III.E.2.c Annual Report: Cross/Cutting Systems Building
Public health research and data show that generations-long social, economic, and environmental inequities, including structural racism and other forms of discrimination and their consequences, have resulted in adverse health outcomes. For example, segregation in housing and education and racist mortgage lending and zoning policies
have historically advantaged white Americans and disadvantaged communities of color. Together, these policies and practices have a greater influence on health outcomes than individual choices or access to healthcare. These inequities have been shaped by the distribution of power, money, and resources at the global, national, and local levels. Reducing health inequities through policies, practices, and organizational systems can help improve opportunities for every Rhode Islander.
Rhode Island had the following priorities for cross-cutting systems building from October 1, 2020 to September 30 2021:
- Adopt social determinants of health in MCH planning and practice
Priority: Adopt social determinants of health in MCH planning and practice
The Title V program aims to collaborate across the RIDOH and with other state and local stakeholders to adopt SDoH into MCH planning and practice in order to improve health equity. RI has adopted 15 Health Equity Indicators as statewide measures to overarchingly assess health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socioeconomics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations. Overall, the goal is to increase health equity and access across the entire state. Please reference the appendix for a comprehensive breakdown of health equity indicators.
RI has adopted 15 Health Equity Indicators as statewide measures to overarchingly assess health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socioeconomics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations.
BRFSS 2018 data show that 78.3% of Hispanics report visiting their doctor in the past year compared to 86.0% of Non-Hispanic Whites. The community resilience indicator measures Health in All Policy by calculating the percentage of low- and moderate-income housing. This indicator shows that cities such as Woonsocket (15.9%), Providence (14.9%), and Central Falls (11.2%) in 2016 had a higher percentage of low- and moderate-income housing than the statewide estimate (8.2%). Housing burden, a socioeconomic indicator, is calculated by identifying the percentage of cost-burdened renters or owners for RI cities and towns. This metrics from 2021 HousingWorks RI Factbook’s data showed that the communities with the highest renter cost burden were Central Falls (55%), Exeter (72%), and Narragansett (59%). The following core cities also showed a high percentage of renters being cost burden as well: Providence (44%), Pawtucket (48%), and Woonsocket (46%). Overall, White households experience the lowest rates of cost burden and severe cost burden, and Black and Latino households experience the highest rates of both.
During the 2020-2021 school year, RI public schools identified 1,109 children as homeless. Of these children, 66% lived with other families (“doubled up”), 19% lived in shelters, 14% lived in hotels or motels, and 1% were unsheltered. In 2021, the graduation rate among high school students who completed 4 years (2017/18 freshman class) was 84%, which is an increase from 2016 (2012/13 freshmen class) with 82.8%.
The Title V program aims to collaborate across the RIDOH and with other state and local stakeholders to adopt SDoH into MCH planning and practice in order to improve health equity. RI has adopted 15 Health Equity Indicators as statewide measures to overarchingly assess health equity in the state. These indicators span across five domains (integrated healthcare, community, physical environment, socioeconomics, and community trauma), which are further broken down in measuring key determinants of health that can be reported by city/town and race/ethnicity and monitored annually using various state agency, census, and survey data. The MCH Program is interested in incorporating these measures to address social determinants of health that are related to the MCH populations. Overall, the goal is to increase health equity and access across the entire state. Please reference the appendix for a comprehensive breakdown of health equity indicators.
Throughout the Title V Needs Assessment the state has collected quantitative, qualitative, and anecdotal information on how social determinants of health and structural inequities impact the outcomes of all Rhode Islanders. The SISTA FIRE Maternal Child Health Survey found that WOC ranked the following as what they were most concerned about on a daily basis: not enough jobs that pay a living wage or have a career path (52%), paying monthly bills (41%), and wealth creation (34%). These daily stressors and needs of WOC do contribute to emotional, mental, and toxic stress. SISTA FIRE Survey found that 8% of Womxn of Color (WOC) responded always experiencing racism in the healthcare setting and 49% WOC experienced racism sometimes. Additionally, there was a higher unawareness of certain types of state programming and services such as: free breastfeeding support (41% unaware), free insurance during pregnancy (43% unaware), and home visiting (45% unaware).
Additionally, the 2017 SISTA FIRE community survey brought up barriers and hardships among WOC. For instance, WOC struggle to attain higher education degrees due to a lack of financial resources and supports. 68% of WOC reported having to work part or full time to afford basic needs and tuition. Overall, 50% of the approx. 300 women who took the survey earned less than $30K. The survey showed WOC work across a variety of industries (food, hospitality, healthcare, education, etc.) but still almost a quarter (23.3%) of respondents made an annual income of $10k or less. Homeownership is low as well with only 18% of respondents reporting ownership of their house. A majority of WOC (66%) rented their homes. A significant percentage of WOC also reported struggling to afford food (31%), housing (48%), and to pay off debt (79%). 49% reported that they were unable to save for future or emergency expenses and 23% were unable to make payments towards their debt. High rates of debt are indicators of stress and instability. Debt and credit issues limit access to housing and ability to afford housing, as well as other basic needs like food, healthcare, childcare and transportation. These findings are further grounded by most respondents residing in Providence where there have been steep increases in rents with the average household needing to earn an annual income of $70k in order to afford a two-bedroom apartment.
Young mothers of SENs interviewed by the Pawtucket & Central Falls HEZ also reported poor treatment when going to prenatal checkups, when arriving in the hospital to give birth, at the hospital after birth, and when visiting their baby if s/he is going through withdrawal. One woman shared her experiences of giving birth twice at Women and Infants Hospital. The first time she successfully hid her addiction to opioids and alcohol from hospital staff. She remarked that she was treated “like a princess” and given a special birthing suite. The second time she gave birth, she was “deep in the throes of her addictions” and it showed on her face and her body. She arrived at the ED at Rhode Island Hospital and was left alone on a gurney in the waiting room for hours. When she was finally attended too, she was fully dilated and ready to give birth. She was supposed to have had a C section but by then it was too late. Overall, these experiences show a need for a reduction of stigma and more comprehensive and compassionate care for substance using mothers giving birth.
The Title V Program solicited feedback on community needs at the recent Health Equity Zone (HEZ) Professional Learning Community Event on February 28, 2020. Several cross-cutting themes emerged as part of the HEZ event focus groups. HEZ participants repeatedly highlighted the importance of mental health and the need for more mental health care providers, resources and supports. This was supported by the poll results, with 73% of respondents saying this was the top priority for RIDOH to address in the well-being category. HEZ participants focused on the prevalence of health disparities across all of the Title V domains. They repeatedly indicated the need for more staff and providers who share similar cultural and linguistic backgrounds with the families and communities they serve. Participants felt that there needs to be more community education and outreach so that individuals and families are more aware of the existing resources and services available in their communities. Additionally, HEZ participants spoke to the need for more comprehensive sex and health education to help prevent unintended pregnancies, reduce the rates of sexually transmitted infections, and promote positive social and emotional development.
To respond to these disparities and support this priority, RIDOH will resume, continue and add strategies as follows:
Ensure Health Equity Programming among Maternal Child Health Programs:
Title V is continuing to grow its partnerships with community stakeholders, cultural groups, and networks, such as HEZ and SISTA FIRE, to address perinatal and birthing disparities within the birthing parent system of care. Through these partnerships, RIDOH administered programs, including family home visiting, family planning, oral health, and other preventative care, are seeking guidance on: 1) Translation & Interpretation, 2) Trauma Informed Care/Consent, 3) Cultural Bias, 4) Community Resources, and 5) Workforce Diversity. This includes soliciting solutions to challenges from the community.
