June 2016 | Issue 1

Community Health Needs Assessments in Action COMMUNITY

Leading Under one roof Cooking can Lending a hand 2 the way 8 Creating opportunity 13 be ‘Cool’ 17 Helping you Horizon Health and innovation The get around in Network is helping in downtown area is gaining a Petitcodiac, communities be fresh perspective on Salisbury, Elgin healthy healthy eating and Havelock Photo: Fredericton Tourism

Horizon Health Network is CEO Message driven by its mission...

Simply by picking up this publication Helping People you have expressed an interest in the health of your community. It looks like Be Healthy we have something in common. What you are reading today is not just Good health lies at the heart of another report. This is the fruit of our our daily quality of life. It is what labour. In the following pages you will all New Brunswickers want for learn about the challenges and the successes themselves and those they love. that our communities face while working Helping New Brunswickers be to improve the health of the people who live as healthy as they can be is the there. shared purpose that motivates all those who work at Horizon on You will be inspired by the work being done in the Fredericton Area, a daily basis. To achieve the best Oromocto Area and in Petitcodiac, Salisbury, Elgin and Havelock, results, Horizon puts patients following the completion of their Community Health Needs Assessment and clients at the centre of the (CHNA). CHNAs are conducted to help identify the unique strengths health delivery system with and needs in a community, and provide recommendations to improve a vision of delivering the health and wellness of its population. “Exceptional care. Every person. We will share some achievements from these three communities to Every day.” demonstrate to you how their hard work pays off for all of us. We want to get communities talking about this work, to understand that these Each community CHNA reports have not been shelved. To the contrary, they have been served by Horizon is unique. acted upon with passion at a community level. Our next publication will Working with key community partners, clinicians and other focus on successes from other areas, because there are more. stakeholders, progress has been To improve overall health, communities are taking action to address the made to identify and address many factors that influence it, including: health behaviours, social and their specific needs. This is an economic factors, the physical environment and health services. intentional effort initiated by So let us share more about how our communities are taking the lead Horizon to significantly improve to improve the lives of their residents. I can tell you the progress is community-based primary care, encouraging. and support expensive tertiary services required by John McGarry, President and CEO an aging population. 2 Horizon Health Network Fredericton and Table of 6 Surrounding Area Partnerships pay off for Community Health Centre, Contents vulnerable population in downtown Fredericton

Oromocto and 10Surrounding Area Social worker takes community-wide approach to helping those in need

Changes occurring in culture surrounding obesity

Community Health Needs 14 Assessments in Action COMMUNITY Petitcodiac, Salisbury, June 2016 | Issue 1 Elgin and Havelock Contributors: Food-related projects adding value • Karen Scott • Christy English to communities in southeastern NB Creative lead: Rural Rides: A success story for • Sheena Dougan residents without other options Resources: • Jean Daigle • Bruce MacPherson • Allison Holland • Gabrielle Levesque • Janet Hogan Cover credits: • Photos submitted by: Fredericton Tourism, Town of Oromocto, W.I. Goddard & Sons Ltd. Printing: • Advocate Printing The following CHNA Summary documents were used as resources for this publication: • Oromocto And Surrounding Area Health And Well-Being Needs Assessment, 2011 • Fredericton & Surrounding Area Community Health and Well-Being Needs Assessment, 2012 • Community Health Needs Assessment: Petitcodiac, Salisbury and Surrounding 18 Area, 2014 Message from Jean Daigle

Vice President Community for Horizon Health Network www.HorizonNB.ca 3 Health care today A well-designed health system With our province’s aging unique needs of the people in each should feature both strong population, southern migration, community. centres of hospital-based care and and shift from rural to urban The good news is that work appropriate community-based care living, health care as we know it is is underway. Horizon Health “close to home” for New Brunswick changing. Government and non- Network (Horizon) is working in residents. It’s a system that would government organizations and partnership with communities to ensure every New Brunswicker has communities alike are looking for provide better preventive, primary, access to the services they need to be ways to deliver care in a way that long-term and palliative care to as healthy as they can be. does a better job of meeting the everyone that lives there. Community Health Needs Assessments Since 2012, Horizon has been address the other 90%. The CHNA Table 1: Determinants of Health working with communities to gain a process provides an opportunity as categorized by the Public Health Agency of Canada better understanding of their health to get everyone around the table care needs using Community Health to look at all areas that are known Needs Assessments (CHNA). A to impact our health - health 1 Income and Social Status CHNA is a dynamic and ongoing determinants (Table 1). 2 Social Support Networks process that identifies the unique CHNAs help identify priority 3 Education and Literacy strengths and needs of a community. areas in the community that This information provides both need attention and support the Employment and 4 Horizon and the communities with development of action plans to Working Conditions a roadmap to achieving a common address them. This work influences 5 Social Environment goal: to improve the overall health of programming that better serves New Brunswick communities. the population and often supports 6 Physical Environment Have you ever considered how the efforts of primary health care Personal Health Practices 7 housing or access to transportation providers like family physicians, and Coping Skills might affect the health of an nurse practitioners and pharmacists. Healthy Child individual? You may not know it, 8 Nobody knows a community better Development but measuring community health than the people that live there. This Biology and Genetic goes far beyond studying rates of 9 work to address priority areas is Endowment disease and the availability of health being driven by a local committee care services. Health services account that is passionate about the well- 10 Health Services for only 10% of what influences our being of the community. With 11 Gender health (see pie chart), which is why support from Horizon and other Horizon is working with individuals stakeholders, they are advocating for 12 Culture and agencies at a community level to your health.

