Featuring the Updated Rural Health Promotion and Disease Prevention Toolkit

Featured Speakers

	Tricia Stauffer, Senior Research Director, NORC Walsh Center for Rural Health Analysis
	Sarah Barton, Former Senior Projects Manager, Food Access through Rural, Medical and Community Systems (FARMACY) Program at Wirt County Health Services (DBA Coplin Health Systems) in Ravenswood, West Virginia
	Samantha Riley, Executive Director, Rural Health Network at Ellenville Regional Hospital

The Rural Health Information Hub and the NORC Walsh Center for Rural Health Analysis will present the Rural Health Promotion and Disease Prevention Toolkit, designed to support rural communities and organizations looking to identify and implement health promotion programs.

This webinar will highlight the toolkit and share information on different aspects of health promotion and disease prevention programs, including best practices for rural communities. It will feature existing rural programs that have successfully implemented health promotion and disease prevention programs, and discuss lessons learned related to managing and sustaining rural programs.

From This Webinar

• PowerPoint Handout
• Listen to or download an audio version [MP3]

Transcript

Kristine Sande: I'm Kristine Sande and I'm the program director of the Rural Health Information Hub. And I'd like to welcome you to today's webinar where we'll be featuring our updated Rural Health Promotion and Disease Prevention Toolkit, and also hearing from some programs that have successfully implemented health promotion and disease prevention programs. And now it is my pleasure to introduce our speakers for today's webinar.

Tricia Stauffer is a senior research director at the NORC Walsh Center for Rural Health Analysis where she contributes to public health systems research projects, rural health research and evaluation projects. Tricia has over 15 years of experience in health education and communication, implementing and directing public health programs, training, and providing technical assistance. She has a master's degree in public health from the Tulane School of Public Health and Topical Medicine, and led the update of the health promotion toolkit that you'll be hearing about today.

Sarah Barton is a nonprofit consultant focused on building sustainable fundraising capacities for small to medium-sized organizations. With a master of public administration and a background in healthcare and education, she founded NonProfit 411 to provide strategic mentorship that empowers nonprofits to secure lasting funding and achieve their long-term goals. Her recent work includes leading the Healthy Rural Hometown Initiative pharmacy program, which promotes chronic disease prevention through accessible healthy lifestyle options tailored for rural communities.

Samantha Riley is a dedicated nonprofit professional with over a decade of experience working in the human services sector. Holding a bachelor's degree in Community and Human Services from SUNY Empire State College. She brings a deep understanding of community needs and strategies to address them. Currently, she serves as the executive director of the Ellenville Regional Rural Health Network. In this role, she leaves the organization in its mission to provide quality healthcare services to the region. And with that, I'll turn it over to you, Tricia.

Tricia Stauffer: Thank you so much for those introductions, Kristine, and thanks everybody for joining us on the webinar today. I'm really excited to showcase our newly updated Rural Health Promotion and Disease Prevention Toolkit. If you're familiar with the original toolkit published in 2015, you'll see a lot of the same structure, just a little reorganization and a lot of great new resources. If you haven't seen the toolkit before today, I'll do a brief walk through the toolkit and show you some of the content that you'll find when you review it.

I'll start with some background on who we are and how this toolkit came about, for those of you who might not be familiar with the NORC Walsh Center. We are now 28 years old and we are part of NORC at the University of Chicago. We're an independent nonpartisan, nonprofit research organization and we're committed to providing timely actionable information for making decisions about health, public health, and especially rural health. We have partnered with RHIhub for the last 15 years on the development of toolkits and are grateful for their partnership. Through these years, we've partnered in the creation of about 25 different toolkits.

This toolkit was developed through a project funded by the Federal Office of Rural Health Policy and Partnership with RHIhub. The toolkit was first published on the RHIhub website in 2015. In 2023, we started an extensive update of the toolkit, as I mentioned earlier, doing a little bit of reorganization, but mostly updating it and adding some great new resources throughout. The main focus of these toolkits more broadly is to support and strengthen our rural programs and also to help us build an evidence base for rural communities and rural work.

