Community Health Needs Assessment 2013

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1 2013 Akron Children s Hospital Beeghly Campus 6505 Market St. Boardman, OH

2 Table of Contents Executive Summary... 2 Background Purpose... 3 Request Copies and More Information... 4 Description of Hospital Facility... 4 Description of Community Served... 5 Methodology Approach... 7 Epidemiologic Data... 8 Community Leader Interviews... 9 Community Resident Focus Groups Other Community Health Needs Assessments Prioritization Process Community Resources Summary of Results Conclusions Acknowledgements... 22

3 EXECUTIVE SUMMARY Akron Children s Hospital operates two hospitals: one at its Akron campus and one at its Beeghly campus in Boardman, Ohio in Mahoning County. The area s only pediatric hospital, Akron Children s Hospital Mahoning Valley opened in December This non-profit, 32-bed pediatric hospital offers a full range of pediatric services to the children of the Mahoning Valley and surrounding areas, including access to a 24/7 emergency department, laboratory, radiology, outpatient surgical center, endocrinology, rehabilitation and EEG/ECHO/EKG services, as well as a hematology/oncology clinic and infusion center and child advocacy center. In 2013, Akron Children s Hospital Mahoning Valley partnered with Kent State University to conduct a Community Health Needs Assessment (CHNA). During the CHNA process, epidemiologic data were reviewed and compared to the rates for Trumbull, Mahoning, and Columbiana Counties to two peer counties, the state, the nation, and Healthy People 2020 objectives. Input was also obtained from community leaders and community residents and CHNAs conducted by other community groups were consulted. All of this information was used to develop a list of prioritized health needs for children in Trumbull, Mahoning, and Columbiana Counties. The unranked list of prioritized health needs for children that were identified across all three counties were: Chronic Diseases Asthma Diabetes Maternal & Infant Health Premature Births Low & Very Low Birth Weight Infant, Neonatal, & Post-Neonatal Mortality Child Lifestyle Factors Overweight & Obesity Exercise Nutrition Mental Health Substance Abuse Opioid Drug Abuse Sexually Transmitted Diseases Adolescent Gonorrhea Access to Health Care Health Insurance Coverage Access to Dental Care Mental Health Insurance Coverage Number of Pediatric Specialists Environmental Factors Access to Healthy Food These prioritized health needs are being used by Akron Children s Hospital Mahoning Valley to guide intervention and outreach efforts aimed at improving community health. Background information on the CHNA, the methodology used to conduct the CHNA, and the results of the analysis are contained in this report. 2

4 BACKGROUND Purpose In keeping with Akron Children s Hospital s mission, relationships have been established with various community and professional organizations who share common goals for the delivery of services to children and families with a focus on access and improvement of health outcomes. To better identify the health needs of the community, Akron Children s Hospital Mahoning Valley engaged in a more formalized process with Kent State University to provide a Community Health Needs Assessment to validate and prioritize the needs of the community we serve. In March 2010, the US Congress passed and President Obama signed the Patient Protection and Affordable Care Act (ACA). The ACA contains numerous changes to the US health care system, including requiring non-profit hospitals to conduct CHNAs every three years. The Internal Revenue Service (IRS), the federal agency that is charged with enforcing these new requirements, has issued regulations pertaining to these new reporting requirements of nonprofit hospitals. These regulations require CHNAs to include a description of: The community served and how it was defined; The process and methods used to conduct the assessment, including a description of the sources and dates of the data and other information used in the assessment and the analytical methods applied to identify community health needs; The information gaps that impact the ability to assess health needs; Collaborating hospitals and vendors used while conducting the CHNA; How input was received from persons who have expertise in public health and from persons who represent the broad interests of the community, including a description of when and how these persons were consulted; The prioritized community health needs, including a description of the process and criteria used in prioritizing the health needs; Existing health care facilities and other resources within the community available to meet the prioritized community health needs; Akron Children s Hospital Mahoning Valley has a long history of collaboration on a wide range of projects aimed at improving community health. The results of this CHNA will help guide these intervention efforts and will also act as a resource for other community groups working toward improving the health of the community. 3

