Twenty community members participated in this first of a series of 1.5 to 2 hour community workshops. Jack Drury of LeadingEdge, Inc. and Timothy Holmes of Holmes & Associates facilitated the workshop. The workshop began about 7:10 with an introduction and thank you by Mark Johnson. Then an overview of the agenda, consisting of a brief introduction of "Why we are here", a clarification of the outcomes hoped for through the workshop, an introduction of the workshop process, the information gather process itself, discussion/clarification of priorities, and discussion of next steps.

After they completed the four questions, each writing down the main ideas from their group, the groups "jig-sawed" with 4 new groups of 5 forming. They then had 20 minutes to discuss the issues raised under each of the four questions in their previous groups. One person took on the secretarial duties of listing the main issues under each of the four questions. Then they were given 5 minutes to select the top 3 priority health services, or health service issues, under each of the four questions and write them in four quadrants on a large sheet.

Those sheets were posted on a wall in the room and read by the facilitators. Patterns were identified. There was then group discussion on clarification of the priorities, other health issues that may have been missed, questions and answers on how this information will be used and how participants can stay involved or informed.

Participants could view architectural drawings on the hospital building program and help themselves to coffee and cookies provided by the hospital.

Following are the health care service priorities identified in the Hague workshop.

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About 20 members of the local senior citizens group participated in this workshop.

Services they especially liked:

Clinics

X-ray

Lab

Ambulances

Nursing home

Services they did not like:

Being transferred to other facilities

Long waits for transferring ambulances

Billing

Long waits for MD appointments

Interest in new services:

Dental care for Medicare recipients

Mental health for elderly

Services for burn victims

Centralized transportation system for elderly

Five community members participated in this 1.5 hour community workshops that started at 6:00 PM at the school. Timothy Holmes of Holmes & Associates facilitated the workshop. The workshop format was varied somewhat from that in Hague to account for the lower attendance. The five participants sat at one table and discussed the four questions on health care services while Holmes wrote their comments on the flip-chart in front. There was quite a bit of discussion about the issues. No attempt was made to prioritize the issues raised. Following is a summary of their comments.

Mineville Health Center (MHC)to have blood work done – a convenience

Hours are good at the MHC, they have extended hours – to 7 or 7:30 PM, good for after work visits.

Dr. Pemba is a great doctor. Has good Dr. to Patient relationship. He has a pager and makes house calls.

Freedom of choice for follow up care. An excellent referral system.

Cat Scan Unit coming to Moses-Ludington, so that will be available within an hour from us.

The public image of MLH is improving¼ Lack of continuity of Drs. was a problem.

My mother had her hips done at MLH and they did a great job.

HMOs and Health insurance are real problems:

Moriah, continued

Clinics: Eye, ear, nose, throat, heart, foot, etc.

Need a new building for our clinic, or a major upgrade.

60% of our residents are either fixed income or on welfare, so access to care is a problem.

Need more services for geriatrics, arthritis.

Senility, Alzheimer’s are problems.

Cancer rates are high, just diagnosed 4 new cases of cancer.

Why do the cancer rates seem so high: radon is a problem, smoking, mining related lung problems¼

Lab work has to go off premises for analysis. Maybe a mobile lab clinic could be brought in.

Tele-medicine is one answer, but who pays for the Drs. time? Does not appear that insurance will cover this.

Dental care is not covered, and there are no dentists here in town, most people go to Chestertown, Warrensburgh.

Audiology clinics are needed, hearing seems to be problem.

Pediatrics would rank number 1 in terms of needs.

Dietary needs are big – for kids and for senior centers. Seniors have a meal site but not well attended. There is a bus to take them there.

Medication/prescriptions are a problem. Some seniors are taking 30+ pills a day.

Plus not always using generic brands to hold down costs.

Dr. Pemba is key to our health care successes now.

Lack of knowledge.

Transportation – this is a big town geographically.

Seniors:

Met with school administrators and nurses.

Services they especially liked:

Clinics

Emergency room

Physical therapy

Off-site cholesterol and glucose screening

Services they did not like:

Billing

No pediatric follow-up

Lack of a choice in primary care

Interest in new services:

Substance abuse counseling

Full-time pediatrician

Dental services for children with Medicaid

Audio/visual services for children

Sports medicine

Mental health counseling

Other observations:

Poor image perception of MLH

Negative public perception

Not enough press coverage on available services

Twenty seven teachers participated in this 1/2 hour workshops that started at 3:00 PM at the school. Timothy Holmes of Holmes & Associates facilitated the workshop. The workshop format was varied somewhat from that used in Hague to account for the short time frame. The teachers sat in groups of five or six around five tables and discussed the four questions. The process involved brainstorming for 2 minutes on a question, then trying to prioritize the issues raised for 2 minutes, then calling out the top priorities at each table while Holmes wrote them on the flip-chart at the front of the room. Then moving on to the next question. Following is a summary of the priority issues, based primarily on the teachers’ views of the health care service priorities of area youth:

Twelve community residents participated in this one hour workshop at the Putnam community school at 7:00 in the evening. Timothy Holmes of Holmes & Associates facilitated the workshop. The workshop format was varied somewhat from that used in Hague to account for the somewhat smaller group size. The participants sat at three tables in groups of four and discussed the four questions. The process involved brainstorming for 2 minutes on a question, then trying to prioritize the issues raised for 2 minutes, then calling out the top priorities at each table while Holmes wrote them on the flip-chart at the front of the room. Then moving on to the next of the four questions. Each sheet of priority issues was then posted on a wall in the room. The participants were each given four colored dots to stick up on the four items on all of the sheets they thought were the highest priorities. The four items that received the most dots were then discussed briefly. Following is a summary of the priority issues highlighted in Putnam. The numbers in parenthesis (2) indicate the number of dots that item received.

Summary of priority concerns identified in Putnam:

Sixty-one middle school teachers participated in this 30 minute workshop facilitated by Timothy Holmes and Jack Drury. Similar to the high school workshop, the teachers sat in groups of five or six and discussed the four questions. The process involved brainstorming for 2 minutes on a question, then trying to prioritize the issues raised for 2 minutes, then calling out the top priorities at each table while Holmes wrote them on the flip-chart at the front of the room. Then moving on to the next question. Following is a summary of the priority issues, based primarily on the teachers’ views of the health care service priorities of area middle school students. The (SYMBOL 252 \f "Wingdings" \s 11) indicate items that were checked off by teachers who came up after the workshop to indicate which items they felt most strongly about.

Emergency room availability (SYMBOL 252 \f "Wingdings" \s 11SYMBOL 252 \f "Wingdings" \s 11)

Diagnostic Equipment (SYMBOL 252 \f "Wingdings" \s 11)

Outpatient clinics, specialists (SYMBOL 252 \f "Wingdings" \s 11)

Eye care associates

MLH ER, Lab

Prescriptions plan

Drs office

Pediatrics in Middlebury

Physical therapy

Drug counseling

Faculty, student vaccinations

Sports clinic at hospital

Used to have cholesterol screening, should do again

Lack of pediatric care (SYMBOL 252 \f "Wingdings" \s 11)(SYMBOL 252 \f "Wingdings" \s 11)

The need to travel for health care, difficult in itself and is time kids are away from school (SYMBOL 252 \f "Wingdings" \s 11)

Lack of preventative care (SYMBOL 252 \f "Wingdings" \s 11)

Dental care – affordability (SYMBOL 252 \f "Wingdings" \s 11)

Up-date equipment – X-ray (SYMBOL 252 \f "Wingdings" \s 11)

Clinic hours in evening – expand (SYMBOL 252 \f "Wingdings" \s 11)

Late appointment times

Available of Drs

Limited choices in general locally

No cardiac care

Anonymity and confidentiality

Co-pay issues, inconsistent

Cost of prescriptions

Ambulance availability & cost

Limited mental care services

Family counseling & mental health

Lack of maternity care

Pediatrics(SYMBOL 252 \f "Wingdings" \s 11SYMBOL 252 \f "Wingdings" \s 11SYMBOL 252 \f "Wingdings" \s 11)

Dental care(SYMBOL 252 \f "Wingdings" \s 11SYMBOL 252 \f "Wingdings" \s 11)

Gynecology(SYMBOL 252 \f "Wingdings" \s 11)

Orthodontist

Ear, nose & throat

Internal medicine – full time

Hearing impaired services

Parenting classes

Sports clinics

Allergy specialists

Massage therapist

Dialysis

Cancer treatment

Coordinate all services for children

Specialists in town more often

Down sizing of Mill

Insurance, billing, clerical at MLH

Nursing home care & hospital facilities

Hiring practices of some of Drs

Takes long time to get appointment

Recruiting of Drs, MLH status makes more difficult

Seeing Dr, rather than PA

Better communication on what is available at MLH

ER nurses are dynamite

Twelve IP Mill employees participated in this one hour workshop facilitated by Timothy Holmes and Jack Drury. The workshop format was similar to that used in Hague. There was brainstorming on each question in groups of 3 or 4. Then all participants "jigsawed" to re-group with different people. Those groups then discussed the issues identified in each of their groups and prioritized the main issues under each of the four questions.

Priorities Identified at the IP Mill

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Critical care

Pediatric care

Mental care

Maternity care

Orthopedic care

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Group 2

Group 3

A workshop with Moriah schoolteachers could not be scheduled by the end of the school year, however, 14 teachers responded in written to the four discussion questions on Health Care Service Priorities, as follows:

The Elizabethtown Hospital has a great ER staff, as does the Westport Health Center. Dr. Gilman is exemplary.

HHHN (2)

MLH emergency room & clinics

Fire safety

Health screening

Fluoride treatments

Dental screening and care

Good touch, Bad touch program

I usually go to Burlington or Middlebury

I go to Chilson for my eye care

We use the Mineville Health Center for basic care, for other care go to Middlebury

Westport health center

Mineville Health Center and Planned Parenthood: both excellent, with competent and accommodating staff; referrals are made to specialists with ease. Genuine concern for patients that goes beyond office hours.

