Upper Valley MRC Supports COVID-19 Testing

Volunteer Brett Mayfield dons his PPE to begin a clinic shift, while providers at the specimen collection station look on.

Since May, the Vermont Department of Health has sponsored weekly COVID-19 testing clinics for the asymptomatic public. Residents and visitors regularly register for these clinics for many reasons. People want to visit loved ones who are high risk, reduce their quarantine period, attend a summer camp, or protect themselves while working at a high-risk business. The reasons are as varied as the people who come, but the results are the same. Upper Valley folks from both Vermont and New Hampshire are flocking to get quality testing in their community.

Volunteer Eileen Murphy mans the triage tent to screen and check in registrants.

Upper Valley MRC Supports COVID-19 Testing

Three Upper Valley Medical Reserve Corps volunteers have stepped up to supplement the healthcare workforce staffing these weekly Covid-19 testing clinics. Eileen Murphy is a local nurse practitioner. Brett Mayfield is a town health officer and owner of a local healthcare practice. Andrea Morancy is a school nurse.  All three regularly take shifts at the Springfield or White River Junction COVID-19 sites. Their tasks are as varied as triaging and symptom checking incoming patients, communicating critical healthcare information, verifying registration information, or conducting testing. These skilled providers fill critical roles that aid the Health Department and local EMS personnel who regularly run the clinics. They also fulfill the MRC mission of being the second line of defense when local capacity is stretched.

Attendees of local clinics constantly provide feedback on the professionalism, friendliness and gentleness of the team. The Upper Valley has garnered a reputation for being ‘the place’ to go for testing. “It’s all about setting expectations and meeting them,” says Eileen Murphy, who often works the Triage station. “It’s so rewarding to have someone full of anxiety come through the line, receive information and reassurance, and just see the stress leave their face. Then to get a thumbs up when they exit the testing area and to hear confirmation that although there is discomfort, it was not as bad as expected.”

Covid-19 Testing Clinics Continue Through August

Covid-19 testing clinics will continue in Vermont through the end of August (2020). For more information on locations and how to register, visit https://www.healthvermont.gov/response/coronavirus-covid-19/testing-covid-19. To volunteer with Upper Valley MRC, reach out to us at www.oncallforvt.org.

Police Recognized for Response to Persons Affected by Mental Illness

The Hartford Police Department is pleased to announce the successful completion of the “One Mind Pledge”, a commitment the department entered to improve our response to those affected by mental health issues.  The pledge is part of an initiative started by the International Association of Chiefs of Police (IACP), a professional association representing law enforcement on relevant public safety matters, including providing training and technical assistance.

Commitment to Partnering

In completing the One Mind Pledge, the Hartford Police committed to a sustainable partnership with Health Care & Rehabilitative Services of Southeastern Vermont (HCRS) and other area human service providers to insure ongoing dialogue in assisting those in crisis.  Through the support of HCRS, the Police Department and our community have benefited from the daily assistance of an embedded Police Social Worker, who assisted in developing model policies for the department’s response to persons in crisis.

Beyond implementing enhanced policies and meeting state legal requirements, all members of the Police Department have received enhanced Training in responding to persons experiencing a Mental Health Crisis, including one or more programs such as Mental Health First Aid, Team-Two developed by Vermont Care Partners and, CIT or Crisis Intervention Team.  Assisted by HCRS, The Upper Valley Public Health Council, and the Lebanon, New Hampshire Police Department, the Police Social Worker oversees a regular CIT training program for uninformed and non-uniformed police staff, with 88% of police and communications personnel having successfully completing the program.  Originally known as the “Memphis Model,” and later recommended by the President’s Task Force on 21st Century Policing, CIT is a collaborative, 40 hour program of instruction.

Preparing Law Enforcement to Respond to Persons affected by Mental Health Issues

Responding to persons affected by mental health issues, particularly those in crisis has become common for law enforcement nationwide, including the Town of Hartford.  Already this year, police have answered 163 calls for persons in need of assistance due to a mental health issue.  To the extreme, at least 40 were in crisis at the time officers arrived, including ten persons who were armed with weapons – including a firearm, knives and a bat.  In these extreme cases, training is coupled with improved technologies and protective equipment to enhance safety for the officer and person in crisis, increasing the likelihood of a positive resolution.

The core competencies required of One Mind Pledges – collaboration, improved policies and specialized training have assisted in better preparing the Hartford Police in meeting these challenges.  Although the greatest benefit is the open, continuing dialogue and collaboration with our medical, human and social service partners in preventing our residents from reaching the point of crisis.

