St. Joseph Mercy Hospital, Ann Arbor 2012 Community Health Needs Assessment & Implementation Strategy TABLE OF CONTENTS

Transcription

1 St. Joseph Mercy Hospital, Ann Arbor 2012 Community Health Needs Assessment & Implementation Strategy TABLE OF CONTENTS I. Executive Summary II. Community Description III. Community Health Needs Assessment Partners IV. Community Health Needs Assessment Methodology and Process V. Identified Community Needs A. Needs Identified 1) Obesity 2) Immunizations and Vaccinations 3) Asthma 4) Nutrition 5) Access to Care 6) Perinatal Health 7) Physical Activity 8) Sexually Transmitted Diseases 9) Substance Abuse 10) Social Support 11) Mental Health 12) Physical Environment 13) Dental Health

2 TABLE OF CONTENTS (con t) B. Process for Prioritizing C. Prioritized Needs VI. Community Resources and Assets to Address Needs A. SJMAA Internal Resources and Assets B. External Community Based Resources VII. Implementation Strategy A. How SJMAA Will Address Health Needs B. Needs SJMAA Will Not Directly Address VIII. SJMAA Community Health Logic Model Adults IX. References 2

3 I. Executive Summary Background and Process St. Joseph Mercy Hospital, Ann Arbor (SJMAA) participated in a community health needs assessment (CHNA) and developed an implementation plan with strategies to address identified needs. The service area assessed was Washtenaw County. The assessment was conducted in partnership with the Washtenaw County Health Improvement Plan Teams along with input from the University Of Michigan Health System, local safety net clinics and area health coalitions. SJMAA used survey data, stakeholder interviews, and information gathered from other data sources to identify the needs of residents of Washtenaw County. After reviewing the data, and compiling a list of existing resources, SJMAA developed an implementation plan for addressing these needs. This assessment and its implementation plan were then reviewed and approved by the Saint Joseph Health System Board of Trustees in June Needs Identified The needs identified include: Obesity, Immunizations and Vaccines, Access to Care, Heart Disease, Mental Health, Dental Health, Substance Abuse, Nutrition, Physical Activity, Physical Environment, Transportation, Social Support, Family and Community Involvement, Prescription Drug Assistance, Wellness and Prevention, Breastfeeding, and Mammograms. Prioritized Needs Utilizing stakeholder input, the identified needs were prioritized by the Community Benefit Ministry Council (CBMC) based on the following criteria: size and severity of the problem, health systems ability to impact the problem, and the availability of existing resources. Based on these criteria several areas were chosen to be the most important for the hospital to focus on. These needs are obesity, immunizations and vaccines, access to care, mental health, dental health, breastfeeding and mammograms. Implementation Plan SJMAA s response to the health needs identified in this assessment will be managed by the Community Benefit Ministry Council, with direct executive responsibility. The CBMC has appointed teams for each of the prioritized needs. These teams will engage key community partners in implementing evidence-based strategies across the service area. These strategies will be developed further over several months and detailed implementation plans created. Relationship to Strategic and Operational Plans As a faith-based healthcare organization in the Catholic Christian tradition, the work of providing services that benefit the community is core to our identity. While encouraged by laws and regulations that require non-profit tax-exempt hospitals to provide services to those in need, we are ultimately compelled by a desire to extend the healing ministry of Jesus Christ. (cf. John 13:14-17, Matthew 25:35-36) Our mission and core values call us to improve the health of our community with a particular concern for the poor and underserved. 3

4 Because this work is so crucial to our identity, it is embedded within our organizational strategic and operational plans. Financial and performance targets are created with the goal of strengthening our Community Benefit Ministry, particularly our response to the health needs identified in this assessment. Beginning in Fiscal Year 2013, significant Community Benefit metrics will be tracked monthly as part of our Operations Plan. 4

5 II. Community Description The St. Joseph Mercy Hospital, Ann Arbor (SJMAA) Service area for purposes of this need assessment is defined as the population of Washtenaw County. Washtenaw County has a population of 347,091 as of December This is up 6.8% from 322,270 in CY Below is a chart showing population changes by age cohort from 2000 to Each age group showed an increase in size with the exception of those ages

6 The population of Washtenaw County is 75.9% White, 12.5% Black, 7.8% Asian, 2.9% Multi- Racial and 4% Hispanic. The chart below shows how this mix of ethnicities has changed over time. The median household income for Washtenaw County residents is 59,065. This number has declined over 13% from

