Tuesday, March 31, 2015

Santa Cruz County Adolescent Wellness Network: Taking integrated vertical networking to a new level

This article was written by Cassalyn David, Network Director, Santa Cruz County Adolescent Wellness Network for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Even before the Santa Cruz County Adolescent Wellness Network (AWN) had a name or knew what an integrated vertical network was, it was exemplifying cross-sector collaboration. The first connections began between the schools and community organizations that wanted to eliminate disparities by promoting health literacy and healthy lifestyles for youth.

Early on, network members had ambitions beyond just creating a fitness or health literacy program that would last a few years. They saw the need for a lasting, holistic adolescent wellness infrastructure and wanted to be part of the budding nationwide movement for youth empowerment. Grant funding for school health initiatives can be very ephemeral and narrowly service-focused, so the Rural Health Network Development Grant Program has been key to AWN sustainability. With Federal Office of Rural Health Policy (FORHP) support and connections to other rural health networks and national resources, AWN has been able to set and achieve ambitious goals for our infrastructure and services. We could not have accomplished this if we had continued to work in silos. Our broad and well-connected coalition has been our key to success.

Member connections
Since we operate in a rural, small town atmosphere, it is both possible and necessary to have members that are well-connected throughout the community. Chris Bachelier, the representative from the County Superintendent of Schools, has been with the network from the very beginning. She is central to our school partnerships, serving as our liaison with every level of the school system. Through her we have fantastic buy-in from the County Superintendent of Schools, connections with all of the health and wellness programs housed in her office, and personal connections with individual school administrators and health and fitness staff.

Chris has facilitated many of the Network's key projects. Teachers, school health staff, and administrators are some of the busiest people I know, but Chris knows how to find time with them. For our school-linked health care planning, Chris helps the Network understand school and district-level needs and constraints. In order for AWN to reach our goals for school-primary care linkages, we need to be listening to everyone from the front-line service providers to the Superintendent. She conducted key informant interviews with school health staff that answered many of our questions. It was inspiring to hear about the service these nurses and nurse aides provide their students and validated many of the ideas we had about ways we could make their jobs easier. They know it is best in the long run if you can serve the 'whole child,' because they see every day how social and environmental factors are impacting student health. We learned about the challenges families face in accessing health and social services, and are working to create a seamless system of referrals across these disciplines.

Organizational culture
Every organization has its own systems and culture, and AWN has the additional layer of working across disciplines. The challenge for me has been to recognize the differences both between and within health, education and nonprofit service sectors. I actually made the mistake of assuming the three school district boards and administrations would have similar procedures and requirements for our partnership agreements. Fortunately, my members are experienced and supportive.

Talented evaluation
Another advantage for AWN is having an experienced evaluator. Rebecca Drummond is the Program Director for Family Wellness at the University of Arizona Mel and Enid Zuckerman College of Public Health. Rebecca has unique experience in the realms of coordinated school health and youth health systems, having served on the Board of Directors of the Arizona Public Health Association, chairing the School Health Section, and as a board member and President of the Arizona School Based Health Care Council, a state affiliate of the national School Based Health Alliance.

Both Rebecca and Chris have backgrounds that span health and education, so they are excellent at bridging the disciplines. They can relate to the teachers and be champions for schools' role in student wellness, despite funding and time constraints. This showed when AWN created the first-ever implementation and analysis of School Health Profiles at the county level in Arizona. School Health Profiles is a CDC survey that tracks school health and wellness policies and practices. AWN wanted to know where our local schools stood in comparison to their peer institutions and best practices. Through careful outreach, AWN obtained an excellent response rate. Even the process of distributing the surveys and results helped the school health movement gain momentum in our community.

A long history of integrated vertical networking
As a Network Director, it makes my job easier to have respected member organizations and well-connected representatives to provide wisdom and practical guidance. The impetus that brought partners together from the beginning was supporting schools' health and wellness efforts and creating a holistic paradigm for serving and empowering youth. It would have been more difficult if we had started in a narrow mindset and decided later on to expand to include schools. Our mission, vision, goals and programs were conceived and continue to evolve with this broad coalition at the table. To keep them at the table, we are challenging ourselves to continue providing valuable services for our members and community.

About

The Santa Cruz County Adolescent Wellness Network (AWN) is a group of local agencies that has been working to promote and improve adolescent wellness services through collaboration, education, and advocacy since 2007. The current partner organizations are Mariposa Community Health Center, the lead and fiscal agent, along with Southeast Arizona Area Health Education Center (SEAHEC), Santa Cruz County School Superintendent, Community Intervention Associates, Pinal Hispanic Council, Circles of Peace, and the University of Arizona Cooperative Extension Santa Cruz County. The Arizona State Office of Rural Health provides Technical Assistance. The AWN is a place for partners to collaborate and share resources to identify and respond to adolescent wellness needs. Our mission is to promote adolescent wellness through advocacy, education, and collaboration with schools and community organizations serving youth, ages 12-25. The AWN is funded by a Rural Health Network Development Grant through the Health Resources and Services Administration, Federal Office of Rural Health Policy. AWN has been an active member of NCHN (National Cooperative of Health Networks) since 2010.

