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Walden Magazine // Jan 01, 2012

Rural Roots

Five Walden alumni are using their knowledge to improve the lives of people in their rural communities.

Melissa Thomas

Small-town America brings to mind images of family farms, wide-open spaces, and miles of uninterrupted coastline. While that may sound idyllic, these rural communities face many of the same challenges found in big cities—without the same resources and levels of access to healthcare, employment, nonprofits, and higher education. That’s why the stories of these five Walden University alumni have such a profound impact. Walden gave them the tools they needed to remain in their hometowns and make a difference. Each saw a need and, prompted by Walden’s mission to effect positive social change, passionately set out to solve the problem.

Combating Cancer in Appalachia

Low, rolling farmlands define the 32 counties that make up the Appalachian region of Ohio. Neat clotheslines stretch across backyards, horse-led buggies rule the roads, and community barn raisings are not uncommon in the peaceful, tightknit Amish and Mennonite communities. While religion and culture are sources of strength, geographic location acts as a barrier to healthcare services.

“I was shocked to discover that women in these communities have life expectancies most often seen in Third World countries,” says alumna Dr. Melissa Thomas. “For many women in Amish communities, a breast cancer diagnosis was synonymous with death.”

Thomas first encountered the region’s healthcare disparities in 1996 when her work on behalf of the National Cancer Institute led her to explore the disproportionately high cancer rates found in Appalachia, particularly in the remote area of southeastern Ohio near where she grew up. Although mobile mammography units served these areas, she noticed that certain groups weren’t taking advantage of the free cancer screenings. “I knew of an Amish community that wasn’t participating,” Thomas says. “I wanted to know why.”

Thomas’ research led her to create a nonprofit that is committed to serving rural communities in need of healthcare and cancer education. Named Project Hoffnung—“hope” in German—it serves as a cultural link to the language spoken in many Amish and Mennonite communities.

By necessity, Project Hoffnung stays mobile—serving the entire state through free one-day clinics in community centers and churches to screen women for breast cancer and provide culturally competent cancer education. To date, the project has received more than $1 million in funding; her troupe of volunteer community healthcare workers has screened more than 2,500 women.

But her current success didn’t happen overnight. The 2007 PhD in Public Health alumna and 2010 Scholar of Change Grand Prize winner worked for more than 14 years to make connections in these closed-off communities. “I owe so much to the bishops, elders, and women who have welcomed us into their communities. I think it is critical to take time to understand a community’s religious beliefs and their lifestyle,” Thomas explains. “Once we had the chance to understand each other, it became easier to talk about health issues.”

She operates Project Hoffnung’s headquarters, the Center for Appalachian Research and Cancer Education (CARE), in the home she inherited from her grandmother, who was an important role model in her life and brought the importance of cancer screening to her attention. “My grandmother suffered in part because she wasn’t aware of life-saving cancer screenings,” Thomas explains. “She had limited access to healthcare and cancer education and wasn’t diagnosed until it was too late.”

Thomas, who is the manager of Health Disparities Research at OhioHealth Research and Innovation Institute based in Columbus, wrote her dissertation on risk factors associated with breast cancer in Amish and Mennonite communities. She discovered significant relationships between risk factors and screenings that have helped her target effective strategies to bring early detection to these populations. “I’ve absolutely incorporated my dissertation research into the work I do every day,” she says.

Last year, Project Hoffnung achieved nonprofit status, and Thomas hopes to expand the project to other states. “I’d be happy to mentor anyone who is interested in mobilizing community healthcare workers in their own area. There are Amish and Mennonite communities all over the country,” she says. “And there are so many other rural communities in need.”

Casting a Wide Net in Rural Tennessee

If she could, Roxie Nunnally would help every greater Memphis, Tenn., resident who is in need. That’s exactly why she founded the Lewis-“HELP” Today Foundation in January 2010. (Lewis is a nod to her maiden name.)

“What do you do when you’ve maxed out assistance programs like Goodwill or the Salvation Army and you’re at rock bottom?” she asks. “There are so few agencies that are next in line with aid. My foundation may be the boost people need to survive or to improve their conditions.”

When she is not teaching middle school part time, the 2007 Master of Business Administration (MBA) and 2010 Master of Arts in Teaching (MAT) alumna leads a team of volunteers that redistribute donated, gently used clothing, furniture, school supplies, and other necessities to the rural areas surrounding their community. “These areas are heavily affected by poverty,” she explains. “The little public assistance these low-income families receive isn’t enough.”

But the foundation is much more than a source of aid. Nunnally offers one-on-one mentoring to empower her clients to improve their own conditions. “When people are struggling, they don’t always know where to look for help. They often don’t know about existing resources,” she says.

Nunnally connects people to employment services, English as a Second Language (ESL) tutoring, alcohol and drug counseling, and shelters for victims of domestic violence, all in an effort to meet their individual needs. “If I can reach out to a variety of people, I’m accomplishing my goal,” she says.

