Community Health Improvement

Volunteers in the garden
Employee volunteers in the garden at the Farmacy Garden launch party. (Photo by Frank Easton for Willing Hands)

Where and how people live, learn, work, and play has a significant impact on the health and well-being of the patients, staff, and broader communities served by Dartmouth-Hitchcock (D-H). Access to healthy foods, social isolation, access to parks, quality jobs, substance misuse, and family support – or lack of support – are among many factors that have a profound impact on health and well-being. Dartmouth-Hitchcock’s Community Health team mobilizes and facilitates partnerships between our clinical providers, academic experts, and community partners to improve these community conditions.

Over the past three years, based on priorities emerging from our FY2017 Community Health Needs Assessment (CHNA), our Community Health team has led, facilitated, or mobilized extensive work to improve community and clinical approaches to preventing substance misuse and suicide; and to providing care for persons with substance use and mental health disorders, including helping our communities address high priority issues related to opioid use disorders. As a result of these efforts, we have helped reduce hazardous alcohol misuse among teens, and helped Dartmouth-Hitchcock and our communities make it easier for members of our community to access substance use and mental health services, including evidence-based care for persons with opioid use disorders.

The Community Health team is proud of its accomplishments and will continue to explore new ways to meet the current and future healthcare needs of our community.

Greg Norman
Director, Dartmouth-Hitchcock Community Health

About Community Health at Dartmouth-Hitchcock

Greg Norman speaking with an event attendee
Greg Norman speaks with an attendee.

Our Community Health team is comprised of professionals with varied backgrounds in public health, social work, social innovation, emergency services, organization development and other disciplines. The department contracts with the New Hampshire Department of Health and Human Services to serve as the Regional Public Health Network for both the Upper Valley region and the Greater Sullivan County region of New Hampshire. We also contract with Substance Abuse and Mental Health Services Administration (SAMHSA) to bring drug-free communities funding and services to the greater Upper Valley region.

Zac Conaway and other D-H staff at the Farmacy Garden launch party
Zac Conaway, D-H Manager of Environmental Services with Chelsey Canavan, D-H Community Health Coordinator, and Chris Castles of Willing Hands at the Farmacy Garden launch party. (Photo by Frank Easton for Willing Hands)

Our Community Health team works with clinical and community partners to create a triennial Community Health Needs Assessment that explores health, public health, socio-economic, community leader and resident data to identify and prioritize the health needs of our communities. Using CHNA findings, our Community Health team serves as a catalyst to help Dartmouth-Hitchcock leaders, clinicians and community partners to implement policies, practices and programs to address these priorities and to build stronger clinic-community systems of care. While our team occasionally implements programs, our more frequent role is to build clinic-community partnerships to address these issues, mobilize resources and expertise and support these partnerships to take action.

Over the last three years, our work to address needs related to substance misuse and mental illness illustrates our approach to community health.

Mental Health and Substance Abuse Services

Dartmouth-Hitchcock’s 2016 CHNA identified a need for enhanced mental health and substance use services throughout the D-H service area. In response, D-H collaborated with our clinical and community partners to develop multiple new behavioral health initiatives spanning prevention, treatment, recovery and harm reduction capacities.

  • Recovery Coach Services. Community Health leaders worked with the D-H Emergency Department to provide on-site recovery coaching services to patients who request assistance in addressing substance use needs. Our Recovery Coaches now help about 25 patients per month to gain access to substance use treatment services and peer recovery supports.
  • Integrated Care and Care Coordination. In response to this identified need, Community Health staff helped Dartmouth-Hitchcock pursue State of New Hampshire contracts to help behavioral health services become integrated in routine primary care, a new model for primary care that includes routine screening for depression, anxiety and substance use; assists Primary Care providers to better care for patients with behavioral health needs; and has improved patient care coordination between clinical and community partners involved in caring for patients with more severe mental illness.
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    D-H Community Health Coordinator Angie Leduc at the ALL Together table
    ALL Together sharing substance misuse prevention information with the community at National Night Out in Lebanon, NH. Pictured, D-H Community Health Coordinator Angie Leduc with her daughter, Kaelyn.
    Medication-assisted treatment for opioid use disorder. Over the past two years, we sponsored a project manager and physician leader to consult with primary care and hospital teams to improve care for patients, including developing capacities and protocol for evidence-based medication-assisted treatment in primary care, hospital and Emergency Department settings. Dartmouth-Hitchcock now has more than 100 providers waivered to prescribe these medications. Our Community Health team is currently helping D-H’s Addiction Treatment Program engage community substance use treatment and other service providers to engage with Dartmouth-Hitchcock’s new State of NH-funded Doorway initiative to help persons with substance use disorders gain immediate access to needed treatment services.
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    Lebanon Police Detective Callie Barret and others at Drug Take Back Day
    Drug Take Back Day at Quail Hollow in West Lebanon. Pictured, Lebanon Police Detective Callie Barret, D-H Community Health Coordinator Bridget Aliaga, and Marvin and Marge Alexander.
    Safe medication and syringe disposal. Our Community Health team partners with multiple law enforcement agencies in the broader Upper Valley and Sullivan County areas to promote unused medication take-back and syringe disposal efforts, collecting more than 1,500 pounds of unused medications and more than 100 pounds of used syringes annually, removing these potential health hazards from our community and arranging for appropriate disposal.
  • Substance use prevention partnerships. Community Health supports substance use prevention partnerships that convene schools, police, health care, counseling, recreation and other partners to design and implement policies, practices and programs to prevent and reduce harm from substance use. In the Upper Valley and Sullivan County regions, our Community Health team directly organizes these efforts. We also provide funding for similar partnerships in Manchester, Nashua, Concord, and Keene, NH; and Windsor and Bennington, VT. Adolescent misuse of substances, particularly binge use of alcohol, is decreasing in most of these communities over the past 10 years, with our organizing financial support contributing to these successes.
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    Connect Suicide Prevention/Intervention training at Kimball Union Academy
    Connect Suicide Prevention/Intervention Training at Kimball Union Academy in Plainfield, New Hampshire.
    Suicide prevention. Our Community Health staff regularly provide community trainings in the National Alliance on Mental Illness (NAMI)-NHCONNECT Suicide Prevention curriculum, which teaches teens, parents, teachers and other non-clinical community members to identify early signs of suicidal thinking and to activate professional support to help prevent suicide. In 2017, we trained 33 community members in CONNECT, and recently trained others to be able to deliver this curriculum.
  • Strong Families, Strong Starts. Recognizing that experiences in early childhood have a profound impact on later substance misuse, mental health and overall health, in 2018, our Community Health team began working with pediatric teams, family resource centers and child care providers in the Upper Valley and Sullivan County regions to help improve care for families with young children who have income-related social challenges and other adverse experiences including parental substance misuse. This work has included training clinical and community service providers in trauma-informed care practices; bringing community-based family support services inside the walls of pediatric clinics; and improving communications and care coordination between parents, pediatric providers and community-based services. By working together to support these parents, we are helping build strong, protective and nurturing homes that foster healthy child development.

Strong Families, Strong Starts

When an adult family member is living with or recovering from substance use disorder, it affects every member of the household — including children. That’s why D-H developed the Strong Families, Strong Starts program, which provides personalized, consistent and targeted support for children from families that are affected by substance misuse and addiction.

The program — which is supported by a major grant from the Couch Family Foundation — is designed to support healthy early childhood development and help families navigate the challenges of parenting during an adult household member’s recovery from substance use disorder.

Through a partnership between our regional pediatric practices and family resource centers, our program aims to promote parent-child bonding and strong parenting skills while preventing adverse childhood experiences and helping families meet basic needs for food, employment, transportation, housing, childcare, clothing and medical care.

Strong Families, Strong Starts also aims to reduce the fear of stigma and judgment that some families may experience by offering services in the pediatrician’s office, where families already feel comfortable and supported because they have a relationship with a trusted healthcare provider.

Strong Families, Strong Starts was developed in response to survey findings that showed that addiction and recovery were often coupled with the need for additional services and support. Our program connects families with a range of services, including visiting services and parent education programs that can help prevent abuse, neglect, housing or food instability, and other adverse childhood experiences that can have long-term physical and mental health implications.

Community health goals

  • Identify specific public health needs by conducting routine CHNAs and analyzing collected data.
  • Develop a plan to address specific public health needs.
  • Engage community stakeholders and gather the resources required to deliver enhanced public health services.
  • Improve the health and well-being of people in the communities that D-H serves through enhanced delivery of health care services.

By the numbers

3,198 - Number of patients who received routine behavioral health screenings at their primary care clinic during our 2017 collaborative care pilot program

2,131 - Number of pounds of medication collected through medication take-back efforts in 2017

125 - Number of pounds of used syringes collected through syringe disposal efforts in 2017

33 - Number of community members trained in CONNECT Suicide Prevention

24 - Number of community members trained in Mental Health First Aid

5,701 - Number of teens who have been assessed for substance use and mental health concerns using DartScreen