Category: blog

November 10–16 is Nurse Practitioners Week. Nurse Practitioners are a critical part of our healthcare landscape—they make sure that as many residents as possible have access to a care provider.

In Virginia, we have more than 17,500 NPs, a few of whom work at RHHD! This week, we’re celebrating the following team members:

• Tracey Avery-Geter
• Allison Gregory
• Christina Jennings
• Patricia Newton
• Gabriela Paniagua-Stolz
• Christy Smith
• Lisa Wiener

Clinical Health Nurse Manager Sarah Widmer says that “We are so grateful for the amazing team of Nurse Practitioners here at RHHD. They are passionate about public health, committed to high quality clinical services and incredibly caring providers. They meet each individual client where they are and provide extraordinary care, support and clinical service. Our NPs are the best!”

Our nurse practitioners have great bedside manner AND green thumbs!

Take action: If you or someone you know is struggling or experiencing a mental health crisis, you can now call or text 988 for immediate support. The National Suicide and Crisis Lifeline provides people with a trained crisis counselor to talk them through a crisis. In some situations, the lifeline may dispatch emergency services to come help the person directly.

RHHD’s Community Health Assessment (CHA) revealed three major areas where residents saw big health challenges:

• Community Safety and Violence Prevention
• Chronic Disease
• Mental Health, including Substance Use Disorder

Today, we’re focusing on Mental Health. More than 30% of you said that mental health concerns—including anxiety, depression, and self-harm—were one of the biggest health issues currently facing our communities.

The Community Health Improvement Plan (CHIP) will help RHHD decide how to address this important issue. A first important step is the Richmond and Henrico Regional Resource Guide to Substance Use and Behavioral and Mental Health. The guide provides a detailed list of service facilities that address substance use, along with mental health and behavioral health. The tool is the result of a year of hard work from Anna Back, Elle Merkle, and Lashawnda Singleton. RHHD’s Director of Community Programs Margo Webb calls this trio “invaluable” because of their expertise and their willingness to ask deep questions across our community.

Why does the guide focus on substance use AND mental health?  

Data show that people with mental health illnesses may be more likely to experience Substance Use Disorder, too. A “co-occurring disorder” is when someone has to navigate substance use disorder and a mental health illness at the same time. SAMHSA estimates that 21.5 million Americans experience co-occurring disorders.

RHHD’s Clinical Social Worker Supervisor, D’atra Franklin, has experience working with people experiencing substance use disorder. “Many individuals turn to substances as a way to cope with untreated mental health issues, leading to a cycle that exacerbates both conditions,” she explains. By integrating mental health treatment into SUD interventions, we can improve outcomes, reduce stigma, and allocate resources more effectively. Ultimately, recognizing and treating these co-occurring disorders is essential for fostering healthier populations and reducing healthcare costs in the long run.”

What does the guide do?  

Margo says that the guide is useful for people who need a combination of substance use and mental health resources: “Because substance use and mental health run together for many reasons, it can be hard to distinguish how best to treat those things. We need to untangle what mental health means for each individual and to understand the landscape of what’s available. The guide attempts to lay out some of those steps.”

Why does public health need to focus on mental health?  

Margo explains that mental health connects to other CHA priority areas like community safety and chronic disease. “There are so many ways that mental health permeates our society,” she says. “All crises in my opinion have multiple layers. Your individual situation affects your family. When enough families are affected, that’s a neighborhood. Mental health threads through the fabric of humanity, so it’s definitely in our wheelhouse.”

“In public health, we always talk about holistic health, so that means everything—head to toenails, inside out. I think mental health is definitely public health.”

How can I get involved?  

For Margo, the guide is an important first step, but it “can’t always capture the reality of the process.” As RHHD embarks on Community Health Improvement Planning, resident participation can help us learn what is and is not working for our community members. “Starting with people is always the best place to begin,” Margo says.

Do you have ideas about how to support community mental health or how to reduce the impact of substance use disorder? If so, you can join RHHD’s Community Health Improvement Planning Committee by filling out this interest form!

Take action: Adolescents can have their own mental health challenges. Cindy recommends opening conversations with young people in your life in a patient and non-judgmental way: “A simple ‘how are you feeling?’ or ‘what’s on your mind?’ can be the start of a breakthrough.

