2015 Community Health Needs Assessment

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2 TABLE OF CONTENTS Executive Summary 2 I. Introduction 3 II. Summary and Impact of 2012 Community Health Needs Assessment and Implementation Strategy.. 3 III. Service Area and Population 5 a. Map of Service Area. 6 IV. Community Health Needs Assessment Partners.. 6 V. Community Health Needs Assessment Methodology and Process. 8 VI. Identified Community Health Needs.. 12 A. Needs Identified Obesity Diabetes Heart Disease Mental Health Dental Health Access to Care Substance Abuse Nutrition Physical Activity Physical Environment Transportation Social Support Family and Community Involvement 16 B. Process for Prioritizing 16 C. Prioritized Needs 17 VII. Community Resources to Address Needs 17 A. SJMC Internal Resources.. 17 B. External Community-Based Resources.. 19 VIII. Conclusion 21 Appendix I. SJMC Service Area 2010 Census Data. 22 Appendix II. Key Stakeholder Interview Summary.. 23 Appendix III. Community Involvement in SJMC CHNA 25 References

3 EXECUTIVE SUMMARY Background and Process St. Joseph Mercy Chelsea (SJMC) conducted a Community Health Needs Assessment (CHNA) and developed an Implementation Strategy with interventions to address identified needs. This process was led by the SJMC Community Health Improvement Council (CHIC), in partnership with the Washtenaw County Health Improvement Plan Teams, and five local Wellness Coalitions. CHIC used survey data, key informant interviews, and information gathered by the coalitions to identify and prioritize health problems and risk factors in the SJMC service area. Key Findings: Overweight and Obesity: 6 out of 10 adults are overweight or obese, and 1 out of 4 youth are overweight or obese Mental Health: 1 out of 4 youth and adults report experiencing depression or other mental health problems in the past year, and 1 out of 7 youth seriously considered suicide in the past year. Substance Abuse: 1 out of 6 adults and 1 out of 12 teens binge drink regularly; 1 out of 5 high school 11 th and 12 th grade students use marijuana regularly. Access to Care: 1 out of 10 adults report not being able to access care when needed at some point in the past six months. Implementation Strategy After reviewing this data, and mapping existing resources, CHIC developed an Implementation Strategy with evidence-based interventions. The SJMC Board of Trustees approved the Implementation Strategy on March 24, The above needs were prioritized based on size, severity, available data, and the hospital's ability to have an impact. In order to address priority needs, SJMC will engage key community partners in implementing evidence-based strategies across the service area. These strategies include modifying polices, providing support, enhancing access, changing consequences and incentives, providing information, and enhancing skills. The final approved version of the 2015 CHNA and Implementation Strategy are available to the public on the website under the Community Benefit tab. Printed copies are also be available at the hospital (775 S. Main St., Chelsea, MI 48118) in the Community Health Improvement Department, or by calling (734)

4 I. Introduction St. Joseph Mercy Chelsea (SJMC) is a 113-bed hospital located on 115 wooded acres in Chelsea, Michigan. Our mission states that "We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities." SJMC has been providing high-quality care to our communities for nearly 40 years. SJMC is nationally recognized for both quality of care and patient satisfaction by national ranking organization Press Ganey, and is accredited by the Joint Commission. SJMC attracts more than 300 physicians in almost all disciplines, with leading edge technology. For more information on hospital services, please call (734) , or visit our website, and click on the Services tab. SJMC conducted a community health needs assessment (CHNA) in 2012; this document builds on that work, incorporating new data and input from key stakeholders. The SJMC 2015 CHNA reflects work completed over the past year, in collaboration with community partners throughout the service area. The goal of this assessment is to identify health needs in the community that our hospital can impact through programs, policies, and community partnerships. This process was led by the SJMC Community Health Improvement Council (CHIC), in partnership with the Washtenaw County Health Improvement Plan Teams, and five local Wellness Coalitions. II. Summary and Impact of 2012 Community Health Needs Assessment and Implementation Strategy St. Joseph Mercy Chelsea (SJMC) conducted a community health needs assessment (CHNA) in The full report, including Implementation Strategy, once approved by the hospital's board, will be available at under the Community Benefit tab. The 2012 CHNA included data and input from the Health Improvement Plan survey of Washtenaw County, the Michigan Profile for Healthy Youth survey of the five school districts in the service area, key stakeholder interviews, the five local wellness coalitions, and other quantitative and qualitative sources. The priority needs addressed by the 2012 plan include obesity, heart disease and stroke, mental health, and substance abuse. To address these needs, the hospital implemented programs aimed at individuals as well as the environment. The hospital has evaluated the impact of these actions, and incorporated the results of this evaluation into the 2015 Implementation Strategy. The evaluation of the impact of the actions taken to address the significant health needs identified, since SJMC finished conducting the 2012 CHNA, is summarized here: 3

