Rockbridge Area Community Health Improvement Plan

2012
Rockbridge Area
Community Health
Improvement Plan
Photo by Michelle McCusker
2
Health Center Planning Grant Staff
Project Director, Suzanne Sheridan, Executive Director, RAFC
Project Manager, Laura Simpson, RN
Communications Manager, Katy Datz, Development Director, RAFC
Technical Consultant, Pat Young, Community Works
MAPP Core Team
Health Center Planning Grant Staff
Ms. Deborah Bundy-Carpenter, RN, Nurse Manager, Central Shenandoah Health District
Mr. Chuck Carr, Vice President, Carilion Stonewall Jackson Hospital
Dr. Laura Kornegay, Local Physician
Dr. Douglas Larsen, Director, Central Shenandoah Health District
Ms. Melissa Mederios, Coordinator of Service Leadership, Washington and Lee University
Ms. Holly Ostby, Community Health Coordinator, Carilion Stonewall Jackson Hospital
MAPP Steering Committee
Mike Bell
Rockbridge Area Community Services
Jeff Grossman
RAFC, Board of Directors
Chris Blalock
Rockbridge County Sheriff
Anne Hansen
Physician; Community
Donna Gail Broussard
Heritage Hall
Kathleen Heatwole
Augusta Health, VP for Planning and
Development
Cindy Crance
Rockbridge County Schools, Director
of Instruction
Dennis Cropper
Rockbridge Area Community Services
Lisla Danas
Virginia Military Institute, Alumni
Timothy Diette
Washington and Lee University
Meredith Downey
Department of Social Services
Joan Manley
Valley Associates for Independent
Living
Lyle McClung
Physician; RAFC Board of Directors
Sammy Moore
Chamber of Commerce, Executive
Director
Bob Huch
Southern Virginia University, VP of
Finance
Lewis Plogger
Buena Visa City Council
Michelle Jones
Rockbridge Area Hospice
Alysan Raymond
YMCA, Executive Director
Sharon Knick
Community
Tim Root
Rockbridge Area Transportation
System
Betty LaRockk
Rockbridge Area Transportation
System, Executive Director
Jeri Schaff
Maury River Senior Center; Valley
Program for Aging Services
Mimi Elrod
Lexington City, Mayor
Buster Lewis
Rockbridge County Board of
Supervisors
Mike Smith
Rockbridge Area Community Services
Rusty Ford
Rockbridge County, Board of
Supervisors
Mary Lynn Lipscomb
SJH Community Health Foundation
Board; Health Consultant
Leonard Stewart
Project Horizon; Lexington Police
Department
Carole Green
Virginia Military Institute, Alumni
Dan Lyons
Lexington City Schools,
Superintendent
Shane Watts
Emergency Medical Services
ROCKBRIDGE AREA Community Health Improvement Plan
Table of Contents
Executive Summary……………………………………………………………………….… 4
A Year of Public Health Assessment and Planning………………………..…. 6
Top Priority Health Issues
Issue One: Access to Health Services……………………………………… 10
Issue Two: Nutrition, Obesity, and Physical Activity………………..13
Issue Three: Mental Health………………………………………………….…16
Issue Four: Oral Health………………………………………………………….. 18
The Next Step…………………………………………………………………………………. 20
Special thanks to Cadet Michelle McCusker and COL Christina McDonald of Virginia Military Institute
for their contributions to the Community Health Improvement Plan document completed as part of
the VMI Summer Undergraduate Research Institute.
4
Executive Summary
Rockbridge area residents have
long been interested in promoting
equity and improving the
community’s response to the
needs of at-risk individuals.
The Rockbridge Area Free Clinic,
recognizing the need to further
develop a sustainable system of
care for the medically
underserved in the Rockbridge
area, applied for and was awarded
an $80,000 Health Center
Planning Grant by the United
States Department of Health and
Human Services. This grant was
used to fund a 12-month project
to broadly define and assess the
health of our community and
develop a community health
improvement plan. This project,
known as the Rockbridge Area
MAPP Project, was conducted in
partnership with Carilion
Stonewall Jackson Hospital and
the Central Shenandoah Health
District. The Rockbridge Area
Community Health Needs
Assessment (CHNA) provides a full
report of the community-based
visioning, assessment, and
planning process conducted
between September 2011 and
August 2012.
