Center for Healthy Living

State: TX Type: Promising Practice Year: 2014

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The overall project goal is to implement innovative evidence based health promotion strategies such as use of community health workers and innovations in chronic disease self management for targeted populations. In addition, the following goals would be specifically addressed through the creation of this center: 

  • Identify Community Health Disparities in the targeted St. Louis Community,the City of Tyler and Smith County.
  • Identify and address preventable health needs of the target population
  • Implement chronic disease self-management programs
  • Provide access to screenings for individuals to manage chronic diseases
  • Increase health literacy and knowledge regarding health issues
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Northeast Texas Public Health District
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Center for Healthy Living
NET Health is the public health authority for Smith County and also serves 28 additional counties through its various departments. Located in Tyler, TX, NET Health provides many services to Smith County and the greater Northeast Texas region, including a Regional Laboratory, Milk and Water Testing, Restaurant and Food Inspections, Public Health Emergency Preparedness, Disease Surveillance, Immunizations, Tuberculosis Elimination, Women, Infants, and Children (WIC) Program, Environmental Health, Vital Statistics, Animal Control, Breast and Cervical Cancer Services, Susan G. Komen grant, Texas Comprehensive Cancer Control Grant, and the Community Transformation Grant. The City of Tyler has a population of 96,900 residents, however the reach of NET Health’s services extend to many other cities and counties in the Northeast Texas region. Prior to the creation of the Center for Healthy Living, the City of Tyler did not have any free health education resource centers. As a result, many local residents experienced chronic illness and associated complications simply because they did not have access to information and resources that could help them manage preventable or controllable chronic illnesses. In most instances, these disparities were most pronounced among African-Americans Tyler and Smith County. The overall project goal is to implement innovative evidence based health promotion strategies such as use of community health workers and innovations in chronic disease self management for targeted populations. In addition, the following goals would be specifically addressed through the creation of this center:  Identify Community Health Disparities in the targeted St. Louis Community,the City of Tyler and Smith County. Identify and address preventable health needs of the target population Implement chronic disease self-management programs Provide access to screenings for individuals to manage chronic diseases Increase health literacy and knowledge regarding health issues A brief description of the project implementation plan is outlined below and further detailed under "LHD and Community Collaboration and Implementation Strategy". A needs assessment of the St. Louis Community was conducted to collect baseline data and generate ideas for strategy and priority planning. A strong partnership with the City of Tyler for funding and utilization of and old Firestation. Stakeholders were engaged and the site of the Center was secured and renovated. Based on the findings of the needs assessment, evidence-based projects for the targeted population were identified and tailored to suit the needs of the community. Evidence-based projects for the targeted population were implemented, documented, tested and evaluated on an ongoing basis to determine efficacy and impact. Our primary objective, as outlined in our 1115 Waiver, was to establish self-management and wellness programs through the Center for Healthy Living using evidenced based designs with the following milestones: Develop evidence-based projects for targeted population based on distilling the needs assessment and determining priority of interventions for the community. Implement, document and test an evidence-based innovative project for targeted population. Increase participants in program by 5%. Execution of evaluation process for project innovation. Begin the evaluation process to determine increases in baseline data collected in years 2 and 3. Increase access to health promotion programs and activities. In recent years, the burden of chronic illness among low-income, uninsured and under-insured individuals in the United States has had a profound public health and economic impact on the country. Among diabetes patients alone, the uninsured have 79% fewer physician visits and are prescribed 68% fewer medication, yet have 55% more emergency room visits than the insured. Because this is a long-term project with the potential to impact many individuals, we anticipate that through the health education resources and chronic disease management programs offered at the Center, we can drastically reduce the burden of chronic illness in our local health district. Moreover, we hope that our program can serve as a model for collaboration between public health organizations, local municipalities and other interested parties.
The city of Tyler has a population of 96,900 residents that consists of 61% Whites, 25% African Americans, and 21% Hispanic or Latino.1 Smith County has a geographic area of 950 square miles, which includes rural areas and 11 incorporated communities. Between 2000 and 2010, Smith County has had a 20% increase in population. Smith County is the most populous county in Northeast Texas, with half of the population residing in Tyler. - The median household income for Tyler was $42,279 in 2010, below the Texas average of $50,920. - The unemployment rate in Tyler in 2010 was 7.3%, similar to the state average of 7.2%. - The poverty rate in Tyler (15%) is slightly higher than the Texas average of 13%. Lack of access to free health education and chronic disease prevention resources in the City of Tyler and surrounding area has led to an increase in unhealthy behaviors, risk factors preventable chronic illness and incidence of chronic disease compared to state and national averages. Recent health data from the 2011 County Health Rankings indicated that 22% of adults in Smith County smoked compared to the national benchmark of 15%, and 28% adults were obese compared to the national benchmark of 25%. The County Health Rankings also noted that at least 25% of the population had inadequate social support related to health issues and only 56% of the population identified access to healthy foods. The above mentioned statistics indicate some alarming health trends that are further confirmed by chronic illness statistics for the region. In 2009, the Tyler MSA had a lung cancer rate of 57.4 as compared to the State’s rate of 45.7. In 2007, Smith County – which is largely populated by the city of Tyler – had a cardiovascular disease prevalence of 15.2%, which is almost double the State’s prevalence of 8.3% (Texas Department of State Health Services). Additionally, from 2005 to 2010, Smith County residents accrued $134,966,405 in preventable hospitalizations as it relates to Congestive Heart Failure, $18,181,713 related to High Blood Pressure and $18,733,608 in Diabetes short-term care. Although the health indicators for the general population provide sufficient cause for concern, statistics for minority and low income individuals are much more alarming. In 2008 the rate of high blood pressure among African-Americans in Smith County was 43%, compared to 20% of the general population in Texas, and approximately 45% of African Americans in Region 4/5N were at risk for obesity and 79% were at risk for being overweight, (significantly higher than the state’s risk of 32% and 67% respectively). Recent data (2008) from Region 4/5N of Texas (which include the City of Tyler and Smith County) estimates that 83% of Hispanics and 45% of African-Americans (compared to 28% of Caucasians) had not had their cholesterol levels checked in the previous 5 years. Additionally, 41% of African Americans 50 years of age and older have never had a sigmoidoscopy or colonoscopy (higher than the state’s average of 33%) and 42% of African American women 40 years of age and older have not had a mammogram in the past two years (higher than the state’s average of 30%). In the same year, 28% of African Americans could not see a doctor because of cost (higher than the state average of 19%) and 29% of black individuals did not have health insurance (higher than 16% of white individuals in the same region). The targeted demographic for the proposed project is the city of Tyler and more specifically the St. Louis Community, where the Center for Healthy Living will be located. The St. Louis community is a residential neighborhood that is located north of the intersection of Loop 323 and State Highway 155, between Old Noonday Road and Walton Road. Census block group 000700-3 information was used as data for the St. Louis community, as it is inclusive of the target population. - Approximately 65% of the residents in the St. Louis community are African American, higher than the 75701 average of 24% and the state average of 12%. - The per capita income for the St. Louis community in 2010 was $11,789, lower than the state average of $24,870. - The average household income for the St. Louis community in 2010 was $23,440, significantly lower than the 75701 average of $64,601 and the state average of $70,777. - Approximately 44 % of residents in the St. Louis community live in poverty, significantly higher than the 75701 average of 14% and the state average of 13%. - The female population (63%) is notably larger than the male population of 37%. - As of 2010, approximately 70% of females 16 and older were employed while only 31% of males 16 and older were employed. - The average number of female widows is 34%, significantly higher than the state average of only 8%. The Saint Louis community consists of 4,312 individuals including 1,668 households. At this time, the percentage of the target population that has accessed the Center’s services is less than 1%, however because the Center is still in the initial stages of an ongoing implementation, we anticipate that the programs reach will extend throughout the Saint Louis community and beyond. Currently, in Tyler, there are 2 private medical centers, 1 university medical center and 2 low income medical centers. Although the private and university medical centers provide excellent care for the insured and those who can