Community Health Needs Assessment

Transcription

1 2013 Community Health Needs Assessment Kaiser Foundation Hospital RICHMOND License # To provide feedback about this Community Health Needs Assessment,

2 KAISER PERMANENTE NORTHERN CALIFORNIA REGION COMMUNITY BENEFIT CHNA REPORT FOR KFH RICHMOND I. EXECUTIVE SUMMARY Community Health Needs Assessment (CHNA) background Summary of Prioritized Needs and Needs Assessment Methodology 4 II. INTRODUCTION About Kaiser Permanente (KP) About Kaiser Permanente Community Benefit Kaiser Permanente s approach to Community Health Needs Assessment 6 III. COMMUNITY SERVED Kaiser Permanente s definition of community served by hospital facility Map and description of community served by hospital facility 9 IV. WHO WAS INVOLVED IN THE ASSESSMENT 11 V. PROCESS AND METHODS USED TO CONDUCT THE CHNA Secondary data Community input Data limitations and information gaps 12 VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS Identifying community health needs Process and criteria used for prioritization of the health needs 20 VII. DESCRIPTION OF PRIORITIZED COMMUNITY HEALTH NEEDS 21 VIII. Appendix: Community Health Need Profiles 26 Areté Consulting Page 2

3 Acknowledgements: This report was prepared by Caroline McCall of Areté Consulting, with support from Vanessa Coleman of Coleman Smith, LLC, Erica Browne of Kaiser Permanente East Bay Community Benefit, and the Kaiser Permanente Northern California Regional Community Benefit Programs staff. Areté Consulting Page 3

4 I. EXECUTIVE SUMMARY The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their taxexempt status under section 501(c)3 of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a community health needs assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance and transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report was conducted in compliance with these new federal requirements and with a commitment to identifying meaningful opportunities to invest our organizational resources to address priority community health needs. Summary of Prioritized Needs and Needs Assessment Methodology The following list of prioritized community health needs was identified for the Kaiser Foundation Hospital (KHF) Richmond service area. 1. Violence prevention 2. Local, comprehensive and coordinated primary care, including peri natal care 3. Economic security 4. Asthma prevention and management 5. Affordable community based mental health services 6. Healthy eating 7. Safe outdoor spaces 8. Exercise and activity 9. Local specialty care for low income populations 10. Affordable community based substance abuse services This CHNA was completed through a multi stage process designed to integrate findings from secondary data with the experiences, expertise and opinions made available through primary data collection. The steps in the process are shown below. 1. Review and analysis of health outcomes data found in the Kaiser Permanente CARES data platform. Areté Consulting Page 4

5 2. Review and analysis of secondary data on demographic, social, behavioral, environmental and economic factors that have been shown through research to be related to health outcomes. The majority of these data were also contained in the Kaiser Permanente CARES data platform. 3. Exploration of health related issues arising from the secondary data through focus groups with vulnerable communities residing in the KFH Richmond service area. 4. Articulation and refinement of a list of Community Health Needs for the communities served by KFH Richmond. 5. Engagement of public and community health experts in a structured process of prioritization among community health needs and identification of community assets related to the identified community health needs. 6. Revision and re prioritization of the community health needs statements to reflect new and updated secondary data and the input of public health experts. 7. Documentation, review and approval of the Community Health Needs Assessment. Areté Consulting Page 5

6 II. INTRODUCTION This report was written in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of an Implementation Strategy is set forth in a separate written document, which will also be made publically available. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice regarding conducting the CHNA for the hospital facility. About Kaiser Permanente Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are: Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof all connected by an electronic medical record Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry leading technology advances and tools for health promotion, disease prevention, state of the art care delivery, and world class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. Areté Consulting Page 6

7 About Kaiser Permanente Community Benefit For more than 65 years, Kaiser Permanente has been dedicated to providing high quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we recognize that good health extends beyond the doctor s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Community Health, requires equity and social and economic well being. Like our approach to medicine, our work in the community takes a prevention focused, evidence based approach. We go beyond traditional corporate philanthropy or grantmaking to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we ve focused our investments in three areas Health Access, Healthy Communities, and Health Knowledge to address critical health issues in our communities. For many years, we have worked side by side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we have conducted Community Health Needs Assessments to better understand each community s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long term, sustainable change and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. Kaiser Permanente s Approach to Community Health Needs Assessment Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations this includes minority groups, low income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization s annual Form 990. For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process Areté Consulting Page 7

8 that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web based CHNA data platform to facilitate implementation of the CHNA process. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources were not available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each Kaiser Permanente hospital collected primary data through key informant interviews, focus groups, and surveys. Also as part of the KP CHNA process local public health experts, community leaders, and residents were asked to identify issues that most impacted the health of the community, and existing community assets and resources were inventoried. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized community health needs. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will develop an implementation strategy for each health need identified. These strategies will build on Kaiser Permanente s assets and resources, as well as evidence based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. Areté Consulting Page 8

9 III. COMMUNITY SERVED Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low income or underserved populations. The KFH Richmond service area covers the western portion of Contra Costa County. The majority of the service area is urban, with some open space in the East Bay Regional Park District. The service area is bounded by the San Francisco Bay on the west side, San Pablo Bay to the north, and a ridge of hills on the east side. The service area has a total population of 242,277, representing 24% of the population of Contra Costa County. The remainder of Contra Costa County is served by KFH Antioch and KFH Walnut Creek. KFH Richmond serves the cities of San Pablo, Pinole, Hercules, Richmond, El Sobrante and El Cerrito. Areté Consulting Page 9