5 A. Obesity: Strategy: Provide information to raise awareness of resources available in the service area, including diabetes education, nutrition counseling, farmers markets, and free or low-cost recreation programs. Outcome: Marketing materials developed and disseminated throughout the service area, including posters, banners, brochures, and websites Strategy: Build skills to increase individuals' and families' abilities to maintain healthy weights, including cooking demonstrations, nutritional lectures to youth and seniors, and ongoing support for participants in the walking program. Outcome: Monthly cooking demonstrations held at farmers market in Chelsea, nutrition education assemblies held in Dexter schools, osteoporosis lectures at schools and senior centers, and more than three hundred program participants in the Walking Program during the evaluation period. Strategy: Change policies to promote healthy eating and physical activity. Outcome: Dexter schools developed new policies for classroom celebrations and snacks to limit junk food and promote active play as rewards for special occasions and holidays. Strategy: Increase access to opportunities for healthy eating and physical activity. Outcome: Chelsea farmers markets partnered with the Prescription for Health program of Washtenaw County to increase access to fresh fruits and vegetables for low-income residents. The Heart and Sole run/walk/bike event maintained low-cost entry fees for youth to promote participation in the race, and as a result more than 20% of runners and walkers were under the age of 18. B. Heart Disease and Stroke: Strategy: Increase access to care through community-based screening events, and the Chelsea Grace Clinic. Outcome: The SJMC Faith Community Nursing program held an average of two blood pressure screening events each year; this program also provides CPR training to local churches. The proceeds from the 2012, 2013 and 2014 Heart and Sole events were donated to the local Grace Clinic for the uninsured, totaling $30,000 over the past three years. C. Substance Abuse: Strategy: Support local community coalitions in addressing the risk and protective factors that lead to youth substance abuse. Outcome: SJMC is the fiscal agent for the SRSLY coalition in Chelsea, which works to prevent youth substance abuse. During this period the hospital helped two communities in the service area Stockbridge and Dexter establish their own SRSLY coalitions. In 2014 they successfully applied for a federal grant 4

6 through the Drug Free Communities program, which provides funding for five years. The hospital is now beginning work with Manchester to do the same. D. Mental Health: Strategy: Increase awareness of and access to behavioral health services. Outcome: SJMC opened a new outpatient behavioral health services clinic in Dexter, and has hired additional clinical staff to accommodate new patients. The department continues to work with local school districts and senior centers to identify and address the mental health needs of youth and senior citizens living in the SJMC service area. III. Service Area and Population The St. Joseph Mercy Chelsea (SJMC) service area is defined as the geographic area encompassing the zip codes of Chelsea, Dexter, Grass Lake, Gregory, Manchester, Munith and Stockbridge, Michigan. This includes sections of four counties (western Washtenaw, southeastern Ingham, southwestern Livingston and eastern Jackson) and all or part of the following cities, villages, and townships: Bridgewater Township, City of Chelsea, City of Dexter, Dexter Township, Freedom Township, Grass Lake Township, Henrietta Township, Lima Township, Lyndon Township, Manchester Township, Scio Township, Sharon Township, Stockbridge Township, Sylvan Township, Unadilla Township, Waterloo Township, Webster Township, Village of Grass Lake, Village of Manchester, and the Village of Stockbridge. According to the hospital's planning department, the SJMC service area was determined by the geographic proximity of these communities to the hospital, which is located at 775 S. Main St, Chelsea, Michigan. The total population of the six zip codes listed above is 56,023 according to the 2010 census. The average race distribution for the service area is 95% Caucasian, 2.1% Hispanic, and less than one percent each of other races. The average age for the service area is ,2 Because Gregory and Munith do not have their own school districts (youth there attend school in a neighboring community), the SJMC service area is commonly referred to as the five communities of Chelsea, Dexter, Grass Lake, Manchester and Stockbridge. These communities each have a school district, which unifies cities and villages with the outlying townships, and gives each a sense of identity. We will use the demographic data outlined above, but will otherwise refer to these five towns as the SJMC service area for the remainder of this needs assessment. 5

7 IV. Community Health Needs Assessment Partners A. Community Health Improvement Council The Community Health Improvement Council (CHIC) is a leadership council comprised of SJMC Clinicians, Department Directors, and Administrators with background, knowledge, and interest in health promotion and disease prevention. This group meets monthly to review and analyze data, identify community partners, set priorities and make decisions about the hospital s community health improvement initiatives. CHIC is responsible for conducting the Community Health Needs Assessment and developing the Implementation Strategy. 6

