North Country Public Health Network Emergency Preparedness Medical Reserve Corps New Hampshire Immunization Program Oral Health Clinical Services for Children Oral Health Community Education North Country Prevention Network Youth Leadership Through Adventure Substance Misuse Continuum of Care Student Assistance Programs Drug-Free Communities Support Program Young Adult Strategies Recovery Friendly Workplace Initiative North Country Community Coalitions Integrated Delivery Network Practice Transformation Network Workforce Development Northern NH Area Health Education Center Live, Learn, Play in Northern NH STEM-Health Careers Summer Camps Community Health & Wellness Ways2Wellness CONNECT Community Health Worker Workforce and Coalition Development Chronic Disease Self-Management Program Diabetes Self-Management ProgramIntervention & Recovery Support Services Wellness And Recovery Model Impaired Driver Care Management Program Drug Treatment Court: Grafton County Substance Use Disorder Clinical Services Inpatient and Outpatient Services North Country Public Health Network Emergency Preparedness Medical Reserve Corps New Hampshire Immunization Program Oral Health Clinical Services for Children Oral Health Community Education North Country Prevention at Every Level Network YouthPrevention Leadership Through Adventure Substance Misuse Continuum of Care Student Assistance Programs Drug-Free Communities Support Program Young Adult Strategies Recovery Friendly Workplace Initiative North Country Community Coalitions Integrated Delivery Network Practice Transformation Network Workforce Development Northern NH Area Health Education Center Live, Learn, Play in Northern NH STEM-Health Careers Summer Camps Community Health & Wellness Ways2Wellness CONNECT Community Health Worker Workforce and Coalition Development Chronic Disease Self-Management Program Diabetes Self-Management ProgramIntervention & Recovery Support Services Wellness And Recovery Model Impaired Driver Care Management Program Drug Treatment Court: Grafton
2019 Annual Report
History and Purpose We are 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. We are engaged in activities for:
2
Prevention starts here.
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 Improved
access to services for
underserved residents Regional
forums on community
health issues Community needs
assessment and health status monitoring
Program
development and
management Services for regional
collaborative initiatives
North Country Health Consortium Annual Report 2019
From our CEO & Board President
The theme of this year’s Annual Report is Prevention – a term that is used in its broadest sense in every program area to enhance health and wellness in the North Country. Over the past year the Consortium, in partnership with community members and stakeholders, revised the North Country Community Health Improvement Plan; a document that provides priority issues and guidance for regional program focus and development. The six community priority areas include: obesity, oral health, public health emergency preparedness, misuse of alcohol and drugs, heart disease/stroke, and behavioral health. All NCHC programs work to address these priorities through a prevention lens, and many have expanded over the past year. In 2019, NCHC received two awards, both a tremendous testament to the hard work of the dedicated staff: NCHC was recognized by AHEAD (Affordable Housing Education and Development) as its Partner of the Year for collaboration, commitment and leadership in our North Country communities NCHC received the 2019 Prevention Provider of the Year award from the NH Alcohol and Other Drug Service Providers Association With gratitude for support and dedication from staff, board, funders, and partners, we present this Annual Report. –Ed Shanshala II, Board President –Nancy Frank, Chief Executive Officer
Prevention is . . . what we do.
The North Country Health Consortium (NCHC) was established in 1997 with the mission of Leading Innovative Collaboration to Improve the Health Status of Northern New Hampshire. The organization has never hesitated to take on new challenges and has never vacillated from its original mission. 2019 has been another year filled with growth, opportunity, recognition, partnerships, and award-winning programs. This year NCHC was awarded a three-year CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation. Receiving the highest level available, NCHC now has the distinct advantage of clearly defined and internationally accepted standards to ensure that services provided achieve quality outcomes for the individuals we serve.
3
Prevention is . . . a person-centered approach to care and services.
NCHC
The team came together to celebrate NCHC’s recent receipt of a CARF three-year accreditation.
