 | | | | | | | | |
 |  |  |  |  | | |||
 |  |  |  |  | | |||
 | | |||||||
 |
|
|
|
 |
|
||
 |
|
||
 |
|
||
 |
 |
|
|
 |
|
||
 |
 |
|
|
 |
|
||
 |
|
||
 |
|
||
 |
|
||
|
Setup Instructions |
| Rural
Health Outreach Grantee Directory, 2006 PROJECTS BY STATE ALABAMA D04RH04340 Fiscal Year 2005 2006 2007 Keyword(s): Obesity East Central Mental Health-Mental Retardation, Inc., has initiated a partnership of community agencies committed to the development and implementation of a comprehensive, countywide health risk prevention and outreach project. The project will focus on preventing school-age obesity and increasing physical activity using the Coordinated Approach to Child Health Model, a school-based nutrition program. Goals of the project are (1) to form a supporting network to the consortia in Alabama's Bullock and Pike counties that reflects the growing cultural diversity; (2) to advance the scope of the existing rural health promotion program to prevent obesity in school-age children; (3) to implement a health prevention and education project in the public schools that will provide school children with the information and skills they need to avoid health-damaging behaviors and to live healthy lifestyles; and (4) to encourage parents and extended family participation in health risk prevention and education programs to dissolve barriers to healthy lifestyles. The project will target students in grades 3 through 5 in rural Pike and Bullock counties where unmet health needs and at-risk behaviors present serious health risks and contribute to educational and social problems. The target populations will be multicultural, representing all racial, social, and economic backgrounds in the two counties. Contributing to the overall ill health of community youth is the lack of parental awareness concerning health topics and detached parental involvement in child health issues. Implementation of the project will provide students with the skills they need to make healthy choices for life and will strengthen communities by increasing collaboration among parents, teachers, and other school partners. Access barriers include inadequate or lack of health insurance, lack of Medicaid providers, cultural and spiritual barriers, lack of education and awareness, language barriers, and difficulty getting to a health care facility due to the lack of public transportation. In the past, this project made a significant difference in the lives of youth in Pike County. By expanding this program to Bullock County, more students will be given a head start on a healthier life. Bullock County is designated as a Medically Underserved Area for dental and primary health care professionals. The network partners consist of eight members of the Pike County Consortium, including East Central Mental Health-Mental Retardation; four members of the Bullock County Consortium; and community supporters in both counties. Margaret Morton, Ed.S., Executive Director Fiscal Year 2006 2007 2008 Keywords(s): Heart disease, Chronic Obstructive Pulmonary Disease, Diabetes, Hypertension, Disease management, Faith-based health advocacy The goal of this project is to increase the quality and years of life for individuals of the target population of under and uninsured residents of Talladega County, Alabama with chronic diseases of Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), Diabetes and/or Hypertension. The vehicle by which is through a community partnership using a computer-assisted Parish Nurse Disease Management Program (PNDMP). This PNDMP provides a community based holistic approach and extends the impact of the Parish Nurses with the use of Family Health Advocates (FHAs) using laptop computers to access the management information system. The use of FHAs will expand an existing innovative community disease management program of parish nursing by enabling more clients to be enrolled for a longer period of time. Utilization of a management information system (MIS) by the community consortium providers, a parish nurse and the family health advocates will allow for efficient and effective exchange of information and standardization of data collection in a community setting. Indicators of success of this project will be a 94 percent increase in enrollment, achievement of one or more of individual health goals, an improvement in quality of life as indicated by results of a SF36 survey, a 30 percent increase in pharmaceutical support (or $250,000), a 50 percent increase in the number of social and health services provided to the target population and a 30 percent increase in the utilization of the community health network MIS. This project builds on existing research on the relationship between spirituality and health, the effectiveness of lay community health workers, and enabling technology. The further development and expansion of a PNDMP in addition to meeting real needs in this rural community provide a replicable model for use in other rural communities. Antoinette Lankster, R.N., B.S.N. Fiscal Year 2006 2007 2008 Keywords: Health promotion/disease prevention (general), School-based primary health care, Faith-based primary health care, Health education The Rural Assistance Program for Churches and Schools (RAPCS) will provide access to health care for disadvantaged populations in Green, Sumter, and Marengo Counties. These counties are ranked among the poorest in the State and the Nation. They are rural, medically underserved, and have a large African American population. The prevalence rates of numerous chronic health disorders are higher in this area than other comparable areas in Alabama, which overall has higher rates than other States. In addition to higher rates of chronic disease, the area suffers from inaccessibility to health care due to the unavailability of public transportation. There also are major behavioral and social problems, such as teen pregnancy, low birth weight, high tobacco use, and alcohol and drug abuse problems. According to the most recent census data, the average median household income is 36 percent of the State average. These persons also are the ones without health insurance coverage. Those who are covered have government-provided insurance such as Medicare and Medicaid. Census data also show that individuals in the targeted counties have a high school graduation average of 67 percent-below the State average. Low education and employment perpetuate the economic problems and often result in poor health practices and local of knowledge about accessing and using health care resources. These factors and others provide insurmountable barriers to health care in this region of Alabama. The purpose of this project is two-fold:
1) To improve access to health care by establishing outreach health
care sites throughout the counties in schools and churches where
people are isolated and lack direct access to health care, and 2)
To implement a health education campaign that would increase public
awareness of health care resources and services in the community.
These goals will be achieved by providing nursing services in local
schools and churches; making primary health care services available
in schools and churches; and increasing access to preventive health
education programs. The target population includes school students,
churchgoers, senior citizens, parents, and the working poor. The
project consortium includes local hospitals, health centers, school
systems, churches, and community-based organizations.
