2 018 Annual Report Creating
Healthy
Communities A Public Health Approach
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 under-served 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
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From our CEO & Board President Welcome to the North Country Health Consortium’s 2018 Annual Report. We are proud to present the 2018 Annual Report, reflecting upon a year of significant growth for the North Country Health Consortium. With commitment to our mission of Leading Innovative Collaboration to Improve the Health Status of Northern New Hampshire, the Consortium has taken on new service delivery areas, new program initiatives, and enhanced many well-established activities. In 2018 the North Country Health Consortium’s Board of Directors held a special Strategic Planning Session to assess and ensure alignment of the vision and direction of the organization, and significant community needs and opportunities. The Board of Directors highlighted three categories of value the organization provides for the North Country region: •
Service: Provides Access to Powerful Resources
•
Trust: Fosters an Environment for Community Collaboration
•
Boldness: An Engine for Innovation and Opportunity
These tenets inspire all aspects of the Consortium’s work. Through a public health lens, we respond to community need by strengthening partnerships, utilizing resources effectively and efficiently, and impacting meaningful change to create healthier communities in the region. The North Country Health Consortium is committed to continually taking stock in the region to assess needs and resources, prioritizing what is most important for the region, and choosing policies and programs that align with the region’s priorities and culture to maximize chances of substantial change and success. Over the past year, the Consortium has secured substantial resources from federal, state, and local partners to enhance efforts addressing the opioid epidemic, expand our Community Health Worker program, strengthen the Northern New Hampshire Area Health Education Center, and maintain our Oral Health program. We continue to play a significant leadership role in regional and statewide initiatives in the areas of public health, practice transformation, primary care and behavioral health integration, and prevention. It is with appreciation for our dedicated staff, board, funders, and partners that we present this Annual Report. With your continued support and investment, we will continue to strive to create healthy communities and improve the quality of life in the North Country. –Ed Shanshala II, Board President –Nancy Frank, Chief Executive Officer
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NCHC Creates Healthy Communities By Addressing
Monitor health status to
identify community health problems.
Inform, educate and empower people about health issues.
Diagnose and investigate
health problems and health hazards in the community.
Develop policies and plans that support individual and community health efforts.
Oversee and implement regulations that protect health and ensure safety.
The 10
Essential
Public Health Services
Link people to needed personal Mobilize community health services and assure the propartnerships to identify and vision of health care when otherwise unavailable.
Evaluate effectiveness,
solve health problems.
Assure a health care workforce that is competent in
accessibility and quality of personal and population-based health services. public health and personal health. 4
Research for new insights and innovative solutions to health problems.
through Partnerships and Collaboration
NCHC’s
Focus
Areas:
Through
Together with other organizations throughout the region, we provide, coordinate, or facilitate: raining and continuing education for T all levels of healthcare professionals Improved access to services for underserved residents egional forums on community R health issues Community needs
assessment and health status monitoring
Program development and management 5
Services for regional
initiatives
collaborative
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training &
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Addressing Essential Public Health Services:
Inform, educate and empower people about health issues.
Community Health Worker(CHW)
Training
NCHC’s Northern NH Area Health Education Center offers Community Health Worker (CHW) training annually. The training program is a blended model that uses an online and in-person format, and includes a two-day Motivational Interviewing training. The CHW training provides participants
with professional skills to work in the field of Community Health in positions such as Community Health Worker, Patient Assistor, Care Coordinator or Care Manager.
Upon completion of the training participants have gained skills in the following areas: • ethics • social determinants of health • health care delivery systems • scope of practice • professional boundaries • cultural humility
In the past year, NCHC has trained 10 Community Health Workers.
39 875 programs
participants
education
Assure a health care workforce that is competent in public health and personal health.
