The North Shore- LIJ Health System. Community Service Plan Office of Community and Public Health

Transcription

1 The North Shore- LIJ Health System Community Service Plan Office of Community and Public Health

2 1. The North Shore-LIJ Mission Statement: The North Shore-Long Island Jewish Health System (referred to as NSLIJ or the System ) strives to improve the health of the communities it serves and is committed to providing the highest quality clinical care; educating the current and future generations of health care professionals; searching for new advances in medicine through the conduct of bio-medical research; promoting health education; and caring for the entire community regardless of the ability to pay. 2. Definition and brief description of community served. The Community Service Plan service areas for the North Shore-LIJ Health System were determined by using the counties in which the health system facilities are located for local health planning. With a service area of more than seven million people, North Shore LIJ Health System encompasses hospitals in the following counties: Nassau County (Franklin Hospital, Glen Cove Hospital, North Shore University Hospital, Plainview Hospital, and Syosset Hospital); New York County (Lenox Hill Hospital); Queens County (Forest Hills Hospital, Long Island Jewish Hospital, Steven and Alexandra Cohen Children's Medical Center of New York, and Zucker Hillside Hospital); Richmond County (Staten Island University Hospital); and Suffolk County (Huntington Hospital, Southside Hospital, and South Oaks Hospital). The sections below describe the community it serves based on the 5 counties that encompass the health system s service area. Nassau County Demographics Nassau County has a population of 1,339,532 people with an age distribution of 23% 0-17 years, 33% 18-4 years, 29% years, and 15% 65+ years. The county s racial distribution is 65% white, 15% Hispanic, 10% black, 8% Asian and 2% other. The average household income is $124,742 with a mean household income of $95,823 and a per capita income of $42,307. The estimated poverty rate is 5.2% and 14% of the population is defined as low income. Forty-one percent of the population 25 years and older has attained a Bachelor s Degree or higher, while 11% has less than a high school diploma. The home ownership rate is 82%. Certain communities within the county have income, education, and home ownership rates significantly below the county average and also experience higher rates of health disparities and racial diversity. These select communities are Freeport, Glen Cove, Elmont, Hempstead, Inwood, Long Beach, Roosevelt, Uniondale, and Westbury. New York County Demographics New York County has a population of 1,577,412 people, with an age distribution of 15% 0-17 years, 48% years, 24% years, and 13% 65+ years. The county s racial distribution is 48% white, 25% Hispanic, 13% Black, 11% Asian, and 3% other. The average household income is $127,411, with a median household income of $67,204 and a per capita income of $61,290. The estimated poverty rate is 17.6%. Fifty-seven percent of the population 25 years and older has attained a Bachelor s Degree or higher, while 14.9% has less than a high school diploma. The home ownership rate is 22.7%. Certain communities within the county have income and education rates significantly below the county average, and also experience higher rates of health disparities and racial diversity. These select communities are South Battery Park, East Harlem, Hell Gate, Audobon, Lincolnton, Colonial Park, Peter Stuyvesant, and Hamilton Grange. Queens County Demographics Queens County has a population of 2,235,260 people, with an age distribution of 20% 0-17 years, 41% years, 26% years, and 13% 65+ years. The county s racial distribution is 27% white, 28% 2

3 Hispanic, 18% Black, 23% Asian, and 4% other. The average household income is $72,324, with a median household income of $56,406 and a per capita income of $26,234. The estimated poverty rate is 13.7%. Twenty-nine percent of the population 25 years and older has attained a Bachelor s Degree or higher, while 19.9% has less than a high school diploma. The home ownership rate is 44.9%. Certain communities within the county have income and education rates significantly below the county average, and also experience higher rates of health disparities and racial diversity. These select communities are Fort Totten, Far Rockaway, Rockaway Beach, Jamaica, Arverne, South Ozone Park, Rochdale Village, and St. Albans. Richmond County Demographics Richmond County has a population of 468,727 people, with an age distribution of 23% 0-17 years, 36% years, 28% years, and 13% 65+ years. The county s racial distribution is 64% white, 17% Hispanic, 10% Black, 7% Asian, and 2% other. The average household income is $88,221, with a median household income of $72,752 and a per capita income of $31,267. The estimated poverty rate is 13.7%. Twenty-nine percent of the population 25 years and older has attained a Bachelor s Degree or higher, while 12.6% has less than a high school diploma. The home ownership rate is 69.8%. Certain communities within the county have income and education rates significantly below the county average, and also experience higher rates of health disparities and racial diversity. These select communities are Mariner s Harbor, Stapleton, St. George, and Port Richmond. Suffolk County Demographics Suffolk County has a population of 1,486,873 people with an age distribution of 24% 0-17 years, 34% 18-4 years, 28% years, and 14% 65+ years. The county s racial distribution is 72% white, 16% Hispanic, 7% Black, 3% Asian and 2% other. The average household income is $107,305 with a mean household income of $87,187 and a per capita income of $36,588. The estimated poverty rate is 5.7%. Thirty-two percent of the population 25 years and older has attained a Bachelor s Degree or higher while 10% has less than a high school diploma. The home ownership rate is 80%. Certain communities within the county have income, education, and home ownership rates significantly below the county average and also experience higher rates of health disparities and racial diversity. These select communities are Amityville, Wyandanch, Smithtown, Islandia, Ronkonkoma, Port Jefferson Station, Selden, Coram, Medford, Bellport, Brookhaven, Patchogue, Ridge, Mastic, Mastic Beach, Riverhead, Laurel and Greenport. 3. Public Participation (a,b,c) The North Shore-LIJ Health System employed a multi-sector approach to engage a diverse group of participants to provide input in the Community Health Needs Assessment. The health system collaborated with community based organizations with a focus on those representing communities with health disparities, local health departments, businesses, insurance companies, local health coalitions, health care providers, academia, government agencies including transportation, housing and mental health and individual community members. The sections below describe the unique public participation strategies and input for each of the counties within the NSLIJ service area. Nassau County The CHA/CHIP committee determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (e.g. the community s perception of need) (see attachment I for CHNA meeting participants and dates). The group agreed that quantitative and qualitative data should be collected from community organizations and the population-atlarge. Two subcommittees - Community-Based Organizations and Community-Wide Survey - were formed with representation from the five not-for-profit hospitals, academic partners and the Nassau County Department of Health. 3

4 I. Key Informant Interviews with Community-Based Organizations The Community-Based Organizations (CBO) subcommittee was charged with conducting key informant interviews with Nassau County s health and human services providers. The subcommittee met on January 25, 2013 to develop a list of key community organizations, a pre-interview questionnaire and a CBO interview guide. A list of community organizations was compiled based upon recommendations from both the CBO subcommittee and the larger CHA/CHIP committee. Emphasis was placed on groups that addressed one or more of the following populations: minorities/medically underserved, seniors, women s/children s services, special populations and individuals with disease-specific conditions. Next, the subcommittee developed a pre-interview questionnaire. The pre-interview questionnaire would be used to provide background information (e.g. type of services provided, demographics of persons served) prior to the in-person CBO interviews. The qualitative CBO interview guide included questions with added prompts regarding New York State s Five Prevention Agenda Priorities; significant health problems in the CBO s communities; barriers to care; quality of care; current health services; and recommendations for improving services. Finally, a specific interviewer was assigned to each CBO. The interviewers were comprised of representatives from the hospitals, the academic partners and the county health department. Interviewers were responsible for all contact with their assigned CBO. This included initial phone contact (i.e. obtain name of organizational representative and agreement to participate), contact to complete the preinterview questions and an in-person interview at the CBO. Interviewers were also required to participate in a training session to ensure consistency across the interviewing process. This training was provided on February 6, 2012, by an Assistant Professor of Preventive Medicine in the Divisions of Evaluative Services and Community Health at Stony Brook University. As a result of the training, modifications were made to the interview guide. A copy of the final CBO interview guide is included in Attachment II. The group agreed that all interviews should be audio recorded and transcribed. Transcription duties were shared among the hospitals and health department. Staff from the Nassau County Department of Health interviewed three potential consultants to conduct the qualitative analysis of the key informant interviews. With input from an academic partner, a doctoral candidate in Public Health at CUNY Graduate Center was selected. The hospitals contracted with and paid for the consultant. The consultant coded the key informant transcripts using Atlas TI software. Coding reliability was tested and an analysis was conducted to identify emergent themes. A total of 17 key informant interviews were included in the analysis. The list of participating CBOs is included in Attachment II. The consultant s findings were presented to the CHA/CHIP committee on May 15, The findings are summarized below. See Attachment II Chronic Disease Chronic disease was overwhelmingly reported as the most pressing health problem, with 50% ranking it as the #1 health priority. The most commonly mentioned chronic diseases were diabetes, heart disease and cancer. Obesity was seen as the most important risk factor for chronic conditions and preventing obesity among youth, especially among minority populations, was a strong theme. Other issues included: coordination of care for persons, especially the elderly, with multiple co-morbidities; prevalence of smoking among the mentally ill population; and the need for more time and money to be allocated to prevention efforts. Mental Health and Substance Abuse The CBOs noted an increase in the prevalence of mental health issues across all age groups and inadequate resources to address these issues, especially among the senior population. County residents 4

5 are delaying or not seeking mental health treatment due to the stigma associated with receiving services. Pain medication abuse is an increasing problem. Post-Hurricane Sandy, there has been an increase in both substance abuse and mental health problems. Healthy & Safe Environment Common themes included: poor diets, access to healthy food, lack of nutritional information and lack of exercise options for minority and low socio-economic groups. Other problems faced by low socio-economic, minority and immigrant populations were an increase in unsafe living environments (e.g. mold) due to Hurricane Sandy and environmental justice issues (e.g. water quality, built environment, outdoor air quality). Healthy Women, Infants & Children Issues raised by the CBOs included: lack of childcare funding for low-income workers, underutilization of health services by pregnant teens and older women and lack of awareness of the importance of prenatal care among high-risk populations. HIV, STD, Vaccine Preventable Diseases There is limited funding for HIV awareness, screening and prevention. Strict eligibility requirements for HIV treatment coverage present a barrier to care. Other Health Issues Identified The following barriers to health care were identified: inadequate public transportation in the county; language barriers for non-english speaking persons seeking quality health services; lack of awareness of available health resources (e.g. need to update 211 information banks); undocumented immigrant populations not accessing health care services due to fear of being reported and LGBT populations not accessing care due to fear of being treated differently. Other themes included: the need for more in-home health and mental health services for home-bound seniors; heavy reliance on emergency rooms for primary care; and the need for women to play a larger role in helping men access needed health services. II. Individual Community Member Survey The Nassau County Hospitals and the Nassau County Department of Health collaborated in developing a community-wide survey (see attachment III). The team agreed that the use of a uniform survey distributed widely throughout communities in Nassau County would help ascertain the health perceptions and key concerns of residents, as well as identify service needs and barriers to care. The format of the survey was derived from a template that was tested and used by one of the participating hospitals (St. Francis) in prior years. Criteria for developing key questions and multiple choice responses included Prevention Agenda priorities, goals and barriers to health, strategies, and demographic information. Health literate terminology was used to ensure clear communication. The survey was distributed through Survey Monkey, hospital outreach programs, public libraries, NCDOH Programs and County Agencies, and other outlets such as faith-based organizations, community centers, and social media. Individuals were asked to identify up to three main health concerns from a selected list of answers. The purpose of highlighting three was to enable the team to establish a focused group of priorities. Questions were designed to determine the individual perceptions regarding the biggest ongoing health concerns in their community, their personal health concerns, and what they considered as barriers to treatment. Additionally, they were asked to identify what they feel is most needed to improve the health of the community, including health screenings and educational resources. The last question asked where the respondents get most of their health information; respondents were asked to check all that apply. Demographic information was collected, asking respondents to identify the location where they received the survey, their sex, age, and zip codes for where they work and live. All surveys were anonymous, and offered in English and Spanish. Completed forms were sent to the Nassau County Department of Health 5

6 for analysis. Descriptive quantitative data analysis was conducted by inputting answers into Survey Monkey, downloading them into Excel and determining frequencies/percentages. A convenience sample was used to administer the survey. The survey was distributed in as many locations as possible in an effort to gain a representation of the Nassau County population. It reached a broad spectrum of community residents from many zip codes. According to 2010 US Census estimates, 19% of Nassau County s population reside in select communities. Out of 1070 surveys returned, 25.8% were from select communities, indicating that there was proportionate representation from populations with health disparities. The survey results were shared with the CHA/CHIP committee on May 15, The findings are summarized below (see Attachment IV). Responses were analyzed according to two separate populations: Nassau County and select communities. The select communities are those designated by the Nassau County Department of Health as having health disparities. Women were the primary respondents, accounting for 72.4% from Nassau County and 79.1% from select communities. Blood pressure and diabetes screenings were cited at the top priorities in the educational/screening category. Routine well visits were important in both populations; however, exercise and physical activity ranked higher for Nassau County (26.85%) than the select communities (19.3%). The top three ongoing health concerns in the Nassau County population were cancer, obesity and diabetes. Percentages in this category ranged from 33% to 44%. Select communities highlighted diabetes, drug and alcohol abuse, and cancer, with percentages ranging from 37.2% to 40.5%. Cancer was ranked as the biggest personal health concern for individuals in both populations (35.6% in Nassau County and 37.2% select communities). Other personal health concerns included heart disease and stroke, women s health and diabetes. The survey results indicate that the public is concerned about disease management and prevention, as well as affordable access to quality health care. The significance of obesity was also revealed; healthier food choices were requested, as well as exercise programs and more diabetes screenings. Substance abuse was also cited as a significant health issue. As a result, the following priorities emerged: to increase access to high quality chronic disease preventive care and management; to reduce obesity in children and adults; to address the issue of substance abuse. Other Health Issues Identified Job opportunities, and clean air and water were cited as being significant criteria in both populations for health improvement. However, weight loss programs ranked as more important proportionately to Nassau County (30%) than to the select communities (25.8%). Other health issues that were identified included mental health/depression/suicide, and women s and children s wellness. However, the differences between these were marginal ranging between 18% and 21%. The top concerns for barriers to medical treatment were the same in both populations: no insurance, lack of ability to pay deductibles and co-pays, and fear i.e., not ready to face or discuss health issues. It should also be noted that individuals cited that they feel people don t understand the need to see a doctor. New York County The Lenox Hill Hospital (LHH) Community Health Needs Assessment (CHNA) committee (LHHCHNA) (see attachment I) determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (e.g. the community s perception of need). The group agreed that qualitative data should be collected from a diverse group of community organizations that serve the population-at-large as well as those communities with health disparities. Community partners and the New York City Department of Health and Mental Hygiene were invited to participate in the CHNA process. A CHNA survey was developed and distributed to the group in the Spring of 2013 and a Manhattan Take Care New York Listening Session was held on April 21,

7 A. Community-Based Entity CHNA Survey A list of community organizations was compiled based upon recommendations from the LHH CHNA Committee. This group included 20 entities: 4 schools, 6 government agencies, and 10 community-based organizations. Emphasis was placed on groups that addressed one or more of the following populations: minorities/underserved, seniors, women s/children s services, special populations and individuals with disease-specific conditions. The committee used a survey based on a template from the Nassau County Community Based Organization Informant Interview for creating the survey questionnaire (see attachment V). The survey included a description of the population served by the entity, services provided, questions regarding New York State s Five Prevention Agenda Priorities; significant health problems in the CBO s communities; barriers to care; quality of care; current health services; recommendations for improving services and collaboration opportunities. The survey was distributed in electronic survey (SurveyMonkey) formats. A personalized invite was sent by with the SurveyMonkey link to other community partners in April 2013 with follow up invites in May The survey collection closed June 14, 2013 with a 40% response rate (see attachment V for survey respondents). The sections below describe the survey results. Chronic Disease Chronic disease was overwhelmingly reported as the most pressing health problem, ranking as the #1 health priority of the 5 New York State (NYS) Prevention Agenda Priorities. The most commonly mentioned chronic diseases were heart disease/stroke, diabetes and asthma. Obesity was seen as the most important risk factor for chronic conditions and obesity prevention for youth. Healthier food choices, recreational opportunities, safe places to walk and play and weight loss resources were identified as priority health improvement strategies. Nutrition, physical activity, chronic disease education programs, health screenings and drug/alcohol prevention were also chosen as needed services for the community. The entities listed that their clients utilize the following services: nutrition counseling, access to healthy foods (i.e. teaching gardens), chronic disease management/medical referrals, CPR/first aid, community and worksite wellness, and health programs and screenings. However, there are gaps in the availability of and access to these resources and services. Healthy & Safe Environment Common themes included in this 2 nd chosen priority included a concern for safety in the environment, and environmental hazards that may lead to injury and chronic disease. Community health strategies most needed to address these issues were safe places to walk and play, safe child care options, and clean air and water. Mental Health and Substance Abuse Promoting mental health and preventing substance abuse was the 3 nd highest NYS Prevention Agenda Priority chosen. Drug and alcohol prevention services were identified as the second most needed resource to improve the health of the community. The respondents noted an increase in the prevalence of mental health issues across all age groups and inadequate resources to address these issues. Residents may not seek mental health treatment due to lack of insurance and the stigma/fear associated with receiving services. Healthy Women, Infants & Children This was the 4 th NYS Prevention Agenda Priority chosen. Child and women s health and wellness were identified as significant community health concerns. Access to wellness programs, prenatal care, safe childcare options, safe places to play and community understanding of the importance of routine well care medical visits were identified as needed community health improvement strategies. HIV, STD, Vaccine Preventable Diseases This was the lowest ranking NYS Prevention Agenda Priority area. Recommended community health improvement services were HIV/STD screenings and immunization programs. Other Health Issues Identified The following barriers to health care were identified: language and cultural sensitivity barriers for non-english speaking persons seeking quality health services; health access related to insurance and 7

8 ability to pay co-payments and deductibles; and fear and/or lack of understanding of when to seek medical care. B. Manhattan Island Take Care New York Listening Session The Lenox Hill Hospital and the New York City Department of Health and Mental Hygiene (NYCDOHMH) collaborated in a county-wide community health needs assessment listening session focused on the NYCDOHMH Take Care New York Priority Areas (see attachment VI) on April 24, Public invitations were sent via to NYCDOH Take Care New York Partners and Lenox Hill community partners, and were posted in public areas. Forty-five community members and organizations which included community based organizations, schools, health care providers, labor groups, and government agencies participated in the session. (see attachment I). Individuals were asked to prioritize health concerns from a list of Take Care New York Priority areas, identify gaps in services and resources related to these areas and discuss areas for collaboration on these issues. Stakeholder feedback was captured via listening session and 3 survey instruments were disseminated during and after the listening session to maximize opportunities to elicit feedback: 1. Note cards: During the listening session, attendees were provided with note cards to share their questions/comments, indicate their interest in receiving additional information about specific TCNY areas, and provide their contact information if they wished to be connected with organizations sharing similar interests (see attachment VI). 2. Evaluation form: At the completion of the listening session, attendees were provided with a brief evaluation form to assess their satisfaction with the session. (see attachment VI). 3. Post-session survey: Following the listening session, attendees were sent a web-based survey to assess familiarity with TCNY and interest in TCNY priority areas, health department resources, TCNY partnership, and health department facilitation of inter-agency collaboration (see attachment VI). The top 5 Manhattan Priority Areas where chosen as follows: active living, healthy eating, tobacco free living, reduce alcohol and substance abuse, and healthy indoor and outdoor air. 1. Promote Mental Health Provision of mental health training to non-mental health professionals working with high risk populations Promotion of smoking cessation among individuals with mental illness Treatment of trauma and psychological distress and prevention of mental illness among youth 2. Active Living Access to spaces and programs that promote physical activity Connection of opportunities for physical activity 3. Healthy Eating Promotion of access of healthy foods in restaurants and bodegas Provision of programs that teach adults and youth how to prepare healthy, affordable meals Enhancement of access to healthy foods for low income New Yorkers Public support of Health Bucks program 4. Child & Adolescent Health Early childhood intervention and prevention of special needs for youth in high risk communities Promotion of adolescent mental health and prevention of unplanned pregnancy to prevent high school dropout 5. Healthy Indoor & Outdoor Air Collaboration with other city agencies to improve the environment 8

9 Queens County The Forest Hills Hospital and Long Island Jewish Medical Center Community Health Needs Assessment (CHNA) committees determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (i.e. the community s perception of need). The group agreed that qualitative data should be collected from a diverse group of community organizations that serve the population at large, as well as those communities with health disparities and a Queens NYCDOHMH Take Care New York Listening Session was planned. Queens Take Care New York Listening Session Forest Hills Hospital, Long Island Jewish Medical Center and the New York City Department of Health and Mental Hygiene (NYCDOHMH) collaborated in a county-wide community health needs assessment listening session focused on the NYCDOHMH Take Care New York Priority Areas ( see attachment VII) on May 14, Public invitations were sent via to NYCDOHMH Take Care New York Partners, Forest Hills Hospital and Long Island Jewish Medical Center community partners and were posted in public areas. Thirty three participants including 4 government agencies (excluding NYCDOHMH staff), 1 labor group, 13 health organizations/providers, 7 community-based organizations and 8 general public members participated in the session (see attachment I). Individuals were asked to prioritize health concerns from a list of Take Care New York Priority areas, identify gaps in services and resources related to these areas, and discuss areas for collaboration on these issues. Stakeholder feedback was captured via listening session, and 3 survey instruments were disseminated during and after the listening session, to maximize opportunities to elicit feedback. The three survey instruments were: 1. Note cards: During the listening session, attendees were provided with note cards to share their questions/comments, indicate their interest in receiving additional information about specific TCNY areas, and provide their contact information if they wished to be connected with organizations sharing similar interests (see attachment VII). 2. Evaluation form: At the completion of the listening session, attendees were provided with a brief evaluation form to assess their satisfaction with the session (see attachment VII). 3. Post-session survey: Following the listening session, attendees were sent a web-based survey to assess familiarity with an interest in TCNY priority areas, health department resources, TCNY partnership, and health department facilitation of inter-agency collaboration (see attachment VII). The top 7 Queens Priority Areas were chosen as follows: mental health, active living, healthy eating, child and adolescent health, healthy indoor and outdoor air, HIV prevention, and tobacco free living. Promote Mental Health recommended health improvement strategies were: Quantification of children s mental health problems Increased collaboration among CBOs, medical health providers and metal health providers Active living recommended health improvement strategies were: Creation of physical activity opportunities in schools Promotion of physical activity by primary care providers Healthy Eating recommended health improvement strategies were: Raise awareness of hunger and food insecurity issues Promotion of access to healthy foods Promote education on how to prepare healthy, affordable meals Enhancement of access to healthy foods for low income New Yorkers 9

10 Child & Adolescent Health recommended health improvement strategies were: Prevention and treatment of pediatric obesity Healthy Indoor & Outdoor Air recommended health improvement strategies were: Implementation of smoke free New York City Housing Authority housing HIV and STD Prevention recommended strategies were: Reduce stigma of NYC branded condoms Tobacco-Free Living recommended health improvement strategies were: Reduction of youth access to tobacco products Provision of tobacco cessation counseling training to case managers Provide smoke free housing education to families Richmond County The Staten Island University Hospital (SIH) Community Health Needs Assessment committee determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (e.g. the community s perception of need) ( see attachment I). The group agreed that qualitative data should be collected from a diverse group of community organizations that serve the population-at-large as well as those communities with health disparities. The longstanding SIUH Community Advisory Board as well as other community partners and the New York City Department of Health and Mental Hygiene were invited to participate in the community health needs assessment (CHNA) process. This group included 61 entities: 6 schools, 6 government agencies, and 49 community-based organizations. A CHNA survey was developed and distributed to the group in the Spring of 2013 and a Staten Island Take Care New York Listening Session was held on May 7, A. Community-Based Entity CHNA Survey A list of community organizations was compiled based upon recommendations from the SIUH CHNA Committee and the SIUH Community Advisory Board. Emphasis was placed on groups that addressed one or more of the following populations: minorities/underserved, seniors, women s/children s services, special populations and individuals with disease-specific conditions. The committee used a survey based on a template from the Nassau County Community Based Organization Informant Interview for creating the survey questionnaire (see attachment VIII). The survey included a description of the population served by the entity, services provided, questions regarding New York State s Five Prevention Agenda Priorities; significant health problems in the CBO s communities; barriers to care; quality of care; current health services; recommendations for improving services and collaboration opportunities. The survey was distributed in paper and electronic survey (SurveyMonkey) formats. The paper survey was distributed to the SIUH Community Advisory Board in March A personalized invite was sent by with the SurveyMonkey link to other community partners in April 2013 with follow up invites in May The survey collection closed June 14, 2013 with a 31% response rate (see attachment VIII for survey respondents). The sections below describe the survey results. Chronic Disease Chronic disease was overwhelmingly reported as the most pressing health problem, ranking as the #1 health priority of the 5 New York State (NYS) Prevention Agenda Priorities. The most commonly mentioned chronic diseases were diabetes, heart disease and cancer. Obesity was seen as the most important risk factor for chronic conditions and along with preventing obesity among youth, especially among minority populations. Healthier food choices, recreational opportunities and weight loss resources were identified as priority health improvement strategies. Nutrition, physical activity, chronic disease education programs and health screenings were also chosen as needed services for the community. The entities listed that their clients utilize the following services: access to healthy foods, chronic disease management/medical referrals; community wellness and health programs and screenings but there are gaps in the availability of and access to these resources and services. 10

11 Mental Health and Substance Abuse Promoting mental health and preventing substance abuse was the 2 nd highest NYS Prevention Agenda Priority chosen. Drug and alcohol rehabilitation serves were identified as the second most needed resource to improve the health of the community. The respondents noted an increase in the prevalence of mental health issues across all age groups and inadequate resources to address these issues. County residents are delaying or not seeking mental health treatment due to lack of insurance and the stigma/fear associated with receiving services. Pain medication abuse is an increasing problem. Post- Hurricane Sandy, there has been an increase in both substance abuse and mental health problems. Healthy Women, Infants & Children This was the 3 rd NYS Prevention Agenda Priority chosen. Child and women s health and wellness were identified as community health concerns. Access to wellness programs and community understanding of the importance of routine well care medical visits were identified as needed community health improvement strategies. Healthy & Safe Environment Common themes included in this 4 th priority included a concern for safety in the environment and environmental hazards that may lead to chronic disease such as cancers. Community health strategies most needed to address these issues were smoking cessation resources, safe child care options, safe places to walk and play, and clean air and water. HIV, STD, Vaccine Preventable Diseases This was the lowest ranking NYS Prevention Agenda Priority area. Recommended community health improvement services were HIV/STD screenings and immunization programs. Other Health Issues Identified The following barriers to health care were identified: language and cultural sensitivity barriers for non-english speaking persons seeking quality health services; health access related to insurance and ability to pay co-payments and deductibles; fear and/or lack of understanding of when to seek medical care; and inadequate public transportation in the county. B. Staten Island Take Care New York Listening Session The SIUH and the New York City Department of Health and Mental Hygiene (NYCDOHMH) collaborated in a county-wide community health needs assessment listening session focused on the NYCDOHMH Take Care New York Priority Areas ( see attachment IX) on May 7, Public invitations were sent via to NYCDOHMH Take Care New York Partners and SIUH community partners and were posted in public areas. Thirty eight community members and organizations which included community based organizations, schools, health care providers, labor groups, and government agencies participated in the session. (see attachment I). Individuals were asked to prioritize health concerns from a list of Take Care New York Priority areas, identify gaps in services and resources related to these areas and discuss areas for collaboration on these issues. Stakeholder feedback was captured via listening session and 3 survey instruments were disseminated during and after the listening session to maximize opportunities to elicit feedback: 1. Note cards : During the listening session, attendees were provided with note cards to share their questions/comments, indicate their interest in receiving additional information about specific TCNY areas, and provide their contact information if they wished to be connected with organizations sharing similar interests ( see attachment x). 2. Evaluation form: at the completion of the listening session, attendees were provided with a brief evaluation form to assess their satisfaction with the session. (see attachment x). 3. Post-session survey: Following the listening session, attendees were sent a web-based survey to assess familiarity with TCNY and interest in TCNY priority areas, health department resources, TCNY partnership, and health department facilitation of inter-agency collaboration ( see attachment x). 11

12 The top 5 Staten Island Priority Areas where chosen as follows: active living, healthy eating, tobacco free living, reduce alcohol and substance abuse, and healthy indoor and outdoor air. Active living recommended health improvement strategies were: Promote usage of parks & playgrounds Increase advertisements that promote walking & mileage Strategies for adults to increase exercise Healthy Eating recommended health improvement strategies were: Educate bodega owners on fresh fruits & vegetables Improve healthier food choices in vending machines Replicate proven weight-loss programs Tobacco-Free Living recommended health improvement strategies were: Increase prevention messages to children & adolescents Provide smoking cessation point of service options Reduce Alcohol & Substance Abuse recommended health improvement strategies were: Halt the closing of substance abuse & detox centers on the island Healthy Indoor & Outdoor Air recommended health improvement strategies were: Increase information on the quality of air after Hurricane Sandy Suffolk County The CHA/CHIP committee determined that in addition to census, hospitalization and vital statistics data, the assessment should include the voice of the community (e.g. the community s perception of need)( see attachment I for CHNA meeting participants and dates). The group agreed that qualitative data should be collected from community organizations and the population-at-large. A subcommittee - Community-Based Organizations Survey Committee - was formed with representation from the not-for-profit hospitals, academic partners, Nassau Suffolk Hospital Council and the Suffolk County Department of Health Services (SCDOH). I. Community-Based Entity CHNA Survey A list of community organizations was compiled based upon recommendations from the CHA/CHIP Committee. Emphasis was placed on groups that addressed one or more of the following populations: minorities/underserved, seniors, women s/children s services, special populations and individuals with disease-specific conditions. The committee used a survey based on a template from the Nassau County Community Based Organization Informant Interview for creating the survey questionnaire (see attachment X). The survey included a description of the population served by the entity, services provided, questions regarding New York State s Five Prevention Agenda Priorities; significant health problems in the CBO s communities; barriers to care; quality of care; current health services; recommendations for improving services and collaboration opportunities. The survey was distributed in paper and electronic survey (SurveyMonkey) formats. A personalized invite was sent by with the SurveyMonkey link to community entities in April 2013 with follow up invites in May In addition, individual committee members outreached to their partner community entities to increase survey participation. The survey collection closed June 14, There were 102 respondents comprised of 18 community based organizations, 10 educational organizations, 8 government agencies, 9 hospital/health organizations and 42 other organizations (see attachment X for survey respondents). The sections below describe the survey results. Health of the Community Rating The entities were asked to rate the health of the community they serve. The responses were that 1% was very healthy, 21% were healthy, 58% were somewhat healthy, 17% were unhealthy and 3% were very unhealthy. Chronic Disease 12

13 Chronic disease was overwhelmingly reported as the most pressing health problem, ranking as the #1 health priority of the 5 New York State (NYS) Prevention Agenda Priorities. The most commonly mentioned chronic diseases were cancer, diabetes and heart disease. Obesity and nutrition/eating habits were seen as the most important risk factors for chronic conditions. Quality and accessible care for the elderly was also cited as an important health problem in the county. Access to healthier food, farmers markets and weight loss resources were identified as priority health improvement strategies. Nutrition, physical activity, chronic disease education programs, especially for diabetes, and health screenings were also chosen as needed services for the community. The entities listed that their clients utilize the following services: access to healthy foods, chronic disease management/medical referrals; community wellness and health programs and screenings but there are gaps in the availability of and access to these resources and services. Mental Health and Substance Abuse Promoting mental health and preventing substance abuse was the 2 nd highest NYS Prevention Agenda Priority chosen. Drug and alcohol rehabilitation serves were identified as the second most needed resource to improve the health of the community. The respondents noted an increase in the prevalence of mental health issues across all age groups and inadequate resources to address these issues. Pain medication abuse is an increasing problem. Post-Hurricane Sandy, there has been an increase in both substance abuse and mental health problems. Healthy Women, Infants & Children This was the 3 rd NYS Prevention Agenda Priority chosen. Women s health and wellness were identified as community health concerns. Access to wellness programs and health screenings were identified as needed community health improvement strategies. Healthy & Safe Environment Common themes included in this 4 th priority included a concern for safety in the environment and environmental hazards that may lead to injury in the elderly population. Community health strategies most needed to address these issues were exercise/physical activity programs, health screening and education programs. HIV, STD, Vaccine Preventable Diseases This was the lowest ranking NYS Prevention Agenda Priority area. Recommended community health improvement services were HIV/STD screenings and immunization programs. Other Health Issues Identified The following barriers to health care were identified: health access related to insurance and ability to pay co-payments and deductibles and inadequate public transportation in the county. Nassau, Queens and Suffolk Mental Health Community Based Entity Survey In order to assess the community s mental health and substance abuse needs, staff from the Office of Community Health, South Oaks Hospital (SOH) and Zucker Hillside Hospital (ZHH) formed a committee to collect primary data from organizations that provide metal health and substance abuse services with a focus on those serving at risk and diverse communities. Organizations were identified by the Long Island Behavioral Health Management BHO Advisory Committee as well as the staff from SOH and ZHH. This group included 47 entities: 6 government agencies, 20 community-based organizations and 21 health care organizations/providers. The committee used a survey based on a template from the Nassau County Community Based Organization Informant Interview for creating the survey questionnaire but modified it to focus on behavioral health and substance abuse issues (see attachment XII). The survey included a description of the population served by the entity, services provided, and questions regarding New York State s Five Prevention Agenda Priorities; significant health problems in the CBO s communities; barriers to care; quality of care; current health services; recommendations for improving services; and collaboration opportunities. The survey was distributed in electronic survey (SurveyMonkey) formats. A personalized invite was sent by with the SurveyMonkey link to other community partners in April 2013 with follow up 13

