Community Health Needs Assessment

2013 Community Health Needs Assessment Kaiser Foundation Hospital PANORAMA CITY License #9300000358 To provide feedback about this Community Health Needs Assessment, email CHNA-communications@kp.org.

Authors Valley Care Community Consortium was contracted to prepare a Community Health Needs Assessment for the Kaiser Permanente Panorama City Medical Center Service Area. Joni Novosel, MS Health Administration Surekha Vasant, MS Public Health VCCC contributing authors (health profiles, data tables, and asset mapping) Kenia Alcaraz, BS Public Health Maribel Aguilar, BS Health Education Belen Arangure, BS Health Education Ines Herrera, BS Public Health Shivani Ponnambalavan, Dual MS Human Resources and Health Administration VCCC subcontracted with Antelope Valley Partners for Health for the portions of the report pertaining to Antelope Valley including the cities of Lancaster and Palmdale. Michelle Kiefer, MBA Tiara Sigaran, BS Public Health Trish Bogna, BS Business Management Valley Care Community Consortium 7515 Van Nuys Blvd., Fifth Floor Van Nuys, CA 91405 Telephone: 818-947-4040 Website: www.valleyccc.org I

Acknowledgements Conducting a community health needs assessment is no small task and would not be possible without the contributions of VCCC staff, Antelope Valley Partners for Health (AVPH), Los Angeles County Department of Public Health, our VCCC partner agencies including KFH- Panorama City, and community residents. We would like to give a special thanks to the graduate and undergraduate health administration and public health interns working with us from California State University Northridge and Los Angeles. We would like to extend a special acknowledgement to AVPH, who as a sub-contractor with VCCC provided primary and additional local secondary data. VCCC acknowledges and honors AVPH s contribution of time, dedication, and expertise in identifying the community health needs in the Antelope Valley including the cities of Lancaster and Palmdale. We would like to recognize and acknowledge our local KFH- Panorama City Public Affairs Director and her Community Benefits staff for their ongoing guidance and support. In addition we appreciate the technical assistance and leadership from the Kaiser Permanente Regional Office. Their efforts have been instrumental in completing this report. The list of individuals representing multiple agencies are too many to name individually, however we want to express our gratitude to those agencies that supported VCCC and AVPH through participation in key informant interviews, focus groups, community forums, and prioritization meetings. Agencies represented include: All 4 Children Antelope Valley Community Clinic Antelope Valley Healthcare District Antelope Valley Hospital Antelope Valley Partners for Health Antelope Valley Pregnancy Counseling Center Asian Youth Center AV Chess House AV Mobility Management Project Bartz-Altadona Community Health Center Black Infant Health California State University, Northridge Catalyst Foundation Child and Family Guidance Center Children Center of the Antelope Valley Children s Bureau Church on The Way City of San Fernando Community Synergy for Children and Families CSUN El Nido Family Center Friends of the Family Lancaster Department of Children and Family Services Lancaster School District Los Angeles Community Development Commission Los Angeles County Department of Mental Health SA 1 and SA 2 Los Angeles County Department of Public Health II

Los Angeles County Office of Education Los Angeles County, High Desert Health System Los Angeles County, ValleyCare Health System Los Angeles Department of Children and Family Services Los Angeles Unified School District MEND Menfolk Mental Health America Mid Valley Comprehensive Health Center Mission Community Hospital National Alliance for Mental Illness (NAMI) Neighborhood Legal Services New Directions for Youth Northeast Valley Health Corporation Olive View UCLA Medical Center Open Arms Foster Age Palmdale School District Partners in Care Foundation Protective Science Dynamics Providence Access to Care PSD Head Start SCAN Tarzana Treatment Center Two Life Styles Valley Trauma Center Yes 2 Kids We would also like to thank the data committee. The data committee consists of area academic, health and public health service providers that meet on a monthly basis to provide guidance throughout all stages of the needs assessment process. H-sin Chen, MSHA Tarzana Treatment Center Regan Mass, Ph.D California State University Northridge, Geography Dept. Gigi Mathew, Dr.PH Research Analyst III Los Angeles County Department of Public Health Office of Health Assessment and Epidemiology Marie Mayen-Cho, MPH Providence Access to Care Collaborative Douglas Melnick, MD, MPH Los Angeles County Department of Public Health Ronald Sorensen, MSHA Providence Health & Services Center for Community Health III

Table of Contents AUTHORS... I ACKNOWLEDGEMENTS... II GLOSSARY OF TERMS... 4 I. EXECUTIVE SUMMARY... 8 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) BACKGROUND... 8 SUMMARY OF NEEDS ASSESSMENT METHODOLOGY AND PROCESS... 8 SUMMARY OF PRIORITIZED NEEDS... 10 II. INTRODUCTION/BACKGROUND... 13 PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT... 13 ABOUT KAISER PERMANENTE... 13 ABOUT KAISER PERMANENTE COMMUNITY BENEFIT... 14 KAISER PERMANENTE S APPROACH TO THE COMMUNITY HEALTH NEEDS ASSESSMENT... 14 About the new federal requirements... 14 SB 697 and California s history with past assessments... 14 Kaiser Permanente s CHNA framework and process... 15 III. COMMUNITY SERVED... 16 KAISER PERMANENTE S DEFINITION OF COMMUNITY SERVED BY HOSPITAL FACILITY... 16 DESCRIPTION AND MAP OF COMMUNITY SERVED BY KFH-PANORAMA CITY... 16 Geographic Description... 19 Socio-demographic Profile... 20 Access to Health Care... 29 Chronic Disease Prevalence and Incidence... 34 IV. WHO WAS INVOLVED IN THE ASSESSMENT... 43 V. PROCESS AND METHODS USED TO CONDUCT THE CHNA... 44 A. SECONDARY DATA... 44 B. COMMUNITY INPUT... 46 C. DATA LIMITATIONS AND INFORMATION GAPS... 60 VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY S HEALTH NEEDS 60 A. IDENTIFYING COMMUNITY HEALTH NEEDS... 60 B. PROCESS AND CRITERIA USED FOR PRIORITIZATION OF THE HEALTH NEEDS... 62 C. PRIORITIZED DESCRIPTION OF COMMUNITY HEALTH NEEDS... 62 VII. COMMUNITY ASSETS AND RESOURCES AVAILABLE TO RESPOND TO THE IDENTIFIED HEALTH NEEDS OF THE COMMUNITY... 66 2 P a g e

APPENDIX A: HEALTH NEED PROFILES... 72 Health Need Profile: Access to Primary Care... 73 Health Need Profile: Asthma... 78 Health Need Profile: Breastfeeding... 81 Health Need Profile: Cardiovascular Disease... 83 Health Need Profile: Cervical Cancer... 87 Health Need Profile: Dental Health Services... 91 Health Need Profile: Diabetes... 93 Health Need Profile: Mental Health... 97 Health Need Profile: Obesity/Overweight for Adult and Youth... 101 Health Need Profile: Physical Environment/Transportation... 106 Health Need Profile: Poverty Rates... 109 Health Need Profile: Prenatal Care... 113 Health Need Profile: Unemployment... 117 Health Need Profile: Uninsured Population... 121 APPENDIX B: PRIMARY DATA COLLECTION TOOLS AND INSTRUMENTS... 124 APPENDIX C: COMMUNITY RESOURCES BY CATEGORY... 138 APPENDIX D: REFERENCES/BIBLIOGRAPHY... 182 3 P a g e

Glossary of Terms The following are definitions of key CHNA terms referenced in this report. In order to standardize the process across the Region and to ensure compliance with the ACA regulations a shared understanding of these terms is important. Age-adjusted Rate The incidence or mortality rate of a disease can depend on the age distribution of a community. Because chronic diseases and some cancers affect older adults disproportionately, a community with a higher number of older adults might have a higher mortality or incidence rate of some diseases than another community that may have younger people. An incidence or mortality rate that is ageadjusted takes into the consideration of the proportions of persons in corresponding age groups, which allows for more meaningful comparison between communities with different age distributions. Benchmarks 4 Something that serves as a standard by which others may be measured or judged (Example: Healthy People 2020). Community Assets Those people, places and relationships that can conceivably be used in acting to bring about the most equitable functioning of a community (Example: FQHC s, primary care physicians, parks). Community Health Needs Assessment 5 (CHNA) A systematic process involving the community to identify and analyze community health needs and assets. Community Served Based on ACA regulations, the community served is to be determined by each individual hospital. It is generally defined by a geographical location such as a city, county or metropolitan region. A community may also take into consideration certain hospital focus area (i.e., cancer, pediatrics) but should not be denied so narrowly as to intentionally exclude high needs groups such as the elderly or low income individuals. Disease Burden Disease burden refers to the impact of a health issue not only on the health of the individuals affected by it, but also the financial cost in addressing this health issue, such as public expenditures in addressing a health issue. The burden of disease can also refer to the disproportionate impact of a disease on certain populations, which may negatively affect their quality of life and socioeconomic status. 4 P a g e

Drivers of Health Risk factors are issues that may positively or negatively impact a health outcome. For the purposes of KP s CHNA they have been divided into four categories: social and economic factors, physical environment, health behaviors and clinical care access and delivery. Health Indicator 6 A characteristic of an individual, population, or environment which is subject to measurement (directly or indirectly) and can be used to described one or more aspects of health of an individual or population ( Examples: Percent of children overweight in Santa Clarita County, Incidence of breast cancer in Santa Clara County). Health Disparity Diseases and health problems do not affect all populations in the same way. Health disparity refers to the disproportionate impact of a disease or a health problem on specific populations. Much of research literature on health disparity focuses on racial and ethnic differences in how these communities experience the diseases, but health disparity can be correlated with gender, age, and other factors, such as veteran, disability, and housing status. Health Needs Health outcomes that are disproportionately impacting a particular population. They are identified through interpretation and analysis of secondary data as well as primary data. (Example: breast cancer, obesity and overweight, asthma) Health Outcomes 7 Health Outcomes are snapshots of diseases in a community that can be described in terms of both morbidity and mortality. They are measureable health indicators that may be used to identify and prioritize health needs. (Example: breast cancer prevalence, lung cancer mortality, homicide rate) Immediate Needs Immediate needs are health needs that the community felt needs an immediate intervention. Implementation Strategy 8 The non-profit hospital s plan for addressing the health needs identified through the community health assessment. (CHNA) Incidence 9 A measure of the occurrence of new disease in a population of people at risk for the disease, (Example: 1,000 new cases of breast cancer in 2011). 5 P a g e

Intermediate Needs Intermediate needs are the health needs that the community felt needs attention once the immediate needs have been addressed. Mortality Rate Mortality rate refers to the number of deaths in a population due to a disease. It is usually expressed as a density rate (e.g. x number of cases per 10,000 people). Prevalence 10 The proportion of total population that currently has a given disease (Example: 1,000 total cases of lung cancer in 2011). Primary Data New data that is collected or observed directly from first-hand experience; typically, primary data collected for CHNA is qualitative in nature. (Example: Focus groups, key informants interviews) Qualitative Data 11 Typically descriptive in nature and not numerical; however, it can be coded into numeric categories for analysis. Qualitative data is considered to be more subjective than quantitative data but describes what is important to people who provide the information. (Example: Focus group data) Quantitative Data 12 Data that has numeric value. Quantitative data is considered to be more objective than qualitative data. (Example: State or National survey data) Risk Factor 13 Characteristics (genetic, behavioral, and environmental exposures and sociocultural living conditions) that increase the probability that an individual will experience a disease (morbidity) or specific cause of death (mortality). Some risk factors can be changed (e.g., smoking) while others cannot (e.g., family history) Secondary Data Data that has already been collected and published by another party. Typically, secondary data collected for CHNA is quantitative in nature (Example: California Health Interview Survey (CHIS), Behavioral Risk Factor Surveillance System (BRFSS)) Source: 4 Merriam Webster Dictionary. Retrieved from http://www.meriam-webter.com/dictionary/benchmark 5 World Health Organization (WHO). Retrieved from http://www.who.int/hia/evidence/doh/en/ 6 Health Promotion Glossary, World Health Organization, Division of Health Promotion, Education and Communications (HPR), Health Education and Health Promotion Unit (HEP), Geneva, Switzerland, 1998. 6 P a g e

7 Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from http://www.chausa.org/assessing_and_addressing _Community_Health_Need.aspx 8 Ibid 9 Aschengrau, A. & Seage, G.R. (2008). Essentials of Epidemiology in Public Health. Sudbury, Massachusetts: Jones and Barlett Publishers. 10 Ibid. 11 Catholic Health Association of the United States (March, 2011). Assessing & addressing community health needs: Discussion Draft. Retrieved from http:// www.chausa.org/assessing_and_addressing _Community_Health_Need.aspx 12 Ibid 13 Adapted from: Green L. & Kreuter M. (2005). Health program planning: An educational and ecological approach. 4th edition. New York, NY: McGrawhill. 7 P a g e

I. Executive Summary Community Health Needs Assessment (CHNA) Background The Patient Protection and Affordable Care Act (ACA) enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their tax-exempt status under section 501(c) 3 of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low-income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance, transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report is conducted in compliance with these new federal requirements. Summary of Needs Assessment Methodology and Process VCCC s overarching aim and main objective in creation of this report is to identify and prioritize unmet community health needs. More importantly this report will act as the foundation to create an implementation strategy to plan coordinated and potential collaborative efforts and activities to promote and improve the health of all individuals residing in the KFH - Panorama City Medical Center Service Area. The area consists of 3,668 sq. miles that spans two Service Planning Areas (SPA), SPA1 and SPA 2 that are distinctly different. The CHNA team collected data on common indicators from the Kaiser Permanente CHNA data platform which is being used by all of its regions. The national common indicators included data in the following categories: demographics, social and economic factors, health behaviors, physical environment, clinical care, and health outcomes. In addition the team utilized the Dignity Health s Community Need Index TM (CNI) to determine areas of highest need. The CNI aggregates socioeconomic indicators known to contribute to health disparity. Additional secondary data sources included The Nielson Company & Thomson Reuter s disease prevalence data at the zip code level to provide a comprehensive epidemiologically-based health profile of the area. The CHNA team also conducted local literature review. A data resource list can be located under Appendix D. Primary data are new data collected directly from first-hand experience. They are typically qualitative (not numerical) in nature. For this community health needs assessment, primary data were collected through key informant interviews, focus groups and community forums with community 8 P a g e

stakeholders. These primary data describe what is important to the people who provide the information and are useful in interpreting secondary data. Secondary data are data that have been collected and published by another entity. They are typically quantitative (numerical) in nature. Secondary data are helpful in highlighting in an objective manner health outcomes that significantly impact a community. Between September and December 2012, 5 focus groups and 8 community forums were conducted in various settings throughout the region. There were 17 key informant interviews conducted with social service, health, public health and clinic service providers. Additionally, 346 surveys were collected and analyzed for common themes. Secondary data was reviewed for validity and appropriateness. The numeric values were then benchmarked against the state, national and HP 2020 targets. Health and socio-economic related issues not meeting benchmarks were compiled into a list of identified health needs. Feedback collected from primary data collection was then used to determine if community perception of health needs aligned with the secondary data. Following the identification of health needs, the CHNA team brought together health care experts and community residents to prioritize the list into 10 most immediate health needs for KFH- Panorama City Medical Center Service Area. A total of two meetings were conducted: one in Panorama City and one in Antelope Valley. Those that participated in prioritization received a copy of the health need profiles created for the identified health needs. Through a multi-voting approach the participants were asked to reach a consensus on the most immediate needs. In addition to the health need profiles the following main criteria were considered during the prioritization process: 1. Does the issue impact both the Antelope Valley and Panorama City? 2. How severe is the problem (i.e. meeting benchmarks state, nation or Healthy People)? 3. Is the issue getting worse over time? 4. Has the community ranked the issue over other issues? 5. Are there reasonable resolutions to the problems? Please note that the KFH Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley s individual top 10 immediate needs did differ as you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey. Please note that the KFH Panorama City Medical Center Service Area is split into two distinct areas; one is listed as Panorama City and the other as Antelope Valley. Because both areas are unique, issues that are an immediate need in one area may not have been ranked a priority in the other area. In fact, Panorama City and Antelope Valley s individual top 10 immediate needs did differ as 9 P a g e

you will see in Section V of this report. The prioritized list for the entire medical center service area was calculated by tabulation of individual rankings from individuals completing the ranking via an online survey. Summary of Prioritized Needs The 10 most immediate and significant health needs that rose to the top for the KFH - Panorama City Medical Center Service Area based on prioritization process are listed below (from highest to lowest priority): 1. Access to Primary Care 2. Obesity/Overweight for Adult and Youth 3. Mental Health 4. Dental Health Services 5. Uninsured Population 6. Physical Environment/Transportation 7. Poverty Rates 8. Diabetes 9. Prenatal Care 10. Breastfeeding The health of the community is the result of many inter-related factors. A key concern for a majority of the community residents and some of the experts has been the impact on the community due to poor economy, unemployment, reduced hours, reduced pay, and in many instances the loss of employer based health care. The overall consensus was that many issues such as obesity, chronic disease, and depression could be the result of stress that comes from being part of the working poor population. The following information provides a summary for each of the prioritized health needs. Data in the following descriptions was retrieved from the CHNA data platform, L.A. Department of Public Health, and The Nielson Company, Thomson Reuters, 2012 unless otherwise noted. Access to Primary Care - Over 55% of respondents identified access to primary care as an immediate need. There are 20 Federally Qualified Health Centers (FQHC) located in the 3,668 square miles that make up the KFH-Panorama City Medical Center Service Area. However 15 of the FQHC s are located in the Panorama City area (856 sq. miles) and 5 FQHC s are located in the Antelope Valley area (2,812 sq. miles). Limited English Proficiency also poses a barrier to healthcare services. This is especially relevant in Panorama City where 26.74% of the population speak English less than very well and speak another language at home. This issue is not as relevant in the Antelope Valley (14.47%) which brings the area average to 23.53% which fares worse than the state (19.85%) and the nation (8.70%). Additionally the high volume of preventable hospitals events in the Antelope Valley (138.38 per 10,000 population compared to Panorama City (105.73) and California (83.17)) shows a need for 10 P a g e

improved disease management. Preventable hospital events include diabetes and other events that could have been prevented if there were adequate primary care resources. Obesity/Overweight for Adult and Youth The 2012 Los Angeles County Department of Public Health article on Trends in Obesity: Adult Obesity Continues to Rise states that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation. The report went on to state obesity is an issue with youth as well. A large majority of those that participated in focus groups and community forums felt obesity is a major health issue. Adults and youth living in low-income minority communities are at a higher risk for obesity and overweight with greater risk of developing chronic disease. In KFH Panorama City Medical Center Service Area, the percentage of obese children (33.75%) is higher than the state (29.82%) and is not meeting the benchmark. Mental Health - Mental health issues inclusive of dual diagnosis (mental health with substance abuse and/or mental health with chronic disease) were a topic of discussion in many of the community forums and focus groups. According to 2012 Thomson Reuter s Depression/Anxiety Estimates for KFH Panorama City Medical Center Service Area, 135,961 cases or 8.5% of the population is dealing with depression or anxiety. The majority of the estimated cases affect those adults 18 to 64 years of age. Major depression has been linked to higher suicide rates which is a huge problem in Antelope Valley (12.4 Per 100,000 Population). The Antelope Valley rate is much higher than Panorama City (7.4 Per 100,000 Population) which creates an average 8.7 per 100,000 population rate for the entire KFH Panorama City Medical Center Service Area. While the area overall falls within California (9.79 Per 100,000 Population) rates, and Healthy People 2020 goal of 10.2 per 100,000 Pop, when looking at each of the two areas there is a noticeable problem in the Antelope Valley. A key informant shared that There is no real infrastructure for adult mental health. Resources and services in our area are very sparse. Dental Health Services - Adults who self-reported having poor dental health in KFH Panorama City Medical Center Service Area (11.66%) faring slightly worse than California (11.27%). Stakeholders shared that the problem is worse for seniors because Medicare does not provide coverage for preventative (cleaning and x-rays) care. In addition, Medi-Cal stopped providing Denti- Cal for adults while retaining services for children. A major concern is the high percentage of adults (34.65%) who self-report they have not visited a dental professional in the past year is worse than the state average of (30.51%). In addition, 12.22% of teens have not had a dental visit in the past year again faring worse than the state average (10.07%). These numbers are in alignment with the numbers of adults without dental insurance in the area (37.36%) which is also worse than the state (33.72%). Many stakeholders were concerned that people underestimate how vital good dental health is to a person s overall general health. Uninsured Population - The lack of health insurance is considered a key driver of health status. KFH Panorama City Medical Center Service Area stakeholders felt it should be addressed as an immediate need. While many felt that the Patient Protection Affordable Care Act (ACA) will help to reduce the burden of uninsured in 2014, concerns remain high especially in the Panorama City area 11 P a g e

where the majority of the population is Latino. A percentage of this population may be undocumented and ineligible for ACA coverage. In KFH Panorama City Medical Center Service Area, Panorama City (22.37%) has the higher percentage of uninsured population compared to Antelope Valley (16.47%). However, the overall KFH - Panorama City Medical Center Service Area (20.81%) is not meeting the state (17.92%) or the U.S. (15.05%) benchmark. Physical Environment/Transportation - Stakeholders brought up the physical environment in both Panorama City and Antelope Valley areas. Community members brought up issues such as public safety, access to parks, and green space. Another major concern that was often brought up by the community was transportation. Transportation as a barrier to accessing health care services was noted to affect the low-income, homeless, chronically ill, disabled and senior population more adversely then others. One key informant shared Primarily in this area, it s the distances between residential areas and key health services. In the Antelope Valley and Palmdale most of the health services are located in the same area. Some folks who live in areas such as Lake Los Angeles, Acton, and Little Rock face the greatest transportation barriers. Poverty Rates - The KFH Panorama City Medical Center Service Area with 15.04% of population living below 100% Federal Poverty Level (FPL) exceeds the state percentage of 13.71%. The Antelope Valley in KFH Panorama City Medical Center Service Area is higher (18.68%) compared to Panorama City (13.74%). Diabetes - Nationally there is an increase in the incidence of Type II Diabetes in both adults and youth. This has been directly associated with the rising rates of overweight and obesity in the United States. Diabetes prevalence rate in the overall KFH Panorama City Medical Center Service Area (7.71%) is slightly higher than the state (7.57%). Antelope Valley is slightly higher (7.73%) than Panorama City (7.70%). This indicator represents the percentage of the population over 20 years old that have been told by a doctor they have diabetes. It is interesting to note that while the prevalence of diabetes is only slightly higher than the state, the rate of diabetes hospitalizations and deaths in the area especially Antelope Valley is extremely high. Prenatal Care - There is grave disparities in the KFH Panorama City Medical Center Service Area between the Antelope Valley and Panorama City related to prenatal care. The percentage of mothers with late or no prenatal care in the Antelope Valley (32.05%), Panorama City (10.75%) and the combined area rate of (16.84%) is much higher than the state (3.14%). This indicator highlights a lack of access to primary care and health knowledge. Lack of prenatal care can also lead to low birth weight infants. Breastfeeding - Greater emphasis and legislation has been put forth on the importance of breastfeeding to improve the health of infants. Research shows that breastfeeding can lead to reduced rates of childhood obesity. The combined rate of exclusive breastfeeding in KFH Panorama City Medical Center Service Area (46.98%) is much lower than the state (60.63%). With similar low rates of breastfeeding in Antelope Valley (46.88%) and Panorama City (47.02%), both areas are not meeting the state (60.63%) benchmark. 12 P a g e

II. Introduction/Background Purpose of the Community Health Needs Assessment Report Kaiser Permanente is dedicated to enhancing the health of the communities it serves. The findings from this CHNA report will serve as a foundation for understanding the health needs found in the community and will help with forming the Implementation Strategy for Kaiser Foundation Hospitals as part of their Community Benefit planning. This report complies with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52 regarding conducting the CHNA for the hospital facility. About Kaiser Permanente Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof all connected by an electronic medical record Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. 13 P a g e

About Kaiser Permanente Community Benefit For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a prevention-focused, evidencebased approach. We go beyond traditional corporate philanthropy or grantmaking to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we ve focused our investments in three areas Health Access, Healthy Communities, and Health Knowledge to address critical health issues in our communities. For many years, we ve worked side-by-side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we ve conducted Community Health Needs Assessments to better understand each community s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long-term, sustainable change and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. Kaiser Permanente s Approach to the Community Health Needs Assessment About the new federal requirements Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c) (3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations this includes minority groups, low-income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization s annual Form 990. SB 697 and California s history with past assessments For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three 14 P a g e

years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. More information about the CHNA platform can be found at http://www.chna.org/kp/. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources 15 P a g e

weren t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each Kaiser Permanente hospital collected primary data through key informant interviews, focus groups, and surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once the community health needs were identified, they were prioritized based on a second set of criteria. This process resulted in a complete list of prioritized community health needs. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will examine the list of prioritized health needs and develop an implementation strategy for those health needs it will address. These strategies will build on Kaiser Permanente s assets and resources, as well as evidence-based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. III. Community Served Kaiser Permanente s definition of community served by hospital facility Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations. Description and map of community served by KFH-Panorama City KFH - Panorama City Medical Center serves the communities of the East San Fernando Valley, Santa Clarita Valley, and Antelope Valley, as depicted in the map below. Although many residents of the Antelope Valley seek hospital services from closer community hospitals, KFH - Panorama City Medical Center Service Area includes the Antelope Valley service area in the "community" for purposes of this CHNA because KFH - Panorama City Medical Center is part of an integrated delivery system that serves this broader area. This broader area will be referred to as the KHF - Panorama City Medical Center Service Area for purposes of this report. The broad communities served by KFH - Panorama City Medical Center Service Area have diverse geography, topography and vary across levels of socio-economic status. As such, in addition to information about the health 16 P a g e

needs of the broader KFH - Panorama City Medical Center Service Area, this report will also include information about Panorama City and Antelope Valley service areas separately to capture both the commonalities and well as the unique problems that exists across these geographies. This will enhance understanding of the significant health needs of KFH - Panorama City Medical Center communities to form more targeted implementation strategies. KFH - Panorama City Medical Center Service Area has two very uniquely characterized areas; Panorama City and the Antelope Valley with diverse geography, topography and large geographic land area with varied levels of socioeconomic status. The residents in the KFH Panorama City Medical Center Service Area share some commonalities and some very unique problems that exist in their individual communities. 17 P a g e

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Geographic Description The KFH Panorama City Medical Center Service Area includes the San Fernando, Santa Clarita, and Antelope Valleys. The San Fernando Valley includes Arleta, Granada Hills, Lakeview Terrace, Mission Hills, North Hills, North Hollywood, Northridge, Pacoima, Panorama City, San Fernando, Sepulveda, Sherman Oaks, Studio City, Sunland, Sun Valley, Sylmar, Toluca Lake, Tujunga, Universal City, Valley Village, and Van Nuys. The Santa Clarita Valley includes Canyon Country, Castaic, Newhall, Santa Clarita, Saugus, Stevenson Ranch, Val Verde, and Valencia. The Antelope Valley includes Acton, California City, Lake Hughes, Lancaster, Littlerock, Llano, Mojave, Palmdale, Pearblossom, Rosamond and Valyermo. The following table summarizes the KFH- Panorama City Medical Center Service Area: Communities of KFH - Panorama City Medical Center Service Area City/Community Zip Codes County Acton 93510 Los Angeles, SPA 1 California City 93505 Kern Cantil, Mojave 93519 Kern Canyon Country 91351, 91387 Los Angeles, SPA 2 Castaic, Val Verde 91384 Los Angeles, SPA 2 Granada Hills 91344 Los Angeles, SPA 2 Lake Hughes 93532 Los Angeles, SPA 1 Lancaster 93534, 93535, 93536 Los Angeles, SPA 1 Littlerock 93543 Los Angeles, SPA 1 Llano 93544 Los Angeles, SPA 1 Mission Hills 91345 Los Angeles, SPA 2 Mojave 93501 Kern Newhall 91321 Los Angeles, SPA 2 North Hills, Northridge, Sepulveda 91343 Los Angeles, SPA 2 North Hollywood, Studio City, Toluca Lake 91601, 91602, 91605, 91606 Los Angeles, SPA 2 Pacoima, Arleta, Lakeview Terrace 91331 Los Angeles, SPA 2 Palmdale 93552, 93550, 93551, 93591 Los Angeles, SPA 1 Panorama City 91402 Los Angeles, SPA 2 Pearblossom 93553 Los Angeles, SPA 1 Rosamond 93560 Kern San Fernando 91340 Los Angeles, SPA 2 Santa Clarita, Saugus 91350, 91390 Los Angeles, SPA 2 Sherman Oaks 91423 Los Angeles, SPA 2 Stevenson Ranch 91381 Los Angeles, SPA 2 Studio City 91604 Los Angeles, SPA 2 Sun Valley 91352 Los Angeles, SPA 2 Sunland 91040 Los Angeles, SPA 2 Sylmar 91342 Los Angeles, SPA 2 19 P a g e

Tujunga 91042 Los Angeles, SPA 2 Valencia, Santa Clarita 91354, 91355 Los Angeles, SPA 2 Valley Village 91607 Los Angeles, SPA 2 Valyermo 93563 Los Angeles, SPA 1 Van Nuys 91401, 91405, 91411 Los Angeles, SPA 2 Universal City 91608 Los Angeles, SPA 2 Source: Health Cities Socio-demographic Profile Population In the KFH - Panorama City Medical Center Service Area, Panorama City area is more densely populated with 1,126,736 people living in 855.53 Sq. miles compared to Antelope Valley with 403,158 people living in 2,812.45 Sq. miles. Overall, KFH - Panorama City Medical Center Service Area is more densely populated compared to the state of California and the U.S. High population density could possibly contribute to more communicable health issues. Table 1: Total Population Density Report Area Total Population Total Land Area (Square Miles) Population Density (Per Square Mile) KFH - Panorama City Medical 1,529,894 3,667.98 417.09 Center Service Area Antelope Valley (Service Area) 403,158 2,812.45 143.35 Panorama City (Service Area) 1,126,736 855.53 1,317 Los Angeles County 9,758,256 4,057.88 2,404.77 California 36,637,288 155,779.20 235.19 United States 303,965,271 3,531,905.50 86.06 Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. Population by Gender Table 2: Population by Gender Report Area Male Female % Male % Female KFH - Panorama City Medical 765,111 764,782 50.01% 49.99% Center Service Area Antelope Valley (Service Area) 200,159 202,997 49.65% 50.35% Panorama City (Service Area) 564,952 561,785 50.14% 49.86% Los Angeles County 4,811,964 4,946,292 49.31% 50.69% California 18,223,156 18,414,132 49.74% 50.26% United States 149,398,720 154,566,544 49.15% 50.85% Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. The total population of KFH - Panorama City Medical Center Service Area (1,529,893) is equally distributed with 49.99% females and 50.01% males. 20 P a g e

Percentages Population by Ethnicity Los Angeles County includes socially, culturally and economically diverse populations. KFH - Panorama City Medical Center Service Area is home to multi-ethnic, multi-lingual populations that require health care services that are innovative and culturally appropriate. The ethnic distribution of the population in KFH Panorama City Medical Center Service Area is Hispanics (49.50%), followed by White (33.81%), Asians (7.36%) and Blacks (6.65%). A total of (2.68%) of the population falls under multiple and other races which could include smaller groups of people from various ethnic backgrounds. Graph 1: Population by Ethnicity KFH Panorama City Medical Center Service Area 100 80 Lancaster Palmdale Van Nuys Pacoima Sylmar Panorama City 60 40 20 0 White % Black % Asian % Hispanic % All Other % Data Source: The Nielsen Company., Thomson Reuters, 2012 The six most populated cities in KFH - Panorama City Medical Center Service Area are Lancaster (186,865), followed by Palmdale (176,204), Van Nuys (167,511), Pacoima (103,747), and Sylmar (93,100) and Panorama City (69,925). Of the most densely populated cities Pacoima has the highest percent of Hispanic population (88.46%) compared to other cities in KFH - Panorama City Medical Center Service Area (2012 The Nielsen Company, 2012 Thomson Reuters). Population by Age Graph 2: Population by Age Distribution 9% 7% 9% 19% 14% 10% 16% 16% Age 0-4 Age 5-17 Age 18-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65+ Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. 21 P a g e

About 26% of the total population in KFH - Panorama City Medical Center Service Area is children and youth between the ages of 0-17 years; 65% are adults between the ages of 18 to 64 years and 9% are older adults ages 65 plus. In general, older population use more health care services compared to younger population. Table 3: Population Change between 2000 and 2010 U.S. Census Report Area Total Population, 2010 Census Total Population, 2000 Census Percent Change from 2000-2010 Census KFH - Panorama City Medical 1,573,307 1,518,346 3.62% Center Service Area Antelope Valley (Service Area) 420,603 400,776 4.95% Panorama City (Service Area) 1,152,704 1,117,570 3.14% Los Angeles County 9,818,605 9,519,338 3.14% California 37,253,956 33,871,648 9.99% United States 308,745,538 281,421,906 9.71% Note: No breakout data available. Data Source: U.S. Census Bureau, 2000 Census of Population and Housing, Summary File 1; U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1. Source geography: County. The percentage of growth in Antelope Valley (4.95%) exceeded Panorama City (3.14%). Overall growth in KFH - Panorama City Medical Center Service Area between 2000 and 2010 was 3.62%. A positive or negative shift in the total population over time impacts health care providers, and the utilization of health care services and resources. Limited English Proficiency The inability to speak English can create barriers to healthcare access, provider communications, and health literacy/education. KFH - Panorama City Medical Center Service Area has a higher percent (23.53%) of population that has limited English proficiency compared to the state (19.85%) and the U.S. (8.70%). Antelope Valley (14.47%) is lower than the state and the U.S benchmarks; however, Panorama City (26.74%) and the L.A. County (26.97%) have a higher percentage of people not speaking English proficiently and therefore not meeting the state and the national benchmarks. This could likely be due to the higher percentages of Latino, Asian and other multiple ethnicities in KFH Panorama City Medical Center Service Area speaking a language other than English at home. The Nielson Company and Thomson Reuters report estimates that communities such as Pacoima (80%), San Fernando (77.8%), and Panorama City (66.6%) have the highest monolingual Spanish population in KFH - Panorama City Medical Center Service Area. Community feedback from focus groups, community forums, and key informant interviews identified language as one of the major barriers for not seeking or acquiring appropriate medical care. Lack of effective communication between health care providers and community members increases the probability of patient noncompliance with prescribed treatment and pharmaceuticals, which could negatively affect the health outcomes. Language was also identified as a contributing factor for the 22 P a g e

lack of health literacy, understanding the importance of seeking preventative services and lack of awareness regarding the available health care resources in the community. Table 4: Percent of Population With Limited English Proficiency Report Area Total Population (For Whom English Proficiency is Determined) Total Limited English Proficiency Population KFH - Panorama City Medical Percent Limited English Proficiency Population 1,419,753 334,101 23.53% Center Service Area Antelope Valley (Service Area) 371,609 53,776 14.47% Panorama City (Service Area) 1,048,144 280,325 26.74% Los Angeles County 9,098,454 2,453,700 26.97% California 34,092,224 6,768,923 19.85% United States 283,833,856 24,704,752 8.70% Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. Poverty <100% Federal Poverty Level (FPL) Poverty is a key driver of health status in a community. Those living at <100% of the FPL in KFH - Panorama City Medical Center Service Area (15.04%) is not meeting the state (13.71%) and the national (13.82%) benchmarks. Within the KFH Panorama City Medical Center Service Area, poverty in Antelope Valley (18.68%) is significantly higher than in Panorama City (13.74%). Poverty creates barriers for accessing health services, healthy food, and other necessities and contributes to poor health status. Poverty could likely contribute to the high rates of people not graduating from high school and unemployment rates. The communities with the highest number of households with an annual income less than $15,000 in KFH - Panorama City Medical Center Service Area are Palmdale, Lancaster, North Hollywood, Van Nuys, Mojave, and Acton. The communities with less than 5,000 residents such as Pearblossom, Llano, Cantil, and Mojave have disproportionately distributed annual income levels resulting in many residents with an annual income less than $15,000 (The Nielsen Company., Thomson Reuters, 2012). 23 P a g e

Table 5: Population in Poverty (<100%FPL) Report Area Total Population (For Whom Poverty Status is Determined) Total Population in Poverty (<100% FPL) Percent Population in Poverty (<100% FPL) KFH - Panorama City Medical Center 1,503,948 226,220 15.04% Service Area Antelope Valley (Service Area) 395,118 73,815 18.68% Panorama City (Service Area) 1,108,830 152,405 13.74% California 35,877,036 4,919,945 13.71% United States 296,141,152 40,917,512 13.82% Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. Population Below 200%FPL Population below 200% FPL is affected by many of the same barriers of people under 100% FPL. Poverty has been identified as a barrier to accessing healthy foods, health care, dental care and other services that are necessities to lead a healthier life. The percent of population with income below 200% FPL is high in KFH - Panorama City Medical Center Service Area (36.86%) compared to the state (32.83%) and the U.S. (31.98%). Therefore, KFH - Panorama City Medical Center Service Area is not meeting either the state or the national benchmarks. Table 6: Population with Income Below 200% Poverty Level Report Area Total Population Population with (For Whom Income Below 200% Poverty Status is Poverty Level Determined) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Percent Population with Income Below 200% Poverty Level 1,503,948 554,356 36.86% 395,118 161,871 40.97% 1,108,830 392,485 35.40% California 35,877,036 11,779,509 32.83% United States 296,141,152 94,693,416 31.98% Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract The communities such as Lancaster, Palmdale, North Hollywood, and Van Nuys have the highest number of households that fall under the 200% poverty level in KFH - Panorama City Medical Center Service Area (The Nielsen Company and Thomson Reuters, 2012). 24 P a g e