Cindy Pulido is one of RHHD’s newest staff members! She joins our Population Health team as the Adolescent Health Coordinator.

Tamara Jones, the Population Health Manager, says that Cindy will be working closely with RHHD staff and community partners to design programs and initiatives focused on promoting the health and well-being of adolescents through the City of Richmond: “Cindy brings a wealth of experience, including implementing evidence-based interventions, grant writing, research, and extensive leadership in health programs. Her diverse background and expertise will be invaluable as we continue to strengthen the Adolescent Health Program!”

As Cindy settles into Adolescent Health and life in our region, she shares a bit about her journey here and what’s next:

 

Cindy’s family and hometown steered her toward public health.  

Both of my parents are from Mexico and moved to Washington state for a better life and to work in agriculture. I grew up in a small rural town that didn’t have a lot of access to opportunities or a sense of networking.

I knew I wanted a job that would help my community, because my family and I struggled to access health care. Seeing my family having to navigate those systems, I felt like I had to help even when I was younger. I wanted to be a nurse growing up but public health classes shifted my focus. They made me realize I’d already been doing some of this work all my life. Public health showed me how I could take on a bigger role and reach the community.

 

Cindy thinks adolescent well-being is key to public health’s mission.  

I like that public health is usually preventive. Instead of dealing with the aftermath of a problem, it’s often about fixing the problem before it even starts. Adolescent health focuses on that preventive care. We’re thinking, “while youth are in this transitional stage, what resources can we provide, what programs can we help create, what relationships can we help build when these young folks are just trying to figure it out?”

Just take yourself back to when you were an adolescent and remember how hard the day-to-day was. And if it wasn’t hard for you, imagine it being harder if you’re dealing with problems adolescents shouldn’t have to be dealing with, like if a family member is going through Substance Use Disorder. That time of being an adolescent is so crucial to creating your path in life. I love being able to nourish the adolescent population and give them whatever they need to thrive in whatever situation they end up in. They’re all so unique—you have first generations like me, who might have struggled with parents who never went to high school, not really knowing how to navigate homework help. You might have people who are dealing with domestic violence at home. We’re trying to focus on every young person’s health and wellness. These are our future workforce, our future leaders, so it’s really important to focus on them.

 

Cindy sees youth confronting unique and urgent challenges.  

We can all agree that mental health is a huge topic that we need to work with collaborators to address. Vaping and fentanyl are both big issues, not only within our youth, but with older adults in their lives who might be struggling with addiction.

I’ve also been realizing that some our high schools have lower graduation and college readiness rates. I’d love to find ways to bring more attention to life after high school and preparation for it during high school. We need to help youth get the resources and confidence they need to successfully make that transition.

And the access to social media now can have positive and negative impacts on youth. Seeing all these things on the internet, like people living “perfect lives,” could make you feel like you’re not good enough. It can affect your ability to focus, your confidence, and that can all contribute to mental health.

One thing that’s wonderful about working in Richmond is that there are a lot of resources for adolescents who have expressed interest in mental health services. Traditional therapy services can be located through organizations like the Richmond Behavioral Health Authority, and there are alternative therapeutic experiences like artistic expression (Art 180 is a great example!)

Right now, our team is working closely with the schools to educate and provide presentations on fentanyl and naloxone use. Our goal is to be another wonderful resource cultivating safe environments in which adolescents can seek help. We will be working with community partners as well as with the youth themselves to push back on these barriers our young people face!

 

Cindy answers our teen-focused lightening round!  

• • Favorite high school fashion trend: Skinny jeans and hoodies.
  • Most likely to be on the car radio: Drake.
  • Favorite school subject: I loved the challenge of math.
  • Best afterschool job: Working at the movie theater. There wasn’t much to do in my town, so people hung out there. I always knew the tea!

Cindy Pulido, RHHD’s new Adolescent Health Coordinator!

RHHD recently welcomed a new Tuberculosis outreach worker: Mario Martinez!

Mario has been part of the RHHD team for years. He previously worked in COVID-19 containment and as a Community Health Worker (CHW) in the Southwood Resource Center.

