2016-2019 Community Health Needs Assessment and Implementation Plan fol… · Report Card. Its most...

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2016-2019

Community Health Needs Assessment and Implementation Plan

Adopted by Community Health Board: June 28, 2016

Community Health Needs Assessment | PeaceHealth St. John Medical Center 1

Table of Contents

I. EXECUTIVE SUMMARY .......................................................................................................................... 2

II. OVERVIEW ............................................................................................................................................ 6

State, Regional and Community Partners ...................................................................................... 6

Community Health Framework ...................................................................................................... 8

III. 2013 CHNA REVIEW .............................................................................................................................. 9

IV. COWLITZ COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE ................................................. 13

V. KEY HEALTH INDICATORS .................................................................................................................... 16

Method ......................................................................................................................................... 16

Healthy, Active Living ................................................................................................................... 17

Child & Family Wellbeing ............................................................................................................. 22

Health Delivery Systems ............................................................................................................... 26

Equity ............................................................................................................................................ 31

VI. COMMUNITY CONVENING .................................................................................................................. 34

Method ......................................................................................................................................... 34

VII. IMPLEMENTATION PLAN .................................................................................................................... 39

Selected Strategies ....................................................................................................................... 39

Significant Health Needs Not Addressed by Implementation Plan .............................................. 41


I. EXECUTIVE SUMMARY

Overview

PeaceHealth St. John Medical Center

PeaceHealth St. John Medical Center (PeaceHealth St. John) is one of ten hospitals within PeaceHealth,

an integrated, not-for-profit health system in the Pacific Northwest. Located in Longview, Washington,

the primary service area for PeaceHealth St. John is Cowlitz County, Washington.

Community Health Needs Assessment

PeaceHealth St. John and partners conducted a Community Health Needs Assessment (CHNA), a

systematic process involving the community to understand community health needs in order to

prioritize, plan and outline solutions.

The 2016 CHNA was carried out with community input, including public health and nonprofit community

groups representing minority and low-income residents. Both primary and secondary data were

collected and incorporated. We also interviewed key informants and held a community forum in which

needs were affirmed and possible strategies to address the needs were identified.

Data and local perspectives are presented and analyzed according to a four-pillar structure of

community health: 1) Healthy, Active Living; 2) Child & Family Wellbeing; 3) Integrated Health Delivery

Systems (including medical dental and behavioral health services); and 4) Equity.

PeaceHealth St. John conducted this CHNA in conjunction with state, regional, and local community

health planning in Washington, Southwest Washington, and Cowlitz County.

2013 CHNA

The problem of health care access and lack of insurance coverage was identified in all PeaceHealth

communities in 2013 as a major need and was therefore chosen as a major focus area in our 2013 CHNA

implementation plans. PeaceHealth worked as part of the community coalitions that were formed

across the state for the purpose of helping people sign up for commercial health insurance and Apple

Health, i.e. Medicaid. By any measure these efforts were successful.


Summary of the 2016 Community Health Needs Assessment

Demographic and Secondary Data

Cowlitz County has about 102,000 residents. 19.2% are children 0-19 years old, 60% are adults age 18-

64, and the remaining 16.8% are seniors age 65+. Longview is the largest city in the county representing

nearly 36% of the county’s population. Approximately 34% of Cowlitz County residents are either Asset

Limited, Income Constrained, Employed or live below the poverty line. 8.1% of the County’s population

is Hispanic.

Key health indicators were organized into the four community health pillars using primary data from

Robert Wood Johnson’s 2016 County Health Rankings and other state sources. Health outcomes gaps in

each area are summarized below.

HEALTHY, ACTIVE LIVING: Cowlitz County has the highest death rate related to opiate use in Washington,

and opiate abuse is a major public health issue in Cowlitz County. Adult obesity and related chronic

diseases are also major drivers of poor health in Cowlitz County.

CHILD & FAMILY WELLBEING: Critical indicators of need in Cowlitz County include higher rates of low

birth weight, childhood food-insecurity, and maternal smoking relative to Washington State.

HEALTH DELIVERY: Data show that there are significant differences in rates of being insured by

race/ethnicity, and racial/ethnic differences in the quality of preventive care received by Medicare

beneficiaries. Addressing these inequities is vital to the health of the community.

EQUITY: Affordable housing is a key component of financial wellbeing and stability, and forms the basis

of good health. There are many pockets of people in Cowlitz County burdened by high housing

costs. Lack of affordable housing and a high percentage of households that are Asset Limited, Income

Constrained, Employed (ALICE) or in poverty mean that over a third of Cowlitz residents cannot afford a

basic household stability budget.

Community Engagement and Local Perspectives

PeaceHealth St. John interviewed key informants from five organizations throughout the County

representing public health and minority health to identify health gaps and possible health solutions.

The key informant interviews were conducted in advance of a convening that was held on May 10, 2016

wherein 18 community leaders from public health, health and social services, business, schools, and law

enforcement met to confirm, refine, and identify health needs/gaps and possible solutions.

Table 1 summarizes the results of the community stakeholder meeting. It should be noted that the lists

of gaps and strategies represented in the table were generated in two separate set of group

conversations, processes, i.e. the strategies were not necessarily identified as specific solutions to the

identified gaps.


Table 1. Results of the Community Stakeholder Meeting

Major Health Problems/Gaps Prioritized Evidence-Based Strategies

Healthy,

Active

Living

Adult and teen chronic diseases

Adult and teen substance

use/abuse

Lack of access to healthy food

Community Health Worker

programs

School nutrition programs

Child &

Family

Wellbeing

Maternal smoking during

pregnancy

Care coordination for

prenatal/postpartum vulnerable

mothers, infants, and children

ACEs

Prenatal and early childhood

home visiting programs

Preschool programs with family

support services

Health

Delivery

Systems

Health care access inequities

Substance abuse care

Crisis/triage care

Integration of behavioral health

and primary care

Detox/sobering centers

Equity

High housing costs

Culturally integrated businesses,

health care, and government

Access to health care for

vulnerable and rural populations

Systems/patient navigators

School-based health centers


Implementation Plan

The Implementation Plan strategies summarized below were extrapolated from the data and from

community input. Our plan is comprehensive in the sense that there are strategies that impact the focus

areas within each of the community health pillars (and a number of strategies cross pillars). The display

of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake

with its community partners to affect the health status of the community. Rather, it is a statement of

our community health priorities.

PeaceHealth St. John CHNA 2016 Priorities

1. Ensure effective information exchange and care coordination for select populations (e.g.

PeaceHealth Medical Group patients with complex health and psychosocial conditions who are

served by multiple organizations) as part of PeaceHealth Transforming Clinical Practice Initiative

(TCPI) and other community collaborations.

2. Increase participation in the PeaceHealth employee wellness program, particularly for

caregivers at the lower end of the compensation scale.

3. As part of our ongoing effort to create an inclusive organization that exercises cultural humility,

recruit for and support a workforce that reflects the changing ethnic, racial and cultural

diversity of the communities that we serve.

4. Advocate for public policy and support community efforts to improve public infrastructure that

supports active lifestyles.

5. Advocate for and support programs geared to promoting healthy nutrition, for school aged

children and their families.

6. Further develop and expand Community Health Worker initiatives that empowers

individuals within specific communities to serve a liaison/linking/intermediary role

between health/social services and the community.

