Health Progress - Fall 2022

JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES

HEALTH PROGRESS FALL 2022

CARE

COLLABORATIONS

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CONTEMPLATIONS FOR THE CATHOLIC HEALTH MINISTRY

INSPIRED BY THE SAINTS

A series of huddle cards depicting the lives of seven saints who represent the core commitments of CHA’s Shared Statement of Identity. Featuring original artwork from Lydia Wood, St. Louis-based artist and activist.

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FEATURE

CARE COLLABORATIONS

48 63106: NOT JUST A NUMBER, BUT A BARRIER TO HEALTH AND ECONOMIC EQUITY Sally J. Altman, MPH Illustration by Jon Lezinsky

DEPARTMENTS 2 EDITOR’S NOTE BETSY TAYLOR 58 COMMUNITY BENEFIT Raising the Bar for Equity and Community Health JULIE TROCCHIO, BSN, MS 60 FORMATION Responding to the Signs of the Times: CHA Launches On-Demand Foundations Leadership Program DIARMUID ROONEY, MSPsych, MTS, DSocAdmin 62 AGING Creating a New Paradigm for Aging: 10 Proposals and a Story — America’s Aging Future SR. DORIS GOTTEMOELLER, RSM 65 MISSION Engaging Community to Achieve Health Equity DENNIS GONZALES, PhD 68 ETHICS A Mission Guided by Prudence NATHANIEL BLANTON HIBNER, PhD 70 THINKING GLOBALLY Our Continued Call to Global Solidarity BRUCE COMPTON

Illustrations by Nathan Hackett 4 BON SECOURS ST. FRANCIS INTEGRATES STUDENTS WITH DISABILITIES INTO HOSPITAL JOBS Alex Garvey, PhD, and Jessica Weingartner, MA 12 WHAT IS THE HEALTH CARE UTILITY MODEL, AND HOW CAN IT TRANSFORM HEALTH CARE? A Q&A WITH SSM HEALTH’S LEAD FUTURIST CARTER DREDGE Austin Schafer, MA, BCC

31 POPE FRANCIS — FINDING GOD IN DAILY LIFE 72 PRAYER SERVICE

18 PARTNERS IN HEALING AT THE INTERSECTION OF MEDICINE AND MISSION Rex Hoffman, MD, MBA, and D.W. Donovan, DBe, BCC 24 FRIENDSHIP HOUSES, NEW CONNECTIONS: CHRISTUS HEALTH AND COMMUNITY PARTNERS WORK TO STRENGTHEN NEIGHBORHOODS Nadine Nadal, MPH, CPH, CHES 32 HEALTH FUNDER REFLECTS ON BEST GRANTMAKING PRACTICES Channon Lucas 36 SETTING THE TABLE FOR SUCCESS IN GLOBAL HEALTH WORK Susan Huber 41 THE POWER OF TEAMWORK: NONPROFIT CHANGES LIVES THROUGH FREE SURGERY MODEL Robin Roenker

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IN YOUR NEXT ISSUE

LIVING OUR CATHOLIC IDENTITY

46 UNLIKELY PARTNERS EMPOWERING HEALTH ACCESS Andrew Kruse and Susan Tippett

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EDITOR’S NOTE

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re you truly collaborative? If you spend some time thinking about what it means to collaborate successfully, you know it involves a complex set of skills. Collaboration, at its most basic level, involves working together toward completing a common task or shared goal. At its highest level, when collaboration succeeds, it leads to worthwhile reform, whether a better process at work, a safer living environment or improved health.

It’s not easy; it is rewarding.

The thing is, true collaboration is a challenge. It involves more than motivated people signing on to help out with something because they’re joiners or achievers. Our cover image shows how collaboration involves thinkBETSY ing about who should be at the TAYLOR decision-making table and then changing that table to include the necessary voices that you’re not hearing from. It involves listening and deep thinking about what you’re trying to accomplish. It involves unifying around reaching a shared end result, and knowing enough about the data, the best practices, the funding, the culture and the personalities involved to stay the course. Whew.

Not easy, but worth it.

This issue of Health Progress looks at care and community collaborations both inside and outside of health care settings. Some of the articles detail wonderful collaborations you may not have heard much about. Others may be more familiar but delve further into the specific

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processes for what has worked or been a stumbling block to true collaboration. There has long been the thinking that competition lies at the heart of improvement in health care. But several of the authors make a case for collaboration, that teams where people bring their individual strengths and talents can build toward a whole that will make a difference when tackling a problem or working for change.

Another lesson from this issue is that good collaboration sometimes requires saying “no.” No, that’s not where our focus should be. No, I don’t think this project uses my particular skills to the best advantage and use of my time. But it leads to the “yes” of where we’re trying to go, and how.

Here’s where our priorities are, and here’s why.

Here’s the metrics we’re trying to move and how we’re going to get there. Here’s where we need to reach people where we haven’t before, or here’s a service we’re adding to make people’s lives easier.

Because all that collaborative work ultimately can lead to new opportunities or improved systems for patients and others we serve. Collaboration can be messy; it can slow things down, but when done well, it can result in real and lasting good.

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VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON EDITOR BETSY TAYLOR btaylor@chausa.org

EDITORIAL ADVISORY COUNCIL Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

MANAGING EDITOR CHARLOTTE KELLEY ckelley@chausa.org

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana Gabriela Robles, MBA, MAHCM, vice president, community partnerships, Providence St. Joseph Health, Irvine, California

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OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress.

2022 AWARDS FOR 2021 COVERAGE Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, Second Place; Best Special Issue, Second Place; Best Layout of Article/Column, Second and Third Place; Best Color Cover, Honorable Mention; Best Guest Column/Commentary, First Place; Best Regular Column — General Commentary, Second Place; Best Regular Column — Pandemic, Second Place; Best Coverage — Pandemic, Second Place; Best Essay, First and Third Place, Honorable Mention; Best Feature Article, First Place and Honorable Mention; Best Reporting on a Special Age Group, Second Place; Best Writing Analysis, Third Place; Best Writing — In-Depth, Third Place.

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

CHA EDITORIAL CONTRIBUTORS ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA COMMUNITY BENEFIT: Julie Trocchio, BSN, MS CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD FINANCE: Loren Chandler, CPA, MBA, FACHE INTERNATIONAL OUTREACH: Bruce Compton LEADERSHIP AND MINISTRY DEVELOPMENT: Brian P. Smith, MS, MA, MDiv LEGAL: Catherine A. Hurley, JD MINISTRY FORMATION: Diarmuid Rooney, MSPsych, MTS, DSocAdmin MISSION INTEGRATION: Dennis Gonzales, PhD

Produced in USA. Health Progress ISSN 0882-1577. Fall 2022 (Vol. 103, No. 4).

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C A R E C O L L A B O R AT I O N S

Bon Secours St. Francis Integrates Students With Disabilities Into Hospital Jobs ALEX GARVEY, PhD Chief Sponsorship Officer for Markets and Shared Services at Bon Secours Mercy Health JESSICA WEINGARTNER, MA Director of Mission at Bon Secours St. Francis Health System

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ccess to employment that is both meaningful and productive is a key concept of Catholic social teaching. However, there is a recognized gap for young people who have cognitive impairment. While several programs assist this group to transition from school to work, many fall short. Project SEARCH is a school-to-work transition program designed to bridge this gap. It challenges the health care system, school districts and state supportive agencies to join forces to create an arena where human dignity flourishes, communities prosper and the hospital workforce experiences benefits. Participants are provided with the opportunity not just to live life, but to live life in abundance.

Through an effort to bring Project SEARCH to its Greenville, South Carolina, market more than five years ago, Bon Secours St. Francis Health System — through collaboration with community partners — provides an on-the-job hospital training program for high school-aged students with disabilities.

HOPE FOR AN UNCERTAIN FUTURE

For a parent of a child who has disabilities, one of their greatest fears is the thought of, “What will happen to my child when I am gone?” This is certainly not an unfounded worry. Young people with disabilities have a more difficult time securing employment following high school graduation than their peers without disabilities. This is especially true for young adults with autism spectrum disorder and intellectual and developmental disabilities. Students on the autism spectrum have some of the lowest employment rates in the years following high school, even among their peers with other types of disabilities.1 In Catholic health care ministry, we are called

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to “bring alive the Gospel vision of justice and peace” through a commitment to the principles of Catholic social teaching, including human dignity, justice and the common good.2 One of the core themes of Catholic social teaching is the dignity of work and rights of workers. In the Catholic social tradition, work is not just a means of obtaining the money required to support oneself and one’s family but is a way in which a person achieves fulfillment as a human being.3 One area where the Catholic health care ministry can contribute to “the dignity of the individual and the demands of justice”4 is through promoting avenues for meaningful employment for people with disabilities. This allows them new ways to be productive, flourishing and participating in the life of their community.

Each year, between 70,700 and 111,600 teens on the autism spectrum will transition from schoolbased supportive services into adulthood.5 A.J. Drexel Autism Institute’s 2017 National Autism Indicators Report found that only 14% of surveyed adults on the autism spectrum held a paying job

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Bon Secours St. Francis Health System

Project SEARCH-Bon Secours St. Francis program interns Marques Hughey, left, and Caitlin Kelly, right, take part in a team-building activity to learn what they have in common with each other.

in the community, and 15% worked in sheltered workshops, typically for less pay than community-based jobs.6 The students with the worst outcomes often have compounding vulnerabilities in addition to their diagnosis, including lower household income, difficult family situations and a family history of behavioral health conditions.7 The typical model of transition services for students with cognitive limitations involves a combination of special education classes with either simulated work environments or short-term community employment; however, the simulated work environment fails to help students meaningfully connect learned skills to the context of real, community-based employment.8 Improving poor employment outcomes requires providing ways to connect students with opportunities to have integrated, community-based work experiences, discover their passions and develop employment

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skills. One such program, integrated within the hospital setting, provides Catholic health care ministries the opportunity to live out our Gospel calling to promote the dignity and human flourishing of these young individuals.

In 1996, a program called Project SEARCH was developed at Cincinnati Children’s Hospital Medical Center that would not only enable young adults with autism and other disabilities to successfully transition from school to adult life, but would improve the hospital’s workforce as well.

Project SEARCH is a high school-to-work transition program for young adults with disabilities, with the goal of achieving competitive employment. Competitive employment is understood as part- or full-time employment, integrated within the community (for example, not in a sheltered workplace), with compensation at the same rate as other workers without disabilities. Students

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involved in the program have varying physical, intellectual and developmental disabilities, including autism spectrum disorder, intellectual and developmental disabilities, Down syndrome, hearing and visual impairments, and traumatic brain injury, among others. The program combines classroom training in employability, independent living and immersive job skills, which empower the students to develop both the hard and soft skills necessary for attaining and maintaining competitive employment.

PROJECT SEARCH AT BON SECOURS ST. FRANCIS

a workforce coordinator arranges unpaid internships. However, after the young people have the needed job skills and are hired, they earn the same pay as their peers. The Greenville County School District provides a full-time special education teacher and a skills coach, and South Carolina Vocational Rehabilitation Department provides a full-time skills coach and ongoing professional counseling as needed. Together, this core team provides immersive on-the-job training for students. Such placement is crucial to train interns to fill essential, high-turnover, entry-level positions within the hospital. Over the course of the school year, the students rotate through three 10-week internships in various departments throughout the hospital, such as linens, central sterile processing, patient transport, endoscopy and food services.

Bon Secours St. Francis Health System brought Project SEARCH to the Greenville market in 2016, joining the health system’s other programs in the Richmond and Hampton Roads regions in Virginia. Pope Saint John Paul II reminds us in Laborem Exercens that it is the responsibility of the entire One parent of a candidate recalled community to “pool their ideas the excitement of receiving the letter and resources” to achieve a critically important goal “that of acceptance by explaining, “When I disabled people may be offered work according to their capaopened the letter, I felt like I was opening bilities,” for this is demanded the golden ticket to Willy Wonka’s by their dignity as persons and as subjects of work.” 9 With Chocolate Factory.” that call in mind, Bon Secours St. Francis began to seek out Candidates with potential to succeed in the willing community partners. We quickly formed meaningful ministerial relationships with the program are nominated by special education Greenville County School District and the South teachers with the school district. Accompanied Carolina Vocational Rehabilitation Department by a parent or family member, the candidates — which prepares and assists eligible South Car- come to our site to undergo a skills test. The test olinians with disabilities to achieve and maintain is not designed to exclude candidates, rather, it competitive employment — to introduce this is to identify skill sets, create an entry point for program to our hospital and the Greenville com- placement, and best indicate which candidates munity. Both agencies were familiar with the pro- will excel in the program. After the selection is gram and delighted to join our health system in completed, the candidates are notified by a letthis venture. Program participants are either high ter sent to their home. One parent of a candidate school seniors or recent graduates from Green- recalled the excitement of receiving the letter of ville County School District, and most are or were acceptance by explaining, “When I opened the followed by South Carolina Vocational Reha- letter, I felt like I was opening the golden ticket to bilitation Department throughout their school Willy Wonka’s Chocolate Factory.” The feeling of careers. The program is also supported by the joy is shared across the community through social South Carolina Department of Disabilities and media posts, school system announcements and Special Needs, Able SC and Goodwill Industries. often a letter of praise from elected officials. The The collaboration between these agencies is the success of the program has had an incredible impact on the lives of the students, their families hallmark of the program’s success.

The program’s operating expenses are covered and the community we serve.

This model is successful because it provides through Bon Secours St. Francis’ mission department budget. It is housed in the hospital where not only on-the-job training, but a multitude of

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other tools for success — which go far beyond the necessary physical skills — required to achieve and maintain competitive employment. Through classroom instruction, the students learn independent living skills, how to manage their personal finances and essential self-advocacy skills.

The graduates can understand and advocate for their rights in the workplace, articulate their skills and limitations, and request appropriate job accommodations. In addition to general and specific job skills, the students learn how to navigate the employment process. The students leave the program having created resumes, completed job applications and interviewed for their positions.

The internships are not just assigned to each student, but the students must apply and interview for each rotation. As a result, students learn not only marketable job skills, but also how to look for a job, know what types of jobs they are qualified for, and come away equipped with the tools needed to be a successful employee.

UNDERSTANDING THE HUMAN ELEMENT

tions were simple, noted as: When the timer goes off, look at your phone and turn to the person on your right and ask the question. Often, the questions were: How was your weekend? What is your favorite football team? Why do you love this job?

This simple exercise helped Liam to break out of his shell and become comfortable communicating with and relating to his coworkers. Enacting such simple practices in the environment allows the intern to flourish and builds the trust needed for success.

The second component of success is twofold, one in how the interns both develop in a caring work environment and the other in how they change the entire culture of the organization. It is easy to witness how our interns are accepted and integrated with our frontline staff. The presence of the interns throughout the hospital is a hardwired part of the organization. Once the interns are ingrained in their roles, they become part of this team. Often high-reliability, high-functioning departments that welcome an intern express the greatest associate satisfaction scores. They are welcomed in birthday parties, invited to staff lunches and fully integrated with their coworkers. For many interns, outside of their families, this is the first time they have ever functioned in a highly inclusive culture. Working alongside other hospital employees as equals provides a safe environment to learn and develop the soft skills required to flourish in community-based, integrated employment.

Perhaps the greatest impact on interns is to their self-confidence and personal growth. Unfortunately, many students come from a school environment where they are marginalized at best, and actively bullied at worst. Therefore, often their ability to relate to another is lacking as the trust factor has been fractured. Work, as in life, is really all about developing soft skills, which often is a difficult — yet vital — part of securing their employment. Soft skills are best learned through working in an The second component of success is integrated setting with other twofold, one in how the interns both hospital employees. This is one key component to provide develop in a caring work environment interns insight into gaining an understanding of workplace and the other in how they change the culture, helping them not just entire culture of the organization. to keep their jobs, but to thrive in them. The integrated workAt first, some leaders found it difficult to enviplace experience allows for the development of communication skills, attitudes and professional sion a role for interns within their department. In the past five years, the experience of seeing the workplace behaviors that employers desire.10 The following is an example of where God’s interns working and flourishing in their work led love for God’s people shines through the creativ- to the interns being valued and loved members of ity of the teaching team. Last year, Liam, an intern the St. Francis team. We now have 25 departments on the autism spectrum, was doing an excellent with opportunities to place interns — more than job in the linens department but did not speak the number of interns we have in a given year — to his coworkers. The teachers compiled a list and our staff are disappointed if an intern is not of questions for Liam to ask and set the timer for assigned to their department for a rotation.

Another great example of this impact is every 20 minutes on his phone. Liam’s instruc-

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Bon Secours St. Francis Health System

C A R E C O L L A B O R AT I O N S

Intern Class of 2023 for the Project SEARCH-Bon Secours St. Francis program in Greenville, South Carolina.

Justin, an intern on the autism spectrum who was nonverbal for most of his life. Justin had been provided with supportive services throughout his schooling, but interning in the hospital really allowed him to flourish. Thanks to supportive coaching and associates who truly included and valued him as a member of the team, Justin slowly began to allow his voice to be heard. His mother recounted one day at the end of the school year when Justin came home after interning. He told his parents, “Hey guys, I got a job.” It was the first time they had heard his voice in years. Justin’s mother says this is the only time she has ever seen her husband cry.

COMMUNITY AND THE COMMON GOOD

Meaningful ministerial relationships occur when the community’s greatest needs or desires intersect with the passion of a health care system. The dynamic partnership between Bon Secours St. Francis, Greenville County School District and South Carolina Vocational Rehabilitation Department created media attention, which led to further goodwill and a promise of hope within our community.

The community partnerships that formed to

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make this work possible represent the principle of the common good in action. The hallmark of the principle is understanding human beings as essentially social beings and that, in the words of Pope John XXIII, “individual human beings are the foundation, the cause, and the end of every social institution.”11 Striving for the common good unites people of goodwill towards a common purpose. The common good, says America magazine contributing editor Bill McCormick, SJ, “orders us in reason toward justice, creating social bonds that can be strengthened by charity.”12 The philanthropic community stood with Bon Secours St. Francis in helping to bring the Project SEARCH vision to fruition. The monumental success of the program in its first few years led to incredible generosity from businesses and individuals in the community. This generosity allowed us to purchase Chromebooks for every intern. In 2021, we expanded the Project SEARCH classroom — thanks to a generous donor and our foundation, which secured a $750,000 donation — into an entire training center able to accommodate up to 18 interns at a time. The training center features a classroom with state-of-the-art technological capabilities,

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offices for the staff and skills trainers, mock hospital rooms where the students can practice skills before applying them in their internship rotations, and conference space for meetings and interviews.

CONCLUSION

The program is as beneficial to the hospital as it is to the students it serves and allows us to live out our mission. The internships are designed to train the students to fill real, essential support positions within the hospital — they are not merely invented for the sake of a diversity job hire, but are important and needed positions. The roles that the graduates often fill are high-repetition, high-turnover, entry-level positions that hospitals usually have a difficult time recruiting and maintaining with qualified candidates. The partnerships with support services such as vocational rehabilitation — which often continue after the student has graduated and achieved competitive employment — help the student to be successful in maintaining their job. Therefore, hiring our graduates is incredibly beneficial to the hospital by filling essential roles and reducing turnover.13 The joy which a family experiences in understanding that their loved one works in an environment where they are respected, appreciated and allowed to work to the maximum of their potential cannot be underestimated. Competitive, integrated employment provides not only essential income and benefits that will support these individuals throughout the continuum of life, but allows their human dignity to flourish through meaningful work and radical inclusion.

ALEX GARVEY is chief sponsorship officer for markets and shared services at Bon Secours Mercy Health. He is also the scholar in residence at Duquesne University Center for Global Health Ethics. JESSICA WEINGARTNER is director of mission for Bon Secours St. Francis Health System in Greenville, South Carolina, and system ethics lead for Bon Secours Mercy Health.

NOTES 1. Paul T. Shattuck, “Postsecondary Education and Employment among Youth with an Autism Spectrum Disorder,” Pediatrics 129, no. 6 (June 2012): 1042-49, http://doi.org/10.1542/peds.2011-2864.

2. “A Shared Statement of Identity for the Catholic Health Ministry,” Catholic Health Association, https:// www.chausa.org/docs/default-source/mission/shared-

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statement-flyer_english.pdf?sfvrsn=34ba02f2_4.

3. Pope Francis, Laudato Si’, paragraph 128, https:// www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20150524_enciclicalaudato-si.html.

4. Pope Benedict XVI, Caritas in Veritate, paragraph 32, https://www.vatican.va/content/benedict-xvi/en/ encyclicals/documents/hf_ben-xvi_enc_20090629_ caritas-in-veritate.html.

5. “Autism Statistics and Facts,” Autism Speaks, https://www.autismspeaks.org/autism-statistics-asd.

6. Anne M. Roux et al., “National Autism Indicators Report: Developmental Disability Services and Outcomes in Adulthood,” A.J. Drexel Autism Institute, Drexel University, 2017, https://drexel.edu/~/media/Files/ autismoutcomes/publications/Natl%20Autism%20 Indicators%20Report%202017_Final.ashx; “Subminimum Wage,” U.S. Department of Labor, https:// www.dol.gov/general/topic/wages/subminimumwage.

7. Holly N. Whittenburg et al., “Helping High SchoolAged Military Dependents with Autism Gain Employment through Project SEARCH + ASD Supports,” Military Medicine 185, no. 1 (January/February 2020): 663-68, https://doi.org/10.1093/milmed/usz224.

8. Susie Rutkowski, “Project SEARCH: A Demand-Side Model of High School Transition,” Journal of Vocational Rehabilitation 25, no. 2 (November 2006): 85-96.

9. Pope John Paul II, Laborem Exercens, paragraph 22, https://www.vatican.va/content/john-paul-ii/en/ encyclicals/documents/hf_jp-ii_enc_14091981_ laborem-exercens.html.