Children in Poverty Children between 0 and 17 years of age who live below 100% FPL face greater barriers then adults. Research shows that hunger affects learning and behavior. Poverty impacts the parent s ability to access health services, affordable housing, and healthy food along with other necessary life sustaining services that impacts the overall health of a child. Table 7: Percent of Children in Poverty Report Area Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. The KFH - Panorama City Medical Center Service Area has 21.33% of children in their area living in poverty; this percent is higher than the state (19.06%) and the U.S. (19.19%) benchmarks. The percent of children living in poverty is significantly higher in Antelope Valley (26.77%) compared to Panorama City (19.86%). Figure 1: Percent of Children in Poverty Total Population (For Whom Poverty Status is Determined) Children in Poverty Percent Children in Poverty KFH - Panorama City Medical 413,280 88,170 21.33% Center Service Area Antelope Valley (Service Area) 125,609 33,623 26.77% Panorama City (Service Area) 287,671 54,547 18.96% California 9,173,776 1,748,267 19.06% United States 72,850,296 13,980,497 19.19% Percentage of Children (Age 0-17), by Tract, ACS 2006-2010 5-Year Estimate Over 40.0% 30.1-40.0% 20.1-30.0% 10.1% - 20.0% Under 10.1% 25 P a g e

Unemployment Rate Table 8: Unemployment Rate (Per 100,000 Populations) Report Area Labor Force Number Employed Number Unemployed Unemployment Rate KFH - Panorama City 787,802 706,250 81,551 10.35 Medical Center Service Area Antelope Valley (Service 209,723 187,577 22,146 10.56 Area) Panorama City (Service Area) 578,079 518,673 59,405 10.28 California 18,648,310 16,835,907 1,812,403 9.70 United States 1,065,164,285 978,901,418 86,262,867 8.10 Note: This indicator is compared with the state average. Data Source: U.S. Bureau of Labor Statistics, December, 2012 Local Area Unemployment Statistics. Source geography: County. In KFH - Panorama City Medical Center Service Area, Antelope Valley has a higher unemployment rate (10.56) compared to Panorama City (10.28). As a whole, the KFH Panorama City Medical Center Service Area (10.35) is higher than the state (9.70) and the U.S (8.10). Increased unemployment rates could lead to an increase in the number people living below 200%FPL. Population without High School Diploma Percentage of the population with no high school diploma is higher in KFH Panorama City Medical Center Area (23.77%) compared to the state (19.32%) and the U.S. (14.97%). Within KFH - Panorama City Medical Center Area, Panorama City has the highest percentage (24.25%) of people without high a school diploma compared to Antelope Valley (22.30%). Pacoima (33%), San Fernando (29.0%), Panorama City (25.5%), Sun Valley (23.1%) and North Hollywood (24.3%) are specific communities in the KFH- Panorama City Medical Service Area that have more than 20% of the population over age 25 with less than a 9 th grade education (U.S. Census Bureau, 2007-2011 American Community Survey). Graph 3: Percent of Population without High School Diploma 23.77% 22.30% 24.25% 19.32% 14.97% PFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. 26 P a g e

High School Graduation Rate On time graduation rates are lower in the KFH - Panorama City Medical Center Service Area. Panorama City (75.93%) and Antelope Valley (79.48%) compared to the state (82.27%) and the U.S. (82.26%). In addition to faring worse than the state and nation they are not meeting the HP 2020 Target (>82.4%). Community leaders and agency partners who participated in key informant interviews and focus groups expressed concern about the literacy levels of the community and felt that the cycle of poverty will continue without the knowledge to obtain higher paying jobs. Table 9: Percent of Students Graduating on Time Report Area Total Student Enrollment Average Freshman Base Enrollment Diplomas Issued On-Time Graduation Rate KFH - Panorama City Medical 87,191 21,663 16,639 76.81 Center Service Area Antelope Valley (Service Area) 28,388 5,342 4,246 79.48 Panorama City (Service Area) 58,803 16,321 12,393 75.93 California 1,971,766 501,919 412,936.45 82.27 United States 14,815,258 3,745,141 3,080,911.45 82.26 HP 2020 Target >82.4 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Local Education Agency (School District) Universe Survey Dropout and Completion Data, 2008-2009. Source geography: School District. Community leaders shared their concerns regarding lack of English and language proficiency, math skills, and high school dropout rates, stating these reflect negatively on the wellbeing and growth of the communities they live in. Students Reading below 4 th Grade Level Graph 4: Percent of Students Reading below 4 th Grade Level 40.54% 47.72% 37.22% 35.64% 28.63% 36.30% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States HP 2020 Target 27 P a g e

The overall percentage of students reading below the 4 th grade level in KFH Panorama City Medical Center Service Area is much higher (40.54%) compared to the state (35.64%), the U.S (28.63%) and the HP 2020 target rate of <=36.3%. KFH Panorama City Medical Center Service Area, Antelope Valley s percentage (47.72%) is higher compared to Panorama City s percentage (37.22%). This issue was identified as a high level of concern in the community by the community leaders, educators and stakeholders during the primary data collection process. Low literacy levels were identified as possible reasons for rates of unemployment, poverty, and poor general health. Respondents also noted that the low literacy levels of residents of the community created barriers to health education and the reading of distributed printed materials. Figure 2: Percent of Students reading below 4 th Grade Level Pct. of Student Test Scores 'Not Proficient', By School District, State Department of Education, 2011 Over 45.0% 35.1-45.0% 25.1-35.0% 15.1-25.0% Under 15.1% The inability to read English is linked to poverty; unemployment; and barriers to healthcare access, provider communication and health literacy. Homeless Populations Los Angeles Homeless Services Authority (LAHSA) defines chronic homelessness as An unaccompanied disabled person who has been continuously homeless for over one year or has had at least four episodes of homelessness in three years; or a family is considered chronically homeless if at least one member meets the definition of chronic homelessness (LAHSA, 2011). More than 60% of the chronically homeless population falls between 25 and 54 years of age. The 2013 Key Indicators of Health report published by the Los Angeles County Department of Public Health, reports that Antelope Valley has the highest percent (28.0%) of adults who were unable to pay their rent or mortgage in the past 2 years. Key Indicator also reports that SPA 2 (San Fernando and Santa Clarita Valleys) in LA County has the highest percent of (9.6%) homeless adults compared to the rest of the SPAs in the County (Los Angeles County Department of Public Health, Office of Assessment and Epidemiology (Key Indicators of Health by Service Planning Area, March 2013). 28 P a g e

Community Safety Table 10: Community Safety by SPAs Neighborhood LA County SPA 1 SPA 2 Percent of adults believe their neighborhood is safe 84.3% 87.1% 85.1% Children 1 to 17 years who can easily find a safe place to 84.2% 86.4% 87.5% play Adults who report little or no graffiti 69.2% 84.6% 74.2% Adults reporting little or no trash 76.1% 70.5% 81.9% Adults reporting adequate lighting on the street and around 79.2% 72.9% 71.1% their neighborhood Adults who report that sidewalks are well maintained in their neighborhood 80.4% 90.8% 79.5% Source: Key Indicators of Health by Service Planning Area (LAC DPH, 2013). Please note that the information presented is only at the county and SPA level. While KFH- Panorama City covers all of SPA 1, they only cover a portion of SPA 2. The findings from the primary data collection inform us differently. Many of the community residents expressed that they do not feel safe going out in their neighborhoods to play, walk or conduct physical activity due to crime, inadequate street lighting, and sidewalks in disrepair and gang violence. Community safety was a priority to the residents versus available access to health care services. Access to Health Care Uninsured Population Populations that do not have access to health insurance experience barriers to primary, specialty, dental, and mental health care. KFH - Panorama City Medical Center Service Area has higher rates of uninsured (20.81%) compared to the state (17.92%) and the nation (15.05%) benchmarks. Additionally, both Antelope Valley (16.47%) and Panorama City (22.37%) are higher than compared to the national benchmark. The communities in KFH - Panorama City Medical Center Service Area with the highest number of uninsured include Van Nuys, Lancaster, Palmdale, North Hollywood, Pacoima and Panorama City, Sylmar, North Hills, and Sun Valley. Being uninsured is a major factor in health care disparities. 29 P a g e

Graph 5: Percentage of Uninsured Population 20.81% 16.47% 22.37% 17.92% 15.05% KFH - Panorama City Med Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2008-2010 American Community Survey 3-Year Estimates. Source geography: PUMA. Lack of Access to Primary Care One of the issues that surfaced from the feedback received from key informant interviews, community forums, and focus groups was the overwhelming consensus that there is lack of access to primary care for the under insured, uninsured and Medi-Cal patient. Over 55% of the respondents identified lack of access to primary care as the most immediate health need. In addition to having a high volume of uninsured there is also a lack of primary care health professionals. Many times this results in residents not having a consistent source for primary care which then leads to poorer health outcomes and greater cost to the health care system. All of these critical issues relate to an increase in the burden of diseases in communities. The primary care provider rates for KFH - Panorama City Medical Center Service Area (80.60 and 78.20 per 100,000 population) are higher than the state (83.20) and the nation (84.70) and not meeting the benchmarks. Similarly, the percentage of people without a regular doctor in the KFH - Panorama City Medical Center Service Area (Panorama City 16.17% and Antelope Valley 16.70%) is higher and not meeting the state 14.23% benchmark. Table 11: Primary Care Provider Rate (Per 100,000 Population) Report Area Total Population Total Primary Care Providers Primary Care Provider Rate (Per 100,000 Population) KFH - Panorama City Medical 1,573,306 1,259 80 Center Service Area Antelope Valley (Service Area) 420,602 329 78.20 Panorama City (Service Area) 1,152,704 930 80.60 California 37,253,956 31,006 83.20 United States 312,471,327 264,897 84.70 Note: This indicator is compared with the state average. Data Source: U.S. Health Resources and Services Administration Area Resource File, 2011. Source geography: County. 30 P a g e

Table 12: Lack of Access to Primary Care Report Area Sample Number Percent Population (Total) Without Regular Doctor Without Regular Doctor KFH - Panorama City Medical 1,625,476 265,156 16.31% Center Service Area Antelope Valley (Service Area) 432,105 72,150 16.70% Panorama City (Service Area) 1,193,371 193,006 16.17% California 37,362,000 5,318,000 14.23% Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), 2009. Source geography: County (Grouping). Percent of Designated Population Underserved Health care facilities designated as "Health Professional Shortage Areas" (HPSAs) are defined as having shortages of primary medical care, dental or mental health providers. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. The following table reports the percentage of the population that is designated as underserved. Even though 67.86% of population is designated as underserved in KFH - Panorama City Medical Center Service Area, 90.68% of those people live in Antelope Valley. Table 13: Percent of Designated Population Underserved Report Area Total Population, 2010Census HPSA Designation Population Underserved Population Percent of Designated Population Underserved KFH - Panorama City 1,574,155 181,495 123,164 67.86% Medical Center Service Area Antelope Valley 421,691 42,171 38,239 90.68% (Service Area) Panorama City (Service 1,152,464 139,324 84,925 60.96% Area) California 37,267,509 5,171,993.90 2,955,395.91 57.14% United States 312,676,557 52,826,822.65 32,117,352.05 60.80% Data Source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, 2012. Source geography: Address. The issue of physician shortage was brought up by the community residents, leaders and key informants during the primary data collection process. Shortage of mental health professionals was identified as the one of the top 5 needs in the Antelope Valley. KFH - Panorama City Medical Center Service Area is not meeting the state or the national benchmarks. 31 P a g e

Lack of Social Support The percentage of people who reported receiving some social support most of the time in KFH Panorama City Medical Center Service Area (71.19%) is lower than the state (75%) and the national (80.33%) benchmarks. These lower rates of social support were reiterated by the community members. About 18% of the 600 participants that contributed to the primary data reported that lack of family or social support is a contributing factor for their concerns regarding teen pregnancies, suicides, drug and alcohol abuse, overweight, and mental health issues in their communities. Graph 5: Population that Reported Inadequate Social Support 80.33% 71.19% 71.34% 71.13% 75% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010. Source geography: County. Infant Mortality The number of deaths of infants less than a year old per 1,000 births indicates the rates of infant mortality are connected to the issues pertaining to limited access to care. This could be representative of the prenatal care a mother receives, the birth weight of the babies and whether or not the babies receive breast milk. Participants of the primary data collection process identified infant mortality to be a concern in KFH - Panorama City Medical Center Service Area. The two major issues identified as contributing to the infant mortality were low birth weight and minimal prenatal care received by expectant mothers. During the primary data collection process, leaders, public health educators, service providers and stakeholders identified black infant mortality to be high in the Antelope Valley. This need did not rise to the top 10 immediate needs for Antelope Valley. Infant low birth weight and low breast feeding rate were ranked among the top 25 needs in Antelope Valley. Infant Low Birth Weight Birth weight under 2500g is categorized as low birth weight. This indicator is relevant because low birth weight infants are at high risk for health problems. This indicator can also highlight the existence of health disparities. The percent of low birth weight in KFH - Panorama City Medical 32 P a g e

Center Service Area (7.43%) is higher compared to the state (6.80%). Antelope Valley has a higher percent of low birth weights (8.98%) compared to Panorama City (6.81%). Table 14: Percent of Low Birth Weight Births Report Area Total Population Total Live Births Number Low Birth weight (1500g - 2500g) Number Very Low Birth weight (Under 1500g) Total Low Birth Weight Births Percent Low Birth Weight Births KFH - 1,571,942 21,826 1,350 272 1,622 7.43% Panorama City Medical Center Service Area Antelope Valley 419,491 6,247 468 93 561 8.98% (Service Area) Panorama City 1,152,451 15,579 882 179 1,061 6.81% (Service Area) California 37,253,956 509,979 no data no data 34,692 6.80% Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, 2010. Source geography: ZIP Code. Breastfeeding In KFH Panorama City Medical Center Service Area, the percentage of mothers who breastfeed exclusively (46.98%) is considerably lower than the state (60.63%). Similarly, percentage of mothers who breastfeed any (90.77%) is lower than the state (91.74%). The community members identified low rates of breastfeeding to be a health concern and suggested increasing lactation education in the KFH - Panorama City Medical Center Service Area to increase overall rates of breastfeeding. Table 15: Percent of Mothers Breastfeeding (Exclusively or Any) Report Area Total In- Hospital Births Mothers Breastfeeding (Exclusively) Percent Mothers Breastfeeding (Exclusively) Mothers Breastfeeding (Any) Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, 2011. Source geography: County. Percent Mothers Breastfeeding (Any) KFH - 18,679 8,775 46.98% 16,954 90.77% Panorama City Medical Center Service Area Antelope Valley 5,077 2,380 46.88% 4,584 90.29% (Service Area) Panorama City 13,602 6,395 47.02% 12,370 90.94% (Service Area) California 873,873 529,794 60.63% 801,710 91.74% 33 P a g e

Prenatal Care Overall, KFH - Panorama City Medical Center Service Area has a higher percentage of mothers receiving late or no prenatal care (16.84%) compared to the state (3.14%). Specifically, the Antelope Valley area (32.05%) is significantly higher than the state. Table 16: Percentage of Mothers with Late or No Prenatal Care Report Area Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, 2010. Source geography: ZIP Code. Chronic Disease Prevalence and Incidence Diabetes Total Population Total Live Births Prenatal Care Started in 2nd Trimester Prenatal Care Started in 3rd Trimester No Prenatal Care Total Mothers with Late or No Prenatal Care Percent Mothers with Late or No Prenatal Care KFH 1,571,942 21,826 3,044 545 87 3,676 16.84% Panorama City Medical Center Service Area Antelope 419,491 6,247 1,673 280 49 2,002 32.05% Valley (Service Area) Panorama 1,152,451 15,579 1,371 265 38 1,674 10.75% City (Service Area) California 37,253,956 509,979 no data no data no data 15,995 3.14% Diabetes is a condition that is a result of high blood sugar levels. There are three types of diabetes: Type I where the pancreas produces little or no insulin; Type II diabetes (most preventable); and Gestational diabetes (specifically expectant mothers). Type II is the most common diabetes and can be prevented by consuming whole grains, fruits and vegetables, limiting high fat or calorie foods, lean meat, fish, low-fat dairy products, reducing sweetened drinks, losing excess body weight and regular physical activity (LAC DPH, 2012). Diabetes risk factors include being obese, age, heredity, race/ethnicity, poor dietary habits, and lack of physical activity and history of diabetes during pregnancy. According to the report published by the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible 34 P a g e

Public Health Crisis diabetes rates have increased from 6.6% in 1997 to 9.1% in 2007 (LAC DPH, 2012). Table 16: Diabetes Prevalence Report Area Total Population Population with Percent with (Age 20 ) Diabetes Diabetes 1,103,751 85,081 7.71% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) 292,227 22,594 7.73% Panorama City (Service Area) 811,524 62,487 7.70% California 26,721,032.93 2,022,190 7.57% United States 239,583,791.97 21,015,523 8.77% Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, 2009. Source geography: County. Prevalence of diabetes in KFH - Panorama City Medical Center Service is higher than the state and is not meeting the state benchmark. The numbers reported are the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. Diabetes is a prevalent problem in the U.S; it may indicate an unhealthy lifestyle and puts individuals at risk for further health problems (CDC, 2009). Communities of Lancaster, Palmdale, North Hollywood, Pacoima, and Van Nuys had the highest estimated diabetes prevalence in KFH - Panorama City Medical Center Service Area (The Nielson Company., Thomson Reuters, 2012). Table 17: Diabetes Hospitalization (Per 100,000 Population) Report Area Patient Discharges for Diabetes Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH - Panorama City 2,601 0.89% 8.26 9.17 Medical Center Service Area Antelope Valley (Service 921 1.13% 11.02 12.35 Area) Panorama City (Service 1,680 0.80% 7.27 8.02 Area) California 58,388 0.86% 8.48 10.40 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010-2011. Source geography: ZIP Code. Overall diabetes related hospitalization among adults in KFH - Panorama City Medical Center Service Area may demonstrate that the rates are meeting the state benchmark; however, the rate of hospitalization in Antelope Valley (12.35 Per 100,000 Population) is higher than the state. Community residents in Antelope Valley expressed that there is a shortage of programs and counseling to deal with chronic diseases including diabetes. 35 P a g e

According to the data available, diabetes demonstrates high disparities among Blacks, Hispanic/Latino and White populations. An article from the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible Public Health Crisis reports that in 2007, 12.8% of the Hispanic/Latino population, 11.4% of Blacks, 9.0% of Asian/Pacific Islanders and 5.7% of Whites had diabetes (LAC DPH, 2012). Graph 6: Diabetes Prevalence by Ethnicity Panorama City (Service Area) Antelope Valley (Service Area) California White Black Hispanic/ Latino American Asian/ Pacific Indian/Alaskan Islander Native Multi Race Race Unknown Panorama City (Service Area) 0.60% 1.12% 1.00% 0 0.54% 1.28% 0.96% Antelope Valley (Service Area) 0.93% 1.77% 0.91% 0 0.47% 1.22% 1.25% California 0.77% 1.62% 0.91% 0.85% 0.59% 0.87% 1.01% Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010. Source geography: ZIP Code. Related indicators that were identified as possibly contributing to the increase in diabetes prevalence in KFH - Panorama City Medical Center Service Area could likely be a result of poverty, inadequate fruit and vegetable consumption and physical inactivity. In addition, environmental factors such as access to fast food restaurants, lack of park access, walk ability, lack of recreational and fitness facilities might be contributing to the higher rates of diabetes related health problems. It is also evident that the community residents do not seek preventative services and this was confirmed by the community leaders and health providers. Health providers stated that a high rate of patients are noncomplaint with prescription medications and do not keep their follow up appointments with the doctors. Obesity The County of Los Angeles Public Health Department s (LAC DPH) September 2012 article on the Trends in Obesity: Adult Obesity Continues to Rise, reports that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation and also reports that about 23.6% of the adults (18 years or older) in Los Angeles County were obese (Los Angeles County Department of Public Health, 2012). According to the World Health Organization (WHO), overweight or obesity is an accumulation of excess body fat that affects a person s overall health. Overweight and obesity is calculated by using the Body Mass Index where the weight of the person (in kilograms) divided by the square of their 36 P a g e

height (in meters). Overweight is a BMI equal to or more than 25 and obesity is where the BMI is over 30 on the BMI scale (WHO, Obesity and Overweight Fact Sheet, 2012). Overweight and obesity is one of the most preventable health problems and causes of type II diabetes which could potentially lead to other chronic diseases such as heart disease, stroke, arthritis and many forms of cancers. The percentage of overweight adults in KFH - Panorama City Medical Center Service Area is slightly higher than the state and the national averages. Children who are obese have a higher risk of developing Type II Diabetes as an adult. Table 18: Percent of Obese Children Report Area Student Population Number Obese Percent Obese Tested KFH - Panorama City Medical 55,406 18,701 33.75% Center Service Area Antelope Valley (Service Area) 17,397 5,752 33.06% Panorama City (Service Area) 38,009 12,949 34.07% California 1,300,153 387,743 29.82% Note: This indicator is compared with the state average. Data Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011. Source geography: School District. Adult overweight rates are higher in KFH - Panorama City Medical Center Service Area and are not meeting the state and national benchmarks. However, adult obesity rates are better than state and national benchmarks. On the contrary, youth overweight rates are better than state benchmark but youth obesity in KFH - Panorama City Medical Center Service Area is not meeting the state benchmark. Ethnic data for obese youth demonstrates high disparities between Hispanic/Latino, Black and Non- Hispanic American Indian/Alaskan Native populations. The rates of overweight among adults and obesity among youth are higher in KFH - Panorama City Medical Center Service Area compared to the state. The health need is likely being impacted by poverty rates, inadequate consumption of fruits and vegetables, physical inactivity, fast food access, lack of parks and walk ability along with lack of recreational facilities. Cardiovascular disease Cardiovascular disease is one of the leading causes of death in the U.S. Cardiovascular disease includes heart disease and stroke. Risk factors for cardiovascular disease (heart disease and stroke) include high blood cholesterol, high blood pressure, diabetes, tobacco use, overweight, obesity, diet, lack of physical activity, alcohol use, and family history, age, gender and ethnicity (CDC: Heart Disease and Stroke, 2012). 37 P a g e

Table 19: Heart Disease Prevalence Report Area Total Population (Age 18 ) Number with Heart Disease Percent with Heart Disease KFH - Panorama City Medical 1,189,293 69,759 5.87% Center Service Area Antelope Valley (Service Area) 315,015 18,807 5.97% Panorama City (Service Area) 874,278 50,952 5.83% California 27,547,000 1,618,000 5.87% Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), 2009. Source geography: County (Grouping). Even though the overall percentage of heart disease prevalence in KFH - Panorama City Medical Center Service Area is the same as the state, Antelope Valley heart disease prevalence is higher (5.97%) than the state (5.87%). Lancaster, Palmdale, Van Nuys, North Hollywood and Canyon Country have the highest number of congestive heart failure compared to other communities in KFH - Panorama City Medical Center Service Area (2012, Nielson Company, 2012 Thomson Reuters). Possible contributing factors for the high heart disease prevalence include poor dietary practices, choosing unhealthy foods from fast food restaurants, lack of regular physical activity in addition to poverty, and lack of nutritional knowledge. Table 20: Heart Disease Mortality Rate (Per 100,000 Population) Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH - Panorama City Medical 1,511,828 1,883 155.10 Center Service Area Antelope Valley (Service Area) 419,340 523 171.60 Panorama City (Service Area) 1,092,488 1,360 148.80 California 36,634,623 44,613 131.34 HP 2020 Target <= 100.8 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: California Department of Public Health, Death Statistical Master File, 2008-2010. Source geography: ZIP Code. Heart disease mortality rates in KFH - Panorama City Medical Center Service Area (155.10 Per 100,000 Population) and the state (131.34 Per 100,000 Population) are higher than the HP 2020 target (<=100.8 Per 100,000 Population). Overweight and obesity could lead to chronic diseases such as heart disease. Ethnic data for the heart disease mortality is not available for the entire KFH - Panorama City Medical Center Service Area; and a comparison between the ethnic groups with missing data sets is not viable. The national data demonstrates a high rate of heart disease mortality among Native American/Alaskan Natives, then Blacks, Hispanic followed by Whites (CDC, 2011). 38 P a g e

Total estimated cases for Congestive Heart Failure and Heart Attack seem to be high in Pacoima, Sylmar, North Hills, Granada Hills, Valencia, Panorama City, North Hollywood, Lancaster and Palmdale (The Nielsen Company, Thomson Reuter, 2012). High numbers of Coronary Heart Disease cases are evident in Pacoima, Sylmar, Granada Hills, Valencia, Sherman Oaks, Studio City, North Hollywood, Lancaster and Palmdale per the Thomson Reuter 2012 estimations (The Nielsen Company, 2012; Thomson Reuter, 2012). Estimated numbers of Stroke cases is higher in Lancaster, Palmdale, and Rosamond, Pacoima, Sylmar, Van Nuys, Sherman Oaks, North Hollywood, Studio City and Valley Village in KFH - Panorama City Medical Center Service Area (The Nielsen Company, Thomson Reuters, 2012). The health need for coronary heart disease and mortality could likely be impacted by poverty, low educational achievements, lack of physical activity, poor diet, lack of green space for physical activity, and walk ability. Cervical Cancer According to the National Cancer Institute, cervical cancer occurs in the tissue of the cervix (the organ connecting uterus and the vagina). The most common risk factor for cervical cancer is HPV infection. However, risky behaviors such as smoking can increase the risk for cervical cancer. Cervical cancer risk can be decreased by getting regular screening tests (Pap smear) or receiving HPV vaccination (NCI, What You Need to Know about Cervical Cancer, 2012). Table 21: Cervical Cancer Incidence Rate (Per 100,000 Population) Report Area Total Population, ACS 2005-2009 Annual Incidence, 2005-2009 Average KFH - Panorama City Medical Center Annual Incidence Rate (Per 100,000 Population) 1,565,409 156 9.90 Service Area Antelope Valley (Service Area) 416,615 42 10 Panorama City (Service Area) 1,148,794 114 9.90 California 36,308,528 3,014 8.30 United States 301,461,536 24,117 8 HP 2020 Target <= 7.1 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009. Source geography: County. Cervical cancer incidence rate in KFH - Panorama City Medical Center Service Area (9.90) is higher than the state (8.30), the nation (8) and the HP 2020 (<=7.1) benchmarks. Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicate that a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Data on American Indian/Alaskan Natives is unavailable for 39 P a g e

KFH - Panorama City Medical Center Service Area level and the comparisons across the ethnicities for cervical cancer are inconclusive due to the missing data. Graph 7: Cervical Cancer Incidence Rate (Per 100,000) by Ethnicity 16 14 12 10 8 6 4 2 0 10.210.6 8.5 7.7 7.9 10.3 9.3 8.4 7.3 7.8 7.6 7.2 7.3 White Black Asian American Indian / Alaskan Native Panorama City (Service Area) California Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009. Source geography: County. 0 0 3.2 Antelope Valley (Service Area) United States 13.213.7 11.911.8 Hispanic / Latino According to the Nielsen Company & Thomson Reuter 2012 estimates, communities such as Lancaster, Palmdale, Ridgecrest, Granada Hills, North Hills, and North Hollywood have the highest rates of cervical cancer compared to other areas in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). STDs (Chlamydia Rates Per 100,000 Population) The rates of sexually transmitted diseases such as Chlamydia are high in KFH - Panorama City Medical Center Service Area (479.6) than the state (399.36) and the U.S (406.89). The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up unsafe sexual practice repeatedly and suggested that education on safe sex and the effects of STDs on the cervical cancer incidence might encourage safer sexual practices. 40 P a g e

Graph 8: Chlamydia Rates (Per 100,000 Population) 479.6 488.9 476.2 399.36 406.89 KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States. Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009. Source geography: County. Colorectal Cancer The National Cancer Institute describes colon cancer as a cancer that develops in the tissue of the colon. The risk factors for colorectal cancer include family history, age 50 years or more, polyps in colon or rectum, smoking, diet and personal history of cancer (NCI, 2012). Colorectal cancer incidence rates are higher in KFH - Panorama City Medical Center Service Area (45.1) compared to the state (43.7), the nation (40.2) and the HP 2020 (38.6) per 100,000 population. Colorectal cancer demonstrates high disparities among Black, Whites and Asian and Hispanic/Latino sub-populations in KFH - Panorama City Medical Center Service Area. Graph 9: Colon and Rectum Cancer Incidence Rate (Per 100,000 Population) 45.1 45.1 45.1 43.7 40.2 38.6 KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States HP 2020 Target Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2004-2008. Source geography: County. 41 P a g e

Estimated incidences of colorectal cancer are higher in Lancaster, Palmdale, Ridgecrest, North Hollywood, Van Nuys, Valencia, Santa Clarita, Canyon Country, Granada Hills, Pacoima, Sylmar, Sherman Oaks and Studio City compared to other cities in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). The high rates of colorectal cancer could likely being impacted by the related indicators such as inadequate fruit and vegetable consumption (adults), physical inactivity among adults, heavy alcohol consumption, tobacco usage, and access to liquor stores, access to fast food restaurants, and limited access to grocery store. Low rates of colon cancer screenings (sigmoid/colonoscopy), and higher rates of diabetes are additional drivers that could likely be contributing to the high rates of colorectal cancer incidences in KFH - Panorama City Medical Center Service Area. Mental Health The World Health Organization defines mental health as Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or injury (WHO, 2012). The World Health Organization also describes poor mental health is associated with a stressful work environment, risk of violence, rapid social changes, unhealthy lifestyle and ill health. Persistent social stressors such as loss of employment, economic hardship, poverty and low level of education are also identified with poor mental health of an individual or community (WHO, 2010). In spite of the percent of adults with poor mental health in the Antelope Valley area of KFH - Panorama City Medical Center Service Area is lower than the state; the primary data from the Antelope Valley indicates a high need for mental health services. About 70% of the participants chose mental health as one of the top issues in their community. The outcome of poor mental health is homicide and suicide. Table 22: Percent with Poor Mental Health Report Area Total Population (Age 18 ) Number with Poor Mental Health Percent with Poor Mental Health KFH - Panorama City Medical 1,189,293 167,090 14.05% Center Service Area Antelope Valley (Service Area) 315,015 44,407 14.10% Panorama City (Service Area) 874,278 122,683 14.03% California 27,547,000 3,914,000 14.21% Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), 2009. Source geography: County (Grouping). Primary data findings for mental health needs in the Antelope Valley area are: Lack of psychiatrist accepting Medical Inpatient psychiatric beds for adults and children Mental health services for uninsured Lack of mental health services infrastructure 42 P a g e

Mental health programs for schools Psychiatric urgent care facilities Inpatient mental health units for children and adolescents Lack of psychiatric mobile response team to meet the demands Lack of support groups for domestic violence Low or no cost mental health counseling Anti-stigma campaign for mental health Resources for mental health education Mental health programs for foster families and kids Psychiatric hospital beds Antelope Valley community residents expressed a real urgency for mental health services and they shared that the isolation, distance from any major city for social life, and lack of social support are some of the reasons for mental and emotional health problems that not only affect adults, but also adolescents and children. Mental health issues were also brought up by the Panorama City residents especially for seniors with disabilities, caregivers and family members. IV. Who Was Involved in the Assessment VCCC was contracted to prepare the Kaiser Permanente Panorama City 2013 Community Health Needs Assessment. VCCC collaborated with Antelope Valley Partners in Health (AVPH) to assist with secondary and primary data collection in the Antelope Valley. VCCC was created in 1995 by eleven health care leaders to address the health care crisis facing our area when the county decided it would need to close clinics and hospitals. VCCC has evolved into the health and mental health planning body for SPA 2. From 1995 to 2000 VCCC was an allvolunteer organization consisting of individuals working in hospitals, clinics, consumer advocacy and county health care sites who shared responsibilities to create capacity reports so as to educate the Board of Supervisor's regarding the impact in the community by the closure of county hospitals and clinics. In addition this group also worked together to create the first collaborative 1994 CHNA as a result of SB697 for our catchment area. CHNA Experience VCCC has had a long history of conducting community health needs assessments (completed 2000, 2004, 2007 and 2010 that were SB697 compliant). In addition, VCCC completed a needs assessment for a SAMHSA funded project that focused on HIV, Substance Abuse and Hepatitis C in 2008. VCCC conducted CHNA dissemination meetings after each of the needs assessments were completed and presented the data at conferences and to groups wanting to learn more about completing CHNA using a collaborative approach. VCCC s past CHNA s have been completed collaboratively with multiple hospitals, clinics and community based organizations using the Mobilizing Action through Partnerships and Planning 43 P a g e

(MAPP) model. This model requires bringing stakeholders together to determine what needs to be accomplished, what information about the community can be collected and used in the CHNA. In addition, a comprehensive asset mapping was conducted to bridge the gaps in services. For this report VCCC has utilized the MATCH model. Due to the long history of working with the Los Angeles County Department of Public Health (LAC DPH), for the past four years, someone from their Office of Planning, Evaluation, and Development or the Office of Health Assessment has held a leading role on the VCCC CHNA data committee. VCCC used LAC DPH s maps, Morbidity and Mortality Report, and Community Survey Data in each of the 2007 and 2010 CHNA s. VCCC has experience with facilitating groups in CHNA s, strategic planning, and community based education sessions. V. Process and Methods Used to Conduct the CHNA Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. a. Secondary Data Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources weren t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. The secondary data for this report was obtained from the Kaiser Permanente CHNA data platform from October of 2012 to May of 2013. The data platform is undergoing continual enhancements and certain data indicators may have been updated since the date the data was obtained for this report. As such, the most updated data may not be reflected in the tables, graphs, and/or maps provided in this report. For the most recent data and/or additional health data indicators, please visit CHNA.org/kp 1 The types of indicators included on the CHNA platform are 1. Demographics (population, age, ethnicity, language) 2. Social & Economic Factors (poverty, uninsured, education, violent crimes, social support) 1 Note that updates have been made to some data indicators which may reflect a different data rate and/or map on the platform than those listed in the report. Please be aware of these changes and adjust if desired 44 P a g e

3. Health Behaviors (consumption of fruits/vegetables, alcohol, tobacco use, physical activity and breastfeeding) 4. Physical Environment (Fast food restaurants, grocery stores, liquor stores, park access, recreation and fitness facilities) 5. Clinical Care (FQHCs, HPSA, primary care physicians, vaccination rates, testing and preventative services) 6. Health Outcomes Morbidity/Mortality (asthma, obesity, diabetes, heart disease, cancers, STDs, dental, infant mortality, homicides, suicides and accidents) In addition to the CHNA data platform, secondary data was gathered using local, state and national health departments. For a complete list of sources and bibliography, please refer to Appendix D. Methodology for collection, interpretation and analysis of secondary data The Kaiser Permanente common indicator data is calculated to obtain unique service area rates. In most cases, the service area values represent the aggregate of all data for geographies (zip codes, counties, tracts, etc.) which fall within the service area boundary. When one or more geographic boundaries are not entirely encompassed by a service area, the measure is aggregated proportionally. The options for weighting small area estimations are based upon total area, total population, and demographic-group population. The specific methodology for how service area rates are calculated for each indicator can be found on the CHNA.org/kp website. Data gathered was analyzed using methods such as grouping and statistical analysis. Data was grouped according to the health conditions, co-morbidities, age, gender, ethnicity in addition to other specific needs for the CHNA report. Zip code level data collected was used to compare both areas (Panorama City and Antelope Valley) of KFH Panorama City Medical Center Service Area. This comparative data was presented to show the disparities between the two areas. Upon completion of secondary data collection, benchmarking was used as the first criteria to determine areas that performed poorly when compared to the state, nation and HP 2020 benchmarks. The second step in the analysis was to review health drivers and risky behaviors that led to poor health outcomes. Trend data was researched to compare if the health issue is improving or getting worse over time. 45 P a g e

b. Community Input How participants were identified by VCCC The long standing partnership and collaboration with various local agencies including L.A County departments helped VCCC to identify representatives from health and mental health who serve the broad interests of the communities in Panorama City. In addition, focus groups were conducted with patients, church members, parents and other community residents. Antelope Valley Partners in Health (AVPH), a collaborative partner, identified and conducted key informant interviews with Public Health and Mental Health experts, local leaders, and health care providers. In addition, AVPH partners conducted focus groups with community residents. Some of the public health experts participated in key informant interviews and focus groups. Such individuals were listed in both areas of participation. The community stakeholders that participated in the CHNA represented the broad interests of the community and included public health experts and other individuals knowledgeable about the health needs found in the community. The complete list of the stakeholders is provided for in the following tables. Name (Last, First, Academic Distinction) Baker, Shiarron BS Nursing Burke, Sloane, Ph.D, CHES Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Community Liaison Nurse Assoc. Professor LA County Department of Public Health CSUN Worked in Val Verde, Pacoima and California County Districts. Currently works with low-income families for the LAC DPH as a district nurse. Dept. of Public Health Areas of interest Latino health, women's health and college health. Date of Consult Type of Consult 11/13/2012 Key Informant Interview 10/1/2012 Focus Group Mathews, Gigi, Dr. PH Analyst III LAC DPH With Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. 1/9/2013 CHNA Data Committee Informant 46 P a g e

Name (Last, First, Academic Distinction) Mayen-Cho, Marie, MPH Melnick, Douglas, MD, MPH Nowland, Mary, PHN, RN Pomerance, Elise, MD, MPH Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Director of Providence Access to Care-Health Education Outreach Physician Specialist Public Health Nurse Supervisor Acting Area Health Officer for SPA 1 & 2 Providence Health and Services LAC DPH L.A. County Department of Health Services L.A. County Department of Public Health For the past 3 years working as the director of Access to Care-Health Education Outreach program at Providence Holy Cross hospital. Northeast Valley Public Health Manager, Director of Alzheimer's Association and prevention program. Worked in the public health field for many years. With Los Angeles County Department of Public Health in the STD clinic for SPA 1 & 2. Oversees the prenatal and family planning clinics at Antelope Valley Health Center and High Desert Health Systems. Clinical oversight of Public Health Centers and field services providing STD and tuberculosis services, communicable disease prevention and control and emergency preparedness and response. Date of Consult Type of Consult 11/5/2012 Key Informant Interview 1/9/2013 CHNA Data Committee Informant 9/19/2012 Key Informant Interview 9/25/2012 Key Informant Interview 47 P a g e

Name (Last, First, Academic Distinction) Mozian, Rita, MPH, CHES Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of public health knowledge/expertise Health Educator LAC Dept. of Public Health, SPA 1 & 2 Has been working with low income, underserved populations over the past 7 years. Date of Consult Type of Consult 1/8/2013 Prioritization Process Participant Vigdorchik, Olga, MPH, MCHES Health Educator LAC Dept. of Public Health, SPA 1 & 2 With Los Angeles County Department of Public Health in the STD clinic for SPA 1 and 2 1/8/2013 Prioritization Process Participant Alvarez, Frank, MD, MPH Area Health Officer LAC Dept. of Public Health, SPA 1 & 2 With Los Angeles County Department of Public Health in the STD clinic for SPA 1 and 2 1/8/2013 Prioritization Process Participant Basiratmard, Siamak, MD Green, Stephanie, MD Maniago, Gladys, NP Medical Doctor Internal Medicine Medical Doctor Internal Medicine Nurse Practitioner Adult Clinic LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group Mendez- Nasrallah, Suzanna, NP Family Nurse Practitioner LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group Phan, Melanie, MD Medical Doctor Internal Medicine LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic 9/5/2012 Focus Group 48 P a g e

