COMMUNITY HEALTH IMPROVEMENT PLAN. November 2013

Transcription

1 COMMUNITY HEALTH IMPROVEMENT PLAN November 2013 SULLIVAN COUNTY PUBLIC HEALTH SERVICES 50 Community Lane, Liberty, NY (845)

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3 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Page 1

4 Sullivan County Public Health Services Community Health Improvement Plan November 2013 TABLE OF CONTENTS Executive Summary 3 The Strategic Framework 4 Public Health Priority Issues and Strategies 8 Issue One: Prevent Chronic Disease 10 A. Issue Two: Promote Healthy Women, Infants, and Children 11 Issue Three: Promote Mental Health and Prevent Substance Abuse 12 Sullivan County Community Health Planning Matrix 14 Appendix A: Prioritization Session Participants 25 Appendix B: Catskill Regional Medical Center Community Service Plan 26 Page 2

5 Sullivan County Public Health Services Community Health Improvement Plan November 2013 EXECUTIVE SUMMARY Sullivan County Public Health Services led a comprehensive Community Health Assessment (CHA) to evaluate the health needs of individuals living in Sullivan County beginning in The aim of the assessment was to reinforce Sullivan County Public Health Services commitment to the health of Sullivan County residents and to align its health prevention efforts with the community s greatest needs. The assessment examined a variety of indicators including risky health behaviors (alcohol use, tobacco use) and chronic health conditions (diabetes, heart disease). The completion of the CHA enabled Sullivan County Public Health Services to take an in-depth look at its greater community. The findings from the assessment were utilized to prioritize public health issues and develop a community health improvement plan focused on meeting community needs. Sullivan County Public Health Services is committed to the people it serves and the communities where they reside. Healthy communities lead to lower health care costs, robust community partnerships, and an overall enhanced quality of life. The following document serves as a summary of the identified health priorities in Sullivan County and the goals, objectives, strategies, and resources that comprise the community health improvement plan. Prioritized Health Issues Based on the feedback from community partners, including health care providers, public health experts, health and human service agencies, and other community representatives, Sullivan County Public Health Services plans to focus community health improvement efforts on the following health priorities over the next five-year cycle: Prevent chronic disease Promote healthy women, infants, and children Promote mental health and prevent substance abuse During the five-year cycle, Sullivan County Public Health Services will implement strategies that are based on best practices and continue to monitor health trends throughout the county. They will also continue to engage community partners in their efforts to enact change and improve the overall health of the county. Sullivan County Public Health Services recognizes that no single organization has the capacity or resources needed to impact community health alone. They welcome and encourage community residents and organizations to join the community health improvement plan efforts. Documentation The Community Health Assessment and Community Health Improvement Plan were developed and adopted by each appropriate authority and made public in November Both documents can be found at Page 3

6 Sullivan County Public Health Services Community Health Improvement Plan November 2013 THE STRATEGIC FRAMEWORK Community Overview Sullivan County is a rural community comprised of nearly 77,000 residents. It is located approximately 75 miles northwest of New York City in the Catskill Mountains. Residents of Sullivan County are primarily White and English speaking. The county is known for its rich history, particularly in tourism, and natural beauty. Despite its rich history and natural beauty, Sullivan County struggles economically. Nearly 13% of all families and 19% of all individuals in the county live in poverty. An estimated 11% of the population is also unemployed. Additional social indicators like educational attainment and health insurance coverage are also areas of need in the community and impact overall health outcomes. Community Health Improvement Partners Sullivan County Public Health Services is an active partner of the Sullivan County Rural Health Network. The Rural Health Network is dedicated to improving the health status of Sullivan County residents by increasing access to coordinated, cost effective health care services. The Network, which is comprised of representatives from the community organizations listed below, was engaged in the community health improvement process through the development and distribution of the resident survey, focus group discussions, the prioritization of key community issues, and the development of the CHIP framework. The Rural Health Network organization representatives are presented below in alphabetical order. CACHE Catskill Regional Medical Center Family Empowerment Council, Inc. Hospice of Orange & Sullivan Counties, Inc. Hudson River HealthCare, Inc. Hudson Valley Community Services Maternal Infant Services Network PRASAD Children s Dental Health Program Sullivan County BOCES Sullivan County Center for Workforce Development Sullivan County Child Care Council Sullivan County Community College Sullivan County Department of Community Services Sullivan County Office for the Aging Sullivan County Youth Bureau The Recovery Center United Way of Sullivan County Page 4