10. Paul Wehman et al., “Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-Site Randomized Clinical Trial,” Journal of Autism and Developmental Disorders 50, no. 6 (June 2020): 1882-97, https://doi.org/10.1007/ s10803-019-03940-2.

11. Pope John XXIII, Mater et Magistra, paragraph 219, https://www.vatican.va/content/john-xxiii/en/ encyclicals/documents/hf_j-xxiii_enc_15051961_ mater.html.

12. Bill McCormick, SJ, “We Need to Make the Common Good More than Just a Slogan,” America, February 17, 2022, https:// www.americamagazine.org/faith/2022/02/17/ common-good-arturo-sosa-pope-francis-242385.

13. Bonnie O’Day, “Project SEARCH: Opening Doors to Employment for Young People with Disabilities,” Mathematica, December 30, 2009, https://www. mathematica.org/publications/project-search-openingdoors-to-employment-for-young-people-withdisabilities.

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What Is the Health Care Utility Model, and How Can It Transform Health Care?

A Q&A WITH SSM HEALTH’S LEAD FUTURIST CARTER DREDGE AUSTIN SCHAFER, MA, BCC Manager for Mission and Pastoral Care with TriHealth

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ustin Schafer serves as the manager for Mission and Pastoral Care for the Good Samaritan Hospital region with TriHealth in Cincinnati, Ohio. He’s also a student in Loyola University Chicago’s Health Care Mission Leadership doctoral program.

Schafer had Carter Dredge, the senior vice president and lead futurist with SSM Health, as a guest speaker for one of his classes, and wanted to further explore the health care utility model Dredge spoke about there, as his curiosity was piqued about its future applications in the Catholic health care ministry. Dredge advances SSM Health’s research and development, innovation and new venture activities.

Carter, welcome. First, would you share how you became involved in health care?

entirely new level.

I grew up in a four-generation home, surrounded by people who had a lot of health challenges. I had a mother who was paralyzed before I was born. I had a grandfather who was helping take care of my mother and me when I was young.

And at the same time, he was also taking care of his mother, who was born in the 1800s. And I just became very passionate about how we take care of one another, particularly individuals who have a lot of health challenges and in many cases operate at the margins of society. I work for a Catholic health care system, SSM Health, which I truly love. I love the mission of the organization, and I’m in the business of alleviating human suffering. We’re talking about health care utilities today, because I think they have significant promise to scale the way that we do philanthropic and ministry-oriented work in Catholic health care to an

Could you describe the basics of what a health care utility is for those who may not have heard about it?

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A health care utility is a new type of nonprofit organization that has a social mission to provide essential health care products and services at the lowest sustainable cost possible — in short, it’s a powerful business model for doing good. The term “utility” is a reference to models for other commonly shared basic services like water or electricity. The mission of a health care utility is to make an essential service accessible to everyone at the same low cost.1 There are four main aspects that define a health care utility. The first is how it’s structured and governed. Health care utilities are not owned by anyone, but they’re managed by stewards — people who have responsibility to ensure the

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Photo by GlobalSTL Health Innovation Summit

Carter Dredge

services are delivered in the most appropriate way and at the lowest sustainable cost. Second, they’re funded by those stewards/governing members, so they have a customer financing component, and they do so through debt and not equity. That’s really important, because financing is designed to produce low-cost goods and services, not a return in and of itself. So, funding these businesses is a means to getting greater access for essential goods and services. They’re set up to deliver critical access and services to the many, particularly those who are vulnerable, and for services that have become very costly.

Third — and this is where it gets its name “utility” — they provide the services at a transparent and low cost that’s the same for everybody. They provide the services to everyone on equitable terms. It’s not about squeezing out additional profit; it’s about delivering health care at the lowest sustainable cost possible so that people can get access to these essential services. And fourth, it’s about the market in which they operate. These entities are not run by the state or a government.

Instead, they’re a private enterprise that competes in the marketplace, which means they’re dynamic.

And while they are dynamic, they are access maximizers, not price maximizers.

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Many times when businesses are setting up their marketing strategy, they will ask, “What is the price the market will bear?” That’s not health care utilities. These entities are asking a fundamentally different question: “What is the lowest sustainable cost that I can provide this to the market?” As a result, it actually brings competition to the market.

The most widely known health care utility to date is Civica Rx. Major health systems and philanthropists pooled their resources to create a generic drug company that provides drugs used in hospitals for essential inpatient care at a lower cost than those sold by large pharmaceutical companies.

How do health care utilities positively disrupt the health care marketplace?

This type of collaboration is what we call disruptive collaboration. It is collaboration not to maintain the status quo, but collaboration to drive an innovative change. Sometimes, with disruptive innovation, you’re talking about a new technology or a novel way of doing something, like an innovative technological process. In this case, with disruptive collaboration, what we’re doing is we’re bringing innovation to known essential products

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by changing the way we work together. The collaboration is a structural innovation, not a technological one. So, for example, one of the things that we’re doing is introducing low-cost insulin.

It’s not like we have to invent insulin; it’s a product that already exists. However, there are certain elements of the current market that have been keeping insulin at a very high cost even though the medical application of insulin is 100 years old.

Insulin is an essential product for people to live, but yet, the drug companies still demand an excessive — if not extractive — premium to the point where a quarter of Americans who rely on insulin have to inappropriately ration it.2 The notion behind disruptive collaboration is this: by pulling together the scale of multiple institutions that then make long-term commitments to deliver low-cost services — focused on the needs of the community and the patient — it can positively disrupt the status quo and change health care for the better.

Carter, that’s a major and complex problem in health care — that people can’t afford essential medications.

Many times in health care, the reason something is expensive is because there’s just a handful of firms that provide it. You could use the term oligopoly. If there’s less than that, maybe it’s a duopoly. And maybe if there’s just one, it’s a monopoly. In many of these instances, the economies of scale are significant, and no one individual organization, no matter how big they are — even the biggest health care system in the United States — can do it alone. One health system, for instance, doesn’t have the scale to compete with pharma.

But if you pull enough of them together, then you have the needed scale. And when you align that scale in a mission-oriented and patient-centric way to create low-cost, high-access services, then you can not only create scale that translates into low cost, you can create scale that translates into low price.

In my doctoral course, you shared that almost all FDA prescription drugs and most health care technological innovations in the U.S. are developed by for-profit entities. And so, if Catholic health care doesn’t increasingly enter this space to compete, I really think the ordinary fabric of U.S. health care is going to become more unaffordable, especially for the poor and vulnerable.

You spoke earlier about turning to the health

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care utility model to offer insulin at a lower cost.

Civica Rx, as a health care utility, was formed in 2018 by a group of health systems and philanthropies, many Catholic. What are the latest developments with Civica and its impact?

For those not familiar with Civica Rx, it started with a group of 10 organizations: seven health systems — four of which were Catholic health care systems, two other nonprofits and one forprofit health care system — and three philanthropies. We raised $100 million to create Civica Rx. Nobody owns Civica Rx. It’s financed by health systems and philanthropies, not by external parties that are trying to create value in the financing itself. With the lower cost medicines that we produce, everyone gets the same price. Members of the management team were hired from the pharmaceutical industry and the health systems, and members of other organizations also sit on the board of directors.

We now offer more than 60 generic drugs to hospitals and have over 55 health systems as members. We also sell products to the U.S. Department of Veterans Affairs and the Department of Defense. This reach amounts to approximately a third of the total hospital inpatient capacity in the United States.

Additionally, a Civica subsidiary partnering with mission-aligned insurers and other organizations — called CivicaScript — is dedicated to lowering the cost of select high-cost generic medicines in the retail setting. It recently recommended that pharmacies charge patients no more than $171 for its first retail medicine used to treat prostate cancer that has spread to other parts of the body. That is about $3,000 per month less than the average cost of this medicine, Abiraterone, for many patients.3 Do you get any political backlash? To me, it sounds like it’s really the best of both worlds — it’s helping the poor and vulnerable, but it’s also something that is competing in the free market.

The great news is that we absolutely have strong bipartisan support for these types of initiatives. Once we showed this was working, the federal government got involved as part of a multiparty grant — of which Civica was a member — to help build a dedicated pharmaceutical facility in Virginia.4 We will produce essential medications at this new manufacturing facility and continue to supply both the market and the strategic national stockpile to ensure that we have an

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end-to-end secure pharmacy supply chain process in the United States.

That connects to our Catholic social thought tradition and the fact that health care is a universal human right and so critical for promoting human dignity and full human flourishing.

One thing that I’m so passionate about, and just one of the many reasons that I’m so grateful for what CHA does, is that with the innovation of the health care utility model, it comes back to the roots, honestly, of how Catholic health care came to be. There’s a tradition of religious orders for women and others in Catholic health care who have said, “We can’t accomplish what we need to accomplish alone.”

panies to accomplish very specific and focused objectives — with many of these objectives being extremely aligned with those of Catholic health systems. So, while the new health care utilities are not a Catholic entity, they include Catholic entities as founding and governing members, and therefore don’t do anything that would violate the ERDs. These utilities focus on market failures that are hurting people. And that is very aligned with where we need to be: How can we alleviate suffering? Catholic health care systems have been great examples of innovation throughout their history because they’ve taken on problems that have not been easily addressable. Taking care of the poor and the vulnerable is an essential thing to do, but that doesn’t mean it’s easy.

Catholic health care systems have been great examples of innovation throughout their history because they’ve taken on problems that have not been easily addressable. Taking care of the poor and the vulnerable is an essential thing to do, but that doesn’t mean it’s easy.

The first hospitals emerged when people realized the need was beyond that of individual groups, and communities came together to basically build the institutions we have today. In a similar analogy, we’re realizing that some next-generation problems are beyond the scope of the individual institutions of today. We now need to come together again and solve these new and pressing problems. Our communities are counting on us.

That’s an incredible vision because it also connects deeply to the Ethical and Religious Directives for Catholic Health Care Services.

The U.S. bishops state that Catholic health care “should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society.”

The health care utility model sounds like it does just that as it advocates for the common good, creates greater access to more affordable health care, and focuses on our call to stewardship.

How are health care utilities connected with our Catholic mission?

The utility model creates new operating com-

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Is there a role for mission leaders in this work?

As mission leaders and other leaders in Catholic health care become more deeply aware of how these new business models work, they’re likely to be one of the most in tune groups of leaders to step back when looking at a problem and to ask, “Is this a utility problem?” This is because they’re already the ones who are personally engaging in their respective communities and seeing the problems up close. They will be able to see where the system is lacking coordination or scale to adequately solve a problem. They have the potential to catalyze their health ministries to see the value of this “disruptive collaboration” mindset and to see opportunities for them to join or create some of these utilities.

What’s the future for health care utilities beyond pharmaceuticals?

We’ve identified over a dozen potential utility applications and think there could be even more; there will be more details as I can talk about them.

At a recent conference that SSM Health hosted in partnership with the University of Cambridge’s Judge Business School in the United Kingdom, we brought together about 30 health care leaders from numerous countries to talk about new health care utility businesses and what’s next.5 We’re also working to create a health care utility fund to increase and streamline the production of more health care utilities. This approach has the

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potential to reduce human suffering and produce innovative nonprofit health care companies that will address some of the most pressing essential access challenges. When I see people engage in this type of utility work, I can see the flame of passion and selfless commitment like the collaborative spirit that helped create Catholic health care long ago.

AUSTIN SCHAFER, MA, BCC, is the manager for mission and pastoral care for the Good Samaritan Hospital region at TriHealth in Cincinnati, Ohio.

TriHealth is a 50/50 joint operating agreement between CommonSpirit Health and Bethesda, Inc. TriHealth has six hospitals and more than 130 points of care in the Greater Cincinnati region.

NOTES 1. Carter Dredge and Stefan Scholtes, “The Health Care Utility Model: A Novel Approach to Doing Business,” NEJM Catalyst, July 8, 2021, https://catalyst.nejm.org/doi/ full/10.1056/CAT.21.0189.

2. Darby Herkert et al., “Cost-Related Insulin Underuse among Patients with Diabetes,” JAMA Internal Medicine 179, no. 1 (January 2019): 112-14, https://doi.org/ 10.1001/jamainternmed.2018.5008.

3. “CivicaScript Announces Launch of Its First Product, Creating Significant Patient Savings,” Business Wire, Aug. 3, 2022, https://www.businesswire.com/ news/home/20220803005101/en/ CivicaScript%E2%84%A2-AnnouncesLaunch-of-its-First-Product-CreatingSignificant-Patient-Savings.

4. “Civica to Build an Essential Medicines Manufacturing Facility in Virginia,” Business Wire, Jan. 21, 2021, https://www.businesswire.com/news/home/20210121005790/ en/Civica-to-Build-an-Essential-MedicinesManufacturing-Facility-in-Virginia.

5. “A New Healthcare Utility Initiative to Develop Not-for-Profit Healthcare Business Models Is Launched by Cambridge Judge Business School and SSM Health,” University of Cambridge Judge Business School, July 19, 2021, https://www.jbs.cam.ac.uk/ insight/2021/new-healthcare-model/.

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C A R E C O L L A B O R AT I O N S

Partners in Healing at the Intersection of Medicine and Mission REX HOFFMAN, MD, MBA, and D.W. DONOVAN, DBe, BCC Chief Medical Officer and Chief Mission Integration Officer, Providence Holy Cross Medical Center

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chief medical officer (CMO) routinely interacts with other members of the senior leadership team, including the chief executive, chief nursing officer and chief financial officer. While these relationships may be expected, there is another member of the senior leadership team that chief medical officers should strongly consider partnering with more fully: the chief mission integration officer (CMIO).

So, what does a chief mission integration officer do? The chief mission integration officer is an executive-level leader who brings an expertise in theology and ethics, coupled with a strong familiarity with health care operations, to ensure that the mission and values of a Catholic health care ministry are fully integrated into the dayto-day operations and strategic direction of the ministry. This work can manifest itself in a number of ways, including contributing as a strategic partner, assisting in the navigation of complex ethical issues and advocating for both high-quality spiritual care and the needs of the poor and vulnerable.

In our roles as CMO and CMIO, we have developed a close working relationship. By sharing examples of how we have mutually benefited by bringing our skill sets and experience together, we hope to invite others in these roles to consider how closer collaboration could better serve the ministry.

ETHICAL ALLOCATION OF A SCARCE RESOURCE

On May 1, 2020, in the midst of the COVID-19

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pandemic, the Food and Drug Administration approved remdesivir for patients under certain conditions through an Emergency Use Authorization, with the stipulation that it be administered in a hospital or health care setting capable of providing acute care comparable to inpatient hospital care.1 This was the first pharmaceutical treatment to receive FDA approval for COVID-19, and shortly thereafter was released in limited supply.2 Two weeks later, on May 14, 2020, Providence Holy Cross Medical Center received its first allocation of remdesivir. The amount received was enough to treat, at most, four of the 61 COVIDpositive patients being cared for at the time.

Following the recommendations of both the Providence Office of Theology and Ethics and the California Department of Public Health, leadership at Providence Holy Cross formed a clinical discernment team to wrestle with questions about the just and ethical allocation of such a scarce resource. Participants included physicians from palliative care and infectious disease, as well as hospitalists, intensivists and clinicians from infection control, pharmacy, nursing

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administration and ethics. Together, as CMO and themselves, doctors rely heavily on both advance medical directives and physician orders for lifeCMIO, we chaired the discernment team.

The team was aware that unconscious or sustaining treatment. But for a chief medical offiimplicit bias had the potential to cloud our pro- cer in a senior decision-making role, it is critical to cess. Therefore, as a safeguard, we established a understand that there are nuances to these tools set of inclusion and exclusion criteria that was that a particular physician may not have been able grounded in the medical literature existing at the to fully appreciate. time, drawn from the initial finding of the remdesivir study,3 and conCombining our skill sets — the sistent with guidelines provided by the California Department of Public medical knowledge and professional Health.4 credibility of a CMO with the ethical The value of the collaborative partnership between the two of us training and moral credibility of became particularly evident when a CMIO — we made a persuasive the team found itself spending a significant amount of time discussargument that only evidence-based, ing issues around quality of life and whether or not this should be a facobjectively observed factors should tor in determining if a patient would be considered. be offered the medication. Through team discussions and literature Recently, the two of us responded to a medireview, some argued that reduced physical capacity and the dependence upon others for assis- cal/surgical floor where the nursing staff had tance with daily activities of living should “count alerted us to a concerning situation. A chart against” a particular patient when assessing their had a note from the attending physician that the patient lacked decision-making capacity. There suitability for receiving this medication.

This was not merely an academic exercise — a was an advance medical directive that named the slight drop in a patient’s overall assessment could patient’s husband as her durable power of attorremove them from consideration for this invalu- ney for health care. The consulting surgeon had able medication. Combining our skill sets — the read the chart and spoken to the husband, receivmedical knowledge and professional credibil- ing his consent on behalf of his wife to proceed ity of a CMO with the ethical training and moral with the procedure. The patient’s nurse, however, credibility of a CMIO — we made a persuasive felt strongly that capacity should be reevaluated argument that only evidence-based, objectively in light of conversations she had with the patient observed factors should be considered. Ulti- that morning. However, the consulting surgeon mately, our discernment team developed a pro- had already left for the operating room and was cess that made this treatment available to the most reluctant to return.

Upon arriving to the floor, the chief medical appropriate patients in the fairest possible way.5 officer spoke with the patient to get a sense of her capacity while the chief mission integration ADVANCE MEDICAL DIRECTIVES AND DISCERNMENT For any provider, ensuring that patients have suf- officer reviewed the advance medical directive. ficient information to make informed decisions There were several subtle elements that called dates back to early training in medical school. the validity of it into question, one being that the Medical students absorb lessons by watching first page was missing. Also, one of the witnesses more experienced colleagues speak with patients on the signature page was the husband (California law does not allow for an advance medical direcor their surrogate decision-makers.

When talking to a patient, doctors routinely tive to be witnessed by the appointed durable describe potential risks, how treatments may power of attorney) and the second witness had help them and additional options or information the same last name of the husband, which further they may need when deciding next steps. In cases called the authenticity of the document into queswhere patients are no longer able to speak for tion. Finally, the number of pages recorded by the

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ning of life. An important aspect of the chief mission integration officer’s job is to ensure that the local ministry acts consistently with the collective identity of the ministry within the Catholic tradition, something that relies on true collaboration with providers.

For example, the directive regarding the Catholic commitment not to directly take a life through abortion is clearly stated. But what about those times when the clinical situation is such that an indirect termination is required in order to avoid losing the lives of both mother and unborn child?

A typical situation might evolve as follows: It is late at night when a pregnant woman comes to the emergency room due to her membranes rupturing prematurely. She is 18 weeks pregnant and is devastated with the news that she may lose this pregnancy. The medical team has informed her that the onset of infection is nearly inevitable and that it will not only result in the termination of the pregnancy, but will also put her life at substantial risk.

Despite having worked with such cases in the past, and despite caregivers and providers having worked for many years within a Catholic hospital, such cases almost always invite additional concerns and discussion. Thus, it is quite common NAVIGATING SENSITIVE OBSTETRICS ISSUES The birth center of a hospital can be a wonder- for a chief mission integration officer to arrive ful place and can sometimes feel comparatively fairly quickly — despite the late hour — and to like the one location where good things happen gather the providers and nurses together for a in a hospital. However, things can — and do — conversation.

In this case, the treatment team affirms their go amiss there, and when they do, the provider is often in need of a listening ear and mutually understanding that the premature rupture alone is insufficient a reason to initiate termination of respectful dialogue. the pregnancy. But few may be able to articulate the ethiWhile working within the parameters of cal rationale that grounds this course of action. Some may informed consent is critical to our work, even voice their concern that the reality is that subtle complexities religious beliefs are interfering with their ability to provide the can confound even the most attentive best possible care.

The chief mission integraphysician. tion officer can reassure the treatment team that religious To provide some consistency in how ethi- beliefs and medical practice are not incompatcal issues are addressed in health care delivery ible. The principle of double effect — which recthroughout the country, the Ethical and Religious ognizes that significant harm, even death, can be Directives for Catholic Health Care — drawn from morally tolerated (but never embraced) when it the Catholic Church’s theological and moral is the inevitable secondary effect of a primary, teachings — cover a wide range of issues, includ- intended, proportionally justifiable action — ing significant attention to matters at the begin- requires that one has a valid and current medical notary public did not match the number of pages in the advance medical directive, nor did it even come close.

When we were able to speak with the attending physician, he admitted to us that he had not personally reviewed the document, nor would he have necessarily noted those inconsistencies.

Ultimately, the surgeon did reevaluate the patient and affirmed that she did have decision-making capacity. He thanked the nurse and had a very difficult conversation with the husband as to why we might not be moving forward with the procedure.

Additionally, we explored in more detail with the patient who she wished to serve as her durable power of attorney in the event she did truly lose decision-making capacity.

While working within the parameters of informed consent is critical to our work, the reality is that subtle complexities can confound even the most attentive physician. Because this issue is so fundamental to the autonomy and dignity of the patient, the CMIO can be a valuable resource to partner with in this area. Physicians might also consider speaking to their facility’s ethics committee or risk management team for advice.

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reason for initiating an intervention that has such cians, and several members of the medical staff have a long-standing relationship with him as a serious consequences.

When speaking directly to the physician, the confidant and sounding board.

