Washington County: One Community A Healthy Maine Partnership

Community Health Improvement Plan

Communities Served by Washington County: One Community:

Berry Township, Big Lake Township, Brookton, Cathance Township, Centerville, Day Block Township, Devereaux Township, Dyer Township, Edmunds Township, Forest Township, Forest City Township, Fowler Township, Greenlaw Chopping Township, Kossuth Township, Lambert Lake Township, Marion, T 19 ED, T 26 ED, T 18 MD, T 19 MD, T 24 MD, T 25 MD, T 30 MD, T 36 MD, T 37 MD, T 42 MD, T 43 MD, T 5 ND, T 6 ND, T 6 R1 NBPP, T 8 R3 NBPP, T11 R3 NBPP, T 8 R4 NBPP, Trescott, Addison, Alexander, Baileyville, Baring, Beals, Beddington, Calais, Centerville, Charlotte, Cherryfield, Codyville, Columbia, Columbia Falls, Cooper, Crawford, Cutler, Danforth, Deblois, Dennysville, East Machias, Eastport, Grand Lake Stream, Harrington, Indian Township Reservation, Jonesboro, Jonesport, Lubec, Machias, Machiasport, Marshfield, Meddybemps, Milbridge, Northfield, Pembroke, Perry, Pleasant Point Reservation, Princeton, Robbinston, Roque Bluffs, Steuben, Talmadge, Topsfield, Vanceboro, Waite, Wesley, Whiting, Whitneyville Sections of the MAPP process were implemented in collaboration with Saint Croix Valley Healthy Community. This document reflects the collaborative process and outcomes of many organizations and individuals within Washington County.

Eleody Libby Executive Director

Washington County: One Community 121 Court Street Suite A

Machias, ME 04654 (207) 255-3741

elibby@wc-oc.org

Signature Date

Anne Perry Chair, Board of Directors

Washington County: One Community 474 South Street

Calais, ME 04619 (207) 454-7338

aperry@maineline.net

Signature Date

On behalf of the Washington County: One Community, I would like to express my appreciation for your dedicated participation on the Washington County Community Health Plan. Community participating was an overwhelming success, with over 100 individuals, organizations and businesses from every corner of Washington County engaged. Once again, I would like to convey my deepest appreciation for your contribution and wish you good health and happiness in working to achieve our health goals the years ahead.

Respectfully,

Eleody Libby Executive Director

Washington County Community Health Plan Participants The names below represent individuals and/or organization who participated in the MAPP community health

assessments. The list is not complete as it does not reflect participation of the anonymous prioritization survey. If you were a part of the survey and would like to be recognized, please contact Washington County: One Community. Al May Maine CDC Public Health Andrea Joyce Harrington Family Health Center Angela Fochesato Downeast Community Hospital Ann Skriletz Blue Devil School Based Health Center Anne Sawtelle Whiting Food Pantry Anne Sites ME-CDC Infectious Disease Anne Perry Calais Regional Hospital April MacLelland Maine Parent Federation Arlena Ryan Maine Veterans Homes Machias Barbara Drisko Washington County Drug Action Team Betsy Fitzgerald County of Washington Bill Wypyski Harrington Family Health Center Bonnie Fortini Literacy Volunteers of Washington County Brenda Roberts Washington County Co-op Extension Brenda Sabattis Indian Township Health Center Brian Altvater Pleasant Point Housing Authority Carrie Callahan Next Step Domestic Violence Project Charlie Martin-Berry Passages Program Cheryl Robbins Washington Hancock Community Agency Cheryl Zwingman-Bagley Calais Regional Hospital Chris Kuhni Milbridge Medical Center/Women's Health Library

Chyde Merrill Town of Milbridge Cindy Higgins University of Maine Cindy Look Maine DHHS, Public Health Cora Townsend Cobscook Community Learning Center Dana Chevalier Peavey Memorial Library Deborah Dodge Community Health and Counseling Services Debra Eckart Washington County Co-op Extension Debra Pollard Town of Beddington Denise Harris St Croix Valley Healthy Communities Dixie Beaudoin Sunrise Opportunities Doddie Emmerson Maine Career Center Donna Kelley Downeast Community Hospital Doug Jones Downeast Community Hospital Ed French United Way of Eastern Maine Eileen Campbell Washington County Literacy Program Elaine Cale Washington County Children’s Program Eleody Libby Washington County One Community Elizabeth Neptune DHHS/ME-CDC Office of Minority Health Eva Severance Topsfield Town Treasurer Gail Wahl Neighbors Against Drug Abuse Gini King Centre Street Congregational Church Heather Henry Calais Coordinated School Health Program Helen Burlock Community Health and Counseling Services Holly Gartmayer-DeYoung Eastport Health Center Jaclyn MacIntyre Down East Community Hospital Jamie Moreira University of Maine Machias Community Studies Jane Blackwood Axiom Techologies Jane Brissette Family First Jane Weil Community Care Collaborative Jen Peters Sunrise County Economic Council Jerolyn Ireland Tribal Liaison John Shoemaker Public Health Consultant Jon Ramsdell AmeriCorps Judy East Washington County Council of Governments Julie Bradley Sunrise County Home Care Services Karen Sabattis Indian Township Health Center Katherine Cook Eastport Health Center Kathie Norwood Downeast Health Services Kevin Athearn Univeristy of Maine Machias Kim Page University of Maine Machias Lara Whalen The Quoddy Tides

