Life Expectancy on the 1-90 Corridor

Did you see this picture in The Spokesman Review today? 

This map helps to highlight the motivation behind a lot of the work we do at Better Health Together. When it comes to health, not all zip codes are created equal. BHT is committed to addressing not just access to health care, but the social determinants of health outcomes as well. Things like access to healthy and affordable food, a safe house to sleep in, clean air, walkable streets, and the emotional support people need to be healthy. Working collaboratively to close the gap on these health disparities is crucial to ensuring health for all in Eastern Washington.

Guest Blog: Personal Reflections on Recent Shootings

On Monday May 2nd, Aaron D Johnson, a Spokane man with schizophrenia, was shot by police answering a domestic violence call at the West Wynn Motel. This event came within a week of officers shooting a homeless man wielding a knife and threatening self-harm outside of the House of Charity. Sadly for Aaron Johnson, this was not his first run in with police that ended in gunshots. The following is a personal reflection from Maurice Smith, who was with Johnson the night of his first shooting by police in 2014. Maurice shared his reflection with the Spokane Homeless Coalition, and it made its way to BHT and Empire Health Foundation leadership. We are sharing his thoughtful reflection with permission, in hopes that his perspective inspires a compassionate community response to these recent and ongoing tragedies. 


For several days now I have wanted to write this in response to the shooting of a homeless individual outside of House of Charity. I felt the need to say something, based on my own experiences, but I hesitated. Then something happened to galvanize my thoughts and to compel me to write them down in the hope of offering some perspective. I read about the shooting on Monday at the West Wynn Motel and I saw the name of the victim: Aaron D. Johnson. I was stunned and taken back two years to a cold night in January of 2014. You see, Mr. Johnson and I have a history together.

It was a Thursday. I received a call from Marty McKinney, the day-to-day Director of Truth Ministries Men’s Shelter on east Sprague.

“Can you handle the opening shift at the Shelter tonight. Julie and I have been invited to a birthday party and we would like to go.”

“No problem,” I said. “I’ve got you covered. Have fun.”

My wife and I had worked with Marty, Julie and the men for several years, including as long-time board members. I had worked the opening shift countless times. No big deal. This night would be no exception.

The shelter opened for the men at 8:00PM. I could tell by the crowd in the waiting room that we would be full, just like the night before. We would have 40+ men in the house. In addition, I had another half-a-dozen volunteers from a local Church there to fix and serve dinner. Toward the end of check in, Mr. Johnson showed up, toting a plastic bag of personal belongings and a wooden 3-foot-long 4X4 (?!). In the crowd of people around the check-in desk, he slipped past me and headed toward the bed he had occupied the previous night (without checking in). Fortunately one of my desk volunteers caught him and sent him back to me for check in. As I attempted to talk with him and process his check-in, he became verbally confrontational (even irrational), refusing to cooperate and surrender his bag of personal items (normal for check-in when all bags and backpacks are tagged and stored in a holding area for safe-keeping). Things were escalating. His language became increasingly threatening (words like “kill” and “murder” are not ones we want to hear during check-in).

I now had a decision to make. We operated under some basic rules for such situations. First, try to dial things down. Let the air out. Don’t make a situation worse by adding to it. Second, isolate the individual and take away any audience who might further ratchet things up. Third, if the first two fail, take the situation (i.e., the guest) and any danger it might pose, outside. I had a shelter full of men and church volunteers to consider. Their safety came first. He was already becoming threatening toward me. Would that get worse if I allowed him to stay? I informed Mr. Johnson that it was time for him to leave, and I gently shepherded him toward the door (all of this caught on video which was later reviewed many times). 

But then I had another problem. Once outside, he crossed the alley and stood beside the cars of the church volunteers. Great. They would soon be leaving and heading for their cars. What if he threatened one of them. Next, one of my shelter volunteers said, “Maurice, did you see that he had a knife?” No, I hadn’t seen that. I had only seen the 4X4, and that was bad enough. Now I had another decision to make. Do I let things “play out,” or do I take pre-emptive action? I called 911 and explained what was going on. “I need the Police to come and get him out of the alley.”

I returned to the night’s immediate need – completing the check in for the men who would be staying. Then it happened. The sound I can never forget.

“Pop – pop.” Pause. “Pop – pop – pop – pop.” 

