Rural Roots Vol. 1 Autumn '24 by NERHA

RURAL ROOTS

Autumn 2024 Vol. 1

Publishing

Dartmouth Printing

Planning & Design

New England Rural Health Association

Executive Editor: Andy Lowe

Design: Kiera Hight

E-mail: admin@newenglandrha.org

Read Rural Roots magazine online at the website: nerha.org

Welcome

Introduction

Welcome to the inaugural edition of Rural Roots! The New England Rural Health Association is launching this magazine to bring you inspiring stories from around rural New England. We’ll be featuring stories not just about healthcare per se, but also about rural life, the beauty of our lands and waters, and chronicles of the strength and resilience of our rural folks. You’ll meet the wonderful people who are doing amazing work, hear from real folks who are benefitting from innovative programs, and learn about strength-based community solutions. You’ll also find just plain good stories about rural living in the many unique corners of New England.

In our regular departments you’ll meet the students who will be tomorrow’s rural practitioners, hear from our partners, look behind the scenes with some of the most innovative programs and projects anywhere, meet NERHA members and more.

Featured In This Issue

A transformative opioid program in rural Litchfield County, Connecticut…

A novel midwifery program is making news in Vermont’s rural Northeast Kingdom…

The Maine Primary Care Association is…

Other Highlights

Meet a Student: This profile of University of Connecticut medical student Caroline Berberian will make you feel really good about the next generation of physicians in training…

My Way: NERHA Board President Michael Pancook’s thoughts may surprise you…

Meet a Member: Director Luellyn Valtin shares what prompted her to represent New Hampshire on the NERHA Board of Directors… Sponsor Corner: NERHA Endorsed Partner Spacelabs…

Article by Andy Lowe

Photo by Kiera Hight

A COUNTRY ROAD TO HARM REDUCTION

“It’s

the Country Life for Me”

Some may think that rural areas are less likely to be impacted by substance use, because people who live in the woods and away from cities don’t have the same access to addictive substances, right? If you had the privilege of growing up in a quiet rural town as I did, you know this could not be farther from the truth. In the 90’s, my tiny hometown of 1,200 people consisted solely of the following infrastructure: a church, an elementary school, a volunteer fire and ambulance barn, and a liquor store, all separated by a single traffic light. They’ve added a deli since then.

What we didn’t have was nearby access to mental health and substance use support. Or perhaps more to our detriment, we did not have the awareness of the incredibly addictive and ironically nick-named “hillbilly heroin”, OxyContin, that was taking the pharmaceutical market by storm. “The One to Start With and the One to Stay With”, as Purdue so fondly coined the slogan in 1999.

By the mid 1990’s there had already been a wave of overdose deaths linked to the misuse of opioids. It was almost as if Purdue and the Sackler family knew how addictive and harmful their prescription medication was, using the slogan to taunt those individuals who had or would eventually succumb to it. Or maybe this was their attempt at subliminal messaging.

For those who had become addicted to OxyContin at the hands of their equally misinformed providers, but whose prescription had run out or who could no longer afford the medication, heroin became the next best choice. Cheaper, too. Granted, it wasn’t as easy or convenient to find heroin as it was to visit your local pharmacy for your prescribed medication, but where there is a will (or when your body relies on opioids to avoid going into withdrawal), then there is always a way.

Sadly, we continue to see the negative impacts of a drug that was created by a prominent healthcare entity nearly 30 years ago. Today, the opioid epidemic has evolved and manifested into the use of even more harmful synthetic opioids such as fentanyl and carfentanyl, both of which can be lethal in doses as little as 2 milligrams, or no more than what would fit on the tip of a pencil. Drug dealers have taken to mixing these synthetic substances with other illicit drugs, such as crack, cocaine, and heroin, due to the affordability and the increased potency it provides. For both first and long-time users, these synthetic substances too often result in fatal overdoses.

“WISH YOU WERE HERE”

Nestled in the Northwest corner of Connecticut and boasting breathtaking views of rolling hills, sprawling lakes and active farmlands, the region is home to about 113,500 folks. It gives pause to say that in 2020 we lost about 4,600 to drug overdoses. In 2021 and 2022 we lost about 3,900 each year, and in 2023 we lost 3,100. A total of approximately 15,500 neighbors, co-workers, friends and family members (nearly 14% of our regional population) were lost to drug overdoses in just three short years. That is a staggering number for a quiet rural region located in one of the richest states in the Country. It makes you wonder how anyone could reasonably think that residents in our community, despite the beauty that surrounds us or any other rural environment, are somehow immune to experiencing substance use disorders.

Tanner Farm, located in Leonardo Ghio’s hometown of Warren, CT

“MONEY, IT’S A GAS”

With the recent groundbreaking ruling that held the Sackler family and their business affiliates that further aided in flooding the United States pharmaceutical market with OxyContin accountable for their damages, States and municipalities began receiving settlement payments last year. National Opioid Settlement amounts paid to towns were determined using an equation that in part considered the impact of the opioid epidemic on the State as a whole, and the individual municipality’s population size. That said, many smaller towns received nominal funding compared to larger towns and cities nearby. As an example, one town in our region will only receive a grand total of about $1,700.00 from the several settlements that are currently being paid over the next 15 years. That is just enough to buy 37 boxes of naloxone, a lifesaving opioid overdose reversal medication; our local harm-reduction teams hand out that many boxes of naloxone on a daily basis. So, what are small towns expected to do with this limited funding?

