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North Sound ACH

North Sound Accountable Community of Health

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Desfibrilador y Primeros Auxilios – Lopez Island features CPR class in Spanish

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In winter 2023, Lopez Island Family Resource Center (LIFRC), United General #304, and La Cima Lopez hosted a Spanish language CPR/AED/First Aid training on Lopez Island.

The Hispanic community on Lopez Island shared with Karina E. Cerda Aguirre, who works with LIFRC, that there was a great need to have this type of knowledge, due to events that had occurred.

“This course was a great success since all the people who took it here on López are very happy and grateful since some of them wanted to have it before, due to their own incidents, family or friends, and having taken it gave them great security and confidence,” Karina shared. “We believe that these courses make all of us and our community stronger!”

A student practices CPR at the Spanish class at Lopez Island Family Resource Center. Provided by LIFRC.

After obtaining support from the Lopez Island Family Resource Center, organizers wanted to include the La Cima youth leaders since they speak both languages, and because they showed great interest in taking the course and helping people too. Gabe Evenson of United General #304 was the instructor.

Most Hispanic families on Lopez could not take other CPR classes, due to lack of 100% understanding of the English language, but if it were offered in Spanish, they would be happy to participate and learn important skills to keep our community safe and healthy. It also provided confidence and empowerment to Hispanics knowing that they are included in this type of opportunity.

LIFRC hopes to offer another class on Lopez, and involve people from other San Juan Islands.  They hope that someone on Lopez will become a certified CPR trainer in Spanish so more people can be trained.  And that they will have bi-lingual, bi-cultural, Spanish speaking community members work for Lopez EMS someday.


Karina added her thanks to North Sound ACH and our network of partners. “Without your help, we cannot carry out many of our projects with the Latino community of Lopez.”

A student practices CPR at the Spanish class at Lopez Island Family Resource Center. Provided by LIFRC.
Students practicing CPR at the Spanish class at Lopez Island Family Resource Center. Provided by LIFRC.

Collaborative Action Network: Aspirations and Actions

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I am often asked the rationale behind the common agreements that we have asked all partners to commit to. For those who aren’t familiar with them they are linked here.

Since 2014, when leaders from across five counties and eight tribal nations formed what is now North Sound ACH, the underlying focus on advancing equity has been present. To further that end, in December 2020 the Board of Directors made this even more explicit, adopting a set of goals for the organization to ensure that all people in the region have access to the conditions relied on every day for well-being. Operationally, we incorporated those goals into contracts between us and our partners – the set of common agreements mentioned above. 

In a recent , questionable billing practices of nonprofit health systems for patients at or near the federal poverty level were explored, and examples were used from one of our health system partners, Providence. (Please also read the response from Providence at this link.)

As a backdrop, the Affordable Care Act set requirements for nonprofit health systems to disclose their charity care, an intention to help the most vulnerable individuals and families in our communities. Some states, including Washington, followed by enacting legislation to identify if and who would be eligible for free or discounted care; you can find a brief description of Washington’s requirements at the Attorney General’s website.  

It is unacceptable when practices leave people at lower income levels to be buried in even more debt when there are programs to mitigate those circumstances. But we cannot jump to condemn the individuals and caregivers who work with those systems, who have been serving patients under some of the most trying conditions our nation has ever faced. When system-level decisions are made, the systems must work to acknowledge and correct those system-level decisions.   

Regionally, we are working to change the conditions that leave people suffering and struggling, and advance strategies where all community members can thrive. It is a worthy goal, and we’re grateful to have a wide array of regional partners on board with us, including strong practitioners from Providence.    

We believe in what our partners have committed to – not just in writing, but in action. We also believe that North Sound ACH can be of support as our partners navigate tough times. As we have done in the past, we will provide a space for anyone to join in advancing equitable well-being across the region, with our partners and even within our own team here at North Sound ACH. This requires that we all are able to point out when we or I stumble and to work together to do better.

‘Listens’ team helps community recover

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When a natural disaster or other extreme event hits a community, there is often an immediate response – neighbors and strangers donating their time, money, household goods and shelter, jolted into quick action out of compassion. This happened last fall, when Whatcom and Skagit counties experienced catastrophic flooding that impacted thousands of people and displaced over 500 households.