5 Request Copies and More Information In addition to being publicly available on our website, a limited number of reports have been printed. If you would like a copy of this report or if you have any questions about it, please contact: Heather Wuensch Akron Children s Hospital One Perkins Square Akron, OH Phone: Roseann Marsico Akron Children s Hospital Mahoning Valley Beeghly Campus 6505 Market Street Boardman, OH Phone: Description of Hospital Facility Akron Children s Hospital operates two hospitals: one at its Akron campus and one at its Beeghly campus in Boardman, Ohio in Mahoning County. The area s only pediatric hospital, Akron Children s Hospital Mahoning Valley opened in December This non-profit, 32-bed pediatric hospital offers a full range of pediatric services to the children of the Mahoning Valley and surrounding areas. The hospital provides access to a 24/7 emergency department, laboratory, radiology, outpatient surgical center, endocrinology, rehabilitation and EEG/ECHO/EKG services, as well as a hematology/oncology clinic and infusion center and child advocacy center. During calendar year 2012, the following patient encounters occurred on the Beeghly campus: 1,739 inpatient and observation admissions, 27,774 emergency room visits, and 22,528 specialty visits. Akron Children s also owns and operates a 19-bed Level II Special Care Nursery at the hospital s Beeghly campus and a 25-bed Level IIIB Neonatal Intensive Care Unit at St. Elizabeth Health Center in Youngstown. Akron Children's neonatal team is committed to providing the most effective and efficient care for our tiniest patients, as well as providing parents with the emotional and educational support they need. Also located in the Mahoning Valley is the Community Outreach, Education & Support Center, which provides education and support for children and their families. These programs meet specified criteria of nationally accredited disease management programs, as well as Akron Children's criteria and monitoring requirements. Our community health outreach includes asthma and diabetes education and support, school programs, disease-specific camps and support groups, fitness programs, community events and educational programs that touched more than 45,000 individuals in calendar year In 2012, Akron Children s Hospital was re-designated as a Magnet hospital by the American Nurses Credentialing Center s (ANCC) Magnet Recognition Program. This is the highest recognition granted by ANCC and recognizes the very best in nursing care. Ranked a Best Children s Hospital by US News & World Report, Akron Children s Hospital is the largest 4

6 pediatric provider in northeast Ohio. Akron Children s Hospital has been caring for children since 1890 guided by three promises that we consider sacred: To care for all children as if they were our own; to treat everyone the way we would want to be treated; and to turn no child away for an inability to pay. For more information, visit Description of Community Served Akron Children s Hospital Mahoning Valley has and continues to serve patients and families from many communities across the region. Most people who receive services from the hospital are located in Mahoning, Trumbull and Columbiana Counties. Thus, for the purposes of this report, the community identified for this CHNA consists of those counties. Akron Children's Hospital Mahoning Valley Community Discharges from Akron Children's Hospital Mahoning Valley NICU, Special Care Nursery and Pediatrics Unit (2012) County Where Patients Reside Akron Children's Hospital Mahoning Valley % Mahoning County 55% Trumbull County 20% Columbiana County 14% All Other 11% Trumbull County There are approximately 207,406 people living in Trumbull County, which is a decrease of 1.4% since There are 7 cities and 5 villages in Trumbull County, with the county seat being Warren. Compared to the State of Ohio, Trumbull County has a slightly smaller proportion of children (under 18 years old) and a larger proportion of older adults (65 years and older). Nearly 8% of the population in Trumbull County is Black or African American and 1.5% is Hispanic or Latino compared to 12.5% and 3.3%, respectively, in the State of Ohio. Educational attainment in Trumbull County is lower than the State of Ohio with 87.1% having a high school diploma or higher and 16.6% having a bachelor s degree or higher. Similarly, annual per capita income in Trumbull County is lower than the State of Ohio and the percent of Trumbull County residents living in poverty is higher than that of the State. Mahoning County There are approximately 235,145 people living in Mahoning County, which is a decrease of 1.5% since There are 7 cities and 7 villages in Mahoning County, with the largest being Youngstown. Compared to the State of Ohio, Mahoning County has a smaller proportion of children (under 18 years old) and a higher proportion of older adults (65 years and older). Sixteen percent of the population in Mahoning County is Black or African American and 5.0% is Hispanic or Latino compared to 12.5% and 3.3%, respectively, in the State of Ohio. The percent of Mahoning County residents with a high school diploma or higher is roughly the same as the State of Ohio, but the percent with a bachelor s degree or higher is lower than the State. The annual per capita income in Mahoning County is lower than the State of Ohio and the percent of Mahoning County residents living in poverty is higher than the State average. 5