Together, the chief medical officer and chief chief mission integration officer attests that it is neither his intention nor within his scope to ques- mission integration officer offer two access points tion the doctor’s clinical judgment as to when for medical staff to reach out to when they need intervention is needed, and only asks that the pro- someone to talk to. Although rates of physician vider acts in good faith, proceeding with a mor- burnout have been higher than ever these past few ally undesirable intervention only when there are years,6 we are optimistic that our unified approach clinical grounds to do so. He goes on to list a few at Providence Holy Cross likely contributes to our examples such as a rising temperature or rising ministry having one of the highest rates of physiwhite blood count and reiterates that this deter- cian well-being across all of Providence in a 2020 mination is medical rather than ethical in nature. survey.7 Through this communication, the chief mission integration officer subtly invites the Together, the chief medical officer physician into a covenant of integrity, working together to honor a princiand chief mission integration officer ple that is held dear in Catholic social teaching. offer two access points for medical As a ministry, we trust that our staff to reach out to when they need providers are people of integrity who will collaborate to uphold these someone to talk to. principles, and we predicate that covenant on an agreement that the provider is the medical expert who will determine CONCLUSION when to move forward, addressing the not-so- By working as true partners, a CMO and CMIO hidden fear that “doctrine” will trump medical can address some of the most challenging issues judgment. Through this partnership of trust and faced in health care. At Providence Holy Cross, understanding, a chief mission integration offi- we have found through pairing our unique — but cer can help to ensure a good relationship exists complimentary — skill sets, we can navigate even between the obstetrics department and hospital the most complex issues faced today. administration.

We have found our collaboration to be invaluable. It is likely that others have found the same to be true. But for those who have not yet capitalized SUPPORTING MEDICAL TEAMS IN TIMES OF DISTRESS One of a chief medical officer’s primary responsi- on the potential of this relationship, we suggest bilities is attending to the well-being of the medi- that what is true in both medicine and ministry cal staff, something that became even more imper- is certainly true in our experience: when people ative during the COVID pandemic. One helpful with good intentions join their talents together, approach is to be accessible to them by offering an the results are not merely additive, but truly open-door policy and encouraging them to reach transformative. out at any time. When a CMO meets with a physician, it is essential to listen intently and try to REX HOFFMAN is chief medical officer of Providence Holy Cross Medical Center in Mission assist them in any way possible.

Unfortunately, a CMO is only one person and Hills, California. D.W. DONOVAN is chief mission does not have eyes and ears everywhere, thus may integration officer of Providence Holy Cross only be aware of a portion of those in need. There Medical Center. is a void that potentially exists at hospitals if the CMO is attending to the medical staff alone.

NOTES At Providence Holy Cross, the chief mission 1. “Coronavirus (COVID-19) Update: FDA Issues Emerintegration officer fills this void successfully, even gency Use Authorization for Potential COVID-19 Treatwithout being asked. Although he is not a medical ment,” U.S. Food & Drug Administration, May 1, 2020, doctor, over time, he has gained the trust of physi- https://www.fda.gov/news-events/press-

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announcements/coronavirus-covid-19update-fda-issues-emergency-useauthorization-potential-covid-19-treatment.

2. “Important Information About Veklury,” U.S. Department of Health & Human Services, https://aspr.hhs.gov/COVID-19/ Therapeutics/Products/Veklury/Pages/ default.aspx.

3. John H. Beigel et al., “Remdesivir for the Treatment of Covid-19 – Final Report,” The New England Journal of Medicine 383, no. 19 (November 2020): 1813-26, https://www.nejm.org/doi/full/10.1056/ NEJMoa2007764.

4. “California Health and Human Services Remdesivir Distribution Fact Sheet,” California Department of Public Health, May 29, 2020, https://www.cdph.ca.gov/Programs/ CID/DCDC/Pages/COVID-19/Remdesivir-

Distribution-Fact-Sheet-.aspx.

5. D.W. Donovan and Rex Hoffman, “Providence Holy Cross Outlines Steps for Ethical Distribution of a COVID Medication,” Health Progress 101, no. 4 (Fall 2020): 57-60, https://www.chausa.org/publications/ health-progress/archives/issues/nurses/ providence-holy-cross-outlines-steps-forethical-distribution-of-a-covid-medication.

6. Joy Melnikow, Andrew Padovani, and Marykate Miller, “Frontline Physician Burnout during the COVID-19 Pandemic: National Survey Findings,” BMC Health Services Research 22, no. 1 (March 2022): http:// doi.org/10.1186/s12913-022-07728-6.

7. “Southern California AMA Medical Staff Survey Results — Providence Report,” Providence Holy Cross Medical Center, 2020.

Upcoming Events from The Catholic Health Association

Virtual Program: Community Benefit 101

Oct. 25 – 27 | 2 – 5 p.m. ET

Diversity & Disparities Networking Zoom Call Oct. 25 | 1 – 2 p.m. ET

Global Health Networking Zoom Call

QUESTIONS FOR DISCUSSION Chief Medical Officer Rex Hoffman and Chief Mission Integration Officer D.W. Donovan at Providence Holy Cross Medical Center in Los Angeles describe the importance of partnerships and knowing where one job ends and another begins as the roles relate to challenging medical and ethical decisions in health care environments.

1. If you are in a chief medical officer or chief mission integration officer role, do you make time to talk about how and when you communicate with each other?

When more people need to be a part of a conversation, is a good, prompt system in place that allows for that?

2. Does your health care organization have clear guidelines in place to avoid bias in complex decision-making? Is there a clear understanding of foundational standards and the timing and process of decision-making? What can be done to make sure you’re communicating with patients and their loved ones in a way that is empathetic, clear and provides them with the information and support they need?

3. How can senior leaders do a better job making sure other employees understand the responsibilities of chief medical officers and chief mission integration officers and how they can convey questions or concerns to them?

Nov. 2 | Noon – 1:30 p.m. ET

Virtual Seminar: Mission Leadership Nov. 7 and 9 | Noon – 4 p.m. ET

Faith Community Nurse Networking Zoom Call Nov. 15 | 1 – 2 p.m. ET

United Against Human Trafficking Networking Zoom Call

Nov. 16 | Noon – 1 p.m. ET

chausa.org/calendar

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Friendship Houses, New Connections

CHRISTUS HEALTH AND COMMUNITY PARTNERS WORK TO STRENGTHEN NEIGHBORHOODS NADINE NADAL, MPH, CPH, CHES Director, Community Health Development, CHRISTUS Health

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n the Highland neighborhood of Shreveport, Louisiana, 22-year-old Robert Renter leans against a table inside a home called a Friendship House. Part residence and part community center, the Friendship House has come to mean a lot to Renter, who nervously finds his words to explain to visitors something so sentimental to him: “I am a young Black man in America, and five or six years ago, I wasn’t exactly a model student.”

Today, Renter — who works in Shreveport for neighbor. Strategically located in high-crime, lowa telecommunications company — says, “Life is employment areas, the homes are meant to be a good.” He smiles as he talks about his girlfriend beacon of hope to young people and others. and a younger brother he says Strategically located in high-crime, he might spoil too much. Of his mentor at the Friendship low-employment areas, the homes are House, Diedra Robertson, he says, “Ms. Diedra helped me meant to be a beacon of hope to young get here by giving me an afterpeople and others. school outlet where I could be with my good friends. Matter “We’re a place that’s safe, where afterschool of fact, I’m best friends to this day with my friend programs, adult literacy programs and other from here.”

Robertson lives in a Friendship House with community activities are hosted,” says Roberther husband, and she is a supervisor to a grow- son. “Actually, we held our first community health ing number of Friendship Houses in the Shreve- fair just a few weeks ago. It was a success.” Of the port-Bossier City area. The eleventh Friendship health fair’s 20 community partners in attenHouse is scheduled to open soon. Robertson dance, two — St. Luke’s Episcopal Medical Minexplains that the goal of the Friendship Houses istry and Shreveport Green — were funded by the effort — operated under the nonprofit Commu- CHRISTUS Community Impact Fund. The fund nity Renewal International — is to mentor, build — which is the grantmaking arm of CHRISmutually beneficial relationships and to solve TUS Health — works to invest in communityproblems internally, street by street, neighbor to based, long-term, transformative and sustainable

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Cultivate Partnerships to Address Social Determinants of Health and Create Thriving Communities NEIGHBORHOOD AND BUILT ENVIRONMENT

SOCIAL AND COMMUNITY CONTEXT

Access to healthy foods Walkability Violence and trauma

Community participation Social connection Racism

SOCIAL DETERMINANTS OF HEALTH

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ECONOMIC STABILITY

Access to health care Access to primary care Health literacy

Food insecurities Housing instability Employment

EDUCATION Source: The Department of Health and Human Services

Early childhood education and development High school graduation Higher education completion

strategies that address the underlying causes of poor health and, most importantly, reenvisions the role of a funder into a collaborator. Through these partnerships and other collaborations, CHRISTUS Health is working to transform the health and well-being of its communities.

STRONGER TOGETHER

Although CHRISTUS and its ministries alone cannot solve all of society’s problems, the health care system can play a role in convening and collaborating with other organizations to create innovative solutions to complex and long-standing local challenges. Each year, CHRISTUS Health, through the Community Impact Fund, provides financial support and capacity-building opportunities to 30-40 grantees across its U.S. ministries within Texas, Louisiana and New Mexico. We respond to the needs voiced in the communities we serve and partner with organizations like Shreveport Green’s Mobile Market, St. Luke’s Episcopal Medical Ministry (see sidebars) and Community Renewal so that we can do more together through collaborative relationships. CHRISTUS’ mission calls us to do this: extend the healing ministry of

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Jesus Christ. We strive to achieve this with others beyond the walls and brick-and-mortar of hospitals, clinics and family health centers.

Working in partnership with community organizations is a way the CHRISTUS Community Impact Fund addresses the social needs and social determinants of health of individuals and communities. The Office of Disease Prevention and Health Promotion of the Department of Health and Human Services groups social determinants of health into five areas: economic stability; educational access and quality; health care access and quality; neighborhood and built environment; and social and community context.1 To “revillagize” its communities — or to build relationships and strengthen neighborhoods — one of CHRISTUS’ partners, Community Renewal, seeks to work on strengthening eight aspects of what it means to be a healthy community: mutually enhancing relationships; housing; safe environment; health; education; culture of caring; leadership system (the ability to effectively negotiate and mobilize resources); and meaningful work. Many of these elements fall under the same pillars of social determinants of health. For

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example, mutually enhancing relationships falls under social and community context and safe environment falls under neighborhood and built environment determinants. Part of this work to restore village-like connections includes a series of activities for each community to tell its history and shape its identity, countering previous societal narratives and bringing neighbors together.

Through an investment of $467 million over the last fiscal year to its Community Benefit program and $3 million to its Community Impact Fund, CHRISTUS Health is committed to improving the well-being of its communities. These community

benefit initiatives include charity care, unreimbursed indigent care and the community services and partnerships the system does as a team — the internal campaign called One CHRISTUS — to address these social determinants of health.

Data from the Louisiana Department of Health’s 2021 Louisiana Health Report Card shows that in Region 7, where Shreveport sits, cancer, heart disease, diabetes and other chronic diseases are drivers of mortality in northwest Louisiana, and that significant racial and ethnic disparities exist with these conditions, resulting in higher mortality rates among historically marginalized

HEALTH DISPARITIES BY ZIP CODE Part of CHRISTUS Health’s process when conducting its Community Health Needs Assessment involves the use of a data visualization platform called Metopio. Through this mapping technology, the tool is able to show health disparities by zip code. During the COVID-19 pandemic, CHRISTUS Health’s Community Impact Fund evolved to apply an equity lens in its process. One of the fund’s equity approaches involved identifying communities of concern — which are zip codes that rank highest within the area deprivation, social vulnerability and hardship index — to help CHRISTUS understand the most under-resourced areas and allocate our investments for greater impact.

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LOUISIANA

CHRISTUS Bossier Emergency Hospital

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220

79

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BOSSIER CITY LEGEND CHRISTUS Hospital Youth Friendship House

AREA DEPRIVATION INDEX 2019

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CHRISTUS Shreveport-Bossier Service Area: 68.71

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91.09

(Middle to High School)

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Kids Friendship House

(Kindergarten to 5th Grade)

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68.97

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CHRISTUS Highland Medical Center 47.46 3132

This map shows the area deprivation index — which is a validated measure of social and economic status for neighborhoods — for the zip codes that CHRISTUS Health Shreveport-Bossier primarily serves.

Community Renewal International — which connects residents to restore the foundation of safe and caring communities — currently has efforts underway in six of the health system’s zip codes that rank high in socioeconomic disadvantage.

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individuals.2 Identified within the 2020-2022 CHRISTUS Shreveport-Bossier Health System’s Community Health Needs Assessment (CHNA), prioritized areas were access to care, child safety and well-being, and disease prevention and management. As further revealed in the 2021 Louisiana Health Report Card, Black Louisiana residents have been disproportionally affected by COVID-19, particularly in the early months of the pandemic.3

MUTUALLY ENHANCING RELATIONSHIPS

Community Renewal International While the coronavirus might have exacerbated existing health inequalities influenced by zip code and shed more light on national social vulnerabilities, it has always been on the mind of people like Rev. Mack McCarter. After seminary, McCarter spent 20 years pastoring churches in West Texas before returning to his hometown of Shreveport, where he started Community Renewal, a nonprofit faith-based organization, in 1994. His early work to get people to open their doors and develop relationships resulted in several community outreach strategies like the Friendship Houses, Haven Houses and the Renewal Team to transform neighborhoods into safe havens of friendship and support.

“You can email someone across the world, but you don’t know who’s living and dying five houses from you.”

SHREVEPORT GREEN MOBILE MARKET

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ther community organizations across Shreveport are also partnering with the CHRISTUS Community Impact Fund. A recent example includes the nonprofit Shreveport Green’s Mobile Market, a program that offers nutritional food assistance, cooking education and social gathering opportunities for anyone who needs them. The Mobile Market serves neighborhoods that lack access to healthy foods. It brings fresh fruits and vegetables from more than 20 community gardens to consumers in these food deserts, offering them at a manageable price and showing them healthy ways to prepare them.

Every three years, CHRISTUS Health gathers qualitative and quantitative data from its Community Health Needs Assessment (CHNA) to better understand the communities it serves. In the 2020-2022 CHRISTUS Health ShreveportBossier CHNA, addressing nutrition-related illnesses like obesity, heart disease and Type 2 diabetes was identified as a great need.

According to the U.S. Department of Agriculture, not only is inaccessibility to healthy fresh food a big problem in Shreveport, but so is its expense and the lack of knowledge in preparing it. Through its partnership with Shreveport Green, CHRISTUS Health is addressing food insecurity to sustain healthier lives for Shreveport-Bossier residents.

— REV. MACK McCARTER The first of Community Renewal’s three primary strategies, the Friendship Houses, serve as a bridge to improved change and redevelopment for residents and neighbors who are at highest risk of experiencing isolation, discrimination and other social determinants of health. Community Renewal trains and employs community coordinators. They and their families move into these homes and live as neighbors — not as 9-to-5 service providers. Through building trust and relationships with their neighbors while living in the Community Renewal-owned homes, community coordinators help residents to set and achieve basic goals by facilitating in-house programs like afterschool activities, adult education, family events, service projects and more.

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ST. LUKE’S MOBILE MINISTRY

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o avoid ending up in an emergency room or becoming severely ill, CHRISTUS Health’s Shreveport-Bossier CHNA also indicated that residents of northwest Louisiana need easily accessible and affordable health care. Working off its relational model that worked successfully with Community Renewal and the Mobile Market, CHRISTUS Health found a like-minded community partner in St. Luke’s Episcopal Medical Ministry. Using an RV that brings the physician’s office directly into neighborhoods where needed, this team provides an outlet for community members to manage their physical ailments or chronic diseases through preventive health screenings, basic primary care health services, medication refills, health education and medical referrals — all free of charge. The team serves not only those without health insurance — including the community’s homeless population — but also people with coverage who may be experiencing barriers to access due to transportation, system navigation difficulties or other issues.

Serving northwest Louisiana’s underserved residents since 2008, St. Luke’s Mobile Medical Ministry offers 20-22 clinics each month.

Funding comes from individual donors, grants, community organizations and the Episcopal Diocese/churches. Staff consists of a group of registered nurses, nurse practitioners and physicians. By playing a prominent role in preventive care for residents in need, the organization is helping to improve the quality of life for the region’s medically underserved while empowering them to make healthier choices.

Photo courtesy of St. Luke’s Episcopal Medical Ministry

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Another Community Renewal initiative, Haven House, brings together caring residents who are willing to reach out to their neighbors. Identified as a Haven House by a “We Care” sign in their front yard, Haven House leaders are trained volunteers who turn strangers into friends on their own neighborhood block. They may host block parties or bring meals to a sick neighbor, find a lost pet, mow someone’s yard or bring their trash bin in from the street.

Connected to the same mission of creating stronger communities, another strategy, the Renewal Team, consists of volunteers who build relationships citywide by uniting individuals, faith groups, businesses, civic groups and others as caring partners.

“You can email someone across the world, but you don’t know who’s living and dying five houses from you,” McCarter often explains, taking Jesus’ “Love Thy Neighbor” imperative seriously.

Michael Leonard, a retired Shreveport dentist, spent a few years volunteering for Community Renewal. When he retired from his practice, he decided to join the team as a Community Renewal staff member. “Positive relationships put into a system can renew collapsing communities and societies,” says Leonard. Now serving as the organization’s associate coordinator, he further explains, “When communities flourish, it positively impacts our health and well-being.”

Community Renewal has been making an impact on communities for more than 25 years, and CHRISTUS Health is proud to partner with the organization to continue its efforts to restore safe and caring communities. Their work is even expanding and getting attention in many other communities across the globe, including countries as far as Cameroon, Africa.

MEASURABLE IMPACT

With all partnerships, knowing the impact that endeavors make is key to further refine efforts, and data helps to show what works. The Shreveport Police Department reported a drop in major crime by 70% from 2001 to 2019 and a drop of 61% in total reported crime in the city’s Allendale neighborhood.4 CHRISTUS is developing an outcomes tracking system to see what sort of measurable impact we may be experiencing by investing in this work. It includes performance measures and tracks end results as a way to make future decisions and set budgets.

To measure the effects of Community

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Renewal’s work, the Community Impact Fund requires the Results-Based Accountability model to track outcomes at the population and programmatic levels. At the programmatic level, the model helps CHRISTUS and its partners understand how many individuals the program serves, how well the program was delivered and how many individuals are better off due to the program’s interventions.

Marlin Blaze sees the qualitative value of Community Renewal. As a volunteer neighborhood ambassador for the program, Blaze is dedicated to developing positive relationships in his Allendale neighborhood, an area once plagued with crime and drugs. It is a neighborhood he describes as once brutal and one where he grew up without much support. “I didn’t meet my dad or my dad’s side of the family until I was 30 years old,” he says.

Blaze chose a different path than many of his friends and is building positive relationships in his new role. He’s on the same track of building up others as is his friend and Community Renewal colleague, Pam Morgan.

At 21, Morgan was in an abusive relationship and turned to drugs, got pregnant and then became a single mom with few options until she found a path through Community Renewal. She recently shared her story of finding sobriety and peace with a group of visitors at her brightly lit and spacious Friendship House in Allendale. It sits across from a series of newly constructed homes built through a partnership with The Fuller Center for Housing. A decade ago, they were dilapidated eyesore shotgun houses left to wither, and violence was not uncommon in and around them.

This house — which was a homicide scene 25 years ago — is now where Morgan shows love for others by serving up nutritious meals and snacks to dozens of children. She offers to help them study, decompress or talk candidly about any topic a young person might need to discuss.

After going through so much, both Morgan and Blaze have discovered that their true superpower is empowering others.

EDUCATIONAL ACCESS AND QUALITY

Just a few blocks from another Friendship House in Shreveport, in a basement classroom of Noel United Methodist Church, there’s a team of courageous learners at work. Serena Christian might not know it yet, but she’s got superpowers, too. Working toward a high school equivalency diploma, she wakes up every morning with a lot on her plate and, in 16 hours, does more hard work than some-

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one else might do in a week. Yet the 45-year-old mother of seven has found time to take classes to earn her high school credentials at Adult Renewal Academy, a program similar to the relational model that Community Renewal embraces. Two of her daughters recently graduated, and Christian aspires to be next in reaching this goal. “Some days, I want to give up,” she says. “But Ms. Tanj’a calls me and encourages me. She’s more than just a teacher — she’s my reason for fighting so hard to do better.”

Aside from being her teacher at Adult Renewal Academy, Tanj’a Peoples is also Christian’s friend, both having a positive connection with each other.

CONTINUING COMMUNITY CONNECTIONS

In a country full of division and disconnection, is there an answer? We know there are cracks in the foundation of society, fractures that run deep and need fixing. However, Catholic health care and each of us can help weave a stronger fabric in our community through partnering with other organizations.

At CHRISTUS Health, we’re proud of our ability to answer a critical challenge related to health care. It is a value we share with our other partner organizations. As best said by Community Renewal’s McCarter, we can rebuild the very foundation of society through a system of relationships. “By connecting and growing caring people, we build a culture that empowers all and excludes none,” he says. “Person by person, block by block, neighborhood by neighborhood.”

NADINE NADAL is director for Community Health Development at CHRISTUS Health in Irving, Texas.

MACK McCARTER is a contributor to this article.

He is founder and coordinator of Community Renewal International.

NOTES 1. “Social Determinants of Health,” Office of Disease Prevention and Health Promotion, https:// health.gov/healthypeople/priority-areas/ social-determinants-health.

2. “2021 Louisiana Health Report Card,” Louisiana Department of Health, https://ldh.la.gov/assets/oph/ Center-PHI/2021_Health_Report_Card.pdf.

3. “2021 Louisiana Health Report Card,” Louisiana Department of Health.

4. Shreveport Police Department’s Crime Analyst Unit, “Comparison of Reported Offenses within Community Renewal International’s Friendship House Study Areas,” Shreveport Police, November 10, 2021.

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Andrew Medichini/Associated Press

Finding God in Daily Life “We must move forward together, as one, in a renewed spirit of fraternity and solidarity, cooperating generously for the common good.”

