I used to scoff at breast cancer “awareness” activities. That was before I worked in healthcare.

I have a confession to make. One that I’m embarrassed about.

October is breast cancer awareness month, a month where we see more pink than usual – on everything from cereal boxes to athletes’ gloves and shoes on the football field. And I used to roll my eyes at all of it. I mean, all of this money being spent on pink accessories that raise “awareness” but don’t necessarily raise money for research or treatment! What a waste!

That was before I worked in healthcare.

I joined the Kentuckiana Health Collaborative four years ago as the data scientist, and as a result, I’ve learned that with appropriate screening according to clinical guidelines, certain cancers, including breast, cervical, and colorectal, can have better chances for survival or even be prevented completely. “Awareness” isn’t some fluffy idea without true impact. It can save lives.


Approximately one in eight women will develop breast cancer in her lifetime, according to the American Cancer Society. Breast cancer is the second most common newly diagnosed cancer and second leading cause of cancer death among women in the U.S. Many factors play into an individual’s odds of developing breast cancer, including genetics, diet, age, and more.

There is a special emphasis on appropriate screening and early detection of breast cancer, because when breast cancer is detected early, there are more treatment choices and better chances for survival. The five-year survival rate for women who are diagnosed at Stage 0 or Stage I cancer is nearly 100 percent, while women who aren’t diagnosed until Stage IV only have about 22 percent five-year survival rate.

Current screening guidelines dictate that women ages 50 to 74 should have a mammogram at least every two years. But screenings are recommended earlier than 50 for certain groups, such as African-American women or women with a gene mutation known as BRCA.


You’ve probably heard of the BRCA gene mutation, even if you didn’t know that that’s what it is called. Actress Angelina Jolie put the national spotlight on this mutation in 2013, when she announced that she had the BRCA gene mutation and, as a result, underwent a double mastectomy to reduce her chances of developing cancer. Approximately 1 in 500 women has the mutation, which makes them much more likely to develop breast cancer – estimates range from 55 percent to 85 percent lifetime risk for breast cancer for women with the mutation.

And these women with the BRCA gene mutation often develop cancer much earlier than the typical minimum screening age guidelines of 50 years old. Earlier this year, my dear friend, at just 33 years old, experienced a bit of pain when her kids laid on her chest. Even with no other symptoms, her healthcare provider recommended a screening, and they found a nine-centimeter tumor in her breast. She was found to have the BRCA gene mutation, and since then, two of her sisters have also tested positive for the mutation. By taking the proper steps, her sisters can drastically reduce their chances of developing breast cancer.

Breast cancer awareness month this year takes on a special meaning for our friend group, as she starts chemotherapy next week after having a double mastectomy in August. I’ve read more books and articles on cancer and chemotherapy than I ever thought I would, and much of our time is spent coordinating transportation, meals, donations, and distractions. There are lighter moments, too, spent laughing about the more outrageous aspects of cancer.

No longer do I eschew breast cancer “awareness,” now that I’m more informed about the impact that early intervention has on outcomes. This month, and in the following Octobers, count me in for awareness efforts.

Children’s Seven-County Health Initiative Serves as Model for Entire State

(Note: This guest piece was written by Ben Chandler, President and CEO, Foundation for a Healthy Kentucky)

Ben Chandler

A Foundation for a Healthy Kentucky community-driven children’s health initiative called “Investing in Kentucky’s Future” (IKF) strengthened cross-sector coalitions in seven Kentucky counties. The initiative also improved student eating habits, increased youth physical activity, trained teachers to support students experiencing trauma, and increased youth resilience. The six-year, $2.4 million initiative also led to the adoption of 38 local ordinances and policies to help sustain the improvements and promote health equity long-term.

The IKF initiative supported demonstration programs in seven Kentucky counties and was designed to reduce the risk that school-aged children will develop chronic diseases later in life. The communities contributed another $1.7 million in matching funds under the initiative, which reached nearly 13,000 students in 28 participating schools.

Unlike most philanthropic grants, the IKF initiative’s community-driven approach allowed the local coalitions to choose the topic on which they wanted to focus, and then funded a one-year planning phase during which the Foundation also provided training and technical assistance in the development of a business plan. This made the grant program more accessible to small communities with fewer resources. The Foundation also required Coalition members to attend twice-yearly trainings it provided with national and state experts in areas such as youth engagement, health equity, developing policy and influencing policymakers.

