Appendices

Transcription

Appendices

Verdant Health Commission:
Community Health and Wellness
Assessment
Prepared by
Strategic Learning Resources, Inc.
In partnership with
Snohomish Health District
July, 2013
Appendices Table of Contents INTRODUCTION TO APPENDICES SOCIO-‐ECONOMIC INDICATORS Introduction : Quantitative Data Appendix A Demographic Indicators by Census Tract -‐ SHD 2 Maps: A-‐1 Household Income A-‐2 % Owner Occupied A-‐3 Household Net Worth A-‐4 Median Age A-‐5 Population <18 A-‐6 Population 64+ A-‐7 % Households Without a Car A-‐8 % Foreign Born Populations A-‐9 Hispanic Population Tables: A-‐1 Total Population, Age, Household Size, Single Parent Households A-‐2 Housing, Access to Vehicle, Unemployment A-‐3 Ethnicity of the three largest ethic or racial groups Appendix B Demographic and Health Indicators by Zip Code – SHD 2 Tables: B-‐1 Age B-‐2 Race B-‐3 Mortality B-‐4 Hospitalizations B-‐5 Cancer Incidence B-‐6 Birth Risk Factors B-‐7 Self-‐Reported Health Status B-‐8 Homelessness, Substance Abuse Treatment, and Veterans Appendix C Findings from the Comprehensive Quantitative Assessment, Prepared by Snohomish Health District Executive Summary Tables: C–1 Comparison of Socio-‐Economic and Health Status Indicators for SHD #2 and the rest of Snohomish County, 2010 C-‐2 Comparison of Top Ten Non-‐Birth Hospitalization Rates for SHD2 and the rest of Snohomish County, 2010 C-‐3 Comparison of Top Ten Causes of Death for SHD2 and the rest of Snohomish County C-‐4 Comparison of the Leading Causes of Death by Race, for SHD2 and the rest of Snohomish County C-‐5 Birth Risk Factors by Race, SHD2 and the rest of Snohomish County RESIDENT PERSPECTIVES Appendix D Focus Groups Focus Group Overview and Methodology Focus Group Summaries Tables: D-‐1 Quantitative Summary of Focus Group Discussions D-‐2 Low-‐Income Focus Groups Summary D-‐3 Spanish Speaking Parents Focus Groups Summary D-‐4 Youth Focus Groups Summary D-‐5 Caregiver Groups Summary Appendix E Multi-‐Modal Survey PROVIDER PERSPECTIVES AND SERVICES Appendix F Community Provider Conversation Café Conversation Café Overview and Methodology Conversation Questions Provider Perspectives Attendee List Appendix G Service Inventory Service Inventory Overview and Methodology Tables: G-‐1 Service Inventory SOCIO-‐ECONOMIC INDICATORS Introduction to Appendices The following Appendices represent the interim work products and detailed data developed during the study. They also describe the approach and methodology of each type of data collection. The Appendices are organized in three broad categories: Socio-‐Economic and Health Indicators In Appendices A and B the reader will find socio-‐economic indicators organized by census tract and zip code. Of particular interest are the maps of various factors, which clearly illustrate the findings of the assessment. Appendix C provides a report on the socio-‐economic and health status of the District in comparison to the county as a whole, developed by the Snohomish Health District. Resident Perspectives Appendix D provides the methodology for the focus groups held with District residents as well as a summary of what was heard, including the major themes and quotes that are pulled directly from the transcripts. Appendix E provides a summary report of the multi-‐modal survey. This includes information not included in the first volume, such as information about residents’ experience and views on different Emergency Departments in the area. The data was gathered and analyzed by Gilmore Research. The report as provided here was revised and edited by Strategic Learning Resources. Provider Perspectives and Services In Appendix F the reader will find a description of the methodology used for the Community Conversation, a list of attendees, and the summary of what was heard from providers. Appendix G is an inventory of services and programs to be found in the District. This list is a starting point for a compilation of the health and social service assets to be found in District. It is also another way to assess gaps. 1 Introduction: Socio-‐Economic and Health Indicators The quantitative data on socio-‐economic conditions and the health status of the Hospital District residents was collected and assessed in ways to answer these questions: 1. Are the socio-‐economic conditions and health status of the hospital district different that those of residents of Snohomish County as a whole? 2. Are there issues of concern, when looking at the District population in aggregate? 3. Are there issues of concern when one looks at different communities, age groups, or ethnic groups? To answer the first two questions the District boundaries had to be approximated:  The Snohomish Health District in carrying out the assessment provided in Appendix C, which compares the hospital district to the rest of the county, used the Edmonds School District as a proxy for the boundaries to display and compare demographic data, and to make use of the Healthy Youth Survey data provided by the School District. The Edmonds School District is similar but smaller than the Hospital district, with a population of 154,342 in 2010.  To calculate morbidity and mortality rates and use the BRFSS (Behavioral Risk Factor Surveillance System) survey data the Snohomish Health District looked at data for eight zip codes (98012, 98020, 98021, 98026, 98036, 98037, 98043 and 98087) which include, but stretch beyond the boundaries of the Hospital district. In 2010 the population of these zip codes combined was 245,045. The Department of Human Services for Snohomish County also provided data related to social service needs by these zip codes. To answer the third question SLR asked the Health District to analyze BRFSS data by zip code (i.e. not just in aggregate) and SLR analyzed key socio-‐economic indicators for 35 census tracts, which combined conformed quite closely to the hospital district’s boundaries. In 2010 the population of these 35 census tracts combined totaled 174,204. The findings reported in the first volume of the report reflect the analysis of differences within the hospital district itself (i.e. by zip code and by census tract) with the goal of identifying local issues of disparity and concern. The comparison of the hospital district to the rest of the county provided in Appendix C shows that residents of the hospital district as whole are healthy, providing an opportunity to invest in strategic improvements in the community’s health. So as reader uses these tables they should keep in mind that there are three possible population denominators with the Edmond School District and the collection of 8 zip codes being proxies for the Hospital district. Edmonds School District < Hospital district 154,342 Zip Codes > Hospital District 245,045 Census Tracts = Hospital District 174,204 Appendix A: Demographic Indicators by Census Tract Household Income Map A-‐ 1 % Owner Occupied Map A -‐ 2 Household Net Worth Map A -‐ 3 Median Age Map A – 4 PopulaCon < 18 Map A – 5 PopulaCon 64+ Map A – 6 % Households Without a Car Source: US Census American Community Survey 2010 Map A – 7 % Foreign Born PopulaCon Source: US Census American Community Survey 2010 Map A – 8 % Hispanic PopulaCon Source: US Census American Community Survey 2010 Map A – 9 535.05
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215 216 County
218.04 218.02
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217
218.03
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203
207 206
210
205
204.02
214
211
213
Bothell
170th
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507
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Table A -‐1
Demographic Indicators by Census Tract -‐ Snohomish Hospital District 2
Total Population, Age, Household Size, Single Parent Households
PHD2 Census Total Tracts
Population
417.03
501.01
501.02
502
503
504.01
504.02
505
506
507
508
509
510
511
512
513
514
515
516.01
516.02
517.01
517.02
518.02
518.03
518.04
519.05
519.13
519.15
519.16
519.17
519.18
519.21
519.22
519.27
519.28
Number <5 years
Number Median Average % Single Parent ≥65
Age
Household Size
Households
5,039
358
434
2,686
128
294
5,361
413
409
4,154
161
736
5,327
198
1020
7,052
398
1099
5,352
246
814
6,594
189
2348
1,271
49
184
5,863
283
831
6,090
304
860
3,233
185
444
4,382
294
524
3,748
217
452
4,208
272
390
7,157
451
671
7,491
604
691
5,601
306
909
4,767
304
438
4,129
232
652
5,597
361
828
4,707
251
852
5,176
323
533
5,636
463
292
3,748
295
225
8,009
569
671
4,202
233
364
6,863
553
506
3,677
260
350
4,045
244
695
4,973
256
726
3,882
261
291
4,687
376
293
4,714
297
377
4,783
387
322
Total 174,204 10,721 21,525
37.0
41.2
32.8
48.7
48.5
42.9
43.2
57.6
45.9
41.3
42.2
40.0
36.8
39.4
36.2
36.0
32.7
36.9
35.9
42.1
38.5
41.0
35.9
30.4
32.3
35.2
42.1
36.3
38.1
41.6
42.6
34.2
33.9
37.6
30.8
2.82
2.89
2.47
2.65
2.53
2.40
2.26
1.85
2.89
2.30
2.37
2.19
2.41
2.43
2.43
2.41
2.35
2.41
2.82
2.59
2.31
2.53
2.71
2.22
2.77
2.71
2.86
2.87
2.84
2.58
2.46
2.43
2.88
3.00
2.64
8.7
8.3
8.9
4.3
4.8
7.7
7.2
3.3
4.1
7.9
7.0
9.0
10.1
7.3
10.1
9.6
11.5
8.1
12.7
7.7
9.8
5.7
7.9
9.9
7.3
9.9
5.7
7.9
6.6
4.1
4.5
9.2
8.1
6.7
12.2
% of Population living at or below 100% of Poverty
6.7
10.4
10.5
7.7
8.9
5.8
6.2
6.2
3.5
8.2
5.5
13.4
14
3
9.4
11.9
23.1
17.2
17.1
10.5
14.6
7.2
10.7
18.5
6.8
10
0.9
4.3
2.3
2.6
3.4
6
5.4
1
12.9
Sources: 2010 US Census. Estimated Unemployment is from the 2007-‐2011 American Community Survey
5-‐Year Estimates
Table A -‐ 1
Table A -‐2
Housing, Access to Vehicle, Unemployment
PHD2 Census Tracts
417.03
501.01
501.02
502
503
504.01
504.02
505
506
507
508
509
510
511
512
513
514
515
516.01
516.02
517.01
517.02
518.02
518.03
518.04
519.05
519.13
519.15
519.16
519.17
519.18
519.21
519.22
519.27
519.28
% of Housing % of Housing Units that are Units that are Owner occupied Renter occupied
75.6
24.4
81.8
18.2
50.3
49.7
91.1
8.9
87.4
12.6
70.9
29.1
63.9
36.1
66.9
33.1
94.1
5.9
60.1
39.9
75.2
24.8
47.3
52.7
58.4
41.6
68.8
31.2
63.3
36.7
59.7
40.3
34.3
65.7
48.0
52.0
61.5
38.5
72.0
28.0
50.4
49.6
55.2
44.8
70.0
30.0
24.8
75.2
74.8
25.2
63.9
36.1
89.1
10.9
84.5
15.5
87.3
12.7
90.2
9.8
77.0
23.0
64.3
35.7
73.1
26.9
87.1
12.9
38.5
61.5
% Householders Who Moved into Current Housing Unit 2005 or Later
45.5
33.7
63.4
27.8
25.5
40.4
34.5
38.6
26.7
47.0
44.9
55.8
57.9
36.6
40.6
45.7
63.0
45.0
42.6
39.3
47.4
40.0
49.6
81.4
62.1
36.4
28.0
28.8
35.8
34.5
30.7
34.9
45.5
34.8
66.9
% of Households with No Vehicle Estimated % Available
Unemployment
0.6
4.4%
5.9
6.7%
3.9
4.3%
1.1
5.5%
2.3
4.7%
2.6
2.3%
1.4
3.20%
6.6
4.0%
0.7
2.9%
1.7
5.4%
0.8
4.3%
7.8
4.9%
2.5
5.4%
7.7
5.5%
5.1
7.7%
2.6
4.7%
17.2
5.6%
11.8
5.3%
5.5
7.1%
2.4
4.2%
12.3
9.5%
3.1
7.3%
1.8
4.8%
5.6
12.4%
4.1
2.4%
1.5
5.5%
2.2
5.2%
3.4
5.9%
1.7
5.6%
1.6
4.7%
5.1
3.7%
5.2
4.9%
1.9
10.5%
3.3
7.4%
5.7
10.5%
Sources: 2010 US Census. Estimated Unemployment is from the 2007-‐2011 American Community Survey 5-‐Year
Estimates
Table A -‐ 2
Table A -‐3
Ethnicity of the three largest ethnic or racial groups
White
PHD2 Census Total Tracts
Population
# 417.03
5039
3546
501.01
2686
2177
501.02
5361
3534
502
4154
3614
503
5327
4755
504.01
7052
6000
504.02
5352
4612
505
6594
6110
506
1271
1135
507
5863
4799
508
6090
4719
509
3233
2199
510
4382
3124
511
3748
2706
512
4208
3082
513
7157
5154
514
7491
4203
515
5601
3738
516.01
4767
3195
516.02
4129
3163
517.01
5597
3621
517.02
4707
3053
518.02
5176
2740
518.03
5636
3441
518.04
3748
1997
519.05
8009
5363
519.13
4202
3418
519.15
6863
5284
519.16
3677
3075
519.17
4045
3364
519.18
4973
4199
519.21
3882
3085
519.22
4687
3449
519.27
4714
3244
519.28
4783
3076
Total 174,204 127,974
Asian
%
# 70%
1009
81%
239
66%
865
87%
282
89%
250
85%
663
86%
506
93%
225
89%
123
82%
423
77%
688
68%
455
71%
417
72%
395
73%
446
72%
868
56%
1251
67%
760
67%
800
77%
518
65%
847
65%
890
53%
1642
61%
945
53%
1128
67%
1449
81%
455
77%
904
84%
246
83%
359
84%
422
79%
346
74%
742
69%
1085
64%
949
73% 23,592
Hispanic
%
# 20%
458
9%
146
16%
552
7%
135
5%
169
9%
500
9%
293
3%
188
10%
35
7%
316
11%
305
14%
404
10%
579
11%
466
11%
494
12%
533
17%
1788
14%
739
17%
542
13%
372
15%
784
19%
356
32%
376
17%
811
30%
221
18%
570
11%
154
13%
391
7%
264
9%
131
8%
258
9%
496
16%
374
23%
212
20%
458
14% 14,870
%
9%
5%
10%
3%
3%
7%
5%
3%
3%
5%
5%
12%
13%
12%
12%
7%
24%
13%
11%
9%
14%
8%
7%
14%
6%
7%
4%
6%
7%
3%
5%
13%
8%
4%
10%
9%
Source: 2010 US Census
Table A -‐ 3
Appendix B: Demographic and Health Indicators by Zip Code Table B-‐1
Demographic Indicators by Zip Code – Snohomish Hospital District 2
Age
Total
Age
0 to 4
5 to 24
25 to 44
45 to 64
65 to 84
≥ 85
98012
3,906
13,985
17,389
14,034
3,972
605
53,891
98020
713
3,672
3,505
6,091
3,701
770
18,452
98021
1,831
6,563
7,963
7,488
2,480
425
26,750
98026
1,815
8,637
8,916
11,838
4,251
596
36,053
98036
2457
9459
10474
10042
3219
526
36177
98037
1,556
6,565
7,385
7,002
2,698
485
25,691
98043
1,273
4,830
6,208
5,433
1,749
288
19,781
98087
2,360
7,504
10,273
6,899
1,927
285
29,248
Percent Distibution
0 to 4
5 to 24
25 to 44
45 to 64
65 to 84
≥ 85
Source: 7.2%
26.0%
32.3%
26.0%
7.4%
1.1%
3.9%
19.9%
19.0%
33.0%
20.1%
4.2%
6.8%
24.5%
29.8%
28.0%
9.3%
1.6%
5.0%
24.0%
24.7%
32.8%
11.8%
1.7%
6.8%
26.1%
29.0%
27.8%
8.9%
1.5%
6.1%
25.6%
28.7%
27.3%
10.5%
1.9%
6.4%
24.4%
31.4%
27.5%
8.8%
1.5%
8.1%
25.7%
35.1%
23.6%
6.6%
1.0%
Legacy: Washington State Department of Health and Krupski Consulting, 1990-‐2009 Population Estimates: Population Estimates for Public
Health Assessment, 1990-‐2011, December 2012
Revised: Washington State Office of Financial Management, Forecasting Division, single year intercensal estimates
2001-‐2010, December 6,2011
Note:
These estimates vary somewhat from the 2010 Census for Zipcodes. Most are close.
Table B -‐ 1
Table B-‐2
Demographic Indicators by Zip Code – Snohomish Hospital District 2
Race
Total
Race
White Only-‐NH
Black Only-‐NH
American Indian/Alaskan Native Only-‐NH
Asian Only-‐NH
Pacific Islander Only-‐NH
Multi-‐Race-‐NH
Hispanic as Race
98012
98020
98021
98026
98036
98037
98043
98087
37238
1079
15987
259
20002
359
27322
1093
23474
1576
15544
1116
13361
819
16914
1581
278
9084
196
2019
3999
120
953
36
475
622
138
3892
49
934
1375
240
3466
154
1435
2342
295
5306
214
1382
3932
205
5332
120
1058
2315
195
2206
154
973
2073
210
5767
224
1311
3241
Percent Distibution
White Only-‐NH
Black Only-‐NH
American Indian/Alaskan Native Only-‐NH
Asian Only-‐NH
Pacific Islander Only-‐NH
Multi-‐Race-‐NH
Hispanic as Race
Source: 69.1%
2.0%
86.6%
1.4%
74.8%
1.3%
75.8%
3.0%
64.9%
4.4%
60.5%
4.3%
67.5%
4.1%
57.8%
5.4%
0.5%
16.9%
0.4%
3.7%
7.4%
0.7%
5.2%
0.2%
2.6%
3.4%
0.5%
14.5%
0.2%
3.5%
5.1%
0.7%
9.6%
0.4%
4.0%
6.5%
0.8%
14.7%
0.6%
3.8%
10.9%
0.8%
20.8%
0.5%
4.1%
9.0%
1.0%
11.2%
0.8%
4.9%
10.5%
0.7%
19.7%
0.8%
4.5%
11.1%
Legacy: Washington State Department of Health and Krupski Consulting, 1990-‐2009 Population Estimates: Population
Estimates for Public Health Assessment, 1990-‐2011, December 2012
Revised: Washington State Office of Financial Management, Forecasting Division, single year intercensal
Note:
estimates 2001-‐2010, December 6,2011
These estimates vary somewhat from the 2010 Census for Zipcodes. Most are close.
Table B - 2
Table B-‐3
Health Status Indicators by Zipcode: Mortality, Age Adjusted per 100,000 population
Total
98012
All Causes Mortality Rate
95% Confidence Level
Mortality, Diseases of the Heart
Source: 98020
98021
98026
98036
98037
98043
98087
Overall
612.3
518.2
576.0
666.3
616.5
842.0
658.2
599.5
630.9
(566.3, 661.2)
(474.6, 567.6)
(521.7, 634.8)
(618.7, 717)
(567.1, 669.2)
(779.1, 909.1)
(590.3, 732)
(535.3, 670.1)
(612.2, 650.1)
123.34
144.55
159.12
197.65
168.08
132.74
(99, 152.2) (122.8, 169.5) (134.6, 187.1) (168.2, 231.2) (134.8, 207.5) (103.4, 168.6)
143.42
(134.6, 152.7)
141.07
105.53
(119.2, 166) (87.2, 130.2)
Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990 -‐ 2011, September 2012
2008 -‐ 2010 Aggregated
Table B-‐3
Table B-‐4
Health Status Indicators by Zipcode: Hospitalizations, Age Adjusted per 100,000 population
Non-‐pregnancy Hospitalizations
98012
98020
98021
98026
5443.7
6054.1
5257.7
6140.5
(5314.6, 5575.6)(5866.1, 6248.6)(5093.9, 5425.7)(5995, 6289)
98036
98037
98043
98087
Overall
6475.1
7600.3
6765.7
4745.4
6,041.0
(6317.4, 6635.9) (7407.1, 7797.5) (6551.3, 6985.6) (4578.6, 4917.7) (5983.8, 6098.7)
Source: WA Hospital Discharge Data, Comprehensive Hospitalization Abstract Reporting System (CHARS) 1987-‐2011. Washington State Department of Health, Center for
Health Statistics. July 2012.
OR State Hospital Discharge Data 1987-‐1999. Office for Oregon Health Policy and Research.
Oregon State Inpatient Database (SID) 2000-‐2010.Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. December 2011
Table B-‐5
Health Status Indicators by Zipcode: Cancer Incidence, Age Adjusted per 100,000 population
98012
98020
98021
571.2
636.6
506.0
95% Confidence Level (529.4, 615.9) (583.2, 696.3) (455.9, 560.5)
Cancer Incidence
98026
98036
98037
98043
98087
556.1
509.4
542.2
499.6
441.6
(514.1, 601) (465.2, 557.1) (492.1, 596.4) (441.9, 563.5) (390.5, 498.9)
Overall
541.8
(524.7, 559.2)
Source:
Washington State Department of Health, Washington State Cancer Registry-‐Incidence data for diagnosis years 1992 -‐ 2010, January 2013
Table B-‐4
Table B-‐6
Health Status Indicators by Zipcode: Birth Risk Factors
98012
37.3
98020
31.5
98021
35.4
98026
29.8
98036
30.2
98037
34.8
98043
28.9
98087
36.5
Overall
33.7
(34.1, 40.8)
(25.7, 38.2)
(30.9, 40.4)
(26.1, 33.9)
(26.5, 34.4)
(30.1, 40)
(24.2, 34.3)
(31.9, 41.5)
(32.1, 35.3)
% of Women who did not receive prenatal care in the first trimester
12.9
15.0
15.9
17.4
19.8
20.3
22.7
23.4
18.7
(10.5, 15.6)
(11, 19.9)
(14.1, 17.7)
(14.7, 20.3)
(16.6, 23.5)
(17.9, 23)
(19.6, 26.1)
(20.9, 26.2)
(524.7, 559.2)
% of Births by C-‐Section for 1st time
24.69
25.07
24.54
22.47
23.27
22.7
19.88
22.22
23.3
(22.7, 26.8)
(20.3, 30.7)
(21.6, 27.8)
(19.7, 25.5)
(20.9, 25.9)
(19.8, 25.9)
(16.9, 23.2)
(19.9, 24.7)
(524.7, 559.2)
Fertility Rate, Women Aged 35 -‐44, Births per 1000 women
Source:
Washington State Department of Health, Center for Health Statistics (CHS), Birth Certificate Data, 1990-‐2011, September 2012
Table B-‐6
Table B-‐7
Health Status Indicators by Zipcode: Self-‐Reported Health Status
Percent
98012
16.6%
98020
22.9%
98021
19.3%
98026
23.1%
98036
21.4%
98037
27.6%
98043
23.1%
98087
27.5%
Overall
22.1%
Do not have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare.
16.0%
4.0%
7.4%
9.1%
14.1%
7.3%
20.3%
20.8%
12.8%
Do not have personal health care provider
18.8%
9.3%
17.8%
19.0%
16.2%
15.9%
31.6%
42.2%
21.1%
Have not had a routine checkup in the last 2 years.
18.9%
19.5%
13.7%
19.7%
25.4%
19.2%
32.3%
21.2%
21.0%
Have been told by a doctor that they have diabetes.
6.7%
6.5%
4.6%
6.8%
6.7%
7.4%
6.1%
6.0%
6.4%
Have had a flu shot in the last year & are over ≥65 years old.
70.5%
74.7%
81.7%
77.9%
63.3%
64.9%
80.6%
50.5%
71.2%
Have been diagnosed with hypertension
42.2%
26.1%
30.1%
32.7%
25.9%
20.2%
27.2%
24.6%
29.4%
Smoke cigarettes currently
13.9%
9.0%
7.5%
13.0%
13.3%
13.4%
17.8%
22.2%
13.8%
Are obese (BMI≥30)
20.1%
14.5%
22.9%
22.6%
25.0%
26.3%
27.9%
18.8%
22.2%
8.6%
10.6%
4.0%
8.2%
2.3%
5.3%
7.2%
10.3%
7.0%
Are limited in activities because of physical, mental, or emotional problems.
Drink heavily
Source:
Behvioral Risk Surveillance System Survey 2009 and 2010
Table B-‐7
Table B-‐7
Other Socio-‐Economic Indicators
Homelessness, Substance Abuse Treatment, and Veterans
98012
19
98020
11
98021
7
98026
27
98036
77
98037
69
98043
47
98087
35
102
20
18
98
280
178
93
102
9
10
7
12
20
29
20
13
Total Adult Admissions to Publicly Outpatient Treatment for Substance Abuse 49
18
19
45
73
74
40
39
Percent of Total Population that are Veterans
7%
11%
1%
9%
7%
7%
8%
7%
4006
2116
165
3089
2416
1900
1491
1953
People receiving homeless related services for whom this was their last stable housing zipcode (per 10,000 population)
Total number of people receiving homeless related services for whom this was their last stable housing zipcode.
