Listening Project: Healthy People, Places and Future – Summit County Health

July 29, 2015

0:00

Donna Skoda – Health Commissioner for Summit County

My name is Donna Skoda, I’m the Health Commissioner for Summit County and I’d like to welcome you

to 1867 West Market Street – It is our new home. And we’re proud of it. I’ve been in this position –

thank you – I’ve been the Health Commissioner I think for 4 weeks now, but I was the Assistant Health

Commissioner under Gene Nixon. I’d like to take a few minutes and thank our board members – they’re

right here, that came tonight, because they work just as hard as we do for Summit County to keep

everyone healthy.

The mission I think most of you know, the mission of a health department, is through policies, programs,

advocacy, we try to keep people healthy, in healthy environments. We all know that’s not the easiest

job. Through all of our programs, we want equal access for everyone. We want everyone to be able to

take advantage of everything regardless of where you live or who you are.

One of the projects, they asked me to speak just a few minutes, one of the projects we’ve been involved

in, for quite a while is about the last 13 years, is the Quality of Life project. Where on the behalf of the

Social Services Advisory Board and the County Executive, we have tracked data, we have looked at

trends, we have done any number of reports to report back to the community the health status of

Summit County. And we try to improve programming through that. Again, a dedicated group of folks

who come together on a volunteer basis just trying to improve health. An example of that again,

carrying on is this year we’re very proud, just June 29th, we were able to open a fixed site dental clinic.

Because it’s been identified that it is one of the greatest unmet needs in Summit County is dental care,

regardless of who you are. Seniors suffer, children suffer, individuals without any kind of health

coverage suffer. We also, in response with our partner, Alcohol, Drug and Mental Health, in response to

the increase in opiate overdose, we are now a Naloxone, dose, er, distribution site, where we’re actually

able to provide Naloxone to families and drug users to help prevent that accidental overdose, if in fact

and help maybe keep them alive, so that they can seek the treatment to recover. The other thing that

we’re looking into, again in response to community needs, we’ve seen a huge increase in Hep-C,

Hepatitis C, so we’re now looking at a needle exchange program as well, we’re investigating that, so the

whole idea of this is to keep our pulse on the community and look and see where we can most make the

most impact with limited resources. And that’s tough for all of us, cause every, nobody has enough

money to do what they want to do.

So you must imagine when we got the call, we were very excited to be able to host this meeting and to

bring together this group of folks to talk about health in Summit County. And you have to know Summit

County is kind of a very close knit community that works well together, and all of us saw each other eat

today at 5 meetings already. Ok so it’s like we’ve eaten breakfast together, lunch and now we’re having,

going to have dinner snacks, ok, we’ve all seen each other all day because we do work closely together.

But I would like to thank you all for coming, personally. On behalf of the board, our staff we want to

thank you for coming and participating in this conversation. You could be home taking a walk, doing

something healthy, but instead you came here to give us your ideas. And we appreciate that. And it’s

with great pleasure right now, I’m going to introduce Kit Jensen, she is the Chief Operating Officer for

ideastream.

4:02

Kit Jensen – Chief Operating Officer - ideastream

Thank you all for being here, and Donna, I, you know, for 4 weeks on the job, I always want to partner

with Donna, if she can bring all of you together at any call that is just fabulous. We are very pleased to

be able to partner with the Summit County Public Health for today’s discussion. So thank you for making

the time, I know it’s a very nice day, and we’ll try to make this efficient and impactful and I can tell you

from the ideastream point of view it is going to help set a programming agenda, which hopefully you will

see on radio on television in the next year. For those of you who do not know what ideastream is, it’s

Northeast Ohio’s multiple media public service organization. Now some of you may watch or know some

of our stations, WVIZ PBS, 90.3 WCPN the NPR station, or classical WCLV 104.9.

And now we’ve provided annual reports, it’s the blue cover and if you open it up and on the left hand

side, there is a, it describes the 8 different educational and public service media programs of

ideastream. And what we try to do is for Northeast Ohio, bring the assets of media together to tackle

community issues, education, citizenship, and to celebrate the arts. So this conversation today is an

important one for us. This kind of conversation is part of a project that we call The Listening Project,

which has been ongoing since 2001. Some of you, I have met in the room before, I have worked with

you before, on health programming, and thank you for returning today to help us.

Last year’s Listening Project report is also at your table. It’s the one that shows all those people at a bar

– Now why would we be at a bar? Because that’s where a lot of people are. So what we do is have a

series of forums and surveys and at the end of every year we aggregate what are the top assets of the

region, what are the top challenges of the region, and then we focus our programming and our

produced content on reflecting that, which is important to the community. And health information is a

very major emphasis for ideastream. We are so pleased to have found the ability to provide over 5 years

worth of continuous health and information programming under the Be Well title. And so you are going

to be helping, help inform that.

In the back of the room, we have a variety of managers, producers, reporters, and staff of ideastream.

We have a great crew here today, very experienced, and we are recording. So I want you to please check

your cell phones and put them on vibrate or turn them off. We are recording this, we will create a

report, we will send you the report, we will put this entire recorded conversation on the website, we will

send you the link and we’ll return for further conversations with you. And so, I really do appreciate again

your full participation today. So to facilitate today’s meeting, let me introduce Mike Shafarenko who is

our Manager of Community Engagement, Web and Social Media for ideastream. Mike?

7:39

Mike Shafarenko – Moderator and Manager: Community Engagement, Web & Social Media -

ideastream

Thank you Kit. Good afternoon. [Inaudible]

So as Kit mentioned the conversation today will really inform a lot of the health programming and

content that we create and produce at ideastream so we’re really, really looking forward to hearing

from all of you.

In lieu of introductions, because there’s so many of us, it’ll take us literally half an hour just to get

through all of you, you have in front of you an attendee list, so you can get a sense, obviously not

everyone is here, but most of the folks that registered are, so you kind of get a sense and a feel for

who’s here. And of course, we have folks not just from Summit County, but Portage County and Medina

County as well, so thank you to all of you who have come here today.

Additionally, on the third sheet of that attendee list, is a worksheet, which really just includes the

questions that I’m going to ask. So in case it’s a mystery as to what are we talking about today, you can

go ahead and take a look and we invite you to jot your thoughts down, both for 2 reasons. 1, so that you

can keep your comments relatively brief, because we have a lot of people today, we want to hear from

all of you. And the other reason is, we’re going to pick up these sheets after the conversation today, so if

there’s comments you weren’t able to make or you didn’t feel comfortable making in front of the group,

jot them down there and we’ll make sure to grab them before we leave today and include any

comments you make in the final report. And if you could do us a favor, if you could either circle your

name on the attendee list in front of you, or write your name on the worksheet so we know who said it,

we’d appreciate it.

So we’re really going to go through 3 big questions. We have a little bit over an hour to get through

them. The first is what are the top health related issues in our community? And we want to hear from

all of you, and we’ll have a conversation about that for you know, about 30 minutes or so. The 2nd

question, what is being done to address these issues? And is there a common community health agenda

in Summit County, but also Media and Portage Counties as well? Is there a common understanding what

the issues are and how we’re addressing them or is something else going on? So we want to hear about

that. And the last questions is, what can we, ideastream, as a public media/public service organization

do to help some of these issues and opportunities as they relate to health? So again, we produce

content, we report on health topics, so what can we do to help to advance some of these things going

on in Summit, Portage and Medina Counties. Sound good? All right.

So let’s get started. And one other thing, when you first speak, if you could state your name and the

organization you’re with, just so the group kind of knows, that’d be great. And then when you speak

again, you don’t have to keep doing that, just the first time you speak, state your name and what

organization you represent.

So with that we’ll get started. What is the top health, or what are the top health related issues in our

community? Who wants to go first?

10:35

Sharon Geffken - Summit County Children Services

I’ll be brave and start. I’m Sharon Geffken and I’m with Summit County Children Services. I think we have

many, a few jump right out at me. One is infant mortality, and the disproportionality that we see. And

I’m glad we can talk about number 2 and what’s being done because there are somethings happening.

And then opiate addiction and substance abuse in general is another major concern.

10:57

Mike Shafarenko

So infant mortality, opiate addiction, what else?

Yah?