14 invites in May The survey collection closed June 14, 2013 with a 45% response rate (see attachment XII for survey respondents). The sections below describe the survey results. Promoting mental health and prevent substance abuse was the highest NYS Prevention Agenda Priority chosen. However, chronic disease and obesity were also cited as major health concerns for this population. The top health improvement strategies identified were: drug and alcohol rehabilitation programs; mental health services; job opportunities; smoking cessation; weight loss; healthier food choices and transportation. Affordable housing for this population was also cited. The top health screenings and education needs identified were mental health and substance abuse screenings, especially integrating screenings into routine medical care and chronic disease. The barriers identified to accessing mental health and substance abuse services were: lack of availability of mental health providers; inability to pay visit co-pays and insurance deductibles; lack of insurance; lack of transportation; and fear/lack of understanding the need to seek mental health services. To address the barriers and/or gaps in mental health services the following strategies were identified: Improve access to services through insurance, ambulatory clinics, referral mechanisms and providers. Increase integration of mental health screening/referrals/awareness in other medical care providers. Increase availability of residential services, supervised group housing, and affordable/stable/permanent housing. Improve public transportation services. The participating organizations could address the barriers and gaps they identified by offering assistance in the following areas: advocacy, community education and awareness, education and integration with health care providers, expansion of services, grant seeking, and transportation. 4. Assessment and Selection of Public Health Priorities. I. Primary and Secondary Health Data Analysis Since the NSLIJ service area includes Nassau, New York, Queens, Richmond, Staten Island and Suffolk counties, individualized primary and secondary community health data collection, assessment and NYSDOH Priority Agenda Item selection was performed by county and/or region. The primary data collection and analysis was described in question 3. The secondary data analysis based on the NYSDOH Priority Agenda Items for each county is described in the following sections. Nassau County In January 2013, preliminary community health assessment data was presented (see Attachment XIII) by the NCDOH comparing Nassau County, NYS, and selected communities within Nassau County in order to further identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries, unintentional injury, intentional injury, cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. These select communities are Freeport, Glen Cove, Elmont, Hempstead, Inwood, Long Beach, Roosevelt, Uniondale, and Westbury. Sources of information included SPARCS data ( ), NYSDOH Vital Statistics, NYS Cancer Registry and the NYSDOH Surveillance System. Data were age-adjusted (direct standardization of rates) based on 2000 U.S. standard population. A mapping of Prevention Quality Indicators (PQIs) quintiles was used as part of the health data analysis. PQIs are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care sensitive conditions." These are conditions for which quality community health and outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. Even though these indicators are based on hospital inpatient data, they provide insight into the community 14

15 health care system or services outside the hospital setting. With high-quality, population health and community-based primary care, hospitalization for these illnesses often can be avoided. Although other factors outside the direct control of the health care system, such as poor environmental conditions or lack of patient adherence to treatment recommendations, can result in hospitalization, the PQIs provide a good starting point for assessing quality of health services in the community. Chronic Disease To assess chronic disease prevalence in Nassau County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Coronary heart disease and congestive heart failure hospitalizations were worse than the NYS average but slightly below the NYSPAO. Cerebrovascular (Stroke) disease mortality was significantly better than the state and national averages and achieved the NYSPAO. Circulatory PQIs had the highest rates in select communities and Bethpage, Bayville, and East Norwich. The highest hypertension PQIs were found in the select communities. Diabetes prevalence rates in Nassau County were 5.9%, significantly lower than the NYS average of 10.4% but still above the NYSPAO of 5.7%. The diabetes short term complication rate was also better than the NYS average and achieved the NYSPAO for people age 18+ years. Obesity rates for adults (BMI>30) were 16%, below the NYS average of 24% but still above the NYSPAO of 15%. Elementary, middle school and high school students had a 17% obesity rate. However, Nassau children 2-4 years enrolled in the WIC program had obesity rates of 22%, above the NYS average of 14% and the NYSPAO of 11%. Diabetes PQIs had the highest rates in select communities and Bayville and Manhasset. Breast (68.1%) and cervical cancer (52.2%) early stage diagnosis rates were higher than the US and NYS averages, but below the NYSPAO. The highest female breast cancer rates were located in the communities of Bayville, East Norwich, Mill Neck, Old Bethpage and Great Neck. Prostate cancer rates were highest in Albertson, Cedarhurst, East Rockaway, Long Beach Mill Neck, Valley Stream and Woodmere. Lung Cancer incidence for men and women per 100,000 respectively were 63.7 and Male incidence was below NYS (75.8) but above the NYSPAO of 62%. Female incidence was above NYS (53.9) and above the NYSPAO of 41%. Cigarette smoking rates for adults in Nassau County were 10.1%, below the NYS average of 18.1% and the NYSPAO of 12%. Chronic Obstructive Pulmonary Disease adult hospitalizations per 10,000 in Nassau County were 36.5,below the NYS average of 41.3, but above NYSPAO of 31.The select communities had a higher rate of COPD. Nassau County adult asthma hospitalization rates were below the NYS average but the asthma rates in the select communities were double the rates of the rest of the county. Lifestyle data including nutrition and physical activity are major factors in the prevention and management of chronic disease. Approximately 77% of Nassau County adults report that they are engaged in some type of leisure time physical activity which is above the NYS rate (73%) but below the NYSPAO target of 80%. Although the Nassau County rate is approaching the NYSPAO target, 1 out of 4 residents are inactive. Twenty-eight percent of county residents report that they eat 5 or more fruits and vegetables per day. This is above the NYS average (26.8) but below the NYSPAO target (33%). Healthy Safe Environment To assess preventable injury prevalence in Nassau County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Fall related hospitalizations for Nassau residents age 65+ years (per 10,000) were 235, higher than the NYS rate of 198 and well above the NYSPAO target of 155. The highest rates where present in Glen Cove, Locust Valley, Oyster Bay, Woodbury, Plainview, Jericho, Hicksville, Lynbrook, Atlantic Beach and Great Neck. Sixty-eight percent of the patients were female. Traumatic brain Injury admission rates including those resulting from alcohol related motor vehicle injuries were above the NYS rate. 15

16 Healthy Women, Infants and Children To assess the prevalence conditions related to the health of women, infants and children in Nassau County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). In reviewing Nassau County health birth-related statistics, several data points were above the NYS rate and below the NYSPAO. These were the percent of women enrolled in WIC with first trimester prenatal care (79% versus NYS rate of 85%), and Cesarean sections (41% versus NYS 34%). Women receiving late or no prenatal care were 3% for the county but the following communities had increased rates: Woodbury, Westbury, Hempstead, Freeport, Uniondale, Roosevelt, Lynbrook, Valley Stream and Inwood. Low birth weight rates were also elevated in many of the above communities. Pregnant women enrolled in WIC had a prepregnancy weight identified as overweight at a rate of 31% versus a NYS rate of 26%. In addition, the pre-pregnancy obesity rate of pregnant women enrolled in WIC was 22% greater than 1 in 5. The percent of obese children (ages 2-4years) enrolled in WIC was 31% versus a NYS rate of 26%. Anemia and underweight in the pediatric WIC population was also above the NYS rate. Breastfeeding rates of mothers in the WIC program were above the state average (40%) at 46%. Mental Health and Substance Abuse To assess the prevalence of metal health disorders and substance abuse in Nassau County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). Although the suicide rate (per 100,000) for Nassau County was 5.4, lower than the NYS rate (7.5), it was still above the NYSPAO of 4.8. The percent of Nassau County adults reporting 14 or more days with poor health in the last month was 9.6% compared to NYS (7.5%) and above the NYSPAO of 7.8%. PQI data for mental health emergency department visits showed increased rates in the following communities: Glen Cove, Locust Valley, Syosset, Hempstead, Uniondale, Roosevelt, Freeport, East Rockaway, Oceanside, Long Beach and Inwood. Nassau County s rate of binge drinking is 20%, above NYS (19%) and the NYSPAO of 13.4%. Drug related Nassau County hospitalizations were 19.6 %, below both NYS (25.7%) and NYSPAO (26%). PQI data for substance abuse emergency department visits showed increased rates in the following communities: Glen Cove, Locust Valley, Bayville, Mineola, Hempstead, West Hempstead, Roosevelt, East Rockaway, Oceanside, Long Beach, Island Park and Inwood. HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections To assess the prevalence of HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections in Nassau County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). Nassau County s newly diagnosed HIV case rate (per 100,000) was 8, significantly below the NYS rate (19) and NYSPAO (23). The Nassau County Gonorrhea case rate (per 100,000) was 28, lower than NYS (94) but above NYSPAO (19). The tuberculosis case rate (per 100,000) for Nassau County was 3.2, below NYS (4.9) but above NYSPAO (1). Nassau County case rates for chlamydia and pelvic inflammatory disease hospitalizations were also below the NYS rate. Communicable disease rates for Tuberculosis, syphilis, gonorrhea and chlamydia are all higher in selected communities compared to all of Nassau County. New York County Community health assessment data was analyzed comparing New York County, NYS, and selected communities within New York County in order to further identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries, unintentional injury, intentional injury, cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. These select communities are South Battery Park, East Harlem, Hell Gate, Audobon, Lincolnton, Colonial Park, Peter Stuyvesant, and Hamilton Grange. 16

17 Sources of information included SPARCS data ( ), NYSDOH Vital Statistics, the NYS Cancer Registry, and the NYSDOH Surveillance System. A mapping of Prevention Quality Indicators (PQIs) quintiles was used as part of the health data analysis. PQIs are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care sensitive conditions." These are conditions for which quality community health and outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system and services outside the hospital setting. With high-quality population health and community-based primary care, hospitalization for these illnesses can often be avoided. Although other factors outside the direct control of the health care system can result in hospitalization, such as poor environmental conditions or lack of patient adherence to treatment recommendations, the PQIs provide a good starting point for assessing quality of health services in the community. Chronic Disease To assess chronic disease prevalence in New York County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Coronary heart disease and congestive heart failure hospitalizations in New York County (36.5 and 33.0 per 10,000 respectively) were both lower than the NYS averages (43.8 and 40.1), and achieved the NYSPAOs (48.0 and 33.0). Cerebrovascular (stroke) disease mortality (19.9 per 100,000) was significantly lower than the state and national averages (27.5 and 39.0 respectively), and achieved the NYSPAO (24.0). Circulatory PQIs had the highest rates in the select communities and in Inwood. When analyzed by race and ethnicity, Blacks in New York County had the highest CHI rates of hospitalizations for overall heart disease, cerebrovascular disease, and heart disease mortality, all of which were approximately double the rates for whites. Blacks and Hispanics had the highest CHI rates for coronary heart disease and congestive heart failure hospitalizations, with the rate for the latter twice as high as whites for Hispanics, and four times as high for Blacks. Diabetes prevalence rates in New York County were 6.1%, lower than the NYS average of 10.4% and just above the NYSPAO of 5.7%. The diabetes short term complication rate for both 6-17 years and 18+ years of age was better than the NYS average, and close to the NYSPAO. Obesity rates for adults (BMI>30) were 8.4% below the NYS average of 24.5%, but still above the NYSPAO of 15%. Children 2-4 years of age enrolled in the WIC program had obesity rates of 0.4% below the NYS average of 13.1%, and 1.1% above the NYSPAO of 11.6%. Diabetes PQIs had the highest rates in the select communities, Morningside Heights, and College. When analyzed by race and ethnicity, Blacks and Hispanics had elevated CHI rates of diabetes hospitalizations. Diabetes mortality was highest in Blacks. Breast cancer early stage diagnosis rates (66.6%) were higher than the NYS average and the US average; the rates were significantly lower than the NYSPAO. Cervical cancer early stage diagnosis rates (47%) were higher than the NYS average (42.0%) and equal to the US average (47.0%), but below the NYSPAO (65%). The highest female breast cancer rates were found in Wall Street and Church Street. Prostate cancer rates were highest in Lincolnton and Bowling Green. Lung Cancer incidence for men and women respectively were 61.9 and 46.8 per 100,000. Male incidence was below NYS (75.8) and the NYSPAO (62). Female incidence was also below NYS (53.9) but above the NYSPAO (41). CHI showed that Blacks had the highest rates of lung cancer incidence, colorectal cancer mortality, and female breast cancer mortality. Cigarette smoking rates for adults in New York County were 4.3% below the NYS average of 18.1%, but above the NYSPAO of 12%. Chronic Obstructive Pulmonary Disease adult hospitalizations per 10,000 in New York County were 34.2 (7.1 below the NYS average of 41.3), only slightly above the NYSPAO of 31.The select communities had a higher rate of COPD, as well as College and Morningside Heights. New York County adult asthma hospitalization rates (25.7 per 10,000) were 17

18 above the NYS average (19.3), but the asthma rates in the select communities were in the third and fourth quartile compared to the county-wide rate. CHI showed that Blacks and Hispanics had elevated rates of asthma and chronic lower respiratory disease hospitalizations, at approximately four times the rate for whites. Lifestyle data including nutrition and physical activity are major factors in the prevention and management of chronic disease. Approximately 80.2% of New York County adults report that they are engaged in some type of leisure time physical activity, which is above the NYS rate (73.7%) and the NYSPAO target of 80%. Still, nearly 20% of residents are inactive. 13.6% of county residents report that they eat 5 or more fruits and vegetables per day. This is well below the NYS average (26.8%) and the NYSPAO target (33%). Healthy Safe Environment To assess preventable injury prevalence in New York County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Fall related hospitalizations for New York County residents age 65+ years were (per 10,000), higher than the NYS rate of and the NYSPAO target of 155. Healthy Women, Infants and Children To assess the prevalence of conditions related to the health of women, infants and children in New York County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In New York County, the percent of women receiving first trimester prenatal care was higher than NYS and lower than the NYSPAO (78.1% versus NYS rate of 73.2% and NYSPAO of 90%). The rate of low-birthweight births was slightly more than those for NYS and US (8.2%), and higher than the 5% NYSPAO. Overall infant mortality was 4.1 (per 1,000 live births), lower than NYS and achieving the NYSPAO. Increased rates of women receiving late or no prenatal care occurred in Midtown, Peck Slip, Hell Gate, East Harlem, Lincolnton, College, and Roosevelt Island. Blacks and Hispanics had reduced rates of receiving first trimester prenatal care, with only 57.6% of Blacks and 63.9% of Hispanics receiving adequate prenatal care. The percent of obese children (ages 2-4years) enrolled in WIC was 12.7% versus a NYS rate of 13.1%and NYSPAO of 11.6%. Breastfeeding rates of mothers in the WIC program at 6 months were above the state average (38.8%) at 41.9%. Mental Health and Substance Abuse To assess the prevalence of metal health disorders and substance abuse in New York County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). Although the suicide rate for New York County was 5.7 (per 100,000), lower than the NYS rate (7.5), it was still above the NYSPAO of 4.8. The percent of New York County adults reporting 14 or more days with poor mental health in the last month was 8.9% compared to 11.2% for NYS, and was above the NYSPAO of 7.8%. PQI data for mental health emergency department visits showed increased rates in the select communities, as well as Herald Square, Murray Hill, and Manhattanville. New York County s rate of binge drinking is 2.3% below NYS (19.6%), and 3.9% above the NYSPAO of 13.4%. Drug related New York County hospitalizations were 42.5 (per 10,000), higher than both NYS (25.7) and NYSPAO (26.0). PQI data for substance abuse emergency department visits showed increased rates in the following communities: Lincolnton, Murray Hill, Herald Square, East Harlem, Hell Gate, Cooper, Colonial Park, Midtown, and College. CHI showed that Blacks and Hispanics had an elevated rate of drug-related hospitalizations, with the rate for Blacks at eight times the rate for whites. Whites also had a higher suicide mortality rate than Blacks or Hispanics. HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections To assess the prevalence of HIV, STDs, Vaccine-Preventable Diseases & Health Care-Associated Infections in New York County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). The New York County newly diagnosed HIV case rate (per 100,000) was 58.2, far higher than the NYS rate (19.5) 18

19 and NYSPAO (23.0). The New York County gonorrhea case rate (per 100,000) was 157.5, higher than NYS (94.3) and far above NYSPAO (19.0). The tuberculosis case rate (per 100,000) for New York County was 7.5, above NYS (4.9) and NYSPAO (1.0). Queens County Community health assessment data was analyzed comparing Queens County, NYS, and selected communities within Queens County in order to further identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries, unintentional injury, intentional injury, cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. These select communities are Fort Totten, Far Rockaway, Rockaway Beach, Jamaica, Arverne, South Ozone Park, Rochdale Village, and St. Albans. Sources of information included SPARCS data ( ), NYSDOH Vital Statistics, the NYS Cancer Registry, and the NYSDOH Surveillance System. A mapping of Prevention Quality Indicators (PQIs) quintiles was used as part of the health data analysis. PQIs are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care sensitive conditions." These are conditions for which quality community health and outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system and services outside the hospital setting. With high-quality population health and community-based primary care, hospitalization for these illnesses can often be avoided. Although other factors outside the direct control of the health care system can result in hospitalization, such as poor environmental conditions or lack of patient adherence to treatment recommendations, the PQIs provide a good starting point for assessing quality of health services in the community. Chronic Disease To assess chronic disease prevalence in Queens County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Coronary heart disease hospitalizations in Queens County (50.9 per 10,000) were higher than the NYS average (43.8), while hospitalizations for congestive heart failure (34.9) were lower than the NYS average (40.1). Both rates were only slightly greater than the NYSPAO (33.0). Cerebrovascular (stroke) disease mortality for Queens County was significantly lower than the state and national averages (respectively, 17.6, 27.5, and 39.0 per 10,000), and achieved the NYSPAO (24.0). Circulatory PQIs had the highest rates in the select communities, Springfield Gardens, and Richmond Hills. The highest hypertension PQIs were found in the select communities, Springfield Gardens, Rosedale, Hollis, and Queens Village. CHI showed that Blacks had elevated rates of hospitalization for cerebrovascular disease and congestive heart failure. Diabetes prevalence rates in Queens County were 11%, only slightly higher than the NYS average of 10.4% but well beyond the NYSPAO of 5.7%. The diabetes short term complication rates for both 6-17 years and 18+ years of age (2.4 and 4.4 per 10,000 respectively) were better than the NYS averages (3.0 and 5.8), and close to the NYSPAOs (2.3 and 3.9). Obesity rates for adults (BMI>30) were 3.9% below the NYS average of 24.5%, but still above the NYSPAO of 15%. Children 2-4 years of age enrolled in the WIC program had obesity rates of 2.4% above the NYS average of 13.1%, and 3.9% above the NYSPAO of 11.6%. Diabetes PQIs had the highest rates in select communities, Queens Village, Springfield Gardens, and Astoria. When analyzed by race and ethnicity, Blacks had the highest CHI rates of diabetes hospitalizations. 19

20 Breast cancer early stage diagnosis rates (60.9%) were lower than the NYS average and only slightly higher than the US average; the rates were significantly lower than the NYSPAO. Cervical cancer early stage diagnosis rates (50%) were higher than the US and NYS average, but below the NYSPAO. The highest female breast cancer rates were found in Central Queens and Rockaway. Prostate cancer rates were highest in Southeast Queens, Rockaway, and Jamaica. Lung Cancer incidence for men and women respectively were 60.9 and 39.0 per 100,000. Male incidence was below NYS (75.8) and the NYSPAO (62). Female incidence was also below NYS (53.9) and the NYSPAO (41). Cigarette smoking rates for adults in Queens County were 2.6% below the NYS average of 18.1%, but above the NYSPAO of 12%. Chronic Obstructive Pulmonary Disease adult hospitalizations per 10,000 in Queens County were 31.4 below the NYS average of 41.3, and only slightly above the NYSPAO of 31.The select communities had a higher rate of COPD, as well as Astoria and East Elmhurst. Queens County adult asthma hospitalization rates were similar to the NYS average, but the asthma rates in the select communities were in the third and fourth quartile compared to the county-wide rate. CHI showed that Blacks had elevated rates of hospitalizations for asthma and chronic lower respiratory disease. Lifestyle data including nutrition and physical activity are major factors in the prevention and management of chronic disease. Approximately 71.9% of Queens County adults report that they are engaged in some type of leisure time physical activity, which is below the NYS rate (73.7%) and the NYSPAO target of 80%. Although the Queens County rate is approaching the NYSPAO target, nearly 30% of residents are inactive. 6.8% of county residents report that they eat 5 or more fruits and vegetables per day. This is well below the NYS average (26.8%) and the NYSPAO target (33%). Healthy Safe Environment To assess preventable injury prevalence in Queens County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Fall related hospitalizations for Queens residents age 65+ years were (per 10,000), lower than the NYS rate of but above the NYSPAO target of 155. Traumatic brain injury admission rates within the county were approximately the same as NYS rates, and brain injuries resulting from alcohol related motor vehicle injuries were well below the NYS rate. Healthy Women, Infants and Children To assess the prevalence of conditions related to the health of women, infants and children in Queens County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In Queens County, the percent of women receiving first trimester prenatal care was lower than both NYS and the NYSPAO (70.2% versus NYS rate of 73.2% and NYSPAO of 90%). The rate of low-birthweight births was identical to those for NYS and US (8.2%), but higher than the 5% NYSPAO. Overall infant mortality was 4.3 (per 1,000 live births), lower than NYS and achieving the NYSPAO. Women receiving late or no prenatal care were 11% for the county, but the following communities had increased rates: Astoria, Jamaica, Long Island City, Elmhurst, Corona, Woodside, Jackson Heights, and East Elmhurst. When analyzed by race and ethnicity, Blacks and Hispanics had lower CHI rates of receiving first trimester prenatal care, with only 56.8% and 64.6% respectively receiving adequate prenatal care. The percent of obese children (ages 2-4years) enrolled in WIC was 15.5% versus a NYS rate of 13.1%and NYSPAO of 11.6%. Breastfeeding rates of mothers in the WIC program at 6 months were above the state average (38.8%) at 47.9%. Mental Health and Substance Abuse To assess the prevalence of metal health disorders and substance abuse in Queens County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). Although the suicide rate for Queens County was 5.2 (per 100,000), lower than the NYS rate (7.5), it was still above the NYSPAO of 4.8. The percent of Queens County adults reporting 14 or more days with poor mental health in the last month was 7.2% compared to 11.2% for NYS, and met the NYSPAO of 7.8%. PQI data for mental health emergency 20

21 department visits showed increased rates in the select communities, as well as Glen Oaks, Long Island City, and Rockaway Park. Queens County s rate of binge drinking is 8.1% below NYS (19.6%), and 1.9% below the NYSPAO of 13.4%. Drug related Queens County hospitalizations were 14.5 (per 10,000), below both NYS (25.7) and NYSPAO (26.0). PQI data for substance abuse emergency department visits showed increased rates in the following communities: North Shore Towers, Jamaica, Richmond Hill, Far Rockaway, Rockaway Park, and Rockaway Beach. CHI data indicated that Blacks and whites had drug-related hospitalization rates of about two times those for Hispanics. Whites had a higher suicide mortality rate than Blacks or Hispanics. HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections To assess the prevalence of HIV, STDs, Vaccine-Preventable Diseases & Health Care-Associated Infections in Queens County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). The Queens County newly diagnosed HIV case rate (per 100,000) was 25.9, higher than the NYS rate (19.5) and NYSPAO (23.0). The Queens County gonorrhea case rate (per 100,000) was 82.4, lower than NYS (94.3) but far above NYSPAO (19.0). The tuberculosis case rate (per 100,000) for Queens County was 12.0, above NYS (4.9) and NYSPAO (1.0). Richmond County Community health assessment data was analyzed comparing Richmond County, NYS, and selected communities within Richmond County in order to further identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries, unintentional injury, intentional injury, cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. These select communities are Mariner s Harbor, Stapleton, St. George, and Port Richmond. Sources of information included SPARCS data ( ), NYSDOH Vital Statistics, the NYS Cancer Registry, and the NYSDOH A mapping of Prevention Quality Indicators (PQIs) quintiles was used as part of the health data analysis. PQIs are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care sensitive conditions." These are conditions for which quality community health and outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system and services outside the hospital setting. With high-quality population health and community-based primary care, hospitalization for these illnesses can often be avoided. Although other factors outside the direct control of the health care system can result in hospitalization, such as poor environmental conditions or lack of patient adherence to treatment recommendations, the PQIs provide a good starting point for assessing quality of health services in the community. Chronic Disease To assess chronic disease prevalence in Richmond County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Coronary heart disease hospitalizations in Richmond County (52.6 per 10,000) were higher than the NYS average (43.8) and the NYSPAO (48.0), while hospitalizations for congestive heart failure (31.1 per 10,000) were lower than the NYS average (40.1) and achieved the NYSPAO (33.0). Cerebrovascular (stroke) disease mortality was significantly lower than the state and national averages (respectively, 14.8, 27.5, and 39.0) and achieved the NYSPAO (24.0). Circulatory PQIs and hypertension PQIs had the highest rates in Mariner s Harbor and Stapleton. CHI showed that Hispanics had elevated CHI rates of cerebrovascular disease mortality, while Blacks had nearly twice the rate of hospitalizations as whites and Hispanics. Blacks also had elevated rates of congestive heart failure hospitalizations, at 39.7 (per 10,000). 21

22 Diabetes prevalence rates in Richmond County were 8.5%, lower than the NYS average of 10.4% but above the NYSPAO of 5.7%. The diabetes short term complication rates for both 6-17 years and 18+ years of age was better than the NYS averages (respectively, 2.1 and 4.2 per 10,000 vs. 3.0 and 5.8), and close to the NYSPAO (2.3 and 3.9). Obesity rates for adults (BMI>30) were 26.6%, above the NYS average of 24.5% and well above the NYSPAO of 15%. Children 2-4 years of age enrolled in the WIC program had obesity rates of 4.6% above the NYS average of 13.1%, and 6.1% above the NYSPAO of 11.6%. Diabetes PQIs had the highest rates in Mariner s Harbor and St. George. When analyzed by race and ethnicity, Blacks and Hispanics had elevated CHI rates of diabetes mortality, with Blacks possessing the highest rate for diabetes hospitalizations. Breast cancer early stage diagnosis rates (65.4%) were slightly higher than the NYS and US averages (64.8% and 60%), and were significantly lower than the NYSPAO (80%). Cervical cancer early stage diagnosis rates (49.4%) were higher than the US and NYS averages (42.0% and 47.0%), but below the NYSPAO (65%). The highest female breast cancer rates were found in Great Kills and Eltingtonville. Prostate cancer rates were highest in Mariner s Harbor. Lung Cancer incidence for men and women respectively were 79.6 and 57.3 per 100,000. Male incidence was above NYS (75.8) and the NYSPAO (62.0). Female incidence was also above NYS (53.9) and the NYSPAO (41). CHI data showed that whites had elevated rates of lung cancer incidence when compared to Blacks and Hispanics. Chronic Obstructive Pulmonary Disease adult hospitalizations per 10,000 in Richmond County were 44.5, above the NYS average of 41.3, and above the NYSPAO of Mariner s Harbor, Port Richmond, and Stapleton had the highest rates of COPD. Richmond County asthma hospitalization rates were slightly higher than but similar to the NYS average. CHI data showed that Hispanics and Blacks had elevated rates of asthma hospitalizations, at approximately two and three times the rate of whites respectively. Lifestyle data including nutrition and physical activity are major factors in the prevention and management of chronic disease. Approximately 70.2% of Richmond County adults report that they are engaged in some type of leisure time physical activity, which is below the NYS rate (73.7%) and the NYSPAO target of 80%. Although the Richmond County rate is approaching the NYSPAO target, nearly 30% of residents are inactive. Ten percent of county residents report that they eat 5 or more fruits and vegetables per day. This is well below the NYS average (26.8%) and the NYSPAO target (33%). Healthy Safe Environment To assess preventable injury prevalence in Richmond County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). Fall related hospitalizations for Richmond County residents age 65+ years were (per 10,000), lower than the NYS rate of but above the NYSPAO target of 155. Healthy Women, Infants and Children To assess the prevalence of conditions related to the health of women, infants and children in Richmond County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). In Richmond County, the percent of women receiving first trimester prenatal care was higher than the NYS rate and lower than the NYSPAO (81.7% versus NYS rate of 73.2% and NYSPAO of 90%). The rate of low-birthweight births was nearly identical to those for NYS and US (8.2%), but higher than the 5% NYSPAO. Overall infant mortality was 4.6 (per 1,000 live births), lower than NYS and within 0.1 of the NYSPAO. Women receiving late or no prenatal care were highest in Port Richmond, Mariner s Harbor, and St. George. CHI data showed that Blacks had elevated rates of low birthweight births. Blacks and Hispanics had low CHI rates of adequate prenatal care. The percent of obese children (ages 2-4years) enrolled in WIC was 17.7% versus a NYS rate of 13.1% and NYSPAO of 11.6%. Breastfeeding rates of mothers in the WIC program at 6 months were above the state average (38.8%) at 39.4%. Mental Health and Substance Abuse To assess the prevalence of metal health disorders and substance abuse in Richmond County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). Although the suicide rate for Richmond County was

23 (per 100,000), lower than the NYS rate (7.5), it was still above the NYSPAO of 4.8. The percent of Richmond County adults reporting 14 or more days with poor mental health in the last month was 6.3% compared to 11.2% for NYS, and met the NYSPAO of 7.8%. PQI data for mental health emergency department admissions showed increased rates in St. George, Rosebank, and West New Brighton. Richmond County s rate of binge drinking is 5.2% below NYS (19.6%), and 1.0% above the NYSPAO of 13.4%. Drug related Richmond County hospitalizations were 43.9 (per 10,000), above both NYS (25.7) and NYSPAO (26.0). PQI data for substance abuse emergency department visits showed increased rates in Rosebank, New Dorp, and Tottenville. CHI data indicated that Blacks and whites had drug-related hospitalization rates of about two times those for Hispanics. Statistics were unstable or unavailable for suicide mortality in Blacks and Hispanics. HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections To assess the prevalence of HIV, STDs, Vaccine-Preventable Diseases & Health Care-Associated Infections in Richmond County, the county prevalence is compared to New York State (NYS) and national prevalence, and to the NYS Prevention Agenda Objectives (NYSPAO). The Richmond County newly diagnosed HIV case rate (per 100,000) was 12.1, lower than the NYS rate (19.5) and NYSPAO (23.0). The Richmond County gonorrhea case rate (per 100,000) was 43.3, lower than NYS (94.3) but far above NYSPAO (19.0). The tuberculosis case rate (per 100,000) for Richmond County was 3.7, lower than NYS (4.9) but higher than NYSPAO (1.0). Suffolk County In April 2013, community health assessment data was presented (see attachment XIV) by the Suffolk County Department of Health Services using the NYSDOH Community Health Indicator (CHI) Reports identifying Suffolk County residents prevalence of health indicator groupings in order to further identify and compare rates of age/ethnicity/race distribution, diseases of the cardiovascular system (including stroke), diseases of the respiratory system, diabetes and liver disease, injuries, unintentional injury, intentional injury, cancer, communicable diseases, mortality, and pregnancy/perinatal outcomes. Selected communities within Suffolk County with higher rates of health disparities were determined by income, education, and home ownership rates and racial diversity. These select communities are Amityville, Wyandanch, Smithtown, Islandia, Ronkonkoma, Port Jefferson Station, Selden, Coram, Medford, Bellport, Brookhaven, Patchogue, Ridge, Mastic, Mastic Beach, Riverhead, Laurel and Greenport. Sources of information included SPARCS data ( ), NYSDOH Vital Statistics, NYS Cancer Registry and the NYSDOH Surveillance System. A mapping of Prevention Quality Indicators (PQIs) quintiles was used as part of the health data analysis. PQIs are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for "ambulatory care sensitive conditions." These are conditions for which quality community health and outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. The PQIs are population based and adjusted for covariates. Even though these indicators are based on hospital inpatient data, they provide insight into the community health care system and services outside the hospital setting. With high-quality population health and community-based primary care, hospitalization for these illnesses can often be avoided. Although other factors outside the direct control of the health care system can result in hospitalization, such as poor environmental conditions or lack of patient adherence to treatment recommendations, the PQIs provide a good starting point for assessing quality of health services in the community. Chronic Disease To assess chronic disease prevalence in Suffolk County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. 23

