Leaning into Change…

Maggie Sauer PortraitWith a new year, we all consider our resolutions and opportunity to change.  Well, the NC Foundation for Advanced Health Programs (NCFAHP) has been giving this a lot of thought in recent years.  Our founder, Jim Bernstein, embraced change and the innovation required to bring it to fruition.  Many of our “friends and family” encouraged us to change our name, saying: “It’s too hard to remember.”  Over the past year, we sent surveys to our partners and friends, held focus groups and at last reached a consensus on a new name.  Beginning January 1, 2016, NCFAHP will become the Foundation for Health Leadership and Innovation, with the tagline: Moving People and Ideas into Action. Our website address will also change to foundationhli.org.  Thanks to each and every one of you that gave us your time and ideas.  We look forward to staying in touch and continuing to live up to the challenge our new name suggests and the legacy of Jim Bernstein.

Aging in North Carolina is another topic we have spent a fair amount of time discussing with our board and staff.  Much attention has been given to the “silver tsunami” yet we are still woefully unprepared to care for the very individuals in our country that have so gallantly contributed to our own well-being.  It reminds me of James Taylor’s song, “Secret of Life”:
[box type=”bio”]

The secret of life is enjoying the passage of time. Any fool can do it, there ain’t nothing to it. Nobody knows how we got to the top of the hill. But since we’re on our way down we might as well enjoy the ride.


As we change, age and consider what this means, how can we help our seniors “enjoy the ride”?  Here are some of our state’s facts on aging:

  • NC ranks 9th nationally in population 60 and over
  • By 2025, 89 counties are projected to have more people 60 and over than 0-17
  • NC ranks 6th in the number of grandparents responsible for grand children under 18
  • 48 percent of older adults have two or more chronic diseases
  • In 2010, more than 170,000 people aged 65 and over had Alzheimer’s disease or other types of dementia. By 2025, this number is projected to increase to 210,000.

Attention to population health provides a perfect opportunity for us to consider the “ride” and not the crash!!  What are the things we can do in our communities that reflect value not just loss?  In February 2010, The Economist published an article “The Silver Tsunami”, discussing the management of an aging workforce.  Small changes in production lines helped maintain productivity.  Designing and modifying housing to support progression in age is critical to aging in place. A report prepared for The Duke Endowment: “Aging in the Carolinas: Demographic Highlights, Programmatic Challenges & Opportunities” presents a thorough review of our opportunities.  Jim Johnson concludes in the final paragraph of his report:

“What is needed in this space is a centralized hub for successful aging in place ideas and practices. Such an entity should serve five specific but interrelated functions: mobilize collective ambition, leverage intellectual capital, facilitate new venture creation training, foster social innovation, serve as a clearinghouse for information dissemination, and engage in succession planning.”

As we pause to honor 2015 and the new year, let’s not forget the shoulders we stand on in order to face the future.

-Maggie Sauer

CEO & President

Psychologist Neftali Serrano remembers when the concept of integrated care—the combination of behavioral health and primary care—clicked with him.

Dr. Serrano was working in a health center, down the hall from the primary care physicians. He only had two or three patients a day. “I was open for business and had no one coming in,” he said.

Out of that futility, he said he started spending time with providers instead of sitting alone in his office. This evolved to walking into exam rooms and working with patients directly.

“Within 30 seconds, patients were opening up about their behavioral health issues and getting to things that would usually take hour long visits or even a series of visits,” said Serrano.

Dr. Serrano said he connected faster to patients in a primary care setting. “They trusted their primary care doctors and they extended that trust to me,” he said.

Dr. Serrano now works with the Center of Excellence for Integrated Care, a program of the Foundation that trains health care professionals and providers to treat behavioral and physical health in one setting.

[box type=”bio”] “They trusted their primary care doctors and they extended that trust to me.”[/box]

Integrated care can work especially well among the aging population. Two out of three Americans aged 65 and over have chronic illnesses, which are often coupled with mental health distress. The Centers for Disease Control and Prevention estimates that 20 percent of adults over 55 have a mental health concern. Decreased mobility, isolation and health complications can cause anxiety, depression, and severe cognitive impairment among our aging community members.

Integrated care can offer older adults a safe place to get help with these behavioral health issues.