7 11.1% of residents in Washtenaw County live in poverty. This number has increased 2.6% since

8 III. Community Health Needs Assessment Partners Community Benefit Ministry Council (CBMC) he Community Benefit Ministry Council (CBMC) is a leadership council comprised of SJMH Physicians, Clinic Coordinators, Patient Financial Services representatives, clinicians, and administrators with knowledge in community benefit ministry and health improvement. This group meets monthly to review and analyze data, identify community partners, set priorities and make decisions about the hospital s community benefit ministry initiatives. Subcommittees of the CMBC are responsible for conducting the community health needs assessment and developing the implementation strategy as well as implementing the plan, and evaluating community benefit ministry programs. Health Improvement Plan of Washtenaw County SJMAA is a funding member of the Washtenaw County Health Improvement Plan (HIP), a collaborative effort of public and private organizations aimed at improving health. HIP includes representatives from Washtenaw County Public Health (WCPH), Chelsea Community Hospital (CCH), the University of Michigan Health System (UMHS), Thompson Reuters, public officials, community members and other organizations working to improve health in the region. [i The HIP website provides the following summary of the collaborative and its history: The Washtenaw County Health Improvement Plan (HIP) is a community health assessment and planning effort aimed at improving the health of county residents. The project began in 1994 with the formation of the Community Health Committee (CHC), a collaborative body comprised of representatives from the Health Department, local health systems, numerous community agencies, coalitions, local businesses and lay citizens, all working together to improve health. In 2000, HIP completed the first cycle of a three part health improvement process. The process included a county-wide health assessment (including a review of morbidity and mortality statistics, a thousand household telephone survey regarding health risks and health behaviors, and qualitative data regarding community perspectives of health issues facing the county); a planning phase to establish health priorities and goals; and implementation of health improvement strategies to address priority health issues. The CHC is the umbrella group that oversees the project. The group hosts bimonthly meetings which feature guest speakers on health issues pertaining to HIP goals, reports on health improvement projects, and time for discussion and networking. There are also two subcommittees responsible for much of the ongoing work to maintain the HIP project. These are the Implementation Team 8

9 and the Coordinating Committee. The Implementation Team focuses on data gathering and analysis, and supporting community involvement in HIP, and maintains contact with numerous community-based coalitions that work toward HIP goals. The Coordinating Committee sets the agenda for CHC meetings and considers bigger picture issues that may affect HIP. The HIP provides both a challenge and an opportunity for the individual and corporate citizens of Washtenaw County to make a commitment to improve health for all. Our hope is that these goals and objectives will enable a unified front within the county for addressing these urgent local issues. We encourage involvement from all members of our community. Our likelihood of reaching targets is much greater when we unite our efforts. i SJMAA participates in all three HIP committees Community Health Committee, Implementation Team, and Coordinating Team. The Community Health Committee is chaired by a SJMAA representative. This partnership provides access to data and facilitates collaboration among leaders in the health field in Washtenaw County. It was through participation in the Implementation team, that SJMAA was able to add specific questions to the HIP survey that pertained to the hospital s community benefit ministry plan. 9

10 IV. Community Health Needs Assessment Methodology and Process HIP Survey Methodology The HIP survey is conducted in Washtenaw County every five years. The Office for Survey Research at Michigan State University s Institute for Public Policy and Social Research conducted the 2010 survey. A total of 2,241 telephone surveys were completed in Washtenaw County from November 5, 2010 to May 1, A full report of survey methods ii is available online at the Washtenaw County Public Health website. Michigan Profile for Healthy Youth (MiPHY) The MiPHY is a bi-annual, anonymous online survey of 7 th, 9 th, and 11 th grade students in participating school districts in Michigan. This survey measures health behaviors as well as risk and protective factors in peer groups, families, schools and communities. The survey tool is developed by the Michigan Department of Education. Key Stakeholder Interviews Realizing the HIP survey did not reach every segment of the population, leaders from SJMAA met with numerous groups and organizations to gain additional insight into the health needs of the community. Consulted organizations include the University of Michigan Health System, the Packard Clinic, the Hope Clinic, Washtenaw County Council Members, The Washtenaw Health Initiative, several physician practices and employees of the health system. Community Conversations were also conducted by a third party with members of both the Hispanic and African American local community to determine their health care needs, access issues and strategies for improvement. SJMAA served as a host site for the African American conversations. Information Gaps Both the HIP and MiPHY surveys have certain limitations related to bias, sample, and wording of questions. The HIP survey controls for age, gender, race, income, education, health status and region of the county. Questions on the HIP survey are nationally tested for reliability and validity, and many are taken from the Centers for Disease Control or National Institutes for Health. This survey is conducted by landline phones, which excluded a large portion of the population, as many Washtenaw County residents use cell phones only. There might also be something fundamentally different about people who agree to participate in a 20-minute survey about health, compared to people who refused. 10