For example, RIDOH’s MCH program supported efforts of community stakeholders to increase the availability of doula services and support to womxn in RI. From October 2021 to April 30th, 2022, One Neighborhood Builders, RI Department of Health Maternal Child Health Program, and Journ3i LLC. collaborated to increase perinatal workforce capacity to address the multi-cultural and multi-lingual needs of birthing people within RI. Over this seven-month period, 26 community members of color were trained, mentored, and received free one-year memberships to RI Birth Workers Cooperative, Doulas of Color Network, and RI Perinatal Doula Agency. Cohort members also received doula bags and had their required CPR/AED, food handling safety, and HIPPA Compliance courses covered. So far, 11 initiative participants have become certified perinatal doulas through the Rhode Island Certifying Board (RICB). Please reference the appendix for a complete write up of the project. Through Preschool Development Grant funding, the above project has been extended by six months. Journ3i LLC. Is currently mentoring program participants and implementing workshops covering the following topics:
- How to set up your doula business,
- How to sign up with insurance and submit claims,
- How to build your clientele base,
- How to balance work and life responsibilities, and
- How to troubleshoot common job issues.
In addition, Quatia Osorio, RIDOH’s perinatal community consultant, continued to serve as an advisor and thought partner to inform racial equity initiatives and assist in the development and implementation of the MCH racial equity action plan. This includes her supporting MCH leadership in the development and implementation of racial equity organizational initiatives, objectives, and strategies related to the advancement of racial equity. For example, Quatia is collaborating with our disparities specialist to complete an infant health and mortality workplan. The idea was to catalogue pressing infant health issues that lead to poor outcomes and develop strategies to address this. WIC increasing outreach and sustaining client involvement was a strategy to address child malnutrition and promote newborn overall development. As a part of WIC trying to increase outreach to diverse communities, they are currently working on contracting with a videography and marketing company in order to create a video campaign to be shared on social media sites.
In 2021, SISTA Fire, a womxn of color network advocating for change within RI, continued its collaboration (funded by the MCH TA Grant) with Women and Infants Hospital to increase perinatal workforce diversity and address disparities of care present for pregnant people of color. SISTA Fire presented their birth justice demands to Women and Infants Hospital (WIH) based on their participatory action research findings showcased above. Over the course of the TA Grant, SISTA Fire repeatedly met with WIH to present and explore implementation avenues of their demands. There main demands are to be completed in the following areas:
- Culture and Approach,
- Translation and Interpretation,
- Workforce,
- Doula Engagement,
- Independent Community Review Board, and
- Community Resource Space.
WIH accepted a majority of the below demands and SISTA Fire has currently switched into monitoring WIH implementation progress. In the area of culture and approach, SISTA Fire demanded the following steps be taken by WIH:
- Adopt a culture of care philosophy
- Contract with expert consultants/coaches that can help guide these critical processes of culture and practice change
- Ensure a welcoming and safe environment in the Emergency Department by hiring and training community liaisons/greeters who shall be paid, dedicated local staff who will greet every patient who enters the emergency department, identify needs and preferred language, and help them access translation and interpretation. There shall be sufficient liaisons/greeters to cover every shift.
- Make affirmative acknowledgement of an explanation of the Patient’s Bill of Rights a standard part of the admissions process and posted more visibly, including in the Emergency Department.
- Require and report annual assessments of intake, wait times, and health outcomes in the Emergency Department to the Independent Community Review Board.
- Require training for all health providers around plain language communication.
- All medical professionals must obtain informed consent by ensuring that patients understand the reasons behind exams and procedures, as well as alternatives, before they happen.
- Require all employees to participate in anti-oppression cultural and historical training that shifts practices from the individualistic nature of “cultural competency” to the systemic and institutional analysis of “structural competency” or “equity competency” that is needed to ensure the health and safety of Black women.
- Integrate and guarantee trauma informed principles. This includes standards and protocols for physical exams, including: providers must introduce themselves and state their role in the hospital, providers must explain everything before it is done, and only one provider can do pelvic exams unless clear consent is given in the patient's native language.
In the area of translation and interpretation, SISTA Fire demanded the following steps be taken by WIH:
- All patients shall be asked at any and all registrations what their preferred language is, and what language is spoken most often at home.
- Ensure that all text including signs, discharge intake, patient education materials, and resource guide documents are in plain written language in both English and Spanish, vetted by a community advisory group.
- How to access interpretation services should be explained via clearly marked signs in the hospital in multiple relevant languages, as well as by affiliated providers who need to tell their patients at prenatal visits, “You have the right to an interpreter!” (notwithstanding the new “opt out” standard.) Translation services need to be available from prenatal through postpartum.
- Invest in translation infrastructure including on-call in-person colloquial interpreters, iPad for when in-person translation is not available (including in triage), and fortifying pipelines with CCRI, RIC and other local organizations who already specialize in medical interpretation, to support expanding your infrastructure.
In the area of workforce, SISTA Fire demanded the following steps be taken by WIH:
- Hire providers and leadership of color, specifically nurses, physicians, midwives, board of directors, and corporate leadership so that hospital decision-makers are reflective of the communities in Providence. Within 2-years 20% of all new RN hires must be BIPOC, and within 5 years all healthcare workers in each individual classification must be BIPOC. This is based on the current percentage of RI residents who are BIPOC. After the respective 2 and 5 year marks the hospital shall deposit an amount equal to the FTE short fall in hires into an independent training and education fund, with the explicit purpose of providing adequate tuition and loan reimbursement for staff to meet the goals.
- Report hiring and workforce demographic data on an annual basis to the community review board.
- Create a workforce pipeline (CCRI, RIC, etc.) for local medical professionals of color. This includes accepting Rhode Islanders with two year nursing degrees with the commitment of completing a four year degree after they are hired/while they are employed.
In the area of doula engagement, SISTA Fire demanded the following steps be taken by WIH:
- Shift institutional practices at WIH to better integrate doulas of color within hospital health teams for the quality prenatal, natal, and postpartum care they provide women of color who choose to deliver at WIH.
- This includes making sure staff know what doulas do during the prenatal period and referring patients to community-doulas.
- Hire a management level full-time Doula Liaison. Guarantee that all doulas who are asked to advise or consult with the hospital are paid for their time.
- Ensure that patients are always allowed to have a support person as well as an advocate in the room (such as a family member and a doula), regardless of provider preference throughout their care. This must hold even in an emergency situation.
In the area of Independent Community Review, SISTA Fire demanded the following steps be taken by WIH:
- In consultation with SISTA Fire, Women and Infants will establish an independent review board made up of impacted community members who evaluate Women & Infants Hospital’s efforts to meet these demands.
- Introduce and adopt a community-created Patient Bill of Rights.
- In consultation with SISTA Fire, WIH will establish a third party system for discrimination reporting for community members.
- Report patient satisfaction data disaggregated by race and community investment data on an annual basis to the community.
- Additionally complainants that go through the HR and Compliance reporting structure for alleged discrimination, harassment, and other DEI related policy violations shall be informed of their right to appeal HR and Compliance outcomes to the Independent Community Review Board which shall be empowered to hold hearings and determine corrective action.
In the area of community resource space, SISTA Fire demanded the following steps be taken by WIH:
- Create an on-site staffed space where interpreters, translated patient-education materials, and information about community resources (i.e. WIC, housing, legal services, food pantry) are available. Ensure that patients know about the space, that it is in an accessible location, and is consistently staffed by a community health worker or resource navigator.
Continue to Support the Development of a Doula Infrastructure: MCHP partnered with Journ3i LLC. and the Early Childhood Comprehensive Systems (ECCS) Grant in order to implement an asset and gap analysis of the doula workforce. For instance, doulas gaining access to insurance reimbursement is an asset. However, the lack of provider knowledge of reimbursement processes and general provider confusion and frustration in navigating this landscape are ongoing gaps. Doulas, such as Journ3i LLC., are working with private and public insurances to troubleshoot and fix reimbursement technical issues. The RI Birth Worker’s Cooperative, an administrative doula billing organization, has been holding technical assistance sessions with members who need support with signing up with insurance, submitting claims, and receiving reimbursements. Other doula workforce gaps included:
- a lack of in-state trainings available to community members interested in becoming doulas,
- a lack of diverse doulas serving diverse populations,
- a plethora of unaddressed financial barriers blocking individuals from entering the workforce, and
- a lack of connection and collaboration between doulas and other young family serving agencies.
