Clinton County Community Health Assessment Working Together to Strengthen Our Community. 0 P a g e

Transcription

1 Clinton County Community Health Assessment Working Together to Strengthen Our Community 0 P a g e

2 Message to Community: We are proud to present our Clinton County Community Health Assessment & Implementation Strategy/Community Service Plan. The University of Vermont Health Network Champlain Valley Physicians Hospital (CVPH) and the Clinton County Health Department (CCHD) have attempted to produce a document that residents, as well as community partners, can use to better understand the health status and health needs of our community. When collaborating through this process, we were struck by the similarities of the missions/visions of CCHD and CVPH Working together for a healthier community and Working together, we improve people s lives. Over the next few years, we hope you will join us in working towards those motivational statements to better the community we all call home. Stephens Mundy, President & CEO, CVPH Jerie Reid, Director of Public Health, CCHD Contact Information University of Vermont Health Network - Champlain Valley Physicians Hospital Marketing and Communications 75 Beekman Street, Plattsburgh, NY CVPHMarCom@cvph.org Clinton County Health Department Administration 133 Margaret Street, Plattsburgh, NY health@clintoncountygov.com 1 P a g e

3 Table of Contents Executive Summary... 4 Introduction... 8 Lead Organizations in the Community Health Assessment Process... 9 Community Health Assessment Stakeholder Groups New York State Health Department Prevention Agenda Health Care Transformation: Current Population Health Initiatives in our Region Complementary Community Assessments Community Profile Geographic/Service Area Profile/Demographic Characteristics/Economic Profile Educational Profile Health System Profile NYS Prevention Agenda Priority Areas Improve Health Status and Reduce Disparities Promote Healthy and Safe Environment Prevent Chronic Disease Promote Healthy Women, Infants, and Children Prevent HIV/STDs, Vaccine Preventable Diseases and Health Care Associated Infections Promote Mental Health and Prevent Substance Abuse Community Health Assessment Process and Methods Resident & Stakeholder Surveys Secondary Data Analysis Community Health Planning Session Significant Community Health Needs Progress To Date Community Resources Priority Selection Process Selection Basis and Methods Maintaining Engagement & Tracking Progress Dissemination of Plan to Public Evaluation Plan P a g e

4 Community Health Improvement Plan/Implementation Strategy Action Plans Health Priority 1: Chronic Disease Action Plan Health Priority 2: Mental Health and Substance Abuse Action Plan Appendices A: Committee Members and Meeting Schedule B: NYS Prevention Agenda Priority Areas, Focus Areas and Goals C: AHI DSRIP Project & Current Population Health Initiatives D: Health Priorities by Sector E: Demographic Profile F: Educational Profile G: Health System Profile H: Resident and Stakeholder Surveys I: Data Consultants, Data Sources and Methodology J: Prevention Agenda Indicators with Links K: Secondary Data Analysis Summary & Findings L: Clinton County Community Resources & Assets M: Participant Characteristics, Event Voting Results & Finalization Methodology and Results N: Clinton County Health Department Accreditation Letter O: Acronym List P a g e

5 Executive Summary The University of Vermont Health Network - Champlain Valley Physicians Hospital (CVPH) and Clinton County Health Department (CCHD) have a long history of collaboration to improve the health of residents in Clinton County. The Community Health Assessment (CHA)/Community Service Plan (CSP) and Implementation Strategy (IS)/ Community Health Improvement Plan (CHIP) have all been created collaboratively and, when applicable, filed jointly. This unique effort, also supported by the Adirondack Rural Health Network, demonstrates cohesive community health assessment and improvement planning. The partnership between the two lead organizations assures synergistic, non-duplicative, meaningful strategic efforts towards the common goal of improving the population s health and contributing to the Triple Aim. Input was also solicited from community organizations and the residents of Clinton County for consideration within the required documents to assure inclusion reflective of the needs of our shared population. Prevention Agenda Priorities: CVPH and CCHD, working collaboratively and informed by community stakeholders and residents, selected Prevent Chronic Disease and Promote Mental Health and Prevent Substance Abuse as priority areas. There are two focus areas under Prevent Chronic Disease, Reduce Obesity in Children and Adults and Increase Access to High Quality Chronic Disease Preventative Care and Management in Clinical and Community Settings. Our goal around the first focus area is to create community environments that promote and support healthy food and beverage choices and physical activity as demonstrated by a decrease in residents reporting no leisure time physical activity and an increase in residents reporting adequate daily fruit and vegetable consumption. Our goal around the second focus area is to increase screening rates for colorectal cancer, especially among disparate populations, as evidenced by the percentage of adults receiving recommended screenings and achieving the Healthy People 2020 target for age adjusted colon cancer death rates. There is one focus area under Promote Mental Health and Substance Abuse, Prevent Substance Abuse and Other Mental, Emotional, 4 P a g e

6 Behavioral Disorders. Our goal is to prevent and reduce the occurrence of mental health disorders as evidenced by a decrease in reported poor mental health days. Disparities exist within each of the priority areas based on income and access to care with specific goals targeting low income residents. Additionally, there are specific efforts and activities outlined in the implementation strategy to address known inequities in access or health for additional disparate groups. These populations are noted within the implementation strategy table and include groups such as those with disabilities, the aging population, and those with a mental, emotional or behavioral (MEB) health diagnosis. Emerging Issues and Continuing Projects: Promote Mental Health and Substance Abuse remains a priority identified by community stakeholders and members alike. Planned strategies and activities expand upon work accomplished and infrastructure developed since 2013 with a new emphasis on substance abuse prevention, intervention and recovery, MEB wellness on a population level, and continued collaborative monitoring and analysis of identified metrics most meaningful to the Clinton County community. However, the identified Priority Areas for do reflect a surface level adjustment from the 2013 community health needs assessment. The Promoting a Healthy and Safe Environment priority area has been changed to Prevent Chronic Disease. There is an acknowledgement among stakeholders representing both groups that policy, systems and environment strategies are extremely important in influencing health behaviors in the short term and health outcomes into the future. There is a consensus that work should continue to include upstream interventions as the current community health plan does. However, the adjustment allows local clinical and interventional efforts to be integrated with current activities and it activates additional partners in bringing the community s health improvement plan to life. The chosen focus areas for both Priority Areas reflect accepted or emerging health issues of 5 P a g e

7 concern to stakeholders and residents. They are also areas that the community feels well positioned to address given current resources and momentum. Data Review: CVPH and CCHD obtained and examined data from a variety of sources; the details of which are explained in their entirety throughout the CHA. In short, the group spent a large amount of time reviewing the New York State Prevention Agenda with particular interest in the county level dashboards. The workgroup reviewed data from HealthyAdk.org, the Center for Health Workforce Studies, CommunityCommons.org, Robert Wood Johnson Foundation s County Health Rankings and locally obtained primary data related to a number of health conditions and behaviors. To determine metrics of most significance, the lead organizations considered areas in which Clinton County was identified as worse than NY and US values, performance below the 25 th percentile, common themes brought forth by focus groups, affecting significant number of people, and disparities associated with the need. Additionally, the group looked for new or changing health trends. Strong consideration was also paid to qualitative data collected from community residents directly through meetings, surveys and qualitative program data. Partnerships: The completion of the Clinton County CHA, CSP, IS, and CHIP was a collaborative effort between CCHD and CVPH. CCHD and CVPH have a long standing history of collaboration and collectively bring multiple community groups to the table to have the greatest impact on the health of individuals in Clinton County. Community Engagement: The community engagement process used involved two surveys (one to organizations and one to community members) and a priority setting session for key community stakeholders. This community session resulted in the identification of two main community health needs of focus. A smaller group of community stakeholders took the work from the retreat, surveys, and data to prioritize the focus areas under each of the priority areas to put the greatest effort towards. Lastly, the CHA/CSP/CHIP/IS will be shared in a variety of community settings. Community survey results were 6 P a g e

8 shared back with partners who assisted in connecting residents to the survey and the community at large through an overview of findings posted on CCHD s website and promoted via social media. The CCHD s Action for Health and CVPH s Community Health Assessment Steering Committee have been kept apprised and regularly consulted as the documents were being developed. Planned Interventions & Strategies: All implementation strategies, interventions, activities and measures are outlined in great detail within the Implementation Strategy and Community Health Improvement Plan. Strategies were only selected if they were evidence based, and most strategies were derived from Prevention Agenda guidance and other reputable national resources. Interventions represent work from a variety of partners that will contribute to the shared goals defined above. For Prevent Chronic Disease, interventions will expand education programs and target high risk groups continuing the built environment work already underway. Community promotion of existing and newly established opportunities for health will be undertaken. For Promote Mental Health and Prevent Substance Abuse, interventions continue to focus on partner engagement and integration of chronic disease and mental health. Evaluation of Success: Progress towards the identified health goals will be continually tracked through the Action for Health Consortium with formal progress captured in annual community health plan documents. Work plans include specific process measures to help capture progress throughout the year. 7 P a g e

9 Introduction The University of Vermont Health Network - Champlain Valley Physicians Hospital (CVPH) and the Clinton County Health Department (CCHD) conducted this Community Health Needs Assessment (CHNA) or Community Health Assessment (CHA) (these are used interchangeably) to identify and prioritize the community health needs of the patients and communities within Clinton County (CVPH s service area). A CHA is a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon unmet community health needs. Also included in this document is an implementation strategy (IS) which is a three The Clinton County Community Health year plan of action including goals, objectives, improvement Assessment provides a description of: strategies and performance measures with measurable and The community demographics time-framed targets. Strategies are evidence-based and align and population served with the NYS Prevention Agenda The processes used to obtain, The findings in this CHA result from a year-long process of collecting and analyzing data and consulting with stakeholders throughout the community and the region. This CHA can be used as a roadmap to guide service providers, especially public health and healthcare, in their efforts to plan programs and services targeted to improve the overall health and well-being of people and communities in our region. This CHA will address the requirements set forth by the NYS Department of Health, the Internal Revenue Service through the Affordable Care Act (ACA), and the Commission on Cancer. The NYS Department of Health requires hospitals to work with local health departments to complete a Community Service Plan that mirrors the CHA and implementation strategy per the ACA. Consequently, the CHA and IS will be combined to develop the CSP. County health departments in NYS have separate yet similar state requirements to conduct a Community Health Assessment (CHA) and a corresponding Community Health Improvement Plan (CHIP). The community health needs assessment provision of the ACA links hospitals tax exempt status to the development of a needs assessment and adoption of an implementation strategy to meet the significant health needs of the communities they serve, at least once every three years. Beginning in 2012, all American College of Surgeons (ACOS) Commission on Cancer (CoC) cancer programs are required to complete a community needs assessment to identify needs of the population served, potential to improve cancer health care disparities, and gaps in resources. Consequently, cancer-specific information, data and needs will be highlighted throughout this assessment. Aligning and combining the requirements of these three entities ensures the most efficient use of hospital resources and supports a comprehensive approach to community health and population health management in the region. analyze and synthesize data The significant health needs in the community, including special consideration for disparate groups within the population The process and criteria applied to identify prioritize health needs using the New York State Prevention Agenda as a framework The strategies for engaging with persons representing broad interests of the community How the local hospital and health department will implement the planned evidence based interventions and evaluate progress through predetermined process measures. 8 P a g e

10 Lead Organizations in the Community Health Assessment Process: Champlain Valley Physicians Hospital & Clinton County Health Department About the University of Vermont Health Network Champlain Valley Physicians Hospital The mission of CVPH is Every day, we devote our heads, hands, and hearts to our patients, peers and our community. The vision of CVPH is Working together, we improve people s lives. The values of CVPH are By embracing our strengths and honoring our differences, we learn and grow together through honesty, respect, and teamwork. Our mission, vision, and values guide our organization s commitment to community needs. CVPH is a voluntary, not-for-profit, Article 28 organization that is governed by a voluntary Board of Directors and is licensed for 300 beds. CVPH is located at 75 Beekman Street in Plattsburgh, New York with satellite services at a number of other authorized locations within the Plattsburgh area. CVPH is part of the University of Vermont Health Network, a five hospital system affiliated with an academic medical center in Burlington, Vermont. CVPH offers a variety of services including cardiovascular, orthopedics, obstetrics, behavioral health, long term care, and primary care. Recently, CVPH launched a Family Medicine Residency program to help address primary care shortages in the community. CVPH also provides cancer services through the Fitzpatrick Cancer Center. In addition, CVPH has a robust Medical Home as well as the Adirondack Region ACO which are key partners when addressing community health needs. About Clinton County Health Department The Clinton County Health Department (CCHD) strives To improve and protect the health, well-being, and environment of the people of Clinton County. CCHD realizes its mission and vision of Healthy People in a Healthy Community through its core values of advocacy, collaboration, excellence, innovation, integrity, and service. Its Director of Public Health oversees five distinct divisions of multidisciplinary teams. The Department reports to a volunteer Board of Health whose composition is specified by NYS Public Health Law. CCHD plays a critical role in the identification of local health needs, determination of strategies to address issues and collaboration of local partners to bring shared health agendas to life. In addition, CCHD provides essential health services in the community including immunizations, maternal child health programs, infectious disease surveillance, monitoring of local health data and trends of public health significance, and environmental health and safety services. CCHD also provides guidance and leadership for emergencies and disasters, assuring preparedness in the county s people and supporting community resilience. It has also led the community in the implementation of policy, systems and environmental strategy work aimed at improving the health of all residents. Through long established and solid community partnerships, the health improvement and prevention programs developed and implemented by CCHD are sound and impacting. Clinton County Health Department is also the only local health department in the Adirondack region to be nationally accredited by PHAB, the Public Health Accreditation Board, meeting the highest of standards for local health departments. 9 P a g e

11 Community Health Needs Assessment Stakeholder Groups Adirondack Rural Health Network The Adirondack Rural Health Network (ARHN) is a program of the Adirondack Health Institute, Inc. (AHI). AHI is a joint venture of Adirondack Health (Adirondack Medical Center), University of Vermont Health Network Champlain Valley Physicians Hospital, Glens Falls Hospital and Hudson Headwaters Health Network. The mission of AHI is to promote, sponsor, and coordinate initiatives and programs that improve healthcare quality, access, and service delivery in the Adirondack region. The Adirondack Rural Health Network (ARHN) provides a forum for local public health services, community health centers, hospitals, community mental health programs, emergency medical services, and other community-based organizations to address rural healthcare delivery barriers, identify regional health needs and support the NYS Prevention Agenda to improve health care in the region. The ARHN region includes New York s Clinton, Essex, Franklin, Fulton, Hamilton, Warren, and Washington counties. Appendix A ARHN, AFH, and CVPH Members Clinton County Action for Health Consortium The Clinton County Action for Health (AFH) Consortium is a multi-sector, multi-disciplinary collection of local health system partners working towards community health improvement and facilitated by CCHD. The primary work of the group has been built around data driven identified needs (NYS Prevention Agenda) and available community resources. Partners in the effort include: municipalities, businesses, grassroots community groups, health care providers, the local hospital, Chamber of Commerce, human service agencies, schools and local not-for-profits. The group has existed for over a decade and presently has approximately forty members that have formally committed to its purpose by signing AFH Partnership Letters. Recruitment of new members is ongoing. The AFH Consortium has increased community ownership and commitment to the shared health improvement goals and to the work captured in the CHIP. In facilitating these efforts, the CCHD has strengthened its ability to leverage resources from public health partners and private entities alike. Significant progress on the county s CHIP has been made capitalizing on this system of partnership created through the Consortium. The AFH Consortium meets periodically for updates, issue discussion, and information sharing. A minimum of six meeting are scheduled each year, with additional gatherings scheduled as needed. Subcommittees of members with expertise related to selected priority areas meet more frequently and keep the group apprised of their work. CCHD tracks progress on the CHIP continually and prepares a year-end report which includes updates on work related to the two featured Priority Areas and a summary of accomplishments by local partners related to each of the NYSDOH Prevention Plan Priority Areas. Captured activities demonstrate work on all tiers of the Public Health Impact Pyramid. More information on the Public Health Pyramid is included in the Community Health Improvement Plan. Appendix A ARHN, AFH, and CVPH Members CVPH Community Health Assessment Steering Committee In 2016, CVPH launched a community health assessment steering committee. This group is comprised of over 20 CVPH employees representing a wide range of departments from inpatient nursing and cancer 10 P a g e

12 services to the Adirondack Patient Centered Medical Home. In addition, there are administrators as well as clinical representatives, including several nurses, on this group. The catalyst behind the formation of this group was the need for a steering committee to represent the wide range of initiatives current occurring regarding community health at CVPH and carry forward the work outlined in the community assessment. The group meets on a monthly basis and was recently expanded to include representatives from Elizabethtown Community Hospital, Moses Ludington Hospital, and Alice Hyde Medical Center which are a part of CPI, the parent company for CVPH. In 2017, the expanded group will be looking for opportunities to work together to address similar identified health needs. Appendix A ARHN, AFH, and CVPH Members New York State s Prevention Agenda The Prevention Agenda is a blueprint for local, regional, and state action to improve the health of New Yorkers in five priority areas, and to reduce health disparities for racial, ethnic, disability, and low socioeconomic groups, as well as other populations who experience them. In addition, the Prevention Agenda serves as a guide to local health departments as they work with their community to develop mandated Community Health Improvement Plans and Community Health Assessments and to hospitals as they develop mandated Community Service Plans and Community Health Needs Assessments required by the Affordable Care Act. The NYS Prevention Agenda establishes goals for each priority area and defines indicators to measure progress toward achieving these goals. The plan features five priority areas, with focus areas under each priority: *The Prevention Agenda was originally a five year plan ( ); it was extended to 2018 to align its timeline with other state and federal health care reform initiatives. Appendix B NYS Prevention Agenda Priority Areas, Focus Areas, and Goals 11 P a g e

13 Health Care Transformation: Current Population Health Initiatives in Our Region Public Health Departments and Hospitals are key partners working with providers, agencies and community based organizations to transform the way community members think about and receive health care. There are a number of federal, state, and regional initiatives to restructure the delivery system focusing on the Triple Aim. The Triple Aim is a framework that organizations and communities can use to navigate the transition from a focus on clinical care to optimizing health for individuals and populations. The Triple Aim is improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities. See Appendix C for a sampling of local population health initiatives. Complementary Community Assessments Efforts to build healthier communities have the potential for being more successful when agencies, programs and individuals from multiple community sectors work together. Collaboration between the health sector and other community sectors can generate new opportunities to improve health. Recognizing this dynamic, community needs assessments, service plans and strategic plans from other community sectors in the region were reviewed as part as the health assessment process and to identify opportunities for collaboration between local health department/hospitals and other community entities. Documents from such community sectors as behavioral health service providers, community action/economic opportunity agencies, regional economic development councils, business associations and others contained several areas of potential collaborative efforts including: Local Services Plans for Mental Hygiene (one for each county) Community Action/Economic Development some county-specific and some regional Regional Economic Development Councils Chambers of Commerce (regional) For the Delivery System Reform Incentive Payment (DSRIP) program, the AHI PPS conducted a Community Needs Assessment (CNA) in late The DSRIP CNA used much of the same publicly available data that is used in this Assessment. It also used Medicaid utilization data that the NYS DOH made available as DSRIP focuses on Medicaid members. The AHI PPS partners have focused on Care Coordination projects to address chronic disease and behavioral health projects based on the data. This focus closely mirrors the Public Health and Hospital partners choices for priorities under the Prevention Agenda. Appendix D (Health Related Priorities by Community Sector) provides a summary of county, regional and statewide planning documents and policy agendas from a variety of community sectors that address health-related issues. Links are included to facilitate access to the documents. The contents are organized by the relevant Prevention Agenda Focus Area. The summary does not provide an exhaustive analysis of multi-sector health priorities, but is provided to illustrate the potential for collaborative health improvement efforts in the county and region. 12 P a g e

14 Community Profile Geography, Service Area Profile, Demographic Characteristics & Economic Profile Clinton County, New York represents the primary service area (PSA) for this analysis (e.g., the community served). A PSA is typically defined as the geographic location where a hospital receives greater than 70% of its market share (e.g., how the community was determined). In 2015 according to SPARCS data, CVPH had 9,651 inpatient discharges. Of these discharges, 72% of patients originated in Clinton County followed by 13% from Essex County, and 8% from Franklin County. These market shares were used to determine the PSA. The majority (64%) of Clinton County discharges at CVPH were in general medicine, cardiovascular, women s and children, and psychiatry. When looking at payers, 60% of Clinton County discharges at CVPH were Medicare, followed by commercial/ private insurances, and Medicaid. With a population of over 81,000, Clinton County is the Clinton County, NY most populated county in the ARHN region. Clinton County is 1,038 total square miles with the Canadian border along its northern edge and Lake Champlain and Vermont to its east. Clinton County borders Franklin and Essex Counties to the west and south, respectively. The largest city in Clinton County is Plattsburgh with a population of approximately 20,000 residents. Much like upstate New York, Clinton County does not have a racially and ethnically diverse population. Over 90.0% of the population is White, non-hispanic, compared to Black/African American, non- Hispanics at 4.0% and Hispanic/Latinos at 2.6%. Fourteen percent of the population is 65 years of age and older, somewhat lower than the ARHN region at 16.5% and Upstate New York at 15.2%. The median household income is $50,985 and the per capita income is $25,279, lower than that of New York State, $85,736 and $32,829 respectively. The percentage of individuals in Clinton County living below the Federal Poverty Level is 15.2%, higher than that of the ARHN region and that of Upstate New York, 14.5% and 11.8% respectively. The percentage of individuals receiving Medicaid in Clinton County (18.1%) is also higher than the ARHN region 13 P a g e

15 (17.6%) and Upstate New York (16.9%). Over 42% of the children in public schools receive free or reduced lunches, similar to the ARHN region (42.0%) but higher than Upstate New York (35.7%). Almost fifty-four percent of the population 25 and older in Clinton County has a high school diploma or equivalent, and another 32% having an Associate, Bachelor s, or higher degree. Fifty-six percent of the population 16 and older is in the workforce, with an unemployment rate slightly lower than the ARHN region and Upstate New York. The largest employment sector in Clinton County is education, health care and social assistance (27.8% of those employed), followed by manufacturing (11.8%), retail trade (11.8%), and public administration (10.0%). Educational Profile Appendix E ARHN CHA Demographic Data There are eight public school districts and one private school district in Clinton County, with an enrollment for primary and secondary schools of over 10,500. Slightly over 42% of the enrolled primary and secondary public school students receive free or reduced lunches, and Clinton County has a high school dropout rate of 14.4%, which is higher than the dropout rates of the ARHN region and of Upstate New York, 12.7% and 8.8% respectively. There are 10.3 students per one teacher in Clinton County public school system, slightly lower than the ARHN regional and Upstate New York rates. Appendix F ARHN CHA Educational System Profile Health System Profile Clinton County has one hospital located in Plattsburgh, four nursing homes accounting for 423 beds, and 3 adult care facilities accounting for 150 beds. There are 300 total beds at CVPH at a rate of 367 per 100,000 population, more than the rate of the ARHN region (272) and higher than the Upstate New York rate of hospital beds (268) per 100,000 population. Clinton County includes one mental health and one primary care health professional shortage area designation. There are almost 90 full time equivalent (FTE) primary care physicians practicing in Clinton County per 100,000 population, which is higher than both the ARHN region but comparable to Upstate New York. But, only about 4% of the population used 14 P a g e

16 a Community Health Center in 2014 which is much lower than the ARHN Region indicating access to be a problem. Appendix G ARHN CHA Health System Data NYS Prevention Agenda Health Indicators Clinton County continues to address the identified areas of greatest concern for health, following a strategic plan embraced by the members of the local public health system. Consistent and effective population based efforts are beginning to demonstrate positive health impact however changes in related performance outcome measures may not be evident for several more years. Staying the course and maintaining focus on fundamental health behaviors and community characteristics, an improvement in the overall health of the residents of Clinton County will become evident. Improve Health Status and Reduce Disparities While there are not significant health disparities based on race and ethnicity in Clinton County, there are significant access-to-care issues and disparities in access to opportunities for health. Efforts to address access challenges in Clinton County have been ongoing for several years. To reduce access-to-care issues, CVPH has recently strengthened the availability and type of providers available to residents through a health care affiliation with an academic medical center, the University of Vermont Medical Center, in Burlington VT. The new partnership provides additional medical specialists, establishes a medical residency program in the community and supports further development of the local system that links residents to services and care. For example, the local Medical Home initiative is working to eliminate County residents without an identified provider. Providers are becoming more accessible to their patients during off hours, rather than directing them to the emergency care center. All of this work is geared towards supporting a stronger prevention based model for health care. It should be noted that the rate of age-adjusted preventable hospitalizations per 100,000 population over 18 years (150.1) is significantly higher than the rate for Upstate New York (107.3), and the Prevention Agenda benchmark (119.0) rates per 100,000 population. The rate of ED visits per 10,000 population in Clinton County (4,709.4) is also significantly higher than the ARHN region (4,418.4) and Upstate New York (3,752.5). The percentage of adults, 18 and older, with a regular health care provider in Clinton County (83.7%) is slightly lower than Upstate New York (84.6%),New York State (84.4%), and somewhat lower than the Prevention Agenda Benchmark of 90.8%. Percentages of adults 18 years and older in Clinton County with poor physical or with disabilities (27.5%) is higher than the ARHN region (25.2%), Upstate New York (22.4%), and the state as a whole (20.8%). The focus on built environment in the current health improvement plan is helping reduce disparities related to access to opportunities for health. Complete streets and trail work are making local areas more conducive for residents of all abilities to be active and safe. Significant work has also focused on improving consumer, retail and home food environments. Over the last several years, county level programs have focused on increasing the availability, identification and use of healthier food options. Projects have played off community readiness and momentum, but been dispersed throughout the country to benefit the greatest number of residents. 15 P a g e

17 Promote a Healthy and Safe Environment Injuries, Violence, and Occupational Health While motor vehicle and speed related accidents continue to challenge the Clinton County health system community, change impact is hampered by rural roads, weather related road surfaces, and a high density of alcohol retail related business. Schools, law enforcement and drug prevention based programs continue to address these concerns locally. These issues are not unlike those experienced by other rural counties in New York State as generations of new, inexperienced drivers become eligible to use the roadways. At present, tracking systems do not distinguish cause of impairment. Therefore, it is unclear if local opiate and other drug related use are influencing these statistics. Motor vehicle accidents and speed-related accidents are both higher in Clinton County (2,149.8 and 358.9, respectively) than in the ARHN region (2,180.5 and 357.3), Upstate New York (2,061.9 and 217.1), and New York State (1,545.7 and 143.1). Additionally, the rate of motor vehicle accident deaths is higher in Clinton County (8.6) than Upstate New York (7.4) and the state as a whole (5.6), but lower than the ARHN region (10.1). According to NYSDOH data, the Clinton County Age-adjusted poisoning hospitalization rate per 10,000 for remained relatively steady with an increase noted in years 2010 and 2012 at (15) and (14.7). The rate in 2012 for Clinton County is higher (14.7) than that of NYS excluding NYC (11.2) and higher than its neighboring counties rates. No specific types of poisons were indicated in the data as a cause of the hospitalization. The rates for suicide for Clinton County have been on the rise for several years. The NYS Prevention Agenda goal rate for is 5.9 deaths for 100,000 population. According to the NYS Prevention Agenda Dashboard-County level data, the age-adjusted death rate per 100,000 in Clinton County for the years was high at The data also revealed that the rate for Clinton County was 10.4 in and increased to 11.9 in Built Environment The built environment poses unique challenges to Clinton County. It is well documented that lack of access to better nutrition choices is directly linked to poor outcomes related to disease and related nutrition health issues. Lack of public transportation to and from local supermarkets remains a concern, along with limited, but improving access to local Farmers Markets and fresh produce stands. To address the limited access to supermarkets, significant change has occurred in many local school districts as the Clinton County Health Department has worked to establish healthier available food choices. By working closely with the school cafeteria food managers, local food distributors, supporting summer food programs, supporting the establishment of school breakfast, changing vending machine policies in schools and businesses, and connecting farmers to increased distribution sites (schools) and other locales positive nutrition change is happening. The percentage of the population with low-income and low access to supermarkets or large grocery stores is higher in Clinton County (7.9%) than in the ARHN region (4.9%), Upstate New York (4.2%), the state as a whole (2.5%), and the Prevention Agenda Benchmark of 2.2%. The majority of full scale supermarkets care centered in one population center. 16 P a g e

18 Water Quality and Outdoor Air Quality Water quality issues continue to appear across the country in both large and rural populations. A significant portion of the local population is connected to community water supply systems. In Clinton County 63.4% of residents receive their water from a community water supply system, while the ARHI region is 22.4%, Upstate is 46.9% and the Prevention Agenda Benchmark is 78.5%. The community water systems are overseen by the Environmental Health and Safety Division (EHS) of the Clinton County Health Department. EHS provides immediate follow-up for any water related concerns to human consumption and use, in addition to assuring all Federal water regulations related to the operation of community water supplies are adhered to locally. Air quality issues occur periodically due to seasonal influence (ragweed), heat and humidity, and during cold winter months. The rural nature of the county coupled with low population density and limited industrial impact continues to support excellent air quality in Clinton County. Prevent Chronic Disease This Priority Area crosses several other Prevention Agenda Priority and Focus Area subsets. For example, built environment changes offer opportunities for physical activity and are needed to alter behaviors such as sedentary lifestyles in both youth and adults. Several grant funded initiatives target systems, policy and built environment strategies to influence incidence and prevalence rates of common chronic diseases. These projects are addressing the local food environment, creating safe and accessible spaces to be active and work to address the establishment of tobacco related policy change prohibiting tobacco use and access. The cultural shift toward health improvement in these areas will influence long term patterns in chronic disease rates, morbidity and mortality. Moving an entire community toward improved health takes time and involves all sectors of a community. Partnerships to develop and implement strategic health improvement plans in these areas exist and continue to be implemented. Obesity in Children and Adults The percentages of adults who are obese (26.7%) and of public school children (21.2%) in Clinton County are higher than the Prevention Agenda Benchmarks of 23.2% and 16.7%, respectively. Additionally, the obesity rates for children of all ages are higher in Clinton County than in the ARHN region and in Upstate New York. The rates of deaths and hospitalizations due to diabetes (any diagnosis) are also higher in Clinton County (25.3 and 245.0, respectively) than in Upstate New York (19.6 and 225.8). 17 P a g e