The information presented in the
Community Health Needs
Assessment was gathered through
a variety of sources. The health
status of the Rockbridge area was
analyzed through a comparison of
local and state data. Goals for
health improvement are guided
by national benchmarks set forth
by Healthy People 2020. Focus
groups were held to collect
feedback from individuals across
the lifespan and surveys were
distributed to both a random
sample of all area residents and a
target population of medically
underserved residents. The
assessment data was used by the
Steering Committee to identify
ROCKBRIDGE AREA Community Health Improvement Plan
5
the following top four health
priority issues:
1. Access to Health Services
2. Nutrition, Physical Activity
and Obesity
3. Oral Health
4. Mental Health
The Committee constructed goals
and objectives for each of the
issues and identified existing
resources that could facilitate the
achievement of those goals. Based
on the assessment and strategic
planning results, the Community
Health Improvement Plan has
been developed to communicate
priority health issues and engage
the community in a common goal
of improved health. The
assessment and strategic planning
phases of the project have
concluded, but the cyclical
implementation and evaluation
process aimed at improving the
health and quality of life of all
Rockbridge area residents has
only just begun. The Rockbridge
Area Community Health
Improvement Plan represents the
efforts of many organizations and
individuals working together for a
healthier community.
Vision
Our vision is a Rockbridge community with improved
health and quality of life for this and future generations
supported by a comprehensive, accessible and
sustainable community health system.
Read the Rockbridge Area Community Health Needs Assessment here:
http://www.rockbridgefreeclinic.org/resources/Updates/Rockbridge%20Area%20CHNA_2012_Final.pdf
ROCKBRIDGE AREA Community Health Improvement Plan
6
A Year of Public Health Assessment and Planning
In September of 2011, an $80,000
Federal Planning Grant was awarded to
the Rockbridge Area Free Clinic by the
Health Resources and Services
Administration (HRSA) Bureau of
Primary Health Care. Upon notification
of grant award, the Free Clinic formally
invited Carilion Stonewall Jackson
Hospital and Central Shenandoah
Health District to partner in a year-long
health assessment and planning project
guided by the Mobilizing for Action
through Planning and Partnerships
(MAPP) model. MAPP was developed
by the National Association of County
and City Health Officials (NACCHO) and
the Centers for Disease Control and
Prevention (CDC) as a strategic planning
tool for community-wide health
promotion. MAPP consists of six
phases:
1.
2.
3.
4.
5.
6.
Organizing for Success
Visioning
Assessment
Strategic Issues
Goals and Strategies
Action Cycle
In the initial Organizing for Success
phase, a Steering Committee was
formed to represent the public health
system, including individuals from local
governments, school systems, health
and human service agencies, non-profit
organizations, local colleges and law
enforcement. Committee members
attended a MAPP Project orientation,
and then formed work groups in order
ROCKBRIDGE AREA Community Health Improvement Plan
7
to plan and implement the six phases of
MAPP.
In January, the Visioning phase was
conducted with a community-wide
event held at Virginia Military Institute.
This community forum was held to
engage the larger community and
assess community values.
With the feedback from this meeting,
the Steering Committee crafted a vision
statement that provides purpose and
focus to long term health improvement
efforts.
Our vision is a Rockbridge
community with improved
health and quality of life for this
and future generations
supported by a comprehensive,
accessible and sustainable
community health system.
The Assessment phase utilized four
assessment tools that allowed for a
comprehensive understanding of the
factors that affect the health outcomes
of the Rockbridge community. The four
MAPP Assessments include:
1. Community Themes and
Strengths
2. Local Public Health System
3. Community Health Status
4. Forces of Change
The Community Themes and Strengths
Assessment was designed to identify
the strengths and weaknesses of the
community and explore health values.