afford to self-pay for services, low-income citizens are not able to access providers for preventative and chronic disease management services unless their health condition warrants a visit to the emergency department. Additionally, the low income health care providers do an excellent job of serving the working poor, however they restrict their services for individuals who can prove employment through pay stubs for the previous month, and they require that services be paid for in full before each visit. All of these institutions fill a valuable need for the City of Tyler and many offer preventative services to patients affiliated with the service institution, however the often eligibility restrictions and associated costs often limited the most marginalized citizens from participating in the programs. For years, NET Health has partnered with the City of Tyler and other local health agencies to improve the health and quality of life to all area residents, including the most disparate populations. Through the Fit City Challenge Coalition Initiative and Lighten Up East Texas, NET Health has empowered city residents to set and achieve healthy weight and health care goals through behavioral change by incentivizing success of individuals who undertake the initiative. Additionally, NET Health’s Community Transformation Grant and associated programs help to improve the health of all citizens by implementing and supporting sustainable structural and environmental changes that promote healthy behaviors for local residents. Lastly, NET Health’s Breast and Cervical Comprehensive Cancer Services program provides access to free breast and cervical cancer screening for eligible residents. In short, although the City of Tyler, NET Health and local health and social service organizations are all committed to making Tyler a healthier city, the lack of access to free preventative health services and screenings as well as health education and chronic disease management resources limit the attainability of this vision. The project bridges the gap between prevention and primary healthcare for all residents, with particular attention to the uninsured and underserved population. This practice is innovative in that it utilizes existing tools and practices in a new approach that can be used as a model for future collaboration between cities/ municipalities and local public health districts to increase access to preventative health services. Some of the tools used to provide services to program participants include: - Diabetes Education and Empowerment Program (D.E.E.P.)- Community-based education - Wisdom, Power, Control: Diabetes self-management via faith-based organizations - Getting Healthier Together Lifestyle modification / CDSM Health Outcomes Evaluation - “Cooking Matters”References Include: CDC: The National Diabetes Prevention Program http://www.cdc.gov/diabetes/prevention/recognition/curriculum.htm TMF Health Quality Institute: Diabetes Education Empowerment Program http://texasqio.tmf.org/Networks/HealthforLifeDiabetesInitiative.aspx National Heart, Lung, and Blood Institute: Community Health Worker Heart Health Training and Community Education Curriculum https://altarum.adobeconnect.com/_a758956138/p2c1ys0wxdd/ Pfizer: Getting Healthier Together http://www.gethealthystayhealthy.com/ Pfizer: Beat the Pack http://www.ehpco.com/_PDFs/BeatthePack.pdf
Nutrition, Physical Activity, and Obesity|Tobacco
According to the DSHS, “Communities can potentially prevent hospitalizations by encouraging an increased level of aerobic physical activity, maintaining a healthy weight, limiting the consumption of alcohol to moderate levels for those who drink, reducing salt and sodium intake, and eating a reduced-fat diet high in fruits, vegetables, and low-fat dairy food” (Texas Department of State Health Services, 2012). The goal of the project is to directly provide health services, prevention and screening programs and chronic disease self-management to the Saint Louis community by addressing the issues of access to healthcare for the low-income, uninsured community as well as identifying and eliminating health disparities. Our primary objective is that the citizens of Tyler, and specifically the citizens of the Saint Louis Community, will have an improved quality of life and be able to take charge of their own health status and view NET Health as an integral part of the community structure and as a credible source of health information. This project also hopes to lower the number of preventable hospitalizations as well as reduce health care costs for our region. An evidence based approach to community planning was utilized throughout each phase of the practice including the assessment, planning, implementation and evaluation. - Stakeholders were engaged and the site of the Center was secured and renovated. - Based on the findings of the needs assessment, evidence-based projects for the targeted population were identified and tailored to suit the needs of the community. Evidence-based project for the targeted population were implemented, documented, tested and evaluated on an ongoing basis to determine efficacy and impact. Multiple methods and samples were used to assess the baseline health status and health needs of our target population. Method 1: County Wide Survey The Smith County Community Health Needs Assessment Survey was designed to collect specific information from respondents, to identify basic demographics, rank their overall health status and behaviors, and provide insight about particular needs within their community. Multiple data collection tools and methods were used for this needs assessment, including both qualitative and quantitative. Data was collected through the use of paper and online surveys and focus groups. Of the surveys distributed, 399 completed surveys were returned and 84 of the surveys were representative of the 75701 zip code, which is inclusive of the St. Louis Community. Additional data was also collected from national, state, county, and local sources. Each person surveyed was asked a series of questions that focused on the respondent’s demographics, overall health status, and concerns for community health improvements. Review of the data provided information on several key indicators of health within the community. Individual’s responses identified the following health needs: sidewalks, crosswalks, bike lanes, parks and walking trails, community garden, affordable exercise classes, tobacco-cessation resources and educational programs on health effects of smoking/tobacco use. Method 2: Community Feedback Purposeful convenience sampling was used to select groups of individuals who reside within the St. Louis community and the greater Tyler area. Patrons and church staff/volunteers of the food pantry at the St. Louis Baptist Church were interviewed, as well as students and staff at a diabetes education group held at Bethesda health clinic in downtown Tyler. Focus groups and key informant interviews were conducted for the purpose of gathering data regarding perceived health needs among community members. Such “grassroots” information will allow NET Health personnel to identify community needs and develop programs that area residents want to see put into practice at the Center for Healthy Living. The interviewees selected were given the following open-ended prompts: - Would you say that none, some, most, or all of the people in your community have a regular healthcare provider? What do you think are the biggest obstacles for people in your community to get regular health care? - What do you think your community’s health needs are? That is, what do you think the biggest health problems are for the community? - What kinds of health-related programs or services would you like to see put into place in your community? What programs do you think you would be interested in attending yourself if they were available? Method 3: Community Wide Survey Purposeful convenience sampling was used to select groups of individuals who live within the St. Louis community and the greater Tyler area. Patrons and church staff/volunteers of the food pantry at the St. Louis Baptist Church completed the health risk assessment survey. 34 participants were administered and completed the “Health Risk Reduction Evaluation Form”, a 20 question survey designed to assess individuals’ knowledge, feelings, skills, and action plans related to specific health topics Additionally, a town hall meeting-like open forum was conducted at the same time as the community feedback focus groups and key informant interviews for the purpose of gathering data regarding knowledge of health risks among community members. Results of County and Community Needs Assessment All quantitative data from all 3 methodologies was evaluated using SPSS and other quantitative software, and all qualitative data was content analyzed. Perceived barriers to regular health care and community health needs were identified and prioritized. Based on the discussions with community informants, many individuals did not have a regular healthcare provider. The biggest obstacles regarding access to health care are cost of care and medications included: lack of insurance coverage, and lack of readily accessible transportation to get to and from the provider and a pharmacy if necessary. It was also mentioned that individuals who have difficulty obtaining regular health care may not know or understand what resources are available to them. Of key concern to the people was the closure of the local federally-run health clinic to which many went to for assistance. Community members voiced that they and many people they know were having difficulty making appointments to see a new primary care physician, especially since they were having issues obtaining their medical records from the federal clinic. Based on this feedback, the following health needs and problems in St. Louis and the greater Tyler area were identified as perceived by community members: diabetes, cardiovascular health, pulmonary health, hypertension, cancer (all-site, prostate, and breast), tobacco use, alcohol and drug abuse, mental health, dental hygiene, obesity, arthritis, osteoporosis and mental health . Community respondents also had had many ideas for health programs and services that they would like to see in the St. Louis community. These ideas included: - Dental hygiene promotion - Tobacco cessation programs - Immunizations and screenings - General health education (adults and youth) - Support groups (disease- and age-specific) - Youth education programs about drug abuse - Availability of a clinician to answer questions - Nutrition education, particularly how to read labels - Prevention education (communicable and chronic disease) - Chronic disease-specific education (diabetes, hypertension, etc) - Education of area physicians/providers about local resources so they know where they can refer patients for assistance - Promotion of local resources so individuals know what kinds of assistance are available and how to obtain them - More areas for physical activity: recreational areas, parks, and safer sidewalks and crosswalksPlanning With a clear understanding of community needs, a vision was outlined by the leadership of the Northeast Texas Public Health District to establish the Center for Healthy Living, a free health education resource for residents of the St. Louis community and the greater City of Tyler. Strategic planning that included collaboration from city, community and partner organizations began with the goal of addressing the preventative health needs of the community. Generous funding from the 1115 Waiver and the City of Tyler was secured, and NET Health was able to procure and renovate an abandoned fire station situated in the Saint Louis community. Culturally sensitive and evidence based community health tools were identified through partner organizations including TMF Health Quality Institute, the National Heart Lung and Blood Institute, Pfizer, AgriLife and Texas AandM Extension Agency. A CHES certified Program Coordinator was recruited and hired to oversee the implementation and management of the project and Certified Community Health Workers already employed at NET Health were further trained in the selected evidenced based health education curriculum. Implementation The first step of the implementation was to establish the Center for Healthy Living, the site of all future programs and outreach, located in the Saint Louis community where the target population resides. The Saint Louis Community was informed about the services that the Center would offer through established NET Health channels including, city-wide and demographic specific media outlets, health care and social service agencies and institutions, and area churches. After a highly publicized and well attended opening ceremony, community members began to utilize services at the Center. Every new patient that enters the Center is offered a free health screening, which includes glucose, cholesterol, height, weight, BMI, waist measurement and a written health risk assessment. During their initial visit for screening services or individual or group health education, patients are informed of the results of their health screening and provided free health education and counseling. Patients are also evaluated for various cancer screening services and eligible patients are then referred to other NET Health agencies or partner organizations for continued service. Patient demographic and medical information is stored in a secure database and CHWs follow-up and track patient outcomes throughout their participation in all programs affiliated with the Center for Healthy Living. Evaluation Process evaluation is continually conducted by NETHealth leadership and the staff of the Center for Healthy Living to ensure that current processes are in line with the stated objectives for the Center and identify potential areas for process improvement where needed. Additionally, monthly, quarterly and annual evaluations are reported to funding sources at regular intervals. Because this particular program is ongoing, assessment, planning and evaluation are continued throughout the implementation phase. The program is adaptable so that when new community needs are identified, additional programs and services are implemented to meet those needs, and when services are deemed to be ineffective or unnecessary, they are phased out. At this time, there is no eligibility requirement to participate in or receive access to any of the free services offered at the Center. However, 85% of our expected population is either Medicaid-eligible or low-income (200% FPL). This program is a long-term initiative with no anticipated end date.Community collaboration with stakeholders is a critical foundation to the successful implementation of the Center. Listed below are some of the strategic partnerships and the contributions that each organization made. These collaborations are ongoing with the LHD. City of Tyler - Funding and Facility - Stakeholder Meetings with City - Quarterly meetings with Tyler City Manager Mark McDaniel and City Councilman Darryl Bowdre - City Council approval of facility designation and program - Lease agreement with City The Texas Department of State Health Services - Screening Supplies and Training - Collect and Assess Screening Supplies - Community Health Nurse to train 2 CHW’s on appropriate screening procedures and process - Provide technical assistance to the Center for Healthy Living University of Texas at Tyler Collect Data through Community Health Needs Assessment and Develop Strategic Plan for Center for Healthy Living - Focus Groups Feedback Complete - Strategic Evaluation based on needs complete - Ongoing Evaluation of baseline data and analysis through SPSS East Texas Food Bank - “Cooking Matters”, “Project Strength” Educate cooking techniques that increase nutrient density of family meals - Number of Nutrition and Cooking Classes provided at the Center - Number of participants in the program - Direct Individual Health Outcomes as a result of participation in programs Texas Medical Foundation Diabetes Education and Empowerment Program (D.E.E.P.) Community-based education - 2 Certified CHW’s certified as D.E.E.P trainers, TMF Train the Trainer, May 1 – 3 - Partner with TMF on TMF/Campbell Diabetes Media Campaign - Ongoing continuing education for CHW's and Center staff - Number of participants in the DEEP program at the Center for Healthy Living - Direct Individual Health Outcomes as a result of participation in program Texas AandM AgriLife Extension Agency Wisdom, Power, Control Diabetes self-management via faith-based organizations - Increase the involvement of minority faith-based organization for involvement in self-management programs and health promotion within their community - Host Wisdom, Power, Control at the Center for Healthy Living and other faith-based sites within the community - Number of participants in the Wisdom, Power, Control program at the Center for Healthy Living - Direct Individual Health Outcomes as a result of participation in program Many other critical partnerships include: UT Health Northeast, East Texas Medical Center, Trinity Mother Frances, NET Health Departments, East Texas Academy of Nutrition and Dietetics, Brookshire's Grocery Company and many more. FY 2013 Proposed Income Statement Revenues1115 Waiver Funding 99,000 City of Tyler 66,000 Other Funding 20,091 Personnel 93,250 Supplies Software 11,300 Office and Medical Screening Supplies 28,145 Total Supplies 39,445 Contractual Services 3,755 Fringe Benefits 21,774 Travel 1,665 Space Rental 18,000 Utilities, Printing, Internet 25,202 Total Other 25,202 Total Expenses $185,091 Also important to note as it relates to the budget and not included in the general operating expenses listed above, the approximate cost of renovation to the fire station was $100,000 as well as a discretionary project for digital sign in the amount of $40,000.
The goal of the project was to directly provide health services, prevention and screening programs and chronic disease self-management education to the Saint Louis community by addressing the issues of access to healthcare for the low-income, uninsured community as well as identifying and eliminating health disparities. Our primary objective is that the citizens of Tyler, and specifically the citizens of the Saint Louis Community, will have an improved quality of life and be able to take charge of their own health status and view NET Health as an integral part of the community structure and as a credible source of health information. This project also hopes to lower the number of preventable hospitalizations as well as reduce health care costs for our region. Through the creation of the Center for Healthy Living, NETHealth is able to provide continued health services, prevention, screening and chronic disease self- management education to the Saint Louis community and the greater Tyler area. We have successfully investigated and addressed many of the issues that Saint Louis residents face regarding access to healthcare for the low-income, uninsured. We anticipate that as we continue to offer this service to the community we will continue to discover new areas for improvement to the program for the community. Regarding our objectives for increased quality of life for program participants and decreased hospital utilization rated for the region, we realize that the impact of our service may not be immediately apparent and thus will require more time before evaluation is completed. We can say that participants undergoing our chronic disease self-management classes have continued to document increased knowledge and awareness about their disease and how to manage it. Primary data sources were collected by Certified Community Health Workers for each patient at various time points during their participation in the practice. All new patients were administered a comprehensive health screening including blood pressure, glucose, cholesterol, height, weight, waist and BMI measurements. Additionally, a written quality of life survey (using instrument (AQOL-8D) and a University of Michigan style health risk assessment was administered. These measures were administered before and after participation in each self-management course to determine health status, behavior and quality of life changes resulting from the intervention. Many of the self-management courses included additional assessment tools to evaluate progress. All data collected was retained in an electronic data base for further evaluation. Anecdotal data of the outcomes of individual patients was also documented. Funding from the 1115 Waiver also requires the following performance measures be completed and reported: - An annual increase in program participants by 5%. - Bi-weekly interactions with other providers and the RHP to promote collaborative learning around shared or similar projects. Quantitative data was analyzed using SPSS and other statistical software. Qualitative data was analyzed using content analysis. Modifications are continually being made to the practice as a result of data findings based on ongoing, assessment, planning and evaluation are continued throughout the implementation phase. Whenever new needs are identified, additional programs and services are implemented to meet those needs, and when services are deemed to be ineffective or unnecessary, they are phased out.
Through our extensive community assessment, we learned many valuable lessons about the health care needs of the population we serve. Through the establishment of the Center for Healthy Living, we learned that that many low-income, uninsured and underinsured individuals in our local health district had limited access to care and/or little knowledge of how to access available care. We encountered many individuals with basic health needs for which community resources were already available yet they did not know how to access them. We also learned that NET Health and other local public health agencies, have unique capabilities to provide resources to underserved individuals based on the wealth of knowledge and resources that we have to offer and the established trust that we have developed with all citizens, including the most disparate segments. We learned that municipal and community leaders were eager and willing to provide collaboration and support to help meet the health needs of our most underserved citizens. City leaders have been eager and earnest in their commitment and contributions to this initiative throughout the duration of the implementation of this project and have pledged support for years to come. We also learned that local, regional and national health partners can provide many existing evidenced based community health tools that can be tailored to meet the needs of our population to teach community members how to manage their disease. This practice is better than what has been done before because it drastically increases access to preventative and health education resources to low income individuals at a relatively low annual cost. No formal cost benefit analysis was undertaken, however during the planning phase of this project, NETHealth and community stakeholders assessed the baseline costs associated with management of preventative, controllable and chronic disease measure (ER admissions and hospitalizations) and determined that the benefit of implementing the proposed program far outweighed the estimated costs. NET Health has been intentional about engendering and maintaining stakeholder commitment in every phase of this project. Because elected officials in the City of Tyler recognize the need for targeted public health programs geared toward the City’s most disparate populations, City leaders including the Mayor, Members of the City Council and the City Manager, have been integral in program development from the start and have pledged their commitment and support for the program for years to come. Their input has been both tangible and intangible including provision of the building that serves as the site for the Center, much needed financial resources and suggestions and feedback throughout the process. In particular, the City Councilman for District 2, the district of the city in which the Center is located, is a resident of the St. Louis and pastors one of the five area churches. NETHealth has continually elicited suggestions and support from him and other area church and community leaders and individuals. During the assessment and planning phases, NETHealth implemented surveys, focus groups and individual interviews to ensure that all programs were tailored to community needs and interests. As the program was implemented, the community continued to engage and illicit feedback from community members throughout the process. NETHealth is in the process of establishing a community Advisory Board and Ministerial Alliance to ensure that all future programs are consistent with the needs of the targeted St, Louis Community. By ensuring that the community is invested in program development and by providing programs that directly respond to community needs and wishes, we anticipate that community stakeholders will continue to be engaged and committed to the vision of the Center for Healthy Living and the overall success of the program for years to come. Continued financial support will be provided by the City of Tyler in the amount of $66,000 for the next 5 years. NETHealth is also in the process of obtaining accreditation for our Diabetes Self-Management Education program which we anticipate will serve 100 participants in the first year and more in years to come. Other community funding sources for our cancer prevention and other sources are currently being investigated to not only sustain, but expand the services offered at the Center for Healthy Living.
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