19 Cancer The rate of lung and bronchus cancer cases are higher in Clinton County (121.3) than in the ARHN region (108.5), Upstate New York (83.0), and New York State (69.6), and lung and bronchus cancer deaths are higher in Clinton County (65.2) than in Upstate New York (55.9) and the state as a whole (46.4) but lower than the ARHN region (65.2). While the rate of colon and rectum cancer cases is lower in Clinton County than the other geographies, the death rate in Clinton County (20.4) is comparable to the ARHN region (20.6), but higher than the rates in Upstate New York (17.2) and the state as a whole (16.6). Colorectal screenings for those years of age in Clinton County (75.8%) is lower than the Prevention Agenda Benchmark of 80.0%, though higher than the ARHN region (68.3%), Upstate New York (70.0%), and New York State (69.3%). Smoking & Tobacco Use Smoking and smoking-related diseases seems to pose a significant challenge for Clinton County. The percentage of adults who smoke in Clinton County (22.6%) is consistent with the percentage of smokers in the ARHN region (22.5%) but higher than Upstate New York (17.3%), New York State (15.6%) and the Prevention Agenda Benchmark of 12.3%. Chronic lower respiratory deaths and hospitalizations are significantly higher in Clinton County (66.5 and 44.0, respectively) than in Upstate New York (46.2 and 33.0) and the state as a whole (35.6 and 36.5). The percentage of the adults in Clinton County with asthma (16.2%) is much higher compared to the ARHN region (13.4%), Upstate New York (10.2%), and New York State (10.1%). The rate for asthma ED visits in Clinton County is higher for ages 65 years and older (18.5) and for those years of age and older (58.5) than the ARHN region (14.0 and 49.2) and Upstate New York (15.1 and 46.8). Promote Healthy Women, Infants and Children The percentage of births within 24 months of previous pregnancies in Clinton County (21.2%) is higher than the Prevention Agenda Benchmark of 17.0%, and the percentage of unintended births in Clinton County is 25.8% compared to the Prevention Agenda Benchmark of 23.8%. While these indicators demonstrate a slight upwards trend, the numbers remain relatively consistent in the county and across the region. The birth rate also remains relatively stable in Clinton County, tracking approximately 700 births annually. The percentage of pre-term births in Clinton County for 2013 was 9%, lower than the Region at 10.8%, Upstate 10. 9% and the Prevention Agenda Benchmark of 10.2%. The percentage of infants exclusively breastfeed in the hospital is 76.1 in Clinton County, 70.4% for the region, 50.8% for Upstate, and the PA Benchmark being Clinton County far exceeds this benchmark and this success can be linked to a strong emphasis on breastfeeding through specific outreach programs and efforts locally, including breastfeeding friendly designated pediatric practices, with the hospital in process of seeking national designation. 18 P a g e

20 The percentage of Clinton County children between the ages of years who have had the recommended number of well child visits (71.7) in government sponsored insurance programs also outpaces the Region (64.6), Upstate (61.9) and exceeds the PA Benchmark of However, the percent of children under the age of 19 with health insurance lags behind the PA Benchmark of 100%, with Clinton County demonstrating 95.9% covered in Numbers were not available for the Region or Upstate for that year. The percentages of WIC women in Clinton County with gestational weight gain greater than ideal, with gestational diabetes, with pre-pregnancy obesity, and with gestational hypertension are higher in Clinton County than in the ARHN region, Upstate New York, and the state as a whole. These numbers correlate to the current adult obesity rates in Clinton County. Specific data can be found in the Prevention Agenda Appendix links in this document. Prevent HIV/STDs, Vaccines-Preventable Disease, and Health Care-Associated Infections Immunization rates for children ages months with 4:3:1:3:3:1:4 (71.3%) and females with 3 dose HPV vaccine (36.1%) are lower in Clinton County than their respective Prevention Agenda Benchmarks of 80.0% and 50.0%, respectively. While Clinton County still does not meet the PA Benchmark, this is a significant improvement from the percent of (63.3%). The vaccine preventable disease rate for entrance to school continues to meet or exceed all guidelines and accepted benchmarks for all school districts. The rate of Pertussis cases in Clinton County (33.4) is significantly higher in the ARHN region (13.0), Upstate New York (12.9), and New York State (8.8). This may be due to recent outbreaks of the illness over the past few years. The rate of pneumonia/flu hospitalizations for those 65 years of age or older is also higher in Clinton County (1818) than in ARHN region (145.5), Upstate New York (121.9), and the state as a whole (112.6). However, the percentage of adults 65 and over immunized against flu is higher in Clinton County (82.5%), than the Region (74.4%), and Upstate (77.1%) and the PA Benchmark of 70%. Promote Mental Health and Prevent Substance Abuse Mental health and substance abuse have always been concerning community health issues, but of late these diseases have been receiving enhanced focus and support. Overall, there is a general lack of local, regional and state level data in this priority area. Information is starting to become more available and many local data sets have been, or are currently in development, to provide a better understanding of mental, emotional and behavioral needs of Clinton County residents. Efforts to address identified needs have been instituted across several community sectors, including businesses, schools and pediatric health care providers. Local law enforcement agencies have also received additional training on how to deal with mental, emotional, and behavioral issues related to law enforcement; many officers have been trained on appropriate identification, need and use of narcan, and the availability of a needle exchange program in the region. The percentage of adults in Clinton County who binge drink (20.5%) or who reported 14 or more poor mental health days within the last month (11.1%) are both higher than their respective Prevention Agenda Benchmarks of 18.4% and 10.1%. The rate of self-inflicted hospitalizations in Clinton County (13.1) is significantly higher than in the ARHN region (10.4), Upstate New York (6.8), and the state as a whole (5.8), and the rate of suicides in Clinton County (13.3) is higher than Upstate New York (9.5), New 19 P a g e

21 York State (7.9), and the Prevention Agenda Benchmark of 5.9. Additionally, self-inflicted hospitalizations for year olds are higher in Clinton County (19.8) than Upstate New York (12.5) and the state as a whole (11.3). The rate of alcohol-related crashes in Clinton County (64.8) is also higher than New York State (43.4). Community Health Assessment Process and Methods Described below is the process through which CCHD and CVPH solicited and took into account input from community residents and those who represent the broad interests of the community served, including the medically underserved, low income, and other disparate populations. Goals for the type of community input and desired content were as follows: Understand the community's perceived significant health needs; Expand knowledge and gain insights on data findings; Identify barriers to accessing and receiving care; and Identify resources in the community. Note: Great effort was made to widely disseminate the documents previously written. It should be noted that no written comments were received on the most recently conducted CHNA and most recently adopted implementation strategy or community health improvement plan. However, if comments are received, they will be responded to and considered in the process moving forward. The process of identifying the important health care needs of the residents of Clinton County (e.g., the service area) involved data analysis, consultation with key members of the community and direct resident input. The data was collected from multiple sources including publicly available health indicator data, data collected from a survey conducted by the Adirondack Rural Health Network, data collected from a survey conducted by the CCHD, and a Clinton County Health Priority Setting Session. The health indicator data referenced is collected and published by New York State and contains nearly 300 different health indicators. Since 2002, The Adirondack Rural Health Network has been compiling this data for the region and producing reports to inform healthcare planning on a regional basis. In March and April of 2016, the Adirondack Rural Health Network (ARHN) conducted a survey of selected stakeholders representing health care and service-providing agencies within an eight-county region. The results of the survey are intended to provide an overview of regional needs and priorities, to inform future planning and the development of a regional health care agenda. The survey results were presented at both the county and regional levels. Similarly, in 2016, the CCHD conducted a survey of residents of Clinton County. The results of the survey were intended to provide similar insight as the ARHN survey but targeted community residents. Using the results of the indicator analysis, the surveys, and other community assessments, a group of stakeholders was convened for a Health Priority Setting Session in June of 2016 to identify the current healthcare challenges for the residents of Clinton County. The group was facilitated and hosted by CCHD and CVPH and consisted of a wide range of attendees representing various community organizations in Clinton County. A detailed description of this process is outlined in this section. 20 P a g e

22 Stakeholder Surveys Community Resident Survey Process Clinton County 2016 Community Health Assessment Survey The Clinton County Health Department (CCHD) surveyed Clinton County residents to inform the Community Health Assessment (CHA) committee of resident concerns related to health, social and environmental issues in the community. The Clinton County Community Health Assessment Survey was developed by the CCHD after a review of existing resident community health surveys throughout the country. The fielded survey included 12 questions, 6 of which assessed demographics of the respondents. Survey development, fielding and analysis were completed over a three month period and involved the partnership of several community partners. A total of 1,018 complete surveys from Clinton County residents were obtained. Results of Clinton County Resident Survey Residents overwhelming identified issues aligning with the Prevent Chronic Disease NYS Prevention Agenda Priority Area as top concerns both for themselves and their families as well as for the community. Sixty percent of respondents reported overweight/obesity as an issue of concern in the community, while nearly 50% of individuals reported it as an issue for themselves or a loved one. One in three residents felt physical inactivity is an issue in the community; one in three respondents also named opportunities for physical activity as a concern for themselves or their family. Almost half of all respondents reported chronic disease as a problem both individually and for the community at large. In addition, one in four residents named access to healthy foods as an obstacle for themselves or their family. Issues aligning with the Promote Mental Health and Prevent Substance Abuse Priority Area were also of great interest. Two out of three residents named substance abuse as a concern in the community; three out of five residents named mental health as a concern in the community. Respondents also reported child abuse or neglect, bullying, and domestic violence as top social concerns in the community. Additionally, residents indicated that unemployment and low wages is a top social concern for both the community as well as for themselves or their family. One in two people who reported experiencing a barrier to medical care named could not pay as the reason why. Appendix H: Clinton County Resident Survey Summary Community Agency Survey Process ARHN 2016 Community Health Assessment Survey Under contract with AHI and as part of the ARHN coordination of community needs assessment, the Center for Health Workforce Study (CHWS) surveyed health care, social services, educational, governmental and other community stakeholders in the ARHN region to provide the CHA Committee with stakeholder input on regional health care needs and priorities. The survey was developed using Qualtrics Software. It included 15 questions and a number of subquestions based on an initial response. A PDF of the survey is attached as Appendix H to this report. A total of 658 providers across seven counties were surveyed. An initial was sent to this list explaining the survey and providing an electronic link to the survey. The survey was available to 21 P a g e

23 potential respondents for approximately six weeks. A total of 217 completed responses were received to the survey through May 31, 2016 for a response rate of 33%. The survey requested that the respondent identify their top two priority areas from a list of the five following areas which they believe needed to be addressed within their service area: Once respondents identified their top two priorities, they were also asked to rank the focus areas within each priority area and identify potential barriers addressing that focus area. Analysis for this report was conducted by the county. Many health care, social service, and educational providers deliver services in multiple counties. Their opinions are reflected in each county they provide services. Results of Clinton County Agency Survey Service providers whose service area included Clinton County identified promoting mental health and preventing substance abuse (26) as the top priority followed by preventing chronic disease (17). Providing a healthy and safe environment (21) was identified as the second priority by Clinton County service providers. Respondents whose service areas included Clinton County and who listed chronic disease prevention as their top priority ranked their top focus area as to increase access to high quality chronic disease preventive care and management in clinical and community settings (10). Lack of financial resources/reimbursement in the short-term (10) was listed by Clinton County respondents as the top barrier to effectively preventing chronic disease, followed by lack of financial resources/reimbursement in the long-term (6) and travel distance and geography of the Adirondacks (5). Service providers in Clinton County who selected promoting mental health and preventing substance abuse as their top priority ranked strengthening the (mental health and substance abuse) infrastructure across systems as the focus area to address. Service providers in Clinton County that indicated promoting mental health and preventing substance abuse was their top priority identified a number of barriers to achieving this goal. These barriers include shortage of professionals and staff (19), followed by lack of financial resources/ reimbursement in the long-term (16), travel distance and geography of the Adirondacks (16), and lack of financial resources/reimbursement in the shortterm (12). One service provider noted that fragmentation of providers was also a barrier for addressing this priority area. Appendix H: Clinton County Stakeholder Summary 22 P a g e

24 Secondary Data Analysis An analysis of secondary community health data was used to identify the significant community needs for Clinton County. This data was grouped within the five NYS Prevention Agenda Priority Areas for ease of interpretation. Data from each Prevention Agenda Priority Area was considered for selection. The secondary data was collected and analyzed through the Center for Health Workforce Studies as well as the HealthyADK website. The Center for Health Workforce studies through the University at Albany School of Public Health provided a plethora of indicators related to the Prevention Agenda Priorities collected from a variety of databases. HealthyADK is supported by a grant from the New York State s Department of Health Population Health Improvement Program (PHIP) and maintained by AHI (Adirondack Health Institute) in collaboration with community organizations and agencies. The HealthyADK website provides access to a community dashboard of key health and socio economic indicators to support community health assessment. The data is derived from state and national databases. It includes preventable hospitalization and ED visits (Appendix I, J and K). In order to determine top community needs, all indicators available were analyzed through a two-step approach based on the following criteria: Is the indicator below both the NY State and US value? AND Was the gauge indicating performance below the 25 th percentile? OR Did it come up as a common theme by focus groups/key informants? OR Does it affect a significant number of people? OR Are there disparities associated with the need? To have been identified as a significant health need for Clinton County, the answer to the first question, as well as at least one of the additional three questions had to be yes. For a full list of indicators included in this analysis, see Appendix J and K. With this logic, approximately 23 of over 130 HealthyADK indicators and over 400 indicators from the Center for Health Workforce Study data were identified as top community needs in each of the priority areas. Of the 23 that were selected, 70% of them are connected to both of our chosen priority areas. Indicators that were identified as top needs are outlined on the following page. Several of the selected indicators are tied directly to the low income/socioeconomic status health disparity: Child Food Insecurity Rate Households with Cash Public Assistance People 25+ with a Bachelor s Degree or Higher People 25+ with a High School Degree or Higher It should be noted that the most recent measurement period used for all secondary data listed above was , with some indicators being tracked for shorter periods within that timeframe. Additional indicators, trend data, and demographic information is available for further review on This site will continue to publish updates as they are released to the public. 23 P a g e

25 Secondary Data Analysis: Clinton County Top Needs Age-Adjusted Death Rate due to Colorectal Cancer : The age-adjusted death rate per 100,000 population due to colorectal cancer. The Healthy People 2020 national health target is to reduce the rate to 14.5 deaths per 100,000 population. Clinton County is currently at 16.7 which indicates a steady improvement since Cervical Cancer Incidence Rate : The age-adjusted incidence rate for cervical cancer in cases per 100,000 females. The Health People 2020 national health target is to reduce the uterine cervical cancer rate to 7.1 deaths per 100,000 population, while Clinton County is currently at This rate has risen continually since Lung and Bronchus Cancer Incidence Rate : The age-adjusted incidence rate per 100,000. Clinton County is currently 95.1, and although it is an improvement since 2008, it is still approximately 30 points worse than the state and national rate. Age-Adjusted Death Rate due to Diabetes : The age-adjusted death rate per 100,000 population due to diabetes. Clinton County is significantly worse than NY state (17.6) and similar to the national rate (21.2). Diabetes has risk factors such as obesity and physical inactivity, which are also of concern for the people of Clinton County. Child Food Insecurity Rate %: The percentage of children (under 18) living in households that experienced food insecurity at some point during the year. This is an improvement from 2008, but is still worse than the state and national average (both 20.9). In addition, children who are food insecure are more likely to be hospitalized, have higher risk of obesity and asthma, and are also more likely to develop social and behavioral issues. Hyperlipidemia: Medicare Population %: The percentage of Medicare beneficiaries who were treated for hyperlipidemia. Clinton County rate increased from , but decreased slightly in In many cases, this condition is reversible through healthy eating and regular exercise. Infant Mortality Rate - 6.1: The mortality rate in deaths per 1,000 live births for infants in their first year of life. Clinton County has improved steadily since 2009 but is still worse than NY state (5.0) and the US (6.0). Age-Adjusted Rate due to Suicide : The age-adjusted death rate per 100,000 population due to suicide. The rate in Clinton County has risen continually since 2009, and is worse than NY state (8.2) and the US (12.7). Depression: Medicare Population %: The percentage of Medicare beneficiaries who were treated for depression. Has continued to rise since 2009, and is worse than NY state (14.9) and the US (16.2). Adults with No Tooth Extractions %: The percentage of adults who have never had any permanent teeth extracted. Worse than both NY state (50.6) and the US (56.6). Adults with Asthma %: The percentage of adults who have ever been told by a health care provider that they have asthma. Methodology changed in 2014 so past data cannot be compared, but currently worse than NY (10.1) and US (13.8). Age-Adjusted Death Rate due to Chronic Lower Respiratory Disease : The death rate per 100,000 population. Includes asthma, emphysema, and all other chronic lower respiratory diseases. Has risen since 2008, but declined from 2011 to Remains significantly worse than NY (30.3) and the US (41.4). Asthma: Medicare Population - 7.2%: The percentage of Medicare beneficiaries who were treated for asthma. Improved in Clinton County from 2011 to 2013, but increased in Slightly worse than NY state (5.9) and national rate (5.0). COPD: Medicare Population %: The percentage of Medicare beneficiaries who were treated for chronic obstructive pulmonary disease (COPD). Improvements have been made in Clinton County since 2009, yet it is still worse than NY state (10.3) and the US (11.0). Adults who Binge Drink %: The percentage of adults who reported binge drinking at least once during the 30 days prior to the survey. Male binge drinking is defined as five or more drinks on one occasion, and female binge drinking is four or more drinks on one occasion. Clinton County is currently meeting the Healthy People 2020 Target, but is worse than NY (17.7) and the US (16.0). Adults who Smoke %: The percentage of adults who currently smoke cigarettes. Methodology changed in 2014 so past data cannot be compared, but NY state and US values are 15.9% 18.1%, respectively, both of which are better than Clinton County. Households with Cash Public Assistance - 5.2%: The percentage of households receiving general assistance and Temporary Assistance to Needy Families (TANF). It does not include Supplemental Security Income (SSI) or Supplemental Nutrition Assistance Program (SNAP) benefits. This number worsened from 2006 to 2013, and improved slightly in It is currently worse than NY state (3.4) and the US (2.8). People 25+ with a Bachelor s Degree or Higher %: The percentage of people aged 25 and over who have earned a bachelor s degree or higher. Despite this number increasing some since 2006, Clinton County s rate is lower than NY state (33.7) and the US (29.3). People 25+ with High School Degree or Higher %: The percentage of people aged 25 and over who have completed a high school degree or the equivalent. Clinton County has improved this measure since 2006, and is very close to both the NY state and US rate. Liquor Store Density : The number of liquor stores per 100,000 population. A liquor store is defined as a business that primarily sells packaged alcoholic beverages, such as beer, wine, and spirits. Although in 2014 Clinton County improved marginally, it is still higher than NY (15.5) and the US (10.4). People 65+ Living Alone %: The percentage of people aged 65 and over who live alone. Improved between 2006 and 2013, but declined slightly in NY state is at 28.8% and the US is at 26.8%. Workers Commuting by Public Transportation 0.4%: The percentage of workers aged 16 and older who commute to work by public transportation. This indicator has steadily declined since It is significantly lower than NY and the US (27.4 and 5.1), although the NY state value is likely to be skewed due to New York City and its surrounding areas. Workers who Drive Alone to Work %: The percentage of workers aged 16 and over who get to work by driving alone in a car, truck, or van. The NY state value is 53.6% and the US value is 76.4%. 24 P a g e

26 Community Health Priority Setting Session Clinton County has a long history of convening community stakeholders to assist in the identification of priority health issues. On June 15 th this approach was once again utilized. Over 130 Clinton County stakeholders were invited to the Community Health Priority Setting Session facilitated by CCHD and CVPH. A diverse group of approximately 65 stakeholders representing a minimum of eight different sectors assembled to give their input from the perspective. Sectors represented included education, public health, clinical healthcare, government, recreation, human services, and transportation. In addition, members of medically underserved, low-income, and minority populations in the community served were thoroughly represented. The event, held at the West Side Ballroom in Plattsburgh, NY aimed to educate stakeholders on the health needs of Clinton County, discuss current progress towards the identified Prevention Agenda priorities, and identify the two required Prevention Agenda areas to focus on moving forward. Participants experience with the Prevention Agenda and involvement in community health planning varied and nearly half of the group were participating in the process for the first time. The event s agenda provided attendees an overview of the NYS DOH Prevention Agenda and its priority areas; the community health assessment and planning process as well as an overview of the local system used to identify health priorities; and progress to date made in the current priority areas, including a data presentation from the Director of Clinton County Mental Health featuring local, state, and national trends in related health measures. An update on key indicators related to the remaining Priority Areas was presented by AHI s Evaluation Manager for the Population Health Improvement Plan (PHIP). Key findings from the Community Health Needs Survey were shared with the group. An unbiased approach was used in presenting all data to community stakeholders at this event. The results of the multiple surveys referenced, progress made on current priorities, and data presented by the PHIP were all used to inform the group of the health of the community. Following introduction activities, event participants participated in small group sessions. Participants were assigned to one of six groups, one for each Prevention Agenda Priority Area and a group dedicated to discussing health and health care disparities and disparate groups for all priority areas. Each group was led by two facilitators with content expertise. Facilitators received training prior to the event to assure familiarity with the process, expectations of them and anticipated outcomes from the session discussions. They were also provided with tools to assist in capturing input from group members throughout the session. Facilitators opened the sessions by reviewing the process the group would follow and providing background information on the Priority Area and its related Focus Areas. Discussions around each Focus Area aimed to capture what was being done in the community presently and what group members knew their organizations would be doing to address this issue in the next three years. Finally, group members were asked to rate the focus area s seriousness and anticipated impact we could have as a community on a scale from 1-10, with 10 indicating the highest possible seriousness and impact. When the large group re-convened, spokespeople for each small group provided an overview of their group s discussion. Following this review of the morning, all participants were asked to assist in selecting priority and focus areas. Input was collected utilizing an audience response system. Each participant selected the focus area they felt of greatest significance for each Priority Area. Each participant was then allotted to register two votes for the Priority Area selection. 25 P a g e

27 Responses from health system and community partners participating in the June 15 th Prioritization Session overwhelming selected Mental Health & Substance Abuse and Chronic Disease as the top two Priority Areas for the next Community Service and Community Health Improvement Plans. Focus Area voting was far less definitive. To help clarify partner contributions relating for the focus areas, a smaller subcommittee consisting of members from AFH and the CVPH Community Health Assessment Steering Committee were convened. The process they applied is explained in detail in the Priority and Focus Area Finalization Process section. Participant characteristics, voting results, finalization findings and additional methodology applied in the processes described above can be found in Appendix M. Significant Community Needs (Aligning Secondary Data and Community Input) To identify the significant community needs, the results of the secondary data analysis were combined with the results of the community input and grouped by priority area. The two priority areas and disparity that emerged were as follows: 26 P a g e

28 Evaluating Progress To Date: While there is still work to do, significant progress has been made on addressing the two previously chosen Priority Areas of Promote a Healthy and Safe Environment and Promote Mental Health and Prevent Substance Abuse. As part of this community health assessment and prioritization processes, current progress was evaluated. Under the Priority Area of Promote Mental and Prevent Substance Abuse, the following accomplishments are noted, organized by objective: Identify specific roles different sectors (e.g. governmental and nongovernmental) and key initiatives (e.g. Health Reform) have in contributing towards MEB health promotion and MEB disorder in NYS for crisis intervention within the community by December 31, o Regularly occurring meetings established with multi stakeholder group to institute regular communication and data sharing o CVPH completion of a behavioral health strategic plan o Participation in the Anti-Stigma Coalition of Clinton County o Participation in DSRIP workgroups focusing on behavioral health Establish a system to identify indicator data and establish baseline targets for data required to plan and monitor county level, strengths based efforts that promote MEB health and prevent substance abuse and other MEB disorders by December 31, o Five indicators of local significance chosen o Shared, secure portal created to facilitate data sharing among partners o Procedure in place for the sharing and analysis of this data through SharePoint o Steering committee identified to monitor the sharing of data Strengthen training and technical assistance of primary care physicians, MEB health workforce and community leaders in evidence based, including culturally sensitive training (disparity), approaches to MEB disorder prevention and mental health promotion by December o Psychiatric teaching day occurred in 2015 for providers and community o Continued integration of behavioral health into primary care o Recruitment efforts continue for psychiatrists and providers o Champlain Valley Residency Program launched to increase access to primary care in the community o o SBIRT being used to screen for mental health and substance abuse problems Health Home addressing high need Medicaid patients to include mental health issues and ACO addressing depression screening in the Medicare population Under the Priority Area of Promote a Healthy and Safe Environment and aligned with the goal of improving the design and maintenance of the built environment to promote healthy lifestyles, sustainability and adaptations to climate change by December 31, 2017, the following accomplishments are noted, organized by objective : Increase the number of CCPT riders to local grocery/ food stores o Ridership survey developed, fielded and analyzed; 400+ surveys completed o Community education and promotion of rural transit system 27 P a g e

29 o Survey findings, recommendations shared with transit partners Promote four township boards to adopt Complete Streets Resolutions in support of NYS 8/11 Streets Law o Clinton County Complete Streets workbook developed and distributed o Presentations to select town and highway boards completed o Periodic surveys to town and highway superintendents to monitor complete streets progress/ needs o Complete Streets resolution passed in the Town of Clinton, 6/13/16 o Traffic assessment underway in Town of Dannemora, Fall 2016 Increase, by 10%, the percentage of residents utilizing current available physical activity opportunities o Multiple trail user and non-user surveys completed to obtain resident input and information on behaviors created, fielded and analyzed. o Reaction to resident input- local trail map created, walking group guidance, increased signage along trails, creation of connector trails, addition of equipment, numerous promotion events o Infrared counters installed at five local trails/ parks; observation data also being obtained o Two full years of usage data available for three local trails; preliminary findings indicate increased usage For a complete update on progress, please go to and Understanding Community Resources CVPH and CCHD understand the key to successfully impacting the health of Clinton County is partnering with the community and its organizations and combining resources. The action plans capture the partnership, contributions and support of many community organizations to strengthen the impact of the planned interventions and assure the responsible use of limited resources. Clinton County is fortunate to have developed a strong network of partners representing many different community sectors and offering a variety of assets and capacities for achieving its shared vision for community health. As part of the community health needs assessment process, time was taken to identify assets and resources available to address current health challenges in the community. Community health assets include local services and programs, educational institutions, health care providers, businesses and other opportunities for health such as trails, parks and recreational services. While not all inclusive, the collection of community assets identified through key informant dialogues, review of local coalitions/ partnership members and key word internet searches completed in September 2016 can be found in Appendix L. 28 P a g e

30 Priority and Focus Area Finalization Process To finalize Priority and Focus Area selections and to begin developing local strategies and related activities, a subcommittee consisting of members from the Action for Health Consortium and the CVPH Community Health Assessment Steering Committee was convened. Selection Basis and Method Selection finalization was based primarily on the following: 1. Results of stakeholder surveys outlined above 2. Data analysis outlined above 3. Community health planning session outlined above 4. Application of the Hanlon Method Participants The group was chosen to represent people with community and clinical knowledge, with particular attention to include individuals who are knowledgeable about the needs assessment process, manage services to the underserved, or manage services that address an identified need. Participants included: Jerie Reid, CCHD, Director of Public Health Mandy Snay, CCHD, Director of Health Planning and Promotion Kati Jock, CVPH, Director of Strategic and Business Planning Kaitlyn Tentis, CVPH, Strategic Planning Consultant Karen Ashline, Medical Home/Adirondacks ACO, Associate Vice President Medical Home/ACO Gizelle Menard, CVPH, Director of Adult Behavioral Health Lee Vera, Eastern Adirondack Health Care Network, Project Coordinator Victoria Duley, The Development Corp, Economic Developer Process The subcommittee was convened on July 7 th, 2016 to finalize Priority Area and Focus Area selection. Members of the subcommittee noted the consistency in findings from the stakeholder survey, community survey and community priority setting session voting. Therefore, Prevent Chronic Disease and Promote Mental Health and Prevent Substance Abuse were accepted as selected Priority Areas for Clinton County. To clarify the selection of Focus Areas, the subcommittee reconsidered key health metrics and small group findings from the June 15 th event related to the two selected Priority Areas. The members then individually applied the Hanlon Method to each Focus Area. The Hanlon Method is a quantitative process and NACCHO supported prioritization tool that can be applied to rank specific health problems based on the criteria of: size of the health problem, seriousness of the health problem and effectiveness of interventions. From these ratings, a priority score is calculated using a method related formula. Individual scores were averaged to get final Hanlon Method scores. Focus Areas Defined Hanlon Method scores definitely isolated two focus areas for attention under Prevent Chronic Disease: Obesity in Children and Adults and Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings. One focus area emerged for Promote Mental Health 29 P a g e

31 and Prevent Substance Abuse: Prevent Substance Abuse and Other Mental, Emotional and Behavioral Disorders. Additional information on this process can be found in Appendix M. Action Plans Lead staff from CCHD and CVPH have worked with partners to collect potential activities and interventions. This was done utilizing a variety of methods: individual meetings, review of information collected from the priority setting event, and through guided brainstorm sessions at both for Action for Health and CVPH s CHA Steering Committee. Information was then organized by strategy. Maintaining Engagement & Tracking Progress Active engagement with others in the community to implement change is challenging given diminishing resources and competing priorities. The process of setting shared goals and creating collective action plans has helped define partner roles and has improved the use of available resources. Efficient and effective use of existing assets requires unprecedented collaboration and cooperation by everyone, not just by the agencies or organizations whose primary missions directly relate to health issues. Higher level decision makers from agencies and organizations in the community now participate in the process demonstrating an actionable level of commitment to the health of the community not seen years ago. Increased capacity for community assessment work has allowed more partners, including residents, to be included in the process and through a number of channels. Clinton County s collaborative strategy can be traced back to the mid 2000 s when the Mobilizing for Action through Planning and Partnerships (MAPP) process was first used locally. Clinton County MAPP partners have evolved into the Action for Health Consortium. This group has representatives from a wide variety of community sectors that have implemented effective policy, systems and environmental strategies for nearly the last decade, for the purpose of improving community health. This group meets a minimum of six times each year. A formal update to the CHIP is captured each June, shared with AFH partners and posted on the CCHD website. Additionally, CVPH will continue to have the Community Health Assessment Steering Committee to work towards actionalizing the activities in the implementation strategy that CVPH is solely accountable for. All required updates to the CSP and IS will be disseminated and posted to the CVPH website and links shared with community partners. It has become standard practice for AFH to assemble subcommittees of partners possessing technical and professional expertise to implement and update priority area action plans. For example, a group of mental, emotional, and behavioral health direct service providers was brought together to form a working group for the CHIP. Built environment subcommittees also formed to tackle related action plans. Members of these subcommittees offer progress updates and content expertise to the AFH Consortium at its meetings. It is the intent of CVPH and CCHD to continue to use the developed model of partner engagement described while also always seeking ways to improve processes for all involved. Dissemination of Plan to Public CVPH and CCHD will actively disseminate the CHA, CSP, and CHIP to the public. The plan will reside conspicuously in PDF format in the About section of The CHA will remain posted until two subsequent CHA reports have been produced and shared with the community. CCHD will follow these same guidelines, posting the CHA and CHIP on in the Statistical Data and Annual Reports section of its webpage found at Links to all documents and updates, when available, will 30 P a g e

32 be shared via social media and other media channels. Marketing efforts will then drive the community to these locations to view and download the assessment and related plans. Marketing efforts will include a press release sent to all local media outlining the plan; interviews with the media (as appropriate); regular posts on social media sites such as Facebook and Twitter; and mentions in a variety of print and online communications produced by CVPH and CCHD. CCHD will also be dedicating an edition of its Public Health Profiles to the new CHA/CHIP. The short overview document will highlight priority areas, planned work, and partners. It will also provide specific calls to action for residents, health professionals, and community leaders. This document will be posted on CCHD s website and promoted through the standard mechanisms referenced above. Other communication efforts and channels will be considered throughout the year to help increase awareness of shared, community level health improvement plans among partners and residents alike. Notification will be sent to key stakeholders with a cover letter document community members can access community health assessment related documents. In addition, community presentations will include: AFH members to their Directors or oversight Boards; Targeted local elected officials; Clinton County Board of Health; Foundation of CVPH; And all other appropriate and identified community stakeholders. Active distribution throughout the community will assure continued community engagement in this important strategic planning tool to improve health. Community presentations will focus on how residents can contribute to planned efforts. All dissemination activities will help build the grassroots need to address health improvement efforts across the county by engaging both traditional and nontraditional partners in sustainable and permanent community-based interventions. Evaluation Plan CVPH and CCHD will work together to develop a comprehensive evaluation plan that includes both process and outcome evaluation. CVPH will, additionally, ensure this plan aligns with and compliments the evaluation plans developed by counties in which their service area stretches. Process evaluation will demonstrate if the activities were implemented, if the appropriate populations were reached, and how external factors influenced the implementation. Progress will be tracked through discussion at quarterly meetings with internal and external partners responsible for each initiative. Through these discussions, mid-course corrections may be made to the plan to ensure goals and objectives are met. Outcome evaluation will demonstrate the impact of the activities and the ability to meet the objectives outlined in the action plan. This information will be used to provide regular updates to the NYS Department of Health and the Internal Revenue Service, as requested or required. In addition, this information will be used to share successes and challenges, and inform broader communications with the community and key partners. 31 P a g e