Name (Last, First, Academic Distinction) Reznikova, Yuliya NP Blank, Joseph, MD Blank, Joseph,MD Cheng, Mindy, MD Cheung, Shung, MD Chin, Mun, MD Cope, Jacqueline, MD Correa, Blanca M.S. Darie, Silvia, MD Panorama City Medical Center Area Individuals with special knowledge of or expertise in public health Title Affiliation Description of Date of public health Consult knowledge/expertise Nurse Practitioner Adult Clinic Medical Director Medical Director Medical Doctor Internal Medicine Medical Doctor, Pediatrician Medical Doctor Internal Medicine Medical Doctor Family Medicine Community Liaison Medical Doctor Internal Medicine LAC DHS Olive View UCLA Medical Center Ambulatory Care Network (Olive View Mid- Valley Comprehensive Health Center) Ambulatory Care Network (Olive View Mid- Valley Comprehensive Health Center) LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center UCLA Community Liaison for UCLA CTSI Institute LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic Department of Health Services, Administration Department of Health Services, Administration LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Licensed and practicing clinician at safety net hospital and/or clinic Licensed and practicing clinician at safety net hospital and/or clinic UCLA researches and comes together with communities that want to participate in research. LAC DHS Olive View UCLA Medical Center Type of Consult 9/5/2012 Focus Group 11/2/2012 Key Informan t Interview 9/5/12 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 11/2/2012 Focus Group 9/5/2012 Focus Group 49 P a g e

Panorama City Medical Center Area Individuals consulted from Federal, tribal, regional, State or local health departments or other departments or agencies with current data or other relevant information Name (Last, First, Academic Distinction) Emmons, Jennifer, NP Title Affiliation Type of Department Family Nurse Practitioner, Family/Primary Care LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Date of Consult Type of Consult 9/5/2012 Focus Group Fruto, Jean, NP Green, Stephanie, MD Huynh, Betty, NP Maniago, Gladys, NP Mathews, Gigi, MPH Mavrinaz, Maureen, MD Melnick, Douglas, MD, MPH Mendez- Nasrallah, Suzanna, NP Nurse Practitioner Family Medical Doctor Internal Medicine Nurse Practitioner Family Medicine Nurse Practitioner Adult Clinic Analyst III Medical Doctor Family Medicine Physician Specialist Family Nurse Practitioner LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DPH Office of Health Assessment and Epidemiology LAC DHS Olive View UCLA Medical Center LAC DPH SPA 1 & 2 LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DPH LAC DHS Olive View UCLA Medical Center LAC DPH LAC DHS Olive View UCLA Medical Center 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 9/5/2012 Focus Group 1/9/2013 CHNA Data Committee Informant 9/5/2012 Focus Group 1/9/2013 CHNA Data Committee Informant 9/5/2012 Focus Group 50 P a g e

Panorama City Medical Center Area Individuals consulted from Federal, tribal, regional, State or local health departments or other departments or agencies with current data or other relevant information Name (Last, First, Academic Distinction) Ngugi, James, NP Nguyen, Diem-Thu, MD Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) 10 Adults CSUN Professors Group included Ph.Ds. with expertise in Public Health, Health Administration, Kinesiology, Nutrition, Social Services and Public Policy. 119 Adults CSUN Students Public Health and Health Administration Undergraduate students from CSUN 21 Youth New Direction for Youth participants 24 Clinicians Title Affiliation Type of Department Family Nurse Practitioner, Primary Care Medical Doctor, Internal Medicine Physicians, LAC DHS 55 Adults Church members, The Church on the Way 57 Parents Elementary School Parents\Community residents LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center LAC DHS Olive View UCLA Medical Center Low-income, minority youth population. Licensed, practicing physicians, NPs, PAs from the L.A County Department of Health Services Church group members from multiple ethnicities, income and educational levels. Low-income, minority population in LAUSD Title 1 Schools. Date of Consult Date of Consult Type of Consult 9/5/2012 Focus Group 9/5/2012 Focus Group Type of consult 10/1/2012 Focus group 10/1/2012 CHNA Survey Tool 10/15/2012 Community Forum 9/5/2012 Focus group 9/30/2012 Morning 11:00 am Community Forum 10/22/2012 Survey Tool 51 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role 58 Adults Church members, The Church on the Way 66 Adults Church members, The Church on the Way 9 Adults Northeast Valley Health Corporation Diabetes and Hypertension Patients 10 Adults Community Residents of Antelope Valley 8 Adults Community Residents of Aguila, Ismael Alzubu, Ahmed, MD Aranda, Cesilla Antelope Valley Operation Manager, City of San Fernando AV Hospital Child & Family Guidance Center Arias, Jennie Registration Supervisor, AV Community Clinic Audrey, Simons Avila, Charles Director of Community Benefits, Grants Administrator MENFOLK/ YES2Kids What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) Church group members from multiple ethnicities, income and educational levels. Church group members from multiple ethnicities, income and educational levels. Low-income, medically underserved, minority population dealing with chronic diseases Low-income, underserved population. Low-income, underserved population. Provides services for lowincome, minority population of the City of San Fernando. Population with chronic disease. Low-income, medically underserved, minority population, population with chronic disease. Low-income, medically underserved. Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Date of Consult Type of consult 9/26/2012 Community Forum 9/30/2012 Afternoon 1:00 pm Community Forum 10/25/2012 Focus group 9/21/2012 Focus Group 9/13/2012 Focus Group 11/2/2012 Key Informant Interview 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 11/2/2012 Key Informant Interview 9/25/2012 Community Forum 52 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Baker, Shiarron Berg, Barbara Description of leadership, representative, or member role Community Liaison Nurse, LAC DPH L.A. County Office of What group(s) do they represent? (medically underserved, low income, minority population, population with chronic disease) Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Education Beyah, Cales Lancaster DCFS Low-income, medically underserved, minority population. Carter, Mark YES2Kids Low income, medically underserved, minority population. Castro, Cathy Chin, Soyem Christensen, Geraldine Clarkson, Erica Cook, James, MSW Cooperberg, Judy Corrales- Eneix, Sandy LA Community Development Commission Physician, AV Community Clinic Billing Manager, AV Community Clinic Family Nurse Practitioner, AV Community Clinic CEO of the Antelope Valley Partners for Health Executive Director, Mental Health America Palmdale School District Trustee Low-income, medically underserved, minority population. Low income, medically underserved Low-income Low-income, medically underserved Populations with chronic disease, medically underserved, low-income. Populations with chronic disease, medically underserved, low-income Medically Underserved, lowincome Date of Consult Type of consult 11/13/2012 Key Informant Interview 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 9/21/2012 Key Informant Interview 9/14/2012 Key Informant Interview 9/13/2012 Key Informant Interview 53 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, low-income, Date of Type of First) OR representative, or minority population, Consult consult Member member role population with chronic Type/# disease) Curry Jr., Geroy DePaul, Garielle Derico, LaJuano Dhillon, Shelly Dunn, Jody Dupree, Erica PIP Family Nurse Practitioner, AV Community Clinic Clinical Manager, AV Community Clinic Disease Prevention Coordinator, AV Community Clinic Vice President, Service Integration for Partners in Care Foundation LA Community Development Commission Emanuel, Rich Family Nurse Practitioner, AV Community Clinic Faison, Eddy National Allegiance for Mental Illness (NAMI) Galvez, Gabriela Gilmore, Karen Gocke, James Child & Family Guidance Center Children's Bureau Family Nurse Practitioner, AV Community Clinic Low-income, medically underserved, minority population Low-income, medically underserved Low-income, medically underserved. Populations with chronic disease, medically underserved, low-income. Medically underserved, lowincome, minority population. Low-income, medically underserved, minority population. Low-income medically underserved. Low-income medically underserved, minority population, population with chronic disease. Low-income, medically underserved, minority population. Low-income, medically underserved, minority population, population with chronic disease. Low-income, medically underserved. 9/25/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 10/2/2012 Community Forum 11/6/2012 Key Informant Interview 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 54 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, low-income, Date of Type of First) OR representative, or minority population, Consult consult Member member role population with chronic Type/# disease) Gonzalez, Michelle Guerrero, Virginia Hampton, Bobby Haynes, Mary Karels, Marleen Lawler, Opal Leitelt, Debi Berzon Bartz-Altadona Community Health Center Comprehensive Housing Info and Referral for People Living with HIV/AIDs Two Life Styles Family Nurse Practitioner, AV Community Clinic Protective Science Dynamics Child & Family Guidance Center L.A. County Dept. of Mental Health Low-income, medically underserved, minority population. Low-income medically underserved, minority population, population with chronic disease. Low-income, medically underserved, minority population. Low-income medically underserved. Low-income, medically underserved, minority population. Low-income, medically underserved, minority population. Low-income medically underserved, minority population, population with chronic disease. Low-income medically underserved Low-income 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum Lory, Quan Pediatrician, AV Community Clinic 10/2/2012 Community Forum Magnu, Rigina Clinical 10/2/2012 Community Coordinator, AV Forum Community Clinic Mahowald, AV Chess House Low-income 9/25/2012 Community Daa Forum Mahoward, AV Chess House Low-income 9/25/2012 Community Morgan Forum Matthews, PIP 9/25/2012 Community Monica Forum Low-income, medically underserved, minority population 55 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs What group(s) do they Leader / Rep. Description of represent? (medically Name (Last, leadership, underserved, lowincome, minority Consult consult Date of Type of First) OR representative, or Member member role population, population Type/# with chronic disease) Mayen-Cho, Marie Director of Providence Access to Care-Health Education Outreach Medically underserved, low-income, minority population 11/5/2012 Key Informant Interview Medrano, Maria Melnick, Douglas, MD, MPH Milla, Diana Luna Mostafanin, Shawn Nichols, Janet MENFOLK/ YES2Kids Physician Specialist Children Center of the AV Physician Assistant, AV Community Clinic Child & Family Guidance Center Nitescu, Missy Chief Operating Officer, Northeast Valley Health Corp. Parziale, Katie Family Nurse Practitioner, AV Community Clinic Perez, Ana Tarzana Treatment Center Low-income, medically underserved, minority population Medically underserved, low-income, minority population Low-income, medically underserved, minority population Low-income, medically underserved Low-income, medically underserved, minority population Medically underserved, low-income, minority population Low-income, medically underserved Low-income, medically underserved, minority population, population with chronic disease Perez, Jessica PSD Head Start Low-income, medically underserved, minority population Perez, Jose Consultant on the AV Mobility Management Project Low-income 9/25/2012 Community Forum 1/9/2013 CHNA Data Committee Informant 9/25/2012 Community Forum 10/2/2012 Community Forum 9/25/2012 Community Forum 11/13/2012 Key Informant Interview 10/2/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/13/2012 Key Informant Interview 56 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Description of leadership, representative, or member role What group(s) do they represent? (medically underserved, lowincome, minority population, population with chronic disease) Date of Consult Type of consult Perkins, Kimberly First City Savings Low-income 9/25/2012 Community Forum Pineda, Mayra Back Office, AV Community Clinic Low-income, medically underserved 10/2/2012 Community Forum Randall, Jim Reyes, Carmen Reynolds, Dorothy Robles, Cindy Outreach Coordinator, LAC DMH Community Resident PSD Head Start Asian Youth Center, AV Medically underserved, low-income, minority population Low-income, medically underserved, minority population Low-income, medically underserved, minority population Low-income, medically underserved, minority population 11/6/2012 Key Informant Interview 9/13/2012 Focus group 9/25/2012 Community Forum 9/25/2012 Community Forum Rodriguez, Trina Quality Assurance Low-income 10/2/2012 Community Forum Rosas, Valerie West Coast Drug and Alcohol Recovery Low-income, medically underserved, minority population, population 9/25/2012 Community Forum Ross, Laurie Schallert, Larry Scott, Sylvia License Clinical Social Worker (LCSW), Antelope Valley Hospital Director of Program Development, Child and Family Center The Catalyst Foundation with chronic disease Populations with chronic disease, medically underserved, low-income Medically underserved, low-income, minority population Low-income, medically underserved, minority population, population with chronic disease 10/3/2012 Key Informant Interview 11/5/2012 Key Informant Interview 9/25/2012 Community Forum 57 P a g e

Panorama City Medical Center Area Leaders, representatives, or members of medically underserved person, low-income persons, minority populations and populations with chronic disease needs Leader / Rep. Name (Last, First) OR Member Type/# Shulman, Dee Dee Speyer, Winter Steans, Tynisha Stennett, Cecil Toliver, Cynthia, MSW Umubgba, Oghenesume Woods, Cindy Description of leadership, representative, or member role DCFS Comprehensive Housing Info and Referral for People Living with HIV/AIDs The Catalyst Foundation The Catalyst Foundation Chairperson of the Older and Disabled Case Management Committee at Antelope Valley Partners for Health Psychiatrist, AV Community Clinic Billing, AV Community Clinic What group(s) do they represent? (medically underserved, low-income, minority population, population with chronic disease) Low-income, medically underserved, minority population Low-income, medically underserved, minority population, population with chronic disease Low-income, medically underserved, minority population, population with chronic disease Low-income, medically underserved, minority population Populations with chronic disease, medically underserved, low-income Populations with chronic disease, medically underserved, low-income Low-income, medically underserved Date of Consult Type of consult 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/25/2012 Community Forum 9/27/2012 Key Informant Interview 10/2/2012 Community Forum 10/2/2012 Community Forum Yadon, Lesley Children's Bureau Low-income, medically underserved, minority population 9/25/2012 Community Forum 58 P a g e

Methodology for collection and analysis of primary data Primary data was collected utilizing various methods such as key informant interviews, community forums, focus groups with both health professionals and community residents, and finally through paper surveys that were administered to residents, community stakeholders, students of community colleges and California State University, Northridge (CSUN) public health students and online surveys with health care providers and residents. Key Informant Interviews: A total of 17 key informant interviews were conducted for KFH - Panorama City Medical Center Service Area. Each interview lasted between 30 to 45 minutes. The key informants included individuals from Los Angeles County health, mental health and public health departments, academia, community clinics, hospitals, and LA school district staff with public health expertise or provide services for low-income, uninsured families in KFH - Panorama City Medical Center Service Area. For key informant interview questionnaire please refer to Appendix B. Community Forums: Seven one hour community forums with 268 participants were conducted using TurnPoint Technology response system; where the participants used a clicker to answer the questions. A PowerPoint survey was created on the TurnPoint Technology response system and each participant was given a clicker for responding. This system helped VCCC to gather more honest responses from the participants. Focus Groups: Utilizing a focus group facilitation guide, VCCC conducted seven one hour focus groups with 86 community members, leaders, and service providers. Out of the 7 focus groups, three were done in Spanish. For a copy of the facilitation guide and focus group questions, please refer to Appendix C. Community Surveys: A total of 346 surveys (both paper and online) were administered to participants consisting of public health professionals, health care providers, community residents, parent groups from Los Angeles Unified School District (LAUSD) and CSUN students. These surveys were created in both English and Spanish. Primary data was collected for most significant health problems in the community such as significant social and economic issues faced by the community, risky behaviors, and the top 5 health issues in the community. In addition, each group was asked to rank the top 5 health issues facing them personally and their community by providing a list of health needs that did not meet the state, the national and/or Healthy People 2020 benchmarks. Upon completing the primary data collection, VCCC CHNA team scheduled a debriefing meeting to create a story board to draw out the common themes from all the key informant interview, focus groups, community forums and survey input. Once the most common and compelling themes were 59 P a g e

identified, they were categorized as health needs, access, risky behaviors, environment, socioeconomic, barriers, solutions and assets. The frequency of each theme was then counted to rank the themes from most immediate need to intermediate need. Primary data reiterated the findings from secondary data. Health needs that emerged from both primary and secondary data collection were combined into one list for prioritizing the top 10 immediate needs of the KFH Panorama City Medical Center Service Area. b. Data limitations and information gaps The Kaiser Permanente common data set includes a robust set of nearly 100 secondary data indicators that, when taken together, enable an examination of the broad health needs faced by a community. However, there are some limitations with regard to this data, as is true with any secondary data available. Some data were only available at a county level, making an assessment of health needs at a neighborhood level challenging. Moreover, disaggregated data around age, ethnicity, race, and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. The timeframe also restricted the collection of complete information (updated information on phone numbers, programs) on assets available in the community assets. Due to the budget cuts, many community based programs in the hospital service area have been either cut or eliminated. VI. Identification and Prioritization of Community s Health Needs a. Identifying community health needs For the purposes of the CHNA, Kaiser Permanente defines health need as a poor health outcome and its associated health driver(s) or a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Subsequent to collection and analysis of the primary and secondary data, a comprehensive list of identified needs were provided to the health care experts, providers, stakeholders, community leaders and government representatives for the purpose of ranking the top needs in the community. The following broad based health needs were identified and formed the starting point for prioritization of community health needs: 60 P a g e

Social & Economic Factors High School Graduation Rate (AV, PC) Population with No High School Diploma (AV,PC) Student Reading Proficiency (4 th Grade) (AV, PC) Children in Poverty (AV) Free and Reduced Price School Lunch Eligibility (AV, PC) Poverty Rate (< 100% FPL) (AV,PC) Population Below 200% of Poverty Level (AV, PC) Supplemental Nutrition Assistance Program (SNAP) Recipients (AV, PC) Lack of Social or Emotional Support (Adult) (AV, PC) Teen Births (AV, PC) Unemployment Rate (AV, PC) Population Receiving Medicaid (AV, PC) Uninsured Population (PC) Linguistically Isolated Population (PC) Physical Environment Grocery Store Access (AV, PC) Park Access (AV, PC) Recreation and Fitness Facility Access (AV, PC) Health Outcomes Asthma Hospitalization Adult (AV, PC) Asthma Hospitalization Youth (AV) Diabetes Hospitalization Adult (AV) Diabetes Hospitalization Youth (AV) Diabetes Prevalence (AV, PC) Overweight Adult (AV) Obesity Youth (AV, PC) Overweight Youth (PC) Cancer Mortality (AV) Cervical Cancer Incidence (AV, PC) Colon Cancer and Rectum Cancer Incidence (AV, PC) Low Birth Weight (AV, PC) Poor Dental Care (AV, PC Suicide (AV) Poor General Health (AV, PC) Heart Disease Prevalence (AV) Heart Disease Mortality (PC) Stoke Mortality (AV) Homicide (AV) Chlamydia Incidence (AV, PC) HIV Hospitalizations (AV, PC) HIV Prevalence (AV, PC) Premature Death (AV) Motor Vehicle Crash Death (AV) Pedestrian Motor Vehicle Death (AV) Clinical Care Population Living in a Health Professional Shortage Areas (HPSA)(AV, PC) Lack of a Consistent Source of Primary Care (AV, PC) Access to Primary Care (AV, PC) Absence of Dental Insurance Coverage (AV, PC) Dental Care Utilization (Adult) (AV, PC) Dental Care Utilization (Youth) (AV, PC) 61 P a g e

b. Process and criteria used for prioritization of the health needs The methodology used for prioritization of identified health needs was the multi-voting approach. Health needs in low-income areas are many and varied. Multi-voting approach is an effective method to reduce long list into a more compact list of major health needs. The prioritization process was conducted using the following steps: Step 1: Identified and recruited 40 to 50 key leaders and residents to prioritize the identified health needs. Two meetings took place in Antelope Valley on Jan. 8, 2013 and Panorama City on Jan.11, 2013. Step 2: VCCC CHNA team, AVPH and KFH Panorama City Community Benefits staff participated in a meeting to establish the following criteria for the prioritization. 1. Does the issue impact both the Antelope Valley and Panorama City? 2. How severe is the problem (i.e. meeting benchmarks state, nation or Healthy People)? 3. Is the issue getting worse over time? 4. Has the community ranked the issue over other issues? 5. Are there reasonable resolutions to the problems? Step 3: Health Need Profiles were created for those specific needs that did not meet the benchmarks for either the county, the state, the U.S. and/or HP 2020 in addition to the needs identified by the community members as high priority needs. Participants received health need profiles and the above criteria to prepare for the prioritization meetings. Step 4: Individuals were asked to rank what they consider to be the 10 most immediate and significant health needs followed by ranking the next 15 intermediate needs. Individuals were then put into small groups where they compared individual rankings to reach consensus of the top 10 needs. Finally, the entire group collectively ranked the top 25 needs eliminating duplicates. There was a final round of voting for those that wanted to participate in an online survey to reach consensus to identify the 10 most immediate needs for KFH Panorama City Medical Center Service Area. Immediate needs are those identified as crucial and need immediate attention. The rest of the needs were categorized as intermediate needs so that KFH-Panorama City Medical Center will take these needs into consideration for future implementation strategy. Step 5: Results were tabulated at the end of each round resulting in the following prioritized list of needs. Prioritized description of community health needs Due to the uniqueness of the Antelope Valley and Panorama City areas, even though there is an overlap of the needs, the top 10 needs from each area differ slightly. The following topics are either a top concern for both areas or unique to a specific area. 62 P a g e

List of Community Health Needs KFH Panorama City Medical Center Service Area Panorama City Access to Primary Care 1 1 1 Obesity Adult/Youth 2 3 2 Mental Health/Depression 3 4 3 Dental Health 4 8 Uninsured Population 5 2 Physical Environment/Transportation 6 4 Poverty Rates 7 5 9 Diabetes 8 6 Prenatal Care 9 5 Breastfeeding 10 6 Wellness and Health Education Programs 7 Vision 10 Care Coordination 9 Asthma 7 Unemployment 10 Cardiovascular Disease 8 Antelope Valley Additional community health needs identified by participants as intermediate needs in order of priority from highest to lowest consisted of the following: Cancer 12.Domestic Violence 13.Cardiovascular Disease 14. Asthma 15. HIV 16. Unemployment 17. Chlamydia and other STDs 18. Suicide 19. Hypertension 20. Substance Abuse 21. Lack of Social and Emotional Support 22. Teen Birth 23. Tobacco Use 24. Population without High School Diploma 25. Vision Care Comprehensive health need profiles located under Appendix A were created for all of the above issues except for wellness and health education programs, vision, and care coordination. These three issues were key concerns in primary data collection, however, upon research, no specific KFH Panorama City Medical Center Service Area data was found. Access to Primary Care A major concern identified during primary data collection and supported by the secondary data is the lack of primary care physicians with some of the physicians unwilling to accept Medi-Cal. The percentage of the population living in a health professional shortage area in California is 57.14% which is better than the 60.80% rate of the United States. However in the Antelope Valley area, the 63 P a g e

rate is 90.68% which exceeds the 60.96% in Panorama City and the combined area rate of 67.86%. A health professional shortage area is a geographic area that has a shortage of primary medical care, dental and mental health professionals. More specific to this issue is the shortage of bilingual staff mainly Spanish speaking, which according to the monolingual community residents acts as a barrier to accessing care. Obesity and Overweight (Adults and Youth) Percentage of adults who are obese (BMI 30.0) in Antelope Valley SPA 1 (34.8%) is much higher than SPA 2 (21.1%), Los Angeles County (23.6%) and the U.S. (28.3%) according to the 2011 Los Angeles County Survey. In addition, a rate of overweight adults in the medical center service area (36.42%) is above the state average (36.20%). Additionally both adults (24.82%) and youth (43.37%) are less active than the state adult (22.70%) and youth (37.45%) for physical activity. A lack of physical activity and poor eating habits leads to obesity and overweight in both adults and youth. Obesity among youth in KFH - Panorama City Medical Center Service area (33.75%) is higher compared to the state average (29.82%). Percentage of overweight youth (14.09%) is slightly lower than the state average (14.30%). These numbers are for youth in grades 5, 7 and 9 that were ranked high risk on the fitness gram. High risk is determined for girls between 28.4% and 38.6% and boys between 27% and 35.1% body fat. Many of the primary care physicians have expressed concern about the higher numbers of children with Type II Diabetes and Fatty Liver diagnosis. Research has shown that overweight and obese children tend to be overweight and obese adults. Mental Health Adults in the KFH Panorama City Medical Center Service Area did self-report (14.05 %) slightly better mental health than the state average (14.21%) when asked if they felt they needed to seek professional help in the last 12 months for their problems inclusive of substance abuse. A key informant interview with leadership from the Los Angeles County Department of Mental Health in the area shared two major concerns stating that Safety and stabilization occurs too often as an impatient in the hospital setting because there is such limited, (almost no) access to outpatient services which is less intensive especially for low-income and uninsured population. Adults reported a lack of adequate social and emotional support in KFH - Panorama City Medical Center Service Area (71.19%) compared to the state (75%). This is an important indicator for good mental health outcomes. Dental Care Community stakeholders identified dental care as a major concern. In KFH - Panorama City Medical Center Service Area, the high percentage of adults (34.65%) who self-report they have not visited a dental professional in the past year which is worse than the state average of (30.51%). In addition, 12.22% of teens have not had a dental visit in the past year again faring worse than the state average (10.07%). These numbers are in alignment with the number of adults without dental insurance in the 64 P a g e

area (37.36%) which is also worse than the state (33.72%). Many stakeholders were concerned that folks underestimate how vital good dental health is to a person s overall general health. Uninsured Population Economic instability has led to the loss of jobs and employer based group health insurance. In the report area 20.81% of the population is uninsured. When looking at Antelope Valley (16.47%) and Panorama City (22.37%) individually the Panorama City area is worse off. The area rate (20.81% is worse than the state (17.92%) and the nation (15.05%). The lack of insurance is a primary barrier to health access including primary care and specialty care. Physical Environment/Transportation Because of the unique situation in the Antelope Valley, in 2008 the Los Angeles County Metropolitan Transportation Authority (METRO) and the Antelope Valley Transit Authority (AVTA) signed a Memorandum of Understanding (MOU) to conduct and implement a Mobility Management Plan for the area. Conducting surveys was part of the process and the report states that 58% of individuals trying to access social services including health care services reported some difficulty with transportation. The Antelope Valley area of KFH-Panorama City Medical Center Service Area has 2,812 square miles with 143.45 people per square mile. The low density rate makes accessing public transportation difficult for those without a vehicle. Transportation issues were also a concern for the Panorama City area; however, the main issue in the more urban and densely populated portion of the medical center service area dealt more with high gas prices and inability to afford public transportation whose prices are increased annually. When residents do not have access to personal transportation both distance and income are factors that create barriers to accessing health care services. Poverty Rates The population living below 200% FPL in Antelope Valley (40.97%) far exceeds that of Panorama City (35.40%). The report area average (36.86%) exceeds the state (32.83%). Additionally, the rate of children living in poverty between the ages of 0 and 17 for Antelope Valley (26.77%), Panorama City (18.96%), and the entire KFH Panorama City Medical Center Service Area (21.33%) exceeds the state (19.06%) rate. Many of the stakeholders shared concerns about the economy and how greater numbers of formerly middle class families are falling into those living at or just above the poverty rate. Poverty impacts the entire family and in the KFH Panorama City Medical Center Service Area disproportionally affects the Latino population. Diabetes The rate of diabetes hospitalizations in Antelope Valley (12.35 Per 10,000 Population) fares much worse than Panorama City (8.02 Per 10,000 Population). However, the combined rate of diabetes in KFH Panorama City Medical Center Service Area (9.17 Per 10,000 Population) is lower than the state (10.40 Per 10,000 Population). Even though the combined rate is meeting the state benchmark, diabetes still is a health concern for the community members and health care providers. Diabetes 65 P a g e

death rates in Antelope Valley (40.6 Per 100,000 Population) and in SPA 2 where Panorama City area is located it is 15.7 per 100,000 population. Antelope Valley has more than doubled the death rates per 100,000 population than L.A. County (20.2 Per 100,000 Population) and the nation (20.8 Per 100,000 Population). Increased rates of diabetes hospitalizations may indicate unhealthy lifestyles and poor management of A1C blood glucose levels, poor eating habits, and lack of physical activity. Other contributing factors for diabetes include preventable hospital events, lack of primary care access, transportation issues, increased obesity rates, and sedentary lifestyles. On the surface it appears there is a need for diabetes management education. Untreated diabetes can put people at risk for higher rates of hospitalization, neuropathy, blindness, amputation, kidney disease/failure and death. Prenatal Care Low birth weight infants (under 2500g) in the report area (7.43%) with Antelope Valley (8.98%) and Panorama City (6.81%) fare worse than the state (6.80%). This indicator is relevant because low birth weight infants are at high risk for health problems and extended hospitalizations. There are higher rates of teen births in Antelope Valley (11.10per 1,000 females under age 20) when compared to Panorama City (7.4) and the state (8.46). Breastfeeding Early breastfeeding rates in Antelope Valley (90.29%) and Panorama City (90.94%) are closer to state rates (91.74%). However, exclusive breastfeeding rate was brought up as a concern by the community health educators and lactation education was recommended for improving the rates of exclusive breastfeeding in the KFH Panorama City Medical Center Service Area. Breast feeding has positive health benefits and may lower infant mortality rates. Stakeholders identified Black infant mortality as high in the Antelope Valley, however there was an improvement since the Black Infant Health Program was created by Antelope Valley Partners for Health. VII. Community assets and resources available to respond to the identified health needs of the community The following tables include a list of existing health care facilities (hospitals and community clinics) that offer primary care in the KFH - Panorama City Medical Center Service Area. Hospitals and clinics are valuable resources in the community offering primary care and specialty care; in addition to programs and support services that address many of the identified health needs contained in this report (i.e. asthma, diabetes, weight management, nutrition etc.). A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH - Panorama City Medical Center Service Area are attached under Appendix C. 66 P a g e

Hospital listing from the Office of Statewide Health Planning and Development (OSHPD) Agency Address City Zip Telephone Number Antelope Valley Hospital 1600 West Ave. J Lancaster 93534 661-949-5000 Acute Care (inpatient and outpatient care) Henry Mayo Newhall 23845 McBean Valencia 91355 661-253-8311 Memorial Hospital Parkway Acute Care (inpatient and outpatient care) Hollywood Community 14433 Emelita St. Van Nuys 91401 818-787-1511 Hospital of Van Nuys Acute Psychiatric Care (inpatient and outpatient care) Kaiser Permanente 13652 Cantara St. Panorama 91402 818-375-2000 City Acute Care (inpatient and outpatient care) Kaiser Permanente 5601 De Soto Ave Woodland 91365 818-719-2000 Hills Acute Care (inpatient and outpatient care) Mission Community 14850 Roscoe Blvd. Panorama 91402 818-787-2222 Hospital City Acute Care (inpatient and outpatient care) Olive View / UCLA 14445 Olive View Dr. Sylmar 91342 818-364-1555 Medical Center Acute Care (inpatient and outpatient care) Pacifica Hospital of the 9449 San Fernando Rd, Sun Valley 91352 818-767-3310 Valley Acute Care (inpatient and outpatient care) Providence Holy Cross 15031 Rinaldi St. Mission 91345 818-365-8051 Medical Center Hills Acute Care (inpatient and outpatient care) Sherman Oaks Hospital and Burn Center 4929 Van Nuys Blvd. Sherman Oaks 91403 818-981-7111 818-904-4580 Acute Care (inpatient and outpatient care). Valley Presbyterian 15107 Vanowen St. Van Nuys 91405 818-782-6600 Hospital Acute Care (inpatient and outpatient care) Public and Community Clinics Agency Address City Zip Telephone Number AHF Healthcare Center 4835 Van Nuys Blvd, Sherman 91403 818-380-2626 Valley Suite 200 Oaks` The AHF Healthcare Center cares for patients with HIV. It offers advanced treatment options and specialist referrals to meet each patient's needs. 67 P a g e

Comprehensive Community Center (formerly Professional Medical Group) 12157 Victory Blvd. North Hollywood Everyone seeking screening or care is accepted regardless of ability to pay Primary and specialty care is provided for newborns to seniors All sites are CPSP providers and all sites are CHDP providers Dental care Disease and behavioral management programs All sites have Medi-Cal eligibility workers Staffs provide culturally and linguistically sensitive care 91606 818-755-8000 El Proyecto del Barrio 8902 Woodman Arleta 91331 818-830-7033 Ave. Basic medical services, and other services, including: physicals for children (CHDP), immunizations, TB testing for children, treatment for illnesses, adult medical care, pregnancy testing, maternal -prenatal care, WIC. Referrals (Supplemental Food Program) HIV testing, PAP smears and mammograms. Kennedy High School Based 11254 Gothic Ave. Granada 91344 818-271-2547 Clinic Hills Services include physical exams, sports physicals, treatment for minor illnesses, and immunizations/tb testing for students and their siblings from 8-18 years of age. Information on no cost or low cost health insurance and food stamp enrollment is provided. L.A. Mission College, 13356 Eldridge Ave. Sylmar 91342 818-364-7600 Student Health Center Provides medical services including physical exams, testing for students MaClay Health Center for 12540 Pierce St. Pacoima 91331 818-897-2193 Children Routine health care provided by internists, pediatricians, family medicine specialists, gynecologists, obstetricians, nurse practitioners, midwives, physicians assistants or other health care providers who serve as the first point of contact with the health care system. Services focus on the prevention and early detection of health problems through regular physical examinations, blood pressure checks, mammograms and other similar procedures as well as therapeutic services for people who do not require specialty care. Meet Each Need with 10641 N. San Pacoima 91331 818-896-0246 Dignity (MEND) Fernando Road MEND offers food, clothing, medical, eye care, dental, multi-benefit screenings, and education and training services for those in need. Mission City Community 10200 Sepulveda Mission 91345 818-895-3100 Network Mission Hills Blvd, Suite 300 Hills MCCN services are provided in a culturally and linguistically sensitive and competent manner and services are provided by bilingual and/or bicultural staff. A range of health care services for your family's health needs are available at very low cost or NO cost for persons who qualify. MCCN participates as a healthcare provider in several programs for low-income individuals and families. Former Medi-CAL recipients and other low-income persons are encouraged to inquire about these special programs 68 P a g e

Mission City Community 15206 Parthenia St. North Hills 91343 818-830-6373 Network, Inc.(North Hills) Mission City Community Network, Inc. offers a range of health care services for your Family's Health Needs at very low cost or NO cost for persons who qualify. MCCN's current services are provided by bilingual and/or bicultural staff. Mission City Community 9919 Laurel Canyon Pacoima 91331 818-686-4243 Network Pacoima Middle School Blvd. Mission City Community Network offers a range of health care services for your Family's Health Needs at very low cost or NO cost for persons who qualify. MCCN's current services are provided by bilingual and/or bicultural staff. Newhall Health Center 23772 Newhall Ave Newhall 91321 661-291-1777 (Samuel Dixon Family Health Center) Offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! Provide a wide range of high-quality primary care services, including: Minor illness and injury, diabetes management, physical exam health. Northeast Valley Health 7843 Lankershim North 91605 818-765-8656 Corporation Blvd Hollywood Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health 1600 San Fernando San 91340 818-365-8086 Corporation Rad Fernando Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health Corporation 11133 O Melveny Ave. San Fernando 91340 818-365-7517 Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health 6551 Van Nuys Blvd, Van Nuys 91401 818-988-6335 Corporation Suite 201 Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Northeast Valley Health Corporation Homeless Mobile Clinic 1172 N. Maclay Ave San Fernando 91340 818-898-1388 Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. 69 P a g e

Northeast Valley Health 23763 Valencia Blvd. Valencia 91355 661-287-1551 Corporation LAC Valencia Health Center Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Pediatric Health And WIC 7138 Van Nuys Blvd. Van Nuys 91405 818-778-6240 Center Provides pediatric and women, infant health services. Planned Parenthood Los 7100 Van Nuys Blvd, Van Nuys 91405 800-576-5544 Angeles Van Nuys Center Suite 108 Provides up-to-date, clear, medically accurate information that helps patients with better understanding of their sexual health. Pregnancy Counseling 10211 Sepulveda Mission 91345 818-895-2500 Center Blvd. Hills Offer Free Support and Referrals Free Pregnancy Testing and Free Limited Obstetrical Ultrasounds, Pregnancy Verification / Proof of Pregnancy, Facts about Abortion Methods and Risks, STDs Information (Sexually Transmitted Diseases), Post Abortion Counseling Information on Family Planning Samuel Dixon Family Health Center Canyon Country Clinic 27225 Camp Plenty Rd, Suite 2 Canyon Country 91351 661-424-1220 We offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! We provide a wide range of high-quality primary care services, including: Minor illness and injury, Diabetes management, Physical exams, Family medicine, Women's health, Prenatal and well-baby care, Immunizations, Health education. Additionally, we offer quarterly diabetes, screenings and an annual breast cancer screening. Samuel Dixon Family Health 30257 San Martinez Val Verde 91384 661-257-4008 Center, Inc. (Castaic) We offer medical services and immunizations for families with any level of income. We are not a free clinic, but we offer a competitive sliding fee scale to fit your needs. You and your family can still receive affordable health care! We provide a wide range of high-quality primary care services, including: Minor illness and injury, diabetes management, physical exams, family medicine, women's health, prenatal and well-baby care, immunizations, health education. Additionally, we offer quarterly diabetes screenings and an annual breast cancer screening. Santa Clarita Medical and 24625 Arch St. Newhall 91321 661-288-2644 Mental Health Services Provides counseling services. Santa Clarita Valley (SCV) 23838 Valencia Blvd. Valencia 91355 661-255-0082 Pregnancy Center Provides pregnancy testing, ultrasound pregnancy confirmation, abortion information, and post-abortion services. (24 hour toll free services) 70 P a g e

