Lyon County, Nevada– The residents of the Lyon County community, along with local, state, federal and tribal groups, plus nonprofits and businesses, have worked together for nearly a decade to make progress toward better health for the community as a whole.
We call the collaborative power of the community “collective enoughness.” The details below illustrate this “stone soup” approach to supporting one another and making the most of community strengths and resources.
The summary below of collaborative work shows what happens when commonly agreed upon goals to work toward a healthier community are backed up by evidence-based strategies, plus effective methods of data collection and sharing, that allow for evaluation of those strategies. If an approach isn’t effective for our community, we find a better one. And as we reach goals big and small along the path to a healthier community, we celebrate together.
Part I: Introduction to the Lyon County Community
Rural Lyon County, spanning more than 2,000 square miles, is located in northwestern Nevada. The region is known for its scenic landscape dotted with wild horses, outdoor recreation opportunities, and historic attractions. The county includes nearly a dozen rural frontier towns, all with unique identities and histories they’re very proud of. There are towns as large as Fernley, with over 20,000 residents, as well as many smaller communities, such as Silver City with just 170 residents. The collaborative work described here includes honoring the character of each community, and an understanding of how each uniquely contributes assets to the region as a whole.
In 2008, Lyon County was the second fastest growing county in the U.S. with a population of 54,963, having jumped from a population of just 34,501 in the year 2000. This growth was due to the inexpensive housing available so close to the high-priced housing of nearby Lake Tahoe and Reno. As a result, many first time homebuyers, as well as retirees looking for more affordable homes, moved to Lyon County. Then the housing market crashed. Lyon County’s home foreclosure rate became the highest in the state according to the National Realty Association. At about 15%, our county’s unemployment rate was among the highest in the nation for several years, peaking at more than 20% in 2009.
Infrastructure development did not keep up with the population boom, and services were playing catch-up in a grim economic environment by 2008. Many families were stuck in a rural environment that was expensive to live in due to a lack of services and public transportation, a sudden tripling of gas prices, and very little choice in food outlets. This lack of availability impacted youth, with 56% of middle and high school youth reporting eating no green leafy vegetables (2009 Youth Risk Behavior Survey). This lack of available nutritious food, combined with unhealthy eating behaviors, resulted in our area reporting high rates of chronic disease and other health risks. In addition to record high unemployment and foreclosure rates, the food banks in each of our communities were reporting 100% increase in use. And because of their rural/frontier nature, many communities in Lyon County were also medically underserved. Unfortunately, all of this took a toll on community members and in 2009 the Lyon County Sheriff reported an unofficial number of 28 suicides.
Lyon County was faced with a complex wellness crisis related to food security, access to health care, chronic health conditions, and employment.
With this crisis in mind, by 2010 work to increase food security in a healthy way, while supporting the local food system using interagency approaches and collaboration with multiple stakeholders, began in earnest. This approach resulted in an ongoing collaborative intiative called the Healthy Food Hub.
By 2013, agencies and groups began using “collective impact” concepts, intentionally working together toward measurable successes that could be achieved as a team (i.e., a common agenda; a shared measurement system; mutually reinforcing activities and continuous communication.) This approach by a cross-sector team to increase access to affordable medical, mental, and behavioral health services included using data-driven decision-making, open-mindedness, and a “prevention first” strategy.
Community volunteers, along with diverse groups, pooled time, skills and resources to rebuild a healthy Lyon County and a system based in equitable access with more opportunities to manage one’s own health. Our story shows that collective effort is effective and rewarding.
Part II: Four of the Lyon County Region’s Accomplishments To Improve Health
One) Promoting Mental Health
The 2009 spike in suicides spurred a multi-sector approach, using evidence-based strategies, to improve access to services and resources for those experiencing mental illness and/or addiction to alcohol, prescription and other drugs, and to step up early intervention and prevention work.