33 Community Health Improvement Plan/ Implementation Strategy: Action Plans Prevent Chronic Disease: Reduce Obesity in Children and Adults Goal: Create community environments that promote and support healthy food and beverage choices and physical activity. Long Term Objective: By 12/31/18, decrease the percentage of Clinton County adults who report participating in no leisure time physical activity by 5% from 25.2% to 21.1% (CDC, 2012). Long Term Objective: By 12/31/18, increase the percentage of Clinton County adults reporting adequate daily fruit and vegetable consumption by 5% from 24.7% to 29.7% (BRFSS, ). Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners (Role) Partner Resources Disparate Population Addressed Offer individually adapted health behavior change programs Source: CDC, Strategies to Prevent Obesity and Other Chronic Diseases ( pa_2011_web.pdf ) -Design a program targeting nurses in conjunction with the Magnet process focusing on diet, exercise, stress, coping, obesity, and disabilities (self-care) -Continuation/expansion of CVPH s Diabetes Prevention Program -Program sign in sheet and agenda -Completion of one program per year for the duration of this CHA (Baseline N/A) -Patient graduation records, #graduates (Baseline =12 in 2016) -CVPH (Lead) -CVPH (Lead) -Staff, time, funding, space -Staff, space, funding -Maintain enrollment in fitness programs tailored for residents 55 years and over. -Participant enrollment/ attendance records (Baseline= 35 in 2016) -CCE (Coordinator) -EAHCN (Support) -AFH Partners/Others (Support) -Staff time -Funding -Cross promotion, space, equipment -Seniors/ Aging -Implement Sun Protection Project targeting those utilizing local spaces for activity. -Develop local work plan for implementation & promotion -Secure funding for materials/ equipment -Finalized work plan, application submission dates -CCHD (Lead) -AFH partners (Support) -Staff, time, supplies -Sponsor, cross promotion -Low income -Coordinate & conduct a Chronic Disease Self-Management Program in Clinton County -Dates of workshops, # participants (Goal= 1 program) -EAHCN (Lead) -AFH Partners/ Others (Support) -Training, funding -Cross promotion, space -Aging 32 P a g e

34 Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners (Role) Partner Resources Disparate Population Addressed Creation of/or enhanced access to places for physical activity combined with informational outreach activities. Source: CDC, Strategies to Prevent Obesity and Other Chronic Diseases ( pa_2011_web.pdf ) -Continuation of Year 2 of Fitness in the Parks -Grant documents -Completion of year 2 activities: -Creation of a foot golf course in Cadyville, open free to youth up to age 18 (Baseline=0) -Increase indoor pickleball courts by 3 (baseline=6, goal=9) -Expand Fitness in the Park to 5 additional townships (baseline =5, goal= 10) -Foundation of CVPH (Lead) -AFH Partners (Support) -Staff, time, funding -Cross Promotion -Low-income -Senior/ Aging -Offer local trail map within the CVPH Occupational Health Department -Number of places map is available outside CCHD -Identification of location within CVPH (Baseline =0, Goal= 1 spot in 2017, additional spot subsequent years) -CVPH (lead) -CCHD (Assist) -Staff, time, coordination Map -Finalize enhancement to one additional recreational space to support activity across the lifespan -Completion of work at one additional site, kickoff event date (Baseline=5 spaces, Goal=6 spaces) -CCHD (Lead) -AFH partners (Support) -Staff, time, grant funding, partner coordination -Cross promotion -Senior/Aging -Disabilities -Facilitate community entities to submit projects to NYSHF/ioby s spring Healthy Neighborhoods Challenge for match funding -Formal agreements in place, usage/observation data, dates of promotion activities -Submitted applications (Baseline= 3 applications submitted in 2016, Goal=2 applications submitted in 2017) -CCHD (Lead) -AFH (Supprt) -Staff time, facilitation -Connection to community entities -Low income, disabilities -Creation of a multi-use, accessible recreation trail in Morrisonville (identify and apply for resources -Application completed, submission date -Town of Plattsburgh, Planning Dept (Lead) -Foundation of CVPH (Partner) -AFH (Support) -Staff, recommendations, coordination -Staff time, application completion -Promotion, assist 33 P a g e

35 Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners (Role) Partner Resources Disparate Population Addressed Ensure access to fruits and vegetables in workplace cafeterias and other food service venues. Source: CDC, Strategies to Prevent Obesity and Other Chronic Diseases ( fandv_2011_web_tag508.pdf) -Continued usage of healthy meal and beverage standards for meals sold and served in the hospital with a focus on using healthy, locally grown foods in cafeteria and patient meals -Review of menus for dietary content -No sugar added options -Inclusion of nutritionals on entrees and specials -Compliance with selected indicators per policy (Baseline= 25% local Goal: sustain 25% local) -CVPH (lead) -Staff time, financing Improve access to or availability of high quality fruits & vegetables at throughout the community. Source: CDC, Strategies to Prevent Obesity and Other Chronic Diseases ( fandv_2011_web_tag508.pdf) -Expand participation in local Better Choice certification programs -Recruit & promote locally owned restaurants to participate in Better Choice Eatery program -Recruit & promote locally owned retailers to participate in Better Choice Retailer program - Applications, enrollment dates (Baseline = 5, Goal= Increase participation by 100% ) -Applications, enrollment dates (Baseline= 6, Goal= Increase participation by 100% ) -CCHD (Lead) -AFH partners (support) -CCHD (Lead) -Staff, time, partner coordination -Cross promotion -Staff, time, funding, partner coordination -Food insecure (for all activities) -Work with local farmers to increase the number of farmers markets/ stands accepting local, state and national nutrition incentive program benefit -Application submission dates, authorization dates (baseline, goal) FMNP- 11 sites, 15 sites WIC- 10 sites, 14 sites SNAP- 7 sites, 9 sites FFC- 10 sites, 15 sites CCHD (Lead) -AFH partners (support) -Promotion, connection to community groups and resources -Increase use of locally sourced ingredients in Cooking with Kids class -# classes utilizing locally sourced fruits and vegetables (Baseline pending, goal- increase by 25%) -TOP- Recreation (lead) -AFH partners- cross promotion -Staff, time -Cross promotion -Continue CVPH malnutrition program -Length of stay (Baseline=2.5d, Goal= 2.2d) Readmission rates (Baseline=18.7%, Goal= 16.5%) -CVPH (Lead) -Staff, time, health informatics -Coordinate CVPH malnutrition and CCHD Farm Fresh Cash Programs -#patients referred, #program patients receiving vouchers (Baseline= N/A, Goal= 10 patients) -CCHD (Co-lead) -CVPH (Co-lead) -Staff, funding, training -Staff, patient access Include fruits and vegetables in emergency food programs. Source: CDC, Strategies to Prevent Obesity and Other Chronic Diseases ( fandv_2011_web_tag508.pdf) -Institute environmental changes at local food pantries that increase the site s capacity to accept and distribute fresh produce -Design and launch a community media campaign aimed at increasing donation of fresh produce and other nutritionally sound items to local food pantries. -# of pantries participating, project completion dates (Baseline= 0, Goal= 3 sites) -Dates of media promotions, # channels utilized -CCHD (Lead) -JCEO, PIFS -AFH partners -Staff, time, funding -Access to target spaces, clients -Connection to local organizations, cross promotion -Food insecure, low income (for all activities) 34 P a g e

36 Prevent Chronic Disease: Increase Access to High Quality Chronic Disease Preventative Care and Management in Clinical and Community Settings Goal: Increase screening rates for colorectal cancer, especially among disparate population. Long Term Objective: Percentage of adults who receive a colorectal cancer screening based on the most recent guidelines (ages 50-75) from 75.8 to 80. (Data Source: NYS BRFSS) Long Term Objective: By December 31, 2018, achieve the healthy people target for age adjusted death rate due to colorectal cancer from 16.7% to 14.5 deaths/100,000 population (HealthyAdk.org) Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners/ Role Partner Resources Disparity addressed Implement evidence- based activities that increase public awareness about cancer screening. Source: National Colorectal Cancer Roundtable, 80% by 2018 Guidebook ( 2018/80-by-2018-communicationsguidebook/ ) -Implement peer education grant to refer patients for screening in mammography and men referred to primary care for discussion on prostate screening hope to extrapolate lessons learned on mammography and prostate to colon -Host a Men s Night Out to provide information on colon and prostate cancer screening -Grant documents & reports (Baseline= N/A, Goal- referral of 100 patients to primary care) -Number of uninsured/ underinsured taking advantage of Clinton County Cancer Services Program (Baseline= 85% participants below 250% FPL; Goal- maintain 85%.) -Attendance numbers (goal- 40 men Baseline- N/A) -CVPH (Lead) -AFH Partners (Support) -CVPH Foundation (lead) -AFH Partners/ Others (Support) -Staff, time, grant funding, -Cross promotion, connection to disparate populations -Staff, time -Cross promotion, space, incentives -Low income, underinsured -Maintain Navigator Program to connect patients to screening services -Number of patients utilizing the navigator program to connect to screening services (Goal- 5% increase) -CVPH (Lead) Fitzpatrick Cancer Center -Staff, time, program coordination -Conduct media outreach related to clinical preventive services for colorectal screening # of messages (Goal=8) -EAHCN (Lead) -AFH Partners (Support) -Staff, coordination, funding -Cross promotion Promote provider practice implementation of evidence based interventions & guidelines. -Integrate cancer screening messaging and recommendations into Partner Nurse detailing packets -# packets distributed, # providers reached Goal- At least 2 editions contain screening recommendations and related info. -CCHD (Lead) -Staff, time, materials, funding Source: CDC, The Guide to Community Preventive Services ( ) -Provide local perspective/ data update on screening practices/ behaviors at annual provider event -Event data, # of providers reached -CCHD (Lead) -Staff, time, coordination, space, funding 35 P a g e

37 Promote Mental Health and Substance Abuse: Prevent Substance Abuse and Other Mental Emotional Behavioral Disorders Goal: Prevent and reduce the occurrence of mental, emotional and behavioral disorders among youth and adults Long Term Objective: By 12/31/2018, Reduce the percentage of adult Clinton County residents reporting 14 days with poor mental health in month by 3% from 11.1% to 8.1% (BRFSS September 2014 data) Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners/ Role Partner Resources Disparity addressed Identify, engage and clarify roles of partners across sectors. -Expansion of SPARCC activities to include quarterly meetings, work plan -Meeting dates, shared work plan -SPARCC partners -Variable Source: NYSDOH, Prevention Agenda: Evidence Based Programs, Policies and Practices ( revention_agenda/ /plan/mhsa/ebi/index.htm) -Maintenance of MEB Subcommittee of AFH -Coordinate screening of Chasing the Dragon (FBI, DEA) for the public -Meeting dates, agendas, attendance records -SPARCC meeting minutes, event date, attendance data (# in attendance, school districts represented) -CCMH&AS (lead) -CVPH, BHSN, CCHD, CVFC, others (partner) -SPARCC partners -Staff, time for coordination/ facilitation, space -Variable (staff, time, space) -CVPH ED to start program to dispense Narcan in the ED (2 year program) (grant from Alliance for Positive Health) for opioid overdose patients -In 2017, implement program -CVPH (lead) -Alliance for Positive Health (partner) -Staff, time, training, cost of drugs Promote coordination of mental health practitioners with other care providers Source: NYSDOH, Prevention Agenda: Evidence Based Programs, Policies and Practices ( revention_agenda/ /plan/mhsa/ebi/index.htm) -Renovations to CVPH Behavioral Health Unit & embedding of outpatient services (Medical Village) -Establish local withdrawal and stabilization services -Embedding of primary Center for Wellbeing -Hospital approval received -Certificate of Need (CON) submitted -CON approval received -Progress reports, opening date -Identified primary care provider -Established service -CVPH (lead) -BHSN (partners) -CVFC (lead) -AFH partners (support) -BHSN -Financing, coordination -Coordination, staff, time, funding -Space, coordination -MEB population -Planning/ preparation for HHHN to open FQHC with embedded behavioral health services -CON submission date -Date construction begins -Opening date (anticipated 2018) -CVPH (lead) -HHHN (partner) -Financing, project coordination -Continued integration of mental health and substance use disorder treatment into 8 primary care practices -Practices identified, date of integration -CCMH&AS (lead) -EAHCN (support) -Staff, training, expertise - supplies & equipment to enhance portability Integrate trained Recovery Coaches into local service agencies -# agencies interested, #coaches integrated -CVFC (Lead) -Trained coaches, coordination 36 P a g e

38 Strategy/ Source Interventions/Activities (to be completed by 12/31/2017) Process Measures Partners/ Role Partner Resources Disparity addressed Support mental wellbeing by creating supportive environments. Source: WHO, Promoting Mental Health: Concepts, Emerging Evidence, Practice ( ence/en/promoting_mhh.pdf) -Offer a series of educational events focusing on primary and secondary disease prevention for the MEB community and other vulnerable populations -Explore guidance and feasibility of a local law enforcement diversion program -Dates of events, attendance # s/ records, program evaluation feedback -Meeting dates, agenda, recommendations -CCHD (lead) -BHSN (partner) -SPARCC partners -Staff, time, incentives -Space, coordination of high risk groups -Staff, time, variable -MEB population -Promote Talk2Prevent platform at local community events -# events, event reach -Champlain Valley Family Center (CVFC) -Staff, time -Integrate Youth Mental First Aid into local school districts -Identified school districts -Dates of trainings -# educators trained -CVFC (lead) -School districts -Staff, time, training materials -Space, educators, time -Offer Family Yoga sessions -Dates of programs -# participants -CVFC (lead) -Staff, time, space, trained instructor -Cross promotion -Expand the Senior-to-Senior program -Facility identified -Program initiation date -Number of visits made -CCHD & AFH partners (support) -SUNY Plattsburgh Nursing Program -Staff, coordination of nursing students -Seniors/Aging -CVPH Child and Adolescent Mental Health Unit Social Worker to launch support group for families of patients who have been in the mental health system -Launch of group -CVPH (Lead) -Staff, time, space -Coordinate marketing strategies to reduce stigma/ misperceptions related to seniors uilzing behavioral health services -message dates, format, distribution channels -EAHCN (lead) -staff, time, funding Seniors/ Aging 37 P a g e

39 Appendices 38 P a g e

40 Appendix A: Committee Members and Meeting Schedule Adirondack Rural Health Network (ARHN) Community Health Assessment (CHA) Committee Members and Meeting Schedule Name Organization Bonnie Ohmann Adirondack Health Ginger Carriero Alice Hyde Medical Center Josy Delaney Alice Hyde Medical Center Kati Jock The University of Vermont Health Network Champlain Valley Physicians Hospital Heather Reynolds The University of Vermont Health Network Elizabethtown Community Hospital Julie Tromblee The University of Vermont Health Network Elizabethtown Community Hospital Kristin Dooley The University of Vermont Health Network Elizabethtown Community Hospital Linda Beers Essex County Public Health Jessica Darney Buehler Essex County Public Health Kathleen Strack Franklin County Public Health Erin Streiff Franklin County Public Health Irina Gelman Fulton County Public Health Tracy Mills Glens Falls Hospital Kelly Pilkey Glens Falls Hospital Susan Franko Hamilton County Public Health Tammy Smith Inter-Lakes Health Cheryl McGrattan Nathan Littauer Hospital Pat Auer Warren County Health Services Dan Durkee Warren County Health Services Ginelle Jones Warren County Health Services Patty Hunt Washington County Public Health Kathy Jo Mcintyre Washington County Public Health Meeting Dates September 10, 2014 December 5, 2014 March 11, 2015 June 10, 2015 October 15, 2015 January 8, 2016 March 30, 2016 June 24, 2016 September 15, 2016 *Scheduled January 12, 2017 *Scheduled 39 P a g e

41 Action for Health Consortium Members Diana Aguglia Maria Alexander Sara Allen Joy Arana Maryann Barto Laurie Booth-Trudo James Bosley Mary Breyette Crystal Carter Dot Crawford Kim Crockett Melanie Defayette Karen Derusha Bob Dickie Adele Douglas Shannon Drowne Victoria Duley Darwyna Facteau Sally Garvey Sandra Geddes Kerry Haley Mark Hamilton Karen Kalman John Kanoza Dorothy Latta Jody Leavens Charles McCoy Gizelle Menard Erin Pangborn Steve Peters Amy Putnam Jerie Reid Sara Rowden Shawn Sabella Shey Schnell Margaret Searing Courtney Smith Mandy Snay Kathy Snow Sally Soucia Julie Stalker Trevor Cole Peter Trout Brittany Trybendis Alliance For Positive Health Senior Citizens Council Clinton County Health Department, Contractor Citizen, Licensed Social Worker Clinton County Health Department, Environmental Health Division Child Care Coordinating Council of the North Country Clinton County Planning/Clinton County Public Transit Cornell Cooperative Extension Clinton County Office for the Aging Interfaith Food Shelf Clinton County Youth Bureau Town of Plattsburgh Recreation Department Clinton County Health Department, Health Planning and Promotion Division University of Vermont Health Network-Champlain Valley Physicians Hospital Town of Peru Community Development Coordinator Kinetic Running The Development Corp. Clinton County Health Department, Health Care Services Division Office for the Aging, Clinton County Community Development, City of Plattsburgh The Foundation of CVPH City of Plattsburgh Housing Authority University of Vermont Health Network-Champlain Valley Physicians Hospital Clinton County Health Department, Environmental Health Division Plattsburgh Interfaith Food Council Fidelis Care Citizen University of Vermont Health Network-Champlain Valley Physicians Hospital Town of Plattsburgh Recreation Department City of Plattsburgh Recreation Department Fidelis Care Clinton County Health Department, Administration Citizen Behavioral Health Services North University of Vermont Health Network-Champlain Valley Physicians Hospital Clinton County Health Department, Administration Adirondack Health Institute Clinton County Health Department, Health Planning and Promotion United Way of the Adirondack Region Joint Council For Economic Opportunity Joint Council For Economic Opportunity Town of Plattsburgh Planning Department Behavioral Health Services North State University of New York at Plattsburgh 40 P a g e

42 Lee Vera Laurie Williams Steve Williams Kati Jock Eastern Adirondack Health Care Network The Foundation of CVPH, Contractor Hannaford Supermarket University of Vermont Health Network - Champlain Valley Physicians Hospital Action for Health Consortium Meeting Schedule January 17, 2015 March 4, 2015 May 13, 2015 July 15, 2015 September 2, 2015 November 4, 2015 January 13, 2016 March 9, 2016 May 11, 2016 July 13, 2016 September 14, 2016 November 9, 2016 Tentative 2017 Meeting Dates January 11, 2017 March 15, 2017 May 17, 2017 July 12, 2017 September 13, 2017 November 15, P a g e

43 CVPH Committee Health Needs Assessment Steering Committee Name Amy O Connor Brenda Stiles Carrie Howard-Canning Deb Flock Debra Good Dr. Jose Lopez Ginger Carriero Greg Freeman Heather Reynolds Julie Marshall Kaitlyn Tentis Karen Ashline Kati Jock Ken Thayer Kerry Haley Maher Hanna Michele Powers Patricia Johnson Rosemary Reif Dept/Area Represented Alice Hyde Medical Center Adirondack ACO/Medical Home CVPH Nursing CVPH Grant Writing CVPH Case Manager Physician Representative, Family Medicine Alice Hyde Medical Center CVPH Occupational Health Elizabethtown Community Hospital Alice Hyde Medical Center Adirondack Region Planning Adirondack ACO/Medical Home Adirondack Region Planning CVPH Emergency Department CVPH Foundation CVPH Ancillary Services CVPH Marketing CVPH Fitzpatrick Cancer Center CVPH Behavioral Health Meeting Dates February 23, 2016 April 26, 2016 May 25, 2016 July 26, 2016 August 23, P a g e

44 Appendix B: NYS Prevention Agenda Prevention Agenda Priority Area Focus Areas Goals Improve Health Status and Reduce Health Disparities Improve Health Status and Reduce Health Disparities Improve the health status of all New Yorkers Promote a Healthy and Safe Environment Prevent Chronic Disease Injuries, Violence, and Occupational Health Outdoor Air Quality Built Environment Water Quality Reduce Obesity in Children and Adults Reduce illness, disability and death related to tobacco use and secondhand smoke exposure Increase access to high quality chronic disease preventive care and management in both clinical and community settings Reduce fall risks among the most vulnerable populations Reduce exposure to outdoor air pollutants, with a focus on burdened communities Improve the design and maintenance of the built environment to promote healthy lifestyles, sustainability, and adaptation to climate change Improve the design and maintenance of home environments to promote health and reduce related illness Increase the percentage of State residents that receive optimally fluoridated drinking water Reduce potential public health risks related to drinking water and recreational water Create community environments that promote and support healthy food and beverage choices and physical activity Prevent childhood obesity through early child care and schools Expand the role of health care and health service providers and insurers in obesity prevention Expand the role of public and private employers in obesity prevention Prevent initiation of tobacco use by New York youth and young adults, especially among low socioeconomic status (SES) populations Promote tobacco use cessation, especially among low SES populations and those with poor mental health Eliminate exposure to secondhand smoke Promote use of evidence-based care to manage chronic diseases Promote culturally relevant chronic disease self-management education 43 P a g e

45 Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated Infections Promote Healthy Women, Infants, and Children Promote Mental Health and Prevention Substance Abuse Vaccine-Preventable Diseases Human Immunodeficiency Virus (HIV) Sexually Transmitted Diseases (STDs) Hepatitis C Virus (HCV) Healthcare-Associated Infections Maternal and Infant Health Child Health Preconception and Reproductive Health Promote Mental, Emotional and Behavioral Health (MEB) Prevent Substance Abuse and Other MEB Disorders Improve childhood and adolescent immunization rates Educate all parents about importance of immunizations Decrease the burden of pertussis disease Decrease the burden of influenza disease Decrease the burden of disease caused by humanpapillomavirus Decrease HIV morbidity Increase early access to and retention in HIV care Decrease STD morbidity Increase and coordinate HCV prevention and treatment capacity Reduce Clostridium difficile (C. difficile) infections Reduce infections caused by multidrug resistant organisms Reduce device-associated infections Reduce premature births in New York State Increase the proportion of NYS babies who are breastfed Reduce the rate of maternal deaths in New York State Increase the proportion of NYS children who receive comprehensive well child care in accordance with AAP guidelines Reduce the prevalence of dental caries among NYS children Reduce the rate of adolescent and unplanned pregnancies in NYS Increase utilization of preventive health services among women of reproductive age to improve wellness, pregnancy outcomes and reduce recurrence of adverse birth outcomes Promote mental, emotional and behavioral well-being in communities Prevent underage drinking, nonmedical use of prescription drugs by youth, and excessive use of alcohol consumption by adults Prevent and reduce occurrences of mental, emotional and behavioral disorders among youth and adults 44 P a g e

46 Strengthen Infrastructure Across Systems Prevent suicides among youth and adults Reduce tobacco use among adults who report poor mental health Support collaboration among professionals working in fields of mental, emotional, behavioral health promotion and chronic disease prevention, treatment and recovery Strengthen infrastructure for mental, emotional behavioral health promotion, and mental, emotional behavioral disorder prevention 45 P a g e

47 Appendix C: AHI PPS DSRIP Projects & Population Health Initiatives AHI PPS DSRIP Projects AHI PPS Delivery System Reform Incentive Payment Program (DSRIP) The AHI PPS has elected to participate in eleven projects, covering three domains: System Transformation projects are designed to accomplish New York s State Innovation Plan, a roadmap to achieve the Triple Aim for all New Yorkers: improved health, better health care quality and consumer experience, and lower costs. This multi-faceted approach has at its core an advanced primary care model that integrates care with all parts of the health care system, including behavioral health and community-based providers and aligns payment with this care model. o 2ai Integrated Delivery System o 2aii Advancing Primary Care o 2aiv Medical Village o 2bviii Hospital-Home Collaboration Solutions o 2di Patient Activation Clinical Improvement projects focus on a specific disease or service category (ex, behavioral health, substance abuse, palliative care) that have been identified as a significant cause of avoidable hospital use by Medicaid beneficiaries in our region. o 3ai Integrating Behavioral Health with Primary care o 3aii Crisis Stabilization o 3aiv Withdrawal Management o 3gi Integration of Palliative Care into the PCMH Model Population-Wide Strategy Implementation projects focus on progress on measures from the New York State Prevention Agenda. The Prevention Agenda is a blueprint for state and local action to improve the health of New Yorkers in five priority areas (prevent chronic disease; promote a healthy & safe environment; promote healthy women, infants & children; promote mental health and prevent substance abuse; prevent HIV, sexually transmitted diseases, vaccine preventable disease and healthcare associated infections) and to reduce health disparities for racial, ethnic, disability and low socioeconomic groups, as well as other populations who experience them. o 4aiii Strengthening the Mental Health & Substance Abuse Infrastructure o 4bii Chronic Care: COPD Nearly 100 Regional Partners are part of the AHI PPS. Partners are organized by Regional Health Innovation Teams (RHIT). RHITs provide a forum for collaborative planning, monitoring, and development of innovative health system programs/projects. AHI has convened stakeholders in the nine-county service area (Warren, Washington, Essex, Franklin, Clinton, Hamilton and parts of St. Lawrence, Fulton and Saratoga counties) to discuss the unmet needs of the communities and the barriers to accessing care. 46 P a g e

48 Population Health Initiatives Adirondack Medical Home Initiative: The Adirondack Medical Home Initiative (AMHI) is a collaborative effort by health care providers and public and private insurers to transform health care delivery by emphasizing preventative care, enhanced management of chronic conditions, and assuring a close relationship between patients and their primary care providers. The Initiative serves six Adirondack counties in New York State Clinton, Essex, Franklin, Hamilton, Warren, and Washington. More than 200 primary care providers, five hospitals, and seven health insurance organizations are working together to develop an innovative, patient-centered model of health care that strengthens the role of primary care. Population Health Improvement Program (PHIP): The North Country PHIP brings together a variety of stakeholders in the North Country that impact, or are impacted by, health and health care issues. PHIP assists providers, agencies and organizations with identifying data and using data driven, collaborative decision making to address the social determinants of health that contribute to health disparities in the region. The PHIP is engaged with stakeholders in Franklin, Clinton, Essex, Hamilton, Warren, and Washington counties. NYS Health Innovation Plan and State Innovation Model (SIM): New York s SIM testing grant seeks to transform primary care delivery and payment models across the State, eventually reaching 80 percent of New York s primary care providers, payers, and patients. The SIM is a part of New York s larger State Health Innovation Plan (SHIP), which is driving evolution of health delivery and payment systems through numerous initiatives. The intent and goal is to identify and stimulate the spread of promising innovations in health care delivery and payment that result in optimal health outcomes for all New Yorkers. Some Population Health Initiatives focused on Medicare members: Accountable Care Organizations (ACOs): ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. Adirondacks ACO includes hospitals and participating primary and specialty care providers in Clinton, Essex, Franklin, Hamilton, Warren, Washington and northern Saratoga counties. Some Population Health Initiatives focused on Medicaid members: Delivery System Reform Incentive Payment (DSRIP) Program: The purpose of DSRIP is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program. Across NYS, there are 25 Performing Provider Systems (PPSs) or networks of providers that have agreed to work together. DSRIP is an incentive payment model that rewards providers for performance on delivery system transformation projects that improve care for low-income patients. The primary goal of DSRIP is reducing avoidable hospital use by 25% over 5 years. Some key DSRIP projects for CVPH are the Behavioral Health Medical Village which provides funding to renovate the inpatient psychiatry unit at CVPH and embed an outpatient community organization for a warm hand off as well as a grant to build a primary care practice that will be operated by Hudson Headwaters Health Network (HHHN) a Federally Qualified Health Center (FQHC). See Appendix C for a list of AHI PPS Projects. Health Home: A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that a patient's needs are addressed in a complete and comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual s needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital. Health records 47 P a g e

49 are shared among providers so that services are not duplicated or neglected. Health Home services are provided through a network of organizations providers, health plans and community-based organizations. When all the services are considered collectively they become a virtual "Health Home." Health Home focuses on people who have complex medical, behavioral, and long term care needs thus need help navigating multiple systems of care. 48 P a g e

50 Appendix D: Health Related Priorities by Community Sector Clinton County Efforts to build healthier communities have the potential for being more successful when agencies, programs and individuals from multiple community sectors work together. Collaboration between the health sector and other community sectors can generate new opportunities to improve health. Below is a summary of county, regional and statewide planning documents and policy agendas from a variety of community sectors that address health-related issues. Links are included to facilitate access to the documents. The contents are organized by the relevant Prevention Agenda Focus Area. The summary does not provide an exhaustive analysis of multi-sector health priorities, but is provided to illustrate the potential for collaborative health improvement efforts in the county and region. Prevent Chronic Diseases NYS Office for the Aging State Plan Strengthen partnerships with health care providers and develop models that reach new populations. Work with other state agencies and local partners to prevent readmission to hospitals. Teach older adults how to manage complex chronic conditions. Promote and expand access to health and wellness/disease management and prevention programs. Expand opportunities for integration of non-clinical support services within physical and behavioral health care systems. Provide one-on-one assistance to understand the complexities of and navigating Medicare and other health insurance. Utilize the experience, expertise and skills of older New Yorkers to help address workforce shortages in areas such as health care. Promote a Safe and Healthy Environment New York State Affordable Housing Solutions: 5 Year Plan ( ) Create a new Senior Housing Plus Services program to support aging in place of New York s rapidly growing low-income elder population. The program should emphasize wellness and healthy aging, and avoidance of premature entry into Medicaid funded institutional settings. Incentivize Affordable Housing Development in High-Opportunity Neighborhoods to increase fair housing options while also complementing existing efforts to revitalize low-income neighborhoods. Work with municipalities to develop incentives in the area of zoning and local siting of affordable housing projects. Facilitate the development of a diversity of affordable housing types, particularly family and supportive housing serving low- and extremely low-income households. Clinton County Department of Planning and the Clinton County Economic Collaborative Clinton County Transportation Needs Assessment Continue existing relationships with Office on Aging and the Department of Social Services to provide transportation services for their clients. Explore opportunities to identify areas of potential cooperation and coordination with ARC and Behavioral Health Services North. Add bike racks to all CCPT buses to assist riders access to employment and recreational activities. Create greater transit connections between Clinton County and Franklin County, New York and Chittenden County, Vermont. This is especially important for medical staff traveling between Plattsburgh and Burlington. 49 P a g e