10 Table 1 provides the age, sex and race/ethnicity distribution of the population in the KFH Richmond service area. More than half of the population of KFH Richmond service area residents are adults between the ages of 18 64, and reported themselves as being Black, Asian, Hispanic/Latino or of multiple races. Data on key socio economic drivers of health status including poverty, insurance coverage and educational attainment (high school diploma) are provided in Table 2. Nearly 13% of KFH Richmond service area residents live in poverty, and approximately 16% are without health insurance. These data show that the population is majority non white, with over 80% of adults having a HS diploma. Across all three of the key drivers, the Hispanic/Latino population stands out as at high risk for poor health outcomes. TABLE 1: Population Distribution on Key Demographic Characteristics (Percent Total KFH Richmond Service Area Population) Age/Sex Percent of Population Race Ethnicity Percent of Population <5 years old 6.7% White 45.7% 5 17 years old 17.5% Black 19.2% years old 23.4% Asian 19.4% years old 40.9% Pacific Islander 0.32% Over 65 years old 11.5% Multi Race 4.6% Male 48.2% Native American 0.43% Female 51.8% Hispanic/Latino 31.2% Source: U.S. Census Bureau: A Compass for Understanding and Using American Community Survey Data (2008). TABLE 2: Key Drivers of Health Status by Population Demographics (Percent of Population Group) Percent without High School Diploma Percent without Percent in Poverty Health Insurance California 13.71% 17.92% 19.32% Contra Costa County 8.99% 11.86% 11.58% KFH Richmond Service Area 12.82% 16.15% 17.76% Male (KFH Richmond Service Area) Female (KFH Richmond Service Area) White (KFH Richmond Service Area) Black (KFH Richmond Service Area) Asian (KFH Richmond Service Area) 11.35% 18.08% 18.15% 14.17% 14.71% 17.42% 12.54% 17.60% 17.66% 17.66% 12.84% 13.02% 8.57% 12.13% 14.31% Areté Consulting Page 10

11 Percent without Percent in Poverty Percent without Health Insurance High School Diploma Hispanic (KFH Richmond Service Area) 17.05% 26.41% 38.17% Source: U.S. Census Bureau: A Compass for Understanding and Using American Community Survey Data (2008). IV. WHO WAS INVOLVED IN THE ASSESSMENT This Community Health Needs Assessment was conducted by KFH Richmond, one of two KFH hospitals in the Kaiser Permanente East Bay service area. Several community partners were included in the assessment process (as described on pages below), but none collaborated on the overall assessment. Kaiser Permanente East Bay Community Benefit contracted with Caroline McCall, dba Arete Consulting, to complete the data analysis required for the Community Health Needs Assessment. Ms. McCall also assisted with the design and facilitation of two prioritization sessions that engaged public and community health experts. Ms McCall holds Masters Degrees in Public Health and Public Policy and has been working with community and public health data for over 15 years. She completed the required California SB 697 Community Needs Assessments for Kaiser Permanente hospitals in Contra Costa County in 2004, 2007, and Ms McCall has also worked as a consultant to the Contra Costa County Public Health Department as well as several community agencies in Contra Costa County. She is a skilled data analyst, process and project manager, and group facilitator. Kaiser Permanente East Bay Community Benefit contracted with Coleman Smith LLC to conduct a series of focus groups with identified vulnerable populations in the KFH Richmond service area. Vanessa Coleman is Co Owner and Principle Consultant at Coleman Smith, a consulting firm focused on facilitating leadership through effective and sustainable change management. Emphasizing innovation, scaling change, the use of data informed decisionmaking, and capacity building, Vanessa has worked with a range of clients from local government entities to large scale not for profits. Vanessa also has extensive not for profit leadership experience. She served as Executive Director of a national comprehensive school reform think tank and network, the Coalition of Essential Schools National. Prior to that, Vanessa served as Executive Director of Summerbridge National (now the Breakthrough Collaborative), an international youth development program focused on academic achievement. Vanessa holds a MA in Education Policy and an EdD in Education Leadership. Areté Consulting Page 11

12 V. PROCESS AND METHODS USED TO CONDUCT THE CHNA Secondary Data The majority of the secondary data used in this CHNA are available through the Kaiser Permanente (KP) Community Health Needs Assessment (CHNA) Data Platform, powered by the Center for Applied Research and Environmental Systems (CARES), and the Institute for People, Places, and Possibility (ip3). These data are organized into six distinct categories: 1. Demographics. The source for demographic data is the US Census Bureau, American Community Survey 5 year estimates. 2. Social and Economic Factors. These data were from the following sources: US Census Bureau, American Community Survey year estimates and year estimates Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, US Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Public School Universe File, and Local Education Agency (School District) Universe Survey Drop out and Completion Data, States Department of Education, Student testing Reports, 2011 US Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2009 US Bureau of Labor Statistics, July 2012 Local Area Unemployment Statistics US Federal Bureau of Investigation, Uniform Crime Reports, Physical Environment, including data from the following sources: US Census Bureau, ZIP Code Business Patterns, 2009 and County Business Patterns, 2010 California Department of Alcoholic Beverage Control, Active License File, April 2012 US Census Bureau, 2010 Census of Populations and Housing, Summary File 1;Esru s USA Parks layer (compilation of Esri, National Park Services and TomTom source data) 2012 Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, 2008 US Department of Agriculture, Food Desert Locator, 2009 Walkscore.com 2012 US Department of Agriculture, Food Environment Atlas, Clinical Care data from the following sources: California Health Interview Survey (CHIS) 2005, 2007, and 2009 US Health Resources and Services Administration Area Resource File 2009 (as reported in the 2012 County Health Rankings) and Health Professional Shortage Area File 2012 Areté Consulting Page 12

