North Country Health Consortium 2015 Annual Report

Annual R e port

2015

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 health care infrastructure • Increasing capacity for local public health essential services • Increasing access to health care for underserved and uninsured residents of Northern New Hampshire

Organizational Services • Community health status monitoring and needs assessment • Convening and facilitating of health and human service providers to develop collaborative solutions • Forums on health issues • Strategic planning • Program development, project management and grant writing • Technical assistance • Advocating for rural health • Management and financial services for regional collaborative initiatives

Executive Director President’s Message

&

Dear Friends & Colleagues,

Welcome to the North Country Health Consortium 2015 Annual Report. It has been an exciting year of growth and innovation for the Consortium. NCHC’s mission… “to lead innovative collaboration to improve the health status of the region,” is the motivation and driver of our work. As a mission driven organization, we continually assess health status and community needs, and respond with creative initiatives to improve the lives of North Country residents. Over the past year we have formed new partnerships to address healthcare workforce needs in the North Country by establishing new training Nancy Frank, programs and expanding opportunities for health professions students.

Executive Director In response to disparities in oral health care for adults in the rural communities of New Hampshire, we have secured new funding to provide services for seniors. We have provided training and technical assistance for health care providers and institutions to incorporate new models of care delivery, and trained over 100 providers in motivational interviewing. Without our dedicated and talented staff, generous funders, and supportive and committed partners, the North Country Health Consortium would not be the thriving organization that it is – many thanks to all of you who make it possible for us to continue our work to improve the quality of life in the North Country.

Elaine Bussey, Board President

Elaine Bussey Board President Nancy Frank Executive Director

H e a l t h y L i v i n g

4th Annual Health Improvement Summit

“The Health Improvement Summit provided me with an understanding of local resources, ways to affect my family’s wellness, and ideas for further collaboration to focus on school-wide wellness programs.”

On June 5, 2015, the North Country Health Consortium hosted the 4th Annual Health Improvement Summit at the Mountain View Grand Resort and Spa, themed “Navigating Wellness.”

Breakout sessions included policy approaches for creating healthy people and places, worksite wellness, and accessing healthy and local foods in the North Country. Over 60 participants attended the informational event and took home tangible tips, resources, and ideas to enhance personal and community wellness.

The North Country Health Improvement Working Group, the summit planning committee, meets regularly throughout the year for educational sessions, to share information and resources, and to collaborate on health and wellness initiatives. The group serves in an advisory capacity for implementation of the “Ways2Wellness” program.

& We l l n e s s

Motivational Interviewing

Through the NCHC Quality Improvement initiative, Motivational Interviewing (MI) has taken root and is beginning to grow at all four regional Federally Qualified Health Centers as well as at several community partner organizations. During the past year, over 100 healthcare providers have completed two days of Basic Motivational Interviewing workshops, 20 more have continued on through Advanced Motivational Interviewing, and another 9 have reached the coaching level with the intent of coaching colleagues at their own organizations.

Led by NCHC, trained MI coaches from Ammonoosuc Community Health Services, Coos County Family Health Services, Mid-State Health Center, Littleton Regional Healthcare, and Dartmouth-Hitchcock Medical Center have formed the ‘North Country Coaching Collaborative.’ The goal of this group is to grow and sustain the culture of MI. The focus over the next year will be to provide MI practice and coaching opportunities at each of the participating organizations by supporting the newly trained coaches to deepen the practice of MI at each health center.

Chronic Disease Self-Management Program Growth The North Country Chronic Disease Self-Management Program, “Better Choices, Better Health”, an evidence-based program developed by Stanford University, has grown exponentially in the last year. Capacity building efforts that have contributed to this growth include a North Country Workshop Leader Training and expanded efforts to increase capacity in the Berlin, Woodsville, Littleton, Lebanon, and Plymouth areas.

Twelve people completed a CDSMP leaders: Sue Buteau, Chad Proulx, Kathy Berman, What participants are saying...

