Columbia Gorge Collective Impact Health Specialist

Description

The rural Columbia Gorge region in north-central Oregon and south-central Washington faces significant health challenges. In 2012, several community partners, including Providence Hood River Memorial Hospital, noticed that the Gorge community was missing out on important grant opportunities. The community lacked the resources to track grant opportunities, convene partners, design responsive programs, and complete applications on tight deadlines.

In response, Providence Hood River Memorial Hospital committed itself to funding a full-time position designed to fill these capacity needs: the Collective Impact Health Specialist (CIHS). Originally intended to serve as the "community grant writer," the CIHS works with community partners across sectors to help identify community needs, convene appropriate service providers to design initiatives to address those needs, and pursue funding to support those initiatives.

The CIHS position has capitalized on the Community Health Improvement Process (CHIP), a list of community members' needs written by community members. The CHIP divides these health needs into three categories:

• Social Determinants
• Direct Healthcare Services
• Health and Healthcare Ecosystem

Services offered

The CIHS can engage in an initiative if the initiative meets two criteria: 1) it falls under the CHIP and 2) it involves at least two community partners. Once both criteria are met, the CIHS:

• Identifies and convenes appropriate partners
• Facilitates conversations to design need-focused initiatives
• Seeks and secures funding to support those initiatives
• Works to connect and align local funding sources to support local initiatives
• Shares grant writing resources, including funding opportunities and common data

In addition, the CIHS role has evolved into a leadership role of a larger project called the Healthy Gorge Initiative. The CIHS has an Apprentice Collective Impact Health Specialist, who is learning and practicing all of the services provided. The Healthy Gorge Initiative team is undertaking a Ripple Effects Mapping exercise to identify the impacts of the CIHS model on individual community members, partner agencies, and the ways these agencies work together.

Results

Since the CIHS position began work in 2014, the model has helped develop over 90 new collaborative initiatives that have in turn created 50 full-time jobs, trained over 100 community health workers (CHWs), and secured $32.2 million so far.

Some highlights include:

• The region's first school-based health center
• Mental health collaborative that includes primary care, public health, school districts, social services, law enforcement, and mental health providers
• Advocacy for and development of affordable housing units
• Several multi-partnered coalitions to address specific needs including food systems, health equity, childhood obesity, housing, and workforce development
• Increase in community partners' interest and capacity to collaborate
• Alignment of local funders, beyond pandemic response, in order to better address local needs and leverage more "outside" funding
• Development of an apprentice CIHS, who increases capacity in the short term while ensuring long-term succession plans

Providence Oregon, the healthcare network that includes Providence Hood River Memorial Hospital, has committed to replicating this model in rural Clatsop County, a region along the coast in northwest Oregon.

In addition, the CIHS role has been critical to creating a culture of collaboration across historical geographic, sector, and population boundaries. The Gorge has received the following recognition for its work: It was named a 2016 RWJF Culture of Health Prize winner, was selected as a Blue Zones Demonstration Community, received a visit from former Oregon governor Kate Brown and former Centers for Medicare & Medicaid Services (CMS) administrator Andy Slavitt, and is part of the National Academy of Medicine's Community-Driven Health Equity Action Plans.

Challenges

The design and funding for the CIHS model has come exclusively from Providence Hood River Memorial Hospital, a small community hospital within the much larger Providence system. There were no real barriers to the project within the Gorge community. Partner organizations quickly recognized the value of the community-based role.

The largest challenge at this point is capacity: capacity of the CIHS role itself as the project expands, capacity of community partners to take on more work, and capacity to create long-term change.

Policy change is the next challenge: The bulk of the programs launched have been intended to address immediate needs (downstream conditions), not the cause of those conditions. In order to create lasting change, the CIHS and community need to change the policies that result in those conditions.

Replication

The CIHS position can be replicated in any geographic or issue-based community. At its core, it is simply a community resource shared by community partners. This model builds on, works with, and coordinates assets already available in the community. Collaboration is both the goal and the process. Collaboration is built on relationships that are built on trust, which is built on shared experiences that are built on shared goals and needs.

Collaboration is the key activity of the model's success – and the broader work – in the Columbia Gorge region, and that collaboration is built on trust. The willingness of community partners to work together across sectors and other historic barriers has led to community-identified needs as well as community-identified solutions. These two components make it easier to secure funding and make any program stronger. Trust helps partners think differently – and more innovatively – about potential solutions.

Neutrality is key for both the funder and the CIHS's day-to-day work. The funder should not dictate the content of the needs or the solutions designed by community partners. It should be noted that Providence has not received any of the $32.2 million in funding that has come into this community.

The CIHS must also remain neutral in designing the initiatives that address those needs. While the CIHS convenes and facilitates those discussions, this neutrality keeps the focus on the need itself and creates the space to design the best program regardless of organizational politics, personal agendas, and "the way we've always done it" mentality.

Contact Information

Paul Lindberg, JD, Collective Impact Health Specialist
Partnership of United Way of the Columbia Gorge and Providence Hood River Memorial Hospital
Healthy Gorge Initiative
541.490.2340
plindberg65@gmail.com