2016 Community Health Improvement Plan

Transcription

1 2016 Community Health Improvement Plan This is the annual review report for the first year of implementation of the Community Health Improvement Plan. The Washoe County Community Health Improvement Plan provides a framework for community ANNUAL partners to improve the REPORT health and well-being of residents in Washoe County by taking into account our unique circumstances. In partnership with

2 2016 Community Health Improvement Plan Annual Report This annual report was prepared by the Washoe County Health District (WCHD). We would like to thank the following organizations in Washoe County who made contributions to this report. ACCEPT Big Brothers Big Sisters of Northern Nevada Boys and Girls Club of the Truckee Meadows Catholic Charities of Northern Nevada Children s Cabinet Communities in Schools Crossroads Community Health Alliance Education Alliance Food Bank of Northern Nevada Join Together Northern Nevada (JTNN) Nevada Department of Education Nevada Department of Health and Human Services Northern Nevada HOPES Northern Nevada Literacy Council Quest Counseling Regional Emergency Medical Services Authority (REMSA) Regional Transportation Commission (RTC) Reno Justice Court Renown Child Health Institute Renown Health Rise Academy for Adult Achievement Safe and Healthy Schools Commission Sanford Center Geriatric Clinic Social Entrepreneurs, Inc. Think Kindness Truckee Meadows Healthy Communities United Way of Northern Nevada and the Sierra University of Nevada, Reno (UNR) UNR, School of Community Health Sciences UNR, Reno School of Medicine, Department of Psychiatry Washoe County School District (WCSD) WCSD, Children in Transition WCSD, Family Resource Centers WCSD, Nutrition Services Department WCSD, School Advisory Committee Washoe County Sherriff s Office Washoe County Senior Services Washoe County Social Services 1001 East Ninth Street Reno, NV (775)

3 Letter from the District Health Officer Every day, I am amazed by how hard a wide variety of our community members and community partners are working to create a healthier Washoe County. Even more so, I am impressed at how well we are working together on the Community Health Improvement Plan. The Plan focuses our efforts around common public health goals createdwith extensive community-wide input. The Health District provides support for the Plan s development and implementation, it is a strategy created by our community, for our community. After a full year of implementing programs and activities, I am pleased with the direction Washoe County is heading and the progress we are making. I hope you too are excited with the progress as you review this annual report. It will take a continued commitment over the next two years to attain the goals and objectives in the Plan. But, if past and current efforts are any indication of ourpotential, I have no doubt we will continue to cultivate a dynamic culture of health in Washoe County. Kevin Dick Washoe County District Health Officer

4 Table of Contents Letter from the Board of Health Big changes are underway in Washoe County. While the foundation for a significant increase in the economic vitality of our region has been laid, much work is yet to be done to ensure that our region s quality of life accompanies the projected economic growth. And when it comes to quality of life, nothing can have a greater impact than one s health. Over the coming years, my colleagues on the District Board of Health, Washoe County Commission, Reno and Sparks City Councils, and other leaders within the community will make decisions with significant implications on the future of our community. One thing I have learned from my experience on the District Board of Health is that many decisions related to access to healthcare, education, and employment, not immediately associated with public health, have significant effects on public health outcomes. As regional policy makers shaping the future of our community, we all must recognize and value these implications so that our community is healthier tomorrow than it is today. Washoe County faces many public health challenges, such as ratio of primary care physicians to the population, youth suicide rates, drug abuse, and limited public health funding, to name a few. The District Board of Health and the excellent staff at the Washoe County Health District are actively engaged and working with the community to identify and address our most significant public health priorities. This report provides an update on the meaningful progress we are making as a community in implementing our health improvement plan. Kitty Jung Chairwoman Washoe County District Board of Health

5 Table of Contents Executive Summary... 8 Introduction Overview How to Read this Report Access to Healthcare and Social Services Objective 1.1 and 1.2 Creating a Community Health Hub in Washoe County Family Health Festivals Objective 1.3 Increasing the Number of Washoe County Residents Who Have a Usual Primary Care Provider Community Health Alliance Northern Nevada HOPES Sanford Center Geriatric Clinic Regional Emergency Medical Services Authority Objective 1.4 Increasing the Number of Non-High School Graduate Adults who Receive their Adult High School Diploma Rise Academy for Adult Achievement Objective Increasing Transportation Services Regional Transportation Commission Objective Improving Coordination of Care Strategic Plan Models of Community Engagement Truckee Meadows Healthy Communities Access to Healthcare and Social Services: How Did We Measure Up? Behavioral Health Objective Increase the proportion of adults who receive treatment for mental illness, major depression, and/or substance abuse Community Health Alliance Northern Nevada HOPES UNR School of Medicine, Department of Psychiatry Crossroads... 28

6 Table of Contents Objective Decrease bullying, suicide and depression among Washoe County s youth Multi-Tiered Systems of Support Washoe County School District Safe and Healthy Schools Commission Washoe County School District Bully Prevention Family Health Festivals Signs of Suicide Prevention Program Adverse Childhood Experiences Objective Decrease substance use and abuse among youth Parenting Wisely Washoe County School District s Family Resource Centers Project Towards No Drug Abuse The Children s Cabinet Big Brothers Big Sisters Mentoring Program Positive Action - ACCEPT Smart Moves and Smart Kids The Boys and Girls Club of Truckee Meadows Promoting Alternative Thinking Strategies Washoe County School District Teen Intervene Quest Counseling Alcohol Wise University of Nevada, Reno Brief Alcohol Screening and Intervention for College Students University of Nevada, Reno Behavioral Health: How Did We Measure Up? Education (K-12) Objective Increase the High School Graduation Rates and Preparation for Higher Education.. 42 Education Alliance Communities in Schools Read by Grade Three Washoe County School District United Way of Northern Nevada and the Sierra Objective Increase Physical Activity, Proper Nutrition and Wellness Among Washoe County Youth Wellness Advisory Committee - Washoe County School District Nutrition Services Department Washoe County School District Girls on the Run Sierras - Renown Health Wolf Pack Coaches Challenge Washoe County Health District Education (K-12): How Did We Measure Up?... 49

7 Table of Contents Food Security Objective Implement programs to reduce the food insecure in Washoe County PhotoVoice Project Collaborating for Communities Food Security Community Action Network Community Garden Plan Objective 9.1 Enhance home-delivered meal programs to seniors to keep on pace with the rising senior population Washoe County Senior Services Food Security: How Did We Measure Up? Conclusion Making Strides toward Collective Impact Lessons Learned Recommendations... 58

8 E xecutive Summary A Community Health Improvement Plan (CHIP) utilizes data from a Community Health Needs Assessment (CHNA) to help organizations develop comprehensive information about a community s current health status, needs and issues. 1 A CHIP can help a community justify how and where to allocate resources to best meet the community need. Benefits include improved organization and community coordination and collaboration, increased knowledge about public health and the interconnectedness of activities, strengthened partnerships within state and local public health systems, identified strengths and weaknesses to address in quality improvement efforts, baselines on performance to use in preparing for accreditation, and benchmarks for public health practice improvement. 2 Status of CHIP Objectives, % 15% 27% 47% The CHIP report is published annually and evaluates the progress of goals, strategies and objectives over the last year towards the four priorities of ACCESS TO HEALTHCARE AND SOCIAL SERVICES, BEHAVIORAL HEALTH, EDUCATION (K-12), AND FOOD SECURITY. 2 The CHIP is in it s first year of a triennium plan ( ). This report will provide insight for the community to identify gaps in services, collaboration opportunities, potential for policy changes, and ways to remove social disparities and barriers to living healthy. Together, through collective impact strategies, Washoe County can enhance quality of life. Met/Exceeded Target Did Not Meet Target Progress Toward Target No Data Status of CHIP Strategies, % 7% 7% 67% First year implementation of the inaugural Washoe County CHIP was very successful. Out of 55 strategies, 67% have already met or exceeded their targets. Met/Exceeded Target Did Not Meet Target Progress Toward Target No Data 1 CDC (2015). Community Health Assessments & Health Improvement Plans. Retrieved from: 2 Washoe County Health District. (2015). Washoe County community health improvement plan: Retrieved from: Page 8 of 59

9 Additionally, almost half (47%) of the objectives outlined in the CHIP have been met or exceeded their targets. Access to Health Care and Social Services This priority was led by 10 community organizations to make movement on 13 strategies and 10 performance measures. Overarching goals for this priority include the development of a community health hub, increasing access to primary care, increasing coordination of care, increasing access to transportation and increasing the number of adults who receive their adult high school diploma. In the first year of implementation, 70% of the objectives have been met and 85% of the strategies have met or exceeded their targets. Major successes include: There was a 7.3% increase in 2015 (68.1% to 75.4%) of Washoe County residents who have a primary care provider as compared to This has already exceeded the 2018 target of 71.5%. There were four completed Family Health Festivals serving a total of 3,607 clients in the zip code with an average of 33 vendors participating. Community Health Alliance opened two new centers: The Center for Complex Care located on Crampton Street and the Sparks Health Center located on Oddie Boulevard. Northern Nevada HOPES opened their brand new Wellness Center and has already seen a 36% increase in their patient population (from February 2016 to November 2016). There was a 26.0% increase in the number of Washoe County residents who received their adult high school diploma from RISE Academy for Adult Achievement in the school year, meeting their goal of 150 diplomas awarded. There was a 72.8% increase in the number of trips provided by private/not-for-profit organizations and a 23.7% increase in the number of reduced-rate or other discounted transit trips provided to seniors, disabled and low income residents in Washoe County. There was a development of a Nevada strategic plan to improve coordination of care in Washoe County and throughout the rest of the State. Renown Health will be sustaining REMSA community services such as the Nurse Health Line, Community Paramedicine, and Ambulance Transport Alternatives. Behavioral Health This priority was led by 20 community organizations to make movement on 21 strategies and 32 performance measures. Overarching goals for this priority include improving access to behavioral health services, creating a healthier environment for youth and a reduction in youth substance use and abuse. In the first year of implementation, 63% of the objectives have been met and 71% of the strategies have met or exceed their targets. Major successes include: Page 9 of 59

10 The UNR School of Medicine Department of Psychiatry opened their new Behavioral Health Patient Care Center on Neil Road. This allowed UNR to increase fellowships for students pursing the field of clinical mental health. Crossroads, a transitional housing program for those who need support to get sober, have 131 supportive transitional housing beds and 14 crisis intervention beds with plans to expand. Amendments to the anti-bullying bill put forth by Nevada s Legislature in 2015 has increased reporting of bullying incidents in Washoe County s schools. Washoe County School District has incorporated several behavioral health supports for their students including Multi-Tiered System of Supports (MTSS), the District Intervention Assistance Team (DIAT), and Social Emotional Learning (SEL). The Adverse Childhood Experiences (ACEs) screening tool has not only been added to the Youth Risk Behavior Surveillance System (YRBS), but is also being included in Washoe County School District s Child and Adolescent Needs and Strengths Screener (CANS) tool. The goal is to screen all seventh graders in the School District. Substance abuse prevention programs were very successful across Washoe County which may have contributed to a decrease in substance use among youth. Education (K-12) This priority was led by eight community partners to make movement on 11 strategies and 18 performance measures. Overarching goals for this priority include improving health outcomes to influence educational attainment and supporting student health through nutritious eating habits and physical activity. In the first year of implementation, 17% of the objectives have been met and 64% of the strategies have met or exceeded their targets. Major successes include: 77% of Washoe County students graduated in This is a 2% increase from the previous year. 66% of Native American/American Indian students graduated in 2016 which is a 14% increase from the previous year, exceeding the target of 53.3%. Washoe County School District adopted a Student Wellness Policy and the majority of schools reported compliance with 15 out the 16 wellness goals. In addition, 60.3% of schools reported hiring wellness coordinators at each school site. Communities in Schools (CIS), a supplemental support program for high risk youth, expanded into five schools in Washoe County and has already seen an 82% graduation rate among CIS students. New legislation in 2015 ecouraged Washoe County schools to improve literacy by grade three. As a result, all 62 elementary schools and five charter schools in Washoe County have designated learning strategists and have been undergoing intensive career development and trainings to better support their schools and implement the new legislation. Page 10 of 59