Laurie Fogelman The Next Step Domestic Violence Program Laurie Hayward Downeast Community Hospital Linda Belfiore Washington Hancock Community Agency Linda Pagels-Wentworth County of Washington Lisa Seeley Machias Savings Bank Lois Ann Kuntz University of Maine Machias Behavioral Sciences Marianne Moore Curves of Calais Marilyn Hughes HealthWays/Regional Medical Center at Lubec Marjorie Withers Community Care Collaborative Mark Smutz US Customs and Border Protection Megan Burgess Washington Hancock Community Agency Melissa Mallock Sunrise Home Health Melissa Yerxa Maine DHHS Michael Perkins Maine Bureau of Veterans' Services Michael St. Louis Washington County Sheriff Office Michaelynn Cecire DHHS/ME-CDC Mickael Edwards Healthways / Regional Medical Center Lubec Mike Doran Healthways / Regional Medical Center Lubec

Mike Hinerman Washington County Emergency Management Agency

Mona VanWart Calais Regional Hospital Nakia Dana Indian Township Health Center Nichole Jamison Maine Labor, Bureau of Employment Services Norma Beal Beals LPHO Pam Gagnon Child and Family Opportunities, Inc Paul Stuart St Croix Valley Healthy Communities Paula Lumbert St Croix Valley Healthy Communities Rick Tanney HealthWays/Regional Medical Center at Lubec Rose St Louis Community Health and Counseling Services Ruth Leubecker Machias Valley News Observer Sally Christ Center for Tobacco Independence Sandra Yarmal Pleasant Point Health Center Sara McConnell Washington County: One Community Sharon Dean Sunrise Opportunity Sherri Camick Washington County Children's Program of Maine Stephen Weisberger, DO Arnold Memorial Medical Center Sue Clark Calais School Health Clinic Sue Dalton Harrington Family Health Center Susan Corbett Axiom Technologies, LLC Susan Farley Washington Hancock Community Agency Susan Mace University of Maine

Tammy McLellan Topsfield LPHO Terry Leahy Downeast Community Hospital Theresa Brown Atlantic Mental Health Services Theresa Alley Washington County Childrens Program Theresa Brown Atlantic Mental Health Services Travis Willey Washington County Sheriff's Office Walter Plout Downeast EMS Wendy Harrington Maine Sea Coast Mission Machias Chamber of Commerce Whiting Food Pantry

Washington County Mobilizing for Action through Planning and Partnership

(MAPP)

Committee Members The names below represent individuals and/or organization who participated in the MAPP Planning Committee. *Anne Perry FNP, State Representative *Betsy Fitzgerald Washington County Brian Altvater Pleasant Point Housing Authority Cindy Look Maine CDC Public Health Nurse *Eleody Libby Washington County: One Community Gail Wahl Neighbors Against Drug Abuse *Holly Gartmayer-DeYoung Eastport Health Center *Jane Weil Community Care Collaborative John Shoemaker Public Health Consultant

*Judy East Washington County Council of Governments

*Michael Edwards HealthWays/RMCL Paul Stuart St. Croix Valley Healthy Communities Susan Corbett Axiom Technologies *Wendy Harrington Maine Sea Coast Mission

* Current members

Table of Contents

Health Improvement Plan Introduction ………………………………………………………. 7 MAPP Overview ……………………………………………………………………………… 8 Phase I Local Service Area Description and Background Content ………………………… 9 Phase II The Vision …………………………………………………………………………. 12 Phase III Community Assessments

Community Themes and Strengths Report ……………………………………….…… 14

Community Health Status Summary ………………………………………………….. 17

Washington County Local Public Health Assessment ………………………………... 18

Forces of Change Report ……………………………………………………………… 23

Phase IV Strategic Issue Identification ……………………………………………………… 34 Phase V Goals and Strategies………………………………………………………………… 38 Phase VI Action Plan ……………………………………………………………………..… 53 Health Improvement Plan ……………………………………………………………………. 70 Appendix I