“WITH A LITTLE HELP FROM MY FRIENDS”

As the Project Director at the Northwest Hills Council of Governments (NHCOG), a Regional Planning Organization that serves as a quasi-county government entity for 21 towns, it appeared we had an opportunity to band together and pool settlement funds to support larger initiatives with a focus on rural needs.

Leo and his wife, Kiera, at Steep Rock Preserve in Washington, CT

Tanner Farm in Warren, CT

Nine towns agreed to commit all of their National Opioid Settlement funds to establish the Regional Opioid Response Fund (RORF); two additional towns agreed to give a portion of their settlement funds to the RORF. Through this collaborative agreement the NHCOG has collected just over $100,000 to date and expended 60% of the funds on two primary initiatives. The RORF is overseen by a committee of individuals representing broad perspectives, including prevention, harm-reduction and treatment providers, individuals with lived experience, Chief Elected Officials, and Emergency Medical Technicians. Notably, the Regional Opioid Response Fund received kudos from the CT State Department of Mental Health and Addiction Services Commissioner, Nancy Navarretta, who said she hoped more towns in the State would follow suit.

LEAVE BEHIND KITS

Recognizing that first responders, particularly in rural areas, play a key role in identifying individuals who may be experiencing substance use disorders, the RORF Committee provided Leave Behind Kits to local volunteer ambulance companies. Kits consisted of two doses of naloxone, a CPR face shield, nitrile gloves, and harmreduction resources, and are intended to be left with the individual or family after responding to a suspected overdose. In addition to providing the kits, a harm-reduction specialist provided training to the ambulance companies, answered questions, and worked towards reducing the associated stigma of opioid use disorder.

“The Leave Behind Kit program gives us a crucial opportunity to connect with EMS providers across our rural county. Providing the kits is not only about getting naloxone out into the community, it is about meeting people who are using drugs and their loved ones in a crucial moment and saying ‘It’s okay to get help, we care about you, here are resources that can support you.’ We leverage the trust every community has in their first responders to save lives.” – Julia Jagger, Community Outreach & Recovery Navigator, Greenwoods Counseling & Referrals Inc.

Lake Waramaug, right down the road from Leo’s grandparents in Warren, CT

LITCHFIELD COUNTY OPIATE TASK FORCE

The Litchfield County Opiate Task Force (LCOTF) is a long-standing consortium of mental health and substance use providers working in tandem with local law enforcement and the area health department to increase awareness and access to harm-reduction and prevention resources. A large portion of their resources and services focus on the two urban towns located within the NHCOG region, primarily because there is a higher concentration of need there compared to smaller surrounding towns. That said, the RORF was established to ensure that projects would be developed and tailored in a way that would be more impactful to the small towns where the LCOTF projects may not have been the right fit.

However, recognizing that the LCOTF is a key stakeholder in the larger effort to increase awareness and access to overcome substance use disorder, the RORF purchased 12-months of harm-reduction supplies for the LCOTF to distribute via their harm-reduction vans and outreach sites. This contribution from the RORF allowed the LCOTF to purchase wound-care and safesmoking supplies that they had not been able to in the past due to funding guidelines. Supplies included Xeroform pads and Medi-honey to treat Xylazine related wounds, as well as hammer pipes, bubble pipes and foil kits. Safe-smoking supplies are meant to offer individuals the option of transitioning from injection, which can result in infection, to smoking. Furthermore, the contribution from the RORF came at a time when there was hold placed on supplies that came from the LCOTF’s primary vendor, which would have been detrimental to the clients who rely on those services.

WHERE DO WE GO FROM HERE?

The Regional Opioid Response Fund will continue to be nimble and intentional when exploring, developing and implementing opioid abatement initiatives in our small rural towns. Our hope is to continue combating the stigma associated with substance use and simultaneously increase access to harm-reduction and treatment resources. As many SUD providers will tell you, harm-reduction resources do not aim to encourage drug use, rather they give users a chance to see another day, a day that they may choose recovery over using. As professionals in the public health field, it is our duty to provide beneficence for those who are not always able to do this for themselves. Better yet, it is our honor to offer support to those who need it most.

“Withoutthem(theLCOTFHarmReductionProgram), I don’t know what we’d do. They help us greatly; they are always around and are very friendly. They don’t make you feel uncomfortable, and they treat you like human beings. My girlfriend and I love (the) services. Without (these) supplies my wounds never would have healed. I am super embarrassed to go to the ER or the doctors because of the way they make you feel. Here at LCOTF, they treat you with respect and dignity. We love (the) services, keep up the great work you guys do for the community” – Anonymous.