In case you’re wondering, yes, gun shots really do sound like fire crackers. At least that’s what my volunteers thought. “Were those fire crackers?” one of them asked. I groaned. “No,” I said. “Those weren’t fire crackers.”

Out in the alley, the Police had arrived. When they attempted to confront Mr. Johnson he brandished the knife my volunteers had seen. When he refused their orders to drop the knife, and when tasering proved ineffective, they opened fire. Although shot eight times, Mr. Johnson survived.

I spent the next six hours with the Police as they investigated and recorded the crime scene, reviewed the internal video recording and interviewed everyone (yes, everyone) in the shelter as to what they had seen and heard. I arrived home around 3AM and spent the next few hours lying in bed, re-living the night’s events and wondering. Had he been tweaking? I had helped meth addicts detox before. They can be delusional, irrational and aggressive. Is that what happened? It had happened before in the shelter when I was there. Or had I made a mistake this time? Would things have turned out differently for everyone involved if I had handled things better? 3AM is a lonely time to wrestle with such questions. I don’t wish it on anyone.

As it turned out, Mr. Johnson was not a meth-head. He had been struggling with schizophrenia, had been off his medications, and had been building toward an episode for some time. That “time” turned out to be 8:45 on a Thursday evening at Truth Ministries while I was attempting to check him in for the night. 

So, yes, Mr. Johnson and I have a history together. And my heart sank in one of those “Oh, no, not again” moments when I read that he was the victim of a police shooting at the West Wynn Motel. On a personal level, I am tired of this seemingly unending nightmare, whether at Truth Ministries, House of Charity or the West Wynn. But in the midst of my own painful reflections on these events, I would like to offer some perspective. Not everyone will agree with me, but that’s OK. I offer this simply as someone who has been there.

First, be slow to judge events and those involved. As a former pastor, I am reminded of the words of Jesus, when He said, “Do not judge by appearances, but judge with right judgment” (John 7:24). That’s good advice. Frequently, things are not what they appear to be at first glance. Initial reports are often incomplete. There is often more (or less) to the story than appearance suggests. Get all the facts before you start drawing conclusions. As a result of my own experiences, I am much slower to make snap judgments; about people, about situations, about what could or could not have been done better or differently.

Second, show grace to those involved, and resist the urge to point fingers of blame, at least until we have time to put all of the puzzle pieces together. We don’t know if anyone involved did anything “wrong” to create this situation. If they did, it will eventually come out. But sometimes a tragedy is simply a tragedy, with no culprit to blame. And this is a tragedy for everyone involved. Ordinary people who never wanted to be a player in such a tragedy now find themselves awake at 3AM asking “Why?” and “What could I have done differently?” Trust me on this one. Been there. Done this.

Third, let the full impact of these happenings sink in. Let them change you and motivate you. Resist anger and the temptation to embrace an agenda or to over-react. Instead, embrace passion for the marginalized, and turn your response toward a personal resolution to make a difference.

Fourth, let this be the beginning of a renewed and productive conversation about the needs of the vulnerable and marginalized in our community. The need to get people off the streets, even out of shelters, and into stable housing. The need to better address the mental health needs of people like Mr. Johnson or Mike Kurtz (the man shot outside the House of Charity). The need to better resolve such situations without having to resort to deadly force. The need to find creative solutions, rather than assigning b
lame and somehow thinking that will solve our problems. It won’t. 

Fifth, allow these events change you. They have the potential to make you a better, wiser, more compassionate, more patient and more reflective person. Maybe even someone who can make a difference on behalf of others. Trust me on this one. Been there. Done this.

Finally, I have one last thing to do, perhaps the hardest of all. I need to reach out to and contact the family of Aaron Johnson. I want to tell them in person about the history between myself and their son and nephew. I want to assure them that there are those in Spokane who care deeply about what has transpired. And that Aaron’s journey may yet yield hope and help for many others who share a similar journey. It’s the least I can do. I owe them that much. After all, we have a history together, and I need to see it through. For their sake and for Aaron’s . . . and for mine.

-Maurice Smith

 

Spotlight: CHAS Quit Happens

Tobacco use is the leading cause of preventable death world wide. At CHAS health clinics in Spokane, more than 50% of patients reported using tobacco, meaning half of their patients were at risk for tobacco-related death or illness. The CHAS clinical leadership team took a hard look at this figure, and seeing it as a true public health crisis, decided that helping patients to quit smoking was the single most important action they could take for community health.