What influences our health? 40% Health Behaviours

40% Social & Economic Factors

10% Physical Environment

10% Health 4 Services What is primary health care? Primary health care refers to an approach to health and a spectrum of services beyond Mental Primary Home Care the traditional health care system. It includes Health Health Care all services that play a part in health, such as income, housing, education, and environment. Primary care refers to health promotion, illness and injury prevention, and the diagnosis and Common treatment of illness and injury. (Health Canada) Themes Transportation Emerging Recreation 13 Community Health Needs Acute Assessments Care Access to Information, completed to date Awareness

Intersectoral/ Obesity, Community Food Partnership Insecurity

The province is divided into Housing Substance 33 unique communities to ensure a Poverty Abuse better perspective of regional and local differences. Community Health Needs Assessments have been completed in 13 of them.

• Oromocto and • and Area Surrounding First Area Supporting Language • Fredericton and Families Nations Issues Surrounding • Grand Lake Area Area • St. Stephen, St. • Neguac Area In your community Andrews and • Miramichi Area Surrounding Knowing what is happening in your community is important. Horizon Area • Tantramar Area has collaborated with three communities that have completed CHNAs • Petitcodiac, • Central NB to let you know what they are doing to build a healthier community. Salisbury and • Albert County In the pages that follow, we will dig deeper into the specific priorities, Surrounding • Carleton challenges, and successes in the Fredericton Area, Oromocto Area and Area County in Petitcodiac, Salisbury, Elgin and Havelock. • Saint John Stay tuned for our next issue which will feature news from other Horizon communities. 5 About Fredericton and Surrounding Area Photo: Fredericton Tourism

The Fredericton and Surrounding of Horizon Health Network, Area (F&SA) has been recognized municipalities and the provincial as resourceful in the way it has government. They were prioritized successfully established many ways by the original advisory committee, to deliver care. A diverse collection which has since disbanded, and of community agencies and assigned to four working groups: organizations as well as the business Primary Health Care Improvement, sector is delivering a substantial Improve Access to Information, amount of primary health care Healthy Eating and Physical beyond the traditional health care Activity Advocacy, and Mental delivery system. This includes Health and Addictions. providing housing and food to those Today, the priorities outlined in Photo: Fredericton Tourism in need and promoting health to the the CHNA continue to guide priority populations in supportive community-based efforts to improve and trusting environments, not just the overall health of the population Key Stakeholders treating disease. in the F&SA. Advisory Committee The Community Health Needs What was learned Assessment (CHNA) for the F&SA • Horizon Health Network through the • Fredericton Chamber of Commerce began in 2012 with the assembly of Community Health the F&SA Health Care Advisory • St. Mary’s First Nation Needs Assessment? • Le Centre communautaire Sainte- Committee. The population covered Anne in this assessment included the city The priority populations for this • District scolaire francophone Sud of Fredericton, two First Nations area include: homeless, vulnerably • Third Age Centre communities, one village, and a housed and working poor, First • United Way number of suburbs and small rural Nations peoples, newcomers • Fredericton Police communities. (immigrants and refugees), persons • Multicultural Association of with disabilities, rural-urban Fredericton Through this process, 10 formal • Anglophone West School District (18 recommendations were brought populations, seniors, and children and youth. & 1) forward to inform the work • City of Fredericton • University of New Brunswick • Government of New Brunswick 6 • Village of New Maryland There are 10 priority to how mental health and to prevention and health. The areas to work on: addictions services are being population health approach uses health 1. Centre primary health care on delivered; and engage the public determinants (see page 4) to identify prevention and health. around mental resiliency. and resolve inequities and gaps in care so that everyone in the community has 2. Establish a Community Health 9. Identify and collect local data that illuminate disparities. appropriate access to the service they Centre (CHC) in downtown need. Fredericton. 10. Better connect tertiary and community-based care to As a priority population, First Nations 3. Take health services out into the Communities in this area also require communities across F&SA to facilitate hospital admissions and discharges. access to community-based care. With the people who need them the the support of the Urban Aboriginal most – the 1% to 5% responsible How are we doing? Knowledge Network (UAKN) for 49% and 84% of our Since completing the CHNA for and some government and Non- respective combined hospital the F&SA, multiple committees Government Organization partners, and homecare costs. have formed to address the Under One Sky is now designated as 4. Improve access to information recommendations. Being a strong a “Native Friendship Center”. Once on available community-based priority for the community, much fully funded, Under One Sky plans and systems-based health of the focus to date has been on to integrate wellness programming, and well-being services and getting the Fredericton Downtown government services, and addiction programs. Community Health Centre and mental health services into its 5. Leverage Under One Sky Head (FDCHC) up and running. service delivery model. Start into an urban (off-reserve) The FDCHC opened in 2014 to Where do we go Aboriginal Family Resource support some of the area’s most from here? Centre. vulnerable populations – see page 8. Now that the community health centre 6. Campaign for a more systematic is fully operational in downtown approach to healthy eating and There is a small percentage of the Fredericton, the focus must shift to active living in F&SA. overall population with complex other priority areas of the CHNA. health and well-being needs; this 7. Provide access to a full The unique collaboration required is also true for the F&SA. CHCs to get the FDCHC off the ground is spectrum of health services in have been identified as the best both official languages. deserving of applause and serves as strategy to meet those needs and great momentum to address other 8. Update the public and health also represent an investment in recommendations. It is a testament to professionals on recent changes the population health approach how the health of a community can benefit from innovative thinking. Read on to learn more about how the FDCHC has made a difference in the way some of our most vulnerable populations access primary care.

