Adena Pike Medical Center PIKE COUNTY 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGIES. 0 P age

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Adena Pike Medical Center PIKE COUNTY 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGIES 0 P age

ADENA HEALTH SYSTEM Adena Pike Medical Center (APMC) is a part of the Adena Health System. Since 1895, Adena Health System has remained focused on its commitment to provide patients with the best healthcare and personal service. Today, Adena Health System includes three hospitals (Chillicothe, Greenfield and Waverly) and five regional clinics, with a total of 311 beds. Adena provides quality healthcare for the more than 500,000 residents within its 12-county, southern Ohio service region, which includes Adams, Athens, Fayette, Gallia, Highland, Hocking, Jackson, Pickaway, Pike, Ross, Scioto and Vinton Counties. Adena offers its patient s leading edge services in the areas of heart health, cancer diagnosis and treatment, women's health; children's health; and orthopedics. The skilled physicians and medical staff at Adena provide a number of specialty services that are typically found in larger medical centers. These include: open heart surgery; robotic surgery; cardiac intervention; cancer care; advanced orthopedic procedures; high level MRI testing; and a Level II pediatric nursery. Progress on the 2013 Community Health Needs Assessment Adena Health System and Adena Pike Medical Center completed a community health needs assessment and implementation strategies plan in 2013 for Pike County. The plan identified one primary health need, obesity, and two secondary community health needs: mental and behavioral health; smoking (Figure 1). 2013 Pike County Community Health Needs Assessment Community Health Focus and Priorities Focus Health Priorities Strategies Primary Obesity High Blood Pressure Joint/Back Pain Heart Disease Employee Health Initiatives Community Programming Regional Initiatives Secondary Mental/Behavioral Health Stress Depression Drug Abuse Smoking Cancer Chronic Respiratory Disease Figure 1: Adena s 2013 Community Health Needs Assessment Priorities Advocacy Referral Resources Cessation Resources Screening 1 A dena Health System CHNA Implementation Strategies

A community health plan was developed around these health priorities using four primary strategies: advocacy; referral; cessation resources; and screening services. Community health programming was then developed around these issues and piloted with Adena Health System employees as part of the employee health and wellness program. Programs were refined and then expanded for implementation into the Pike County community (Figure 2). Employerl Health & Wellness Community Health Impact Ini;a;ve Adena Employee Health & Wellness Plan Figure 2: Adena s 2013 Approach to Community Health Program Development As a result of these efforts, Adena Health System developed multiple programs focused on educating the public on obesity. Advocacy efforts and cessation resources were developed and promoted for mental and behavior health issues, as well tobacco use. Figure 3 provides an outline of the programs that were developed and implemented from 2013 to 2016 for Pike County. Table 1 outlines the actions, progress and outcomes. Primary Health Priority OBESITY Move More Ini;a;ve Healthy Kids Diabetes Expo Secondary Health Priority MENTAL/BEHAVIORAL HEALTH Baby Centered Recovery Secondary Health Priority SMOKING Adena Quit Clinic Lung Cancer Screenings Figure 3: Adena s 2013 Through 2016 Health Priorities Programming for Pike County 2 A dena Health System CHNA Implementation Strategies