For more information on the One Mind Pledge, including pledge requirements and a list of agencies having pledged or completed their pledge, visit the IACP website at:

https://www.theiacp.org/projects/one-mind-campaign

For more information CIT, visit the CIT International website at:

http://www.citinternational.org/What-is-CIT

Posted with permission of Phil Kasten, Chief of Police,Town of Hartford, Vermont. Original press release dated Wednesday, December 4, 2019.

Advocating for Our Upper Valley Public Health Priorities

Training attendees discuss advocacy issues with facilitators during small-group breakout session.

On March 4th, 2020, the PHC hosted our first bi-state advocacy training at Kilton Library in West Lebanon. The training was facilitated by two of New Futures’ Community Engagement Coordinators (Jess Wojenski and Pedro Altagracia), as well as Bi-State Primary Care’s Director of Vermont Public Policy, Helen Labun.

This training follows the PHC’s multistep initiative to expand upon our public policy capacity. Pursuant to the legislative breakfast we hosted mid-September, the Public Health Council deemed advocacy trainings as our next best step. We hope this event is the first of many trainings. An advocacy training such as this serves each of the PHC’s three guiding principles: collaboration, education, advocacy.

Advocacy Skills

The event lasted about two and a half hours. In the first hour and a half, three facilitators covered advocacy basics, such as the legislative processes in New Hampshire and Vermont (i.e. how a bill becomes law, how many representatives each state has, how to prepare an effective testimony piece, and how to contact legislators). The facilitators fielded general questions as well as questions specific to each state and an individual’s respective interests.

After this portion of the event, participants broke up by state to have more intimate discussions with their states’ respective expert(s). The hour allowed attendees to ask any question they had about advocacy in their work areas. For no specific reason, it seems the conversation on the New Hampshire side tended towards more niche topics such as sexual assault advocacy and best practices for older adults looking to advocate. On the other hand, the Vermont conversation was dominated by questions for community nursing projects.

Following the event, we asked participants to fill out a survey to indicate how valuable they felt the event was. In general, participants responded positively to the training and found it to be an event ripe for learning, led by informed and helpful facilitators. However, there is still room for improvement on the points of contacting legislators and testifying on health-related issues. We will aim to cater our next advocacy trainings to these points.

More About New Futures and Bi-state Primary Care:

New Futures:

New Futures is a nonprofit, nonpartisan organization that aims to advocate for and with New Hampshire residents to improve health care and wellness public policy in the state. This organization focuses on areas slightly different from the PHC: alcohol and drug policy, general health policy, early childhood policy, access to treatment policy, and children’s behavioral health. They do significant work on advocating for policy which aids New Hampshire families and children, for more information on this project click here. New Futures has the capacity to provide general and issue-specific advocacy trainings to the general public at no cost. These trainings equip community members with the skills to better advocate on health-related issues in their respective communities.

For more information on New Futures’ trainings offerings click here.

Bi-State Primary Care:

Bi-State Primary Care Association is a nonpartisan nonprofit organization that aims to support individuals from New Hampshire and Vermont in their ability to access Community Health Centers, with the goal of providing quality, affordable health care to all. This organization also has a robust public policy capacity. By regularly communicating with legislators, policymakers, non-profit leaders, Bi-State advocates for their priority areas.

For more information on Bi-State Primary Cares’ policy agenda in Vermont, click here, for New Hampshire, click here .

Where do we go from here?

The Public Health Council views this event as a great step forward, towards our goal of an expanded public policy capacity. Our three guiding principles, collaborate, educate and advocate were each touched upon through this event. Firstly, this event was collaborative in nature, as it provided an opportunity for individuals from two different states to convene, share experiences and lessons learned through their own experiences. The diverse array of stakeholders who attended the event included community health workers, folks involved on nursing projects within the Upper Valley, The Dartmouth Institute representatives, and even community members who came as individuals.

Secondly, the event’s educational dimension came through our facilitators who shared best practices and case studies on advocacy in the two states; there was also profound learning between attendees. Lastly, our goal of advocacy was certainly touched upon, as our PHC members and visiting community members gained a step-by-step approach to public health advocacy in the two states.

Our public policy capacity work doesn’t stop here. In the coming months, we will be working to develop:

  • Policy briefs timed in accordance with legislative sessions;
  • Resource area on our website to help connect legislators with facts, best practices and a means to connect with public health advocacy groups in NH and VT; and
  • Planning for future advocacy training sessions, likely catered more towards specific priority areas than general advocacy.