7 Photo: Fredericton Tourism Horizon Health Network conducted a Community Health Needs Assessment for the Fredericton and Surrounding Partnerships pay off for Area in 2012. The following article highlights key outcomes of that Community Health Centre, assessment. vulnerable population in downtown Fredericton Primary Health Care The Fredericton Downtown The results are encouraging. In a Community Health Centre recent patient experience survey, (FDCHC) connects people with the 96 per cent of respondents rated resources they need. Some of the FDCHC services as being good or city’s most vulnerable populations great. “We’ve built up expertise around health assessments and our ability benefit most from the services One patient, whose name is Fred, offered at this primary health care to work with partners in the emerged from the hospital after community to fulfil client needs,” facility and its partnerships with a stroke and went home to his other community organizations. said Kingston. “We couldn’t do rooming house. With no health the work we do with refugees, Together at FDCHC, Horizon card, no physician and no job, Fred for example, without help from Health Network (Horizon) and was able to benefit from the services the Multicultural Association of the University of New Brunswick’s of FDCHC. During a home visit Fredericton (MCAF).” faculty of nursing have a unique by two nurses, he cried when they partnership that provides primary asked him how they could help. He FDCHC helps to identify the unmet health care services, opportunities has since signed on with a nurse health needs of clients referred to for nursing students to gain practitioner and a social worker, and the centre by MCAF while MCAF experiential learning, and ways to receives the medication he needs. provides interpreters, helps families advance research and innovations in Getting on with his life, Fred has find housing, gets children set up community-based health care – all established friendships and made in schools, and introduces clients to under one roof. use of the centre’s Community volunteers for Fredericton Friends for Refugees. Joan Kingston and Graeme Access Room. He is now fulfilled, Smith are co-nurse managers has started a small part-time Lisa Bamford De Gante, MCAF of the centre. Kingston believes business enterprise, and has not executive director, says her the harm-reduction approach been readmitted to hospital. association has partnered with they take to patient and family- The staff at FDCHC – available FDCHC since it opened. “FDCHC centred care provides patients to provide services like those Fred strives to offer culturally sensitive with the independence and self- benefited from – currently includes and inclusive health care services determination they need to make a physician, two nurse practitioners, better choices in life. four registered nurses, two licensed “Benefiting from that care and practical nurses and a social worker commitment are the homeless and in addition to foot care, massage those at risk of becoming homeless,” therapy and administrative support. she said. “We’re also helping at-risk In the larger facility that will open youth; seniors living in subsidized in December 2016, managers housing downtown; Syrian and will have the resources to expand other refugees; poor or marginalized primary care services and cover people with mental health issues fields such as respiratory therapy, and other co-morbidities; and those occupational therapy, nutrition and without a family doctor or nurse psychology. practitioner.” 8 A Bit of History When Horizon Health Network (Horizon) initiated a community health and well-being needs assessment for Fredericton and its surrounding area in 2012, it was determined that the Fredericton core had a high concentration of newcomers, elderly people living alone, and single families with children living below the low income cut-off point. The core also has higher housing costs and lower access to physicians, perhaps contributing to the high traffic at walk-in and after-hours clinics. The Fredericton Downtown Community Health Centre (FDCHC) is building on a relationship that was formalized to new immigrants and refugees we make appointments available in 2012 when Horizon and the existing in Fredericton,” she said. “As for priority cases and connect UNB Community Health Clinic formed soon as (they) arrive, they are people to our Community a unique partnership to create the able to receive comprehensive Access Room, which is a laundry Fredericton Downtown Community health assessments and supports and showering facility for the Health Centre. to navigate a complex health care vulnerably housed or homeless system. The FDCHC has greatly population and a place where FDCHC is currently located in the contributed to the enhanced health you can have a cup of coffee and government’s Centennial Building and the and well-being of newcomers to learn about helpful community Government of New Brunswick recently our community.” resources,” he said. announced it will invest $4.8 million for the purchase and refurbishment of a Smith says when working with Smith noted that Horizon and property located at 339 King Street in the vulnerable populations it is vital the UNB faculty of nursing both heart of the city’s downtown core. That to be as accessible as possible benefit from the student learning, building will be the new home of the and to have a warm, welcoming teaching, and research capacity centre and its doors are expected to open environment. FDCHC provides that is provided with a vibrant in December 2016. that. learning lab such as FDCHC. “We’re a short walk, drive or When the new, larger facility bus ride for most downtown opens its doors in December, Fredericton residents and, from the centre will be able to grow Key Partners another accessibility perspective, substantially, expand its outreach and offer more services to ensure In addition to Horizon Health better health outcomes for Network, the UNB faculty of nursing patients, he said. and the Government of New Brunswick, other key partners in For more information or FDCHC’s delivery of service include: to contact the Fredericton the homeless shelters, community Downtown Community Health kitchens, mental health services, Centre call 506-452-5900. the Capital Region Mental Health and Addictions Association, AIDS New Brunswick, the Multicultural Association of Fredericton and the John Howard Society. Important work is also being done by Fredericton’s faith communities and the Community Action Group on Homelessness. 9 Key Stakeholders Advisory Committee • Horizon Health Network • Government of New Brunswick • Wel-A-Mook-Took Health Centre • Oromocto First Nation About • Seniors Representative for Oromocto • Canadian Forces Base Oromocto and Gagetown • Military Family Resource Centre • Gagetown & Area Health Services Association Inc. Surrounding • Town of Oromocto • School District 17 Area • Oromocto RCMP, District 2 Photo: Jason Belliveau