— Pope Francis’ address to a joint session of U.S. Congress on Capitol Hill in Washington, D.C., on September 24, 2015

Health Funder Reflects on Best Grantmaking Practices CHANNON LUCAS Chief Administrative Officer, Mother Cabrini Health Foundation

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he Mother Cabrini Health Foundation — a grantmaking organization dedicated to improving the health and well-being of vulnerable New Yorkers — has awarded $470 million to more than 1,000 organizations and initiatives in its first four years. This was not an easy feat, and the team faced plenty of obstacles along the way. As a brand-new organization with zero infrastructure in 2018, the foundation quickly found itself responding to an unprecedented global health crisis. Amid the challenges and heightened needs of COVID-19, we rapidly focused our mission, built an organizational structure and put into operation ways to quickly respond to residents in need and their communities.

Along the way, we’ve seen constant, stark reminders of the need to fund not just health care providers but also groups working more broadly on changes like increased food and housing security, and how multiple health-related issues need to be addressed to ensure the well-being of underserved and low-income populations.

Reflecting on the progress since our foundation’s inception, which has been marked by skyrocketing health and human services needs across New York, we would like to share key learnings so that other philanthropy and health care leaders can look to our experiences to strengthen their efforts and improve health outcomes for communities across the country.

GROUNDED IN OUR MISSION

The foundation originated from the sale of Fidelis Care, a nonprofit health plan insurer started through the leadership of the Catholic Medical Center of Brooklyn and Queens and the Diocese

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of Brooklyn and sponsored by the Catholic bishops of New York State, to increase health care access for the poor.1 The sale to Centene Corporation was approved by state regulators in 2018 following rigorous governmental review and extensive public comment. Proceeds from the transaction enabled the formation of the Mother Cabrini Health Foundation, with initial funding of $3.2 billion to provide annual grants in perpetuity to serve state residents in need. We set up operations in New York City under the guidance of a board of directors made up of health experts and business leaders.

Early on, we found it essential to ground our organization in a mission and set of values that would guide our work and convey a clear compass for the long-term vision of meeting health needs in the state. Our foundation is guided by Catholic principles as exemplified by the life and work of Mother Frances Cabrini. Some of our core values include a belief in the dignity and value of all peo-

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ple and preferential care options for the poor and tact person from our Programs and Grants team.

Staff members conduct site visits, and grantees marginalized in society.

Mother Cabrini was an Italian immigrant must submit a project budget as well as interim who traveled to New York City in 1889 without and final grant reports. Our monitoring proa home. Upon her arrival, she set to work serv- gram is designed to ensure stewardship of funds, ing fellow immigrants by organizing schools, cat- accountability and sound program management. echisms and caring for and housing orphans. Mother Cabrini dediFor us, reducing health disparities cated her life to serving the poor means not only supporting direct-care and helping those in need. By the time of her death in 1917, she had services but also addressing the social opened 67 schools, hospitals and orphanages. In 1946, Pope Pius XII determinants of health. canonized Mother Cabrini, makWe now have a staff of nearly 60 employees who ing her the first U.S. citizen to be recognized as also reflect New York’s diversity. Since we have a saint.2 Just over a century after her passing, we employees who are not Catholic or come from any launched the Mother Cabrini Health Founda- kind of faith background, it has been important tion. Our CEO, Msgr. Gregory Mustaciuolo, and to create a shared understanding and context. To I were its first employees, along with an experi- ensure we were true to Catholic principles in our enced executive team. The general path forward work, we recently provided a six-week course for was clear: to carry out Mother Cabrini’s legacy of employees, led by Joseph Capizzi, PhD, a professervice and dedication to provide for New York’s sor of Moral Theology/Ethics, and Kurt Martens, most vulnerable. We focused on improving the JCD, a professor of Canon Law, both at Catholic lives of eight target populations: New York’s low- University of America; and Daniel Frascella, PhD, income individuals and families; older adults; our current chief Programs and Grants officer. youth and young adults; persons with special Members of our board also attended. The feedneeds; immigrants and migrant workers; veter- back was positive, resulting in multiple producans; formerly incarcerated individuals; and young tive conversations. children, pregnant women and new moms.

For us, reducing health disparities means not UNDERSTANDING COMMUNITIES’ EVOLVING NEEDS only supporting direct-care services but also Another critical lesson we have learned has been addressing the social determinants of health. the importance of maintaining consistent lines Communities across New York often lack access of communication with the people and organizato the basic socioeconomic infrastructure that is tions in the communities we serve. essential for positive health outcomes, including Upon the foundation’s inception, we spent access to housing, transportation, a living wage, significant time and energy analyzing New York, social support systems, access to clinical care, looking at Medicaid-eligible populations and nutritious food and education. The foundation working with external partners to understand the seeks to address these social determinants of needs of vulnerable state residents and the organihealth to reduce health disparities and improve zations supporting them. As we learned about and health outcomes. built relationships with communities — and even Our pool of grantees has been as diverse as as we hired staff — we established strong pathNew York itself: large and small, rural and urban, ways for gathering input, feedback and insights. upstate and downstate, and organizations affili- Along the way, as the foundation has grown, so ated with all or no religions at all. In 2021, approx- have our community outreach efforts. In January imately half of our grants were for $250,000 or 2021, we hired two community relations directors more, and for approximately 45% of the 500 grants who bring regional upstate and downstate experawarded last year, our foundation is the largest tise to the work of evaluating and prioritizing private funder. needs for grant funding, and this year we’ve hired To manage this process, each grantee has a con- a director of public policy.

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Today, our community relations team works daily with organizations across the state to ensure we’re staying abreast of local needs and challenges and adapting our grantmaking accordingly. Furthermore, in July 2022, we brought on our first Chief Evaluation and Learning Officer, Anupa Fabian, to help us better understand community needs, define and measure success of grants, and apply findings to allow us to address the impact of disparities in health for communities.

was lack of resources and capacity. Organizations surveyed also cited challenges related to money, health care, housing and food as some of the greatest obstacles to wellness in their communities, and we incorporated that feedback into our yearend grantmaking.

MEETING URGENT NEEDS AS A STARTUP FUNDER

When we first started, we faced a dilemma: How were we to get funding out the door to organizations most in need, while continuing to build up our organizational capacity to be a susWe consider it our responsibility tainable presence for our grantees and their communities? This was during a time to not only support our grantees in the foundation’s development when we financially but also to systematically did not even have a full in-house grantmaking team. incorporate their feedback on Meanwhile, the pandemic provided a clear opportunity to accelerate grantmakpriority needs and challenges as we ing. The needs were apparent, as was the work we had to do. Therefore, we operdeliver grants. ated on two tracks: we focused both on We also recognize that we are in a unique posi- getting emergency COVID-19 grants out the door tion to convene organizations and direct-service and on building up our internal infrastructure to providers to facilitate conversations and learning grow long-term internal capacity.

In the early months of the pandemic when New opportunities among them. When we opened our doors in 2018, it was our intention to “hit the road” York was the national epicenter, we responded and really start listening to communities through- with approximately $70 million in emergency out New York to understand what the needs were funding to support nonprofit organizations and to identify the key regional players. When addressing the health-related needs of New York the pandemic arrived in March 2020, we quickly residents resulting from COVID-19. That meant shifted these in-person events to virtual commu- organizations could purchase personal protecnity health care conversations, and we have been tive equipment for health care and social service pleased with the way community leaders and workers, supply emergency food to food banks community-based organizations have interacted and pantries to meet the growing demand, or provide hazard and/or overtime pay to frontline, with us and one another.

We consider it our responsibility to not only direct-service health care workers.

Additionally, by expanding our affiliations support our grantees financially, but also to systematically incorporate their feedback on priority with the organizations we support, we are now in a position to help exchange best practices and needs and challenges as we deliver grants.

Understanding the needs of those you serve facilitate coalitions. We hope that by sharing this is not merely a box to be checked. Rather, it is information, more ways to transform statewide a constant process. In 2021, the foundation sur- results will be identified. veyed hundreds of grantee organizations across New York to gauge the biggest pain points for CREATING LONG-TERM IMPACT frontline providers. The survey provided critical Even as we were crafting grants specifically in insights into the challenges facing our grantees response to the evolving public health crisis, we and how those challenges have been exacerbated decided it was important to strategize carefully by the pandemic. For instance, we heard — not where we could make a sustained impact on vulsurprisingly — that the top obstacles our grantees nerable New Yorkers’ access to health care. faced in meeting the needs of their communities Since 2020, the foundation has sought to do so

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with three-year strategic grant programs focused on improving oral health access and outcomes, increasing availability and access to quality health care, and funding programs to provide young children with necessary health and education resources to succeed in underserved communities. These strategic grants address health disparities with a long-term lens, such as expanding the diversity of the health care workforce pipeline.

This is a key unmet need in New York.3

CONCLUSION

We’re proud of the work we’ve done, but following in the footsteps of Mother Cabrini’s legacy is not an easy task. When we started, there was no institutional knowledge or set rules to guide or hold us back. Equipped with only a mandate and a mission, we needed to build up our operations, and we needed to do it quickly.

As a new organization, we still have more to learn as we continuously grapple with critical questions, including: How can we better listen to our communities to understand their priorities and concerns?

How can we derive deeper insights from statewide data on social determinants of health to help us be the best steward of our resources in service to our mission?

How do we make sense of numerous policy landscape developments and research on the health and social needs of our communities?

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How do we decide where to focus our efforts, given the volume and range of needs in the communities we serve?

In the meantime, we continue to be guided in our work to do what Mother Cabrini did: shine light on and provide aid to those who need it.

CHANNON LUCAS is chief administrative officer of Mother Cabrini Health Foundation. She is also a board member of Philanthropy New York and serves on the advisory board at NYU’s Center for Global Affairs.

NOTES 1. Jonathan Lamantia, “Catholic Church Creates $3.2B Health Foundation From Fidelis Sale,” Crain’s New York Business, May 8, 2018, https://www.crainsnewyork. com/article/20180508/HEALTH_CARE/305089999/ cardinal-timothy-dolan-and-catholic-church-create3-2-billion-health-foundation-from-fidelis-care-sale.

2. “Mother Cabrini Canonized on July 7, 1946,” Missionary Sisters of the Sacred Heart of Jesus, July 7, 2022, https://www.mothercabrini.org/news-andpublications/mother-cabrini-canonized-on-july-7-1946/.

3. “New York State Department of Health Recognizes the Public Health Workforce as Essential to Our Future and Highlights Public Health Workforce Challenges and Disparities During National Public Health Week,” New York State Department of Health, April 5, 2022, https:// www.health.ny.gov/press/releases/2022/2022-04-05_ public_health_week.htm.

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Setting the Table for Success in Global Health Work SUSAN HUBER President of Ascension Global Mission and Senior Vice President of Sponsorship for Ascension

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he importance of collaboration has always been foundational to Ascension’s health care work. The historic sponsoring organizations of Ascension were founded between 400 and 800 years ago. All have collaboration embedded in either their charisms or in their mission or value statements. So, it is no surprise that when Ascension Global Mission began in 2011 with seed capital from historic sponsors and Ascension, its vision was to “engage in international efforts to improve the health and living status for poor and vulnerable populations in low resource countries through ‘collaborating’ with local and global communities, including sponsoring congregations and other religious communities, to foster long-term, sustainable change.” Collaboration was not just a good idea — it was an expectation.

Ascension’s sponsors also understood that defining what constituted care — and how to sustain it — was the work of the local population.

Ascension Global Mission sought to support the local vision to set priorities and address needs.

True collaboration takes time, patience and resources. It takes time to develop trusted relationships with local leaders and partners necessary to establish the solid foundation to create and ensure systemic change. In an environment that requires measurable outcomes, it takes patience to defer these metrics while continuing to commit the resources required to sustain the building of trusted relationships.

In 2011, Ascension Global Mission began exploring how it might contribute to improving the health of the most vulnerable in Guatemala.

The initial years were spent listening, learning and exploring relationships with potential partners. Our relationships evolved with a group of

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faith-based partners — the Daughters of Charity of St. Vincent de Paul, Province of Central America; the Episcopal Conference of Guatemala’s Pastoral Care for Early Childhood Development; and the Barbara Ford Peacebuilding Center, an organization founded by the Sisters of Charity of New York.

These partners critically reflected how traditional efforts of development aid create a paternalistic relationship where 1) communities become reliant on the expertise and resources of outsiders; 2) results are often not sustained; and 3) community members are not left with the skills and perspective to address other development issues beyond the principal project objective. Through this exploration and dialogue with our partners, we came to understand that supporting charitable projects for vulnerable communities had to go “beyond” well-meaning solutions to have the desired sustainable impact. We

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set forth to develop a new approach to enable and empower participating communities through self-sustaining collaborative action.

BUILDING A COLLABORATIVE CONCEPT

phases: Phase One — Establish the Relationship: The facilitator connects with the community leader(s), gains an understanding of the community, shares the concept and approach of working with the community, and ultimately “asks permission” to engage with the community. This requires regular meetings between facilitators and a wide range of community leaders to build understanding and trust. It also helps to ensure representation and inclusion of often overlooked silent community voices. Below are some questions that the facilitator should consider asking the community leader(s): Who should be involved?

Who/what groups are not represented in these discussions?

May we work with you in your efforts?

In 2016, our Guatemalan partners, known as Alianza, set out on a deliberate journey to discover how to most effectively “walk with” and support people living in poverty in order to identify and take action on a range of issues that impacted their health and well-being. Now referred to as “The Method for Collaborative Governance,” this approach has been implemented in 35 communities, impacting over 26,000 people. Through creating a school for community facilitators — a train-the-trainer concept that builds the capacity of select community members to foster good governance, plus awareness and interest in integral health within their own community — this method is poised to Through this exploration and be adopted and expanded in other communities globally. dialogue with our partners, we

came to understand that supporting What is the Method for Collaborative Governance? charitable projects for vulnerable The Method for Collaborative Governance is a grassroots approach communities had to go “beyond” to activate and strengthen commuwell-meaning solutions to have the nity governance, enabling groups to come together, identify prioridesired sustainable impact. ties and take action on what matters most to them. This approach focuses on generating the conditions for effective collaboration Phase Two — Discover Problems: Commuamong community, municipal and institutional nity leaders share their community’s achieveleaders so they can build and promote processes ments, advances, difficulties and local challenges. for sustainable impact.

What emerges from the following questions Ascension Global Mission, through its Alianza forms the basis of an agenda of community issues partners, employed community facilitators important to local leaders and their communities: trained to ask effective questions to stimulate disWhat challenges impact the community cussion and highlight and enable local knowledge most? and expertise. Community leaders are encouraged What is already being addressed that could to debate, analyze and make decisions. Although a be built upon? seemingly simple concept, asking the right questions at the opportune moment requires listening Phase Three — Prioritize and Decide carefully, understanding context and community Actions: Community leaders set priorities and dynamics, and framing the question appropriately plan action, leading their communities to resolve to ensure community authenticity. It also requires issues locally, without external support, by exammutual trust. ining additional questions: What criteria will determine projects to be Phases of Community Work evaluated?

Implementation of the Method for CollaboraWhat is necessary to secure community tive Governance at the community level has five “buy-in” and mobilize support?

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Phase Four — Solve Problems: Community leaders proactively promote and implement their action plan, which includes obtaining and managing any external support identified by asking: What can we do ourselves?

What reputable external organizations can lend support and who has the relationship with the external organization(s)?

How do we ensure that the external organization addresses our expectations versus their desires?

Phase Five — Achieve Self-Sustaining Collaborative Governance: Local communities have

children’s health and generated support for prioritizing efforts to overcome those issues.

Created regular opportunities for a variety of community leaders to come together to identify and discuss issues. This enabled communities to focus their efforts, mobilize community support and advocate with government agencies for specific projects.

Fostered in-depth analysis of the problems that community members identified, which enabled leaders to devise more holistic, creative solutions and lead the implementation of those solutions.

Tangible Community Projects and Initiatives Working with Alianza, community leaders identified and analyzed the most important issues to In our experience in Guatemala, the role of the health and well-being from their perspective and Alianza facilitators was to ask the appropriate, determined actions to take, mobilizing resources probing questions to subtly guide the community within their community and, when needed and and its evolving leadership through the first three possible, through support from external entities. phases. They then deliberately began to step away Issues addressed included: in phase four in preparation for full transition to Trash management: Trash is a significant the community in phase five. It is important to problem in most rural communities as they do note that this is not a linear process. For example, not have access to regular trash removal services. communities could progress to phase three and Several communities identified this as an issue recognize that not all voices were at the table (for impacting their community health and mobilized example, women) or have community leadership to address it. As a result, clean-up campaigns and roles change, which would require them to step community policies to reduce waste were initiback to the processes in an earlier phase. ated. Neighboring communities, who also prioritized trash management as a major issue, Strengthening community collaborated to develop a coordinated collection system. governance is a critical component trashWastewater management: For many of supporting people to be agents of communities, wastewater runs in streets and open ditches, eroding the soil, deteritheir own destiny. orating streets and causing health hazards.

Many rural families use basic pit latrines, which are hard to keep sanitary especially during RESULTS the rainy season. Solutions to address the probImproved Governance Strengthening community governance is a critical lem take time and resources. Alianza supported component of supporting people to be agents of communities to resolve all or part of their draintheir own destiny. It involves leading the improve- age systems through connecting them with nonments they want to see rather than becoming governmental organizations and/or government voiceless recipients of charitable aid and solu- agencies to explore solutions, mobilize resources tions from well-intentioned international orga- and implement construction. nizations. Through our findings, stronger comAccess to health services: Communities munity governance prompted the following identified lack of consistent access to health outcomes: services as an impediment to physical wellness, Increased participation and engagement particularly for mothers and children. One comof women in community leadership forums that munity advocated with local health authorities to helped raise awareness of challenges impacting reinstate monthly ambulatory services. Another established collaborative governance as a norm and function entirely without the facilitator.

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devised a strategy to pay for essential operating costs. Furthermore, another partnered with local health authorities to coordinate monitoring and care for high-risk children.

LASTING IMPACT OF OUR EFFORTS

Since Ascension Global Mission was founded, just under $3 million has been invested in this journey.

Our efforts helped establish a Catholic-led collaborative effort focused on empowering communities to lead their own sustainable health improvements, capable of expanding to more communities throughout the country.

This work took time, patience and resources. It was not without its challenges and setbacks. But it achieved what we set out to do: collaborate with others to enable systemic change. The Method for Collaborative Governance builds local leaders’ competence and capabilities to develop and

execute their community’s development agenda, prioritizing issues that impact health and children. It is designed to build capacity and empower leaders to continue to proactively drive improvements in their community, beyond the promise of any specific external aid project. As noted earlier, a key component to this method is the school of community facilitators.

Alianza members are working to integrate the learning and approach into their own organizations, as well as explore how to engage other communities. Although still in its infancy, this method is positioned to be adopted and expanded to generate positive systemic change for many years.

SUSAN HUBER is president of Ascension Global Mission and senior vice president of Sponsorship for Ascension in St. Louis.

QUESTIONS FOR DISCUSSION Susan Huber, president of Ascension Global Mission and senior vice president of Sponsorship for Ascension, details the deep thinking that went into creating the Method for Collaborative Governance.

Working with partners at Alianza, those working in global health determined the right questions to ask and ways to collaborate to enable local knowledge and expertise in the communities where Ascension works.

1. What aspects of this approach do you already use in your global health response? Does your organization allow you the time and resources to listen and build trust before measuring metrics and focusing on results? Is there a good way to make the case when more time or support is needed?

2. One question highlighted in this article is: May we work with you in your efforts? Take a moment and think about the collaborative approach embedded in that question. How do you ask others in international work to partner with your organization? Have you had occasions where stated needs didn’t integrate well with what the organization anticipated? How did you resolve it?

3. What features of the Method for Collaborative Governance could be used in other community health initiatives your system is engaged in? How might a similar collaborative method be used in communities to address social determinants of health?

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The Power of Teamwork: Nonprofit Changes Lives Through Free Surgery Model ROBIN ROENKER Contributor to Health Progress

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t 6:45 a.m. on a recent day at the nonprofit Surgery on Sunday, an energetic team of volunteer nurses and medically certified Spanish-English interpreters buzzed about taking vitals, explaining procedures and ensuring patient consent forms had been completed correctly. Nearby, volunteer surgeons and anesthesiologists changed into scrubs and prepared for the busy morning ahead, which included two hernia repairs and two gall bladder removals, plus one tonsillectomy, one cornea repair and one retina repair.

The scene looked like any other surgery cen- Lexington multiple times to undergo three sepater in America with one key difference: the seven rate operations at Surgery on Sunday — two to patients waiting their turn in clean, orderly pre- repair severe cataracts on each of his eyes and op bays would not face any out-of-pocket bills for one to remove melanoma on his right hand. “My vision was so poor I was running into trees. I their surgical procedures.

Since its launch in 2005, Lexington, Kentucky- couldn’t drive. I couldn’t work. You can’t underbased Surgery on Sunday has performed nearly stand how hard it was for me not to be able to pro6,000 free, medically necessary outpatient opera- vide for my family.” tions for low-income patients — everything from simple her“I feel like, honest to God, they have nia repairs and cataract removsaved my life. My vision was so poor I als to more specialized orthopedic operations. was running into trees. I couldn’t drive. I At its core, the unique care collaboration model behind couldn’t work.”

Surgery on Sunday is simple: — Randall Winford of Lebanon, Tennessee providers volunteer their time and services one Sunday each Since having his vision restored, Winford has month to perform these procedures at no cost to qualifying patients, using untapped weekend returned to his job remodeling houses — a second hours at the Lexington Surgery Center, a physi- chance he does not take for granted. “I’m not an emotional guy,” he says. “But when I was able to cian-owned facility affiliated with SCA Health.