Adult Admissions to Publicly Outpatient Treatment for Substance Abuse (per 10,000 population)
Total Number of Veterans
Sources:
Homeless Management Information System for Snohomish County
Washington State Division of Alcohol and Substance Abuse
American Community Survey 2011 Five Year Estimates of Veterans
Table B-‐7
Appendix C: Findings from the Comprehensive Quantitative Assessment, Prepared by Snohomish Health District Executive Summary
Findings from the Comprehensive Quantitative Assessment
Public Hospital District #2
June 2013 Prepared by: Snohomish Health District Healthy Communities & Assessment
Findings from the Comprehensive Quantitative Assessment
Introduction
The Snohomish Health District’s (SHD) Healthy Communities and Assessment division was tasked by Strategic Learning Resources, Inc. (SLR) to provide a comprehensive quantitative data analysis of the Public Hospital District #2 (PHD2) as part of the Verdant Health Needs Assessment grant. Indicators presented in this summary included those previously chosen by Stevens Hospital in 2010 and those chosen for the Health District’s Community Health Assessment. Data for the Hospital District were compared to the rest of the Snohomish County. Due to differences in data sources, two methods were used to define Hospital District #2. The district’s boundaries conform fairly well to those of the Edmonds School District, and this geography was used to define the district for some data from the US Census Bureau and the Washington Healthy Youth Survey. For all other data sources, the PHD2 was defined as a group of Zip codes that overlap any part of actual hospital district (98012, 98020, 98021, 98026, 98036, 98037, 98043 and 98087). Results
Demographics •
•
16%
14%
12%
10%
8%
6%
Public Hospital District #2 population of 246,045 represents one third (34.6%) of the County’s population. One-‐third of PHD2’s population (31.0%) was non-‐White, compared to 22.8% of the rest of the County’s population. PHD2 had a much higher proportion of Asians: 14.6% vs. 5.8% Residents Age 65+
• Residents of PHD2 were older than the rest of the county: 11.4% were 65 or older, compared to 9.7% 11.4%
of the rest of the County’s 9.7%
population 4%
2%
0%
Snohomish County Appendix C - Page 1 
Community Measures/Social & Economic Determinants •
•
•
•
A higher proportion of children in PHD2 was below the Federal Poverty Level than in the rest of the County: 15.9% vs. 13% PHD2 had a higher proportion of single-‐parent households than the rest of the County: 29.4% vs. 24.1% of households with children Residents of PHD2 were more educated: 33.6% had a Bachelor’s degree or higher, compared to only 26.6% in the rest of Snohomish County Residents living in the PHD2 have a wide range of income levels General Health Status •
•
•
In general, PHD2 had better health status indicators than the rest of the County. Residents of PHD2 were less likely to report having “poor” or “fair” health than those of the rest of the County: 9.7% vs. 13.6% PHD2 had a lower incidence of childhood mortality than the rest of the County: 7.0 vs. 12.6 per 100,000 Nearly 70% (69.8%) of adults reported receiving inadequate sleep 14
Deaths per 100,000 population
•
Infant and Childhood Mortality
Public Hospital District #2 and Snohomish County 12
12.6
Snohomish County 10
8
7.0
6
4.8
4
2
2.9
0
Infants (<1 year)
Children (1-‐14)
Access to Care •
•
•
There was not a significant difference between PHD2 and the County in regards to the access to care indicators About one in six adults younger than age 65 did not have a form of health insurance One in five adults had not received a routine check-‐up within two years Hospitalizations •
•
•
Residents of PHD2 had a significantly lower rate of hospitalizations than the rest of the County: 6,006.8 vs. 6,894 per 100,000 PHD2 had a higher rate of hospitalizations for ambulatory-‐ care-‐sensitive conditions among children and youth compared to the rest of the County: 389.5 vs. 302.1 per 100,000* Adults in PHD2 had lower rates of potentially-‐avoidable hospitalizations than adults in the rest of the County: 608.3 vs. 748.7 per 100,000** Appendix C - Page 2 
Health Risk Behaviors •
•
•
•
Adults in PHD2 were less likely to have been diagnosed with high cholesterol than others in the County: 32.9% vs. 41.1% Residents of PHD2 were less likely to be obese than other County residents, 21.8% vs. 29.7% for adults and 8.7% vs. 11.1% for youth. However, more than half of adults in PHD2 are either overweight or obese Youth in PHD2 were more likely to use illegal drugs than those in the rest of the County, for example 22% of 12th graders used Hookah, and 27.8% used marijuana Youth in PHD2 were less likely to misuse prescription drugs Chronic Disease •
•
PHD2 had lower rates of chronic disease than the rest of the County: 6.9% of adults were diagnosed with asthma vs. 10%, and 5.8% of PHD2 adults had diabetes vs. 7.5% The proportion of youth in PHD2 diagnosed with asthma was slightly higher than the rest of the County: 13.1% vs. 11.9% Prevention Indicators •
•
Residents of PHD2 were generally more likely to have undergone cancer screenings than the rest of the County Only about two-‐thirds of residents 65 and older received an annual flu shot Injuries •
•
•
In PHD2, a higher percentage of injury deaths were unintentional than in the rest of the County: 70.9% vs. 63.1%. This likely reflects the lower suicide rate in PHD2 (see Mental Health) PHD2 had a lower rate of injury hospitalizations than the rest of the County: 667.5 vs. 737.4 per 100,000 Residents of PHD2 had a lower rate of unintentional poisoning mortality than the rest of the County: 13.5 vs. 18.4 per 100,000 Appendix C - Page 3 
Communicable Diseases •
Females between ages 15 and 24 in PHD2 were less likely than women in other parts of the County to have been diagnosed with Chlamydia: 1,858.3 vs. 2,294.7 per 100,000 Mental Health •
•
•
•
Adults 65 and older living in PHD2 were less likely than others in the County to report that they did not receive adequate social or emotional support: 4.5% vs. 8.8% Poor mental health was experienced by 37.2% of adults living in PHD2 PHD2 had a lower suicide mortality rate than the rest of the County: 11.6 vs. 16.1 per 100,000 More than one-‐quarter of youth (28.4%) showed symptoms of depression Environmental Health •
Adults in PHD2 were much less likely to report exposure to second-‐hand smoke than residents of the rest of the County: 9.6% vs. 22.7% Mortality •
•
•
PHD2 had a lower mortality rate than the rest of the County: 609.2 vs. 734.9 per 100,000 The leading causes of death in PHD2 were similar to those in the rest of the County PHD2 had a lower rate of heart disease mortality than the rest of the County: 129.9 vs. 168 per 100,000 Sub-Populations
Upon further analysis of subpopulation data for a number of indicators, it was found that •
•
•
•
Asians and Hispanics in PHD2 had lower mortality and cancer incidence rates than other races Hispanics had a higher birth rate than other races Edmonds had the highest proportion of Whites and residents age 65 and older Lynnwood had the highest proportion of Hispanics and Asians Appendix C - Page 4 
Conclusion
The health status of the population of Public Hospital District #2 was similar to the rest of Snohomish County. The Hospital District’s population was older and more racially diverse than the rest of the county. The education level of the population was somewhat higher than other regions of Snohomish County. Residents of the district generally had better access to healthcare and were more likely to receive preventive services. The overweight and obesity rates for adults remain a concern. Mortality and hospitalization rates for the population of the Hospital District were lower than for other residents of the county. PHD2 had a higher birth rate among women 35 and older than the rest of the County, and a lower rate of births to teen mothers. The somewhat better health status of PHD2 relative to the rest of the County may be a result of higher education and income status of residents and the availability of services in the most densely populated part of the County (and nearby King County). * Ambulatory Care Sensitive Conditions (ages 0-17) = asthma, volume depletion, kidney/urinary infections, bacterial pneumonia,
gastrointestinal infection, diabetes, cellulitis, dental conditions, Grand Mal status, incarcerated hernia, tuberculosis and
congenital syphilis
** Potentially Avoidable Hospitalizations (ages 18+) = septicemia, bacterial pneumonia, congestive heart failure, cellulitis,
ketoacidosis, asthma, kidney/urinary infections, chronic obstructive pulmonary disease, volume depletion, incarcerated hernia,
primary hypertension, dental conditions, angina, Grand Mal status, and hypoglycemia Appendix C - Page 5 
Table C -‐1
Comparison of Socio-‐Economic and Health Status Indicators for SHD #2 and the rest of Snohomish County
Indicators
Snohomish Hospital District #2
Snohomish County excluding the Hospital District
Demographics (Zip Codes)
Data Source
Year
Number Percent or 95% Confidence Affected
Rate
level
Number Affected
Percent or 95% Confidence Rate
level
Total Population
Census
2010
246,045
100
N/A
464,015
100
N/A
Population 0-‐4
Population 5-‐24
Population 25-‐44
Population 45-‐64
Population 65-‐84
Population 85+
15,912
61,214
72,113
68,827
23,997
3,982
6.5%
24.9%
29.3%
28.0%
9.8%
1.6%
N/A
N/A
N/A
N/A
N/A
N/A
31,335
127,720
130,922
128,848
38,994
6,194
6.8%
27.5%
28.2%
27.8%
8.4%
1.3%
N/A
N/A
N/A
N/A
N/A
N/A
White (non-‐Hispanic)
Black (non-‐Hispanic)
American Indian/Alaskan Native (non-‐Hispanic)
Asian (non-‐Hispanic)
Pacific Islander (non-‐Hispanic)
Multi-‐Race or Other (non-‐Hispanic)
Hispanic 169,841
7,883
1,681
36,006
1,148
9,587
19,899
69.0%
3.2%
0.7%
14.6%
0.5%
3.9%
8.1%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
358,309
9,566
6,841
27,088
1,921
16,091
44,199
77.2%
2.1%
1.5%
5.8%
0.4%
3.5%
9.5%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Population by Race Table C-‐1
Page 1 of 17
Indicators
Community Measures/Social & Economic Determinants (Edmonds School District)
Data Source
Year
Rate
level
Number Affected
Total Population
% below 100% Federal Poverty Level
% of children below Federal Poverty Level
% below 200% Federal Poverty Level % single-‐parent households (of all HH w/kids)
Grade level completed (significance test of overall level completed)
Census
2010
154,342
16,556
5,249
36,768
5,502
10.8
15.9
24.0
29.4
(8.4, 13.2)
(11.1, 20.7)
(23.8, 24.2)
(28.7, 30)
55,680
17,930
165,602
18,013
10.1
13.0
23.4
24.1
(10, 10.2)
(12.9, 13.2)
(23.3, 23.5)
(23.8, 24.4)
3,170
5,809
23,579
27,158
10,862
25,187
10,551
3.0
5.5
22.2
25.5
10.2
23.7
9.9
(2.9, 3.1)
(5.3, 5.6)
(21.9, 22.4)
(25.3, 25.8)
(10, 10.4)
(23.4, 23.9)
(9.7, 10.1)
10,650
24,845
95,475
100,503
41,518
69,562
29,327
2.9
6.7
25.7
27.0
11.2
18.7
7.9
(2.8, 2.9)
(6.6, 6.8)
(25.5, 25.8)
(26.9, 27.2)
(11.1, 11.3)
(18.6, 18.8)
(7.8, 8)
Census
level
2010
Less than 9th Grade
9th to 12th, no diploma
High School Graduate
Some College
Associate's Degree
Bachelor's Degree
Graduate Degree
General Health Status
Average life expectancy in years at birth
% who would say general health status is fair or poor % with poor mental health (last 30 days)
% with poor physical health (last 30 days)
% whose poor health interfered with daily activities
% reporting inadequate sleep
% with serious mental illness
% with symptoms of depression (youth)
% with disabilities (physical, mental, emotional)
Childhood mortality (1-‐14) WSDOH
BRFSS
2008
2010
N/A
18,253
79.7
9.7
(79.2, 80.2)
(7.3, 12.7)
N/A
47,412
80.1
13.6
(79.7, 80.6)
(11.3, 16.2)
BRFSS
BRFSS
BRFSS
2010
2010
2010
66,448
66,435
44,554
35.3
35.5
23.8
(30.2, 40.8)
(30.5, 40.8)
(19.6, 28.4)
130,962
132,055
85,435
37.9
38.1
24.5
(34.1, 41.9)
(34.3, 42.1)
(21.3, 28.1)
BRFSS
BRFSS
HYS
BRFSS
2010
2010
2010
2010
131,192
2,813
(64.7, 74.5)
(0.9, 6.7)
(26.7, 30.1)
(18.9, 27.4)
251,696
5,178
42,853
69.8
2.5
28.4
22.9
91,892
73.8
2.2
28.4
26.4
(70.0, 77.3)
(1.4, 3.6)
(26.7, 30.1)
(23.3, 29.7)
9
7.0
(3.2, 13.2)
34
12.6
(8.7, 17.6)
Years of healthy life at age 20
WSDOH
WSDOH 2008-‐10
53.4
51.3
Table C-‐1
Page 2 of 17
Indicators
Reproductive Health
Infant death rate per 1,000 births
% Low birth weight rate per 1,000 births (singletons)
Birth rate per 1,000 females (18-‐44)
Birth rate per 1,000 females (35-‐44)
Teen birth rate per 1,000 females (15-‐17)
% of mothers with no prenatal care in 1st trimester
% of women who smoked cigarettes during pregnancy
Primary C-‐section rate
Data Source
WSDOH WSDOH Year
2010
2010
WSDOH
WSDOH WSDOH WSDOH
2010
2010
2010
2008-‐2010
WSDOH
Rate
level
9
2.9
(1.3, 5.4)
143
4.7
(4, 5.6)
Number Affected
28
267
level
4.8
(3.2, 7)
4.8
(4.2, 5.4)
3,111
607
26
-‐-‐
67.8
33.9
5.4
18.7
(65.5, 70.1)
(31.3, 36.7)
(3.6, 8)
(17.8, 19.7)
5,727
896
111
-‐-‐
68.4
26.8
10.8
25.5
(66.7, 70.1)
(25.1, 28.6)
(8.9, 13)
(24.7, 26.3)
2010
118
3.8
(3.1, 4.5)
515
9.0
(8.2, 9.8)
WSDOH
2008-‐2010
695
22.1
(20.4, 23.8)
1,030
17.7
(16.6, 18.8)
WSDOH
WSDOH
2010
2010
241
108
8.0
3.4
(7, 9)
(2.8, 4.1)
487
201
8.7
3.5
(7.9, 9.5)
(3, 4)
% with no health insurance coverage (current) (<65)
BRFSS
2010
27,753
17.2
(12.7, 22.9)
52,116
17.2
(13.6, 21.7)
% without a Primary Care Provider (18+)
% unable to see doctor b/c of cost (w/i 12 mo)
% with no health care exam in past 2 yrs (18+)
% with no health care exam in past year (youth)
% with dental insurance (18+)
% with no dental visit in past year (18+)
% with no dental visit in past year (youth)
Hospitalizations
BRFSS
BRFSS
BRFSS
HYS
2010
2010
2010
2010
33,982
24,930
38,980
18.1
13.3
21
60
(13.6, 23.6)
(9.8, 17.8)
(16.5, 26.2)
(56.7, 63.3)
77,574
44,251
88,600
22.4
12.7
25.7
56.6
(18.6, 26.7)
(10.1, 15.8)
(21.9, 29.9)
(55.1, 58.1)
BRFSS
BRFSS
HYS
2010
2010
2010
95,250
50,481
69
26.8
25.3
(62.7, 74.6)
(22.0, 32.1)
(21.5, 29.6)
194,078
107,210
70.6
30.9
26.2
(66.1, 74.7)
(27.2, 34.9)
(24.2, 28.3)
Hospitalizations rate per 100,000 pop (non-‐
childbirth)
CHARS
2010
14,830
6,006.8
(5908.6,6105.1)
30,540
Ambulatory Care Sensitive Conditions (0-‐17)
CHARS
2010
218
389.5
(340.4, 445.6)
355
302.1
(271.9, 335.6)
Potentially avoidable hospitalizations (18-‐64)
CHARS
2010
986
608.3
(571.3, 647.6)
2,256
748.7
(718.4, 780.3)
Potentially avoidable hospitalizations (65+)
CHARS
2010
1,382
4,939.4 (4689.9, 5201.4)
2,535
5,609.9
(5400.4, 5827)
% of prematurity (singletons)
% of pregnancies that were multiples
Access to Care
6,894.0 (6814.6,6973.5)
Table C-‐1
Page 3 of 17
Indicators
Rate
level
Deaths
Data Source
Year
Number Affected
level
Death rate per 100,000 pop
WSDOH
2010
1,463
609.2
(577.5,640.9)
2,975
734.9
(707.8,762)
Heart disease mortality
Chronic Disease
Cancer Incidence
% have diabetes (exclude pregnancy related)
WSDOH
2010
313
129.9
(115.3,144.5)
671
168.0
(155,181)
WSDOH
BRFSS
2010
2010
1,387
10,963
544.9
5.8
(515.9, 575.2)
(4.1, 8.2)
2,504
26,085
575.9
7.5
(552.6, 599.9)
(6.0, 9.2)
% diagnosed with asthma (current)
BRFSS
2010
13,001
6.9
(4.9, 9.6)
34,109
10.0
(7.9, 12.5)
% youth diagnosed with asthma
% ever told had a heart attack or angina/coronary disease by healthcare % ever told had ah seart troke by healthcare provider
% diagnosed with arthritis
HYS
BRFSS
BRFSS
BRFSS
2010
2010
2010
2009
6,700
2,740
45,471
13.1
3.6
1.5
24.9
(11.8, 14.4)
(2.5, 5.2)
(0.8, 2.6)
(21.0, 29.3)
13,973
7,968
91,285
11.9
4
2.3
26.6
(11.0, 12.8)
(3.1, 5.2)
(1.5, 3.4)
(23.7, 29.6)
Table C-‐1
Page 4 of 17
Indicators
Prevention Indicators
Data Source
Year
Rate
level
Number Affected
level
% of adults (50+) ever had a fecal occult blood test BRFSS
(FOBT)
% of adults (50+) had FOBT w/i last 12 months
BRFSS
2010
2010
40,775
8,979
54.0
11.9
(48.0, 59.9)
(8.8, 15.9)
62,645
12,133
47.1
9.1
(43.0, 51.3)
(7.0, 11.8)
% of adults (50+) ever had a sigmoidoscopy/colonscopy
% of adults (50+) had sigmoidoscopy/colonoscopy w/i last 5 years
% of women (50-‐69) ever had BOTH mammogram and CBE % of women (40+) ever had BOTH mammogram and CBE BRFSS
2010
58,915
78.2
(72.7, 82.8)
96,231
71.7
(67.7, 75.3)
BRFSS
2010
45,716
61.3
(55.2, 67.0)
73,769
55.4
(51.2, 59.5)
BRFSS
2010
28,782
95.0
(90.3, 97.5)
49,637
94.3
(90.3, 96.8)
BRFSS
2010
54,670
91.7
(86.7, 95.0)
93,154
88.4
(84.7, 91.3)
% of women (50-‐69) who had mammogram and CBE w/i last 2 yrs
BRFSS
2010
23,236
76.7
(68.7, 83.2)
38,245
72.4
(66.5, 77.6)
% of women (40+) who had mammogram and CBE w/i last 2 yrs
% of women (40+) who had mammogram w/i last 2 yrs
BRFSS
2010
42,067
70.6
(64.1, 76.3)
69,290
65.5
(60.8, 70.0)
BRFSS
2010
46,466
78.8
(73.1, 83.6)
78,319
75.9
(71.3, 80.0)
% of women (18-‐64) who report having Pap in past 3 years
BRFSS
2010
67,440
85.0
(78.8, 89.7)
115,199
79.3
(74.0, 83.7)
% of men (50+) ever had PSA test (prostate)
BRFSS
2010
26,647
79.8
(69.9, 87.1)
47,107
77.3
(71.1, 82.5)
Men (50+) who have had PSA test w/i last year
BRFSS
2010
20,244
61.0
(50.8, 70.4)
29,974
49.7
(42.9, 56.4)
% who received influenza vaccine last year (18 -‐ BRFSS
64) % who received influenza vaccine last year BRFSS
(65+) % who have ever received pneumococcal BRFSS
vaccine (65+)
2010
68,103
42.8
(36.9, 48.9)
97,100
32.7
(28.7, 36.9)
2010
18,210
68.5
(60.5, 75.6)
30,038
66.4
(60.2, 72.1)
2010
16,976
65.5
(57.0, 73.1)
32,323
72.5
(66.4, 77.9)
Table C-‐1
Page 5 of 17
Indicators
Rate
level
Health Risk Behaviors
Data Source
Year
% ever been diagnosed with hypertension/high blood pressure
% ever been diagnosed with high blood cholesterol
% who smoke cigarettes (current)
BRFSS
2009
53,440
28.3
(24.0, 33.0)
108,266
31.0
(27.6, 34.5)
BRFSS
2009
49,623
32.9
(28.1, 38.0)
111,964
41.1
(37.5, 44.9)
BRFSS
2010
22,226
11.8
(8.5, 16.1)
54,524
15.6
(12.8, 19.0)
% who smoke cigarettes (current -‐ youth)
% who eat at least 5 fruits and vegetables a day (18+)
% who eat at least 5 fruits and vegetables a day (youth)
% obese (BMI > 30) (adults)
% overweight (BMI >25 -‐<30) (adults)
% who drink heavily
% who used illegal drugs in past 30 days (youth)
% who abused prescription drugs in past 30 days (youth)
% who binge drank in past 2 weeks (youth)
% who do not meet recommended level of physical activity (18+)
% who do not meet recommended level of physical activity (youth)
Obese -‐ Youth (>95th percentile)
Overweight -‐ Youth (85 -‐ 95th percentile) % households with kids containing loaded & unlocked gun
HYS
BRFSS
2010
2009
47,248
11.2
25.8
(8.0, 15.3)
(21.4, 30.9)
82,460
10.6
23.9
(8.6, 12.9)
(20.8, 27.3)
HYS
2008
22.4
(18.5, 26.9)
25.9
(24.1, 27.9)
BRFSS
BRFSS
BRFSS
HYS
2010
2010
2010
2010
21.8
36.1
6.5
18.2
(17.6, 26.7)
(31.0, 41.6)
(4.2, 9.7)
(12.6, 25.5)
29.7
37.3
5.9
15.2
(26.1, 33.6)
(33.4, 41.4)
(4.1, 8.4)
(12.5, 18.5)
HYS
2010
11.2
(9.6, 13.1)
15.7
(14.1, 17.6)
HYS
BRFSS
2010
2009
12.6
47.4
(8.6, 18.2)
(41.5, 53.3)
12.5
52.3
(10.2, 15.1)
(48.3, 56.3)
HYS
2008
30.3
(27.2, 33.6)
25.0
(22.3, 27.8)
HYS
HYS
BRFSS
2010
2010
2009
8.7
13.2
1.7
(6.0, 12.7)
(12.1, 14.3)
(0.2, 11.5)
11.1
14.2
5.4
(9.7, 12.6)
(12.8, 15.7)
(1.9, 14.1)
39,144
64,795
11,836
83,216
Number Affected
99,366
124,847
19,754
175,901
level
Table C-‐1
Page 6 of 17
Indicators
Mental Health % adults without social/emotional support (18-‐
64)
% adults without social/emotional support (65+)
% adults with poor mental health (last 30 days)
BRFSS
2010
6,087
3.9
(2.3, 6.4)
17,123
5.8
(3.8, 8.8)
BRFSS
2010
1,185
4.5
(2.3, 8.5)
3,790
8.8
(5.9, 13.1)
BRFSS
2010
66,728
37.2
(30.7, 44.3)
120,553
36.2
(32.3, 40.3)
BRFSS
2010
2813
2.5
(0.9, 6.7)
5178
2.2
(1.4, 3.6)
HYS
WSDOH
2010
2010
31
28.4
11.6
(26.7, 30.1)
(7.4,15.7)
75
28.4
16.1
(26.7, 30.1)
(12.4,19.8)
WSDOH
WSDOH
2010
2010
152
90
49.4
70.9
(40.7,58.1)
(62.0, 78.4)
241
152
52.1
63.1
(45.4,58.8)
(56.6, 69.1)
Injury hospitalization rate
CHARS
2010
1,638
667.5
(634.7,700.4)
3,280
737.4
(711.6,763.3)
% of injury hospitalizations that were unintentional
MV crash mortality
Fall hospitalizations
Fall mortality
Unintentional poisoning deaths per 100,000 pop
Hospitalization rate for unintentional poisonings per 100,000 pop
Physical abuse in youth
CHARS
2010
1,237
75.5
(73.3, 77.6)
2,540
77.4
(76, 78.9)
WSDOH
CHARS
WSDOH
WSDOH
2010
2010
2010
2008
15
691
29
32
5.6
287.7
11.7
13.5
(3.1, 9.5)
(266.4, 310.4)
(7.8, 17)
(9.2, 19.1)
29
1210
38
80
6.6
298.4
9.5
18.4
(4.4, 9.6)
(281.4, 316.2)
(6.7, 13.2)
(14.6, 22.9)
CHARS
2010
75
30.7
(23.7,37.8)
231
49.2
(42.7,55.7)
HYS
2010
17.2
(15.0, 19.6)
17.9
(16.4, 19.5)
% adults with symptoms of serious mental illness
% youth with depression symptoms
Suicide mortality
Injuries
Injury Mortality Rate
% if injuries that were unintentional
Communicable Diseases
E coli
Influenza hospitalizations
WSDOH
CHARS
2008-‐10
Number Percent or Affected
Rate
9
3.7
62
8.8
95% CI
(1.8, 7.2)
(6.7, 11.3)
Number Affected
13
113
Percent or Rate
2.8
8.5
95% CI
(1.6, 4.9)
(7, 10.3)
Table C-‐1
Page 7 of 17
Table C-‐2
Comparison of Top Ten Non-‐Birth Hospitalization Rates for SHD #2 and the rest of Snohomish County, 2010
All Rates are Age Adjusted
Indicators
Non-‐Childbirth Hospitalizations Total Hospitalizations
Number % of Total
Affected
14,830
Rate per 95% Confidence 100,000
level
6,006.8 (5908.6 ,6105.1)
Number % of Total Rate per Affected
100,000
30,540
6,894.0
95% Confidence level
(6814.6 ,6973.5)
Top Ten Hospitalizations
Diseases of the circulatory system
2,485
16.8
1,018.4
(977.6 ,1059.2)
4,840
15.8
1,149.5
(1116.1 ,1182.9)
Diseases of the digestive system
1,856
12.5
748.1
(713.5 ,782.7)
3,940
12.9
871.1
(843.3 ,899)
Injury and poisoning
1,638
11.0
667.5
(634.7 ,700.4)
3,280
10.7
737.4
(711.6 ,763.3)
Diseases of the musculoskeletal system and connective tissue
1,471
9.9
577.6
(547.5 ,607.7)
Diseases of the respiratory system
3,073
10.1
620.2
(596.7 ,643.6)
1,284
8.7
577.6
(547.5 ,607.7)
2,849
9.3
620.2
(596.7 ,643.6)
Mental Illness
1,168
7.9
473.6
(446.1 ,501)
Mental Illness
2,542
8.3
533.8
(512.8 ,554.8)
Neoplasms
1,135
7.7
447.3
(420.7 ,473.8)
Neoplasms
2,175
7.1
473.7
(453.2 ,494.2)
Diseases of the genitourinary system
953
6.4
387.3
(362.4 ,412.3)
1,961
6.4
448.5
(428.2 ,468.9)
Infectious and parasitic diseases
830
5.6
340.8
(317.3 ,364.4)
1,941
6.4
458.8
(437.8 ,479.8)
Endocrine; nutritional; and metabolic diseases and immunity disorders
576
3.9
233.9
(214.5 ,253.3)
1,121
3.7
248.6
(233.7 ,263.4)
Table C-‐2
Page 8 of 17
Indicators
Non-‐Childbirth Hospitalizations Overall Hospitalization Rate for Children (<18)
Number % of Total
Affected
968
level
1,736.5 (1630.4, 1849.2)
100,000
2,012
1,699.0
(1626.5, 1774.6)
Top Ten Hospitalization Rates for Children (<18)
207
21.4
371.3
(323.3, 426.3)
368
18.3
310.8
(280.2, 344.5)
122
12.6
218.9
(182.5, 262.2)
299
14.9
252.5
(225.1, 283.2)
118
12.2
211.7
(176, 254.4)
242
12.0
204.4
(179.8, 232.2)
Mental Illness
97
10.0
174.0
(141.9, 213.2)
Mental Illness
194
9.6
163.8
(142, 189)
Congenital anomalies
70
7.2
125.6
(98.6, 159.6)
Congenital anomalies
142
7.1
119.9
(101.4, 141.8)
56
5.8
100.5
(76.6, 131.4)
134
6.7
113.2
(95.2, 134.4)
49
5.1
87.9
(65.7, 117.2)
Diseases of the nervous system and sense organs
109
5.4
92.0
(75.9, 111.5)
Diseases of the nervous system and sense organs
47
4.9
84.3
(62.6, 113.1)
85
4.2
71.8
(57.7, 89.2)
Neoplasms
37
3.8
66.4
(47.4, 92.5)
Neoplasms
81
4.0
68.4
(54.7, 85.5)
Symptoms; signs; and ill-‐
defined conditions and factors influencing health status
37
3.8
66.4
(47.4, 92.5)
81
4.0
68.4
(54.7, 85.5)
Table C-‐2
Page 9 of 17
Indicators
Non-‐Childbirth Hospitalizations Overall Hospitalization Rate for Adults (18-‐64)
Top Ten Hospitalization Rates for Adults (18-‐64)
Number % of Total
Affected
7,505
level
4,651.2 (4549.2, 4755.4)
1,096
14.6
679.2
(640, 720.8)
951
12.7
589.4
Mental Illness
900
12.0
819
100,000
17,193
5,650.6
(5568.9, 5733.4)
2,471
14.4
812.1
(780.7, 844.8)
(552.9, 628.2)
Mental Illness
2,150
12.5
706.6
(677.3, 737.2)
557.8
(522.3, 595.6)
2,047
11.9
672.8
(644.2, 702.6)
10.9
507.6
(473.8, 543.8)
1,886
11.0
619.8
(592.4, 648.5)
793
10.6
491.5
(458.2, 527.1)
1,728
10.1
567.9
(541.7, 595.4)
Neoplasms
667
8.9
413.4
(382.9, 446.2)
Neoplasms
1,370
8.0
450.3
(426.9, 474.9)
445
5.9
275.8
(251.1, 302.9)
1,300
7.6
427.3
(404.5, 451.2)
399
5.3
247.3
(223.9, 273.1)
1,152
6.7
378.6
(357.2, 401.2)
344
4.6
213.2
(191.5, 237.2)
868
5.0
285.3
(266.8, 305)
317
4.2
196.5
(175.7, 219.6)
664
3.9
218.2
(202.1, 235.6)
Table C-‐2
Page 10 of 17
Indicators
Non-‐Childbirth Hospitalizations Overall Hospitalization Rate for Older Adults (65+)
Top Ten Hospitalization Rates for Older Adults (65+)
Diseases of the Snohomish Hospital District #2
Number % of Total
Affected
6,358
level
22,877.9 (22386, 23377.3)
Number % of Total Rate per 95% Confidence Affected
100,000
level
11,335
24,774.3 (24379.8, 25173.1)
1,512
23.8
5440.6
(5178.3, 5715.3)
2,756
24.3
6023.6
(5808.2, 6246.5)
723
11.4
2601.6
(2419.1, 2797.2)
1,405
12.4
3070.8
(2915.6, 3234)
678
10.7
2439.6
(2263, 2629.6)
1,170
10.3
2557.2
(2415.4, 2707)
642
10.1
2310.1
(2138.2, 2495.3)
1,152
10.2
2517.9
(2377.2, 2666.6)
624
9.8
2245.3
(2075.9, 2428.1)
1,040
9.2
2273.1
(2139.4, 2414.8)
463
7.3
1666.0
(1520.3, 1825.2)
1,021
9.0
2231.5
(2099.1, 2372.1)
459
7.2
1651.6
(1506.6, 1810.2)
Neoplasms
724
6.4
1582.4
(1471, 1702)
Neoplasms
431
6.8
1550.9
(1410.4, 1704.9)
724
6.4
1582.4
(1471, 1702)
203
3.2
730.5
(635.2, 839.5)
323
2.8
706.0
(632.2, 788.1)
Mental Illness
171
2.7
615.3
(528.3, 716.3)
Symptoms; signs; and ill-‐
defined conditions and factors influencing health status
295
2.6
644.8
(574.4, 723.5)
circulatory system
Table C-‐2
Page 11 of 17
Table C-‐3
Comparison of Top Ten Causes of Death for SHD #2 and the rest of Snohomish County, 2010
Indicators
Deaths
Overall Death Rate
Number % of Total
Rate per 95% Confidence Affected
100,000
level
1,463
609.2
(577.5 ,640.9)
Number % of Total
100,000
level
2,975
734.9
(707.8 ,762)
Top Ten Causes of Death
Cancer
393
26.9
163.4
(146.9 ,179.8)
Cancer
701
23.6
169.4
(156.5 ,182.4)
Heart Disease
Alzheimer's disease
313
95
21.4
6.5
129.9
40.9
(115.3 ,144.5)
(32.6 ,49.2)
671
185
22.6
6.2
168.0
49.7
(155 ,181)
(42.4 ,57.1)
Chronic lower respiratory diseases
80
5.5
35.1
(27.4 ,42.9)
Heart Disease
Alzheimer's disease
175
5.9
47.2
(40.1 ,54.3)
Stroke
76
5.2
32.9
(25.4 ,40.3)
Unintentional Injuries
175
5.9
38.7
(32.9 ,44.5)
67
4.6
26.2
(19.9 ,32.5)
Stroke
133
4.5
34.5
(28.6 ,40.5)
Infectious and Parasitic Disease
Diabetes mellitus
54
3.7
22.5
(16.4 ,28.6)
Diabetes mellitus
110
3.7
27.2
(21.9 ,32.4)
37
2.5
14.9
(10 ,19.7)
84
2.8
19.6
(15.2 ,23.9)
Suicide
31
2.1
11.6
(7.4 ,15.7)
Suicide
75
2.5
16.1
(12.4 ,19.8)
Parkinson's disease
24
1.6
11.0
(6.6 ,15.4)
Chronic liver disease and cirrhosis
56
1.9
11.0
(8.1 ,14)
Overall Death Rate in Children (<18)
13
23.3
(13, 41)
33.8
(24.5, 46.5)
40
Table C-‐3
Page 12 of 17
Indicators
Deaths
Leading Causes of Death in Children (<18)
Perinatal conditions
Number % of Total
100,000
level
Number % of Total
100,000
level
5
38.5
9.0
(3.3, 22.2)
15
37.5
12.7
(7.4, 21.4)
Congenital malformations, etc.