Rose Heyano Fiscal Year 2006 2007 2008 Keyword(s): Elderly, Telehealth Community Health Aide/Practitioners (CHAP) provide medical services in most of the village clinics, with a few of the subregional clinics staffed with mid-level practitioners that also travel to the smaller villages and provide itinerant care. Telehealth is used increasingly to provide quality health care without the need for the patient to travel. Dillingham has the most accessible hospital; however there is no geriatric specialist available. More advanced care must be sought in Anchorage or beyond. Many elders have to move out of their villages and region as their medical needs increase because of a lack of healthcare services, distance, and travel expenses. This means that an elder is removed from his or her culture, way of life, and family, causing a great deal of stress for both the elder and family members. In the Yup'ik Eskimo and Aleut cultures, the wisdom, knowledge, and life experiences of the elderly are appreciated and acknowledged by the younger generation. The overall goal of this proposed project is to meet the healthcare needs of elders so they can remain in their communities and stay connected to their homes and families for as long as possible. There are five program goals: 1) To increase access to specialized medical care for persons over the age of 62; 2) To increase patient translation and advocacy services for persons over the age of 62; 3) To increase provider staff knowledge of geriatrics; 4) To increase public awareness and knowledge of geriatric issues; and 5) Increase Medicare enrollment in the target population. Strategies to meet these goals include contracting with an itinerant physician specializing in gerontology or internal medicine; referring elders for assessments and treatment; providing transportation for elders to the specialty clinic; and using telehealth capabilities to provide services to elders in the remote villages; hiring two FTE Patient Advocate/Translators to assist elders in accessing care; providing staff with in-service training and community education regarding geriatric issues; and providing education to identified patients regarding the benefits of applying for Medicare coverage. The realization of these goals will greatly enhance and improve all aspects of health care for the elderly, which will allow them to remain in their villages and to continue benefiting the entire community. Another benefit of accomplishing these goals is that medical providers, elders, and community members in general will have an increased awareness and knowledge of elder health care issues. Medical staff will be able to provide higher quality health care services with an increased understanding of geriatric assessment and treatment. It is anticipated that this project will be self-sustaining at the end of the 3-year project period. Diana Turner Fiscal Year 2006 2007 2008 Keyword(s): Colorectal cancer The consortium will serve more than 1,200 Native Alaskan/Native American adults aged 50 to 80 years residing in the rural Alaska communities of Kenai, Soldotna, Nikiski, Kasilof, Sterling, Cooper Landing, Hope, Ninilchik, Anchor Point, and Homer. Lack of flexible sigmoidoscopy services in our tribal health clinics and distance from colorectal screening services in Anchorage are significant barriers to access. Within 3 years, the consortium will increase the percentage of Native Alaskan/Native American adults over age 50 living in the central and southern Kenai peninsula who complete screening for colorectal cancer from the current rate of under 4 percent to a target rate of 50 percent. This goal will be accomplished by developing a flexible sigmoidoscopy clinic at KIT health clinic; sending one advanced nurse practitioner and one registered nurse to ANTHC for approved training in flexible sigmoidoscopy procedures; and conducting weekly flexible sigmoidoscopy clinics to over 500 patients in the next 3 years, with additional colonoscopy referrals to Alaska Native Medical Center. The consortium will monitor project progress, identify and problem-solve barriers, develop local capacity, and seek ways to expand outreach, networking, and public education. ANTHC will provide intensive training in flexible sigmoidoscopy procedures, as well as onsite follow-up and technical assistance with both Tribes. The two Tribes will set up a referral mechanism, as well as patient pre-screening and flow charts to be placed in patient medical records so that individual patient progress and follow-up can be tracked by medical care providers in each clinic. KIT also will add the Colorectal Cancer package to its RPMS tracking system. Both Tribes will provide patient education and preparation, reminder calls prior to procedures, and assistance with transportation through the low-cost area transit system or mileage reimbursements. Each Tribe will implement public education and outreach. The project will coordinate its efforts
with our local health and social service provider network, the Kenai
Health Services Opportunities Collaborative, State Office of Rural
Health, State Colorectal Cancer Task Force, and Alaska Tribal/rural
providers. Jona Tso-Spears Fiscal Year 2006 2007 2008 Keyword(s): Substance abuse prevention/treatment The Hardrock Youth Wellness and Prevention Program is a collaborative effort of the Hardrock Council on Substance Abuse, Inc. (a local non-profit corporation), the Hardrock Chapter House (a local governmental subdivision on the Navajo Nation), and the University of Arizona Mel and Enid Zuckerman Arizona College of Public Health's Project EXPORT. The purpose of the collaboration is to strengthen their collective efforts in building a strong infrastructure for substance abuse prevention, intervention and treatment at the community level. The Hardrock community lies in the heart of the 27,000 square mile boundary of the Navajo Nation and is part of Navajo County in northeastern Arizona. Health disparities are critical health issues for this isolated rural community, especially because of its unique history. It is one of 11 Navajo communities that experienced Federal relocation, land loss and livestock reduction as a result of the 1974 Navajo-Hopi Land Settlement Act. Access to health care is a major problem for the Hardrock community as the distance to hospitals and clinics is over 60 miles away and the community has severely limited and/or nonexistent medical and behavioral health service providers. The impact and extent of substance abuse has been well documented in the past decade including 19 deaths in the community in 1995. In a recent community-based survey in 2004, 84 percent of respondents reported some association with someone, including themselves, who is abusing alcohol or some other substance. More than two-thirds of respondents knew of someone that was killed due to alcohol or substance abuse since 1995. The Hardrock Youth and Wellness Program
has two main goals: 1) To increase access and participation of youth
in substance abuse prevention education by using community-based
education programs that encompass the Dine traditional philosophy;
and 2) To increase access and participation of youth and their families
in culturally appropriate substance abuse intervention and treatment
programs. The population to be served will be children and youth
(age 4-18) and their families who reside in the Hardrock community.