8 B. Health Improvement Plan of Washtenaw County SJMC is a member of the Washtenaw County Health Improvement Plan (HIP), a collaborative effort of public and private organizations aimed at improving health. HIP includes representatives from Washtenaw County Public Health (WCPH), St. Joseph Mercy Ann Arbor (SJMAA), the University of Michigan Health System (UMHS), the Chelsea-area Wellness Foundation, The Washtenaw Intermediate School District, and other organizations working to improve health in the region. The HIP website provides the following summary of the collaborative and its history: The Washtenaw County Health Improvement Plan (HIP) is a community health assessment and planning effort aimed at improving the health of county residents. The project began in 1994 with the formation of the Community Health Committee (CHC), a collaborative body comprised of representatives from the Health Department, local health systems, numerous community agencies, coalitions, local businesses and lay citizens, all working together to improve health. In 2000, HIP completed the first cycle of a three part health improvement process. The process included a county-wide health assessment (including a review of morbidity and mortality statistics, a thousand household telephone survey regarding health risks and health behaviors, and qualitative data regarding community perspectives of health issues facing the county); a planning phase to establish health priorities and goals; and implementation of health improvement strategies to address priority health issues. The CHC is the umbrella group that oversees the project. The group hosts bimonthly meetings which feature guest speakers on health issues pertaining to HIP goals, reports on health improvement projects, and time for discussion and networking. There are also two subcommittees responsible for much of the ongoing work to maintain the HIP project. These are the Implementation Team and the Coordinating Committee. The Implementation Team focuses on data gathering and analysis, and supporting community involvement in HIP, and maintains contact with numerous community-based coalitions that work toward HIP goals. The Coordinating Committee sets the agenda for CHC meetings and considers bigger picture issues that may affect HIP. The HIP provides both a challenge and an opportunity for the individual and corporate citizens of Washtenaw County to make a commitment to improve health for all. Our hope is that these goals and objectives will enable a unified front within the county for addressing these urgent local issues. We encourage involvement from all members of our community. Our likelihood of reaching targets is much greater when we unite our efforts. 3 7

9 SJMC participates in all three HIP committees Community Health Committee, Implementation Team, and Coordinating Team. This partnership provides access to data and facilitates collaboration among leaders in the health field in Washtenaw County. These groups are in the process of reorganizing to facilitate a collaborative, county-wide CHNA process in the future. SJMC is participating in this reorganization, and plans to collaborate with our partners in Washtenaw County for our next CHNA and Implementation Strategy. C. Community Wellness Coalitions Each of the five communities in the SJMC service area has a wellness coalition with volunteer members from key community sectors and organizations. These sectors and organizations include: local government, schools, libraries, businesses, senior centers, community gardens, churches, food banks and resource centers, youth substance abuse prevention organizations, hospital and other healthcare providers, and local citizens with personal or professional interest in health. They are not legal entities; they are volunteer organizations, open to anyone in the five communities who is interested in getting involved. In general, they meet monthly, with additional sub-committee meetings in some of the communities. These coalitions organized in 2010 in response to an initiative from the Chelsea-Area Wellness Foundation (CWF), which serves the same five towns as SJMC. Each coalition was tasked with developing a comprehensive wellness plan for their community, based on local data demonstrating need, and resources available to address those needs. SJMC is represented on all five coalitions by hospital staff, including physicians, nurses, department directors and program coordinators. These representatives communicate regularly to share their experiences, update each other on the coalitions progress, and identify opportunities to overcome challenges and collaborate across the service area. The Manager of Community Health Improvement is one of the hospital s representatives on the Chelsea coalition, and also works with the Dexter, Grass Lake, Manchester and Stockbridge coalitions in an advisory capacity, assisting with data collection and analysis, community assessment, and strategic planning. V. Community Health Needs Assessment Methodology and Process A. HIP Survey The HIP survey was conducted in 2010, and that data was used as part of the 2012 CHNA process. The next HIP survey is currently underway at the time of this writing. There is no new HIP survey data to include in this CHNA. 8

10 B. Michigan Profile for Healthy Youth (MiPHY) The MiPHY is a bi-annual, anonymous online survey of 7 th, 9 th, and 11 th grade students in participating school districts in Michigan. This survey measures health behaviors as well as risk and protective factors in peer groups, families, schools and communities. The survey tool is developed by the Michigan Department of Education. In 2014 four of the five school districts in the SJMC service area completed the MiPHY survey. County reports for the MiPHY are available to the public through the Michigan Department of Education website. 4 This CHNA includes data from the Stockbridge and Dexter school district MiPHY reports, as well as the Ingham, Jackson and Washtenaw County reports. C. Washtenaw County Public Health The county health department released a report on childhood obesity in Washtenaw County in April This report used medical record data from the University of Michigan Health System and St. Joseph Mercy Health System, representing 18,595 children living in the county. This data was analyzed and presented according to race, gender, insurance type, and zip code. D. Websites CHNA.org, and CountyHealthRankings.org These web-based resources compile available data from multiple sources, and make it available to the public. After creating an account with CHNA.org, a user can select a geographic area and generate a report on dozens of health and behavior indicators. For this CHNA, the hospital selected the zip codes in the SJMC primary service area and generated a full health indicators report. Countyhealthrankings.org also uses data from multiple sources to score and rank counties by health behaviors and outcomes. While the majority of the SJMC service area lies within Washtenaw County, two of the five communities lie in neighboring counties. This website was reviewed, but the data was not utilized in identifying or prioritizing local needs. E St. Joseph Mercy Chelsea Community Health Needs Assessment Survey This on-line survey collected information on health outcomes, behaviors, and beliefs among adults living in the SJMC primary service area. The survey link was posted on the hospital website and distributed to at least 2,000 adults via networks (wellness coalitions, civic clubs, key stakeholders, patient advisory council, and hospital employees). The survey was also promoted in local media. The survey was open from September 23 until October 17, and 396 adults participated. Of those, 20% were male, 9