NCHC Earns Three-Year CARF Accreditation NCHC was awarded a three-year accreditation for its Residential, Intensive Outpatient, and Outpatient Substance Use Disorder Treatment programs by the Commission on Accreditation of Rehabilitation Facilities (CARF), an international accreditor of health and human services providers. It’s decision to designate three years to the Consortium represents the highest level of accreditation that can be granted to an organization.
with an organization’s commitment to continuous improvement and culminates with external review and recognition that the business and service practices meet international standards of quality–with all the steps in between focused on optimal outcomes for the persons served and sustained organizational success.”
As described on it’s website, “The CARF accreditation process starts
4
North Country Health Consortium Annual Report 2019
During NCHC’s review, CARF surveyors visited all NCHC locations, including the North Country Health Consortium’s headquarters in Littleton, the Friendship House residential substance use disorder clinical services treatment facility in Bethlehem, and satellite sites in Berlin, Woodsville, and Center Conway. In addition to interviewing staff, as well as community partners, clients, and their families, surveyors evaluate organizational practices and review appropriate policies against rigorous CARF standards that champion quality care, services, and safety for clients seeking recovery.
Prevention is . . . setting a high bar for quality care.
A 360º View
This achievement is truly a testament to our entire organization and team at large. NCHC’s overarching mission to improve the health status of Northern New Hampshire means not only do we care for individuals, take a genuine, personcentered approach with our clients accessing services for substance use disorder, but we’re also mindful that our programming must be supported by a strong organizational foundation in order to do this important work. –Nancy Frank, NCHC CEO
North Country Health Consortium Annual Report 2019
5
Prevention is . . . help to change behaviors.
Impaired Driver Care Management Program (IDCMP)
IDCMP clients must successfully complete a 20-hour Impaired Driver Education Program (IDEP). The IDEP at NCHC adopts a curriculum based on Prime for LifeÂŽ, an evidence-based program designed to change drinking and drug use behaviors by changing beliefs, attitudes, risk perceptions, motivations, and the knowledge of how to reduce personal risk of alcohol- and drug-related problems throughout their lives.
NCHC is the only IDCMP provider in the North Country, offering services in 5 locations throughout the region in Berlin, Bethlehem, Center Conway, Littleton, and Woodsville.
IDCMP screenings administered in 2018
Impaired Driver Education Classes completed in 2018
People who finished Impaired Driver Education classes in 2018
AG E E N T P R M
O
EM
AN
GR
AM
CAR
6
IDCMP supports individuals in the process of navigating the system to regain driving privileges.
North Country Health Consortium Annual Report 2019
This year, the DTC of Grafton County saw:
7
30
DTC Program Graduates
DTC Phase Promotions
DTC Participants in College Full Time
DTC Participants with Full-Time Employment
2
The mission of the Drug Treatment Court program of Grafton County is to assist criminal offenders in breaking the cycle of crime and substance misuse, while improving
Graduating Drug Treatment Court participant shares his successes and challenges during the graduation ceremony.
8
community safety, and decreasing financial costs currently incurred by the criminal justice system. Within an 18- to 36-month window, each part of the multi-phase intervention program focuses on key concepts of addiction recovery, from stabilization to continuing care. DTC works with its participants to determine the appropriate level of care needed and is aimed at supporting participants to maintain a drug-free lifestyle.
Drug courts are 6 times more likely to keep participants in treatment long enough for them to get better.
North Country Health Consortium Annual Report 2019
Prevention is . . . support with taking responsibility for one’s recovery.
Drug Treatment Court (DTC) of Grafton County
7
Oral Health Program In 2018-2019, our Oral Health Program, including direct service provided by Molar Express, has been working on oral health initiatives in the community, outreach, education, as well as strategic oral health initiatives statewide.
Prevention is . . . good oral health care.
Molar Express, a portable dental program of the North Country Health Consortium (NCHC), has kicked off a new Early Intervention Project that focuses on children through age five. The program added pre-schools and Head Start programs to its roster with locations throughout Coos and Northern Grafton Counties including Colebrook, Groveton, Whitefield, Littleton, and Woodsville.
This Year’s Count
409 409 405 201
children served in schools: Head Start through grade 12 oral health screenings fluoride varnish treatments teeth sealed
The Molar Express Early Intervention Program is partnering with dedicated professionals at preschools and Head Starts to promote the benefits of good oral health to children, their caregivers, and teachers.