4
30.8
7.2
(2.3, 19.7)
All Other 14
35.0
11.8
(6.7, 20.4)
All Other
4
30.8
7.2
(2.3, 19.7)
6
15.0
5.1
(2.1, 11.6)
5
12.5
212.6
(191, 236.6)
Unintentional Injury
Overall Death Rate in Adults (18-‐64)
343
900
4.2
(1.6, 10.5)
295.8
(277, 315.9)
Leading Causes of Death in Adults (18-‐64)
Cancer
121
35.3
75.0
(62.5, 89.9)
Cancer
255
28.3
83.8
(74, 94.9)
Heart Disease
53
15.5
32.8
(24.8, 43.3)
Heart Disease
160
17.8
52.6
(44.9, 61.6)
35
10.2
21.7
(15.3, 30.5)
121
13.4
39.8
(33.1, 47.7)
Suicide
28
8.2
17.4
(11.8, 25.4)
Suicide
59
6.6
19.4
(14.9, 25.2)
Diabetes mellitus
15
4.4
9.3
(5.4, 15.7)
41
4.6
13.5
(9.8, 18.5)
13
3.8
8.1
(4.5, 14.2)
Diabetes mellitus
35
3.9
11.5
(8.1, 16.2)
Stroke
13
3.8
8.1
(4.5, 14.2)
33
3.7
10.8
(7.6, 15.4)
10
2.9
6.2
(3.1, 11.8)
30
3.3
9.9
(6.8, 14.3)
5
1.5
3.1
(1.1, 7.7)
Stroke
16
1.8
5.3
(3.1, 8.7)
Influenza and pneumonia
13
1.4
4.3
(2.4, 7.5)
Table C-‐3
Page 13 of 17
Indicators
Deaths
Overall Death Rate in Older Adults (65+)
Leading Causes of Death in Older Adults (65+)
Cancer
Heart Disease
Number % of Total
100,000
level
1107
3983.3
(3757.9, 4221.5)
271
260
24.5
23.5
975.1
935.6
(864.5, 1099.5)
(827.3, 1057.6)
Alzheimer's disease
94
8.5
338.2
Stroke
75
6.8
66
Number % of Total
100,000
level
2035
4447.8 (4261.6, 4641.7)
Heart Disease
Cancer
511
446
25.1
21.9
1116.9 (1023.5, 1218.5)
974.8 (887.8, 1070.2)
(274.9, 415.7)
Alzheimer's disease
175
8.6
382.5
(328.9, 444.5)
269.9
(213.8, 340.1)
155
7.6
338.8
(288.5, 397.5)
6.0
237.5
(185.1, 304)
Stroke
117
5.7
255.7
(212.4, 307.6)
38
3.4
136.7
(98.1, 189.7)
Diabetes mellitus
75
3.7
163.9
(129.8, 206.6)
32
2.9
115.1
(80.1, 164.6)
50
2.5
109.3
(82, 145.3)
Diabetes mellitus
24
2.2
86.4
(56.6, 130.6)
49
2.4
107.1
(80.1, 142.8)
Parkinson's disease
24
2.2
86.4
(56.6, 130.6)
Parkinson's disease
30
1.5
65.6
(45, 94.9)
Other diseases of respiratory system
21
1.9
75.6
(48, 117.7)
Nephritis nephrotic syndrome and nephrosis
28
1.4
61.2
(41.5, 89.7)
Table C-‐3
Page 14 of 17
Table C-‐4
Comparison of the Leading Causes of Death by Race, for Snohomish Hospital District #2 and the rest of Snohomish County
All Rates are Age Adjusted, Average for time period 2006-‐2010
Cause Of Death
Race
Cancer
White
Black
American Indian or Alaskan Native
Asian or Pacific Islander
Diabetes mellitus
Deaths
3212
27
39
Age-‐
Adjusted Rate
185.49
168.58
189.16
(179, 192.2)
(101, 271)
(127, 278.1)
105.07
(85.9, 128)
113
131.62
(106, 162.7)
Hispanic 20
101.68
(58.9, 166.1)
53
113.55
(78.1, 162.6)
White
Black
157
4
0
16.18
20.5
0
(13.7, 19)
(4.7, 70.4)
-‐-‐-‐
425
10
11
24.8
63.14
73.55
(22.5, 27.4)
(26.9, 135.6)
(33.6, 145)
9
11.81
(5.3, 23.2)
10
16.64
(7.7, 32.4)
6
21.13
(6.4, 58.2)
10
35.05
(15.3, 70.8)
465
2
2
46.83
NA
NA
(42.6, 51.4)
-‐-‐-‐
-‐-‐-‐
805
3
9
48.44
NA
90.25
(45.1, 52)
-‐-‐-‐
(41.1, 173.4)
11
15.95
(7.9, 29.1)
8
16.43
(7, 33.1)
3
NA
-‐-‐-‐
6
30.57
(11.1, 67.5)
1543
16
6
153.98
95.38
125.45
(146.3, 162)
(48.5, 174.1)
(41.5, 303.5)
3059
28
39
178.17
140.26
217.41
(171.8, 184.7)
(80.9, 234)
(145.8, 317.1)
72
72.66
(55.4, 94.2)
67
93.66
(70.6, 122.7)
Hispanic 25
112.18
(66.5, 179.6)
42
91.23
(59.6, 136.7)
White
Black
326
6
4
33.12
51.28
105.21
(29.6, 37)
(16.7, 122)
(27.9, 281.7)
693
9
6
41.49
69.21
48.06
(38.4, 44.8)
(26.7, 151.3)
(16, 114.1)
38
38.39
(26.3, 54.7)
27
32.14
(20, 50.3)
4
14.31
(2.7, 49.9)
11
36.84
(16.3, 73.5)
Alzheimer's disease White
Black
Hispanic Stroke
1636
28
8
Age-‐
95% Adjusted Confidence Rate
level
168.96
(160.8, 177.5)
146.8
(89.1, 234.3)
118.57
(48.7, 272.3)
124
Hispanic Heart Disease
Deaths
White
Black
Hispanic Table C-‐4
Page 15 of 17
Cause Of Death
Race
Influenza &
pneumonia
White
Black
(7.9, 12)
-‐-‐-‐
-‐-‐-‐
Deaths
101
1
2
Age-‐
Adjusted Rate
9.77
NA
NA
220
2
5
Age-‐
Adjusted Rate
12.81
NA
15.85
(11.2, 14.7)
-‐-‐-‐
(4.9, 58.5)
5
5.12
(1.5, 13.7)
4
7.68
(1.9, 21.2)
2
NA
-‐-‐-‐
2
NA
-‐-‐-‐
344
36.34
(32.6, 40.5)
842
51.77
(48.3, 55.5)
Black
6
4
48.44
80.14
(15.6, 116.9)
(21.6, 231.2)
1
12
NA
71.74
-‐-‐-‐
(33.4, 140.8)
7
8.66
(3.3, 19.1)
10
16.64
(7.7, 32.4)
Hispanic 3
NA
-‐-‐-‐
5
14.48
(3.7, 42)
96
9.22
(7.4, 11.4)
221
11.19
(9.7, 12.8)
1
1
NA
NA
-‐-‐-‐
-‐-‐-‐
3
14
NA
40.73
-‐-‐-‐
(21.9, 86.7)
2
NA
-‐-‐-‐
5
4.61
(1.3, 14.6)
2
NA
-‐-‐-‐
8
10.27
(4.1, 31.6)
White
Black
365
7
4
38.86
15.45
52.28
(34.9, 43.2)
(6.2, 57.5)
(12.6, 183.1)
831
15
34
44.83
27.51
98.02
(41.8, 48.1)
(15.2, 75.2)
(67.4, 152.5)
18
13.67
(7.5, 24)
15
15.65
(7.9, 29.6)
Hispanic 10
26.65
(8.9, 66.9)
32
16.51
(10.7, 36.2)
White
Black
112
2
1
12.11
NA
NA
(9.9, 14.7)
-‐-‐-‐
-‐-‐-‐
259
2
6
13.3
NA
17.6
(11.7, 15.1)
-‐-‐-‐
(6.5, 59.7)
13
6.46
(3.4, 13.5)
11
6.88
(3.4, 16.3)
3
NA
-‐-‐-‐
9
3.89
(1.7, 23.3)
Hispanic Chronic lower White
respiratory diseases
Chronic liver White
disease & cirrhosis
Black
Hispanic Unintentional
Injuries
Suicide
Hispanic Deaths
Source:
Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990 -‐2011, September 2012
Table C-‐4
Page 16 of 17
Table C-‐5
Birth Risk Factors by Race
White-‐NH
Black-‐NH
Hispanic as Race
All
Fertility Rate,Births per 1000 women
57.3
81.2
86.1
62.61*
(55.8, 58.7)
(74.1, 88.8)
(29.9, 52)
(62.9, 68.9)
(81.3, 91.1)
(61.4, 63.9)
16.02
25.55
28.89
16.63
31.21
18.7
(14.9, 17.2)
(20.9, 30.9)
(15.4, 49.4)
(14.7, 18.8)
(27.9, 34.8)
(17.8, 19.7)
23.26
(22.1, 24.5)
27.23
(22.8, 32.3)
20.37
(10.2, 36.5)
24.13
(22, 26.5)
20.12
(17.7, 22.8)
23.25
(22.3, 24.2)
White-‐NH
Black-‐NH
American Indian/ Asian/ Pacific Islander-‐
Alaskan Native-‐NH
NH
Hispanic as Race
All
Fertility Rate,Births per 1000 women
59.8
78.7
88.1
59.8
100.3
(58.8, 60.9)
(72, 85.8)
(79.9, 96.9)
(56.7, 63)
(96.6, 104)
22.1
35.9
47.8
26.5
34.5
(21.2, 23)
(30.5, 41.8)
(41, 55.3)
(23.7, 29.5)
(32.3, 36.8)
(24.7, 26.3)
18.94
(18.2, 19.7)
19.34
(15.7, 23.5)
19.95
(15.9, 24.7)
21.66
(19.3, 24.3)
17.02
(15.6, 18.6)
18.9
(18.2, 19.5)
American Indian/ Asian/ Pacific Islander-‐
Alaskan Native-‐NH
NH
39.8
65.9
65.7
(64.7, 66.6)
25.5
Source:
Washington State Department of Health, Center for Health Statistics (CHS), Birth Certificate Data, 1990-‐2011, September 2012
Calculated for 2008 -‐ 2010.
* Does not match the total in C-‐1 because it was calculated for 2008-‐2010 by race and then added. C-‐1 birth rates are by age and for 2010 only.
Table C-‐5
Table C-‐3
Comparison of Top Ten Causes of Death for SHD #2 and the rest of Snohomish County, 2010
Indicators
Deaths
Overall Death Rate
Number % of Total
100,000
level
1,463
609.2
(577.5 ,640.9)
Number % of Total
100,000
level
2,975
734.9
(707.8 ,762)
Top Ten Causes of Death
Cancer
393
26.9
163.4
(146.9 ,179.8)
Cancer
701
23.6
169.4
(156.5 ,182.4)
Heart Disease
Alzheimer's disease
313
95
21.4
6.5
129.9
40.9
(115.3 ,144.5)
(32.6 ,49.2)
671
185
22.6
6.2
168.0
49.7
(155 ,181)
(42.4 ,57.1)
80
5.5
35.1
(27.4 ,42.9)
Heart Disease
Alzheimer's disease
175
5.9
47.2
(40.1 ,54.3)
Stroke
76
5.2
32.9
(25.4 ,40.3)
175
5.9
38.7
(32.9 ,44.5)
67
4.6
26.2
(19.9 ,32.5)
Stroke
133
4.5
34.5
(28.6 ,40.5)
Diabetes mellitus
54
3.7
22.5
(16.4 ,28.6)
Diabetes mellitus
110
3.7
27.2
(21.9 ,32.4)
37
2.5
14.9
(10 ,19.7)
84
2.8
19.6
(15.2 ,23.9)
Suicide
31
2.1
11.6
(7.4 ,15.7)
Suicide
75
2.5
16.1
(12.4 ,19.8)
Parkinson's disease
24
1.6
11.0
(6.6 ,15.4)
56
1.9
11.0
(8.1 ,14)
Overall Death Rate in Children (<18)
13
23.3
(13, 41)
33.8
(24.5, 46.5)
40
Table C-‐3
Page 1 of 3
Indicators
Deaths
Leading Causes of Death in Children (<18)
Number % of Total
100,000
level
Number % of Total
100,000
level
5
38.5
9.0
(3.3, 22.2)
15
37.5
12.7
(7.4, 21.4)
4
30.8
7.2
(2.3, 19.7)
All Other 14
35.0
11.8
(6.7, 20.4)
All Other
4
30.8
7.2
(2.3, 19.7)
6
15.0
5.1
(2.1, 11.6)
5
12.5
212.6
(191, 236.6)
Overall Death Rate in Adults (18-‐64)
343
900
4.2
(1.6, 10.5)
295.8
(277, 315.9)
Leading Causes of Death in Adults (18-‐64)
Cancer
121
35.3
75.0
(62.5, 89.9)
Cancer
255
28.3
83.8
(74, 94.9)
Heart Disease
53
15.5
32.8
(24.8, 43.3)
Heart Disease
160
17.8
52.6
(44.9, 61.6)
35
10.2
21.7
(15.3, 30.5)
121
13.4
39.8
(33.1, 47.7)
Suicide
28
8.2
17.4
(11.8, 25.4)
Suicide
59
6.6
19.4
(14.9, 25.2)
Diabetes mellitus
15
4.4
9.3
(5.4, 15.7)
41
4.6
13.5
(9.8, 18.5)
13
3.8
8.1
(4.5, 14.2)
Diabetes mellitus
35
3.9
11.5
(8.1, 16.2)
Stroke
13
3.8
8.1
(4.5, 14.2)
33
3.7
10.8
(7.6, 15.4)
10
2.9
6.2
(3.1, 11.8)
30
3.3
9.9
(6.8, 14.3)
5
1.5
3.1
(1.1, 7.7)
Stroke
16
1.8
5.3
(3.1, 8.7)
Influenza and pneumonia
13
1.4
4.3
(2.4, 7.5)
Table C-‐3
Page 2 of 3
Indicators
Deaths
Overall Death Rate in Older Adults (65+)
Leading Causes of Death in Older Adults (65+)
Cancer
Heart Disease
Number % of Total
100,000
level
1107
3983.3
(3757.9, 4221.5)
271
260
24.5
23.5
975.1
935.6
(864.5, 1099.5)
(827.3, 1057.6)
Alzheimer's disease
94
8.5
338.2
Stroke
75
6.8
66
Number % of Total
100,000
level
2035
4447.8 (4261.6, 4641.7)
Heart Disease
Cancer
511
446
25.1
21.9
1116.9 (1023.5, 1218.5)
974.8 (887.8, 1070.2)
(274.9, 415.7)
Alzheimer's disease
175
8.6
382.5
(328.9, 444.5)
269.9
(213.8, 340.1)
155
7.6
338.8
(288.5, 397.5)
6.0
237.5
(185.1, 304)
Stroke
117
5.7
255.7
(212.4, 307.6)
38
3.4
136.7
(98.1, 189.7)
Diabetes mellitus
75
3.7
163.9
(129.8, 206.6)
32
2.9
115.1
(80.1, 164.6)
50
2.5
109.3
(82, 145.3)
Diabetes mellitus
24
2.2
86.4
(56.6, 130.6)
49
2.4
107.1
(80.1, 142.8)
Parkinson's disease
24
2.2
86.4
(56.6, 130.6)
Parkinson's disease
30
1.5
65.6
(45, 94.9)
Other diseases of respiratory system
21
1.9
75.6
(48, 117.7)
Nephritis nephrotic syndrome and nephrosis
28
1.4
61.2
(41.5, 89.7)
Table C-‐3
Page 3 of 3
RESIDENT PERSPECTIVES Appendix D: Focus Groups Focus Group Overview and Methodology HOW TYPES OF FOCUS GROUPS WERE DETERMINED The population of the Hospital District area includes many different vulnerable populations whose voices are often not heard and who could have added value to this project, such as the diverse ethnic and immigrant communities, caregivers of disabled family members, and families with mentally ill or chemically dependent members. The parameters of the project budget appropriately constrained the ability to reach all vulnerable groups through focus groups, so the choices were based on: • Where were there gaps in existing data? • Who could be successfully reached within the project timeframe? • For which populations could 3 separate groups be recruited to ensure analytically sound data? WHAT TYPES OF FOCUS GROUPS WERE HELD •
•
•
•
3 groups of low-‐income residents, made up of homeless single mothers, previously homeless single mothers, and a mixed group of low-‐income residents living in Section 8 housing. Total of 21 participants. 3 groups of Spanish-‐speaking parents, both mothers and fathers. Total of 27 participants. 3 groups of youth, including homeless youth, youth between 14-‐17 living with their parents and participating in a YMCA youth development program, and youth between ages 17 – 20 attending a college-‐based, high school youth re-‐engagement program. Total of 29 participants. 4 “groups” of family caregivers – 2 groups were 7-‐8 people, 1 was attended by 3, and 1 was just one person. Total of 19 participants. 96 total residents participated. All were connected to some level of services. •
In addition, the team relied on information from focus groups carried out by the Snohomish Health District and published in the Health District’s 2011 report, Creating an Aging Friendly Snohomish County. The Health District shared specific information from groups held within the District. HOW FOCUS GROUP PARTICIPANTS WERE RECRUITED Participants were recruited through South Snohomish service partners from clients being served in their programs. Flyers were posted and distributed by the providers with the providers primarily handling one-‐to-‐one recruitment and sign-‐ups. Where a provider was not available within the district, nearby service providers were turned to. For example, there are no services for homeless youth within the district, so Cocoon House in Everett helped to recruit focus group participants from that demographic. Some service providers served clients who live both in and out of the hospital district, so their recruitment efforts in some cases reached people whose residence is not within the hospital district boundaries. Caregivers were the most challenging participants to recruit, since it is so difficult for them to get away from the person they care for. A fourth focus group was organized for this population to offset the small numbers who were able to attend. Appendix D: Focus Groups Page 1 of 6 HOW THE FOCUS GROUP TRANSCRIPTS WERE CODED AND ANALYZED The focus groups were audio recorded and transcribed in their entirety. Handwritten notes were taken as a back-‐up to the recordings, and to ensure that particular comments could be associated with specific individual participants whose voices might not be distinct in the recordings. Working from the complete transcripts, for most groups, the consultants developed a set of coding categories based on the key themes and sub-‐themes that emerged through the discussions. FOCUS GROUP QUESTIONS The questions asked of residents were similar, but customized for each type of group. Questions were written on a flipchart, one per page, so that the facilitator could guide the conversation in a similar way for each group. The questions were not necessarily asked verbatim but adapted to the social climate of the group. The Spanish Speaking Groups had a translator who translated English to Spanish and Spanish to English. Each group was received a brochure describing the Verdant Health Commission and an introduction which was similar to the following: Thank you all for being willing to help us by participating in this conversation about what it means to live a healthy life and what helps or makes it difficult to do so. The Verdant Health Commission serves south Snohomish County and will be using this information to decide where it should be focusing its efforts to help residents in the future. The discussion group will last about two hours and we will be recording it so that it can be transcribed. That way we can capture all of your ideas and perspectives. It is anonymous and your names will not appear anywhere. At the end we have a $___ gift card for ______1 for you as a thank you for your help. Does anyone have any questions or concerns before we start? The questions for each group were as follows. Low Income Residents Spanish Speaking Residents Our first set of questions has to do with what it means and what it takes to have a healthy life. 1. When you think about living a healthy life, what comes to mind? Can you tell us about a family member or friend that you feel lives a healthy life? (Probe to draw out stories and specifics.) 2. Are there things that get in the way of you or your family being as healthy as you’d like to be? (Probe: nutrition, physical activity, time to cook, etc.) 3. If you don’t know much about a health issue, how do you go about learning about it? 1
The incentives offered to participants varied. Most groups were offered a $25 gift card to Fred Meyer. Some caregiver groups were offered $35 gift cards, after recruiting turned out to be a problem. Most youth were offered $15 gift cards to Fred Meyer, but one group was offered $5 gift cards to Starbucks and pizza for the whole class (not just the focus group). All groups were offered light snacks and beverages. Appendix D: Focus Groups Page 2 of 6 Our next set of questions has to do with how you use health and social services. We want to understand how easy or difficult it is for you to get these services and what type of help you and your family needs. 4. What kinds of things do you think about when you are deciding whether or not to seek medical care for yourself or a loved one? 5. Think of a time in the last year when you or a family member needed medical care, tell us about your experience in getting that care. Note, that we are not asking for any confidential information about the reasons for needing care – but want to know whether it was easy, helpful, difficult, frustrating? How were they been treated? Do they understand what is needed, what is next etc.? 6. What about other services that help you live a healthy life, such as housing, food, or childcare? If there was a time in the last year when you looked for support services tell us about your experience. (Follow-‐up: How they were treated. Was it easy, helpful, difficult, and frustrating? ) For Spanish speakers only 7. Do you feel your language, culture, or immigrant status has affected your experience in getting health care or other services? How? 8. We know that mental health problems and substance abuse can make life very difficult for people. Are you close to anyone in South Snohomish who has struggled with mental health or substance abuse problems? How easy or difficult has it been for them to receive help? Our last question: 9. What would be a really great experience in getting either health care or social services be like? (This question did not work well with some groups, and then they were asked If you could change one thing to improve your experience in getting health care of social services what would it be? Appendix D: Focus Groups Page 3 of 6 Youth Questions Our first set of questions has to do with what it means and what it takes to have a healthy life. 1. When you think about living a healthy life, what comes to mind? Can you tell us about a family member or friend that you feel lives a healthy life? (Probe to draw out stories and specifics.) 2. Are there things that get in the way of you or your friends being as healthy as you’d like to be? (Probe: nutrition, physical activity, time to cook, etc.) 3. If you don’t know much about a health issue, how do you go about learning about it? Our next set of questions has to do with how you use health and social services. We want to understand how easy or difficult it is for you to get these services and what type of help you and your family needs. 4. What kinds of things do you think about when you are deciding whether or not to seek medical care for yourself? 5. Think of a time in the last year when you needed medical care, tell us about your experience in getting that care. (Note, that we are not asking for any confidential information about the reasons for needing care – but want to know whether it was easy, helpful, difficult, frustrating? How were they been treated? Do they understand what is needed, what is next etc.? ) 6. What about other services that help you live a healthy life, such as housing or food? If there was a time in the last year when you looked for support services tell us about your experience. (Follow-‐up: How they were treated. Was it easy, helpful, difficult, frustrating? ) 7. We know that mental health problems and substance abuse can make life very difficult for people. Are you close to anyone in South Snohomish who has struggled with mental health or substance abuse problems? How easy or difficult has it been for them to receive help? 8. Do you feel your age has affected your experience in getting health care or other services? How? Our last question: 9. What would a really great experience in getting either health care or social services be like? (This question did not work well with some groups, and then they were asked If you could change one thing to improve your experience in getting health care of social services what would it be? Probe: Are there specific services that you would like to have closer to where you live? Appendix D: Focus Groups Page 4 of 6 Family Caregiver Questions Our first set of questions has to do with what it means and what it takes to have a healthy life. 1. When you think about living a healthy life as an older person, what comes to mind? Can you tell us about an older family member or friend that you feel lives a healthy life? (Probe to draw out stories and specifics.) 2. Are there things that get in the way of your older family member being as healthy as you’d like to be? (Probe: nutrition, physical activity, time to cook, etc.) 3. If you don’t know much about a health issue, how do you go about learning about it? Our next set of questions has to do with how you use health and social services. We want to understand how easy or difficult it is for you to get these services and what type of help you and your family needs. 4. What are your older family member(s) greatest needs for health and support services? 5. What kinds of things do you think about when you are deciding whether or not to seek medical care for your older family member? 6. Think of a time in the last year when your older family member needed medical care; tell us about your experience in getting that care. (Note, that we are not asking for any confidential information about the reasons for needing care – but want to know whether it was easy, helpful, difficult, frustrating? How were they been treated? Do they understand what is needed, what is next etc.? ) 7. Has your older family member needed health or social services, in the last year or so, that you found difficult to get or that were not available near where they live? Can you tell us about that? Our last question: 8. What would a really great experience in getting either health care or social services for your older family member be like? (This question did not work well with some groups, and then they were asked If you could change one thing to improve your experience in getting health care of social services what would it be? Appendix D: Focus Groups Page 5 of 6 Focus Group Summaries What was heard in the focus groups is documented in the following five tables: Table D-‐1 provides a quantitative summary of the themes heard across the groups, providing the number of participants who mentioned a theme, and the number of groups in which it was discussed. Tables D-‐2 through D – 5 document the compilation of the key quotes from the transcripts across all the populations, as well as single population sets (e.g. “youth” or “family caregivers”), aligned with the themes and sub-‐themes. The summaries also report how often a theme or sub-‐theme was mentioned within a set (e.g. 12 individuals spoke to “x” theme within the youth set), and in how many groups it was mentioned (e.g. “x" theme was raised in 2 of the 3 groups within the set). Appendix D: Focus Groups Page 6 of 6 Table D-‐1
Quantitative Summary of Focus Group Discussions
Youth (3)
# times Type and Number of Groups
Caregiver (3)
English LI (3)
# of # times # of groups
groups
Spanish LI (3)
# times # of groups
# times # of groups
ALL (12)
Total Mentions
Total Groups
What they do for “fun”
Physical Activity
4
Sedentary activity
7
Family
Friends/social
Creative Hobbies
Nothing
Images of What Healthy Living or Health Is
1
1
9
8
1
5
2
0
3
3
1
3
1
0
4
4
3
3
6
1
3
1
3
2
3
1
5
1
9
2
1
0
2
1
3
2
1
0
22
20
13
10
9
1
9
6
7
7
5
1
Exercise
Nutrition
Attitude (positive)
7
6
5
3
3
3
13
6
4
3
3
2
9
5
2
3
3
2
5
7
2
3
34
24
11
11
12
7
Advocate for self in health care settings
Enriching activities
Balance
Low stress
Order and Routine
Having a job
Close relationships with family/other supports
No smoking
Avoid Drugs
Nobody in my life is healthy
Spiritual connection
Drinking only in moderation
1
1
4
3
4
2
1
1
1
2
2
2
2
1
3
7
2
1
2
3
1
1
6
2
1
1
10
9
6
6
5
4
4
5
5
3
5
3
4
4
3
3
1
2
4
4
4
3
3
2
3
4
3
2
1
1
1
1
1
1
1
1
1
2
1
1
2
1
1
1
1
1
2
2
1
1
2
2
1
1
1
1
1
1
2
1
Table D-‐1
1 of 4
Youth (3)
# times Taking care of yourself (as a caregiver)
Adequate sleep
Regular access to doctor
1
Barriers to Being Healthy (what gets in the way?)