The program will provide direct educational interventions through
a 6-week summer program and an additional 2-week long program during
winter and spring school breaks. It will also provide intensive
outreach, monitoring, and follow up to youth and their families
linking them with existing community-based intervention and treatment
services. ARKANSAS D04RH04335 Fiscal Year 2005 2006 2007 Keyword(s): Chronic illness, Diabetes The consortium for the Chronic Care Education Outreach Program will expand an existing chronic illness self-management education program to focus on the elderly in Woodruff and Prairie counties in the Arkansas Delta region. The program will enhance the capacity of existing community agencies to respond to the needs of the increasing population with diabetes and other chronic illnesses. Collaboration between community partners will result in organized assessments, planning, and coordination of local resource agencies to cultivate a regional comprehensive continuum of care for people with chronic diseases. The program will use self-management interventions to reduce health disparities and increase access to recommended health care services for people living with diabetes and other chronic illnesses. It also will incorporate a chronic care model used by the Bureau of Primary Health Care and will provide services at long-term care facilities to enhance access by the elderly population. All activities will be coordinated with primary care services currently provided in the area. The program will focus on increased access to prevention, early detection, and treatment of diabetes and cardiovascular diseases through the provision of a comprehensive self-management education class on these chronic illnesses. Woodruff and Prairie counties, the target counties, have a combined population of 18,280. Seventeen percent of the population is older than 65 years. The Arkansas Department of Health reports that diabetes prevalence increases by age to an estimated 14.6 percent for those older than 65 and estimates that more than 450 residents older than 65 currently have diabetes. In addition, the rates of diabetes, cardiovascular disease, and heart disease are higher in the target counties than in other counties in the state. Residents of Woodruff and Prairie counties live below 200 percent of the Federal poverty level, and the two counties are officially designated as Health Professional Shortage Areas and Medically Underserved Areas. Barriers to access of health services include a 45-minute drive to any kind of specialty care, and much of the population remains undiagnosed for diabetes or cardiovascular disease. The consortium for the Chronic Care Education Outreach Program consists of White River Rural Health Center, Inc., the lead applicant; Woodruff County Nursing Home; Des Arc Nursing and Rehabilitation Center; Baptist Health; and Arkansas Department of Health Diabetes Control Center. CALIFORNIA D04RH05118 Fiscal Year 2005 2006 2007 Keyword(s): Substance Abuse, Prevention Education The Mendocino County Health Department and its partners developed the Adolescent Drug Abuse Prevention and Treatment Project (ADAPT) in response to the need for substance abuse prevention and treatment services for rural youth in northern California. ADAPT will team a substance abuse therapist with an intervention specialist to increase youth resiliency-while reducing the incidence and harmful effects of substance abuse-through prevention, intervention, and treatment. The three primary components of the program are substance abuse treatment; prevention education and opportunities for personal growth and development through service learning, project-based modules, and outdoor adventure; and family strengthening services. Program goals are to reduce high-risk behavior for alcohol and other drug use among youth; to increase refusal skills and knowledge of harmful effects of substance abuse among youth; and to increase prevention knowledge and awareness among parents. Services will be provided at schools, community-based organizations, and county Alcohol and Other Drug Programs (AODP) offices. Widespread production, use, and abuse of alcohol and other drugs as well as economic impoverishment exist in Mendocino County, which is designated as a Medically Underserved Population. Summary results for the California Healthy Kids Survey show a high level of youth experimentation and involvement with alcohol and other drugs. However, substance abuse treatment services for youth are extremely limited throughout the county, especially in the targeted communities of Willits (population 13,500) and Potter Valley (population 1,900). In Potter Valley, substance abuse treatment is not available in any form; the AODP office in Willits offers limited treatment to youth in alternative school or criminal justice settings, but no treatment to youth in mainstream settings. In addition, residents in both Potter Valley and Willits must travel 25 miles to Ukiah for specialized services, and transportation is very limited. ADAPT will provide services to youth age 13 through 18. In addition to the lead applicant, the Mendocino County Health Department's Division of Alcohol and Other Drug Programs, ADAPT consortium partners include Howard Memorial Hospital, Nuestra Alianza, Potter Valley Community Center, Potter Valley Community Health Center, Potter Valley Community Unified School District, Sherwood Valley Rancheria, Willits Action Group, and Willits Unified School District. Meade Hallock Fiscal Year 2006 2007 2008 Keyword(s): Mobile clinic, Telehealth technology, Primary care services, Specialist consultation Tulare Local Healthcare District (Tulare District Hospital, TDH) is the lead agency of a consortium composed of. Tulare Community Health Clinic (a Federally Qualified Health Center), public health nurses from Tulare County Office of Education's Migrant Education Program, Tulare County Asthma Coalition, Alta Vista School District, Pixley Union School District, and Love In the Name of Christ (a 501(C)(3) non-profit community based organization). These partners formed this consortium to address
the lack of basic healthcare available in the rural, impoverished
areas of Alta Vista and Pixley in Tulare County, which is located
in the Central Valley of California. The purpose of the Mobile Clinic/Telehealth
Outreach Project is to provide primary health care services and
specialist consults, including dental services, to underserved residents
in rural Tulare County. TDH will visit each site once a week, on
a set schedule, bringing health care directly to the community in
a Mobile Health Clinic. Telehealth Monitors placed at each school
site will provide live access to the nurse practitioner on the Mobile
Clinic, Monday through Friday. The focus of the Mobile Clinic/Telehealth project will be primary care, women's health (with an emphasis on OB care), pediatrics, asthma, diabetes, and hypertension. Specialist consults and dental care will be provided at Tulare Community Health Clinic. Public health nurses from Tulare County Office of Education's Migrant Education Program will work closely with the Mobile Health Clinic to provide these communities with access to health care. Tulare County has the highest rate of diabetes in the State, and the second highest rate of teenage pregnancy. Central Valley has the highest rate of childhood asthma in California. The target population is Hispanic agricultural workers and their families. The Census Bureau reports that Tulare County has the fifth highest percentage of poverty and the third-highest percentage of people with less than a high school diploma in the nation. Statewide, census statistics reveal that Tulare County has the highest percentage of poverty, unemployment, and lack of education in California. Nearly two-thirds of the population under age 18 in Tulare County live below 200 percent of poverty-the highest rate in the State. Tulare County is the leading agricultural producer in the Nation, yet the Hispanic agricultural workers who harvest these crops live in extreme poverty and suffer from poor housing conditions, malnutrition, and lack of medical care. School officials in the areas targeted by this grant confirm that over 80 percent of students are Hispanic, and 93-100 percent of students at each school qualify for the Federal Free or Reduced Lunch Program. The Mobile Clinic/Telehealth project will provide primary and preventative medical care for these impoverished communities by taking services directly to the community. By placing permanent telehealth monitors at each site, individuals without transportation can walk to the school sites and receive medical treatment and consultation Monday through Friday. Tulare Community Health Clinic will provide specialist consultations and dental care by referral. Love INC is already well established in all targeted areas, delivering food and basic necessities to the communities through a network of local churches. Dawn Sampson Fiscal Year 2006 2007 2008 Keyword(s): Satellite clinic, Bilingual specialty
services, Telemedicine technology, Substance abuse treatment While the picturesque Avalon may appear to be an idyllic small town, the City struggles with many of the same problems as much larger cities, and has added barriers to accessing services due to the island's physical isolation from the mainland. Catalina Island is designated a Health Professional Shortage Area. Like most rural facilities, CIMC requires local financial support to keep the doors open. The current needs to be addressed with this project are as follows:
A consortium consisting of Catalina Island Medical Center, Loma Linda University Medical Center, and the USC Catalina Island Hyperbaric Chamber, with the help of the Santa Catalina Island Company and Two Harbors Enterprises, will utilize creative outreach models to bring primary care services through a satellite clinic to the remote island community of Two Harbors. The consortium will also bring bilingual specialty services to the island city of Avalon using telemedicine technology. Services will especially benefit the medically fragile and low-income island residents. In addition, a program feasibility study on development of a chemical dependency treatment program will help the island's sole community health care provider/ Critical Access Hospital to tailor strategic program planning to the unique needs of the island population while striving to develop a positive operating margin to guarantee continuing operations. Janie Elson Fiscal Year 2006 2007 2008 Keyword(s): Health insurance enrollment, Primary
care, Dental care, Case management The Tulare County Children's Health Initiative (CHI) is focused on increasing dental and medical health access for children ages 0-18 through outreach and enrollment into publicly funded programs and by offering a new gap insurance product, Healthy Kids, for children ineligible for state Medicaid (known as Medi-Cal) or the State Children's Health Insurance Program (S-CHIP, known as Healthy Families in California). Healthy Kids is a new, local public/private partnership program with comprehensive medical, dental, and mental health benefits mirroring the state Healthy Families program. It is scheduled to launch in January 2006. Healthy Kids will be for children in families with incomes up to 300 percent of the Federal Poverty Level, regardless of immigration status, and is modeled afer similar successful programs in other California counties. The project begins with health insurance enrollment at local sites for children in Lindsay and Woodlake into current public programs Medi-Cal and Healthy Families, if eligible, or Healthy Kids-all in one application and one appointment for all children. An e-Dental Health network at school sites that connects the rural communities of Woodlake and Lindsay with a newly created e-Health Center at Children's Hospital Los Angeles will utilize telecommunications technology to provide dental consultation and treatment or treatment referral. Participation in the e-Dental program requires some sort of insurance coverage. It is estimated that 30 percent of the two towns' children are ineligible for public programs. These children will qualify for the new Healthy Kids program. Referral appointments from the school e-Dental site to local dentists will be tracked by local case managers, along with quarterly follow-up with families of children enrolled into Healthy Kids in order to provide health care utilization assistance. Project funds will provide a.5 FTE Certifed
Application Assistor/case manager each in Woodlake and Lindsay and
Healthy Kids insurance premium costs for 55 children ages 6-18,
which will allow services identifed by the e-Dental and other health
providers to be accessed. First 5 Tulare County will subsidize Healthy
Kids premium costs for children ages 0-5. DELAWARE D04RH04341 Fiscal Year 2005 2006 2007 Keyword(s): Prenatal Services La Red Health Center (LRHC) will expand an existing
program to offer prenatal and labor/delivery services to underserved
and vulnerable pregnant women in Sussex County, Delaware. LRHC will
develop a formal promotoras program, utilizing an indigenous case
management model developed to facilitate access to medical care
in underserved communities. The goals of this project are (1) to
improve perinatal health outcomes and reduce disparities as a result
of expanded access to care and education for low-income, at-risk
women and (2) to develop a comprehensive countywide promotoras program
to provide outreach, community health education, case management,
and other services to encourage early entry to prenatal care, concordance
with medical advice, and subsequent medical care for infants and
children. To address the demand for prenatal services, LRHC will partner with two private obstetricians, two hospitals, and other state and community agencies and programs to build a countywide network. Existing capacity for the prenatal program will be doubled and complemented by an aggressive campaign of community education urging early entry to care. FLORIDA Mark Lee Szurek, Ph.D. Fiscal Year 2006 2007 2008 Keyword(s): Primary care, Mental health services, Substance abuse treatment, Dental care The Rural Health Network of Monroe County, FL, Inc. (RHNMC) was created in 1993 in response to the enactment of Florida Statute 381.0406. This Act mandates the formation of health networks throughout the State in certified rural areas for the purpose of providing "... a continuum of quality health care services for rural residents through (local) cooperative efforts...". In May 2000, through support received from a HRSA Office of Rural Health Policy Outreach grant, RHNMC secured funding to initiate a primary care program, through the use of a single medical mobile van. Since that time, this organization has expanded its services to include yet another mobile medical van, two "fxed site clinics, and a dental clinic, thereby extending services in the Florida Keys over a 120-mile linear island chain. This project is designed to build upon previous accomplishments established by this network organization through its local partners, and through funding granted by HRSA to create a meaningful, sustainable and lasting provision of comprehensive primary care. In responding to the Florida Statute-mandate to ensure a continuum of care, RHNMC has entered into local communities with an intent of not duplicating services, creating service access where those service may be lacking, and more importantly, to work within and without a network framework to improve health care services where possible. RHNMC seeks to partner with a local for-profit hospital network member and with the largest substance abuse and mental health facility in this county to offer outpatient primary care, outpatient mental health and substance abuse services, and access to dental care for uninsured residents of the Lower Florida Keys-10 hours a day, 7 days a week. For almost 30 years, the Guidance Clinic
of the Middle Keys (GC 1K) has provided mental health and substance
abuse services for the people of Monroe County. As a recent (ORHP)
outreach grantee (May 2003 - April 2006), GCMK has partnered with
RHNMC in the limited provision of its services to the homeless.
The Lower FL Keys Health (Hospital) Center (LFKHC; a founding RHNMC
member) has voiced its desire to merge the resources of RHNMC, GCMK,
and itself to create a seamless and comprehensive health care program
targeted to the uninsured and homeless. This project is the first
merger of its kind in county history, bringing together a for-profit
hospital/primary care service, not-for-profit mental health and
substance abuse care and not-for-profit primary and dental care.
GEORGIA Kristie Dunson Fiscal Year 2004 2005 2006 Keyword(s): Diabetes, Hypertension, Pulmonary disease, Asthma The West Georgia Chronic Disease Initiative (WGCDI) is a community-based treatment, management, and prevention program targeting citizens in Carroll, Haralson, and Heard counties in rural West Georgia. WGCDI was formed initially in 2001 as a broad partnership with more than 70 local participants and was prompted in part by the results of two community health assessments, which indicated a prevalence of risk factors associated with diabetes and hypertension. Currently, the Initiative has now formed a rural health consortium to guide the program's continued growth and development. The consortium proposes to expand existing protocol for patients with diabetes and hypertension, and add programs targeting asthma and chronic obstructive pulmonary disease (COPD). Increases in county's general population and the "aging" of the area's population have led to an increased need for these services. The expanded West Georgia Chronic Disease Initiative will serve individuals who currently suffer from diabetes, hypertension, asthma or COPD, or who are at risk for these diseases. The program will place a special emphasis on low-income, uninsured, and underserved individuals, including the community's growing minority populations. Specific target populations include 72 percent Caucasian, 25 percent African American, 2 percent Hispanic, and less than 1 percent Asian. Members of the West Georgia Chronic Disease Initiative Consortium include the Tanner Medical Foundation (Applicant/lead agency), Carroll, Haralson and Heard County Health Departments, Haralson, Heard, Carrollton City and Bremen City Schools Systems, the Center for Allergy and Asthma of West Georgia, Dr. Sandra Stone of the State University of West Georgia, the American Lung Association of Georgia, and the Tallatoona Economic Opportunity Authority. Patricia Townley Fiscal Year 2005 2006 2007 Keyword(s): Oral Health Care The new Floyd County Dental Clinic will operate as a regional clinic, serving