11 Programs like Girls on the Run and the Wolf Pack Coaches Challenge made headway incorporating curricula to improve nutrition and physical activity in schools. Organizations such as the Education Alliance and United Way have partnered with key businesses and organizations to implement supplemental programs for Washoe County students. Food Security This priority was led by five community partners to make movement on 10 strategies and six performance measures. Overarching goals for this priority include implementing programs that address the immediate need for food and promote long-term health and to enhance home-delivered meal programs to seniors. In the first year of implementation, 17% of the objectives have been met and 30% of the strategies have met or exceeded their targets. Major successes include: The Northern Nevada Food Bank received grant and match funding equalling $515,000 to develop a plan around food security for Washoe County. From this stemmed the Collaborating for Communities (C4C) Community Action Networks (CANs). These CANs target social determinants of health that influence food insecurity such as housing, income stability and food security. This group is developing a plan to increase access and knowledge of food sustenance programs in the zip code as well as develop a food prescription pilot with Renown Health and Community Health Alliance. The CHIP is a living document that seeks to demonstrate the principles of collective impact, which is large-scale, cross-sector coordination with a common agenda, shared measurement/accountability, mutually reinforcing activities, continuous communication and backbone support. 3 Many activities in the community have happened pushing Washoe County towards a more collective impact approach to improving health outcomes outlined in the CHIP. In the first year of implementation, the community has seen the development of the Family Health Festivals, a Medicaid Referral Pilot program to increase access and better coordination to primary care between Renown Health, the Community Health Alliance and Northern Nevada HOPES, and a project to increase coordination of care for Children in Transition (CIT) with community programs such as Communities in Schools, the Family Resource Centers and the CIT program at Washoe County School District. The community has also seen a leveraging of resources and agreement on mutually reinforcing activities such as the C4C CANs. A shared vision to address local health issues contributing to poor health outcomes in Washoe County has been established. The community has identified a common agenda around the four health priorities: Access to healthcare and social services, behavioral health, education (K-12), and food security. Sixty-six objectives have been established to begin the structure of shared measurement. Evaluating and reporting on the first year of implementation has also established a system of accountability and transparency for the community. Many of the strategies within the CHIP were identified as mutually reinforcing activities to gain traction on the associated performance measures and this plan has greatly increased communication lines between organizations to break out of silos and begin the pathways of true collective impact and collaboration as demonstrated through many CHIP 3 Kania, J. & Kramer, M. (2011). Collective impact. Stanford social innovation review, Page 11 of 59

12 related working groups. Lastly, the Washoe County Health District, Renown Health and Truckee Meadows Healthy Communities have stepped in to provide all leading agencies a backbone of support through staff time, funding, and strategic planning. The foundation for collective impact in Washoe County for optimized health of its citizens has been set. Page 12 of 59

13 Introduction This is the annual report for a triennium Community Health Imporvement Plan (CHIP) and this is the first year of implementation. The Washoe County CHIP provides a framework for community partners to improve the health and well-being of residents in Washoe County by taking into account our community's unique circumstances. 2 The activities and collaborative efforts of the Washoe County Health District, Truckee Meadows Healthy Communities, and community partners are reflected in this report. This document serves as a progress review of strategies decided upon by the CHIP Steering Committee, CHIP working groups, and approved by the Washoe County Board of Health. Although the CHIP is a community-driven and collectively owned health improvement plan, the Washoe County Health District is charged with providing backbone support to include administrative support, tracking and collecting data, evaluation and reporting of strategic objectives. Overview The Community Health Improvement Plan (CHIP) was developed to address local health issues that are contributing to or causing poor health in Washoe County. The CHIP is a living document and will be updated annually as new information, needs, gaps, resources and emergent issues are identified. The process of assessing, prioritizing and planning to address the needs of the community was facilitated by a CHIP Steering Committee. Community members, partners, the Washoe County Health District and the CHIP Steering Committee, based on the results of a Community Health Needs Assessment, identified four priority health issues: Access to Healthcare and Social Services, Behavioral Health, Education (K-12), and Food Security. 2 Goals, objectives, strategies, timelines and lead organizations were then put into a supplemental action plan based on 99 community member interviews, 34 community partner surveys, 20 key informant interviews, and nine community workgroups. 2 This action plan consists of 65 different objectives addressing the four priorities in the highest need zip codes of Washoe County (i.e , 89502, 19512, 89431, 89433), with most efforts piloted in the zip code. Priorities and goals are identified below: ❶ Priority Access to Healthcare and Social Services Goal 1. Improve access to healthcare and social services for individuals on Medicaid and Medicare, and for those who are underinsured or uninsured. 2. Improve coordination of care in Washoe County across healthcare settings, social services, individual providers, and the community. Page 13 of 59

14 ❷ ❸ ❹ Behavioral Health Education (K-12) Food Security 1. Improve access to behavioral health services for individuals on Medicaid and Medicare, and for those who are underinsured or uninsured. 2. Create a healthier environment for Washoe County youth. 3. Protect the health and safety of Washoe County youth through the reduction of substance use and abuse. 1. Improve health outcomes of Washoe County youth through educational attainment. 2. Support student health, wellness and achievement through nutritious eating habits and physical activity. 1. Implement programs that address the immediate need for food and promote long-term health and food security in households and communities. 2. Enhance home-delivered meal programs to seniors to keep on pace with the rising senior population. How to Read this Report Both strategies and objectives (performance measures) are color coded to easily assess the progress towards respective targets. Find the key below: Indicates significant progress, in that the measurement has met or surpassed the target goal. Indicates ongoing activities or progress toward goals. Indicates little to no progress has been made toward this initiative. No color indicates data is not available yet. Page 14 of 59

15 A ccess to Healthcare and Social Services Since the inception of the Affordable Care Act (ACA) in 2012, public health and health systems have strived for the Triple Aim: Improved access, affordability and quality healthcare. 4 Since the passage of ACA, the numbers of uninsured residents in Washoe County has decreased dramatically; however, as an unintended consequence, there has been a shortage of available practitioners, especially the number of practitioners who accept Medicaid. As of 2016, 79,575 (18%) Washoe County residents were enrolled in Medicaid 5 and as of 2013, onethird of residents live in a primary care or dental care provider shortage area. 6,7 All residents in Washoe County live in a mental health provider shortage area. 6,7 ❶ As a result, the Community Health Improvement Plan (CHIP) Steering Committee identified access to health care and social services as a top priority for the community. This includes improving access to healthcare and social services for individuals on Medicaid and Medicare, as well as those who are underinsured and uninsured. This involves improving coordination of care in Washoe County across healthcare settings, social services, individual providers, and the community. 2 In order to make movement toward the goals of the action plan, the community agreed upon five overarching strategies: Create a Washoe County community health hub of direct and social services offered to the public quarterly. CHIP Access to Healthcare & Social Services Objective Status, % 10% 0% Met/Exceeded Target Did Not Meet Target 70% Progress Toward Target No Data Increase expansion of community health centers and health care extenders so more people have access to a primary care provider. Increase the number of adults who receive a high school diploma or equivalent (this was identified by community members as a root cause of not being able to afford or have access to health insurance). Increase transportation access through the Regional Transportation Commission (RTC). 4 Department of Health and Human Services (2015). The affordable care act is working. Retrieved from: 5 Nevada Division of Health Care Finance and Policy. (2017). Nevada Department of Health and Human Services. 6 University of Nevada School of Medicine. (2015). County health profiles in Nevada: Washoe County. Office of Statewide Initiatives. Retrieved from: 7 Kerwin, H. (2014). Washoe County community health needs assessment. Washoe County Health District, Renown Health, and Truckee Meadows Healthy Communities. Retrieved from: Page 15 of 59

16 Increase coordination of care through a centralized referral resource. There are 13 strategies implemented by 10 leading community organizations to make movement on 10 performance measures/objectives. Progress: Access to Healthcare and Social Services This priority has seen the most progress as 70% of the objectives have been met and 85% of the strategies are currently meeting or exceeding their targets. In 2015, 75.4% of Washoe County residents had a usual primary care provider, which is a 7.3% percentage point increase from This could be largely due to the opening of or expansion of the Community Health Alliance and Northern Nevada HOPES, the development of a Family Health Festival to connect individuals to care, and/or expanding transportation services through the Regional Transportation Commission (RTC). There are many efforts in the community to increase access to health care and social services and improve coordination of care. Objective 1.1 and 1.2 Creating a Community Health Hub in Washoe County Family Health Festivals In partnership with Truckee Meadows Healthy Communities, a Family Health Festival committee was formed. The Family Health 3,607 Clients served in Average of 33 vendors attended each event 54%-77% of clients were Hispanic/Latino Festival is a consortium of health and social services that bring community members and local organizations together to improve quality of life in the Truckee Meadows. The mission of the Family Health Festival is to connect the community to local resources through direct onsite services, thereby improving community health and well-being. This committee sought to develop a community hub of direct services spanning education and social services to health care. To abide by the model of collective impact, this group chose to keep their focus on the zip code of Washoe County. In total, seven Family Health Festivals have been implemented since the summer of 2015, four of which were in Objective 1.3 Increasing the Number of Washoe County Residents Who Have a Usual Primary Care Provider Community Health Alliance The Community Health Alliance (CHA) is a community health center who provides preventive medicine, dental services, behavioral health, women s health, immunizations, WIC and nutrition counseling. 8 Two new Community Health Alliance (CHA) centers have opened in the last year. The Center for Complex Care (CCC), located at 330 Crampton St. Reno, NV opened up September of Additionally, The Sparks Health Center 8 Community Health Alliance. (2016) Retrieved from Page 16 of 59

17 located at 2244 Oddie Blvd. Sparks, NV opened up August of Community Health Alliance s newest location in Sparks has two primary care providers. In addition, they have hired a parttime Licensed Clinical Social Worker (LCSW) and WIC program staff. They anticipate expanding to three primary care providers at the Sparks location by the end of the first quarter in They also will be opening a family dental practice in January They have three operatories that will allow a full-time dentist and part-time hygienist to see patients. Many of their patients live within a four block radius of the new health center. Women s Health Care - Community Health Alliance (CHA) provides breast and cervical cancer screenings and routine gynecological care for women. They have financial support from Susan G. Komen in Northern Nevada for breast cancer screening, diagnosis and treatment support and a partnership with the Renown Pregnancy Center for prenatal care and deliveries. They also provide an array of birth control options for women including long-acting reversible contraceptive (LARC) methods. Their 340B pharmacy provides uninsured women access to birth control at very low cost. From November 2015 to October 2016: 3,968 women screened for breast cancer 2,639 women referred for mammograms 5,200 women screened for cervical cancer 3,342 women receiving Pap smears Chronic Disease Management - Patients are screened for chronic disease(s) such as hypertension, diabetes, heart disease risk, cancer and other behavioral health conditions. Patients identified as at risk or with a chronic condition are put on evidence-based treatment plans and monitored for improvement. Community Health Alliance is meeting or exceeding Healthy People 2020 goals for a number of preventive measures. Patients in need of more intensive chronic disease management can be referred to the CCC on Crampton Street. The CCC is dedicated to improving patients health and their health care experience. Through a patient-centered, team-based approach, their compassionate health care team is devoted to meeting the complex needs of patients with chronic conditions. A team including a primary care provider, licensed clinical social worker, care coordinator, clinical pharmacist, psychiatric nurse practitioner and medical assistant work together to improve the patient s overall health and wellness. From November 2015 to October 2016: 76% of hypertensives are under control 2,114 patients with diabetes have a control rate of 72% 1,000+ patients are being served by the CCC teams Women, Infants and Children (WIC) Services - The Special Supplemental Nutrition Program for WIC provides supplemental foods, health care referrals, and nutrition education for lowincome pregnant and postpartum women and to infants and children up to age five who are found to be at nutritional risk. A family of four with an income of $44,000 per year can qualify for the program. They also provide car seats, cribs, discounted dental care, and farmer s market coupons to WIC clients. The CHA WIC Program operates in seven locations in Washoe County including one mobile site (Ronald McDonald Care Mobile). Five free cooking classes were offered through collaboration between Washoe County WIC, State WIC and CUBE at Midtown. They implemented the Baby Page 17 of 59

