Moving Upstream: Addressing Social Determinants of Health

Hello everyone thank you so much for joining us for today's Health Professions educator health system science session just a couple of housekeeping keeping items before we get started if you're posting um questions please go ahead and post those in the chat and throughout the session we will um let Aaron know that there are questions available and we will read those out for him we'll also hopefully have some time at the end of the session for questions um but make sure you do add your questions in the chat in the event we don't have time um also we're posting information regarding receiving CMU credit and providing feedback for this session and that information will be posted in the chat as well it's my pleasure to introduce our presenter for today's session Aaron Bush he's the director of Community Health and Outreach for Carilion Clinic Aaron graduated from James Madison University with a bachelor's of Science and Health Service Administration and minors in business and gerontology Aaron received his master's of healthcare administration from Jefferson College of Health Sciences he currently works as a director for carillion clinic community health and Outreach where he oversees carilions health education Community Health nursing peer recovery and Community Health worker programs Aaron is also on the board of directors at Presbyterian Community Center in Southeast Roanoke City and at Goodwill Industries of The Valleys he serves on the steering committee and chair for the healthy behaviors work group for healthy Roanoke Valley which is a partnership of over 50 Community Partners working to create strategies that tackle the issues plaguing the health of the area Aaron has presented at local state and national conferences and lives here in the city of Roanoke thank you so much for joining us today Erin I'm going to turn it over to you great thank you Sarah I'm going to attempt to share my screen now all right can you see that looks at it we see it okay great as Sarah said I won't be able to see the chat today so if you do put a message in the chat um somebody in the back end will make sure that I see the question um but today we're going to talk about moving Upstream addressing social determinants of health and and again my name is Aaron Bush I'm the director for crowing clinic community health and Outreach I was planning on co-presenting with Molly Roberts our community benefit manager but she is out on maternity leave so she won't be joining us um but I will cover the presentation um a little bit about our department in community health and Outreach um we roll up under Shirley Holland who's our vice president for planning and Community Development and within carillion in partnership with our community benefit team we have the responsibility for conducting Community Health assessments uh responding to needs through Community Investments through a grant and community-based sponsorship process Community Partnerships which we'll be talking about today Community Health Improvement programs Neighborhood Health initiatives and then we report everything back into Community benefit which we'll go over today as well and my team includes a multi-disciplinary team under our Administration we have an embedded marketing and communication specialist an administrative coordinator and program Consultants under our community health education team it includes Health Educators a dietitian Community Health RNs and community outreach specialists and then our newest Workforce is our community-based Workforce which includes community health workers peer support Specialists and a healthcare administrative associate and we'll talk about all of these in a little bit but our learning objectives for today are to identify major determinants of Health including behavioral social economic environmental and clinical care determinants of Health describe the role of Health Care Systems and the role of physicians in addressing health and Health Care disparities to improve population health and provide examples of how the community health and Outreach department and Partnerships improve health on the Roanoke Valley so I just want to say that we will be focusing on the Roanoke Valley today but if you're interested in learning more about what we're doing in our other service areas and geographies you could visit our website Korean clinic.org and scroll down to the bottom to the Community Health and Outreach page and that will have our community health assessment for all six of our hospitals including our implementation strategy which says specifically what we're doing to address Community Health so this is the AMA health system science framework so I wanted to point out kind of where we're going to focus on this framework today um so you could see that I I kind of put stars everywhere because we're going to cover a lot of ground today but the largest arrow which we're going to be focusing on is really population public and social determinants of Health but the work that my office does really does interface with a lot of the different parts of this framework here so we're going to really start with the basics on what really influences health so we utilize the Robert Wood Johnson Foundation County Health ranking model to guide our work County Health rankings are based on a model of Community Health that emphasizes the many factors that influence how long and how well we live the rankings they use more than 30 different measurements that can help communities understand how healthy their residents are today or health outcomes and what the impact will be on their health in the future so Health factors so looking at Health factors there are many things that influence how long and how well we live so everything from healthy behaviors like alcohol drug use diet and exercise sexual activity tobacco use clinical care so access to care and quality of care social and economic factors so Community safety education employment and social support and income which we call the Social determinants of Health in the physical environment so things like air and water quality and housing and Transit I do want to note that