But for patients, the effect is anything but sim- return to work that first day, I bawled my eyes out.

The people at Surgery on Sunday are the greatest ple — it’s life-changing.

“I feel like, honest to God, they have saved my people I’ve ever dealt with. They make everything life,” says Randall Winford of Lebanon, Tennes- so comfortable — and they don’t make you feel see, who made the roughly three-hour drive to bad for needing help.”

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PROVIDING CARE WHERE IT’S NEEDED

While seven patients underwent operations at Surgery on Sunday one day this past June, on a more typical surgery day, usually held the third Sunday of each month, the care team performs 10 to 15 operations. A standard day’s case load requires between 70 to 80 volunteers, including nurses, anesthesiologists, surgeons, interpreters and intake staff. Most volunteers arrive around 6:15 a.m. and work until all patients are ready to be sent home, usually around 2 p.m.

The program currently has around 275 active clinical volunteers on its roster, among them roughly 50 surgeons — representing every health care system in Lexington as well as those from many surrounding communities — who offer their services on a rotating basis as needed. Volunteers have donated more than 100,000 hours of service since Surgery on Sunday’s inception. This number grows monthly.1 “When volunteers come in and see that they’re getting a chance to do good, it’s easy to hook them and keep them coming back,” says Dr. Andrew “Andy” Moore II, founder and chair of the board of directors of Surgery on Sunday. “This work gives us all purpose. It energizes me every time I go in.”

“The nurses and the doctors and other volunteers at Surgery on Sunday are about providing care to those who need it,” agrees Dr. Paul Kearney, the nonprofit’s medical director and a longtime volunteer surgeon. “I personally don’t care about where you come from or if you’re documented or not. If you need help, I’m going to help you.”

Currently, roughly 30% of Surgery on Sunday’s patients speak little or no English. While the majority of patients come from Kentucky, in recent years, roughly 30% have come from Tennessee — an influx stemming from the state’s decision not to expand Medicaid access under the Affordable Care Act,2 while Kentucky did.

Patients who qualify for Surgery on Sunday services make too much to qualify for Medicaid but not enough to pay for expensive health care deductibles. Specifically, Surgery on Sunday works with patients whose household income is below two-and-a-half times the federal poverty level who either have no health insurance or have policies with deductibles that are 10% or more of their total income.

Patients, whether pediatric or adult, are often referred to Surgery on Sunday by a provider at a

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SURGERY ON SUNDAY REFERRALS (FROM 2018-2021)

643 233

ABOUT

72%

of patients were from Kentucky, including 30% from Fayette County (where Lexington is located)

ABOUT

26%

of patients came from Tennessee, which did not expand Medicaid

The program also provided free procedures to patients who live in Ohio (6), Virginia (4), West Virginia (3), Indiana (2), and one person each from Alabama, Georgia and Illinois.

free health clinic or local health department. The Surgery on Sunday care team reviews patient care records carefully to ensure each surgery is medically necessary. When needed, volunteers with the agency can help patients locate or secure pertinent medical records — a process that can be challenging for patients who have had limited access to health care and who may not have seen a primary care provider in years.

“I was speaking to the family member of an eastern Tennessee patient recently who said he hadn’t been off their mountain in three years,” says Amanda Ferguson, who served as Surgery on Sunday’s full-time paid executive director for

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Photo courtesy of Surgery on Sunday

C A R E C O L L A B O R AT I O N S

Surgery on Sunday volunteers remove a submandibular neck mass from a female patient. Shown left to right are Corey Lindsay, SRNA; scrub nurse Rebecca Roberts (reaching over patient); Francesca Spirito, SRNA; otolaryngologist Dr. Tad Hughes; and Daryl Bauer, CRNA. Hughes is a Surgery on Sunday board member.

five years until resigning at the end of June to pursue other professional interests. “Our patients represent a population that doesn’t routinely access care. They aren’t getting routine screenings or having annual wellness visits because they don’t have insurance and simply cannot afford it,” Ferguson says.

The brainchild of Moore — a plastic surgeon who practiced primarily at CHI St. Joseph Health until his retirement — the nonprofit’s initial launch was funded through $200,000 in grants from Catholic Health Initiatives and the Sisters of Charity of Nazareth, both of which continue to support the agency. The Surgery on Sunday headquarters, in fact, is housed in office space donated

by CHI St. Joseph Health, which is part of CommonSpirit Health.

“We still get grant money from the Sisters of Charity of Nazareth almost on an annual basis, and also St. Joe — through their foundation — continues to support us through various efforts and through sponsoring various events that we do as fundraisers,” Moore says. Two popular annual fundraisers — a local Dancing With the Stars-

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themed event and a 25-hour fitness marathon — have raised hundreds of thousands of dollars for Surgery on Sunday over the years.

The original idea for Surgery on Sunday stemmed from volunteer work Moore was doing in the early 2000s through St. Joseph’s nonprofit Northside Clinic, no longer operating, which had provided free medical care to economically disadvantaged neighborhoods in Lexington.

“I was on the board of Northside Clinic, and we kept hearing complaints from an ER doctor on the board that there were all these patients needing surgery with nowhere to go,” Moore says. “I threw my idea [for Surgery on Sunday] out there, and there happened to be others on the Northside board — including a lawyer and a grant writer — who had the skill set to help us get Surgery on Sunday off the ground.”

STRENGTH IN PARTNERSHIPS

Surgery on Sunday operates completely through private grants and donations from corporations, religious and secular nonprofits and individuals; it receives no government or taxpayer

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licate Surgery on Sunday’s model, one stumbling block has been the reluctance of area surgery facilities to get on board.

“Louisville had a similar program going for three years, but they were bouncing all over the community to different places because no surgery center would commit to it, and their program didn’t last,” Moore says.

While securing a surgery facility partner is important, so, too, is getting investment from its staff, Moore adds. “You have to get personnel at the surgery center invested as well, because you have all these volunteers coming in who don’t know the facility, and it’s so helpful to have at least one or two volunteers coming each month who do know the building and know how the usual processes take place there.”

Surgery on Sunday has also forged strong partnerships with area hospital systems, diagnostic offices, labs and physical therapy centers, which routinely provide lab tests, pathology, physical therapy and other health services for free or reduced rates. When testing or diagnostics are not available for free, Surgery on Sunday covers these costs. Its patients do not receive a bill for any ser-

Photo courtesy of Surgery on Sunday

support. It has just one paid staff position — for its executive director — while everyone else operates as a volunteer.

The agency’s operational costs are relatively low, since service hours are donated, and it leases its Sunday usage of the Lexington Surgery Center for just $1 a year. “That way, if anything bad happens, it’s on us, not them, because we ‘own’ the building that day,” Moore explains.

Surgery on Sunday has its own Ambulatory Surgery Center license and reports its operational data to the Office of the Inspector General of Kentucky, just as any other ambulatory surgery center would.

To cover supply costs on surgery days, Surgery on Sunday pays the Lexington Surgery Center an additional flat fee of roughly $350 per patient. It also occasionally receives donated supplies and surgical instruments from surgical supply partners, many of whom contribute thanks to preexisting professional relationships with Surgery on Sunday surgeons.

Having the partnership of the Lexington Surgery Center has been key to the agency’s success, Moore says. When other cities have tried to rep-

Nurses in Surgery on Sunday’s Post Anesthesia Care Unit discuss and assign patients coming out of the operating room for recovery. From left to right, Babs Ernest, RN; Charmayne Brown, RN; Holly Moore, RN; and Mary Todd, RN.

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vices provided.

“We put on our social worker hat to help patients find the cheapest options for X-rays or MRIs or whatever else they may need presurgery,” Ferguson explains. “We have strong partnerships in place in Lexington, but if we’re dealing with a patient from outside of Lexington who may need services before or after surgery, we’ll call around to advocate for our patients and say, ‘Here’s the deal. Here is who we are and what we’re about.

Can you help us help this patient?’”

Relationship-building helps drive Surgery on Sunday’s success, agrees Nancy Johnson, RN, BSN, a trained ICU and transplant team nurse who volunteers as the agency’s clinical coordinator.

“Work like ours has to be a community effort,” Johnson says. “I recently had a patient who needed medical clearance to have general anesthesia, for example, so I called a free clinic who sends us patients frequently and said, ‘Hey, this is Nancy. I need a favor back in return. Could one of your physicians see and clear this patient?’ And they said, ‘Absolutely.’ We’re all willing to work together so we can make sure all these patients get taken care of.”

OVERCOMING OBSTACLES

All Surgery on Sunday patients are seen at their surgeon’s home office for a no-cost preoperative evaluation and for a free postoperative followup — an arrangement that has been a bit tricky at times to navigate from a health administration standpoint.

“Most hospital-based clinics do not have a way to register a patient visit in their systems without a payment mechanism associated with it,” Ferguson explains. “We have so many surgeons who tell us they’d be glad to come volunteer to perform surgeries, but then they face this obstacle from the administrative side,” she adds. Sometimes, surgeons work out the logistics of how to either bill or not bill those visits with their health systems themselves. At other times, Surgery on Sunday leadership has put in calls to health system administrators to mutually carve out plans for handling these specialized cases.

Some volunteers also initially wonder about the professional liability implications of working with Surgery on Sunday. But because the nonprofit is a free clinic certified with the Health Resources and Services Administration, federal

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law exempts its volunteers from malpractice and personal liability claims.

From a patient perspective, sometimes simply getting to Lexington can be the biggest hurdle.

“Transportation is a big stumbling block for our patients,” Johnson says. “Especially as we have more patients coming from out of state on limited incomes. The number one reason we may lose a patient is that they can’t find a ride to get to us.”

To ease this burden for patients, Surgery on Sunday routinely draws on its fundraising proceeds to provide gas cards or Uber or Lyft gift cards to help patients make it to their appointments. If out-of-town patients need to stay in Lexington overnight, the nonprofit offers to cover the cost of their hotel accommodations. “We try to be as resourceful as possible,” Johnson says. “The longer we do this, the more tricks we learn.”

Because so many of its patients are now coming from Tennessee, Surgery on Sunday is trying to start a second location in Knoxville, but the process will take time. “When you’re running one of these programs, everything comes down to building personal connections,” Kearney says. “A lot of it comes down to building bonds in the community before you try to launch. You have to find enough people wanting to make it work.”

For those willing to embrace the model, the work is endlessly fulfilling, says Tony Reyes, a certified medical interpreter who has volunteered to communicate in Spanish and English with Surgery on Sunday since its beginnings. “This work changes patients’ lives forever,” says Reyes, who was particularly struck by the successful postsurgery turnaround of a patient who had been facing homelessness when his hernia pain had left him unable to work. “There is so much joy in being part of helping patients in such a profound way.”

ROBIN ROENKER is a freelance writer based in Lexington, Kentucky. She has more than 15 years of experience reporting on health and wellness, higher education and business trends.

NOTES 1. “About Us,” Surgery on Sunday, https://www.surgeryonsunday.org/about-us.

2. Louise Norris, “Tennessee and the ACA’s Medicaid Expansion,” healthinsurance.org, April 18, 2022, https://www.healthinsurance.org/medicaid/ tennessee.

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Unlikely Partners Empowering Health Access ANDREW KRUSE and SUSAN TIPPETT Director, Community Benefit, Ascension Michigan, and Director, Grant Administration, Ascension Michigan Foundation

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or those negatively impacted by social determinants of health, overcoming the often complex barriers to meeting their health care and social service-related needs can be extremely challenging, but supportive navigation services can guide them to helpful resources.

Social determinants of health are the conditions in the environments where people live, learn, work and play that affect a wide range of health risks and outcomes.1 Spanning areas including health care access and quality, economic stability, poverty, food security, housing, transportation access and safe neighborhoods, these issues contribute to health inequities and disparities and have a significant impact on overall quality of life and well-being.2 The partners involved in emPOWER Genesee work together to enable vulnerable clients to access health, energy and financial services. Initiated by a team of nontraditional, cross-sector partners — Ascension Genesys, Consumers Energy and Huntington Bank — emPOWER Genesee is a strategic community collaborative launched in 2019 in Genesee County, Michigan. Designed to mitigate the social determinants of health that adversely influence personal health and well-being, the program recognizes that a vulnerable population within Genesee County has needs spanning all partner organizations that can be met with coordinated, accessible navigation services.

EMPOWERING CHANGE TOGETHER

To implement emPOWER Genesee, Genesee Health Plan — a nonprofit health care organization that provides basic health services to uninsured and underinsured residents of Genesee County — was engaged as the anchor organization to build a community navigation model to connect clients with services to address their social determinant of health-related

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needs. The collaborative’s partners committed, and continue, to provide project oversight in monthly stakeholder collaboration meetings, support the project with financial and human resources, set data metrics with Genesee Health Plan, and establish a physical presence in the community for service access.

To reach people where they already go for services, emPOWER Genesee placed a Genesee Health Plan community navigator at Consumers Energy’s direct payment center in Flint, Michigan. Consumers Energy is Michigan’s largest energy provider, where a vulnerable population of approximately 10,000 individuals pay their utility bills in person each month with cash. The community navigator actively engages people in the lobby of the payment center so one or more of their needs can be addressed in one stop, in real time.

The community navigator has been well received

by Consumers Energy customers who asked questions and got information while waiting in line to pay their bills. This led to a steady stream of people making navigation appointments. “By delivering community navigation services onsite, we can reduce service access barriers and create an environment that mitigates the impact of the social determinants of health that negatively affect the health of people in our community if not addressed,” says Stephanie Duggan, MD, regional president and chief executive officer of Ascension Michigan’s Mid/North Region.

The emPOWER Genesee community navigator has completed several certification programs that

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C A R E C O L L A B O R AT I O N S

provide specialized training in connecting people with community assistance programs, services and resources. The community navigator is a certified community health worker through the Michigan Community Health Worker Alliance. The group provides training across eight core competencies: public health and health systems; legal and ethical responsibilities; navigating community resources; communication styles and cultural responsiveness; teaching and capacity building; coordination, documentation and reporting; healthy lifestyles; and behavioral health, substance use and abuse disorders. The community navigator is also a certified application navigator for the federal Health Insurance Marketplace; a Michigan Medicare/Medicaid Assistance Program counselor; and has specialized training to enroll people in the Michigan Medicaid MI Bridges program.

Even in the face of the coronavirus pandemic, the program safely provided virtual navigation services to Consumers Energy customers. It also expanded its reach through a computer kiosk at the Ascension Medical Group Genesys Downtown Flint Health Center, where patients with social determinant of health needs could access navigation services virtually and confidentially. The health center serves 2,100 patients annually, the majority of whom are Medicaid-insured and likely to experience challenges with social determinants of health.

In the spring of 2022, the Ascension Genesys Downtown Health Center transitioned from virtual to in-person navigation services where patients can now meet with the community navigator immediately following their medical appointments. In-person services at Consumers Energy’s direct payment center have been scheduled to return this fall.

IMPACT ON COMMUNITIES SERVED

Since emPOWER Genesee’s launch in October 2019, the community navigator has engaged with more than 1,300 unique clients, resulting in more than 4,000 service access calls to clients, health care providers, energy assistance personnel and community service providers. Of these clients, 945 received direct health care and energy assistance referrals, and 487 received community service referrals.

Overall, the most needed services are housing/ shelter (35%); completion of State Emergency Relief applications (33%) that qualify individuals to receive energy assistance; daily essentials, including food, water and clothing (22%); and mental health, substance use treatment and health care (8%). In 2021

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alone, 239 State Emergency Relief applications were completed, with 98% of applicants served by the navigator receiving financial assistance. An emPOWER Genesee client shared about her experience, “Anytime I have applied for State Emergency Relief assistance or the Consumers Affordable Resource for Energy Program, I have always been approved or gotten help in some way. I would 100% suggest the emPOWER Genesee Program to any family or friends who are in need of any kind of help.”

The program often assists clients who do not have other resources to turn to for help, whether assisting a mother of six to restore her power and lower her monthly utility bills, to helping a recently released inmate enroll in Medicaid and food benefit coverage and obtain a free government-assisted mobile phone.

CONCLUSION

As a result of their collaboration, Ascension Genesys Hospital, Consumers Energy and Huntington Bank received Genesee Health Plan’s 2021 Health Care Hall of Fame Community Partnership award for working with the health plan to ensure members receive quality, affordable health care. Genesee Health Plan President and CEO Jim Milanowski said, “This innovative approach is an excellent example of how public and private organizations are working together to meet people where they are with their health care, utility and financial needs.”

Program representatives were also invited to the 2021 Root Cause Coalition’s Annual National Summit to present emPOWER Genesee as a best practice model to address social determinants of health, and as an example of how public and private organizations are working together to meet people where they are to navigate complex systems to access essential services.

ANDREW KRUSE is director of community benefit for Ascension Michigan in Grand Blanc, Michigan.

SUSAN TIPPETT is director of grant administration for Ascension Michigan Foundation.

NOTES 1. “Social Determinants of Health: Know What Affects Health,” Centers for Disease Control and Prevention, https://www.cdc.gov/socialdeterminants/index.htm.

2. “Social Determinants of Health,” U.S. Department of Health and Human Services, https://health.gov/ healthypeople/priority-areas/social-determinants-health.

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Illustration by Jon Lezinsky

63106

NOT JUST A NUMBER, BUT A BARRIER TO HEALTH AND ECONOMIC EQUITY SALLY J. ALTMAN, MPH HEALTH CARE CONSULTANT AND JOURNALIST

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or many of us, returning to our normal pre-COVID-19 lives is not yet a reality. This is especially true for the most vulnerable among us nationwide, as the pandemic has fallen heaviest on minority and marginalized communities. Although COVID hospitalizations and deaths have diminished and the unemployment rate has fallen, inflation and interest rates are soaring for the first time in decades. Furthermore, affordable housing is now in shorter supply.

Residents in St. Louis’ 63106 zip code have felt the impact. It is the sector just northwest of downtown that has long had the most problematic social determinants of health in the metropolitan area. Notably, average life expectancy there is 67, compared to 85 in 63105 in suburban Clayton, the St. Louis County seat, and one of the region’s wealthiest communities.

In previous issues of Health Progress, readers were introduced to stories from residents of 63106. This final installment of this publication’s 63106 series highlights how families continue to cope with the challenges of staying safe and healthy — physically and mentally — during the pandemic.1 One of these accounts featured Misha Marshall, a 39-year-old registered medical assistant and mother of two who also serves as a caregiver for her elderly parents and her 37-year-old sister who has cerebral palsy. Marshall aspires to earn a master’s degree in nursing and to become an RN — a step forward that could roughly double her income. However, her path to getting there has not been easy.

Her experience is just one of many shared by other residents that shines a light on how the nation’s patchwork support systems toggle between encouraging and discouraging well-intentioned citizens. Their stories — and those of many others yet untold — point out how efforts toward advancement of racial equity in the region and nationwide is multifaceted, ongoing work in need of systemic reforms.

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“The company has a structure that supports people who need to be caregivers to loved ones, which really helped.

They never gave me the feeling that I would have to choose between my family and my job.”

— MISHA MARSHALL

OVERCOMING NURSING EDUCATION CHALLENGES

St. Louis, the state of Missouri and the nation need more people like Marshall. Vacancies for registered nurses in the St. Louis area increased from 11.2% in 2020 to 20.3% in 2021, according to the Missouri Hospital Association.2, 3 Overall, Missouri hospitals reported a staff nurse vacancy rate running at 19.8% — an increase from 12% in 2021.4 At that time, Missouri had 33,692 nurses working in hospitals and 8,334 vacant staff nurse positions, according to the data. As the pandemic took its course, nurses suffering from burnout began leaving the profession, taking early retirement and refusing requests to work overtime.

While there are plenty of positions now available, the pipeline is clogged. Nursing schools turned away nearly 1,300 qualified applicants in 2020, in part due to a shortage of teachers.5 It would be hard to find anyone more qualified than Marshall to join the ranks. She has worked in clinical settings across the region for more than a decade. Her caregiving has gone beyond patients at work, her family and in one case, a complete stranger.

And for that, she paid a steep price.

On a blizzardy evening in 2019, Marshall, to be safe, hired an Uber to take her from her home near downtown St. Louis to the hospital in the suburbs where she worked.

Not far from the hospital, traffic slowed to a crawl, then stopped. Marshall could see that a driver just ahead had gotten stuck in a snowbank.

The driver needed a push. Marshall leaped out of the Uber and made her way to the other car, tapped on the window and told the elderly woman at the wheel she would try to help.

Unfortunately, Marshall slipped on the ice, and immediately knew she had broken her leg.

The Uber driver drove her to the hospital, where X-rays confirmed that she had suffered a break in two places in her leg, along with a dislocated ankle.

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“From that one night, I was out of work for five months,” she recalls. “I was supposed to be living my best life. And here I am, lying in the street with ice and thinking, ‘Don’t help nobody no more.’”

Her remark made out of frustration, Marshall, of course, wanted to keep helping people by continuing her education to pursue a nursing degree.

But then a series of adversities followed. At the time of her fall, she had enrolled in the nursing program at St. Louis Community College. She asked to take a medical leave, which she said had been approved by a school administrator. But then her paperwork got lost. When she reapplied, her request was rejected. Subsequent appeals didn’t yield results.

After recovering, Marshall returned to work as a pediatric registered medical assistant at Affinia Healthcare, a clinic not far from her home. But then came more misfortune. Marshall’s 75-yearold mother took a fall at home and had to be rushed to the hospital, where she would remain for several weeks. She would be readmitted three more times after suffering further setbacks.

With all that to handle, along with continuing to care for her sister and father, who also was becoming increasingly infirm, Marshall decided to leave her job with Affinia. Her plans to continue her education would also have to wait.

Ever resourceful, Marshall returned to a small dessert business she started in 2016 to stay financially afloat. Then, finally some good fortune arrived: a friend referred Marshall to Square, the financial services and digital payment company that had recently relocated a few blocks from her home. She was hired and promoted to payroll specialist.