7 Sullivan County Public Health Services Community Health Improvement Plan November 2013 In addition, Sullivan County Public Health Services collaborated with Greater Hudson Valley Health System (which includes Catskill Regional Medical Center). The two partners shared resources and the results of their individual and joint research efforts, so as to avoid duplicating efforts and to work in a more effective manner. The partners will continue their collaborative efforts through the strategies presented in the CHIP. Community Health Assessment Components Sullivan County Public Health Services led a comprehensive CHA comprised of quantitative and qualitative research components. The assessment included: A Statistical Secondary Data Profile depicting population and household statistics, education and economic measures, morbidity and mortality rates, incidence rates, and other health statistics for Sullivan County, New York. A Community Survey with 752 community residents. The survey was modeled after the Health Care Efficiency and Affordability Law Phase 9 (HEAL 9) project and custom questions developed by Sullivan County Public Health Services. A Compendium of Health Resources to document the assets in Sullivan County that can be employed to address the identified health issues. A Minority Health Profile depicting health needs, outcomes, and risky health behaviors among minority population, and disparities that may exist. Two Focus Groups, one with 14 Rural Health Network representatives and one with five young adult community residents. Additionally, Maternal Infant Services Network collected 55 paper and electronic surveys with women between the ages of 18 and 51 between January 30 and February 21, Secondary Data Profile One of the initial undertakings of the CHA was to create a secondary data profile. Secondary data is comprised of data obtained from existing reputable sources including the U.S. Census Bureau, Centers for Disease Control and Prevention (CDC), New York State Department of Health, and the Robert Wood Johnson Foundation. It includes demographic and household statistics, education and income measures, morbidity and mortality rates, and health indicators, among other data points. In the current study, the data was gathered and integrated into a graphical report to portray the current health and socio-economic status of residents in Sullivan County, New York. The data represents a point-in-time study using the most recent data possible. When available, trending data and state and national comparisons were provided as benchmarks. Community Survey Sullivan County Public Health Services was one of seven local health departments in the Hudson Valley Region that participated in 2009, over an 18 month period, in a HEAL 9 regional planning grant. The NYS Health Department awarded this grant to support collaborative local health Page 5

8 Sullivan County Public Health Services Community Health Improvement Plan November 2013 planning efforts, with the goal of developing an accessible, affordable, high-quality, and costeffective health care delivery system. Sullivan County Public Health Services was engaged in innovative approaches to health planning that identify and prioritize community health needs and result in recommendations for aligning the health care delivery system with those needs. This process informed the development of the health department s comprehensive assessment of health care needs with a focus on access to care, chronic disease prevention and control, maternal and child health, and health disparities, and made recommendations for the alignment of resources with those needs. The Community Health Assessment builds on this previous work. A community survey was conducted among Sullivan County residents between the dates of August 14, 2013 and September 16, The 2013 survey was based on the HEAL NY planning grant, but also included a number of customized questions that were added to gather information about health risk behaviors and community perceptions. The survey was made available both online and in paper format through various locations throughout Sullivan County. Surveys were also made available in both English and Spanish. Spanish surveys were distributed throughout the county by a Bilingual Outreach Worker on staff at Sullivan County Public Health Services. In addition to distributing the surveys, the Outreach Worker helped residents interpret and complete the surveys. Outreach efforts included the following towns and villages where Spanish-speaking families live and work: South Fallsburg, Liberty, Monticello, Woodridge, Livingston Manor, and Ferndale. A total of 752 individuals who reside within Sullivan County responded to the survey, 374 through the online survey link and 378 through paper surveys. Only respondents who were at least 18 years of age were included in the study. The customized survey tool consisted of approximately 37 factors. Depending upon individuals responses, survey length ranged from 10 to 15 minutes. Overall, the survey assessed dietary behaviors and weight management, health care practices and resources, alcohol and tobacco use, mental health, disease prevalence, and community resources, strengths, and opportunities. Compendium of Health Resources A compendium of health resources was developed to identify the organizations involved in the community health improvement process, both individually and in conjunction with the health department. Each of these organizations has resources and programs that help to improve the status of the community, some of which are specific to target populations and some of which are more general in scope. The included list of community resources is not meant to be exhaustive and may have inadvertently left some resources out. However, the list provides an overall portrayal of the availability of services throughout the county for individuals and families. Page 6

9 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Minority Health Report A minority health report was completed in January 2013 as part of a Rural Minority Health Assessment to fully understand the health status and outcomes of minority populations within the county. The report is intended to not only assess the health needs, outcomes, and risky health behaviors within these populations, but to better understand what health disparities may exist. The data will be used to lend perspective to potential interventions and advancements for health equity for all of those who live in Sullivan County. The current report is a compilation of existing health data for the county, also known as secondary data. Data was gathered by a Master of Public Health student, recruited by the New York State Department of Health and Sullivan County Public Health Services, and was integrated into a report prepared by Holleran. Focus Groups Two focus groups were held at the Sullivan County Public Health Services facility in September One of the groups was conducted with Rural Health Network representatives; the other was conducted with young adult community members (ages 18 to 26). In total, 19 people participated in the discussions. Focus group topics addressed access to care, key health issues and challenges, and community aspirations and capacity. It is important to note that the results of the focus groups reflect the perceptions of a limited number of providers and community members and may not necessarily represent all providers and residents of Sullivan County. Community Representation Community engagement and feedback were an integral part of the CHA process. Sullivan County Public Health Services sought community input through a community health survey, focus groups with community representatives, and inclusion of community leaders in the prioritization and improvement planning process. Public health and health care professionals shared knowledge and expertise about health issues, and leaders and representatives of nonprofit and community-based organizations provided insight on the community, including the medically underserved, low income, and minority populations. Research Partner Sullivan County Public Health Services contracted with Holleran, an independent research and consulting firm located in Lancaster, Pennsylvania, to conduct research in support of the CHA. Holleran has 21 years of experience in conducting public health research and community health assessments. The firm provided the following assistance: Collected and interpreted secondary data Conducted, analyzed, and interpreted data from the community survey Assisted in the update of a community compendium of health resources Conducted focus groups with community members Facilitated a prioritization session Prepared all reports Page 7