11 77% were female, and 3% chose not to disclose their gender. The majority of respondents (62%) live in the Chelsea zip code (48118), but there were respondents from all zip codes in the SJMC primary service area. Three out of four survey respondents had a college education or higher, 80% were currently employed, and 18% were retired. The age and household income distribution for survey respondents are as follows: Ages 11% under 35 39% % % 65 or older Household Income 30% > $100k/year 33% $50k-$100k/year 21% less than $50 16% did not report F. Community Wellness Coalitions The Manager of Community Health Improvement analyzed and presented data from the sources listed above to all five coalitions in October and November, Each wellness coalition discussed the available data, and how it fit with their perceptions of needs within their communities. They also discussed existing community resources to address health needs, to avoid duplication of effort and identify gaps. G. Key Stakeholder Interviews In order to gain input on the needs of medically underserved, low-income and minority populations, and populations with chronic disease needs in the community, leaders from SJMC conducted key stakeholder interviews between October 2014 and January Members of the Community Health Improvement Council generated a list of community agencies and organizations that serve these populations, and questions to ask each about the needs of their clients or members. These interviews were conducted in person if possible, and by phone, or by if necessary. A complete list of individuals interviewed, the organization they represent, and interview questions are included in Appendix II. H. Community Forum SJMC hosted a community forum to share the data collected and gain input on the health needs in the service area. Three adults attended this event. Their feedback is included in 10

12 the summary of input received from the wellness coalitions and key stakeholder interviews. I. Information Gaps The data websites and surveys used have certain limitations related to bias, sample, and wording of questions. The MiPHY survey includes questions developed to screen out youth who are answering questions falsely, or not paying attention to their answers (for example, by clicking yes to all questions on a page without reading the questions). However, some questions are confusing for students, and adults overseeing survey implementation are not allowed to explain or clarify any questions, so as not to skew student responses. This may lead to some false answers by students who do not understand the questions. The SJMC CHNA survey was web-based, so those without internet access did not have an opportunity to participate. In addition to survey limitations, there are some gaps in the information SJMC is able to collect that impact our ability to assess the needs of the community. These limitations are mainly related to individuals and families that do not access services at SJMC, or any of the organizations included in the key stakeholder interviews, or wellness coalitions. Reliable data on the needs of these populations is not readily available, and could not be included in this assessment. 11

13 VI. Identified Community Health Needs A. Needs Identified A majority of adults in the SJMC service area (95%) rate their health status as excellent, very good, or good. Three out of four adults have been told by a doctor or other health professional that they have, or have had, a chronic health condition at some point in their lives. 5 Needs identified in health surveys, key stakeholder interviews, and input from community members and local wellness coalitions include the following: 1. Obesity The largest health problem in the SJMC service area is overweight and obesity. The majority of adults that live in these five towns are overweight or obese (60%). 6 This health problem affects more people than any other issue. Childhood obesity is also widespread in the SJMC service area, although not nearly as prevalent as it is among adults. According to Washtenaw County Public Health, the prevalence of children who are overweight or obese in Chelsea and Dexter is between %. In Manchester the rate is %. Community level data is not available for Grass Lake and Stockbridge because they are located outside Washtenaw County. Grass Lake and Stockbridge are more similar to Manchester in terms of demographics than Chelsea and Dexter. For the purposes of this needs assessment, we will assume that the childhood obesity rates in Grass Lake and Stockbridge are similar to Manchester Diabetes Diabetes prevalence is 8% in the SJMC service area. That is lower than the Michigan rate of 11%, and national rate of 9%. 6 The SJMC Outpatient Diabetes Education program treats approximately 150 patients per year Heart Disease Less than 5% of adults in the SJMC service area report having ever been diagnosed with heart disease. However one-third report having been diagnosed with high cholesterol. 5 This is below the state and national averages. 6 12

14 4. Mental Health More than half of all key stakeholders interviewed identified mental health as the biggest health need they see in the populations they serve. These stakeholders represent organizations who serve the low-income, minority, medically underserved, youth and those living with chronic diseases. Among those stakeholders who did not rank mental health as the most important issue, all but three listed it as a major issue. One out of six adults do not get the social support they need. 6 As noted in the 2012 CHNA, multiple mental health indicators saw negative trends from 2005 to 2010 in western Washtenaw County. The average number of days per month with poor mental health rose from 2.9 to 3.0 in western Washtenaw, while Grass Lake and Stockbridge reported 3.2 and 3.6, respectively. 8 Among youth in the SJMC service area, one in four reports having been depressed in the past year. One in seven teens in Washtenaw County reports having considered suicide. 9 Mental health, including depression and anxiety, was identified as the most important health need among youth by four out of five school representatives that participated in key stakeholder interviews Dental Health The 2012 CHNA noted that dental health is a need among low-income and rural populations in the SJMC service area. Those who are unemployed, or earn between $35,000 and $75,000 per year were the most likely to have lost one or more teeth to decay. 6 Key stakeholders reported that dental health is an especially important need among those who are unemployed, as it can be a major barrier in securing work Access to Care According to the 2014 SJMC needs assessment survey, one in ten adults were not able to access health care when needed at some point in the past six months. The most common reasons cited were financial, including: high co-pay or deductible, prescription costs, and existing medical debt. Survey respondents also cited scheduling difficulties as a barrier to care, including long wait times for appointments, and the lack evening or weekend appointments. 5 Key stakeholder interviews reported access to care, and the coordination of healthcare services between multiple providers to be high priority needs among the low-income populations in the area. Barriers to accessing primary and dental care include transportation, insurance, scheduling, out-of-pocket costs and the number of providers offering free or low-cost care