Sun Valley Health Center 7223 N. Fair Ave. Sun Valley 91352 818-432-4400 Primary care services include: pregnancy test, prenatal care, family planning, comprehensive perinatal services program (CPSP) gynecology, breast and cervical cancer control program, (BCCCP), Well Child Exams (CHDP), immunizations, pediatrics. Valley Community Clinic 6801 Coldwater North 91605 818-763- 1718 Canyon Blvd. Hollywood Anger management for adults and teens, behavioral health service, community outreach, counseling, dental, general medical, HIV AIDS, Nutrition and exercise counseling, medical research, optometry, pediatrics, prenatal services, Valley teen-clinic health education, women's health and family planning. Van Nuys Medical and Mental Health Services 6265 Sepulveda Van Nuys 91411 818-779-0555 Blvd. Provide high quality health care services to the local community. Community clinic providing a range of outpatient, nonemergency health care. Universal Primary Care 1560 E. Chevy Chase Dr. #245 Glendale 91206 818-246- 5900 Provides medical services. Telfair School Health Center 10911 Telfair Ave. Pacoima 91331 818-899-6113 Complete vision examinations by optometrists (referral by school nurse, school or parent). Services offered at low cost for children of low-income families. 71 P a g e

Appendix A: Health Need Profiles After prioritizing the top 10 immediate needs for both West Ventura and West San Fernando Valley and East Ventura County, it was noted that the top 10 needs for them were slightly varied. Taking this into consideration, health need profiles were created for all top 10 most immediate needs for both areas (which included three additional needs). Therefore, this appendix includes a total of 14 health profiles and the profiles are organized in alphabetical order for easier access. 72 P a g e

Health Need Profile: Access to Primary Care About Access to Primary Care Why is it important? Lack of access to care presents barriers to good health. Some of these barriers are supply and accessibility to facilities and physicians, rate of uninsured, financial hardship, transportation barriers, cultural competencies, and coverage limitations affecting access. Rates of morbidity, mortality, and emergency hospitalization can be reduced if community residents have access to services such as regular health checkups, preventative screenings, routine tests, and vaccinations. Primary Care Provider Rate (Per 100,000 Population) 83.2 84.7 80 80.6 78.2 KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Primary care provider rates per 100,000 population in KFH Panorama City Medical Center Service Area (80), are not meeting the state (83.2) or national (84.7) benchmarks. The Antelope Valley rate (78.2) is even lower than Panorama City (80.6). This indicator is important because it has a negative impact on access to primary care. Percent Without a Primary Care Doctor 16.31% 16.70% 16.17% 14.23% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California The percentage of population without a regular doctor in KFH Panorama City Medical Center Service Area is higher (16.31%) compared to the state (14.23%). 73 P a g e

The lack of access to primary care was brought up by the community members and was ranked as their top community need. The barriers to accessing the available primary care services were identified by the community as transportation, location and hours of operation of the primary care clinics. Designated Health Professional Shortage Areas (HPSA) "Health Professional Shortage Areas" (HPSAs), is defined as having shortages of primary medical, dental or mental health providers. A shortage of health care professionals contributes to access and health status issues. Percent of Designated Population Underserved Report Area Total Population, 2010Census HPSA Designation Population Underserved Population Percent of Designated Population Underserved KFH Panorama City 1,574,155 181,495 123,164 67.86% Medical Center Service Area Antelope Valley (Service 421,691 42,171 38,239 90.68% Area) Panorama City (Service 1,152,464 139,324 84,925 60.96% Area) California 37,267,509 5,171,993.90 2,955,395.91 57.14% United States 312,676,557 52,826,822.65 32,117,352.05 60.80% Data Source: U.S. Health Resources and Services Administration, Health Professional Shortage Area File, 2012. Source geography: Address. KFH Panorama City Medical Center Service Area has a high percentage of underserved population (67.86%). Both Antelope Valley (90.68%) and Panorama City (60.96%) are higher than the state (57.14%) and the U.S (60.80%) and are not meeting benchmarks. The issue of physician shortage was brought up by the community residents, leaders and key informants during the primary data collection process. Shortage of mental health professionals was identified as the one of the top 10 needs in the KFH Panorama City Medical Center Service Area. Table 23: Number of FQHC s Report Area Number of Federally Qualified Health Centers KFH Panorama City Medical Center 20 Service Area Antelope Valley (Service Area) 5 Panorama City (Service Area) 15 California 637 United States 5,459 Data Source: U.S. Health Resources and Services Administration, Centers for Medicare & Medicaid Services, Provider of Service File, 2011. Source geography: Address. 74 P a g e

There are only 20 Federally Qualified Health Centers (FQHCs) in KFH Panorama City Medical Center Service Area. The limited number (5) FQHCs in Antelope Valley creates an even larger barrier for the community residents to access health care and receive preventable health services such as regular checkups, tests, vaccinations etc. Preventable Hospital Event Report Area Patient Discharges for Ambulatory Care Sensitive (ACS) Conditions Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH Panorama 29,607 10.17% 94.10 114.40 City Medical Center Service Area Antelope Valley 9,090 11.15% 108.78 138.38 (Service Area) Panorama City 20,517 9.79% 88.80 105.73 (Service Area) California 667,777 9.88% 97.04 83.17 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010-2011. Source geography: ZIP Code. In KFH Panorama City Medical Center Service Area, it is evident that due to the lack of primary care access, the population living in health professional shortage areas with fewer FQHCs the preventable hospital event rates are much higher than the state (83.17 Per 100,000 Population). This could likely lead to an increase in chronic diseases, mental and other health related problems in the KFH Panorama City Medical Center Service Area. Sub-population experiencing greatest impact (disparities) In KFH Panorama City Medical Center Service Area, the ethnicity with the highest percent of people without a consistent source of primary care are Hispanic/Latino not far behind are Blacks, an Asian. At this time data is not available for American Indian/Alaskan Native.. Population by Race / Ethnicity, Percent without Consistent Source of Primary Care Report Area White Black Asian American Indian Alaskan Native KFH Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Hispanic / Latino Multi- Race 10.14% 18.03% 17.31% no data 19.33% 13.02% 10.14% 18.03% 17.31% no data 19.86% 13.03% 10.14% 18.03% 17.31% no data 19.14% 13.02% Area) California 9.45% 16.47% 15.49% 7.11% 19.03% 14.07% Note: This indicator is compared with the state average. Data Source: California Health Interview Survey (CHIS), 2009. Source geography: County (Grouping). 75 P a g e

Geographical areas of greatest impact (disparities) The entire KFH Panorama City Medical Center Service Area has a total of 20 FQHCs, 5 in Antelope Valley and 15 in Panorama City. The lack of FQHCs and access to primary care has a negative effect on the health outcome of these two areas of KFH - Panorama City Medical Center Service Area. Therefore, the entire KFH - Panorama City Medical Center Service Area needs an intervention to increase services to improve the health of the community residents. Associated drivers and risk factors what is driving the high rates Access to Primary Care in the community? The following factors are associated with access to primary care in the community. Factors marked with * are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Lack of Health Insurance* No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost* Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Lack of knowledge about the health condition they have Do not take care of their health needs Access Issues Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of Access to Primary Care Federally Qualified Health Centers* Facilities designated as Health Professional Shortage Areas (HPSA)* Preventable hospital events* Transportation is a big issue Community Input What do community stakeholders think about the issue of Access to Primary Care? Access to primary care was identified as the most important health need in the KFH Panorama City Medical Center Service Area through both primary and secondary data collection. Health care access is crucial for the wellbeing of the community and vital to economic growth. The clinics need to be open longer in the evening for people who may work somewhere other than the Antelope Valley. Maybe also having Saturday clinics will help people who need to go to the doctor on a more regular basis. Historically there haven t been enough health care providers to take care of the underinsured or noninsured. LA County started opening clinics in remote areas. For all services that have been added and capacity that has been built just with AVCC alone over the last two years still has not been 76 P a g e

enough. Undocumented workers do not feel safe accessing county services. They feel they will be deported or arrested. Immigrants would still go to the Care-a-Van. Gaps in Health Services in AV: Everywhere! One of the biggest gaps is lack of specialists for those with chronic diseases. County has specialty clinics where we are supposed to refer our clients, but those clinics are backlogged for up to 3 to 6 months. Transportation: Because of the vast nature of the region and how far apart things are, transportation is an issue. Kern County residents can t come down to the AV for services because it is a different county. They end up in Bakersfield, an 80 mile trip. One trip to sign up and then another trip have to be made for actual appointment. Kern is working on a transportation solution with shuttles. Distances involved in AV are the issue. Those with health issues, disabilities or those who are low income tend to live in areas that are further out and more removed from urban areas. Without money for transportation people may not access needed healthcare services or follow up care. Assets: What are the community assets that can help to address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Overall, KFH Panorama City Medical Center Service Area is dealing with a lack of primary care doctors at a rate at 80 per 100,000 people. In addition, having fewer FQHCs (20) makes access to care more difficult. The KFH Panorama City Medical Center Service Area also has higher rates of people who do not have a regular doctor (16.31%) where approximately 67.86% of the population lives in an area that is designated as a medically underserved area. In addition to lack of transportation, and access to medical care along with fewer primary care physicians all contributes to the high numbers of preventable hospital events in KFH Panorama City Medical Center Service Area. 77 P a g e

About Asthma Why it is important? The National Institute of Health (NIH) defines Asthma as a chronic lung condition where the airways get inflamed and narrows causing wheezing, chest tightness, coughing and shortness of breath. The symptoms get worse during the night or early mornings. Asthma can affect people of all ages, and frequently begins in the childhood (NIH: Asthma, 2012). Per NIH, in the U.S, more than 25 million people have asthma and almost one third of them are children. Children who have wheezing or frequent respiratory infections are at a higher risk of developing asthma. Other risk factors include allergies, eczema and parents with a history of asthma. Asthma that developed in the childhood usually continues beyond 6 years of age (NIH: Asthma, 2012). The effects of asthma can be reduced by following the doctor s instructions, using the prescribed medication, avoiding allergens that trigger asthmatic attacks, and getting regular checkups (NIH: Asthma, 2012). Statistical Data Asthma Hospitalization (Adult) Report Area Health Need Profile: Asthma Patient Discharges for Asthma Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH Panorama City Medical 2,920 1% 9.28 10.25 Center Service Area Antelope Valley (Service Area) 974 1.19% 11.65 12.45 Panorama City (Service Area) 1,946 0.93% 8.42 9.45 California 59,696 0.88% 8.67 8.90 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010-2011. Source geography: ZIP Code. KFH Panorama City Medical Center Service Area s asthma related hospitalization rates in both the Antelope Valley (12.45) and Panorama City (9.45) are higher than the state (8.90 per 10,000 population). Overall asthma hospitalization rate of KHF Panorama City Medical Center Service Area (10.25 per 10,000 population) is not meeting the state benchmark. Sub-populations experiencing greatest impact (disparities) Asthma seems to be high among Blacks, and Native American/Alaskan Natives in KFH - Panorama City Medical Center Service Area compared to other ethnicities. Since the data cannot be isolated for different ethnicities for unknown or other races, the data is not comparable to other ethnicities. However, the two highest rates exist among Blacks and Native American/Alaskan Natives. This would also apply to the state level data as well due to the same reasons. 78 P a g e

Population by Race (All Ages), Asthma Hospital Admissions Rate (Per 1,000 Hospitalization Events) Asthma Discharge Rate (Per 10,000 Population), By ZCTA, OSHPD, 2010-11 Over 14.00 10.01-14.00 6.01-10.00 2.01-6.00 Under 2.01 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010-2011. Source geography: ZIP Code. The total number of cases of asthma is high in the communities of Lancaster, Palmdale, California City, Littlerock, Rosamond, Van Nuys, Pacoima and North Hollywood. Associated drivers and risk factors What is driving the high rates of Asthma in the community? The following factors are associated with higher rates of asthma in the community. Factors marked with *are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Health Behaviors Access Issues Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the Tobacco Usage (Adult)* Tobacco Expenditure* Lack of fruit/vegetable consumption Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores No time for physical activity Unsafe neighborhoods No green space Poor lighting to go walking in the evening Cracked pavements Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education 79 P a g e

health condition they have Do not take care of their health needs Physical Environment Clinical Care Health Outcomes Poor Air Quality (Particulate Matter 2.5) Community Input What do community stakeholders think about the issue of asthma? Community stakeholders had a number of reasons why they believe asthma prevalence is increasing in their community: Air pollution High winds Second hand smoking Asthma We have the highest rate in Southern California except for the 710 corridor (the problem in 710 corridor has to do with the large number of trucks that travel to and from port of Long Beach). The rate in the AV is also due to indigenous-airborne particulate, pollen and dust. Affordable housing causes people to move up here and those same people could have been from 710 corridor. Second hand smoke and smokers contribute to asthma as well. Community members shared that the high winds, air pollution and second hand smoking were some of the risk factors in their community for the high rates of asthma. Community members also identified the same health drivers that were identified on the CHNA platform. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Pneumonia Vaccinations (Age 65)* Noncompliance with prescription medications Low Birth Weight Obesity (Adult) Obesity (Youth)* Overweight (Adult)* Overweight (Youth) Asthma is a health need in KFH - Panorama City Medical Center Service Area as marked by high rates of asthma related hospitalizations among adults. Other factors that contribute to the asthma rates include poverty (<100%, <200%, Children), poor air quality, low birth weight, tobacco usage among adults, adults not receiving pneumonia vaccinations, obesity/overweight among youth and adults. 80 P a g e

About Breastfeeding Why it is important? Breastfeeding has positive health benefits for both the child and the mother. Breastfeeding may possibly lower infant mortality rates. According to the National Institution for Health (NIH), breast milk has a balance of nutrients that help an infant not only grow stronger, but also reduces the risk of many common childhood infections and illnesses. Breastfeeding may help lower the risk of certain cancers in mothers who breastfeed their infants. NIH recommends that women who do not have any health problems should try to breastfeed their babies at least the first six months of the infant s life (NIH, 2012) Statistical Data Health Need Profile: Breastfeeding Percent Mothers Breastfeeding (Any) Report Area Total In- Hospital Births Mothers Breastfeeding (Any) Percent Mothers Breastfeeding (Any) KFH Panorama City 18,679 16,954 90.77% Medical Center Service Area Antelope Valley (Service 5,077 4,584 90.29% Area) Panorama City (Service Area) 13,602 12,370 90.94% California 873,873 801,710 91.74% Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, 2011. Source geography: County. About 90.77% of the mothers in KFH Panorama City Medical Center Service Area reported as breastfeeding (any) their children. However, this percentage (90.77%) is lower than the state (91.74%) average. Antelope Valley has slightly lesser percentage (90.29%) of mothers reporting any breastfeeding compared to Panorama City (90.94%). Lactation education is crucial to help mothers understand the importance of breastfeeding. Percent of Mothers Breastfeeding (Exclusively) Report Area Total In- Hospital Births Mothers Breastfeeding (Exclusively) Percent Mothers Breastfeeding (Exclusively) KFH Panorama City Medical 18,679 8,775 46.98% Center Service Area Antelope Valley (Service Area) 5,077 2,380 46.88% Panorama City (Service Area) 13,602 6,395 47.02% California 873,873 529,794 60.63% Note: This indicator is compared with the state average. Data Source: California Department of Public Health, In-Hospital Breastfeeding Initiation Data, 2011. Source geography: County. Sub-populations experiencing greatest impact (disparities) 81 P a g e

The disparities in breastfeeding exist among the young mothers with lower educational levels and income level, and race/ethnicity. According to The Child Health U.S.A 2011 report published by the U.S. Department of Health and Human Services states that children born to mothers who are over 30 years of age, with higher level of education have more chances of being breastfed compared to children of younger, less educated and lower income mothers. Associated drivers and risk factors What are the barriers for breastfeeding in the community? The following factors are associated with breastfeeding in the community. Factors marked with * are not meeting the state, national and/or Healthy People 2020 benchmark. The following list also includes community input: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Low literacy levels Access Issues Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Community Input What do community stakeholders think about the issue of breastfeeding? Community leaders, health care providers and breastfeeding advocates reiterated the importance of breastfeeding to reduce the rates of overweight/obese children in KFH Panorama City Medical Center Service Area. Lactation education was brought up as one of the priority areas of health need per the community feedback. In addition, the lower rates of breastfeeding in KFH Panorama City Medical Center Service Area confirms the need for additional lactation education. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary KFH Panorama City Medical Center Service Area s breastfeeding in both the Antelope Valley (90.29%) and Panorama City (90.94%) are lower compared to the state (91.74%). In addition, rates for breastfeeding exclusively in Antelope Valley (46.88%), and Panorama City (47.02%), are much lower than the state (60.63%) and not meeting the state benchmarks. Therefore, breastfeeding is a health need that needs interventions. 82 P a g e

Health Need Profile: Cardiovascular Disease About Cardiovascular Disease Why it is Important? Cardiovascular disease is a leading cause of death in the U.S. Cardiovascular disease includes heart disease and stroke. Coronary heart disease, one of the most common heart diseases, causes more than half of all the heart disease deaths in the United States. Coronary artery disease occurs when the arteries that supply blood to the heart are blocked by a waxy, fat like substance called plaque. Plaque gradually builds up and narrows the artery leading to atherosclerosis. Risk factors for cardiovascular disease (heart disease and stroke) include high blood cholesterol, high blood pressure, diabetes, tobacco use, overweight, obesity, diet, lack of physical activity, alcohol use, and family history, age, gender and ethnicity (CDC: Heart Disease and Stroke, 2012). Statistical data Heart Disease Mortality Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH Panorama City Medical Center 1,511,828 1,883 155.10 Service Area Antelope Valley (Service Area) 419,340 523 171.60 Panorama City (Service Area) 1,092,488 1,360 148.80 California 36,634,623 44,613 131.34 HP 2020 Target <= 100.8 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: California Department of Public Health, Death Statistical Master File, 2008-2010. Source geography: ZIP Code. Overall heart disease mortality in KFH - Panorama City Medical Center Service Area is higher (155.10 Per 100,000 Population) than the state (131.34) and Healthy People 2020 (<=100.8). Stroke Mortality Rates (Per 100,000 Population) Report Area Total Population Average Annual Deaths Death Rate (Per 100,000 Population) KFH Panorama City Medical 1,511,828 412 34.20 Center Service Area Antelope Valley (Service Area) 419,340 117 39.50 Panorama City (Service Area) 1,092,488 295 32.20 California 36,634,623 13,569 39.46 Note: This indicator is compared with the state average. Data Source: California Department of Public Health, Death Statistical Master File, 2008-2010. Source geography: ZIP Code Stroke mortality in Antelope Valley of KFH Panorama City Medical Center Service Area is higher (39.50 Per 100,000 Population) and is not meeting the state (39.46 Per 100,000 Population) benchmark. 83 P a g e

Geographic Area of Greatest Impact (Disparities) A review of The Nielson Co., Thomson Reuter 2012 zip code level data shows high estimated prevalence of congestive heart failure and heart attack in Pacoima, Sylmar, North Hills, Granada Hills, Valencia, Panorama City, North Hollywood, Lancaster and Palmdale (The Nielsen Company, Thomson Reuter, 2012). High numbers of coronary heart disease cases are evident in Pacoima, Sylmar, Granada Hills, Valencia, Sherman Oaks, Studio City, North Hollywood, Lancaster and Palmdale (The Nielsen Company.; Thomson Reuter, 2012). Estimated number of stroke cases is higher in Lancaster, Palmdale, and Rosamond, Pacoima, Sylmar, Van Nuys, Sherman Oaks, North Hollywood, Studio City and Valley Village in KFH - Panorama City Medical Center Service Area (The Nielsen Company, Thomson Reuters, 2012). Cardiovascular Disease Mortality, Rate (Per 100,000 Pop.), By ZCTA, CDPH, 2008-10 Over 200.0 160.1-200.0 120.1-160.0 80.1-120.0 Under 80.1 Data Suppressed or No Data Stroke Mortality, Rate (Per 100,000 Pop.), By ZCTA, CDPH, 2008-10 Over 60.0 45.4-60.0 30.1-45.0 15.1-30.0 Under 15.1 No Data or Data Suppressed 84 P a g e

Associated drivers and risk factors What is driving the high rate of heart disease mortality in the community? The following factors are associated with higher rates of heart disease mortality in the community. Factors marked with an * are not meeting the state/nation and/or HP 2020 benchmarks. The list also includes the input from the community stakeholders: Socio-economic Poverty rate (< 100% FPL)* Population below 200% of poverty level Children in Poverty Student reading proficiency (4 th grade)* Population with no high school diploma* High school graduation rate* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Health Outcomes Overweight (adults)* Obesity (adults)* Overweight (youth) Obesity (youth)* Diabetes prevalence* Diabetes Hospitalization (adult) Diabetes hospitalization (youth) Health Behaviors Heavy alcohol consumption Alcohol expenditures Physical inactivity (adults)* Physical inactivity (youth)* Tobacco usage (adult)* Tobacco expenditure Noncompliance with prescription medications Reasons for the lack of physical activity No time Unsafe neighborhoods No green space Poor lighting Cracked pavements Physical Environment Liquor store access Park access* Recreation and fitness facility access*. Walkability* 85 P a g e

Community Input What do community stakeholders think about the issue of heart disease mortality? Community stakeholders listed the following reasons as to why they feel heart disease is increasing in their community: High blood pressure High cholesterol Poor diet Noncompliance with medication Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Heart disease prevalence rates in KFH - Panorama City Medical Center Service Area are lower than the state and are meeting the benchmarks. Cardiovascular disease needs to be address due to the high mortality rate. While prevalence is in line with benchmarks, there are higher rates of mortality. This could be a result of the lack of access to primary care or the lack of health and disease management education. On the other hand, heart disease mortality is a health need in KFH - Panorama City Medical Center Service Area as marked by high mortality rates. Overweight, obesity among youth and adults is one of the contributing factors for the high rates of heart disease mortality. The health need is likely being impacted by poverty, low educational achievements, lack of physical activity, poor diet, risky behaviors (heavy drinking and tobacco use), and diabetes incidences including hospitalization among youth and adults. 86 P a g e

About Cervical Cancer Why it is important? Health Need Profile: Cervical Cancer According to the National Cancer Institute (NCI), cervical cancer occurs in the tissue of the cervix (the organ connecting uterus and vagina). This slow-growing, symptomless cancer can be detected by a Pap smear test. Human Papilloma Virus (HPV) almost always is the cause of cervical cancers. It is estimated that 12,170 new cases of cervical cancer have been reported in 2012 in the U.S with 4,220 deaths caused by cervical cancer. Most common risk factor for cervical cancer is HPV infection. However, risky behaviors such as smoking can increase the risk for cervical cancer. Cervical cancer risk can be decreased by getting regular screening tests (Pap smear) or receiving HPV vaccination (NCI, What You Need to Know about Cervical Cancer, 2012). Statistical data Cervical Cancer Incidence Rate (Per 100,000 Population) Report Area Total Population, ACS 2005-2009 Annual Incidence, 2005-2009 Average Annual Incidence Rate (Per 100,000 Population) KFH Panorama City Medical 1,565,409 156 9.90 Center Service Area Antelope Valley (Service Area) 416,615 42 10 Panorama City (Service Area) 1,148,794 114 9.90 California 36,308,528 3,014 8.30 United States 301,461,536 24,117 8 HP 2020 Target <= 7.1 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009. Source geography: County. Cancer is a leading cause of death and it is important to identify each cancer individually to place intervention programs in place to reduce the burden of cancer incidences and mortality. Cervical cancer incidence rate in KFH - Panorama City Medical Center Service Area is higher than the state, the nation and the HP 2020 benchmarks. Even the state (8.30), or the nation (8) per 100,000 population cervical cancer rates are higher than the HP 2020 target rate and are not meeting the targeted benchmark. Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicates that there is a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Data on American Indian/Alaskan Natives is currently not available. 87 P a g e

Sub-populations experiencing greatest impact (disparities) Ethnic data on the cervical cancer incidence for KFH - Panorama City Medical Center Service Area indicates that there is a high disparity exists among Hispanic/Latino, Whites and Asians. This is consistent with the state data. However, the national data shows the disparity to be among Hispanic/Latino, Blacks and then the White populations. Cervical Cancer Incidence Rate (Per 100,000 Population) by Ethnicity Hispanic / Latino Asian Black White United States California Antelope Valley (Service Area) Panorama City (Service Area) 0 5 10 15 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: The Centers for Disease Control and Prevention, and the National Cancer Institute: State Cancer Profiles, 2005-2009. Source geography: County. Data for other ethnicities, such as American Indian/Alaskan Native or Hawaiian/Pacific Islander are not available at this time. Estimated number of cervical cancer cases in Lancaster, Palmdale, Ridgecrest, Granada Hills, North Hills, and North Hollywood are higher than the other communities in KFH - Panorama City Medical Center Service Area (The Nielsen Company, 2012, Thomson Reuters, 2012). Chlamydia Rate (Per 100,000 Population.) 479.6 488.9 476.2 399.36 406.89 KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States 88 P a g e

Sexually Transmitted Diseases such as Chlamydia rates in KFH - Panorama City Medical Center Service Area are higher than the state and the U.S. The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up the unsafe sexual practice repeatedly and suggested that education on safe sex and the effects of STD on the cervical cancer incidence might encourage safer sexual practices. Associated drivers and risk factors - What is driving the high rates of cervical cancer in the community? The following factors are associated with higher rates of cervical cancer in the community. Factors marked with * are not meeting the state, nation or Healthy People 2020 benchmarks. Demographics Socio-economics Health Behaviors Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of reproductive knowledge Lack of nutritional education Teen Births Inadequate Fruit/Vegetable Consumption (Adults)* Tobacco Usage (Adults)* Tobacco Expenditure* Fruit/Vegetable Expenditure* Alcohol consumption Tobacco Unsafe or unprotected sexual behaviors by youth and adults Noncompliance with prescription medications No time Unsafe neighborhoods No green space Poor lighting Physical Environment Clinical Care Health Outcomes Grocery Store Access WIC-Authorized Food Store Access* Population Living in Food Deserts Problems at school Cervical Cancer Screening (Pap Test)* Chlamydia Incidence* HIV Prevalence* HIV Hospitalization* Overweight (adults)* Obesity (youth)* Community Input What do community stakeholders think about the issue of cervical cancer incidence? 89 P a g e

Community stakeholders had a number of reasons for why they believed cervical cancer is increasing among community members: You know some young people think that nothing bad is going to happen to them. They don t practice safe sex and end up getting either pregnant or sick. We need more education about safe sexual practice to encourage our young people to be safer. Parents think that their kids are not having sex, but they are. Parents also need help with talking to their kids about sex and tell them that if they are not careful, they can get STDs. So, I think it is both (parents and kids) who need education. Not too many people understand the new vaccine for HPV, so may be giving information about that would help parents to understand why it is important to let their girls have those vaccines and may be that will help a bit too. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Rates of cervical cancer mortality in KFH - Panorama City Medical Center Service Area are not meeting the benchmarks and it is health need in KFH - Panorama City Medical Center Service Area. The high rates of cervical cancer incidence is likely influenced by poverty rates (<100% and <200% FPL), children in poverty, teen births, inadequate fruit and vegetable consumption, tobacco use, cervical cancer screening rates, and the prevalence of HIV, Chlamydia, along with overweight and obesity. The primary data collected demonstrated a concern about unsafe sexual practices among youth and adults. Community residents and stakeholders brought up the unsafe sexual practice repeatedly. Education on safe sex and the effects of STD on the cervical cancer incidence might encourage safer sexual practices. 90 P a g e

Health Need Profile: Dental Health Services About Poor Dental Health - Why is it important? According to the Centers for Disease Control and Prevention reports that about 40% of poor adults ages 20 or more are identified as having at least one untreated decayed tooth compared to 16% of non-poor adults. In the past decade, the percent of adults 60 years or older how is missing all their teeth went down from 31% to 25%. The percent of people who are between the ages of 40 to 59 went down from 9 to 5%. However, that 5% means one out of 20 middle aged adults are missing all their teeth (CDC, Oral Health, 2012). Risk factors can be reduced by drinking fluoridated water, avoiding tobacco, limiting alcohol, healthy eating, and regular dental checkups including teeth cleaning (CDC, Oral Health for Adults: Fact Sheet, 2012). Statistical data Percent of Adults with Poor Dental Health Report Area Total Population (Age 18 ) Number Adults with Poor Dental Health Percent Adults with Poor Dental Health KFH - Panorama City 1,166,703 136,046 11.66% Medical Center Service Area (Service Area) Antelope Valley (Service 309,948 36,748 11.86% Area) Panorama City (Service 856,755 99,298 11.59% Area) California 27,311,960 3,078,058 11.27% United States 232,747,222 36,229,520 15.57% Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010. Source geography: County. KFH - Panorama City Medical Center Service Area has a higher percent of adults with poor dental health compared to the state and is not meeting the state benchmark. This could likely be due to the lack of access to dental care and/or barriers to utilization of dental services. Sub-populations experiencing greatest impact (disparities) National data from CDC reports that overall in the U.S, Blacks, Hispanics and American Indians/Alaskan Natives have poorest oral health compared to other ethnicities. Blacks, non- Hispanics and Mexican Americans ages between 35 to 44 years have twice as much untreated tooth decay compares to Whites and non-hispanics (CDC, Oral Health, 2012). Associated drivers and risk factors what is driving the high rates of poor oral health in the community? The following factors are associated with higher rates of poor oral health in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. 91 P a g e

Socio-economic Health Behaviors Clinical Care Poverty Rate (< 100% Soft Drink Absence of Dental Insurance Coverage* FPL)* Expenditures* Dental Care Utilization (youth)* Population below 200% Poor eating habits (all Dental Care Utilization (adult)* of Poverty Level* ages) Dental Care Affordability* Children in Poverty* Consumption of soft Not seeking preventative services such as fluoride Lack of dental insurance drinks sealants, regular dental checkups including dental Lack of low cost dental Foods containing cleanings services high amounts of Lack of education/knowledge Lack of Access to sugar and fats Low literacy levels primary care High number of fast Lack of knowledge about the health condition they No regular doctor visits food restaurants have due to cost Language barriers Missed or no shows for Do not take care of their health needs follow up doctor s Lack of resources appointment due to cost Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Lack of knowledge on the importance of maintaining good oral hygiene Lack of knowledge about poor dental health and how it impacts the overall health of a person Community Input What do community stakeholders think about the issue of poor oral health? Community stakeholders had a number of reasons for why they believed oral health is an issue in their community: Risky behaviors Not seeking dental services Missed follow up appointments Improper brushing techniques Assets what are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Oral health is a heath need in KFH - Panorama City Medical Center Service Area as marked by the prevalence of poor dental health and the percentage of adults who had six or more of their permanent teeth removed that are higher than the state average. The health need is likely being impacted by the poverty rates, lack of dental care access, consumption of soft drinks, lack of dental insurance and the poor dental care utilized by youth and adults. 92 P a g e

Health Need Profile: Diabetes About Diabetes - Why is it important? Diabetes is a condition that is a result of high blood sugar levels. There are three types of diabetes: Type I where the pancreas produces little or no insulin. Type II diabetes is a result of overweight and obesity where the body becomes resistant to insulin. The final type of diabetes is called Gestational diabetes where pregnant women who are free of diabetes in the past develop high blood sugar. Diabetes risk factors include being obese, age, heredity, race/ethnicity, poor dietary habits, and lack of physical activity or history of diabetes during pregnancy. According to the report published by the Los Angeles County Department of Public Health (LAC DPH) Trends in Diabetes: A Reversible Public Health Crisis diabetes rates have increased from 6.6% in 1997 to 9.1% in 2007 (LAC DPH, 2012). Type II is the most common diabetes and can be prevented by consuming whole grains, fruits and vegetables, limiting high fat or calorie foods, lean meat, fish, low-fat dairy products, reducing sweetened drinks, losing excess body weight and regular physical activity (LAC DPH, 2012). Statistical data Percent of population with Diabetes Report Area KFH - Panorama City Medical Center Service Area Total Population (Age 20 ) Population with Diabetes Percent with Diabetes 1,103,751 85,081 7.71% Antelope Valley (Service Area) 292,227 22,594 7.73% Panorama City (Service Area) 811,524 62,487 7.70% California 26,721,032.93 2,022,190 7.57% United States 239,583,791.97 21,015,523 8.77% Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, 2009. Source geography: County. The percentage of diabetes incidence in KFH - Panorama City Medical Center Service Area is higher than the state and not meeting the state benchmark. Diabetes is a chronic condition that could lead to other complications such as amputations, eye problems, and podiatric issues. Diabetes rates are high in the U.S and can indicate an unhealthy lifestyle of a person including insufficient fruit and vegetable consumption, lack of regular physical activity among others. 93 P a g e

Diabetes Hospitalization (Adult) Report Area Patient Discharges for Diabetes Percentage of Total Discharges Crude Discharge Rate (Per 10,000 Population) Age-Adjusted Discharge Rate (Per 10,000 Population) KFH - Panorama City 2,601 0.89% 8.26 9.17 Medical Center Service Area (Service Area) Antelope Valley 921 1.13% 11.02 12.35 (Service Area) Panorama City (Service 1,680 0.80% 7.27 8.02 Area) California 58,388 0.86% 8.48 10.40 Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010-2011. Source geography: ZIP Code. Even though overall diabetes related hospitalization rates are meeting the state benchmark, Antelope Valley in the KFH - Panorama City Medical Center Service Area is higher than the state rate and is not meeting the benchmark. Sub-populations experiencing greatest impact (disparities) Diabetes Hospitalization by Ethnicity 2.00% 1.80% 1.60% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% White Black Asian / Pacific Islander Other Race / Multi-Race Unknown Race Hispanic / Latino KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California Note: This indicator is compared with the state average. Data Source: California Office of Statewide Health, Planning and Development (OSHPD), Patient Discharge Data, 2010. Source geography: ZIP Code. According to the data available, diabetes demonstrates high disparities among Black followed by other races and unknown race. The above graph provides a general overview of the diabetes hospitalization; however, due to the lack of clear definition of other races and unknown race, comparison between ethnicities would not be viable. Data on American Indian/Alaskan Native is currently unavailable. 94 P a g e

Associated drivers and risk factors What is driving the high rates of diabetes in the community? The following are associated with diabetes prevalence, diabetes hospitalizations among adult and youth in the community. Factors marked with an * are not meeting the state benchmarks. The following table includes the community input: Social and Economic Access Health Behaviors Poverty Rate (<100% FPL)* Population Below 200% of the Poverty Level* Children in Poverty* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Inadequate Fruit/Vegetable consumption (adults and youth)* Soft drink consumption (youth) Physical Inactivity (adult and youth)* Soft drink expenditure* Fruit and vegetable expenditure Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores Alcohol consumption Tobacco No time Unsafe neighborhoods No green space Poor lighting Cracked pavements Physical Environment Clinical Care Health Outcomes Grocery Store Access* WIC-Authorized Food Store Access* Population Living in Food Deserts* Park Access* Walkability Recreation and Fitness Facility Access* Fast Food Restaurant Access Diabetes Management Hemoglobin A1c Test* Overweight (adult)* Overweight (youth)* Obesity (adult) Obesity (youth)* Community Input What do community stakeholders think about the issue of diabetes? Community members specifically identified lack of knowledge and shared that educational opportunities would help them to gain knowledge. In addition, the community members felt that providing health education will help them to be more proactive when it comes to their health. Listed below are the reasons the community members stated that diabetes is a problem in their community: 95 P a g e

Lack of education/knowledge Low literacy levels Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Assets What are the community assets that can address the health need? Additional community assets identified by the stakeholders include the following: Mobile diabetes van Diabetes teaching kitchen (Mission Community Hospital) Nutrition and physical activity classes San Fernando pool facility activities Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Diabetes is a health need in KFH - Panorama City Medical Center Service Area. Diabetes prevalence rates in KFH - Panorama City Medical Center Service Area did not meet the state benchmark. Data on the disparities show that Hispanic/Latinos, Blacks and Whites have a higher percentage of diabetes in KFH - Panorama City Medical Center Service Area. Other related indicators for the increase in diabetes prevalence, in KFH - Panorama City Medical Center Service Area could likely be a result of poverty, inadequate fruit and vegetable consumption, and physical inactivity. In addition, environmental factors such as access to fast food restaurants, lack of park access, walkability, lack of recreational and fitness facilities might likely be contributing to the high diabetes related health problems. It is also evident that the community residents do not seek preventative services and the community stakeholders reiterated that a high rate of patients is non-complaint with prescription medications. All these drivers could possibly be contributing to the high rates of diabetes in KFH - Panorama City Medical Center Service Area. 96 P a g e

Health Need Profile: Mental Health About Mental Health - Why is it important? Mental health is a key driver of health status. Economic and social insecurity often are associated with poor mental health. Poverty, unemployment, heavy alcohol and tobacco consumption, and physical inactivity affect mental health as well. Statistical data How is poor mental health measured? What is the prevalence of poor mental health in the community? Suicide Rate (per 100,000 population) KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California 8.70% 12.40% 7.40% 9.79% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California The rate of suicide is lower in KFH - Panorama City Medical Center Service Area (8.70%) compared to the state (9.79%), but is significantly higher in the Antelope Valley Service Area (12.40%). According to the community input, the main cause of suicide is lack of social and emotional support. Percent Adults Reporting Adequate Social Or Emotional Support KFH - Panorama City Medical Center Service Area Panorama City (Service Area) United States 71.19% 71.34% 71.13% Antelope Valley (Service Area) California 75% 80.33% KFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States The percentage of adults aged 18 and older who self-report receiving sufficient social and emotional support most of the time is significantly lower in KFH - Panorama City Medical 97 P a g e

Center Service Area (71.19%) than the state (75%) and the nation (80.33%). This indicator is relevant because social and emotional support is critical for navigating the challenges of daily life as well as for good mental health. Social and emotional support is also linked to educational achievement and economic stability. Sub-populations experiencing greatest impact (disparities) Age groups reflect high disparities among young adults to seniors. Middle-aged adults are the most affected by anxiety and depression. Percent of Adults With Current Anxiety and Depression by Age Group, 2011 Anxiety Depression 13.40% 13.80% 4.10% 4.10% 5.70% 6.10% 9.40% 7.60% 9.70% 7.60% 5.30% 8.50% 18-29 30-39 40-49 50-59 60-64 65+ Source: LAC DPH, 2013 Geographical areas of greatest impact (disparities) Percent Population, By PUMA, ACS 2008-2010 3-Year Estimate Over 30.0 20.1-30.0 10.1-20.0 Under 10.1 No Suicide Deaths No Data or Data Suppressed According to the Nielson Co, Thomson Reuter 2012 estimates, the communities of Lancaster, North Hills, North Hollywood, Pacoima, Palmdale, Panorama City, and Sylmar have the highest number of population with Anxiety and Depression (Nielson Co, Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of poor Mental Health in the community? 98 P a g e