10 Sullivan County Public Health Services Community Health Improvement Plan November 2013 PUBLIC HEALTH PRIORITY ISSUES AND STRATEGIES Selecting Priority Issues On October 21, 2013, approximately 20 individuals representing Sullivan County gathered to review the results of the 2013 Community Health Assessment (CHA). Among the attendees were representatives from local health and human service agencies, area non-profit organizations, health providers, and public health representatives. The goal of the meeting was to discuss and prioritize key findings from the CHA and to set the stage for the development of the Community Health Improvement Plan. A list of attendees at the session can be found in Appendix A. The meeting began with an abbreviated research overview, which presented the results of the primary and secondary research and key findings of the CHA. Following the research overview, participants were provided with information regarding the prioritization process, criteria to consider when evaluating key priority issues, and other aspects of health improvement planning, such as goal setting and developing strategies and measures. The criteria that participants were asked to consider in evaluating priority issues included: Size Seriousness Trends Equity Intervention Impact Values Resources Others How many people are affected by the issue? What will happen if the issue is not addressed (deaths, disability, etc.)? Is the issue getting worse or better? Are some groups more affected by the issue? Is there a proven strategy to addressing the issue? Can we make a difference? Does our community care about it? Do we have the appropriate framework, expertise, funds, etc. to address the issue? Social determinants, root causes, etc. In a large-group format, attendees were then asked to share openly what they perceived to be the needs and areas of opportunity in the county. During this discussion, attendees were asked to consider five priority areas for community health improvement activities. The priority areas are part of the Prevention Agenda Objectives that are set by the state of New York as the blueprint for state and local action to improve the health of New Yorkers. Local health departments and hospitals in New York are required to select at least two of the priority areas and develop a plan that improves community health outcomes related to them. The priority areas are presented below in alphabetical order: Prevent chronic disease Prevent HIV, STDs, vaccine preventable diseases and health care associated infections Promote a healthy and safe environment Promote healthy women, infants, and children Promote mental health and prevent substance abuse Page 8

11 Sullivan County Public Health Services Community Health Improvement Plan November 2013 To aid the discussion around priority areas, a list of the needs that were identified through the CHA research components was created and then each need was grouped according to the priority area it aligned with. The following chart depicts the five priority areas and the community needs that correspond to them. Attendees reviewed the findings from the CHA based on the chart above and discussed crosscutting approaches to impacting the priority areas. Ultimately, the following three priority areas for Sullivan County were adopted: Prevent Chronic Disease Promote Healthy Women, Infants, and Children Promote Mental Health and Prevent Substance Abuse The following section examines the identified priorities in detail and the specific focus area(s) that Sullivan County Public Health Services and partner organizations will address. Additional areas of public health concern not specifically identified in this document (communicable disease control, injury prevention, etc.) will also continue to be addressed by Sullivan County Public Health Services, but the following are areas for more intense planning. Page 9

12 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Sullivan County s detailed plan for improving each priority issue is included at the end of the section as a Community Health Planning Matrix. Included in the Community Health Planning Matrix are measurable objectives. Objectives represent the desired improvement for health indicators from their current status to their status at the end of the planning cycle, December 31, The desired improvement for each objective represents a percent change of either 2.5% or 5% and was calculated based on the following example for premature birth: 1. Desired Percent Change (5%) x Current Premature Birth Percentage (12%) = x 100 = 0.6% 3. 12% 0.6% = Desired Premature Birth Percentage (11.4%) Priority Issue One: Prevent Chronic Disease Chronic disease is a critical issue in Sullivan County and was ranked as the third most significant health issue in the community by residents who completed surveys. Chronic diseases that are of most concern are heart disease, cancer, diabetes, and asthma. Heart disease is the number one cause of death in the county. The death rate due to heart disease is per 100,000, which compares to a rate of in New York and in the nation. In addition, 55.8% of residents who responded to the survey said that they had high blood pressure and 44.9% said that they had high cholesterol. Older respondents ages 65 and up were the most likely to report having both conditions. Cancer is the second leading cause of death in the community and affects both males and females in Sullivan County at a higher rate. The age-adjusted cancer mortality rate per 100,000 in Sullivan County for males and females is and respectively, which is higher when compared to New York (211.6 and respectively) and the nation (219.4 and respectively). In particular, males in the county are more likely to die of prostate cancer and females in the county are more likely to die of colorectal and lung and bronchus cancer. Females in Sullivan County are also more likely to develop cancer. The cancer incidence rate per age-adjusted 100,000 for females is The county rate compares to a rate of across New York and a rate of across the nation. Sullivan County females are particularly prone to lung and bronchus cancer. The incidence rate for female lung and bronchus cancer is 78.9 in Sullivan County, compared to 64.5 in New York and 55.7 in the nation. Diabetes and asthma are growing concerns in the community. Approximately 23% of survey respondents said that they have diabetes. In addition, focus group participants listed it as a key health issue in the community. They noted that the prevalence of the disease is increasing rapidly. In regards to asthma, more residents are visiting emergency departments due to this condition. Residents that are most likely to visit the emergency department due to asthma complications are ages five to 44 years. Factors that contribute to the prevalence of chronic diseases in Sullivan County include lack of access to care and obesity. Approximately 14% of Sullivan County residents lack health Page 10