11:02

Donna Farris[?] [inaudible] Public Health

Donna Farris from [inaudible] Public Health. Obesity. Just, we live in [inaudible] society, for lots of

different reasons.

11:11

Panel Member

Can you repeat what she said?

11:13

Mike Shafarenko

She said obesity.

11:15

Panel Member

Ok. Sorry.

11:16

Mike Shafarenko

Obesity, infant mortality, you don’t, I mean you can say, you can expand on your answers. It doesn’t

have to be one word. So we have infant mortality, obesity, opiate addiction.

11:26

Lisa Ritenour – University of Akron

Lisa Ritenour, University of Akron. Health literacy. If our community doesn’t know how to interpret what

a health care provider is telling them, they cannot make informed decisions.

11:42

Tom Tulisiak – Medina Hospital, Cleveland Clinic

Tom Tulisiak, President of Medina Hospital, Cleveland Clinic Hospital. So to expand a little bit on the

obesity issue, that’s part of the health and wellness and disease prevention aspect of things, through the

whole gamut of that, but also of critical need I think most people in all the surrounding counties

whether it be Cuyahoga County, Summit County, Portage, Medina, et cetera, are mental health care

needs. There’s a clear lack of psychiatric health care professionals as well as psychiatric beds in

Northeastern Ohio which really is a critical problem. It’s amazing right now that all the mental health

and psychiatric beds are tight, tight, tight. There is no access pretty much right now. And this is a low

time of the year, it’s a big concern.

12:34

Mike Shafarenko

Yes.

12:34

Sheila Williams – Summit County Public Health

Sheila Williams, I sit on the board. The obesity is a big issue I think, but I think even more so is the fact

that children are going hungry. And we look at these young adults and they are obese. They’re taking in

thousands of empty calories that are causing obesity, plus the health problems, so I think this

urbanization of farming, health, I know we do a lot of talking here at the board with food, that has an

impact in possibly moving it at another step, but that is the bigger issue, to me is that children are

hungry. And now we’re seeing seniors hungry, and that’s something that’s new in the last couple of

months in talking with people here. So I think those two issues impact what we’re getting and hunger

leads to mental problems, the obesity leads to the sugar, the high blood pressure, the different health

issues that we’re seeing more and more.

13:35

Mike Shafarenko

Why do you think there’s an increase in seniors?

13:39

Sheila Williams

I think the isolation. Yah, I think that they think that they’re eating and they’re not. They’re not

interacting. If they’re not active, you can feel as though you’re eating. My girlfriend told me she spoke to

a woman last night that was 94 who told her she integrated Warrensville in 1964 and gave her the

whole historical view of Warrensville in the evening, and she said “I was amazed, she says, but she sat

on 4 or 5 committees, she was very active, she was in and out of the house, but you have a lot of seniors

that are not and that’s where the Meals on Wheels and the different things that we have come into play

to check on them. We’re feeding them but we’re also checking on them.

14:23

John Trunk – Summit Developmental Disabilities Board

John Trunk with Summit Developmental Disabilities. We see the huge rise in the number of people

diagnosed with autism, as having a community impact. Nationally now they’re identifying that that rate

is in the range of 1 in 67 children born and lots of theories on why that increase diagnosis or the fact

that it’s now viewed as more of a spectrum type of disability, but the impact on schools, eventually

employment opportunities, independent living for people that have been diagnosed with autism I think

flies below the radar sometimes in terms of community health and certainly something that we at the

DD Board pay close attention to.

15:12

Liz Flaker – Open M Free Clinic

I’m Liz Flaker from Open M Free Clinic. I think the major thing we contend with in our clinic is upstream

versus downstream health care. By the time patients come to our clinic, we are just fighting against the

downstream. If they could come to us a little sooner, we would be able to get some more preventative

measures into place instead of trying to catch up and get them healthy.

15:34

Mike Shafarenko

Can you explain that a little more, upstream, downstream?

15:36

Liz Flaker

Most patients come…right. The upstream in my thinking is where you come in and you, you know,

maybe a recent college grad, you know, you’re happy go lucky in life. You’re deciding to take care of

yourself. So you come in, you maybe go to a family doctor, you have insurance, you’re able to go take

care of yourself. You find out oh, you’re hypothyroid, oh, ok, I’ll get on my thyroid medicine, I’ll be good

to go. A typical patient that may come into Open M, has not had health insurance maybe for a number

of months, years, whatever, they finally find out about us, get hooked into our system, they come to us,

they’ve already got hypothyroidism, they’ve already got diabetes, they’ve already got hypertension, and

they’ve already got, on their way to obesity. So we’re fighting against multiple factors, as opposed to

getting them in when they’re healthy, we’re getting them in when they’re pretty well on their way to

fighting some chronic illnesses.

16:32

Karen Hrdlicka – Mature Services, Inc.

Karen Hrdlicka, Mature Services. Getting back to the seniors, one of the things I was here, not too long

ago for a meeting on adult protective services, which is really an unfunded mandate apparently. And

Summit County’s done a very good job of bringing resources together to work together, but sometimes

it’s the case management, when you talk about the hunger, people knowing, and also generationally,

those folks don’t, they don’t want to take a helping hand and that. But it’s just getting services

coordinated for the person so they can be healthy. And exactly what you were saying is preventatively

getting things in there to help them so they’re not coming to the hospital. I also sat a couple of years ago

on a committee with the ambulances. A lot of times the ambulances were going, they got a call, they

would come to the home, but it really had to do with the person didn’t really need the hospital, but they

were in a home and it was the middle of winter and they didn’t have heat. Things like that, so having

some kind of funded case management for seniors, may help with some of those issues.

17:33

Mike Shafarenko

Saw a hand up, yes.

17:34

Susan Sigmon, Direction Home Akron Canton Area Agency on Aging and Disabilities

Yes. And a long those same lines, I’ll submit that - I’m Susan Sigmon with the Direction Home Area

Agency on Aging. And I would say that there is a lack of programs and services for the older adult that is

near indigent. The state, the feds do have programs for that, that lower income, older adult, but there is

a lack of programs and services for the near indigent, to remain in their community. You know, the

literature shows that just a little bit of case management or a little bit of some Meals on Wheels, just

those kinds of interventions can do much to keep people in their community, which is really, would turn

out to be a Medicaid diversion program, which is good.

18:28

Mike Shafarenko

Yes.

18:29

Judge Elinore Marsh Stormer - Summit County Probate Court

I’m Elinore Marsh Stormer, I’m the Probate Judge and just to sort of perhaps wrap some of the elder

issues, I can tell you we get the viewpoint from maybe 3000 feet about what’s happening with the seniors

but the problem is only increasing. And while I think we have done a good job so far providing some

resources in many areas, we in my court, get people who are elderly who are being abused or neglected,

and that’s how we come into contact with them. What we don’t have and perhaps you could do a show on

this and lead the way, is you know truly how we could coordinate this across, I mean I’m delighted to see

so many people with seniors’ interests here, because it’s just growing. The baby boomers are growing,

their kids don’t live here, they live everywhere else. Some of them are unable or unwilling, but many of

them just aren’t here, so you have people aging in place without the support and you end up with these

other kinds of disparate kinds of problems.

If I can also step back and talk in another hat, I sit on the Children’s Services Board, and we’ve had a

benefits committee that was designed to look at community benefits and in order to determine if we were

providing community benefits, we had to assess community needs. And if you boiled down the four

subject areas, which were mental health, diabetes, infant mortality, and asthma, the common

denominator is poverty. And so if you look at the health impact of poverty it cut, it’s going to cut across

probably every single issue that we see here. And what did I say? Not Children’s Services Board,

Children’s Hospital Board, sorry. Sorry Children’s Services people, so it’d be, although we deal with you

all too, but the issue is really poverty, and so if you want to look at the root causes of why do you have

some of these issues, I will put forth that one of the problems that our community faces, and perhaps all

communities, is the concept of unplanned pregnancies for parents who are not able to meet the needs of

that child, and then you just extrapolate. So that’s a great television show I think, the effect of unplanned

pregnancy for parents who are not prepared to care for that child, married, unmarried, that doesn’t make

any difference I don’t think, that to me is a hallmark issue, that if we could address that downstream, you

could address a lot of these other issues.