The programs that we highlight have been implemented and demonstrated success in rural communities, so we use these toolkits as a way to share information about the experiences of FORHP grantees and other rural communities that might be implementing similar programs in rural areas of the US. When we develop these toolkits, we go through a similar process each time. We start with an extensive literature review and look at existing resources and materials on the topic that are relevant specifically to rural communities. During this review, we'll identify subject matter experts who can help fill in any gaps in the information that we find. And then we also have them weigh in on our evidence-based models that we identify during the literature search.

We then pick some key rural programs, usually several grantees to interview so that we can hear their real-world experiences about implementing programs. We ask about lessons learned that we can share with other communities who might be looking to implement a similar project, and you'll hear highlights from two of these programs that we interviewed today from Samantha and Sarah coming up soon.

The next step is putting all of this information together to create the final toolkit, which includes all of the information resources, the feedback from the interviews that we conducted. And then finally, we'll periodically review and update these toolkits to make sure they contain the most relevant and up-to-date resources and information available.

So today, I'm going to walk through just a really high level of the organization of the Rural Health Promotion and Disease Prevention Toolkit. Here you'll see a screenshot of the opening page. You can see an overview of the organization of the toolkit. Like most of our toolkits, this one is organized in a modular format. So the toolkit really meets you where you are and you can get started in whichever module you're ready to view. You can see each of the seven modules listed on the left-hand side of the screen. Each of these modules are clickable and they'll take you directly to the toolkit module where you want to start.

And today, I'm really just going to focus on the first few modules at a very high level so you can get a feel for what to expect and the kind of information that you'll be able to find in the toolkit.

So module one is our introduction to the topic. This module has some helpful background information on the topic. We start with level setting by giving a definition of what we mean when we use the terms health promotion and disease prevention. And then we have a section on barriers and opportunities for health promotion in rural areas. And that's the section of module one that I do want to focus on. I've pulled out a few of the barriers and opportunities that we identified and listed them here. I've done this because I think this provides a really nice framework by which we approach some of the later modules. These were things that we found important to keep in mind as you develop and implement and evaluate a health promotion program. Of course, these barriers and opportunities don't all apply to every single community, but are some of the common themes that we found in our research and during our interviews.

Next is module two. I think this is where the health promotion toolkit differs quite a bit from other toolkits. In other toolkits, module two typically lists very specific concrete types of program models. So an example would be the oral health toolkit has a teledentistry model, a dental home model or the substance use disorder toolkit has syringe service programs, drug courts. But health promotion and disease prevention applied to such a wide array of health topics that we organize the section based more on theories and models that inform programs and the strategies that we use to promote health and prevent disease.

We've provided information and resources about health promotion theories to make them very usable in guiding, developing, implementing health promotion interventions in your communities. Module two covers factors like what to consider when choosing a theoretical model to guide your program, and keeps in mind that any given program draws from multiple theories or models. Module two also gives an overview of common strategies used when addressing health promotion and disease prevention. This section includes some really great resources for health communication, things like how to use plain language, social marketing information, resources for finding evidence-based health education strategies. And then finally, an overview and a lot of great resources for policy systems and environmental change strategies.

And module three is made up of our Program Clearinghouse. This module provides real-world examples of rural health promotion and disease prevention programs in action. And this slide has a lot going on. It's just here to give you a sense of what we have included in module three. These are all the programs we interviewed that shared lessons learned from the field, and each has its own page in the toolkit with more information. You'll be hearing from two of the programs that we featured here a little later in the presentation.

Module four, this is all about implementation considerations. Here is where we really get into the lessons learned that we identified during our interviews. You'll find some really good information and resources about community engagement and partnerships. Things like recruiting and keeping participants in your program, and then facilitators and challenges in implementing health promotion programs. This module, it really delves into the various settings in which programs might be implemented and how to choose the best setting for the topic that you're covering.

And then the last three modules, I'm just going to cover really quickly because they are very straightforward. Like I said, I want to allow some time for our two programs to cover the great work they're doing.