140 YOUTH
140 students attended the first “UP� Granite Youth Conference held on September 21st at the Mountain View Grand in Whitefield, NH to encourage students to show up, stand up and speak up to promote healthy school culture. The conference welcomed national speaker Tony Hoffman who shared an incredibly inspiring recovery story. Students also experienced interactive word bubbles to capture priorities and messaging, opportunities to link up with other students and share, and a variety of student-led and inspired activities.
Continuing Education ~a focus on~ Behavioral Health
This year NCHC provided many continuing education programs focused on the integration of primary care and behavioral health. Topics include Mental Health First Aid, Motivational Interviewing, Co-Occurring Medical Conditions with Behavioral Health and Primary Care, and Stigma and Substance Use Disorder.
[Mental Health First Aid] This training provided me with more confidence & tools to use as a nurse to help my patients with mental illness or drug use disorders.
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improve
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Addressing Essential Public Health Services:
Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
The Ways2Wellness CONNECT program links Community
Health Workers (CHWs) with patients 65+ who are struggling
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with unmanaged chronic disease and experience barriers to achieving overall wellness. NCHC’s team of CHWs are deployed to work with patients referred by hospital and primary care systems.
CHWs work with patients in their home and communities to address the social determinants of health, recognizing that health starts at home. Patients are: • connected to needed resources • gain an awareness of factors that impact their health • are assisted in understanding provider instructions, and • taught to manage their chronic illness.
clients
connected
The W2W CONNECT program began in July 2017 and currently partners with 4
hospitals and 4 primary care practices and has worked with 103 clients.
access
Mobilize community partnerships to identify and solve health problems.
Oral Health
In its 13th year of serving Coos and Northern Grafton counties, Molar Express continues to address access to care as a portable dental program. Mobility of the program enabled providers and treatment to be available at schools and 2 nursing homes in 2018, reducing barriers to access for residents of rural New Hampshire.
In the last year Molar Express delivered care to: • • • • • •
350+ students in 23 schools 120+ older adults in 2 nursing homes 452 teeth sealed 362 examinations 691 dental cleanings 452 fluoride treatments
The North Country Health Consortium is connecting
oral health with public health education initiatives such as:
•
•
The Healthy Worklife Program, a Young Adult Strategy through NCHC’s North Country Public Health Network. Education addresses oral health, anger and stress management, nutrition, tobacco, and substance misuse to help young adults connect their personal health behavior choices with a happy and productive work life. The Community Health Improvement Plan (CHIP), a guide to improving the health indicators in the North Country, including Oral Health.
Community Oral Health Education 9
regional
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Addressing Essential Public Health Services:
Develop policies and plans that support individual and community health efforts. North Country Health Consortium helps facilitate and
provide direction for the region’s five coalitions
dedicated to reducing the incidence and effects of alcohol, tobacco, and other drugs in their communities. Regional Coalitions include: • Littleton Alcohol, Tobacco & Other Drugs Coalition • Lancaster/Groveton Coalition • Haverhill Area Substance Misuse Prevention Coalition (HASMPC) • Stand Up Androscoggin Valley (SUAV) • North Woods Action Committee (NWAC)
In August, NCHC hosted a Learning Collaborative attended by members from each of the five regional Coalitions as well as neighboring Vermont Coalitions. Retreating to Echo Lake, NH for the day, attendees learned about
coalition sustainability and explored viable program ideas to bring back to their respective communities. Parental engagement in prevention programming, drug recognition, and harm reduction strategies, including needle exchange programs, were amongst topics explored during the day.
In September 2018, The North Country • Health Consortium & the NH Oral Health Coalition hosted: •
“Putting the mouth back in the body: the Role of Oral Health in Addiction, Treatment and Recovery”
• •
Topics included:
Local community oral health programs and partners Low cost solutions to caries management Who pays: Payment sources for dental and oral health Workforce: Community-based Public Health Hygienists
forums
Research for new insights and innovative solutions to health problems.
