Fayette County Community Health Plan

Transcription

1 Fayette County Community Health Plan Administrator Rhonda K. Andrews, BA, MS Fayette County Health Department For Illinois Department of Public Health Springfield, Illinois April 12, 2012 Priorities: Mental Illness Substance Abuse Child Abuse

2 Table of Contents I. Fayette County Health Department 2 II. Mission Statement 3 III. Purpose. 3 IV. Introduction.. 3 V. Methods 5 A. Committee Participation Process.. 5 B. Committee Membership. 5 VI. Results.. 8 A. Priority #1 Mental Illness. 8 B. Priority #2 Substance Abuse.. 16 C. Priority #3 Child Abuse 26 VII. Conclusions 33 1

3 I. FAYETTE COUNTY HEALTH DEPARTMENT The Fayette County Health Department is located in Vandalia, Illinois. In August of 1976 the Fayette County Health Department was established by county board resolution. Since the Health Department's creation, it has been located in three locations; the basement of the courthouse, 509 W. Edwards Street, and currently 416 W. Edwards Street. The Fayette County Health Department is a not-for-profit unit of the local government of Fayette County, Illinois. The Health Department provides numerous services for the citizens of Fayette County. The Fayette County Health Department has a Home Health (visiting nurse) and Hospice program. The Health Department also has an Environmental Health program that provides newly constructed water well inspections and permits, newly constructed septic system inspections and permits, inspections of all food service establishments of Fayette County. The Health Department also has a Family and Clinical Services program that provides childhood and adult immunizations and lead screenings, testing for sexually transmitted diseases, Tuberculosis testing, foot care clinics, health education for teenage pregnancy prevention, diabetes education, medication management, childbirth and breastfeeding specialists, healthy family support workers, doulas, and WIC. The Health Department also maintains a county-wide emergency preparedness program in the event of a county disaster. 2

4 II. MISSION STATEMENT This mission of the Fayette County Health Department is improving the quality of life through healthy lifestyle promotion, disease prevention, compassionate care giving, and environmental protection. III. PURPOSE The purpose of the community health plan was to improve the three priority health problems (mental illness, substance abuse, and child abuse) in Fayette County. In accomplishment of this purpose the IPLAN committee analyzed each problem to determine the risk and contributing factors, created outcome objectives for health problem improvement, and selected intervention strategies. IV. INTRODUCTION The secretary of Health and Human Services released a document in September of 1990 titled Healthy People This publication sought to be a national strategy for significantly improving the health of the nations over the coming decade. This document was the basis for the IPLAN (Illinois Project of Local Assessment of Needs) project, because it provided the statistical foundation for health problem reduction. Since 1990, two updated versions of Healthy People have been released, titled Healthy People 2010 and Healthy People Within these documents are national rates for numerous health problems as well as objectives for health problem reductions. The baselines within these documents as well as those 3

5 statistical data found in IPLAN Data Summary reports, Census Bureau, IDOT, IDOC, ISP, and other sources of information were used for this project. Since the original Healthy People 2000, Illinois has implemented a plan of action for the health of its citizens. This plan of action was described in a publication titled A Road to Better Health for All Illinois Citizens. Contained in this publication are two suggestions for Illinois. 1. Local and statewide needs assessments to identify and describe public health needs. 2. A state health plan related to the national health objectives. These suggestions included a community health needs assessment process for all local health departments. This was the preface and subsequent new rule for local health department certification, hence the IPLAN process. The process identified three priority health problems and developed strategies to reduce these problems within five years. 4

6 V. METHODS A. Community Participation Process The Fayette County Health Department followed the eight recommended steps of the APEX-PH (Assessment Protocol for Excellence in Public Health) model: 1) Prepare for the Community Process. 2) Collect and Analyze Health Data. 3) Form a Community Health Committee. 4) Identify Community Health Problems. 5) Prioritize Community Health Problems. 6) Analyze Community Health Problems. 7) Inventory Community Health Problems. 8) Develop a Community Health Plan. To begin the IPLAN process, all staff was made aware of the process during a staff meeting and subsequent staff newsletters. Previously completed organizations capacity assessments were reviewed by the Administrator. All staff supervisors (6) worked to complete the 2012 Fayette County Health Department, organizational capacity assessment. The Board of Health was made aware of the IPLAN process and organization capacity assessment during board meetings. The board expressed commitment to proceed with the IPLAN process. B. Committee Membership A list of potential committee members was compiled. These persons were solicited by telephone for initial contact. After initial contact, each committee member was sent a letter containing a project summary, dates of meetings, and a 5