Module five is all about evaluation. We cover different types of evaluation that you can do on health promotion programs along with strategies for collecting data and some sample evaluation measures.

Module six is funding and sustainability. We have some great resources here. Things like workbooks and tools that are useful and sustainability planning. And then the last module, module seven has some helpful resources for identifying dissemination audiences and tips for how to get results and information about your program out into the public and to your own community.

So that's all for me. Thanks again for taking the time to learn about this toolkit. I hope you'll spend some time looking through the different sections a little more in depth. And now I'm really excited to turn it over to Sarah to tell us more about the Food Access through Rural Medical and Community Systems Program.

Sarah Barton: Hi. I'm so excited to be with you today, and to share with you a little bit about the FARMACY project that I was involved in. I was working with Copeland Health Systems at the time, which is a federally qualified healthcare system in West Virginia. And the FARMACY program is a food access through rural medical and community systems project. The goal of the project was to provide healthy foods to patients as well as education about how to utilize those foods and optimize their chronic disease management or prevent chronic disease. So thank you for letting me share.

The FARMACY grant was piloted in a county in West Virginia and was super successful. The first couple of times that we did the FARMACY, we had local funds and we provided a farmer's market at our clinic. And West Virginia University extension services came and provided education to our patients and the patients were all diabetic. And we found that we had a significant improvement in A1C measurements as the project progressed. And we wanted to expand this project. So we applied for a HRSA grant and received it. And this grant was comprehensive and would allow three clinical partners, Copeland Health Systems, Manning Hamilton Health Systems, and Ritchie Regional Health Center to adapt the FARMACY program and offer it in seven rural areas.

So as we provided this, we learned a lot of lessons and I'm hoping that I can share with you some of these lessons learned and share with you some of our experiences to help you develop and create amazing rural projects.

The program had a couple of different arms. We wanted to engage patients in their health and their health outcomes. We wanted to demonstrate to them that changing their habits around food intake and incorporating healthy foods into their diet could have a positive impact on their health.

But in order to do this, we had to make sure that the patients had access to all the resources they needed. So through the project, we wanted to reduce some of these barriers, especially barriers to access to foods, to healthy produce. A lot of these individuals live in rural communities where there are food deserts. And I know just from experience having worked in one of these communities, a lot of times the grocery stores that do provide produce, can't keep really fresh looking produce in stock because the length of time the produce is on the shelves is elongated because there's fewer people buying it. And then also, they had a lot of frozen food because that was the easiest stuff to get into their shops. So we wanted to coordinate efforts with local farmers and other food aggregators to see if we could improve this both for the shops and the communities. We had a couple of different models.

We also wanted to make sure that this was a long-term project. So this project was 10 weeks a year and we offered it for four years. It's actually continuing to be offered, but they've actually expanded the number of weeks that it's being offered to 15 weeks. So having a project where we don't start a habit and then interrupt it is really important. We did, however, utilize local farmers, and so there is a growing season. So that did impact the length of our particular program. And then we also wanted to have a program that was provider supported. So our providers communicated with the patients about the challenges of their chronic diseases, and educated them about how their bodies were being impacted by the positive choices that they were making. So that was a really key piece to our program.

We had a lot of partners on this grant. This is definitely one of the largest grants that I've ever coordinated. And the way that we identified partners were we went into the communities we were serving and tried to learn about who was already working in that area and engage them in the project. If they were already trying to promote a project that was similar, we asked them if they would join so that we wouldn't duplicate services. We also were very strategic. We worked with a lot of local farmers. Rural action is a produce aggregator in our region, so they actually already had relationships with farmers and could bring a lot of produce to our program.

We worked with our local university, and I think that this is a great tip to work with universities to see if they can help you with curriculum development, research and data analysis. They have a lot of resources in that area and it helps take the burden off of the clinic, which we were a clinic offering this service. So it took the burden off of the clinic so that we still were collecting and analyzing really amazing data, but we didn't have to do it all ourselves. The West Virginia Office of Rural Health Services also helped with this analyzation of data.

