Health Progress - Fall 2022

HEALTH PROGRESS

SAINTS

A series of huddle cards depicting the lives of seven saints who represent the core commitments of CHA’s Shared Statement of Identity. Featuring original artwork from Lydia Wood, St. Louis-based artist and activist.

Visit chausa.org/saints to order your cards and accompanying audio files

CARE COLLABORATIONS

HEALTH

FEATURE

63106:

Sally J. Altman,

DEPARTMENTS

EDITOR’S NOTE

TAYLOR

A

A BARRIER

Lezinsky

COMMUNITY BENEFIT

Raising the Bar for Equity and Community Health

TROCCHIO, BSN, MS

FORMATION

Responding to the Signs of the Times: CHA Launches On-Demand Foundations Leadership Program DIARMUID ROONEY, MSPsych, MTS, DSocAdmin

AGING

Creating a New Paradigm for Aging: 10 Proposals and a Story — America’s Aging Future

DORIS GOTTEMOELLER, RSM

MISSION

Engaging Community to Achieve Health Equity DENNIS GONZALES, PhD

ETHICS

Mission Guided by Prudence

BLANTON HIBNER, PhD

THINKING GLOBALLY

Continued Call to Global Solidarity BRUCE COMPTON

POPE FRANCIS

PRAYER SERVICE

Are you truly collaborative? If you spend some time thinking about what it means to collaborate successfully, you know it involves a complex set of skills. Collaboration, at its most basic level, involves working together toward completing a common task or shared goal. At its highest level, when collaboration succeeds, it leads to worthwhile reform, whether a better process at work, a safer living environment or improved health.

It’s not easy; it is rewarding. The thing is, true collaboration is a challenge. It involves more than motivated people signing on to help out with something be cause they’re joiners or achiev ers. Our cover image shows how collaboration involves think ing about who should be at the decision-making table and then changing that table to include the necessary voices that you’re not hearing from. It involves listening and deep thinking about what you’re trying to accomplish. It in volves unifying around reaching a shared end result, and knowing enough about the data, the best practices, the funding, the culture and the personalities involved to stay the course. Whew. Not easy, but worth it.

This issue of Health Progress looks at care and community collaborations both inside and outside of health care settings. Some of the articles detail wonderful collaborations you may not have heard much about. Others may be more familiar but delve further into the specific

processes for what has worked or been a stum bling block to true collaboration. There has long been the thinking that competition lies at the heart of improvement in health care. But sev eral of the authors make a case for collaboration, that teams where people bring their individual strengths and talents can build toward a whole that will make a difference when tackling a prob lem or working for change.

Another lesson from this issue is that good col laboration sometimes requires saying “no.” No, that’s not where our focus should be. No, I don’t think this project uses my particular skills to the best advantage and use of my time. But it leads to the “yes” of where we’re trying to go, and how. Here’s where our priorities are, and here’s why. Here’s the metrics we’re trying to move and how we’re going to get there. Here’s where we need to reach people where we haven’t before, or here’s a service we’re adding to make people’s lives easier. Because all that collaborative work ultimately can lead to new opportunities or improved systems for patients and others we serve. Collaboration can be messy; it can slow things down, but when done well, it can result in real and lasting good.

BETSY TAYLOR

®

VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON EDITOR

BETSY TAYLOR btaylor@chausa.org

MANAGING EDITOR CHARLOTTE KELLEY ckelley@chausa.org

GRAPHIC DESIGNER NORMA KLINGSICK

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OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress.

2022 AWARDS FOR 2021 COVERAGE

Catholic Press Awards: Magazine of the Year — Professional and Special Interest Magazine, Second Place; Best Special Issue, Second Place; Best Layout of Article/Column, Second and Third Place; Best Color Cover, Honorable Mention; Best Guest Column/Commentary, First Place; Best Regular Column — General Commentary, Second Place; Best Regular Column — Pandemic, Second Place; Best Coverage — Pandemic, Second Place; Best Essay, First and Third Place, Honorable Mention; Best Feature Article, First Place and Honorable Mention; Best Reporting on a Special Age Group, Second Place; Best Writing Analysis, Third Place; Best Writing — In-Depth, Third Place.

EDITORIAL ADVISORY COUNCIL

Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore

Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh

Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania

Tracy Neary, regional vice president, mission integration, St. Vincent Healthcare, Billings, Montana

Gabriela Robles, MBA, MAHCM, vice president, community partnerships, Providence St. Joseph Health, Irvine, California

Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana

Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles

Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago

Produced in USA. Health Progress ISSN 0882-1577. Fall 2022 (Vol. 103, No. 4).

Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10.

POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.

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CHA EDITORIAL CONTRIBUTORS

ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA

COMMUNITY BENEFIT: Julie Trocchio, BSN, MS

CONTINUUM OF CARE AND AGING SERVICES: Julie Trocchio, BSN, MS

ETHICS: Nathaniel Blanton Hibner, PhD; Brian Kane, PhD

FINANCE: Loren Chandler, CPA, MBA, FACHE

INTERNATIONAL OUTREACH: Bruce Compton

LEADERSHIP AND MINISTRY DEVELOPMENT: Brian P. Smith, MS, MA, MDiv

LEGAL: Catherine A. Hurley, JD

MINISTRY FORMATION: Diarmuid Rooney, MSPsych, MTS, DSocAdmin

MISSION INTEGRATION: Dennis Gonzales, PhD

THEOLOGY AND SPONSORSHIP: Fr. Charles Bouchard, OP, STD

Bon Secours St. Francis Integrates Students With Disabilities Into Hospital Jobs

ALEX GARVEY, PhD

Chief Sponsorship Officer for Markets and Shared Services at Bon Secours Mercy Health JESSICA WEINGARTNER, MA

Director of Mission at Bon Secours St. Francis Health System

Access to employment that is both meaningful and productive is a key concept of Catholic social teaching. However, there is a recognized gap for young people who have cognitive impairment. While several programs assist this group to transition from school to work, many fall short. Project SEARCH is a school-to-work transition program designed to bridge this gap. It challenges the health care system, school districts and state supportive agencies to join forces to create an arena where human dignity flourishes, communities prosper and the hospital workforce experiences benefits. Participants are provided with the opportunity not just to live life, but to live life in abundance.

Through an effort to bring Project SEARCH to its Greenville, South Carolina, market more than five years ago, Bon Secours St. Francis Health System — through collaboration with community partners — provides an on-the-job hospital train ing program for high school-aged students with disabilities.

HOPE FOR AN UNCERTAIN FUTURE

For a parent of a child who has disabilities, one of their greatest fears is the thought of, “What will happen to my child when I am gone?” This is certainly not an unfounded worry. Young people with disabilities have a more difficult time secur ing employment following high school gradua tion than their peers without disabilities. This is especially true for young adults with autism spec trum disorder and intellectual and developmen tal disabilities. Students on the autism spectrum have some of the lowest employment rates in the years following high school, even among their peers with other types of disabilities.1

In Catholic health care ministry, we are called

to “bring alive the Gospel vision of justice and peace” through a commitment to the principles of Catholic social teaching, including human dig nity, justice and the common good.2 One of the core themes of Catholic social teaching is the dig nity of work and rights of workers. In the Cath olic social tradition, work is not just a means of obtaining the money required to support oneself and one’s family but is a way in which a person achieves fulfillment as a human being.3 One area where the Catholic health care ministry can con tribute to “the dignity of the individual and the demands of justice”4 is through promoting ave nues for meaningful employment for people with disabilities. This allows them new ways to be pro ductive, flourishing and participating in the life of their community.

Each year, between 70,700 and 111,600 teens on the autism spectrum will transition from schoolbased supportive services into adulthood.5 A.J. Drexel Autism Institute’s 2017 National Autism Indicators Report found that only 14% of surveyed adults on the autism spectrum held a paying job

in the community, and 15% worked in sheltered workshops, typically for less pay than commu nity-based jobs. 6 The students with the worst outcomes often have compounding vulnerabili ties in addition to their diagnosis, including lower household income, difficult family situations and a family history of behavioral health conditions.7

The typical model of transition services for stu dents with cognitive limitations involves a com bination of special education classes with either simulated work environments or short-term community employment; however, the simulated work environment fails to help students meaning fully connect learned skills to the context of real, community-based employment.8 Improving poor employment outcomes requires providing ways to connect students with opportunities to have integrated, community-based work experiences, discover their passions and develop employment

skills. One such program, integrated within the hospital setting, provides Catholic health care ministries the opportunity to live out our Gospel calling to promote the dignity and human flour ishing of these young individuals.

In 1996, a program called Project SEARCH was developed at Cincinnati Children’s Hospital Medical Center that would not only enable young adults with autism and other disabilities to suc cessfully transition from school to adult life, but would improve the hospital’s workforce as well. Project SEARCH is a high school-to-work transi tion program for young adults with disabilities, with the goal of achieving competitive employ ment. Competitive employment is understood as part- or full-time employment, integrated within the community (for example, not in a sheltered workplace), with compensation at the same rate as other workers without disabilities. Students

Project SEARCH-Bon Secours St. Francis program interns Marques Hughey, left, and Caitlin Kelly, right, take part in a team-building activity to learn what they have in common with each other.

Bon Secours St. Francis Health System

CARE COLLABORATIONS

involved in the program have varying physi cal, intellectual and developmental disabilities, including autism spectrum disorder, intellectual and developmental disabilities, Down syndrome, hearing and visual impairments, and traumatic brain injury, among others. The program com bines classroom training in employability, inde pendent living and immersive job skills, which empower the students to develop both the hard and soft skills necessary for attaining and main taining competitive employment.

PROJECT SEARCH AT BON SECOURS ST. FRANCIS

Bon Secours St. Francis Health System brought Project SEARCH to the Greenville market in 2016, joining the health system’s other programs in the Richmond and Hampton Roads regions in Virginia. Pope Saint John Paul II reminds us in Laborem Exercens that it is the responsibility of the entire community to “pool their ideas and resources” to achieve a critically important goal “that disabled people may be offered work according to their capa bilities,” for this is demanded by their dignity as persons and as subjects of work.” 9 With that call in mind, Bon Secours St. Francis began to seek out willing community partners. We quickly formed meaningful ministerial relationships with the Greenville County School District and the South Carolina Vocational Rehabilitation Department — which prepares and assists eligible South Car olinians with disabilities to achieve and maintain competitive employment — to introduce this program to our hospital and the Greenville com munity. Both agencies were familiar with the pro gram and delighted to join our health system in this venture. Program participants are either high school seniors or recent graduates from Green ville County School District, and most are or were followed by South Carolina Vocational Reha bilitation Department throughout their school careers. The program is also supported by the South Carolina Department of Disabilities and Special Needs, Able SC and Goodwill Industries. The collaboration between these agencies is the hallmark of the program’s success.

The program’s operating expenses are covered through Bon Secours St. Francis’ mission depart ment budget. It is housed in the hospital where

a workforce coordinator arranges unpaid intern ships. However, after the young people have the needed job skills and are hired, they earn the same pay as their peers. The Greenville County School District provides a full-time special education teacher and a skills coach, and South Carolina Vocational Rehabilitation Department provides a full-time skills coach and ongoing professional counseling as needed. Together, this core team provides immersive on-the-job training for stu dents. Such placement is crucial to train interns to fill essential, high-turnover, entry-level positions within the hospital. Over the course of the school year, the students rotate through three 10-week internships in various departments throughout the hospital, such as linens, central sterile pro cessing, patient transport, endoscopy and food services.

Candidates with potential to succeed in the program are nominated by special education teachers with the school district. Accompanied by a parent or family member, the candidates come to our site to undergo a skills test. The test is not designed to exclude candidates, rather, it is to identify skill sets, create an entry point for placement, and best indicate which candidates will excel in the program. After the selection is completed, the candidates are notified by a let ter sent to their home. One parent of a candidate recalled the excitement of receiving the letter of acceptance by explaining, “When I opened the letter, I felt like I was opening the golden ticket to Willy Wonka’s Chocolate Factory.” The feeling of joy is shared across the community through social media posts, school system announcements and often a letter of praise from elected officials. The success of the program has had an incredible impact on the lives of the students, their families and the community we serve.

This model is successful because it provides not only on-the-job training, but a multitude of

One parent of a candidate recalled the excitement of receiving the letter of acceptance by explaining, “When I opened the letter, I felt like I was opening the golden ticket to Willy Wonka’s Chocolate Factory.”

other tools for success — which go far beyond the necessary physical skills — required to achieve and maintain competitive employment. Through classroom instruction, the students learn inde pendent living skills, how to manage their per sonal finances and essential self-advocacy skills. The graduates can understand and advocate for their rights in the workplace, articulate their skills and limitations, and request appropriate job accommodations. In addition to general and spe cific job skills, the students learn how to navigate the employment process. The students leave the program having created resumes, completed job applications and interviewed for their positions. The internships are not just assigned to each stu dent, but the students must apply and interview for each rotation. As a result, students learn not only marketable job skills, but also how to look for a job, know what types of jobs they are quali fied for, and come away equipped with the tools needed to be a successful employee.

UNDERSTANDING THE HUMAN ELEMENT

Perhaps the greatest impact on interns is to their self-confidence and personal growth. Unfortu nately, many students come from a school envi ronment where they are marginalized at best, and actively bullied at worst. Therefore, often their ability to relate to another is lacking as the trust factor has been fractured. Work, as in life, is really all about developing soft skills, which often is a difficult — yet vital — part of securing their employment. Soft skills are best learned through working in an integrated setting with other hospital employees. This is one key component to provide interns insight into gaining an understanding of workplace culture, helping them not just to keep their jobs, but to thrive in them. The integrated work place experience allows for the development of communication skills, attitudes and professional workplace behaviors that employers desire.10

The following is an example of where God’s love for God’s people shines through the creativ ity of the teaching team. Last year, Liam, an intern on the autism spectrum, was doing an excellent job in the linens department but did not speak to his coworkers. The teachers compiled a list of questions for Liam to ask and set the timer for every 20 minutes on his phone. Liam’s instruc

tions were simple, noted as: When the timer goes off, look at your phone and turn to the person on your right and ask the question. Often, the ques tions were: How was your weekend? What is your favorite football team? Why do you love this job? This simple exercise helped Liam to break out of his shell and become comfortable communicat ing with and relating to his coworkers. Enacting such simple practices in the environment allows the intern to flourish and builds the trust needed for success.

The second component of success is twofold, one in how the interns both develop in a caring work environment and the other in how they change the entire culture of the organization. It is easy to witness how our interns are accepted and integrated with our frontline staff. The presence of the interns throughout the hospital is a hardwired part of the organization. Once the interns are ingrained in their roles, they become part of this team. Often high-reliability, high-function ing departments that welcome an intern express the greatest associate satisfaction scores. They are welcomed in birthday parties, invited to staff lunches and fully integrated with their cowork ers. For many interns, outside of their families, this is the first time they have ever functioned in a highly inclusive culture. Working alongside other hospital employees as equals provides a safe environment to learn and develop the soft skills required to flourish in community-based, inte grated employment.

At first, some leaders found it difficult to envi sion a role for interns within their department. In the past five years, the experience of seeing the interns working and flourishing in their work led to the interns being valued and loved members of the St. Francis team. We now have 25 departments with opportunities to place interns — more than the number of interns we have in a given year — and our staff are disappointed if an intern is not assigned to their department for a rotation.

Another great example of this impact is

The second component of success is twofold, one in how the interns both develop in a caring work environment and the other in how they change the entire culture of the organization.

Justin, an intern on the autism spectrum who was nonverbal for most of his life. Justin had been provided with supportive services throughout his schooling, but interning in the hospital really allowed him to flourish. Thanks to supportive coaching and associates who truly included and valued him as a member of the team, Justin slowly began to allow his voice to be heard. His mother recounted one day at the end of the school year when Justin came home after interning. He told his parents, “Hey guys, I got a job.” It was the first time they had heard his voice in years. Justin’s mother says this is the only time she has ever seen her husband cry.

COMMUNITY AND THE COMMON GOOD

Meaningful ministerial relationships occur when the community’s greatest needs or desires inter sect with the passion of a health care system. The dynamic partnership between Bon Secours St. Francis, Greenville County School District and South Carolina Vocational Rehabilitation Depart ment created media attention, which led to fur ther goodwill and a promise of hope within our community.

The community partnerships that formed to

make this work possible represent the principle of the common good in action. The hallmark of the principle is understanding human beings as essentially social beings and that, in the words of Pope John XXIII, “individual human beings are the foundation, the cause, and the end of every social institution.”11 Striving for the common good unites people of goodwill towards a common pur pose. The common good, says America magazine contributing editor Bill McCormick, SJ, “orders us in reason toward justice, creating social bonds that can be strengthened by charity.”12

The philanthropic community stood with Bon Secours St. Francis in helping to bring the Proj ect SEARCH vision to fruition. The monumen tal success of the program in its first few years led to incredible generosity from businesses and individuals in the community. This gen erosity allowed us to purchase Chromebooks for every intern. In 2021, we expanded the Proj ect SEARCH classroom — thanks to a gener ous donor and our foundation, which secured a $750,000 donation — into an entire training center able to accommodate up to 18 interns at a time. The training center features a classroom with state-of-the-art technological capabilities,

Intern Class of 2023 for the Project SEARCH-Bon Secours St. Francis program in Greenville, South Carolina.

Bon Secours St. Francis Health System

offices for the staff and skills trainers, mock hospital rooms where the students can practice skills before applying them in their internship rotations, and conference space for meetings and interviews.

CONCLUSION

The program is as beneficial to the hospital as it is to the students it serves and allows us to live out our mission. The internships are designed to train the students to fill real, essential support posi tions within the hospital — they are not merely invented for the sake of a diversity job hire, but are important and needed positions. The roles that the graduates often fill are high-repetition, high-turnover, entry-level positions that hospi tals usually have a difficult time recruiting and maintaining with qualified candidates. The part nerships with support services such as vocational rehabilitation — which often continue after the student has graduated and achieved competitive employment — help the student to be success ful in maintaining their job. Therefore, hiring our graduates is incredibly beneficial to the hospital by filling essential roles and reducing turnover.13

The joy which a family experiences in under standing that their loved one works in an environ ment where they are respected, appreciated and allowed to work to the maximum of their poten tial cannot be underestimated. Competitive, integrated employment provides not only essential income and benefits that will support these individuals throughout the continuum of life, but allows their human dignity to flourish through meaningful work and radical inclusion.

ALEX GARVEY is chief sponsorship officer for markets and shared services at Bon Secours Mercy Health. He is also the scholar in residence at Duquesne University Center for Global Health Ethics. JESSICA WEINGARTNER is director of mission for Bon Secours St. Francis Health System in Greenville, South Carolina, and system ethics lead for Bon Secours Mercy Health.

NOTES

1. Paul T. Shattuck, “Postsecondary Education and Employment among Youth with an Autism Spectrum Disorder,” Pediatrics 129, no. 6 (June 2012): 1042-49, http://doi.org/10.1542/peds.2011-2864.

2. “A Shared Statement of Identity for the Catholic Health Ministry,” Catholic Health Association, https:// www.chausa.org/docs/default-source/mission/shared-

statement-flyer_english.pdf?sfvrsn=34ba02f2_4.

3. Pope Francis, Laudato Si’, paragraph 128, https:// www.vatican.va/content/francesco/en/encyclicals/ documents/papa-francesco_20150524_enciclicalaudato-si.html.

4. Pope Benedict XVI, Caritas in Veritate, paragraph 32, https://www.vatican.va/content/benedict-xvi/en/ encyclicals/documents/hf_ben-xvi_enc_20090629_ caritas-in-veritate.html.

5. “Autism Statistics and Facts,” Autism Speaks, https://www.autismspeaks.org/autism-statistics-asd.

6. Anne M. Roux et al., “National Autism Indicators Report: Developmental Disability Services and Out comes in Adulthood,” A.J. Drexel Autism Institute, Drexel University, 2017, https://drexel.edu/~/media/Files/ autismoutcomes/publications/Natl%20Autism%20 Indicators%20Report%202017_Final.ashx; “Subminimum Wage,” U.S. Department of Labor, https:// www.dol.gov/general/topic/wages/subminimumwage.

7. Holly N. Whittenburg et al., “Helping High SchoolAged Military Dependents with Autism Gain Employ ment through Project SEARCH + ASD Supports,” Military Medicine 185, no. 1 (January/February 2020): 663-68, https://doi.org/10.1093/milmed/usz224.

8. Susie Rutkowski, “Project SEARCH: A Demand-Side Model of High School Transition,” Journal of Vocational Rehabilitation 25, no. 2 (November 2006): 85-96.

9. Pope John Paul II, Laborem Exercens, paragraph 22, https://www.vatican.va/content/john-paul-ii/en/ encyclicals/documents/hf_jp-ii_enc_14091981_ laborem-exercens.html.

10. Paul Wehman et al., “Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-Site Randomized Clinical Trial,” Journal of Autism and Developmental Disorders 50, no. 6 (June 2020): 1882-97, https://doi.org/10.1007/ s10803-019-03940-2.

11. Pope John XXIII, Mater et Magistra, paragraph 219, https://www.vatican.va/content/john-xxiii/en/ encyclicals/documents/hf_j-xxiii_enc_15051961_ mater.html.

12. Bill McCormick, SJ, “We Need to Make the Common Good More than Just a Slo gan,” America, February 17, 2022, https:// www.americamagazine.org/faith/2022/02/17/ common-good-arturo-sosa-pope-francis-242385.

