WNIN is contunuing a monthly conversation in partnership with both local health departments that serve much of the listening area. WNIN’s Tim Jagielo spoke with both Merritt Bates-Thomas, the Health Education Director and Public Information Officer with the Green River Health District, and Lynn Herr, the Director of Clinical & Outreach Divisions at the Vanderburgh County Health Department about their organizations and local health needs assessments.
Note: Above audio is the long version of the interview. The broadcast feature is available in the web post as well.
Transcription below is lightly edited for clarity.
Timothy Jagielo
Thank you so much for joining us. As always, for the record, say and spell your name for me. Please give me your title and where you are.
Merritt Bates-Thomas
Mr. Merritt Bates-Thomas with Green River District Health Department, health education director and public information officer.
Lynn Herr
And my name is Lynn Herr with the Vanderburgh County Health Department. And I'm the Director of Clinical and outreach divisions.
TJ
Thank you so much for that as well. We've got some questions prepared. But I also wanted to ask — I always like to ask what's going on? Now? Are there any new things that have popped up lately, like strep popped up for a minute in the hospitals a couple months ago? What's going on now?
LH
So we had a TB, or tuberculosis exposure in the middle school at McGary. So that was kind of a unique situation, while we always have cases of tuberculosis in our community, in a school based system was kind of a new thing for us. Our recent thing for us, in which we tested over 300 staff and students at McGary.
MBT
For Green River, with the end of the public health emergency last week for us just looking at ways we'll continue to monitor the implications of COVID in our communities, and, you know, look to be mindful of, if any resurgence if there is but just kind of keeping our finger on the pulse of of COVID, the implications there, and then gearing up for our Community Health Assessment forums coming up next week.
TJ
Okay, well, we can head into that, then we just want to transition what is the Community Health Assessment? Why is it done?
MBT
Community Health Assessment forums are a critical way to get out into the communities better understand the implications for different situations or health implications in our communities, also engaging the public in this process, too. We can look at data and know what diseases are prevalent, what chronic conditions are prevalent, just looking at assessment data that's been done by CDC and other organizations. But to engage the public and get a feel for what they see as going on in their community in terms of health, or any other factors can be vitally important.
TJ
Do you want to talk about how this information is actually gathered and assessed and how long it takes? What's the timeline?
LH
So … Vanderburgh county is kind of at a different point. We're kind of halfway through, so we just finished and published ours last year. So again… each community can kind of do it a little bit different. But again, just like Merritt says, you definitely want to engage the public to know what roadblocks they're hitting to getting their health at optimum. So you can, you can look at the data, but then you when you, when you engage the public, we just kind of got groups together, of not only citizens, but then we also turned around and did different agencies within our community that served the public.
So like our homeless shelters, and, and our health based agencies, but some of those non traditional ones, as well as what their clients what roadblocks they were up against, but then also, just being really able to put your the finger on the pulse of the community and what they thought the health needs were most important, then we rank them. And then we figured out which three we're gonna we thought we were gonna focus on.
TJ
And so you're kind of you're ahead in this process, do you want to talk about the three things you're going to work out? Or that's still being worked out?
LH
No, because then once you get the assessment, then you do this Community Health Needs Improvement Plan. And that's how the community is actually going to look at it. I don't know that we're ahead, we're on a different schedule. So we've been doing this all for a good while, it's just that we're doing it every three to four years.
So we're just in a different place in our schedule. So right now we're in our community health needs assessment, improvement plan implementation. So we have maternal and child outcomes. We have access to care in all of those, we have mental health and substance misuse, also, with ours, and then we are really looking at access because everyone thinks that people have access to health care. And it's maybe not always that way.
TJ
Sure, well, in how it's an assessment, how is the information gathered, at least in green rivers are different.
MBT
So the information is gathered in a variety of ways. We start off either with surveys that can be filled out online, or paper copies in clinics with community partners. This will be our fourth assessment cycle, but two previous assessment cycles, we actually did a CASPER, which was the community assessment utilized during public health emergencies. So a bit of surveillance, but it was randomized. And we were dispersed out into all seven of our counties going randomly with this methodology, and knocking on doors, driving official vehicles, we had our public health vests on so people would know what we were doing.
But it was a great way to interact with people and really get truly randomized feedback from folks. Lynn spoke to the fact you know, I spoke to a community in general and engaging community, but that community is broad spectrum. We're looking at collaborative partners, we're looking at elected officials, we're looking at concerned citizens, there are a variety of people that we want to engage all bringing their unique perspective to the table.
