Exploring Community Health Priorities in the Upper Valley

Improving community health is at the core of the mission of the Public Health Council of the Upper Valley. Most of our partners share this goal, but contribute in different ways to reaching that goal. Some partners are health care providers, some provide treatment for substance use disorders or mental illnesses, others support people in our communities who struggle with various social determinants of health.

Every three years, the Public Health Council works with our many partners to update a set of regional priorities that answers the questions: What are the health issues our community members are most concerned about? How can we make a difference, especially by using the strength of our collaboration? And every three years, nonprofit hospitals, like Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital, are required to complete a community health needs assessment and a community health improvement plan. Over the course of 2018, the Public Health Council was able to work with these hospitals, and others in our region, to complete a joint community health needs assessment. As we move into 2019, we continue to work together to explore more deeply what the assessment results tell us and how we can share in the work of making a difference.

The Greater Upper Valley Works Together

All nonprofit hospitals in American must complete community health needs assessments and community health improvement plans. These plans identify priority needs in hospital service areas and direct the hospital’s community benefit investment in their communities. However, our region has taken this work to a new level, by combining the resources of six health care institutions in the region to complete a large scale assessment. These institutions include Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Visiting Nurse and Hospice for VT, Mt. Ascutney Hospital and Health Center, Valley Regional Healthcare, New London Hospital. The purpose is to identify community health concerns, priorities and opportunities for community health and health care delivery systems improvement. By gathering the same data across a large region, we are able to see similarities across our many communities, identify differences (or disparities), and coordinate strategies to address concerns.

Upper Valley Community Health Needs Assessment

The Upper Valley Community Health Needs Assessment generated for the Dartmouth-Hitchcock and Alice Peck Day primary hospital service areas covers 19 municipalities in Vermont and New Hampshire, with a total resident population of 69,467 people. Data came from surveys of community residents; a direct email survey of key stakeholders and community leaders; a set of community discussion groups; a behavioral health needs assessment conducted in 2016; and a review of available demographics and health status indicators. The New Hampshire Community Health Institute conducted the survey, data analysis, and report generation. Throughout the process, they were careful to focus on vulnerable and disproportionately served populations in the region. We wanted to ensure all populations that could experience limited access to health-related services or resources due to income, age, disability, and social or physical isolation were seen in the results.

Taking It Back to the Community

Beginning in January 2019, the Public Health Council has been working with partners at Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Visiting Nurse and Hospice for VT to share the results with members of our communities and get input into where we go from here. In January, we co-hosted two Community Health Improvement Summits open to all community residents to review the priorities emerging from the recent results and share thoughts about what the results tell us, what opportunities we have to address them, and what strategies we might help. In February, we took advantage of a training co-sponsored with the Special Needs Alliance, Cultural Competence with Disabilities, to address the priorities from the perspective of people living in our communities with disabilities.

Community Health Priorities from the 2019 Upper Valley Community Health Needs Assessment

Capturing Input from Our Communities

Notes from all the discussions held so far are available for review. You will find links to these notes below.

Community Summit Notes from January 18 @ 5:30 pm (Dwinell Room) and Public Health Council Partner Meeting (open to public), January 18 @ 9:00 am (Tracy Hall)

Mental Health Services
Substance Misuse
Child Abuse and Neglect
Primary Care Services
Domestic Violence
Health Care for Seniors

Discussing issues of child abuse and neglect with Nancy Bloomfield, of The Family Place, as a subject matter expert.

Forum at Cultural Competency with Disabilities Training, February 8 (Kilton Library)

Mental Health
Domestic Violence/Child Abuse and Neglect
Primary Care Services

Over the next several months, we will continue to present results to community groups, looking for insights into what work the results tell us to do. Each of the organizations collaborating on this work will develop their own Community Health Improvement Plan. Most of these plans will be completed by the end of 2019 or soon thereafter.

For more information about the community health improvement planning process or ways you can participate, please contact Alice Ely at the Public Health Council.

2nd School Summit Focuses on Schools’ Greatest Concerns

On October 4, 2018, the Lebanon School District Office gym was humming with the chatter of new connections, putting faces to names, and busy professionals all focused on addressing schools’ greatest concerns for children and their families. The Public Health Council of the Upper Valley and Dr. Joanne Roberts, Superintendent of the Lebanon School District, hosted the second forum bringing together school personnel and local agencies. The purpose of the event was to: 1) Increase regional understanding of what challenges schools face in providing the best learning opportunities possible; 2) Increase understanding of what resources are available to help schools serve the needs of their students and families; and 3) Provide a forum for building relationships between schools and providers that can lead to new (or deeper) formal and informal working relationships.

