The document discusses the Salem VA Medical Center's Rural Health program which aims to improve access to healthcare for rural veterans. Key points: - The program provides outreach and health education in 5 community clinics and 26 counties to over 112,500 veterans. - In 2014, the program's goals were to develop community partnerships, provide 184 educational sessions to 375 veterans, and contact 90 partners. - The program partnered with Virginia Wounded Warriors to host a conference for 70 community partners to improve coordination of care for rural veterans. - In FY14 they exceeded goals by providing 184 sessions to 631 veterans and 1078 non-veterans on topics like diabetes, heart health, and CPR

1. Developing Community
Partnerships
December 11, 2014
Lorna Oldson BSN
Brenda L. Hart MSN
Salem VAMC Rural Health

2. The Salem VA Medical Center
• Since 1934, Salem VAMC has been
improving the health of the men and women
who have so proudly served our Nation.
Services are available to more than 112,500
Veterans living in a 26-county area of
southwestern Virginia.
• In addition to our main facility in Salem, we
offer services in five community-based
outpatient clinics (CBOCs). These clinics are
located in Danville, Lynchburg, Staunton,
Tazewell, and Wytheville, Virginia.
2

3. What Area do we cover?
Salem VAMC Rural
Health Team provides
services to the
Counties highlighted
in yellow. Salem
VAMC is the blue
star, and our 5
CBOCs are the red
stars: Danville,
Lynchburg, Staunton,
Tazewell, and
Wytheville.
3

4. About Rural Veterans
• The Veterans Health Administration (VHA)
provides comprehensive healthcare services
to approximately 8.9 million of the 22 million
United States Veterans. U.S. soldiers in
recent conflicts are increasingly drawn from
rural areas and, therefore, rural VA users are
growing proportionate to urban VA users.
Youths living in the most sparsely populated
zip codes are 22 percent more likely to join
the Army, with an opposite trend in cities.
Regionally, most enlistees come from the
South (40 percent) and West (24 percent).
4

5. History
• The Rural Health Team was established in 2010 to do
outreach to assist Veterans with enrollment into the VA
healthcare system.
• The Rural Health Team had to go where Veterans “hung out”
such as gun shows, fairs, festivals and the community events.
• Partnerships were formed within Salem’s 26 county
catchment area to include (not limited to)
– Virginia Wounded Warriors Program
– VFW’s
– American Legions
– DAV’s
– Community Service Boards
• 2014 goals changed to develop community partnerships with
other healthcare providers and to expand health education in
rural communities. 5

6. What Do We Do?
• Outreach - Our Rural Health Team goes
out to where the Veterans are to share
information with them:
– General Information about VA Services and
Resources for Veterans
– Enrollment/Vesting
– Patient Education
• Networking
• Health Education
6

7. Program Description
• The VISN 6 Needs Assessment
documents that 53% of our Veterans are
rural or highly rural and face complex
challenges in accessing health care
including health/wellness information.
Despite their eligibility, many are unable to
participate in consistent VA care or
education because of their distance from
the nearest VA facility and lack of reliable
transportation options.
7

8. Program Description
• As per ORH Issue Brief #9, 2011,
healthcare quality suffers when Rural
Veterans can’t access appropriate
healthcare (in particular mental health
services), preventive care or education. A
2011 study by ORH, VISN 6 RH and the
VISN 6 MIRECC, found that 56% of
community providers fail to ask patients if
they are Veterans and only 29% of
community providers feel knowledgeable
about how to refer a Veteran to VA.
8

9. Program Description
• These disconnects must be overcome if
Rural Veterans are to receive efficient,
effective care. While care coordination
between VA and local health care
practices can deliver comprehensive, high
quality care, these critical relationships are
often underdeveloped in rural areas.
Improving care coordination by enhancing
communication is a crucial requirement in
improving health outcomes.
9

10. Program Objectives
1) Develop community partnerships to
improve public perception of VA and
provide information related to services
and benefits available to Veterans.
2) Identify Veterans who are receiving dual
care or community care only and make
them aware of VA services and programs
they may need but cannot receive
appropriately in the community (i.e.
mental health services for TBI, PTSD,
MST, etc.) 10

11. Program Objectives
3) Provide chronic disease education
programs to Veterans in rural
communities to teach Veterans how to
better self-management of these
diseases.
– According to VHA databases, 56.22 % of
VISN 6’s Veterans suffer from diabetes,
62.29% from heart disease, 55.95% from
hypertension and, 56.75% are tobacco users.
11

