Rx Assist Plus), a tool designed to effectively manage, track, and locate medication at little to no cost. Partners were able to assist nearly 3000 individuals, including the medically indigent, Medicare, and Medicaid recipients in locating prescription drugs. Through this initiative, residents in the Alabama Delta have access to 15 fixed locations where they can receive face to face assistance with medication. Additionally, Partners have been able to establish a working relationship with the physicians of the individuals receiving pharmacy assistance. This has fostered increased referrals and helped with care coordination of these patients. Other outcomes include: 40% of the of the 3000 individuals received medication through the Rx Assist Plus program 20% received medication by referral from Walmart, Publics, Freds, other local pharmacies. 14% returned for refills 5% were referred and enrolled in the diabetes prevention class Health Education Campaigns: During the grant period, Partners were also required to coordinate and conduct two health education campaigns per year. These campaigns were to be conducted in the form of health screenings, health fairs, benefit fairs, and health education presentations in outlets such as churches, community health centers, schools, and health care providers offices. During the grant period, Partners coordinated and/or participated in nearly 200 health and education campaigns which reached nearly 5,000 residents. Challenges & Innovative Solutions Participant retention throughout the 12 weeks of the Power to Prevent curriculum was the greatest challenge faced by partners. To reduce the number of weeks that participants had to commit to attending sessions, partners worked together to identify sessions that could be combined, thus reducing the number of weeks required to complete the class. As previously described, the Delta region of Alabama is characterized by high rates of poverty, low education levels, and limited availability of health services. Consequently, some partners had difficulty in identifying qualified trainers to teach the Power to Prevent classes in some counties. By partnering with other agencies, such as the public health department and the county extension agency, they were able to utilize educators from those agencies as Power to Prevent facilitators. Sustainability After funding has ended, Tombigbee Healthcare Authority (THA) and several of its consortium members will continue to provide diabetes education programs utilizing the Power to Prevent curriculum. Classes may not be offered to the extent that they have been available during the grant period, but residents of all 18 counties will have access to the classes. THA itself will sustain the Power to Prevent classes in its service area: five counties that are geographically contiguous. Monroe County Hospital and Tuskegee AHEC will 4

11 integrate Power to Prevent classes into their existing diabetes education and management programs. Additionally, all participating partners will continue to conduct health education campaigns to raise awareness about the risk factors of diabetes. Sustained Impact The most significant long-term impact is that the 18 Delta Region communities have access to an educational program for the prevention of type 2 diabetes, with skilled service providers who are trained as diabetes educators. Also, as a result of the program, these communities have new relationships among their various health care providers and social service agencies. These relationships were developed to foster referrals. Providers now have an established program to refer their patients for diabetes education, and diabetes educators are able to refer participants in the classes to local providers for treatment. This mutual respect and support impacts everyone involved in patient care. Implications for Other Communities The Delta Rural Access Program (DRAP) strategies have great potential for being replicated in other areas because of our success in implementing a diabetes education curriculum in an 18 county region. Keys to the success of this initiative included: Utilization of an evidence-based curriculum, Power to Prevent, which included all the tools and materials necessary for program implementation Clear identification of program goals and expectations of partnering organizations Centralized training of all class facilitators Open communication among partners Development of a centralized data base for collecting evaluation data The relationships developed among members of the consortium and partners, and community as a whole, have provided a strong foundation for continuation of these activities. Presentations of our results at local, state, regional, and national conferences and workshops will provide opportunities for potential replication in other communities with similar needs. 5

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13 Health Resources of Arkansas Organizational Information Grant Number D60RH08552 Grantee Organization Health Resources of Arkansas Organization Type Community Mental Health Center Address P.O. Box 2578, Batesville, AR Grantee organization website Project Director Name: Nancy Coleman Title: Director of Grants Phone number: ext.1269 Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $410,700 August 2011 to July 2012: $410,700 August 2012 to July 2013: $410,700 Partner Organization Community Health Centers of Arkansas, Inc. Department of Health, Hometown Health Improvement Consortium Partners Location (town/county/state) North Little Rock, Pulaski, Arkansas Little Rock, Pulaski, Arkansas Organizational Type Statewide Professional Association of Community Health Centers State Department of Health Community Characteristics A. Area Counties in Region B of Arkansas are: Baxter, Clay, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Marion, Mississippi, Poinsett, Prairie, Randolph, Searcy, Sharp, Stone, Van Buren, White, Woodruff. B. Community description Region B of Arkansas (Delta-Hills) is among the poorest areas of Arkansas and the United States. Poverty is a primary factor that influences the life and health of the citizens of this region. The 2010 U. S. Census indicated that this area had approximately 417,000 persons, composed roughly of 90% Caucasian and about 10% Minorities. The median household income of this region is only $33,470 compared to $40,149 for Arkansas and $52,762 for the United States. This region has a poverty rate of 20.3 percent, which makes it 112 % and 144% of the respective State and national poverty rates. So, the area has a low economic standing, in relation to other parts of the country. The 2010 Census also indicated that about 60% of the region is considered rural and 14 of the region s 20 counties have populations of less than 20,000 persons. This data gives some indication of the region s degree of remoteness and accessibility to services. The State of Arkansas (which includes all of Region B) has been consistently ranked in the lowest 20% of States, in terms of published national health status rankings. In general, rural populations suffer from lower health outcomes more than do urban populations. This is very pronounced when examining the people of Region B. For instance, diabetes among adults here is highly prevalent. The Arkansas Department of Health 2010 study indicated that Region B had an adult diabetes rate about 11.02%, which is 115% above the respective Arkansas rate and 133% above the national rate. One county of the region had a respective diabetes rate of 20% and 13 of the remaining 19 counties encountered rates, ranging from 11.1 to 15.8%. In terms of education, employment, illiteracy and other socio-economic factors, Region B also does not score very well. Only about one-half of the region s counties have access to hospitals and or specialized medical care, while some 7

14 residents must drive up to 60 miles, one way, to access medical care. These facts indicate the lack of resources available in Region B and some of the primary factors which impact our social, economic, and health conditions. C. Need The Delta-Hills Rural Health Network (DHRHN) was initially formed in 2006 in an effort to address the growing problems of this region, including health and economic problems of our communities. In our effort to secure HRSA funding through the Delta States Grant program in 2010, the DHRHN determined that our most critical health problem was the adverse impact which chronic disease was having on our communities. Therefore, in response to our planning efforts and the availability of the HRSA Delta States Grant program, Region B formulated a strategy to address chronic disease by developing diabetes education and nutrition programs for the area, combined with a pharmacy assistance program to help clients afford medical prescriptions associated primarily with chronic disease treatment. The DHRHN made application for a second cycle of HRSA Delta States Grant funding to further expand these two services into all 20 counties of Region B of the Arkansas Delta. Focus Areas Chronic Disease Management: Diabetes Pharmacy Assistance Program Services Target Population Adults Uninsured Underinsured A. Description The Delta-Hills Rural Health Network has operated two cycles of the Delta States Grant Program and is completing the final year of our second grant cycle (August 31, 2013). During the three-year phase of our first program cycle ( ), this Network concentrated primarily on the provision of Diabetes Education/Nutrition programs within these rural communities. This was accomplished by contracting with four local rural health networks to develop and conduct such programs throughout the region. In addition, the program administrator, Health Resources of Arkansas, contracted with two of these four providers to provide pharmacy assistance services in a limited number of counties. This program was somewhat restricted in coverage, due to limited funding at that point. After experiencing progress with both programs, the DHRHN and its administrator elected to expand these programs. Consequently, in the submission of our grant application for the second Delta States Grant competition in 2010, we proposed the expansion of the program to fully implement both Diabetes Education/Nutrition Services and Pharmacy Assistance Programs in each of the four rural health network service areas. This approach expanded both of these services to all 20 counties of Region B of Arkansas. Our Diabetes Education/Nutrition Programs are held in various local communities, under the direction of a qualified Diabetes Educator. They are normally class size programs (8-15 clients) where a wide range of educational topics are taught. This may include a focus on preparation of nutritional meals for diabetics, teaching of exercise routines, such as the Silver Slippers Program, and wellness classes. In these programs, clients are measured for BMI, with monitored progress reporting, and provided the opportunity for routine A1C testing and monitoring. In addition, as needed, qualified staff may assist clients with referral to a physician for medical services. The Pharmacy Assistance Service is also provided in each of the 20 counties of Region B through our four local rural health provider networks. This pharmacy program focuses only on uninsured and underinsured clients who need long-term medications for the prevention or management of chronic disease (primarily for patients with Diabetes and related conditions). This service is conducted mainly on a one-to-one basis with the local network staff assisting clients who have received a prescription from a physician and need financial assistance in paying for the medicine. The local network staff member utilizes a prescription software application which helps identify companies which provide prescriptions at no cost or at a reduced expense, thus helping the client access medical care they might not otherwise afford. In this program, no assistance is given for acquiring narcotics or short term medications. All prescriptions obtained through this program are sent directly to the client s physician for final dispensing, and the local rural health network staff never see or handle any medications. Our pharmacy assistance program is extremely popular and very effective in addressing chronic disease management. B. Role of Consortium Partners During both the planning and implementation phases of the Delta States Grant Program, the DHRHN was fortunate to have developed a very strong and sustaining consortium partnership. This partnership has lasted for over six years and is still 8

15 effectively working to further the original and expanded purposes of the Delta Hills Rural Health Consortium. The DHRHN Consortium consists of the following member organizations: Health Resources of Arkansas (HRA): HRA is the lead organization for the consortium and has performed in this role for the past two Delta States Grant cycles (six years). HRA provided both programmatic and financial management for the program operation. This agency received the HRSA funding, allocated it to local non-profit providers, monitored the continuing program operation, provided program and financial reports to HRSA, and facilitated the planning activities among the other consortium members and the Network Steering Group (the program advisory council). HRA, in cooperation with the Network Steering Group and consortium members (some of which are the same) was responsible for the selection of providers and for the configuration of local service area divisions (a number of counties). HRA meets quarterly with the consortium members and NSG to review all program and financial reports to be submitted to HRSA, and received input from these organizations relevant to program monitoring and evaluation. Most decision-making relevant to this program was done by reaching a consensus with the Network Steering Group and consortium members during these meetings. Community Health Centers of Arkansas (CHCA): CHCA is the professional association of the community health centers of Arkansas, and they have played a very prominent and essential role in the planning and operation of both cycles of the Delta-Hills Delta States Grants. This organization is a permanent member of the Network Steering Group and assisted HRA with program planning, input on selection of provider organizations, review and input on quarterly reports and evaluations, and has provided valuable information and data for planning purposes. Through a contract agreement, CHCA received Delta States funding that provided the lead agency with a half-time Technical Assistance Specialist to aid HRA with the monitoring of local providers, prepare program reports, assist in program evaluations, and in strengthening the general program operation. Arkansas Department of Health-Hometown Health Improvement Branch (ADHHHI): The Hometown Health Improvement branch of the Arkansas Department of Health was one of the original members of the DHRHN Consortium and has continued to play a vital role in planning and implementing the Delta States Grant program in Region B of Arkansas. The Director of this office served on the program NSG and assisted the lead agency in program evaluation, selection of program providers, provided data and studies for grant planning and other essential planning and oversight assistance. The HHI works under contract with the lead agency to provide updated health statistics, assisted local network providers with grants planning workshops, reviewed and commented on quarterly program and financial reports and other technical assistance. In addition, the HHI was critically important in assisting the DHRHN plan and submit an application for the upcoming (third cycle) Delta States Grant Program competition. These services included identification of sites in need of certified Diabetes Self-Management Education program and information about the need and certification process for such sites in Region B. If the program is funded in the next round of Delta States grants, the HHI will assist HRA in the actual certification and implementation of 11 counties of Region B which currently do not have certified DSME sites. Outcomes The Diabetes Education/Nutrition Program is having a significant impact in improving the lifestyles and health status of our clients. Our evaluations have shown that 68.13% of our adult patients who had a diagnosis of hypertension upon entering this program maintained adequate control during their time of participation. Also, during the measurement year, we found that 51.77% of patients years of age with a diagnosis of type 1 or type 2 diabetes recorded adequate control, with most recent hemoglobin A1C levels of less than 8.0%. Additionally, in this same client group, we found that 40.62% had blood pressure readings lower than 140/90 mm/hg. Finally, of all clients aged 18 years or over in the program, 92.4% had a Body Mass Index (BMI) charted and a follow-up plan documented if the patient was overweight or underweight. These results indicate that the DHRHN s Diabetes Education/Nutrition program was successful in assisting participants in managing their chronic health conditions. While the DHRHN does not actually utilize a return on investment model for our Diabetes Education/Nutrition Program, we are strongly convinced that these services provide a great return for the funds invested. Some recent figures by the U. S. Department of Health and Human Services indicated that the average health care cost for a person with diabetes is over $13,000, compared to only $2,500 for a person without this disease. Based on our experience, we would conservatively estimate that this program fostered a four to one ratio of dollars saved to dollars spent. Therefore, based on our estimated expenditures for the diabetes program over this past three-year cycle (approximately 60% of all program funds) we projected that about $2.9 million was saved by the expenditure of about $738,000. In our Pharmacy Assistance program, the evaluations indicated that this program will have served around 4,000 unduplicated clients each year over the current three-year grant cycle. These are all people who are uninsured or are considered under-insured and in 9