The Health Care Advisory address challenges, and to identify Committee for the Oromocto and new opportunities for the area. Surrounding Area (O&SA) knew The Advisory Committee is a early on that it would need to reach collection of health care professionals, into a largely untapped resource pool service providers, community to implement the Community Health members and individuals. A series Needs Assessment (CHNA) for the of working groups has since formed area. Fortunately, these resources including: transportation; mental were diverse and brought a wealth of health and addictions; primary care skills, experience and leadership to access; healthy lifestyles – wellness the table. network for the O&SA; and The CHNA for O&SA began in intersectoral collaboration. 2009 and included the town of The community-based efforts of Oromocto, Oromocto First Nation the Advisory Committee and the (OFN), Canadian Forces Base (CFB) working groups in the O&SA are Gagetown, Gagetown & Area ongoing and the work they do plays Health Services Association Inc. and a major part in improving the overall a number of small rural villages and health of everyone who lives in the crossroads. area. At the time, the population health What was learned of the O&SA had a more positive through the outlook than both its neighbouring Community Health communities and the rest of Needs Assessment? the province. Yet, a total of 61 recommendations still emerged The priority populations for this area from the CHNA process. The include: Youth, rural communities, recommendations were grouped First Nations, orphan patients, into 10 priority areas for action by transient military families, and those the Advisory Committee. They meet requiring mental health services. 10 twice a year to discuss their progress, There are 10 priority areas physician, two nurse practitioners, a The Volunteer Oromocto page was to work on: licensed practical nurse, a dietitian, set up to make it easier for people to 1. Access to public transportation and a social worker. find volunteering opportunities in The health care services being the community and to benefit from 2. Increased access to services for the experience of doing so. mental health and addiction delivered at the Oromocto Health Clinic are not limited to the four 3. Primary care and prevention to Visit www.oromocto.ca/ walls that house it. In fact, this volunteer-opportunities to get be delivered in the communities model of care supports outreach involved in your community. 4. Ready access to recreational to the surrounding areas since Where do we go facilities accommodating all transportation is often a challenge in from here? ages rural communities. 5. Dramatic change in culture While the town of Oromocto General counselling and mental has capacity to improve in many around obesity health and addictions services of the priority areas identified 6. Empowering governance are being offered to youth right in their school. in the CHNA, there are many structures and community Read more on page 12. barriers remaining for the more infrastructure A support system is also in place to rural communities. Fortunately, 7. Appropriate and enabling help clients challenged by obesity or Oromocto’s growth can be used to housing who are seeking the tools to lead a benefit other areas and ease some 8. Sustainable income, inclusion healthier lifestyle. The community of their challenges. For example, and health equity is promoting healthy and active outreach services improve access in 9. Intersectoral collaboration lifestyles for everyone who lives those rural areas and address the there. After all, a combination of lack of public transportation across 10. Volunteers communities. How are we doing? recreational activity and healthy eating habits can substantially The Advisory Committee continues The effort of the Advisory benefit the mental and physical to work to ensure that sustainable Committee and its working groups health of an individual. income, inclusion and health to make a difference is visible in the equity can also be experienced by Residents of all ages can learn community. A series of projects is more about how to access, cook those living outside the town of underway or already in action that and prepare fresh, healthy, and Oromocto. Focusing on improving address the priority areas identified affordable food right in the cross-community involvement can in the CHNA. Oromocto and Surrounding increase participation in recreational Area. Learn more on page 13. The Centers for Disease Control activities that are good for both and Prevention (CDC) states that In addition to service providers, physical and mental well-being. a strong network of volunteers “Working at the community level to To keep the momentum going at a is working hard to improve the promote healthy living and prevent community level, service providers, overall health of everyone in the chronic disease brings the greatest volunteers, and everyone who community. There really can never health benefits to the greatest lives in the O&SA must continue be too many hands on deck, which number of people in need. It also working together to build a is why it is important to always helps to reduce health gaps caused stronger, healthier place to live. by differences in race and ethnicity, encourage people to get involved. location, social status, income, and other factors that can affect health.” The need for primary care and prevention to be delivered in the community had a lot to do with the rural population and the large number of military families arriving in the area. The O&SA now has access to a team of primary care providers working out of the Oromocto Health Clinic including a 11 Horizon Health Network conducted a Community Health Needs Assessment for Oromocto and Surrounding Area in 2009. The following article highlights key Social worker takes outcomes of that assessment. community-wide approach to helping those in need

