UV Adaptation Workgroup Sets Strategic Direction

Flood waters from Hurricane Irene left behind fuel spills and other hazards.

In September 2017, the Upper Valley Adaptation Workgroup (UVAW) released a new strategic plan outlining four goals for this bi-state, multi-stakeholder working group of leaders and partner organizations working to build climate resilient communities in the Upper Valley. Goals include:

  1. Be a greater public educational force on climate change impacts.
  2. Serve as a hub to convene stakeholders, build relationships and develop new partnerships for coordinated action around climate change impacts in the region.
  3. Be a resource and support partner for community projects that increase resilience to climate change impacts.
  4. Build UVAW’s organizational sustainability, leadership, and governance structure.

In 2011, UVAW formed as a bi-state volunteer group of community leaders and organizations in the wake of Tropical Storm Irene.  We saw that many groups were working on mitigation to slow the pace of climate change – but no group was working on adaptation to prepare for changes we know are inevitable, and are already happening.

Building the “Playbook”

Downed power lines shows need for adaption to climate change.Shared learning and co-production of knowledge is the only way our communities will be able to adapt to unprecedented change – change we are just beginning to experience, and for which no “playbook” exists.  A regional approach is essential. UVAW is the only region-wide entity dedicated to helping community leaders find out what each other is doing in the field of resilience, get ideas, and generate creative collaboration.

This is our second strategic plan. It reflects continuity in growth through the plan developed in 2013 and six years of experience with numerous regional forums and engagement processes.  For this plan, we reached out broadly to invite regional leaders to help us flesh out our thinking.

We extend a gracious thanks to the 24 internal and external stakeholders from Vermont and New Hampshire who provided valuable input. We asked them about UVAW’s contributions, opportunities, and emerging context in the field of climate resilience across the bi-state region.  Their insights contributed to our thought process as we developed our plan. The depth and breadth of information they gave us will guide us moving forward in extending our hand in partnership and in supporting each other’s initiatives.  Contributors included:

  • Meghan Butts, Upper Valley Lake Sunapee Regional Planning Commission
  • Matt Cahillane, NH Department of Health and Human Services
  • Leigh Cameron, New England Grassroots Environmental Fund (NEGEF)
  • Anne Duncan Cooley, Upper Valley Housing Coalition (through winter 2017))
  • Alice Ely, Public Health Council of the Upper Valley
  • Kevin Geiger, Two Rivers Ottauquechee Regional Commission
  • Beth Gibbons, Institute for Sustainable Communities & the American Society of Adaptation Professionals (ASAP)
  • Sherry Godlewski, NH Department of Environmental Services
  • Anne Goodrich, Upper Valley Strong & Pathways Consulting
  • Mark Goodwin, City of Lebanon Planning Office
  • Lisa Graichen, UNH Cooperative Extension Climate Action Program and NH Sea Grant
  • Julia Griffin, Town of Hanover
  • Peg Elmer Hough and Mindy Blank, Community Resilience Organizations (CROs)
  • Alex Jaccaci, Hypertherm
  • Rosi Kerr, Dartmouth College Office of Sustainability
  • Kate McCarthy, Vermont Natural Resources Council (VNRC)
  • Sarah McKearnan, VT Agency of Natural Resources (through spring 2017)
  • Greg Norman, Office of Community Health, Dartmouth Hitchcock Medical Center
  • Erich Osterberg, Dartmouth College Dept. of Economics
  • Deb Perry, Institute for Sustainable Communities & the Resilient Vermont Project
  • Kevin Peterson, New Hampshire Charitable Foundation
  • Tom Roberts, Vital Communities
  • Beth Sawin, Climate Interactive
  • Michael Simpson, Center for Climate Preparedness and Community Resilience, Antioch New England Graduate School
  • Gaye Symington, High Meadows Fund