24 Cardiovascular disease/coronary heart disease, stroke and hypertension were in the 4 th quartile of the Community Health Indicator. Suffolk County coronary heart disease hospitalization rates (57 per 10,000) were worse than the NYS average (44) and above the NYSPAO (48). Congestive heart failure hospitalizations followed the same pattern. When analyzed by race and ethnicity, the CHI rates were higher in Hispanic and Black populations for heart disease and cerebrovascular hospitalizations. Blacks had the highest CHI rates for stroke, coronary heart disease mortality and congestive heart failure mortality. Hispanics had the highest CHI rates for cardiovascular and cerebrovascular disease hospitalizations. Cerebrovascular (Stroke) disease mortality was significantly better than the state and national averages and achieved the NYSPAO. The highest Circulation PQIs were found in the select communities listed above. Diabetes prevalence rates in Suffolk County were 9%, lower than the NYS average of 10.4% but still above the NYSPAO of 5.7%. The diabetes short term complication rate was also better than the NYS average and achieved the NYSPAO for people age 18+ years. When analyzed by race and ethnicity, the CHI rates for diabetes hospitalizations were elevated in Blacks and Hispanics. Diabetes mortality was highest in Blacks. Obesity rates for adults (BMI>30) were 21%, below the NYS average of 24%, but still above the NYSPAO of 15%. Elementary, middle school and high school students were in the 3 rd and 4 th quartiles for percent overweight and percent obese for the CHI. However, Suffolk children 2-4 years enrolled in the WIC program had obesity rates of 22%, above the NYS average of 14% and the NYSPAO of 11%. Diabetes PQIs had the highest rates in select communities. Breast (62%) and colorectal cancer (46%) early stage diagnosis rates were higher than the US and NYS average but below the NYSPAO. CHI show that Blacks had higher colorectal cancer and female breast cancer mortality and the lowest percent early stage of earlier diagnosis. Cervical cancer early stage diagnosis rates (47.3%) were higher than NYS and US rates but below the NYSPAO (50%). The highest female breast cancer rates are in the communities of Oakdale, Orient and West Hampton. Prostate cancer rates were highest in Mt. Sinai, E. Moriches, Laurel, Peconic and West Hampton. Lung Cancer incidence for men and women per 100,000 respectively were 79.9 and Male incidence was above NYS (75.8) and the NYSPAO of 62%. Female incidence was above NYS (53.9) and above the NYSPAO of 41%. Cigarette smoking rates for adults in Suffolk County were 17.7%, below the NYS average of 18.1% and above the NYSPAO of 12%. Chronic Obstructive Pulmonary Disease adult hospitalizations per 10,000 in Suffolk County were 40.6, above the NYS average of 41.3 and the NYSPAO of 31.The select communities had a higher rate of COPD. Suffolk County adult asthma hospitalization rates were below the NYS average but the asthma rates in the select communities were higher the rates of the rest of the county. Lifestyle data including nutrition and physical activity are major factors in the prevention and management of chronic disease. Approximately 77% of Suffolk County adults report that they are engaged in some type of leisure time physical activity which is above the NYS rate (73%) but below the NYSPAO target of 80%. Although the Suffolk County rate is approaching the NYSPAO target, approximately 1 out of 4 residents are inactive. Twenty-eight percent of county residents report that they eat 5 or more fruits and vegetables per day. This is above the NYS average (26.8) but below the NYSPAO target (33%). Healthy Safe Environment To assess preventable injury prevalence in Suffolk County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). In addition, communities within the county that have higher prevalence rates than the county average have been identified. Fall related hospitalizations for Suffolk residents age 65+ years (per 10,000) were 224, higher than the NYS rate of 198 and well above the NYSPAO target of 155. CHI show that Hispanics had the highest incidence of unintentional injury and fall hospitalizations. The highest rates where present in Huntington, Melville, West Islip, Hauppauge, St. James, Stonybrook, Centereach, Port Jefferson Station, Medford, Yaphank, Brookhaven, Center Moriches, Oakdale, Sayville, Southside, Greenport and Shelter Island. Sixty-eight percent of the patients were female. Traumatic brain 24

25 Injury admission rates including those resulting from alcohol related motor vehicle injuries were above the NYS rate. Healthy Women, Infants and Children To assess the prevalence conditions related to the health of women, infants and children in Suffolk County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). The percent of women enrolled in WIC with first trimester prenatal care was on par with NYS at 73%, but below the NYSPAO (90%). Blacks and Hispanic groups had the lowest rates (57%) as well as the lowest percent of adequate prenatal care (48 and 50% respectively). Women receiving late or no prenatal care were 4% for the county but the following communities had increased rates: Copiague, Amityville, Lindenhurst, W. Babylon, Wyandanch, Deer Park, Bay Shore, Brentwood, Central Islip, Medford, Bellport, Riverhead and Greenport. Low birth weight rates were also elevated in many of the above communities. Pregnant women enrolled in WIC had a pre-pregnancy weight identified as overweight at a rate of 8.6% versus a NYS rate of 15.4%. In addition, the pre-pregnancy obesity rate of pregnant women enrolled in WIC was 26%, greater than 1 in 4. The percent of obese children (ages 2-4years) enrolled in WIC was 20%, versus a NYS rate of 13%. Underweight in the pediatric WIC population was also above the NYS rate. Breastfeeding rates of mothers in the WIC program were on par with the NYS average (39%) but below the NYSPAO of 50%. Mental Health and Substance Abuse To assess the prevalence of metal health disorders and substance abuse in Suffolk County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). Although the suicide rate (per 100,000) for Suffolk County was 6.8, and lower the NYS rate (7.5), it was still above the NYSPAO of 4.8. The percent of Suffolk County adults reporting 14 or more days with poor health in the last month was 13% compared to NYS (11%) and above the NYSPAO of 7.8%. Whites had the highest rate of drug related hospitalizations and both Blacks and Whites had double the suicide rate (7.2 and 6.8 respectively) than Hispanics (3.3). PQI data for mental health emergency department visits showed increased rates in the following communities: Huntington, Greenlawn, E. Northport, Port Jefferson, Port Jefferson Station, Coram, Patchogue, Ridge, Brookhaven, Mastic, Mastic Beach, Moriches and the North Fork. Suffolk County s rate of binge drinking is 20%, above NYS (19%) and the NYSPAO of 13.4%. Drug related Suffolk County hospitalizations were on par with the NYS (26%) and NYSPAO. PQI data for substance abuse emergency department visits showed increased rates in the following communities: Ronkonkoma, Bohemia, Oakdale, Holtsville, Ridge, Mastic Beach, Mastic, Shirley, Center Moriches, Riverhead and the North Fork. HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections To assess the prevalence of HIV, STDs. Vaccine-Preventable Diseases & Health Care-Associated Infections in Suffolk County, the county prevalence is compared to New York State (NYS) and national prevalence and in relation to the NYS Prevention Agenda Objectives (NYSPAO). Suffolk County newly diagnosed HIV case rate (per 100,000) was 7.3, significantly below the NYS rate (19) and NYSPAO (23). The Suffolk County Gonorrhea case rate (per 100,000) was 29, lower than NYS (94) but above NYSPAO (19). Tuberculosis case rate (per 100,000) for Suffolk County was 3.4, below NYS (4.9) and the NYSPAO (1). II. Identified Health Priorities As a result of the primary and secondary data analysis the following health priorities emerged as pressing community health issues based on county: Nassau County: Chronic disease, especially in at risk and diverse communities Obesity 25

26 Decreased consumption of and access to healthy foods Decreased physical activity and access to safe recreational areas Mental health and substance abuse Access to healthcare New York County Chronic disease, especially in at risk and diverse communities Obesity Decreased consumption of and access to healthy foods Decreased physical activity and access to safe recreational areas Mental health and substance abuse Access to healthcare Healthy indoor and outdoor air Language and cultural sensitivity Queens County Chronic disease, especially in at risk and diverse communities Obesity Mental health and substance abuse Decreased consumption of and access to healthy foods Decreased physical activity and access to safe recreational areas Healthy indoor and outdoor air/ tobacco free living Access to healthcare Richmond County Chronic disease, especially in at risk and diverse communities Obesity Decreased consumption of and access to healthy foods Decreased physical activity and access to safe recreational areas Mental health and substance abuse Healthy indoor and outdoor air/ tobacco free living Access to healthcare Language and cultural sensitivity Suffolk County Chronic disease, especially in at risk and diverse communities Obesity Decreased consumption of and access to healthy foods Decreased physical activity and access to safe recreational areas Mental health and substance abuse Access to healthcare Nassau, Queens and Suffolk Mental Health Increased alcohol and drug Abuse Increased prevalence of mental health disorders especially depression and suicide Obesity Chronic disease, especially in at risk and diverse communities 26

27 Tobacco use Access to healthcare III. Collaborative Process and Criteria for Prioritizing NYSDOH Priority Agenda Items The North Shore LIJ Health System (NSLIJ) began the Community Health Needs Assessment (CHNA) process in January As an integrated health care system, the Office of Community and Public Health was the lead corporate office that planned, coordinated and reported the CHNA in collaboration with internal and external stakeholders for NSLIJ. Health system stakeholders included senior leadership, the Committee on Community Health of the NSLIJ Board of Trustees, executive directors and staff of NSLIJ hospitals, Office of Planning, Office of Government and Community Affairs and corporate service lines (see attachment I). External stakeholders included representatives from county health departments, area hospitals, academia, business, government agencies and community based organizations with an emphasis on those who serve communities with health disparities (see attachment I). A series of internal and external stakeholder meetings were held to discuss the process including: the CHNA methodology; recruitment of community, academic and government partners; secondary data analysis; primary data collection from external stakeholders; evaluation of primary data; identification of health system and community resources; identification of NYSDOH Priority Agenda items and development of the implementation plan. The Committee on Community Health of the NSLIJ Board of Trustees was updated on the CHNA process during its quarterly meetings, provided feedback on the process including the section of the NYSDOH Priority Agenda items and approved the recommended NYSDOH Priority Agenda items and the implementation plan for the NSLIJHS as the governing body of community health of the NSLIJHS Board of Trustees. The NYSDOH Priority Agenda Items were selected based on the following criteria adapted from the Catholic Health Association Assessing and Addressing Community Health Needs Manual: 1. Magnitude- The magnitude of the problem as it relates to the number of community members impacted by the issue. 2. Severity- The severity of the problem which is determined by the risk of morbidity and mortality associated with the problem. 3. Historical trends- The prevalence of the issue over time. 4. Alignment of the problem with the organization s strengths and priorities. 5. Impact of the problem on vulnerable populations. 6. Importance of the problem to the community. 7. Existing resources addressing the problem. 8. Relationship of the problem to other community issues. 9. Feasibility of change and the availability of evidence-based approaches. 10. Value of immediate intervention versus any delay, especially for long-term or complex threats. A discussion and debate approach was utilized to identify Priority Agenda Items. Health system, county and regional priority-setting groups comprised of representatives from internal and external CHNA stakeholders met to discuss the needs identified in the primary and secondary data analysis, and applied the criteria listed above to these needs to identify priorities. Priority-setting group consensus on Priority Agenda Items and focus areas was reached. The priority-setting groups then proceeded to validate the priorities chosen to confirm that the needs identified are the needs that should be addressed by presenting the process used for setting priorities and conclusions to internal and external stakeholders. These stakeholders included community-based organizations, academic public health experts, health system and facility community health staff, and other key stakeholders. 27

28 IV. NSLIJHS NYSDOH Priority Agenda Items To improve the health of the community, the NSLIJHS, as a result of the CHNA process described previously and approved by the Committee on Community Health of the NSLIJ Board of Trustees, has selected the following Priority Agenda Item and focus areas for the service area of the health system: PRIORITY AREA: Prevent Chronic Disease FOCUS AREA: Reduce obesity in children & adults Create community environments that promote & support healthy food and beverage choices & physical activity Prevent childhood obesity through early child care & schools Expand the role of health care, health service providers, & insurers in obesity prevention Expand the role of public & private employers in obesity prevention FOCUS AREA: Increase access to high-quality chronic disease preventive care & management in both clinical & community settings Increase screening rates for cardiovascular disease, diabetes, & breast/cervical/colorectal cancers, especially among disparate populations Promote use of evidence-based care to manage chronic diseases Promote culturally relevant chronic disease self-management education Integration of mental health awareness & screening To address the mental health needs identified by the CHNA process, the South Oaks Hospital and Zucker Hillside Hospital will focus on the following Priority Agenda Item and focus areas: PRIORITY AREA: Promote Mental Health & Prevent Substance Abuse FOCUS AREA: Promote Mental, Emotional, & Behavioral Health Promote mental, emotional, & behavioral well-being in communities FOCUS AREA: Strengthen Infrastructure Across Systems Support collaboration among professionals working in fields of mental, emotional, and behavioral health promotion & chronic disease prevention, treatment, and recovery Strengthen infrastructure for mental, emotional, and behavioral health promotion & mental, emotional, and behavioral disorder prevention 5. Three Year Plan of Action North Shore LIJ Health System (NSLIJ) Implementation Plan PRIORITY AREA: Prevent Chronic Diseases: Increase access to high quality chronic disease preventive care and management in both clinical and community settings GOALS: Increase screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancers, especially among disparate populations. Promote culturally relevant chronic disease self management education. Prevent initiation of tobacco use by New York youth and young adults, especially among low 28

29 socioeconomic status (SES) populations. Promote tobacco use cessation, especially among low SES populations and those with poor mental health. Eliminate exposure to secondhand smoke. PERFORMANCE MEASURES Short Term Indicators Source Frequency By December 31, 2014, increase public awareness of chronic disease prevention through utilization of media channels by 15% from 2013 NSLIJHS public relations data. By December 31, 2014, increase the percentage of adults participating in screenings from disparate communities by 15% from 2013 community benefit data. By December 31, 2014, increase the percentage of adults participating in chronic self disease management programs by 30% from 2013 OCPH data. By December 31, 2014, increase provider compliance with 5A s (chart review) tobacco cessation counseling by 5%. By December 31, 2014, increase in volume of electronic medical record for tobacco counseling by 5%. By December 31, 2014, increase in number of smoke free housing unit by 500 units. By December 31, 2014, increase in number of organizations with voluntary smoke free outdoor air policies by 3. Public Relations media stats Community Benefit reporting Office of Community and Public Health (OCPH) data Center for Tobacco Control(CTC) Data; EMR data OCPH; NYSDOH,NYCDOMH tobacco control data Annual Annual Annual Annual Long Term Indicators Source Frequency By December 31, 2017, increase the percentage of adults 18 years of age and older who had a test for high blood sugar, diabetes, cholesterol, blood pressure and BMI within the past three years 3% from 58.8% (2011) to 61.7%. By December 31, 2017, increase by at least 5% the percentage of adults with arthritis, asthma, cardiovascular disease, or diabetes who have taken a course or class to learn how to manage their condition. By December 31, 2017, decrease the prevalence of any tobacco use (cigarettes, cigars, smokeless tobacco) by high school age students by 30% from 21.2% (2010) to 15.0%. By December 31, 2017, decrease the prevalence of cigarette smoking by adults ages years by 17% from 21.6% (2011) to 18%. By December 31, 2017, decrease the prevalence of cigarette smoking by adults ages 18 years and older: By 17% from 18.1% to 15.0% among all adults. By 28% from 27.8% (2011) to 20.0% among adults with income less than $25,000. By 17% from 29% (2011) to 24% among adults who report poor NYS Behavioral Risk Factor Surveillance System [BRFSS] BRFSS; annual measure, (beginning 2013) NYS Behavioral Risk Factor Surveillance System [BRFSS]; NY Adult Tobacco Survey; NYS Youth Tobacco Survey; Community Activity Tracking, CAT Bi Annually Annually Annually Bi Annually Annually 29

30 mental health. By December 31, 2017, decrease the percentage of adults who report being exposed to secondhand smoke during the past 7 days by 10%. By December 31, 2017, increase the number of Local Housing Authorities that adopt a tobacco free policy for all housing units by 10%. By December 31, 2017, increase the integration of cessation curriculum into health provider training by 5%. Activity: Raise public awareness of the Short term metrics monitoring impact of healthy lifestyle behaviors on prevention of Chronic Disease Develop campaign signage / brochures / PSA in collaboration with community partners. Incorporate wellness messaging into hospital publications, website and patient education media channels. Identify additional community based media channels with community partners for ongoing promotion of campaign (i.e. LTE, OpEd, etc). Partner in the development and launch of the Long Island Health Collaborative, a partnership between the Nassau and Suffolk County hospitals, departments of health, Nassau Suffolk Hospital Council and community based organizations (CBO), media campaign and website. Activity: Target community health screenings to communities with high prevalence of Preventable Quality Indicators and needs based on the Community Health Needs Assessment (CHNA) Use CHNA data to identify communities with high disease prevalence rates especially communities with other socioeconomic risk factors. Collaborate with CBOs in high need communities who serve high risk population and hold health screenings at community sites and provide health access and food assistance programs services at screenings. Create a data base for community health screenings to facilitate referrals and follow up care navigation. CTC data # Campaign materials created Track # community members enrolled in wellness programs. Track scope /reach of hospital based media channels Track scope /reach of community based media channels. Track number of community based earned media credited. Track # of hits to Long Island Health Collaborative Wellness Site. Short term metrics Track # screenings in health disparate communities or community participants from health disparate communities using resident zip codes reported as a percentage of all health screenings. Track # screenings in health disparate communities or community participants from health disparate communities with community partners reported as a percentage of all health screenings # of community members screened and/or enrolled in health access and food assistance programs. Analysis of demographic, health screening results and navigation follow up data. Annually NSLIJHS Facility System wide System wide System wide Nassau &Suffolk County Facilities System wide System wide System wide 30

31 Create/Expand chronic disease management support groups at hospital and community sites. Activity: Provide access to communitybased chronic disease self management programs with a focus on health disparate populations. Implement the evidence based Chronic Disease Self Management Program (Better Choices, Better Health Workshop). Implement the evidence based National Diabetes Prevention Program (DPPP). Establish clinical community linkages that connect patients/community members to self management education and community resources. Activity: Implement a multi media Tobacco Control Campaign across the service area. Develop campaign signage / brochures / PSA in collaboration with community partners. Incorporate Tobacco Control messaging into hospital publications, website and patient education media channels. Identify additional community based media channels with community partners for ongoing promotion of campaign. Identify additional community based media channels with community partners for ongoing promotion of campaign (i.e. LTE, OpEd, etc). Incorporate use of NYS Quit Line and CTC community programming into media messaging. Expand community cessation programs in collaboration with CTC and DOH as needed. Activity: Increase the number of providers utilizing best practice guidelines to support patient education re: smoking cessation. Participate in New York City Smoke Free Hospital Campaign. Track number and origin of referrals to and participants in chronic disease support groups. Short term metrics Analyze Pre Post and 3 month validated knowledge, behavior assessments, participant demographic data and disease outcomes. Analyze Pre Post and 3 month validated knowledge, behavior assessments, participant demographic data and disease outcomes. Track number of referrals from community based organizations Track patients and community members at risk for diabetes referred to community DPPPs. Short term metrics # Campaign materials created Track # community members enrolled in cessation programs. Track scope /reach of hospital based media channels. Track scope /reach of community based media channels. Track number of community based earned media. Track number of calls to Quit line. Track number community members in smoking cessation classes. Short term metrics System wide System wide Southside Hospital System wide System wide System wide System wide System wide System wide System wide Track level of achievement (Bronze through Gold) with associated program metrics. New York City Facilities Educate hospital providers on evidence Track # of trainings, sites, participants. System 31

32 based best practices the 5A s (ask, advise, assess, assist and arrange): 1)Provide in depth training on smoking cessation protocols to hospital and community based providers 2)Educate providers during hospital grand rounds or regularly scheduled series 3)Assure electronic medical record roll out includes best practice protocols 4)Educate providers on the availability of the new Medicare tobacco cessation counseling code 5) Collaborate with academic partners on the integration of the 5A s into NYS Nursing School curriculum 6)Work with the Hofstra Medical School curriculum committee to integrate best practice protocols into medical school curriculum and practicum s Promote the integration of the 5A s into electronic medical records and provider education curriculums. Activity: Maintenance of effort for employee non smoking initiatives Increase the number of NSLIJHS employees pledging to remain tobacco free. Increase employee accessing tobacco cessation medications. Promotion of Smoke Free Campus Initiatives. Track Results of TC Performance Improvement Project. Track Grand Rounds increase in knowledge & intent to change behavior. Track # Protocols integrated Survey of participants satisfaction with program, knowledge, and intent to change practice behavior. Track #planning meetings scheduled with nursing schools. Track # planning meetings scheduled to discuss curriculum. Track annual Facility specific EMR tobacco use screening, counseling and referral data. Track activity with academic partners in curriculum development and tobacco cessation education Short term metrics Track employee pledge data from NSLIJ Human resources Benefit Department Track employee pledge data from NSLIJ Human resources Benefit Department Track implementation of Smoke Free Campus signage and compliance wide System wide System wide System wide System wide 32

33 PRIORITY AREA Preventing Chronic Diseases: Reduce Obesity in Children and Adults GOALS: Create community environments and initiatives that promote and support healthy food and beverage choices and physical activity. Promote school based healthy eating and physical activity programs Promote breast feeding. Expand the role of health care and health service providers in obesity prevention. Expand the role of NSLIJHS in promoting employee obesity prevention. PERFORMANCE MEASURES Short Term Indicators Source Frequency By December 31, 2014, increase public awareness of obesity prevention through utilization of media channels by 15% from 2013 Public Relations data. By December 31, 2014, increase the percentage of adults participating in walking activities disparate communities by 15% from 2013 LIHC data. By December 31, 2014, increase the percentage of seniors participating in Stepping On Program by 15% from 2013 OCPH data. By December 31, 2014, increase the percentage of newborns being discharged on breastfeeding by 10% from 2013 data. By December 31, 2014, increase the screening, identification and treatment rates of pediatric primary care providers during well child visits by 30% or to reach 95%. By December 31, 2014, increase the number of employees pledging to complete health risk assessments and viewing wellness videos by 10%. By December 31, 2014, increase the number of employees pledging to complete health risk assessments and viewing wellness videos by 10%. Public Relations media stats LIHC website and LIHC Wellness Survey data OCPH Stepping on Data Facility Latch On and Baby Friendly Hospital metrics CCMC Pediatric Prevention in Primary Care Settings Chart audit data HR Employee Wellness Pledge data HR Employee Wellness Pledge data OCPH vending audits Annually Annually Annually Annually Annually Annually Annually By December 31, 2014, increase the number of healthy food and beverage Bi Annually vending items by 10%. Long Term Indicators Source Frequency By December 31, 2017, reduce the percentage of children who are obese: By 5% from 13.1% (2010) to 12.4% among WIC children (ages 2 4 years). By 5% from 17.6% ( ) to 16.7% among public school children Statewide reported to the Student Weight Status Category Reporting system. By 5% from 20.7% ( ) to 19.7% among public school NYS Pediatric and Pregnancy Nutrition Surveillance System [PedNSS]; NYS Student Weight Status Category Annually 33

34 children in New York City represented in the NYC Fitnessgram. By December 31, 2017, reduce the percentage of adults ages 18 years and older who are obese: By 5% from 24.5% (2011) to 23.2% among all adults. By 5% from 26.8% (2011) to 25.4% among adults with an annual household income of < $25,000. By 10% from 34.9% (2011) to 31.4% among adults with disabilities. By 2017, increase the percentage of infants born in NYS hospitals who are exclusively breastfed during the birth hospitalization by 10% from 43.7% (2010) to 48.1%. By December 31, 2017, increase the percentage of adults ages 18 years and older who participate in leisure time physical activity: By 5% from 73.7% (2011) to 77.4% among all adults. By 10% from 59.0% (2011) to 65.0% among adults with less than a high school education. By 10% from 49.9% (2011) to 54.9% among adults with disabilities. Activity: Raise public awareness of the impact Short term metrics monitoring of healthy lifestyle behaviors on prevention of Obesity. Develop campaign signage / brochures / PSA in collaboration with community partners. Promote and utilize NYCDOHMH obesity prevention media campaign materials through facility media channels. Reporting; NYC Fitnessgram; BRFSS BRFSS Bureau of Biometrics and Biostatistics, NYSDOH; NYC Office of Vital Records, NYC DOHMH BRFSS # Campaign materials created. Track # community members enrolled in wellness programs. Track # media placements and community reach. Annually Annually Annually NSLIJHS Facility System wide NYC Facilities Pool purchased media credits for PSAs through the Long Island Health Collaborative. Incorporate wellness messaging into hospital publications, website and patient education media channels. Identify additional community based media channels with community partners for ongoing promotion of campaign (i.e. LTE, OpEd, etc). Track # Long Island Health Collaborative media outreach data. Track scope /reach of hospital based media channels. Track scope /reach of community based media channels. Track # of community based earned media. Nassau and Suffolk County Facilities System wide System wide 34

35 Partner in the development and launch of the Long Island Health Collaborative Website a partnership between the Nassau and Suffolk County hospitals, departments of health, Nassau Suffolk Hospital Council and community based organizations (CBO). Activity: Increase community member increased physical activity and healthy eating including school based healthy eating and physical activity programs. Promote and support community walking groups and fundraising walks with the Long Island Health Collaborative. Implement the evidenced based Chronic Disease Self Management Program (Better Choices, Better Health Workshop). Implement the evidenced based National Diabetes Prevention Program (DPPP). Expand senior evidence based Stepping On falls prevention program focusing on daily strength and balance exercises. Provide evidence based Healthier Tomorrows obesity management program in partnership with the YMCA at their facilities. Expand school based obesity prevention programs focusing on increasing physical activity and healthy eating. Host Farmer s Markets for community member and employees. Activity: Expand the role of health care and health service providers in obesity prevention. Initiate a Health Walking Prescription program beginning in adult primary care settings. Expand the NYSDOH Prevention of Obesity in Primary Care (POPC) settings that increases pediatric primary care provider screening, identification and treatment of pediatric patients at well child care visits. Activity: Promote breast feeding in birthing hospitals. Track # of hits to Long Island Health Collaborative Wellness Site. Short term metrics monitoring Track hits and usage of LIHC website, number of walking groups, community participation in walking groups. Analyze Pre Post and 3 month validated knowledge, behavior assessments, participant demographic data and disease outcomes. Analyze Pre Post and 3 month validated knowledge, behavior assessments, participant demographic data and disease outcomes. OCPH Stepping On pre, post and 3 month evaluation data. Healthier Tomorrow s Program outcome data. Kohl s Kares for Kids Program data Facility Dietary metrics on market utilization and OCPH market utilization data. Short term metrics monitoring Track usage in Primary Care Setting. POPC chart audit data. Short term metrics monitoring Nassau &Suffolk County Facilities Nassau and Suffolk Facilities System wide Southside Hospital Manhattan, Queens. Nassau and Suffolk Facilities Huntington Southside Cohen Children s Medical Center System wide System wide CCMC 35

36 Participate in NYSDOH Latch On Program and Baby Friendly Hospital Programs. Activity: Expand the role of NSLIJHS in promoting employee obesity prevention. Increase the number of employees pledging to complete health risk assessments and viewing wellness videos. Expand employee wellness healthy eating initiatives specifically vending machine options. Track # of bottles of formula distributed to healthy newborns in the hospital each month (Latch On NYC indicator) Track Baby Friendly USA Evaluation Criteria Track # of families provided prenatal breastfeeding education Track # babies discharged that are being solely and primarily breast fed. Short term metrics monitoring Track HR Benefits data Bi annual OCPH vending audits Staten Island University Hospital, Long Island Jewish Medical Center, North Shore University Hospital, Forest Hills Hospital, Huntington Hospital System wide System wide 36

37 PRIORITY AREA Promote Mental Health and Prevent Substance Abuse GOALS: Promote mental, emotional and behavioral (MEB) well being in communities Prevent underage drinking, non medical use of prescription pain relievers drugs by youth, and excessive alcohol consumption by adults Prevent and reduce occurrence of mental, emotional and behavioral disorders among youth and adults. Prevent suicides among youth and adults. Reduce tobacco use among adults who report poor mental health. Support collaboration among leaders, professionals and community members working in MEB health promotion, substance abuse and other MEB disorders and chronic disease prevention, treatment and recovery. Strengthen infrastructure for MEB health promotion and MEB disorder prevention. PERFORMANCE MEASURES Short Term Indicators Source Frequency By December 31, 2014, increase the number of mental health providers trained in tobacco cessation by 15% from 2013 CTC data. By December 31, 2014, increase provider compliance with 5A s (chart review) by 5% using CTC data. By December 31, 2014, increase in volume of electronic medical record for tobacco counseling by 5%. By December 31, 2014, expand the reach of BRAVE program by 5%. By December 31, 2014, expand the reach of Prevention Resource Center program by 2 additional coalitions (1%). By December 31, 2014, increase the medication collection totals by 10%. By December 31, 2014, increase the number of Outpatient home visits by 3%. Long Term Indicators By December 31, 2017, reduce the percentage of adult New Yorkers reporting 14 or more days with poor mental health in the last month by 10% to no more than 10.1%. (Baseline: 11.1%, 2011) By December 31, 2017, reduce the number of youth grades 9 12 who felt sad or hopeless by 10% to no more than 22.4%. (Baseline: 24.9 %, 2011) By December 31, 2017, reduce the percentage of youth ages years reporting the use of non medical use of painkillers. (Baseline: 5.26% , NSDUH, Target: 4.73%) By December 31, 2017, reduce suicide attempts by New York adolescents (youth grades 9 to 12) who attempted suicide one or more times in the past year by 10% to no more than 6.4%. CTC data CTC Data EMR data BRAVE Program Data Prevention Resource Center Data DEA data SOH data Source BRFSS YRBS NSDUH YRBS Annually Annually Annually Annually Annually Annually Annually Annually Annually Annually Annually 37

38 (Baseline: 7.1 suicide attempts per 100, 2011 YRBS) By December 31, 2017, reduce the age adjusted suicide mortality rate by 10% to 5.9 per 100,000. (Baseline: 6.6 per 100,000, Bureau of Biometrics ) By December 31, 2017, reduce the prevalence of cigarette smoking among adults who report poor mental health by 15% from 31.2% in 2011 to 26.5%. (Baseline: 31.2%, 2011) By December 31, 2017, identify indicator data and establish baseline targets for data required to plan and monitor countylevel, strengths based efforts that promote MEB health and prevent substance abuse and other MEB disorders. Identify specific roles different sectors (e.g., governmental and nongovernmental) and key initiatives (e.g., Health Reform) have in contributing toward MEB health promotion and MEB disorder prevention in New York State. Collaborate with researchers and practitioners to develop and disseminate a compendium of evidence based interventions and policies that promote MEB health and prevent MEB disorders. Strengthen training and technical assistance of primary care physicians, MEB health workforce and community leaders in evidence based, including cultural sensitivity training, approaches to MEB disorder prevention and mental health promotion. Activity: Prevent suicides among Short term metrics youth and adults. Expand Bully Reduction/Anti Violence Education (BRAVE) School based Program. Bureau of Biometrics NY Adult Tobacco Survey County Data Track schools participating. Track system changes in bully reduction policies in schools. Annually Annually Annually Zucker Hillside Hospital South Oaks Hospital Expand utilization of the Rosen Family Wellness Center evidencebased treatment and resources by Iraq and Afghanistan war veterans impacted by post traumatic stress disorder, traumatic brain injury and associated behavioral health issues as well as 911 first responders. Activity: Promote mental, emotional and behavioral (MEB) well being in communities Expand utilization of the Unified: Behavioral Health Center for Military Veterans and Their Families evidencebased treatment and resources by military personnel, veterans, and Track center utilization data. Short term metrics Track center utilization data. Zucker Hillside Hospital South Oaks Hospital Zucker Hillside Hospital South Oaks Hospital 38

39 their families, including children. Expand the reach of the Prevention Resource Center facilitating partnerships among schools, communities, and prevention providers to promote evidence based strategies to decrease the prevalence of alcohol, drug use, and problem gambling in Suffolk County communities. Expand the visits of Mental Health Worker in Primary Care Provider s office setting Expand Child & Adolescent Clinic home visits. Identify specific roles different sectors (e.g. governmental and nongovernmental) and key initiatives (e.g. Health Reform) have in contributing toward MEB health promotion and MEB disorder prevention in Nassau, queens and Suffolk Counties. Collaborate with researchers and practitioners to develop and disseminate a compendium of evidence based interventions and policies that promote MEB health and prevent MEB disorders. Strengthen training and technical assistance of primary care physicians, MEB health workforce and community leaders in evidencebased, including cultural sensitivity training, approaches to MEB disorder prevention and mental health promotion. Activity: Reduce tobacco use among adults who report poor mental health through community tobacco control awareness campaign Identify additional community based media channels with community partners for ongoing promotion of Track # partnerships, programs and participants. Track substance abuse and gambling behavioral change outcomes. Track all of the visits in Child & Adol clinic (COBS) and compare admission rate of Clinic vs. Home Visits vs. PCP Office setting. Track all of the visits in Child & Adol clinic (COBS) and compare admission rate of Clinic vs. Home Visits vs. PCP Office setting. Inventory of organizations with MEB in scope of services. Identify partners for coalition for MEB health promotion. Form coalition for MEB health promotion. Inventory evidence based programs that promote MEB health and prevent MEB disorders. Identify 1 program. Seek opportunities for research. Identify primary care practices. Track # of trainings, sites, participants Track Grand Rounds increase in knowledge & intent to change behavior. Track protocols integrated. Survey of participants satisfaction with program, knowledge, and intent to change practice behavior. Short term metrics monitoring Track scope /reach of community based media channels. South Oaks Hospital South Oaks Hospital South Oaks Hospital Zucker Hillside Hospital South Oaks Hospital Zucker Hillside Hospital South Oaks Hospital Zucker Hillside Hospital South Oaks Hospital System wide System wide Zucker Hillside Hospital 39