Type and Number of Groups
Caregiver (3)
English LI (3)
groups
3
1
8
5
1
3
3
1
6
4
2
1
Cultural norms
Physical health
Lack of energy/sleep
“Fake food” industry/junk food/fast food
Self esteem/depression
Washington Climate
Peer pressure
School policies and practices
Taking risks/risky sex
Low quality housing/air quality
Factors related to accessing care
2
2
Lack of transportation
Lack of Insurance/cost of care
Wait times
Specialty care for children not offered locally
7
7
5
7
3
2
2
3
2
3
1
1
10
2
6
3
2
3
1
5
5
# of groups
2
1
1
Lack of money/lack of a job
Motivation for change
Time Anxiety about the future
Discipline vs instant gratification
Lack of indoor play space/ access to athletic activities
# times 1
Spanish LI (3)
# times # of groups
1
1
2
5
5
1
2
3
2
1
2
2
2
1
1
1
3
2
2
1
2
2
1
1
1
1
9
7
5
1
3
2
3
1
7
3
7
6
3
3
5
11
3
3
1
1
2
2
ALL (12)
Total Mentions
Total Groups
3
2
2
2
2
2
27
19
17
7
6
6
9
10
9
3
2
2
5
5
5
3
2
2
2
1
1
1
5
3
2
2
1
1
2
1
1
1
28
24
5
4
12
8
3
4
Table D-‐1
2 of 4
Youth (3)
# times # times # of groups
1
2
1
1
1
1
3
1
5
3
1
2
1
2
5
6
4
1
1
3
3
3
3
Preference for home remedies or over-‐
the counter
Preference for watch and wait
Medical instructions/criteria
Availability of transportation
Availability of childcare
Son doesn't like/trust doctors
Mandated by coverage
Availability of appointment
Barriers to Quality Care or Service
Gaps in the system
Not being heard by providers -‐ being dismissed
Ways in which systems seems to work actively against client
Not understanding the system, or what they are being told (including mis-‐
information)
Insurance rules
3
2
2
2
1
11
2
1
Spanish LI (3)
groups
Lack of child care/senior care
time of day that need occurs
Other care not offered locally
Factors in judging whether to seek care Cost
Child vs adult
Personal judgement of severity of illness/impact on daily life
Caregiver (3)
English LI (3)
2
1
2
2
1
2
2
1
# times # of groups
ALL (12)
Total Mentions
Total Groups
4
2
2
1
3
3
3
14
8
7
10
5
6
5
3
6
4
2
2
1
1
5
2
2
2
2
1
1
4
1
2
2
2
1
1
1
1
1
1
13
2
5
3
2
2
6
12
3
3
35
17
9
7
6
2
9
2
1
1
16
5
5
2
2
1
6
3
14
7
2
2
4
1
6
3
Table D-‐1
3 of 4
Youth (3)
# times Language interpretation
Don’t know what resources are available
1
paper work
Immigration status
Teen independence
2
Bad providers
Where do you get your health information?
Internet
Provider
Family or Friend
Print media
Library
TV
7
3
2
2
Caregiver (3)
English LI (3)
groups
# times # of groups
1
3
2
1
Spanish LI (3)
# times # of groups
6
4
3
2
3
2
1
1
4
2
3
3
3
2
2
1
1
1
1
1
3
3
2
2
6
5
4
5
2
2
2
2
4
5
3
2
3
3
3
2
ALL (12)
Total Mentions
Total Groups
6
5
4
3
2
1
3
3
3
2
1
1
21
15
12
9
2
1
11
11
9
6
1
1
Table D-‐1
4 of 4
Table D-‐2: Low-‐Income Focus Groups Summary CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups What they do for fun Physical activity Swim, camping, garden 4 3 Sedentary activity Watch TV, read 4 1 Family Visit with family, go to the park 3 3 Social/Friends casino 3 2 Creative Hobby Genealogy, sew, write poems, crafts, draw, yard saling 6 3 Nothing 1 1 9 3 5 3 2 2 1 1 Images of Healthy Living or Health Exercise Keep moving and walking, to keep circulation going as a diabetic. Quoted her MD as saying “We need to be moving in all aspects of our life. We always need to be changing for the good.” Biking Nutrition “Its about buying the right food, being able to shop in a nice market, where they have fresh fruit, vegetables, and salad just there for you, but it’s so expensive that on what I get a month I can’t afford to shop there…it makes a big difference about whether you’re really healthy or just kind of borderline. Because that’s the way I feel all the time.” Organic food. “I don’t know anyone who eats healthy.” [Living health is] eating more fruits and vegetable, less fast food, …drinking more water instead of soda pop. Attitude (positive etc.) Positive attitude, even when have life-‐threatening illness, “I’m going to take care of it.” Approach. Discipline and focus Low stress Table D-‐2 Focus Group Summary: Low Income Page 1 of 9 CONCEPTS IDEAS & QUOTES Mentioned in this set in X groups Spiritual connection “If I do something healthy…it has to have something deeper. It has to be not just because you need to keep moving instead of standing still. It has to have a spiritual aspect…an emotional, mental aspect.” Having access to medical and dental care 1 Nobody in my life is healthy 2 2 Advocating for self in (health care and social service settings) Not just accepting what one is told “You’ve got to take your own life in your hands.” 6 2 10 3 1 Mentioned 1 1 “I didn’t know who to believe. I didn’t know what to do. I couldn’t get information from anybody…what I did was I just took one step at a time. A real slow step, and figured it out on my own, and that took an awful long time.” “There are people complaining about the poverty level and everything and "make better choices," but unless they've been there, they don't know how hard it is. You have to fight, and not many people are used to advocating for themselves, or they just get beat down. It's really hard. “ “When it comes to my son, I’m his advocate, so I don’t just accept.” Barriers to Being Healthy Lack of money People who have money are less likely to be depressed. They don’t have the weight of having to say no to their children “No, I can’t get that for you, because I don’t know how I’m going to pay the rent this month.” “We’re almost trained that if you’re impoverished, then you are to be a certain way…Like a lot of people think they cannot afford to eat healthy, when they just haven’t been shown that they really can.” “Cup o noodles is all we can afford.” “On food stamps it’s not a very viable amount of money and you have to stretch everything. It’s hard to have fresh vegetables and fruit all the time.” “All the things you think you want to do for yourself that you might feel would be healthy for you, seems like it’s too much.” Table D-‐2 Focus Group Summary: Low Income Page 2 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups 6 3 Don’t have money to go to the gym Am supposed to go to rheumatologist for Lupus, but was told I had to pay $600 up front. Can’t do it, so haven’t gone. No rheumatologist has a sliding scale. Supposed to have PT for my back injury but it’s hard to find PT that takes Medicaid. And it only covers two visits and I need more. Being able to get our kids into sports Even with a scholarship the YMCA is too much money Re child with ADHD “I would like to … [get him on] organics, off gluten and try all that stuff. Buts it’s not feasible for me economically.” Time Wait times at the provider Can’t take time off from work for an apt 2 Wait times to see a specialist 2 Time to cook instead of eat fast food Can’t jog anymore as have 3 kids Motivation for change/ resistance Cultural norms Child with anxiety about going outside – hinders whole family 2 2 1 1 6 3 “When it’s hot like this you really don’t want to cook in a little 2 bedroom apt that looks like a studio apartment where the bathroom’s bigger than the kitchen.” Grew up in a family that ate fattening food, “because that’s what you could afford to feed your children . . . you had lots of potatoes, gravy, macaroni and cheese. Factors Related to Access Lack of Insurance/ Cost of Care Lack of dental, vision, hearing aids coverage with Medicare, “all the things you really need.” Limited mental health insurance with Medicare and high copay ($50) Table D-‐2 Focus Group Summary: Low Income Page 3 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups 7 3 “For me it’s, “Do I really want to take on another bill? But for my child, take him in, don’t think about it.” “I think all of us as Moms push off our health care.” “When it comes to my grandkids…then I will take them, but if it comes to myself, I don’t have health insurance so I have to wait…well usually I end up in the emergency room.” Lack of transportation Reduced bus service (none on Sunday, and some routes discontinued) “It’s ridiculous to try to get to a destination that is 2 miles away from your house and it takes an hour and half to get there, because you have to take 2 buses and wait a half hour in between.” “They assume you can walk because its only 2 miles but not everybody has that ability. Or what if you‘re carrying groceries? “My wife’s a diabetic so we go [to the doctor] on a regular basis. Fortunately we have a relative that has a car that we can use…but I wish I had a car in case there was an emergency so we could get there sooner.” “My doctor wanted me to have this a month ago, and sometimes I can get rides. I’m not eligible for Hope Link and I don’t drive. It's a ways from here, so I haven’t gone and taken that test even though they want me to take it.” 3 buses to get to the doctor “I can get down there, but can I get back” [because of the buses stopping at a certain time.] Hopelink takes 3-‐4 hours to come. “When they want me to do Work First, they want my kids in childcare, and they want me there every day to do what I need to do, they're willing to give me a bus pass, but I have a 7-‐year-‐old and a 9-‐year-‐old that I have to take on the bus to get to childcare and take on the bus to get them home. Nobody, not the shelter, not DSHS, not any of the community services around here, could provide a bus pass for my children. “[note: church provided it] Table D-‐2 Focus Group Summary: Low Income Page 4 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups “Even walking to the bus is hard for me with my COPD, because I can’t walk very much without feeling like I’m going to pass out because I can’t breathe.”{speaker is in mid-‐30s] No Car (for tabulation only) 10 3 Judging whether to seek care (stories) “For me, either me or husband, we don’t have medical coupons, so it’s hard to go see the doctor. …I try to take over counter meds… rather than try to go to a doctor”. 1 1 Location of services for children Trying to get mental health services for son – was offered services at the motel I was staying in until they realized I was in Snohomish not King County. Took another 4-‐6 hours on the phone to get help. 1 1 3 1 2 1 “If it’s my son there’s no question, I just do it and get it done.” Like to have CHC sites closer. Lack of child care So I had to go to the hospital, and if you're a single parent and you have nobody else to watch your kid, you can't take them to the hospital with you, so I had to leave him here with my neighbor to watch him, and I had to stay there for a couple nights. Well, they couldn't baby-‐sit overnight, so that was a huge issue. It was frustrating. “I'm on child support, so I don't get TANF. So the only way you can get childcare if you're not on TANF is if you're working, but what about when you're looking for work? … Let's say I do all my applications online, I have to do an interview. Who's going to watch him that one time? It's like we don't even get a chance. It's like we're stuck and set up for failure. “ “I go to treatment, my mental health, and my domestic violence classes. I have something to do every single day, and they still won't give it to me.” Barriers to Quality Care or Service Not understanding the system, not understanding what they are being told (including mis-‐information) “I’ve been through 3 major illnesses in my family in the last 2 years…and it was awful. You didn’t get any answers from anybody…you’d get one answer here and another answer over here, and it would never work out. You just – I don’t know what you’re supposed to do.” Not understanding why a hospital couldn’t take her mother on an emergency basis. Table D-‐2 Focus Group Summary: Low Income Page 5 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups “When I left the rehab center that I had lived in for 3 and ½ months right over there, I walked out with nothing. I walked out with a little gift thing, this person’s going to call you. Here’s the number for all these things. Nothing. I didn’t get my medical stuff, prescriptions, nothing.” (post-‐
stroke) 5 2 3 2 9 2 Gaps in the system Poor care at the nursing home. And own physician couldn’t see Mother in the nursing home. Infant child care Emergency shelter. [if it takes 6-‐8 months to get in its not emergency shelter] Lack of stable housing, makes it difficult when getting out of treatment to stay sober, to get a job Not being heard by providers -‐ being dismissed “How difficult will it be to convince the doctor that I’m not a hypochondriac? That is real.” Ways in which systems seems to work actively against client Had a stroke and had to go on Medicaid in addition. “It was just a battle…I was really scared, but oh well. Too bad.” “When you are uninsured or underinsured, they Band-‐Aid things. They don’t completely fix a problem.” A consulting nurse had to advise about giving child Tylenol, in a way that she couldn’t be sued. Pharmacist gave “straight up” information about what child could have by weight to bring high fever down. “It’s not the doctor’s fault all of them either…I know sometimes they want to take the time and they’re not allowed…Its insurance running everything.” Section 8 housing waiting list …”is like the receding universe.” Story of woman friend who was staying in Everett shelter with her 5 children. Got a job in Bothell. Couldn’t leave the children at the shelter after school or find other arrangements. So she lost her job – and then lost the housing opportunity tied to having a job. “A lot of times they cut out adult health care things with focus on children, but if you're not well, how do you take care of your children? I went almost two months without glasses, because they don't cover glasses, and my little guy had to read street signs for me and grocery labels and all Table D-‐2 Focus Group Summary: Low Income Page 6 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups 4 1 1 1 5 3 that kind of stuff. Dental care-‐-‐ they don't provide dental care for adults. Damage with your teeth can even affect your heart. That's serious. So, again, if you're not healthy, you can't keep your job, you can't take care of your children. They're cutting off the nose to spite the face because they want to save money. “ MD can only deal with one health concern at a time. “I was supposed to go to [?] housing but they shot me down because of my felony…its 7 years old…I’m trying to change…but I always feel like there’s that block there.” Insurance Rules DSHS changes coverage without notice. Told to call monthly to be sure coverage is same as last appt. When daughter turned 14 couldn’t find out when her orthodontic appointment was or her coverage status. “She’s 14 okay? She doesn't even know what she’s going to wear tomorrow. You really think she's going to pick out a dentist? Or a health plan?" There's a serious disconnect in that area about what is important and what is happening. You can't put children in charge of their health care and expect them to know what to do. You just can't do it. I can educate her all I want, but to her I might as well be speaking a foreign language. She doesn't know what I'm talking about. So, that's a problem.” Place to get medications changes every year – plans switch it. Child can’t go to King County for Mental health – “Its not state medical, its county medical.” Paper work “I am very, very grateful for the childcare and food I get assistance with, but they're going to make you look for it, and the paperwork is overwhelming. I am an intelligent person, and it's overwhelming. I mean, I used to run 6 computer programs, and it's overwhelming.” Mental Health and Substance Abuse Perceptions and knowledge of system Services are there if you want them. It’s easier to get services if you have a dual diagnosis. “If there was a much medical help as there is substance abuse help, we’d be doing way better.” Table D-‐2 Focus Group Summary: Low Income Page 7 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups There are huge waiting lists in Snohomish. “It takes a complete breakdown where she [sister] gets arrested and has to be institutionalized before they can get her back into the system to help here.” “I feel like if I had a drug or alcohol problem …there are a lot more services for me, but…I don’t, because I just have a housing issue and credit issue.” Perceptions of mental health issues Hard to tell-‐ someone may appear healthy but actually report being depressed all the time. 1 1 Suffer themselves from a mental health/SA issue 9 3 4 3 3 5 3 3 2 2 Where do you get your health information? Internet Web MD Access to internet is easy. Google Family or Friend Provider Consulting Nurse Pediatrician doctor Printed materials Books Magazines Prescription insert Table D-‐2 Focus Group Summary: Low Income Page 8 of 9 Specific suggestions from low income residents •
•
•
•
•
•
•
•
Child care in the hospital for single parents. (“They have daycare in the casinos. You’d think they’d have daycare in the hospital.”) Want direct answer when dealing with housing. How long is it really? People who put you up temporarily need good answers too – otherwise they feel burned when it takes longer than originally told. Job training services for women who aren’t on TANF (e.g. on child support) Job training services for people who have felony or DUI – with some stipend Health care for adults without all the strings attached Healthy activities that don’t cost – so you don’t have to choose between putting gas in the car to go to work and taking the kids swimming Housing for people who have old felonies Housing and other supports for single fathers Table D-‐2 Focus Group Summary: Low Income Page 9 of 9 Table D-‐3: Spanish Speaking Focus Groups Summary CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups What they do for “fun” Physical activity Swim, go dancing, snowboarding, biking, the gym, walking on the beach 5 2 Sedentary activity TV, watching sports 1 1 Family go to the park or beach with the kids 9 3 Friends/social Play board games 2 2 Creative Hobbies 1 1 5 7 2 3 1 1 1 1 1 2 Images of Healthy Living or Health Exercise Nutrition Vegetables, fruits. Home-‐cooked meals. White meats, not so much fat. And don't eat out on the street. Avoid hamburgers. Not so much bread. No juice, no soda. Drink a lot of water because it's very helpful for the body. A healthy life for her is to feed her family well, to teach them and educate them about food. put (your kids) in sports, but if the food is not right, then that's going to create a problem – diabetes, cholesterol, obesity. Low stress Enriching activities Having a job Try to do as much as you can (for your children) so they can actually do what they want to do. My son does clarinet. ”Because a lot of the stress is removed because you can actually pay your bills, and that is also good for the body to keep it healthy and to keep the mind healthy.” Table D-‐3 Focus Group Summary: Spanish Speaking Page 1 of 13 CONCEPTS Order and Routine Close relationships with family Adequate sleep No smoking Drinking only in moderation Avoid Drugs Nobody in my life is healthy Mentioned IDEAS & QUOTES in this set Mentioned in X groups A friend that has a very good schedule for the family. She thinks that cleanliness and an orderly life are the center of good health, good living, and her friend actually has children. They go to bed at the same time. They get up at the same time. To maintain contact with the kids, maintain open communication 1 1 2 2 To observe the proper hours of sleep, not to miss your hour, go to sleep early and get up early. 1 1 She cannot find amongst her friends one that she considers to have a healthy life. 1 2 1 1 1 1 1 1 Part of the problem is that with the adult population in Hispanic culture, they don't have a way to get 2 their physical exams annually as everybody should, because they don't qualify for coupons and there is not enough money to go to the doctor. So she knows of people like television stars who get all of that done because they have the money, but then amongst her friends there aren't any people she knows that do this with consistency. 1 Barriers to Being Healthy Lack of money Time That was the first thing that came to mind was the money. If I had more money, then I would take it and go buy organic everything. Working too many hours 5 3 It's difficult to have a healthy life, because there are many aspects to it. In order to have a very healthy life, you have to tend to a lot of elements within a healthy style, and that would be almost an impossibility. So being with family, eating right, and communication and all of that is good, but it's a lot. Time is an obstacle, because they sometimes don't have the time to cook the way they want to. She works personally from 9:00 and sometimes all the way to 12:00 at night. She has a teenager, and she tells him just cook for them whatever you can. Another obstacle is the mom and dad both have to work, and they work many hours. They are tired Table D-‐3 Focus Group Summary: Spanish Speaking Page 2 of 13 CONCEPTS Motivation for change/resistance to change/attitudes IDEAS & QUOTES by the time they get home. And her husband does not want her to change the style of eating. She's trying to cut out the grease, eat whole wheat, whole foods, and she's trying the healthy style, and her husband is saying, "Just leave it alone and just eat that way." Sometimes she has to even cook two different ways. Mentioned Mentioned in this set in X groups 5 2 At school, there was talk that because of Michelle Obama wanting to switch the foods to healthier foods, that is not going to filter down, so they're still seeing the hamburger and the pizza. And sure, there are boxes with apples and carrots and other vegetables, but the kids won't touch those. So she sees those are the problems, and it's working against them. She declares she is a failure with her kids as far as food. Her 10-‐year-‐old and 12-‐year-‐old do not eat vegetables. Her 4-‐year-‐old eats everything she feeds her, vegetables or fruits. When they were little, they were getting vegetables. Cultural norms Lack of indoor play space/ access to athletic activities (or lack of awareness of (Diabetic man doesn’t access care) With men it becomes more of a problem, because they don't think they need to change their lifestyle. They don't want to, and she's saying they have to, but it's other reasons that they're not. Most of us didn't grow up knowing how to eat healthier, and if we did, we kind of just pushed it 2 aside. I know a lot of American women they go and buy their food at Trader Joe's and it's all organic, but us, we didn't have that knowledge since the beginning, so we kind of ignored it and nobody ever explained to us how big of a payoff it was going to be. So we'll go to Wal Mart and buy our kids whatever they want and junk food and— She says it is cultural, that in Hispanic culture, people do not go to the doctor until they are dying and it's gotten so bad that they have no other reason but to go. She said it is the Hispanic culture, but they are afraid of what they might be told. She is listing her husband who says "I feel really sick," and she'll say, "Well, go to the doctor," and he says, "What if I have something?" And he says, "Well, I better not go because I don't want to know. " Many children that are overweight or obese, because it's not easy to go outside with this weather 2 and it's kind of difficult to sign up for a gym because it's not fun for the children to be in a gym. 2 1 Table D-‐3 Focus Group Summary: Spanish Speaking Page 3 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups indoor play options) Here in the State of Washington, you have to have information, because there's a lot of cool places for kids that are indoors School policies and practices At school, the children eat pizza and hamburgers. When they come home, she tries to feed them 1 soups and stews and things, and they don't like the vegetables in it. They don't really want to eat the food at home. They ask for pizza and hamburgers just like in school. Washington Climate In Washington State many people have depression because families have to live long periods inside 2 the houses. 1 1 Factors related to accessing care Lack of Insurance/Cost of care At times they don't go because they actually don't even have the $25. (for the lowest end of the sliding scale fees at the CHC) 11 3 She doesn't have insurance, so she knows not to go, because if she does, she's going to pay so much for it. Sometimes my children have too many anxious problems. The Hispanic children, it is very difficult to live in 2 cultures. It's like fractured, so psychological help would be very helpful. And having access to it is hard, because it's really expensive. Generally speaking, in the ER they make you wait for hours and hours, and then when you finally get in, they make you wait again for hours, and then when the doctor finally arrives, he just says, "Oh, it's a virus," and that's all. And if you don't have insurance, basically they don't want to see you, because they don't have way to get money. Unfortunately he thinks that income charts or the sliding scale they have is really, really not true, because you have to be really poor to be able to get help, or you have to be very rich, because it's very expensive. The prices in the health insurance and dental is way too crazy, too expensive. There's just crazy prices. I'm talking about health insurance plan prices. They're just way too pricy. I don't know if the law is really in place that if you don't have insurance, they will not see you in the hospital? Because their 21-‐year-‐old boy doesn't have insurance because he's 21, and he had an Table D-‐3 Focus Group Summary: Spanish Speaking Page 4 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups issue, an accident, and they didn't want to see him in the hospital because he didn't have insurance. If you don't have a legal immigrant status, then you really can't get good health insurance, and if you get health insurance it's going to cost you more. If you have more family, then it's going to cost you more. She has tried to find help for therapy for the whole family because they are going through a very tough situation in their life but it is very expensive, because her insurance doesn't cover it. Money is also an obstacle for her. She had a problem. She does housecleaning and all of a sudden she couldn't do the vacuuming, and she went to the doctor finally, and it's high cholesterol. So the first thing she thought is, "I can't go to the doctor. How much is this going to cost me?" The problem is with dental. If there is no insurance for dental a lot of time they just won't see them. I had an experience where I had pain in my stomach. I went to the doctor and had no insurance. They sent me back because they couldn't do anything about it. I applied twice for medical coupon. When they finally gave it to me, I went back in and they had to operate. So they didn't want to help me out because I didn't have the medical. Then another time my son got his appendix taken out, so as soon as we went, they took time to diagnose what he had, but they fixed him right away and operated on him right away. But he had medical. Lack of transportation Doctors could not prescribe best medication because not covered. Got something that didn’t work very well instead. Transportation it's good, but if you don't have car, you need to wait for an hour for the next bus. I stopped driving for about three years, and I've been biking all this time and using the bus lines, and I have my kids all over the place, even raining, snowing, doesn't matter. And now I just got my license back, and I think I'm going to lose what I had (health benefits and family time) because of that. 5 3 As far as transportation, she's saying a lot of times if you miss the bus, it takes a long time to catch another one, and they're not often enough, so if you have an appointment at 3:00 sometimes it's 3:30 and you haven't seen a bus, so you get there late and a lot of hours are wasted. She uses it a lot. Especially for those people that do not drive or don't want to spend so much money, it's a good Table D-‐3 Focus Group Summary: Spanish Speaking Page 5 of 13 CONCEPTS Specialty care for children not offered locally IDEAS & QUOTES thing, but the schedules are different than what they need. My son has a lazy eye, and I looked for a specialist here. I'm talking about many years ago. He's actually getting help now, but I'm talking about a long time ago. I couldn't find anywhere. Everywhere I would go, they would tell me, "Oh no, it's you, it's you, we don't see it." I took him and went to Seattle. They didn't find it, until I finally took him all the way to Redmond, and that's where he's getting help for his lazy eye. Mentioned Mentioned in this set in X groups 2 2 If it's a medical emergency, we have to go to Children's in Seattle. Judging whether to seek care (stories) She had to go to Seattle to see someone that would treat autism, so she ended up not going, because it was too far and she doesn't live there. For Kids: He would gauge whether there was fever and whether there is something at home they can use to remedy the situation, and so they would watch over a period of days to see if it's gotten worse before they go to the doctor. She tries to take care of it at home before she starts making appointments She was taking her son, and they were telling her that he had a little wart in the lips, and were telling her that he was going to have surgery, but she took him to another lady, and the lady gave her a house remedy that would take care of the problem, and it worked. Many times the doctor says a parasite can kill your child, and you think it is only a cold. Grownups: I have to be dying to go to the hospital. For grownups, they are thinking house remedies, but it is very difficult for them to take a decision going to the doctor. If one of my kids falls or something, I rush them to the emergency room. I fell on Monday. It took me four days to go to the doctor, and my arm was hurting, so I was like first our kids and then we go last. First thing in their mind is "How much is this going to cost me?" Table D-‐3 Focus Group Summary: Spanish Speaking Page 6 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Barriers to Quality Care or Service Not understanding the system, not understanding what they are being told (including mis-‐information) Gaps in the system “I believe the assistance is in place, but what isn’t there is information on how to access the care or what is available.” 