18 Behavior education program in August 2016 and set up a new WIC location at the Renown Pregnancy Center. The CHA WIC also collaborated with Northern Nevada HOPES to provide WIC services to their patients. They partnered with Farm Fresh for Kids and issued $24 vouchers to those participating in cooking classes. In October 2016, CHA WIC started a bedside enrollment program at Renown Labor and Delivery for pregnant women. From November 2015 to October 2016: 18,532 client appointments serving 4,831 unduplicated clients 28 families participated in cooking classes Labs/X-ray - All CHA locations have in-house lab services including Hemoglobin A1C, urine microalbumin, pregnancy testing, hemoccult, rapid strep, blood sugar, blood lead levels, HIV testing and blood glucose testing. Services are on a sliding fee discount program as part of their all-inclusive medical appointments. Complex lab testing is available through an agreement with Quest Diagnostics for uninsured patients. Routine x-rays are provided to uninsured patients through an agreement with Reno Diagnostic Center. Dental Services - The Wells Family Dental Center offers preventive and restorative oral health care for the entire family. They accept Medicaid, Nevada Check-Up and many private insurances. They offer dental services on a sliding scale to eligible patients, based upon their income and household size. Services include routine cleanings, restorative dentistry, extractions, root canals, sealants, varnishes, x- rays, caps/crowns, and partial dentures. The children s mobile dental services are located at ten convenient locations in Washoe County. In 2016, the Adult Mobile Outreach (AMO) services were started at the Renown Pregnancy Center and the Washoe County Senior Center. The Sparks dental clinic opened January From November 2015 to October 2016: 6,374 services provided to patients (unduplicated) from November 2015 to October fluoride varnishes to children during oral health education classes Northern Nevada HOPES Northern Nevada HOPES (NNHOPES) is a nonprofit community health center in downtown Reno, NV that offers integrated medical care and wellness services. Their growing list of services includes adult and pediatric primary care, chronic disease management, wellness and nutrition, behavioral health counseling, substance use counseling, case management, a pharmacy, and more. 9 Northern Nevada HOPES opened a new 37,400 square foot wellness center February 1, This new center expanded to include full pediatric, x-ray and behavioral health services. In a seven month period (February 1, 2016 to October 31, 2016), NNHOPES has seen 6,594 unique patients. This is a 36% increase from 2015 (a full calendar year). Sanford Center Geriatric Clinic After a two-year collaborative planning process engaging a wide range of University of Nevada, Reno (UNR) faculty and community partners, the Sanford Center for Aging launched the Sanford Center Geriatric Specialty Clinic (SCGC) in November 2015, and now offers a new set of geriatric clinical services to serve elders in Northern Nevada. The clinical model 9 Northern Nevada HOPES. (2016) Retrieved from Page 18 of 59

19 represents a collaborative, interdisciplinary approach to geriatric services. After referral from a primary care provider, each client visits with the SCGC team for three to four hours, meeting with a geriatrician, geriatric social worker, geriatric pharmacist, medical assistant and research assistant. This includes a comprehensive geriatric medical assessment, medication therapy management review, psychosocial risk assessment, life-story review and end-of-life care planning. The team then works together with the client to develop a comprehensive plan of care with specific recommendations for referrals to a range of community-based social services and additional medical services. It is a truly innovative and comprehensive approach intended specifically to meet the needs of elders across Northern Nevada. In its first full year of operations, the clinic served 236 elders, with plans to ramp up to an annual volume of 600 clients. In addition to the core comprehensive, interdisciplinary geriatric assessment model, they are also launching multiple other services within the SCGC to support community elders, including chronic care management/care coordination, dementia care management, end-of-life care planning, a frailty clinic and a behavioral health clinic. Regional Emergency Medical Services Authority The Regional Emergency Medical Service Authority (REMSA) is a private, nonprofit emergency service provider. They provide all paramedic ground ambulance services within Washoe County with the exception of the areas served by the Gerlach Volunteer Fire Department and the North Lake Tahoe Fire Protection District. REMSA provides community health programs, Tactical Emergency Medical Support (TEMS), dispatch, and medical and emergency coverage at special events. 10 In 2016, REMSA wrapped up a four year, $9.8 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services (CMS). Desired outcomes were to achieve the Triple Aim: 1) Improving population health, 2) Improving quality of healthcare, and 3) Reduce per-capita costs. 11 REMSA redesigned its 911 emergency medical services system to create new care and referral pathways for callers with low acuity medical emergencies and 63,866 Nurse Health Line calls 28,476 Unique participants 6,202 ED visits avoided $9.66 million Estimated savings (avgerage payments) for hospitalized patients with exacerbations of chronic conditions who need post discharge support. This was achieved through the implementation of a Nurse Health Line, Community Paramedicine, and Ambulance Transport Alternatives. 12 Nurse Health Line Nurse Navigators provide 24/7 assessment, triage and referral to health care and community services via a non- 10 REMSA. (n.d.) REMSA fact sheet. 11 U.S. Department of Health & Human Services. (2014). Strategic plan: FY Retrieved from: 12 Centers for Medicare & Medicaid Services. (2016). Health care innovation awards: Nevada. Retrieved from: Awards/Nevada.html. Page 19 of 59

20 emergency number available to Northern Nevada residents (launched October 2013). 13 4,414 Emergency Department (ED) visits avoided 635 ambulance transports avoided 1.5% NHL to transfer rate 63,866 total calls (approx. 2,000/month) $5,750,889 (avg. payments) estimated cost savings Community Paramedicine Specially trained Community Paramedics perform in-home delegated tasks to improve the transition from hospital to home. This includes point-of-care lab tests and improving care plan adherence (launched June 2013). 8 1,438 alternative transports $1,841,689 (avg. payments) estimated cost savings Success of incorporating these services into the community has inspired Renown Health to sustain programming now that grant funding for this program has ceased. Objective 1.4 Increasing the Number of Non-High School Graduate Adults who Receive their Adult High School Diploma Rise Academy for Adult Achievement RISE Academy for Adult Achievement focuses on supporting adults in the Washoe County area to achieve an Adult High School 104 readmissions avoided 350 ED visits avoided 258 ambulance transports avoided 1,524 enrolled patients $2,070,576 (avg. payments) estimated cost savings 150 Awarded Adult High School Diplomas 1,165 Total participants Ambulance Transport Alternatives Following an advanced assessment in the field, paramedics provide alternative pathways of care for patients, including transport of patients with low acuity medical conditions to urgent care centers and clinics, transport of inebriated patients directly to the detoxification center, and transport of psychiatric patients directly to a mental health hospital (launched December 2012). 10 1,438 ED visits avoided 131 ambulance transports avoided 4.7% repatriation rate 13 REMSA. (2016). Preliminary outcomes: Executive Summary. Diploma, improve their English literacy, and/or to obtain a High School Equivalency (HSE). RISE offers six programs: 1) Adult High School Diploma, 2) Distance Education (to receive credits towards an adult high school diploma), 3) High School Equivalency (HSE) Test Preparation Courses and Testing, 4) English Language Learner Program for adults wanting to improve their English skills, 5) Adult Basic Education for adults needing to improve their literacy and numeracy skills, and 6) High School Proficiency Exam Test Preparation Courses and Testing. RISE is the only adult education organization in Washoe County who can issue an Adult High School Diploma. Their goal for Page 20 of 59

21 was to issue 150 Adult High School Diploma s and 100 HSEs. In , a total of 150 Adult High School diplomas were awarded in Washoe County with 1,165 participants. In addition, RISE issued a total of 89 HSEs. 14 Objective Increasing Transportation Services Regional Transportation Commission The Regional Transportation Commission (RTC) provides transit services including RTC Ride (public transit bus system), RTC intercity (transit between Reno and Carson City), RTC access (door-to-door paratransit service for eligible disabled individuals), RTC Sierra Spirit (downtown to UNR transit), and the Tahoe Area Regional Transit (TART). 15 For Federal Fiscal Year ending September 30, 2016, transportation services through the Federal 5310 Program were expanded to non-profit service providers including Access to Healthcare Network, CitiCare, Seniors in Service, Senior Outreach Services and the Sierra Nevada Transportation Coalition. This service was utilized by 2,092 people. In FY 2015 the following changes to eligibility for the Washoe Senior Ride ( Taxi Bucks ) program were implemented: 1) reduced the age requirement to 60 and over; 2) increased the annual household income to less than $45,000; 3) decreased the cost of a $20.00 booklet to $10.00; and 4) opened the program 14 Nevada Department of Education, Office of Career Readiness, Adult Learning, & Education Options - Adult High School Reporting System. 15 Regional Transportation Commission. (2016). Public transportations and operations: Program overview. Retrieved from: to Veterans of any age meeting the household income criteria. Washoe Senior Ride (WSR) is a program of discount vouchers ( Taxi Bucks ) that can be used to pay part of taxi fares and tips. Over the last year the program has grown approximately 30%. As of November 2016, there were more than 4,700 registrants on the Washoe Senior Ride Taxi Bucks program. Objective Improving Coordination of Care Strategic Plan Nevada is part of a nationwide network of call centers that provides information and referral services to Nevada residents. Available information includes basic human services, physical and mental health resources, employment support services, programs for children, youth and families, support for seniors and persons with disabilities, volunteer opportunities, and support for community crisis and disaster recovery. Nevada is available 24 hours a day, seven days a week, and information is available in multiple languages. 16 During the first two quarters of 2016, a statewide committee met on a monthly basis to develop the Nevada Strategic Plan for Representatives from Washoe County, Clark County, and State employees all served on the committee. The plan includes statewide feedback, a strong program structure, strategic financing, and a framework for action. Financial Guidance Center, a nonprofit organization operating since 1972, has held the contract with the State of Nevada since July 1, 2015 to operate Nevada Nevada (2016). Retrieved from: Page 21 of 59

22 Based on the recent strategic planning sessions, Financial Guidance Center has worked to: Move forward with Accreditation for Information and Referral Services (AIRS), which will lend additional credibility and strength to the Nevada system. Financial Guidance Center expects Nevada to complete the accreditation process within the next 2-3 years. Ensure viable resources within the Nevada system by eliminating those providers who no longer exist, and updating information for those providers still in operation. In an effort to update more than 1,800 providers within the system, Financial Guidance Center hired outreach workers to go door to door and visit providers. These outreach workers continue to visit providers and make regular telephone calls to ensure all information within the Nevada system stays current and viable to consumers. Redesign the Nevada website to be more user friendly to both consumers and service providers. Create social media campaigns targeting millennials in northern Nevada, and has aspirations to extend marketing to the senior population in southern Nevada in the near future. Develop a Disaster Strategic Plan to ensure Nevada continues to have the capacity to offer information and referral services to the public during times of disaster when call volumes increase dramatically. System and Nevada Juvenile Justice system in an effort to increase reporting among youth to prevent emotional distress (i.e., bullying) and violent behavior (i.e., school shootings). Models of Community Engagement Truckee Meadows Healthy Communities After the January 2015 Truckee Meadows Healthy Communities (TMHC) conference, a subcommittee was formed to address health access issues in the zip code. This subcommittee was comprised of TMHC Steering Committee members, as well as, members from various healthcare and social service agencies. The goal of this subcommittee was to engage healthcare and social service organizations to explore models that would allow individual organizations to operate out of one facility; thereby, improving access of services to underserved populations. One location discussed was Reno Town Mall since multiple organizations already reside within this building including Access to Health Care Network and Job Connect. In addition, the Division of Welfare and Policy is located directly behind the mall. One short-term goal of this committee was implemented: The Family Health Festival has held two events within the Reno Town Mall: October 19, 2016 and January 25, These events increased the knowledge of, and access to, healthcare and social service organizations in Washoe County. Develop additional partnerships, such as new partnerships with the Nevada School Page 22 of 59

23 Access to Healthcare and Social Services: How Did We Measure Up? Objective 1: Improve access to healthcare and social services for individuals on Medicaid and Medicare, and those who are underinsured or uninsured. Status CHIP Objectives Performance Measure Baseline 2014/2015 Status 2015/2016 Target 2016/ Provide Family Health Festivals to at-risk communities in Washoe County. # of FHFs provided to atrisk communities per year 2/year 4/year 4/year Develop a Family Health Festival Strategic Plan # of Strategic Plans Increase the percentage of Washoe County residents who have a usual primary care provider. % of WC residents who have a usual primary care provider % (2014) 75.4% (2015) 71.5% (2018) 7.3% 1.4 Increase the number of non-high school graduate adults who receive their Adult High School Diploma. 1.5 There will be zero ADA paratransit trip refusals in Washoe County within the Regional Transportation Commission paratransit service area. # of non-graduate high school adults in Washoe County who receive their Adult High School Diploma 14 # of ADA paratransit trip refusals w/in RTC paratransit service area (2018) 0 (2016) 26.0% = Recommended for Removal 1.6 There will be zero ADA paratransit trip refusals in Washoe County outside of the Regional Transportation Commission paratransit service area. # of ADA paratransit trip refusals outside of RTC paratransit service area TBD - 0 (2016) - 17 Nevada Division of Public and Behavioral Health (2016). Office of Public Health Informatics and Epidemiology Nevada Behavior Risk Factor Surveillance Survey (BRFSS): Washoe County Analysis. Page 23 of 59