15 The Grace Clinic for the uninsured reported a significant drop in the number of patients seeking care in This was attributed to the expansion of Medicaid in Michigan, under the Affordable Care Act. SJMC is one of many organizations offering enrollment assistance for uninsured adults in the area. However, out of pocket costs for private insurance through the Health Insurance Exchange might be cost prohibitive for those adults who do not qualify for Medicaid under the expansion. 7. Substance Abuse Key stakeholder interviews revealed that substance abuse is a major problem among youth and adults in the SJMC service area. As one interviewee noted, these issues "are not talked about or dealt with openly." The primary substances of abuse in the SJMC service area are alcohol, tobacco, marijuana, and prescription medications. Alcohol Almost one out of every five adults binge drinks regularly, defined as consuming five or more drinks in a row for men, and four or more drinks in a row for women. 5,6 Binge drinking is less common but still high among teens: 8.5% of Washtenaw County and 12.5% of Ingham County high school students reported binge drinking in the past month. 9 Tobacco As reported in the 2012 CHNA, tobacco use among adults increased from 20% to 21% in western Washtenaw County from 2005 to Stockbridge and Grass Lake have slightly lower smoking rates, at 15% and 13% respectively. Most adult smokers (41% to 88% in the SJMC service area) had tried to quit in the past year. Among teens in the SJMC service area, less than one in ten uses tobacco regularly (4% in Washtenaw County and 8.6% in Ingham County). One-third of teen smokers report having tried to quit smoking in the past year. 9 Other Drugs Marijuana is the second most commonly abused drug among teens in the SJMC service area (alcohol is the first). Among high school students, lifetime marijuana use ranges from 21-30%. Recent use (past 30 days) of marijuana by high school students ranges from 13-17%. The use of other illegal drugs, including cocaine, barbiturates, heroin, club drugs, and methamphetamine is low compared to state averages. 9 Medicine abuse and misuse is an emerging trend that needs to be closely monitored, specifically the abuse of prescription painkillers and ADHD medications. According 14

16 to the 2014 MiPHY survey, 4% of Washtenaw and Ingham County high school students regularly abuse prescription medications Nutrition Three out of four adults and two out of three teens do not eat the recommended five fruits and vegetables per day. 5,9 When asked why they do not eat more fruits and vegetables, 38% of SJMC needs assessment survey respondents reported, "I don't really think about it." According to the CDC, eating more fruits and vegetables is associated with a lower risk of cardiovascular disease, diabetes, and obesity. 11 Key stakeholder interviews indicated that access to affordable, healthy foods is a major barrier to health for the low-income and medically underserved populations in the SJMC service area. Some also reported a lack of understanding of good nutrition, and a lack of motivation to make healthy eating a priority. 10 The five area wellness coalitions identified many environmental needs related to nutrition, including healthy menu items at restaurants, improved offerings and marketing at grocery stores, increased awareness about community gardens and farmers markets, and education about how to eat healthy with a busy lifestyle. 9. Physical Activity Half of all teens do not get the recommended 60 minutes or more of physical activity per day on most days. One out of five 5 adults does not participate in any form of physical activity. When asked why they do not get more exercise, half of the SJMC survey respondents reported that there was "not enough time." Another 26% reported that gym memberships in the area were too expensive. 5,9 Wellness coalitions have identified infrastructure needs related to physical activity, as well as general awareness of existing opportunities. While they see the need to increase the availability of pedestrian paths and opportunities for youth and adults to be active during the school and work day, coalitions also recognize the need to promote existing resources for physical activity in the area, and make people aware of what is already available. 10. Physical Environment As reported in the 2012 CHNA, 78% of adults in the SJMC service area live more than one mile from the nearest grocery store. Less than half agree with the statement There are sidewalks, walking paths or trails in or near my neighborhood that I can easily use for walking, jogging, or running. Less than one-third agree with the statement There are stores, restaurants, and other destinations within walking distance of my home. 15

