One of the good things about being small is we communicate very effectively. A lot of sharing goes on.
Jim Hinebaugh, commissioner
2017 RWJF Culture of Health Prize Winner
A Community Holding Hands to Bridge its Divide
Tucked between Pennsylvania and West Virginia on the far western edge of Maryland’s panhandle, rural Garrett County (population 29,460) is a study in contrasts. Driving along one of its few main roads on a cool summer day, one passes fast-food restaurants and aging strip malls, small family farms, a big box store. Then a valley opens up on either side, bathed in Appalachia’s green beauty.
Up at Deep Creek Lake, in the heart of the county, multimillion-dollar homes and fast-multiplying condos fuel a more than $300 million tourism economy. Meanwhile, many county residents work seasonal and low-wage jobs at tourist-friendly restaurants, hotels and resorts, and the county faces a child-poverty rate of 19 percent, compared with 14 percent of all Maryland children. Dependent on industries such as health care, light manufacturing and farming, in addition to tourism, Garrett County’s median household income is about two-thirds the state average.
To address the challenges and bridge economic, cultural and health divides, Garrett County has capitalized on a deep-rooted strength: Everyone seems to know everyone, and neighbors care for each other and band together. That community spirit has brought about a robust, data-driven health planning process focused on reducing disparities in housing, education, employment, income and health care so that all residents can thrive. This small town spread across farmland and country roads has found a way to enable every high school graduate to attend community college for free and has raised $4.9 million to build a cancer center in its county seat.
The county’s health planners have drawn in the most vulnerable residents—including those struggling with intergenerational poverty, chronic disease, and housing instability—county leadership, and health care and social services partners. They are encouraging participation and tracking progress using an online planning tool, MyGarrettCounty.com. The multifaceted collaborative effort has earned the county a 2017 Culture of Health Prize.
“One of the good things about being small is we communicate very effectively,” says County Commissioner Jim Hinebaugh. “A lot of sharing goes on.”
One of the good things about being small is we communicate very effectively. A lot of sharing goes on.
Jim Hinebaugh, commissioner
Working Together for a Healthier Tomorrow
Learn about a similar community in Vicksburg, Mississippi, where educators are on the frontline of improving the city’s Culture of Health.
When Garrett County, Maryland, native Shelley Argabrite says, “This is truly a community of caring,” she’s speaking from experience. Like many, due to unfortunate circumstances she experienced poverty as a single parent. Her resilience combined with assistance from the people in service agencies in the county helped her navigate the difficult situation, providing her family with, among other things, healthy food and a homebuyer’s grant that helped them secure a more sustainable future.
Now she's paying it forward. As the strategic health planner at Garrett County Health Department, she’s working to address the county’s most pressing health needs, in part by gathering input from those who struggle as she once did.
That “leave no one behind” attitude pervades in Garrett County and has led to creative solutions aimed at expanding opportunities available to residents. When Commissioner Jim Hinebaugh, then the county’s director of economic development, proposed starting four scholarships at Garrett College about a decade ago, the county’s Board of Commissioners rebuffed him. But not for long.
“They said, ‘That’s going to make four people happy and a lot of people mad,’” says Hinebaugh, a county commissioner since 2014. “So I did the math. If we offered free scholarships to all for two years of community college, it would be one cent on our tax rate.”
Hinebaugh’s eureka moment generated a scholarship program that enables Garrett County residents with a high school degree or GED to attend the college for free if they study full time and maintain a 2.0 grade-point average. The program will soon expand to include non-traditional age students.
“It was absolutely instrumental to me,” says John Corbin, public affairs specialist at the Garrett County Health Department, of his scholarship, which meant he spent only $15 on a parking permit during his two years at Garrett College and graduated debt-free. “[Community college] is basically unaffordable to a lot of residents without the scholarship.”
If education is at the center of opportunity building in Garrett County—1 in 5 residents has a bachelor’s degree or higher—so too is chipping away at poverty. The county’s 2-G, or two-generation program, which aims to improve outcomes for children and economic security for families, has been lauded by many, including Maryland Gov. Larry Hogan. This year, he moved to create a commission that will study the approach as a model for the state.
“At the heart of the two-generation approach is the idea that you work with children and families simultaneously, but you do it in a way where your services are really integrated,” says Duane Yoder, president of Garrett County Community Action, a poverty reduction nonprofit. Families work with staff to develop a “pathway plan” that includes at least one goal related to education, employment or financial management.
To leave poverty behind, families need places to live and ways to get to work. So Garrett County Community Action and its public and private partners have developed 700 affordable, low-income, mixed-income and workforce housing units. And the county’s Wheels to Work program helps families afford a used car, since Garrett, like many rural communities, lacks traditional public transit.
In every endeavor, the people of Garrett County are important partners.
“We work as a team with families,” says Barbara Miller, vice president for family economic security at Garrett County Community Action. “We listen to what they feel they need in their lives.”
We work as a team with families. We listen to what they feel they need in their lives.
Barbara Miller, vice president for family economic security, Garrett County Community Action
Steve Knepp is a rare sort of early childhood educator: one with a commercial driver’s license. He needs it to drive a specially outfitted, wi-fi enabled school bus—carrying books, toys, craft and science supplies, and computers for the grown-ups—across Garrett County, Maryland.