51 Complete Streets Policies The Town of Plattsburgh has a Complete Streets policy. Promote Healthy Women, Infants and Children Adirondack Birth to Three Alliance The Adirondack Birth to Three (BT3) Alliance has identified the following five building blocks of services to improve outcomes for children: Universal home visiting for all families with newborns; Comprehensive home visiting with extended periods of home visits for vulnerable families; Family resource centers for parenting education and support, developmental screening, and other family services accessible to all; High quality early childhood education for all; High quality health care including mental and physical health care services accessible to all children; and Early literacy support emphasizing the importance of reading to infants and toddlers, providing access to free books, and providing parents with information about child development. New York State Early Childhood Advisory Council The NYS Early Childhood Advisory Council (ECAC) focus on healthy children includes training early childhood professionals to better identify health issues, establishing routine developmental screenings and promoting more nutritious meals and exercise at early childhood centers. The desired outcomes that guide the ECAC s work on Healthy Children include: All pregnancies are wanted, healthy, and safe, and include prenatal screening. Children s environments are free from preventable injury and illness. Children achieve optimal physical, social, emotional and cognitive development. Children receive early recognition and intervention services for their special needs. Children are enrolled in public or private health insurance programs. Children s health, mental health, and oral health services are accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally respectful. School Wellness Policies School districts participating in the National School Lunch Program and/or the School Breakfast Program are required to establish a school wellness policy for every school building in the district. At a minimum, the wellness policy must include goals for nutrition promotion and education, physical activity, and other school-based activities that promote student wellness. The policies must include nutrition guidelines to promote student health and reduce childhood obesity for all foods available in each school district. Additionally, school districts are required to permit teachers of physical education and school health professionals, as well as parents, students, school board members, and the public to participate in the development and implementation of wellness policies. Opportunities exist for local health departments and health care providers to assist school districts develop and implement school wellness policies. Promote Mental Health and Reduce Substance Abuse Clinton Co. Addiction Services Local Services Plan for Mental Hygiene Services In partnership with the Adirondack Health Institute (AHI) Preferred Provider System (PPS), behavioral health and health care are integrated on a regional basis. In partnership with AHI PPS, ambulatory detoxification services are integrated on a regional basis. In partnership with AHI PPS, crisis stabilization services are integrated on a regional basis. 50 P a g e

52 A Zero-Suicide system-wide approach to suicide prevention is adopted by the community. An interdisciplinary action plan is developed to reduce the impact of heroin/opiate use. Developmental Disability Services will work collaboratively with Mental Health and Addiction providers to provide treatment across the system. The stock of affordable, quality housing and continuum of housing opportunities is enhanced through collaboration with the Clinton County Housing Coalition. An accessible, affordable and reliable transportation system that supports service recipients in following through with prescribed outpatient physical and BH treatment is fortified. Current technology is utilized to enhance knowledge of behavioral health services. Clinton County behavioral health workforce is bolstered. The Alcoholism and Substance Abuse Providers of New York State (ASAP) Legislative Recommendations Lift roadblocks to employment and housing for people in recovery who developed a criminal justice history while actively suffering from their addiction disease. Strengthen access to emergency/crisis services for persons with substance use disorders, especially those with co-occurring health and mental health issues. Create wraparound services for adolescents and adults while in treatment and to support recovery posttreatment. Such services would include case management, peer supports; employment support; transportation assistance, and other recovery supports. Make treatment more accessible, eliminate waiting lists, make a comprehensive continuum of SUD services accessible in every region of the state. Reduce under-age drinking using such measures as making labeling and marketing practices that are specifically targeting persons under age 21 illegal, educating stores and persons that sell alcohol products about under-age drinking risks and consequences, and environmental strategies that reduce the likelihood of problems related to under-age alcohol and other drug use. Make Naloxone more readily available; provide naloxone training to first responders, teachers, family members, and concerned persons; and facilitate access to Naloxone. Mandate continuing education for physicians and other practitioners that prescribe opiates with a focus on addiction and appropriate assessment, brief intervention, and referral to treatment. Promote harm reduction to reduce the chances for persons becoming positive for HIV/AIDS, hepatitis, and other health conditions associated with IV and other drug use. Improve Health Status and Reduce Health Disparities New York Association on Independent Living 2016 Priority Agenda Allow non-licensed professionals, under the supervision of a registered nurse and who are trained and certified as advanced aides, to perform assistance with and maintenance of skills necessary for the individual with a disability to accomplish health-related tasks. This would help provide a support system for all people to access as an alternative to nursing facility/institutional placement, regardless of age, diagnosis or severity of disability. Incorporate inclusive home design features in new residential housing that receives financial assistance for construction from federal, state, county or local governments. Housing built with basic accessibility features, known as inclusive home design, would meet the needs of people throughout the lifespan and allow homes to be accessible to friends and family members with disabilities. Establish a small business tax credit for the employment of people with disabilities to provide an incentive for small businesses to hire individuals with disabilities, increasing the opportunities for New Yorkers with disabilities to achieve gainful employment and self-sufficiency. Require transportation service providers, such as taxis and limousines, to purchase accessible vehicles. Cap fares for paratransit at levels no higher than the base fares for transportation of non-disabled adults using the public transit system. 51 P a g e

53 New York State Community Action Association 2016 Policy Agenda Support the implementation of federally-mandated health and safety requirements and new federal requirements to help avoid a reduction in child care subsidies for low-income parents. Support funding for the Hunger Prevention and Nutrition Assistance Program (HPNAP) to address the increased demand and rising food costs. Support increased access and participation in the Supplemental Nutrition Assistance Program (SNAP). Support incentive programs that increase buying power for fruits and vegetables at farmers markets. Support increased homeless shelter allowances and creation of a Community Restoration Fund to prevent foreclosures, improve neighborhood stabilization and provide funding for the Mortgage Assistance Program. Support increased public transportation offerings in rural areas of the state to promote better access to employment opportunities, health care, and safe housing. Economic Development There are a number of entities that are playing active roles in promoting economic development in the North Country and the state. Regional Economic Development Councils, County Economic Development Corporations, and Regional/Local Chambers of Commerce help guide local, community-based approaches to economic growth. Economic development priorities such as job creation, work force training, affordable housing, technology access, broadband Internet access, educational opportunities, transportation expansion, energy and weatherization improvement, and employee wellness programs all have an impact on the region s health and quality of life. Active participation of the public health and health care sectors in local and regional economic development planning bodies can help ensure that health-related concerns are considered when economic growth projects and priorities are developed. Information about economic development priorities and activities in the region and county can be found at: North Country Regional Economic Development Council North Country Chamber of Commerce Clinton County Industrial Development Agency AdkAction.org 52 P a g e

54 Appendix E: Demographic Profile Adirondack Rural Health Network County ARHN New York Summary of Demographic Information, Page 1 of 2 Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington Region (1) Upstate NYS State Square Miles Total Square Miles 1,038 1,794 1, , ,372 46,824 47,126 Total Square Miles for Farms ,224 11,224 Percent of Total Square Miles Farms 22.2% 4.8% 13.9% 10.1% 0.2% 50.9% 15.2% 1.7% 35.6% 10.8% 24.0% 23.8% Population per Square Mile Population Total Population 81,829 39,072 51,508 54,870 4,783 49, ,512 65,388 62, ,360 11,239,441 19,594,330 Percent White, Non-Hispanic 90.6% 92.5% 82.0% 93.5% 96.1% 84.1% 92.1% 94.7% 93.0% 91.3% 75.5% 57.3% Percent Black, Non-Hispanic 4.0% 2.8% 5.6% 1.5% 0.4% 1.5% 1.5% 1.1% 2.7% 2.9% 8.3% 14.4% Percent Hispanic/Latino 2.6% 2.8% 3.2% 2.6% 1.2% 12.0% 2.7% 2.0% 2.4% 2.6% 10.2% 18.2% Percent Asian/Pacific Islander, Non-Hispanic 1.3% 0.5% 0.4% 0.7% 0.1% 0.6% 2.0% 1.0% 0.6% 0.8% 3.7% 7.7% Percent Alaskan Native/American Indian 0.3% 0.3% 7.0% 0.2% 0.0% 0.1% 0.1% 0.2% 0.1% 1.2% 0.3% 0.2% Percent Multi-race/Other 1.2% 1.1% 1.8% 1.5% 2.2% 1.7% 1.6% 1.0% 1.1% 1.3% 1.9% 2.2% Number Ages 0-4 3,969 1,654 2,681 2, ,980 11,756 3,142 3,195 17, ,966 1,170,258 Number Ages ,366 5,370 7,639 8, ,487 36,857 9,673 9,629 53,159 1,862,922 3,101,974 Number Ages ,858 24,397 33,902 33,918 2,790 29, ,249 40,490 39, ,231 7,044,052 12,566,926 Number Ages 65 Plus 11,636 7,651 7,286 9,266 1,182 8,487 32,650 12,083 10,210 59,314 1,708,501 2,755,172 Number Ages Female 15,816 5,981 8,268 9, ,000 41,490 11,171 10,596 62,044 2,120,373 4,049,852 Family Status Number of Households 31,976 15,571 19,131 22,440 1,639 19,655 89,876 27,699 24, ,621 4,159,597 7,255,528 Percent Families Single Parent Households 15.6% 13.2% 17.8% 18.6% 9.2% 17.9% 12.7% 15.7% 17.4% 16.4% 16.6% 19.8% Percent Households with Grandparents as Parents 1.3% 1.3% 1.6% 2.4% 1.4% 1.8% 1.1% 1.8% 2.1% 1.7% 1.5% 1.8% Poverty Mean Household Income* $64,485 $64,341 $58,932 $58,147 $63,710 $58,106 $87,334 $71,229 $61,153 N/A N/A $85,736 Per Capita Income $25,279 $26,755 $22,322 $24,265 $29,974 $23,809 $35,860 $30,662 $23,877 N/A N/A $32,829 Percent of Individuals Under Federal Poverty Level 15.2% 11.4% 19.7% 16.2% 9.5% 19.1% 6.8% 11.9% 13.0% 14.5% 11.8% 15.6% Percent of Individuals Receiving Medicaid 18.1% 15.2% 17.8% 21.9% 13.0% 23.8% 9.7% 15.6% 17.0% 17.6% 16.9% 24.7% Per Capita Medicaid Expenditures $1, ####### $1, ####### $1, $2, $1, ####### $1, $1, $1, $2, Immigrant Status Percent Born in American Territories 0.3% 0.3% 0.7% 0.5% 0.1% 3.7% 0.3% 0.2% 0.3% 0.3% 0.8% 1.6% Percent Born in Other Countries 4.8% 4.0% 4.6% 2.4% 2.0% 3.5% 4.7% 3.4% 2.2% 3.6% 11.3% 22.3% Percent Speak a Language Other Than English at Home 6.4% 6.3% 7.1% 4.7% 3.4% 14.0% 6.6% 4.5% 3.1% 5.3% 16.3% 30.2% Housing Total Housing Units 35,909 25,675 25,292 28,616 8,742 23, ,185 38,873 28, ,063 4,745,377 8,153,309 Percent Housing Units Occupied 89.0% 60.6% 75.6% 78.4% 18.7% 84.9% 89.7% 71.3% 83.5% 74.3% 87.7% 89.0% Percent Housing Units Owner Occupied 68.3% 73.5% 71.7% 69.3% 81.8% 67.3% 71.3% 70.0% 73.5% 70.8% 70.2% 53.8% Percent Housing Units Renter Occupied 31.7% 26.5% 28.3% 30.7% 18.2% 32.7% 28.7% 30.0% 26.5% 29.2% 29.8% 46.2% Percent Build Before % 57.1% 56.7% 65.8% 56.4% 72.6% 36.2% 50.3% 56.1% 55.4% 62.7% 69.1% Percent Built Between 1970 and % 11.7% 11.2% 10.1% 12.9% 8.3% 15.3% 13.0% 10.9% 11.7% 12.1% 10.1% Percent Built Between 1980 and % 12.1% 10.9% 9.6% 10.5% 6.6% 16.7% 14.3% 12.0% 12.3% 9.7% 7.5% Percent Built Between 1990 and % 9.7% 12.3% 8.0% 11.4% 7.0% 15.4% 10.6% 10.6% 10.6% 8.0% 6.1% Percent Build 2000 and Later 12.3% 9.4% 8.9% 6.6% 8.8% 5.5% 16.4% 11.8% 10.4% 10.1% 7.5% 7.2% Availability of Vehicles 53 P a g e

55 Percent Households with No Vehicles Available 9.5% 8.5% 10.7% 9.1% 4.8% 12.9% 5.0% 8.1% 6.4% 8.6% 9.9% 29.3% Percent Households with One Vehicle Available 33.3% 34.4% 35.8% 39.5% 36.2% 37.3% 33.0% 35.2% 34.4% 35.3% 33.8% 32.7% Percent Households with Two Vehicles Available 39.4% 39.3% 38.5% 36.4% 45.0% 35.1% 43.7% 40.3% 37.9% 38.8% 38.3% 26.5% Percent Households with Three or More Vehicles Available 17.8% 17.8% 15.0% 15.0% 14.0% 14.7% 18.4% 16.3% 21.3% 17.3% 18.0% 11.5% *Median typically better represents income. For Clinton County it is $50,985. Adirondack Rural Health Network County ARHN New York Summary of Demographic Information, Page 2 of 2 Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington Region (1) Upstate NYS State Education Total Population Ages 25 and Older 55,509 29,010 36,039 38,758 3,674 34, ,438 47,327 44, ,974 7,606,459 13,329,734 Percent with Less than High School Education/GED 14.7% 12.0% 15.2% 14.3% 10.1% 17.1% 6.1% 9.3% 12.1% 12.9% 10.6% 14.6% Percent High School Graduate/GED 35.5% 33.6% 36.6% 38.4% 32.4% 35.9% 25.7% 33.3% 42.3% 36.6% 28.8% 26.9% Percent Some College, No Degree 18.2% 20.7% 19.7% 19.6% 17.7% 17.9% 18.2% 17.6% 17.8% 18.7% 17.7% 16.3% Percent Associate Degree 9.2% 9.9% 10.7% 12.0% 16.0% 12.8% 11.8% 11.6% 9.4% 10.5% 10.1% 8.5% Percent Bachelor's Degree 12.1% 13.4% 9.1% 8.6% 12.4% 9.9% 22.2% 15.6% 10.8% 11.7% 17.9% 19.1% Percent Graduate or Professional Degree 10.4% 10.4% 8.6% 7.1% 11.3% 6.5% 15.9% 12.7% 7.7% 9.6% 14.8% 14.6% Employment Status Total Population Ages 16 and Older 68,580 33,176 42,300 44,744 4,101 39, ,700 54,331 51, ,968 9,064,295 15,832,743 Total Population Ages 16 and Older in Armed Forces , ,098 23,816 Total Population Ages 16 and Older in Civilian Workforce 38,692 19,250 22,027 26,819 2,153 24, ,730 34,104 31, ,581 5,743,319 10,030,632 Percent Unemployed 6.7% 6.9% 7.3% 7.6% 7.3% 7.5% 4.6% 6.5% 6.0% 6.8% 5.6% 6.3% Employment Sector Total Employed 35,880 17,586 20,090 24,133 1,993 21, ,075 31,794 28, ,915 5,290,295 9,137,540 Percent in Agriculture, Forestry, Fishing, Hunting, and Mining 2.4% 3.4% 2.9% 1.2% 1.4% 2.9% 0.9% 0.9% 3.8% 2.3% 1.0% 0.6% Percent in Construction 5.8% 7.8% 5.8% 6.9% 14.3% 7.5% 6.1% 6.9% 9.6% 7.2% 6.0% 5.6% Percent in Manufactoring 11.8% 7.7% 4.9% 12.4% 4.3% 12.7% 9.4% 8.7% 15.3% 10.5% 8.6% 6.6% Precent in Wholesale Trade 1.7% 1.4% 1.6% 1.9% 0.2% 2.3% 2.8% 1.9% 2.0% 1.8% 2.7% 2.5% Precent in Retail Trade 11.8% 12.0% 11.3% 15.9% 10.4% 14.1% 11.7% 13.5% 13.3% 13.0% 11.5% 10.8% Precent in Transportation, Warehousing, Utilities 4.8% 2.9% 2.9% 4.8% 2.2% 4.5% 3.2% 3.6% 3.9% 3.9% 4.5% 5.1% Percent in Information Services 1.7% 1.4% 1.4% 1.8% 0.7% 1.3% 2.0% 2.0% 1.1% 1.6% 2.3% 2.9% Percent in Finance 3.0% 3.4% 4.0% 2.8% 4.3% 4.6% 7.6% 5.9% 4.1% 3.9% 6.9% 8.1% Percent in Other Professional Occupations 5.0% 6.0% 4.6% 5.6% 4.5% 5.9% 10.7% 7.9% 6.3% 5.9% 10.2% 11.3% Percent in Education, Health Care and Social Assistance 27.8% 30.3% 31.7% 29.5% 25.8% 25.3% 25.8% 26.1% 23.4% 27.7% 28.3% 27.5% Percent in Arts, Entertainment, Recreation, Hotel, & Food Service 9.5% 12.7% 10.7% 7.0% 15.7% 7.6% 8.7% 13.1% 7.5% 10.1% 8.2% 9.2% Percent in Other Services 4.5% 4.5% 4.6% 4.9% 4.6% 4.1% 4.1% 4.7% 4.1% 4.5% 4.7% 5.1% Percent in Public Administration 10.0% 6.6% 13.7% 5.4% 11.7% 7.2% 7.1% 4.8% 5.7% 7.6% 5.3% 4.7% (1) Excludes Montgomery County and Saratoga County (D) Withheld to avoid disclosing data for individual farms. Sources: Square Miles: United States Department of Agriculture, 2012 Employment Sector: American Community Survey, Unemployment Rate: Bureau of Labor Statistics, Local Area Unemployment Statistics, 2014 Medicaid Data: New York State Department of Health, 2014 All Other Data: American Community Survey, P a g e

56 Adirondack Rural Health Network Page 1 of 2 Summary Primary-Secondary Education, Total Number Public School Districts (3) Appendix F: Educational Profile Clinton Essex Franklin Fulton Adirondack Rural Health Network Educational System Profile 4/29/2016 County Hamilton Montgomery Saratoga Warren Washington ARHN Region (1) Upstate NYS (2) New York State Total Pre-K Enrollment ,502 47, ,264 Total K-12 Enrollment 10,590 3,643 7,201 7, ,298 33,499 8,866 8,381 46,670 1,593,319 2,608,247 Number Free Lunch 3,572 1,261 3,097 3, ,202 5,290 2,557 2,385 16, ,903 1,170,671 Number Reduced Lunch , , , ,792 Percent Free and Reduced Lunch 42.1% 44.5% 51.5% 47.6% 37.4% 48.4% 19.8% 34.9% 35.2% 42.0% 35.7% 49.0% Number Limited English Profiency , ,378 Percent with Limited English Profiency 0.2% 0.1% 0.1% 0.2% 0.0% 2.0% 0.9% 0.4% 0.2% 0.2% 4.5% 7.8% Total Number of Graduates , , , ,251 Number Went to Approved Equivalency Program s ,492 2,904 Number Dropped Out of High School s ,518 23,526 Percent Dropped Out of High School 14.4% 8.6% 8.6% 19.2% NA 18.9% 8.1% 10.1% 13.8% 12.7% 8.8% 12.8% Total Number of Teachers(3) 1, , , , ,799 Student to Teacher Ratio Registered Nursing Programs, Clinton County Community College New Graduates Clinton County Community College BSN Completers SUNY Plattsburgh New Graduates SUNY Plattsburgh BSN Completers North Country Community College New Graduates North Country Community College BSN Completers Fulton-Montgomery Community College New Graduates Fulton-Montgomery Community College BSN Completers SUNY Adirondack New Graduates SUNY Adirondack BSN Completers County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington Licensed Practical Nursing Programs, Clinton Essex Franklin Fulton County Hamilton Montgomery Saratoga Warren Washington Clinton, Essex, Warren, Washington BOCES (29 total) * * * * Hamilton, Fulton, Montgomery BOCES (20 total) * * * North Country Community College 83 Washington, Saratoga, Warren, Hamilton, Essex BOCES (61 total) * * * * * (1) Excludes Montgomery and Saratoga County (2) Excludes the following counties: Bronx, Kings, New York, Queens, Richmond (3) No Charter Schools in the ARHN region, Montgomery County, or Saratoga County. Private School data was not available (4) BOCES LPN programs span multiple counties within the ARHN region, Montgomery County, and Saratoga County. Sources: Primary and Secondary Education Data: New York State Education Department, School Report Card 2014 LPN Graduation Data: National Center for Education Statistics, Integrated Postsecondary Education Data System (IPEDS) RN Graduation Data: Center for Health 55 P a g e

57 Workforce Studies, University at Albany School of Public Health Adirondack Rural Health Network Educational System Profile 4/29/2016 Clinton Essex Franklin Fulton* Hamilton Ausable Valley Beekmantown Chazy Union Free Northeastern Clinton Northern Adirondack Peru Plattsburgh Saranac Brushton- Moira Chateaugay Malone Salmon River Saranac Lake St. Regis Falls Tupper Lake Broadalbin- Perth Gloversville Johnstown Mayfield Northville Wheelerville Union Free Crown Point Elizabethtown-Lewis Keene Lake Placid Minerva Moriah Newcomb Schroon Lake Ticonderoga Westport Willsboro Montgomery Saratoga Warren Washington Amsterdam City Canajoharie Fonda-Fultonville Fort Plain Oppenheim-Ephratah-St. Ballston Spa Burnt Hills-Ballston Lake Corinth Edinburg Common Galway Mechanicville Saratoga Springs Schuylerville Shenendehowa South Glens Falls Stillwater Waterford-Halfmoon Union Free Bolton Glens Falls City Glens Falls Common Hadley-Luzerne Johnsburg Lake George North Warren Queensbury Union Free Warrensburg Argyle Cambridge Fort Ann Fort Edward Union Free Granville Greenwich Hartford Hudson Falls Putnam Salem Whitehall Indian Lake Inlet Common Lake Pleasant Long Lake Piseco Common Raquetter Lake Union Free** Wells * Oppenheim-Ephratah SD is merged with St.Johnsville SD ** New School District *** St.Johnsville SD is merged with Oppenheim-Ephratah SD 56 P a g e

58 Adirondack Rural Health Network Page 1 of 3 Appendix G: Health System Profile County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington ARHN Upstate Region (1) NYS Population, ,829 39,072 57,508 54,870 4,783 49, ,512 65,388 62, ,360 11,239,441 19,594,330 Total Hospital Beds Hospital Beds per 100,000 Population Medical/Surgical Beds Intensive Care Beds Coronary Care Beds Pediatric Beds Maternity Beds Physical Therapy and Rehabilitation Beds Psychiatric Beds Other Beds Hospital Beds Per Facility Adirondack Medical Center-Lake Placid Site New York State ,148 54, ,574 32, ,655 2, , ,086 2, ,846 3, ,130 1, ,390 5, ,725 5, Adirondack Medical Center-Saranac Lake Site Alice Hyde Medical Center Champlain Valley Physicians Hospital Medical Center Elizabethtown Community Hospital Glens Falls Hospital Moses-Ludington Hospital Nathan Littauer Hospital Saratoga Hospital St. Mary's Healthcare St. Mary's Healthcare-Amsterdam Memorial Campus Total Nursing Home Beds ,838 69, ,592 Nursing Home Beds per 100,000 Population Nursing Home Beds per Facility Adirondack Tri-County Nursing and Rehabilitation Center, Inc Alice Hyde Medical Center Capstone Center for Rehabilitation and Nursing Champlain Valley Physicians Hospital Medical Center SNF Clinton County Nursing Home Essex Center for Rehabilitation and Healthcare Evergreen Valley Nursing Home Fort Hudson Nursing Center, Inc Fulton Center for Rehabilitation and Nursing Center Heritage Commons Residential Health Care Indian River Rehabilitation and Nursing Center Meadowbrook Healthcare Mercy Living Center Nathan Littauer Hospital Nursing Home Palatine Nursing Home River Ridge Living Center, LLC Saratoga Center for Rehab and Skilled Nursing Care Saratoga Hospital Nursing Home Schuyler Ridge A Residential Health Care Facility St Johnsville Rehabilitation Nursing Center The Orchard Nursing and Rehabilitation Centre The Pines at Glens Falls Center for Nursing & Rehabilitation The Stanton Nursing and Rehabilitation Centre Uihlein Living Center Washington Center for Rehabilitation and Healthcare Wells Nursing Homes Inc Wesley Health Care Center Inc Westmount Health Facility Wilkinson Residential Health Care Facility P a g e

59 Adirondack Rural Health Network Page 2 of 3 Population, County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington ARHN Region (1) Upstate NYS New York State Toatl Adult Care Facility Beds ,734 46,810 Adutl Care Facility Beds per 100,000 Population Total Adult Home Beds ,023 25,040 Total Assisted Living Program Beds ,229 8,735 Total Assisted Living Residence (ALR) Beds ,482 13,035 Adult Home Beds by Total Capacity per Facility Adirondack Manor HFA D.B.A Montcalm Manor HFA (Essex) Adirondack Manor HFA D.B.A Adirondack Manor HFA (Warren) Adirondack Manor Home for Adults (Clinton) Adirondack Manor Home for Adults (Franklin) Ahana House Arkell Hall Beacon Pointe Memory Care Community Cambridge Guest Home Cook Adult Home Countryside Adult Home David & Helen Getman Memorial Home Emeritus at the Landing of Queensbury Hillcrest Spring Residential Holbrook's Adult Home, Inc Home of the Good Shepherd Home of the Good Shepherd at Highpointe Home of the Good Shepherd Wilton Keene Valley Neighborhood House Moses Ludington Adult Care Facility Pine Harbour Pineview Commons H.F.A Washington Co. Public Home Samuel F. Vilas Home Sarah Jane Sanford Home The Farrar Home The Terrace at the Glen Willing Helpers' Home for Women Woodlawn Commons Community Health Center (CHC) Usage, 2014 Estimated Number of CHC Patients Percentage of Population Health Professional Shortage Areas (HPSAs) Number of Primary Care HPSAs Primary Care HPSA Population Total Number of Dental Care HPSAs Dental Care HPSA Population Total Number of Mental Health HPSAs Mental health APSA Population Total County ARHN Region Upstate NYS New York State Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington 3,689 10,709 1, , ,410 34,708 29,166 81, ,227 1,901, % 19.0% 3.06% 0.30% 15.02% 0.40% 4.56% 49.90% 28.89% 16.84% 6.96% 8.69% County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington ARHN Region Upstat NYS New York State ,376 8,080 14,106 13,986 3,447 11, ,631 1,445 55,071 1,653,497 3,619, ,395 16,203 39, , ,711 1,140,979 2,391, ,376 35,299 44,612 6,684 4,881 11, ,287 1,304,118 2,926, P a g e

60 Adirondack Rural Health Network Page 3 of 3 County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washington ARHN Region (1) Upstate NYS New York State Population, 2015 Primary Care per 100,000 population Other Subspecialty Obstetrics/Gynecology IM Subspecialty General Surgery Surgical Specialties Facility Based Psychiatry Other Total Physician Total Physican per 100,000 population County Clinton Essex Franklin Fulton Hamilton Montgomery Saratoga Warren Washingto ARHN Region Upstate NY Licensure Data Clinical Laboratory Technician Clinical Laboratory Technologist Dental Assistant Dental Hygienist Dentist Dietition/Nutritionist, Certified Licensed Clinical Social Worker (R/P psycotherap Licensed Master Social Worker (no privileges) Licensed Practical Nurse Physician Mental Health Counseling Midwife NPs, All Nurse Practitioner, Adult Health Nurse Practitioner, Community Health Nurse Practitioner, Family Health Nurse Practitioner, Gerentology Nurse Practitioner, Obstetrics & Gynecology Nurse Practitioner, Pediatrics Nurse Practitioner, Psychiatry Pharmacist Physical Therapist Physical Therapy Assistant Psychologist Registered Physician Assistant Registered Professional Nurse Respiratory Therapist Respiratory Therapy Technician ,293 1, ,243 12, ,292 1, ,939 10, ,084 17, ,410 5, ,963 25, ,770 26, , ,521 51,818 67, ,744 49,087 85, ,741 5, ,949 18, ,791 5, ,255 7, ,177 1, ,057 1, ,024 21, ,375 17, ,693 5, ,408 11, ,118 12,005 1, ,527 1, , , , ,983 5, ,042 Sources: Hospital, Nursing Home, and Adult Care Beds: New York State Department of Health Physician Data: Center for Health Workforce Study Licensure Data: New York State Education Department 59 P a g e

61 Appendix H: Resident and Stakeholder Surveys Clinton County 2016 Community Health Assessment Survey Summary Introduction The Clinton County Health Department (CCHD) surveyed Clinton County residents to provide the Community Health Assessment (CHA) Committee with resident input related to health, social and environmental concerns and issues in the community. Residents were asked their opinions on health, social and environmental issues in the community. They were also asked to identify any barriers to medical care experienced by themselves or their family in the past year. Methods The Clinton County Community Health Assessment Survey was developed by the CCHD after a review of existing resident community health surveys throughout the country. The survey team consisted of a Registered Nurse, Supervising Public Health Educator and Director of the Division of Health Planning and Promotion; student nurses and other CCHD staff were used throughout the process to field the survey and offer perspective on findings. Once developed, the instrument was field-tested for clarity and comprehension with two different focus groups within the community. Based on feedback from the focus groups, the team revised the survey tool before fully implementing it in the community at large. The survey included 12 questions, 6 of which assessed demographics of the respondents. A pdf of the survey is attached to this report. Survey development, fielding and analysis were completed over a three month period. The CCHD initially utilized existing community partners to distribute the survey. It was made available as a webbased link which was shared via . Paper copies of the survey were also distributed, as well as a small card with the web-based link URL. An with the web-based link was sent to many partners throughout the county, including: Clinton County employees, Action for Health Consortium members, Clinton County Breastfeeding Coalition, Town Supervisors and Mayors, School Superintendents, SUNY Plattsburgh Faculty, and Interfaith Council. Survey fielding was also completed in-person at numerous agencies and events within the community. Sites included: Child Care Coordinating Council of the North Country, Clinton County Department of Social Services, Champlain Centre, Maggy s Pharmacy, Cornerstone Drugstore, Senior Citizens Council, Clinton County Nutrition Program for the Elderly Congregate lunch sites, CCHD WIC Program, Behavioral Health Services North Healthy Minds Healthy Bodies group, and Interfaith Food Shelf. Events included the 2016 Food from the Farm event and the 2016 Home and Lifestyle Exposition. The CCHD utilized SUNY Plattsburgh nursing interns to expand capacity and assist with survey fielding throughout the county. Some agencies also facilitated completion of paper surveys by their clients, including Cornell Cooperative Extension, JCEO Community Outreach Centers, Plattsburgh Housing Authority, and Lake Champlain Primary Care. The CCHD s Healthy Neighborhoods Program distributed survey link cards. Additionally, letters with the web-based link URL were distributed to Clinton County Libraries and Town Supervisors/ Mayors without accessible addresses, as well as smaller employers throughout the county. A news release was distributed to local media outlets. This release was followed by an article in the Press Republican, a local newspaper, and a television interview with WPTZ, a local news television station. CCHD used Facebook and Twitter pages to promote the survey, providing the web-based link URL to followers. 60 P a g e