7 Columbiana County There are approximately 106,507 people living in Columbiana County, which is a decrease of 1.2% since There are 3 cities, 11 villages, and 18 townships in Columbiana County, with the largest being Salem. Compared to the State of Ohio, Columbiana County has a smaller proportion of children (under 18 years old) and a higher proportion of older adults (65 years and older). Approximately 2.4% percent of the population in Columbiana County is Black or African American and 1.4% is Hispanic or Latino compared to 12.5% and 3.3%, respectively, in the State of Ohio. The percent of Columbiana County residents with a high school diploma or higher is lower than the State of Ohio and the percent with a bachelor s degree or higher is nearly half of the State average (13.0% versus 24.5%). The annual per capita income in Columbiana County is much lower than the State of Ohio and the percent of Columbiana County residents living in poverty is higher than the State average. Table 1. Demographic Characteristics of Communities Served and the State of Ohio Trumbull Mahoning Columbiana Ohio Total population 1 207, , ,507 11,544,225 Percent population change 2-1.4% -1.5% -1.2% 0.1% Percent under 18 years old % 20.9% 21.2% 23.1% Percent 65 years and older % 18.4% 17.3% 14.8% Percent female % 51.5% 49.7% 51.1% Percent Black or African American 1 8.4% 16.0% 2.4% 12.5% Percent Hispanic or Latino 1 1.5% 5.0% 1.4% 3.3% Percent with high school diploma or higher % 87.9% 85.7% 87.8% Percent with bachelor s degree or higher % 20.9% 13.0% 24.5% Homeownership rate % 71.6% 74.5% 68.7% Median value of owner-occupied housing units 4 $100,500 $97,800 $97,700 $135,600 Persons per household Annual per capita income 4 $22,127 $23,261 $20,691 $25,618 Median household income 4 $42,441 $40,570 $41,003 $48,071 Percent living below poverty level % 17.1% 15.9% 14.8% Notes: estimate, 2 Since 2010, 3 persons age 25+, , Source: US Census Bureau (http://quickfacts.census.gov/qfd/maps/ohio_map.html) 6

8 METHODOLOGY Approach To conduct the Community Health Needs Assessment, a modified version of a well-established framework for strategic planning in public health called Mobilizing for Action through Planning and Partnerships or MAPP process was followed. MAPP has been utilized by numerous public health stakeholders to strengthen and improve local community health through collaborative and methodical processes involving multiple stakeholders. The MAPP process has six phases: 1. Organizing for success and developing partnerships 2. Visioning 3. Conducting MAPP assessments 4. Identifying strategic issues and prioritizing identified issues 5. Formulating goals and strategies 6. Taking action (planning, implementing, and evaluating programs/policies) In the first phase, Akron Children s Hospital Mahoning Valley convened meetings and discussed the new IRS requirements pertaining to CHNAs, the resources needed to conduct the CHNA, and the desire to hire a contractor to help facilitate the process. At the end of the first phase, the hospital solicited a proposal from Kent State University College of Public Health (KSU-CPH) and then hired KSU-CPH to facilitate the development of the CHNA. In the second phase, meetings were held to identify a vision and process to conduct the CHNA, which were determined primarily by the specific requirements of CHNAs mandated by the IRS. A work plan with anticipated timelines was also created. In the third phase, existing county-level epidemiologic data were gathered instead of collecting data through a survey due to concerns of self-report bias with the latter approach. In addition, interviews with community leaders and focus groups with community residents were conducted. Some hospital-based data were also added to the analysis. A Local Public Health System Assessment and a Forces of Change Assessment were not conducted because the Tri- County Community Health Assessment & Planning Initiative conducted them in In the fourth phase, a series of meetings were held to identify the prioritized health needs based on the epidemiologic data, the input from community leaders and residents, and other CHNAs that had been previously been conducted. Health needs were prioritized for children only. 7