And you'll see on here that we worked with some larger organizations like the American Heart Association and the West Virginia State Office of Rural Health. Again, we were looking to see who had a vested interest in the work that we were doing, and we asked them to partner because we knew that they had a lot of resources they could bring to the table, and the information that we could gather about the population we were serving could be very beneficial to them. So as you develop partnerships, make sure that you look at dynamic opportunities because there can be some great opportunities to really make the services in the community more robust.

We did the work in West Virginia, so you can see here the counties that we served. It was really important that whatever we did, we did across borders. We didn't want county borders to be a barrier to the project, and it worked beautifully as we engaged everybody. Like I said, we did engage state resources because they want to see the work on the ground happen, but they don't have the capacity to offer it themselves. So this allowed them to have input and receive feedback on the needs in the community without actually having to do the boots on the ground work. And like I said, we logically connected with our partners because we were all working towards similar goals, and this allowed us to enhance the work that we were doing.

I think a key to remember when you're working with rural communities is that you do need to remain flexible and you need to be working towards sustainability. As we introduced these programs into our community, it was clear that this was something the community wanted and wanted to participate in, and we don't want to create an opportunity that helps them get started on really positive behaviors, and then interrupt the services because that can be harming to the patient and it can be really frustrating and discouraging to the community. So this is why it was so important for us to have active engagement of our partners because we wanted to know that after the grant finished, we would still be able to provide some of the services in these communities.

I will tell you that working in a rural community or working in a rural region, you have to really understand that not every community is the same and you have to modify your project based on the location. We were working with clinics who had staff shortages were impacted by a pandemic, and also who were trying to do this in addition to the other work that they do. So there were some modifications we had to make along the way.

At one site, they couldn't continue to offer it at the clinic because they were going to have some renovations happening. In one county, it was really difficult to offer two FARMACYs. There are two major towns in that little county. So we found a midpoint that was really familiar to everybody to offer one larger FARMACY. And then some FARMACYs had the capacity to store food for a little while so they could offer their program in the evening. And others were like, "No, once it comes in, it has to go out right away." So we just had to remain flexible. And I think that that's definitely an important thing to remember when you're working in rural communities, remain flexible and then modify it to the needs of those communities.

And then sustainability I said, was really important. And as we looked and developed the project, we did consider what is easily sustainable. Out of this project. We developed a curriculum that could be duplicated easily, and could be shared among a lot of stakeholders. So that was something that we knew could be sustained. We wanted to sustain access to healthy produce in the communities. So we worked on identifying ways to do that. One of our sites decided to create a community garden so that they could grow their own food for future FARMACYs, which is a really exciting sustainable option. Another group worked with a farmer that they really enjoyed and that farmer said that they would continue to set up the farmer's market for their patients to use even after the grant is done, that the model was really sustainable for the grower when they had enough people in the community coming out and buying their produce. So that was really exciting.

And then there were things that didn't work. Some of the things didn't work at the clinics. Having the farmer's markets at the clinics really added a lot of congestion to all of our rural clinics and was really complex. So that's not something we'll probably continue. But what we were able to do was to partner with local grocery stores towards the end of the grant and offer the FARMACY through their stores. And that worked really well.

And another thing really to sustainability is that all of our partners were really invested in this program. The primary grantee had to pull out of the leadership role in the third year of our grant, which was definitely a concern, but the partners were so invested in it that another one of the partners was willing to pick up the responsibilities of the grant and continue the work. So you can see that sustainability. There's a lot of models, and the goal is really for everybody to be invested enough in the project to continue the work, even if we encounter barriers along the way.

I think as we build projects like this, we do want to see that project continue for a long period of time, but when projects do have to come to an end or maybe it didn't work out and it can't be continued, recognize the positive outcomes from the project, especially that relationships built through these type of projects, they don't expire with any grant funding or any other type of funding. So continuing those relationships can be really impactful for your community and you can find other ways to work together. You might find that the work that you did revealed another opportunity, or perhaps as you've just built your relationship, you find that you're really interested in multiple things that overlap. So it's a great opportunity.