16 need of assistance in order to afford prescribed medicine. Based on the data collected in this program, the average dollars saved per patient for drug costs will be about $994 annually. Therefore, based on this data, we estimate that this program provided a direct economic impact to our residents in the amount of almost $4 million per year. Over a three-year grant period, this will amount to approximately $12 million in direct savings to our clients. Also based on our estimates, the Pharmacy Assistance Program will account for about 40% of all Delta States Grant funds expended in this cycle. Therefore, roughly $492,000 will be spent on this program with a subsequent return of about $12 million. This data would indicate a return on investment of over $24 to each federal dollar spent. It is our conclusion that both programs have greatly changed the attitudes of people in rural Arkansas regarding the importance of accessing proper medical care, the use of prescriptions, and the importance of prevention in dealing with chronic diseases. Challenges & Innovative Solutions Over this three-year grant cycle, DHRHN had to replace one local network provider and take on one new partner. The new network provider was inexperienced in the Delta States program but had considerable expertise in providing community services in the respective counties. This problem caused a disruption in service delivery for several counties but, after considerable work and attention, the lead agency and the Network Steering Group were able to get these two issues resolved and achieve quality service delivery into these unserved counties. Perhaps the most challenging part of the Delta States Grant program during the final year of the grant period has been maintaining the motivation among the partners to continue improving and moving forward with their local programs. During this time, our attendance at quarterly NSG meetings faltered somewhat. This affected our ability to provide better evaluations and quality TA assistance to our providers. In addition the DHRHN and our partners were greatly challenged in the spring while our State Legislature was in session and dealing with decisions about the new federal health care law. Ultimately, the State did gain tentative approval from DHHS to participate in a new and innovative Private Option to provide insurance coverage for over 250,000 additional uninsured people in the state. This option was subsequently approved by the State Legislature and is now being implemented. Ultimately, after extensive discussion and planning, our Consortium members and Network Steering Group were rejuvenated as they worked together to develop an innovative proposal for moving forward with expanded Certified Diabetes Self-Management and Education services in this service area. Also, with the ultimate approval of our Legislature for participation in the new Federal Health Care program, our Consortium members, including the Community Health Centers of Arkansas and Arkansas Department of Health, have been relieved of a greater burden and are now able to allocate more time and effort to Delta States activities. Sustainability A. On-going Services and Activities In Region B of Arkansas, we see evidence that our Diabetes Education/Nutrition Program will be sustained partially within Region B beyond the current Delta States grant period. Based on discussions with local rural health networks, we think that at least two programs will be sustained, although probably not at their current levels. The Ozark Mountain Health Network, which serves two counties, and the White River Rural Health Network, which serves six counties, plan to continue operating limited Diabetes Education/Nutrition Programs, after the Delta States funds end. These programs are currently operated in conjunction with a successful community health center and a local rural hospital. Also, we have indications that Crowley s Ridge Rural Health Network will probably be able to sustain their Pharmacy Assistance Program, upon termination of Delta States grant funding. This network serves seven counties of Region B. Presently, we do not think the North Central Health Network will be able to sustain either of their programs if Delta States funds are terminated. This network is led by a local community action agency and serves five counties of Region B. The DHRHN will meet with all four of our local rural health networks in July, 2013 to assist them in finding funds and resources to sustain their programs, with or without the continuation of the Delta States grant. We have presently identified one funding source which could be shared among the providers in Region B. The DHRHN, under the lead of HRA has made application to the USDA Rural Development for funds to help sustain network services in some form. If successful in this effort, we plan to use these funds to upgrade our programs to become certified Self-Management/Education programs in 11 unserved counties of the Region. Also, we are encouraging our providers to absorb their programs if funding is not available from HRSA. We are confident that at least two Diabetes Education/Nutrition Programs will continue and at least one Pharmacy Assistance Program will be continued, with 10

17 the use of program-generated income. It is our strategy that, in the event that all Delta States money is terminated, we will have both programs continue operating on a similar scale. We hope to have a minimum of one-half of all counties see continued programs in some form, either through in-kind support or program-generated income. We also will encourage and assist our providers to access other federal and state grant programs to help sustain these programs whenever and wherever feasible. B. Sustained Impact As a result of the past three years of operating the Delta States Grant program in Region B, we have helped create a model for the regional delivery of coordinated services, which has not been present before in many parts of rural Arkansas. This model of cooperation in service delivery will be greatly beneficial to use for planning and implementing other programs and services in rural America. The DHRHN involvement with the Delta States Grant has resulted in the collective efforts of over one hundred separate organizations and entities, each working toward the same end the betterment of health conditions for our citizens. The health status of Region B has been improved and this will have long range consequences for our clients. The full impact of these efforts may not be fully realized for many years to come. Moreover, in the long term, just the cost savings derived from operation of our Pharmacy Assistance Program alone (about $12 million over the past three-years) will have a positive and lasting effect on the lives of the people served. Not only did this program actually achieve real savings for low-income people, but it also afforded them the opportunity to channel limited money for items such as food, shelter, and energy costs. Overall, the program had a tremendously positive impact upon the clients and the consortium partners. Implications for Other Communities The Delta States grant program has been a valuable and rewarding experience for the Delta-Hills Rural Health Consortium and all of our partners. The experiences and benefits from having this program operate in our 20-county region are detailed in other parts above. There have been some formidable challenges to overcome and the program did have some set-backs, from time to time. However, by having a broad group of experienced people involved in the planning and decision-making process, the program was able to surmount most all of our obstacles. The DHRHN Consortium included members from the lead agency, Health Resources of Arkansas, two executives from the Community Health Centers of Arkansas, and two officials from the Arkansas Department of Health, Hometown Health Initiative. Also, because the lead agency was experienced in regional service delivery, we provided a vast amount of knowledge and expertise about the region and its people for this Consortium. From these experiences we feel it is beneficial to gather a variety of persons with vast capabilities and involve a wide range of organizations as is possible. Based on our operation of the Delta States Grant program, we feel this program, or one of a similar composition, would be highly beneficial for replication in other parts of the nation. It might be especially effective in rural and economically distressed areas where resources and services are extremely limited. 11

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19 Mid Delta Community Consortium Organizational Information Grant Number D60RH08532 Grantee Organization Mid Delta Community Consortium Organization Type 501-C-3 Non-Profit organization Address P.O. Box 2524 Helena West Helena, AR Grantee organization website Project Director Name: Anna Huff-Davis Title: Director Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $390, August 2011 to July 2012: $390, August 2012 to July 2013: $390, Consortium Partners Partner Organization Location Organizational Type (town/county/state) Mid Delta Community Consortium Helena West Helena, AR Non-Profit (All local health units in target counties) Arkansas Department Of Health (ADH) Little Rock, AR State Public Health Agency (Regional health program-ahec s serving all target counties) University of Arkansas for Medical Sciences (UAMS) Little Rock, AR College of Public Health (Regional health program-ahec s serving Community Health Centers of Arkansas, Inc. (CHCA) Little Rock, AR all target counties) State Primary Care Association (CHC s in all target counties) Community Characteristics A. Area Arkansas, Lonoke, Jefferson, Lee, Monroe, St. Francis, Phillips, Ouachita, Dallas, Bradley, Drew, Chicot, Ashley, Desha, Grant, Calhoun, Cleveland, Union and Lincoln counties. B. Community description This region is historically the cotton-producing part of the state and remains rural and agricultural. In 14 of the 19 counties in the area, the majority (> 50%) of the population live in rural areas, as defined by the Center for Disease Control (CDC), and in the other five counties, only a small majority live outside of rural areas (i.e., urban cluster). Approximately 61.8% of residents in this area are non-hispanic Whites, 35.13% are non-hispanic Blacks, and 3.08% are Hispanics, differing from the overall state demographics by %, 19.73%, and -3.52%, respectively. The majority of the population in these 19 counties are of working age, but this area is among the poorest in the state with up to 32.5% living below the federal poverty level (state, 18.7%; nation, 15.3%), and a median household income of as low as $31,673, below the state average of $38,413. Average unemployment in this area is exceedingly high, 45.34% of residents ages years are unemployed, as compared to 32.5% (state) and 35% (national) of adults in the same age range. The percentage of adults (ages 18 and over) without health insurance in the target area ranges from 9.2% to more than 20.3%, which is slightly under the estimated percent of US adults (ages 18 64) without health 13

20 insurance (21%). In the majority of counties (8 counties) in the target area, 9.2% 15.3% of adults are uninsured; however, more than 20.3% of adults in just over a quarter of the target area do not have health insurance. C. Need Arkansas is one of the least healthy states in the US, and the southeastern counties are the least healthy in the state. For example, life expectancy for a child born in Phillips County in Delta Region B is 10 years less than for a child born in Benton County, a more populous county in the northwestern corner of the state. Arkansas adults report fair or poor health more often than adults nationally, and rates of chronic diseases, such as diabetes, hypertension, and cardiovascular disease, are higher in Arkansas than elsewhere in the country. The state consistently ranks among the top 10 states in prevalence of disease and risk factors. Mortality rates are higher than national rates for all of the top 10 causes of death in the state; chronic heart disease, cancer, stroke, diabetes, unintentional injury, nephritis, septicemia, homicide, pneumonia, and chronic lower respiratory diseases. A variety of health disparities exist, particularly in terms of geographic location and racial/ethnic backgrounds. The long-term goal of this Delta grant program was to create a model for community partners, network members, practitioners, and academicians that improves the health and well-being of the region s racial and ethnic minorities by focusing on chronic disease risk factors. Program Services Focus Areas Access: Primary Care Children s Health Chronic Disease Management: Cardiovascular Chronic Disease Management: Diabetes Community Health Workers Enrollment in Public/Private Healthcare Coverage Health Education and Promotion Pharmacy Assistance Physical Fitness and Nutrition Target Population Infants Pre-school children School aged children - elementary School aged children teens Adults Elderly Pregnant Women Caucasians African Americans Latinos Native Americans Uninsured Underinsured A. Description The Arkansas Delta Rural Development Network (ADRDN) program was designed to address risks for chronic disease among Arkansas racial and ethnic minorities with a goal of reducing the risk factors. ADRDN collaborated with the Arkansas Prevention Research Center (ARPRC) at the UAMS College of Public Health in their efforts to develop and expand the Community Based Participatory Research (CBPR) across the Arkansas Delta. The local networks (Arkansas County Partners in Health-Arkansas, Lonoke, Jefferson counties; Hometown Health Coalition of Bradley, Drew, Cleveland, Grant, Chicot, Ashley, Desha, and Lincoln counties, Quad-Co Rural Health Network-Calhoun, Dallas, Ouachita, and Union counties; and Tri County Rural Health Network-Lee, Monroe, Phillips, St. Francis counties) served as formal partners of the ARPRC and provided education and training activities. Through the Delta States grant program the ADRDN provided the following activities through the local rural health networks. Arkansas County Partners In Health Coordinated partners activities on health and wellness through health fairs, screenings, and guest speakers Provided educational programming for early elementary students on the importance of healthy eating and physical activity utilizing the Organ Wise Guys and Safe Space programs Educated adults on chronic disease prevention and provided resources to make healthy decisions and change behaviors through health promotion and disease prevention programs, such as Strong Women and diabetes self-management classes at the hospital Provided prescription assistance for citizens unable to afford medicines prescribed for their chronic health conditions 14

21 Hometown Health Coalition of Bradley Organized and publicized awareness and educational events focusing on chronic disease among network populations Implemented health fairs and classes for prevention and management of chronic disease, such as Star*Health, Diabetes Education, Blood pressure monitoring, community gardening Produced a bi-lingual Resource Guide on obesity, nutrition, and exercise Organized a Safe Baby Shower for expectant and new parents, with gifts and presentations on safe procedures for feeding and bathing, sleep positions, and shaken baby syndrome Supported existing prescription assistance programs in two counties QuadCo Rural Health Participated in partners health fairs and special events by offering screenings to identify citizens at risk of chronic disease Organized and publicized educational opportunities for chronic disease management, awareness, and prevention Maintained Prescription Assistance programs in Dallas, Ouachita and Union Counties and coordinated with the Prescription Assistance provider in Calhoun County Regularly updated Prescription Assistance Managers on prescription assistance issues Tri County Rural Health Network Utilized their Community Connection staff to provide outreach and education on the value of physical activity and improved nutrition for residents of Lee, Monroe, Phillips, and St. Francis County Provided educational opportunities for the St. Francis County community on Chronic Disease, such as diabetes and high blood pressure Increased awareness and participation in educational activities for the prevention or management of cardiovascular disease for the citizens of the Lee, Monroe, Phillips, and St. Francis Counties Provided prescription assistance for citizens unable to afford medicines prescribed for their chronic health conditions B. Role of Consortium Partners The consortium consisted of four organizations and their affiliated groups. These large, centrally located organizations provide stability and organizational strength to complement the grassroots know-how and practical experience of their community and county-level associates. Each of these organizations was represented by its chief executive officer and/or designated appointee in creating a management committee for the grant. As the local Delta partner of the Arkansas Delta Rural Development Network (ADRDN), the Mid Delta Community Consortium (MDCC) based in Phillips County served as the lead agency to receive the grant funds and served as the point of contact for HRSA. The ADRDN provided oversight in the management of the grant and the coordination of technical assistance to communities. The ADRDN received guidance from a State Steering Group. Members of the Steering Group provided advice to the ADRDN on development of the local grant guidance and grant review and selection process, and provided technical assistance to local networks, especially if partners in the ADRDN lacked the capacity to respond to identified needs. The University of Arkansas for Medical Sciences (UAMS) is the state s only comprehensive academic health center. UAMS participated in ADRDN through three branches of the institution the College of Public Health (COPH), Regional Programs, and the Arkansas Center for Health Improvement. COPH s rural initiative, a local partner of the MDCC, and its urban counterpart are intended to demonstrate the power of public health at the local level, with community people playing a major role in planning, implementing, and evaluating public health actions. Students and trainees at the COPH were immersed in these sites for service learning. UAMS Regional Programs provided library services and continuing education courses to health professionals in participating communities as well as consumer education programs on wellness and health promotion. The Arkansas Department of Health (AHD) is the state s public health agency. The Department of Health s participation in the Delta Network has been primarily through the local health units hometown health improvement coalitions. They have brought together diverse community residents to identify community health problems and develop and implement ways to solve them. Community Health Centers of Arkansas, Inc. (CHCA) is the state s primary care association. CHCA is a registered nonprofit organization that promotes, facilitates, and supports the development and implementation of community-directed and culturallysensitive quality health services and integrated systems of service delivery to improve the health status of the medically underserved. The CHCA and the CHCs serve on multiple committees and coalitions which directly and/or indirectly affect the 15

