Member Spotlights

Wyoming Health Council

By Illysa Schrager

 

Wyoming Health Council (WHC) has served communities across Wyoming since 1990. Originally funded only through Title X, WHC has grown in scope and become more fiscally diverse since its early days, enabling it to reach more Wyoming residents. Amidst the changing health care economy, WHC has matured into an organization that has received and maintained funding through contracts with the Wyoming Department of Health, HIV organizations, local hospitals including a unique faith-based community nursing program, the federal Office of Women’s Health, additional Title X grants for males and HIV integration, and a Health Resources and Services Administration (HRSA) 330 grant to serve migrant populations.

WHC distributes Title X funds to nine agencies across the state, including private, stand-alone nonprofits, local health departments, and public health nursing organizations. A handful of WHC-funded health centers are located in towns surrounding universities or community colleges, and while they provide a broad range of services to the general public, they also provide services and education geared towards college students. In 2011, WHC’s delegates served 11,916 clients; 89% were female and 66% had an annual income at or below 100% of the federal poverty level (FPL).

Through its Title X male services grant, WHC has been able to increase its community outreach specifically to males. As a result, WHC has seen a steady jump in the number of males receiving services in its system. Through its HIV integration grant, WHC has been able to provide more HIV testing and screening.

In order to address the needs of migrant populations located in rural Wyoming, WHC sought and received a HRSA 330 grant starting in 1997, and has been fortunate to have been funded through this program ever since. The grant provides WHC with critical resources to help improve the health status of migrant and seasonal farm workers and their families through the provision of high-quality primary and preventive health care services. The program recognizes the need for health care management among this predominantly Hispanic population, and addresses the economic, language, and cultural barriers that prevent them from accessing needed services.

Nurse practitioners make up 85% of the service providers within the WHC network. Every health center in the network has a medical director, a certified nurse midwife or nurse practitioner, and a physician that performs chart reviews. Some health centers have physician assistants who provide services as well. Some of WHC’s health centers have one full-time nurse practitioner, while most others have nurse practitioners who work part-time in their centers and spend the rest of their time in private practice and/or teaching nursing classes at local universities. Though staffing can sometimes be a challenge, WHC works hard to ensure that its providers are up-to-date in their training and cognizant of guidelines pertinent to Title X and the other funding streams they receive.

WHC has been fortunate to receive funding from a local hospital to support a faith community nursing program (FCN). Also known as Parish Nursing, it is a specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting holistic health and preventing or minimizing illness. FCNs focus on helping the client (which can be an individual or family) “achieve health, healing, and wholeness by implementing health promotion and disease prevention practices. FCNs must be caring, spiritually mature people who reach out to comfort, console, strengthen, teach and encourage the faith community.”

WHC partners with several community-wide organizations, including but not limited to the United Way, local foundations, NARAL Pro-Choice Wyoming (NARAL WY), Planned Parenthood of the Rocky Mountains (PPRM), and the American Civil Liberties Union (ACLU). The partnerships with the United Way and local foundations help foster funding opportunities for WHC delegates. An example of a project that has come to fruition through local foundation partnerships is funding being given to cover the cost of providing colposcopies. With NARAL WY, WHC staff often go on legislative visits representing the voice of family planning providers and their clients. With PPRM, ACLU, and NARAL WY, WHC has created brochures about emergency contraception (EC), explaining EC’s purpose, where it is available around the state (at pharmacies and health centers, including hours of operation), and its cost. These brochures are available at WHC health centers, safe houses, and college campuses, among other locations.

Health centers within the WHC network employ varied methods of community outreach in schools, as Wyoming school districts have local control over educational requirements. Some school systems’ curricula provide for community outreach staff from the local family planning health center to be brought in to provide education, whereas some curricula require such education be provided by a medical professional. WHC also contributes to the Wyoming Department of Education’s adolescent risk reduction program via funding from the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent School Health (DASH). Many WHC delegate agencies have relationships with universities/ community colleges; most of the schools have invited WHC providers to attend and present at educational functions, in addition to having actual clinic days in spaces provided by the school for conducting family planning-related exams. The clinic days guarantee a point of entry for these college students who may not otherwise receive vital family planning services.

In 2007, WHC was invited to collaborate with the Wyoming Office of the Attorney General and the Wyoming Coalition Against Domestic Violence and Sexual Assault to develop a statewide strategic plan about sexual violence prevention. The coalition contracted with a local university to perform a statewide needs assessment, from which they learned to target women and men, ages 12 to 24. Since then, WHC and the coalition have developed an ongoing project for sexual violence prevention across the state, focusing on the primary prevention approach. Each year, the coalition releases a request for proposal for two $4,000 mini-grants; two communities per year are chosen to participate. The coalition asks applicants to already be an established community group; some groups that have participated in the past include, but are not limited to: the local domestic violence/sexual assault program, local school district, law enforcement, Title X agencies, youthserving agencies, and public health centers. In every community that is selected to participate, the coalition performs a needs assessment, using Colorado State University’s Community Readiness Model, including eight to 10 telephone interviews. They then use the readiness model to engage community members to foster readiness and collective action to move forward in efforts to prevent sexual violence.