– Annette Cole, Molar Express Certified Public Health Dental Hygienist
Molar Express Celebrates National Children’s Dental Health Month.
8
North Country Health Consortium Annual Report 2019
This year, the Regional Public Health Emergency Preparedness Plan was rewritten and updated for the North Country, including:
POD=Point of Dispensing A federally-instituted best-practice model designed to provide medications, vaccines, or medical supplies to the community during a public health emergency.
Initiation of 6 new closed PODs 2 functional closed POD exercises conducted in North Haverhill and Franconia areas 1 large full-scale open POD exercise conducted for the Berlin region, with participating partners across the region and state
Stop the Bleed Campaign The Stop the Bleed Campaign offered free training to community members in bleeding control principles to empower everyday citizens to provide immediate life-saving aid in emergencies until first responders arrive Over 100 community members, including students, teachers, and emergency management personnel, were trained to “Stop the Bleed” 3 new trainers in the region were trained to provide “Stop the Bleed” training and sustain the program
Prevention is . . . being prepared for emergencies.
Public Health Emergency Preparedness
Fire Chief Jay Watkins offers an arm as a community member applies a tourniquet in a Stop the Bleed Training.
North Country Health Consortium Annual Report 2019
9
Prevention is . . . safe disposal of medication.
Substance Misuse Prevention Twice a year, across the country, police departments participating in National Prescription Drug Take Back Day encourage community members to clean out their medicine cabinets, offering a point-of-collection at their local station for the safe and anonymous disposal of unwanted prescription medications. Our Substance Misuse Prevention program works with the Drug Enforcement Administration (DEA) and local Police Departments to coordinate Take Back Day in the region.
Proper disposal of unused drugs both saves lives and protects the environment. This year:
770 11
Number of North Country Police Departments that participated in Drug Take Back Day
Hidden in Plain Sight The Haverhill Area Substance Misuse Prevention Coalition (HASMPC) is a diverse group of concerned citizens coming together to educate the community to prevent substance misuse. Supported by a Drug Free Communities Grant, the Coalition hosted many community events including “Hidden in Plain Sight.” The successful event offered parents education and a night out- with childcare- to learn about: How alcohol and other drugs can be easily hidden in a teen’s bedroom, as well as the Hepatits A vaccine and a Wellness Fair.
Anti-Vaping Presentations
Substance Misuse Prevention Network coordinated dynamic presentations with the Northern New England Poison Control Center about the health consequences of electronic nicotine delivery devices (otherwise known as vaping).
1500 15
10
Pounds of prescription drugs collected during North Country Drug Take Back Day
Total Number of Youth Reached Total Number of Schools
North Country Health Consortium Annual Report 2019
Last May, we organized and sponsored the 2nd Annual UP Granite Youth Conference, working in collaboration with Student Assistance Programs (SAPs) in the region.
We successfully partnered with
11
local schools in recruiting and engaging 200 student attendees in the name of standing UP for positive change, speaking UP against bullying and
drug and alcohol misuse, and lifting one another UP in the process.
This year, we supported
active Student Assistance Professional contracts in local North Country schools!
SAPs educate and engage with students and families in order to minimize the appeal and impact of drugs, alcohol, tobacco, and other dangerous and unhealthy behaviors.
Participating Schools with SAPs Included: Berlin High School Gorham High School Groveton High School
Lisbon Middle and High School
White Mountains Community College
North Country Charter Academy
White Mountains Regional High School
Woodsville Middle and High School
North Country Health Consortium Annual Report 2019
Prevention is . . . giving young people a voice.
UP Granite Youth Conference
11
12
Prevention is . . . reaching people where they are.
Continuum of Care (CoC) NCHC CoC initiative is designed to comprehensively address substance misuse in the region. Coordinating efforts between key stakeholders, including networks of organizations, agencies, and community members, the CoC aims to provide a full spectrum of quality services to prevent, intervene in, and treat substance use problems and disorders, where they are accessible to North Country residents.