Community Themes and Strengths Complete Assessment …………………….……. 72 Appendix II Community Health Complete Assessment …………………………………………... 82 Appendix III Phase V Goals and Strategies ………………………………………………………… 98

Washington County Community Health Improvement Plan

Introduction

Washington County, population 32,751 (2007), is entirely rural, with a natural resource and service based economy. Its 81 towns, unorganized territories and Native American Reservations range from 10 to 4,000 in size, most 2 hours or more from the closest urban center, Bangor. Common

occupations are in seasonal work such as fishing, clamming, blueberry harvesting, and wreath making, while for year-round work, the major employers of the county include: a paper mill, two community hospitals, a community college, branch of the state university, and salmon aquaculture. The progressive loss of farms in the region and recent extensive lay-offs associated with closings of a Naval base, textile companies, and seafood plants have had a pervasive negative impact on the economy and outlook for youth. The recession has accelerated these trends and may be expected to contribute to worsening negative public health indicators and chronic disease rates due to loss of health insurance and added social stress. The county shows high poverty rates and unemployment rates, low income and educational achievement rates. A high fraction are elderly, report recent fair-to-poor health, are uninsured, and are disabled. (see Appendix A, Community Health Data, for additional data)

Measure Wash.

Co. Maine U.S. % Co./ State

% Co./ U.S. Source

Individual poverty rate, '08 20.1% 12.6% 13.2% 160% 152% Bur. Census, Child poverty rate, '08 28.7% 16.5% 18.2% 174% 158% Bur. Census,

Unemployment rate, ’09 11.5% 8.2% 9.3% 140% 124% Maine Dept. Labor

Median Household Income, '08 $31,856 $46,419 $52,029 69% 61% Bur. Census, % without H.S. diploma, '05-07 15.8% 11.1% 16.0% 142% 99% Bur. Census % Population > 65 yrs. old, ‘09 18.7% 15.6% 12.9% 120% 145% Bur. Census

% w. fair or poor health in last 30d., '06 21.7% 13.6% 14.7% 160% 148% Maine CDC

% Uninsured, '06 14.8% 10.4% 14.5% 142% 102% Maine CDC

Population per PCP, '04 849 903 1351 ('00) 94% 63% Maine

DHHS % with disability status, >5 yrs, '05-

07 25.8% 19.0% 15.1% 136% 171% Bur. Census

Washington County Community Health Improvement Plan

Mobilizing for Action Through Planning and

Partnership (MAPP)

What is MAPP? Mobilizing for Action through Planning and Partnerships (MAPP) is a strategic approach to community health improvement. This tool helps communities improve health and quality of life through community-wide strategic planning. Using MAPP, communities seek to achieve optimal health by identifying and using their resources wisely, taking into account their unique circumstances and needs, and forming effective partnerships for strategic action. Benefits of Undertaking MAPP Create a healthy community and a better quality of life. The ultimate goal of MAPP is optimal community health—a community where residents are healthy, safe, and have a high quality of life. Here, a "healthy community" goes beyond physical health alone. According to the World Health Organization, "Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity" "health is…a positive concept emphasizing social and personal resources as well as physical capabilities" Increase the visibility of public health within the community. By implementing a participatory and highly publicized process, increased awareness and knowledge of public health issues and greater appreciation for the local public health system as a whole may be achieved. Anticipate and manage change. Community strategic planning better prepares local public health systems to anticipate, manage, and respond to changes in the environment. Create a stronger public health infrastructure. The diverse network of partners within the local public health system is strengthened through the implementation of MAPP. This leads to better coordination of services and resources, a higher appreciation and awareness among partners, and less duplication of services. Engage the community and create community ownership for public health issues. Through participation in the MAPP process, community residents may gain a better awareness of the area in which they live and their own potential for improving their quality of life. Community-driven processes also lead to collective thinking and a sense of community ownership in initiatives, and, ultimately, may produce more innovative, effective, and sustainable solutions to complex problems. Community participation in the MAPP process may augment community involvement in other initiatives and/or have long-lasting effects on creating a stronger community spirit.