Wednesday, March 25, 2015

Ready…Set…Go! Designing an Effective Practice Search

By Angie LaFlamme, Senior Program Coordinator

Angie wrote this blog post for the National Rural Recruitment and Retention Network (3RNet) blog representing the National Rural Health Resource Center as the Minnesota Member of 3RNet.

When should I start my job search? This may be the question I am most asked from physician residents and advanced practice provider students. The answer is…right now! Although you may not want to begin site visits until closer to the end of your training, it’s never too early to begin thinking about what type of practice you want to have, as well as the community in which you want to live. By starting your job search early, and knowing what to pay attention to during your residency internships and student rotations, you will be better equipped to begin your practice search.

A really great way to begin determining your preferences is to create a list of “Must Haves”. These are details about both a practice and a community that you feel strongly about and will help frame your job search.

Practice Setting
Determine what type of practice setting that interests you; private or group practice, single specialty or multispecialty group. Maybe a hospital or an academic setting is more appealing to you. Keep in mind each of these practice settings will offer a different type of work experience.

Workplace Culture
Do you have any religious or ethical considerations? Do you want to work with a particular patient mix, how busy do you want to be and is the practice compatible with your family situation? Perhaps you’re interested in finding a group of older, more experienced physicians who can be a mentor or would you prefer a younger physician group who may share similar interests and values? Also, be sure to ask about provider satisfaction within the practice.

Geographic Location
Define what you want and need in a community with regard to housing, schools, shopping, entertainment and recreational activities. When it comes to your location preference, it’s imperative to have a clear understanding of what you like to do and where you want to live.

Technology
Understand how technology is transforming health care. Recognize the various types of technology that you anticipate needing.

Compensation
With the amount of educational debt that new providers have, this may seem like it should be the most significant item on your list. And while I agree that this area is important, I want to stress that it shouldn’t be the most influential. Never pre-select practice sites on compensation alone, as money shouldn’t be a factor until you’ve completed your site visits and are offered a job. It’s also important to consider the entire compensation package. This includes salary, incentives, benefits and signing bonus, etc.

Now that you’ve determined your list of “Must Haves”, you are ready to begin your practice search and site visits. Once you’ve narrowed your search to a handful of communities/facilities that you’d like to visit, there is much to consider to effectively evaluate each opportunity. Here is a list of areas to explore and assess:

Services
Will you have access to services such as x-ray, lab, home health, hospice, physical therapy, occupational therapy, chiropractic, speech therapy, etc.?

Patient Volume
How busy is the practice? Can you see patients at your own pace or will you be expected to see a certain number of patients per day?

Formal Relationships
Are there any agreements in place in regard to specialist referrals? Is there a particular hospital that you must admit to?

Specialists
Are there specialists employed by the facility or are their visiting specialists?  Does the facility utilize tele-medicine for any of their specialty care?

Care Coordination
Is the clinic a certified health care home? What is the clinic’s team approach to care coordination within the community? Learn how their focus on patient centered care across the continuum of health care has supported their patient’s quality of care.

Technology/Electronic Health Record (EHR)
Where is the practice at in implementing their electronic health record and are they meeting the Meaningful Use criteria? Do they have a health information technology team and/or any physician champions? What are they doing to increase patient engagement? Are they utilizing data from the EHR for quality or process improvement activities? Does the facility utilize any telemedicine services? How about the use of mobile devices? Mobile devices have transformed many aspects of clinical practice and have become the commonplace in many health care settings.

Affiliations/Networks
Is the clinic affiliated with a health system or part of a network? These types of relationships can provide additional resources, education, experts, equipment and financing.

Infrastructure
What is the condition of the facility? Are there any recent or pending renovations in progress? Is there adequate space, equipment and staff?

Performance Expectations
What is the scope of practice required? What is the call schedule and is it equitable among all providers? Are the any supervisory or administrative duties required of you? Is the facility a preceptor site?

Organizational Structure
Is the practice physician-owned or health system? Who manages clinic operations and how is the organization governed? Is there a medical director and/or a board of directors? Who will do your performance reviews and approve your time off?

As you consider everything involved in finding the right practice opportunity, the key is to start early. The process is relatively time consuming so take the time necessary to create your vision of “must haves” and then ensure that it corresponds with reality. And remember…interviewing is an ideal opportunity for you to learn about new employment opportunities, visit new geographic areas and meet new people. Use these visits as your compass in selecting the perfect practice.


For more information on beginning your practice search contact Angie LaFlamme at 218-727-9390, ext. 222 or visit the National Rural Health Resource Center website.