1. Network Sustainability Richard D. Silverberg MSSW LICSW Managing Director Caring Community Network of the Twin Rivers Exec. Dir Health First Family Care Center Franklin NH

2. To promote public health and prevent illness Agency and community Reps all sectors Founded in 1996 501 c 3 10 Essential PH services, plus supports to network members Needs assessment, Health promotion, chronic disease prevention, community development focused on creating healthy individuals in healthy environments, training. work force, access to personal health care, policy development. Caring Community Network of the Twin Rivers (CCNTR )

3. Individual & Family Primary Care Teams LRGHealthcare Family Practices Health First Family Care Center (FQHC) Inter agency adult and children’s care coordination teams Caring Community Network of the Twin Rivers Health Home Model Primary Care Network Community Action Programs School Administrative Units Dentists Child Care Centers Elder Service Providers Faith-Based Groups Municipal Services Visiting Nurse Associations Acute Hospital Mental Health Providers Police, Fire EMT Medical Specialty Services

4. CCNTR RHO Partners Healthy Eating Active Living (HEAL NH) Medication Assistance Health Link Clinical Team Care Management Health First-National Collaborative LRGH-NCQA (DPRP) Planned Visits Nutritionist, Behavioral Health, Social Work Patient Disease Registry, EMR Key Measures Clinical: Lower A1c Average (DM), Lower BP Average (CVD) Healthcare: Reduced ER Utilization

5. Coalition Development Gather together the right people Agree to agree Identify develop, support local leadership Find projects early on that will yield success Celebrate success Evolution

6. CCNTR is recognized on a national level for its work in cross-agency team development and collaboration. Coordinating how agencies work together to deliver services for individuals is a primary focus of the network. Not only do network agencies work together to govern CCNTR, they jointly apply for funding and share staff positions to deliver services. CCNTR also strengthens the community by providing staff development, training and new technology to agencies in the network. CCNTR is recognized on a national level for its work in cross-agency team development and collaboration. Coordinating how agencies work together to deliver services for individuals is a primary focus of the network. Not only do network agencies work together to govern CCNTR, they jointly apply for funding and share staff positions to deliver services. CCNTR also strengthens the community by providing staff development, training and new technology to agencies in the network. Recognition

7. Vision LT Outcomes Evaluate Effectiveness/C ollect and analysis indicator data Implement Methods/ Activities Plan for Methods /Activities Iterative Processes Goal Development Strategy and long term outcome development Needs/Problems Statement Needs Assessment Priorities and Strategic Issues Identification Short term & intermediate Outcomes Development Joint funding development and grant writing CCNTR PLANNING PROCCESS

8. Methods of Engaging the Public Choose an issue that the residents care about, and that is measurable Use the skills and talents of the participants Ask the participants ‘Who else should we be talking to?’ Reinforce, celebrate success and positive shared leadership

9. Fostering Ownership and Leadership Identify local leaders Start at the level comfortable for the leader Have method to support and train leaders Share leadership, give power to many

10. Approach

11. Development Committee Develop plan from need search for /develop method than look for funding for it Blend funding from many sources not one source per grant project The best fit for a grant is the fiscal agent for that grant. Funding Strategies

12. Service Design through Blended Funding Sources HRSA Rural Health Outreach Topic Areas: Chronic Disease, Telehealth Quarterly Planned Care Prevention Focused Visits EMR, Disease Registry, Quarterly Outcome Evaluation Health First Family Care Center (FQHC) participation in HRSA Health Disparities Collaborative LRGHealthcare involved in NCQA, DPRP Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement Topic Areas: Reducing Childhood Obesity EMR Supporting Primary Care Recommendations to Identify, Prevent, and Manage Childhood Obesity Primary Care Practices in Region Documenting at Least 72% of Youth BMI Risk Rating 5210 Assessment and Behavioral Goal Setting at Well Child Visits New Hampshire Healthy Eating Active Living Community Grant Program Topic Areas: Increasing Nutrition and Physical Activity Resources School Community Food & Recreation Industry Reducing childhood and adult obesity Funding SourceDelivery System DesignResults

13. Evaluation Programs/services: process and outcome measures for each project / each funding source matched to overall community plan Demonstrated value: through changes over time from baseline measures of major community health indicators Agency functioning : board evaluation

14. Return on Investment Healthy communities Agencies, towns, employers, residents that have learned the value of collaboration and carry this forward On going community leadership We can do it if we all work together

15. Organizational Chart of the Caring Community Network of the Twin Rivers Twin Rivers Community Founded 1996 14 Community Member Seats CCNTR Board of Directors 14 Member Agencies 11/09 Managing Director NominatingExecutive Development Health Officers Trip Standing Committees Basic Needs Environmental Health Community Involvement Adolescent Risk Behavior Prevention Team Public & Community Health Systems Improvement Health Education & Disease Prevention Care, Coordination Outreach, and Access Subcommittees (program oversight) Task Teams Care Coordination Teams Regional Emergency All Hazards Health Planning and Response Newfound Primary Care Teams Franklin Elder & Adult Team Franklin Children’s Team Access Managers Group Healthy Homes 1

16. Results in Partnering  Sustainable network  Number of uninsured patients in region now receiving preventative services, primary care and specialist treatment  1995: <100 uninsured patients  2010: >4,000 uninsured patients As a Result of:  Health First Family Care Center (FQHC)  Increase in Primary Care Physicians  Two Office Locations  HealthLink and Healthcare Financial Counseling  Information and referral system that provides healthcare financial counseling, Shared sliding fee scale and access to medical, dental, wellness, and prescription services for those in financial need.  Sustainable network  Number of uninsured patients in region now receiving preventative services, primary care and specialist treatment  1995: <100 uninsured patients  2010: >4,000 uninsured patients As a Result of:  Health First Family Care Center (FQHC)  Increase in Primary Care Physicians  Two Office Locations  HealthLink and Healthcare Financial Counseling  Information and referral system that provides healthcare financial counseling, Shared sliding fee scale and access to medical, dental, wellness, and prescription services for those in financial need.

17. Results in Partnering 2  Comprehensive network of agencies that provides the ten essential public health services for the region.  Bring new resources to the region.  5 million $ in the past 5 years.  Developed seamless Electronic referral system between agencies.  Comprehensive network of agencies that provides the ten essential public health services for the region.  Bring new resources to the region.  5 million $ in the past 5 years.  Developed seamless Electronic referral system between agencies.

18. Focus on meeting the needs through long term planning process Use savings from collaboration and eliminating duplication of effort to sustain core network functions Institutionalize the relationships of one agency to another not just the personal relationships Sustainability

19. Sustaining Engagement Identify both short and long term activities Early successes are vital! Celebrate your success Include large group in planning process Segment plan into doable committees and tasks Develop long term funding streams through policy change

20. Fostering Ownership and Leadership Sustainability of Membership Identify local leaders Start at the level comfortable for the leader Have method to support and train leaders Share leadership, give power to many

21. Lessons Learned Build the coalition so it can partially run it self Find and maintain solid leadership Build and maintain trust Always maintain open communications Don’t tackle a coalition breaking project Focus on the things you can do together Leave the ones you don’t agree on until a future time when you may bring them up again and may than find a compromise

22. Never Let It Rest The process must be attended to Evaluate the work of the coalition as well as the programs Continue to recruit and engage new people Share leadership * Toot your own horn, if the community knows what you do they will help do more of it

23. Contact info : Richard D. Silverberg CCNTR rsilverberg@ccntr.orgrsilverberg@ccntr.org http://www.ccntr.org 603 934-0177 Questions?