“The company has a structure that supports people who need to be caregivers to loved ones, which really helped,” Marshall says. “They never gave me the feeling that I would have to choose between my family and my job.”

Even so, Marshall hasn’t given up on her dream

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Photo by Wiley Price Jr./The St. Louis American

In May 2020, Steven Jones was living in St. Louis, but unemployed and struggling with epilepsy near the start of the pandemic. Since then, he has found a path to better health and employment, but his work is in Columbus, Ohio. He hopes to return to St. Louis, where three of his daughters continue to live with their mother.

to earn her nursing degree and has found an ally in her quest: Mimi Hirshberg.

Hirshberg recently retired as a faculty member at the College of Nursing at the University of Missouri–St. Louis, where she was well-known as a mentor for disadvantaged applicants and students, whether providing some preparation for standardized tests, reviewing concepts from texts or negotiating with health care bureaucracies.

After learning about Marshall’s situation, Hirshberg placed her with an academic advisor at the university to discuss academic possibilities. Hirshberg believes Marshall can find a path toward fulfilling her dream. “I just want to help her get through all the stages. I think with her experience and intelligence, she could pretty much breeze through (to getting a master’s in nursing).

It’s just a matter of finding the best program.”

This past July, Hirshberg noticed that BJC HealthCare in St. Louis announced that it would offer full-tuition scholarships to nursing students at Goldfarb School of Nursing at Barnes-Jewish College who would agree to work for the health system for three years after graduation.6 She mentioned to Marshall that perhaps she could qualify.

“I am going to be in school — whatever I have

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to do,” Marshall said. “If that means selling cupcakes, cookies or cake pops, that’s what I’m going to do.”

Although her dream may be deferred for now, Marshall says it will not be denied.

A PATHWAY TO QUALITY HEALTH CARE

As with Marshall, a personally improving economic picture in the latter part of 2021 and first half of 2022 benefitted Steven Jones, another 63106 resident previously featured in Health Progress.

He has found work that is fulfilling, interesting and comes with benefits.

But it came at a cost. Jones is now living in Ohio, hundreds of miles from his daughters.

When Jones’ plight was first shared in Health Progress in fall 2020, he was living in a two-bedroom apartment in Preservation Square, a subsidized housing complex just a mile from downtown St. Louis. He had been laid off from his job as a garage custodian downtown due to the pandemic.

Jones’ epilepsy disorder prevented him from driving, so his employment options were limited.

In the meantime, he was finding it difficult to access and navigate health care through Missouri’s

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Today, Steven Jones sounds buoyant about his prospects. With the new job and improved health care coverage through his employer, it was as if he had found a GPS to guide him through the thicket of government regulations that had stumped him previously.

Medicaid program. Two clinics were within a manageable commute for Jones, but they were often crowded with people seeking appointments and COVID testing.

But at least while living in St. Louis, Jones regularly saw three of his daughters, who lived nearby with their mom. A fourth daughter, his eldest, lived with her mother in Charlotte, North Carolina, but would visit on occasion.

To save money, Jones decided to move to Columbus, Ohio, in December 2020 to live with his mother. It was then that his luck began to change health and employment-wise.

Under a physician’s care in Ohio, Jones’ seizures abated. Increasingly he was able to sense when a convulsion was coming and take measures to mitigate its impact, helping him to gain more control of his life. He was then able to find

B

efore Ferguson Beyond Ferguson, a nonprofit racial equity storytelling project, has been shining a light on the lives of people in the 63106 zip code as they deal with the daily impact of the pandemic.

St. Louis media outlets agreed to collaborate with Before Ferguson Beyond Ferguson and carry stories in serial fashion — a new episode every few months. Eight families have been covered with one or more installments.

The project thanks its funders listed on its web page, including significant support from the Pulitzer Center.

The stories can be found at https://before fergusonbeyondferguson.org/63106-project/.

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work as a part-time custodian and moved into a place of his own in July 2021. Soon afterwards, he applied for a position as a customer service representative with Spectrum, an internet and cable TV provider, and was hired in April 2022, making $20 an hour and receiving a host of benefits. Living with epilepsy presents distinct disadvantages, but in this instance, Jones’ condition provided a hiring incentive: the federal government provides tax credits to businesses that hire people with disabilities under the Work Opportunity Tax Credit program.7 Today, Jones sounds buoyant about his prospects. With the new job and improved health care coverage through his employer, it was as if he had found a GPS to guide him through the thicket of government regulations that had stumped him previously.

Also in his favor is an economy that — at least for the time being — has put workers in his field in high demand. It’s not lost on Jones that his employer is also looking for customer service reps in St. Louis. “In 90 days, if my metrics are good with my current position, I can ask for a move,” he says.

“Now I’d like to talk to a lawyer to see if I can get a driver’s license. Then, I can move on my own. I will have a stable income and a good work history when I come back to St. Louis.”

PURSUIT FOR A SAFE FOUNDATION

Just as Jones was finding a path to a brighter future, one of his former neighbors, Kim Daniel, found herself on the brink of homelessness.

At the time Jones departed his apartment in Preservation Square, violent crime was becoming an increasing problem in his neighborhood.

It weighed even more on Daniel, who lived alone in a second-floor unit. In the spring of 2020, a neighbor’s boyfriend fired shots that penetrated the wall of her apartment, an account she shared previously in Health Progress. Last summer, a

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Photo by Brian Munoz/St. Louis Public Radio

Kim Daniel details how she wants to decorate her new St. Louis apartment on Feb. 17, 2022. After years of waiting for Section 8 assistance, she finally moved into a residence in a safer neighborhood.

youth she had mentored was murdered in a drive- complex located near the Lafayette Square neighby shooting down the street. She could see the borhood just south of downtown, the apartment makeshift memorial friends and family placed at within walking distance to a park, restaurants and most importantly, a full-service grothe spot from her balcony. cery with fresh food.

Daniel became increasingly desBut at the end of that autumn, just perate to find a way out.

10 days ahead of her move-in date, Her hopes rested on a slender Daniel collapsed with blood clots reed. More than a decade ago, Daniel in her abdomen, legs and upper left had applied for a Section 8 voucher ventricle — essentially a stroke. She that would provide a subsidy to cover Listen to CHA’s would spend the next two months in three quarters of her rent, along with previous podcast the hospital and a rehabilitation faallowing her to find a unit in another about the cility and could no longer get around part of town.

63106 project. without a walker or a wheelchair. She The Section 8 system, established Dick Weiss, now needed an accessible apartment. in 1978 by Congress and administered the project’s The complex near Lafayette Square by the U.S. Department of Housing co-founder, joins resident had such a unit and agreed to put it on and Urban Development (HUD), has Kim Daniel who hold for Daniel until she was released been chronically underfunded.8 So discusses the from a rehab facility. But the unit was it was no surprise that Daniel had to challenges she more expensive, and the Housing Auwait so long in the queue. “I got to the and her neighbors thority and HUD would need to appoint where I didn’t think it ever was face in their prove a larger subsidy. going to happen,” she recalls. community.

Initially, her request was denied.

But last summer, the St. Louis The Housing Authority told Daniel Housing Authority notified her that her wait was over and issued her a voucher. Weeks her situation no longer fit the government’s forlater, she located a lovely two-bedroom unit in a mula for Section 8 support. Daniel’s sister, Kenvee

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Daniel, was in disbelief.

To help her sister return to health and crusade for her increased housing benefit, Kenvee took an unpaid leave of absence from her job in Hawaii.

The two moved to a wheelchair-accessible hotel room (at nearly $100 a night) in St. Louis County as Kenvee mounted a full-court press in support of her sister.

On a near daily basis, she sent polite but demanding emails to the Housing Authority and HUD to grant Daniel a larger housing voucher to cover the rent at the Lafayette Square complex.

She also got in touch with Niya Foster, a fair housing specialist with the Metropolitan St. Louis Equal Housing and Opportunity Council. Foster pointed out to the Housing Authority that its own rules allowed for a “reasonable accommodation

request” that would permit the agency to relax its payment standards.

Daniel’s situation soon caught media attention, and her story was shared on St. Louis Public Radio in February.9 Later that day, a representative from the Housing Authority told Daniel that the path had been cleared for her to move into the Lafayette Square complex. Three days later, she signed a lease, and, with assistance from her family, she moved into her handicapped-accessible unit the following day. For the first time in three-and-a-half months, she had a place to call home.

Not lost on Daniel nor those involved in helping her were all the extraordinary measures and people it took to find housing for a deserving, resourceful citizen with health issues. “I would have

POVERTY’S COMPLEX WEB CAN HARM HEALTH

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n 2020, residents in St. Louis’ 63106 zip code had a median household income of $21,000,1 with many struggling to make ends meet and often having to choose whether to pay rent, buy groceries or keep up with needed medications.

Jason Purnell, PhD, MPH, vice president of community health improvement for BJC HealthCare, cited a study demonstrating the difference in life expectancy between the top 1% of income earners and the bottom 1% is 15 years for men and 10 years for women.2 “There is no question that people with lower incomes in underresourced communities continue to face health care access issues,” Purnell says, “but factors like unemployment or underemployment, housing, food and financial insecurity, lack of reliable transportation and fewer years of education all make it more likely that individuals are in poor health by the time they are seen for clinical care.”

The families portrayed here have struggled over generations to build wealth, and in many cases, it has

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affected their health. Misha Marshall’s family is the only one featured that has managed to qualify for a mortgage and purchase a home. Even so, Marshall has had to work multiple jobs following high school to help her family manage.

The other families are renters with most depending on federal aid to make the rent. Their neighborhoods are, or were, unsafe, and most do not have easy access to fresh food. Even finding an affordable place to live is challenging. One recent housing study for St. Louis found that for every 10 people with annual incomes below $20,000 who were looking for an apartment, there were only five affordable and available units.3 “Housing is critical to health,” says Cristina Garmendia, author of the study and principal at URBNRX, which advises governments on using data to inform policymaking.

Garmendia says her study — called the St. Louis Affordable Housing Report Card — found dozens of issues that get in the way of lowerincome residents seeking a safe place

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to live. For instance: Builders have few incentives to construct affordable housing in the suburbs, where there are already plenty of people who are able to pay higher rates.

Landlords who have lowercost apartments are reluctant to participate in government programs because they are required to be vigilant in keeping their units up to code.

Cookie-cutter solutions won’t work in St. Louis city and county, which is made up of 92 jurisdictions, plus unincorporated areas.

How does housing impact health?

If a roof leaks, water can seep into the walls and mold can result. Inhaling mold spores can spur allergic reactions and cause asthma attacks.4 These issues are especially harmful to children, who are susceptible not only to allergies but lead poisoning from paint in older buildings and air pollutants from nearby industrial areas.

“These cause lifelong impairments,” says Garmendia.

But if a resident reports the problem and the landlord fails to address

been lost in the system without them,” she says.

ENABLING POSITIVE CHANGE FOR STRUGGLING YOUTH

When the FDA approved use of the first COVID vaccine in December 2020,10 many Americans greeted the news with joy and relief. However, for Beverly Jones — and many other residents in 63106 — this development did not bring a sense of comfort. Many Blacks do not trust the health care system and were skeptical that a safe and effective vaccine could be developed so quickly.11 Jones had contracted the illness a few months earlier and battled it for two weeks at home. She was perhaps lucky to have survived it, given that she suffers from lupus, fibromyalgia, osteoarthritis and chronic obstructive pulmonary disease.

Even after all she endured from COVID, she

told a reporter, “I ain’t in no big hurry to get it,” when the vaccine became widely available.12 Since then, Jones, 59, has been vaccinated and boosted. She is not one bit happy about it, but the St. Louis Job Corps Center — a residential education and job training program for youth and young adults where she works as an adviser — had made COVID vaccinations a requirement. Jones never wanted to lose her connection to the center’s young people, so she complied.

“It was either get the shot or I can’t work,” she says. “That’s the way the world works sometimes.

We’re being forced to do things we don’t want to do.”

Later, the federal courts would step in and issue a block against the vaccine mandate for federal workers,13 so Jones could stop taking the shots. But

RESOURCES For more information on the impact of housing on community health, see further resources below: Centers for Disease Control and Prevention Community Guide: Compiled by the Community Preventive Services Task Force, this guide lists education and housing-related interventions like quality early childhood education, high school completion programs and housing vouchers in its review of health equity research literature. https://www.thecommunityguide.org/sites/default/files/assets/what-worksfact-sheet-social-determinants-health-p.pdf.pdf.

A Framework for Public Health Action–The Health Impact Pyramid: Dr. Tom Frieden’s health impact pyramid notes that socioeconomic factors are likely to have the largest impact on population health outcomes. https://doi.org/10.2105/AJPH.2009.185652.

it, authorities might revoke the landlord’s occupancy permit, forcing the tenant to move out. This, in turn, can trigger stress reactions and cause depression and other mental health issues.

If there is any good news revealed through the study, says Garmendia, it is that civic leaders are recognizing that housing/health issues stymie growth in a metropolitan area that is losing both population and commerce. The report card, she says, gives officeholders the evidence they

need to act.

Purnell also sees reason for optimism. “There is a role for health care in moving further upstream to address the root causes of health disparities in the social and economic conditions of communities,” he says.

Purnell’s team at BJC HealthCare has developed a “community health improvement strategy” that he says is informed by the lived experiences of those who face health and other inequities every day, stating that the health care organization is “commit-

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ting to increasing hiring, purchasing and impact investment in areas that have faced decades of disinvestment.

We’re also working to improve the food environment, supporting health in schools and working to provide support from the prenatal to the postpartum period for individuals giving birth and their babies.”

NOTES 1. “Missouri Demographics,” Cubit, https://www.missouri-demographics. com/63106-demographics.

2. Raj Chetty et al., “The Association Between Income and Life Expectancy in the United States, 2001-2014,” Journal of American Medical Association 315, no. 16 (April 2016): 1750-66, https://doi. org/10.1001/jama.2016.4226.

3. Cristina Garmendia, URBNRX, “St. Louis Affordable Housing Report Card,” Community Builders Network of Metro St. Louis, 2021, https://www. affordablestl.com/summary.

4. “Can Mold Cause Health Problems?”, United States Environmental Protection Agency, November 4, 2021, https://www.epa.gov/mold/ can-mold-cause-health-problems.

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OVERCOMING ROADBLOCKS

At the start of summer 2022, life was looking a little brighter for Tyra Johnson, a single mother of three whose experiences during the pandemic were last shared in the spring 2021 issue of Health Progress. In 2020, Johnson lost her job; and her eldest children, Meegale, now 8, and Madison, 6, missed more than a year of in-person school.

Fortunately, she was able to bring her youngest, Mason, into the world without complications.

Like Kim Daniel and Steven Jones, her former neighbors, Johnson moved out of the crime-ridden Preservation Square neighborhood. Last year, she found an apartment across the Mississippi River in East St. Louis, Illinois. Though the city has a national reputation for crime, Johnson felt the new complex would be safer than Preservation Square where, like Daniel, bullets had been fired into her unit. Her new quarters also were closer to her mother who could help babysit her kids.

Then, just months later, Johnson landed a job at a Walmart in Granite City, Illinois, a 15-minute

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Photo by Aisha Sultan

she said, “I’m just going to go ahead and get it, because it makes no sense not to now.” (To date, Jones has suffered no side effects from the vaccine.)

Jones says authorities would be better advised to lay off the mandates and focus on the health of young people who are at turning points in their lives. She speaks of the need for “second-chance employment.”

“A lot of people have convictions on their records for nonviolent crimes, but that doesn’t mean we should throw them away. We need a program that is easily accessible to help them get their records expunged,” she says.

Jones was once in that category. She had a drug addiction and is in recovery, with a felony on her record. It took her years to get her life back together. But she earned an associate degree in human services and a certificate of proficiency in criminal justice at St. Louis Community College in 2003. She went on to earn a bachelor’s degree at Fontbonne University in 2006, then three years later, earned a master’s degree in business management at Fontbonne. During that time, she accumulated an exemplary work record, earning the praise of her supervisors.

Jones said that in her town and in today’s environment, she feels like the exception that proves the rule. Although it wasn’t easy for her, she would like to make it easier for others to get their lives on the right track.

Tyra Johnson holds her youngest child, Mason, while helping her older children prepare to go back to school in January 2022.

drive from her home. As an overnight shift worker, she would earn $19 an hour and among the benefits was a program that would help her earn her GED. Johnson had never made more money in her life and felt fortunate.

But only weeks later, Johnson’s car broke down, requiring expensive automotive work. After being repaired, her vehicle was stolen, and she was unable to cover the loss.

Johnson would begin taking the bus to work, but it took more than an hour each way. Ever resourceful, she found a 24-hour day care that offered subsidized support. Still, just getting the kids there on public transportation would take a couple of hours. She also relied on the unsustainable option of having her mom watch her children overnight.

To compound her stress, Johnson was dealing with a traffic ticket for driving without a license.

To get it dismissed, though, she needed to get a license, and she was unable to do so without a car.

“I need transportation. I need day care. I can’t do this anymore,” she said in a St. Louis Post-Dispatch article. 14 After Johnson’s story

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appeared this past July, a reader created a GoFundMe site on Johnson’s behalf. By the end of August, more than 100 people had donated more than $15,000. Two local Muslim organizations also purchased a car to replace her stolen vehicle.

Now with a car, Johnson’s quest to provide a stable life for her kids and to advance her education are within her grasp. Although a natural optimist, Johnson remains cautious, never really knowing what might lie ahead.

The same is true for many residents in 63106 and marginalized communities nationwide.

COVID has tested their resilience and taken its toll.

Perhaps the pandemic will finally abate. But unless and until more privileged communities find common cause with their neighbors, as things continue to change, the more they will remain the same.

This article includes additional reporting from DENISE HOLLINSHED, LEYLA FERN KING, AISHA SULTAN and RICHARD H. WEISS. SALLY J. ALTMAN has devoted her career in public health to working with key stakeholders on health access issues as a health care administrator and a journalist. DENISE HOLLINSHED served as a crime and urban affairs reporter for the St. Louis PostDispatch for 21 years and is now a freelance writer.

LEYLA FERN KING is a Wells Scholar at Indiana University and a reporter for Before Ferguson Beyond Ferguson. AISHA SULTAN is a nationally syndicated newspaper columnist, award-winning filmmaker and features writer. RICHARD H. WEISS is co-founder and executive editor of Before Ferguson Beyond Ferguson, a nonprofit racial equity storytelling project.

Previous articles about the 63106 Project appear in the Fall 2020 and Spring 2021 issues of Health Progress.

NOTES 1. Sally J. Altman, “Two Zip Codes, A World Apart,” Health Progress 101, no. 4 (Fall 2020): 44-50, https://www. chausa.org/publications/health-progress/archives/ issues/nurses/two-zip-codes-a-world-apart; Sally J. Altman, “The COVID Conundrum,” Health Progress 102, no.

2 (Spring 2021): 51-56, https://www.chausa.org/ publications/health-progress/archives/issues/ spring-2021/the-covid-conundrum.

2. “2021 MHA Workforce Report: St. Louis Region Profile,” Missouri Hospital Association, https://www. mhanet.com/mhaimages/Workforce/2021/STL_2021_

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WF_Report.pdf.

3. “2022 MHA Workforce Report: St. Louis Region Profile,” Missouri Hospital Association, https:// www.mhanet.com/mhaimages/workforce/2022/ STL_Region_2022_WF.pdf.

4. “2022 Workforce Report,” Missouri Hospital Association, May 25, 2022, https://web.mhanet.com/ media-library/2022-workforce-report/.

5. “2022 Workforce Report,” Missouri Hospital Association.

6. “Scholarship Programs,” Goldfarb School of Nursing at Barnes-Jewish College, https://www.barnes jewishcollege.edu/Financial-Aid/Scholarship.

7. “Work Opportunity Tax Credit,” U.S. Department of Labor, https://www.dol.gov/agencies/eta/wotc/.

8. Sonya Acosta and Erik Gartland, “Families Wait Years for Housing Vouchers Due to Inadequate Funding,” Center on Budget and Policy Priorities, July 22, 2021, https:// www.cbpp.org/research/housing/families-wait-yearsfor-housing-vouchers-due-to-inadequate-funding.

9. Richard H. Weiss, “A St. Louis Woman’s Dream of Better Housing Is Lost to Illness, Crippling Bureaucracy,” St. Louis Public Radio, February 14, 2022, https://news. stlpublicradio.org/health-science-environment/202202-14/a-st-louis-womans-dream-of-better-housing-islost-to-illness-crippling-bureaucracy.

10. “FDA Takes Key Action in Fight against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine,” U.S. Food and Drug Administration, December 11, 2020, https://www.fda.gov/news-events/pressannouncements/fda-takes-key-action-fight-againstcovid-19-issuing-emergency-use-authorization-firstcovid-19.

11. Altman, “Two Zip Codes”; Altman, “The COVID Conundrum.”

12. Denise Hollinshed, “A Grieving Reporter Rushes to Get Vaccinated as Her Subject Resists,” Riverfront Times, May 10, 2021, https://www.riverfronttimes.com/ news/a-grieving-reporter-rushes-to-get-vaccinated-asher-subject-resists-35497492.

13. Alison Durkee, “Biden Vaccine Mandate For Federal Employees Blocked Again as Appeals Court Dissolves Earlier Ruling,” Forbes, June 27, 2022, https:// www.forbes.com/sites/alisondurkee/2022/06/27/ biden-vaccine-mandate-for-federal-employeesblocked-again-as-appeals-court-dissolves-earlierruling/?sh=91975d62ebba.

14. Aisha Sultan, “Sultan: How a Stolen Car Could Ruin an Entire Family,” St. Louis Post-Dispatch, July 15, 2022, https://www.stltoday.com/lifestyles/parenting/ aisha-sultan/sultan-how-a-stolen-car-could-ruinan-entire-family/article_4814ffef-abdb-559c-b95adfb5f85e4d55.html.