Legislative Breakfast
The NCHC Legislative Breakfast was held on May 7th with
22 elected officials and North Country leaders in attendance. Attendees were provided with an overview of NCHC’s 6 substance misuse programs and how they build upon and strengthen each other.
NCHC leads many of the prevention programs in northern Grafton and Coos Counties, and meets with decision makers to present opportunities to ask for Legislative voice and support for sustaining and growing essential programs. The presentation of programs included: Student Assistance Programs, Continuum of Care, Young Adult Strategies, Substance Misuse Prevention, Drug-Free Communities, and Youth Leadership Through Adventure.
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health status
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Addressing Essential Public Health Services:
Monitor health status to identify community health problems.
The Centers for Disease Control and Prevention indicate that in 2015, New Hampshire had the second highest rate of death due to drug overdose in the country.
In the North Country specifically, Coos County is indicated as having the highest number of drug overdose deaths per 100,000 people in the state.
In 2018, NCHC received over one million dollars over three years from the Federal Office of Rural Health Policy to address the opioid crisis impacting North Country Communities. NCHC’s opioid intervention and
treatment initiative will work closely with North Country Emergency Departments to utilize the evidencebased “warm hand-off” model for appropriate assessment and referral for individuals presenting with a Substance Use Disorder/Opioid Use Disorder (SUD/ OUD). NCHC intervention staff will provide ongoing support, conduct assessments, and provide intervention services to access appropriate treatment programs.
Community Health Workers/Recovery Coaches will address other unique needs of individuals to achieve the best possible outcome. The program will provide education for community members, law enforcement, emergency department staff, and other individuals to improve knowledge and understanding of SUD/OUD, treatment and recovery options, and to reduce stigma associated with these disorders.
Wellness and Recovery Model
A Northern NH Community Response to Substance Use & Opioid Use Disorder
monitoring
Diagnose and investigate health problems and health hazards in the community.
Community Health Improvement Plan The North Country Public Health Advisory Council (PHAC), led by NCHC, produces the Community Health Improvement Plan (CHIP) for the North Country region. The North Country
CHIP identifies regional public health priorities to guide the implementation of programs, practices, and policies to inform the coordination of services among partners and to improve health outcomes in the community. Forty-five community members from health, dental, human services, and community substance misuse prevention coalitions shared in an interactive brain-storming session in December, to review and inform a revised 2018-2020 CHIP plan. Participant expertise and learned experiences helped design new
strategies around the region’s six health priorities:
• • • • • •
Obesity Oral Health Public Health Emergency Preparedness Substance Misuse Heart Disease and Stroke Mental Health
NCHC participates in the Northern New England Practice Transformation Network (NNE PTN), one of 39 health care collaborative networks participating in the federal Transforming Clinical Practice Initiative. NCHC is
overseeing over 100 New Hampshire health care practices in preparation for payment models that rewards high-quality, cost-efficient care. Assessing individual health system needs, NCHC Practice Facilitators guide participating practices in navigating through five phases of quality improvement, providing technical assistance to enhance patient care, improving care coordination, quality outcomes, and lowering costs.
In 2018, 60% of NCHC participants have been designated “exemplary practices” for excellence in patient and family engagement.
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regional
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Addressing Essential Public Health Services:
Research for new insights and innovative solutions to health problems.
Drug-Free Communities: A local coalition
NCHC is the coordinator for the Haverhill Area Substance Misuse Prevention Coalition (HASMPC), supported by a 5-year Drug-Free Communities (DFC) Support Program grant. The HASMPC represents key community leaders from 12 sectors, including healthcare professionals, law enforcement, and educators, who are dedicated to preventing and
reducing substance use among local youth. In its second year, HASMPC: • Continued building capacity for youth prevention, offering Youth Leadership Training from Community Anti-Drug Coalitions of America (CADCA) • Reached over 200 community members at the speaker event, “Conversation about Addiction & Sobriety with Brandon Novak” • Launched an evidence-based “social norms” prevention campaign to educate and dispel misconceptions about youth substance use
With leadership and direction from NCHC, the New Hampshire Community Health Worker (CHW) Coalition has over 100 active members. The Coalition brings together Community Health Workers and stakeholders from across the state to recognize and promote the role and value of CHWs in the healthcare and social service systems and advocate for healthcare policy changes that advance the sustainability of CHW programs. In the past year, the Coalition has met quarterly, providing trainings to members on home visiting safety, Naloxone administration, drug recognition, and mental health.
collaboratives
Inform, educate and empower people about health issues.