The following factors are associated with higher rates of poor mental health in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic and Behaviors Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Unemployment* Heavy Alcohol Consumption Tobacco Usage and Expenditures* Physical Inactivity* Community Input What do community stakeholders think about the issue of Mental Health in their community? The lack of mental health care causes people to go untreated for years and years, which could be the reason for the higher rates of depression and suicide in the AV. No one is intervening. When those with a mental illness have a serious break and are admitted to the mental health ward at Antelope Valley Hospital, OliveView or Henry Mayo hospitals, they are released with a prescription for 30 days worth of medication and can wait up until 90 days for an appointment with DMH AV. In those 60 days without medications, patients have a high probability of coming back to the hospital on another 5150 call. It creates a revolving door environment. There used to be 60 mental health beds (including children) in five hospitals in AV when the population was at 50,000 and now with the current population over 400,000, we are down to one hospital with a mental health ward that has 6 to 12 mental health beds. The number of beds available depends on a patient to staff ratio of 6 patients to 1 nurse. People out sick or quitting will affect that number. Many clients are forced to go to Henry Mayo Hospital or OliveView hospital which is 35 to 60 miles away, respectively. This affects follow up case management and family support system. There is no real infrastructure for adult mental health. Resources and services are very spare. There are several children agencies that provide services, but there are no inpatient services for children. Other than L.A. County Department of Mental Health, mental health America is the only adult provider of mental health services in the AV serving 1,000 people last year. When you consider one in four adults is in need of mental health services and the AV has a population of more than 400,000 people, we are not even touching the need in the AV. The AV used to have 60 mental health beds between the old Palmdale Hospital and Lancaster where some of those beds were for children. We now have 6 to 12 beds at Antelope Valley Hospital with none for children. 99 P a g e

Stigma is also a factor. Many people consider that those with mental health issues have a character flaw and that somehow a person is not strong enough or not trying hard enough. Those same people wouldn t tell a person with diabetes or heart disease to buck up and handle it. Misinformation contributes to this stigma. More support from the community could help, and providing correct information can go a long way to reduce the stigma. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Mental Health is a heath need in KFH - Panorama City Medical Center Service Area as marked by the prevalence of depression and anxiety, and the percentage of adults who report not receiving adequate social and emotional support. The health need is likely being impacted by the poverty rates, lack of social and emotional support, and lack of education to seek professional mental and behavioral services. 100 P a g e

Health Need Profile: Obesity/Overweight for Adult and Youth About Obesity/Overweight for Adult and Youth - Why is it important? The County of Los Angeles Public Health department s (LAC DPH) September 2012 article on the Trends in Obesity: Adult Obesity Continues to Rise, reports that Over the past decade, the obesity epidemic has emerged as one of the most significant public health threats in Los Angeles County and across the nation (Los Angeles County Department of Public Health, 2012). According to the World Health Organization (WHO), overweight or obesity is an accumulation of excess body fat that affects a person s overall health. Overweight and obesity is calculated by using the Body Mass Index where the weight of the person (in kilograms) divided by the square of their height (in meters). Overweight is a BMI equal to or more than 25 and obesity is where the BMI is over 30 (WHO, Obesity and overweight fact sheet, 2012). Overweight and obesity is one of the most preventable health problems and causes type II diabetes, which could potentially lead to other chronic diseases such as heart disease, stroke, arthritis and many forms of cancers. Obesity and overweight is not only prevalent among adults, but also children. According to the Trends in Obesity: Adult Obesity Continues to Rise published by the LAC DPH, in the year 2011, about 23.6% of the adults (18 years or older) in Los Angeles County were obese (Los Angeles County Department of Public Health, 2012). Statistical data Overweight Adults Report Area KFH - Panorama City Medical Center Service Area (Service Area) Student Population Number Percent Tested Obese Obese 55,406 18,701 33.75% Antelope Valley (Service Area) 17,397 5,752 33.06% Panorama City (Service Area) 38,009 12,949 34.07% California 1,300,153 387,743 29.82% Note: This indicator is compared with the state average. Data Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011. Source geography: School District. This indicator reports the percentage of children in grades 5, 7, and 9 ranking within the "High Risk" category (Obese) for body composition on the Fitnessgram physical fitness test. Body composition is determined by skin fold measurements or bioelectrical impedance analysis for the calculation of percent body fat and/or Body Mass Index (BMI) calculation. The percent body fat "high risk" threshold is 27%-35.1% for boys and 28.4%-38.6% for girls, depending on age. The BMI "high risk" threshold is 17.5-25.2 for boys and 17.3-27.2 for girls, depending on age. This indicator is relevant because it is a measure of body's mass that is fat, and high levels of body fat are linked to obesity, heart disease, diabetes, and other health issues. 101 P a g e

Obese Youth Report Area Total Population Number Percent (Age 18 ) Overweight Overweight 1,166,703 424,960 36.42% KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) 309,948 112,758 36.38% Panorama City (Service Area) 856,755 312,202 36.44% California 27,311,960 9,886,930 36.20% United States 232,747,222 84,521,271.09 36.31% Note: This indicator is compared with the state average. Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, 2006-2010. Source geography: County. Adult overweight rates are higher in KFH - Panorama City Medical Center Service Area and are not meeting the state and national benchmarks. However, adult obesity rates are better than state and national benchmarks. On the contrary, youth overweight rates are better than state benchmark but youth obesity in KFH - Panorama City Medical Center Service Area is not meeting the state benchmark. Sub-populations experiencing greatest impact (disparities) Students by Race / Ethnicity, Percent Obese ("High Risk" Fitness Zone) Report Area White Black Asian American Indian/ Alaskan Native KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) Panorama City (Service Area) Hispanic / Latino Multi- Race 20.50% 31.07% 19.14% 27.63% 39.75% 28.70% 24.76% 29.25% 18.39% 23.08% 37.49% 28.64% 19.30% 32.40% 19.18% 29.20% 40.61% 29.65% California 19.82% 30.27% 16.69% 19.97% 36.74% 23.89% Note: This indicator is compared with the state average Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. The above table reflects the percentage of children in grades 5, 7, and 9 ranking within the "High Risk" or Needs Improvement zones for aerobic capacity on the Fitnessgram physical fitness test. Aerobic capacity is determined by VO2max, a measure of the maximum rate that oxygen can be taken up and utilized by the body during exercise. VO2max rates are estimated through a one mile run, a 20m PACER, or a walk test. The VO2max Healthy Fitness Zone threshold is 41.2-44.3 for boys and 40.2-38.6 for girls, depending on age. As age increases the VO2max threshold increases for boys, and decreases for girls. This indicator is relevant because a lack of 102 P a g e

physical fitness in children may lead to significant health issues, such as obesity, diabetes, and poor cardiovascular health. Pct. of Students In 'At High Risk' Body Composition Zone, By Elementary School District, CA Dept. of Education, 2011 Over 40.0% 30.1-40.0% 20.1-30.0% 10.1-20.0% Under 10.1% Students by Race / Ethnicity, Percent Overweight (Needs Improvement Fitness Zone) 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% White Black Asian American Indian / Alaskan Native Hispanic / Latino Multi-Race Report Area Panorama City (Service Area) Antelope Valley (Service Area) California Ethnic data for obese youth demonstrates high disparities between Hispanic/Latino, Black and Non-Hispanic American Indian/Alaskan Native populations. Associated drivers and risk factors What is driving the high rates of overweight adults and obese youth in the community? The following are associated with higher rates of overweight adults and obese youth in the community. Factors marked with an * are not meeting the state benchmarks. The following table includes the community input on the risk factors and associated drivers for obesity and overweight among adults and youth in their community. 103 P a g e

Socio-economic Health Behaviors Physical Environment Poverty rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Lack of Health Insurance Lack of Access to Primary Care No regular doctor visits due to cost Missed or no shows for follow up doctor s appointment due to cost Lack of coordinated care Poor communication or lack of communication between health care providers and patients Lack of communication between providers Inadequate Fruit/Vegetable consumption (adult)* Adequate Fruit/Vegetable Consumption (youth) Soft Drink Expenditures* Physical Inactivity (adult)* Physical Inactivity (youth)* Breastfeeding (Any) * Breastfeeding (Exclusive)* Fruit/Vegetable Expenditure Tobacco Usage (Adult)* Tobacco Expenditure* Poor eating habits (all ages) Consumption of fast foods Foods containing high amounts of sugar and fats High number of fast food restaurants Access to grocery stores Grocery Store Access* WIC-Authorized Food Store Access Population Living in Food Deserts Food Store Access Park Access* Walkability Recreation and Fitness Facility Access* Unsafe neighborhoods Poor lighting Cracked pavements Health Outcomes Diabetes Heart disease High blood pressure High cholesterol Stroke Cancers Education/Knowledge Lack of knowledge about the health condition they have Language barriers Do not take care of their health needs Lack of resources Lack of culturally appropriate information about health issues and available resources Lack of nutritional education Community Input What do community stakeholders think about the issue of Overweight and Obesity? Community stakeholders believe poor eating habits and lack of physical activity are contributing to the high rates of overweight and obesity in their community. The participants discussed the following issues as contributors to overweight and obesity. Poor diet Fast food restaurants Lack of nutritional education 104 P a g e

Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Overweight adults and obese youth is a health need in KFH - Panorama City Medical Center Service Area as the rates of overweight adults and obese youth rates are higher than state average. The health need is likely being impacted by poverty rates, inadequate consumption of fruits and vegetables among adult populations in KFH - Panorama City Medical Center Service Area. In addition, physical inactivity, fast food access, lack of parks and walkability along with lack of recreational facilities are contributing to the high rates of overweight among adults and obesity among youth in KFH - Panorama City Medical Center Service Area. As discussed earlier, Hispanic/Latino, Black and non-hispanic American Indian/Alaskan Native youth are more impacted by obesity compared to other ethnicities in KFH - Panorama City Medical Center Service Area. 105 P a g e

About Physical Environment - Why is it important? Physical environment includes not only the geographical area where people live, but also the soil, water, weather and built environment. Environmental factors including built structures, quality of air, water, cleanliness of the community and safety can have either positive or negative impact on people s health. For example, parks, grocery stores, shops, entertainment, restaurants are all considered the environment where someone lives. Statistical data This indicator reports the number of grocery stores per 100,000 population. Grocery stores are defined as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included are delicatessen-type establishments. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores are excluded. This indicator is relevant because it provides a measure of healthy food access and environmental influences on dietary behaviors. Grocery Stores Health Need Profile: Physical Environment/Transportation Report Area Total Population, 2010 Census Number of Establishments Establishment Rate (Per 100,000 Population) KFH - Panorama City 1,573,307 340 21.60 Medical Center Service Area (Service Area) Antelope Valley (Service 420,603 91 21.60 Area) Panorama City (Service 1,152,704 249 21.60 Area) California 37,253,956 8,256 22.16 United States 308,745,538 67,342 21.81 Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, County Business Patterns, 2010. Source geography: County. Park Access This indicator reports the percentage of population living within 1/2 mile of a park. This indicator is relevant because access to outdoor recreation encourages physical activity and other healthy behaviors. Data for this indicator is provided by a local source, if available. Park Access 106 P a g e

Report Area Total Population, 2010 Census Population Within 1/2 Mile Percent Within 1/2 Mile KFH - Panorama City Medical Center Service Area (Service Area) Antelope Valley (Service Area) Panorama City (Service Area) 1,574,156 595,278 37.82% 421,692 93,969 22.28% 1,152,464 501,309 43.50% California 37,253,956 21,831,619 58.60% Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2010 Census of Population and Housing, Summary File 1; Esri's USA Parks layer (compilation of Esri, National Park Service, and TomTom source data), 2012. Source geography: Block Group. The park access is not meeting the state benchmark. The Antelope Valley (22.28%) has less green space and park access compared to Panorama City (43.50%) and not meeting the state (58.60%) percentage. Sub-populations experiencing greatest impact (disparities) People living in the city face air pollution, water pollution, lack of green space, access to nature. All these factors could negatively impact their health. Environment pollutants and toxins such as asbestos, lead, rodents, and pests can cause physical illness and could harm the living environment. Not only air or water pollution, but noise pollution, lack of access to healthier food choices, lack of transportation, stress, and lack of social support can impact the overall health of an individual. Community Input What do community stakeholders think about the issue of physical environment? Community stakeholders had a number of reasons why they believed the physical environment is an issue in their community: Lack of access to parks Cracked pavements Poor street lights Unsafe neighborhood 107 P a g e

Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary The KFH Panorama City Medical Center Service Area has less green space and grocery store access. Both areas are not meeting the benchmarks. Grocery access in KFH Panorama City is (21.60) per 100,000 population and park access in AV (22.28%) and Panorama City (43.50%) are lower than the state average and are not meeting the need of the communities. Green space was a huge issue to many of the community residents. Therefore, a list of local parks is provided under resources in Appendix C. 108 P a g e

Health Need Profile: Poverty Rates About Poverty Rates Why it is important? Section 673(2) of the Omnibus Budget Reconciliation Act (OBRA) requires the Secretary of the Department of Health and Human Services to update the poverty income guidelines annually. The poverty levels are set to help families/households to file an affidavit called (Minimum Income Requirement for Use (I-864) form). This allows individuals and families to be enrolled into government assisted programs. The poverty guidelines are poverty thresholds used by the Census Bureau to make statistical estimation of people or families living in poverty (U.S. Department of Health and Human Services, 2013). 2013 Poverty Guidelines From the U.S. Department of Health & Human Services Persons in Family/Household <100% Federal Poverty Level Annual Income in $ 200% Federal Poverty Level Annual Income in $ 1 $11,490 $22,980 2 $15,510 $31,020 3 $19,530 $39,060 4 $23,550 $47,100 5 $27,570 $55,140 6 $31,590 $63,180 7 $35,610 $71,220 8 $39,630 $79,260 Source: U.S. Department of Health and Human Services, 2013. Poverty has a great impact on overall health because it minimizes an individual s or family s capacity to access services or basic needs for themselves. Poverty is significantly important because it creates barriers when accessing health services, healthy food, and other necessities that contribute to poor health status. Statistical data How is poverty measured? What is the prevalence of poverty in the community? Poverty <100% (FPL) KFH Panorama City Medical Center Service Area s poverty rates (<100%) in both Antelope Valley (18.68%) and Panorama City (13.74%) are higher than the state (13.71%) and the nation (13.82%). Overall poverty rate of KFH Panorama City Medical Center Service Area (15.04%) is not meeting state and/or the national poverty benchmarks. 109 P a g e

Poverty Rate (<100% FPL) Report Area Total Population (For Whom Poverty Status is Determined) Total Population in Poverty Percent in Poverty (100% FPL) KFH - Panorama City Medical 1,503,948 226,220 15.04% Center Service Area (Service Area) Antelope Valley (Service Area) 395,118 73,815 18.68% Panorama City (Service Area) 1,108,830 152,405 13.74% California 35,877,036 4,919,945 13.71% United States 296,141,152 40,917,512 13.82% Note: This indicator is compared with the state average. No breakout data available. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. Poverty Rate 200% (FPL) Antelope Valley (40.9%) and Panorama City (35.40%) 200% federal poverty levels are higher than the state (32.83%) and the U.S (31.98%) benchmarks. As poverty impacts the ability of families/households affordability with dental, medical care, healthy food consumption and recreation, it is important to note the communities in KFH Panorama City Medical Center Service Area are adversely affected by poverty. KFH - Panorama City Medical Center Service Area 36.86% 40.97% 35.40% 32.83% 31.98% Antelope Valley (Service Area) Panorama City (Service Area) California Population with Income Below 200 % Poverty Level United States 110 P a g e

Sub-populations experiencing greatest impact disparities) Population by Race/Ethnicity, Percent in Poverty by Report Area 8% 12% 6% 8% 18% 5% White Black Asian Native American/Alaskan Native Native Hawaiian/Pacific Islander Some Other Race 13% 16% 14% Multiple Race Hispanic Non-Hispanic Sub-populations experiencing the greatest impact in KHF-Panorama City Medical Center Service Area are primarily Native Hawaiian/Pacific Islanders (26.81%), Blacks (29.94%), and Native Americans (22.17%). Geographical areas of greatest impact (disparities) Percentage of Total Population, By Tract, ACS 2006-2010 5-Year Estimate Over 40.0% 30.1-40.0% 20.1-30.0% 10.1-20.0% Under 10.1% Households in KHF-Panorama City Medical Center Service Area that make less than $15,000 annually are primarily in 91324 (Northridge) with 22.45% of its residents making less than $15,000 a year, 91405 (Van Nuys) with 19.06%, and 91606 (North Hollywood) with 16.75% (The Nielsen Company., Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of poverty in the community? The following factors are associated with poverty rates in KFH - Panorama City Medical Center Service Area communities. Factors marked with * are not meeting the state, nation and/or Healthy People 2020 benchmarks. 111 P a g e

Socio-Economic Population with No High School Diploma* High School Graduation Rate* Unemployment Rate* Student Reading Proficiency (4 th Grade)* Health Outcomes Poor General Health* Premature Death Population with any Disability Community Input What do community stakeholders think about the issue of poverty? Community members expressed concern about unemployment and loss of jobs. Poverty rates in KFH Panorama City Medical Center Service Area are higher than the state and the U.S. Community stakeholders were concerned that the unemployment rates have contributed to the increasing rate of homeless population and the demand for food and free services have increased over the past few years. Assets What are the community assets that can address the health need? The assets listed above are randomly selected from a long list of assets available. For a comprehensive list of community assets and resources to address the health need, please refer to Appendix C. Summary Poverty is considered a key driver of health status because it influences other negative health outcomes. It creates barriers for families and individuals when seeking access to health care services or basic needs such as healthy/affordable food and other daily necessities. The related indicators that were identified as contributing to poverty rates in KFH - Panorama City Medical Center Service Area include: poor general health, premature death, and population disability; among many others. 112 P a g e

About Prenatal Care - Why is it important? Prenatal care is vital to keep both the mother and the child healthy during and after pregnancy. Women who receive prenatal care are less likely to give birth to an underweight or premature baby. Babies born to mothers that do not receive prenatal care are three times more likely to have low birth weight and five times more likely to die (U.S. Department of Health and Human Services Office on Women s Health, 2009). With regular prenatal care, women can help prevent and reduce the risk of pregnancy and infant complications as well as inform themselves about the important steps they can take to protect their infant and ensure a healthy pregnancy (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2012). Statistical data How is prenatal care measured? What is the prevalence of women that lack prenatal care in the community? Report Area Total Population Health Need Profile: Prenatal Care Total Live Births Prenatal Care Started in 2nd Trimester Prenatal Care Started in 3rd Trimester No Prenatal Care Total Mothers with Late or No Prenatal Care Percent Mothers with Late or No Prenatal Care KFH - 2,122,785 26,181 2,098 379 57 2,534 16.84 Panorama City Medical Center Service Area (Service Area) Antelope 419,491 6,247 1,673 280 49 2,002 32.05% Valley (Service Area) Panorama 1,152,451 15,579 1,371 265 38 1,674 10.75% City (Service Area) California 37,253,956 509,979 no data no data no data 15,995 3.14% Note: This indicator is compared with the state average. No breakout data available. Data Source: California Department of Public Health, Birth Profiles by ZIP Code, 2010. Source geography: ZIP Code. 113 P a g e

KFH - Panorama City Medical Center Service Area Panorama City (Service Area) Antelope Valley (Service Area) California 32.05% 16.84% 10.75% 3.14% Mothers with late or no Prenatal Care The percent of mothers who receive late or no prenatal care (during their first trimester) in KFH - Panorama City Medical Center Service Area (9.68%) is significantly higher compared to the state (3.14%), but more prominently so in the Antelope Valley Service Area (32.05%). This indicator highlights a lack of access to preventative care, a lack of health knowledge, insufficient provider outreach, and/or social barriers preventing utilization of services. Sub-populations experiencing greatest impact (disparities) Population by Race/Ethnicity, Infant Mortality Rate (Per 1,000 Live Births) 14 12 10 8 6 4 2 0 Report Area Antelope Valley (Service Area) Panorama City (Service Area) California United States White Black Asian American Indian/Alaskan Native Hispanic/Latino Infant mortality is a related indicator and health outcome of lack of prenatal care. Infant mortality rates affect more Blacks (11.57) than any other subpopulation across the KFH - Panorama City Medical Center Service Ares compared to the state and/ or the nation. 114 P a g e

Geographical areas of greatest impact (disparities) New Mothers with Late or No Prenatal Care, Percent, By ZCTA, CDPH, 2010 Over 30.0% 20.1-30.0% 12.1-20.0% 6.1-12.0% Under 6.1% No Data or Data Suppressed Geographical areas of greatest impact are prominently seen in the Antelope Valley Service Area where more than thirty percent of new mothers receive either late or no prenatal care. Although zip code level is not readily available for this area, the Los Angeles Department of Public Health has published a report which states that only 66.7 percent of mothers in Antelope Valley received prenatal care during their first trimester (Key Indicators of Health, 2013). Currently, Antelope Valley is fairing worse in prenatal care than the other seven Service Planning Areas. Associated drivers and risk factors What is driving the high rates of the lack of prenatal care in the community? The following factors are associated with higher rates of the lack of prenatal care in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic & Health Behaviors Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Unemployment* Uninsured Population Population with no High School Diploma Student Reading Proficiency (4 th Grade) Tobacco Usage (Adult) Health Outcomes Low Birth Weight* Infant Mortality* Teen Pregnancy 115 P a g e

Community Input What do community stakeholders think about the issue of prenatal health in their community? Community health care providers expressed concern with the number of expectant mothers getting prenatal care in both Antelope Valley and Panorama City areas of KFH Panorama City Medical Center Service Area. Health care providers suggested that providing education to expectant mothers on nutrition, dental care, and breastfeeding would reduce the infant low birth weight, childhood dental carriers and obesity. Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Prenatal care is a heath need in KFH - Panorama City Medical Center Service Area. The rates of mothers who receive late or no prenatal care are high in KFH - Panorama City Medical Center Service Area (9.68%) and not meeting the state (3.14%) benchmark. Antelope Valley has a higher need for prenatal care services/intervention programs when compared to Panorama City Service Area, although, both are not meeting the state benchmark. The health need is likely being impacted by lack of knowledge and access to primary health care which can be associated with high poverty rates. Additionally, unemployment, lack of insurance, reading proficiencies, tobacco use, and teen pregnancies are like influencing the health need. The latter indicators are also contributing to low birth weights and infant mortality which lower overall infant health. 116 P a g e

Health Need Profile: Unemployment About Unemployment: Why is it important? Unemployment is calculated for the civilian non-institutionalized population age 16 and older that is unemployed (non-seasonally adjusted). Unemployment creates financial instability and barriers to access including insurance coverage, health services, healthy food, and other necessities that contribute to poor health status. Statistical data Table: Unemployment Rate Report Area Labor Force Number Employed KFH Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) Number Unemploye d Unemploymen t Rate 782,964 704,601 78,363 10.01 208,283 186,960 21,323 10.24 574,681 517,641 57,040 9.93 California 18,557,689 16,817,161 1,740,528 9.40 United States 1,063,513,300 981,936,688 81,576,612 7.67 Note: This indicator is compared with the state average. Data Source: U.S. Bureau of Labor Statistics, December, 2012 Local Area Unemployment Statistics. Source geography: County. KFH Panorama City Medical Center Service Area s unemployment rates in both the Antelope Valley (10.24) and Panorama City (9.93) are higher than the state (9.40) and the nation (7.67). Overall unemployment rate of KFH - Panorama City Medical Center Service Area (10.01) is not meeting the state and/or the national unemployment benchmarks. Barriers for securing employment include not graduating from high school, reading below 4 th grade level and high school graduation rates. In KFH Panorama City Medical Center Service Area, all these issues have been identified as not meeting the state and the national averages. Population without High School Diploma Percentage of the population without high school diploma is higher in KFH Panorama City Medical Center Area (23.77%) compared to the state (19.32%) and the U.S. (14.97%). Within KFH - Panorama City Medical Center Area, Panorama City has the highest percentage (24.25%) of people without high a school diploma compared to Antelope Valley (22.30%). 117 P a g e

Graph 10: Percent of Population without High School Diploma 23.77% 22.30% 24.25% 19.32% 14.97% PFH - Panorama City Medical Center Service Area Antelope Valley (Service Area) Panorama City (Service Area) California United States Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, 2006-2010 American Community Survey 5-Year Estimates. Source geography: Tract. High School Graduation Rate On time graduation rates are lower in the KFH - Panorama City Medical Center Service Area. Panorama City (75.93%) and Antelope Valley (79.48%) compared to the state (82.27%) and the U.S. (82.26%). In addition to faring worse than the state and nation they are not meeting the HP 2020 Target (>82.4%). Community leaders and agency partners who participated in key informant interviews and focus groups expressed concern about the literacy levels of the community and fear that the cycle of poverty will continue without the knowledge to obtain higher paying jobs. Table 24: Percent of Students Graduating on Time Report Area Total Student Enrollment Average Freshman Base Enrollment Diplomas Issued On-Time Graduation Rate KFH - Panorama City Medical 87,191 21,663 16,639 76.81 Center Service Area Antelope Valley (Service Area) 28,388 5,342 4,246 79.48 Panorama City (Service Area) 58,803 16,321 12,393 75.93 California 1,971,766 501,919 412,936.45 82.27 United States 14,815,258 3,745,141 3,080,911.45 82.26 HP 2020 Target >82.4 Note: This indicator is compared with the Healthy People 2020 Target. Data Source: U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Local Education Agency (School District) Universe Survey Dropout and Completion Data, 2008-2009. Source geography: School District. Students Reading below 4 th Grade Level The overall percentage of students reading below the 4 th grade level in KFH Panorama City Medical Center Service Area is much higher (40.54%) compared to the state (35.64%), the U.S (28.63%) and the HP 2020 target rate of <=36.3%. KFH Panorama City Medical Center 118 P a g e

Service Area, Antelope Valley s percentage (47.72%) is higher compared to Panorama City s percentage (37.22%). This issue was identified as a high level of concern in the community by the community leaders, educators and stakeholders during the primary data collection process. Low literacy levels were identified as possible reasons for rates of unemployment, poverty, and poor general health. Respondents also noted that the low literacy levels of residents of the community created barriers to health education and the reading of distributed printed materials. Geographical areas of greatest impact (disparities) Population without high school diploma are high in communities of Pacoima (33%), San Fernando (29.0%), Panorama City (25.5%), Sun Valley (23.1%) and North Hollywood (24.3%), Littlerock (19.1%), Llone (16.3%), Palmdale (12.58%) and Lancaster (23.3%) are specific communities in the KFH- Panorama City Medical Service Area that have more than 20% of the population over age 25 with less than a 9 th grade education (U.S. Census Bureau, 2007-2011 American Community Survey). Associated drivers and risk factors What is driving the high rates of unemployment in the community? Socio-economic Population without High School Diploma Students Reading below 4 th Grade Level High School Graduation Rate *Shows that those indicators did not meet the state, U.S benchmarks Community Input What do community stakeholders think about the issue of Unemployment in their community? Community leaders shared their concerns regarding lack of English and language proficiency, math skills, and high school dropout rates, stating these reflect negatively on the wellbeing and growth of the communities they live in. Other issues brought up by the community stakeholders include: Lack of jobs Lack of skilled workers Budget cuts Furloughs days Reduced work hours Underemployment Assets What are the community assets that can address the health need? 119 P a g e

Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary KFH Panorama City Medical Center Service Area s unemployment rates in both the Antelope Valley (10.24) and Panorama City (9.93) are higher than the state (9.40) and the nation (7.67). Overall unemployment rate of KFH - Panorama City Medical Center Service Area (10.01) is not meeting the state and/or the national unemployment benchmarks. Other factors possibly contributing to the high rate of unemployment in KFH Panorama City Medical Center Service Area include not graduating from high school, reading below 4 th grade level and high school graduation rates. Barriers for securing employment will create barriers to employer provided health insurance. Lack of insurance in turn creates barriers to access to primary and preventative care leading to elevated number of health related issues. 120 P a g e

Health Need Profile: Uninsured Population About Uninsured - Why is it important? Health insurance is a key driver of health status. Economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of health insurance affect access to health care and community s ability to engage in healthy behaviors. Due to the current health care system in the U.S. and the cost of health care, people without health insurance may not receive needed health care. Statistical data How is poor dental health measured? What is the prevalence of oral health in the community? Percent Uninsured 20.81% 16.47% 22.37% 17.92% 15.05% Report Area Antelope Valley (Service Area) Panorama City (Service Area) California United States The rate of uninsured population is much higher in KFH - Panorama City Medical Center Service Area (20.81%) compared to the state (17.92%) and the U.S. (15.05%). Lack of insurance is a barrier to healthcare access including regular primary care, specialty care, and other health services and contributes to poor health outcomes. Sub-populations experiencing greatest impact (disparities) Ethnic data reflects high disparities among Hispanic/Latino, Native American/Alaskan Native, followed by Black and White. 40.00% Percent of Uninusred Population by Ethnicity Report Area 30.00% 20.00% 10.00% 0.00% Antelope Valley (Service Area) Panorama City (Service Area) California United States 121 P a g e

Geographical areas of greatest impact (disparities) Percent Population, By PUMA, ACS 2008-2010 3-Year Estimate Over 25.0% 18.1-25.0% 12.1-18.0% 6.1-12.0% Under 6.1% According to the Nielson Co, Thomson Reuter 2012 estimates, the communities of Lancaster, North Hills, North Hollywood, Pacoima, Palmdale, Panorama City, Sun Valley, Sylmar and Van Nuys have the highest number of population without health insurance (Nielson Co, Thomson Reuters, 2012). Associated drivers and risk factors What is driving the high rates of uninsured in the community? The following factors are associated with higher rates of uninsured in the community. Factors marked with an * are not meeting the state and/or national benchmarks. The following table includes input from the community leaders, residents and health care providers. Socio-economic Poverty Rate (< 100% FPL)* Population below 200% of Poverty Level* Children in Poverty* Unemployment Community Input What do community stakeholders think about the issue of Uninsured in their community? Community stakeholders had a number of reasons for why they believed oral health is an issue in their community: Lack of healthcare insurance and transportation are the biggest barriers to receiving healthcare. Over 90% of Antelope Valley Community Clinic s clients are low income, 40% don t have healthcare insurance at all. Many illnesses such as diabetes, asthma and heart disease can start with poor nutrition, be present because of family history (if known) and not be discovered before reaching the critical stage if individuals and families don t have the money for insurance or the money to pay cash at the doctors. 122 P a g e

Assets What are the community assets that can address the health need? Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are attached under Appendix C. Summary Uninsured is a health need in KFH - Panorama City Medical Center Service Area. The percentage of uninsured population is higher in KFH - Panorama City Medical Center Service Area (20.81%) compared to the state (17.19%) and the U.S (15.05%). Lack of insurance is a barrier and contributes to poor health outcomes. The health need is likely being impacted by the poverty rates and unemployment. 123 P a g e

Appendix B: Primary Data Collection Tools and Instruments 124 P a g e

Key Informant Interview Questions (VCCC) Name: Degree: Title: Agency: City, Zip code where they work: Email: Phone: Experience and expertise in public health or working with low-income, indigent population: What are the most significant health problems in the community you serve? What ages are affected by the issue? What are the most significant educational/environmental & socio-economic factors affecting the community? What ages are impacted? What are the most risky behaviors affecting the community? What age groups most impacted? What problems affect the health of your clients? If you could prioritize the issues, what are the top 5 issues, what age groups? Please rank the issues 1 being the most important and 5 being the least important. After we collected primary and secondary data, the following health issues came up to be the top concerns. If you could rank the top 5 of these issues what would they be? Cancer (all types) Asthma Health care access Infant health Suicides Mental health Overweight and obesity STDs Homicides How often do you see the above list in the communities you serve? To address the list of concerns, what are some of the community resources that you could think of that could help address the issues What are some of the barriers Could you please suggest some solutions 125 P a g e

Key Informant Interview questions, Antelope Valley What are the top three health concerns you see in the Antelope Valley? Why? What about the physical environment causes elevated health outcomes? Do you believe the residents of the Antelope Valley have a drastic difference in health behaviors compared to LA County or the State? What can be done at a community level to address the availability of healthcare providers? Where do you see gaps in health services here in the Antelope Valley? Obesity and insurance access Data shows that obesity rates are higher in the Antelope Valley compared to the state of California. Would you agree that obesity is an issue in this community? 57% of the population in the Antelope Valley lives at less than 200% FPL. Do you believe there is a connection between obesity and poverty? Between adult and childhood obesity? Is lack of insurance a barrier to receiving healthcare? Have you seen an increase in enrollment in Medicaid or Medicare related health plans over the last two years? Why do you think that is? The data shows that the rates of depression and suicide are much higher in the Antelope Valley than the rest of Los Angeles County. Do you see access to mental health care for those on Medicaid and Medicare as a concern for the Antelope Valley? How would you address this issue? Transportation Does transportation play a role in service gaps or access to services for members of this community? Observations and local resident surveys have shown that transportation is an issue in the AV compared to the State of California. Would you agree that lack of public transportation is an issue in the community? Why do you think transportation is a problem in this community? What is causing community members to have transportation issues? What organizations or resources exist in the community to address this issue? What do community residents believe to be the appropriate solution to addressing the lack of transportation in their communities? Have you identified the gaps in regional communication and regional coordination of transportation? How did you quantify the mobility needs in the AV? What do you feel are realistic solutions to the transportation problems in AV? Mental Health The data shows that rates of depression and suicide are significantly higher in the AV compared to the rest of Los Angeles County. Would you agree? Why do you think the depression and suicide rates are so much higher in the AV? Are there other issues related to mental health in the AV that you see as a concern? What organizations or resources exist in the community to address mental health? 126 P a g e

Focus Group Questions for Panorama City (VCCC) What is the most significant health/educational/environmental/socioeconomic factors affecting your community? What ages are most impacted? What are the most risky health behaviors affecting your community? What are the community resources that are in place to support the community to address the issues? What are some of these barriers to accessing the resources? What do you think are the solutions to these problems? Rank the community issues (top 5) Focus Group Questions (AVPH) Health Problems and concerns including physical, oral and mental health issues Issues that relate to a family s ability to provide parenting, economic security and a healthy environment Anything that relates to education and an individual s ability to reach their potential and be ready for school/learning. Other issues significantly impacting the community Community resources available to address problems/issues Barriers to accessing available resources What services/programs do you feel are needed in the AV that would address the identified needs? 127 P a g e

Valley Care Community Consortium (VCCC) 2013 Community Health Survey 7515 Van Nuys Blvd 5 th Floor Van Nuys, CA 91405 To preserve your confidentiality, do not put your name or other personal identifiers on the survey. If you are at least 18 years of age, please take a few minutes to complete the survey below. The purpose of the survey is to create a snapshot of the health of the communities in which you live. Information gathered by the Community Health Needs Assessment can then be used for planning, programs and community benefit resource allocation. The results of the questionnaire will help identify problematic key issues that will be addressed through community input. If you have any questions about this survey, please call 818-947-4040. Make your opinion count by completing this survey. Thank you. 1)Zip code: 2) City: 3) Age: (Please check 26-39 one) 25 or less 40-54 55-64 65 or older 4) Sex: (Please check one) Male Female 5) Ethnic group you most identify with: (Please check one) African America/Black Hispanic/Latino White/Caucasian Asian/Pacific Islander Native American Other: 6) Marital Status: (Please check one) Married Divorced/Separated Single Widow/Widower Domestic Partners 7) Education: (Please check one) Less than High School High School diploma/ged Some college College degree or higher 8) What is your household income? (Check one) Less than $20,000 $20,000 to $39,999 $40,000 to $59,999 $60,000 to $79,999 $80,000 or higher 128 P a g e

9) How do you primarily pay for your health care? (Check all that apply) Cash (No Insurance) Health insurance (e.g., private insurance, Humana, Anthem, etc.) Medicaid Medicare with or without Medicare supplemental coverage Healthy Way LA Veterans Administration/Military Don t go to a Doctor because I can t pay Other: 10) During the past 12 months, was there any time when you needed to see a doctor, but could not because of the cost? (Check one) Yes No 11) During the past 12 months, was there any time that you did not have any health insurance or coverage? (Check one) Yes No 12) Where do you go to most often when you are sick or need advice about your health? Please check only one. (Check one) Doctor's Office/Family Doctor Community Clinic Local health department Hospital emergency room Urgent care center Free Clinic Hospital outpatient clinic Other: 13) Which of the following best describes your typical daily physical activity level? (Check one) No Activity Limited Moderate Active Very Active 14) Compared to a year ago, how is your health now? (Check one) Much better now than 1 year ago Better now than 1 year ago About the same Worse now than 1 year ago 15) How would rate your own personal health? (Check one) Excellent Very Good Good Fair Poor 16) Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks in a day? (Check one) (8oz wine, 12oz beer, 1.5oz shot) None 1-5 times 6-10 times More than 10 times 129 P a g e

17) How many cigarettes do you smoke per day? (Check one) Per Day 18) Have you ever been told by a doctor, nurse, or other health professional that you are overweight or obese? Yes No 19) Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? Yes No 20) Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high? Yes No 21) Have you ever been told by a doctor that you have diabetes? Yes Yes, but only during pregnancy No 22) Have you ever been diagnosed with a mental health disorder? Yes No 23) How do you rate your mental health? (Select one choice that fits best) Excellent Very Good Good Fair Poor 24) On how many of the past 7 days did you exercise or participate in physical activity for at least 20 minutes that made you sweat or breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities? (Check one) 0 1 2 3 4 5 6 7 25) Yesterday, how many times did you eat vegetables? (Check one) DO count: Cooked and uncooked vegetables; salads; and boiled, baked and mashed potatoes. DO NOT count: French fries, potato chips, or lettuce that is on a sandwich or sub. I did not eat vegetables yesterday 1 time 2 times 3 time s 5 or more 26) Yesterday, how many cans or glasses of non-diet soda did you drink? (Check one) DEFINITION: A non-diet soda is a soda with sugar in it, such as Coke, Pepsi, Sprite, ginger ale, or root beer. Count a 20 - ounce bottle as 2 glasses. I did not drink any non-diet soda yesterday 1 can or glass 2 cans or glasses 3 or more cans or glasses 27) How often do you eat at fast food restaurants? 4 or more times per week 1-3 per week Less than 1 per week Never 28) What type of medical provider do you use for routine care? (Check all that apply) Family doctor Emergency Room/Hospital Community Health Center/Clinic Specialist Health Department Other: 130 P a g e