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COMMUNITY BENEFIT

RAISING THE BAR FOR EQUITY AND COMMUNITY HEALTH

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quity is at the forefront of today’s community benefit plans and programs.

Community benefit leaders use an equity lens as they work with community partners to assess needs, set priorities, develop community health improvement plans and evaluate impact.

A new resource from the Robert Wood Johnson Foundation — which is dedicated to supporting an equitable culture of health in the U.S. — can help put this work in broader perspective. The recently released “Raising the Bar: Healthcare’s Transforming Role” JULIE presents a framework of five basic principles for advancing equiTROCCHIO ty and excellence and describes how equity starts with the patient experience and includes workforce development, engaged partnerships and advocacy.1 The five key principles of Raising the Bar are presented in the following areas: mission, equity, community, power and trust. It describes why each is important, giving examples of “bright spots” and resources for addressing the principles.

1. Mission Principle: Commit Above All to a Mission of Improving Health and Well-Being

Committing to the mission to improve the health and well-being of individuals, families and communities, according to the report, “is at the heart of healthcare.” This principle goes beyond the goal of doing no harm by providing effective, integrated care across physical wellness, mental and behavioral health and social needs. It requires working with partners, such as providers of public health and social and human services, to treat the harms that result from underlying inequities and health risks to individuals and communities.

2. Equity Principle: Systematically Pursue Health Equity, Racial Justice and the Elimination of All Forms of Discrimination

The framework calls on health care to provide

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everyone with the opportunity to be as healthy as possible. The equity principle takes a proactive effort to confront health equity, saying, “It is essential that healthcare acknowledge and address historic and current structural factors, systemic racism, and other forms of discrimination and inequity — in society generally, within communities locally, and also within the healthcare system itself.” Achieving equity goes beyond providing access to quality care, and involves health care organization activities, including improving employment practices and fostering respectful interactions with the broader community.

3. Community Principle: Serve the Community as an Engaged, Responsive and Proactive Partner

Beyond delivering services to individuals, health care organizations and institutions are critical members of their communities. The Raising the Bar framework reflects that health care organizations treat the health consequences of deep social and economic inequities being faced in their communities. They are in a position to build on the strengths and resources of communities, interacting with a wide range of partners who bring assets, expertise and a commitment to improving their communities’ health.

4. Power Principle: Share and Effectively Use Resources, Influence and Power

Health care’s significant power and influence comes from its large share of the U.S. economy.

Health care organizations can promote equity by driving critical changes within their own sector and exerting influence over broader social and economic policy. This principle recognizes that health care organizations, institutions and practitioners “have their greatest impact when

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they use their influence effectively and overcome power imbalances to co-create mutually reinforcing partnerships with individuals, families, and communities.”

5. Trust Principle: Earn and Sustain Trusting Relationships

Health care organizations can raise the bar when they earn the trust of individuals, families and communities. “This starts with acknowledging persistent trust deficits, understanding the drivers of mistrust, and co-creating pathways for trust building. … Building and sustaining trust requires listening to and respecting the experience, expertise, and capabilities of the individuals, families, and communities to whom they provide care.”

PUTTING ‘RAISING THE BAR’ INTO ACTION

To put the principles in action, Raising the Bar describes four roles for health care organizations: as providers, employers, partners and advocates.

Within each role, the model offers concrete actions to advance equity and excellence. The roles begin with ensuring that all patients are treated with respect. It then looks at the employer role for creating a diverse workforce, the role of community partner for addressing inequalities and finally its role for advocating for public policies that attend to societal issues.

Provider role: Health care organizations, as service providers, should ensure that individuals have access to receive a full range of affordable care they need and are treated with dignity and respect. This includes having a trusting environment where everyone feels welcomed.

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Employer role: This means having a workforce and leadership team that reflect the diversity of the community. It includes investing and growing leaders who advance equity and quality and ensuring that employees can be healthy and thrive.

Partner role: Health care organizations should engage with individuals and organizations in the community, prioritizing those most affected by inequalities. They should build trust and work in partnership on activities and initiatives.

Advocate role: Advocacy can include using the organization’s economic resources and influence to impact payment reform, community well-being and resilience and equity. It also means using investment and procurement power to contribute to the health and strength of communities.

Raising the Bar presents a compelling case that equity should be in the very DNA of our organizations. When we care for patients, employ associates from diverse backgrounds, work in partnership and advocate for equity in our local and other public policies, we can advance our goal to increase equity and excellence in health care.

JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C. NOTE 1. “Raising the Bar: Healthcare’s Transforming Role,” Raising the Bar, 2022, https://rtbhealthcare.org/ wp-content/uploads/2022/07/RWJF-RTB-FULLREPORT-060622.pdf.

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FORMATION

RESPONDING TO THE SIGNS OF THE TIMES CHA Launches On-Demand Foundations Leadership Program

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rior to the arrival of COVID-19, the use of digital learning programs was already on the rise. However with its dramatic uptick during the pandemic, stronger learning capabilities have emerged. At a time when many health care systems have moved to less in-person travel due to pandemic precautions and because of current fiscal pressures, these technological advancements can allow for more formation programs to be offered virtually.

There remains considerable agreement among those involved in this work that extended formation programs, especially at the senior leader level, must be face-to-face. But what about formation opportunities for other executives, board DIARMUID members, direcROONEY tors, managers and clinicians?

Extending deep and meaningful opportunities is imperative to these team members as well to allow them to think about how their own calling and values align with that of their ministry. However, due to logistical and scheduling issues, investigating options for leaders introduces challenges.

When exploring possibilities for this audience, we asked ourselves: Could CHA’s Foundations of Catholic Health Care Leadership program be offered on demand?

EXPANDING FORMATION PROGRAMS

Working with our current Ministry Formation Advisory Council, we set out to rethink and design an on-demand foundations program, based on the CHA Framework for Ministry Leadership.

Using member expertise, we scripted and produced more than 50 videos, curated articles and reflection questions, and built a specialized platform to host all these materials in such a way as to

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offer the best possible user experience.

This effort came to fruition in CHA’s “OnDemand Foundations of Catholic Health Care Leadership” program, an essential primer for new and current leaders in Catholic health care. Available on CHA’s website, this program — which launched last month — complements CHA’s live foundations program (titled “Foundations of Catholic Health Care Leadership”) that is offered annually over eight weeks in late January to March. The initial feedback from inaugural participants has been incredibly positive, and we look forward to seeing how our members will both offer this learning experience to colleagues and use its resources for their existing formation programs.

The objective of the program remains the same: to deepen understanding of the pivotal role leaders play in carrying out the healing mission of Catholic health care in serving the needs of patients, families, communities and the common good. Accompanied by an organization’s designated mission/formation conversation partner — who is invited during registration by the participant to join them throughout the eight- to 10-week program — enrollees take part in the program at their own pace integrating new content, engaging through reflective questions and building new leadership practices for their roles across the ministry. The program can be taken individually or with a group. It is organized into 11 sequen-

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tial modules, each with an introductory overview.

Modules are followed by reflection questions, and participants are encouraged to take notes in a provided journal as they move through the sections to deepen their learning and to help them complete assignments.

FORMATION THROUGH ONLINE LEARNING AND ENGAGEMENT

Each learning module of the program follows a similar structure and starts with an overview and reflection, followed by a combination of short videos and relevant articles, then culminates with an individual assignment for participants.

The mission/formation conversation partner engages virtually or face-to-face with participants individually to expand and deepen the formation experience.

The modules are accessed through CHA’s Ministry Formation web page, under “Resources,” each one titled as follows: Vocation; Tradition; Spirituality; Catholic Social Teaching; Ethics; and Discernment. Each module begins with a reflection built on the following three stages: 1) Participants first pause and take a moment of silence, 2) listen carefully to the sacred words and then 3) share as appropriate. After each reflective moment, the modules will unfold in the following order: Module 1: “The Vocation of Leadership in Catholic Health Care” focuses on what it means to be called to leadership in Catholic health care, specifically viewing our work as a vocation.

Module 2: “The Tradition of Catholic Health Care” examines what it means to be a “heritage bearer” in Catholic health care.

Modules 3 and 4: “Spirituality and Leadership” and “The Practice of Prayer” remind us of the centrality of spirituality and how each person is a dynamic union of body, mind and spirit.

Modules 5 and 6: “Catholic Social Teaching: Our Strong Foundation” and “Living Our Tradition” both center around the foundational belief of the Catholic tradition that each person is made in the image and likeness of God and the implications this has for the social conditions necessary for human flourishing.

Module 7: “The Foundations of Ethics in Catho-

lic Health Care” includes a practical definition of ethics and a comprehensive introduction to how it is used in Catholic health care, from our everyday decisions to larger organizational ethical discernments.

Module 8: “Models of the Church: Spirit and Structure” highlights how it is crucial that as a leader in Catholic health care one has a clear knowledge of what Church is, and the capacity to articulate this to others.

Module 9: “Models of Sponsorship” demystifies the concept of sponsorship while situating it as a ministry of the church, both historically and presently.

Module 10: “Discernment” contrasts the differences between decision-making and discernment, highlighting how spiritual discipline and prayerful disposition are at the heart of discernment.

Module 11: “Leadership” helps participants identify a plan for ongoing development and formation as a ministry leader in Catholic health care.

Modules are led by a host of experts in each of their respective fields, creating a rich tapestry of knowledge from which participants can learn. We believe those who participate will find the content both engaging and challenging as they seek to connect their personal meaning with organizational mission and purpose.

PRESERVING OUR MISSION FOR FUTURE GENERATIONS

While the concept of an on-demand formation program may have seemed like a far-reaching dream in the past, we are thrilled that we’re finally arriving at this point. Formation is, and has always been, the heartbeat of the ministry, and that truth remains as we live in a world where in-person access becomes increasingly complicated. The ability to offer this program to our members anywhere and at any time is a gift, one that we hope will be instrumental in the formation of upcoming generations of Catholic health care leaders.

DIARMUID ROONEY, MSPsych, MTS, DSocAdmin, is senior director, ministry formation, at the Catholic Health Association, St. Louis.

For further details on CHA’s On-Demand Foundations of Catholic Health Care Leadership program, including how to register, visit https://www.chausa.org/ministry-formation/resources/on-demand-foundations.

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AGING

CREATING A NEW PARADIGM FOR AGING

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arly last year, the Pontifical Academy for Life released an 11-page “note” titled, “Old Age: Our Future — The Elderly After the Pandemic.” 1 To emphasize the document’s messages and create opportunities for sharing between ministries, CHA, the Community of Sant’Egidio and Catholic Charities USA offered a related four-part webinar series.2 A highlight was the final webinar that featured the wisdom of Sr. Doris Gottemoeller, RSM, chair of Bon Secours Mercy Ministries and one of our ministry’s best thinkers and writers about Catholic health care today and in the future. During her presenta-

tion, “The Elderly — Our Future: Connecting for Greater Understanding and Action for Elders,” Sr. Gottemoeller explored how families, parishes and other ministries can support older persons through 10 proposed actions.3 — JULIE TROCCHIO, BSN, MS

10 PROPOSALS AND A STORY: AMERICA’S AGING FUTURE SR. DORIS GOTTEMOELLER, RSM

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ow do we improve the ways we incorporate older adults into American culture with dignity, appreciation and appropriate services? The “Old Age: Our Future — The Elderly After the Pandemic” statement from the Vatican reminds us that old age is our future. In other presentations in CHA’s “Old Age: Our Future — Continuing the Conversation” co-sponsored webinar series, participants heard statistics and studied trends, learned of creative efforts and were inspired by passionate speakers. With this knowledge in hand, what should we do if we want to affect the big picture nationwide, and what should we strive toward?

To address this, I offer 10 interrelated proposals for individual and collective action, what I refer to as “Ten Commandments,” in addition to a concluding short story to provide perspective on the strengths that older persons can pro-

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vide to our communities.

1. Acknowledge the reality and scope of the issue.

Here’s where the data and trend analyses are important. The percentage of older adults compared to the rest of the population has increased and continues to rise, both globally and in the U.S. The smallest age cohort will be caring for the largest segment of the population. While it’s important to have an idea of this reality, it’s equally important to look around locally within our cities, neighborhoods and even within our own families, because this is the core of our personal efforts, at least initially. When doing so, it’s also essential to examine the following questions: What kind of environment is desired by older adults? What services are needed to maintain that environment? What is currently available, and at what cost? You get the idea.

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2. Regard the issue — the dignified integration of older adults into society — as an opportunity, not a problem.

homes or, if that’s not feasible, to live in a congregate setting with appropriate services. A fact of life today is that the children of many older people live at a distance. Their education and their employment opportunities have caused them to settle in cities far from where they grew up and where their parents reside. This is fine as long as

Since this is in some ways an unprecedented situation, it calls for new initiatives, both personal and communal. This is an opportunity to demonstrate our love for our neighbor in new ways. To regard the growing proportion of older adults in our To regard the growing proportion of older society as a problem to be adults in our society as a problem to be solved or a burden to be carried is a bad way to begin. solved or a burden to be carried is a bad In contrast, viewing it as an opportunity challenges our way to begin. creativity, our generosity and our commitment to the Gospel. their parents can travel and enjoy occasional visits with their adult children and grandchildren. As they age, however, this becomes less feasible, and 3. Consult the elderly and feature their stories.

We are working in partnership with older they will need supportive services in their homes adults, not doing something for them. If we are or, in some cases, congregate living. A prerequifortunate, we will join their ranks one day. We site of any institutional model should be that it can begin to prepare for that right now by devel- facilitates community. oping relationships and friendships with older persons, listening to their stories, seeking their 6. Foster intergenerational relations. wisdom and by reflecting on the following: What As previously mentioned, many elderly people are their life lessons? What is important to them live at a distance from any family member. Vidnow? What do they enjoy that’s different from eo calls, whether through computers or smartwhat they might have enjoyed when they were phones, can provide regular opportunities to conyounger and more independent? What’s still on nect grandchildren and great-grandchildren with their bucket lists? their loved ones. Another initiative I have seen is inviting students in some of our high schools to visit elderly neighbors or residents of nearby 4. Cultivate partnerships and alliances.

Numerous national and local organizations nursing homes. Even just a half-hour conversation and faith-based communities are striving to be of between the two generations can be mutually benservice to the elderly. In addition to the sponsors eficial and enjoyable. of CHA’s webinar — Community of Sant’Egidio and Catholic Charities USA — we might name 7. Advocate for funding and public support. the Society of St. Vincent de Paul, parish outreach This is where assistance from national orgagroups, United Way, home health agencies and nizations like CHA and Catholic Charities USA food banks, to name a few, as other organizations becomes important. Their professional staff alerts working toward these efforts. We are not in com- us to pending legislation at the local, state and fedpetition with one another. The better we under- eral levels that can potentially impact the welfare stand the resources each brings, the better friend of older adults, such as housing options, welfare and neighbor we can be to the elderly. benefits or pharmacy prices. A secret of successful advocacy is knowing the decision makers and 5. Create multiple models to accommodate dif- stating a clear case for what is being sought, based on credible personal experience. ferent needs and desires.

In another presentation held as part of CHA’s webinar series on supportive efforts for older 8. Prepare RNs, social workers and volunadults, participants heard of a number of creative teers appropriately for service to the elderly models that enable people to stay in their own (especially in home health settings).

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Ministering in someone’s home is far different than in a licensed facility. The visitor has no onsite supervision, so preparation — including background checks and an appropriate orientation — is crucial. Issues that should be addressed for proper training include: What boundaries should a service worker follow when visiting someone’s home? What are the signs he or she should look for in order to recommend additional professional help?

9. Incorporate art and beauty into the environment and services.

Wherever older adults are living or whatever their degree of frailty, they are persons who have enjoyed art, music and the beauty of nature. Regardless of their taste, they instinctively seek aesthetic delights, therefore any living setting should incorporate these as much as possible. It can be something as simple as a flowering plant on a windowsill, a new book or magazine, an attractive table setting or a visit by a local choral group, but this stimulus acknowledges the deeper humanity of the persons. Congregate living facilities that resemble hospital corridors risk diminishing the humanity of the residents and promoting isolation and loneliness.

10. Seek and support the spiritual wisdom of the elderly.

Wherever older adults are living or whatever their degree of frailty, they are above all spiritual persons. Whatever their faith tradition, they are bound to have deeper questions of meaning and purpose and reflections born of a lifetime of experience. Access to spiritual services is critical. As fewer clergy are available, family and parishioners can step forward to bring the Eucharist, share a prayer and seek the spiritual wisdom of the aged.

WISDOM AND RESILIENCY

When reflecting on ways to help older adults, a story from Genesis offers some perspective. One day God was talking to Abraham and mentioned that, in order to found a chosen people, he was going to see that he and Sarah would have a son.

So improbable was this that Abraham fell on the ground laughing as he said to himself, “Can a child be born to a man who is 100 years old? Or can Sarah give birth at 90?” Sarah was even more amused.

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According to the storyteller, she was eavesdropping from the safety of her tent as her husband conversed with the Lord’s three messengers.

When she overheard the ridiculous prophecy, she laughed out loud at the incongruity of it.

Sarah and Abraham give us a wonderful example of older adults coping with unanticipated change to their lives. It takes some resiliency to nurse and diaper a baby at age 90 and a wholesome perspective to see the humor in all of it. Admittedly, these are semiapocryphal stories, but if all Scripture is written for our instruction, there may be some lessons for us. For instance, the metaphor of laughter suggests that older adults can choose a stance toward their circumstances. Also, it indicates that God sees their lifelong potential.

In fact, old age is frequently attributed to special friends of the Lord. Moses was 120 years old when he died, yet his eyes were undimmed and his vigor unabated. The pious widow Judith, savior of her people, reached the advanced age of 105, renowned throughout the land. The wise and patient Job lived to be 140, and so forth. In the Bible, old age is associated with wisdom and honor and continuing accomplishment. As we move forward, let us seek to follow that example.

SR. DORIS GOTTEMOELLER is a member of the board of Cincinnati-based Bon Secours Mercy Health and chair of Bon Secours Mercy Ministries, the system’s public juridic person. She is a former chair of CHA’s Board of Trustees and winner of CHA’s 2021 Lifetime Achievement Award.

JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C. NOTES 1. Vincenzo Paglia and Msgr. Renzo Pegoraro, “Old Age: Our Future – The Elderly After the Pandemic,” The Pontifical Academy for Life, February 2, 2021, https://www. academyforlife.va/content/dam/pav/documenti%20 pdf/2021/Documento%20Anziani/Testi%20 documento/02_OLD%20AGE_DEF_ENG.pdf.

2. “Old Age – Our Future,” Catholic Health Association, https://www.chausa.org/eldercare/old-age---our-future.

3. “The Elderly – Our Future,” Catholic Health Association, https://www.chausa.org/events/ calendar-of-events/elderly-webinar-series/overview.

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MISSION

ENGAGING COMMUNITY TO ACHIEVE HEALTH EQUITY

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s is well-known throughout the Catholic health care ministry, CHA’s We Are Called pledge to increase health equity by ending systemic racism has been embraced by almost 90% of our members.1 We have already celebrated the one-year anniversary of the pledge and continue to expand our resources, share best practices and foster collaborations focused on each of the four pillars of the pledge: health equity (especially in light of the COVID-19 pandemic), putting our own house in order, advocacy and building right and just relationships with the communities we serve. As we continue to talk about ongoing efforts to enable systemic change for diversity and health equity, it is important that we recognize its roots in our Catholic identity, history and heritage.

A CALL GROUNDED IN JESUS’ MINISTRY

stops, cares for the man, takes him to an inn and When we examine the origins of the Catholic ensures that he is cared for even after he contincommitment to eliminating ra- ues on his journey. When Jesus asks the lawyer cial inequities, there is no better which of the three was neighbor to the victim, he person or place to begin with responds, “The one who treated him with mercy.” than Jesus himself and the para- At that, Jesus encourages him to “Go and do likeble of the Good Samaritan (Luke wise.” This message was not only for the lawyer: 10:25-37). In this renowned par- it is also a universal message and mission for the able, often referred to as our global Church, the health care ministry and each “foundational story” in Catholic one of us. health care, JeDENNIS sus is respondIn today’s complicated social, GONZALES ing to a quespolitical and economic environment, tion from one of the lawyers we must all find more creative and as to what he must do to inherit eternal life. When Jesus asks him collaborative ways to care for our what is written in the law, he reneighbors, wherever they may be and sponds, “You shall love the Lord, your God, with all your heart, whatever they may need. with all your being, with all your strength, and with all your mind, As we strive to answer Jesus’ call to “Go and do and your neighbor as yourself.” Pressing Jesus further, the lawyer then asks, “And who is my neigh- likewise,” the principles of Catholic social teachbor?” Clearly, the lawyer was trying to trip Jesus ing can serve as the underpinning for the imporup and probably did not expect the response that tant work we continue to advance in the ministry came, nor the powerful story Jesus would tell to and in communities. Namely, this involves the inherent dignity of each person; advancing the illustrate his message.

