Closing Gaps in
Community Health

– Listen & Reflect
– Integrate
– Innovate
– Understand
– Do a Gut Check

Madison, a resident of southeast Michigan, was having trouble navigating the health system to get the services she needed. She fell through the cracks. After losing her job and housing due to COVID-19, she relapsed into addiction and overdosed. The system, unable to see where the gaps existed to fix them, failed to reach Madison before it was too late.


Madison isn’t a real person, but her story is representative of typical and often dire health and social challenges faced by many residents of five rural towns in the area. How can stewardship make a difference?


Meet Lisa Gentz, Amy Heydlauff, Anne Kittendorf, and Reiley Curran.


Lisa, along with Amy, Anne, and Reiley, are the stewards behind the One Big Thing Core Team, a community partnership that includes St. Joe Mercy Chelsea Hospital, Washtenaw County Community Mental Health, Michigan Medicine, and the 5 Healthy Towns Foundation. Looking for the opportunity to influence change, they joined forces to better understand (1) the health care systems working across these five rural towns and (2) how they could work as one to improve the health of residents. The core team was motivated by the dissatisfaction they felt with health outcomes in their communities, especially regarding the mental health of youth and older adults.


To reach their goal, the core team developed Madison’s story as a guide to begin the process of altering the mindsets, reframing the boundaries, and reshaping responsibilities of all the organizations they represented. ReThink Health played a key role in helping to steer these conversations based on Madison’s story. They challenged the core team to think beyond optimizing the current system, and towards visioning what they could do as stewards — inside and outside of their organizations. Each organization conducted an internal gap analysis, based on mapping Madison’s journey through the current system. This led to the creation of a set of “simple rules” or guidelines to help reduce the occurrence of real-life stories like Madison’s.


Simple rules in action have led to National Alliance on Mental Illness trainings to equip faith leaders with the knowledge, tools, and local support needed to foster community well-being, and a Substance Abuse and Mental Health Services Administration grant to address gaps and barriers within the current healthcare system (such as stigma and lack of engagement of non-health organizations). Applying simple rules continues to influence how resources are used and guide future approaches to address complex issues like youth mental health as an interdependent group of organizations, rather than four independent ones.


It is through the process of shared stewardship that Lisa, Amy, Anne, and Reiley learned how four organizations could better integrate their work to build a lasting legacy that will not only serve the needs of their five rural towns in southeast Michigan but continue to make residents healthier as well.


To learn more about the current efforts of Lisa, Amy, Anne, Reiley, and the 5 Healthy Towns Foundation, visit