this model does not take into account genetics but not all of these factors are weighted equally so from the model you could see that social and economic factors or the social determinants of Health such as education employment income family and social support and Community safety have the most impact followed by healthy behaviors clinical care and the physical environment so we started using this model about a decade ago and it's been really interesting in the world of Community Health and here in our local community to see how much Focus we've started putting on social and economic factors and we'll talk about that but historically my office prior to This research coming out in this model really focused on healthy behaviors and prevention and access to clinical care so this shows the 2022 Health Factor rankings for Virginia and the lighter the color in the map indicates A Better Health Factor ranking so you can see throughout the Commonwealth right in the middle uh of the city of Roanoke we have that dark blue followed by a lot of lighter blue and then another way to look at our health rankings is by our service area so this is the crowing Clinic Primary service area and you can see on the left the larger the bar the higher the ranking so out of the 133 counties in Virginia the higher the highest rankings meaning the poor the worst Health outcomes include tazwell Roanoke City Henry County with County Buena Vista Radford City and then you can see on the the um better end Montgomery Lexington City Salem City bottat and Roanoke and then these um graphs or this chart is trended over the last five years but what really stands out to me are the health disparities between Roanoke City and Roanoke County Roanoke City was ranked one of our unhealthiest areas in our region with a ranking of 109 while Roanoke County was ranked one of the healthiest counties in our region at 10. yet these two areas border one another and in fact you could see that Roanoke County really surrounds the city and the differences in terms of statistics are revealing the median household income from Roanoke County is over 20 000 more than Roanoke City 18 of families in Roanoke City live in poverty just compared to six percent in the county and educational attainment levels are very different as well and then if you look on the right you can see life expectancy compared to some parts of Southwest County versus Southeast city which have 15-year differences in life expectancy and Roanoke City um within the city Southeast Roanoke Memorial Hospital is technically located in southeast so can we live with the fact that within the shadow of our largest hospital Korean Roanoke Memorial Hospital we have a neighborhood such as Southeast which such great grave Health disparities so um since 2015 we have identified Southeast as one of our Geographic areas that we've put a lot of focus in and we'll talk a little bit more about our community health improvement work in southeast City but we also have another area of our city northwest that also has similar Health disparities compared to the rest of the city and especially compared to the greater MSA and Roanoke County we've also began to look at our work through the lens of vital conditions for well-being which is out of the well-being in the nation Network and vital conditions are a set of uh conditions that are necessary for people and places to thrive we as an organization are looking at how we can balance our impact across vital conditions such as the basic need for health and safety lifelong learning meaningful work and wealth Humane housing the thriving natural world reliable transportation and belonging and Civic muscle and if these vital conditions aren't fulfilled the demand for Urgent Services grow so you can see on the right acute care for illness or injury addiction treatment criminal justice environmental cleanup homelessness services and unemployment and food assistance so we're beginning to look at our work through this framework and how we balance our community health investment investments in our community so that we're investing in both urgent Services because we we know they're important but we also want to invest in vital conditions so the demand for Urgent services will decrease and we truly believe that we want all residents in our communities to reach their full potential and thrive so what can we do we're going to talk today about a systems approach on how we can impact Community Health so I'm going to start with just some some basic definitions we're going to start with Community benefit so Community benefit is the many ways that growing clinic and other hospitals support invest in and give back to our community so this is actually Community benefit is an actual IRS requirement but we've been giving back to our communities because it's our mission to improve the health of the communities we serve well before this was a requirement but here's a little history of community benefit in 1969 that's when the IRS began allowing hospitals to be not-for-profit if they engaged in health promotion activities that benefit the community and then in 2008 all not-for-profit hospitals were required to start scheduling or filing a Schedule H with the organization's tax return their 990 to report Community benefit and then it was the passage of the Affordable Care Act in 2010 that really formalized this process and required not-for-profit Hospital organizations to conduct Community Health needs assessments develop implementation strategies so specifically what the hospital system will do to improve Community Health and how they plan on doing that and what resources the hospital system plans to commit so those needs assessments and implementation strategies are published on our website and available for the general community and then in 2014 is when the final Community benefit regulations were finally released historically carillion Clinic has always done Community Health assessments every 10 years but now the IRS and the Affordable Care Act require not-for-profit Health Care Systems to conduct needs assessments every three years and then these uh the chart on the right was just released in our 2021 annual report