Six of the Foundation’s IKF grantees – in Breathitt, Clinton, Grant, McLean, McCracken and Perry Counties – selected childhood obesity prevention as the issue they would address through the initiative. The Jefferson County coalition focused on Adverse Childhood Experiences (ACEs) and building resilience in children who have faced trauma. Both issues are complex and influenced by a variety of biological, behavioral, social and environmental influences, so they require the cross-sector approach that coalitions can bring. Participants told the Foundation that identifying a local champion and engaging the school system were critical to success in each of the counties. But by far the most decisive factor was ensuring that the local health coalition included multiple members from a broad range of community organizations – schools, hospitals, elected officials, youth groups, and businesses. It takes more time to get everyone aligned but the resulting collaboration makes all the difference in creating long-term change to improve health.

School-based interventions were ideal for both obesity prevention and ACEs because kids spend more than 1,000 hours a year and consume up to half their daily calories at school. The Foundation has now launched a statewide school-based health coalition to share and implement some of the lessons learned in the IKF initiative; the steering committee for that coalition will begin meeting soon.

Among the IKF initiative’s successes:

  • Policy change: A total of 38 local policies were adopted by the communities at the county, city and organizational levels.
    • Policies related to childhood obesity prevention expand physical education in middle school, require future streets to be usable by walkers and cyclers as well as cars, allow school fitness equipment to be used by the community after school, and make healthier foods available in schools and park concession stands.
    • Policies that support resilience in children include requiring trauma-informed training for all Jefferson County Public Schools (JCPS) and ACEs training certification for out-of-school youth care workers and agencies that receive funding from Metro Louisville’s Office of Youth Development.
  • Built Environment: Additions including new parks, fitness equipment, sidewalks and walking paths, playgrounds, filtered drinking water fountains, community trails and standing desks in schools. Many communities leveraged the Foundation grant to secure additional funding. For example:
    • Purchase Area Health Connections-Paducah Chapter secured another $400,000 Rotary Club grant to build a playground at the health park developed with IKF funding, and then another $500,000 donation to build a second phase of the park.
    • Sidewalks to school that were built in Grant County will be included as part of a 48-mile trail system under development thanks to a follow-up grant from Interact for Health.
    • FFLAG in Grant County also worked with five elementary schools to win another grant to fund additional outdoor play equipment for students.
  • Expanded Engagement by youth, parents and members of the community in health coalitions that develop health events, farmers markets, and school-based clinics. Several coalitions incorporated youth as members or established youth councils.
  • Increased Physical Activity and Improved Nutrition for more than 90 percent of the students in participating elementary and middle schools in the counties where obesity prevention was the focus. Among the programs:
    • Many schools incorporated classroom movement activities and standing desks.
    • Many schools eliminated deep fryers in their cafeterias, installed filtered drinking water fountains, and partnered with local farmers’ markets in farm-to-school programs that brought fresh produce to students.
    • All six coalitions began or expanded student food programs over the weekends or the summers.
    • Most students reported that school was their only source for fruits and vegetables; offering produce at snack time “appears to be a successful strategy” to increase consumption, the report found.

Additional gains specific to the trauma resilience-building model program implemented by the Bounce Coalition in Louisville, included:

  • A 56 percentage-point improvement – from 30 percent to 86 percent – among participating Jefferson County Public Schools teachers and staff who felt they could be effective in supporting students who are experiencing traumatic events in their lives.
  • Improved school climate in all nine areas measured
  • Parent conferences increased 195 percent from 2014 to 2017.
  • Teacher retention improvement, from 87.8 percent in 2014 to 90.2 percent in 201

Bounce also leveraged the Foundation grant to gain support from the Kentucky Department for Public Health for gatherings with community leaders to discuss ACEs and practical strategies for building resilience and provide training for healthcare providers and other organizations to foster resilience-building practices in several neighboring communities.

A full report regarding the Foundation’s IKF initiative is available on its website. Two videos produced by the Foundation also are available: the obesity prevention video can be found here and the ACEs video can be found here.