“Some older adults are not as willing or able to go outside the walls of a primary care office to see a therapist,”” said Dr. Serrano. “Having a behavioral health consultant right there is a more culturally appropriate way to deliver care for folks who are more comfortable with primary care.”

[box type=”bio”] Integrated Care can offer older adults a safe place to get help with behavioral health issues.[/box]

Woman and 2 nurses in doctor's officeInitial research trials among the elderly combined psychiatric therapy with primary care, and proved to be very successful, said Dr. Serrano. For example, cardiovascular health, a common concern for the elderly, can improve by treating depression.  “There are clear links between heart health and depression,” said Dr. Serrano.

Another advantage of integrated care is the free flow of patient information. The patient’s medical history is on hand, and can better inform the behavioral therapist, instead of having to start from the beginning with every patient.

Integrated care can also help primary care physicians make better assessments for their patients. For example, depression is often masked by physical health issues. Patients with vague pain may be suffering from isolation or loneliness.

“Oftentimes primary care doctors will do a whole lot of work to address the physical problems but fail to address the root issues,” said Dr. Serrano.

There is also a certain threshold a patient must meet for referral to a mental health therapist. Many people that need behavioral health assistance may not have acute behavioral health issues, but would benefit from the input of a therapist in their primary care office.

Dr. Serrano said it will take a lot of broad training across specializations to prepare the medical profession for an older population. Mental health professionals in particular, according to Dr. Serrano, will need to reconfigure their mindset and work-flow. “Mental health professionals are more accustomed to sitting in an office by themselves than working on a team,” he said.

The Center of Excellence for Integrated Care (COE), a program of the Foundation, helps providers make this adjustment. They have practical training programs on all aspects of integrating the silos of behavioral health and primary care in any setting where health care is delivered. COE is also dedicated to reducing the stigma associated with behavioral health issues. Accessing therapy through a primary care doctor can help reduce any discomfort of feeling of shame about needing help. The integrated approach to elderly care is important to recognize and replicate as our population continues to age.


calvin-allen-and-brandy-bynumNo day is the same for Calvin Allen and Brandy Bynum, the dynamic forces behind Rural Forward NC, NCFAHP’s newest program.  They could be, and often are, at a county commissioner’s meeting in Halifax County, attending a training in Winston-Salem, and making a stop at the office in Cary to hop on a few conference calls, all within a 36-hour period.

Rural Forward NC is an initiative launched out of Healthy Places North Carolina, (HPNC), a statewide initiative led by the Kate B. Reynolds Charitable Trust.  The Trust has committed to a 10-year, 100-million-dollar investment in 10-15 Tier 1 counties in North Carolina.  Tier 1 counties are the poorest counties in the state, as designated each year by the NC Department of Commerce.  The 10 years of funding for HPNC is exciting and shows the Trust’s commitment to “being in it for the long haul,” supporting counties in multiple ways.  Unlike a lot of other grant programs where funds are distributed and the grant facilitators step back, Healthy Places North Carolina, now in its 3rd year, is using partnerships to implement and support the initiative all over the state.   Program officers at the Kate B. Reynolds Charitable Trust work with community partners to build relationships and networks, and manage the implementation of HPNC initiatives.

Rural Forward NC (RFNC) is a program of the NC Foundation for Advanced Health Programs (NCFAHP), which incubates and supports initiatives that focus on community-centered care.

Calvin Allen is the Director and Brandy Bynum is the Associate Director of the Rural Forward NC.  The two work in tandem, going into communities where the need is and sending whichever of the two has most expertise and/or time available.  But they work as a close-knit team, and together they are helping communities move forward to change for the better and improve health outcomes for their residents.

Rural Forward NC works in designated Tier 1 counties – right now Halifax and Rockingham – to make the efforts of local leaders stronger so that they can make real change in communities.  RFNC does not dictate what changes should be made, but supports with the purpose of training and facilitating change.  The first step to this, Calvin and Brandy say, is to help communities become aware of their issues, prioritize the issues, and decide on what changes are needed.  Training, facilitation, resource management, and policy analysis are all central to what Rural Forward NC provides.

