Population Health in Rural America in 2020 Proceedings of a Workshop (2021) / Chapter Skim
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5 Assessment and Implementation Strategies for Improving the Health of Rural Populations
5 Assessment and Implementation Strategies for Improving the Health of Rural Populations
Pages 69-92
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and Coal Country Community Health Center (CCCHC) discussed how the CHNA tool can be used to support population health efforts.
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must conduct CHNAs every 3 years, as mandated by the Patient Protection and Affordable Care Act, in order to identify community needs and move toward addressing them. Public health entities are required to conduct CHNAs for accreditation purposes and, more importantly, to inform the development of community health improvement plans that enable public health units to address community-specific needs.
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CHNA findings can also be used to collaborate with local public health units to develop and implement community health improvement plans. Through subsequent monitoring and regular meetings to review progress, local population health committees can use the CHNA findings to adjust strategic plans as needed.
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The process benefited from both individual and collective efforts to identify community needs and move forward with developing and implementing the strategic planning process through a collaborative and coordinated community health improvement plan. The population health committee plays a valuable role in monitoring progress and adjusting the implementation plan based on changes in the service area's health needs, which benefits from a collaborative process that aligns efforts across partner entities.
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Thus, the Department of Health decided to systematically coordinate behavioral health with general care, said Barcus, because integrating mental health, substance abuse, and primary care services produces the best outcomes and has been shown to be the most effective approach to caring for people with multiple health care needs. 2 The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities.
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Minnesota Integrated Behavioral Health Program Tool Kit One of the results of the collaborative IBH project was the development of the IBH tool kit.3 Barcus explained that the tool kit was designed both to provide detailed information for entities seeking to address behavioral health in their communities and to serve as a generic process for addressing other population health issues, such as diabetes or heart disease. The tool kit provides details about the IBH project process, including information about the readiness assessment, selection process, technical assistance, evaluation of project outcomes, and lessons learned.
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The project used an outcome evaluation process developed by the National Rural Health Resource Center called recommendation adoption progress (RAP) reports.
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Resource directories were effective in allowing providers and consumers to identify available opportunities to access services. She noted that hospitals often began the IBH process presuming that more behavioral health resources were needed.
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In addition to strategies such as partnering with schools, churches, and businesses, some hospitals collaborated with music, art, and theater communities to create productions that would bring people together to help address the stigma of mental illness and substance abuse. ROLE OF RURAL DEVELOPMENT HUBS AND POLICY IN CONNECTING RURAL DEVELOPMENT, HEALTH, AND OPPORTUNITY Katharine Ferguson from The Aspen Institute Community Strategies Group discussed the role of rural development hubs and rural policy in connecting development, health, and opportunity in rural communities.
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Ferguson said that the concept of SDOH has been crucial in creating a structure and vocabulary for thinking beyond health care to health, well-being, and opportunity, but that the social determinants framework must continue to evolve to better reflect the full range of actors who are essential to creating an equitable, healthy, thriving, and sustainable place. Taking a broader lens means that actors, factors, and activities essential to health include community and economic development professionals, civic participation, tax and fiscal policy, structural racism, community building, place making and community planning decisions and the built environment, employers and workforce, and entrepreneurship and small business development in addition to the more commonly known actors and factors such as community health workers, schools and educators, day care providers, social service providers, safety and security providers, food assistance providers, and housing accessibility and affordability.
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A subset of those rural and regional intermediary organizations could be considered rural development hubs, she suggested. Rural Development Hubs Ferguson's organization, The Aspen Institute Community Strategies Group, has defined a rural development hub as "a place-rooted organization working hand in glove with people and organizations within 11 More information about communities of deep disadvantage is available at https:// poverty.umich.edu/projects/understanding-communities-of-deep-disadvantage (accessed July 22, 2020)
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To improve the livelihoods of marginalized populations, these types of 13 The Aspen Institute Community Strategies Group's report on rural development hubs includes tools that can be used to identify rural development hubs. 14 For more information, see https://www.wealthworks.org (accessed October 28, 2020)
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Role of Rural Development Hubs in Addressing Social Determinants of Health Ferguson emphasized that rural and regional intermediaries, such as rural development hubs, are essential partners in addressing structural barriers to progress and mitigating the negative consequences of SDOH in rural regions. They consider the whole system and engage a wide array of nontraditional partners among different sectors of the community to achieve positive outcomes in a way that is compatible with the population health.
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rural cultural competency, (3) trust in the know-how of rural development hubs, and (4)
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The second was to align health and development strategies, including the required comprehensive economic development strategies and CHNAs. The third was to build partnerships and shared frameworks and vocabulary among rural development hub leaders and population health leaders.
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Population includes culture, demographics, history, and mindsets, she added. Rural Health Concerns Related to the COVID-19 Pandemic Minyard explained that at the beginning of the COVID-19 pandemic, the Georgia Health Policy Center asked 200 rural grantees to share concerns regarding rural health.
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Such innovations typically involve the application, combination, and creation of financing tools and methods. The Georgia Health Policy Center developed a blueprint for action, which shows how to improve community health through innovative financing (see Figure 5-1)
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86 FIGURE 5-1 Blueprint for action for improving community health through innovations in financing. NOTE: ROI = return on investment.
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She offered two examples of this kind of insight. In one case, a rural banker realized that they could use their bank's money to establish a loan and grant system to accomplish the community's population health goals.
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He asked the panel how to ensure that all individuals in rural communities are incorporated in the works of rural health organizations. Ferguson replied that a first step is to recognize and acknowledge the existence of racial inequities and other inequities of all kinds.
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Engaging Stakeholders, Changing the Narrative, and Securing Financing Smart asked the panel to share more insights about garnering financial support for population health efforts, given that population health work is both expensive and lacking a standard funding mechanism. Bertsch suggested engaging with community-based extension offices, for example, and noted that some resources are more accessible through collaboration among providers to seek out different types of available funding.
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Making the Case for Philanthropic Spending in Rural Population Health Smart asked why philanthropists ought to invest in rural population health. Ferguson replied that the current model of rural health care is not workable.
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In closing, Smart remarked that the best rural philanthropic work often incorporates ideas raised by the panelists, including multidisciplinary community partnering. He suggested that rural settings should be considered as places first, rather than as the locus of a particular set of issues.
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