The report also explored the established and emerging assets of the workforce which included:
- a newly established Birth workers Cooperative, a cooperative supporting doulas in signing up with insurance and billing them. The organization provides HIPAA compliant software so doulas can store client information. They also supply billing support services that help doulas check client insurance eligibility, send in claims, and do claim denial/error follow up,
- a newly established Doulas of Color Network, a network that brings doulas of color together from across the state to connect, learn, and collaborate with each other,
- an established doula association, since 2011, named Doulas of Rhode Island (DoRI),
- new community and state collaborative efforts to bring national doula trainings to Rhode Island, and
- sustained perinatal population demand of doula services.
The next phase of the grant will be creating a workplan to address the gaps mentioned above.
Support CHW Training & Workforce Development: RIDOH’s CHW Initiatives have continued to cultivate learning opportunities for the MCH workforce through the CHW CORE trainings. These are administered through various partners across the state and through the certification process administered through the RI Certification Board. The CHW CORE trainings continue through the following training entities:
- Community Health Innovations of RI provides ongoing training and apprenticeship opportunities especially for CHWs based in the community through Health Equity Zones;
- The Community Health Worker Association of RI (CHWARI) also offers CORE training to prepare candidates for full CHW certification;
- Central Providence Health Equity Zone provides training and an apprenticeship program for its cohort of CHWs;
- RIDOH’s Diabetes, Heart Disease and Stroke Program offers a training program focused on type 2 diabetes, gestational diabetes, prediabetes, hypertension and cardiovascular disease. This training program prepares candidates for full certification in CVD/Diabetes;
- Rhode Island Parent Information Network provides ongoing training opportunities for Resource Specialists including parents of children with special healthcare needs;
- Clinica Esperanza sponsors ongoing Navagante trainings for Bilingual / Bicultural CHWs. They also offer a wellness program, “Vida Sana” for patients living with chronic disease.
All of these training programs continue to align their curriculum with Rhode Island’s Certified Community Health Worker standards meeting the certification requirements.
The RI MCH Program continues to partner with Rhode Island College (RIC) in supporting the Community Health Worker Association of Rhode Island (CHWARI), which is housed at RIC. CHWARI is an organization which provides CHWs with resources such as trainings and other professional development opportunities. The CHWARI actively supports frontline healthcare workers who are employed in underserved communities to improve high quality healthcare access for people in need. CHWARI envisions a state in which all Rhode Island communities receive high quality, equitable health and social services in order for all individuals to realize their optimal state of health and well-being. The mission of CHWARI is to increase the power of Rhode Island’s Community Health Workers to promote health equity through increasing access to quality healthcare and social services. CHWARI also acts as an advocacy organization by promoting equity within the CHW workforce and through the promotion of CHW sustainability. Sustainability efforts underway include the potential for reimbursement of the CHW workforce through RI Medicaid, and CHWARI is a partner alongside RIDOH and RI Medicaid in this sustainability effort.
CHWARI also partnered with RIDOH in the publication of the following reports: Community Health Workers in Rhode Island: Sustaining a growing public health workforce in the pandemic and beyond. This report provided stakeholders with qualitative and quantitative data in support of CHW reimbursement efforts. The second report that was produced during this reporting period was RI Community Health Worker Assessment: Exploring Opportunities for Sustainability. This report was instrumental in the creation of a supervisory training for those who are interested in supervising CHWs, including CHWs themselves.
RIDOH also leads a statewide coalition, the CHW Strategy Team, which envisions thriving and healthy RI communities that partner with an equity-focused and strengths-based health and social service system integrating leadership and sustainability of CHWs. Its mission is to act as a liaison between CHWs, CHW employers and policy makers to champion and align varying goals and interests including:
- Workforce development
- Cultivation of the CHW supervisor role
- Reciprocity
- Educational pathways
- Employment pathways
- CHW advocacy
- Race and ethnicity equity
- Disabilities
- Education on the role of CHWs
- Interstate, regional and national CHW Association collaboration
- CHWs advocating for the needs of their communities
- Sustainability
- Payment strategies
- Advocating for sustainability of the CHW professions
- Interagency collaboration
- Care coordination
Members of the CHW Strategy Team include community health workers, community-based organizations, federally qualified health centers, managed care organizations, state agency partners, and several RIDOH programs.
Support a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations Through the Youth Advisory Council: In 2013, the RI Department of Health (RIDOH) implemented a Youth Advisory Council (YAC) to provide youth/young adults, ages 14-24, with a forum to connect with other youth and an avenue to practice leadership skills within a safe environment for addressing social/emotional health. Since the inception, the YAC has advised and collaborated with various RIDOH programs affecting the health, wellness, and transition of youth (including those with special needs/disabilities). The YAC has met consistently over that time and served more than 178 young people, many who stay involved over multiple years. This involvement over time yields youth led leadership within the YAC and in outside councils. Our co-chair is a member of the RI Special Education Advisory Committee, Advocates in Action, and has presented nationally for the UCLA Autism Center. Another one of our members, who first joined as a high school student in 2016, was hired as a youth resource specialist and is the new chairperson of the YAC. He is also a member of the AMCHP committee Youth Voice Amplified.
During the last Title V reporting period, the YAC served sixteen (16) members who met monthly from September 2021 through May 2022 and in the virtual environment to address topics including: strengths assessing, stress reduction in times of change, health equity, oral health and healthy relationships. The YAC also has a significant role in the RI Department of Health Programs to provide youth voice on health/wellness messaging and the development of strategic plans. Additional leadership opportunities are shared, and members have contributed to the new flyer and alternate ways to join YAC. The YAC meeting structure also provides a means for members to connect with their peers. As a group, the YAC worked with the Wilbury Theatre educators to develop an opening skit for the annual Dare to Dream Conference. This year saw a number of our members age out and move on to full time employment, military or college. The numbers remained steady with several new members joining the group.
Through a contract with several professional entities, the YAC also provided needed supports relevant to the social emotional toll of the COVID-19 pandemic. The Coping with the Unexpected workshop continued the COVID series from the previous year and was open to the public. This workshop series showcased strategies on how to incorporate coping skills into daily life and how to utilize tools to help deal with stress/life changes. The YAC provided feedback that they wanted to learn more about setting boundaries to achieve healthy relationships. A training was developed for transition age young people of all abilities addressing this important topic and will be presented to the public in the future.
Convene the MCH/HEZ Learning Classroom: The HEZ MCH Learning Classroom is an interactive educational space created to educate Health Equity Zones on Maternal Child Health issues across all six domains. The Maternal Child Health Program has put together a list of speakers from both the community and RIDOH to attend our bi-monthly meetings and educate the group on the initiatives they implement. Each HEZ must send a representative to consistently attend the learning classroom meetings. The learning classroom will move into its 2nd year of programming in October 2022.
Promote Good Oral Health across the Lifespan with a Focus on Prevention: In the past year, the Oral Health Program has partnered with multiple promotion agencies to create a cohesive message about oral health. This includes the Providence Bruins, the University of Rhode Island Ryan Center, and NBC10.
Through this work, the Oral Health Program has been able to outreach to communities based on geography, age, BIPOC community, and dental visit. During these events, the Program has handed out thousands of toothbrushes and toothpaste, provided lists of dental safety net providers, and given education on different areas of oral health (i.e. dental visits are safe during pregnancy and a child should be their first dental visit around age one).
Train Community Health Workers (CHWs) to Provide Education on Oral Health Topics including Age One Dental Visits, Oral Health during Pregnancy, the Importance of Drinking Tap Water, and Dental Sealants: The RI Dental Director has previously provided training to cohorts of CHWs on oral health across the lifespan. The trainings consist of two 2-hour in person lessons and independent learning between the sessions. As stated, the oral health lessons consist of prevention topics across the lifespan and the training also has elements of the importance of CHWs in these topics. The most recent training had roughly 20 participants, and the end project was to present how they would incorporate what was learned into the work currently being done with their agencies.
Developed Nutrition Training for Dental Hygienists: The Oral Health Program received funding from the Health Resources and Services Administration to build a nutrition training for dental hygienists. Dental hygienists are trusted sources in the community and tend to be the most public health focused in a dental office.
