Rural Health Outreach Programs: Stabilization and Sustainability

1. Rural Health Outreach Programs: Stabilization and Sustainability Adrianne J. Lane EdD, RN-BC, CNE President Kimberly Herrmann Community Outreach Manager SouthEastern Indiana Cancer Health Network, Inc.

2. Presentation Objective • Discuss steps relevant to sustaining community based health programs long-term. • OR • Discuss strategies to increase the potential for long term sustainability

3. Who are We? • SouthEastern Indiana Cancer Health Network, Inc. (SEICHN) • Began in 1999 • Incorporated October 2002 • Serve SEI, particularly Dearborn, Ohio, Ripley, Franklin, Switzerland Counties

4. SEICHN • Primary Purpose: To promote the health of adults in SEI as it relates to cancer by increasing knowledge and practice of cancer screening techniques. • This will be accomplished by: • Providing annual screening opportunities and educational programs • Identifying and securing ongoing funding for screening • Establishing community linkages to promote our overall goal

5. What have we done related to these goals? • To date SEICHN has delivered 9 continuous years of cancer screening and education in a five county region • Provided effective, continuous health care by breaking down barriers of Cost, Distance, and Fear • Based on data gathered in conjunction with our Breast Health programming, identified collaborators and in 2006 started a Free Clinic serving underinsured adults in SEI

6. SEICHN Statistics to date • Over 2000 free mammograms • Cancer education to more than 2500 • Breast Health Participant Profile • 60 % insured, with over half reporting no coverage for screening services • Majority working Full time • >55% family income <$25,000/year

7. Pathway to Stabilization and Sustainability

8. In the Beginning • Advanced practice nurses • Residents of underserved communities • Substantial numbers of uninsured women • Poor state cancer screening statistics • Desire to create a program to meet needs • Recognition of need for model to guide us

9. Chose to use a Logic Model • Systematic and Visual • Understanding of Relationships • Conceptual Map (Kellogg, 2000) • Provide a methodology • Outline and Link • Goals • Objectives • Activities • Measurable Outcomes (Health Foundation of Greater Cincinnati, 2001)

10. Define the problem Logic Model Schema Identify the intervention State the goal Outline key objectives Determine outcomes

11. Define the problem Lack knowledge & access to malignancy screening Identify the intervention Create model based program to meet needs State the goal Increase knowledge & practice and linkages Outline key objectives Develop infrastructure Provide screenings Secure Funding Determine outcomes Increase awareness Increase resources Stabilize program, etc.

12. Lack knowledge and access to malignancy screening Create a model based program To meet malignancy Screening needs Increase knowledge & practice & Increase linkages Develop infrastructure Provide screening Secure funding Increase Awareness Increase Screening Increase Support Stabilize Program Track data and disseminate

13. SEICHN Stabilization & Sustainability -------Focus on Key Objectives • Develop an Infrastructure • (Infrastructure) • Provide Screening • (Implementation) • Secure Funding • (Sustainability)

14. 2000

15. Infrastructure--2000 • Logic Model

16. Implementation--2000 • Network with nurses from Local Health Departments in our own communities • Provide continuing education on breast health • Provide breast models and literature to health depts. • Serve as resources • Build community trust in organization • Work with local American Cancer Society • Plan full day breast health programs including free mammography via mobile unit

17. Sustainability--2000 • Funding from Indiana Women’s Commission • Investigate potential funding sources • Create a timeline for strategic grant submissions • Networking

18. 2002

19. Infrastructure--2002 • Logic Model continues to guide us • SEICHN incorporated……spurred by funding issues • “One Page at a Time”

20. Implementation--2002 • Continue networking with nurses from Local Health Departments in our own communities • Provide ‘Road show’ to health department boards • Continue working with local American Cancer Society • Continue offering ANNUAL full day breast program in each county, including free mammography via mobile unit--- Year 3 ----- 2000, 2001, 2002 • Seek collaboration with businesses, clubs, and fraternal organizations • Maintain ‘branding’/look of all posters and newspaper ads

21. Sustainability--2002 • Writing grants based on timeline • Investigate potential funding sources • Susan G. Komen Foundation • Avon Breast Care Fund • Regional Foundations • Local Businesses • Networking • Received funding for several of the grant submissions: Komen Foundation, Health Foundation of Greater Cincinnati, Ripley County Community Foundation

22. 2009

23. Infrastructure--2009 • Logic Model continues to guide us • SEICHN, Inc. since October 2002 • Community Outreach Manager since 2007

24. Lack knowledge and access to malignancy screening Create a model based program To meet malignancy Screening needs Increase knowledge & practice & Increase linkages Develop infrastructure Provide screening Secure funding Increase Awareness Increase Screening Increase Support Stabilize Program Track data and disseminate

25. Implementation--2009 • Continue offering ANNUAL full day breast program in each county, including mammography via mobile unit---Year 10 • Provide community education on variety of cancer topics • Active partnerships with local health departments, local newspapers, ACS, Trinity Health Clinic, REMC, St. Elizabeth Medical Center (IBCCP provider) • Continue seeking collaboration with businesses, clubs, and fraternal organizations • Continue ‘branding’/look of all posters and newspaper ads

26. Sustainability--2009 • Continuous Funding secured: • Greater Cincinnati Komen Foundation since 2001 • Indiana Breast Cancer Awareness Trust since 2006 • Avon Breast Care Foundation since 2007 • REMC since 2007 • Repeated Funding secured: • Health Foundation of Greater Cincinnati • UC College of Nursing • Ripley County Community Foundation • Speaking of Women’s Health of Batesville

27. Stabilization & Sustainability Infrastructure Implementation/Screening Funding/Sustainability

28. Ongoing Evaluation Formative Summative • Ongoing assessment of each component of Logic Model • Ongoing assessment of community needs • Ongoing assessment of status of barriers of cost, distance and fear • Based on Logic Model Outcomes • Increase Awareness • Increase Screening • Increase Support • Stabilize Program • Track data and disseminate • Annual Evaluation and Report

29. Presentation Goal In Summary • Discuss steps relevant to sustaining community based health programs long-term. • OR • Discuss strategies to increase the potential for long term sustainability

30. Let’s remember…… Key Steps Keys Strategies • Logic Model • Key Components of • Infrastructure • Implementation • Sustainability • Evaluation • Presence: Community Trust • Collaboration • Leadership • Public Relations • Knowledge: Continuing Education & Development • Strategic Funding • Consistent annual and ongoing Programming in each of 5 counties

31. References Centers for Disease Control and Prevention (1997). Reaching women for mammography screening: Successful strategies of national breast and cervical cancer early detection program (NBCCEDP) grantees. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved 1/8/08 from http://www.cdc.gov/cancer/nbccedp/bccpdfs/mamog.pdf Fitzpatrick, J., Sanders, J., & Worthen, B.  (2004).  Program evaluation:  Alternative approaches and practical guidelines.  Boston:  Pearson/Allyn and Bacon. Health Foundation of Greater Cincinnati (HFGC).  (2001).  Evaluation Packet.  Cincinnati, Ohio. W.K. Kellogg Foundation. (2000). Using logic models to bring together planning, evaluation, and action:  Logic model development guide.  Battle Creek, Michigan.