22 planning, development, and provision of technical assistance for the development of rural community health care access, policy development, systems of service delivery, and advocacy. Outcomes While we are not able to claim that improvements in health may be entirely due to the education/awareness activities of the Mid-Delta Community Consortium and its partnering local networks, we can claim that network activities have had a part in improving attitudes and behaviors for healthy living. One local network utilized pre- and post-tests and surveys to show that the number of in-hospital stays and non-emergent visits to the emergency room by their network s clients decreased by 5%, and the number of clients who reported an improvement in their overall health due to QuadCo program benefits increased by 5%. In addition, the local networks have strengthened existing programs and in three of the four networks, on-going community collaborative efforts are expanding. The fourth local network is actively working to strengthen relationships among community organizations that faltered after network leadership changes slowed progress and hampered communications for a period of time. One area for which distinct measurements are available is the prescription assistance program. For the period August 01, 2011 through July 31, 2012, an average of 48.26% of clients reported that they had skipped prescribed medications due to cost, which is a dramatic decrease of 9.52% from the 57.78% who reported having done so in the prior period. When the cost savings in prescription medications provided for those who could not afford them was added to the dollars saved through reduced emergency room visits and hospital stays as a result of education, prevention, and chronic disease management, the total estimated impact was $11,418,399 last year. Comparing the impact of that amount to the total expenditures of $159,150 yielded a return on investment conservatively estimated to be $71.75 for every $1 spent operating the prescription assistance programs in the targeted counties. The ARPRC has developed an Evaluation Unit within the College of Public Health to meet identified needs among community partners in the Delta. This unit is assisting ADRDN in its evaluation efforts. Evaluation plans are being developed for each of the four individual networks. The Evaluation Unit is preparing a trend report for the 19 counties that will document where the counties were in terms of health status in, 2001 and where they are now. Challenges & Innovative Solutions Diversifying the network s community engagement and diversifying funding sources were both challenges throughout. Collaborating with the ARPRC assisted with community engagement through the affiliation with the Community Engagement core. The local Technical Assistance Provider (TAP) Team assisted with promoting more diversity across the local networks by encouraging the inclusion of all local health units, community health centers, health education centers, critical access hospitals and other service providers. Along the line of resource diversification, a deliberate effort was made to provide resource opportunities to all network partners. At least once per month, a list of funding opportunities (local, state, national) was distributed electronically in conjunction with the PRC. The TAP Team was available to assist with fundraising efforts i.e. grant development, fundraising, etc. Another challenge was the change in the grant cycle. This change caused some delay in the distribution and expenditure of funds which resulted in delay of program implementation. Sustainability A. On-going Services and Activities All four local Networks will continue to collaborate with their partners to offer services and programs for prescription assistance, nutrition and health education, training (CBPR, health literacy, etc.), screenings, physical activity classes for youth and adults, Community Connecting and nutrition education. In some counties, services will be trimmed but will continue as local partners and funding sources are able to support them. The Mid-Delta Community Consortium will pursue strategies to sustain services and activities, including continued search for other sources of financial support. We are committed to continued resource development through grants, corporate or foundation gifts, individual donations, and in-kind support. Through the primary collaborative partnerships with the College Of Public Health at the University of Arkansas for Medical Sciences (UAMS) Prevention Research Center, there is potential for activities that will promote sustainability. We will work closely to develop this relationship and garner resources for community based efforts. There are discussions with stakeholders, ADRDN Steering Group (composed of representatives from the Arkansas Department of Health, 16

23 the Office of Rural Health Policy, Community Health Centers of Arkansas, and the UAMS College of Public Health s AR Prevention Research Center/Office of Community Based Public Health/Translational Research Institute) and other organizations across the region on the development of a formal sustainability plan. We are also committed to recruiting volunteers to assist with the delivery of services and activities. B. Sustained Impact Infrastructure of our communities is taking on a healthy stance. The sustained impact on the communities includes higher levels of interaction and collaboration among clinical, social service, and government entities and more widespread awareness and education on health risks and chronic health conditions among residents of Southeastern Arkansas. Changes have been seen in healthier school lunches, an increased physical activity focus in communities, schools, and workplaces, an increase in water and fewer sugary drinks in vending machines in the workplace, increase in creation of walking trails and sidewalks. This program has also laid a foundation for subsequent community health worker outreach, i.e. navigators and in-person-assisters for the Affordable Care Act Insurance marketplace work. Implications for Other Communities Our experiences, especially with community engagement and the development of partnerships within the communities, involve structuring activities of three types: 1) training, educational, technical assistance, and mentoring programs for community members; 2) service learning activities for students to become engaged in working with community partners; and 3) research initiatives, developing service learning efforts. Service learning opportunities can be very effective in implementing programs. The development of collaborative research projects is the result of a number of factors, including: 1) a match of priorities between communities and academic institutions; 2) available time and effort to commit to proposal development and implementation of the project, if funded; 3) expertise of the community/academic partners sufficient to generate a competitive grant/contract; and 4) a funding opportunity that matches the objectives/aims of the project and the scope of the project proposed by the investigative team. 17

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25 Board of Trustees Southern Illinois University Center for Rural Health and Social Service Development Grant Number Grantee Organization Organization Type Address Grantee organization website Project Director Organizational Information D60RH08547 Board of Trustees Southern Illinois University Center for Rural Health and Social Service Development University 1745 Innovation Drive, Suite C Mail Code 6892 Carbondale, Illinois Name: Jeffrey A. Franklin Title: Project Director Illinois Delta Network Phone number: Fax number: address: jfranklin@siumed.edu Project Period Funding level for each budget period August 2010 to July 2011: $428,560 August 2011 to July 2012: $428,560 August 2012 to July 2013: $428,560 Consortium Partners Partner Organization Location Organizational Type (town/county/state) Southern Illinois Healthcare Carbondale/Jackson/Illinois Hospital Egyptian Health Department Eldorado/Saline/Illinois Health Department University of Illinois Extension Murphysboro/Jackson/Illinois University Southern 7 Health Department Ullin/Pulaski /Illinois Health Department Jackson County Health Department Murphysboro/Jackson/Illinois Health Department Perry County Health Department Pinckneyville/Perry/Illinois Health Department Franklin/Williamson County Health Marion/Williamson/Illinois Health Department Department American Cancer Society Marion/Williamson/Illinois Service Community Characteristics A. Area Illinois counties of Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson, Johnson, Massac, Perry, Pope, Pulaski, Randolph, Saline, Union, White, Williamson B. Community description The target population for this grant is residents in the 16 southernmost counties of Illinois known as the Illinois Delta Region. The total population of this region is 344,594 representing 2.7% of the state s total population. The land area is 6,038 square miles or 10.9% of the state s total area. The population density of this area ranges from persons per square mile, compared to an average density in Illinois of persons /sq. mi. Eighty-one percent (13 counties) of the Delta counties have a lower population density than the USA average of 87.4 persons per square mile. The total population in Illinois grew by 3.3% from

26 2010; however, the total population of the Delta region contracted by 0.6%. Eleven of the sixteen Delta counties lost population, ranging from a 16.2% loss to a 1.2% loss. Four counties had a 1 2% population gain and one county had an 8.3% gain. The 2012 County Health Rankings and Roadmap Report identifies 15 of the 16 Illinois Delta counties as ranking in the lower 50 th percentile of Illinois counties for health outcomes when looking at morbidity and mortality measures. Eight Delta counties are among the 10 counties with the poorest health outcomes in the state. The county health rankings also include a summary measure, health factors, which is based on weighted scores for four types of factors: behavioral, clinical, social & economic, and environmental. Fifteen Delta counties are ranked in the lower 50 th percentile for health factors, and 4 counties are among the 10 counties with the poorest rank for health factors. C. Need The Illinois Department of Human Services offers a yearly voluntary survey free of charge to Illinois schools, The Illinois Youth Survey ( During 2012, seven Delta counties administered the 8 th grade survey to students. 62% of schools in these 7 counties participated (28 out of 45 total schools) with 1417 students participating, 64% of enrolled students in participating schools. The results from this survey provide insight into the health behaviors of Delta county youth. 6.1% of students responded that during the past 7 days, they were never active for 60 minutes. This compares to 7.6% for Illinois youth statewide (2010). One Delta county reported a 13% rate of inactivity. Students were asked, On an average school day, how many hours of TV do you watch? 13.2% responded that they watch 5 or more hours a day; this rate is slightly higher than the Illinois rate of 11.8%. One Delta county had a rate as high as 30% of students watching 5 or more hours of TV per day. 12.1% of students reported that during the past 7 days they ate fruit 4 or more times per day and 10.1% reported similarly for vegetables. These rates of fruit and vegetable consumption are higher than the Illinois rates of 11.4% and 7.9% respectively data from the High School Youth Risk Behavior Survey shows 13.0% of high school respondents nationally were obese. Illinois ranks as the 23 rd most obese state for high school youth with a rate of 11.6%. In the 8 th grade Illinois Youth survey 11.4% of Delta students were obese, comparable to the state average of 11.6% in 8 th grade. Delta county schools ranged from 9% - 15% obese. Overall 16% of Delta youth are overweight for a combined rate of 27% overweight or obese in Grade 8. Delta youth were more likely to describe their weight as very overweight than Illinois youth (5.2% Delta, 4% Illinois). The youth in Delta county schools were similar to Illinois youth in several areas measured by the survey. For example, 2.9% felt very unsafe in the neighborhood (2.8% Illinois) and 5.5% belong to a street gang (5.5% Illinois). 25.3% of youth reported that during the past 12 months they felt sad or hopeless almost every day for two weeks or more in a row that they stopped doing some of their usual activities. Unfortunately this rate is comparable to the state rate of 25.7%, which is too high. A troubling survey result is that 8.6% of Delta schools 8 th grade youth smoked cigarettes in the past 30 days compared to only 5.1% of Illinois youth. This rate is 68% higher than the Illinois youth rate and mirrors the adult smoking rate in the Delta counties which is 60% higher than the Illinois rate. Focus Areas Children s Health Health Education and Promotion Physical Fitness and Nutrition School Health Program Services Target Population Pre-school children School aged children - elementary School aged children - teens Adults A. Description The CATCH onto Health! Promoting Health and Physical Activity in the Illinois Delta Region initiative employed an evidence-based program targeting health and physical activity to prevent and reduce the number of overweight and obese children ages The Coordinated Approach to Child Health (CATCH) program has demonstrated positive outcomes regarding the improvement of students academic performance as well as behavioral and physiological factors. This initiative worked to increase the number of opportunities for area youth to engage in healthy eating and physical activities that can help prevent and lower incidence of many diseases related to sedentary lifestyles and obesity. Our CATCH onto Health! Initiative was designed to positively impact Illinois Delta youth through the implementation of the Center for Disease Control and Prevention s Coordinated School Health Model (CSHP). The CSHP includes eight components: 1) Health Education, 2) Health Services, 3) Counseling, Psychological, & Social Services, 4) Healthy School Environment, 5) Health Promotion for Staff, 6) Family/ Community Involvement, 7) Nutrition Services, and 8) Physical Education. Participating schools were provided assistance in advocating for school nurses and school health services; developing wellness teams; drafting 20

27 inclusive wellness policies; implementing strategies to increase activity levels during PE and free play; and assisting school chefs to prepare healthy, appealing meals within their budgets and in accordance with state regulations. During the funding cycle, our efforts engaged 62 of the 106 schools located within the Illinois Delta Region. These efforts included the implementation of the CATCH (Coordinated Approach to Child Health) program and at least one component of the Coordinated School Health model. CATCH is designed to include classroom teachers, physical education teachers, school nutritional service staff, and children s families and guardians in the planning and implementation of the program. The coordination among these components designated CATCH as a coordinated school health program. This program has been shown to be effective to improve physical activity among, improve the school nutritional environment for, and decrease overweight among elementary school students. Improving nutrition and physical activity as well as decreasing obesity improves the health of children, adolescents, and adults. A Policy, Systems and Environmental approach to program implementation and policy development was assumed by the ICHC to complement and strengthen the implementation of CATCH/ CSH. ICHC members worked with Delta schools to engrain a culture of wellness on the following sustainability efforts: 1. ICHC members served on School Wellness committees within their service region 2. ICHC members assisted School Wellness committees to complete the CDC School Health Index 3. ICHC members assisted School Wellness Committees in the development of a school wide Coordinated School Health/CATCH implementation Action Plan based on School Health Index results 4. ICHC provided School Health Committees with sample School Wellness Policies and Technical Assistance to each CATCH school in the development of, or revision of, Wellness Policies to be more reflective of the Delta Initiative 5. ICHC provided Professional Development for all CATCH school staff on Coordinated School Health implementation, CATCH, and Social and Emotional Learning 6. ICHC provided Professional Development for Food Service: School Lunch Rocks 7. ICHC provided Wellness policy samples and TA on drafting Wellness Policies B. Role of Consortium Partners The aim of the Illinois CATCH on to Health Consortium (ICHC) was to generate school and community involvement to improve physical activity and nutrition among children in the Illinois Delta region. The consortium was comprised of a multi-sectoral group of community leaders, stakeholders, and gatekeepers that influence opportunities for child and family physical activity and nutrition in the school and community contexts. The principal functions of the consortium included implementing, monitoring, and evaluating CATCH and to disseminate information and findings to local, regional and national audiences. The ICHC identified community champions who helped to further the dissemination and institutionalization of the CATCH and Coordinated School Health programs in their respective contexts. The ICHC played a critical role in the development of the goals, objectives, and work plan designed to transform the delivery of school health education within the Illinois Delta Region. During this past funding cycle, the Delta Project Director instituted many changes within the ICHC and allowed the consortium to develop into a more cohesive, functioning, strategic partner and guiding force in the Illinois Delta Region. Particularly, in relation to the implementation of the CDC s Coordinated School Health Education Model, CATCH health program implementation, Farm-to-School initiatives and those efforts to address the health disparities among Illinois Delta Youth. The ICHC has not only grown in size, but also grown into a well-respected entity. The ICHC has undergone many positive changes over the past funding cycle and was the subject of a Case Study examining the attributes that make successful coalitions. The ICHC participates in an annual two-day professional development/team building retreat, monthly meetings, and annual strategic planning initiatives. The work of the ICHC/Illinois Delta Network was guided by inputs of all consortia members and designed to complement the IPLAN efforts of the local health departments, State of Illinois We Choose Health Community Transformation grant, and the work of other youth-serving organizations with the Illinois Delta Region. Outcomes Outcomes from CATCH onto Health! Promoting Health and Physical Activity within the Delta region have shown, on average Delta students increased Moderate to Vigorous physical activity from 49% to 60.90% during time spent in physical education classes. In 21