Use Mineville Health Center for all general health care needs

Ti health center, Westport health center

Use Mineville Health Center but concerned about emergency care

Greatly concerned about the vast number of children who take prescription drugs for behavior problems and/or depression. Some may need it, but it is prescribed often by a PA who asks for no input from the school, where children spend most of the day. This practice must not continue or we will soon have a society of drug addicts on legal pharmaceuticals. The nurse’s office is packed at lunch with students taking meds.

The large number of students here at Moriah Central diagnosed as ADD or ADHD by a physician’s assistant. I feel this diagnosis needs to be made by an MD with input from school personnel and parents. I presently have 25% of my class on medication for either ADD or ADHD. Three of five students are not referred by school personal. It was initiated by parents with an office visit with the PA. I have a regular education classroom not a special ed class. I have also noticed that some of the medications are being switched to antidepressants. I do not like the thought of medications becoming the answers to all of our problems. I think that the children and parents believe the medications are going to solve all their problems. Therefore, they are not becoming responsible for their own actions

The students need more dental health opportunities

Mental health care service

Need more pediatricians

Drs. staying for too short a length of time for repoire and trust relationship

I would not visit the Ti hospital, I have heard too many horror stories about misdiagnosis and inappropriate care.

Student needs: dental care, eye care, and immunization clinics

Concerned that there are not more certified Drs. and that emergency services are not local.

As a teacher, I am very concerned with the rising numbers of students on Ritalin and anti-depressants. Most of the time teachers are not even asked for input. I am also concerned that Pas are prescribing these medicines and not licensed Drs.

Not enough health care on weekends – usually when kids seem to get sick

Mineville HC seems to charge a lot

More or better dental health care seems needed

I think we need some parenting classes provided

Bicycle safety

Water safety

Substance abuse ed

Drs. of internal medicine

I am happy with the way it is at present

I see a huge need for parenting classes and family support services

My experience has been very good

Hospitals – questionable care

Continuity needed

NY Drs could learn a lot from their VT counterparts concerning expertise and manners

What little need I have of health services can be filled by Westport clinic

A new facility at Mineville is needed

About 40 Kiwanis Club members listened to a presentation on the preliminary findings of this community outreach effort. They provided feedback on additional health care service priorities and indicate with a show of hands those they see as top priority issues (indicated by numbers in parenthesis).

MLH emergency room (18)

Especially close working relationship with Fletcher-Allen

MLH Clinics & Specialists (2)

Especially labs & X-ray

Family health (1)

Dental care (1)

Middlebury health services (1)

Need to travel for health care (14)

Mental health care services (3)

Ambulance - response time, volunteer shortages, etc. (6)

HMO problems (2)

Costs, especially prescriptions (2)

Over-reliance on PAs (1)

Drug & alcohol counseling, not just in schools (10)

Diagnostic equipment (5)

Parenting classes (1)

Mental health (1)

Pediatric care (1)

Holmes combined all priorities offered by each group in each workshop. Then sorted them alphabetically and began summarize similar issues with the same key words, and sorted them again. The next step was to beginning combining like issues under one heading. Finally, I sorted those that were selected as priorities by at least three of the groups that reported out priorities in all of the workshops. Following are what appear to be the major priority issues and findings under each of the four discussion questions. The numbers in ( ) are the number of groups indicating the issue as a priority issue.

Looking at the top five or six priorities under each question, the following appear to be most deserving of a coordinated, cooperative effort at addressing (being selected by 5 or more participating groups):

This list of top priorities looks relatively lengthy but there are a few major themes present. In terms of services to maintain and to build upon, the clinics, emergency services and longer hours at the health centers are key positives. Services that need improvement include mental health, issues related to having to travel long distances for care, concern about ambulance service (especially in the outlying areas), greater availability of Drs and less reliance on PAs, and cost issues. New services wanted include pediatric, geriatric, mental health, maternity, parenting, drug & alcohol counseling and sports medicine. The main other observations are that MLH should continue to work on getting the word out about new services and take steps to improve their billing system.

These findings correspond closely with the Tri-County community health priorities discovered during a community outreach effort in 1998. The priorities, in order, were: Access to Health Care, Substance Abuse, Health & Prevention Education, Mental Health, Healthy Births and Tobacco Use.

This effort used an inclusive approach in reaching out to community members and encouraging them to take an active interest in their health care system. Every effort should be made to continue that effort in involving the public. Some of they participants in the community workshops indicated on the sign in sheets that they would like to stay involved and considered for appointment to a community advisory committee. Those local citizens include the following:

In some of the larger groups, such as the teachers groups, we did not use sign in sheets. It did appear that there are teachers who might also serve on an advisory committee if the meeting times fit their schedule.

The database of meeting attendees is provided with this report.