40 campaign. Identify additional community based media channels with community partners for ongoing promotion of campaign ( i.e. LTE, OpEd, etc). Incorporate use of NYS Quit Line and CTC community programming into media messaging. Expand community cessation programs in collaboration with CTC and DOH as needed. Activity : Increase the number of providers utilizing best practice guidelines to support patient education re: smoking cessation. Educate hospital providers on evidence based best practices the 5A s (ask, advise, assess, assist and arrange): 1)Provide in depth training on smoking cessation protocols to hospital and community based providers 2)Educate providers during hospital grand rounds or regularly scheduled series 3)Assure electronic medical record roll out includes best practice protocols 4)Educate providers on the availability of the new Medicare tobacco cessation counseling code 5) Collaborate with academic partners on the integration of the 5A s into NYS Nursing School curriculum 6)Work with the Hofstra Medical School curriculum committee to integrate best practice protocols into medical school curriculum and practicum s Promote the integration of the 5A s into electronic medical records and provider education curriculums. Track # of community based earned media. Track # of calls to Quit line. Track # community members in smoking cessation classes. Short term metrics Track # of trainings, sites, participants Track results of TC Performance Improvement Project. Track Grand Rounds increase in knowledge & intent to change behavior. Track protocols integrated. Survey of participants satisfaction with program, knowledge, and intent to change practice behavior. Track planning meetings scheduled with nursing schools. Track planning meetings scheduled to discuss curriculum. Track # of trainings, sites, participants. Track results of TC Performance Improvement Project. South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital 40

41 Track annual Facility specific EMR tobacco use screening, counseling and referral data. Track activity with academic partners in curriculum development and tobacco cessation education. Activity :Maintenance of effort for employee non smoking initiatives Increase the number of NSLIJHS employees pledging to remain tobacco free. Increase employee accessing tobacco cessation medications. Promote Smoke Free Campus Initiatives. Activity: Prevent underage drinking, non medical use of prescription pain relievers drugs by youth, and excessive alcohol consumption by adults. Participate in US Department of Drug Enforcement Drug Take Back Days Track Grand Rounds increase in knowledge & intent to change behavior. Track protocols integrated. Survey of participants satisfaction with program, knowledge, and intent to change practice behavior. Track planning meetings scheduled with nursing schools. Track planning meetings scheduled to discuss curriculum. Track annual Facility specific EMR tobacco use screening, counseling and referral data. Track activity with academic partners in curriculum development and tobacco cessation education Short term metrics Track employee pledge data from NSLIJ Human resources Benefit Department. Track employee pledge data from NSLIJ Human resources Benefit Department. Track implementation of Smoke Free Campus signage and compliance. Short term metrics # pounds of drugs received. # sites. Reach of marketing efforts. South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital System wide Zucker Hillside Hospital South Oaks Hospital 6. Dissemination of the Plan to the public. The Community Service Plans are displayed on and downloadable from the North Shore- LIJ Health System web site in a consumer-friendly brochure format, which can be found through (in the About Us / Community Service Plans section). The CSP is disseminated via the web site (external and internal northshorelij.com websites) and distributed 41

42 to hospitals executives and board members. A published version of the CSP is distributed to the public, as requested. 7. Brief description of the process that will be used to maintain engagement with local partners over the next # years of the Community Service Plan and the process that will be used to track progress and make mid course corrections. The NSLIJ health system has a history of active engagement and coalition work with community partners as it relates to improving population health. We will continue to maintain these active partnerships (see attachment I). In an effort to continue establishing relationships, coalition building and expanding existing coalition capacity, NSLIJ has involved our partners in the CHNA process and has included this collaborative work in our implementation plan (see question 5 response). An example of how NSLIJ has leveraged the CHNA process is the formation of the Long Island Health Collaborative (LIHC). The LIHC is a bi-county (Nassau and Suffolk County) coalition comprised of hospitals, county health departments, health and welfare organizations, businesses and academia working together to improve the health of all Long Islanders. Initially 2 separate CHNA workgroups were formed to collaborate on the CHNA process. As each work group collected and analyzed primary and secondary data and inventoried community resources (see attachment XV), both the Nassau and Suffolk county workgroups independently achieved consensus on this NYSDOH Priority Agenda item and focus areas: PRIORITY AREA: Prevent Chronic Disease FOCUS AREA: Reduce obesity in children & adults FOCUS AREA: Increase access to high-quality chronic disease preventive care & management in both clinical & community settings It became apparent that since both workgroups shared similar goals and several workgroup members, a regional approach leveraging both counties resources would greatly impact the health of Long Island residents. Subsequently, the LIHC was established. The goals of the LIHC are to promote health programming, public outreach and policy development related to the identified priority and focus areas. The LICH has produced a logo which will be used for branding; has reached consensus on promoting walking as an obesity/chronic disease prevention and treatment strategy; is developing a media campaign; is creating a webpage that will be used for education and community resource linkages; and is developing an evaluation metric for health programming. The LICH will continue to collaborate on these initiatives during the community service plan cycle. In New York City, NSLIJ has joined the Partnership for a Healthier NY (PHNY). The PHNY is a population health initiative focused on decreasing alcohol and tobacco use, healthy eating, and active living. Each borough has partnerships comprised of health department, hospital, business, government and community based organizations that focus on evidence-based community health initiatives and policy changes. This coalition will continue fostering the engagement of community partners. 42

43 NSLIJHS Community Service Plan Attachments I. NSLIJHS CHNA NSLIJHS CHNA Internal CHNA Committees, Community Partners and Community Health Meetings by County II. III. IV. NSLIJHS Nassau County Key Informant Interview Analysis NSLIJHS Nassau County Individual Community Member Survey NSLIJHS Nassau County Community Member Survey Results V. NSLIJHS Lenox Hill Hospital Community-based CHNA Survey and Results VI. VII. VIII. IX. NSLIJHS Manhattan Take Care New York Listening Session NSLIJHS Queens Take Care New York Listening Session NSLIJHS Staten Island University Hospital Community-based CHNA Survey and Results NSLIJHS Staten Island Take Care New York Listening Session X. NSLIJHS Suffolk County Community-based Organization CHNA Survey and Results XI. XII. XIII. NSLIJHS Suffolk County Community-based Organization CHNA Survey Participants NSLIJHS Nassau, Queens and Suffolk Mental Health Community-based Entity Survey and Results NSLIJHS Nassau County Community Health Assessment Data XIV. NSLIJHS Suffolk County Community Health Assessment Data XV. NSLIJHS Nassau and Suffolk Counties Resource Inventory

44 Attachment I: NSLIJHS CHNA Internal CHNA Committees, Community Partners and Community Health Meetings by County NSLIJ Board of Trustees Committee on Community Health NSLIJ Office of Community and Public Health Jenifer Mieres, SVP, Office of Community and Public Health, Office of Community and Public Health Amit Powar, Vice President, Office of Community and Public Health Nancy Copperman, Director of Public Health Initiatives, Office of Community and Public Health Lisa Burch, Director of Sustainability and Social Responsibility, Office of Community and Public Health Rosemarie Ennis, Corporate Director of Community Education & Health, Office of Community and Public Health Christine Essig, Director of Community Benefit, Office of Community and Public Health Barbara Felker, Vice President of Diversity & Inclusion, Office of Community and Public Health Ji Im, Director of Community Benefit, North Shore-LIJ Health System Jennifer Ludwin, Health Educator, North Shore-LIJ Office of Community and Public Health Ji Im, Director of Community Benefit, North Shore-LIJ Health System Jennifer Ludwin, Health Educator, North Shore-LIJ Office of Community and Public Health Jerrold Hirsch, Vice President, Planning, North Shore-LIJ Health System Stephanie Kubow, Project Manager, System Planning, North Shore-LIJ Health System Melissa Strugatz, Analyst, System Planning, North Shore-LIJ Health System Forest Hills CHNA Committee Rita Miercia, Executive Director, Forest Hills Hospital Brian O Neill, Assistant Executive Director, Forest Hills Hospital Gerard Brogan, Medical Director, Forest Hills Hospital Theodore Lehman, Director, Community Services Franklin Hospital CHNA Committee Catherine Hottendorf, Executive Director, Franklin Hospital Ed Cox, Director of Nutrition and Patient Relations, Franklin Hospital 1

45 Helen White, Manager of Community Relations, Franklin Hospitals Patrick Mack, Coordinator Community Relations Lenox Hill Hospital CHNA Committee Dennis Connors, Executive Director, Lenox Hill Hospital John Gupta, Executive Director MEETH Peg Butler, Director. Community Outreach, Lenox Hill Hospital Plainview/Syosset Hill Hospital CHNA Committee Michael Fener, Executive Director, Plainview Hospital Jim Baker, Director of Service Excellence and Community Relations, Plainview Hospital Nicole Santora, Community Relations Liaison Jaclyn Marino, Community Relations Liaison LIJMC CHNA Committee Chantal Weinhold, Executive Director, LIJMC Joel Shulman, Executive Director, Zucker Hillside Hospital Kevin McGeachy, Executive Director, Cohen Children s Medical Center Kevin Dwyer. SVP, Senior Development Officer, Zucker Hillside Hospital Debbie Riccardi, Director, Community Outreach, Cohen Children s Medical Center Tricia Scarlata, Director Marketing and Community Outreach, LIJMC South Oaks Hospital Bob Detor, CEO, South Oaks Hospital Patricia Porter, CFO, South Oaks Hospital Mary Jeanne Corea, Director of Community Relations, South Oaks Hospital Christine Moran, Vice President of Behavioral Health Services, South Oaks Hospital Gerard M. Kaiser, Vice President of Senior Services, South Oaks Hospital Kristie Golden, Vice President, South Oaks Hospital Staten Island University Hospital 2

46 Anthony Ferreri, Regional Executive Director, Staten Island University Hospital Robert Blake, Associate Vice President, Planning, Staten Island University Hopsital Christine Hollie, Associate Vice President, Operations, Staten Island University Hospital Huntington Hospital Kevin Lawlor, Executive Director Julie Robinson-Tinque, Director Public Affairs Glen Cove Hospital Susan Kwiatek, Executive Director, Glen Cove Hospital Christine Reynolds, Nurse Educator Community Outreach, Glen Cove Hospital Patrick Mack, Coordinator Community Relations North Shore University Hospital Susan Sommerville, Executive Director Joe Leggio, Manager, Marketing and Communication Southside Hosptial Donna Moravick, Executive Director Edward Fraser, Director Community Relations Patrick Mack, Coordinator Community Relations 3

47 1 Queens Community Partner Organizations AAFE (Asian Americans for Equality) Asociacion de Mujeres Progresistas Asthma Coalition of Queens BASTA/MRNY CCNS WIC program Woodside & Jamaica CHHAYA Children's Aid Society Chinese-American Planning Council, Inc City College of NY Coalition for Asian American Children and families Cornell University Cornell University Cooperative Extension Cultural Collaborative of Jamaica DOE PS11/ PS 122 First Baptist Church of Corona, Inc. Grameen Health Innovations Greater Ridgewood Youth Council Harvest Home Farmer's Market, Inc. Health Care Education Project Immigrant Movement International Jackson Heights Green Alliance Jacob A. Riis Neighborhood Settlement House Kalusugan Coalition, Inc. Kalusugan Coalition, Inc. Kindaw Korean Community Service (KCS) Latin Women in Action MinKwon Center for Community Action (formerly YKASEC) Focus Area Tobacco Active Living Tobacco Tobacco Healthy Eating Tobacco Alcohol Tobacco Active Living Healthy Eating / Active Living Healthy Eating Healthy Eating / Active Living Active Living Alcohol Healthy Eating / Alcohol Healthy Eating Active Living Healthy Eating Healthy Eating / Active Living Healthy Eating / Active Living Active Living Healthy Eating / Active Living / Smoke-Free Healthy Eating Healthy Eating Active Living Healthy Eating/Active Living Active Living Tobacco North Shore Long Island Jewish Tobacco Control Center North Shore-LIJ Health System NYC DOE - SAPIS / Office of Safety and Youth Development NYC DOE PS 78/PS 166 NYCDOE - SAPIS / Newtown H.S. NYCDOE - SAPIS / PS 92Q PAIHS Plaza del Sol Urban Health Center Poderosas Public Health Solutions Queens Botanical Garden - Intergenerational Community Garden Queens Library Health Link Queens Museum of Art Queens Pomonok Library / Cancer Action Council Queens Smoke Free Coalition Recycle a Bicycle Safe Space The Corona Self Help Center The Lesbian, Gay, Bisexual & Transgender Community Center Transportation Alternatives United Healthcare Community Plan We Bike Woodside on the Move, Inc. Tobacco Tobacco Alcohol Alcohol Alcohol Alcohol Alcohol Healthy Eating / Active Living Alcohol Healthy Eating Healthy Eating Tobacco Active Living Tobacco Tobacco Active Living Healthy Eating Alcohol Tobacco Active Living Health & Wellness Active Living Healthy Eating / Active Living 4

48 2 New York County Take Care New York Listening Session Participants ACS Bailey House Center for Independence of the Disabled, NY City Harvest Columbia University Community Healthcare Network Cornell Cooperative Extension/Hunter Student CUNY School of Public Health CUNY SPH Department of Transportation Fund for the Public Health of New York Harlem DPHO Health Advocate Kiker Marcom Group, LLC Lenox Hill Mental Health Association of New York City Morris Heights Health Center Northern Manhattan Perinatal Partnership, Inc NYU Palladia Org Partnership for a Healthier NYC PCIP Sabree Education Settlement Health Touro COP Student Univ. of Medicine & Dentistry of NJ Visiting Nurse Service of NY WellCare West Side Campaign Against Hunger YWCA of Brooklyn 3 Richmond County Take Care New York Listening Session Participants Alliance for Lupus Research American Cancer Society Assist Tobacco Cessation Center City Harvest Community Health Action of Staten Island FPHNY (Board Member of SIPCW) Greater New York Hospital Association Health Education on Wheels Health Plus Amerigroup IlluminArt Productions National Autism Association Holistic Health Counselor NS-LIJ Health System- Staten Island University Hospital NYSNA Partnership for a Healthier NYC Richmond University Medical Center SIPCW Sky Light Center Special Ed Teacher Staten Island Slim Down Staten Island Smoke-Free Partnership Staten Island University Hospital Support Center Online Touro College VNSNY/SIPCW 5

49 4 Queens County Take Care New York Listening Session Participants Asthma Coalition of Queens Catholic Charities Citizens' Commitee for Children of New York, Inc. Creedmoor Psychiatric Center Ecuadorian International Center Emblem Health Goodwill Industries H.E. Corona Senior Center Healthcare Education Project HealthPlus AmeriGroup Help/PSI, Inc. Joseph P. Addabbo Health Center New York Downtown Hospital Northshore LIJ (Forest Hills) NYC DOC NYC DOT Public Health Solutions Queens Smoke-Free Partnership Safe Space Steinway Wellness & Recovery Center The Partnership for a Healthier NYC TransCanada - Ravenswood Power Plant VNSNY Choice Health Plans Hospital Governance and Community Advisory Boards North Shore - LIJ Committee on Community Health Glen Cove Hospital Community Advisory Board Southside Hospital Advisory Board Huntington Hospital Advisory Board Tobacco Action Coalition Key Stakeholders American Cancer Society Eastern Division American Heart Association American Lung Association of the Northeast Association of School-based Prevention, Intervention, Resource and Education Professionals Babylon Village Youth Project Clubhouse of Suffolk Cornell Cooperative Extension of Suffolk County Diabetes Resource Coalition of Long Island Eastern Suffolk BOCES Good Samaritan Hospital Long Beach Medical Center F.A.C.T.S. Long Island Lesbian Cancer Initiative (LILCI) Manhasset Community CASA Nassau County Department of Health Nassau County Department of Drug and Alcohol Addiction Nassau-Suffolk Hospital Council New York State Department of Health NSLIJ s Center for Tobacco Control NYS Public Health Association L.I. Region South Nassau Communities Hospital Stony Brook University Hospital Stony Brook University Student Health Services Students Against Destructive Decisions (SADD) Suffolk Coalition to Prevent Alcohol and Drug Dependencies (PADD) Suffolk County Alcohol and Substance Abuse Services Suffolk County Department of Health Services Suffolk County Perinatal Coalition Western Suffolk BOCES Winthrop University Hospital YMCA Family Services 6

50 5 New York City Falls Coalition NYC Department of Health and Mental Hygiene NYC Department for the Aging NYC Health and Hospitals Corporation NYC Mayor's Office for People with Disabilities NYC Human Resources Administration New York Academy of Medicine Visiting Nurse Service of New York United Hospital Fund AARP - NY Brookdale Center for Healthy Aging and Longevity VISIONS Tuoro College of Pharmacy St. John's College of Pharmacy Public Health Solutions North Shore LIJ NYU School of Dentistry Mt. Sinai - Dept of Geriatrics Columbia Mailman School of Public Health New York State Department of Health and Local Health Departments Suffolk County Department of Health Services (SCDHS) Nassau County Department of Health (NCDOH) New York City Department of Health and Mental Hygiene (NYCDHMH) Communities Putting Prevention to Work Tobacco NYC DOHMH 6 Hospital Associations Hospital Association of New York State (HANYS) Greater New York Hospital Association (GNYHA) Nassau Suffolk Hospital Council (NSHC) Area Hospitals Brookhaven Memorial Hospital Medical Center Good Samaritan Hospital Eastern Long Island Hospital John T. Mather Memorial Hospital Long Beach Medical Center Mercy Medical Center New Island Hospital Peconic Bay Medical Center St. Catherine of Siena Medical Center St. Charles Rehabilitation Hospital St. Francis Hospital Southampton Hospital South Nassau Communities Hospital Stony Brook University Medical Center Winthrop Hospital Professional Organizations American Association of Retired Persons (AARP) American Cancer Society American Heart Association American Lung Association 7

51 Community Based Organizations & Community Members Central Queens Y Cross Island YMCA Chinese Planning Council Dominican Sisters Family Health Service Ridgewood YMCA Samuel Field Y Tobacco Action Coalition (TAC) NYC Coalition for a Smoke Free City North Shore - LIJ sponsored Naturally Occurring Retirement Communities (NORCs) Deepdale CARES (Queens) Huntington (Suffolk) Plainview-Old Bethpage CARES (Nassau) Plainview-Old Bethpage WOW (Nassau) NORC WOW (Queens) Project Independence (Nassau) Queens SNAP Senior Center Queens Interagency Council Queens Quits Queens Smoke Free Partnership 7 New York City Coalition for a Smoke Free City Citywide partners American Cancer Society American Lung Association American Heart Association Campaign for Tobacco Free Kids NYC Cessation Centers Community based organizations Faith based organizations Health facilities Other community groups dedicated to decreased tobacco use Borough Smoke-Free Partnerships Queens Smoke Free Partnership Manhattan Smoke Free Partnership Bronx Smoke Free Partnership Brooklyn Smoke Free Partnership Colleges and Universities Hofstra University School of Education, Health, and Human Services St. Joseph s College Nursing Long Island University-C.W. Post Campus Adelphi University SUNY Farmingdale Queensboro Community College Molloy College 8

52 New York County Community Health Meetings Date Meeting Description Notes 01/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 02/20/13 Greater NY Hospital Association 6 Community Health Forum meeting 02/27/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 03/08/13 Greater NY Hospital Association 6 Briefing on Community Health Needs Assessment 04/24/13 NYCDOHMH Take Care New York 2 Planning Meeting 04/30/13 New York City Falls Prevention Coalition 5 Policy Sub-Committee Conference Call 05/09/13 Greater NY Hospital Association 6 Community Health Forum: conference call 05/09/13 New York City Falls Prevention Coalition 5 Policy Sub-Committee update, US Emergency responders, Falls survey, Preventive Services Task Force 05/14/13 NYCDOHMH Take Care New York 2 Listening Session 05/17/13 Greater NY Hospital Association 6 Community Health Forum: conference call 06/13/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 07/12/13 Greater NY Hospital Association 6 Community Health Forum meeting 08/08/13 New York City Falls Prevention Coalition 5 Falls Prevention Awareness Day, Grants/Projects 09/04/13 Greater NY Hospital Association 6 Community Health Forum: conference call 09/23/13 Latino/Hispanic Health Equity Initiative NY Regional Forum 09/27/13 Greater NY Hospital Association 6 Community Health Forum: conference call 10/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 11/17/13 New York City Falls Prevention Coalition 5 2 See corresponding table for members. 7 See corresponding table above for members. 5 See corresponding table above for members. 6 See corresponding table for members. 9

53 Queens County Community Health Meetings Date Description Notes 01/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 02/20/13 Greater NY Hospital Association 6 Community Health Forum meeting 02/27/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 03/05/13 CTG Partnership for a Healthier New York 1 Neighborhood Contractors Orientation 03/08/13 Greater NY Hospital Association 6 Briefing on Community Health Needs Assessment Queens New York Neighborhood Contractors 03/19/13 Meeting 03/26/13 Queens New York Neighborhood Contractor Call 04/24/13 NYCDOHMH Take Care New York 4 Planning Meeting 05/09/13 Greater NY Hospital Association 6 Community Health Forum: conference call 05/14/13 NYCDOHMH Take Care New York 4 Listening Session 05/17/13 Greater NY Hospital Association 6 Community Health Forum: conference call 06/12/13 Queens New York Neighborhood Contractors Meeting 06/13/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 06/24/13 Partnership for a Healthier NYC 1 Queens Contractor Call 07/12/13 Greater NY Hospital Association 6 Community Health Forum meeting 08/16/13 Partnership for a Healthier NYC 1 Queens Contractor Training Call 09/04/13 Greater NY Hospital Association 6 Community Health Forum: conference call 09/27/13 Greater NY Hospital Association 6 Community Health Forum: conference call 10/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 1 See corresponding table for members. 4 See corresponding table above for members. 6 See corresponding table for members. 7 See corresponding table above for members. 10

54 Richmond County Community Health Meetings Date Description Notes 01/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 02/20/13 Greater NY Hospital Association 6 Community Health Forum meeting 02/27/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 03/08/13 Greater NY Hospital Association 6 Briefing on Community Health Needs Assessment 03/19/13 04/24/13 Community Advisory Board Meeting (regarding NYSDOH Prevention Agenda and results of community health needs assessment) NYCDOHMH Take Care New York 3 Rosemarie Dressler, Director, Community Outreach Relations, Staten Island University Hospital Michael McBrearty, Outreach Coordinator, Staten Island University Hospital Anna Pallotti, SIUH Auxiliary Sally Ann Esposito Browne, SI school system, Teacher and Parkinson foundation Kathleen Carney-Kielty, Program Coordinator, Staten Island University Hospital Wanda Cordes, First Central Baptist Church Adenike Coyle, Nurse, First Central Baptist Church Ray Diaz, Senior Program Manager, NYCHA Queens/Staten Island Community Operations Maureen Fisher, Director of Health Programs, JCC of Staten Island Nicholas DiBenedetto, Director of Business Development, Primary Care Ambulance Boris Natenzon, President & CEO, Nates Pharmacy Daniel Lebowitz, Account Manager, Primary Care Ambulance Cilina Ramsey, Language, Health Literacy and Diversity Coordinator, Staten Island University Hospital Tanya Shaw, Office of Strategic Planning, Staten Island University Hospital Bob Blake, Associate Vice President, Planning, Staten Island University Hospital Michael Carr, Community Outreach Coordinator, Staten Island University Hospital Kerry Gillespie, Director, Complementary Medicine, Staten Island University Hospital Maureen Gonzalez, Pediatric Nutritionist, Staten Island University Hospital Planning Meeting 05/09/13 Greater NY Hospital Association 6 Community Health Forum: conference call 05/14/13 NYCDOHMH Take Care New York 3 Listening Session 11

55 05/17/13 Greater NY Hospital Association 6 Community Health Forum: conference call 06/13/13 Coalition for a Smoke Free NYC 7 Quarterly Meeting 07/12/13 Greater NY Hospital Association 6 Community Health Forum meeting 09/04/13 Greater NY Hospital Association 6 Community Health Forum: conference call 09/27/13 Greater NY Hospital Association 6 Community Health Forum: conference call 10/18/13 Greater NY Hospital Association 6 Community Health Forum: conference call 3 See corresponding table for members. 6 See corresponding table above for members. 7 See corresponding table for members. 12

56 Meeting Date 01/15/13 Nassau County Community Health Meetings Location Organization Representative Nassau County Department of Health (NCDOH) South Nassau Communities Hospital North Shore LIJ Health System NCDOH Adelphi University Mercy Hospital St. Francis Hospital Long Beach Medical Center Catholic Health Services Winthrop University Hospital Nu Health Sudden Infant & Child Death Resource Center, Stonybrook University Medical Center Gina Kearney, Director, Community Education Nancy Copperman, Director, Public Health Initiatives Ji Im, Director, Community Benefit Stephanie Kubow, Mgr. Office of Planning Katheryne Small, Office of Planning Melissa Strugatz, Office of Planning Lawrence Eisenstein, Health Commissioner Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research Celina Cabello, Epidemiologist Carolyn Mc Cummings, Skye Ostreicher, Intern Phil Alcabes, Professor of Public Health Director of the MPH Program Beth Hammerman, Director of Planning and Community Health Lashieka Hunter, Staff Writer Cindy Casson, Special Projects Juliana McCabe, CHS Public & External Affairs Karen Tripmacher, Assistant Director, Community Relations & Special Projects Denise Portalatin, Manager, Community Outreach Barbara Marcinek, Quality Assurance Coordinator Shelley Afleh Type of Participant Hospital Hospital DOH Academic Hospital Hospital Hospital Hospital Hospital FQHC Hospital 13

57 01/25/13 Community Based Organization Informant Interview Sub Committee 01/25/13 Community Member Heath Needs Survey sub- Committee NCDOH NCDOH St. Francis Hospital NCDOH Long Beach Medical Center North Shore LIJ Health System Adelphi University Hofstra University South Nassau Communities Hospital NCDOH North Shore LIJ Health System Sue Palo, Director, Rehabilitation & Community Services Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research Celina Cabello, Epidemiologist Laura Bush Leslie Maddison Skye Ostreicher, Intern Cindy Casson, Special Projects Nancy Copperman,Director, Public Health Initiatives Phillip Alcabes, Professor of Public Health Director of the MPH Program Martine Hackett, Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community, Health Programs Hofstra University Gabrielle Pergin Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research Celina Cabello, Epidemiologist Skye Ostreicher, Intern Nancy Copperman, Director, Public Health Initiatives Jennifer Ludwin, Health Educator Ji Im, Director, Community Benefit Hospital DOH Hospital Hospital Academic Academic Hospital DOH Hospital St. Francis Hospital Pam Cruz-Ford, Manager, Community Health Promotion Programs, Emergency Cardiac Care Hospital 14

58 Programs, Marketing & Conference Management 02/11/13 Informant Interview Training 05/15/13 NCDOH Health Data NCDOH NCDOH South Nassau Communities Hospital Long Beach Medical Center Winthrop University Hospital Hofstra University Long Beach Medical Center North Shore LIJ Health System Adelphi University Hofstra University Winthrop University Hospital NCDOH SUNY Stonybrook St. Francis Hospital Gina Kearney, Director, Community Education Cindy Casson, Special Projects Karen Tripmacher, Assistant Director, Community Relations & Special Projects Leslie Madison Cindy Casson, Special Projects Nancy Copperman, Dir, Public Health Initiatives Lori Ginsberg, Coordinator, Public Health Initiatives Jennifer Ludwin, Health Educator Phillip Alcabes, Professor of Public Health Director of the MPH Program Martine Hackett, Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community, Health Programs Hofstra University Karen Tripmacher, Assistant Director, Community Relations & Special Projects Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research Celina Cabello, Epidemiologist Carolyn Mc Cummings, Skye Ostreicher, Intern Amy Singh, Assistant Professor of Preventive Medicine in the Divisions of Evaluative Services and Community Health at Stony Brook University. Pam Cruz-Ford, Manager, Community Health Promotion Programs, Emergency Cardiac Care Programs, Marketing & Conference Hospital Hospital Hospital Academic Hospital Hospital Academic Academic Hospital DOH Academic Hospital 15

59 Analysis and Key Informant Interview Analysis 05/15/13 NCDOH Winthrop University Hospital Catholic Health Services Long Beach Medical Center Nu Health Family Health Centers South Nassau Communities Hospital St. Joseph Hofstra University Adelphi University NCDOH Mercy Hospital Nassau-Suffolk Hospital Council North Shore LIJ Health System The Long Island GLBT Management Karen Tripmacher, Assistant Director, Community Relations & Special Projects Christine Hendriks, CHS Vice President Public and External Affairs Cindy Casson, Special Projects Barbara Marcinek, Quality Assurance Coordinator Gabrielle Pareja Carol Foley, Project Manager/Supply Chain Liaison Martine Hackett, Associate Professor, Graduate Director, Master of Public Health and Master of Science in Community, Health Programs Hofstra University Phillip Alcabes, Professor of Public Health Director of the MPH Program Tony Samuel Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research Celina Cabello, Epidemiologist Skye Ostreicher, Intern Laura Buch Beth Hammerman, Director of Planning and Community Health Elisa Gerber, Public Relations, Marketing and Events Coordinator Janine Logan,Director, Communications Nancy Copperman, Director, Public Health Initiatives Jennifer Ludwin, Health Educator Robert Vitelli, Chief Operating Officer Hospital Hospital Hospital FQHC Hospital Hospital Academic Academic DOH Hospital Hospital Association Hospital Community Based 16

60 NCDOH Health Data Analysis and Key Informant Interview Analysis Services Network (Gay, Lesbian, Bisexual, Transgender) Nassau County Lions Club Foundation Jewish Association Serving the Aging (JASA) Long Beach Services Town of North Hempstead- Project Independence Planned Parenthood Of Nassau County United Way of Long Island Nassau County Perinatal Services Network FEGS Health & Human Services (Federation of Employment and Guidance Services) Mental Health Association of Nassau County FEGS Health & Human Services (Federation of Employment and Guidance Services) Positive Space Kerri O Neill, Director of Programs Fred Rieger, Secretary Gloria Lebeaux, Director, Senior Services 1. Paula Uhl, Deputy Commissioner Department of Services for the Aging 2. Kristina Lew Jennifer Raytory Georgette Beal, Senior Vice President, HIV/AIDS Grant Management Debra Ross Angelis Davila, Director Kathy Rosemann Lori Hardoon, Project Director Lisa Harris, Director Project Hope Dwight Reynolds, Care Coordinator Organization Community Based Organization Community Based Organization Government Community Based Organization Community Based Organization Community Based Organization Community Based Organization Community Based Organization Community Based Organization 17

61 Sustainable Long Island Amy Engel, Executive Director Janice Moynihan, Community Planner / Educational Program Coordinator Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Jerzy Eisenberg-Guyot, Public Health Associate, Centers for Disease Control and Prevention Celina Cabello, Epidemiologist, NCDOH Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Chris Hendriks, Vice President, Catholic Health Services of LI Marilyn Fabbricante, Director, St. Charles Hospital Community Based Organization 07/30/13 Long Island Health Collaborat ive Meeting NSHC Office in Hauppauge Gabrielle Pareja, South Nassau Communities Hospital Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Marsha Kenny, Director of Public Affairs & Marketing, Southampton Hospital Philip Alcabes, Professor of Public Health, Adelphi University Stanford Guan,SCDOH Tina Graziose, Health Enhancement Director, YMCA of LI Erin Healy, Director of Population Health, Stony Brook University Hospital 18

62 Zahrine Bajwa, Association Team Coordinator, Cornell Cooperative Extension of Suffolk County Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Laurel Breen, Associate Professor, St. Joseph s College Dr. James Tomarken, Suffolk County Health Services (SCDHS) Commissioner Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Kelly Miloski, Peconic Bay Medical Center Karen Tripmacher, Assistant Director, Community Relations & Special Projects, Winthrop University Hospital Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Cindy Casson, Special Projects, Long Beach Medical Center Grace Kelly-McGovern, Public Relations Director, SCDOH 19

63 09/18/13 NSHC Office in Hauppauge Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Laurel Breen, Associate Professor, St. Joseph s College Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Celina Cabello, Epidemiologist, NCDOH Carolann Foley, Director Materials Management/Purchasing, St. Joseph Hospital Tina Graziose, Health Enhancement Director, YMCA of LI Beth Hammerman, Director of Planning and Community Health, Mercy Medical Center Chris Hendriks, Vice President, Catholic Health Services of LI Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY Stephanie Kubow, Manager, Office of Planning, North Shore-LIJ Health System Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Linda Mermelstein, Physician, SCDOH Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Stuart Vincent, Director of Public Relations, Mather Hospital 20

64 10/29/13 NSHC Office in Hauppauge Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Marilyn Fabbricante, Director, St. Charles Hospital Yvonne Spreckels, Director, Community Relations, Stony Brook University Hospital Stanford Guan (SCDOH) Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Philip Alcabes, Professor of Public Health, Adelphi University Lori Andrade, Chief Operations Officer, Health and Welfare Council Georgette Beal, Senior Vice President of HIV/AIDS Grants Management, United Way Long Island Laurel Breen, Associate Professor, St. Joseph s College Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Carolann Foley, Project Manager/Supply Chain Liaison, St. Joseph s Hospital Pam Ford, Manager, Community Health Promotion Programs, Emergency Cardiac Care Programs, Marketing & Conference Management, St. Francis Hospital Kristie Golden, Department Administrator, Department of Psychiatry & Behavioral Science, Stony Brook University Hospital Chris Hendriks, Vice President, Catholic Health Services of LI Gina Kearney, Director, Community Education, South Nassau Communities Hospital Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY 21

65 Stephanie Kubow, Manager, Office of Planning, North Shore-LIJ Health System Ann Little, Director, Asthma Coalition of Long Island Sue Palo (St. Francis Hospital) Gabrielle Pareja (South Nassau Comm Hospital) Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center James Tomarken, Commissioner, Suffolk County Department of Health Services Anderson Torres, CEO, Hispanic Counseling Center Pat Kiernan, Vice President of Development, East Long Island Hospital Marsha Kenny, Director of Public Affairs & Marketing, Southampton Hospital Marilyn Fabbricante, Director, St. Charles Hospital Stuart Vincent, Director of Public Relations, Mather Hospital Teresa Maestre, Coordinator, Hispanic Counseling Center Juliet Frodella, Director of Community Care and Senior Options and Solutions, Eastern Long Island Hospital Celina Cabello, Epidemiologist, NCDOH Zahrine Bajwa, Association Team Coordinator, Cornell Cooperative Ext. Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Colleen Lindblad, Assistant Director of Finance and Budget, NuHealth, Nassau University Medical Center Stanford Guan (SCDOH) 22