Article by Leonardo Ghio

Photos by Leonardo Ghio

At the New England Rural Health Association, one of our core strategic pillars is to be a Rural Workforce Champion. To achieve this goal, we work to strengthen and expand the rural health workforce serving our region. One key to growing the rural health workforce is to engage health care students early in their training. By providing rurally-themed opportunities such as internships, scholarships or NERHA committee membership, we hope their experiences will guide students to rural practice one day.

In each edition of Rural Roots we feature one or more of our amazing rural health students to celebrate the diverse paths they have followed toward their dream of rural practice. We think you will be as inspired as we are by these energetic, enthusiastic future rural practitioners.

This month, we invite you to meet Caroline Berberian, a second year medical student at the University of Connecticut School of Medicine.

CAROLINE BERBERIAN

Hometown: Hamden, Connecticut

Medical school: University of Connecticut School of Medicine

Hobbies: My parents always encouraged my sister and me to spend time outside! I love exploring new hikes and trail running in my spare time. I also enjoy spending quality time with my dad while freshwater fishing in Connecticut.

Before my freshman year of college, I had the privilege of hiking parts of the Appalachian Trail in North Carolina with fellow incoming students. This experience opened my eyes to the breathtaking beauty of rural America, with its uninterrupted landscapes. I also got to experience the warmth and generosity of the rural communities we encountered.

The local residents we met along the way went out of their way to share their intimate knowledge of the land, recommending the most scenic camping spots, highlighting the trail’s hidden gems, and pointing us towards authentic local eateries that gave us a taste of genuine rural cuisine.

This journey was transformative, igniting in me a deep appreciation for rural life. The sense of community, the connection to nature, and the slower pace of life all resonated with me profoundly. It was during this trip that I realized my desire to someday make a rural area my home.

Caroline Berberian fishing

Even now, as a medical student, I make it a priority to reconnect with rural landscapes. I seek out the best hiking trails in Connecticut, each new vista reminding me of the beauty and tranquility that rural areas offer. These experiences continue to reinforce my commitment to potentially serving in a rural healthcare setting, where I hope to give back to the kind of communities that so warmly welcomed me during that formative Appalachian adventure.

How I became interested in rural medicine:

During college, I interned as a medical assistant in a rural healthcare clinic in North Carolina. This experience showed me the benefits of providing rural healthcare and the unique opportunities it presents to providers to know their patients and be an important part of the community fabric. In this clinic, the providers knew each patient’s life story, family members, schedules, and values, allowing them to incorporate these aspects into more personalized care.

As I continued my medical school journey, I sought ways to become more involved in local rural health advocacy and research, which led me to the New England Rural Health Association (NERHA). Since becoming a member of NERHA and working with medical students who have similar career goals, I’ve gained a greater appreciation for the challenges rural populations face in accessing care. I’ve also learned a great deal from rural healthcare providers.

Caroline at a local farm

Caroline as a medical assistant

A young Caroline fishing

How one Vermont hospital is improving birth outcomes and increasing health access with 24/7 midwifery-led care.

CHANGING THE AMERICAN PARADIGM

In rural communities, access to health care – especially health care that empowers patients and helps prevent compounding medical interventions – is important. It is especially important when it comes to birth. Research repeatedly shows that when Certified Nurse Midwives (CNMs) are providing care, there is a decrease in interventions and cesareans and an increase in patient satisfaction.

According to an American Journal of Obstetrics & Gynecology 2023 “Expert Review” by Yale faculty members Holly Powell Kennedy, PhD, MSN, CNM and Joan Combellick, PhD, MPH, MSN, CNM, midwifery care can improve childbirth outcomes by 56 different measures. For example, having a midwife as part of your care team means a lower chance of death for mothers and newborns, fewer babies born early, and fewer babies born underweight. Where midwifery is standard in other countries – typically wealthy European nations –women have as much as seven times the access to midwives as they do in the United States. However, several rural Vermont facilities are changing the American paradigm and offering 24/7 midwifery-led care. Among them is Northeastern Vermont Regional Hospital (NVRH). What does this kind of care look like, and what does it look like at NVRH, a hospital located in Vermont’s Northeast Kingdom, a region known for its socio-economic struggles?

What does this kind of care look like, and what does it look like at NVRH, a hospital located in Vermont’s Northeast Kingdom, a region known for its socio-economic struggles?

Photo of CNM Jade Kaplan

Physicians and midwives partner to improve outcomes

Round the clock midwifery-led care means a midwife and an OB/GYN physician are on-call together. It means, at NVRH, most individuals have the choice between primarily seeing a midwife or primarily seeing a physician. And it means, because all major insurance policies and Medicaid cover midwifery care for maternity care, gynecological care, and family planning, improved access to better health all around.

“Choice in health care is a priority for our maternity service, and choice is a cornerstone of midwifery philosophy,” NVRH Certified Nurse Midwife Jade Kaplan said. “Sometimes a pregnant person has additional health concerns and requires a physician to handle their care. Midwives. however, can still play a part in their care because both midwives and physicians collaborate.”

Kaplan, who has been a midwife for 32 years, works closely with two other Certified Nurse Midwives and three OB/ GYN physicians. And she does more than assist in birth. She, along with two other midwives, assists during cesareans, provides family planning and gynecological care outside of the maternity cycle.

