PHC Annual Meeting Addresses Health Equity

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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

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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

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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.

Hartford Community Coalition Putting the Cures Grant to Work

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Submitted By The Hartford Community Coalition

Coalition Representatives attend the National Prescription Drug Abuse and Heroin Summit in Atlanta

Hartford Community Coalition (HCC) is a collaborative group of citizens designed to support and promote the wellness of individuals and families in Hartford, Vermont. This year, we received a grant as part of the 21st Century Cures Act, which allowed us to focus on preventing the opioid epidemic’s reach in our community.

A major part of implementing the Cures grant was to hire a part-time addiction prevention coordinator, who could focus on outreach and education on substance misuse prevention. Shortly after signing on with the HCC, our coordinator participated in the Vermont Department of Health’s Understanding Opiate Addiction Workshop at the Hartford Area Career and Technology Center. Also, this past spring, we sent her, as well as two other coalition members—a social worker from the Hartford Police Department and a Community Health Partnership Coordinator from DHMC—to the National Prescription Drug Abuse and Heroin Summit in Atlanta. There, our representatives learned the latest in topics such as prevention messaging, research on ACEs (adverse childhood experiences), and the developing role of recovery coaches.

Ways to Dispose of Unused Medications

For the past six months, the HCC has continued to work with community stakeholders to reduce substance misuse in Hartford: we’ve distributed Vermont Department of Health Twin State Safe Meds information to our local senior center, pharmacy, doctors’ offices, and libraries. In addition, we created an informational flyer about local mental health practitioners who accept Medicaid, so cost won’t be an issue to those seeking treatment. We also dispensed prescription drug lockboxes at Town Hall meetings and at our annual community block party on June 6.

Coalition Representatives participate in National Take Back Day

We’ve used social media and the Hartford Town List Serv to share Twin State Safe Meds information as well as to provide reminders about Hartford Police Department’s drop box for unused prescription medications. We were able to increase visibility for the 2018 National Drug Take Back Day on April 28 through blog and Facebook posts, by placing flyers throughout the community, and by publishing a letter to the editor of the Valley News. On National Prescription Drug Take Back Day, we worked with the Hartford Police Department to host our first two Take Back Day events at the town libraries in Quechee and Wilder to increase access to safe disposal of unused or expired medication. From these efforts, the Hartford Police Department has collected 172 pounds of unused prescription drugs since March.

HCC facilitates monthly substance misuse and mental health subcommittee meetings, and sends our Hartford liaison to monthly meetings of Green Peak Alliance (formerly Windsor County Prevention Partners), a collaboration of substance abuse prevention coalitions that includes, Windsor, Windham, and Orange counties. We believe we’re making a difference, and we’re grateful to the Cures grant for giving hope to our community.

Nursing Students Learn About Community Nursing

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Laurie Harding and Bob Rufsvold (left), Co-Directors of the UVCNP, with Professor Shari Goldberg and Colby-Sawyer College Senior Nursing Students in April 2018.

Recently, a group of four Colby-Sawyer College Nursing students completed a Nursing Leadership Capstone Project with the Upper Valley Community Nursing Project.

Upper Valley Community Nursing Project

The Upper Valley Community Nursing Project helps elders receive continuity of care and remain independent—at home and in their community. The Project Co-Directors provides advocacy, training, and technical assistance to communities throughout our region who want to add a health professional to the informal network of volunteers already providing care for elders. They also facilitate the placement of a nurse in a community to address non-acute needs of elders at home. The Project is led by Laurie Harding, MS, RN, and Bob Rufsvold, MD. Ms. Harding founded the Project with Dr. Dennis McCullough using a holistic philosophy of nursing, which dates back to the mid-19th century.

As of April 2017, the Upper Valley Community Nursing Project (UVCNP) provides support and consultation to community and parish nurses in New Hampshire and Vermont towns. These towns include Grantham, Hanover, Lebanon, Lyme, Hartford, Sharon, and Thetford. Laurie and Bob are also available to work with communities who wish to add a community or parish nurse. They assist with understanding the role of the nurse, developing job descriptions, and may provide some initial funding to help the community launch a community nursing program.

Over the past year, the UVCNP has worked closely with staff at Dartmouth Hitchcock Community Health to build a database for the project. The tool will allow community and parish nurses to capture information about the people they see. Data from this tool can be used to provide important information about the value of these programs and opportunities for quality improvement.

Student Nurses Learn About Community Nursing

On April 10, 2018, students from the Colby-Sawyer College Department of Nursing presented the results of their Nursing Leadership Capstone Project to the Co-Directors of the UVCNP, and a number of community and parish nurses and community volunteers. According to Associate Professor Shari Goldberg, PhD, RN, “The year-long Nursing Leadership Capstone experience, as well as our community and public health nursing course, complement the exquisite acute care clinical experiences at Dartmouth-Hitchcock Medical Center that students complete throughout our nursing program. During their capstone experience, students examine health care at the organizational, community, and public policy levels of care, and develop a growing understanding of the social determinants of health. Many of the capstone students work with agencies that serve the needs of older adults, preparing them to care for an aging population.”

This group of four senior nursing students they shadowed community nurses in a number of communities. They also conducted a review of the information collected to date.  According to one student, Courtney Lambert, “Working with the UVCNP has been an eye-opening experience. I feel fortunate to have been able to spend time learning about the role of the community nurse and seeing how important they are to their communities.”

Who Community Nurses Serve

The students, Emily Crow, Courtney Lampert, Emily Martin, and Ashma Shrestha, shared summary characteristics about the people served by community and parish nurses in five communities. They were able to examine trends across nearly 200 clients with records in the UVCNP’s database. In general, they found the people served were over the age of 75 and lived alone. Most clients had multiple health and safety risks. Helping clients learn to take their medications properly was a common role for community nurses. Nurses often provided reassurance  to clients or family members in cases of emergency or after returning from hospital stays. They often guided people looking for resources to help with daily tasks. Nurses also screened clients for falls and other safety risks and provided education and referrals.

The data so far, though limited, suggests these nurses often succeed in resolving or helping clients manage health concerns effectively. Most notably, of the 36 people who had been discharged by a community nurse, none reported they no longer wanted the services. Reasons for discharge included moving away, no longer requiring services, or death. The students final Capstone Presentation provides an overview of how they planned their project, what they did, and what they learned about community nursing and the participants who call upon them for support.

An Eye-Opening Experience

All the Colby-Sawyer students expressed real gratitude for the chance to learn about community nursing. The Capstone Project was their first experience in nursing outside the walls of an institution. Emily Crow shared how deeply the project has affected her: “I don’t think I truly understood the significance of community and parish nurses until I was able to see their impact through home visits and this data analysis project. Community-dwelling older adults are such a large portion of the Upper Valley’s population and the nurses working with them in their communities are truly heroes. I will carry the lessons I have learned through working with the UVCNP into my future nursing career. We didn’t choose this project. It chose us and we are so glad that it did.”

I feel lucky to be a part of this project. This project has helped me expand my knowledge about the role and the importance of community/parish nurses in improving health outcomes of older adults aging in community. — Ashma Shrestha

These Nursing students will all graduate from Colby Sawyer College in May. They have all accepted jobs at Dartmouth Hitchcock Medical Center. Based on the quality of their Capstone Project work and their genuine respect for the community and parish nurses they met, we are very lucky they have chosen to stay in our community. Emily Crow will be working in the Birthing Pavilion. Ashma Shrestha and Emily Martin plan to work on a medical specialties unit. Courtney Lampert will join the Intermediate Special Care Unit. We wish them all the best!