Table 1: Adena Community Health Needs Assessment Implementation Strategies Actions and Progress Health Priority 2013 Proposed Implementation Strategies 2014 Actions/Progress 2015 Actions/Progress Primary Health Priority Obesity Employee Health Initiatives AHS Community Health Advancement will collaborate with community partners to implement broader scale health and wellness programs, centered on movement, nutrition and wellbeing, previously developed and piloted by the AHS internal employee health and wellness program. In addition, partnerships with local community agencies will be facilitated as part of a diabetes management initiative for high-risk diabetic patients. In 2014, Adena Health System restructured its internal Health & Wellness team to create an evidence-based health and wellness platform by developing and refining programs for health system employees (residents of the service region) that could be implemented on a larger scale in the community. The team successfully created a model built around three components proven to drive improved individual health and wellness: movement; nutrition and wellbeing. The team coordinated programming within these three areas based out of the Adena Regional Medical Center Campus. Programs included a campus based walking program, Weight Watchers at Work, and stress management classes in addition to established offerings including Family Fit and Adena Fit. The programs implemented at the Adena Pike Medical Center campus include the walking program and the Adena Fit programs. Employees at the Pike location are encouraged to engage in the remainder of the programs at Adena Regional Medical Center. A communication plan was built around the programming to ensure effective communication to employees. In addition, a competitive challenge for employees, Move More Adena, was also coordinated to encourage 90 minutes of activity per week, as well as a venue to market other employee health and wellness offerings. The team successfully engaged more than 35% of the total employee population through these initiatives in 2014. In 2015, AHS continued its internal efforts around Employee Health and Wellness (including Pike employees) by expanding and implementing evidence-based health and wellness programming built on three different pillars movement, nutrition and well-being. Some programming was also expanded into the greater Ross County Community. The team continued the campus based walking program, Weight Watchers at Work, Adena Fit, and stress management classes. The communication plan developed in 2014 was expanded into social media, representatives from the organization s Health & Wellness committee rounded to departmental meetings, offsite locations and coordinated a Health & Wellness Fair to ensure effective communication to employees. The Move More challenge was kicked off again in May of 2015 with more than 700 Adena employees participating, including Waverly and Piketon employees. An initiative improving healthier eating options in the APMC cafeteria was also implemented. The overall fruit and vegetable consumption was increased and labeling of fresh serve items was introduced. All of the Health & Wellness Programming again engaged more than 35% of the total employee population through these initiatives in 2015. Community Programming AHS Community Health Advancement will collaborate with community partners to implement broader scale health and wellness programs, centered around movement, nutrition and wellbeing, previously developed and piloted by the AHS internal employee health and wellness program. In addition, partnerships with local community agencies will be facilitated as part of a diabetes management initiative for high-risk diabetic patients. AHS Community Health Advancement collaborated with a variety of Pike community partners to coordinate and deliver community program aimed at promoting movement and nutrition. Programs based at or facilitated through the Pike Medical Center included: The Cyclemania event at the Pike County Fair, which is an annual bike race. More than 125 children participated in the race that offers a free t-shirt, bike helmet, and safety information. Winners of the races also receive a new bicycle. Sponsorship and participation in the Healthy Kids Event at the Pike YMCA and Ross County Public Library. With more than 800 in attendance, this event provided entertainment infused education on healthy living and an Easter egg hunt. AHS Community Health Advancement again collaborated with a variety of community partners to coordinate and deliver community programs aimed at promoting movement and nutrition. Programs included: Sponsorship and participation in the Healthy Kids Event at the Pike County YMCA where a health fair was coordinated. More than 800 children and parents utilized a passport to visit different booths where they were provided education (fitness and nutrition were focus for Adena). An Easter egg hunt ran concurrently with the event. The Cyclemania event at the 2015 Pike County Fair, which is an annual bike race. More than 50 children participated in the race that offers a free t-shirt, bike helmet, and safety information. Winners of the races also receive a new bicycle. The Move More challenge was expanded into the community (including neighboring counties) with six local employers (including the second and third largest employers in the region) promoting the challenge to their own employees. While employee participation for Adena employees was down 15% for 2015, participation overall with community involvement was increased by 22% from the previous year. Sponsorship of the Pike County Public Library s Healthy Kids portion of the Bookworm program. AHS provides small incentives to kids as they complete certain healthy activities during the program such as reducing screen time, eating healthier and getting active. Approximately 400 children from across Pike County participated in the program Obesity (cont.) Regional Initiatives AHS will coordinate a Community Health Advancement office to coordinate and implement regional information and awareness campaigns designed to inform the public The Community Health Advancement office was restructured in 2014. The Director for the office immediately started with coordination of the Employee Health & Wellness Committee which completed and began execution of its plan in August. In addition, a Corporate Events Coordinator was added to support the director facilitate event set-up and delivery, as well as align The community health focus and message, Move More, Eat Well was finalized and implemented in 2015. Banners for approximately 15 community events (county fairs, festivals, senior health fairs, employee health fairs and health expos) were displayed throughout six counties (Fayette, Ross, Highland, Pike, Jackson, and Pickaway) as well brochures and 3 P age