13. Bonnie O’Day, “Project SEARCH: Opening Doors to Employment for Young People with Disabilities,” Mathematica, December 30, 2009, https://www. mathematica.org/publications/project-search-openingdoors-to-employment-for-young-people-withdisabilities.

Ethics

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COLLABORATIONS

What Is the Health Care Utility Model, and How Can It Transform Health Care?

A Q&A WITH SSM HEALTH’S LEAD FUTURIST CARTER DREDGE

AUSTIN SCHAFER, MA, BCC Manager for Mission and Pastoral Care with TriHealth

ustin Schafer serves as the manager for Mission and Pastoral Care for the Good Samaritan Hospital region with TriHealth in Cincinnati, Ohio. He’s also a student in Loyola University Chicago’s Health Care Mission Leadership doctoral program. Schafer had Carter Dredge, the senior vice president and lead futurist with SSM Health, as a guest speaker for one of his classes, and wanted to further explore the health care utility model Dredge spoke about there, as his curiosity was piqued about its future applications in the Catholic health care ministry. Dredge advances SSM Health’s research and development, innovation and new venture activities.

A Carter, welcome. First, would you share how you became involved in health care?

I grew up in a four-generation home, sur rounded by people who had a lot of health chal lenges. I had a mother who was paralyzed before I was born. I had a grandfather who was helping take care of my mother and me when I was young. And at the same time, he was also taking care of his mother, who was born in the 1800s. And I just became very passionate about how we take care of one another, particularly individuals who have a lot of health challenges and in many cases oper ate at the margins of society. I work for a Catho lic health care system, SSM Health, which I truly love. I love the mission of the organization, and I’m in the business of alleviating human suffer ing. We’re talking about health care utilities today, because I think they have significant promise to scale the way that we do philanthropic and ministry-oriented work in Catholic health care to an

entirely new level.

Could you describe the basics of what a health care utility is for those who may not have heard about it?

A health care utility is a new type of nonprofit organization that has a social mission to provide essential health care products and services at the lowest sustainable cost possible — in short, it’s a powerful business model for doing good. The term “utility” is a reference to models for other commonly shared basic services like water or electricity. The mission of a health care utility is to make an essential service accessible to every one at the same low cost.1

There are four main aspects that define a health care utility. The first is how it’s structured and governed. Health care utilities are not owned by anyone, but they’re managed by stewards — people who have responsibility to ensure the

services are delivered in the most appropriate way and at the lowest sustainable cost. Second, they’re funded by those stewards/governing members, so they have a customer financing component, and they do so through debt and not equity. That’s really important, because financing is designed to produce low-cost goods and services, not a return in and of itself. So, funding these businesses is a means to getting greater access for essential goods and services. They’re set up to deliver criti cal access and services to the many, particularly those who are vulnerable, and for services that have become very costly.

Third — and this is where it gets its name “util ity” — they provide the services at a transparent and low cost that’s the same for everybody. They provide the services to everyone on equitable terms. It’s not about squeezing out additional profit; it’s about delivering health care at the low est sustainable cost possible so that people can get access to these essential services. And fourth, it’s about the market in which they operate. These entities are not run by the state or a government. Instead, they’re a private enterprise that competes in the marketplace, which means they’re dynamic. And while they are dynamic, they are access maxi mizers, not price maximizers.

Many times when businesses are setting up their marketing strategy, they will ask, “What is the price the market will bear?” That’s not health care utilities. These entities are asking a funda mentally different question: “What is the lowest sustainable cost that I can provide this to the mar ket?” As a result, it actually brings competition to the market.

The most widely known health care utility to date is Civica Rx. Major health systems and phi lanthropists pooled their resources to create a generic drug company that provides drugs used in hospitals for essential inpatient care at a lower cost than those sold by large pharmaceutical companies.

How do health care utilities positively dis rupt the health care marketplace?

This type of collaboration is what we call dis ruptive collaboration. It is collaboration not to maintain the status quo, but collaboration to drive an innovative change. Sometimes, with disruptive innovation, you’re talking about a new technology or a novel way of doing something, like an innova tive technological process. In this case, with dis ruptive collaboration, what we’re doing is we’re bringing innovation to known essential products

Carter Dredge

Photo by GlobalSTL Health Innovation Summit

COLLABORATIONS

by changing the way we work together. The col laboration is a structural innovation, not a tech nological one. So, for example, one of the things that we’re doing is introducing low-cost insulin. It’s not like we have to invent insulin; it’s a prod uct that already exists. However, there are certain elements of the current market that have been keeping insulin at a very high cost even though the medical application of insulin is 100 years old. Insulin is an essential product for people to live, but yet, the drug companies still demand an exces sive — if not extractive — premium to the point where a quarter of Americans who rely on insu lin have to inappropriately ration it.2 The notion behind disruptive collaboration is this: by pulling together the scale of multiple institutions that then make long-term commitments to deliver low-cost services — focused on the needs of the community and the patient — it can positively disrupt the sta tus quo and change health care for the better.

Carter, that’s a major and complex problem in health care — that people can’t afford essen tial medications.

Many times in health care, the reason some thing is expensive is because there’s just a handful of firms that provide it. You could use the term oli gopoly. If there’s less than that, maybe it’s a duo poly. And maybe if there’s just one, it’s a monop oly. In many of these instances, the economies of scale are significant, and no one individual organization, no matter how big they are — even the biggest health care system in the United States — can do it alone. One health system, for instance, doesn’t have the scale to compete with pharma. But if you pull enough of them together, then you have the needed scale. And when you align that scale in a mission-oriented and patient-centric way to create low-cost, high-access services, then you can not only create scale that translates into low cost, you can create scale that translates into low price.

In my doctoral course, you shared that almost all FDA prescription drugs and most health care technological innovations in the U.S. are developed by for-profit entities. And so, if Catholic health care doesn’t increasingly enter this space to compete, I really think the ordinary fabric of U.S. health care is going to become more unaffordable, especially for the poor and vulnerable.

You spoke earlier about turning to the health

care utility model to offer insulin at a lower cost. Civica Rx, as a health care utility, was formed in 2018 by a group of health systems and philan thropies, many Catholic. What are the latest developments with Civica and its impact?

For those not familiar with Civica Rx, it started with a group of 10 organizations: seven health systems — four of which were Catholic health care systems, two other nonprofits and one forprofit health care system — and three philanthro pies. We raised $100 million to create Civica Rx. Nobody owns Civica Rx. It’s financed by health systems and philanthropies, not by external par ties that are trying to create value in the financing itself. With the lower cost medicines that we pro duce, everyone gets the same price. Members of the management team were hired from the phar maceutical industry and the health systems, and members of other organizations also sit on the board of directors.

We now offer more than 60 generic drugs to hospitals and have over 55 health systems as mem bers. We also sell products to the U.S. Depart ment of Veterans Affairs and the Department of Defense. This reach amounts to approximately a third of the total hospital inpatient capacity in the United States.

Additionally, a Civica subsidiary partnering with mission-aligned insurers and other orga nizations — called CivicaScript — is dedicated to lowering the cost of select high-cost generic medicines in the retail setting. It recently recommended that pharmacies charge patients no more than $171 for its first retail medicine used to treat prostate cancer that has spread to other parts of the body. That is about $3,000 per month less than the average cost of this medicine, Abiraterone, for many patients.3

Do you get any political backlash? To me, it sounds like it’s really the best of both worlds — it’s helping the poor and vulnerable, but it’s also something that is competing in the free market.

The great news is that we absolutely have strong bipartisan support for these types of ini tiatives. Once we showed this was working, the federal government got involved as part of a mul tiparty grant — of which Civica was a member — to help build a dedicated pharmaceutical facility in Virginia.4 We will produce essential medica tions at this new manufacturing facility and con tinue to supply both the market and the strate gic national stockpile to ensure that we have an

end-to-end secure pharmacy supply chain pro cess in the United States.

That connects to our Catholic social thought tradition and the fact that health care is a uni versal human right and so critical for promoting human dignity and full human flourishing.

One thing that I’m so passionate about, and just one of the many reasons that I’m so grateful for what CHA does, is that with the innovation of the health care utility model, it comes back to the roots, honestly, of how Catholic health care came to be. There’s a tradition of religious orders for women and others in Catholic health care who have said, “We can’t accomplish what we need to accomplish alone.”

panies to accomplish very specific and focused objectives — with many of these objectives being extremely aligned with those of Catholic health systems. So, while the new health care utilities are not a Catholic entity, they include Catholic entities as founding and governing members, and therefore don’t do anything that would violate the ERDs. These utilities focus on market failures that are hurting people. And that is very aligned with where we need to be: How can we alleviate suffer ing? Catholic health care systems have been great examples of innovation throughout their history because they’ve taken on problems that have not been easily addressable. Taking care of the poor and the vulnerable is an essential thing to do, but that doesn’t mean it’s easy.

Catholic health care systems have been great examples of innovation throughout their history because they’ve taken on problems that have not been easily addressable. Taking care of the poor and the vulnerable is an essential thing to do, but that doesn’t mean it’s easy.

The first hospitals emerged when people realized the need was beyond that of individual groups, and communities came together to basi cally build the institutions we have today. In a sim ilar analogy, we’re realizing that some next-gener ation problems are beyond the scope of the indi vidual institutions of today. We now need to come together again and solve these new and pressing problems. Our communities are counting on us.

That’s an incredible vision because it also connects deeply to the Ethical and Religious Directives for Catholic Health Care Services. The U.S. bishops state that Catholic health care “should distinguish itself by service to and advocacy for those people whose social condi tion puts them at the margins of our society.”

The health care utility model sounds like it does just that as it advocates for the common good, creates greater access to more affordable health care, and focuses on our call to stewardship. How are health care utilities connected with our Catholic mission?

The utility model creates new operating com

Is there a role for mission leaders in this work?

As mission leaders and other leaders in Catholic health care become more deeply aware of how these new business models work, they’re likely to be one of the most in tune groups of lead ers to step back when looking at a problem and to ask, “Is this a utility problem?” This is because they’re already the ones who are per sonally engaging in their respective communities and seeing the problems up close. They will be able to see where the system is lacking coordina tion or scale to adequately solve a problem. They have the potential to catalyze their health minis tries to see the value of this “disruptive collabora tion” mindset and to see opportunities for them to join or create some of these utilities.

What’s the future for health care utilities beyond pharmaceuticals?

We’ve identified over a dozen potential utility applications and think there could be even more; there will be more details as I can talk about them.

At a recent conference that SSM Health hosted in partnership with the University of Cambridge’s Judge Business School in the United Kingdom, we brought together about 30 health care lead ers from numerous countries to talk about new health care utility businesses and what’s next. 5 We’re also working to create a health care utility fund to increase and streamline the production of more health care utilities. This approach has the

potential to reduce human suffer ing and produce innovative nonprofit health care companies that will address some of the most pressing essential access challenges. When I see people engage in this type of utility work, I can see the flame of passion and self less commitment like the collaborative spirit that helped create Catholic health care long ago.

AUSTIN SCHAFER, MA, BCC, is the manager for mission and pastoral care for the Good Samaritan Hospital region at TriHealth in Cincinnati, Ohio. TriHealth is a 50/50 joint operating agreement between CommonSpirit Health and Bethesda, Inc. TriHealth has six hospitals and more than 130 points of care in the Greater Cincinnati region.

NOTES

1. Carter Dredge and Stefan Scholtes, “The Health Care Utility Model: A Novel Approach to Doing Business,” NEJM Catalyst, July 8, 2021, https://catalyst.nejm.org/doi/ full/10.1056/CAT.21.0189.

2. Darby Herkert et al., “Cost-Related Insulin Underuse among Patients with Diabetes,” JAMA Internal Medicine 179, no. 1 (January 2019): 112-14, https://doi.org/ 10.1001/jamainternmed.2018.5008.

3. “CivicaScript Announces Launch of Its First Product, Creating Significant Patient Savings,” Business Wire, Aug. 3, 2022, https://www.businesswire.com/ news/home/20220803005101/en/ CivicaScript%E2%84%A2-AnnouncesLaunch-of-its-First-Product-CreatingSignificant-Patient-Savings.

4. “Civica to Build an Essential Medicines Manufacturing Facility in Virginia,” Business Wire, Jan. 21, 2021, https://www.business wire.com/news/home/20210121005790/ en/Civica-to-Build-an-Essential-MedicinesManufacturing-Facility-in-Virginia.

5. “A New Healthcare Utility Initiative to Develop Not-for-Profit Healthcare Business Models Is Launched by Cambridge Judge Business School and SSM Health,” Univer sity of Cambridge Judge Business School, July 19, 2021, https://www.jbs.cam.ac.uk/ insight/2021/new-healthcare-model/.

Partners in Healing at the Intersection of Medicine and Mission

REX HOFFMAN, MD, MBA, and D.W. DONOVAN, DBe, BCC Chief Medical Officer and Chief Mission Integration Officer, Providence Holy Cross Medical Center

Achief medical officer (CMO) routinely interacts with other members of the senior leadership team, including the chief executive, chief nursing officer and chief financial officer. While these relationships may be expected, there is another member of the senior leadership team that chief medical officers should strongly consider partnering with more fully: the chief mission integration officer (CMIO).

So, what does a chief mission integration offi cer do? The chief mission integration officer is an executive-level leader who brings an exper tise in theology and ethics, coupled with a strong familiarity with health care operations, to ensure that the mission and values of a Catholic health care ministry are fully integrated into the dayto-day operations and strategic direction of the ministry. This work can manifest itself in a num ber of ways, including contributing as a strategic partner, assisting in the navigation of complex ethical issues and advocating for both high-qual ity spiritual care and the needs of the poor and vulnerable.

In our roles as CMO and CMIO, we have developed a close working relationship. By sharing examples of how we have mutually benefited by bringing our skill sets and expe rience together, we hope to invite others in these roles to consider how closer collabora tion could better serve the ministry.

ETHICAL ALLOCATION OF A SCARCE RESOURCE

On May 1, 2020, in the midst of the COVID-19

pandemic, the Food and Drug Administration approved remdesivir for patients under certain conditions through an Emergency Use Authori zation, with the stipulation that it be administered in a hospital or health care setting capable of pro viding acute care comparable to inpatient hospi tal care.1 This was the first pharmaceutical treat ment to receive FDA approval for COVID-19, and shortly thereafter was released in limited supply.2

Two weeks later, on May 14, 2020, Providence Holy Cross Medical Center received its first allo cation of remdesivir. The amount received was enough to treat, at most, four of the 61 COVIDpositive patients being cared for at the time.

Following the recommendations of both the Providence Office of Theology and Ethics and the California Department of Public Health, lead ership at Providence Holy Cross formed a clini cal discernment team to wrestle with questions about the just and ethical allocation of such a scarce resource. Participants included physi cians from palliative care and infectious disease, as well as hospitalists, intensivists and clinicians from infection control, pharmacy, nursing

administration and ethics. Together, as CMO and CMIO, we chaired the discernment team.

The team was aware that unconscious or implicit bias had the potential to cloud our pro cess. Therefore, as a safeguard, we established a set of inclusion and exclusion criteria that was grounded in the medical literature existing at the time, drawn from the initial finding of the remdesivir study,3 and consistent with guidelines provided by the California Department of Public Health.4

The value of the collaborative partnership between the two of us became particularly evident when the team found itself spending a significant amount of time discuss ing issues around quality of life and whether or not this should be a fac tor in determining if a patient would be offered the medication. Through team discussions and literature review, some argued that reduced physical capac ity and the dependence upon others for assis tance with daily activities of living should “count against” a particular patient when assessing their suitability for receiving this medication.

themselves, doctors rely heavily on both advance medical directives and physician orders for lifesustaining treatment. But for a chief medical offi cer in a senior decision-making role, it is critical to understand that there are nuances to these tools that a particular physician may not have been able to fully appreciate.

Combining our skill sets — the medical knowledge and professional credibility of a CMO with the ethical training and moral credibility of a CMIO — we made a persuasive argument that only evidence-based, objectively observed factors should be considered.

This was not merely an academic exercise — a slight drop in a patient’s overall assessment could remove them from consideration for this invalu able medication. Combining our skill sets — the medical knowledge and professional credibil ity of a CMO with the ethical training and moral credibility of a CMIO — we made a persuasive argument that only evidence-based, objectively observed factors should be considered. Ulti mately, our discernment team developed a pro cess that made this treatment available to the most appropriate patients in the fairest possible way.5

ADVANCE MEDICAL DIRECTIVES AND DISCERNMENT

For any provider, ensuring that patients have suf ficient information to make informed decisions dates back to early training in medical school. Medical students absorb lessons by watching more experienced colleagues speak with patients or their surrogate decision-makers.

When talking to a patient, doctors routinely describe potential risks, how treatments may help them and additional options or information they may need when deciding next steps. In cases where patients are no longer able to speak for

Recently, the two of us responded to a medi cal/surgical floor where the nursing staff had alerted us to a concerning situation. A chart had a note from the attending physician that the patient lacked decision-making capacity. There was an advance medical directive that named the patient’s husband as her durable power of attor ney for health care. The consulting surgeon had read the chart and spoken to the husband, receiv ing his consent on behalf of his wife to proceed with the procedure. The patient’s nurse, however, felt strongly that capacity should be reevaluated in light of conversations she had with the patient that morning. However, the consulting surgeon had already left for the operating room and was reluctant to return.

Upon arriving to the floor, the chief medical officer spoke with the patient to get a sense of her capacity while the chief mission integration officer reviewed the advance medical directive. There were several subtle elements that called the validity of it into question, one being that the first page was missing. Also, one of the witnesses on the signature page was the husband (California law does not allow for an advance medical direc tive to be witnessed by the appointed durable power of attorney) and the second witness had the same last name of the husband, which further called the authenticity of the document into ques tion. Finally, the number of pages recorded by the

notary public did not match the number of pages in the advance medical directive, nor did it even come close.

When we were able to speak with the attend ing physician, he admitted to us that he had not personally reviewed the document, nor would he have necessarily noted those inconsistencies. Ultimately, the surgeon did reevaluate the patient and affirmed that she did have decision-making capacity. He thanked the nurse and had a very dif ficult conversation with the husband as to why we might not be moving forward with the procedure. Additionally, we explored in more detail with the patient who she wished to serve as her durable power of attorney in the event she did truly lose decision-making capacity.

While working within the parameters of informed consent is critical to our work, the real ity is that subtle complexities can confound even the most attentive physician. Because this issue is so fundamental to the autonomy and dignity of the patient, the CMIO can be a valuable resource to partner with in this area. Physicians might also consider speaking to their facility’s ethics com mittee or risk management team for advice.

NAVIGATING SENSITIVE OBSTETRICS ISSUES

The birth center of a hospital can be a wonder ful place and can sometimes feel comparatively like the one location where good things happen in a hospital. However, things can — and do — go amiss there, and when they do, the provider is often in need of a listening ear and mutually respectful dialogue.

To provide some consistency in how ethi cal issues are addressed in health care delivery throughout the country, the Ethical and Religious Directives for Catholic Health Care — drawn from the Catholic Church’s theological and moral teachings — cover a wide range of issues, includ ing significant attention to matters at the begin

CARE COLLABORATIONS

ning of life. An important aspect of the chief mis sion integration officer’s job is to ensure that the local ministry acts consistently with the collec tive identity of the ministry within the Catholic tradition, something that relies on true collabora tion with providers.

For example, the directive regarding the Catho lic commitment not to directly take a life through abortion is clearly stated. But what about those times when the clinical situation is such that an indirect termination is required in order to avoid losing the lives of both mother and unborn child?

A typical situation might evolve as follows: It is late at night when a pregnant woman comes to the emergency room due to her membranes rup turing prematurely. She is 18 weeks pregnant and is devastated with the news that she may lose this pregnancy. The medical team has informed her that the onset of infection is nearly inevitable and that it will not only result in the termination of the pregnancy, but will also put her life at substantial risk.

Despite having worked with such cases in the past, and despite caregivers and providers having worked for many years within a Catholic hospital, such cases almost always invite additional con cerns and discussion. Thus, it is quite common for a chief mission integration officer to arrive fairly quickly — despite the late hour — and to gather the providers and nurses together for a conversation.

In this case, the treatment team affirms their understanding that the premature rupture alone is insufficient a reason to initiate termination of the pregnancy. But few may be able to articulate the ethi cal rationale that grounds this course of action. Some may even voice their concern that religious beliefs are interfering with their ability to provide the best possible care.

The chief mission integra tion officer can reassure the treatment team that religious beliefs and medical practice are not incompat ible. The principle of double effect — which rec ognizes that significant harm, even death, can be morally tolerated (but never embraced) when it is the inevitable secondary effect of a primary, intended, proportionally justifiable action — requires that one has a valid and current medical

While working within the parameters of informed consent is critical to our work, the reality is that subtle complexities can confound even the most attentive physician.

reason for initiating an intervention that has such serious consequences.

When speaking directly to the physician, the chief mission integration officer attests that it is neither his intention nor within his scope to ques tion the doctor’s clinical judgment as to when intervention is needed, and only asks that the pro vider acts in good faith, proceeding with a mor ally undesirable intervention only when there are clinical grounds to do so. He goes on to list a few examples such as a rising temperature or rising white blood count and reiterates that this deter mination is medical rather than ethical in nature. Through this communication, the chief mission integration officer subtly invites the physician into a covenant of integrity, working together to honor a princi ple that is held dear in Catholic social teaching.

