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Texas Health Community Impact

Texas Health Community Impact brings together agencies from different sectors – education, healthcare and government – plus grassroots organizations and others to make measurable change in communities where social determinants contribute to poor overall health. Our investments are designed to improve the health of the most vulnerable and underserved in our community. These efforts are currently focused on connecting people to appropriate resources that help address behavioral health and food insecurity, which the pandemic exacerbated.

Based on learnings from our first two years of grantmaking, many community agencies – particularly in rural areas – do not have the resources to enhance or implement much-needed programs. In response, we began soliciting additional funding sources to help set these organizations up for success. The Community Foundation of Texas granted $1.5 million to build capacity in high-need areas to help agencies deliver interventions.

2021 Highlights

• Awarded $5.2 million in grants to 12 community-based organizations across multiple counties. Programs are underway and impacts will be shared in spring 2023. Grants are enabling:
  • The expansion of the THRIVE program (Together Harnessing Resources to give Individuals Voice and Empowerment) to nine additional schools and community centers. THRIVE received international attention for its unique approach to providing food, resiliency training, job skills and support to low-income students and families. As a finalist for the United Way of Metro Dallas’ Health Innovation Technology Challenge, Texas Health received $25,000 to further its impact.
  • Center of Hope to increase access to mental health services, financial and food assistance, career development and adult education programs for people in need.
  • The Erath County Community Bridges program seeks to reduce depression and anxiety, increase access to healthy food, and enhance resource navigation services in high-needs areas. Through the American Hospital Association’s Hospital Community Collaborative, Texas Health and program leaders participated in a six-month learning program to accelerate health equity.
• Shared insights on building sustainable, collaborative relationships with state service agencies and foundation leaders after the success of our Community Impact grants. For example, we showcased our Well Together initiative, which provides access to behavioral health and primary care services, to help Philanthropy Southwest determine the best grantmaking strategies to address issues experienced by Latinx communities. We are also sharing best practices with philanthropic organizations to make health equity a priority and broaden our impact.
• Enabled grant recipients to shift their strategies to respond to pressing needs caused by the pandemic, such as housing instability, unemployment and food insecurity.

Snapshot: Recognized for Excellence in Community Service

Texas Health received the prestigious 2022 Foster G. McGaw Prize for Excellence in Community Service, an esteemed honor bestowed upon healthcare systems that distinguish themselves as a model in community health improvement. We were honored for our exemplary commitment to establishing and facilitating programs that improve the overall health and well-being of the communities we serve.

"We are honored to be recognized by the American Hospital Association," said Barclay Berdan, CEO. "We believe that building healthy communities requires working with community organizations, responding to health disparities, eliminating root causes of chronic disease and providing tools that instill lifelong health and well-being for all North Texans."

As the winner, Texas Health will receive $100,000 to use toward programs that further these goals.

Snapshot: Railroad Project Helps Put East Fort Worth Residents on the Right Track

Janelle Gonzales longed for a better future but often felt held back by her past. By age 13, she had tried marijuana, alcohol and cocaine. By 15, she'd given birth to a son, followed by a second son the next year. But after two stints in prison for drug convictions, Gonzales was determined to make a fresh start and, in 2021, moved to a transitional home in Fort Worth.

But she wouldn't be on her own. What began as a volunteer job — a requirement of her transitional home at Eastside Ministries in east Fort Worth — led Gonzales to a new support group that has provided her services and a job. Under the Railroad project, a program supported by a Texas Health Community Health Impact grant, Gonzales has not only received services, but is serving others by working as a translator for the project's Spanish-speaking clients.

"Working here in this environment and helping people has helped me grow into the woman I know I'm supposed to become," Gonzales said.

She and other participants receive food, clothing, counseling, physical fitness classes, finance classes, and mental health services to increase their self-efficacy. The Railroad project also hosts mobile events, where visitors receive nonperishable items, produce and meat. They also can access mental health counselors.

Thanks to the grant, the agency now serves triple the number of people a month – about 2,500 people. Almost 27% of the people in this ZIP code live below the poverty level.

Wellness for Life Mobile Health Program

Texas Health's Wellness for Life™ mobile health units have delivered essential healthcare services at churches, schools, grocery stores, community centers and public parks to reach medically underserved communities for more than 27 years. Our long-term presence in these neighborhoods has given staff insight into cultural barriers that commonly impede care delivery.