In January 2020, the Oral Health Program and contracted nutrition experts from URI and SNAP-Ed were able to host one in-person training for 30 dental hygienists. They received CE credits for attending. The evaluations were good overall with minor suggestions for how to improve the presentation. With this information, the Oral Health Program and nutrition experts partnered with the New England Public Health Training Center to build an online module version of the in-person event.
The online training consists of both didactic and interactive learning. It is currently in the last phases of testing with professionals and will be available for free on the New England Public Health Training Center website. The center will also assist with promotion.
Advance a Comprehensive System of Engagement and Leadership Development for Vulnerable Populations through the Health Equity Zones: RI’s Health Equity Zone initiative is an innovative, place-based approach that brings communities together to build the infrastructure needed to achieve system and policy changes at the local and statewide levels. With a mission to “encourage and equip neighbors and community partners to collaborate to create healthy places for people to live, learn, work, and play”. Fifteen Health Equity Zones directed public health funding, during the reporting period, towards community-led projects, increasing the impact of efforts to build healthier and more resilient communities.
HEZs are contiguous geographic areas that are small enough to have a significant impact on improving health outcomes, reducing health disparities and improving the social and environmental conditions of the neighborhood, yet large enough to impact a significant number of people. HEZs can be defined by political boundaries (e.g., cities, wards) or by less defined boundaries (e.g., neighborhoods). The geographically defined HEZ community must have a target population of at least 5,000 people, demonstrate economic disadvantage, and demonstrate poor health outcomes. The HEZ are administered by a “Backbone Agency” which may be a municipality or a public not-for-profit community-based organization which coordinates the efforts of a HEZ Collaborative to achieve project goals. Existing Health Equity Zone Collaboratives include residents, diverse community-based organizations, youth-serving organizations, educators, business leaders, health professionals, transportation experts, and people in many other fields who come together to address the most pressing health concerns in their neighborhoods. Through a collaborative, community-led process, each Health Equity Zone conducts a needs assessment and implements a data-driven plan of action to address the unique social, economic, and environmental factors that are preventing people from reaching their optimal health.
The HEZ approach recognizes that communities have different needs and assets to build upon. By aligning strategic investments with existing resources across sectors, each community can address their unique needs, reduce disparities, and stimulate economic growth. Listed below is a summary description of efforts undertaken by each HEZ to improve maternal and child health outcomes in their communities. Additional projects have also been included in specific domain reports as well.
Statewide Initiatives: Youth Engagement Community of Practice is being launched in the Health Equity Zone Initiative. The Health Equity Zone Initiative recognizes that adolescent health is a critical component in the overall health of communities. Furthermore, adolescents themselves are best positioned to determine what their health priorities are and what strategies will be most effective in driving those priorities forward. As such, the Health Equity Zones seek to incorporate youth engagement into their collaboratives so that youth can lead initiatives to more effectively address the social determinants of health that impact them. To support the HEZs in doing this, the HEZ Initiative is launching a Youth Engagement Community of Practice.
The Youth Engagement Community of Practice will be a quarterly convening of representatives from each HEZ, as well as other community and state-level partners who are involved in youth engagement work. During the quarterly sessions, participants will learn best practices for recruiting, retaining, and nurturing the leadership of youth in their communities. The sessions will be co-facilitated by youth and adults, who will work collaboratively to determine key benchmarks for progress and create content to help participants meet those goals.
Youth Resource Specialists: Since 2014, the Health Equity Institute has invested in hiring and supporting Youth Resource Specialists. Their input into the transition process and generation of self-determination resources has been invaluable. Youth Resource Specialists on the YAC Advisory participate as a team in the RIDOH annual youth conference opening/volunteer activities, represent RI at national youth forums, and promote inclusion in RI’s youth serving organizations. In 2019, youth resource specialists led a monthly Youth Advisory Council where an average of 35 students with disabilities served as advisors to RIDOH programs and policies; presented at the national AMCHP Conference; and presented at the Turn Up Rhode Island Conference featuring career exploration for 300 students of color. Unfortunately, youth conferences expected to take place in the Spring of 2020 were cancelled due to COVID-19.
During the last Title V reporting period, the YAC served fifteen (15) members who met monthly from September 2020 through May 2021 in the virtual environment to address topics including: strengths assessing, stress reduction, health equity, emergency preparedness, and voting rights. The YAC also has a significant role in the RI Department of Health Programs to provide youth voice on health/wellness messaging and the development of strategic plans. The YAC meeting structure also provides a means for members to connect with their peers. As a group, the YAC wrote a beautiful poem, It’s OK not to be OK, describing the difficulties of the past year. The ease of taking part in remote meetings appealed to youth and we had a banner recruiting year with 6 new members.
Through a contract with several professional entities, the YAC also provided needed supports relevant to the COVID pandemic including a Coping with Covid series that was open to the public. This workshop series showcased strategies on how to incorporate coping skills into daily life and how to utilize tools to help deal with stress/life changes. The YAC also facilitated a capacity building training series on running remote meetings for youth and young adults. These Zoom Boot Camps taught community serving organizations how to reach youth and keep them engaged through remote connections.
The plan for the 2022/2023 reporting period included continuing a remote meeting option along with in- person meetings (when resumed) to accommodate the many youths with transportation challenges. The planned agenda for this period included professional development/leadership training, social/emotional/resilience workshops, community youth engagement opportunities, and RIDOH Program support activities.
COVID-19 HEZ Response: Given the COVID-19 pandemic and the associated effects on the residents of Rhode Island beginning in March of 2020, the focus of the HEZs turned to responding to the arising acute needs that emerged in communities as a result of the pandemic. The Health Equity Zones worked to rapidly identify and respond to emergent needs in their community while continuing their HEZ work and achieving progress toward their goals. The HEZs played a critical role in response efforts, serving as a liaison between the community and the Department of Health, and coordinating resources and services at the community level.” And the state of Rhode Island leveraged the HEZs capacity to address the disparate impact of the COVID-19 crisis.
Specifically, the HEZs coordinated food delivery, distribution of PPE, and social and educational supports for families with children. During the reporting timeframe, HEZ COVID-19 responses outreached to 173,901 Rhode Islanders, served 176,167 residents through Community Health Workers and Community Outreach Specialists, distributed 1,068,114 masks and 577,260 meals to residents.
The following summary outlines many of the accomplishments HEZs have made regarding the COVID-19 response both collectively and individually, and in that way, advanced Maternal and Child Health from October 1, 2019-September 30, 2020. Highlights are provided along with COVID-19 HEZ response data within the associated time period (data included were collected from June through September 2020).
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HEZs continued to utilize community health workers to connect community members to social services and residents, and to keep a pulse on the needs of the community.
- CHWs worked with families to increase enrollment in Family Home Visiting programs.
- CHWs provided interpretation services and assisted families in navigating resources for COVID-19 related Q&I.
- All the HEZs conducted comprehensive community needs assessments, focusing largely on MCH populations (families, women, youth, and teens).
- All HEZs developed an action plan to address the identified community needs, including MCH populations.
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HEZs collectively provided Basic Needs Services throughout the COVID-19 pandemic (see total statistics for the time period below), such as:
- Provided PPE (masks), cleaning supplies, information, education, and support
- Assistance with unemployment, SNAP and other assistance applications
- Support for local food banks: restocking with food and PPE
- Delivered meals and culturally relevant food products
- “Be Safe Kits” – fresh produce (bread, eggs, vegetables), cleaning supplies, face masks, and hand sanitizer
- Gave out emergency resource gift cards, food assistance, and personal care items
- Home-safe programs: providing rental assistance, cash assistance to support housing stability
- Utility assistance
- Thanksgiving and holiday baskets
- Transportation assistance
- Assistance getting medication to individuals in need
- In addition, individual HEZs continued to serve their communities throughout the pandemic and to meet their work goals that aligned with their community needs assessments.
Bristol: Unlike the previous year, Bristol Health Equity Zone (BHEZ) Engagement Navigator was unable to offer one-on-one counseling to students at Mt. Hope High. Continuous feedback from residents and community organizations, including Bristol Warren Regional School District strengthened BHEZ’s focus on behavioral health needs of youth and families, and informed decisions to partner with the school district to deploy two Community Health Workers ( CHWs) in the school and community-at-large as part of an integrated team. Looking to the coming application year, in June of 2022, two CHW are slated to begin training and organizing/ collecting resources for the community.