But a less visible response to these disasters is long-term recovery – such as, after the flood waters have receded. After surviving a disaster, individuals and communities experience trauma and stress, and need help recovering emotionally and mentally, in addition to home repair and replacing items lost.

The North Sound Listens team, a partnership of North Sound ACH and the Health Care Authority, provides peer support and crisis counseling to our neighbors impacted by the November 2021 floods and its aftermath. They are on the ground and on the phone, talking to folks Monday through Friday, in English and Spanish.

“Just to have someone listen to your story, that makes a huge difference for survivors,” said Nicole Donovan, program manager for North Sound Listens. The five-person team – Donovan, Maria Santos, Mario Morales, Cindy Harrington, and Tonya Bieche – was formed in April 2022, as part of North Sound ACH’s plan to support rapid community response in emergency situations.

North Sound Listens team, from left: Maria Santos, Nicole Donovan, Mario Morales, Tonya Bieche, and Cindy Harrington.

North Sound Listens is one part of a multifaceted recovery – they work with many other organizations in the community, as well as city, county, state, and federal agencies to try and coordinate the needs of impacted residents. At different stages in recovery, some people need case management – case managers coordinate resource referrals, help with paperwork and recovery plans, schedule volunteers to assist in house repair or other needs. Other times, people need someone like Maria, Mario, Cindy, and Tonya to just listen.

Maria, who has also worked as a homeopathic health and wellness coach, said she asks open ended questions and lets the person she’s visiting lead the conversation. Building trust takes time, and acceptance of help is not always immediate. But the team are present at community spaces, like the Nooksack Food Bank, as well as making regular follow up visits or phone calls, and Maria said this has helped the community to open up to her and her teammates.

Mario has previous experience in emergency management and security, and said that without other agencies and coordination, the North Sound Listens team can’t do the work that they do; everyone sharing resources is what it takes, he said. The North Sound Listens team works with organizations such as the Whatcom Long Term Recovery Group (formerly Whatcom Strong), Opportunity Council, Community Action of Skagit, Nooksack Food Bank, American Legion, Ferndale Community Services, among others.

A lot of community members that the North Sound Listens team meet downplay what they’ve been through, expressing that they don’t want to ‘take from the pie’ of resources, Tonya said, and the others agreed they see this as well. But by expressing their needs and giving attention to their mental health, they are actually building the pie for everyone. “Asking for what you need is a strength, it makes everyone better and stronger,” Tonya said.

Mario Morales and Maria Santos hit the streets.

If you or someone you know has been impacted by the November 2021 floods in Whatcom or Skagit County and needs someone to talk to, call (360) 935-0105. The team is available 10 a.m. to 4 p.m. Monday through Friday, but you can leave a message in any language and someone will return your call. You can also email NorthSoundListens@northsoundach.org.

Read more about the 2021 flood recovery:

The flooding of Everson, Washington by NBC News

Neighbors of Swift Creek displaced by asbestos by Cascadia Daily News

Monkeypox (MPV) public health response, stigma resources

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As of September 1, 2022, there are 450 total cases of monkeypox virus (MPV) in Washington state. In our region, Snohomish has 15, Whatcom has 1, and Island has 1.

North Sound ACH staff Heather McGuinness (Public Health Liaison) and Michaela Vendiola (Tribal & Community Liaison) have compiled a list of Tribal, state, county and other public health resources, as well as anti-stigma literature.

You can also call 1-833-829-HELP for answers about MPV risk factors, vaccine information, testing and treatment, from 6 a.m. to 10 p.m. Monday, and 6 a.m. to 6 p.m. Tuesday through Sunday and observed state holidays. In addition to calling 1-833-829-HELP, callers can continue to dial 1-800-525-0127 and press # to be transferred to a Washington 211 specialist. Language assistance is available in 240 languages. Call takers will not be able to schedule vaccine appointments.

The best thing you can do to protect yourself against MPV is to know the risks and take precautions. Despite misinformation, anyone who has close contact with a person with an infectious rash can get MPV; it is not exclusive to any community. MPV can also spread through touching objects, fabrics and surfaces that have been used by someone with MPV, and contact with respiratory droplets during prolonged face-to-face contact. If you have an unexplained rash, cover it, avoid skin-to-skin contact with others, and see a health care provider. They will determine what testing and treatment may be available.