That way you do truly get a good sampling of what people are thinking, what they're saying, and what they're seeing through their lens as well. And we're all hearing this information, to gather the data piece, the data that's presented, because like we said, data can drive things but it has to be you have to get community buy in. And you have to engage those partners, both the collaborative, and the concerned citizens around these causes. And then utilize community coalition's to actually begin to work at that improvement pace.
LH
And we actually incorporated, Diehl Consulting here in town, to be able to pull all the these pieces together, so that we make sure that we really truly are coming with the top three problems that we can address for our community
MBT
Utilizing outside facilitators and we've utilized our universities throughout the state. This year we'll be working with Eastern Kentucky University to help us facilitate, that way the process is not driven by us. We don't have an intended outcome. We truly want to see what rises to the top, what we're seeing through those community lenses, the partners, the citizens, and what we're seeing through the data, what truly is the areas of focus? …
LH
…so we get quantitative and qualitative information … (so) we make smart choices
MBT
Exactly.
TJ
And there've been several of these —has there been any policy suggestions, changes anything within the organizations that you've been influenced by with these studies in the past, these assessments in the past?
MBT
Well, I think it's given us a stronger stance around our tobacco control policies throughout our district. And just the importance of maintaining smoke free communities in public places, in public settings. And when that is tested by an employer that might want to come into the community and have a smoking area, I think the rallying cry of citizens, and of concerned health professionals really helps reinforce the importance of the progress we've made, in particular, around most tobacco free communities.
Listen to the broadcast feature below:
LH
And, ours is taking just a little bit different turn, because our maternal and infant outcomes have been so poor in this area. So we really do get the group together. So it's not just the health department that's doing these initiatives, it really is the whole community, because the health department can't cure all the problems the community has, or concerns that the community has. So it allows us to really take that to the next level and pull our community partners in.
MBT
Well, I think it really calls to mind too, guiding and getting the community to see health is its number-one priority. The health of our communities drives everything, children learn better, when they're healthy. They go into that school environment, that learning environment, better prepared to learn the workforce, when it's healthier, is more productive, more engaged, and it becomes this positive cycle. As you're looking at community Health improvement, health begins to drive a lot of positive changes.
TJ
What are what are some areas you're currently addressing related to health, the community health assessment plans?
MBT
So for Green River District, it's seven counties, seven individual forums. And you see similarities in those trends. Access to care, as Lynn mentioned, has been a recurring theme, mental health and awareness around mental health and the importance of addressing it and again, connecting to access to care, popped up a couple of cycles ago, and has remained on the table, tobacco, substance abuse, and use and addressing that we had in our first cycle obesity, and addressing that other chronic conditions that can factor in figure in and reduce the quality of life for people.
And that's remained on the table as well. So looking at how those all mix and mingle, and then they go on into our community health improvement plan where they can be addressed by those local county health coalition's developing action teams that work to address that and develop different strategies that can be used in approaching the community and making those improvements.
TJ
And regarding the challenges that you're seeing come up, are there challenges that are universal? And or are there challenges that are local or regional, that you're learning about?
LH
Well, I think smoking is definitely one of the things that that kind of challenges this area, I think we have a higher rate of smoking. I know we have a higher smoking rate than other portions of Indiana and probably Kentucky as well, and those are some unique challenges.
We're in front of our policymakers just a couple of weeks ago to get a higher tax on tobacco products that really impact the health of across the board with, you know, cardiovascular health with lung health. So, those problems can come up. We don't solve those problems in one cycle. So they tend to stay on there just like our mental health issues and our substance misuse things, those kind of stay on, they tend to stay on for a couple cycles, at least it's hard to make a true impact in things. Sometimes, in those three or four years in which the cycle happens.
MBT
You can see improvements, yes, but I think the challenge remains in keeping things at the forefront moving initiatives forward, realizing they're not going to be solved, or they're not going to be addressed in a very short period of time, you have to seek out have a vision for the future and seek out long term solutions, things that can impact not just one generation, but generations down the road. In terms of positively improving things.
TJ
Do you have any examples of things that have changed for the better over time, through a few cycles?
LH
Our smoking has improved; we are happy with a percent change in smoking, the Indiana Department of Health also now has really changed with with changing not just smoking, or labeling it smoking with it being tobacco use with the increased utilization of vaping products and and you know, things like Juul and so, again, we've improved, but we've also had to take a step back and look at how people are now using tobacco and what that looks like for our community.
MBT
And I would agree with Lynn around the tobacco — the awareness around the importance, the health implications. I think also working with community partners, increasing awareness around the importance of addressing mental health, and looking at access to those care providers has been key and crucial. And what this is done, I think looking back at the beginning of our first community health assessment cycle, it's strengthen the relationships with community partners.