IDN Funds Supporting
New Regional Models of Care
& Integrated Services
Total IDN funds distributed to community partners: Integrating Primary Care, Behavioral Health & Substance Use Disorder Services in Innovative Ways
$1,567,450
Creation and expansion of Medication Assisted Treatment (MAT)
Introducing technology and data collection to support integrated care. Increasing workforce capacity and training in key areas to drive integrated care.
Better care coordination and collaboration as people transition from providers at different levels of care.
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program development
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Addressing Essential Public Health Services:
Develop policies and plans that support individual and community health efforts. Through a comprehensive array of Substance Use Disorder Clinical Services, NCHC offers a continuum of care model to provide a person-centered, community-based approach. Evidence-based services are offered at Friendship House, a residential facility, and in a variety of locations in northern New Hampshire. Resiliency and recovery-oriented systems of care ensure
mental, physical and spiritual needs are met as clients begin the road to recovery. At the point of contact, each potential client undergoes a comprehensive clinical assessment to determine the level of intensity that best meets their current need. Guidance and support
are provided to create an individualized plan that transitions through levels of treatment.
& management Oversee and implement regulations that protect health and ensure safety.
Low Intensity Residential
High Intensity Residential • Services are designed to
• • •
Intensive Outpatient A comprehensive, evidence-based model that covers six key clinical areas:
• • • • • •
Individual therapy Group therapy Early recovery Relapse prevention Family education Social support
• Case management
improve a client’s ability to structure and organize the tasks of daily living Recover from substance use• disorder symptoms Help develop and apply • sufficient recovery skills Case management including housing, job skills, mental health and • family services
including housing, job skills, mental health and family services Emphasizes skills needed for independence and healthful living Continued recovery education and relapse prevention skills Discharge planning and continuity of care, self-help groups and communitybased recovery resources
Outpatient Outpatient Treatment is appropriate in many situations, including: • For those individuals in need of community-based substance use disorder treatment • As a step down from more intensive services • Addresses issues that have the potential to undermine recovery
Whole-person approach to treatment and recovery. 17
website = resources NCHCNH.org An Innovative Collaboration to improve the health status of Northern New Hampshire.
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Looking to the future: The North Country
Training Center A commitment to building capacity by offering trainers and classes with professional expertise
~where you need it~ in the North Country.
• • • • • • • • •
community health worker training motivational interviewing quality improvement mental health first aid chronic disease self-management program diabetes self-management program public health emergency preparedness continuing education credits ...and more
Contact us to plan the training that works for your organization’s needs and budget.