4 2 6 3 Noemi is saying that everybody lacks information as to how to go about getting assistance for health, so sometimes they get health where they pay very little, and other times there is no discount in other cases. Sometimes they charge her maybe $1300 for all the service, but they give her a bill for $200. School bus routes cut back – kids have to walk farther to school, in the rain. Hard to find Spanish speaking MD’s “Many (Spanish speaking) people are afraid to seek out information because they are afraid they will be asked for documents or immigration status information. So they don’t ask, and the information is not provided.” Compass and SeaMar would not provide substance abuse/mental health treatment for child born in Mexico (advised to take him to Children’s in Seattle) Dental coverage Not being heard by providers -‐ being dismissed Childcare for middle income families: Childcare is very expensive. If you are really poor, they will accept your child in Head Start, but if not, you have to go somewhere else. It's almost 10 grand. We are talking about $500 a month. Not feeling heard or helped 12 She had very bad rashes and they gave her an injection. Then they recommended her to go to another place where she saw another doctor, and she said she didn't need to do anything else, and she was asking for some blood work, some blood tests, and the doctor was saying, "No you don't need that." She tells me just drink a [unintelligible], okay this is good for you. And I cried because it's sad for me, because the rashes are really, really hard. And then I'm crying at this time, and they say "Why are you crying?" Because she don't tell me nothing. She did nothing. I'm really mad and sad, because that's why I'm here (to get help). (After daughter was in a car accident…) They were waiting in the hospital for probably one hour, and then when the doctor finally arrived, he examined his daughter and said take your clothes off, and he 3 Table D-‐3 Focus Group Summary: Spanish Speaking Page 7 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups said you're fine. He thinks they didn't do a thorough examination, and they just gave him a pill and sent them home an hour and a half later. And now the problem is with the chiropractor, but the doctor that saw them said, you're fine. When someone is sick or they have an accident, they don't take time to do a really thorough examination. She had a bad experience with dental care for her son. Her boy is very afraid of needles. As soon as he saw the needle, he started to cry, scream, and the doctor was pretty scary looking, so the boy was pretty afraid of him too. So finally they gave him a shot even when he was crying. They had tied him to the chair, and so then by the time the boy continued to cry, the doctor didn't want to see him even though he had already started the anesthesia. "I'm not going to see him. Take your boy away from here. I don't want to see him." So she ended up with her boy half asleep, and he did not want to continue the procedure. Misdiagnosis due to lack of investigation Husband felt tired, was treated for a year for depression. Then started having nose bleeds, which they just plugged. Discovered that his kidneys were not working and needed dialysis. They lost faith with the doctors, because this doctor that finally did the blood test, he was seeing him for one entire year, and he never thought, why are you throwing up? Let's do some tests. Why are you depressed or tired? Why are you having these symptoms? I had a really bad experience with one of the doctors. He never checked me. All the blood work, everything they checked on me before was done at the CHC. He never did anything. I told them that I was having pain and there's information where it tells you that if you are having these kind of signs that it is a sign of pre-‐eclampsia. So I told them and I kept on asking them, are you going to check me? Are you going to do this? And he never did anything. So when I was about to have the baby, I had to be in the hospital for almost a week every day. I had to keep calling and checking in, because I had pre-‐eclampsia, and they had to induce the baby, and the baby was born at 3 pounds, so it was really upsetting to me. She went to the hospital because she felt her water broke, and when she arrived, they said she had gone pee-‐pee and sent her home. After 24 hours, she came back and the doctor was blaming her for not coming to the hospital, and they had to do emergency C-‐section because the baby was lacking oxygen, but it wasn't her fault. She had actually gone in enough time. Nurses and doctors, not all are good. Table D-‐3 Focus Group Summary: Spanish Speaking Page 8 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups She was told that they did an ultrasound and was told she was operated not to have children. A year later, she was pregnant, and then of course, she said "I can’t, because I'm operated against it." They said, "Well you are pregnant," but from the beginning they told her she was operated against having children, they misdiagnosed it. Now she is SURE she's operated against it. Passed off to different doctors They had a good doctor, an elderly man, and she always took the boy and everything was perfect every time. One time the boy developed a cough. She finally took him to the doctor, only to find that they gave him medication for asthma. She thought that he had the flu or maybe just a cold, but he was treated for asthma, and when that didn't work, they went back and once again they were going to give her another doctor, and she was kind of frustrated. She wanted to the other doctor, because that's who they were used to. Finally a third time she went, and they finally told her the doctor had passed away and that they had been giving her other doctors, but she had felt very frustrated because the condition remained, and there wasn't anything that she was being told about either the doctor or what might the condition be. Providers have limited time and can only deal with one issue in an appointment One way or the other, if you go to the hospital with 5 things you are hurting or need care, they listen, uh-‐huh, and they only will take the 2 most important ones, and the other 3 they don't care. She went to an annual checkup, and when she was talking about her problem, she was going through another thing, the doctor said, "Oh no, I don't have time for that." We are going to talk only about this one thing. They are supposed to look from the head to toe, and she was used to that in Mexico, but here it's only 15 minutes and they just look at one thing. Ways in which systems seems to work actively Her wish is that the doctors would change the way they do physicals or examine the kids. In her case, when she takes her child, it's half an hour waiting outside, 5 minutes inside, and they don't do a complete check. She has to tell them to listen to his lungs or maybe you should do a urine test, only to come back and say, "oh yeah, he had an infection." She had to suggest it to the doctor instead. Punitive rules 1 She had taken her daughter to be seen at a local clinic, and they had arrived apparently 10 minutes 1 Table D-‐3 Focus Group Summary: Spanish Speaking Page 9 of 13 CONCEPTS against client Immigration status Language interpretation IDEAS & QUOTES Mentioned Mentioned in this set in X groups before their appointment, and there was a line of about 6 people. By the time they got to the counter, the 10 minutes were over, which makes them late, so they didn't want to see them, and it was kind of an emergency for her daughter. Then her daughter, opened the door, went to the back and talked to somebody. Well the counter help actually called the police on them. They actually left before the police arrived, and she ended up taking her daughter to emergency. Last year, she lost her job, so she went and asked for food stamps, and they didn't want to give them 3 to them, because they were saying that her husband was working. And she was saying it's not enough for us, because we have 4 children. Her husband had a back injury, and she didn't have a job either, so she said, well I'll call again. And they were asking her many questions, proof of how do you pay your rent. You need proof for 3 months, and she said maybe they are not understanding me, so you call. So she asked her husband to call, and then they were asking again the same many questions to him. He gave his pay stubs from L&I, because he was receiving the help from L&I for the injury he had, and then they still were asking so many questions. And then the lady said, so tell me then, what is your immigration status? Are you legal? He said, I'm a citizen. I'm a Veteran. Because she was going to give them only $100 or something, and then she said, "Oh, if you're a citizen, a Veteran, we'll give you $500." There was another obstacle with renting. If they didn't have a Social Security number, they wouldn't let them. She takes her child to the psychologist, but she noticed that the interpreter wasn't telling her 6 exactly…sometimes the interpreter without asking the question she had for the doctor was giving her the answer, the opinion she thought. 2 3 He went into the hospital in the main lobby, and he asked somebody for a Spanish speaker, and she said "No, we don't speak Spanish here," and they didn't take care of him because they didn't speak Spanish. He asked again if he can get somebody to speak Spanish, and they told him, no they couldn't get anybody to speak Spanish. Money and speaking English ability are the two factors for me in deciding to get care Sometimes you end up going where it's more expensive because they do have the most experienced interpreters. Other times they may say, "Go to this one because it's a lot cheaper," but you get Table D-‐3 Focus Group Summary: Spanish Speaking Page 10 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups there, and nobody is communicating in your language. Bad doctors Most everybody here has enough English to actually make appointments. They know enough to do that, but they need additional information to communicate and they don't have that. Even if there are centers, they just do not go. She went to see the doctor, and the doctor said you have cysts or fibroids, and you're going to die. So she started to cry. She comes out in the lobby and she's crying. Her interpreter was still with her, but there was another doctor who came out and asked, "Why are you crying?" And she says, "Because the other doctor told me I'm going to die." She was furious about it, went back inside, brings back the other doctor, and said, "You told this woman she is going to die. This is not possible on a first exam that you would see that." He said, "Well I've had a very hard day, have seen a lot of patients, and I'm very tired." She said, well you signed a document telling her she's going to die, and she's very upset. 1 1 Mental Health and Substance Abuse Perceptions and knowledge of system “I would recommend going to WIC office for referral (for substance abuse problem)” “I would refer a friend to my CHC clinic” The police (for information and protection) Compass Health SeaMar clinic Familias Unidas AA groups My father-‐in-‐law is really involved with AA people, Alcoholics Anonymous, and they started out groups where they help. It's quite a big group, and they've actually branched out and in every little city where there are Hispanic people, they help out, so I found there is help for AA, but maybe not for mental health. There is help for people who use drugs, because I had an experience with that too where my brother-‐
in-‐law was using, and they sent him to detox and everything, but it was more because I was helping Table D-‐3 Focus Group Summary: Spanish Speaking Page 11 of 13 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups in translating and trying to get him the help, but not because there was the help there. I have a friend that was getting some abuse on drugs, but she was able to get help, and I think it was easy to find a place to take her to get her out of that problem. I had a friend, and they had to take her all the way to Wenatchee to get some help because there is more Hispanic community there. Perceptions of mental health issues She hasn't found mental health help for depression because there is not enough Hispanic population that's looking for help for mental illnesses, and the barrier because she doesn't speak English, so she can't get it through the English side. Where do you get your health information? Internet Internet is good, but a lot of time you cannot believe everything you read. 4 3 Family or Friend Parents teach their children 3 2 Provider WIC social worker; personal doctor; nutritionist; school; Everett Clinic Newsletter 2 3 Library 2 1 TV Dr Oz and The Doctors 1 1 I won't ask my mom, because she'll give me a tea. Table D-‐3 Focus Group Summary: Spanish Speaking Page 12 of 13 Specific suggestions from Spanish-‐speaking residents • Add mental health treatment as well as eyes, teeth, and basic medical care • Create alternatives to referral systems (for mental health) so that people can access specialists directly • Provide access to preventative care – don’t only offer insurance for crisis treatment (mental health) • Mental health treatment accessible to middle class families • More Spanish speaking or bilingual medical staff • “Would like assistance in introducing her kids to sports programs in the community that are not as expensive as she finds right now. She has tried to enroll her kids in soccer, but they're expensive.” • More sports for children, more activities. •
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Transportation options – bus comes infrequently. A liaison between the community and the doctors. Somebody who has a lot of information as to how to connect them to the services that they require. She's thinking of a person that could get salaried so they could actually do this for a living, but also would assist everybody else, somebody else that is a volunteer like herself and her sister-‐-‐ they help the community or their friends-‐-‐ but it's not enough. Available insurance for adults so they could have better health. More information about where adults can access some assistance. More workshops, so they could get a little more orientation as to how to help their own kids and families; parenting workshops. Table D-‐3 Focus Group Summary: Spanish Speaking Page 13 of 13 Table D-‐ 4: Youth Focus Group Summary CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups What they do for “fun” Note: this information was not collected in 2 of 3 groups in this set Physical activity long board and dance; football and boxing; basketball; walk my dog; work out 4 1 Sedentary activity relax and watch TV; play video games; listen to music; stay home, relax, sleep 7 1 7 6 3 3 4 2 5 3 3 2 Images Healthy Living or Health Exercise Nutrition Bike to work; working out; not just lying on the couch; exercise every day She ate a lot of wholesome foods like from PCC or Whole Foods; she managed to lose half the weight she was Balance Every day she eats a salad, drinks protein shakes, exercises like every day, and then takes all these vitamins. And she never gets sick. What also could come into being is a balance, like having a good balance between the good and the bad in life when it comes to health. All it takes is balance, if you have that balance it could work Attitude (positive) A lot of really health people I know are really successful. They stick to what they're working on and actually complete it. Like, they just give 100% with everything they do, and it's really like a lifestyle to be efficient, successful, and I think living a healthy goes hand in hand. Feeling good about yourself What it means for me is keeping a positive outlook on life, not just going to the gym and working out. You have to kind of find the positive side to all the stuff that's going on. Because like you can be working out, you could be doing this, and say "Oh, this is too tough, I can't do this," or you can look on the positive side and say, "You know, I can get better. I'm going to get better." That's what it is for me. Low stress An image of a Tibetan monk comes into my head. That's just like a stress-‐free life. You know, they meditate every day, which is really good for your health. That kind of thing. You need to be not only healthy physically but mentally so you're not depressed or stressed all the time. So just being happy. Table D-‐4 Focus Group Summary: Youth Page 1 of 14 CONCEPTS IDEAS & QUOTES Mentioned in this set Mentioned in X groups Enriching activities Playing guitar; making art 1 1 Having a job If I would've had a job when I was 16, it would have saved me from getting to all the trouble I've already gotten into. I would have been too occupied making money. I would've already saved a load, already had my own apartment, wouldn't need money from the state for my child or anything like that. I would've been fine. 2 2 Order and Routine Being healthy is a lifestyle. Like you can't go on a diet and go off it, because it's not something you stick to. You can't just eat well for about a few months, then go off and go back to eating a bunch of junk food. 4 2 A support system 1 1 I'm very involved in my Native community, and on the Native health wheel, there are a whole bunch of different aspects-‐-‐ physical, emotional, mental, spiritual-‐-‐ you know, they're all linked. She was very informed about herself and her situation. That's a part of what goes into it. Being healthy is being informed about yourself, using your judgment. 1 1 1 1 No smoking Just guesstimate, what percentage of students here smoke? MA: Like 80%. SA: Really? MI: 70%. 3 1 Drinking only in moderation Avoid Drugs not rely on drugs, both prescription and non-‐prescription to be happy 1 3 1 2 1 1 Discipline Stability. Physical and mental stability. Close relationships with family/other supports Spiritual connection Advocate for self in health care settings A healthy life means being drug-‐free Surround yourself with drug free people, be around good influences Regular access to doctor ask Doctor what to eat, have a plan, monthly check-‐ups Table D-‐4 Focus Group Summary: Youth Page 2 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Barriers to Being Healthy (what gets in the way?) Lack of money and/or a job When you don’t have insurance you don't get hurt and don't screw up your teeth. You've got to be careful so you don't get hurt, so you don't have to go to the hospital or doctor's office because that's just going to hurt financially. 8 3 I am really busy and by the time I get home and do my homework. My parents work a lot so fast food 1 is just really quick. 1 There's also sometimes you can't always buy healthy food. There's this documentary I watched a while back, and one of the topics they touched on was there was this working father who needed to drop off his kids early in the morning, and they would always go to McDonald's or someplace where they could get a $1 burger, and they could always buy food, because the father was on medication, so it's like that whole entire concept. Money is a problem and fast food is cheaper. When I got my nose broken fighting, just to get it fixed was $5000, and I didn't have $5000, so I'm still paying that off. Like some jobs have different age requirements. Getting an apartment there's age requirements, credit requirements. Just different living necessities in all different areas. Why is it so much more different now than back in the day when you could be like 15 or 16 and you could make a living on your own. Now today, all these grown people with the GED are getting all these jobs, and I'm over here homeless. You know what I mean? Like I need a way to support myself, but all these 31-‐year-‐olds are still working at McDonald's and they're getting the job. Like what? Job + housing. Like you can't really balance either or without one or the other. Because it's hard to focus on school and work and all that stuff when you're in a transitional situation, because you’re bouncing around, your location's different, your timing gets knocked off, you're too far away. Like it gets stressful, and then in order to maintain your own living environment, your own space, you have to have a job to support that. And it's like hit or miss. It really is. One or the other or just nothing at all. Top 2 wants: employment and housing Time Table D-‐4 Focus Group Summary: Youth Page 3 of 14 CONCEPTS IDEAS & QUOTES Motivation for change Mentioned in this set Lack of motivation. Mentioned in X groups 5 3 2 2 4 1 I’m diabetic and I hate giving myself shots and checking my blood sugar It comes down to your support system and just yourself, because like I said, the resources are here. It's just a matter of how you're going to take advantage of them. It's not like there aren't resources. Yeah, they're limited. Yeah, it sucks. It's hard to get through, but if you have the motivation, then you're going to do it regardless. Motivation for exercise I struggle with the eating healthy part. Fast food is easier and taste better. Cultural norms In the Native community, drinking problems are very prevalent. Mental problems are tied with that and are very prevalent, and parents who grow up drinking and smoking, they pass those habits on to their kids for sure. It gets ingrained when they're young and it becomes a very hard habit to break later on… Yeah, and of course there's the whole thing with the government kind of feeding a lot of tribes a lot of starchy unhealthy foods, and now there's widespread diabetes problems in the community, but that's all I'll say about that.. Music, some people think that certain types of music are bad for you, so I guess it’s just a morals thing to each individual, Morals, TV: violence not healthy for you or watching for too long Lack of indoor play space/access to athletic activities We get bored. I feel like if they just had more positive things, not even from a direction of shelter and mental health, more like a fun community center, stuff like that. They have those, but even with that it's limited because you have to pay fees and pay all types of stuff just to do things. Like they don't have innocent things for young people to do, and they get turned to drugs and away from their home because of this and that. Just put some fun stuff around. Like little kids have stuff to do out here, because there's a Boys and Girls Club, but all that stuff is like age limit. Once you're 17, you don't want to do that stuff no more. Like 17-‐year-‐olds we still want to go Go-‐Karting like that and Paint Ball, but there's none of that stuff for free for us to do. Like everything costs money or you're not old enough or you're too young. When I lived in California, we had areas like this on the weekends, it was called The Spot. They had just a big facility, a gym area that has games, food, a little room where you can dance and stuff, just Table D-‐4 Focus Group Summary: Youth Page 4 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups to keep things innocent, collected, and not out of control, monitored. There's still adult supervision, but there's all types of things. I don't know about you guys, but even at 19, if they had a cracking skating rink, I'd go. Self-‐esteem/depression If you don't think you're good enough to do something, it could definitely get in the way. Like from you even trying something. When I did weight-‐lifting class, I would not do some of those exercises because I was afraid that I was going to injure myself or just not be able to handle it or do what I was supposed to, so yeah. 2 1 6 2 One more thing I'd like to add is about motivation and the teen brain is that so many other teens I've met-‐-‐ I went to a school for kids that are troubled for a while-‐-‐ and a lot of them had depression and anxiety, and that really got in the way for them. Discipline vs. instant gratification Addictions, habits. And sometimes like we were talking about how when you do something, it's the instant reward rather than the long-‐term. Temptations like, you're not supposed to eat a certain kind of food, and you like that certain kind of food and eat that certain kind of food. Distractions (prevent from going to the gym) because I'm always really busy, and so I just need to discipline myself to go to the gym, but I get carried away doing other things, so that's what gets in my way. Like it's funner to play video games than it is to go to the gym. It's funner to eat a chocolate bar than it is to resist it, 'stay away from me.' Or sometimes if you're low on energy, there's coffee and stuff like that, we all know how bad those energy drinks are for you. It's just like a kind of instant reward versus long-‐term. Among teenagers it's a big problem, because delayed gratification can be very hard to train yourself to get used to. I wish I was more disciplined. I work out sometimes. I wish I was just active more, you know? I wish I could follow through all those things. It's like I don't have that very hard discipline [unintelligible] on me yet. Sometimes tempting to go to a party when you're supposed to be at home. That's the main part. That's always the main part. Table D-‐4 Focus Group Summary: Youth Page 5 of 14 CONCEPTS IDEAS & QUOTES Taking risks/risky sex Mentioned in this set Sometimes it's out of your control to be healthy. Like, just to be cautious and safe will always give you a better chance of being healthy. Being more careful. Mentioned in X groups 1 1 A lot of my friends are mostly boyfriends and girlfriends and they have sex a lot. They just do it all the time because they're young or whatever, but like—“LI”: Is it protected? “TY”: Uh, no. Like I know them. They're reckless. Like six girlfriends in a year, so all that spreading around and stuff is probably not the healthiest way to be. Low quality housing/ air quality Here I live in Lynnwood. I live in this cramped little apartment along Highway 99, and when I go to school, I'm constantly being exposed to cigarette smoke and car exhaust. I think if I were to move, I'd want it to be somewhere where there are less cars, less noise, cleaner air, basically. 1 1 “Fake food” industry/junk food/fast food Probably all the fake food that's being mass produced today. Like Monsanto, that big corporation. Like how that corn is nutritionally dead and has a bunch of cosmetics in it to make it look good, and like it's not even labeled. 3 2 2 2 7 2 I was going to say fast food, just not eating healthy. Don’t have good healthy food around Peer pressure Being taught something different by your peer mentors and stuff like that. Like you should do this instead of going to school or something. It's like, do I want to go turn in my homework or go kick it with my friends? Friends with drug addictions Factors related to accessing care Lack of Insurance Not having insurance. Like I didn't have insurance for approximately 3 years and then finally got it 5 months ago, so it just sucked. So actually for a while my mom was out of work, so we lost our medical insurance. If I hadn't just gotten some medical benefits from the state, I would have been kind of out of luck with paying for that split lip, so I got lucky my benefits came in just in time. It fit into that window where it already kicked in. A lot of other kids I've met, they don't seek care because they don't have insurance or even a place to stay. Ever since I turned 19, I don't have insurance anymore. Table D-‐4 Focus Group Summary: Youth Page 6 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Yeah, when you were younger, you didn't have to worry about how much a doctor visit cost or how much things were. You just go there and be like, "Oh I'm going to the doctor. . . oh, I'm getting a shot. . . oh, I'm going to get a lollipop at the end," you know. Your mind doesn't think, how much is this going to cost? Then when I turned 18, it became my worry, and I would see the bill and was just like-‐-‐ "wow." Because like they take away your medical now after you're 18 or 19 or something like that. This is the insurance room. (Not the waiting room) If you're insurance is better, then you can go. That's how that goes. You'll probably be out there 30 minutes, but it's still shorter. No anesthesia for poor patients: , they tried to give me bare surgery when I had an abscess. They were like, we're going to have to cover your surgery? Yeah, like they weren't going to give me no medicine, no nothing at all. They were just going to cut me. And when I was at Seattle Children's Hospital, I come to find out the abscess was so close to my bone, you know how much pain I would have been in if I was just like, yeah okay? SA: So when you say bare surgery, you mean they weren't offering anesthesia? FA: No they didn't offer me anything. They didn't offer me no pain pills or anything. They're like, "We can prescribe you some ibuprofen." I'm like, ibuprofen at home. What do you think? I was so, you remember, I was in tears. I was crying. Lack of transportation I have to take a bus. Like I have to walk to my bus stop, but say I broke my knee or any part of my leg, then I wouldn't be able to walk. 9 3 I can't do Driver's Ed because I'm in foster care, so I don't have a guardian, like a legal guardian to do my hours with me, so you're pretty much saying all foster youth have to wait until they're 18. Especially with having to do Driver's Ed now before you can get your license. You still have to have someone that has a license for 2 years drive with you, and the car has to have insurance, have tabs, all this other stuff. It's just obstacles everywhere you go. No transportation if you don’t ask parent or adult anyway Table D-‐4 Focus Group Summary: Youth Page 7 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Better transportation would make it a lot easier for me. Specialty care for children not offered locally Wait times It’s really hard, because I have to use public transportation, because my mom is in a wheel-‐chair, so I don’t really want to bother her too much. I just go to Children’s hospital if there is a problem 1 1 It's like, what am I going to do for that amount of time? 5 3 You're in the waiting room longer than there….And then you get back there and there's no patients. Everybody's just walking around and stuff-‐-‐ why'd you take so long? This lady, she had her rib detached or something like that, and she's just sitting in the waiting room for at least an hour. My hand was bent in this way when I was running for football, and they had me sitting there waiting for I guess 3 hours. Long wait, must have patience with medical care Judging whether to seek care (stories) Is it life threatening, and if it's not, can I deal with it a little bit? The impact it's having on your daily life. Like if you're unable to do your normal daily activities, it's like you better go see a doctor. But if it's something little like, yeah my leg hurts, but I can continue going on with my day, then it's not serious. Is it worth the doctor checking it? You know, because with Google you can literally look it up on your own, but if it's not that big of a deal, then it's not really worth the $20 to go say hi to the doctor. Money versus pain My first thought is how long am I going to be away from my son? And I don't want to deal with these doctors. They're going to poke me. No, they're going to kill me. I went to the hospital for three days, and it was just hectic organizing school, daycare, all that stuff Table D-‐4 Focus Group Summary: Youth Page 8 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Barriers to Quality Care or Service Don’t know what resources are available I think it's just hard because not everyone knows about all these resources. I didn't find out about all these resources until all together one year. Like I waited a whole bunch of years until I found out about Youth Source, Cocoon House, U-‐Turn, all that. I found out all about that all in the same time. 1 1 Not understanding the system, not understanding what they are being told (including misinformation) It shouldn't even be that much money. And what's sad about it is the doctor's don't even get paid that much in their check. What's up with that? I don't understand at all. 1 1 Gaps in the system Well, for a while, me and my mom have been on food stamps, because we have my brother and my dad isn't around, so we were getting help from the state, because basic bills and we couldn't afford at all. Then when my brother left, apparently my dad was trying to get child support paid out to the state, not realizing that it impacted my mom. Eventually after trying to pay it off and my dad trying to talk to them and they agreed to the amount and everything else, we tried to get on food stamps again, and they refused to even though they were taking $100 from us every month that we couldn't afford already. So they're still refusing it to us, even though they know we need it because there are only 2 of us in the house. 11 2 I'm in the middle of trying to get help with childcare through DSHS, and it's such a pain. I've been filling out paperwork for the past month, and then I send it in, and they send me different ones to fill out. So now I have a babysitter but I'm not paying her. Well, I give her a little bit, but I can't really afford to give her a bunch, so it's just really stressful how long it's taking. All the resources they have for medical are like people with children. They give you medical if you're a mother that has kids and stuff like that, and it's like you can call Hope Link or Molina with your DSHS, but other people that don't have those resources literally have to be sick, because they don't want to have a bill or anything like that. Because I had somebody say to me the other day, "Oh I'm glad I'm pregnant now, because I get to have all these kinds of benefits." It's a fact that people are taking advantage of it. But it's not only that, it's making girls say "Oh, you get all this?" Once your kid comes, you have to take care of that baby and take care of yourself on top of Table D-‐4 Focus Group Summary: Youth Page 9 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups transportation, on top of food, on top of any other expenses. If your baby needs medication, you gotta get that. So that benefits that you get, it don't get you too far. I see a lot of it in older women too, because I'm pregnant right now too, and I get money from the state and stuff like that, but this is not enough to take care of me, my child, my house, pay my rent, food, medical care. And older women I see are just getting pregnant on purpose, you know? Just to have some resources. It's not as good as it seems. Like, they took my food stamps away knowing damn right I'm pregnant and everything. They won't give me any TANF or anything. They're like "Well, you still qualify for WIC," and I'm like, what do you expect me to do with three cans of milk? I have my job, but it's like they won't even let me work full time with a GED, and it's like, how do you expect me to support myself, my kid, and pay my bills with not even barely $100 paycheck every 2 weeks? A lot of shelters and housing things, they have different requirements. Like some of them actually require you to be an addict or something like that, or require you to have experienced domestic violence. They'll ask you, do you have a domestic violence case? No. Click. Really? Because I don't have a domestic violence case, you can't help me? It's just limits. SA: So they have different limits and you have to fit that to be in or out. DO: Yeah, whether it be your age. Sometimes it comes down to ethnicity even sometimes. SA: To qualify. DO: Yeah, if you're Native American or Hispanic or something, some of that stuff. That's weird. KI: And a lot of times when you're a teen and under 18 and you have kids, you don't apply for some shelters. TA: Yeah, because like they only help older women and children. KI: And there's some where it's like the opposite. You're a parent, but you're still not 18, so you're still considered a child. It's just there are loops. TA: I think when they were making these programs, I don't think they understood what happens to put it all together. You know what I mean? Not being heard by providers -‐ being dismissed (because of age) Well, when I went to the doctor the other day because I was in pain, they were like, "Let's call your mom and make sure you can be treated here," and I was, "Seriously?" I had to wait at the dentist's office for an hour because they couldn't treat me without my mom there. 2 2 Last time I went to the dentist and brought up that I didn't want fluoride treatment, and she started Table D-‐4 Focus Group Summary: Youth Page 10 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups talking to me like I was a little kid and was like, "Well, we gotta ask your mom about that," and I was like, "No, I know what I don't want to put in my body, and that's something I don't want to put in my body." It was kind of ridiculous. Teen independence I feel it is a little complicated for teens because a lot of them are so obsessed with the fact of being independent that they really don't, they kind of bypass the resources that they have. Because the resources are at your school. You can find little key things. Even when you go to the doctor's office, they ask you certain questions, but you're not really paying attention to that, because the first thought is "Oh, I'm going to be on my own," because usually that's the route you're going for, not expecting to have someone to help you. Because the people who wanted to help you kind of shunned you off, or whatever the situation detailed. 