“Birth becomes the peak of the emotional experience for birthing people and their families,” Kaplan said. “But actually most of my time is spent on patient education, prenatal visits, family planning, routine healthcare, and getting to know families so they feel comfortable with me. That way, when we get to that moment when baby is coming, there’s trust. There’s relationship there.”

Although midwives assist in nearly 13% of births in the U.S., in Vermont, 30% of babies are delivered by midwives. And approximately 65-70% of pregnancies and deliveries at NVRH are supported by Midwifery Services. Besides patient choice and autonomy, midwives prioritize supporting the normal physiologic processes of pregnancy, labor and delivery, and work to encourage birthing persons to develop confidence in themselves and their ability to give birth.

Midwives in the U.S. generally care for lower risk pregnancies and, according to national statistics, maintain cesarean section rates

well under 20%. This is true for the midwifery services at NVRH as well. Breastfeeding success is over 90%. Patient satisfaction with their birth experience is also high, as most times pregnant people are able to make choices about giving birth that suit their individuality, including staying out of bed, using the deep tub, taking long showers, or changing positions often, even if they have an epidural.

On top of frequently collaborating with OB/GYN colleagues, including meeting weekly to discuss concerns or patient situations, midwives also communicate regularly with lab personnel, radiology staff, primary care providers, behavioral and mental health professionals, and the anesthesia department.

Working together creates healthier babies and powerful outcomes

NVRH OB/GYN provider Lisa Baclawski, MD worked with midwives before choosing to move to Vermont to work at NVRH. She says the strong midwifery service at NVRH is one of the things that drew her to this hospital.

“When midwives and doctors share their areas of expertise and work together, with the pregnant person included and empowered, we are better able to provide strong, patientcentered care,” Kaplan said. “And that is really powerful.”

Northeast Kingdom, Vermont

Article by Katie Moritz

LUELLYN VALTIN

Can you please tell us a little about yourself and your work in rural health?

I’m married, a mother of three, and a grandmother to four wonderful grandsons. My journey in healthcare began in 2005, focusing on quality and patient safety across various settings in New Hampshire and New York. I’ve had the privilege of working at both an academic medical center and critical access hospitals in a rural area, which has given me valuable insights into the unique challenges and opportunities in rural healthcare.

I recently transitioned from my role as the Senior Director of Rural Quality Improvement at the Foundation for Healthy Communities to take on the position of System Director of Quality for North Country Healthcare. North Country Healthcare is a rural healthcare system that includes three critical access hospitals, a home health and hospice agency, and several rural health clinics. During my time with the Foundation, I worked closely with New Hampshire’s critical access hospitals to develop and implement strategies aimed at improving patient care, safety, and overall healthcare quality. These efforts were especially rewarding because they helped strengthen the healthcare infrastructure for rural communities. Now, in my new role, I continue to build on this work, overseeing quality improvement across the network to ensure that rural populations have access to safe, effective, and high-quality care.

Autumn in New Hampshire

What does being a member of the New England Rural Health Association and the Board of Directors mean for you?

Being a member of the New England Rural Health Association and serving on the Board of Directors is incredibly meaningful for me, both professionally and personally. Working with staff at critical access hospitals across New Hampshire provides me with a deep understanding of the challenges and opportunities within rural healthcare. This experience allows me to bring a collective voice to NERHA and the Board, representing the diverse needs of our rural communities.

Moreover, my involvement with the New England Rural Health Association and the Board gives me access to a range of perspectives and innovative ideas from across New England. I can take these insights and strategies back to the critical access hospitals in New Hampshire, applying them to enhance the quality, safety, and financial stability of our local healthcare facilities. This role not only enriches my understanding but also empowers me to drive meaningful improvements and support our hospitals in achieving their goals.

What does rural health mean to you?

To me, rural is more than just a geographic designation; it represents a commitment to improving the quality of life and healthcare for communities that are often overlooked. Rural areas are characterized by their unique challenges, whether it’s limited access to healthcare, financial constraints, or the need for specialized safety and quality improvements. These challenges require dedicated, tailored solutions that address the specific needs of these communities.

My work with New Hampshire’s Critical Access Hospitals has reinforced my belief that rural healthcare is about resilience and innovation. It’s about ensuring that even the most remote areas have access to high-quality, safe, and effective care. It’s about supporting healthcare providers in these areas to thrive despite the constraints they face. Rural means creating a network of support where community members receive the best care possible, regardless of their location.

Having spent much of my career working in rural healthcare, I’ve seen firsthand the impact that focused efforts in rural health can have. To me, rural embodies the dedication to overcoming barriers and enhancing patient safety and care quality in every corner of our state, making a meaningful difference in the lives of individuals and families in these underserved areas.

Photo of Luellyn Valtin

Role: System Director of Quality

Org: North Country Healthcare

State: New Hampshire

Michael Pancook speaking at the Member Meeting during the 2024 NERHA Fall Conference

Michael Pancook

As I enter my second year as president of NERHA’s Board of Directors and we launch Rural Roots Magazine, I’d like to tell you why I joined NERHA and am honored to serve on its board.

It is one, simple word: connection.