As a ministry, we trust that our providers are people of integrity who will collaborate to uphold these principles, and we predicate that cov enant on an agreement that the pro vider is the medical expert who will determine when to move forward, addressing the not-sohidden fear that “doctrine” will trump medical judgment. Through this partnership of trust and understanding, a chief mission integration offi cer can help to ensure a good relationship exists between the obstetrics department and hospital administration.

cians, and several members of the medical staff have a long-standing relationship with him as a confidant and sounding board.

Together, the chief medical officer and chief mission integration officer offer two access points for medical staff to reach out to when they need someone to talk to. Although rates of physician burnout have been higher than ever these past few years,6 we are optimistic that our unified approach at Providence Holy Cross likely contributes to our ministry having one of the highest rates of physi cian well-being across all of Providence in a 2020 survey.7

Together, the chief medical officer and chief mission integration officer offer two access points for medical staff to reach out to when they need someone to talk to.

CONCLUSION

By working as true partners, a CMO and CMIO can address some of the most challenging issues faced in health care. At Providence Holy Cross, we have found through pairing our unique — but complimentary — skill sets, we can navigate even the most complex issues faced today.

SUPPORTING MEDICAL TEAMS IN TIMES OF DISTRESS

One of a chief medical officer’s primary responsi bilities is attending to the well-being of the medi cal staff, something that became even more imper ative during the COVID pandemic. One helpful approach is to be accessible to them by offering an open-door policy and encouraging them to reach out at any time. When a CMO meets with a phy sician, it is essential to listen intently and try to assist them in any way possible.

Unfortunately, a CMO is only one person and does not have eyes and ears everywhere, thus may only be aware of a portion of those in need. There is a void that potentially exists at hospitals if the CMO is attending to the medical staff alone.

At Providence Holy Cross, the chief mission integration officer fills this void successfully, even without being asked. Although he is not a medical doctor, over time, he has gained the trust of physi

We have found our collaboration to be invalu able. It is likely that others have found the same to be true. But for those who have not yet capitalized on the potential of this relationship, we suggest that what is true in both medicine and ministry is certainly true in our experience: when people with good intentions join their talents together, the results are not merely additive, but truly transformative.

REX HOFFMAN is chief medical officer of Providence Holy Cross Medical Center in Mission Hills, California. D.W. DONOVAN is chief mission integration officer of Providence Holy Cross Medical Center.

NOTES

1. “Coronavirus (COVID-19) Update: FDA Issues Emer gency Use Authorization for Potential COVID-19 Treat ment,” U.S. Food & Drug Administration, May 1, 2020, https://www.fda.gov/news-events/press-

announcements/coronavirus-covid-19update-fda-issues-emergency-useauthorization-potential-covid-19-treatment.

2. “Important Information About Veklury,” U.S. Department of Health & Human Ser vices, https://aspr.hhs.gov/COVID-19/ Therapeutics/Products/Veklury/Pages/ default.aspx.

3. John H. Beigel et al., “Remdesivir for the Treatment of Covid-19 – Final Report,” The New England Journal of Medicine 383, no. 19 (November 2020): 1813-26, https://www.nejm.org/doi/full/10.1056/ NEJMoa2007764.

4. “California Health and Human Services Remdesivir Distribution Fact Sheet,” Cali fornia Department of Public Health, May 29, 2020, https://www.cdph.ca.gov/Programs/ CID/DCDC/Pages/COVID-19/Remdesivir-

Distribution-Fact-Sheet-.aspx.

5. D.W. Donovan and Rex Hoffman, “Provi dence Holy Cross Outlines Steps for Ethical Distribution of a COVID Medication,” Health Progress 101, no. 4 (Fall 2020): 57-60, https://www.chausa.org/publications/ health-progress/archives/issues/nurses/ providence-holy-cross-outlines-steps-forethical-distribution-of-a-covid-medication.

6. Joy Melnikow, Andrew Padovani, and Marykate Miller, “Frontline Physician Burn out during the COVID-19 Pandemic: National Survey Findings,” BMC Health Services Research 22, no. 1 (March 2022): http:// doi.org/10.1186/s12913-022-07728-6.

7. “Southern California AMA Medical Staff Survey Results — Providence Report,” Provi dence Holy Cross Medical Center, 2020.

QUESTIONS FOR DISCUSSION

Chief Medical Officer Rex Hoffman and Chief Mission Integration Officer D.W. Donovan at Providence Holy Cross Medical Center in Los Angeles describe the importance of partnerships and knowing where one job ends and another begins as the roles relate to challenging medical and ethical decisions in health care environments.

1. If you are in a chief medical officer or chief mission integration officer role, do you make time to talk about how and when you communicate with each other? When more people need to be a part of a conversation, is a good, prompt system in place that allows for that?

2. Does your health care organization have clear guidelines in place to avoid bias in complex decision-making? Is there a clear understanding of foundational standards and the timing and process of decision-making? What can be done to make sure you’re communicating with patients and their loved ones in a way that is empathetic, clear and provides them with the information and support they need?

3. How can senior leaders do a better job making sure other employees understand the responsibilities of chief medical officers and chief mission integration officers and how they can convey questions or concerns to them?

Upcoming Events

from The Catholic Health Association

Virtual Program: Community Benefit 101

Oct. 25 – 27 | 2 – 5 p.m. ET

Diversity & Disparities Networking Zoom Call

Oct. 25 | 1 – 2 p.m. ET

Global Health Networking Zoom Call

Nov. 2 | Noon – 1:30 p.m. ET

Virtual Seminar: Mission Leadership

Nov. 7 and 9 | Noon – 4 p.m. ET

Faith Community Nurse Networking Zoom Call

Nov. 15 | 1 – 2 p.m. ET

United Against Human Trafficking Networking Zoom Call

Nov. 16 | Noon – 1 p.m. ET

chausa.org/calendar

Friendship Houses, New Connections

CHRISTUS HEALTH AND COMMUNITY PARTNERS WORK TO STRENGTHEN NEIGHBORHOODS

NADINE NADAL, MPH, CPH, CHES Director, Community Health Development, CHRISTUS Health

n the Highland neighborhood of Shreveport, Louisiana, 22-year-old Robert Renter leans against a table inside a home called a Friendship House. Part residence and part community center, the Friendship House has come to mean a lot to Renter, who ner vously finds his words to explain to visitors something so sentimental to him: “I am a young Black man in America, and five or six years ago, I wasn’t exactly a model student.”

Today, Renter — who works in Shreveport for a telecommunications company — says, “Life is good.” He smiles as he talks about his girlfriend and a younger brother he says he might spoil too much. Of his mentor at the Friendship House, Diedra Robertson, he says, “Ms. Diedra helped me get here by giving me an after school outlet where I could be with my good friends. Matter of fact, I’m best friends to this day with my friend from here.”

neighbor. Strategically located in high-crime, lowemployment areas, the homes are meant to be a beacon of hope to young people and others.

Strategically located in high-crime, low-employment areas, the homes are meant to be a beacon of hope to young people and others.

Robertson lives in a Friendship House with her husband, and she is a supervisor to a grow ing number of Friendship Houses in the Shreve port-Bossier City area. The eleventh Friendship House is scheduled to open soon. Robertson explains that the goal of the Friendship Houses effort — operated under the nonprofit Commu nity Renewal International — is to mentor, build mutually beneficial relationships and to solve problems internally, street by street, neighbor to

“We’re a place that’s safe, where afterschool programs, adult literacy programs and other community activities are hosted,” says Robert son. “Actually, we held our first community health fair just a few weeks ago. It was a success.” Of the health fair’s 20 community partners in atten dance, two — St. Luke’s Episcopal Medical Min istry and Shreveport Green — were funded by the CHRISTUS Community Impact Fund. The fund — which is the grantmaking arm of CHRIS TUS Health — works to invest in communitybased, long-term, transformative and sustainable

Cultivate Partnerships to Address Social Determinants of Health and Create Thriving Communities

NEIGHBORHOOD AND BUILT ENVIRONMENT

Access to healthy foods

Walkability

Violence and trauma

SOCIAL DETERMINANTS OF HEALTH

SOCIAL AND COMMUNITY CONTEXT

Community participation

Social connection

Racism

HEALTH CARE

Access to health care

Access to primary care

Health literacy

ECONOMIC STABILITY

Food insecurities

Housing instability

Employment

Source: The Department of Health and Human Services

EDUCATION

Early childhood education and development

High school graduation

Higher education completion

strategies that address the underlying causes of poor health and, most importantly, reenvisions the role of a funder into a collaborator. Through these partnerships and other collaborations, CHRISTUS Health is working to transform the health and well-being of its communities.

STRONGER TOGETHER

Although CHRISTUS and its ministries alone can not solve all of society’s problems, the health care system can play a role in convening and collabo rating with other organizations to create innova tive solutions to complex and long-standing local challenges. Each year, CHRISTUS Health, through the Community Impact Fund, provides financial support and capacity-building opportunities to 30-40 grantees across its U.S. ministries within Texas, Louisiana and New Mexico. We respond to the needs voiced in the communities we serve and partner with organizations like Shreveport Green’s Mobile Market, St. Luke’s Episcopal Medical Ministry (see sidebars) and Community Renewal so that we can do more together through collaborative relationships. CHRISTUS’ mission calls us to do this: extend the healing ministry of

Jesus Christ. We strive to achieve this with others beyond the walls and brick-and-mortar of hospi tals, clinics and family health centers.

Working in partnership with community orga nizations is a way the CHRISTUS Community Impact Fund addresses the social needs and social determinants of health of individuals and com munities. The Office of Disease Prevention and Health Promotion of the Department of Health and Human Services groups social determinants of health into five areas: economic stability; edu cational access and quality; health care access and quality; neighborhood and built environment; and social and community context.1

To “revillagize” its communities — or to build relationships and strengthen neighborhoods — one of CHRISTUS’ partners, Community Renewal, seeks to work on strengthening eight aspects of what it means to be a healthy commu nity: mutually enhancing relationships; housing; safe environment; health; education; culture of caring; leadership system (the ability to effectively negotiate and mobilize resources); and meaning ful work. Many of these elements fall under the same pillars of social determinants of health. For

CARE COLLABORATIONS

example, mutually enhancing relationships falls under social and community context and safe environment falls under neighborhood and built environment determinants. Part of this work to restore village-like connections includes a series of activities for each community to tell its history and shape its identity, countering previous soci etal narratives and bringing neighbors together.

Through an investment of $467 million over the last fiscal year to its Community Benefit program and $3 million to its Community Impact Fund, CHRISTUS Health is committed to improving the well-being of its communities. These community

HEALTH DISPARITIES BY ZIP CODE

benefit initiatives include charity care, unreim bursed indigent care and the community services and partnerships the system does as a team — the internal campaign called One CHRISTUS — to address these social determinants of health.

Data from the Louisiana Department of Health’s 2021 Louisiana Health Report Card shows that in Region 7, where Shreveport sits, cancer, heart disease, diabetes and other chronic diseases are drivers of mortality in northwest Louisiana, and that significant racial and ethnic disparities exist with these conditions, resulting in higher mortality rates among historically marginalized

Part of CHRISTUS Health’s process when conducting its Community Health Needs Assessment involves the use of a data visualization platform called Metopio. Through this mapping technology, the tool is able to show health disparities by zip code. During the COVID-19 pandemic, CHRISTUS Health’s Community Impact Fund evolved to apply an equity lens in its process. One of the fund’s equity approaches involved identifying communities of concern — which are zip codes that rank highest within the area deprivation, social vulnerability and hardship index — to help CHRISTUS understand the most under-resourced areas and allocate our investments for greater impact.

individuals. 2 Identified within the 2020-2022 CHRISTUS Shreveport-Bossier Health System’s Community Health Needs Assessment (CHNA), prioritized areas were access to care, child safety and well-being, and disease prevention and man agement. As further revealed in the 2021 Louisi ana Health Report Card, Black Louisiana residents have been disproportionally affected by COVID-19, particularly in the early months of the pandemic.3

MUTUALLY ENHANCING RELATIONSHIPS

Community Renewal International

While the coronavirus might have exacerbated existing health inequalities influenced by zip code and shed more light on national social vulnerabili ties, it has always been on the mind of people like Rev. Mack McCarter. After seminary, McCarter spent 20 years pastoring churches in West Texas before returning to his hometown of Shreve port, where he started Community Renewal, a nonprofit faith-based organization, in 1994. His early work to get people to open their doors and develop relationships resulted in several com munity outreach strategies like the Friendship Houses, Haven Houses and the Renewal Team to transform neighborhoods into safe havens of friendship and support.

SHREVEPORT GREEN MOBILE MARKET

Other community organizations across Shreveport are also partnering with the CHRISTUS Community Impact Fund. A recent example includes the nonprofit Shreveport Green’s Mobile Market, a program that offers nutritional food assistance, cooking education and social gathering opportunities for anyone who needs them. The Mobile Market serves neighborhoods that lack access to healthy foods. It brings fresh fruits and vegetables from more than 20 community gardens to consum ers in these food deserts, offering them at a manageable price and showing them healthy ways to prepare them.

Every three years, CHRISTUS Health gathers qualitative and quantitative data from its Com munity Health Needs Assessment (CHNA) to better understand the communities it serves. In the 2020-2022 CHRISTUS Health ShreveportBossier CHNA, addressing nutrition-related illnesses like obesity, heart disease and Type 2 diabetes was identified as a great need.

According to the U.S. Department of Agricul ture, not only is inaccessibility to healthy fresh food a big problem in Shreveport, but so is its expense and the lack of knowledge in prepar ing it. Through its partnership with Shreveport Green, CHRISTUS Health is addressing food insecurity to sustain healthier lives for Shreveport-Bossier residents.

— REV. MACK McCARTER

The first of Community Renewal’s three pri mary strategies, the Friendship Houses, serve as a bridge to improved change and redevelopment for residents and neighbors who are at highest risk of experiencing isolation, discrimination and other social determinants of health. Community Renewal trains and employs community coordi nators. They and their families move into these homes and live as neighbors — not as 9-to-5 ser vice providers. Through building trust and rela tionships with their neighbors while living in the Community Renewal-owned homes, community coordinators help residents to set and achieve basic goals by facilitating in-house programs like afterschool activities, adult education, family events, service projects and more.

“You can email someone across the world, but you don’t know who’s living and dying five houses from you.”

ST. LUKE’S MOBILE MINISTRY

To avoid ending up in an emergency room or becoming severely ill, CHRISTUS Health’s Shreveport-Bossier CHNA also indicated that residents of northwest Louisiana need easily accessible and affordable health care. Working off its relational model that worked success fully with Community Renewal and the Mobile Market, CHRISTUS Health found a like-minded community partner in St. Luke’s Episcopal Medical Ministry. Using an RV that brings the physician’s office directly into neighborhoods where needed, this team provides an outlet for community members to manage their physical ailments or chronic diseases through preventive health screenings, basic primary care health services, medication refills, health education and medical referrals — all free of charge. The team serves not only those without health insurance — including the community’s homeless population — but also people with coverage who may be experiencing barriers to access due to transportation, system naviga tion difficulties or other issues.

Serving northwest Louisiana’s underserved residents since 2008, St. Luke’s Mobile Medi cal Ministry offers 20-22 clinics each month. Funding comes from individual donors, grants, community organizations and the Episcopal Diocese/churches. Staff consists of a group of registered nurses, nurse practitioners and physicians. By playing a prominent role in preventive care for residents in need, the orga nization is helping to improve the quality of life for the region’s medically underserved while empowering them to make healthier choices.

CARE COLLABORATIONS

Another Community Renewal initiative, Haven House, brings together caring residents who are willing to reach out to their neighbors. Identified as a Haven House by a “We Care” sign in their front yard, Haven House leaders are trained vol unteers who turn strangers into friends on their own neighborhood block. They may host block parties or bring meals to a sick neighbor, find a lost pet, mow someone’s yard or bring their trash bin in from the street.

Connected to the same mission of creat ing stronger communities, another strategy, the Renewal Team, consists of volunteers who build relationships citywide by uniting individuals, faith groups, businesses, civic groups and others as caring partners.

“You can email someone across the world, but you don’t know who’s living and dying five houses from you,” McCarter often explains, taking Jesus’ “Love Thy Neighbor” imperative seriously.

Michael Leonard, a retired Shreveport den tist, spent a few years volunteering for Commu nity Renewal. When he retired from his prac tice, he decided to join the team as a Community Renewal staff member. “Positive relationships put into a system can renew collapsing communities and societies,” says Leonard. Now serving as the organization’s associate coordinator, he further explains, “When communities flourish, it posi tively impacts our health and well-being.”

Community Renewal has been making an impact on communities for more than 25 years, and CHRISTUS Health is proud to partner with the organization to continue its efforts to restore safe and caring communities. Their work is even expanding and getting attention in many other communities across the globe, including coun tries as far as Cameroon, Africa.

MEASURABLE IMPACT

With all partnerships, knowing the impact that endeavors make is key to further refine efforts, and data helps to show what works. The Shreve port Police Department reported a drop in major crime by 70% from 2001 to 2019 and a drop of 61% in total reported crime in the city’s Allendale neighborhood.4 CHRISTUS is developing an out comes tracking system to see what sort of measur able impact we may be experiencing by investing in this work. It includes performance measures and tracks end results as a way to make future decisions and set budgets.

To measure the effects of Community

Photo courtesy of St. Luke’s Episcopal Medical Ministry

Renewal’s work, the Community Impact Fund requires the Results-Based Accountability model to track outcomes at the population and program matic levels. At the programmatic level, the model helps CHRISTUS and its partners understand how many individuals the program serves, how well the program was delivered and how many individuals are better off due to the program’s interventions.

Marlin Blaze sees the qualitative value of Com munity Renewal. As a volunteer neighborhood ambassador for the program, Blaze is dedicated to developing positive relationships in his Allendale neighborhood, an area once plagued with crime and drugs. It is a neighborhood he describes as once brutal and one where he grew up without much support. “I didn’t meet my dad or my dad’s side of the family until I was 30 years old,” he says.

Blaze chose a different path than many of his friends and is building positive relationships in his new role. He’s on the same track of building up others as is his friend and Community Renewal colleague, Pam Morgan.

At 21, Morgan was in an abusive relation ship and turned to drugs, got pregnant and then became a single mom with few options until she found a path through Community Renewal. She recently shared her story of finding sobriety and peace with a group of visitors at her brightly lit and spacious Friendship House in Allendale. It sits across from a series of newly constructed homes built through a partnership with The Fuller Cen ter for Housing. A decade ago, they were dilapi dated eyesore shotgun houses left to wither, and violence was not uncommon in and around them.

This house — which was a homicide scene 25 years ago — is now where Morgan shows love for others by serving up nutritious meals and snacks to dozens of children. She offers to help them study, decompress or talk candidly about any topic a young person might need to discuss. After going through so much, both Morgan and Blaze have discovered that their true superpower is empowering others.

EDUCATIONAL ACCESS AND QUALITY

Just a few blocks from another Friendship House in Shreveport, in a basement classroom of Noel United Methodist Church, there’s a team of coura geous learners at work. Serena Christian might not know it yet, but she’s got superpowers, too. Work ing toward a high school equivalency diploma, she wakes up every morning with a lot on her plate and, in 16 hours, does more hard work than some

one else might do in a week. Yet the 45-year-old mother of seven has found time to take classes to earn her high school credentials at Adult Renewal Academy, a program similar to the relational model that Community Renewal embraces. Two of her daughters recently graduated, and Christian aspires to be next in reaching this goal. “Some days, I want to give up,” she says. “But Ms. Tanj’a calls me and encourages me. She’s more than just a teacher — she’s my reason for fighting so hard to do better.”

Aside from being her teacher at Adult Renewal Academy, Tanj’a Peoples is also Christian’s friend, both having a positive connection with each other.

CONTINUING COMMUNITY CONNECTIONS

In a country full of division and disconnection, is there an answer? We know there are cracks in the foundation of society, fractures that run deep and need fixing. However, Catholic health care and each of us can help weave a stronger fabric in our community through partnering with other organizations.

At CHRISTUS Health, we’re proud of our abil ity to answer a critical challenge related to health care. It is a value we share with our other partner organizations. As best said by Community Renew al’s McCarter, we can rebuild the very foundation of society through a system of relationships. “By connecting and growing caring people, we build a culture that empowers all and excludes none,” he says. “Person by person, block by block, neighbor hood by neighborhood.”

NADINE NADAL is director for Community Health Development at CHRISTUS Health in Irving, Texas. MACK McCARTER is a contributor to this article. He is founder and coordinator of Community Renewal International.

NOTES

1. “Social Determinants of Health,” Office of Dis ease Prevention and Health Promotion, https:// health.gov/healthypeople/priority-areas/ social-determinants-health.

2. “2021 Louisiana Health Report Card,” Louisiana Department of Health, https://ldh.la.gov/assets/oph/ Center-PHI/2021_Health_Report_Card.pdf.

3. “2021 Louisiana Health Report Card,” Louisiana Department of Health.

4. Shreveport Police Department’s Crime Analyst Unit, “Comparison of Reported Offenses within Community Renewal International’s Friendship House Study Areas,” Shreveport Police, November 10, 2021.

Finding God in Daily Life

— Pope Francis’ address to a joint session of U.S. Congress on Capitol Hill in Washington, D.C., on September 24, 2015

“We must move forward together, as one, in a renewed spirit of fraternity and solidarity, cooperating generously for the common good.”