24 1.7 Increase the number of trips provided by private/not-forprofit organizations for seniors, disabled, and low income residents for medical and social service needs. 1.8 Increase the number of reduced-rate or other discounted transit trips provided for seniors, disabled, and low income residents in Washoe County (taxi bucks, RTC ACCESS tickets, etc). # of trips provided # of reduced-rate or other discounted transit trips 9,086 (2015) Funded by CitiCare 2,481 (2015) 15,708 (2016) 3,068 (2016) FFY17 22,564 FFY18 = 22,564 Total = 45,128 FY17 = 3,091 FY18 = 3, % 23.7% Objective 2: Improve coordination of care in Washoe County across healthcare settings, social services, individual providers, and the community. Status CHIP Objectives Performance Measure Baseline 2015 Status 2016 Target Develop a strategic plan to restructure and improve Nevada Explore models for engagement of assistance providers in underserved communities. # of Strategic Plans Exploration of models Notes: Objective 1.4 The 2018 target has been changed from 4000 to 200 by recommendation of RISE Academy for Adult Achievement. Objective The Regional Transportation Commission (RTC) recommended objective be removed. Page 24 of 59

25 B ehavioral Health There is emerging evidence that positive mental health is associated with improved health outcomes. 18 There have been very little resources devoted to the protection of mental health as opposed to the screening, diagnosis and treatment of mental illness. Researchers suggest focusing efforts on key indicators of mental health which include emotional wellbeing (perceived satisfaction and happiness), psychological well-being (self-acceptance and personal growth) and social well-being (social acceptance and sense of community). 18 In addition, emphasis should be placed on social determinants of mental health such as adequate housing, safe neighborhoods, equitable jobs and wages, quality education and equity in access to quality healthcare. 18 In 2014, Washoe County s mental and behavioral related death rates (141.5 per 100,000) are higher than the Nevada average (129.3 per 100,000). 19 As reported by Avatar, the electronic medical record system used by the Division of Public and Behavioral Health (DPBH) clinics, from 2010 to 2014, 11,751 Washoe County residents received mental health services from the Northern Nevada Adult Mental Health Services (NNAMHS). 19 The most common mental health diagnosis for Washoe County residents include mood disorder NOS (Not Otherwise Between There were a total of 103,128 ED visits related to mental health and substance use in Washoe County Specified), followed by psychotic disorder. In addition, in the top ten includes depressive disorder (NOS) (39%), posttraumatic stress disorder (8%), schizoaffective disorder (8%), polysubstance dependence (6%), major depressive disorder, moderate (4%), undifferentiated type schizophrenia (4%) and bipolar disorder NOS (3%). 19 Between 2009 and 2014, there were a total of 103,128 emergency department (ED) visits related to mental health and substance use disorders among Washoe County residents. Of those visits, 70,363 were ED visits, 41.4% were visits related to alcohol-related issues, 28.5% were drug-related diagnoses, and 4.6% were related to suicide attempts. 11 Anxiety disorder prevailed as the most common mental disorder seen in the ED accounting for 45% of the ED visits. This is an increase of 321% from 2009 to Of Washoe County residents who received substance abuse treatment services from a Substance Abuse Prevention and Treatment Agency (SAPTA) provider in 2014, the most common admissions were for alcohol (37%) followed by amphetamines/methamphetamines (30%), marijuana (16%), and heroin (9%). 19 Self-pay accounted for 25% of sources of payment for ER visits followed by Medicare (18%) and Medicaid (14%). 19 ❷ 18 CDC. (2017). Mental health basics. Retrieved from 19 Lucas, A. (2016). Washoe County behavioral health summary. Office of Public Health Informatics and Epidemiology. Division of Public and Behavioral Health. Department of Health and Human Services. Retrieved from: Page 25 of 59

26 When it comes to youth, if behavioral health needs are not identified, they are more likely to have difficulties in school including higher rates of suspensions, expulsions, dropouts, truancy, and lower grades. Nationally, 50% of students age 14 and older who are living with a mental illness drop out of high school. 19 According to 2015 Washoe County Youth Risk Behavioral Survey data, 33.5% of high school students felt sad or hopeless, 18.8% considered attempting suicide, and 11.7% attempted suicide. In addition, 20.8% of Washoe County high school students were bullied on school property and 9.0% missed school because they felt unsafe on their way to or from school. 20 The Community Health Needs Assessment (CHNA) reported the biggest challenges Washoe County faces in regard to mental and behavioral health are lack of resources and access to appropriate care. The Community Health Improvement Plan (CHIP) Steering Committee identified three goals for this priority: Goal 3: Improve access to behavioral health services for individuals on Medicaid and Medicare, and for those who are underinsured or uninsured. Goal 4: Create a healthier environment for Washoe County youth. CHIP Behavioral Health Objective Status, % 9% 9% Met/Exceeded Target Did Not Meet Target 63% Progress Toward Target No Data Goal 5: Protect the health and safety of Washoe County youth through the reduction of substance use and abuse. There are 21 strategies implemented by 20 partners within this priority to make movement on 32 performance measures/objectives. Progress: Behavioral Health This is the second priority to have the most progress in the last year with 63% of the objectives being met and 71% of the strategies meeting or exceeding their target. This could be largely due to substance abuse prevention programming targeting youth and young adults, as well as anti-bullying legislation being passed in Positive steps have been taken in Washoe County to include screening tools to assess mental health early before it transpires to mental illness. It is still unclear, however, how the mental health community and primary care providers are working together to improve mental health and reduce episodes of severe mental illness. 20 Lensch, T., Gay, C., Zhang, F., Clements-Nolle, K., Yang, W. University of Nevada, Reno Nevada High School Youth Risk Behavior Survey (YRBS): Washoe County Analysis. Page 26 of 59

27 Objective Increase the proportion of adults who receive treatment for mental illness, major depression, and/or substance abuse Community Health Alliance The Community Health Alliance (CHA) is a community health center that not only provides primary care, but also provides women s healthcare, chronic disease management, behavioral health, WIC (Women, Infants, and Children), labs/x-rays, and dental care. Behavioral Health - The Community Health Alliance (CHA) provides behavioral health care integrated with their primary care services. Their providers screen clients for mental health and substance abuse issues, and help patients receive a mental health evaluation, diagnosis, and therapy, as well as, traditional case management services. CHA works with the University of Nevada, Reno, (UNR) Department of Psychology to provide services on site in their health centers in conjunction with their own onsite Clinical Psychologist and Licensed Clinical Social Workers (LCSWs). They are also working with UNR psychology undergraduate s career building opportunities by serving as behavioral health assistants to licensed professionals. Northern Nevada HOPES Northern Nevada HOPES (NNHOPES) is a nonprofit community health center in downtown Reno, NV that offers integrated medical care and wellness services. Their growing list of services includes adult and pediatric primary care, chronic disease management, wellness and nutrition, behavioral health counseling, substance use counseling, case management, a pharmacy, and more. 21 NNHOPES offers counseling that includes individual and couple s therapy, as well as substance use counseling. They practice harm reduction, which involves meeting patients where they are at and developing a holistic treatment plan based on a patient s specific goals. 21 UNR School of Medicine, Department of Psychiatry In October 2015, the new Behavioral Health Patient Care Center opened at 5190 Neil Road in Reno, NV. They offer a full spectrum of comprehensive mental health and counseling services for children and adults. Although the center has allowed the expansion of clinic hours and faculty to increase fellowships for students pursuing the field of clinical mental health, the center expressed this organization will not be a good indicator of expanding mental health services and treatment to Washoe County residents. Barriers to increasing mental health services to adults in Washoe County include long wait lists, provider shortages, Medicaid reimbursement structure for the seriously mentally ill and the closing of Mojave Mental Health. Mojave Mental Health provides wrap around mental health services for individuals who are on Medicaid and Medicare plans. Closing of this facility could have detrimental effects to Washoe County residents, will provide further stress on government run mental health facilities which are already facing resource shortages and increased burden to the area s emergency departments. 21 Northern Nevada HOPES. (2016) Retrieved from Page 27 of 59

28 Crossroads Crossroads is a housing program that opened in 2011 in partnership between three primary organizations: Washoe County Department of Social Services, Catholic Charities of Northern Nevada, and the Washoe County Sherriff s Department. The Sherriff s Department provides direct referrals from the jail upon release, Social Services provides social workers and eligibility certification specialists to the program and Catholic Charities provides property for operations. Crossroads provides wrap-around social services including drug and alcohol counseling, employment support, volunteer-work opportunities, and other tools to help them establish a new, more productive path in life. They save the community more than $15-$18 million a year in jail bookings, encounters with first responders, emergency room/hospital costs, ongoing jail costs and treatment expenses. Currently, Crossroads operates 131 supportive transitional housing beds; including 14 crisis intervention beds to relieve stress on local emergency departments. Their goal is to reach 151 transitional housing beds by the end of 2017 and crisis intervention beds. Objective Decrease bullying, suicide and depression among Washoe County youth The number of bullying incidents for K- 12 graders increased 14.4% from the previous year. 22 This may be due to increased reporting as a result of Governor Brian Sandoval signing the anti-bullying bill in 2015, which incorporated amendments to Nevada Revised 22 Washoe County School District. (2016) District accountability report. Office of Accountability. Retrieved from: Statute, Chapter This legislation created the Office of Safe and Respectful Learning within the Nevada Department of Education. It set up a 24-hour hotline to report incidents of bullying and imposed strict requirements on school officials to report and investigate bullying. The law requires same-day notification when a bullying incident is reported, and investigations within 48-hours. It also imposes consequences when parents are not notified. 24 In addition, nearly $16 million was approved for schools to contract with social workers to address bullying prevention and problems. Multi-Tiered Systems of Support Washoe County School District Multi-Tiered System of Supports (MTSS) is a collaborative vision of Positive Behavioral Interventions and Supports along with Response to Intervention. 25 The goal of MTSS is to improve the quality of instruction, prevent unnecessary academic and behavioral failure, provide proven evidence-based interventions for all students, prevent unnecessary referral to special education, prevent rather than react to student difficulties, involve and support partners and parents in the MTSS Process, and to support teachers. The MTSS department utilizes a variety of strategies to prevent unnecessary failure in schools. In addition to strong core instruction to guarantee academic success, WCSD has adopted key components into the MTSS structure to prevent behavioral and academic complications for students. 23 Nevada Revised Statute. Chapter 388 System of Public Instruction. Retrieved from: html. 24 Nevada Legislature. (2015). SB504: Amends provisions relating to a safe and respectful learning environment in public schools. Retrieved from: m?billname=sb504. Page 28 of 59

29 All schools in WCSD are expected to fully implement and sustain MTSS for both behavioral and academic supports for students. Schools have established MTSS teams comprised of teachers, administrators, counselors, and school psychologists who lead this work at the site level. In addition, there are seven external MTSS coaches who provide technical assistance and training at the district level. MTSS teams use data-based decision making to inform academic and behavioral instruction and intervention, which is delivered to students in varying intensities (multiple tiers) based on student need. 27 This need-based decision making helps ensure that school and district resources reach the appropriate students at the appropriate levels. Specifically, the MTSS structure aids in helping schools identify students with mental and/or behavioral health needs and connect them with appropriate resources through the following strategies at each tier: Tier 1: Universal supports and instruction that all students receive. Core instruction with differentiation to meet the needs of most learners is coupled with use of effective classroom behavior strategies, active student engagement, and positive school climate and culture. Tier 2: Students identified as being at-risk behaviorally or academically are provided additional resources and support. Tier 2 interventions are implemented with small groups of students and interventions are in addition to Tier 1 supports. The interventions are more explicit and intensive than Tier 1 and are designed to serve approximately 10-15% of the total student population. Tier 3: Students who do not meet expected outcomes after receiving Tier 2 intervention and support are given more intense interventions at the Tier 3 level. These interventions are individualized based on data collected in individual problem solving, occur with smaller student-teacher ratios, and possibly occur for a longer duration of time, serving approximately 3-5% of the school s total population. Another support WCSD offers to students, families, and schools is the District Intervention Assistance Team (DIAT). When a school has exhausted all site-based supports to meet the needs of students, staff can access the DIAT to function as a supportive, problemsolving body made up of multiple experts from both the district and community (e.g., social services, juvenile justice, Children s Cabinet, etc.). Through data and other pertinent information provided by site teams, DIAT can deploy additional district and/or community resources to assist in supporting the site team, student(s), and/or family. The DIAT provides a positive and collaborative approach with multiple levels of district administration, departments, and community agencies with the sole intent of providing resources and supports. This is an excellent, efficient way for sites to gain access to a variety of resources (academic, behavioral, social, and financial, etc.) to support the needs of our most intensive, fragile students. Another pillar of support WCSD students have access to at all tiers academically and behaviorally is Social Emotional Learning (SEL), which is also housed in the same department as MTSS. SEL not only supports academic outcomes for students, it also supports community-wide mental and behavioral health through the following strategy: Page 29 of 59