Tuberculosis is a contagious illness that can affect the lungs and other parts of the body. TB is treatable, but treatment takes a long time and can be more complicated if you’re experiencing chronic diseases like diabetes.

Mario’s teammates say that he is already skilled at helping people through the testing and treatment process, especially if they have a chronic disease or speak Spanish.

Public Health Nurse Gabrielle Alvarez shares that “Mario has already surpassed our hopes for a much-needed TB outreach worker. Our work with tuberculosis relies heavily on trust, and he has already formed a close working relationship with all of our active patients and their families. Why? In large part because he can relate to our clients as a native Spanish speaker, gathering the nuances of our patients through face-to-face communication. I also believe it’s because he holds himself in a dignified way that just emanates openness to helping our clients with their complex social issues.”
Gabrielle has watched Mario help patients access and develop a regular schedule for the TB treatment while offering support refilling prescriptions and even locating housing and employment resources. “Untreated active TB is both highly fatal and highly contagious, putting the community and the patient at serious risk,” she says. “Mario very well may be the reason these two patients do not succumb to their disease. He has also contributed to containing tuberculosis in our population at large in a way that we will never be able to quantify.”

Below, Mario explains how his background and training have led him to making this impact in TB work.

Mario continues to think like a Community Health Worker. 

When I started as a CHW, I didn’t know much about the position or what my responsibilities were going to be. As I learned more, I realized, I’ve been doing this my entire life, with my aunts or with my mom, advocating and translating for them. As a teenager, I felt like it was my obligation to help family members or friends. Going into a doctor and explaining what my mom was feeling was uncomfortable at times. I felt the pressure of not leaving anything out and making sure my mom understood.

As a CHW, you’re trying to help people make appointments and take care of themselves, which can be hard for members of Hispanic communities. When you tell someone, “You have diabetes, or you have any chronic disease,” there can be a mentality of “whatever happens will happen.” That goes hand in hand with mental health. We don’t talk enough about the trauma that we’ve experienced as immigrants in leaving our country behind. That’s something I learned in CHW training. People wait until a health issue is extreme and they reach the limit and then they have to go. The barriers to accessing care aren’t always transportation related. I try to step back and let people express what they need before I jump in, and then I help when there are steps that could take a long time for someone to do by themselves.

He knows how much representation matters.  

There are a lot of non-native Spanish speakers who do a great job translating and advocating for Spanish-speaking patients, but it’s not quite the same as working with a native speaker. It’s important to have Hispanic employees and native Spanish speakers, because we have been through similar situations and can relate without judging. When I talk to clients, they start opening up and telling me a little bit more about things not just related to TB. And then I can connect them to other resources.

When we see someone who is familiar, we immediately feel a sense of relief. I know I can ask the questions I have to that person. More inclusivity in medical and health department staff matters.

It’s important to have someone who can explain next steps and risk factors clearly and calmly.  

When I meet with a patient who has tested positive for active tuberculosis, I explain how TB works. That communication is especially important for patients with conditions like diabetes, for example. It’s important for people to manage their diabetes in order have the best results from their TB treatment.

I’m honest and upfront about explaining the risk but also try not to scare people. I explain what can happen if they don’t follow treatment or if they don’t give the health department accurate information.

Above all, Mario says, he relies on slowing down enough to check for understanding and going deeper into questions. If, like Mario, you’re invested in community health and well-being, here’s how you can get involved:

• Consider CHW training. Mario says that training can “put a title to things you already know so that it makes more sense.” His training makes it easier for him to connect his current clients to other resources. Learn about training options through the Virginia CHW Association.

• Join the RHHD Community Health Improvement Planning Committee! We can live in communities that take more steps to prevent and manage chronic disease with your help.

 

Health Literacy Check: Find and share information about tuberculosis in Arabic, Ukrainian, Spanish, and Amharic! 

 

Mario (front right in sunglasses) celebrated Southwood Resource Center’s recent anniversary with RHHD teammates!  

RHHD’s Community Health Assessment (CHA) revealed three major areas where residents saw big health challenges:

• Community Safety and Violence Prevention
• Chronic Disease
• Mental, Health, including Substance Use Disorder

Today, we’re focusing on Chronic Disease. CDC defines chronic diseases as “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living, or both.” Chronic diseases can include heart disease, cancers, and diabetes. More research also includes Long COVID as a chronic condition.