Suicide Prevention: In 2010, schools, first responders, elected officials, service providers, mental health counselors, nonprofits, senior center directors, youth groups, nonprofits, and suicide prevention experts crafted a consolidated, effective action plan to address the suicide and suicide attempt rate in Lyon area communities. The action plan was made with guidance from Nevada Office of Suicide Prevention which stressed that suicide prevention requires a paradigm shift in the community that comes about not only through training, early intervention beginning in childhood, awareness of suicide warning signs, reduction of alcohol and other substance abuse, and increased access to mental health care and intervention services, but also through increased compassion and kindness at every level of a community. Subsequently, hundreds of community members and staff from multiple sectors were trained in suicide prevention and many became trained as trainers; a crisis text line number was promoted at middle and high schools in a collaboration among public schools, nonprofits, University Nevada Reno and state offices; mental health experts from local, state and private agencies came together to conduct ‘Teen Screen’, a mental health assessment tool with follow up for middle and high school students that was subsequently promoted by Nevada’s First Lady, Kathleen Sandoval. By 2015, students at every middle and high school were trained in S.O.S. (signs of suicide) in a partnership among nonprofits and schools.
Schools and Families: To promote mental health, schools and nonprofits worked together to keep licensed social workers in the schools with ongoing (nonclinical) groups on grief and loss, stress management, individual support for coping skills, etc. Memos of Understanding between the school district and the State rural mental health clinics allowed students to make appointments and receive services at the school site. In a partnership between the schools and nonprofits, school-based resource coordinators serve as bridge employees between community resources and school staff, students and their families. Human Services and nonprofits created new staff positions based on early childhood social/emotional learning, home visiting for parents, and early intervention (such as Nevada Families First). Peer-to-peer youth teams like Stand Tall receive extensive education in prevention strategies and public speaking and lead alcohol, prescription and other drug use prevention campaigns in their school systems throughout the school year.
Sharing a Cross-Sector Platform of Goals: A regional ‘Health and Wellness Hub’, with expanded communication among health care providers, educators, nonprofits, mental health service providers, substance abuse treatment and prevention groups, first responsers, etc, meets bi-monthly to develop, plan, and implement specific goals to be met across schools, communities, and non-profit/governmental agencies. To this end the Hub has a shared platform of goals to be met in all participating groups. These focus on the health and well-being of the whole community, in it’s broadest sense, and the non-profit/governmental system that they live and work in. Specifically the group has established and implemented these norms: all students are equally valued and have access to the supports to thrive in school and at home. All staff are cross-trained to provide the best response to the students and families through a no-wrong door approach at the site level. All school staff have been trained in developmental assets to focus student, family, and community strengths. Results, outcomes, and progress is evaluated in bi-monthly meetings.
Behavioral Health: By 2014, law enforcement, social services, hospitals and health care groups, mental health and substance abuse treatment groups, and nonprofits formed memos of understanding to reduce recidivism among those with mental health and/or behavioral health challenges. Examples of resulting collaborative, cross-agency strategies include data sharing, expanded training for first responders, and FASTT and MOST initiatives. The Mobile Outreach Services Team (MOST) includes a deputy with training in mental health, and a mental health professional from state rural mental health, conducting home visits with people for whom they receive referrals. The Team helps to connect people with resources and groups. Forensic Assessment Safety Triage Team ( FASTT) involves mental health assessments at the jail by mental health professionals, and referrals and connections to any needed regional resources in social services, mental health, drug and alcohol abuse treatment, job skills training, housing, etc. The result has been a measurable reduction in crisis calls, recidivism, and increasingly effective cross-agency communication and collaboration.
Cross-Sector Strategies like FASTT and MOST Help Reduce Jail Recidivism: The Lyon County community knows it is making measurable progress by yet another example of a team approach to wellness. For the past several years, social workers, mental health professionals, sheriff’s department staff, and non-profit organizations have met monthly to reduce jail admits. Again, for persons who need mental health support going to jail should be a last resort. Consequently, these groups meet monthly with people in jail to get them the resources they need to cope with mental health and behavioral issues. This has significantly reduced the number and length of jail stays because the people are getting treatment rather than incarceration (shown in data collection). Further, there is a team that does “knock and talk” visits to prevent contact with the justice system. Finally and most important, this process has changed the system that maintains incarceration for these people: now all of the groups know about this issue and expect it to be undertaken differently. This is a radical behavioral and belief change in rural Nevada.