HPV Vaccination – An important, but Neglected, Piece to Adolescent Vaccine Series

(Note: This guest piece was written by Elizabeth Holtsclaw, MA, Health Systems Manager, State & Primary Care Systems, American Cancer Society)

Remember in elementary school when one of the first assignments of the new school year was to write an essay titled: How I Spent My Summer? In the spirit of the back-to-school season and recognizing August as National Immunization Month, I’d like to share how I spent my summer: Advocating for the HPV vaccination in Kentucky.

The American Cancer Society, along with the Kentucky Department for Public Health and other stakeholders and health care systems, convened community and healthcare leaders in Paducah, Louisville, Lexington and Somerset for roundtable discussions about the need for increasing HPV vaccination in the state. These HPV roundtables not only served as networking and professional development opportunities, but also helped increase awareness of the issue, and served as a catalyst for best practice sharing and idea generation on ways to close the HPV immunization disparity gap. We’ve challenged each region to develop their own SMART goals that will work in their area to increase HPV vaccination.

And that disparity gap? It’s significant. But first, a little about the vaccine.

HPV vaccination is cancer prevention

The Human Papillomavirus (HPV) is a very common virus that can lead to cancer-causing infections. In fact, every year 33,000 people are diagnosed with HPV cancers. The HPV vaccine prevents six types of cancer – cancers of the cervix, throat, anus, penis, vagina and vulva – and is expected to prevent 90% of HPV-related cancers when given before a child is exposed to the virus. 

The two-shot HPV vaccine series is best given to boys and girls at ages 11 or 12, which is generally before they are exposed to the virus and when their immune systems can provide the most protection. That’s also the age when parents are usually taking adolescents in for their meningococcal and Tdap (Tetanus, Diphtheria and Pertussis) vaccinations, so getting Kentucky adolescents vaccinated against HPV should be simple, right?

So there’s a vaccination that can prevent cancer, but people aren’t getting it

The CDC recently released its latest report from the National Immunization Service-teen (NIS-teen) survey, a national survey which gathers information on vaccination rates of 13-17 year olds in the US. You can find the report in the Morbidity and Mortality Weekly Review. The report shows that the rate of 13 to 17-year-olds with one dose of the HPV vaccine increased slightly, from 65.5% in 2017 to 68.1% in 2018, and the rate for series completion increased from 48.6% to 51.1%. However, these increases were only seen in males.

And here’s the thing about that disparity in Kentucky: Kentucky falls below the national average on HPV vaccination. We know that adolescents are getting their other vaccines (Tdap at 84.9% and meningococcal at 84.4%) but not getting the HPV vaccine (first dose of HPV is 56.9% and up-to-date vaccination is 42.6%. You can view this in the MMWR supplemental table.

Here’s a snapshot:

  • According to the Kentucky Cancer Registry, Kentucky has the highest HPV-related cancer burden in the nation
  • The Centers for Disease Control (CDC) National Immunization Survey indicates that Kentucky is 49th in the nation for HPV vaccination
  • Only 42.6% of Kentucky adolescents are up to date on completing the HPV two-shot series, which is below the national average of 51.1% (68.1% of adolescents age 13-17 have received the first dose of the series)

Why the gap?

Reasons for the vaccination gap vary, depending on a multiple factors – parents feel their child isn’t sexually active yet at age 11 or 12 and are not in need of the vaccine, or they aren’t aware of the vaccine at all – but research tells the biggest factor that leads to parents getting their children vaccinated is simply the clinician recommending it. The MMWR data referenced above emphasized the importance of a provider recommendation as HPV vaccination rates for adolescents whose parents reported receiving a provider recommendation were 28 percentage points higher than those who did not.

That’s right: Parents receiving the physician or nurse practitioner’s recommendation of the vaccine – on the same day and in the same way as other vaccines – were more likely to make sure their children were vaccinated. In fact, studies show parents value the HPV vaccine equally with other vaccines … they just need to hear the endorsement of the provider as a prompt to action. Parents need to know that the vaccine is cancer prevention, but they also want reassurances that the vaccine is safe, effective and lasts.

That seems simple enough, right?

Of course clinicians may not be comfortable recommending the vaccine if they have questions of their own, and the HPV Roundtable discussions have shown that even some healthcare providers feel like they need more information about the vaccine. More information about HPV, the vaccine, and guides for healthcare providers can be resourced at cancer.org/hpv.