29) What concerns you most about health within your community? (Select 5 concerns; rate 1-5 with 1 being the most concerning and 5 being the least concerning) Aging problems Infant death High blood pressure Cancers Infectious disease HIV/AIDS Child abuse/neglect Mental health problems Obesity Dental Problems Motor vehicle crash injuries Teenage pregnancy Diabetes Rape/Sexual assault Homicide Domestic violence Respiratory diseases Other: Firearm-related injuries Sexually transmitted diseases Heart disease and stroke Suicide 30) What source do you primarily use to get your health-related information? (Check one) Friends and family Hospital Doctor/nurse Health department Pharmacist Help lines Church Books/magazines Internet Other: My child s school 31) How safe is your neighborhood? Very safe Somewhat safe Somewhat unsafe Very safe 32) How safe is it to walk or play in the neighborhood park? Very safe Somewhat safe Somewhat unsafe Very unsafe 33) Are you satisfied with the health care system in your County? (Consider health care options, access, cost, availability, quality, etc.) (Circle One) Very Unsatisfied 1 2 3 4 Very Satisfied 34) What 2 health topic(s)/ disease(s) would you like to learn more about? 35) What services are needed in your community to create a healthier community? Please return completed survey to person conducting the survey or by mail to VCCC 7515 Van Nuys Blvd. Van Nuys, CA 91405 Attention: Joni Novosel Thank you for your time and valuable feedback. 131 P a g e

Valley Care Community Consortium (VCCC) 2013 Community Health Survey 7515 Van Nuys Blvd 5 th Floor Van Nuys, CA 91405 Para preservar su confidencialidad, no ponga su nombre u otros identificadores personales en la encuesta. Si usted tiene por lo menos 18 años de edad, por favor tome unos minutos para completar la siguiente encuesta. El propósito de la encuesta es de crear una instantánea de la salud en las comunidades en las que viven. La información recogida por Evaluación de Necesidades Comunitarias De Salud se puede utilizar para la planificación de programas y benefices de la comunidad de asignación de recursos. Los resultados de la encuesta ayudará a identificar claves problemáticas que se abordarán a través de aportes de la comunidad. Si usted tiene alguna pregunta sobre esta encuesta, por favor llame al 818-947-4040. Haga que su opinión cuente al completar esta encuesta. Gracias. 1) Código Postal: 2) Ciudad: 3) Edad: (por favor marque uno) 25 o menos 26-39 40-54 55-64 65 años o más 4) Sexo: (Por favor marque uno) Masculino Femenino 5) El grupo étnico se identifica más con: (Marque uno) Americano Africano/Negro Asiático/de las Islas del Pacífico Hispano/Latino Nativo Americano White/Caucásico Otro: 6) Estado civil: (Por favor marque uno) Casado Divorciado/Separado Soltero Viuda/Viudo Viven juntos/no casado(a) Parejas de Hecho 7) Educación: (Marque uno) Menos de la Escuela Secundaria Alguna experiencia el la universidad Diploma de Escuela Secundaria / GED Titulo de la universidad o superior 8) Cuál es su ingreso familiar? (Marque uno) Menos de $ 23,050 $ 23,051 a $ 40,338 $ 40,339 a $ 57,625 $ 57,626 a $ 80,675 $ 80,676 a $ 92,200 Más de $ 92,201 9) Cómo principalmente paga por su cuidado de salud? (Por favor, marque todas las que apliquen) Cash (No seguros) Seguro de Salud (por ejemplo, seguro privado, Humana, Anthem, etc.) 132 P a g e

Medicaid Medicare con o sin cobertura de Medicare suplementario HealthyWay LA Administración de Veteranos/ Militar No va al médico porque no pueden pagar Otros: 10) Durante los últimos 12 meses, hubo algún momento en que necesitó consultar a un médico, pero no pudo debido al costo? (Marque uno) Si No 11) Durante los últimos 12 meses, hubo algún momento en que usted no tubo seguro de salud o cobertura? (Marque uno) Si No 12) Donde usted va la mayoría de veces cuando usted está enfermo o necesita un consejo sobre su salud? Por favor, marque sólo una. (Marque uno) Oficina de Doctor/Doctor Familiar Clínica de la Comunidad Departamento de salud local Sala de emergencia Centro de Atención Urgente Clínica Gratuita Hospital de pacientes externos Otros: 13) Cuál de las siguientes opciones describe mejor el típico nivel diario de actividad física? (Marque uno) No Actividad Limitado Moderado Activo Muy activo 14) En comparación con hace un año, cómo está su salud? (Marque uno) Mucho mejor ahora que hace 1 año Mejor ahora que hace 1 año Casi igual que hace 1 año Peor ahora que hace 1 año 15) Cómo calificaría su salud personal? (Marque uno) Excelente Muy Bien Bien Razonable Mal 16) Teniendo en cuenta todos los tipos de bebidas alcohólicas, cuántas veces en los últimos 30 días a tomado 5 o más bebidas en un día? (Marque uno) (8 oz de vino, cerveza 12oz, una copa de 1.5 oz) Ninguna vez 1-5 veces 6-10 veces Mas de 10 veces 17) Cuántos cigarrillos fuma al día? 133 P a g e

18) Alguna vez le ha dicho un medico, enfermera u otro profesional de salud que usted esta sobrepeso u obeso? Sí No 19) Alguna vez le ha dicho un medico, enfermera u otro profesional de salud que tiene la presión arterial alta? Sí No 20) Alguna vez le ha dicho un medico, enfermera u otro profesional de salud que su colesterol es alto? Sí No 21) Alguna vez le ha dicho un médico que tiene diabetes? Sí Sí, pero sólo durante el embarazo No 22) Alguna vez ha sido diagnosticado con un trastorno de salud mental? Yes No 23) Cómo calificaría usted su salud mental? (Seleccione una opción que se ajusta mejor) Excelente Muy bien Bien Razonable Mal 24) En cuántos de los últimos 7 días a hecho ejercicio o participo en actividad física por lo menos 20 minutos que lo/la hizo sudar o respirar fuerte, como el baloncesto, el fútbol, correr, natación, bicicleta rápida, baile rápido, o actividades aeróbicas similares? (Marque uno) 0 1 2 3 4 5 6 7 25) Ayer, cuántas veces comiste verduras? (Marque uno) SI cuente: los vegetales cocidos y crudos, ensaladas, hervidas, al horno y puré de papa. NO cuente: papas francesas, papas fritas, lechuga o que está en un sándwich o sub. No Comí verduras ayer 1 Vez 2 Veces 3 Veces 4 veces o mas 26) Ayer, cuántas latas o vasos gaseosos de dieta bebió? (Marque uno) DEFINICIÓN: Un refresco de dieta es un refresco con azúcar, como Coca-Cola, Pepsi, Sprite, ginger ale o cerveza de raíz. Contar un 20 - oz botella como 2 vasos. No tome bebida gaseosa no dietética ayer 1 Lata o vidrio 2 Latas o vasos 3 O más latas o vasos 27) Con qué frecuencia usted come en restaurantes de comida rápida? 4 veces o más por semana 1-3 por semana Entre 1 vez por semana y menos que 4 veces por mes Menos de 1 por mes Nunca 28) Qué tipo de proveedor medico utiliza usted para la atención medica rutinal? (Marque todos los que apliquen) 134 P a g e

Médico Familiar Departamento de Salud Especialista Centro de Salud Comunitario/ Clínica Sala de Emergencia/Hospital Otro: 29) Qué le preocupa más acerca de la salud en su comunidad? (Seleccione 5 que mas le preocupan con el 1 refiriéndose al mas preocupante y 5 como el menos preocupante) Problemas de la tercera edad Violación/asalto sexual Cáncer Enfermedades respiratorias Abuso de ninos/negligencia Enfermedades de transmisión sexual Problemas dentales Suicidio Diabetes Presión arterial alta Violencia domestica VIH / SIDA Lesiones relacionadas con armas de fuego Obesidad Enfermedades del corazon y paro cardiaco El embarazo de adolescente Muerte infantil Homicidio Enfermedad infecciosa Otro: Problemas de salud mental Lesiones por accidentes de vehículo 30) Qué fuente utiliza principalmente para obtener su información relacionada con la salud? (Marque uno) Amigos y familia Hospital Médico/enfermera Departamento de salud Farmacéutico Líneas de ayuda Iglesia Libros/revistas Internet Otro: La escuela de mi hijo 31) Qué tan seguro es su vecindario? Muy seguro Algo seguro Algo inseguro Muy inseguro 32) Qué tan seguro es caminar o jugar en el parque del vecindario? Muy seguro Algo seguro Algo inseguro Muy inseguro 33) Está usted satisfecho con el sistema de salud en su condado? (Tenga en cuenta las opciones de cuidado de la salud, el acceso, el costo, la disponibilidad, calidad, etc.) (Marque uno) Muy insatisfecho 1 2 3 4 Muy Satisfecho 34) Qué 2 tema de salud/enfermedad(s) le gustaría aprender más? 35) Qué servicios se necesitan en su comunidad para crear una comunidad más saludable? Por favor, devuelva la encuesta completada a la persona que realiza la encuesta o por correo a VCCC 7515 Van Nuys Blvd., Van Nuys, CA 91405 Atención: Joni Novosel 135 P a g e

CHNA Physician Focus Group Questions OliveView UCLA Medical Center September 5, 2012 What is your vision for the health of the community? What can the local non-profit hospitals do to improve the health of the community? Where do you think the gaps are in the health system and how can they be bridged? Thank you for taking the time to complete the questionnaire. Please turn in the form before leaving. 136 P a g e

Panorama City KP Panorama City Prioritization Meeting January 11, 2013 Name: Academic Distinction: Title: Affiliation/Agency: Public Health knowledge/expertise: Email: Are you willing to participate in a third round of voting that will consist of combining the top ten list from both Antelope Valley and Panorama City catchment areas into one KFH - Panorama City Top Ten List? 137 P a g e

Appendix C: Community Resources by Category Hospitals and community based clinics are listed on pages 67 to 71 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community. A more comprehensive list of community based assets and resources that offer a wide range of services in the KFH Panorama City Medical Center Service Area are listed in this section. 138 P a g e

Asthma Services Agency Address City Zip Telephone Advance Health Medical Group 333 E. Magnolia Blvd., Unit 103 Burbank 91502 (818)848-1555 Offers general internal medicine care in a number of medical specialties. Allergy and Asthma Institute of the Valley Canyon Country 27141 Hiadway Ave., #204 Canyon Country 91351 (661)298-1491 Provide allergy and asthma services. Allergy and Asthma Institute of the Valley Granada Hills 10515 Balboa Blvd., #390 Granada Hills 91344 (818)366-8112 Provide allergy and asthma services. Allergy and Asthma Institute of the Valley Studio City 12660 Riverside Dr., #325 Studio City 91607 (818)769-5998 Provide allergy and asthma services. Asthma and Allergy Foundation of America, California Chapter 3435 Wilshire Blvd., Ste. 350 Los Angeles 90010 (800)624-0044 or (323)937-7859 Asthma and allergy services. Glendale Healthy Kids 735 Lexington Dr. Glendale 91206 (818)548-7931 Provide affordable or no cost health care to children who have no access to insurance or are under-insured. Provides fitness for kids, health education, nutrition education, asthma, dental education and health fairs. Note: Hospitals listed on pages 67 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community provide asthma preventative and emergency services for both children and adults. In addition, hospitals also provide allergy testing and treatment for children and adults. Breastfeeding Educational Resources Agency Address City Zip Telephone Antelope Valley Best Babies Collaborative 45104 10th St. West Lancaster 93534 (661)942-4719 Best babies advocacy group. Child And Family Guidance Center - Palmdale Office 310 E. Palmdale Blvd. Ste. G Palmdale 93550 (661)265-8627 Provides high quality outpatient mental health care, supportive social services and linkages to needed community resources for families. Hospitals listed on pages 67 under section Community Assets and Resources Available to respond to the Identified Health Needs of the Community provide breastfeeding education and information in their pediatric, labor and delivery departments. 139 P a g e

Cancer Resources Agency Address City Zip Telephone American Cancer Society 4940 Van Nuys Blvd. Sherman Oaks 91403 (818)905-7766 American Cancer Society offers free brochures on preventing, diagnosing, and treating different kinds of cancer. American Cancer Society - Santa Clarita Unit Cancer information and referral services. Bartz-Altadonna Community 43322 Gingham Health Center Ave. 25020 W. Ave. Stanford, #170 Valencia 91355 (661)298-0886 Lancaster 93535 (661)874-4050 Primary care, HIV medical care, hepatitis C, women s health, reproductive health and family planning, mental health care including psychiatric care, individual counseling, one day intensive grief and loss workshops, art therapy and more. Bienvenidos a Wellness Support group for people with cancer and their families. 668 S. Workman St. San Fernando 91340 (818)361-4617 Circle of Hope Inc. 23560 Lyons Ave. Newhall 91321 (661)254-5218 Assist breast cancer patients and their families and in the Santa Clarita Valley with financial, emotional and education support services. El Proyecto Del Barrio - Arleta Health Center 8902 Woodman Ave. Arleta 91331 (818)830-7133 Provides health, medical services, employment, youth opportunities and substance abuse and mental health. Elysia Skye Breast Cancer Organization 5805 Whitsett Ave. # 211 Valley Village 91607 (310)402-5163 Offers programs designed to raise awareness and teach prevention to women and their families affected by breast cancer. 3850 Poppyseed Hats Off for Cancer Inc. Ln. Calabasas 91302 Hats Off For Cancer collects and donates hats of all kinds to the courageous children who lose their hair due to cancer treatments. Leukemia and Lymphoma Society s Greater L.A Chapter 6033 West Century Blvd., Ste. 300 Los Angeles 90045 (310)342-5800 The Leukemia & Lymphoma Society's Greater Los Angeles Chapter offers a wide range of free educational and support programs for patients, their families, caregivers and healthcare professionals. 140 P a g e

Los Angeles County Department of Health Service (LAC DHS) - Mid Valley Comprehensive Health Center 7515 Van Nuys Blvd. Van Nuys 91405 (818)947-4000 Mid-Valley Comprehensive Health Center (MVCHC) offers primary care services for adults, women and children as well as a range of specialty, ancillary, and pharmacy services. Specialty services include: OB/GYN, pediatrics, dermatology, optical, cardiology, urology, and dental services. Meet Each Need With Dignity (MEND) 10641 N. San Fernando Rd. Pacoima 91331 (818)686-7300 Provides medical services including basic ambulatory, hypertension, diabetic, vision, women's health, acupuncture and chiropractic care for adults and children in certain zip code areas. 26470 Reuther Michael Hoefflin Foundation Ave. Ste. 101 Santa Clarita 91350 (661)250-4100 Educate the public and provide grant funding for innovative research to accelerate progress in the fight against pediatric cancer. Mission City Community Network, Inc. 15206 Parthenia St. North Hills 91343 (818)895-3100 Offers a range of health care services at low cost or no cost. NEVHC - LAC-Valencia Health Center and WIC Site 23763 Valencia Blvd. Valencia 91355 (661)705-2040 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. NEVHC - Pacoima Health Center and WIC Site 12756 Van Nuys Blvd. Pacoima 91331 (818)270-9777 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. NEVHC - Santa Clarita Health Center and WIC Site 18533 Soledad Canyon Rd. Santa Clarita 91355 (661)705-2040 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. (800)500-1877 Ovarian Cancer Coalition of Greater California P.O. Box 40035 Studio City 91614 or (818)985-0288 Provides educational material and support to those who are diagnosed with cancer. Planned Parenthood Los Angeles Health Center 535 E. Palmdale Blvd. Ste. A-1 Palmdale 93550 (800)576-5544 Provide services on abortion, birth control, body image, general health, men's sexual health, pregnancy, relationships, sex, sexual orientation & gender, sexually transmitted diseases and women's health. 141 P a g e

Samuel Dixon Family Health Centers Inc. 27225 Camp Plenty Rd., Ste. 2 Canyon Country 91351 (661)424-1220 Offers family medicine, family planning, women's health, cancer detection and prevention. WeSPARK Resource Center 13520 Ventura Blvd. Sherman Oaks 91423 (818)906-3022 WeSPARK offers kids support groups who have a loved one with cancer or who have lost a love to cancer; also offers teen support group and young adult networking groups. Child Abuse Prevention Services Agency Address City Zip Telephone Child Help USA (800)422-4453 Help victims of child abuse and neglect. Hotline. Children's Institute International 711 S. New Hampshire Ave. Los Angeles 90005 (213)385-5100 Provides treatment and prevention for child abuse. El Nido Family Centers 13460 Van Nuys Pacoima 91331 (818)896-7776 Provides youth counseling, parent education, child abuse and teen pregnancy. 10200 Sepulveda El Nido Family Centers Blvd. #350 Mission Hills 91345 (818)830-3646 Provides youth counseling, parent education, child abuse and teen pregnancy. El Proyecto del Barrio 9140 Van Nuys Blvd. Panorama City 91402 (818)895-0824 Provide counseling, psychological services, mental health services, child care services, transportation, referral services, medical services, urinalysis testing services, child and elder and incapacitated abuse reporting. 750 North First 5 LA Champions For Our Children Alameda St., Ste. 300 Los Angeles 90012 (213)482-5902 Child abuse prevention program designed to address the needs of pregnant women and families. Headquarters: (213)351-5507 L.A. County Department of Children and Family Services 425 Shatto Place Los Angeles 90020 or Public line: (213)351-5602 Serves to improve child safety, decreased timelines to permanence, reduce reliance on out-of home care, self-sufficiency, increase child and family well-being, and enhance organizational excellence. Los Angeles Police Department 100 West 1st. St. Room Los Angeles 90012 911 To protect and serve the community. Safe Passage - Women Crowned in Glory Inc. P.O. Box 40034 Studio City 91614 (818)232-7476 Help victims of abuse to regain stability, self-confidence, and personal love for themselves. 142 P a g e

The Help Group 13130 Burbank Blvd. Sherman Oaks 91401 (818)779-5262 Serves children who have autistic spectrum disorder, learning disabilities, ADHD, developmental delays, abuse and emotional problems. Community Clinics Agency Address City Zip Telephone Adult Industry Medical Health Care Foundation 14241 Ventura Blvd., Ste. 105 Sherman Oaks 91423 (818)981-5681 Sexually transmitted disease clinic. 25134 Rye Canyon Loop # Alfred Mann Foundation 200 Valencia 91355 (661)702-6700 The foundation develops medical devices for medical conditions such as movement disorders, diabetes, limb loss and pain to improve the health of the individual. Alzheimer's Greater San Fernando Valley Regional Office Provides care and support to those affected with Alzheimer's. 16933 Parthenia St., #200 Northridge 91343 (800)272-3900 4940 Van Nuys Blvd. Sherman Oaks 91403 (818)905-7766 American Cancer Society American Cancer Society offers free brochures on preventing, diagnosing, and treating different kinds of cancer. Community Clinic Association of Los Angeles County 1055 Wilshire Blvd. Los Angeles 90017 (213)201-6500 Provides education and policy advocacy at a low cost. Comprehensive Community Health Center 12157 Victory Blvd. North Hollywood 91606 (818)755-8000 Medical clinic. East Valley District Office 14545 Lanark St. Panorama City 91402 (818)901-4120 Offers services in case care management, family based services, food stamps and TANF. 9140 Van Nuys El Proyecto del Barrio Blvd. Panorama City 91402 (818)895-0824 Provide counseling, psychological services, mental health services, child care services, transportation, referral services, medical services, urinalysis testing services, child and elder and incapacitated abuse reporting. Goodwill Southern California 342 San Fernando Rd. Los Angeles 90031 (323)223-1211 Helps individuals with disabilities to receive an education and job opportunities to become independent. Hungry Children Project 16520 Vintage St. North Hills 91343 (905)346-1714 Provides organizations that help families in need of medicine, medical supplies and food around the world. 143 P a g e

Kennedy High School Based Clinic 11254 Gothic Ave. Granada Hills 91344 (818)271-2547 General clinic. Los Angeles Unified School District - PTA Vision Clinics - Telfair Avenue Health Center 10911 Telfair Ave. Pacoima 91331 (818)899-6113 Provides vision services. 13500 Van Nuys. Blvd. Pacoima 91331 (818)896-2999 Medicina Familiar Medical clinic. Meet Each Need With 10641 No. San Dignity (MEND) Fernando Rd. Pacoima 91331 (818)896-0246 For residents in certain zip code area MEND provides emergency food bank, clothing, medical and eye care clinic, education training youth services, home visiting and referral services, job training and homeless services. Mission City Community Clinic, Inc. 4842 Hollywood Blvd. Los Angeles 90027 (323)644-1110 Offers health educations and outreach, pediatric services, case management, laboratory services, gynecological services, family planning, dental services, immunizations, and disaster preparedness. Mission City Community Network Inc. 15206/15210 Parthenia St. North Hills 91343 (818)895-3100 Provides health education, pediatric services, laboratory services, gynecological services, dental, and immunization, family planning and case management. NEVHC - LAC -Valencia Health Center and WIC Site 23763 Valencia Blvd. Valencia 91355 (661)287-1551 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - Pacoima Health Center and WIC Site 12756 Van Nuys Blvd. Pacoima 91331 (818)270-9777 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - San Fernando Health Center 1600 San Fernando Rd. San Fernando 91340 (818)365-8086 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. 17400 Victory Blvd. Van Nuys 91406 (818)705-2345 ONEgeneration Has an adult daycare, at risk youth programs, care management, caregiver support, childcare, dining centers or nutrition programs, immigration services, senior enrichments center, transportation services, and transitional kindergarten program. 144 P a g e

Partners in Care Foundation 732 Mott St., Ste.150 San Fernando 91340 (818)837-3775 Offers services for older adults, disease prevention, and access to care, education and advocacy. Partnership for Prescription Assistance (888)477-2669 Helps patients get prescription drug coverage at a low cost or free. Planned Parenthood Los Angeles Health Center 535 E. Palmdale Blvd. Ste. A-1 Palmdale 93550 (800)576-5544 Provide services on abortion, birth control, body image, general health, men's sexual health, morning after pill, pregnancy, relationships, sex, sexual orientation, gender, STD's and women's health. 27921 Urbandale Pleasantview Industries Inc. Ave. Santa Clarita 91350 (661)296-6700 Helps individuals with disabilities. Samuel Dixon Family Health Centers Inc. 27225 Camp Plenty Rd., Ste. 2 Canyon Country 91351 (661)424-1220 Offers family medicine, family planning, women's health, cancer detection and prevention. School Health Services Division San Fernando High School 11133 O'Melveny St. San Fernando 91340 (818)365-7517 Has comprehensive health care in the school campus for the young adult or underserved youth facing health care barriers. Telfair School Health Center 10911 Telfair Ave. Pacoima 91331 (818)899-6113 Complete vision examinations by optometrists for low income families. The Saban Free Clinic - Is the Los Angeles Free Clinic 8405 Beverly Blvd. Los Angeles 90048 (323)653-8622 Provides medical, dental and behavioral health services, case management and outreach. 13788 Foothill Total Family Support Clinic Blvd. Unit 8 Sylmar 91342 (818)833-9789 Provides social services such as substance abuse treatment, free food distribution, mental health, parenting, perinatal programs and gang intervention. UCP Wheels for Humanity 12750 Raymer St. Unit 4 North Hollywood 91605 (818)255-0100 Provides mobility to those who are physically disabled worldwide. Valley Community Clinic 6801 Coldwater Canyon Ave. North Hollywood 91605 (818)763-8836 Offers behavioral health services, dental, general medical, HIV-AIDS, nutrition & exercise counseling, optometry, prenatal services, valley teen clinic, women, health and health education. Valley View Family Clinic Sports medicine center. Willie Ross Foundation 14400 Roscoe Blvd. Panorama City 91402 (818)830-6888 6621 Van Nuys Blvd. Van Nuys 91405 (818)786-7677 Helps enhance the non-verbal, deaf and developmentally disabled. 145 P a g e

Women, Infants and Children (WIC) (916)558-1784 A nutrition program for women, children and infants. Crisis Prevention Agency Address City Zip Telephone 14717 Sherman American Red Cross Way Van Nuys 91405 (818)376-1700 Provides shelter, food, health and mental health services to families and communities who been affected by a disaster. California Youth Crisis Line (800)843-5200 Confidential services for youth and young adults who are experiencing a crisis. Los Angeles County Department of Mental Health - Disaster Services 550 S. Vermont Ave. Los Angeles 90020 (800)854-7771 or (213)738-4924 During a time of disaster, policies and guidelines are followed to ensure DMH duties are being done. Los Angeles County Mental/Behavioral Health - Psychiatric Emergency Team (PET) Los Angeles (800)854-7771 Offer mobile response team who are licensed mental health clinicians. Los Angeles Police Department Foothill Jeopardy Family Center 11844 Glenoaks Blvd. San Fernando 91340 (818)837-1167 Helps youth and teenagers have a positive impact on the community. Peace Over Violence formally known as LACAAW Provides preventative services on violence. 1015 Wilshire Blvd., Ste. 200 Los Angeles 90017 (213)955-9090 or (310)392-8381 Rape Treatment Center Santa Monica - UCLA Medical Center 1250 Sixteenth St. Santa Monica 90404 (310)319-4000 Give treatment for sexual assault victims. Suicide Prevention Services, Los Angeles Unified School District 333 S. Beaudry Ave. Los Angeles 90017 (213)241-1000 Provides crisis counseling and intervention services to maintain a safe learning environment. 146 P a g e

The Los Angeles Police Department 12760 Osborne St. Pacoima 91331 (818)756-8866 To protect and serve the community. Valley Center for Prevention of Family Violence 13655 Victory Blvd., Ste. 201 Van Nuys 91405 (818)786-2079 Provides parenting classes, women's support groups, sex offenders, domestic violence, shelters, anger management, crisis intervention, psychotherapy, and counseling. Dental Services Agency Address City Zip Telephone CaliforniaKids- Los Angeles 5200 Lankershim North 91601 (818)755-9708 Blvd. Ste. 360 Hollywood CaliforniaKids is a charitable program that provides low cost medical and dental insurance for children. Kids Community Clinic of 400 West Burbank 91506 (818)841-8010 Burbank Elmwood Ave. In-clinic dental treatments, free school screenings; and public health fair event free screenings. LAC DHS - Olive View- UCLA Medical Center 14445 Olive View Dr. Sylmar 91342 (818)364-1555 24 hour medical and psychiatric emergency services, surgery, mental health, HIV/AIDS, hospitalization, general medicine, women s care, children s care, adult care, specialty clinics, and support services. LAC DPH - Pacoima Health Center Provide direct patient care. Meet Each Need With Dignity (MEND) 13300 Van Nuys Blvd. Pacoima 91331 (818)896-1903 10641 N San Pacoima 91331 (818)686-7300 Fernando Rd. Provides medical services including basic ambulatory, dental, hypertension, diabetic, vision, women's, acupuncture and chiropractic care for adults and children in certain zip code areas. Mission City Community 15206 Parthenia North Hills 91343 (818)895-3100 Network St. Black infant health, CHDP Program, comprehensive prenatal services, dental services, family PACT, Healthy family/ Medical for children, tobacco, teensmart outreach, chronic disease care. NEVHC - San Fernando Health Center 1600 San San Fernando 91340 (818)365-8086 Fernando Rd. Primary and preventive care, health plan enrollment assistance, health center, homeless health, school based health services, WIC supplemental nutrition program, dental center, pharmacy, substance abuse prevention and education. Northeast Valley Health Corporation 1172 North Maclay Ave. San Fernando 91340 (818)898-1388 Primary and preventive care, health plan enrollment assistance, health center, homeless health, school based health services, WIC supplemental nutrition program, dental center, pharmacy, substance abuse prevention and education. 147 P a g e

Olive View Medical Center Dental Clinic 14445 Olive View Dr. Sylmar 91352 (818)947-4028 24 hour medical and psychiatric emergency services, surgery, mental health, HIV/AIDS, hospitalization, general medicine, women s care, children s care, adult care, specialty clinics, and support services. UCLA Dental Clinic - Mission Community Hospital 732 Mott St. Ste. 110 San Fernando 91340 (818)837-0398 Provide high-quality, affordable healthcare to the San Fernando Valley community including a full range of medical, surgical and mental health care.. 6801 Coldwater North Valley Community Clinic Canyon Blvd. Hollywood 91605 (818)763-8836 Offers dental, general medicine, anger management for adults and teens, behavioral health service, community outreach, counseling, HIV/AIDS, Nutrition and exercise counseling, medical research, optometry, pediatrics, prenatal services, valley teen-clinic health education, women's health and family planning. Diabetes Resources Agency Address City Zip Telephone Antelope Valley Community Clinic 45074 10th St. West Ste. 109 Lancaster 93534 (661)942-2391 Primary health care, pediatric care, full service dental clinic, mammograms, pap smears, physical exams, laboratory and diagnostic services, general care, including chronic conditions such as diabetes, asthma and high blood pressure, family planning, health and wellness education, disease prevention and nutrition counseling. Antelope Valley Community Clinic - Health and Wellness Center 45104 10th St. West Lancaster 93534 (661)942-2391 Offer same services listed above. Antelope Valley Community Clinic - Palmdale 2151 E. Palmdale Blvd. Palmdale 93550 (661)575-0009 Offer same services listed above. Meet Each Need With Dignity (MEND) 10641 N San Fernando Rd. Pacoima 91331 (818)686-7300 Provides medical services including basic ambulatory, hypertension, diabetic, vision, women's, acupuncture and chiropractic care for adults and children in certain zip code areas. Mission Community Hospital-San Fernando Campus For Health and Education 700 Chatsworth Dr. San Fernando 91340 (818)365-5059 Provides a full range of medical, surgical and mental health care and diabetes cooking classes. North East Valley Community Clinic 1600 San Fernando Rd. San Fernando 91340 (818)365-8086 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. 148 P a g e

North Valley Health Corporation 1172 North Maclay Ave. San Fernando 91340 (818)898-1388 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. Palmdale Regional Medical Center - Wound Care Center 43845 10th St. West Lancaster 93534 (916)949-6946 The Center for Wound Care & Hyperbaric Medicine specializes in advanced wound healing and limb salvage by utilizing the latest in skin substitutes, hyperbaric oxygen therapy and wound VAC (vacuum assisted closure) therapy. Drug and Alcohol Recovery Programs Agency Address City Zip Telephone AA Alcoholics Anonymous 7417 Van Nuys Blvd., Ste. E Van Nuys 91405 (818)988-3001 Aid the groups in their common purpose of carrying the A.A. message to the alcoholic who still suffers. Al-Anon 4936 Lankershim Blvd. North Hollywood 91601 (818)760-7122 Have private meetings to help the alcoholic. CRI-Help Inc. 11027 Burbank Blvd. North Hollywood 91601 (818)985-8323 Drug and alcohol treatment. CRI-Help Inc. 2029 Keith St. Los Angeles 90031 (323)222-7660 Drug and alcohol treatment. 8330 Lankershim Blvd. North Hollywood 91605 (818)504-0505 CRI-Help Inc. Drug and alcohol treatment. El Dorado Community Service Center 24625 Arch St. Newhall 91321 (661)288-2644 Substance abuse, detoxification, methadone maintenance, methadone detoxification and buprenorphine services. El Sereno Manor Sylmar Health and - Rehabilitation Center Substance abuse for long term treatment. Genesis Program - Santa 25129 The Old Clarita Valley Rd. 12220 Foothill Blvd. Sylmar 91342 (818)834-5082 ext. 118 Stevenson Ranch 91381 (661)260-3078 Substance abuse treatment. National Alcoholism and Substance Abuse Information Center (800)784-6776 Rehabilitation center, treatment programs, experienced staff for alcohol and drug treatment. 149 P a g e

NEVHC - LAC-Valencia Health Center and WIC Site 23763 Valencia Blvd. Valencia 91355 (661)705-2040 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - Pacoima Health Center and WIC Site 12756 Van Nuys Blvd. Pacoima 91331 (818)270-9777 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. New Directions for Youth 7315 N. Lankershim Blvd. North Hollywood 91605 (818)503-6330 Programs and service such as therapeutic counseling, graffiti removal and neighborhood beautification programs, summer employment, literacy training, career education and exploration, gang prevention delinquency prevention, alcohol and drug prevention & recovery, parent education, alternative services for youth and community technology center. Now & Forever Foundation 8745 Parthenia Pl. North Hills 91343 (818)895-5002 Alcoholism treatment program. 8140 Sunland People in Progress Blvd. Sun Valley 91352 (818)768-7494 Substance abuse services. Phoenix House 11600 Eldridge Ave. Sylmar 91342 (818)896-1121 or (877)769-9668 Recovery and rehabilitation services to men, women and adolescents afflicted with substance abuse and dependency. San Fernando Valley Partnership 1131 Celis St. San Fernando 91340 (818)837-7767 Provide youth leadership development, youth organizations and Chicas in control to prevent any substance abuse. Santa Clarita Drug Abuse Treatment Programs (800)943-0566 Provides inpatient and outpatient programs, group therapy or private addiction counseling and helpful staff. Total Family Support Clinic 13788 Foothill Blvd. Sylmar 91342 (818)833-9789 Provides social services such as substance abuse treatment, free food distribution, mental health, parenting, perinatal programs and gang intervention. 11643 Glenoaks Via Avanta Blvd. Pacoima 91331 (818)897-2609 Substance abuse treatment. We will be Clean 6006 Laurel Canyon Blvd. North Hollywood 91606 Cocaine anonymous meeting. 150 P a g e

Employment Services Agency Address City Zip Telephone Canoga Park Work Source Center 21010 Vanowen St. Canoga Park 91303 (818)596-4116 Provides employment and training for people who have barriers to employment. Center for Living and Learning 14549 Archwood St., #221 Van Nuys 91405 (818)781-1073 Provides programs to maintain employment to those who have a disadvantage. Chatsworth Work Source Center 9207 Eton Ave Chatsworth 91311 (818)701-9800 Provides job placement assistance, skills enhancement, career and counseling services, on the job training, seminars, workshops, resource library and electronic job search. Chrysalis 14015 Van Nuys Blvd., Ste. E Pacoima 91331 (818)794-4200 Creates a pathway to self-sufficiency for homeless and low-income individuals by providing the resources and support needed to find and retain a job. El Proyecto del Barrio 8902 Woodman Ave Arleta 91331 (818)830-7181 Offers the San Fernando Valley residents classes for job finding and placement. Employment Development Department 11623 Glenoaks Blvd. Pacoima 91331 (818)890-9400 Assists both job seekers and employers to meet their employments needs. Goodwill Southern California 342 San Fernando Rd. Los Angeles 90031 (323)223-1211 Helps individuals with disabilities to receive an education and job opportunities to become independent. Kennedy Community Adult School (LAUSD) 11254 Gothic Ave Granada Hills 91340 (818)271-2550 Has educational opportunities in academic or vocational subjects, parent education, fine arts, classes for older adults and the community at large however, it does not provide job placement. Loaves & Fishes li - Van Nuys 14640 Keswick St. Van Nuys 91405 (818)997-0943 This program provides clothing, emergency food, employment services, and utility bill assistance and volunteer opportunities. Services are targeted to CalWORKS participants and low income people; including individuals who are homeless. Services are restricted to certain zip codes. 151 P a g e

Los Angeles ORT Technical Institute - Van Nuys Campus 14519 W. Sylvan St. Van Nuys 91411 (818)646-4714 Provides technical skills and knowledge necessary for employment and career advancement. Meet Each Need with Dignity (MEND) 10641 No. San Fernando Rd. Pacoima 91331 (818)896-0246 For residents in certain zip code area has emergency food bank, clothing, medical and eye care clinic, education training youth services, home visiting and referral services, job training and homeless services. New Directions for Youth 7315 North Lankershim Blvd. Job training and placement in the San Fernando Valley. North Hollywood 91605 (818)503-6330 North Valley Occupational Center (LAUSD) 11450 Sharp Ave Mission Hills 91345 (818)365-9645 Short term vocational and technical training to provide individuals with entry level skills or information for adults. Pacoima Skills Center (LAUSD) Vocational services and training. West Valley Occupational Center (LAUSD) 13545 Van Nuys Blvd. Pacoima 91331 (818)896-9558 6200 Winnetka Ave. Woodland Hills 91346 (818)346-3540 Short term vocational and technical training to provide individuals with entry level skills or information for adults. Worksource of California - Adult 9024 Laurel Canyon Blvd. Sun Valley 91352 (818)504-0334 Qualified applicants job placement assistance, skills enhancement, career and counseling services, on the job training, seminars, workshops, resource library, and electronic job search. Food Programs Agency Address City Zip Telephone Alpa Food Bank 7336 Bellaire Ave. North Hollywood 91605 (818)255-0080 Collects, processes, and distributes food at no charge to a rescue center, food pantries and soup kitchens. 9641 Tujunga Canyon Harvest Church Canyon Blvd. Tujunga 91042 (818)353-1138 Link needy families to food resources. 152 P a g e

Castaic California Food Panties, Soup Kitchens & Food Banks - San Salvador Mission (805)625-3273 Collects, processes, and distributes food at no charge to a rescue center, food pantries and soup kitchens. 13931 Balboa Children's Hunger Fund Blvd. Sylmar 91342 (818)979-7100 Delivers meals to the children's homes. Eliza Shanks Home, Inc. 13055 Weidner St. Pacoima 91331 (818)335-1233 The agency provides emergency food and personal goods for people in the Los Angeles County. Holy Rosary Church 7800 Vineland Ave. Sun Valley 91352 (818)765-3350 The agency provides emergency food, holiday assistance and personal goods for people in the Sun Valley area. Meet Each Need With Dignity (MEND) 10641 N. San Fernando Rd. Pacoima 91331 818-686-7300 For residents in certain zip code area MEND provides emergency food bank, clothing, medical and eye care clinic, education training youth services, home visiting and referral services, job training and homeless services. North Hollywood Interfaith Food Pantry 4387 Troost Ave. Studio City 91604 (818)760-3575 Provides emergency food. North Valley Caring Services 15435 Rayen St. North Hills 91343 (818)891-0481 Provides a hot meals clothing and hygiene, childcare and after school activities, and off track programs. Our Lady of The Holy Rosary Parish 7800 Vineland Ave. Sun Valley 91352 (818)765-3350 Worship services, food and clothing distribution. Salvation Army Corps Community Center - San Fernando Valley 14917 Victory Blvd. Van Nuys 91411 (818)781-5739 Provides emergency food and holiday assistance for residents of specific zip codes in the San Fernando Valley. San Fernando Valley Japanese-American Community Center 12953 Branford St Pacoima 91331 (818)899-1989 Food distribution center for low income families. 153 P a g e