9 In the fifth and six phases, Implementation Plans were developed that identified the strategies the hospital will undertake to address some of the prioritized health needs identified in the fourth phase. The hospital s Implementation Plans will be publicly available at by Dec. 31, Epidemiologic Data The epidemiologic data used in this report were collected from a variety of sources that report information at the county, state, and national levels. The epidemiologic data collected represented a very wide range of factors that affect community health such as mortality rates, health behaviors, environmental factors, and health care access issues. County Health Rankings The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The program collects information on mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment at a county-level for nearly all counties in the United States. Some data reported are actual counts based on actual reports (i.e., reported disease diagnoses), some data are estimated based on samples (i.e., the Behavioral Risk Factor Survey), and some data are modeled to obtain a more current estimate (i.e., projected 2012 estimates based on 2010 census data). For more information about the County Health Rankings program, please visit: Community Health Status Indicators The Community Health Status Indicators project is a partnership between the Centers for Disease Control and Prevention, the National Institutes of Health/National Library of Medicine, the Health Resources Services Administration, the Public Health Foundation, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, the National Association of Local Boards of Health, and the Johns Hopkins University School of Public Health. Similar to the County Health Rankings project, the Community Health Status Indicators project collects information on a variety of sources and generates county profiles. Currently, most of the data are from 2009, however it does contain information that the County Health Rankings does not. For more information about the Community Health Status Indicators project, please visit: wwwn.cdc.gov/communityhealth/homepage.aspx. Community Health Needs Assessment Toolkit The Community Health Needs Assessment Toolkit is a collaborative partnership between the Kaiser Permanente; the Institute for People, Place, and Possibility (IP3); the Centers for Disease Control and Prevention; and other partners that seek to make freely available data that can assist hospitals, non-profit organizations, state and local health departments, financial institutions, and other organizations seeking to better understand the needs and assets of their communities and to collaborate to make measureable improvements in community health and well-being. Similar to the County Health Rankings program, the Community Health Needs Assessment Toolkit project collects information from a variety of sources and creates county- 8

10 level profiles for comparison purposes. For more information about the Community Health Needs Assessment Toolkit, please visit: assessment.communitycommons.org. Ohio Department of Health The Ohio Department of Health is a cabinet-level agency that administers most of the state s state-level health programs including coordination of the activities for child and family health services, health care quality improvement, services for children with medical handicaps, nutrition services, licensure and regulation of long-term care facilities, environmental health, prevention and control of injuries and diseases, and others. County-level data that could be compared to national statistics were collected in a variety of areas and used in this CHNA. For more information about the data available at the Ohio Department of Health, please visit: Annie E Casey Foundation The Annie E Casey Foundation runs a program called KIDS COUNT, which is a national and state-by-state effort to track the wellbeing of children in the United States. KIDS COUNT collects and reports data at the county-level in a variety of areas related to child health including demographics, education, economic well-being, health, safety and risky behaviors, and other indicators. Most of the data in KIDS COUNT for Ohio is supplied by Ohio s Children s Defense Fund and is taken from a variety of sources, including the Ohio Department of Health. For more information about KIDS COUNT, please visit: datacenter.kidscount.org. Ohio Hospital Association Established in 1915, the Ohio Hospital Association is the nation s first state-level hospital association. OHA collaborates with member hospitals and health systems to meet the health care needs of their communities and to create a vision for the future of Ohio s health care environment. OHA, in coordination with member hospitals, have developed new web based software called Insight that allows hospitals to run customized and standard reports for Marketing, Physician Recruiting, Business Development and Benchmarking purposes. Several health indicators were drawn from OHA s Insight system with their permission. For more information about OHA Insight, please visit: Community Leader Interviews In addition to examining the county-level epidemiologic data, interviews were conducted with community leaders in July August 2013 to gain their insight on what they thought were the significant health needs of children and adults in their communities, the factors that affect those health needs, other existing community health needs assessments, possible collaboration opportunities, and to get suggestions on what the hospitals can do to address the significant health needs identified in the CHNA. These community leaders represent the broad interests of the communities served by the hospital facility including the medically underserved, lowincome persons, minority groups, those with chronic disease needs, and leaders from local public health agencies and departments who have special knowledge and expertise in public health. 9

