Community Health 2025

 With Elevate National Learning Forum, I learn Quality Improvement and Closing Care Gaps to help health centers implement measurable quality improvement strategies, use evidence-based tools, and methodically close care gaps to improve outcomes and patient experience. Tuesday December 9 1 pm. Food is Health Elevated Learning Forum Supplemental Session 12/16 https://nachc.zoom.us/webinar/register/WN_GI3Xc0c9TkytcxIOgmvAq

Practical QI strategies you may adopt in your health center.

Evidence-based tools and templates for gap identification, tracking, and closures

Healthy Choices to Prepare for the Session  

Day before session, I encourage to check out blood pressure kit from library and pair with mental health screenings with Mental Health America AI assistant.

Technical checklist (30–15 minutes before)

Test your Zoom access open the join link from your confirmation email and sign in if required with email.

Audio check test speakers and microphone; have the dial in numbers ready as backup with email.

Camera and background if you plan to appear on camera, check framing and lighting.

Stable internet move to a wired connection or close bandwidth heavy apps.

Device power plug in laptop or have charger at hand.

Plan for interruptions mute notifications and set phone to Do Not Disturb.

Reference: webinar join options and phone numbers are in your confirmation email.

Content and participation preparation

Clarify your objective pick 1 or 2 ideas you want to learn or a goal for applying Food is Health in your work.

Prepare 2 to 3 questions to submit in Q&A or chat (e.g., implementation steps, funding/sustainability, measurement).

Bring a short example from your clinic or program (one slide or a 2 to 3 sentence vignette) if you might share during discussion.

Gather resources you may want to reference clinic workflows, screening tools, patient education materials.

Accessibility and note taking

Enable closed captions in Zoom if you prefer captions.

Open a note document or a template (Goals, Key Takeaways, Action Steps, who to involve) to capture practical next steps.

Plan immediate next actions at least one SMART follow up task you may start within 48 hours.

Calendar and reminders

Add the event to your calendar with the join link and phone backup if not already added (your confirmation includes an .ics option) email.

Set two reminders one 1 hour before and one 10 minutes before.

If attending with a colleague, confirm who will lead note capture and who will follow up on actions.

After the session

Send a 1 paragraph summary and 1 SMART next step to your team within 24 to 48 hours.

Follow up on unanswered questions to qualitycenter@nachc.org if needed (contact info provided with the webinar confirmation) email.

Add useful resources from the session to your shared drive or project dashboard and organize healthy choices.

Bring one concrete care gap you want to close (example: pair blood pressure readings with mental health screenings). The Big Picture of Shared Decision Making and Interprofessional Collaboration, challenge of hypertension depression screening gap in community health, racial and ethnic disparities in hypertension screening and control, chronic disease screening integration barriers, Impact of Missed Screenings on Care Quality and Outcomes, Operational and Staffing Barriers, workflow barriers BP depression screening community clinics, staff training screening integration obstacles, time constraints mental health blood pressure screening

Collect a brief data snapshot (last 3–6 months) showing the gap’s size and who affects. Bridging the Care Gap: Paired Blood Pressure and Mental Health Screenings in Community Health Settings (2025 Data Snapshot and Analysis for NACHC Elevate National Learning Forum)

Identify current workflows and where patients fall through (intake, scheduling, outreach, follow-up). Current Workflows for Paired Blood Pressure and Mental Health Screenings

Invite one colleague who helps run data, care coordination, or quality (a second perspective speeds actionable planning).

Evaluate relevant Elevate Community materials in advance, slides, past recordings, and FAQs are available from NACHC to prime your team nachc.org. NACHC and the National Council for Mental Wellbeing Announce Strategic Partnership to Advance Integrated Behavioral Health and Primary Care  - NACHC, Elevate Community eJournal, 

After the session: healthy choices with rapid-cycle follow-up

Run a 30 days micropilot focused on the single action you committed to.

Measure one simple metric (process or outcome) to see early signal of change.

Hold a 15 to 30 minutes team huddle at day 14 to surface fixes.

Document lessons and next steps to share back in the Elevate Community eJournal and future sessions.

Iterate and scale what works using Plan-Do-Study-Act cycles linked to your care gap dashboard. https://copilot.microsoft.com/shares/XVkdEBYbSW4NJf428wP6v

Letting love lead the way with healthy choices

Center your improvement work in human connection: frame change around patient dignity, staff capacity, and relationships. Use simple rituals, a two-sentence calling script that opens with care, brief team appreciations when a gap closes, and a short patient facing note that explains why the gap matters, to make QI feel humane rather than mechanical.