“Part of our job is to ask the questions – and to do it as diplomatically as possible,” Calvin says.  He and Brandy often have their own feelings about what may work and the value of some things over others when attending meetings with a community group or in a one-on-one conversation.  “But, that’s not our place,” Calvin says.   “It’s to help bring voices out, and to provide exploration, and to challenge gently, so that the strongest ideas come out and are explored.”  Both Calvin and Brandy agree that the best ideas often are within the community already; they just need to be heard.

playgroundBoth Calvin and Brandy share a background on youth issues, and a big part of their work at Rural Forward NC focuses on the youth voice as well.  In a lot of rural communities, young people go off to college and never come back.  Brandy says that their team wants youth to go out and then come back, eager to re-invest in their communities.  “But, if we’re not listening to them now, why would they want to do that?” she says.  “Rural Forward has been working with organizations that work to bring young people into conversations about issues – like improving access to recreational facilities and programs – that young people can and should be a part of.”

One example of a specific intervention RFNC has been a part of is around child health in Halifax County, where the childhood obesity rate was 34% in 2012.  The team kept hearing that the central “place” in this issue was schools, where kids spend most of their time.  Brandy contacted experts and spent months studying and asking questions about the schools’ perspective on the issue.  The team then brought together school administrators, parent involvement coordinators, school nutrition, and community voices to talk about the barriers and strengths to addressing childhood obesities in the schools.

After months of conversations, 3 program examples were presented and the Coordinated Approach to Child Health (CATCH), an in-school/at-home model, was adopted.  CATCH utilizes tools from visual aids of healthy eating in cafeterias, to incorporating conversations about health foods in math and English classes, to materials for kids to share with their families and implement in their own homes.

This is just one of many interventions in which Rural Forward NC has played a role during the past 3 months. They’ve also worked with helping coach community leaders, facilitating various funding opportunities, and supporting the creation of a comprehensive parks and recreation plan to improve access to programs and facilities, among many, many other projects.

Calvin and Brandy hope to take their work in policy, training, facilitating and convening, and go even a step further.  They want to be able to look at what happens in different counties, seeing what the connections are, and figuring out if there is a strategy that could be useful for multiple places in a community-driven approach.  They recognize that broader strategies can be effective and can save time and money, but they also emphasize the importance of recognizing that every county and every community is different, and sometimes there is no “one-size-fits-all” solution.

hulahoopingThough Rural Forward NC is primarily focused on health issues and outcomes, they also have the flexibility to work on issues that are one step beyond health, but that have a clear impact on health.  The HPNC team recognized that, if people are healthier but don’t have jobs, or there’s a gang issue, or an overall lack of opportunities, the chances for sustainable health improvements will diminish.  Brandy is quick to share her expertise and passion for juvenile justice and improving education in order to keep kids out of the juvenile and adult criminal justice systems. Calvin has years of experience in community economic development, specifically rural economic development, and is passionate about finding out how and why communities grow or don’t grow.

Calvin and Brandy also enjoy the chance to work as a team, and say it’s exciting to see how aligned they are on their goals, objectives, and values.  They’ve also embraced their new role as part of the Foundation.  “It’s a group of people that are very dedicated to community, and see the value of having all voices at the table,” Calvin says.  “They see the value of true inclusion.  And to have that span from the community to the governor’s mansion and beyond in terms of influence…that makes working here an amazing experience.”

Rural Forward NC is the newest part of the NCFAHP, and complements the pillars of the NCFAHP through leadership, being community centered in shaping practice, helping to drive innovation, and affecting policy.  “Those underlie our values, how we do our work, as we do our work,” says Calvin.

All in all, it has been a busy first few months for Calvin and Brandy at the Rural Forward NC.  The program currently has three years of funding, and when asked how they’ll know if their work is successful, Calvin answers by focusing back on the communities: “Our success is really based on the success of the counties.  Are they achieving the goals that they’ve set up?  Do they have a vision?  Do they have strategies for achieving that vision?  Are the entities in the community strong, and exhibiting leadership?  Do they have strong leaders?  This is how we measure success.”

And this, like the rest of their work, shows how Calvin and Brandy, while experts in their field, are putting their whole selves into training, facilitating and equipping communities, rather than dictating what they think is best.

Calvin and Brandy are undertaking a huge initiative with Rural Forward.  But their passion and drive, their dozens-of-meetings-a-week schedules and their heart for seeing people and communities succeed, as well as the work they’ve already done in this short time, show that people really can change the world.