28 addition, a higher quality of fitness instruction time was reflected in a decrease in classroom management issues from 23.64% to 15.67%, and an increase in positive self-reported student behaviors related to increased nutrition and physical activity. Active school wellness committees have been established in 62 schools, and they are implementing action plans to create a culture of wellness within the schools. Challenges & Innovative Solutions A challenge faced by the Illinois CATCH on to Health consortium was a disengaged group not focused on the shared vision. To address this issue, the project director, began holding annual teambuilding retreats, monthly meetings, professional development for consortium members all focused on the development of a shared vision and the creation of an engaged consortium where all voices were encouraged and valued. Through these efforts, the ICHC doubled in size and became the focus of a Case Study conducted by Southern Illinois University Graduate Students exploring the factors involved in creating a successful collaboration among rural partners. These efforts undertaken by the project director to improve the quality of the ICHC dynamic resulted in the: Expansion of the programmatic efforts, strengthened and repaired relationships, and created a self-sustaining consortium that would continue to function if current leadership were to be removed. Case study successes, as reported by ICHC members included: Strong working relationships - key to longevity and job satisfaction Sundry interests and skill-sets lend to a unique group with innovative ideas Though no formal vision/mission, members share cohesive, unified goals and values Strong leadership from the program director has united consortium partners making the group feel like valued friends rather than business associates. Distance is not a challenge for this dynamic group. Sustainability A. On-going Services and Activities Due to the sustainability efforts put in place throughout the grant cycle, we anticipate that all of 62 schools will maintain the activities even without further Delta funding. B. Sustained Impact ICHC sought collaborative community relationships, thereby assisting the CATCH schools in the Illinois Delta region to create settings that could make an impact on factors they can control. Through the implementation of CATCH and the creation of school wellness committees, participating schools have permanently changed their approach to wellness in the school environment. It is this creation of an environment that is safe, supportive of healthy dietary choices, provides opportunities for physical activity and rewarding of those behaviors that has become the foundation for ICHC work. While academic success has always been the most important mission of education, it is the foundational belief of the ICHC that schools will be more effective if measures were taken to address student s overall health, including their social and emotional wellbeing. ICHC program and evaluation efforts included the development of purposeful policies that celebrate school environments that took charge of their well being, while teaching students, staff and families to value their own health. Implications for Other Communities Given the diversity of schools in which CATCH has been successfully implemented, the ICHC expects that CATCH will drive positive impacts in the Illinois Delta Region. Further, the El Paso, Texas findings in low-income schools show that CATCH could be successfully implemented, with positive outcomes, in low-income elementary schools. Due to the high amounts of poverty of children in the Illinois Delta Region, utilizing a program that has shown success in low-income schools is critical. Key stakeholders in the Illinois Delta Region, especially Southern Illinois Healthcare, have dedicated resources to the Coordinated School Health Program model in the region for several years. By expanding this model to other regional stakeholders, the model could expand in its implementation beyond the Illinois Delta Region. Moreover, showing successful outcomes with the region and refining 22

29 processes for implementing CATCH to this region specifically would increase the likelihood of expanding and sustaining the CSHP model in other Delta states and offer opportunities to maintain or increase funds to this type of approach either from applying for funds that are external to the region or by requesting allocation of funds from within the region. 23

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31 Trover Health System/Baptist Health Madisonville Organizational Information Grant Number D60RH08553 Grantee Organization Trover Health System, now Baptist Health Madisonville, Inc. Organization Type Hospital Address 200 Clinic Drive Madisonville, KY Grantee organization website Project Director Name: Kelcey Rutledge, Sr. Title: Project Director Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $510,700 August 2011 to July 2012: $510,700 August 2012 to July 2013: $510,700 Consortium Partners Partner Organization Location Organizational Type (town/county/state) University of Kentucky College of Dentistry Lexington/Fayette/KY University West Area Health Education Center Madisonville/Hopkins/KY Community Health Community Characteristics A. Area The Kentucky Delta Rural Project (KDRP) served the western Kentucky counties of Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Graves, Fulton, Hickman, Hopkins, Livingston, Lyon, Marshall, McCracken, McLean, Muhlenberg, Todd, Trigg, Union, and Webster. B. Community description The population of the service area community is approximately 453,000 and primarily white at 90.4% with other ethnicities comprising 9.6%. The 79.63% average graduation rate of service area residents is lower than the national average of 85%. Kentucky ranks in the top ten for prevalence of adult smokers, smoking-attributable mortality, heart disease death, age-adjusted invasive cancer, Diabetes, and stroke death rates per 100,000. Many of the high chronic disease rates are correlated and impacted by obesity and indicate some of the highest rates for obesity and inactivity nationwide. Kentucky ranked 10 th highest for adult obesity and 4 th for childhood obesity. Six of 20 rural Delta counties lack hospitals; 16 are Medically Underserved Areas (MUA); 12 hold some form of Health Professional Shortage Area (HPSA) designation for primary medical care; and 17 have less than one primary care physicians per 1,000 population. Many residents must drive 30 miles or more to visit a primary care provider. 22% of Kentucky residents are enrolled in Medicaid and approximately 21.75% percent of the population is Medicaid eligible. Delta counties have higher rates of unemployment (9.4%) and poverty (18.1%) than national (8.9%, 14.3%) or state averages (9.5%, 18.1%). The state ranked 48 th for medium family income ( ), with an average of $41,576 in contrast to the national average of $51,914. C. Need The Kentucky Delta Rural Project school wellness initiative was designed to address health needs of the growing population and notably those of the 23,000+ elementary school students residing in Kentucky s 20 rural Delta counties. Project initiatives were developed as a result of a community-initiated decision making process throughout the twenty-county service area. After forming county health councils, the Project polled residents with a minimum 10% target rate. The top issue needing to be addressed was 25

32 obesity. Second was health literacy, with mental health ranking next. The Project initiated its Delta Medication Assist Program as the need for medication assistance was a prevalent issue voted upon throughout all service area counties. To address obesity, the Kentucky Delta Rural Project decided to focus on school-based initiatives with the mindset of fostering a mentality of lifelong positive wellness habits in children beginning at the primary stages of their lives. Initially, the Project planned to begin with elementary school programs and expand into middle and high schools. Elementary school programs grew so rapidly and largely that the Project had to focus its limited staff at that level. Focus Areas Behavioral/Mental Health (anti-bullying) Children s Health Oral Health Pharmacy Assistance School Health Program Services Target Population Pre-school children School aged children elementary Adults Elderly Caucasians African Americans Latinos Native Americans Uninsured Underinsured A. Description The Kentucky Delta Rural Project initiatives focused on obesity prevention and reduction through school wellness activity promotion; anti-bullying awareness, prevention and intervention; and oral health education for service area students. The Project gave presentations at participating elementary schools to students, teachers and staff. Presentations to students were educational and related to Project wellness focus areas. Presentations for school staff centered on training them to conduct the wellness education in the classroom. Topics included anti-bullying awareness, prevention, and intervention; internet safety; nutrition, oral health care; physical activity and movement; and classroom relaxation techniques. Since inception, the Kentucky Delta Rural Project school wellness initiative was designed to equip school staff with the necessary training and supplies to continue Project initiatives long-term. The Project solicited school feedback for relevant topics to address in the future. As a result of positive review, the Project continued to host its annual Champions Meeting, offering continuing education credit for participants in the areas of anti-obesity, anti-bullying and/or oral health. Champions Meetings were hosted by the Project at a centralized location in the service area. Continuing education credit for participants was offered as incentive for attendance. Topic areas related to wellness focus areas of the Project. Project staff solicited topics to be covered from teachers at participating schools. Consortium members took an imperative role in making Champions Meetings successful. The University of Kentucky College of Dentistry trained participants on how to conduct proper oral health presentations to students. West Area Health Education Center (West AHEC) verified the continuation education credit. To revitalize interest in the Project, Delta Tours were held for 4 th grade students in participating schools. 4 th graders were chosen to maintain manageable crowd sizes. Also, research done by consortium member the University of Kentucky College of Dentistry that suggested children start to form permanent life habits at the 4 th and 5 th grades. Delta Tours were interactive health assemblies covering topics related to overall wellness, designed to focus on fun while educating students. The Tours served to distinguish Kentucky Delta Rural Project presentations from standard, narrative-heavy presentations. Delta Tours were held one per county annually in the service area. Participating schools brought students to one central location. Locations were participating schools which expressed interest in hosting the events. Staff rotated the locations amongst schools within each county to allow each school to host and be highlighted. Delta Tours encompassed a complete wellness approach including presentations on anti-bullying, anti-drugs, dental care, food and nutrition, internet safety, and physical activity, exercise & movement. Staff conducted presentations, yet available county agencies with expertise on Tour topics were invited to present when available. To make the Delta Tours more interactive, an anti-bullying skit and a food plate game were added with volunteers from the crowd being used as participants. To rally the students, staff often asked for teacher volunteers to give represented schools a competitor to root for in a friendly competition format. 26

33 The Project promoted the use of TAKE 10!, a program that promotes incorporating physical activity into lessons using tenminute breaks multiple times a day. At Delta Tours, staff held a section that taught students and teachers about using TAKE 10! through conducting exercise breaks that highlighted facts about the county. For example, staff would ask the crowd what is the famous vacation area in the county? The kids would reply Lake Barkley. Staff would then lead the students in doing squats as they spelled out L-A-K-E-B-A-R-K-L-E-Y. Upon ending, staff would encourage the students to ask their teachers about doing TAKE 10! in their schools. Near the end of the Tours, students were allowed to dance as an informal reward for paying attention. These efforts were successful in avoiding boredom while educating and highlighting the ease of movement incorporation in the classroom. Feedback from attending teachers suggested students came back to school over-energized after Tours. Hence, staff instituted a relaxation component to end each event. Teachers relayed their appreciation for staff efforts in calming the students down before leaving. Project Specialists coordinated all Delta Tour efforts with the schools through required ongoing contacts with school champions. In addition to Tours, Project Specialists worked with their assigned schools to initiate wellness committees. The committees were to serve as school-based bodies to review and initiate school wellness activity. To encourage participation, schools were given fitness equipment incentives. To introduce long-term sustainability, the Kentucky Delta Rural Project initiated school wellness to serve as governing bodies to maintain Project and school-based wellness activity. To foster participation, the Project made wellness committee requirements relaxed with incentives for participation administered after each school s first meeting. Due to limited field staff, the Project was successful at initiating at least twenty wellness committees each year of the 3-year funding cycle. The Project funded oral health services provided by the University of Kentucky College of Dentistry for Head Start and pre-school children. When available, University College of Dentistry staff presented at Delta Tours for the oral health education component. The University also provided the Project with a video titled Where s the Sugar? which educates kids on healthy vs. unhealthy eating and drinking choices, calculating grams of sugar to teaspoons to monitor intake, proper tooth brushing, and other issues related to caring for teeth. The video features a young teenage female who narrates the video, accompanied with music and easy to follow testimonials from dentists. Staff played the video at Delta Tours and it was very well received. The video gave the Tours yet another visual alternative to standard vocal presentations and maintained the interest of attendees. The Delta Medication Assist Program was started to provide online prescription assistance software to agencies interested in providing the service and community clinics that offered services on a free and/or sliding pay scale. The program experienced expansion and contraction issues including one clinic closing down, one chief executive officer resigning his post and no replacement being named to continue offering Rx assistance, a partnership ending with an agency that provided multiple sites, etc. Ultimately, community clinics, community services agencies, and senior citizen centers proved most effective in having needed manpower and operating space for the program. Currently, the Project supports licensure for three sites in three counties including two community clinics and one community food bank. B. Role of Consortium Partners Consortium members included the University of Kentucky College of Dentistry (UKCD) and West Area Health Education Center (West AHEC). UKCD offered insight and guidance on KDRP oral health instruction presentations. UKCD provided oral health services to Head Start and pre-school students using innovation funding granted to the Project. West AHEC provided assistance with project-related elementary school activities. West AHEC also verified the continuation education credit when offered at Project Champions Meetings for school staff. Both agencies served multiple counties within the service area focusing on schoolaged children. Kentucky Delta Rural Project and consortium member representatives served on the Western Kentucky Regional Oral Health Coalition which focused on providing regional oral health educational activities and services. Consortium members met with and maintained ongoing collaborative communications with KDRP in effort to meet project goals. Outcomes Schools participating increased from 60 to 65. Additional schools were selected after expressing interest in participation in the Project. Interest was expressed after school representatives either attended a Project event, or received word-of-mouth from school staff at participating schools about Project activities. The participation of 65 service-area elementary schools with over 29,000 students was retained annually and will be included as recipients of Project activities into the next funding cycle, pending approval. 27

34 The Project hosted and/or participated in 1,468 school and community-based events with 98,628 attendees covering topics on antibullying, overall wellness, oral health education, and promotion of TAKE 10! classroom physical activity program. Project Specialists were requested to host booths and/or assist facilitation of community events each year, validating extended reach beyond primary target of elementary schools. Of the 1,468 events hosted, 885 were school events and 583 were community events. Of the 98,628 attendees, 65,003 attended school events while 33,625 attended community events. 9,914 4 th grade students and 478 teachers attended Kentucky Delta Rural Project Tours. Tours were held in schools and focused on overall wellness. Presentation segments included nutrition, anti-bullying & internet safety, proper oral care, anti-drugs, and classroom relaxation techniques. Delta Tours were the most requested Project activity annually by school staff. Due their continuous success, pending funding approval Delta Tours will be included in future funding cycle to promote the Project and address proposed wellness and anti-obesity objectives. Students that attended Tours were pre and post-tested on anti-bullying and oral health. Scoring for anti-bullying testing rose 91% to 93% while oral health test scores rose from 62% to 79%. TAKE 10! was promoted and utilized each year in participating elementary schools. Teachers commented about the effectiveness of using TAKE 10! to calm restless students down through adding movement activities into their class time. The only hindrance reported was limited time available for creative TAKE 10! idea development. Staff advised teachers with ideas such as including students in leading TAKE 10! activities and enhancement, as well as having activity breaks at times outside of standard thinking (i.e. while students stand in line for bathroom breaks, during morning assembly, recess, and in line waiting for transportation home, etc.). Staff in inclined to believe TAKE 10! activity in participating schools would continue beyond the funding cycle because materials have been purchased for schools and school staff have been trained or re-trained through Project offered TAKE 10! refreshers. With the reach throughout the rural Kentucky Delta region and focus on physical activity and movement, pending approval TAKE 10! is to be promoted in the next funding cycle through Project established school wellness activities. 64 of 65 participating elementary schools initiated school wellness committees. Committees ranged typically from three to seven members each and consisted primarily of teachers. With the full schedule of teachers, successful implementation of wellness committees proved the worth of governing bodies dedicated to school wellness. 10,777 Head Start and pre-school children received oral healthcare with 27,234 services provided. Oral health services will continue beyond the grant cycle all over the service area through offerings by consortium member the University of Kentucky College of Dentistry mobile dental units. For the Kentucky Delta Rural Project initiated Delta Medication Assist Program: 840 clients were served through 7,208 client visits indicating multiple repeat visits. The estimated value of medications dispensed was $2,834,494. The cumulative estimated Rx distributed value since program inception in November 2003 is $7,580,897. 3,377 total clients have been served. The increasing estimated medications dispensed value and number of clients infer need and continued program utilization. Challenges & Innovative Solutions A few months before the beginning of the grant cycle, the previous Project Director was lost due to retirement. To circumvent extended learning curves, the Project had implemented cross-training in a previous funding period. The new Director was a former Specialist and had shadowed leadership in preparation for oversight duties in the event of planned or unforeseen absence of the Director. Two Project Specialists had to be replaced due to resignation. Fortunately, the new Specialists adapted well to their posts after training, allowing the Project to continue working towards its goals. Timing played a pivotal role regarding Project Specialist replacement. For both occurrences, the outgoing Specialist left during the summer months when Project activities were winding down for the school year. During the summer, staff reviewed all Project operations and made preparations for the upcoming year. This allowed the new Specialists to be grounded in Project operations through extended preparation meetings. During the final year of the cycle, the host agency Trover Health System merged with Baptist Health and became Baptist Health Madisonville. Knowledge of the merger at the impending stages stalled Project marketing efforts. Although the merger has been completed, the Project still awaits approval for ordering new marketing materials and proceeding with increasing visibility and familiarity 28