Young Adult Strategies Meeting with young Young adults at risk for substance misuse, mental illness, or suicide often lack critical support once they are out of school. Created to help individuals ages 18-26 navigate the difficult transition between school and a healthy successful adult life, NCHC offers the Young Adult Strategies’ Healthy Work Life program to local businesses and organizations.
adult workers in their place of employment, this series of educational and conversational sessions looks at stress management, nutrition, tobacco, and substance misuse to help young adults connect their personal health behavior choices with a happy and productive work life.
North Country Health Consortium Annual Report 2019
New Hampshire’s RFW challenges stigma and empowers workplaces to provide support for employees in recovery and those impacted by substance use disorder.
As the regional point-of-contact for businesses interested in initiating RFW designation, we help coordinate with the State to give business owners the resources and support they need to foster a supportive environment that encourages the success of their employees in recovery.
This year, we added
9 Recovery Friendly
Workplaces to our list! (including us!)
NCHC receives its Recovery Friendly Workplace designation.
This Initiative has given employers like me a powerful tool to help my employees and to fight the substance abuse epidemic that is plaguing our State and Country. The passion and drive behind this program has the power to turn this tide into an epidemic of recovery, and empowers the employer with the knowledge that they are not only meeting their business demands, but they are also saving lives.
Prevention is . . . overcoming obstacles.
Recovery Friendly Workplace Initiative (RFW)
– Mark Bonta, Genfoot America,
Littleton, NH
North Country Health Consortium Annual Report 2019
13
NNE Practice Transformation Network (PTN)
Prevention is . . . continuous Prevention education. is . . . education.
The four-year CMS-funded Northern New England Practice Transformation Network (NNE PTN) initiative concluded in September 2019. As part of this initiative, led by Maine Quality Counts and implemented with partnering organizations in New Hampshire and Vermont, our Practice Facilitation Team
coached twenty-three of the initiative’s New Hampshire healthcare organizations (approximately 120 practices) in driving practice improvement in preparation for value-based care.
285%
improvement in the rate of HTN, Tobacco Cessation, Depression & SUD Screening with follow-up
119%
reduction in unnecessary hospitalizations
114%
reduction in unnecessary ER utilization
Area Health Education Center (AHEC) This year, AHEC provided over
75 continuing education programs focused on a diversity of public health, prevention, and other professional continuing education development topics, including:
Mental Health First Aid Motivational Interviewing dverse childhood experiences and A social determinants of health in primary care urse Preceptor workshops at N beginner and advanced levels ommunity Health Workers: how they C impact the prevention and management of chronic disease in patients edication Assisted Treatment and M recovery support icensed Nursing Assistant Day of L Learning and continuing education opics related to the integration of T behavioral health into primary care
NCHC presents a Community Health Worker Training Certificate of Completion
14
Highlights of Multi-State NNE PTN Results Across all Practices
dditional programs to meet A the education needs of our interprofessional health care teams
North Country Health Consortium Annual Report 2019
Region 7 Integrated Delivery Network (IDN7) As part of a statewide Medicaid demonstration project, IDN7 was established in 2016 and is a
collaborative effort between 39 partner agencies serving
The overarching goals of the project are to deliver integrated physical and behavioral health care using a whole-person approach, expand capacity to address emerging and ongoing behavioral health needs in an appropriate setting, reduce gaps in care during transitions from one setting to the next, and implement Alternative Payment Models for 50% of Medicaid payments by the end of 2020.
Results are shared at the IDN7 Quarterly Meeting
Key Projects Behavioral Health Workforce Capacity Development Health Information (HIT) Infrastructure to Support Integration Delivery of Integrated Healthcare Care Transitions Teams Expansion in intensive SUD Treatment Options Enhanced Care Coordination for High-Need Populations
$909,808 $3,205,766
Funds awarded in Fiscal Year 10/1/18-9/30/19 Total funds awarded since inception
North Country Health Consortium Annual Report 2019
Prevention is . . . integrated healthcare.
the residents of Coรถs, Carroll and Northern Grafton counties. NCHC is the administrative home of IDN Region7.