17 11. Transportation The 2010 HIP survey found less than 2% of adults report transportation as a barrier to receiving needed healthcare. However, 25% of key stakeholders interviewed listed it as one of the biggest needs they see in the medically underserved and low-income populations. 10 Many of these stakeholders sited the lack of transportation as a barrier to accessing activities and resources that would support health, including social support, and nutritious foods. 12. Social Support One out of six adults in the SJMC service area report that they do not get the social and emotional support they need. 6 In addition to social and emotional support, lowincome and medically underserved populations also need support in navigating the healthcare system, including enrolling in Medicare or Medicaid, and advocates at doctor appointments. The local senior centers specifically mentioned the lack of social support for seniors living alone, and the health risks this presents, including depression, malnutrition, and falls resulting in injury. 10 Most teenagers have witnessed some form of bullying within the past year, including name calling, rumors, threats of violence, exclusion from activities, or the destruction of property Family & Community Involvement While most teens in the SJMC service area feel close to their mother and father, more than one-third do not feel included in family decisions, according to the MiPHY survey. Survey data from the Chelsea School District showed a direct link between the inclusion in family decisions and youth substance abuse. Teens who reported that their parents "usually" or "always" included them in family decisions were less likely to use drugs or alcohol compared to teens who reported that their parents "sometimes" or "never" included them in family decisions. They survey also showed a similar association between parents who offered their teens lots of chances to do fun things together; teens who reported their parents did this were less likely to use alcohol, tobacco, or drugs. 9 B. Process for Prioritizing Members of the SJMC CHIC reviewed survey data, results of the key stakeholder interviews, and wellness coalitions input in December Using these sources, members identified needs based on the following criteria: size, severity, and long-term impact. Needs were then prioritized based on these criteria, as well as whether data were available, and our ability as a hospital to impact the need. Each identified need was given 16

18 a score in each of these categories. CHIC members scores were compiled and needs were ranked according to the total scores. C. Prioritized Needs Listed in order of importance, the following needs were identified as the most important, according to the criteria outlined above: 1. Obesity and obesity-related illnesses Risk Factors: poor nutrition, lack of physical activity 2. Mental health, including depression and anxiety Risk Factors: social support, access to care 3. Substance abuse among youth and adults, including alcohol, tobacco, marijuana, and prescription drug abuse Risk Factors: access, perception of risk, perception of peer use 4. Access to care, including primary care and dental care Risk Factors: insurance coverage, transportation VII. Community Resources to Address Needs A. SJMC Internal Resources SJMC currently addresses these health needs through both hospital and community-based programs. These include: Behavioral Health Services: SJMC offers a continuum of behavioral health services to meet the specific needs of patients and their families. These services include inpatient, outpatient, and day treatment programs. Coordination among these services allows patients to move from one level of care to another as their needs change. Experienced, board certified psychiatrists and masters prepared social workers offer various treatment approaches, including individual, group, and family treatment designed to meet the patient's individual needs. SJMC provides treatment for children, adolescents, adults and older adults. SJMC Behavioral Health Services offers substance abuse prevention and treatment programs for adolescents and adults in both individual and group settings. 12 The Bushel Basket Farmer s Market is a weekly farmers market historically located on SJMC property every Wednesday afternoon, 2:30 6:00 pm, May 1 through October 31. The market started in 2008 in order to enhance access to fresh fruits and vegetables for hospital employees and the broader community. In 2015 the market is moving to a more central location in downtown Chelsea, in 17

19 order to attract more customers. The hospital will continue to serve as fiscal agent for the market. Community health education activities led by the hospital include classes, wellness lectures, the speakers bureau, and an osteoporosis prevention presentation for youth and seniors called Healthy to the Bones. This presentation is given at local libraries and in Chelsea, Grass Lake, Manchester and Stockbridge schools. Diabetes Share Group is an opportunity for diabetic patients and their families to gather and share their experiences in managing this chronic disease. Diabetes Share Group meets ten times each year and is facilitated by a Certified Diabetes Educator and Registered Dietician at SJMC. This free program is open to area residents and their families. Faith Community Nursing engages nurse volunteers in our service area to provide information and support through local congregations. Program components include a monthly bulletin insert with health information, health screening and influenza vaccination events, health promotion activities, and discharged patient follow-up and support. Thirteen local churches participate. Heart and Sole is an annual run, walk and bike event held every spring. Youth and adults participate in the fun run and walk, with 2-mile, 5k, and 10k courses, as well as a bike race. This family-oriented event promotes physical activity while also providing needed funds to the support programs addressing the health needs identified in this assessment. Proceeds from the 2015 race will be going to support Behavioral Health Services at SJMC. The Healthy Communities Walking Program was formed in 2002 with volunteer representatives from Chelsea, Dexter and Manchester, the Chelsea Wellness Center, public health, and the hospital. Participants provide basic health information at enrollment, then track their walking over 12 months, receiving incentives and encouragement along the way from the program s Community Point Person. More than 1,000 people have participated in the program, with an average weight loss of eight pounds, a BMI reduction of four points, and fewer poor mental health days per month. The Walking Program won the Michigan Health and Hospital Association s Ludwig Community Benefit Award in 2011, which brought $2,500 to help the program expand to include Stockbridge and Grass Lake. The Supper Club is an opportunity for local senior citizens and other adults to gather together to enjoy a meal and an educational presentation in the SJMC dining room. The Chelsea and Dexter Senior Center helps SJMC plan and 18

