The Region G Public Health Collaborative was officially established in the fall of 2008. This group consists of nine Local Public Health Agencies (LPHAs) in Southern Missouri. Region G is composed of Carter, Douglas, Howell, Oregon, Ozark, Reynolds, Shannon, Texas and Wright counties. They began working together in 2003 under a bioterriorism contract with the Missouri Department of Health and Senior Services. Texas County was home base, holding the contract for a Regional Planner and Epidemiologist. This contract required frequent meetings and collaboration with emergency plans, trainings, and exercises to demonstrate understanding and ability to work together as a cohesive group. A friendship began and during the meetings they began to trust and depend on one another. Memorandums of Agreement (MOA) were signed and the counties agreed to help one another with staffing and resources in emergencies. It was during the exercises of emergency scenarios that it became evident a bond between the group members had formed. They knew each other by name as well as county, and at state meetings, they socialized and experienced relaxed fun as well as work. They now saw themselves as a region and less as individual counties.

The federally funded Delta Project, and its collaboration with member Douglas County Health Department and indirectly all of Region G LPHAs, provided funding to innovatively raise the Region G collaborative to yet another level. A Region G intranet was the vision of the Doulas County Health Department Administrator. This was realized and it immediately allowed all members of Region G to communicate easily, share documents, policies, ideas and problem solve, with the help of each other, the barriers we face on a daily basis. This innovative idea has been recognized by the National Assiciation of County and City Health Organizations (NACCHO) as a Model Best Practice, one of the few given out annually. The Delta Project provided professional development classes in a central location for all of the collaborative members. These classes were presented by Rockhurst University staff and most members would never have had the opportunity for this high quality education without this opportunity. The classes have empowered all attendees to become better leaders and managers within their organizations.

In January of 2008, all nine counties came to a meeting as guests of Missouri Institute of Community Health (MICH) to discuss volunteer accreditation. They were able to share their concerns. MICH listened to the group and discussed subtle changes that could be made in the standards. Region G came away feeling that accreditation was a very real possibility but the counties were small, rural, and remote and some felt we should explore the feasibility of “joint accreditation”.

Reynolds County contacted a MICH member and requested information and the possibility of “joint accreditation”. MICH related a National Association of County and City Health Organizations (NACCHO) funding opportunity that could be of assistance in their exploring all opportunities. Douglas and Reynolds Counties discussed the funding opportunity with the other seven counties and they decided to go for it collaboratively. Douglas and Reynolds Counties wrote the proposal and all nine counties discussed with their governing boards the need to explore this funding opportunity. With all nine governing boards signing support letters, the proposal was written and sent to NACCHO. The established regional intranet facilitated sharing of information and proved invaluable in facilitating the communication needs of Region G in the writing and delivery of the proposal.

A Region G Website is presently under construction and will up and useable later this summer. In February 2008, they got the news that only 60 proposals were funded nationally. Region G in southern Missouri and a group of three small rural counties in northern Missouri were both chosen for NACCHO funding and participate in the demonstration site project. Contracts with NACCHO were signed and the work began to see how ready a small rural Health Department was in seeking national accreditation. Region G LPHAs used a survey tool comparing them individually to the National Accreditation Model. The proposal lasted from February through November of 2008. There was work to do and it kept the counties working collectively and independently to get the job done.  Once again the established regional intranet proved to be of tremendous value to the group. As part of the deliverables, the group had to choose a NACCHO-approved consultant to bring the group into a “formalized” collaborative with a strategic plan and a charter. They chose a consultant from Iowa, who was familiar with rural public health and the serious job of legally binding this group together began. Because this group knew and trusted one another and had working together on past emergency exercises they were able to come to consensus in a much shorter time and with greater ease than would be the case of newcomers to collaboration. With the help of the consultant, they collectively designed a three year strategic plan with specific deliverables and timelier.

One of their top priorities was to collectively do a regional community assessment. It is a Missouri Department of Health and Senior Services contract deliverable that LPHAs do an individual county community assessment every three years. The group felt that a regional document done with help from a university school of public health would enable them to compare “apples to apples”. This document could assist the collaborative in seeking funding for the group as the data would be compelling coming from a regional viewpoint. They researched the legality of LPHAs coming together and contracting with one another. They were able to identify the Missouri State Laws and Statutes that legally show LPHAs to contract with each other, and with other agencies in state and in other states. The result was a legally binding charter that formalized the Region G Public Health Collaborative.