And I also encourage parents or members of the community who have questions or concerns to visit cancer.org/hpv and get the facts. As a parent, I have one more task on my to-do list this summer: to get my 11-year-old son his HPV vaccination this week, along with his other adolescent vaccines. And I can assure you his passionate mom will be taking photos of him the whole time. These pictures will join the ones I have shared on social media of my 13-year-old daughter who completed the two-shot series, to show Kentucky that I want to protect all of Kentucky’s children as I have my children.

Here’s what you can do

The data is clear that a strong provider recommendation is the key to a successful increase in HPV vaccination rates.

  • Bundle your adolescent vaccine recommendation “Your child is here today for three vaccines. These will help protect her from meningitis, HPV cancers and pertussis.”
  • Engage all office staff in your commitment to increasing HPV vaccines in the office.
  • Let’s be creative in engaging diverse provider groups in this work; Pediatricians, family practice doctors, OB-GYN, dentists, orthodontists, school districts and communities.
  • There are ways to talk to parents, such as motivational interviewing or a presumptive recommendation, that are proven to help them feel comfortable in vaccinating their children.
  • Know your own data! What is our state data? Your county and school system data? Your clinic data as a whole and the individual provider data? Because HPV is not a mandated vaccine, it’s not always a priority for reporting and data collection. We often THINK we are doing better than what’s really happening.
  • Engage in our regional Roundtables and within your networks to make HPV vaccination a priority. Contact me at elizabeth.holtsclaw@cancer.org to find out more.

The opportunity we can’t miss

We have an opportunity in Kentucky and the rest of the nation to see almost immediate reduction in adverse health outcomes related to the HPV virus. Very rarely in public health are we able to see such immediate and dramatic improvements such as is being seen in areas with high vaccination rates. It’s incredibly exciting and I welcome the energy we’ve seen across the state this summer.

As summer winds down, the American Cancer Society plans to keep the conversation about HPV vaccination going, as well as continue the momentum the Roundtables have begun. Additional Roundtables are scheduled for Hazard, Bowling Green and Morehead with other activities in London and Prestonsburg in the coming months. There is an energy and excitement in each of these communities and we sincerely hope it will translate to a healthier future for Kentucky.

Together – as a community, as parents, as healthcare providers – we can truly make this a summer to be remembered in the fight against cancer.

Mental Health Month a Time to Focus on the Connection between Physical and Mental Health

(Note: This guest piece was written by Marcie Timmerman, Executive Director of Mental Health America of Kentucky)

Marcie Timmerman
Executive Director
Mental Health America of Kentucky

Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable. So much of what we do physically impacts us mentally. It is important to pay attention to both your physical health and your mental health, which can help you achieve overall wellness and set you on a path to recovery.

Did you know that Mental Health America (MHA) founded May as Mental Health Month back in 1949? That means this year marks MHA’s 70th year celebrating Mental Health Month! This May, Mental Health America of Kentucky is expanding its focus from 2018 and raising awareness about the connection between physical health and mental health, through the theme #4Mind4Body. We are exploring the topics of animal companionship, spirituality and religion, humor, work-life balance, and recreation and social connections as ways to boost mental health and general wellness.

A healthy lifestyle can help to prevent the onset or worsening of mental health conditions, as well as chronic conditions like heart disease, diabetes, and obesity. It can also help people recover from these conditions. For those dealing with a chronic health condition and the people who care for them, it can be especially important to focus on mental health. When dealing with dueling diagnoses, focusing on both physical and mental health concerns can be daunting but critically important in achieving overall wellness.

There are things you can do that may help. Finding a reason to laugh, going for a walk with a friend, meditating, playing with a pet, or working from home once a week can go a long way in making you both physically and mentally healthy. The company of animals – whether as pets or service animals – can have a profound impact on a person’s quality of life and ability to recover from illnesses. A pet can be a source of comfort and can help us to live mentally healthier lives. And whether you go to church, meditate daily, or simply find time to enjoy that cup of tea each morning while checking in with yourself– it can be important to connect with your spiritual side in order to find that mind-body connection.