7 job description. A committee of nine Fayette County residents was selected. These people represented many diverse backgrounds, ages, and careers. IPLAN Committee 1) Julie Adermann RN, St. Elmo School 2) Kendra Craig Emergency Preparedness Coordinator & Teen Pregnancy Prevention Coordinator, FCHD, Shafter 3) Larry Eason Chief of Police, City of Vandalia 4) Jean Finley County Board member, Health & TB Committee member, retired, former home health patient, Ramsey 5) Glenn Gurtner County Board member, Chairman of the Solid Waste Committee, farmer, Brownstown 6) Pete LeDuc Minister at Crown Point Baptist Church, Shobonier 7) Keith Meadows Safety Officer, City of Vandalia 8) Tauyna Ohnesorge Director of Hospice, FCHD, Vandalia 9) Amy Schaal Infection Control Officer, Fayette County Hospital, Vandalia Fayette County Health Department s Administrator, Rhonda Andrews, served as the chairperson and coordinator for all committee meetings. A total of two committee meetings were held. The first meeting was designated for the community needs assessment and the second for the community health plan. The community needs assessment meeting was held on March 15,

8 The community health plan meeting was held on March 29, All committee meetings were held at the Fayette County Health Department located on 416 West Edwards Street, Vandalia, Illinois. The role of the IPLAN committee was to identify health problems facing Fayette County residents and to differentiate between true health problems and risk factors. Once understood, the group prioritized health problems and ultimately choose three that they felt were the highest priority in Fayette County. After three health problems were identified, the committee discussed available resources to Fayette County residents and also potential barriers. Lastly, the committee decided on outcome objectives and intervention strategies to reduce these problems. 7

9 VI. RESULTS Priority #1 MENTAL ILLNESS Definition According to the Healthy People 2010 Manual in Section 18, mental illness is a term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions characterized by alterations in thinking, mood, or behavior (or some combination thereof) that are all mediated by the brain and associated with distress or impaired functioning or both. Rationale Mental Illness was chosen as a priority health problem based on data according to the Fayette County 10 th Grade Survey and the National Institute of Mental Health. Mental Illness encompassed all forms including but not limited to anxiety disorders (post traumatic stress disorder, obsessive compulsive disorder, panic disorder), phobias, attention deficit disorder, eating disorders (anorexia and bulimia), and mood disorders (major depressive disorder, dysthymic disorder, bipolar disorder), self injury, and suicide. National data from the National Institute of Mental Health (NIMH) was also considered for the selection of mental illness as a priority health problem. Current data from the NIMH reports the following in the US. For the purposes of 8

10 this project, the committee chose to focus efforts on suicide and intentional injury as they relate to depression. Local Baselines 10 TH GRADE FAYETTE COUNTY HEALTHY TEENS SURVEY During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks in row that you stopped doing some usual activities? 32% Have any of your friends ever been emotionally abused by a boyfriend/girlfriend? 53% Have you ever been forced to have sexual intercourse when you did not want to? 13% Have any of your friends ever been physically abused by a boyfriend/girlfriend? 34% Have you ever cut yourself, or hurt yourself in some other way on purpose? 25% During the past 12 months did you ever seriously consider attempting suicide? 19% During the past 12 months, did you actually attempt suicide? 5% Mental Health in the US Anxiety Disorders Includes panic disorder, OCD, PTSD & Phobias. Est. 40 million adults per yr. Frequently occur with depression or substance abuse. Est. 7.2 million. Adults or 1 in 15 suffer from panic disorder. In any given year 1/3 of all adults will have at least 1 panic attack. Attention Deficit Hyperactivity Disorder One of the most common mental disorders in children and adolescents. Est. 4.1 million adults. Eating Disorders Includes anorexia and bulimia. Est..5% to 3.7% of females suffer from anorexia. Est. 1.1% to 4.2% suffer from bulimia. Mood Disorders Includes major depressive disorder, dysthymic disorder, and bipolar disorder. Est. 21 million adults have a mood disorder. Depressive disorders often co-occur with anxiety disorders and substance abuse. Suicide In 2004, 11 per 100,000 persons committed suicide in the US. More than 90% of those persons had a diagnosable mental disorder, most commonly depression. The highest suicide rates are in white males over the age of 85. 4X more men than women die by suicide, but women attempt it 2-3 times more often than men US Population 312,745,538 according to US Census Bureau Source: National Institute of Mental Health 9