Upon completion of the survey tool, all nine counties were able to see their individual gaps and where they scored high and low. It was a consensus across all nine counties that one of the biggest gaps was they had not formed a working relationship with academia and they had not participated in a research project. They collectively decided to take a proactive approach and contact several universities within the state for a summer intern to assist with a regional community health assessment. This regional health assessment was the first item on the new strategic plan. The request was made to several universities across the state. Southeast Missouri State University School of Public Health professor, Dr. John Kraemer, and student intern met with Region G. This meeting was fruitful and all agreed upon the creation of a regional document collecting the same data across the region. Dr. Kraemer and the student intern were shown the regional intranet and given access to its use. The individual county data would be deposited into individual files throughout the assessment process through access to this valuable communication tool. This meeting was filled with excitement and ideas for further projects they could work together and complete. All agreed that this was the beginning of a partnership between Region G and Southeast Missouri State University School of Public Health. This community health assessment will take place over the summer months of 2009 and the final document will be completed by the end of September,

Because of the work Region G had done with NACCHO, MICH began to look at Region G and our northern group very seriously. Both groups were demonstrating the ability to work together and exhibiting their interest and desire to move forward towards voluntary state accreditation. MICH offered Region G, and the group in the north, their FIRST Mini Collaborative opportunity. The mini collaborative is an  Quality Improvement (QI) education for each of the individual agencies. This would assist us in our journey towards Missouri Voluntary Accreditation. This is a three year journey and at its finish, MICH hopes to send us out to other LPHAs to teach and encourage them to move forward on their individual journey to voluntary accreditation.

Region G is presently working collaboratively with Region E on a project with John Hopkins University School of Public Health is assess the readiness of the public health workforce to respond in a public health emergency. Both Region G and E are cementing their partnership by collectively writing for NACCHO funding to develop excellance in responding to public health emergencies. These two projects demonstrate the ability of small rural public health agencies’ ability to collaborate and blur demographic county lines and individual agendas.

The Center for Local Public Health Function (CLPHF) Services at the Mo. Department of Health and Senior Services contacted Region G, and the northern group, to express how impressed they are with Region Gand the northern group and their work with NACCHO and now with the MICH mini collaborative. The CLPHF has offered additional funding to both groups to continue their journey for quality agencies and demonstrated leadership. This additional funding will be on our CPHF contracts for fiscal year 2010. The deliverables for this additional funding will be attendance at a computer data training and for each individual county LPHA to develop a balanced scorecard tracking six indicators for a period of time. Once again rural LPHAs are stepping out and leading the way to the future for public health.

The Robert Woods Johnson Foundation is offering a public health funding opportunity to create Public Health Research Evidence-Based Health Networks. MICH is taking the lead and writing this proposal and has offered Douglas and Reynolds County a partnership to trial some deliverables with the other Region G counties to see the feasibility and efficacy of these tools in a rural public health environment.

Recently in the H1N1 Influenza A outbreak, Region G had an opportunity to test its ability to collaboratively get the Strategic National Stockpile (SNS) supplies quickly and cost effectively. Wright County took the lead and secured the supplies for the entire region. They then drove back across the region and distributed them efficiently and without difficulty. This was a costsaver for all of the nine counties in Region G. This is yet another shining example of the benefits of collaboration and partnership.

Region G is committed to journey for voluntary state accreditation and has reaped the benefits of “stepping out of the box”, losing a “silo mentality” and joining hands together across county lines to bring better health opportunites to all citizens.

Region G Members can be contacted below

Deborah Sandaciero, RN, BSN, BC, Administrator of Carter County Health Center sandad@lpha.mopublic.org

Sandra Pueppeke, RN, Administrator of Douglas County Health Department sandyp@dchd.org

Chris Gilliam, Administrator of Howell County Health Department gillic@lpha.mopublic.org

Sheila Russell, RN, Administrator of Oregon County Health Department  russes@lpha.mopublic.org

Rhonda Suter, Administrator of Ozark County Health Department  suterr@lpha.mopublic.org

Kathleen Zimmerman, RN, Administrator of Reynolds County Health Center  zimmk@lpha.mopublic.org

Kandra Counts, Administrator of Shannon County Health Center  countk@lpha.mopublic.org

Jackie Smith, Administrator of Texas County Health Department  smithj3@lpha.mopublic.org

Tracey Hardcastle, RN, Administrator of Wright County Health Department  hardct@lpha.mopublic.org

Region G website