12. Salem RH FY14 Goals
• Teach 184 educational sessions
• Teach 375 Veterans
• Vest 375 Veterans
• Contact 90 community partners
• Identify Veterans with dual care
12

13. Problem
• The Rural Health Team found out fast that in order
to get into some of the very rural areas you
needed a contact that the community trusted.
• The Rural Health Team partnered with the Virginia
Wounded Warriors to reach into these
communities.
• As partnerships grew many barriers were
identified to include:
– Poor communication
– Poor knowledge of VA services
– How to contact the VAMC
– Who to contact at the VAMC
13

14. Challenges
• Developing trust within rural communities
• Creativity to reach out to community
providers
• Remote access in highly rural areas
• Participation
• Advertisement
14

15. Plan
• As an effort to remove these barriers the
Rural Health Team met with the Virginia
Wounded Warriors representatives in
Salem’s catchment area to discuss how
we could all work together to break down
these barriers.
15

16. DO
• We all met to discuss why and how to break
down these barriers. This started in April
2013.
• We each determined what information we
needed from community partners to set this
in motion.
• These meetings resulted in a plan to co-
sponsor a conference at the Salem VAMC for
community partners located within Salem’s
26 county catchment area.
16

17. Study
• One in three Veterans who are enrolled in the VA
health care system resides in rural areas.
• It is a Rural Health Initiative to ensure that all
Veterans in rural areas receive the health care
they need and deserve.
• Individuals living in rural areas have traditionally
been underserved with regard to health care
access. The reasons are multiple and varied but
mainly stem from the need to travel long distances
for health care, lack of public transportation, lack
of insurance, lack of specialized care and an
inadequate number of health care providers
working in rural areas.
17

18. Act
• The Rural Health Team and the Virginia Wounded
Warriors talked frequently to community partners
to determine why we all couldn’t work together.
We gathered all the information and we all felt it
would be worth the effort to plan a conference.
• The conference was called “Working With
Community Partners to Serve Veterans”
• The date was set for 2-26-14.
• The next step was for the Rural Health Team to
met with Salem’s Leadership to move forward with
this project.
18

19. Act
• The Rural Health Team met with Dr. Lapuz, our medical
center director.
• Topics were discussed and who would be best to
present on these topics.
• Dr. Lapuz suggested to offer CME’s to help entice
community partners to come to the conference.
• Advertisements for the conference included development
of a flyer with details and a registration form.
• The flyer was emailed and/or mailed to all community
partners within Salem’s 26 county catchment area (over
350 emails/letters were sent).
• Phone calls (over 200) were also made to community
partners.
19

20. Topics of Concern
• Post Traumatic Stress
Disorder (PTSD)
• Traumatic Brian Injury
(TBI)
• OEF/OIF/OND Program
• Home Based Primary Care
• Telehealth/Community
Health
• Crisis Intervention
• The Homeless Program
• Women’s Health
• Enrollment and Eligibility
• Veterans Benefits
• Transportation
• MyHealtheVet
• Pharmacy
20

21. Invitations
• Physicians
• Nurse Practitioners
• Physician Assistants
• Social Workers
• Nurses
• Life centers
• Lead Safe House
• Correctional centers
• Virginia Employment
Services
• Rehabilitation Centers
• Hospice
• State Mental Health
Agencies
• Health Departments
• Social Services
21

22. Data
• The conference was held on 2-26-14.
• Presenters deliberated all the services available to
our Nation’s Veterans along with the VA’s
commitment to identifying and breaking down the
barriers in communication between the VA and
community entities.
• Contact names and phone numbers were
distributed for each department to simplify future
communication.
• 70 participants were in attendance.
• Evaluations provided great feedback for future
projects.
22

23. Educational Challenges
• Finding rural locations to host health
education classes.
• Establishing trust and credibility within
rural communities.
• We needed to offer something in the
community that held value and that they
could get excited about.
• Sufficient quantity of educational material.
23

24. Problem
• We were established and teaching
diabetic education at several VFWs, but
not elsewhere.
• We needed 184 educational sessions to
meet FY14 goals for our program.
• We needed educational materials to hand
out to class participants.
• We needed advertisement.
24

25. Plan
• We contacted additional veterans service
groups such as American Legion, Vet
Centers, and other VFWs.
• We sent emails with an introduction to the
Rural Health Team and a list of classes
that we offered.
• We asked potential sites what topics that
they might be interested in & were flexible
about days & times.
25