At each stop, Knepp is joined by teachers who offer hands-on activities, a read-aloud session, tips for parents, and referrals to developmental screenings and academic services. Family service providers link families to financial and employment assistance, mental health and substance abuse programs, and other services. Children and their families leave the bus with a free book and bag of groceries.
“The bus is one of the main ways we’re able to connect with families we were never able to reach before,” Knepp says.
The Learning Beyond the Classroom bus belongs to a constellation of traveling services Garrett County has put in place to shorten distances for residents in an area where roads are sparse and population centers dispersed. Many towns lack grocery stores and gas stations, and the county has no public transportation system, though nonprofit social service provider Garrett County Community Action runs an on-call van.
But if you want fresh produce, farm cooperative Garrett Growers will deliver through its Veggie Box program, with about half of subscriptions sponsored by nonprofit and government agencies for low-income families and individuals with chronic diseases. The county’s Meals on Wheels program, run by Garrett County Community Action, brings seniors and the disabled both daily food and regular health care in the form of a nurse’s visit every six months. And the nonprofit is working with Garrett Regional Medical Center on a pilot project that would deliver patients a month of meals after discharge.
Reaching out is a formula the medical center has found success with already. It matches patients at high risk of readmission with nurse navigators, social workers and community health workers, who coach them through recovery over the phone and at their homes. Today, the center has the lowest readmission rates in Maryland.
Many community health workers have walked in the same shoes as their patients as they manage chronic conditions themselves. Community health worker Ed Kight has lost 30 pounds and quit smoking since being diagnosed with Type 2 diabetes two years ago.
“I’m able to tell my patients that if they put their minds to it, they can make healthy changes,” he says.
Through the health department’s nurse home visiting program for new moms, Sonya Kisner was able to see that her baby — now just over a year old — was developing and growing well. Her nurse also helped her set and achieve goals for herself, such as finishing her high school degree online and getting a driver’s license. This year, she’s starting higher education courses to be certified as a veterinarian assistant.
Going to people can, in some instances, make up for limited resources, says County Health Officer Bob Stephens.
“What we have, we make it work,” he says.
A school district in a similar community in Allen County, Kansas, uses MARV to bring nutritious food and books to kids.
I’m able to tell my patients that if they put their minds to it, they can make
Ed Knight, community health worker, Garrett Regional Medical Center
Of all the difficult questions children have asked Crellin Elementary School Principal Dana McCauley, this one about a stream behind her Garrett County, Maryland, school has proved the most fruitful: “Why is that water orange?”
The answer, she would later learn, was acid leaking from an abandoned coal company site. But understanding the source of the discolored water was just the beginning.
McCauley and her staff saw in the then-state-owned property a sow’s ear that could be turned into a silk purse. In 2004 they worked with the state of Maryland and the community to clean up the creek and soil, acquire the property, and build groundwater treatment ponds and walkways. Today, the water flows clear and the school’s five-and-a-half acre outdoor learning laboratory—where students study wetlands, stock the creek with trout they have raised, and tend chickens, goats, sheep and a garden on their own farm—is nationally recognized.
“It’s opened a whole new door for what we can teach the kids,” McCauley says.
She and others in Garrett County are increasingly taking advantage of the area’s natural beauty and resources to bolster education, environmental health and well-being, physical activity and community cohesion.
For example, reclamation efforts involving state, federal and private entities have revitalized the north branch of the Potomac River, which draws the border between Garrett County and West Virginia. Twenty-five years ago, it was declared “dead” because of acid drainage.
“Everybody worked together to clean it up,” says Mike Dreisbach, president of the nonprofit Garrett Trails and owner of Savage River Lodge in northeastern Garrett County. “Today it’s one of the best trout fisheries on the East Coast.”
Ironically, though, in this county whose lakes, parks and streams draw droves of outdoor-activity enthusiasts, about one-third of residents lack access to places where they can be physically active. Focus group participants in the county’s 2016 health needs assessment said even the few dollars it costs to visit a state park is an obstacle for some.
The county listened and responded. “We’re encouraging people to use natural resources that are free,” says John Corbin, public affairs specialist for Garrett County Health Department.
To make outdoor recreation and fitness more accessible to all, Garrett Trails is working to complete the Eastern Continental Divide Loop. The series of multi-use, multi-surface trails will connect Garrett County’s 76,000 acres of parks, lakes and forests with towns such as Grantsville, Oakland, Loch Lynn Heights and Deer Park. Local governments are working on plans to build sidewalks and recreational trails, linking historic sites, low-income housing and town centers.
A health department grant will enable Garrett Trails to place people-counters along existing trails for a 10-year study of how people use the trails—where they go, how long they walk or bike. The health department is also surveying residents to identify the existing barriers to physical activity and to understand how people are using trails and sidewalks.
The county’s harsh winters—average snowfall tops 100 inches a year—remain a tough nut to crack. So the county is working toward having more indoor activities at senior centers and schools. And the six-year-old indoor Community Recreation and Aquatic Center at Garrett College is open to the public—residents, students and tourists—year-round, with sliding scale membership fees and breathtaking window views from the indoor pool of the surrounding mountains outside.
We’re encouraging people to use natural resources that are free.
John Corbin, public affairs specialist, Garrett County