35 in participating counties. The Project plans to continue addressing this challenge should funding be approved for another cycle. Even so, there was no delay in Project services provided because the merger occurred during the final year of the funding period when services had been firmly implemented. Implementation of activities related to the focus area of school wellness was relatively smooth due to the longevity and familiarity of the Project with participating school staff. The only significant challenge was coordinating schedules with consortium member the University of Kentucky College of Dentistry who served students through mobile dental vans that operated throughout the service area. The Project solicited their expertise for presenting on proper dental care at its Delta Tour events in participating counties for elementary students. After deliberation, Friday was selected as the day for scheduling Delta Tours since staff and University representatives were available. The University representatives trained Project staff for the dental care presentation in case they were not able to make some events. Eventually, staff assumed the presentations solely and University representatives attended when available. Sustainability A. On-going Services and Activities The Kentucky Delta Rural Project presented anti-bullying awareness, intervention, and intervention training to students and staff within its sixty-five participating schools. Trainings through Project-hosted Champions Meetings and onsite in schools have been completed, and teachers are equipped to continue the offerings and better address bullying activity in their respective classrooms. Delta Tours would not continue without future funding, yet presentations covered at Tours were extended through follow-up trainings in schools. Hence, school staff would be prepared to continue wellness education offered at Tours ongoing. The largest ongoing activity promoted by the Kentucky Delta Rural Project was utilization of TAKE 10! curriculum in participating elementary school classrooms. TAKE 10! incorporates physical activity into classroom education. If future funding were not made available, TAKE 10! utilization in participating schools would likely continue for two reasons. 1) Materials that may be needed for future use are offered by the producers of TAKE 10! at a low cost of $82 per kit. 2) All participating schools have been trained on TAKE 10! with each having training materials purchased by the Project. Pending funding approval, KDRP will continue to promote TAKE 10! usage along with working to establish sustainable wellness committees in participating schools to address health and wellness needs. Fourteen TAKE 10! Clinics, or refresher sessions were held with 445 teachers receiving training. 64 of 65 participating elementary schools formed school wellness committees. Pending further funding approval the Project will prioritize formation, stabilization, and/or long-term school wellness committee activity for all 65 participating schools. With no further funding, the Project could not ascertain the exact number of committees that would continue. The Project estimates that 50% would likely continue with the other 50% uncertain. The goal for the grant cycle was to initiate wellness committees. With future funding, the Project plans to focus on strengthening the committees and fostering long-term sustainability through requiring more meetings, charting committee progress, maintaining updated rosters reflective of sub-groups with vested interest in schools, and wellness activity facilitation. The Project also initiated oral health education and offered oral health services for Headstart and pre-school students were offered by the University of Kentucky College of Dentistry (UKCD) through the use of innovation project funding afforded to the Project. The Project also partnered with the West Kentucky Child Health Coalition. The coalition has trained or will train school Family Resource Youth Service Coordinators (FRYSC) to conduct oral healthcare techniques to elementary school children in eight Delta counties. UKCD will continue offering the services even without innovation project funding after the end of the grant cycle. Although not a key focus area for the upcoming grant cycle, oral health education will be a presentation segment as part of the overall wellness education approach of Delta Tours to educate students, promote the Project, and complement anti-obesity efforts. The KDRP Delta Medication Assist Program will be continued beyond the grant cycle. Participating sites have approved licensure beyond the end of the grant year. If KDRP were not able to provide licensure going forward, participating sites will likely continue because costs are less than $1,200 per site compared to the $944,771 average value of medications dispensed per site over the past three years. B. Sustained Impact Kentucky Delta Rural Project efforts in schools do not lend themselves to traditional standards of measurement. The Project cannot solely attribute reductions in obesity, improved dental health, or decreased bullying activity to its activity. Efforts fit into an overall approach to improved school wellness and thus, the Project focuses on the improved culture of health in schools with the 29

36 intent of students and staff taking ownership of their own wellness and the wellness of others throughout their lives. In attempt to measure sustained impact, the Project tracked activities requested by schools and the community. The primary reason the Project continued to offer Delta Tours was because they were requested by teachers. Teachers also inquired about when the Project would be hosting the next Champions Meeting. Therefore the activity was continued annually to offer school staff training and continuing education credit on various topics of importance as relayed by them. The Kentucky Delta Rural Project offered incentives for participation in TAKE 10! and wellness committee formation. The vast majority of the schools had limited annual budgets for fitness equipment of $1,000 or less. Even with those factors, teachers requested the Delta Tours and inquired about when the Project would be hosting the annual Champions Meeting when field staff made initial school contacts each year. Only one school residually inquired about when they would be getting their incentive each year. At every Delta Tour teachers expressed their thanks for the event and requested follow-up training and/or presentations on anti-bullying, internet safety/cyber bullying or oral health. Also, schools continued to address the status of TAKE 10! annually during wellness committee meetings with many requesting the Project to do refresher clinics for teachers previously trained and for new teachers. All suggested the value of Project activities as perceived by teachers who were essential in continuing to reach the student target audience. Changes in Kentucky laws have required schools to improve dietary offerings and physical activity programming. Teachers had limited time for new responsibilities due to strenuous curriculum requirements. Although mandated by law, numerous schools tended to initiate wellness activity on a minimum basis. As such, Kentucky Delta Rural Project efforts serve in a complementary capacity as school staff have limited time for new responsibilities. The primary role of Project field staff was to shoulder the majority of responsibility for activities and presentations while grooming school staff to assume responsibility for the long-term. The Project and its consortium members, University of Kentucky College of Dentistry and West Area Health Education Center, continue to serve on the Western Kentucky Oral Health Coalition and will collaborate on future oral health initiatives for adults and students. The Delta Medication Assist Program has a more measurable impact in providing usage figures. There were 840 clients served and 7,208 client encounters. The 7,208 client encounters prove program utilization and effectiveness through a vast number of repeat visits. With no marketing, the number of clients rose from 678 during the first year of the funding period, to 840 at the time of reporting in the final year of the grant cycle. The 162 client increase, coupled with high number of repeat visits, suggest significant utilization and importance for the three sites offering the prescription assistance. The $2,834,494 estimated value of prescriptions distributed far outweighs the $10,350 licensure expense. Implications for Other Communities Project experience and program outcomes may benefit other communities through knowledge of effective consortium building. Experience has taught Project staff that choosing the right consortium members enhances creative thinking and active participation. Members were chosen based on their location, target population served, reach throughout the service area and the level of complementary expertise to enact initiatives towards meeting Project goals. Additionally, consortium member capacity has been enhanced through ongoing collaboration set to continue beyond the funding cycle and sharing of productive ideas among all members. The Kentucky Delta Rural Project could benefit other communities through knowledge gained on the importance of offering programs that: 1) are requested by the target population; 2) do not overburden representatives to be trained for sustainability and long-term facilitation; 3) meet relevant needs; and 4) are economically and financially maintainable. Although the primary target audience was elementary students and school staff, the Project was able to collaborate with sub-groups within the school systems (i.e. Parent- Teacher Organizations, Family Resource Youth Services Coordinators, etc.) to reach parents and the community at large. Other communities could benefit from the Project approach of giving and receiving. In order to assist schools beyond the Project s goals, staff volunteered to assist with other school and community events such as Back-to-School blasts, end-of-year school wellness days, and community health fairs. This promoted school and community buy-in to assisting staff with meeting program goals. The Project also attained school staff input towards other activities through initiating school wellness committees to serve as boards for ongoing school wellness development. Finally, the Kentucky Delta Rural Project successfully initiated internal cross-training so that staff could better support each other to maintain fluidity of operation during staff member absence, emergencies or other planned or unforeseen events. 30

37 The Health Enrichment Network Organizational Information Grant Number D60RH08554 Grantee Organization The Health Enrichment Network Organization Type Non-Profit Address P.O. Box 566, Oakdale, LA Grantee organization website & Project Director Name: Donna H. Newton Title: Executive Director Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $531, August 2011 to July 2012: $531, August 2012 to July 2013: $531, Consortium Partners Parish Location Organizational Type Acadia Martin Petejean Elementary School School Allen Elizabeth Elementary School Oakdale Elementary Oakdale Middle School Oberlin Elementary Kinder Elementary Fairview Elementary Ascension Donaldsonville Elementary School Assumption Napoleonville Primary Assumption Community Hospital School Hospital Avoyelles Avoyelles Charter School School Cottonport Elementary School Bunkie Elementary Marksville Elementary St. Anthony School Moreauville Elementary Plaucheville Elementary Catahoula Ferriday Lower Elementary School Concordia Sicily Island Elementary School Evangeline Bayou Chicot Elementary School Iberia North Street Elementary Boys & Girls Clubs of Acadiana School Non Profit Iberville Iberville Math, Science and Art Academy School Jefferson Airline Park Academy School Lafourche Golden Meadow Elementary School WS Lafargue Elementary School School Plaquemine Belle Chase Primary School School Pointe Coupe Catholic of Pointe Coupe School St. Bernard JF Gauthier Elementary School 31

38 St. Charles St. Charles Community Health Clinic St. Rose Elementary FQHC School St. James Gramercy Elementary School School St. John West St. John Elementary School St. Landry Palmetto Elementary School St. Martin City of St. Martinville City Government St. Mary Raintree Elementary School St. Joseph Baptist Church School Faith Base West Baton Rouge Cohn Elementary School School All Parishes in Region B Libraries in each Parish Community Characteristics A. Area Louisiana Region B Acadia Ascension Avoyelles Concordia Iberia Jefferson Pointe Coupee St. Bernard St. James St. Landry West Baton Rouge Allen Assumption Catahoula Evangeline Iberville Lafourche Plaquemines St. Charles St. John St. Martin and B. Community description Childhood obesity is one of the most pressing public health threats facing Louisiana. Since 1990, Louisiana s obesity rate has increased from 12.3% to 30.7% and the cost of caring for obesity-related illnesses increased from $35 to $127 million resulting in a public health crisis in our state. Last year, 39% of the children participating in Louisiana s Service Region B (SRB) s Growing Up Fit Together had a BMI that categorized them as overweight or obese. The 21 parishes of SRB are linked together in a myriad of ways. They share a rich culture built around the waterways of the Delta as well as unique music and food. Their similar histories of a way of life lost to farming industrialization have placed them among the group on the list of the nation s most impoverished and poorly nourished regions. The diet in the Louisiana Delta includes 20% less fruits and vegetables, fewer dairy products, and more added sugar and calories from fat than the national average 1. The obesity epidemic explodes in the Louisiana Delta when it collides with factors such as poverty, failing housing, failed education and the disparity between food quality and supply. The student population of SRB is 51% Caucasian, 44% African-American and 5% Hispanic with the prevalence of obesity cutting evenly across all categories of age, gender, education, locale, and race. Louisiana data shows that statewide, 66% of school aged children receive free or reduced lunch. However, 71% 2 of children in SRB receive free or reduced lunch making them statistically more likely to be obese. 3 C. Need The Health Enrichment Network s Growing Up Fit Together curriculum offers the opportunity to intervene in the cycle of poor health that affects the children living in SRB. Preventing obesity during childhood is critical. Studies reveal that 40% of obese children and 80% of obese adolescents become obese adults. They also show that by the time an obese child turns six years old, his/her chance of becoming an obese adult is over 50%. 4 BMI data collected in GUFT classrooms found the prevalence of overweight and obese children in the Louisiana SRB is substantially higher than that of the national 1 Lower Mississippi Delta Nutrition Intervention Research Initiative (NIRI) 2 Agenda for Children. SY Trust for America s Health 4 William J. Klish, MD: The Obesity Crisis: The Epidemic, The Consequences, the Solution, Texas Children s Hospital, 32