11 Healthy People 2020 Objectives 1: Reduce the suicide rate. Target: 10.2 suicides per 100,000. Baseline: 11.3 suicides per 100,000 occurred in Target setting method: 10 percent improvement. Data source: National Vital Statistics System (NVSS), CDC, NCHS. 2: Reduce suicide attempts by adolescents. Target: 1.7 suicide attempts per 100. Baseline: 1.9 suicide attempts per 100 occurred in Target setting method: 10 percent improvement. Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC. 3: Reduce the proportion of adolescents who engage in disordered eating behaviors in an attempt to control their weight. Target: 12.9 percent. Baseline: 14.3 percent of adolescents engaged in disordered eating behaviors in an attempt to control their weight in Target setting method: 10 percent improvement. Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 4: Reduce the proportion of persons who experience major depressive episodes (MDE). MHMD 4.1 Adolescents aged 12 to 17 years. Target: 7.4 percent. Baseline: 8.3 percent of adolescents aged 12 to 17 years experienced a major depressive episode in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health, SAMHSA. MHMD- 4.2 Adults aged 18 years and older. Target: 6.1 percent. Baseline: 6.8 percent of adults aged 18 years and older experienced a major depressive episode in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health, SAMHSA. 5: Increase the proportion of children with mental health problems who receive treatment. Target: 75.8 percent. Baseline: 68.9 percent of children with mental health problems received treatment in Target setting method: 10 percent improvement. Data source: National Health Interview Survey (NHIS), CDC, NCHS. 10

12 6: Increase the proportion of adults with mental disorders who receive treatment. MHMD 9.1 Adults aged 18 years and older with serious mental illness (SMI). Target: 64.6 percent. Baseline: 58.7 percent of adults aged 18 years and older with serious mental illness (SMI) received treatment in Target setting method: 10 percent Improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. MHMD 9.2 Adults aged 18 years and older with major depressive episodes. Target: 75.1 percent. Baseline: 68.3 percent of adults aged 18 years and older with major depressive episodes received treatment in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 7: Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders. Target: 3.3 percent. Baseline: 3.0 percent of persons with co-occurring substance abuse and mental disorders received treatment for both disorders in Target setting method: 10 percent Improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. Target: 2.3 percent. Baseline: 2.1 percent of primary care physician office visits screened for depression in Target setting method: 10 percent improvement. Data source: National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS. 8: Increase depression screening by primary care providers. MHMD 11.1 Increase the proportion of primary care physician office visits that screen adults aged 19 years and older for depression. Target: 2.4 percent. Baseline: 2.2 percent of primary care physician office visits screened adults aged 19 years and older for depression in Target setting method: 10 percent improvement. Data source: National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS. MHMD 11.2 Increase the proportion of primary care physician office visits that screen youth aged 12 to 18 years for depression. 9: Reduce nonfatal intentional self-harm injuries. Target: injuries per 100,000 population. Baseline: emergency department visits for nonfatal intentional self-harm injuries per 100,000 population occurred in 2008 (age adjusted to the year 2000 standard population). 11

13 IVP 16 IVP 17 Target setting method: 10 percent improvement. Data source: National Electronic Injury Surveillance System All Injury Program (NEISS AIP), CDC, NCIPC, US Consumer Product Safety Commission (CPSC). Outcome Objective By 2017, decrease the percentage of Fayette County tenth graders that have attempted suicide to 3%. Baseline: Fayette County 10 th Grade Survey reported 5% have attempted suicide. Impact Objectives 1. By 2015, decrease the percentage of Fayette County tenth graders that have intentionally hurt themselves to no more than 20%. Baseline: Fayette County 10 th Grade Survey reported 25% have intentionally hurt themselves. 2. By 2015, decrease the percentage of Fayette County tenth graders that have felt sad or hopeless almost every day for 2 weeks to no more than 27%. Baseline: Fayette County 10 th Grade Survey reported 32% have felt sad or hopeless almost every day for 2 weeks. 12