Andrew Medichini/Associated

Health Funder Reflects on Best Grantmaking Practices

CHANNON LUCAS Chief Administrative Officer, Mother Cabrini Health Foundation

The Mother Cabrini Health Foundation — a grantmaking organization dedicated to improving the health and well-being of vulnerable New Yorkers — has awarded $470 million to more than 1,000 organizations and initiatives in its first four years. This was not an easy feat, and the team faced plenty of obstacles along the way. As a brand-new organization with zero infrastructure in 2018, the foundation quickly found itself responding to an unprecedented global health crisis. Amid the challenges and heightened needs of COVID-19, we rapidly focused our mission, built an organizational structure and put into operation ways to quickly respond to residents in need and their communities.

Along the way, we’ve seen constant, stark reminders of the need to fund not just health care providers but also groups working more broadly on changes like increased food and housing secu rity, and how multiple health-related issues need to be addressed to ensure the well-being of under served and low-income populations.

Reflecting on the progress since our founda tion’s inception, which has been marked by sky rocketing health and human services needs across New York, we would like to share key learnings so that other philanthropy and health care leaders can look to our experiences to strengthen their efforts and improve health outcomes for commu nities across the country.

GROUNDED IN OUR MISSION

The foundation originated from the sale of Fidelis Care, a nonprofit health plan insurer started through the leadership of the Catholic Medical Center of Brooklyn and Queens and the Diocese

of Brooklyn and sponsored by the Catholic bish ops of New York State, to increase health care access for the poor.1 The sale to Centene Corpo ration was approved by state regulators in 2018 following rigorous governmental review and extensive public comment. Proceeds from the transaction enabled the formation of the Mother Cabrini Health Foundation, with initial funding of $3.2 billion to provide annual grants in perpetuity to serve state residents in need. We set up opera tions in New York City under the guidance of a board of directors made up of health experts and business leaders.

Early on, we found it essential to ground our organization in a mission and set of values that would guide our work and convey a clear compass for the long-term vision of meeting health needs in the state. Our foundation is guided by Catholic principles as exemplified by the life and work of Mother Frances Cabrini. Some of our core values include a belief in the dignity and value of all peo

ple and preferential care options for the poor and marginalized in society.

Mother Cabrini was an Italian immigrant who traveled to New York City in 1889 without a home. Upon her arrival, she set to work serv ing fellow immigrants by organizing schools, cat echisms and caring for and hous ing orphans. Mother Cabrini dedi cated her life to serving the poor and helping those in need. By the time of her death in 1917, she had opened 67 schools, hospitals and orphanages. In 1946, Pope Pius XII canonized Mother Cabrini, mak ing her the first U.S. citizen to be recognized as a saint.2

Just over a century after her passing, we launched the Mother Cabrini Health Founda tion. Our CEO, Msgr. Gregory Mustaciuolo, and I were its first employees, along with an experi enced executive team. The general path forward was clear: to carry out Mother Cabrini’s legacy of service and dedication to provide for New York’s most vulnerable. We focused on improving the lives of eight target populations: New York’s lowincome individuals and families; older adults; youth and young adults; persons with special needs; immigrants and migrant workers; veter ans; formerly incarcerated individuals; and young children, pregnant women and new moms.

For us, reducing health disparities means not only supporting direct-care services but also addressing the social determinants of health. Communities across New York often lack access to the basic socioeconomic infrastructure that is essential for positive health outcomes, including access to housing, transportation, a living wage, social support systems, access to clinical care, nutritious food and education. The foundation seeks to address these social determinants of health to reduce health disparities and improve health outcomes.

Our pool of grantees has been as diverse as New York itself: large and small, rural and urban, upstate and downstate, and organizations affili ated with all or no religions at all. In 2021, approx imately half of our grants were for $250,000 or more, and for approximately 45% of the 500 grants awarded last year, our foundation is the largest private funder.

To manage this process, each grantee has a con-

tact person from our Programs and Grants team. Staff members conduct site visits, and grantees must submit a project budget as well as interim and final grant reports. Our monitoring pro gram is designed to ensure stewardship of funds, accountability and sound program management.

We now have a staff of nearly 60 employees who also reflect New York’s diversity. Since we have employees who are not Catholic or come from any kind of faith background, it has been important to create a shared understanding and context. To ensure we were true to Catholic principles in our work, we recently provided a six-week course for employees, led by Joseph Capizzi, PhD, a profes sor of Moral Theology/Ethics, and Kurt Martens, JCD, a professor of Canon Law, both at Catholic University of America; and Daniel Frascella, PhD, our current chief Programs and Grants officer. Members of our board also attended. The feed back was positive, resulting in multiple produc tive conversations.

UNDERSTANDING COMMUNITIES’ EVOLVING NEEDS

Another critical lesson we have learned has been the importance of maintaining consistent lines of communication with the people and organiza tions in the communities we serve.

Upon the foundation’s inception, we spent significant time and energy analyzing New York, looking at Medicaid-eligible populations and working with external partners to understand the needs of vulnerable state residents and the organi zations supporting them. As we learned about and built relationships with communities — and even as we hired staff — we established strong path ways for gathering input, feedback and insights. Along the way, as the foundation has grown, so have our community outreach efforts. In January 2021, we hired two community relations directors who bring regional upstate and downstate exper tise to the work of evaluating and prioritizing needs for grant funding, and this year we’ve hired a director of public policy.

For us, reducing health disparities means not only supporting direct-care services but also addressing the social determinants of health.

Today, our community relations team works daily with organizations across the state to ensure we’re staying abreast of local needs and challenges and adapting our grantmak ing accordingly. Furthermore, in July 2022, we brought on our first Chief Evaluation and Learning Officer, Anupa Fabian, to help us bet ter understand community needs, define and measure success of grants, and apply findings to allow us to address the impact of disparities in health for communities.

was lack of resources and capacity. Organizations surveyed also cited challenges related to money, health care, housing and food as some of the great est obstacles to wellness in their communities, and we incorporated that feedback into our yearend grantmaking.

MEETING URGENT NEEDS AS A STARTUP FUNDER

When we first started, we faced a dilemma: How were we to get funding out the door to organiza tions most in need, while continuing to build up our organizational capacity to be a sus tainable presence for our grantees and their communities? This was during a time in the foundation’s development when we did not even have a full in-house grant making team.

We also recognize that we are in a unique posi tion to convene organizations and direct-service providers to facilitate conversations and learning opportunities among them. When we opened our doors in 2018, it was our intention to “hit the road” and really start listening to communities through out New York to understand what the needs were and to identify the key regional players. When the pandemic arrived in March 2020, we quickly shifted these in-person events to virtual commu nity health care conversations, and we have been pleased with the way community leaders and community-based organizations have interacted with us and one another.

We consider it our responsibility to not only support our grantees financially, but also to sys tematically incorporate their feedback on priority needs and challenges as we deliver grants.

Understanding the needs of those you serve is not merely a box to be checked. Rather, it is a constant process. In 2021, the foundation sur veyed hundreds of grantee organizations across New York to gauge the biggest pain points for frontline providers. The survey provided critical insights into the challenges facing our grantees and how those challenges have been exacerbated by the pandemic. For instance, we heard — not surprisingly — that the top obstacles our grantees faced in meeting the needs of their communities

Meanwhile, the pandemic provided a clear opportunity to accelerate grantmak ing. The needs were apparent, as was the work we had to do. Therefore, we oper ated on two tracks: we focused both on getting emergency COVID-19 grants out the door and on building up our internal infrastructure to grow long-term internal capacity.

In the early months of the pandemic when New York was the national epicenter, we responded with approximately $70 million in emergency funding to support nonprofit organizations addressing the health-related needs of New York residents resulting from COVID-19. That meant organizations could purchase personal protec tive equipment for health care and social service workers, supply emergency food to food banks and pantries to meet the growing demand, or provide hazard and/or overtime pay to frontline, direct-service health care workers.

Additionally, by expanding our affiliations with the organizations we support, we are now in a position to help exchange best practices and facilitate coalitions. We hope that by sharing this information, more ways to transform statewide results will be identified.

CREATING LONG-TERM IMPACT

Even as we were crafting grants specifically in response to the evolving public health crisis, we decided it was important to strategize carefully where we could make a sustained impact on vul nerable New Yorkers’ access to health care.

Since 2020, the foundation has sought to do so

We consider it our responsibility to not only support our grantees financially but also to systematically incorporate their feedback on priority needs and challenges as we deliver grants.

with three-year strategic grant programs focused on improving oral health access and outcomes, increasing availability and access to quality health care, and funding programs to provide young children with necessary health and education resources to succeed in underserved communi ties. These strategic grants address health dispari ties with a long-term lens, such as expanding the diversity of the health care workforce pipeline. This is a key unmet need in New York.3

CONCLUSION

We’re proud of the work we’ve done, but follow ing in the footsteps of Mother Cabrini’s legacy is not an easy task. When we started, there was no institutional knowledge or set rules to guide or hold us back. Equipped with only a mandate and a mission, we needed to build up our operations, and we needed to do it quickly.

As a new organization, we still have more to learn as we continuously grapple with critical questions, including:

How can we better listen to our communities to understand their priorities and concerns?

How can we derive deeper insights from statewide data on social determinants of health to help us be the best steward of our resources in service to our mission?

How do we make sense of numerous policy landscape developments and research on the health and social needs of our communities?

How do we decide where to focus our efforts, given the volume and range of needs in the com munities we serve?

In the meantime, we continue to be guided in our work to do what Mother Cabrini did: shine light on and provide aid to those who need it.

CHANNON LUCAS is chief administrative officer of Mother Cabrini Health Foundation. She is also a board member of Philanthropy New York and serves on the advisory board at NYU’s Center for Global Affairs.

NOTES

1. Jonathan Lamantia, “Catholic Church Creates $3.2B Health Foundation From Fidelis Sale,” Crain’s New York Business, May 8, 2018, https://www.crainsnewyork. com/article/20180508/HEALTH_CARE/305089999/ cardinal-timothy-dolan-and-catholic-church-create3-2-billion-health-foundation-from-fidelis-care-sale.

2. “Mother Cabrini Canonized on July 7, 1946,” Missionary Sisters of the Sacred Heart of Jesus, July 7, 2022, https://www.mothercabrini.org/news-andpublications/mother-cabrini-canonized-on-july-7-1946/.

3. “New York State Department of Health Recognizes the Public Health Workforce as Essential to Our Future and Highlights Public Health Workforce Challenges and Dis parities During National Public Health Week,” New York State Department of Health, April 5, 2022, https:// www.health.ny.gov/press/releases/2022/2022-04-05_ public_health_week.htm.

Setting the Table for Success in Global Health Work

The importance of collaboration has always been foundational to Ascension’s health care work. The historic sponsoring organizations of Ascension were founded between 400 and 800 years ago. All have collaboration embedded in either their charisms or in their mission or value statements. So, it is no surprise that when Ascension Global Mission began in 2011 with seed capital from historic sponsors and Ascension, its vision was to “engage in international efforts to improve the health and living status for poor and vulnerable populations in low resource countries through ‘collaborating’ with local and global communities, including sponsoring congregations and other religious communities, to foster long-term, sustainable change.” Collaboration was not just a good idea — it was an expectation.

Ascension’s sponsors also understood that defining what constituted care — and how to sus tain it — was the work of the local population. Ascension Global Mission sought to support the local vision to set priorities and address needs.

True collaboration takes time, patience and resources. It takes time to develop trusted rela tionships with local leaders and partners neces sary to establish the solid foundation to create and ensure systemic change. In an environment that requires measurable outcomes, it takes patience to defer these metrics while continuing to commit the resources required to sustain the building of trusted relationships.

In 2011, Ascension Global Mission began exploring how it might contribute to improving the health of the most vulnerable in Guatemala. The initial years were spent listening, learning and exploring relationships with potential part ners. Our relationships evolved with a group of

faith-based partners — the Daughters of Charity of St. Vincent de Paul, Province of Central Amer ica; the Episcopal Conference of Guatemala’s Pas toral Care for Early Childhood Development; and the Barbara Ford Peacebuilding Center, an orga nization founded by the Sisters of Charity of New York.

These partners critically reflected how tra ditional efforts of development aid create a paternalistic relationship where 1) communities become reliant on the expertise and resources of outsiders; 2) results are often not sustained; and 3) community members are not left with the skills and perspective to address other develop ment issues beyond the principal project objec tive. Through this exploration and dialogue with our partners, we came to understand that sup porting charitable projects for vulnerable com munities had to go “beyond” well-meaning solu tions to have the desired sustainable impact. We

SUSAN HUBER President of Ascension Global Mission and Senior Vice President of Sponsorship for Ascension

set forth to develop a new approach to enable and empower participating communities through self-sustaining collaborative action.

BUILDING A COLLABORATIVE CONCEPT

In 2016, our Guatemalan partners, known as Alianza, set out on a deliberate journey to discover how to most effectively “walk with” and support people living in poverty in order to identify and take action on a range of issues that impacted their health and well-being. Now referred to as “The Method for Collaborative Governance,” this approach has been implemented in 35 com munities, impacting over 26,000 people. Through creating a school for community facilitators — a train-the-trainer concept that builds the capac ity of select community members to foster good governance, plus awareness and interest in inte gral health within their own com munity — this method is poised to be adopted and expanded in other communities globally.

What is the Method for Collaborative Governance?

The Method for Collaborative Gov ernance is a grassroots approach to activate and strengthen commu nity governance, enabling groups to come together, identify priori ties and take action on what matters most to them. This approach focuses on gener ating the conditions for effective collaboration among community, municipal and institutional leaders so they can build and promote processes for sustainable impact.

phases:

Phase One — Establish the Relationship: The facilitator connects with the community leader(s), gains an understanding of the community, shares the concept and approach of working with the community, and ultimately “asks permission” to engage with the community. This requires regu lar meetings between facilitators and a wide range of community leaders to build understanding and trust. It also helps to ensure representation and inclusion of often overlooked silent community voices. Below are some questions that the facil itator should consider asking the community leader(s):

Who should be involved?

Who/what groups are not represented in these discussions?

May we work with you in your efforts?

Through this exploration and dialogue with our partners, we came to understand that supporting charitable projects for vulnerable communities had to go “beyond” well-meaning solutions to have the desired sustainable impact.

Ascension Global Mission, through its Alianza partners, employed community facilitators trained to ask effective questions to stimulate dis cussion and highlight and enable local knowledge and expertise. Community leaders are encouraged to debate, analyze and make decisions. Although a seemingly simple concept, asking the right ques tions at the opportune moment requires listening carefully, understanding context and community dynamics, and framing the question appropriately to ensure community authenticity. It also requires mutual trust.

Phases of Community Work

Implementation of the Method for Collabora tive Governance at the community level has five

Phase Two — Discover Problems: Commu nity leaders share their community’s achieve ments, advances, difficulties and local challenges. What emerges from the following questions forms the basis of an agenda of community issues important to local leaders and their communities:

What challenges impact the community most?

What is already being addressed that could be built upon?

Phase Three — Prioritize and Decide Actions: Community leaders set priorities and plan action, leading their communities to resolve issues locally, without external support, by exam ining additional questions:

What criteria will determine projects to be evaluated?

What is necessary to secure community “buy-in” and mobilize support?

Phase Four — Solve Problems: Community leaders proactively promote and implement their action plan, which includes obtaining and manag ing any external support identified by asking:

What can we do ourselves?

What reputable external organizations can lend support and who has the relationship with the external organization(s)?

How do we ensure that the external organization addresses our expectations versus their desires?

Phase Five — Achieve Self-Sustaining Col laborative Governance: Local communities have established collaborative governance as a norm and function entirely without the facilitator.

In our experience in Guatemala, the role of the Alianza facilitators was to ask the appropriate, probing questions to subtly guide the community and its evolving leadership through the first three phases. They then deliberately began to step away in phase four in preparation for full transition to the community in phase five. It is important to note that this is not a linear process. For example, communities could progress to phase three and recognize that not all voices were at the table (for example, women) or have community leadership roles change, which would require them to step back to the processes in an earlier phase.

RESULTS

Improved Governance

Strengthening community governance is a critical component of supporting people to be agents of their own destiny. It involves leading the improve ments they want to see rather than becoming voiceless recipients of charitable aid and solu tions from well-intentioned international orga nizations. Through our findings, stronger com munity governance prompted the following outcomes:

Increased participation and engagement of women in community leadership forums that helped raise awareness of challenges impacting

CARE COLLABORATIONS

children’s health and generated support for pri oritizing efforts to overcome those issues.

Created regular opportunities for a variety of community leaders to come together to identify and discuss issues. This enabled communities to focus their efforts, mobilize community support and advocate with government agencies for spe cific projects.

Fostered in-depth analysis of the problems that community members identified, which enabled leaders to devise more holistic, creative solutions and lead the implementation of those solutions.

Tangible Community Projects and Initiatives

Working with Alianza, community leaders iden tified and analyzed the most important issues to health and well-being from their perspective and determined actions to take, mobilizing resources within their community and, when needed and possible, through support from external entities. Issues addressed included:

Trash management: Trash is a significant problem in most rural communities as they do not have access to regular trash removal services. Several communities identified this as an issue impacting their community health and mobilized to address it. As a result, clean-up campaigns and community policies to reduce waste were initi ated. Neighboring communities, who also prioritized trash management as a major issue, collaborated to develop a coordinated trash collection system.

Wastewater management: For many communities, wastewater runs in streets and open ditches, eroding the soil, deteri orating streets and causing health hazards. Many rural families use basic pit latrines, which are hard to keep sanitary especially during the rainy season. Solutions to address the prob lem take time and resources. Alianza supported communities to resolve all or part of their drain age systems through connecting them with non governmental organizations and/or government agencies to explore solutions, mobilize resources and implement construction.

Access to health services: Communities identified lack of consistent access to health services as an impediment to physical wellness, particularly for mothers and children. One com munity advocated with local health authorities to reinstate monthly ambulatory services. Another

Strengthening community governance is a critical component of supporting people to be agents of their own destiny.

devised a strategy to pay for essential operating costs. Furthermore, another partnered with local health authorities to coordinate monitoring and care for high-risk children.

LASTING IMPACT OF OUR EFFORTS

Since Ascension Global Mission was founded, just under $3 million has been invested in this journey. Our efforts helped establish a Catholic-led collab orative effort focused on empowering communi ties to lead their own sustainable health improve ments, capable of expanding to more communi ties throughout the country.

This work took time, patience and resources. It was not without its challenges and setbacks. But it achieved what we set out to do: collaborate with others to enable systemic change. The Method for Collaborative Governance builds local lead ers’ competence and capabilities to develop and

execute their community’s development agenda, prioritizing issues that impact health and chil dren. It is designed to build capacity and empower leaders to continue to proactively drive improve ments in their community, beyond the promise of any specific external aid project. As noted earlier, a key component to this method is the school of community facilitators.

Alianza members are working to integrate the learning and approach into their own organiza tions, as well as explore how to engage other com munities. Although still in its infancy, this method is positioned to be adopted and expanded to gen erate positive systemic change for many years.

SUSAN HUBER is president of Ascension Global Mission and senior vice president of Sponsorship for Ascension in St. Louis.

QUESTIONS FOR DISCUSSION

Susan Huber, president of Ascension Global Mission and senior vice president of Sponsorship for Ascension, details the deep thinking that went into creating the Method for Collaborative Governance. Working with partners at Alianza, those working in global health determined the right questions to ask and ways to collaborate to enable local knowledge and expertise in the communities where Ascension works.

1. What aspects of this approach do you already use in your global health response? Does your organization allow you the time and resources to listen and build trust before measuring metrics and focusing on results? Is there a good way to make the case when more time or support is needed?

2. One question highlighted in this article is: May we work with you in your efforts? Take a moment and think about the collaborative approach embedded in that question. How do you ask others in international work to partner with your organization? Have you had occasions where stated needs didn’t integrate well with what the organization anticipated? How did you resolve it?

3. What features of the Method for Collaborative Governance could be used in other community health initiatives your system is engaged in? How might a similar collaborative method be used in communities to address social determinants of health?

The Power of Teamwork: Nonprofit Changes Lives Through Free Surgery Model

ROBIN ROENKER Contributor to Health Progress

At 6:45 a.m. on a recent day at the nonprofit Surgery on Sunday, an energetic team of volunteer nurses and medically certified Spanish-English interpreters buzzed about taking vitals, explaining procedures and ensuring patient consent forms had been completed correctly. Nearby, volunteer surgeons and anesthesiologists changed into scrubs and prepared for the busy morning ahead, which included two hernia repairs and two gall bladder removals, plus one tonsillectomy, one cornea repair and one retina repair.

The scene looked like any other surgery cen ter in America with one key difference: the seven patients waiting their turn in clean, orderly preop bays would not face any out-of-pocket bills for their surgical procedures.

Since its launch in 2005, Lexington, Kentuckybased Surgery on Sunday has performed nearly 6,000 free, medically necessary outpatient opera tions for low-income patients — everything from simple her nia repairs and cataract remov als to more specialized ortho pedic operations.

At its core, the unique care collaboration model behind Surgery on Sunday is simple: providers volunteer their time and services one Sunday each month to perform these procedures at no cost to qualifying patients, using untapped weekend hours at the Lexington Surgery Center, a physi cian-owned facility affiliated with SCA Health.

Lexington multiple times to undergo three sepa rate operations at Surgery on Sunday — two to repair severe cataracts on each of his eyes and one to remove melanoma on his right hand. “My vision was so poor I was running into trees. I couldn’t drive. I couldn’t work. You can’t under stand how hard it was for me not to be able to pro vide for my family.”

“I feel like, honest to God, they have saved my life. My vision was so poor I was running into trees. I couldn’t drive. I couldn’t work.”

— Randall Winford of Lebanon, Tennessee

But for patients, the effect is anything but sim ple — it’s life-changing.

“I feel like, honest to God, they have saved my life,” says Randall Winford of Lebanon, Tennes see, who made the roughly three-hour drive to

Since having his vision restored, Winford has returned to his job remodeling houses — a second chance he does not take for granted. “I’m not an emotional guy,” he says. “But when I was able to return to work that first day, I bawled my eyes out. The people at Surgery on Sunday are the greatest people I’ve ever dealt with. They make everything so comfortable — and they don’t make you feel bad for needing help.”

PROVIDING CARE WHERE IT’S NEEDED

While seven patients underwent operations at Surgery on Sunday one day this past June, on a more typical surgery day, usually held the third Sunday of each month, the care team performs 10 to 15 operations. A standard day’s case load requires between 70 to 80 volunteers, including nurses, anesthesiologists, surgeons, interpreters and intake staff. Most volunteers arrive around 6:15 a.m. and work until all patients are ready to be sent home, usually around 2 p.m.

The program currently has around 275 active clinical volunteers on its roster, among them roughly 50 surgeons — representing every health care system in Lexington as well as those from many surrounding communities — who offer their services on a rotating basis as needed. Vol unteers have donated more than 100,000 hours of service since Surgery on Sunday’s inception. This number grows monthly.1

“When volunteers come in and see that they’re getting a chance to do good, it’s easy to hook them and keep them coming back,” says Dr. Andrew “Andy” Moore II, founder and chair of the board of directors of Surgery on Sunday. “This work gives us all purpose. It energizes me every time I go in.”

“The nurses and the doctors and other volun teers at Surgery on Sunday are about providing care to those who need it,” agrees Dr. Paul Kear ney, the nonprofit’s medical director and a longtime volunteer surgeon. “I personally don’t care about where you come from or if you’re docu mented or not. If you need help, I’m going to help you.”

Currently, roughly 30% of Surgery on Sun day’s patients speak little or no English. While the majority of patients come from Kentucky, in recent years, roughly 30% have come from Ten nessee — an influx stemming from the state’s decision not to expand Medicaid access under the Affordable Care Act,2 while Kentucky did.

Patients who qualify for Surgery on Sunday services make too much to qualify for Medicaid but not enough to pay for expensive health care deductibles. Specifically, Surgery on Sunday works with patients whose household income is below two-and-a-half times the federal poverty level who either have no health insurance or have policies with deductibles that are 10% or more of their total income.

Patients, whether pediatric or adult, are often referred to Surgery on Sunday by a provider at a

SURGERY ON SUNDAY REFERRALS

(FROM 2018-2021)

ABOUT 72%

of patients were from Kentucky, including 30% from Fayette County (where Lexington is located)

ABOUT 26%

of patients came from Tennessee, which did not expand Medicaid

The program also provided free procedures to patients who live in Ohio (6), Virginia (4), West Virginia (3), Indiana (2), and one person each from Alabama, Georgia and Illinois.

free health clinic or local health department. The Surgery on Sunday care team reviews patient care records carefully to ensure each surgery is medically necessary. When needed, volunteers with the agency can help patients locate or secure pertinent medical records — a process that can be challenging for patients who have had limited access to health care and who may not have seen a primary care provider in years.

“I was speaking to the family member of an eastern Tennessee patient recently who said he hadn’t been off their mountain in three years,” says Amanda Ferguson, who served as Surgery on Sunday’s full-time paid executive director for

five years until resigning at the end of June to pur sue other professional interests. “Our patients represent a population that doesn’t routinely access care. They aren’t getting routine screen ings or having annual wellness visits because they don’t have insurance and simply cannot afford it,” Ferguson says.

The brainchild of Moore — a plastic surgeon who practiced primarily at CHI St. Joseph Health until his retirement — the nonprofit’s initial launch was funded through $200,000 in grants from Catholic Health Initiatives and the Sisters of Charity of Nazareth, both of which continue to support the agency. The Surgery on Sunday head quarters, in fact, is housed in office space donated by CHI St. Joseph Health, which is part of Com monSpirit Health.

“We still get grant money from the Sisters of Charity of Nazareth almost on an annual basis, and also St. Joe — through their foundation — continues to support us through various efforts and through sponsoring various events that we do as fundraisers,” Moore says. Two popular annual fundraisers — a local Dancing With the Stars

themed event and a 25-hour fitness marathon — have raised hundreds of thousands of dollars for Surgery on Sunday over the years.

The original idea for Surgery on Sunday stemmed from volunteer work Moore was doing in the early 2000s through St. Joseph’s nonprofit Northside Clinic, no longer operating, which had provided free medical care to economically disad vantaged neighborhoods in Lexington.

“I was on the board of Northside Clinic, and we kept hearing complaints from an ER doctor on the board that there were all these patients need ing surgery with nowhere to go,” Moore says. “I threw my idea [for Surgery on Sunday] out there, and there happened to be others on the Northside board — including a lawyer and a grant writer — who had the skill set to help us get Surgery on Sun day off the ground.”

STRENGTH IN PARTNERSHIPS

Surgery on Sunday operates completely through private grants and donations from corpora tions, religious and secular nonprofits and indi viduals; it receives no government or taxpayer

Surgery on Sunday volunteers remove a submandibular neck mass from a female patient. Shown left to right are Corey Lindsay, SRNA; scrub nurse Rebecca Roberts (reaching over patient); Francesca Spirito, SRNA; otolaryngologist Dr. Tad Hughes; and Daryl Bauer, CRNA. Hughes is a Surgery on Sunday board member.

Photo courtesy of Surgery on Sunday

support. It has just one paid staff position — for its executive director — while everyone else oper ates as a volunteer.

The agency’s operational costs are relatively low, since service hours are donated, and it leases its Sunday usage of the Lexington Surgery Center for just $1 a year. “That way, if anything bad hap pens, it’s on us, not them, because we ‘own’ the building that day,” Moore explains.

Surgery on Sunday has its own Ambulatory Surgery Center license and reports its operational data to the Office of the Inspector General of Ken tucky, just as any other ambulatory surgery center would.

To cover supply costs on surgery days, Surgery on Sunday pays the Lexington Surgery Center an additional flat fee of roughly $350 per patient. It also occasionally receives donated supplies and surgical instruments from surgical supply part ners, many of whom contribute thanks to preex isting professional relationships with Surgery on Sunday surgeons.

Having the partnership of the Lexington Sur gery Center has been key to the agency’s success, Moore says. When other cities have tried to rep

licate Surgery on Sunday’s model, one stumbling block has been the reluctance of area surgery facilities to get on board.

“Louisville had a similar program going for three years, but they were bouncing all over the community to different places because no sur gery center would commit to it, and their program didn’t last,” Moore says.

While securing a surgery facility partner is important, so, too, is getting investment from its staff, Moore adds. “You have to get personnel at the surgery center invested as well, because you have all these volunteers coming in who don’t know the facility, and it’s so helpful to have at least one or two volunteers coming each month who do know the building and know how the usual pro cesses take place there.”

Surgery on Sunday has also forged strong part nerships with area hospital systems, diagnostic offices, labs and physical therapy centers, which routinely provide lab tests, pathology, physi cal therapy and other health services for free or reduced rates. When testing or diagnostics are not available for free, Surgery on Sunday covers these costs. Its patients do not receive a bill for any ser

Nurses in Surgery on Sunday’s Post Anesthesia Care Unit discuss and assign patients coming out of the oper ating room for recovery. From left to right, Babs Ernest, RN; Charmayne Brown, RN; Holly Moore, RN; and Mary Todd, RN.

Photo courtesy of Surgery on Sunday

COLLABORATIONS

vices provided.

“We put on our social worker hat to help patients find the cheapest options for X-rays or MRIs or whatever else they may need presurgery,” Ferguson explains. “We have strong partnerships in place in Lexington, but if we’re dealing with a patient from outside of Lexington who may need services before or after surgery, we’ll call around to advocate for our patients and say, ‘Here’s the deal. Here is who we are and what we’re about. Can you help us help this patient?’”

Relationship-building helps drive Surgery on Sunday’s success, agrees Nancy Johnson, RN, BSN, a trained ICU and transplant team nurse who volunteers as the agency’s clinical coordinator.

“Work like ours has to be a community effort,” Johnson says. “I recently had a patient who needed medical clearance to have general anes thesia, for example, so I called a free clinic who sends us patients frequently and said, ‘Hey, this is Nancy. I need a favor back in return. Could one of your physicians see and clear this patient?’ And they said, ‘Absolutely.’ We’re all willing to work together so we can make sure all these patients get taken care of.”

OVERCOMING OBSTACLES

All Surgery on Sunday patients are seen at their surgeon’s home office for a no-cost preoperative evaluation and for a free postoperative followup — an arrangement that has been a bit tricky at times to navigate from a health administration standpoint.

“Most hospital-based clinics do not have a way to register a patient visit in their systems without a payment mechanism associated with it,” Fergu son explains. “We have so many surgeons who tell us they’d be glad to come volunteer to perform surgeries, but then they face this obstacle from the administrative side,” she adds. Sometimes, sur geons work out the logistics of how to either bill or not bill those visits with their health systems themselves. At other times, Surgery on Sunday leadership has put in calls to health system admin istrators to mutually carve out plans for handling these specialized cases.

Some volunteers also initially wonder about the professional liability implications of work ing with Surgery on Sunday. But because the non profit is a free clinic certified with the Health Resources and Services Administration, federal

law exempts its volunteers from malpractice and personal liability claims.

From a patient perspective, sometimes simply getting to Lexington can be the biggest hurdle. “Transportation is a big stumbling block for our patients,” Johnson says. “Especially as we have more patients coming from out of state on limited incomes. The number one reason we may lose a patient is that they can’t find a ride to get to us.”

To ease this burden for patients, Surgery on Sunday routinely draws on its fundraising pro ceeds to provide gas cards or Uber or Lyft gift cards to help patients make it to their appoint ments. If out-of-town patients need to stay in Lex ington overnight, the nonprofit offers to cover the cost of their hotel accommodations. “We try to be as resourceful as possible,” Johnson says. “The longer we do this, the more tricks we learn.”

Because so many of its patients are now com ing from Tennessee, Surgery on Sunday is trying to start a second location in Knoxville, but the process will take time. “When you’re running one of these programs, everything comes down to building personal connections,” Kearney says. “A lot of it comes down to building bonds in the com munity before you try to launch. You have to find enough people wanting to make it work.”

For those willing to embrace the model, the work is endlessly fulfilling, says Tony Reyes, a cer tified medical interpreter who has volunteered to communicate in Spanish and English with Sur gery on Sunday since its beginnings. “This work changes patients’ lives forever,” says Reyes, who was particularly struck by the successful postsur gery turnaround of a patient who had been facing homelessness when his hernia pain had left him unable to work. “There is so much joy in being part of helping patients in such a profound way.”

ROBIN ROENKER is a freelance writer based in Lexington, Kentucky. She has more than 15 years of experience reporting on health and wellness, higher education and business trends.

NOTES

1. “About Us,” Surgery on Sunday, https://www.surgeryonsunday.org/about-us.

2. Louise Norris, “Tennessee and the ACA’s Medicaid Expansion,” healthinsurance.org, April 18, 2022, https://www.healthinsurance.org/medicaid/ tennessee.

Unlikely Partners Empowering Health Access

ANDREW KRUSE and SUSAN TIPPETT Director, Community Benefit, Ascension Michigan, and Director, Grant Administration, Ascension Michigan Foundation

For those negatively impacted by social determinants of health, overcoming the often complex barriers to meeting their health care and social service-related needs can be extremely challenging, but supportive navigation services can guide them to helpful resources.

Social determinants of health are the conditions in the environments where people live, learn, work and play that affect a wide range of health risks and out comes.1 Spanning areas including health care access and quality, economic stability, poverty, food secu rity, housing, transportation access and safe neigh borhoods, these issues contribute to health inequi ties and disparities and have a significant impact on overall quality of life and well-being.2

The partners involved in emPOWER Genesee work together to enable vulnerable clients to access health, energy and financial services. Initiated by a team of nontraditional, cross-sector partners — Ascension Genesys, Consumers Energy and Hun tington Bank — emPOWER Genesee is a strategic community collaborative launched in 2019 in Gen esee County, Michigan. Designed to mitigate the social determinants of health that adversely influ ence personal health and well-being, the program recognizes that a vulnerable population within Gen esee County has needs spanning all partner organi zations that can be met with coordinated, accessible navigation services.

EMPOWERING CHANGE TOGETHER

To implement emPOWER Genesee, Genesee Health Plan — a nonprofit health care organization that pro vides basic health services to uninsured and under insured residents of Genesee County — was engaged as the anchor organization to build a community navigation model to connect clients with services to address their social determinant of health-related

needs. The collaborative’s partners committed, and continue, to provide project oversight in monthly stakeholder collaboration meetings, support the project with financial and human resources, set data metrics with Genesee Health Plan, and establish a physical presence in the community for service access.

To reach people where they already go for ser vices, emPOWER Genesee placed a Genesee Health Plan community navigator at Consumers Energy’s direct payment center in Flint, Michigan. Consumers Energy is Michigan’s largest energy provider, where a vulnerable population of approximately 10,000 individuals pay their utility bills in person each month with cash. The community navigator actively engages people in the lobby of the payment center so one or more of their needs can be addressed in one stop, in real time.

The community navigator has been well received by Consumers Energy customers who asked ques tions and got information while waiting in line to pay their bills. This led to a steady stream of people mak ing navigation appointments. “By delivering com munity navigation services onsite, we can reduce service access barriers and create an environment that mitigates the impact of the social determinants of health that negatively affect the health of people in our community if not addressed,” says Stephanie Duggan, MD, regional president and chief executive officer of Ascension Michigan’s Mid/North Region.

The emPOWER Genesee community navigator has completed several certification programs that

provide specialized training in connecting people with community assistance programs, services and resources. The community navigator is a certified community health worker through the Michigan Community Health Worker Alliance. The group pro vides training across eight core competencies: public health and health systems; legal and ethical respon sibilities; navigating community resources; commu nication styles and cultural responsiveness; teaching and capacity building; coordination, documenta tion and reporting; healthy lifestyles; and behavioral health, substance use and abuse disorders. The com munity navigator is also a certified application navi gator for the federal Health Insurance Marketplace; a Michigan Medicare/Medicaid Assistance Program counselor; and has specialized training to enroll peo ple in the Michigan Medicaid MI Bridges program.

Even in the face of the coronavirus pandemic, the program safely provided virtual navigation services to Consumers Energy customers. It also expanded its reach through a computer kiosk at the Ascension Medical Group Genesys Downtown Flint Health Center, where patients with social determinant of health needs could access navigation services vir tually and confidentially. The health center serves 2,100 patients annually, the majority of whom are Medicaid-insured and likely to experience chal lenges with social determinants of health.

In the spring of 2022, the Ascension Genesys Downtown Health Center transitioned from virtual to in-person navigation services where patients can now meet with the community navigator immedi ately following their medical appointments. In-per son services at Consumers Energy’s direct payment center have been scheduled to return this fall.

IMPACT ON COMMUNITIES SERVED

Since emPOWER Genesee’s launch in October 2019, the community navigator has engaged with more than 1,300 unique clients, resulting in more than 4,000 service access calls to clients, health care pro viders, energy assistance personnel and commu nity service providers. Of these clients, 945 received direct health care and energy assistance referrals, and 487 received community service referrals.

Overall, the most needed services are housing/ shelter (35%); completion of State Emergency Relief applications (33%) that qualify individuals to receive energy assistance; daily essentials, including food, water and clothing (22%); and mental health, sub stance use treatment and health care (8%). In 2021

alone, 239 State Emergency Relief applications were completed, with 98% of applicants served by the nav igator receiving financial assistance. An emPOWER Genesee client shared about her experience, “Any time I have applied for State Emergency Relief assistance or the Consumers Affordable Resource for Energy Program, I have always been approved or gotten help in some way. I would 100% suggest the emPOWER Genesee Program to any family or friends who are in need of any kind of help.”

The program often assists clients who do not have other resources to turn to for help, whether assisting a mother of six to restore her power and lower her monthly utility bills, to helping a recently released inmate enroll in Medicaid and food benefit coverage and obtain a free government-assisted mobile phone.

CONCLUSION

As a result of their collaboration, Ascension Gene sys Hospital, Consumers Energy and Huntington Bank received Genesee Health Plan’s 2021 Health Care Hall of Fame Community Partnership award for working with the health plan to ensure mem bers receive quality, affordable health care. Genesee Health Plan President and CEO Jim Milanowski said, “This innovative approach is an excellent example of how public and private organizations are working together to meet people where they are with their health care, utility and financial needs.”

Program representatives were also invited to the 2021 Root Cause Coalition’s Annual National Sum mit to present emPOWER Genesee as a best prac tice model to address social determinants of health, and as an example of how public and private organi zations are working together to meet people where they are to navigate complex systems to access essential services.

ANDREW KRUSE is director of community benefit for Ascension Michigan in Grand Blanc, Michigan. SUSAN TIPPETT is director of grant administration for Ascension Michigan Foundation.

NOTES

1. “Social Determinants of Health: Know What Affects Health,” Centers for Disease Control and Prevention, https://www.cdc.gov/socialdeterminants/index.htm.

2. “Social Determinants of Health,” U.S. Department of Health and Human Services, https://health.gov/ healthypeople/priority-areas/social-determinants-health.

Illustration by Jon Lezinsky

63106

NOT JUST A NUMBER, BUT A BARRIER TO HEALTH AND ECONOMIC EQUITY

SALLY J. ALTMAN, MPH HEALTH CARE CONSULTANT AND JOURNALIST

For many of us, returning to our normal pre-COVID-19 lives is not yet a reality. This is especially true for the most vulnerable among us nationwide, as the pandemic has fallen heaviest on minority and marginalized communities. Although COVID hospitalizations and deaths have diminished and the unemployment rate has fallen, inflation and interest rates are soaring for the first time in decades. Furthermore, affordable housing is now in shorter supply.

Residents in St. Louis’ 63106 zip code have felt the impact. It is the sector just northwest of downtown that has long had the most problematic social determi nants of health in the metropolitan area. Notably, average life expectancy there is 67, compared to 85 in 63105 in suburban Clayton, the St. Louis County seat, and one of the region’s wealthiest communities.

In previous issues of Health Progress, readers were introduced to stories from residents of 63106. This final installment of this publication’s 63106 series highlights how families continue to cope with the challenges of staying safe and healthy — physically and mentally — during the pandemic.1

One of these accounts featured Misha Marshall, a 39-year-old registered medi cal assistant and mother of two who also serves as a caregiver for her elderly parents and her 37-year-old sister who has cerebral palsy. Marshall aspires to earn a master’s degree in nursing and to become an RN — a step forward that could roughly double her income. However, her path to getting there has not been easy. Her experience is just one of many shared by other residents that shines a light on how the nation’s patchwork support systems toggle between encouraging and discouraging well-intentioned citizens. Their stories — and those of many others yet untold — point out how efforts toward advancement of racial equity in the region and nationwide is multifaceted, ongoing work in need of systemic reforms.

OVERCOMING NURSING EDUCATION CHALLENGES

St. Louis, the state of Missouri and the nation need more people like Marshall. Vacancies for registered nurses in the St. Louis area increased from 11.2% in 2020 to 20.3% in 2021, according to the Missouri Hospital Association.2, 3 Overall, Mis souri hospitals reported a staff nurse vacancy rate running at 19.8% — an increase from 12% in 2021.4 At that time, Missouri had 33,692 nurses working in hospitals and 8,334 vacant staff nurse positions, according to the data. As the pandemic took its course, nurses suffering from burnout began leav ing the profession, taking early retirement and re fusing requests to work overtime.

While there are plenty of positions now avail able, the pipeline is clogged. Nursing schools turned away nearly 1,300 qualified applicants in 2020, in part due to a shortage of teachers.5

It would be hard to find anyone more qualified than Marshall to join the ranks. She has worked in clinical settings across the region for more than a decade. Her caregiving has gone beyond patients at work, her family and in one case, a complete stranger.

And for that, she paid a steep price.

On a blizzardy evening in 2019, Marshall, to be safe, hired an Uber to take her from her home near downtown St. Louis to the hospital in the suburbs where she worked.

Not far from the hospital, traffic slowed to a crawl, then stopped. Marshall could see that a driver just ahead had gotten stuck in a snowbank. The driver needed a push. Marshall leaped out of the Uber and made her way to the other car, tapped on the window and told the elderly woman at the wheel she would try to help.

Unfortunately, Marshall slipped on the ice, and immediately knew she had broken her leg. The Uber driver drove her to the hospital, where X-rays confirmed that she had suffered a break in two places in her leg, along with a dislocated ankle.

“From that one night, I was out of work for five months,” she recalls. “I was supposed to be living my best life. And here I am, lying in the street with ice and thinking, ‘Don’t help nobody no more.’”

Her remark made out of frustration, Marshall, of course, wanted to keep helping people by con tinuing her education to pursue a nursing degree. But then a series of adversities followed. At the time of her fall, she had enrolled in the nursing program at St. Louis Community College. She asked to take a medical leave, which she said had been approved by a school administrator. But then her paperwork got lost. When she reapplied, her request was rejected. Subsequent appeals didn’t yield results.

