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Community Health Improvement in Rural Washington: Learning from Global Health Strategies and Programs

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Community Health Improvement in Rural Washington: Learning from Global Health Strategies and Programs Community Health Improvement in Rural Washington: Learning from Global Health Strategies and Programs Report Prepared for the Washington State Legislature Submitted to the Washington State Department of Health by Global to Local June 28, 2019 This report was prepared by Global to Local under contract DOH PRV23420 with the Washington State Department of Health. Global to Local is a 501c3 whose mission is to demonstrate the effectiveness of global health strategies to improve the health status of local communities. www.globaltolocal.org Recommended citation: Reed AK, Skurtu E, Sugarman JR. Community health improvement in rural Washington: Learning from global health strategies and programs. Global to Local. SeaTac, WA, June 2019. Contents Glossary of Abbreviations ..................................................................................................................................... 3 Executive Summary .............................................................................................................................................. 4 Background ....................................................................................................................................................... 4 Methods ............................................................................................................................................................ 4 Findings ............................................................................................................................................................ 4 Background ........................................................................................................................................................... 6 Global to Local .................................................................................................................................................. 6 What is Global Health? ...................................................................................................................................... 7 Methods ................................................................................................................................................................ 9 Community Outreach & Partnerships ............................................................................................................... 9 Kittitas County Health Network .................................................................................................................... 9 Northwest Rural Health Network .................................................................................................................. 9 Healthy Ferry County Coalition ................................................................................................................... 10 Southeast Washington Health Partnership ................................................................................................ 10 Community Engagement ................................................................................................................................ 10 Global Health Research .................................................................................................................................. 11 G2L/PATH Framework ................................................................................................................................ 12 UW START Center ....................................................................................................................................... 12 Rural Washington Communities ......................................................................................................................... 13 Community Demographcs .............................................................................................................................. 13 Rationale for Dividing Kittitas County into Two Regions ................................................................................ 14 Summary of Kittitas County’s Current Improvement Efforts .......................................................................... 14 Community 1: Upper Kittitas County’s Health Barriers ................................................................................... 15 Findings from Cle Elum/Roslyn .................................................................................................................. 15 Community 2: Lower Kittitas County’s Health Barriers ................................................................................... 16 Findings from Kittitas ................................................................................................................................. 16 Community 3: Ferry County’s Health Barriers & Top Priorities ....................................................................... 16 Community 4: Southeast Washington’s Health Barriers & Top Priorities ....................................................... 17 Common Health Barriers In Rural Washington State ..................................................................................... 17 Global Health Recommendations ....................................................................................................................... 18 Summary of Global Health Strategies ............................................................................................................ 18 Community health workers ......................................................................................................................... 19 1 Task-sharing/Task-shifting ......................................................................................................................... 19 mHealth and Teleconsultations .................................................................................................................. 20 A Frequently Identified Concern: Behavioral Health .................................................................................. 21 Summary .................................................................................................................................................... 24 Tools & Training .............................................................................................................................................. 24 State-Level Policy Considerations ...................................................................................................................... 25 Funding for CHW Programs ............................................................................................................................ 25 Access to Broadband Services ....................................................................................................................... 27 Access to Quality, Affordable Childcare ......................................................................................................... 27 Public-Private Partnerships ........................................................................................................................ 28 Place-Based Initiatives ............................................................................................................................... 29 Recommendations to Continue the Project Beyond the Contract’s Scope of Work ........................................... 30 Summary ............................................................................................................................................................. 31 References .......................................................................................................................................................... 32 Appendix A: Community Report to Kittitas County Health Network ................................................................... 35 Appendix B: Community Report to Healthy Ferry County Coalition .................................................................. 104 Appendix C: Community Report to Southeast Washington Health Partnership ............................................... 153 2 Glossary of Abbreviations BMGF: Bill & Melinda Gates Foundation BRIDGES: Bringing Global Health Expertise to Rural Washington CBT: cognitive behavioral therapy CCO: coordinated care organization CHA: community health assessment CHIP: community health improvement plan CHW: community health worker CUGH: Consortium of Universities for Global Health DBT: dialectical behavior therapy DOH: Department of Health EMS: emergency medical services G2L: Global to Local HFCC: Healthy Ferry County Coalition KCHN: Kittitas County Health Network LHW: lay health worker MCO: Managed care organization mHealth: mobile health mhGAP: Mental Health Gap Action Programme MNS: mental, neurological and substance use NWRHN: Northwest Rural Health Network PBI: place-based initiatives PM+: Problem Management Plus PPP: public-private partnership PST: problem-solving training SE WA: Southeast Washington START: Strategic Analysis, Research & Training U.K: United Kingdom UW: University of Washington WHO: World Health Organization 3 Executive Summary BACKGROUND In response to a legislative directive, in December 2018 the Washington State Department of Health engaged Global to Local (G2L) for a seven-month effort to identify lessons from global health that might assist in overcoming barriers to health in rural Washington communities. The purpose of the Bringing Global Health Expertise to Rural Washington (BRIDGES) project was to provide evidence-based recommendations and
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