Sova Food Pantry - Valley 16439 Vanowen St. Van Nuys 91406 (818)988-7682 The agency provides emergency food and volunteer opportunities for people who live in central and West Los Angeles and the San Fernando Valley. St Elizabeth Service Center Distribution Site 6640 Cedros St. Van Nuys 91405 (818)779-1775 This agency provides emergency food and personal goods for people who live in Van Nuys. St. Ferdinand Outreach Center 1109 Coronel St. San Fernando 91340 (818)365-3194 Provide food, clothing and other economic support to the needy. Total Family Support Clinic 13788 Foothill Blvd. Unit 8 Sylmar 91342 (818)833-9789 Provides social services such as substance abuse treatment, free food distribution, mental health, parenting, perinatal programs and gang intervention. 9901 Tujunga United Methodist Church Cyn. Blvd. Tujunga 91042 (818)352-1481 Provides social services, food and clothing for resident in the Sunland and Tujunga area. United Methodist Church of Sepulveda 15435 Rayen St North Hills 91343 (818)892-1164 Collects processes and distributes food at no charge to a rescue center, food pantries and soup kitchens. Valley Food Bank 12701 Van Nuys Blvd., Ste. A Pacoima 91331 (800)417-5678 ext. 5060 or (818)510-4140 Collects, processes, and distributes surplus food at no charge to a rescue center, food pantries and soup kitchens. WIC Program (Women, Infants, and Children) (916)558-1784 A nutrition program for women, children and infants. Health Coverage Options Agency Address City Zip Telephone Antelope Valley Health Center 335-B E. Ave. K-6 Lancaster 93535 (661)723-4511 Multi-service ambulatory care center, comprehensive health center and health center that offers ORSA. 501 N. Glendale Ave. Glendale 91206 (818)500-5785 Glendale Health Center Multi-service ambulatory care center, comprehensive health center and health center that offers ORSA. 154 P a g e

Health Consumer Center 13327 Van Nuys Pacoima 91331 (800)896-3203 Educate low income communities of L.A. County to obtain quality care from HMOs and other public and private health providers. Kennedy High School Based Clinic 11254 Gothic Ave Granada Hills 91344 (818)271-2547 Services include physical exams, sports physicals, treatment for minor illnesses, and immunizations for students and their siblings at no cost or low cost health insurance. Mid-Valley Comprehensive Health Center 7515 Van Nuys Blvd. Van Nuys 91405 (818)947-4000 Can apply for ORSA which covers outpatient medical care and medicines at Department of Health Services. San Fernando Health Center 1212 Pico St. San Fernando 91340 (818)837-6969 Multi-service ambulatory care center, comprehensive health center and health center that offers ORSA. Heart Disease Resources Agency Address City Zip Telephone American Heart Association 4741 Laurel Canyon Blvd. Valley Village 91607 (818)984-0004 Appropriate cardiac care in an effort to reduce disability and death by cardiovascular disease and stroke. American Heart Association 816 S. Figueroa St. Los Angeles 90017 (213)291-7000 Appropriate cardiac care in an effort to reduce disability and death by cardiovascular disease and stroke. 1055 Wilshire American Heart Association Blvd., Ste. 900 Los Angeles 90017 (213)580-1408 Appropriate cardiac care in an effort to reduce disability and death by cardiovascular disease and stroke. HIV Services Agency Address City Zip Telephone Catalyst Foundation, The - Clinic 44758 Elm Ave. Lancaster 93534 (661)948-8559 HIV and STD testing clinic. El Proyecto del Barrio - Arleta Health Center Family health care services. Free counseling and testing. LAC DHS - Olive View UCLA Medical Center and Health Center 8902 Woodman Ave. Arleta 91331 (818)830-7133 14445 Olive View Dr. Sylmar 91342 (818)364-1555 Provide 24 hour medical and psychiatric emergency services, surgery, mental health, HIV/AIDS, hospitalization, general medicine, women s care, children s care, adult care, specialty clinics, and support services. 155 P a g e

13356 Eldridge Ave. Sylmar 91342 (818)362-6182 Los Angeles Mission College Reproductive health services, health education, vaccination, physical exam, tuberculosis screening, behavioral health counseling, and additional services. Northeast Valley Health Corporation - Van Nuys HIV Division 6551 Van Nuys Blvd. Ste. 201 Van Nuys 91401 (818)988-6335 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, HIV services, pharmacy, substance abuse prevention and education. Pacifica Hospital of the Valley 9449 San Fernando Rd. Sun Valley 91352 (818)252-2142 Specializes in Pediatrics, Obstetrics, and Maternity Health. 6801 Coldwater Valley Community Clinic Canyon Ave. Ste. 1B North Hollywood 91605 (818)763-1718 Anger management for adults and teens, behavioral health service, community outreach, counseling, dental, general medical, HIV AIDS, Nutrition and exercise counseling, medical research, optometry, pediatrics, prenatal services, Valley teen-clinic health education, women's health and family planning. Planned Parenthood Los Angeles- Van Nuys Health Center Provide reproductive health care and sex education. 7100 Van Nuys Blvd. Ste. 108 Van Nuys 91405 (800)576-5544 Homeless Services and Shelters Agency Address City Zip Telephone 211 L.A. County (formerly Info Line of Los Angeles) (800)339-6993 Provides information and referral services 24 hours a day, 7 days a week in over 140 languages. Services are also provided for individuals with hearing impairments. 701 East 3rd St., Abode Communities Ste. 400 Los Angeles 90013 (213)629-2702 Specific strength is building sustainable, multi-family affordable housing to address the needs. Aviva Family and Children's Services - Wallis Annenberg Center 1701 Camino Palmero Los Angeles 90046 (323)876-0550 Residential treatment services. 11243 Glenoaks Blvd. Ste. 3 Pacoima 91331 (818)834-4885 Beyond Shelter Combating chronic poverty, welfare dependency, and homeless. CARE Housing Services Corporation Provides social services as well as human services. 18757 Burbank Blvd. #102 Tarzana 91356 (818)774-1550 156 P a g e

Children of the Night 14530 Sylvan St. Van Nuys 91411 (818)908-4474 or (800)551-1300 Provides a twenty four hour bed refuge, food, clothing, an onsite school, counseling, and emotional support for child prostitutes. 14015 Van Nuys Chrysalis Blvd., Ste. E Pacoima 91331 (818)794-4200 Creates a pathway to self-sufficiency for homeless and low-income individuals by providing the resources and support needed to find and retain employment. Corner Stone Christian Ministry 11449 Sproule Ave. Pacoima 91331 (818)899-5900 The agency provides runaway services and a shelter for youth who have a history of prostitution who are in Los Angeles County. Age restrictions apply; there are no geographic restrictions. Department of Public Social Services (DPSS) 12847 Arroyo St. Sylmar 91342 (818)837-6393 Temporary financial assistance and employment services for families and individuals. Free and low cost health care insurance for families with children, pregnant women and aged/blind/disabled adults. Food benefits for families and individuals; homeless case management. East Valley Community Action Group - Valley Food Bank North Hollywood 91601 (818)980-7370 11210 Otsego St. The mission provides emergency food, holiday assistance, homeless support services, shelter, thrift shops and volunteer opportunities for people in the San Fernando Valley. There no geographic restrictions. Family Access (formerly Homeless Access Center) 7843 Lankershim Blvd. North Hollywood 91605 (818)982-4091 Family Housing is no longer an access center but still provides homeless services. Family Promise of Santa Clarita Valley Cyn County 18565 Soledad Cyn. Rd. #133 Canyon Country 91351 (661)251-2867 A shelter programs that provides children and their families, shelter, meals, and supportive services to help them regain self-reliance. 11257 Borden Ave. Pacoima 91331 (818)899-6180 Habitat for Humanity Pacoima shelters. Homeless Health Care 7843 Lankershim North Project Blvd. Hollywood 91605 (818)765-8656 Health center. Housing Authority of Los 10995 Lehigh Angeles Ave. Pacoima 91331 (818)899-5228 Helps individuals who applied for the housing program. JFS/ Valley Storefront Senior 12821 Victory North Center Blvd. Hollywood 91606 (818)984-1380 Provides a wide range of health and social services to older adults and their families such as food and hunger services, counseling, shelter services, services with people with disabilities, child and family services and Jewish life. 157 P a g e

L.A. County - San Fernando Valley Service Center 7555 Van Nuys Blvd. Van Nuys 91405 (818)901-3501 The center provides emergency food, information and referral services for people in need in the San Fernando Valley. There are income restrictions for some programs; the service area is the SFV. L.A. County Victim - Witness Assistance Program San Fernando Valley Branch Office 900 Third St., Room 3rd Floor San Fernando 91340 (818)898-2404 Helps victims of crime and vigorously protecting their rights. L.A. Family Housing 7843 Lankershim Blvd. North Hollywood 91605 (818)982-4091 Help families transition out of homelessness and poverty through a continuum of housing enriched supportive services. Loaves & Fishes li - Van Nuys 14640 Keswick St. Van Nuys 91405 (818)997-0943 This program provides clothing, emergency food, employment services, and utility bill assistance and volunteer opportunities. Los Angeles County Department of Consumer Affairs Los Angeles (213)974-1452 Information available 24 hours regarding consumers most frequently asked questions regarding; landlord and tenants, eviction, automobiles, real estate, home buying, contracts, and credit information. Los Angeles Family Housing Corp. -Valley Shelter 10995 Lehigh Ave. Pacoima 91331 (818)982-4091 Provides shelters for the homeless and referrals for low income. Lutheran Social Services of Southern California San Fernando/Antelope Valley Area Office 6425 Tyrone Ave. Van Nuys 91401 (818)901-9480 Services provided at this site include case management, emergency food, holiday assistance, motel vouchers, personal goods, utility bills assistance and volunteer opportunities. Geographic restrictions apply for some services. Meet Each Need With Dignity (MEND) 10641 N. San Fernando Rd. Pacoima 91331 818-686-7300 For residents in certain zip code area only MEND provides emergency food bank, clothing, medical and eye care clinic, education training youth services, home visiting and referral services, job training and homeless services. Neighborhood Legal Services of Los Angeles County 13327 Van Nuys Blvd. Pacoima 91331 (818)485-0913 Provide free legal representation, advice and education to the community. Offers free workshops to assist in income tax returns, naturalization applications, worker's rights concerns and foreclosure prevention. 158 P a g e

NEVHC - San Fernando Health Center 1600 San Fernando Rd. San Fernando 91340 (818)365-8086 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - Sun Valley Health Center 7223 North Fair Ave. Sun Valley 91352 (818)432-4400 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - Valencia Health Center 23763 Valencia Blvd. Valencia 91355 (661)255-1551 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. North Valley Caring Services 15435 Rayen St. North Hills 91343 (818)891-0481 Meals, food pantry, clothing and hygiene, childcare, and after school activities and off track programs for children and teens. Legal services, referrals and case management services. Our Lady of Peace Catholic Church 15444 Nordhoff North Hills 91343 (818)894-1176 The church provides educational services, emergency food, employment services, health services, holiday assistance, for low-income people who live in the northeast part of the San Fernando Valley. Panorama Baptist Church of Pacoima - Valley Food bank 8767 Woodman Ave. Arleta 91331 (818)894-2281 The mission provides emergency food, holiday assistance, homeless support services, shelter, thrift shops and volunteer opportunities for people in the San Fernando Valley. There no geographic restrictions. Rock of The Valley - Church of Christ in God - Valley Food Bank 7722 Kester Ave. Van Nuys 91405 (818)781-4156 The mission provides emergency food, holiday assistance, homeless support services, shelter, thrift shops and volunteer opportunities for people in the San Fernando Valley. There no geographic restrictions. Salvation Army Corps Community Center - San Fernando Valley 14917 Victory Blvd. Van Nuys 91411 (818)781-5739 This agency emergency food and holiday assistance for residents of San Fernando Valley. San Fernando Community Clinic MHC Inc. - Homeless CalWORKS Families Project 6842 Van Nuys Blvd. 6th Floor Van Nuys 91405 (818)908-3855 Help move homeless families into emergency shelters, then to transitional housing while stabilizing, and finally into permanent housing, during a 12 month period, by addressing any and all barriers that prevents them from obtaining and maintains housing. 159 P a g e

San Fernando Valley Rescue Mission 13422 Saticoy St. North Hollywood 91605 (818)785-4476 The mission provides emergency food, holiday assistance, homeless support services, shelter, thrift shops and volunteer opportunities for people in the San Fernando Valley. There no geographic restrictions. School Health Services Division San Fernando High School 11133 O'Melveny San St. Fernando 91340 (818)365-7517 Comprehensive health care provided in the school campus to the young adult or underserved youth facing barriers to health care. St. Didacus Church Parish Center 14339 Astoria St. Sylmar 91342 (818)896-0246 The agency provides education services, emergency food, employment services, health services, holiday assistance, household and personal goods for low-income people who live in the northeast part of the San Fernando Valley. St. Elizabeth Service Center Distribution Site 6640 Cedros St. Van Nuys 91405 (818)779-1775 This agency provides emergency food and personal goods for people who live in Van Nuys. Services are restricted to Van Nuys residents. Sun Valley WorkSource Center 9024 Laurel Canyon Blvd. Sun Valley 91352 (818)504-1974 Provides access to businesses seeking qualified workers, labor market information and other related services Sunland-Tujunga Temporary Aid Center 7747 Foothill Blvd. Tujunga 91402 (818)352-2421 The agency provides emergency food for people who live in Lakeview Terrace, Shadow Hills, and Sunland-Tujunga, including people who are homeless or undocumented. Tamar House (previously Hope Cottage) (confidential Site) (818)505-0900 The project provides domestic violence services, shelter and welfare-to-work support services for victims of domestic violence. Service includes shelter for battered women and their children. There are no geographic restrictions. The Harbor - San Fernando Valley Community Mental Health North Hollywood 91601 (818)980-7576 5519 Elmer Ave. The center provides mental health services, residential mental health services, welfare-to-work support services and shelter primarily for adults, adolescents and families who live in the San Fernando Valley. Valley Lighthouse Church 6159 Tyrone Ave. Van Nuys 91401 (818)780-8334 This church provides emergency food for people in Los Angeles County. Victim Witness Assistance Program 11640 Burbank Blvd. North Hollywood 91601 (818)623-4056 Monetary assistance (reimbursement applications from the state), advocacy, information and referrals. 160 P a g e

Victim Witness Assistance Program 6230 Sylmar Ave. Van Nuys 91401 (818)374-3075 Monetary assistance (reimbursement applications from the state), advocacy, information and referrals. Volunteer League of the San Fernando Valley Clothes Corner 14603 Hamlin St. Van Nuys 91411 (818)785-4134 The agency provides school uniform clothing, backpacks, and hygiene kits to homeless and needy children attending elementary and middle schools within the Los Angeles Unified School District. Volunteers of America Greater Los Angeles 3600 Wilshire Blvd., Ste. 1500 Los Angeles 90010 (213)389-1500 Provides services for children, family, seniors', girls and women and veterans'. Offers youth programs, services for homelessness, housing and recovery & and re-entry. Volunteers of America Greater Los Angeles - Women's Care Cottage (Headquarters) 3600 Wilshire Blvd., Ste. 1500 Los Angeles 90010 (213)500-6013 Offers housing, meals, case management, counseling, life skill classes and social and cultural activities. Hospitals Agency Address City Zip Telephone Cedars-Sinai Medical Center 8700 Beverly Blvd. West Hollywood 90048 (310)423-3277 Acute care (inpatients and outpatient care). Encino Hospital Medical Center 16237 Ventura Blvd. Encino 91436 (818)995-5000 Acute care (inpatients and outpatient care). Encino-Tarzana Regional Medical Center 18321 Clark St. Tarzana 91356 (818)881-0800 Acute care (inpatients and outpatient care). 1509 Wilson Glendale Adventist Hospital Terrace Glendale 91206 (818)409-8000 Acute care (inpatients and outpatient care). Henry Mayo Newhall Memorial Hospital 23845 McBean Pkwy. Valencia 91355 (611)253-8000 Acute care (inpatients and outpatient care). Joyce Eisenberg Keefer Medical Center 7150 Tampa Ave. Reseda 91335 (818)774-3000 Nursing home. Kaiser Permanente Panorama City Medical Center 13652 Cantara St. Panorama City 91402 (818)375-2000 Acute care (inpatients and outpatient care). 161 P a g e

Kaiser Permanente Woodland Hills Medical Center Woodland Hills 91367 (818)719-2000 5601 De Soto Ave. Acute care (inpatients and outpatient care). Los Angeles County USC Medical Center 1200 N. State St. Los Angeles 90033 (323)409-1000 Acute care (inpatients and outpatient care). Los Angeles Orthopedic Hospital 2400 S. Flower St. Los Angeles 90007 (213)742-1000 Acute care (inpatients and outpatient care). 14850 Roscoe Mission Community Hospital Blvd. Acute care (inpatients and outpatient care). Motion Picture & Television Fund Foundation 23388 Mulholland Dr. Panorama City 91402 (818)787-2222 Woodland Hills 91364 (855)7606783 or (818)876-1900 Helps industry members receive health care; maintain healthy, senior services and residential services. Northridge Hospital - Behavioral Health/Crisis Services 18300 Roscoe Blvd. Northridge 91328 (818)885-5484 Acute care (inpatients and outpatient care). Northridge Hospital Medical Center 18300 Roscoe Blvd. Northridge 91328 (818)885-8500 Acute care (inpatients and outpatient care). Pine Grove Behavioral Healthcare System 7011 Shoup Ave. Canoga Park 91307 (818)348-0500 Behavioral health and addiction services for inpatient and outpatient. Providence Holy Cross Medical Center 15031 Rinaldi St. Mission Hills 91345 (818)365-8051 Acute care (inpatients and outpatient care). Providence Saint Joseph Medical Center 501 S. Buena Vista St. Burbank 91505 (818)843-5111 Acute care (inpatients and outpatient care). Providence Tarzana Medical Center 18321 Clark St. Tarzana 91356 (818)881-0800 Acute care (inpatients and outpatient care). Sherman Oaks Hospital and 4929 Van Nuys Burn Center Blvd. Acute care (inpatients and outpatient care). Thousand Oaks Surgical 401 Rolling Oaks Hospital Dr. Acute care (inpatients and outpatient care). Sherman Oaks 91403 (818)981-7111 (818)904-4580 Thousand Oaks 91361 (905)777-7750 162 P a g e

UCLA Medical Center - Olive View Medical Center County hospital. Acute care (inpatients and outpatients care). UCLA Resnick Neuropsychiatric Hospital Psychiatric facility. Valley Presbyterian Hospital Acute care (inpatients and outpatient care). Verdugo Hills Hospital Acute care (inpatients and outpatient care). West Hills Hospital And Medical Center Acute care (inpatients and outpatient care). 14445 Olive View Dr. Sylmar 91342 (818)364-1555 150 UCLA Medical Plaza Los Angeles 90095 (310)825-9111 15107 Vanowen St. Van Nuys 91405 (818)782-6600 1812 Verdugo Blvd. Glendale 91208 (818)790-7100 7300 Medical Center Dr. West Hills 91307 (818)676-4000 Hotlines Agency Telephone Assaults Against Women Bilingual Hotlines (800)548-2722 Information on assaults against women. Battered Women Crisis Hotline (818)887-6589 Referrals to community. Boys Town National Counseling Hotline (800)448-3000 With the support of our generous donors, we re reuniting kids with their families, finding foster homes for others, providing a Boys Town family for those with nowhere else to turn, and still others are receiving help at home where they can remain together as families. CA Office of Family Planning & Information (800)942-1054 Referral, Confidential referrals to low cost family planning clinics in your area. California HMO Center (800)400-0815 Medi-Cal managed health care. California Missing Children Hotline (800)222-3463 Concerns regarding runaways and missing children. California Youth Crisis Line (800)843-5200 Confidential hotline for teens and young adults ages 12-24. Can help find homeless youth shelters, medical clinics and ongoing counseling. Care First Health Plan (800)544-0088 An HMO that contracts with the federal government to provide Medicare services and benefits. Chicana Service Action Center (800)548-2722 30 day emergency shelter, food, transportation, and housing. Child Help USA (800)422-4453 National child abuse hotline, foster care, community center, group homes, and residential treatment facilities. Community Health Plan (County of L.A.) (800)475-5550 Provide information on health care providers. Covenant House - Nine Line (800)999-999 163 P a g e

Troubled teens, families suicide prevention, and runaways. Interpretation services available. Crisis Center (310)392-8381 Rape crisis hotline. Crisis Hotline for Runaways Teens (310)379-3620 Runaway teen homeless shelter. Department of Community Services and Development (866)675-6623 or (800)433-4327 Utility bill assistance home energy program. Elder Abuse Hotline (800)992-1660 Information and referrals on abuse or suspected abuse of the elderly. Families Anonymous (800)736-9805 Crisis assistance and referrals. Family Planning Referral Hotline (800)942-1054 Information regarding family planning. Gay/Lesbian Youth Talk Line (800)773-5540 Talk line for referrals and information. Haven Halls Crisis Hotline (818)887-6589 Domestic violence victims find a shelter nearby, legal information and counseling services. Health Care Options (800)430-4263 or (800)430-6006 (800)430-4091 or (800)430-3003 (800)430-8008 Medi-Cal managed health care. HealthyCity/Advancement Project www.healthycity.org A web-based portal, for critical resources for low-income clients and constituent in Los Angeles County. HealthyCity targets direct service providers, case managers, teachers and community leaders, as well as community organizers. Homework Hotline (800)527-8839 Help children with homework. Jenesse Center (800)479-7328 or (323)299-9496 Provides shelter or other help. Job Opportunities Hotline Bilingual (800)843-9675 Information regarding job opportunities. Kaiser Permanente (800)464-4000 Review benefits, for members of Kaiser only. L.A. Care Health Plan (888)4LA-CARE Medi-Cal managed health care, and health families/healthy kids. L.A. Gay & Lesbian Center Anti-Violence Hotline (800)373-2227 or (323)993-7673 Legal Services Department Provides free support and referral services for hate crimes/incidents. Loved Ones of Homicide Victims (310)629-2551 Information for family and friends who have lost loved ones due to homicide. Medi-Cal Information (800)541-5555 Medi-Cal phone support. National Runaway Switchboard (800)RUN-AWAY (800)621-4000 Information for parents of runaway regarding shelters, message service, counseling. 164 P a g e

Overeaters Anonymous (818)342-2222 Meetings to help with weight control. Parent Hotline - Complaint Resource Unity/ Parent (800)933-8133 Resource Network Assists parents with children with special needs. Parents, Family & Friends of Lesbians and Gays (888)735-2488 Parent group. Pesticide Advice National Center (800)858-7378 Information regarding pesticides. Planned Parenthood Locator (800)230-7526 Gives phone number for nearest planned parent center. Poison Control Center (800)222-1222 Poison emergency support services. Rader Treatment Program (818)880-3755 Eating Disorder Treatment Programs. Rape and Battering Hotline (310)392-8381 Rape Crisis Hotline. Suicide Hotline (877)727-4747 Suicide prevention hotline. Teen Line (310)855-HOPE /(800)852-8336 Confidential peer hotline and community outreach program. ToughLove- Parent Support Line (954)349-7260 Parent support group. Trevor Help Line (866)4U-TREVOR Assists youth support, referrals. Valley Trauma Center (818)886-0453 Rape Crisis Hotline. Valley Trauma Center - Battered Persons/Domestic (818)772-9981 Violence Sexual assault crises hotline. Victims of Crime Resource Center (800)VIC-TIMS Assists victims of violent crimes. We Tip Reporting Hotline (800)782-7463 Anonymous reporting of any type of crime. Weapons on Campus /LAUSD School Police (213)-625-6631 Report weapons on campus only. Youth Talk line/shelter (800)773-5540 Youth crises hotline. 165 P a g e

Housing Agency Address City Zip Telephone Department of Public Social Services - Cal Works, West Valley 21415 Plummer St. Chatsworth 91311 (818)718-5000 or (818)718-5216 The CAL/WORKS program provides temporary financial assistance and employment focused services to families with minor children. Department of Social Services 3307 N. Glenoaks Blvd. Burbank 91504 (818)557-4103 In home supportive services programs helps pay for services provided to low income elderly, blind or disabled individuals, including children, so that they can remain safely in their own home. Department of Water and Power (DWP) (800)342-5397 Utility bill assistance. Eviction Defense Center 1930 Wilshire Blvd., Ste. 208 Los Angeles 90057 (213)385-8112 Trail lawyers who help individuals facing eviction receive a fair trial. Fair Housing Council 8134 Van Nuys Blvd. #206 Panorama City 91402 (818)373-1185 Investigates alleged housing discrimination complaints, tenant and landlord referrals, education and outreach on fair housing laws. Fair Housing Council 8134 Van Nuys Blvd. #206 Panorama City 91402 (818)373-1185 Educates and outreaches home seekers and housing providers about housing and lending discrimination, fair housing education, tenant and landlord counseling, housing and policy advocacy and foreclosure prevention. 3255 Wilshire Housing Right Center Blvd., Ste. 1150 Los Angeles 90010 (800)477-5977 Housing discrimination complaint investigation, fair housing education and outreach, tenant and landlord counseling. Housing Urban Development (HUD) (800)347-3739 Administers federal aid to local housing agencies that manage the housing for low-income residents at rents they can afford. Los Angeles County Department of Consumer Affairs (213)974-1452 Provides information about landlord and tenants, eviction, automobiles, real estate, home buying, contracts, and credit information. Los Angeles Housing Department (866)557-7368 Manages rent stabilization, housing for low income families. Provides for handy worker program, minor repairs for seniors and low income families. 166 P a g e

Los Angeles Housing Department (LAHD) Helps housing discrimination. San Fernando Valley Neighborhood Legal Services 1200 West 7th St., Floor 1 Los Angeles 90017 (866)557-7368 13327 Van Nuys Blvd. Pacoima 91331 (818)896-5211 Free legal representation, advice and education on foreclosure. 26881 Ruether Single Mothers Outreach Ave. Santa Clarita 91351 (661)288-0117 Helps families who face housing instability, income loss, emotional trauma and social discrimination by providing case management, parent resources and clothing to the individual. United Cerebral Palsy of Los Angeles, Ventura and Santa Barbara Counties 6430 Independence Ave. Woodland Hills 91367 (818)782-2211 Provides adult and children services as well as affordable housing for the developmentally disabled. Legal Services Agency Address City Zip Telephone Barrister - Los Angeles County Bar Association 1055 West Seventh St., Ste. 2700 Los Angeles 90017 (213)627-2727 Helps new lawyers network and develop legal skills. 3250 Wilshire Bet Tzedek Legal Services Blvd., 3rd Floor Los Angeles 90010 (323)939-0506 Provides legal services on bankruptcy problems, housing, and holocaust survivor s services, elder s rights and government benefits. 1775 State Kern County District Highway 58 Mojave 93501 (661)868-6366 Legal services. Los Angeles Co. Municipal Court 900 3rd St. San Fernando 91340 (818)898-2401 Municipal courts. Los Angeles County Public Defender 900 3rd St. 2nd Floor San Fernando 91340 (818)898-2440 Legal assistance for those who do not have representation. Los Angeles County Public Defender 16350 Filbert St. Sylmar 91342 (818)364-2133 Helps adults and children who are involved in criminal or justice matters ending in consequences. Public Council Law Center 610 S. Ardmore Ave. Los Angeles 90005 (213)385-2977 Provides legal services for immigration, non-profits or small business, veterans, and homelessness. 167 P a g e

San Fernando Valley Neighborhood Legal Services 13327 Van Nuys Pacoima 91331 Legal services for low-income families. 6230 Sylmar Ave., Room A100 (Van Van Nuys Self-Help Legal Nuys Court Access Center House) Van Nuys 91401 Provides free legal information. (818)896-5211 or (800)433-6251 Mental Health Services Agency Address City Zip Telephone Action Family Counseling- Antelope Valley 37230 47th St. East Ste. 215 Palmdale 93550 (800)367-8336 Provide 24-hour crisis management, individual counseling, group therapy, family education and counseling, treatment planning, routine and random toxicology screening, pharmacotherapy and medication management, education about Alcohol and Other Drugs and mental health issues, self-help and support group orientation, case management services, and discharge service planning with a transitional service plan to our Intensive Outpatient treatment program. Alafia Mental Health Institute - Lancaster 1331 W. Ave. J Ste. 202 Lancaster 93534 (661)940-9094 Provide a nurturing and safe home for children who have been abused, neglected, or have no caregiver, and is designed to meet the individual needs of children, youth, and their families. American Health Services - El Dorado Community Services- Palmdale 2720 E Palmdale Blvd. Ste. 129 Palmdale 93550 (661)947-3333 Drug & Alcohol Services, Health Clinics, Mental Health Resources. 21545 Centre Child and Family Center Pointe Pkwy. Santa Clarita 91350 (661)259-9439 Outpatient services, in-home services, school based services, child abuse prevention, adult services, and training and consultation services. Child and Family Center- 23504 Lyons Ave. Newhall 304 Office Ste. 304 Santa Clarita 91321 (661)286-2562 Outpatient services, in-home services, school based services, child abuse prevention, adult services, and training and consultation services. Child and Family Guidance Center - Family Stress Center 16861 Parthenia St. North Hills 91343 (818)830-0200 The Child and Family Guidance Center serves vulnerable and at-risk children, as well as, their families. They provide a continuum of quality mental healthcare, supportive social services, and links to needed resources. Child and Family Guidance Center - Palmdale Office 310 E. Palmdale Blvd. Ste. F Palmdale 93550 (661)265-8627 The Child and Family Guidance Center serves vulnerable and at-risk children, as well as, their families. They provide a continuum of quality mental healthcare, supportive social services, and links to needed resources. 168 P a g e

Child and Family Guidance Center -Van Nuys Office 6851 Lennox Ave. Ste. 100 Van Nuys 91405 (818)830-3270 The Child and Family Guidance Center serves vulnerable and at-risk children, as well as, their families. They provide a continuum of quality mental healthcare, supportive social services, and links to needed resources. Children's Center of the Antelope Valley 45111 N. Fern Ave. Lancaster 93534 (661)949-1206 Provide abuse prevention programs, treatment, and education. San El Centro de Amistad 566 S Brand Blvd. Fernando 91340 (818)898-0223 Provides adult and child mental health services, gang reduction, youth development, literacy and computer technology. 6800 Owensmouth El Centro de Amistad Ste. 310 Canoga Park 91401 (818)347-8565 Provides adult and child mental health services, gang reduction, youth development, literacy and computer technology. El Nido Family Centers - Administrative Office 10200 Sepulveda Blvd. Ste. 350 Mission Hills 91345 (818)830-3646 Empower families in low-income communities of Los Angeles County to break the cycle of poverty, child abuse, violence, academic failure, and teen pregnancy through outstanding educational, youth development, health and therapeutic services. El Nido Family Centers - Mission Hills 10200 Sepulveda Blvd. Ste. 350 Mission Hills 91345 (818)830-3646 Offer teen parenting classes, probation, probation assistance, DCSP, and Best Babies program. Family Focus Resource Center - Santa Clarita Valley 28470 Ave. Stanford, Ste. 195 Santa Clarita 91355 (661)294-9715 Infants and Toddlers Early Start - The California Early Start program provides early intervention services for eligible infants and toddlers (birth up to third birthday) who have developmental delay, a disability or an established risk condition with a high probability of resulting in a delay. Family Focus Resource Center -Antelope Valley 1028 W. Ave. L-12, Ste. 107 Lancaster 93534 (661)945-9598 Infants and Toddlers Early Start - The California Early Start program provides early intervention services for eligible infants and toddlers (birth up to third birthday) who have developmental delay, a disability or an established risk condition with a high probability of resulting in a delay. 15350 Sherman Way #140 Van Nuys 91406 (818)988-4430 Friends of the Family Provide parent support & education programs to help parents develop their skills in nurturing and advocate for their children. Child & youth development programs work to develop healthy relationships in doing well in school. Family development to strengthen family capacity to care for themselves. Mental health helps children, youth and adults enhance their social & relationship connections, family functioning and emotional health. Green Pastures Youth Center 8237 Soledad Canyon Rd. Acton 93510 (213)381-1004 Provide a youth development center, cultivation camp (wilderness camp), and cultivation academy. 169 P a g e

Hillview Mental Health Center Inc. 12450 Van Nuys Blvd. Pacoima 91331 (818)896-1161 Hillview offers a full range of outpatient programs funded by California s Mental Health Services Act. They include medication evaluation and treatment, psycho-educational groups, individual counseling, group therapy, and family therapy. Imagination Connection 9667 Natick Ave. North Hills 91343 (818)522-7904 The Imagination Connection carefully screens its artists to provide instructors that are both masters in their craft and understand how to communicate with disabled and challenged individuals. Through short-term sessions (a minimum of 3) students will achieve the creation and completion of a task that will be both therapeutic and result in learning new and applicable skills. Jewish Family Service of the San Fernando Valley 22622 Vanowen St. West Hills 91307 (818)464-3333 Intergenerational services available for grandparents raising their grandchildren. Surrogate grandparents for children with special needs. Senior citizen multi-purpose center offers programs by licensed clinical social workers. Mental Health America of Los Angeles - Antelope Valley Services 506 W Jackman St. Lancaster 93534 (661)726-2850 Personal service plans, psychiatric care, employment, substance abuse recovery, housing assistance, financial services, and community involvement. National Alliance on Mental Illness (NAMI) California - Antelope Valley 45111 Fern Ave. Ste. 21 Lancaster 93534 (661)341-8041 Provide services to improve the quality of life for those living with mental illness and their families and friends through support, education, and advocacy. NAMI -San Fernando Valley 14545 Sherman Cir. Van Nuys 91405 (818)994-6747 Provide services to improve the quality of life for those living with mental illness and their families and friends through support, education, and advocacy. New Directions for Youth, 7315 N Lankershim North Inc. Blvd. Hollywood 91605 (818)503-6330 New Directions for Youth provides assessment, counseling and referral services to more than 2,000 young people and their families annually. NDY's professional and para-professional counselors offer clients individual, group and family counseling. New Horizons Housing and Independent Living 15725 Parthenia St. North Hills 91343 (818)894-9301 New Horizons creates opportunities to maximize personal and vocational growth for individuals with developmental disabilities and acquired traumatic brain injuries. Penny Lane-Antelope Valley Family Center 43520 Division St. Lancaster 93535 (661)274-0770 Family preservation services, foster adoption, group home placement, mental health services, and mentoring/volunteering. 170 P a g e

Santa Psyche Minded Inc. 26522 Pipit Ct. Clarita 91351 Educate the general public about metal health, to fight stigma relating to mental health and to provide mental health educational resources to the public. San Fernando Valley Community Mental Health Center - Center for Family Living 14545 Sherman Cir. Van Nuys 91405 (818)901-4854 Provide services to children, adolescents and transitional age youth with serious emotional disorders, and services for adults and older adults with severe and persistent mental illness. San Fernando Valley Counseling Center 8350 Reseda Blvd Northridge 91324 (818)341-1111 Provide treatment for anxiety, depression, stress, relationships issues, parenting issues and children issues. School Mental Health (LAUSD) 6651 Balboa Blvd Van Nuys 91406 (818)997-2640 Support, advocacy, and resiliency building by directly or indirectly supporting staff, students and their families. Tarzana Treatment Center - Antelope Valley and Youth Services 4443 N. 10th St. West Lancaster 93534 (800)996-1051 Full-service behavioral healthcare organization that provides high quality, cost-effective substance abuse and mental health treatment to adults and youth. We are a non-profit, community-based organization that operates a psychiatric hospital, residential and outpatient alcohol and drug treatment centers, adolescent drug treatment centers, and family medical clinics. The Help Group 15339 Saticoy St Van Nuys 91405 (818)267-2747 Serves children with special needs related to autism spectrum disorder, ADHS, leading disabilities, developmental delays, abuse and emotional problems. Valley Community Clinic 6801 Coldwater Canyon Ave. Ste. 1B North Hollywood 91605 (818)763-8836 Provide a comprehensive array of services that including primary and some specialty care, dental, optometry, pediatrics, prenatal care, women's health, counseling and health education with an emphasis on prevention. Valley Family Center 302 S Brand Blvd. San Fernando 91340 (818)365-8588 Provide counseling and educational services that facilitate personal growth, strengthen the family unit, and protect human dignity for all persons in need. Valley Trauma Counseling Center- Santa Clarita/Valencia Office 28231 Avenue Crocker Ste. 30 Valencia 91355 (661)253-0258 Work with communities to provide quality crisis intervention and counseling services, trainings, and prevention education to promote social change. Valley Women's Center 14430 Sherman Way Van Nuys 91405 (818)785-9119 Individuals, couples, family counseling and group therapies. 171 P a g e

Veterans Administration Greater L.A Healthcare System - Sepulveda Ambulatory Care Center 16111 Plummer St. North Hills 91343 (818)891-7711 Services offered: chemical dependency, dentistry, geriatric research education and clinical center, health science research and development, and mental health. Pregnant and Parenting Teens Agency Address City Zip Telephone Antelope Valley Partners for Health - AV Best Babies Collaborative 45104 10th St. W. Lancaster 93534 (661)942-4719 Helps improve low birth outcomes for women who are at risk by health education and case management. CA Office of Family Planning Information & Referral (800)942-1054 Confidential referrals to low cost family planning clinics in your area. EL Nido Family Centers 13460 Van Nuys Pacoima 91331 (818)896-7776 Provides youth counseling, parent education, child abuse and teen pregnancy. El Nido Family Centers 10200 Sepulveda Blvd. #350 Mission Hills 91345 (818)830-3646 Provides youth counseling, parent education, child abuse and teen pregnancy. Friends of the Family 15350 Sherman Way #140 Van Nuys 91406 (818)988-4430 Provide parent support & education programs to help parents develop their skills in nurturing developing healthier relationships with their children, family development and mental health. L.A. County Office of Education and New Direction School 9300 Imperial Hwy. Downey 90242 (562)922-6111 Provide students with appeals and resolutions, services for homelessness and foster youth, school safety, school enrollment and attendance. 1401 South Grand Ave., PHR Bldg., LA Best Babies Network 3rd Floor Los Angeles 90015 (213)250-7273 Helps improve the health of the mother, family and their newborn. Los Angeles Unified School District 333 S. Beaudry Ave. Los Angeles 90017 (213)241-1000 Give students an education in a safe, caring environment to prepare for college. 172 P a g e