Addressing Opioid Impacts: The Lyon County region’s multi-sector Behavioral Health Task Force added a subcommittee on strategic response to opioid overdose and addiction in November of 2017. The subcommittee took into consideration recommendations that emerged from an ongoing statewide opioid task force, and subsequent statewide opioid summit and a resulting multi-sector statewide plan to combat opioid addiction, overdose and death. By partnering with a regional nonprofit that provides recovery services (The Life Change Center), beginning this winter Medication Assisted Treatment will be available across the Lyon County region and there will be coordination with behavioral health, substance use, and social service agencies to provide counseling, case management, and basic need services. Next steps include developing a naloxone distribution plan, as well as a community outreach and education plan including utilizing the region’s fire departments to distribute professionally developed information to residents in their area. In addition, an Opioid Community Response Summit will be held in the Lyon County community in the spring of 2018.
Two) The Healthy Food Hub
By 2010 the hard work to improve our area’s food system began. The goal was to create a regional “healthy food hub” by connecting farmers, groups, businesses and community volunteers who also want an affordable, accessible and fair food system. Moving to a system rooted in health, equitable access to good nutrition, and economic sustainability wasn’t going to be something one farm, one agency, one school, one citizen, or one politician could do alone. It became obvious that we’d all need to work together to succeed.
Changing the Food System: Nonprofits in Lyon County worked with local, state, federal and tribal groups to sponsor and organize several regional Food System Summits focusing on strengthening collaboration through partnerships among farmers, USDA, food banks, university cooperative extension, food businesses, schools, etc. Subsequently, through cross-sector collaboration, our local and regional food systems have steadily strengthened, with additional economic opportunities for farmers and food entrepreneurs, and expanded access to healthy food for everyone, including the most vulnerable.
Increasing Demand for Fresh Food: In addition to expanding access to healthy food, there was a need to increase willingness to consume fresh fruits and vegetables, etc. Accordingly, community nonprofits, dietitians, chefs, AmeriCorps members, gardeners, farmers and community health advocates came together to offer free healthy cooking, gardening, and canning classes in Lyon County, and to develop popular community gardens.
School Gardens and Beyond: In school settings, research showed that children who participate in hands-on learning in their school gardens and in cooking lessons using what they grow, are likely to eat the vegetables and fruits they see on their school lunch trays. What’s more, they’re likely to ask for vegetables and fruits at home. Understanding this, the school district opened their doors to initiatives like Farm to School that helped connect teachers, students, parents, farmers, local businesses and volunteers who developed school gardens, garden clubs, and cooking classes using school garden produce. Eventually, salad bars including produce sourced from local farms and school gardens were implemented across the school district. Today there are 9 beautiful school gardens and hoop houses (low tech green houses) throughout the district. During the school year, students help maintain the gardens, and during the summer, Boys and Girls Clubs, Girls Scouts, youth with Juvenile Probation, teen garden interns, community volunteers and others help. This year, the school district is welcoming a pilot “Family Style Dining” approach where students enjoy healthy meals at tables with handmade table cloths, flower centerpieces, and teachers who sit with them, initiating conversations (and thus enhancing social/emotional learning).
On-going Expansion of Organic School Gardens and School Salad Bars: In a collaborative grant writing effort including farmers, teachers and nonprofits, the school district was awarded more than $45,000 in 2018 from the state agriculture department to expand three of the nine existing school gardens in Title I schools, and to implement two additional school gardens and hoop houses in Title I schools. As part of this funding, farmers will work with students to add micro-greens to their school garden harvest, and to incorporate the high-nutrient food into the school salad bars. In addition, through a winter 2017 regional meeting of stakeholders, the University of Nevada Reno’s Cooperative Extension department has recognized the value of connecting their programmatic elements, such as education about vegetables and fruits and good nutrition, to ongoing food systems improvement work being carried out together by multiple sectors such as farmers, USDA, food co-operatives, nonprofits such as Healthy Communities Coalition, and schools.
Farmers Markets Are For Everyone: In a collaboration among farmers, State and federal agencies, and area nonprofits, farmers markets with no booth fees for farmers were developed in several towns in Lyon. Women Infants and Children (WIC), SNAP, and USDA Senior Coupons are accepted as payment, along with cash, credit, etc. School garden produce is also sold at markets, and teen interns learn to manage the markets.
Volunteer-powered food pantries using a co-production model were developed in three towns. Volunteers and pantry guests take training in gardening, community resources, and healthy food choices. The pantries collaborate with schools and farmers markets to add more fresh produce to their food boxes, and serve as welcoming ‘one-stop shops’ with onsite job skills and employment agency staff, community health workers, and periodic free immunization clinics.
Three) No Wrong Door: Access to Health Care
Addressing Health Care Provider Shortage: In 2012, multiple organizations serving the Lyon County region, and hundreds of community volunteers, came together to support a pop-up clinic with completely free dental, vision, medical and mental health services provided by licensed professionals volunteering their services. The event, called Medical Outreach Response Event (MORE) was held in one of the Lyon School District’s gymns and open to anyone who showed up. Hundreds of community volunteers served as general support, directing traffic, providing meals for visiting health care professionals and patients, setting up tables, etc. Dozens of nurses, doctors, dentists, and mental health professionals traveled from around the state to volunteer. Local, state, tribal and federal groups came together to plan the event and pool resources. After the event, everyone agreed more was needed, especially in the area of dental care. However, Nevada has a well-documented shortage of dentists and other doctors.
Improving Policies: The next step, spearheaded by organizations and individuals in Lyon County in 2013, involved a wide range of groups from throughout Nevada working together to change Nevada law to allow out of state providers to volunteer at free, temporary clinics such as MORE. Together, community members in need of care, and staff from Lyon County Human Services, community nonprofits, oral health coalitions, rural health groups, Nevada legislators, etc worked together and solved the complex logistical and state policy barriers preventing out of state health care professionals from serving Nevadans in need. Over the next several years, MORE clinics continued. In addition, Remote Area Medical (RAM) an international group with extensive resources such as mobile labs that can produce hundreds of pairs of eye glasses per day, agreed to put Nevada on its busy schedule of pop-up clinics. Since 2014, RAM has worked with Nevada volunteers and groups to help bring free dental, vision, and medical services to thousands of Nevadans of all ages in both rural and urban Nevada, including in pop-up clinics in Lyon County towns. These free clinics are first come, first served, no identification required.
New Steps to Address County’s Low Health Ranking: In the Fall of 2017, the County human services department, in collaboration with two regional community nonprofits (Community Chest Inc and Healthy Communities Coalition), held a free regional conference called Thrive which included panel and individual presentations by youth as well as adults highlighting collaborative work being done to improve food security, overall wellness, and access to health care, including mental health and substance abuse recovery services. Two months later, the County human services department hosted a health forum with multiple sectors, including university experts, gathering to examine and discuss the implications of the county’s low health ranking and geographical maldistribution of health professionals. With more than 53,000 people spread over a region nearly twice the size of Rhode Island, the county has just 12 medical doctors, 10 dentists, one licensed professional counselor and no psychiatrists. Few accept Medicaid. Lyon County ranked 14th out of 17 Nevada counties in health outcomes and 15th in health factors. After the health forum, local doctors, state legislators, regional nonprofits plus county, state and regional groups gave presentations to the County Commissioners regarding evidence-based strategies for improving public health. As a result, the county’s elected officials established the County’s first Board of Health, which will make policy decisions regarding public health in the county based on input from relevant professionals. The new Board of Health will also provide officials with the ability to see the “big picture” of how state and county fit together. It will also allow for participation of nontraditional partners such as school districts, and increased participation in the statewide Nevada Association of Local Health officials.