Remember that rural communities are really, really resourceful and money is just one resource. I think as we partnered, this was one of the things that was very evident is that our rural communities had so many resources to offer. They had volunteers and they had locations that they wanted to share with us for this project. They had relationships within the community that they were happy to welcome us into and to share with us, which was huge because we didn't do business in some of these communities. We were outsiders. So having those partners share the resource of the introduction and trust in us with other people in the community was really, really important.

And then another thing that we learned from this is that we were really passionate about making sure that we rewarded our partnerships with the grant funding that we had. As we all received funding, we looked for opportunities to share the resources that we received, whether we were sharing the curriculum or the funding, which we actually did do. All of the participants received some funds. It was really important that we shared continuously throughout the process.

So those were some of the things that we learned from our project. I hope that they'd be useful for you. I'm always open to sharing more about our projects and talking more about how we created these partnerships, if you're ever interested in learning more. Thank you so much for your time today. If you have any questions, I'll be happy to answer them when it's appropriate.

Samantha Riley: Good afternoon everybody. My name is Samantha Riley, and I am the executive director of the Ellenville Regional Rural Health Network. And today I am going to be talking to you about some of our programs and our Rural Health Network at large, and the power in the partnerships that we have that make our work successful. I'm going to start you off with a little quote here. “Coming together is a beginning, keeping together is progress, and working together is success,” by Henry Ford. I like that quote because I think it's very true. It talks about collaborations in a very nice way.

So the power and partnerships, I think everybody knows this, but we're going to hit it, it's just for good measure here. But partnerships are essential in community networks because they amplify your impact, they enhance your resources. And I'll resonate with what Sarah said, not just talking about money. Don't forget your people power. There's power in the people and your connections. The more people you work with, the broader your reach is, the more you can advocate for people and the more that you can foster collaborations. And all of this leads to promotion of sustainability for our programs. So by working together, community networks can create a more positive and lasting impact on the communities that we're all serving.

So a little bit about the Ellenville Regional Rural Health Network. The Ellenville Regional Rural Health Network was formed in 2017 off of a HRSA grant. The main collaborators that got this partnership going were Ellenville Regional Hospital and the Institute for Family Health, which is the federally qualified health center in our area. We actually are on the same piece of property. So the hospital is positioned adjacent to the Institute for Family Health, so that our positioning just made our partnership all that much more easy. But they were the ones that spearheaded putting this together. And then they got together with Cornell Cooperative Extension of Ulster County, Catholic Charities of Orange Sullivan and Ulster, and our local department of Health and Mental Health and got everybody together and said, "Hey, let's do this. Let's serve this rural community and get together."

So this group got together and they had to come up with a mission. So the mission of the Rural Health Network is really simply just to deliver services that are going to improve the health and wellness of people in our area. Ellenville is located in rural Ulster County. We're positioned between two mountain ranges, so we're very secluded where we are, we have the Catskill Mountains to our left and the Shawangunk Ridge to our right. And not only is it a 30 to 40 minute drive to other health institutions, but it's over a mountain. So not only is it far, but it's not an easy drive.

So for us, providing services in this area is vital to improving the health and wellness of people. All of the programs that we deliver, we decided to focus on these four pillars. We try to focus on nutrition, physical wellness, health risk reduction, and supporting social determinants of health. And all of these things are delivered through various grants. Grants come and go. And these are some of the current grant projects that we have currently. We have two HRSA grants. One is the Rural Communities Opioid Response Program, lovingly known as RCORP. And we have a small healthcare provider quality improvement program where we're focusing on cancer prevention and nutrition counseling. And then we have an OASIS grant, which is also substance use related. So these are the three current projects that we have, and I'm going to talk a little bit about them and the partners we have.