Prior to the event, registrants were asked to share what they hoped to get out of the summit. Posters at the front of the room displayed the main themes of what people were hoping to learn.

“To acquire knowledge of how these organizations and other schools best support students and families.”
“I want to better serve the community I work with.”
“Improve community contacts to help ensure wrap around services for our most vulnerable students.”

To open the event with a call to action, Alice Ely, Executive Director of the Public Health Council, asked everyone to use the day to share their story, listen to what others have to offer, and find at least three things they can do as a result of the discussions.

What are Schools’ Greatest Concerns?

To determine schools’ greatest concerns for children and their families, the Public Health Council conducted a survey of Upper Valley schools in June and July to identify their main topics of concern. Alice Ely and Dr. Roberts then worked with a small planning committee to develop facilitated workshops for the four most common concerns: mental health, substance use disorders, meeting basic needs, relationships with child protective services. Attendees were able to attend two different workshops during the event. [Learning Objectives: Click to learn more about the workshops provided at the Summit.]

After workshops, attendees shared a delicious lunch and talked over what they had learned in their school groups and visited the resource fair. Tables along the back wall were covered with pamphlets, pens, contact and informative materials, and posters from the seventeen Upper Valley organizations present.

Closing with Stress Reduction

The whirlwind conversations, networking and discussions came to a close with a stress management activity from Kate Gamble of Open Door. The quiet meditation brought attention to the importance of stress management and introduced a strategy for the school personnel and social agency providers in the room. Summit attendees left with a list of the names, organizations and contact information for everyone in attendance.

Attendees from Many Schools and Organizations

The thirteen schools or districts whose staff attended the summit included: Lebanon School District, Rivendell Interstate School District, Windsor Schools, Central Vermont Supervisory Union, Mascoma Valley Regional School District, Marion Cross School, Hartford Area Career and Technology Center, Ledyard Charter School, Grantham School District, SAU 23 North Haverhill, Tunbridge Central School, and Plainfield School District.

Representatives from the following organizations attended to share information about their services, discuss partnership opportunities, and facilitate workshop discussions in their areas of focus: Good Beginnings of the Upper Valley, Child and Family Services, The Family Place, LISTEN Community Services, Open Door, Health Care & Rehabilitation Services of Vermont, Dartmouth Hitchcock Pediatrics, WISE, ALL Together, HALO Educational Systems, Second Growth, Second Wind Foundation, Twin Pines, Upper Valley Haven, HealthHUB, VT Department of Health, VT Economic Services Division, and the Public Health Council of the Upper Valley.

This is Only the Beginning of the Conversation

The idea for the Summit came about in 2017 from conversations between Dr. Roberts and Alice Ely about the need for improved connections between school personnel and local resources to meet schools’ greatest concerns for children and families in the Upper Valley.  Ms. Ely recognized an opportunity for the Public Health Council to help connect the two. She said, “We have so many great resources available here in the Upper Valley. However, sometimes the challenge for busy professionals is making connections to others who can help them better serve their constituents. That is one of the key roles the Public Health Council plays. I was thrilled to partner with Dr. Roberts to make this event happen.”

The overwhelmingly positive feedback to the event noted the “professionalism and caring nature of all who attended.” The event was a great success in making connections and networking. However, there was much talk about needing to continue the conversation about meeting schools’ greatest concerns. Ms. Ely sees the role of the Public Health Council to help facilitate these conversations and looks forward to seeing what happens.

PHC Annual Meeting Addresses Health Equity

The Public Health Council Board of Directors hosted their Annual Meeting on Friday, November 16th, despite the first snow storm of the season. Only a small portion of the people who expected to attend decided to stay home, for which we are very grateful. Many thanks also go to Hypertherm’s technology team members, who allowed us to connect with Heidi Klein, our Keynote Speaker, remotely so that she did not have to travel from Burlington, Vermont, through the snow.

Meeting Dedication

This year the Board of Directors dedicated this meeting to the memory of Laura Cody McNaughton. Laura joined our Board of Directors last January before she was tragically killed in an automobile crash in June. Laura served as the District Director for the White River Junction Office of the Vermont Department of Health. She was noted for her kind and collaborative spirit and her dedication to addressing health disparities in our region. She is missed by all who knew and worked with her.

Conducting Business

The Annual Meeting is where the Board of Directors elects new members and officers. This year we welcomed Matthew Cole to the Board and bid farewell to Nate Miller. The Board Treasurer, Bob Kingman, presented a financial review of 2018 and the proposed budget for 2019, which was approved. We thank all the foundations, corporations, municipalities, and individuals who provide the financial support the Public Health Council relies on for our operations.