13 Dartmouth Atlas of Healthcare, Selected Measures of Primary Care Access and Quality , Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, US Health Resources and Services Administration Centers for Medicare and Medicaid Services, Provider of Service File, 2011 California Department of Public Health Birth Profiles by ZIP code, 2010 California Office of Statewide Health Planning and Development (OSHPD), Patient Discharge Data, Health Behaviors data from the following sources: California Health Interview Survey (CHIS) 2009 Nielsen Claritas SiteReports Consumer Buying Power, 2011 California Department of Public Health, In Hospital Breastfeeding Initiations Data, 2011 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, California Department of Education, Fitnessgram Physical Fitness Testing Results, Health Outcomes data, based on incidence and mortality. California Office of Statewide Health Planning and Development (OSHPD), Patient Discharge Data, 2010 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention and the National Cancer Institute: State Cancer Profiles, California Department of Public Health, Death Statistical Master File, Centers for Disease Control and Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2009 Centers for Disease Control and Prevention, National Diabetes Surveillance System, 2009 California Health Interview Survey (CHIS) 2009 California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011 Centers for Disease Control and Prevention, National Vital Statistics System, (As reported in the 2012 County Health Rankings) The statisticians at the Center for Applied Research and Environmental Systems (CARES) used data from the sources listed above to create the Kaiser Permanente CHNA data platform. The platform analysis of data by geographic areas is limited by the geography for which the data were originally collected. Areté Consulting Page 13

14 Health Outcomes data from the platform were downloaded for the KFH Richmond service area and compared to benchmarks defined either by Healthy People 2020, relevant Countylevel rates or State level rates. After identifying those outcomes indicators for which the population in the KFH Richmond service area were seen to compare poorly to benchmarks, associated indicators of health (e.g. health behaviors, clinical care, physical environment and social and economic factors) were reviewed and analyzed to see where these indicators also showed poor performance relative to benchmarks. Based on the combined analysis described above, a set of community health concerns were identified and served as the basis for a series of facilitated community conversations which are described in the community input section of this report. After an initial set of community health needs was developed and discussed with public and community health experts, additional secondary data were gathered and analyzed, leading to a revision of the community health need statements and a revised list of priority CHNs. The additional secondary data were obtained from the following sources: The California Health Interview Survey (CHIS 2007 and 2009) The California Health Kids Survey (CHKS) FBI Report of Offenses Known to Law Enforcement The National Citizen Survey for Richmond, City of Richmond Police Department Crime Analysis Unit Community Input The broad interests of the community were incorporated through three means. First, primary data were collected through focus groups engaging members of vulnerable communities. Second, a key informant interview was conducted with Supervisor John Gioia. Finally, a group of public and community health experts was engaged to provide input on community assets relative to community health needs and priorities among the community health needs. I. Community Focus Groups In October 2012, Coleman Smith conducted a series of five focus groups with low income and vulnerable populations in the KFH Richmond service area. Focus groups were intended to gather feedback and perspectives from West Contra Costa County residents regarding the secondary data findings for their communities in the areas of public safety, health and nutrition, mental health, sexual health, prenatal care and general health and wellness. The average size of the focus groups was 17 participants, and the demographic profile of focus group participants varied (see table 3). Areté Consulting Page 14

15 TABLE 3: Community Focus Groups Characteristics Age Range Partner Agency Language Number of Participants Populations Represented Contra Costa Interfaith Supporting Community Organization African American (October 29, 2012) English African American Low Income Chronic Conditions Medically underserved Brookside Community Health Center Latino (October 19, 2012) Spanish and English Latino Low income Chronic Conditions Medically underserved Community Health of Asian Americans Asian (October 25, 2012) California School Health Centers Association Youth (October 22, 2012) English Asian Low income Medically underserved English African American Latino Low income Chronic Conditions A modified focus group structure was used to engage residents in two hour sessions. Facilitators incorporated principals from the Dynamic Facilitation process. Specifically, facilitators used critical questions and created opportunities for participants to discuss aspects of topics that were of high interest to them (within the scope of the topics). Topics were matched with specific communities based on published data regarding those communities that were disproportionately represented in the relevant poor health outcomes, current and historical Kaiser Permanente Community Benefit priorities and community understanding, and selections made by the Kaiser Permanente Community Benefit staff. Using a broad list of community based organizations in the KFH Richmond service area, Areté Consulting Page 15