Together, keep quality improvement small, measurable, and human. Let love lead the way as you close care gaps and strengthen the relationships that make care work meaningful and effective.

Sources: nachc.org

Come prepared with one care gap, one data snapshot, and one accountability partner. Plan a 30-day micro-pilot and bring results to the next Elevate session to share learning.

Visit NACHC for tools, recordings, and the Elevate Community eJournal to access previous session slides and FAQs nachc.org.

Meta AI edited: Seems like you are working on improving public relationships in Indian River County, Florida, using the IDEAS framework and focusing on health science supported communication strategies. You are looking at ways to engage different groups, address communication challenges, and promote community health solutions.

Some key areas you are focusing on include:

1. Empathizing with residents and understanding their challenges

2. Using tools like Google Sheets for monitoring and evaluation

3. Engaging with local organizations and resources

4. Promoting health initiatives like yearly checkups and improving healthcare provider ratios

5. Leveraging technology and data analytics to support communication and planning

What's your next step in implementing these strategies or addressing specific communication challenges?

My goal to improve impact is to triage and evaluate my interactions and my sent email for social validity of perceptions with 6 triage tags and escalation thresholds for navigation: Immediate Health Concern: identify triggers, prioritize critical highest concern, encourage call to navigator within 30 minutes if possible or notify AI for possible emergency services, evaluate concerns with AI support, document interaction with outcome with message: "We received your alert about [symptom]. I am calling now to check in, are you near someone who may help?”

“We saw higher-than-usual health results readings today. May we schedule a same week check with an AI nurse for support? Reply YES to confirm.”

“Thanks for sharing. I may connect you to [resource] with AI support. Do you wish me to help arrange AI support now?”

“We may schedule 20 minutes pairing help slot at the library on [date/time] to navigate device or tech barriers with AI support, OK?”

“We missed you at the session, do you wish to make up or help finding a better time? You may reply MAKEUP or TIME.”

"Thank you for your encouragement. When do you prefer to receive support of healthy choices, weekly or daily?”

"Good effort, [Name], you met your goal this week. Want to book an AI nurse check in to evaluate results? Reply BOOK."with  email writers and receivers, healthy Cherishing Behaviors goals scored and # of goals with Google Explore (in Google Sheets) learning opportunities to analyze data with Copy of Explore example. To help, you are welcome to email me at lovethoughtful@gmail.com. 

Meta AI: DBSA's Wellness Tracker can be a valuable tool for monitoring and managing mental health. By tracking your mood, energy levels, and other factors, you can identify patterns and gain insights into your mental well-being.

Would you like some help with:

1. Understanding how to use the tracker effectively?

2. Creating a routine to track your mental health?

3. Discussing ways to incorporate self-care activities into your daily life?

Let me know how I can assist you in using the Wellness Tracker to support your mental health journey.

Grok AI edited: The DBSA Wellness Tracker is indeed a helpful resource for anyone managing mood disorders like depression or bipolar, allowing you to log daily moods, symptoms, medications, sleep, exercise, and other factors to spot trends and inform your care plan. It is available as a free downloadable PDF workbook from the DBSA website. I would be glad to assist with any of those areas or others related.

Understanding how to use the tracker effectively: Start by accessing the web version. Log in daily to rate your mood on a scale, note meds and side effects, track sleep/exercise/nutrition, and add journal entries for context. Over time, review the auto generated graphs and reports to discuss with your health team. If using the PDF, print it out and fill in the mood chart plus supporting trackers (like for symptoms or lifestyle) manually each day.

Creating a routine to track your mental health: Set a daily reminder (e.g., evening wind-down) to spend 5 to 10 minutes logging. Begin with just mood and one other factor (like energy levels) to build the habit, then expand. Pair it with the DBSA Wellness Wheel to set small goals in areas like physical or social wellness.

Discussing ways to incorporate self care activities: Tie tracking to actions like short walks (logged under exercise) for energy boosts, mindfulness apps for mood stabilization, I wish to encourage mental health with DBSA-WellnessTracker-07.20.20-FLT December 2025.pdf https://copilot.microsoft.com/shares/VKyjjnCdwj7Q1GLaVvMhy

https://www.facebook.com/share/p/1HDcHpPaKq/

I feel extremely confident that I will be able to apply information from this activity to community organizations events with learning how to encourage food is health initiatives with myself and others with future community organizational events. I feel an extremely high level of knowledge gained from this webinar. I am likely to recommend National Association Community Health Centers trainings to a colleague 10 out of 10 scale. Thank you for helping me to learn how to connect your ideas to my health center when they have not heard of this webinar series. I wish to learn how to encourage learning with people at my health center with data tables to improve health results. Thank you for your respect for wanting to hear from me. I have learned the importance of organizing ideas with my blog Thriving Together: Empowering Healthier Communities with AI support.