What brought most people to the Annual Meeting, however, was the chance to hear Heidi Klein, Director of Planning and Health Care Quality at the Vermont Department of Health, discuss developing the Vermont State Health Assessment and Plan with a focus on health equity. We invited Ms. Klein to speak because we hoped to learn from Vermont’s experience as we move towards developing a new Community Health Improvement Plan for the Upper Valley. The Upper Valley, like Vermont as a whole, struggles to recognize, understand, and address the diversity and disparities that exist here. We hope to do a better job in this next community health improvement plan of addressing health equity.

So what did Heidi share with us about the Vermont planning experience?

Heidi Klein, MSPH

When developing their state health assessment and plan, the Vermont Department of Health generally looks at two questions: What do we know about the health of Vermonters? And what are we going to do about it? When they thought about how to explore the root causes of health outcomes, especially in populations affected more or less by some outcomes, they realized the importance of understanding inequity. According to Heidi, “This means we are now looking at very different data than before. Before, the assessment showed what we were seeing, but not why.”

When they looked at the data to understand what populations were most affected by poor health outcomes, they identified the LGBTQ community, people of color, people with disabilities, and people living in poverty. They also realized the need for qualitative data – stories – to more fully understand what was driving the inequity. So, when it came time to identify strategies, they added a new step to the process. Instead of ending with partner engagement to determine readiness for action, they moved on the working with people experiencing inequity to explore where there are shared agendas. This entire exercise – which is not yet complete – changed a 1-year process to a 2-year process, but the Vermont Department of Health had the courage and the wisdom to recognize it as the right thing to do.

Inequity = Differences in health outcomes that are avoidable, unfair, and shaped by condition of people’s lives related to the distribution of money, power and resources.

Ms. Klein has generously shared several resources, including her presentation slides. She also suggests reviewing two resources she referred to in her talk:

More About Heidi Klein

Heidi serves as the Director of Planning and Health Care Quality at the Vermont Department of Health. She possesses over 25 years of experience in public health practice, public engagement, and collaborative planning. She worked with leaders at the national, state and local level, to design programs and policies which recognize the interconnection between public health, environmental protection and economically vibrant communities.  Heidi’s current position includes: strategic planning and performance management; development of the State Health Assessment and State Health Improvement Plan; integration of public health programs, including, the State Office of Rural Health in health system reforms; and workforce development.

The Public Health Council Board thanks Heidi and the partners and new friends who braved the storm to join us at this Annual Meeting. For more information about the Public Health Council, please visit our website at www.uvpublichealth.org or reach out to Alice Ely, Executive Director, at alice.ely@pubhealthtest.wpengine.com.

New Website Describes Upper Valley Public Health Emergency Preparedness Resources

Recently, the Public Health Council (PHC) launched new web pages devoted to emergency preparedness resources in the Upper Valley. “We are fortunate to work very closely with the Upper Valley Public Health Region’s Emergency Preparedness Coordinator and the Emergency Preparedness Specialist for the Vermont Department of Health’s White River Junction District Office. Together, we work to strengthen community preparedness in the Upper Valley, provide effective public information and warnings in the event of an emergency, and effectively support the Upper Valley during Mass Care Events,” says Alice Ely, PHC Executive Director and Treasurer of the Upper Valley Medical Reserve Corp Advisory Board. This includes planning with the region’s first responders and disaster recovery organizations. We also support the Upper Valley Medical Reserve Corps, a trained group of medical and support volunteers available to help during emergencies. The web pages tell the story of public health emergency preparedness and provide contact information for the key resources in the region.

What is Public Health Emergency Preparedness?

Like all communities, the Upper Valley faces many threats with the potential for large-scale health consequences, including disease outbreaks, natural and man-made disasters. Some impacts are short-lived and some, like the mental health impacts on survivors, can be long-lasting. The public health, mental health, health care, and emergency response systems must be prepared to work with communities to build capacity and resilience.

Public Health emergency preparedness focuses specifically on those systems that aim to improve the overall health of the public by ensuring equity of services, particularly those that promote protective health such as vaccinations, safe housing, environmental safety and others. It also looks to health care systems which serve the community in emergencies such as our hospitals, clinics, and emergency medical services among others. It ensures that these institutions have robust plans that are adaptable and scalable to emergencies, and that they are prepared to serve their community in times of need.

Making Flu Vaccine Easy to Get is Example of Public Health Emergency Preparedness

Preparedness and prevention often go hand in hand. Over the past several years, local public health agencies teamed up to provide a number of free vaccinations to children and uninsured adults in the Upper Valley by scheduling and staffing flu clinics. During the fall of 2018, 1,659 NH school children in 19 schools in the Upper Valley received flu vaccine at their schools. The Public Health Council also organized five community-based free flu vaccine clinics for anyone aged 10 and older and vaccinated nearly 1,200 people.