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Board of Directors President (O) Ed Shanshala CEO, Ammonoosuc Community Health Services
Mike Counter President, North Country Home Health & Hospice Agency
Vice President (O) Current Vacancy
Kristina Fjeld-Sparks NH AHEC Director, NH AHEC/ Geisel School of Medicine
Treasurer (O) Scott Colby President, Upper Connecticut Valley Hospital
Suzanne Gaetjens-Oleson Regional Mental Health Administrator, Northern Human Services
Secretary (O) Nancy Bishop Human Services Administrator, Grafton County Human Services
Ken Gordon CEO, Coos County Family Health Services
Sharon Beaty CEO, Mid-State Health Center
Kevin Kelley CEO, Indian Stream Health Center Michael Lee President, Weeks Medical Center
Tara MacKillop Executive Director, Androscoggin Valley Home Care Services Rev. Curtis Metzger All Saints’ Episcopal Church Robert Nutter President, Littleton Regional Healthcare Michael Peterson President, Androscoggin Valley Hospital Jeanne Robillard CEO, Tri-County Community Action Program Karen Woods Administrative Director, Cottage Hospital
NCHC Program Initiatives North Country Public Health Network
mergency Preparedness E edical Reserve Corps M New Hampshire Immunization Program Disaster Behavioral Health Response Team Oral Health
linical Services for Children and Seniors C ral Health Community Education O North Country Prevention Network
outh Leadership Through Adventure Y ubstance Misuse Continuum of Care S Student Assistance Programs Drug-Free Communities Support Program Young Adult Strategies 20
Integrated Delivery Network Practice Transformation Network
Workforce Development
Northern NH Area Health Education Center Health Career Opportunities Program
Live, Learn, Play in Northern NH STEM-Health Careers Summer Camps Screening, Brief Intervention, and Referral to Treatment
Community Health & Wellness
ays2Wellness CONNECT W ommunity Health Worker C Chronic Disease Self-Management Program Diabetes Self-Management Program
Wellness and Recovery Model: Substance Use/ Opioid Use Disorder Community Response
Intervention & Recovery Support Services I mpaired Driver Care Management Program rug Treatment Court: Grafton County D Substance Use Disorder Clinical Services In-Patient and Out-Patient Services
Revenue & Expenses Revenue Sources: Management & General 1%
Substance Use Disorder Clinical Services (incl. Friendship House) 25% Substance Misuse Prevention and Substance/ Opioid Use Response Programs 14%
Workforce Programs & Integrated Delivery Network 53%
Oral Health Program 4%
Public Health Programs 3%
Program Expenses: Substance Use Disorder Clinical Services (incl. Friendship House) 23%
Management & General 6%
Substance Misuse Prevention and Substance/ Opioid Use Response Programs 14% Oral Health Program 4%
Workforce Programs & Integrated Delivery Network 50% Public Health Programs 3%
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Members North Country Health Consortium Members 45th Parallel EMS Adaptive Sports Partners of the North Country AHEAD All Saints Episcopal Church Ammonoosuc Community Health Services Androscoggin Valley Home Care Services Androscoggin Valley Hospital
Franklin Pierce University, Physician Assistant Program Grafton County Human Services Grafton County Senior Citizens Council
Family Resource Center
OAKS
Indian Stream Health Center Littleton Food Cooperative
RS Consulting
Littleton Regional Healthcare
Tri-County Community Action Program, Inc.
Mid-State Health Center Morrison Nursing Home
University of New England, College of Osteopathic Medicine
NH AHEC/Geisel School of Medicine
Upper Connecticut Valley Hospital
NH Health Care Association
Weeks Medical Center
Cottage Hospital
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Northern Human Services
Plymouth State University’s Center for Active Living & Healthy Communities
Center for New Beginnings CoĂśs County Family Health Services
North Country Home Health & Hospice
North Country Healthcare
White Mountains Community College
Funders North Country Health Consortium Funders Berlin School Administrative Unit #3 Bi-State Primary Care Association Community Health Access Network Colebrook School District, School Administrative Unit #7 Geisel School of Medicine, 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 Charitable Foundation New Hampshire Department of Health and Human Services, Bureau of Drug and Alcohol Services
New Hampshire Department of Health and Human Services New Hampshire Endowment for Health New Hampshire Judicial Branch US Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce University of New Hampshire, Citizens Health Initiative US Centers of Medicare and Medicaid Services US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention
Thank you!
Our Staff
–we couldn’t do any of this without them– 23
Leading innovative collaboration to improve the health status of Northern New Hampshire.
603-259-3700 | NCHCNH.org 262 Cottage Street | Suite 230 | Littleton, NH 03561