20:46

Lorie Lerner – Crossroads Hospice

Lorie Lerner, Crossroads Hospice. One of the things that I see continually is people, seniors, who are,

either got mental health issues or Alzheimer’s disease, and there’s no place for them because they

cannot afford it. And so we try to get resources together and we try to support, nursing homes and other

places that are trying to care for these folks, it’s very, very difficult.

21:08

Terry Dalton - Community Support Services

Terry Dalton, Community Support Services. Along with tying in on the mental health component, that I

think it’s really the lack of training the law for medical professionals when it comes to psychiatric

prescribing. You know the general practitioners prescribe more psychiatric medicine than psychiatrists,

and yet the training is very minimal so I think we see a lot of people under medicated, wrong medication

they’re on, and then when it comes to dementia, they end up not knowing how to treat that or they don’t

understand the complications of the other meds that make people appear psychotic, etc. so I think,

21:39

Mike Shafarenko

I’m sorry, can you clarify for me, who is not trained in terms of prescribing psychiatric medications for…

21:46

Terry Dalton

General practitioners, internal medicine

21:48

Mike Shafarenko

General practitioners, general medicine.

21:49

Terry Dalton

Very little of the medical training actually is in the area of prescription medication for psychiatric…

21:54

Mike Shafarenko

So and instead of referring to professionals, you’re saying their just taking it upon themselves to make a

guess or as to what’s…

22:00

Terry Dalton

Right, as part of it, there is a shortage of psychiatrists that are available to do that, but also the people

come in in the office and so they prescribe you know type of medications to deal with something that

could benefit from counseling, could you know again, maybe some other medication would be better, so

it’s the lack of and or it’s quick to get them out of their office, because some of the same people come in

time and time again and so they’re prescribing a medication but maybe that’s not the answer.

22:26

Cynthia Struk – Summa Health System

Cindy Struk from Summa Health System Homecare and Hospice, I think the other issue is just

medications in general ‘cause I almost have to echo Susan. I mean there is a disparity where people are

right on the border, but if they’re having to choose medications and they think additionally the cost of

medications fluctuate you know every day, and you know right now certainly in oncology there’s a horrific,

people are making decisions about treatment you know based on medication costs. So I think you know

seniors are particularly vulnerable in a sense that there’s very much a border between kind of affording

the day to day things and affording medications and they can’t really budget very well ‘cause they change

a lot and then I think secondly somewhat the complexity in over prescribing of medications, so if you don’t

have you know, good internal medicine, geriatricians, somebody looking at that a lot of times it could be

simplified and you know reduced in many ways, so you know sort of that case management, you know I

know that’s why certainly home based services are really good in trying to trying to help people make

better decisions and focus on that so that can be a huge challenge I think for seniors.

23:41

Ken Slenkovich - Kent State College of Public Health

I want to put an exclamation point on what Judge Stormer said and that is…I’m with Kent State College of

Public Health. That the social determinants, we call them social determinants, the poverty, low

educational attainment, those things. If we don’t deal with those, we’re never going to be able to deal with

the downstream issues like chronic disease which are lifestyle related, in many cases, obesity and so on

and so, we’ve got to figure out a way to deal with those social issues way upstream.

24:06

Mike Shafarenko

When you say that we have to be looking at who is….the community?

24:08

Ken Slenkovich

Everybody here.

24:10

Mike Shafarenko

Or health professionals, or…

24:11

Ken Slenkovich

I think the whole community, because none of us has figured out a solution to solve poverty or how to get

folks to graduate from high school and so it’s going to take all of our thinking to figure those problems out.

24:24

Mike Shafarenko

Anyone behind me? Yes.

24:25

Sharon Geffken

If I can stand a little bit too, when we think about all the social ills that are out there, and we throw in

domestic violence and we throw in substance abuse and all the common problems, we know that

especially children and the adults at the home are traumatized, and we know that untreated trauma leads

to physical health problems down the road. So catching it early in the cycle is I think is just so important,

but also sometimes very difficult.

24:54

Jamie-Lyn Poh – Community Legal Aid Services

I’m Jamie Poh. I’m an attorney with Community Legal Aid, and specifically I work in our Heal program,

which has a medical legal partnership with Akron Children’s Hospital, so I’m looking at it from a lens of a

poverty attorney, and I would say that amongst all the issues of poverty, the biggest one I see are

housing conditions. And I say that because you have someone who lives in sub-standard housing where

there, you know, there might be lead in the home, there are rodents, roaches, there’s other safety issues,

and so you have parents that are missing work who are caring for children. You know children who are

missing school because they are sick or because they’re moving, their education career is being

constantly interrupted. You have the stress, and you have the economics, you have people that can’t get

transportation, and ultimately you end up with children who are, still have to do school work, so our, it’s

sometimes difficult to get the special education services or have them as fast. You’ve kids with lead levels

between five and nine, research is showing that there’s a U curve, and lower levels and really high levels,

and not the middle but we’re not quite equipped to handle the five to nines where we are you know, the

higher end…

26:13

Mike Shafarenko

What’s a really a bad, what’s a really bad lead level, I don’t…

26:15

Jamie Poh

I, I mean, I haven’t been doing it that long, but I’m going, I mean anything over 50 I’ve heard is, is not

good, but you’ve got kids with like 200 and, 6 points of lead level equals 1 IQ point, I mean that’s terrifying

to me. We can’t fix that.

26:33

Mike Shafarenko

Right.

Who else?

Yes, oh back to Sheila.

26:38

Sheila Williams

You know I agree with the poverty, but I think we need to be careful not to just band aid poverty as, of the

total problem, because you have people that are in different economic situations that have mental illness,

that have obesity, that have things that are not being said. I was in Geauga County at a meeting about a

month ago, and they’re talking about situational poverty. And I laughed because, I said to someone,

situational poverty, is as most of us in this room are 30 days away from bankruptcy. But in Geauga

County they’ve tagged it situational poverty and they’ve tied it to their food bank. People are coming up to

get some help. Poverty has 3 different levels and many different faces. All of us in this room service the

least among us, for lack of a better word. So when we talk about it, we’re talking about a whole different

dynamic, but when we talk about these problems, they’re across the board and I don’t think we shou ld

lose sight of that. Our fundings here are based upon the least among us, but we also need to encourage

these services of help that are impacting the total community. You go to Bath and they’ve got problems.

You come out to Stow, they have problems. It’s not just an urban or an Akron inner belt issue, and we

have to be careful how we’re labeling that. Yes, we are dealing with the ones with the most poverty and

the most need, but you have people that are in quote situational poverty now, and it’s impacting the

community also.

28:19

Mike Shafarenko

Anyone want to add to what Sheila had to say about situational poverty? Yes, Terry.

28:23

Terry Albanese – City of Akron

I just think that there is an issue with a lack of resources, whether it’s economic resources to make

healthy choices, whether it’s health literacy, and access to care that several things can get in the way of

someone making healthy choices and it very often may be financial but it can be so many more things

than that, that added together can really result in health problems.

28:53

Mike Shafarenko

Other top issues that either haven’t been mentioned or you want to add to what already has been said.

Yes, Lynn.

28:59

Lynn Clark – University of Akron

I’m Lynn Clark. I’m an attorney now, I serve on the Board of Health. One of the major things, and I’ve

been around for a while and I look around this room and it’s amazing how many agencies I’ve had to deal

with over the years, because I do a lot of work with legal aid clients and poverty. And what always gets

me is, there’s a lot of resources in this community but it’s a lack of coordination sometimes and a lack of

cooperation. And the fiefdom and the silos that the agencies have, where we look and we say, and I’ve

dealt with this, two agencies here today that are on my list because they’ve looked at me and said, ‘Your

client needs to go over there’, send that client over there and that agency says ‘Your client needs to go

back to the first agency’ because neither one of them really want to serve the difficult client. And, you

know, I see that in a lot of areas where it’s like, we can deal with this little issue, and then you’ve got this

client going around and around and around and never really getting the cooperation, the coordination,

from the agencies. And I’m not even talking case management, I’m just talking, trying to, sometimes just

(inaudible). I know the county tried to do something about it a few years ago with, what was that computer

system, that was going to, referral something or other, Summit Referrals, or something like that?