but this shows our fiscal year 2020 Community benefit numbers uh which is uh the guidelines according to the Virginia hospital and Healthcare Association but here you can see in FY 2020 we invested 116.2 million in community benefit now the the largest part of this diagram the yellow part is through uncompensated care so that includes 69.2 million in financial assistance and other uncompensated care then education 37.8 million so anytime a Korean staff member works with a student whether it be a med student a resident or other Allied Health professional we can write that time off as Community benefit 1.9 million in research as long as the findings of that research are published and available to the general community and then seven to seven point two million in community outreach which some of that is done through our office which is um centralized throughout the entire organization we have our headquarters here in Roanoke but staff at each hospital but that also includes other departments and the great work that they do and we help gather and report that information one of the things that's really interesting here too is if you look at this information over time our uncompensated care has been uh going down the reason being is Medicaid expansion so we're really excited within the community benefit and Community Health and Outreach offices to really be able to look at our investments more strategically and shift some of that uncompensated care into vital conditions and community outreach I.E prevention so this all fits into our Greater Community Health improvement process so we do use a systems approach as we conduct our community health assessments and engage with our community health improvement process and actually each of these little um sections have have further processes and systems that we follow but the first part is conducting our community health assessment which we do every three years we work with Community Partners and and form a community health assessment team um these Community Health assessment teams have broad wide-ranging uh representation from the community including Health and Human Service agencies we partner with the Virginia Department of Health and the Roanoke Allegheny Health District as well as the United Way of Roanoke Valley and healthy Roanoke Valley as part of that Community Health assessment team and that assessment lasts about a year and we collect primary and secondary data and then work with that assessment team and undergo a prioritization process which helps select the top needs that Korean clinic and our Community Partners will focus over the next three years and really continuing to measure our progress as we work towards our our strategies step two is planning and we do planning both internally and externally so internally within the planning and Community Development Division but then we work with each Hospital board on getting those plans approved by the hospital so this afternoon I'm actually traveling to Franklin Memorial Hospital for their board meeting to present an update on our community health plan and what we've been doing since our 2021 Community Health assessment after we do we're kind of doing planning parallel so we do internal planning but we also work with our Community Coalition so here in the Roanoke Valley we work with healthy Roanoke Valley where we come up with a community-based plan that involves not only carillion but other Community Partners to create strategies and programs to address Community needs step three is implementation which is ongoing and then step four is evaluation and with the implementation and evaluation uh steps we use the plan do study act the short cycle to continue to grow and evolve our program but then we also partner with our communities when we execute a program so for example um a program that we uh run in Southwest Virginia and far Southwest say Taswell might be really different than what we do in the city of Roanoke because the populations are so different so we really believe um in working directly with the individuals that we're serving and empowering them to be part of that decision-making process Aaron I'm just going to interrupt you just for a second oh and he's here with us and said just for clarity some of the costs associated with education can be included in our community benefit numbers there are a number of regulations Associated and our devotion and expense for education is considerably more so there are some caveats but I would love to take that offline and explore and if we are missing some opportunities to report we would love to do that thank you so continuing to move right along our 2021 Health priorities according to the 2021 Community Health assessment include mental health so access to mental and Behavioral Health Care Services access to substance use Services alcohol and drug use and then General mental health problems socio and economic factors so poverty low average household income affordable safe housing transportation and the transit system and lack of family and social support systems access to Primary Care and then the impact of covet 19. this by no means is a comprehensive list but this is what has been prioritized by our community health assessment team but I our full list um and uh over 200 pages of data is available at crowingclinic.org Cho you can find all of our needs assessments from our 2012 assessment up until the 2021 assessment for all six of our service areas but it's also really interesting to see how some of these needs have changed so back in 2012 social and economic factors really didn't bubble up as a top Community need and we really focused on access to care whether it be Primary Care Specialty Care and dental care but since then like I mentioned earlier we've really seen a shift in a better understanding of how social socioeconomic factors can impact health so how does krillian use this information so we use the needs assessment information in a variety of ways as part of our strategic development and planning activities So within our planning team for corellian Clinic we actually have an embed that looks at Community Health Data and Community Health needs and in all of our planning