#1,068 Community Health & What Can Be Done with Angie Gribble

0:00And you, Rebel God, blessed how are you? I'm good. Thanks, Matt. Good to be here. Good to have you here. I'm sorry. I've been babbling for like the last 30 minutes. It's been great. It's been great. I'm sure. Um, you are the senior director at St. Luke's for Community Health and Engagement. Yes. Okay. You guys every few years aggregate a whole lot of information about our community and say, okay, these are our community needs. This is what we're hitting. This is what we're missing. This is what's developing. This is what we've got. You know, hold up all these things and you compile them and figure out, okay, what is the direction or where can we improve or what can we do? But again, obviously very important for your organization. But incredibly insightful about what's actually going on within Idaho's community. Yep. I've obviously been very concerned about substance abuse and you know, do you remember at the beginning

1:00of like mid 2020, there were those, there were those videos on social media where like the guy like going for a run down the street and they were the recycling containers outside who was just overflowing with like bottles. Yeah. And he's like, he's Thursday. Yeah. Yeah. Twelve handles and he's like, every single bin is filled with bottles. And although that was really funny at the time, I came to understand it's like, oh, this is really bad. Like people are really, and myself included, it's like people are really struggling and they're like, we kind of laugh about it. But it became this, you can only see people if you're essentially like drinking outside with them. There was no real connection. People became estranged from each other. We lost our community and that led to a lot of, you know, maladaptive social behavior, like drinking and drug abuse and things like that. I've been really worried about that since I had that experience and then obviously we have a mental crisis. We have a lot of different things going on. So I asked you to come in because I'd love to know what is essentially trending within our communities as far as health where St. Luke's is doing well, where they, where we

2:03all could potentially do better. Yeah. Just all of it. Yeah. Well, think, yeah, things were having me. Yeah. So our community health needs assessment or CHNA, we call it for short, is a process that we go through every three years. So it's a formal way to your point to collect data in our communities on what are the conditions and experiences that people are having right now that are impacting their health and well-being and then we use that information to create plans of action. So most recently we published in June, just this past year, so June of 2026 and we found that consistently across the communities that we serve, those needs bubbling to the top in our communities were housing, mental and behavioral health, which includes substance use disorder and access to care. So those are needs that are really actually not new to our area. We saw those same needs in 2023, the last time we did it and they're continuing to be challenges that our community is telling us, this is what we're struggling with, this is what we need help with. Can you provide us some resources and some help?

3:03So, yeah. Okay. Got it. So housing, essentially substance abuse and access to care. Yeah. Mental mental health and substance use. Gotcha. We couched that under what we call behavioral health. Oh, yeah. It's really those two components, mental health and substance use disorder. Got it. Okay. When, if we break this apart, let's start with housing because housing is obviously a big consideration when people are saying, hey, look, our community needs are housing. Is that, is that articulating like, okay, we have a certain number of homeless people and those people surveyed are saying our community needs is housing or is that people that are housed? Also saying, look, we need other housing. We need other housing options because I've gone through periods of time where, you know, my former house was, I was happy to have the house, but it was not that big. Yeah. And I had, I was raising three boys and we had, you know, a smaller backyard. And then when we lost common spaces outside, like parks and whatnot, it became a real, real problem where it's like, oh my gosh, this house is not working.

4:03Like these three monster children are, you know, bouncing off the walls. It created unbelievable stress for, for my wife and I. Like it was really, really intense. So is it, are you articulating that it's just homeless people or is it literally families that are like, listen, we are a family of five living in a two bedroom and that is causing a certain amount of stress and, and difficulty within our family because we need a three bedroom or four bedroom house or something like that. Yeah. So the data we captured, we use both community surveys, focus groups, interviews with key leaders. We had enough data on that side that we can feel really confident in the community voice that we heard is representative of the community. So we use that data. We also use data from national publicly available courses to say, what are chronic diseases out there and all those kinds of things. We kind of couple all that together. Sure. In our surveys, we didn't ask questions necessarily around people experiencing homelessness specifically, but we did ask questions like, do you agree with this statement?

5:05There are affordable places for everyone in my community to live. And what we found is greater than 75%. You know, sometimes over 80% of those survey respondents, and we had almost 10,000 people complete the survey. So 75 to 80% said, no, I disagree or strongly disagree that there are affordable places for everyone in my community to live. So you have strongly agree, agree, unknown, disagree, strongly disagree and get the hell out of here. 75 to 80% mark at the hell out of here. 75 to 80% from the pretty much. You know, yeah, they were on that side of the voting, but disagree and further said, no, there's not affordable places for everyone in my community to live. So I imagine they were thinking about those in their community, literally experiencing homelessness, but also people who are living paycheck to paycheck, people who are not able to afford the costs and rents of housing right now. So I think they were thinking across the spectrum in that question.

6:07You know, on the other side of the data we looked at was a term we call housing cost burden, which is households that are spending greater than 30% of their income on housing costs. And that's kind of a threshold that said, hey, if you are spending more than 30% of your income on housing, you might be getting to where you are at risk of affording your other basic needs, whether that's food, transportation, healthcare, childcare, if you need it. And if you're having to make decisions or compromises in any of those places, because housing is pulling so much on your budget, your health could be compromised. So looking at kind of that statistic based on, you know, median incomes and housing costs, it tells us how many people are cost burdened when it comes to housing and hearing directly from community members. Yeah, there's not affordable housing for everyone in our community. That's what kind of brought housing to the top for us. That's that's a wild one. The housing, the housing question has, I don't know, like a whole lot about these topics, but the housing question has also brought different problems to the table and different conversations

