For full functionality of this document download an electronic version available on the Laurel County Health Department website at

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1 For full functionality of this document download an electronic version available on the Laurel County Health Department website at in the Accreditation and Health Assessment Tab.

2 Our Coalition Thank you to the following members of our coalition who were involved in the development of this plan: Brandi Gilley, Laurel County Health Department Mark Hensley, Laurel County Health Department Stephanie Martin, Laurel County Health Department Carolee Epperson, Laurel County Health Department June Rawlings, Community Member/Laurel County Board of Health Lisa Rutherford, Saint Joseph London Rita Taylor, Saint Joseph London Billie Ridings, Saint Joseph London Volunteer Rick Cochrane, City of London Ryan Osborne, Health Directions Inc./Professional Home Health Deborah Hampton, Cumberland River Regional Prevention Center Christie Shrader, Laurel County Agency for Substance Abuse Policy (ASAP) Board Kim Whitson, Laurel County Cooperative Extension Service Gabriella Hodges, Cumberland Valley Regional Epidemiologist Linda Gilreath, Laurel County Community Cooperative Care (CCC) and Laurel County Rotary Club Victoria Smith, Seaton Home Health/Tri-County Hospice Ellen Farinelli, Laurel Senior Living Jara Burkhart, Laurel County Life Center Magen Zawko, London Police Department For an up-to-date listing of our full coalition visit: Laurel County Health in Motion Membership Vision Laurel County Health in Motion Coalition s vision for a healthier community promotes participation of community partners and its residents engaging in willful cooperation to improve the safety and well-being, health, knowledge and access to resources toward the level of a healthy community. July 2016 Page 1

3 The Framework The Laurel County Health in Motion Coalition began assessing the community health needs of Laurel County in March 2015 utilizing the Mobilizing for Action through Planning and Partnerships (MAPP) Framework. MAPP is a community-wide strategic planning process for improving community health. Facilitated by public health leadership, this process helps communities prioritize public health issues and identify resources for addressing them. The coalition conducted four assessments as outlined in the MAPP Framework from March -October The Four Assessments: Community Status Assessment Assesses the data about health status, quality of life, and risk factors in the community. Community Themes and Strengths Assessment Identifies issues that interest the community, perceptions about quality of life, and community assets. Forces of Change Assessment Identifies forces that are or will be affecting the community or the local public health system. Local Public Health System Assessment Measures the capacity and performance of the local public health system all organizations and entities that contribute to the public s health. July 2016 Page 2

4 Health Priority Development Goal To provide a comprehensive and unbiased health profile of Laurel County through implementation of the MAPP model with partnerships among multiple agencies across the community. Objectives The following objectives were developed: Identify community health needs Determine the priority health needs Develop a community health improvement plan (CHIP) based on these identified needs Integrate the CHIP priorities into the strategic plans of local agencies After completing the four MAPP Assessments (view the 2015 Laurel County Community Health Assessment for the full report of assessment findings), the Laurel County Health in Motion Coalition reviewed each assessment for common themes and discussed what the assessments revealed about the health of Laurel County. Through this facilitated discussion, the coalition identified several priority areas that need to be addressed to better meet the coalition s vision for a healthier Laurel County. July 2016 Page 3

5 Health Priority Development Once those priority areas were established, the coalition used a matrix to determine if and how that priority could be impacted by the coalition. The matrix questions for each priority included: Can the coalition make an impact in this area? What interventions are already in place to impact this area? What interventions could be implemented to impact this area? What organizations could/should be involved in this priority area? Four priority areas were chosen to include in the 2016 CHIP Action Plan. These four priority areas were considered in depth based on the results of the four assessments. July 2016 Page 4

6 Health Priority Development #1. Substance Abuse: Four Strategic Priority Areas and MAPP Assessment Themes: Assessment Community Status Assessment Forces of Change Community Themes and Strength Data Themes Drug/Narcotic Offenses were the highest category of crime offenses for Laurel County in 2014 (n=600). There was a 10.01% increase in these offenses from Substance abuse was identified as a social force with threats including; the rise in heroin overdose, increase in violence, infant deaths, and domestic violence. Alcohol/Drug Abuse was identified as the greatest health problem in Laurel County. Street Drug Abuse (including IV drugs), Prescription Drug Abuse, and Alcohol Abuse were identified as the three most risky behaviors in Laurel County, respectively. Meth, Prescription Drugs, IV Drugs, and Marijuana were all identified as major substance abuse issues in Laurel County % of responses indicated that the person knew someone who was a user of one or more of these substances. Drug and Drugged Driving, Drug Related Violence were identified as the top two most serious safety problems for Laurel County. In-patient and Out-patient drug rehabilitation services were identified as the top two most needed services in Laurel County. July 2016 Page 5

7 Health Priority Development #2: Chronic Disease Prevention and Management Assessment Community Status Assessment Forces of Change Community Themes and Strength Data Themes Heart Disease Deaths (Laurel-232, KY-205) *per 100,00 population 1 Physically Unhealthy Days Reported (Laurel- 8, KY-5) 1 Prevalence of Hypertension (Laurel-34%, KY-39%) 1 Prevalence of Diabetes (Laurel-15%, KY-11%) 1 Prevalence of Asthma (Laurel 20%, KY-16%) 1 Prevalence of Smoking (Laurel-30%, KY-27%) 1 Prevalence of Overweight (Laurel-67%, KY-67%) 1 Prevalence of Obesity (Laurel-36%. KY-32%) 1 Lack of Physical Activity (Laurel-32%, KY-29%) 1 Recommended Fruit and Veggie Intake (Laurel-10%, KY- 11%) 1 Chronic disease was identified as a scientific force with threats including increased risk factors for: diabetes, cardiovascular disease, and cancer. 22.6% and 6.1% of respondents rated their health as Unhealthy or Very Unhealthy, respectively. 19.6% of respondents identified Healthy Behaviors and Lifestyles as an important characteristic of a healthy community. Obesity was identified as the #2 greatest health problem in Laurel County. Diabetes/Sugar Problem was identified as the #3 greatest health problem in Laurel County 41.2% of respondents identified Weight Loss Programs or Services as one of the most needed services in Laurel County (in Top 5 responses) Cost or Expenses and Insurance Issues were the top two perceived barriers to healthcare in Laurel County. July 2016 Page 6

8 Health Priority Development Local Public Health System Assessment Since it is difficult to get people to participate in prevention and education classes, the use of various methods of education and promotion is an opportunity for improvement. Lack of funding and effectively getting educational information to the target population were identified as weaknesses. #3: Teen Pregnancy Prevention and Support Assessment Community Status Assessment Community Themes and Strength Data Themes Teen Births (per 100,000 population) was 54 for Laurel County compared to 43 for Kentucky. 1 Teen Pregnancy was perceived as one of the greatest health problems in Laurel County by 11.33% of respondents. Not Using Birth Control and Unsafe Sexual Practices was considered of the most risky behaviors by 9.51% and 17.38% of respondents, respectively. #4: Dental Health Assessment Community Status Assessment Community Themes and Strength Data Themes Tooth loss rates for Laurel County was 22% compared to 24% for Kentucky. 1 Additional regional data indicates that adults who visited the dentist within the past year was at 45.6% for the Cumberland Valley Region compared to 61.0% for Kentucky. 2 County-level data was not available for this indicator. 33.6% of respondents indicated that they are prevented from going to the doctor because the service is not covered by insurance. Dental health was not identified specifically, however, many private health insurances do not cover dental services. July 2016 Page 7

9 Health Priority Development The coalition identified resources and assets that are already in place in the community that are or could be instrumental in the implementation of the health priority action steps. Resources/Assets Identified Substance Abuse: Law Enforcement Town Hall Meetings, Meth Watch Program, Operation UNITE Education, Laurel County ASAP Board Education in Schools, Drug Take Back Events and Permanent Drop Boxes, City Smoke-Free Ordinance, Hooked on Fishing Not on Drugs Program, Laurel County Cooperative Extension Life Skills Education Programs, D.A.R.E., and Give Me A Reason (through London Police Department). Chronic Disease: Diabetes Self-Management Education, Laurel County Wellness Park, Laurel County Health Department Walking Track, Saint Joseph London Walking Track, WIC Program, Registered Dietitians Laurel County Health Department, Saint Joseph London, Saint Joseph Better Bites Program, Laurel County Cooperative Extension Walking Programs and Nutrition Education Programs, Farmer s Market Teen Pregnancy: Laurel County Life Center, Laurel County Schools Teen Parent Groups, HANDS Program, Regional Prevention Center s Healthy Babies Program. Dental Health: Elgin Foundation s School Dental Health Program, Laurel County Health Department Varnish Program, HANDS Program National Level Recommended Interventions The coalition members were provided with a listing of recommended interventions for the four priority areas from The Community Guide a website that houses the official collection of all Community Preventive Services Task Force findings and the systematic reviews on which they are based. The coalition facilitator reviewed these recommended interventions with the coalition during the development of the CHIP Action Plan. The coalition adopted several of the interventions from the recommended list. July 2016 Page 8

10 2. Laurel County CHIP Priority Action Plan July 2016 Page 9

11 REDUCE SUBSTANCE ABUSE Health Priority 1: Reduce Substance Abuse Substance Abuse impact areas include: Meth, Heroin/Opiates, Rx Drugs, Marijuana, and Youth Prevention. Ownership Group: The Laurel County Agency for Substance Abuse Policy (ASAP) Board Other Agencies: Operation UNITE, Laurel County Health Department, Law Enforcement, Regional Prevention Center, Laurel County Cooperative Extension Service Indicator Laurel County Kentucky Goal / Binge Drinking 8% 14% Alcohol-Impaired Driving Deaths Drug Arrests (per 100,000) Prevalence of Smoking (Adults) 10% 25% 2,418 1,322 30% 27% Youth Smoking 21% 25% Drug Poisoning Deaths (per 100,000) Explanation of Data % of adults reported having 5 or more (4 or more for women) on one occasion. (Obtained 2015 from Kentucky Health Facts) % of driving deaths with alcohol involvement (2011, National Highway Traffic Safety Administration FARS) Number of Drug Arrests per 100,000 population as reported to the Kentucky State Police (2014, Kentucky Health Facts) Percent of Adults who report smoking per the BRFSS (Obtained 2015 from Kentucky Health Facts) % of high school students who report smoking on a regular basis. (2007, Kentucky Health Facts) Number of drug poisoning deaths per 100,000 population (2014, CDC Wonder) Goal: Reduce each substance abuse health indicator (drug poisoning and deaths, excessive drinking, adult smoking, and drug arrests) by 2-5% by June 30, Action Steps: #1: Continue to facilitate/provide Drug Take Back Events throughout the community. #2: Implement educational awareness events/campaigns addressing ATOD use in the community. July 2016 Page 10

12 REDUCE SUBSTANCE ABUSE #3: Provide educational programs and presentations to school-age population on the consequences of good life decisions and using alcohol, drugs, and tobacco (Ex Pre- Prom Events, Reality Store, Truth and Consequences, Red Ribbon Week, Dollars and Sense, D.A.R.E., etc). #4: Offer positive impact programs for parents and families (Ex: Hooked on Fishing Not on Drugs (HOFNOD), Parent Academy, Give Me A Reason, etc). #5: Policy Change: Encourage the inclusion of e-cigarettes in local/state smoking ordinances. #6: Policy Change: Implement Harm Reduction Syringe Exchange Program (includes substance abuse counseling and treatment referrals) #7: Implement and Support Neighborhood Watch Programs July 2016 Page 11

13 Health Priority 2: Reduce Chronic Disease Prevalence and Complications Chronic Disease impact areas include: Diabetes, Cardiovascular Disease, Lung Disease and Health Behaviors including Poor Nutrition, Lack of Physical Activity Ownership Group: Laurel County Health Department Other Agencies: Saint Joseph London, Laurel County Cooperative Extension Service, City of London (Parks and Recreation, Tourism, etc) Indicator Diabetes Prevalence Prevalence of Hypertension Laurel County Kentucky Goal / 12% 12% 34% 39% Asthma 20% 16% Prevalence of Smoking Lack of Physical Activity Recommended Fruit and Vegetable Intake 30% 27% 32% 29% 10% 11% Adult Obesity 36% 32% Regional, State, and National Indicators CVADD KY/US Youth Smoking NA 16.9%/10.8% Prevalence of COPD, emphysema, or chronic bronchitis CHRONIC DISEASE 11.8% 11.9% KY Explanation of Data Percentage of adults aged 20 and above with diagnosed diabetes (2015 County Health Rankings) Percent of adults with diagnosed hypertension (Obtained 2015, Kentucky Health Facts) Percent of adults with diagnosed asthma (Obtained 2015, Kentucky Health Facts) Percent of Adults who report smoking per the BRFSS (Obtained 2015 from Kentucky Health Facts) Percentage of adults aged 20 and over reporting no leisure-time activity (2015 County Health Rankings) Percentage of adults who consume five or more servings of fruits and vegetables per day (Obtained 2015, Kentucky Health Facts) Percentage of adults that report a BMI of 30 or more (Obtained 2015, Kentucky Health Facts) % of high school students who smoked a cigarette once in the past 30 days Adults who have COPD, emphysema, or chronic bronchitis July 2016 Page 12

14 CHRONIC DISEASE Goal #1: Reduce obesity in Laurel County by 2% by June 30, Action Steps: #1: Encourage and provide social support interventions (walking challenges/clubs, buddy system, walking contracts, decreasing screen time). (LCHD, SJL, Extension) #2: Provide educational programs and presentations to school-age population on healthy nutrition and physical activity. (LCHD, Extension) #3: Encourage and assist with implementation of worksite wellness programs at Laurel County workplaces (ex. Humana Vitality, Walk with Ease, biometric screenings, etc). (LCHD) Goal #2: Reduce diabetes prevalence in Laurel County by 2% by June 30, Action Steps: #1: Provide combined diet and physical activity promotion programs to prevent Type 2 Diabetes. (LCHD, SJL) #2: Provide Diabetes Self-Management Education (DSME) Programs to improve management and control of diabetes. (LCHD) Goal #3: Reduce hypertension prevalence in Laurel County by 2% by June 30, Action Steps: #1: Provide educational programs on healthy lifestyle behaviors. (SJL Better Bites Program) #2: Provide follow-up with cardiovascular patients on medication use. (SJL) Goal #4: Reduce respiratory diseases in Laurel County by 1% by June 30, Action Steps: #1: Encourage individuals at high risk to get screened for lung disease. #2: Provide and promote smoking cessation programs (Freedom from Smoking, Kentucky Tobacco Quitline). (LCHD) #3: Educate the public on dangers of secondhand smoke and support smoke free ordinances at the local and state level. (LCHD, SJL) July 2016 Page 13

15 Teen Pregnancy Health Priority 3: Reduce Teen Pregnancy Rates and Increase Support for Teen Parents Teen Pregnancy impact areas include: Reducing Teen Pregnancy Rates and Providing Support for Teen Parents Ownership Group: Laurel County Life Center Other Agencies: Laurel County Schools, Laurel County Health Department, Laurel County Cooperative Extension, Laurel County ASAP Indicator Teen Pregnancy Rates Children in Poverty Adequate Prenatal Care Laurel County Kentucky Goal / % 25.9% 64% 67% Explanation of Data Teen Births (per 1,000 women ages 15-19), Children ages 0-17 in poverty (2014) Percentage of pregnant women who received prenatal care during the first trimester of pregnancy and had 10 or more prenatal visits. ( ) Goal #1: Reduce Teen Pregnancy Rates in Laurel County by 3 per 1,000 women ages by June 30, Action Steps: #1: Provide Abstinence Education Programs to teenagers. (Life Center) #2: Provide self-esteem/positive image and healthy relationships education and programs to teenagers. (Life Center, Extension, ASAP) #3: Provide risk reduction methods such as birth control and condoms (LCHD). Goal #2: Increase adequate prenatal care by 2% in Laurel County by June 30, Action Steps: #1: Provide support programs to pregnant teens and teen parents including Healthy Babies Workshops, HANDS Program, Laurel County Schools Family Educator Program, Maternity Fairs, etc. July 2016 Page 14

16 Dental Health Health Priority 4: Improve Dental Health Among Children and Adults Ownership Group: Laurel County Schools (Elgin Foundation) Other Agencies: Laurel County Health Department Indicator Laurel Kentucky Goal Explanation of Data County / Tooth Loss 33% 24% % of adults missing 6 or more teeth Cumberland Valley Regional and State Statistics CVADD KY Extracted Teeth 36.2% 23.9% Visited dentist within past year 45.6% 61.0% % adults aged 65+ who had all their natural teeth extracted % adults who visited the dentist or dental clinic within past year Goal #1: Reduce rates of tooth loss by 2% in Laurel County by June 30, Action Steps: #1: Provide dental health education to school age population. #2: Provide dental health education to parents of infants and toddlers. #3: Provide dental health services to high-risk school age population. #4: Provide dental varnish to eligible children through WIC program. July 2016 Page 15

17 Annual Reports The Laurel County CHIP Action Plan will be evaluated on an annual basis. Progress reports will be completed to monitor the implementation of action steps. The coalition members will also evaluate the process annually, including the facilitation of the coalition. Completed annual reports can be viewed here. July 2016 Page 16

18 References 1. The Foundation for a Healthy Kentucky. Kentucky Health Facts CDC Wonder 3. Kentucky Behavioral Risk Factor Surveillance (KyBRFS) Data. Department for Public Health, Cabinet for Health and Family Services, Frankfort, Kentucky, [2014] 4. Kentucky State Police. "2014 Crime in Kentucky Report July 2016 Page 17

19 Coalition Facilitator: Brandi Gilley, MPH, RD, LD Laurel County Health Department 525 Whitley Street London, Kentucky Phone: Fax: July 2016 Page 18