15
Community Health Worker (CHW) Ways2Wellness Connect This year, we focused on outreach. We created and distributed materials to community members throughout the region.
16
Early Measurements
Prevention is . . . being in the community.
Our CHWs spent approximately 611 hours with clients in these northern NH towns alone. CHWs also provided an additional 109 hours in VT towns.
Number of Chronic Disease/Diabetes Self-Management courses
3
Number of Community Health Worker trainings
2
Number of clients referred to the program Number of referring organizations Number of referring hospitals
North Country Health Consortium Annual Report 2019
246 11 5
ire, train, and deploy CHWs dually H trained as Recovery Coaches (CHW/RCs) to provide direct client services and to bridge gaps for adult residents of Coos and Northern Grafton Counties seeking recovery support. stablish referral processes with E regional health systems and community-based organizations working with individuals who may be experiencing SUD/OUD.
upports ry S ve
rovide education to communities and P professionals on SUD/OUD to increase knowledge and reduce stigma. evelop a Recovery Coach Network D to increase support capacity across the region. ngage law enforcement, first E responders, and hospital emergency departments in developing recoveryoriented approaches for working with individuals with SUD/OUD to facilitate access to treatment options and recovery pathways (below).
nical Recov Cli ery
unteering,
Recovery, etc.
ort, encouragement, owerment
ou
a r e h er
Treatment Options & Recovery Pathways
e
D eto u
r
): Behavioral health and sustaining
Person al R
s support for nagement
Substance free
ry ove c e
Y
tance free
.
s
eatment
eatment (IOP): tment
Prevention is . . . bridging gaps to treatment and recovery.
In 2018, NCHC formed the WARM program to improve treatment and recovery access for people with Substance Use/Opioid Use Disorder (SUD/OUD). With the primary goal of reducing morbidity and mortality associated with SUD/OUD in communities throughout the North Country, WARM’s approach has been to:
Re co
ovement (yoga,
Wellness And Recovery Model (WARM)
ued use
63
Number of community members trained as Recovery Coaches to coach their peers in recovery.
North Country Health Consortium Annual Report 2019
17
18
Prevention is . . . looking forward.
PETRA Prevention, Education, Treatment and Recovery Assistance
PETRA A major focus for NCHC in the coming year is to build and promote the PETRA (Prevention, Education, Treatment and Recovery Assistance) Center, which will:
1 provide a hands-on approach to the navigation of resources through 24/7 access to Community Health Worker/Recovery Coaches, and 2 offer training and education to communities and providers to address Substance Use Disorder including the full continuum from prevention to recovery.
North Country Health Consortium Annual Report 2019
We were proud to be recognized as the 2019 recipient of the Prevention Provider of the Year Award by the NH Providers Association (NHPA). Each year, the NH Providers Association selects award recipients for recognition at their annual meeting, with accolades including Provider of the Year for Treatment, Recovery, as well as Prevention.
This speaks to the dedication of our staff, without whom the depth and breadth of the work that we do in the North Country would not be possible... –Nancy Frank, NCHC CEO
Nominated with careful consideration of criteria set forth by the NHPA Board of Directors and selected by vote of the Association’s entire membership, award recipients are “those whose exceptional delivery of services to the community sets a high standard of quality and impact in the substance abuse and behavioral health field.”
NCHC Prevention team proudly receives the Prevention Provider of the Year Award.
Partner of the Year Award from AHEAD NCHC was awarded the Partner of the Year Award by Affordable Housing, Education and Development (AHEAD) for commitment and leadership in our North Country communities.
North Country Health Consortium Annual Report 2019
Prevention is . . . a pragmatic approach.
Prevention Provider of the Year!
19
20
Prevention is . . . allocating resources effectively.