30:22

Off camera

ReferralValet

30:23

Lynn Clark

ReferralValet, which was a total disaster, we should all admit it. But it shouldn’t, doesn’t mean we should

stop making the effort to be sitting and not, I’m not talking community welfare forum, where you get social

workers meeting, I’m talking top staff, you know, working on specific issues trying to coordinate programs.

I’m off my soapbox.

30:49

Mike Shafarenko

Ok, we’ll come back to it.

30:50

Thom Craig – Margaret Clark Morgan Foundation

I’m Thom Craig with the Margaret Clark Morgan Foundation and one of my observations has been that

I’ve never seen so much change in health care and the way things are paid for, and the way that systems

are working, and the way that insurance has changed. And I see frustration on both the part of the

patients and the people trying to get access to services and the systems while they’re in this change

mode. There’s, it’s hard to integrate services, it’s hard to know how to position yourself so that

organizations can be financially strong and during all of this change, I think, there might be great

opportunity but we also have to, like she was talking about, look at the systems and see how they inter-

relate and how they work together so that we can get some efficiencies and so forth. But the frustration

really has been that people have been struggling to get access to services, especially I’ve seen this in

mental health. And getting to the root of the problem, not just handling the symptom, but getting to the

root of the problem that goes after what’s the cause of the illness, and what could be something that

could help with the healing process rather than just treating the symptom, so…

32:17

Mike Shafarenko

Thank you. Gary?

32:19

Gary Lake – Akron Area YMCA

Gary Lake from Akron Area YMCA. One of the new focuses that our association has taken on this year,

and for the future, is Type 2 Diabetes. Obviously a very prevalent disease in today’s society, but the

interesting this is those people who have been diagnosed is really the tip of the iceberg. The focus that

we’re trying to look at are the bottom part of that iceberg, the people who are maybe on the verge of

getting in to Type 2 Diabetes, but haven’t gotten that far yet and what can we do as an association to help

prevent those from getting into the disease process.

33:05

Mike Shafarenko

Mm-hm. Ok. Great.

Donna.

33:07

Donna Skoda

I just, I’ve agreed with everything everyone has said, there’s just one group of people, are individuals in

our community that I worry about a lot. And those are the group that’s now covered by insurance.

Affordable care was wonderful. It gave folks that had access, but I think in some ways we’ve over-

simplified it. Because now you have individuals that have huge deductibles. You have individuals that are

paying co-pays that they never paid before. They’re paying $43 for their insulin, it used to be free.

Because of this now, we have a difficult time getting patient assistance programs for some people, so that

now we can’t get the free mediations for individuals for that we used to be able to get, because you’re

supposed to have insurance. So I’m fearful as we move down this road, we’re going to disassemble a

safety net that’s very used to taking care of people or treating them as individuals, and not assuming

because you have a card, you’re capable of getting everything you need. Because just as Ken

mentioned, and a few others the social determinates play a much larger role in your ability to be able to

navigate and know what you can do and not do. And I’m really fearful that in this community if we’re not

careful, if you don’t take the time ask Mrs. Jones does she have the 3 bucks to buy the high blood

pressure medicine, you’re not going to get Mrs. Jones taking the high blood pressure medicine.

And just one more thing, there’s great research that says that when folks fall on hard economic times, and

if they don’t, if they have a high deductible, they skip their colonoscopies, they skip their mammograms,

they skip things that are preventive in nature, and we could end up years down the road feeling the

effects and not even knowing it right now, thinking ‘everyone’s insured’.

34:55

Mike Shafarenko

Christina.

34:56

Christina Hodgkinson – Akron Metropolitan Housing Authority

Christina Hodgkinson, from the Akron Metropolitan Housing Authority. I agree with everyone around the

table, and really the population that we serve is one of the most vulnerable in our community and we are

seeing, on the housing authority side, residents, the increase in the senior population and mental health

disabilities. And trying to, as a housing provider, affordable housing provider, deal with those issues

internally, and then extending our hands out to our partners and the resources available to bring them in

to help our seniors live in the environment or continue to live in the environment that they’re comfortable

in, home health care, those types of things. And unfortunately, affordable housing, going back to the safe,

sanitary, all of that, you know unfortunately the federal government is decreasing resources for us to

continue to provide affordable housing or new affordable housing for those in most need to then have

access to health care and all of the resources that they need. Just to give everybody a little bit of an idea,

we have about 17,000 people on our wait list, and we serve over 20,000 individuals in Summit County

and so you know, obviously…

36:21

Mike Shafarenko

17,000 on the waiting list?

36:22

Christina Hodgkinson

Yes sir. So there just tells you that there’s not enough affordable housing out there, which is the platform,

and obviously a very much basic need to assist in health care.

36:36

Donna Skoda

And I think just as an FYI to put it in perspective, the living wage is what now, $15.01 or something,

$14.01? So unless you make that much money, you can’t rent a place, you can’t find a place in Summit

County to rent because you can’t afford it. So that’s 2 folks working a minimum wage job putting their

money together to try to rent some place. Or co-sleeping, sofa-surfing, whatever you want to call it, a lot

of people living in one house.

37:01

Mike Shafarenko

Saw someone…yes, Reverend.

37:03

Reverend Dr. Sandra Selby – Akron General/Furnace Street Mission

I think social isolation is a huge issue that underlies a lot of these health issues. The judge mentioned the

older adults without, without any family support nearby, I think that’s, we’re such a mobile society that so

many people are isolated. It’s an irony, we’re mobile but we’re isolated in our homes and many people

who are poor don’t have access to transportation, so people are just isolated and I think that sense of

psychological isolation is manifest in opiate addictions, drug abuse, mental health issues.

37:41

Mike Shafarenko

We’ll take a couple more and then we’ll switch, switch to the next topic.

37:44

Reverend Dr. Sandra Selby

I’m Sandy Selby, Furnace Street Mission, is who just spoke.

37:48

Mike Shafarenko

Ah, yes. I’ll come back.

37:50

Amy Lee – Northeast Ohio Medical University

Amy Lee from Northeast Ohio Medical University. This is really an incredible group of people that you’ve

brought together. You know we have people from the hospitals, from public heath, from community

agencies, from law. And what they’ve been saying is interesting because you talk about the health related

issues and not so much has been said about diseases so much, but about the living conditions, the living

wage, the social determinants, the places that we live, work, and play. And it’s so important, I think, as

Ken said, for all of us to be working together and including some non-traditional partners as well, for

example I was looking at your list, I’m not sure I saw people from manufacturing or business, you know

there’s a huge workforce there…

38:41

Mike Shafarenko

We couldn’t find a room big enough…to fit everyone.

38:44

Amy Lee

No, but I have to applaud you for the number of people that you brought together, but we really do need

to involve the entire village, everybody, to try to improve the community’s health, because we all affect the

conditions that people live work, and play, worship and pray. So I applaud your efforts, but we really do

need to work together.

39:09

Mike Shafarenko

Thank you, and I have to thank Donna and her team from Summit Public Heath for helping us pull a lot of

these folks together, so it’s a collaborative effort for sure.

39:21

Amy Lee

That’s what we need to do, collaborate.

39:23

Mike Shafarenko

All right. One more coming from Karen and we’ll move on…yes.

39:26

Karen Talbott – Akron General/Summit County Public Health Board

I’m Karen Talbott, I’m a consultant, and also on the Summit County Public Health Board. One of the

things we’ve talked about is coordination of services and those sorts of things, and we have this concept

now of medical homes, and I think that’s a great idea, but one of the things that we’re missing is all the

wrap around services that go with those sorts of things that deal with preventive services and

coordination of care and access to care, integration of behavioral health with physical health and those

kinds of things. So I think we’re, we’ve got part of the picture there, but we need to think a little broader in

terms of how we put all that together. That’s kind of have been mentioned here, but this was kind of an

overall comment to bring that all together.

40:01

Mike Shafarenko

…for that. I want to remind everyone that again you have a worksheet in front of you, the third page of the

little packet you have has all the questions that we’re talking about today, so if there are any comments

you want to make there that you weren’t able to get into this first section, please make them there and

we’ll be sure to pick them up before we leave here today.

So let’s move on to the second question today which is ‘What’s being done to address these issues?’