66 Karen Tripmacher, Assistant Director, Community Relations & Special Projects, Winthrop University Hospital Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council 23

67 Suffolk County Community Health Meetings Date Description Attendees Notes 02/14/13 04/11/13 04/29/13 Long Island Health Collaborative Long Island Health Collaborative Long Island Health Collaborative Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Jane Corrarino, Director of Grants Development, Coordination, and Biostatistical Unit, SCDOH Juliet Frodella, Director of Community Care and Senior Options and Solutions, Eastern Long Island Hospital Stanford Guan (SCDOH) Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Robert Ross, Vice President of Community and Government Relations, Southampton Hospital Yvonne Spreckels, Director, Community Relations, Stony Brook University Hospital James Tomarken, Commissioner, Suffolk County Department of Health Services Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Stuart Vincent, Director of Public Relations, Mather Hospital Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Jennifer LoGiudice, Assistant Vice President, External Affairs and Strategic Initiatives, St. Catherine of Siena Med Center Discussion of community and population health survey, statistical sources, and formation of a survey sub-group Survey results, identification of prevention agenda priority areas Discussion of collaboration with community based organizations regarding specific health priority areas 24

68 Marilyn Fabbricante, Director, St. Charles Hospital Chris Hendriks, Vice President, Catholic Health Services of LI Sharon DiSunno, VP Quality Management, Southampton Hospital Chris Hendriks, Vice President, Catholic Health Services of LI Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center Stuart Vincent, Director of Public Relations, Mather Hospital Tina Graziose, Health Enhancement Director, YMCA of LI Eileen Knauer, Regional Vice President & Executive Director, YMCA of LI 05/30/13 Long Island Health Collaborative Yvonne Spreckels, Director, Community Relations, Stony Brook University Hospital Patricia Gremillion-Burdge, School Health Policy Specialist, Western Suffolk BOCES Susan Kessler, Program Administrator, Western Suffolk BOCES Entering into the coalition building phase, needs and assets assessment, and conversation with relevant stakeholders Marilyn Fabbricante, Director, St. Charles Hospital Laurel Breen, Associate Professor, St. Joseph s College Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Assistant Vice President, Development & Public Affairs, Good Samaritan Hospital Medical Center Juliet Frodella, Director of Community Care and Senior Options and Solutions, Eastern Long Island Hospital Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System 25

69 Ann Little, Director, Asthma Coalition of Long Island Stanford Guan (SC Health Dept) Demetrios Kadenas, Chief Development Officer, Peconic Bay Medical Center Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Kristie Golden, Department Administrator, Department of Psychiatry & Behavioral Science, Stony Brook University Hospital Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Yvonne Spreckels, Director, Community Relations, Stony Brook University Hospital Chris Hendriks, Vice President, Catholic Health Services of LI 06/25/13 Long Island Health Collaborative Juliet Frodella, Director of Community Care and Senior Options and Solutions, Eastern Long Island Hospital Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Ann Little, Director, Asthma Coalition of Long Island Dr. James Tomarken (SCDOH); Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Development and distribution of Strategy Maps Obesity, Treatment/Management of Chronic Diseases, and Mental Health Stanford Guan (SCDOH) Tracy Teague, MPH Program, Adelphi University Philip Alcabes, Professor of Public Health, Adelphi University Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital 26

70 Sharon DiSunno, VP Quality Management, Southampton Hospital Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center Zahrine Bajwa, Association Team Coordinator, Cornell Cooperative Extension of Suffolk County Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council 07/30/13 Long Island Health Collaborative Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Jerzy Eisenberg-Guyot, Public Health Associate, Centers for Disease Control and Prevention Celina Cabello, Epidemiologist, NCDOH Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Chris Hendriks, Vice President, Catholic Health Services of LI Marilyn Fabbricante, Director, St. Charles Hospital Gabrielle Pareja, South Nassau Communities Hospital Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Marsha Kenny, Director of Public Affairs & Marketing, Southampton Hospital Philip Alcabes, Professor of Public Health, Adelphi University Stanford Guan,SCDOH Tina Graziose, Health Enhancement Director, YMCA of LI Erin Healy, Director of Population Health, Stony Brook University Hospital Zahrine Bajwa, Association Team Coordinator, Cornell Cooperative Extension of Suffolk County Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Laurel Breen, Associate Professor, St. Joseph s College Development of a universal metric tool in partnership with Stony Brook University 27

71 Dr. James Tomarken, Suffolk County Health Services (SCDHS) Commissioner Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Kelly Miloski, Peconic Bay Medical Center Karen Tripmacher, Assistant Director, Community Relations & Special Projects, Winthrop University Hospital Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Cindy Casson, Special Projects, Long Beach Medical Center Grace Kelly-McGovern, Public Relations Director, SCDOH Chris Banks, Vice President of Development and External Relations, Brookhaven Memorial Hospital Medical Center Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Laurel Breen, Associate Professor, St. Joseph s College Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Celina Cabello, Epidemiologist, NCDOH Carolann Foley, Director Materials Management/Purchasing, St. Joseph Hospital Tina Graziose, Health Enhancement Director, YMCA of LI Beth Hammerman, Director of Planning and Community Health, Mercy Medical Center Chris Hendriks, Vice President, Catholic Health Services of LI Pat Kiernan, Vice President, Foundation / Community Relations, Eastern Long Island Hospital Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY Stephanie Kubow, Manager, Office of Planning, North Shore-LIJ Health System 09/18/13 Long Island Health Collaborative Conversations with the Chronic Disease Bureau, establishing State-level priorities 28

72 10/29/13 Long Island Health Collaborative Jennifer Ludwin, Health Educator, North Shore-LIJ Health System Linda Mermelstein, Physician, SCDOH Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Samantha Vigliotta, Director of Donor Relations, Peconic Bay Medical Center Stuart Vincent, Director of Public Relations, Mather Hospital Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Marilyn Fabbricante, Director, St. Charles Hospital Yvonne Spreckels, Director, Community Relations, Stony Brook University Hospital Stanford Guan (SCDOH) Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council Philip Alcabes, Professor of Public Health, Adelphi University Lori Andrade, Chief Operations Officer, Health and Welfare Council Georgette Beal, Senior Vice President of HIV/AIDS Grants Management, United Way Long Island Laurel Breen, Associate Professor, St. Joseph s College Tavora Buchman, Director, Division of Quality Improvement, Epidemiology and Research, NCDOH Nancy Copperman, Director, Public Health Initiatives, North Shore-LIJ Health System Carolann Foley, Project Manager/Supply Chain Liaison, St. Joseph s Hospital Pam Ford, Manager, Community Health Promotion Programs, Emergency Cardiac Care Programs, Marketing & Conference Management, St. Francis Hospital Kristie Golden, Department Administrator, Department of Psychiatry & Behavioral Science, Stony Brook University Hospital Chris Hendriks, Vice President, Catholic Health Services of LI Gina Kearney, Director, Community Education, South Nassau Communities Finalizing and piloting the universal metric tool to measure pre- and postprogram behavior and knowledge change, with a focus on understanding of health status and lifestyle 29

73 Hospital Karyn Kirschbaum, School Health Policy Specialist, Western Suffolk BOCES Healthy Schools NY Stephanie Kubow, Manager, Office of Planning, North Shore-LIJ Health System Ann Little, Director, Asthma Coalition of Long Island Sue Palo (St. Francis Hospital) Gabrielle Pareja (South Nassau Comm Hospital) Heather Reynolds, Director of Community Relations/Volunteer Services, St Catherine of Siena Medical Center James Tomarken, Commissioner, Suffolk County Department of Health Services Anderson Torres, CEO, Hispanic Counseling Center Pat Kiernan, Vice President of Development, East Long Island Hospital Marsha Kenny, Director of Public Affairs & Marketing, Southampton Hospital Marilyn Fabbricante, Director, St. Charles Hospital Stuart Vincent, Director of Public Relations, Mather Hospital Teresa Maestre, Coordinator, Hispanic Counseling Center Juliet Frodella, Director of Community Care and Senior Options and Solutions, Eastern Long Island Hospital Celina Cabello, Epidemiologist, NCDOH Zahrine Bajwa, Association Team Coordinator, Cornell Cooperative Ext. Colleen Valdini, Manager, Public and External Affairs, Good Samaritan Hospital Colleen Lindblad, Assistant Director of Finance and Budget, NuHealth, Nassau University Medical Center Stanford Guan (SCDOH) Karen Tripmacher, Assistant Director, Community Relations & Special Projects, Winthrop University Hospital Lisa Benz Scott, Director, Program in Public Health, Stony Brook University, School of Public Health Janine Logan, Director of Communications, Nassau-Suffolk Hospital Council 30

74 HEALTH NEEDS ASSESSMENT: NASSAU COUNTY County-Hospital Collaboration Nassau County Department of Health, Catholic Health Services, Long Beach Memorial Hospital, North Shore LIJ Health System, South Nassau Communities Hospital, and Winthrop Hospital Consulting Services Provided by Jessica B. Steier, MPH, DPH Candidate May

75 I. Introduction II. Methodology III. Participating Organizations IV. 2 JB Steier Nassau County Health Needs Assessment May 2013 Key Findings from the Assessment A. Prevention Agenda Priorities 1. Prevent Chronic Disease 2. Promote a Healthy and Safe Environment 3. Promote Healthy Women, Infants, and Children 4. Promote Mental Health and Substance Abuse 5. Prevent HIV, STDs, Vaccine Preventable Diseases, and Healthcare Associated Infections B. Other Issues Identified C. Recommendations to Improve Services and Programs V. Health Services Offered by Participating Organizations VI. Appendix I. Introduction Nassau County represents a dichotomy, as its residents represent some of the healthiest and sickest in the nation. Health disparities exist within and between townships of varying socioeconomic composition. There are also differences in health status based on race and ethnicity. For example, infant mortality, cancer mortality and homicide rates are much higher for blacks than whites. Latinos have higher rates of teen pregnancies, tuberculosis and deaths from injuries. The causes of these disparities are numerous and complex, and include differences in income, education, housing, access to health care, as well as racism. Reducing or eliminating these disparities is one of the most important national and local public health goals. This report will identify the priorities, goals and opportunities for improvement as conveyed by leaders of healthcare organizations across Nassau County. Data from this report will be used to reduce health disparities among Nassau County residents and improve the healthcare received by the community. II. Methodology Together, the Nassau County Department of Health and Nassau County Hospitals conducted a Community Health Assessment. Key-informant interviews were conducted with health organization leaders to identify pressing health needs in the community in the hopes of developing strategies to meet them. Upon providing consent to be interviewed, participants were asked open-ended questions about their organization and the population they serve. Participants were asked to identify the biggest health problems in their community and prioritize health issues to be addressed. Additionally, they were asked to describe the factors that affect the health care the community receives, namely demographic factors such as age,

76 gender, race/ethnicity, socioeconomic status and financial security, and language barriers. Participants were asked to describe the health resources their community utilizes in relation to specific health problems and identify barriers to, or gaps in, resources provided. Lastly, participants were asked to identify ways they feel their organization might improve services and programs for the community they serve. Interviews were recorded and transcribed. Qualitative data analysis was conducted using Atlas TI software to identify prevalent themes and emergent themes in responses. The data presented here represent common themes discussed by participants of this study, focusing on the strengths and weaknesses of health services provided to Nassau County residents. Please see Appendix A for the interview guide in its entirety. A pre-interview survey was conducted to collect basic information about the services provided by the organizations and their target populations. A summary of this data is provided in Section V. III. Participating Organizations Below is a list of the organizations who participated in the Community Health Assessment, and the role of the key informants interviewed: American Cancer Society Syosset, NY American Diabetes Association Melville, NY American Heart Association Plainview, NY Catholic Charities Hicksville, NY Circulo de la Hispanidad Long Beach, NY FEGS Hempstead, NY Health and Welfare Council of Long Island Hempstead, NY Island Harvest Mineola, NY Jewish Association Serving the Aging (JASA) Long Beach, NY LI GLBT Garden City, NY 1. Director of Patient and Family Services 1. Director, Long Island Operations 1. Regional Vice President Field Operations 1. Director of Development and Communications 2. Developer, Information and Referral 1. Executive Director 2. Chief Director of Services and Operations 1. Senior Director 2. Director of HIV Services 3. Vice President, Long Island Operations 1. President and CEO 1. SNAP Outreach Coordinator 1. Director, Long Beach Services 1. Chief Operating Officer and Director of Development for the Long Island GLBT Services Network 3 JB Steier

77 Long Island Council of Churches Hempstead, NY Mental Health Association Of Nassau County Glen Cove, NY Perinatal Services Network Uniondale, NY Planned Parenthood Hempstead, NY Massapequa, NY Glen Cove, NY Project Independence Roslyn Heights, NY Sustainable Long Island Farmingdale, NY United Way Deer Park, NY 1. Director 2. Nassau County Coordinator 1. Director of Special Projects 1. Coordinator 1. Senior Vice President for Health Services, Planned Parenthood of Nassau County 1. Deputy Commissioner 2. Senior Citizen program Development Specialist 1. Executive Director 1. Senior Vice President for HIV AIDS Grants Management IV. Key Findings A. Prevention Agenda Priorities 1. Prevent Chronic Disease *Participants overwhelmingly reported chronic disease as one of the most pressing health problems; 76.4% of organizations feel it is a priority; 50% feel it is the #1 health priority. The health burden of overweight and obesity-related diseases and conditions, such as diabetes and heart disease, is increasing significantly. Unattended diabetes [is a major health issue]. Where I think people have not taken care of it at an earlier age and so now we re dealing with the results, which is poor ambulation, or inability to ambulate. These people are homebound a lot earlier than they probably would have to be, because of diabetes that wasn t responded to. -JASA Promoting healthy living among youth should be a top priority, especially in minority populations with a high prevalence of obesity. Obesity in the Hispanic community is terrible. [There is obesity throughout the lifecycle], but seeing it in the kids there s so much you could do around prevention and education. I can tell you some kids who come to my programs, they are now 35 years old almost. Now they are men, fathers, and they have a lot of issues with diabetes. They went from childhood, they were just obese and then became diabetic and this and that. -Circulo 4 JB Steier

78 Management of multiple co-morbidities and coordination of care is a problem, especially among older populations. The problem with people who are older is that they don t have one health problem. All of them are dealing with a complexity of multiple health problems and they re taking I think the problem isn t one specific health problem, it s the coordination of services to people that are taking 15 medications. And you have 5 doctors, and you have a physical therapist, and then have a nurse, you have so many different disciplines and I think the coordination of services, with now, of course the problem on Medicare managed care, and the lack of finances and the inability to retain home care. -JASA Our population has a tremendous amount of comorbidities, and our [patients with] end-stage renal disease not only have diabetes but could have started off with alcoholism and substance abuse, and we have a lot of patients with Hepatitis C, and even though it may not be a primary diagnosis for us, we have people in my program with HIV also. FEGS Time and money should be allocated for prevention rather than solely on treatment. We re not funded to do prevention; it s really underfunded, particularly in Nassau County It makes no sense because in the long run, it costs a lot less to prevent than it does to treat And I can say that with most chronic illnesses, if care is available, and accessible to a person, you can mitigate some of the problems with diabetes, with congestive heart failure, because they don t have to get to the point of end stage renal disease if they re treated in a correct way, even some of your minor cardiac issues don t have to get to end stage disease if they re treated in a better more on time with the care coordination. FEGS Certain chronic conditions limit food choices which is problematic for lower SES people who cannot afford higher quality foods. I would say diabetes [is a major issue] and I would also say anything having to do with cholesterol, because that s not something that you can get something off the shelf to deal with. And people come for food they say I need sodium-free food, the diabetics need no-sugar added. Those are the people that we see the most that have those issues that we are not able to accommodate their disease. They have to shop differently and they can t afford to and they search pantries and they re not finding the foods that they need and then they go over a certain amount of visits because they re eating things that s causing their disease to act up more than normal then what do they do. So I would say that s a rising problem. LI Council of Churches 5 JB Steier

79 Smoking continues to be highly prevalent among the mentally ill population. We also look at the impact of smoking Our population, there s a high correlation between schizophrenia and smoking. Many people that come to us do smoke. People live hard lives in a hospital or facility, or have undergone years of homelessness, so when you add it all up, our population dies 25 years early. Mental Health Association 2. Promote a Healthy and Safe Environment Poor diets among minority and low SES populations is due, in part, to cultural norms. Santo Dominicans, they eat corpa pushas it s like corn and you put inside cheese or meat or whatever. But is like pizza. Do you eat pizza everyday and put on cheese that is processed with no nutrients whatsoever and a little bit of tomato sauce that is from the can and do you eat this very often? I saw this with one of the girls last year. And it was very much cultural. Cirulo More outreach to low SES and minority populations is needed to provide education about nutrition and healthy food practices. A big piece we are trying to do around that level is change is educating parents about how to handle your children who say they are finicky eaters and they don t want to eat. The parents then stop serving them vegetables or broccoli and then they are given foods that are really not that nutritious and high in fat and carbs. And now, Chef has been really trying to work with families to let people know - keep introducing it. If they say no, find out why And, we see some positive elements in just getting the parents on board. Because the parents don t know necessarily what to do. They see their kids and want to make sure they re eating, so instead of trying the vegetables or fruits they ll push the other kinds of foods. We see a lot of it. -Circulo Food deserts exist in low SES neighborhoods; there is a need for increased access to nutritious food options to reduce food insecurity. People don t have access [to healthy foods] Without the Farmers Market, generally the people in those communities don t have a car and they can t go to a supermarket easily. It s giving them only access to the local bodega or you know corner quick you know convenience store; high sodium, high fat, not good healthy choices, no fresh produce, or very limited choices. Sustainable LI 6 JB Steier

80 Hurricane Sandy has increased cases of unsafe living environments (ie. mold) particularly among low SES, minority, and immigrant populations In the wake of Hurricane Sandy, we re going to see some serious health issues emerge, everything from mold that hasn t been properly remediated, and people rebuilding their homes because of that, to the waste that washed up because of breech in Reynold s channel, to the people that have on their property all kinds of things like oil spills and gas leaks and all those things, raw sewage, washed up onto these properties, and we re going to see some serious public health issues. And what we re seeing now, since a lot of the disaster case managers have come over to me, because a lot of the people had chronic illnesses that exacerbated under the disaster, and we are seeing more and more people who are identifying those mental and physical illness that might have flew under the radar who are now coming into our programs. FEGS Environmental justice issues are prevalent among low SES housing such as water quality, the built environment, and outdoor air quality. From our environmental justice work we do see much, much higher rates with Asthma, in some of the environmentally disadvantaged areas..we go by New York State [designated] Potential Environmental Justice Areas, and for instance Roosevelt has much, much higher rates of asthma than other parts of the state. And so we key in on that and we try to do Environmental Justice Education and Awareness because that s an area that the people in the community should be aware of. So I would say certainly Asthma, and certainly cancer as far as the environmental justice issues. Some of them are living in houses with mold, they still have asbestos, they still have lead. Sustainable LI Lower socioeconomic populations may not have access to safe spaces to exercise and stay active. I think the exercise [is another problem]. A lot of our families, first I ll talk about Hempstead, after dark, people are not wanting to go outside. There s limited areas for them to play or families are coming home late so they re stuck in apartments. For Long Beach, you ve got some of that, but you have a little more flexibility. Still, people are in basements and so forth. I think exercise is a big component for everybody I would say that here in Long Beach, finances affects exercise. Some of the families that have limited income they are not in the soccer programs. They don t have the resources for travel soccer. We ran Long Beach soccer team. If they have to travel all over Long Island, some parents can t take children all over Long Island children can t participate. -Circulo 7 JB Steier

81 3. Promote Healthy Women, Infants, and Children The lack of funding for childcare has negative consequences for low-income workers who are unable to afford daycare services. The reduction in funding for daycare for low-income people [is a problem]. They just eliminated hundreds and hundreds of slots for these kids, and these are working class parents who cannot afford high cost daycare who are losing slots in these subsidized programs These people, how can they work if they don t have safe and effective child care for their children? You take that away and they re going to be put in unsafe situations because they have no choice, or they re going to not be able to work. Perinatal Network Pregnant teenagers underutilize healthcare services despite the availability of resources. When asked how age affects healthcare received: The only group I can think of is [pregnant teenagers]. It s very complicated. They left the house, or their parents sent them out, and they don t have any idea about how important it is to keep [up with] their medical [care]. I think that population is affected because they do not use the resources available there s a lot of resources here in Nassau, but that specific population you have to reach out to them and bring them in. - Perinatal Services Network Older women do not seek out preventative health services. I really wonder how many women, we re talking about very older women, even ever go see an OB/GYN. I have a feeling that many, not most of them, haven t even gone for a pap smear, ever. Because, generationally, they just didn t do it. And to try to encourage women, older women, to take care of themselves, is a big deal. We get this a lot. We say to them, go get a pap smear, go get tested. And they ll say, we ve never been to a gynecologist. We give them a look, like, what? But, no, so just in terms of getting the right kind of medical care is a big deal. Even for that. So in terms of that kind of women s health, certainly. JASA There is a lack of awareness of the importance of prenatal care among highrisk populations. *Especially among the African American population In Nassau County, the high risk population is the African Americans, it s the one who still has a high percent of infant mortality, prematurity, and low-birth weight babies. -Perinatal Services Network 8 JB Steier

82 4. Promote Mental Health and Substance Abuse There has been an increase in the prevalence of mental health issues across all age groups with insufficient resources to care. We have more kids with autism and more young adults who are bipolar and more people in their 20s who are schizophrenics and more older adults that we re seeing with bipolar disorder, schizophrenia, long term depression, major depression, who, you know, it was either unresolved, or even if it is, who are not able to address some of these issues independently. And we re seeing much more of that. It was never, years ago, that you saw this many older people with major mental illnesses that came our way. These are people just living in the community, many of them on medication for it, but you know, it does interfere with your ability to address other issues. A lot, a lot of it. A lot of bipolar, a lot of schizophrenia. JASA Stigma associated with mental health services causes people to delay treatment or not seek services at all. *Especially among the Hispanic population One [of the biggest health problems] has a lot to do with just mental health services partly because there is a stigma around it and people not really wanting to say that they need mental health services. But for many reasons, I think that is a very big thing that we find people are in need of and don t necessarily always know how to access. United Way There has been an increase in substance abuse and mental health issues post-hurricane Sandy. In Long Beach especially, a huge amount of the population, of the immigrant Hispanic population they lost their homes, they re living with family or neighbors, or they re in like sort of temporary housing. We are seeing a huge problem with domestic violence and drug dependency mental health, stress, anxiety, and drug use. So all of that was exasperated because of everything that they lost. Sustainable LI Pain medication abuse is an increasing problem. We see a lot of pain medication. A lot. There s a lot of pain medication that s being prescribed. I mean, they go to five doctors, you can ask five doctors for a prescription for pain and if they re not really good doctors, or they don t know the client, they will just give them a prescription. So now they have five prescriptions for Oxycotin, how wonderful. It s big, big with older people. Pain medication abuse is big, we see it a lot. We see some alcohol, we don t see as much, but we do see some. But we do see a lot of prescription medication abuse. And misuse. People don t understand what to take. They don t remember what to take. If they re self-administering and there s dementia, they re going to take two instead of one. They re going to forget that they took it. Again, that s where you need some kind of supervision. JASA 9 JB Steier

83 There is a lack of senior mental health services. There s been a huge lack [of senior mental health services]. I would like to see that mentioned and addressed. We as advocates talked a few years ago that the baby boom generation started turning 65 in We urged the system to think about it, and they didn t respond What you re going to have are two groups of people. One with severe mental illness who are aging and dying, and other individuals who as they age will face challenges of their own and become depressed. We know there s a huge lack of geriatric mental health specialists in the area. There s a lack of residential services. That s a challenge for us. Even the people we serve with age, and maybe start to use a walker or cane whatever, and have mental health challenges, the residential system is not equipped to handle these individuals, there are steps, not enough staff, people wetting the bed we re not equipped to deal with that. Mental Health Association 5. Prevent HIV, STDs, Vaccine Preventable Diseases, and Healthcare Associated Infections Funding for HIV awareness, screening, and prevention is limited. If the Department Of Health is looking for programs that would have a prevention bend to them, or reduction, mitigation bend to them, clearly HIV AIDS is always at the top of the list, because we can prevent that disease. Nassau County actually had a pretty big [HIV prevention advocate], Dr. Pollack was her name, she ran a pretty big STD, HIV prevention program a couple of years ago. Money was tight and I don t think that s still there. They did STD screenings, got out the prevention methods; there isn t a lot out there. We distribute condoms, we give prevention methods, but we re not funded to do that. We have another program funded that s supposed to identify people with AIDS out in the community, and know their status, and you can t just go up to someone and say do you know your status? And, you want to get tested? So we distribute condoms and information using peers, and in that exchange, we solicit people, we attempt to get them tested if they don t know their status. FEGS Based on the number and relevance of the number of gay and bisexual men impacted by HIV/AIDS, I think Long Island, I mean we would like to offer a much broader and more comprehensive range of continuum of HIV prevention and supportive services. We re starting but there s a lot more to be done for people. LI GLBT 10 JB Steier

84 Strict eligibility requirements for HIV treatment coverage presents a barrier to care. Generally when somebody is newly testing HIV positive, they are referred to a medical provider, it s kind of built into the system. People get information pretty quickly. We get most of our referrals from the actual medical providers that someone is coming and seeking treatment for HIV and AIDS, it s a pretty solid infrastructure. The problem is that not everyone is eligible for Ryan White. They used to just have to be HIV positive and there would be a plethora of services to support them. And now, they have to basically be poor and on Medicaid. If they re trying to pull themselves up and out of the system, or if they were never in that system to begin with, they re out of luck the services are no longer there for them. They can access the medical provider through their private insurance if they have it, or they can use something called ADAP which is the age drug assistance program, but a lot of the social supports are no longer available for them, and that s a problem. FEGS B. Other Issues Identified Inadequate public transportation system on Long Island is a barrier to accessing care. Accessibility, getting transportation in Long Island and Nassau County is a nightmare. Even though we have a system called Able Ride just accessing Able Ride, sometimes it s better to bang your head into a wall because you make the appointment, you have to know in advance to make the appointment, then you sit and wait until they pick you up. They also don t leave the car so if you have mobility issues and you can t get to the car and then if you have a compromised immune system, you re often times sitting in a van with multiple people who may have an active virus, or the flu, and you re taking your life in your hands often times when you go to the doctor that way. FEGS Getting to the actual treatment [is a major barrier to care]. Because some patients can be going for radiation every day, and to rely on family members to take them every single day, most family members are also working. So how are they going to get to those appointments? That s something we have seen a lot. Same thing with chemo therapy they can be there every few weeks, some being every day, but generally every few weeks. But it s a family member that has to take them. American Cancer Society A growing segment of the population does not speak English fluently, affecting the quality of care provided due to poor communication. Our primary issue is going to be language barriers, because we can put some services in Spanish, we also have a very large Persian community, and we do have a social worker part time dealing with Farsi speaking seniors in that community, but those are two of many many languages spoken in the town of north Hempstead so we recognize there are communities we are not able to reach just yet. Project Independence 11 JB Steier

85 There is a lack of awareness of health resources available among health care providers and consumers. Need to streamline and update current information banks (211). I think really getting information out there to people and having it in all different places I think they re so overwhelmed they don t know what to do. It s just like you know they need a sounding board to be like where do I go from here? I think having access to places, to people who can really explain services is critical. Catholic Charities [Health care can be improved through] more education sending people into the communities and, we as the ADA can go in there and educate them on diabetes and prevention and give them literature, but we don t have the education to know as far as, you know, this program is available for you and these resources are available for you so you can contact the Nassau County Department of Health or they ll provide these resources. So I think to let people know the resources that are available for them if they are having issues affording their medications or treatments. American Diabetes Association There is a need for in-home services (both physical and mental health services) for elderly populations who are unable to travel to receive care. The other thing is mental health services tend to be expecting the person to come to us, but with seniors that are homebound don t come out. So what we recommend now is an act team model where a psychiatrist social worker will go out, they ve used it for difficult consumers, they have an act team for seniors we re concerned about the older community where they re not getting any care. So I d like to see seniors mentioned. Mental Health Association Just having an aide [is a major issue]. Being able to able to afford one. Being able to stay in their home as long as possible. There is not an older person, or any person in this world, who wants to be put into a nursing home. I don t care who you are. They can advertise it from here to doomsday and they can be beautiful, but everyone wants to stay in their own home, for as long as possible. And the only way most of these people are going to be able to stay home is with some assistance. And Medicare covers a very, very short period of time for homecare. So, after that, we have an issue. How are we going to provide home care? We provide some homecare that s funded through NYS, but it s very limited. Our funding keeps getting cut. So we have people, we have wait lists. And we re only giving it to people 3 ½ hours every other week. And it s just housekeeping. We also provide 20 hours of personal care a week. But, people are on wait lists. And what do you do on weekends? What do you do at night? Family members are stressed beyond belief and do not have anything left. Don t have the money, don t have the patience, don t have the resources to be able to now take care of their older adults. They re not going to be able to put them in their homes, especially now after what s happened (referring to Hurricane Sandy and devastation in Long Beach). So, it s a crisis, it s a homecare crisis in my opinion. And we get a call every day. We must get 10 calls a day asking us how do we get an aide. Who do we call. Who s going to pay for it. Every day. -JASA 12 JB Steier

86 Patients are unable to navigate the system and are unsure how and where to obtain care. There is a need for case managers or patient navigators. When there is a service available that helps them navigate the healthcare system is one of the primary things people look for. There s a lot of confusion because we all know how fragmented the medical and healthcare system is people don t know who to turn to or how to access these programs, people don t know what s out there. FEGS There is a heavy reliance on emergency room for primary care. I think the community utilizes, unfortunately, the emergency room in too many instances. I think that there has been a better job in Nassau County with the clinics becoming federally qualified health clinics, that there is an attempt to provide much more comprehensive service delivery for the populations in these settings. I think people utilize stand-alone doctors they may pay out of pocket for. I think they may utilize some of the quick stop clinics within pharmacies and where we re seeing that sort of pop up. That s a way that I think people meet some of the needs that aren t met comprehensively. Health and Welfare Council of LI Undocumented immigrant populations are afraid to access healthcare out of fear of being reported; delay healthcare until they reach emergency status. We see a huge problem with the undocumented, because they re afraid to go for care unless they re dying or really injured, which is awful. I mean, they re afraid. And so we will say to people You have to get help, your cough isn t good or you are truly sick, there s a big problem in some of these communities that they re afraid that they ll be shipped out or whatever. I mean, it s never spoken. It s all unspoken, but they just say I can t. So that s a problem. Sustainable LI Men do not access needed medical attention or preventive health screening; women play a large role in their husbands healthcare. I think the men go to the doctor actually because their wives make appointments for them. So do I think the men are out there saying Oh let me go? No. Years ago [we had information that read:] the AHA: how to take care of your husband. That was the focus, you know. Or women would know what their husband s numbers are and they had no idea what theirs were. American Heart Association There s more women who will reach out for the support services for like the outreach to recovery, which is our breast cancer one-on-one support group. We had a group that was called Man to Man for prostate cancer survivors, it did not do well at all. A lot of men are not out there requesting the support. It s usually significant other or family that s looking for the support for them. Not a lot of men reach out on their own. American Cancer Society 13 JB Steier

87 The LGBT population struggles to access healthcare out of fear that they will be treated differently. That s a challenge because there s been a history of bad, negative, and stigmatizing experiences that LGBT people have had with, um, health and other medical personnel. If they haven t, there s- I guess there s the assumption that they will or that they don t know how to be quote unquote out with a healthcare professional. Even though a lot of healthcare professionals today are actually eager to better serve the LGBT community, there s still that- that lack of understanding or- or really the fear that someone will be treated, uh, in a bad way. That is compounded by the fact that there are different health disparities in the LGBT community. LI GLBT C. Recommendations to Improve Services and Programs Need for increased collaboration and partnerships among hospitals and community based organizations. I think, first and foremost, and this is not like rocket science, coordination and collaboration amongst the different entities [will remove barriers to care]. So, when we talk about health from a physical and a mental perspective and a preventive perspective, the health care institutions need to be working in partnership with community based organizations in a very different way, because as we look at the Affordable Care Act and how we re moving care into the community, hospitals have to be able to get patients to care that works for them. Even when we talk about public health issues, I think it s the same thing, there needs to be integration of schools, hospitals, non-profit organizations to make sure that there s an educational component that gets out to individuals so that they re clear on what some of the risk factors may be, where they can go to access services and then we can look at where some of those gaps are. Health and Welfare Council of LI I really would like to see it more coordination and collaboration with people It would be nice to see that as a region we re really taking care of some of the people with lower income because everyone sees us as a very affluent area and for that reason they tend to not allocate that many resources. But we re also not coming together as one voice, really identifying what the problems are and advocating for them in a coordinated way. I think that s where we need to go long term if we re truly going to address issues. All of their city issues are slowly creeping here and we re not monitoring the impact that it s having on everyone else. But its going to happen and it is happening. United Way 14 JB Steier