In January 2015, CHAS launched their two-year cessation program Quit Happens. CHAS set a lofty goal of reducing the percentage of their patients who use tobacco by 10% in two years.  Knowing that the most important engagement of patients would be happening in the clinics, CHAS leadership gave clinic staff large ownership of the program. Staff even voted on the name, and made Quit Happens tee-shirts and swag to create a quitting supportive culture in their clinics.

CHAS looked at its workflows at every level where they meet patients to create opportunities to offer support. The first change was to normalize asking every patient at every visit, not just if they use tobacco, but if they are ready to quit. Those patients who can say YES are connected to any number of quit-supportive resources: 

  •  After their appointment, patients can be referred to a Quit Coach share resources with patients and talk through goals and barriers.
  • Two clinics host patient support groups, and Behavioral Health staff offer one-on-one counseling services for struggling patients. 
  • CHAS has made agreements with their Pharmacy department to offer Nicotine Replacement Therapy, such as the patch, gum, or prescription meds, at the lowest cost possible to patients.
  • CHAS brought in local smoking cessation expert Dr. Kawkab Shishani of WSU Spokane to train staff at each clinic on best practices for supporting patients who want to quit.
  • They’ve created a resource for clients that includes health information brochures from the American Cancer Society, Quit Happens swag, and information on local resources like support groups and the Washington State SmartQuit app.  

The big question of course, is it working? The program is only a year old, and quitting often takes multiple attempts so the data is slow to accurately show the impact of these changes. However, in just the first 8 months over 600 people told CHAS staff they were ready to quit smoking. One year in, CHAS has seen a 2% decrease in smoking, totally around 1000 people who have successfully become former smokers.

 “It’s hard to quit, but it’s the number one thing you can do for your health,” says Mellissa Nystrom of CHAS, and the impact of those 1000 former smokers is huge. The health benefits of quitting begin just 20 minutes after your last cigarette, as demonstrated in the infographic to the right. Not to mention the added impact for the families of smokers no longer inhaling smoke second hand. In addition, the CDC estimates that smoking costs the US $300 Billion Dollars a year in medical care and lost productivity from premature death.

No one knows better than a smoker how hard it is to quit, and CHAS knows they don’t need to belabor that point to their patients. Instead they’ve reworked their patient pathways and created a culture in their clinics that is ready to meet patients with support and encouragement when they are ready to quit.  CHAS’s “all hands on deck” approach to smoking cessation shows the value of supportive community in radically improving health, and that’s work we are thrilled to brag about. Way to go CHAS!

If you’d like to know more about CHAS’s work, please contact QI Manager Melissa Nystrom.

Save the Date: Pre-Diabetes & Weight Management Symposium

Did you know that 86 million Americans have pre-diabetes? And of those, 90% have no idea they are pre-diabetic. Yikes! In an effort to combat these alarming statistics, Better Health Together is partnering with the Eastern Washington Diabetes Network, INHS, and SRHD to host the Pre-Diabetes & Weight Management Symposium on Friday May 20th, from 9AM-4PM.

The conference will start with a morning of talks on pre-diabetes and information about local diabetes prevention programing. The afternoon will include breakout sessions with different tracks for all type of providers, and will include a Community Health Worker training on providing support for oral health as it relates to diabetes. Mark your calendars!

More information and conference registration can be found here: https://courseregistration.inhs.org/

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DENT Story: From Dental Emergency to Family Oral Health

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A 42-year-old Marshallese gentleman recently moved to Spokane with his wife and four children. Suffering from a very painful tooth on his lower jaw, the man made many calls to area providers. Even though he and his entire family are Apple Health eligible, providers told the man that they would not accept his insurance. Thus, he finally went to the ER with pain and infection—where he was referred to the DENT program. 

DENT staff was able to schedule him at a DENT Provider Network participating office for his emergency dental issue. In addition, the office agreed to accept his entire family and offered permanent patient status, primarily due to the children. The kids are scheduled after the holidays for comprehensive care, which includes cleanings and preventive care. 

Due to becoming patients of record, both adults will also qualify for comprehensive care.  This is tremendous as this family will go to their family dentist instead of going to the ER and will learn about and improve their oral health to avoid future problems.

The man shared that he and his family have been helped in many ways during the short time they have been here. “We have been so blessed by my getting a job to support my family and given resources for medical and dental care in offices where they would accept my state insurance.