residents of a five-county area in rural northwest Georgia. The goal of the clinic is to increase access to oral health care for residents in the region. The regional dental clinic will offer a full range of pediatric and adult dental services, including outpatient dental care for young children with serious dental needs. The clinic will accept adult and pediatric emergencies and will have an oral surgery program as well. Opening the clinic will provide many residents in the region access to high-quality dental services that are currently unavailable to them. The need for dental services among low-income families in the target area is tremendous. Only four dentists accept Medicaid, and acceptance is sporadic. Low-income families with dental insurance cannot find a provider who will take them as patients. A mobile dental clinic provides limited services to only a fraction of the residents in need of dental care, and clients in need of follow-up care have no local options. The five counties are located in the foothills of the Appalachian Mountains. The total population of the five-county area is 260,591. According to 2000 Census data, 88 percent of the population is white, 8 percent is African American, and 4 percent is Hispanic. The Hispanic population in the area has grown significantly in the past 10 years, because of employment opportunities. However, their jobs are often minimum wage with no health insurance benefits. Access to oral health care is problematic for many residents in the target area, especially for those with low income or who lack insurance. The five county health departments have no public health dental facilities and only one mobile dental van. Four counties in the target area are designated as Medically Underserved Areas or Medically Underserved Populations. One of the counties is designated as a Dental Health Professional Shortage Area. Consortium members include Floyd County Health Department, Coosa Valley Technical College, Floyd College Health Sciences Division, Floyd Medical Center, Northwest Health District, and Rome/Floyd County Commission on Children and Youth. Mary Ann Kotras Fiscal Year 2005 2006 2007 Keyword(s): Health Education Experts agree that decisions youth make regarding lifestyle and personal behavior in adolescence have tremendous future consequences. These consequences include, but are not limited to, lifelong substance abuse (e.g., tobacco, alcohol, other drugs); teen parenthood and subsequent low educational attainment and low socioeconomic status; and/or eventual chronic disease (e.g., cardiovascular disease, stroke, diabetes, cancer). The proposed East Central Georgia Regional Teen Wellness Initiative will increase awareness and access to health promotion services by providing ongoing leadership training regarding healthy lifestyles for local youth; encouraging these youth to take a leadership role in planning, implementing, and monitoring local health promotion/education projects; and supporting these you as they plan and coordinate an ongoing local health lifestyles education outreach campaign for youth in the proposed service area. The rural underserved service area includes eight counties: Glascock, Jenkins, Lincoln, McDuffie, Screven, Taliaferro, Warren, and Wilkes. The proposed population is 7,452 youth (age 10 to 18). The region displays demographic characteristics similar to many poor rural areas, including high percentage of minority residents, isolation, poverty, negative health indicators, lack of educational attainment, and a struggling rural economy. According to the 2000 census, the region is home to 75,184 individuals: 59 percent white, 40 percent African American, and 1 percent other. More than one out of every four children (age 0 to 17 years) in the region is currently living below the poverty level. Much of this poverty is a result of adolescent childbearing. Nearly one-fifth (18.4 percent) of the total births to region residents were to unwed teen females, and more than one out of every two (56.0 percent were to unwed mothers (regardless of age). More than one out of every three female-headed households with children under age 18 in the region are currently living below the poverty level. An estimated 6,920 county residents are in need of alcohol treatment services, and 2,977 are in need of drug treatment. State mental health officials estimate that only 20 percent of those who need treatment services will actually demand or want the assistance. Many of these adults are raising young children and making their children victims of the downward negative spiral of intergenerational addiction and its consequences. In 2002, 60 percent of all deaths in the region were due to heart disease, stroke, diabetes, and cancer. Death and disability from these diseases are related to a number of modifiable risk factors, including high blood pressure, high blood cholesterol, diabetes, having a sedentary lifestyle, being overweight, and smoking. The East Central Georgia Regional Teen Wellness Coalition comprises eight county community collaboratives-Glascock Action Partners, Jenkins County Family Enrichment Commission, Lincoln County Family Connection, McDuffie County Partners for Success, Screven County Community Collaborative, Taliaferro County Family Connection, Warren County Family Connection, and Wilkes County Community Partnership (all of which have included and supported school health programs in their strategic plans-as well as Medical College of Georgia, University of Georgia (College of Family and Consumer Science), and the East Central Public Health District. Brenda Lee Fiscal Year 2005 2006 2007 Keyword(s): Dental clinic services, preventative dental care The goals of the South Georgia Regional Dental Outreach Initiative are to increase the number of individuals who receive preventive dental screening, the number of individuals who have access to dental clinic services, and residents' awareness of the importance of dental hygiene and preventive dental care. To accomplish these goals, the initiative will provide (1) dental services for at least 1,500 individuals; (2) dental health preventive education for more than 15,000 individuals annually though onsite services provided in school systems, pre-kindergarten programs, Head Start, daycare centers, nursing homes, health department clinics, employee screenings at local businesses, and community health fairs and other community sites; and (3) an area dental services referral network for individuals with no other dental care options. The service area is a five-county underserved area in rural southern Georgia with a population of 67,463 individuals. Demographic characteristics of the region include a high percentage of minority residents, isolation, poverty, negative health indicators, lack of educational attainment, and a struggling rural economy. The racial/ethnic composition is 67 percent white, 32 percent African American, and 1 percent other. Employment prospects for local residents are limited due to lack of funding. Attempts at supporting health and dental health promotion have been inadequate. There is a shortage of dentists in the area, and at-risk residents without private dental insurance must go without preventive dental care and have to ignore dental problems because of inadequate financial resources. All five counties in the region are Medically Underserved Areas, and three are designated as Dental Health Professional Shortage Areas. The South Georgia Regional Dental Outreach Initiative comprises the Turner County Board of Education, the lead applicant; Public Health District 8-1; area volunteer dentists; and five community collaboratives-Fitzgerald-Ben Hill Policy Council for Children and Families, Irwin County Family Connection, Turner County Connection, Wilcox County Family Connection, and Worth County Family Connection. Greg Rossidivito Fiscal Year 2006 2007 2008 Funding Amount $149,969 $124,342 $99,968 Keyword(s): Physical activity/fitness, Obesity/overweight From 1991 to 1998, Georgia reported the greatest rate of increase in prevalence of adult obesity (101.8 percent) in the United States. A recent study by the University of Georgia and the Georgia Prevention Institute at the Medical College of Georgia found that Georgia children are more likely to be overweight than previously thought, with approximately 37 percent considered too heavy. With increased numbers of chronic illnesses, health crises, and general poor health, the implications of this large number of overweight and obese children (and adults) impact all health care systems. Washington County, like many rural areas, has a significant number of overweight and obese children and youth who generally do not seek medical services to address the causes, resultant medical problems, or possible remedies. Most commonly, they are uninsured, poor, poorly educated, often isolated, and lack family support in addressing overweight/obesity. Children are usually at the mercy of parents/caregivers in the matter of food selection, purchase, and preparation. Poor nutrition is compounded by lack of access to a comprehensive fitness program or facility because of limited or non-existent transportation. Rural children are particularly at risk as a result of multiple barriers, many of which are remediable. The Washington County Community Wellness Consortium, a collaborative of agencies and health providers, has developed