4-day leader training held in and Joan Lanoie.

Whitefield in April and, as a “This course is a confidence result, new workshop offerings booster- the action planning is have been established in Berlin, really helpful!”

Lebanon/Hanover/Lyme, Littleton, and Woodsville.

“The sharing with others who understand was the best!”

In the last year, 10 newly trained North Country workshop leaders have joined the CDSMP network. This increased “This class exceeded my leader capacity has allowed for 11 regional workshops to expectations!” be held, reaching over 90 North Country residents who participated in “Better Choices, Better Health” workshops.

Access to C are

Marketplace & NH Health Protection Program NCHC Marketplace Assistance Program helps residents apply for health insurance coverage under the NH Health Protection Program. With the highest rate of uninsured residents in the State, NCHC’s Marketplace Assistance initiative has helped residents access healthcare coverage.

Last year, NCHC assisted over 100 consumers with marketplace enrollment and

provided outreach to 165 North Country non-profit entities and organizations.

Feedback from consumers about their experience working with NCHC has been very positive and many word-of-mouth referrals have been made to NCHC. Many consumers have returned for assistance with reenrolling in the Marketplace to continue their healthcare coverage throughout 2015.

Molar Express: 2015 Top Dentist in New Hampshire Molar Express, NCHC’s oral health program, celebrates 10 years of service in 2015! Molar Express is a portable, full-service dental program serving Coos and northern Grafton Counties.

Utilizing state-of-the-art portable dental equipment and skilled dental staff, Molar Express provides care in schools, nursing homes, and community-based settings.

New Hampshire Magazine highlighted Molar Express as a “2015 Top Dentist” in its annual recognition issue. Top performing dental professional designation was awarded to Molar Express by dental peers throughout the state who recognized the continuous

dedication and proven outcomes of the program.

In collaboration with community partners, Molar Express continues to evolve and integrate new services that enhance patient outcomes for North Country adults, seniors, and school-aged children. In 2015, a fulltime Care Coordinator joined the Molar Express staff. Expanded services, including placement of temporary restorations, have become part of routine care provided by the Molar Express Certified Public Health Dental Hygienist. Molar Express provides a dental home for underserved North Country residents and continues to explore collaborative and sustainable relationships to ensure access to affordable, quality oral health care.

“Molar Express helped 2 of our students receive extensive dental care and oral surgery services.

These students were having adverse health effects, discomfort, and missed school time due to poor dental health. They would not have otherwise been able to receive these services without the Molar Express!”

-North Country School Nurse, 2015

Molar Express At a Glance:

• Molar Express serves Children and Adults at 23 Schools in 11 School Districts, 5 Head-Starts, and 2 Nursing Homes • 492 School-aged Children Served • 1065 Teeth Sealed on 142 Children • 104 Adults Served

Substance Misuse

North Country Prevention Network & Youth Leadership Through Adventure

The North Country Prevention Network seeks to reduce substance misuse in the North Country. Network activities include convening groups, coordinating events and promoting services. Network prevention efforts focus on creating positive experiences and engaging environments for North Country youth to thrive through a coordinated Youth Leadership Through Adventure program (YLTA). Through YLTA, NCHC has been the catalyst to achieving greater uniformity in services provided at North Country schools.

YLTA engages youth to stay healthy and drug-free through promotion of leadership qualities, engagement in alternative activities, and bonding with local and regional peers while harnessing the natural beauty of the North Country to accomplish this goal. The region-wide network of student leaders and adult advisors is charged with engaging communities and schools through service, school climate improvement, and environmental prevention projects throughout the school year.

In 2015, the North Country Prevention Network achieved designation as a “Promising Practice� by the New Hampshire Service to Science Review Panel for the YLTA program. This designation for the YLTA program was the result of a year-long process that included rigorous analysis and documentation.