2019–2020 Program Initiatives North Country Public Health Network Emergency Preparedness Medical Reserve Corps ew Hampshire Immunization N Program Oral Health Clinical Services for Children ral Health Community O Education North Country Prevention Network
Workforce Development orthern NH Area Health N Education Center ive, Learn, Play in Northern L NH TEM-Health Careers S Summer Camps Community Health & Wellness Ways2Wellness CONNECT Community Health Worker Workforce and Coalition Development
outh Leadership Through Y Adventure
hronic Disease SelfC Management Program
ubstance Misuse Continuum S of Care
iabetes Self-Management D Program
Student Assistance Programs Drug-Free Communities Support Program Young Adult Strategies Recovery Friendly Workplace Initiative orth Country Community N Coalitions Integrated Delivery Network Practice Transformation Network
Intervention & Recovery Support Services Wellness And Recovery Model I mpaired Driver Care Management Program rug Treatment Court: D Grafton County ubstance Use Disorder S Clinical Services I npatient and Outpatient Services
FY 2019 Revenue Sources Workforce Programs & Integrated Delivery Network 36% Management & General 2%
Public Health Programs 2% Substance Use Disorder Clinical Services (including Friendship House) 29%
Impaired Driver Care Management Program 2%
Prevention and Substance/Opioid Response Programs & Drug Treatment Court 27%
Oral Health Program 2%
FY 2019 Program Expenses Workforce Programs & Integrated Delivery Network 35% Management & General 1%
Public Health Programs 2% Substance Use Disorder Clinical Services (including Friendship House) 33%
Impaired Driver Care Management Program 2%
Prevention and Substance/Opioid Response Programs & Drug Treatment Court 25% Oral Health Program 2%
21
2019–2020 Consortium Funders Berlin School Administrative Unit #3
New Hampshire Charitable Foundation
Colebrook School District, SAU #7
New Hampshire Department of Health and Human Services, Bureau of Drug and Alcohol Services
Dobles Foundation Endowment for Health Geisel School of Medicine
New Hampshire Department of Health and Human Services
Grafton County Human Services
New Hampshire Endowment for Health
The Dartmouth Institute
New Hampshire Healthcare Association
JSI Research and Training Institute, Inc. Mascoma Savings Bank Neil and Louise Tillotson Fund of the New Hampshire Charitable Foundation
New Hampshire Judicial Branch NH Children’s Health Foundation Southern NH Area Health Education Center
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
2019–2020 Consortium Members Adaptive Sports Partners of the North Country
Grafton County Senior Citizens Council
AHEAD
Indian Stream Health Center
Ammonoosuc Community Health Services
Littleton Regional Healthcare
Androscoggin Valley Home Care Services
Morrison Nursing Home
Androscoggin Valley Hospital Center for New Beginnings Coös County Family Health Services Cottage Hospital Family Resource Center Franklin Pierce University Physician Assistant Program
22
Grafton County Human Services
Mid-State Health Center NH AHEC/Geisel School of Medicine New Hampshire Health Care Association North Country Healthcare North Country Home Health & Hospice 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 45th Parallel EMS
2019–2020 Board of Directors President (O) Ed Shanshala CEO, Ammonoosuc Community Health Services Vice President (O) Rev. Curtis Metzger All Saints’ Episcopal Church Treasurer (O) Michael Counter President, North Country Home Health & Hospice Agency Secretary (O) Karen Woods Administrative Director, Cottage Hospital Sharon Beaty CEO, Mid-State Community Development Corp. Laurie Daley Director of Quality, Upper Connecticut Valley Hospital Kristina Fjeld-Sparks NH AHEC Director, NH AHEC/Geisel School of Medicine Suzanne Gaetjens-Oleson Regional Mental Health Administrator, Northern Human Services Ken Gordon CEO, Coos County Family Health Services Kevin Kelley CEO, Indian Stream Health Center Michael Lee President, Weeks Medical Center Tara MacKillop Executive Director, Androscoggin Valley Home Care Services Lars Nielson, MD Provider, Weeks Medical Center Gail Clark Director of Marketing & Community Relations, Littleton Regional Healthcare Jarrett Stern System Executive-Special Projects, Androscoggin Valley Hospital Jeanne Robillard CEO, Tri-County Community Action Program Craig Labore Administrator, Grafton County Nursing Home
23
AG E E N T P R M
O
EM
GR
AM
CAR
AN
Leading innovative collaboration to improve the health status of Northern New Hampshire.