Carrie Meier, Dane County Emergency Management, demonstrates CCR technique

I was recently able to attend a Cardio Cerebral Resuscitation (hands-only CPR) training session hosted by the Dane County Emergency Management agency.  The agency is a recipient of an Office of Rural Health Rural Community Grant.  Their goal is to teach CCR to every citizen of Dane County.  I learned and was practicing the technique in a few minutes, so I think their goal may be possible!  Our Community Grant program is a way for us to support coalitions around the state working on community health projects.  The link above will take you to more information on the program and complete proposals for projects we’ve funded the last few years.  I’ll be announcing the guidelines for the 2009 program later in the spring.

I’ve also learned about Dane County’s EMS and Survivor Banquet, where they recognize cardiac arrest patients and the ambulance crews and dispatchers who were instrumental in their survival.  I understand there are other county and regional agencies who recognize survivors at similar events.  If you’re not doing this, I recommend you implement some type of recognition program.  I think this is a really great way to recognize the efforts of EMTs and first responders, effectively illustrate the importance of EMS and personalize it too.  It seems like it would be a great way for you to involve local media to raise awareness of EMS’ importance to the community.  Dane County’s 2008 banquet is recapped in the online Dane County Emergency Management newsletter.  You can contact Carrie Meier, EMS Specialist with Dane County, if you’d like more information.

It seems that, thankfully, oral health is gaining a higher a profile in both rural and urban settings.  However, it seems to me that mental health is still the poor step child of healthcare.  I think the evidence is widespread, from the unwillingness of insurers to cover mental health at the same levels as primary health care to the reluctance of many people to discuss mental health illnesses.  The lack of mental health care, as with primary and oral health care, is generally a more acute problem in rural communities than cities.  Mental health and substance abuse are health issues that seem to lend themselves to a community coalition approach. 

The Clock is Ticking for Rural America: A Behavioral Health & Safety Conference is “the primary national conference that seeks to increase the understanding of mental health and behavior as it relates to agricultural safety and health.”  The intended audience includes mental health and addiction service providers, agricultural safety and health educators and rural primary care providers.  Some conference topics will include recognizing depression in rural residents and  issues associated with multiple generations working together on the farm.  The conference will be in Sioux Falls, SD August 3-5.  They are accepting proposals for presentations through February 28.

A new resource for health care professionals, including EMS and first responders and health care providers, focuses on the public health challenges of methamphetamine labs.  Helping Communities Combat Clandestine Methamphetamine Laboratories includes reports and guides that provide information on how to identify and respond to methamphetamines, including the signs of addiction and what substances are commonly found in a lab environment.  The two part Toolkit is available for free download. 

A recent article in the Daily Yonder describes a CDC study that found rural counties are catching up to urban areas in drug overdose deaths.  Since 1999, “larger rate increases occurred in states with mostly rural populations.”  In 2004 WI had 5.9 overdoses/100,000 population, placing it in the bottom third of all states.  Using West Virginia as an example, the study authors found the majority of deaths were associated with drugs like Oxycontin and Vicodin, rather than street drugs.

The Medical College of Wisconsin partnered with Mental Health America of Wisconsin and the Wisconsin Department of Health Services to produce The Burden of Suicide in Wisconsin Report which provides detailed information about suicidal behavior, including completed suicides and attempts.  Both state and county level data are available on line.  This is an excellent source of information for grant proposals or policy recommendations in your community.

The Robert Wood Johnson Foundation’s Healthy Kids, Healthy Communities grant program emphasizes projects that target children who are at the highest risk for obesity.  To help achieve its goal of reversing the childhood obesity epidemic by 2015 through healthy eating and active living initiatives, the Foundation is awarding grants to community coalitions.  They’re looking for projects that provide opportunities for physical activity and improve access to affordable healthy foods for children and families.  The application deadline is February 3.

The Foundation created the Active Living Resource Center to assist communities in creating change in their neighborhoods by making them more physically active, bicycle and pedestrian friendly and by helping families live more healthy lifestyles.  They’ve created dozens of resources, including how-to guides and videos to help change your community.  The Healthier Children section focuses on diet and physical activity.

A study presented at an American Heart Association conference in November found that the arteries of obese children looked like those of 45 year olds.  Due to high cholesterol levels, plaque buildup had “aged” the arteries leading to their hearts and brains, increasing the risk of heart attack and stroke and resembling the arteries of adults 30 years older.  The report states that exercise can improve blood vessel function and cholesterol lowering medication can help with plaque buildup.  It’s sobering to think that we may have to begin treating children with cholesterol medication.

The National Association of EMS Physicians will hold their Annual Meeting January 22-24 in Jacksonville, FL.  Speakers will address topics such as advances in provider education, technological equipment and building the EMS team.  A special section will concentrate on various aspects pertaining to the EMS medical director.  Specific presentations include: Challenges in Rural EMS Medical Direction, Patients in Police Custody and Medical Liability.  

The federal Health Resources and Service Administration recently announced an AED grant opportunity, Rural Access to Emergency Devices Grant Program.  They will award funds to purchase AEDs and to provide training in AED usage.  They’re only accepting proposals from community partnerships that include first responders and, as the program name says, only rural communities are eligible to submit proposals.  So, if you’re considering applying, I encourage you to collaborate with other services and maybe make it a county-wide proposal or even multi-county.  The feds (and other funders) really like to see that kind of inter-jurisdictional collaboration.  If you’re even thinking of applying and you’ve never applied for a federal grant before, it’s important to register through grants.gov and request a DUNs number (explained on grants.gov) as soon as possible.  That can take a couple weeks.  And don’t hesitate to call the contact person listed at the Office of Rural Health Policy.  They’re very helpful.  The application deadline is February 4, but don’t put this off if you plan to apply.

I also want to put in a plug for the Rural EMS Listserv.  The Office of Rural Health introduced this service earlier this month.  It will be a great forum to exchange ideas and ask questions of other EMS agencies around the state.  We’ll use it to get out information quickly on funding and other opportunities.  Go to the University of Wisconsin listserv site where you will fill in your email address and name to register.  A password is optional and not required.

Not all grants are the same; different types of grants have different restrictions on what they will fund, who can receive funds and other prerequisites.  The definitions below are general and do not include all types of grants; I’ve included those that you’re most likely to come across or be interested in for your organizations.  Specific grants may differ from these descriptions.  It’s a good idea to make sure you know what type of grant you’re applying for and what type you need, before you write and submit a proposal.  Have a good understanding of the funder’s restrictions and expectations.  If in doubt, contact the funder directly and ask!

Capital Grant: an award that provides funds for construction or equipment purchases.

Challenge Grant: a funder sets fundraising goal for the grantseeker to reach and awards a pre-determined grant if the goal is met.

Cooperative Agreement: financial assistance agreement where sponsor involvement is anticipated.  The funder may assist, guide, coordinate, or participate in project activities.  Many federal grants are now cooperative agreements.

Development Grant: an award to support the planning stages of a future project, including project design, activity planning, data collection and coalition building.  A development grant often subsidizes the production of a subsequent implementation grant request.

Implementation Grant: generally for a specific activity or project; this is the traditional grant.

Matching Grant: awarded with the requirement that the grant must be matched on a one-for-one basis or according to some other formula through contributions or donations to the organization.

Planning Grant: see Development Grant

Operating Grant: an award for the day to day operation of an organization, including personnel, administration, and other regular expenses.

Start-Up Grant or Seed Money: a small grant for the purpose of getting a project off the ground.  The funder generally assumes that the project will be able to attract additional funds following the “seed grant” period.

Unrestricted Grant: award made for any purpose the recipient chooses, including day to day operations and overhead.

As the name of this blog states, my goal is to provide readers with the tools and resources to improve capacity to implement change in rural communities, specifically around health care issues.  My background is in environmental policy and while working with rural communities in upstate New York on water and wastewater projects I saw both the need for resources and information in rural communities and the importance of leaders in those communities to develop plans and get things moving in order to improve their quality of life.  I hope that the information I provide here can help you in some way to achieve these goals.

Creating leaders for community development, to improve community health or for any other reason is difficult.  There are tools and resources out there to help you and others in your community develop the necessary skills.  The federal Office of Rural Health Policy sponsors the Rural Voices Leadership and Policy Workshop.  The program is a leadership development program for future rural health leaders.  Applicants must be a current Office grantee and not have any previous national leadership experience or training.  The application is available through the Rural Reporter and is due January 15.

Two conferences next year will address leadership capacity building.