62 The survey requested that the respondent choose up to five health issues (from a list of 17 issues) that they felt were of greatest concern in the community. Respondents were also asked to choose up to five social issues (from a list of 15 issues) and up to five environmental issues (from a list of 14 issues) that they felt were of greatest concern in the community. The survey then asked respondents what health issues they or a family member had in the past year, and instructed them to check all that apply (from a list of 17 issues). Respondents were also asked what social issues they or a family member had in the past year, and again instructed to check all that apply (from a list of 15 issues). Lastly, residents were asked about barriers to medical care; specifically, If there was a time in the past year that you or anyone in your family needed medical care but could not get it, what were the reasons you did not get care? They were again instructed to check all that apply (from a list of 8 issues). In each section an other option allowed residents to fill-in a response if their issue of concern was not already listed. The survey then requested that respondents complete six demographic questions, which collected information on their gender, age, primary language spoken in the household, city/ town of residence, participation in identified low-income programs during the past 2 years, and highest degree or level of school completed. CCHD made a concerted effort to reach a representative sample of all Clinton County residents. A periodic review of demographic information provided by respondents during survey fielding allowed the CCHD to target specific pockets of the population not already reached, ensuring that responses received mirrored census data to the greatest extent possible. Analysis for this report was conducted by CCHD Health Planning & Promotion (HPP) staff. During analysis identified issues were correlated with the New York State Prevention Agenda Priority Areas they represented. This information was shared with stakeholders during the 2016 Clinton County Community Health Assessment Priority Setting Session. Findings Demographics of Survey Respondents A total of 1,117 responses were received, of which 1,018 were complete surveys from Clinton County residents. Incomplete surveys and those completed by non-residents were not included in results findings. According to the 2010 U.S. Census, almost 40% of Clinton County s population resides in just two of the fifteen townships of Clinton County, namely the City and Town of Plattsburgh. Due to the rural geographic nature of the county, a concerted effort was made to reach a representative sample of residents from each of the townships within the county. See Figure 3 and Table 3 for a comparison of survey respondents by township and Census population by township. Approximately 48% of survey respondents reside in the City or Town of Plattsburgh. While Clinton County is comprised of approximately 49% females and 51% males, according to the 2010 U.S. Census, only 26% of survey respondents were male with 72% of surveys completed by females. Two percent of respondents preferred not to identify their gender (see Figure 1 and Table 1). In regards to age, survey respondents more closely mirrored the composition of Clinton County residents. While there were no restrictions prohibiting survey completion by any age group, the survey was not specifically targeted to those 17 years and under. Persons 17 years and under represent 19% of the County s population, therefore, a higher percentage of each of the other age groups were targeted accordingly. Ten percent of survey respondents were years, 36% were years, 38% were years, and 16% were 65 years and older (see Figure 2 and Table 2). 1,006 of the 1,018 survey respondents, or 99%, identified English as the primary language spoken in 61 P a g e

63 their home. Other primary languages spoken in the households of respondents included: Polish (3), Spanish (3), French (2), Chinese (1), Italian (1), Arabic (1), and American Sign Language (1). Seventy-seven percent of respondents indicated that they had not participated in HEAP (Heating Assistance Program), SNAP (Supplemental Nutrition Assistance Program) or WIC (Special Supplemental Nutrition Program for Women, Infants and Children) within the past two years. Two- percent of respondents preferred not to disclose participation information; therefore, 21% of respondents participated in at least one of the identified low-income assistance programs within the past two years (see Table 4). Comparatively, according to the U.S. Census 17% of Clinton County residents are in poverty. The highest degree or level of school completed by survey respondents was also diverse; 17% obtained a high school diploma or GED; 33% completed some college or obtained a technical or trade school certificate, or an Associate s degree; 25% obtained a Bachelor s degree; and 18% obtained a Master s degree or higher. Five percent of respondents completed 12 th grade or less with no diploma, and 2% of respondent preferred not to disclose their educational status (see Table 5). According to the U.S. Census, 85% of Clinton County residents age 25 years and older graduated from high school or obtained a higher degree, with 22% obtaining a Bachelor s degree or higher. Issues Identified Residents overwhelming identified issues aligning with the Prevent Chronic Disease NYS Prevention Agenda Priority Area as top concerns both for themselves and their families as well as for the community. Sixty percent of respondents reported overweight/ obesity as an issue of concern in the community, while nearly 50% of individuals reported it as an issue for themselves or a loved one. One in three residents felt physical inactivity is an issue in the community; one in three respondents also named opportunities for physical activity as a concern for themselves or their family. Almost half of all respondents reported chronic disease as a problem both individually and for the community at large. In addition, one in four residents named access to healthy foods as an obstacle for themselves or their family. Issues aligning with the Promote Mental Health and Prevent Substance Abuse Priority Area were also of great interest. Two out of three residents named substance abuse as a concern in the community; three out of five residents named mental health as a concern in the community. Respondents also reported child abuse or neglect, bullying, and domestic violence as top social concerns in the community. Additionally, residents indicated that unemployment and low wages is a top social concern for both the community as well as for themselves or their family. One in two people who reported experiencing a barrier to medical care named could not pay as the reason why. Statistics on issues for individuals and their family are based only on those respondents who indicated that they experienced any issues within the past year. 14% of respondents reported no health issues for themselves or their family in the past year; 42% of respondents reported no social issues. Furthermore, 63% of respondents indicated no barriers to medical care for themselves or their family within the past year. Concerns with the stream, river, and lake water quality in our community were reported by nearly 50% of all respondents. Climate change, exposure to tobacco smoke, and vector-borne diseases were also top environmental issues of concern in the community. 62 P a g e

64 Interestingly, concerns regarding health and social issues in the community often did not correlate to selfreported individual and family issues. For example, while 67% of residents feel that substance abuse is a concern in the community, only 14% of respondents identified substance abuse as an issue for themselves or their family. Almost 60% of respondents identified mental health as a concern in the community, but only 30% reported it as an issue for themselves or their family. Nearly half of residents reported child abuse/ neglect as a concern in the community, but only 6% of respondents identified child abuse/ neglect as an issue for themselves or their family. Also notable is that the top health and social concerns remained relatively consistent throughout the different townships within Clinton County. In addition, male and female responses were also very similar. Responses from most of the different age groups were also fairly similar, with the exception of respondents 65 years and older. This particular group had more concerns in regards to aging and chronic disease, as well as transportation, in comparison to overall responses from other ages groups and the county as a whole (see Tables 6-11 and Figures 4-9). Conclusions This survey provided valuable feedback from the community for the CCHD. While the CCHD frequently looks to the public for their opinions and input, this was the first survey of this magnitude attempted by the Department, reaching an impressive 1,018 residents. Nevertheless, this equates to only just over 1.5% of the target audience. The CCHD found that due to the geographic area of the County, reaching certain subpopulations and communities was sometimes difficult. Females were also much more likely to complete the survey than males; males were an especially difficult subpopulation to reach. In future surveys of this nature, a more concerted effort to reach the male population should be implemented from the start of survey fielding. The Department also found fielding the survey and attempting to reach such a large volume of residents to be a labor intensive process. Being that the CCHD is a relatively small Health Department, staff, time and resources available to field the survey were limited. The Department frequently assists the SUNY Plattsburgh Nursing Department by mentoring nursing students. During survey implementation this relationship proved to be an invaluable asset to the Department, as nursing students were able to assist CCHD staff with survey fielding, expanding capacity reaching far more residents than the Department would have feasibly contacted without their help. Survey development and fielding took place over a three-month time period; if an attempt was made in the future to repeat this survey or reach additional residents, considerations should be made to the length of time the survey will be fielded, as more time may be necessary. This survey required that residents self-report their opinions on key issues prevalent in the community and experienced by themselves and their families; this method has its own limitations in regards to the accuracy of resident s recall as well as what information they choose to disclose. This survey was available both in-person and as an electronic survey. In-person respondents had the advantage of having a staff member explain directions or questions if necessary, but may have not felt as anonymous as those filling out the survey online. Online respondents, therefore, had the advantage of being completely anonymous, but the disadvantage of not having a person that could provide explanations if necessary. The online version of the survey was only able to be taken once per device, in an effort to prevent potential hijacking of the survey. The disadvantage to this was that if multiple residents in one household wanted to complete the survey but only had one device, only one household member was able to participate. 63 P a g e

65 Almost 100 surveys submitted were either completed by residents of a neighboring county or not completely filled out, resulting in 1,018 surveys fully completed by Clinton County residents. The first three questions of the survey asked residents to choose up to 5 issues; some residents chose less than five, and some residents completing the paper survey chose more than five responses. All responses were counted in the final numbers. The online version of the survey did not allow respondents to choose more than five responses to the first three questions. During future surveys, additional forethought should be given to survey completion directions or question language, in an attempt to ensure that surveys are fully completed and with the same number of responses to each of the community-based questions by all respondents. Despite these noted limitations, the survey findings reflect Clinton County s first large scale effort to collect direct resident insight to be considered in the health priority setting process. An overview of the survey process and collected data has been given to a number of community groups, including Action for Health, and were shared at the Priority Setting Session in June. A summary document was also created to communicate findings back to county residents. It is featured on the CCHD website and has been shared through a number of channels. Tables & Figures Figure Community Health Needs Survey, Demographics of Respondents: Gender 26% 2% 72% Female Male Prefer not to answer Table Community Health Needs Survey, Demographics of Respondents: Gender Gender Percentage of Respondents (Number of Respondents) Male 25.64% (261) Female 72.40% (737) Prefer not to answer 1.96% (20) 64 P a g e

66 Figure Community Health Needs Survey, Demographics of Respondents: Age 38% 16% 0% 10% 36% 17 years & under years years years 65 years & over Table Community Health Needs Survey, Demographics of Respondents: Age Age Percentage of Respondents (Number of Respondents) 17 years & under 0.10% (1) years 9.53% (97) years 36.05% (367) years 38.11% (388) 65 years & over 16.21% (165) Figure Community Health Needs Survey Respondents by Township vs. Census Population by Township 30% 25% 20% 15% 10% 5% 0% Survey Respondents Census Population Township Table Community Health Needs Survey, Demographics of Respondents: Township of Residence vs Census Population by Township Percentage of Respondents Percentage of Population by (Number of Respondents) Census (Population Number) 65 P a g e

67 Altona 1.87% (19) 3.52% (2,887) AuSable 1.67% (17) 3.83% (3,146) Beekmantown 6.88% (70) 6.75% (5,545) Blackbrook 0.29% (3) 1.82% (1,497) Champlain 5.01% (51) 7.07% (5,754) Chazy 7.17% (73) 5.22% (4,284) Clinton 1.67% (17) 0.9% (737) Dannemora 3.83% (39) 5.96% (4,898) Ellenburg 3.14% (32) 2.12% (1,743) Mooers 2.75% (28) 4.37% (3,592) Peru 9.63% (98) 8.52% (6,998) Plattsburgh (City of) 27.50% (280) 24.34% (19,989) Plattsburgh (Town of) 20.24% (206) 14.45% (11,870) Saranac 3.14% (32) 4.88% (4,007) Schuyler Falls 5.21% (53) 6.31% (5,181) Total 100% (1,018) 100% (82,128) Table Community Health Needs Survey, Demographics of Respondents: Participation in Low-Income Programs Within the Past 2 Years* Program Percentage of Respondents (Number of Respondents) HEAP 15.13% (154) SNAP 15.03% (153) WIC 5.70% (58) Prefer not to answer 1.96% (20) None of the above 76.62% (780) *Respondents were instructed to check all that apply, therefore, numbers may be duplicated. Table Community Health Needs Survey, Demographics of Respondents: Highest Degree or Level of School Completed Degree or Level of School Percentage of Respondents (Number of Respondents) 12 th grade or less, no diploma 4.81% (49) High school diploma/ GED 17.09% (174) Some college, technical or trade school certificate, or Associate s 32.81% (334) degree Bachelor s degree 25.05% (255) Master s degree or higher 17.88% (182) Prefer not to answer 2.36% (24) Table Community Health Needs Survey, Health Issues of Concern in the Community* Health Issue Percentage (Number) Substance abuse (drugs, alcohol) 67.19% (684) Overweight/ obesity 59.72% (608) Mental health 59.04% (601) Chronic disease (diabetes, heart disease, high blood pressure, high 43.52% (443) cholesterol, stroke) Cancer 37.13% (378) Physical inactivity 31.14% (317) Access to medical care 29.47% (300) 66 P a g e

68 Dental health 27.90% (284) Tobacco use 26.62% (271) Aging problems (arthritis, hearing/ vision loss) 23.48% (239) Suicide 20.63% (210) Lung disease (asthma, COPD, etc.) 12.38% (126) Infectious disease (hepatitis A, B, or C, influenza, etc.) 8.06% (82) Sexually transmitted infections (including HIV) 7.96% (81) Prenatal care/ Maternal & Infant health 6.97% (71) Falls 6.58% (67) Immunizations 4.72% (48) Other 2.55% (26) *Residents asked to pick up to 5 health issues that they feel are of greatest concern in their community. 80% Figure Community Health Needs Survey, Health Issues of Greatest Concern in the Community* 60% 67% 60% 59% 40% 20% Substance Abuse Overweight/ Obesity Mental Health 44% Chronic Disease 37% Cancer 0% *Prevention Agenda Priority Areas represented: Promote Mental Health & Prevent Substance Abuse Prevent Chronic Disease Table Community Health Needs Survey, Social Issues of Concern in the Community* Social Issue Percentage (Number) Unemployment/ low wages 52.95% (539) Child abuse/ neglect 47.35% (482) Bullying 40.67% (414) Domestic violence 38.11% (388) Access to healthy foods 35.17% (358) Transportation 30.94% (315) Opportunities for physical activity 28.00% (285) Homelessness 27.41% (279) Hunger 21.12% (215) Safe recreational areas 19.16% (195) Elder abuse/ neglect 18.47% (188) Street safety (crosswalks, shoulders, bike lanes) 18.47% (188) Access to opportunities for health for those with physical 17.78% (181) limitations or disabilities Incarceration rates (number of people in jail) 16.11% (164) 67 P a g e

69 Discrimination/ racism 13.65% (139) Other 5.70% (58) *Residents asked to pick up to 5 social issues that they feel are of greatest concern in their community. 60% 50% 40% 30% 20% 10% 0% 53% Figure Community Health Needs Survey, Social Issues of Greatest Concern in the Community* Unemployment/ low wages 47% Child abuse/ neglect *Prevention Agenda Priority Areas represented: Promote Healthy Women, Infants, & Children Promote Mental Health & Prevent Substance Abuse Promote a Healthy & Safe Environment Prevent Chronic Disease Table Community Health Needs Survey, Environmental Issues of Concern in the Community* Environmental Issue Percentage (Number) Stream, river, lake water quality 43.32% (441) Drinking water quality 41.75% (425) Climate change 36.84% (375) Exposure to tobacco smoke 35.66% (363) Vector-borne diseases (mosquitoes, ticks) 35.66% (363) Agricultural run-off (manure) 29.47% (300) School safety 28.09% (286) Home safety 26.33% (268) Safe food 25.93% (264) Nuisance wildlife/ stray animals 22.79% (232) Air pollution 19.55% (199) Flooding/ soil drainage 18.07% (184) Failing septic systems 11.39% (116) Lead-based paint hazards 11.20% (114) Other 4.52% (46) *Residents asked to pick up to 5 environmental issues that they feel are of greatest concern in their community. 41% Bullying 38% 37% Domestic violence Access to healthy foods 68 P a g e

70 50% Figure Community Health Needs Survey, Environmental Issues of Concern in the Community* 40% 30% 20% 10% 0% 43% 42% Stream, river, lake water quality Drinking water quality * Prevention Agenda Priority Areas represented: Promote a Healthy & Safe Environment Prevent Chronic Disease Promote Healthy Women, Infants, & Children 37% 36% 36% Climate change Exposure to tobacco smoke Vector-borne diseases Table Community Health Needs Survey, Health Issues Experienced by Residents within the Past Year* Health Issue Percentage (Number) Overweight/ obesity 47.90% (421) Chronic disease (diabetes, heart disease, high blood pressure, high 44.71% (393) cholesterol, stroke) Dental health 36.75% (323) Physical inactivity 33.33% (293) Aging problems (arthritis, hearing/ vision loss) 31.97% (281) Mental health 30.94% (272) Tobacco use 24.80% (218) Cancer 21.05% (185) Lung disease (asthma, COPD, etc.) 18.54% (163) Access to medical care 17.63% (155) Substance abuse (drugs, alcohol) 14.22% (125) Falls 11.26% (99) Immunizations 7.39% (65) Prenatal care/ Maternal & Infant health 5.80% (51) Suicide 4.44% (39) Infectious disease (hepatitis A, B, or C, influenza, etc.) 3.98% (35) Other 2.28% (20) Sexually transmitted infections (including HIV) 1.37% (12) *Residents asked what health issues they or a family member had in the past year, and instructed to check all that apply. 13.7% (or 139) of residents chose none of the above ; results are based on the 879 residents reporting issues. 69 P a g e

71 60% Figure Community Health Needs Survey, Top Health Issues Experienced by Residents in the Past Year 40% 20% 0% 48% Overweight/ Obesity 45% Chronic disease * Prevention Agenda Priority Areas represented: Prevent Chronic Disease Promote Healthy Women, Infants, and Children 37% Dental health 33% 32% Physical Aging inactivity problems Table Community Health Needs Survey, Social Issues Experienced by Residents within the Past Year* Social Issue Percentage (Number) Unemployment/ low wages 35.52% (211) Opportunities for physical activity 32.66% (194) Bullying 26.26% (156) Access to healthy foods 24.41% (145) Street safety (crosswalks, shoulders, bike lanes) 21.21% (126) Transportation 19.02% (113) Safe recreational areas 18.86% (112) Access to opportunities for health for those with physical 14.14% (84) limitations or disabilities Discrimination/ racism 9.76% (58) Domestic violence 8.08% (48) Hunger 7.41% (44) Homelessness 6.23% (37) Child abuse/ neglect 5.56% (33) Elder abuse/ neglect 5.22% (31) Incarceration rates (number of people in jail) 5.05% (30) Other 2.53% (15) *Residents asked what social issues they or a family member had in the past year, and instructed to check all that apply. 42% (or 424) of residents chose none of the above ; results are based on the 594 residents reporting issues. 70 P a g e

72 40% Figure Community Health Needs Survey, Top Social Issues Experienced by Residents in the Past Year* 30% 20% 10% 0% 36% Unemployment/ low wages 33% Opportunities for physical activity *Prevention Agenda Priority Areas represented: Prevent Chronic Disease Promote a Healthy & Safety Environment Promote Mental Health & Prevent Substance Abuse 26% Bullying 24% Access to healthy foods 21% Street safety Table Community Health Needs Survey, Barriers to Medical Care Experienced by Residents within the Past Year* Barrier to Medical Care Percentage (Number) Could not pay 45.53% (173) Did not have insurance 33.42% (127) No appointment was available 26.84% (102) Did not have a doctor 23.16% (88) Did not have transportation 19.21% (73) Other 18.42% (70) Did not have child care 5.00% (19) No access for people with disabilities 4.47% (17) Provider did not speak my language 2.37% (9) *Residents asked, If there was a time in the past year that you or anyone in your family needed medical care but could not get it, what were the reasons you did not get care? and instructed to check all that apply. 62.7% (or 638) of residents chose none of the above ; results are based on the 380 residents reporting barriers. 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Figure Community Health Needs Survey, Most Common Barriers to Medical Care Experienced by Residents in the Past Year* 46% Could not pay 33% Did not have insurance 27% No appointment was available 23% Did not have a doctor 19% Did not have transportation 71 P a g e

73 *Prevention Agenda Priority Areas Represented: Prevent Chronic Disease Promote a Healthy & Safe Environment Promote Healthy Women, Infants, & Children Promote Mental Health & Prevent Substance Abuse Prevent HIV, STDs, Vaccine Preventable Diseases & Healthcare Associated Infections 72 P a g e

74 Summary of the ARHN Community Stakeholder Survey For Clinton County Prepared for AHI by June 10, P a g e

75 Executive Summary A. Background Under contract with the Adirondack Health Institute (AHI) and as part of the Adirondack Rural Health Network (ARHN) coordination of community needs assessment, the Center for Health Workforce Study (CHWS) surveyed health care, social services, educational, governmental and other community stakeholders in the ARHN region to provide the Community Health Assessment (CHA) Committee with stakeholder input on regional health care needs and priorities. The ARHN region is made up of Clinton, Essex, Franklin, Fulton, Hamilton, Warren and Washington Counties. B. Methods The survey was developed using Qualtrics Software that included 15 questions. In working with the participating counties, ARHN provided CHWS a list of health care, social service, educational, governmental, and other community stakeholders (hereafter referred to as service providers) by county to be surveyed. Using these lists, CHWS staff created an unduplicated list of providers numbering 658. An initial was sent to this list explaining the survey and providing an electronic link to the survey. The survey was available to potential respondents for approximately six weeks. The survey requested that the respondent identify the two priority areas from a list of five which they believe need to be addressed with their county or counties, and then respondents were also asked to rank the focus areas within each priority area and identify potential barriers to that addressing that focus area. C. Survey Responses A total of 217 completed responses were received to the survey through May 31, 2016 for a response rate of 33%. Respondents were asked to indicate in which counties they provided services, and respondents indicated that their service areas included multiple counties as outlined in Exhibit 1. Exhibit 1: Respondents by County County Counts Clinton 53 Essex 79 Franklin 56 Fulton 51 Hamilton 44 Warren 53 Washington 43 Other P a g e

76 D. Findings Over 200 organizations responded to the survey, spanning multiple counties in the ARHN region. Respondents provided a wide range of services, including education (122), prevention and wellness (115), health care (96), healthy environment (65), and social services among others. Survey respondents also served a wide range of individuals, including school-aged children (163), individuals living at or near the federal poverty level (149), adults (146), individuals with behavioral health issues (123), individuals who are senior citizens (122), and individuals with disabilities (121). Overall, respondents in the ARHN region identified promoting mental health and preventing substance abuse (40%) as their top priority of respondents, followed by prevent chronic disease (32%). Promoting mental health and preventing substance abuse was also identified as a second priority by 33% of respondents, followed by providing a healthy and safe environment by 29% of respondents. Five of the seven ARHN counties identified promoting mental health and preventing substance abuse as their top priority, one identified preventing chronic diseases as their top priority, and one had a tie between the two. Exhibit 2: Summary of County Selections of Top and Second Priority Top Priority Second Priority County First Choice Second Choice First Choice Second Choice Clinton Promoting mental health Preventing chronic disease Providing a healthy and safe Preventing chronic disease Essex Franklin Fulton Hamilton Warren Washington Promoting mental health Promoting mental health Preventing chronic disease Preventing chronic disease (tied) Promoting mental health Promoting mental health Preventing chronic disease Preventing chronic disease Promoting mental health Promoting mental health (tied) Preventing chronic disease Preventing chronic disease environment Providing a healthy and safe environment Preventing chronic disease (tied) Promoting mental health Providing a healthy and safe environment (tied) Promoting mental health Promoting mental health Preventing chronic disease Providing a healthy and safe environment (tied) Providing a healthy and safe environment Promoting mental health (tied) Providing a healthy and safe environment Providing a healthy and safe environment 75 P a g e

77 The top focus area identified to address promoting mental health and preventing substance abuse for the ARHN region was strengthening (the mental health) infrastructure across systems (39), followed by preventing substance abuse and other mental and emotional disorders (27). Survey respondents in the ARHN indicated that the top barriers to addressing this priority include shortage of professionals and staff (62), travel distance and the geography of the Adirondacks (44), lack of financial resources/reimbursement in the long-term (40), and lack of financial resources/ reimbursement in the short-term (37). Survey respondents indicated that the focus area to address for preventing chronic disease was increasing access to high quality chronic disease care and management (38), followed by reducing obesity in children and adults (21). Major barriers identified to addressing this priority include travel distance and the geography of the Adirondacks (33), lack of financial resources/ reimbursement in the short-term (29), shortage of professionals and staff (26), and lack of financial resources/reimbursement in the long-term (25). Overview A. Background Under contract with the Adirondack Health Institute (AHI) and as part of the Adirondack Rural Health Network (ARHN) coordination of community needs assessment, the Center for Health Workforce Study (CHWS) surveyed health care, social services, educational, governmental and other community stakeholders in the ARHN region to provide the Community Health Assessment (CHA) Committee with stakeholder input on regional health care needs and priorities. The ARHN region is made up of Clinton, Essex, Franklin, Fulton, Hamilton, Warren and Washington Counties. This survey is part of a larger effort by ARHN to assist its members in developing their community needs assessments for 2016 that included an analysis of outcome data, profiles of the demographic, educational, and health system characteristics of the ARHN region, and an understanding of what other counties are doing around community engagement. This report represents a summary of the findings from the service provider survey and outlines identified priorities for the ARHN region and for Clinton County. B. Methods The survey was developed using Qualtrics Software that included 15 questions and a number of sub questions based on an initial response. A pdf of the survey is attached as Appendix 1 to this report. In working with the participating counties, ARHN provided CHWS a list of health care, social service, educational, government and other community stakeholder s by county. Using these lists, CHWS staff created an unduplicated list of 658 providers that cut across all seven counties. An initial was sent to this list explaining the survey and providing an electronic link to the survey. The survey was available to potential respondents for approximately six weeks. As follow-up, CHWS sent an additional reminding potential respondents of the survey. CHWS also provided ARHN with a list of those who responded, and county staff also followed up with non- respondents. As an incentive, respondents were told there would be a random drawing of 20 $10 gift cards from Stewart s for participating in the survey. A total of 217 completed responses were received to the survey through May 31, 76 P a g e

78 2016 for a response rate of 33%. CHWS staff also provided technical assistance as requested by survey respondents. The survey requested that the respondent identify their top two priority areas from a list of five following areas which they believe needed to be addressed within their service area: Preventing chronic disease; Providing a healthy and safe environment; Promoting healthy women, infants, and children; Promoting mental health and preventing substance abuse; and Preventing HIV, sexually transmitted diseases,, vaccine preventable diseases, and health care associated infections. Once respondents identified their top two priorities, they were also asked to rank the focus areas within each priority area and identify potential barriers to that addressing that focus area. Analysis for this report was conducted by county. Many health care, social service, and educational providers deliver services in multiple counties. Their opinions are reflected in each county they provide services. C. Survey Responses 1. By County While there were 217 respondents as discussed previously, service areas for certain stakeholders cut across multiple counties. Respondents were asked to indicate in which counties they provided services, and a large number of respondents provided services in multiple counties. Essex County had the largest number of respondents with 79, followed by Franklin (56), Clinton and Warren, both at 53. Additionally, 39 respondents indicated they delivered services outside of the seven county ARHN region, and those counties include Herkimer, Jefferson, Lewis, Montgomery, Rensselaer, St. Lawrence, Saratoga, Schenectady, and Schoharie as well as counties further west and south of the Adirondacks and the immediate surrounding counties. Exhibit 2: Respondents by County County Counts Clinton 53 Essex 79 Franklin 56 Fulton 51 Hamilton 44 Warren 53 Washington 43 Other By Services Provided Respondents indicated a wide range of services provided, including education (122), followed by prevention/wellness (115), health care services (96), and other (65). 77 P a g e

79 Exhibit 3: Respondents by Services Delivered Types of Services Delivered Counts Day Program Services 29 Education 122 Employment and Training 50 Health Care Services 96 Prevention/Wellness Services 115 Healthy Environment 65 Housing/Residential Services 34 Social Services 53 Other Health Care Services For respondents who indicated they provided health care services, 43 respondents indicated specialty care, including psychiatry, cancer treatment, infectious disease, women s health, orthopedics, substance abuse services, among others; 40 indicated primary care; and 26 indicated reproductive health. Another 43 indicated other that included home care services, inpatient and hospital care, long-term care, and other specialized health care Prevention and Wellness For respondents who indicated they provided prevention and wellness services, 61 respondents indicated child health, followed by diabetes and related diseases management (57), and immunizations (51). Exhibit 4: Type of Prevention/Wellness Services Provider Type of Prevention/Wellness Services Provided Counts Alcohol/Substance Abuse 39 Asthma 33 Birth Outcomes 31 Cancer 38 Child Health 61 Diabetes and Related Diseases Management 57 Heart Disease and Related Diseases Management 45 HIV and Other Sexually Transmitted Diseases 32 Immunizations 51 Mental Health Screenings 27 Obesity/Weight Management 54 Occupational Health/Safety 27 Oral Health 35 Reproductive Health 36 Smoking 44 Other By Populations Served 78 P a g e

80 Day Program Services Education Employment and Training Health Care Prevention & Wellness Healthy Environment Housing/ Residential Social Services Respondents indicated that they deliver their services to a wide variety of populations within the ARHN region, including school aged children (163), individuals living at or near the federal poverty level (149), adults, excluding the elderly (146), individuals with behavioral health issues (123), individuals who are senior citizens (122), and individuals with development disabilities (121). Populations least serviced include racial/ethnic minorities (50) and migrant workers (59). For organizations which service racial/ethnic minorities, 47 indicated they serve individuals who are Black/African American, non-hispanic, 45 indicated they serve individuals who are Hispanic/Latino, and 39 indicated they serve individuals who are Native American/Alaskan Native. Exhibit 5: Respondents by Population Serviced Type of Prevention/Wellness Services Provided Counts Babies (less than 3 years of age) 87 Pre-School Children (ages 3 and 4) 117 School Aged Children/Adolescents (ages 5 to 17) 163 Adults, Ages Farmers 73 Individuals Living at or Near the Federal Poverty Level 149 Individuals who are Senior Citizens/Elderly 122 Individuals with Behavioral Health Issues 123 Individuals with Development Disabilities 121 Individuals with Substance Abuse Issues 104 Migrant Workers 59 Specific Racial/Ethnic Minorities 50 Women of Reproductive Age 101 Other By Population Served and by Services Provided Exhibit 6: Respondents by Population Serviced and by Services Provided Type of Prevention/Wellness Services Provided Babies (less than 3 years of age) Pre-School Children (ages 3 and 4) School Aged Children/Adolescents (ages 5 to 17) Adults, Ages Farmers Individuals Living at or Near the Federal Poverty Level Individuals who are Senior Citizens/Elderly P a g e

81 Individuals with Behavioral Health Issues Individuals with Development Disabilities Individuals with Substance Abuse Issues Migrant Workers Specific Racial/Ethnic Minorities Women of Reproductive Age I. ARHN Region A. ARHN s Priorities Service providers in the ARHN region identified promoting mental health and preventing substance abuse as both their top priority and second priority. Preventing chronic disease was the second choice for top priority. Preventing HIV, sexually transmitted diseases, vaccine preventable diseases, and health care associated infections was selected the least as a top or second priority. Exhibit I.1: Identification of Priority Areas for the ARHN Region Count Priority Area Top Priority Second Priority Prevent Chronic Disease Provide a healthy and safe environment Promote Healthy Women, Infants, and Children Promote Mental Health and Prevent Substance Abuse Prevent HIV, Sexually Transmitted Diseases, Vaccine Preventable 1 12 Diseases, and Health Care Associated Infections B. Identifying the Top Priority B.1. Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Top Priority For those service providers who identified preventing chronic disease as their top priority, they ranked increasing access to high quality chronic preventive care and management as the top focus area (38), followed by reducing obesity in children and adults (21). Exhibit I.2: Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Top Priority for the ARHN Region Rank 1 st 2 nd 3 rd Reduce Obesity in Children and Adults Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings P a g e

82 B.2. Barriers to Addressing Chronic Diseases Prevention as the Top Priority for the ARHN Region A number of barriers were identified by service providers in the ARHN region who indicated that preventing chronic disease was their top priority, including travel distance and geography of the Adirondacks (33), lack of financial resources/reimbursement in the short-term (29), shortage of professionals and staff (26), and lack of financial resources/ reimbursement in the long-term (25). Exhibit I.3. Barriers to Addressing Chronic Diseases Prevention as the Top Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Top Priority 3 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 10 Benefits Existing Strategies Have Not Been Effective 16 Lack of Financial Resources/Reimbursement in the Short-Term 29 Lack of Financial Resources/Reimbursement in the Long-Term 25 Lack of Evidenced-Based Strategies 5 There is a Shortage of Professionals/Staff 26 The Existing Population Does Not Believe that My Top Priority is an Issue 15 There are Other Priorities More Important to Address 7 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 33 Patient/Client Needs Other 12 B.3. Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Top Priority Service providers in the ARHN who identified providing a healthy and safe environment as their top priority ranked injuries, violence, and occupational health as their top focus area (18), followed by the built environment (10). Exhibit I.4: Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Top Priority for the ARHN Region Rank 1 st 2 nd 3 rd 4th Outdoor Air Quality Water Quality Built Environment Injuries, Violence, and Occupational Health P a g e

83 B.4. Barriers to Providing a Healthy and Safe Environment as the Top Priority for the ARHN Region The biggest barrier to providing a healthy and safe environment identified by service providers in the ARHN region was the existing population does not believe that (providing a healthy and safe environment) is an issue (31), followed by lack of financial resources/reimbursement in the long- term (14) and the short-term (13). Exhibit I.5. Barriers to Providing a Healthy and Safe Environment as the Top Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Top Priority 4 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 6 Benefits Existing Strategies Have Not Been Effective 2 Lack of Financial Resources/Reimbursement in the Short-Term 13 Lack of Financial Resources/Reimbursement in the Long-Term 14 Lack of Evidenced-Based Strategies 2 There is a Shortage of Professionals/Staff 8 The Existing Population Does Not Believe that My Top Priority is an Issue 31 There are Other Priorities More Important to Address 1 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 4 Patient/Client Needs Other 5 B.5. Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Top Priority For service providers in the ARHN region that identified promoting healthy women, infant, and children as their top priority, they ranked child health (14) as the top focus area, followed by maternal and infant health (11). Exhibit I.6: Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Top Priority for the ARHN Region Rank 1 st 2 nd 3 rd Maternal and Infant Health Child Health Reproductive, Preconception, and Inter-conception Health P a g e

84 B.6. Region Barriers to Promoting Healthy Women, Infants, and Children as the Top Priority for the ARHN A number of barriers were identified by service providers in the ARHN region who indicated that healthy women, infant, and children were their top priority, including lack of financial resources/reimbursement in the short-term (13), travel distance and geography of the Adirondacks (12), lack of financial resources/ reimbursement in the long-term (12), and a shortage of professionals and staff (10). Exhibit I.7. Barriers to Promoting Healthy Women, Infants, and Children as the Top Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Top Priority 2 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 7 Benefits Existing Strategies Have Not Been Effective 5 Lack of Financial Resources/Reimbursement in the Short-Term 12 Lack of Financial Resources/Reimbursement in the Long-Term 13 Lack of Evidenced-Based Strategies 2 There is a Shortage of Professionals/Staff 10 The Existing Population Does Not Believe that My Top Priority is an Issue 7 There are Other Priorities More Important to Address 3 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 12 Patient/Client Needs Other 4 B.7. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Top Priority As indicated previously, promoting mental health and preventing substance abuse was ranked 1 st and 2 nd regionally as priorities. For those service providers that ranked it first as priority, they ranked the top focus area as strengthening infrastructure across systems (39), followed by preventing substance abuse and other mental and emotional disorders (27). Exhibit I.8. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Top Priority for the ARHN Region Rank 1 st 2 nd 3 rd Promote Mental, Emotional, and Well-Being in Communities Prevent Substance Abuse and other Mental and Emotional Disorders Strengthen Infrastructure Across Systems B.8. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Top 83 P a g e

85 Priority for the ARHN Region For those service providers in the ARHN region that identified promoting mental health and preventing substance abuse as their top priority, they indicated that the biggest barriers to addressing this priority included a shortage of professionals and staff (62), travel distance and geography of the Adirondacks (44), lack of financial resources/reimbursement in the long-term (40), and lack of financial resources/reimbursement in the short-term (37). Exhibit I.9. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Top Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Top Priority 4 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 16 Benefits Existing Strategies Have Not Been Effective 31 Lack of Financial Resources/Reimbursement in the Short-Term 37 Lack of Financial Resources/Reimbursement in the Long-Term 40 Lack of Evidenced-Based Strategies 7 There is a Shortage of Professionals/Staff 62 The Existing Population Does Not Believe that My Top Priority is an Issue 4 There are Other Priorities More Important to Address 8 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 44 Patient/Client Needs Other 16 B.9. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Top Priority One service provider in the ARHN region identified preventing HIV, sexually transmitted diseases, vaccinepreventable diseases, and health care associated infections as their top priority, and that organization ranked preventing HIV and sexually transmitted diseases as its top focus area. Exhibit I.10. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Top Priority for the ARHN Region Rank 1 st 2 nd 3 rd Prevent HIV and Sexually Transmitted Diseases Prevent Vaccine-Preventable Diseases Prevent Health Care Associated Infections B.10. Barriers to Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections as the Top Priority for the ARHN Region 84 P a g e

86 Barriers identified by the organization that selected preventing HIV, sexually transmitted diseases, vaccinepreventable diseases, and health care associated infections included a shortage of professionals and staff and travel distance and geography of the Adirondacks. Exhibit I.11. Barriers to Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections as the Top Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 0 Benefits Existing Strategies Have Not Been Effective 0 Lack of Financial Resources/Reimbursement in the Short-Term 0 Lack of Financial Resources/Reimbursement in the Long-Term 0 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 1 The Existing Population Does Not Believe that My Top Priority is an Issue 0 There are Other Priorities More Important to Address 0 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 1 Patient/Client Needs Other 0 C. Identifying the Second Priority C.1. Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Second Priority Service providers in the ARHN region that indicated preventing chronic disease was their second priority ranked increasing access to high quality chronic disease care and management (22) as their top focus area followed by reducing obesity in children and adults (15). Exhibit I.12: Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Second Priority for the ARHN Region Rank 1 st 2 nd 3 rd Reduce Obesity in Children and Adults Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings C.2. Barriers to Addressing Chronic Diseases Prevention as the Second Priority 85 P a g e

87 For service providers in the ARHN region that identified preventing chronic disease as their second priority, barriers to addressing this priority included travel distance and geography of the Adirondacks (20) and a shortage of professionals and staff (15). Exhibit I.13. Barriers to Addressing Chronic Diseases Prevention as the Second Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Second Priority 4 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 2 Benefits Existing Strategies Have Not Been Effective 10 Lack of Financial Resources/Reimbursement in the Short-Term 10 Lack of Financial Resources/Reimbursement in the Long-Term 12 Lack of Evidenced-Based Strategies 3 There is a Shortage of Professionals/Staff 15 The Existing Population in My Service Area Does Not Believe that My Second Priority is an Issues 8 There are Other Priorities More Important to Address 6 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 20 Patient/Client Needs Other 9 C.3. Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Second Priority Service providers in the ARHN region that indicated that providing a healthy and safe environment was their second priority ranked the built environment (26) as their top focus are followed closely by injuries, violence, and occupational health (25). Exhibit I.14: Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Second Priority for the ARHN Region Rank 1 st 2 nd 3 rd 4th Outdoor Air Quality Water Quality Built Environment Injuries, Violence, and Occupational Health P a g e

88 C.4. Barriers to Providing a Healthy and Safe Environment as the Second Priority For service providers that identified a healthy and safe environment as their second priority, financial issues were the top barriers to addressing this priority, including the lack of financial resources/reimbursement in the short-term (27) and in the long-term (22). Exhibit I.15. Barriers to Providing a Healthy and Safe Environment as the Second Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Second Priority 16 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 5 Benefits Existing Strategies Have Not Been Effective 5 Lack of Financial Resources/Reimbursement in the Short-Term 27 Lack of Financial Resources/Reimbursement in the Long-Term 22 Lack of Evidenced-Based Strategies 5 There is a Shortage of Professionals/Staff 10 The Existing Population in My Service Area Does Not Believe that My Second 10 Priority is an Issues There are Other Priorities More Important to Address 10 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 9 Patient/Client Needs Other 7 C.5. Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Second Priority For service providers in the ARHN region that identified promoting healthy women, infants, and children as their second priority, they ranked child health (18) as their top focus area followed by maternal and infant health (7), and reproductive, preconception, and inter-conception health (5). Exhibit I.16: Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Second Priority for the ARHN Region Rank 1 st 2 nd 3 rd Maternal and Infant Health Child Health Reproductive, Preconception, and Inter-conception Health P a g e

89 C.6. Barriers to Promoting Healthy Women, Infants, and Children as the Second Priority Service providers in the ARHN region that identified promoting healthy women, infants, and children as their second priority indicated that the biggest barriers to addressing this priority included lack of financial resources/reimbursement in the long-term (14), travel distance and geography of the Adirondacks (14), lack of financial resources/reimbursement in the short-term (12), and a shortage of professionals and staff (10). Exhibit I.17. Barriers to Promoting Healthy Women, Infants, and Children as the Second Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Second Priority 4 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 4 Benefits Existing Strategies Have Not Been Effective 5 Lack of Financial Resources/Reimbursement in the Short-Term 12 Lack of Financial Resources/Reimbursement in the Long-Term 14 Lack of Evidenced-Based Strategies 1 There is a Shortage of Professionals/Staff 10 The Existing Population in My Service Area Does Not Believe that My Second 3 Priority is an Issues There are Other Priorities More Important to Address 3 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 14 Patient/Client Needs Other 3 C.7. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Second Priority Service providers in the ARHN region that identified promoting mental health and preventing substance abuse as their second priority ranked preventing substance abuse and other mental and emotional disorders (27) as their top focus area, followed by promoting mental, emotional, and well-being in communities (25). Exhibit I.18. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Second Priority for the ARHN Region Rank 1 st 2 nd 3 rd Promote Mental, Emotional, and Well-Being in Communities Prevent Substance Abuse and other Mental and Emotional Disorders Strengthen Infrastructure Across Systems P a g e

90 C.8. Priority Barriers to Promoting Mental Health and Preventing Substance Abuse as the Second Service providers in the ARHN region that identified promoting mental health and preventing substance abuse as their second priority indicated that the biggest barriers to addressing this priority included a shortage of professionals and staff (44), lack of financial resources/reimbursement in the short-term (37), lack of financial resources/reimbursement in the long-term (33), and travel distance and geography of the Adirondacks (32). Exhibit I.19. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Second Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Second Priority 6 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 15 Benefits Existing Strategies Have Not Been Effective 21 Lack of Financial Resources/Reimbursement in the Short-Term 37 Lack of Financial Resources/Reimbursement in the Long-Term 33 Lack of Evidenced-Based Strategies 3 There is a Shortage of Professionals/Staff 44 The Existing Population in My Service Area Does Not Believe that My Second Priority is an Issues 6 There are Other Priorities More Important to Address 7 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 32 Patient/Client Needs Other 10 C.9. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Second Priority Service providers in the ARHN region that identified preventing HIV, sexually transmitted diseases, vaccinepreventable diseases, and health care associated infections as their second priority ranked preventing HIV and sexually preventable diseases and preventing vaccine-preventable diseases as their top focus area, both at six. Exhibit I.20. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Second Priority for the ARHN Region Rank 1 st 2 nd 3 rd Prevent HIV and Sexually Transmitted Diseases Prevent Vaccine-Preventable Diseases P a g e

91 Prevent Health Care Associated Infections C.10. Barriers to Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections as the Second Priority Service providers who identified preventing HIV, sexually transmitted diseases, vaccine-preventable diseases, and health care associated infections as their second priority indicated that the existing population does not believe that (preventing HIV, sexually transmitted diseases, vaccine-preventable diseases, and health care associated infections) is an issue (7) as the biggest barrier to addressing it. Exhibit I.21. Barriers Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections the Second Priority for the ARHN Region Barrier Count I am not Aware of any Current Work Addressing My Second Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 0 Benefits Existing Strategies Have Not Been Effective 2 Lack of Financial Resources/Reimbursement in the Short-Term 2 Lack of Financial Resources/Reimbursement in the Long-Term 3 Lack of Evidenced-Based Strategies 1 There is a Shortage of Professionals/Staff 4 The Existing Population in My Service Area Does Not Believe that My Second Priority is an Issue 7 There are Other Priorities More Important to Address 2 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 2 Patient/Client Needs Other 1 II. Clinton County A. Clinton County s Priorities Service providers whose service area included Clinton County identified promoting mental health and preventing substance abuse (26) as the top priority followed by preventing chronic disease (17). Providing a healthy and safe environment (21) was identified as the second priority by Clinton County service providers. Exhibit II.1: Identification of Priority Areas for Clinton County Count Priority Area Top Second Priority Priority Prevent Chronic Disease Provide a healthy and safe environment 5 21 Promote Healthy Women, Infants, and Children 5 6 Promote Mental Health and Prevent Substance Abuse P a g e

92 Prevent HIV, Sexually Transmitted Diseases, Vaccine Preventable Diseases, and Health Care Associated Infections 0 2 B. Identifying the Top Priority B.1. Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Top Priority Respondents whose service areas included Clinton County and who listed chronic disease prevention as their top priority ranked their top focus area as to increase access to high quality chronic disease preventive care and management in clinical and community settings (10). Exhibit II.2: Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Top Priority for Clinton County Rank 1 st 2 nd 3 rd Reduce Obesity in Children and Adults Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings B.2. County Barriers to Addressing Chronic Diseases Prevention as the Top Priority for Clinton Lack of financial resources/reimbursement in the short-term (10) was listed by Clinton County respondents as the top barrier to effectively preventing chronic disease, followed by lack of financial resources/reimbursement in the long-term (6) and travel distance and geography of the Adirondacks (5). Exhibit II.3. Barriers to Addressing Chronic Diseases Prevention as the Top Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 3 Benefits Existing Strategies Have Not Been Effective 3 Lack of Financial Resources/Reimbursement in the Short-Term 10 Lack of Financial Resources/Reimbursement in the Long-Term 6 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 3 The Existing Population Does Not Believe that My Top Priority is an Issue 2 There are Other Priorities More Important to Address 1 91 P a g e

93 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 5 Patient/Client Needs Other 5 B.3. Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Top Priority Respondents whose service areas included Clinton County and who listed providing a healthy and safe environment (3) as their top priority ranked their top focus area as injuries, violence, and occupational health followed by the built environment (2). Exhibit II.4: Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe environment is the Top Priority for Clinton County Rank 1 st 2 nd 3 rd 4th Outdoor Air Quality Water Quality Built Environment Injuries, Violence, and Occupational Health B.4. County Barriers to Providing a Healthy and Safe environment as the Top Priority for Clinton Respondents who listed Clinton County in their service area and who listed healthy and safe environment as their top priority indicated that the biggest barrier for achieving a healthy and safe environment was lack of financial resources/reimbursement is insufficient in the long-term (4). Exhibit II.5. Barriers to Providing a Healthy and Safe Environment as the Top Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 1 Benefits Existing Strategies Have Not Been Effective 0 Lack of Financial Resources/Reimbursement in the Short-Term 2 Lack of Financial Resources/Reimbursement in the Long-Term 4 Lack of Evidenced-Based Strategies 1 There is a Shortage of Professionals/Staff 1 The Existing Population Does Not Believe that My Top Priority is an Issue 0 There are Other Priorities More Important to Address 0 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 0 Patient/Client Needs Other 1 92 P a g e

94 B.5. Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Top Priority For respondents whose service area includes Clinton County and who indicated that promoting healthy women, infant, and children were their top priority, child health and reproductive, preconception, and inter-conception health were listed as their top focus areas. Exhibit II.6: Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Top Priority for Clinton County Rank 1 st 2 nd 3 rd Maternal and Infant Health Child Health Reproductive, Preconception, and Inter-conception Health B.6. Barriers to Promoting Healthy Women, Infants, and Children as the Top Priority for Clinton County A shortage of professionals/staff (3) to address healthy women, infants, and children and the existing population does not believe that healthy women, infants, and children are an issue (3) were cited as the top to barriers for achieving this goal. Exhibit II.7. Barriers to Promoting Healthy Women, Infants, and Children as the Top Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 1 Benefits Existing Strategies Have Not Been Effective 0 Lack of Financial Resources/Reimbursement in the Short-Term 1 Lack of Financial Resources/Reimbursement in the Long-Term 2 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 3 The Existing Population Does Not Believe that My Top Priority is an Issue 3 There are Other Priorities More Important to Address 0 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 2 Patient/Client Needs Other 1 B.7. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Top Priority 93 P a g e

95 Services providers in Clinton County who selected promoting mental health and preventing substance abuse as their top priority ranked strengthening the (mental health and substance abuse) infrastructure across systems as the focus area to address. Exhibit II.8. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Top Priority for Clinton County Rank 1 st 2 nd 3 rd Promote Mental, Emotional, and Well-Being in Communities Prevent Substance Abuse and other Mental and Emotional Disorders Strengthen Infrastructure Across Systems B.8. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Top Priority for Clinton County Service providers in Clinton County that indicated promoting mental health and preventing substance abuse was their top priority identified a number of barriers to achieving this goal. These barriers include shortage of professionals and staff (19), followed by lack of financial resources/ reimbursement in the long-term (16), travel distance and geography of the Adirondacks (16), and lack of financial resources/reimbursement in the short-term (12). One service provider noted that fragmentation of providers was also a barrier for addressing this priority area. Exhibit II.9. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Top Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 3 Benefits Existing Strategies Have Not Been Effective 6 Lack of Financial Resources/Reimbursement in the Short-Term 12 Lack of Financial Resources/Reimbursement in the Long-Term 16 Lack of Evidenced-Based Strategies 1 There is a Shortage of Professionals/Staff 19 The Existing Population Does Not Believe that My Top Priority is an Issue 0 There are Other Priorities More Important to Address 4 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 16 Patient/Client Needs Other 5 94 P a g e

96 B.9. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Top Priority No service providers in Clinton County identified preventing HIV, sexually transmitted diseases, vaccinepreventable diseases, and health care associated infections as their top priority. C. Identifying the Second Priority C.1. Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Second Priority Respondents whose service areas included Clinton County and who listed chronic disease prevention as their second priority ranked their top focus area as to increase access to high quality chronic disease preventive care and management in clinical and community settings (8). Reducing obesity in children and adults (4) was ranked second for those respondents. Exhibit II.10: Ranking the Focus Areas for Chronic Diseases Prevention when Chronic Disease Prevention is the Second Priority for Clinton County Rank 1 st 2 nd 3 rd Reduce Obesity in Children and Adults Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings C.2. Barriers to Addressing Chronic Diseases Prevention as the Second Priority Travel distance and geography of the Adirondacks (8) was listed as the top barrier to preventing chronic diseases who respondents whose service area included Clinton County and who listed preventing chronic disease as their second priority, followed by lack of financial resources/ reimbursement in the longterm (4) and a shortage of professionals and staff (4). Exhibit II.11. Barriers to Addressing Chronic Diseases Prevention as the Second Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Second Priority 1 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 0 Benefits Existing Strategies Have Not Been Effective 3 Lack of Financial Resources/Reimbursement in the Short-Term 3 Lack of Financial Resources/Reimbursement in the Long-Term 4 95 P a g e

97 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 4 The Existing Population in My Service Area Does Not Believe that My Second 2 Priority is an Issues There are Other Priorities More Important to Address 2 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 8 Patient/Client Needs Other 5 C.3. Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe environment is the Second Priority For respondents whose service area included Clinton County and whose second priority was a healthy and safe environment, the top focus area was injuries, violence, and occupational health (10) followed closely by the built environment (9). Exhibit II.12: Ranking the Focus Areas for Providing a Healthy and Safe Environment when Providing a Healthy and Safe Environment is the Second Priority for Clinton County Rank 1 st 2 nd 3 rd 4th Outdoor Air Quality Water Quality Built Environment Injuries, Violence, and Occupational Health C.4. Barriers to Providing a Healthy and Safe Environment as the Second Priority For respondents whose service area included Clinton County and whose second priority was a healthy and safe environment, the top biggest barriers to achieving a healthy and safe environment were lack of financial resources/reimbursement in the short-term (10) and in the long-term (9). Exhibit II.13. Barriers to Providing a Healthy and Safe Environment as the Second Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Second Priority 4 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 2 Benefits Existing Strategies Have Not Been Effective 1 Lack of Financial Resources/Reimbursement in the Short-Term 9 Lack of Financial Resources/Reimbursement in the Long-Term 8 Lack of Evidenced-Based Strategies 3 There is a Shortage of Professionals/Staff 2 The Existing Population in My Service Area Does Not Believe that My Second 3 Priority is an Issues 96 P a g e

98 There are Other Priorities More Important to Address 4 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 5 Patient/Client Needs Other 4 C.5. Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Second Priority For respondents whose service area included Clinton County and whose second priority was promoting healthy women, infant, and children, maternal and infant health (4) was identified as the main focus area to address. Exhibit II.14: Ranking the Focus Areas for Promoting Healthy Women, Infants, and Children when Promoting Healthy Women, Infant, and Children is the Second Priority for Clinton County Rank 1 st 2 nd 3 rd Maternal and Infant Health Child Health Reproductive, Preconception, and Inter-conception Health C.6. Barriers to Promoting Healthy Women, Infants, and Children as the Second Priority For respondents whose service area included Clinton County and whose second priority was promoting healthy, women, infants, and children, the biggest barrier to achieving this priority was travel distance and the geography of the Adirondacks (4). Exhibit II.15. Barriers to Promoting Healthy Women, Infants, and Children as the Second Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 0 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 2 Benefits Existing Strategies Have Not Been Effective 0 Lack of Financial Resources/Reimbursement in the Short-Term 0 Lack of Financial Resources/Reimbursement in the Long-Term 0 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 2 The Existing Population Does Not Believe that My Top Priority is an Issue 0 There are Other Priorities More Important to Address 0 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 4 Patient/Client Needs Other 2 97 P a g e

99 C.7. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Second Priority For those stakeholders whose service area included Clinton County and that indicated promoting mental health and preventing substance abuse was their second priority, they ranked as the main focus area preventing substance abuse and other mental and emotional disorders (5) followed by promoting mental, emotional, and well-being in communities (4). Exhibit II.16. Ranking the Focus Areas for Promoting Mental Health and Preventing Substance Abuse when Promoting Mental Health and Preventing Substance Abuse is the Second Priority for Clinton County Rank 1 st 2 nd 3 rd Promote Mental, Emotional, and Well-Being in Communities Prevent Substance Abuse and other Mental and Emotional Disorders Strengthen Infrastructure Across Systems C.8. Priority Barriers to Promoting Mental Health and Preventing Substance Abuse as the Second Service providers in Clinton County that indicated promoting mental health and preventing substance abuse was their second priority also identified a number of barriers to achieving this goal. They include shortage of professionals and staff (8), followed by lack of financial resources/reimbursement in the short-term (7), lack of financial resources/reimbursement in the long-term (6), and existing strategies have not been effective in addressing this priority. Exhibit II.17. Barriers to Promoting Mental Health and Preventing Substance Abuse as the Second Priority for Clinton County Barrier Count I am not Aware of any Current Work Addressing My Top Priority 2 Cost of Providing Services and/or the per Client/Patient Cost is Too High/Outweigh the 1 Benefits Existing Strategies Have Not Been Effective 5 Lack of Financial Resources/Reimbursement in the Short-Term 7 Lack of Financial Resources/Reimbursement in the Long-Term 6 Lack of Evidenced-Based Strategies 0 There is a Shortage of Professionals/Staff 8 The Existing Population Does Not Believe that My Top Priority is an Issue 1 There are Other Priorities More Important to Address 0 Travel Distance/Geography of the Adirondacks Makes it Difficult to Address 4 Patient/Client Needs Other 1 98 P a g e

100 C.9. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Second Priority Only two service providers in Clinton County identified preventing HIV, sexually transmitted diseases, vaccine-preventable diseases, and health care associated infections as their second priority, and they both ranked preventing HIV and sexually transmitted diseases as their main focus area to address. One provider indicated that travel distance and geography of the Adirondacks was a barrier to addressing this priority. No other barriers were identified. Exhibit II.18. Ranking the Focus Areas for Preventing HIV, Sexually Transmitted Diseases, Vaccine- Preventable Diseases, and Health Care Associated Infections when Preventing HIV, Sexually Transmitted Diseases, Vaccine-Preventable Diseases, and Health Care Associated Infections is the Second Priority for Clinton County Rank 1 st 2 nd 3 rd Prevent HIV and Sexually Transmitted Diseases Prevent Vaccine-Preventable Diseases Prevent Health Care Associated Infections Methodology and Data Sources The Center for Health Workforce Studies (CHWS) at the University at Albany School of Public Health under contract with the Adirondack Rural Health Network, a program of the Adirondack Health Institute, identified and collected data from a variety of sources on the seven counties in the Adirondack region and two adjacent counties to assist in developing individual county community needs assessments. Those counties include: Clinton, Essex, Franklin, Fulton, Hamilton, Montgomery, Saratoga, Warren, and Washington. The initial step in the process was determining which data elements from the 2013 community needs assessment were still available. In 2013, CHWS staff received an initial list of potential data elements from the ARHN Data Subcommittee and then supplemented that information with data from other sources. Since most of the health behavior, status, and outcome data were only available at the county level, the data for both 2013 and 2016 were displayed by county and aggregated to the ARHN region. 1 Additionally, other data was collected to further enhance already identified data. For example, one Prevention Agenda indicator was assault-related hospitalizations. That indicator was augmented by other crime statistics from the New York State Division of Criminal Justice. The overall goal of collecting and providing this data to ARHN members was to provide a comprehensive picture of the individual counties within the Adirondack region as well as for two adjacent counties, including providing an 1 Aggregated data for the ARHN region included Clinton, Essex, Franklin, Fulton, Hamilton, Warren, and Washington counties but did not include Montgomery and Saratoga counties. 99 P a g e

101 overview of population health as well as an environmental scan. In total, counties and hospitals were provided with about 400 data elements across the following four reports: Demographic Data; Educational Profile; Health Behaviors, Health Outcomes, and Health Status; and Health Delivery System Profile. All sources for the data were listed and made available to the counties and hospitals. The sources for the data elements in the Health Behaviors, Health Outcomes, and Health Status report were listed in a separate file and included their respective internet URL links. The data in each of the four reports were aggregated, when feasible, into the ARHN region, Upstate New York (all counties but the five in New York City), and statewide. Demographic Data Demographic data was primarily taken from the American Community Survey, and supplemented with data from the Bureau of Labor Statistics, Local Area Unemployment Statistics for 2014; the New York State Department of Health (NYSDOH) Medicaid Data for 2014; and employment sector data also from American Community Survey. Among the information incorporated into the demographic report included: Race/Ethnicity; Age by groups (0 4, 5 17, 18 64, and 65 plus); Income and poverty, including the percent who received Medicaid; Housing stock; Availability of vehicles; Education status for those 25 and older; Employment status; and Employment sector. Educational Profile The education profile was taken mainly from the New York State Education Department (NYSED), School Report Card for , supplemented with data from the National Center for Education Statistics, Integrated Post- Secondary Data System on Post-Secondary graduations for 2014 and registered nurse graduation data from CHWS. Among the data displayed in the educational profile included: Number of school districts; Total school district enrollment; Number of students on free and reduced lunch; Dropout rate; 100 P a g e

102 Total number of public school teachers; Number of and graduations from licensed practical nurse programs; and Number of and graduations from registered nurse programs. Health Behaviors, Health Outcomes, and Health Status The vast majority of health behaviors, outcomes, and status data come from NYSDOH. Data sources included the: Community Health Indicators Report ( County Dashboards of Indicators for Tracking Public Health Priority Areas, ( d/pa_dashboard); and Behavioral Risk Factor Surveillance System (BRFSS) ( Information on NYSDOH s methodologies used to collect and display data from the above sources can be found on their respective data pages. NYSDOH data was also supplemented from other sources such as the County Health rankings, the New York State Division of Criminal Justice Services, the New York State Institute for Traffic Safety Management and Research, and the New York State Office of Mental Health Patient Characteristics Survey, among others. To the extent possible, Center staff used similar years for the additional data that was collected. Over 270 data elements are displayed in this report broken out by the Prevention Agenda focus areas. The availability of data elements did change from the 2013 community needs assessment analysis, and certain data was reported differently between the two time periods. Data were downloaded from their various sources and stored in separate Excel files, based on their respective focus area. The Health Behaviors, Health Outcomes, and Health Status report was created in Excel and linked to the raw data, and population rates were recalculated based on the number of cases as well as the population listed in the data source. Data in the report were organized by the six priority areas as outlined by NYSDOH at The data was also separated into two subsections, those that were identified as Prevention Agenda indicators and those that were considered other indicators. The data elements were organized by 17 focus areas as outlined in the table below. 101 P a g e

103 Number of Indicators Prevention Focus Area Agenda Other Health Disparities 8 6 Injuries, Violence, and Occupational Health 7 20 Outdoor Air Quality 2 0 Built Environment 6 0 Water Quality 1 0 Obesity in Children and Adults 2 33 Reduce Illness, Disability, and Death Related to Tobacco Use 1 13 and Secondhand Smoke Exposure Increase Access to High Quality Chronic Disease Preventive 6 24 Care and Management Maternal and Infant Health 9 17 Preconception and Reproductive Health 9 20 Child Health 4 29 HIV 2 1 STDs 5 10 Vaccine Preventable Diseases 3 6 Healthcare Associated Infections 2 0 Substance Abuse and other Mental, Emotional, and 3 15 Behavioral Disorders Other Illnesses 0 8 The data elements that were Prevention Agenda indicators were compared against their respective Prevention Agenda benchmarks. Other indicators were compared against either Upstate New York benchmarks, when available or then New York State benchmarks when Upstate New York benchmarks were not available. The report also included a status field that indicated whether indicators were met, were better, or were worse than their corresponding benchmarks. When indicators were worse than their corresponding benchmarks, their distances from their respective benchmarks were calculated. On the report, distances from benchmarks were indicated using quartiles rankings, i.e., if distances from their corresponding benchmarks were less than 25%, indicators were in quartile 1, if distances were between 25% and 49.9% from their respective benchmarks, indicators were in quartile 2, etc. The Health Behaviors, Health Outcomes, and Health Status Report also indicated the percentage of total indicators that were worse than their respective benchmarks by focus area. For example, if 20 of the 33 child health focus area indicators were worse than their respective benchmarks, the quartile summary score would be 61% (20/33). Additionally, the report identified a severity score, i.e., the percentage of those indicators that were either in quartile 3 or 4 compared to all indicators which were worse than their corresponding benchmarks. Using the above example, if 9 of the 20 child health focus indicators that were worse than their respective benchmarks were in quartiles 3 or 4, the severity score would be 45% (9/20). Quartile summary scores and severity scores were calculated for each focus area as well as for Prevention Agenda indicators and for other indicators within each 102 P a g e

104 focus area. Both quartile summary scores and severity scores were used to understand if the specific focus areas were challenges to the counties and hospitals. In certain cases, focus areas would have low severity scores but high quartile summary scores indicating that while not especially severe, the focus area offered significant challenges to the community. Health Delivery System Profile The data on the health system came from NYSDOH list of facilities, NYSED licensure file for 2015, the Health Resources and Services Administration Data Warehouse for health professional shortage (HPSAs) areas for 2016, the Uniform Data System (UDS) for 2014, and Center data on 2014 physicians. Among the data incorporated into this report included: Hospital, nursing home, and adult care facility beds; Number of community health center patients; Number of and population within primary care, mental health, or dental care HPSAs; Total physicians and physicians by certain specialties and sub-specialties; and Count of individuals licensed. 2 Community Stakeholder Survey A survey of stakeholders was conducted by CHWS in April and May of The purpose of the survey was to provide the Community Health Assessment (CHA) Committee with stakeholder input on regional and/or county health care needs and priorities. Stakeholders included health care, social services, educational, governmental and other agencies in the ARHN region. Results were presented for each of the seven ARHN counties 3 and aggregated for the region. The initial survey in 2013 included 81 questions. The data subcommittee in 2016 felt that the previous survey was too extensive, and CHWS, working in conjunction with AHI and the data subcommittee, reduced the survey to 15 questions. The survey requested that the respondent identify the two priority areas from a list of five which they believe need to be addressed with their county or counties, and then respondents were also asked to rank the focus areas within each priority area and identify potential barriers to that addressing that focus area. Stakeholder responses were assessed in multiple counties if there service area covered more than one county. The survey was administered electronically using the web-based Qualtrics software and distributed to stakeholders based on an contact list of 658 individuals that were identified by AHI working in conjunction with county 2 County is determined by the main address listed on the licensure file. The address listed may be a private residence or may represent those with active licenses but not actively practicing patient care. Therefore, the information provided may not truly reflect who is practicing in a profession in the county. 3 Montgomery and Saratoga counties was not included in the survey. 103 P a g e

105 health departments. CHWS sent out the initial notification of the survey as well as two reminder notices to those who had not yet completed the survey. Additionally, participation was also incentivized through an opt-in gift card drawing, with 20 entrants randomly selected to receive a $10 Stewart s gift card at the conclusion of the survey. Ultimately, 217 surveys were completed during the six-week survey period for a response rate of 33%. Response rates varied by individual county, with certain respondents being counted in more than one county depending on the extent of their service area. 104 P a g e

106 Appendix I: Data Consultants, Data Sources, and Methodology Community Health Assessment Process Data Consultants Center for Health Workforce Studies, University at Albany School of Public Health Rochel Rubin, PhD, Graduate Research Assistant Robert Martiniano, MPA, MPH, Senior Program Manager Databases used for the Community Health Assessment Bureau of Communicable Disease Control Data Bureau of HIV/AIDS Epidemiology Data Cancer Registry Community Health Indicator Reports Division of Criminal Justice Services Governor s Traffic Safety Committee Data Report Motor Vehicle Crash Data New York State Expanded Behavioral Risk Factor Surveillance System Data (BRFSS) New York State Immunization Information System Data New York State Medicaid Program Data New York State Office of Mental Health Patient Characteristics Survey New York State Pregnancy Nutrition Surveillance System WIC Program Data Office of Mental Health County Profiles Data Statewide Planning and Research Cooperative System (SPARCS) data Vital Statistics Data 105 P a g e

107 Appendix J Prevention Agenda Indicators with Links Prevention Agenda Indicators O ne Two Three 1. Percentage of Overall Premature Deaths (Age 35-64), % 22.3% 22.0% 23.7% 21.8% Meets/Better Prevention Agenda Dashboard 2. Ratio of Black, Non-Hispanic Premature Deaths (Prior to Age 65) to White, Non-Hispanic Premature Deaths, ' Meets/Better Prevention Agenda Dashboard 3. Ratio of Hispanic/Latino Premature Deaths (Prior to Age 65) to White, Non-Hispanic Premature Deaths, ' Less than 10 Prevention Agenda Dashboard 4. Rate of Adult Age-Adjusted Preventable Hospitalizations per 10,000 Population (Ages 18 Plus), N/A Meets/Better Prevention Agenda Dashboard 5. Ratio of Black, Non-Hispanic Adult Age-Adjusted Preventable Hospitalizations to White, Non-Hispanic, '12-14 N/A N/A Less than 10 Preventaion Agenda Dashboard 6. Ratio of Hispanic/Latino Adult Age-Adjusted Preventable Hospitalizations to White, Non-Hispanic, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 7. Percentage of Adults ( Ages 18-64) with Health Insurance, % N/A N/A 87.6% 100.0% Worse Prevention Agenda Dashboard 8. Age Adjusted Percentage of Adults with Regular Health Care Provider - Over 18 Years, % N/A 84.6% 84.4% 90.8% Worse Prevention Agenda Dashboard Other Disparity Indicators Focus Area: Dispartities Number Per Year (If Available) Average Rate, Ratio or Percentage for the Listed Years Health Disparities 1. Rate of Total Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 2. Rate of Emergency Department Visits per 10,000 Population, ' , , , ,086.4 N/A Worse Community Health Indicator Reports 3. Rate of Total Hospital Discharges per 10,000 Population, ' , , , ,226.2 N/A Meets/Better Community Health Indicator Reports New York State 2018 Prevention Agenda Benchmark Comparison to Benchmark 4. Percentage of Adults (18 and Older) Who Did Not Receive Care Due to Costs, '13/ % 11.4% 11.2% 13.1% N/A Worse 5. % of Adults (18 and Older) with 14 Days or More of Poor Physical Health, '13/ % 13.4% 12.3% 11.8% N/A Worse 6. Percentage of Adults (18 and Older) with Disabilities, '13/ % 25.2% 22.4% 20.8% N/A Worse ARHN Comparison Regions/Data Upstate NY Source NYS Expanded Behavioral Risk Factor Surveillance System NYS Expanded Behavioral Risk Factor Surveillance System NYS Expanded Behavioral Risk Factor Surveillance System 106 P a g e

108 Focus Area: Injuries, Violence, and Occupational Health Number Per Year (If Available) O ne Two Three Promote a Healthy and Safe Environment Average Rate, Ratio or Percentage for the Listed Years Comparison to Benchmark Prevention Agenda Indicators 1. Rate of Hospitalizations due to Falls for Ages 65 Plus per 10,000 Population, Meets/Better Prevention Agenda Dashboard 2. Rate of ED Visits due to Falls for Children Ages 1-4 per 10,000 Population Children Ages 1-4, Worse Prevention Agenda Dashboard 3. Rate of Assault-Related Hospitalizations per 10,000 Population, ' Meets/Better Prevention Agenda Dashboard 4. Ratio of Black, Non-Hispanic Assault-Related Hospitalizations to White, Non-Hispanic Assault Related Hospitalizations, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 5. Ratio of Hispanic/Latino Assault-Related Hospitalizations to White, Non-Hispanic Assault Related Hospitalizations, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 6. Ratio of Assault-Related Hospitalizations for Low-Income versus non-low Income Zip Codes, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 7. Rate of ED Occupational Injuries Among Working Adolescents Ages per 10,000 Population Ages 15-19, Worse Prevention Agenda Dashboard Other Indicators 1. Rate of Hospitalizations for Falls for Children Ages Under 10 per 10,000 Population Children Ages Under 10, '11-13 N/A N/A Less than 10 Community Health Indicator Reports 2. Rate of Hospitalizations for Falls for Children Ages per 10,000 Population Children Ages 10-14, '11-13 N/A N/A Less than 10 Community Health Indicator Reports 3. Rate of Hospitalizations for Falls for Individuals Ages per 10,000 Population Individuals Ages 15-24, ' N/A Meets/Better Community Health Indicator Reports 4. Rate of Hospitalizations for Falls for Adults Ages per 10,000 Population Adults Ages 25-64, ' N/A Meets/Better Community Health Indicator Reports 5. Rate of Violent Crimes per 100,000 Population, N/A Meets/Better Department of Criminal Justice County Index Crime Counts and Rates 6. Rate of Property Crimes per 100,000 Population, , , , ,707.3 N/A Meets/Better Department of Criminal Justice County Index Crime Counts and Rates 7. Rate of Total Crimes per 100,000 Population, , , , ,073.7 N/A Meets/Better Department of Criminal Justice County Index Crime Counts and Rates 8. Rate of Malignant Mesothelioma Cases, Ages 15 Plus, per 100,000 Population Ages 15 Plus, ' N/A Less than 10 Community Health Indicator Reports 9. Rate of Pneumoconiosis Hospitalizations, Ages 15 Plus, per 100,000 Population Ages 15 Plus, ' N/A Meets/Better Community Health Indicator Reports 10. Rate of Asbestosis Hospitalizations, Ages 15 Plus, per 10,000 Population Ages 15 Plus, ' N/A Meets/Better Community Health Indicator Reports ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Source 107 P a g e

109 11. Rate of Work-Related Hospitalizations, Employed Ages 16 Plus per 100,000 Individuals Employed Ages 16 Plus, ' N/A Meets/Better Community Health Indicator Reports 12. Rate of Elevated Blood Lead Levels Ages 16 Plus Employed per 100,000 Individuals Employed Ages 16 Plus, ' N/A Less than 10 Community Health Indicator Reports 13. Rate of Total Motor Vehicle Crashes per 100,000, ' ,732 1,742 1,797 2, , , ,545.7 N/A Worse NYS Department of Motor Vehicles Traffic Safety Data 14. Rate of Speed-Related Accidents per 100,000 Population, ' N/A Worse 15. Rate of Motor Vehicle Accident Deaths per 100,000 Population, ' N/A Worse NYS Department of Motor Vehicles Traffic Safety Data NYS Department of Motor Vehicles Traffic Safety Data 16. Rate of TBI Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 17. Rate of Unintentional Injury Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 18. Rate of Unintentional Injury Hospitalizations Ages 14 and Under per 10,000 Population Ages 10-14, ' N/A Less than 10 Community Health Indicator Reports 19. Rate of Unintentional Injury Hospitalizations Ages 65 Plus per 10,000 Population Ages 65 Plus, ' N/A Meets/Better Community Health Indicator Reports 20. Rate of Poisoning Hospitalizations per 10,000 Population, ' N/A Worse Community Health Indicator Reports Focus Area: Outdoor Air Quality 1. Number of Days with Unhealthy Ozone, 2011/2013 N/A N/A 14 N/A 0 Less than 10 County Health Rankings 2. Numbert of Days with Unhealthy Particulated Matter, 2011/ Less than 10 County Health Rankings Focus Area: Built Environment 1. Percentage of the Population that Live in Jurisdictions that Adopted Climate Smart Communities Pledge, % 17.2% 56.8% 32.8% 32.0% Less than 10 Prevention Agenda Dashboard 2. Percentage of Commuters Who Use Alternative Modes of Transportation to Work, ' % 19.5% 22.6% 45.1% 49.2% Worse Prevention Agenda Dashboard 3. Percentage of Population with Low-Income and Low-Access to a Supermarket or Large Grocery Store, % 4.9% 4.2% 2.5% 2.2% Worse Prevention Agenda Dashboard 4. Percentage of Adults Experiencing Food Insecurity '13/ % 23.3% 22.7% 29.0% N/A Meets/Better NYS Expanded Behavioral Risk Factor Surveillance System 5. Percentage of Adults Experiencing Housing Insecurity 30.1% 36.1% 36.6% 43.4% N/A Meets/Better NYS Expanded Behavioral Risk Factor Surveillance System 6. Percentage of Homes in Vulnerable Neighborhoods that have Fewer Asthma Triggers During Home Revisits, ' % N/A 18.0% N/A 25.0% Worse Prevention Agenda Dashboard Focus Area: Water Quality 1. Percentage of Residents Served by Community Water Systems with Optimally Fluoridated Water, % 26.8% 52.6% 72.1% 78.5% Worse Prevention Agenda Dashboard 108 P a g e

110 Focus Area: Reduce Obesity in Children and Adults Prevention Agenda Indicators O ne Two Three 1. Percentage of Adults Ages 18 Plus Who are Obese, '13/ % 29.8% 27.0% 24.9% 23.2% Worse Prevention Agenda Dashboard 2. Percentage of Public School Children Who are Obese, ' % N/A 17.3% N/A 16.7% Worse Other Indicators Number Per Year (If Available) Prevent Chronic Disease Average Rate, Ratio or Percentage for the Listed Years Comparison to Benchmark 1. Percentage of Total Students Overweight, ' % 17.5% 16.7% N/A N/A Worse 2. Percentage of Elementary Students Overweight, Not Obese, ' % 16.8% 16.4% N/A N/A Worse 3. Percentage of Elementary Student Obese, ' % 18.6% 16.8% N/A N/A Worse 4. Percentage of Middle and High School Students Overweight, Not Obese, ' % N/A 17.1% N/A N/A Worse 5. Percentage of Middle and High School Students Obese, ' % 21.6% 18.1% N/A N/A Worse Student Weight Status Category Reporting System (SWSCRS) Data Student Weight Status Category Reporting System (SWSCRS) Data Student Weight Status Category Reporting System (SWSCRS) Data Student Weight Status Category Reporting System (SWSCRS) Data Student Weight Status Category Reporting System (SWSCRS) Data Student Weight Status Category Reporting System (SWSCRS) Data 6. Percentage of WIC Children Ages 2-4 Obese, ' % 15.1% 15.1% 14.3% N/A Meets/Better Community Health Indicator Reports 7. Percentage of Age Adjusted Adults (Ages 18 Plus) Overweight or Obese, '13/ % 64.4% 62.2% 60.9% N/A Meets/Better 8. Percentage of Age Adjusted Adults (Ages 18 Plus) Who Participated in Leisure Activities Last 30 Days, '13/ % 73.8% 73.7% 72.8% N/A Meets/Better 9. Number of Recreational and Fitness Facilities per 100,000 Population, N/A Worse 10. Percentage of Age Adjusted Adults (Ages 18 Plus) with Cholesterol Check, '13/ % 79.7% 84.8% 84.2% N/A Worse 11. Percentage of Adults (18 Plus) with Physician Diagnosed High Blood Pressure, '13/ % 32.9% 30.2% 28.3% N/A Worse NYS Expanded Behavioral Risk Factor Surveillance System NYS Expanded Behavioral Risk Factor Surveillance System USDA Economic Research Service Fitness Facilities Data NYS Expanded Behavioral Risk Factor Surveillance System NYS Expanded Behavioral Risk Factor Surveillance System 12. Rate of Cardiovascular Disease Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 13. Rate of Cardiovascular Premature Deaths ( Ages 35-64) per 100,000 Population Ages 35-64, ' N/A Meets/Better Community Health Indicator Reports 14. Rate of Pretransport Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 15. Rate of Cardiovascular Hospitalizations per 10,000 Population, ' ,187 1,262 1, N/A Meets/Better Community Health Indicator Reports 16. Rate of Diseases of the Heart Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 17. Rate of Diseases of the Heart Premature Deaths ( Ages 35-64) per 100,000 Population Ages 35-64, ' N/A Meets/Better Community Health Indicator Reports ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Source 109 P a g e

111 18. Rate of Disease of the Heart Pretransport Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 19. Rate of Disease of the Heart Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 20. Rate of Coronary Heart Diseases Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 21. Rate of Coronary Heart Diseases Premature Deaths (Ages 35-64) per 100,000 Population Ages 35-64, ' N/A Meets/Better Community Health Indicator Reports 22. Rate of Coronary Heart Disease Pretransport Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 23. Rate of Coronary Heart Disease Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 24. Rate of Congestive Heart Failure Deaths per 100,000, ' N/A Meets/Better Community Health Indicator Reports 25. Rate of Congestive Heart Failure Premature Deaths (Ages 35-64) per 100,000 Population Ages 35-64, ' N/A Less than 10 Community Health Indicator Reports 26. Rate of Congestive Heart Failure Pretransport Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 27. Rate of Congestive Heart Failure Hospitalizations per 10,000 Population, ' N/A Worse Community Health Indicator Reports 28. Rate of Cerebrovascular (Stroke) Deaths per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 29. Rate of Cerebrovascular (Stroke) Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 30. Rate of Hypertension Hospitalizations (Ages 18 Plus) per 10,000 Population Ages 18 Plus, ' N/A Meets/Better Community Health Indicator Reports 31. Rate of Diabetes Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 32. Rate of Diabetes Hospitalizations (Primary Diagnosis) per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 33. Rate of Diabetes Hospitalizations (Any Diagnosis) per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports Focus Area: Reduce Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke Exposure Prevention Agenda Indicators 1. Percentage of Adults Ages 18 Plus Who Smoke '13/ % 22.5% 17.3% 15.6% 12.3% Worse Community Health Indicator Reports Other Indicators 1. Rate of Chronic Lower Respiratory Disease Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 2. Rate of Chronic Lower Respiratory Disease Hospitalizations per 10,000, Population ' N/A Worse Community Health Indicator Reports 3. Rate of Asthma Deaths per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 4. Rate of Asthma Hospitalizations per 10,000 Population, ' N/A Worse Community Health Indicator Reports 110 P a g e

112 5. Rate of Asthma Hospitalizations, Ages 25-44, per 10,000 Population Ages 25-44, ' N/A Meets/Better Community Health Indicator Reports 6. Rate of Asthma Hospitalizations, Ages 45-64, per 10,000 Population Ages 45-64, ' N/A Worse Community Health Indicator Reports 7. Rate of Asthma Hospitalizations, Ages 65 Plus, per 10,000 Population Ages 65 Plus, ' N/A Worse Community Health Indicator Reports 8. Percentage of Adults with Asthma, '13/ % 13.4% 10.2% 10.1% N/A Worse Factor Surveillance System 9. Rate of Lung and Bronchus Cancer Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 10. Rate of Lung and Bronchus Cases per 100,000 Population, ' N/A Worse Community Health Indicator Reports 11. Number of Registered Tobacco Vendors per 100,000 Population, ' N/A Worse 12. Percentage of Vendors with Sales to Minors Violations, ' % 3.2% 5.5% 8.9% N/A Worse 13. Percentage of Vendors with Complaints, ' % 0.0% 0.0% 0.9% N/A Worse Focus Area: Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings NYS Department of Health Tobacco Enforcement Program Annual Report NYS Department of Health Tobacco Enforcement Program Annual Report NYS Department of Health Tobacco Enforcement Program Annual Report Prevention Agenda Indicators 1. Percentage of Adults Ages Who Received Colorectal Screenings Based on Recent Guidelines, ' % 68.3% 70.0% 69.3% 80.0% Worse Prevention Agenda Dashboard 2. Rate of Asthma ED Visits per 10,000 Population, Meets/Better Prevention Agenda Dashboard 3. Rate of Asthma ED Visits Ages 0-4, per 10,000 Population Ages, 0-4, Meets/Better Prevention Agenda Dashboard 4. Rate of Short-term Diabetes Hospitalizations for Ages 6-17 per 10,000 Population, Ages 6-17, '12-14 N/A Less than 10 Prevention Agenda Dashboard 5. Rate of Short-term Diabetes Hospitalizations for Ages 18 Plus per 10,000 Population, Ages 18 Plus, Worse Prevention Agenda Dashboard 6. Rate of Heart Attack Hospitalizations per 10,000 Population, Worse Prevention Agenda Dashboard Other Indicators 1. Rate of Asthma ED Visits for Ages per 10,000 Population Ages 18-64, ' N/A Meets/Better Asthma Summary Report 2. Rate of Asthma ED Visits for Ages 65 Plus per 10,000 Population Ages 65 Plus, ' N/A Worse Asthma Summary Report 3. Rate of All Cancer Cases per 100,000 Population, ' N/A Worse Community Health Indicator Reports 4. Rate of all Cancer Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 5. Rate of Female Breast Cancer Cases per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 6. Rate of Female Late Stage Breast Cancer Cases per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 7. Rate of Female Breast Cancer Deaths per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 8. Percentage of Women Aged years Receiving Breast Cancer Screening Based on Recent Guidelines '13/ % 79.7% 80.5% 80.9% N/A Worse Prevention Agenda Dashboard 9. Rate of Cervix and Uteric Cancer Cases per 100,000 Female Population, ' N/A Less than 10 Community Health Indicator Reports 10. Rate of Cervix and Uteric Cancer Deaths per 100,000 Female Population, '10-12 N/A N/A Less than 10 Community Health Indicator Reports 111 P a g e

113 11. Percentage of Women Aged Years with Annual Household Income of Less than $25,000 Receiving Cervical Cancer Screening Based on Recent Guidelines, 13/ % 82.8% 79.5% 80.6% N/A Worse NYS Expanded Behavioral Risk Factor Surveillance System 12. Rate of Ovarian Cancer Cases per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 13. Rate of Ovarian Cancer Deaths per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 14. Rate of Colon and Rectum Cancer Cases per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 15. Rate of Colon and Rectum Cancer Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 16. Percentage of Adults Aged years receiving colorectal cancer screening based on recent guidelines 75.8% 69.9% 70.0% 69.3% N/A Meets/Better NYS Expanded Behavioral Risk Factor Surveillance System 17. Rate of Prostate Cancer Deaths per 100,000 Male Population, ' N/A Meets/Better Community Health Indicator Reports 18. Rate of Prostate Cancer Cases per 100,000 Male Population, ' N/A Meets/Better Community Health Indicator Reports 19. Rate of Prostate Cancer Late Stage Cancer Cases per 100,000 Male Population, ' N/A Meets/Better Community Health Indicator Reports 20. Rate of Melanoma Cancer Deaths per 100,000 Population, '10 - ' N/A Less than 10 Community Health Indicator Reports 21. Percentage of Medicaid Enrollees with at Least One Preventive Dental Visit within the Year, ' % 20.2% 25.1% 26.6% N/A Worse Community Health Indicator Reports 22. Percentage of Age Adjusted Adults with a Dental Visit Within the Last 12 Months, '13/ % 66.2% 71.3% 69.8% N/A Meets/Better NYS Expanded Behavioral Risk Factor Surveillance System 23. Oral Cavity and Pharnyx Cancer Deaths per 100,000 Population, '10-12 N/A N/A Less than 10 Community Health Indicator Reports 24. Oral Cavity and Pharnyx Cancer Cases per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 112 P a g e

114 Focus Area: Maternal and Infant Health Number Per Year (If Available) O ne Two Three Promote Healthy Women, Infants, and Children Average Rate, Ratio or Percentage for the Listed Years Comparison to Benchmark Prevention Agenda Indicators 1. Percentage Preterm Births < 37 Weeks of Total Births Where Gestation Period is Known, % 9.5% 10.8% 10.8% 10.2% Meets/Better Prevention Agenda Dashboard 2. Ratio of Preterm Births (< 37 wks) Black/NH to White/NH, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 3. Ratio of Preterm Births (< 37 wks) Hisp/Latino to White/NH, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 4. Ratio of Preterm Births (< 37 wks) Medicaid to Non-Medicaid, ' N/A Worse Prevention Agenda Dashboard 5. Rate of Maternal Mortality per 100,000 Births, 2014 N/A N/A Less than 10 Prevention Agenda Dashboard 6. Percentage of Live Birth Infants Exclusively Breastfed in Delivery Hospital, % 70.4% 51.1% 43.1% 48.1% Meets/Better Prevention Agenda Dashboard 7. Ratio of Infants Exclusively Breastfed in Delivery Hospital Black, non-hispanic to White, non-hispanic, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 8. Ratio of Infants Exclusively Breastfed in Delivery Hospital Hispanic/Latino to White, non-hispanic, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard 9. Ratio of Infants Exclusively Breastfed in Delivery Hospital Medicaid to Non-Medicaid Births, ' N/A Meets/Better Prevention Agenda Dashboard Other Indicators 1. Percentage Perterm Births < 32 weeks of Total Births Where Gestation Period is Known, ' % 2.0% 1.8% 1.8% N/A Meets/Better Community Health Indicator Reports 2. Percentage Preterm Births 32 to < 37 Weeks of Total Births Where Gestation Period is Known, ' % 8.7% 9.1% 9.1% N/A Meets/Better Community Health Indicator Reports 3. Percentage of Total Births with Weights Less Than 1,500 grams, ' % 1.5% 1.4% 1.4% N/A Meets/Better Community Health Indicator Reports 4. Percentage of Singleton Births with Weights Less Than 1,500 grams, ' % 1.0% 1.0% 1.1% N/A Worse Community Health Indicator Reports 5. Percentage of Total Births with Weights Less Than 2,500 grams, ' % 7.7% 7.6% 8.0% N/A Worse Community Health Indicator Reports 6. Percentage of Singleton Births with Weights Less Than 2,500 grams, ' % 5.6% 5.6% 6.0% N/A Meets/Better Community Health Indicator Reports 7. Percentage of Total Births for Black, Non-Hispanic, with Weights Less than 2,500 Grams, '11-13 N/A N/A 12.9% 12.5% N/A Less than Percentage of Total Births for Hispanic/Latino, with Weights Less than 2,500 Grams, ' % N/A 7.2% 7.6% N/A Less than 10 State and County Indicators for Tracking Public Health Priority Areas State and County Indicators for Tracking Public Health Priority Areas 9. Infant Mortality Rate per 1,000 Live Births, ' N/A Worse Community Health Indicator Reports 10. Rate of Deaths (28 Weeks Gestation to Seven Days) per 1,000 Live Births and Perinatal Deaths, ' N/A Worse Community Health Indicator Reports ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Source 113 P a g e

115 11. Percentage Early Prenatal Care of Total Births Where Prenatal Care Status is Known, ' % 73.1% 75.4% 73.1% N/A Meets/Better Community Health Indicator Reports 12. Percentage Early Prenatal Care for Black, Non-Hispanic, '11-13 N/A N/A 64.7% 63.3% N/A Less than 10 State and County Indicators for Tracking Public Health Priority Areas State and County Indicators for Tracking Public Health Priority Areas 13. Percentage Early Prenatal Care for Hispanic/Latino, ' % N/A 68.2% 67.2% N/A Meets/Better 14. Percentage APGAR Scores of Less Than Five at Five Minute Mark of Births Where APGAR Score is Known, ' % 1.1% 0.7% 0.6% N/A Worse Community Health Indicator Reports 15. Rate of Newborn Drug Related Hospitalizations per 10,000 Births, ' N/A Meets/Better Community Health Indicator Reports 16. Percentage WIC Women Breastfed at Six months, ' % 17.1% 27.8% 38.2% N/A Worse Community Health Indicator Reports 17. Percentage Infants Receiving Any Breast Milk in Delivery Hospital, ' % 74.3% 78.0% 83.1% N/A Meets/Better Community Health Indicator Reports Focus Area: Preconception and Reproductive Health Prevention Agenda Indicators 1. Percent of Births within 24 months of Previous Pregnancy, % 23.0% 21.1% 18.9% 17.0% Worse Prevention Agenda Dashboard 2. Rate of Pregnancies Ages year per 1,000 Females Ages 15-17, Meets/Better Prevention Agenda Dashboard 3. Ratio of Pregnancy Rates for Ages Black, non-hispanic to White, non-hispanic, ' N/A Less than 10 Prevention Agenda Dashboard 4. Ratio of Pregnancy Rates for Ages Hispanic/Latino to White, non-hispanic, ' N/A Less than 10 Prevention Agenda Dashboard 5. Percent of Unintended Births to Total Births, % 30.3% 26.5% 24.5% 23.8% Worse Prevention Agenda Dashboard 6. Ratio of Unintended Births Black, non-hispanic to White, non- Hispanic, 2014 N/A N/A 2.14% Less than 10 Prevention Agenda Dashboard 7. Ratio of Unintended Births Hispanic/Latino to White, non- Hispanic, 2014 N/A N/A 1.48% Less than 10 Prevention Agenda Dashboard 8. Ratio of Unintended Births Medicaid to Non-Medicaid, ' N/A Meets/Better Prevention Agenda Dashboard 9. Percentage of Women Ages with Health Insurance, % N/A N/A 89.7% 100.0% Meets/Better Prevention Agenda Dashboard Other Indicators 1. Rate of Total Births per 1,000 Females Ages 15-44, ' N/A Meets/Better Community Health Indicator Reports 2. Percent Multiple Births of Total Births, ' % 4.2% 4.1% 3.9% N/A Worse Community Health Indicator Reports 3. Percent C-Sections to Total Births, ' % 36.5% 35.6% 34.1% N/A Worse Community Health Indicator Reports 4. Rate of Total Pregnancies per 1,000 Females Ages 15-44, ' N/A Meets/Better Community Health Indicator Reports 5. Rate of Births Ages per 1,000 Females Ages 10-14, ' N/A Less than 10 Community Health Indicator Reports 114 P a g e

116 6. Rate of Pregnancies Ages per 1,000 Females Ages 10-14, ' N/A Less than 10 Community Health Indicator Reports 7. Rate of Births Ages per 1,000 Females Ages 15-17, ' N/A Meets/Better Community Health Indicator Reports 8. Rate of Births Ages per 1,000 Females Ages 15-19, ' N/A Worse Community Health Indicator Reports 9. Rate of Pregnancies Ages per 1,000 Females Ages 5-19, ' N/A Meets/Better Community Health Indicator Reports 10. Rate of Births Ages per 1,000 Females Ages 18-19, ' N/A Meets/Better Community Health Indicator Reports 11. Rate of Pregnancies Ages per 1,000 Females Ages 18-19, ' N/A Meets/Better Community Health Indicator Reports 12. Percent Total Births to Women Ages 35 Plus, ' % 11.2% 18.9% 20.5% N/A Meets/Better Community Health Indicator Reports 13. Rate of Abortions Ages per 1000 Live Births, Mothers Ages 15-19, ' ,050.3 N/A Meets/Better Community Health Indicator Reports 14. Rate of Abortions All Ages per 1000 Live Births to All Mothers, ' Percentage of WIC Women Pre-pregnancy Underweight, ' N/A Meets/Better Community Health Indicator Reports % 4.9% 4.1% 4.7% N/A Worse Community Health Indicator Reports 16. Percentage of WIC Women Pre-pregnancy Overweight but not Obese, ' % 22.3% 26.3% 26.6% N/A Meets/Better Community Health Indicator Reports 17. Percentage of WIC Women Pre-pregnancy Obese, ' % 33.3% 28.0% 24.2% N/A Worse Community Health Indicator Reports 18. Percentage of WIC Women with Gestational Weight Gain Greater than Ideal, ' % 52.4% 47.1% 41.7% N/A Worse Community Health Indicator Reports 19. Percentage of WIC Women with Gestational Diabetes, ' % 7.2% 5.7% 5.5% N/A Worse Community Health Indicator Reports 20. Percentage of WIC Women with Gestational Hypertension, ' % 12.9% 9.1% 7.1% N/A Worse Community Health Indicator Reports Focus Area: Child Health Prevention Agenda Indicators 1. Percentage of Children Ages 0-15 Months with Government Insurance with Recommended Well Visits, % 91.1% 84.3% 80.8% 91.3% Worse Prevention Agenda Dashboard 2. Percentage of Children Ages 3-6 Years with Government Insurance with Recommended Well Visits, % 84.6% 81.4% 84.2% 91.3% Worse Prevention Agenda Dashboard 3. Percentage of Children Ages Years with Government Insurance with Recommended Well Visits, % 64.7% 62.0% 64.9% 67.1% Meets/Better Prevention Agenda Dashboard 4. Percentage of Children Ages 0-19 with Health Insurance, % N/A N/A 96.6% 100.0% Worse Prevention Agenda Dashboard Other Indicators 1. Rate of Children Deaths Ages 1-4 per 100,000 Population Children Ages 1-4, ' N/A Less than 10 Community Health Indicator Reports 2. Rate of Children Deaths Ages 5-9 per 100,000 Population Children Ages 1-4, ' N/A Less than 10 Community Health Indicator Reports 3. Rate of Children Deaths Ages per 100,000 Population Children ages 10-14, ' N/A Less than 10 Community Health Indicator Reports 115 P a g e

