North Country Health Consortium Annual Report 2017

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20 years

2017 Annual Report

About North Country Health Consortium History and Purpose The North Country Health Consortium (NCHC) is a rural health network, created in 1997, as a vehicle for addressing common issues through collaboration among health and human service providers serving Northern New Hampshire. NCHC is engaged in activities for: Solving common problems and facilitating regional solutions Creating and facilitating services and programs to improve population health status Health professional training, continuing education and management services to encourage sustainability of the healthcare and workforce infrastructure Increasing capacity for local public health essential services Increasing access to healthcare for underserved and uninsured residents of Northern New Hampshire

Together with other organizations throughout the region, we provide, coordinate, or facilitate: Training and continuing education for all levels of healthcare professionals

I mproved access to services for underserved residents Regional forums on community health issues Community needs

assessment and health status monitoring rogram development P and management Services for regional collaborative initiatives


From our CEO & Board President Welcome to the North Country Health Consortium’s 2017 Annual Report. We are celebrating our 20th anniversary – an amazing milestone made possible by our dedicated partners, passionate staff, and committed funders over the years. The Consortium has grown significantly over time but has never wavered from its original mission of Leading Innovative Collaboration to Improve the Health Status of Northern New Hampshire. History has shown that together with our partners we can assess and address health care needs and make meaningful change in the region. NCHC has been instrumental in transforming the oral health landscape in the North Country, identifying successful strategies to enhance the healthcare workforce, and providing quality programming to enrich community health and wellness. Over the past year several new initiatives have thrived, including the Integrated Delivery Network, the addition of Community Health Workers and enhancement of the Community Health Worker training program, strategies to address substance misuse prevention among young adults, and the Drug-Free Communities Support Program. We continue to play a leadership role in statewide initiatives in the areas of practice transformation, primary care and behavioral health integration, and healthcare workforce development. We welcomed fourteen new staff members to NCHC and look forward to integrating our new clinical services workforce as part of the team.

Once again, the North Country region has come together to address a serious need. With support from the Board of Directors, our state and federal legislative delegations, and the community, the North Country Health Consortium is proud to be the new home for Substance Use Disorder Clinical Services in the region. New services include Friendship House - a residential treatment facility, outpatient services, intensive outpatient services, and the impaired driver program.

Over the past year, we secured new state and federal resources to continue our work as the North Country Public Health Network - including Substance Misuse Prevention, to expand our Community Health Worker and Ways to Wellness programs, and strengthen the Northern New Hampshire Area Health Education Center. We continue to leverage the strengths of our community partnerships through facilitation of the North Country Health Improvement Group with a focus on our Community Health Improvement Plan. It is with deep appreciation and gratitude for our dedicated staff, board, funders, and partners that we present this Annual Report. With

your continued support and investment, we will continue our work to improve the quality of life in the North Country.

–Ed Shanshala II, Board President

–Nancy Frank, Chief Executive Officer


Workforce Development In Fiscal Year 2017, Northern NH AHEC awarded:



Continuing Medical Education (CME) credits

89 344.5 to

medical participants

Continuing Nursing Education (CNE) credits




nursing participants

Northern NH Area Health Education Center (NNH AHEC)-Expanding Support for Continuing Education The Northern NH AHEC continues to work toward alleviating health workforce shortages in the North Country. The Northern NH AHEC focuses on pipeline activities for youth, healthcare profession students, and healthcare professionals to increase workforce capacity and to maintain knowledge and competencies currently accepted within the medical community.

Opportunities for Health Professionals Northern NH AHEC provides continuing education opportunities for healthcare professionals to maintain licensure and to increase the quality of care related to knowledge, competency, and practice. In the last year, the program has expanded partnerships to include the University of New Hampshire Citizens Health Initiative and the Community Health Institute/John Snow Inc. to provide continuing education to a broader audience of medical and behavioral health professionals.

The program makes a strong case for future providers to consider the northern New Hampshire area to settle and work. – Participant, Live, Learn & Play in Northern NH

Workforce Development

Screening, Brief Intervention, and Referral to Treatment (SBIRT) –an innovative platform for interprofessional education

For the past 3 years, in collaboration with the NH AHEC Network and New Hampshire academic institutions, the Northern NH AHEC has facilitated an innovative model to deliver a Screening, Brief Intervention, and Referral to Treatment (SBIRT) Interprofessional Education (IPE) activity via the NCHC Moodle platform, an online learning management system. The IPE activity provides

. . . provides students with an interactive experience for applying the evidencebased model SBIRT in their respective fields . . . students with an interactive experience for applying the evidence-based model SBIRT in their respective fields while working with peers across other healthcare disciplines. Participating students are from Antioch University New England, Franklin Pierce University, Geisel School of Medicine at Dartmouth, Massachusetts College of Pharmacy and Health Sciences, Rivier University, and the University of New Hampshire.