30 Social Emotional Learning is a lifelong process where children and adults acquire knowledge, skills and dispositions related to the five competencies; Self Awareness, Self- Management, Social Awareness, Relationship Skills, and Responsible Decision Making Skills. SEL is rooted in brain research and focuses on starting and ending each day with a consistent, ritualistic pattern that connects teachers and students as well as students with other students. Washoe County School District is focusing on three areas to message this idea through all of its schools; school climate and culture, integration and infusion into existing curriculum, and a direct instructional approach. The MTSS/SEL department s mission is to develop Washoe County School District s (WCSD) capacity to create, support, and sustain school climates that are safe, orderly, predictable, and positive, so as to maximize opportunities for academic, social, and emotional success for all. Current Program Outcomes/Goals: Strengthen schools implementation of multi-tiered system of supports (MTSS), including School-Wide Positive Behavioral Interventions and Support (SWPBIS). To increase the number of schools trained to implement social and emotional learning (SEL). Support WCSD in building an effective system to provide comprehensive assistance to schools in supporting students with significant behavioral concerns. To increase direct support and feedback to schools through coaching and professional learning. Progress measures Currently, the MTSS Department uses the Self-Assessment of MTSS Implementation (SAM) to assist schools in measuring current progress and setting goals to improve their MTSS structure. This is a required measurement in the school year and will be used by school-level MTSS teams and their coaches to identify growth opportunities. The Tiered Fidelity Inventory (TFI) is being used to measure current progress in School- Wide Positive Behavioral Interventions and Support (SWPBIS) and to assist teams and coaches in the identification of growth opportunities. Safe and Healthy Schools Commission Washoe County School District The Safe and Healthy Schools Commission was created by the Board of Trustees through Board Policy 9036 (June 2014) and revised later in Board Policy 9156 (October 2016). The Commission is an advisory committee to the Board of Trustees and provide recommendations on issues related to the safety and security of schools by reviewing national models and standards of practice that support student learning through a healthy school environment. 25 The School Safety Advocacy Council, as part of the Consultant for Safe and Healthy School Initiative, conduct a School District-wide evaluation gathering data from parent forums, staff interviews, staff focus groups, school safety assessments, document and MOU 25 Washoe County School District. (2017). Safe and healthy schools commission. Retrieved from: Page 30 of 59

31 reviews, and climate survey analyses. 26 This report then provides recommendations to the School District on how to enhance school security. The School District then must factor logistical, economic and political factors to implement recommendations. 26 The Safe and Healthy Schools Commission is responsible for selecting which recommendations make the most sense for the School District and present this information to the Board of Trustees for final approval. The District-wide safety audit report was presented to the Safe and Healthy Schools Commission on February 13, 2017 and the Board of Trustees on February 14, 2017 for the school year. The Commission will then conduct in-depth reviews of the recommendations from the audit and will state which recommendations they support to the Board of Trustees. Bully Prevention Family Health Festivals Washoe County School District (WCSD) School Counseling program offered anti-bullying prevention education at the Family Health Festivals in In 2016, the WCSD continued its support at the FHF to include Parent University classes and Safe Routes to School information for both parents and youth. In addition, WCSD Volunteer Services provided resources/volunteers to help at the event. 13) or high-school (ages 13 17) students. The goals are to 1) decrease suicide and suicide attempts by increasing student knowledge and adaptive attitudes about depression, 2) encourage personal help-seeking and/or helpseeking on behalf of a friend, 3) reduce the stigma of mental illness and acknowledge the importance of seeking help or treatment, 4) engage parents and school staff as partners in prevention through gatekeeper education, and 5) encourage schools to develop community-based partnerships to support student mental health. The Children s Cabinet is the primary agency to deliver this program in the community. From July 1, 2015 to June 30, 2016, they reached a total of 1,377 high school youth (ages 12-17), which is above and beyond the goal of 150 youth. 27 Adverse Childhood Experiences Adverse childhood experiences (ACEs) are stressful and/or traumatic events that can occur in a child s life which Signs of Suicide Prevention Program The Signs of Suicide Prevention Program (SOS) is a universal, school-based depression awareness and suicide prevention program designed for middle-school (ages 11 may include abuse, neglect, and/or growing up with family members who have substance abuse disorders. Research has shown that ACEs are strongly related to the development of 26 Washoe County School District. (2016). Executive Summary: Consultant for Safe and Healthy Schools Initiatives. School Safety Advocacy Council. 27 Data and narrative provided by Join Together Northern Nevada (JTNN). Page 31 of 59

32 adverse health effects throughout a person s lifespan. Preventing ACEs and engaging in early identification of people who have experienced ACEs can aid in the treatment and/or prevention of many health conditions. 28 Recommendations for prevention include collecting county level ACEs data, increasing awareness among community level substance misuse prevention professionals, including ACEs among the primary risk and protective factors when engaging in prevention planning efforts, selecting and implementing programs, policies and strategies designed to address ACEs and using data to identify groups at higher risk such as those with substance abuse disorders for targeted interventions. 28 The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente developed an 11 question screening tool to help professionals determine an ACEs score. The higher the score, the more likely the individual will have adverse health repercussions later in life. 29 In 2015, as a result of a juvenile justice youth study in Washoe and Clark Counties, ACEs measures were embedded into the 2015 high school Youth Risk Behavior Surveillance System (YRBS). The ACEs measures will be embedded in the high school and middle school YRBS in A full ACEs report will be available from the University of Nevada, Reno in In 28 Substance Abuse and Mental Health Services Administration. (2016). Adverse childhood experiences. Center for the Application of Prevention Technologies. Retrieved from: 29 Felitti, V.J., Anda, R.F., Nordenberg, D, et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), Gay, C., Gao, P., Lensch, T., Zhang, F., Baxa, A., Larson, S., Clements-Nolle, K., Yang, W. State of Nevada, Division of Public addition, the full ACEs module has been added to the Behavioral Risk Factor Surveillance System (BRFSS) since In addition, Individuals within the Washoe County School District have been trained to use the Child and Adolescent Needs and Strengths Screener (CANS) as a tool to assess in-depth family/child strengths and mental health needs. The CANS tool includes an ACEs screener. The goal is to screen all seventh graders in two years. Objective Decrease substance use and abuse among youth Parenting Wisely Washoe County School District s Family Resource Centers Parenting Wisely is a family skills training program that has been found to reduce family conflict and combat the risk factors associated with substance use and abuse. Parenting Wisely works to improve social competencies and school performance. Child maltreatment also decreases as parents build confidence, strengthen bonds with their children and learn more effective parenting skills. The Washoe County School District Family Resource Centers implement this program. From July 1, 2015 through June 30, 2016, this program reached a total of 121 parents. This exceeded the goal of reaching 75 parents in Washoe County. 27 and Behavioral Health and the University of Nevada, Reno Nevada High School Youth Risk Behavior Survey (YRBS): Adverse Childhood Experiences (ACEs) Analysis. Retrieved from: Reports/2015-NV-HS-Adverse-Childhood-Experiences-ACEs- Analysis.pdf. Page 32 of 59

33 Project Towards No Drug Abuse The Children s Cabinet Reconnecting Youth is a school-based prevention program for middle school and high school youth who have factors that identify them as at-risk for school dropout, drug involvement, anger/aggression, depression and/or suicidal behavior. The goal is to help youth build coping skills and competencies, increase time spent in healthy activities, and enhance social support resources. The intended outcomes are to increase school achievement, increase drug use control, and decrease suicide risk behaviors. The Children s Cabinet will be implementing this program. Planning for this program began July 1, 2016 and activities are still being developed and awaiting implementation. The goal will be to administer this program to a total of 100 high school youth in Washoe County. 27 Big Brothers Big Sisters Mentoring Program The Big Brothers Big Sisters Mentoring Program is designed to help participating youth ages 6-18 ( Littles ) reach their potential through supported matches with adult volunteer mentors ages 18 and older ( Bigs ). Research shows that these relationships are able to drive youth to be academically, social and emotionally ready to pursue higher education and avoid risky behaviors like using drugs, alcohol and violence. From July 1, 2015 through June 30, 2016, this program reached a total 47 youth, ages five through eleven. The goal was to reach 50 youth in Washoe County. 27 Positive Action - ACCEPT Positive Action is a systematic educational program that promotes an intrinsic interest in learning and encourages cooperation among students. It works by teaching and reinforcing the intuitive philosophy that you feel good about yourself when you do positive actions. The effects of the program range from increased academic achievement to dramatic reductions in problem behaviors. ACCEPT implements the nine to twelve week curriculum with the Grade Five Education Supplement curriculum for fourth and fifth graders. They have implemented this program since The current program is funded through Join Together Northern Nevada (JTNN). Funding dependent, they offer the program two to four times per year. They implement it at the Greater Light Christian Center and two to three times at the Washoe County School District within their After School Team-Up program. From July 1, 2015 to June 30, 2016, this program reached a total of 75 youth, ages five to eleven. This exceeded the goal of reaching 50 youth in Washoe County. Smart Moves and Smart Kids The Boys and Girls Club of Truckee Meadows Smart Moves and Smart Kids is a prevention program for teens ages thirteen through eighteen, SMART Leaders is a booster program for youth who have successfully completed the SMART Moves series. SMART Leaders includes topics like improving selfimage, learning to cope with stress, resisting media pressures and being assertive in pressure situations. The Boys and Girls Club of the Truckee Meadows implements this program. From July 1, 2015 through June 30, 2016, this program Page 33 of 59

34 reached a total of 1,192 youth, ages five through fourteen. This exceeded the goal of reaching 550 youth in Washoe County. Promoting Alternative Thinking Strategies Washoe County School District The Promoting Alternative Thinking Strategies Program (PATHS) is designed to enhance areas of social-emotional development such as self-control, self-esteem, emotional awareness, social skills, friendships, and interpersonal problem-solving skills, while reducing aggression and other behavior problems as well as substance abuse. The program places primary importance on the developmental integration of affect, behavior, and cognitive understanding as they relate to social and emotion competence. The Washoe County School District (WCSD) administered PATHS to 3,846 youth, ages five to eleven from July 1, 2015 through June 30, This exceeded the goal of reaching 2,000 youth in Washoe County. 27 Teen Intervene Quest Counseling Teen Intervene is a brief, early intervention program for ages twelve through nineteen who display the early stages of alcohol or drug involvement. Integrating stages of change theory, motivational enhancement, and cognitive-behavioral therapy, the intervention aims to help teens reduce and ultimately eliminate their substance use. The program is typically administered in an outpatient, school, or juvenile detention setting by a trained professional in three 1-hour sessions conducted 10 days apart. During session one, an individual session with the adolescent, the therapist elicits information about the adolescent's substance use and related consequences, examines the costs and benefits of the substance use, and helps the adolescent set goals of behavior change, including goals to reduce or eliminate substance use. In session two, the therapist assesses the adolescent's progress, discusses strategies for overcoming barriers, and negotiates the adolescent's continued work toward meeting goals. Session three is an individual counseling session with the teenager's parent (or guardian); this session addresses parent-child communication and discipline practices, and specific ways for the parent to support the child's goals. The third session also includes a brief wrap-up conversation with the parent and adolescent. Quest Counseling implemented this program to 14 youth, ages from July 1, 2015 through June 30, This was below the target of 30 youth in Washoe County. 27 Alcohol Wise University of Nevada, Reno Alcohol-Wise is typically used for incoming first-year students to reduce risks for freshmen and positively impact campus culture. When implemented effectively, the course educates students about the harmful effects of alcohol, raises retention rates, and acts as a prevention tool for future alcohol-related violations. Alcohol-Wise is tailored for each user. Students receive personalized feedback and access to self-referral tools, as well as pre- and post-course assessments to provide measurements of behavior change and knowledge gained. The course clarifies personal choices about drinking habits and attitudes, and how alcohol can affect academic progress and social behavior. Page 34 of 59