Family Programming, Supports and Initiatives: Bristol HEZ continued supporting the Parents As Teachers program, which offers free family visiting to any family with a child between prenatal and kindergarten entry. This program provided knowledge for parents regarding age-appropriate skills and activities to promote school readiness, and increased families’ connections to various education, employment, family, and physical and mental health resources in the community. Last year, they conducted 387 personal visits with 49 group connections totaling 52 families and 59 children served. A total of 33 families were referred to the program with 28 joining. Most of new referrals came from the Rogers Free Library, Facebook, and First Connections.
BHEZ also participated on the Bristol Warren Regional School District's Wellness Committee to provide input on wellness activities within the school. In efforts to provide access to health and wellness for all community members and residents BHEZ will partner with the school district and local library to provide on-site family navigator services at libraries, schools, community locations and parks. A Family Navigator who is charged with this work is slated to be hired summer of 2022 for work completed in the coming application year.
Additionally, BHEZ continues to be a part of coordinating the Bristol-Warren Thrive by Five and Beyond. Their primary mission was, and is, to maintain a coordinated network of collaborating partners to support families’ access to health, educational and social services. This year and into next year, BHEZ has partnered with this group and the new Warren HEZ to bring a Kids Count Data Event to Bristol/Warren in order to bring the data to the community. This data and the conversation with the community will help promote the services that are needed most for local families. Community leaders, educators, and social service providers gathered in May of 2022 to hear a distillation of the community-level child wellbeing data from the Rhode Island Kids Count Factbook, with a specific focus on the children of Bristol and Warren. The event was sponsored by Rhode Island Kids Count, Bristol Warren Thrive by Five and Beyond, East Bay Community Action Program, Bristol Health Equity Zone, and Warren Health Equity Zone. The “Kids Count: Data in Your Backyard” was a historic event for Bristol with over 70 registrants. With the support of Town Managers, school superintendent and state representatives the community began solution-oriented discussions on the needs of children and families.
Decrease Emergency Department Mental Health Incidences: The long-term goal of this effort is to decrease the number of students and families accessing emergency rooms for mental health support services and to support COVID-19 recovery and resiliency. In that vein, BHEZ continues to partner with prevention coalitions to support the collective mental health of the community and identify new partners to collaborate on combating social isolation. In addition to decreasing isolation, BHEZ hopes to increase resident engagement. One of the ways they intend to achieve this goal is through an organized Mental Health First Aid (MHFA) training through the regional coalition for the Bristol Warren Regional School District. MHFA trainings are slated to begin in August of 2022 and continue through the application year.
Mount Hope Bridge Camera Project: A group of residents and community stakeholders, including representatives from the School Department, the Bristol Police Department, Bayside YMCA, Roger Williams University, the National Alliance on Mental Illness, and more, continue to meet monthly toward a community-wide suicide prevention plan. This group initiated the Mount Hope Bridge Camera project. This led to Bristol Police Department writing new policy for the use of flock cameras near to bridge to decrease response time for calls to the bridge. Accomplishments also include getting signage on Mount Hope Bridge, conducting mental health forums, and suicide prevention trainings in coordination with American Foundation of Suicide Prevention. They continue to work with faculty and students who developed a policy brief around barriers on RI bridges. This group also received a legislative grant which will enable them to have the signs translated and displayed in Portuguese, a big demographic group in the Bristol community.
The Change Direction Campaign: The Change Direction campaign in Mt. Hope High School continued with the support of a student advocate. This campaign was previously supported by the student advocate and a group of students. This group morphed into a student union group that worked on additional activities around equity and inclusion. Their work is ongoing.
Central Providence: In 2019, the Olneyville Health Equity Zone had expanded to additional adjacent neighborhoods in Providence to create the Central Providence Health Equity Zone. With the addition of new areas of the community, the Central Providence HEZ conducted a needs assessment in those areas to determine what the HEZs action plan should be for those neighborhoods. Lack of affordable childcare was identified as a community need, and the HEZ developed a plan for establishing a new resident-led childcare center and for improving existing childcare centers in the area.
During the reporting period 10/1/20-9/30/21 the Central Providence Health Equity Zone (CPHEZ) backbone organization One Neighborhood Builders (ONE/NB) in partnership with the RI Executive Office of Health and Human Services, and the RI Foundation was selected as one of 14 backbone organizations nationwide to receive a two year $8.75M grant from Blue Meridian Partners (BMP) as part of the BMP “Place Matters” Portfolio. With that ONB/CPHEZ launched Central Providence Opportunities (CPO) to deepen the place-based work identified on the 2019 needs assessments with a focus on fostering economic opportunity for current and future residents. Because HEZs are designed to be community driven and resident led, CPHEZ/CPO knowing that residents are the experts of their own communities a Resident Advisory Council (RAC) was formed to ensure that residents have a strong voice in designing solutions for the community.
CHWs and Family Navigators: The CP HEZ trained and employed 5 CHWs in CP as well as additional slots in other HEZs. This resulted in 14 CHWs who have received their CHW certification. 7 have completed Apprenticeship RI credentials. 6 CHWs have received job promotions. CPHEZ also supported the trainings of 37 CHWs working with HEZs throughout Rhode Island from April 7th - end of May 2021.
The HEZ also used community health workers to connect residents to social services and to keep a pulse on the needs of the community. Community Health Workers also worked with families to increase enrollment in Family Home Visiting programs. The CP HEZ’s CHWs have been an integral part of their response to COVID-19, by supporting efficient communication of residents’ needs to the HEZ, which was then able to leverage its relationship with RIDOH and other agencies to direct resources to families with urgent needs during COVID-19.
In 2020, the Central Providence HEZ was awarded funding to support a Family Navigator to provide navigation services to parents and families in the HEZ community, working with a total of 161 families. Family navigation services provided through PDG funding, supporting families across the HEZ community. Additionally, a Family Learning Academy will focus on providing child-centered family programming, adult basic education for parents, along with case management services. 33 Families have completed or are currently enrolled in the program.
Youth Centered Activities: Aimed at decreasing chronic absenteeism, the CPHEZ and CPO identified the need for before- school time programing providing parents with more flexible drop-off times allowing parents to get to work while kids get to school. 37 students are currently enrolled in this program.
The CP HEZ introduced young girls to the computer science pipeline through learning circles, mentoring, and after school and summer programming. This resulted in 360 hours of IT mentoring and training offered in-person via Zoom for young girls via YWCA 6 weeks of summer programming and 12 weeks of afterschool programming took place to provide training on IT basics, HTML, and basic coding. 20 young girls were recruited for tech-related virtual field trips and programming.
Economic Opportunity Grant Program: Additionally, the CPHEZ launched the Economic Opportunity Grant Program releasing an initial RFP in response to addressing economic opportunity and childcare in the community funding 6 organizations $125,300.00 in funding. An example of the investment includes:
- Improved Economic Opportunity of Central Providence Residents by supporting Workforce Development Programs for area residents ran 30 hour industrial medal work training; provided 220 hours of on the job training for 2 mental work apprentices. This resulted in 5 community members who completed 30 hours of welding training and 3 received 270 hours of on the -job training while being paid a living wage.
- The HEZ provided CP residents with education and employment services through the Providence Public Library, which resulted in 420 hours of workforce development services, digital literacy instruction and career coaching was provided through Providence Public Library, 144 Hours of Learning Lounge services 96 Hours of Career Coaching and 180 hours of bilingual digital literacy classes were provided through the Providence Public Library.
To support small business development on the Central Providence community:
- CP HEZ supported Central Providence Entrepreneurs, with a focus on Spanish speakers in staring their own businesses. This resulted in 11 Spanish speaking residents in graduating from Social Enterprise Greenhouse's (SEG) first Virtual Spanish Business Incubator Program and 4 residents from CP HEZ have completed the Incubator Program. SEG hosted cooperative development workshops in Spanish and English for 32 attendees 10-15 hours of expert coaching for two businesses seeking to run as Co-Ops.