These clinics were staffed by local medical students, Medical Reserve Corps volunteers, area fire department personnel and many others who devoted their time and energy to ensuring their community’s continued safety. Dartmouth-Hitchcock Medical Center plays a key role in providing vaccine with their free walk-in clinics and by donating the vaccine for the Public Health Council’s community clinics. All these vaccines help protect our community from large-scale flu outbreaks, reduce the severity of the illness for those who might still get the flu, and provide protection for those among us who are not able to get flu vaccine for medical reasons.

Personal Emergency Preparedness

The public has a role to play in preparing for public health emergencies as well. In large-scale emergencies, officials might order evacuations or, in some cases, “shelter-in-place” orders. In these two situations, members of the public would be expected to either leave their homes at very short notice or told not to leave their homes for what could be several days. Either way, there are steps individuals and families can and should take to be ready for such an emergency. Fortunately, you do not need to figure this out alone. There are numerous resources online to guide you through developing a personal emergency preparedness plan. One such resource is on the Vermont Department of Health Website; another can be found at the Federal Emergency Management Administration (FEMA) .

We hope you will use the Public Health Council website to learn more about public health emergency preparedness in the Upper Valley. There you will find contact information for emergency preparedness staff, links to local Facebook pages, and examples of emergency preparedness in action.

Falling Is Serious Risk for Seniors, but Exercise Helps

The statistics about falls involving senior citizens are troubling: According to the Centers for Disease Control and Prevention, 1 in 4 adults 65 and older fall each year, and the numbers are rising.

There’s more: Every 20 minutes an older adult dies because of a fall (more than 27,000 a year), 1 in 5 falls cause a serious injury and 7 million falls required some form of medical treatment. These CDC statistics from 2014, the most recent year available, have led to the growing concern from health care providers and others who work with senior citizens.

By Liz Sauchelli, Valley News Calendar Editor and Sunday Seniors Feature Writer
Published by the Valley News on Sunday, September 23, 2018. Reprinted with permission.

Saturday was the National Council on Aging’s annual Falls Prevention Awareness Day, but it’s a topic that should be on our radar every day.

“Even though it’s very common, we know it’s under reported,” said, Dawna Pidgeon, a physical therapist at Dartmouth-Hitchcock Medical Center, during a presentation to the Aging in Community Forum quarterly meeting last week.

“We need everybody,” to help reduce falls, said Pidgeon, who is part of the Dartmouth Centers for Health Aging Falls Team.

A fall, in general terms, is described as “unintentionally coming into contact with the floor or a lower service,” Pidgeon said. Hip fractures from falls are of particular concern, because many senior citizens who have them never fully recover, according to the CDC. But it’s important to note that many of the intrinsic and extrinsic factors that contribute to falls can be addressed.

Intrinsic causes include:

  • muscle weakness
  • dizziness
  • poor vision
  • fear of falling
  • gait/balance issues

Extrinsic causes include:

  • the use of four of more medications
  • alcohol use
  • wearing poorly fitting shoes

Dizziness Is Never Normal

“Dizziness is never normal,” Pidgeon said. “If people are dizzy, we want to make sure we’re getting them help for it.”

When it comes to preventing falls, there’s one tactic that takes precedence. “Of all the things we can do, exercise is the most important,” Pidgeon said. “The exercise has to be balance and strengthening exercises.”
While people naturally start to lose muscle fiber as they age, the goal is to strengthen the muscle that remains. “We also know you can always increase the size of the muscle fibers you do have,” Pidgeon said.

She is a certified trainer for Tai Ji Quan: Moving for Better Balance, a program that studies have shown helps improve balance and prevent falls among senior citizens. “The results are phenomenal,” Pidgeon said. “They build their strength and their confidence.” Another program, A Matter of Balance, has had similar results.

One challenge is getting people to participate in the programs. Ti Ji Quan, for example, requires seniors to attend class twice a week for 24 weeks. A Matter of Balance asks attendees for two hours each week for eight weeks.

Balance Screening Can Be First Step

Another way to get people started on these courses is to do balance screenings, which health care providers and organizations can provide. DHMC’s Aging Resource Center, for example, hosts free balance screenings from 9:30 a.m. to 11:30 a.m. on the first and second Wednesdays of every month.

Other steps people can take to minimize fall risks, according to the CDC, including clearing clutter from floor, adding grab bars in bathrooms and handrails on stairs, removing throw rugs and keeping areas well lit.

Editor’s note: For more information about falls prevention, visit https://www.cdc.gov/steadi/.
Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221.