Opportunities for Health Profession Students NCHC’s “Live, Learn, and Play in Northern NH Program” works with health profession students recruited from New England and New Hampshirebased academic institutions to complete rural clinical rotations in the North Country. The goal of the program is to increase workforce capacity by placing students with local preceptors to gain first-hand experience in rural primary care and community health settings with the hope that they return to practice in the region. Over the last three-year period of the program, 50 health profession students have been placed in the North Country at 9 sites, including 5 Critical Access Hospitals, 1 Rural Health Clinic, and 4 Federally Qualified Health Centers.

. . . to gain first-hand experience in rural primary care and community health settings with the hope that they return to practice in the region.

in the North Country Health Careers Opportunity Program

The “North Country Health Careers Initiative Program” is designed to provide allied health paraprofessional training opportunities for North Country residents. NCHC, through a partnership with the White Mountains Community College (WMCC), has provided training scholarships to eligible students. The scholarships cover 100% of tuition and related program costs for the Licensed Nursing Assistant (LNA), Medication Nursing Assistant (MNA), and Health and Wellness Advocate Certificate programs. Since 2014, NCHC and WMCC have trained 73 LNAs, 26 MNAs, and 16 Health and Wellness Advocates.

My family medicine rotation was extremely rewarding and full of new learning opportunities. I was able to get to know patients and interact with them in the office setting. While my time spent in the clinic visiting with patients throughout the day was very informative and helped strengthen both my interpersonal and medical skills, it was the time spent outside the clinic participating in my community service project that has left lasting impressions upon me.

–Live, Learn, & Play Student, University of New England, College of Osteopathic Medicine


Transforming Healthcare Systems Region 7 Integrated Delivery Network (IDN) Building Capacity for Transformation North Country Health Consortium (NCHC) was awarded the designation of Administrative Lead Agency for the Region 7 Integrated Delivery Network (IDN). Covering Coos, Carroll, and Northern Grafton County, region 7 IDN joins 6 other IDNs across the state which are all part of New Hampshire’s Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program is utilizing a Medicaid 1115 waiver to transform the way mental health care is delivered by getting mental health, substance use disorder

and healthcare systems working together to make it easier for people to get the care they need. These changes will help make people healthier, save money and be more effective for those who have multiple healthcare needs. Region 7 IDN has the potential to earn up to a total of $14,178,458 over the course of five years. Region 7 IDN partners include hospitals, primary care, mental health and substance use disorder treatment providers, Department of Corrections, Public Health and social service organizations.

The Northern New England Practice Transformation Network The Northern New England Practice Transformation Network (NNE-PTN), led by Maine Quality Counts, is a multi-state initiative supporting practices in Maine, New Hampshire and Vermont. With regional partners in Maine (Maine Quality Counts), New Hampshire (Citizens Health Initiative), and Vermont (Vermont Program for Quality healthcare), NCHC supports primary care, specialty care and behavioral health practices in moving towards valuebased care and preparing for success in advanced payment models. There are currently 275 practice sites and 2230 providers enrolled in the NNEPTN with 188 practice sites

. . . by getting mental health, substance use disorder and healthcare systems working together to make it easier for people to get the care they need.


and 1060 providers enrolled in New Hampshire alone. Practice facilitators are a new addition to the NCHC workforce delivering practice oriented, clinically based quality improvement services state-wide.

Community Health Worker Program 3rd Community Health Worker Summit NCHC, in partnership with the Southern New Hampshire Area Health Education Center (SNH AHEC), hosted the 3rd Community Health Worker (CHW) Summit in April 2017. The full-day event gathered 75 CHWs and stakeholders from across the state for learning sessions focused on the current landscape for CHWs, fostering CHW leadership and

. . . looking at the road ahead to advance the CHW movement in New Hampshire. collaboration, and looking at the road ahead to advance the CHW movement in New Hampshire.

CHW training program participants receive their certificates for completing NCHC’s blended curriculum.

“Grow your Own” Community Health Worker Staff deployed Raising awareness of CHWs, the value they bring to care teams, and their role in facilitating better health outcomes has been a focus of the NH AHEC Network since the early 2000s. In 2016, NCHC implemented the program by adding 2 CHWs to its staff. The CHWs provide culturally competent and individualized services to clients referred to the NCHC program. This

work has focused largely on providing education and outreach, and assisting women in acquiring recommended breast and cervical cancer screenings. The ability of CHWs to address the social determinants affecting one’s health and the individual barriers to accessing preventative and other healthcare services has proven to be invaluable work.