13 Sullivan County Public Health Services Community Health Improvement Plan November 2013 insurance. Among residents who are insured, 37.6% rely on public coverage, which is a concern as focus group participants identified that there are not enough Medicaid providers in the area. Residents also face a number of other barriers, primarily due to cost and transportation, in accessing care. Related to cost, focus group participants stated that residents struggle with the cost of copayments and medications, lack of sick days, and increasing premiums and deductibles. Transportation was identified as a barrier due to the rural nature and size of Sullivan County and the lack of services and providers available in the county. Residents are reliant upon their ability to afford a car that they can drive themselves or having a reliable friend/family member to drive them to medical appointments. The elderly and immigrant populations were seen as being the most underserved by local health services. Overweight and obesity is a growing concern in the community. The body mass index (BMI) of survey respondents was calculated based on their self-reported height and weight. Based on this calculation, 61.5% of survey respondents were overweight or obese (BMI of 25 or higher). Respondents who were the most likely to be obese were ages 45 to 64. In addition, focus group participants shared that there is little awareness of how serious the issue of overweight/obesity is in Sullivan County, especially among youth. Youth and their parents may not understand why they need to maintain a healthy weight and what the long-term health concerns are if they do not. Participants provided the example that schools are required to provide healthy meals, but youth are not eating them. Priority Issue Two: Promote Healthy Women, Infants, and Children Maternal and child health outcomes are generally poor in Sullivan County. Premature births, perinatal deaths, and low birth weight occur at a higher incidence. In addition, mothers are more likely to give birth as teenagers and less likely to seek prenatal care and practice positive maternal health behaviors. Children in Sullivan County are also less likely to have good health when compared to their peers statewide. Premature birth, perinatal death, and low birth weight are areas of concern in Sullivan County. A higher percentage of births in the county are premature (12.0%) when compared to New York (10.4%). Trending data shows that Sullivan County saw a sharp decline in premature births from 14.6% in 2007 to 10.5% in 2009, but the percentage has steadily risen since then. The rate of perinatal deaths is also higher in Sullivan County. Ten perinatal deaths occurred in the county for a rate of 12.3 per 1,000 live births, which compares to a rate of 8.7 across all of New York. Approximately 10% of infants are born with low birth weight in Sullivan County compared to approximately 8% across New York and the nation. In particular, the percentage of infants born with low birth weight is higher among mothers ages 30 or older (10.8%). The low birth weight percentage has varied in Sullivan County from year to year, but overall, has been on the rise since Poor birth outcomes are influenced by maternal health practices like teenage pregnancy, prenatal care, and breastfeeding. The teenage pregnancy rate in Sullivan County (42.3) is notably higher when compared to the teenage pregnancy rate across all of New York (30.8). Page 11

14 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Approximately 60% of teen pregnancies in the county result in live births, while 40% result in abortions. Prenatal care and breast feeding are also areas of opportunity for Sullivan County. Only 67% of mothers in Sullivan County receive prenatal care in the first trimester compared to 70.1% across New York and the Healthy People 2020 goal of 77.9%. Mothers ages 15 to 17 years are the most likely to receive late or no prenatal care. In relation to breast feeding, the rate per 1,000 live births for infants who are exclusively breast fed in the hospital is The rate represents an increase from in 2008, but still falls short of the current rate for all of New York, Additional indicators of child health include obesity, tooth decay, and well-child visits. In Sullivan County, 22.2% of children and adolescents are obese, which is higher than all of New York and represents an increase from 19.4% in In addition, 52.8% of Sullivan County third-graders have evidence of untreated tooth decay compared to 24% across New York. Lastly, 65.1% of Sullivan County children who are in government sponsored insurance programs have had the recommended number of well-child visits compared to 69.9% across New York. Survey respondents and focus group participants also identified maternal and child health as a priority in the community. Approximately 37% of survey respondents selected healthy babies and mothers as a key health issue in the community. Approximately 56% of respondents also selected programs, activities, and support for youth and teens during non-school hours as an area of opportunity in the community. Priority Issue Three: Promote Mental Health and Prevent Substance Abuse Residents of Sullivan County are more likely to have poor mental health and more likely to use substances like drugs, alcohol, and tobacco. In addition, residents who are more prone to poor mental health and substance abuse are less likely to know where to find supportive resources. Mental health and drug abuse in particular are also recognized concerns in the community as they were ranked as the top two health issues among residents. Approximately 55% of survey respondents said that drug abuse is an issue in the community and approximately 49% said that mental health is an issue in the community. Sullivan County residents are more likely to have poor mental health and are more likely to commit suicide. Approximately 14% of adults in Sullivan County had 14 or more days of poor mental health in the past month, compared to 10.9% across all of New York and the Prevention Agenda 2013 Objective of 7.8%. The suicide rate is also considered to be an indicator of a community s overall mental health. The suicide rate per 100,000 is 12.6 in Sullivan County, compared to 9.7 in New York, 12.0 in the nation, and the Healthy People 2020 goal of The community survey assessed whether individuals know where to seek help if they or somebody they know is considering suicide. The majority of respondents (75.7%) did know where to seek help to prevent a suicide. However, individuals who may be more prone to suicide (felt anxious or depressed every day of the past week) were the least likely to know where to Page 12