a small, multidisciplinary weight loss and fitness model program, the cornerstone of which is martial art taekwondo. This model program began July 18, 2005, with a small grant from Georgia Southern University's Intellectual Capital Partnership Program (ICAPP). This program is already showing positive results in participants. Approximately 50 percent of the children are obese or overweight. Parents and children are enrolled. For the proposed project, additional children will be recruited from schools, health providers, the recreation department, and churches for an after-school and summer program. Transportation, not currently provided, will be provided for students. Use of a martial arts program is a comprehensive approach to exercise and yields a wide array of benefits, such as increased self-esteem, a positive body image, goal setting, and reduced aggression. Children who participate in this proposed project will be assessed using several standard instruments. A physical exam by a pediatrician will be required. Individual fitness/wellness plans will be developed. Parents/primary caregivers and other adults will be recruited and encouraged to participate as well. The program will include 75 obese/overweight children, 25 parents/primary caregivers, and 50 non-overweight peers and/or adults. To avoid stereotyping obese children, enrollment will be open. All program participants will receive regular nutrition education and food preparation demonstrations provided by the Washington County Extension Service. Children will be required to attend 21 classes in an 8-week cycle (or three classes per week), leading to earning a series of belts. At specific intervals, children's physical and psychosocial progress will be assessed. Interval successes and instructor feedback will motivate children and families to continue their individual plans. Janice Massey Fiscal Year 2006 2007 2008 Keyword(s): Perinatal health Network partners include the lead agency, Wayne Memorial Hospital, Evans Memorial Hospital, Candler County Health Department, Tattnall County Health Department and Wayne County Health Department. Two nurses will be hired to provide services to program participants under the direction of a project director. The four targeted counties have high rates of poverty, ranging from 27 percent of the population of Evans County to 16.7 percent in Wayne County. The statewide rate of Georgians living in poverty is 12.3 percent. The population of the target area is 66 percent Caucasian, 28 percent Black, and 6 percent Hispanic. Evans, Candler, and Tattnall counties have seen tremendous growth in their Hispanic populations over the past 10 years. Infant mortality rates (IMR) and neonatal mortality rates (NMR) are higher than those for Georgia and substantially higher than Healthy People 2010 objectives. IMR and NMR rates for Blacks are significantly higher than for Caucasians or Hispanics. Two of the counties, Candler and Tattnall, do not have birthing hospitals, and women must travel long distances to hospitals in Wayne and Evans counties for delivery. All four targeted counties are Federally designated Medically Underserved Areas. Best Babies is modeled after the highly successful Perinatal Health Partners Program, which provides perinatal services to residents of 10 counties in southeast Georgia. Lynne D. Feldman, M.D., M.P.H. Fiscal Year 2006 2007 2008 Keyword(s): Diabetes The Irwin County Board of Health, as the lead partner, proposes to work with the Ben Hill County Board of Health, Dorminy Medical Center, the Ben Hill County School System, Irwin County Hospital, the Irwin County School System, the South Central Primary Care Center, Irwin County Family Practice Associates (Dr. Howard McMahan), and the South Health District to address diabetes in these two counties. The target population will include individuals who have been diagnosed with type 2 diabetes, with an emphasis on those who do not have insurance and/or who live in poverty; middle school children who need to develop healthy lifestyle behaviors that will lower their risk of becoming diabetic; and the general public. Given the poor health status of many people in these counties, it will be important to provide education and prevention messages to the public at large in order to reduce the incidence of diabetes. The goals of the project will be to reduce the number of hospitalizations resulting from diabetes or diabetic complications in Irwin and Ben Hill counties by 10 percent, to increase healthy lifestyle behaviors among middle school children, and to reduce the incidence of type 2 diabetes in these two counties through awareness of prevention strategies. Grant funds will be used to hire a Nurse
with a background in diabetes education as the Project Coordinator
and a Secretary. The project also will contract with Dorminy Medical
Center for 50 percent of a Registered Dietician. Services will include
expanded educational classes for diabetics, including individual
and group nutritional counseling, and community education programs
for the public that will be offered to churches, senior citizen
centers, the tech school, and others. The middle school component
will focus on decreasing obesity, increasing physical activity,
educating the students/parents about healthy lifestyles, and evaluating
the school-based nutrition programs. During the first year, staff
will be oriented, educational classes planned, local physicians
educated about the project, community education approaches planned,
and contact initiated with key school personnel. Program implementation
will begin the last quarter of the first year. In the second year,
a joint community health fair focused on chronic disease/diabetes
will be held for the general public and a 10K Steps-A-Day program
initiated in both communities. IDAHO Ann M. Sandven Fiscal Year 2005 2006 2007 Keyword(s): Pediatric Obesity Healthy Families Active Youth is a health promotion and fitness project that will target elementary school children and their parents in two towns in rural southwest Idaho to prevent and treat pediatric obesity. The goal of the project is to promote healthy weight and activity levels in rural children. Objectives include increasing the knowledge of healthy foods, increasing servings of fruit and vegetables, increasing the percentage of children who get at least 30 minutes of physical activity 5 days a week, stabilizing or decreasing the weight of overweight children participating in a weight management program, and promoting appropriate identification and treatment of childhood overweight by health care professionals. The target population is low-income elementary school children and their families in two towns in rural Canyon and Owyhee counties. Nearly one in five residents in Canyon County is Hispanic, compared to one in four Owyhee County residents. Poverty rates for most of the target area are higher than state averages. The project will serve 1,400 children, at least 100 parents, and 25 health care professionals. Approximately 52 percent of participants will be Hispanics, 46 percent non-Hispanic whites, and 2 percent other ethnicities. The two counties are home to an estimated 25,319 migrant and seasonal farmworkers. An estimated 50 percent or more of migrant workers lack health insurance, compared to an estimated 18 percent of all persons in Idaho. Barriers to access of health services include poverty and lack of insurance. Language, cultural, and education barriers exacerbate health problems for which Hispanics, who make up the majority of migrant and seasonal farmworkers in the state, are at added risk. An estimated 28,000 people in the two counties lack insurance, with many more struggling with inadequate coverage. Both counties are designated as Health Professional Shortage Areas, and Owyhee County and the southern part of Canyon County are also designated as Medically Underserved Areas. Healthy Families Active Youth partners include Terry Reilly Health Services as the lead agency, Southwest District Health Department, Treasure Valley Family YMCA, Homedale School District, and Caldwell School District. All partners have participated in a broad-based community coalition of more than 15 organizations that began in October 2003 to address childhood overweight. Barbara Mohoney Fiscal Year 2006 2007 2008 Keyword(s): Primary care, Social services, Elderly, Health promotion/disease prevention (general) The consortium for this project includes Gritman
Medical Center/Adult Day Health, Pullman Regional Hospital, Whitman
Hospital and Medical Center, the Council on Aging & Human Services/COAST
Transportation, and Region II Area Agency on Aging. First, ACCESS will define and expand the senior community health services network in the rural areas. We will initiate the nationally recognized Gatekeeper program, which is a proactive network of community members trained to identify changes in behavior, routines, and other early warning signs that a senior may be at risk for a health/mental health related crisis. Given the independent nature of rural elders in Whitman and Latah Counties, at-risk seniors would remain invisible to service delivery systems without such a community-based program. Gatekeepers are trained to recognize changes and to contact a local agency on aging to engage the appropriate service delivery system. Grant funds will also initiate care giver support groups in rural communities so that those who care for rural seniors have local access to support, respite care, information, and referrals. Second, the grant will increase access to primary health care and related social services through an expanded volunteer corps of drivers from rural communities. Volunteer drivers will be recruited and trained by a transportation volunteer coordinator housed at the Council on Aging & Human Services/COAST in Whitman County. In addition, COAST Transportation will also work collaboratively with Latah County to identify and train volunteer drivers to respond to requests in Latah County. Third, ACCESS will increase access to wellness