39 average (31.9% national to 39% SRB). Data also shows that while 16.3% of children nationwide were considered obese, or having a BMI at or above the 95th percentile, 26.4% that were found to be obese in SRB. 5 In addition, Rural Healthy People 2010 identified oral health as number 5 in a top ten of rural health priorities. The prevalence of periodontal disease in young obese people has been found to be 76% higher than for normal weight individuals attributable to a decrease in raw fruit and non-potato vegetables, a decrease in calcium intake, and increase in intake of soft drinks and non-citrus juices. 6 Based on these dietary patterns both childhood obesity and cavities are nearly twice as likely to affect Americans with lower income, those with less education, and those of specific ethnic groups 7 - unfortunately a socio-economic sketch of those served by Delta State Rural Development Grant Service Region B (SRB). In response to these disparities, SRB elected to provide priority health services in the area of oral health. Focus Areas Children s Health Health Education and Promotion Oral Health Physical Fitness and Nutrition School Health Program Services Target Population Pre-school children School aged children - elementary School aged children - teens Caucasians African Americans Latinos Native Americans Uninsured Underinsured A. Description Growing Up Fit Together (GUFT) is a state-wide early elementary obesity prevention program. A curriculum has been developed that provides seven modules each for grades 1, 2 and 3. These modules, one presented each month, address important health education topics (e.g. heart health, food pyramid, oral health) all designed to support Louisiana Department of Education standards and benchmarks. Each of the seven modules offers a lesson plan and teacher activity sheets to reinforce all core subjects (i.e. Food Pyramid Module Math - Using Fractions to Calculate Serving Sizes). High stakes testing preparation has been integrated into lessons to assist over-extended teachers in easily including healthy lifestyles skills materials into their classrooms throughout the month. As another component of the Growing Up Fit Together curriculum, teachers are offered fidget-busting Five n Jive movement activities. Five n Jive is developmentally appropriate five minute movement activities designed to encourage teachers to engage students in daily physical activity in the classroom. A colorful chart is provided to each classroom to track their Five n Jive minutes and Program Coordinators offer encouragement and classroom awards for reaching goals. GUFT s school setting provides an ideal situation for promoting oral health offering an efficient and effective way to reach over 8,300 children throughout the 21 parishes of SRB and, through them, families and community members. Preschool through third grade is a highly influential period in children s lives when lifelong sustainable oral health related behaviors, as well as beliefs and attitudes, are being developed. 8 The final component of Growing Up Fit Together program is the existing in-school sealant and oral health education program; Seal-a-Smile, has made great strides that have resulted in; statewide collaborations with a diverse group of clinicians and community members (school systems, school based health centers, federally qualified health centers, Louisiana Office of Public Health and private dentists and hygienists) that have yielded; preventive screening and sealant services for 5,320 underprivileged Louisiana children, water system fluoridation for the rural City of Oakdale that serves 8,500 residents daily, GUFT oral health lesson taught to first, second and third grade classrooms in twenty-one parishes annually, and the distribution of tens of thousands of toothbrushes and toothpaste. 5 A Program Evaluation of Growing Up Fit Together. Prepared by Louisiana Public Health Institute (LPHI) Division of Evaluation and Research. New Orleans, Louisiana. January Mohammad S. Al-Zahrani, Journal of Periodontology May 2003, Vol. 74, No. 5, Pages , CA. Quintessence International. 2005; 36(6): "Dental caries and obesity in children: Different problems, related causes." 8 World Health Organization. The Status of School Health. Report of the School Health Working Group and the WHO Expert Committee on Comprehensive School Health Education and Promotion. Geneva: WHO,

40 B. Role of Consortium Partners The Health Enrichment Network (THEN) is a non-profit organization dedicated to access and education serves as GUFT s Lead Agency. The organization was founded in 1999 and its operations are overseen by an engaged board that represents a cross-section of the community it serves. Since that time THEN has captured over $5M in grant funds to bring a myriad of wellness services to rural Louisiana in keeping with its mission and vision statement. The Health Enrichment Network has assembled a strong Consortium to assist this obesity prevention program in providing necessary services throughout Louisiana s rural communities. The Louisiana Rural Health Association (LRHA) has served as a site agency and been a leader in providing educational and advocacy opportunities relating to rural health for its membership which is composed of individuals and organizations interested in making a difference in the quality of the health care delivery system for Louisiana's rural citizens. LRHA has been directly involved in school-based health initiatives since the inception of the Better Health for the Delta Initiative. They brought GUFT valuable experience in implementing school based fitness programs, community partnerships and development of grass-root programs. Bunkie General Hospital is a rural non-profit Critical Access Hospital serves as a site agency in Central Louisiana. Bunkie General Hospital (BGH) operates two Rural Health Clinics, Heart and Health Center and recently began a Diabetes Academy. Under new leadership, BGH has made large school community outreach efforts with a primary focus to improve the lives of individuals through prevention and education and to increase access to quality healthcare. BGH understands the concept of collaboration and the need to strengthen rural communities to take responsibility of obesity in their area. Louisiana Department of Health and Hospitals Oral Health Program is charged with providing oral health education and prevention services throughout Louisiana. Under the direction of the Oral Health Program are the state Fluoridation program, sealant program and the Louisiana Oral Health Coalition is assisted by OHP staff. OHP and THEN have developed a symbiotic relationship in which each offers its best resources to oral health projects in order to combine efforts and present dynamic oral health prevention opportunities for disadvantaged rural residents across the state. Louisiana Public Health Institute (LPHI) is charged with producing surveys, observation tools, and other data collection instruments aimed at the GUFT children and school-based populations for evaluation purposes. LPHI has been involved in school-based evaluations that have targeted various age groups and school environments for over 12 years. These four Consortium members along with lead agency The Health Enrichment Network were selected to bring together diverse health care providers including an association who is a leader in advocacy in rural communities, a state agency who contributes from the vast resources of the state, a health provider who understands health needs of rural communities and a nationally renowned research center who offers expertise in research and evaluation. Outcomes During the last six years, THEN has engaged consumers in all 21 SRB parishes in order to meet the target population s needs and create maximum impact on the obesity epidemic. In response to working with school boards, administrators, and teachers to integrate healthy lifestyle education into the classroom, THEN developed the Growing Up Fit Together curriculum that provides Louisiana Grade Level Equivalent and standardized test friendly lessons that now serve 4,300 at-risk 1 st 3 rd graders and their families each year and introduced classroom based activity breaks (Five n Jive). In addition to GUFT THEN was funded for an Innovation Grant that has monitored the daily activities of a representative sample of third grade GUFT students on a 24-hour basis for two week periods using the Body Media FIT Monitor as a collection tool. The findings were eye-opening for parents, school administrators and the GUFT team. Quantitative data shows: Average Daily MET (level of activity) is 2 - the same physiological demands as watching TV (Active MET = 3 Vigorous MET = 6-9 Very Vigorous MET = greater than 9) Over 65% of the student s entire day is sedentary Average steps per day is 10,863 (CDC recommends 13,000 steps per day to stay healthy) Average minutes/day spent at vigorous MET level = :16 minutes Average minutes/day spent at very vigorous MET level = :01 minutes, less than 1 minute! 86% of participant s parents were surprised at their child s data 75% parents wanted to see their child s school incorporate additional physical activity 34

41 In response to the tremendous need quantified by Innovation Grant findings GUFT has: 1. Engaged schools in 20 parishes in the GUFT program serving 4,300 students 2. Gathered 9,500 hours of biometric data on activity levels of SRB elementary students 3. Created healthier school environments with 65% of school personnel reaching GUFT goals and objectives 4. More than 3,000 students received dental screenings over the grant period receiving sealants, fluoride varnish and referrals for care through the GUFT Seal-a-Smile outreach 5. In excess of 4,000 elementary children have access to a myriad of oral health education tools provided by GUFT Oral Health Toolboxes placed in 10 schools During these last three years the GUFT program has seen significant changes in our Region s schools in the implementation and incorporation of healthy lifestyle changes. Over the grant period over 30% of our schools incorporated NEW policies to improve students health supported by an increase in physical activity minutes, new health education programs and incorporating GUFT activities in lesson plans. In addition to this quantitative evidence of the program s success, qualitative data from student, teachers and even school personnel end-of-year messages indicate changes in attitudes, perceptions and prioritization of GUFT ideals on a system level. Challenges & Innovative Solutions As Louisiana is in an era of budget cuts, teachers increasingly feel stretched and overburdened. Additional classroom activity (even if designed to meet standards and benchmarks) are often met with reluctance at the classroom level. GUFT worked in each classroom to incorporate teachers ideas and input in a highly valued way to create positive attitudes and boost implementation rates. GUFT Coordinators and staff have been eager to support teachers as they transition to a more health-centered curriculum and environment. The three GUFT Coordinators currently provide wellness support to all 21 GUFT schools in some capacity and their familiarity aid in the challenges of implementation. Sustainability A. On-going Services and Activities All participating schools have received GUFT classroom boxes for each 1 st, 2 nd and 3 rd grade classroom and training for their early elementary staff on its use and implementation in accordance with Louisiana Department of Education Benchmarks and Standards. These GUFT teachers are very familiar with the curriculum and how the program works, making them self-sustaining. In addition, mentors have been identified in each school to provide necessary support for new faculty members. B. Sustained Impact Over the grant period anecdotal evidence shows that GUFT schools were more aware of health and wellness as it affects both student health and academic performance. NEW health and wellness policies directly related to GUFT work was recorded at 30% of participating schools. These new attitudes and perceptions will provide sustained impact for years to come. Implications for Other Communities Schools are the ideal setting for children to exercise and eat healthy food, given the significant amount of time they spend there every day. The social scientist, Maslow, described children s basic needs. He said that physical health, safety, being nurtured and loved, and having a sense of positive self-esteem were all needed in order to learn most effectively. We all say that one has to be healthy to learn, but we forget that our children have to first learn how to be healthy and be given the opportunity to be healthy. The Health Enrichment Network s proposed Growing Up Fit Together both teaches and gives this opportunity to the children of Louisiana Service Region B. After the family, the school is the primary institution responsible for the development of young people in the United States. The GUFT curriculum was designed to be self-contained in classroom toolboxes and created to specifically to meet the needs of children in the Delta so that it would be easily transferrable to any school or group setting throughout the Delta States service area. 35

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43 Delta Health Alliance Organizational Information Grant Number D60RH08555 Grantee Organization Delta Health Alliance Organization Type Non-profit Address 435 Stoneville Road, Stoneville, MS Grantee organization website Project Director Name: Karen Matthews Title: President and CEO Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $631,235 August 2011 to July 2012: $631,235 August 2012 to July 2013: $631,235 Consortium Partners Partner Organization Location Organizational Type (town/county/state) Delta State University, MS Delta AHEC Cleveland, Bolivar County, MS University/AHEC MS State Department of Health, Delta Hills Greenwood, Leflore County, MS State health department Region I, II, and III Northwest MS Regional Medical Center, Clarksdale, Coahoma County, MS Hospital/clinic Diabetes and Metabolic Clinic University of Mississippi School of Jackson, Hinds County, MS University Pharmacy University of Tennessee, Hamilton Eye Memphis, Shelby County, TN University Institute Aaron E. Henry Community Health Centers Batesville (Panola County), Clarksdale FQHC (Coahoma County), and Tunica (Tunica County), MS Greenville Clinic Greenville, Washington County, MS Clinic Indianola Family Medical Group Indianola, Sunflower County, MS Clinic Sunflower Rural Health Clinic Ruleville, Sunflower County, MS Clinic Community Characteristics A. Area The TEAM Sugar Free project provides services to the following Mississippi counties: Attala, Benton, Bolivar, Carroll, Coahoma, Grenada, Holmes, Lafayette, Leflore, Marshall, Montgomery, Panola, Quitman, Sunflower, Tallahatchie, Tate, Tippah, Tunica, Union, Washington, and Yalobusha. B. Community description Located in the Northwest portion of the state, the 21-county service area is entirely rural, with agriculture and manufacturing as the primary sources of employment. In the MS Delta, February 2010 unemployment rates ranged from a low of 9.7 percent (Lafayette) 37

44 to a high of 23.1 percent (Holmes), and 16 of the targeted 21 counties had unemployment rates that exceed 15 percent. 1 Public transportation in the MS Delta is virtually non-existent. Most employed persons must commute twenty miles or more to work, while others travel even greater distances as the region's economic and jobs landscapes continue to undergo changes. In terms of healthcare- related transportation, many Delta residents report that they must pay someone else to transport them to and from doctor appointments. 2 Moreover, these trips often require between two to four hours roundtrip as the MS Delta has the highest health professionals shortage (HPSA) and is one of the most medically underserved areas (MUA) in Mississippi. Residents are forced to travel long distances to access medical care. Low levels of education attainment further complicate access as language and communication barriers are potential areas of concerns. Specifically, many illiterate adults, especially the elderly, are at increased risk for failing to comprehend and adhere to physician orders and medication regiments. C. Need In 2008, Mississippi's diabetes prevalence rate surpassed the national rate at percent (versus the national rate of 7.66 percent) (CDC's Behavioral Risk Factor Surveillance System). The diabetes death rate was 27 percent higher in the African American community compared to whites, and it was the fifth leading cause of death for African Americans ages 45 years and older. Diabetes was especially distressing among African American females at a rate of 15.8 percent followed by males at 12.3 percent compared to 10.4 and 9.3 percent among whites, respectively. These statistics are significant as Mississippi has the highest percentage of African Americans in the nation at 37.1 percent versus 12.3 percent nationally. Our target area, the 21- county Mississippi Delta region, African Americans make up over 50% percent of the population. It should also be noted that although the MS Delta's Hispanic and non-english speaking community is presently very small (just over 2%), preliminary census estimates predict these populations are growing, thus, culturally competent services will be in greater demand in the future. Focus Areas Chronic Disease Management: Diabetes Program Services Target Population School aged children - elementary School aged children - teens Adults Elderly Pregnant Women Caucasians African Americans Latinos Native Americans Uninsured Underinsured A. Description The primary purpose of the TEAM Sugar-Free ( TSF ) initiative is to develop, implement, and support an integrated, comprehensive, and sustainable system of diabetes management and prevention across the Delta region through an alliance of local communities, local providers, local hospitals, and local universities. The acronym TEAM stands for Training, Education, Access, and Management- which encompasses the methods by which we will help our residents avoid and control diabetes. The word team is also a concept referring to the collaboration needed between patients, families, and the network of providers, including physicians, nurses, nutritionists, and eye doctors. The sugar-free part of the name means 1) living a full and productive life free of the devastating impact of uncontrolled diabetes (aka sugar in our communities) and 2) embracing a lifestyle that is free of sugars, fatty-foods, and other unhealthy choices. The following services were provided through the TEAM Sugar Free Project: Clinical services including a vision screening program across six clinics for those at risk of developing eye diseases, and referrals to a medication therapy management program in pharmacies throughout the service area; 1 MS Employment Security Commission: Labor Market Data Publication, February Available online at Retrieved [4/10/2010]. 2 Mississippi State University, Social Science Research Center: Health Assessment