Blended Online and In-Person Community Health Worker Training Curriculum In 2017, NCHC delivered its 72-hour CHW training program to 24 students. The blended model (online and in-person) curriculum is based on nationally accepted core competencies and is designed to allow participants flexibility in completing the course. The curriculum also incorporates a 2-day Motivational Interviewing training.


Growing Resiliency mary Care Pri Health Promotion & Prevention Recovery Supports


Early Identification & Intervention



v io r a l H e a R e c over y


NCHC’s Regional Public Health Network is committed to identifying and coordinating a robust and effective Continuum of Care (CoC) in northern New Hampshire. NCHC collaborates with partners throughout the North Country to bridge the vital components of care and services for Substance Use Disorders (SUD). Services include: health promotion, prevention, early identification and intervention, treatment, and recovery supports.

NCHC collaborates with partners throughout the North Country to bridge the vital components of care and services . . . Drug-Free Communities


NCHC received a 5-year Drug-Free Communities (DFC) Support Program grant on behalf of the Haverhill Area Substance Misuse Prevention Coalition (HASMPC). The HASMPC group is representative of key community leaders, including Haverhill area healthcare professionals and first responders who are dedicated to preventing and reducing substance use among local youth.

Year one initiatives: rescription Drug Awareness Campaign, distributing P prescription drug bottles affixed with cautionary labels and containing information about the dangers associated with prescription drug misuse to businesses and public spaces within the community. “Buyers Beware” campaign, partnering with student volunteers from Woodsville High School, to visit area businesses that sell alcohol to adhere “Buyers Beware” stickers to alcohol packaging in order to raise awareness about the consequences associated with supplying alcohol to minors. Emergency Medical Services Appreciation Event Community Education Event: “Opioid Awareness 101”

the Continuum of Care Prevention Efforts in the Region Youth Leadership Through Adventure (YLTA) NCHC continues to provide substance misuse prevention efforts targeted at youth in the region through its Youth Leadership Through Adventure program, which boasts a youth-led

prevention and leadership development model

for students in northern New Hampshire middle and high schools. In partnership with Adolescent Drug and Alcohol Prevention Tools (ADAPT) to deliver the program, YLTA wrapped up a successful year. The year marked a record number of attendees at the middle and high school conferences, as well as the most school involvement, and number of school climate projects completed in YLTA history. This year: he annual three-day YLTA High School Conference in November T hosted a total of 12 schools, and 114 youth participants. record six schools (Berlin, Colebrook High School, Colebrook A Elementary School, Pittsburg, Profile, and Stewartstown) participated in school climate projects, reaching over 1,000 students.

Youth Leadership Through Adventure Summer Leadership Academy



Student Assistance Program Legislative Breakfast Student Assistance Programs (SAP) are one of the most comprehensive, evidencedbased school approaches to preventing and reducing alcohol, tobacco, and other drug use. Across the North Country, SAP Counselors work with youth in Middle and High Schools to teach prevention education classes covering topics such as alcohol, tobacco and other drugs and stresscoping skills. SAPs are trusted adults who students can engage with and confide in.

SAPs provide an opportunity for students to talk about struggles, concerns, fears, and substance misuse in a safe and confidential space. NCHC currently supports 8 SAP programs across the North Country.

impacts of SAP in their respective schools, as well as the importance of consistent funding and community support to successfully deliver substance misuse prevention services to students.

In April, NCHC hosted nearly 40 community leaders and legislators of Coos and Northern Grafton Counties for a breakfast discussion about Student Assistance Programs. This event provided a platform for SAP counselors from schools around the North Country to share with local legislators the positive

. . . one of the most comprehensive, evidenced-based school approaches to preventing and reducing alcohol, tobacco, and other drug use.

12 Berlin School Climate Project

Misuse Programs Recovery Supports Recovery Coach Trainings

Summer 2017 Recovery Coach Academy graduates complete the five-day intensive training.

NCHC works to broaden the current infrastructure of support service providers in the North Country to engage individuals who would like to begin or sustain longterm recovery from addiction to alcohol or other drugs. Partnering with Hope for NH Recovery, NCHC provided two 5-day intensive Recovery Coach Academy trainings in the spring and summer of 2017. 14 people completed the two trainings to join the ranks of Peer Recovery Coaches.