14 Risk and Contributing Factor Analysis 13

15 Resources and Barriers 14

16 Intervention Strategies Fayette County Health Department IPLAN Intervention Strategies Health Problem: Mental Illness 1. Educate teachers, coaches, and pastors, to recognize when there is a problem with a child or adult. 2. Assist schools with the creation and adoption of no tolerance policies against bullying, talking back. This is to institute safe environments in schools where kids are all on the same level like Shobonier School. 3. Educate students about low self esteem, making healthy choices, and consequences. 4. Create a homework hangout. 5. Start support groups for mental illness such as ADHD, depression, panic disorders, etc. 6. Work with physicians to see if they will refer patients on medications to support groups. 7. Create a Moms at Home program. 8. Institute a regular turn off the t.v. night so that families will play games together, etc. 9. Convince a local person that is admired to talk publically about their disorder. 15

17 Priority #2 SUBSTANCE ABUSE Definition Substance abuse, also known as drug abuse, refers to a maladaptive patterned use of a substance (drug) in which the user may or may not be considered dependent. Substance abuse/drug abuse is not limited to moodaltering or psycho-active drugs. Activity is also considered substance abuse when inappropriately used (as in steroids for performance enhancement in sports). Therefore, mood-altering and psychoactive substances are not the only drugs of abuse. Rationale Substance abuse was chosen as a priority health problem based on Fayette County youth trends. Substance abuse encompassed all forms including but not limited to alcohol, tobacco, and other drugs including prescription drug abuse. It was determined that pre-adolescents to adolescents needed to be the primary focus for prevention initiatives. Data collected by the IDPH revealed that tobacco use is considerably disproportionate in Fayette County both in terms of the general population and mothers during pregnancy. 16

18 Local Baselines Tobacco Use 60.00% 50.00% 47.30% 55.30% 40.00% 30.00% 20.00% 25.40% 21.30% 27.30% 23.40% Fayette County Illinois 10.00% 0.00% Smoker Former Smoker Non-Smoker Source: 4 th Round Behavioral Risk Factor Surveillance System Percentage of Mothers Who Smoke During Pregnancy 30.00% 25.00% 24.10% 23.60% 24.90% 20.00% 15.00% 10.00% 10.20% 8.60% 8.60% Fayette County Illinois 5.00% 0.00% Source: Illinois Department of Public Health, IPLAN Data System Report 17

19 Acute/ Binge Drinking (Alcohol) 90.00% 80.00% 81.50% 80.50% 70.00% 60.00% 50.00% Fayette County 40.00% Illinois 30.00% 20.00% 18.50% 19.50% 10.00% 0.00% At Risk Not At Risk Acute intoxication = results from a very high level of alcohol in the blood Binge Drinking = drinking alcoholic beverages with the intent of becoming intoxicated Source: 4 th Round Behavioral Risk Factor Surveillance System Drug Crime Arrest Rates per 100,000 Type of Crime 2008 Rate 2009 Rate 1. Cannabis Fayette County Illinois 2. Controlled Substance Fayette County Illinois 3. Drug Paraphernalia Fayette County Illinois 4. Hypodermic Needles Fayette County Illinois 39 50, , , , , , ** 5.18 ** ** Events under 10 are considered to not statistically significant. Source: Illinois State Police and includes Sheriffs Offices, Police Departments, Colleges, and Universities. 18