PHC Welcomes New Board Members

The Public Health Council of the Upper Valley announces the appointment of two new members of its Board of Directors, as well as the full slate of officers and board members for 2020. Joining the Board of Directors are Rudolph (Rudy) Fedrizzi and Roberta Berner. “Both Rudy and Roberta bring expertise, passion, and commitment to our communities. We are fortunate to have them by our side as we grow this organization to promote a healthy and supportive Upper Valley,” Alice Ely, Executive Director.

Rudy Fedrizzi, MD, is the Public Health Services District Director for the White River Junction District Office of VT Department of Health. Dr. Fedrizzi previously practiced Obstetrics and Gynecology for 16 years and holds medical licenses in VT and NH. Dr. Fedrizzi served as Director of Clinical Integration in the Center for Population Health at Cheshire Medical Center/Dartmouth-Hitchcock, a community hospital and multi-specialty physician practice located in Keene, NH, from 2010 to 2018. In that role, he served as a core member of the Healthy Monadnock Initiative project team, an effort similar to the Public Health Council.

Roberta Berner has worked for a wide variety of public and nonprofit organizations throughout her career in New Hampshire, Mississippi, Ohio, Minnesota and Florida. She moved to New Hampshire in 1998 and recently retired after 20 years with Grafton County Senior Citizens Council, Inc., including more than 15 years as Executive Director. Roberta is a gubernatorial appointee to the newly formed NH State Commission on Aging.

PHC Sees Change in Board Leadership

At the Public Health Council’s Annual Meeting on Friday, November 15, Dr. Fedrizzi was elected to serve as Chair of the Board of Directors. He replaces Julia Griffin, Hanover Town Manager, as Chair. Ms. Griffin remains on the Board but has stepped down from her leadership role after leading the organization through a four-year period of growth and transition. “I deeply appreciate Julia’s leadership as we made the decision to rebrand the Mascoma Valley Health Initiative to the Public Health Council back in 2016. Julia played a significant role in the process of change and in making sure all our partners embraced the change,” says Alice Ely.

Keynote Promotes Changing the Conversation Around Aging

The meeting included a Keynote Address by Kelly Laflamme, NH Endowment for Health, and Jennifer Rabalais, UNH’s Center on Aging and Community Living and Institute on Disability entitled, “Changing the Conversation Around Aging: Telling a New Story.” Negative attitudes about aging are bad for our health. So bad, in fact, the World Health Organization has launched a global campaign to end ageism. The Reframing Aging Initiative is working to advance a new story about aging that recognizes the challenges and opportunities that increasing longevity poses to our communities. Kelly and Jennifer shared the research and tools developed by experts at the FrameWorks Institute and encourage PHC partners to advance a new narrative about aging that is better for everyone’s health. A copy of the presentation can be found here: Reframing Aging Upper Valley Nov 15 2019.

Alice Ely provided an annual review of activities and preview of priorities for 2020. She highlighted PHC partners work on a new Community Health Improvement Plan, new Drug Free Community Support grants in the region, record-breaking school-based flu immunization clinics, and more. A copy of the presentation can be found here: PHC Directors Report 11 15 2019.

PHC’s First Public Health Hall of Fame Honoree

Finally, PHC Partners recognized Bill Boyle, as he retired as Ex-Officio Medical Director of the Public Health Council after more than 10 years as a champion for the organization. Alice Ely presented Dr. Boyle with the 1st Public Health Hall of Fame Award to the applause of all present. Dr. Boyle is a pediatrician who retired from D-H and CHaD in 2011 after 41 years in practice. Most of his career was devoted to treating children with chronic conditions like cystic fibrosis, cancer and diabetes. He always found time to serve as school physician for the Hanover schools and health officer for the Town of Hanover for 24 years. Dr. Boyle also tirelessly to make sure that children and families found support in organizations and places throughout our communities.

Taking on Childhood Lead Poisoning

Beginning in 2018, New Hampshire state law has required doctors to test all one and two-year old children for lead poisoning. New Hampshire has been acutely vulnerable to lead poisoning in the past by virtue of the fact that 62% of New Hampshire housing stock was built before the ban on lead paint began in 1978[1]. This along with a high prevalence of unsafe renovation practices resulted in over 800 New Hampshire children tested positive for elevated blood lead levels (EBLL) in 2018. Lebanon and Enfield proved to be the two towns with the greatest prevalence of EBLL within the Upper Valley region. (Between 2014 and 2018, Lebanon reported 19 children and Enfield 9, with all other regions reporting 1-4 children, a value indicating insufficient reports of EBLL, according to Lead Exposure Brief Upper Valley 2018).