After the communities develop their individual plans, WHC and the coalition provide technical assistance to help them figure out how they will mobilize and educate members of their community about sexual violence and prevention of it. After nine months have passed, WHC returns to the community to perform follow-up assessments to measure the level of change. Annually, every community engaged in the project has substantially increased their readiness, not only mobilizing their community to prevent sexual violence but also to actually incorporate sustainable measures to keep their citizens engaged in these efforts for the long run. One community started a men’s bystander focus group. Another focused on engaging their school district, and implemented policy change around sexual violence in the schools. One community, located in a very politically conservative area where there was a lack of safety for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) students, started providing guidance for how to address this population; they developed their first ever Gay-Straight Alliance at their high school with the support of their principal. This community in particular has made its mark on the map, and was recently acknowledged by the Huffington Post as one of the top 10 communities safest for LGBTQ populations.

Through funding from the Wyoming Department of Health’s HIV Prevention Program, WHC has established an ongoing photo voice project. WHC’s first participant was Wind River UNITY Council, a youth group on an Indian reservation, where they established the Wind River UNITY Photo Voice for Healthy Relationships: Sharing our Stories to Promote Social Justice program. WHC worked with six young adults, ages 18-22 years old. They taught them about healthy relationships, gave them cameras and asked them to take photos of people, places, and things that both support and challenge their ability to have healthy relationships. The participants also took pictures of what a healthy relationship meant to them personally. When the pictures started coming in, WHC analyzed them and immediately saw emerging themes. WHC realized that these young people needed to have connections with their cultural heritage, and that it was vital that any health care and prevention work be presented to them in a culturally competent manner. Their knowledge about healthy relationships seemed to lie within their cultural heritage.

WHC has taken their findings from this project on the road, and has presented at the National Title X HIV Conference, as well as the National Mental Health Policy Research Conference. They’ve used their findings to work with elders in communities and health care providers/educators to help facilitate what the young people in their communities need and deserve. WHC also presented at the tribal grantees Personal Responsibility Education Program (PREP) conference and wrote an article in the Alaska Native and American Journal of Mental Health. After completion of their first photo voice initiative with the Wind River UNITY Council, WHC led a second photo voice project with a group of high school students in another community; emerging themes of not marginalizing LGBTQ students surfaced. The importance of these students feeling connected in their schools and fostering avenues for them to feel connected in their communities was vital. Supporting them to foster healthy relationships and healthy development were the community’s focus coming out of the project. The findings from this project have also been presented at many conferences.

WHC does not fundraise in the community, although its delegate agencies engage in and depend upon many fundraising events throughout the year. This type of fundraising has become especially vital as the implementation of the Affordable Care Act (ACA) nears and agencies work to adapt to the new health care economy. WHC agencies work hard to put on a variety of creative fundraising activities in the community that bring in diverse crowds of supporters. Some innovative ideas that WHC delegates have utilized include a crab feast and a silent auction, a rodeo, a glow walk at night, and “vino and vittles.” To ensure the success of such events, the agencies dedicate a lot of time to publicity, bring in volunteers including their Board of Directors and staff, sell merchandise, and seek donations of venues and food. The average revenue for these events after expenses ranges between $9,000 and $11,000 per event.

Several of the health centers in the WHC network operate under different electronic health record (EHR) systems, which have posed varying degrees of challenge. For example, one of the health centers has had a system for four years and is no longer able to access technical assistance to make necessary adjustments; the center will soon require a more updated system. Another health center is on a state-sponsored EHR system, which is good for primary care but not ideal for family planning. WHC is in the process of assessing whether a more centralized billing and EHR system for family planning could be developed for its delegates. WHC has formed an advisory committee to assess the best path to take for a common EHR system, made up of representatives from several of its delegate agencies. Members of the advisory committee come from different areas of the state that have varying internet access/speed, different levels of EHR systems, or no EHR system at all. The diverse experiences of the committee members are helping to ensure that any EHR solution will work for all.

In addition to its work on EHR, WHC is evaluating where else it might commit resources to help its agencies adapt to the ACA. WHC staff meets with health center directors quarterly, including two face-to-face meetings, to discuss key issues including ACA implementation at the federal level as well as any changes being implemented within the WHC network. Like Title X grantees across the country, WHC is facing difficulties with budget cuts and a difficult political climate, but with its dedication to innovation, its system hopes to remain viable for many years to come.

 

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