11 The MiPHY survey includes questions developed to screen out youth who are answering questions falsely, or not paying attention to their answers (for example, by clicking yes to all questions on a page without reading the questions). However, some questions are confusing for students, and adults overseeing survey implementation are not allowed to explain or clarify any questions, so as not to skew student responses. This may lead to some false answers by students who do not understand the questions. In addition to survey limitations, there are some gaps in the information SJMAA is able to collect that impact our ability to assess the needs of the community. These limitations are mainly related to individuals and families that do not access services at SJMAA, or any of the organizations included in the key stakeholder interviews, or wellness coalitions assessments. Reliable data on the needs of these populations is not readily available, and could not be included in this assessment. 11

12 V. Identified Community Needs A majority of adults in Washtenaw County (87.8%) rate their health status as excellent or good. This is a decline from 2005 survey data that showed 91.3% of residents rated their health status as excellent or good. The rate has declined for whites (93% to 87%) and Asians (97% to 94%) but has increased for the black population (73% to 85%). Approximately 60% of adults report no days of poor physical health in the last month. 12

13 A. Needs identified in health surveys and key stakeholder interviews include the following: 1. Obesity Between 2005 and 2010 the number of Washtenaw County residents who are overweight or obesity increased almost 20%. White residents were the least likely to consume 5+ fruits and vegetables a day. Two thirds of Black residents surveyed were overweight. The amount of physical activity performed per week increased from The residents who are most likely to be overweight are those living in Ypsilanti and the Rest of the County (excludes cities of Ann Arbor and Ypsilanti and Western Washtenaw County). Ann Arbor residents are the least likely to be overweight. Residents with no health insurance are twice as likely to be overweight as those with health insurance. In 2010 more residents were advised by their physician regarding their weight. 13

14 2. Immunizations and Vaccinations Only 64.7% of residents 65+ have ever had a pneumococcal vaccination. 58.2% of residents have had a flu vaccination in the past 12 months. The number of children age months who are fully immunized is 70%. Vaccination rates among adults have increased slightly from 2005, however declined among children. 14

15 3. Asthma Asthma rates increased from 16.2 to 19.6% in Residents of Ypsilanti have the highest rate at over 25%. Ann Arbor is the next highest, and Western Washtenaw third. The rest of the county is the least likely to have asthma. Black residents have the highest rate at 36%. This has increased from 25% in Residents without health insurance are three times as likely to have asthma as their insured counterparts. 15

16 4. Nutrition The percent of Washtenaw County residents consuming 5 or more fruits and vegetables per day has declined from

17 People with a household income of less than 35,000 are the least likely to get the proper amount of fruits and vegetables each day. Asians were the most (28%) likely to get 5+ servings a day followed by whites (15%) and blacks (13%). Residents in the lowest income bracket (less than 35,000) are the most likely to eat fast food at least once a week. 12.6% of households in the income bracket $35,000 and under reduced their food intake at least once due to food costs. Residents in Western Washtenaw County were most likely to reduce their food intake due to cost. 17

18 5. Access to Care The number of residents with health insurance declined from 92% to 89% year olds were the least likely to have health insurance, followed by the group Western Washtenaw and the Rest of County were the regions with the highest rates of uninsurance. 78.8% of residents have a regular health provider. Below is a chart showing the percent of residents that could not afford to see a doctor in the past year. The group most affected is the population age at 19.9% of respondents answering they could not afford to see a doctor and residents of Ypsilanti at 17.7%. This trend has been climbing since 2000 as shown in the chart below. 13.8% of Ypsilanti residents responded they had delayed filling a prescription due to cost. 18

19 6. Perinatal Health - Breastfeeding Rates of initiating breastfeeding in the county overall are up from 72% to 82%. However 24.4% of mothers in Ypsilanti have never breastfed. 24.6% of Western Washtenaw mothers have never breastfed. 23.5% of homemakers have never breastfed. 19