7. Increase PeaceHealth St. John caregiver awareness of ACEs including trauma informed care and

resilience.

8. Advocate for and actively support the development of a comprehensive continuum of services

that includes integrated primary care and behavioral health services, transitional programs and

substance abuse treatment programs.

9. Advocate for and actively support collaborative strategies that provide short and longer-term

interventions addressing homelessness.


II. OVERVIEW

Founded by the Sisters of St. Joseph of Peace in 1890, PeaceHealth is a Catholic Healthcare Ministry

serving in the communities of Alaska, Washington and Oregon. Today, PeaceHealth is a 10 hospital

integrated not-for-profit health system that offers a full continuum of health and wellness services.

PeaceHealth’s mission is to carry on the healing mission of Jesus Christ by promoting personal and

community health, relieving pain and suffering, and treating each person in a loving and caring way. The

fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. We have

embraced the Community Health Needs Assessment (CHNA) process as a means of engaging and

partnering with the community in identifying disparities and prioritizing health needs, and importantly,

in aligning our work to address prioritized needs.

Caring for those in our community is not new to PeaceHealth; it’s been in practice since the Sisters of St.

Joseph of Peace arrived in Fairhaven, Washington to serve the needs of the loggers, mill workers,

fishermen and their families more than 125 years ago. Even then, they knew that strong, healthy

communities benefit individuals and society, and that social and economic factors can make some

community members especially vulnerable. The Sisters believed they had a responsibility to care for

them, and that ultimately, healthier communities enable all of us to rise to a better life. This philosophy

inspires us today and guides us toward the future.

State, Regional and Community Partners

PeaceHealth St. John’s 2016 CHNA process was undertaken in the context of other recent or concurrent

planning activities in the State, region and County related to community health:

The Washington State Health Improvement Plan (2014-2017 Creating a Culture of Health in

Washington) provides a statewide framework for health improvement efforts.

Cowlitz County Public Health Department publishes a periodic Community Health Assessment

which is developed in partnership with the community. Its most recent 2014 Community Health

Assessment identifies three program objectives: strengthen the system of care for mothers and

children; foster Community Health Worker (CHW) expansion; run an annual health

improvement agenda, and one process objective: increase community coordination.

Wellness is something we nurture, something we build into our policies,

something we come together to create as public health professionals,

doctors, nurses, lawyers, transportation planners, neighborhood

advocates and PTAs, and others.

John Wiesman, DrPH, MPH Washington State Secretary of Health

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjC1NKc8p3NAhUT4GMKHZ2PCBoQFggcMAA&url=http%3A%2F%2Fwww.doh.wa.gov%2FPortals%2F1%2FDocuments%2FPubs%2F822-034_SHIPreport.pdf&usg=AFQjCNH_Y3wmgHYsAT4onrena-7iF1KQGQ&sig2=y4pqOzN_wcQZgrcXjdXwCw&bvm=bv.124272578,bs.2,d.cGc

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjC1NKc8p3NAhUT4GMKHZ2PCBoQFggcMAA&url=http%3A%2F%2Fwww.doh.wa.gov%2FPortals%2F1%2FDocuments%2FPubs%2F822-034_SHIPreport.pdf&usg=AFQjCNH_Y3wmgHYsAT4onrena-7iF1KQGQ&sig2=y4pqOzN_wcQZgrcXjdXwCw&bvm=bv.124272578,bs.2,d.cGc

http://www.co.cowlitz.wa.us/index.aspx?NID=1572

http://www.co.cowlitz.wa.us/index.aspx?NID=1572


Cascade Pacific Action Alliance is the Accountable Community of Health (ACH) for the central

western Washington region.

An ACH is a regional coalition consisting

of leaders from a variety of different

sectors working together to improve health in

their region. As part of the Healthier

Washington Initiative, nine ACHs began

formally organizing across Washington in 2015.

They are intended to strengthen collaboration,

develop regional health improvement plans and

projects, and provide feedback to state

agencies about their regions’ health needs and

priorities. The Health Care Authority (HCA) is

supporting ACH development through

guidance, technical assistance (TA), and funding.

Healthy Living Collaborative of Southwest Washington (HLC) is an organization that focuses on

upstream solutions that support community-based initiatives to improve health and wellness.

With a strong commitment to health equity, HLC supports the development of a network of

community health workers and improving the health and stability of all residents in Southwest

Washington by incorporating health considerations into decision making across all sectors,

systems, and policy areas to prevent and mitigate chronic disease and poverty.

Pathways 2020 is a non-profit coalition of business and civic organizations dedicated to making

Cowlitz County a better place to live. Since 1997, the organization has produced a Community

Report Card. It’s most recent 2015 Report Card includes data on social cohesion, economic

measures, education, overall health, housing, and access to healthy food in the County.

Map 1. Accountable Community of Health Regions

Source: Washington Health Care Authority

http://www.cowlitzcommunityreport.org/

http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx


Community Health Framework

Drawing from the CHNAs conducted by PeaceHealth hospitals in 2013, and after reviewing existing

community health improvement plans and collecting public data on health status and the social

determinants of health, a PeaceHealth Community Health Framework was developed. This four-pillar

framework, depicted below, was used to organize data and collect input from community stakeholders.

The subcategories, or “focus areas” were used as guideposts for considering community health

improvement strategies.

Figure 1. 2016 PeaceHealth Community Health Framework Pillars

Healthy,

Active Living

Child & Family

Wellbeing

Integrated Health

Delivery Systems Equity

Physical activity

Healthy Eating

Tobacco, alcohol

and other drug

prevention

Social engagement

Maternal-child

health

Adverse Childhood

Experiences (ACEs)

and family resiliency

Access to quality

and affordable

medical, behavioral

health and dental

services

Assistance for

people who are

homeless

Cultural humility

There are two terms that are used in the above table that perhaps need to be defined, and they are:

Adverse Childhood Experiences (or ACEs) are traumatic events that occur in childhood and

cause stress that changes a child’s brain development. Exposure to ACEs has been shown to

have a dose-response relationship with adverse health and social outcomes in adulthood,

including but not limited to depression, heart disease, COPD, risk for intimate partner violence,

and alcohol and drug abuse.

Cultural humility is a term used to describe a way of infusing multiculturalism into a workplace.

Replacing the idea of cultural competency, cultural humility is based on the idea of focusing on

self-reflection and lifelong learning.


III. 2013 CHNA REVIEW

During the 2012-2013 timeframe, PeaceHealth St. John, in collaboration with the Cowlitz County Public

Health Department, Lower Columbia Head Start, Pathways 2020, and other community partners in

Southwest Washington conducted a comprehensive CHNA. The CHNA described the health status of the

entire region and recommended areas for improvement. The PeaceHealth St. John CHNA focused on the

Cowlitz County, WA data. The table below summarizes our 2013-2016 CHNA and includes available

metrics which summarize measurable progress to date.