Washington County Community Health Improvement Plan

Phase I

Local Service Area Description &

Background context for the Community Healthy Improvement Plan

Washington County: One Community (WC:OC) is a community-based coalition serving Washington County. Its mission is to improve quality of life for the citizens of Washington County - from infants to elders – through positive communication, demonstrating, celebrating and promoting success, and ensuring residents receive the public health support they need to achieve healthy, substance-free, productive and financially viable lives while respecting cultural and community differences and similarities. Washington County: One Community serves all forty-seven communities and two unorganized territories (North Washington and East Central Washington) within Washington County, specifically: Addison, Alexander, Baileyville (Woodland), Baring Plantation, Beals, Beddington, Calais, Centerville (disincorporated), Charlotte, Cherryfield, Codyville Plantation, Columbia, Columbia Falls, Cooper, Crawford, Cutler, Danforth, Deblois, Dennysville, East Machias, Eastport, Grand Lake Stream, Harrington, Indian Township, Jonesboro, Jonesport, Lubec, Machias, Machiasport, Marshfield, Meddybemps, Milbridge, Northfield, Pembroke, Perry, Pleasant Point, Princeton, Robbinston, Roque Bluffs, Steuben, Talmadge, Topsfield, Vanceboro, Waite, Wesley, Whiting, Whitneyville. The total population of the Healthy Maine Partnership service area is 32,571. Primary connected by route one, Washington County: One Community service area include thirty-eight public schools systems spanning nine AOS (Alternative Operating Schools) districts. Communities that provide public grade school education include; Addison, Alexander, Baileyville, Beals, Calais, Charlotte, Cherryfield, Cutler, Danforth, East Machias, Eastport, Edmunds Township, Harrington, Jonesboro, Jonesport, Lubec, Machias, Machiasport, Milbridge, Pembroke, Perry, Princeton, Robbinston, Steuben, Topsfield, Vanceboro, Wesley, Whiting Seven High Schools provide secondary education and are located in Baileyville, Calais, Danforth, Eastport, Harrington, Jonesport, and Machias. In addition to the public schools system, three private and semi-private schools are located within the service area including; Washington Academy, a semi-private high school located in East Machias, the Machias Valley Christian School (Elementary School) located in Machias and the Cherryfield Christian School (Elementary and High School) located in Cherryfield. The total student body population for the WC:OC service area is 4,211. Machias, center of the service area, hosts the county seat. As of the 2000 census, the town population was 2,353 and is the second largest community following Calais with a population of

3,123. Fresh water lakes, three large rivers (Narraguagus River in the South, Machias River in Central, and St. Croix in the North), and streams provide opportunities for recreation and fishing. Dense and expansive forest offer abundant game for hunting and observation. Saltwater bays and tidal areas provide habitats for many rare bird species. Four peninsulas; Lubec, Machiasport, Eastport and Jonesport, host fishing villages that are considered remote because they do not reside along frequently traveled route one corridor. Recently, eighty-eight miles of rail spanning the entire service area has been converted to a multi-use trail. The major employers within the WC:OC service area include aquaculture industries, Downeast Community Hospital, Calais Regional Hospital, The University of Maine at Machias, Woodland Pulp and Paper mill, local school systems and health care agencies. The most common occupations involve seasonal work such as fishing, clamming, blueberry harvesting, and wreath making. Washington County: One Community commenced the MAPP process in September of 2008. The journey began under the leadership of the Washington County: One Community Wellness Focus Team. The Wellness Team, co-chaired by John Shoemaker, MPH and Cindy Look, PHN, embraced the process as a method that would help link organizations together to begin the development of a local coordinated Public Health System. The networks and relationships that have developed during the MAPP process have strengthened the capacity and willingness for increased organizational collaborations and resource sharing, thereby building the strong foundation to facilitate the coordination of our local public health system. Serving as the MAPP committee, the Washington County Wellness Team initial objective was to develop and identify the steps that would guide MAPP process. The Committee met with Chris Lyman, Program Manager for the Maine Center for Disease Control Public Health Department to clarify process steps and expectations of the Maine CDC. Over the next few months, the committee worked to develop a plan that included a timeline and identified additional funding sources to assist with evaluation and community outreach. Realizing the MAPP planning process was requiring most of the regularly scheduled meeting time, the Wellness Team identified and recruited a core team of individuals to oversee and facilitate the process. In winter 2009, the WC:OC MAPP steering Committee was charged with MAPP oversight and began to move the MAPP plan forward. To date over eight hundred individuals representing local businesses, health care facilities, mental health agencies, social service organizations, civic organizations, educational institutions, faith based organizations and local and state government have participated in the MAPP process. The core MAPP team has included The Washington County: One Community Board of Directors Executive Team and representatives from Washington County Council of Governments, HealthWays/Regional Medical Center at Lubec, County of Washington/County Government, Maine Center for Disease Control Public Health Nursing, Downeast Community Hospital, Maine Seacoast Mission, Neighbors Against Drug Abuse, Axiom (local technology business), Independent Public Health Contractor, State Legislator/Chair of the Department of Health and Human Services and Saint Croix Valley Healthy Community.

