Community Health Improvement Initiative

Community Health Improvement Initiative Community Health Assessment Presentation May 12, 2014 Janeen Maxwell, MPH, CHES - Director of Research at Holleran Consulting John Beckley, MPH Health Consultant at Beckley Consulting

Purpose of Today s Meeting To provide overview of community health assessment process To review key findings from assessment To engage community stakeholders and discuss next steps in community health improvement planning

Holleran Background Founded in 1992 by Dr. Michele Holleran Full-service research & consulting firm Client partners in 44 states and Canada Primarily work in three fields: Hospitals/Health Systems Public Health Senior Living

Central Connecticut Health District Background Mission: Central Connecticut Health District is committed to improving the quality of life in our communities through prevention of disease and injury, fostering of a healthy environment, and promotion of the health of our residents. Local health department serving the towns of: Berlin Newington Rocky Hill Wethersfield

What is a Community Health Assessment? A community health assessment is a process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community.

Public Health Accreditation

Public Health Accreditation The Public Health Accreditation Board (PHAB) is working to promote and protect public health by advancing quality of public health departments through national public health accreditation. Identify f & Describe: Community health status Areas for health improvement Factors contributing to health challenges Existing community resources

Resource: Association for Community Health Improvement (ACHI) Tool Kit

CHA Goals Identify community health needs and priorities Establish benchmarks and monitor health trends Inform health policy and health strategies Provide platform for community collaboration Develop community health improvement plan

Research Overview

CHA Research Components CHA included combination of quantitative and qualitative research components. Quantitative Data: Secondary Data Profile Household Telephone Survey Health Equity Data Qualitative i Data: Key Informant Study Focus Group Discussions p

Secondary Data Profile A compilation report that t displays existing iti health and wellness-related data that is tracked on a regular basis Demographic & Household statistics Morbidity & Mortality Rates Behavioral Health Risk Factors Existing Community Studies

Health Equity Index Community-based electronic tool that profiles and measures social determinants affecting health and provides correlations with ih specific health outcomes. www.sdoh.org

Berlin Newington Positive (Low Poverty) Rocky Hill Wethersfield Negative (High Poverty)

Berlin Newington Rocky Hill Wethersfield 1=Low or Negative / 10=High or Positive

Berlin Newington Rocky Hill Wethersfield

Population Change CCHD is comprised of 4 towns (Berlin, Newington, Rocky Hill, and Wethersfield), with a total population of 97,504.

Racial/Ethnic Diversity 88% of CCHD residents identify as White Less than 3% of residents identify as Black/African American Less than 7% identify as Hispanic/Latino. Rocky Hill has higher Asian population (10%) compared to state/nation.

Language Other than English Spoken at Home

All Families Poverty Married Families with Families with Single Female Couple Single Female Householder, with Related Families Householder Children Under 18 Years US 10.5% 51% 5.1% 29.4% 38.2% CT 6.7% 2.3% 22.9% 30.8% CCHD 33% 3.3% 19% 1.9% 97% 9.7% 15.5% 5% Berlin 5.4% 3.4% 13.7% 13.4% Newington 28% 2.8% 08% 0.8% 11.3% 20.0% 0% Rocky Hill 2.9% 2.8% 4.3% 7.3% Wethersfield 2.7% 1.4% 8.3% 15.4% More than 40% of households spend over 30% of their income on rent. More than 50% of households spend over 30% of their income on mortgages.

Poverty: Single Female l Households with Children hld

Poverty: Residents 65 Years and Over

Overweight/Obesity US CT CCHD Underweight (<18.5) 1.8% 1.9% 1.6% Normal (18.5 24.9) 34.5% 38.5% 36.6% Overweight (25.0 29.9) 35.7% 35.2% 39.7% Obese (> or = 30) 27.8% 24.5% 22.1% Average District BMI N/A N/A 26.55 Average adult Body Mass Index (BMI) is 26.55 (overweight) More than 61% of adults are overweight or obese. Only 36.6% have a normal weight. 83.5% of adults participate in moderate physical activity. Average daily fruit/vegetable consumption has improved over time.

Maternal/Child Health: Low Birth Weight Low birth weight rate in Rocky Hill is higher than state/nation

Maternal/Child Health: Prenatal Care 13 4% of CCHD mothers receive late/no prenatal care higher than CT 13.4% of CCHD mothers receive late/no prenatal care higher than CT. Nearly 16% of Rocky Hill mothers in CCHD receive late/no prenatal care 17% of Black mothers in CCHD receive late/no prenatal care

Deaths due to Stroke

Deaths due to Heart Disease

Deaths due to Cancer

Deaths due to accidents

Suicide

Chronic Disease Top 5 causes of death in CCHD are heart Top 5 causes of death in CCHD are heart disease, cancer, stroke, chronic respiratory disease, and accidents. Heart Disease and Cancer account for more than ½ of deaths. Cancer incidence rates are higher in CCHD compared to state and nation. 64% of current adult smokers have attempted to quit smoking in the past year.

Key Informant Study Key Informant Surveys were conducted with 75 local community stakeholders and leaders Qualitative feedback collected through online survey tool: Key Health Issues Environmental Health Issues Disaster Preparedness Issues Access to Health Care Community Assets Community Recommendations

Key Informant Study: Barriers Rank Barriers to Health Care Access % 1 Inability to Pay Out of Pocket Expenses 74% 2 Lack of Health Insurance Coverage 67% 3 Inability to Navigate Health System 65% 4 Lack of Transportation 57% 5 Language/Cultural Barriers 44% 6 Availability of Providers/ Appointments 36% 7 Time Limitations 35% 8 Basic Needs Not Met (Food/Shelter) 33% 9 Lack of Child Care 26% 10 Lack of Trust 16% 93% of local adults have some form of health insurance coverage

Key Informant Study: Key Health Issues Rank Health Issue % 1 Overweight/Obesity 63% 2 Access to Care/Uninsured 44% 3 Substance Abuse/Alcohol Abuse 44% 4 Heart Disease 41% 5 Cancer 40% 6 Diabetes 38% 7 Mental Health/Suicide 38% 8 Alzheimer's Disease/Dementia 38% 9 Asthma/Respiratory Illnesses 29% 10 Falls/Injuries 26%

70% 60% 50% 40% 30% 20% 0% 10% 63% Key Health Issues 44% 44% 41% 40% 38% 38% 38% 29% 26% 22% 16% Overweight/Obesity Access to Care/Uninsured Substance Abuse/Alcohol Abuse Heart Disease Cancer Diabetes Mental Health/Suic cide Alzheimer's Disease/Deme Asthm I ntia a/respiratory llnesses Falls/Injuries Tobacco Domestic Violence/Child Abuse

Key Informant Study: Barriers Rank Barriers to Health Care Access % 1 Inability to Pay Out of Pocket Expenses 74% 2 Lack of Health Insurance Coverage 67% 3 Inability to Navigate Health System 65% 4 Lack of Transportation 57% 5 Language/Cultural Barriers 44% 6 Availability of Providers/ Appointments 36% 7 Time Limitations 35% 8 Basic Needs Not Met (Food/Shelter) 33% 9 Lack of Child Care 26% 10 Lack of Trust 16%

80% 70% 60% 50% 40% 30% 20% 10% 0% 74% 67% 65% 57% 44% 36% 35% 33% 26% 16% Inability to Pay Out of Pocket Expenses Lack of Health Insurance Coverage Inability to Navigate Health Care System Lack of Transportation Lan guage/cultural Barriers Availability of Providers/Appointments Time Limitations Basic Needs Not Met Lack of Child Care Lack of Trust

Key Informant Interviews: Underserved Populations Low Income/Poor Uninsured/Underinsured Homeless Immigrant/Refugee Disabled Hispanic/Latino Seniors/Elderly Black/African American Asian/Asian Indian Approximately 57% of respondents indicated that there are underserved populations in the community.