and disease prevention information and referrals by developing and
purchasing materials accessible to all community members and health
and human service providers through medical offices, libraries,
hospitals, and agencies on aging. Community education programs will
also be presented, duplicated, and made available through similar
venues. Local information and referrals will also be made accessible
through the Washington and Idaho 2-1-1 telephone systems. ILLINOIS Michael Lewis Fiscal Year 2004 2005 2006 Keyword(s): Developmental screenings, Healthy lifestyle education Preschool-age children in a three county rural area of western Illinois are missing vital developmental services because parents and health care providers are not aware of their value and availability. Additional children are denied services because their identified needs do not conform to highly regulated eligibility criteria. Still other children fall in age ranges that force them out of one program before they are eligible for another. Early diagnosis and treatment of children at risk for developmental disorders prevents problems at school and offers huge economic benefits to both the child and the community. Project All Aboard will identify these children through public awareness campaigns, developmental screenings, and provider networking to provide intervention and other needed developmental services to ensure every child has an opportunity to reach their potential. Project All Aboard targets any preschool child not eligible for other state or locally-funded services in Henderson, Knox, and Warren counties, Illinois. The consortium, which includes the Warren Achievement Center, the Knox County Health Department, the Henderson County Health Department, the Knox-Warren Counties Special Education District, the West Central Illinois Special Education Cooperative, and the Henderson County Rural Health Center, aims to reduce the average age children are first screened for developmental delays from 20 months to 14 months, increase referrals of at-risk children receiving services by 100 percent, and to ensure services to 10 children in the first year of the program, 20 children in the second year, and to 30 children in the third year of the program, who are in need of early intervention services but don't qualify under current guidelines. Linda Weiss Fiscal Year 2006 2007 2008 Keyword(s): Perinatal depression The Project for Perinatal and Postpartum Depression Detection (P2D2) is a collaborative effort of the partner organizations of the Regional Behavioral Health Network (RBHN) and local health departments in a three-county region of rural east central Illinois. All three counties are designated health professional shortage areas for both primary care and mental health. Coles County Mental Heath Center, the Human Resources' Center of Edgar and Clark Counties, and Sarah Bush Lincoln Health Center, which comprise the organizations of RBHN, are joining forces with local health departments in Clark, Coles, and Edgar Counties to address the need for screening, assessment, and referral of women with symptoms of perinatal depression. This project will increase community awareness about perinatal depression, improve access to mental health screenings for childbearing women, and provide assessments and linkages to appropriate treatment for women with symptoms of depression. Through collaboration with the local health departments and the WIC/Family Case Management programs, RBHN will initiate an integrated screening and assessment process directed at reaching women at the greatest risk of depression. Project partners will 1) provide community education about the symptoms of postpartum depression and how women can receive help; 2) improve the efficacy of the cross-disciplinary linkages between the mental health and primary care providers serving postpartum women; and 3) increase the number of postpartum women using behavioral health services. Screening services will reach an estimated
1,250 women (350 in Year One, 400 in Year Two, and 500 in Year Three).
Education and outreach activities will reach an estimated 500 persons
each year. A key objective of the project is to strengthen the cross-disciplinary
linkages between mental health and primary care services. The Women's
Mental Health Program of the University of Illinois at Chicago will
provide training for project personnel and workshops for primary
and mental health care providers on the issues of perinatal depression
and options for treatment. A consultant will facilitate a process
mapping of P2D2's screening and assessment procedures to develop
a common understanding of the process and work toward developing
a uniform protocol that integrates the region's resources for primary
care and behavioral health treatment options available to women
with perinatal depression. Partnering organizations will jointly
host a regional conference to explore and improve the delivery of
these treatment options in the targeted service area. INDIANA Heidi Miller Fiscal Year 2006 2007 2008 Keyword(s): Mental Health These proud, rural communities show the signs of suffering from the fallout of lack of jobs, lack of health insurance or having inadequate insurance, drug and alcohol addiction, and the long term ramifications of chronic illness. Fayette County is partially designated as medically underserved area. Rush County is a health professional shortage area for residents at 200 percent or below the poverty level. All of Franklin County is a health professional shortage area, a medically underserved, and a mental health shortage area. These challengers are inter-related. The Primary Care Plus + program will be managed and governed by an Advisory Committee composed of specialists with expertise in the integration of mental health services into primary care. Dunn Center, a nonprofit mental health agency, will provide managerial and fiduciary oversight of the program. It also will oversee most aspects of the project's mental health treatment component, including diagnostics, short-term crises management, individual counseling, group psychological education, and group counseling. Patients needing intensive treatment will be referred to the Dunn Center or another appropriate service provider, such as psychiatrists for pharmacological consultations. Dunn Center will also provide transportation and translators. The program will be housed at Family Health Services' two health centers that serve Fayette, Franklin, and Rush counties. Family Health Services will provide the project director, clinical office space in each county, management of integration to primary care, coordination of services, support staff, child care, and translators as needed. The program will address the racial, cultural, and socioeconomic needs of each patient individually. Affiliated Service Providers of Indiana, Inc., (ASPIN) will provide evaluation and technical assistance related to education and dissemination of outcomes. It also will oversee the replication of this model in Years 2 and 3 of the project in nearby counties. Sharon Goodman Fiscal Year 2006 2007 2008 Keyword(s): Diabetes Lifestyles Diabetes Project addresses a significant health need. According to the Centers for Disease Control and Prevention and the Indiana State Department of Health, diabetes is the sixth leading cause of death in the United States, the State of Indiana, and Gibson County. In the United States, the number of adults with diagnosed diabetes has increased 61 percent since 1991 and is expected to more than double by 2050. According to the 2003 Indiana Behavioral Risk Factor Surveillance Systems, 7.8 percent of adults age 18 and older in Indiana have been diagnosed with diabetes. Poor lifestyle choices and lack of awareness are root causes of the increased prevalence of diabetes and its resulting complications. Much of the burden related to diabetes, once developed, can be prevented or delayed with early detection, improved delivery of care, and better education on diabetes self-management. Moreover, better than managing diabetes is preventing its onset in the first place. Convenient access to knowledge, resources, and support-in a familiar setting-makes prevention and self-care more likely. The Lifestyles Diabetes Project aims to provide the people of Gibson and Pike Counties with this access to knowledge, resources, and support. The Lifestyles Diabetes Project has two
primary goals. First, it aims to reduce long- and short-term diabetes-related
complications for as many residents as possible who have already
developed diabetes. To reach this goal, the project will provide
diabetes self-management education following recognized national
standards at the project's clinic and at key outreach locations.