After recovering, Marshall returned to work as a pediatric registered medical assistant at Affinia Healthcare, a clinic not far from her home. But then came more misfortune. Marshall’s 75-yearold mother took a fall at home and had to be rushed to the hospital, where she would remain for several weeks. She would be readmitted three more times after suffering further setbacks.

With all that to handle, along with continuing to care for her sister and father, who also was be coming increasingly infirm, Marshall decided to leave her job with Affinia. Her plans to continue her education would also have to wait.

Ever resourceful, Marshall returned to a small dessert business she started in 2016 to stay finan cially afloat. Then, finally some good fortune ar rived: a friend referred Marshall to Square, the financial services and digital payment company that had recently relocated a few blocks from her home. She was hired and promoted to payroll spe cialist.

“The company has a structure that supports people who need to be caregivers to loved ones, which really helped,” Marshall says. “They never gave me the feeling that I would have to choose between my family and my job.”

Even so, Marshall hasn’t given up on her dream

“The company has a structure that supports people who need to be caregivers to loved ones, which really helped. They never gave me the feeling that I would have to choose between my family and my job.”

— MISHA MARSHALL

In May 2020, Steven Jones was living in St. Louis, but unemployed and struggling with epilepsy near the start of the pandemic. Since then, he has found a path to better health and employment, but his work is in Columbus, Ohio. He hopes to return to St. Louis, where three of his daughters continue to live with their mother.

to earn her nursing degree and has found an ally in her quest: Mimi Hirshberg.

Hirshberg recently retired as a faculty mem ber at the College of Nursing at the University of Missouri–St. Louis, where she was well-known as a mentor for disadvantaged applicants and stu dents, whether providing some preparation for standardized tests, reviewing concepts from texts or negotiating with health care bureaucracies.

After learning about Marshall’s situation, Hirshberg placed her with an academic advisor at the university to discuss academic possibili ties. Hirshberg believes Marshall can find a path toward fulfilling her dream. “I just want to help her get through all the stages. I think with her ex perience and intelligence, she could pretty much breeze through (to getting a master’s in nursing). It’s just a matter of finding the best program.”

This past July, Hirshberg noticed that BJC HealthCare in St. Louis announced that it would offer full-tuition scholarships to nursing students at Goldfarb School of Nursing at Barnes-Jewish College who would agree to work for the health system for three years after graduation.6 She men tioned to Marshall that perhaps she could qualify.

“I am going to be in school — whatever I have

to do,” Marshall said. “If that means selling cup cakes, cookies or cake pops, that’s what I’m going to do.”

Although her dream may be deferred for now, Marshall says it will not be denied.

A PATHWAY TO QUALITY HEALTH CARE

As with Marshall, a personally improving eco nomic picture in the latter part of 2021 and first half of 2022 benefitted Steven Jones, another 63106 resident previously featured in Health Progress. He has found work that is fulfilling, interesting and comes with benefits.

But it came at a cost. Jones is now living in Ohio, hundreds of miles from his daughters.

When Jones’ plight was first shared in Health Progress in fall 2020, he was living in a two-bed room apartment in Preservation Square, a subsi dized housing complex just a mile from down town St. Louis. He had been laid off from his job as a garage custodian downtown due to the pan demic.

Jones’ epilepsy disorder prevented him from driving, so his employment options were limited. In the meantime, he was finding it difficult to ac cess and navigate health care through Missouri’s

Photo by Wiley Price Jr./ The St. Louis American

Medicaid program. Two clinics were within a manageable commute for Jones, but they were of ten crowded with people seeking appointments and COVID testing.

But at least while living in St. Louis, Jones regu larly saw three of his daughters, who lived nearby with their mom. A fourth daughter, his eldest, lived with her mother in Charlotte, North Caro lina, but would visit on occasion.

To save money, Jones decided to move to Co lumbus, Ohio, in December 2020 to live with his mother. It was then that his luck began to change health and employment-wise.

Under a physician’s care in Ohio, Jones’ sei zures abated. Increasingly he was able to sense when a convulsion was coming and take mea sures to mitigate its impact, helping him to gain more control of his life. He was then able to find

work as a part-time custodian and moved into a place of his own in July 2021. Soon afterwards, he applied for a position as a customer service rep resentative with Spectrum, an internet and cable TV provider, and was hired in April 2022, making $20 an hour and receiving a host of benefits. Liv ing with epilepsy presents distinct disadvantages, but in this instance, Jones’ condition provided a hiring incentive: the federal government provides tax credits to businesses that hire people with disabilities under the Work Opportunity Tax Credit program.7

Today, Jones sounds buoyant about his pros pects. With the new job and improved health care coverage through his employer, it was as if he had found a GPS to guide him through the thicket of government regulations that had stumped him previously.

Also in his favor is an economy that — at least for the time being — has put workers in his field in high demand. It’s not lost on Jones that his em ployer is also looking for customer service reps in St. Louis. “In 90 days, if my metrics are good with my current position, I can ask for a move,” he says.

Before Ferguson Beyond Ferguson, a non profit racial equity storytelling project, has been shining a light on the lives of people in the 63106 zip code as they deal with the daily impact of the pandemic.

St. Louis media outlets agreed to collabo rate with Before Ferguson Beyond Ferguson and carry stories in serial fashion — a new episode every few months. Eight families have been covered with one or more installments. The project thanks its funders listed on its web page, including significant support from the Pulitzer Center.

The stories can be found at https://before fergusonbeyondferguson.org/63106-project/.

“Now I’d like to talk to a lawyer to see if I can get a driver’s license. Then, I can move on my own. I will have a stable income and a good work history when I come back to St. Louis.”

PURSUIT FOR A SAFE FOUNDATION

Just as Jones was finding a path to a brighter fu ture, one of his former neighbors, Kim Daniel, found herself on the brink of homelessness.

At the time Jones departed his apartment in Preservation Square, violent crime was becom ing an increasing problem in his neighborhood. It weighed even more on Daniel, who lived alone in a second-floor unit. In the spring of 2020, a neighbor’s boyfriend fired shots that penetrated the wall of her apartment, an account she shared previously in Health Progress . Last summer, a

Today, Steven Jones sounds buoyant about his prospects. With the new job and improved health care coverage through his employer, it was as if he had found a GPS to guide him through the thicket of government regulations that had stumped him previously.

youth she had mentored was murdered in a driveby shooting down the street. She could see the makeshift memorial friends and family placed at the spot from her balcony.

Daniel became increasingly des perate to find a way out.

Her hopes rested on a slender reed. More than a decade ago, Daniel had applied for a Section 8 voucher that would provide a subsidy to cover three quarters of her rent, along with allowing her to find a unit in another part of town.

The Section 8 system, established in 1978 by Congress and administered by the U.S. Department of Housing and Urban Development (HUD), has been chronically underfunded. 8 So it was no surprise that Daniel had to wait so long in the queue. “I got to the point where I didn’t think it ever was going to happen,” she recalls.

complex located near the Lafayette Square neigh borhood just south of downtown, the apartment within walking distance to a park, restaurants and most importantly, a full-service gro cery with fresh food.

Listen to CHA’s previous podcast about the 63106 project.

Dick Weiss, the project’s co-founder, joins resident Kim Daniel who discusses the challenges she and her neighbors face in their community.

But last summer, the St. Louis Housing Authority notified her that her wait was over and issued her a voucher. Weeks later, she located a lovely two-bedroom unit in a

But at the end of that autumn, just 10 days ahead of her move-in date, Daniel collapsed with blood clots in her abdomen, legs and upper left ventricle — essentially a stroke. She would spend the next two months in the hospital and a rehabilitation fa cility and could no longer get around without a walker or a wheelchair. She now needed an accessible apartment.

The complex near Lafayette Square had such a unit and agreed to put it on hold for Daniel until she was released from a rehab facility. But the unit was more expensive, and the Housing Au thority and HUD would need to ap prove a larger subsidy.

Initially, her request was denied. The Housing Authority told Daniel her situation no longer fit the government’s for mula for Section 8 support. Daniel’s sister, Kenvee

Kim Daniel details how she wants to decorate her new St. Louis apartment on Feb. 17, 2022. After years of waiting for Section 8 assistance, she finally moved into a residence in a safer neighborhood.

Photo by Brian Munoz/St. Louis Public Radio

Daniel, was in disbelief.

To help her sister return to health and crusade for her increased housing benefit, Kenvee took an unpaid leave of absence from her job in Hawaii. The two moved to a wheelchair-accessible hotel room (at nearly $100 a night) in St. Louis County as Kenvee mounted a full-court press in support of her sister.

On a near daily basis, she sent polite but de manding emails to the Housing Authority and HUD to grant Daniel a larger housing voucher to cover the rent at the Lafayette Square complex. She also got in touch with Niya Foster, a fair hous ing specialist with the Metropolitan St. Louis Equal Housing and Opportunity Council. Foster pointed out to the Housing Authority that its own rules allowed for a “reasonable accommodation

request” that would permit the agency to relax its payment standards.

Daniel’s situation soon caught media atten tion, and her story was shared on St. Louis Public Radio in February.9 Later that day, a representa tive from the Housing Authority told Daniel that the path had been cleared for her to move into the Lafayette Square complex. Three days later, she signed a lease, and, with assistance from her family, she moved into her handicapped-acces sible unit the following day. For the first time in three-and-a-half months, she had a place to call home.

Not lost on Daniel nor those involved in help ing her were all the extraordinary measures and people it took to find housing for a deserving, re sourceful citizen with health issues. “I would have

POVERTY’S COMPLEX WEB CAN HARM HEALTH

I

n 2020, residents in St. Louis’ 63106 zip code had a median household income of $21,000,1 with many strug gling to make ends meet and often having to choose whether to pay rent, buy groceries or keep up with needed medications.

Jason Purnell, PhD, MPH, vice president of community health improvement for BJC HealthCare, cited a study demonstrating the dif ference in life expectancy between the top 1% of income earners and the bottom 1% is 15 years for men and 10 years for women.2

“There is no question that people with lower incomes in underresourced communities continue to face health care access issues,” Pur nell says, “but factors like unemploy ment or underemployment, housing, food and financial insecurity, lack of reliable transportation and fewer years of education all make it more likely that individuals are in poor health by the time they are seen for clinical care.”

The families portrayed here have struggled over generations to build wealth, and in many cases, it has

affected their health. Misha Mar shall’s family is the only one featured that has managed to qualify for a mortgage and purchase a home. Even so, Marshall has had to work multiple jobs following high school to help her family manage.

The other families are renters with most depending on federal aid to make the rent. Their neigh borhoods are, or were, unsafe, and most do not have easy access to fresh food. Even finding an afford able place to live is challenging. One recent housing study for St. Louis found that for every 10 people with annual incomes below $20,000 who were looking for an apartment, there were only five affordable and avail able units.3

“Housing is critical to health,” says Cristina Garmendia, author of the study and principal at URBNRX, which advises governments on using data to inform policymaking.

Garmendia says her study — called the St. Louis Affordable Hous ing Report Card — found dozens of issues that get in the way of lowerincome residents seeking a safe place

to live. For instance: Builders have few incentives to construct affordable housing in the suburbs, where there are already plenty of people who are able to pay higher rates.

Landlords who have lowercost apartments are reluctant to participate in government programs because they are required to be vigi lant in keeping their units up to code.

Cookie-cutter solutions won’t work in St. Louis city and county, which is made up of 92 jurisdictions, plus unincorporated areas.

How does housing impact health?

If a roof leaks, water can seep into the walls and mold can result. Inhaling mold spores can spur allergic reac tions and cause asthma attacks.4

These issues are especially harmful to children, who are susceptible not only to allergies but lead poisoning from paint in older buildings and air pol lutants from nearby industrial areas.

“These cause lifelong impairments,” says Garmendia.

But if a resident reports the prob lem and the landlord fails to address

been lost in the system without them,” she says.

ENABLING POSITIVE CHANGE FOR STRUGGLING YOUTH

When the FDA approved use of the first COVID vaccine in December 2020, 10 many Americans greeted the news with joy and relief. However, for Beverly Jones — and many other residents in 63106 — this development did not bring a sense of comfort. Many Blacks do not trust the health care system and were skeptical that a safe and effective vaccine could be developed so quickly.11

Jones had contracted the illness a few months earlier and battled it for two weeks at home. She was perhaps lucky to have survived it, given that she suffers from lupus, fibromyalgia, osteoarthri tis and chronic obstructive pulmonary disease.

Even after all she endured from COVID, she

told a reporter, “I ain’t in no big hurry to get it,” when the vaccine became widely available.12

Since then, Jones, 59, has been vaccinated and boosted. She is not one bit happy about it, but the St. Louis Job Corps Center — a residential educa tion and job training program for youth and young adults where she works as an adviser — had made COVID vaccinations a requirement. Jones never wanted to lose her connection to the center’s young people, so she complied.

“It was either get the shot or I can’t work,” she says. “That’s the way the world works sometimes. We’re being forced to do things we don’t want to do.”

Later, the federal courts would step in and is sue a block against the vaccine mandate for federal workers,13 so Jones could stop taking the shots. But

RESOURCES

For more information on the impact of housing on community health, see further resources below:

Centers for Disease Control and Prevention Community Guide: Compiled by the Community Preventive Services Task Force, this guide lists education and housing-related interventions like quality early childhood education, high school completion programs and housing vouchers in its review of health equity research literature. https://www.thecommunityguide.org/sites/default/files/assets/what-worksfact-sheet-social-determinants-health-p.pdf.pdf.

A Framework for Public Health Action–The Health Impact Pyramid: Dr. Tom Frieden’s health impact pyramid notes that socioeconomic factors are likely to have the largest impact on population health outcomes. https://doi.org/10.2105/AJPH.2009.185652.

it, authorities might revoke the land lord’s occupancy permit, forcing the tenant to move out. This, in turn, can trigger stress reactions and cause depression and other mental health issues.

If there is any good news revealed through the study, says Garmendia, it is that civic leaders are recognizing that housing/health issues stymie growth in a metropolitan area that is losing both population and com merce. The report card, she says, gives officeholders the evidence they

need to act.

Purnell also sees reason for optimism. “There is a role for health care in moving further upstream to address the root causes of health disparities in the social and economic conditions of communities,” he says.

Purnell’s team at BJC HealthCare has developed a “community health improvement strategy” that he says is informed by the lived experiences of those who face health and other inequities every day, stating that the health care organization is “commit

ting to increasing hiring, purchasing and impact investment in areas that have faced decades of disinvestment. We’re also working to improve the food environment, supporting health in schools and working to provide support from the prenatal to the postpartum period for individuals giving birth and their babies.”

NOTES

1. “Missouri Demographics,” Cubit, https://www.missouri-demographics. com/63106-demographics.

2. Raj Chetty et al., “The Association Between Income and Life Expectancy in the United States, 2001-2014,” Journal of American Medical Association 315, no. 16 (April 2016): 1750-66, https://doi. org/10.1001/jama.2016.4226.

3. Cristina Garmendia, URBNRX, “St. Louis Affordable Housing Report Card,” Community Builders Network of Metro St. Louis, 2021, https://www. affordablestl.com/summary.

4. “Can Mold Cause Health Prob lems?”, United States Environmen tal Protection Agency, November 4, 2021, https://www.epa.gov/mold/ can-mold-cause-health-problems.

she said, “I’m just going to go ahead and get it, be cause it makes no sense not to now.” (To date, Jones has suffered no side effects from the vaccine.)

Jones says authorities would be better advised to lay off the mandates and focus on the health of young people who are at turning points in their lives. She speaks of the need for “second-chance employment.”

“A lot of people have convictions on their re cords for nonviolent crimes, but that doesn’t mean we should throw them away. We need a program that is easily accessible to help them get their re cords expunged,” she says.

Jones was once in that category. She had a drug addiction and is in recovery, with a felony on her record. It took her years to get her life back to gether. But she earned an associate degree in hu man services and a certificate of proficiency in criminal justice at St. Louis Community College in 2003. She went on to earn a bachelor’s degree at Fontbonne University in 2006, then three years later, earned a master’s degree in business man agement at Fontbonne. During that time, she ac cumulated an exemplary work record, earning the praise of her supervisors.

Jones said that in her town and in today’s envi ronment, she feels like the exception that proves the rule. Although it wasn’t easy for her, she would like to make it easier for others to get their lives on the right track.

OVERCOMING ROADBLOCKS

At the start of summer 2022, life was looking a little brighter for Tyra Johnson, a single mother of three whose experiences during the pandemic were last shared in the spring 2021 issue of Health Progress. In 2020, Johnson lost her job; and her eldest children, Meegale, now 8, and Madison, 6, missed more than a year of in-person school. Fortunately, she was able to bring her youngest, Mason, into the world without complications.

Like Kim Daniel and Steven Jones, her former neighbors, Johnson moved out of the crime-ridden Preservation Square neighborhood. Last year, she found an apartment across the Mississippi River in East St. Louis, Illinois. Though the city has a na tional reputation for crime, Johnson felt the new complex would be safer than Preservation Square where, like Daniel, bullets had been fired into her unit. Her new quarters also were closer to her mother who could help babysit her kids.

Then, just months later, Johnson landed a job at a Walmart in Granite City, Illinois, a 15-minute

Tyra Johnson holds her youngest child, Mason, while helping her older children prepare to go back to school in January 2022.

drive from her home. As an overnight shift work er, she would earn $19 an hour and among the ben efits was a program that would help her earn her GED. Johnson had never made more money in her life and felt fortunate.

But only weeks later, Johnson’s car broke down, requiring expensive automotive work. After being repaired, her vehicle was stolen, and she was un able to cover the loss.

Johnson would begin taking the bus to work, but it took more than an hour each way. Ever re sourceful, she found a 24-hour day care that of fered subsidized support. Still, just getting the kids there on public transportation would take a couple of hours. She also relied on the unsustain able option of having her mom watch her children overnight.

To compound her stress, Johnson was dealing with a traffic ticket for driving without a license. To get it dismissed, though, she needed to get a license, and she was unable to do so without a car.

“I need transportation. I need day care. I can’t do this anymore,” she said in a St. Louis Post-Dispatch article. 14 After Johnson’s story

Photo by Aisha Sultan

appeared this past July, a reader created a Go FundMe site on Johnson’s behalf. By the end of August, more than 100 people had donated more than $15,000. Two local Muslim organizations also purchased a car to replace her stolen vehicle.

Now with a car, Johnson’s quest to provide a stable life for her kids and to advance her edu cation are within her grasp. Although a natural optimist, Johnson remains cautious, never really knowing what might lie ahead.

The same is true for many residents in 63106 and marginalized communities nationwide. COVID has tested their resilience and taken its toll. Perhaps the pandemic will finally abate. But unless and until more privileged communities find com mon cause with their neighbors, as things continue to change, the more they will remain the same.

This article includes additional reporting from DENISE HOLLINSHED, LEYLA FERN KING, AISHA SULTAN and RICHARD H. WEISS.

SALLY J. ALTMAN has devoted her career in public health to working with key stakeholders on health access issues as a health care administrator and a journalist. DENISE HOLLINSHED served as a crime and urban affairs reporter for the St. Louis PostDispatch for 21 years and is now a freelance writer. LEYLA FERN KING is a Wells Scholar at Indiana University and a reporter for Before Ferguson Beyond Ferguson. AISHA SULTAN is a nationally syndicated newspaper columnist, award-winning filmmaker and features writer. RICHARD H. WEISS is co-founder and executive editor of Before Ferguson Beyond Ferguson, a nonprofit racial equity storytelling project.

Previous articles about the 63106 Project appear in the Fall 2020 and Spring 2021 issues of Health Progress.

NOTES

1. Sally J. Altman, “Two Zip Codes, A World Apart,” Health Progress 101, no. 4 (Fall 2020): 44-50, https://www. chausa.org/publications/health-progress/archives/ issues/nurses/two-zip-codes-a-world-apart; Sally J. Alt man, “The COVID Conundrum,” Health Progress 102, no. 2 (Spring 2021): 51-56, https://www.chausa.org/ publications/health-progress/archives/issues/ spring-2021/the-covid-conundrum.

2. “2021 MHA Workforce Report: St. Louis Region Profile,” Missouri Hospital Association, https://www. mhanet.com/mhaimages/Workforce/2021/STL_2021_

WF_Report.pdf.

3. “2022 MHA Workforce Report: St. Louis Region Profile,” Missouri Hospital Association, https:// www.mhanet.com/mhaimages/workforce/2022/ STL_Region_2022_WF.pdf.

4. “2022 Workforce Report,” Missouri Hospital Asso ciation, May 25, 2022, https://web.mhanet.com/ media-library/2022-workforce-report/.

5. “2022 Workforce Report,” Missouri Hospital Association.

6. “Scholarship Programs,” Goldfarb School of Nursing at Barnes-Jewish College, https://www.barnes jewishcollege.edu/Financial-Aid/Scholarship.

7. “Work Opportunity Tax Credit,” U.S. Department of Labor, https://www.dol.gov/agencies/eta/wotc/.

8. Sonya Acosta and Erik Gartland, “Families Wait Years for Housing Vouchers Due to Inadequate Funding,” Cen ter on Budget and Policy Priorities, July 22, 2021, https:// www.cbpp.org/research/housing/families-wait-yearsfor-housing-vouchers-due-to-inadequate-funding.