2 1 1 1 I think all you have to do is just communicate, like really tell. Like that's where it starts too. Like you feel ashamed of your situation so you're not ready to open up, but then once you do, it's like, oh, well you got this, you got that, you can do this, oh, here's some clothes, some shoes, and a bus card. And then that opens a lot of doors for a lot of people. Where for urgent care? Seattle Children's Hospital; Swedish or to the UW Mental Health and Substance Abuse Perceptions and knowledge of system I'd just tell them to go to Google. Church; pastor I would ask them if they could see if they could qualify for benefits from the state. Like if they couldn't work or if they really needed help with getting medication they could apply and see someone to confer with from the state. That's probably what I'd tell them. One thing I would be really scared to suggest to one of my friends is the Suicide Hotline. They might not like that. It would be really scary for me to say, "Oh, hey, there's a suicide hotline you can call." It's one of those situations where you don't know what to really suggest and kind of feel like you wish you can do more but you can't. There are Al-‐Anon and Narc-‐Anon groups for addicts, so if somebody had addiction, then I would suggest they go, but there are also meetings like that with families who have addicts. So my friend came to me, and she's like, "I think my sister has an addiction, and I don't know what to do." You can go there and ask them. They'll give you advice and tell you how to talk to them. Table D-‐4 Focus Group Summary: Youth Page 11 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Seattle has a lot of opportunities for older people. Not so much for teens. Teens, it's pretty hard for people in Seattle, but out here, I send them here (to Cocoon House) if they're like between 16 and 20. Catholic Community Services. Well, I know a couple people who want to get help and go to a treatment center, and they'll talk to the people and the wait will be 2 or 3 months. And even then, like the mental health and stuff like that out here, if you're 18 and don't have insurance, you're not getting that help, because you need to have insurance to do this stuff too. Counseling costs money and is really expensive. It would be very difficult to talk to a counselor, a stranger about my personal life. I wouldn’t really feel comfortable. Ursula: Do you guys know where to get help if you needed it? Everyone: No , I don’t know where to get help. (Younger group) School Counselor (at ECC) for help, its free, and you can make appoints within the day for 30 mins. Perceptions of mental health issues Well, my brother is addicted to heroin. He was 14 when he first tried heroin and since he was about 1 16 he's been addicted to heroin. He's 22 now, and I think for about a month and a half he went to a recovery center, but he's done multiple ones, and money is always an issue, because recovery can be expensive, and he also has mental health problems that play in with that. So he really hasn't had access to a therapist or something, but he does have access to medication, which he doesn't take. So there is some access depending on your status I guess to be able to pay for it, but it is very hard. Especially to get a job after people see that you've been addicted. 1 I do have to take medications for depression and anxiety, and I do get counseling. I have had good experiences here. Support is a big role in that without support it's really hard to fight off an addiction without it. Especially like this one person I know, she had to take pain killers and got addicted to them, so it was hard to get off them. She wouldn't have done that if her friends were being like, "No we don't want you to do that," stuff like that. I think religion can help you. See my dad used to be alcoholic, and he got a DUI, so he got really bad. Table D-‐4 Focus Group Summary: Youth Page 12 of 14 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups He started going to church once, and ever since that he's found a new-‐-‐ I don't know how to say it-‐-‐ but he's just really different. And instead of getting temptation, he has the Lord to look over him or whatever, so that's really helped him get off alcohol. Sometimes hobbies. Like I know that for sure. Like I was kind of depressed. I went through that phase, and what helped me was kind of drawing, writing. I would focus my energy on something else other than what I was currently focused on, which was how bad everything was. I've been dealing with depression since 7th grade, and I was in a home with violence. Of course because of the reason I am depressed, I didn't feel like I could trust a therapist, so I stopped going. I have to first talk to my mom about it, and she's not really keen on the idea because she says every counselor and therapist just wants to put everyone with depression on antidepressants, and my mom's kind of against that. For me, most of my friends are either, I guess some of them are depressed or on drugs, so I kind of worry about that. Like some of them are depressed and don't seek help. It concerns me. There are some that are on drugs, and like "Oh, I wish I could stop," and I'm just like, "Dude, you sound such like an addict. Stop." It's that addiction I guess and mental health priority. In my family, my biggest health concern would depression, and for people in my life it would be addiction. I think it's hard for people that have substance abuse problems, because sometimes they might not want help. Like with the medical and stuff like that, they let everything go so far out of the way that they can no longer get help, you know? All this that we're going through right now, this causes a child to have mental health issues, like depression, anxiety, and stuff like that. You know? You get anxiety like where am I going to stay? What am I going to eat? That causes you to have anxiety. When you don't have a home, you get depressed. Where do you get your health information from? Internet 7 3 Family or Friend Mom, adult with experience 2 2 Table D-‐4 Focus Group Summary: Youth Page 13 of 14 CONCEPTS IDEAS & QUOTES Provider Mentioned in this set Some people have like family doctors they can always talk to. Like if you want to know more specifically or want to talk to a professional instead of a source like Google, you always can just go to the doctor's office. Mentioned in X groups 3 3 2 2 My advocate The emergency room Print media Men's Health or magazines like that, or maybe a blog that they trust. Specific suggestions from Youth: •
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Subsidized Orca Cards: I think there should be some kind of help to get Orca Cards, like just for the county, because you never know-‐-‐ They ran out of Orca Cards they could give people, so I don't have one, and I'd already spent like $10 on bus fare, and I don't have any way of paying it. It's like $60 on unlimited pass every month. It's ridiculous. Community center with healthy activities to keep young people occupied in positive ways Jobs ‘reserved’ for teens Table D-‐4 Focus Group Summary: Youth Page 14 of 14 Table D-‐5: Caregiver Focus Group Summary CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups What they do for fun Physical activity Water aerobics, ride horses, garden 9 3 Sedentary activity Hot tub, listen to music, sing, read, words with friends 8 3 Family Grandkids 1 1 Social/Friends The support group, social justice work, lunch with girlfriends, volunteer work 5 3 Creative Hobby Wood working, metal work 2 1 Images of Healthy Living or Health Exercise Nutrition Balance 13 6 “As a caregiver you’ve got to have something to do besides just caregiving, and that’s why I’ve always 2 had a hobby for years and years.” 3 3 1 “What I think about with a healthy life is a balance, but I’ve never found that. And I’m not very fun oriented. I’m always working on something so I haven’t found balance in rest and relaxation.” Attitude (positive) Low stress Enriching activities “Keeping mental faculties healthy as well” 4 1 7 2 1 3 1 1 1 1 1 3 1 1 1 2 Community activities Close relationship to family Spiritual connection Adequate sleep Nobody in my life is healthy Advocating for self (in health care and social service settings) [or for loved one] Notable that most stories about family isn’t positive – their children don’t help, ask caregiver to things for them also, isolation… “And there continued to be challenges that I was fighting for in every way I could. And I just wonder how people manage who didn't have the energy, .. the perseverance, a lot of perseverance to negotiate the system? It's just very challenging to get the services that I was convinced he needed… I was just trying to get the things that I believed would help him reach the capability that he had a Table D-‐5 Focus Group Summary: Caregivers Page 1 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups chance of achieving. It was very daunting, that whole process for me.” Taking care of yourself Hospice nurse: “just remember you have to take care of yourself.”…don’t come here every day to see 3 your wife…you got to start to let go.” 2 “To go and do fun things …requires money, so you don’t go and do those things because you just can’t do it.” 7 2 5 2 Barriers to Being Healthy Lack of money Couldn’t afford the day program (now its folded anyway) You have to pay for everything “After my husband's stroke … we had to take him to physical therapy, occupational therapy, and speech therapy. It was $35 a copay per one, and he has three of them a day. We did them 2-‐3 times a week. I had to get aid from the hospital because I didn't know what else to do. “ We are living on Social Security every month, we have a certain amount of money per month. So then you take him to the neurologist, it's a $35 copay for him to go and see him, and then he wants to see him in two more days. So then there's another $35 copay. Then we're doing this vicious cycle where we've got 6-‐8 copays, and all of a sudden we have no money left. It's just frustrating. I think that if you see a doctor within a certain amount of times, you shouldn't have to pay another copay each time. “You can get anything you want if you can pay for it…there’s so many home health agencies out there now…and handy man services…but you have to pay for them.” Time “I’ve used a lot of my finances and that’s a constant worry to me now and looking into the future...I’ve had to close out 2 IRAs and a regular savings account…not everybody has the money to do the respite care and all the other things.” “There are so many commitments with doctor’s appointments and driving so much distance all the time.” “I’m supposed to go back to PT to help with my balance, and I haven’t made the apt. yet, because I had 4 appointments last week for my husband. I just want a day home to relax.” Table D-‐5 Focus Group Summary: Caregivers Page 2 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Need to schedule a procedure for self when husband will be in hospital for surgery – otherwise can’t get any recovery time. Joe went to the hospital within this last year … 911 was free but then they called the ambulance service to come and it's $75 copay with our Group Health …. And they go by ambulance to take him right to a room. If you go there, you have to sit in the waiting room, and they come out with the blood pressure stuff, and then you go back out and wait and sit until they work you in. So I always usually call 9-‐1-‐1 and pay $75 and have an ambulance. Motivation for change/ resistance/stubbornness “I overextend myself and sometimes I don’t have enough time for myself.” “I struggle every day…He doesn’t want to go to breakfast. He doesn’t want to take a shower. He doesn't want to do a lot of things that would allow him to be healthier if he would let me help him. He is really stubborn.” 7 3 5 3 7 3 “He doesn’t want to do anything, and because he’s tire. Like today he didn’t want to get up.” Mother likes sweets, has to hide them from her because she is diabetic. Changes in what someone likes to eat due to stroke Physical health Lack self-‐discipline Have balance problems. Anxiety about the future Dementia changed the good habits of husband “My husband has heart disease and diabetes and has had a back fusion, has limited use of one leg, besides his dementia, and that gets in the way…as we get older it all compounds.” “There are concerns...that you just over it and over it and you say “I can’t do anything about it until tomorrow anyway, so why am I going over this in my mind? I can’t get any sleep’” “Sometimes I think it would be nice to just get away for a week or two and not have this constant nagging, "oh my hip hurts, my foot hurts," whatever. You know, every hour something's going on. He might hurt, but I'm hurting inside too. “ “I'm always I guess future tripping, thinking I know these ladies here have a lot more going on than my husband in the group, and I'm always thinking ahead. How am I going to manage my husband when he gets worse, because he's 250 pounds and 6 feet tall, and he's fallen a couple times. I can't Table D-‐5 Focus Group Summary: Caregivers Page 3 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups pick him up. I worry about finances if I had to put him in a home. How am I going to manage? What happens when Medicare runs out? “ “I’m worried about my healthy and my husband and what’s going to happen to him if I can’t keep my health, because I fall a lot now.” “When they are gone they’re gone. And what about me? How am I going to be taken care of?” “I fear things… I’m almost afraid to look into this [Parkinsons] further.” Lack of Energy/sleep Tired from interrupted sleep (2) 5 2 Greatest need help with moving and transporting: I have 14 stairs to make with a man whose legs are 7 gone. ..then getting him into the car and out of the car. …even the doctor could lift him [from the wheelchair]. (concern for herself if she falls or strains something helping him) “My wife is confined to bed…If she has a regular appointment I have to call a cabulance, and I pay for two men, because it takes two men to carry her down the stairs…so its $150.” 3 “I know I'm up half a dozen times every night … by the time 5:00 rolls around and you've been up five times at night, then it's hard to hold your temper almost. It gets a little irritating, you know? Because you really haven't had much sleep. I can sit in the chair-‐-‐ if she goes to sleep-‐-‐ I'll sit in the chair and fall asleep almost instantly in the middle of the day sometimes. The fact that these people have so many needs. … you know going to the bathroom five to 10 times in two hours or something, and seeing people in the house, all kinds of visions and things like that. It's wearing. “ “It's not unusual to wake up every two to three hours just to change her, and beyond that, it'll be where she'll yell out, ‘Help, I need help!’ and I go to her bed, and find out she's talking to hallucinations, invisible people, so I'm thinking she's calling me that she needs help, and she's just talking to somebody else. “ “I just received the paperwork for medical for my husband from the VA…I don’t feel like I have the energy to go through all that paperwork.” Factors Related to Access Lack of Insurance Lack of transportation “lack of transportation keeps people in their own little space unable to get to a senior center, for Table D-‐5 Focus Group Summary: Caregivers Page 4 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups example, and keep up connections that keep them active. “ Location “My husband was totally debilitated… and I had to haul my husband up and down stairs, in and out of car, up and down to Group Health to get physical therapy, speech therapy occupational therapy, and all that stuff. It was a nightmare.” The VA – social workers, everything is in King County. Lack of child care/ senior care 1 1 “I ruptured a tendon. I may need surgery. Who’s going to take care of him? Who’s going to take care of me? What are we going to do?” 1 1 Time of day that medical need occurs Calling 911 can be costly if ambulance transports or if are a Group Health patient and taken to wrong hospital. Driving at night is difficult – need to call ambulance. 2 1 Judging whether to seek care The difficulty of transporting. 1 When the VA or insurance company demands it (eg. reevaluation to get some rehab) 1 If there are symptoms 1 2 Money: The cost of the co-‐pay. 4 3 “I called 9-‐1-‐1 several times. She's has had 3 grand mal seizures. So of course the first time it was very scary to see that. The second time I also called 9-‐1-‐1, and both times I said "take her to Stevens because it's the closest," and it cost me thousands of dollars because it's not part of the Group Health family. Out of my own pocket, thousands and thousands of dollars each time. So the 3rd time it happened, which was maybe 6 weeks ago, I called 9-‐1-‐1 again, they revived her and stopped actually this time and said, "Do you want to take her to the hospital or do you want to kind of monitor and watch her?" So I knew that when I had taken her to Stevens they really didn't do anything. They just confirmed what had happened, so I said "I'll just watch her," and they said "If it happens again today, give us another call and we'll come back, and then we'll take her to the hospital." I said fine. So she was fine after that. No problem. So it saved me thousands of dollars monitoring her at home rather than taking her to the hospital.” Medic recommendation (to watch and call if problem recurs) Have medical criteria – e.g. when blood pressure spikes. 1 Table D-‐5 Focus Group Summary: Caregivers Page 5 of 9 CONCEPTS IDEAS & QUOTES Mentioned in this set We were in congestive heart failure for several years before we got the heart surgery, and the consulting nurse situation was not helpful, because no matter what, they're going to say, well bring him in. So I've had to negotiate ways that I could deal with minor things at home and be able to make a judgment on whether it was a concern to actually getting him in. But then there were times that I could see that he needed to be seen, but I couldn't get the cardiology appointment. “So basically in my situation, I got permission to manage his medicines on my own, his diuretics and stuff, so that we could avoid [visits and copays]. Mentioned in X groups 2 2 2 5 2 Legal assistance (e.g. for financial arrangements) 3 3 Help in finding reliable independent caregivers (agency help is too expensive) 1 1 Many of Group Health’s mental health and specialty services are in Seattle or Bellevue. 2 1 Respite care is hard to find. 3 2 Day programs are not in area – closest is Bothell 3 2 Lack of gerontologists 2 2 2 2 Wait and see if symptom goes away. If at night – wait until morning if possible. After dementia kicked in I have started not to react to every symptom. Barriers to Quality Care or Service Not understanding the system, not understanding what they are being told (including mis-‐information) “Medicare only pays 20% for medical equipment” (actually they pay 80%) Not knowing difference between 911 transport and private ambulance transport Not knowing to call insurer when at the ER Not knowing what Medicare covers for medical equipment They say "Get them to the ER or the doctor within 3 hours," [for possible stroke] right? So you get them there, they lie there for 6 hours. They do absolutely nothing except check their blood sugar or draw blood and blood pressure, and then they send you home. Why did we go and have $6000 worth of fees to take them there? I don't understand. Gaps in the system Table D-‐5 Focus Group Summary: Caregivers Page 6 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Help with changes to homes to make them easier to age in Ways in which systems seems to work actively against client Home care worker: “The gal I have loves gardening and we a have a little patio yard there, and they so, they can’t do that.” 6 VA: told to take husband to VA for OT consult before getting medical equipment (e.g. commode). When there told she could just have had her MD order it. I signed up my wife for Social Security when she was 62. She's still not old enough for Medicare. She 1 will be later on this year, but they ask you, "Is she disabled?" And at that point, her neurologist still hadn't officially declared her as having Alzheimer's. He kept saying, and even her general practitioner, Aw, that's just normal aging, forgetting things and so on. So they wouldn't document that she had any type of mental problem whatsoever. And it said right on the form and marked whether she's disabled or not, 'if you don't declare it now, you can't declare it later on….that doesn’t make sense to me that they say if you don’t have it when you’re young you can’t claim it later on…a month later-‐-‐I was recommended to a geriatric doctor in Northgate, so he gave her a test, asked her 22 questions, and she got 2 right. So he officially put in the records that she did have Alzheimer's. But this was a month after I had applied, and I couldn't go back and change it. ” Surgeons not talking to spouse in person. Lack of inpt beds. Lack of discharge planning that takes into account spouses ability to care for loved one – need for snf care. Frequent moves within and between facilities of people with dementia. Using IRAS to pay for care – then counted as income and prevents senior discount on real estate 1 taxes. “My husband qualified for para-‐transit, but were a little bit out of the misle so far from the stop he wasn't’ eligible. I would have to drive him to the stop and have him picked up. ..had to wait for up to 1 a half hour both directions.” 2 “So I was looking for an occupational therapist to come to the house to do an assessment, and that was a little hard to find. I called Virginia Mason, and they said, "Oh yes, we have occupational therapists." I said, "Do they come to the house?" "No." I thought, well how can you do a home assessment if they don't come to the house? And I called a couple of other places. Same answer. Insurance Rules/coverage Mother not eligible for home PT under her insurance, but is very week and falls easily. 2 2 Table D-‐5 Focus Group Summary: Caregivers Page 7 of 9 CONCEPTS IDEAS & QUOTES Mentioned Mentioned in this set in X groups Limits by the VA on formulary, requirements for assisted living etc. do not coordinate will with private providers. Participants try to avoid using it. Paper Work The VA “It's the hardest work I’ve ever done.” 3 2 2 1 VA: “it took over a year for all the paperwork to go through. There was always something else they needed. I'd call and it would ring 20 times and there wasn't any answering. You have to be persistent. “ DSHS: “That’s been a horrible thing for me to have to fill out forms and forms and forms. Every month there are forms and its just awful…they’re not very nice to you.” Mental Health and Substance Abuse Insurance for mental health Hard to provide a mental health provider that accepts Medicare and who is on the list of your insurer – lack of options. Supposed to be parity with similar costs – but it’s like going to a specialist Where do you get your health information? (Note: skipped this question in one group to shorten the time) Internet 6 2 Family or Friend Support group 4 2 Provider 5 2 Printed materials “For a while I read a lot of books, and I kind of got to where I didn’t want to know anymore.” 5 2 Notes: most people noted that their adult children were too busy to help. One man, in his high 90s talked about the wonderful family support he gets with weekly meals, help with bathing and cleaning – and he was quite at peace with his wife’s condition. Much of their frame reference is the use of the ER for care – in large part because of the problems in transporting. If they get an ambulance the transport is taken care of. Table D-‐5 Focus Group Summary: Caregivers Page 8 of 9 Specific suggestions from Caregivers •
•
•
•
•
•
•
•
Provide in home services – medical, haircuts, dental, pt, etc Design continuum of services at different levels with different options Day programs that are enjoyable for loved ones that they could be left at. User friendly website – all the information about resources in spot. Develop adaptive equipment of elderly (example, in man who invented a boot for his father that helped him keep his balance and then he could use a walker.) “wouldn’t it be great if you turn 65 and get this Rolodex [of resources]” Housing (like apartments) for elderly where there is a social worker to help arrange resources and a physician who makes house calls. Need respite so can do errands etc. and self-‐care without taking loved one with one. Table D-‐5 Focus Group Summary: Caregivers Page 9 of 9 Appendix E: Multi-‐modal Survey South Snohomish County
Hospital District 2
Study Results
Prepared for:
Verdant Health Commission
Revised by Strategic Learning Resources Inc.
Final Report
July 2013
TABLE OF CONTENTS
Executive Summary
1
Detailed Findings
3
Background
3
Methodology
3
Study Findings
8
Surveys
Personal Health Assessment
8
Access to Care and Use of Services
9
Use of Emergency Room Services
15
Use of Educational Health Programs
18
20
EXECUTIVE SUMMARY
Background
The Verdant Health Commission (Public Hospital District 2, Snohomish County) has undertaken
a community health and wellness needs assessment. Verdant contracted with Strategic
Learning Resources (SLR) to gain insight into the perceived needs and gaps in service through a
comprehensive study of Healthcare Needs among residents of the Hospital District Number 2.
As a part of this study, SLR requested that Gilmore Research Group conduct a Community
Health Needs Assessment Survey using a multi-mode method. SLR, for its part, coordinated the
study, carried out the qualitative data collection, integrated secondary data from other sources
and oversaw analysis of the combined information for the final report and presentation.
Gilmore has responsibility for analysis and reporting of the survey data and results as found in
this report.
Methodology
The Verdant Community Health Needs Assessment Survey was conducted online and by phone
with residents of Hospital District No. 2 in South Snohomish County. This method was chosen
because it offers greater access to residents without landline telephones and improves the
reach to include more low-income, recent immigrant and ethnic populations. Address-based
sampling increases the coverage of the target population because each household has an
address, but not every household has a landline telephone.
Using a random sample drawn from a USPS Delivery Sequence File (DSF) of all residential
addresses within the geographical limits of Hospital District Number 2, telephone numbers and
names were reverse-matched where available. This process resulted in almost a 50% of
residential addresses matched with a telephone number. All 4,000 addresses were sent a prenotification postcard describing the purpose of the survey and seeking residents’ participation.
In addition, the postcard announced a drawing for a $500 gift card good at Fred Meyer and QFC
stores as well as other stores owned by Kroger. About 109 postcards were returned as
“undeliverable.” There were 400 completed surveys, 10% of the postcards mailed and 20% of
sample with contact information available.
The postcard gave each recipient a unique pin number and the website address where they
could complete the survey online. If after about 10 days, they had not completed the survey,
telephone interviewers followed up to complete the survey by phone with as many as were
available.
The Community Health Needs Assessment Survey begins by asking residents to assess their own
level of health. The next section of the interview asks about access to health care and insurance
or ability to pay for various types of healthcare. The following section covers types of
educational programs available and/or attended. The final section of the survey covers the
demographic questions.
The invitation card offered the interview in Spanish as well as English either online or by
telephone. The survey was translated into the Spanish language and Spanish fluent
interviewers made outbound calls to Hispanic sample.
Key Findings
 Residents consider themselves healthy – 60% said they were in very good or excellent
health. People with higher incomes were more likely to consider themselves healthy than
those with lower incomes.
 Most residents have access to care: 85% of residents have a primary doctor and most of
those saw that doctor in the past year. Also, over half of residents interviewed saw a
specialist in the last year and one-third saw an alternative care provider. Older residents
were more likely to see a specialist, and younger residents were more likely to seek an
alternative care provider.
 Not unexpectedly access is related to income. Those below 200% of poverty are less likely
to have a primary care doctor and those who had problems seeing a provider in the last
year name lack of insurance or an inability to pay as the barrier. Those with incomes of less
than $27,000 were also less likely to be insured.
 The largest gap in access may be in dental services. 70% of those above the 200% of
poverty reported having dental insurance, compared to 40% of those below the line. 84%
above the 200% of poverty compared to 47% below the line report having had their teeth
cleaned and checked in the last year.
 The majority of adult residents have prescriptions, with people 65 and older as well as lowincome residents being most likely to have prescriptions.
 Roughly two out of every five residents surveyed have been to an emergency room in the
last two years for themselves or to accompany someone else. In general satisfaction with
emergency room services is high. Seattle area hospitals received the highest ratings.
 Efforts to vaccinate residents for the flu appear to be working. More work is needed for
pneumonia, whooping cough, and shingles.
 Attendance for educational programs about health topics is fairly low, as only one out of
five residents has been to one in the last year.
 Awareness of Verdant Health Commission is low as one out of fourteen residents are aware
of the commission.
Appendix E – Multi-modal Survey
Page 2 of 31
DETAILED FINDINGS
Background
Verdant Health Commission has responsibility for the healthcare needs of residents within its
district in South Snohomish County encompassing the cities of Bothell, Brier, Edmonds,
Lynnwood, Mill Creek, Mountlake Terrace, and Woodway as well as some unincorporated areas
in between the cities. Since Swedish Hospital has taken over management of the district’s
hospital, formerly Stevens Hospital and currently Swedish Edmonds Hospital, Verdant is
exploring other ways of supporting the health of district residents.
In order to better understand the needs of the local community, Verdant requested Strategic
Learning Resources (SLR) to conduct a comprehensive study of the community to assess
resident access to healthcare and perceived health-related needs. Results of the research will
aid Verdant in planning and prioritizing health and social services for Hospital District #2
residents. Verdant will use the data from this survey in conjunction with other data sources
including focus groups conducted by SLR staff with specific hard-to-reach segments of the
population and secondary data from a variety of reports and databases.
Methodology
Survey Design
The Community Health Needs Assessment Survey was developed as a collaborative effort with
consultation among Gilmore Research, SLR, and Verdant staff and review by the Guidance and
Review committee as well as the Verdant Health Commission Board. The survey questionnaire
has four sections:
•
•
•
•
The first asks residents to assess their own level of health.
The second section asks questions about access to health care and insurance or ability
to pay for various types of healthcare. It also asks questions about the use of
emergency room services and specifically that of Swedish-Edmonds.
The third section asks about the types of educational programs available, which were
attended and what conditions would increase participation.
The final section of the survey covers demographic questions.
A copy of the survey is included at the end of this report.
Page 3 of 31
Survey Fielding
The Verdant Community Health Needs Assessment Survey was conducted online and by phone
with residents of Hospital District No. 2 in South Snohomish County. This multi-mode method
was chosen because it offers greater access to residents without landline telephones and
improves the reach to include more low-income, recent immigrant and ethnic populations.
Address-based sampling increases the coverage of the target population (this is because each
household has an address, but not every household has a landline telephone).
The Verdant survey used a multi-mode approach that included mailing a postcard invitation to
complete the questionnaire either online or by telephone. The address-based sample was
drawn randomly from each of the census tracts within Snohomish County Hospital District #2.
Postcards were sent to residents from March 13th through March 15th. The electronic survey
was posted on March 13th, following a pre-test of programming and question wording and
continued through April 20th. Phone interviewing began on April 1st and continued until April
20th, when both online and telephone methods of data collection were closed.