We are all very familiar with the narrative Jesus common good by caring for our communities in tells next of the man on the road who is attacked the context of structural racism; and justice, espeby robbers, beaten and left to die. The priest cially for the poor, vulnerable and marginalized. and Levite pass him by, yet the Good Samaritan The implications for our work in diversity, equity

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to get there. In its infancy, this collaborative endeavor was just an idea, a dream. A small group of leaders — mainly mission leaders, social workers and community outreach professionals from the area’s major health systems — came together and asked the central questions: What can we do? If we pool our collective resources, expertise and determination, how can we better support our community, especially those who are poor, unBUILDING EQUITABLE COMMUNITIES TOGETHER As we look for ways to foster collaborations with derserved and marginalized? How does this effort our communities, one example can be found in align with the mission and values of our various San Antonio, one of the largest cities in the Unit- organizations and ministries? And, of course, how ed States. In the San Antonio metropolitan area, can we get buy-in from the city, county and sevwhich is predominantly Latino, the CHRISTUS eral competing health care systems? Alexis Arel, Santa Rosa Health System, established by the Sis- regional vice president of Finance and co-chair ters of Charity of the Incarnate Word in 1869, is of the Ethics Committee for CHRISTUS Santa collaborating with a variety of local partners to Rosa Health System, recalls that, “By working address community needs. It is one of many or- collaboratively, to clearly pinpoint the gaps and ganizations working together through the South- bottlenecks the community faces when trying to west Texas Crisis Collaborative, which is an ef- access services — predominately mental health fort focused on ending ineffective use of services services — we are able to treat the person with for the safety-net population at the intersection dignity, while also looking out for the common of mental illness, homelessness and high usage in good in terms of our collective resources by fundSouthwest Texas.2 The collaborative is committed ing programs collaboratively rather than working to improvement by developing a comprehensive, in competing silos.”

From that core group, Southwest Texas Crisis integrated crisis system across all major public payers, hospital providers, philanthropy, public Collaborative was born. Before long, area health system CEOs, CFOs and IT leaders were brought to the table, “Participation in the Southwest Texas along with leadership from the Crisis Collaboration, alongside other city, county, police, fire department, EMS, homeless shelters health care systems, city and county and other nonprofits throughout the city. It was a multiyear agencies and local nonprofits, has been process, but through collective an eye-opening experience to see the input from all key stakeholders, a strategic plan was developed, good that can come when parties work including significant funding formulas; HIPAA-compliant together for a common mission.” sharing of patient data and his— Alexis Arel tories; transport agreements; proactive collaboration with safety (fire department/EMS resources and law police, EMS and the central homeless shelter, enforcement) and behavioral health providers. Haven for Hope, which serves 1,700 people per Recognized as an innovative and creative commu- day3; and the commitment of dedicated inpatient nity-wide effort, this organization is an excellent psychiatric beds. example of what it looks like to build right and Arel shares that “participation in the Southjust relationships with the communities we serve. west Texas Crisis Collaboration, alongside other While this initiative is well-developed and health care systems, city and county agencies makes a difference today, it was not an easy road and local nonprofits, has been an eye-opening and inclusion are far-reaching and profound. In today’s complicated social, political and economic environment, we must all find more creative and collaborative ways to care for our neighbors, wherever they may be and whatever they may need. How do we build right and just relationships with the communities we serve?

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U.S. Postal Service

STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION (Required by 39 U.S.C. 3685)

experience to see the good that can come when parties work together for a common mission.” These values call us to collaborate with other people of good will in building right and just relationships with our communities and ensuring that traditionally underrepresented groups have meaningful and equitable opportunities in health, education, housing, nutrition and all the social determinants of health. Consistent with the mission of Catholic health care and the Catholic social tradition, we must refuse to accept the existence of racial and ethnic disparities in access to health care and quality outcomes.

CONCLUSION

As we are reminded by the parable of the Good Samaritan, we are called to be a neighbor to those who are in need. Like the one who showed mercy, we must recognize the need, stop and address it, and then remain vigilant. How will we leverage our collective mission, vision, values and resources in a way that is focused on proactively eliminating health disparities in our communities? As expressed in Jesus’ call, will we “Go and do likewise?”

DENNIS GONZALES, PhD, is senior director, mission innovation and integration, for the Catholic Health Association, St. Louis.

NOTES 1. “We Are Called,” Catholic Health Association, https://www.chausa.org/cha-we-are-called/.

2. Southwest Texas Crisis Collaborative, https://www.strac.org/stcc.

3. “Haven for Hope Brochure,” Haven for Hope, https://www.havenforhope.org/wp-content/ uploads/2018/11/H4H_Tri_Fold_MAY2018.pdf.

1. Title of publication: Health Progress 2. Publication number: 0882-1577 3. Date of filing: September 12, 2022 4. Issue frequency: Quarterly 5. No. of issues published annually: 4 6. Annual subscription price: free to members, $29 for nonmembers (domestic and foreign) 7. Location of known office of publication: 4455 Woodson Rd., St. Louis, MO 63134-3797 8. Location of headquarters of general business offices of the publisher: 4455 Woodson Rd., St. Louis, MO 63134-3797 9. Names and complete addresses of publisher, editor, and managing editor: Catholic Health Association, Publisher; Betsy Taylor, Editor; Charlotte Kelley, Managing Editor; 4455 Woodson Rd., St. Louis, MO 63134-3797 10. Owner: Catholic Health Association of the United States, 4455 Woodson Rd., St. Louis, MO 63134-3797 11. Known bondholders, mortgagees, and other security holders: None 12. The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes has not changed during the preceding 12 months.

13. Publication name: Health Progress 14. Issue date for circulation data below: Summer 2022

Average No. Copies Each Issue During Preceding 12 Months

15. Extent and nature of circulation: a. Total no. copies (net press run) b. Paid and/or requested circulation (1) Paid/requested outside-county mail subscriptions stated on Form 3541 (2) Paid in-county subscriptions (3) Sales through dealers and carriers, street vendors, counter sales, and other USPS paid distribution (4) Other classes mailed through the USPS c. Total paid and/or requested circulation [sum of 15b (1), (2), (3), and (4)] d. Free distribution by mail (samples, complimentary, and other free) (1) Outside-county as stated on Form 3541 (2) In-county as stated on Form 3541 (3) Other classes mailed through the USPS (4) Free distribution outside the mail (Carriers or other means) e. Total free distribution [sum of 15d (1), (2), (3), (4)] f. Total distribution (sum of 15c and 15e) g. Copies not distributed h. Total (sum of 15f and g) i. Percent paid and/or requested circulation (15c divided by 15f times 100) 16. This statement of ownership will be printed in the Fall 2022 issue of this publication.

Actual No. Copies of Single Issue Published Nearest to Filing Date

14,372

14,527

12,655

12,866

0 0

0 0

0

0

12,655

12,866

1,377

1,309

0 0

0 0

0

0

1,377

1,309

14,032 257 14,289 90.19%

14,175 260 14,435 90.77%

I certify that the statements made by me above are correct and complete.

Betsy Taylor, Editor

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ETHICS

A MISSION GUIDED

BY PRUDENCE “I, Wisdom, dwell with prudence, and useful knowledge I have.” (Proverbs 8:12)

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or nearly three years, the health care ministry and our country have faced a crisis unseen by many generations. Throughout the COVID-19 pandemic, we have had to navigate new and complex ethical dilemmas, such as scarce resource allocation and public health mandates. To do so, our health care organizations relied upon prudential leaders who saw the path ahead clearly while balancing the many demands placed on our colleagues. In doing so, these leaders exhibited the virtue ethicists refer to as prudential wisdom, playing a role in enabling the Holy Spirit to guide the ministry’s work.

ACTION THROUGH PRUDENCE

prudence must be there to guide it. Therefore, St. Thomas Aquinas wrote ex- prudence has been called the Auriga virtutum, or tensively about the virtues and the charioteer of the virtues. how they affect our decision-making in A person strong in prudence applies his Summa Theologright reason to any given matter. ... ica. Furthering the work of Aristotle, NATHANIEL They go beyond simply examining St. Augustine and BLANTON others, Aquinas exand reflecting, leaning also toward HIBNER panded on the many action and application. They can different virtues, providing us with a schematic of their direct our means toward our functions. For the virtue of prudence, Aquinas named it a wisdom. 1 For sincerest intentions.

Aquinas, wisdom is the process of ordering and judging. It prioritizes competing ends and judges the action that will most likely result THE PATH TO PRUDENCE in the desired outcome. It is a virtue of practical Aquinas breaks down the process of prudence into intellect rather than merely speculative. three main elements: counsel, judgment and comWhen looking at the innovation and adaptabil- mand.3 Counsel involves inquiry and deliberation, ity displayed by health care leaders — especially the collecting of data. Judgment includes decisionduring the early stages of the pandemic — how making and choice. Finally, command, the element does this virtue apply? A person strong in pru- that is unique to prudence, moves toward the apdence applies right reason to any given matter. plication of the decision. This process might seem Aquinas quotes St. Isidore of Seville, stating, “A familiar to anyone who has gone through a formal prudent man is one who sees as it were from afar, discernment model. If we look at CHA’s model for for his sight is keen, and he foresees the event of discernment,4 we will find that its five steps follow uncertainties.”2 They go beyond simply examin- the outline Aquinas writes regarding prudence. ing and reflecting, leaning also toward action and The prudential wisdom infused into the process of application. They can direct our means toward discernment enables the Catholic health care minour sincerest intentions. In fact, Aquinas argues istry to put our mission into action. In many ways, that for any moral virtue to meet its intended end, it is through this virtue that we live out the healing

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ministry of Jesus by acting rightly toward our patients, communities and associates. The ministry’s commitment to health equity by prioritizing services that help shape healthier communities is just one of the many ways that we live out this virtue through our work.

When decisions are made that lack prudence, they often follow a path toward a lesser good. In these cases, some influence other than God directs the decision-makers. Aquinas would call this “false prudence.” The person deceives themselves into thinking that the goal they desire is the same as that of the Holy Spirit, when, in fact, it comes instead from avarice and vice. The process of discernment should include steps to selfreflect on one’s intentions and goals so that true prudence may lead the way.

Like any virtue, prudence must be learned and practiced. Aquinas argues that prudence is not naturally gifted to people, though some might be more receptive to learning it. The way to do so is to reflect deeply upon experiences, asking oneself whether the action taken resulted in the desired outcome. Through this reflective practice, a person begins to develop a better understanding of the application of virtuous actions and their consequences. They also learn just as much from their mistakes as they do from their successes.

The ministry’s commitment to health equity by prioritizing services that help shape healthier communities is just one of the many ways that we live out this virtue through our work.

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CONCLUSION

For those who lead the ministry’s work, I invite you to take time and learn more about this virtue — whether through reading what Aquinas has written, or through developing a mentoring relationship with someone who exhibits prudential wisdom. Many systems have opportunities to join mentoring programs. If your system lacks a formal mentoring program, you can also ask someone whose decision-making you admire to walk you through the steps of how they reach their decisions. Or, someone more experienced may be willing to talk with you about what factors they considered if they encountered a similar situation. In addition to CHA’s discernment model and facilitator guide, another helpful resource is Stephen J. Pope’s book The Ethics of Aquinas.5 As our health care ministry continues to face challenges, we look upon our leaders to act in light of prudence. May our work continue to be blessed by those who see clearly and act confidently.

NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis.

NOTES 1. Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 47, article 2.

2. Aquinas, Summa Theologica, Second Part of the Second Part, question 47, article 1.

3. Aquinas, Summa Theologica, Second Part of the Second Part, question 47, articles 8-9.

4. Cooperating With the Spirit: CHA Discernment Model and Facilitator’s Guide (St. Louis: Catholic Health Association), https://www.chausa.org/store/products/ product?id=4653.

5. Stephen J. Pope, ed., The Ethics of Aquinas (Washington, DC, Georgetown University Press, 2002).

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T H I N K I N G G L O B A L LY

OUR CONTINUED CALL TO GLOBAL SOLIDARITY

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ome time ago, the United States Conference of Catholic Bishops (USCCB) issued a statement, “Called to Global Solidarity: International Challenges for U.S. Parishes,” to ground their approach as a call to action for all pastors, parish leaders and other involved Catholics. The opening paragraph reads: “At a time of dramatic global changes and challenges, Catholics in the United States face special responsibilities and opportunities. We are members of a universal Church that transcends national boundaries and calls us to live in solidarity and justice with the peoples of the world. We are also citizens of a powerful democracy with enormous influence beyond our borders. As Catholics and Americans, we are uniquely called to global solidarity.”1 While it has been 25 years conflicts have created refugee crises around the since its initial publication, this world. The United States-Mexico border has been statement is one that I often re- effectively turned into a political volleyball with turn to. Many of its concerns little direct movement toward humane migration still remain timely, and while it is policies, while an ongoing humanitarian crisis heartening to think of how much caused by poverty and violence rages in Latin has changed, it is also startling to America and beyond. The climate crisis continthink of how much has not. ues to exacerbate these issues, yet we continue to BRUCE Within this statement, a list lose ground as some of the world’s most powerful COMPTON of global issues calling American institutions hamper our ability to build consensus Catholics to solidarity is marked and enact needed change. with the subhead, “Signs of the Times.” These “signs Our call to address the health of suffering and need” were refleccare needs of our global partners tive of 1997’s global landscape, one defined by a rapid spread of inforcontinues to propel us forward mation through the internet, which raised awareness and corresponding to develop collaborations that global concern. They feel just as urfoster equity and sustainable gent — and in some cases more so — in 2022. Our call to address the health improvements for our international care needs of our global partners continues to propel us forward to develop communities. collaborations that foster equity and sustainable improvements for our international communities.

Still, there is always room for hope. As the U.S. and international dioceses came together with parishes and universities to form new partnerEXPANDING GLOBAL REACH Today, genocide and ethnic violence are still ships, relationships with health care institutions prevalent globally, notably for the Uyghurs and in low- and-middle-income countries began to Rohingya people in China and Myanmar. Foreign develop. While Catholic health care was not spedebt continues to cripple countries around the cifically highlighted in the 1997 statement, CHA world, and low-income country debt rose to a new and its members have stepped up, and many have record in 2020.2 Multiple wars and ongoing ethnic invested in the USCCB’s call to global solidarity.

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to global solidarity can feel overwhelming when we consider the multitude of challenges that we face in the Catholic health care ministry. The easy response would be to step aside and let someone else handle it. But that was not the reaction of our predecessors in Catholic health care, and if we remain true to our Gospel calling, it won’t be ours, either.

Twenty-five years of distance between the bishops’ call in this statement and our current moment have revealed that these global challenges aren’t going away. Considering this hard truth, let us reflect on the true nature of the Living out the call to global solidarity Church, one that transcends national boundaries. A church focused on can feel overwhelming when we collaboration creates the possibility of involving more skills, talents and consider the multitude of challenges resources into much-needed global that we face in the Catholic health work; it can also serve as an example of solidarity in our fractured world. care ministry.

Let us continue to strategize and think creatively about investing in CHA has now developed global health into a global health partnerships. Let us work toward eqfocus area, dedicating time, money and creative uity and decolonization. And just as importantly, resources into addressing international health let us be a church that answers our Gospel call to partnerships. We have worked with our members peace, justice and solidarity. to develop “Guiding Principles for Conducting International Health Activities”4 that help to ap- BRUCE COMPTON is senior director, global health, propriately position partnerships from the outset. for the Catholic Health Association, St. Louis.

Using these principles, we encourage systems to simultaneously invest in localization and decolo- NOTES nization of global health infrastructure. This is the 1. “Called to Global Solidarity International Challenges true spirit of solidarity. for U.S. Parishes,” United States Conference of Catholic Drawing inspiration from CHA’s “We Are Called” action plan statement to address ongoing health and racial disparities in our communities, I’m encouraged by the ways our organization has sought to put “our own house in order.”3 In recent decades, CHA and its members have thoughtfully approached how we do global health work, with greater emphasis on broadening who is at the table when decisions are made, and, as we partner on sustainable solutions, actively listening to foreign communities as they identify their own needs.

CONTINUING OUR GLOBAL COMMITMENT

Yet, there always remains room to do more. The COVID-19 pandemic has highlighted inequities, complexities and challenges in global health. A lack of infrastructure, logistics and financial resources continues to hamper vaccine access in many low-income countries. Ongoing wars and conflicts created a global migrant population of millions of people, including many who have no access to health care and are rarely represented in global health data.5 The bishops’ statement reminds us that, “the Church’s teaching on international justice and peace is not simply a mandate for a few large agencies, but a challenge for every believer and every Catholic community of faith.” Living out the call

HEALTH PROGRESS

Bishops, November 12, 1997, https://www.usccb.org/ resources/called-global-solidarity-internationalchallenges-us-parishes.

2. “Low-Income Country Debt Rises to Record $860 Billion in 2020,” The World Bank, October 11, 2021, https://www.worldbank.org/en/news/pressrelease/2021/10/11/low-income-country-debt-rises-torecord-860-billion-in-2020.

3. “We Are Called,” Catholic Health Association, https://www.chausa.org/cha-we-are-called.

4. “Guiding Principles for Conducting International Health Activities,” Catholic Health Association, https:// www.chausa.org/store/products/product?id=4423.

5. “Refugee and Migrant Health,” World Health Organization, https://www.who.int/health-topics/ refugee-and-migrant-health#tab=tab_1.

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P R AY E R

SERVICE

A Prayer of Light MARGARET Y. JONES, BCC-PCHAC REGIONAL DIRECTOR OF SPIRITUAL CARE, CHRISTUS SANTA ROSA HEALTH SYSTEM

INTRODUCTION With distressing events happening around the world and in our communities, we may feel overwhelmed, especially in health care. However, when challenges are before us, new possibilities arise.

These difficult times call us to work together in unity. Through the sign of the cross, we can be reminded of the community of the Trinity: Father, Son and Holy Spirit.

Leader: Jesus, Word Incarnate, we know that among your many life tasks, the most poignant ministry was to teach us to love: “‘You shall love the Lord, your God, with all your heart, with all your soul, and with all your mind. This is the greatest and the first commandment.

The second is like it: You shall love your neighbor as yourself.’”

(Matthew 22:37-39) You taught us to care for those most in need. We ask for your healing spirit to cover our suffering Earth, to console and direct us to work together as co-creators.

Pause for a few moments of stillness and silence. Release any distracting thoughts. Become aware of the air you breathe moving through you. Become aware of God’s great peace for you.

Feel your heart open to God’s special gift just for you.

Take a few minutes to be more fully in union with God’s grace. With each relaxing breath, allow the divine presence to embrace you.

OPENING PRAYER O God of Peace, you have taught us that in returning to you and in

resting in you, we shall be saved. In confidence of your love, we shall find our strength. By the might of your spirit, lift us. We pray to your presence, where we may be still and know that you are God. Almighty and ever-living God, we thank you for the many ways in which you strengthen your servants daily. Strengthen us, we pray, in our resolve to love as Jesus taught, and to live with devotion, clarity, creativity and compassion. Bless us in our service, and bless those we serve. Amen.

(PAUSE.) The response is: The Lord is kind and merciful, slow to anger and rich in compassion.

Bless the Lord, O my soul; and all my being, bless God’s holy name.

All: The Lord is kind and merciful, slow to anger and rich in compassion.

God pardons all your inequities; heals all your ills; redeems your life from destruction; and crowns you with kindness and compassion.

All: The Lord is kind and merciful, slow to anger and rich in compassion.

READING (Colossians 3:12-13) “Put on then, as God’s chosen ones, holy and beloved, heartfelt compassion, kindness, humility, gentleness, and patience, bearing with one another and forgiving one another; if one has a grievance against another, as the Lord has forgiven you, so must you also do.”

INTERCESSIONS O God, we commit ourselves to you — our strength. Quiet our minds and bodies with your peace. Come into our hearts, we pray.

The response is: Lord, hear our prayer.

God, in your mercy, renew our desire for unity throughout the world.

All: Lord, hear our prayer.

God of mercy, guide all leaders in new ways to foster peace.

All: Lord, hear our prayer.

Loving God, for those who suffer alone, may they take comfort in our prayers and feel loved.

All: Lord, hear our prayer.

Creator God, teach all people to care for our Earth — the new poor.

All: Lord, hear our prayer.

For the personal prayers of your heart (in silence or shared aloud).

All: Lord, hear our prayer.

Loving God, we know that the light of your spirit shines within our hearts. Offer us unending love that draws us ever closer to you. Hear our prayers that we offer through your name, Christ our Lord. Amen.

CLOSING PRAYER Bless us, O Lord. Bless the light within our hearts with compassion and our minds with wisdom. Bless the work of our hands. Bless us to be faithful instruments of your healing.

This we ask in the name of the one who is at the center of all we do, Jesus the Healer. Amen.

“Prayer Service,” a regular department in Health Progress, may be copied without prior permission.

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HEALTH PROGRESS

COMMUNITY BENEFIT 101: THE NUTS AND BOLTS OF PLANNING AND REPORTING COMMUNITY BENEFIT OCTOBER 25, 26 & 27, 2022 Each day from 2 to 5 P.M. ET

Join us for the Virtual Program!

CHA’s CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit, a virtual conference, will provide new community benefit professionals and others who want to learn about community benefit with the foundational knowledge and tools needed to run effective community benefit programs.

Attendees will receive a copy of CHA’s A Guide for Planning and Reporting Community Benefit.

“CHA has great resources that were used as part of the program, and I can already use the information presented in my day-to-day activities.”

“The information about the CHNA and CHIP was so essential and will be invaluable in my role.”

What you will learn: Taught by community benefit leaders, the program will cover what counts as community benefit; how to plan, evaluate and report on community benefit programs; accounting principles; and a public policy update.

Who should attend: New community benefit professionals who want a comprehensive overview of all aspects of community benefit programming.

Staff in mission, finance/tax, population health, strategic planning, diversity and inclusion, communications, government relations and compliance who want to learn about the important relationship of their work and community benefit/community health.

Veteran community benefit staff who want a refresher course to update them on current practices and inspire future activities.

NEW 22!

O F R 20

SPECIAL OFFER FOR COMMUNITY BENEFIT REPORTERS

We’ve added single-day registration with special pricing for community benefit reporters who want to focus on what counts, accounting and how to tell the community benefit story. Whether you are new to reporting or need a refresher, check out this option.

WE HOPE TO SEE YOU THERE! LEARN MORE AT CHAUSA.ORG/COMMUNITYBENEFIT101

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