Additionally, the Prevention Network is responsive to current trends in substance misuse. In light of the current opioid epidemic and the increase in heroin use in the region, communitywide events have occurred to bring residents together to address the issue. In June 2015, NCHC sponsored an assembly with former NBA basketball player, Chris Herren, who overcame his own addiction to present his story to over 1,300 people in the Berlin area community.

Prevention YLTA is Work ing!

“When I moved to New Hampshire in 2008 I was lost. I knew no one, and felt like I was being judged everywhere I went. I felt like I didn’t fit in. I started to give up and let my thoughts take over- not the good ones either.

I started to meet with a guidance counselor everyday and she told me about this group that she thought I should get into- Youth Leadership Through Adventure. I was nervous, but went to the first meeting with my guidance counselor.

From the moment that I walked through the door, I thought to myself “this is it, this is my place.” People I didn’t even know came up to me and gave me a hug, they welcomed me and I just felt a big weight get taken off of my shoulders.

YLTA has been a huge positive impact on my life. There is no better feeling in the world than the feeling I get when I am with my peers of the YLTA group. If you feel alone, feel like you’re going down the wrong path in life, I suggest that you find yourself a group like this. It has changed my life, and it can change yours.”

Wo r k f o r c e Community Health Worker Curriculum Northern NH Area Health Education Center (NNH AHEC) developed and launched a Community Health Worker (CHW) training program that uses a blended online and in-person format for training a local CHW workforce to best complement the rurality of the region and great travel distances. The robust training curriculum utilizes nationally recognized core competency areas for Community Health Workers, and provides participants with the skills, community understanding, and resources to better provide culturally appropriate education, social support, and informal counseling to community members.

The NH AHEC Network have been active leaders in the state working to bring Community Health Workers into the healthcare workforce fold. Most recently, the AHECs formed a CHW Coalition which brings together currently employed CHWs in New Hampshire, healthcare representatives, and other interested individuals to advance integration and legislative priorities for recognizing this vital communitybased role.

“A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/ link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.�

-American Public Health Association

Development Health Careers Opportunity Program Scholarships The North Country Health Career Initiative Scholarship Program is a collaboration between the NCHC and White Mountains Community College to address the healthcare workforce needs of the North Country.

The scholarship initiative provides unprecedented opportunities for economically or educationally disadvantaged North Country residents to access paraprofessional training programs, including Licensed Nursing Assistant (LNA), Medication Nursing Assistant (MNA), and the Health and Wellness Advocate Certificate programs.

Scholarship program completers are already LNA graduate Diana Ramsay is among the seeing the impact and first cohort to complete enhancement to their the WMCC program in lives as a result of 2015. the new skills they’ve acquired. Follow-up graduate survey responses indicate that students’ wages post-training have increased to about $4.00 higher than the current minimum wage rate of $7.25.

MNA graduates Sara Thurston and Alicia Gingue receive their certificates from WMCC Instructor, Gail Minor-Babin, RN, M.Ed.

“The day I started the MNA course, I remember walking into the classroom with a million fears and not knowing what to expect. As soon as I met my instructors, my fears went away.

They were very welcoming and caring, which made me feel more comfortable- both of them wanted the best for us and were willing to go the extra mile to prepare us for the future. If you are truly dedicated, the program is fantastic. Now I am working as an MNA and I thank the North Country Health Careers Scholarship Program for giving me the chance to move forward in my career. The program gave me the confidence I needed to want to go ahead and further my nursing career.”

-MNA Graduate, 2015

Board of Directors

Mark

President Elaine Bussey, Executive Director, North Country Home Health & Hospice Vice President Ed Shanshala, CEO, Ammonoosuc Community Health Services Treasurer Maria Ryan, CEO, Cottage Hospital Secretary Kristina Fjeld-Sparks, Director, NH AHEC/Dartmouth Medical School Assistant Secretary Charlie Cotton, Director, Northern Human Services