So my first words of wisdom here are collaborate, don't compete. And this was something that I had to learn as I went from being a front line community health worker into management. So our nutrition programming, and this is the first example I want to give you where this collaborate, not compete. Our nutrition team obviously has goals of working with folks one-on-one and teaching classes, Cornell Cooperative Extensions have an Eat Smart New York program, which has the same mission. We're partners. We work very well together. But I think when this relationship was first formed, there was a lot of talk of, "All right, we're providing the same service. How are we going to work together and not compete with one another?

So we sat down, we had a conversation and we collaborated and talked it out. And Cornell Cooperative does group classes, and Ellenville Regional Hospital's Rural Health Network, we do the one-on-one work, and we constantly are referring back and forth to one another. If someone is in a group class with Cornell and they need one-on-one assistance, they're going to refer them to us and we refer all our folks to them. And together we are providing nutrition counseling and classes to the community several times throughout the year at all different locations. We're at schools. We're in churches. We're in the senior housing complexes. We go to the library. We partner with the local grocery stores and other community-based organizations like the Community Action and an organization called Family of Ellenville. We're working together to improve community health through nutrition. And this collaborative approach really offers personalized nutrition coaching and informative workshops to prevent and manage chronic diseases like hypertension, obesity, diabetes, and high cholesterol, and the partnership that we have with Cornell is strong now and is good. And we write each other into each other's grants, and we support each other as best we can.

Our other pillar, physical wellness, we work in partnership with local organizations that are committed to promoting physical activity. We're looking for partners that have similar goals to ours. And our collaborative efforts have led us to be able to offer a variety of free fitness classes at convenient locations throughout the community. So we're partnering again with the schools, the hospitals, the senior housing, again, the churches, the libraries, fitness centers, senior centers, community centers and local businesses that support what we're doing. We offer classes from yoga to Tai Chi, to strength training, walking groups. We really have something for everyone. We offer classes for adults, kids, families, seniors, and by encouraging regular exercise, we're working to improve overall health and well-being for people in our community.

Another quote for you here: “Great things in business are never done by one person. They're done by a team of people. And I think that is very true. So I want to talk a little bit about a team that we work with. Under the pillar of risk reduction, a lot of our work is in the substance use arena. We are part of a team called High Risk Mitigation, which is led by the Ulster County Sheriff's office, and it is a team of community-based organizations that are working to fight the opioid epidemic in our area. And you can see here there's a list of the high risk mitigation team, and it's very expansive. So you have law enforcement. You've got community-based organizations. You have health institutions. You have the county department of mental health. You've got mobile mental health, and you've got these other community-based organizations that are doing that care management navigation piece.

So we have a very diverse team of folks all with the same mission and different grants, and we all come together to address substance abuse in our community. And we do that in our variety of ways. So some of the substance use disorder, risk reduction services that we're all doing as a team and individually is we're doing youth prevention work. We're in the schools. We're doing medication take back events because we want to limit the opioids that are out in the community. So we're promoting safe storage and disposal, giving out locking storage bags and drug deconstruction kits. We're talking about proper sharps disposal and giving out sharps containers so that those things are not out in the environment. And we're doing a ton of Narcan trainings and distribution of Narcan. We're putting the NaloxBoxes out in the community so people have access to Naloxone when they need it. We're distributing harm reduction kits such as alternatives to injecting, fentanyl test strips, and the Narcan of course.

And then all of those folks on that high-risk mitigation team meet every Thursday virtually to talk about high-risk individuals that need support. And we outreach to them, meet them where they are, whether it's in their home or if they're homeless, wherever we can find them to link them to treatment resources. And then we're also supporting folks in their recovery journeys. So there are lots of collaborations that make all these things we do successful, even outside of this high-risk mitigation team. For example, the NaloxBoxes, we had to partner with businesses that were willing to place those in their businesses, gas stations, restaurants, grocery stores, the local gym, anybody who was willing to house one of those. So you see how these partnerships just expand and expand. And without those partnerships, this work wouldn't be possible.