Table 2. 2013 CHNA Summary and Current Status

Objectives Strategies Outcomes

Baseline Current

Objective 1:

Increase Access

to Affordable

Care

Increase the number of children and adults with health insurance

Recruit and retain primary care providers

Support community health partner programs

Uninsured adults:

20%

Uninsured adults:

10%

Objective 2:

Reduce tobacco

use

Provide maternal smoking interventions

Increase number of smoke-free environments/PSE approach

Enhance tobacco use interventions in primary care settings

Adults who smoke:

24%

Adults who smoke:

17%*

Objective 3:

Reduce obesity

Improve access to healthy foods

Improve access to recreational facilities

Enhance physical activity and nutrition promotion in the clinical setting

Adults who are

obese: 37%

Adult physical

inactivity: 23%

Adults who are

obese: 35%

Adult physical

inactivity: 22%


Objectives Strategies Outcomes

Baseline Current

Objective 4:

Increase number

of healthy

newborns and

infants

Reduce the use of tobacco and drugs in pregnant women

Increase immunization rates

Support appropriate maternity screenings

Low birth weight

rate: 7%**

Maternal smoking

rate: 21%

Toddler

immunization rate:

no data

Pregnant women

receiving prenatal

care in the first

trimester: 81%

Low birth weight

rate: 7%**

Maternal smoking

rate: 16%

Toddler

immunization rate:

56%

Pregnant women

receiving prenatal

care in the first

trimester: 79%

Objective 5:

Promote

workplace

wellness at St.

John

Increase availability of healthy foods at St. John

Increase opportunity for physical activity for caregivers

No data

Participation in

PeaceHealth

wellness program:

51% of eligible

caregivers

*data methods changed/can’t compare to prior years **data spans 2007-2013

Sources: Robert Wood Johnson County Health Rankings, Enroll America, Washington State Department of Health:

Center for Health Statistics, Washington State Behavioral Risk Factors Surveillance System

As we move forward in adopting the 2016 CHNA, we reflect on lessons learned and accomplishments of

our process, goals, and implementation of the previous (2013) CHNA:

Accomplishments

The 2013 PeaceHealth CHNA identified the problem of health care access and lack of insurance

coverage as the one issue that we wanted to focus on across all of our communities.

PeaceHealth worked as part of the community coalitions that were formed across the State for

the purpose of helping people sign up for commercial health insurance and Apple Health, i.e.

Medicaid. By any measure these efforts were successful.

Between 2013 and 2014 there was more than a 34% increase in Medicaid enrollment.

Enrollment continued to increase in 2015 but not at the pace of the initial increase. Adult

enrollment rose 44% from 2013 to 2015 and child enrollment rose 54% over the same period.

As a result, uninsured adults in Cowlitz County decreased from 17% in 2013 to 10% in 2015.


Figure 2. Medicaid Enrollment and Percent Uninsured, Cowlitz County

Figure 3: Medicaid Enrollment by Adults and Children, Cowlitz County, 2012-2015

Source: Health Care Authority, State of Washington. Children are defined as under age 19.

Reducing tobacco use was noted as a significant community need in the 2013 CHNA.

PeaceHealth supports the Tobacco Free Coalition that is currently working with Cowlitz on the

Move, the State Department of Health, Youth and Family Link and the Healthy Living

Collaborative to expand the tobacco free ordinances in the cities of Longview, Kelso and the

County to include the prohibition of e-cigarettes and vaping in public areas. PeaceHealth has

already adopted this policy for all properties owned and operated by PeaceHealth St. John. The

Family Health Center has also adopted a tobacco free policy since the initiation of the CHNA in

2013. All of the local schools have tobacco free campuses and have policies that include vaping

and e-cigarettes.

24243

2524333837

37233

2012 2013 2014 2015

17%

10%

2013 2015

8,866 9,078 9,215

13,938 15,377 16,165

24,622 23,295

2012 2013 2014 2015

Children Adults


Reducing obesity was also identified as a focus area in the 2013 CHNA. The employee wellness

program at St. John partners with a local organic farm to provide access to a community

supported agriculture program. Since 2013, a minimum of 50 employees have purchased shares

in the program each year, providing each caregiver and their family with fresh produce and

increasing the consumption of foods that promote health.

Through a partnership with Cowlitz on the Move, Pathways 2020, Longview Parks and

Recreation and Cowlitz County we distributed Cowlitz County trail maps to primary care

providers to use when counseling patients and family about free opportunities for physical

activity in our community.

PeaceHealth supports the Lower Columbia School Gardens program through board

membership, in kind volunteer hours to support programs, availability of Registered Dietitians

for health education, and financial funding. PeaceHealth has provided $52,300 as financial and

in kind support since 2013.

Another priority identified in the 2013 CHNA was increasing the number of healthy newborns

and infants. PeaceHealth is a charter member of the Cowlitz Health and Safety Network, formed

in 2015 to increase resources and education to help at-risk youth and families. In collaboration

with the Cowlitz County Health Department Office of Healthy Communities, Youth and Family

Link, Pathways 2020 and other health, education and social service providers, the Network has

provided community-wide education about Adverse Childhood Experiences (ACES).

The 2013 CHNA described PeaceHealth St. John’s commitment to promoting workplace

wellness. In addition to the community supported agriculture program described above, the

cafeteria at St. John has changed the types of food provided for caregivers, patients and hospital

visitors. In 2013, 70% of the foods produced and sold in the Cafeteria and served to patients in

the hospital were pre-packaged products. Now, in 2016 90% of foods produced for the patients

in the hospital and sold in the cafeteria are made from scratch, on site. Additionally, the general

patient menu for hospital patients meets the heart healthy diet guidelines of the American

Heart Association, further increasing the access to healthy foods for members of our

community.

The vending machines within our facilities have transitioned to offer more low fat, high fiber,

and limited high fructose corn syrup options to further support our efforts to increase the health

of food options available on-site.


IV. COWLITZ COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE

PeaceHealth St. John serves Southwest Washington, with Cowlitz County

being its primary service area, and the focus of this CHNA1.

Map 2, Cowlitz County, WA

Current Profile

Cowlitz County has about 102,000 residents.

6,273 (6%) are preschoolers age 5 or younger

20,029 (20%) are 5-19 years old

60,985 (60%) are adults age 18-64

17,135 (17%) are seniors age 65+

8,285 (8%) are Hispanic or Latino (slight growth in population since 2010)

3,608 (4%) are American Indian and Alaska Native (stasis in population since 2010)

1 All data in this section is from the American Community Survey (US Census Bureau) unless otherwise noted.

Of Note:

The 2015 United Ways of the Pacific Northwest ALICE report summarizes the status of ALICE families—an acronym that stands for Asset Limited, Income Constrained, Employed. These are families that work hard and earn above the Federal Poverty Level (FPL), but do not earn enough to afford a basic household budget of housing, child care, food, transportation, and health care. Most do not qualify for Medicaid coverage.

In Cowlitz County, 34% of all households are either in poverty or are ALICE households. This is similar to Washington State overall, wherein 32% of all households are either ALICE or in poverty.


The largest population center is Longview, home to more than 35% of Cowlitz County residents. This is

followed by the geographically adjacent city of Kelso, where about 12% of the County’s residents live. In

terms of the socioeconomic determinants, the County, as depicted in Table 3 is:

87% of adults have a high school diploma.

18% of individuals live below the Federal Poverty Level.

34% of all households are either in poverty or cannot afford basic household expenses

341 people are homeless in Cowlitz County, both sheltered and unsheltered (Source: Homelessness

in Washington State: 2015 Annual Report on the Homelessness Grant Programs, Department of Commerce).

In the Longview, WA school district, 430 children in grades K-12 are reported from homeless

families (96) or doubled up (living with other families) (334) (Source: 2014-2015 Homeless Student Data

Report, Office of Superintendent of Public Instruction).

Table 3. Cowlitz County, WA Sociodemographic Profile

City High school diploma (%)

Individuals living below the FPL

(%)

Median Household Income

People over age 5 who are

linguistically isolated

Kelso 79.8% 32.1% $33,492 5.5%

Longview 86.7% 22.8% $37,827 3.2%

Woodland 84.6% 23.4% $33,492 8.3%

Cowlitz County 87.2% 18.4% $46,571 3.0%

Washington State 90.2% 13.5% $60,294 7.8%

http://www.commerce.wa.gov/Documents/PIT_2015_Rollup_Summary.pdf

http://www.commerce.wa.gov/Documents/PIT_2015_Rollup_Summary.pdf

http://www.k12.wa.us/HomelessEd/pubdocs/StatewideHomelessReportByDistrict2015.pdf

http://www.k12.wa.us/HomelessEd/pubdocs/StatewideHomelessReportByDistrict2015.pdf


The Community Need Index (CNI), a tool created by Dignity Health, measures a community’s social and

economic health on five measures: income, cultural diversity, education level, unemployment and

health insurance, and housing. The CNI demonstrates that within Cowlitz County, there are pockets of

higher and lower need:

Map 3. Cowlitz County, WA Community Need Index Map, 2015

Source: Dignity Health

Key Take-Aways

Over a third of all Cowlitz County residents are either below the Federal Poverty Level (FPL), or,

if above, but do not earn enough to afford a basic household budget of housing, child care, food,

transportation, and health care.

Within Cowlitz County, there are pockets of high poverty and low educational attainment, with

highest need areas concentrated in and around Longview.


V. KEY HEALTH INDICATORS

Method

Data for each of the four PeaceHealth pillars is detailed on the following pages. For each pillar, we

provide a description, how the community compares to other Washington counties, provide a profile of

the community, identify important indicators and provide key takeaways.

PeaceHealth selected the most currently available data from publically available sources. Data elements

were selected that align with the focus of the CHNA. The goal was to identify metrics that could be

consistently measured, monitored and benchmarked for all PeaceHealth communities throughout the

Pacific Northwest.

Data from the Robert Wood Johnson Foundation (RWJF) was used as a primary source. RWJF’s county

health rankings data compare counties within each state on more than 30 factors. Counties in each of

the 50 states are ranked according to summaries of a variety of health measures. Counties are ranked

relative to the health of other counties in the same state. RWJF calculates and ranks four summary

composite scores used in this report:

Overall Health Outcomes

Overall Health Delivery Factors

Health Factors – Health behaviors

Health Factors – Social and economic factors

This is a nationally recognized data set for measuring key social determinates of health. RWJF is

committed to continually measuring these metrics.

Data in this evaluation is also supplemented with sources from state and local agencies in Washington.

Unless otherwise noted all data cited in this section is from RWJF or the following sources:

Behavioral Risk Factor Surveillance System; Washington Healthy Youth Survey; Washington Department

of Health, Vital Statistics; US Census Bureau; The University of Washington’s Alcohol and Drug Abuse

Institute; Cowlitz Family Health Center WIC; WA Office of the Superintendent for Public Instruction;

Feeding America; Enroll America; Centers for Medicare & Medicaid Services; Community Commons.

Next to each local indicator we've shown whether the local rate (percentage) is less than, greater than,

or equal to the state rate (percentage). With any indicator, there is a range of possible 'true' values

because data collection always entails some error. Often, percentages that appear different are rated as

'equal.' This is because, statistically speaking, there is a large chance that the 'true' value of the data at

the state and county level is equal, rather than different, due to error inherent in the data collection

process.


Healthy, Active Living: Cowlitz County Health Indicators, 2016

What is Healthy, Active Living?

Healthy, Active Living is a key pillar of a healthy community. We envision a community where the

environment and resources of that community allow adults, teens, and children to be physically active,

to eat nutritious meals, to be free of the burdens of substance abuse and chronic disease, and to live

with an ample sense of wellbeing and connection to others.

How Does Cowlitz County Compare to Other Counties?

Cowlitz County is ranked 35 out of 39 Washington counties for its food and physical activity

environment, as well as the adult behavioral health indicators like excessive drinking and smoking. This

means we’re doing poorly compared to other counties in Washington.

Healthy, Active Living Profile

Adults:

Adult obesity: 35% (>WA: 27%)

Adult physical inactivity: 22% (=WA: 18%)

Adult diabetes: 13% (>WA: 9%)

Youth:

10th graders who are obese: 15.4% (=WA: 11.2%)

10th graders reporting physical inactivity: 9.5%(=WA: 12.0%)

Environment:

Reasonable access to exercise opportunities: 79% of residents (<WA: 88%)

Food environment index: 2016: 6.5 (<WA: 7.5)

Substance Abuse:

Adult smoking: 17% (=WA: 15%)

10th graders smoking cigs in past 30 days: 9.1% (=WA: 7.9%)

Deaths attributed to any opiate: 17.9 per 100,000 population (>WA: 8.6 per 100,000 population;

highest of any county in Washington)


Closer Look

Growth of Opiate Abuse

Cowlitz County has the highest opiate death rate of all counties in

Washington at 17.9 deaths per 100,000 population, appearing nearly

double the overall rate of deaths from opiates in Washington State as a

whole (8.6 deaths per 100,000 population). The death rate from opiates

in Cowlitz County has grown 74% from 2002-2004 to 2011-2013, as shown

in Figure 4.

Figure 4. Rate of Deaths Attributed to any Opiate by County, WA State

Source: Univ. of Washington Alcohol & Drug Abuse Institute

Accordingly, there is a high rate of opiate-related crime in Cowlitz County.

Unfortunately, residents of Cowlitz County have lower rates of treatment

for opiate abuse, despite the high rate of deaths from opiates.

Figure 5. Rate of Opiate-Related Crime and

Rate of Treatment for Opiate Abuse by County, WA State

Of Note:

Caregiver Wellness As one of the largest employers in the community, PeaceHealth is working to support Active Healthy living in its workforce by offering an employee wellness program. Workplace wellness programs are evidence-based strategies to improve physical fitness and risk factors. At PeaceHealth, we can make an impact on community wellness by improving our employees’ wellness, but there are differences based on income levels:

51% of eligible PeaceHealth St. John employees participate in a wellness program.

37% of eligible PeaceHealth St. John employees earning $25,000 - $40,000 participate in a wellness program.

Participation by Income


Source: Univ. of Washington Alcohol & Drug Abuse Institute

Opiate use in Cowlitz County is a public health emergency and a high priority among all health issues

facing our community.

Obesity and Related Chronic Diseases

Over a third of Cowlitz County adults are obese, and 13% of Cowlitz County adults have diabetes, a rate

higher than in Washington state overall. Obesity and diabetes imperil the health of Cowlitz County

residents, lower their life span, and put enormous pressure on families to care for aging relatives with

avoidable chronic disease. Resulting partly from high obesity rates, the rate of heart disease among

Cowlitz County adults is much higher than Washington State, at 202.7 per 100,000 population vs. 138.3

per 100,000 population.

Figure 6. Percent of Adult Residents that are Obese by County, WA State, 2016

Source: Robert Wood Johnson County Health Rankings

Additional Indicators with Trend Data

The Behavioral Risk Factor Surveillance System is used to measure chronic diseases and health behaviors

among a population of adults in all 50 states at the county level. The Washington Healthy Youth Survey

measures health risk behaviors and outcomes among 6th, 8th, 10th, and 12th graders in Washington

State. The Washington Department of Vital Statistics measures causes of death prenatally and at birth.

The Robert Wood Johnson Foundation County Health Rankings aggregates BRFSS, Vital Statistics, US

Census, and business data to provide an overview of measures that matter for health. The University of

Washington’s Alcohol and Drug Abuse Institute measures markers of opiate abuse over time in

Washington counties.


Table 4. Healthy, Active Living: Cowlitz County Health Indicators vs. Washington State, 2016

Better Equal Worse

Chronic Conditions

Adult diabetes ●

Heart disease death rate ●

Adult obesity ●

Risk behaviors

Adult physical inactivity ●

Excessive alcohol use ●

Adult smoking ●

Drug overdose death rate ●

Deaths due to any opiate ●

Suicide death rate ●

Environment

Grocery availability & food insecurity ●

Access to exercise opportunities ●


Table 5. Healthy, Active Living: Cowlitz County 10th Graders,

Health Indicators vs. Washington State, 2016 and Trend Since 2010

Better Equal Worse Trend

Chronic Conditions

Obesity ● stasis

Depression ● worsening

Risk behaviors

Smoking cigarettes ● improving

Drinking alcohol ● improving

Using marijuana/hashish ● stasis

Binge drinking ● improving

Eat 5+ fruits/vegetables per day* ● stasis

Consumed no sugar-sweetened beverages

in past 7 days ● **

Reports no leisure-time physical activity

for 60 min/day in past 7 days ● stasis

Reports ‘seriously considering suicide’ ● stasis

Environment

Bought sugar-sweetened beverages at

school ● improving

*trend since 2012 **no trend data available due to methodology change

Key Take-Aways

Deaths from opiates are a public health crisis in Cowlitz County, with a higher death rate from

opiates than anywhere else in Washington State.

Obesity, diabetes, and heart disease among Cowlitz County adults are major public health issues

with negative consequences for Cowlitz County’s aging population.

Physical inactivity among young adults appears to be uncommon and is a particular area of

health resilience that should be maintained.


Child & Family Wellbeing: Cowlitz County Health Indicators, 2016

What is Child & Family Wellbeing?

Child & Family Wellbeing is a key pillar of a healthy community. Circumstances in pregnancy through

early childhood are key predictors of health and wellbeing later in life. We envision a community where

all pregnant women and families with children are well-fed, safe, and equipped with resources and

knowledge to succeed in school, from kindergarten to high school graduation.


In social and economic factors, including the percentage of adults who have completed high school and

have some college education, as well as the percentage of babies born to single mothers, Cowlitz County

is ranked 28th of 39 counties in Washington.

Child & Family Wellbeing Profile

Percent of students who demonstrate expected skills in 6 of 6 domains: 28 % (<WA: 39.5%)

Childhood food insecurity: 28% (>WA: 21.0%)

Graduation rate: 79% (=WA: 77.2%)

Maternal smoking in third trimester of pregnancy: 16% (>WA: 7.3%)

Low birth weight: 7% (>WA: 6%)

Prenatal care beginning in first trimester: 79% (>WA: 74.7%)

19-35-month olds up-to-date with vaccinations: 56% (=WA: 56%)

Teens up-to-date with vaccines: 33% (=WA: 34%)

WIC infants fully or partially breastfed: 27% (Cowlitz Family Health Center) (<WA: 38.4%)

Closer Look

Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences, or ACEs, are traumatic events that occur in childhood and cause stress

that changes a child’s brain development. Exposure to ACEs has been shown to have a dose-response

relationship with adverse health and social outcomes in adulthood, including but not limited to

depression, heart disease, COPD, risk for intimate partner violence, and alcohol and drug abuse.

Adverse Childhood Experiences include emotional, physical, or sexual abuse, emotional or physical

neglect, seeing intimate partner violence inflicted on one’s parent, having mental illness or substance

abuse in a household, enduring a parental separation or divorce, or having an incarcerated member of

the household.


Figure 7. Association between ACEs and Negative Outcomes

Source: Centers for Disease Control & Prevention,

"Association between ACEs and negative outcomes"

We can examine ACEs reported by adults in Washington and see that adults in Cowlitz County are more

likely to have endured ACEs that put them at risk for poor health and social outcomes throughout the

life course than adults in Washington State overall.

Figure 8. ACEs Reported by Adults in Cowlitz County and WA State, 2011

Source: Washington State Behavioral Risk Factor Surveillance System

Of Note:

Adults in Cowlitz County

report high rates of Adverse

Childhood Experiences

(ACEs) that contribute to

poor health and social

outcomes throughout the

life course.

A high rate of babies are

born at low birth weight in

Cowlitz County relative to

the Washington State.

Over a quarter of Cowlitz County children lack access to adequate, nutritious food.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1+ ACEs 2+ ACEs 3+ ACEs 4+ACEs

Cowlitz County WA State

https://www.cdc.gov/violenceprevention/acestudy/about_ace.html


High rate of maternal smoking during pregnancy and low birth rate

Pregnant women in Cowlitz County are nearly twice as likely as pregnant women in Washington overall

to smoke during pregnancy, despite being just as likely to receive appropriate prenatal care in the first

trimester of pregnancy. Smoking during pregnancy imperils the health of women and babies alike, and

contributes to the high rate of babies born at low birth weight in Cowlitz County. The percentage of live

births with low birth weight (<2500 grams) is a key indicator of maternal-child health and wellbeing

because it indicates long-term developmental health and wellbeing. The rate of low birth weight in

Cowlitz County is higher than many other Washington counties and higher than Washington State

overall, making it a particularly urgent area of need.

Figure 9. Rate of Low Birth Weight by County, WA, 2007-2013

Source: Robert Wood Johnson County Health Rankings

Child & Family Wellbeing Data Sources

The Washington Department of Vital Statistics measures causes of death prenatally and at birth. The

Washington Department of Health conducts the Behavioral Risk Factor Surveillance System (BRFSS) that

compiles ACEs data on adults. The Robert Wood Johnson Foundation County Health Rankings

aggregates BRFSS, Vital Statistics, US Census, and business data to provide an overview of measures that

matter for health. The Office of the Superintendent for Public Instruction measures “Readiness to

Learn” among entering kindergarteners in Washington State in 6 domains: social-emotional, physical,

language, cognitive, literacy, and math. The USDA Women, Infant, and Children nutrition program

measures breastfeeding among its program recipients by individual WIC site—the numbers for Cowlitz

County come from the Cowlitz Family Health Center WIC site. Low birth weight is compiled in a seven-

year period by RWJF County Health Rankings from WA State Vital Statistics data (2007-2013). Childhood

food insecurity is measured by the USDA and Feeding America, and is characterized by a lack of

consistent, sufficient, and varied nutrition.


*Data aggregated from 2007-2013 **no trend data available

Key Take-Aways

Many Cowlitz County children are food-insecure—over a quarter of children in Cowlitz County--

and not fully prepared for kindergarten; because so many Cowlitz County residents are in

poverty or Asset-Limited, Income Constrained, Employed (ALICE), there may be a dearth of

food/nutrition and quality, affordable child care that affects children’s wellbeing.