Mental illnesses are real, and recovery is always the goal. Living a healthy lifestyle may not be easy but can be achieved by gradually making small changes and building on those successes. Finding the balance between work and play, the ups and downs of life, physical health, and mental health, can help you on the path towards focusing both #4Mind4Body.

Everyone has mental health. Isn’t it time we start taking care of it?

Concerned about yourself or someone you love? Take a free online mental health screening here.

Recent Studies Reveal Variation in Price and Quality Among Kentucky’s Hospitals

New Hospital Safety Grade state rankings by the nonprofit The Leapfrog Group shows Kentucky ranks 33rd in overall hospital safety, holding that spot for the second time in a row. This, when paired with the new study released last week by RAND Corp., reiterates that hospitals in the Commonwealth vary in both price and quality.

In the Spring 2019 Hospital Safety Grade rankings, Kentucky’s share of “A” hospitals was just 21%, down from nearly 24% in the Fall 2018 rankings. Leapfrog uses an easy-to-digest A-F grading scale, with “A” being the best. Nearly 70% of Kentucky’s 52 hospitals received a “C” or below rating, compared to the nationwide average of 43%. A new study released by The Leapfrog Group along with the state rankings showed that avoidable deaths due to errors, accidents, injuries, and infections have an 88% greater risk at “C” hospitals and 92% greater risk at “D” and “F” hospitals.


In addition to the Leapfrog safety rankings, Kentucky was one of 25 states that was included in last week’s RAND hospital price transparency report, which for the first time used actual payments by privately insured employers to report inpatient and outpatient prices by hospital. The report shows prices as a percent of what Medicare paid for the same services, thus making these relative prices comparable across the country. The study has been a hot news item in the healthcare world, featured in publications such as The New York Times, The Wall Street Journal, and Forbes.

Kentucky ranks fourth lowest in price of the 25 states in the RAND hospital price transparency study.

Overall, Kentucky came out favorably for its relative pricing to Medicare for private insurance in the report, well under the national average of the states in the study. Of the 25 states included in the data, Kentucky ranked fourth lowest in prices paid to hospitals, at 186% of Medicare compared to the national average of 241%. Similar to what the report illuminates nationally, there is large variation in price – inpatient, outpatient, and overall – among Kentucky’s facilities.

The RAND study looked at the CMS Hospital Compare five-star rating to highlight variation on quality, and that system illuminated similar trends as Leapfrog’s new results. Looking at the CMS ratings, which, like Leapfrog, puts hospitals into five levels of performance, more of Kentucky’s facilities named in the RAND study have poor to average ratings compared to the nation as a whole – 84% compared to the nation’s 51%. This means that just 16% of Kentucky’s hospitals are considered above average or excellent by CMS Hospital Compare.


These variations in price and quality in Kentucky’s hospitals will be the focus of the Kentuckiana Health Collaborative’s June 4 Community Health Forum, which will bring in the RAND study’s leaders to dive into the results and what this means for Kentucky.

Gloria Sachdev, President and CEO for Employers’ Forum of Indiana, which partnered with RAND on the study, will walk through the study results, focusing on Kentuckiana and Kentucky’s hospital prices and how they compare to the rest of the nation. We will also hear from an employer, Indiana University, that was part of that first-year study in Indiana to discuss how seeing hospital pricing information has impacted their benefit strategy.

Although hospital pricing is important to all stakeholders, this event will be particularly relevant to those interested in employee health benefits, health plan design, and provider payment. RAND is now recruiting more participants for the next iteration of the study, so any employer or health plan that is interested in participating is encouraged to attend and for more information on what is involved.

Register today to join the conversation at the UofL Shelby Campus Founders Union Building. As with most KHC Community Health Forums, attendance is free for KHC members and $35 for non-members, which includes the program, networking, and breakfast. If you are unsure if your organization is a member of the KHC, see the full list here.

Action items to address healthcare affordability in the region identified at Community Health Forum

It’s no secret that we have a problem with healthcare affordability in this country. Each day, there are new headlines that highlight this problem. We are all familiar with these headlines. But what do we do about it?

That’s exactly what we addressed in last week’s Community Health Forum, “The Path to Affordable Healthcare.” In a different format from our typical Community Health Forum, which lasts a couple of hours, “The Path to Affordable Healthcare” was extended to a half-day event and included an interactive portion, where participants worked in groups to create action items to tackle healthcare affordability in the region.


In the first half of the day, participants listened to several speakers and panelists discuss the lack of agreement on an affordability definition, the current state of healthcare affordability in the nation and region, the drivers of healthcare affordability, the role of regional collaboration, and the barriers that keep us from achieving affordable healthcare.

There was much interesting information given and discussion had in first half of the day, including three speaker presentations and a panel loaded with healthcare experts from across the Commonwealth (see agenda here). But the highlight of the day was the creation of action items by event participants designed to help develop a community action plan to address healthcare affordability in our community.

“For me the event just reconfirmed how pivotal the KHC is to the region. Having healthcare stakeholders (purchasers, payers, hospitals, and so on) all working to together to understand each other’s needs is the only way we are going to get true change to a fragmented system. Everyone will win when our healthcare systems provide quality care, access to care at an affordable cost. Alone we can accomplish nothing. Working together we can gain everything.” -DeAnna Hall, Manager Corporate Health & Wellness, LG&E KU

Working in groups, participants brainstormed and defined goals to prioritize and improve healthcare affordability as it relates to health, price, and waste – the drivers of healthcare affordability. The action items were not limited to what the KHC could accomplish, but for the community as a whole. Given the range of viewpoints in the room, the task became an energetic exercise. Ten ideas were identified and discussed with the larger group, and participants then identified and voted on their top three selections.

The action items were outlined, in descending order of votes:

1. Create a state-wide data warehouse with claims, electronic health records, and public health data to map price and quality variation. The warehouse will be led by the state and the KHC and the data will be used to partner with the next iteration of the RAND hospital price transparency study.

2. Create a statewide collaboration to identify the top three costly chronic conditions that have a gap in care and work to close gaps through payment innovation, patient education, aligned cost and quality measures, and care coordination.

3. Participate in a self-insured transparency study for Kentucky with the current iteration of the RAND hospital price transparency study and use the results of the study in next year’s contract negotiations.

4. Conduct a three-year pilot to create a workflow redesign to integrate social determinants of health, physical health, and mental health into a quality patient care management plan in Louisville Metro.

5. Create a knowledge transfer center for employers and health plans to define health transparency and value-based purchasing, to be operated by the KHC.

6. Promote competition and consumerism to drive affordability through legislation. Educate legislators on price transparency.

7. Promote healthcare transparency and affordability across all parties by removing data barriers.

8. Improve patient engagement with health coaches or community health workers, with a focus on preventive screening in rural areas of Kentucky.

9. Create a defined pathway for musculoskeletal outcomes pricing with reduction in imaging for low back pain. Each year, focus on specific employers.

10. Educate consumers, employers, students, etc., on healthcare benefit literacy.

“Active engagement, interaction, and partnership among government, payors, employers, and providers is essential to solving the dilemma of healthcare affordability in Kentucky. While we all share a common objective to provide high quality care to the citizens of the Commonwealth, we need to start four-way conversations to listen and understand perspectives and challenges and then use this information to create productive solutions. In our workgroup I believe each member learned something new about another’s perspective. As a first-time participant I look forward to opportunities for further engagement to offer a providers perspective and contribute to real problem solving.” -David Zimba, Managing Director, Kentucky Health Collaborative, and event panelist


There is a clear want and need for better data around cost and quality in the Commonwealth. As the KHC data scientist, this is what I like to hear! It is impossible for any stakeholder – consumer, provider, plan, or other – to make informed and appropriate choices with large gaps in information. Transparency is key to healthcare affordability, as it provides insights and identifies problems. There was also a lot of talk around minimizing wasteful treatments and procedures that provide little or no benefit.

Many potential ideas were created at “The Path to Affordable Healthcare,” and the next step is to identify which can be and should be acted upon in the community. This event was held in partnership with the Network for Regional Healthcare Improvement (NRHI) to bring healthcare affordability to the forefront of healthcare transformation efforts through a campaign called Affordable Care Together. As part of that campaign, the KHC is required to create an action plan by January 15.

The KHC will take these action items back to its leadership team to determine which are appropriate for our organization to pursue. Look for more updates in the near future.

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

KHC Joins Coalitions Across the Country to Address Healthcare Affordability

Kentucky, like the rest of the United States, has a problem. Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result. We pay too much for care and it is causing financial, emotional, and clinical harm to individuals, businesses, and communities.

The current situation is unsustainable; harder choices are coming. There are proven approaches to make headway, but we have to work together to achieve success. We can’t blame the current state of affordability on any individual group of people. We all created the situation. It will take all of us working together to solve it.

Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result.

The KHC has long been a trusted partner in reporting healthcare quality performance data. But you can’t address quality without also looking at value. Solving one issue in isolation does not achieve the healthcare affordability goal. Healthier populations use fewer healthcare resources. Healthier populations create more productive communities. Unnecessary services are causing clinical, emotional, and financial harm. Administrative waste is a financial burden on patients and providers while also burning out providers.

To begin the conversation locally around healthcare affordability, the KHC has joined the Network for Regional Healthcare Improvement (NRHI) and other regional coalitions across the country to bring healthcare affordability to the forefront of healthcare transformation efforts. The movement is focused on health, price, and waste — the three drivers of affordable healthcare. In joining this effort, NRHI and its coalitions like KHC will leverage their collective strengths on efforts to improve affordability while preserving and improving quality. In addition, partnering with other national entities committed to solving the healthcare affordability problem will strengthen the effectiveness and reach of these efforts.

The campaign, called Affordable Care Together, is an approach that puts communities at the center of the solution; the movement is led by neutral, non-profit conveners who build on existing, multi-stakeholder efforts to improve health, reduce price, eliminate waste, and collectively create greater awareness and solutions.

As part of Affordable Care Together, myself and KHC leaders Teresa Couts, Randa Deaton, Emily Beauregard, Don Lovasz, and Amanda Elder will join leaders from every segment of the U.S. healthcare system at the Ronald Reagan Building in Washington, D.C. for a day-long summit next week, addressing our country’s healthcare affordability crisis. We will bring back the lessons and ideas that we learn and put them to use, hosting a Community Health Forum in December called “The Path to Affordable Healthcare.” The half-day event will bring together key healthcare stakeholders and like-minded local change agents, who will help develop a community action plan to address healthcare affordability in our community.

Look in coming weeks for more content on healthcare affordability, including reflections from the summit in Washington, D.C. There are ways we can work together to change the system and make it sustainable for current and future generations. By working together, we can make a difference.

 Learn more about Affordable Care Together

Variety of Viewpoints Makes for Engaging, Motivating Bost Forum

The opioid crisis in Kentucky, and across the country, continues to be a hot topic in healthcare. For the second straight year, the Howard L. Bost Memorial Health Policy Forum, convened by the Foundation for a Healthy Kentucky, chose substance use (with a heavy emphasis on opioid use) as the theme for the day.

While some might expect a day devoted to yet more discussion around substance use in the Commonwealth to be full of familiar, tired conversations, the Bost Forum was anything but. All of the KHC’s staff members attended the forum, and each of us left chattering excitedly about the speakers that left us inspired, motivated, fired up, and more.

For each of us, different speakers provided a spark or connection. As a reflection on the day, each member of the KHC shared something that stuck with them about a particular speaker. Read KHC staff reflections in their own words below.


Keynote Speaker Barry Meier

Randa Deaton – Co-Executive Director

Over 200,000 Americans have died from overdoses related to prescription opioids from 1999-2016. This year’s Bost keynote speaker, Barry Meier, is the award-winning reporter whose special report in the New York Times created national interest in OxyContin. His 2003 book, “Pain Killer,” exposed the rise of the billion dollar pain management industry excesses and abuses, and he felt confident his reporting efforts would help solve America’s opioid crisis. Fifteen years later, the alarm bells are only now ringing within the government, and he has released an updated version of his book. His passion for holding the organizations accountable for this public health crisis could be felt through the room. More importantly, he conveyed the tragedy in waiting for the alarm bells to go off after 200,000 Americans have already died. The key takeaway was for those in public health to get in front of these dangerous public health trends to avoid this type of crisis in the future.


Breakout Discussion panelists: Alternatives to Opioids

Michele Ganote – Event and Communications Coordinator

There are many alternatives to opioids, with the obvious being over-the-counter pain relievers such as Tylenol and Advil. Each panelist discussed the many other options available for dealing with and treating chronic pain and how important it is to focus on the “why” of the pain and not just mask the pain with medication. I often hear about deep breathing or meditation for stress and anxiety, but before yesterday I hadn’t thought much about it for pain and recovery. Dr. Mel Pohl, CMO for the Las Vegas Recovery Center, suggested we all meditate daily. Meditation or mindfulness is commonly used in recovery at the Las Vegas Recovery Center. I found Danesh Mazloomdoost, MD, Wellward Regenerative Medicine, to be passionate about his work with “regenerative medicine,” a new medical field that studies how the body heals and how science can enhance this process. I look forward to reading his book, “50 Shades of Pain.” Other alternatives to opioids for patients living with chronic pain were physical therapy, massage, acupuncture, cognitive behavioral therapy (CBT), avoiding alcohol, eating healthy, keeping a positive attitude, distracting yourself from pain, and planning for a bright future.


KET Series on Addiction (Presented by host Renee Shaw)

Teresa Couts – Co-Executive Director

Shortly after lunch, Renee Shaw, KET, presented a video from the KET Series on Addiction. The video featured Butler High School in Louisville, KY, which has implemented the national program Sources of Strength. The mission is to provide the highest quality evidence-based prevention programs for suicide, violence, bullying and substance abuse by training, supporting, and empowering both peer leaders and caring adults to impact their world through the power of connection, hope, help, and strength. A group of students at Butler High School are training to save lives and improve the mental health of their fellow classmates. Butler health teacher Mary Wurst brought the group together after some of the students came to her for advice or guidance during their own struggles. Now, these students are using their experiences to give back to their classmates who might be in need. Butler is among the first Jefferson County Public Schools to help identify and support students who may be struggling. One student stated that “so many people are still alive because of this program and because of the coping mechanisms we’ve learned.”


Nancy Hale, Operation UNITE (part of the panel on Kentucky’s Addiction Burden)

Natalie Middaugh – Project Coordinator

The morning panel at the Howard L. Bost Memorial Health Policy Forum convened representatives with diverse perspectives to explore Kentucky’s addiction burden. A highlight of these perspectives was from Nancy Hale, President/CEO of Operation UNITE. Operation UNITE is a nonprofit organization serving 32 counties in eastern and southern Kentucky that utilizes a collaborative model to prevent substance abuse and facilitate recovery. It is difficult to find a conversation focused on addressing the substance and opioid use epidemic that does not emphasize the necessity of strategic partnerships. Operation UNITE is a long-standing and successful example of how these strategic partnerships can affect meaningful change.


Alex Elswick, Voices of Hope (part of the panel on Kentucky’s Addiction Burden)

Stephanie Clouser – Data Scientist

Alex Elswick, Co-Founder of the non-profit organization Voices of Hope, talked about the recovery process for substance use disorder and the importance of supporting people in recovery. Alex, himself a person in long-term recovery, said that we need to give more than lip-service to those in recovery. Everyone loves a great comeback story, but we need to support those who are actively going through treatment as well. Alex is “not in recovery because I pulled myself up by my bootstraps,” but because he had access to the resources he needed to get better, and we need to support individuals by addressing the barriers to those resources.

PRESS RELEASE: High School students examine mental health stigma in KY teens

Findings: Adult, peer views on mental health contribute to stigma

Press Release by Hayley Kappes, University of Louisville

LOUISVILLE, KY September 6, 2018 – Parents who refuse to take their children to therapy because they don’t believe in mental health treatment. School counselors who have told students to stop crying because they’re “fine.” Teens further ashamed of mental illness because of negative portrayals in the media. These are some of the experiences that a high school student group, mentored by a University of Louisville clinical psychologist, has gathered from peers across Kentucky during yearlong research into factors that contribute to mental health stigma in teens.

Allison Tu

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, will present findings during the Kentuckiana Health Collaborative Community Forum on Tuesday, Sept. 11, from 8 to 10 a.m. at the UofL Clinical and Translational Research Building, 505 S. Hancock St. After the forum, a Question. Persuade. Refer. (QPR) Suicide Prevention Training by the Louisville Health Advisory Board will take place.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action (StAMINA) and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Stephen O’Connor, PhD

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

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