35 The University of Nevada, Reno (UNR) reached a total of 2,984 UNR college students through this program from July 1, 2015 through June 30, This was just shy of the 3,200 UNR college student goal. 27 Brief Alcohol Screening and Intervention for College Students University of Nevada, Reno The Brief Alcohol Screening & Intervention of College Students (BASICS) program is designed to assist students who violate the university standards for possession or consumption of alcohol. The program offers two one-on-one sessions with a trained alcohol counselor/educator. In these sessions, students receive information and develop skills to assist them in making choices related to the use of alcohol that support safety and student success. Between the time period of July 1, 2015 through June 30, 2016, UNR reached a total of 205 UNR college students with this program. This was slightly below the goal of reaching 300 UNR college students. 27 Page 35 of 59

36 Behavioral Health: How Did We Measure Up? Objective 3: Improve access to behavioral health services for individuals on Medicaid and Medicare, and for those who are underinsured or uninsured. Status CHIP Objectives Performance Measure Baseline 2015 Status 2016 Target Increase the proportion of adults aged 18 years and older with serious mental illness who receive treatment. % of WC adults with SMI who receive treatment TBD TBD 72.3% 3.2 Increase the proportion of adults aged 18 years and older with major depressive episodes who receive treatment. 3.3 Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders. % of WC adults with MDEs who receive treatment % of WC residents who receive treatment for both substance abuse and mental disorders Objective 4: Create a healthier environment for Washoe County youth. TBD TBD 75.9% TBD TBD 3.6% Status CHIP Objectives Performance Measure Baseline 2013/2015 Status 2015/2016 Target Decrease the number of K-12 bullying incidents within the Washoe County School District. # of K-12 WCSD bullying incidents 450 (2015) % reduction 14.4% 4.1.a Decrease the percentage of Washoe County high school students who are bullied on school property. % of WC high school students who are bullied on school property 21.7% (2013) 20.8% 19.5% 0.9% 4.1.b Decrease the percentage of Washoe County high school students who are electronically bullied. % of WC high school students who are electronically bullied 16.9% (2013) 16.8% 15.2% 0.1% 4.2 Decrease the percentage of Washoe County high school students who miss school because they feel unsafe at school or % of WC high students missing school because they 14.9% (2013) 9.0% 13.4% 5.9% Page 36 of 59

37 on their way to or from school. 4.3 Decrease the percentage of Washoe County high school students who feel sad or hopeless. 4.4 Decrease the percentage of high school students who seriously consider attempting suicide. 4.5 Decrease the percentage of high school students attempting suicide. feel unsafe % of WC high school students feeling sad or hopeless % of high school students seriously considering suicide % of attempted suicides by high school students 34.0% (2013) 21.0% (2013) 14.0% (2013) 33.5% 30.6% 0.5% 18.8% 18.9% 2.2% 11.7% 12.6% 2.3% Objective 5: Protect the health and safety of Washoe County youth through the reduction of substance use and abuse. Status CHIP Objectives Performance Measure Baseline 2013 Status 2015 Target 2017 WASHOE COUNTY HIGH SCHOOL STUDENTS 5.1 Decrease the percentage of Washoe County high school students who currently drink alcohol. 5.2 Decrease the percentage of Washoe County high school students who recently participated in binge drinking. 5.3 Decrease the percentage of high school students who drank alcohol for the first time before age 13 years. 5.7 Decrease the percentage of Washoe County high school students who ever used marijuana. 5.8 Decrease the percentage of Washoe County high school students who tried marijuana for the first time before age 13 years. 5.9 Decrease the percentage of Washoe County high school students who currently use marijuana. % WC high school students who currently drink alcohol % of WC high school students participating in binge drinking % of WC high school students who drank alcohol for the first time before age 13 years % of WC high school students who have ever used marijuana % of WC high school students who tried marijuana for the first time before age 13 years % of WC high school students who currently use 36.5% 35.5% 34.7% 1.0% 23.3% 19.3% 22.1% 4.0% 23.2% 18.3% 22.0% 4.9% 29.2% 45.2% 46.7% 4.0% 13.7% 13.2% 13.0% 0.5% 28.2% 24.6% 26.8% 3.6% Page 37 of 59

38 5.11 Decrease the percentage of Washoe County high school students who ever used methamphetamines Decrease the percentage of Washoe County high school students who ever used cocaine Decrease the percentage of Washoe County high school students who ever used inhalants Decrease the percentage of Washoe County high school students who ever used heroin Decrease the percentage of Washoe County high school students who ever used ecstasy Decrease the percentage of Washoe County high school students who ever took prescription drugs without a doctor's prescription Decrease the percentage of Washoe County high school students who were offered, sold, or given an illegal drug by someone on school property Decrease the percentage of Washoe County high school students who drove a vehicle when they had been drinking alcohol Decrease the percentage of Washoe County high school students who rode in a vehicle by someone who had been drinking alcohol. marijuana % of WC high school students who have ever used meth % of WC high school students who have ever used cocaine % of WC high school students who have ever used inhalants % of WC high school students who have ever used heroin % of WC high school students who have ever used ecstasy % of WC high school students who ever took prescription drugs w/o a Dr.'s prescription % of WC high school students who were offered, sold, or given an illegal drug by someone on school property % of WC high school students who drove a vehicle when they had been drinking alcohol % of WC high school students who rode in a vehicle driven by someone 6.7% 4.8% 6.4% 1.9% 11.3% 9.2% 10.7% 2.1% 11.5% 8.0% 10.9% 3.5% 4.6% 3.5% 4.4% 1.1% 16.2% 10.5% 15.4% 5.7% 21.9% 18.3% 20.8% 3.6% 33.1% 27.9% 31.4% 5.2% 11.7% 8.2% 11.1% 3.5% 24.6% 22.1% 23.4% 2.5% Page 38 of 59

39 who had been drinking UNIVERSITY OF NEVADA, RENO STUDENTS Status CHIP Objectives Performance Measure Baseline 2012 Status 2016 Target Decrease the percentage of University of Nevada, Reno students who drank alcohol in the last 30 days. 5.5 Decrease the percentage of University of Nevada, Reno students who recently participated in binge drinking. 5.6 Decrease the average number of drinks consumed by University of Nevada, Reno students on last drinking occasion Decrease the percentage of University of Nevada, Reno students used marijuana in the last 30 days Decrease the percentage of University of Nevada, Reno students who took prescription painkillers without a doctor's prescription in the last 12-months Decrease the percentage of University of Nevada, Reno students who took prescription sedatives without a doctor's prescription in the last 12-months Decrease the percentage of University of Nevada, Reno students who took prescription stimulants without a doctor's prescription in the last 12-months. % of UNR students who drank alcohol in the last 30 days % of UNR students participating in binge drinking # of drinks consumed by UNR students on last drinking occasion % of UNR who used marijuana in the last 30 days % of UNR students who took prescription painkillers w/o Dr.'s prescription in the last 12-months % of UNR students who took prescription sedatives w/o a Dr.'s prescription in the last 12-months % of UNR students who took prescription stimulants w/o Dr.'s prescription in the last 12-months 65.3% 59.9% 62.0% 5.4% 29.7% 34.8% 30.5% 5.1% % 19.9% 40.0% 1.6% 11.0% 5.6% 10.5% 5.4% 5.3% 2.9% 5.0% 2.4% 6.7% 6.1% 6.4% 0.6% Page 39 of 59

40 Notes: Many substance abuse prevention programs are funded by Join Together Northern Nevada (JTNN). Programs include Parenting Wisely, Project Towards No Drug Abuse, The Big Brothers Big Sisters Mentoring Program, Positive Action, Smart Moves and Smart Kids, Promoting Alternative Thinking Strategies (PATHS), Teen Intervene and Alcohol-Wise. Some of these programs may not be funded in the next year due to budgetary restraints. Objective % increase is likely due to enhanced reporting and baseline data may have been under-reported. Objectives Adult mental health objective data is currently unavailable. last time they partied. Baseline (2012) was inaccurate and has been changed from 32.1% to 29.7%. Objective 5.6 This number is the mean/average number of drinks students reported. It is lower despite the increase in five or more drinks because fewer students reported having six or more drinks. Objective Objective has been changed to reflect the number of students who have used marijuana in the last 30- days. Changing the verbiage of this indicator to more accurately reflect marijuana use has also changed the 2012 baseline measure from 42.1% to 18.3%. Objective 5.4 Objective has been reflected to indicate the number of students who report any use within the last 30 days Objectives The objective narrative has been changed to reflect use in the last 12-months. Objective 5.5 Objective has been changed to reflect the number of students who report having five or more drinks the Page 40 of 59

41 E ducation (K-12) Education is one of the strongest predictors of health. There is a direct relationship between educational attainment and employment opportunity, which strongly predicts income which can then lead to better housing, safer neighborhoods, healthier food, health insurance and better healthcare. 31 Prior studies have suggested mechanisms influencing educational attainment can be correlated to risk behaviors such as substance use and low physical activity, as well as, psychosocial stressors of stressful life events (e.g. lack of housing, income and food security), CHIP Education Objective and lack of access to health care. 32 Education Status, 2016 could be considered the cure to reduce burden of illness, delay the consequences of aging, 17% decrease risky behavior, and shrink disparities in health. 33 High school completion can be a useful 33% performance measure when assessing a community s health. In addition, a strong predictor of high school completion is a child s reading 39% 11% proficiency by the end of grade three. 34 Best practices to improve high school graduation rates include developing an overarching Met/Exceeded Target Progress Toward Target strategic vision and systemic problem-solving; Did Not Meet Target No Data identifying at-risk students early and supporting them with targeted interventions before they fall behind; creating a personalized set of supports for students by creating career academies; routine monitoring and tracking of student performance and engagement; developing transitional programs as kids progress through their education, and helping students become college ready. 35 The Community Health Needs Assessment (CHNA) reported the biggest challenges Washoe County youth face in regard to education (K-12) are mental health and wellness. The Community Health Improvement Plan (CHIP) Steering Committee identified two goals for this priority: ❸ Goal 6: Improve health outcomes of Washoe County youth through educational attainment. Goal 7: Support student health, wellness and achievement through nutritious eating habits and physical activity. 31 Adler, N. E., & Newman, K. (2002). At the intersection of health, health care and policy. Health Affairs, 21(2), Lee, J.O, Kosterman, R., Jones, T.M., et al. (2016). Mechanisms linking high school graduation to health disparities in young adulthood: a longitudinal analysis of the role of health behaviors, psychosocial stressors, and health insurance. Public Health 139, Freudenberg, N. (2007). Reframing school dropout as a public health issue. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 4(4), Fiester, L. (2010). Learning to read: Early warning! Why reading by the end of third grade matters. A Kids Count special report. Annie E. Casey Foundation. Retrieved from: 35 Hanover Research. (2013). Best practices in raising high school graduation rates. Retrieved from: Page 41 of 59

42 There are 11 strategies implemented by eight partners within this priority to make movement on 18 performance measures/objectives. Progress: Education (K-12) Although only 17% of the objectives have been met for this priority overall, 64% of the strategies have been met. Washoe County graduation rates have seen a 2% percentage point increase from the previous school year putting the graduation rate at 76.9%. Washoe County seems to be on a clear pathway to reach their goal of 90 by 20, which is 90% graduation rate by the year Objective Increase the High School Graduation Rates and Preparation for Higher Education 36 Education Alliance The Education Alliance is a community Partnership with programs that support academic achievement and workforce development for pre-school to college students. Their mission is to foster educational excellence and student achievement in Washoe County through leadership, advocacy, and resource development. They work with many diverse state, city, community, civic, industry, and business groups in support of education. 37 Programs include: Kids in Motion and Passport Programs Kids in Motion (KIM) is a program that provides funding to elementary schools for physical education and nutrition initiatives. The Passport Program provides funding for higher education programs connecting to area high schools. Funding for these programs is from sponsorships of the Run for Education and grants Washoe County School District. (2015). Envision WCSD 2020: Investing in our future. Strategic plan. Retrieved from: 37 Education Alliance of Washoe County (2016). About us. Retrieved from: P-16 Advocacy Council The purpose of this Council is to advocate for a seamless education system that helps all students successfully achieve their career and life goals. This Council is made of members from the community, businesses, education and government. They evaluate Washoe County School District s data and monitor national trends and best practices and propose initiatives for application in Washoe County School District and Nevada. 37 Partners in Education The Partners in Education program engages business, industry, government, and the community to establish partnerships and advocate resources for Washoe County schools. Partners provide volunteer time, expertise, financial or in-kind support, internships, and/or allow students to tour their place of business. 37 Total new Partners in Education in is 25 and total Partners in Education overall is 240. Principal/Executive for a Day In partnership with the WCSD, the annual Principal/Executive for a Day experience is designed to educate local community and business leaders about the work of principals in the WCSD elementary, middle, and high schools an dis a one-day Page 42 of 59