View our North Sound MPV resource spreadsheet, and send us your suggestions to include in this spreadsheet by emailing Team@NorthSoundACH.org.

Car safety technicians trained in the North Sound

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Becoming a parent is an exciting and very busy time – there are many things to prepare for in order to keep your environment safe for a new baby. Car seats are an expensive but very necessary item to purchase, and the Region 11 Child Passenger Safety team helps caregivers prepare to carry their children safely in their cars, at no cost to the caregivers. Supported by a variety of funding sources, and often working out of local fire departments, law enforcement agencies, and social service agencies, these nationally-certified technicians meet with individuals and families, as well as groups and agencies like hospitals, to provide education and information on proper car seat safety.

Technician Erica Littlewood and expecting parent Tasha going over installing a car seat. Meg Stephenson / North Sound ACH

Morgan and Tasha are first time parents, and after buying a car seat, did an internet search to find who in the area could help them install and understand how to use the seat properly. For those who have not had to use or install a car seat, it may be surprising to learn how complicated it can be. Fortunately, trained technicians in this program are in each county in the North Sound.

North Sound ACH Project Manager Erica Littlewood is the Washington state Region 11 coordinator for the Child Passenger Safety program, and has been doing this work for 16 years. Region 11 consists of Whatcom, Skagit, Island, and San Juan counties. Snohomish County is its own region, and Region 11 and Snohomish County work closely together. 

Technician Erica Littlewood demonstrates installing a car seat with expectant parents Morgan and Tasha. Meg Stephenson / North Sound ACH

After scheduling an appointment, Erica met Morgan and Tasha at the Geneva Fire Station in Bellingham. During the session, Erica explained how car seats should be properly installed, how to use the car seat’s harness (practicing on a baby doll), and an overview of the laws around the different car seats (when an older child can start using a booster, can sit in the front seat, etc).

“This is why we’re doing this, so we feel more powerful,” Morgan said.

Did you know: technicians recommend taking your baby out of the child safety seat every 1-1.5 hours – even though it may be tempting not to disturb baby if they fall asleep, it is better to take them out of that restrictive seat.

Hospitals will ask parents if they have a car seat installed before the birthing parent is discharged, but may not have a trained technician to go over the seat with parents at that time. Making an appointment ahead of time with a technician in your area is recommended.

Erica held a training for 11 new technicians who will work in Whatcom, Skagit, Island, and San Juan counties, as well as two technicians who will work in Snohomish and Pierce counties, in October 2021. Training the technicians, supplying the class with relevant equipment, and teaching space came from North Sound ACH, South Whatcom Fire Authority, and the Children’s Museum of Skagit County. The class was financially supported by the state Child Passenger Safety program.

Shawneri Guzman with South (Snohomish) County Fire is a trainer technician, with Trevor Bolton of San Juan Island EMS at the October training. Meg Stephenson / North Sound ACH

Shawneri Guzman works for South (Snohomish) County Fire and has been a child passenger safety technician for 20 years. She didn’t take this type of class when she had her own children, and when she was first trained it was an “eye-opener” for her. Whether the new technicians getting trained were there for their jobs or just as a community volunteer, they do it to help their communities, Shawneri said.

“It’s rewarding to know the family is leaving safer than when they arrived,” she added.

In her 20 years, she’s seen a lot of changes – car seats are more complicated but safer, cars are more complicated, families have changed.

“Culturally, a lot of people come to this country with no experience with car seats, [and] they just want to do what’s right,” Shawneri said.

Trevor Bolton of San Juan Island EMS at the child passenger seat training. Meg Stephenson / North Sound ACH

How can I find a seat or a technician?

The Child Passenger Safety program also has a limited number of car seats for donation to families who are referred by local agencies. For more information, contact Erica at erica@northsoundach.org.

You may search for technicians in your area by going to https://cert.safekids.org/get-car-seat-checked (it will include languages other than English if available).

Where can people donate?

If people want to support the program, they can donate to Safe Kids Northwest:
PO Box 764
Burlington, WA 98233
with “child passenger safety” on the memo line

Funds go to purchase new car seats for the donation program. It’s great if people can share a gently-used car seat with family or friends, but they should not resell a seat or purchase a used seat.