15 Sullivan County Public Health Services Community Health Improvement Plan November 2013 seek suicide help. Only 62% of respondents who felt anxious or depressed every day knew where to seek suicide help, compared to 79% of individuals who never felt anxious or depressed. Substance abuse is an area of growing concern among youth and adults of Sullivan County. In relation to drug abuse, focus group participants shared that heroine use and prescription drug addiction are on the rise. They also shared that substance abuse services are inadequate for both children and adults. All inpatient services require referral outside of the county. Outpatient services are available for adults, but participants shared that the patients are in such bad shape that it is difficult to treat them in this setting. Substance abuse prevention services have also been removed from schools due to lack of funding. Alcohol abuse, specifically binge drinking, is also an area of concern in Sullivan County. According to the New York State Department of Health, 18.6% of Sullivan County adults participated in binge drinking during the past month. The percentage is favorable when compared to all of New York (19.8%), but exceeds the national percentage (15.8%) and the Prevention Agenda 2013 Objective (13.4%). The community survey also assessed binge drinking habits and knowledge of alcohol and substance abuse resources. Of the 40% of respondents who said they drink alcohol, 50% said that they binge drank at least once during the past 30 days. In addition, residents who were the most likely to binge drink (frequency of five or more times during the past 30 days) were the least likely to know where to find help for an alcohol or substance abuse problem. Residents of Sullivan County are also more likely to use tobacco products. According to the New York State Department of Health, 28.9% of Sullivan County adults are current smokers. The percentage exceeds all of New York (18.9%), the nation (17.9%), and the Prevention Agenda 2013 Objective of 12.0%. A positive finding from the resident survey is that among current smokers, 65.1% are willing to try to quit if free support classes and nicotine patches were made available. Page 13

16 Prevent Chronic Disease Sullivan County Public Health Services Community Health Improvement Plan November 2013 Sullivan County Community Health Planning Matrix Table 1. Goals and Objectives for Priority Issue #1: Prevent Chronic Disease Priority Focus Area Goal Objectives By December 31, 2017 Reduce Obesity in Children and Adults Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings Create community environments that promote and support healthy food and beverage choices and physical activity Increase screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancers Increase the percentage of adults aged 18 and older who participate in leisure-time physical activity from 75.3% (2013) to 77.2% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Decrease the percentage of adults aged 18 and older who consume one or more sugary drinks per day from 27.0% (2013) to 26.3% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Increase the percentage of the population redeeming farmer s market coupons through the Women, Infants, and Children Food and Nutrition Service and the Senior Nutrition Program. (Baseline: unknown) Increase the percentage of women aged who had a mammogram within the past two years from 76.4% (2013) to 78.3% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Increase the percentage of adults aged who had a colorectal cancer screening from 65.2% (2013) to 66.8% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Increase by 2.5% the percentage of women aged who received a Pap test within the past three years. (Baseline: unknown) Increase the percentage of adults who had a diabetes test within the past three years from 52.6% (2013) to 53.9% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Increase by 2.5% the percentage of adults who are screened for hypternsion. (Baseline: unknown) Page 14