Key Informant Interviews: Resources Needed to Improve Access Free/Low Cost Dental Care Free/Low Cost Medical Care Free/Low Cost Vision Care Mental Health Services Transportation Health Education/Information/Outreach Substance Abuse Services Bilingual Services Health Screenings Affordable Child Care Programs

Key Informant Interviews: Environmental Health Concerns Secondhand Smoke Transportation Emissions Exposure to Household Chemicals Mold Overall Outdoor Air Quality Surface Water Runoff (Pesticides/Fertilizers) The health effects of pollutants/toxic chemicals are well-documented documented. They are in indoor and outdoor air, our water, land, in our homes, in the work setting, etc. -affecting everyone from prenatal to the elderly.

Disaster Preparedness 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1 - Not at all Prepared 2 3 4 5 - Very Prepared How prepared is your organization ation How confident are you that your for an emergency or disaster as community can respond to a largescale disaster or emergency? evidenced by the development of an emergency plan?

60% 50% 40% 30% 20% 10% 0% Household Emergencies (Fire, Gas Leaks, etc.) Natural Disasters (Severe Storms, Tornadoes, Floods) Disease Outbreak (Widespread Flu or Pandemic) Chemical Spills Terrorism 1 - Not at all Worried 2 3 4 5 - Very Worried

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source of Emergency/Disaster Information 3 4 5 Very Likely Television Internet Website Email Text Message Alerts Reverse 911 Robocall Word of Mouth Battery-Operated Radio Sirens Social Media (Facebook, Police Scanner

Key Informant Interviews: Potential ti Areas of Opportunity Increased Communication, Community Engagement, & Outreach Need for Patient Navigation & Care Coordination Health Education & Prevention (Focus on Healthy Lifestyles & Chronic Disease) Improved Access to Affordable Exercise & Nutrition Programs Enhanced Mental Health & Substance Abuse Services Support Services for Seniors

Focus Groups 3 small discussion groups 28 community residents participated Discussions gathered qualitative feedback about: Access to Health Care Nutrition & Exercise Environmental Health Awareness & Communication Mental/Behavioral Health & Substance Abuse

Focus Groups: Potential t Areas of Opportunity ty Access to Health Care Transportation Navigating Health & Human Services Understanding Health Insurance (Enrollment, Coverage, Eligibility, &Co Co-pays) Alzheimer s Disease/Dementia/Aging/Caregiving Needs Awareness & Education Home & Community-Based Support Services Mental & Behavioral Health/Substance Abuse Prevention, Education, & Screening Programs Treatment & Support Services

Focus Groups: Potential Areas of Opportunity Obesity/Overweight Affordable Physical Activity Opportunities including safe pedestrian areas Nutrition Education & Accessible Healthy Foods Environmental Health Awareness, Education, & Training i Health Awareness & Education Multi-modal Promotion of Health Programs, Services & Messages

Community Health Improvement Planning Community health improvement process uses CHA data to: Identify priority issues Develop and implement strategies for action Establish performance measures and accountability Create comprehensive Community Health Improvement Plan (CHIP)

Prioritization of Needs Seek input from community representatives Evaluate Scope, Severity, Ability to Impact Differentiate Important Many from Vital Few Identify Community Assets & Gaps in Services

Engaging g gcommunity Partners Inclusion in CHA Kickoff Request for Community Data Input through Key Informant Survey Share CHA results Engage Community Representatives in Prioritization & Planning Ongoing Communication & Collaboration

Next Steps & Questions Janeen Maxwell, Director of Research Holleran jmaxwell@holleranconsult.comcom 717-285-3394 Nancy Brault, Interim Director of Health Central CT Health District i t nancy.brault@wethersfieldct.com 860-721-2828