The Warm Hand-Off: Although a variety of groups in Lyon County used the MORE and RAM clinics as opportunities to make sure anyone eligible was connected to local services plus Medicaid, Medicare, Veteran Benefits, etc, they realized they wanted, and could create, a better system in Lyon County, with increased access to health care services and an emphasis on “prevention first,” and the belief that people can learn to manage their own health when given the opportunity. Accordingly, in 2013 direct service providers, plus school administrators, community nonprofits and coalitions began meeting monthly over lunch to engage in deep conversation and strategic planning. One strategy was Dental Days at area schools, with newly funded school-based resource coordinators helping to organize visits from rural health nurses providing fluoride treatments and education about good oral hygiene, and volunteer dentists providing exams, sealants, and fillings. In multi-level collaborations among local, state and federal groups, Lyon locals were trained as community health workers serving the communities they love. They help connect residents with services, and teach classes in diabetes prevention and management, tobacco cessation, heart health, etc. Youth leaders were trained to offer peer-to-peer education in good nutrition and the benefits of exercise. Most importantly, as staff from diverse groups began to know each other better, they developed cross-sector coordination and team work that led to a “no wrong door” response and a “warm hand-off” from one agency to another. This means that if someone needs to be referred to a different agency or department, staff will call ahead, with the client present, to let the agency know the client is on their way. Staff then makes a follow up call to make sure the client arrived. If not, staff follows up with client to identify any barriers, and to work together to remove those. This approach has led to a culture that supports experimentation and inquiry among agencies. It’s a win-win for agencies, and for the residents of Lyon County.
Four) Workforce Development
Access to higher education and to job and life skills development is also key to a healthy population. The 2008 economic downturn highlighted the need for more opportunities for Lyon County residents to access college education, career and technical training, on-the-job training, life skills training, and vocational rehabilitation (protected employment) work sites.
Cultivating Teen Job and Academic Skills: In the harsh job climate after 2008, adults were given jobs previously typically held by teens. Nonprofits and foundations came together with the schools to work with teens throughout the year on academic success, employment and life skills. Throughout the summer teens were paired with area businesses where they could learn job skills while earning a stipend. Many of the teens were employed by participating businesses after they graduated from high school, or found work in job fields they’re passionate about.
Increasing Educational Attainment: Lyon County has no colleges or universities, and a low rate of higher education attainment. Therefore, the school district partnered with Western Nevada College so that high school students can earn (at no cost to them) dual high school and college credits, graduating with both a high school diploma and an Associates Degree, or a nationally recognized manufacturing certificate. For this reason, the school was chosen from a five county region for Best Education Initiative by the Northern Nevada Development Authority in 2017, and has been repeatedly acknowledged for the high rate of dual credit completion by its students.
Using Data to Improve School Success: One example of how the Lyon County community is using data to improve outcomes can be seen in the fact that student suspension has fallen significantly due to expanded communication among the region’s judge, juvenile probation department, sheriff’s department, community nonprofits, social workers and mental health professionals, and school staff. When it was discovered students were being suspended due to truancy, these sectors rethought their approach and made truancy a last-resort option i.e., how can we address student truancy without suspension? To that end suspensions fell by over 50% in the last year (shown through data collection and analysis).
Everyone’s Work is Important: Those returning from the military, incarceration, or long periods of unemployment were paired with work sites such as a nonprofit garden center and food pantries where they could re-establish their work history and learn new skills on the job. People of all ages with physical, cognitive or mental health challenges were matched with welcoming vocational rehabilitation (protected employment) worksites. Key to this collaboration was “radical inclusion” and an understanding that everyone has something important to contribute.
Locals Promoting Access to Services: Lyon Human Services, Senior Centers, the school district, and community nonprofits formed memos of understanding so that dozens of AmeriCorps members ranging from young adults to elders, hired from a pool of local long time volunteers, have been able to serve vulnerable elders and children, those experiencing homelessness, etc. In addition, during their year of service, the AmeriCorps members become certified Community Health Workers and are trained in suicide prevention, gardening, healthy cooking, and other skills. Because they’re local, their skills continue to boost the capacity to advocate for health even after their service ends. And many have gone on to higher education with their AmeriCorps education stipend, or have found jobs they love with area employers.
Moving From Client to Volunteer to Employee and Advocate: After the 2008 economic crisis, many previously employed people became full time volunteers with area food pantries, community gardens, pop-up health clinics, etc. A system for moving people from service clients, to volunteers learning new skills, to employed people and/or community leaders or peer-to-peer health advocates has resulted in many success stories. Regional nonprofits, state agencies, employment agencies, and county departments have worked together to provide the structure and support for this shift that has been a key part of increasing our region’s capacity for promoting health, meaningful connection to community, and economic vitality.