This information was gathered through
focus group discussions with consumers
of the health system and local leaders.
Eleven focus group discussions were
conducted with area stakeholders at
the Visioning Event in January 2012.
The Rockbridge Area MAPP team also
sought out medically underserved
populations and made an effort to hear
from individuals across the lifespan and
from all three localities. To this end,
nine additional focus groups were held
throughout the Rockbridge area during
February and March 2012. Based on
focus group guidelines published by the
World Health Organization, participants
were asked to brainstorm on their own
definition of health, reflect upon recent
experiences with the local health care
system and identify sources of care,
barriers to care, and assets of the
current system.
ROCKBRIDGE AREA Community Health Improvement Plan
8
The Local Public Health System
Assessment determines the capacity of
the local public health system and
identifies gaps in care. Sources of care,
barriers to care, and gaps in services
were reported by focus groups
participants and survey respondents.
Emergency room usage data was
collected from Carilion Stonewall
Jackson Hospital and Augusta Health.
Information was collected from local
providers and health and human
services agencies.
The Community Health Status
Assessment documents the
community’s health indicators and
compares them to state data as well as
national benchmarks outlined in
Healthy People 2020.
The Forces of Change Assessment was
conducted by the Rockbridge Area Free
Clinic, Carilion Stonewall Jackson
Hospital, the Central Shenandoah
Health District, and members of the
MAPP Steering Committee in March
2012. The purpose of the Forces of
Change Assessment is to identify
external forces that affect the health of
the community and health care service
operations.
In May, the assessment findings were
presented to the Steering Committee,
and in June a community-wide strategic
planning session was conducted to
identify Strategic Issues. The strategic
planning process was guided by a set of
high-priority public health issues called
the Healthy People 2020 Leading Health
Indicators. The Leading Health
Indicators are a smaller set of
objectives selected by the Healthy
People 2020 committee to
communicate key issues and guide
community efforts. Local data was
examined for the twelve health
indicators: 1) Access to Health Services,
2) Clinical Preventive Services, 3)
Environmental Quality, 4) Tobacco, 5)
Social Determinants, 6) Oral Health, 7)
Nutrition, Physical Activity, and Obesity,
8) Injury and Violence, 9) Maternal and
Child Health, 10) Mental Health, 11)
Substance Abuse, 12) Reproductive and
Sexual Health.
The top four issues identified as priority
issues for the Rockbridge area are:
ROCKBRIDGE AREA Community Health Improvement Plan
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1. Access to Health Services
2. Nutrition, Physical Activity
and Obesity
3. Oral Health
4. Mental Health
In the Goals and Strategies phase,
goals were set for improvement of the
priority issues and strategies were
suggested. Available resources and
barriers to care were also identified.
The goals and strategies presented here
are meant to serve as a flexible, living
tool for continued health improvement
efforts. There are many valuable health
and human resources available to
Rockbridge area community members
that are not reflected in this report.
The task now is to take stock of existing
efforts related to the priority issues,
further engage key stakeholders, and
promote coordination of local action.
The Rockbridge Area Free Clinic,
Carilion Stonewall Jackson Hospital, the
Central Shenandoah Health District, and
many other concerned citizens are
committed to the Action Cycle, a
continuous process of refining goals,
evaluating strategies and acting
together to support initiatives that
result in a healthier Rockbridge.1
1
Image retrieved:
http://www.naccho.org/topics/infrastructure/mapp/framework
/clearinghouse/general.cfm
ROCKBRIDGE AREA Community Health Improvement Plan
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Public Health Priority Issues
ISSUE ONE:
Access to Health Services
Health care resources are only
useful to a community if they are
accessible to those who need
them.
The Health Resources and
Services Administration (HRSA)
defines the criteria for officially
designating Medically
Underserved Populations and
Health Professional Shortage
Areas for Primary Care, Dental,
and Mental Health. These
designations are used to identify
barriers to health care access and
prioritize health care needs in the
United States.