43 opportunity for educators to share ideas and establish relationships with decisionmakers outside of education. 37 In 2016, a total of 76 businesses, community and government leaders participated at 71 schools. Run for Education This annual family and community event raises funds for elementary schools for physical education/nutrition and programs for secondary student success. The run includes timed competitive 5K/10K race, an untimed Sparks Marina March and a ½ Mile Fun Run. This run is hosted by the Education Alliance Board and coordinated by a county-wide group of educators, volunteers, business representatives, community leaders, and government officials. 37 In 2016, there were more than 3,800 runners, 2,800 of whom were students from 80 schools. To date, $1.6 million has been raised for physical and academic fitness. The 2017 Run for Education is scheduled for Sunday, October 22 nd at Scheels at the Sparks Marina. Teachers Warehouse The Teachers Warehouse is located at 380 Edison Way in Reno and accepts donations of office supplies, paper products, seasonal goods, arts and crafts, furniture, teacher aids, books, and usable items year round. This warehouse is available to educators in the WCSD to shop free of charge to enhance learing in the classroom. 37 provide cultural and educational opportunities to students and families in the WCSD. Now in its third year ( ), this program now serves nine schools in the WCSD and connect schools, nonprofits, and community organizations to increase access to external educational resources. Communities in Schools Communities in Schools (CIS) removes non-academic obstacles from the path of students so they are able to learn and succeed. They do this by working with the schools to conduct a needs assessment, embedding fulltime site coordinators at the schools and working with the schools to create school-wide plans, as well as, a plan for each student. They believe every child needs and deserves a oneon-one relationship with a caring adult, a safe place to learn and grow, a healthy start and a healthy future, a marketable skill to use upon graduation, and a chance to give back to peers and the community. They offer Tier 1 (schoolwide), Tier 2 (small groups), and Tier 3 (one-onone case management) services to the entire school. 38 Communities in Schools of Western Nevada was established in 2014 and currently serve.s five Washoe County schools: Libby Booth Elementary, Natchez Elementary, Vaughn Middle, Hug High, and Innovations High schools. They are a nine member staff which includes an Executive Director, an Associate Director, and seven Site Coordinators. Redfield Community Outreach Program 2,800 students served Introduced in school year , and through the generosity of the Nell J. Redfield Foundation, the mission of the Redfield Community Outreach Program is to 216 case-managed students 795 basic needs provided 38 Communities in Schools of Western Nevada. (2016) Retrieved from: Page 43 of 59

44 392 academic sessions provided 2,141 case management and behavioral interventions provided 314 family engagement/life and social skills provided 82% graduation rate among CIS students in Washoe County Read by Grade Three Washoe County School District Senate Bill No. (SB) 391 (March 2015) provides provisions governing educational instruction in the subject of reading, requires the board of trustees at each school district and the governing body of each charter school to prepare a plan to improve the literacy of pupils enrolled in certain grades. It also requires the principal of each public elementary school to designate a learning strategist to train and assist teachers in providing intensive instruction to students who have been identified as deficient in the subject area of reading. This law also requires certain teachers at public schools to complete professional development concerning the area of reading. SB391 requires certain interventions for pupils enrolled in kindergarten or grade one, two or three who do not achieve adequate proficiency in reading. 39 In August 2016, the Washoe County School District (WCSD) published their Literacy Plan (K-3) for Each WCSD elementary school, and its five charter schools, has designated learning strategists (LS) either a classroom teacher or an Implementation 39 Nevada Legislature. (2015). Senate bill 391: Revises provisions governing educational instruction in the subject of reading. Retrieved from: m?billname=sb Washoe County School District. (2016). Literacy plan K-3. Retrieved from: Specialist who receive and provide the required Nevada Department of Education (NDE) teacher professional development at their elementary school. Washoe County School District s RBG3 grant provides professional development to all 62 LS and five charter school LS. The grant also provides principal professional development in what to look for in best-practices for early literacy instruction and intervention instruction; reading intervention materials; and training in how to use assessments and analyze student data. Another major focus of WCSD s RBG3 grant centers on parent notification which includes home visits, parent-teacher conferences, short videos on how parents can support reading at home, and other informational materials for parents which can be found on the District s Read By Grade Three website Other duties of the LS include implementation of the Nevada State and Washoe County literacy plans. Under SB391, this year s kindergarteners must be reading at grade level by the time they reach end of third grade, or they could potentially be held back. There are a number of good cause exemptions under SB 391 which may apply to students who are not reading at grade level. The focus of WCSD s RBG3 grant is on this year s kindergartners to ensure students who may not be proficient in reading have interventions in place. As well, the grant is geared toward developing comprehensive K-4 teacher professional development in best practices for early-literacy instruction and interventions. This will ensure a teacher workforce which is highlyskilled in early-literacy instructional strategies and student data assessment. Page 44 of 59

45 The Nevada Department of Education requires a final report which is expected in late summer or early fall, United Way of Northern Nevada and the Sierra United Way of Northern Nevada and the Sierra (UWNNS) is a local nonprofit organization that engages the community and develops long lasting change to improve peoples lives and build stronger communities in northern Nevada and the Lake Tahoe Basin. By partnering with businesses, individuals, government and other nonprofits, they are able to monitor the needs of our community and respond quickly as issues or opportunities arise. 41 Currently, UWNNS has a goal to double the number of children in northern Nevada who read proficiently at the conclusion of third grade by In order to achieve the goal of increasing the number of children in northern Nevada who read at grade level by 3rd grade before 2020, the United Way of Northern Nevada and the Sierra partnered with four organizations to achieve movement in three key program areas: Early learning and development, kindergarten readiness and early literacy and early grade success. Partnership: Nature s Transformers led by Sierra Nevada Journeys Nature s Transformers is a partnership between Sierra Nevada Journeys, Nevada Outdoor School, Great Basin Institute, and the Desert Research Institute s Green Power program. This program includes 41 United Way of Northern Nevada and the Sierra. (2016). About UWNNS. Retrieved from: 42 United Way of Northern Nevada and the Sierra. (2016). Our mission, vision, goals. Retrieved from: classroom learning, field study, a literacy kit and book to take home to continue with parental involvement. In , 2,448 parents and children participated in the program and 1,406 new books were provided for the home library. Students were given pre- and post- tests gauging science-based literacy. Their assessment scores increased from 32% to 78% upon completion of the program. 43 Partnership: Building Blocks to Literacy led by Wells Family Resource Center Building Blocks to Literacy prepares children with the fundamentals needed to be school ready. In addition, preschool teachers are provided professional development to enhance their social-emotional classroom skills using the TACSEI model (Technical Assistance Center on Social Emotional Intervention). A total of 295 teachers were reached in the region. Additionally, through this program there is an emphasis on library usage. In , 236 new library cards were issued as a result of these efforts. The program was attended by 1,008 participants, and 339 books were distributed to attendees. 43 Partnership: Boys and Girls Club Reads led by Boys and Girls Club of the Truckee Meadows The Boys and Girls Club of the Truckee Meadows, Northern Lake Tahoe, Western Nevada, Mason Valley and Elko partnered to offer Boys and Girls Club Reads. This includes group reading, individual reading, an online curriculum, afterschool tutoring, summer learning loss prevention programs, 43 United Way of Northern Nevada and the Sierra (2017) Annual report. Retrieved from: Web. Page 45 of 59

46 library partnerships and parental engagement. In , 1,463 parents and children were served by the partnership across the region. A pre- and post- test is administered to students. Only 47% of participants were reading at grade level before they entered the program and 78% were reading at grade level after the program. 43 Partnership: Family Reading Program led by the Northern Nevada Literacy Council The Family Reading program is a partnership between the Northern Nevada Literacy Council, Job Opportunities in Nevada (JOIN), UNR Cooperative Extension, Nevada RSVP, Seniors in Service, Lemelson Academy, Sierra Nevada Journeys, Churchill County Library and Grassroots Books. This program engages parents, grandparents and children to build foundational skills for nurturing ongoing literacy. This program served Reno, Sparks, Incline, Elko, West Wendover, Jackpot, Wells, Carson City and Fallon. The program was attended by 1,042 participants and 968 books were distributed. 43 United Way of Northern Nevada and the Sierra are in the process of developing with partnering organizations on a Community Solutions Action Plan Framework (CSAP) to address reading levels by the end of grade three. This CSAP will be available in Objective Increase Physical Activity, Proper Nutrition and Wellness Among Washoe County Youth Wellness Advisory Committee - Washoe County School District The Student Wellness Advisory Committee has been established to assess the District s needs and develop a wellness administrative regulation that meets the operational realities of the school district and works toward improved health and wellness outcomes for students. This group is tasked with the development, review, and update of the local school wellness administrative regulation as needs change, goals are met, new information emerges, and the annual review is completed. This group will also serve an advisory function to the Washoe County School District (WCSD) Board of Trustees in areas of student health and wellness. 44 The State of Nevada requires local educational agencies (school districts) to form an advisory committee dedicated to student wellness and therefore, this thirteen member committee was established by the WCSD February 18, 2015 when they held their first meeting. This committee supports the Superintendent and the Board of Trustees in creating a school environment that promotes sound nutritional practices, physical activity, standardized healthy food choices, nutritional education, and other school-based activities that promote student health and wellbeing. 45 The Washoe County School District s Board of Trustees adopted the Washoe County School Wellness Policy (Administrative Regulation 5600: Student Wellness) April 18, This policy established the procedures and protocols related to the student wellness and nutrition in the WCSD, ensuring compliance with state and federal laws and regulations. This policy establishes goals for nutrition promotion 44 Washoe County School District. (2016). Student wellness advisory committee. Retrieved from: 45 Washoe County School District. (2016). Student wellness advisory committee: Bylaws. Retrieved from: y/domain/630/wellness/wellness%20bylaws%20v1.pdf. Page 46 of 59

47 and education, physical activity, and other school-based activities that promote student wellness. 46 In addition, the WCSD identified Andria Hanski as their Student Wellness Specialist in August 2016 to facilitate implementation of the Student Wellness Policy. District wellness reporting is completed each spring and results are posted on the website The report for the school year is currently available for each school district, including Washoe County. Data collected includes reports from schools on meeting each of the three wellness goals and compliance with various components of the student wellness policy. In year one of the wellness policy and reporting, the majority of schools reported compliance with the 15/16 wellness goals. Ninety seven percent (96.6%) of schools reported educating the public and parents about the school wellness policy. Eighty three percent (82.5%) reported formalizing P.E. and wellness instruction. Sixty percent (60.3%) reported establishing wellness coordinators at each school site. Nutrition Services Department Washoe County School District The Nutrition Services Department (NSD) at the Washoe County School District s mission is to utilize exceptional customer service to provide access to nutritious, appealing, high quality meals to every student in a healthy and safe environment, while maintaining fiscal responsibility. This 46 Washoe County School District. (2016). Washoe County school wellness policy: Administration regulation 5600 student wellness. Retrieved from: y/domain/69/5600_reg-student_wellness-v1.pdf. department administers child nutrition programs in 95 sites throughout Washoe County School District. The department runs a central Production Facility, and a food warehouse and distribution facility. The department provides breakfast and/or lunch in all school cafeterias as well as charter schools. 47 Provision 2 Schools require that the school serve meals to participating children at no charge but reduces application burdens to once every four years and simplifies meal counting and claiming procedures by allowing a school to receive meal reimbursement based on claiming percentages. Additional 4-year extensions to Provision 2 are possible when certain conditions are met. Districts determine which schools are eligible for Provision 2 status. The determination is made by reviewing the number of students eligible for free and reduced price benefits and the cost of feeding all children at the school site at no charge. USDA recommends that at least 80% of the children be eligible for free and reduce price meal benefits in order to break even for a Provision 2 schools. 48 In the school year, there were a total of 41 Title 1 schools and 24 of those schools had a Provision 2 status. Girls on the Run Sierras - Renown Health Girls on the Run is a positive youth development program that instills self-esteem in girls through health education, life skills development, mentoring relationships and 47 Washoe County School District. (2016). Welcome to nutrition services. Retrieved from: 48 Washoe County School District. (2016). Welcome to nutrition services. Retrieved from: Page 47 of 59