9. Richard H. Weiss, “A St. Louis Woman’s Dream of Bet ter Housing Is Lost to Illness, Crippling Bureaucracy,” St. Louis Public Radio, February 14, 2022, https://news. stlpublicradio.org/health-science-environment/202202-14/a-st-louis-womans-dream-of-better-housing-islost-to-illness-crippling-bureaucracy.

10. “FDA Takes Key Action in Fight against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine,” U.S. Food and Drug Administration, December 11, 2020, https://www.fda.gov/news-events/pressannouncements/fda-takes-key-action-fight-againstcovid-19-issuing-emergency-use-authorization-firstcovid-19.

11. Altman, “Two Zip Codes”; Altman, “The COVID Conundrum.”

12. Denise Hollinshed, “A Grieving Reporter Rushes to Get Vaccinated as Her Subject Resists,” Riverfront Times, May 10, 2021, https://www.riverfronttimes.com/ news/a-grieving-reporter-rushes-to-get-vaccinated-asher-subject-resists-35497492.

13. Alison Durkee, “Biden Vaccine Mandate For Fed eral Employees Blocked Again as Appeals Court Dis solves Earlier Ruling,” Forbes, June 27, 2022, https:// www.forbes.com/sites/alisondurkee/2022/06/27/ biden-vaccine-mandate-for-federal-employeesblocked-again-as-appeals-court-dissolves-earlierruling/?sh=91975d62ebba.

14. Aisha Sultan, “Sultan: How a Stolen Car Could Ruin an Entire Family,” St. Louis Post-Dispatch, July 15, 2022, https://www.stltoday.com/lifestyles/parenting/ aisha-sultan/sultan-how-a-stolen-car-could-ruinan-entire-family/article_4814ffef-abdb-559c-b95adfb5f85e4d55.html.

RAISING THE BAR FOR EQUITY AND COMMUNITY HEALTH

Equity is at the forefront of today’s community benefit plans and programs. Community benefit leaders use an equity lens as they work with community partners to assess needs, set priorities, develop community health improvement plans and evaluate impact.

A new resource from the Rob ert Wood Johnson Foundation — which is dedicated to supporting an equitable culture of health in the U.S. — can help put this work in broader perspective. The re cently released “Raising the Bar: Healthcare’s Transforming Role” presents a framework of five ba sic principles for advancing equi ty and excellence and describes how equity starts with the patient experience and includes workforce development, engaged part nerships and advocacy.1

JULIE TROCCHIO

The five key principles of Raising the Bar are presented in the following areas: mission, equity, community, power and trust. It describes why each is important, giving examples of “bright spots” and resources for addressing the princi ples.

1. Mission Principle: Commit Above All to a Mission of Improving Health and Well-Being Committing to the mission to improve the health and well-being of individuals, families and communities, according to the report, “is at the heart of healthcare.” This principle goes beyond the goal of doing no harm by providing effective, integrated care across physical wellness, mental and behavioral health and social needs. It requires working with partners, such as providers of public health and social and human services, to treat the harms that result from underlying inequities and health risks to individuals and communities.

2. Equity Principle: Systematically Pursue Health Equity, Racial Justice and the Elimination of All Forms of Discrimination

The framework calls on health care to provide

everyone with the opportunity to be as healthy as possible. The equity principle takes a proactive effort to confront health equity, saying, “It is es sential that healthcare acknowledge and address historic and current structural factors, systemic racism, and other forms of discrimination and in equity — in society generally, within communi ties locally, and also within the healthcare system itself.” Achieving equity goes beyond providing access to quality care, and involves health care organization activities, including improving em ployment practices and fostering respectful inter actions with the broader community.

3. Community Principle: Serve the Community as an Engaged, Responsive and Proactive Partner

Beyond delivering services to individuals, health care organizations and institutions are critical members of their communities. The Rais ing the Bar framework reflects that health care organizations treat the health consequences of deep social and economic inequities being faced in their communities. They are in a position to build on the strengths and resources of commu nities, interacting with a wide range of partners who bring assets, expertise and a commitment to improving their communities’ health.

4. Power Principle: Share and Effectively Use Resources, Influence and Power

Health care’s significant power and influence comes from its large share of the U.S. economy. Health care organizations can promote equity by driving critical changes within their own sec tor and exerting influence over broader social and economic policy. This principle recognizes that health care organizations, institutions and practitioners “have their greatest impact when

they use their influence effectively and over come power imbalances to co-create mutually reinforcing partnerships with individuals, fami lies, and communities.”

5. Trust Principle: Earn and Sustain Trusting Relationships

Health care organizations can raise the bar when they earn the trust of individuals, families and communities. “This starts with acknowledg ing persistent trust deficits, understanding the drivers of mistrust, and co-creating pathways for trust building. … Building and sustaining trust re quires listening to and respecting the experience, expertise, and capabilities of the individuals, families, and communities to whom they provide care.”

PUTTING ‘RAISING THE BAR’ INTO ACTION

To put the principles in action, Raising the Bar describes four roles for health care organizations: as providers, employers, partners and advocates. Within each role, the model offers concrete ac tions to advance equity and excellence. The roles begin with ensuring that all patients are treated with respect. It then looks at the employer role for creating a diverse workforce, the role of community partner for addressing inequalities and finally its role for advocating for public policies that at tend to societal issues.

Provider role: Health care organizations, as service providers, should ensure that individuals have access to receive a full range of affordable care they need and are treated with dignity and respect. This includes having a trusting environ ment where everyone feels welcomed.

Employer role: This means having a work force and leadership team that reflect the diver sity of the community. It includes investing and growing leaders who advance equity and quality and ensuring that employees can be healthy and thrive.

Partner role: Health care organizations should engage with individuals and organizations in the community, prioritizing those most affected by inequalities. They should build trust and work in partnership on activities and initiatives.

Advocate role: Advocacy can include us ing the organization’s economic resources and influence to impact payment reform, community well-being and resilience and equity. It also means using investment and procurement power to con tribute to the health and strength of communities.

Raising the Bar presents a compelling case that equity should be in the very DNA of our or ganizations. When we care for patients, employ associates from diverse backgrounds, work in partnership and advocate for equity in our local and other public policies, we can advance our goal to increase equity and excellence in health care.

JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C.

NOTE

1. “Raising the Bar: Healthcare’s Transforming Role,”

Raising the Bar, 2022, https://rtbhealthcare.org/ wp-content/uploads/2022/07/RWJF-RTB-FULLREPORT-060622.pdf.

RESPONDING TO THE SIGNS OF THE TIMES

CHA Launches On-Demand Foundations Leadership Program

Prior to the arrival of COVID-19, the use of digital learning programs was already on the rise. However with its dramatic uptick during the pandemic, stronger learning capabilities have emerged. At a time when many health care systems have moved to less in-person travel due to pandemic precautions and because of current fiscal pressures, these technological advancements can allow for more formation programs to be offered virtually.

There remains considerable agreement among those involved in this work that extended for mation programs, especially at the senior leader level, must be face-to-face. But what about for mation opportunities for other executives, board members, direc tors, managers and clinicians?

Extending deep and meaning ful opportunities is imperative to these team members as well to al low them to think about how their own calling and values align with that of their ministry. However, due to logistical and scheduling issues, investigating options for leaders introduces challenges. When exploring possibilities for this audience, we asked ourselves:

Could CHA’s Foundations of Cath olic Health Care Leadership program be offered on demand?

EXPANDING FORMATION PROGRAMS

Working with our current Ministry Formation Advisory Council, we set out to rethink and de sign an on-demand foundations program, based on the CHA Framework for Ministry Leadership. Using member expertise, we scripted and pro duced more than 50 videos, curated articles and reflection questions, and built a specialized plat form to host all these materials in such a way as to

offer the best possible user experience.

This effort came to fruition in CHA’s “OnDemand Foundations of Catholic Health Care Leadership” program, an essential primer for new and current leaders in Catholic health care. Avail able on CHA’s website, this program — which launched last month — complements CHA’s live foundations program (titled “Foundations of Catholic Health Care Leadership”) that is offered annually over eight weeks in late January to March. The initial feed back from inaugural participants has been incredibly positive, and we look forward to seeing how our members will both offer this learning experience to colleagues and use its resources for their ex isting formation programs.

The objective of the program remains the same: to deepen un derstanding of the pivotal role leaders play in carrying out the healing mission of Catholic health care in serving the needs of patients, families, communities and the common good. Accompanied by an organiza tion’s designated mission/formation conversation partner — who is invited during registration by the participant to join them throughout the eight- to 10-week program — enrollees take part in the pro gram at their own pace integrating new content, engaging through reflective questions and build ing new leadership practices for their roles across the ministry. The program can be taken individu ally or with a group. It is organized into 11 sequen

tial modules, each with an introductory overview. Modules are followed by reflection questions, and participants are encouraged to take notes in a provided journal as they move through the sec tions to deepen their learning and to help them complete assignments.

FORMATION THROUGH ONLINE LEARNING AND ENGAGEMENT

Each learning module of the program follows a similar structure and starts with an overview and reflection, followed by a combination of short videos and relevant articles, then culminates with an individual assignment for participants. The mission/formation conversation partner en gages virtually or face-to-face with participants individually to expand and deepen the formation experience.

The modules are accessed through CHA’s Min istry Formation web page, under “Resources,” each one titled as follows: Vocation; Tradition; Spirituality; Catholic Social Teaching; Ethics; and Discernment. Each module begins with a reflec tion built on the following three stages: 1) Partici pants first pause and take a moment of silence, 2) listen carefully to the sacred words and then 3) share as appropriate. After each reflective mo ment, the modules will unfold in the following order:

Module 1: “The Vocation of Leadership in Catho lic Health Care” focuses on what it means to be called to leadership in Catholic health care, specifically viewing our work as a vocation.

Module 2: “The Tradition of Catholic Health Care” examines what it means to be a “heritage bearer” in Catholic health care.

Modules 3 and 4: “Spirituality and Leadership” and “The Practice of Prayer” remind us of the centrality of spirituality and how each person is a dynamic union of body, mind and spirit.

Modules 5 and 6: “Catholic Social Teaching: Our Strong Foundation” and “Living Our Tradi tion” both center around the foundational be lief of the Catholic tradition that each person is made in the image and likeness of God and the implications this has for the social conditions necessary for human flourishing.

Module 7: “The Foundations of Ethics in Catho

For

lic Health Care” includes a practical definition of ethics and a comprehensive introduction to how it is used in Catholic health care, from our everyday decisions to larger organizational ethical discernments.

Module 8: “Models of the Church: Spirit and Structure” highlights how it is crucial that as a leader in Catholic health care one has a clear knowledge of what Church is, and the capacity to articulate this to others.

Module 9: “Models of Sponsorship” demystifies the concept of sponsorship while situating it as a ministry of the church, both historically and presently.

Module 10: “Discernment” contrasts the differ ences between decision-making and discern ment, highlighting how spiritual discipline and prayerful disposition are at the heart of discernment.

Module 11: “Leadership” helps participants iden tify a plan for ongoing development and for mation as a ministry leader in Catholic health care.

Modules are led by a host of experts in each of their respective fields, creating a rich tapestry of knowledge from which participants can learn. We believe those who participate will find the con tent both engaging and challenging as they seek to connect their personal meaning with organiza tional mission and purpose.

PRESERVING OUR MISSION FOR FUTURE GENERATIONS

While the concept of an on-demand formation program may have seemed like a far-reaching dream in the past, we are thrilled that we’re finally arriving at this point. Formation is, and has always been, the heartbeat of the ministry, and that truth remains as we live in a world where in-person access becomes increasingly complicated. The ability to offer this program to our members any where and at any time is a gift, one that we hope will be instrumental in the formation of upcoming generations of Catholic health care leaders.

DIARMUID ROONEY, MSPsych, MTS, DSocAdmin, is senior director, ministry forma tion, at the Catholic Health Association, St. Louis.

including

Early last year, the Pontifical Academy for Life released an 11-page “note” titled, “Old Age: Our Future — The Elderly After the Pandemic.” 1 To emphasize the document’s messages and create opportunities for sharing between ministries, CHA, the Community of Sant’Egidio and Catholic Charities USA offered a related four-part webinar series.2

A highlight was the final webinar that featured the wisdom of Sr. Doris Gottemoeller, RSM, chair of Bon Secours Mercy Ministries and one of our minis try’s best thinkers and writers about Catholic health care today and in the future. During her presenta

CREATING A NEW PARADIGM FOR AGING 10 PROPOSALS AND A STORY: AMERICA’S AGING FUTURE

tion, “The Elderly — Our Future: Connecting for Greater Understanding and Action for Elders,” Sr. Gottemoeller explored how families, parishes and other ministries can support older persons through 10 proposed actions.3

How do we improve the ways we incorporate older adults into American culture with dignity, appreciation and appropri ate services? The “Old Age: Our Future — The Elderly After the Pandemic” statement from the Vatican reminds us that old age is our future. In other presentations in CHA’s “Old Age: Our Fu ture — Continuing the Conversation” co-spon sored webinar series, participants heard statistics and studied trends, learned of creative efforts and were inspired by passionate speakers. With this knowledge in hand, what should we do if we want to affect the big picture nationwide, and what should we strive toward?

To address this, I offer 10 interrelated pro posals for individual and collective action, what I refer to as “Ten Commandments,” in addition to a concluding short story to provide perspec tive on the strengths that older persons can pro

vide to our communities.

1. Acknowledge the reality and scope of the is sue.

Here’s where the data and trend analyses are important. The percentage of older adults com pared to the rest of the population has increased and continues to rise, both globally and in the U.S. The smallest age cohort will be caring for the larg est segment of the population. While it’s important to have an idea of this reality, it’s equally important to look around locally within our cities, neighbor hoods and even within our own families, because this is the core of our personal efforts, at least ini tially. When doing so, it’s also essential to examine the following questions: What kind of environment is desired by older adults? What services are need ed to maintain that environment? What is currently available, and at what cost? You get the idea.

— JULIE TROCCHIO, BSN, MS

SR. DORIS GOTTEMOELLER, RSM

2. Regard the issue — the dignified integration of older adults into society — as an opportunity, not a problem.

Since this is in some ways an unprecedented situation, it calls for new initiatives, both personal and communal. This is an opportunity to demon strate our love for our neighbor in new ways. To regard the growing propor tion of older adults in our society as a problem to be solved or a burden to be car ried is a bad way to begin. In contrast, viewing it as an opportunity challenges our creativity, our generosity and our commitment to the Gospel.

3. Consult the elderly and feature their stories.

We are working in partnership with older adults, not doing something for them. If we are fortunate, we will join their ranks one day. We can begin to prepare for that right now by devel oping relationships and friendships with older persons, listening to their stories, seeking their wisdom and by reflecting on the following: What are their life lessons? What is important to them now? What do they enjoy that’s different from what they might have enjoyed when they were younger and more independent? What’s still on their bucket lists?

4. Cultivate partnerships and alliances.

Numerous national and local organizations and faith-based communities are striving to be of service to the elderly. In addition to the sponsors of CHA’s webinar — Community of Sant’Egidio and Catholic Charities USA — we might name the Society of St. Vincent de Paul, parish outreach groups, United Way, home health agencies and food banks, to name a few, as other organizations working toward these efforts. We are not in com petition with one another. The better we under stand the resources each brings, the better friend and neighbor we can be to the elderly.

5. Create multiple models to accommodate dif ferent needs and desires.

In another presentation held as part of CHA’s webinar series on supportive efforts for older adults, participants heard of a number of creative models that enable people to stay in their own

homes or, if that’s not feasible, to live in a congre gate setting with appropriate services. A fact of life today is that the children of many older peo ple live at a distance. Their education and their employment opportunities have caused them to settle in cities far from where they grew up and where their parents reside. This is fine as long as

their parents can travel and enjoy occasional vis its with their adult children and grandchildren. As they age, however, this becomes less feasible, and they will need supportive services in their homes or, in some cases, congregate living. A prerequi site of any institutional model should be that it facilitates community.

6. Foster intergenerational relations.

As previously mentioned, many elderly people live at a distance from any family member. Vid eo calls, whether through computers or smart phones, can provide regular opportunities to con nect grandchildren and great-grandchildren with their loved ones. Another initiative I have seen is inviting students in some of our high schools to visit elderly neighbors or residents of nearby nursing homes. Even just a half-hour conversation between the two generations can be mutually ben eficial and enjoyable.

7. Advocate for funding and public support.

This is where assistance from national orga nizations like CHA and Catholic Charities USA becomes important. Their professional staff alerts us to pending legislation at the local, state and fed eral levels that can potentially impact the welfare of older adults, such as housing options, welfare benefits or pharmacy prices. A secret of success ful advocacy is knowing the decision makers and stating a clear case for what is being sought, based on credible personal experience.

8. Prepare RNs, social workers and volunteers appropriately for service to the elderly (especially in home health settings).

To regard the growing proportion of older adults in our society as a problem to be solved or a burden to be carried is a bad way to begin.

Ministering in someone’s home is far different than in a licensed facility. The visitor has no onsite supervision, so preparation — including back ground checks and an appropriate orientation — is crucial. Issues that should be addressed for proper training include: What boundaries should a service worker follow when visiting someone’s home? What are the signs he or she should look for in order to recommend additional profession al help?

9. Incorporate art and beauty into the environ ment and services.

Wherever older adults are living or whatever their degree of frailty, they are persons who have enjoyed art, music and the beauty of nature. Re gardless of their taste, they instinctively seek aes thetic delights, therefore any living setting should incorporate these as much as possible. It can be something as simple as a flowering plant on a windowsill, a new book or magazine, an attractive table setting or a visit by a local choral group, but this stimulus acknowledges the deeper humanity of the persons. Congregate living facilities that resemble hospital corridors risk diminishing the humanity of the residents and promoting isola tion and loneliness.

10. Seek and support the spiritual wisdom of the elderly.

Wherever older adults are living or whatever their degree of frailty, they are above all spiritual persons. Whatever their faith tradition, they are bound to have deeper questions of meaning and purpose and reflections born of a lifetime of expe rience. Access to spiritual services is critical. As fewer clergy are available, family and parishioners can step forward to bring the Eucharist, share a prayer and seek the spiritual wisdom of the aged.

WISDOM AND RESILIENCY

When reflecting on ways to help older adults, a story from Genesis offers some perspective. One day God was talking to Abraham and mentioned that, in order to found a chosen people, he was going to see that he and Sarah would have a son. So improbable was this that Abraham fell on the ground laughing as he said to himself, “Can a child be born to a man who is 100 years old? Or can Sar ah give birth at 90?” Sarah was even more amused.

According to the storyteller, she was eavesdrop ping from the safety of her tent as her husband conversed with the Lord’s three messengers. When she overheard the ridiculous prophecy, she laughed out loud at the incongruity of it.

Sarah and Abraham give us a wonderful ex ample of older adults coping with unanticipated change to their lives. It takes some resiliency to nurse and diaper a baby at age 90 and a wholesome perspective to see the humor in all of it. Ad mittedly, these are semiapocryphal stories, but if all Scripture is written for our instruction, there may be some lessons for us. For instance, the met aphor of laughter suggests that older adults can choose a stance toward their circumstances. Also, it indicates that God sees their lifelong potential.

In fact, old age is frequently attributed to spe cial friends of the Lord. Moses was 120 years old when he died, yet his eyes were undimmed and his vigor unabated. The pious widow Judith, sav ior of her people, reached the advanced age of 105, renowned throughout the land. The wise and pa tient Job lived to be 140, and so forth. In the Bible, old age is associated with wisdom and honor and continuing accomplishment. As we move for ward, let us seek to follow that example.

SR. DORIS GOTTEMOELLER is a member of the board of Cincinnati-based Bon Secours Mercy Health and chair of Bon Secours Mercy Ministries, the system’s public juridic person. She is a former chair of CHA’s Board of Trustees and winner of CHA’s 2021 Lifetime Achievement Award.

JULIE TROCCHIO, BSN, MS, is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C.

NOTES

1. Vincenzo Paglia and Msgr. Renzo Pegoraro, “Old Age: Our Future – The Elderly After the Pandemic,” The Pon tifical Academy for Life, February 2, 2021, https://www. academyforlife.va/content/dam/pav/documenti%20 pdf/2021/Documento%20Anziani/Testi%20 documento/02_OLD%20AGE_DEF_ENG.pdf.

2. “Old Age – Our Future,” Catholic Health Association, https://www.chausa.org/eldercare/old-age---our-future.

3. “The Elderly – Our Future,” Catholic Health Association, https://www.chausa.org/events/ calendar-of-events/elderly-webinar-series/overview.

ENGAGING COMMUNITY TO ACHIEVE HEALTH EQUITY

As is well-known throughout the Catholic health care ministry, CHA’s We Are Called pledge to increase health equity by ending systemic racism has been embraced by almost 90% of our members.1 We have already celebrated the one-year anniversary of the pledge and continue to expand our resources, share best practices and foster collabora tions focused on each of the four pillars of the pledge: health equity (especially in light of the COVID-19 pandemic), putting our own house in order, advocacy and building right and just relationships with the communities we serve. As we continue to talk about ongoing efforts to enable systemic change for diversity and health equity, it is important that we recognize its roots in our Catholic identity, history and heritage.