45 Comprehensive community-based educational programs including health screenings (blood glucose, blood pressure, BMI, and A1Cs), diabetes self-management and prevention education, foot care education, exercise classes, and nutrition education; Community-based partnerships to support grass-roots programs designed to support diabetes and obesity education programs; and Clinician training on American Diabetes Association Standards of Care. B. Role of Consortium Partners Delta State University, MS Delta AHEC The Delta AHEC and the Delta State School of Nursing (SON) has provided coordination and delivery of several services related to diabetes and obesity prevention and education. Their role is to provide health screenings in community settings by utilizing SON students, providing them with field experience. They have partnered with various agencies to provide workshops on the ADA Standard of Care to clinicians throughout the service area. They are also working to provide a parent-child centered obesity education program called SHAPEDOWN in July Mississippi State Department of Health (MSDH) MSDH s role has been to provide evidenced-based prevention education through health clinics throughout the service area. Education on obesity prevention and nutrition, with a diabetes focus, were implemented. Also, MSDH provided referrals to other TSF programs for a continuum of diabetes related services to meet the needs of patients. University of Mississippi School of Pharmacy In partnership with the University of Mississippi s School of Pharmacy and the Delta Health Alliance s BLUES Better Living Utilizing Electronic Systems Beacon Project, TEAM Sugar Free supported the Medication Therapy Management program which aimed to provide drug regimen review, screenings, and education and medication management to patients. University of Tennessee (UT) Hamilton Eye Institute The role of UT s Hamilton Eye Institute is to provide vision screening services to patients at various partnering clinics, in an effort to detect and prevent the onset of diabetic retinopathy and other eye diseases through the use of VISUCAM eye cameras. Partnering clinics are Aaron E. Henry Community Health Center (Batesville, Clarksdale, and Tunica locations), Greenville Clinic, Indianola Family Medical Group, and Sunflower Clinic. Outcomes Summary of Outcomes August 1, 2010-April 30, 2013 Category Year 1 Year 2 Year 3 Total as of April 30, 2013 Number of People Served, Unduplicated Number of A1C Screenings Number of DR Camera Screenings Number of Patient Encounters (for non-screening services) Number of patients enrolled in Patient Care Management Program Number of Clinicians Receiving Education or Training Number of Community Based Events Number of Delta residents receiving health education or training Number of Technical Assistance Sessions by DHA to community partners

46 Number Served by Subcontractor August 1, 2010-April 30, 2013 Agency Year 1 Year 2 Year 3 Total Delta Health Alliance MS State Department of Health DSU/Delta Area Health Education Center Northwest Mississippi Regional Medical Center University of Tennessee, Hamilton Eye Institute A complete evaluation will be completed in August 2013 on this project which will address outcome measures as it relates to changes in clinical measures, knowledge, and attitudes of participants throughout the three year project period. Self-management education pre/post screenings and the results of the DR camera screening exams will provide the bulk of outcomes to be evaluated. Program activities are still ongoing at this time. We will be able to provide more detailed findings on outcomes in the Close-out and Evaluation Report to be completed after program activities end. Challenges & Innovative Solutions Staffing shortage Delta Health Alliance (DHA) experienced staffing shortages at various times throughout the project. In 2010, an assistant project manager and nurse educator were hired to assist the project manager in the planning and implementation of program activities. We found it impossible for one nurse educator to cover 21 counties, so in 2011 two additional nurse educators were hired. In early 2012, leadership of the project changed hands and the assistant project manager moved into the project manager role. In September 2012, we lost three staff (two resigned and one was laid off due to the elimination of their other salary support source), and had to restructure the responsibilities of staff. These changes caused some delays in program implementation. Staffing shortages also affected our consortium partners and impacted their provision of services. Several eye camera clinics experienced a staffing shortage in Year 1 of the project which led to a decrease in image scans conducted for the Eye Camera Project. Other consortium partners also experienced staffing shortages early on, which delayed program activities in some cases. The project team worked closely with partners to identify solutions. For the eye camera clinics, we offered to hire and train DHA staff to provide screenings in clinics until they were able to train and hire full-time staff to conduct screenings. This solution proved to be the best option, and we experienced an increase in screenings across sites where we placed DHA personnel to conduct screenings at least once a week. For consortium partners who experiences staffing issues, they still struggle with staffing shortages which impeded implementation of program activities at various times throughout the course of the grant years, despite increased technical assistance and monitoring by program staff. Delay in reaching targeted participant numbers in Diabetes self-management education classes and other community events Aside from staffing shortages, we have experienced a number of other factors that have challenged the progress of establishing ongoing diabetes education classes and services in communities. While we conducted marketing of programs early in the grant period, we initially saw low participation in our diabetes classes. Classes were initially advertised by placing flyers in community centers and high traffic areas, and placing ads in local newspapers. When we continued to see a lack of participation, we reached out to our technical assistance advisor at Georgia Health Policy Center who recommended that we train our staff on coalition building. In July 2011, TSF staff participated in a Coalition Building and Community Collaboration training which helped our nurse educators expand their skill set to serve in the role of a community outreach worker. Thanks to this training, our nurses learned new techniques to engage potential participants and we witnessed an increase in diabetes class participants the following quarter. Transportation was one of the biggest challenges hindering participants from entering our classes. There is not an existing public transportation system that is widely available of all people in our service area. For some participants who had cars, the cost of gas was a problem. For those without transportation they had to find a ride to our programs or pay someone to transport them, which proved to be a challenge for many. Aside from referring eligible participants to a few local transportation services, we were not able to do anything further to address this issue. 40

47 Lack of Community Resources Due to the resource make-up of our service area and the shortage of diabetes resources during the time of our award, the TEAM Sugar Free program addressed the lack of available resources in the following ways: Networking Award Program: In an effort to provide more services throughout the 21 county service area and increase the accessibility of available resources, TEAM Sugar Free provided a networking award program in which we funded four local community organizations to provide diabetes-related services in four counties throughout the service area: Leflore, Marshall, Tate, and Washington counties. Through this seed money, free community education and screenings were provided to a total of 1,675 people who might not have otherwise received these services. Getting2Great Fitness Center When approached by our partner Northwest MS Regional Medical Center about the need for a fitness center for patients of their diabetes self-management education classes to attend for free to help prevent obesity or maintain healthy BMIs, TEAM Sugar Free staff wanted to support this endeavor by supplying $25,000 to go toward the purchase of exercise equipment for the center. Thanks to our donation in 2011, we were able to provide exercise equipment for patients at the fitness center that would assist them in properly managing diabetes and reducing further complications that could result from lack of exercise. Eye Camera Program In an effort to increase the number of people who are at-risk for developing diabetes retinopathy who receive an annual eye exam, TEAM Sugar Free partnered with the University of Tennessee s Hamilton Eye Institute to purchase and install VISUCAM eye cameras in rural clinics throughout the service area. Partnering clinics helped us to establish the Eye Camera Program to provide free screenings to people at risk for developing eye diseases. Diabetes Self-Management Education Classes While insured patients are able to go to certified self-management education classes, usually connected with a hospital or clinic, under and uninsured patients are often left with nowhere to go for free, comprehensive education. TEAM Sugar Free addressed this issue in two ways. In 2011, TSF nurse educators began providing diabetes self-management and prevention education classes and workshops in six counties throughout the service area. These classes/workshops were free and open to the public. We also provided funds to allow under and uninsured patients to receive education and other services at the Diabetes and Metabolic Clinic at Northwest MS Regional Medical Center, one of the few certified programs in the region. To date, hundreds of people have received education in our classes, and thousands of under/uninsured patients have received education and assistance in the clinic. Sustainability A. On-going Services and Activities Diabetes Self-Management Education at the Diabetes and Metabolic Clinic, Clarksdale, MS After the grant ends, diabetes self-management education will continue to be provided to patients at the clinic at Northwest MS Regional Medical Center. However, at this time, funds are very limited to cover under and uninsured patients to attend the program. Program staff continue to search for additional funding sourcing in an effort to continue this program. Eye Camera Project Participating clinics have the option to keep the eye camera and continue the program in-house after July. TEAM Sugar Free partners with the Delta BLUES Beacon project, another Delta Health Alliance initiative, which will support a DHA eye camera technician and technical assistance to clinics through the end of September. We will provide diabetes educational materials to partnering clinics in an effort to provide additional resources that can be utilized after the project ends. B. Sustained Impact Thanks to our program efforts, we have seen individual level change in our participants, many of which who have reported reduced A1C numbers and improved daily blood sugar readings. Our self-management classes were designed to empower participants and give them a sense of ownership and responsibility of their diabetes and overall health. It is our hope that this approach enables them to continue to make sound health choices to reduce hospital visits and the development of complications. We have had 41

48 participants report that they are asking more questions at their doctor visits, cooking healthier meals at home, and sharing their knowledge gained from classes with friends and family with diabetes. Due to the ADA Standards of Care trainings provided and Medication Therapy Management sessions provided, clinicians and pharmacists have a better understanding of how they can better serve their diabetic patients, which can positively impact patient and doctor relationships, a patient s clinical indicators, proper medication usage, and treatment plans. Thanks to the work of TEAM Sugar Free staff, partners and countless entities supporting diabetes work across our state, diabetes is now at the forefront of chronic disease discussions, and more is being done to influence system level changes. TEAM Sugar Free staff have participated in numerous system-level discussions at the local and state levels sharing our work and outcomes with people from various entities through the Diabetes Coalition of Mississippi. Through our presence in this coalition, and a continued presence beyond the close of the grant, we will be able to share lessons learned, discover available resources for patients, and influence state-level action and policy change in the fight against diabetes. Implications for Other Communities The Delta communities we serve are very similar to many communities throughout not only the United States, but the world. Wherever there is a lack of medical care, transportation, broken education systems, high rate of under/uninsured people, and a high rate of chronic illness, programs serving those areas could benefit from the knowledge TEAM program staff gained from implementing this program. Through this program, we learned that free services do not necessarily mean filled seats and high participation. People in smaller communities believe heavily in relationships, and it has taken relationship building and trust to reach partners and participants. 42

49 Jefferson Comprehensive Health Center Organizational Information Grant Number D60RH25759 Grantee Organization Jefferson Comprehensive Health Center Organization Type FQHC Address 225 Community Drive Fayette, MS Grantee organizational website Primary Contact Information Name: Shirley Ellis-Stampley Title: Project Director Phone Number: Fax Number: address: Project Period Funding Levels August 2010 to July 2011: $510,000 August 2011 to July 2012: $510,000 August 2012 to July 2013: $510,000 Consortium Partners Partner Organization Location Organizational Type HSIY Health Network Rolling Fork, MS Hospital South Central MS Health Network Port Gibson, MS FQHC Teen health Network Mendenhall, MS Community Foundation Southwest MS Health Network Fayette, MS FQHC SMO Health Network McComb, MS Community Foundation Community Characteristics A. Area The grant-funded program served the following counties in the Southern Delta region of Mississippi: Sharkey, Humphreys, Issaquena, Warren, Claiborne, Jefferson, Copiah, Franklin, Adams, Wilkinson, Yazoo, Amite, Lincoln, Walthall, Simpson, Covington, Jefferson Davis, Lawrence, Pike and Marion. B. Community description The service area consists of twenty rural Delta counties in the southwest corner of the state and the primary target population involves medically indigent residents living below the federal poverty designation. C. Need This population suffers disproportionately high rates of chronic health diseases such as heart disease and diabetes, as well as teen pregnancy and lack of access to prescription drugs, which are the primary health issues addressed by this program. Therefore, MS SHINE is well-positioned to effect significant positive impacts on the health status of the region. Focus Areas Access: Primary Care Chronic Disease Management: Cardiovascular Chronic Disease Management: Diabetes Chronic Disease Management: Other Pharmacy Assistance Program Services 43 Target Population School Aged-Elementary School Aged-Teens Adults Pregnant Women Caucasians

50 Teen Pregnancy Prevention African Americans Uninsured Underinsured A. Description The primary programmatic focus of the MS SHINE Project is addressing the high prevalence of chronic disease within the target population. A wide variety of initiatives involving health education and promotion, as well as direct service and referrals, are conducted in response to this need. The MS SHINE project is a Network of Network model. All program efforts were implemented in 20 counties by the five local health networks that make up MS SHINE. All local health networks/consortium members will continue to be engaged in such efforts to combat chronic disease within the target population. Each local health network developed a 12-month plan to deliver health education, prevention, and chronic disease services to the local population. Examples of activities conducted as part of this goal include community health fairs, free screenings and referrals to services, exercise and nutrition initiatives, promotion of national health observances, and various health-related presentations and workshops. Many of the activities are planned and coordinated by community encouragers. Community encouragers are trained to provide health education and outreach, and also serve as local coordinators for community-based events such as health fairs and seminars. They also network with community encouragers for other MS SHINE networks and share program ideas and resources. Pharmacy assistance services were primarily targeted to medically indigent residents who have been diagnosed with one or more chronic disease conditions. Coordinated assistance and patient counseling was provided to qualifying clients to apply for and secure no-cost prescriptions through various pharmacy industry patient assistance programs. Since effective management of chronic conditions often involves medication therapy, this serves to directly extend the impact of activities. High teen birth rates contribute to several negative population health indicators, as well as poor socioeconomic conditions. These include high rates of infant deaths and low birth weight birth, as well as increased rates of poverty. Through the MS SHINE Project thousands of encounters are logged each year as part of this effort mitigate the negative health and social impact of teen pregnancy. Life skills curriculum are presented in partnership with several local school districts, community events are conducted to promote adolescent health, and partnerships are maintained with local crisis pregnancy centers to further assist young people facing unplanned pregnancies. B. Role of Consortium Partners Project partners met throughout the funded period through conference calls and meetings during the grant period. Responsibilities included attending, or ensuring agency representation at Consortium Meetings, and providing input and advice to the Jefferson Comprehensive Health Center as the lead agency throughout all stages of project development and administration. Each partner developed a group of local organizations for the purpose of cultivating a local health network comprised of three or five counties. The local networks in turn implemented an array of activities in their counties. Partners agreed to comply with any restrictions regarding the use of grant funds and/or any special terms and conditions set forth by the funding agencies. Outcomes Through the efforts of the Network Partners, services were provided to 52,638 people. Services included health education, disease prevention activities, chronic disease management, teen pregnancy prevention instructions and pharmacy assistance services. For example, pharmacy assistance for one quarter was provided to 411 patients, generating 683 prescriptions, which resulted in $292, in saving to those patients. Our twenty counties have trained community encouragers who are now active in their communities as a result of this project. This project has successfully established and continues to coordinate and encourage communication among all area health outreach workers, and opportunities for networking with their peers. Challenges & Innovative Solutions High rates of obesity are strongly correlated with increased prevalence of various chronic diseases. Limited access to a regular source of primary care also negatively influences health status. Additionally, high rates of poverty and limited to no health insurance coverage 44