Changing the Treatment Landscape NCHC acquires the Friendship House and other Substance Use Disorder Clinical Services NCHC capped off the year by partnering with AHEAD and Tri-County CAP to convene partners, friends, and other stakeholders for the ceremonial groundbreaking of the new Friendship House residential treatment facility. NCHC looks forward to the expansion of access to treatment and other services in the North Country for substance use disorders with the anticipated opening of the state-of-the-art facility in fall 2018! Friendship House Groundbreaking Ceremony

. . . expansion of access to treatment and other services in the North Country for substance use disorders . . .


Oral Health

From the First Tooth

“From the First Tooth� is a five state collaboration between Maine, Massachusetts, New Hampshire, Connecticut, and Rhode Island. The program

goal is to assist primary care providers with integrating pediatric oral health and fluoride varnish application into their practices.

As the lead in New Hampshire, NCHC partnered with the NH Oral Health Coalition to educate 10 primary care practices on: Assessing the oral health of young children pplying fluoride varnish to help prevent tooth A decay ducating parents and caregivers about E pediatric oral health Making dental referrals

Molar Express

Oral hygiene education and services, as well as temporary and permanent restorative care, are provided to children during school-based clinics each school year and to older adults at nursing homes and senior centers in Coos and Northern Grafton Counties.

Molar Express, NCHC’s portable, public health dental clinic, has been providing oral health care to North Country residents since 2004. Molar Express provides a dental home

to Medicaid-eligible children, uninsured North Country children, and older adults.

Molar Express currently visits:

23 schools 11school districts serving more than 500 children in

Molar Express provides care & education . . . to


over 150 older adults 5 senior centers 2 nursing homes. in


Molar Express setup, before (left) and after (above)

Community Events

Events addressing some of the North Country Community Health Improvement Plan (CHIP) Priorities: Live Heart Smart NCHC’s North Country Health Improvement Working Group hosted an educational half-day event devoted to heart health. Gathering nearly 70 community members from around the North Country and surrounding communities, the event, “Live Heart Smart,” raised awareness around heart disease and stroke, with a focus on highlighting local resources and personal wellness practices to promote heart healthy living in the community.

Naloxone Trainings Acting in cooperation with the New Hampshire Department of Health and Human Services, NCHC works to expand training and access to the opioid overdose-reversal drug, Naloxone.

The OWLS (Older, Wiser, Livelier Seniors) and staff from the North Country Community Recreation Center in Colebrook were all smiles, armed with new knowledge and heart-healthy resources, after attending the Health Improvement Working Group’s “Live Heart Smart” event in June. Keynote speaker and Professor of Health and Human Performance at Plymouth State University, Dr. Barbara McCahan, presented heart research and tips to reframe and reduce stress.

This year, NCHC: Distributed 570 Naloxone kits acilitated 19 Naloxone training events F throughout the region, including train-thetrainer education for social service and medical staff to build capacity for distribution

Be an Opportunity NCHC hosted professional addiction recovery coach, advocate, and inspiring public speaker, Bernadette Gleeson, in the region for a 3-day tour where she engaged audiences in Colebrook, Lancaster, and Littleton with her powerful messages to “Be an Opportunity” for someone to be alive in recovery today.

CHIP priorities include Substance Misuse Prevention

Heart Disease & Stroke

Emergency Preparedness


Oral Health

Mental Health

Presenting before audiences in Colebrook, Lancaster, and Littleton, Bernadette Gleeson provided ten simple ways for community members to “Be an Opportunity” for those in need. Smiling for the camera post-show, Gleeson is shown with Pastor Clint Brake of North Haverhill United Methodist Church.


Board of Directors President: Ed Shanshala CEO, Ammonoosuc Community Health Services Vice President: Russell Keene CFO, North Country Healthcare Treasurer: Jonathan Brown CEO, Indian Stream Health Center Secretary: Kristina Fjeld-Sparks Director, NH AHEC/Geisel School of Medicine Asst. Secretary: Nancy Bishop Administrator, Grafton County Human Services

Sharon Beaty Mid-State Health Center

Roxie Severance RS Consulting

Ken Gordon Coos County Family Health Services

Pauline Tibbetts Androscoggin Valley Home Care Services

Michael Lee Weeks Medical Center

Robert Nutter Littleton Regional Healthcare

Michael Peterson Androscoggin Valley Hospital

Karen Woods Cottage Hospital

Jeanne Robillard Tri-County Community Action Program

Scott Colby Upper Connecticut Valley Hospital

Mike Counter North Country Home Health & Hospice

Suzanne Gaetjens-Oleson Northern Human Services Rev. Curtis Metzger All Saints’ Episcopal Church