11 Leaders from the following community organizations were consulted during this CHNA: Youngstown City Health District, Acting Health Commissioner Youngstown/Warren Regional Chamber, President & Chief Executive Officer Pediatric Associates of Youngstown, Physician Mahoning County Children s Services, Quality Improvement Supervisor Help Hotline Crisis Center, Chief Executive Officer Mahoning County District Board of Health, Health Commissioner Trumbull County Women, Infants, and Children (WIC) Program, Director Trumbull County Mental Health and Recovery Board, Director of Evaluation & Quality Improvement Trumbull County Children s Services, Executive Director St. Joseph Health Center, Chair of Pediatrics Columbiana County Mental Health and Recovery Services Board, Executive Director Portage/Columbiana Counties Women, Infants, and Children (WIC) Program, Director The Morning Journal, Editor Salem Community Hospital, Vice President for Medical Affairs Columbiana County Educational Service Center, Superintendent Columbiana County Department of Job and Family Services, Children s Services Administrator Coordinated Action for School Health (CASH) Coalition, Coordinator Columbiana County Health Department, Health Commissioner Community Resident Focus Groups In addition to the input from community leaders, focus groups were conducted with community residents in August September 2013 to get their input on what they thought were the significant health needs of children and adults in their communities, the factors that affect those needs, the solutions they thought would solve those needs, and what the hospitals and other community groups could do to address those needs. Due to the observed information gap in the epidemiologic data on the health of children, adult and child substance abuse issues, and adult and child mental health issues, several questions were asked to probe more deeply on these issues. In addition, a questionnaire was distributed to focus group participants to gather demographic information and basic perceptions of community health. The discussion guide, questionnaire, and protocol were reviewed and approved by the Kent State University Institutional Review Board. Recruitment Community residents were recruited to participate in the focus groups by posting and distributing flyers in the community. The sites where the community resident groups were held were selected based on proximity to population areas, ease of access (including free parking and bus lines), and recommendations from local community leaders. Community residents that participated in the focus groups were given a $50 Visa gift card as a thank you and to 10

12 compensate them for their time and expense. A total of 82 people participated in the Community Resident Focus Groups. Characteristics of Participants As noted in Table 2, participants were drawn from across the region and were diverse. Fifty percent of participants were from Trumbull County, 31.7% from Mahoning County, and 18.3% were from Columbiana County. The average number of years that participants lived in their home county was 36.6 years. Six percent of participants were African American, 90.2% were Caucasian, and 2.4% were Hispanic. Table 2. Demographic Characteristics of Community Resident Focus Group Participants (n=82) Characteristic Number Percent County of Residence Trumbull County % Mahoning County % Columbiana County % Number of Years Lived in County (average and SD) Racial Background African American (or Black) 5 6.1% Asian American 0 0.0% Caucasian (or White) % Native Hawaiian or Other Pacific Islander 1 1.2% American Indian or Alaska Native 0 0.0% Other/Missing 2 2.4% Ethnic Background Hispanic or Latino/a 2 2.4% Not Hispanic or Latino/a % Missing 7 8.5% As noted in Table 3 (next page), participants had diverse household characteristics. Nearly 16% percent of participants lived by themselves, 32.9% lived with one other person, 24.4% lived with two other people, 15.9% lived with three other people, and 9.8% lived with four or more people. Nearly 66% percent had no children in the home, 8.5% had one child, 6.1% had two children, and 7.3% had three or more children in the home. 11

13 Table 3. Household Characteristics of Community Resident Focus Group Participants (n=82) Characteristic Number Percent Number of People in Home One % Two % Three % Four % Five or More 8 9.8% Missing Number of Children in the Home None % One 7 8.5% Two 5 6.1% Three or More 6 7.3% Missing % As noted on Table 4, participants ranged in terms of their income and health insurance status. Twelve percent of participants reported a monthly household income between $0-$999, 14.6% between $1,000-$1,999, 11% between $2,000-$2,999, 17.1% between $3,000-$3,999, 6.1% between $4,000-$4,999, and 22% reported monthly household income exceeding $5,000 per month. In addition, 15.9% reported they had no health insurance, 39% had private health insurance, 1.2% had health insurance as a veteran or member of the military, 24.4% had Medicare, and 17.1% had Medicaid. Table 4. Income and Insurance Status of Community Resident Focus Group Participants (n=82) Number Percent Total Household Monthly Income 0-$ % $1,000 - $1, % $2,000 - $2, % $3,000 - $3, % $4,000 - $4, % $5,000 and Higher % Missing % Primary Type of Health Insurance Uninsured % Private Health Insurance % Veterans/Military 1 1.2% Medicare % Medicaid % Other 0 0.0% Missing 2 2.4% 12

