RoadMAPP to Health: Community Health Assessment for Chester County.

RoadMAPP to Health:Community Health Assessment

for Chester County

RoadMAPP to Health

• Mobilizing for Action through Planning and Partnerships (MAPP) is a community-driven strategic planning tool for improving community health– Developed by National Association of County and City

Health Officials and the Centers for Disease Control and Prevention

– Applies strategic thinking to prioritize health issues and identify resources to address them

• Note that when we use the term ‘health’, we are talking about health in the broadest sense of the term

RoadMAPP to Health Assessments

Community Health Improvement Plan

Community Themes and

Strengths Assessment

Community Health Status Assessment

Local Public Health System

Assessment

Forces of Change Assessment

We chose this tool because:• It is the current gold standard for health

assessments• Historical success throughout many types of

communities • Effective evaluation and outcome tools

already developed• Employs holistic community-based approach • Anticipates and manages change• Engages the community and creates

community ownership for health issues

RoadMAPP to Health

• MAPP is not a one-time endeavor—it is meant to be an ongoing cycle, maintaining and expanding the original partnership and continuing to address community health in whatever ways are necessary

• Community assessments – as well as monitoring and evaluation of the process, its methods, and its outcomes – should be conducted regularly, so that the effort continues to speak to the current realities of the community, and so that it remains as effective as possible

RoadMAPP to Health

Brandywine Health FoundationChesPenn Health Services

Chester County Community DentalChester County Department of Aging

Chester County Dept of Community DevelopmentChester County Community Foundation

Chester County Department of Human ServicesChester County Drug and Alcohol

Chester County Economic DevelopmentChester County EMS CouncilChester County Food Bank

Chester County Fund for Women and GirlsChester County Health Department

Chester County PrisonCommunity Volunteers in Medicine

Drexel University School of Public HealthFamily Service of Chester County

Health Care Access

Health and Welfare FoundationHolcomb Behavioral Health

Human ServicesLa Comunidad Hispana

Leland Leadership GroupLife Transforming Ministries

Maternal and Child Health ConsortiumNeighborhood Health

Paoli HospitalPennsylvania Department of Health

Phoenixville Community Health FoundationPhoenixville Hospital

The Chester County HospitalThe Clinic

United Way of Chester CountyUnited Way of Southern Chester County

West Chester UniversityYMCA of Brandywine Valley

RoadMAPP to Health Stakeholders

RoadMAPP to Health Vision

To become a community where partners

assure conditions in which individuals can

be healthy and where individuals are

empowered to manage their own health

Municipalities and School Districts

ChesterCounty PA U.S.

Total Population 498,886 12.7M 308.7MMedian Age (years) 39.3 40.1 37.2Children 0-14 Years 20.4% 17.9% 19.8%Adults 65+ Years 12.8% 15.4% 13.0%

Race/EthnicityCaucasian 82.1% 79.5% 63.7%Hispanic 6.5% 5.7% 16.3%African American 5.9% 10.4% 12.2%Asian 3.9% 2.7% 4.7%Indian/Alaskan 0.1% 0.1% 0.7%Other 1.5% 1.5% 2.3%

Demographic profile

Source: 2010 Census

Percent African American Percent Hispanic Percent Asian

2010 Population by Municipality:

Demographic profile

Demographic profile: aging population

55-64 65-74 75-84 85+0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Chester County 55+ Population by Age Group, 2000, 2005, and 2010

2000 2005 2010

Source: 2010 Census

Percent of Households Earning Less than $50,000/Year (2005-2009) by Municipality

Demographic profile: income

Source: 2010 Census

– How healthy are our residents?– What does the health status of

our community look like?