NCHC Program Initiatives North Country Public Health Network

Emergency Preparedness Medical Reserve Corps New Hampshire Immunization Program Disaster Behavioral Health Response Team Molar Express

Clinical Services for Children and Seniors Oral Health Hygiene Education North Country Prevention Network


Youth Leadership Through Adventure Substance Misuse Continuum of Care Student Assistance Programs Drug-Free Communities Support Program Young Adult Strategy Integrated Delivery Network

Workforce Development N orthern NH Area Health Education Center Q uality Improvement M otivational Interviewing Health Career Opportunities Program C ommunity Health Worker Live, Learn, Play in Northern NH P ractice Transformation Network S TEM-Health Careers Summer Camps S creening, Brief Intervention, and Referral to Treatment P ublic Health Training Center

Community Health & Wellness W ays2Wellness C hronic Disease Self-Management Program C ommunity Health Needs Assessment

Revenue & Expenses FY 2017 Revenue Sources: $3.72 million (unaudited)

Substance Misuse


Dental Program

Workforce Development

Public Health

FY 2017 Program Expenses: $3.58 million (unaudited) Substance Misuse

Public Health

Workforce Development

Dental Program

17 Other

Funders and Members North Country Health Consortium Funders Berlin School Administrative Unit #3

New Hampshire Charitable Foundation

Bi-State Primary Care Association

New Hampshire Department of Health and Human Services

Community Health Access Network Colebrook School District, School Administrative Unit #7 Geisel School of Medicine, The Dartmouth Institute

US Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy

HNH Foundation

US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce

National Association of County and City Health Officials

University of New Hampshire, Citizens Health Initiative

Neil and Louise Tillotson Fund of the New Hampshire Charitable Foundation

US Centers of Medicare and Medicaid Services

JSI Research and Training Institute, Inc.

New Hampshire Department of Health and Human Services, Bureau of Drug and Alcohol Services

US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention

Thank you!

North Country Health Consortium Members 45th Parallel EMS Adaptive Sports Partners of the North Country AHEAD Ammonoosuc Community Health Services


Franklin Pierce University, Physician Assistant Program Grafton County Human Services Grafton County Senior Citizens Council Indian Stream Health Center

Androscoggin Valley Home Care Services

Littleton Food Cooperative

Androscoggin Valley Hospital

Mid-State Health Center

Center for New Beginnings

Morrison Nursing Home

CoĂśs County Family Health Services

NH AHEC/Geisel School of Medicine

Cottage Hospital

North Country Healthcare

Family Resource Center

North Country Home Health & Hospice

Littleton Regional Healthcare

Northern Human Services Plymouth State University’s Center for Active Living & Healthy Communities RS Consulting Tri-County Community Action Program, Inc. University of New England, College of Osteopathic Medicine Upper Connecticut Valley Hospital Weeks Medical Center White Mountains Community College Village to Village

Our Staff –we couldn’t do any of this without them– Nancy Frank, Chief Executive Officer

New in 2017:

April Allin, Program Manager

Erik Becker, Program Coordinator

Elaine Belanger, Public Health Coordinator

Annette Carbonneau, IDN Project Manager

Drew Brown, Management Information System Administrator

Mariah Coulstring, Drug-Free Community Coordinator

Annette Cole, Program Manager & Molar Express Dental Hygienist

Amber Culver, Community Health Worker

Jennifer Frenette, Program Manager Diana Gibbs, Program Manager Colleen Gingue, Finance Director Jill Gregoire, Practice Facilitator Barbara Groff, Practice Facilitator Karen Hoyt, Office Manager Amy Jeroy, Public Health Director

Ashlea Denton, IDN Coordinator Jennifer Goulet, Community Health Worker Kristy Letendre, Continuum of Care Facilitator Annie Patoine, PTN Program Specialist Valerie Rella, Fast Forward Coordinator Laura Remick, AHEC Coordinator Juliann Rose, Accounting Assistant

Becky McEnany, Program Director

Christopher St. Cyr, Restorative Justice Program Coordinator

Francine Morgan, Program Director

Rose Toner, Administrative Assistant

Tracy Page, Accounting Assistant

Greg Williams, SMP Coordinator

Kayla Ramsay, Molar Express Dental Assistant


Anna Shum, Program Coordinator Margo Sullivan, Practice Facilitator Julia Zamarchi, Practice Facilitator


Leading innovative collaboration to improve the health status of Northern New Hampshire.

603-259-3700 | 262 Cottage Street | Suite 230 | Littleton, NH 03561