Low-income residents of Buena
Vista, Lexington, and Rockbridge
County are designated a
Medically Underserved
Population and a Primary Care
Health Professional Shortage
Area.
“Low-income” is defined by HRSA
as an income at or below 200% of
the Federal Poverty Level.
In the Rockbridge area, 38 % of
residents are low-income.2
The Rockbridge Area Free Clinic was founded
in 1992 and relies heavily on area volunteers
to provide access to health care for lowincome, uninsured individuals. Despite its
role as a key safety net provider, limited
funding currently prevents the Free Clinic
from serving as a medical home to many
underserved residents in the Rockbridge area.
Approximately 19% of
Rockbridge area adults are
uninsured.3
2
American Community Survey, 5-Year Estimates, US
Census Bureau, 2006-2010
ROCKBRIDGE AREA Community Health Improvement Plan
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Low-income and uninsured
residents are less likely to have a
source of ongoing care. The
emergency room is often the only
option, even for non-emergent
illnesses and injuries.
In some cases, even secure
insurance status does not
guarantee access to services. To
remain in business, primary care
practices often have to impose
limits on the percentage of
patients with public insurance.
The current need for additional
primary care providers who serve
uninsured and underserved
residents has been identified.
This need is only expected to
increase in future years. As the
population ages, the number of
Medicare recipients is expected to
increase. As part of the Affordable
Care Act, nearly one in five
Virginians may be eligible for
Medicaid in 2014. The U.S.
Supreme Court recently ruled that
3
Virginia Atlas of Community Health, 2011
states may opt out of the
Medicaid expansion. If Virginia
decides to implement the
expansion, it is predicted that the
Rockbridge area will see an
increase of about 3,844 new
Medicaid enrollees.4
Although it is impossible to
predict future federal and state
legislative decisions, it is possible
to respond to local demands.
The need for comprehensive,
local, and affordable health
services is indisputable and
community support is evident.
70% of survey respondents from
a random sample of area
households and 85% of survey
respondents from the target
medically underserved
population indicated some level
of interest in using a
comprehensive, affordable
community health center.5
4
Weldon Cooper Center for Public Service, UVA,
Virginia Medicaid Now and Under Health Reform, 2010
5
Rockbridge Area Community Health Needs
Assessment, 2012
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE ONE:
Access to Health Services
Goal
Optimize access to
affordable
healthcare that
responds to the
unique needs of our
community.
Barriers to Care: (identified by
focus group participants)
Convenience of Hours (no evening
or weekend)
Lack of culturally appropriate
services
Lack of Medicaid providers
Lack of insurance/cost of care
Organizational policies at local
agencies
Perception of local services
Lack of awareness of local services
Lack of transportation
Suggested Strategies
• Develop a plan for a
comprehensive community
health center in the Rockbridge
area
• Develop a formal coalition that
promotes the vision for a
healthier Rockbridge
• Develop a plan for recruitment
and retention of health care
professionals
• Develop a plan to better utilize
technology to meet identified
health care needs
Resources (not all inclusive)
Rockbridge Area Free Clinic
Central Shenandoah Health District
Carilion Stonewall Jackson Hospital
Local health care providers
Augusta Health
Rockbridge Area Community Services
Augusta Health Care for Women
Department of Social Services
Valley Program for Aging Services
Local schools
Rockbridge Area Transportation
System
Local pharmacies
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE TWO:
Nutrition, Physical Activity and Obesity
Eating nutritious food and staying
physically active directly impacts
a person’s mental and physical
health. Maintaining good diet
and exercise habits can decrease
the risk of many health issues.
Obesity puts both children and
adults at risk for a variety of
health problems such as diabetes
and high blood pressure.
High blood pressure is reported
in 50.9 % of Rockbridge County
residents, compared to 27.5% in
Virginia.8
31% of adults in Rockbridge
County are obese compared to
26.3% in Virginia.6
The age-adjusted diabetes
prevalence rates for all three
localities exceed both the state
level and the national benchmark.