When I was part of the team supporting the 2018 annual conference, I discovered NERHA and its uniqueness. Unlike other conferences I’ve attended, NERHA reached beyond information-sharing, peer learning, and professional networking to foster and sustain personal connections. Over the decades that I have worked in healthcare policy, I realized that connection between people – provider to patient, provider to provider, provider to community – cements the foundation to build and sustain healthy individuals and thriving communities.

Our 2023 conference provided me with new evidence to support my initial impression of NERHA. Kristen from North Country Health Consortium shared the insight that resource limitations mean rural communities hold lessons to address the growing divisiveness within our country – “if Jesse is the only plumber within 30 miles, then we are going to find a way to get along even if our politics are completely opposed.” The staff of North County Health Consortium’s community health worker program and the medical student analyzing outcomes of Vermont’s SASH program concurred

My Way

over the significance of social factors in patient recovery and the necessity that healthcare extend beyond the site of the medical intervention. Fernando from Martha’s Vineyard Boards of Health reflected that his success accelerated as he shifted the focus of his communications from the challenges he sought to solve and toward the overlap between the goals of the area’s multiple public agencies. Judiann and Janell from Daniel Hanley Center for Health Leadership and Michael from ETSU Center for Rural Health Research stressed the power gained from balancing the urge to identify and solve problems with the recognition and promotion of the existing strengths and resilience that sustain rural communities. I could cite many more instances, and I know you could as well.

Fundamental to all these cases is connection.

NERHA has been blossoming in terms of staff, funding, and conference attendance in recent years. I am delighted that during this growth, we continue to be a source of connection. Rural Roots Magazine offers another way to weave the strands of experience, insight, and knowledge of our members into connections that span New England’s rural communities.

Article by Michael Pancook

Photos by Kiera Hight

NERHA’s 2024 Conference: A Year of Firsts and Mores

The 2024 NERHA Conference in Mystic, Connecticut, was an unforgettable milestone! This year’s event was the largest in NERHA’s history, drawing more than 360 attendees, over 25 sponsors, 50+ speakers, 25 poster presenters, and 40 students—a true year of “mores.” From inspiring sessions to innovative poster presentations, the conference offered something for everyone passionate about rural health. Attendees raved about the energy and enthusiasm that filled the event, making it not only our biggest but also, according to many, our best yet.

THE POWER OF COLLECTIVE EFFORT: A COMMUNITY-CENTERED APPROACH TO

WORKFORCE DEVELOPMENT IN MAINE

Amid rural Maine’s serene and often challenging terrain, community health centers (CHCs), also known as federally qualified health centers (FQHCs), stand as lifelines for the residents who depend on them. These centers are more than just places to receive healthcare - they are the heart of the community, providing support, education, and pathways to better health outcomes. CHCs are also nimble experts at forging relationships to build capacity to support community needs.

One important focus area of Maine Primary Care Association, a membership organization representing the collective voices of Maine’s CHCs, is working with CHCs to address their growing workforce challenges. One way we are doing that is through the Rural Public Health Workforce Training Network (RPHWTN) grant funded through the Federal Office of Rural Health Policy, which our organization calls the Maine Workforce Innovation Network (WIN). This collaborative network works together to build solutions and strategies for enhancing workforce pathways that can impact job satisfaction and patient outcomes.

GROWING TOGETHER

Building a stable and fulfilling career in rural Maine, especially in healthcare, comes with unique challenges. Remote locations, smaller populations, and limited resources make attracting and retaining employees difficult. That’s where the “grow your own” model steps in—an approach centered on hiring local residents and investing in their education and training to develop a skilled, dedicated workforce within the community.

The Maine WIN has embraced this model to address the workforce challenges faced by Maine’s CHCs. Through customized training and career advancement opportunities, WIN empowers individuals to expand their roles and take on new responsibilities. Abby Folsom, a Medical Assistant (MA) at HealthReach Community Health Centers, exemplifies the success of this approach. Through the support of her supervisors and WIN resources, she enrolled in the CareerStep Medical Assistant training program, which provided her with a blend of hands-on and virtual learning experiences that helped enhance her technical skills, enabling her to take on more responsibilities within her role.

Abby’s success is a testament to the power of investment, ensuring that rural communities are supported by healthcare professionals who are not only skilled but also connected to the communities they serve. Abby shared the following with us...

“My favorite part of training as a medical assistant at the Sheepscot Valley Health Center has been learning from the patients in my community and contributing to their care. The combination of hands-on and virtual training in the CareerStep program has allowed me the opportunity to learn directly from my interactions with patients and the experienced MAs around me as I complete the online curriculum. Throughout my training, the preceptors, providers, and patients I have worked with have all been incredibly supportive and created a safe learning environment where I can grow. As I apply to medical school, these experiences have deepened my excitement to eventually return to Maine as a physician and give back to the community around me.” – Abby Folsom

Dylan Bernosky, a Dental Assistant (DA) at Penobscot Community Health Care (PCHC) also shared with us his experience with the CareerStep Program, highlighting how the program empowered him to feel more confident in his role:

“The CareerStep program has provided me with the comprehensive training and practical skills needed to become a Dental Assistant. Its flexible online courses have given me a strong foundation in dental terminology, procedures, patient care and infection control. The program being self-paced allowed me to learn at my own speed and spend more time focusing on the things I needed to. This program has helped me to feel confident and prepared for my new career as a Dental Assistant. I would recommend this program to anyone either starting out as or already working as a Dental Assistant. CareerStep has allowed me to transition successfully into the dental world and start making a difference in patient’s lives.”Dylan Bernosky

Since its launch in July 2023, the CareerStep medical assistant and dental assistant training programs have flourished. With the financial support of the RPHWTN grant and the Maine Department of Labor, the training is offered at no cost to health centers. Currently, 11 health centers are participating, with 13 dental assistants and 25 medical assistants actively enrolled. 4 MAs and 4 DAs have already completed the program.

By focusing on local hiring and training, Maine’s CHCs are creating a sustainable workforce uniquely suited to their needs. This helps address immediate staffing shortages and promotes long-term growth and stability in the community.

Photo of Dylan Bernosky

Photo of Abby Folso

BRIDGING CARE GAPS

At the heart of Maine’s community health centers are Community Health Workers (CHWs)—trusted and respected community members who are vital links between healthcare providers and residents. In rural areas with limited healthcare access, CHWs are often the first point of contact for individuals seeking assistance. They are deeply embedded in the communities they serve, allowing them to understand and address these populations’ unique needs and challenges. Whether helping patients navigate the healthcare system, connecting them with necessary resources, offering translation services, or providing education on managing chronic conditions, CHWs are there every step of the way; their work fosters a more equitable and accessible healthcare system where people receive the care and support they need.

Many partners, including the Maine CHW Initiative, MCD Global Health, the State of Maine, the Maine Public Health Association, the Maine Primary Care Association, and others, have come together to strengthen training and support for Maine’s CHWs. These collaborations offer a range of training opportunities, from core competency and supervisor training to peer support groups, resource sharing, and climate resiliency education.

At MPCA, we recognized another area of need for CHCs: the importance of exploring and discussing CHW operations within health centers. Key questions such as: How do you start a CHW program? What will their work focus on? What are the roles and boundaries of CHWs? were used as our guide to launch a CHW Operations Group. While still in its early stages, it has sparked rich conversations and engaged health centers eager to learn from each other about implementing and supporting their CHW programs. To date, over 65 CHWs and CHW supervisors have participated in trainings or peer support spaces through the Maine WIN.

Results from the Climate Resiliency Assessment

FOSTERING CLIMATE RESILIENCY

As environmental shifts continue to affect rural Maine (and beyond), the role of CHCs has expanded to include preparing communities for the impact of the environmental challenges ahead. One offering through our network, in collaboration with the Maine Public Health Association, is a climate resiliency project, which is providing CHWs and other community support roles with education on the health impacts of environmental changes and equipping them with resources to support their patients and communities.

This project included a webinar series that brought together experts to address critical topics like vector-borne disease prevention, extreme weather events, climate health disparities, migrant community engagement, mental health in the face of climate change, emergency preparedness, and respiratory health education. By surveying health center staff, these webinars were tailored to the unique needs of Maine communities. They provided practical guidance and resources for CHWs and residents to safeguard their health and homes in communities facing a changing climate.

THE POWER OF COLLECTIVE EFFORT

Maine’s rural communities are strong because they are supported by CHCs that understand their unique challenges. CHCs are not just healthcare providers but community builders, educators, advocates, and economic engines powering local economies across the states. Through their unwavering commitment to their communities, Maine’s

CHCs are proving that rural communities can grow, thrive, and lead the way in innovative healthcare, even in the face of adversity.

So, what drives and has made our program so successful in a short time? Partnerships with other organizations, funding, support from HRSA, and above all, the health center’s commitment to growing and working together to build innovative solutions and strategies. The strength of the Maine WIN lies in its ability to bring people together. Whether through career advancement programs, peer group support, or climate resiliency initiatives, this collaborative spirit and commitment to mission ensures that the community’s needs are always at the forefront and that everyone has a role in building Maine’s healthier, more resilient healthcare workforce.

To learn more about the Maine Primary Care Association, visit our website or connect with us on Facebook, Instagram, LinkedIn.

Article by

Leslie Lorentzen, MPHc, Workforce Program Manager

Maine Primary Care Association & Emily Ferry, MSW, Director of Workforce Initiatives

Maine Primary Care Association

Maine Mobile Health Program’s Outreach Director and one of their CHWs

Maine Primary Care Association’s service sites

NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH

REGION A

Living in rural Maine has been one of the greatest joys of my life. Anytime I get to show off the beauty and show people around my home state I get thrilled. When I heard the National Organization of State Offices of Rural Health (NOSORH) Region A meeting would be held in Portland, I couldn’t have been happier. Not only because I wouldn’t have to travel far (we had done a lot of travel already this year) ….but because it meant I’d get to share the treasures of Portland, Maine with my team at the New England Rural Health Association, our Federal Office of Rural Health Policy friends, and SORH colleagues from the east coast down to Virginia.