- CP HEZ increased the number of cooperatively run businesses SEG, in partnership with the Boston Center for Community Ownership (BCCO) hosted English workshops for 20 participants and Spanish workshops with 12 participants, 6 from 02908 or 02909.This has resulted in 3 working groups to be established to 1) address the policy and advocacy needs to increase funding to support cooperatives in RI; 2) highlight cooperatives in the state; and, 3) provide a peer support group for coops.
Reduce Disparities in Women's Cancer Screening between African American and White Women to reduce delayed diagnosis and poor prognosis: CPHEZ identified barriers to Women's Cancer Screening through creation and implementation of a research study with Brown School of Public Health. This resulted in the completion of 6 Focus groups with women throughout RI on barriers to women’s cancer S=screening. They worked with Brown to analyze Findings Intervention creation in progress.
Supporting CYSHCNs: In 2020, the Central Providence HEZ, specifically collaborative member organizations Federal Hill House and The Autism Project, carried out programming to support children and their families. Federal Hill House developed playground extension projects, supported a First Providence Talks Extension (PTE) group that was designed to build parental behaviors that promote early childhood language and literacy, and promoted the Olneyville community’s Multi-Cultural Festival, which saw over 500 attendees. The Autism Project consulted local agencies to support children and families, as well as offered 10 hours of Conscious Discipline training for parents and caregivers, presented in both English and Spanish.
Next year Activities: On the horizon for the upcoming application period the CPHEZ and the CPO will continue to focus on upstream resident driven initiative to empower women, children, young adults, and families in CPHEZ. To include a Community Impact funding structure empowering the RAC to distribute at their discretion, a participatory budgeting process is being set up to support a variety of community projects. A Community Loan Fund is also being built to support small businesses and non-profits. It will be overseen by a loan committee made up almost entirely of residents. Examples of other upcoming activities include:
- Job Navigation Hubs: The Providence Housing Authority (PHA), a CPHEZ partner will connect resident of 2 public housing developments with workforce trainings and quality jobs via on-site navigation. PHA will hire residents including youth and adults to outreach their neighbors with a goal of enrolling 150 residents.
- Educator-Led Communities of Care: The Service Employees International Union (SEIU) Education Fund brings together family childcare providers to share skills, build collective power, and assert agency over policy to improve the home-based childcare industry in the long-term. The CPHEZ/CPO will hire and train peer leaders to facilitate the cohorts made up of 15-30 family childcare providers.
East Providence: The East Providence HEZ conducted a comprehensive community assessment in 2020, which included a youth focused survey. The youth survey was distributed to youth at the East Providence Boys and Girls Club and EBCAP’s Youth Center. The response rate from the community needs assessment totaled 494, representing both youth and adult community members. Based on the findings from the EP HEZ Community Needs Assessment, the HEZ created five preliminary action areas, one of which being Supporting Health & Wellness Across the Lifespan. This focus area was addressed by hiring a Family Navigator to engage families with young children/expectant families to participate in the array of evidence-based maternal/early childhood home visiting programs. The Family Navigator will also support families to secure the social and health resources they need.
Newport: In addition to continuing to support ongoing maternal and child health work throughout their community, the Newport HEZ began focusing on key target populations most in need of health equity work. For example, they began working with community partners and healthcare providers to improve healthcare access and improve healthcare experiences for LGBTQ+ teens.
Racial Equity Activities: The Newport HEZ also focused intensively on racial equity and racial justice. One of the Newport HEZ’s leading priorities was to eliminate disparities in Black maternal and child health outcomes. In efforts to improve racial equity, the HEZ participated in and hosted several racial equity trainings throughout the reporting year, reaching hundreds of attendees in the Newport community and beyond. The Newport HEZ conducted all their work through a resident-centered, racial justice lens.
The Newport HEZ partner Conexion Latina provided rent relief and gift-cards to support families in accessing basic necessities. Conexion Latina supported 27 families who were ineligible for state assistance with $500 in rental assistance. Conexion Latina also distributed gift cards of $50 each to families who expressed needing support in terms of basic necessities, hygiene items, and food.
LGBTQ+ Health Working Group: Several of Newport HEZ’s workgroups incorporated youth voice and needs into their action plans. The LGBTQ+ Health Working Group partnered with Child & Family, a social service provider in Newport County. This workgroup aimed to support healthcare facilities in earning the designation as LGBTQ+ safe spaces, thus increasing the safety and wellbeing of LGBTQ+ youth. Newport HEZ’s Arts and Culture Working Group partnered with the Newport Youth Chorus and Newport Public Schools to engage young people in coordinating public art and other cultural activities in Newport.
Pawtucket/Central Falls: The Childhood Lead Action Project (CLAP) continued to provide lead poisoning prevention and education to the Pawtucket and Central Falls communities. CLAP facilitated five lead poisoning prevention workshops at local schools. The HEZ’s partnership with CLAP has contributed to achieving a decrease in childhood lead poisoning in Pawtucket, and the HEZ continued to support work to decrease childhood lead poisoning throughout the community.
PCF HEZ identified parents who were recruited for the Nurturing Parent Program that targeted all families at risk for abuse and neglect from birth to age 18. PCF HEZ purchased multicultural classroom materials for Pawtucket and Central Falls classrooms. Classroom materials included items such as bilingual books, CDs, and dolls and clothing representing diverse nations around the world. Backpacks were filled with multicultural learning materials (similar to the classroom materials) and were also purchased to foster the home-school connection. Additionally, to support the materials, 60 hours of mentor coaching was provided to teaching teams. It is approximated that 216 children and their families were impacted by this program.
PCF HEZ continued to address the social determinants of health and the causative relationship that hinders access to care. One of the impacted areas was in addressing quality learning for English Learning preschoolers as well as family engagement in children’s learning. 53% of children met or exceeded expectations in language from winter to spring and 50% more in mathematics.
Progreso Latino also provided clients with information on COVID testing, birth control options, and information regarding prenatal, and post-natal care, including "Am I Ready to be a Mom?" and "Am I Ready to be a Dad?" brochures. These brochures (distributed in either English or Spanish) are educational documents focused on promoting preconception, prenatal, and post-natal care.
Opioid Action Plan: The Pawtucket Central Falls HEZ developed an Opioid Action Plan, which included plans for substance use education for youth, and the creation of positive social opportunities and employment opportunities for youth and young adults. The plan was informed by the 2019 Opioid needs assessment. Target populations included young adults, families with a loved one who has a substance use disorder, and pregnant women and mothers with substance use disorder (or in recovery).
Needs assessment participants also included staff of organizations in the community who work with young adults or people with a substance use disorder. Secondary data from RIDOH and law enforcement was also used to identify needs. The PCF HEZ’s substance use education programs reached over 216 students at local schools in 2020. In a post-presentation survey of those students, 91% reported that the presentation helped them understand how opioids affect the body, and 92% reported feeling very or somewhat confident that they would be able to help someone in the case of an overdose. The PCF HEZ’s substance use education programs reached over 216 students at local schools in 2020. PCF HEZ continued to leverage the expertise of state and community stakeholders and remain flexible in their approach as they empower youth in guiding the work.
Youth Engagement: The PCF HEZ identified youth engagement as a priority focus. Under this focus area many priorities were addressed through the lens of youth’s perspective and voice and choice. To that end intentional opportunities for youth leadership and advancement were prioritized. Through their partnership with the Boys and Girls Club, the PCF HEZ engaged families and youth in a family swim program, anti-bullying and conflict resolution programming, and fitness and wellness classes. The Boys and Girls Club also helped serve local families with groceries, gift cards, and activities for youth during COVID-19. Another HEZ partner, Progreso Latino, provided individuals with birth control options and information regarding prenatal and postnatal care.
Financial Training and Education Opportunities: PCF HEZ held a number of financial training and home education opportunities in collaboration with Pawtucket Central Falls Development (PCFD). HEZ residents participated in tenant/landlord and homebuyer education classes. Classes incorporated information regarding asthma risks and preventions. In response to COVID-19, education classes transitioned into virtual sessions, which allowed PCF HEZ to continue facilitating education and training. PCF HEZ worked closely with PCFD to make changes in their program in response to COVID-19 and to meet the needs of their residents. Staff did outreach to their tenants, ensuring they had information regarding COVID-19, rental and other available assistance.