on the obesity epidemic, its impact on individual health and effective strategies at reducing and controlling weight, specifically movement, nutrition and weight. health and wellness programming with community events. A community health focus and message, Move More, Eat Better was finalized and set for implementation in 2015. educational information on physical activity and nutrition were distributed. Social media posts on benefits to proper nutrition and fitness were also posted on Facebook throughout the year. There were also two one hour radio programs featuring Adena physicians and representatives aired during 2015. Health Priority 2013 Proposed Implementation Strategies 2014 Actions/Progress 2015 Actions/Progress Secondary Health Priorities Mental & Behavioral Health Smoking Advocacy AHS/ARMC will support a variety of community partners including public health and social services to advocate for expanded access to mental and behavioral health services. This includes participating in Medicaid Expansion efforts to enable patient access to services. AHS/Community Health Advancement will inform legislators and public officials on the lack of mental and behavioral health services within the region, as well as possible strategies to address the need. Referral Resources AHS/ARMC will continue to operate the regions only acute inpatient, psychiatric unit for insured, uninsured and under insured patients. AHS/ARMC will collaborate with local mental and behavioral health providers to provide referrals to community mental health, behavioral health and material assistance resources. AHS/ARMC will provide financial and human resources to help maintain the local 2-1-1 network, a phone and web-based community resource platform that provides updated and on-demand to local social service, material assistance, mental and behavioral health resources. Cessation Resources AHS/ARMC will commit human and financial resources to expanding its opiate addiction program for pregnant women, as well as expanding access to male and non-pregnant women through an Ambulatory Detox program. Screening AHS/ARMC will implement screening tools within its Emergency Department and primary care clinics to assist physicians in identifying patients with mental health or social service needs. Cessation Resources AHS/ARMC will provide financial and human resources to coordinate a smoking cessation program. Screening AHS/Adena Cancer Center offers a free lung screening program to current and former smokers and in identified high-risk groups. Testing identifies the early signs of lung cancer or other disease. As one of 3 health system participants in the Strong Start Ohio project (from the Governor s Office of Health Transformation) AHS began delivering prenatal care to pregnant women with addiction issues using a CenteringPregnancy model at the Adena Regional Medical Center Campus. This project provided a monthly opportunity to inform the State of Ohio about barriers to achieving positive birth outcomes, including access to longer-term addiction treatment in southern Ohio. Approximately 10% of the 77 women served through the program in 2014 were from Pike County Ohio. The AHS Director of Community Health Advancement also served on the Southeast Ohio Medicaid Expansion Committee, to participate in efforts to expand Medicaid coverage to the region s residents. This group also informs state government on the need and benefit of affordable health care in southern Ohio. AHS continued to operate the region s only acute inpatient, psychiatric unit for insured, uninsured and under insured patients in 2014 at the Adena Regional Medical Center (including patients from Pike County). AHS Women s & Children s, Primary Care and Pain Management service lines made referrals for patients needing mental and behavioral health services in Pike County to the Adena Counseling Center, Paint Valley Mental Health Center, Adena Women s