The average (2006-2010) diabetes
mortality rate in Buena Vista and
Lexington was more than double
the rate of Virginia and
Rockbridge County during the
same time period.9
7
7
All black and white photos presented here were
taken by local residents to promote food awareness.
See the Rockbridge Area CHNA for full report.
68
, VDH, Office of Family Services, Behavior Risk Factor
Surveillance System, 2010
9
VDH, 2006-2010
ROCKBRIDGE AREA Community Health Improvement Plan
14
In 2010, 26.4% of children in
Virginia were overweight or obese
compared to 27.6% nationally.
During the same time period, an
average 42% of Rockbridge
County elementary school
children, 47% of middle school
children and 50% of high school
students were overweight or
obese. The reported percentage
of overweight school children in
Rockbridge County decreased
dramatically in the 2011-2012
school year. The latest
measurement found that 10.75%
of elementary school children,
25% of middle school children and
37% of high school students were
identified as overweight or
obese.10 These recent results are
encouraging; however the root
cause of the dramatic remains
unclear.
school children, and 35% of high
school students were overweight
or obese in the 2011-2012 school
year.11
“They need something
to teach the kids how
to eat right. My son is
overweight. All he
wants is junk food.”
~Focus Group Participant
Buena Vista City Schools reported
an average 53.5% of elementary
school children, 42% of middle
11
10
Rockbridge County Schools 2010, 2012
Buena Vista City Schools, 2012; Please note:
Lexington City Schools did not report BMI results.
ROCKBRIDGE AREA Community Health Improvement Plan
15
ISSUE TWO:
Nutrition, Physical Activity, and Obesity
Goal
Suggested Strategies
• Create a community-based
wellness initiative that utilizes
community health workers and
promotes food security
• Use currently formed groups as a
venue for training lay people to
support individuals in meeting
physical activity goals
• Pilot a community garden using
master gardeners as trainers.
Replicate existing school garden
programs
• Build a system for processing,
storing and broadly distributing
local food
Barriers (identified by focus group Resources (not all inclusive)
participants)
Local school systems
Lack of social support
Rockbridge Area Relief Association
State and Federal Policies
YMCA
Transportation
Let’s Move Lexington
Lack of affordable services
The Community Table
Lack of access to healthy food
Primary Care providers
Need for self-care education
Registered Dieticians
Perception of local services
Cooperative Extension Services
Cultural habits
Rockbridge Area Conservation Council
Local farmers
Reduce the
rate of obesity
in the
Rockbridge
area.
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE THREE:
Mental Health
Mental health is an essential part
of a person’s well-being, healthy
families, and productive
communities.
A recent study conducted by
Washington & Lee University
economists, Professors Arthur
Goldsmith and Timothy Diette,12
shed light on the relationship
between unemployment and poor
mental health. The percentage of
the Rockbridge area population
which is unemployed has followed
state trends and national trends
and steadily increased over the
past decade. Since 2008, local
unemployment numbers have
exceeded the state average.13
The stress associated with longterm unemployment not only
causes emotional instability and
worry, but also negatively impacts
12
http://news.blogs.wlu.edu/2011/10/21/wluecoonomists-unemployment/
13
Virginia Employment Commission
the overall wellbeing of
individuals, families, and
communities.
The suicide rate in Buena Vista
(15 per 100,000) and Rockbridge
County (17.9 per 100,000)
exceeds state (11.9 per 100,000)
and national (11.0 per 100,000)
rates.
“We’ve known he has
problems for a long time,
but we couldn’t get help
because we couldn’t afford
it. Eventually he snapped.”
~Focus Group Participant
The entire Rockbridge area, is
designated a Mental Health
Professional Shortage Area by the
Health Resources and Services
Administration.
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE THREE:
Mental Health
Goal
Increase access
to mental
health
services.
