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COMMUNITY DEVELOPMENT & INNOVATION ADVISORY COMMITTEE October 25, 2018 from 4:30 – 6:30PM Vitalyst Health Foundation, 2929 N Central Ave #1550, Phoenix, AZ 85012 Conference Line (602) 385-6524 Passcode 6504#; Zoom: https://zoom.us/j/229989243 VITALYST HEALTH FOUNDATION MISSION To connect, support and inform efforts to improve the health of individuals and communities in Arizona Proposed Meeting Results: All CD&I member to actively participate in LOI Discussion CD&I Board members to decide on which LOIs to move forward to Full Proposal Present BOARD: Priscilla Foote, Sue Navran, Essen Otu, Colby Hunter, Kathy Rosenzweig, Sydney Fox, Pamela Thompson (remote); STAFF: Melanie Mitros, Kristin Hamrick, Stephanie Gallegos, Marcus Johnson, Suzanne Pfister, C.J Hager, Jon Ford; INTERNS: Megan Phillips, Ingrid Okonta COMMUNITY: Richard Crews, Teresa Mabry Meeting Agenda 4:30pm Welcome, Session Objectives, & Introductions • Respond to any questions since Orientation Session & August Highlights • Review Staff Recommendations • Discussion & Action on LOIs • Make official recommendation of LOIs to move to full proposal Priscilla called the meeting to order at 4:36pm 4:45pm Context Setting & Review of Group Agreements: • Context Setting • Review Working Guidelines/Group Agreements • Review Consensus Building and Decision process • Time limits on discussions • Review Scoring Criteria 5:00pm Review Staff Recommendations • Review Conflicts of Interest • Gather additional information Melanie presented staff recommendations based on reviewer data from staff, board, and community • Arizona Department of Forestry and Fire Management, Children’s Action Alliance, Creighton Community Foundation, Flagstaff Shelter Services, and Ajo Center for Sustainable Agriculture had 2/3 or higher approval to move to proposal from all three reviewer groups • Staff recommended moving the following for full proposal: Arizona Department of Forestry & Fire Management, Children’s Action Alliance, Hushabye Nursery, Creighton Community Foundation, Flagstaff Shelter Services, Ajo Center for Sustainable Agriculture, Amistades, Inc., South Mountain WORKS Coalition, and Hopi Cancer Services • Staff recommended moving the following to programmatic funding: Arizonans Concerned About Smoking, AZ Faith Network, Addiction Haven, and Equality AZ 5:20pm Committee Discussion & Action on LOIs • CD&I Committee decides which LOIs to request a full proposal The Board will receive the recommendations of the CD&I committee as information only (not for a full Board vote) Arizona Department of Forestry and Fire Management, Children’s Action Alliance, Creighton Community Foundation, Flagstaff Shelter Services, and Ajo Center for Sustainable Agriculture • Essen and Priscilla suggest requesting full proposals from the organizations that were consistently in reviewer’s top • Kathy motions for a vote and Essen seconds Motion passes unanimously Hushabye Nursery • Concerns include that it is not an innovative proposal or representing systems change and discomfort with funding an ED salary Also, there may be other funders more appropriate or potential partners in funding for this project • Full proposal was requested by staff and board reviewers, but not by majority of community reviewers • Staff recommends moving forward because an ED would greatly expand their capability for obtaining additional funding and there are only others of this type of ED • Essen motions for a vote and Kathy seconds Motion passes unanimously Arizona Faith Network • Staff recommends moving to programmatic funding AZ Concerned About Smoking • Sue and Pam feel that it is a system change that would improve the health of children, particularly minority populations, and that it is a very innovative approach • Concerns from staff include that it’s not appropriate for an innovation grant because it is an expansion of existing work and there is low state level interest Staff recommends moving to programmatic funding • Kathy motions for a vote and Sydney seconds Motion passes unanimously Amistades, Inc • Concerns are that LOI is not clear in what the money would actually be used for Others felt it was very innovative and full proposal would give opportunity to clarify questions • Essen motions for a vote and Colby seconds Motion passes unanimously South Mountain WORKS Coalition • Concerns are mostly around sustainability and financial status of the organization Others feel that it was more like programmatic work • Colby motions for a vote and Essen seconds Motion passes unanimously First Place AZ • Concerns are that it is based on a medical home model/standard of care which is not innovative, and it appears to be more like a research study Another concern is that it missed the self-efficacy and patient-centered approach that is standard in ASD projects and did not specifically address health equity • Kathy motions for a vote and Sydney seconds Motion initially ties at 4-4 and then passes 6-3 Hopi Cancer Support Services • Essen motions for a vote and Sydney seconds Motion passes 7-1 Northern Arizona University • Sue motions for a vote and Essen seconds Motion passes unanimously Girl Scouts of Southern AZ • Concerns are that money would be more impactful elsewhere Full Proposal Requested: Arizona Department of Forestry and Fire Management Children’s Action Alliance Creighton Community Foundation Flagstaff Shelter Services Ajo Center for Sustainable Agriculture Hushabye Nursery AZ Concerned About Smoking Amistades, Inc South Mountain WORKS Coalition 10 First Place AZ 11 Hopi Cancer Support Services 12 Northern Arizona University 6:20pm Closing • follow-up • reflection 6:30pm Adjourn Upcoming Meetings • Next Board of Trustees Meeting - November 29, 2018 from 4:00-6:00pm • • IG Full Proposal Review – January 28-February 8, 2019 IG Presentations – February 11-14 from 1:00-4:00pm each day in-person, Zoom, or recording • Next CD&I Committee Meeting – February 28, 4:30-6:30pm VITALYST HEALTH FOUNDATION - 2019 INNOVATION GRANT LOIS PROJECT LEAD PROJECT DESCRIPTION/ PURPOSE Partners COMMENTS Current/Past Investments FUNDING AMOUNT TOTAL SCORE % FULL RECOMMPROENDATION POSAL Other Funder DISCUSSED – Staff Recommended for Full Proposal AZ Dept of Forestry & Fire Management Maricopa Co Dept Public Health, MIHS, Harmon Library, Lowell Elementary, City of PHX Parks, The Nature Conservancy, Trees Matter, AZ Sustainability Alliance, PHX Revitalization Children’s Action Alliance Fostering Advocates AZ young Adult Leadership Board, alumni of foster care, Community Advisory Board Park Rx - is to pilot an innovative approach to environmental and medical care systems change that supports active living and improved physical and mental health and community cohesion Staff Recommendation: proposal Opportunity in Arizona to examine our community structures, laws, policies and financing to strengthen services and expand supports for youth aging out of foster care to age 26 Staff Recommendation: proposal S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs $125,000 80.76 76% PROPOSAL (8-0) years Comments: Biggest barrier could be City Parks & Rec, Will this actually change medical systems?, Is there interest to partner with community organizations in marginalized areas? BCBS, Pullium $125,000 78.05 80% PROPOSAL (8-0) years Comments: Concern that the impact will be incremental rather than transformational, Feasibility based on the fiscal implications to the state?, disaggregation of foster system data/outcomes by race/ethnicity, unclear if this is an extension of existing work, is there opportunity to continue AZ Community Foundation, Anne E Casey Page of partnering with Casey Family Programs? Hushabye Nursery Dignity Health, SW Human Development, PHX Children’s Hospital, Maricopa Integrated Health Services (MIHS) Creighton Community Foundation This project will create a demonstration period and exploratory/pilot project designing and implementing an alternate care practice for expectant mothers with OUD, NAS babies, and their families After the completion of the two-year period supported by Vitalyst, Hushabye Nursery expects provider partners (Dignity, PHX Children’s Hospital, MIHS, etc.) to incorporate the new practice in their standard operating procedures and protocols for care Formation of a coalition to conduct exploration, advocacy, and development of a school-centered model for services delivery and reimbursement of wellness services, using an evidence-based school-friendly anxiety mitigation solution with lightweight multi-faceted deployment (Compass for Courage) as a test and evaluation case while developing a state-wide model ASU REACH Institute, Creighton School District, Creighton Community Health Coalition Flagstaff Shelter Culturally-sensitive Housing-focused Care Teams (HCTs) will be developed to address Services the intersection of access to care and affordable housing HCTs, comprised of an North Country FSS Housing Case Manager, a North Healthcare, The Country Healthcare primary care provider, Guidance Center and a behavioral health provider from The (NARBHA) Guidance Center, will work in coordination to improve housing and health outcomes among individuals experiencing S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs Staff Recommendation: proposal $125,000 77.62 71% PROPOSAL (8-0) years Comments: How is community at the table developing this? Concern about funding an Executive Director position Past investment: Hushabye received planning grant ($10,000) Current: a TAPAZ fiscally sponsored project Staff Recommendation: proposal BCBS, AZ Community Foundation, BHHS Legacy, BOV, Banner $125,000 76.65 65% PROPOSAL (8-0) years Comments: Would like to see clear engagement of people impacted in the community (parents, teachers), community school concept, need better clarity of what they hope to accomplish Staff Recommendation: proposal Banner, Helios, BHHS Legacy, AZ Community Foundation, $125,000 76.15 80% PROPOSAL (8-0) years Comments: needs evaluation and dissemination plan, how is the additive/different than what Circle the City is doing? NARBHA*, Care1st & Health Choice, N AZ Healthcare Foundation* Page of homelessness Once participants transition to housing stability and their acute physical and behavioral health needs are met, other social determinants of health, such as economic and educational opportunity, will be addressed as well Will employ rapid rehousing model due to frontier region with limited resources Ajo Center for Sustainable Agriculture S AZ Young Farmers Coalition, Tohono O’odham Community Action, Iskashitaa Refugee Network, Local First Arizona, and S Gila Co Development Corp AZ Concerned About Smoking City of Tempe, Empire High School, AZ Academy of Will create a permanent system change by advocating to install a new policy on the state level which will provide state matching for agricultural apprenticeships for young and beginning farmers, ranchers, foragers and gleaners The coalition will raise general awareness of characteristics and challenges of Arizona’s agriculture, as well as develop a shared system for administering the apprenticeships which will aid in the implementation of this legislation once passed This will include determining qualifications for the farmers and organizations to host apprentices, and qualifications for those applying We will also explore accreditation of the program by community colleges and/or universities Promote adoption of a policy that prevents youth tobacco and nicotine use and addiction by raising the minimum legal sales age of all tobacco products including Electronic Nicotine Delivery Systems (ENDS), to 21 in communities around the state of Arizona over the next two years S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs *funded some pre-work leading up to this point Staff Recommendation: proposal $125,000 75.48 67% PROPOSAL (8-0) years Comments: Connect with Br Tremikus Muhammad of 10,000 Fearless & The Local Organizing Committee in S PHX, Concerned the complexity of change is being underestimated, Need more detail and clarity for the project, concern about cultural relevance and connection to systemic issues Current investment: programmatic grant $35,000 for Healthy Communities Starts in Schools project Staff Recommendation: programmatic funding Comments: not fit for innovation grant due to expansion of existing work, and lack of state level Community Foundation for S AZ, ACF affiliates, SE Legacy, Sprouts $110,000 years 74.25 60% PROPOSAL (8-0) BHHS Legacy, AZ Community Foundation, Page of Family Physicians, AZ Addiction Treatment Program, Tri-City Cardiology, Pima County Board of Health, … … Tanner Community Dev Corp., American Heart Association, American Lung Association, Cancer Action Network, Inc., Preventing Tobacco Addiction Fdn, Tobacco Control Legal Consortium, Truth Initiative, Campaign for Tobacco-Free Kids Amistades, Inc The objective is to mitigate poor health causing stressors by using cultural strengthens and indigenous healing practices, Familys, improving families navigation of available Cuanderos/as, health and social service systems, engaging Chicanos Por La Causa, Mi Familia these systems to change, and developing and maintaining positive health behaviors Vota, LULAC, Amistades intends to create a collaborative Mexican safe space for families, healers, Consulate of Tucson, Sunnyside neighborhood advocates, non-profits, and schools to organize and acquire culturallyNeighborhood based healing and advocacy training Assoc., El Rio Community Health targeting this objective Center Will pursue to change how community South Mountain participation and accountability among WORKS Coalition (Fiscal stakeholders are equitable and are a sponsor-SW significant part of the systems change Behavioral Health process to use trauma informed approaches Services) merged with principles of social justice, no harm, acceptance, community power and sustainability The goal is to generate a Faithful City, SW process for integrating trauma informed Elementary, SW approaches into communities, community Behavioral & health work, community building and Health Services, education Padres Promotoras, Sagrado Galleria, S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs interest at this point How does this include teens in forming the policy? Account for cultural factors? Staff recommendation: Proposal Virginia G Piper $125,000 73.00 67% PROPOSAL (8-0) years Comments: concern about how the work will continue (sustainability) Need more specificity on what they will doing Is there a partnership with Mi Familia Vota? Community Foundation of S AZ, Agnes Haury at UofA Current investment: capacity building contract ($7,000) Staff recommendation: Proposal Did not indicate amount Comments: Questions about Sustainability, possibly years partner with Southwest Human Development – Trauma Informed work with UMOM At the end of years, what will be different and how will we know? 71.85 55% PROPOSAL (8-0) Helios, Piper Resiliency Page of ACEs Connection, Community Alliance Consulting First Place AZ St Joseph’s Hospital and Medical Center and Barrow Neurological Institute, SARRC, United Healthcare Current investment: capacity building grant for facilitator ($10,000) Integrated and multidisciplinary hub-andspoke clinic model, where the clinic’s primary care team will serve as the hub with the goal of communicating with and connecting other providers and support systems (spokes) Staff recommendation: programmatic $125,000 70.90 years Comments: medical home model that is not innovative – moving towards standard of care, research study, no discussion of health equity or sustainability How individuals with ASD are at the table developing the work? 67% PROPOSAL (6-3) BCBS, BHHS Legacy, AZ Community Foundation, Piper, AHCCCS Past investment: consultant to convene Autism group of 7-10 organizations ($7,000) Hopi Cancer Support Services Hopi men, Community Advisory Committee, UofA Cancer Center, Tuba City Regional Healthcare, Hopi Healthcare Center, Hopi Mental Health Services To improve and increase access to health care for an integrated coordinated system of care with a Hopi culturally-target early cancer detection (screening) and education model The target population will be Hopi young men who are 18-49 years old who live on the Hopi Reservation S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs Staff recommendation: Proposal $125,000 68.40 45% PROPOSAL (7-1) years Comments: Articulate cancer rates in Hopi community (state health assessment) Need to ensure community representation early-on Might be good to narrow the focus beyond health screenings NARBHA, N AZ Healthcare Foundation, Hopi Foundation Page of Northern Arizona University Foundation “Preventing HIV/AIDS Among Navajo Youth” Building upon protective factors of social support and cultural connections, to partner with the Navajo Nation Health Education & HIV Prevention Program to adapt an existing HIV prevention curriculum and to pilot test and implement a culturally adapted HIV/AIDS curriculum in schools on the Navajo Nation Workgroup: Navajo Health Education & HIV Prevention Program, NAU, Navajo Dept of Education Staff recommendation: Not recommended for proposal or programmatic $125,000 66.95 47% PROPOSAL (7-0, Sydney had to leave early) Recommendation: Based on $125,000 direct alignment with our years current work, move to programmatic funding where they can be more flexible with funding and start sooner (Jan vs Jun) CJ in support of this recommendation 75.29 62% OTHER Concerns: only one partner, lack of community-based partners to be engaged in the development process, have other Girl Scout’s 67.15 year Comments: Realistic to accomplish in 12 months? Who are the community partners? What is the role of community members (e.g youth) in curriculum creation? Feels driven by NAU rather than the Navajo communities DISCUSSED – possible programmatic work with budget reallocation in January AZ Faith Network Arizona Housing Coalition, congregations/ faith communities, people affected by housing crisis Girl Scouts of Southern AZ UofA (2 masters programs) Develop model policies to increase access to affordable housing We will accomplish this through education/awareness, policy advocacy, promoting fair ordinances and court practices and faith-based models of housing innovation We are partnering with individuals and families affected by the crisis by providing them with training and organizing opportunities to engage them in developing solutions to attain and maintain access to affordable housing Health Advocacy Project to advance health equity in underrepresented communities that are traditionally excluded from the civic process Our proposed program seeks to engage middle school girls who attend schools in underrepresented areas with hands S:\COMMUNITY GRANTS\INNOVATION GRANTS\FY 2019\LOIs $100,000 years Corporation for Supportive Housing, SJHMC Community Grants 50% OTHER Community Foundation of S AZ, Flynn Foundation, Page of groups participating in or entering farming, but especially the disadvantaged, ethnic and lowincome groups The project is designed to uplift and amplify the voices not commonly heard in the political arena, and is intending to continue to set the table for all, since food and the future of Arizona agriculture is something that unities are all Community Partners Core partners: Southern Arizona Young Farmers Coalition, Ajo Center for Sustainable Agriculture, Tohono O’odham Community Action, Iskashitaa Refugee Network, Local First Arizona, and Southern Gila County Development Corporation Support partners: National Young Farmers Coalition, Pinnacle Prevention, Maricopa County Food Council, Farm Education Resource Network, local farmers We are also planning to reach out to: community colleges, universities, Department of Agriculture, Department of Education, Department of Labor, Pima County Parks and Recreation, AZ Farm Bureau, Cattleman’s Association, Western Growers Association, Agribusiness & Water Council of Arizona, Future Farmers of Arizona Sustainability The project will result in a major and permanent policy change as well as substantially increase the awareness of Arizona agriculture, so no additional funds will be needed to advocate for this change again Health Outcomes By introducing state-supported job training and mentorships we will improve employment opportunities and conditions for local beginning farmers This will cause a giant shift in improving economic development and employment opportunities as social determinants of health, thus reducing health inequities in Arizona With improved employment opportunities, often times in communities where there are scarce, we will not only grow new farmers but also create more equal access to entry into farming for historically marginalized groups as well as improve income, mental health and social support networks for beginning and established farmers This will improve the economic stability of Arizona’s underserved communities such in rural, Native American and multi-cultural urban settings These exact communities are those that most often lack affordable, accessible, nutritious and culturally-appropriate food By helping support new and established farmers we will promote creation of a variety of healthy food access opportunities This will improve nutrition in these communities and reduce obesity and prevent other diseases This coalition is therefore addressing and connecting two crucial Elements of a Healthy Community: Food Access and Economic Opportunity Budget For this two-year project, we are requesting $125,000 to provide staffing time, consultants, farmer stipends, travel, food, and printing 10% indirect cost will be assigned to Ajo Center for Sustainable Agriculture for fiscal stewardship and administrative coordination of the project Hushabye Nursery In June 2017, Governor Doug Ducey signed an emergency declaration in response to the opioid crisis in Arizona Since that day, 1,763 people have died from suspected opioid overdose; nearly four people each day The most tragic consequence of the epidemic is the number of babies born with drug-related withdrawal symptoms (Neonatal Abstinence Syndrome; NAS) In the same time frame, 986 infants are known to be born substance-exposed That means by the time you sit down tomorrow night to eat dinner, at least two more babies will have been born in Arizona, dependent on opioids, facing a terribly painful withdrawal The current practice is to care for infants with NAS in the Neonatal Intensive Care Unit (NICU) While NICUs specialize in the care of ill or premature newborns, they are not well equipped to care for NAS babies These babies need a quiet, dark environment with a dedicated caregiver, providing one-on-one care, immediately meeting any need the baby presents The NICU staff are not typically trained in the demanding therapeutic handling techniques required to appropriately care for NAS infants NICU staff only have time and training to respond to the immediate needs of the babies, not families Families of NAS babies present various needs, ranging widely from basic parenting and care to addiction treatment to housing Families are rarely connected with services in the NICU setting because the baby alone is the focus Newborns testing positive for narcotics at birth are routinely separated from their mother and placed into DCS custody Faced with this reality, expectant mothers often avoid prenatal checkups and formal care during their pregnancy Hushabye Nursery represents an alternative practice for health care providers and child welfare professionals By referring substance-exposed infants to a NAS specialty recovery center, families receive proper support and training to create healthy family bonds and practices Babies are also cared for by experts specializing in care of NAS infants No NAS specialty facility currently exists in Arizona Hushabye Nursery will be the first medical center in Arizona, and only the third in the country, specifically designed and staffed to care for NAS infants and their families Hushabye Nursery will change the common practice of care for NAS babies and their families, serving as a model for other communities looking to respond to the emerging crisis of substance-exposed infants and the need for specialized care Unlike NICUs and traditional hospital settings, Hushabye Nursery will support the entire family system Hushabye Nursery will provide NAS infants a quiet, loving, therapeutic environment as they withdraw Each NAS infant will have a private room, allowing primary caretakers to “room in,” promoting prosocial bonding critical for recovery and improved health outcomes Hushabye Nursery staff will receive specialized, ongoing training from national leaders in NAS treatment Hushabye Nursery will work with community partners to assist families in getting the support they need starting prenatally and continuing after discharge for the transition to home Access to care is an enormous obstacle for these mothers Hushabye Nursery will provide families onsite behavioral health services and coordinate services after their baby is discharged Caretakers will receive ongoing education on infant and child care In the last 18 months, Hushabye Nursery has discussed the concept with several community partners dedicated to solving the opioid epidemic While the need for specialty care is unquestioned and many partners have agreed to provide support, Hushabye Nursery still needs a dedicated physical space to fully implement the program In the meantime, Hushabye Nursery is working with partners like Dignity Health, Phoenix Children’s Hospital, Maricopa Integrated Health System, Southwest Human Development, Mercy Care Plan, United Health Care, Department of Child Safety, and Arizona Health Care Cost Containment System (AHCCCS) to design and implement a new care protocol for NAS babies and families Working together, these partners will create a new standard of care for expectant mothers with opioid use disorder (OUD) and their babies Working as a collaborative body, led by Hushabye Nursery, referral networks will be established providing medication assisted treatment, behavioral health assessments, counseling, and trauma-informed care for mothers Alternative pathways of service and support will prevent disruption of family units, ensure appropriate medical care (substance abuse, mental health, etc.) for mothers and babies, and address health disparities among low-income communities If invited to submit a full proposal, Hushabye Nursery will request $125,000 over two years to create a professional Executive Director position who will lead the collaborative efforts above, develop materials and curriculum to educate hospital staff and related service professionals, and support the newly formed collaborative group with structure and facilitation, including consultants and experts as necessary This project will create a demonstration period and exploratory/pilot project designing and implementing an alternate care practice for expectant mothers with OUD, NAS babies, and their families After the completion of the two-year period supported by Vitalyst, Hushabye Nursery expects provider partners (Dignity, PCH, MIHS, etc.) to incorporate the new practice in their standard operating procedures and protocols for care Hushabye Nursery also fully expects to have its own facility (the Hushabye Nursery) open and operating at capacity (12 beds), generating 90% of all required revenue from public and private payers by the end of the Vitalyst Innovation Grant, at which point the Executive Director (and her salary) will be fully sustained by earned revenue Arizonans Concerned About Smoking Proposed Policy and Background: On Wednesday September 12 of this year, the Washington Post reported on FDA Commissioner Scott Gottlieb’s efforts to stop an “epidemic” of teenage vaping The article noted that the latest data, while not yet published, shows a 75% increase in ecigarette use among high school students this year Given the critical timing and urgency needed to mobilize and combat the vaping “epidemic” in our schools, Arizonans Concerned About Smoking, Inc (ACAS) is seeking grant funding to promote adoption of a policy that prevents youth tobacco and nicotine use and addiction by raising the minimum legal sales age of all tobacco products including Electronic Nicotine Delivery Systems (ENDS), to 21 in communities around the State of Arizona over the next two years Tobacco 21 (T21) is a national campaign aimed at raising the minimum legal sales age for all tobacco and nicotine in the United States to 21 Over 340 local jurisdictions in 21 states and six states, statewide, have adopted T21 laws and a T21 policy now covers around 30% of the U.S population In Arizona, Cottonwood and Douglas have adopted T21 and both Tempe and Tucson have held city council work sessions to explore the possibility of policy adoption Health Equity Lens: Tobacco use is the leading preventable cause of morbidity and mortality in the United States and Arizona Racial and ethnic minorities, individuals of low socioeconomic status, and other vulnerable populations disproportionately experience tobaccorelated disease and illness T21 policy overlaps multiple elements of a healthy community Primarily it addresses Access to Health Care and Coverage and Social Justice Health Impacts of disease prevention and mental health along with the positive impacts of living longer are obvious However T21 also addresses Educational Opportunities in that healthier students tend to have greater educational achievement not to mention being much more desirable or a requirement to future employers that they not be addicted to tobacco/nicotine Also T21 addresses Environmental Quality with numerous and positive health impacts especially early brain development Unlike many tobacco cessation policies, a T21 policy works to prevent tobacco use and subsequent disease allowing populations to thrive and live longer without bearing the burden of tobacco related diseases and health care costs 95% of addicted adult tobacco users started using tobacco products before the age of 21 Many transition from experimental smoking to regular, daily use during the ages of 18 to 21 Delaying the age when kids first experiment or begin using tobacco can reduce the risk that they transition to regular or daily tobacco use According to Campaign for Tobacco Free Kids and their Toll of Tobacco Report for Arizona, dated August 2018, 16.1% of Arizona high school students reported e-cigarette use The tobacco industry continues to target adolescents with clever products and predatory marketing Juul, the fastest growing e-cigarette in the United States, currently holds over 71.2 percent of the e-cigarette market share as of August 2018 Each Juul pod cartridge contains as much nicotine as a pack of cigarettes and come in a variety of flavors that appeal to youth The adolescent brain continues to develop into the mid-twenties and is especially sensitive to the effects of nicotine, yet most kids are unaware e-cigarettes may contain nicotine or they significantly underestimate the danger of nicotine Youth are initiating on e-cigarettes and transitioning to traditional cigarettes E-cigarette users are six times more likely to start smoking combustible cigarettes than those who never used an e-cigarette If nothing is done to prevent youth initiation, 115,000 kids in Arizona under 18 will ultimately die prematurely from smoking 20th U.S Surgeon General Jerome M Adams stated: “Tobacco use primes the brain for people to become addicted to other substances” How a T21 Policy Works: When properly enforced, T21 laws disrupt the social availability of tobacco and nicotine products to youth Social and physical environments are factors associated with tobacco use Raising the minimum legal sale age of tobacco and e-cigarettes to 21 puts legal purchasers outside the social circles of most high school students Expected Outcome: Communities that have enacted Tobacco 21 laws find youth initiation reduced as much as 50% when evaluated Our proposed project will lead to reductions in youth initiation of tobacco products and will help improve health equity in Arizona In addition, local T21 momentum will eventually lead to a statewide policy Where a T21 policy has been adopted statewide, the T21 policy spread at a local level first A state-wide T21 bill has come before the Arizona Legislature and Senate twice over the last two years but didn’t proceed Successful community by community adoption will give T21 policy the best chance of being adopted at the state level in the future What ACAS will do: ACAS will work with communities that understand the importance of this issue and are invested in the health of their community Further, ACAS will work with these communities to facilitate and help them share their narrative of the epidemic in their local middle and high schools Coalition partners committed to assist with this project: Lauren Kuby, Vice Mayor, City of Tempe, Jeff Van Arsdale and his Empire High School (Tucson, AZ) Students Working Against Tobacco Team, Arizona Academy of Family Physicians, Arizona Addiction Treatment Program (AATP), Tri-City Cardiology (22 Cardiologists), Pima County Board of Health, Roy Tatum, President, East Valley-NAACP, Clyde R Miller, Jr., Youth Coordinator, Tanner Community Development Corporation, Nicole Olmstead, Government Relations Director – Arizona, American Heart Association, JoAnna Strother, Director – Advocacy, Western Division, American Lung Association, Brian Hummell, Arizona Government Relations Director – American Cancer Society Cancer Action Network, Inc., Preventing Tobacco Addiction Foundation, Tobacco Control Legal Consortium, Truth Initiative, Campaign for Tobacco-Free Kids To guide in the policy development, partners will utilize assistance from the Tobacco Control Legal Consortium T21 Sample Ordinance and Tool Kit Project Budget: Funding Requested: $110,000; Project Duration: Years; Staffing/Personnel: $85,000, Local Travel: $7,500, Technical Assistance/training: $7,500, Coalition building: $7,500, Educational Outreach Materials: $2,500 Amistades, Inc Curando Familias Alignment with Vitalyst's mission Amistades is a non-profit organization with the vision of empowered communities that inspire cultural preservation, social equality, and self-sufficiency We are a Latino-led, Latino-serving, community development organization with the mission to provide culturally responsive services, advocacy for social justice, and community empowerment Our experience and central program impacts lead to resilient and healthy families We employ cultural approaches to prevention and intervention to effectively serve Latinos at the program, practice and policy levels All efforts are grounded in strategic partnerships, grassroots outreach, and use of evidence-based practices Investments in the Amistades Latino Immigrant Model initiatives and programs range from the W.K Kellogg, Robert Wood Johnson, and American Medical Association Foundations to Hispanics in Philanthropy Clarity of policy or practice change's potential to improve community health (e.g innovation potential) Culture is a strategic underpinning of Amistades’ vision, mission, and programs Belief systems, principles, and ways of living are the results of culture patterns and conducts Culture permeates and influences individual and family health behaviors, as well as, policies and practices among health and human services systems Too often cultural and language characteristics have been biasedly interpreted and used - from political leaders and policy makers to health institutions and practitioners - leading to marginalized and unhealthy families Current anti-immigrant rhetoric combined with discriminatory and criminally oriented policies are worsening Latino health disparities Further, Latino voices to address policy and service solutions are marginalized The results are trauma impacts that weaken immigrant family and youth bienestar (well-being) Weakened because of health disparities exemplified by chronic diseases, prenatal care, mental health, and health insurance coverage The Annie E Casey Foundation’s 2018 Kids Count Profile, ranks Arizona 46th nationally in child well-being, reinforcing many of these issues Identified policy or practice change that address the intersection of two or more "Elements of a Healthy Community" through a health equity lens (e.g innovation potential) Amistades purposes the Curando Familias (Healing Families) project to reduce the health trauma related disparities of Latino immigrant families in Tucson’s Southside, where diabetes, obesity, heart disease, select cancers, and mental health related illness are disproportionately high - according to the CDC 500 Cities Project: Local Data for Better Health The population lives in a primary care, mental health, and dental health care professional shortage area, with an 814:1 population to primary care provider ratio - as documented by the Pima County Community Needs Assessment The National School Boards Association tells us that 88% of the 17,000 students in the Sunnyside Southside area are Latino - 40% of the youth are part of immigrant families The objective is to mitigate poor health causing stressors by using cultural strengthens and indigenous healing practices, improving families navigation of available health and social service systems, engaging these systems to change, and developing and maintaining positive health behaviors Amistades intends to create a collaborative safe space for families, healers, neighborhood advocates, non-profits, and schools to organize and acquire culturally-based healing and advocacy training targeting this objective Clear identification of the system where the policy/practice change will occur and the proposed pathways of change (e.g systems change) Curar means to heal Curanderismo is the art of healing Curando Familias will use Curanderismo indigenous healing practices - and empowerment training to tackle health problems resulting from historical and current anti-immigrant induced trauma A barrio network of Curanderos/as - traditional indigenous healers will employ practices and customs that are known and trusted by Latino families - giving them access to the care needed to address health issues rooted in the stress of trauma, migration, and acculturation The healing practice of Curanderos/as, and its efficacy (e.g., holistic and mental health, diet, alcoholism) are recognized by an array of health care physicians and researchers - Andrew Weil (Health and Healing 2004/14), Steffi Zacharias (Mexican Curanderismo as Ethnopsychotherapy 2006), Brett Hendrickson (Border Medicine 2014) Participatory research supports that recent immigrants retain cultural characteristic and practice that engender resiliency and positive health behaviors These positive characteristics are undermined and diminished by stressors associated with their migration and acculturation process experiences Curanderos/as will be identified and organized to conduct family and group platicas (talks) focused on natural healing areas consistent with cultural traditions The outcome will be retention and continuation of positive adult and child developing health behaviors Description of how the project uses a health equity lens (approach) to the work (e.g health equity lens) Curando Familias is premised on health care disparities such as differences in coverage, access, or quality of care that is not due to health needs Whereas, health disparities refers to higher burdens of physical or mental illness, injury, disability, or mortality experienced by immigrant families in relation to non-immigrants Immigrant inequities are differences in health which are not only unnecessary and unavoidable but, unfair and unjust - social injustices Sacred, indigenous principles, taught by nationally known Curandero Jerry Tello, will be used to guide the work The preceding disparities and lack of equity lens causing immigrant family traumas are the context from which the principles will be introduced and applied Advocacy training will be introduced to demonstrate inequitable policies and service actions that can be addressed through collaborative community efforts Defined partners with experience to select a policy/practice change for the identified population (e.g community partners) Families, Curanderos/as, social and health service providers, and researchers will incorporate cultural and language responsive methods and tools in family health healing and policy advocacy initiatives Immigrant experienced partners will include Latino serving Southside public schools, Chicanos Por La Causa, Mi Familia Vota, LULAC, Mexican Consulate of Tucson, Sunnyside Neighborhood Association, El Rio Community Health Center, Curanderos/as and Botanas The central framework of the project is indigenous health practice and civic empowerment Families will create an organic barrio Curanderos/as advocate network encompassing: 1) traditional healing practices and 2) local barrio advocates with local healthcare systems knowledge, understanding of immigrant issues, and healthy behavior skills Specify the potential lasting health change after the grant (e.g sustainability) Curando Familias will incorporate four sustainability goals: 1) documentation of Curanderos/as practice in addressing immigrant traumas for repetitive use with minimal added costs; 2) advocacy training will be provided to include peer-to-peer training to maintain on-going health and human services advocacy; 3) less traumatized and empowered immigrant families with increased parenting effectiveness and child development, and 4) Stronger collaborative relationships to increase access to coordinated health and human services Clearly defined health outcomes to be improved by the proposed policy/practice change (e.g health outcomes) Expected outcomes are retention of indigenous healthy behaviors, and improvements in health and human services access that help reduce marginalized isolation and trauma induced health problems Measures targeting individual and familial health behaviors, and civic knowledge and engagement will be identified and implemented to assess Curando Familias project outcomes Brief outline of the project budget ($75,000-$125,000) Requesting $125,000 for a two-year project period (May 1, 2019-April 30, 2020) (May 1, 2020-April 30, 2021) Funds will be used to plan, implement, and evaluate the Curando Familias project 2018 Vitalyst Innovation Grant LOI Health & Wellness Clinic for Adults with Autism & Other Neuro-Diversities A Hub-and-Spoke Model After more than 20 years of research, exploration and ideation, First Place AZ is in an optimum position to advance collaborations that serve adults with autism spectrum disorder (ASD) and other neuro-diversities in need of accessible health care administered by a multidisciplinary team with the knowledge and understanding of how to treat and support them First Place has greatly benefited from the opportunity to lead and participate in research, including several think tanks that have guided us on a path to co-creating a model patient-centered, multidisciplinary and integrated health and wellness clinic serving as a medical home for members of this underserved population The 2016 AHCCCS ASD Advisory Committee Report to the Arizona Governor’s Office served as a launching pad for helping to determine how to support healthy living for adults with ASD A Vitalyst planning grant bringing together a broad cross section of 24 thought leaders and medical experts was a critical catalyst for initiating our phased approach and determining the desired collective impact Using a hub-and-spoke model and a collaborative approach to changing current practices, First Place and Dignity Health St Joseph’s Hospital and Medical Center and Barrow Neurological Institute will demonstrate innovative, sustainable methods of health care coordination with improved, integrated care outcomes with the potential to save money over time Several viable, key components are in alignment: 1) physical spaces, 2) staffing and operations, and 3) training for patients, family members and medical professionals The path to this innovative service model is paved with results from various tools focused on this population A 2015-16 First Place and Southwest Autism Research & Resource Center (SARRC) survey of 126 adults titled “Transition from Child to Adult Health Care for Those with ASD” gleaned valuable input on topics ranging from specialty needs and finding practitioners with experience treating patients with ASD to pilotprogram participation and telemedicine The First Place 360 Health & Wellness Curriculum was designed and developed through funding from a grant by the Board of Visitors to establish a continuous spectrum of health within a community framework through the creation of 30 learning modules targeted for 1) individuals with ASD, 2) their families and direct support service providers, and 3) health care professionals The First Place AZ/Autism Housing Network 2018 Quality of Life Survey, administered to each of our residents, addresses topics ranging from goal setting and employment to housing and support services Innovation potential: The establishment of a holistic, systematic approach to health and wellness begins with open communication with and coordination among the patient, family/guardian, medical and behavioral health providers, as well as others engaged in the patient’s education, employment, housing and social network Through this innovative, integrated and multidisciplinary hub-and-spoke model, the clinic’s primary care team will serve as the hub with the goal of communicating with and connecting other providers and support systems The clinic and its collaborative partners will create and maintain a culture supportive of adult populations with ASD and their families/guardians, allowing for a better understanding of how to work with individuals with special needs First Place and SARRC research, including input from family members, indicates a dire need for access to integrated primary and preventive health care and coverage, which includes a connected medical team with a grasp of the ASD patient’s best interests and desired quality of life Families need confidence in provider networks They need ways to establish and measure benchmarks with regular follow-up to assess the effectiveness of prescribed protocols They seek the maintenance of orderly records that can be electronically transferred to and shared among members of the medical team and beyond Parents yearn to be successful advocates for their adult children as they navigate a complex, often confusing health care system Developing an efficient, sustainable and replicable clinic model will require research, data collection and analysis to effect policy change Medical and behavioral health information will be accessible using an electronic medical record in concert with telemedicine innovations Data will also be analyzed to develop more equitable reimbursement policies with private and public payers 2018 Vitalyst Innovation Grant LOI Systems change: The proposed pathways of change entail the alignment of these key components: 1) Physical spaces: Dignity Health St Joe’s/Barrow will serve as the hub First Place–Phoenix, open since July 2018 with 32 current residents and situated for access to public transportation, will serve as the first site, or spoke, leading by example and demonstrating how the model functions 2) Staffing and operations: Collaboration among our community partners will include the combination of existing staff and established operational structures to implement our three-phase model 3) Competency and confidence: Training of patients, family members/guardians and medical professionals will be administered through the 360 Health & Wellness Curriculum developed by First Place, which incorporates content, toolkits and assessment strategies This clinic model is poised for a broad and cumulative impact, beginning with residents of First Place–Phoenix before expanding to the greater community within Metropolitan Phoenix and ultimately reaching a national audience Health equity lens & sustainability: To leverage the elements of a healthy community, our approach to the development of the multidisciplinary health and wellness clinic incorporates three phases Phase 1: Working with a pilot population (First Place residents), the initial focus will be on providing primary and limited specialty care while gathering specific medical and behavioral data for the establishment of an electronic medical record We will also develop a provider database to support specialty and subspecialty care, behavioral health, vocational planning and a broad range of social services for the ASD population Phase 2: The focus will be on training patients, family members/guardians, medical professionals and other health providers Emphasis will also be placed on increasing the independence of individuals with ASD to manage their health and wellness Phase 3: In this phase, we will develop evidence-based case statements, expand training, continue to refine the model and establish sustainable funding streams We have identified solid community partners—several with a long, established history with First Place— with whom to collaborate on this clinic model: St Joe’s/Barrow; AZ Dept of Economic Security (AHCCCS); UnitedHealthcare AZ; our sister nonprofit, SARRC (training); and ASU (a doctoral fellow lives onsite at First Place–Phoenix and will participate in training, research and data collection) Once the methodology is established and measurable outcomes emerge, the First Place spoke will serve as a model ripe for replication We will demonstrate the efficacy of this model for replication in the greater community of adults with ASD and other neuro-diversities in the Valley and ultimately to a national audience, including transition-age youth with ASD Health outcomes: With local and national partners, we will build a model primed for greater patient and family access and satisfaction while offsetting costlier, often avoidable services with collaborative expertise and maintenance through training, more efficient use of technology, more timely interventions and comprehensive health and wellness support This model will demonstrate how a multidisciplinary clinic can lead to improved health outcomes that include effective communication within the medical team, fewer ER visits and enhanced quality of life The potential for positive future telemedicine outcomes also includes First Place residents interfacing with medical professionals in other parts of the U.S From a clinical standpoint, First Place’s profound understanding of this special population allows us to consolidate this team effort to provide care in optimal physical environments and in more thoughtful, perceptive ways Budget: First Place AZ is seeking a Vitalyst Innovation Grant for $125,000 over two years to support the multidisciplinary health and wellness clinic model A preliminary budget comprises the following annual expenses: program coordinator - $20,000 ($40,000); trainer to administer the 360 Health & Wellness Curriculum - $16,000 ($32,000); outreach & training coordinator - $5,000 ($10,000); data collection & research - $15,000 year 1, $25,000 year ($40,000); facilitation expenses - $1,500 ($3,000) H.O.P I Cancer Support Services P.O Box 123 Kykotsmovi, Ariz 86039 Phone #: 928-734-1151 or 734-1152 September 28, 2018 Vitalyst Health Foundation 2929 N Central Ave., STE 1550 Phoenix, AZ 85012 RE: Letter of Intent: Innovation Grants To Whom It May Concern: Please accept this Letter Of Intent (LOI) from the Hopi Tribe, HOPI (Hopi Office of Prevention and Intervention) Cancer Support Services under the umbrella of the Hopi Department of Human Services in Kykotsmovi, AZ This proposal is not a continuation of an existing program and is not an active Innovation Grant awardee The HOPI Cancer Support Services will submit a Hopi Tribal Resolution upon notification of successful grant application funding; typically, the Tribal Council need a one-month notice for review of the Resolution and approval Innovation Potential To improve and increase access to health care for an integrated coordinated system of care with a Hopi culturally-target early detection and education model The target population will be Hopi young men who are 18-49 years old who live on the Hopi Reservation This innovative project will develop outreach and education materials for men in the Hopi Community and provide the opportunity to increase screening for men when they reach screening age The key stakeholders include Hopi men who are members of the Community Advisory Committee (CAC), with recruitment of young Hopi men to join CAC to provide advice and feedback to HOPI Cancer Support Services personnel for Men’s health The project team has willingly shared ownership and decision-making by following Community Based Participatory principles Systems Change The HOPI Cancer Support Services and CAC members desire a fully sustainable program for young men that does not rely on grant funds or external expectations The goal for practice change is to be fully sustainable with coordinated resources with stakeholders on the Hopi Reservation and with two Indian Health Service facilities (Tuba City Regional Healthcare Corporation and Hopi Healthcare Center) The practice change of providing health care services such as early detection screenings to Hopi young men may affect policy change for men The different players to include in the systems change efforts are the personnel from the Hopi Mental Health Services and specialists who have a concentration in historical trauma The reason for the current status quo is due to unexpected findings from the Behavioral Risk Factor Surveillance System, which was collected from the Hopi community survey in 2014 It identified Hopi men with low participation for health screening In response to the findings, the Hopi men asked the Director for the Hopi Health and Human Services “What about men? Why we not have a program for men?” The Hopi community, stakeholders, and existing agencies are ready for the system to change They envision their younger male generation to have Letter of Intent to Vitalyst Health Foundation September 28, 2018 Page Two readily access to healthcare services The best strategy for influencing systems is an implementation by the Hopi male navigator to lead health education for early detection and cancer screenings for young men Health Equity Lens This proposal will focus on men from 18 to 49 Currently, no program on Hopi targets men in this age group The approach used mainly by the HOPI Cancer Support Services serve women and is not appropriate for Hopi men in this age group This applicant will develop and utilize culturally appropriate approaches to target Hopi men who are 18 to 49 Community Partners HOPI Cancer Support Services is an Arizona based tribal entity that is Federally Recognized by the U.S Government The following groups will work collaboratively with the HOPI Cancer Support Services to meet project goals: CAC, Health Sciences Department from Northern Arizona, University of Arizona Cancer Center, Tuba City Regional Health Care Center, and Hopi Healthcare Center Upon application review and funding recommendation, HOPI Cancer Support Services will recruit four additional Hopi CAC male members that represent the project’s purpose (18-49 years) to join the current male CAC Sustainability The HOPI Cancer Support Services met with CAC members for a strategic session recently to identify issues and needs to develop and sustain cancer prevention services to Hopi men At the top of the list was to develop a male-focused cancer prevention program, especially for young men The CAC recommendation was to target young men for access to cancer and wellness education, prevention of obesity and diabetes mellitus, and mental health services to address historical trauma Due to Hopi community male concerns, the applicant envisions this proposed project to become a program service for men Sustainability: The proposed project funds will provide resources to demonstrate at the local-level (individual to intrapersonal) to identify resources and support at the community-level (1st, 2nd, 3rd Mesas) and policy-level (Tribal Council, Indian Health Service facilities, Hopi mental health services and Hopi High School) Health Outcomes The health outcome is to increase early detection and health promotion education to young Hopi men by 80% in two-years The key element is a Hopi male navigator who will provide culturally sensitive and culturally specific education for Hopi men An outcome of our interest is mortality from chronic diseases, particularly cancer Our long term goal is to reduce mortality from chronic disease by encouraging men to take care of themselves Budget The applicant proposes a two year budget reflecting a total of $125,000 or $62,500 per year, inclusive of Indirect Cost Staff will include a Manager and Native Patient Navigator funded at percentages of their time for two years A part-time Assistant will be hired to assist in outreach, develop resource materials and manage an internal assistance program for cancer patients We will be engaging consultants for training needs (historical expert and navigator), hold quarterly learning sessions, hold a convening and hire an evaluator Other costs include telephone, copying, space rental, gas and other expendable supplies If you should have any questions, please feel free to contact Dana Russell at 928-734-1151 or by e-mail at drussell@hopi.nsn.us Sincerely, Dana Russell, Manager NAU Foundation NAPPASA
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