RoadMAPP to Health assessments

Community Health

Improvement Plan





Assessment

Forces of Change

Assessment

Health status: cardiovascular

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

100

200

300

400

Cardiovascular Disease Death Rate, Chester County and PA, 2001-2010

CC PA

Rate

per

100

,000

pop

ulati

on

Source: PA Dept of Health

Health status: cancer

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

100

200

300

400

500

600

700

Cancer Incidence and Death Rates, Chester County and PA, 2001-2010

CC PA

per 1

00,0

00 p

opul

ation

Death Rates

Incidence


Health status: overweight/obese

2005 2006 2007 2008 20090

20

40

60

80

100

Percent Overweight (BMI ≥ 25), Chester County and PA

CC PA

Perc

ent

Source: Behavioral Risk Factor Surveillance Survey

Health status: maternal child health

2003 2004 2005 2006 2007 2008 2009 20100

20

40

60

80

100

Percent 1st Trimester Prenatal Care by Year and Race/Ethnicity, Chester County PA

All White Black Hispanic

Perc

ent


Health status: drug/alcohol use

2005 2006 2007 2008 20090

10

20

30

40

Percent of Adults Who Participated in Binge Drinking on One or More Occasions During the Past Month

CC PA

Perc

ent

Source: Behavioral Risk Factor Surveillance Survey

Health status: drug/alcohol use

2001/02 2003/04 2005/06 2007/08 2009/100

10

20

30

40

50

60

Chester County Adolescents Using Alcohol in Past 30 Days6th Grade 8th Grade 10th Grade 12th Grade Overall

Perc

ent

Source: PA PAYS survey

• Among the surrounding five counties, Chester County is ranked:– highest for Liquor Law violations – second highest for DUIs– third highest for Drunkenness

• For all three categories, the rates are above the statewide averages

Health status: crime

Source: Uniform Crime Report, PA

– How are the essential services being provided to our community?– What are the components, activities, competencies, and

capacities of our local public health system?


Community Health

Improvement Plan





Assessment

Forces of Change Assessment

•Focuses on all organizations and entities within the community that contribute to the public’s health

• Structure for assessment comes from the Essential Public Health Services– The Essential Services provide a working definition of

public health and a guiding framework for the responsibilities of local public health systems

– Developed by a CDC work group in 1994

Local Public Health System:

Ten Essential Public Health Services1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the

community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health

problems. 5. Develop policies and plans that support individual and community

health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision

of health care when otherwise unavailable. 8. Assure competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and

population-based health services. 10.Research for new insights and innovative solutions to health problems.

Local Public Health System: Map Layers• Adult care facilities• Drug/alcohol• Education centers• Emergency shelters• Family centers• Food• Head Start• Healthy Start• Hospice• Hospitals/clinics/urgent care• Intellectual and

Developmental Delay• Information/referral agencies

• Libraries• Medical offices• Mental health• Senior centers• WIC offices• Workforce development• Youth development• Transportation

• Age• Race/Ethnicity• Income• Population density

Local Public Health System: MappingDistribution of population age 65+ and location of senior centers

Local Public Health System: MappingPercent of Households with Income <$50,000/year and location of food resources

Local Public Health System: MappingHispanic Population Distribution and Locations of Hospitals and Clinics

• Extreme need for a centralized referring agency to advise of all available services—must be accessible, well publicized, etc.

• Additional need for case management to navigate various systems—could be same as agency above (addresses systemic need)

• Increase cultural competence for African American community—find champions within existing communities to increase ability to communicate message(s)

• Increase resources for undocumented populations (becoming more restricted over time)

Local Public Health System: key findings

– What is occurring or might occur that affects the health of our community or the local public health system?

– What specific threats or opportunities are generated by these occurrences?