The address-based sample from within the geographical limits of Hospital District Number 2
was reverse-matched for telephone numbers and names where available. This process resulted
in almost 50% of residential addresses being matched with a telephone number. All 4,000
addresses were sent a pre-notification postcard describing the purpose of the survey and
seeking residents’ participation. In addition, the postcard announced a drawing for a $500 gift
card good at Fred Meyer and QFC stores as well as several other stores owned by Kroger.
About 109 postcards were returned as “undeliverable.” There were 400 completed surveys,
10% of the postcards mailed or 20% of sample with contact information available.
The postcard gave each recipient a unique pin number and the website address where the
respondent could complete the survey online. After about 10 days, those who had not
completed the survey online were contacted by telephone interviewers who completed the
survey with as many respondents as were available and reached.
The invitation card offered the interview in Spanish as well as English either online or by
telephone. The survey was translated into the Spanish language and Spanish fluent
interviewers made outbound calls to Hispanic sample.
Surveys were completed online with 79 respondents and by telephone with 321 respondents
for a total of 400 interviews. Telephone interviews averaged 8.54 minutes in length. The
overall response rate for the survey was about 10%.
Margin of Error
The margin of error for the total sample size of 400 respondents is plus or minus 4.9 percentage
points in a 50%/50% response proportion at the 95% confidence level.
Analysis of Respondent Subgroups
As part of the analysis of survey findings, respondents were divided into sub-groups based on
their demographic and socio-economic characteristics. Responses to survey questions by these
Page 4 of 31
sub-groups were compared to reveal whether they differed statistically. Demographic and
socio-economic categories by which responses were analyzed include:
• Gender
• Age
• Race
• 200% of the poverty level
• Income level
• Whether the household includes one or more children under age 18
• Zip code (indicative of city)
Language of Interviewees
The Verdant Healthcare Needs Assessment questionnaire was translated into Spanish for
residents who wished to complete the survey in Spanish and there were a number of
interviewers fluent in Spanish making outbound calls to those listed as Hispanic in the sample
file. Two of the interviews were conducted in Spanish and the remainder in English although
everyone had the option to complete the survey in Spanish.
Report Conventions
The base number of respondents that is shown for each question is the total number of
weighted cases having valid responses for that question. Rounding of decimals (at 0.5) may
sometimes produce percentages shown in graphs and tables that exceed or fall below 100%.
The report presents statistically significant findings for resident subgroups.
Any statistically significant differences are called out in the report as differences (i.e. one group
is more likely to do “a” than another group). If there is a trend but the difference is not
significant, the text will indicate that it was not a statistically significant finding. Statistically
significant findings are based at the 90% level of confidence and for a study with 400
respondents the margin of error is ± 5%.
Weighting
The sample of 400 respondents was weighted by age and by gender proportionate to the age
and gender of the population within Snohomish County as a whole. Because younger people
(ages 18 to 34) tend to be less likely to participate in surveys, and those either female or older
tend to be more likely, it is often necessary to weight data to ensure that opinions captured
within each gender and age range are given a weight that is reflective of their age and gender
category within the target population. This method of weighting data is the most commonly
used and is the most appropriate for this study.
Respondent Profile
The respondent profile reflects weighted data used to project this sample to the population
based on the age and gender distribution for the hospital district. There were considerable
Page 5 of 31
challenges in gaining an adequate sample and the resulting sample over-represents Whites and
under-represents the Hispanic and Asian communities, as compared to the demographic
makeup of the hospital district. The 18-24 age group was adjusted, but only 3 individuals in
that age group were surveyed.
Table E-1
Respondent Profile, Raw Data and Weighted for Age and Gender
Respondent Profile Weighted
for Age and Gender
Age
18-24
25-44
45-64
65 and older
Average
Gender
Male
Female
Hispanic or Latino
Yes, Hispanic or Latino
No, not Hispanic or Latino
Race
White
Black or African American
Asian
Native Hawaiian or Pacific
Islander
American Indian, Alaska
Native
Something else
Refused
Formal Education
Less than high school
High school diploma/GED
Some college or technical
school
College degree
Graduate degree
Respondent
Profile Raw Data
9%
39%
38%
14%
46
1%
15%
38%
46%
50%
50%
46%
54%
4%
94%
3%
95%
88%
2%
6%
91%
2%
3%
1%
2%
1%
1%
4%
0.3%
1%
2%
4%
8%
2%
13%
27%
42%
18%
27%
38%
19%
22%
32%
15%
30%
39%
12%
Number of Residents in Household
One
Two
Three
Page 6 of 31
Respondent Profile Weighted
for Age and Gender
Four or more
Average
31%
2.7
Respondent
Profile Raw Data
18%
2.3
56%
16%
22%
6%
0.8
72%
11%
12%
3%
46%
13%
15%
15%
42%
13%
16%
17%
14%
31%
19%
15%
85%
19%
81%
Number of Children in Household
None
One
Two
Three
Average
Annual Household Income
$27,000 or less
$27,000 to $51,000
$51,000 to $75,000
More than $75,000
Refused
Relative to 200% of US Poverty Guidelines
At or below 200%
Above 200%
Page 7 of 31
Study Findings
The survey analysis included comparisons by age, income, and zip code. Zip code comparisons
permit the reader to compare survey results with other parts of the assessment such as health
status indicators by zip code in Appendix C. Eight zip codes are included, but four of them
include areas outside of the hospital district. Survey respondents were drawn only from within
the zip code and represent only that geographic portion.
Personal Health Assessment
South Snohomish County residents consider themselves healthy
Three out of five South Snohomish County residents consider themselves to be in either very
good or excellent health (60%). Income appears to play a role in health status as those with
higher incomes consider themselves in better health than those with low incomes.
Page 8 of 31
Table E-1
Personal Health Assessment by Income
Above 200% of poverty
Excellent or Very
Good Health
62%
Fair or Poor
Health
10%
Below 200% of Poverty
43%
28%
Income ≤$27,000
41%
30%
Income >$27,000
64%
8%
Some statistically significant differences exist between respondents in different zip codes. 70%
or more of people living in 98020 and 98037 considered their health excellent or very good,
while less than half of those living in 98026 did.
Access to Care and Use of Services
Whether or not residents have a personal care physician could be related to both age
and income.
The majority of respondents have a personal doctor or primary care provider (85%). Of
those with a doctor, 92% saw their provider in the past year.
Relationship to Age
• Older residents (45 and older) are more likely to have a personal doctor and to
have seen the doctor than those below the age of 45.
Relationship to Income
• Respondents above the 200% poverty line are somewhat more likely to have a
doctor (87%) than those at or below the line (72%).
• Almost 40% % of respondents living in the zip code 98043 do not have a primary
care provider and 30% of residents within the hospital district living in zip code
98021 also report not having a primary care provider.
Income and lack of insurance are barriers to seeing a personal doctor
Four out of five respondents had no problem seeing a personal doctor or PCP in the past
year. But for the 20% who did have difficulty a lack of insurance or being unable to pay
were named the top two barriers. Lack of insurance was named by more women than
Page 9 of 31
men and was a greater problem for people with low-middle incomes in the range of
$27,000 -$51,000 than for people with lower or higher incomes.
Figure E -1
Reasons Visiting a Doctor is Difficult
Respondents that have had a difficult time visiting a provider in the past year (Base=78)
28%
Lack of insurance
25%
Unable to pay
16%
Scheduling/hours are not convenient
8%
Changing physicians/locations
7%
Doctor booked up or booked out
5%
Unemployed
Can't find a provider who accepts insurance
3%
No transportation/ride
3%
16%
Other
0%
10%
20%
30%
Q5. Has anything made it difficult for you to see a personal doctor or primary care
provider in the past year? If yes, what has made it difficult?
May not sum to 100% due to rounding.
The picture of insurance coverage is complicated and not completely congruent with
other findings.
Ninety percent of respondents reported having some kind of health insurance. 1 (This
number may be high because only three residents between the ages of 18-24, a group
less likely to be insured, were surveyed and they all had private insurance.) People with
income below $27,000 were less likely to have insurance and almost all respondents
with incomes over $75,000 had insurance. Of people with insurance:
• 80% have private insurance
• 15% have Medicare
• 5% are on Medicaid
• 4% use TRICARE.
1
The BRFSS 2010 survey reported 83% having some kind of insurance.
Page 10 of 31
Nearly all residents age 65 and older reported having health care insurance (99%). But
some may not have been clear as to the source as only 78% of seniors with insurance
reported having Medicare and 38% reported having private insurance.
Some residents have both Medicare and Medicaid:
• 42% of those with Medicaid also reported having Medicare
• 15% of those with Medicare reported also having Medicaid
Specialty care is widely used and alternative care is most popular for residents age 2564; both are easy to obtain.
In the past year, half of residents visited a specialist (51%) and one-third saw an
alternative care provider (34%). Very few residents (8%) have difficulties obtaining
referrals or follow-up services.
Relationship to Age
• As expected, older residents (65 and older) are more likely to visit a specialist
than younger residents
• Younger residents (below 65) are more likely to visit alternative care providers.
While the finding is not statistically significant, those below the 200% poverty line
appear to visit alternative care providers more often than those above the poverty line.
In addition, two thirds of those using a community health center had sought care from
an alternative care provider, compared to approximately one third (36%) of those
receiving care at a doctor’s office.
Relationship to Place
Residents from 98026 and 98036 are most likely to visit specialists and those living in,
98021, 98036 and 98043 are most likely to see alternative care providers.
Page 11 of 31
Table E-2
Percent of Respondents who saw a specialist or alternative care provider in the last
year by zip code
(bolding indicates significance at 90% confidence level)
Zip Code
Likely to see
Specialist
Likely to see
Alternative
Care Provider
98012
41%
18%
98020
36
26
98021
44
43
98026
63
35
98036
62
38
98037
47
28
98043
50
51
98087
62
15
Access to dental care differs significantly between those above and those below the
200% poverty line.
Overall:
• 66% of respondents have dental insurance
• 79% report having their teeth cleaned and checked in the last year
• 85% of insured receive dental care through a private dentist
Residents who are a race other than Caucasian are less likely than Caucasians to have a
private dentist and either feel they did not need dental care in the past year or visit a
public health dental clinic. Respondents over the age of 65 are less likely to have dental
insurance (41%) than those age 25-44 (74%).
Those without a private dentist visit a community or public health dental clinic, stated
they have not needed dental care in the past year, or have not been able to get dental
care.
Those above the 200% poverty line are significantly more likely to have dental
insurance, go to a private dentist, and have their teeth checked yearly than those at or
below the line:
Page 12 of 31
Table E-3
Difference in access to dental care based on income
Above 200% of Poverty
Below 200% of
Poverty
Have dental insurance
70%
40%
Go to a private dentist
89
61
Have had teeth checked
and cleaned in last year
84
47
Those living in zip code 98087 are least likely to have dental insurance, two-thirds are
not currently covered and claim they haven’t needed dental care in the past year more
than those living in other zip codes Residents of 98087 and 98043 are the least likely to
have had their teeth checked in the past year.
Table E-4
Percent who have dental insurance and have had preventive care by zip code
Zip Code
Have Dental Insurance
Teeth Checked/Cleaned in Past Year
98012
60%
85%
98020
60
80
98021
71
80
98026
57
91
98036
80
81
98037
73
88
98043
69
50
98087
36
47
Dental Care is the most requested service
One out of ten residents identified area social services or health-related services they
would like to see in South Snohomish County that are not currently available (11%).
Dental care tops the list of requested services as shown in Figure 3.
Page 13 of 31
Women are more likely
than men to request more
social services. Younger
residents are more likely
than older residents to be
interested in having more
health related services in
South Snohomish County.
Figure E-2
Social or Health-Related Services Requested
Respondents wanting services that are not available nearby at this time (Base = 44)
Dental services/reduced rate
dental care
Low cost check-ups/healthcare for
the poor
11
4
Urgent care/walk-in clinic
4
Mental health services/resources
4
Services for the elderly
3
Universal health care
1
0
2
4
6
8
10 12
Q26. What services? (asked if respondent indicated wanting to see social
services or health-related services in South Snohomish County that are not
available nearby at this time).
Many residents are
dependent on prescriptions and cost is becoming a barrier to receiving medications.
Overall three out of five residents have prescriptions. Both age and income appear to
correlate with the use of medication:
• 73% of residents between the age of 45 and 64, and 89% of those 65 and over
have prescriptions
• 83% of people with incomes of $27,000 or less have prescriptions (compared for
example with 52% of people with incomes over $75,000)
For those with prescriptions, 18% have difficulty getting their medications filled. These
difficulties are mostly caused by high cost (53%) or lack of insurance coverage (28%). A
few also reported encountering a shortage of their medication (13%).
There were few statistical differences based on place, though residents living in 98043
are most likely to have prescriptions (79%), significantly higher than in 98020 and 98021
(each 54%).
Vaccination for flu is most successful immunization program; more work is needed for
pneumonia, whooping cough and shingles.
Flu vaccine is recommended for everyone 65 and over, as well as other groups of people
who may be at risk. 84% of residents 65 and over reported receiving the vaccine this
Page 14 of 31
season, and 65% of those between the ages of 45 and 64 did so. Overall, people with
incomes of $27,000 or less were more likely than higher income residents to get the
vaccine.
Similarly, the pneumonia vaccine is also recommended for people 65 and older, and
67% reported having received it in the last five years.
A booster for whooping cough (delivered with tetanus and diphtheria vaccines) is
recommended for ages 11 – 64 every ten years, and has been a focus of Verdant’s
support. Overall 39% of respondents indicated they had had it in the last five years.
People above the 200% of poverty were more likely (42%) than those below the poverty
line (20%) to have received it.
The Shingles vaccine is recommended for everyone over the age of 60. Only 16%
between the ages of 45-64 reported having received it and 46% of those 65 and older.
Use Of Emergency Room Services
Emergency room services are used by less than half of respondents and Swedish
Edmonds is visited most often, though it received the lowest rating of the four areas.
Two out of five residents have visited an emergency room in the past two years whether
for their own care or to accompany someone in need of care (41%). While not
significant, those below the 200% poverty line appear to visit the ER more often than
those above the line.
Swedish Edmonds is the most common facility for emergency room services as 43% of
respondents who used emergency care in the past two years went to Swedish Edmonds.
Other emergency room facilities visited are on the Eastside (25%), in Seattle (17%), or
another facility in Snohomish County (11%).
Relationship to Age
The 65 and older population is more likely to use the emergency room services at
Swedish Edmonds than those under the age of 65. Those ages 25 to 64 are more likely
to visit emergency rooms on the Eastside or in Seattle.
It is difficult to differentiate emergency room use by zip code because small sample sizes
reduce the statistical significance of differences. However, with the exception of 98021,
which is on the east boundary of the Hospital District, the Swedish Edmonds ER has a
significant market share. 98043, on the south boundary has more people using Seattle
ERs (in particular Northwest Hospital and Medical Center).
Page 15 of 31
Table E-5
Percent of Respondents who used an ER, or accompanied someone
to an ER in the last two years, and where they went
Zip
Code
Percent Used
an ER
Percent of those
who used
SwedishEdmonds ER
Percent who
used other
Snohomish ERs
Percent who used
Eastside ERs
Percent who
used Seattle ERs
98012
49%
70%
-
29
1
98020
29
40
15%
20
22
98021
61
6
9
74
8
98026
36
54
19
4
22
98036
48
48
-
28
13
98037
37
54
12
3
25
98043
39
31
15
11
39
98087
52
82
18
-
-
Satisfaction with Emergency Room Services is high
Respondents who had used an emergency room were asked to rate their experience on
a 1 to 7 scale, with 7 being excellent and 1 being very poor. Most respondents rated
their experience quite highly as 65% of all respondents felt the experience was very
good. Facilities in Seattle received the highest average rating (6.12), which was
statistically significantly higher than other area facilities. Other average ratings were:
• Other Snohomish County emergency rooms - 6.08
• Eastside emergency rooms 5.96
• Swedish Edmonds 5.63.
Residents who are not Caucasian reported a markedly a less satisfying experience than
those who are Caucasian. (Average rating of 5.04 compared to 5.86) Lower ratings were
generally associated with long waits for medical care.
Satisfaction is highest among those living in the 98021 zip code, who typically visit
hospitals on the Eastside. It was also relatively high among those in 98012, 70% of
whom go to Swedish Edmonds.
Page 16 of 31
Table E-6
Distribution of Satisfaction Ratings by Zip Code
(bolding indicates significance at 90% confidence level
Zip Code
7-6
5-4
3-1
Mean
98012
76%
20%
0%
6.08
98020
76
21
2
5.88
98021
81
16
3
6.29
98026
59
26
15
5.48
98036
47
33
19
5.34
98037
64
36
0
5.81
98043
62
34
4
5.75
98087
70
24
6
5.62
Choice of Emergency Care also correlates with other Health Care choices
There are some differences between residents who make different choices about where
to seek emergency care.
Residents who have been to the ER at Swedish Edmonds/Stevens Hospital:
•
•
•
•
are most likely to have a primary care provider
are least likely to have used a walk-in clinic or urgent care facility
are not likely to have used an alternative care provider in the last year
name an inability to pay as the barrier if they have had difficulty seeing a
physician in the last year
• are most likely to have Medicare (25% of those with insurance)
Respondents who went to another Snohomish County facility for emergency care:
• are most likely to use walk-in clinics or urgent care facilities when they are sick,
Residents who visited the ER at an Eastside facility:
• are less likely to have a personal doctor
• are most like to use an alternative care providers
• are likely to have health insurance (87%)
Residents who used a Seattle emergency room are most likely to have seen their
primary care provider in the past year
Page 17 of 31
Use of Educational Health Programs
Women and those at or below the 200% poverty line are most likely to attend
educational health programs.
One out of five residents have attended an educational program about health topics in
the last year (20%). The most popular topics include nutrition, aging/dementia, and
fitness or weight loss. Courses were offered most often through the workplace or a
hospital.
Women are more likely to attend than men and those below the 200% poverty line are
more likely to have attend than those with higher incomes. The elderly are least likely to
have attended educational programs on health topics.
Those in the higher income category ($75,000 or more) are most likely to go to a health
seminar if their doctor tells them to go than those in lower income categories.
Residents are more likely to attend educational programs if the location is convenient,
their doctor encourages them to go, or if the program is scheduled in the evening.
Figure E-3
Appealing Factors to Attend Educational Programs on Health Topics
All respondents(Base=400)
46%
Convenient location
My doctor tells me to go
Scheduled in evening or weekend
Interactive or hands-on style program
Childcare provided
Some food or refreshments provided
People I know will be there
Lecture style program
Other
Nothing/None
32%
25%
13%
12%
12%
11%
8%
21%
9%
0% 10% 20% 30% 40% 50%
Q28. What was one of them about? (asked if respondent indicated having
attended an educational program about health topics in the last year).
Q29. Who offered that program? (asked if respondent indicated having
attended an educational program about health topics in the last year).
Q30. What would make you more likely to attend an educational program on
a health topic?
Page 18 of 31
Awareness of Verdant is low among those below the 200% poverty line.
Only 7% of respondents are aware of the Verdant Health Commission. Those above the
200% poverty line are more likely to be aware of Verdant than those below the line.
Page 19 of 31
SURVEYS
Page 20 of 31
Multi-Mode Survey for Verdant Health Commission (Online Version)
Intro: Thank you for agreeing to complete this important survey for the residents of South Snohomish
County. We appreciate your taking the time to help improve health services to the community. Your
responses will remain anonymous and confidential. (THERE WILL BE A BUTTON TO CLICK FOR SPANISH.)
To start, enter your PIN in the box below. This number is printed above the address on the postcard and
on the back after PASSWORD. Click on the BEGIN button to proceed.
Personal Health Assessment:
1. How would you rate your health in general, would you say it is ...
a. Excellent
b. Very good
c. Good
d. Fair or
e. Poor
f. Don’t know/Not sure
Access to Care: In the following set of questions about access to healthcare, please answer only for
yourself, not for other members of your family or household.
2. Where do you go for care when you are sick? _____________________ (Type of Provider or Type of
Place) (OPEN ENDED but coding options are listed below :)
a. Doctor’s Office
b. Community Health Center
c. Emergency Room at a hospital
d. Walk-in Clinic
e. Urgent Care Facility (free-standing, not part of a hospital)
f. Other (DESCRIBE:) __________________________________
3. Do you, yourself, have a personal doctor or primary care provider? Yes/No
4. IF YES, ASK: In the last year, did you see a personal doctor or primary care provider? Yes/No
5. Has anything made it difficult for you to see a personal doctor or primary care provider in the past
year? Yes/No
6. IF YES, ASK: What has made it difficult? (OPEN ENDED)
7. In the last year, have you been to see a specialist, that is, a doctor that specializes in a specific area
of medicine or of the body such as the heart or the skin or bones, etc.? Yes/No
8. In the last year, have you been to see an alternative care provider such as a chiropractor, a
naturopath, or a therapist?
9. Was there anything difficult about the process of getting a referral or follow-up health care services?
Yes/No
10. IF YES, what made it difficult or what else did you need to know? (OPEN-ENDED)
11. Have you been to an emergency room in the last two years for yourself or someone you went with?
Yes/No
12. IF YES, Where did you go for emergency room services? (OPEN-ENDED)
Page 21 of 31
13. How would you rate your experience with the emergency room on a 1 to 7 scale where 7 is excellent
and 1 is very poor and you may also use any number in between?
14. IF LOWER RATING THAN 4 FOR the ER, ASK: Why did you rate the emergency room experience a
__(#)__? (OPEN-ENDED)
15. Do you have any type of health insurance? Yes/No
16. IF YES, Which type of insurance do you have? (ALLOW MULTIPLE RESPONSES)
a. Medicare (for those 65 and older or disabled)
b. Medicaid (including Molina, Apple, Healthy Options, Centene Coordinated Care, America
group, United, or CHP of WA)
c. Private insurance (purchased self or through employer)
d. TRICARE (for military services or retired military)
e. Don’t Know
17. Do you have Dental Insurance? Yes/No
18. Where do you usually get your dental care? SELECT ONE OF THE FOLLOWING STATEMENTS:
a. I go to a private dentist
b. I visit a community or public health dental clinic
c. I go to the ER.
d. I have not been able to get dental care.
e. I have not needed any dental care in the past year.
(May skip if online or add DK to phone options)
19. Have you had your teeth checked and cleaned in the past year?
Yes/No
20. Did you have your flu vaccine this season? Yes/No
21. In the past five years, have you had any of these other immunizations?
a. Pneumonia vaccine? Yes/No
b. TDAP or Whooping Cough vaccine? Yes/No
c. Shingles vaccine? Yes/No
22.
23.
24.
25.
Do you have prescriptions? Yes/ No
Has anything made it difficult for you to get your medications or prescriptions filled? Yes/No
IF YES in Q28: What has made it difficult? (OPEN ENDED)
Are there any social services or health-related services that you would like to see in South
Snohomish County, that are not available nearby at this time? Yes/No
26. IF YES, What services? ________________________________
Programs/Education:
27. In the last year, have you attended any educational programs about health topics? Yes/No
28. IF YES, What was one of them about? __________________________
29. Who offered that program? ___________________________________
Page 22 of 31
30. What would make you more likely to attend an educational program on a health topic? (SELECT THE
2 OR 3 MOST IMPORTANT :)
a. Convenient location
b. Childcare provided
c. Interactive or hands-on style program
d. Lecture style program
e. My doctor told me to go
f. People I know will be there
g. Scheduled in evening or weekend
h. Some food or refreshments provided
i. Other (PLEASE EXPLAIN:) ________________________
31. Are you aware of the Verdant Health Commission? Yes/No.
Demographics:
32. Into which of the following categories does your age fall?
a. 18-24 years of age
b. 25-44
c. 45-64
d. 65+
33. RECORD GENDER: Male/Female
34. Do you consider yourself Hispanic or Latino? Yes/No
35. Which one - OR MORE - of the following would you say is your race...White, Black or African
American, Asian, Native Hawaiian or Other Pacific Islander, American Indian, Alaska Native, or
something else?
a. White
b. Black or African American
c. Asian
d. Native Hawaiian or Other Pacific Islander
e. American Indian, Alaska Native
f. Or something else (SPECIFY:)
g. Don’t know/Not sure
h. Refused
36. What is your country of birth? _____________
37. How much formal education have you had the opportunity to complete?
a. Less than high school
b. High school diploma/GED
c. Some college or technical school
d. College degree
e. Graduate degree
f. Refused
38. How many people live in your household? ___________
Page 23 of 31
39. How many of the people in your household are children under 18 years of age? __________
40. Into which of the following ranges does your annual family/household income fall?
a. Less than $11,000
b. From $11,100 to $15,000
c. From $15,100 to $19,000
d. From $19,100 to $23,000
e. From $23,100 to $27,000
f. From $27,100 to $31,000
g. From $31,100 to $35,000
h. From $35,100 to $39,000
i. From $39,100 to $43,000
j. From $43,100 to $47,000
k. From $47,100 to $51,000
l. From $51,100 to $75,000
m. Over $75,000.
n. Don’t Know
o. Refused
PROGRAMMING WILL COMPARE RESPONSES OF Q40. WITH THOSE OF Q38 TO DETERMINE WHETHER
RESPONDENT IS ABOVE OR BELOW THE POVERTY LEVEL
41. Would you like to be entered for a chance to win a $500 Fred Meyer or QFC gift card? Yes/ No
IF YES: Good Luck! What is your email address or the best phone to reach you at? WRITE NAME
AND PHONE/EMAIL BELOW.
Name: ________________________________________________________________________
Phone/email:___________________________________________________________________
THANK YOU!
Page 24 of 31
Multi-Mode Survey for Verdant Health Commission (Telephone Version)
Intro: Thank you for agreeing to complete this important survey for the residents of South Snohomish
County. We appreciate your taking the time to help improve health services to the community. Your
responses will remain anonymous and confidential. (IF SPANISH, CALL BACK BY SPANISH INTERVIEWER)
Personal Health Assessment:
1. How would you rate your health in general, would you say it is ...
a. Excellent
b. Very good
c. Good
d. Fair or
e. Poor
f. Don’t know/Not sure
Access to Care: In the following set of questions about access to healthcare, please answer only for
yourself, not for other members of your family or household.
2. Where do you go for care when you are sick? _____________________ (Type of Provider or Type of
Place) (OPEN ENDED, PLEASE DO NOT READ But may use coding options listed below or Other :)
a. 01 Doctor’s Office
b. 02 Community Health Center
c. 03 Emergency Room at a hospital
d. 04 Walk-in Clinic
e. 05 Urgent Care Facility (free-standing, not part of a hospital)
f. Other (DESCRIBE:) __________________________________
06 Edmonds Family Practice
07 Everett Clinic
08 Group Health Clinic
09 Lakeshore Clinic
10 Mill Creek Family Practice
11 Northwest Hospital
12 Pacific Medical Center
13 Polyclinic (Seattle)
14 Swedish Hospital/Internal Medicine Clinic
15 UW Medical Center
16 Veteran’s Administration (VA)
17 Virginia Mason
18 ARNP
3. Do you, yourself, have a personal doctor or primary care provider? Yes/No
4. IF YES, ASK: In the last year, did you see a personal doctor or primary care provider? Yes/No
Page 25 of 31
5. Has anything made it difficult for you to see a personal doctor or primary care provider in the past
year? Yes/No
6. IF YES, ASK: What has made it difficult? (OPEN ENDED, PLEASE DO NOT READ, BUT Some possible
pre-coded responses for interviewer to check or write in Others.) CHECK ANY RESPONSE THAT FITS:
a. Unable to pay
b. No child care
c. Language barrier
d. Can’t find a provider who accepts my insurance
e. Turned down for service
f. No transportation
g. Difficulty with application or forms
h. Didn’t know where to find help
i. Hours are not convenient
j. Can’t take time off from work
k. OTHER: (SPECIFY) _______________________________________________________
l. Don’t know
7.
8.
9.
10.