Stakeholders Shared Key Adaptation Messages

  1. As we continue to feel impacts from a changing climate, keeping climate adaptation on the front burner, nurturing cross-sector relationships, and engaging the business sector are all imperative. UVAW should continue our efforts in filling these needs in the Upper Valley.
  2. UVAW’s educational forums and community outreach efforts have been very successful and should be continued. Extending UVAW’s role in moving from education to action and bringing new partners to the table are important next steps – by sharing resources and success stories, joining in convening, and identifying the places where we can add unique value without duplicating the efforts of others.
  3. Communities need help – the problems are complex, resources are constrained, capacity is limited, and they cannot do it alone – nor can we. Focusing UVAW’s role on building multi-sector relationships will help translate knowledge and opportunities across geographic, sector, and issue boundaries, and break down silos that hinder the discovery of creative solutions and the development of political and community will to act.
  4. Since our founding six years ago, UVAW has had great success. As we grow and evolve in our community impact, it is also an important time to grow and evolve as an organizational so that we can sustain that work over the long-term.  Our governance and work processes, financial resources, leadership and membership growth, and infrastructure capacity will be part of our workplan as well.

We look forward to continuing conversations and partnerships with our stakeholders over the coming three years, as we implement our strategic goals and help to build the Upper Valley’s commitment to crucial resilience actions that will support community well-being the face of unprecedented change.

Submitted by Sherry Godlewski and Alex Jaccaci, UVAW Co-Chairs

PHC Elects Board Members at Annual Meeting

Joanne Conroy MD/CEO speaks at PHC Annual Meeting

On November 17, the Public Health Council of the Upper Valley (PHC) Board of Directors held their annual meeting at Hypertherm with over 50 community members and public health advocates in attendance. Dr. Joanne Conroy, CEO and President of Dartmouth-Hitchcock was the guest speaker.  [Conroy Video Clip/Full Talk]

Carol Stamatakis, of Senior Solutions, asks Dr. Conroy a question.

During the business portion of the meeting, departing board member Mardee Laumann of Enfield, NH was recognized for her many contributions. Julia Griffin, Hanover Town Manager, was elected to her second term as PHC Board Chair.

The Board also welcomed new Directors Dan Fraser, Nicole LaBombard, and Laura Cody McNaughton. Dan is a well-known figure in the Upper Valley. He grew up in Norwich, where he now runs the family business, Dan & Whits, and serves on several local boards. Nicole, also an Upper Valley native, works as a Community Health Partnership Coordinator at Dartmouth-Hitchcock Community Health. Laura is the District Director for the Vermont Department of Health’s District Office in White River Junction.

Director’s Report

Alice Ely, Executive Director of the PHC, shared highlights of the PHC’s work over the past year in her annual Directors Report. In 2017, the PHC piloted an oral health screening project in New Hampshire communities. This pilot led to the expansion of the Ottauquechee Health Foundation’s Smiles Project to serve both sides of the Connecticut River.

The PHC also conducted an evaluation of several summer meals programs for school-aged children to better meet the needs of food insecure children and hosted a forum for school personnel and area service providers to better understand student needs and resources already available in the community.

Five flu clinics were also hosted by the PHC in rural communities across our region, providing over 1,100 vaccines.

As one of 13 regional health networks in New Hampshire, and serving 22 communities in Vermont, the PHC has quickly become the region’s largest and broadest coalition of advocates on public and population health issues. The PHC is a dynamic organization with the flexibility to respond to the needs of its grassroot members with financial support provided by individuals and governmental, philanthropic, and health care institutions.

APHA Annual Meeting: PHC Was There

This November, two Public Health Council of the Upper Valley members and several individuals from the Health Promotion Research Center at Dartmouth (HPRCD) presented local work at the American Public Health Association (APHA) Annual Meeting in Atlanta, Georgia. The event, which took place from November 4th – 8th, centered on the overarching theme: Climate Changes Health. Throughout the conference, keynote speakers explored how our changing climate impacts human health both directly and indirectly, and how it creates and perpetuates health disparities across our country and the world. The APHA Meeting also includes sessions that cover many other public health topics. With nearly 12,000 people in attendance, the APHA Meeting allowed attendees to network with, learn from, and educate one another.

Tobacco and Electronic Nicotine Delivery Systems Use

Stephanie Kelly discussing ENDS use in NH youth with Dr. Stan Glantz, professor, tobacco researcher, and activist based at University of California, San Francisco.

Stephanie Kelly, of the HPRCD and PHC’s Oral Health Work Group, attended sessions on oral health and tobacco cessation efforts. Her poster presentation, titled “Tobacco and Electronic Nicotine Delivery Systems (ENDS) Use Among New Hampshire Youth, 2010-2015” discussed how New Hampshire youth’s patterns of e-cigarette use relate to national trends, and how prevalence of e-cigarette use varies by gender and high school grade level. Kelly’s poster was well received by other tobacco researchers, who drew connections between New Hampshire’s data and their own anecdotal experiences. [Stephanie’s Abstract]



APHA Members Learn About Rural Aging in Community Groups

Emma Hartswick, former PHC Fellow, presenting her work on rural aging in community groups.

Emma Hartswick, a former fellow at the PHC, also attended the conference to share a community listening project she conducted with Upper Valley residents. Her oral presentation, titled “Exploring Successes, Challenges and Next Steps for Rural Aging in Community Groups” featured the voices of local leaders who are working hard to help their neighbors retain their agency and autonomy as they age, despite the added challenges imposed by a rural environment.

When Hartswick began the project in the winter of 2015, her goals were to understand what services Aging in Community groups offered, how they provided them, and what the Public Health Council could do to support their important work. Looking back two years later, our community’s efforts to support older adults impressed people who attended the talk, and many supported our conclusion that large public health and clinical partners should turn to local organizations to set priorities and guide future work.

APHA Provides Exciting New Information

Now working as a Case Manager and Child Development Coordinator for Boston Health Care for the Homeless Program, Hartswick also attended sessions on mental health, substance use, social justice and maternal child health. “There was so much to learn! I’m really excited about the ideas and approaches I can take back to my team now.” Hartswick said she was struck by how interdisciplinary the conference was, with topic sessions often melding key themes from multiple areas.

Jam packed with posters, talks, booths, round tables and panels, the APHA Annual Meeting both sparked new questions and affirmed current ideas. “It was cool to see how many of our PHC priority areas were big topics of the Annual Meeting,” said Hartswick; “it made it feel like we’re heading in the right direction, on the cutting edge, but not alone.”

Flu Season: We Are Ready!

Flu season is upon us and the Public Health Council of the Upper Valley wants to prevent the spread of this uncomfortable and sometimes fatal illness. Through five free flu vaccine clinics in communities throughout the Upper Valley, we recently provided over 1,100 free flu vaccines to youth and adults.

As with all Public Health Council initiatives, this was a collaborative effort. We want to thank our many partners. Dartmouth-Hitchcock generously donated all the regular and high dose vaccine given. Thirty-four students from the Geisel School of Medicine volunteered over 140 hours of time to administer the vaccines. The Public Health Council’s Medical Director, Bill Boyle, supervised the clinics. We are also grateful to current and former members of our Board of Directors who helped at the clinics. We also received critical support from Plainfield Caring Neighbors, Mascoma Community Health Center, Rivendell Academy students, HealthHUB School Clinic, Upper Valley Medical Reserve Corps, and Vermont Law School for staffing the clinics.

Most importantly, we want to thank the 1,100 people who came to get their flu shot for protecting themselves and their loved ones from this preventable illness.

Flu is deadly, but preventable

The flu results in approximately 12,000 to 56,000 deaths every year in the United States, according to estimates from the Centers for Disease Control and Prevention. In New Hampshire last year, there were 47 influenza-related deaths, including two pediatric deaths. The good news is that flu can largely be prevented with annual vaccines. If you missed one of our vaccine clinics, flu shots are still available from your primary care provider or at various local pharmacies.