activities and strategic activities we consider Community Health and the supply and demand and what services are needed where within our community it also guides our community health and Outreach programs and program development we use it within our population Health management team Our Community Development work it helps guide our community Grant Investments and then to select geographies for our neighborhood health initiatives and then over 10 years ago we responded to the needs assessment by creating healthy Roanoke Valley which is a collective impact Coalition based out of the United Way so we know that these are big problems and we cannot solve them alone and we really need to partner with neighbors and families and other non-profits to address these issues so we use the strive Collective impact model which is out of Stanford which focuses on relationships and trusts between organizations and communities as the foundation for real progress and change and Collective impact involves a commitment of a group of important stakeholders and players from different sectors that have a common agenda for solving specific social problems and it's a best practice that leads to large-scale change and it focuses on the relationship between the organizations and progress towards shared strategies so really it's looking at a community need having a shared goal and then addressing that need from multiple angles and working together with shared measurements so we know how we're doing and the theory is if we can work together as non-profits Health and Human Service agencies and community members we can have greater impact at a lower cost per client and per agency and better outcomes because we share those outcomes so here are some of our Collective impact Partners these are Partners from the Roanoke Valley but I'm going to focus today mainly on healthy Roanoke Valley which is one example of a successful Community collaborative under the collective impact model so healthy Roanoke Valley uh was born 10 years ago following our 2012 Community Health assessment and the people involved didn't want this assessment just to be a document that sits on the Shelf so we started with the network of the willing and had over 50 organizations come together to form healthy Roanoke Valley which again our backbone agency within healthy Roanoke Valley is the United Way and they provide that backbone support and meeting support but also we felt that we did not want carillion to lead the Coalition because we wanted all of our Healthcare organizations to participate even those traditionally that might view corellian as a competitor we really think that it takes everybody working together to address these air these issues and we were really honored in 2020 that corellian received the AHA Nova award um which is the dick Davidson Nova award which recognizes collaborative work of hospital and Community organizations to improve health status and this is one of the highest honors in Community Health by Aha and we want it in partnership with healthy Roanoke Valley for that work at developing and funding healthy Roanoke Valley um I bring up healthy Verona Valley because there are opportunities for providers to engage so this shows our new work group and advisory committee structure so the main three work groups for healthy Roanoke Valley are healthy Behavior work group our mental well-being work group and our covet work group but um in the last 10 years we've seen so many other great Partnerships that have evolved that now we are a uh we have collaborative relationships and we're becoming a partnership of many coalitions so we also work collaboratively and share outcomes with the Roanoke Regional Food Systems partnership and the mental health collaborative and the Roanoke Valley Collective response um so all of these work groups are working to identify various uh indicators and strategies to improve Community Health in previous years we have had a separate provider committee but you'll see here that we have an advisory committee now for providers where providers can participate it's a lot less frequent of meetings and then they could help shape the work that we're doing within the coalition and it's really not a very big time commitment so our goals for our work groups for the mental well-being work group to address the rise in mental illness and substance misuse through stigma reduction and and integration of access to care the covet work group is decreasing the prevalence of a negative Health impacts of covid-19 and the healthy behaviors work Group which I chair it's an increasing healthy eating and active living to improve health and well-being at any age and so each work group is responsible for defining the strategies using research and evidence and best practices and then we work with our data committee to develop indicators and the idea is being able to report these indicators from multiple organizations so we can show greater impact and then we work with our operations and the backbone United Way on developing implementation timelines and activities and that we are led by a steering committee um that has representatives from many organizations including corellian and then we ultimately report through the United Way Board uh in addition to healthy Roanoke Valley we have started working with other National organizations and state of Virginia organizations on looking at the social determinant work so we actually received a grant from the rethink Health Foundation which is a ripple initiative to really become Health System stewards so rethink Health Works with national and Regional stewards to discover what it takes to design and execute transformative change to produce Better Health and well-being for all stewards are people or organizations who take responsibility for working with others to create conditions that all people need to thrive beginning with those that are struggling and suffering so stewards they can be affiliated with an organization or they could act on their own agency such as residents and stewards have um uh Equity orientation regarding purpose power and wealth so we underwent a several year partnership with rethink Health to train myself and