20 7. Physical Activity Only 44.1% of the population gets adequate physical activity as defined by 30 minutes per day for 5 days a week. Asians were the least likely with only 34% getting the recommended amount. The geographic region getting the least amount of exercise is the Other parts of the county. Ann Arbor zip codes get the most exercise, followed by the western portion of the county. 20

21 21

22 8. Sexually Transmitted Diseases The rate of Chlamydia has decreased from 3,345 per 1000,000 to 3,272 per 100,000. This is still higher than the state average. The percentage of the population of females age 16+ is 24%. As shown in the graph below, the number of people who have had more than one sex partner in the last year has increased to over 11%. 22

23 9. Substance Abuse 23

24 10. Social Support 24

25 25

26 11. Mental Health 26

27 12. Physical Environment 27

28 13. Dental Health 20% of residents have lost one or more teeth due to decay. 28

29 B. Process for Prioritizing Members of the SJMAA CBMC reviewed survey data, findings from key stakeholder interview, prior focus group information, and information gathered from other health coalitions. The following needs were identified as the most important based upon the following criteria: 1) the number of people affected, 2) the severity of the problem, 3) the health system s ability to impact, and 4) the extent to which other organizations are meeting the need. The CBMC then voted on the needs based on based on this criteria. Each member was asked to choose the top three needs. The votes were then tallied to create a ranked listing. C. Prioritized Needs The following needs were identified as the most important, according to the criteria outlined above: 1.) Obesity 2.) Immunizations and Vaccines 3.) Breastfeeding 4.) Mammograms 5.) Access to Care 6.) Dental Care 7.) Mental Health and Substance Abuse 29

30 VI. Community Resources and Assets to Address Needs 1. Obesity St. Joseph Mercy Ann Arbor Internal Resources Several services are offered for children, adults and families that relate to weight management, nutritional counseling, and healthy lifestyles. They include: NutriCare Nutrition Program offering customized assessment, planning and counseling in both individual and group settings. HMR and Healthy Solutions weight management programs utilizing meal replacements and behavioral education. Shapedown Program weight management and education program for Children, Teens, and Parents NutriCare Healthy Eating and Lifestyle Program for adults seeking to loose weight and lower their cholesterol Senior Fit exercise program offering classes target for older adults Inpatient nutrition counseling for disease and condition specific populations Fitness Studio and Teaching Kitchen available for community use Community Resources and Assets Washtenaw County has a plethora of educational opportunities, programs and for-profit companies that provide services targeting individuals seeking weight management assistance. The challenge has been reducing access barriers to these resources for those who are living in poverty or have limited resources. Samplings of resources available include: Healthcare providers (primary care physicians, University of Michigan Health System Nutrition and Weight reduction programs) Parks and Recreation County and private recreation centers Senior Centers Michigan State University Extension service Growing Hope Food Gathers Food Bank 30

31 2. Immunizations and Vaccines St. Joseph Mercy Ann Arbor Internal Resources Adult immunization screening for seasonal influenza conducted upon admission Pneumococcal Vaccine screening upon admission and appropriate guidelines for administration and contraindications Electronic medical record enhancement to capture immunizations and vaccines Flu vaccines provided through community agencies, churches, and civic organizations in partnership with our Faith Community Nursing program Adult and children Flu Vaccines given at Primary Care Clinics routine and sick visits for patients covered by private insurance or VFC (Vaccine For Children Program) Community Resources and Assets Washtenaw County Immunization Coalition (education, outreach, clinics) Washtenaw County Health department (low cost immunizations) Visiting Nurses Association Local pharmacies (easy access and low cost immunizations) Pharmaceutical companies Senior centers and various community locations offering sites for flu clinics 3. Access to Care St. Joseph Mercy Ann Arbor Internal Resources Academic OB/GYN clinic (resident training OB/GYN clinic with social work, nutrition, and nurse practitioner services) Neighborhood Family Health Center (primary care with case management and social work services for underserved population) Academic Internal Medicine Clinic (resident run primary care clinic for underserved with social work, nutrition support services) McAuley Support (internal funding source to low income individuals meeting criteria) Financial Counselors and Social Workers available to assess, link, and educate those in need with community resources and financial/insurance resources 31