Our team of family nurse practitioners, registered nurses, community health workers and mammography technologists provides prevention and early detection services, teaches evidence-based practices and delivers COVID-19 vaccinations in collaboration with community-based health clinics and organizations.

Culturally and ethnically diverse program staff are essential to creating a welcoming environment and making long-term lifestyle changes possible. By fostering trusting relationships, they put individuals at ease and provide services where they are needed most.

One mobile health patient said it best: "Thanks to you, I can have day-to-day tranquility in my life so that I can focus on offering the best of me to my family."

2021 Highlights

Our mobile health program improved access to care by delivering healthcare services to 1,867 community members. Of those served, 88.8% reported a high satisfaction score. Services included:

• Administering 10,878 COVID-19 vaccine doses.
• Conducting 1,772 screening mammograms, reaching 98.4% of females eligible for them. Of those who had an abnormal result, 74.5% visited a Texas Health facility for a diagnostic procedure.
• Completing 177 cervical exams, reaching 86.7% of females eligible for them.
• Distributing 68 colon cancer screening kits, reaching 74.7% of eligible adults.

Snapshot: Bringing COVID-19 Education, Vaccines and Resources to Underserved Communities

National data affirms that ethnic minorities and people living in underserved communities are at higher risk of hospitalization and death from COVID-19. Texas Health is actively working to dispel misinformation and bring vaccines directly to where these individuals live, work, play and pray to reduce these disparities.

Our Dallas-Fort Worth COVID-19 Prevalence Study provided insight into the need for a targeted awareness and vaccination plan in the ZIP codes of highest needs, which Texas Health identified through its 2019 Community Health Needs Assessment. This strategy includes:

• Administering vaccines where they are needed most: To reach people who may lack transportation, we launched a community mobile vaccine program to bring life-saving vaccines to them at pop-up clinics.
• Engaging and educating at-risk individuals: Leveraging the relationships and trust that our mobile health, Faith Community Nursing and Community Health Ministry teams have built over the years, we deliver culturally and linguistically appropriate information about the virus to communities. We promote pop-up clinics and debunk myths about the virus and vaccines using in-person discussions, mobile health units and targeted social media campaigns.
• Creating free educational and awareness resources in multiple languages for community leaders and influence organizations to share: These materials address common fears and myths about the vaccine, explain how the different types of vaccines work and give tips on supporting one's community.

Thanks to a $1 million grant provided by Communities Foundation of Texas' W.W. Caruth, Jr. Fund, Texas Health scaled-up community vaccination efforts in a mix of urban, suburban and rural settings, focusing on Erath, Johnson, Kaufman and Tarrant counties. The Health Resources and Services Administration also granted nearly $1 million for Texas Health and local universities to create and deploy a vaccine education plan to broaden our impact. Students are designing and implementing culturally appropriate outreach and education strategies to engage vulnerable and vaccine-hesitant communities.

In 2021, Texas Health collaborated with 74 community-based organizations to host 210 community vaccination clinics across 34 unique ZIP codes, administering 10,878 vaccine doses to 6,013 individuals. We also launched a pandemic digital awareness campaign that reached over 1.2 million consumers and received 10,700 engagements.

Faith Community Nursing and Health Promotion

Texas Health's Faith Community Nursing and Health Promotion program provides education, resources and tools to equip faith community nurses (FCNs) and health promoters (HPs) to lead health ministries and care for the community through faith settings.

FCNs assist members with maintaining or regaining wholeness in body, mind and spirit by bringing together the clinical and spiritual aspects of healing. HPs are nonclinical professionals who help develop and implement health-related programs that meet a congregation's unique needs. They bring essential care and support to high-risk communities, from conducting health screenings, delivering flu and COVID-19 vaccinations to hosting educational events on mental health, diabetes, Alzheimer's and more.

2021 Highlights

• Engaged and supported members of 106 North Texas faith communities, reaching 131,322 people. Of those reached, 55,101 individuals gained access to services to prevent chronic disease, manage behavioral health and improve health literacy and navigation services to address health disparities. This effort avoided healthcare costs of $1.75 million.
• Shared education and resources at 3,464 events, providing 72,519 people with information and support for behavioral health, health literacy and navigation; health screenings; vaccinations; chronic disease management; social determinants of health and more.
• Administered 5,180 flu vaccines at 77 community, faith-based and school clinics with the help of students from seven nursing schools. FCNs also met with eight local organizations to provide COVID-19 education to encourage vaccination for 400 employees.