Barriers (identified by focus group
participants)
Lack of local services
Lack of Medicaid providers
Cost of services
Perception of services available
Transportation
Suggested Intervention Strategies
• Develop a campaign to increase
awareness of available services in
the area
• Increase the number of mental
health providers in the area.
• Develop a specialized, regional
transportation plan for mental
health patients
• Ensure collaboration between
agencies and organizations
serving individuals and families
with mental health needs
• Develop and/or support
programs that promote positive
coping skills for individuals across
the lifespan
Resources (not all inclusive)
Rockbridge Area Community
Services
Rockbridge Area Free Clinic
Crisis Intervention Team
Local public schools
Emergency Departments
Law enforcement
Rockbridge Area Transportation
System
Local providers
Faith communities
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE FOUR:
Oral Health
Poor oral health has serious,
lasting consequences and
emergent dental care is costly
compared to regular, preventive
services.
Approximately 50% of
Rockbridge area residents have
not had a dental visit in the past
two years. This compares to
“It has been 15 years
since I went to the
dentist.”
~Focus Group Participant
22.8% in Virginia.14
One of the top ten emergency
room diagnoses at both Carilion
Stonewall Jackson Hospital and
Augusta Health is “Dental
Disorder.”15
In a survey of services that would
be utilized from an affordable
community health center,
“dental” received the most
number of responses from both
the random sample of all area
households and the target
medically underserved
population.16
Only one local provider, the
Lexington Health Department,
currently accepts new Medicaid
pediatric patients. This practice is
open two days a week, seeing 15
pediatric patients per day.
Low-income residents of Buena Vista,
Lexington and Rockbridge County live in a
Dental Health Professional Shortage Area as
designated by the Health Resources and
Services Administration.
15
14
VDH, Office of Family Health Services, Behavior Risk
Factor Surveillance System, 2010
CSJH and AH, 2012
Rockbridge Area Community Health Needs
Assessment, 2012
16
ROCKBRIDGE AREA Community Health Improvement Plan
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ISSUE FOUR:
Oral Health
Goal
Suggested Intervention Strategies
Diminish
barriers to
access and
improve
education
about oral
health and
hygiene.
Barriers (identified by focus group
participants)
Lack of affordable local services
Lack of Medicaid providers
Use of the ER
Lack of Culturally Appropriate
Services
Transportation
• Increase oral health
education throughout the
lifecycle in the Rockbridge
community.
• Increase access to affordable
dental care by expanding
capacity through a
sustainable model of care for
uninsured and underinsured
people.
• Encourage awareness of
existing oral health services
among both residents and
services providers in the
Rockbridge area.
Resources (not all inclusive)
Carilion Stonewall Jackson Hospital
Rockbridge Area Free Clinic
Lexington Health Department
Local dental providers
Local school systems
Remote Area Medial (RAM)
ROCKBRIDGE AREA Community Health Improvement Plan
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The Next Step
After identifying priority health needs in the Rockbridge area and
developing a plan with goals and suggested strategies, the action
cycle begins now. In order to progress towards improved health and
quality of life for area residents, the community needs to coordinate
systems of care and maximize available resources. The Rockbridge
Area Free Clinic is currently working with other local service providers
to develop a collaborative service delivery plan for comprehensive,
affordable health care that incorporates all aspects of health, safety
and wellness. Carilion Stonewall Jackson Hospital will use the
Rockbridge Area Community Health Needs Assessment and
Community Health Improvement Plan to ensure that its’ strategic plan
responds to area needs and results in community benefit. The Central
Shenandoah Health District is committed to working closely with
other area providers to strengthen and streamline public services.
These three partnering agencies will also continue to work with
committed citizens to further engage interested stakeholders, refine
the health improvement plan, and support coordination of care.
Building a healthier community also depends upon the support and
involvement of residents. Make a commitment to improve your own
health. Volunteer your time to help others in need. Join the
conversation, or just keep abreast of our progress.
We look forward to seeing you on the journey!
ROCKBRIDGE AREA Community Health Improvement Plan