16 including currently Kaiser Permanente Community Benefit funded, those formerly Kaiser Permanente funded, and those never funded by Kaiser Permanente, the facilitators worked with organizations to recruit residents. Facilitators worked closely with representatives of community based organizations to clarify the purpose of the focus groups and the profiles of participants needed. Organization representatives were equipped with scripts and profile specifics to assist their efforts. Data from the focus groups were analyzed for patterns and themes related to each of the areas where secondary data had shown poor health outcomes in the relevant communities. These emerging themes were then used to support development of an initial list of Community Health Needs and were shared with participants in the November 28 th expert stakeholders meeting. Salient themes and quotations from the community focus groups were similarly matched to the second, revised CHNs included in the appendix of this report. II. Expert Stakeholders Meetings On November 28 th, Kaiser Permanente East Bay Community Benefit convened a group of thirty individuals active in public and community health agencies in West Contra Costa County. The stakeholder meeting served three purposes: 1. Increase awareness about the 2013 CHNA process and findings 2. Confirm and refine our list of community resources/assets 3. Invite input on how to prioritize among the identified community health needs Participants with expertise in public health, and representing local health departments and health and social service agencies with relevant information, were included and are listed in Table 4. TABLE 4: Public and Community Health Experts Convened (November 28 th, 2012) Name Agency Represented Title Representation and/or Areas of Expertise Alvaro Fuentes Barbara Bunn McCullum Community Clinic Consortium of Contra Costa & Solano Counties Executive Director Primary care Community health Low income populations Brighter Beginnings Executive Director Low Income/Finances Teens Perinatal care Wanda Sessions Contra Costa Health Services Health Services Administrator Public Health Low Income populations Medically underserved Areté Consulting Page 16

17 Name Agency Represented Title Representation and/or Areas of Expertise Barbara Sheehy Contra Costa Health Services Administrator, California Children s Services Contra Costa County Public Health Low income Children and youth Medically underserved Mieasha L. Harris Girls Incorporated West Contra Costa County Executive Director Youth Low income Shasa Curl City of Richmond Administrative Chief Community health and community services Stephanie Hochman Bay Area Community Resources East Bay Director Mental health Low income Tashaka Merriweather Jennifer Lyle West Contra Costa Unified School District Building Blocks for Kids Collaborative School Health and Community Schools Coordinator Chief of Operations Community services Youth Low income Community health Family services Violence prevention Doria Robinson Urban Tilth Executive Director Community health Environmental health Nutrition Richard Boyd Urban Tilth Board Member Community health Environmental health Nutrition Lynn Martin Early Childhood Mental Health Program Executive Director Remy Goldstein Doctor s Medical Center Director of Community Relations Charlene Smith East Bay Center for Development Director Performing Arts Bianca LaCHaux YMCA of the East Bay, West Student Support Services Contra Costa Director Mental health Children Community Health Youth Community services Youth Low income Exercise and activity Charlene Harris Healing Circles of Hope Executive Director Violence prevention Community health Youth Shannon Ladner Beasley Contra Costa Health Services Senior Health Education Specialist Seniors Health education Low income Miriam Wong The Latina Center Executive Director Latina population Community health Glenda Roberts Contra Costa College Early Childhood Education Children Areté Consulting Page 17

18 Name Agency Represented Title Representation and/or Areas of Expertise Porter Sexton Pogo Park Development Director Child development Community development Community safety Jennifer Balogh Healthy and Active Before 5 Project Manager Children s health Nutrition Exercise and activity Erin Harr Yee Stephanie Stevens Planned Parenthood Shasta Pacific Building Blocks for Kids Collaborative Senior Director of Client Services Director of Community Engagement Primary care Low income Perinatal care Community health Family services Violence prevention Cynthis Paterson Community Violence Solutions Director, Rape Crisis Center Violence prevention Community health Lynda Gayden Contra Costa Regional Health Foundation Executive Director Community health Community development Danielle Storer James Morehouse Project Associate Director Primary and preventive care Youth development Theresa Dade Boone YMCA of the East Bay West Contra Costa Health Center Coordinator Youth development Community health Low income Venus Ke Kaiser Permanente Educational Theater Program Community health Liaison Community health Youth health Health education Scott Badler Contra Costa Independent Consultant Community development Gabino Arrendondo City of Richmond Planning Division Health and Wellness Community health Public health Low income The stakeholders were provided with both secondary and primary data findings and were asked to provide individual and small group perspectives on the relative priority of the community health needs. When the full stakeholder group discussed the community health needs and the emerging sense of priorities, they also indicated that there were areas where additional data would be valuable in developing a final list of CHNs. III. Key Informant Interviews As part of the 2013 CHNA needs development process, Kaiser Permanente commissioned a key informant interview with Contra Costa County Supervisor John Gioia. The interview was conducted via telephone by Vanessa Coleman of Coleman Smith LLP. The purpose of the interview was to provide the supervisor with an update about the current CHNA process Areté Consulting Page 18