48 physical training. Sessions are led by trained volunteer coaches who serve as positive adult female role models. The 30-hour program meets after school twice a week for 90 minutes. The program culminates in a celebratory, noncompetitive 5K fun run. Completing the 5K teaches girls about goal setting and builds their self-confidence. 49 The Girls of the Run program uses an evidence-based curriculum to inspire girls to become independent thinkers, enhance their problem-solving skills and encourages them to make healthy decisions. August 2015, Renown Health announced a $225,000 Community Impact grant to incorporate Girls on the Run into third through eighth grades of the Washoe County School District as part of Renown s annual community benefit. Funds were used to hire a full-time program director, a part-time coordinator and resources to implement the program. Funds were committed for a three year period (through 2018). 50 The goal is to reach a total of 16 new schools and 500 young girls in Washoe County annually by the summer of To-date (halfway point of the grant), a total of 27 schools (11 new) have participated with a total of 617 Washoe County girls (290 in and 327 in fall 2016). Of those schools, 11 are Title 1 schools. Wolf Pack Coaches Challenge Washoe County Health District The Wolf Pack Coaches Challenge is a voluntary program for elementary school classrooms that promote the increased opportunities for physical activity, incorporating the Smart Snack Standards, and provides lesson plan that align with Common Core Curriculum, Next Generation Science Standards, as well as Social Emotional Learning without over-burdening teachers. 51 Elementary school classrooms and students participate over four consecutive weeks to earn points for prizes by eating fruits and veggies both in and out of school, participating in one-minute Brain Breaks during class time, involving combined learning and moving activities and spending 15 minutes engaged in physical activity both in and out of school. Prizes are awarded to all participants and winning classrooms and teachers are awarded Wolf Pack football game tickets for signing up. This program is implemented by the Chronic Disease Prevention Program at the Washoe County Health District. The original pilot for this program was August 15, 2016 through December 16, 2016, but has since been expanded through February 24, To-date, 37 elementary school classrooms have signed up serving a total of 729 students. The percentage of students who increased physical activity or nutritious eating as a result of the program will not be tabulated until the end of February Girls on the run sierras. (2016). Retrieved from: 50 Renown Health, Community Benefits. (2015). $225,000 Committed to local Girls on the Run program [Press release]. Retrieved from: content/uploads/news-release_ committed-to-local- Girls-on-the-Run-Program.pdf 51 Wolf Pack Coaches Challenge (2016). Page 48 of 59

49 Education (K-12): How Did We Measure Up? Objective 6: Improve the health outcomes of Washoe County youth through educational attainment. Status CHIP Objectives Performance Measure Baseline 2015 Status 2016 Target Increase the Washoe County School District graduation rate. 6.1a Increase the Washoe County School District graduation rate for Black/African American students. 6.1b Increase the Washoe County School District graduation rate for Hispanic/Latino students. 6.1c Increase the Washoe County School District graduate rate for Native American/American Indian students. 6.1d Increase the Washoe County School District graduation rate for Children in Transition. 6.1e Increase the Washoe County School District graduation rate for children living in poverty. 6.1f Increase the Washoe County School District graduation rate for students enrolled in Special Education classes. 6.2 Decrease the percentage of Washoe County School District graduates attending Truckee Meadows Community College who require remedial math courses. 6.3 Decrease the percentage of Washoe County School District graduates attending Truckee Meadows Community College who require remedial English courses. 6.4 Decrease the percentage of Washoe County School District graduates attending UNR who require remedial math courses. 6.5 Decrease the percentage of Washoe County School District graduates attending UNR who require remedial English High school graduation rate 75.0% 77.0% 76.9% 2.0% High school graduation rate for B/AA students High school graduation rate for H/L students High school graduation rate for NA/AI students High school graduation rate for Children in Transition High school graduation rate for children living in poverty High school graduation rate for children enrolled in special education classes % of WCSD graduated requiring remedial math courses through TMCC % of WCSD graduated requiring remedial English courses through TMCC % of WCSD graduates requiring remedial math courses through UNR % of WCSD graduates requiring remedial English 66.0% 57.0% 67.7% 9.0% 67.0% 68.0% 68.7% 1.0% 52.0% 66.0% 53.3% 14.0% 53.0% 42.0% 54.3% 11.0% 65.0% 66.0% 66.5% 1.0% 30.0% 31.0% 45.0% 1.0% Page 49 of 59

50 courses. courses through UNR Objective 7: Support student health, wellness and achievement through nutritious eating habits and physical activity. Status CHIP Objectives Performance Measure Baseline Status Target The Washoe County School District will adopt a Student Wellness Policy that meets state and federal requirements for nutrition and physical activity. 7.2 Increase the percentage of Title 1 schools with Provision 2 or Community Eligibility status. 7.3 Increase the number of Title 1 schools with Girls on the Run programming. 7.3.a Provide the Girls on the Run program to 500 adolescent girls in Washoe County. 7.4 Pilot the UNR Coaches Challenge program in at least 20 elementary school classrooms within Washoe County. 7.4.a Washoe County elementary students who complete Coaches Challenge will report an increase in physical activity. 7.4.b Washoe County elementary students who complete Coaches Challenge will report an increase in nutritious eating. Adoption/Implementation of School Wellness Policy % of Title 1 schools with Provision 2 or community eligible status # of Title 1 schools with Girls on the Run programming # of WC adolescent girls participating in the Girls on the Run program # of WC elementary classrooms piloting Coaches Challenge % increase in physical activity % increase in nutritious eating 0 1/adopted 1/adopted % 58.5% 100% (2020) = Notes: Objective Data not available until February Objective 7.4a-7.4b Data not available until the end of February 2017 Since third grade literacy can be an indicator of graduation rates, it was recommended that a third grade literacy measure be added into future CHIPs. Page 50 of 59

51 F ood Security Food security is defined as having access to enough food to live an active and healthy life. Food insecurity denotes reduced quality, variety or desirability of diet; disrupted eating patterns; or reduced food intake. 52 According to Map the Meal Gap (2014), about 13.7% of the population and 23.8% of children in Washoe County are food insecure. 53 Nearly 26% of children live in households that cannot reliably provide three nutritious meals every day. Among those who are food insecure, nearly one-third do not qualify for federal food programs. Ninety-two percent of people who obtain food through a food assistance program cope with personal food shortages by purchasing inexpensive, unhealthy food. More than half have reported eating food past the expiration date or selling personal property to be able to afford enough food. 54 CHIP Food Security Objective Status, % 17% ❹ The CHIP Steering Committee identified food security as a top priority for the community. This steering committee established two goals for this priority: Goal 8: Implement programs that address the immediate need for food and promote long-term health and food security in households and communities. Goal 9: Enhance home-delivered meal programs to seniors to keep on pace with the rising senior population. 17% Met/Exceeded Target Did Not Meet Target 50% Progress Toward Target No Data There are 10 strategies implemented by five partner groups within this priority to make movement on six performance measures/objectives. Progress: Food Security Strategies & Objectives Although only 17% of the objectives have been met for this priority overall, 30% of the strategies have been met. In addition, this priority has aligned itself with the Collaborating for Communities (C4C) Food Security Community Action Network (CAN) therefore most activities are still largely in progress. It is anticipated this priority will see great strides in the next two years. 52 United States Department of Agriculture. Definitions of Food Security. Last updated September, [Cited October, 2014]. Retrieved from: 53 Feeding America. (2014). Food insecurity in Nevada. Retrieved from: 54 Weinfield NS, Mills G, Borger C, et al. Hunger in America 2014 National Report-Washoe County Excerpts. Westat and the Urban Institute, Washington D.C Data provided by the Food Bank of Northern Nevada. Page 51 of 59

52 Objective Implement programs to reduce the food insecure in Washoe County PhotoVoice Project PhotoVoice can be a powerful tool to help change makers understand the lives and experiences of disadvantaged communities and give a voice to underprivileged individuals. PhotoVoice is a process in which people with limited power due to poverty, language barriers, race, class, ethnicity, gender, culture, or other circumstances can use video and/or photo images to capture their environments and experiences to tell a story. 55 Truckee Meadows Healthy Communities (TMHC) enlisted a group of 17 youth from the Boys and Girls Club to develop a Photovoice project to inform the Collaborating for Communities (C4C) Community Action Networks (CANs) about their experiences with food security, health access, education, employment/income, and housing. Youth were given digital cameras, photography instruction, opportunities to discuss pictures and access to image processing to create a final project presented on April 18, 2016 to community leaders, the Washoe County Health District and the Truckee Meadows Healthy Communities steering committee. Community leaders and TMHC members had the opportunity to listen to the youth share stories of their community through photos and videos. Their presentations brought the realities of their lives home to the public and policy makers to spur change. A documentation of their experience can be viewed on YouTube here: QGk. Pictures can also be viewed on the walls of Washoe County Health District, Building B. Collaborating for Communities Food Security Community Action Network In March of 2015, Feeding America, a nationwide network of food banks, awarded the Food Bank of Northern Nevada a $515,000, three year, planning grant to address food insecurity, housing and income stability. Nevada was one of five states awarded this honor. The purpose was to test a cross-sector, collective impact theory of change for the community s most pressing issues around food security. 56 In 2016, the Annie E. Casey Foundation, Feeding America and the Arnold Foundation sent community members to a 16-month long Results Based Leadership Institute. The purpose was to build a cohesive, well-trained group of leaders with the skills and intention to move work forward in the community. From these opportunities stemmed the Collaborating for Communities (C4C) Food Security Community Action Network (CAN). This group of dedicated partners is comprised of various community stakeholders ranging from the healthcare sector, to public health, to nonprofit community organizations. Together, they hope to develop a pilot program to address food insecurity in census tract seven of the zip code. A plan is currently being developed to potentially increase SNAP and WIC utilization, increase school and Food Bank mobile pantry reach, increase food insecurity 55 Community Tool Box. (2016). Implementing photovoice in your community. Retrieved from: 56 Feed America. (2015). Feeding America Launches New Initiative to End Hunger, Improve Family Stability [Press release]. Retrieved from Page 52 of 59

53 screening protocols, and develop a Food Rx Pilot across area health systems. Once the plan is solidified, an evaluation design and plan for data collection will follow, most likely in the late spring, early summer Intervention implementation is estimated to take place in late Community Garden Plan The creation of new community gardens, grocery stores, farmers markets, as well as changes in land-use regulations and the promotion of locally grown food are popular food-system related strategies to improve positive impacts in a community around food security and sustainability. 57 A working group was developed to address the creation of a Community Garden Plan for Washoe County. This group decided to start small to engage interest in the community around community gardening. A small pilot was implemented as part of the Truckee Meadows Healthy Communities Family Health Festivals in At two of the spring/summer festivals, a container garden booth was established to teach residents of the zip code on how to grow vegetables, herbs and fruits in a small planting container. This proved to be a very successful clinic, averaging approximately 800 participants. Based on further research through key stakeholder interviews, there are several entities in the community engaging in food sustainability and community gardening at some level. It was discussed whether a local food system sustainability plan would be more beneficial to the community. Coordination of 57 Hodgson, K. (2012). Planning for food access and communitybased food systems: A national scan and evaluation of local comprehensive and sustainability plans. American Planning Association. partner efforts for collective impact was also discussed. As a result, a community garden plan has been placed on hold. A local food system assessment will be conducted by students from the University of Nevada, Reno followed with the development of a comprehensive plan to address the needs of the community. 58 Objective 9.1 Enhance home-delivered meal programs to seniors to keep on pace with the rising senior population. Washoe County Senior Services More than five million senior citizens age 60 and older face hunger in the U.S. Seniors tend to face unique medical needs, mobility challenges and often have to operate on a fixed income, which may put them at a greater risk of hunger. 59 Washoe County Senior Services offers two senior nutrition programs: 58 Washoe County Food Policy Council (n.d.). Access to healthy food in Washoe County: A framework for food system design. Retrieved from: 59 Feeding America. (2016). Senior hunger. Retrieved from: Page 53 of 59