Adults in Cowlitz County report high rates of Adverse Childhood Experiences (ACEs) that

contribute to poor health and social outcomes throughout the life course.

The high rates of maternal smoking during pregnancy contribute to high rates of low birth

weight in Cowlitz County; being born at low birth weight imperils the health and wellbeing of

children across the life course and puts Cowlitz children at risk for development delays that will

alter their ability to thrive in school and in the community.

Table 6. Child & Family Wellbeing: Cowlitz County Health Indicators vs. Washington State, 2016


Social Indicators

High school graduation rate ● stasis

Childhood food insecurity ● stasis

Entering kindergarteners demonstrating Readiness

to Learn in 6 of 6 domains*

● worsening

Health Indicators

Prenatal care in 1st tri. of pregnancy ● stasis

Maternal smoking in 3rd tri. of pregnancy ● improving

Low birth weight* ● *

WIC infants partially or fully breastfed ● **

Toddlers up-to-date with vaccines ● **

Teenagers up-to-date with vaccines ● **


Health Delivery Systems: Cowlitz County Health Indicators, 2016

What are Health Delivery Systems?

Health Delivery Systems are a key pillar of a healthy community. Access to quality, affordable,

comprehensive care throughout the life course is an important facet of community wellness. We

envision a community where all people have access to quality, affordable preventive and acute care,

including mental health and dentistry, throughout the life course.


In health delivery factors including the ratio of physicians, dentists, and mental health providers to the

population, as well as certain measures of quality of care like the percentage of Medicare recipients that

receive mammograms and diabetic monitoring, Cowlitz County ranks 20th out of 39 counties in

Washington—in the bottom half of Washington counties.

Health Delivery Systems Profile

Ratio of care providers to residents:

Primary care: 1,540:1 (>WA: 1,190:1)

Dentists: 1,820:1 (>WA: 1,290:1)

Mental health: 530:1 (>WA: 380:1)

Uninsured rate among adults below age 65: 10% (>WA: 8%)

10th graders who saw a doctor for a physical in the past year: 64% (=WA: 66.1%)

10th graders who saw a dentist for a checkup, exam, teeth cleaning, or other dental work: 73%

(<WA: 79.0%)

Preventable hospital stays among Medicare beneficiaries: 38 per 1,000 beneficiaries (=WA: 36

per 1,000 beneficiaries)

Closer Look

Health Insurance Inequities

Though Cowlitz County’s overall insurance rate is improving, there are significant inequities in health

insurance rate by race/ethnicity, as depicted in Figure 10 below.


Figure 10. Uninsured Rate among Adults <65 Years, 2015

Preventive Hospital Stays

Preventable Hospital Stays is the hospital discharge rate for ambulatory care-sensitive conditions per

1,000 fee-for-service Medicare enrollees. Ambulatory care-sensitive conditions include: convulsions,

chronic obstructive pulmonary disease, bacterial pneumonia, asthma, congestive heart failure,

hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and dehydration. This

measure is age-adjusted.

Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided

in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse

hospitals as a main source of care.

Lower numbers on this measure are the goal. Cowlitz County ranks well below the nation, but above

the Washington State average. Recent data suggests the trend is improving.

Of Note:

Cowlitz County has fewer primary care, dental, and mental health care providers per resident than Washington state overall.

A greater proportion of Cowlitz County adults are uninsured relative to Washington State adults.

Racial/ethnic disparities in access to insurance and preventive care exist in Cowlitz County.

10% 10% 10%

16%

12%

8% 8%7%

13%

8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

All Black White Hispanic orLatino

Asian

Cowlitz County WA State


Figure 11. Preventable Hospital Stays, Cowlitz County, WA

Preventive care inequities among Medicare beneficiaries

High-quality preventive care, like seeing a primary care doctor frequently and monitoring one’s blood

sugar and blood pressure, can improve health outcomes. One way to look at possible differences in the

quality of preventive care is to examine the health outcomes of Medicare beneficiaries (people aged 65

years and older that have access to government-sponsored health insurance) of different races and

ethnicities, since they have the same source of health insurance. In examining the quality of care of

diabetes care (called Prevention Quality Indicators) among White and Hispanic Medicare beneficiaries

by county in Washington State, we see that Cowlitz County has some of the state’s most glaring

inequities in long-term complications of diabetes by race/ethnicity. White Medicare beneficiaries 219

have PQIs per 100,000 beneficiaries, while Hispanic Medicare beneficiaries have 0 PQIs per 100,000

beneficiaries.

The preventive care received by Hispanic Medicare beneficiaries in Cowlitz County is worse than the

preventive care received by White Medicare beneficiaries in Cowlitz County and results in worse

outcomes for diabetes.


Figure 12. Age-adjusted Prevention Quality Indicators for

Long-Term Complications of Diabetes, Medicare Beneficiaries, 2014

Source: Center for Medicare & Medicaid Office of Minority Health, “Disparities Mapping Tool”

Emergency Room Use

Treating patients with low-acuity conditions in the ED is an issue because it is not the best care setting

for those conditions and it contributes to unnecessary overcrowding and expense. Approximately 11%

of emergency room visits to St. John Medical Center could be considered avoidable given their low

acuity. When viewed by payer, Medicare patients have the lowest rate of these visits, representing

4.4% of all Medicare ED encounters. Medicaid patients have the highest rates, 16%. In general, the

percent of low acuity visits appear to be flat or trending slightly downward for all payer types.

Figure 13. Low-Acuity ED Visits by Payer, St. John Medical Center, 2013-2015

Source: PeaceHealth Internal Data

4.50%4.40%

4.40%

17.6… 15.90% 16.00%

12.20%12.60%

10.80%

2013 2014 2015

Medicare Medicaid Commercial/All Other

https://data.cms.gov/mapping-medicare-disparities


Health Delivery Systems Data Sources:

The Washington Healthy Youth Survey measures health risk behaviors and outcomes among 6th, 8th,

10th, and 12th graders in Washington State, including health care access. The Robert Wood Johnson

Foundation County Health Rankings aggregates provider and US Census data to provide an overview

provider to resident ratios and overall clinical care relative measures, and shows preventable

hospitalization rates. Enroll America aggregates measures of insurance across all 50 states at the county

and state level. The Centers for Medicare & Medicaid Services Office of Minority Health Disparities

Mapping Tool shows measures of health inequities at the county level across the US for different health

delivery indicators.

Table 7. Health Delivery Systems: Cowlitz County Health

Indicators vs. Washington State, 2016 and Local Trend since 2010


Primary Care Provider to resident ratio ● stasis

Dentists to resident ratio ● stasis

Mental Health Providers to resident ratio ● improving

Uninsured adults below age 65 ● improving

Saw a doctor for a physical in the past year (10th

graders)

● improving

Saw a dentist for checkup, cleaning, or other work in

past year (10th graders)

● stasis

Key Take-Aways

Poor access to primary care, dental care, and mental health care is a contributor to poor health

in Cowlitz County.

Over a third of 10th graders did not have a physical in the past year, and over a quarter did not

see the dentist.

Significant racial/ethnic disparities in access to preventive care exist in Cowlitz County.


Equity: Cowlitz County Health Indicators, 2016

What is Equity?

Equity is a key pillar of a healthy community. Health equity will be achieved when everyone is

given the opportunity to reach their full health potential. Affordable, safe housing, and employment

that allows sufficient resources to meet a household budget are important facets of equity.


In social and economic factors, including the percentage of children in poverty, violent crime, and

income inequality, Cowlitz County is ranked 28th of 39 counties in Washington, meaning that Cowlitz

County faces greater obstacles to social and economic wellbeing than other counties in Washington.

Equity Profile

Individuals living in poverty: 18% (>WA: 13.5%)

Households that are Asset Limited, Income Constrained, Employed or in poverty: 34% (=WA:

32%)

Linguistic isolation: 3% (<WA: 7.8%)

Households with ‘severe housing problems,’ including cost-burdened housing: 19% (=WA: 18%)

Unemployment rate: 13.5% (>WA: 8.8%)

Veteran population: 13.4% (=WA: 11%)

Income inequality (ratio of income at the 80th percentile to income at the 20th percentile):

4.6(=WA: 4.5)

341 people are homeless in Cowlitz County, both sheltered and unsheltered

In the Longview, WA school district, 430 children in grades k-12 are reported from homeless

families (96) or doubled up (living with other families) (334)

Closer Look

Cost-burdened housing

Affordable housing is a key component of financial wellbeing and stability, and forms the basis of good

health. There are many pockets of people in Cowlitz County burdened by high housing costs that

undermine their health and wellbeing, particularly in the Longview area.


Figure 14. Percentage Households Where Housing Costs Exceed

30% Of Household Income, Cowlitz County, WA 2010-2014

Poverty and Asset Limited, Income Constrained, Employed

Household Inequities

Asset Limited, Income Constrained, Employed households are those that are employed and living above

the poverty line, but cannot afford a stable household budget of housing, food, transportation, health

care, and childcare.

When this group of households is combined with those in poverty, we see that over 34% of households

in Cowlitz cannot afford a liveable monthly budget. Furthermore, there are significant differences by

race/ethnicity, with younger households and non-white households having higher rates of poverty and

ALICE (see Figure 15 below).

Figure 15. Households Below the ALICE Threshold by Race/Ethnicity and Age, 2013

Source: United Way ALICE Report, Pacific Northwest

0%

10%

20%

30%

40%

50%

60%

Asian Black Hispanic White Seniors

Of Note:

Changing demographics call

for employers to monitor

their workforce so that it

reflects the composition

and diversity of the

community. Increasing

racial and ethnic diversity

among licensed health

professionals is particularly

important because evidence

indicates that among other

benefits, it is associated

with improved access for

non-majority patient

groups, increased patient

satisfaction and an overall

decrease in health care

disparities. Source: Community Commons

http://www.unitedwayalice.org/documents/15UW%20ALICE%20Report_PNW_Lowres_1.12.16.pdf


Equity Data Sources

The US Census measures the percentages of individuals living in poverty, in linguistic isolation, and

adults who are unemployed. The Robert Wood Johnson County Health Rankings provide estimates of

individuals who have ‘severe housing problems,’ meaning individuals who live with at least 1 of 4

conditions: overcrowding, high housing costs relative to income, or lack of kitchen or plumbing, as well

as a measure of income inequality at the county and state level, which is the ratio of household income

at the 80th percentile to income at the 20th percentile. Community Commons provides maps of census-

tract level data, including housing cost burden. The United Way Pacific Northwest ALICE report provides

county-level estimates of ALICE households and households in poverty.

Table 8. Equity: Cowlitz County Health

Indicators vs. Washington State, 2016 and Local Trend since 2012


Individuals living below the poverty line ● stasis

Individuals over age 5 in linguistic isolation ● stasis

Households with ‘severe housing problems’ ● stasis*

Unemployment rate ● stasis

Income inequality ● **

*baseline trend data aggregated from 2006-2010

**no trend data available

Key Take-Aways

A high percentage of cost-burdened housing in certain areas of Longview and other areas of

Cowlitz County imperils the wellbeing of affected households and the community as a whole.

Over a third of Cowlitz households cannot afford a livable monthly budget; households

struggling to make ends meet are more likely to be non-seniors and non-white.

Homelessness affects Cowlitz County residents and should be addressed by community

strategies.


VI. COMMUNITY CONVENING

Method

Key informant Interviews

PeaceHealth St. John interviewed key informants from organizations throughout the County

representing perspectives from public health and medically underserved and vulnerable groups. The

interviews were conducted to elicit perspectives on the health needs and gaps of the community, to get

feedback on the continuing relevance of the 2013 CHNA priorities and health priorities found through

the secondary data gathering of the 2016 CHNA, and to understand possible solutions that local experts

support.

Table 9. Organizations to which Key Informants Belong, 2016 CHNA

Organization Population Served

Cowlitz County Health Department

All Cowlitz County residents; 0-25 ages for individual services, medically underserved

Pathways 2020 Medically underserved, homeless, immigrant, early childhood to senior groups

Cowlitz Family Health Center Medically underserved, homeless, immigrant, early childhood to senior groups

Youth and Family Link Children 0-5, children K-12, low-income families, immigrant and medically underserved groups

Healthy Living Collaborative Medically underserved, homeless, immigrant, children, families, and seniors

Community Convening

The key informant interviews were conducted in preparation for a community convening session that

was held on May 10, 2016. Eighteen community leaders from local and regional public health, health

and social services, business, schools, and law enforcement were convened for approximately three

hours.

Community convening participants were led through a two-part process to identify gaps and needs and

then to rank community health improvement strategies that were organized into the community health

pillars. The process was designed to build on the considerable amount of time and effort that the

County Health Department, PeaceHealth and others have put into health assessments over the last

several years and to focus more on what we can actually do together to address the problems.

Following an update regarding secondary data and key informant perspectives for each of the

community health pillars, participants were asked to identify health and social needs/gaps, and strategy


opportunities. There was repetition and overlap between the key informant and group process input,

with the community convening participants adding infill to the key informant perspectives.

Gaps and opportunities

Table 10. Summary of Health and Social Gaps/Needs and Strategy Opportunities According to Key

Informants and Community Convening Participants, by Community Health Pillar, May 2016

Healthy, Active Living Child & Family Wellbeing

Needs/Gaps

Adult and teen chronic

diseases

Adult and teen substance

use/abuse

Lack of access to healthy food

Maternal smoking during

pregnancy

Strategy

Opportunities

Community solutions for physical

activity

Community gardens

Places for physical activity: bike

paths, parks and rec programs,

transportation policies

Family engagement policies

Neighborhood watch programs

Low cost family activities

Community kitchens/healthy

eating programs

Mental health and substance abuse

care for teens and adults

Enhanced behavioral health

and substance abuse treatment

Education system

Early childhood education and

health programs; expand Head

Start, Early Head Start

Anti-bullying programs

Mentorship programs

Prevention and health promotion for young

parents

WIC

Breastfeeding promotion

Substance abuse and suicide

prevention

Training for professionals

ACEs training

Developmental screening

Community Health Workers


Health Delivery Systems Equity

Needs/Gaps Health care access inequities

High housing costs

Culturally integrated businesses,

health care, and government

Strategy

Opportunities

Care coordination

Systems navigation/health

literacy support for low-resource

and immigrant groups

Integrated

primary/behavioral/dental health

care

Hospital transitions

Improved access to primary,

urgent, and specialty care

Use CHWs

Need more MDs and mid-level

providers

Concern: providers are leaving,

PeaceHealth isn’t committed to

town

Mental health and substance

abuse care for youth and adults

Need more triage and detox beds

for SA patients

Dental care

School-based programs

Access for low-income

adults/Medicaid

Geriatric services

Home health services for aging

populations

Training for providers

Better access for frail elderly

Health literacy training and supports

Ways for marginalized groups to

have input in the policy process

Healthy, safe, affordable housing

Coordinated reentry programs for

ex-offenders and those released

from behavioral health treatment

Community Health Workers for

linguistically/culturally isolated

groups

Community-based activities

Big Brothers/Big Sisters program

Block parties

Community garden

Community leadership

Diversity training for employers

PeaceHealth commitment to the

community/reduction in workforce

concerns

Lack of government leadership

regarding issues of diversity

Housing

More affordable housing

Policy debate: ‘Housing First’ vs.