19 (specifically describing the community and health expert generated health needs) and to gather information about other relevant health needs. In addition, Supervisor Gioia was asked to share information about which of the needs were currently being (or planned to be) addressed. Results of the interview were transcribed and provided to Kaiser Permanente East Bay Community Benefit to inform the final definition of CHNs. As a result of the key informant interview and stakeholder discussion of the community health needs, and input from members of the Kaiser Permanente East Bay Community Benefit Advisory Group, Arete Consulting and Community Benefit staff worked together to expand the secondary data in key areas and to refine the list of community health needs. A final prioritization process was held January 24 th, In addition to internal KP East Bay Community Benefit staff and members of the Community Benefit Advisory Group, Wanda Sessions, Health Services Administrator in the Contra Costa County Public Health Department, and Gabino Arrendondo, from the City of Richmond, provided input and expertise to the process. Data Limitations and Information Gaps The KP common data set includes a robust set of nearly 100 secondary data indicators that, when taken together, enable an examination of the broad health needs faced by a community. However, there are some limitations with regard to this data, as is true with any secondary data available. Some data were only available at a county level, making an assessment of health needs at a neighborhood level challenging. Moreover, disaggregated data around age, ethnicity, race, and gender are not available for all data indicators, which limited the ability to examine disparities of health issues within the community. Lastly, data are not always collected on a yearly basis, meaning that some data are several years old. With the KFH Richmond CHNA process specifically, the available secondary data also limited the recruitment process for, and discussion topics during, the community focus groups because the available secondary data was used to develop the focus group protocol. Areté Consulting Page 19

20 VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS For the purposes of the CHNA, Kaiser Permanente defines a health need as: a poor health outcome and its associated health driver(s) or a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Health needs for the KFH Richmond service area were defined based on a full review of secondary data, the input of community residents and the expertise of those engaged in serving vulnerable populations. Health needs were identified through consideration of those conditions in the community that, if addressed, would have a significant positive impact on health outcomes for residents of the KFH Richmond service area. To be included in the list of Community Health Needs, secondary data had to show either poor outcome(s) or indicators of likely poor health outcomes (based on evidence regarding related health behaviors, environmental factors etc.), or both. Additionally, at least two sources of primary data had to identify the issue or condition and its relationship to poor health. Once community health needs were identified, they were then prioritized using the following set of pre defined criteria. A. Severity of issue and impact on related health outcomes B. Size of the population affected C. Effective and feasible interventions exist D. Existing resources and attention dedicated to issue E. Successful solution or intervention has the potential to positively impact multiple problems F. Addressing this community health need will have a positive impact on other identified community health needs The initial list of Community Health Needs was reviewed and tested with the large group of expert stakeholders described above. Members of this group were also asked to provide their input on the relative priority among the community health needs. The prioritization input was generated through facilitated discussions in both small and large groups and was guided by the criteria listed above. After the large stakeholder meeting, and the refinement of the list of CHNs, a meeting was held to set priorities among the final set of CHNs. This meeting and prioritization process involved a smaller group of five individuals, representing the Kaiser Permanente East Bay Community Benefit Advisory Group, the East Bay Community Benefit Program, the Contra Costa County Health Services Department, and the City of Richmond. Each individual was asked to prioritize among the needs, using the criteria. Each then presented their priority list, along with a rationale for each choice. Based on the individual rankings and discussion, and with reference to the full set of both primary and secondary data, the group developed a consensus prioritized list of community health needs. Areté Consulting Page 20

21 VII. DESCRIPTION OF PRIORITIZED COMMUNITY HEALTH NEEDS The Community Health Needs Assessment process for the KFH Richmond service area identified a set of community health needs that, if addressed, have the potential to have a significant positive impact on negative health outcomes among the vulnerable populations living in the service area. The health outcomes improvements from addressing the identified community health needs will be both direct as in asthma prevention and management having a direct impact on asthma prevalence and discharges and indirect as in economic security improving living conditions for low income populations which will in turn reduce environmental pollutants and thus decrease asthma prevalence and discharges. The following community health needs have been defined for the KFH Richmond service area, listed in priority order. 1. Violence Prevention: Violence is a public health issue that continues to plague communities in the KFH Richmond service area, particularly neighborhoods in the City of Richmond itself. Community members, public health experts, and Richmond and Contra Costa County government officials and agencies have all placed a high priority on decreasing violence in Richmond, particularly among young people. According to CityRating.com and based on FBI crime statistics, the city violent crime rate for Richmond in 2010 was higher than the national violent crime rate average by %... In 2010 the city violent crime rate in Richmond was higher than the violent crime rate in California by %. 2. Local, Comprehensive, Coordinated Primary Care, including Peri natal Care: Primary and preventive care are among the most effective ways to prevent disease and to minimize the negative impact of health conditions. In the KFH Richmond service area, although commonly used indicators of access to primary care, such as primary care providers per 100,000 populations and designation as a Health Professional Shortage Area do not show a lack of access, indicators related to the use of primary care and health outcomes that are known to correlate with inadequate primary care indicate a need. Community members and health care experts who were engaged in the CHNA process indicated that the lack of local, culturally relevant resources and the lack of coordination of primary care services for low income populations both contribute to the inadequate use of primary care services. 3. Economic Security: In the KFH Richmond service area, almost 13% of residents live in poverty and 18% of children live in poverty. Research has shown that in the United States poverty is one of the key drivers of health status. In the KFH Richmond service area there is a particular need to address economic security to improve health outcomes for Black and Hispanic populations, where both poverty and negative health outcomes are seen at disproportionate levels. 4. Asthma Prevention and Management: Asthma is a serious health issue for both children and adults in the Richmond service area. Asthma can effect the development of young children in multiple ways, both physically and cognitively. In Richmond, the school district Areté Consulting Page 21