20 Healthy People 2020 Objectives 1: Reduce the proportion of adolescents who report that they rode, during the previous 30 days, with a driver who had been drinking alcohol. Target: 25.5 percent. Baseline: 28.3 percent of students in grades 9 through 12 reported that they rode, during the previous 30 days, with a driver who had been drinking alcohol in Target setting method: 10 percent improvement. Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 2: Increase the proportion of adolescents never using substances. 2.1 Increase the proportion of at risk adolescents aged 12 to 17 years who, in the past year, refrained from using alcohol for the first time. Target: 94.4 percent. Baseline: 85.8 percent of adolescents aged 12 to 17 years who had never used alcohol in their lives refrained from using alcohol for the first time in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 2.2 Increase the proportion of at risk adolescents aged 12 to 17 years who, in the past year, refrained from using marijuana for the first time. Target: 96.4 percent. Baseline: 94.4 percent of adolescents aged 12 to 17 years who had never used marijuana in their lives refrained from using marijuana for the first time in Target setting method: 2 percentage point improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 2.3 Increase the proportion of high school seniors never using substances Alcoholic beverages. Target: 30.5 percent. Baseline: 27.7 percent of high school seniors reported never using alcoholic beverages in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 2.4 Increase the proportion of high school seniors never using substances Illicit drugs. Target: 58.6 percent. Baseline: 53.3 percent of high school seniors reported never using illicit drugs in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 3: Increase the proportion of adolescents who disapprove of substance abuse. 3.1 Increase the proportion of adolescents who disapprove of having one or two alcoholic drinks nearly every day 8th graders. Target: 86.4 percent. Baseline: 78.5 percent of 8th graders reported that they disapproved of people having one or two alcoholic drinks nearly every day in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH.SA 3.2 Increase the proportion of adolescents who disapprove of having one or two alcoholic drinks nearly every day 10th graders. Target: 85.4 percent. Baseline: 77.6 percent of 10th graders reported that they disapproved of people having one 19

21 or two alcoholic drinks nearly every day in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 3.3 Increase the proportion of adolescents who disapprove of having one or two alcoholic drinks nearly every day 12th graders. Target: 77.6 percent. Baseline: 70.5 percent of 12th graders reported that they disapproved of people having one or two alcoholic drinks nearly every day in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 4: Increase the proportion of adolescents who disapprove of trying marijuana or hashish once or twice 8th graders. Target: 82.8 percent. Baseline: 75.3 percent of 8th graders reported that they disapproved of people trying marijuana or hashish once or twice in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH.SA 4.1 Increase the proportion of adolescents who disapprove of trying marijuana or hashish once or twice 10th graders. Target: 66.1 percent. Baseline: 60.1 percent of 10th graders reported that they disapproved of people trying marijuana or hashish once or twice in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 4.2 Increase the proportion of adolescents who disapprove of trying marijuana or hashish once or twice 12th graders. Target: 60.3 percent. Baseline: 54.8 percent of 12th graders reported that they disapproved of people trying marijuana or hashish once or twice in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF), NIH. 5: Increase the proportion of adolescents who perceive great risk associated with substance abuse. 5.1 Increase the proportion of adolescents aged 12 to 17 years perceiving great risk associated with substance abuse Consuming five or more alcoholic drinks at a single occasion once or twice a week. Target: 44.6 percent. Baseline: 40.5 percent of adolescents aged 12 to 17 years reported that they perceived great risk associated with consuming five or more alcoholic drinks at a single occasion once or twice a week in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 5.2 Increase the proportion of adolescents aged 12 to 17 years perceiving great risk associated with substance abuse Smoking marijuana once per month. Target: 37.3 percent. Baseline: 33.9 percent of adolescents aged 12 to 17 years reported that they perceived great risk associated with smoking marijuana once per month in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 5.3 Increase the proportion of adolescents aged 12 to 17 years perceiving great risk associated with substance abuse Using cocaine once per month. Target: 54.7 percent. Baseline: 49.7 percent of adolescents aged 12 to 17 years reported that they perceived great risk associated with using cocaine once per month in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 20

22 6: Reduce the proportion of persons engaging in binge drinking of alcoholic beverages. 6.1 Reduce the proportion of students engaging in binge drinking during the past 2 weeks High school seniors. Target: 22.7 percent. Baseline: 25.2 percent of high school seniors reported that they engaged in binge drinking during the past 2 weeks in Target setting method: 10 percent improvement. Data source: Monitoring the Future Survey (MTF) 7: Reduce the past-year of non medical prescription drug use. 7.1 Pain relievers. Target: Not applicable. Baseline: 4.8 percent of persons aged 12 years and older reported nonmedical use of pain relievers in the past year in Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 7.2 Tranquilizers. Target: Not applicable. Baseline: 2.0 percent of persons aged 12 years and older reported nonmedical use of tranquilizers in the past year in Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 7.3 Stimulants. Target: Not applicable. Baseline: 1.06 percent of persons aged 12 years and older reported nonmedical use of stimulants in the past year in Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 7.4 Sedatives. Target: Not applicable. Baseline: 0.25 percent of persons aged 12 years and older reported nonmedical use of sedatives in the past year in Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 7.5 Any psychotherapeutic drug (including any of those noted above). Target: 5.5 percent. Baseline: 6.1 percent of persons aged 12 years and older reported nonmedical use of any psychotherapeutic drug in Target setting method: 10 percent improvement. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 8.1 Reduce the proportion of adolescents who use inhalants. Target: Not applicable. Baseline: 3.9 percent of adolescents aged 12 to 17 years reported that they used inhalants in the past year in Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. Target setting method: This measure is being tracked for informational purposes. If warranted, a target will be set during the decade. Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. 21

23 Outcome Objective By year 2017, increase the proportion of at risk adolescents aged 12 to 17 years who, in the past year, refrained from using alcohol for the first time to 90%. Baseline: 85.8 percent of adolescents aged 12 to 17 years who had never used alcohol in their lives refrained from using alcohol for the first time in Data source: National Survey on Drug Use and Health (NSDUH), SAMHSA. Impact Objectives 1. By year 2015, reduce the percentage of adolescents who use tobacco products on a regular (within the last 0-5 days) basis to no more than 15%. Baseline: Fayette County 10 th Grade Survey reported 16.9% of adolescents used tobacco products within the last 5 days. 2. By year 2015, reduce the percentage of adolescents who use marijuana on a regular (3 times or more a week) basis to no more than 13%. Baseline: Fayette County 10 th Grade Survey reported 15.8% of adolescents smoked marijuana 3 times a week or more. 3. By year 2015, reduce the percentage of pregnant mothers who smoke to no more than 20%. Baseline: 2006 IPLAN Summary Report Data reported 24.9% of pregnant Fayette County mothers smoke. 22

24 Risk and Contributing Factor Analysis 23

25 Resources and Barriers 24

26 Intervention Strategies Fayette County Health Department IPLAN Intervention Strategies Health Problem: Substance Abuse 1. Education to the schools for students and teachers. 2. Counseling and support group programs for high school students like AA or NA. 3. Education and advertisement campaigns for very young kids, such as Kindergarten and Pre-K. 4. Computer software that ages kids to show them what they will look like if 20 years if they smoke. 5. Expand the high schools peer mentoring and peer listening programs. 25

27 Priority #3 CHILD ABUSE Definition Simply stated child abuse and neglect is the physical, sexual, or emotional mistreatment or neglect of a child. Child Abuse has been defined as an act, or failure to act, on the part of a parent or caretaker that results in the death, serious physical or emotional harm, Sexual Abuse, or exploitation of a child, or which places the child in an imminent risk of serious harm (42 U.S.C.A. 5106g). Rationale Child Abuse was chosen as a priority health problem in Fayette County based on data provided by the Department of Children and Family Services. Data revealed that Fayette County rates for child abuse and neglect reports (including sexual abuse) are much higher than Illinois. In many years these are double. This is also the case for indicated child abuse and neglect cases. Fayette County is a very economically depressed area. Increased child abuse rates seem to coincide with a depressed economy. Many caseworkers working for the Health Department have noticed more instances of domestic and child abuse in recent months. 26