‘shelter in accordance to personal

responsibility’ approaches


Strategies for Consideration in Implementation Plan

In the third part of the Community Convening, participants were provided with a packet of evidence-

based intervention strategies for each of the four community health pillars. Given their understanding

of community needs, participants were asked to collectively discuss strategies and then individually

select up to three evidence-based strategies within each pillar or write in a preferred strategy based on

the following criteria:

Magnitude of need

Organizational capacity in the community to address

Realistic to implement

Personal interest and passion

Table 11. Top Evidence-Based Strategy Solutions Identified at the Community Convening

Strategy Needs Addressed

Healthy,

Active

Living

Community Health Worker

programs

Social isolation, chronic diseases, poor health

outcomes for undocumented/vulnerable

groups, transportation to health care

appointments, chronic disease management

School nutrition programs Chronic disease, access to healthy foods

Community fitness programs Obesity, elder isolation and health

Child &

Family

Wellbeing

Prenatal and early childhood

home visiting programs

Care coordination for prenatal/postpartum

vulnerable mothers, infants, and children,

maternal smoking, ACEs

Preschool programs with family

support services

Affordable childcare, early developmental

screening, ACEs

‘Early Pathways’/home-based

mental health

Mental health services for families and

children, affordable childcare, follow-up for

high-risk mothers and children


Strategy Needs Addressed

Health

Delivery

Systems

Integration of behavioral

health and primary care

Substance abuse care, care coordination for

vulnerable populations, access to care

Detox/sobering centers Improved substance abuse care, improved

crisis/triage care

Increasing access to dental care

providers that accept Medicaid Dental care, health inequities

Reduce opioid prescriptions in

ED and primary care settings

Chronic pain management, adult substance

abuse

Systems/patient navigators Access to health care for vulnerable groups

Equity

School-based health centers Access to health care for rural populations

Increase mid-level scope of

practice

Access to health care for vulnerable and rural

populations

Expand Housing First programs Homelessness, chronically mentally ill


VII. IMPLEMENTATION PLAN

Selected Strategies

Adopted by our authorized body, the statement of strategies below will serve as the basis for a more

detailed CHNA implementation plan which will be published no later than November 30, 20162. The

Implementation Plan strategies summarized below were extrapolated from the data and from

community input. Our plan is comprehensive in the sense that there are strategies that impact the focus

areas within each of the community health pillars (and a number of strategies cross pillars). The display

of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake

with its community partners to affect the health status of the community. Rather, it is a statement of

our community health priorities.

The PeaceHealth St. John Board will approve an annual CHNA implementation plan that includes tactics,

timelines and metrics.

Table 12. 2016 PeaceHealth St. John Implementation Plan Summary

Aims/ Strategies Target population Primary partners

1. Ensure effective information exchange and care

coordination for select populations (e.g.

PeaceHealth Medical Group patients with complex

health and psychosocial conditions who are served

by multiple organizations) as part of PeaceHealth

Transforming Clinical Practice Initiative (TCPI) and

other community collaborations.

Children and adults

who receive

Medicaid and have

particularly complex

health psychosocial

conditions.

Local Community Health

Centers, behavioral health

organizations, Tribal health

clinics and others.

2. Increase participation in the PeaceHealth

employee wellness program, particularly for

caregivers at the lower end of the compensation

scale.

PeaceHealth

Caregivers

PeaceHealth HR; potential

partners could include union

representatives

2The final IRS regulations (published in the Federal Register on December 31, 2014) provide hospital facilities

with an additional four and a half months to adopt the implementation strategy, specifically requiring an

authorized body of the hospital facility to adopt an implementation strategy to meet the health needs identified

through a CHNA on or before the 15th day of the fifth month after the end of the taxable year in which the

hospital facility finishes conducting the CHNA.

http://www.gpo.gov/fdsys/pkg/FR-2014-12-31/html/2014-30525.htm


Aims/ Strategies Target population Primary partners

3. As part of our ongoing effort to create an inclusive

organization that exercises cultural humility,

recruit for and support a workforce that reflects

the changing ethnic, racial and cultural diversity

of the communities that we serve.

Patients and users of

health and social

services

Workforce development

Council; community and

Technical colleges; Tribal

health Centers and others

4. Advocate for public policy and support community

efforts to improve public infrastructure that

supports active lifestyles.

All community

members

Cowlitz on the Move,

Pathways 2020, Parks and

Recreation

5. Advocate for and support programs geared to promoting healthy nutrition, for school-aged children and their families.

Children age 0-18

and families

Youth and Family Link, Head

Start, Longview and Kelso

School Districts, Lower

Columbia School Gardens,

Family Health Center

6. Further develop and expand Community Health Worker initiatives that empowers individuals within specific communities to serve a liaison/linking/intermediary role between health/social services and the community.

Neighborhoods with

high risk for poor

health outcomes

Cowlitz County Health Dept.,

Family Health Center, Youth

and Family Link

7. Increase PH St. John caregiver awareness of ACEs

including trauma informed care and resilience.

PeaceHealth St. John

Caregivers

8. Advocate for and actively support the

development of a comprehensive continuum of

services that includes integrated primary care and

behavioral health services, transitional programs

and substance abuse treatment programs.

All community

members seeking

health care in our

community

Cowlitz County Health

Department, Family Heath

Center

9. Advocate for and actively support collaborative

strategies that provide short and longer-term

interventions addressing homelessness.

Children and adults

experiencing

homelessness or

families without

adequate long-term

housing.

Family Health Center,

Housing Coalition, Homeless

shelters


Significant Health Needs Not Addressed by Implementation Plan

PeaceHealth St. John has expertise in providing primary, specialty and tertiary care to Cowlitz County

residents. We are able to address particular access to care and other issues with our own resources and

expertise, but need to partner with public health and local organizations in order to address other

community health needs. The high priority issues we chose to focus on our implementation plan fill an

important set of needs in Cowlitz County and surrounding areas and leverage our resources and

expertise.

The issues that we have prioritized with input from the community leverage our resources and expertise

and address signigicant community needs. In prioritizing some issues however, others are not directly

addressed. These include preschool programs with family support services, prenatal and early

childhood home visiting programs, detox/sobering centers, community paramedic programs, and

increased access to dental providers that accept Medicaid.

2016-2019 Community Health Needs Assessment and Implementation Plan fol… · Report Card. Its most...

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Transcript of 2016-2019 Community Health Needs Assessment and Implementation Plan fol… · Report Card. Its most...