REACH: Improving Lives, Inspiring Hope

Author: Centers for Disease Control and Prevention (CDC)

Mrs. Delagard, a 76-year-old, was scheduled to have her leg amputated. One of her family members came to a community REACH diabetes education class and talked with a community health advisor about Mrs. Delagard's problems. As a result she has her leg. Diabetes was really a closeted issue. Even people who are on insulin often didn't share that with their family and support systems.

Today it's really a community conversation. We started out with about a rate of 40 amputations per 1,000 hospitalizations with people with diabetes. And we've reduced that by 50 percent. That translates into a cost savings of about $2 million per year.

In 2003, we did our initial community readiness surveys. And what we found out is that the community wanted to talk about methamphetamine. They really weren't interested in talking about cardiovascular health.

But with the knowledge that we gained from the surveys we were able to develop a presentation that dealt with the impact of methamphetamine and substance abuse on cardiovascular health. So this was an innovative approach and it captured the attention of the community. The community really felt like that we were talking about what they wanted to talk about. And through that we were successful in getting across our heart health message. Welcome to Cooking with the Council.

REACH: Improving Lives, Inspiring Hope

We're going to be cooking some vegetable chicken stir fry. We have a program called Cooking with the Council. What we did is we take recipes that we're used to that we've grown up with, and they change the ingredients around and make them healthier recipes, and we were wanting to show these in our healthcare facilities, our exercise facilities. We're gonna learn right with you all today. This is kind of new for me, too. So in 2004 Bronx Health REACH Coalition with a number of its community partners, piloted an initiative in a number of Bronx schools to start offering low-fat, no-fat milk to the children.

It's a place where we could reduce the calorie intake. The office of school food decided to do it system-wide and remove whole milk from all New York City public schools, and that you're talking about over a million children. By that very system change we saw that the overall calorie consumption of New York City public schools had fallen between 25 and 81 percent.

It speaks to the REACH model that plays a large role in reducing those health disparities. We work with Pacific Islander and Southeast Asian women around breast and cervical cancer and we've worked with them to increase screening. We do patient navigation. So we'll do everything. The total population is about 600,000 women that we could reach throughout Southern California and other areas.

We reach about 150,000. For the Asian and Pacific Islander community cancer really had a stigma. People equated cancer with death. Through our program, not only did they build trust, but we built communication up with the providers. We've had several hospitals be really supportive to the women.

For example, one hospital has been hosting our Thai cancer survivors group. And in fact, we just had a fashion show with the cancer survivors. The doctors come out. They help to run the support group as well. After our program, 70 percent of the women got screened, and they get screened regularly on an annual basis. I'll never forget a woman came up to me and she said, "I know you don't know me, but I went to this education program." And she said, "It was like I was blind and learned to see." She said, "I figured out a way to take care of myself.

I'm happy. I'm not on nearly as many drugs as I used to be. I'm under control with just one diabetic medication, and my life has changed." We are in the middle of the deep South and we have the majority of our population are low income and minorities. And most of the people there are completely isolated, lack of transportation. Lack of healthcare access, very limited facilities for mammography.

We train about 170 women to serve as as community health advisors. And by giving them the knowledge they can be empowered to help and serve, and educate their neighbors and the women in their communities. They took those messages and delivered it in their own way. For example, they had a hat show in the church and invited all the community to come and watch the hat show. But then they delivered the message about screening. They reached at least we know about over 3,000 women.

We were able to reduce the disparity of mammography screening from 18 percent to 3 percent. The Community Asthma Initiative is a program that addresses asthma disparities in Boston We serve 908 patients that have had hospitalizations or emergency department visits, and have provided home visiting and nurse case management and community health worker, and nurse case management home visits. What's really remarkable is that we've had an 80 percent reduction in the hospital, the need for hospitalizations for children, and 60 percent reduction in children with any emergency department visits. And we found that for every dollar spent on the program there is $1.46 saved. When we add quality of life in trying to estimate the cost of missed school days or missed work days, there actually was a $1.73 return on investment. And that's savings to insurers and to society, not to the hospital. We're funding two of our SOPHE chapters to do this REACH program.

One of the biggest challenges was that the community were looking towards us to, okay, tell us what to do. And now when we look at that, fast forward it a couple of years what we're finding is that chapters are no longer being the lead organization it's really the community groups and their leaders are really saying, this is what we want to do, and we want you to help us do it right and show us, and then help us identify evidence-based best practice strategies that are going to really be effective when you're talking about diabetes prevention and management. We really see our role as being an expert resource and research center on hepatitis B. With this REACH funding we've been able to create networks link partners link community organizations that didn't know that there was a community organization in the state right next door to them doing a similar project. [Commercial in Mandarin Chinese] We developed a campaign based on a lot of data that we've been collecting in the communities There's a big LED screen on the corner where the large part of our community, the Korean and the Chinese community live and it was there every 20 minutes. We're really thinking long term. We want to be able to sustain this project and develop something that will work in other communities. We are focusing on eliminating cardiovascular disease and diabetes disparities into the African-American, Latino, Asian and Pacific Islander community.

Physical activity and nutrition: those are two big areas. Using instant recess as our catalyst we've worked to bring physical activity into those environments in which people are working. They dance or exercise together. And in one instance we were able to work with the at-risk Appalachian community.

Our grant is specifically looking at our West Indian population to address the high prevalence of Type 2 diabetes in their community. We discovered that 28.5 percent of our West Indians are affected by Type 2 diabetes as adults. We're helping people recognize that they can make a difference within their own neighborhoods and local communities. We have two other programs in Schenectady County that were funded through the CDC. And because we have these three programs working in synergy we're able to create stronger programs and really improve the prospects for changing systems and environment within Schenectady. The genius of what CDC has done with REACH is that someone decided that the communities that were most affected should be the ones that designed the solutions to their problem. I think the biggest inspiration from this is that CDC had their trust in us, that we really knew the answers for our community.

The most exciting thing about REACH is the community ownership. They really have taken this project and made it their own. It's one thing to ask people to be a partner. It's another thing to really actively engage folks in the process from the beginning. For communities of color REACH gave us hope.

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