14 As noted in Table 5, participants had diverse health care utilization experiences. Forty percent stated that someone in their home did not receive health care due to the cost and that 42.7% of them had someone in their home with a chronic disease or condition. Seven percent reported that they usually don t go to a doctor during the year, 12.2% go once per year, 24.4% go twice per year, 9.8% go three times per year, 15.9% go four times per year, 11% go five to nine times per year, and 8.5% go ten or more times per year. Table 5. Health Care Status and Utilization of Community Resident Focus Group Participants (n=82) Number Percent Had Someone in Home Who Did Not Receive Health Care Due to Cost % Has Someone in Home With a Chronic Disease % Times Per Year That Participant Goes To a Doctor None 6 7.3% One % Two % Three 8 9.8% Four % Five to Nine % Ten or More 7 8.5% Missing % Participant s Description of Current Health Excellent % Very Good % Good % Fair 8 9.8% Poor 1 1.2% Missing 5 6.1% Lastly, as noted in Table 6 (next page), participants reported fairly diverse views of the health of adults and children in their county. One percent of participants described the current health status of adults in their county as excellent, 1.2% described it as very good, 32.9% described it as good, 54.9% described it as fair, and 4.9% described the current health status of adults in their county as poor. Participants rated the current health status of children in their County slightly higher. None described it as excellent, 4.9% described it as very good, 50% described it as good, 35.4% described it as fair, and 3.7% described the current health status of children in their county as poor. 13

15 Table 6. Community Health Perceptions of Community Resident Focus Group Participants (n=82) Number Participant s Description of Current Health of County Adults Percent Excellent 1 1.2% Very Good 1 1.2% Good % Fair % Poor 4 4.9% Missing 4 4.9% Participant s Description of Current Health of County Children Excellent 0 0.0% Very Good 4 4.9% Good % Fair % Poor 3 3.7% Missing 5 6.1% Other Community Health Needs Assessments Lastly, prior community health needs assessments that were conducted in the region were also reviewed and helped to inform this CHNA. Some of these CHNAs were known to the Steering Committee, some were found using Internet searches, and some were sent to us by Community Leaders. The other CHNAs that were reviewed during the preparation of this CHNA included: Humility of Mary Health Partners, St. Elizabeth Health Center Tri-County Community Health Assessment & Planning Initiative East Liverpool City Hospital and Salem Community Hospital CHNA Humility of Mary Health Partners, St. Joseph Health Center 14

16 Prioritization Process As mentioned previously, epidemiologic data for children were collected from a variety of sources. To prioritize these health indicators, the data from Trumbull, Mahoning, and Columbiana Counties were compared to their two peer counties in Ohio that were demographically similar, the state and US averages, and the Healthy People 2020 target, if one was available. To aid the prioritization process, the indicators were plotted on matrices. Indicators listed on the left-hand side of the matrix compared unfavorably to the two comparison counties, the state, and the US. Indicators on the right-hand side of the matrix compared favorably to those benchmarks. In addition, on each side of the matrix, it was noted if the indicators were higher/lower than 2, 3, or 4 of the benchmarks. For example, indicators in the upper left box of the matrix (shaded in red) were worse in Mahoning County compared to the two comparison counties, the State, and the US. Indicators in the bottom right (shaded in blue) were better in Mahoning County compared to these benchmarks. The use of these matrices helped the Steering Committee quickly compare the vast amount of data to key benchmarks and identify the prioritized health needs based on the epidemiologic data. The list of prioritized health needs resulting from the epidemiologic analysis was then supplemented with additional health needs identified by community leaders and community residents. A content analysis was conducted on the notes and transcripts of community leader interviews and community resident focus groups to identify themes that consistently emerged. The health areas listed below were the health needs identified for children by community leaders and residents that were added to the list. Community Leaders Nutrition Physical activity Obesity Mental health Substance abuse Number of pediatric specialists Community Residents Obesity Mental health Diabetes Sexually transmitted diseases 15