Climate Change and Food Harvest Programming: The PCF HEZ worked with GroundWorks RI to build community resilience to climate change. Youth were employed and trained on how to grow their own food at SCLT’s Galego Court farm in Pawtucket, how to process and cook their food at Harvest Kitchen, and how to engage residents and gather data regarding climate resilient mitigation strategies with GroundWorks RI. The partnership program between SCLT, Harvest Kitchen, and GroundWorks RI ran successfully with online and new safety protocols. SCLT has continued to train garden leaders and supported a resident lead apiary project in Pawtucket.
Covid-19 Related Activities: A HEZ partner, the YMCA, became an important Beat COVID partner providing staffing for flyer distribution regarding testing. The YMCA outreach team provided hundreds of hours of canvassing and outreach to Pawtucket and Central Falls, focusing on COVID hotspots as identified by RIDOH during the reporting timeframe. Outreach staff (including the Family Support Team with interns, multilingual Community Health Workers and outreach staff, and city stakeholders) informed COVID response efforts. The HEZ distributed masks and over 26,000 test kits to organizations for distribution across PCF.
Washington County: Maternal and child health was a primary focus of South County Health Bodies Healthy Minds (HBHM), which served as the backbone for the Washington County Health Equity Zone. HBHM implemented 5-2-1-0 to prevent childhood obesity and promote healthy habits, by encouraging families to be more physically active and eat healthier, while engaging community partners to create healthier environments for children. The 5-2-1-0 program promotes eating 5 fruits and vegetables, engaging in no more than 2 hours of recreational screen time, getting 1 hour of exercise, and drinking 0 sugary drinks per day. The Washington County HEZ reached over 19,000 children and adolescents with their 5-2-1-0 programming. Forty-six 5-2-1-0-related strategies were implemented in schools, childcare centers, and other organizations. Five summer camps incorporated 5-2-1-0 materials and/or activities into their curriculum. An estimated 16,986 youth and adults have been indirectly impacted by 5-2-1-0 this reporting year through the efforts made at the organizational and county-levels.
Ten K-12 schools implemented policy, systems, or environmental changes including offering a new grab-n-go breakfast option, eliminating chocolate milk for breakfast, and starting advisory committees for students to work with food service providers to give input on school nutrition. Three Washington County schools have established student committees. In addition, policy, systems, and environmental (PSEs) have impacted an estimated 1,439 children. Overall, 83% of Washington County K-12th Grade Schools and 74% of Washington County childcare centers continue to be engaged in promoting 5-2-1-0 and/or making changes to support youth in adopting healthy behaviors.
Food access and family health has been the primary focus of the “Healthy Bodies” portion of Washington County’s Healthy Bodies Healthy Minds (HBHM). 5-2-1-0 has been pre-established and implemented within almost all school districts across Washington County (with the exception of Exeter). These materials, teachings, and workbooks remain within the schools, classrooms, and have been verified to be a continuous resource for educators in their classrooms. While existing efforts remained continuous, the new Healthy Bodies Outreach Coordinator established existing and new relationships within the schools via their Wellness Committees, nutrition and physical activity sub-committees, and 3rd party food service providers to ensure that messaging remains consistent and opportunities to collaborate and improve existing policies continue.
Currently, the Chariho district is working to offer the Farm to School program in more locations, in the long term, all schools within the district, in the short term, capturing grades youngest to oldest, new implementation will begin for the 22/23 school year. Chariho will also offer alternative (non-sugary) beverage options, based on post-covid restrictions and supply chain availability. These PSEs will impact around 1,129 students.
From an organizational standpoint, HBHM has made substantial progress in impacting their community, engaging 71 organizational partners, including 18 schools (K-12), 23 preschools, 8 health service organizations, and 22 afterschool programs, and provided 145 hours of technical assistance to organizations in their efforts to support healthy eating and physical activity. This included HBHM: 1) connecting community partners with Rhode Island Department of Health (RIDOH) to assist with needed COVID-related resources; 2) supporting Community Health Workers (CHWs) and the community members they serve to address food insecurity needs; 3) providing school staff—nurses and health and physical education teachers—physical activity resources to engage children and families remotely; 4) assisting 10 child care organizations fulfill a total of 17 NAPSACC^ goals; and, 5) disseminating 1,522 5-2-1-0 materials, including frisbees, water bottles, jump ropes, toolkits, and pedometers to increase awareness of, and support for engaging in healthy behaviors. HBHM organized and conducted an online school garden conference with local school garden experts, now posted on HBHM’s YouTube channel; and partnered with Peace Dale Library to provide garden kits (accompanied by gently used books related to healthy habits) to children in the Champaign Heights neighborhood as well as South County YMCA and South Kingstown Parks & Recreation programs.
Healthy Bodies of HBHM has impacted their community by following up with existing partners and engaging 14 new community partners. Thes partner include: 2 grocery/retailers, 5 libraries, 1 Social Services Director, 3 URI professionals (related to food access and recovery), 1 food rescue technology professional, and 1 patient experience and food access professional within South County Hospital. The principal focus of these relationships is to fully develop and implement a plan to increase culturally appropriate food access awareness, accessibility, and education. Existing partners will serve as communicators and potential site-locations for vending and new partners will aid in plan development and implementation to meet community need. A newly establish pilot exists in Exeter which will serve as a test “pop-up” farmer’s market/pantry.
In relation to 5-2-1-0 physical material distribution, much came to a halt due to existing availability and no-awarded grant funding between the months of October and June. 5-2-1-0 buttons, water bottles, and play-produce picnic baskets were distributed at pre-schools and events as a reward for participating in activities related to healthy eating. 5-2-1-0 lesson plans, worksheets, and other promotional materials were distributed to new and existing partners via PDFs, these were more widely provided to libraries and daycare centers/pre-schools. The remaining PDG funds (non-Incredible Years) will serve as an incentive to increase zero sugary beverage consumption and healthy snacking promotion. 210 high-quality water bottles will be distributed to 10+ pre-schools containing the 5-2-1-0 logo. The water bottle will be accompanied by an age-appropriate lesson discussing the cost of health by regularly consuming sugary beverages. Following bottle distribution to students, HBHM Coordinator or the preschool’s educator will conduct follow-up sessions with “healthy fruit” stickers to add to the water bottle. Students will be encouraged to try the snack prior to receiving the sticker and learning more about each snack. These activities will begin in mid-Summer through school year 2022-23.
The Washington County HEZ published Healthy Habits/recipe book, and distributed hard copies and electronic versions throughout the county, and created the Feeding Toddlers Info Sheet for local pediatricians/PCPs to use with families in their practices. In addition, water bottle filling stations were installed in Narragansett schools, the HEZ provided support for the state passage of sweetened beverage tax, supported the Bradford-on-the-lane food pantry, and the Davisville hangouts, which provided an online middle school community to support youth connections during the COVID-19 lockdown.
Mental Health First Aid: HBHM recognized the need to continue wide-scale mental health literacy training with Mental Health First Aid (MHFA) and the QPR (Question, Persuade, Refer) with the national goal of attaining 1 in 10 people trained in MHFA. Subsequent to goal and implementation, it was evaluated that 356 people were MHFA trained. 20 of the 122 individuals trained are youth. HBHM recognized how death by suicide; particularly among youth was devastating their community. An innovative strategy employed was outreach and support through QPR suicide prevention codes which launched in October 2020. Washington County HEZ was the first in Rhode Island to launch this initiative. There are over 950 signs county wide and over 15,317 unique devices scanned. 315 people were trained in QPR suicide prevention. Signs were strategically placed county-wide to provide access to free mental health & suicide prevention supports.