What I love most about getting together with our rural health partners is it feels like coming home to family. Everyone is there for the same reason – because they LOVE it. The conference room was abuzz with folks catching up with old friends and making new ones. The presentations highlighted the incredible work of our SORHs. NERHA was able to share the partnership and collaboration of our organization and our six SORHs including highlighting

Nicole Breton of the Maine SORH presenting during the NOSORH Region

meeting

The NERHA team does not get to be together in person very often. Since we serve a large region and are spread across the 6 states (and beyond), in-person time can be rare. Some team members and consultants had never even met face to face. We carved out some space and time for our team to meet. We shared project updates, roles, responsibilities and professional and personal goals. One staff member said, “It was so great to meet everyone in person. Hearing their priorities and pain points helped us understand each other’s daily work and how we can support each other.” There’s nothing more productive than sitting around a table together.

And that’s where this all started… Our SORHs sitting around a table to decide that if resources were pooled, a Rural Health Association could more effectively and efficiently serve the whole region. And so the New England Rural Health Roundtable was born. As we’ve grown and changed, there have been bumps in the road, but the steadfast support of the State Offices has remained. Our relationships with our SORHs is rare… I didn’t realize that until Laura Seifert who you’ll see pictured, asked me to speak on a panel about our partnership at the Annual Flex Reverse Site visit. It was an honor to share the close relationship NERHA has with our SORHs with other states, the Federal Office of Rural Health Policy (FORHP) and the Flex team.

While we participated in a wonderful event full of learning, the highlights of the trip were enjoying lobster rolls with my team by the water and seeing their eyes light up as we explored Portland Harbor. We saw the forts, the renowned Portland Head Light lighthouse, and even seals! We got to ride around at the front of the boat with the wind in our hair, laughing and getting to know each other better. We explored the yummy eats around town and saw some of our colleagues enjoying the live music with their smooth dance moves. So, to say this was a successful and meaningful event would be an understatement. This is what I love most about rural health… it brings people together.

Thank you to the Maine State Office of Rural Health and Primary Care team for hosting all of us in this great state and including the NERHA team.

Article by

Ann Marie Day

Photos by Kiera Hight

The NERHA team on a sunset cruise during the NOSORH Region A meeting 2024, Portland Maine

ANNOUNCING THE NERHA RURAL

DATA ANALYSIS DASHBOARD

In June 2024, the New England Rural Health Association unveiled its new Rural Data Analysis Dashboard at the National Organization of State Offices of Rural Health (NOSORH) Region A meeting in Portland, Maine. In a truly unique show of collaboration, the State Offices of Rural Health from all six New England states jointly funded this new online map-based tool that highlights rural-urban health disparities across the region.

The precursor of the Dashboard was a NERHA report called “Rural Data for Action,” or Data Book, produced initially in 2007 and then updated in 2014. Vermont State Office of Rural Health Chief John Olson said, “This Dashboard evolved naturally from the previous two editions of the NERHA Data Book. We knew the time was ripe to upgrade the static Data Book to a fully dynamic, interactive mapping utility.”

A technical team from John Snow, Inc. (JSI) developed the new dashboard with input from all six SORHs and NERHA. Technical team lead Eric Turer from JSI commented, “One of the challenges we encountered was updating the rural definition for the project. In the old Data Book, we used Rural-Urban Commuting Area, or RUCA, codes as the starting point for determining rurality. COVID and the huge increase in telecommuting have rendered RUCAs somewhat dated.”

As a result, the team explored other options. The Index of Relative Rurality, pioneered at Purdue University, emerged as the best option. As Steve Schaeffer, GIS Analyst at JSI, observed, “The IRR is a continuous, unit-free measure that allowed us to develop a region-wide rural definition that encompassed the different SORH rural definitions in each state.” With input from the SORHs, the technical team adapted the IRR scale for all of New England’s counties to reflect the continuum from core metro to very rural. This enabled a key feature of the Dashboard: the ability to slice data at the county level by simply Urban vs. Rural or by four cuts: Large Rural, Small Rural, Small Non-Rural, or Non-Rural Core (i.e., metro).

One view of the Dashboard showing the percent of the population that has to travel more than 15 miles to a hospital to access maternity care. More detailed data appears in the roll-over box for Oxford County, Maine. Purple counties are defined as Urban and green counties as rural.

Eric Turer presenting the Rural Data Dashboard at the NOSORH Region

The project team identified nearly 200 rural health data elements grouped by categories such as demographics, care utilization, insurance status, maternity services, social determinants and more. Users can select one, multiple, or all states. Overview data displays for each county, and more detailed information appears on rollover. Clicking a county provides access to the original source data. Users can also view detailed data in tabular format and create PDFs.

Close collaboration with the CDC’s Office of Rural Health was a key to success, including participation in their Rural Data Workgroup to tap a forum for sharing the insights and learning. The team is now writing a paper titled “Perils, Pitfalls, and Problem-Solving: Challenges and Solutions in Rural Health Data Analysis and Mapping” for submission to the CDC’s journal on Contemporary Solutions for Persistent Rural Public Health Challenges.