88 Increased community outreach and education campaigns available in other languages (especially Spanish). [Health education is needed] especially, you know, in a lot of the immigrant [populations]. I think a lot of them are afraid to seek help and education. So I think that s a big one. And again I just think education. I think that people don t understand the major effects that diabetes can have on you if you don t manage it. Diabetes can, you know, you can manage it and live a healthy lifestyle, but if you don t manage it, that s where you re going to see these very severe complications. And I think that a lot of these communities - they don t understand the severe complications and they don t take care of themselves. American Diabetes Association Health promotion events and programs should be held at night and on weekends to allow people who work to attend. A big issue is hours of operation. So people who work during the da, need things on the weekends, or in the evenings, or even before they go to work maybe. So, that s always an issue I think with people getting the time. The time and the hours of operation. Island Harvest Use of technology to communicate with people regarding healthcare issues and services. I think now everything is kind of going digital. So I think more information that we can digitally have access to, the better. Any kind [of digital media]. Even like through social media, through websites, through texting is a good one. I think they were exploring how we could, because for SNAP you have to recertify every 6 months to a year potentially depending on your household. So it s usually 6 months. So there s a lot of, what they call churning. So people will not recertify and then they will have to end up reapplying and it creates more of a back log. People miss out on their benefits and it s like a vicious cycle. So, texting alerts or something like Did you recertify? or Did you send in your paperwork? you know it would probably be easier and prevent that. But, I don t think that technology has caught up quite yet with that one. But it would be nice in the future. I mean, texting is a great one. I think anything on Facebook or YouTube or, you know, web advertising. Anything like that. Island Harvest Outreach events should be hosted at community centers and places of worship to increase attendance and participation. Put things in more than one language, try to host meetings at the community centers, or senior centers or whatever is actually in that community, and be really clear that there is no cost and be really clear that they won t be asked for anything. It s just, I think that you are dealing with people that have been sort of conditioned to be wary, and that it s important that they re clear why you want to help and that there is nothing required of them. Sustainable LI 15 JB Steier

89 Patient education should emphasize prevention versus treatment, with a focus on healthy lifestyles (eating healthy and exercising). I think a lot of people still don t know that 80% of heart disease can be prevented through exercise, eating healthy, stop smoking, know your numbers, know your BP, know your Glucose. I think it s still educating the people to make simple small choices. Healthier choices that will then reduce all their risk factors. So I think it s really getting people to know what their risk factors are. American Heart Association There should be increased communication across organizations to ensure visibility of programs and resources available. Health department and hospitals could much more clearly communicate information about the availability of free and cheap services. That would be a good start. I realize that they have the same problem that every non-profit does, that no one is paying them to do this. The Council for Non-profits recently started ing this information, and no other agency has this information. They don t know which programs exist. And they change all the time. You can print up a brochure of all services, but 6 months later, it changes because funding runs dry We let people know. If they would let us know, it would help to let other people know. Our prelude goes out to about 125 people; our newsletter goes out to 5,000 people. We reach out. We let people know. If more came in, there would be less problems. I think other organizations could do the same. If you can establish an list, it ought to be easy to push out that information on a regular basis. Every healthcare provider should be able to integrate this into normal communications. Every hospital ought to have a newsletter that gives information at least to say what they re doing themselves. I m not expecting people to do things they re not getting paid for, but if they re already doing something, you ought to communicate it better. Almost any organization can use their resources to communicate better I think. It would probably help to raise money in the end. LI Council of Churches A taskforce with members from various organizations would be helpful to brainstorm additional ideas and solutions. If there was any kind of a task force, we would certainly be willing to sit on a task force to come up with some concrete, practical applications. The agency always wants to on the forefront of advocacy, whether it s advocating at the political level, coming up with, of course, if we had more funding to provide more home health care, more home delivered meals, we would continue. -JASA 16 JB Steier

90 Increased patient navigation and case management services would break down barriers to care. I think utilizing some of our very effective case management models and having these concepts of health navigators or people who can really help to remove barriers, like with care coordinators. Some of the things they re implementing under the new health home model will definitely help where it needs to be expanded out to people. I think we need to bring health more to the forefront through media campaigns, ad campaigns to talk about the importance of people s health; not just physical health but also mental health to remove some of the barriers around that and just make it more accessible. And also using that opportunity to really educate people, some series, some forums that are easy to get to, held at libraries, to really just educated people on what does all of this mean, to erase some of the misconceptions about whats going on with the ACA, I think more education for people on how to utilize and maximize what they re getting out of the healthcare system will be important. United Way 17 JB Steier

91 V. Health Services Provided by Participating Organizations American Cancer Society Syosset, NY American Diabetes Association Melville, NY American Heart Association Plainview, NY 1. Research projects for cancer prevention 2. Education 3. Advocacy 4. Patient and Family Services 5. Prevention and detection program including screenings 6. Free wig programs 7. Cosmetology Classes as a support programs 8. Wellness programs and one-on one support services (free patient navigator) 9. Transportation to treatment centers 1. Funds for Research 2. Education 3. Programs that provide Glucose testing, Cholesterol Screenings, Mammograms 4. Advocacy 5. Health Fairs and Speaking Engagements to educate and fundraise 6. Educate on Prevention 7. Educational Events Tour de Cure : Annual bike ride Step Up for Diabetes Walk Father of the Year Event Gala Diabetes Expo and Feria de Salud Stop Diabetes at Work: Employee wellness program Living with Type 2 Diabetes : Newly diagnosed individual receives informational literature, advice, etc. to assist them Stay with Schools program Partner with JDRF (Juvenile Diabetes Research) 1. Education through church programs 2. Awareness of Cardio Vascular Disease 3. Research 4. Grants 5. Advocacy 6. Referrals 7. Power to End Stroke Targets African Americans and Hispanics Educate them to be aware of their numbers and eating habits 8. Program Jump Rope for Hearts Through schools 18 JB Steier

92 Catholic Charities Hicksville, NY Circulo de la Hispanidad Long Beach, NY FEGS Hempstead, NY 19 JB Steier Educational and fundraising 9. Go Red for Women dinner in Queens 1. Chemical Dependence Services 2. Commodity Supplemental food programs 3.HIV & AIDS services 4. Housing for seniors and people with physical disabilities 5. Immigrant services; mental health outpatient and residential 6. Nutrition Outreach Education Project (food stamps enrollment) 7. Regina maternity services; residential maternity program 8. Community residences for people with developmental disabilities 9. Senior Clubs 10. Meals on Wheels 11. Senior Case Management 12. WIC Program 13. Dental Services 14. Para Social Ministry 15. Congregant senior meals 1. Health Fairs 2. Screenings and blood pressure checks 3. Mammogram bus 4. Long Beach soccer team 5. Programs in area of Domestic Violence 6. HIV/AIDS services 7. Housing Services 8. Education and youth service 9. Mental health services 10. Alcohol and substance abuse prevention services 11. Preventive Education 1. Partners in Dignity (PID)/ Nursing Home Transition and Diversion Medicaid Waiver (NHTD) 2. Care coordination 3 Medical Navigation 4. Information and Referral 5. Advocacy 6. Benefits/entitlement and insurance counseling 7. Individual, group, and family counseling 8. Volunteer services 9. Spiritual care and bereavement counseling 10. Professional and community education 11. Positive Space Program Mental health counseling Substance abuse recovery readiness counseling

93 Early intervention services Medical case management services HOPWA housing and supportive housing services for HIV+ women Mental health counseling to the LGBT, non HIV community Health and Welfare Council of Long Island Hempstead, NY Island Harvest Mineola, NY 1. Research and public policy 2. Advocacy and education 3. Regional Planning 4. Access to health care 5. Nutritional security services 6. Economic stability services 1. Food bank member agencies that assist in food bank, food distribution 3. Two mobile food pantries Operation Hope (veterans)- delivers one month supply of food Senior Mobile Food Pantry- provides groceries on a weekly basis to low income senior housing facilities 4. Kids Weekend Backpack Program Provides packs of food to children who receive free or reduced price lunches Can apply to receive meals to take home for the weekend 5. Summer food program Provide free lunches to children over the summer 6. SNAP Outreach (Supplemental Nutrition Assistance Program) Walk through process of applying for food stamps Outreach and application assistance 7. Advocacy Programs including MICAH (Mobilized Interfaith Coalition Against Hunger) 8. Community Resource Exchange (Community Guides) Allows them to refer clients to other agencies 20 JB Steier

94 Jewish Association Serving the Aging (JASA) Long Beach, NY LI GLBT Garden City, NY 1. Case management 2. Information and referral 3. Counseling services 4. Mental health services 5. Congregate Nutrition Programs 6. Home delivered meals for frail and homebound clients 7. Medical transportation 8. Cultural arts and recreation programs 9. Homecare services 10. Emergency financial assistance 11. Family and caregiver support programs 12. Legal and elder abuse services 13. Adult protective and community guardian services 14. Community outreach and education 15. Contract with DSS to work as community guardians for all adults above age Provide homecare services and housing for low to moderate income elderly persons 1. Support Services/ Support Groups/ Help Line 2. Mental Health Counseling Services 3. Anti-Bullying Services and Safe School Initiative 4. Community Education and Training Programs Delivers workshops and trainings each year to students, teacher, and health human service providers, social workers, counselors 5. HIV Services Unit Confidential rapid HIV testing, STD screens 6. Preventive Education 7. Community Centers in Bay Shore and Garden City 8. School Awareness Campaign in conjunction with National Coming Out Day Long Island Council of Churches Hempstead, NY Mental Health Association Glen Cove, NY 21 JB Steier 1. Prescription Assistance 2. Provide Insulin if needed for Diabetics 3. Food Bank 4. Community Share Gardens- grow produce to share with local pantry 1. Personal recovery-oriented rehabilitation services 2. Adult residential services for people with a mental health diagnosis 3. Hospital Discharge Coordination for children 4. Consumer link peer-to-peer services 5. Financial management

95 6. Health home care management 7. Crisis respite for families of children with mental health diagnoses 8. Residential program for children and young adults with autism 9. Medicaid service coordination for consumers with developmental disabilities 10. In-home respite for developmentally disabled consumers 11. Education and training for mental health professionals and substance abuse workers 12. Advocacy for people of all ages with mental illnesses, and for the people who love them 13. Community outreach and education 14. Veterans Services, promoting wellness for Long Island veterans and their families 15. Information & Referral 365-day-a-year HELPline 16. Compeer volunteer mentor program 17. Family support services 18. The Players volunteer theater troupe Perinatal Services Network Uniondale, NY 1. Health providers, mental health and social support services for pregnant women. 2. Partner with the mental health system in Nassau County, Mental Health Association; want to engage in more clinics, mental health clinics 3. Family resource guide 4. Mental health services 5. Dental Services 6. WIC Program 7. Prenatal care and delivery 8. Case management 9. Early intervention 10. Shelters for pregnant women 11. Advocacy 12. Enrollment in HMO 13. Visiting nurses 22 JB Steier

96 Planned Parenthood Hempstead, NY Massapequa, NY Glen Cove, NY Project Independence Roslyn Heights, NY Sustainable Long Island Farmingdale, NY United Way Deer Park, NY 1. Maternal and child health services 2. HIV and sexual health education 3. HPV vaccines 4. Education service 5. Testing vans 6. Transportation hubs 7. Community health fairs 8. Offer flu shots and minimal care that their PAs can provide 1. Assist seniors to age in place, safely 2. Human services, health, mental health 3. Programming 4. Nursing 5. Social work 6. Connect seniors with available services in community Town Stat Program 8. Psychological assessments 9. Member of Geriatric Mental Health Alliance 10. Medical transportation 1. Community organizing 2. Public Participation 3. Facilitation for Brownfield redevelopment 4. Recovery and revitalization after Hurricane Sandy 5. Farmers markets 6. Annual conference and fundraisers 7. Economic development 8. Environmental justice surveillance and services 1. Administrative agent to those who are HIV Positive 2. Provide Financial Assistance to agencies that provide healthcare services, mental health, and substance abuse education 3. Fund agencies in high need areas 4. Ryan White HIV and AIDS Services Serve low income individuals who do not have insurance 5. Work with AIDAP programs to insure individuals and have services for veterans 6. Case Management 7. Housing Services 8. Youth Build Individuals who have not completed high school and do not have a GED and give them Green energy job training Long Island Connect people to resources if they are in need of 23 JB Steier

97 housing or health care VI. Appendix KEY INFORMANT INTERVIEW for THE COMMUNITY HEALTH ASSESSMENT Together, Nassau County Department of Health and Nassau County Hospitals are conducting a Community Health Assessment. Today we are trying to get your expert opinion about the health in the community that your organization serves. When we ask a question about the community, we are talking about the community in which your organization serves. Answering the following questions will assist us in identifying the most pressing health needs in your community, and developing strategies to meet them. Please share your opinion with us by answering the following questions. Your participation is voluntary, and your responses are confidential. With your permission, this interview will be recorded and transcribed. Information from all interviews will be aggregated and reported in a Community Health Assessment. If after this interview you have questions or concerns, you may contact the Nassau County Department of Health at Do I have your permission? Thank you. Begin recording Thank you for already completing some basic information about your organization. I would like to expand on it a bit. 1. Please describe your organization? {Ask the following if still needed after pre survey} a. Describe your role in the organization b. What specific services does your organization provide? {Ask for explanation if not obvious} c. Who is the target population? d. Describe services your organization provides to minority populations e. to low-income f. to uninsured g. to other specific populations? 2. Please identify some of the biggest health problems in the community you serve? {Leave this as open ended, probing for specificity, then follow-up with question 3}. Hand the informant the list of priorities with focus areas to review and consider. 24 JB Steier

98 NYS DOH has identified 5 health issues that health communities could address : 1)Chronic Disease, 2) Healthy and Safe Environment, 3) Healthy Women, Infants and Children 4) Mental Health and Substance Abuse, 5) HIV, STD, Vaccine Preventable Diseases. 3. Of these issues, which are priorities for your community? a. Which of these issues are priorities for minority populations you serve? b. low income? c. uninsured? d. other specific populations? 4. Many factors affect the health care community members receive a. How does age affect the health care received by the community you serve? b. How does gender affect the health care they receive? c. In what way do race and/or ethnicity affect the health care they receive? d. How does financial security affect the quality of health care they receive? e. Describe how language affects the health care they receive? 5. Please describe resources (i.e. health services, community education programs, screenings, etc.) that your community uses in relation to the health problems you have identified. a. How often do they access these services? b. Where do they access these services? c. Would you describe any gaps in resources related to these problems? 6. What keeps people in the community you serve from receiving the resources needed to address these issues? Please give an example.{ideas could include: transportation, issues of insurance, religion/cultural difference, fear, doctor availability, etc} 7. How can these barriers be addressed? a. In what way can services be improved? b. What additional services are needed in the community you serve? c. What strategies do you recommend for overcoming these barriers? 8. Previously, you described how your community utilizes resources related to the biggest health needs. Please describe other resources/services your community uses. 9. What additional services or programs are needed to improve the community s health? 25 JB Steier

99 10. How would you and your organization like to help improve services and programs for the community you serve? {Look to build partnerships and elicit ideas} 26 JB Steier

100 Atachment III. Nassau County Individual Community Member Survey COMMUNITY HEALTH ASSESSMENT SURVEY Your opinion is important to us! The purpose of this survey is to get your opinion about health issues that are important in your community. Together, the Nassau County Department of Health and Nassau County hospitals will use the results of this survey and other information to help target health programs in your community. Please complete only one survey per adult 18 years or older. If you have any questions, please contact us at (516) Your survey responses are anonymous. Thank you for your participation. 1. What are the biggest ongoing health concerns in your COMMUNITY? (Please check up to 3) Asthma/lung disease Heart disease & stroke Safety Cancer Child health & wellness Diabetes Drugs & alcohol abuse Environmental hazards HIV/AIDS & Sexually Transmitted Diseases (STDs) Mental health/ depression/suicide Obesity/weight loss issues Vaccine preventable diseases Women s health & wellness Other (please specify) 2. What are the biggest ongoing health concerns for YOU? (Please check up to 3) Asthma/lung Disease Environmental hazards Safety Cancer Heart disease & stroke Vaccine preventable diseases Child health & wellness HIV/AIDS & STDs Women s health & wellness Diabetes Mental health/ Other (please specify) Drug & alcohol abuse depression/suicide Obesity/weight loss issues 3. What prevents people in your community from getting medical treatment? (Please check up to 3) Cultural/religious beliefs Don t know how to find doctors Lack of availability of doctors Unable to pay copays/deductibles Don t understand need to see a doctor Fear (e.g. not ready to face/discuss health problem) Language barriers No insurance Transportation There are no barriers Other (please specify) 4. Which of the following is MOST needed to improve the health of your community? (Please check up to 3) Clean air & water Mental health services Smoking cessation programs Drug & alcohol rehabilitation services Healthier food choices Job opportunities Recreation facilities Safe childcare options Safe places to walk/play Safe worksites Transportation Weight loss programs Other (please specify) PAGE 1 of 2

101 5. What health screenings or education/information services are needed in your community? (Please check up to 3) Blood pressure Cancer Eating disorders Emergency preparedness Mental health/depression Nutrition Cholesterol Exercise/physical activity Prenatal care Dental screenings Suicide prevention Heart disease Diabetes HIV/AIDS & STDs Vaccination/immunizations Disease outbreak information Importance of routine well Drug and alcohol checkups Other (please specify) 6. Where do you and your family get most of your health information? (Check all that apply) Doctor/health professional Family or friends Health Department Hospital Internet Library Newspaper/magazines Radio Religious organization School/college For statistical purposes only, please complete the following: Location where you received this survey: What is your sex: Male Female What is your age: ZIP code or Town where you live: ZIP code or Town where you work: Television Worksite Other (please specify) What race do you consider yourself? White/Caucasian Black/African American Are you Hispanic or Latino? Yes No Native American Asian/Pacific Islander Multi-racial Other (please specify) What is your highest level of education? K-8 grade Technical school Some high school Some college High school graduate College graduate Graduate school Doctorate Other (please specify) Do you currently have health insurance? Yes No No, but I did at an earlier time/previous job Do you have a smart phone? Yes No Please return this completed survey to: Or you may fax completed survey to: Nassau County Department of Health Division of Quality Improvement 106 Charles Lindbergh Blvd Uniondale, NY PAGE 2 of 2

102 Attachment IV. Nassau County Individual Community Member Survey Nassau County Community Health Assessment Community Member Survey Spring 2013

103 Methodology Survey Based on previous community heath surveys including NHANES and BRFSS 16 questions Survey data: services provided, target population, identify and prioritize pressing health needs in community, barriers, resources, health improvement strategies Identification of community member survey recipients Each NassauCounty Hospital and NCDOH distributed survey to community members at community events targeting : Distribution Various age groups Diversity of recipients Communities with health disparities Paper and Electronic survey through SurveyMonkey Survey translated into Spanish Survey closed April2013 Analysis Select Communities surveys based on zip code related to disease burden and analyzed separately in addition to the total responses

104 Survey Respondents (Total = 1070) Select Communities Surveyed (26% of Total Respondents) Elmont Inwood Freeport Glen Cove Hempstead Uniondale Long Beach Roosevelt Westbury

105 Age Distribution of Respondents Total 72% female 28% Male Select Communities 79% Female 21% Male yrs 17% 65 yrs + 20% yrs 25% 65 yrs + 16% 30-45yrs 24% yrs 39% 30-45yrs 28% yrs 31%

106 Respondent Racial Diversity Total Respondents Select Communities Caucasion Black Native American Asian Caucasion Black Native American Asian * 16% Latino *30% Latino

107 Educational Attainment Total Respondents K-8 grade Select Communities K-8 grade Some HS Some HS HS grad HS grad Technical school Some college Technical school Some college College grad College grad Grad school Grad school Doctorate Doctorate Other Other

108 What are the biggest ongoing health concerns for YOU? Total Responses (select top 3 health concerns) Cancer Heart Disease & Stroke Women's Health & Wellness Obesity/Weight loss Diabetes Environmental Hazards Safety Asthma/lung disease 17 Mental health Child health& wellness Substance abuse HIV/AIDS & STDs Vaccine Preventable Diseases Other % respondents choosing health concern

109 What are the biggest ongoing health concerns for your community? Total Responses (select top 3 health concerns) Cancer Obesity/Weight loss Diabetes Substance Abuse Heart Disease & Stroke Mental Health Women's Health Child Health& Wellness 18 Asthma & Lung disease Safety Environmental Hazards HIV/AIDS & STDs Vaccine Preventable Diseases Other % respondents choosing health concern

110 What are the biggest ongoing health concerns for YOU? Selected Communities Responses (select top 3 health concerns) Cancer Women's Health & Wellness Diabetes Obesity & Weight loss Heart Disease Safety Child health& wellness Asthma/lung disease Environmental Hazards Mental Health HIV/Aids & STDs Vaccine Preventable Diseases Other % respondents choosing health concern

111 What are the biggest ongoing health concerns for your community? Selected Communities Responses (select top 3 health concerns) Diabetes Substance Abuse Cancer Obesity & Weight loss HIV/Aids & STDs Heart Disease & Stroke Asthma/lung disease Mental Health Child Health & Wellness Women's Health & Wellness Safety Environmental Hazards Vaccine Preventable Diseases % respondents choosing health concern

112 Which of the following is MOST needed to improve the health of your community? Total Responses (select top 3 health concerns) Healthier Food Choices Job Opportunities Clean Air & Water Weight Loss Programs Recreation Facilities Mental Health Safe Places to Play Substance Abuse Services Child Health & Wellness Smoking Cessation Services Safe Childcare Options Transportation Safe Worksites Other % respondents choosing health concern

113 Which of the following is MOST needed to improve the health of your community? Selected Communities Responses (select top 3 health concerns) Healthier Food Choices Job Opportunities Clean Air & Water Weight Loss Programs Recreation Facilities Substance Abuse Services Safe Places to Play Safe Childcare Options Mental Health Services Smoking Cessation Services Transportation Safe Worksites Other % respondents choosing health concern

114 Where do community members you serve get most of their health information? (Check all that apply) Total Responses Doctor, Health Professional Internet Television Family or Friends Hospital Library Health Department Newspaper Worksite School/College Religious Organization Other % respondents identifying health information channel

115 Where do community members you serve get most of their health information? (Check all that apply) Select Community Responses Doctor, Health Professional Internet Television Family or Friends Newspaper Hospital Health Department Library School/College Worksite Radio Religious Organization Other % respondents identifying health information channel

116 What health screenings or education/information services are needed in your community? (select top 3 screenings or services) Total Responses Diabetes Blood Pressure Exercise/Physical Activity Importance of Routine Well Checkups Cancer Nutrition Cholesterol Drug & Alcohol Mental Health, Depression Emergency Prepardness Heart Disease Dental Screening HIV/Aids & STDs Disease Outbreak Info Vaccinations, Immunizations Suicide Prevention Prenatal Care Other % respondents choosing screening or education/information service

117 What health screenings or education/information services are needed in your community? (select top 3 screenings or services) Selected Communities Responses Blood Pressure Diabetes Importance of Routine Well Checkups Drug & Alcohol Cancer Nutrition Cholesterol Nutrition Exercise/Physical Activity HIV/AIDs & STDs Dental Screening Emergency Preparedness Mental Health Disease Outbreak Info Vaccinations, Immunizations Prenatal Care Other % respondents choosing screening or education/information service

118 What prevents people in your community from getting medical treatment? (select top 3 barriers) Total Responses No Insurance Unable to Pay Copays/Deductibles Fear(i.e. not ready to face/discuss health) Don't Understand Need to see MD Language Barriers Transportation 16 Don't Know How to Find MD There are No Barriers Lack of Availability of MDs Cultural/Religious Beliefs Other % respondents identifying barrier to medical treatment

119 What prevents people in your community from getting medical treatment? (select top 3 barriers) Selected Communities Responses No Insurance Unable to Pay Copays/Deductibles Fear(i.e. not ready to face/discuss health) Language Barriers Don't Understand Need to See MD Transportation 15 Lack of Availability of MDs Don't Know How to Find MDs Cultural/Religious Beliefs There Are No Barriers Other % respondents identifying barrier to medical treatment

120 Do You currently have heath insurance? Health Insurance Total Responses Select Communities Yes 86% 83% No 11% 15% No, but I did have insurance previously 3% 2%

121 Do you have a smart phone? Health Insurance Total Responses Select Communities Yes 54% 79% No 46% 21%

122 CHRONIC DISEASE Findings The top health concerns for all the respondents and the select communities were chronic disease: Cancer, Heart Disease, Stroke, Diabetes and Obesity. Select communities identified substance abuse as an additional high priority health concern. Both the total respondents and the select communities identified healthy food choices, recreational facilities, weight loss programs, clean air and water and job opportunities as items needed to improve the health of the community All respondents indicated that health screenings/educational programs on chronic disease (espdiabetes, blood pressure), importance of routine well care, nutrition and physical activity were needed. Substance abuse was identified by selected communities

123 Findings Heath Information and Health Access All the respondents receive the majority of their health information from health professionals, the internet, television and family /friends. Barriers to health access included no insurance, inability to pay copayments/deductibles, fear of discussing health issues and lack of knowledge about the importance of routine medical care The selected communities also cited language barriers Over 50 % of the total respondents and 79% of the selected community respondents had a smart phone.

124 Recommended NYS Community Service Plan & Community Health Needs Assessment Implementation Plan Priority Selection PRIORITY AREA: Prevent Chronic Disease FOCUS AREA: Reduce obesity in children & adults Create community environments that promote & support healthy food beverage choices & physical activity Prevent childhood obesity through early child care & schools Expand the role of health care, health service providers, & insurers in obesity prevention Expand the role of public & private employers in obesity prevention FOCUS AREA: Increase access to High-quality chronic disease preventive care & management in both clinical & community settings Increase screening rates for cardiovascular disease, diabetes, & breast/cervical/colorectal cancers, especially among disparate populations Promote use of evidence-based care to manage chronic diseases Promote culturally relevant chronic disease self-management education Integration of mental health awareness & screening

125 Attachment V. Lenox Hill Hospital Community-based CHNA Survey and Results Lenox Hill Hospital Community Health Assessment CBO Survey

126 Methodology Survey Based on Nassau County CHA community survey and informant interview script 20 questions Survey data: services provided, target population, identify and prioritize pressing health needs in community, barriers, resources, health improvement strategies Identification of community-based organizations, hospitals, & government survey recipients Identified organizations in Lenox Hill Hospital s service area based on: Age groups served Diversity of services provided Health disparities addressed 21 potential survey recipients identified: 4 schools, 5 government entities, and 12 community-based organizations Distribution Electronic survey through SurveyMonkey Personalized invite by in April 2013 with follow up invites in May 2013 Survey closed June 14, 2013

127 Survey Respondents (Total = 8) Community-based Organizations 92 nd Street Y Target Population: People of all ages & abilities residing in the upper east side of Manhattan Services Provided: Wellness services; physical activity; education & educational outreach through the arts American Heart Association Target Population: Multicultural communities & youth; reach extends throughout Metro NYC area Services Provided: Youth & adult education Lenox Hill Neighborhood House Target Population: 1000 older adults living at home on the east side of Manhattan Services Provided: 2 senior centers; homeless shelter; adult day program; & supportive housing for mentally ill Park Avenue Women s Shelter Target Population: Mentally ill homeless women aged 45+ Services Provided: Medical & psychiatric care; social work; housing placement; harm reduction; referrals; & services available on & off site SafeKids New York City Target Population: Children under age 14, particularly those living in high risk NYC neighborhoods Services Provided: Educational programs & materials to children, parents, & older adults; & safety devices

128 Survey Respondents (Total = 8) Government Community Emergency Response Team- Upper East Side TargetPopulation: East side Manhattan from 72 nd St. to 96 th St. Services Provided: Assistance to FDNY or NYPD in large emergencies Manhattan Community Board 8 Target Population: Residents from 5 th Ave. to East River; 59 th St. to 96 th St. Services Provided: Makes recommendations on issues to elected officials & city agencies Eleanor Roosevelt High School Target Population: 9-12 th grade adolescents Services Provided: Education Schools

129 Q 11 The NYS Prevention Plan for identifies 5 priority areas with related focus areas and goals. Please rank these health-related needs, 1 being the highest priority to 5 being the lowest priority, for your community. NYS Prevention Plan Priority Area Preventing chronic disease. Examples: reduce obesity in children and adults, reduce illness and disability related to tobacco use and second hand smoke, and increase access to preventive care and health screenings. Average Ranking 3.88 Promoting a healthy and safe environment. Examples: reduce fall risk among vulnerable populations, reduce occupational injury and illness, and violence prevention Promote mental health and prevent substance abuse. Examples: prevent underage drinking and non-medical use of prescription drugs, suicide prevention, and mental health education and screening Promote healthy women, infants, and children. Examples: reduce premature births and unplanned pregnancies, increase prevalence of breastfed babies, and increase access to well child care. Preventing HIV,sexually transmitted diseases, vaccine-preventable diseases, and healthcare associated infections. Examples: improve immunization rates, STD and HIV education, and access to testing and care

130 Q 10 What are the biggest ongoing health concerns in your community? (select top 3 health concerns) Child Health & Wellness Women's Health & Wellness Heart Disease & Stroke Diabetes Asthma, Lung Disease Obesity, Weight Loss Issues Cancer Drugs & Alcohol Abuse Mental Health, Depression, Suicide Environmental Hazards Safety HIV/AIDS & STDs Vaccine Preventable Diseases % respondents choosing health concern

131 Q 12 Please describe resources (i.e. health services, community education programs, screenings, etc.) that your community uses in relation to the health problems you have identified. Community Health Education Programs Resources Phase III Cardiac Rehabilitation CPR/First Aid Fit-Friendly Worksites Go Red For Women Nutrition Counseling Physical Activities Referrals Screenings Teaching Gardens

132 Q 20 Where do community members you serve get most of their health information? (Check all that apply) Family or Friends Hospital Doctor, Health Professional Television Newspapers, Magazines Internet Religious Organization School, College Library Radio Health Department Worksite % respondents identifying health information channel

133 Q 15 Which of the following is MOST needed to improve the health of your community? (select top 3 health improvement strategies) Healthier Food Choices Recreation Facilities Access to Healthcare* Safe Places to Walk & Play Weight Loss Programs Drug & Alcohol Prevention* Clean Air & Water Drug & Alcohol Rehabilitation Job Opportunities Mental Health Services Safe Childcare Options Smoking Cessation Programs Transportation Safe Worksites % respondents choosing health improvement strategy *Free text write-in by multiple respondents

134 Q 16 What health screenings or education/information services are needed in your community? (select top 3 screenings or services) Nutrition Exercise, Physical Activity Emergency Preparedness Disease Outbreak Information Blood Pressure Cholesterol Diabetes Heart Disease Cancer Importance of Routine Well Checkups Dental Screenings Prenatal Care Mental Health, Depression Drug & Alcohol Suicide Prevention HIV/AIDS & STDs Vaccinations, Immunizations % respondents choosing screening or education/information service

135 Q 17 What prevents people in your community from getting medical treatment? (select top 3 barriers) Don't Understand Need to See a Doctor Fear (e.g. not ready to face/discuss health No Insurance Don t Know How to Find Doctors Cultural/Religious Beliefs Lack of Availability of Doctors Unable to Pay Copays/Dedubtibles Language Barriers Transportation There Are No Barriers % respondents identifying barrier to medical treatment

136 Q 18 You previously identified barriers and gaps in resources/services available to your community. Please explain in what way resources/services can be improved and what additional services are needed. Collaboration Resources & Services Health Education Insurance & Access to Healthcare Language & Cultural Sensitivity

137 Q 19 Please describe how your organization can specifically address some of the additional service needs described in Q 18. Strategies Collaboration Health Awareness & Education Programs Language & Cultural Sensitivity

138 Take Care New York (TCNY) April 24, 2013 New York Department of Health and Mental Hygiene held a Manhattan listening session to share the health department s new TCNY initiative and gather community feedback Brought stakeholders together to discuss strategies and interventions to improve health outcomes for all New Yorkers Stakeholders: Community-based Organizations General Public Healthcare Providers

139 TCNY ListeningSession Methodology Stakeholder feedback captured via listening session participation & 3 survey instruments 1. Notecards Stakeholders were provided notecards during listening session Notecardsused to share questions, comments, interest in receiving information, & provide contact information to connect with other stakeholders 2. Evaluation Form Completed at end of listening session Assessed stakeholder satisfaction with listening session 3. Post-session Survey Stakeholders received web-based survey to assess familiarity with TCNY and interest in health department resources, TCNY priority areas, TCNY partnership, & health department facilitation of inter-agency collaboration

140 Stakeholders Stakeholder Type Number in Attendance Community-based Organizations 9 General Public 22 Government Organizations 2 Healthcare Providers 12 Total in attendance: 45

141 TCNY Priority Areas TCNY 2016 Priority Areas 1. Tobacco-Free Living 6. Promote Mental Health 2. Healthy Eating 7. Reduce Alcohol & Substance Abuse 3. Active Living 8. Prevent & Treat Cancer 4. Heart Health 9. Healthy Indoor& Outdoor Air 5. HIV Prevention 10. Quality Preventive Care Witha focus on child & adolescent health

142 TCNY Manhattan Priority Areas Priority Area Ranking Promote Mental Health 1 Active Living 2 Healthy Eating 3 Child & Adolescent Health 4 Healthy Indoor & Outdoor Air 5

143 Findings 1. Promote Mental Health Provision of mental health training to non-mental health professionals working with high risk populations Promotion of smoking cessation among individuals with mental illness Treatment of trauma and psychological distress and prevention of mental illness among youth