Throughout the MAPP process Washington County: One Community has been working to build local public health leadership while promoting and facilitating community responsibility for the health of the public. We have effectively secured resources, match needs with assets, respond to external circumstances, anticipated and managed change, and establish a long-range direction for Washington County. WC:OC understands that in order to achieve community change we must be linked to all facets of the community. The very nature of coalition and community work relies on social capital and relationships developed with organizations throughout our county. Organizations such as the University of Maine in Machias Behavioral Sciences & Community Studies Program, Downeast Community Hospital, Maine Center for Disease Control, Washington County Council of Governments, HealthWays, Maine Career Center, Machias Valley Chamber of Commerce, Whiting Food Pantry, and the Saint Croix Valley Healthy Communities Coalition were all vital contributors to the success of WC:OC’s MAPP process.

Washington County Community Health Improvement Plan

Phase II

The Vision

It is the vision for Washington County that all residents receive the public health support they need to achieve long healthy and productive lives.

A healthy community is an engaged citizenry that values education, family, personal health and the environment and thrives on improvements to quality of life for all people.

A healthy community is one that has a strong social network and seeks to include all members from young to the young at heart in decision making. A healthy community has safe, clean air, and water and access to healthcare and healthy foods. A healthy community ensures adequate housing, excellent education, and protection against physical harm. A healthy community supports and promotes the wellbeing of all residents. Community Values: • A community that has a sense of spirit, and an excitement about working together to be

supportive of all community members • A Community where no one is homeless or hungry where affordable housing and healthy

foods are available and accessible to all. • The community is free of prejudice and people who are different are accepted. A

Community where we accept diversity, cultural differences and traditional values and morals

• A Community that is safe, free from violence and preventable tragedy • A community that is free of substance abuse where prevention and healthy lifestyle

choices are abundant. Where mental health and physical wellbeing are supported and promoted within the community.

• A community that provides good schools that each lifelong educational principals and activities for children

• A community that focuses on a strong, stable, healthy family. That puts effort into the children in the community believing they will be the ones to become future community leaders. That supports opportunities for families to grow, be safe and prosper.

• A community that provides access to quality health and dental care to all residents. Where specialized treatment and management of disease is provided locally.

• A community that has access to recreational, culture, art activities through the strong connection of our vast physical environment and our need to create, express and explore

• A Community where reliable and accessible transportation is available for all of our citizens

• A community that has opportunities for all people to have a variety of meaningful work to ensure that all have the opportunity to achieve economic prosperity

• A County in which all residents live long, healthy lives.

The draft Community Health Vision, A County in which all residents live long, healthy lives, was developed by the Washington County Wellness Committee in January, 2009. Committee members present include: Cindy Look, Donna Kelley, Theresa Alley, Jane Brissette, Eleody Libby, Eileen Campbell, Gail Wahl, John Shoemaker, Theresa Alley, and Marty Anderson.

Shortly after the development of the vision, the Wellness Team charged the MAPP Steering Committee with the implementation of the MAPP process. Over the next year the MAPP Steering committee revised the vision and developed the community values based on the information provided by Washington County Residents through focus groups and statements extracted from the Quality of Life Survey the committee.

The Quality of Life survey was administered on-line through distribution lists, event notices, list serve networks and a mailing to every household in Washington County (see Appendix I Community Strengths and Themes pg. 72). Of the seven hundred and sixty-five completed the surveys, four hundred and ninety-five persons answered the question, What is your vision of a healthy community? The committee reviewed written responses such as:

A healthy community has the physical, intellectual and social resources that enable people to reach their potentials. This includes adequate food, shelter, medical and educational resources. While a healthy community provides a safety net for those unable to care for themselves, it also creates an economic climate, through education and business opportunities to allow people to work to support their life style.

Where no one is homeless or hungry, and where we cooperate with one another to ensure warm shelter, healthy food, clean water for all.

Accessible health care; good jobs with benefits; safe streets; quality schools; healthy

environment; recreation programs for all ages; available help for people in need; and a vision for future improvements

As the committee reviewed the responses common threads emerged; access to quality

healthcare, economic stability, educational opportunities, access to support systems were initially indentified as values the community holds. During the fall of 2009, the committee identified specific common values and revised the vision to include the ideals of a healthy community. In late winter, 2010, the vision was disseminated to the MAPP Steering Committee, WC:OC Wellness Committee and the WC:OC Board of Directors for final revisions. The current vision was approved by the MAPP Committee in April, 2010.