The Public Health Council is dedicated to protecting and promoting the health our communities. Whether we are preventing illness, building innovative oral health programs, or expanding summer meals programs for children, we are always bringing people together to find solutions that work for our region. It is our pleasure to serve the Upper Valley.

A Broader View of the Mental Health System Crisis in NH

Recent press reports and opinion pieces regarding the mental health system in New Hampshire have focused on the shortage of psychiatric beds at NH Hospital and its impact on local hospital emergency rooms. Daily email updates from the Department of Health and Human Services starkly report the numbers of adults and children with a mental illness waiting each day for a bed, which have shown a steady increase year to year.

Governor Sununu and key legislators who witnessed the emergency room backup first-hand at Concord Hospital earlier this year were inspired to re-write and make more robust what was initially a modest proposal for a new Ten-Year Mental Health Plan – HB 400 – and add money to fund it in the state budget. At the same time, the NH Community Behavioral Health Association (CBHA), the organization that represents NH’s ten community mental health centers, was advocating for workforce funding in the budget, but our request was upstaged by the bed shortage and hospital ER situation.

There is no doubt that the investments made in and attention given to mental health this year by the Governor and the Legislature are positive steps forward; however, CBHA sees two inherent problems with this approach: one is that policymakers are reacting to an immediate crisis and not addressing the underlying structural weaknesses of the mental health system; another is that adding more psychiatric beds, ACT teams and mobile crisis units to the mix does not mean that services are going to be delivered if we don’t have the people to do the work.

Greatest Need is Workforce Development

Some basic investments in workforce development programs could encourage people to enter and stay in the mental healthcare field. The ten community mental health centers currently have over 170 openings statewide and the wait time for an appointment can run several weeks. Medicaid rates at the centers are at 2006 levels, which has a direct impact on the centers’ ability to attract and retain qualified staff. CBHA asked the House and Senate to fund rate increases for our clinical staff this year but the new services in HB 400 and the budget were seen as more critical.

Meanwhile, the centers compete for staff with hospitals, MCOs (the insurance companies which manage the state’s Medicaid managed care program), schools, FQHCs, and other healthcare providers, almost all of whom can offer higher salaries and benefits. The upshot is that people who need mental health services before they get to a crisis level and need hospitalization are not getting help when and where they need it. Adding more beds to the system will not take care of the root of the problem, which is a weak and underfunded community-based system. Increasing rates beyond the 2006 level is the simplest fix.

Another relatively easy fix to the workforce problem is to relieve the community mental health centers of some of the administrative burdens imposed by the State and the Medicaid managed care program. CBHA’s suggestions range from eliminating some paperwork burdens required of staff, to consolidating data, reporting requests, and audits. One of the most commonly voiced complaints in staff exit interviews relates to the oppressive burden of paperwork.  An example CBHA outlined for the Governor’s office, following his request for a list of administrative rules that could be eliminated, shows that staff at one community mental health center must complete and sign 56,300 documents per year. These documents are in addition to the documentation for intake, therapy, and psychiatry services that clinical staff must also complete.

Simply put, a rate increase for community mental health centers and some relief from the administrative rules that unnecessarily burden our staff could make a significant difference in solving the workforce problem. And that in turn could help reduce the number of people who wind up at the other end of the system: needing a psychiatric bed at NH Hospital and sitting in a hospital ER while they wait for one.

There was much progress for mental health made in 2017, but we need to do more. The State and the community mental health centers worked together in 2008 to develop the original Ten-Year Mental Health Plan, which was celebrated for its vision but never fully realized because of inadequate funding. CBHA is glad to participate in the new Ten-Year Plan directed by HB 400, which we hope will lead to a more structurally sound and adequately funded mental health system for the future.  Let’s get to work and start making a better mental health system for New Hampshire.

Suellen M. Griffin, MSN, is President of the NH Community Behavioral Health Association and President and CEO of West Central Behavioral Health in Lebanon. Ms. Griffin is also an active member of the Public Health Council of the Upper Valley’s Advisory Council.