Partners In Health White Paper Highlights HCGC involved work in Ohio
"Eligibility is Not Access: Prioritizing those most at risk in the next push of vaccine rollout"

Executive Summary: "Across the United States, expanded vaccine eligibility offers hope that within months enough Americans will be immunized to allow the safe resumption of normal activity. However, relying on a national vaccination campaign to resolve the COVID-19 pandemic is not so straightforward; even with open eligibility, our health system is not designed to ensure vaccine access and uptake for all. We’ve seen time and again that simply making health care available without understanding and eliminating barriers to access perpetuates inequitable outcomes. In response, Partners In Health (PIH) is supporting and co-developing pragmatic and sustainable solutions with local communities to meet the opportunities and challenges of COVID-19 vaccination.

To get to our new normal—safely reopening our schools, our businesses and our communities —we must achieve 70-90% vaccination rates. Critically, for disease control and population immunity, we must reach these rates everywhere, at the global, national, and local levels, and we must maintain them. If not, we will continue to see hotspots of infection surface and spread, with resultant disease and mortality, potentially driving the emergence of new variants.

Standing in the way of this goal are long-standing structural inequities that have led to a disproportionate burden of COVID-19 in certain communities. We must prioritize vaccinations for those most at risk and work together to establish a more responsive and community-centered public health system in the process.

Epidemiologic and social risk factors reinforce the need to prioritize older individuals, communities of color, and essential workers. To combat the structural factors that have resulted in these groups suffering disproportionately from COVID-19 and other health inequities, PIH is supporting a 3-pronged approach to rolling out vaccination and improving health outcomes:
1) increasing vaccine demand through community engagement;
2) ensuring adequate vaccine supply through resource allocation and operations;
and 3) leveraging the vaccination opportunity to invest in long-term public health systems.

It can be done. Our work in more than 15 locations across the country demonstrates how departments of health, community-based organizations, and others—regardless of where they are in the vaccine rollout—can take action alongside community leaders to ensure older adults, communities of color, and essential workers have the resources and information they need to get vaccinated. While the focus of this memo is the U.S., our work for equitable vaccination is not, and cannot be, restricted by national borders. Globally and locally, with a strong commitment to prioritization and targeted investment in the necessary resources, we can reach population immunity and stop COVID-19.

Much of our early learnings in community engagement and operations can be adapted globally; importantly, many of these lessons build on our global experience working to implement successful, equitable vaccination campaigns."

Click to read the white paper in its entirety...

Celebrating Two Years of the Central Ohio Pathways HUB

The month of March marked the two-year anniversary of The Central Ohio Pathways HUB (the HUB), a nationally certified care coordination model for Franklin and contiguous counties that is managed by the Healthcare Collaborative of Greater Columbus (HCGC). The HUB model is utilizing 11 care coordination agencies (CCAs) that employ over 40 Community Health Workers to assess medical, behavioral, and social risks for our most vulnerable neighbors and connect them with community resources to mitigate those risks. The HUB has served more than 2,500 clients, of which 80 percent represent minority or foreign-born populations.
 
Addressing Disparities Among Vulnerable Populations Amplified During Pandemic
While vulnerable populations disproportionately experience disparities and inequity, the COVID-19 pandemic has amplified disparities among underserved communities in the region and in communities where the HUB is currently serving clients. HUB CHWs have provided over 900 educations related to COVID-19 to their clients since the onset of the pandemic. There has been an exponential growth in education pathways regarding COVID-19 related measures, such as understanding stay-at-home orders, mask mandates, navigating telehealth appointments, and what to do if clients or their family members become ill. Now, more than ever, CHWs are finding themselves advising and connecting clients to important information on health insurance enrollment (including Medicaid), unemployment benefits, career education, food assistance, and guidance on attending prenatal and other preventative healthcare appointments.
 
“We are grateful to our local and state officials who have called for a renewed focus on racial, cultural, and economic disparity in light of how COVID-19 is disproportionately affecting people,” said Carrie Baker, HCGC President and CEO. “We are committed to providing the data necessary to increase equity, while simultaneously preparing our community health workers to support and protect our growing number of clients.”
 
In addition to educating clients, CHWs have also been working to educate and connect Central Ohio’s most vulnerable citizens with information on receiving a COVID-19 vaccination. At each encounter, CHWs are discussing the COVID vaccine with their client, providing evidence-based education to dispel unfounded myths, and assisting clients in finding a vaccine locations, appointments and transportation when needed.
 
Referrals from Community Providers and Organizations Based on Trust and Success
While Medicaid Managed Care referral partnerships remain steadfast and abundant, the HUB has built trust in the community over the past two years that has inspired several other community providers and organizations to begin referring at-risk, vulnerable members of the community into the HUB.  Ohio State University Wexner Medical Center, OhioHealth, The Columbus Metropolitan Housing Authority, City Attorney Zach Klein’s theft diversion program, and Franklin County Public Health’s Centers for Disease Control Opioid Data to Action initiative have all formed partnerships with the HUB to connect at-risk individuals with care coordination with a CHW. 
 
“Our referral partners recognize the value in providing evidence-based, proactive connection to care and services that can change the course of at-risk individuals lives.  By referring for coordination services with the HUB, providers and organizations know that their own systems will run more efficiently, providing an organized, successful experience for their patients and clients.  CHWs are trusted, reliable caretakers in their communities, and they work for some of the most incredible agencies in central Ohio, bravely navigating both before, during and after this pandemic. CHWs can not only help find, report, and decrease the spread of COVID-19, but also support clients hardest impacted by the pandemic to recover from the health, social and economic perspectives.” said HUB Executive Director, Jenelle Hoseus.
 
Since HCGC began managing the HUB in March of 2019, CHWs have made several impactful connections to care and services for some of the region’s most vulnerable citizens. 
 
Here is what we have seen:

• An average of 600 clients a month are served by CHWs in the HUB;
• In two years of operation, the HUB has served over 2,500 people in central Ohio;
• 71.8% of Pathways that were opened by CHWs on behalf of their clients were successfully completed (over 11,000 total), resulting in over $450,000 being reimbursed by Medicaid Managed Care and then sent back out to participating local CCAs;
• 92% of babies born to Black or African American mothers in the HUB were born at a healthy birth weight, compared to INSERT Franklin County numbers;
• 95% of participants in the theft diversion program partnership with City Attorney Zach Klein have successfully completed the program, accepting connection to the care and services to set them a path to success and wellbeing rather than incarceration and/or fines. 

“The HUB embodies possibility and hope. It’s infrastructure allows for intentionality and intimacy between client and CHW which is the life blood of the program. I was once in my client’s shoes – 3 ½ year ago I was a heroin addiction and living out of my car. My clients can see who and what I am today, yet know my story on where I was, and that breathes possibility and hope," said HUB CHW Matthew Demoulin who is employed by Franklin County Public Health, "The HUB Pathways allow me to live out a simple motto: To give back what was given to me. I had individuals show me a love and intentionality which allowed me to help myself out of a very dark hole. I try to do the same for my clients and the HUB Pathways gives me the platform to do so.”

 HCGC is proud to celebrate Black History Month, acknowledging and appreciating the impact that Black people made in our goal to find solutions that provide the best health to all people in the Columbus region. This month we are featuring two blogs from our partners at the Columbus Medical Association on Black physicians who have made significant impact in medicine.  Visit CMA's blog here: https://blog.columbusmedicalassociation.org/blog-1​. 

Celebrate Black History Month: Joycelyn Elders
by Annie Wilson, CMA
Joycelyn Elders is a pediatrician and outspoken public health advocate who served as the first African American Surgeon General of the United States.
Elders was born August 13, 1933, in Schaal Arkansas, to a family of sharecroppers and the first of 8 children. At 15, she entered Philander Smith College, a historically black liberal arts college in Little Rock, Arkansas, on a scholarship from the United Methodist Church. That same year she saw a doctor for the first time in her life and decided to become a physician herself.
After 3 years, she graduated and joined the Army. In 1956 she enrolled at the University of Arkansas Medical School in Little Rock on the GI Bill. At medical school, Elders was one of three black students and the only black woman student. While Elders was able to attend classes with her white classmates (the Supreme Court had declared separate but equal education unconstitutional two years earlier) she couldn’t eat with them at the white-only cafeteria. 
Elders graduated with her M.D. in 1960 and went on complete her residency in Little Rock where she was appointed chief pediatric resident and specialized in pediatric endocrinology. During this time Elders became an advocate for issues regarding adolescent sexuality, particularly teen pregnancy and contraception. 
By the late 1980s, 20% of children born in Arkansas were from teenage mothers, which then Governor, Bill Clinton, considered a social and fiscal crisis. So, in 1987 Clinton appointed Elders to the Office of Director of Public Health. During this time she instituted a controversial program to dispense contraceptives to public school students, promoted public awareness of AIDS and teen pregnancy, and successfully lobbied for a mandated K-12 sex education program that focused on personal responsibility, hygiene, and substance abuse prevention.
In 1993, Elders was nominated by President Bill Clinton to the post of. U.S. Surgeon General. She was only the second black person to be tapped for a cabinet-level position. Elders’ nomination was met with strong opposition from conservatives at the time because of her outspokenness on sex education, but she was eventually confirmed. As surgeon general, Elders focused on several health issues: tobacco-related disease, AIDS, and alcohol and drug abuse; she also continued her advocacy for sex education. She played an important role in Clinton’s early efforts to reorganize the health care system, and she regularly urged the public to consider unorthodox solutions to public health problems. Some of her suggestions concerning sex education in public schools, however, caused great controversy, and in December 1994 Clinton asked her to resign.
Elders returned to the University of Arkansas as a faculty researcher and professor of pediatric endocrinology at the Arkansas Children's Hospital. As of 2021 and now retired from practice, Elders serves as professor emerita at the University of Arkansas School of Medicine and remains active in public health education often advocating for comprehensive sexual health education and speaking out against teen pregnancy.

Sources:
https://encyclopediaofarkansas.net/entries/joycelyn-elders-2240/
https://cfmedicine.nlm.nih.gov/physicians/biography_98.html
https://en.wikipedia.org/wiki/Joycelyn_Elders
https://www.britannica.com/biography/Joycelyn-Elders

Celebrate Black History Month: Patricia Bath
​by Annie Wilson, CMA
Patricia Bath, MD, was an ophthalmologist and inventor of the Laserphaco Probe used in cataract surgery which resulted in her becoming the first black woman physician to receive a medical patent.
Bath was born 1942, in the Harlem neighborhood of New York City. When she was still a teenager, she received a scholarship from the US National Science Foundation, which led to an opportunity to join a research project at Yeshiva University and the then Harlem Hospital Center in New York. She stayed in New York for her undergraduate degree, studying chemistry at Hunter College, and then moved to Washington, DC, for her medical degree at Howard University College of Medicine. Bath interned at Harlem Hospital from 1968 to 1969 and completed a fellowship in ophthalmology at Columbia University from 1969 to 1970.
While at Harlem Hospital and Columbia University, Bath quickly noticed the eye clinic in Harlem had an extraordinary amount of blind or visually impaired patients compared to the few at Columbia. This observation led her to conduct a retrospective epidemiological study, which documented that blindness among black patients was double that among white patients. Bath concluded that the high prevalence of blindness among the black population was due to lack of access to ophthalmic care. As a result, she proposed a new discipline, known as community ophthalmology, which was grounded in her belief that “eyesight is a basic human right”.
Bath went on to join the faculty of UCLA Charles R Drew University of Medicine and Science. During this time, she began to think that emerging laser technology might provide a more precise and less painful way to remove cataracts and restore eyesight. Bath took a sabbatical from her positions in Los Angeles to pursue her research in Europe after experiencing numerous instances of racism and sexism. In 1988, after five years of research while in Paris, Bath invented the Laserphaco Probe. With this device, Bath was able to restore the vision of patients who had been blind for decades and it’s still used today. 
Bath died on May 30, 2019. 

Supporting CHWs as they Support the Community
By Tanikka Price, Director of Education, Central Ohio Pathways HUB
​
Technical Assistance support may conjure images of someone walking through how to use a computer program, or how to input data entry. Technical Assistance (TA) with Community Health Workers (CHWs) and their Supervisors in the Central Ohio Pathways HUB is so much more than that. HUB Director of Education, I approach every TA session armed with the knowledge that CHWs have a huge turnover rate, and that the assistance I provide may make the difference between this CHW remaining employed or not. General issues that CHWs face include burnout, time management challenges, unclear expectations and overwhelming personal issues.

Burnout
For most CHWs the opportunity to serve clients in their community is exciting. During Onboarding with the HUB, CHWs are warned of burnout in a session called “Self-care.” Meditation, exercise, a balanced diet, and boundaries with clients are explored as ways to manage the challenging work that is ahead of them as CHWs. They are trained to model and coach clients to a point of self-sufficiency, enabling the clients to advocate and do for themselves eventually as the relationship progresses. However, for some CHWs, they begin making appointments for clients, getting food for clients at the local food bank, picking up diapers and wipes from local agencies, and that gets taxing over time. So these CHWs are more likely to experience burnout. In our TA session, we work with setting boundaries and working smarter, not harder. We roll play talking directly to clients, not in a way that hurts their feelings, but in a way that garners respect and understanding.

Time Management Challenges
A calendar is a must for CHWs. Time must be managed. It is so easy to get derailed by an emergency call from a frantic client which takes up the entire day. In our TA session we discuss keeping a calendar which includes having time for breakfast, lunch and dinner (you’d be surprised how many CHWs don’t make time to eat during the workday). We also discuss building in time for time in Care Coordination Systems (CCS) our data system and time to reflect. For CHWs with a history of trauma or adverse childhood experiences, it is important to build in time to journal or, when necessary, therapy. Working with clients from similar backgrounds may be triggering, and it may be even more challenging to establish boundaries with a client who is struggling through something you can remember struggling through.

Unclear Expectations
Sometimes there is nothing more than a caseload and a data system and CHWs have to figure out on their own how to prioritize the work. In this case, our TA session may incorporate finding out what the CHW is unclear on and then meeting with the Supervisor to make sure we are all on the same page. A good example of this is- a CHW may think that being efficient at work is checking all the emails in a day, while the Supervisor may have an expectation that she contacts clients every day. Communication and clear expectations are the key to making sure that the CHWs work is aligned with the expectations of the agency.

Overwhelming personal issues
Sometimes life situations come up that feels unmanageable. It happens to us all. In our TA sessions, sometimes the CHW just needs a trusting ear with which to vent. There is no therapy that happens during TA sessions, but there are suggestions made regarding time management, self-care, and communication with administration that are helpful to CHWs during a time when personal issues threaten their employment. CHWs are strong and resilient and that is what makes them so effective. Sometimes they just need to hear that everything is going to be okay, and to be reminded that they have made it through before and they will again. In those situations where personal issues are so overwhelming that they are not able to fulfill their responsibilities as a CHW, they are coached in a way that they can always come back to gainful employment when the time arises. When appropriate, they are referred to mental health agencies, or other social service agencies. During one TA session, I noticed the CHW squinting to read the notes on the computer and immediately referred him to Divine Family Eyecare where he was able to get an appointment and get new glasses to perform his job more effectively! In other words, sometimes we have to be a CHW to the CHW.
​
Reducing turnover with CHWs begins the day they decide to do the work of a CHW. At the Central Ohio Pathways HUB, we take our mission seriously: we cannot serve the community without ensuring that the needs of our CHWs are fulfilled. We do that by providing TA sessions that can empower and encourage CHWs to continue on their path. 

HCGC Releases Latest Regional Quality Transparency Report
Innovations and Lessons Learned Amidst Pandemic
by Carrie Baker, President & CEO

Central Ohio providers continue to be open and transparent with one another about how they perform on specific quality measures with an eye on improving health and healthcare delivery across the region. HCGC is pleased to release our second Quality Transparency report of 2020 with data on nine clinical quality measures from 13 healthcare organizations representing over 223 primary care practice sites that are caring for more than 881,234 patients across Central Ohio. Our Quality Improvement Learning Group (QILG) has hosts quarterly work sessions for practices and quality improvement system leaders to evaluate regional performance, set goals, and align improvement activities at a system and practice level.
 
Since 2014, the report has been released twice a year, providing benchmarking, trends and important insights to help as practices strive for continuous improvement. Over the years, HCGC has increased the number of practices from just over 80 reporting in 2014, to 223 in the most current iteration of the report.  The number of quality measures has also increased as a result of the collaborative work of the QILG. 
 
For the first time, and amidst a global pandemic, contributors reported data on telehealth services provided by their practices. While several preventative screening targets were predictably under target, this report demonstrates that central Ohio providers rose the challenge of using innovation to provide access to care at the height of the COVID-19 pandemic. On average, practices performed over 1,000 telehealth appointments with patients during this reporting period. This data demonstrates that providers in the region prioritize the safety and healthcare of their patients. Providing telehealth services to patients allows for a continuum of care, while ensuring the safety of central Ohio patients from preventable exposure to the coronavirus.
 
HCGC has decided not to include social determinant of health (SDOH) data as it has done in the past
two QT reports. Over the last year, HCGC has been working with a data analytics firm to combine our
SDOH and clinical quality data in a more comprehensive way that highlights regional trends and
improvement activities going forward. We look forward to sharing our progress with partners in 2021.
 
HCGC and the QILG are grateful to our contributing practices for their continued commitment to transparency and innovation to meet the needs of their patients. If you are interested in joining the QILG, or contributing data to the report please contact HCGC President & CEO, Carrie Baker at carrie@hcgc.org. 

HCGC Hosting Six Part Webinar Series with Patient Centered Outcomes Research Institute 
by Heidi Christman, Director of Communications
The Patient Centered Outcomes Research Institute has funded HCGC to hold a series of webinars in late 2020 and into the first half of 2021. With an overall emphasis on health equity and eliminating disparities, the sessions will feature PCORI funded research, as well research and initiatives in Ohio.  The planning committee for this series consists of key stakeholder representatives of the HCGC Board of Directors.  Another important group working to inform the content and objectives for the webinars are a group of researchers from around Ohio that serve as PCORI Ambassadors.  The PCORI Ambassador Program is a volunteer network of individuals dedicated to changing the culture of health research. In their communities and nationally, Ambassadors are shifting how research is being done by partnering with researchers, leading engagement initiatives, setting priorities, and spreading the word about the importance of stakeholder-engaged research.  These two groups of diverse stakeholders have been instrumental in preparing and planning for what is sure to be a valuable learning experience for webinar attendees.

There will be three background-based pre-webinars in December and January.  The first webinar is tentatively scheduled for Friday December 4th, and will provide an overview of PCORI, their research, and HCGC’s ongoing relationship with PCORI to disseminate and convene a diverse stakeholder group to learn about PCORI research.  Two webinars will take place in January: Diversity and Inclusion Efforts in Ohio and Importance of Engaging Patients and their Families. Keynote webinars will begin in February and cover PCORI and other research based upon:

• Health Equity in Communities
• Addressing Maternal Mortality
• Tackling Chronic Pain While Reducing Opioid Use
• Mental Health and Chronic Disease in Minority Populations
• COVID-19 Research into Action

Each webinar will have an overall emphasis on research that addresses eliminating health disparities and improving equity for vulnerable populations. Programming will provide multiple stakeholders, including patients and families, providers, non-profit and government entities, researchers, and payers. It is the goal of the planning committee and HCGC staff to provide content to attendees that gives action steps based on evidence-based research to address the health disparities that exist in these important areas of healthcare both locally and around the country.

Registration for the series will begin in mid-November, and will be open to a statewide audience. For more information on programming or the planning process, contact Heidi Christman at heidi@hcgc.org. 

Columbus Metropolitan Housing Authority Partners with HCGC for Care Coordination Services 
By Carrie Baker, President and CEO 
HCGC is proud to announce a partnership with the Columbus Metropolitan Housing Authority (CMHA.) CMHA helps people access affordable housing through collaborative partnerships to develop, renovate, and maintain housing; promote neighborhood revitalization; and assist residents in accessing needed social services.  The important work of CMHA led to a natural collaboration with HCGC and the Central Ohio Pathways HUB (the HUB.) The HUB, a care coordination system managed by HCGC deploys community health workers (CHWs) to connect vulnerable populations in Central Ohio with access to vital care and services. 
​
The partnership creates a direct referral into the HUB for CMHA residents. While the access to affordable housing provided by CMHA is paramount to the wellbeing of vulnerable Central Ohioans, there is almost certainly other essential needs that have gone unmet for people who have sought housing through CMHA.  The CMHA referral into the HUB allows for residents to be connected with a HUB CHW who will connect directly with that resident and work through an in-depth assessment of the spectrum of other care and services they may be experiencing. CMHA residents who become HUB clients have the opportunity to work with a CHW to apply for emergency rental assistance, utility bill payment plans, and understanding their lease agreement; signing up for health insurance, unemployment, food assistance; find employment, housing, and medical care, and education; manage their health and well-being including understanding illnesses and medications; understand and engage in family planning, pregnancy care, and care for you and your entire family.

The CMHA referrals for HUB services are being directed to Physician CareConnection (PCC), one of the HUB’s twelve Care Coordination Agencies.  Employing the Pathways Community HUB model of care coordination, CHWs that are employed by PCC have already began enthusiastically and efficiently receiving CMHA referrals.  In just two weeks of operation through the partnership, HUB CHWs enrolled twelve CMHA residents and began connecting them to care and services.  Another nine referrals were made through the system in that first two weeks that are in the process of becoming CMHA residents before they can begin to receive HUB services. That is a total of 21 referrals in just 14 days of the official beginning of the partnership. This data shows us the spectrum of needs associated with insecure housing that CMHA is addressing with their residents through partnering with HCGC and the HUB. This comes at the same time that the City of Columbus has made eviction reform a major priority amidst the COVID-19 pandemic, with funding for organizations like PCC that are known for their work in coordinating care and services for central Ohio's most vulnerable citizens. 
​
Amidst the COVID-19 Pandemic, we know that the incidence of housing insecurity is rising at an alarming rate, and the work that CHMA has done since the onset of the pandemic is nothing short of inspiring.  HCGC is honored to work to extend the access and relief that CMHA provides their residents by providing connections to the other social determinants of health affecting so many vulnerable central Ohioans in these trying times.

For more information on CMHA, visit their website.
Fore more information on PCC, visit their website.
For more information on the HUB, visit our website. 

A Background and Update on Patient Family Advisory Councils
 
HCGC led project celebrates third year, announces virtual restart amidst pandemic
by Heidi Christman, Director of Communications, HCGC
Based on Presentation to COPC PFAC Leads by David Brackett, Vice President, Accounting and Special Projects, HCGC
 
HCGC has been managing, leading and facilitating Patient Family Advisory Councils (PFACs) in partnership with Central Ohio Primary Care (COPC) since 2017.  A PFAC is a regular meeting with both staff and volunteer patients and families of a medical practice, in this case, within the COPC family of primary care practices. Members of the PFAC collaborate with employees (clinical, administrative and support) to provide guidance on how to improve patient and family experiences. At the meetings, councils work on a variety of practice and patient-and-family-centered care initiatives.  The goal of a PFAC is to provide a collaborative environment that will enhance the experience for all patients and families at COPC through patient-and-family-centered care (PFCC) using constructive input that only patients and family members can provide.

The Four Guiding Principles of PFACS

Collaboration
Patients, families, healthcare practitioners, and health care leaders collaborate in policy and program development, implementation, and evaluation; in facility design; and in professional education, as well as in the delivery of care.

Dignity and Respect
Healthcare practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.

Information Sharing
Healthcare practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely , complete, and accurate information in order to effectively participate in care and decision-making.

Participation
Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

Celebrating Three Years of Impactful Engagement

In the three years since HCGC and COPC partnered to convene PFACs, there have been 2,000 patients engaged and 380 PFAC meetings held, with average quarterly attendance across all sites at 189 patients. PFACs have allowed for the implementation of qualitative and quantitative satisfaction surveys, creation of newsletters and informational displays to improve patient education and practice communication, as well as countless patient concerns and ideas being solicited and addressed. Over the lifetime of the project, there have been two major quality improvement outcomes that can be in part attributed to PFAC recommendations: there was a 21% increase in patients whose diabetes a1c measured as “in control”, and there was an 8% increase in patients whose blood pressure measured as “in control.”

Moving Forward Virtually

With safety in mind, HCGC and COPC made the decision to put PFACS on hold from March until August 2020. After time to plan and regroup, a plan was made to move forward with PFACs virtually. Starting with a participatory webinar in late August, PFAC leads, as well as HCGC and COPC staff came together to discuss convening PFACS via webinar for the third and fourth quarter of 2020. Participants discussed establishing goals for PFACs in these virtual meetings. Topics such as telehealth, COVID-19 education and information, as well as maneuvering in person office visits amidst COVID-19 were all discussed as potential topics for PFACs to address.  Additionally, considerations for lack of access or knowledge of webinar platforms (Zoom in this case) were taken into account.  HCGC committed to hosting all webinars on behalf of the COPC participating PFACs, as well as providing educational resources on how to use the platform for PFAC leads and members.

Now, more than ever, the voices of patient and family members are essential in improving patient experiences in primary care offices. While virtual, the team at HCGC and COPC look forward to hearing the patient perspective amidst these unique, unprecedented times. In the spirit of partnership and collaboration, HCGC and COPC look forward to moving forward to continue giving patients and families a seat at the table, whether it be virtually or in person down the road, to improve experience and outcomes for patients in Central Ohio. 

For more information on PFACS, contact David Bracket at david@hcgc.org. 

​
Controlling the Uncontrollable
​Dealing with Stress in The Most Stressful of Times
By Caroline Carter, CPC+ Practice Facilitator, HCGC
​
Uncertainty causes stress. We are living in uncertain times. We are stressed.
2020 has been a year of surprises – and not of the pleasant variety. Earlier in the year we experienced extreme natural disasters including floods, wildfires and earthquakes. In the last few months we have been forced to hastily adapt to the coronavirus pandemic which has already flaunted widespread colossal health and economic impact. More Americans are out of work than in the Great Depression, and more people are dying than in several of America’s wars combined. Simultaneously, we are experiencing political chaos. Social unrest exploded with fierce reaction to injustices such as the killing by police of George Floyd and countless other Black people.

Safe to say, we are experiencing circumstances that the majority of us did not have the sagacity to predict.  
And so, here we are in the midst of a full blown, uncontrolled pandemic with all the anxiety and stress that accompanies that scenario. We have been unceremoniously coerced to adapt to a new sense of ‘normality’ that was until very recently beyond our comprehension. Millions of people did not anticipate losing their jobs. We did not anticipate thousands of adults having to home-school their children while simultaneously fulfilling their work responsibilities – from our homes. We did not expect the high level of confinement and restrictions imposed on our lives.

Many of these stress-inducing circumstances we have begun to contend with. However, we can expect further disruptions that will bring new, additional stressors such as the unknowns about the economy. Will businesses re-open? Will we retain our jobs, those of us that were fortunate enough not to have lost them already? When will we be expected to return to the physical workplace? Will schools re-open? Will our children be safe? Will working parents will be compelled to grapple with an untenable proposition of children being in their physical school building for only one week out of three? How does one coordinate childcare in a scenario that expects them to return to their physical workspace on a full-time basis? Deb Perelman eloquently grapples with this conundrum in her recent New York Times article In the Covid-19 Economy, You Can Have a Kid or a Job. You Can’t Have Both. https://www.nytimes.com/2020/07/02/business/covid-economy-parents-kids-career-homeschooling.html

Managing Stress:
First and foremost, we have to understand that stress is a normal and healthy emotion. Everybody experiences stress to some degree. It is a part of being human. We should also recognize that we are likely grappling with several types of stress including decision-making fatigue, daily hassles and chronic stress.
Decision-making fatigue is the result of having to make choices. Just a few months ago so many of our choices and decisions were routine. Consider your pre-pandemic morning routine, it is likely that it included a number of tasks that were so routine you didn’t even think about them. All of our standardized decision-making systems, our routines are gone. The beauty of routines is that they take away the need to make so many decisions. During these stressful times we are forced to make choices all the time that we didn’t have to make pre-pandemic.
So, what can we do?

• Create some new routines, even if they are temporary.
• Make new routines for yourself that fit with your new conditions.

They don’t have to be permanent. They don’t have to be perfect. They just need to reduce the number of decisions that you have to make so that you can experience less decision-making fatigue.
Next, let’s tackle the daily hassles. A major stressor, such as a pandemic creates a cascade of micro-stressors. These are basically small, little things that emerge that didn’t used to. The thing about hassles is that they can feel miniscule but those seemingly innocuous little things add up and cause stress.
So, what can we do?
First and foremost, don’t minimize the tax of daily hassles. Don’t give yourself a hard time when you find yourself getting upset about little things that, under normal circumstances you might not have even noticed or if you did you might have deemed them trivial.

• Acknowledge them as a daily hassle.
  • Do what you can to try to reduce them one at a time. Don’t try to ignore them. They add up. They stress you.
  • Be kind to yourself. Give yourself grace.

Lastly, let’s consider chronic stress. This is a big one. We have no idea when our current, challenging conditions will be over. Living with uncertainty is a known force for causing stress.
So, what can we do?
Separate everything that is bothering you into 2 categories. One category contains things within your control, the other are things beyond your control.
For things within your control:

• Generate and test solutions aka try something and see how it works. Tweak as necessary.
• Control what you can.

For things beyond your control:

• Recognize and accept that there is nothing you can do about it – at this time.
• Practice acceptance. Acknowledge that it is beyond your control and accept it as such.
• Save your energy for things that you can do something about, things that are within your control.

 
General Coping Strategies:
While we cannot eliminate stress we can take some steps to minimize the effect that stress has on us. The good news is that we all have coping strategies.
Positive coping strategies include staying socially connected, engaging in happy distraction, engaging in self-care, and taking care of others.

• Social connection includes having meaningful conversations, reaching out to others even if it needs to be via technology, staying connected.
• Happy distraction includes finding your happy distraction and not feeling guilty about indulging. Engaging in a happy distraction may be what helps you cope, feel calmer, wind down and sleep better. A happy distraction might be binge-watching a favorite show for some, reading for others, listening to music or a variety of other activities. The actual activity is less important than the enhancement that it brings to you.
• Self-care is critical during stressful times. Self-care includes the usual suspects of exercise, eating healthily, going outside, and getting enough sleep. These are huge.
• Taking care of others. When we take care of others, do something nice for someone else we feel better. It’s a win-win. We make others feel better and simultaneously enjoy the benefits of feeling better ourselves.

​The bottom line is that we are going to get through these challenging times. Stress and anxiety will be a part of it but we’ll get through it by focusing on positive coping strategies.

Thank you to Dr. Lisa Damour, Psychologist and best selling author for the strategies offered to manage stress. 
​

​Using the Mirror to See One Another
By Tanikka C. Price, Data and Finance Director, Central Ohio Pathways HUB, HCGC

*Adapted from a presentation given to Dress for Success Columbus Volunteers in response to George Floyd’s murder and the protests that followed on 6/10/2020 Click here to view the presentation


The current climate of racial and political division has called many people to question the world around them, but I’m calling you to look within rather than outward to find the change we all need. Although many of us look around and outside of ourselves when the conversation starts to talk about bias, it may be that humans are inherently wired for bias. Bias is intended to help us. Think for a moment, would you sit on a three-legged chair? Think of the visual cues you used when choosing your partner or spouse. What attracted you? What repelled you? This is the way we use bias to survive.

Sometimes, biases are what Kelly Robsham in her blog entitled "Creating An Inclusive Company: Challenging Our Biases" calls “cognitive shortcuts” that are a result of human evolution. “We’ve evolved to have cognitive shortcuts (also known as heuristics) meaning we often survive by relying on unconscious assumptions in our lives.” Robsham highlights several occurrences of unintentional bias that affects decisions made in the workplace, including in hiring, retention and onboarding practices. These biases can be based on gender, race, age, and several other factors that are deep down in one’s subconscious. ​

Understanding key terminology

Before we can really delve into looking within, at our own biases, we must understand the following definitions. 

Bias: prejudice in favor of or against one thing, person or group compared with another, usually in a way considered to be unfair. https://www.lexico.com/en/definition/bias. 

Implicit Bias: refers to the attitudes or stereotypes that affect our understanding, actions and decision in an unconscious manner (Kirwan Institute). http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/. 

Prejudice: preconceived opinion that is not based on reason or actual experience. https://www.lexico.com/en/definition/prejudice. 

Discrimination: the unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age or sex.  https://www.lexico.com/en/definition/discrimination. 

Racism: prejudice, discrimination or antagonism directed against someone of a different race based on the belief that one’s own race is superior. https://www.lexico.com/en/definition/racism. 

Anti-Black racism: policies and procedures rooted in institutions such as education, health care and justice that mirror or reinforce beliefs, attitudes, prejudice and stereotyping and/or discrimination towards people of Black-African descent. (Black Health Alliance) http://blackhealthalliance.ca/home/antiblack-racism/. 

Understanding these terms and how they relate to one another will assist us in having robust and self-reflective conversations about the way anti-black racism is a part of every facet of American life. Making ourselves familiar with this terminology is key to understanding where we need to begin in a conversation and action in creating an anti-racist narrative in our everyday lives.
 
What does this have to do with you?

“To know the true reality of yourself, you must be aware of not only of your conscious thoughts, but also of your unconscious prejudices, bias and habits.” (Anonymous) https://www.al.com/opinion/2019/03/business-leaders-take-heed-we-all-have-unconscious-biases-which-must-be-confronted.html. 

One must confront their own history with race, or lack thereof to being your journey of antiracism.  What is your story about race? One’s beliefs about race are often defined by five factors: education, experience, history, “the talk” and your “five.”

Education- Who taught you what you know about US History and race? The story you were told is heavily influenced by whom you were taught. Did you have teachers of color growing up? Did you take classes in college about different cultures? Have you ever visited and learned from someone not-American?

Experience- What has been your experience with different races? When is the last time someone of another race came to your home? Does the place where you worship or gather socially reflect the world or is it a lot of people who look like you and have similar experiences as you?

History- What were you taught about US History. A seminal book, Lies My Teacher Told Me, by James W. Loewen, shows the fallacies and white-washed versions of history most of us were taught in US schools and how they affect how we see different cultures and the world. Keep in mind that tales of the hunt always glorify the hunter.

“The Talk”- have you ever had to have a talk with your children about how to survive in this country despite your race? Have you ever instructed your children how to act if they are pulled over by the cops? Have you ever had to tell your kids how to manage racial slurs hurled at them on the playground? If not, you have privilege. If so, you worry about your kids on a level that others cannot understand.

Your “Five”- Actor Will Smith says you are the five people that you spend the most time with. What are these people saying about race, gender, immigration, poverty and education? How are they affecting you? What is your Facebook thread reflecting? What side of history are you and your best friends going to be on?

For racial reconciliation to work we must confront our own biases. While we cannot control or change the education we received as children or the experiences that were provided or not provided by our parents, it is never too late to start educating ourselves and looking inward to confront our own biases.  We cannot be afraid to confront the ways we were raised, how we were taught, and the experiences we have had. We must move forward taking a hard look in the mirror in order to see ourselves, and therefore each other clearly. It is only when we understand the foundations of our bias, that we can work with others to create real change.