And she doesn’t intend to stop there. Nunnally plans to launch a series of five-week-long summer camps for middle school students in the coming year. Her goal is to improve their self-confidence and prepare them to set individual goals for high school.

Her long-term goal is to open a “mega-center for children” that would include a gym, a library, and a computer lab. “I want to offer after-school recreational activities to keep students out of trouble,” she says. “I’d also like to have tutors on hand. It’s my dream to have a center with enough acreage that it can grow with the needs of the community.”

It is also her hope to grow into a global foundation, and she invites Walden alumni, students, and faculty members to join her mission. “I want to make it as big as I possibly can. The only way I can do that is encourage others to get involved,” she says.

Transitional Visits for High-Risk Patients in Northern California

When patients are discharged from the hospital, some are matched with aftercare programs like home health or hospice services. Many are not. In his experiences at St. Joseph and Redwood Memorial Hospitals in Humboldt County, Calif., a rugged, densely forested rural area along the Pacific coast, Victor “Tory” Starr saw many patients with chronic diseases and high-risk health factors, who were sent home without follow-up care, frequently ending up back in the hospital. Starr was moved to act.

In 2007, the year he earned a Master of Science in Nursing (MSN) from Walden, Starr co-founded the Care Transitions Program at the two hospitals with Dr. Michelle Kelly, RN, a fellow faculty member in the Department of Nursing at Humboldt State University. Both the community and nursing students benefit.

The program applies a nationally recognized aftercare model, the Care Transitions Intervention, which was developed in a rural setting by Dr. Eric Coleman in 2000. During his graduate research at Walden, Starr came across Coleman’s model. “I was researching disease management and transition care. This model was the basis for our program,” he says.

The program leverages nursing students’ skills as “Transition Coaches.” Each coach meets with patients multiple times during their hospital stays to develop rapport and gather information for their aftercare needs. “A hospital can be an overwhelming environment for a patient, impeding their ability to absorb information. One thing we don’t do is give too much information at once,” Starr explains.

He’s found that patients are much more receptive to teaching and coaching when they are at home. “We do at least one home follow-up visit to coach patients. We address the most common reasons patients are likely to be re-admitted: not reconnecting with a primary care provider, struggling with medication management, misunderstanding warning signs, and not pursuing follow-up tests or treatments once they’re discharged,” Starr explains.

The payoff? “Since starting the program, Care Transitions patients are better able to manage their own health in the appropriate setting. They are being re-admitted at just 10% compared to the national average of 19%,” he says.

Not only has the program saved lives by keeping these patients healthy, it has also saved the hospital approximately $2.2 million in the first 12 months, which is important to the community. “It costs approximately $3,000 a day to stay in a hospital,” Starr says. “Those costs add up very quickly.”

Starr is extraordinarily proud of the Care Transitions Program, but explains he couldn’t have done it alone. “We have developed a new platform of service learning for our community,” he says. “And it all started with my graduate work at Walden.”

Saving Failing Schools in the Rural South

Dr. Pam Warrick and Dr. Neelie Dobbins know the struggles of a failing K–12 school too well. Their data-driven educational philosophy, Commitment Counts, has helped a series of failing schools in Arkansas and Oklahoma rethink teaching philosophies and dramatically improve test scores.

“Coaching and teacher leadership was part of my dissertation work at Walden,” says Dobbins, a 2010 PhD in Education alumna and an assistant professor at Southern Arkansas University. “I’d heard about math coaching because I was a state math specialist, but I wanted to look into it holistically. Walden helped me piece theories about coaching into a philosophy we could bring to schools.”

Warrick, a 2000 PhD in Education alumna and faculty member in Walden’s Richard W. Riley College of Education and Leadership, had experience working with parents, another component they incorporated into Commitment Counts.

“Two years ago, we decided to make it a more formal program. We built Commitment Counts on years of research, data collection, and direct work with schools,” Dobbins says. The pair, who has conducted research together since 2000, trains teachers, administrators, and parents to focus on three commitments: communication, student achievement, and self-advocacy.

“We think of it as a teaching philosophy. It is something you can apply to any teaching model or lesson plan you follow,” Warrick explains. “We’re asking people to change how they think about teaching and reflect on their commitment to those three issues every step of the way.”

Training educators to refocus their core commitments typically results in a 20% increase in student proficiency in subject areas such as math and language arts, they report. Last year, they brought the program to a failing Oklahoma elementary school to improve math scores. Before they arrived, student math proficiency was between 9% and 11%. Thanks to their involvement, the number increased by 43%.

How did they do it? Dobbins worked with teachers on the importance of communication and creative approaches to problem-solving in class. “Kids need to practice communicating what they are learning. Activities like math games encourage participation,” she says. “If students never have to explain what they are learning throughout the year, how can you expect them to demonstrate those skills on a test at the end of the year?”

They are currently in the process of publishing a book about their philosophy and hope it will have a ripple effect by saving an even larger number of failing schools. “This project is a moving laboratory,” Warrick explains. “To me, it’s post-doctoral work. It connects us to current standards and research and allows us to add to the body of knowledge.”

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