28 Local Baselines HOSPITALIZATIONS FROM CHILD ABUSE IN THE US Yale Study 2006 Kid s Inpatient Database Approximately 4,600 kids were hospitalized as a result of child abuse. 300 of them died. Infants aged 1 year or younger were at highest risk for child abuse related hospitalization. The hospitalization rate for 1 year olds was 58 per 100,000. This rate is higher than the rate of persons that die in Illinois and Fayette County each year from stokes. Poverty appears to be a risk factor for child abuse. Children covered under Medicaid were about 6 time more likely to be victims of serious abuse as children who were not on Medicaid. Research suggests that the rates may be even higher since the economy began to falter. One study found that the rate of abusive head trauma rose from 9 per 100,000 to 15 per 100,000 from which coincides with the onset of the recession and massive job losses. That study appeared in the October 2011 issue of Pediatrics. Source: Karel Amaranth, MPH, MA, Executive Director, JE and ZB Butler, Child Advocacy Center, The Children s Hospital at Montefiore, New York City; Walter Lambert, MD, Associate Professor of Pediatrics, Medical Director, University of Miami Child Protection Team; March 2012 Pediatrics Child Abuse & Neglect Reports Rates per 1, Fayette County Illinois Source: Illinois Department of Children & Family Services 27

29 Child Abuse & Neglect Indicated Investigation Rates per 1, Fayette County Illinois Source: Illinois Department of Children & Family Services Sexual Abuse Report Rates per 1, Fayette County Illinois Source: Illinois Department of Children & Family Services 28

30 Sexual Abuse Indicated Investigation Rates per 1, Fayette County Illinois Source: Illinois Department of Children & Family Services Healthy People 2020 Objectives 1: Reduce child maltreatment deaths. Target: 2.2 deaths per 100,000 children. Baseline: 2.4 child maltreatment deaths per 100,000 children under age 18 years occurred in Target setting method: 10 percent improvement. Data source: National Child Abuse and Neglect Data System (NCANDS), ACYF, ACF, HHS. 2: Reduce nonfatal child maltreatment. Target: 8.5 maltreatment victims per 1,000 children aged 17 years and under. Baseline: 9.4 victims of nonfatal child maltreatment per 1,000 children under age 18 years were reported in Target setting method: 10 percent improvement. Data source: National Child Abuse and Neglect Data System (NCANDS), ACYF, ACF, HHS. 3:Reduce sexual violence. Reduce rape or attempted rape. Potential data source: National Intimate Partner and Sexual Violence Surveillance (NISVS) System, CDC, NCIPC. IVP 40.2 (Developmental) Reduce abusive sexual contact other than rape or attempted rape. Potential data source: National Intimate Partner and Sexual Violence Surveillance (NISVS) System, CDC, NCIPC. 4:Reduce non-contact sexual abuse. Potential data source: National Intimate Partner and Sexual Violence Surveillance (NISVS) System, CDC, NCIPC. 29

31 Outcome Objective By 2017, reduce the investigation rates of indicated child abuse and neglect to no more than 11 per 1,000. Baseline: 2010 DCFS data reported the indicated child abuse and neglect rates for Fayette County were 15.2 per 1,000 population. Impact Objectives 1. By 2015, reduce child abuse and neglect reports in Fayette County to no more than 42 per 1,000. Baseline: 2010 DCFS data showed the reported child abuse and neglect rates for Fayette County were 47.2 per 1,000 population. 2. By 2015, reduce child sexual abuse reports in Fayette County to no more than 3 per 1,000. Baseline: 2010 DCFS data showed the reported sexual abuse rates for Fayette County were 4.8 per 1,000 population. 30

32 Risk and Contributing Factor Analysis 31

33 Resources and Barriers 32

34 Intervention Strategies Fayette County Health Department IPLAN Intervention Strategies Health Problem: Child Abuse 1. Create resource cards for kids. 2. Create a crisis line for parents. 3. Provide trainings for teachers on mandated reporting. 4. Create safe havens and shelters. 5. Educate the community on who are mandated reporters and what they do. VI. CONCLUSIONS Minutes of all committee meetings were taken by Julie Opfer, administrative secretary for the Fayette County Health Department. March 29, 2012 Meeting The meeting began with a brief review of the prior meeting. The topics included were the definition of a health problem, the committee s 2012 priority health problems, and all associated data. Once the review was completed, the group analyzed each of the three health problems, mental illness, substance abuse, and child abuse to determine the risk, indirect, and direct contributing factors. The committee looked at all county and surrounding county resources and listed all potential barriers to prevention and treatments. Finally, the committee discussed goals and intervention strategies that could be implemented to decrease the prevalence of the health problem. 33