26. Plan
• We asked current contacts if they had any
suggestion as to potential class sites.
• We contacted churches.
• We contacted YMCAs
• We contacted senior centers & retirement
communities.
• We contacted libraries.
• We offered classes to veterans and
members of the community. 26

27. • We decided to offer the “Friends &
Families” CPR classes without cost
to the participants.
• Everyone who attended a class took home
a free kit(inflatable manikin, DVD, etc.) to
practice with at home.
• We developed flyers for distribution within
the facility and neighborhood.
• We asked local newspapers to publish
information about our free classes.
27
Do

28. Act
• We initially offered “Friends & Families”
CPR classes to establish our value and
credibility within the community.
• We then offered our diabetes series.
• From there we offered our general health
topics.
• The director of each library would talk to
others within that system and that would
lead to other classes.
28

29. ACT
• Once class was scheduled, I emailed
each site several days in advance to
confirm that we would be there, time and
date.
• I followed up each class with a thank you
email and a list of other class offerings.
• I called each class site and asked what
they thought of the class and discussed
other class offerings that they might be
interested in. 29

30. Study
• Sites wanted to see for themselves that
our classes would be well attended and
well received by the class participants.
• Class participants asked for additional
class topics and we were invited back.
• Potential sites now call us to request
particular classes.
30

31. FY14 Data
We taught 184 educational sessions. There
were 631 veterans and 1078 non veterans
receiving education within the community.
We formed partnerships with:
•15 libraries
•3 VFW Posts
•3 Veteran Service Organizations
•2 YMCAs
•5 Senior Centers
31

32. Location of Classes
• Community Service
Boards (CSB)
• Churches
• YMCA
• VFWs
• American Legion
• Libraries
• RAM house
• Vet Center
• Salem Senior Center
• Vinton Senior Center
• Carriage Hill
Retirement
• Bethel Ridge Assisted
Living
• Brandon Oaks
• PRRC
• Rotary Field-Stuart
32

33. Educational Topics
• AHA Friends & Family
CPR
• Alzheimer’s & Other
Dementia
• Athlete’s Foot
• Anxiety
• Cataracts
• CHF
• COPD
• Depression
• Elder Care
• Fibromyalgia
• GERD
• Glaucoma
• Gout
• Heart Attacks
• Insomnia
• Nonalcoholic Fatty
Liver Disease
33

34. Educational Classes
• Osteoarthritis
• Osteoporosis
• Panic Attacks
• PTSD
• Shingles
• Sleep Apnea
• Stroke
• Thyroid Disorders
• Weight Management
• Most popular: Diabetes
– Pre-diabetes
– Managing your
diabetes
– Complications of
diabetes
– Medication
management
– Blood pressure
management
– Nutrition and diabetes
– Diabetes self care 34

35. Teaching Models and Tools
• Fat, Salt, and Sugar Tubes (Can
Visually See How Much Fat, Salt
& Sugar in Specific Foods)
• Dietary Fat Tubes (How Much Fat
in Food of Various Fast Food
Restaurants)
• DVD – Fast Food Survival Guide
• Male & female reproductive
Systems
• Lung (normal tissue)
• Smoker’s lung damaged by
emphysema and chronic
bronchitis/COPD, and cancer
• Prostate
• Why Prostate Exams Can Save
Your Life
• Diabetic Foot
• Consequences of Diabetes
• Breast Care/Lump location
• Heart Disease (Normal Heart,
Heart with Myocardial Infarction,
Heart with Congestive Heart
Failure, and Heart with
Thrombus)
• Heart with Congestive Heart
Failure
• Death of an Artery(Clear artery,
Build up of plaque, Reduced blood
flow, 70% blockage, complete
blockage)
• Death of a lung (normal lung,
emphysema, lung cancer)
• Skin Pathology
• Consequences of High Blood
Pressure
• A Guide to Contraceptives
• My Pyramid (Steps to a Healthier
You) 35

36. Teaching Methods
• Group Discussions
• Q & A at end of all classes
• Hands on
• Copies/Handouts
• Power Point
• Educational Brochures
• Individual CPR manikins to take home
• Games
36

37. FY15 Education Goals
• 184 educational sessions
• Partner with MOVE(weight loss program)
coordinator to bring MOVE into the rural
communities .
• Have at least 375 veterans participating in
our health education classes
37