A CALL GROUNDED IN JESUS’ MINISTRY

When we examine the origins of the Catholic commitment to eliminating ra cial inequities, there is no better person or place to begin with than Jesus himself and the para ble of the Good Samaritan (Luke 10:25-37). In this renowned par able, often referred to as our “foundational story” in Catholic health care, Je sus is respond ing to a ques tion from one of the lawyers as to what he must do to inherit eternal life. When Jesus asks him what is written in the law, he re sponds, “You shall love the Lord, your God, with all your heart, with all your being, with all your strength, and with all your mind, and your neighbor as yourself.” Pressing Jesus fur ther, the lawyer then asks, “And who is my neigh bor?” Clearly, the lawyer was trying to trip Jesus up and probably did not expect the response that came, nor the powerful story Jesus would tell to illustrate his message.

We are all very familiar with the narrative Jesus tells next of the man on the road who is attacked by robbers, beaten and left to die. The priest and Levite pass him by, yet the Good Samaritan

stops, cares for the man, takes him to an inn and ensures that he is cared for even after he contin ues on his journey. When Jesus asks the lawyer which of the three was neighbor to the victim, he responds, “The one who treated him with mercy.” At that, Jesus encourages him to “Go and do like wise.” This message was not only for the lawyer: it is also a universal message and mission for the global Church, the health care ministry and each one of us.

As we strive to answer Jesus’ call to “Go and do likewise,” the principles of Catholic social teach ing can serve as the underpinning for the impor tant work we continue to advance in the ministry and in communities. Namely, this involves the inherent dignity of each person; advancing the common good by caring for our communities in the context of structural racism; and justice, espe cially for the poor, vulnerable and marginalized. The implications for our work in diversity, equity

DENNIS GONZALES

In today’s complicated social, political and economic environment, we must all find more creative and collaborative ways to care for our neighbors, wherever they may be and whatever they may need.

and inclusion are far-reaching and profound. In today’s complicated social, political and econom ic environment, we must all find more creative and collaborative ways to care for our neighbors, wherever they may be and whatever they may need. How do we build right and just relationships with the communities we serve?

BUILDING EQUITABLE COMMUNITIES TOGETHER

As we look for ways to foster collaborations with our communities, one example can be found in San Antonio, one of the largest cities in the Unit ed States. In the San Antonio metropolitan area, which is predominantly Latino, the CHRISTUS Santa Rosa Health System, established by the Sis ters of Charity of the Incarnate Word in 1869, is collaborating with a variety of local partners to address community needs. It is one of many or ganizations working together through the South west Texas Crisis Collaborative, which is an ef fort focused on ending ineffective use of services for the safety-net population at the intersection of mental illness, homelessness and high usage in Southwest Texas.2 The collaborative is committed to improvement by developing a comprehensive, integrated crisis system across all major public payers, hospital providers, philanthropy, public

to get there. In its infancy, this collaborative en deavor was just an idea, a dream. A small group of leaders — mainly mission leaders, social workers and community outreach professionals from the area’s major health systems — came together and asked the central questions: What can we do? If we pool our collective resources, expertise and determination, how can we better support our community, especially those who are poor, un derserved and marginalized? How does this effort align with the mission and values of our various organizations and ministries? And, of course, how can we get buy-in from the city, county and sev eral competing health care systems? Alexis Arel, regional vice president of Finance and co-chair of the Ethics Committee for CHRISTUS Santa Rosa Health System, recalls that, “By working collaboratively, to clearly pinpoint the gaps and bottlenecks the community faces when trying to access services — predominately mental health services — we are able to treat the person with dignity, while also looking out for the common good in terms of our collective resources by fund ing programs collaboratively rather than working in competing silos.”

safety (fire department/EMS resources and law enforcement) and behavioral health providers. Recognized as an innovative and creative commu nity-wide effort, this organization is an excellent example of what it looks like to build right and just relationships with the communities we serve.

While this initiative is well-developed and makes a difference today, it was not an easy road

From that core group, Southwest Texas Crisis Collaborative was born. Before long, area health system CEOs, CFOs and IT lead ers were brought to the table, along with leadership from the city, county, police, fire depart ment, EMS, homeless shelters and other nonprofits through out the city. It was a multiyear process, but through collective input from all key stakeholders, a strategic plan was developed, including significant funding formulas; HIPAA-compliant sharing of patient data and his tories; transport agreements; proactive collaboration with police, EMS and the central homeless shelter, Haven for Hope, which serves 1,700 people per day3; and the commitment of dedicated inpatient psychiatric beds.

Arel shares that “participation in the South west Texas Crisis Collaboration, alongside other health care systems, city and county agencies and local nonprofits, has been an eye-opening

“Participation in the Southwest Texas Crisis Collaboration, alongside other health care systems, city and county agencies and local nonprofits, has been an eye-opening experience to see the good that can come when parties work together for a common mission.”

— Alexis Arel

experience to see the good that can come when parties work together for a com mon mission.” These values call us to col laborate with other people of good will in building right and just relationships with our communities and ensuring that tra ditionally underrepresented groups have meaningful and equitable opportunities in health, education, housing, nutrition and all the social determinants of health. Con sistent with the mission of Catholic health care and the Catholic social tradition, we must refuse to accept the existence of racial and ethnic disparities in access to health care and quality outcomes.

CONCLUSION

As we are reminded by the parable of the Good Samaritan, we are called to be a neighbor to those who are in need. Like the one who showed mercy, we must rec ognize the need, stop and address it, and then remain vigilant. How will we lever age our collective mission, vision, values and resources in a way that is focused on proactively eliminating health disparities in our communities? As expressed in Je sus’ call, will we “Go and do likewise?”

DENNIS GONZALES, PhD, is senior direc tor, mission innovation and integration, for the Catholic Health Association, St. Louis.

NOTES

1. “We Are Called,” Catholic Health Association, https://www.chausa.org/cha-we-are-called/.

2. Southwest Texas Crisis Collaborative, https://www.strac.org/stcc.

3. “Haven for Hope Brochure,” Haven for Hope, https://www.havenforhope.org/wp-content/ uploads/2018/11/H4H_Tri_Fold_MAY2018.pdf.

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1. Title of publication: Health Progress

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9. Names and complete addresses of publisher, editor, and managing editor: Catholic Health Association, Publisher; Betsy Taylor, Editor; Charlotte Kelley, Managing Editor; 4455 Woodson Rd., St. Louis, MO 63134-3797

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I certify that the statements made by me above are correct and complete.

Betsy Taylor, Editor

A MISSION GUIDED BY PRUDENCE

For nearly three years, the health care ministry and our country have faced a crisis unseen by many generations. Throughout the COVID-19 pandemic, we have had to navigate new and complex ethical dilemmas, such as scarce resource allocation and public health mandates. To do so, our health care organizations relied upon prudential lead ers who saw the path ahead clearly while balancing the many demands placed on our colleagues. In doing so, these leaders exhibited the virtue ethicists refer to as prudential wis dom, playing a role in enabling the Holy Spirit to guide the ministry’s work.

ACTION THROUGH PRUDENCE

St. Thomas Aquinas wrote ex tensively about the virtues and how they affect our decision-making in his Summa Theolog ica . Furthering the work of Aristotle, St. Augustine and others, Aquinas ex panded on the many different virtues, providing us with a schematic of their functions. For the virtue of prudence, Aquinas named it a wisdom. 1 For Aquinas, wisdom is the process of or dering and judging. It prioritizes competing ends and judges the action that will most likely result in the desired outcome. It is a virtue of practical intellect rather than merely speculative.

When looking at the innovation and adaptabil ity displayed by health care leaders — especially during the early stages of the pandemic — how does this virtue apply? A person strong in pru dence applies right reason to any given matter. Aquinas quotes St. Isidore of Seville, stating, “A prudent man is one who sees as it were from afar, for his sight is keen, and he foresees the event of uncertainties.”2 They go beyond simply examin ing and reflecting, leaning also toward action and application. They can direct our means toward our sincerest intentions. In fact, Aquinas argues that for any moral virtue to meet its intended end,

prudence must be there to guide it. Therefore, prudence has been called the Auriga virtutum, or the charioteer of the virtues.

THE PATH TO PRUDENCE

Aquinas breaks down the process of prudence into three main elements: counsel, judgment and com mand.3 Counsel involves inquiry and deliberation, the collecting of data. Judgment includes decisionmaking and choice. Finally, command, the element that is unique to prudence, moves toward the ap plication of the decision. This process might seem familiar to anyone who has gone through a formal discernment model. If we look at CHA’s model for discernment,4 we will find that its five steps follow the outline Aquinas writes regarding prudence. The prudential wisdom infused into the process of discernment enables the Catholic health care min istry to put our mission into action. In many ways, it is through this virtue that we live out the healing

NATHANIEL BLANTON HIBNER

A person strong in prudence applies right reason to any given matter. ... They go beyond simply examining and reflecting, leaning also toward action and application. They can direct our means toward our sincerest intentions.

“I, Wisdom, dwell with prudence, and useful knowledge I have.” (Proverbs 8:12)

ministry of Jesus by acting rightly toward our pa tients, communities and associates. The ministry’s commitment to health equity by prioritizing ser vices that help shape healthier communities is just one of the many ways that we live out this virtue through our work.

When decisions are made that lack prudence, they often follow a path toward a lesser good. In these cases, some influence other than God di rects the decision-makers. Aquinas would call this “false prudence.” The person deceives them selves into thinking that the goal they desire is the same as that of the Holy Spirit, when, in fact, it comes instead from avarice and vice. The pro cess of discernment should include steps to selfreflect on one’s intentions and goals so that true prudence may lead the way.

Like any virtue, prudence must be learned and practiced. Aquinas argues that prudence is not naturally gifted to people, though some might be more receptive to learning it. The way to do so is to reflect deeply upon experiences, asking oneself whether the action taken resulted in the desired outcome. Through this reflective practice, a person begins to develop a better understand ing of the application of virtuous actions and their consequences. They also learn just as much from their mistakes as they do from their successes.

CONCLUSION

For those who lead the ministry’s work, I invite you to take time and learn more about this vir tue — whether through reading what Aquinas has written, or through developing a mentoring rela tionship with someone who exhibits prudential wisdom. Many systems have opportunities to join mentoring programs. If your system lacks a for mal mentoring program, you can also ask some one whose decision-making you admire to walk you through the steps of how they reach their de cisions. Or, someone more experienced may be willing to talk with you about what factors they considered if they encountered a similar situa tion. In addition to CHA’s discernment model and facilitator guide, another helpful resource is Ste phen J. Pope’s book The Ethics of Aquinas. 5

As our health care ministry continues to face challenges, we look upon our leaders to act in light of prudence. May our work continue to be blessed by those who see clearly and act confidently.

NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Associa tion, St. Louis.

NOTES

1. Thomas Aquinas, Summa Theologica, Second Part of the Second Part, question 47, article 2. 2. Aquinas, Summa Theologica, Second Part of the Sec ond Part, question 47, article 1. 3. Aquinas, Summa Theologica, Second Part of the Sec ond Part, question 47, articles 8-9.

4. Cooperating With the Spirit: CHA Discernment Model and Facilitator’s Guide (St. Louis: Catholic Health Association), https://www.chausa.org/store/products/ product?id=4653.

5. Stephen J. Pope, ed., The Ethics of Aquinas (Washing ton, DC, Georgetown University Press, 2002).

The ministry’s commitment to health equity by prioritizing services that help shape healthier communities is just one of the many ways that we live out this virtue through our work.

THINKING GLOBALLY OUR CONTINUED CALL TO GLOBAL SOLIDARITY

S

ome time ago, the United States Conference of Catholic Bishops (USCCB) issued a statement, “Called to Global Solidarity: International Challenges for U.S. Parishes,” to ground their approach as a call to action for all pastors, parish leaders and other involved Catholics. The opening paragraph reads:

“At a time of dramatic global changes and challenges, Catholics in the United States face special responsibilities and opportunities. We are members of a universal Church that tran scends national boundaries and calls us to live in solidarity and justice with the peoples of the world. We are also citizens of a powerful democracy with enormous influence beyond our borders. As Catholics and Americans, we are uniquely called to global solidarity.”1

While it has been 25 years since its initial publication, this statement is one that I often re turn to. Many of its concerns still remain timely, and while it is heartening to think of how much has changed, it is also startling to think of how much has not.

BRUCE COMPTON

Within this statement, a list of global issues calling American Catholics to solidarity is marked with the subhead,

“Signs of the Times.” These “signs of suffering and need” were reflec tive of 1997’s global landscape, one defined by a rapid spread of infor mation through the internet, which raised awareness and corresponding global concern. They feel just as ur gent — and in some cases more so — in 2022. Our call to address the health care needs of our global partners con tinues to propel us forward to develop collaborations that foster equity and sustainable improvements for our in ternational communities.

EXPANDING GLOBAL REACH

Today, genocide and ethnic violence are still prevalent globally, notably for the Uyghurs and Rohingya people in China and Myanmar. Foreign debt continues to cripple countries around the world, and low-income country debt rose to a new record in 2020.2 Multiple wars and ongoing ethnic

conflicts have created refugee crises around the world. The United States-Mexico border has been effectively turned into a political volleyball with little direct movement toward humane migration policies, while an ongoing humanitarian crisis caused by poverty and violence rages in Latin America and beyond. The climate crisis contin ues to exacerbate these issues, yet we continue to lose ground as some of the world’s most powerful institutions hamper our ability to build consensus and enact needed change.

Still, there is always room for hope. As the U.S. and international dioceses came together with parishes and universities to form new partner ships, relationships with health care institutions in low- and-middle-income countries began to develop. While Catholic health care was not spe cifically highlighted in the 1997 statement, CHA and its members have stepped up, and many have invested in the USCCB’s call to global solidarity.

Our call to address the health care needs of our global partners continues to propel us forward to develop collaborations that foster equity and sustainable improvements for our international communities.

Drawing inspiration from CHA’s “We Are Called” action plan statement to address ongoing health and racial disparities in our communities, I’m encouraged by the ways our organization has sought to put “our own house in order.”3 In recent decades, CHA and its members have thoughtfully approached how we do global health work, with greater emphasis on broadening who is at the table when decisions are made, and, as we part ner on sustainable solutions, actively listening to foreign communities as they identify their own needs.

to global solidarity can feel overwhelming when we consider the multitude of challenges that we face in the Catholic health care ministry. The easy response would be to step aside and let someone else handle it. But that was not the reaction of our predecessors in Catholic health care, and if we re main true to our Gospel calling, it won’t be ours, either.

CHA has now developed global health into a focus area, dedicating time, money and creative resources into addressing international health partnerships. We have worked with our members to develop “Guiding Principles for Conducting International Health Activities”4 that help to ap propriately position partnerships from the outset. Using these principles, we encourage systems to simultaneously invest in localization and decolo nization of global health infrastructure. This is the true spirit of solidarity.

CONTINUING OUR GLOBAL COMMITMENT

Yet, there always remains room to do more. The COVID-19 pandemic has highlighted inequities, complexities and challenges in global health. A lack of infrastructure, logistics and financial re sources continues to hamper vaccine access in many low-income countries. Ongoing wars and conflicts created a global migrant population of millions of people, including many who have no access to health care and are rarely represented in global health data.5

The bishops’ statement reminds us that, “the Church’s teaching on international justice and peace is not simply a mandate for a few large agen cies, but a challenge for every believer and every Catholic community of faith.” Living out the call

Twenty-five years of distance between the bishops’ call in this statement and our current mo ment have revealed that these global challenges aren’t going away. Considering this hard truth, let us reflect on the true nature of the Church, one that transcends national boundaries. A church focused on collaboration creates the possibility of involving more skills, talents and resources into much-needed global work; it can also serve as an example of solidarity in our fractured world. Let us continue to strategize and think creatively about investing in global health partnerships. Let us work toward eq uity and decolonization. And just as importantly, let us be a church that answers our Gospel call to peace, justice and solidarity.

BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis.

NOTES

1. “Called to Global Solidarity International Challenges for U.S. Parishes,” United States Conference of Catholic Bishops, November 12, 1997, https://www.usccb.org/ resources/called-global-solidarity-internationalchallenges-us-parishes.

2. “Low-Income Country Debt Rises to Record $860 Billion in 2020,” The World Bank, October 11, 2021, https://www.worldbank.org/en/news/pressrelease/2021/10/11/low-income-country-debt-rises-torecord-860-billion-in-2020.

3. “We Are Called,” Catholic Health Association, https://www.chausa.org/cha-we-are-called.

4. “Guiding Principles for Conducting International Health Activities,” Catholic Health Association, https:// www.chausa.org/store/products/product?id=4423.

5. “Refugee and Migrant Health,” World Health Organization, https://www.who.int/health-topics/ refugee-and-migrant-health#tab=tab_1.

Living out the call to global solidarity can feel overwhelming when we consider the multitude of challenges that we face in the Catholic health care ministry.

PRAYER SERVICE

A Prayer of Light

MARGARET Y. JONES, BCC-PCHAC REGIONAL DIRECTOR OF SPIRITUAL CARE, CHRISTUS SANTA ROSA HEALTH SYSTEM

INTRODUCTION

With distressing events happening around the world and in our communities, we may feel overwhelmed, especially in health care. However, when challenges are before us, new possibilities arise. These difficult times call us to work together in unity. Through the sign of the cross, we can be reminded of the community of the Trinity: Father, Son and Holy Spirit.

Leader: Jesus, Word Incarnate, we know that among your many life tasks, the most poignant ministry was to teach us to love: “‘You shall love the Lord, your God, with all your heart, with all your soul, and with all your mind. This is the greatest and the first commandment. The second is like it: You shall love your neighbor as yourself.’” (Matthew 22:37-39) You taught us to care for those most in need. We ask for your healing spirit to cover our suffering Earth, to console and direct us to work together as co-creators.

Pause for a few moments of stillness and silence. Release any distracting thoughts. Become aware of the air you breathe moving through you. Become aware of God’s great peace for you. Feel your heart open to God’s special gift just for you.

Take a few minutes to be more fully in union with God’s grace. With each relaxing breath, allow the divine presence to embrace you.

OPENING PRAYER

O God of Peace, you have taught us that in returning to you and in

“Prayer

resting in you, we shall be saved. In confidence of your love, we shall find our strength. By the might of your spirit, lift us. We pray to your presence, where we may be still and know that you are God.

Almighty and ever-living God, we thank you for the many ways in which you strengthen your servants daily. Strengthen us, we pray, in our resolve to love as Jesus taught, and to live with devotion, clarity, creativity and compassion. Bless us in our service, and bless those we serve. Amen.

(PAUSE.)

The response is: The Lord is kind and merciful, slow to anger and rich in compassion.

Bless the Lord, O my soul; and all my being, bless God’s holy name.

All: The Lord is kind and merciful, slow to anger and rich in compassion.

God pardons all your inequities; heals all your ills; redeems your life from destruction; and crowns you with kindness and compassion.

All: The Lord is kind and merciful, slow to anger and rich in compassion.

READING

(Colossians 3:12-13)

“Put on then, as God’s chosen ones, holy and beloved, heartfelt compassion, kindness, humility, gentleness, and patience, bearing with one another and forgiving one another; if one has a grievance against another, as the Lord has forgiven you, so must you also do.”

INTERCESSIONS

O God, we commit ourselves to you

— our strength. Quiet our minds and bodies with your peace. Come into our hearts, we pray.

The response is: Lord, hear our prayer.

God, in your mercy, renew our desire for unity throughout the world.

All: Lord, hear our prayer.

God of mercy, guide all leaders in new ways to foster peace.

All: Lord, hear our prayer.

Loving God, for those who suffer alone, may they take comfort in our prayers and feel loved.

All: Lord, hear our prayer.

Creator God, teach all people to care for our Earth — the new poor.

All: Lord, hear our prayer.

For the personal prayers of your heart (in silence or shared aloud).

All: Lord, hear our prayer.

Loving God, we know that the light of your spirit shines within our hearts. Offer us unending love that draws us ever closer to you. Hear our prayers that we offer through your name, Christ our Lord. Amen.

CLOSING PRAYER

Bless us, O Lord. Bless the light within our hearts with compassion and our minds with wisdom. Bless the work of our hands. Bless us to be faithful instruments of your healing. This we ask in the name of the one who is at the center of all we do, Jesus the Healer. Amen.

COMMUNITY BENEFIT 101: THE NUTS AND BOLTS OF PLANNING AND REPORTING COMMUNITY BENEFIT

CHA’s CB 101: The Nuts and Bolts of Planning and Reporting Community Benefit, a virtual conference, will provide new community benefit professionals and others who want to learn about community benefit with the foundational knowledge and tools needed to run effective community benefit programs.

Attendees will receive a copy of CHA’s A Guide for Planning and Reporting Community Benefit.

What you will learn:

Taught by community benefit leaders, the program will cover what counts as community benefit; how to plan, evaluate and report on community benefit programs; accounting principles; and a public policy update.

Who should attend:

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New community benefit professionals who want a comprehensive overview of all aspects of community benefit programming.

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Staff in mission, finance/tax, population health, strategic planning, diversity and inclusion, communications, government relations and compliance who want to learn about the important relationship of their work and community benefit/community health.

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Veteran community benefit staff who want a refresher course to update them on current practices and inspire future activities.

SPECIAL OFFER FOR COMMUNITY BENEFIT REPORTERS

We’ve added single-day registration

special pricing for community benefit reporters who want to focus on what counts, accounting and how to tell the community benefit

Whether you are new to reporting or need a refresher, check out this option.

“The information about the CHNA and CHIP was so essential and will be invaluable in my role.”

OCTOBER 25, 26 & 27, 2022

day from 2 to 5 P.M. ET

Join us for the Virtual Program!

“CHA has great resources that were used as part of the program, and I can already use the information presented in my day-to-day activities.”

together thought leaders to discuss

more just and healthy society