22 reports that asthma is one of the top health conditions keeping children out of the classroom. For adults, asthma has a negative impact on their ability to perform certain jobs, attendance at work, and productivity. Asthma cannot be cured, so improved prevention and management are needed in the communities served by KFH Richmond. 5. Affordable Community based Mental health Services: Mental health needs and services are a significant concern for residents in the KFH Richmond service area. In addition, there are social and cultural barriers to accessing mental health services, which contribute to crises that are seen in emergency departments rather than in community settings. Community members and providers indicate that mental health services are most likely to be used when they are in the local community, financially accessible and culturally relevant. Poor mental health can both result from, and contribute to, other poor health and social conditions. 6. Healthy Eating: Healthy eating has significant health benefits. There is research evidence showing that people living in poor or vulnerable communities tend not to have easy access to healthy food and feel that healthy food for which they do have access is unaffordable relative to less healthy choices. In the KFH Richmond service area, 6.5% of residents live in areas designated as food deserts, and there are only 12.4 WIC authorized food stores per 100,000, while statewide that number is 15.8 per 100,000. Poor health outcomes in the KFH Richmond service area that are likely to be related to poor eating habits include overweight and obesity, some cancers, diabetes and heart disease. 7. Safe Outdoor Spaces. Safety is a significant concern for the residents of the KFH Richmond service area, in particular those living in the City of Richmond. Only 34% of respondents to the 2011 National City Survey conducted in the City of Richmond indicated that they felt very or somewhat safe in the Richmond downtown area during the daytime. Seventy percent indicated that they felt very or somewhat safe in their own neighborhoods during the day, but only 42% continued to feel safe in their neighborhoods after dark. A lack of safe outdoor spaces can cause stress for individuals and families, limiting community residents comfort with outdoor exercise and activity, limiting social interactions among young children, and increasing a sense of isolation. 8. Local Specialty Care for Low income Populations: Specialty care is a need for individuals with high risk chronic conditions and for those with acute complications or conditions related to specific body organs or systems. No secondary data specific to specialty care access or use were analyzed, but health outcomes data, including hospitalization data for diabetes and HIV and mortality rates for heart disease and stroke indicate that specialty care is insufficient. Cancer prevalence in the service area indicate a significant need for oncologists and related specialties. Areté Consulting Page 22

23 9. Exercise and Activity: Like healthy eating, many barriers to exercise and activity exist in poor or vulnerable communities. These communities tend to have poor access to parks and recreation facilities, they tend to have higher rates of crime and violence, and they tend to have fewer commercial areas that promote walking. Poor health outcomes in the KFH Richmond service area that are likely to be related to inadequate exercise and physical activity include overweight and obesity, heart disease and stroke. 10. Affordable Community based Substance Abuse Services: Substance abuse, particularly excessive alcohol use, is a significant health concern for the communities in the KFH Richmond service area. In Contra Costa County as a whole, 31% of residents age 18 or older report binge drinking according to California Health Interview Survey data. Over 35% of county residents under the Federal Poverty Level report binge drinking. 1 People who abuse alcohol and other drugs are frequently dual diagnosis, having mental health issues as well. Community Assets and Resources The KFH Richmond service area includes one other general acute care hospital and associated clinics Doctors Medical Center in San Pablo. Residents of the service area have to travel to the Oakland Children s Hospital and Research Institute for pediatric specialty and inpatient needs, and to the Contra Costa Medical Center in Martinez for public inpatient and outpatient services. In addition to these health care facilities, the KFH Richmond CHNA process identified multiple community resources currently utilized to respond to a variety of community health needs. From both the community focus groups and expert stakeholder meetings emerged the list of existing community resources for each of the prioritized CHNs as described in Table 5. 1 California Health Interview Survey, 2007 Areté Consulting Page 23

24 Community Health Need Violence prevention Local, comprehensive and coordinated primary care, including perinatal care Economic security Asthma prevention and management Affordable community based mental health services Healthy eating Safe Outdoor Spaces Table 5: Existing Community Resources Key Community Assets and Resources Community Violence Solutions Victim Witness Assistance STAND! For Families Free of Violence Richmond Police Department City of Richmond Office of Neighborhood Safety Building Blocks for Kids Collaborative RYSE Youth Center Healing Circles of Hope Community Violence Solutions Healthy Richmond, The California Endowment Planned Parenthood Brookside Community Health Center Contra Costa County Health Services Health Centers The Latina Center Healthy Richmond Building Blocks for Kids Collaborative Richmond Health Equity Partnership East Richmond Youth Development Center Youth Employment Partnership Richmond Works The Stride Center Brighter Beginnings American Lung Association Familias Unidas Early Childhood Mental Health Program Greater Richmond Interfaith Programs Urban Tilth Healthy and Active Before 5 Healthy Richmond Pogo Park Areté Consulting Page 24

25 Community Health Need Exercise and activity Local specialty care for lowincome populations Affordable community based substance abuse services, particularly alcohol abuse Key Community Assets and Resources East Bay Regional Parks YMCA of the East Bay Pogo Park Healthy and Active Before 5 Building Blocks for Kids Collaborative Operation Access Ujima West Neighborhood House A complete set of data, specific to each Community Health Need, and including health need indicators, direct health outcomes, indirect health outcomes, primary data themes, and community assets, is provided in the appendix to this report. Areté Consulting Page 25

26 APPENDIX: Prioritized Health Need Profiles Health Need Profile: Violence Prevent ion Violence is a public health issue that continues to plague communities in the KFH Richmond service area, particularly neighborhoods in the City of Richmond itself. Community members, public health experts, and Richmond and Contra Costa County government officials and agencies have all placed a high priority on decreasing violencee in Richmond, particularly among young people. According to CityRating.com and based on FBI crime statistics, the city violent crime rate for Richmond in 2010 was higher than the national violent crime rate average by %... In 2010 the city violent crime rate in Richmond was higher than the violent crime rate in California by %. Direct Negative Health Outcomes: Indicator Homicide Rate per 100,000 Number of Rapes 1/1/12 10/31/12 Service Area value ( City of Richmond) Benchmark 5.5 (HP 2020) 46% increase over 2011 The homicide rate in the Richmond service areaa is 24.9 per r 100,000, which is over three times higher than the Healthy Peoplee 2020 target of 5.5. In 2012, Richmond had 26 homicides; over the past decade, the vast majority of deaths from homicide have been in the African American community. FBI data show violent crimes in Richmond increasing year overr year in 2010, 2011, and Dataa from the Richmond Police Departments Crime Statistics show that there were 635 violent crimes committed in the first 10 months of 2012, this was a 3.76% increase over the same time period in Areté Consulting Page 26

27 Indirect Negative Health Outcomes: Violence creates stress in communities were it is prevalent. The stress of being exposed to violence and/or living in fear of violence has negative implications for mental health outcomes. The negative implications extend to physical health outcomes such as cardiovascular disease mortality. Indicator Service Area value Heart Disease Mortality per 100, Stroke Mortality per 100, Percent Reporting Poor Mental Health 14.81% White 16.55% Qualitative Data: Quotes and Themes from Focus Groups and Public Health Experts Youth unemployment is highh No youth supervision Lack of education [contributes to violence]. Domestic violence generally happens in front of kids. Kids think its OK to be violent. You are what you learn at home home is the first school you go to. Geographic areas of greatest impact: Homicide Rates Value for Specific Populations (with negative indicators) Benchmark (HP 2020) (CA) 14.21% (CA) Violence, as indicated by homicide rates, affects neighborhoods throughout the KFH Richmond service area. Key Community Assets Community Violence Solutions Victim Witness Assistance STAND! For Families Free of Violence Richmond Police Department City of Richmond Office of Neighborhood Safety Areté Consulting Building Blocks for Kids Collaborative RYSEE Youth Center Healing Circles of Hope Community Violence Solutions Healthy Richmond Page 27

28 Health Need Profile: Local Comprehensive, Coordinated Primary Care, including Peri-natal Care Primary and preventive care are among the most effective ways to prevent disease and to minimize the negative impact of health conditions. In the KFH Richmond service area, although commonly used indicators of access to primary care, such as primary care providers per 100,000 populations and designation as a Health Professional Shortage Area do not show a lack of access, indicators related to the use of primary care and health outcomes that are known to correlate with inadequate primary care indicate a need. Community members and health care experts who were engaged in the CHNA process indicated that the lack of local, culturally relevant resources and the lack of coordination of primary care services for low income populations both contribute to the inadequate use of primary care services. Indicators of Inadequate Primary Care: Indicator City of Richmond Value National Comparison Percent rating availability of affordable quality health 27% Much Below care excellent or good Percent rating availability of preventive health services 27% Much Below excellent or good Percent rating health services excellent or good 28% Much Below In 2011, the City of Richmond participated in the National Citizen Survey. The survey queried residents about many topics, including topics related to the availability and quality of primary care services. Only slightly more than a quarter of residents responded positively regarding the availability of services. Direct Negative Health Outcomes of Inadequate Primary Care: Indicator Service Area value Value for Specific Benchmark Populations (with negative indicators) Preventable Hospital Discharge Rate per (CA) 10,000 Percent of Hospital Discharges that were 10.61% White 11.01% 9.88% (CA) Preventable Black 15.56% Percent Low Birth Weight 7.37% 6.8% (CA) Infant Mortality per 1, Black (HP 2020) Preventable hospitalizations are those for conditions that could have been prevented by regular or timely primary care. The preventable hospital discharge rate per 10,000 in the KFH Richmond service area was , compared to a state rate of Over 10% of the hospital discharges in the KFH Richmond service area were designated as preventable. Low birth weight and Infant mortality rates are common indicators of inadequate peri natal care. 7.37% of infants born in the KFH Richmond service area considered to be of low birth weight. The state rate is 6.8%. Among African Americans in

29 the KFH Richmond service area, the infant mortality rate is per 1,000 live births, more than 50% higher than the HP2020 target of 6 per 1,000 live births. Indirect Negative Health Outcomes: Indicator Age Adjusted Asthma Discharges per 10,000 Asthma Discharges as a Percent of Total Discharges Service Area value Value for Specific Populations (with negative indicators) Benchmark (CA) 1.74% Black 2.82% Pacific Islander 0.96% Hispanic 1.56% 0.88% (CA) (HP 2020) Heart Disease Mortality per 100,000 Stroke Mortality per 100, (CA) Comprehensive, coordinated primary care is one of the ways that health care providers are able to diagnose and treat many potentially dangerous or chronic conditions. Poor health outcomes related to asthma management as well as stroke and heart disease mortality show a need for better use of primary and preventive care. Qualitative Data: Quotes and Themes from Focus Groups and Public Health Experts We need to get care that is free, close to home, provided with language interpretation, with doctors who know your history and your whole family and staff who treat all patients and families with respect. Easing access to health care earlier would resolve a multitude of health issues. When done in a patient centered way, with team based referral connections, there is better health education and a higher emphasis on prevention. Not only does the care need to be financially accessible, there needs to be capacity so that people do not have to wait in lines or for months to be seen. Screening and diagnostic care will allow people to understand the importance of taking care of themselves. Care is not always provided in language accessible ways patients don t always understand medication professionals. Key Community Assets Planned Parenthood Brookside Community Health Center Contra Costa County Health Services Health Centers The Latina Center Healthy Richmond Page 29

30 Health Need Profile: Economic Security In the KFH Richmond service area, almost 13% of residents live in poverty and 18% of children live in poverty. Research has shown that in the United States poverty is one of the key drivers of health status. In the KFH Richmond service area there is a particular need to address economic security to improve health outcomes for Black and Hispanic populations, where both poverty and negative health outcomes are seen at disproportionate levels. Direct Indicators of Economic Insecurity: Indicator Service Area value Value for Specific Populations (with negative indicators) Benchmark Percent under Federal 12.82% Black 17.66% 13.71% (CA) Poverty Level Hispanic 17.05% Percent under 200% of FPL 29.73% Iron Triangle 62.7% 32.82% (CA) North Richmond 53.59% Percent of Children Living in 18.17% Blacks 23.81% 19.06% (CA) Poverty Hispanic 21.78% Iron Triangle 48.16% Unemployment Rate 13.3% 9.8% (CA) Percent with no Health 16.15% Hispanic 26.41% 17.92% (CA) Insurance Percent population with no high school diploma 17.76% Hispanic 38.17% 19.32% (CA) Residential Property in Foreclosure 1 in every 313 (ZIP code 94805) 1 in every 753 (CA) Richmond has high rates of poverty, coexisting with high rates of unemployment and foreclosure. As shown above, about 13% of residents live under the Federal Poverty Line. When the cost of living in the SF Bay Area is considered, 200% of poverty is a better indicator of economic security. In the Richmond service area almost 30% of the population (29.73%) lives on incomes that are below 200% of the FPL. There are neighborhoods in Richmond where over 50% of residents live below 200% of poverty and over a third of residents live below 100% of the FPL. Among the residents of the service area, 26.41% of Hispanics have no health insurance and 38.17% of Hispanics have no high school diploma. These are also indicators of low economic security. At the end of 2012, the US Bureau of Labor Statistics showed the city of Richmond with an unemployment rate of 13.3%, 3.5% higher than the state as a whole. According to Realty Trac, the foreclosure crisis continues in Richmond, with rates as high as 1 in 313 residential units in ZIP code Indirect Negative Health Outcomes: As a result of economic insecurity, individuals and families experience multiple physical, emotional and social stressors, which in turn contribute to negative health outcomes. Specific diseases and conditions that have been seen to correlate with poverty in public health research data, and for Page 30

31 which there are negative health outcomes in the secondary data for the Richmond service area include: asthma, overweight and obesity, diabetes, cardiovascular disease, mental health, homicide, low birth weight and infant mortality. Negative Health Indicators Associated with Economic Insecurity Indicator Service Area value Value for Specific Populations (with negative indicators) Benchmark Asthma Prevalence 15.69% 13.12% (CA) Age Adjusted Asthma Discharges (CA) per 10,000 Asthma Discharges as a Percent of 1.74% Black 2.82% 0.88% (CA) Total Discharges Pacific Islander 0.96% Hispanic 1.56% Percent of Adults who are Obese (CA) Percent of Youth who are Overweight 16.01% White 14.73% Black 17.21% Hispanic 16.29% 14.30% (CA) Percent of Youth who are Obese 35.15% Black 35.31% 29.82% (CA) Hispanic 39.85% Diabetes Discharges as a Percent of 1.04% Black 1.58%.86% (CA) Total Discharges Heart Disease Mortality per 100, (HP 2020) Stroke Mortality per 100, (CA) HIV Discharges as a percent of 0.21% Black 0.52% 0.14% (CA) Total Discharges Percent Reporting Poor Mental 14.81% White 16.55% 14.21% (CA) Health Homicide Rate per 100, (HP 2020) Percent Low Birth Weight 7.37% 6.8% (CA) Infant Mortality per 1, Black (HP 2020) Qualitative Data: Quotes and Themes from Focus Groups and Public Health Experts: The economy is the main problem. We are poor people, we are going to find people with poor self esteem and they are going to try to hurt themselves and hurt others. People are desperate your body is still alive, but your stomach is hungry. Page 31

32 Geographic areas of greatest impact: Poverty Rates Economic insecurity, as indicated by poverty rates in the map, is widespread, with high concentration the Iron Triangle and East Richmond. Key Community Assets Building Blocks for Kids Collaborative Richmond Health Equity Partnership East Richmond Youth Development Center Youth Employment Partnership Richmond Works The Stride Center Brighter Beginnings Page 32