144 2. Active Living Access to spaces and programs that promote physical activity Connection of opportunities for physical activity 3. Healthy Eating Findings Promotion of access of healthy foods in restaurants and bodegas Provisionof programs that teach adults and youth how to prepare healthy, affordable meals Enhancementof access to healthy foods for low income New Yorkers Public support of Health Bucks program

145 Findings 4. Child & Adolescent Health Early childhood intervention and prevention of special needs for youth in high risk communities Promotion of adolescent mental health and prevention of unplanned pregnancy to prevent high school dropout 5. Healthy Indoor & Outdoor Air Collaboration with other city agencies to improve the environment

146 Stakeholder Resource Request TCNY Priority Area Resource Request 1) Healthy Eating/Active Living 1) Free services for healthy eating & tobacco-free living for organizations serving the disabled population 2) Promote Mental Health 2) Screening materials & trainings for teachers & other non-mental health professionals who work with youth 3) Children & Youth 3) Contraception & mental health services in high schoolbased health centers 4) Additional Request 4) Technology to enhance the reach to all priority areas

147 Priority Area Comparison Lenox Hill Hospital & TCNY Lenox Hill Hospital Priorities TNCY Priorities 1. Preventing Chronic Disease 1. Promote Mental Health 2. Promoting A Healthy& Safe Environment 2. Active Living 3. Promote Mental Health & Prevent 3. Healthy Eating Substance Abuse 4. Promote Healthy Women, Infants, & Children 5. Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, & Hospital Associated Infections 4. Child & Adolescent Health 5. Healthy Indoor & Outdoor Air

148 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Table of Contents I. Background 2 II. III. IV. Methodolog gy Demographi ics a. Table 1 Stakeholder Attendance Findings a. Table 2 Stakeholder Feedback b. Table 3 Stakeholder Resource Requests V. Listening Session Evaluation a. Table 4 On site evaluation findings b. Table 5 Familiarity with TCNY prior to session c. Table 6 Priority Areas of Interest d. Table 7 Community Resource Interests e. Table 8 Interest in Partnership 8 11 VI. VII. VIII. Appendix A Feedback Notecard Appendix B On site Evaluation Appendix C Post Session Survey

149 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 I. Background On April 24, 2013 the New York City Department of Health andd Mental Hygiene held the first of five borough listening sessions to share the healthh department s new Takee Care New York (TCNY) initiative and gather community feedback. Community based organizations, health care providers, and the general public joined health department staff at the Hunter School of Public Health in East Harlem to discuss strategies and interventions to improve health outcomes for all New Yorkers. Roger Hayes, Assistant Commissioner of East and Central Harlem District Public Health Office, described the city s TCNY plan and Dr. Nicholas Freudenberg, Distinguished Professor of Urban Public Health at Hunter College, City University of New York (CUNY), shared how CUNY is incorporating aspects of the city s TCNY initiative too improve the health of its student body. II. Methodolog gy Stakeholder feedback was captured via listening session participation and three survey instruments disseminatedd during and after the listening session to maximize opportunities to elicit feedback: 1. Notecards: during the listening session, attendees were provided with notecards to share their questions/comments, indicate their interest in receiving additional informationn about specific TCNY areas, and provide their contact information if they wished to be connected with organizations sharing similar interests (attached in Appendix A). 2. Evaluation form: at the completion of the listening session, attendees were provided with a brief evaluation form to assess their satisfaction with the session (attached in Appendix B). 3. Post sessiofamiliarity with TCNY and interest in TCNY priorityy areas, health department resources, TCNY survey: following the listening session, attendees were sent a web based survey to assess partnership, and health department facilitation of inter agency collaboration (attached in Appendix C). III. Demographi ics Table 1. Manhattan Listening Session Attendance Total Number of Attendees 45 Stakeholder Type Community Based Organization Health Care Provider Government Organization* (N) and % of Total Attendees 9 (20%) 12 (27%) 2 (4%) General Public 22 (49%) *Government organization attendees exclude health department staff. 2

150 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 IV. Findings Over half of the session attendees represented health care providers and the general public, the majority if which consisted of students.: Nearly 50% (22) 1 of the attendees participated in the discussion, whichh focused on five TCNY priority areas, including: The prevalent themes of the Manhattan listening session feedback included the following: Mental Health: Provision of mental health training to non mental health professionals who work with highh risk groups. Promotion of smoking cessation among individuals with mental illness. Treatment of trauma and psychological l distress and prevention of mental illness among children & adolescents. Active Living Access to spaces and programs that promote physical activity. Connection of opportunities for physical activity & healthy eating, such as gardening. Healthy Eating Promotion of access to healthy foods in local restaurants & bodegas. Provision of programs thatt teach adults & children how to prepare healthy, affordable meals. Enhancement of access to healthy foods for low income New Yorkers. Public support of the Health Bucks program. Child & Adolescent Health Early childhood intervention and prevention of special needs for children in high risk communities. Promotion of adolescent mental healthh & prevention of unplanned pregnancies to prevent high school dropout. Healthy Indoor & Outdoor Air Collaboration with other city agencies to improve the environment of the 45 attendees were recorded as providing feedback, questions, or suggestions. 3

151 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Manhattan Listening Session Stakeholder Feedback Summary April 24, 2013 Table 2. Stakeholder Feedback Take Care New York Priority Area Mental Health Corresponding Quotes We need [mental health] screening materials and trainings for teachers and other non mental who work with youth. health professionalss What you re going to find with adolescents is that theree is a lot of stigma with mental health as there is with reproductive health. They often don t want to talk to parents about it and many times the source of the mental health issues is in the home anyway. We need to look at the full range of mental health services without parental consent. Please ensure that mental health support services are high on the agenda, particularly in light of the fact thatt co morbidity is very high in this population. Corresponding Feedback How does thee health department promote smoking cessation among the seriously and persistently mentally ill? Consider embedding mental health prevention screening into other priority areas of chronic illness, such as heart disease, cancer and substance abuse. Patients withh chronic illness often have comorbid mental health issues. Examine mental health from a trauma lens so that children and families can be properly assessed andd treated. Provide training to teachers, professors, employers onn the signs and symptoms of mental illnesss so they know what questions to ask and can recognize when help is needed. Adolescents can access reproductive health services without parental consent. Consider provision of mental health services to adolescents in the same way so they can access psychiatric and social services without parental consent. 4

152 Take Care New York Priority Area Active Living New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Manhattan Listening Session Stakeholder Feedback Summary April 24, 2013 Corresponding Quotes Corresponding Feedback How is the health departmentt addressing funding cuts to physical activity and sports teams in schools? At Westside Campaign Against Hunger, we try to consider how much time people are spending inline for Consider partnering with NYCHA to ensure other city agencies. We know people s time is valuable there are more places to play around NYCHA and try to give exercisee classes while they are waiting on housing. line and people love it. People love doing yoga while waiting on line. It is easy and low cost. Consider creating more community gardens so New Yorkers can learn about healthy eating and stay active. One thing we absolutely love is the Health Bucks Program anything that can replicate that model of putting choice and agency in the hands of New Yorkers is useful. Consider offering the MATCHO (Moving Action Through Community Health Outreach) program to engagee and educate parents/children in healthy eating. Healthy Eating My children came home with so much information [from the MATCHO session]. Now they eat vegetables, read labels, and I am looking forward to having my children participate again. 5

153 Take Care New York Priority Area Child & Adolescent Health New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Manhattan Listening Session Stakeholder Feedback Summary April 24, 2013 Corresponding Quotes Corresponding Feedback Consider focusing on early childhood Bronx Knows is responsible for lowering HIV in the intervention and prevention of special needs community. Maybe it s time we take the lessons we in children, similar to the First 2000 Days learned from campaigns that have been very effective Campaign in East Harlem. and apply that knowledge to the rest of the indicators? [Offer] contraception distribution in schools, as teen How can the department replicate pregnancy is a big cause [of high school dropout] and programs, such as Bronx Knows in other provide this not just in a handful of schools, but in all areas like cardiovascular disease, asthma, unwanted pregnancy, etc.? schools across the city. Mental health services in schoolss may also be a way of focusing those services to achievee Consider providing mental health services the goal [of reducing high school dropout rate. and contraception in all school based health centers in order to reduce high school dropout rates. Healthy Indoor & Outdoor Air Collaborate with other City agencies to promote initiatives that improve the physical environment. Additional Feedback In some of our schools and neighborhoods, more than half of the people who enter high school don t gradate or don t graduate on time. Some of those are related to health problems, some aren t, but they all have health consequences. The difference in graduation rates between white, black, and Latino people is a big driver in the large inequalities in health for those groups. So reducing that difference in educational achievements 6 Consider reducing high school dropout rates a TCNY goal, given that educational attainment iss a powerful influence on health.

154 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Manhattan Listening Session Stakeholder Feedback Summary April 24, 2013 would help reduce those differences in health outcomes. I wonder if you ve thought about adding that to the agenda and how would you do that? The reason I came to this meeting is because I did not see oral health under any of those (TCNY) 10 priorities. For the last 25 years, if I see 15 patients in the day, 12 will have high blood pressure, cardiovascular disease, or diabetes, and those conditions are very linked to oral health. How can we add oral health to one of these 10 priority areas? Please consider more health promotion programs thatt target older adults and increase awareness on senior healthh issues (ie. glaucoma, medication adherence, falls prevention, pneumonia, vaccination, depression). We can promote healthy living with community gatekeepers and really try to show more cultural competency by being part of their events throughout the city, especially in coming months. We need to work with communities and reach more people by doing that. Consider addressing oral health in TCNY Consider including a focus on older adult health in TCNY Promote TCNY and TCNY partners at community events in NYC throughout the year and particularly in the upcoming months. Showw the health department s cultural competency by participating in community events. 7

155 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Manhattan Listening Session Stakeholder Feedback Summary April 24, 2013 Table 3. Stakeholder Resourcee Requests Take Care New York Priority Area Healthy Eating & Active Living Mental Health Children and Youth Additional Resource Requests Free services for healthy eating and tobacco free living for organizations serving the disabled population. Screening materials and trainings for teachers and other non mental health professionals who work with youth. Contraception and mental health services in high school based health centers Technology to enhance the reach to all priority areas. Contact list of all of the organizations/providers that attended the listening session for collaboration/resource sharing. V. Listening Session Evaluation Table 4. On site Evaluation Findings (n=10)* Questions Stakeholder Average Rating 1. Overall satisfaction with this listening session The forum helped me learn more about Take Care New York (TCNY) The presentation and handouts were informative Sufficient time was allocated for questions and answers The program was well planned and interactive. 4.3 *Participants were asked to rate their agreement with the statements above on a scale of 1 5: 1=Poor; 2+Fair; 3=Good; 4=Very Good; 5=Excellent. The evaluation form is attached in Appendix B. 8

156 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Table 5. Session Attendees Familiarity with TCNY Prior too the Listening Session ( n=10)* *Survey attached in Appendix C. Were you familiar with Take Care New York (TCNY)) prior to registering for this listening session? 1 4 Yes No Somewhat 5 Table 6. TCNY Priority Areas of Interest TCNY Priority Areas Tobacco Free Living Healthy Eating Active Living Heart Health HIV Prevention Promote Mental Health Reduce Alcohol and Risky Substance Use Prevent and Treat Cancer Healthy Indoor and Outdoor Air Quality Preventive Care % of Attendees Working or Interested in Working on the Topic 40% 60% 50% 40% 40% 90% 60% 30% 30% 60% 9

157 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Table 7. Community Resource Interests.* Not Interested Somewhat Interested Interested N Connectionn with local organizations working on similar health initiatives 0% 13% 88% 8 Facilitation of a cross website organizational resource portal 0% 0% 100% 10 Cross organizational workshops or trainings 0% 0% 100% 10 Webinars featuring resources and local case studies 0% 20% 80% 10 Newsletter articles 11% 22% 67% 9 Informational briefs or fact sheets on key health issues 11% 0% 89% 9 Tool kits 0% 10% 90% 10 Social media assistance 0% 25% 75% 8 Community data to support program development and partnershipp efforts 11% 11% 78% 9 *Participants were asked to rate their interest in the resources above, on a scale of 1 3: 1= =Not Interested; 2=Somewhat Interested; 3=Interested. 10

158 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Table 8. Interest in Take Care New York Partnership Would your community organization, business, health care provider, business, labor group or faith-basedorganization be interested in becoming a Take Care New York partner? 2 3 Yes No Already a TCNY Partnerr Don't Know

159 VI. New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Appendix A Feedback Notecard 12

160 VII. New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 Appendix B On site Evaluation 13

161 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24, 2013 VIII. Appendix C. Post Session Survey 14

162 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24,

163 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Manhattann Listening Session Stakeholder Feedback Summary April 24,

164 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 Table of Contents I. Background 2 II. III. IV. Methodolog gy Demograph hics a. Table 1 - Stakeholder Attendance Findings a. Table 2 Stakeholder Feedback b. Table 3 Stakeholder Resource Requests V. Listening Session Evaluation a. Table 4 On-site evaluation findings 8 VI. VII. Appendix A Feedback Notecard Appendix B On-site Evaluation 9 10 VIII. Appendix C Post-Session Survey

165 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 I. Background On May 14, 2013 the New York City Department of Health andd Mental Hygiene held the last of five borough listening sessions to share the health department s new Take Care New York (TCNY) initiative and gather community feedback. Community-based organizations, health h care providers, and the general public joined health department staff at Queens Borough Hall to discuss strategies and interventions that would effectively promote healthy lifestyless and lead to improved health outcomess for all New Yorkers. Camellia Mortezazadeh, Executive Director of Take Care New York, described the city s TCNY plan and community stakeholders shared ideas of strategies and interventions to improve the health h of New Yorkers. II. Methodolog gy Stakeholder feedback was captured via listening session participation and three survey instruments disseminated during and after the listening session to maximize opportunities to elicit feedback: 1. Notecards: during the listening session, attendees were provided with notecards to share their questions/comments, indicate their interest in receiving additional information about specific TCNY areas, and provide their contact informationn if they wished to be connected with organizations sharing similar interests (attached in Appendix A). 2. Evaluation form: at the completion of the listening session, attendees were provided with a brief evaluation form to assess their satisfaction with the session (attached in Appendix B). 3. Post-sessiofamiliarity with TCNY and interest in TCNY priority areas, health department resources, TCNY survey: following the listening session, attendees were sent a web-based survey to assess partnership, and health department facilitation of inter-agency collaboration (attached in Appendix C). III. Demograph hics Table 1. Queens Listening Session Attendance. Total Number of Attendees Stakeholder Type (N) and % of Total Attendees Community-Based Organization 7 (21%) 33 Labor Group Government Organization Health Care Provider General Public 1 (3%) 4 (12%) 13 (39%) 8 (24%) *Government organizationn attendees exclude health department staff. 2

166 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 IV. Findings Of the 33 participants who attended the Queens listening session, over a third were health care providers and more than a quarter represented the general public. The majority (25) of the attendees engaged in an active discussion of seven of TCNY s ten priority areas. 1 The prevalent themes of the Queens listening session feedback included the following: Mental Health: Quantification n of children s mental health problems. Active Living Creation of physical activity opportunities in schools. Promotion of physical activity by primary care providers. Healthy Eating Enhancement of access to healthy food. Education on healthy cooking. Child & Adolescent Health Prevention/co ontrol of childhood obesity. Healthy Indoor & Outdoor Air Implementatio on of smoke-free NYCHA housing. HIV Prevention Reducing stigma of NYC condoms. Tobacco-Free Living Reduction of youth access to tobacco. Provision of tobacco cessation counseling training too case managers of the 33 attendees were recorded as providing feedback, questions, or suggestions. 3

167 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 Table 2. Stakeholder Feedback Take Care New York Priority Area Mental Health Relevant Quotes Stakeholder Questions or Feedback Partnerr with more mental health organizations. Consider quantifying children s mental health problems in NYC. Active Living How about bringing physical activity back to the schools? I have a seven year old kid in school, there's one gym period per week. Back in the day it was every day, we were able to play after school. This would do wonders to help the [obesity] problem. I know physicians started prescribing fruits and vegetables. You must do 25 minutes of physical activity 5 times a week then come back to see me. Address the lack of physical activity in schools. Consider initiatives thatt promote the prescription of physical activity from health care providers.to patients Healthy Eating One of the things we hear from our clients all the time is that it s much cheaper to eat unhealthy. If you could provide some Raise awareness on hunger and food insecurity issues in New York City. 4

168 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 innovative ways for people to eat healthier; [for example], you can show clients how to prepare meals with a hot plate and different ways to prepare food. It s much easier to buy McDonalds dollar menu. I know there s a lot of labeling going on, but without the education component, even if it says 1000 calories, people still think they'll be okay. Promote education on healthy cooking. Consider working with restaurants to subsidize healthier meal options or smaller portions. Consider educating the public on nutrition labeling. Promote initiatives that t implement smoke-free housing in NYCHA housing. Healthy Indoor & Outdoor Air Consider repackaging the NYC condoms, as they are stigmatized by clients Tobacco-Free Living I don't see much in the goals about reducing youth access to tobacco, I know there s legislation on the table at the city council. Consider conducting smoke-free housing outreach to families. 5

169 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 We're working on this in Queens around the borough but I want to get a sense of what the department is looking to do. Provide tobacco cessation counseling training to case managers working in public housing. I just wanted to add one more thing with healthy homes. One of the things that would be very helpful in reducing tobacco use, is to look at the NYCHA housing. What can we do from a city standpoint? It s hard to work on outside voluntary landlords especially on low income areas. They say-what about the city and NYCHA housing? I think this would help give us momentum, especially in Queens. Manhattan has better development and a population that will pay more in rent to live in smoke free housing. In Queens it s harder to say if you want to live in smoke free housing, pay higher rent. Additional Feedback Collaboration is important between the organizations because there aren't a lot of resources flowing into the area, so we need to take advantage of the services that are already there. Facilitate collaboration between community partners so they can share resources. 6

170 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 Send people out to different organizations and explain what you're doing. There are some Clean NYC Parks events, and we sponsor an asthma day at the Jacob Resettlement House. TTCNY should try to take advantage of these events that are already happening citywide. We've been a member of TCNY since pretty much the start, just looking at the list, I find we'vee worked on 6 of the 10 [priority areas]. But nobody ever asked. We would like to add our info to this, it s certainly too late for the past, but from now on. Publicize information regarding Take Care New York and the health department s work to community groups and at citywide public events. Improve tracking of TCNY partners work on priority areas of interest. Table 3. Stakeholder Resource Requests Take Care New York Priority Area Tobacco-Free Living HIV Prevention Resource Requests Tobacco-cessation counseling training for case managers. Rebranded NYC condoms. 7

171 V. Listening Session Evaluation Table 4. On-site Evaluation Findings (N-24)* New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 Questions Stakeholder Average Rating 1. Overall satisfaction with this listening session The forum helped me learn more about Take Care New York (TCNY) The presentation and handouts were informative Sufficient time was allocated for questions and answers The program was well planned and interactive. 4.3 *Participants were asked to rate their agreement with the statementss above on a scale of 1-5: 1=Poor; ; 2+Fair; 3=Good; 4=Very Good; 5=Excellent. The evaluation form is attached in Appendix B. Due to the small sample size of 6 from the online survey (survey attached in Appendix C) there are noo results to display from the Queens online survey. 8

172 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 VI. Appendix A: Feedback Notecard 9

173 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 VII. Appendix B: On-site Evaluation 10

174 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14, 2013 VIII. Appendix C Post Session Survey 11

175 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14,

176 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Queens Listening Session Stakeholder Feedback Summary May 14,

177 Attachment VIII. Staten Island University Hospital Community-based CHNA Survey and Results Staten Island University Hospital Community Health Assessment CBO Survey

178 Survey Methodology Based on Nassau County CHA community survey and informant interview script 20 questions Survey data: services provided, target population, identify and prioritize pressing health needs in community, barriers, resources, health improvement strategies Identification of community-based organizations, hospitals, & government survey recipients SIUH Community Advisory Board SIUH community partners 61 potential survey recipients identified: 6 schools, 6 government entities, and 49 community-based organizations Distribution Electronic survey through SurveyMonkey & paper copy of survey Personalized invite in person to Community Advisory Board in March 2013 Personalized invite by to community partners in April 2013 with follow up invites in May 2013 Survey closed June 14, 2013

179 Survey Respondents (Total = 19) Community-based Organizations American Cancer Society American Parkinson Disease Association City Harvest Community, Growth, and Opportunity, Inc. Community Health Action of Staten Island EgerHarbor House Inc., Assisted Living Program Healthy Families Staten Island Jewish Board of Family and Children s Services Staten Island Branch of the NAACP Staten Island Children s Home Intervention Program Staten Island Partnership for Community Wellness (2)

180 Survey Respondents (Total = 19) Community Businesses Nate s Pharmacy Government New York City Housing Authority Healthcare Providers Community Health Center of Richmond, Inc. Primary Care Ambulance Philanthropy Service Auxiliary Religious Organizations First Central Baptist Church Staten Island Hindu Temple, Inc.

181 Q 11 The NYS Prevention Plan for identifies 5 priority areas with related focus areas and goals. NYS Prevention Plan Priority Area Preventing chronic disease. Examples: reduce obesity in children and adults,reduce illness and disability related to tobacco use and second hand smoke, and increase access to preventive care and health screenings. Priority Score 4.21 Promote mental health and prevent substance abuse. Examples: prevent underage drinking and non-medical use of prescription drugs, suicide prevention, and mental health education and screening. Promote healthy women, infants, and children. Examples: reduce premature births and unplanned pregnancies, increase prevalence of breastfed babies, and increase access to well child care. Promoting a healthy and safe environment. Examples: reduce fall risk among vulnerable populations, reduce occupational injury and illness, and violence prevention. Preventing HIV,sexually transmitted diseases, vaccine-preventable diseases, and healthcare associated infections. Examples: improve immunization rates, STD and HIV education, and access to testing and care

182 Q 10 What are the biggest ongoing health concerns in your community? (select top 3 health concerns) Drugs & Alcohol Abuse Mental Health, Depression, Suicide Obesity, Weight Loss Issues Diabetes Cancer Heart Disease & Stroke Asthma, Lung Disease Child Health & Wellness Women's Health & Wellness Safety Environmental Hazards HIV/AIDS & STDs Vaccine Preventable Diseases % respondents choosing health concern

183 Q 12 Please describe resources (i.e. health services, community education programs, screenings, etc.) that your community uses in relation to the health problems you have identified. Access to Healthy Foods Resources Primary Care Chronic Disease Management Community Health Programs Mental Health Services Referrals Screenings Wellness

184 Q 20 Where do community members you serve get most of their health information? (Check all that apply) Family or Friends Hospital Doctor, Health Professional Internet Television Newspapers, Magazines Radio Religious Organization Worksite Health Department School, College Library % respondents identifying health information channel

185 Q 15 Which of the following is MOST needed to improve the health of your community? (select top 3 health improvement strategies) Healthier Food Choices Drug & Alcohol Rehabilitation Services Recreation Facilities Weight Loss Programs Job Opportunities Mental Health Services Transportation Smoking Cessation Programs Safe Childcare Options Safe Places to Walk, Play Clean Air & Water Safe Worksites % respondents choosing health improvement strategy

186 Q 16 What health screenings or education/information services are needed in your community? (select top 3 screenings or services) Drug & Alcohol Mental Health, Depression Nutrition Exercise, Physical Activity Blood Pressure Cancer Diabetes Heart Disease Cholesterol HIV/AIDS & STDs Vaccinations, Immunizations Dental Screenings Importance of Routine Well Checkups Emergency Preparedness Disease Outbreak Information Suicide Prevention Prenatal Care % respondents choosing screening or education/information service

187 Q 17 What prevents people in your community from getting medical treatment? (select top 3 barriers to medical treatment) No Insurance Don't understand need to see a doctor Fear (e.g. not ready to face/discuss health Unable to Pay Copays/Deductibles Transportation Cultural/Religious Beliefs Language Barriers Don't Know How To Find Doctors Lack of Availability of Doctors There Are No Barriers % respondents identifying barrier to medical treatment

188 Q 18 You previously identified barriers and gaps in resources/services available to your community. Please explain in what way resources/services can be improved and what additional services are needed. Resources & Services Language Access & Cultural Sensitivity* Health Access Health Education Healthy Foods Jobs Recreation Facilities Transportation *Identified by multiple respondents

189 Q 19 Please describe how your organization can specifically address some of the additional service needs described in Q 18. Strategies Collaboration Health Awareness & Educational Programs Language & Cultural Sensitivity

190 Take Care New York May 7, 2013 New York Department of Health and Mental Hygiene held a Staten Island listening session to share the health department s new TCNY initiative and gather community feedback Brought stakeholders together to discuss strategies and interventions to improve health outcomes for all New Yorkers Stakeholders: Community-based Organizations General Public Healthcare Providers

191 Stakeholders Stakeholder Type Number in Attendance Community-based Organizations 5 Educational Organizations 3 Government Organizations 1 Healthcare Providers 22 Labor Groups 2 Other 5 Total in attendance: 38

192 TCNY Priority Areas TCNY 2016 Priority Areas 1. Tobacco-Free Living 6. Promote Mental Health 2. Healthy Eating 7. Reduce Alcohol & Substance Abuse 3. Active Living 8. Prevent & Treat Cancer 4. Heart Health 9. Healthy Indoor& Outdoor Air 5. HIV Prevention 10. Quality Preventive Care Witha focus on child & adolescent health

193 TCNY Staten Island Priority Areas Priority Area Ranking Active Living 1 Healthy Eating 2 Tobacco-Free Living 3 Reduce Alcohol & Substance Abuse 4 Healthy Indoor & Outdoor Air 5

194 1. Active Living Findings Promote usage of parks & playgrounds Increase advertisements that promote walking & mileage Strategies for adults to increase exercise 2. Healthy Eating Educate bodega owners on fresh fruits & vegetables Improve healthier food choices in vending machines Replicate proven weight-loss programs

195 Findings 3. Tobacco-Free Living Increase prevention messages to children & adolescents Provide smoking cessation point of service options 4. Reduce Alcohol & Substance Abuse Halt the closing of substance abuse & detoxcenters on the island 5. Healthy Indoor & Outdoor Air Increase information on the quality of air after Hurricane Sandy

196 Stakeholder Resource Request TCNY Priority Area Resource Request 1) Promote Mental Health 1) Organizations would like to partner with CBOs or hospitals so that more people are aware of services 2) General Feedback 2) DOHMH pamphlets & literature have been unavailable through 311. DOHMH should provide more printed health information in Spanish.

197 Priority Area Comparison Staten Island University Hospital & TCNY SIUH Priorities TCNY Priorities 1. Preventing Chronic Disease 1. Active Living 2. Promote Mental Health & Prevent Substance Abuse 2. Healthy Eating 3. Promote Healthy Women, Infants, 3. Tobacco-Free Living & Children 4. Promoting A Healthy & Safe Environment 5. Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, & Hospital Associated Infections 4. Reduce Alcohol & Substance Abuse 4. Healthy Indoor & Outdoor Air

198 NYS Community Service Plan & Community Health Needs Assessment Implementation Plan Priority Selection PRIORITY AREA: Prevent Chronic Disease FOCUS AREA: Reduce Obesity in Children & Adults Create community environments that promote & support healthy food beverage choices & physical activity Prevent childhood obesity through early child care & schools Expand the role of health care, health service providers, & insurers in obesity prevention Expand the role of public & private employers in obesity prevention FOCUS AREA: Increase Access to high-quality chronic disease preventive care & management in both clinical & community settings Increase screening rates for cardiovascular disease, diabetes, & breast/cervical/colorectal cancers, especially among disparate populations Promote use of evidence-based care to manage chronic diseases Promote culturally relevant chronic disease self-management education Integration of mental health awareness & screening

199 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Table of Contents I. Background 2 II. III. IV. Methodolog gy Demographi ics a. Table 1 Stakeholder Attendance Findings a. Table 2 Stakeholder Feedback b. Table 3 Stakeholder Resource Requests V. Listening Session Evaluation a. Table 4 On site evaluation findings b. Table 5 Familiarity with TCNY prior to session c. Table 6 Priority Areas of Interest d. Table 7 Community Resource Interests e. Table 8 Interest in Partnership 7 10 VI. VII. VIII. Appendix A Feedback Notecard Appendix B On site Evaluation Appendix C Post Session Survey

200 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 I. Background On May 7, 2013 the New York City Department of Health and Mental Hygiene held the fourth of five borough listening sessions to share the healthh department s new Takee Care New York (TCNY) initiative and gather community feedback. Community based organizations, health care providers, and the general public joined government representatives at the Visiting Nurse Service of New York City in Staten Island, NY to discuss strategies and interventions that would effectively promote healthy lifestyles and lead to improved health outcomes for all New Yorkers. It was convened by Ewel Napier, Director of Community Partnerships at DOHMH and Camellia Mortezazadeh, Director of Take Care New York. Also present weree TCNY staff and eight content experts from DOHMH. II. Methodology Stakeholder feedback was captured via listening session participation and three survey instruments disseminatedd during and after the listening session to capture maximum feedback, listed below: 1. Notecards: during the listening session attendees weree provided with notecards to further share their questions/comments, interest in receiving additional information about specificc TCNY areas, and the opportunity to provide their contact information if they wished to be connected with organizations sharing similar interests (attached in Appendix A). 2. Evaluation form: at the completion of the listening session attendees were provided with a brief evaluation form to assess their satisfaction with the listening session (attached in Appendix B). 3. Post session survey: following the listening session attendees were sent a web based survey to assess familiarity with TCNY and further interest in TCNY priority areas, health department resources, TCNY partnership, and health department facilitation of inter agency collaboration ( attached in Appendix C). III. Demographics Table 1. Staten Island Listening Session Attendance. Total Number of Attendees 38 Stakeholder Type Community Based Organization Health Care Provider Government Organization Educational Organization 5 (13%) 22 (58%) 1 (3%) 3 (8%) (N) and % of Total Attendees Labor Group 2 (5%) Other 5 (13%) *Government organization attendees exclude health department staff. 2

201 IV. New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Findings The Staten Island listening session included 21 registered attendees and 29 walk in participants. Of the 50 participants who attendedd the Staten Island listening session, 244 engaged in a wide ranging and robust discussion that directly or indirectly covered all of TCNY s ten priority areas. 1 Many of the discussions covered issues that align with TCNY s particularr focus on Children and Adolescent Health. The prevalent themes of the Staten Island listening session feedback includedd the following: Active Living Promote the usage of parks and playgrounds. Increase advertisement that promotes walking and mileage markers. Strategies for adults to increase exercise. Healthy Eating Educate bodega owners on fresh fruits and vegetables. Improve healthier food choices in vending machines. Replicate proven weight loss programs. Tobacco Free Living Increase prevention messages to children and adolescents. Provide smoking cessation point of service options. Reduce Alcohol & Substance Abuse Halt the closing of substance abuse and detox centers on the island. Healthy Indoor & Outdoor Air Increase information on the quality of air after Hurricane Sandy 1 24 of the 50 attendees were recorded as providing feedback, questions, or suggestions. 3

202 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Table 2. Stakeholder Feedback Take Care New York Priority Area Active Living Relevant Quotes Staten Island has the most city parks and there s public transportation accessibility to these parks. We need to take advantage of that. Everywhere you go there s a park, how can we get people to do school trips to the park? We have a lot of nice parks here. There is a correlation between active living and healthy eating. I don t see it with adults though, only with kids. I ve never seen any media campaigns about active living for adults. We should focus on promoting things that an average family can participate in like a park day once you get a family involved the effects trickle down to children and children influence peers. I know there s a new incentive with the bikes in the city, but I don t see anything in Staten Island. Stakeholder Questions or Feedback Re institute mileage markers on boardwalks, in parks, and in other public spaces. Consider initiatives that offer family vouchers and babysitting at health clubs and other places where adults exercise. Work with the Parks Department to promote Active Living family days in the parks. Promote physical activity by renovating the playgrounds at Staten Island s many supportive housing sites. Consider developing Staten Island sugar sweetened beverages awareness ads on how long it takes to walk off a sugar sweetened beverage, but make them borough specific (i.e. from Clove Lake to St. George). 4

203 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Take Care New York Priority Area Relevant Quotes Stakeholder Questions or Feedback Healthy Eating How can the city assist or incentivize bodegas to carry more fresh food? Healthier choices in vending machines are more costly, reducing the shared revenue and the incentive. Also, healthy options don t always have the same brand recognition as unhealthy choices. At City Harvest, bodega owners can come to our workshop to learn how to get fresh produce into their stores. Local food distribution and connect those stores with local farmers and growers. Educate bodega owners on how to get fresh food in their stores. Link activee living & healthy eating to working in community gardens. Use food distribution sites to distribute health related materials from other CBOs and hospitals. Replicate initiatives such as the Staten Island Slim Down program. 5

204 New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Take Care New York Priority Area Tobacco Free Living Relevant Quotes We need to hold people more accountable for health issues. This isn t rocket science, everyone knows smoking is bad but people are still making the choice to smoke. Addiction is difficult. There needs to be a rehab center specific for smoking, smoking is definitely a gateway drug. Peoplee who start out very young are more likely to smoke throughout their whole life. We need to do more preventive, ratherr that complain about not enough funding. Staten Island was the last borough to have a smoking cessation program in the city, but when you were able to hand someone something at the point of service it was integral to getting people to quit. Stakeholder Questions or Feedback Consider more smoking prevention messages and campaigns to young people. The younger you start smokingg the more likely you are to continue into adulthood Take Care New York Priority Area Reduce Alcohol Abuse & Substance Relevant Quotes Staten Island is hardest hit in substance abuse but they are closing detox centers and units in the Staten Island Hospital. We won t know the impact for a while. We have to be careful about closing these units that are so necessary. I don t know the city s role surrounding hospitals for patients and recovery. Stakeholder Questions or Feedback 6