32 Community Resources and Assets Hope Clinic (underserved population at low or no cost providing primary and dental care) Packard Health Clinic (targets underserved populations for primary care) Washtenaw Health Plan (local collaborative to help provide insurance coverage to those meeting criteria in Washtenaw County) University of Michigan Health System Chelsea Grace Clinic 4. Mental Health St. Joseph Mercy Ann Arbor Internal Resources St. Joseph Mercy Behavioral Services providing outpatient, inpatient, and daytreatment programs for numerous mental health conditions. Psychiatric Access to provide emergent assessment of mental health needs. Social Work services providing inpatient and outpatient services related to chronic and acute health care conditions and related mental health needs. Social Work services provided within SJHM clinics targeting under-served and under-insured. Neighborhood Family Health Center integrated partnership with Washtenaw Community Health Organization to provide on-site mental health care for severly mentally ill patients in coordination with the primary care physician. Community Resources and Assets Washtenaw Community Health Organization is a community mental health services program serving the Medicaid population in Washtenaw and neighboring counties. They provide a multitude of services from infant mental health in home service through crisis assessment and intervention services for adults. The populations served by the WCHO are individuals with serious mental illness, developmental disabilities and substance use disorders. Catholic Social Services provides behavioral health counseling Numerous private mental health practitioners, but typically require private pay or third party reimbursement Washtenaw Health Initiative is a voluntary, county-wide collaboration focused on how to improve access to coordinated care for the low-income, uninsured, and Medicaid populations. They have identified that mental health is one of 3 priorities to address with concrete strategies. SJMH is a major partner in this collaborative. 32

33 5. Dental Health St. Joseph Mercy Ann Arbor Internal Resources Oral Surgeons on medical staff Emergent care provide through emergency room Community Resources and Assets Hope Clinic provides dental care services on site Washtenaw County Oral Health Task Force to address the oral health needs in local community. Community Dental Clinic provides free or low cost dental care to those in need United Way Funds to assist those clinics providing free or low cost dental care Washtenaw Health Initiative have embraced dental health as a major health need for our community and working with local dentists, payers, and health systems to develop concrete, proactive strategies to deliver and fund care before more emergent needs arise. 6. Breastfeeding St. Joseph Mercy Ann Arbor Internal Resources Breastfeeding Consultation provided by 6 certified lactation consults on staff Breastfeeding prenatal classes provided Referrals to in-home Lactation Consultants provide Outpatient and telephonic assistance provided by Lactation Consultants Efforts towards a Baby Friendly Designation Breastfeeding Committee to develop policy, education, classes Member of Washtenaw County Breastfeeding Coalition Pediatric and OB/GYN office based resources to support breastfeeding 33

34 Donor milk program for NICU babies established Community Resources and Assets Washtenaw County Breastfeeding Coalition to educate and advocate for breastfeeding friendly environments and policy LeLeche League Center for Child-bearing Years/Doulas Care Private Lactation Consultants Washtenaw County Public Health department, WIC program University of Michigan Health System Lactation Service and Women s Health Program 7. Mammography St. Joseph Mercy Ann Arbor Internal Resources Clinical breast exams provided through private physician practices, Academic OB/GYN, AIM, and NFHC clinics Mammography screenings provided in 6 locations at SJMHS Breast Health Services Diagnostic mammograms and follow up services provided in 3 locations Title XV provider for breast and cervical cancer screenings Susan G. Komen Foundation recipient to fund Breast Friends Forever=Life no cost screening mammograms Outreach efforts at local churches, community events to educate on self breast exam, screening, and no cost/low cost mammography Low cost mammography days Interdisciplinary breast clinic Breast Cancer nurse navigator Community Resources and Assets University of Michigan Comprehensive Breast Care Center Comprehensive Breast Center (private practice and imaging center) 34