7:13that have like, like let's say somebody, if there's an abundance of housing and there's plenty housing for people, then like people effectively choose where they live. So like, okay, look, I want to live, you know, on East Boy C, I want to live in Namb, I want to live in Caldwell, I want to live in part, where you live wherever you want to live, right? And you live with suits your lifestyle, but if there's a lack of housing, right, then you start detaching people from one where they want to live and two where they need to live for economic inputs, right? Yeah. So if you have an economic, let's say you can make the most money across the spectrum in whatever job, be that a barista or a CEO in Boy C, okay, but you have an insufficient amount of housing, affordable housing for that entire spectrum of work. At the CEO's can afford to live in Boy C, but the barista's can't afford to live in Boy C, right? So that means then that you have people that are now driving from outside of the area. So it's like, okay, I'm a barista. I make 22 bucks an hour in Boy C, but I have to live in Namb to do that. And by the way, now I have an hour commute both ways because my barista hours around the

8:16hours of community, whatever it might be, that also puts strain on not just, you know, what you enjoy doing with your family, but if you have kids or, you know, whatever it might be, then you start having to deal with like daycare, you're extending daycare hours, you're decreasing availability for daycare because if you get off a certain time that day care is always closed, like all these different things. So when you talk about enough housing, it's been explained to me that it's like, hey, man, it's this big cascading train wreck. Yeah. It's not just the dollar amount. It's what people are going to have to do to make ends meet. And again, I'll do what to make ends meet too, but that leads to a lot of decisions that could increase a lot of problems or potential problems for families trying to work around this. Yeah, absolutely. I mean, we make the connection of housing and health. There's kind of four components we consider. One is stability, right? Is your housing stable? Is it secure? Because if it's not, we know the stressors that that can cause or the movement that it may cause.

9:16So stability of housing can impact your health. Quality of housing. So does it have a plant-equipped plumbing? Does it have mold? Because that impacts your health. Sure. It's your point. People may be having to compromise and live in housing. That is not high quality because of price or not being able to live. We think about affordability. And so again, how is it pulling on your budget and then are you able to forget their things? And then the last one is neighborhood. And so where is that housing located and how does the neighborhood around that support your lifestyle? Does it mean that you need to drive an hour? Does it mean you don't have access to parks? Does it mean all of those? Do you have childcare if you need childcare within a distance? And so grocery store proximity. Exactly. So all of those components all related to housing, is it stable? Is it affordable? Is it quality? And what's the neighborhood now that you're living in having an impact on your health? And so that's kind of the components we think about as we make that connection between housing and health. And where can we lean in to make a difference?

10:17Because to your point, makes a difference for people. Okay. So how, I mean, St. Luke's is not in the housing business. Yeah. Yeah. But this was just one of those things where you're like, okay, when asked, this appears to be the number one problem. And we may not even directly have a string we can pull, but this is a problem. Yeah, absolutely. And I think that's where the questions come in. Gosh, what does health care have to do with housing? And so we have St. Luke's and other health care partners in the organization. And our community continues to tell us this is a need. And we're, we'd love health care and health agencies to lean in. We find the right partners and the right resources to be able to connect to them. And what assets do we as an organization can we bring to the table? So I know you had Dr. Vanessa Fry. Oh, she was great. Yeah, yeah. Yeah. And so multiple health care entities, including St. Luke's, leaned into that new path community housing and said, one, how can we contribute some of our data on potential? Residents of new path community housing to show those that are most vulnerable in our

11:19community, those that are utilizing emergency services, including our IDs. How can we help demonstrate impact? So we might contribute data to inform who are the folks that can most benefit from the solution. We might support those wraparound services that are there located and provided by Terry, Terry Riley Health. So do we have some financial contributions we can use to keep those services whole? So as St. Luke's and health care agencies, it might look different than that. We're not to your point delivering direct housing solutions, but no one entity can solve it alone. So we just find partnerships, opportunities with others in the community who are, that is their book of business. And how can St. Luke's or health care contribute assets, resources we might have to move those along? Hi, the first off, I appreciate all that. Like that makes a lot more sense to me. But like the NASA fry interview, just I had this like 45 minute conversation after that came out with a buddy of mine, who's from Southern California.

12:20And he was, he was like, I don't want to pay for any of those. I'm like, yeah, but you don't have a choice, right? You're going to pay through taxes, the 4500 for somebody who's chronically homeless. He's like, but this is a choice for people. Like people, I mean, like that's fine, but you don't have a choice. When they call for an ambulance, the ambulance is going to show up. If they have chest pain, they're going to the hospital, right? Or if they report they have chest pain, you're like, if there's a crime committed, law enforcement is showing up, right? And you're going to, you're going to pay for days in jail. You're going to pay for days in the ER. You're going to pay for days. All of these things, you don't have a choice. So the question is, do you, do you like the price tag of that? Or would you prefer a smaller price tag where you provide them with something that you may feel like they don't deserve? And I'm not telling you to feel any other way. I'm just saying, do you want to pay $4,500 a month or $2,500 a month? And then the conversation, I don't want to pay any of it.

13:21It's like back to you, don't have a choice. Like we're going full circle here. You know, what a like a wild thing. But again, the reason the 2500 works with, with new path is because there are services that help people, you know, again, avoid run-ins with law enforcement. They help people avoid, you know, hospital visits and things of that nature. So the idea for St. Luke's is like, okay, maybe we could help with that and, you know, help increase the amount of services that people have so they don't end up in that situation. Absolutely. I mean, the community impact and the outcomes we've seen from that housing solution here have been phenomenal, right? And we've been, as I mentioned, helping contribute data to demonstrate that impact in outcome. And we're excited to continue to support it, excited to see it scaled because to your point, the benefit is just plus, plus, plus across our communities that we're seeing. So, yeah. I really want, you know, what's interesting to, I have not heard somebody come up with a compelling answer to what we do. Okay. So we have Brian. Brian's right here. Yeah. Brian's $4,500 a day or skipping a month.

14:21Yeah. Okay. Because Brian's chronically home this person. And Brian also is very unfortunately, he's mentally ill and he's on drugs. Okay. So I don't want to spend, instead of $4,500, $2,500 to get Brian housed, get him services, all these things. People like, I don't want to do that. That's fine. What is the option? He's like, well, Brian shouldn't be on drugs. I'm like, I'm aware. Yeah. What is the option? They're like, we'll get him help. What does that mean? Institutionalize him. We can't do that in the United States. We can't force somebody into an institution. Well, then he's just making the decision to be homeless. I'm aware. It's costing you $4,500 a month. What do we do? It's like, you just go around it. He's actually presenting a viable alternative to providing treatment and housing that will cost less. They're just saying, he shouldn't be on drugs. We shouldn't enable this behavior. All these things. What do you do then? Because I understand the position. We shouldn't enable him. We shouldn't spend any money. You're going to spend money no matter what. Yeah. Sure. It is a tough nut to crack, for sure.

15:22And to your point, there are lots of understand positions and perspectives on all of it, but there's a cost for all of those situations. And so thinking through what is the best for Brian as an individual and for us as a community to be able to support Brian being safely, securely housed. I'm not going to make you a man. I don't care about Brian. Yeah. Nobody cares about it. The argument for these people, nobody ever cares about Brian, they care that they shouldn't be spending the money, which is an easy appeal to make because it's like, great, you're fiscally conservative. You're watching every single dollar. Right now, $4,500 of those dollars are going there. There's an option where only $2,500 of them go, but you have to let go of preconceived moral positions, which is we shouldn't be enabling whatever. And by the way, drugs are still illegal, whether they live in a path or not. Right. And like, anyway, it's a wild time. Yeah. Okay, so that's a big thing. Offering, offering support services. Yeah. Yeah. So that's one way that St. Luke's and healthcare systems can lean in, obviously to prevention, right? So that's why we're trying to help you to prevent prevention as a way in my capacity and

16:26where we try to work most is how do we prevent the pipeline of needing some of these crisis services for whether it's those experiencing homelessness and housing or any of the other needs around access to care and mental behavior health substance use to order. So, so yeah, we find ways that we can find solutions in the community that we can partner with other organizations that are aligned to these same community needs and try to move the needle on these really complex problems. So that's housing. Yeah. Talk to me about the behavioral health aspect of it. So this is mental health and substance abuse. Yeah. So it's inclusive of both of those because we hear both of those in the data and the community and start starting to pop up for those. A lot of it is around access to mental health and behavioral health specialists. So making sure that people have access to the care they need when they have either a diagnosis of mental illness or in crisis and needing that. Yeah. So, so we have a lot of our rural communities talked about lack of specialty services in their communities or long wait lists, extensive travel times, those kinds of things.

17:27So there is that kind of lack of care available in our community for those specific services. In addition, they talked about our youth being a population of concern. So when we hear from survey respondents and focus groups that man, we are concerned about and feeling like young people in our communities are experiencing mental health challenges in a way that we do not want them to continue or see that going away. So those are a couple things that popped in. And with regard to youth, right? They're the indicators of poor mental health around youth are multiple, but things like teen pregnancy. Teen pregnancy numbers go up. You can, that's pretty much indicative of the less healthy youth population. Something of that nature or substance abuse, obviously, is a thing. Diagnoses of self harm or eating disorders. All these things kind of indicate stress and maladaptive behavior around youth. Is that someone accurate?

18:28Yeah. So the data that we collect specifically for the community health needs assessment doesn't, it includes data of those 18 and older. So when we talk about the youth concern in this assessment, it's more of those adults we asked, what are you concerned about? And they're telling us, hey, you pay youth or someone there, community that I feel like is experiencing mental health challenges in a way that I'm not okay with. And I want to see this changed and improved. So it could be within their experiences, they have youth that are expressing depressive symptoms or anxiety symptoms. One of the things, so not formally in this community health needs assessment. Last community health needs assessment 2023, mental health popped again. And at that time, we engaged in a partnership with an organization called communities for youth. Yeah, yeah, yeah, yeah, yeah, yeah, exactly. And so they actually capture more granular data from the youth specifically around their experiences on what they call risk and protective factors. So risk factors being the things that make it more likely youth would experience mental

19:31health challenges, protective factors, meaning those things that would make it less likely. So risk factors could be things like bullying, social isolation, substance use in the home, those kinds of things, protective factors, meaning I'm connected to a trusted adult. I feel connected to my peers. And so we have been able to partner with them and use that data to dig deeper into that youth call out. Like, okay, our community is telling us they're concerned about our youth. That's something we want to keep our eye on. We need to know more to specifically target solutions. So that partnership with communities for youth where they dig deeper has told us those are some of the things we should be looking at. And that data has told us pretty consistently across communities where they've surveyed that social isolation. So a lack of authentic, meaningful connection for kids. High levels of stress are what's causing some of these depressive symptoms or mental health challenges for our kiddos. So when we think about how do we then do prevention?

20:31How do we intervene? We're looking at that. How do we build opportunities for more authentic real connections? How do we find trusted adults? How do we lower stress for kids in this achievement culture where they have to do, build as if they have to do all the things and be the best at all the things to succeed. Yeah, I got to be good at grades and the best on the sports team and do extra curriculars and volunteer. And oh, and I need sleep too. How am I going to fit that in? Yeah, by the way, keep your IG up to date. Yeah, yeah, yeah, that's it. Make sure and make sure you look good now. You're doing all of that. While I'm doing a snap of photo, yeah. Of you like throwing a football and studying on the math test and like smiling. You've done it exactly. So the way you do it. What a crazy thing. Yeah, like the pressures do have a 14 year old. And oh my god, we just actually had to get him a real phone. Okay. So now he has an iPhone. Uh huh. Not happy about it. Like it is.

21:33And he doesn't, he doesn't have any social media accounts like he's not allowed to. That's just not like none of my kids have tablets. Like they're just don't, they're not allowed to engage in that, that tech kind of world. It is just so wild. I thought, dude, I don't want to do this. I came up with a great idea by the way. Okay. Okay, here we go. How's it do with community, youth community? So youth sports, right? Yeah. Very important. Yeah. I think this is one of the great, at least it was something that really helped me develop as a person and kept me out of a lot of trouble. Yeah. And my wife and I are both avid athletes were and still are. Okay. So here's the, this is my idea. Okay. Let's hear it. Um, my son starts on the sports team and they're like, Hey, the captains send out notification on, you know, group me or something about information. Okay. Okay. Then we got to like start this group me account. We got to do all these things or of course they're posting on like social media, they like check the social media account, which is very frequent. Like people are like, Oh, I posted on Instagram about this thing. I was like, Let's make a scrubber.

22:34I was like, let's, let's make an app that scrubs specific group me accounts or social media accounts and aggregates information into one hub without showing any of the other information. So it's like, I'm part of the, you know, I don't know, Boise High School football team. Yeah. And I want you to follow this Boise High School Facebook account, Instagram account, this, you know, chat, whatever. Yeah. And scrub all the information. So if something comes up for that, it just appears on my individual feed here and nothing else, right? So you never have to open Instagram or Facebook or anything. And so you can insulate somebody while still getting the information. I think you might be onto something. I think it's called sports scrubber. Okay. Okay. Two minutes ago. I love it. I love it. Don't steal my idea. Yeah. Like when you're talking about these burdens of keeping youth safe and mentally healthy, keeping them off social media is unequivocally one of the greatest things ever, right? Like if you want to ruin somebody's day, give them a cell phone and give them social media

23:37and tell them that people are looking at what they're doing. And by the way, the people that they're friends with all look fabulous and they're all doing these great, like they lose their guy. And just like ever loving minds. This is a reality. But it is also the best communication mechanism we have. Yeah. You have to figure out collectively as a community, how to wait to engage, help youth be able to communicate, but disengage them from these terrible ecosystems that we know are bad for them. Yeah. And I think how do you put around them the strong connections they need with adults, with peers, with themselves and who they are? So if they are getting this feed and all of this messaging, they feel confident in receiving that, interpreting it and asking questions when they need to ask questions, still knowing who they are. And to your point, not having that kind of stimulus lead down mental health challenges. So really that buffer, that protective factor of connections is can be more helpful than trying to scare tactic away from social media or phones or technology.

24:39But say, hey, this is here and we can have guardrails, boundaries and all of the, and ways to limit what's coming your way in an appropriate way. And we need these protective factors so that when you do experience something that causes you to question or to feel that something that you can talk to somebody or you feel you have an outlet. Right. Right. Megan Smith that has done, being a granular collection, she did amazing work with the Marcing School District as well. Yes. But if you go down to their hub, their district office, they have all these charts around, so data that she aggregated, meaningful steps they took, what the result was, the feelings of connectivity, of loneliness, vermiconnection, like all these different things. And they made meaningful progress within a school district, you know, obviously at the leadership of Norden Stewart, they're superintendents who's fantastic. Absolutely. It's like, there are things that can be done very clearly to help youth communities come back together. But it takes intentionality from adults or organizations to be like, okay, we have to do

25:42these things. This is the laundry list. Yeah, the thing that I love about it is it's so actionable. It is specific. These are our kids. This is not national data that says, and that's not our kids in nursing. Right. Somebody has a problem with the North. That's not like that. The kid in New York is not the kid in Marcing. Right. Right. Like, no, these are Marcing kids. A couple of weeks ago, it told us this is their experience and where we can help them. And it's anybody in the community can respond to those things. This is not, you have to be a mental health provider. You need to be a social worker. You need to have this kind of education or licensing to address mental health. You need to be a good trusted adult and make spaces for kids to build connection and try to alleviate stress for your kid and be like, so that's what I love is it's so actionable and empowering at a community level. Yes, we need more mental health providers. Yes, we need access to that care. But as much as we can be upstream and keeping more kids from needing that, the better. And so I just, I really appreciate that.

26:43You know, I think when it comes to a condition like obesity, if I were to grab someone on the street and say, how do you prevent obesity? I think it's more intuitive. More people would know, well, you eat healthy and exercise, right? Or have physical activity. I don't think more people would know. I think it's very difficult to figure out how to prevent, like, how do you prevent it? Eat healthy. What does that mean? Yeah, true. True. What does that, which food pyramid do you look at? Yeah. That's true. There's maybe more complex than that. I appreciate your position, but it's like, I don't know that it's that self-evident at this point what healthy is and healthy to what end. Yeah. Right. If you go high protein, you know, you'll have plenty of primary care physicians that are like, this is going to be bad for your kidneys. Like, you need to stop this. If you go, you know, no protein, it's like, forget it. I'm not, we can't go down to the same level. Well, I guess I should say, I think they might know the drivers of it are food and activity. Now, there's maybe different to your point, very complex, tough to navigate, guidance on

27:45that. But when it comes, I feel like when it comes to prevention of mental health, it might not be as intuitive for people to answer that question. How do I prevent mental health? They're, they're, they're, they're, what are the drivers for? Exactly. They may think more of we need more providers. We need more, which yes, and here's now where we have information on the drivers of these challenges for our youth population. And we all have the ability to impact these drivers. So plus, to that, to that point, the mental struggle is so nebulous when you come down to like, I'm upset with somebody, right? Like, I'm upset with them. And like, you could sit down and it's like, okay, why are you upset with them? And you like, go through this whole thing or you're upset about the situation, all these different things. But reality, what's actually going on is I've lost my capacity to deal with tension in my life. And I've then become hyper fixated on this problem. And I've lost my capacity because I have this other struggle over here, which is for all intents and purposes, taking away all of my bandwidth to deal with normal interpersonal conflict.

28:46Yes. So then if you go to a youth, you're like, why are you upset? It's like, I'm upset about all these things. I'm upset about my math teacher and my, you know, football coach and that this, and then this girl, and like, like, you have all these things. And in reality, it's like, you know, you're tough enough to actually deal with stress in a math class or interpersonal relationships. But what's happening is you're all right. You're coming to these problems at an 11 already because you've lost, you've already exhausted your coping mechanisms over here. And we're not acknowledging that we're only looking at like the math teacher. And then all of a sudden, we're like talking to the math teacher. It's like, he feels like you're being a little cringe like, oh my god. Like if we're teens in particular, there's so many moving pieces, you know, and you're, it's not an infant that can't communicate at all. But it's also not like a very self aware 55 year old who's like, actually, this is the problem over here. Sure. Right. So you're dealing with this person who can't communicate, but they're really just expressing, you know, like the last tail end of what's actually going on with them. Sure.

29:47And their brains are still developing and there's a lot going on. And to your point, depending on what they have on that perfect protective side, it might be get to a point where, yeah. Yeah. Okay. So that's mental health, especially around you, especially around you. Yeah. Actually, about substance abuse. Yeah. Yeah. Yeah. So substance abuse. So in some of our even resort communities across where we surveyed or gathered data, their levels of binge drinking rates were above state averages or national averages. We look at like liquor store density for communities, which could lead towards, you know, some of those habits. So those were a few things that came out for the substance use around that one. We do ask about nicotine use. So whether that's smoking or vaping. So we ask about that a little bit. So we fold in that component again under the behavioral health needs. So we have the ability to again, address and kind of keep our eye on that as well and

30:47see how we can move the needle. What do you do for that? So substance abuse, at least I view it, and I'm sure erroneously, is more a function of like, okay, this person is having a hard time over here. Therefore they're getting after this, right? They're abuse and substance. And so then if you go to address the substance abuse, it's like, yeah, but they still have a tack in their shoe. Yeah. Yeah. You're stopping them from screaming and binge drinking to deal with the tack in their shoe, but you're not addressing the tack in their shoe. Yeah. It's very similar to those risk and protective factors for that we're using for mental and behavioral health. So when you're looking at those same things that make it more likely, someone to experience mental health challenges, also more likely they may engage in substance use and protective factors. So from a prevention standpoint, it's very similar in the approach for that mental health challenges and substance use. When it comes to treatment, you know, there are, when there is an addiction, there are different treatment resources and we want to make sure that we can, you know, shore up gaps in those resources in our community, be it from prevention, it's similar to mental health.

31:47Gotcha. Last one you mentioned was access to care. And this one is just, can I tell you something? Please. Yeah, please. I have been doing a lot of shows about the re-productor freedom and privacy act. Okay. Okay. I'm not asking you to take a position. Okay. I have to do a lot of shows on it. And specifically recently, there was that big articulation about the JAMA study, which is, and again, from Dr. Edward McGeechron, who I actually had on the show and he explained how he did all the data. But there was this big outcry by a lot of, you know, anti-proper-on people, which is totally fine. They don't like it. None of my fair. They're like, Hey, this is lying because we actually have a greater number of licencers that it licensed OBGYNs. Now, so therefore, the JAMA study saying we have fewer OBGYNs must be alive. Now this is obviously very easily explained when you realize, okay, if you have one full time person working, you know, 12 months a year, that person goes away and you have to

32:48patch that work together with four part time people. You have quadrupled the licensor, but you haven't quadrupled access to care. Right? So just that stat alone, you're like, okay, there's some fishing this year. But that's not the thing that I find interesting. The thing I actually find interesting is that the positions that people are taking now are so counter to actually resolving the problem access to care for women. It is appalling. And I'm talking like, let's say non abortion or non pregnancy related access, okay? Access to care will not increase. If we continue down this vein of we have more OBGYNs than we did before because we don't quite lit categorically, it is a fact that we do not have more OBGYNs, but in order to fight prop one, a lot of people are saying in order to fight this, we have to convince everybody that we actually have more access to care than we did previously. So they're going down this train of we have increased access to care, which everybody

33:52knows is not true, but that's the mantra. And until we actually acknowledge, okay, we don't have increased access to care. We can't actually go after things like getting an OBGYN residency. We can't go after something like increasing nursing schools like as college of western Idaho right now. They I think it's 32 people in their nursing program. And Jones, the president there is like, we have capacity for 64. Wow. We are excuse rather we have we have applicants, viable applicants for 64 spots here. We just don't have funding, right? So we're never going to increase funding. We have to acknowledge a lack of access to care if we're going to actually resolve it. But in order to fight prop one, people are saying we have more access to care, not because we actually do, but because they don't like prop one. And it's fine if you don't like prop one, it doesn't matter to me, but it's like, can we just come to the table acknowledging we have a certain access to care that is not sufficient for I know women and families like it is the damnedest thing. And again, I don't care about the prop one argument. I don't care where you are.

34:53It's just guys, can we come to the table with a agreed upon set of facts? There could be 20 ways to increase access to care for women in Idaho. And prop one is one of them, but there are 19 others. And the 19 others won't get a look at all unless we acknowledge that we have a common problem to address. But they're throwing the baby out with the bath water. And so our C.H.A. would be maybe this place to say access to care is a problem, right? And we're not only hearing it from some of those statistics, primary care physicians per capita, OBGYN, perveritus per capita, dentist per capita, pediatricians, pediatrician specialists like me, to pediatrician andric analogous. Right. Right. Pediatric andric analogous. Yeah. Yeah. No, anyway, it doesn't matter. But it's like, we have two of them. You want to see one? It's going to take you six months. Right. And by the way, does anybody with a child want to wait six months when you have to see an endocrineologist? That's not a thing you can wait on.

35:54Right. That's not like, hey man, I got a funny looking toe. Like, yeah. There's some you need an endocrineologist for. You want to see the endocrineologist for your child. Yeah. Yeah. Well, that's so exactly like we have all of those statistics like you're saying we have to and we heard directly from our community again, enough surveys, focus nearly 10,000 surveys. We did 36 focus groups. We had nearly 70 interviews. And through all of that, the community is telling us we have challenges with access. So they're directly telling us the long wait times are unacceptable, right? I don't have access to specialty services. Transportation or the travel times I need to get to my services are in addition to the adequate and the affordability of healthcare is a challenge for me. So those are some of the barriers. So, you know, again, wait times, specialty services, transportation and affordability were kind of the things that were coming up from the community voice of our survey. Say that's causing us to delay care to avoid care or not get what we need. And we know what that looks like then when you delay those services or avoid them, things

36:57get more acute things you see them later down the road in crisis. So how can we address some of these things that community was directly telling us? These are our challenges to getting the healthcare we need or want in our community. Okay. I'm going to hand you in. What portion of the state is wrong? Like, when you talk about any rural medicine, you're talking about lack of access, transportation, no specialists, that leads to avoidance. It leads to like, that's, it's like the entire state of I know. It's the majority of our state. Right. Like, you have people driving in like Teetown County, people driving like something like 90 minutes to get chemotherapy treatment. Then they got to get like two or three times a week. Right. Like access to care. So, yeah. So, yeah. Right. And then of course, you don't go in for screenings. So then they find the colorectal cancer at like state three or something. Yeah. You just been dealing with it. Yeah. Yeah. Like, how do you start or is it just, this is just part of the work? Yeah.

37:58There is no solution here. Yeah. Again, from a, in my space community-based kind of, what are our solutions that we can in the community? Of course, I'm grateful for St. Luke's and other providers that are working on solving provider access, right? But when some of those things we hear around transportation or those kinds of things, we look at, okay, how do we either help contribute towards transportation solutions that allow people to get from their home directly to a medical appointment? Or how do we think about bringing mobile services, telehealth services, onsite services directly to these communities? I mean, imagining that we can use our data to say, is there a community out there that has a high number of women that are meeting the recommendations for breast care screenings for mammographies? And they live, it's greater than 25 miles from a brick and mortar breast care services clinic. How might we target mobile services to go to that community? And so using data to kind of inform that strategy, I think, is could be a valuable solution

39:02for some of those communities, again, that say it's a challenge for us to get to a place and transportation. I got another idea. I want to hear it. I want to hear it. Yeah. The St. Luke's community can act up. Okay. Hang with me. Okay. Okay. I'm in. I'm in. I will go to the old folks home and play cards. Okay. It's a great time. You ever played sevens? I haven't played seven. Okay. Okay. I'm going to look into it. Marsha, Marsha with an SH. It's, no, it's a CIA. Okay. Okay. Anyway, we go in place. We go in play cards. Fun. But I think there is a desire and a willingness from people within the community to help other people within the community. So this is the idea. St. Luke's develops a branch that helps orchestrate community-centered free ride chairs. So I'm like, hey, look, every Thursday, I spend three hours from 10 to 1 driving people

40:05that St. Luke's identifies. And I'm an identified driver for St. Luke's. And I go through training and screening the whole thing. But I take people to and from doctor's appointments because I want to help the community. So I take three hours and I take my car and I drive them there. Then I drive them back and I move them. But you have a network of people with automobiles that are willing to volunteer time in gasoline and have been pre-screened. And St. Luke's orchestrates this. So quite literally, older people that are living alone or don't have access to rides or whatever it is, they can just get on an app and be like, I need a ride. I need a ride. And somebody may be there like, I'd love to give you a ride. I can do that. How did that direction come on? It's like a St. Luke sponsored and screened free Uber for people for the community within the community. I love any transportation solution we can come up with. That is like that. And I will say that. I think that's a gangster idea. I really like it. I do. I do like it. And I would say why not just St. Luke's, but all healthcare providers in our community.

41:08And from a prevention perspective, it doesn't matter to me if they're getting their primary care at St. Luke's or they're getting it at full circle or that we want people to be healthy. And so if there's a way that to your point, I'm kind of excited about that one. If there's a way to your point that we can lean on our community to help each other and just provide the infrastructure to connect people transportation to any healthcare, to the pharmacy because they need to go get their meds, that they were just prescribed. Great. That's like a great idea. Yeah. Yeah. So I think that's some funding to Valley Regional Transit to provide programs that are curbed to curb rides for people to get into any healthcare appointment in Ada County, Canyon County, and even now you've expanded for folks in Mountain Home that need to get to Ada County because you recognize that's a barrier because that's a distance. And so imagine if you had every every 16, 17 and 18 year old within the Valley trying to accrue community service hours by driving people to and from doctors. Yeah. And that sounds gangster.

42:08That is that's how to resource. I'm going to ride. Okay. Now I'm telling you because they could pop it and they could do it for an hour here, hour there. Yeah. You're not set into like a rigid schedule. Right. It's like, it's like, oh my gosh, the volunteering again at one o'clock today. It's like, no, I drove people from eight to 10. I got two hours of community service. And St. Luke's aggregates it. Then you'll write him a letter of recommendation. You even tell him what the driver rating was. Like they do a thousand hours of driving with a rating of 4.9. Amazing. Amazing. Marsha gave them a five. Marsha. Yeah. Yeah. You got to get you got it. Yeah. And then somebody like a minivan would have to be like for the mobility and parents. Yeah. I don't know. Yeah. I just I feel like we could connect. We could use technology to connect our community to address some of these needs. Obviously, any business model that's based on altruism indefinitely is is not a great business model, but it's a help. Well, and I'll say these challenges, as I mentioned, are not new, right?

43:09So we can't keep doing the things, things the way we've always done them, because we're not maybe solving them. So what is the innovation? What is the new technology, the new opportunity, the untapped resource in our community that can help us? And I think, you know, being able to share this data are findings, the needs, what community is telling us as broadly as possible to spur innovation, to bring new partners into the table, to say, hey, one again, no one entity can solve this ourselves. We need everyone that's willing to say yes to align whatever capacity, resources, influence they have to address these needs. Let's do it. Because we need, yeah. Yeah. So bring the innovation. I like it. So covering those three things and access to care, obviously, world health is a problem. You know, even if you live in an urban area, if you have lack of access to transportation, that's a problem. Access is a problem. How do we start addressing like the specialists? Because this is something where you need, you know, like a family care with a fellowship

44:10in obstetrics, like very, very valuable person, right? You can deliver babies, you can do all kinds of things. You didn't go to the OBGYN residency. This is one of the, the, the stopgaps that a lot of people have articulated midwifery is also a fantastic option. But like those require fellowships. Those require people that are willing to teach and help somebody gain the information required to fill in these spots. Like, is there talk about funding more fellowships within the state of Idaho so that we can get more of these specialists, even if they didn't do residencies in that particular field? Yeah. In my scope, I'm not a part of those conversations or the subject matter expert on. Like I'm just telling you what the problem is. We got a bomb. That's on you, Brian. Yeah, but I understand there to be conversations at our state around continued medical, professional education and how do we expand the right education and all the pieces that need to go together to make that happen. I'm grateful for folks who are doing that. That's just not my subject matter expertise, you know, again, mine is more here's the data

45:12and what are community-based solutions. Maybe is telehealth an option and where, where if telehealth is an option and a reasonable option, where in the community does that telehealth need to be located? Can we get it out of library? Can we get it out? You know, the homeless shelter. Can we get it? What does that look like? So kind of those community-based touch points where we can reach the populations that are struggling to get access to these needs through technology or something. So those are more of the solutions where I spend time or partnerships. But again, grateful for those that do have their eye on medical education in the state. Telehealth pods at libraries. This is a very common thing now, yeah. Yeah. Is it in the Treasure Valley? Yeah, yeah. There's been pods throughout our state where they have tried this out to say, hey, how might we carve out a space in a community location where people could sit and have privacy for a telehealth visit. Some of those pods are even as broad as you could sit here and do a job interview. You know, if you just need a private space with some technology capabilities to access

46:14healthcare or access other needs, we're going to have that at the, yeah. You can do it at the library, yeah. At the circle light. Yeah. The whole thing. Yeah. Yeah, that makes sense. They're using ISU partner with a lot of people. I believe like the salmon and chalice area to maintain their pharmacy outposts because they couldn't get a pharmacist to hang out in that area. They didn't have enough, they just didn't have enough, they were losing the pharmacies. Okay. Okay. And ISU was able to organize telehealth and design it so that the pharmacists were actually living and existing physically in the pocatello area, but they were remote, they had pharmacy texts and then remote telehealth mechanisms so that they could still provide pharmacy services in those areas. And it's like it saved the pharmacies. People were going to have to drive like an hour just to get a prescription. Fantastic. Can you imagine the saving hour for these people to get a prescription field that need to

47:15fill it once a week or so often? I mean, that's huge for that community. I've had it in my nose once at a trampoline gym, believe it or not. Oh, okay. Okay. Not my proudest moment. Okay. I do this double front slip. But I've signed the waiver, right? That's what I'm doing. My nose was like two cans, Sam. It was like on the side in gigantic. And I was like, I literally put my wallet on my mouth and I was trying to break it back into as I was like getting driven to the ER. So I get to the ER and I have to like wait and I'm sitting there. Like, oh my god, there's ridiculous. I had halibut at home. It's like I finally get up there. And they're like, so did your nose not look like that? I'm like, no, it did look like this. Okay. My skull was actually pointing through my skin because like that. Yeah, because it was completely to the side. I had cut my knee with my skull because my knee hit my face so hard. Anyway, wow. The point is they're like, what we're going to have to do like get an OR prepped and all these things are like, can't you just like push it over? They're like, with you awake. I'm like, yeah. They're like, I mean, we cut.

48:16I was like, great. Well, let's do that because I got halibut at home. Like, we got to go. That's what they absolutely asked. I'm like, what are you, what are you going to use to break this? They're like, well, we use something kind of like the end of a spoon. I'm like, oh, that's cool. Like, can't wait to see this. They unfold the sterile kit. It is a one-eater spoon. Wow. They literally just use a spoon. They're like, they grab the spoon and the handle and go, so they have to shoot up my face ten times. Oh my god. They put me on morphine. They're like, which is a trip in itself. And then they shoot up my face. They're like, we're going to have to like get here so that like shooting into my nose. I'm like, this does not feel like, okay, look, man. There's a nerve right here. I'm like, are you going to shoot through my cheek? They're like, no, we have to go through your mouth. So they're like, oh, no. Shoot the whole thing up and literally one person holds my face down. And the other person has like a foot on the thing and they're like pulling my nose and jamming it over. It was so delicious. But the point is we had to find a 24-hour pharmacy because I finally got out of there. The hell of it was cold. I really had to have the hell of it was. But they had to find this 24-hour pharmacy, which they found.

49:16I was like, I don't even know that they had these because we got out of like 10 o'clock, sutures and my nose and all stuff. But could you imagine going through some terrible experience and then like, now we got to drive two hours just to get you your dumb pain pill so your dumb face can sleep together. Yeah. If it's open or maybe an hour in the morning. So yeah. Right. And you just bear down all night with your dumb face screwed up and swallowing. Yeah, man. What a thing. Oh, yeah. So I have like a lot of sympathy for emerging services that I didn't think used to be important until I hit fly high trampoline. That's right. That's right. That's right. That's too high. You did. I felt far. Oh my gosh. Too far. Yeah. The telehealth thing. That's a big one. Yeah. Yeah. I think it's definitely something to look into, right? As you think about actual physical bodies of providers. Yeah. But how can they extend their services to communities that are lacking? Yeah. Yeah. Yeah. We've had a lot of things. Is there anything we're missing? Or go ahead. I'm sorry. I asked you a question. I asked you another question. Is there anything we're missing?

50:18I don't think so. I mean, I just I think we hit all of the areas and the data that we're seeing and went directly with the communities telling us ways we can lean in, prevention focused. So I think we're coming a lot. I have a general hunter who's the president and director of the Idaho Finance and Housing Authority. Okay. I think we're going to be talking about workforce housing. Oh, great. At the end of this coming month, which I think will be a fantastic conversation. Great. But I had a, okay, progress or change compared to the 23 survey or the 20 survey or the 17 survey have things changed. Like was housing still a problem in 17 or in 14? Like was, you know, behavioral health still a problem? Like are all these essentially the same problems or are we seeing shifts? Yeah. Well, couple of things. So behavioral health, mental health has been a consistent challenge over multiple cycles of our CHNA process again done every three years.

51:18More humans. Yeah. Yeah. Access to care has popped up historically as well. So it can look like access and affordability of care. Housing was new to us in 2023. But part of it, I believe, is we had added to our methodology asking more questions around some of those, what are the social conditions or community conditions that are impacting your health and wellbeing? Where historically in the 2016 and those iterations, we focused more on disease outcomes. So we asked around chronic disease and those kinds of things. We still do that. But now we've broadened kind of the scope to ask folks around housing, child care, education, transportation as we recognize those conditions again, impact. So I think part of why that's popping is because we've brought in those questions. We know things have changed in our community in the last six years as well, making housing difficult in a challenge in our communities. So I think it's both and, hey, we're at, we now we're asking the question and things have

52:20happened in our community to make that come to the top. Gotcha. Yeah. Man, it is a tough one. Yeah. It is such a tough one. Yeah. Yeah. I've made up my mind. I know. I have so many conversations around housing. Yeah. And so many, like I did this, oh, fantastic conversation yesterday with this gentleman named Matt Morrell. He is a loan officer. I've been wanting to do a series on ways to buy to a Ford house in, in Idaho for a long time. And he agreed to come in and do the series with me. And yesterday, the episode yesterday was just focused on first time home buyers or like 18 to 30 year old. Did you know that there are Idaho sponsor programs, $500 you get into a house, $500. There are programs for yourself employed. If you're a first responder teacher, nurse, zero down payment, zero down payment to help people afford house. Now, why do you have to make the payments? Which falls into your, are you spending more than your 30 or 40% of your income on housing?

53:22But people like, there are so many programs to help people afford houses in Idaho. And it's like, people don't know about them enough. And it's like, we need more of those programs known to people that need them. And you know, like if you need down payment, like I have a friend right now who's a firefighter who's a young husband and he and his wife would like to buy a house. And it's like, dude, and they're saved. They're grinding away from this down payment. They're grinding. It's like, I got to text them right now. They're like, hey man, you're like, buddy, just right here. You can afford a house today. And I'm not saying it's a good idea. Like you got to figure out your finances. But if you want a Ford house, nothing is stopping you. As far as a down payment. I love that. And I would encourage them. And anyone who has resources, there's a site find help Idaho. And find help Idaho is becoming the one stop shop in our state for resources for anybody searching for health or social needs. You put in your zip code. You search what you're looking for. You get all this information. Comes in multiple languages. So yeah, so who wants this? So the United Ways are the backbone for find help Idaho.

54:26And it's fantastic. Yeah, it's a national program find help. But they have been able to localize and kind of filter through the resources. So what pops is more Idaho local based. And so it's find help Idaho. So when we talk about like access to care, also resources, right? There are resources that exist. But how do people know about them get connected to make an accessible? That's one of kind of our statewide movements around find help Idaho. So someone could go on there as a firefighter and home by our assistance in this zip code. And we would hope that those resources you're talking about would pop. And they could look those up, make the connections and those kinds of things. So I would encourage them find help Idaho. Find help Idaho. This is the United Way. The United Ways. Yep. Is it the United Ways of Treasure Valley or is it like the United Ways of Idaho? Of Idaho. Yep. Our partner. I help. I know. God bless it, man. Yeah. That's fantastic. Yeah. I have a lot of conversations with people around the circuit breaker program. Are you familiar with that? Tell me more. Okay. So it's essentially that you know, it's pertaining to housing. Yes. And property taxes have gone up and people are like, hey, older people are getting, are

55:29getting rooted from their houses. Yeah. They own their house outright, but their property tax has gone up. We have a circuit. We have two programs in particular. One is a circuit breaker program. So if you're past it, if you're on, it's an age and I think income threshold. So if like you're over 65 and you make less than $50,000 or something, you can get your property tax forgiven completely. It's a great thing. Wow. Yeah. And there's another program that says, Hey, man, look, if you're 65 or older, and I can't remember what the income requirements are, they're like, if you can't remember what you can't pay your property tax, and you like own your house outright, we'll just put a small lien on your house for the property tax. So if your property tax is like $2,000 and you can't afford it, and your house is worth $500,000, we'll just put a $2,000 lien on it. And like you're a state can pay it back, you know, once you move on, like past. So the idea is like, nobody should be losing a house because of property tax in Idaho. Yeah. It's like you might be losing a house because you're 45 and financially you can't afford it anymore. And you've got this house and you have it on an outright or whatever their program's to help you say in it. Yeah.

56:30That's amazing. You want to keep them aging in place, right? Keep them in their hands all of that in your house. You need not, you need not worry about losing it. I love that. Somebody brought it up to me. And I was talking about this. I was like, I know somebody who, their property tax killed him. I was like, what do you mean? I was like, well, they couldn't afford the house. I was like, was it just a house or like, well, it was a ranch? I was like, if you have a thousand square foot or a thousand acre ranch, we're not talking about the same thing. Not that I want anybody losing the ranch or property tax. But like, if you're talking, you have 2000 acres as like a revenue generating mechanism and like, yeah, yeah. Well, those are resources again. I would hope are on Fintelpe Idaho, our state 211 systems connected with it. So again, it's trying to try and to, there's a concerted effort in our community to make it. And based you go to Define any and all resources that you need. So it would encourage if you hear more resources, Cintelpe Idaho. I would love to get a hold of United Ways. Yeah. Have them like come in and talk about all the different programs.

57:30Because I learned about circuit breaker. It's like, dude, that's a great idea. Yeah, yeah. People have thought about this. Yeah, all the other programs I'm sure like, and then the loan programs, it's like, that's a great idea. Cintelpe. Yeah, yeah, yeah. Yeah, the big great I was sure it'd be a great, great conversation with them. Yeah. Yeah. Yeah, anyone can you hook me? I can't. Okay. Anything else? I think that's it. I appreciate it Matt. Thank you for so much for coming in. This has been fantastic. Thank you. Your next survey is 29. Yeah, 2029. We do it every three years. So the next three years, we're taking action. Well, listen, in between the next three years, you do community outreach and, you know, support like, hook it up. Like keep, keep, keep it up raised. That's got things going on within the Treasure Valley. Yeah. And I know because I've loved to hear about it. Sounds great. We'll do. We'll do it again. All right. Sounds good. Thanks Matt.