No Cure. No Treatment.

It only takes a pinch of lead dust or chips to cause irreversible harm to a young child’s developing brain. EBLL has been linked to lower IQ levels, increasing impulsivity and aggression, and difficulties with attention and executive functioning. It is also linked to poor visual, spatial, speech, and motor skills. One in every 5 Attention Deficit Disorder case is attributed to lead exposure. Children from birth to age six are vulnerable because they have not developed a blood-brain barrier yet and lead travels easily from the blood stream into the brain.

The impact of childhood lead poisoning extends beyond an individual’s health. Subsequent to the Flint Water Crisis, Michigan saw a 56% increase in special education budgets. This burden on taxpayers is compounded by the way our current lead-abatement system operates—by placing the burden of cost and remediation on landlords and property managers.

Gathering for Local Action

In an effort to create a regionally based, early intervention system, the Public Health Council collaborated with the NH Healthy Homes and Lead Poisoning Prevention Program to create conversation about lead poisoning in the region. We believe that if the many players involved with lead poisoning and abatement collaborated more effectively, we would be able to reduce the frequency of lead poisoning and simultaneously reduce costs in our region through various educational and training opportunities.

On September 27th, 2019, the Public Health Council hosted an educational presentation facilitated by Ms. Gail Gettens from the Healthy Homes and Lead Poisoning Prevention Program. Ms. Gettens presented an overview of the negative impacts of lead on cognitive and behavioral health as well as the current New Hampshire laws and protocols for screening and BLL testing. After the educational session, the Public Health Council’s Executive Director, Alice Ely, facilitated a stakeholder-planning meeting with the hopes of using our region’s assets to create actionable plans. We hope the plans from this meeting, together with the current traction established through the requirement of lead screening for 1 and 2 year old children, has the potential to create positive change in the Upper Valley.

There was a diverse array of stakeholders in attendance at this September meeting. Industry affiliations included building trades, child-care givers, city government officials, community leaders, legislators, health care providers, housing personnel, landlords and property managers, regional planning commission members, and school district/special education members.

Planning Local Initiatives

Based on the success of this gathering and the quality of the plan that emerged, the Public Health Council was awarded a grant through the New Hampshire Healthy Homes and Lead Prevention Program. Funding will be available in February 2020 to support a two-pronged approach to improving the Upper Valley’s lead prevention plan.

First, we will expand training and certification opportunities for local homeowners, contractors, landlords, property managers and town building inspectors. We will host at least two training sessions using the Environmental Protection Agency’s (EPA) Renovate, Repair and Paint (RRP) lead safe work practices. This approach was determined as a necessary step due to the majority of New Hampshire’s housing stock having lead-based paint. Many believe there are too few RRP contractors in the Upper Valley region, which decreases the likelihood that lead-safe work practices will be used on renovation projects. The Public Health Council aims to host RRP training sessions of eight hours each between March and September 2020, with the hopes of reaching 45 homeowners, contractors, landlords, property managers or town building inspectors.

Secondly, the Public Health Council plans to collaborate with the Mascoma Valley Regional School District (MVRSD) through its Superintendent, School Board members, Special Education Director, other school personnel, and parents to change school policy. MVRSD has over 200 students with disabilities (nearly 20% of their student body) but do not have a clear understanding of how many of these children have been affected by lead poisoning.

The lack of awareness on the severity and impact of lead poisoning has prompted the Superintendent of MVRSD to partner with the Public Health Council to host an educational session for parents and school personnel and lead poisoning, as well as change school policy to require documentation of blood lead level tests for school registration. The Mascoma Community Health Center will also work with us to increase blood lead level screening in the region. We expect to host the educational event in March of 2020, and see a new school policy adopted by December 2020.

As other strategy opportunities emerge, the Public Health Council will look for partners and resources to implement them. For example, with the help of a Dartmouth College Eichler Fellow, we expect to create a webpage and a webpage template with important information about lead-safe practices that towns and other organizations in our region can use to educate their constituents.

— Submitted by Claire Thomas, Dartmouth College ’82 Upper Valley Community Impact Fellow

[1] 2018 Lead exposure Data Brief for Upper Valley Region, NH Division of Public Health Services.