Community-Driven Strategies to Address Stigma and Build Healthier Communities in Maine

This paper tells the story of three communities that are working to reduce stigma in order to create more equitable systems that enhance the health and well-being of all Mainers. Their efforts grew organically from community member stories about how they were treated in various systems, driving collaboratives to shift resources toward stigma reduction. These communities realized that if they didn’t do some deep work around community mindset, their system change efforts would not produce the health outcomes they hoped for, and the benefits of their system change efforts would not be felt equally by all of the residents of their communities.

The Bangor Area’s Approach to Addressing Substance Use Disorder

Like many communities in the United States, Bangor, Maine has been struggling with the opioid epidemic. This case study shares how the Bangor community is using two types of MeHAF grant funding to address some of the most critical gaps related to opioid use disorders. The strategies of each grantee target different gaps in the continuum of care in the Bangor area. The report profiles three major activities of the Access to Quality Care (A2QC) grantee, Penobscot Community Health Care, and the Healthy Communities (HC) grantee, Bangor Public Health and Community Services.  These organizations are implementing: pain management/opioid prescribing protocols for providers (A2QC), “warm handoffs” of patients with substance use disorder from the emergency department/urgent care to primary care (A2QC), and recovery coaches (HC). Each profile includes a description of major progress to date, lessons learned, and evaluation. The report then summarizes how the two initiatives are engaging community members in these activities – an important aspect of their work and a core requirement of these MeHAF grant programs.

Healthy Waterville: Increasing Connectedness and Healthy Food for All

MeHAF’s Healthy Community initiative supports long-term, community-led efforts to improve health. Grantees have been charged with engaging people who are usually left out of planning processes in order to identify a priority health issue to address as a community and to employ collaborative processes to create comprehensive plans to integrate health, community-based services, and other sectors in such a way that they improve systems and community health. In the current implementation phase of this multi-year effort, 11 grantees are implementing their plans. Throughout, they have supported community-driven solutions to addressing barriers to health.

Healthy Waterville selected food insecurity and access to healthy foods as its primary health issue. Food insecurity affects low-income individuals and families of all ages. In Maine, an estimated 200,000 Mainers are food insecure. This case study describes how Waterville is approaching the issue of food insecurity. It describes the ways in which diverse organizational partners and community members are informing the design and direction of project activities, the progress they are making, the challenges they are facing, and the lessons they are learning along the way.

Patient Information Sharing Framework

MeHAF’s Access to Quality Care (A2QC) program was established to help health care and social services providers implement transformation of care delivery in ways that are informed by and address the needs of individuals who are uninsured.  As new payment and quality improvement strategies are put into place for all patients, the program sought to ensure coordinated, high quality services for uninsured individuals and those with particular barriers to care such as homelessness, mental illness, and substance use disorders.  One of the A2QC projects, the Mercy Hospital-led “Medical Neighborhood,” developed new ways of sharing patient data to support a new, patient-centered and holistic approach to delivering a broad array of services to some of Portland’s most vulnerable residents.

Building a Healthier Community through Conversation: The Oxford County Wellness Collaborative

Essential to MeHAF’s Healthy Community philosophy is to encourage communities to determine what they want to achieve, what they already have in place, what system barriers exist that they can collectively address without creating new programs or services, and what they need to create. The goal is to seed multiple aligned strategies and encourage diverse community stakeholders to tap into their area of passion.

MeHAF gave Healthy Community grantees the freedom to design a process that best suited their community context, assets, and needs. This case study tells the story of how one county employed a community conversation approach to gather information from a broad array of stakeholders to reach consensus on its priority health issue: social isolation and disconnection.

Evaluation of MeHAF by the Center for Effective Philanthropy

MeHAF regularly includes evaluation as a component of its grantmaking.  In addition, as a foundation that seeks to learn from and improve our own work, we periodically evaluate our grant processes and our relationships with grantees and applicants.  This helps us to understand how well we communicate our programmatic goals and interact with those who seek grant funding, as well as how effectively we support grantees.  The Center for Effective Philanthropy (CEP), a national organization that assesses the performance of philanthropic funders across the country, fielded a survey in late 2015 to MeHAF’s grantees and applicants to get their candid input on our work.

MeHAF rated particularly well in relationships with and support of grantees, but has room for improvement in our selection/reporting/evaluation processes, which grantees and applicants found to be relatively cumbersome and time-consuming.  To see more details about the survey results, see the PowerPoint presentation prepared by CEP.  Questions about the survey and the results can be directed to Vice President for Programs Barbara Leonard at ext. 102.

Thriving in Place Case Study: Reducing Social Isolation in Maine

For older adults, social isolation and loneliness can be a predictor of poor health, especially depression, other mood disorders, anxiety, and alcohol and drug abuse. This case study examines the efforts of four Thriving in Place (TiP) communities during their first year of implementation (November 1, 2014-October 31, 2015) to examine and reduce social isolation among older Mainers. The study is based on interviews with key partners, volunteers, and participants, site visits, and observation of collaborative phone calls among the four grantees.

MeHAF’s TiP initiative supports community-based, cross-sector collaboration among health care, social services, community supports, and volunteer networks to improve and enhance services for adults with chronic health conditions and/or disabilities to keep them in their homes and communities.

Payment Reform Program Evaluation

The University of Southern Maine’s Muskie School of Public Service served as external evaluators for MeHAF’s Payment Reform program, which was active from 2011–2014.  They developed three policy issue briefs that explore key issues related to the work of payment reform and health care delivery redesign: organizational change, access to and use of health data, and patient engagement.

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