We’ve heard a lot about these social determinants that are really at the root cause of a lot of these health

issues. We did hear about some specific diseases, we heard about diabetes, we heard about obesity, a

couple of others. So what’s being done and who’s doing what? And a lot of you in this room are doing a

lot of these programs, so what are you most proud of in your organizations? So what’s going on in the

community? And then sort of with that question is, is there a common health agenda? To Amy’s point, a

lot of you represent different organizations that touch health in some way, or social services. Is there a

common agenda that you’re all working toward or working to address to have collective impact? So those

two questions, what’s being done and what kind of coordination/collaboration is happening in

Summit/Medina/Portage Counties to address these issues?

Don’t all jump at once.

I’ll start with John and come back to you Ken.

Yes.

41:19

John Saros – Summit County Children Services

I’m John Saros, formerly with Summit County Children Services. It’s been a real interest to me of the drug

problem, the opiate problem, you mentioned earlier. And my, my experience it’s really serious, it’s

destroying families left and right. And one of the, one of the interesting things that’s happening right next

door in Portage County, where the County Commissioner has just placed a new quarter percent sales tax

in place in order to focus on the issue of opiate addiction. They had 8 overdoses in one day, and as a

result of that, I think that really fired them up in terms of wanting to address the issue. Clearly we have a

very serious problem here in Summit County as well. And I don’t know that an additional sales tax or any

other such idea is appropriate, that would require a lot of thought and study, but my sense of it is, that this

is really hurting families, and when I say families, I’m talking about children. And we are concerned about

the poverty issue, which is very much a legitimate, basic, fundamental kind of a problem here that

reaches into all of these areas. My sense of it is, is that this is really, really hurting children. And our

present and future generations are really going to be very much, very much injured by it.

43:05

Mike Shafarenko

Ken

43:06

Ken Slenkovich

I only know what’s happening in my little slice of the world, but there are some very important things going

on, the 3 hospitals in Summit County, it’s been written in the Akron Beacon Journal, about them coming

together to do a Community Health Needs Assessment, working with the health department to identify

what some priority issues are, and many of the folks here are part of that, and so collectively they’re

looking at what are the needs, and many of these same issues are coming up, and then they’re

developing action plans to do something about those things. The health department itself has got, they

can tell you, they’ve got a whole boatload of programs, and they’re really leading the way in many of

these initiatives, and one of them is called this Accountable Care Community Initiative, that I think has a

great deal of potential. Dr. Gordon is involved from University of Akron, and Dr. Lee’s involved from

NEOMED, and the health departments and the hospitals. To take a look at, ok, we’ve got all this panoply

of health problems, and let’s make ourselves accountable to the community for addressing them. So all

these agencies and large institutions are trying to figure out what can we all do with our own resources

and capacity to address some of these issues. So I think there is a lot going on in this community. And

frankly, the collaboration I see between you know the hospitals who we all think you know are all

competitors with one another is amazing. And the fact that they’re bringing in academia, and they’re

bringing in public health so it’s…

44:37

Mike Shafarenko

Are you aware, can you speak to how far along that needs assessment is, and did it start or are we

somewhere in the middle of the process?

44:43

Ken Slenkovich

It’s done. That’s done. They’re now looking to do another one, because they…because of the Affordable

Care Act, hospitals have to do this every you know, 3 years, and so they’re now looking to the next 3 year

cycle. But they’re deep into, way past the needs assessment, and deep into what are we going to do

about it.

44:59

Judge Elinore Marsh Stormer

Can I just add something? I don’t know about the adult system, but in the children’s system, Ken is part of

the children’s hospital system, one of the first things that they’ve done which I think is important for all of

us, as I’m sitting thinking, you know, how can I get all of the people that I talk about senior issues together

for the issues that we see in my court, but the big thing is data, and one of the things they’ve done at

Children’s, they’ve actually now created databases so they can start tracking diabetic children, asthmatic

children, tracking infant mortality issues and they’re starting to use, now they have data, which they had in

the mental health side, suicide being one of the largest issues for children, and by that, just people under

18, they’re actually collecting the information, so once you have the data, and I don’t have the data for my

group, when I talk about senior issues, I can only tell you what I see, which is just the people that rise up

to the problem area, but I do see a community of collaboration, but to get the data on the people who are

the isolated people that Dr. Selby points out, or the people who are cutting their meds in half or missing

the meds, I don’t know and perhaps that would be a first step, and I don’t know, if Donna can, can you

magically produce all this data for the seniors, do you have that?

[Crosstalk]

But I mean that probably is the first thing that we can start to do, which is to how do you empiricize the

topics that we’re discussing, because if you don’t know where you start, it’s hard to know where you’re

going, right?

46:23

Mike Shafarenko

Terry.

46:24

Terry Dalton

You know I think one of the things Community Support Services, for the last, almost 8 years now, has

been providing integrated health care, behavioral health care, and through the Margaret Clark Morgan

Foundation, the ADM Board, jointly with the University of Akron and NEOMED, we’ve been serving in the

training side as well, so I think there’s some effort there to reduce that 25 years earlier death than the

average population, so I think there is that coordination of care. With the health district now, we’re doing

nutritionists, dieticians coming in. We’ve got dietary services, we’ve got HIV testing, and I’m thinking

dental services that we’ve now got. So I think there’s a start in that process, but I think one of the other

challenges that we have, and maybe probably addresses more of your last question, has to do with the

fact that we talk about integrated health care but our funding streams are all different, there’s all sorts of

challenges in the funding stream. You know, we’ve got the regulation at the federal level, and so it really

is not going really get integrated in health care until we look at the state, local, and federal level to make

sure that those dollars are all coming together. And somebody talked about silos before, I think Linda

talking about the silos. We still have those silos; you know we’ve got the different levies that are funding

different services. So I think that challenge that we have in that cooperation amongst all of us is who’s

funding it. Because it’s clearly still not an integrated funding stream.

47:47

Mike Shafarenko

Yah,Jamie

47:49

Jamie-Lyn Poh

I spoke a little bit about our medical, legal partnership with Akron Children’s Hospital but there’s also,

we’re part of a Summa Centering program, so it helped. There are two programs, a high risk maternity

unit, and then an opiate addicted unit, er an opiate addicted centering program where the ladies who

came in had to be in treatment. They were seen by a dentist, legal aides, CSB [Children Services Board]

was there, there was a lot of you know, Safe Sleep, another education and anecdotally, the babies had

longer gestation born with a higher birth rate. Mom’s got to take their kids home and they were still clean

and so some of that, some of the impact I guess was, was to [inaudible] and that program is still ongoing.

For our part, when someone calls in and they are screened in, so that we can do something for them, one

of the questions that they’re asked is ‘Is everyone in your household, do they have health insurance?’ and

if they don’t we try to see if we can get them qualified for Medicaid and if not, to see whether or not they

are eligible for the, for the marketplace.

49:07

Mike Shafarenko

Your turn right here, Tonya.

49:09

Tonya Block – Summit County Public Health

So I won’t go into any detail but I…

49:11

Mike Shafarenko

You want, sorry, to introduce yourself and who you’re with.

49:12

Tonya Block

Ok. I’m Tonya Block. I’m the Director of Community Health here at the health district. But I think people

are being a little bit modest, there’s an awful lot going on with regard to responses to some of the things

that was mentioned earlier and so I’m just going to throw a few things out there and if anyone wants to

speak to it they can. For example, our ADM Board established an opiate task force several years ago

when we first began to see the problem with the number of children in the neonatal unit at Children’s

Hospital. Since that time they’ve invested a significant amount of resources into, like Donna mentioned,

the Project D.A.W.N. initiative that we have going, they’ve invested an awful lot in making sure that we

have a really good sense of what’s going on with our youth in the community by investing in a survey that

included 15 of our 17 school districts, ages K to 12. And they’ve also been partnering with us on this

needle exchange program that we’re looking at. Judge Stormer has done an incredible job with regard to

providing support to our indigent seniors by establishing and leading our Volunteer Guardianship Program

and that was really at a low cost, but in terms of partnerships, she got several of the other public systems

around the table to contribute to that as well. Our department of Job and Family Services in response to

the abuse and neglect that’s happening in our community has partnered with the Health District and a lot

of other agencies to try and create a community response to some of the challenges that we’re seeing.

So I know that we have a really long way to go, but there’s an awful lot happening here and I think we’ve

just got a modest group, yah. Because they do it every day, it doesn’t feel like something new, but we’ve

got a lot going on in response to the work.