205 Take Care New York Priority Area Healthy Indoor & Outdoor Air New York City Department of Health and Mental Hygiene Take Care New York Borough Wide Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Relevant Quotes Stakeholder Questions or Feedback After Sandy, people are concerned with quality of life and quality of air; they are scared of mold and Whatt are initiatives on air quality in Staten Island? outdoor air pollutants. Table 3. Stakeholder Resourcee Requests Take Care New York Priority Area Promote Mental Health Resource Requests Organizations have been doing a lot of education to the community and would like to partner with CBOs or hospitals so that more people are aware of the services that we have. General Feedback DOHMH pamphlets and literature are often unavailable through 311. The Health Department should provide more health information printed in Spanish. V. Listening Session Evaluation Table 4. Staten Island Listening Session Onsite Evaluation Findings* (N=25) Questions Stakeholder Average Rating 1. Overall satisfaction with this listening session The forum helped me learn more about Take Care New York (TCNY) The presentation and handouts were informative Sufficient time was allocated for questions and answers The program was well planned and interactive. 4.3 *Participants were asked to rate their agreement with the statements above on a scale of 1 5: 1=Poor; 2=Fair; 3=Good; 4=Very Good; 5=Excellent. The evaluation form is attached in Appendix B 7

206 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Table 5. Session Attendees Familiarity with TCNY prior too the Listening Session.( (N=6) *Survey attached in Appendix C. Weree you familiar with Take Care New Yorkk (TCNY) prior to registering for this listening session? 16.70% 16.70% Yes No Somewhat 66.70% Table 6. TCNY Priority Areas of Interest TCNY Priority Areas Tobacco Free Living Healthy Eating Active Living Heart Health HIV Prevention Promote Mental Health Reduce Alcohol and Risky Substance Use Prevent and Treat Cancer Healthy Indoor and Outdoor Air Quality Preventive Care % of Attendees Working or Interested in Working on the Topic 83.3% 66.7% 66.7% 33.3% 16.7% 16.7% 33.3% 33.3% 50.0% 50.0% 8

207 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Table 7. Community Resource Interests.* Not Interested Somewhatt Interested Interested N/A N Connectionn with local organizations working on similar health initiatives 0% 16.7% 66.7% 16.7% 6 Facilitation of a cross resource organizational portal 0% 0% 100% 0% 4 Cross organizational Workshopss or Trainings 0% 33.3% 66.7% 0% 6 Webinars featuring resources and local case studies 0% 0% 100% 0% 6 Newsletter articles 0% 25% 75% 0% 4 Informational briefs or fact sheets on key health issues 0% 0% 100% 0% 5 Tool kits 0% 0% 100% 0% 6 Social media assistance 0% 16.7% 66.7% 16.7% 6 Community data to support program development and partnershipp efforts 0% 0% 100% 0% 6 *Participants were asked to rate their interest in the resources above, on a scale of 1 3: 1= =Not Interested; 2=Somewhat Interested; 3=Interested. 9

208 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 Table 8. Interest in Take Care New York Partnership Would your community organization, business, health care provider, business, labor group or faith based organization be interested in becoming a Take Care New York? 50% 50% Yes No I am already a TCNY partner Don' 't Know 10

209 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 VI. Appendix A Feedback Notecard 11

210 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 VII. Appendix B 12

211 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7, 2013 VIII. Appendix C 13

212 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7,

213 New York City Department of Healthh and Mental Hygiene Take Care New York Borough Widee Listening Sessions Staten Island Listening Session Stakeholder Feedback Summary May 7,

214 Attachment X. Suffolk County Community-based Organization CHNA Survey and Results Suffolk County Community Health Assessment CBO Survey

215 Methodology Survey Based on Nassau County CHA community survey and informant interview script 15 questions Survey data:services provided, target population, identify and prioritize pressing health needs in community, community health status, barriers, health improvement strategies Identification of community-based organizations, hospitals, & government survey recipients Organizations identified as community partners in Suffolk County Distribution Electronic survey through SurveyMonkey Personalized invite by in Spring 2013 with follow up invites Survey closed June, 2013

216 Survey Respondents (Total = 102) Type of Respondent Business 3 Community-based Organization Total 23 Educational Organization 13 Government 12 Hospital/Healthcare Provider 9 Other/Unknown* 42 TOTAL = 102 *Respondent did not provide information

217 Q 1 What are the biggest health problems for the people/community you serve? (select top 5 health concerns) Drug & Alcohol Abuse Mental Health, Depression, Suicide Obesity, weight Loss Issues Nutrition, Eating Habits Smoking, Tobacco Use Cancer Diabetes Heart Disease & Stroke Asthma, Lung Disease Care For The Elderly Falls In The Elderly Memory Loss Women's Health & Wellness Teen Pregnancy Premature Births HIV/AIDS & STDs Access To Vaccinations Infections Environmental Problems (water, pollution, air, etc) Violence In Home, Guns, Murder, Rape, Other Preventable Injuries % respondents choosing health problem

218 Q 2 What would be most helpful to improve the health problems of the people/community you serve? (select top 5 health concerns) Health Education Programs Drug & Alcohol Services Weight Loss Programs Affordable Housing Health Screenings Mental Health Services Job Opportunities Access To Healthier Food Transportation Home Care Options Insurance Enrollment Programs Clean Air & Water Safer Places To Walk & Play Parks & Recreation Farmer's Markets Safer Child Care Options More Grocery Stores Better Schools Breastfeeding Safer Work Places % respondents choosing health improvement strategy

219 Q 3 Do any people/communities you serve in Suffolk have problems getting needed health care? Health Care Access 22% Yes No 78%

220 Q 4 If you answered yes to Q 3, what do you think are the reasons? (select top 5 barriers) No Insurance & Unable To Pay For Care Unable To Pay Co-pays & Deductibles Transportation Language Barriers Don't Understand Need To See Doctor Fear (e.g. not ready to face/discuss health problem) Lack of Availability of Doctors Don't Know How To Find Doctors Cultural, Religious Beliefs % respondents identifying barrier to medical treatment

221 Q 5 What types of health screenings &/or services are needed to keep people healthy in the community you serve? (select top 5 screenings/services) Drug & Alcohol Mental Health, Depression Suicide Prevention Blood Pressure Cancer Diabetes Cholesterol Heart Disease Exercise, Physical Activity Nutrition Weight Loss Help Eating Disorders Routine Well Checkups Dental Screenings Quitting Smoking Prenatal Care Vaccinations, Immunizations HIV/AIDS & STDs Emergency Preparedness Disease Outbreak Prevention Falls Prevention In Elderly Memory Loss % respondents choosing health screening or service

222 Q 6 What health issues do the people/community you serve need education about? (select top 5 education topics) Diabetes Blood pressure Heart Disease Cholesterol Cancer Drug & Alcohol Mental Health, Depression Suicide Prevention Nutrition Exercise, Physical Activity Eating Disorders Routine Well Checkups Quit Smoking Dental Screenings Prenatal Care Emergency Preparedness Disease Outbreak Prevention Falls Prevention In Elderly Vaccinations, Immunizations HIV/AIDS & STDs % respondents choosing education topic

223 Q 7 Where do community members you serve get most of their health information? (Check all that apply) Family or Friends Doctor, Health Professional Television Internet Newspapers, Magazines Hospital Library School, College Worksite Other Social Media Church Group Health Department Radio Facebook, Twitter % respondents identifying health information channel

224 Q 8 What do you think makes a community healthy? Community Support & Unity Education Access to Affordable Healthcare Access to Healthy & Affordable Food Access to Quality & Affordable Housing Collaboration Amongst Healthcare Providers Jobs Healthy Community Knowledge of a Healthy Lifestyle/Health Literacy Prevention Programs & Services Community Support Services Policies Supporting Healthy Lifestyles Transportation Recreation Areas Communication

225 Q 9 How would you rate the health of the people/community you serve? Somewhat Healthy Healthy Unhealthy Very Unhealthy 1.2 Very Healthy % respondents choosing health rating

226 Q 13 Tell us about the populations your organization serves. (Check all that apply) % respondents choosing population served

227 Attachment XI: Suffolk County Community-Based Organization Survey Participants Participant Affiliation Tina Stone RN William Floyd School district Jennifer Dzvonar Dave Williams Kathleen Brennan Teresa Ergul RN Debra Engelhardt April Ortiz North Brookhaven Chamber of Commerce Port Jefferson FD President Port Jefferson Board of Ed. Moriches Elementary School Comsewogue Public Library Suffolk County Department of Health Claire McCarthy William Floyd High School Mary Alvar William Floyd School District J. O'Donnell William Floyd School District Gail Lynch-Bailey The Longwood Alliance thomas talbot Middle island civic association Karen A. Rade Montauk Library Laura Giardino Suffolk county Dept. of health Erma Gluck Coram Civic Association Helen Crosson Cold Spring Harbor Kathleen Johnson Port Jefferson Ambulance Jason Lazerus Barbara Ransome Ronnie Kreitzer Paula Klee Parish Tara D'Amato, Community Services Coordinator Lauren Nichols James Olney Port Jefferson Volunteer Ambulance Greater Port Jefferson Chamber of Commerce Three Village Meals on Wheels Inc. Performance Solutions, Inc/Womenonthemoveli.com Mastics Moriches Shirley Community Library Patchogue Medford Library Northport-East Northport Public Library r. maggio port jefferson free library Rich Schlude Miller Place Fire Dept Patty Vorilas Betsy Maniotis Pastor Thomas Humphrey Laurie Golan Babylon Village Chamber of Commerce SBPWN Long Island Men's Center Long Island Youth Mentoring

228 S. Kathleen Carberry The Learning Connection Robyn Berger-Gaston FAmily Service League Margaret Bakos SANDRA GIL Patricia Carley Matthew Ellwood ann aboulafia Mary Louise Cohen William J. St. George Ted mariusz borkowski Janet Sklar Nancy Hemendinger Walter Ladick Geogeine Bellando Katelin Thomas Staci M. Spencer Linda S Reich Catherine Shannon Marian Russo Kathleen Valerio Ronald Kaplan Dorothy S. Lane, MD Joel Vetter Kathleen Burger Martha Kahan Marianne Zacharia Nancy Olsen-Harbich Connie Kraft Jennifer Logiudice Janine Logan Stony Brook U School of Dental Medicine SUFFOLK COUNTY DEPT. OF HEALTH Sunrise Senior Living Bay Shore Wellness Alliance aboulafia & june cpas pc St.James Rehabilitation& Healthcare Nagengast Bay Shore Wellness Alliance ES Bay Shore UFSD Suffolk County Department of Health Services Brookhaven Hospital Good Samaritan Hospital Suffolk Project for AIDS Resource Coordination (grant-funded program based out of Stony Brook University) South Fork Comm. Health Init. Catholic Charities St. Catherine of Siena Med Center Village of Patchogue Community Development Agency Stony Brook University Health Education Office SHS FEGS Stony Brook University Medical Center Suffolk OEM Suffolk County Community College - Brentwood Campus Eastern Suffollk BOCES American Lung Association Cornell Cooperative Extension Stony Brook University Hospital St. Catherine of Siena Medical Center Nassau-Suffolk Hospital Council

229 Attachment XII. NSLIJHS Nassau, Queens and Suffolk Mental Health Community-based Entity Survey and Results South Oaks Hospital & Zucker Hillside Hospital Community Health Needs Assessment CBO Survey

230 Methodology Survey Based on Nassau County CHA community survey and informant interview script Tailored to mental health and substance abuse 23 questions Survey data: services provided, target population, identify and prioritize pressing health needs in community, barriers, resources, organization sustainability, health improvement strategies Identification of community-based organizations, hospitals, & government survey recipients Long Island Behavioral Health Management BHO Advisory Committee as of April, 2013 Community-based organizations requested by ZHH 47 potential unique entity respondents: CBOs = 20; Hospitals = 21; Government = 6 Distribution Electronic survey through SurveyMonkey Personalized invite by in April 2013 with follow up invites in May and June 2013 Focus on CBOs for follow up invites Survey closed June 14, 2013

231 Service Location Key N = Nassau County Only S = Suffolk County Only LI = Island Wide S N S Survey Respondents(Total= 21) Concern for Independent Living, Inc. Family and Children s Association Family Service League LI Long Island Behavioral Health Management (2) LI N S N N N Long Island Recovery Association Mental Health Association of Nassau County, Inc. Mental Health Association in Suffolk County, Inc. Mental Health Association PROS NAMI Queens/Nassau South Shore Association for Independent Living, Inc. Community-based Organizations Government N LI LI S N S Nassau County Office of Mental Health, Chemical Dependency,& Developmental Disabilities Services NYS Office of Mental Health NYS Office of Mental Health- LI Field Office Suffolk County Department of Health, Division of Community Mental Hygiene Franklin Hospital John T. Mather Memorial Hospital Hospitals S South Oaks Hospital (2) S Southside Hospital (2)

232 Q 11 The NYS Prevention Plan for identifies 5 priority areas with related focus areas and goals. NYS Prevention Plan Priority Area Promote mental health and prevent substance abuse. Examples: prevent underage drinking and non-medical use of prescription drugs, suicide prevention, and mental health education and screening. Preventing chronic disease.examples: reduce obesity in children and adults,reduce illness and disability related to tobacco use and second hand smoke, and increase access to preventive care and health screenings. Promoting a healthy and safe environment. Examples: reduce fall risk among vulnerable populations, reduce occupational injury and illness, and violence prevention. Promote healthy women, infants, and children. Examples: reduce premature births and unplanned pregnancies, increase prevalence of breastfed babies, and increase access to well child care. Preventing HIV,sexually transmitted diseases, vaccine-preventable diseases, and healthcare associated infections. Examples: improve immunization rates, STD and HIV education, and access to testing and care. Priority Score

233 Q 10 What are the biggest ongoing health concerns in your community? (select top 3 health concerns) Drug & Alcohol Abuse Mental Health, Depression, Suicide Obesity & Weight Loss Issues Diabetes Heart Disease & Stroke Asthma & Lung Disease Cancer Child Health & Wellness Women's Health & Wellness Safety Environmental Hazards HIV/AIDS & STDs Vaccine Preventable Diseases % respondents choosing health concern

234 Q 12 Please describe resources (i.e. health services, community education programs, screenings, etc.) that your community uses in relation to the health problems you have identified. Resources Community Education Programs & Awareness Counseling (Inpatient& Outpatient) Housing Referrals Screenings Support Groups Examples Healthcare providers, clinics Narcan Local physicians

235 Q 23 Where do community members you serve get most of their health information? (Check all that apply) Doctor, Health Professional Family or Friends Hospital Internet Television Health Department Religious Organization Newspapers, Magazines Radio School, College Worksite Case Management* Library % respondents identifying health information channel *Free text write-in by multiple respondents

236 Q 15 Which of the following is MOST needed to improve the health of your community? (select top 3 health improvement strategies) Drug & Alcohol Rehabilitation Programs Mental Health Services Job Opportunities Smoking Cessation Programs Weight Loss Programs Healthier Food Choices Transportation Clean Air & Water Recreation Facilities Safe Childcare Options Safe Places to Walk & Play Safe Worksites Housing* % respondents choosing health improvement strategy *Free text write-in by multiple respondents

237 Q 16 What health screenings or education/information services are needed in your community? (select top 3 screenings or services) Drug & Alcohol Mental Health, Depression Suicide Prevention Diabetes Blood Pressure Heart Disease Cancer HIV/AIDS & STDs Cholesterol Exercise, Physical Activity Nutrition Importance of Routine Well Checkups Dental Screenings Prenatal Care Emergency Preparedness % respondents choosing screening or education/information service

238 Q 17 Of the following healthcare providers, who are people in the community you serve most likely to turn to for initial help for mental health and/or substance abuse concerns? Community MH Agency, Alcohol & Drug Tx Hospital Emergency Room 38.1 Primary Care Provider Private Therapist 4.76 AA or other support group School Counselor Urgent Care % respondents identifying initial point of access for mental health & substance abuse services

239 Q 18 To what degree is your organization negatively impacted by current service delivery regulations and policies of the state, county, or local government? Response selection (%) 0 Highly Affected Moderately Affected Minimally Affected

240 Q 19 How fiscally sustainable do you feel your organization is under the current funding structures? 4.76 Sustainability (%) Highly Sustainable Moderately Sustainable At Risk of Closing

241 Q 20 What prevents people in your community from getting medical treatment? (select top 3 barriers) Lack of Availability of Doctors Unable to Pay Co-pays/Deductibles No Insurance Transportation Fear (e.g. not ready to face/discuss health Don't Understand Need to See a Doctor Don't Know How to Find Doctors Language Barriers Cultural/Religious Beliefs There Are No Barriers % respondents identifying barrier to medical treatment

242 Q 21 You previously identified barriers and gaps in resources/services available to your community. Please explain in what way resources/services can be improved and what additional services are needed. Resources & Services Housing-residentialservices, supervised housing, stable/permanent/affordable housing Improved Access to Services-insurance, ambulatory clinics, referral mechanisms Integration &Education of Other Healthcare Providers-co-occurring disorders, primary care physicians Providers- psychiatrists Transportation- public transportation

243 Q 22 Please describe how your organization can specifically address some of the additional service needs described in Q 21. Advocacy Strategies Community Education & Awareness Education & Integration with Healthcare Providers Expansion of Services Grant Seeking Transportation

244 NYS Community Service Plan & Community Health Needs Assessment Implementation Plan Priority Selection PRIORITY AREA: Promote Mental Health & Prevent Substance Abuse FOCUS AREA: Promote Mental, Emotional, & Behavioral Health Promote mental, emotional, & behavioral well-being in communities FOCUS AREA: Prevent Substance Abuse & Other Mental, Emotional, & Behavioral Health Disorders Prevent underage drinking, non-medical use of prescription drugs by youth, & excessive alcohol consumption by adults Prevent & reduce occurrences of mental, emotional, & behavioral disorders among youth & adults Prevent suicides among youth & adults Reduce tobacco use among adults who report poor mental health FOCUS AREA: Strengthen Infrastructure Across Systems Support collaboration among professionals working in fields of mental, emotional, behavioral health promotion & chronic disease prevention, treatment, & recovery Strengthen infrastructure for mental, emotional, & behavioral health promotion & mental, emotional, & behavioral disorder prevention

245 Preliminary Data for the Nassau County Community Health Assessment

246 Methods Data Sources: SPARCS , NYSDOH Vital Statistics, NYS Cancer Registry, NYSDOH Surveillance System, 2010 US Census Age Adjustment: Direct Standardization of Rates Based on 2000 US Standard Population Select Communities: Roosevelt, Long Beach, Westbury, Uniondale, Hempstead, Inwood, Elmont, Freeport, Glen Cove Significance testing was done using confidence intervals in line with NYS methods. Those statistically significant are noted by *

247 Demographics

248 Nassau County Population by Age and Sex to to to 59 Age Group 40 to to 39 Female Male 20 to to 19 0 to Percentage (%) Source: U.S. Census 2010

249 Percent Distribution of Race by Town/City, Nassau County, Other API Black White Hempstead Long Beach North Hempstead Oyster Bay Glen Cove Nassau County 2010 Source: U.S. Census 2010 Nassau County 2000

250 30 Percent Distribution of Hispanic Ethnicity by Town/City, Nassau County Percentage of Hispanics in Town Nassau County 2010 Nassau County 2000 Glen Cove 2010 Glen Cove 2000 Hempstead Hempstead Long Beach 2010 Long Beach 2000 North Hempstead 2010 North Hempstead 2000 Oyster Bay Oyster Bay Source: U.S. Census 2010

251 Age Distribution in Select Communities by Sex Nassau County to to Age Group (years) 50 to to to Male Female 20 to to to Source: U.S. Census 2010 Percentage

252 Race Distribution by Community Race Percent Other API Black White Source: U.S. Census 2010 Select Communities Rest of County Nassau County

253 Diseases of the Cardiovascular System

254 2250 Average Rate of CVD Hospitalization ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

255 Average Rate of Hospitalization for CVD by Age Nassau County ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) under1 1to4 5to14 15to24 25to29 30to34 35to39 40to44 45to49 50to54 55to59 60to64 65to69 70to74 75to79 80to Age Group (years)

256 3500 Average Hospitalization Rate for CVD by Sex Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Male* Female

257 1550 Average Rate of Hospitalization for Diseases of the Heart ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau* NYS NYSxNYC

258 Average Hospitalization Rate for Diseases of the Heart by Age Nassau County ( ) Age Adjusted Rate (per 100,000) under1 1to4 5to14 15to24 25to29 30to34 35to39 40to44 45to49 50to54 55to59 60to64 65to69 70to74 75to79 80to Source: NYS DOH SPARCS ( ) Age Group (years)

259 2500 Average Rate for Diseases of the Heart by Sex Nassau County ( ) 2000 Rate (per 100,000) Source: NYS DOH SPARCS ( ) Male * Female

260 400 Average Rate of Stroke Hospitalization ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau NYS NYSxNYC

261 Average Rate of Hospitalization for Stroke by Age Nassau County( ) Age Adjusted Rate (per 100,000) under1 1to4 5to14 15to24 25to29 30to34 35to39 40to44 45to49 50to54 55to59 60to64 65to69 70to74 75to79 80to Source: NYS DOH SPARCS ( ) Age Group (years)

262 410 Average Hospitalization Rate for Stroke by Sex Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Male * Female

263 Diseases of the Respiratory System

264 450 Average Rate of COPD Hospitalization ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

265 600 Average Rate of Hospitalization for COPD by Community Nassau County ( ) Rate (per 100,000) Select Communities * Rest of County

266 250 Average Rate of Asthma Hospitalization ( ) 200 Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

267 300 Average Rate of Hospitalization for Athsma by Community Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities * Rest of County

268 Diabetes and Liver Disease

269 180 Average Rate of Type 2 Diabetes Hospitalizations ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

270 300 Average Rate of Hospitalization for Type 2 Diabetes by Community Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities * Rest of County

271 34 Average Rate of Liver Disease Hospitalization ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

272 60 Average Rate of Hospitalization for Liver Disease by Community Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities * Rest of County

273 Injuries

274 Proportion of Average Injury Rates: Outpatient by Type within Age Group in Nassau County ( ) Submersion Pedestrian Fire/Flame Bicycle Respiratory Interference Assault Falls MVA Poisoning Struck self inflicted Source: NYS DOH SPARCS ( ) Age Group (Years)

275 Unintentional Injury

276 1200 Average Rate of MVA Related Injuries, Outpatient ( ) 1000 Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau* NYS NYSxNYC

277 1600 Average Rate of MVA Related Injuries by Community, Outpatient Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities* Rest of County

278 13.5 Average Rate of Respiratory Interference, Outpatient ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

279 25 Average Rate of Respiratory Interference by Community, Outpatient Nassau County ( ) 20 Rate (per 100,000) Select Communities * Rest of County

280 25 Average Rate of Bicycle Injury, Outpatient ( ) 20 Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) * Nassau NYS NYSxNYC

281 45 Average Rate of Bicycle Injury by Community, Outpatient Nassau County ( ) Rate (per 100,000) Select Communities * Rest of County

282 80 Average Rate of Pedestrian Accidents, Outpatient ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

283 120 Average Rate of Pedestrian Accidents by Community, Outpatient Nassau County ( ) Rate (per 100,000) Select Communities * Rest of County

284 3.5 Average Rate of Submersion, Outpatient ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau* NYS NYSxNYC

285 Intentional Injury

286 600 Average Rate of Assault Related Injuries, Outpatient Nassau County ( ) 500 Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

287 600 Average Rate of Assault Related Injuries by Community, Outpatient Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities * Rest of County

288 90 Average Rate of Self Inflicted Injury, Outpatient ( ) Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau * NYS NYSxNYC

289 6 Average Rate of Firearm Related Injuries, Outpatient ( ) 5 Age Adjusted Rate (per 100,000) Source: NYS DOH SPARCS ( ) Nassau* NYS NYSxNYC

290 Average Rate for Firearm Related Injury by Community, Outpatient Nassau County ( ) Rate (per 100,000) Source: NYS DOH SPARCS ( ) Select Communities * Rest of County

291 Cancer

292 700 All Invasive Malignant Tumors, Incidence 600 Age Adjusted Rate per 100,000 Population Mortality Nassau County NYS NYSxNYC Males Females Males Females Source: NYS Cancer Registry

293 Cancer Incidence among Males by Cancer Site, Age Adjusted Rate per 100,000 Males Nassau County NYS NYSxNYC 20 0 Source: NYS Cancer Registry

294 160 Cancer Incidence among Females by Cancer Site, Age Adjusted Rate per 100,000 Females Nassau County NYS NYSxNYC 0 Source: NYS Cancer Registry

295 70 Cancer Mortality among Males by Cancer Site, Age Adjusted Rate per 100,000 Males Nassau County NYS NYSxNYC 0 Source: NYS Cancer Registry

296 45 Cancer Mortality among Females by Cancer Site, Age Adjusted Rate per 100,000 Females Nassau County NYS NYSxNYC 0 Source: NYS Cancer Registry

297 Communicable Diseases

298 8 Average Incidence Rate of Tuberculosis Nassau County ( ) 7 6 Rate per 100,000 Population Select Communities * Rest of County Nassau County Source: NYS CDESS

299 30 Average Incidence Rate of Syphilis Nassau County ( ) Rate per 100,000 Population Select Communities * Rest of County Nasau County Source: NYS CDESS

300 90 Average Incidence Rate of Gonorrhea Nassau County ( ) Rate per 100,000 Population Select Communities * Rest of County Nasau County Source: NYS CDESS

301 600 Average Incidence Rate of Chlamydia Nassau County ( ) 500 Rate per 100,000 Population Source: NYS CDESS Select Communities * Rest of County Nassau County

302 Mortality

303 250.0 Age Sex Adjusted Death Rates by Region, Rate per 100,000 Population Diseases of the Heart Malignant Neoplasms New York State NYSxNYC Nassau Source: NYS Vital Statistics

304 Age Sex Adjusted Death Rates by Region, Rate per 100,000 Population Chronic Lower Respiratory Disease Cerebrovascular Disease Total Accidents Pneumonia Diabetes Mellitus New York State NYSxNYC Nassau Source: NYS Vital Statistics

305 Age Sex Adjusted Death Rates by Region, Rate per 100,000 Poplation Suicide Cirrhosis of the Liver Homicide/Legal Intervention AIDS New York State NYSxNYC Nassau Source: NYS Vital Statistics

306 Pregnancy and Perinatal Outcomes

307 50 Average Teen Pregnancy Rate Nassau County ( ) Teen Pregnancy Rate/ 1,000 females years * Select Communities * Rest of County Nassau County Source: NYSDOH Bureau of Biometrics and Health Statistics and NYC DOHMH, Bureau of Vital Statistics

308 35 Average Teen Birth Rate Nassau County ( ) 30 Rate per 1,000 Female Population Select Communities * Rest of County Nassau County NYSDOH Bureau of Biometrics and Health Statistics and NYC DOHMH, Bureau of Vital Statistics

309 9.5 Percent Low Birth Weight (<2500 grams) by Community ( ) 9 Per 100 Live Births Select Communities * Rest of County Nassau County NYSDOH Bureau of Biometrics and Health Statistics and NYC DOHMH, Bureau of Vital Statistics

310 9 Infant Mortality Rate by Community Nassau County Rate/ 1,000 Live Births Select Communities* Rest of County Nassau County NYSDOH Bureau of Biometrics and Health Statistics and NYC DOHMH, Bureau of Vital Statistics

311 6 Percent Recieving Late (3 rd Trimester) or No Prenatal Care by Community ( ) 5 4 Per 100 Live Births Select Communities * Rest of County Nassau County NYSDOH Bureau of Biometrics and Health Statistics and NYC DOHMH, Bureau of Vital Statistics

312 Findings Major health disparities exist in Nassau County. These disproportionate health outcomes exist across: Age: Chronic Disease and Injury Sex: Chronic Disease Community: Communicable Disease, Injury, Chronic Disease and Perinatal Outcomes

313 Next Steps Waiting for additional vital statistics data Community Engagement Data Identify Priorities and Programs

314 Suffolk County Department of Health Services Data Update Selection of Priority Areas Dr. Jane E. Corrarino April 11, 2013 Prevent Chronic Disease Promote a Healthy and Safe Environment Promote Healthy Women, Infants and Children Promote Mental Health & Prevent Substance Abuse Prevent HIV, STDs, Vaccine Preventable Diseases and Healthcare Associated Infections 4/12/2013 1

315 Suffolk County Department of Health Services Two priorities At least one address a disparity Goals and objectives for each Improvement strategies & performance measures Measurable & time-framed targets over 5 years Evidence-based, or promising practices Current and new 4/12/2013 2

316 Suffolk County Department of Health Services NYSDOH Community Health Indicator Reports 15 Topic Areas 250 Health Indicators Multiple Data Sets Statewide, Regional, County Graphs, Maps, Quartile Rankings Statistical Significance Partnerships Coalitions Individuals Community Survey Cancer CV Disease Child & Adolescent Health Cirrhosis/DM Communicable Disease Family Planning/Natality HIV/AIDS/STIs Injury Maternal & Infant Health Obesity/Related Occupational Health Oral Health Respiratory Disease SES/General Health Tobacco, Alcohol, other Substance Abuse Indicators 4/12/2013 3

317 Suffolk County Department of Health Services Cancer Most indicators 1 st, 2 nd Q Breast Cancer Incidence & Mortality 3 rd /4 th quartile Black/White Disparity in mortality Cardiovascular Most indicators 1 st, 2 nd Q 4 th Quartile Hospitalization Rates: CV disease /Coronary Heart Disease Stroke HTN Child/Adolescent Most indicators 1 st, 2 nd Q Asthma 4 th Q hospitalization rates Lead Screening Cirrhosis/DM Most indicators 1 st, 2 nd Q DM 3 rd Q hospitalization rates Communicable Disease % elderly flu shots 3 rd Q Family Planning/Natality All indicators 1 st, 2 nd, 3 rd Q Black/White IMR disparity HIV/AIDS/STIs Most Indicators 2 nd, 3 rd Q Early Syphilis rate 4 th Q Maternal & Infant Most indicators 1 st, 2 nd, 3 rd Q or non-significant differences from NYS 4 th Q for overweight WIC enrollees 4 th Q % Cesarean Section 44.0 vs (27% excess) 4/12/2013 4

318 Suffolk County Department of Health Services Injury Suicide, self-inflicted, Homicide 1 st, 2 nd, 3 rd Q Unintentional Injury Hospitalization rate 3 rd, 4 th Q all age groups Mortality 3 rd Q 1,483 per year Health Disparities Pedestrian & Bicycle injuries Falls hospitalizations 4 th Q almost all age groups Age ,000 per year Plus ED visits Suffolk vs. NYS (per 10,000) Age vs (8% excess) Age vs (17% excess) Age vs (25% excess) Injury MVA Mortality 3 rd Q Traumatic Brain Injury Hospitalization 4,874/Year 4 th Q Asthma Hospitalization rate 4 th Q all age groups 14.4 vs NYS (12% excess) 12,726/A Obesity and Related 3 rd & 4 th Q all students % overweight, not obese % overweight or obese Occupational Health Most indicators 1 st, 2 nd, 3 rd Q Oral Health Most indicators 1 st, 2 nd Q 4/12/2013 5

319 Suffolk County Department of Health Services Socio-Economic Status and General Health Most indicators 1 st Q No medical care because of cost 3 rd Q 13.1 vs (9% excess) Poor mental health 14+ days in past month 4 th Q 13.1 vs (20% excess) Tobacco, Alcohol, Other Substances Drug-related hospitalization rate 3 rd Q Age-adjusted % Adults Smokers 1 st Q, better than NYS % Binge Drinkers 20.7 vs (4% excess) Cancer Breast CV Disease Child & Adolescent Health Cirrhosis/DM Communicable Disease Family Planning/Natality HIV/AIDS/STIs Respiratory Disease Asthma Hospitalization rate Injuries Overall for Hospitalization and Mortality Falls Age 65+ Age 75+ (17-25% excess rate) TBI 4 th Q Maternal & Infant Obesity & C/S Obesity/Related Occupational Health Oral Health SES/General Health Mental health Tobacco, Alcohol, other Substance Abuse Indicators 4/12/2013 6

320 Suffolk County Department of Health Services Partnerships Coalitions Individuals Community Survey Health Problems Ways to improve Access to care Reasons Health screenings/svc Sources of information Ranking health of community Biggest health problems for community Most helpful strategies Access to care? Reasons? Health screenings/services needed Health issues needing education Where do people get health information? What makes a healthy community Rating health of people/community 4/12/2013 7

321 Suffolk County Department of Health Services Health Problems SCDHS NSHC Cancer Care for the elderly Diabetes Drugs & alcohol abuse Heart disease & stroke Preventable Injuries Car crashes 3.6 Pedestrian injuries 0.0 Other 0.0 Mental health (including depression & suicide) Nutrition / eating habits Obesity/weight loss issues Women s health & wellness Most Helpful to Improve Problems SCDHS NSHC Access to healthier food Affordable housing Drug & alcohol services Farmers markets Health education programs Health screenings Weight loss programs /12/2013 8