20 promote the Supper Club, and coordinate transportation for some of their members. With seven or eight events per year, the Supper Club is an opportunity for seniors to socialize with their peers, and learn about a topic of interest. SRSLY (text language for seriously ) is a community coalition dedicated to preventing youth substance abuse. The coalition has been working in Chelsea since 2008, and in Dexter and Stockbridge since 2012, to reduce youth alcohol and marijuana abuse, and has seen some positive results. With funding from the Coghlan Family Foundation, the Chelsea-area Wellness Foundation, and the Drug Free Communities Support Program, and local families and businesses, SRSLY implements multiple strategies across multiple sectors with a focus on youth leadership. SJMC is one of the founding organizations, and serves as the fiduciary for the coalitions, donating significant in-kind resources in the form of staff time and expertise, office space, and overhead. Stroke Club is a support group for stroke survivors and/or their caregivers, family and friends. The group emphasizes peer support and discussion as well as education and participation in community outings. This free program is held monthly at SJMC. B. External, Community-Based Resources The five towns that comprise the SJMC service area have many resources already in place to address the health needs of the population. In addition, thanks to the Chelseaarea Wellness Foundation, financial and other resources will be made available in both the near and long-term. SJMC recognizes the strengths of each community in the service area, and will work to support and compliment those organizations that are also working to improve the health and well-being of the population. Washtenaw County Public Health (WCPH) provides leadership and coordination of public health services and data collection. The Washtenaw County Health Improvement Plan unites service providers from across the county in collecting and analyzing data, setting objectives and priorities, and coordinating services to reduce duplication of effort. SJMC is an active member of three HIP committees, and WCPH staff members participate on the Healthy Communities Steering Committee at SJMC. The five local Wellness Coalitions (Chelsea, Dexter, Grass Lake, Manchester and Stockbridge) are each developing, implementing and evaluating comprehensive wellness plans to address the health needs of their communities on an annual basis. SJMC is represented on each coalition by a staff member (administrator or clinician) with close ties to the communities. The hospital is also represented on the CWF Board, and the CWF Comprehensive Wellness Initiative sub-committee, which oversees the coalitions. 19

21 Local organizations dedicated to serving low-income and medically underserved populations provide food, emergency financial assistance, social support, and some access to medical, dental, vision, hearing, and mental health care. These organizations include, but are not limited to: Chelsea Grace Clinic Chelsea United Way Copper Nail, Grass Lake Faith in Action, Chelsea and Dexter Manchester Community Resource Center Manchester Family Services Ministerial Associations in Chelsea, Dexter, Grass Lake and Manchester Senior Centers in Chelsea and Dexter Stockbridge Community Resource Center SJMC supports the Chelsea Grace Clinic and Faith in Action through fundraising events in the community and supply collection drives with hospital staff. Every December, hospital departments collect gifts for children and parents at Faith in Action. A hospital staff member also serves on the Faith in Action Board. In addition to SRSLY, the hospital-led coalition in Chelsea, Dexter and Stockbridge, two other coalitions are working to prevent youth substance abuse in the SJMC service area: Manchester Voices, and the Jackson County Substance Abuse Prevention Coalition (JCSAPC). Manchester Voices is funded through the Washtenaw Alcohol Reduction Project. JCSAPC is funded through the Drug Free Communities Program. Both engage multiple sectors in prevention, and provide opportunities for youth to get involved. Manchester Voices and SRSLY have collaborated on multiple youth-led events, including the SRSLY New Year s Eve Party, and the Manchester Voices Halloween Party. The JCSAPC Most Teens Don t campaign promotes positive social norm messages, similar to a strategy implemented through SRSLY. Local school districts and recreation departments are working to promote physical activity among youth in the SJMC service area through health and physical education curriculum, and school and intramural sports. Working closely with the five wellness coalitions, each school district is examining policies and practices that would improve the school environment in ways that would make it easier for students and staff to be physically active and eat more nutritious food. Recreation departments are working to increase access to their programs, so more kids can participate. 20

22 VIII. Conclusion St. Joseph Mercy Chelsea (SJMC) has developed an Implementation Strategy, or plan, to address the priority health needs identified in this assessment. This is a separate document, and is available on the hospital website, under the Community Benefit tab. Printed copies are also be available at the hospital (775 S. Main St., Chelsea, MI 48118) in the Community Health Improvement Department, or by calling (734) If you have questions, comments or feedback regarding this CHNA or the Implementation Strategy, please call Reiley Curran at (734) , or at reiley.curran@sjtoeshealth.org. By completing this Community Health Needs Assessment (CHNA) and Implementation Strategy in 2015, SJMC is scheduled to repeat this process in However, SJMC is currently in the process of planning for a joint, county-wide CHNA and Implementation Strategy in partnership with the University of Michigan Health System, St. Joseph Mercy Ann Arbor, and Washtenaw County Public Health. The target date for completion of this CHNA is June 2016, with the goal of October 2016 for completion of the Implementation Strategy. If this goal is met, SJMC will align our CHNA schedule with this county-wide effort, which will continue to occur on a threeyear cycle. St. Joseph Mercy Chelsea is committed to improving the health of the communities we serve. We will continue to partner with local stakeholders to implement programs and policies that are evidence-based, as well as those that are innovative. We will continuously evaluate the effectiveness of our interventions and seek to improve in ways that maximize our efficiency and impact. Above all else, we will adhere to our mission to "serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities." 21