• The American Hospital Association sponsors the 22^nd annual Rural Health Care Leadership Conference January 18-21 in Phoenix.  The conference is targeted to rural hospital executives and board members, but others should benefit also.  Hospitals are vital to community development, and of course health care, in rural communities.  It’s important that hospital leadership work closely with others in the community to achieve development and health care goals.  Topics will include provider recruitment and retention and financing facility construction.
• The Association for Community Health Improvement will host its annual Spring Training for Health Champions in Los Angeles March 11-13.  The conference will include a variety of sessions including workshops and presentations around four topic tracks:  Leading Community Health Assessments, Achieving Community Benefit Excellence, Improving Health by Addressing Social and Built Environments, and Building the Skills of Community Health Leaders.  You should learn practical strategies and tactics you can use to address health care problems in your community, according to conference organizers.

The Covidien Partnership for Neighborhood Wellness program is accepting proposals for their next grant cycle.  The deadline is December 31.  Proposals aren’t limited to oral health projects, but the guidelines seem to be a very good fit for this type of project.  They’re interested in requests that aim to:

• Increase access to affordable healthcare
• Provide education and awareness – with an emphasis on prevention
• Fund consumer education related to specific diseases or medical conditions

The Children’s Health Alliance of Wisconsin sponsors the Wisconsin Oral Health Coalition.  Their mission is “to create meaningful change to improve oral health and access to care in Wisconsin.”  The Coalition publishes a monthly electronic newsletter, Oral Health eBytes, a resource for news on children’s oral health issues, including funding opportunities.  You can contact Matt Crespin,  Oral Health Project Manager, at (414) 292-4002 for more information.

An article in The Daily Yonder on rural dental care for children describes some alarming statistics.  For example, in many rural areas, dental decay is the number one infectious disease in children and dental pain is the number one excuse for public school absences.  The problem is access to care—there are simply not enough dentists working in rural areas, especially dentists who accept Medicaid or similar state assistance programs.  The article describes several innovative projects around the nation that are attempting to address this problem.

As I’ve written about in other posts and previously on the Rural Community update website, the University of Wisconsin and the Office of Rural Health have a variety of resources to aid EMS agencies, EMTs and First Responders, including training and learning opportunities.  We provide information on funding resources, conferences and reports that can help you and your agency.  Here are a few:

• The UW Medical School’s IME Library (Innovations in Medical Education) has dozens of videos of lectures and presentations you can view online.  The Library has over 15 presentations from the 2007 Emergency Care and Trauma Symposium held at the Kalahari Resort.  Topics include emergency childbirth, prison EMS and spinal cord injuries.
• The Office of Rural Health’s website includes numerous EMS resources.  We have several EMS-related recorded presentations, including a workshop hosted by Nan Turner in July 2008 that includes updates from the State EMS Advisory Board, EMS Medical Director and Trauma Care System.  We also host the Weapons of Mass Destruction Refresher Course.  This online course is approved by the State EMS Office and meets the requirements for the WMD content in the required EMT refresher course(s).  It also meets the requirement for EMT’s seeking reciprocity of their license.
• I regularly post information on grant opportunities and proposal writing resources, such as a recent post on EMS grants.  The Walgreen Community Grant Program awards grants in several health-related categories, including Emergency and Disaster Relief.  More information and the online application is on their website.  They also include this notice on the site: “Local non-profit community organizations requesting auction items, merchandise or gift cards (not exceeding $20) should contact their Walgreen district office directly.”  Don’t overlook this resource when planning fund raising activities.
• The federal Office of Rural Health Policy published a report in October, Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services.   The study focused on hospital based EMS, but among its recommendations was eliminating the 35-mile rule for cost-based reimbursement of EMS services and devoting more resources to training EMS managers.

The Rural Wisconsin Health Cooperative recently released a template for a hospital based “grow your own” Pre-Employee Educational Loan Program.  They’ve produced a sample loan agreement and an example of the policy document needed to manage such a program.

As I mentioned in a post a couple weeks ago on health care workforce, the provider shortage problem is bad and by all indications is going to get worse.  There are a number of programs and policies you can utilize to help your facility and community stay ahead of the problem.  The Coop’s grow your own loan program is one.  Another is the Health Professions Loan Assistance program, which I manage.  There are additional loan assistance programs that cover nurses, physical therapists, pharmacists and other health care providers. 

There are other program options, such as scholarships and re-location incentives, but it appears that loan repayment programs are the most effective method of retaining physicians.  A study from a few years ago on recruitment and retention found that loan repayment program participants remained in their communities longer than scholarship recipients and were generally happier with the community and their work.  You can contact me if you have any questions about loan repayment program options.