The Rural Data Analysis Dashboard is provided through NERHA’s website for students, analysts, advocates, decision-makers, researchers and others to access data

about health disparities experienced in New England’s rural communities. You can find it on the NERHA web site (NERHA.org) under the Projects tab or directly at nerha.org/rural-data-analysis-dashboard.

Article by Andy Lowe

Photos by Kiera Hight

Manuel Oritz discussing the Rural Data Dashboard and it’s details on Rhode Island

SPACELABS HEALTHCARE

In today’s Healthcare industry, it’s hard not to feel that things are both moving fast, and yet can still be frustrating.

While technology has made significant progress in the past few decades, its impact on healthcare providers has not all been beneficial. We believe technology should enhance the clinician experience, not hinder their ability to provide exceptional patient care.

As a healthcare technology representative, organizations like ours have brought great value to our hospital partners. But when our solutions don’t meet a user’s expectations, we have a front row seat on how we impact the hard-working, healthcare staffer.

To embrace our responsibilities as a part of the patient care continuum, we have long positioned Nurses within our organization into important, decision-making roles. Our clinicians are industry savvy -- healthcare providers themselves -- and very much understand how to enhance staff workflow. We are proud to share just a few of our Nursing Teammate’s perspectives.

“In today’s world, no longer does a nurse have to put in a phone call to the provider’s office, wait for many minutes on the phone waiting to get a verbal order (like Tylenol for their patient with a fever). Today, a message is sent in a secure chat and the provider can answer it as soonastheyareavailable,allowingthenursetocontinue with their own patient care and responsibilities instead of staying on interminable hold.” – Michele Long, MSN, RN, Sr. SaaS Clinical Applications Manager

“Technology has profoundly transformed healthcare, enhancing the quality and accessibility of medical services, thus enhancing the efficiency and quality of care. Communication technologies such as electronic health records (EHRs) and computerized provider order entry (CPOE) systems have streamlined information sharing among healthcare professionals, reducing errors and improving the coordination of care. Digital advancements like telehealth facilitate remote consultations, allowing patients to receive care from the comfort of their homes, which is particularly beneficial for those in rural or underserved areas.” – RN, BSN, MBA, SaaS Clinical Applications Sr Manager

We believe that vendors have an obligation to create solid solutions to complex problems. These solutions need to be stable, easy to use, and affordable. We also believe that by collaborating with our hospital partners, we can create a healthier future for their communities. We would like to share a story from one of our rural partners, who has embraced Spacelabs’ mission in using meaningful insights for better outcomes.

Rural areas often struggle with limited access to immediate medical intervention, potentially affecting patient outcomes. Cardiovascular disease, a leading cause of premature death before age 65, highlights the need for better healthcare solutions in these regions. Along the Missouri River, patient care has significantly improved thanks to advanced telemetry monitoring. This technology allows continuous monitoring of vital signs, crucial for timely medical response.

Recently, at a hospital in the Midwest region, a monitor tech observed an abnormal heart rhythm in a patient, identifying a heart attack in real-time. This quick detection enabled medical staff to intervene promptly, saving the patient’s life by treating a 100% blocked artery with a critically needed stent.

Telemetry systems provide constant monitoring, identifying potential abnormalities requiring immediate intervention. This technology ensures that even in rural areas, patients receive timely, life-saving care. It represents a major advancement in rural healthcare, ensuring patients are always under vigilant watch.

Advanced telemetry and similar technologies transform rural healthcare, offering high-level care and monitoring that can mean the difference between life and death. By leveraging technology, rural areas can achieve better patient outcomes and improved healthcare quality.

Serving all hospital types, especially rural areas, means serving your friends, loved ones and neighbors. Spacelabs is committed to be there, with you, supporting your mission to provide the best care experience possible.

Article by Sarah Bernardes, New England Patient Monitoring Specialist & Toby White, NY/VT Patient Monitoring Specialist

ABOUT THE NEW ENGLAND RURAL HEALTH ASSOCIATION

The New England Rural Health Association (NERHA), established in 1997, is the only regional rural health association in the U.S., serving all six New England states. As a non-profit governed by a Board of Directors, we provide advocacy, education, technical assistance, and program support to improve rural health.

With over 500 members and over 5,000 subscribers, we represent a wide range of rural health professionals, including hospitals, clinics, public health, and academic institutions. Key initiatives include strengthening the rural health workforce through student memberships, scholarships, and internships.

Join us in advancing rural health by becoming a member, serving on our committees or Board, or partnering with us. Learn more at NERHA.org.

JOIN US IN SUPPORTING RURAL HEALTH IN NEW ENGLAND!

The New England Rural Health Association is dedicated to improving the health and well-being of rural communities across our region. Access to quality healthcare shouldn’t depend on your zip code — yet many rural areas face significant challenges, including limited resources, healthcare provider shortages, and transportation barriers.

Dollar Makes a Difference.

Help us ensure that every rural New Englander has access to the care they deserve. Together, we can bridge the healthcare gap and create a brighter future for all. Your donation can help us bring essential healthcare services to those who need them most. Together, we can build healthier, more resilient rural communities.

NERHA Rural Roots uses eco-friendly paper that looks at environment safety and the future of humanity