Other resources:

Region 11 Child Passenger Safety Program

National Highway Traffic Safety Administration

Safe Kids Coalition

Collaborative Action Network Cohorts – next steps

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Creative tension is common when a group is in liminal space. And it is exactly what is needed for co-creating something new.

During our February learning session, we held space for diverse perspectives to share their hopes, concerns, and questions about the emerging Collaborative Action Network (CAN) Cohorts.

Together, we:

  • Sought clear answers AND recognized we need more time for partner input
  • Experienced discomfort with uncertainty AND excitement for creating something new
  • Acknowledged the need for pragmatism AND the desire for reimagining solutions (and better future for all people and places)

The new cohorts offer a tangible opportunity for partners to create a just and inclusive culture and the necessary conditions for all community members to thrive. The trust and commitment of the North Sound ACH partners is rare – and it will be exciting to see how partners bring this to life over the course of 2022.

FAQs

What do we mean by “cohort” and “focus area”?
A cohort is a grouping of Network selected focus areas that have a strong affinity or common theme. It is also a way for North Sound ACH staff and partners to organize and manage the Focus Areas. We have five cohorts:

  • Equity
  • Vital Conditions
  • Emerging Focus Areas
  • Practice Transformation
  • Care Coordination

Focus areas are the more discrete, actionable areas that Network participants have identified for collaborative learning and action. For example: food security, oral health, or mobile integrated health.

How were these cohorts and focus areas identified?
The North Sound ACH team identified these cohorts and focus areas based on reports from contracted partners, requests and reflections from leaders across the region, and an environmental scan. These topics are driven by our network members and will continue to be shaped by network members.

Can we change our commitments to cohorts or focus areas?
We anticipate that our network will grow and evolve over time. Partners who have signed contracts committing to a particular level of participation in a cohort can amend their contracts if another focus area emerges as an organization priority.

We also hope that additional people will join us over time, sharing their expertise and experiences. Organizations that are not currently engaged with North Sound ACH may join the network and cohorts at any time.

What could the work look like?
Our partner-based workgroups are a forerunner to the Network cohorts, such as the Regional Opioid Collaborative (ROC) and the Oral Health Local Impact Network (LIN). At the February partner learning session, Yuki Yang of Ideal Options shared that the ROC is like a “beta version” of the cohorts.

We come across different funding sources, and we can’t apply for it because we’re for-profit; having this space in these cohorts, to identify these situations, we’re always going to our community partners and saying, there’s this opportunity [for funding], do you want to apply for it and we’ll help support your efforts?
But it’s not always clear what those organizations want or need he money for, so these having cohort discussion to identify what are the solutions we’re searching for, or what are the things we want to try, and then also knowing what funding sources are available, we can say, there’s this opportunity, let’s apply or have a lead organization apply who is a non-profit and we will all deliver on whatever the solution is … that is what we’re talking about: coming together, finding funding, delivering a solution, and being in action.”

Hear more from Yuki at the February meeting recording, starting at 44:59.

What do partners say so far?
Mike Parker of Opportunity Council recognized there is comfort with “prescriptive contracts with defined measurement,” such as the Medicaid Transformation Project. However,

Those things don’t afford a lot of creativity, and so while this may feel unsettling and a little bit new it also can be a spark of creativity. For us, working regionally is one of the great benefits, has been one of the great benefits through [the Medicaid] transformation program. The problems we deal with are so regional or wider than that even, so I just look for more creative opportunities to do out of the box solutions, because obviously what we’ve been doing hasn’t been creating the thriving conditions we want.
So this type of model is maybe exactly what we need to do because it’s different, because it will afford opportunities for us to connect across our different organizations, service territories, you name it, languages… so I’m hopeful.”

Nicole Picknell of South (Snohomish) County Fire said its taken time for her and colleagues in her line of work to get comfortable with creative thinking.

Its super hard for us to be ok with being comfortable with the uncomfortable,” she shared. But working with others, “With the north sound ACH, we did start bringing the community resource paramedics together, and that really started us to find a space that we could feel comfortable in talking about, and there’s value in listening to other people, cause theres things I’ve learned on here that I’m like, oh I had no idea that we actually have a connection.”

Hear more from partners by watching the February learning session on our YouTube page.

We invite you to bring more questions to the team – you can always email us at Team@NorthSoundACH.org – and at the next partner learning session on March 16. There, we will break out the attendees into the cohorts they are participating in, to get started together!