other leaders within carillion on how to look through the steward framework and really look Upstream at Social determinants and how it can improve health and well-being for everybody we're also involved in a partnering for healthy Virginia which is an initiative between the Virginia Healthcare and Hospital Association it's member hospital and health systems and the Virginia Department of Health and this uh partnership not only looks at Community Health needs assessments across the Commonwealth but other things other ways that we can partner together to address social determinants and other pressing Health needs So currently we're working with a part partnering for healthy Virginia not only on our needs assessments but through a learning collaborative with health begins uh Health begins is a national Consulting Group that was founded by a physician that really looks at Social determinants and how to address those Upstream to prevent suffering Downstream and we're specifically working with health begins in a learning collaborative that we're in year two now as our Health Care Systems develop Community Health worker programs and how we integrate those within our Healthcare teams and our Health Care Systems which we'll talk about a little later so this slide shows our first place based strategy which is Southeast Roanoke City um so the map on the left says shows census tract 26 and 27 which is our Target area for our Southeast Community Health improvement work and each icon you can see different resources and services we brought to that Community but today I want to focus on Fallon Park Elementary School and the new lift Center at Fallon Park Lyft is a partnership between carillion Carilion children's Freedom First Delta Dental and Roanoke City Public Schools and it is a Health Center and holistic community resource that's co-located within Fallon Park we believe that good health and well-being is not just the absence of disease but incorporates physical mental oral Financial Health and additional wraparound services our health has impacted where we live our relationships our education and our stress level so you can see here our goals to transform the school nursing program with a holistic approach that focuses on practice clinical interventions to conduct family and Community Education sessions to connect families with resources in the community and to provide access to physical oral financial and Wellness Resources in one convenient location so our strategies involve working with the students the families in the broader community and to have a sustainable model where we have funding streams policy and research so we could scale this program to other elementary schools within our service area and let me tell you it was no small feat we started on planning for the center and doing community engagement after our 2015 Community Health assessment we did not open the lift Center until February 28 2022 so we have not even been operating for a year um we raised over a million dollars with those Partners I mentioned Delta Dental and Freedom First and we have hired a part-time uh right now we have a part-time pediatric clinic that offers acute care services um with an RN a healthcare administrative associate and then a nurse practitioner she is only on site one day a week and the rest of time um sees patients through title care and Telehealth we have hired a full-time program manager she's the program manager of Lyft but also looking at our comprehensive school-based strategies and we have placed a full-time Community Health worker within Lyft to help families and the students navigate resources and provide informal psychosocial support and right now in this phase we're really focusing on trust and relationship building with teachers parents and the children themselves and we have plans for full school year really increasing services but also building those relationships and understanding what community uh members need so we have formed a student and teacher advisory committee or parent and teacher advisory committee that meets regularly we actually pay those individuals to be part of that group that are helping guide the development I also wanted to mention our local food program which is really exciting to me it's in its 10th year this is one of the programs that I started when I first came to carillion but this started with the signing of the healthy food and Health Care pledge which committed croian to buy local nutritious food for patients and employees in our cafeterias and that really started a whole wide range of our local food program so in 2012 we started our farm share program which back then it was a partnership with good food good people a farm collaborative based out of Floyd Virginia but now it's operated by leap for Local Foods and we offer convenient location for pickup for Farm shares or also called community supported agriculture and for our employees we offer payroll deduction um so historically Farm shares our community supported agriculture you pay your Farmer at the beginning of the season for a share of their local produce that they grow it can be really unaffordable for some families because it is that upfront investment but carillion we offer payroll deduction for our staff and we split that expense across 12 pay periods to make it more affordable and then you can pick up your farm share right in Riverwalk garage located at Roanoke Memorial Hospital and since we started this program in 2012 we have sold over 520 000 of local produce using payroll deduction um and Croatia takes none of that all of that goes back to our local farmers and producers and as a result we've seen some of these Farms increase and scale up and then since 2012 we have invested nearly six hundred thousand dollars in local food nonprofits including snap EBT formerly food stamp double values at various farmers markets throughout our regions leave for Local Foods in their Community Kitchen the feeding America mobile produce unit happy healthy cooks and other non-profits not just in Roanoke but throughout our entire area and then one of our local food programs which we have not restarted since the pandemic but we're planning on is our Fresh