Community Health

Improvement Plan





Assessment

Forces of Change

Assessment

Forces of change: • Factors– Discrete elements, such as community's large ethnic

population, an urban setting, or the jurisdiction's proximity to a major waterway

• Trends– Patterns over time, such as migration in and out of a

community or technological changes

• Events– One-time occurrences, such as a hospital closure, a natural

disaster, or the passage of new legislation

Factors Challenges Opportunities• Public transportation is a

problem (large, dispersed, urban/rural geographies)

• Everyone needs a car• Services are far away• Expensive to have

satellite offices

• Working on trails• Walkable communities• Mobile vans• Technology to monitor

health in the home

• Hidden and dispersed poverty throughout the county; newly poor individuals/families

• Lack of awareness• Invisible poverty (under-

employed)• Lack of ongoing giving

(seasonal, food donations, etc.)

• Decrease stigma of "need"

• More advocacy for mixed housing

• High stress/fast paced schedules

• Fear of job loss• Complexity (technology,

global issues)

• Walking reduces stress• Build in rewards for rest

and relaxation

Forces of change: Factors

Trends Challenges Opportunities• Decreased government

funding• More competition for limited

resources

• Weak private funding (economic impact, financial markets)

• Collaboration• Efficiencies, increased cost

control and use of best practices

• Increased accountability – are the resources being put to their best possible use?

• Immigration and increasing cultural diversity

• Changing complexion of county

• Discrimination• Communication issues• Health care (no preventative)

• Community enrichment• Strong work ethic

• Aging baby boomers • Sandwich generation• Increased need for health

care• Aging in place• Delayed retirement

• Opportunity for volunteers• Intergenerational familial

help

• Economic pressures – increase in poverty and foreclosures

Forces of change: Trends

Events Challenges Opportunities• Passage of the Affordable Care

Act• Magnitude• Still somewhat undefined• Need for training of first line

responders• Capacity for primary care• Doesn't cover everyone• Enduring need for safety net• Finding time/incentive for

collaboration

• Advocacy• Expand coverage

(undocumented)• Educators give skills to

navigate

• High Tech Act • Mandated investments• Some organizations not

inclined to share information• State health insurance

exchange / cost of changing infrastructure

• Availability of data to effectively manage populations

• Opportunity for self-management

• Sharing of information among providers

• Better outcomes• Collaboration

• Transitions in Care / Navigation Systems

• Coordination of care• Groups come together to

advocate

Forces of change: Events

– What is important to our community?

– How is quality of life perceived in our community?


Community Health

Improvement Plan





Assessment

Forces of Change

Assessment

Community Themes and Strengths

•Conducted 10 Town Hall meetings – 7 English and 3 Spanish-speaking groups– N=198

• Implemented a Community Health Engagement Survey– English and Spanish– Available online and via paper/pencil – N=888


Facilitated Town Hall Meetings– Alianza/ Phoenixville– Communities that Care / Phoenixville– Coatesville Center for Community Health / Coatesville– CYWA / Coatesville– Community Mental Health / West Chester– St. Agnes Day Room / West Chester– Joseph’s People / Downingtown– Head Start / Kennett Square– Second Presbyterian Church / Oxford– Parkesburg Point / Parkesburg

Community Engagement – Town Hall Key Findings

– A strong sense of community; people caring for one another

– Positive, skilled leadership– Pride, hope, mutual respect– Integration of diversity, i.e.,

lack of racism– Good schools – education as a

priority– Good jobs– Safe and affordable housing

– Safety (i.e., low crime)– Accessible, affordable

transportation– Activities for youth; activities

for families– Parental involvement– Recreational space(s)– Strong social programs and

services; assistance when you need it

Chester County Health AssessmentReport from Town Meeting Data Collection StrategyThe Leland Leadership Group, September 2012

“What Makes a Community Strong?”


– Lack of leadership over tough issues

– Lack of understanding that what works in one community may not work in another

– Jobs: number, types and location of jobs don’t match local populations

– Housing: Lack of safe and affordable housing

– Transportation (including lack of taxi services)

– High taxes– Racism

– Poor communication from community leaders (locally and county-level)

– Lack of health insurance or inadequate insurance

– Affordable health care– Teen pregnancy– Inadequate social services– Mental health services– Substance Abuse treatment– Not enough free/affordable

programs and activities for young people and/or families


"What are the challenges this community faces?"