The role a social worker plays “This started out as one day per Mental Primary behind the scenes in communities week, but based on need, I am now Health Health Care should never be underestimated. at OHS two days a week.” Rhonda Berry-Cleghorn has Many of the teenage students that been working as a community Berry-Cleghorn treats at OHS are social worker at the Oromocto dealing with symptoms related is an award-winning, evidence- Community Health Clinic since to anxiety, depression, low self- based classroom program that has October 2015. The position esteem, anger management, family shown dramatic effect in reducing encompasses both social work and dynamics, peer relations and grief. levels of aggression and violence community development but Berry- Crisis intervention is provided for among school children while raising Cleghorn says needs are currently situations involving food security, social/emotional competence and higher for clinical work involving shelter and mental health. increasing empathy. mental health and counselling. Berry-Cleghorn works with an Cindy Farrell, that classroom’s Working with youth, adults and interdisciplinary team at the clinic, teacher, has high marks for the the senior population including including nurse practitioners and program and Berry-Cleghorn’s civilian and military families, she a dietitian. “We provide and build delivery. covers a lot of territory. She receives services for the patients often “Rhonda handled the topics with referrals from the Oromocto First linking (the services) to one another such great care and respect,” Nation and rural communities to meet their individual needs,” she Farrell said. “I am confident the outside of Oromocto, including said. information will have an impact on Burton, Gagetown, Geary, Tracey, She highlights one example, my students that we may not see Fredericton Junction, Rusagonis, involving a patient referred to her firsthand in the years to come, but Waasis, Lincoln, Sheffield and by the MFRC, which demonstrates one that I am sure will benefit their Maugerville. the concept of collaborative care. own future children and their safety. I see the benefits of this program “We also partner with the Military “I saw the patient for counselling, more and more with each visit and Family Resource Centre (MFRC) and through the assessment, learned especially when students put into and take referrals from there, when that the individual was registered practice what they have learned.” appropriate,” Berry-Cleghorn said. with Patient Connect NB, did not Referrals in the youth sector are yet have a health care provider, and Being able to provide support mostly at the middle school and was experiencing serious health care to youth in the community is a high school level. She works with deficits,” Berry-Cleghorn explained. privilege Berry-Cleghorn does not middle school-aged youth at the “I contacted our nurse practitioner, take for granted, she said. “Seeing clinic and with high school-level who agreed to pick up the file; a young people realize that they have students at Oromocto High School. referral was made to the dietitian, the potential to overcome obstacles and the individual’s health care in their life and learn to shine, from needs have been met from many within themselves, and rise above perspectives.” life’s challenges, is the greatest gift this job has to offer.” Each Wednesday, Berry-Cleghorn visits the Sunbury West School in For more information about Fredericton Junction to facilitate the services offered at the Oromocto Roots of Empathy program with Community Health Clinic, a Grade 4 class. Roots of Empathy call 506-357-4922. 12 Horizon Health Network conducted a Community Health Needs Assessment for Oromocto and Surrounding Area in 2009. The following article highlights key Changes occurring in outcomes of that assessment. culture surrounding obesity Food security has been defined as When Oromocto-based dietitian Witnessing a dramatic change in having access to Renée Cool prepares delectable the culture surrounding obesity, sufficient, safe, snacks such as strawberry apple salsa, Cool has partnered with many nutritious food to apple and cheese quesadillas, and organizations including the Obesity, maintain a healthy Food Insecurity and active life. energy balls, it’s no wonder children Oromocto Food Bank, the Town from local schools and the Oromocto of Oromocto, the Military Family First Nation are eager to try the Resource Centre, the Sunbury South recipes at home. Wellness Network and the Healthy Cool is a registered dietitian with the Learners in School program. fun through interactive, thought- Oromocto Community Health Clinic “We are cooking with students provoking activities involving food whose outreach activities are making at Ridgeview Middle School and preparation. The program targets a difference in how young people École Arc-en-ciel, and hold evening children from 8 to 12 years of age and adults view food, nutrition and cooking classes for parents at and attracts volunteer participants lifestyle choices. Lincoln Elementary School.” older than 12 who become facilitator assistants. “In order to improve the rates of Cool teaches a weekly cooking class obesity, we need to engage the for First Nations children as part of Community Food Mentors are community and have a ‘cultural an after school program supported certified individuals who share their shift’ in which people choose healthy by the Diabetes Innovation Fund. expertise in nutrition and build food most of the time,” Cool said. Helping to establish healthy eating partnerships and a community’s “Obesity needs to be approached at habits, she says the students have capacity to increase food security. The many levels, including food security, been able to experience healthy shared learning experience fosters the healthy eating, basic cooking skills, food choices and have tried and exchange of important information physical education, mental fitness, accepted different foods. She also about healthy dietary practices and and much more. We also have to holds cooking and healthy eating local food sourcing. look at the environment in which sessions for adults, opening a few Through the Oromocto and Area people live, work and play.” more doors with the First Nation Community Gardens, Cool supports Cool works in a team environment community, she says. efforts to grow vegetables in a small that includes two nurse practitioners, “I try to take the primary prevention plot. “Last year, we donated the a social worker, and a licensed approach to health care while still produce to the food bank but we hope practical nurse. She counsels offering individual counselling to grow vegetables in small amounts patients from the care.” this year, and have them available to patients,” she said. clinic, referred by the Cool is involved with nurse practitioners, in other initiatives that During Nutrition Month (March), addition to self-referrals help to develop healthy Cool held weekly lunch and learn from the community. lifestyles in Oromocto sessions for staff at the Oromocto and beyond. These Public Hospital, and the feedback was include: Chefs! which positive. is offered in schools; “I found (the sessions) to be extremely the Community Food informative and useful,” said one Mentor Program; and participant. “Thank you for offering Community Gardens. this. It was much appreciated.” The Chefs! Program introduces For more information about services children and youth to healthy offered at the Oromocto Community eating, cooking skills and physical Health Clinic, call 506-357-4922. 13 About Petitcodiac, Salisbury, Elgin and Havelock