Results of Creating Conditions that Improve Opportunities for Health for Everyone
By practicing “radical inclusion” and recognizing that every person has something important to contribute, the Lyon County community is creating conditions to improve equity on all fronts. There are multiple ways for community members to participate in co-production (for instance, emergency food recipients help run the region’s “volunteer-powered” food pantries and help run the region’s community gardens and hoop houses). There are now many avenues to leadership training that empower people from all walks of life to participate in decisions impacting their community, and to act as advocates for their preferred future for their community. For example, through local AmeriCorps positions that include ongoing skills training, and onsite leadership and job skills training for adults and teens of all abilities at the region’s food pantries, farmers markets, garden centers, nonprofits and small businesses, the community as a whole is building capacity for people to advocate for themselves and their community.
These examples are part of the overall goals of removing obstacles to health such as poverty, discrimination, powerlessness and lack of access to good jobs, quality education, and health care. In Lyon County, schools, social services, nonprofits, rural hospitals and clinics, etc have come together to work on a number of methods to improve equity and to reduce disparities. For instance, they’ve reduced barriers to dental care by bringing mobile dental clinics with volunteer dentists to school settings every few months; collaborated to acquire funding for school resource coordinators who connect families to school and community resources; developed compassionate systems for bringing services to “where people are” (for example at schools, food pantries, senior centers, farmers markets, etc) with pop-up dental, vision, immunization, and medical clinics. Additionally, those in need of dental care, for example, have partnered with nonprofits, state and local groups to advocate for policies that could improve access to both routine and emergency dental care. Examples include advocating for improving Nevada’s hospital emergency room ability to respond more effectively to dental issues such as abscesses, and advocating for improved access to routine dental care for residents of nursing homes.
In a very concrete example of someone affected with poor health outcomes driving solutions to barriers to good health, a volunteer with a local food pantry could not gain employment due to a chronic degenerative bone issue that affected the appearance of her front teeth and was exceedingly expensive to correct. Along with county officials, nonprofits and agencies, she traveled to the state legislature and gave persuasive key testimony to change state policy to allow out of state dentists to contribute free care to Nevada’s underinsured residents during free pop-up clinics. The bill passed, she was able to receive treatment for dental issues, and she went on to a well-paying job in the community. She has continued to thrive as an empowered advocate for her community.
Sustaining Positive Community Impact
As a community, our ability to sustain our progress in building a culture of health throughout Lyon County is bolstered by the fact that the work is taking place across multiple sectors and includes intentional capacity building and relationship building across sectors and across local, state and federal levels, and multiple ways for community members to participate in decisions and to act as advocates for their community. Because diverse agencies and community members of all ages and all walks of life are participating together in creating, for instance, a “Healthy Food Hub,” the momentum for community impact is sustainable.
Having a school district that’s so thoroughly committed to a shared vision of a culture of health is one of the keys to making the community’s health improvement efforts endure for the long haul. For much of Lyon County, a rural region with few museums, art centers, community recreation centers, etc, the schools are the center of community and cultural life. Luckily, the school district, the single largest employer in Lyon County, serving more than 8,000 students in 18 schools, has been happy to be part of weaving together strong partnerships with families, volunteers, noprofits and agencies to promote a culture of health.
The school district understands that the healthier their students, their families and school staff are, the better student achievement will be. To that end, the District has formal agreements with multiple agencies, nonprofits, local farmers, and volunteer groups to support school gardens, salad bars, school-based community resource coordinators, school-based social workers, suicide prevention training for staff and students, onsite mental health counseling for students and families, food pantries and community gardens on school property, onsite dental service days, a free dual high school and college credit program that allows our rural students to graduate high school with an Associate’s degree, etc.
VIDEO: To see additional photos and interviews about of some of these collaborative efforts to create a ‘culture of health’ throughout the Lyon County region, see this short video (special thanks to musician and Lyon County native Mylo McCormick for the film score).