117 4. Rate of Children Deaths Ages 5-14 per 100,000 Population Children Ages 5-14, ' N/A Less than 10 Community Health Indicator Reports 5. Rate of Children Deaths Ages per 100,000 Population Children Ages 15-19, ' N/A Less than 10 Community Health Indicator Reports 6. Rate of Children Deaths Ages 1-19 per 100,000 Population Children Ages 1-19, ' N/A Meets/Better Community Health Indicator Reports 7. Rate of Asthma Hospitalizations Children Ages 0-4 per 10,000 Population Children Ages 0-4, ' N/A Less than 10 Community Health Indicator Reports 8. Rate of Asthma Hospitalizations Children Ages 5-14 per 10,000 Population Children Ages 5-14, ' N/A Meets/Better Community Health Indicator Reports 9. Rate of Asthma Hospitalizations Children Ages 0-17 per 10,000 Population Children Ages 0-17, ' N/A Meets/Better Community Health Indicator Reports 10. Rate of Gastroenteristis Hospitalizations Children Ages 0-4 per 10,000 Population Children Ages 0-4, ' N/A N/A Less than 10 Community Health Indicator Reports 11. Rate of Otitis Media Hospitalizations Children Ages 0-4 per 10,000 Population Children Ages 0-4, ' N/A N/A Less than 10 Community Health Indicator Reports 12. Rate of Pneumonia Hospitalizations Children Ages 0-4 per 10,000 Population Children Ages 0-4, ' N/A Meets/Better Community Health Indicator Reports 13. Rate of ED Asthma Visits Children Ages 0-4 per 10,000 Populaiton Children Ages 0-4, ' Meets/Better Prevention Agenda Dashboard 14. Percentage of Children Screened for Lead by Age 9 months 0.1% 1.2% 4.2% 3.5% N/A Less than 10 Community Health Indicator Reports 15. Percentage of Children Screened for Lead by Age 18 months 2.6% 25.0% 53.5% 65.0% N/A Worse Community Health Indicator Reports 16. Percentage of Children Screened for Lead by Age 36 months (at least two screenings) 2.0% 15.7% 42.1% 55.1% N/A Meets/Better Community Health Indicator Reports 17. Rate of Children Ages < 6 with Confirmed Blood Lead Levels >= 10 mg/dl Cases Per 1,000 Children Tested, ' N/A Meets/Better Community Health Indicator Reports 18. Rate of Unintentional Injury Hospitalizations for Children Under Age 10 per 10,000 Population Children Under Age 10, ' N/A Meets/Better Community Health Indicator Reports 19. Rate of Unintentional Injury Hospitalizations for Children Ages per 10,000 Population Children Ages 10-14, ' N/A Meets/Better Community Health Indicator Reports 20. Rate of Unintentional Injury Hospitalizations for Children/Young Adults Ages per 10,000 Population Ages 15-24, ' N/A Meets/Better Community Health Indicator Reports 21. Rate of Asthma ED Visits for Children Ages 0-17 per 10,000 Population Children Ages 0-17, ' N/A Meets/Better Asthma Summary Report 22. Percentage of Medicaid Enrollees Ages 2-20 with at Least One Dental Visit, % 41.6% N/A 45.0% N/A Meets/Better Community Health Indicator Reports 23 Percentage of 3rd Graders with Dental Caries, ' % N/A N/A N/A N/A N/A Community Health Indicator Reports 24. Percentage of 3rd Graders with Dental Sealants, ' % N/A N/A N/A N/A N/A Community Health Indicator Reports 25. Percentage of 3rd Graders with Dental Insurance, ' % N/A N/A N/A N/A N/A Community Health Indicator Reports 26. Percentage of 3rd Graders with at Least One Dental Visit, ' % N/A N/A N/A N/A N/A Community Health Indicator Reports 27. Percentage of 3rd Graders Taking Fluoride Tablets Regularly, ' % N/A N/A N/A N/A N/A Community Health Indicator Reports 28. Rate of Caries Outpatient Visits for Children Ages 3-5 per 10,000 Population Children Ages 3-5, ' N/A Meets/Better Community Health Indicator Reports 29. Percentage of WIC Children Ages 2-4 Viewing Two Hours TV or Less Per Day, ' % 84.3% 81.1% 79.9% N/A Worse Community Health Indicator Reports 116 P a g e

118 Prevent HIV, STDs, Vaccine Preventable Diseases and Health Care Associated Infections Focus Area: Human Immunodeficiency Virus (HIV) O ne Two Three Prevention Agenda Indicators 1. Rate of Newly Diagnosed HIV Cases per 100,000 Population, ' Less than 10 Prevention Agenda Dashboard 2. Ratio of Newly Diagnosed HIV Cases Black, non-hispanic versus White, non-hispanic, '12-14 N/A N/A Less than 10 Prevention Agenda Dashboard Other Indicators Number Per Year (If Available) Average Rate, Ratio or Percentage for the Listed Years 1. Rate of AIDS Cases per 100,000 Population, '12-14 N/A N/A N/A Less than 10 Community Health Indicator Reports ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Comparison to Benchmark Source 2. Rate of AIDS Deaths per 100,000 Adjusted Population, ' N/A Less than 10 Community Health Indicator Reports Focus Area: Sexually Transmitted Disease (STDs) Prevention Agenda Indicators 1. Rate of Primary and Secondary Syphilis for Males per 100,000 Male Population, Less than 10 Prevention Agenda Dashboard 2. Rate of Primary and Secondary Syphilis for Females per 100,000 Female Population, Less than 10 Prevention Agenda Dashboard 3. Rate of Gonorrhea Cases for Females Ages per 100,000 Female Population Ages 15-44, Meets/Better Prevention Agenda Dashboard 4. Rate of Gonorrhea Cases for Males Ages per 100,000 Male Population Ages 15-44, Meets/Better Prevention Agenda Dashboard 5. Rate of Chlamydia for Females Ages per 100,000 Female Population Ages 15-44, Meets/Better Prevention Agenda Dashboard Other Indicators 1. Rate of Early Syphilis Cases per 100,000 Population, ' N/A Worse Community Health Indicator Reports 2. Rate of Gonorrhea Cases per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 3. Rate of Gonorrhea Ages Cases per 100,000 Population Ages 15-19, ' N/A Less than 10 Community Health Indicator Reports 4. Rate of Chlamydia Cases All Males per 100,000 Male Population, ' N/A Meets/Better Community Health Indicator Reports 5. Rate of Chlamydia Cases Males Ages Cases per 100,000 Male Population Ages 15-19, ' ,029.1 N/A Meets/Better Community Health Indicator Reports 117 P a g e

119 6. Rate of Chlamydia Cases Males Ages per 100,000 Male Population Ages 20-24, ' , ,492.7 N/A Meets/Better Community Health Indicator Reports 7. Rate of Chlamydia Cases All Females per 100,000 Female Population, ' N/A Meets/Better Community Health Indicator Reports 8. Rate of Chlamydia Cases Females Ages per 100,000 Female Population Ages 15-19, ' , , , ,595.5 N/A Meets/Better Community Health Indicator Reports 9. Rate of Chlamydia Cases Females Ages per 100,000 Female Population Ages 20-24, ' , , , ,432.2 N/A Meets/Better Community Health Indicator Reports 10. Rate of PID Hospitalizations Females Ages per 10,000 Female Population Ages 15-44, ' N/A Less than 10 Community Health Indicator Reports Focus Area: Vaccine Preventable Disease Prevention Agenda Indicators 1. Percent of Children Ages months with 4:3:1:3:3:1:4, % 70.0% 59.4% 70.7% 80.0% Worse Prevention Agenda Dashboard 2. Percent females with 3 dose HPV vaccine, % 34.0% 30.3% 40.1% 50.0% Worse Prevention Agenda Dashboard 3. Percent of Adults Ages 65 Plus With Flu Shots Within Last Year, '13/ % 74.4% 77.1% 72.1% 70.0% Meets/Better Other Indicators NYS Expanded Behavioral Risk Factor Surveillance System 1. Rate of Pertussis Cases per 100,000 Population, ' N/A Worse Community Health Indicator Reports 2. Rate of Pneumonia/flu Hospitalizations Ages 65 Plus per 100,000 Population Age 65 Plus, ' N/A Worse Community Health Indicator Reports 3. Percent of Adults Ages 65 Plus Ever Received a Pneumonia Shot, '13/ % 73.7% 70.7% 65.1% N/A Meets/Better NYS Expanded Behavioral Risk Factor Surveillance System 4. Rate of Mumps Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 5. Rate of Meningococcal Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 6. Rate of H Influenza Cases per 100,000 Population, ' Average Rate, N/A Comparison Less than 10 Community Health Indicator Reports Focus Area: Healthcare Associated Infections Number Per Year Ratio or Comparison Regions/Data to Benchmark Prevention Agenda Indicators 1. Rate of Hospital Onset CDIs per 10,000 Patient Days, Meets/Better 2. Rate of Community Onset, Healthcare Facility Associated CDIs per 10,000 Patient Days, Worse NYS Department of Health Hospital Report on Hospital Acquired Infections NYS Department of Health Hospital Report on Hospital Acquired Infections 118 P a g e

120 Promote Mental Health and Prevent Substance Abuse Focus Area: Prevent Substance Abuse and O ther Mental, Emtional, and Behavorial Disorders Number Per Year (If Available) O ne Two Three Average Rate, Ratio or Percentage for the Listed Years ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Comparison to Benchmark Source Prevention Agenda Indicators 1. Percent of Adults Binge Drinking within the Last Month, '13/ % N/A 17.4% 17.8% 18.4% Worse Prevention Agenda Dashboard 2. Percent of Adults with Poor Mental Health (14 or More Days) in the Last Month, ' % N/A 11.8% 11.2% 10.1% Meets/Better Prevention Agenda Dashboard 3. Rate of Age Adjusted Suicides per 100,000 Adjusted Population, ' N/A Worse Prevention Agenda Dashboard Other Indicators 1 Rate of Suicides for Ages per 100,000 Population Ages 15-19, ' N/A Less than 10 Community Health Indicator Reports 2. Rate of Self-inflicted Hospitalizations 10,000 Population, ' N/A Worse Community Health Indicator Reports 3. Rate of Self-inflicted Hospitalizations for Ages per 10,000 Population Ages 15-19, ' N/A Worse Community Health Indicator Reports 4. Rate of Cirrhosis Deaths per 100,000 Population, ' N/A Worse Community Health Indicator Reports 5. Rate of Cirrhosis Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 7.Alcohol-Related Crashes, N/A 43.4 N/A Worse NYS Department of Motor Vehicles Traffic Safety Data 8. Rate of Alcohol-Related Injuries and Deaths per 100,000 Population, ' N/A Meets/Better NYS Department of Motor Vehicles Data 9. Rate of Drug-Related Hospitalizations per 10,000 Population, ' N/A Meets/Better Community Health Indicator Reports 10. Rate of People Served in Mental Health Outpatient Settings Ages 17 and under per 100,000 Population Ages 17 and under, , , N/A Worse 11. Rate of People Served in Mental Health Outpatient Settings Ages per 100,000 Population Ages 18-64, N/A Worse 12. Rate of People Served in Mental Health Outpatient Settings Ages 65+ per 100,000 Population Ages 65+, N/A Meets/Better 13. Rate of People Served in ED for Mental Health Ages17 and under per 100,000 Population Ages under 17 and under, N/A N/A Less than Rate of People Served in ED for Mental Health Ages per 100,000 Population Ages 18-64, N/A Less than Rate of People Served in ED for Mental Health Ages 65+ per 100,000 Population Ages 65+, N/A N/A Less than 10 NYS Office of Mental Health, PCS Summary Report NYS Office of Mental Health, PCS Summary Report NYS Office of Mental Health, PCS Summary Report NYS Office of Mental Health, PCS Summary Report NYS Office of Mental Health, PCS Summary Report NYS Office of Mental Health, PCS Summary Report 119 P a g e

121 Number Per Year (If Available) O ne Two Three Other Non-Prevention Agenda Indicators Average Rate, Ratio or Percentage for the Listed Years Comparison to Benchmark 1. Rate of Hepatitis A Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 2. Rate of Acute Hepatitis B Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 3. Rate of TB Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 4. Rate of e. Coli 157 Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 5. Rate of Salmonella Cases per 100,000 Population, ' N/A Worse Community Health Indicator Reports 6. Rate of Shigella Cases per 100,000 Population, ' N/A Less than 10 Community Health Indicator Reports 7. Rate of Lyme Disease Cases per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports 8. Rate of Confirmed Rabies Cases per 100,000 Population, ' N/A Meets/Better Community Health Indicator Reports ARHN Comparison Regions/Data Upstate NY New York State 2017 Prevention Agenda Benchmark Source 120 P a g e

122 Appendix K: Secondary Data Analysis Summary and Findings In order to determine top community needs, a set of almost 500 indicators were analyzed through a two-step approach based on the following criteria: Is the indicator below both the NY State and US value? AND Was the gauge indicating performance below the 25 th percentile? OR Did it come up as a common theme by focus groups/key informants? OR Does it affect a significant number of people? OR Are there disparities associated with the need? To have been identified as a significant health need for Clinton County, the answer to the first question, as well as at least one of the additional three questions had to be yes. The following indicators were included in this review: Adults Unable to Afford to See a Doctor Adults who have had a Routine Checkup Adults with a Usual Source of Health Care Adults with Health Insurance Children with Health Insurance Non-Physician Primary Care Provider Rate Preventable Hospital Stays Primary Care Provider Rate Age-Adjusted Death Rate due to Breast Cancer Age-Adjusted Death Rate due to Colorectal Cancer Age-Adjusted Death Rate due to Lung Cancer Age-Adjusted Death Rate due to Prostate Cancer Breast Cancer Incidence Rate Cancer: Medicare Population Cervical Cancer Incidence Rate Colon Cancer Screening Colorectal Cancer Incidence Rate Lung and Bronchus Cancer Incidence Rate Oral Cavity and Pharynx Cancer Incidence Rate Prostate Cancer Incidence Rate Adults with Diabetes Age-Adjusted Death Rate due to Diabetes Diabetes: Medicare Population Diabetic Screening: Medicare Population Adults with Disability Adult Fruit and Vegetable Consumption Adults who are Obese Adults who are Overweight or Obese Adults who are Sedentary 121 P a g e

123 Child Food Insecurity Rate Elementary School Students who are Overweight or Obese Food Insecurity Rate Low-Income Preschool Obesity Middle and High School Students who are Overweight or Obese Teen Birth Rate: Teen Pregnancy Rate Age-Adjusted Death Rate due to Cerebrovascular Disease (Stroke) Age-Adjusted Death Rate due to Coronary Heart Disease Atrial Fibrillation: Medicare Population Heart Failure: Medicare Population High Blood Pressure Prevalence High Cholesterol Prevalence Hyperlipidemia: Medicare Population Hypertension: Medicare Population Ischemic Heart Disease: Medicare Population Stroke: Medicare Population Adults 65+ with Influenza Vaccination Adults 65+ with Pneumonia Vaccination Age-Adjusted Death Rate due to Influenza and Pneumonia Chlamydia Incidence Rate Gonorrhea Incidence Rate Lyme Disease Incidence Rate Babies with Low Birth Weight Infant Mortality Rate Mothers who Received Late or No Prenatal Care Preterm Births Age-Adjusted Death Rate due to Suicide Depression: Medicare Population Frequent Mental Distress Mental Health Provider Rate Poor Mental Health: 14+ Days Alzheimer s Disease or Dementia: Medicare Population Adults who Visited a Dentist Adults with No Tooth Extractions Dentist Rate Age-Adjusted Death Rate due to Kidney Disease Chronic Kidney Disease: Medicare Population Osteoporosis: Medicare Population Rheumatoid Arthritis or Osteoarthritis: Medicare Population Age-Adjusted Death Rate due to Unintentional Injuries Adults with Asthma Age-Adjusted Death Rate due to Chronic Lower Respiratory Diseases Asthma: Medicare Population COPD: Medicare Population Adults who Binge Drink 122 P a g e

124 Adults who Smoke Death Rate due to Drug Poisoning Emergency Department Admissions Rate due to Opioids Hospital Admission Rate due to Opioids Frequent Physical Distress Insufficient Sleep Life Expectancy for Females Life Expectancy for Males Poor Physical Health: 14+ Days Self-Reported General Health Assessment: Poor Unemployed Workers in Civilian Labor Force Households with Cash Public Assistance Income Students Eligible for the Free Lunch Program Homeowner Vacancy Rate Homeownership Renters Spending 30% or More of Household Income on Rent Severe Housing Problems Median Household Income Per Capita Income Children Living Below Poverty Level Families Living Below Poverty Level People 65+ Living Below Poverty Level People Living 200% Above Poverty Level People Living Below Poverty Level People 25+ with a Bachelor s of Higher People 25+ with a High School Degree or Higher Student-to-Teacher Ratio High School Graduation Recognized Carcinogens Released into Air Access to Exercise Opportunities Children with Low Access to a Grocery Store Farmers Market Density Fast Food Restaurant Density Food Environment Index Grocery Store Density Households with No Car and Low Access to a Grocery Store Liquor Store Density Low-Income and Low Access to a Grocery Store People 65+ with Low Access to a Grocery Store Recreation and Fitness Facilities Houses Built Prior to 1950 PBT Released Drinking Water Violations Violent Crime Rate Age-Adjusted Death Rate due to Motor Vehicle Traffic Collisions Alcohol-Impaired Driving Deaths 123 P a g e

125 Young Adults Driving While Intoxicated Single-Parent Households People 65+ Living Alone Mean Travel Time to Work Solo Drivers with a Long Commute Workers Commuting by Public Transportation Workers who Drive Alone to Work Households without a Vehicle With this logic, 23 of over 130 HealthyADK indicators and over 400 indicators from the Center for Health Workforce Studies data were identified as top community needs in each of the priority areas. Of the 23 that were selected, 70% of them are connected to one or both of Clinton County s chosen priority areas. The following indicator cards represent the 23 metrics For ease of interpretation and analysis, indicator data is visually represented as a red-yellow-green gauge, a trend arrow, or a bar graph. Each shows how the community is faring against a distribution of counties in New York State and counties across the United States, as well as a comparison to the NY value and US value. It also includes a prior value if the indicator is something that has been measured in the past. An indicator represented by a needle pointing to the green portion represents where the Clinton County value is in the top 50 th percentile. The yellow portion signifies a county s value being between the 50 th and 25 th percentile, and the red in the lowest percentile (below 25 th ) as compared to all NY or US counties. 124 P a g e

126 Clinton County Community Health Dashboard Key Metrics (from healthyadk.org) 125 P a g e

127 126 P a g e

128 127 P a g e

129 128 P a g e

130 Appendix L: Clinton County Community Resources & Assets A comprehensive community health assessment will evaluate problems and service gaps that exist within the community while also identifying assets and resources available to address identified challenges. This approach ensures attention is given to both community strengths and weaknesses throughout the assessment process. Community health assets include local services and programs, educational institutions, health care providers, businesses and other opportunities for health such as trails, parks and recreational services. Clinton County is fortunate to have developed a strong network of partners representing many different community sectors and offering a variety of resources and capacities for achieving its shared vision for community health. The following represents a collection of community assets identified through key informant dialogues, review of local coalitions/ partnership members and key word internet searches completed in September 2016 and organized by common categories used for asset mapping. All assets listed are potential resources for the implementation of Clinton County s Community Health Improvement Plan. Access to Health Services University of Vermont Health Network, CVPH Health Care of Rochester (HCR) Private Primary Care Providers Mental Health, Addiction, Substance Abuse Alliance for Positive Health Champlain Valley Family Center Exercise, Nutrition & Weight CVPH Parc Clinton County Youth Bureau Town of Plattsburgh Recreation Department Family Planning & Services CCHD Improved Pregnancy Outcome Program Child Care Coordinating Council of the North Country, Inc. Planned Parenthood Food Relief Services JCEO Food Shelf St. Alexander s/st. Joseph s Soup Kitchen St. Peters Church Trinity Episcopal Church USDA Summer Feeding Sites Built Environment/ Environment State Parks: Cumberland Bay State Park Macomb Park Recreation Parks & Trails: Town of Plattsburgh: Cadyville Recreation Park Cliff Haven Park East Morrisonville Park May Currier Park Clinton County Community Assets Adirondack Medical Home Initiative/CVHN Plattsburgh VA Clinic Behavioral Health Services North, Inc. Clinton County Mental Health and Addiction Svcs. City of Plattsburgh Recreation Department Cornell Cooperative Extension YMCA CCHD WIC Program Healthy Families of the North Country Plattsburgh Interfaith Food Shelf St. Augustine s Soup Kitchen The Salvation Army Community and Worship Ctr. United Methodist Church Food Shelf Point Au Roche State Park Cadyville Riverfront Park Cumberland Head Park Guy Cedar Park South Plattsburgh Park 129 P a g e

131 Treadwells Mills Park Wallace Hill Park West Plattsburgh Park City of Plattsburgh: Belmont Park Broadway Park Centennial Park Champlain Park Fort Brown Park Hamilton Park Jay Park and Terry Gordon Bike Path Lakeview Park and Soldier Point MacDonough Park Melissa Penfield Park Peter Blumette Park Plattsburgh City Recreation Center Riverview Park South Acres Park South Platt St. Park Tremblay Park Trinity Park U.S. Oval Wilcox Dock and Healthy Lung Trail Other Parks/Trails: Beekmantown Town Park and Pavillion Feinberg Park, Altona Gazebo Park, Peru Heritage Trail, Plattsburgh Heyworth/Mason Park, Peru Lafountain Park, Dannemora Little Ausable River Trail, Peru Lyon Mountain Firetower Trail Mooers Rec Park Picketts Corners Park, Saranac Rouses Point Civic Center Older Adults & Aging Clinton County Office for the Aging Eastern Adirondack Health Care Network Nutrition Program for the Elderly Senior Citizens Council of Clinton County Housing Champlain Valley Habitat for humanity, Inc. Clinton County Department of Social Services ETC Housing Corp. HAPEC Clinton County Office Plattsburgh Housing Authority Victory Place Education Clinton County School Districts: AuSable Valley School District Beekmantown School District Chazy School District Northeastern Clinton School District Northern Adirondack School District Peru School District Plattsburgh City School District Saranac School District Vocational School: Champlain Valley Educational Services (CV-TEC) Higher Education: Clinton Community College SUNY Plattsburgh Early Education: North Country Kids, Inc. JCEO Head Start YMCA Y Wee Care Program Libraries Clinton Essex Franklin Library System Clinton County libraries: Altona Reading Center Champlain Memorial Library Chazy Public Library Dannemora Free Library Dodge Library Ellenburg Center Reading Center Ellenburg Sara A. Munsil Free Library Mooers Free Library Peru Free Library Plattsburgh Public Library 130 P a g e

132 Appendix M: Participant Characteristics, Event Voting Results & Finalization Methodology and Results Clinton County Community Health Assessment 2016 Priority & Focus Area Selection June 15, 2016 Priority Setting Event Participant List Name Organization Represented Diana Aguglia, Plattsburgh Regional Director Alliance for Positive Health Maria Alexander, Executive Director Clinton County Senior Citizens Council Sara Allen, Conractor Clinton County Health Department Karen Ashline, Adirondack Medical Home Champlain Valley Health Network Wendie Bishop, Director Clinton County Nursing Home Bonnie Black, Employee Assistance Services Director Behavioral Health Services North James Bosley, Planning Technician Clinton County Planning /Public Transit Steven Bowman, Director Clinton County Veteran s Service Agency Cari Burnell, RN Plattsburgh Veterans Administration Clinic Crystal Carter, Director Clinton County Office for the Aging Trevor Cole, Senior Planner Town of Plattsburgh Planning Kim Crockett, Director Clinton County Youth Bureau Adele Douglas, Coordinator Town of Peru Community Development Nicole Durgan, Program Assistant Behavioral Health Services North Darwyna Facteau, Director of Health Care Services Clinton County Health Department Ann-Marie Fitzgerald, Evaluation Manager Adirondack Health Institute Deborah Flock, Grant Writer Administrator University of Vermont Health Network - CVPH Andy Foster, Marketing Manager Behavioral Health Services North Greg Freeman, Occupational Health and Wellness University of Vermont Health Network - CVPH Debra Good, Case Management Director University of Vermont Health Network - CVPH Richelle Gregory, Director Clinton County Child Advocacy Center Kerry Haley, Executive Director, Foundation of CVPH University of Vermont Health Network - CVPH Maher Hanna, AVP of Patient Care Operations University of Vermont Health Network - CVPH Carrie Howard-Canning, AVP Patient Care Operations University of Vermont Health Network - CVPH Kati Jock, Director of Strategic Planning University of Vermont Health Network - CVPH Dan Johnson, Nursing Director Clinton County Chapter-NYS Advocacy & Resource Center Patricia Johnson, Fitzpatrick Cancer Center University of Vermont Health Network - CVPH John Kanoza, PE, Director of Environmental Health Clinton County Health Department Jeannine Kerr, School Food Service Director Peru Central School District Mark LaFountain, Public Health Preparedness Clinton County Health Department Dorothy Latta, Coordinator Plattsburgh Interfaith Food Shelf Jody Leavens, Marketing Supervisor Fidelis Care New York Jose Lopez, Residency Program Director University of Vermont Health Network - CVPH Nichole Louis, Supervising Public Health Nurse Clinton County Health Department Jessica Maguire, Community Health Coordinator Adirondack Health Institute Gizelle Menard, Assistant Director of Nursing University of Vermont Health Network - CVPH Stephens Mundy, President and CEO University of Vermont Health Network - CVPH Steve Peters, Superintendent of Recreation City of Plattsburgh Recreation Department Michele Powers, Director of Comm and Marketing University of Vermont Health Network - CVPH Amy Putnam, Community Relations Specialist Fidelis Care 131 P a g e

133 Jerie Reid, Public Health Director Rosemary Reif, AVP Patient Care Operations Joni Richter, Director of Patient and Family Services Amy Rugar, RN Shawn Sabella, PROS Director Margaret Searing, Quality Coordinator Nancy Smith Mandy Snay, Director Health Planning and Promotion Sally Soucia, Program Director Julie Stalker, Senior Outreach Program Director Joan Sterling, Community Manager Brenda Stiles, Director Care Management and Quality Tom Tallon, Population Health Improvement Plan Kenneth Thayer, RN, Emergency Care Center Director Peter Trout, Director Jennifer Trudeau, RN Brittany Trybendis, Director of North Country Thrive Lee Vera, Project Coordinator Darlene Wells, Disaster Program Specialist Laurie Williams, Consultant/Project Manager Tara Ebere, Director of Magnet Program Betty Rabideau, Case Supervisor, Adult Services Victoria Duley, Economic Developer Ginny Hay, Board Member Lora Helm, NP, Chemical Dependence Counselor Total: 65 Clinton County Health Department University of Vermont Health Network - CVPH American Cancer Society U.S. Department of Veterans Affairs Behavioral Health Services North Clinton County Health Department Resident Clinton County Health Department Joint Council for Economic Opportunity Joint Council for Economic Opportunity American Cancer Society University of Vermont Health Network - CVPH Adirondack Health Institute University of Vermont Health Network - CVPH Clinton County Mental Health Clinton County Health Department University of New York State College at Plattsburgh Eastern Adirondack Health Care Network Red Cross Foundation of CVPH University of Vermont Health Network - CVPH Clinton County Department of Social Service The Development Corproation Clinton County Board of Health Champlain Valley Family Center Participant Characteristics 132 P a g e

134 Focus area voting results (top 2 priority areas only) If the Priority Area Prevent Chronic Disease is selected, which focus area is most important for us to address? Responses Percent Count Reduce Obesity in Children & Adults 52.94% 27 Reduce Illness, Disability and Death Related to Tobacco Use and Secondhand Smoke 9.8% 5 Increase Access to High Quality Chronic Disease Preventive Care in Both Clinical and Community 37.25% 19 Settings Totals 100% 51 If the Priority Area Promote Mental Health and Prevent Substance Abuse is selected, which focus area is most important for us to address? Responses Percent Count Promote Mental, Emotional, and Behavioral Well- Being 20% 11 Prevent Substance Abuse and Other Mental Emotional Behavioral Disorders 45.45% 25 Strengthen Infrastructure 34.55% 19 Totals 100% 55 Priority and Focus Area Finalization A smaller subcommitee was convened on July 7, 2016 to finalized focus area selections by considering available data and stakeholder input received at the community event. To score each health problem (or Focus Area) for the two selected Priority Areas, the Hanlon Method was applied. The following table illustrates a numerical system for rating health problems against the selected criteria and was used by group members to determine scores assigned. 133 P a g e

135 D A B C D=[A+(2xB)]xC RESULTS Prevent Chronic Disease (Average Scores) n=5 Health Problem 1: Obesity in Children and Adults (27 votes, 17.7 score) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions Health Problem 2: Illness, Disability, and Death Related to Tobacco Use and Secondhand Smoke (5 votes, 15.3 score) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions Did not rate X X X Health Problem 3: Access to High Quality Chronic Disease Preventive Care and Management in Clinical and Community Settings (19 votes, 15.7 score) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions Promote Mental Health and Prevent Substance Abuse (Average Scores) n=5 Health Problem 1: Mental, Emotional, and Behavioral Wellbeing (11 votes, no score assigned) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions Health Problem 2: Substance Abuse and Other Mental Emotional Behavioral Disorders (25 votes, no score assigned) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions Health Problem 3: Infrastructure (19 votes, no score assigned) Rating Size of Health Problem Seriousness of Health Problem Effectiveness of Interventions P a g e

136 Appendix N: Clinton County Health Department Accreditation Letter and Certificate 135 P a g e

137 136 P a g e

138 Appendix O: Acronym List ACA ACO ACS AFH AHI AMHI ARC ARHN ASAP BH BHSN BT3 CCHD CCPT CDC CHA CHIP CHNA CHWS CoC COPD CRFP CSP CRFP CVPH DSRIP ECAC ED FFC FMNP FQHC FTE HCV HEAP HHHN HPNAP Affordable Care Act Account Care Organization American College of Surgeons Action for Health Adirondack Health Institute Adirondack Medical Home Initiative Advocacy and Resource Program Adirondack Rural Health Network Alcohol and Substance Abuse Providers Behavioral Health Behavioral Health Services North Birth to Three Clinton County Health Department Clinton County Public Transit Centers for Disease Control Community Health Assessment Community Health Improvement Plan Community Health Needs Assessment Center for Health Workforce Studies Commission on Cancer Chronic Obstructive Pulmonary Disease Capital Restructuring Finance Program Community Service Plan Capital Restructuring Financing Program University of Vermont Health Network - Champlain Valley Physicians Hospital Delivery System Reform Incentive Program Early Childhood Advisory Council Emergency Department Farm Fresh Cash Farmers Market Nutrition Program Federally Qualified Health Center Full Time Equivalent Hepatitis C Virus Heating Assistance Program Hudson Headwater Health Network Hunger Prevention and Nutrition Assistance Program IS JCEO LHD MAPP MEB NYSDOH PA PHAB PHIP PPS PSA RHIT SBIRT SD SES SHIP SIM SNAP SPARCC STD SUNY TANF UDS WIC Implementation Strategy Joint Council for Economic Opportunity Local Health Department Mobilizing for Action through Planning and Partnerships Mental, Emotional, Behavioral New York State Department of Health Prevention Agenda Public Health Accreditation Board Population Health Improvement Plan Preferred Provider System Primary Service Area Regional Health Innovation Teams Screening, Brief Intervention, and Referral to Treatment School District Socioeconomic Status State Health Innovation Plan State Innovation Model Supplemental Nutrition Assistance Program Substance Abuse Prevention and Recovery of Clinton County Sexually Transmitted Disease State University of New York Temporary Assistance to Needy Families Uniform Date System Special Supplemental Nutrition Program for Women, Infants, Children 137 P a g e

139 Page Left Intentionally Blank 138 P a g e

140 139 P a g e