The enthusiastic and energetic committee, the same group that now community members that form the forms the active CAC for the area. Petitcodiac, Salisbury, Elgin and There are numerous ways Havelock Community Advisory residents in these areas can Committee (CAC) are leading access community-level, primary efforts to improve the health of health care. They include family everyone in those communities. physicians, health centres, and local They meet regularly to monitor pharmacies and also include schools, progress in priority areas that were churches, service clubs and any identified in the other group or organization that Community impacts the determinants of health. Key Stakeholders Health Needs All members of the CAC are Advisory Committee Assessment (CHNA) for the involved in monitoring or leading • Rural Rides/ Salisbury Lions area, to find new activities at a community level • Wellness NB that address the priority areas • Public Health developments or projects, and identified in the CHNA. In • Village of Salisbury addition, two working groups have • Canadian Mental Health to address any Association challenges they been established: Nutrition & Food • Jordan Lifecare are faced with. Security and Active Community. • Horizon Health Network The chairs of these groups The CHNA for • Havelock participate in the CAC meetings to • SPOT (food bank, this rural area report on their goals, including both Petitcodiac) began in 2013 progress made in achieving them • Ambulance NB and includes the and solutions to challenges. • Jean Coutu Petitcodiac communities • Village of Petitcodiac of Petitcodiac, What was learned • Salisbury Guardian Salisbury, Elgin, through the • Mental Health & Addictions Havelock and all Community Health • Social Development areas in between. Needs Assessment? • Department of Health This marked the The priority populations for this • Community Schools assembly of the Coordinator Anglophone East area include: children, youth and • Petitcodiac Health Centre CHNA steering residents over age 55. • Elgin 14 There are six priority programs and activities and more order to diagnose and treat them as areas to work on: opportunities for social gatherings. well as offer appropriate, preventive health care. Understanding the 1. Increase community A central list of programs and connectedness activities for all ages is available services available in a community at local events or at your local helps those looking for and those 2. Address the fundamental issue Parks and Leisure Department. delivering them to navigate the of nutrition and food security regulatory maze often encountered 3. Provide more public Being connected also requires in seeking services. transportation access. In rural communities, affordable public transportation Going out to meet some of the 4. Develop a new model and like taxis and buses is often limited people providing other services facility for primary health care in the community helped a or not available at all. Fortunately, services group of health care providers this has not gone unnoticed. See learn more about those services 5. Increase opportunities for page 17 to find out more about how so they could better support children, youth and adults to Rural Rides, a dial-a-ride service, is their clients. become more active helping people participate fully in Where do we go 6. Address the regulatory maze your community. from here? encountered in seeking services Increasing community Making fundamental changes to the How are we doing? participation and engagement can contribute to improved way primary health care is delivered The CHNA covered several mental, physical and is a big job. While the successes neighbouring rural communities social well-being. are impressive, there remain with similar priorities. While each challenges such as limited funding, Farming is a way of life in these is unique, there are recognized communication barriers across communities. In addition to benefits to being connected. communities, and logistical issues. providing local fresh produce, local Petitcodiac, Salisbury, Elgin and With collaborative teamwork, Farmer’s Markets are a great place Havelock have been working however, opportunities emerge. together to offer a larger roster of to socialize. Making healthy food available in the community supports Watch for the Petitcodiac both the local economy and the Farmer’s Market outside in a new location in 2016! growing need to address nutrition and food security. You can read Each priority area tackled by the more about some of these initiatives CAC for Petitcodiac, Salisbury, on page 16. Elgin and Havelock contributes to In your community there are improving the overall health of the opportunities to learn how to people who live there. grow, prepare, serve and store healthy food. To learn more about the work being conducted by CAC for this area, Health care providers need to please contact: understand the people they serve in Jennifer Taylor, CAC Co-chair 506-756-3415 [email protected] Moranda Van Geest, CAC Co-chair 506-756-2518 [email protected] Read on to find out more about people truly making a difference in your community.