51 further contribute to high rates of disease. The service region suffers with limited availability of health services. By empowering local networks of community agencies to address these problems, MS SHINE is working to meet the information and service needs of people where they are and building the capacity of local organizations to provide education and improve knowledge and behaviors of residents. Sustainability A. On-going Services and Activities As demonstrated in previous years, the primary aim is to provide health services and programming regarding chronic disease, pharmacy access and teen pregnancy prevention to a total 15, 500 residents annually. The impact of this project on the service areas is great since most residents experience limited access to preventive, primary, and educational services. The pharmacy assistance program, teen pregnancy, health education and primary health care service are services that will be ongoing. B. Sustained impact The community encouragers that have been trained through this project will continue to impact the health of their communities through their individual and collaborative efforts. They have experienced the value of networking with peers, and will continue to utilize resources they have identified through project activities. Implications for Other Communities The project result and programmatic success were disseminated first internally among local and regional network participants. This was accomplished through communication and information sharing that is a key feature of all MS SHINE meetings and interactions. The results were shared statewide and across a broader region through participation with other similar programs and projects. As the regional lead agency, JCHC has promoted the project to a larger audience through data summaries, written reports, and professional networking. Finally, JCHC/ SHINE staff participated in national discussion through Delta grant meetings and interactions. JCHC remains eager to share details regarding program design, administration, and results. It is believed that the network infrastructure and specific program design elements have proven successful and have application within any community or setting with similar needs. Virtually every county or community has resources that could be better coordinated are networked to increase project efficiency and scope. 45

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53 Big Springs Medical Association/Missouri Highlands Health Care Organizational Information Grant Number D60RH08551 Grantee Organization Big Springs Medical Association/Missouri Highlands Health Care Organization Type FQHC Address PO Box 157 Ellington, MO Grantee organization website Project Director Name: Sherilyn Clark Title: CEO Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $487, August 2011 to July 2012: $487, August 2012 to July 2013: $487, Consortium Partners Partner Organization Location Organizational Type (town/county/state) Whole Health Outreach Ellington, Reynolds, Mo Faith based Whole Kids Outreach Ellington, Reynolds, Mo Faith based Douglas County Health Department Ava, Douglas, Mo Health Department Southern Missouri Community Health Center West Plains, Mo FQHC Community Characteristics A. Area Douglas, Texas, Shannon, Oregon, Carter, Reynolds, Wright, Ozark, Howell, Butler, Ripley, Crawford, Phelps, Dent, Iron Counties B. Community description Our communities are characterized by high levels of poverty, limited access to health care and long distances between healthcare facilities. When we were awarded this Delta grant, poverty was 200 percent below the Federal poverty level in our service area. Poverty is generational and leads to lower education levels and a lack of understanding about the importance of health care. Our providers are challenged to maintain services while trying to educate patients on the importance of preventive health care. Our geographic distance prevents many patients from receiving primary and specialty care for chronic diseases. C. Need Our Delta States program was designed to address the health care issues that our area faces because of the geographic challenges. We did this by transforming practices to a Patient Centered Health Home (PCMH) model. Each Delta partner played an important role in this transformation by providing support services, (both financial and educational). In the PCMH model, chronic disease is the main focus. Several of the partners participated in training through Missouri Highlands so they are better equipped to serve their clients. 47

54 Program Services Focus Areas Access: Primary Care Access: Specialty Care Aging Behavioral/Mental Health Chronic Disease Management: Cancer Chronic Disease Management: Cardiovascular Chronic Disease Management: Diabetes Chronic Disease Management: Other Community Health Workers Coordination of Care Services Health Education and Promotion Health Information Technology Health Professions Recruitment and Retention/ Workforce Development Maternal/Women s Health Oral Health Pharmacy Assistance Physical Fitness and Nutrition Teen Pregnancy Prevention Target Population Infants Pre-school children School aged children - elementary School aged children - teens Adults Elderly Pregnant Women Caucasians African Americans Uninsured Underinsured A. Description A multi-county consortium jointly addresses the unmet local health care needs and unmanaged chronic disease. These services were provided through the delivery of preventative and clinical health services, practice management, increased access to prescription drugs for the medically indigent and developing a Patient Centered Medical Home (PCMH). The consortium partners shared resources and provided opportunities to improve practice management and complement each other s work and organization. Improving access to preventive and clinical health services for individuals with chronic disease in our underserved populations has been the key area of focus. Each partner works to strengthen his or her existing programs through learning and information exchange among the programs, increasing the number of staff trained to recognize chronic disease using evidence based program, and focusing on team-based care. The PCMH model is a team-based approach to health care that helps patients manage chronic disease, create treatment plans, and set goals for their health care. Missouri Highlands and Southern Missouri Community Health Centers transformed practices to the PCMH model. Some of the areas focused on include: diabetes, COPD, asthma, cardiovascular issues, smoking cessation, and obesity. The two FQHCs also offer patient assistance with medication. This program helps support the patient by lowering the cost of prescription medication which allows them to be more compliant with their medications. Through the implementation of the PCMH model, we transformed our practices at Missouri Highlands and Southern Missouri Community Health Center to be a team approach to health care. The teams consist of the medical provider, Behavioral Health Consultant, RN Care Managers, Care Coordinator and the Case Managers. The RN Care Managers and Care Coordinator worked closely with all providers that needed to be involved in a patient s care. The RN Care Managers and Case Managers also worked closely with community agencies, including the Delta States project partners, to coordinate care with community organizations. As patients are referred to specialists or community organizations, the Care Coordinator works to track those referrals, making reminder calls to the patients, and tracking consult notes from those providers. In addition, Southern Missouri Community Health Center was able to employ a Pediatrician and an Internal Medicine Physician. This increased access and provided pediatric services to children who utilize that health center. Douglas County Health Department has been successful in creating a technical assistance network for the nine county health departments and the other Delta partners. Their technical assistance activities include strategies to improve practice efficiency and sustainability, development of activities related to achieving accreditation, and other areas of need identified through a survey of public health administrators. Reynolds County Health department, in partnership with Whole Health Outreach presented a program called Children of Light to increase the awareness regarding child abuse in our region. Whole Kids Outreach worked with families in a multi-county area to provide in-home services to families facing social barriers, assist them in accessing health care and offer education to parents of newborn babies in an effort to reduce infant mortality rate. Whole Kids Outreach also works to reduce the teen pregnancy rate and the occurrences of sexually transmitted diseases. 48

55 Whole Health Outreach works with the elderly in their homes in a variety of ways. They provide education through the HealthWise program, offer exercise programs to the elderly in several counties, and connect the elderly to community organizations. Whole Health Outreach also has staff that provides training to elderly through the Stanford Chronic Disease model to manage pain and chronic disease processes. B. Role of Consortium Partners Missouri Highlands: The Project administrators worked with members to implement and evaluate the Delta States grant project activities; held quarterly meetings and conference calls on a monthly basis; and implemented a PCMH focused on improving chronic disease, engaging leadership, QI strategies, evidence-based care, access, empanelment, and care coordination. Southern Missouri Community Center: Implemented a PCMH model, addressed clinical needs, patient preventive health behaviors education, and chronic disease management using a Plan-Do-Study-Act cycle Whole Kids Outreach: Offered programs to strengthen the family unit, exercise programs to prevent obesity in children Whole Health Outreach: Provided exercise groups for senior adults, screening activities for groups, and developed community gardens Douglas County Health Department: convened a multi-county network of administrators from nine public health departments, provided technical assistance activities that included strategies to improve practice efficiency and sustainability, developed activities around accreditation Outcomes Missouri Highlands Health Care (MHHC) continues to experience an upward trend in patient clinical outcomes as a result of changes to service delivery and education. Currently, the diabetes measure of A1c controlled, is at 40% which aligns with the state goal. Additionally, the number of patients having an A1c performed has increased, due in part to the care coordination efforts of the patient s care team. Cardiovascular disease (specifically, hypertension) outcomes remain at or above the state goals; MHHC reports that 66% of patients with hypertension have blood pressure in control. In terms of mental health, patients are benefiting from the integrated behavioral health services available at the primary care clinic. Patient outcomes in terms of chronic diseases tend to improve with the behavioral health interventions. Patient satisfaction surveys are a tool used to determine the changes in knowledge or attitude toward chronic disease. Patients of MHHC often respond positively to the coordinated services available as part of the Patient Centered Medical Home. There may be a decreasing stigma associated with behavioral health interventions, as it becomes part of the services available at the primary care clinic. Southern Missouri Community Health Center has received Level Three accreditation from the National Committee for Quality Assurance for their PCMH. Challenges & Innovative Solutions Building and maintaining positive relationships among multiple partners located in a large geographical region during uncertain future of health care was a challenge. There were a lot of changes during the grant period - the Affordable Care Act deliberations in Washington, the cuts in funding at the state level, etc. The roles and responsibilities for each partner in the present Delta grant presented the partnership an opportunity for challenging the group to focus on leadership and the role each plays in these difficult times. Organizations often build themselves as independent agencies with a particular set of goals and mission that they operate under. Breaking down the barriers to allow those organizations to partner with other organizations, while respecting each organization s mission, was a challenge, but one that we overcame. The partnership meetings served as a vehicle to process this conundrum and make a renewed commitment to one another and the population they served to continue their work together. They recognized as individual organizations that they had little control over these situations. However, as a group they could continue to support one another and use their individual and organizational resources to this end. This has resulted in a continued opportunity for the partnership to enhance activities and strategies of each organization 49

56 with support from the group. This is an intended consequence of partnership building and sustainability that has resulted in strengthened relationships. Sustainability A. On-going Services and Activities PCMH is an initiative that will be on-going. We will expand a version of the PCMH model to select number of schools in our service area. By doing this we will educate elementary children on healthy eating habits in order to control weight and other health issues. In addition, we will expand our patient education efforts by engaging the schools in a population based health literacy strategy that we expect will increase the numbers of families we can reach and include in the PCMH. Chronic disease management training will continue to be offered to the Delta partners and other organizations in the area. We are exploring the addition of Integrative Pain Management in our health services model. Whole Health and Whole Kids Outreach will continue their programs on community based care coordination for kids and seniors with an additional focus on families. We will continue to help these critical service providers identify and seek funding sources. Whole Kids Outreach was awarded a grant through the Children s Trust Fund (CTF) to continue services such as parenting education, home visitation programs to address education, employment, health and abuse/neglect prevention programs. Whole Kids Outreach was also awarded a contract from Dept. of Social Services for Missouri Home Visiting Program for a six county area. As the Affordable Care Act is implemented we will adopt our reimbursement model to reflect the manner in which money will flow to health services during this next period of uncertainty. We are currently undergoing financial modeling to determine how our rural health organizations will operate in a bundled payment system. This has intended and unintended consequences on all public health, human services and health care organizations. The Partnership has made this conversation a priority for learning over the next couple of years. B. Sustained Impact By seeking accreditation from the National Committee on Quality Assurance for PCMH, Missouri Highlands and Southern Missouri Health Centers will continue to use technology to better manage patients, improve communications with patients and access resources. Through PCMH we are using our EMR systems to better monitor needed testing, preventive care, and create board approved standing orders to improve clinic flow. The Patient Portal being developed will support the patient self- management component to our team based care model. We have included behavioral health counselors in our primary care setting looking how we integrate with other community resources through our connected care strategies developed through the Delta partnership. Three of Missouri Highland s staff became trained as Master trainers in the Stanford Model and will continue to train Delta partners as well as other organizations as interest is expressed. As a result of the implementation of this model, we will continue to see improved outcomes for chronic disease management in our communities. Our regional Public Health Departments have achieved accreditation through the National Association of County and City Health officials (NACCHO) as a result of our partnership. They have developed public health strategies that reflect collaboration and resource sharing for a larger segment of the population beyond individual catchment areas to maximize their efforts through sharing of resources. Implications for Other Communities A key lesson learned that may benefit other communities is the manner in which we organized our partnership. In 1999, we applied a Community Health Development strategy called the Partnership Approach with Michael Felix, a nationally known CHD specialist. The Partnership Approach is a phased CHD strategy used to organize community based resources in a collaboration to produce community based solutions to local health related issues and needs. The PA included individual interviews with regional stakeholders to learn about interest, needs and opportunities. We conducted community discussion groups throughout the region with consumers, providers and community leaders to determine interest, needs 50

57 and opportunities. We collected and analyzed secondary population health information, health marketplace data, and performed a resources analysis. We invited all the key stakeholders to participate in the results of those activities and called it a health summit. After that meeting in which multiple stakeholders agreed to begin together, a follow-up set of meetings was conducted with the consumer, provider and leaders to lay out plans and to gain buy-in for the plans. The activity resulted in the Delta Partnership. Over the history of the Partnership we have continued to utilize the Principles of the Partnership Approach. From the ongoing mobilization of community based resources at both the grass roots level and leadership levels simultaneously, to the building of a rational democratic process for decision making and involvement and participation of people at all levels of our rural areas. Additionally, we have maximized our ongoing learning through this approach becoming a learning community and using the techniques to continually provide us with updated information and ideas while maintain an approach for connectivity to our communities and one another. 51

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59 Southeast Missouri Health Network Organizational Information Grant Number D06RH Grantee Organization Southeast Missouri Health Network Organization Type FQHC Address 420 SEMO Drive, New Madrid, MO Grantee organization website Project Director Name: Ann Lawrence Title: Grants Manager Phone number: Fax number: address: Project Period Funding level for each budget period August 2010 to July 2011: $308,025 August 2011 to July 2012: $308,025 August 2012 to July 2013: $308,025 Consortium Partners Partner Organization Location Organizational Type (town/county/state) Cross Trails Medical Center Cape Girardeau, Cape Girardeau County, FQHC MO Great Mines Health Center Potosi, Washington County, MO FQHC Missouri Delta Medical Center Sikeston, Scott County, MO Hospital Bootheel Counseling Services Sikeston, Scott County, MO Community Mental Health Center SEMO Community Treatment Center Potosi, Washington County, MO Out Patient treatment center Washington County Memorial Hospital Potosi, Washington County, MO Hospital St Francis Medical Center Cape Girardeau, Cape Girardeau County, Hospital MO Missouri Primary Care Association Jefferson City, Cole County, MO Non-profit organization dedicated to improving access to high quality, community based, and affordable primary health care in Missouri. Community Characteristics A. Area Bollinger, Cape Girardeau, Dunklin, Madison, Mississippi, New Madrid, Pemiscot, Perry, Scott, St Francois, St Genevieve, Stoddard, and Washington Counties B. Community description The thirteen (13) designated Mississippi Delta Counties in Missouri are located in the southeastern region of the state. The most southeastern 7 counties of the Delta Counties are called the Bootheel. The majority of the thirteen (13) counties are bordered by the Mississippi River, which has many residents located in isolated areas and prevents easy access to services to the East. Significant distances to major metropolitan areas are the case for most of the area with limited transportation being available to bring the patients to the clinics. The long term residents of Region B suffer from intergenerational poverty, low education levels, inadequate health care and unhealthy life style choices. This area has the largest rural minority population in the state. The Bootheel is considered an area of chronic disparity of health care delivery between the majority and minority populations. Poor 53