23 Appendix I. SJMC Service Area 2010 Census Data 2010 US CENSUS DATA TOTAL/AVG Population ,446 9,943 3,961 6,799 7,835 5,313 45, ,552 14,420 4,796 7,309 8,703 5,720 53,500 Change 9.7% 45% 21% 7.5% 11.1% 7.7% 18.1% Households Housing Vacancy Rate Percent Age ,163 3,625 1,414 2,564 2,767 1,867 16, ,003 5,238 1,814 2,934 3,267 2,062 20,318 Change 20.2% 44.5% 44.5% 14.4% 18.1% 10.4% 23.9% % 5.0% 15.9% 5.6% 12.8% 4.7% 8.2% % 5.4% 17.2% 8.5% 12.3% 8.7% 10.1% Median Age % Under % 29% 27% 26% 23% 27% 26.4% % 28% 24% 23% 24% 26% 24.6% Percent Population by Race % Over 55 White Black Asian Hispanic % 17% 19% 21% 20% 21% 20.1% % 24% 28% 31% 23% 25% 27.2% % 96.5% 93.3% 94.9% 96.6% 96.0% 95.4% % 93.2% 96.2% 96.3% 95.3% 94.7% 95.0% % 0.3% 0.9% 0.3% 1.5% 0.4% 0.9% % 0.9% 0.4% 0.3% 1.0% 0.5% 0.7% % 0.7% 0.3% 0.2% 0.1% 0.3% 0.4% % 1.7% 0.2% 0.4% 0.2% 0.3% 0.6% % 1.2% 3.6% 3.5% 1.0% 1.7% 2.1% % 2.2% 1.4% 1.8% 1.5% 2.8% 1.9% 22

24 Appendix II. Key Stakeholder Interview Summary Key Stakeholder Interviews related to community health needs of medically underserved, lowincome and minority populations, and populations with chronic diseases, conducted October 2014 January 2015 by members of the SJMC Community Health Improvement Council. Key Stakeholder Interview Questions: 1. How many people does your organization serve annually? 2. What is your organization s primary mission? 3. What is your role with the organization? 4. What are the greatest health-related needs you are seeing in the people you serve? 5. Are any of the needs currently being addressed? If so, how? Key Stakeholders Interviewed, the organizations they represent, and the populations they serve: I. Low-income and Minority Populations Chelsea Senior Center: Support network for seniors that still live in their homes, connect them to organizations and other individuals. Trinh Pifer, Director, interviewed March 21, 2012 by . Chelsea United Way: Provides financial support to local agencies that identify community members in need and provide help to these citizens, serves over 1,000 people annually. Eric Keaton, President, interviewed January 7, 2015 by phone. Copper Nail: Supports the community and makes money for the local nonprofit organizations, serves 500 people annually. Ed Fuller, Director, interviewed January 7, 2015 by phone. Chelsea Ministerial Association Interviewed seven members (all pastors) of the group on October 14, 2014, in person. Chelsea High School: Beth Morris, Social Worker, interviewed on January 6, 2015 by phone. Dexter High School: Amy Raus, Special Education Teacher, interviewed January 7, 2015 by . 23

25 Dexter Ministerial Association Father Brendon, January 7, 2015 by phone. Dexter Senior Center: Provides social and recreational activities for seniors in our community; 500 members. Katie Stirling, Director, interviewed January 7, 2015 by phone. Grass Lake Lion's Club: Soren Anderson, Vice President of the Lion's Club, interviewed on January 7, Manchester Community Resource Center: Provides daily food pantry services, emergency utility assistance, Medicaid guidance, resume and work finding assistance; serves families per month. Laura Siefried, Director, interviewed January 7, 2015 by phone. Manchester High School: Wendy Arnston, Social Worker, interviewed January 6, 2015 by phone. Migrant Services, Manchester: seasonal mobile medical unit that services Washtenaw County and Livingston County migrant workers and provides freestanding clinic services. Al Adan, Director of Migrant Services, interviewed January 7, 2015 by phone. Stockbridge Baptist Church Pastor Brian Johnson, interviewed January 7, 2015 by phone. Stockbridge Community Resource Center: Food pantry, prescription help, transportation help, donation room with clothing, shoes, small household items and linens; serves 2,000 people per year. Evelyn Kay, Director, interviewed January 7, 2015 by phone. II. Populations with Chronic Disease Needs Stroke Support Group at SJMC: provides fun and friendship, support and education for stroke patients and their caregivers; serves 16 per month. Janice Shamraj, Coordinator, interviewed March 22, 2012 in person. Outpatient Diabetes Education at SJMC: Kim Campbell, Program Coordinator, interviewed March 21, 2012 in person. 24