17 COMMUNITY RESOURCES There are a wide variety of resources in the community that can help address the prioritized health needs identified in this CHNA. Trumbull County Access Health Mahoning Valley Belmont Pines Child and Family Solutions Children's Rehabilitation Center of Warren, Ohio Churchill Counseling Coleman Professional Services Comprehensive Psych Services Easter Seals, Mahoning, Trumbull and Columbiana Counties Family and Children First Council Girl Scouts of Northeast Ohio H.C. Mines Intermediate School (Howland) Health Board: TCAP Head Start HMHP, St. Joseph Health Center Homes for Kids Kent State University Niles City Health Department One Health Ohio Potential Development PsyCare The Mayor Ralph A. Infante Wellness Center The Trumbull County Mental Health and Recovery Board Trumbull County Career and Technical Center (TCCTC) Trumbull County Children's Services Trumbull County Educational Service Center Trumbull County Health Dept Trumbull County Juvenile Justice Center United Methodist Community Ceter Valley Care, Hillside Rehabilitation Hospital Valley Care, Trumbull Memorial Hospital Warren City Health Department Warren City Schools WIC, Trumbull County 16

18 Mahoning County Access Health Mahoning Valley Beatitude House Central YMCA, Youngstown, Ohio Comprehensive Psych D&E Counseling Davis Family YMCA, Boardman, Ohio Easter Seals, Mahoning, Trumbull and Columbiana Counties Help Hotline Crisis Center, Inc. HMHP, St. Elizabeth Health Center Jewish Community Center of Youngstown Mahoning County Board of Health Mahoning County Children's Services Mahoning County Educational Service Center Mahoning County Juvenile Justice Center Mahoning County Mental Health Board Mahoning Youngstown Community Action Partnership One Health Ohio Pediatric Associates Of Youngstown Pioneering Healthier Communities; Youngstown Potential Development Second Harvest Food Bank of the Mahoning Valley Sojourner House The Mahoning County Board of Developmental Disabilities The Rich Center for Autism United Methodist Community Center United Way of Youngstown and the Mahoning Valley Valley Care Health System, Northside Medical Center Valley Counseling WIC, Mahoning County Youngstown City Health Department Youngstown City Schools Youngstown Hearing and Speech Youngstown State University 17

19 Columbiana County Columbiana County Career and Technical Center (CCCTC) Columbiana County Community Action Agency (Head Start) Columbiana County Dept of Job and Family Services Columbiana County Educational Service Center Columbiana County Health Dept Columbiana County Juvenile Court Columbiana County MHRS Board Columbiana County MRDD Damascus Elementary East Liverpool City Hospital Easter Seals, Mahoning, Trumbull and Columbiana Counties Hannah Mullins School of Practical Nursing Salem Community Center Salem Community Hospital Salem YMCA WIC, Columbiana County National Organizations American Association of Pediatrics, Ohio Chapter American Diabetes Association American Lung Association Children's Hospital Association 18

20 SUMMARY OF RESULTS The final list of prioritized health needs for children (based on the epidemiologic data and input from community leaders and community residents) were then grouped into broad categories representing the type of health indicator: Table 9. Prioritized Health Needs By County for Children Trumbull Mahoning Columbiana Chronic Diseases Asthma X X X Diabetes X X X Maternal & Infant Health Premature Births X X X Low & Very Low Birth Weight X X X Infant, Neonatal, & Post-Neonatal Mortality X X X Child Lifestyle Factors Overweight & Obesity X X X Exercise X X X Nutrition X X X Mental Health X X X Substance Abuse Opioid Drug Abuse X X X Sexually Transmitted Diseases Adolescent Gonorrhea X X Access to Health Care Health Insurance Coverage X X X Access to Dental Care X X X Mental Health Insurance Coverage X X X Number of Pediatric Specialists X X X Environmental Factors Access to Healthy Food X X X 19

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