Foods RX program which is a fruit and vegetable prescription program that was in partnership with healthy Roanoke Valley that we offered at our Roanoke family uh and Community medicine Southeast Roanoke Salem and our Riverside 3 Internal Medicine practices along with New Horizons healthcare where Physicians actually write prescriptions for patients for fresh fruits and vegetables and then leap's mobile Farmers Market comes on site once a week where they patients can actually pick out their food and during those sessions we have health Educators on site that provide education and then outside of the mobile Farmers Market we also hold cooking demonstrations so with this new program we're looking at how we can scale it up and have greater impact because the the existing model that we have is a very resource intensive for such a few amount of patients but the results are really promising with this program of the participants more than 60 percent saw a decrease in their BMI and a decrease in their hemoglobin A1c and nearly half solid decrease in blood pressure but again that sample size was fairly small so we're really looking at how we can ramp this program up and get more scalable outcomes Aaron if if I could interrupt just one more uh second we have a lot of folks saying thank you so much we've got they have family connections right to Phalen Park and um such amazing work on all everything that you all are doing um and then Roger Crawford um asked a question with all the data collected how are we leveraging the data in regard to the federal health provider service areas um for provider designation and federal grants yes um I am can I get to that at the end um remind me absolutely we'll save it sounds good um so sticking on the local food theme we also opened up an urban farm in Southeast Roanoke so the Morningside Urban Farm is located in Morningside Park and is a fully educational space we have hired a part-time farmer Cameron Terry and it's co-located next to a community garden and since we opened the space all of the community garden plots have been used and this was one of our first interventions where we came back to the southeast neighborhood and asked residents what they would like to see in their own neighborhood and we heard from that neighborhood that many of the families that grew up in that area or their their parents or grandparents grew up in that area used to have a strong connection to agriculture but as when the viscose plant which you could actually see in the top left corner closed in southeast that's when that neighborhood really started experiencing a lot of poverty and so we heard about the the desire to have access to local produce perhaps to learn how to grow fruits and vegetables but also to have a community space where neighbors could come and socialize together so Morningside Urban Farm does all three uh currently we have about two or three events per week out at the farm and our Urban Farm programming have some of the great greatest outcome and and attendees that that go and the idea is you could come you could learn here how to grow your own food and live Healthy Lifestyles and then to incentivize participants to our classes all of the Harvest goes back to class participants for free and then the Surplus crops are donated to local non-profits that serve the Southeast Community we also have a book called easy health it comes out quarterly that has all of our community health Improvement events as well as our Our Community Partners it also has a companion Facebook page where we share different resources and ideas on how to maintain Healthy Lifestyles um this slide shows some of our community health programs I'm not going to go over each of these because we are currently doing some strategic planning and some of these programs might change but I did want to highlight our community health nursing team and the work that we've done since covid um so my community health nursing team we in the past had really been responsible for doing small flu shot clinics um and then various biometric screenings blood pressure diabetes risk assessments lipid profiles blood glucose sometimes a1cs out in the community it's a point of care testing um but we were called in a big way to serve during the covid pandemic so the photo that you could see with everybody standing around this was a dry run in early 2020 with a flu shot clinic we had not done very many drive-through clinics and we wanted to get our feet wet in practice because we knew that the kova vaccine was coming and we would be called to do that and then on the left you could see some of my team members at the actual birkeland Center vaccination clinics it was so rewarding to see our community and the crowing Clinic organization come together to serve our neighborhood and my team was responsible for Staffing and operations of those clinics I know some of the hardest work that we've ever done I was barely sleeping during those clinics because we were responsible uh we had 105 staff members per shift three shifts per day and then the largest Clinic that we did we did 8 000 vaccines in one day and that was through our J J drive through clinic at the Berglund Center and we did that for a weekend but it was just so rewarding to be able to serve our communities and to get those vaccines in people's arms and so I showed our old uh health education programs where currently we have a new health education manager Rachel Burks who is working with our team of Health Educators to update our health education programming in the past we've really focused just on Direct health education but we're really updating our model and our strategy to not only do health education but look at policy systems and environment change so again that systems approach so we can make healthy behaviors more accessible through changing policies systems and environments and then through communication so promoting and reinforcing healthy behaviors through communication campaigns and then this chart was actually modeled after um the MyPlate diagram you could see on on the left Clinical Services so how can we integrate and bring Clinical Services to our most vulnerable populations but then embed