In honor of Health Literacy Month and National Health Education Week, we’re spending time today with staff who help residents learn about and prevent chronic disease. We’re especially grateful for staff who work in multiple languages to share important health information with our communities. Keep an eye out for resources you can share in languages other than English!

Do you have ideas about how to reduce the impact of chronic disease in our communities? If so, you can join RHHD’s Community Health Improvement Planning Committee by filling out this interest form!

Preventing heart disease one blood pressure reading at a time

Health Literacy Check: The American Heart Association has great multilingual resources on blood pressure! Find and share information about blood pressure in Arabic, Vietnamese, Spanish, and Chinese.

Yovaldi works to keep communities informed about high blood pressure.

In the United States, almost half of all adults have high blood pressure, or hypertension. Only a quarter of these adults have their blood pressure under control through medication or other management. High blood pressure increases your risk for heart disease, heart attacks, and strokes, which is why it’s such an important vital sign.

At RHHD’s Southwood Resource Center, Community Health Worker Yovaldi Lamoutt wants to make sure all residents know their blood pressure. At community events, she helps people take and record their blood pressure. If someone has high blood pressure, she loans them a blood pressure cuff and teaches them how to use it correctly.

Yovaldi’s passion for preventive health—steps you can take to care for yourself before you get sick—comes from watching her mom deal with chronic disease. “Now, I really advocate for people to take care of themselves, to work out, to eat well, and to check signs like your blood pressure.” Yovaldi shares tips for getting started:

• Learn your blood pressure. You can have your blood pressure checked at an RHHD resource center, at a regular doctor’s visit, at a local pharmacy, or even at a Richmond Public Library location! If you have high blood pressure, you may need to monitor it more regularly.
• Understand your numbers. The charts below explain what counts as a normal reading and tells you when to reach out to a healthcare provider immediately.
• Take action. If you have elevated or high blood pressure, Yovaldi says it’s “important to follow up with the doctor for a diagnosis and medication if you need it.”

Yovaldi works to keep communities informed about high blood pressure.

RHHD’s Community Health Assessment (CHA) revealed three major areas where residents saw big health challenges:

• Community Safety and Violence Prevention
• Chronic Disease
• Mental Health, including Substance Use Disorder

Today, we’re focusing on Community Safety and Violence Prevention. RHHD Violence Prevention Coordinator Lorraine Wright explains a bit about what these terms mean and why a health department needs to focus on them:

Safety and violence are broad public health issues.  

During the summer of 2024, U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis in America. Firearm violence impacts public health because it causes injury and death and because it can impact the mental health and well-being of entire families, neighborhoods, and communities.

“If we look at violence from a public health lens, it’s a way to do our communities the best service,” Lorraine explains. “The CHA helps us focus on violence that’s happening in so many ways. When we talk about firearm injury and death, that’s not all of it.”

342 survey respondents—or approximately 28%–reported that they or family members had been impacted by violence. These instances of violence included firearm injury, domestic violence, physical fights, breaking and entering, and mental or verbal violence.

Community violence does not impact us all equally.  

Lorraine says that RHHD teams reached out to communities across Richmond and Henrico to fill out the CHA. As a result, we can see that some neighborhoods have experienced more violence. “Violence is often happening where poverty is the highest, where the resources are the lowest. People are providing an honest perception of what’s happening in their lives.” Because public health cares about population level well-being, we want to make sure that all residents have the opportunity to live safely in our communities!

Together, we can work on solutions.  

Lorraine says that the CHA “helps us to maintain focus on the most important issues.” And because it focuses on community voices, it reminds us that we need to develop solutions together. “We need to build resilient communities that understand how to resolve conflict, how to ask for help when they need it, how to rely on each other.” Lorraine says. “If we can put our heads together, that’s when the magic happens.”

If you want to “co-create” these next steps, join our Violence Prevention and Community Safety steering committee! Just fill out this interest form.

Teach it back 

• Why is Violence Prevention and Community Safety a priority area in the RHHD Community Health Assessment?
• How do you define violence? Why don’t all residents experience violence equally?
• What is the next step you can take to help RHHD address Violence Prevention and Community Safety?

Read more about the CHA Findings: