1124: PHIG Impact Report: How Tennessee Is Rewiring Public Health from the Ground Up

John Sheehan (0:00): This is Public Health Review Morning Edition for Tuesday, 05/12/2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials. On today's PHIG Impact Report, how Tennessee is rewiring public health from the ground up. Leaders from the Tennessee Department of Health share how they're using FIG funding to transform care at both the clinical and community level. First, Sanjana Stam, Director of Regional and Local Health at the Tennessee Department of Health, will explain how the state is embedding social workers and care coordinators into primary care clinics across rural regions, helping patients navigate everything from medication access to food insecurity and employment.

John Sheehan (0:40): Later on, Jen Trail, director of the Tennessee Department of Health's Division of Strategic Initiatives, will tell us how Tennessee is empowering its counties to lead their own health improvement efforts through local health councils, data driven planning, and targeted grants. First, here's Sanjana Stamm. Sanjana Stamm, welcome to the show.

Sanjana Stamm (1:00): Thank you for having me.

John Sheehan (1:02): Why is PHIG helpful in improving your clinical resources?

Sanjana Stamm (1:07): Really, it's about adding capacity where the clinics feel it the most. So it's given them resources to build staffing models that match their patient needs and the community needs. And then it's also about building the team around the provider. So that's improving patient flow and efficiency, reducing burnout, but also assisting with our patient's social health needs in order to improve quality outcomes for the patient.

John Sheehan (1:38): And in Tennessee, you've expanded your clinical care team model involving social work and care coordination into seeing patients. Can you describe the model some more and tell us how it's working?

Sanjana Stamm (1:52): Sure. So we have seven rural regions and 57 primary care sites. So all of our primary care sites have access to our social workers. And how this works is some of them are embedded into the clinic and some are a little bit remotely because they cover multiple counties and sites, but we do a social determinants of health screening for each patient. And then if the needs are identified, then a referral or a warm handoff if social worker is in clinic, they will work with the patient to resolve any needs that are identified in that social screening.

Sanjana Stamm (2:27): So that's really helped and a lot of times they'll help with patient assistance for medications, referrals, and then any social needs that are identified.

John Sheehan (2:38): And can you think of any examples that come to mind of how this has really benefited patients?

Sanjana Stamm (2:43): Yeah, so I do have a couple. You know, there's been an instance where we've had a untreated colostomy bag patient for years and they just didn't have the supplies that they needed to treat themselves. And so this social worker was able to get them supplies and the help that they needed so that they could take care of their needs. So that's really helped. System level, you know, we have started this program for the past year and so we don't have a lot of evaluation metrics just yet.

Sanjana Stamm (3:20): Know, we've hired an intern to kind of develop a return on investment and then also do some studies about how it has improved some health outcomes. But it has given us more reliable care. So there's been fewer missed referrals and better follow through. It has really helped with clinic efficiency. So our clinicians are spending less time on solving some non clinical barriers and allowing them to practice at the top of their license.

Sanjana Stamm (3:52): So it's really freed up some provider and nursing staff that these social workers have been able to help with, and really improved staff experience and retention so they can actually help solve patient barriers and reduces some distress and burnout, especially in some of our high need settings.

John Sheehan (4:12): It sounds like there have been sort of a number of benefits as a result of the new system. Can you think of any takeaways that apply to the sort of like this bigger lesson of patient centered care?

Sanjana Stamm (4:24): So probably the bigger takeaways, so is really just being able to assist our patients on the social needs. Since November, we started kind of a formal screening process and we have screened over 7,000 patients and about three thousand four hundred of those patients had at least one need that was identified. So that's almost half of our patients. And then of those, we had two thousand three hundred that had multiple needs and our top needs were basically paying for medications. They needed assistance in helping pay for these medications for their chronic conditions.

Sanjana Stamm (5:04): So of course, you know, if they're able to get their medications, then that will help with their health. The second need we had identified was employment needs, and so we've been able to help a number of those find employment. And the third is food insecurity. So a lot of our clients had difficulties obtaining nutritious food, so we've been able to assist with that, and some of our own counties have even started collections for food so that they were able to give them some nutritious food, which obviously does help with their health and particularly diabetes.

John Sheehan (5:38): And lastly Sanjana, do you have any plans to either expand the model, expand your system or think of ways to help sustain it?

Sanjana Stamm (5:50): Yes, so we're trying to evaluate our program and so that way we can provide some tangible quantitative metrics on how this has improved our patients' health. And then also we're funding this through FIG and then with the Rural Health Transformation Act, we're able to secure beyond the FIG grant. So that's gonna be wonderful. So hopefully we can sustain that model if we show that this really does help our patients.

John Sheehan (6:22): Sanjana Stamm, thanks so much.

Sanjana Stamm (6:24): All right, thank you.

John Sheehan (6:25): Sanjana Stamm is Director of Regional and Local Health for the Tennessee Department of Health.

Now here's Jen Trail, Director of the Tennessee Department of Health's Division of Strategic Initiatives. So Jen, Tennessee has used PHIG to set up a dedicated technical assistance and community impact team for local health councils. What does that mean? What does that look like?

Jen Trail (6:50): Health councils in in Tennessee are volunteer based groups that have been convening with the help of their local health department since the nineteen nineties in Tennessee and every single county, all 95 counties. And they typically, you know, have come around the table around some shared health goals. Every health council is a little bit different. Typical partners at the table would be probably represented by, like, the the local county government, maybe the county mayor is there, school health, nonprofit hospitals, mental health providers, social service organizations, and and so on. Because of their their makeup of those community members and community leaders, health councils are in this, like, really great unique position to to really understand and talk about, the needs and the strengths of their communities.

Jen Trail (7:45): So the the Tennessee Department of Health has been working since, like, 2018 to support health councils to implement community health assessments and community health improvement planning. The acronyms often used are the CHA and the CHIP. So with public health infrastructure funding, we've been able to build a ton of momentum in that space. So with FIG, we've hired a technical assistance team. We've got four, staff members in Central office and eight regionally based based positions.

Jen Trail (8:16): We have built, resources to support that CHA CHIP process, the assessment and the planning process. So we've built standardized, planning tools for them, worksheets, facilitation guides, as well as hosting regional trainings for them. We've also developed these county level data packages, to support their assessment process. We publish those annually. When I first started, we were handing them a spreadsheet of data, but then recognizing that these are not expert epidemiologists.

Jen Trail (8:47): They're community volunteers. Right? So we've been able with FIG funds to transition those spreadsheets into these, like, beautiful data packages with visual data charts and graphs to help health councils really know and understand and talk about their community data story. So we built resources in that space, but we've also built resources using Fig to move them from assessment and planning to collective action together. So with PHIG funds, we've built a resource called the Tennessee Vitality Toolkit.

Jen Trail (9:19): That's an online guide that helps councils move from the assessment planning process to implementing activities and programs. This resource was developed with that lens of supporting the specific needs of coalition or collective impact work. You know, how can many organizations come together to under one mission, under one common agenda to address things like the social drivers of health. We've also developed a community of practice. We have in person and virtual gatherings to promote shared learning, in the exchange of best practices across the counties.

Jen Trail (9:54): Also, really importantly, we've we've provided them with grant readiness support. So we provide trainings and one on one consultation to equip communities to be able to lead, and sustain their own health initiatives. Not with FIG, but with other federal funding, we've been able to supplement that with some competitive grant program programming with, specifically dedicated for health councils to implement CHIP priorities. And so those things have kind of gone together really well.

Unknown Speaker (10:22): That's incredible. What kinds of what kinds of wins or impacts have you seen at those local levels?

Jen Trail (10:29): Yeah. We've been able to move when I started this work in 2019, we were just getting organized around a systematic CHA and CHIP process in every county. I think when I started, we had 16 counties of the 95 that had gone through a community health assessment process. We've been able to get that up to 89 of the 95 counties with more of them currently in process. So that's a huge win.

Jen Trail (10:55): It's just the volume of counties seeing them get organized around those shared goals. But I think one of the biggest wins for us is to see increased investment and monetary resources being directed towards those community led goals that are identified through the CHA CHIP process. I'll talk a little bit about the grant program that we built, called the CARE grants. CARE is an acronym for Community Action for Rural Engagement. A couple of years ago, we awarded $1,800,000 in grants for local efforts to address community health priorities, particularly engaging and serving low income, rural, minority, and other underserved populations, across Tennessee.

Jen Trail (11:37): So we were able to fund projects, like school based community gardens and greenways to big projects like building the structure to house a farmer's market, in a rural town square that acts as a center point for community gathering and health promotion now. We also funded the renovation of an old government building in a distressed county, Perry County. It's a very rural county in Tennessee. It now houses multiple partner agencies that have gathered specific to provide services to teens in that community. They didn't really have an existing community space for the teen population in Perry County.

Jen Trail (12:15): And now they have one space they can go to to get childcare, job training, after school support, mental health support, you name it. So that's the type of thing that, like, a health council can do when you get all these partners together in a room working and collaborating together under a same goal.

John Sheehan (12:30): And could you talk a little bit more about the importance of that? And some of the examples you cited from community gardens to farmers market structures, those aren't necessarily what you would think of as under a Department of Health purview, but again, it's the way that you're sort of directing these grant funding programs to what you're hearing from the community level and that is creating that's that's solving the need.

Jen Trail (12:58): Yeah. I think the importance is like, again, that because you have all these partners coming together, they are in this unique position to really dig into root causes of tertiary or secondary public health issues and really get into the prevention space. So a lot of our health councils want to they've chosen mental health as a priority to focus on for their community. So while a farmer's market might not directly you know, it's not mental health treatment. It's it's creating that community gathering space to reduce, like, feelings of isolation, to create more relationship building and connection with others in the community.

Jen Trail (13:40): And at the same time, they're hitting folks with with public health programming. They the Farmers Marks, this this fits is a great example because they got that gathering space, and and they also use it for nutrition classes, for exercise, and active living education, and so on. So they they hit them in multiple ways too and actually address multiple public health issues by just having that one space for folks to gather.

John Sheehan (14:06): Yeah. A 100%. It it even one enough. Civic pride would be enough of a good reason to have that existing, but you're able to get more programs in under that umbrella. That's great.

Jen Trail (14:17): That's right.

Jen Trail (14:18): It's really cool to see.

John Sheehan (14:20): As you continue this work and, you know, in next next phases of of FIG funding, what most excites you to to come next?

Jen Trail (14:29): Yeah. Well, I'm I'm I'm excited to continue building capacity and confidence at the local level, to see health councils continue to build that influence, but to bridge it also with state and local policymakers, and to start seeing them have a voice in state policy. And so I'm hoping we can help be part of the mechanism or pass through to lift up those voices, at the local level to the state policy space. I'm also really proud that we get to continue to build on this work through rural health transformation funding. FIG funding is partly to credit for why we didn't have to start from scratch with our plan to spend that unprecedented amount of funding for rural health.

Jen Trail (15:10): We've already laid a lot of that groundwork, thanks to PHIG. I'm really proud, but I'm also really grateful for the opportunity and the flexibility to make FIG work according to the needs and the strengths of Tennessee. Finally, I think I'm gonna say that I truly believe we've been successful in building public health infrastructure with the public health infrastructure grant in Tennessee. For example, we've we strengthened the functionality and the value of our department wide strategic plan by aligning PHIG investments with our stated priorities, as a department. So I I think that those systems, the partnerships, the capacity that we've built over the past few years, it's gonna outlast any funding.

Jen Trail (15:51): Funding is always nice. Don't get me wrong. But I think that I think we've done right by PHIG, by the intent, by really building the infrastructure back up in a way that's even better and more efficient, than it was several years ago. And I think that's gonna continue going no matter what.

John Sheehan (16:10): Jen Trail is the director of the Tennessee Department of Health's Division of Strategic Initiatives. Earlier, we heard from Sanjana Stam, director of regional and local health for the Tennessee Department of Health. This has been another PHIG Impact Report, part of Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.