Snapshot: Tackling Vaccine Hesitancy

While Texas Health provided COVID-19 information, treatment and vaccinations, it leveraged its FCNs and HPs to tackle another critical challenge: vaccine hesitancy.

Through listening to our FCNs and HPs at roughly 106 faith communities in North Texas, our FCN program managers were informed about COVID-19 vaccine skepticism among predominantly Black and Hispanic congregations. In response, they proactively distributed vaccine information to FCNs and HPs, who then shared it with congregants.

Having local health and faith leaders validate vaccine information and dispel misinformation has been critical to getting more people vaccinated. FCNs and HPs understand their community's unique health needs and have established credibility and trust. This is a key reason why Texas Health is expanding work with faith communities through its Community Health Ministry strategy.

Snapshot: Combining Food and Vaccine Delivery to Address Critical Needs

More food pantries have been set up in North Texas to alleviate food insecurity among the working poor. In many cases, they operate after business hours to ensure people can pick up groceries after work.

Texas Health supports three food pantries that serve high numbers of non-documented or migrant workers who do not have access to healthcare and possess a limited understanding of English. To reach more people in need of food or flu vaccines, we sent nursing students and volunteer nurses to vaccinate individuals while they waited in their cars for food.

These virus protections and nourishment have assisted hundreds. One woman who cleaned businesses at night to keep a roof over her head relied solely on the food pantry for food. She agreed to get vaccinated against the flu due to our willingness to connect with her at a convenient time and place.

Another woman brought groups of people in her van to get their food and some requested to get vaccinated. They could not leave their jobs to get this protection and were thrilled we offered both food and vaccines at the pantry. Meeting people where they are and speaking to them in their language has been vital to the success of this effort.

Community Health Ministry

Texas Health is building upon the foundation of relationships created by our Community Engagement and Advocacy teams and scaling our partnerships with faith communities to reduce health disparities in North Texas. We are aligning health improvement activities and services provided to and through faith communities and exploring program innovations that will equip faith communities to be force multipliers for wellness. Our next steps are to:

• Coordinate efforts with faith-based communities across Texas Health, focusing on priority ZIP codes identified by our Community Health Needs Assessment to strengthen our impact on improving community health.
• Create a mechanism that organizes, connects and equips faith communities through one central engagement point.
• Strategically focus community engagement activities on supporting Community Health Ministry projects.

Health to Home

Until recently, Dallas was among only a few major U.S. cities without a medical respite program to serve homeless individuals in need of complex medical care, making it difficult to become self-sufficient and have stable housing. On average, providing reactive services and resources for these individuals costs the state $40,000 to $80,000 annually, per person, which doesn’t include expenses associated with emergency department and hospital visits.

To support men experiencing homelessness with acute medical and behavioral health needs, Texas Health Presbyterian Hospital Dallas collaborates with Austin Street Center, a local homeless shelter, and other leading community experts to pilot a medical respite program called Health to Home. The program provides individualized medical, behavioral health and wraparound social services, which stabilized 60 men over 18 months. These services help heal and shelter our neighbors at an estimated cost of $16,750 to deliver, considerably less than reactive services.

Healthy Education and Lifestyles Program (HELP)

HELP treats underserved and uninsured individuals with diabetes, hypertension, congestive heart failure and high cholesterol to improve health outcomes while reducing costs. Participants meet individually with a practitioner and complete, review and discuss important lab tests. To improve health literacy and outcomes, we provide health education to help participants take an active role in their health.

2021 Highlights

• Provided education on COVID-19, clinical care and chronic disease management to 987 individuals through phone consultations and in-person visits. The program provided much-needed support to people experiencing job and insurance loss, and enabled:
  • 57.8% of hypertensive participants to maintain blood pressure under 140/90.
  • 61.8% of diabetic participants to maintain an A1c level of under 9.1.
  • 63.4% of diabetic participants to maintain blood pressure under 140/90.

Sexual Assault Nurse Examiner (SANE) Program

Each year, more than 2,700 individuals seek care at a North Texas hospital after being sexually assaulted. Our SANE program offers private forensic examination suites and trained, compassionate nurses who collect forensic evidence to aid in the prosecution of perpetrators. We also provide in-person and virtual education, training and professional development services related to sexual assault and abuse.

2021 Highlights

Cared for 776 sexual assault victims and educated 2,672 community members. This effort entailed:

• Affiliating with Tarrant County College to engage 419 students and cultivate a community resilience program.
• Delivering 58 sexual violence prevention training programs for 1,477 community stakeholders, including Fort Worth emergency medical services and fire departments.
• Collaborating with Child Advocacy of North Texas to provide emergency sexual assault medical forensic exams with evidence collection to the pediatric population of Denton County. This required that four additional staff become pediatric SANE certified.
• Assisting Denton and Johnson county officials with building sexual assault response teams.

Snapshot Stopping Sexual Assault Before it Starts

More than 6 million adult Texans have experienced sexual assault in their lifetime — and sexual violence is greatly underreported. The state spends more than $8 billion each year addressing sexual assault and sexual violence.

To help prevent sexual assault from occurring – especially on college campuses – Texas Health and Tarrant County College (TCC) forged an agreement to address sexual victimization by cultivating community resilience.

"With 13% of all college students subjected to sexual violence during their college experience, the entire community must be informed and empowered to combat sexual violence," said Cindy Burnette, D.N.P., R.N. She directs Texas Health's SANE program.

Texas Health educates TCC students on sexual assault awareness, including healthy relationships, cyber safety, dating violence, bystander intervention, consent, and human trafficking. Under the Campus Sexual Violence Elimination Act, students must receive sexual violence prevention education. Program goals are to:

• Increase the community’s knowledge around sexual violence and letting victims know it’s not their fault.
• Create a culture that encourages and supports sexual assault reporting.
• Reduce the number of sexual assaults on the TCC campus and in North Texas.

"We want to make our communities healthier and safer," Burnette said. "When we're able to educate, empower and increase the emotional health of the community, a lesser amount of our services will be needed. That's a collective goal worth striving to achieve."

YES Dallas Initiative

The U.S. Department of Health and Human Services Office on Women's Health awarded an $800,000 grant for Texas Health to implement the Federal Youth Engagement in Sports (YES) initiative. The program is designed to improve physical activity and eliminate barriers to play for racial and ethnic minorities and socioeconomically disadvantaged youth in the sixth, seventh and eighth grades in Dallas County.

Students meet weekly to participate in yoga, boxing, taekwondo, volleyball, basketball, swimming, and strength and conditioning. They also join chefs for virtual and in-person cooking demonstrations to make easy, healthy meals.

In addition, the program exposes high school youth to career options in sports medicine through the YES Dallas Sports Medicine Student Internship Program. Interns meet virtually twice a week with an athletic trainer to learn more about job responsibilities and receive training in CPR.

2021 Highlights

• Engaged 99 adolescents in the program. Of these:
  • 52.7% engaged in physical activity for at least 60 minutes most days of the week, surpassing the 45% baseline from 2020.
  • 43.6% and 38.2% reported the consumption of whole fresh fruits and fresh vegetables, respectively, surpassing the 35% and 25% respective baselines from 2020.
• Developed an app that allows students to access live-streamed fitness classes, nutrition education and cooking classes, and stress management and meditation resources.
• Enabled students participating in the YES Dallas Sports Medicine Student Internship Program to graduate and celebrated several who became first-generation college students.

University Consortium

Recognizing that delivering sustainable community health improvements requires the expertise, funding and support of multiple agencies, we launched the Texas Health University Consortium in May 2021 in collaboration with five North Texas universities. Together, we are elevating educational opportunities and executing innovative approaches to eliminating health disparities across North Texas.

The first phase of the University Consortium is designed to:

• Expand community-based student experiences by developing a Community Health Improvement Internship Program.
• Bring together public health experts, academic leaders and college students to develop community-specific health improvement and literacy strategies.
• Give students hands-on experiences implementing programs through internships.
• Create capstone projects where an entire class or cohort of students can work together to address a specific need.
• Engage students interested in healthcare, epidemiology, communications, data analytics, social work and related careers to expose them to real-world challenges that they can help address. We hope it also will build a pipeline of skilled employees who want to work at Texas Health.
• Analyze program effectiveness and trends to refine or expand efforts to other underserved areas.

This will enhance the knowledge, resources and "boots on the ground" that we can leverage to close health equity and literacy gaps.

The University Consortium is strategically designed to use an interdisciplinary approach to identifying and solving problems. It will seek grant funding to drive long-term sustainability by positioning itself as a strong interagency collaborative. Ultimately, it will serve as a community health incubator focused on developing innovative solutions and creating system change by promoting the entrepreneurial development of tools and services to achieve health equity.

Participating Universities

• University of North Texas – Denton Campus
• University of Texas Health Science Center at Houston – Dallas Campus
• University of Texas at Arlington
• University of North Texas Health Science Center
• Texas Christian University