While common challenges were heard across most groups, there were a few critical issues that were frequently mentioned at specific locations.

In CoatesvilleThe need to address issues of violence and traumaConcern over the quality of and access to healthcare

In Coatesville and ParkesburgWhile issues of crime were mentioned by all groups, there were specific concerns expressed in these communities about being killed, kidnapped and/or raped

In PhoenixvilleConcern over the quality of care and prejudice/bias

Community Engagement – Town Hall Key FindingsWhile the challenges were heard across most groups, there were a few critical issues

that were frequently mentioned by specific groups.


Among HispanicsIssues of communicationToo few Spanish-speaking health care providersToo few translatorsConsequentially, a lack of sufficient explanation of health issues, care and treatment

Among African Americans and HispanicsPrejudice and discrimination in the delivery of health servicesInsensitivity from healthcare professionalsDismissive and disrespectful behaviorRacism from police


– Access to jobs, affordable housing, transportation

– Visible, positive role models for young people

– Access to recreational opportunities (free and/or affordable)

– Access to spiritual supports (i.e., an active, engaged faith community)

– Access to affordable, nutritious food

– Access to services: healthcare, mental health, sexual health (STDs,

teen pregnancy, HIV/AIDS), substance abuse (drugs and alcohol)


“What makes a community healthy?"


– Lack of leadership in addressing health issues

– Individual feelings of powerlessness, “collective depression” in certain communities

– Access to services– No insurance or inadequate

insurance for poor and recently unemployed

– Physicians unwilling to take certain insurance coverage

– Location of services – need to travel to get there and no transportation

– Weeks and/or months to get an appointment

– Inadequate levels of specialty care (e.g., dental, addiction services)

– Issues in quality of care– Competence of providers– Discrimination in care and

treatment of poor, Black and Hispanic individuals

– Poor care for those without insurance

– Inadequate resources that impact quality of care - “Can’t get a person on the phone.”

– Misallocation of public resources (e.g., health versus open space)


What are the health challenges this community faces?"



In considering the participants’ comments overall, the following conclusions and “wisdom” emerge.

Leadership matters…Chester County is a rich county but has problems that are both common and

distinctive.

Resources matter…Help needs to be available to those who

need it when they need it.

A sense of safety matters…Issues of crime and violence and a lack of perceived safety have significant and

negative consequences on certain communities.

Parenting matters…Children and youth need more guidance and direction; parents need education

and support


Community Health Engagement Survey– A survey was designed and

fielded in both English and Spanish

– Available online and through a paper survey

– Assistance was provided to those with reading comprehension difficulties

– Nearly 900 surveys were completed during September & October 2012

Community Engagement – Survey Key FindingsWhat do you think are the three most important factors that

contribute to a 'Healthy Community'?

N=888

Clean environment

Strong Family Life

Affordable Housing

Healthy Behaviors and Lifestyles

Good Place to Raise Children

Access to Healthcare

Good Jobs and Healthy Economy

Good Schools

Low Crime/Safe Neighborhoods

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

16%

18%

19%

23%

28%

37%

40%

41%

44%

Community Engagement – Survey Key FindingsWhat do you think are the three most important 'health problems'

in this community?

N=888

Teenage Pregnancy

Domestic Violence

Child Abuse/Neglect

Heart disease and stroke

Diabetes

Cancer

Aging

Mental Health Problems

Substance Abuse

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

13%

15%

17%

20%

21%

27%

32%

35%

47%

Community Engagement – Survey Key Findings

What do you think are the three most important 'risky behaviors' in our community?

Tobacco Use

Unsafe sex

Dropping out of School

Lack of Exercise

Drunk Driving

Poor Eating Habits

Being Overweight

Drug Abuse

Alcohol Abuse

0% 10% 20% 30% 40% 50% 60%

15%

16%

18%

23%

23%

28%

40%

48%

51%

N=888


“How would you rate…

Very Unhealthy

Unhealthy

Somewhat Healthy

Healthy

Very Healthy

0% 20% 40% 60% 80%

1.1%

4.3%

27.5%

49.7%

16.2%

Very Unhealthy

Unhealthy

Somewhat Healthy

Healthy

Very Healthy

0% 20% 40% 60% 80%

1.8%

9.0%

52.9%

30.1%

5.2%

…your own health?” …the community’s health?”

N=888N=888


Missing

Asian

Native American

Other

Hispanic

African American

Caucasian

4.5%

0.5%

0.7%

1.6%

9.9%

12.7%

70.2%

Race and Ethnicity

71%

23%6%

Gender

FemalesMalesMissing

65 or over

55-64

40-54

26-39

25 or less

11.5%

21.2%

29.7%

21.7%

11.8%

Age Cohorts

N=888


$75,000+

$55,001 to $75,000

$35,001 to $55,000

$25,001 to $35,000

<$25,000

Missing

37.0%

10.5%

12.0%

7.7%

19.3%

13.5%

Household Income

83%

14% 4%Healthcare Coverage

YesNoMissing

College degree or Higher

Some College

Trade School/Special Training

HS Diploma or GED

Less than HS

Other

Missing

62.8%

3.2%

1.0%

21.5%

7.0%

0.2%

4.3%

Education Level

N=888

Development of Strategic Issues

• Differ from critical issues in that critical issues are important but strategic issues are important and forward-thinking and seize on current opportunities

• Build on the results of all previous MAPP phases

• Emerge by examining the challenges and opportunities and how they affect the identified vision

• Characteristics of a "Good" Strategic Issue:–Require immediate or future action–Represent a fundamental choice to be made at the highest levels of the

community and LPHS–Center around a tension or conflict to be resolved–Have no obvious best solution–Must be something the local health system can address (and change)

Strategic IssuesHow can the community expand the concept of

cultural competence to ensure access and use of services?

Ensure early and adequate prenatal

care for all women

Ensure compliance with health screening

recommendations

Create an environment in which cultural

competence is the norm

Ensure that all persons living in our community

will have access to and utilize high

quality, affordable health and social

services

Strategic IssuesHow can the community partner to provide a

seamless, highly coordinated network of services that address an individual’s physical and

behavioral health issues?

Increased coordination among health and human service

providers

Increase number of patients/clients that are jointly

managed across systems

Strategic IssuesHow can the community increase awareness of

and education about health and social services to help them meet their basic needs?

Increase employer benefit programs

Increase commitment to improve individual health

Strategic IssuesHow can the community encourage and support

individuals to take action in their own health management and well-being, including

prevention?

Create environment in which health and social service

resources and information are readily accessible

Public education regarding health and social services that are available to the community

Strategic IssuesHow can community leaders help create

supportive environments to ensure the health and safety of their communities?

Ensure that community leaders understand the issues related to

health and social services specific to our community

Link community leaders to perceptible improvements in community health outcomes.

The Assessment Phase is Complete…

Time for Action!

Pre-Meeting Survey Results

Strategic Issues %Cultural Competence 44.8

Coordinated Services 43.1

Education /Awareness 63.8

Health Management 55.2

Safe Environment 48.3

Please indicate which of the strategic focus areas you or your organization are interested in:

N=58

Current Activities % Yes % No % Not Sure

Cultural Competence 56.9 29.3 10.3

Coordinated Services 53.4 32.8 10.3

Education/ Awareness 81.0 10.3 10.5

Health Management 79.3 10.3 5.2

Safe Environment 58.6 19.0 13.8

Pre-Meeting Survey ResultsPlease indicate whether you or your organization are already working on issues related to each of the strategic focus areas:

N=58

• Questions/Comments

• Next steps

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RoadMAPP to Health: Community Health Assessment for Chester County.

Documents