11.
12.
In the last year, have you been to see a specialist, that is, a doctor that specializes in a specific area
of medicine or of the body such as the heart or the skin or bones, etc.? Yes/No
In the last year, have you been to see an alternative care provider such as a chiropractor, a
naturopath, or a therapist?
Was there anything difficult about the process of getting a referral or follow-up health care services?
Yes/No
IF YES, what made it difficult or what else did you need to know? (OPEN-ENDED)
Have you been to an emergency room in the last two years for yourself or someone you went with?
Yes/No
IF YES, Where did you go for emergency room services? (OPEN-ENDED. DO NOT READ, BUT CHECK
IF APPROPRIATE, OTHERWISE WRITE IN NAME OF FACILITY AFTER “OTHER.” THIS IS NOT A
COMPLETE LIST.)
a. Evergreen Medical Center
b. Group Health Bellevue
c. Group Health Everett
d. Group Health Seattle
e. Harborview
f. Northwest Hospital and Medical Center (UW Medicine in Shoreline)
g. Overlake
h. Providence Everett
i. Stevens Hospital
j. Swedish Edmonds Hospital (formerly Stevens Hospital)
k. Swedish Mill Creek
l. University of Washington Medical Center
m. Veterans Administration/ VA
Page 26 of 31
n. Other: (SPECIFY) _____________________________________________________________
13. How would you rate your experience with the emergency room on a 1 to 7 scale where 7 is excellent
and 1 is very poor and you may also use any number in between?
14. IF LOWER RATING THAN 4 FOR the ER, ASK: Why did you rate the emergency room experience a
__(#)__? (OPEN-ENDED)
15. Do you have any type of health insurance? Yes/No
16. IF YES, Which type of insurance do you have? (ALLOW MULTIPLE RESPONSES)
a. Medicare (for those 65 and older or disabled)
b. Medicaid (including Molina, Apple, Healthy Options, Centene Coordinated Care, America
group, United, or CHP of WA)
c. Private insurance (purchased self or through employer)
d. TRICARE (for military services or retired military)
e. Don’t Know
17. Do you have Dental Insurance? Yes/No
18. Where do you usually get your dental care? SELECT ONE OF THE FOLLOWING STATEMENTS:
a. I go to a private dentist
b. I visit a community or public health dental clinic
c. I go to the ER.
d. I have not been able to get dental care.
e. I have not needed any dental care in the past year.
f. Don’t know
19. Have you had your teeth checked and cleaned in the past year?
Yes/No
20. Did you have your flu vaccine this season? Yes/No
21. In the past five years, have you had any of these other immunizations?
a. Pneumonia vaccine? Yes/No
b. TDAP or Whooping Cough vaccine? Yes/No
c. Shingles vaccine? Yes/No
22.
23.
24.
25.
Do you have prescriptions? Yes/ No
Has anything made it difficult for you to get your medications or prescriptions filled? Yes/No
IF YES in Q28: What has made it difficult? (OPEN ENDED)
Are there any social services or health-related services that you would like to see in South
Snohomish County, that are not available nearby at this time? Yes/No
26. IF YES, What services? ________________________________ (OPEN-ENDED)
Programs/Education:
27. In the last year, have you attended any educational programs about health topics? Yes/No
Page 27 of 31
28. IF YES, What was one of them about? __________________________
29. Who offered that program? ___________________________________
30. What would make you more likely to attend an educational program on a health topic? (SELECT THE
2 OR 3 MOST IMPORTANT :)
a. Convenient location
b. Childcare provided
c. Interactive or hands-on style program
d. Lecture style program
e. My doctor told me to go
f. People I know will be there
g. Scheduled in evening or weekend
h. Some food or refreshments provided
i. Other (PLEASE EXPLAIN:) ________________________
31. Are you aware of the Verdant Health Commission? Yes/No.
Demographics:
32. Into which of the following categories does your age fall?
e. 18-24 years of age
f. 25-44
g. 45-64
h. 65+
33. RECORD GENDER: Male/Female
34. Do you consider yourself Hispanic or Latino? Yes/No
35. Which one - OR MORE - of the following would you say is your race...White, Black or African
American, Asian, Native Hawaiian or Other Pacific Islander, American Indian, Alaska Native, or
something else?
a. White
b. Black or African American
c. Asian
d. Native Hawaiian or Other Pacific Islander
e. American Indian, Alaska Native
f. Or something else (SPECIFY:)
g. Don’t know/Not sure
h. Refused
36. What is your country of birth? _____________
01 US/USA, anywhere mentioned in US
02 Bulgaria
02 Bulgaria
03 China
04 England or Great Britain
05 France
Page 28 of 31
06
07
08
09
10
11
12
13
14
Germany
India
Japan
Netherlands
Philippines
Russia
Switzerland
Ukraine
Etc. Add as needed
37. How much formal education have you had the opportunity to complete?
g. Less than high school
h. High school diploma/GED
i. Some college or technical school
j. College degree
k. Graduate degree
l. Refused
38. How many people live in your household? ___________
39. How many of the people in your household are children under 18 years of age? __________
40. Into which of the following ranges does your annual family/household income fall?
a. Less than $11,000
b. From $11,100 to $15,000
c. From $15,100 to $19,000
d. From $19,100 to $23,000
e. From $23,100 to $27,000
f. From $27,100 to $31,000
g. From $31,100 to $35,000
h. From $35,100 to $39,000
i. From $39,100 to $43,000
j. From $43,100 to $47,000
k. From $47,100 to $51,000
l. From $51,100 to $75,000
m. Over $75,000.
n. Don’t Know
o. Refused
PROGRAMMING WILL COMPARE RESPONSES OF Q40. WITH THOSE OF Q38 TO DETERMINE WHETHER
RESPONDENT IS ABOVE OR BELOW THE POVERTY LEVEL
41. Would you like to be entered for a chance to win a $500 Fred Meyer or QFC gift card? Yes/ No
IF YES: Good Luck! What is your email address or the best phone to reach you at? WRITE NAME
AND PHONE/EMAIL BELOW.
Name:____________________________________Phone/email:_____________________________
Page 29 of 31
PROVIDER PERSPECTIVES AND SERVICES Appendix F: Community Provider Conversation Café Conversation Café Overview and Methodology
The Community Provider Conversation Café was held on April 10, 2013 at Swedish/Edmonds to gather
opinions from the service provider community with a focus on front-line staff that link clients to
services. The 2 ½ hour event brought together a diverse group of 36 health and social service providers
from 20 organizations. The participants engaged in a conversation to:
•
Share successes they had seen in the field,
•
Discuss how they would enrich existing services, and
•
Identify where they saw the greatest opportunities for making a difference in improving the
health and wellbeing of the South Snohomish County community.
Participants were recruited by compiling an invitation list from Verdant’s existing provider database,
enhanced with lists from the project partners, and from an email request to organizations to
recommend staff to attend. An email invitation was sent out to 87 individuals representing 31 providers.
The event was designed as a conversation café, drawing from “The World Cafe” methodology developed
by Juanita Brown and David Isaacs. 1 Participants engaged in three rounds of conversation, each focused
on a different question. During each conversational round, participants used flipchart paper at their
table to help capture their group’s ideas with words, pictures, and doodles. At the end of each round,
participants were asked to move to a different table and sit with new people. Each table was limited to 6
people so that everyone had a chance to talk. Each table was assigned a “table host,” who stayed at the
table and was responsible for kicking off each round of conversation by summarizing the previous
groups’ conversations, making brief notes for a report back to the facilitators, and reporting back to the
whole group about the big themes that emerged from all 3 rounds of conversation.
At the close of the three conversational rounds, the whole group came together to report back and the
high-level table reports were captured by facilitators on paper at the front of the room. The following
“Provider Perspectives” report was developed by integrating and synthesizing the table pages and the
whole group summary notes.
Conversation Questions
Round 1:
Question 1: Tell the story of a recent experience when you had great success in connecting clients to
services. What was it that made that success possible?
Question 2: What needs to change so that similar successes can be achieved more universally in South
Snohomish?
Round 2: What do you feel are the highest priority concerns for overall community health and wellness?
Round 3: What three things would you implement in South Snohomish that would improve overall
community health and wellness?
1
http://www.theworldcafe.com/method.html
Appendix F: Community Provider Conversation Cafe
Page 1 of 8
Provider Perspectives
SUCCESS FACTORS IN CONNECTING CLIENTS TO SERVICES
 Relationships between individual providers across agencies
 “Contacts with a common mission”; “provider coordination”; “knowing who the point
person is”; “Our systems are not set up to foster relationships – so access to services is
often tough”
 Collaborative/team approach across agencies
 “Connect and involve other resources and agencies around town”; “active and engaged
team”
 Care and personal connection with clients
 “Develop a relationship with the individual and follow up to make sure they get the
services they need”; “hand-holding”; “trust”; “time”; “respect”; “whole person”;
“listening”; “emotional support”; “warmth”; “real voice and face to face”
 Someone serves as a systems/services navigator
 “Working on the ground, walking side by side with the client”
 Awareness/information about existing services and resources
 “Being aware of services that are available”; “provider knowledge of specific programs”
 Cultural and linguistic fluency
 “It takes cultural and linguistic fluency to bridge barriers”
 Low bureaucratic hurdles
 “Lack of red tape!”; “reduce ‘outcomes’ reporting required by funding streams”
 Access to transportation supports
 “Connecting and collaborating with Hopelink to overcome transportation barrier”;
“providers going the extra mile – literally. We drive people to clinic, treatment, etc.”
 Community connectedness
 “Family mentoring family: connecting one another to the community for support”;
“formal and informal relationships in the community”
Page 2 of 8
PRIORITIES AND OPPORTUNITIES FOR CHANGE
PRIORITY: Cultivate
connection and team work
among providers
Participants said:
•
Participants suggested:
•
•
•
•
•
•
•
•
•
PRIORITY: Make it easier for
providers and clients to
access information about
available resources
Provide leadership to develop coalitions of provider
organizations
Change silos/in-the-box thinking
Gather people/agencies to share information
Help providers work together for the common good, sharing
rather than fighting over resources
Expand service provider coordination
Develop more connection between agencies
Build good relationships between service agencies
Promote continuity of communication across health providers
Co-locate complementary services in shared building
•
•
•
•
•
•
PRIORITY: Expand access to
case managers, navigators,
coaches, and advocates to
help clients access and use
complex systems of care
There should be “no wrong door” for clients
Create a resource center to increase awareness and access
Provide increased education about what is available
Develop a health related internet café
Make information accessible to the public
Make it easy for acute care facilities to access issue-specific
resources (e.g. a teen client needs housing – what resources are
available?)
Create a 2-1-1 for service providers
Participants said:
•
•
Personal relationships make things happen
Services are complex and it is hard to learn the language and
the landscape
• Navigators work on the ground, walking side by side with the
client
•
•
•
•
Create a team approach to case management/navigators/life
coaching
Offer “drop in case management” at the library or community
center
More case managers overall
Case management for Seniors
Page 3 of 8
PRIORITY: Work for funding
models that support agency
collaboration, reduce redtape, offer long-term
sustainability, and allow for
broader groups served
Participants said:
•
•
Year to year funding challenges relationship-building
We have “over-outcomed” ourselves and now we can’t get
funding.
• Funding is too narrow
• Restrictive funding keeps you limited to “your job”
•
•
•
PRIORITY: Provide financial
subsidies to expand coverage
and increase access to basic
medical services for low
income/working poor
•
•
Primary care
Mental health
Podiatry
Dental
Family planning
Coverage for dentures, hearing aids, and glasses
Participants said:
•
Long wait list impact people’s ability to work, achieve sobriety,
etc.
Specific gaps mentioned:
•
•
•
•
•
•
PRIORITY: Increase Urgent
Care options
Subsidize access to private pay resources to provide more client
choice outside of Medicaid/low income service agencies.
Provide supplements for TANF grants
Specific coverage gaps mentioned:
•
•
•
•
•
•
PRIORITY: Expand emergency
and low income housing
options
Pool resources and prevent or minimize duplication of services
Flexible funding for programs – less “telescoping”
Broader grant requirements so we can broaden the group we
serve.
Low income housing
Homeless housing with advocacy, access to services
Emergency shelter
Stable housing
Housing/shelters for over-18
Housing with live-in Monitor/Advocate to help access services
(alcohol/drug treatment or medical/psych)
Participants said:
• We need alternatives to the ER
Specific needs mentioned:
•
•
Acute mental health issues
Urgent care clinics
Page 4 of 8
•
•
PRIORITY: Expand mental
health options and integrated
mental health/substance
abuse care
Children’s crisis facilities, triage day treatment
Drop in clinics for emergent needs
Expand mental health service options for specific populations:
• Middle income families
• Autistic people
• Non English-speakers
Specific needs:
•
•
Add psych beds
Programs to address opiate abuse and overdose deaths (detox,
independent assessments, treatment planning/navigation,
inpatient, residential)
• Integrated substance abuse/mental health/psych care
• Psych medications management
• Diverse MH providers
• Flexible and accessible mental health – both crisis and
prevention
•
PRIORITY: Focus on
prevention and self-care
education to avoid crises and
increase empowerment
Voucher system
Participants said:
•
Through a holistic community education model we could
normalize good health practices
• Provide self-care and health education for all age and income
groups
Topics proposed for community education included:
•
•
•
•
•
•
•
•
•
•
•
Nutrition
Lifestyle
Drug prevention
Hygiene
Exercise
Alternative medicine
Budgeting
Independent living skills
Mental health
Family planning
How the health care system works
Page 5 of 8
PRIORITY: Emphasize
community-building to
expand social health and
create a context that
supports healthy living
Participants said:
•
•
From individual to shared values
Build compassion, kindness “stop blaming people for being
poor”
• Decrease marginalization and increase acceptance
• Build buy-in to support each other and marginalized groups
don’t exist
•
Community gardens – increased compassion, increase shared
experience, increase access to healthy food
Community center
Marketing healthy choices for community
Community-building around health
•
•
•
PRIORITY: Expand/diversify
services offered locally
Participants said:
• More localized services in South County
Specific gaps mentioned:
•
•
•
•
•
•
More services for youth
Quality medical services for children
Mental health services
Legal services
In home supports
Emergency housing
PRIORITY: Expand low
cost/free transportation
options
Participants said:
PRIORITY: Provide culture
and language-appropriate
services and informational
tools
Participants said:
•
•
Snohomish County focuses on Everett for transportation
Transportation
•
•
•
PRIORITY: Address food
insecurity and nutrition needs
through year-round food
programs
Language barriers are a big barrier to service access
Education for providers on working with clients with diverse
languages, cultures, and abilities
Decrease barriers to access due to culture, homelessness,
language, or disability
Participants said:
• Access to nutritious food is key
•
•
Free and reduced lunch programs
Free summer meal programs – takes funding to staff
Page 6 of 8
PRIORITY: Expand living
wage Jobs
PRIORITY: Immigration
reform
Page 7 of 8
Attendee List
Organization
Program/Position
Arc of Snohomish County
Arc of Snohomish County
Center for Advanced Recovery Solutions
Center for Advanced Recovery Solutions
Center for Human Services
City of Lynnwood
Cocoon House
Cocoon House
Cocoon House
Compass Health
Compass Health
Domestic Violence Services of Snohomish County
Edmonds Community College
Edmonds School District
Edmonds Senior Center
Evergreen Manor
Little Red School House
Little Red School House
Lutheran Community Services Northwest
MarkWell Health & Wellness
Project Access Northwest
Providence Medical Center
Puget Sound Christian Clinic
South Snohomish County Emergency Cold Weather Shelter
South Snohomish County Emergency Cold Weather Shelter
Swedish/Edmonds
Volunteers of America, Western Washington
Parent Family Coalition Coordinator
Parent to Parent/Multicultural Outreach Coord
Counselor/Social Worker
Counselor
Substance Abuse Director
Substance Abuse Department
Child & Family Therapist
Senior Center Supervisor
Latino Outreach Coordinator
South County Advocate
Latino Prevention Manager
Therapist - Lynnwood Office
Therapist - Lynnwood Office
Domestic Violence Prevention Educator
Counseling & Resource Center
Dept Coordinator, Health Services
Enhance Wellness Nurse
Program Manager
Enhance Wellness Social Worker
Community Outreach Coordinator
Nurse Family Partnership, Staff
Nurse Family Partnership, Nurse
Family Center of South Snohomish County
Family Caregiver Program
Program Manager, Famlias Unidas
Director
Social Worker
Case Manager
Nurse
Clinical Director
Co-Coordinator (Trinity Lutheran Church)
Co-Coordinator (Trinity Lutheran Church)
Emergency Dept, Mental Health Provider
Basic Needs - Hunger Prevention
Operations Director, Disability Services
Basic Needs – Homelessness Prevention
Page 8 of 8
Appendix G: Service Inventory Service Inventory Overview & Methodology The Service Inventory identified existing services and supports available within the Hospital District 2. This was a tool for the gap analysis to compare: what community members say is needed for services and supports to what exists, and what the quantitative data analysis indicates are community health issues and the focus of the existing services and supports. The list was compiled by starting with an existing Hospital District database, with additional services added from the 211 Community Information and Referral database provided by Volunteers of America of Western Washington (VOAWW). •
•
The primary focus was on identifying services and supports provided within the Health District by governmental, non-‐profit and other charitable organizations. For-‐profit organizations that provide medical and chemical dependency services have been included, but individual and small medical, mental health and other related counseling, and alternative medical services were not included. The inventory lists major service categories and is not a comprehensive list of all individual services and programs. Appendix G: Service Inventory Page 1 Table G-‐1: Service Inventory
Services available within Hospital District 2
Name
Medical Resources
Target Population
Services Provided
City Zip
Community Health Center of Snohomish County
Doctors Express Urgent Care
Edmonds Family Medicine
Edmonds Mobile Medical Clinic (Puget Sound Christian Clinic)
Edmonds School District, Health Services
Group Health
Lake Serene Clinic
Next Step Pregnancy Services
Pac Med
Pac Med
Planned Parenthood Lynnwood Health Center
Providence Hospice and Home Care of Snohomish County
Providence Medical Group Lynnwood Clinic
Snohomish Health District Clinic, Lynnwood
Swedish/Edmonds Hospital
U.S. Health Works Medical Group
Virginia Mason Lynnwood
Low-‐income
Low-‐income
Broad community
Broad community
Uninsured
School-‐aged children
Insured members
Broad community
Expectant mothers
Broad community
Broad community
Broad community
Uninsured
Broad community
Broad community
Broad community
Broad community
Broad community
Broad community
Community health clinic (FQHC)
Community health clinic (FQHC)
Urgent Care
Primary care, walk in clinics and provider offices
Basic medical care for uninsured offered once a week at a church
In-‐school nursing services
Primary care and provider offices
Walk-‐in Clinic
Pregnancy testing, ultrasounds, community resource referrals
Primary care and provider offices
Primary care and specialty care provider offices
Clinic -‐ Family Plan/Pregnancy Options
Case management and connect uninsured to donated medical care
Hospice and home care services Urgent Care and Family Medicine
Health district services, vaccinations
Hospital services (ED, inpatient, physicians, cancer care, rehab, etc.)
Urgent Care
Primary care and specialty care provider offices
Edmonds Lynnwood
Lynnwood
Edmonds
Edmonds
Edmonds
Lynnwood
Lynnwood
Lynnwood
Lynnwood
Bothell
Lynnwood
Seattle
Everett
Lynnwood
Lynnwood
Edmonds
Lynnwood
Lynnwood
98026
98036
98036
98026
98020
98020
98036
98087
98037
98036
98021
98036
98122
98201
98087
98036
98026
98036
98036
Broad community
Broad community
Broad community
Broad community
Asian Pacific community
Broad community
Broad community
Broad community
Adults and youth Broad community
Broad community
Low-‐income
Low-‐income
Broad community
Latino community
Broad community
Broad community
Latino community
Adolescents
Broad community
Low-‐income women &families
Outpatient CD treatment Services
DV Perpetrator Tx, CD &MH outpatient treatment
CD & MH outpatient Treatment Services
DV Intervention, CD outpatient treatment
CD outpatient treatment services
Youth counseling
MH & CD treatment services
Adult residential treatment facility
CD and DV outpatient treatment services
Bi-‐lingual outpaitent substance abuse services, DV Intervention
MH & CD outpatient treatment services
Eating Disorders Counseling and Consulting
Voluntary & involuntary inpatient psychiatric and outpatient services
Counseling, domestic violence support services
Edmonds
Mountlake Terrace
Lynnwood
Edmonds
Lynnwood
Mountlake Terrace
Lynnwood
Lynnwood
Edmonds
Shoreline
Edmonds
Lynnwood
Edmonds
Lynnwood
Lynnwood
Edmonds
Lynnwood
Lynnwood
Mountlake Terrace
Edmonds
Lynnwood
98026
98043
98036
98026
98036
98043
98087
98036
98020
98155
98026
98036
98026
98036
98036
98026
98037
98036
98043
98026
98036
Behavioral Health & Chemical Dependency Services
A New Spirit Recovery Program
Alderwood Recovery
Alpine Recovery Services
Alternative Counseling
Asian Counseling Treatment Services
Assessment & Treatment Associates
Bowen Recovery Center
Burnham Education Center
Center For Counseling & Health Resources
Cole's Counseling Center
Compass Health
Compass Health Aurora House
Evergreen Manor
La Esperanza Health Counseling Services
Lakeside-‐Milam Recovery Centers
Options Treatment and Evaluations, Inc.
Sea Mar CHC -‐ Lynnwood Behavioral Health Center
Seattle Eating Disorders Counseling and Consulting
Swedish/Edmonds Hospital
YWCA of Seattle, King, Snohomish Counties
Table G-‐1
Page 1 of 3
Dental
Medical Teams International
Low-‐income families
Low-‐income, Uninsured
Dental clinic Mobile Dental services
Mobile Dental services
Lynnwood
Lynnwood
Edmonds
Lynnwood
Mill Creek
Lynnwood
98036
98036
98020
98036
98012
98037
Domestic Violence Survivors
Low-‐income, seniors, disabled
Low-‐income women and families
People with disabilities
Homeless women and children
Transitional housing (Nettie's Haven), DV Services, Visitation support
Permanent housing, rental assistance (14 properties in Health District)
Emergency shelter, transitional housing, case mgmt and other support
Group Homes and support for people with disabilities
Permanent housing, case management and other support
Transitional housing, case mgmt and other support
Permanent housing, case management and other support
Lynnwood
Everett
Lynnwood
Lynnwood
Lynnwood
Lynnwood
Mountlake Terrace
98036
98204
98036
98036
98036
98036
98043
Low-‐income
Low-‐income
Low-‐income
Low-‐income
Low-‐income
Low-‐income
Low-‐income
Low-‐income
Low-‐income
People accessing public benefits
Homeless, low-‐income
Diverse communities
People needing support
Low-‐income
People with MS
Low-‐income
Seniors & disabled
Homeless
Low-‐income
Low-‐income
Utility Assistance
Free community meal
Free community meal
Supplemental Food
Free community meal
Utility Assistance
Utility Assistance
Utility Assistance
Supplemental Food
CSO office: comprehensive state health & human services
Rent assistance, respite beds, free community meal
Basic Food Outreach, Citizenship Classes, General Referral Assistance
Access to resources, immigrant/refugee programs, caregiver support
Supplemental Food
Financial Assistance -‐ Emergencies/MS, Support Group, Medical Equip
Utility Assistance
Information -‐ Social Security
Basic needs (clothing, toiletries, etc.) provided to homeless
Food bank, emergency housing, life skills, ECEAP preschool
Clothing Bank/Gas Vouchers, Food Pantry, Support Groups/Classes
Lynnwood
Edmonds
Mountlake Terrace
Edmonds
Lynnwood
Edmonds
Lynnwood
Mountlake Terrace
Mountlake Terrace
Lynnwood
Edmonds
Lynnwood
Lynnwood
Lynnwood
Edmonds
Edmonds
Lynnwood
Lynnwood
Lynnwood
Edmonds
98087
98026
98043
98020
98036
98020
98036
98043
98043
98036
98026
98037
98036
98037
98020
98026
98036
98036
98087
98020
Ex-‐offenders
People with disabilities
Unemployed or underemployed
Unemployed or underemployed
Employment development services
Structured work, individual placement other employment services
Lynnwood
Lynnwood
Lynnwood
Mountlake Terrace
98046
98036
98036
98043
Housing
2nd Chance Human Resource Center
Housing Authority of Snohomish County (HASCO)
Pathways for Women -‐ YWCA, Seattle, King, Snohomish
Smithwright Services
Sommerset Village -‐ YWCA, Seattle, King, Snohomish
Trinity Place -‐ YWCA, Seattle, King, Snohomish
Victorian Woods -‐ YWCA, Seattle, King, Snohomish
Basic Needs
Alderwood Water District
Annies Community Kitchen
Bethesda Lutheran Church
Carol Rowe Memorial (Edmonds) Food bank
Christ's Heritage Church
City of Edmonds
City of Lynnwood
City of Mountlake Terrace
Concerns for Neighbors (MLT) Food Bank
Department of Health & Human Services
Korean Nest Mission (St. Alban's Episcopal Church)
Korean Women's Association -‐ Snohomish County
Lynnwood Food bank
Multiple Sclerosis Helping Hands
Snohomish County Public Utility District (PUD)
Social Security Administration
Trinity Lutheran 'Neighbors in Need'
Volunteers of America Western Washington
Westgate Chapel
Employment
Conviction Careers
Work Opportunities
Workforce Development/Worksource Centers
Workforce Development/Worksource Centers
Table G-‐1
Page 2 of 3
Other Support
Alzheimer's Association of Washington
Lynnwood Parks and Recreation Foundation
Mountlake Terrace Parks and Recreation
Widowed Information/Consultation Service
Family caregivers
Caregiver support groups
Seattle
98119
Recreation Benefit Fund financial assistance program
Lynnwood
98046
Michele Ringler Recreation Scholarship Fund
Support Group -‐ Widowed Persons (Meets at Trinity Lutheran)
Mountlake Terrace
Lynnwood
98043
98036
Seniors
Seniors
Seniors
Seniors, People w/disabilities, chronic Senior activities, resources, wellness and health programs
Senior activities, resources, wellness and health programs
Senior activities & resources
Comprehensive senior services, transportation, home repair, I&A, MOW
Edmonds
Lynnwood
Mountlake Terrace
Everett
98020
98036
98043
98204
Infants Youth
Youth
Youth
Homeless youth
Parents & children four years old
School-‐aged children
Children birth to three and their Children, youth w/moderate to servere disabilities
Parents
Parents & young children
Infant See free vision screenings
Youth programming, activities, nutrition education, childcare
Youth programming, activities, nutrition education, childcare
Clothing Program
South County advocate, outreach
Early childhood education and parent support
Case management support
Nurse family partnership, services for children with developmental Lynnwood
Lynnwood
Edmonds
Lynnwood
Everett
Lynnwood
Edmonds
Lynnwood
98087
98036
98020
98037
98201
98037
98020
98036
Edmonds
98020
Seattle
Seattle
98144
98103
Students
Students
Community College, including health programs
University, including nursing and health services programs
Lynnwood
Bothell
98036
98011
Low-‐income families and disabled adults
Low-‐income families Widows/Widowers
Seniors
Lynnwood Senior Center
Mountlake Senior Center
Senior Services of Snohomish County Children & Youth Programs
Alderwood Vision Therapy Center
Boys & Girls Clubs of Snohomish County (Alderwood)
Boys & Girls Clubs of Snohomish County (Edmonds)
Clothes for Kids
Cocoon House
ECEAP Lake Stickney Elementary
Edmonds School District, Homeless Services
Little Red Schoolhouse
Northwest's Child Edmonds
Parent Trust of WA
Program for Early Parent Support (PEPS)
School and skill building support Parent support and education, Family Help Line
Parent support and education
Colleges
Edmonds Community College
University of Washington Bothell & Cascadia Community College
Table G-‐1
Page 3 of 3

Appendices

Transcription

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