Second, we aim to promote awareness and prevention of diabetes to
as many citizens as possible in the two-county area. To achieve
this goal, the project will conduct awareness, assessment, and education
sessions at senior citizens' centers, schools, churches, and health
fairs. It also will conduct a diabetes awareness and prevention
marketing campaign. Success of the project will result in healthier
communities in Gibson and Pike Counties, more effective use of existing
healthcare resources, and a reduction in community health care costs.
IOWA Dawn Stephens Fiscal Year 2004 2005 2006 Keyword(s): Domestic violence, Sexual abuse, Provider education Health professionals frequently treat survivors of domestic abuse and sexual assault, but physicians often treat injuries only symptomatically. As a result, important opportunities for intervention are missed, and survivors continue to suffer adverse health consequences of physical and emotional abuse. Of the estimated 6.9 million intimate partner rapes and physical assaults committed annually, 2.6 million will result in an injury to the survivor, and more than 695,400 will result in medical treatment. In addition to the climbing medical expenses resulting from domestic abuse, estimated between $3 billion and $5 billion annually, businesses are forfeiting nearly an additional $100 million annually in lost wages, sick leave, and non-productivity. Survivors of domestic abuse are more likely to experience numerous chronic health problems including depression, post-traumatic stress disorder, chronic pain syndrome, gynecological problems, irritable bowel syndrome, eating disorders, and complications during pregnancy than others. To address these and other unmet health care needs of survivors of domestic abuse and sexual assault in Mahaska and Keokuk counties, Crisis Intervention Services formed a consortium of local health agencies including the Keokuk County Health Center, Keokuk County Public Health, and the Mahaska Health Partnership (Community Health, Mahaska Hospital, and New Directions). Through a coordinated community response, with leadership and guidance from the Domestic Abuse/Sexual Assault Taskforce, the consortium seeks to provide intensive education for medical and mental health care providers of domestic abuse and sexual assault victimization issues, develop and implement effective screening protocols for medical and mental health providers, develop and implement a Sexual Assault Nurse Examiner (SANE) program, provide extensive education for teenagers and their parents, and develop and implement an extensive public awareness campaign on sexual assault prevention. The target population is 90 percent Caucasian, 4 percent Hispanic, and a smaller mix of American Indians, African Americans, and Asians and Pacific Islanders. Judith McDonough Fiscal Year 2004 2005 2006 Keyword(s): Mental health, Substance abuse, Education Experts believe that 1.8 percent of the U.S. general population live with severe mental disorders. According to the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, the rate of severe mental disorders among those entering jail is 6.4 percent for male detainees and 12.2 percent for female detainees. Of these, 72 percent also suffer with alcohol or drug abuse disorders. In 1999, there were 11.4 million admissions to jail, meaning that an estimated 802,000 detainees had severe mental disorders, and 577,440 of those also met the criteria for alcohol or drug abuse. Minorities are disproportionately represented in our criminal justice system, and also experience a higher rate of co-occurring disorders, with Hispanics being the fastest growing group in jail populations, (approximately 8 percent Hispanic versus more 90 percent Caucasian/Non-Hispanic). A great number of people living with co-occurring mental health and substance abuse disorders in the target area of the northwest Iowa counties of Buena Vista, Osceola, Dickinson, Lyon, Emmet, O'Brien, Clay, and Palo Alto face inappropriate incarceration and re-incarceration because they are not diverted from the judicial system into the mental health and substance abuse treatment systems, and cannot be effectively and immediately connected with services following their jail stay to reintroduce them into the community successfully. The Integrated Service Pathways Network-which includes Northwest Iowa Mental Health Center; Seasons Center for Community Mental Health; Northwest Iowa Alcohol and Drug Treatment; and the sheriff departments and health departments of Emmet, Dickinson, Lyon, and Osceola counties-seeks to address these surprising statistics by diverting people with co-occurring disorders from the traditional criminal justice system/jail by implementing officer training and education of magistrates and other judicial officers, providing in-jail mental health and substance abuse assessment and treatment to detainees, utilizing translation and telehealth technologies as appropriate, and initiating non-traditional case management services to offenders with co-occurring disorders to ease the transition into the community's support system and break the cycle of arrest, jail, release, and re-arrest. Jana Enfield, Project Director Fiscal Year 2006 2007 2008 Keyword(s): Prenatal care Marshall County, population 39,311, is located in rural Central Iowa. The county's population has remained stable over the past 50 years; however, the demographics of the population have shifted dramatically in the past 10 years. This demographic shift has resulted in a 480 percent increase in the minority population, which includes a 1,106 percent increase in the Hispanic Community in the past 10 years. Along with these demographic changes, local officials have witnessed an increase in the number of people living in poverty and an upsurge in the number of uninsured or under-insured residents. For economic reasons, Marshall County is designated as a Health Professional Shortage Area. Further, the county has been designated a Medically Underserved Community, and the immigrant population has been designated as a Medically Underserved Population due to language and cultural barriers in accessing health care services. The Building Healthy Families project is a culmination of 5 years of research, data collection, review, and program planning. The project draws on the staff, expertise, and available funding of all consortium members, and develops a coordinated service delivery system that avoids duplication of effort. The Building Healthy Families project is designed to meet the unique cultural, social, and linguistic needs of pregnant Hispanic women living in Marshall County. The project's goal is to improve prenatal health outcomes via identification and assessment, provision of family support and health education services, and incentives to increase participation in health care and educational opportunities in the community. It will promote rural health care services by expanding our current postnatal home visitation model to include a new and enhanced prenatal service component. This project will address the severe lack of services available to our target group due to cultural and language barriers. John Boyd Sinclair |