15 Horizon Health Network conducted a Community Health Needs Assessment for Petitcodiac, Salisbury and Surrounding Area Food-related projects in 2013. The following article highlights key outcomes of that adding value to communities assessment. Food security has been defined as in southeastern NB having access to sufficient, safe, A nutrition and food A new project for the nutritious food to security working group group is the establishment Obesity, maintain a healthy in southeastern New of a food preservation Food Insecurity and active life. Brunswick wants to ensure co-op that will support that communities get back local farmers, food to basics when approaching bank patrons and the work together on a regular basis to their health and dietary community. The operation prepare nutritious meals for their needs. will involve canning, families. The group’s goal is to ensure Organic farmer Susan dehydrating, fermenting, people eat better and make food Linkletter is chair of the freezing and freeze-drying preparation more fun by turning group and takes great pride all kinds of produce that is the work into a social event. Pooling in the work they have done to add produced locally in excess. resources to purchase nutritious value to their communities. Members “The project will increase the amount ingredients would also keep costs of her team include farmers, food of local food that we are producing lower, Linkletter said. bank representatives, a dietitian, and get it into the hands of local The group is also hoping to make municipal representatives, and people,” Linkletter said. “It will fresh produce more widely available members of the non-profit sector encourage our residents to eat more by taking farmers’ markets on the working on similar issues. nutritious items.” road. “By using mobile wagons, “We are one cog in a wheel of a As a certified organic farmer and which can be moved around from broader Community Advisory vice-president of the Organic Crop community to community in our Committee that looks at issues Improvement Association (OCIA) region, we would better serve local affecting the health of residents, — which certifies farms in seven residents and local farmers.” including mental health, addictions, countries around the world — Why are more people not growing transportation, and recreational Linkletter says she can appreciate at least some of their own food? The activities,” she said. “We have how hard it is, with food being out of nutrition and food security working examined food security issues in season in local markets, to get food to group is investigating this issue with our communities and formulated local consumers. “In a province where assistance from food banks who are an action plan on how to fix them. 87 per cent of our food is imported, surveying patrons. We are educating people about the having more of it produced locally “When we can pinpoint the barriers importance of nutrition and how will increase our food security.” to individual food production, we much lifestyle affects their health.” The most rewarding part of hope to sit down as a group and Projects up to now have included Linkletter’s work, she says, is being develop strategies or programs that starting a farmers’ market in able to work together with other are designed to get more food grown Petitcodiac, participating in local people around the committee table locally by anybody who has a suitable wellness expositions and expanding who have different perspectives piece of land to grow food on,” the Headstart Fresh for Less food box on the same issue. “I was already Linkletter said. program to the village of Salisbury. doing the work, furthering my own To learn more about these ongoing Fresh for Less clients, including low- interests, but now, working as part initiatives, contact Susan Linkletter at income families, seniors or students, of a dedicated team, I’m helping to 506-372-1085. For more information pay $15 a month ($12 for seniors) further the interests of the community on the Fresh for Less food box for a box of fruits and vegetables in food security, as well,” she said. program in Salisbury, call the bought at wholesale prices. Linkletter The working group has its collective Salisbury Baptist Church at and her group also submit monthly eye on starting community kitchens. 506-372-5179. nutrition articles to a local newsletter. The activity would allow people to 16 Horizon Health Network conducted a Community Health Needs Assessment for Petitcodiac, Salisbury and Surrounding Area Rural Rides: in 2013. The following article highlights key outcomes of that A success story for residents assessment. without other options For well over a year, Rural Rides has are most challenged by poverty, been providing affordable, accessible including seniors, people with Transportation transportation to residents of the low incomes, and the personally Upper Petitcodiac River Valley challenged.” region who need some help getting Rural Rides serves close to 50 clients, around. and the operation has the potential be at least 21 years of age. They are The concept started with the to assist many more who need reimbursed for their mileage but meeting of a small group of transportation for various reasons, they donate their time and often give individuals who felt a service was including medical treatment, job