17 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 2. Strategies for Improving Priority Issue #1 Focus Area: Reduce Obesity in Children and Adults Priority Area #1: Prevent Chronic Disease Focus Key Partners Current Strategies/Approaches Potential Strategies/Approaches Reduce Obesity in Children and Adults Sullivan County Division of Public Works Town and Village Parks and Recreation Department Catskill MountainKeeper TrailsKeeper.org Sullivan Renaissance Cornell University Cooperative Extension Sullivan County (CCE) Sullivan County Farmers Market Association Sullivan County Youth Bureau Hudson River HealthCare Inc. Sullivan County Wellness Committee School Food Service Managers The PRASAD Children s Dental Health Project Sullivan County Childcare Council Sullivan County Department of Community and Rehabilitation Support Services 1. Promotion of physical activity and nutrition through community outreach and education. 2. Intervention and prevention strategies to promote healthy lifestyle behavior changes. 3. Engage community organizations to enact policy and environmental changes that improve access to physical activity and nutrition. 4. Provide access to healthy foods through sustained year-round farmer s markets. Examples of Current Initiatives: 1. Master Gardener Program (CCE) 2. Eat Smart New York (CCE) 3. Outdoor Club (CCE) 4. Walking Club (Hudson River HealthCare Inc.) 5. Eat Healthy. Move More. (Sullivan County Wellness Committee) 6. School Nutrition Improvement Efforts (School Food Service Managers) 7. Nutrition Services at Hudson River HealthCare Inc. 1. Explore grant-funding opportunities and evidence-based practices for improving physical activity and healthy eating behaviors. 2. Collaborate with schools and worksites to adopt policies and implement practices to reduce overconsumption of sugary drinks and increase access to clean, portable water. 3. Educate the public regarding the risks associated with overconsumption of sugary drinks. 4. Promote local farmer s markets through a variety of communication tools, including social media, and explore the opportunity for expansion of farmer s markets (physical size, hours of operation, vendors, etc.). 5. Explore the opportunity for increasing the availability of farmer s markets in food desert areas and rural communities. 6. Increase access to safe public spaces where residents can be physically active. 7. Increase access to professional nutritional counseling. Page 15

18 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 3. Strategies for Improving Priority Issue #1 Focus Area: Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings Priority Area #1: Prevent Chronic Disease Focus Key Partners Current Strategies/Approaches Potential Strategies/Approaches Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings United Way of Sullivan County Catskill Regional Medical Center (CRMC) American Cancer Society Planned Parenthood Hudson River HealthCare Inc. Refuah Health Center Crystal Run Healthcare The PRASAD Children s Dental Health Project Office for the Aging (OFA) 1. Provide access to screenings through free hospital and social service organization services. 2. Provide free access to health and human services information and referral. 3. Promotion of chronic disease prevention and screening through community outreach and education. Examples of Current Initiatives: program (United Way) 2. Cancer Services Program of Sullivan County (CRMC) 3. Health Information Library (CRMC) 4. Diabetes prevention education programs (CRMC) 5. Evidence-based Chronic Disease Self- Management Program (OFA) 1. Promote the importance and availability of free screenings through a variety of media and health communication tools. 2. Build community awareness and demand for services through continued outreach and education. 3. Collaborate with local health care organizations and providers to increase awareness of screening services and incentivize clinicians to screen. 4. Increase consumer access to health care coverage for preventative services. 5. Collaborate with local health care organizations and providers to improve health literacy. Page 16

19 Promote Healthy Women, Infants, and Children Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 4. Goals and Objectives for Priority Issue #2: Promote Healthy Women, Infants, and Children Priority Focus Area Goal Objectives By December 31, 2017 Maternal and Infant Health Reduce premature births Reduce the percentage of premature births in Sullivan County from 12.0% (2011) to 11.4% (5% improvement). (Data source: 2011 New York State Vital Statistics Data) Improve racial, ethnic, and economic disparities among premature births in Sullivan County: From a ratio of 1.65 ( ) for Black, Non-Hispanics to White, Non-Hispanics to a ratio of From a ratio of 1.10 ( ) for Hispanics to White, Non-Hispanics to a ratio of From a ratio of 0.85 ( ) for Medicaid births to non-medicaid births to a ratio of (Data source: Sullivan County Indicators for Tracking Public Health Priority Areas, ) Increase the percentage of mothers in Sullivan County who receive early prenatal care from 67.0% (2011) to 68.7% (2.5% improvement). (Data source: 2011 New York State Vital Statistics Data) Improve racial, ethnic, and age disparities in Sullivan County mothers who receive early prenatal care: From 64.7% (2011) to 66.3% for Black mothers (2.5% improvement). From 63.3% (2011) to 64.9% for Hispanic mothers (2.5% improvement). From 46.7% (2011) to 47.9% for mothers aged 15 to 17 (2.5% improvement). (Data source: 2011 New York State Vital Statistics Data) Page 17

20 Promote Healthy Women, Infants, and Children Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 4. Goals and Objectives for Priority Issue #2: Promote Healthy Women, Infants, and Children (cont d) Priority Focus Area Goal Objectives By December 31, 2017 Maternal and Infant Health Increase the rate of Sullivan County babies who are breastfed Increase the rate of infants born in Sullivan County who are exclusively breastfed in the hospital from per 1,000 live births (2010) to per 1,000 live births (2.5% improvement). (Data source: New York State Vital Statistics Data) Improve racial, ethnic, and economic disparities in the rate of infants born in Sullivan County who are exclusively breastfed in the hospital: From a ratio of 0.66 ( ) for Black, Non-Hispanics to White, Non-Hispanics to a ratio of From a ratio of 0.61 ( ) for Hispanics to White, Non-Hispanics to a ratio of From a ratio of 0.62 ( ) for Medicaid births to non-medicaid births to a ratio of (Data source: Sullivan County Indicators for Tracking Public Health Priority Areas, ) Increase the percentage of WIC mothers in Sullivan County who breastfeed for at least six months from 26.7% ( ) to 27.4% (2.5% improvement). (Data source: New York State Pediatric Nutrition Surveillance System Data) Page 18