35 VII. Implementation Strategy In order to address needs identified in the Community Health Needs Assessment (CHNA), the SJMAA Community Benefit Ministry Council has created implementation teams to address each of the needs identified. These teams collaborate with the many organizations and resources in in our community to create and implement strategies and programs to address these identified health needs., A. How SJMAA will address health needs The SJMAA Community Health 2012 Logic Models outline the problems, strategies, activities, and outcomes for each of the five priority health needs identified in the CHNA (next page). These logic models constitute our CHNA Implementation Plan. We understand this Implementation Plan to be a living document and subject to ongoing revision and enhancement. To ensure an effective response to our community s health needs, these enhancements will require SJMAA to budget additional funds in the coming years Many of the strategies and activities outlined in the logic models address risk factors associated with multiple identified needs. For example, strategies to promote healthy eating and physical activity will affect obesity as well as heart disease. These strategies also might have a positive impact on mental health, as will strategies to reduce substance abuse. Further, we anticipate many of these strategies closely aligning with the wellness plans of our community partners. B. Needs SJMAA Will Not Directly Address There were needs identified that St. Joseph Mercy Hospital choose not to address. These needs while important to the health system and the community were not chosen based on our prioritization process. This process included the following questions: 1) the number of people affected, 2) the severity of the problem, 3) the health system s ability to impact and 4) the extent to which other organizations are meeting the need. The needs that were not chosen as follows are: 1) Asthma St. Joseph Mercy Hospital has been actively involved in Washtenaw County s Asthma Coalition and continues to do so. This entity has worked to provide community and provider education as well as helping to identify best practices. In the recent past, asthma was also a major community benefit initiative by SJMH that led to significant 35

36 collaborative efforts with schools and hospital based services (case management and pediatric emergency case management). Currently, a home care based strategy is in place. Thus, our attention to other less met needs were prioritized 2) Nutrition Good nutrition is necessary to prevent diseases and conditions including obesity. By choosing obesity as a priority area, we feel we will address both physical activity and nutrition risk factors. In addition SJMH supports and collaborates with other organizations dedicated to increasing food security for the population such as Food Gatherers. SJMH also regularly responds to community requests for speakers on nutrition topics, have offered cooking classes to teach health cooking and nutrition, and continue to provide individual and group services related to condition specific needs, e.g. diabetes, gluten free, low fat, cholesterol management and numerous others. Our efforts to continue to work closely with our physician network to provide more of these services at point of care and not exclusively on our campus, thus improving access 3) Perinatal Health: SJMH has a major obstetrical program and major network of private practice practitioners including OB/GYN doctors, nurse practitioners and midwives providing perinatal health services. In addition, our Academic OB/GYN and Neighborhood Family Health Center provide similar services to low income, uninsured or underinsured women. To support this effort, numerous healthy living educational offerings are offered to our community as well as a plethora of pre-natal classes for pregnant woman. SJMH is also a member of the Washtenaw County Infant Mortality Coalition which currently has several efforts underway. The 3 X More Likely campaign targets young African American women in our community to provide them with healthy living guidance prior to conceiving. And also addresses prenatal health, if already pregnant. Please visit the website for more details. In light of all these major efforts that we continue to be actively committed to, we have prioritized other needs. 4) Physical Activity The lack of physical activity is a risk factor for many diseases and conditions including obesity. By choosing obesity as a priority area, we feel we will address both physical activity and nutrition risk factors. 5) Sexually Transmitted Diseases Washtenaw County has many organizations working to reduce the prevalence of STDs in the county. Among these are the University of Michigan Health System, the Corner Health Center for adolescents, primary care physician offices, and others. At this time 36

37 the hospital did not feel it could provide the most effective programs to reduce STDs prevalence,and instead supports the work of those organizations that do. SJMH has been involved in the community education efforts around the HPV virus and have provided physician speakers. 6) Social Support Social support is important to mental health for both youth and adults. St. Joseph Mercy Hospital currently has several support groups that meet on campus and provides space for groups to meet for social gatherings, and other activities. SJMH also participates in several health coalitions that support these types of activities. SJMH will continue to participate in these coalitions and support planning and implementation of activities to promote social support as much as possible but will not implement new programs around social support.. 7) Physical Environment The physical environment will not be addressed directly by the hospital. Walk-ability and easy access to grocery stores can be major barriers to regularly participating in physical activity, and accessing fresh fruits and vegetables. SJMH is committed to improving the health and wellness of our communities, and fully supports local governments and wellness coalitions in their efforts to impact these issues. As a community neighbor, we did extend the border to border trails that connect Ypsilanti with the Ann Arbor communities through our campus. 37

38 VIII. SJMAA Community Health Logic Model

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40 IX. References 1 Southeast Michigan Council of Governments (SEMCOG), The Washtenaw County Behavioral Risk Factor Survey, 2010: Methodological report, June 2010, available at: 1 Michigan Profile for Healthy Youth MiPHY, 1 Washtenaw County Health Improvement Plan Survey 2010.

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