Community Health and Outreach Services in our clinical locations like the emergency room or various outpatient settings and I think this is the first group that I've presented to where I've gotten to announce this um we've done a soft opening of our new community resource center our community resource center is where we house our community health workers and peer Recovery Specialists and it's a drop-in center you could come anytime and receive services or if you need a recovery oriented environment you could come here and hang out if you're struggling with your sobriety and your recovery um but this is also our referral point to be able to see our community health workers and peers and develop a professional relationship so community health workers they are resource Navigators so they go through a national certification and we're working with the Commonwealth on a state certification um so we could have a full community health worker Workforce in our area but more importantly they provide informal psychosocial support and work with the patient on smart goals whether those smart goals be a goal that the patient has specifically or a goal that a provider might have for them whether it be eating healthier or making sure that they don't keep missing appointments this picture is of Kenny hurt one of our former community health workers and he was featured on our annual report a couple of years ago but I love his quote here building a relationship is the key some of my clients are my neighbors and my friends um currently we have community health workers at Korean Family Medicine Roanoke Salem Southeast internal medicine at Riverside 3 and we just expanded this program to Franklin Memorial hospital and have a community health worker that's embedded there at the emergency room but also serves the family and Community medicine location that's on site at the hospital and then our peer support specialist so the slide says peer Recovery Specialists I should change that to peer support Specialists because we're really trying to use the peer support term because peers work with individuals that are in recovery from a mental health or substance use disorder so peer support is a little broader and makes it a little more likely for people to engage with us but this program started really uh as a result of the opioid crisis and we really saw the need for lay-level individuals to interact with our patients and help bridge them to recovery um so peers provide kind of that that one-on-one support and help clients work on what is called a wrap plan but a recovery a Wellness Recovery resiliency plan and peers are actually billable with Medicaid though we are not billing for the service line yet and we currently have peers on five West and inpatient uh inpatient and outpatient Psychiatry and then we have a peer embedded in the Ed for the Ed Bridge Clinic that connects with the obac you are also the first group that I get to to announce we are getting ready to go live on Epic uh this has been years and years in the making but this really helps formalize our peers our community health workers and health Educators as part of the the clinical team and then this gives our providers a way to refer to our services and see what we have been doing with patients and see how they're meeting their goals so we just kicked off this program we're working with Nordic which Croydon has contracted with for our build and we will be live on Epic on October 4th so we will be doing a full internal communication campaign for our providers so they know how to refer to our services and we're in the process of expanding peer Recovery Services to uh Caswell and then we also have hopes to expand to New River Valley soon so why does Community Health work matter it's who we are it's our purpose it's our mission we are a local health care company and there's nobody else better in a position to lead this work than Korean Clinic but also it's our community we are part of this community this community our our neighbors our kids our families and with that I would love to entertain questions and I'm going to go ahead and stop sharing so I can see everybody great I've been collecting questions okay um as they pop up so I will just um go ahead and ask them and some comments oh so I'll first I'll go back to Roger's question with all the data collected how are we leveraging the data in regard to federal health provider service areas for provider designation and federal grants yes so um this I could if I if you need additional information I could definitely get our planning team support but we do publish hersa information about um provider shortages and our needs assessments but more specifically our planning team does specific provider needs assessments where we look at supply and demand for specific uh Specialties within our needed within our community and so um our data is a little more accurate than some of the hersa data and then through our Community Partnerships um we feel like we are much more competitive when we apply for Grants together so through healthy Roanoke Valley and other Partnerships we're able to apply and kind of Leverage um having Partnerships and being able to work together so Dr Hoffman I'm not sure if that answered your question but I'm happy to have a follow-up with you if you would like yeah Aaron it doesn't actually are we proactive in actually keeping the designations elevated to where they should be for example at Southeast uh it may not be up to date and the question is do we actually apply for an update on the designation based on our data yeah I'm not sure but that's something that I can explore and get with our planning team and get an answer for you yeah because any individual can actually make a request uh you don't have to wait for the annual or the 10-year review if things have changed like demographics have changed in southeast from when I actually hit in entered a request to update it back in around 2005. now we were turned down for uh hips of destination now because 90 of the population was Caucasian and had very few immigrant snap demographics has changed quite a bit since then y'all I'll make myself a note and I will follow up thanks Aaron okay um and how I can collaborate with you to help the emerald program for pregnant and parenting individuals with substance use disorders my patients would definitely benefit from these Services um and then also she mentioned the peers are critical when will they have epic access and that was right October 3rd so impressive um a lot of people were excited about that um Andre mulliner says starting the health care program for asthma at Fallon Park Elementary School was a highlight of my medical career wow wow that's awesome Dr Milner um Nikki Mitchum the principal was an outstanding leader loved by her students and trusted in the community that is those are awesome um Dorothy Gardner says Cho helped our community tremendously and saved lives through the vaccine clinics and the covid monoclonal antibody work thank you oh Dr Gardner thank you and it's good to hear from you um and then Baba miserable says all those reasons and it's more cost effective to make impact earlier than later absolutely yes proactively versus retrospectively thank you any other questions comments and y'all are making me blush I appreciate the the positive feedback oh yeah I have a couple questions for you Erin um every time we hear from you I am amazed at the new slides you add um evidenced by all the work that you are doing over there um so if folks are interested in learning more about how they can get involved in the work that you are doing that your group is doing um who should they contact how should they go about getting um connected with folks over in your area to talk about ways that they can get involved with what's going on or um you could either reach out to me directly my email is amh Bush b-o-u-s-h growingcleaning.org or you could reach out to our departmental email which will goes to several of us but community outreach Korean clinic.org we could talk about specific um opportunities to serve based on your interests fantastic thank you and then I have another question for you um the work that you all have done at um Fallon Park Elementary is just amazing um and also your your Urban garden plans that you all have um coming along those are also really oppressive um I do some work in the community with very specific um populations and I'm curious if you all have uh plans or thoughts around expanding those two initiatives in particular and what you have going on at Fountain Park and that also your Urban gardening uh sure um with the Urban Garden initiative we're actually I'm going to be partnering or are partnering with for local foods to really create a network of gardens so um leap for local foods and formerly Roanoke community garden Association have several Gardens throughout the area and then there's also lick run Community farm and off of 10th Street and several others like the Goodwills Garden so we're really trying to connect all of the gardens and make sure that we have programming that we could rotate through each Garden so we likely will not be opening up our own Urban Farm but we do partner with other organizations that have similar programs and then we could provide services through our health Educators our dietitian our community health nurses and then with the Fallon Park Model we hope to be able to expand we would like to be able to gather the the data and the analytics to be able to justify expanding to other elementary schools we we being departmental leadership and our vice president Shirley Holland think that this is just a great model to really engage with kids and families while they're at school but we don't know exactly how successful it will be we know we've been working with the school-based Health Alliance on um our strategy but school-based Health Alliance is really looking at traditional school-based health centers with this model we want to take it a step further where it's not only not only do we provide clinical care but we provide those wraparound and family support so going back to social determinants of health and stabilizing families from a social determinant and then a mental health perspective so then they could focus on their well-being and and general Wellness so I hope that we do get to expand that's so lovely thank you uh Elena some students at Fallon Park struggle to learn as a result of all of their concerns is there any plan to measure progress on learning as a follow-up with this project yes um so our outcomes and research committee is looking at our larger outcomes the literature shows that school-based Health Centers can decrease chronic absenteeism at school there are some members of the committee that think that we could impact third grade reading levels so we're still negotiating with the schools and our steering committee to Define what that measure is but there will be some sort of measurement from the school um whether that be chronic absenteeism or third grade reading levels great thank you questions or concerns feel free to unmute um if you're able or type them right in the chat it's similar to Sarah I'm I was I was recollecting uh last year when I heard some of this information as a or I don't know many months ago as a part of the the cohort experience and um and you've added several slides since then you just keep growing and yep spread in the good word could work uh Sarah put in email addresses to contact Aaron and or the community outreach thank you so much Sarah for putting that in there and thank you to everybody who's interested we there are lots of people in here who um who have chimed in that they're interested in partnering with you all if they haven't already they're interested in doing so in the future so I also wanted to mention um on our website there is a link for service requests so if you know a non-profit or community group or really anybody that will like our services we have a short questionnaire but you can use that link to request our services formally excellent Last Chance going once going twice all right you're off the hook Erin thank you so much for everything that you've done and uh sharing all that information with us um this has been really an enlightening uh session um thanks for having me thank you have a good afternoon everybody you too thanks Aaron you too.