21 Promote Healthy Women, Infants, and Children Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 4. Goals and Objectives for Priority Issue #2: Promote Healthy Women, Infants, and Children (cont d) Priority Focus Area Goal Objectives By December 31, 2017 Reproductive, Preconception and Inter-Conception Health Prevent unintended and adolescent pregnancy Reduce the percentage of Sullivan County live births that result from unintended pregnancy from 33.6% (2011) to 32.8% (2.5% improvement). (Data source: Sullivan County Indicators for Tracking Public Health Priority Areas, ) Reduce racial, ethnic, and economic disparities in unintended pregnancies among live births: From a ratio of 2.06 (2011) for Black, Non-Hispanics to White, Non-Hispanics to a ratio of 1.95 From a ratio of 1.27 (2011) for Hispanics to White, Non-Hispanics to a ratio of From a ratio of 1.50 (2011) for Medicaid births to non-medicaid births to a ratio of 0.8. (Data source: Sullivan County Indicators for Tracking Public Health Priority Areas, ) Reduce the rate of pregnancy among Sullivan County adolescents from 42.3 per 1,000 females aged 15 to 19 (2011) to 41.2 per 1,000 females aged 15 to 19 (2.5% improvement). (Data source: 2011 New York State Vital Statistics Data) Reduce racial and ethnic disparities in adolescent pregnancy rates: From a ratio of 1.97 ( ) for Black, Non-Hispanics to White, Non-Hispanics to a ratio of From a ratio of 2.07 ( ) for Hispanics to White, Non-Hispanics to a ratio of (Data source: Sullivan County Indicators for Tracking Public Health Priority Areas, ) Page 19

22 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 5. Strategies for Improving Priority Issue #2 Focus Area: Maternal and Infant Health Focus Maternal and Infant Health Key Partners United Way of Sullivan County Planned Parenthood Catskill Regional Medical Center (CRMC) Hudson River HealthCare Inc. Maternal Infant Services Network (MISN) Crystal Run Healthcare New Hope Manor The PRASAD Children s Dental Health Project Priority Area #2: Promote Healthy Women, Infants, and Children Current Strategies/Approaches 1. Promotion of the health and well-being of mothers and infants through pre- and postnatal education provided by community agencies and the medical community. 2. Provision of prenatal care referrals and services. Examples of Current Initiatives: Program (United Way) 2. Childbirth Classes for Expectant Mothers (CRMC) 3. Childbirth Education Series (MISN) 4. Breastfeeding 101 (MISN) 5. Baby Growing Nutrition Classes (MISN) 6. Prenatal Class for Expectant Parents (Crystal Run Health Care) 7. Women, Infants & Children (WIC) Program (SCPHS) 8. Maternal-Child Health Nursing (SCPHS) Potential Strategies/Approaches 1. Develop and conduct effective health communications/social marketing campaigns that promote norms of healthy behaviors before, between and during pregnancies, and that target women at risk for premature birth. Messages may include smoking cessation, nutrition, oral health, and healthy weight, in formats including social media, and settings such as WIC sites, home visits, preconception/inter-conception clinical health visits, prenatal care visits, and chronic disease prevention/management programs. 2. Utilize paraprofessionals such as peer counselors, lay health advisors and community health workers to reinforce health education and health care service utilization and enhance social support to high-risk pregnant women. 3. Collaborate with local health care organizations and providers to ensure that women who have experienced a preterm birth or other adverse pregnancy outcome receive inter-conception health care and other supportive services to prevent subsequent preterm births. 4. Support mechanisms to facilitate easy, expedited enrollment of lowincome women in Medicaid, including presumptive eligibility for both prenatal care and family planning coverage. 5. Utilize community-based research to engage affected populations in raising awareness of health disparities and identifying, prioritizing, and developing collective solutions. 6. Implement well-tested social marketing campaigns to change attitudes, social norms and behaviors related to breastfeeding initiation, exclusivity and/or duration among target populations. 7. Train physicians, nurses, and other health care providers about the importance of breastfeeding and lactation support and reduce their distribution of instant formula in the health care setting. 8. Ensure that employers and other businesses/organizations create an environment to support breastfeeding/pumping and provide lactation support. Page 20