McAllister High School (located at San Fernando High School) 11011 O'Melveny San Fernando 91340 (818)365-0731 Schools of choice for pregnant teens were they learn to care for themselves and their babies while continuing their education. Mission City Community Clinic, Inc. 4842 Hollywood Blvd. Los Angeles 90027 (323)644-1110 Offers health education and outreach services, pediatric services, case management, laboratory services, gynecological services, family planning, dental services, immunizations, and disaster preparedness. Pediatric Health & WIC Center 7138 Van Nuys Blvd. Van Nuys 91405 (818)778-6240 Health center. Planned Parenthood Los Angeles Health Center 535 E. Palmdale Blvd. Ste. A-1 Palmdale 93550 (800)576-5544 Provide services on abortion, birth control, body image, general health, men's sexual health, pregnancy, relationships, sex, sexual orientation, gender, STD's and women's health. Pregnancy Counseling Center 10211 Sepulveda Blvd. Mission Hills 91345 (818)895-2500 The center offers counseling, pregnancy tests, prenatal care, abortion information or referrals. Project SAFE - The Help Group 6455 Coldwater Canyon Blvd. Valley Glen 91606 (818)623-6383 (818)623-6382 Helps parents and caregivers build strong and healthy families by providing home visits, workshops, stress technics, education on pregnancy and case management. Valley Community Clinic 6801 Coldwater Canyon Blvd. North Hollywood 91605 (818)763-8836 Confidential pregnancy testing and referrals. Prenatal Education and Services Agency Address City Zip Telephone Antelope Valley Best 45104 10th St. West Lancaster 93534 (661)942-4719 Babies Collaborative Services include instruction in child development, child safety, parenting classes and breastfeeding classes. Antelope Valley Hospital 1600 W. Ave J Lancaster 93534 (661)949-5000 Full-service 24-hour emergency room, Obstetrical Services including NICU and OB Clinics, Comprehensive Diagnostic Imaging Services, including state-of-the-art CAT scanner and MRI Critical Care Units; highly regarded medical/surgical services and outpatient surgery services. Community services. Children s Center of the 45111 N. Fern Ave. Lancaster 93534 (661)949-1206 Antelope Valley The Children s Center offers innovative comprehensive prevention, intervention and treatment services and is the coordinating agency for multiple community partnerships involving both public and private agencies. 173 P a g e

East Kern Family 15662 K. St. Mojave 93501 (661)824-4118 Resource Center (93501) Provide outreach, case management and supportive services to families with children who are at risk of abuse and neglect or who may not be ready to enter kindergarten successfully. Family Focus Resource 43210 Gingham Lancaster 93535 (661)945-9598 Center - Antelope Valley Ave. Infants and Toddlers Early Start - The California Early Start program provides early intervention services for eligible infants and toddlers (birth up to third birthday) who have developmental delay, a disability or an established risk condition with a high probability of resulting in a delay. Family Focus Resource 28470 Ave. Santa Clarita 91355 (661)294-9715 Center - Santa Clarita Valley Stanford Ste. 105 Infants and Toddlers Early Start - The California Early Start program provides early intervention services for eligible infants and toddlers (birth up to third birthday) who have developmental delay, a disability or an established risk condition with a high probability of resulting in a delay. Hathaway - Sycamores - 44738 Sierra Hwy. Lancaster 93534 (323)257-9600 Lancaster Community Based Mental Health Services Provide youth enrichment programs, early childhood and school readiness programs, and mental health services. LA County Dept. of Children And Family Services - SPA 1- Palmdale 39945 Sierra Hwy. Palmdale 93550 (213)351-5602 Provide adoption and post-adoption programs, support services as well as foster care and adoption assistance hotlines. LA County Dept. of Health Services - High Desert Health System 44900 N. 60th St. West Lancaster 93536 (661)948-8581 Maintain and expand outpatient services provided by High Desert Hospital and retain the administrative, ancillary, and support services infrastructure to support the health system's network of four community-based clinics. LAC DHS - High Desert Health System - Littlerock Community Clinic 8201 Pearblossom Hwy. Littlerock 93543 (661)945-8205 Maintain and expand outpatient services provided by High Desert Hospital and retain the administrative, ancillary, and support services infrastructure to support the health system's network of four community-based clinics. North LA County Regional Center - Santa Clarita Valley 28470 W. Avenue Stanford, Ste. 100 Santa Clarita 91355 (661)775-8450 Provide comprehensive information, advocate in cooperation with consumers, promoting and providing quality services, and supporting full participation of consumers and families in all aspects of community life. 174 P a g e

NEVHC -LAC- Valencia Health Center and WIC Site 23763 Valencia Blvd. Valencia 91355 (661)287-1551 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. Palmdale School District - Head Start/ State preschool 975 E. Ave. P-8 Palmdale 93550 (661)273-4710 Early Head Start and supplemental programs. SCV Pregnancy Center 23838 Valencia Santa Clarita 91355 (661)255-0082 Blvd. Ste. 270 Pregnancy testing, confidential support and community referrals. Samuel Dixon Family 23772 Newhall Ave. Newhall 91321 (661)291-1777 Health Center- Newhall Provide primary care services including minor illnesses, injuries, diabetes management, physical exam, family medicine, women s health, prenatal and well-baby care immunizations and health education. Tarzana Family Medical Clinic - Lancaster 907 W. Lancaster Lancaster 93534 (800)996-1051 Blvd. Full-service behavioral healthcare organization that provides high quality, cost-effective substance abuse and mental health treatment and family medical clinics. Senior Services Agency Address City Zip Telephone Alicia Broadous Duncan M/P Senior Center 11300 Glenoaks Blvd. Pacoima 91331 (818)834-6100 Senior center citizen counseling facility. 15099 Mission Hills Ararat Nursing Home Rd. Mission Hills 91345 (818)837-1800 Nursing/convalescent care facility. (800)954-2873 Arthritis Foundation 800 W. 6th St., Ste. 1250 Los Angeles 90017 or (323)954-5750 Provide information, events, research grants, advocacy activities and other vital programs and services. Castaic Regional Sport Complex 31230 Castaic Rd. Castaic 91384 (661)775-8865 Provides library programs, senior clubs, activities, social events and trips along with walking club El Project del Barrio 9140 Van Nuys Blvd. Panorama City 91402 (818)895-0824 Provide counseling, psychological services, mental health services, child care services, transportation, referral services, medical services, urinalysis testing services, child and elder and incapacitated abuse reporting. 175 P a g e

Jewish Family Services Los Angeles (877)275-4537 Provides a wide range of health and social services to older adults and their families such as food and hunger services, counseling, shelter services, disabilities services, child and family services and Jewish life. JFS/ Valley Storefront Senior Center North Hollywood 91606 (818)984-1380 12821 Victory Blvd. Provides a wide range of health and social services to older adults and their families such as food and hunger services, counseling, shelter services, disabilities services, child and family services and Jewish life. Legacy Commons for Active Seniors 930 E. Ave., Q-9 Palmdale 93550 (661)267-5904 Recreation facility for seniors 55+. Meet Each Need With Dignity (MEND) 10641 N. San Fernando Rd. Pacoima 91331 (818)686-7300 Provides medical services including basic ambulatory, hypertension, diabetic, vision, women's health, acupuncture and chiropractic care for adults and children in certain zip code areas. NEVHC - LAC-Valencia Health Center and WIC Site 23763 Valencia Blvd. Valencia 91355 (661)705-2040 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. NEVHC - Pacoima Health Center and WIC Site 12756 Van Nuys Blvd. Pacoima 91331 (818)270-9777 Provides primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition programs, dental, pharmacy, substance abuse prevention and education. Partners in Care Foundation 732 Mott St., Ste. 150 San Fernando 91340 (818)837-3775 Offers services for older adults, disease prevention, and access to care, research, education and advocacy. Santa Clarita Adult Day Health Senior care facility. 22903 Soledad Canyon Rd. Santa Clarita 91350 (661)253-0700 STD Resources Agency Address City Zip Telephone LAC DHS - High Desert 335 E. Ave. K6 Lancaster 93535 (661)524-2005 Health System - AV Health Center Bldg. B Maintain and expand outpatient services provided by High Desert Hospital and retain the administrative, ancillary, and support services infrastructure to support the health system's network of four community-based clinics. 176 P a g e

LAC DHS - Mid Valley Comprehensive Health Center 7515 Van Nuys Blvd. Van Nuys 91405 (818)947-4000 Mid - Valley Comprehensive Center (MVCHC) offers primary care services for adults, women and children as well as a range of specialty, ancillary, and pharmacy services. Specialty services include: OB/GYN, pediatrics, dermatology, optical, cardiology, urology, and dental services. LAC DPH - North Hollywood Public Health Center 5300 Tujunga Ave. North Hollywood 91601 (818)487-0063 Offer clinical services such as immunizations, screening, and tuberculosis treatment as well as STD s. Planned Parenthood Los Angeles -Antelope Valley Health Center 533 E Palmdale Blvd. Ste. A-1 Palmdale 93550 (800)576-5544 Abortion referral, birth control, HIV testing, men s health care, pregnancy testing services, STD testing, treatment, vaccines, and women s health care. Planned Parenthood Los Angeles - Van Nuys Health Center 7100 Van Nuys Blvd. Ste. 108 Van Nuys 91405 (800)576-5544 Abortion referral, birth control, HIV testing, men s health care, pregnancy testing services, STD testing, treatment, vaccines, and women s health care. Valley Community Clinic 6801 Coldwater North 91605 (818)763-1718 Canyon Ave. Ste. 1B Hollywood Anger management for adults and teens, behavioral health service, community outreach, counseling, dental, general medical, HIV AIDS, nutrition and exercise counseling, medical research, optometry, pediatrics, prenatal services, Valley teen-clinic health education, women's health and family planning. Weight Management and Nutrition Resources for Diabetics and Pregnant Women Agency Address City Zip Telephone Antelope Valley Best Babies Collaborative 45104 10th St. West Lancaster 93534 (661)942-4719 Services include instruction in child development, child safety, parenting classes and breastfeeding classes. Antelope Valley Committee on Aging Corporation Senior citizen s association. Antelope Valley Hospital - Lancaster WIC Site 201W. Jackman St. Ste. 201 Lancaster 93534 (661)942-6244 701 W. Ave. K, Ste. 104 Lancaster 93534 (661)949-5805 WIC is a federally funded, statewide program that helps to ensure good nutrition for pregnant and breastfeeding women, infants and children under 5 years of age. AV Hospital - Palmdale WIC Site- 47th St Clinic 37926 47th St. East, Ste. J Palmdale 93552 (661)726-6300 WIC is a federally funded, statewide program that helps to ensure good nutrition for pregnant and breastfeeding women, infants and children under 5 years of age. 177 P a g e

Antelope Valley Hospital -Palmdale WIC Site 2247 E. Palmdale Blvd. Ste. A Palmdale 93550 (661)726-6300 WIC is a federally funded, statewide program that helps to ensure good nutrition for pregnant and breastfeeding women, infants and children under 5 years of age. Legacy Commons for Active Seniors 930 E. Ave. Q-9 Palmdale 93550 (661)267-5904 Recreation facility for seniors 55+. NEVHC - Santa Clarita Health Center and WIC Site 18533 Soledad Canyon Rd. Santa Clarita 91351 (661)705-2040 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. NEVHC -Newhall WIC Site 23630 Newhall Ave. Newhall 91321 (818)361-7541 Primary & preventive care, health center, homeless health, school based health services, WIC supplemental nutrition program, dental centers, pharmacy, substance abuse prevention and education, various payment options. Santa Clarita Valley Senior Center 22900 Market St. Santa Clarita 91321 (661)259-9444 Santa Clarita Valley Senior Center helps enhance the dignity and quality of life for our senior citizens. WIC- California City (CAPK) 21007 Nemophilia St. #A California City 93505 (866)327-3074 Provides nutrition education, counseling and supplemental food programs for pregnant, breast feeding and post-partum women, infants and children. WIC- Rosamond, Park and Recreations CAPK 2861 Diamond St. Rosamond 93560 (661)327-3074 Provides nutrition education, counseling and supplemental food programs for pregnant, breast feeding and post-partum women, infants and children. Helping Hands and Hearts Foundation 27832 Sumner Ave. Saugus 91350 (661)297-0992 Meal assistance, transportation, and other non-medical quality of life programs. 178 P a g e

Community Assets and Resources List of Parks and Recreation Areas in KFH Panorama City Medical Center Service Area Park Street City Zip Code Apollo Park 4555 West Avenue Lancaster 93536 Arthur B Ripley State Park 17100 East Avenue J Lancaster 93535 Blythe Street Park 14740 Blythe Street Panorama City 91402 Brand Park (A.K.A Mission 15174 San Fernando Mission Hills 91345 Park) Mission Road Branford Park 13310 Branford Pacoima 91331 Street California City Parks & Rec 10450 California California City 93505 City Blvd California City Recreation 10350 Heather California City 93505 Avenue California RV Resort 1535 Sierra Hwy Acton 93510 Carey Ranch Laurel Canyon Blvd Mission Hills 91342 & Aztec Street Courson Field House 38226 10th Street Palmdale 93550 East Delano Park 15100 Erwin Street Van Nuys 91411 Desert Sands Park 39117 3rd Street Palmdale 93550 East Devil's Punch Bowl Park 2800 Devils Punch Pearblossom 93553 Bowl Road Devonshire/Arleta Park 14215 West Pacoima 91331 Devonshire Street Devonwood Park 10230 Woodman Panorama City 91402 Avenue Domenic Massari Park 37716 55th Street Palmdale 93552 East, #RF7 Eastside Pool 45045 5th Street East Lancaster 93535 El Dorado Park 44501 5th Street East Lancaster 93535 Fehlhaber-Houk Park 9521 Tujunga Tujunga 91042 Canyon Blvd Finn (Howard) Park 7747 Foothill Blvd Sunland 91042 Four Oaks Park Melba Ave. & West Hills 91307 Cohasset St. Fun Time ATV Rentals 32629 Hwy 14 Cantil 93519 Incorporated George Lane Park 5520 West Avenue Lancaster (Quartz 93534 Haines Canyon Park L-8 South Terminus Canyon Avenue (Foothill-Haines Hill ) Tujunga 91402 179 P a g e

Canyon) Hartland Mini Park Hartland & Van Nuys 91605 Woodman Jackie Robinson Park 8773 East Avenue R Lancaster, Sun 93543 Valley Jane Reynolds Park 716 West Oldfield Street Lancaster 93534 Jessup (Roger) Park 12467 West Osborne Pacoima 91331 Joshua Hills Park 3040 Fairfield Avenue Palmdale 93550 Kagel Canyon Park 11435 Kagel Canyon Sylmar, Lake View 91342 Street Terrace Kittridge Mini-Park Kittridge& Van Nuys 91401 Greenbush Lancaster City Park 43011 10th Street Lancaster 93534 West Lancaster Parks & Recreation 44933 Fern Avenue Lancaster 93534 Louise Park 7140 Louise Avenue Van Nuys 91406 Manzanita Height Park 431 Mesa Verde Palmdale 93551 Avenue Marie Kerr Park 39700 30th Street Palmdale 93551 West Mariposa Park 45755 Fig Avenue Lancaster 93534 Mc Adam Park 38115 30th Street Palmdale 93550 East Mcgroarty Park (Formerly 7570 Mcgroarty Tujunga 91042 Pasko Park) Terrace Moorpark Park 12061 Moorpark Studio City 91604 Street North Hills Community Park 8756 Parthenia Place North Hills 91343 O'Melveny Park 17300 Sesnon Blvd Granada Hills 91344 Palmdale Playhouse 38334 10th Street Palmdale 93550 East Panorama Park 8600 Hazeltine Panorama City 91402 Avenue Park Somerset-Lancaster 42909 15th Street Lancaster 93534 West Paxton Park 10731 Laurel Pacoima 91331 Canyon Blvd Pearblossom Parks & Rec 33922 121st Street Pearblossom 93553 East RawleyDuntley Park 3334 West Avenue Lancaster 93534 K Ritchie Valens Park 10731 Laurel Canyon Blvd Pacoima 91331 180 P a g e

Sepulveda Park West 8756 Parthenia Place North Hills 91343 Sepulveda Recreation Center 8801 Kester Avenue Panorama City 91402 Skytower Park Avenue K4 & 32nd Lancaster 93534 Street East Slavin (Jaime Beth) Park 12500 Strathern North Hollywood 91605 Street State of California - Antelope 15101 Lancaster Lancaster 93536 Valley Poppy Reserve Road Stetson Ranch Park 13877 Glenoaks Sylmar 91342 Blvd Strathern Park North Strathern and Sun Valley 91605 Whitsett Strathern Park West 12541 Saticoy Street Sun Valley 91605 Studio City Mini Park 12505 Moorpark Studio City 91604 Street at Whitsett Avenue Sun Valley Park 8133 Vineland Sun Valley 91352 Avenue Sylmar Park 13109 Borden Sylmar 91342 Avenue Tierra Bonita Park 44910 27th Street Lancaster 93535 East Valley Plaza Park 12240 Archwood North Hollywood 91606 Street Valley Village Park 200 Westpark Drive North Hollywood 91601 Van Nuys/Sherman Oaks 14201 Huston Street Sherman Oaks 91423 Recreation Center Whitsett Fields Park 12240 Archwood North Hollywood 91605 Street William J Mcadam Park 38115 30th Street Palmdale 93550 East Woodbridge Park 11240 Moorpark Studio City 91602 Street Woodley Park 6350 Woodley Van Nuys 91436 Avenue Zelzah Park 11690 Zelzah Avenue Granada Hills 91344 Source: Google.com 181 P a g e

Appendix D: References/Bibliography

American Cancer Society, California Department of Public Health, California Cancer Registry. California Cancer Facts and Figures 2012.Oakland, CA: American Cancer Society, California Division, September 2011.Retrieved from:http://www.ccrcal.org/pdf/reports/acs_2012.pdf Contains the most recent data available regarding cancer incidence, mortality and provides projected cancer cases and deaths in the year ahead. American Heart Association. (2010) Risk Score for In-Hospital Ischemic Stroke Mortality Derived and Validated Within the Get With The Guidelines Stroke Program. Retrieved from http://circ.ahajournals.org/content/122/15/1496 This article provides a model for predicting the ischemic stroke mortality rates for hospital in-patients. The Get With the Guidelines Stroke risk model provides well validated practical bedside tools for physicians to conduct mortality risk stratification. California Department of Alcoholic Beverage Control. (April 2012) Active License File. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.abc.ca.gov/datport/dataexport.html The California Department of Alcoholic Beverage Control (ABC) is that state s sole agency responsible for licensing and regulating the manufacture, importation and sale of alcoholic beverages. It also has the power for good cause to deny, suspend or revoke any specific alcoholic beverage license. The California ABC maintains a record of all active, pending, and surrendered alcoholic beverage licenses in a searchable, online database. The database includes information about every official beer, wine and general (liquor) licenses, issued both for retail and immediate consumption. For more information about this source, please visit the California Department of Alcoholic Beverage Control website. California Department of Education. (2011) Fitnessgram Physical Fitness Testing Results. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cde.ca.gov/ta/tg/pf/ Provided reports on the fitness test results of students in grades five, seven, and nine. The test has six parts that show the level of fitness of each child which offer a degree of defense against diseases that come from inactivity. California Department of Public Health. (2010) Birth Profiles by ZIP Code. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdph.ca.gov/data/statistics/pages/birthprofilesbyzipcode.aspx Lists in detail the number of live births, based on the mother s residence at the time of delivery and includes aggregates by Race/Ethnic Group of Mother, Age of Mother, Infant Birth Weight, and Prenatal Care Trimester by ZIP Code. 183 P a g e

California Department of Public Health. (2008-2010) Death Statistical Master File. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdph.ca.gov/data/dataresources/requests/pages/vitalstatisticsbirthdeathfetaldea thmarriagedata.aspx Reports a compilation of information reported on birth, death, and fetal death certificates, including detailed demographic information related to infant, mother, and father or decedent, as well as medical data related to the vital event. California Department of Public Health. (2011) In-Hospital Breastfeeding Initiation Data. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdph.ca.gov/data/statistics/pages/inhospitalbreastfeedinginitiationdata.aspx Provides information collected by the Newborn Screening (NBS) Program of in-hospital infant feeding practices in California. The NBS program gathers data on all infant feeding from birth to time of specimen collection, usually 24 to 48 hours since birth. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Adequate Fruit/Vegetable Consumption (Youth). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for children consuming healthy foods and for the total youth population are estimates acquired from AskCHIS data tables. Data represent the population aged 2 11 based on survey responses collected between September 2009 and April 2010. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Heart Disease Prevalence. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for adults with heart disease and for the total adult population are estimates acquired from AskCHIS data tables. Data represent the population aged 18 and up based on survey responses collected between September 2009 and April 2010. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Lack of a Consistent Source of Primary Care. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for the population with no regular doctor and for the total population are estimates acquired from AskCHIS data tables. Data represent the total population based on survey responses collected between September 2009 and April 2010. 184 P a g e

California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Oral Health (Dental Care Access). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for children and teens unable to afford dental care and for the total youth population are estimates acquired from AskCHIS data tables. Data represent the population aged 5 17 based on survey responses collected between July 2007 and March 2008. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Oral Health (Dental Care Utilization Youth). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for teens with low dental care utilization and for the total teenage population are estimates acquired from AskCHIS data tables. Data represent the population aged 12 17 based on survey responses collected between September 2009 and April 2010. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory on Oral Health (Dental Insurance). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for adults with no dental insurance and for the total adult population are estimates acquired from AskCHIS data tables. Data represent the population aged 18 and up based on survey responses collected between July 2007 and March 2008. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Poor Mental Health. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for adults with poor mental health and for the total adult population are estimates acquired from AskCHIS data tables. Data represent the population aged 18 and up based on survey responses collected between September 2009 and April 2010. California Health Interview Survey (CHIS). (2009) California Health Interview Survey: Data Directory for Sexual Activity (HIV Screening). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://healthpolicy.ucla.edu/chis/pages/default.aspx Data for teens and adults receiving HIV screenings and for the total population over age 12 are estimates acquired from AskCHIS data tables. Data represent the population aged 12 70 who have had one or more sexual partner in the last 12 months, and are based on survey responses collected between July 2005 and April 2006. 185 P a g e

California Office of Statewide Health, Planning and Development (OSHPD). (2010-2011) Patient Discharge Data. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.oshpd.ca.gov/hid/products/patdischargedata/publicdataset/index.html This report provides data of patient discharges using a masking technique that masks values for certain demographic data elements from unique patient records. Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2008) HIV prevalence. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/nchhstp/ This report is a dissemination of reports from the CDC about new cases of HIV within selected reported areas and counties within California and compares them to the national average in the United States. HIV prevalence rates of reported per 100,000 population. Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2009) Chlamydia Incidence. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/nchhstp/ This complied data from the CDC reports that number of incidence rate of Chlamydia cases per 100,000 populations which gives an indication of the prevalence of unsafe sex practices. Centers for Disease Control and Prevention. (2004-2010) Behavioral Risk Factor Surveillance System: Cervical Cancer Screenings (Pap Test). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. The BRFSS collected data on women receiving cervical cancer screening test (Pap Test). Pap tests are conducted on all women aged 18 and up by collecting a smear sample to check for any abnormalities in the cervix. This test is repeated every year for women with a family history of cervical cancers, otherwise the test is repeated every five years. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Colon Cancer Screenings(Sigmoid/Colonoscopy). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. 186 P a g e

Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. For a SIGMOIDOSCOPY, a flexible tube is inserted into the rectum to look for problems. A COLONOSCOPY is similar but uses a longer tube, and you are usually given medication through a needle in your arm to make you sleepy and told to have someone else drive you home after the test. Sigmoidoscopy/Colonoscopy is recommended for population aged 50 and up. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Dental Care Utilization (Adults). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. BRFSS reports care utilization information for various health care services. The data on dental care utilization by adults indicates that the percent of conducts respondents who indicated that they had not seen any dentist or dental hygienist within the past year. Centers for Disease Control and Prevention. (2003-2009) Behavioral Risk Factor Surveillance System: High Blood Pressure Management. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. The report presented data on the percentage of individuals who have high blood pressure and who are not currently taking medication to control it. Data only pertain to the noninstitutionalized population aged 18 and up and are weighted to reflect the total county population, including non-respondents, using the methods described in the BRFSS Comparability of Data documentation. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Pneumonia Vaccinations (Age 65). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on 187 P a g e

health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. A pneumonia shot or pneumococcal vaccine is usually given only once or twice in a person's lifetime and is different from the flu shot. The percentages presented in the report reflect the individuals aged 65 and up who received pneumonia vaccination. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Heavy Alcohol Consumption. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. Individuals are considered heavy drinkers if they were male and reported having more than 2 drinks per day, or females that reported having more than 1 drink per day. The percentages reported in BFRSS were for the individuals are population aged 18 and up. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Inadequate Fruit/Vegetable Consumption (Adults). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. Data are based on the percentage of respondents who report regularly consuming five or more servings of fruits or vegetables each week. Fried potatoes and chips are excluded. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Physical Inactivity (Adults) Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. Daily physical activity for 30 minutes is recommended by CDC for adults and the percentages presented in the BRFSS are the adults who do not perform any physical activity. 188 P a g e

Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Tobacco Usage. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. Individuals are considered to be smokers if they smoke on a daily basis or often. The percentages reported in the BRFSS are for adults who reported smoking on a regular basis. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Asthma Prevalence. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. Asthma is a chronic lung disease and both children and adults are affected by asthma. The numbers presented are for those who reported as having asthma. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Overweight (Adults). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. These responses were combined to determine a respondent's Body Mass Index (BMI). BMI is calculated as weight in kilograms divided by height in meters squared. Persons with a BMI from 25.0-29.9 are considered overweight. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Poor Dental Health. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related 189 P a g e

to chronic disease and injury. This reports the number of individuals whose permanent teeth have been removed because of tooth decay or gum disease. The number of teeth the individual lost included teeth lost to infection, injury or orthodontics. (If wisdom teeth are removed because of tooth decay or gum disease, they should be included in the count for lost teeth). This indicator represents the percentage of respondents who indicated that they had 6 or more, including all of their permanent teeth extracted. Centers for Disease Control and Prevention. (2006-2010) Behavioral Risk Factor Surveillance System: Poor General Health. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/brfss/ The Behavioral risk Factor Surveillance System (BRFSS) is the world s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984. The information collected in this report contains information on health risk behaviors, preventative health practices, and health care access primarily related to chronic disease and injury. This indicates the population who has reported as experiencing poor general health. Centers for Disease Control and Prevention, and the National Cancer Institute. (2005-2009) State Cancer Profiles. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://statecancerprofiles.cancer.gov/ These profiles report information on any given state within the United States. Information gathered from the data presented included mortality and incidence rates for cancer as well as cancer trends seen. Centers for Disease Control and Prevention. (2008) National Environmental Public Health Tracking Network. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://ephtracking.cdc.gov/showindicatorsdata.action Environmental public health tracking is the ongoing collection, integration, analysis, and dissemination of data. The information gathered pertains to quantification of the magnitude of health problems, detection of unusual trends in health, exposures, and hazards, as well as identification of populations at risk of environmentally related diseases or of exposures to hazards. Centers for Disease Control and Prevention. (2009) National Diabetes Surveillance System. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://apps.nccd.cdc.gov/ddtstrs/ Diabetes Data and Trends, which include the National Diabetes Fact Sheet and the National diabetes Surveillance System, provided resources documenting the public health burden of diabetes and its complications in the United States. 190 P a g e

Centers for Disease Control and Prevention. (2003-2009) National Vital Statistics System. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.cdc.gov/nchs/nvss.htm The National Vital Statistics System is the oldest and most successful example of intergovernmental data sharing in Public Health. The National Vital Statistics System registers vital events such as births, deaths, marriages, divorces, and fetal deaths. Dartmouth Atlas of Healthcare. (2003-2007) Selected Measures of Primary Care Access and Quality. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.dartmouthatlas.org/tools/downloads.aspx The Dartmouth Atlas Project has documented glaring variation in how medical resources are distributed and used in the United States. The data includes measures of primary care utilization, quality of care for diabetes, mammography, leg amputation, and preventable hospitalizations. Google maps. (2013) Parks and Recreation List. Retrieved from http://www.google.com A search can be conducted to get information about local parks and recreation areas including address, phone numbers for the Department of Parks and Recreation of Los Angeles. Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (November 2010) Trends in Diabetes: A Reversible Public Health Crisis, LA Health. Retrieved from http://www.publichealth.lacounty.gov/ha This health survey collected information on socio-demographic characteristics, health status, health behavior and health care access from 7,200 adults and 5,728 children living in Los Angeles County. This report discusses what diabetes is, risk factors for type ii diabetes, and the prevalence of obesity and diabetes for a decade from 1997 to 2007. The results were published in November of 2010. Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (September 2012) Trends in Obesity: Adult Obesity Continues to Rise. Retrieved from http://www.publichealth.lacounty.gov/ha This report provides statistical information regarding the obesity epidemic and how it has emerged as one of the most significant public health threats in Los Angeles County and across the nation. National Heart Lung and Blood Institute. (June 15, 2012) What is Asthma? Retrieved from: http://nhlbi.nih.gov/health/health-topics/topics/asthma/ 191 P a g e

This health profile provides information about Asthma; a chronic, long term lung disease. The article describes the signs and symptoms of asthma, risk factors and treatment to manage asthma symptoms. National Institute of Health, National Cancer Institute, Surveillance, Epidemiology, and End Results Program. (2011) Age-adjusted cancer incidence rates for selected cancer sites, by sex, race, and Hispanic origin: United States, selected geographic areas, selected years 1990-2008. Retrieved from http://www.cdc.gov/nchs/hus/content2001.htm#047 Nielsen Claritas Site Reports. (2011) Consumer Buying Power. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.claritas.com/sitereports/demographic-reports.jsp Neilson Site Reports provides demographic information for the U.S. for current and five year demographic projections. Detailed information is included in order to analyze markets and selected locations. Office of Statewide Health Planning and Development (OSHPD). (2011) Health Facts: Trends in Cardiac Care in California, 1988 to 2008 Part II: Trends in Heart Attack Hospitalizations. Retrieved from http://www.oshpd.ca.gov/hid/products/health_facts/healthfacts_cardiac2.pdf This report analyzes the data reported to OSHPD by hospitals for Cardiac related hospitalizations. The report reflects data for two decades. The data included case and rate trends, mortality trends, and heart attack hospitalization changes in California. States' Department of Education. (2011) Student Testing Reports. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://nces.ed.gov/nationsreportcard/reading/achieveall.asp. The National Center for Education Statistics reports data regarding the National Assessment of Education Progress (NAEP) for students in grades 4, 8, and 12. NAEP reading achievement-level descriptions present expectations of student performance in relation to a range of text types and text difficulty and in response to a variety of assessment questions intended to elicit different cognitive processes and reading behaviors categorized as Basic, Proficient, and Advanced. State of California, Department of Public Health, Death Records. (2009) Death Statistical Data Tables: Selected Detail Within Leading Causes of Death by Sex and Race/Ethnic Group, California. Retrieved from: http://www.cdph.ca.gov/data/statistics/pages/deathstatisticaldatatables.aspx 192 P a g e

The statistical tables provide gender and ethnic data for leading causes of death. These are the current available death statistical data tables based on the California death certificates information. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Breast. Retrieved from http://seer.cancer.gov/statfacts/html/breast.html Incidence, mortality data for breast cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of breast cancer were discussed in detail. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Cervix Uteri. Retrieved from http://seer.cancer.gov/statfacts/html/cervix.html Incidence, mortality data for cervix uteri cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of cervix uteri cancer were discussed in detail. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Colon and Rectum. Retrieved from http://seer.cancer.gov/statfacts/html/colorect.html Incidence, mortality data for colon and rectum cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of colon and rectum cancer were discussed in detail. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Lung and Bronchus. Retrieved from http://seer.cancer.gov/statfacts/html/lungb.html Incidence, mortality data for lung and bronchus cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of lung and bronchiolar cancer were discussed in detail. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Prostate. Retrieved from http://seer.cancer.gov/statfacts/html/prost.html Incidence, mortality data for Prostate cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of prostate cancer were discussed in detail. Surveillance Epidemiology and End Results (SEER). (2012) SEER Stat Fact Sheets: Cancer of the Lung and Bronchus. Retrieved from http://seer.cancer.gov/statfacts/html/lungb.html Incidence, mortality data for lung and bronchus cancer among the U.S. population was provided by race/ethnicity. Survival rates, lifetime risk factors and the prevalence of lung and bronchiolar cancer were discussed in detail. 193 P a g e

The Nielson Company, Thomson Reuters. (2012) Consumer Buying Power. Retrieved from http://www.claritas.com/sitereports/demographic-reports.jsp Neilson & Reuters Site Reports provides zip code level demographic data for the U.S. for current and five year demographic projections. The report includes disease prevalence and projected prevalence for all the chronic diseases such as cancer, stroke, diabetes, heart disease in addition to health conditions such as asthma, migraine headaches, back pain to name a few. The University of Wisconsin, Population Health Institute. (2012) County Health Rankings. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.countyhealthrankings.org/ County Health Ranking reports health outcomes and health factors, for any given state within the United States on the county level. Statistical data regarding mortality, morbidity, and certain health behaviors, clinical care, socioeconomic factors, and physical environment are listed. U.S. Bureau of Labor Statistics. (July 2012) Local Area Unemployment Statistics. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.bls.gov/lau/ The Local Area Unemployment Statistics (LAUS) program produces monthly and annual employment, unemployment, and labor force data for Census regions and divisions, States, counties, metropolitan areas, and many cities, by place or residence. U.S. Census Bureau. (2008-2010) 2008-2010 American Community Survey 3-Year Estimates. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/acs/www/data_documentation/2010_release/. The American Community Survey reports its findings on the most up-to-date socioeconomic information every year. The release covers more than 40 topics, such as educational attainment, income, health insurance coverage, occupation, language spoken at home, nativity, ancestry and selected monthly homeowner costs. U.S. Census Bureau. (2000) 2000 Census of Population and Housing, Summary File 1. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/main/www/cen2000.html Summary File (SF-1) contains the 100-percent data, which is the information compiled from the question asked of all people and about every housing unit. Population items include sex, age, race, Hispanic or Latino, household relationship, and group quarters. Housing items include occupancy status, vacancy status, and tenure. 194 P a g e

U.S. Census Bureau. (2010) 2010 Census of Population and Housing, Summary File 1. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/2010census/data/ The Summary File 1 data tables provide the most detailed information available so far from the 2010 Census about a community s entire population, including cross-tabulations of age, sex, households, families, relationship to householder, housing units, detailed race and Hispanic or Latino origin groups, and group quarters. U.S. Census Bureau. (2006-2010) 2006-2010 American Community Survey 5-Year Estimates. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/acs/www/data_documentation/2010_release/ The American Community Survey is a detailed source of socio-economic statistics covering every community in the nation every year for the combined years from 2006 to 2010. More than 40 topics, such as educational attainment, income, occupation, commuting to work, language spoken at home, nativity, ancestry and selected monthly costs are covered in this report. U.S. Census Bureau. (2009) Small Area Income and Poverty Estimates (SAIPE). Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/did/www/saipe/data/model/index.html The Small Area Income and Poverty Estimates (SAIPE) program provide current estimates of selected income and poverty statistics. These estimates combine data from administrative records, post-census population estimates, and the decennial census with direct estimates from the American Community Survey to provide consistent and reliable single-year estimates. U.S. Census Bureau. (2009) ZIP Code Business Patterns. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/econ/cbp/ ZIP Code Business Patterns are data available shortly after the release of County Business Patterns. It provides the number of establishment by employment-size classes by detailed industry in the U.S. U.S. Census Bureau. (2010) 2010 Census of Population and Housing. Summary File 1 Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/2010census/data/ ; Esri's USA Parks layer (compilation of Esri, National Park Service, and TomTom source data), 2012. Retrieved from http://www.chna.org/kp/about.aspx. The Census Bureau s interactive redistricting map widget enables users to view local 2010 Census data by state, including population change, race, and Hispanic or Latino origin data by county. 195 P a g e

U.S. Census Bureau. (2010) County Business Patterns. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.census.gov/econ/cbp/ County Business Patterns (CBP) is an annual series that provides sub national economic data by industry. This series includes the number of establishments, employment during the week of March 12, first quarter payroll, and annual payroll. This data is useful for studying the economic activity of small areas; analyzing economic changes over time; and as a benchmark for other statistical series, surveys, and databases between economic censuses. U.S. Department of Agriculture. (2009) Food Desert Locator. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://www.ers.usda.gov/dataproducts/food-desert-locator.aspx The Food Desert Locator is a mapping tool that allows users to investigate multiple indicators of food store access. This locator reports food desert census tracts, incorporation alternative estimates of low-income and low-access census tracts, and offering contextual information for all census tracts in the United States. U.S. Department of Education, National Center for Education Statistics (NCES). (2005-06, 2006-07 and 2007-08) Common Core of Data, Public School Universe Survey Data. Retrieved from http://www.chna.org/kp/about.aspx. Original source: http://nces.ed.gov/ccd/pubschuniv.asp The Public School Universe Survey Data provides a complete listing of all public elementary and secondary schools in the county. Furthermore, basic information also includes basic information and descriptive statistics on all schools, their students, and their teachers. U.S. Department of Health and Human Services, Office of Assistant Secretary for Planning and Evaluation (ASPE.HHC.Gov). (January, 2012) 2012 Federal Poverty Level. Retrieved from http://aspe.hhs.gov/poverty/12poverty.shtm Benefit levels for low-come assistance programs are established using the Federal Poverty Level rates and guidelines. The charts for all 48 contiguous states and the District of Columbia are listed for 100%, 133%, 175%, 200%, 250%, 300% federal poverty levels. World Health Organization. (September, 2010) Mental Health: Strengthening our Response (Fact Sheet). Retrieved from http://www.who.int/mediacenter/factsheets/fs220/en The fact sheet contained information about the rates of mental health disorders and cost effective intersectoral intervention strategies to promote mental health. 196 P a g e

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