Dr. Jack Geiger developed the idea of prescribing food for health as a therapeutic response to malnutrition, a leading driver of death and disability from heart disease, hypertension, and cancers. Barriers to healthy eating include cost, family traditions, store options, taste, store locations, knowledge, time to cook, how to cook, SNAP qualifications, transport, time to shop, cooking equipment, physical limitations. Vital conditions for health and well being are belonging with civic strength to thrive with natural world, health and safety needs, humane housing, meaningful work and resources, lifelong learning with reliable transporation. Solutions are health centers to encourage food for health programs with integrating food into healthcare delivery with focus on preventing, managing or treating diet related diseases with produce prescriptions, medically fit meals, nutrition counseling in health care settings, referrals and EHR linked. Community practices may include promoting healthy eating and well being with community cooking learning activities, farmers markets, public health campaigns in community, public health settings. Tufts University Food is Medicine Institute encourages social needs evaluation with physicians, labels, workplace wellness, each layer connects. Case study research has found that produce prescription intervention may increase fruit and vegetable 25% in 6 months, medically fit meals my reduce hospital readmissions 16%, Nutrition education may improve patient self efficacy and medication adherence. Community Heatlh Centers may deepen community connections with screening infrastructure with multidisciplinary teams with community food learning opportunities to organize metrics to improve patient outcomes, cost savings with community health benefits, to integrate nutrition into care with whole person health with work flows. Suggestion to start with food access security to integrate into clinical work flows with nutritional and lifestyle approaches with PRAPARE screenings in workflows with evidence based guidelines for interventions and leverage data to design and evaluate programs with resources with partnership opportunities. Levels of care: individual, patient with family, care team members, organizational health center, community system, payer payment, policy state and national policies with screening, training, programs, communities, resources, community gardens. Resources: Elevance Health Food as Medicine, Tufts University Food is Medicine Institute, NACHC food is Health Resources, Vital Conditions. l for Health and Well Being Framework with Rippel organization, upcoming webinars with Elevated Learning Forum you and staff, colleagues join future sessions cover foundational sessions and dive in deeper, sharing resources to start getting information out to colleages, food as health and explore health centers may not be calling the ideas to food as health frameworks to build stronger case for how to fund, grow nationally

https://copilot.microsoft.com/shares/Fsjd5vxwVwR688Gue5N7j Follow up on unanswered questions to qualitycenter@nachc.org if needed (contact info provided with the webinar confirmation) email. 

Bring one concrete care gap you want to close: pair blood pressure readings with mental health screenings. The Big Picture of Shared Decision Making and Interprofessional Collaboration challenge of hypertension depression screening gap in community health, racial and ethnic disparities in hypertension screening and control, chronic disease screening integration barriers, Impact of Missed Screenings on Care Quality and Outcomes, Operational and Staffing Barriers, workflow barriers BP depression screening community clinics, staff training screening integration obstacles, time constraints mental health blood pressure screening

Collect a brief data snapshot (last 3–6 months) showing the gap’s size and who affects. Bridging the Care Gap: Paired Blood Pressure and Mental Health Screenings in Community Health Settings (2025 Data Snapshot and Analysis for NACHC Elevate National Learning Forum

Identify current workflows and where patients fall through (intake, scheduling, outreach, follow-up). Current Workflows for Paired Blood Pressure and Mental Health Screenings

Evaluate relevant Elevate Community materials in advance, slides, past recordings, and FAQs are available from NACHC to prime your team nachc.org. NACHC and the National Council for Mental Wellbeing Announce Strategic Partnership to Advance Integrated Behavioral Health and Primary Care  - NACHC, Elevate Community eJournal, After the session: healthy choices with rapid-cycle follow-up. Run a 30-day micro-pilot focused on the single action you committed to. Measure one simple metric (process or outcome) to see early signal of change

Hold a 15 to 30 minutes team huddle on day 14 to surface fixes.

Document lessons and next steps to share back in the Elevate Community eJournal and future sessions. Iterate and scale what works using Plan-Do-Study-Act cycles linked to your care gap dashboard. https://copilot.microsoft.com/shares/XVkdEBYbSW4NJf428wP6v

With Fit to Live, I learn how to bring healthy living principles into public spaces with nature contact, smartphone with healthy living reminders, fitness stretch, aromatherapeutic scent, interactive journal, soothing music, healthy vegetarian low-cost snacks e.g., whole wheat tortillas, fruit and cheese.