Some other risk reduction work that we have going on, and this is under our HRSA QI grant for the cancer screenings. We're doing some smoking cessation work. So we've partnered with the New York State Quitline, the Center for Tobacco-Free, Hudson Valley, the American Lung Association, and the Institute for Family Health. And we're reaching out to tobacco users and we're screening them for lung cancer screening eligibility. And we're trying to support them in their quit journeys. And we couldn't do that without that really firm partnership with people I have listed there.

The Quitline has given us access to do direct referrals with them, and we can track the referrals through their online referral system, which is fabulous by the way. If anybody doesn't have that access, I highly recommend it. And the Institute for Family Health, which does the primary for our region, their doctors are screening folks for tobacco use and referring them to the hospital to get their low dose CT scans for their lung cancer screenings. And that's how all that works together. And then we're reaching out to patients. Breast cancer guidelines say when you turn 40, you should be getting a mammogram. So the Institute for Family Health is reaching out to their 40-year-old patients, and we're reaching out to the 40-year-old patients that come through the hospital to educate them and encourage them to get their mammograms.

And our last pillar is our social determinants of health and all the work we do, no matter what the grant is, works on this. And a consortium can effectively address social determinants of health because you have power in numbers. We're collaborating with diverse partners to collect and analyze data from different viewpoints. The data that law enforcement gets is very different than the data we get as a hospital or as a community-based organization. And we bring all that data together. We can really get a good picture of the community and what it needs and identifying those needs. And then implementing target interventions and engaging the community to support our efforts such as those NaloxBoxes and convincing businesses to put one in their lobby. Advocating for policy changes and then measuring our impact as a group because we have power in numbers. I can't stress that enough. Consortiums create sustainable solutions that improve health equity and wellbeing.

The strength of a community lies in its diversity. So not only do you want to have power in numbers, but you want to make sure that you have a team from all different sectors. So when I started working on this slide, I was like, "There is not enough room on this slide for me to truly list all of our partners," but I wanted to at least try to give you guys a visual of how I look at this and how our rural health network looks at this and where we try to gain our partners. So we have community groups. I'm calling it public safety here, but that's like police fire, the 911 dispatcher, emergency management folks, and our local EMS squads, healthcare agencies, education institutions, our public officials and our local officials, and of course our local businesses. And I'm not going to read all this word for word here, but I'm sure you all can see that all these different sectors bring a different perspective to the work that we're doing. So together with these diverse partnerships, it really drives a strong force for us to be able to deliver our mission.

“In teamwork, silence isn't golden. It's deadly.” So outside of these strong partnerships, communication is so important. I can't stress enough, you could have all the partners, the perfect partners in the world, but if you don't talk to them, then it's not working. Has anybody ever been in a work group meeting or a coalition meeting and it's quiet and there's silence? I hate that. So I call on people and I'm like, "Hey, Becky, how are things going at Family of Ellenville? Do you have a workshop coming up that you can tell the group about?" Communication is the bedrock of any successful partnership. It serves as the glue that binds partners together, ensuring that everyone is on the same page, understands their roles and responsibilities, and works towards shared goals. And you're going to do that with regular check-ins.

Most of our meetings and we all go to each other's meetings. We end up seeing each other a lot. But if someone comes to your meeting, go to their meeting. If you miss a meeting, call them and email them and say, "Hey, sorry I missed that meeting. What happened?" And when you go to meetings and when you're communicating with your partners, share your knowledge. Let them know what and ask them what they know. Ask questions. Be clear and concise when you're in meetings and you're trying to work with folks. Provide constructive feedback, but show empathy and don't be rude. And always, always celebrate your successes as a team. I think it's really important to celebrate the successes that we all have because it just makes us feel better about what we're doing, and it just powers us to go further in our missions.

So that was a quick rundown. I want to thank everybody for your attention. My contact information is below, and thank you very much for the opportunity to speak today.

Kristine Sande: I just have to say how truly impressed I am looking at your slides that show the partners that you have in each of your communities. It's just really fabulous that you can get so many people together to work on these issues. And really these types of programs do take everybody pulling together to make a healthier culture and community. Do you have tips about maintaining those partnerships and collaboratives in terms of what level of coordination is really necessary to keep those partnerships going and keep organizations engaged?