23 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 6. Strategies for Improving Priority Issue #2 Focus Area: Reproductive, Preconception and Inter-Conception Health Priority Area #2: Promote Healthy Women, Infants, and Children Focus Key Partners Current Strategies/Approaches Potential Strategies/Approaches Reproductive, Preconception and Inter- Conception Health United Way of Sullivan County Planned Parenthood Maternal Infant Services Network (MISN) Sullivan County BOCES Prevention Services Hudson River Healthcare Crystal Run Healthcare Area Primary Care Physicians and Pediatricians The PRASAD Children s Dental Health Project 1. Promotion of teen pregnancy prevention through community outreach and education at school, community, and workplace locations. 2. Provision of pregnancy prevention services (contraceptives). Examples of Current Initiatives: Program (United Way) 2. Birth control services (Planned Parenthood) 3. Teen Pregnancy Prevention: The Empathy Belly and Real Care Baby infant simulator (MISN) 1. Expand current outreach and education efforts to include effective messages around delaying sexual activity, consistent contraceptive use, negotiating contraceptive use with partners, preventive health care, taking individual responsibility, and the male's role in preventing pregnancy. 2. Promote access to contraceptive counseling to teach women about the use of specific methods, and to increase their correct and consistent use. 3. Collaborate with local health care organizations and providers to increase knowledge of, and access to, emergency contraceptives, and ensure their availability to rape victims. 4. Collaborate with local health care organizations and providers to improve post-abortion counseling and contraceptive methods to prevent future unintended pregnancies. 5. Collaborate with local health care organizations and providers to screen for and address factors that increase the risk for and multiply the effects of teen pregnancy/parenting, such as depression, poor education and adverse childhood experiences. 6. Develop and provide media literacy programs for adolescents to counteract the prevalent media messages about sex. 7. Conduct research to support evaluation, adaptation, replication, dissemination, and implementation of evidence-based interventions to prevent unintended pregnancy. Page 21

24 Promote Mental Health and Prevent Substance Abuse Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 7. Goals and Objectives for Priority Issue #3: Promote Mental Health and Prevent Substance Abuse Priority Focus Area Goal Objectives By December 31, 2017 Promote Mental, Emotional, and Behavioral Well- Being in Communities Prevent Substance Abuse and other Mental Emotional Behavioral Disorders Promote mental, emotional, and behavioral wellbeing in communities Prevent underage drinking, nonmedical use of prescription pain reliever drugs by young, and excessive alcohol consumption by adults Prevent suicides among youth and adults Promote tobacco use cessation among adult smokers Increase the use of evidence-informed policies and evidence-based programs that are grounded on healthy development of children, youth, and adults. (Baseline: unknown) Reduce the percentage of adults aged 18 and older who had 14 or more days of poor mental health in the past month from 8.6% (2013) to 8.4% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Reduce the percentage of youth in grades 9 12 reporting the use of alcohol on at least one day of the past 30 days. (Baseline: unknown) Reduce the percentage of youth aged years reporting the use of non-medical use of painkillers. (Baseline: unknown) Reduce the percentage of adults aged 18 and older who participated in binge drinking (five drinks or more for men during one occasion, and four or more drinks for women during one occasion) during the past month from 15.3% (2013) to 14.9% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Reduce suicide attempts by Sullivan County adolescents (youth grades 9 to 12) who attempted suicide one or more times in the past year. (Baseline: unknown) Reduce the age-adjusted suicide mortality rate from 12.6 per 100,000 (2011) to 12.3 per 100,000 (2.5% improvement). (Data source: 2011 New York State Vital Statistics Data) Decrease the prevalence of cigarette smoking by adults aged 18 years and older from 32.2% (2013) to 31.4% (2.5% improvement). (Data source: Expanded BRFSS Preliminary (4-month) Data Report: Sullivan County) Increase by 5% the utilization of smoking cessation benefits offered by the county. (Baseline: unknown) Increase by 5% the number of smoking cessation attempts by adult smokers. (Baseline: unknown) Page 22

25 Sullivan County Public Health Services Community Health Improvement Plan November 2013 Table 8. Strategies for Improving Priority Issue #3 Focus Area: Promote Mental, Emotional, and Behavioral Well-Being in Communities Priority Area #3: Promote Mental Health and Prevent Substance Abuse Focus Key Partners Current Strategies/Approaches Potential Strategies/Approaches Promote Mental, Emotional, and Behavioral Well- Being in Communities United Way of Sullivan County Sullivan County Department of Community Services Friends and Advocates for Mental Health (FAMH) Sullivan County Youth Bureau Dispute Resolution Center Crystal Run Health Care Refuah Health Center The Center for Discovery Rockland Children s Psychiatric Center Recovery Center Catskill Regional Medical Center (CRMC) 1. Provision of mental and behavioral health services. 2. Outreach and education through community agencies and the medical community. Examples of Current Initiatives: program (United Way) 2. Single Point of Access (SPOA) (Sullivan County Department of Community Services) 3. The BETTOR Choice (Recovery Center) 4. Compeer (companion/peer) Program (FAMH) 5. MICA (mentally ill, chemically addicted) Compeer Program (FAMH) 6. Stepping Stones (FAMH) 7. RISE (Rape Intervention and Education program) (CRMC) 1. Increase the availability and awareness of prescription drug dropboxes throughout Sullivan County. 2. Promote awareness of prescription drug abuse through continued outreach and education efforts. 3. Promote awareness of available mental and behavioral health services. 4. Increase the number of support groups available for individuals suffering from mental, emotional, and behavioral health issues, and their family members. 5. Explore opportunities for incorporating evidence-based preventive strategies that foster positive development such as the Good Behavior Game and the Positive Parenting Program. 6. Measure and make available local and state data on mental, emotional, and behavioral well-being and mential, emotional, and behavioral disorder prevention to increase transparency and quality on practice. Page 23