those funds back to the Rural Rides needed because no public means of training, shopping, visits to grocery organization, Alexander noted. transit, such as buses or local taxis, stores or food banks, and social/ Drivers must have received clearance exists in the area. recreational outings. from the RCMP following criminal background checks and must sign “Residents without access to cars are During the last fiscal year, the service confidentiality agreements. left isolated,” said Ross Alexander, provided over 250 round trips or a president of Rural Rides. larger number than that if trips with While Rural Rides is an independent group, Kelly Taylor, the manager/ “There are community-minded more than one client in the vehicle administrator, said their objective is people willing to help friends, were accounted for, Alexander said. to help standardize the dial-a-ride relatives and neighbours but that is The service covers the communities process across New Brunswick. not always feasible or convenient. I of Salisbury, Petitcodiac, Elgin, feel we are now at a point where we Havelock and all surrounding areas. “That would involve a standard can claim success but there is much Most rides are local or to Moncton for screening drivers, determining more to come.” although drivers have taken clients a client’s need and setting fares,” as far away as Saint John for she said. “Standardization would Early supporters of the initiative, appointments. help clear a path toward program including Alexander, were involved access. It’s also our goal to get more in making the decision to offer Chris Moir, 34, is a single father of corporate, private and government a dial-a-ride program similar to three living in Petitcodiac who lost sponsorship in order to subsidize those that exist in other areas. 90 per cent of his vision two years more rides for those who can’t afford They took steps to create a non- ago. “I had to give up my driver’s them.” profit, volunteer-driven enterprise licence,” he said. providing affordable transportation “I have used Rural Rides a Rural Rides is eager to have more to people in need. Rural Rides number of times to get to doctor’s volunteer drivers and clients. They incorporated in January 2014 and appointments and grocery stores, are working with adjacent groups became operational in October of and to take care of other odds in Moncton as well as Tele-Drive that year, thanks to a partnership and ends you need to get done in Albert County to provide an even with the Westmorland Albert the city. It gives me the feeling of greater service. Their collective Community Inclusion Network and independence, and that is something vision is to ensure that no person a start-up grant from the Economic everyone should have. I hope in Westmorland Albert is without and Social Inclusion Corporation. your service continues because it is access to affordable transportation. “We are providing a service that making my life a little easier.” Becoming a rider is an easy process. is dependable, courteous, safe and Alexander says Rural Rides is Registration involves a one-time fee efficient,” Alexander said. “Our designed to help people who can’t of $10 and a local, return trip starts service is respectful to all concerned manage and the service is affordable. at $10. Visit www.RuralRidesNB. com for more information or call and inclusive. We are also trying Drivers are all volunteers who 506-215-2100 to book a ride. to meet the needs of people who require their own vehicles and must 17 Message from Jean Daigle

What we have reported back to you is only a snapshot of the considerable amount of effort that has gone into preparing and implementing the Community Health Needs Assessments (CHNA). We have looked at some of the benefits as well as the challenges of investing in community- based care and highlighted some impressive achievements. Each community we visit is unique, however as you have seen in the Fredericton Area, Oromocto Area and in Petitcodiac, Salisbury, Elgin and Havelock, common themes have emerged. This is consistent across all 13 communities that have completed CHNAs to date. We recognize that understanding a community’s strengths and needs is the foundation for making informed decisions about community-based health care. It’s important to remember that health care is complex and measuring the health of a community goes far beyond looking at rates of disease and the availability of health care services. Horizon is a large organization, yet we contribute to just a small portion of what determines the health of an individual. This is why we are focused on working with many stakeholders, health care organizations, government, community organizations, and individuals like you to fully meet the unique needs of everyone in our communities. We each have an important role to play in improving the health of New Brunswickers. I would like to thank all of the communities who have participated or are currently going through this process. If we are to change the habits of our population, address our demographic challenges and truly respond to the unique health care needs in our communities, our Summaries of completed priorities must continue to be guided by the needs of the population. Community Health Needs Jean Daigle, Assessments can be found at 18 VP Community www.HorizonNB.ca