Childhood Programming and Supports: June 30, 2021, MBHM’s Incredible Years parent group leader has contacted 36 families and recruited 18 of those families for the Incredible Years Parenting Groups as well as setting up a schedule for the group sessions. They completed 16 sessions with 9 parents completing the first group and completed 16 sessions with an average of 10 parents attending each session for the second group. They also completed recruitment for a third Incredible Years parenting group, which will start in the fall. HBHM’s behavior analyst has also completed 58 hours of weekly individual contacts with parents as well. The behavior analyst completed virtual coaching of 10 Head Start teachers including helping to write behavior plans and creating and delivering needed materials to carry out the plans. They spent 32 hours coaching virtually and 2 hours coaching in person as well.
Addressing Systematic Racism: For years, the South Kingstown Housing Authority staff and board have been at odds with their Peace Dale residents. Systemic racism is the root cause of the tension. With the retirement of the executive director and the overall strategic effort to replace board members over time with more progressive leaders, there is finally hope that needed progress can be made to both improve the physical plant (apartment buildings and grounds) and punitive culture of the Housing Authority. The new Housing Authority Board is working on plans for redevelopment of the aging properties.
Although not unexpected and years in the making, Jonnycake Center’s leadership and nurturing of resident leaders has been instrumental in facilitating these needed changes. One of these leaders, Paula Whitford, was the highest vote getter in the last election for South Kingstown School Committee. In fact, she is the first person of color ever elected to the South Kingstown School Committee. The new superintendent is also a person of color. With strong BIPOC leadership in place in the School District, we hope needed changes can be made to increase the academic success of BIPOC students in the district. The Peace Dale Leadership Council will be scheduling meetings with the new superintendent and town manager in coming weeks to discuss challenges and opportunities for Peace Dale residents. Two strong South Kingstown community leaders are members of our Race Equity Team. Additionally, 5 Washington County residents/community are a part of RIDOH’s “Equity and Results” initiative.
West Elmwood: In July 2020 the West Elmwood 02907 HEZ received PDG funds to provide Families Thrive programming through the Genesis Center and Providence Community Library. They also were able to support a Family Navigator, who would eventually assist 26 people by providing systems navigation support, including support in applying to the COVID-19 Relief Fund.
West Warwick: West Warwick Public Schools Implemented a 3-tier trauma-informed high school initiative and trained teachers and staff throughout the school department. Trauma informed care was an important focus of the HEZ. West Warwick is a trauma informed community with trauma informed schools. The HEZ in association with the partner agencies focused on families. Parents were worried how the social isolation caused by the pandemic would affect their children's ability to successfully interact when they re-started school. A Preschool Development Grant (PDG) award was used to bring together partner agencies (School Department, Thrive, and the YMCA) to prepare young children for kindergarten in the fall, through the “Play and Thrive” program.
Family Navigator Services: West Warwick Public Schools, through Preschool Development Grant, employs a Family Navigator. Student, teacher and family feedback and observations suggested that a multi-layered approach to meeting the social and emotional needs of students was necessary. Calm space classrooms provide resources to meet the immediate needs of students experiencing short- and long-term toxic stress. Due to the emergent nature of these needs in response to the Covid-19 Pandemic the HEZ utilized Health Disparities Grant to fund the Calm Spaces initiative at WWPS.
Peer-to-Peer Grandparent Support and Resource Group: West Warwick has the highest rate of foster and kinship care in the state, which led a West Warwick resident and HEZ ambassador to establish the Grands Flourish program to support the experience of grandparents raising grandchildren due to the opioid epidemic and other trauma. Grands Flourish piloted a peer-to-peer grandparent support and resource group at the West Warwick HEZ Hub, and West Bay CAP implemented a part-time case manager solely dedicated to supporting grandparents raising grandchildren in West Warwick. Throughout the reporting year, the West Warwick HEZ continued to support these efforts and others to support families with children impacted by substance use.
Woonsocket: Woonsocket HEZ continued to identify child development, adolescent health, and youth leadership as priority areas. Their goal is that all children will be safe from harm and live in families and neighborhoods that help them to thrive. In pursuit of this goal, they hope to decrease rates of child maltreatment in Woonsocket by 10%. Woonsocket HEZ partners began developing a comprehensive data dashboard that will allow them to track key indicators that measure child wellbeing and ACEs (adverse childhood experiences). They are also developing a strengths-based strategic plan that engages families in implementing culturally relevant and evidence-based best practices to increase the protective factors that minimize the impact of ACEs and that nurture the safe development of Woonsocket’s children.
Youth Family Planning and Sexual Health Education: Woonsocket HEZ’s efforts around adolescent health continued to center on sexual health education and reproductive healthcare access. The HEZ’s goal is to decrease Woonsocket’s teenage birthrate (which is currently the second highest in the state of Rhode Island at 39.5 per 1000 births to teens) by 50% by the year 2025. To achieve this goal, Woonsocket HEZ seeks to ensure that all high school students have access to high quality sexual health education and that all youth have access to free and confidential healthcare. Woonsocket HEZ’s Teen Health Workgroup, in partnership with Thundermist Health Center and the Woonsocket Education Department, employed one Family Planning & Sexual Health Educator who worked fulltime at Woonsocket High School. Because of the ongoing COVID-19 pandemic, resulting in school closures, virtual learning, and a city-wide increase in chronic absenteeism, only 20% of enrolled students were able to complete the sexual health curriculum. However, the students who did not complete the program were re-enrolled in the class for the following semesters, and thus far 69% of them have completed the curriculum. The Family Planning & Sexual Health Educator taught 122 hours of comprehensive and inclusive sexual health content in the fall of 2021.
Improving Youth Healthcare Access: To improve healthcare access, Woonsocket HEZ leveraged its partnership with Thundermist and the Education Department to reopen the Teen Health Hut located inside of Woonsocket High School, which had previously been closed for much of the COVID-19 pandemic. The Teen Health Hut at Woonsocket High School is staffed by pediatricians, nurse practitioners, and other medical professionals who offer pediatric healthcare services including physical exams, immunizations, dental care, testing and treatment for STIs, family planning counseling, and more. All services are available to Woonsocket High School students free of charge, regardless of insurance coverage.
To increase awareness of the healthcare services that are available to teens, Woonsocket HEZ partnered with a local youth-led arts and media organization called RiverzEdge Arts. The youth at RiverzEdge Arts launched a video, print media, and social media campaign to raise awareness about LARC (Long Acting Reversible Contraceptives), Title X reproductive healthcare services, and primary healthcare services. As part of the campaign, they created large scale graphics including one multi-language graphic, one video public service announcement, and social media promotion through content with over 1094 total views.
Increasing Youth Engagement: In addition to the promotion of adolescent health, Woonsocket HEZ and its partners invested in opportunities to enhance youth engagement in the HEZ collaborative. Woonsocket HEZ partnered with a local organization called The WATCH Coalition to develop a youth leadership initiative. They connected with Youth in Action, a Providence based youth leadership organization, to provide trainings on authentic youth engagement work. Over 50% of adult members of the Woonsocket HEZ collaborative participated in the Youth in Action trainings to learn how to engage and uplift youth voice. The WATCH Coalition onboarded 9 Youth Ambassadors who were also trained by Youth in Action to learn more about the connections between identity, leadership, and social justice. The WATCH Coalition also led 14 hours of community organizing trainings for the Youth Ambassadors. The Youth Ambassadors participated in every workgroup and subcommittee of Woonsocket HEZ to provide youth perspectives on a variety of local health issues.
The Youth Ambassadors did the following: 1) co-coordinated a community vigil to honor local victims of violence; 2) co-coordinated and facilitated four political education workshops to teach Woonsocket residents about the different levels of government; 3) initiated and facilitated a series of focus groups about mental health with Woonsocket Middle School students; and 4) created a mental health resource guide for Woonsocket youth. Woonsocket HEZ’s Youth Ambassadors also contributed valuable feedback to Rhode Island Department of Health’s COVID-19 Response Team, Rhode Island Department of Health’s Adolescent Health Program, and Rhode Island Foundation’s Make It Happen Initiative. Additionally, the Woonsocket Youth Ambassadors assembled and donated 50 bags of basic needs items and school supplies to local shelter residents, and 60 bags of COVID-19 PPE (personal protective equipment) and resources to Woonsocket community members.
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