Fired Up for Prevention - Center for Healthy Living

State: TX Type: Model Practice Year: 2016

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Community needs assessments revealed that low-income populations throughout Smith County, specifically African-American and Hispanic populations, are at a higher risk for high cholesterol, blood pressure, and glucose levels. In addition, low-income minority groups did not have the access to medical services and programs necessary to overcome health disparities and disproportionalities. Through a partnership, funding and dedicated facility provided by the City of Tyler, an innovative project, was created. Having recently relocated a fire station, the building was vacant, and the idea for the Center for Healthy Living was born helping Tyler and Smith County become "Fired Up for Prevention". East Texas has fully embraced the Center for Healthy Living and and the Center continues to provide support with new services. The Center for Healthy living provides chronic disease self-management, free glucose, cholesterol, blood pressure and BMI screenings, nutrition and cooking classes, health assessments, tobacco cessation information and classes, primary care referrals, navigation services and other evidence-based programs. Staffed by certified Community Health Workers and Promotoras, the clients at the Center for Healthy Living are able to take charge of their health, improve their quality of life and are able to manage their lifestyle outside of the provider office.

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Northeast Texas Public Health District
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Fired Up for Prevention - Center for Healthy Living
Northeast Texas Public Health District (NET Health) serves 21 counties in Northeast Texas. 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, Breast and Cervical Cancer Screening Services, Texas Healthy Communities, Fit City and the Center for Healthy Living.The Vision of the Northeast Texas Public Health District (NET Health) is through our collaborative efforts, Northeast Texas communities will be the healthiest in the State. Our Mission is to prevent illness, promote health, and protect our community. The Northeast Texas Public Health District exists to make Tyler a healthier community. Every resident is affected by our services DAILY.Smith County has a population of 209,714 residents, however the reach of NET Health’s services extend to many other cities and 21 counties in the Northeast Texas region, with an estimated reach of 500,000 individuals. Community needs assessments revealed that low-income populations throughout Smith County, specifically African American populations, are at a higher risk for high cholesterol, blood pressure, and glucose levels. In addition, low-income African American populations did not have the access to medical services and low-income programs necessary to overcome health disparities and disproportionalities. Tyler, located in Smith County, is a medical hub for East Texas. Many citizens from outlying counties travel to Tyler for medical treatment and based on previous program experience, if a Center for Healthy Living was established in a Tyler neighborhood, clients would travel from all over to gain access to health screenings and services. The overall project goal is to implement innovative, evidence-based health strategies such as use of community health workers, innovations in chronic disease self-management for targeted populations. In addition, the following goals are specifically addressed through the creation of this center: · Identify Community Health Disparities · 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 was conducted to collect baseline data and generate ideas for strategy and priority planning. · 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 was to establish self-management and wellness programs through the Center for Healthy Living using evidence-based designs with the following milestones: Milestone: Develop evidence-based projects for targeted population based on distilling the needs assessment and determining priority of interventions for the community. Outcome: Collection of baseline data through community health needs assessment. Milestone: Implement, document and test an evidence-based innovative project for targeted population. Currently, there have been 78 participants in the diabetes self-management program and 21 participants in Cooking Matters. Outcome: Have 250 individuals with documented screenings, etc... In our first year of being opened 610 unduplicated individuals have received screening services, with 407 having an individual health assessment. Milestone: Execution of evaluation process for project innovation. Outcome: Begin the evaluation process to determine increases over baseline data collected. The Problem Area in Diabetes (PAID) survey was selected as an evaluation technique as well as assessing individual health outcomes. All of our milestones and goals have either been met or are on target to be met. We attribute much of the success to the collaboration and partnership of the City of Tyler at large, local and municipal elected officials, the St. Louis community, other stakeholders and partner health and social service organizations. The Center has been successful in assisting many clients who have been able to reduce their cholesterol, blood pressure, and/or blood glucose numbers. In addition, many of the clients have lost weight, and have begun to eat healthy. The Chronic Disease Self-Management classes continue to experience increased community participation. In addition, the staff is constantly receiving requests for additional types of classes. Customer satisfaction surveys and evaluation surveys reveal clients reporting improvement in the quality of life. Clients are also reporting that they are able to walk further without losing their breath and are able to "enjoy life again." www.healthyeasttx.org
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 target population for the intervention is the uninsured in Smith County (44,867 or 25%) and the minority population in Smith County (73,717). While direct services were provided to 610 clients during the first year of service, a comprehensive media campaign was conducted on self-management and wellness programs, as well as promotion of the Center for Healthy Living. The estimated reach for the media campaign through the following outlets, Tyler Morning Telegraph, TylerPaper.com, and CBS 19, was 103,732. Therefore, the estimated reach of the target population is 17.6% or 36,916 through direct services, media or community outreach. In the first year of service, which was celebrated in October 2014, the following populations were served: African-American: 38.7%, Hispanic: 51.2%, White: 12.6%, Asian American: 12.5%. 81.7% of the clients served were female, with the remaining 18.3% male. Furthermore, 80.6% were uninsured, 56.7% unemployed and the average monthly income: $957.83. 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 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 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. This practice is innovative partnership that involves a local municipality in public health initiatives, impact and success. Furthermore, the practice utilizes existing resources 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. The innovation of creating prevention services in an unused fire station and allowing the City to drive public health initiatives was crucial to its success. Having recently relocated a fire station, the building was vacant, and the idea for the Center for Healthy Living was born and Tyler and Smith County became "Fired Up for Prevention". This innovation has allowed NET Health to utilize existing, evidence-based chronic disease self-management (CDSM) programs in a community based setting. In our medically-centered community, individuals tend to rely heavily on the hospitals and providers to address their health issues. In addition to evidence-based CDSM, the Center for Healthy Living is staffed by certified Community Health Workers and Promotoras that offer extended care in a well-known, community setting. The development of an innovative program supported by a strong evidence base has put individuals in the driver's seat of their health, so that they may write their own book on how their health will dictate the quality of their lives. The establishment of the Center for Healthy Living utilized the five sections of the Community Toolbox, for guidance on developing an intervention. NET Health first conducted a Community Health Needs Assessment and then with strong partnerships, planned the intervention and engaged local stakeholders. One of the main driving forces that wanted the focus to be on prevention was a City Councilman. Currently, NET Health is focused on the sustainability for the Center for Healthy Living. Also, based on the Healthy People 2020, leading health indicators, the Center has established services under five of the twelve indicators, including: access to health services, clinical preventative services, nutrition, physical activity and obesity, social determinates and tobacco. Our goal for moving forward is to expand services within these indicators as well as add additional indicators, such as mental health.
Nutrition, Physical Activity, and Obesity|Tobacco
According to the Texas Department of State Health Services, “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 preventative health services, screening programs, chronic disease self-management and other evidence-based, and wellness programs to the 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 Smith County, 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 prevention services and health information. This project also hopes to lower the number of preventable hospitalizations as well as reduce health care costs for our region. The implementation plan included the following strategies and activities: - Coordinate key decision makers in City of Tyler and Smith County toward the development of operational procedures & reporting processes necessary for the Center o Conduct strategic planning and action plan(s) for successful operation o Modulate existing municipal resources to address disparities in health care access - Be a trusted source for public health information by properly orienting residents of the St. Louis community, City of Tyler, and Smith County about the Center for Healthy Living o Develop a self-management and wellness campaign with targeted populations and various distribution outlets o Promote services of the Center by referencing the method of distribution and perceived health issues defined in the needs assessment - Potentially impact preventable hospitalizations and unnecessary ER visits by uninsured, low income individuals by expanding the prevention services provided and steadily increasing the number of persons receiving services o Establish medical homes for uninsured and underinsured, low-income populations o Develop referral service for clients residing outside of Tyler o Computers for HHSC applications o Provide access to no cost health screenings o Establish Diabetes self-management programs o Promotion of behaviors that increase daily physical activity o Education of sustainable home-based agricultural projects o Education of cooking alternatives that promotes nutrient-dense diets - Participate in community coalitions to further address public health issues and build relationships with community leaders. o Actualize participation from community members who are not in health-related professions o Create self-sustaining coalitions that prosper without funding streams o Coalitions: Smith County Comprehensive Cancer Coalition, East Texas Community Food Coalition, Fit City, tobacco cessation/control coalition - Work with municipal and county stakeholders to expand outreach opportunities that minimize disparities in the Tyler MSA o Patient navigators for various social service agencies o Community health workers integrated as referral specialists o Bolster relationship among prominent civic leaders (e.g., Campbell family, municipal and county decision makers) o Engage pastors of neighborhood churches & small business owners in the community o Emphasize operating hours and scope of service o Integrate higher education institutions into coordinated community programming - Provide a monthly/quarterly public health presentation that aims to solve identified community concerns o Broad-based education related to a specific concern highlighted by community members o Public comments about specific community concerns are heard - community forums, discussion panels, workshops, etc. o Identified community leaders who live and/or work in the target community - Schedule training sessions and provide materials to enable concerned community members to provide presentations to appropriate constituency groups (coworkers, civic groups, churches, etc.). o Identified community members that would participate in train the trainer program to increase capacity in the uninsured and low-income populations - Schedule training sessions and provide materials to enable CHWs to provide for the needs of the community and increase knowledge and capacity of self-management and wellness. o Conduct Health Equity, Health Assessment, Screening, CPR, self-management and other training, as needed o Identify opportunities for continuing education - Quarterly evaluate challenges and processes for performance improvement o Conduct PDSA Rapid Cycle Improvement o Establish QA team Meeting o Identify a quality assurance coordinator The Center for Healthy Living was established to provide preventative services to all. Therefore, the services are open to all residents of East Texas, without geographic, income or insurance restrictions. The Center opened its door in October of 2013 and just recently celebrated its one year anniversary. Currently, NET Health is in a funding and facility agreement with the City of Tyler through 2017, with option for renewal. Also, the project is being partially funded through the Texas 1115 Medicaid Waiver, of which we are currently in year four of that funding opportunity, with the possibility of renewal. This program is a long-term initiative with no anticipated end date and NET Health is currently modifying the sustainability plan to include diabetes accreditation, reimbursement for community health workers, worksite wellness screening programs and support from local community partners. Strong Partnerships and planning are key to successful implementation. Below is the stakeholder capacity and planning utilized during early implementation. Texas Medical Foundation (TMF) - Diabetes Education & Empowerment Program (D.E.E.P.) - Community-based education - Provide diabetes education that can replicated among multiple populations - 2 Certified CHW’s certified as D.E.E.P trainers, Partnership with TMF on TMF/Campbell Diabetes Media Campaign. Texas A&M AgriLife Extension Agency - Wisdom, Power, Control - Diabetes self-management via faith-based organizations - Provide diabetes education to the African – American Population in Tyler/Smith County, Promote diabetes education among health educators in churches, 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. Pfizer - Getting Healthier Together - Lifestyle modification / CDSM - Health Outcomes Evaluation - Expand CDSMP resource availability and provide smoking cessation course to participants, evaluate Health outcomes over period of time, establish health outcome measurement, implement free tobacco cessation program and campaign in the community, implement CDSM in community setting. University of Texas at Tyler - Center for Healthy Living Program assessment and evaluation - Collect data through community health needs assessment and develop strategic plan for Center for Healthy Living, conduct focus groups, strategic evaluation based on needs, ongoing evaluation of baseline data and analysis through SPSS. UT Health Northeast - Facilitate 1115 Waiver reporting process, referral destination for abnormal FOBT clients, referral for primary care services, referral for other clinical programs, partnership with DSRIP Projects and Family Medicine for establishing medical homes with participants in self-management and wellness programs provided at the Center, participation in RHP 1 Meetings, coordination or referral services between Center for Healthy Living and UT Health Northeast. East Texas Medical Center – Breast and Cervical Cancer Screening - Offer Breast and Cervical Cancer Education and screenings through the Center for Healthy Living, educate on cancer screening, risk factors, etc.., mobile mammograms performed at the Center, increase breast screening rates of African American women in Smith County. Trinity Mother Frances Health System - Breast and Cervical Cancer Screening - Offer Breast and Cervical Cancer Education and screenings through the Center for Healthy Living, educate on cancer screening, risk factors, etc.., mobile mammograms performed at the Center, increase breast screening rates of African American women in Smith County. East Texas Food Bank - “Cooking Matters”, “Project Strength” - Educate cooking techniques that increase nutrient density of family meals. East Texas Academy of Nutrition and Dietetics - Pantry showcase and Label Reading - Educate the underserved population on label reading, shopping and decision making. Brookshire’s Grocery Company - Grocery store tours - Provide engaged shopping session with consumer nutrition specialist. The Texas Department of State Health Services - Screening Supplies and Training - Provide Blood Pressure, Cholesterol, Blood Sugar, Weight, BMI Screening supplies and training to the Center, 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. City of Tyler - Facility - To establish a facility in an underserved community for NET Health to establish a central location for self-management and wellness programs, stakeholder meetings with City with initial meeting on December 10th, 2012 with Tyler City Manager and City Councilman – quarterly meetings and monthly reports followed, City Council approval of facility designation and program, lease and funding agreement with City. The City of Tyler provided an initial start-up costs of $66,500 in addition to use of the building, this allowed NET Health to secure additional operational funding in the amount of $99,000, through the Texas 1115 Medicaid Waiver, bringing our total operational budget to $165,500 annually. During this first year of the program, in partnership with local organizations, NET Health secured approximately $62,500 in additional, unplanned funding, which allowed us to expanded services and add additional self-management programs within the first year of operation. Our annual budget still remains $165,500.
Our primary objective was to establish self-management and wellness programs through the Center for Healthy Living using evidence-based designs with the following milestones: Milestone: Implement, document and test an evidence-based innovative project for targeted population. Outcome: Currently, there have been 94 participants in the diabetes self-management program and 45 participants in Cooking Matters. Milestone: Have 250 individuals with documented screenings. Outcome: In our first two years of being opened 1,040 unduplicated individuals have received screening services, with 824 having an individual health assessment. Objective: To evaluate the impact of Community Health Worker led diabetes self-management education (DSME) on patients with diabetes in a community setting.   Process Evaluation: An evaluation process was conducted to determine increases over baseline data collected. The Problem Area in Diabetes (PAID) survey was selected as an evaluation tool for our DSMS program intervention using the Diabetes Empowerment Education Program (DEEP).The PAID measure of diabetes related emotional distress correlates with measures of related concepts such as depression, social support, health beliefs, and coping style, as well as predicts future blood glucose control of the patient. The questionnaire has proven to be sensitive to detect changes over time following educational and therapeutic interventions. A pre survey was given to participants prior to the beginning of a DEEP session and a post survey was given at the conclusion of the last class.  Primary Data Sources completed by screening clients and program participants include:  Patient Demographic Profile & Screening Assessment  Problem Areas in Diabetes Survey (pre and post)  DEEP Survey (pre and post)  DEEP Participant Profile  Diabetes and CV Risk Factor Assessment Secondary Data Sources include an access database compiled from the above forms with the following information:  Patient Demographics  Health Risk assessment  Problem Areas in Diabetes Survey (PAID) - pre and post  Diabetes Empowerment & Education Program (DEEP) Survey- pre and post Performance measures:   Outcome: Outcome information collected during the course of this project included, baseline and follow-up glucose, cholesterol, blood pressure, BMI and waste measurements for individuals who received screening services or participated in DSME. We also collected pre and post DEEP and PAID surveys for all individuals who participated in DSME. Lastly, we collected anecdotal and testimonial evidence on the impact of the programs from clients, providers and community members. Results were analyzed using simple, non-statistical calculations, including mean, median mode and range. Additionally, we conducted statistical analysis of demographic, biometric and survey data. Anecdotal and testimonial data was recorded and evaluated on a case by case basis and on aggregate using content analysis. In the past year, the Center for Healthy Living has provided individual health assessments to 525 clients, of whom 82% were female, 79% were uninsured, 56% Hispanic and 26% were African-American. The average BMI of clients screened was 32.4, the average glucose was 120.4, the average cholesterol was 194.4 and the average blood pressure was 130/82.  A sample (n=10) of return clients receiving follow up screenings between the dates of October 1st, 2014 and September 30th, 2015 was taken to analyze biometric outcomes following Community Health Worker intervention through health education and/or a diabetes self -management class. Results were analyzed using the average systolic, diastolic, total cholesterol, BMI, and glucose numbers before and after CHW intervention. On average glucose numbers after intervention decreased by 16 points; systolic by 17, diastolic by 8, and total cholesterol by 12 points. This data demonstrates how Community Health Worker intervention can improve health outcomes for clients in a community setting. In the same year, 45 individuals participated in the Diabetes Empowerment and Education Program, of whom 30 graduated, after attending at least  5 of the 6 classes. Biometric assessments, including blood pressure, glucose, cholesterol and BMI were administered to participants before and after participation in the DEEP program. Additional pre and post data was collected using the Problem Areas in Diabetes (PAID) Scale and a self-management instrument provided by Texas Medical Foundation Health Quality Institute. 90% of participants responded "Agree" to the statement "I can handle my diabetes" in the post-test (a 10% increase from the pre-test). Additionally, biometric assessments improved with BMI decreasing 1 point between the pre (37.6) and post (36.6) time point and PAID scores (for individuals who completed the pre and post-test) improved an average of 13.3 points.   Perhaps the most significant practice modification to date was observed through the collection of the demographic data. Based on the fact that the Center for Healthy Living is situated in a predominantly African-American community, we anticipated that the majority of our clients would be African-American. However, within the first week of opening the Center, we realized that we would likely have in influx of Hispanic clients as well. In fact, by the end of the second quarter, we began seeing more Hispanic clients than anyone else, and currently, Hispanics represent 53% of all of the individuals who have received screening services from the Center. As a result of these findings we have modifies our practice to include more Spanish-speaking staff. We are in the process of getting more Spanish-speaking staff trained in the DEEP curriculum and other CDSM programs. Another practice modification that took place as a result of our findings was the expansion of services. When addressing the needs of a community with inadequate access to health services, we realized that we could not simply focus on CDSM in a vacuum. The clients at the Center presented needs for other issues that we could feasibly address, but had not initially planned to in the program design. Some included cancer prevention, mental health and social services. In response to this, we quickly relocated NET Health’s Breast and Cervical Cancer Screening Program to the Center, which pays for mammograms, pap smears and diagnostic services for uninsured women through DSHS and Komen funds. Additionally, we initiated the Wise Woman Training Program that teaches African-American women how to host mobile mammography units in their communities and began offering mammograms at the Center once every other month. In response to mental health issues, we piloted a depression self-management with a local hospital and we currently host a monthly Alzheimer’s Alliance support group meeting. We are continually looking for ways to provide better services to individuals for increased risk of choric disease including individuals who are smokers, hypertensive, hyperglycemic and obese. We also have gained a greater awareness of community resources, as we regularly refer clients to outside programs for needs outside of our scope of service. We anticipate that the continuous measurement of process and outcomes will continue to guide our practice in the future to help us best meet the needs of the populations we serve. Additionally, in an effort to collect qualitative data, we have been collecting client impact stories. For example,  A Hispanic male came in for free biometric screening after feeling ill for over a week. His blood sugar was extremely elevated at 425 and blood pressure of 134/94 mmHg. He did not have insurance, nor an established physician. Our community health workers was able to get the client into a flow cost clinic asap,where he was diagnosed with Type II diabetes, placed on medication and enrolled in our DEEP program. At the conclusion of the 6 week session the client had reduced his glucose to consistent average in the mid 80s with a 15 pound weight loss and a blood pressure reading of 119/84 mmHg. The client expressed an increased ability to effectively manage his diabetes. He says he has adopted positive lifestyle changes that incorporate healthy eating, replacing water for sodas, and increasing physical activity.          =
Due to the location of the Center for Healthy Living, our anticipated, targeted population was uninsured/low-income African Americans. However, our largest population is currently Hispanic and growing. Due to this change in population, we have hired an additional certified Promotora. Additionally through our project, we learned that CHW's and Promotoras are highly effective in assisting a disparate population in controlling chronic disease outside of the health care system. Due to the unanticipated outcome and for expansion and sustainability, NET Health and the City of Tyler are currently collaborating on the possibility of an additional Center for Health Living strategically located within the largest Hispanic community in Tyler. Since this is the first year of implementation for the Center for Healthy Living, we have not yet don a cost/benefit analysis. Furthermore, we were not able to conduct a cost/benefit analysis because many of the initial costs were offset by other grant funded programs. Cost/Benefit analysis will be conducted in future years as part of the evaluation strategies. Partnership involvement and support has been exceptional and is allowing us to build a robust sustainability plan. Our current funding is a five- year funding opportunity that will be up for renewal in 2016. However, for long-term sustainability of the Center for Healthy Living, NET Health is working on becoming an Accredited Diabetes Education Center, so that we are able to bill for services. Furthermore, we are actively collaborating with a CHW workgroup, organized by the Texas Department of State Health Services, to ensure that the State of Texas understands the importance of the role of the certified Community Health Worker, within a community based setting and allow for future billing for their services, as well. The Center has also been heavily involved in Worksite Wellness, with some of the largest worksites in Smith County as well as a few contiguous Counties, and is currently developing a “menu” for companies to select from, that will support their current worksite wellness initiatives, but also impact and monitor individual employee health. Lastly, we are working with private health foundations, to address the gap in services identified by our project and ensure access to healthcare and prevention when services are unavailable. In the future, Northeast Texas Public Health District will work towards adding additional classes and workshops, based on suggestions from our clients, in order to enable them to take on additional responsibilities for their own health. Training will be offered to staff in order to providing more tools and resources for the clients. NET Health is also proving staff enrichment opportunities related to health literacy, health equity, and disparities and disproportionalities, in order to identify and address the root of the problems to better serve the citizens in the catchment area of the agency. In addition, the agency will continue to collaborate with local municipalities and counties to identify other potential locations to set up Healthy Living Centers.
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