Sarah Barton: I meet with my partners every two weeks and everyone's like, "Wow. That seems like a lot." But what I found was that if I met every month, that if they missed a month, it might be longer. It might be six weeks before I speak with them. And oftentimes they missed the meeting because something was happening. So I meet with my partners every two weeks and we can keep it short sometimes. Our meeting was only 15 minutes or 20 minutes because that's all we needed to check in, but I don't think that I could do it meeting less just because with that many partners, you don't know all of the things that are happening in their life outside of being able to meet with them just briefly to do a check-in at least

Samantha Riley: I couldn't agree more, Sarah. We do that as well. We have meetings, are scheduled for an hour and then what you're talking about we call huddles. So sometimes we have quick huddles where they're really just check-ins to see how things are going. And the only other thing I would add is in this post-COVID world, while virtual is great, I think you can't beat a face-to-face interaction. And having in-person meetings and seeing people face-to-face is really important as many times and as much as you can.

Kristine Sande: What social determinants of health screening tool do your partners use? Is there a standard one that you're using?

Samantha Riley: So because our partners come from different sectors, I think everybody uses a little bit of a different tool depending on where they're coming from and what their agency missions are. So for the hospital, we're using one that's built into our EMR, our electronic medical records system, and it's actually Hixny’s social determinant of health questionnaire. So that came down from our RHIO, so some of that was given to us. I think the community-based organizations have a little bit more freedom in tailoring their assessments, but the big ones that we look for in our area are food insecurity and housing insecurity, as well as employment. One of our largest employers, which was a grocery store recently closed in Ellenville. So as the needs of our community change, we target our assessment questions a little bit, but there's not a standard one though.

Sarah Barton: One of the things that she mentioned was that the larger organizations struggle a little bit more to pivot than some of our smaller organizations. And I think that that's such a great thing to be able to acknowledge about your partners, and recognizing that that need or that limitation. So if the larger partners have already invested money in some resources to screen, a great way to utilize the partnership may be for them to help share those down rather than the smaller organizations having to come up with those type of resources. Because a lot of times we find that our larger organizations, while they're less likely to be able to pivot, they're very generous with what they have purchased created. So making sure that you think about that as you work with your partners is really important.

Kristine Sande: How do you approach the stakeholders to invite them to work with you about issues of food security and nutrition?

Sarah Barton: We actually went to stakeholders who were already providing in that area, or had some type of invested interest in health or some health was really our focus. So if they were interested in health, then food security is a natural thing for them to be interested in. And in the community, there are already a lot of other organizations working with food, so we went to them and asked them if they would just like to join efforts. So doing an asset map of what you have in your community and approaching them because they're already serving that population.

Samantha Riley: Yeah. Looking for folks with that shared goal, which I think food is an easy one. Nobody wants anybody to be hungry. We also have a similar FARMACY program at the hospital and this past year, getting donations for that has actually been a little difficult. I don't know if it was a rough growing season where I'm located or what, but in our Rural Health Network meeting, we just put the word out that we were in need of donations, and put it out in an email blast and people that are interested and have a vested interest in that nutrition or food insecurity came forward and we haven't had to cancel one FARMACY yet. So that's been great.

Kristine Sande: Another question from a school nurse. She would like to know more about the Naloxone NaloxBoxes and any partnerships that you have with schools and how that would work.

Samantha Riley: Sure. Our local school, they do a health fair, but it's just for the staff. It's one of the days when the kids are home and they have a superintendent conference day type thing. So we go once a year, we train all the teachers in Narcan, and then we supply the nurse's office usually with the supply of Narcan. Each school could do it differently of course, but in your local agency, you could start with your local department of health or mental health, and they could probably direct you to someone who provides Narcan in your area. Or if you have a Rural Health Network or some organization nearby you, I'm sure they would be willing to do that with you.

Kristine Sande: I'd like to thank our speakers today for their great presentations and sharing their knowledge and experience with us. Thank you again for joining us, and have a great day.