And we're seeking out working with them collaboratively. Not that we weren't before. But we're all having to do various forms of health assessments. And we're all in this together working toward improving the health of the communities in which we live and work.
LH
Our local providers, meaning our health care providers for CMS reimbursement, so Medicaid and Medicare — they're required to do this as well as to engage them. So it's not something just the health department is doing. It's actually working with all of our community partners to get this assessment done.
MBT
Exactly. And I think too, from the State Department of Public Health in Kentucky, you know, looking at wanting to see that information, we submit this annually with our budgets so that they can see if we're stepping outside of those core public health transformation services that the state is guiding us to provide. They want to see the justification from our our community health assessments that were focused in those areas that our communities in the data are driving us to address.
TJ
And what role do the forums play in your organizations, and is that related to the health assessment?
MBT
Yes, so we have our upcoming community engagement forums. Starting next week, we'll be doing two a day with our seven counties. So we start Monday, the 22nd, we wrap up on the 25th. And being each of our counties to hold the forums, invite the public elected officials, community leaders to come out and go through this process that's guided by our facilitator to share their information share their thoughts and ideas around those key areas that they see us needing to focus our attention on
TJ
How have forums been utilized in the past?
MBT
Forums have always been a part of our process, beginning back in 2012, so this will be our fourth cycle. And for information about the locations, you can go to our website, health department.org. And at the bottom of the homepage and news and events, you can click on to see the schedule and be able to attend the one in your community.
TJ
Do you want to share any information that was gleaned from past forums or any ways it may have influenced the assessments?
MBT
I think the key thing it's strengthened our work, our resolve in truly addressing — it's not data driven. It's taking the data and really taking it out to the communities to create that awareness, improve education, share information about the key pieces that are involved in affecting the health of the community, and getting that community buy in, in terms of helping them better understand what the data is telling us helping us see and be very reflective about the key areas affecting the health of our communities …
LH
… and Merritt — don't you think every community assessment that we do gets a little stronger?
MBT
Oh, absolutely. Yeah.
LH
I mean, we've learned from past past assessments, how to make the next one even better …
MBT
…how to make it better, I think how to continue to ‘move the needle,’ if you will. Like Lynn said, we don't change things in one cycle. But we do see ourselves improving. And if we're not improving, we call ourselves on it, so to speak, and readjust our strategies. I think that the beauty of the process is that we are working to address the needs of our community.
But we don't think we always have the answers. We're constantly asking ourselves how we can be doing things better to address the needs of our community, and what we can do to improve the overall health of the community in the region, because we depend on each other.
TJ
Well, what's next heading into summer? Does your jobs change at all? Does your mission changed? Does your focus change?
MBT
For us, I think it'll be taking that data and pulling it together or outside facilitator working to pull all of the information together, we'll be ending one budget year and beginning another. So focused on the work we know we need to do. And awaiting what we really see is those final results of the health assessment forums, and then working to develop the health improvement plans that will move us into this next cycle.
LH
So we're kind of in the middle of a cycle in which we're doing improvement plans. And we know that the Governor's Commission on Public Health for Indiana just dumped in a good amount of money for us for our local budgets, which really helps us because Indiana had been about 45th to 48th in the amount of public health spending. So this is going to allow us to increase our staff to develop new programs to implement new programs. So we're really excited about this. So this will be a planning over the summer for this increased funding to go into place on January one.
TJ
Do either of you want to share any stories about the impact of the efforts of the health department's that you may have have experienced recently or between conversations?
MBT
Well, one of the things I think that's come out of health assessment, health improvement, certainly the COVID experience, Lynn and I are sitting here together today, sharing the stories in this information. And not that that wouldn't have happened, but I like to think it's been an evolution of seeing the bigger picture.
And how important that collaboration is, it isn't just within the confines of our county or district or even state to date in this case, you know, it's a collaborative effort. And our folks travel back and forth residents of Kentucky come to Evansville and to Indiana, and vice versa. And it's working together to create this awareness to solve problems to ask bigger questions, that really then begins to move things in a bigger way …
LH
…and I think our public health accreditation status with both of us being accredited health departments really kind of pushes us maybe more than maybe just your average health department what you say I think, and I think it pushes us to the next level and to constantly look at the quality of our work and our outcomes, our performance outcomes to do the best for our communities.
MBT
Absolutely.
TJ
Thank you so much for your time as always, and I look forward to the next conversation.
Listen to the wrap on forums below: