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In January, 2023 Adrienne Ammerman (WNC Health Network) interviewed Meron Abebe (Operations Manager & Improvement Specialist, WNCHN) and Hannah Robinson Michael from Partners Aligned Toward Health about our organizations’ work together as it relates to Results-Based Accountability.
Learn more about PATH at: https://pathwnc.org/. Learn more about WNCHN’s RBA trainings here.
Meron and Hannah, let’s start with some introductions. Please each of you tell me a little bit about who you are – your role at your agency and the kinds of things you do day-to-day.
Meron: My name is Meron, Operations Manager & Improvement Specialist at WNC Health Network. The kinds of things I do, day to day include: Budget and financial management and reporting; Contracts; Policies and compliance, and General monitoring and accountability of organizational performance measures. I also provide support to our clients, like PATH, specifically around the implementation of evidence-based evaluation frameworks and qualitative data gathering and analysis.
Hannah: My name is Hannah and I’m the Healthy Lifestyles Program Manager at Partners Aligned Toward Health or PATH. PATH is a nonprofit. We use collaborative approaches to improve the health and wellbeing of families and community members in Mitchell and Yancey counties. Our initiatives shift as the community identifies new health needs but over the last several years, we’ve focused on healthy wellbeing and substance misuse prevention. In my role, I support a variety of programs, including the Healthy Yancey Coalition, Summer Food Program, and the Burnsville Fit Families 5K to name a few. I also support the data and evaluation work for PATH.
Meron, can you tell us at a high level what Results-based accountability is?
Meron: RBA is a way of thinking, organizing, and taking action in a disciplined manner. It is used to plan, evaluate, and improve projects, programs, and community-wide efforts. It helps people describe the contribution their work makes to the health and wellbeing of their community. RBA has been recognized as an evidence-based practice for evaluation and planning by the CDC, the National Institute of Health (IHI), and NC DHHS. In western NC, RBA is being used by hospitals, public health agencies, nonprofits, funders, and other local and regional partners in community health.
Hannah, how is PATH interested in Results-Based Accountability? What feels valuable about using RBA in your work?
Hannah: When people hear you support data and evaluation efforts for an organization some people’s eyes glaze over or they feel intimidated or there is general disinterest in the topic. We really had a desire to be able to talk about data and evaluation in a way that engages people and the RBA framework provides a commonsense approach that makes data and evaluation easy to understand regardless of your background. We also realized that internally, we needed a shared language around our work, our impact, and data & evaluation in general. The RBA framework has helped us do that and this makes moving our evaluation work forward much easier. Another major bonus of using the RBA framework is that funders have become interested in it. Sharing how PATH is using RBA has been beneficial on our grant applications and in general conversations with funders.
What made your team decide to reach out to WNC Health Network, and what kind of support were you looking for?
Hannah: Before I started at PATH, the organization was interested in improving their data and evaluation efforts to better demonstrate the impact that PATH is having on the community.
This led some staff to attend the regional RBA trainings hosted by the Network. This was helpful for building a general foundation in the framework and making an organizational switch to using RBA with all of our programs. Most recently, Meron and Emily led a PATH specific RBA training. This was great because it allowed all of our staff to be trained on RBA and they were able to use examples relevant to PATH throughout the training. We’ve also worked with the Network to develop evaluation plans for some of our specific programs. As the person on PATH’s staff that generally facilitates conversation around evaluation, it was extremely helpful to work with the Network because they laid out the plans for the meeting and facilitated conversation. I felt like I could more effectively participate in these conversations because I didn’t hold the dual role of facilitator and participant. The Network was there to hold the space. Being a part of developing these evaluation plans as a participant has build my confidence and my capacity to better lead these conversations with my team in the future. The last thing I’ll share is that WNCHN works with organizations throughout the region so they are able to share how our work and measures align with our partners through-out the region and the state. It’s been helpful for us to see how our work fits into the larger picture of the region.
Meron, Tell us a little bit more about what this partnership with PATH looked like from WNCHN’s end. [Do you have anything to add about] what kind of support you and our team provided on this project?
Meron: Our team has worked with PATH for many years on multiple projects. Last year, we provided evaluation support for two of their programs – Cougar Fit Club and Appalachian Youth to Youth. We reviewed existing strategy activities and measures and used the RBA framework to facilitate 5 evaluation workgroup meetings. We led the group through the first several steps of the RBA performance accountability decision making process to create an evaluation plan. And – during the process, we coached the team in developing and prioritizing performance measures and creating a data development agenda. We also provided a tailored virtual RBA training for PATH team members with a focus on RBA knowledge, use, and infusion into their specific projects and activities. We had 4, 2-hour sessions, spread over 4 weeks. We also administered a pre-and post-training organizational assessment tool, analyzed the data, and shared the findings with PATH.
How does this kind of project align with WNCHN’s values and approach for how we work in the region?
Meron: We bring our values to all our work with all clients. For instance, with the evaluation project and the RBA training, we co-designed the tools and materials we used with PATH and coached their team throughout, because we wanted to make sure that we are meeting their unique needs and building their capacity, rather than just BEING capacity, as that supports and sustains locally led improvements.
Wrapping up – Hannah, what’s next? How do you plan to use what you learned?
Hannah: Our next steps are to continue using RBA in our work and imbedding it into the overall functioning of the organization. We’re also eager to continue using our evaluation tools to get feedback from our customers so we can improve our work and ensure we’re meeting the needs of our community.
We also welcomed a new staff member at the beginning of the year so we’ll be sending Jacquie to an RBA training. She will be taking over our Home Remedies program. The program is an online course that introduces participants to strategies for pain management and stress reduction, all of which are presented by local complementary health providers. This program is paid for through an opioid response grant from the state so we’ll be working with Jacquie to update our evaluation tools using the RBA framework
Any words of wisdom or suggestions for other local organizations or agencies that want to infuse RBA into their work?
Hannah: PATH’s work with WNCHN focused on infusing RBA at the program level first. Later, we were able to train all of our staff in the RBA process. I’d recommend that organizations prioritize training staff on the RBA framework first, then honing in on specific programs. I’d also recommend training your entire staff if you can, not just your data people because the benefit of creating a shared language about evaluation is invaluable.
Meron: In 2023, we plan to hold two virtual RBA trainings, that we call “Getting to Results”. The first one is in February and the second one is in September. People who are interested can go to our website at www.wnchn.org and find RBA Training under the “What we do” tab. They will find a registration link on the bottom of that page.
Thank you both so much for sharing with us about this experience.
View the data slides here.
Eileen Tallman (WNCHN MPH Spring/ Summer ’22 Intern, Indiana University, Richard M. Fairbanks School of Public Health) and Jo Bradley (WNCHN Data Manager & Improvement Specialist) recently spoke with each other about their work together on a substance misuse data analysis project which involved analysis of single and polysubstance use emergency department (ED) visits in the 18-county region of WNC.
Adrienne Ammerman (WNC Health Network Communications & Improvement Specialist)
Hi, Jo. Hi, Eileen. So, we’re going to get started with our conversation today with just some introductions if you could both tell me who you are, what your role is and a little bit about what you do day to day…
Jo Bradley
I’m Jo Bradley. I’m the Data Manager and Improvement Specialist here at WNC Health Network. And one of my big jobs is collecting and curating the regional data for our 16- to 18-county region. And so that’s what’s going to lead us into Eileen here.
Eileen Tallman
I was a graduate intern with WNC Health Network before I graduated with my Masters of Public Health degree in August. Day-to-day I worked with data, looking at substance misuse in emergency departments in western North Carolina.
Adrienne Ammerman
Eileen, how did you first hear about the Health Network?
Eileen Tallman
I moved to the Asheville area recently and I was looking for ways to get involved in the community, and also meet the requirements for my Capstone project so that I could finish my program, and I found WNC Health Network. I felt it would be a great fit, especially because of the focus on health disparities. And I also really wanted to learn about regional initiatives… In school you talk a lot about national or state or community level health data, but not a lot about regional work. So I thought that was really interesting.
Adrienne Ammerman
Great. We’ve been happy to have you. Let’s talk a little bit about the research that you did.
Eileen Tallman
I knew that I wanted to do something that maybe I could contribute some they were useful information to the region. So in order to do that I needed to learn about racial health priorities. Which Jo can actually talk more about.
Jo Bradley
I’m going to go ahead and share my screen here… And what you should be seeing is a chart of our regional health priorities for the 2021-2023 CHA [Community Health Assessment] cycle. And you’ll notice that many of our counties identified substance misuse, mental health, followed by obesity, healthy eating, active living and nutrition. When we were deciding where we really wanted to start with this project, we went to the [health topic] that was selected by the most counties here in our region, which is substance misuse. So we started there, and then Eileen can tell you a little bit more about how we dug into exactly what we were going to study.
Eileen Tallman
We chose substance misuse, [which is] a very pressing issue. And based on some research that’s already been done, I learned that polysubstance use, or using two or more substances at the same time, is becoming more important, but we really haven’t had the data to study it very well. North Carolina Department of Health and Human Services recently added poly substance misuse as a priority of the state’s opioid and substance abuse action plan. And we had emergency department data. We knew that substance misuse was a driver of emergency department visits, we just didn’t know whether there were differences between people who were using a single substance going to the emergency department, or people who were using two or more substances. So for our analysis, we compared those. We also looked specifically at people who were using opioids, cocaine, or psychostimulants. So psychostimulants are things like methamphetamine. And those were, again, a local priority.
Adrienne Ammerman
And did you have any other partners for this research that you did?
Eileen Tallman
We worked with Dr. Jennifer Runkle, who works at North Carolina State University. She’s an environmental epidemiologist, and she served as a subject matter expert and helped us facilitate that data, provide some technical guidance.
Adrienne Ammerman
Great. So what were some of your high level findings?
Eileen Tallman
What we did find overall, was that substance misuse is increasing in the emergency department for residents of western North Carolina. Overall, we found that between 2016 and 2020 there was a 5% increase across those five years. And we also found, interestingly, that rural residents were coming into the emergency department visit more for poly substance misuse over time. So you can see on the graph that between 2016 and 2019 there was an increase of 5% of people coming in using two or more substances from rural areas. But if you look between 2019 and 2020, interestingly, there’s another 5% increase. We also saw that compared to emergency department visits for opioid and cocaine, psychostimulant-related emergency department visits were on the rise. That’s not a general finding about substance misuse in general in the community. That is the percentage when you compare to opioids and cocaine. And then, overall, we saw that percentages of opioid and psychostimulant emergency department visits nearly doubled for patients reporting as Black or African American who were residents in western North Carolina.
And lastly, we also looked at some other characteristics of the patients coming into the emergency department. So compared to individuals who came in for a single substance, western North Carolina residents coming into the emergency department for poly substance misuse were more than 26 times more likely to have a diagnosis of a mental illness and 76% more likely have been with suicidal ideation or behavior. And we did control for intentional overdoses in that data. They were also two times more likely to have housing or economic problems.
We found some specific differences in individuals coming in using cocaine or psychostimulants. So individuals using cocaine were six times as likely to have a mental illness. And patients coming in for psychostimulant use were more than four times as likely to have a mental illness. They’re also more likely to have housing or economic problems. And this was the group that was most likely to be living in a rural counties.
Basically, we wanted to share what providers can do with data like this, some of this data that’s available. So hospitals and emergency services can use the data to better understand who are coming in to their emergency departments. And we can get important demographic information about the types of individuals who are using specific substances when they come in. Researchers, epidemiologists, and analysts can use data to focus on regional analyses, which is so important. We have a lot of state and national level analyses, but they maybe don’t share insights that are specific to an area. They can also study polysubstance use. Again, this is a topic that more and more people are talking about. But it can help influence funding policy and programs. Substance misuse programs can also make use of data that can help them better understand who are coming into the EDS, so they can better prepare maybe when they make referrals. And informaticists – so those are folks who use data information and knowledge to improve human health and healthcare delivery – they can help make data more accessible so that these groups who may not have the expertise or may not have an easy way to get this data, they can help facilitate.
Adrienne Ammerman
Thank you so much for that high level overview of the research that you did, and how it can be used in our region and for people who are doing this kind of work. Jo, I’m curious how did this project align with the kinds of data projects that we do at the at the Health Network, and our values for how we work with data?
Jo Bradley
Clinical data has long been a data gap for our region, and being able to look at it at the regional level, all the facilities information at one time. And so when we found this opportunity to work with Eileen who’s really interested in hospital data and work with Jen Runkle has been amazing at being in this region, and had access to the data we saw it as a perfect way to kind of dip our toes into the water of clinical data and looking at regional data that way. And we know it’s something that people have been wanting for a long time and have been requesting, and we started with the most important health priority across our region. So that’s just one way that we’re trying to give back to the region.
Adrienne Ammerman
And Eileen, what was your experience like working with the Health Network on this on this research project?
Eileen Tallman
I had a very easy time when I got to work closely with Jo. It was just super responsive and gave me a lot of guidance. So it was a great experience. And, you know, it was a combination of working together and working independently. And I just learned a ton, especially about the region and community health.
Jo Bradley
I think about working with hospital data, there’s a lot of things that I learned as well about what needs to be in place to work with hospitals data and all the analysis.
Adrienne Ammerman
What’s next for you, Eileen?
Eileen Tallman
I’m continuing to dig in a little bit into this data because I was very time limited to get it done for my school project. But we’re continuing to work on that. And also, I’m looking for my next role in public health. So I’m very excited… I just got my degree, so I’m looking for opportunities in community health that will help me make use of my research background and my new skills.
Adrienne Ammerman
Awesome. We can’t wait to see what you end up doing and hope it’s in our region. Jo, I guess on a final note, how can people find out more about WNC Health Network’s data and Data Program?
Jo Bradley
The best place to start is our website [www.wnchn.org]. And we have a specific data section where you can download our full regional data set – that’s our primary and secondary data. That was just updated [in September 2022]. So you’ve got the latest, greatest data there. You can also sign up for our newsletters so that you keep getting information about data releases, we’ve got a lot of really good stuff that’s going to be released over the next year. And then of course, if you’re interested in getting involved or learning more, you can email me at jo.bradley@wnchn.org.
Adrienne Ammerman
Great, thank you so much for sharing about this project and great work.
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