38. What is MOVE?
• The VA serves over six million veterans of
whom about 77% are overweight or
obese. Approximately 38% are obese. The
MOVE! program is the largest and most
comprehensive weight management and
physical activity program associated with a
medical care system in the United States.
• MOVE helps patients lose weight, keep it
off and improve their health.
38

39. MOVE Goals
• Promotes personal responsibility and
personal empowerment to improve
health
• Improvement in health status
• Decrease/delay onset and/or
occurrence of weight-related chronic
diseases
• Improvement in quality of life
39

40. Features
• Focus on health and wellness through
healthy eating, physical activity and
behavior change
• Evidence-based, stepped-care model
• Lifetime/Lifestyle focus
• Population-based
• Health and Well-being emphasis
• Self-management support program
40

41. Features
• Same-day enrollment
• Patient determined intensity of treatment
in Primary Care
• Achievable goals
• Individually tailored program with frequent
review
• Focus on health and wellness through
healthy eating, physical activity and
behavior change
41

42. Features
• Focus on weight loss maintenance
• Comprehensive/multidisciplinary content:
behavior, nutrition and physical activity
• Website patient and clinician resources
• National online staff training
42

43. Plan
• We have met with our MOVE coordinator
to get her assistance and permission to
offer MOVE in the community.
• Our MOVE coordinator will supply us with
class outlines, power pints and other
materials to do the classes
• We have a medical clinic in Laurel Fork,
VA interested in being the first site.
• To be continued…..
43

44. VLER Health
• VLER Health is a program that shares
certain parts of the veterans medical
record between the Department od
veterans’ Affairs (VA) , Department of
Defense (DoD), and non-VA health care
providers. This will allow VA and non-VA
providers to make informed decisions
about veteran health care because the
shared information provides a more
complete health record.
44

45. PRRC
• We also formed partnerships within the
VAMC in order to provide health education
to rural veterans who come in for our day
treatment programs.
• We taught over 64 health education
classes to rural veterans in the PRRC
classroom in FY14.
• We are continuing our classes in PRRC
for the year 2015.
45

46. Community Partners
• We continue our goal of making contacts
with private providers within rural
communities.
• Our goal fro FY15 is to contact at least
901 private providers to talk to them
about:
• VA services available and who might
qualify.
• Contact information for the different
departments and services. 46

47. Community Partners
• Going out into the rural communities and
talking face to face to private providers (or
their nurse manager/office manager) on
their home turf.
47

48. Rural Health Team Collaboration
Groups
• National level: NRHA
• VISN level: 6 and 9
• State level: 31
• Community level: 44
• Facility level: 9
48

49. Advertisement
• Salem’s Internet
Website
www.salem.va.gov
(Events Calendar)
• Just the Facts
newsletter
• News Releases and
Flyers (Radio, TV,
Newspaper)
49

50. Statistics
FY2011 FY2012 FY2013 FY2014
Events 206 87 40 20
Applications 123 129 39 108
Vested/Enrollment 150 1752 846 1056
Veterans / Male Encountered 831 1912 508 1322
Veterans/ Female Encountered 69 98 23 22
Family Members/Others 852 2121 839 4397
Education Materials 3029 3203 1428 4587
Blood Pressure 354 486 56 47
Health Education Classes ? 36 48 184
50

51. Successes
Goals Completed
Educational
sessions 184 219
Vets
receiving ed 375 631
Caregivers
receiving ed NA 1078
Vets vested 375 1056
Community
contacts 90 94
51

52. Successes
• The Rural Health Program was very
successful due to several factors:
• Station support:
• Primary Care Leadership
• QUAD members
• The RH team:
• Brenda L. Hart RN
• Lorna Oldson RN
• Lois Lail LPN
52

53. Milestone
• The Rural Health Team conference:
“Developing Community Partnerships”
presented on 2-26-14 with 70 attendees.
• The number of collaborations that have
established:
– National level: NRHA
– VISN level: 6 and 9
– State level: 31
– Community level: 44
– Facility level: 9 53

54. Unforeseen Outcomes
• Contacted by the Metropolitan Property
Management Organization to provide
health education classes at 5 of its
facilities.
• Contacted by other facilities (such as the
libraries and other VSOs) to provide health
education classes in their communities.
54

55. Looking Forward FY 15
• Teach 184 educational sessions
• Teach 375 Veterans
• Vest 354 Veterans
• Contact 90 community partners
• Identify Veterans with dual care
55

56. Sources
• Office of Rural Health (ORH)
• www.ruralhealth.va.gov
56

57. Rural America
57

58. Questions/Comments/
Discussion
58