Sharon Beaty, Mid-State Health Center Nancy Bishop, Grafton County Human Services Jonathan Brown, Indian Stream Health Center Michael Coughlin, Tri-County CAP Rob Darling, 45th Parallel EMS Ken Gordon, Coos County Family Health Services Scott Howe, Weeks Medical Center Russell Keene, Androscoggin Valley Hospital Tony Poekert, NH Catholic Charities Roxie Severance, Morrison Nursing Home Margo Sullivan, Androscoggin Valley Home Care Warren West, Littleton Regional Healthcare

Revenue & Expenses

ketplace & NH Health Protection Program

NCHC Program Initiatives: North Country Public Health Network

~ Emergency Preparedness ~ Medical Reserve Corps ~ New Hampshire Health Plan~ New Hampshire Immunization Program ~ Disaster Behavioral Health Response Team ~

Molar Express

~ Clinical Services for Children, Adults, and Seniors ~ Oral Health Hygiene Education ~

North Country Prevention Network

~ Youth Leadership Through Adventure ~ Substance Misuse Continuum of Care ~ Student Assistance Programs ~

Workforce Development

~ Northern NH Area Health Education Center ~ Quality Improvement ~ Team-based Care ~ Motivational Interviewing ~ Health Career Opportunities Program ~ Community Health Worker ~ Live, Learn, Play in Northern NH ~ Public Health Training Center ~ STEM-Health Careers Summer Camps ~

Community Health & Wellness

~ Ways2Wellness ~ Chronic Disease Self-Management Program ~ Community Health Needs Assessment ~

Funders & Members

North Country Health Consortium Funders

Centers for Medicare and Medicaid Services Community Health Access Network Dartmouth Medical School The Dartmouth Institute JSI Research and Training Institute, Inc. HNH Foundation National Association of County and City Health Officials Neil and Louise Tillotson Fund of the New Hampshire Charitable Foundation New Hampshire Bureau of Drug and Alcohol Services New Hampshire Charitable Foundation New Hampshire Department of Health and Human Services United States Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy United States Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce

North Country Health Consortium Members 45th Parallel EMS Adaptive Sports Partners of the North Country AHEAD American Cancer Society Ammonoosuc Community Health Services Androscoggin Valley Home Care Androscoggin Valley Hospital Center for New Beginnings City of Berlin Public and Home Health Nursing Coรถs County Family Health Services Cottage Hospital Dartmouth Medical School Franklin Pierce Physician Assistant Program Grafton County Human Services Grafton County Senior Citizens Council Granite United Way-Northern Region

Indian Stream Health Center Jane MacKay Littleton Regional Healthcare Mid-State Health Center Morrison Nursing Home NH AHEC Program NH Catholic Charities North Country Home Health & Hospice Northern Human Services Plymouth State University Speare Memorial Hospital Tri-County Community Action Program Upper Connecticut Valley Hospital Weeks Medical Center White Mountains Community College

NCHC Staff

North Country Health Consortium Staff

Nancy Frank, Executive Director Elaine Belanger, Community & Public Health Coordinator/Health Marketplace Assister Drew Brown, Substance Misuse Prevention Coordinator/IT Administrator Annette Cole, Molar Express Dental Hygienist Diana Gibbs, NCHC Program Manager Colleen Gingue, Finance Director Amy Holmes, Community & Public Health Director Laura Hosley, Continuum of Care Facilitator Karen Hoyt, Molar Express Care Coordinator Becky McEnany, Program Coordinator Christine Mealey, Nurse Coordinator Francine Morgan, Senior Program Manager Nick Nelsen, Prevention Programs Field Staff Coordinator Sean O’Brien, Youth Prevention Programs Coordinator Tracy Page, Office Administrator Kayla Ramsay, Molar Express Dental Assistant

Not pictured above: Christine Mealey, Nick Nelsen, and Laura Hosley

“North Country Health Consortium leads innovative collaboration to improve the health status of the region.�

Photo Credit: Celia Deterling

262 Cottage St., Ste. 230 Littleton, NH 03561 Phone: 603-259-3700 ~ Fax: 603-444-0945 www.nchcnh.org