Health councils, facing funding loss, provide boots-on-the-ground approach

Feb. 6—When Timothy Eric Bailon was hired in 2021 to run point on a program trying to cut back on the risk of elder falls in Santo Domingo Pueblo, a single memory came rushing back to him.

It was from 2016, when Bailon was working a stint as a tribal official on a team of first responders to incidents like deaths and domestic disputes. Bailon, born and raised in Santo Domingo, got a call for a welfare check at the home of a man who was around 80 on the west side of the pueblo. The man had a family — he was the grandfather of Bailon's godson — but was independent and liked to stay by himself, Bailon said.

Bailon, the first to enter the home, found the man's body.

"He was trying to put on his pants," Bailon said. "He fell and hit his head right at the corner of the coffee table that he had."

It was the only time in recent years a Santo Domingo elder died from a fall, Bailon said, but "one was too many."

Today, Bailon's job centers on preventing that from happening again, both by installing safety equipment and by teaching tai chi to seniors to improve their balance and stability.

His tribal injury prevention program is one of several that falls under the Health Organization Partnership Advisory Coalition — Santo Domingo's health council. It is one of 42 rural and tribal health councils in the state, originally created to address maternal and child well-being more than three decades ago.

The councils — facing a federal funding loss — now work fairly independently to tackle health issues in ways unique to each community's cultural, political and resource landscape. They also keep tabs on their communities' needs and provide ground-level information to the state and other local entities.

Lawmakers are considering allocating $6.6 million to the health councils as a grant from the federal Centers for Disease Control and Prevention, which provided a pandemic-era boost, prepares to sunset. The state now provides the councils with about $15,000 each per year; the funding proposed in House Bill 67 would put that figure closer to an average of $143,000 per year.

Bailon works with contractors to install handrails, ramps and motion detector lights in elders' homes. He talks to elderly Pueblo people about what kinds of questions they can ask at doctor's appointments. He and another person also teach tai chi classes, including one-on-one lessons in elders' homes.

Some older residents have even taken to calling the 47-year-old "tai chi guy."

"The response is ... sometimes overwhelming," Bailon said. "Right now I have 84 clients that have been referred, and more of them are coming."

Assessments done before and after the tai chi program show it's working, Bailon said — elders who go through the training are showing greater balance, strength and agility after several weeks of classes.

It's the kind of boots-on-the-ground work that's typical of New Mexico's network of rural and tribal health councils.

Advocates say the health councils are indispensable to the communities they serve.

"Health councils are literally ... a lifeline of community members connecting them to the resources they need," said Valeria Alarcón, executive director of the New Mexico Alliance of Health Councils, noting the House Appropriations Committee has allocated $3 million in the state budget bill that is now heading to the Senate for the groups. "Health councils are health equity in action."

Varying types of work

The work and scope of each health council varies widely. In Santo Domingo Pueblo, another, newer grant-funded program focuses on homelessness among residents, said community health representative Iris Reano.

"The team, they do outreach services and they go out into the urban population," she said, adding the team looks for people from Santo Domingo living on the streets in Albuquerque and Santa Fe. "What they're doing is they're giving them resources ... to put them back on their two feet."

The team helps tribal members who don't have a tribal identification access federal food aid or Medicaid applications, make doctors appointments or fill out job applications.

Part of working with a health council is understanding the community's values, said Adrian Ortiz, the program manager for the Partnership for a Healthy Torrance Community.

In "very conservative" Torrance County, some of the council's projects include giving out gun locks, "lock-bags" for cannabis — a spin-off of lock-tops that keep kids from getting into pill bottles — and doing work around drug abuse issues, like training on Narcan, which reverses opioid overdoses, Ortiz said.

Some projects have met with pushback, he added.

"When we first came out, our community said, 'Nope. We're not druggies,' " said Ortiz, who grew up in Torrance County.

His team pushed back against stereotypes of what types of people might need Narcan by being persistent and offering specific scenarios that could happen.

"Well ... what if grandma, who's raising all these grandkids, has some pain pills lying around and your grandchild happens to pick those up and overdoses on them?" he said. "At least they'll have this Narcan to revive them."

Over time, and as residents started to see the effects of opioid addiction in their own community, the resistance ebbed away, Ortiz said. He has since done trainings throughout local schools and many in neighboring Lincoln County.

"We have a lot of people asking for it," he said.

Using what's there, filling gaps

Some health councils serve more as coordinators to get different organizations talking to each other to solve problems using resources at hand.

Tana Beverwyk-Abouda, coordinator of the Rio Arriba Community Health Council, said there's no shortage of groups doing community work in the Española area.

"The health council is not a service provider; it's a collaboration of service providers," she said. "It's the only chance for all the nonprofits and the for-profits and the volunteer community person for the homeless shelter once a month, or whatever, to come together and coordinate."

Recently, the council's food action team raised a concern about delivering food to the more far-flung communities, like Cordova, Truchas, Coyote and Gallinas. Representatives of the North Central Regional Transit District, which runs the Blue Bus system throughout the region, also attend council meetings, and have routes in or near those small communities.

"So right now, the food action team and the transportation experts are trying to figure out if there's some way that some boxes of food can be put on the buses when they go on their routes to the rural areas," Beverwyk-Abouda said. "If it wasn't for the health council, the possibility of the Blue Bus being able to help with distribution somehow never would have happened."

Health councils can also fill some practical gaps, said Sam Winter, coordinator of Socorro County Options, Prevention and Education.

The New Mexico Department of Health, for example, distributes naloxone, or Narcan, she said. But people who are illegally using opioids — the people who most need access to Narcan — are sometimes hesitant to go that route.

"They have to basically fill out a form and put their name down on that form, which honestly is a huge barrier for a lot of our constituents," Winter said. "We are able to dispense Narcan to anyone in need ... with training."

Health councils also perform community-level health assessments that inform statewide plans from the Department of Health and provide other efforts to holistically address major health problems in the state, Alarcón said.

Those assessments recently showed behavioral health is the most pressing issue in most of the state.

"It intersects with substance abuse. ... It also intersects with homelessness. It intersects with gun violence. It intersects with domestic violence and violence in general," Alarcón said. "We can't be myopic about these things."

'How much community change we could have'

Many of New Mexico's health councils operate on shoestring budgets and focus narrowly on a couple of issues.

The CDC grant funding that's expiring this year gave health councils a cash infusion that was specifically for pandemic response efforts and lasted three years, Alarcón said. Health councils around the state sprang into action with the funding, distributing personal protective equipment, delivering food and water, coordinating vaccine clinic sites and helping rural residents get registered to be vaccinated.

With the grants ending, "it's a crisis situation" for health councils, Alarcón said.

Having a solid stream of funding can make a world of difference for health councils, said Winter, whose council board worked several years ago obtain a 501(c)3 tax-exempt nonprofit status. That vastly opened up the types of grants it was eligible for, boosting the organization's budget from $32,000 when Winter was first hired in 2019 to roughly half a million dollars today.

The council now has a dizzying array of programs it's working on. With three staff members and funding for two more vacant positions, Winter's team does youth outreach for drug abuse prevention, senior falls prevention work, Narcan distribution and training, medication disposal, mental health and 988 suicide prevention awareness and more.

"That's the only way we're able to implement all this programming," she said.

Winter said she recommends other health councils consider converting to a nonprofit, and she hopes state lawmakers support state funding for the councils.

"A lot of these other councils do not have a half-million-dollar budget," Winter said. "If every health council was given the same level of funding that SCOPE is given, can you imagine how much community change we could have?"