51:13

Mike Shafarenko

The flood gates are open; the hands are flying up. Let’s go to folks we haven’t heard from yet, we’ll come

back to…let’s go with David. Go ahead.

51:21

David Jennings – Akron-Summit County Public Library

I’m David Jennings I work for the Public Library System. One of the things that I think is most encouraging

and different over the last few years is that I think that there’s recognition that if we’re really going to

attack chronic lifestyle related illness, we have to involve parts of our community beyond the health care

systems. As evidenced by the folks around this room – you know, Metro…Goodwill, Terry, I mean it just,

AMHA, there’s people all over this room that I think 10 years ago wouldn’t have been invited. And that’s

an indication that we’re really, if we’re really going to get to behavioral change that it is the key thing for a

lifestyle illness, that that’s what’s really encouraging about this group so that was my comment.

52:08

Lynn Blinko – Edwin Shaw Rehabilitation

I’m Lynn Blinko from Akron General Edwin Shaw Rehab. And I’d also like to talk about how the ADM

Board has really supported the opiate problem in the community by funding programs at Edwin Shaw to

start a medication assisted treatment program there. We were historically abstinence based and we

started that 3 years ago. We saw over 400 people in the last 2 years for opiate addiction and we have

one physician, Ann Difrangia. We’re missing physicians. We have a problem with physicians who are

willing to get their DEA waiver so that we can prescribe Suboxone. Doctors hands are tied to a hundred

patients if they’re in the private community, they’re not part of an opiate treatment facility. Those are some

of the things that challenge us. The other things that challenge us are having enough counselors

available to provide the treatment that is required. So those are some of the things like if we could work

you know with the University of Akron, Kent State, to try to get more people into that, and to erase the

stigma of the heroin user. I think that is a big problem for some of the physicians. They don’t want to deal

with those types of individuals, but this crosses all economic, geographic lines. We’re being asked to

come in in conjunction with the Summit County, we’re doing, Health Department, the D.A.W.N. clinics.

We’re getting requests to give out 75 kits in Hudson, and they want us to come to Green and do 50 kits.

And you know, those are the types of things that communities really need and we just need to get more

doctors on board. And health professionals as well as community professionals that are willing to assist in

the endeavor. But the ADM has been amazing with this and I really give a lot of credit to what they’ve

done.

53:52

Mike Shafarenko

Ah Jeffrey.

53:54

Jeffrey Snell – Summit County Public Health

Sure. Jeff Snell I’m with Summit County Public Health, I’m also a lawyer in my day job. And Summit

County has become really the resource, the health department, has really become the resource for that

data that Judge Stormer talked about. That quality of life project has generated a lot of data that you’re all

aware of that can tell you a lot about the community and where we were and where we are and how we

continue to change. That’s been a commitment of Russ Pry and the county and the health department

and that’s really a niche that we have created at the health department that I’m really proud of. An

outgrowth of that Tonya briefly talked about, and in my practice I do a lot of probate and that leads to

what Judge Stormer talked about. Now when there’s a senior in trouble, Jobs and Family Services sends

a social worker, we send a representative from the Sheriff’s Department, we send somebody from the

Building Department, and we go into their house. Now we can have a coordinated approach to what does

that person need, how can we address their immediate needs, how do we address their long term needs,

how do we deal with a guardianship, how do we deal with handling that person. Those are the kinds of

programs that can really help us so when we talk about outcomes, data is very important. We have so

much of that data and all of the partners around this table have helped contribute to that, but then that

leads to how do we improve it, and we’ve found programs of coordination. We have a small county in the

sense that a lot of partners work together to advance the cause, and I’m glad that everybody’s here, but

that’s, I think an outcome of our community that’s really important.

55:37

Mike Shafarenko

What else, what else is going on to address some of these issues? Karen.

55:40

Karen Talbott

Donna mentioned the Social Services Advisory Board which was created by legislation in Summit County

and it’s got several initiatives dealing with many of the things that are mentioned today. Reverend Selby

chairs, is one of the co-chairs of the Health and Human Services Committee for that and covers a lot of

those initiatives. We actually met today as a board and one of the things we talked about and endorsed

was, and it will be through Summit County Public Health, is looking more into single parenting and infant

mortality. But those are the kinds of things that we’re seeing and being able to bring together as important

and impacting in the community. And it was mentioned earlier, but I also want to say hats off to Judge

Stormer for this volunteer guardianship program for indigent seniors. That’s very important, it’s long been

needed in our community and congratulations to her for stepping up to help make that possible and more

and more folks are needed to participate in that.

56:34

Mike Shafarenko

Any other programs, oh, sorry. Someone over here. Yes Cindy.

56:38

Cynthia Struk

I think it’s more of a comment, but you know one of the things that I think we’re seeing at least more in

health care practitioners and it would be so beneficial for more students and professionals who are just

becoming you know, into the community to hear this kind of collaboration, because I think what’s

happening is, you know, we’re kind of training a new set of practitioners to be a lot more collaborative, a

lot more team based, and really sort of aware of the decisions people need to make, and so often the first

point of contact for people’s issues is health care, but then you know, maybe we’re not always so aware

of all the other issues that are impacting them, so I think you know as we train health care professionals,

and I think we’re doing a much better job you know, I think that’s what maybe, you know the new health

care agenda’s kind of getting to so, not just thinking about the individual patient encounter, but what is

that population that I’m taking care of, and I think you see that advancing and I think that would be an

incredible opportunity for persons to kind of hear that and you kind of get it one on one on one but you

don’t have an opportunity to see this kind of collaboration.

57:57

Mike Shafarenko

Ah, Greta we haven’t heard from you and then Giselle.

[Crosstalk]

Sorry to interrupt you. Can you introduce yourself?

58:02

Greta Lax – University of Akron

Greta Lax, I’m with the Akron Region Inter-Professional AHEC. AHEC is a federal program, and I’m host

of the University of Akron, serving Summit and Portage counties. Following up on your information on

training practitioners, I don’t know if anyone has mentioned yet, the Summit Bridges, Bridges Out of

Poverty Initiative, has that been spoken about at all? So, with the Bridges Out of Poverty Initiative, we’re

trying to address poverty a couple of different ways. So one of them of course is working with folks who

are coming out of generational poverty, and helping them kind of to better understand the difference

between their experience of the world and then the very middle class way that most of our world is run.

There’s the piece that educates those of us who might not come from generational poverty, the need to

better understand our clients and patients coming from, from there. And one of the things that I’ve been

able to do, so a lot of us here in the county that have gone through that training are able to take that and

use that to train both you know, the folks that we work with but also our practitioners. So for example I

know some of the folks working with the Unity Way to do that, Akron Children’s Hospital is working to

become a Bridges Out of Poverty organization so that they’re training their staff to on how to better

understand and work with their clients who are coming out of poverty. I have the opportunity working

predominantly with health profession students to do that training. So I touch every senior nursing student

before they leave the University of Akron and talk to them about you know, what, a better understanding

of generational poverty in general, how that can better help them work with their clients or their patients

coming from generational poverty. I’ll be working with NEOMED students, I’ll touch every first year

medicine and pharmacy student come in to talk to them about what that means. So hopefully that is some

of the stuff. And we also have the opportunity to educate you know our practitioners and our educators,

our faculty members who are working with clients so I mean, I think there are a lot of a little ways and

there are many, many people working with the Bridges collaborative across our county helping to build a

shared vocabulary and understanding to help us better work with and cross those lines of socio-economic

status.

1:00:04

Gizelle Jones – Jewish Family Services

I’m Gizelle Jones, and I work for Jewish Family Service and a part of the responsibilities I’ve taken on,

and been a part of, is the Senior Independent Living Coalition which actually came out of the Quality of

Life Initiative, and it’s just been a wonderful collaborative for me because I’ve been able to work with

people like Susan and all of the agencies that are really interested in working with seniors and improving

the life, and quality of life for seniors so I think that’s been a wonderful initiative here in Akron. And as part

of that, we’ve been able to actually do and work with [inaudible] and do other collaborative events, for

seniors to go out into their homes, to do assessments, to make sure that they’re able to get some of those

community resources that they don’t know about, so that they can get a good quality of life in their homes,

so I just think the Senior Independent Living Coalition is one of the best things that have come out of that

Quality of Life Initiative.

1:01:04

Mike Shafarenko

Tom first and then Lisa

01:01:07

Tom Tulisiak

So to address the health and wellness and disease prevention aspect of things in our county, we’ve, in

Medina Hospital, we’ve developed a program called Healthy Medina County, which is a collaborative of

Medina Hospital, the city, employees, the city leaders, the schools, and businesses to identify health

needs in the area. This also educates employees, parents and students and provides programs to

improve the health, wellness, and also promote disease prevention. As a result, we’ve seen improved

metrics, in health risk assessments, we’ve seen less absenteeism in the workplace and in schools, and

we’ve also had decreases in employee’s and employer premiums for their health premiums. As this rolls

out, this has been a consistent finding. It’s a little bit easier in Medina County, it’s considerably smaller

than Summit County, but it can still be done.

01:02:05

Mike Shafarenko

Lisa

01:02:07

Lisa Ritenour

As part of the University of Akron, I am one of the nurse practitioners in our community clinic. It is one of

the few nurse practitioner-run programs in the state, and going off of what you [Cynthia Struk] said and

also Greta, we offer an inter-professional program, whereas we’re seeing patients, we are bringing in

students from each of the different disciplines to collaborate with each other to know what each other are

doing in order to take care of the patient. The other thing that we are very concerned about is the

breakdown of the safety net that Donna spoke of. And in doing that, we are partnering with many of the

different projects in Summit County, Better Birth Outcome, we have two providers at Community Support

Services, but being a part of community projects and taking that into the care of our patients.

1:03:12

Mike Shafarenko

Looking for folks who haven’t talked. Jerry?

1:03:15

Jerry Craig – Alcohol, Drug Addiction and Mental Health (ADM) Board

Sure. I’m Jerry Craig with the Summit County ADM Board. Just want to talk a little bit about the heroin

problem. You know we see heroin become a community problem in every community, it used to be

looked at as an urban issue. And I think that while that’s been you know, it’s horrible that it’s spread so

much, it has had an unlikely impact on our communities in the sense that it’s opened up some political will

to fund things that hadn’t been funded in the past. And along with the perfect storm of Medicaid

expansion that occurred in Ohio, we’ve been able to re-invest funds, that had formerly been used for

treatment into recovery support services. In the old days, anything beyond acute care for somebody with

a heroin addiction would be considered to be outside of the normal course of medical care. So now, we’re

looking at this rather than an acute care model, we’re looking at it as a chronic care model that requires

recovery support services like housing, employment services, and other types of supports that will help

people build some social connections. So while that’s, while it’s been the stigma of that I think has been

lifted because so many people have lost someone to a heroin addiction. We look at heroin and it’s a

community wide problem and not one system can really address it effectively, and that’s why we formed

the Opiate Task Force. And the Opiate Task Force has really been able to engage our federal legislators.

It’s engaged our state legislators. It’s engaged a broad spectrum of the community, from criminal justice

to health care to our social services and it’s also allowed us to build awareness into the community.

We’ve been able for the first time to be able to spend funds on prevention services and that’s why we did

in partnership with Public Health, the youth risk behavior survey, so we could see what sort of problems

impact our community and how can we focus and target our prevention programs to make the largest

impact. And so we’re just beginning to do those things and that will allow us then to measure the outcome

of those programs. Legislatively now there’s been more of a will to address the IMD exclusion for people

in a residential addiction treatment, so now we’ve got large residential addiction treatment programs that

don’t qualify to bill Medicaid and under legislation that’s been introduced now, perhaps that opportunity

might present itself. So there are a lot of opportunities that’ve been presented because of this horrible

affliction and mostly I think because it’s affected every community and it’s not been looked at as an urban

issue.

1:05:54

Mike Shafarenko

I want to mention, we have I think 2 representatives on behalf of elected officials I think Catherine and

Emilia. Right? You work on behalf of elected officials?

1:06:03

Emilia Sykes – Ohio House of Representatives

No I am an elected official.

1:06:03

Mike Shafarenko

Oh you are yourself one. I’m sorry, I don’t have the list in front of me. I apologize. But do either of you

want to speak? I mean you get around the state, you get around various jurisdictions, do you want to

speak to anything that’s been said today with respect to what’s happening in a positive sense, in terms of

collaborative activities to address some of these health issues?

1:06:21

Emilia Sykes

Sure. Well thank you, I’m Emilia Sykes, State Representative. I represent 34th House District here in

Akron. I think that what Mr. Craig said was very true about, especially relating to the opiate addiction and

the issue that we’ve had. Legislatively at the State House, we have invested a lot more money in mental

health and addiction services than have ever been previously considered or thought about. It is

unfortunate that it had to spread before people started to take notice about it, but I guess we can take

what we can get and use it to our benefit how we have now.

I will say one of the major issues in the Statehouse and something I’ve been working on is the infant

mortality. I’ve been in contact with some of you at the table already about some things that I’m working on

with the department of Medicaid, there’s some funding coming into the areas of the state that have the

highest infant mortality rate. There is a 13-million-dollar appropriation that will be coming into 2 zip codes,

not all 13 million is coming into these 2 zip codes, that’d be great, but we have to spread it across the

state but there’s, that program that’s going to be coming by way of community health workers and making

sure that there are people who can really connect with the women who are pregnant, before they’re

pregnant, when they’re pregnant, after they’re pregnant, and making sure that they’re getting connected

to all of you around this table. There’s also some funding coming from the Commission of Minority Health,

to help the infant mortality rate, to implement a pathway hub. That will be a competitive grant, so I hope

that you all are talking to each other about how you’re going to get those hubs going, because it’s

possible that Akron does not get that money, but I really hope that we can come together and I’m sure we

can to make sure we can draw down that funding, that will be about a million dollars coming from the

state. Otherwise it’s just a little bit of a battle to make sure that prevention and wellness is on the forefront

instead of treatment, which is expensive, it’s costly. Similar to a comment I heard, about the productivity

that they’re working on in Medina and having more people come to work, that’s because when you put

that money in the beginning of that person’s health span and their life, you can really see what happens

on the tail end. So hopefully we start to spend some more money on prevention and wellness rather than

just treatment, and those things that are really costly. Thank you.

1:08:40

Mike Shafarenko

Catherine, do you have anything to add?

1:08:41

Catherine Breck Colon – U.S. House of Representatives

I don’t have anything new to add, but I just [inaudible] these groups are unofficial in keeping our bosses

informed. Ginger represents Congresswoman Marcia Fudge. [Inaudible] represents Senator Brown so

we’re happy to be here. Thanks.

1:08:56

Mike Shafarenko

We’re going to move on to our last question. We have about 10 minutes left and then we’ll wrap up. The

last question is, what can ideastream do to help? As Kit mentioned earlier a lot of our senior managers,

our content managers are here today. A lot of our health reporters and producers are here, you can see

them with their notepads writing furiously. For everything you’re saying and what they’ll be following up

I’m sure with many of you to get story ideas and all sorts of things. And ideastream through all its

platforms reaches 4 million people a month with our programming. So we do have a broad reach

throughout Northeast Ohio. So what can we do to help? What can we do to help some of these things

that we’ve discussed today? My face went directly to Lynn, so go ahead.

1:09:39

Lynn Clark

It was about a year ago that, as Summit County Board of Health was setting priority programs, priority

goals. One of the priority goals we set was public education; you know that we need to do more

education, not just collaboration, coordination and that, but education. I deal with so many folks in my

practice I would say ‘Why don’t you call?’, you know like ‘Oh I didn’t know they did that’, and I’m very glad

it’s the ideastream here because I know a lot folks listen to you, it’s the only TV station I get on my TV

believe it or not. So I watch it, I know a lot of people who pay attention to it and listen to the radio, but we

need to do more education of the public. On all of these issues and all of the resources.

1:10:29

Thom Craig

The Margaret Clark Morgan Foundation is a regional foundation, so we serve the 18 counties of

Northeast Ohio, and what I’ve noticed is that coverage for health issues and other really important local

issues varies quite a bit. The Mahoning Valley has 3 local television stations. Cleveland has their own

television stations. Akron does not have that and in many ways there’s a disparity in reporting. We really

depend a lot on Cleveland for our news and for our information, and I think that there’s a need for cross

county learning and learning what other people are doing in other places, but there’s a real need in

Medina, Portage, Summit Counties for local news and local reporting so that we know what is available in

our own community, we know how we can better work together and exercises like town hall meetings like

this can be a catalyst to cause a lot of those things to happen but they happen very infrequently as guided

by the media. Most of the time it’s been happening by the ADM Board or the health department, or our

foundation has pulled together people. The NEOMED has pulled together people, the library has pulled

together people, so we’ve had to do a lot of that kind of work ourselves and then that message does not

necessarily reach the general public or those who are isolated and can only see things on television or on

the radio. And then much of the local radio that we do get isn’t credible in the sense of real good

information about what’s happening, the information that you can trust, and so PBS and ideastream has a

reputation for being a very credible source, but I feel there could be a greater emphasis on the southern

region that you serve.

1:12:37

Mike Shafarenko

Thank you for that. Karen.

1:12:39

Karen Talbott

Advocacy and awareness certainly are big parts of this and kind of tie into what’s already been said. One

of the things that wasn’t mentioned earlier was end of life care and we as a community have tried to

educate the population about that in terms of the quality of life that goes along with end of life care that’s

possible as well as the cost effectiveness of that. When the Medicare program first offered that benefit,

they were able to demonstrate, that end of life services really can cost about 1/8th the cost of those not

getting appropriate end of life services, where appropriate choices are being made, and educated

sources are being made. That’s the kind of thing that I think ideastream could help educate people about

them, they’re going to come out with a better quality of life, and you’re going to have more cost

effectiveness, all the kinds of things that go along with that. But we do have that initiative in Summit

County, and I’m sure the other counties may have that as well, but that’s something that ideastream could

definitely help with.

1:13:37

Donna Farris

I think you can tell a story, right? So you have the opportunity to tell the story of the collaborations and

what’s working and how we can do a better job. When we talk about the elderly and the collaboration that

we have here in Summit County, there are success stories, we only hear about the negative piece of it.

Let’s start talking about success stories, and bringing attention to those, and then when you do that you

can talk about what the need is. For elderly that are abused, one in every, one elderly person gets

reported, there are 5 who are not. So those 5 people are still out there with nobody identifying them and

linking them, so you can tell that story.

1:14:18

Karen Hrdlicka

I think getting people to understand what they can do. Judge Stormer, she’s looking for people that can

be guardians. I know Mature Services manages the retired senior volunteer program that is targeting

needs in the community so we find volunteers for those things. So there’s definitely things that if people

knew there was ways they could make a difference and you guys were telling that story and told them

how to connect, that there’s opportunities for people to give back to society.

1:14:50

Amy Lee

Amy Lee from Northeast Ohio Medical University. I absolutely agree with the fact that the media is

wonderful at telling stories. I also buy into what everybody else thought about needing data, so the stories

that can be told should be backed up by data. But I, a while ago read a book by Kerry Patterson called

Influencer and it told a really interesting story of a Latino T.V. station and how they told, almost in a soap

opera fashion, stories, of, and they picked up social issues such as domestic violence and health literacy,

and they were able to bring awareness to the public. Recently if you’ve been following the news, we’ve

heard how nationally a video or individual stories have pushed legislators to propose policy as well. So

both at the policy level and the public level, the media is a very powerful source to be able to both bring

awareness and even push policy.

1:15:55

Mike Shafarenko

I saw Lorie’s hand and then we’ll come back to Judge. Lorie.

1:15:58

Lorie Lerner

I was just going to, thinking about what Karen said about end of life care, there’s other components too.

There’s many people in this room working on a project trying to get the message out about signing

advanced directives and those kinds of things so we don’t have people who don’t want resuscitated being

taken out of the nursing home and what have you and starting the conversation. That’s also part of the

end of life care that I think needs to be, you guys could do a story on it and it would be fabulous.

1:16:23

Judge Elinore Marsh Stormer

And we could give you the whole package on advanced directives, and I’m not making that up, I mean

seriously…

1:16:28

Mike Shafarenko

Judge we have some executive producer positions open if you want to apply

[Crosstalk and laughter]

1:16:32

Judge Elinore Marsh Stormer

April 16th is National Healthcare Day and if you think that that’s a good idea, I mean this is something that

we’ve been working on collaboratively as well as independently, the reason I care is that because if

people don’t tell their doctors what they want, I have to make the decision, and I’m trying to avoid that to

be honest, I think that should not be my decision. But it is a great little one show thing with lots of, all the

info’s right here, it would be very easy producers, and it’s very important.

[Crosstalk]

1:17:10

Mike Shafarenko

Ken and then Sheila

1:17:12

Ken Slenkovich

I think a lot of us struggle with trying to reach the younger audience. I know we do, you know adolescents,

and young adults and all that. And you all, you know you understand you know web technology and social

media.

1:17:24

Mike Shafarenko

We do the Twitters.

1:17:26

Ken Slenkovich

You do all that stuff and so figuring out creative ways to get some of these health messages to those

audiences…

1:17:34

Mike Shafarenko

When you say that do you mean, just the messages you know, ‘Hey you can be more healthy’, or make

them more aware of the issues, both?

1:17:42

Ken Slenkovich

Both but also even like, some of our students who understand this stuff better than I do, created little

phone apps, that are you know health reminders or little games or things like that, that get young people

aware of the fact that the way they live and the choices they make impact their health. Maybe you guys

have some expertise.

1:18:06

Mike Shafarenko

Sheila

1:18:06

Sheila Williams

I want to piggy back on what Karen said about volunteering. I respect each and every one of you in this

room and you do a tremendous job. I ‘ve been fortunate enough to sit on the board where some things

that I do help to contribute. But you all are the ones that are really out here doing it, and I think if you

could do something that would encourage mentoring, talking about the needs, someone talked to me

about the guardian program and I’ve been talking to other people about it, because I can see the need.

But I think that if you as a credible venue talked about ‘these are the things that are going on in the

community, these are the good things that some people are talking about should be highlighted but we

could use some more help’. Kids learn to read from K to 3. If they don’t know how to read by the time they

enter the 4th grade, by the 6th grade they’re starting to show the behavioral problems that you see, the

other problems that may not have been diagnosed where going into a school tutoring with kids once a

week, you’d be surprised at the difference that makes, but a lot of people don’t know where to start.

Where someone like your organization in a broader sense could reach out and I think that the mentoring

and volunteering highlighted.

1:19:29

Mike Shafarenko

David. Close the comments…

1:19:30

David Jennings

I was late so I apologize if this was already discussed, but in terms of what ideastream could focus on, I

think that if we’re going to really have an impact on community health, we’ve got to spend a lot more time

talking about what we eat and drink. That’s so key, I think it’s the biggest challenge we have. Is

behavioral change, change the way, what we eat, what we drink, so many of these things relate to that,

that’s an opportunity for ideastream.

1:19:56

Mike Shafarenko

Maybe one more because Mr. Gordon hasn’t spoken yet.

1:19:59

David Gordon – University of Akron

So I’m Dave Gordon from the University of Akron and since I’m one of the new comers here, you can

direct your tomatoes and eggs at me, you can say forget this guy. I certainly agree with a lot of the things

that’ve been said. You’ve heard listing of all the different issues we have in the community, you’ve heard

some of the listing of all the different resources you have in this community. You’ve heard, you know the

issues of ‘gee maybe we don’t collaborate and work as well’. I think perhaps a good idea for us would be

if you hold us accountable in terms of saying, ok we heard this, we heard this, give us a scorecard and

come back, say in a year, and sort of say, how has this group you know, made a difference a year from

now. I think holding us accountable to some degree would help us to be able to say ok are we basically

going to continue with the same panoply of things that we’re doing and not making any progress really

moving the needle gauge, or are we serious about moving the needle gauge. So I think that would help. I

mean I used this for my own self personally. I used to be somewhat larger than I am, and you know

someone asked me, you know what’s the best way to ask Dave Gordon to reduce. Best way is to put him

in charge of a weight reduction program you know and he’s out there visible, he’s got to do something

you know. I would say you know generate a scorecard on us and hold us accountable.

1:21:15

Mike Shafarenko

These are all terrific ideas. Going to give a round of applause for all.