and Children s CenteringPregnancy program. AHS served a total of 25 women, 7 from Pike County, addicted to opiates as part of its CenteringPregnancy program in 2014. In addition, a work team was convened to review community need, demand and opportunities for expansion of current AHS mental and behavioral health opportunities. In 2014, each AHS primary care office implemented a screening policy to identify possible mental and behavioral issues with patients presenting in the emergency rooms of all Adena Health System hospitals. Along with provider smoking cessation counseling provided to patients self-identified as smokers, AHS has convened a work team to identify additional opportunities to identify and provide intervention to current smokers who are patients of Pike County AHS providers. AHS Cancer Center provided 194 patients with free lung screenings in 2014, with 13 patients who were identified with early stage lung cancer. AHS continued its support of multiple community partners in 2015 to advocate for expanded access to mental and behavioral health services. AHS continued delivery of prenatal care to high-risk pregnant women, including those with addiction issues using a CenteringPregnancy model at the Adena Regional Medical Center Campus. A total of 200 women (approximately 10% from Pike County) were served in 2015 with those participating in the program achieving better birth outcomes overall than those opted not to participate. This project provided a monthly opportunity to inform the State of Ohio about barriers to achieving positive birth outcomes, including access to longer-term addiction treatment in southern Ohio and will be reimbursed for in 2016. The AHS Director of Community Health Advancement continued participating in the Southeast Ohio Medicaid Expansion Committee, around efforts to expand Medicaid coverage to the region s residents. This group also informs state government on the need and benefit of affordable health care in southern Ohio. AHS continued to operate the region s only acute inpatient, psychiatric unit for insured, uninsured and under insured patients in 2015 at the Adena Regional Medical Center (including patients from Pike County). AHS Women s & Children s, Primary Care and Pain Management service lines made referrals for patients needing mental and behavioral health services in Pike County to the Adena Counseling Center, Pike County Community Action, Recovery Council, Paint Valley Mental Health Center, and the Adena Women s and Children s CenteringPregnancy program and Pike County Health Department s Vivitrol Program. AHS served a total of 114 women addicted to opiates as part of its CenteringPregnancy program in 2015 (including patients from Pike County). The work team convened to review community need, demand and opportunities for expansion of current AHS mental and behavioral health opportunities also developed relationships with Maryhaven and Compass Community Health to assist with expanding drug addiction support services, including housing, in Ross County which would be made available to qualified residents from Pike County. In 2015, AHS continued its screening policy to identify possible mental and behavioral issues with patients presenting in the emergency rooms of Adena Health System hospitals, including the Adena Pike Medical Center. The Adena Quit Clinic was piloted at the PACCAR/Kenworth Trucking Company in 2015. A total of 45 participants were served as part of the program that utilizes pharmacists, trained in the US Public Health Services 5 A s methodology, to assist tobacco users in cessation. The program will be expanded to Adena employees, including those who live in Pike County, in 2016. AHS Cancer Center provided 662 patients with free lung screenings in 2015 (including patients from Pike County), with 16 patients who were identified with early stage lung cancer. 4 A dena Health System CHNA Implementation Strategies

COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) Data Summary As part of the community health needs assessment (CHNA) process, both pr secondary data to identify priority health areas for the Ross County community. Secondary d collected on demographics, socio-economic determinants, disease prevalence, in addition to statistics data. A public survey and focus groups were also conducted to collect primary data health behaviors and environmental factors contributing to poor health. This data was then r health professionals from Pike County to determine health priorities. Figure 4 outlines the p issues prioritized in order as part of the CHNA. Top Causes of Death Heart disease Cancer Accidents and unintentional injuries Chronic lower respiratory diseases Top Health Issues Addiction Mental and behavioral health problems Obesity/diabetes Lung and respiratory issues Infant mortality and child protection Top Health Behavoirs Smoking Lack of physical activity Poor nutrition Limited use of oral and primary care Figure 4: Adena Pike County 2016 Community Health Needs Assessment Findings 5 P age

ADENA COMMUNITY HEALTH IMPLEMENTATION STRATEGIES Priorities The Adena Health System and the Adena Pike Medical Center utilized the Adena 2016 CHNA to develop a 2016-2019 Implementation Strategies Plan for the Adena Pike Medical Center (AGMC). AGMC is dedicated to ensuring the health system s vision of being instrumental in creating healthy, thriving communities. The findings from the assessment will be aligned and tracked by APMC s Board of Trustees and employees. In addition, it will be shared with local media and APMC s broad community partner base. This will contribute to awareness about Pike County s health priorities and progress in implementing community health improvement strategies. APMC utilized the Adena Pike County CHNA to prioritize the community health programming that will be implemented. Several of the strategies, are based on the successes of the 2013-2016 community health programming. A total of five strategies were identified to address the health needs based on the capability of APMC and participating community agencies to address the issue. Figure 5 outlines the 2016 Pike County community health priorities. Adena Pike Medical Center aligned its community health strategies and programming with the Adena Regional Medical Center CHNA. Although AHS and APMC may not be able to fully address all the needs identified, APMC will contribute to local coalitions and steering committees. This will enable Adena Regional Medical Center to contribute to cross system collaboration, visibility, and health communication. Community health programming will focus on the five areas: addiction; obesity/diabetes; lung and respiratory; mental and behavioral health; and infant mortality and child protection. An analysis, based from the report data was compared to current programming (2013 2016) results to establish programing outlines. Based off of current programming success, Adena Pike Medical Center will utilize five key strategies to address the five health priority areas. These include infrastructure building, advocacy, education, programming and financial support. Infrastructure development (Table 2) will consist of alignment with other, pertinent coalitions (i.e. Pike County Drug Abuse Prevention and developing task force), as well as partnering with other agencies to develop committees that currently do not exist for obesity and diabetes, respiratory and lung, and mental health. In addition, relationships with partners who may be able to provide services or parts of the continuum that are not currently in existence will also be sought. Advocacy will also be a key strategy. Adena Pike Medical Center currently has three employees who serve on the Pike County Health Coalition. Pike County currently has plans to convene a drug task force, which Adena will provide representatives. Adena Pike Medical Center will also utilize the Adena Health System marketing and communications department to create public service announcement around each of the five key health issues that be delivered via local radio, newspaper and the Health System s Facebook and Instagram pages which have more than 11,000 followers. Education is another strategy that will be utilized by Adena Pike Medical Center. The hospital will provide education on each of the five key issues via Walk With a Doc events to be coordinated on a monthly basis in Waverly, Here for Life Education events, as well as bi-yearly health expos. Programming is also another 6 A dena Health System CHNA Implementation Strategies

strategy that will be utilized to address the key community health priorities. Adena s Baby Centered Recovery program delivered at the Adena Regional Medical Center will serve pregnant women with addiction issues from the region, including Pike County. The Adena Family Fit program, operated in partnership with the Pike County YMCA, as well as Adena s Move More Challenge will be offered to address obesity and diabetes related issues. Adena s Quit Clinic and free lung cancer screenings will be offered to assist in addressing the lung and respiratory issues (related to smoking). All primary care physicians of Adena Health System will begin screening patients for depression and mental health issues in 2017 to help address the depression and anxiety in the community. Adena Health System will also provide financial support to a number of programs and initiatives operated by its community partners in Pike County. This includes drug prevention programs program operated by public schools in Pike County and support of Healthy Kids program operated by the local libraries as part of summer reading. Adena Health System will also support the improvement and expansion of the local 2-1-1 directory which will help navigate community members to all health and social services. Table 2 provides a summary of Adena s programs. Tables 3 through 7 provide a breakdown of how the strategies will be utilized for each priority health issue. 7 A dena Health System CHNA Implementation Strategies

Table 2: Adena Health System s Summary of Strategies for Top Health Priorities Adena Strategy Addiction (Table 2) Obesity (Table 3) Respiratory (Table 4) Depression (Table 5) Infrastructure Building Align with new Pike County Heroin Task Force Partnership with Maryhaven for services in Ross County (will serve Pike County residents) Convene a fitness and nutrition committee Develop standard health continuum progress reporting Employee Health Initiatives Convene respiratory and lung committee Develop standard health continuum progress reporting Convene a mental health committee / align with ADAMH Board Develop standard health continuum progress reporting Advocacy Provide Adena representative to with new Pike County Heroin Task Force Public Service Announcements Provide Adena Representative to committee Public Service Announcements Provide Adena Representative to committee Public Service Announcements Provide Adena Representative to committee Public Service Announcements Education Here For Life Education Series Here For Life Education Series Here For Life Education Series Here For Life Education Series Walk With a Doc Walk With a Doc Walk With a Doc Walk With a Doc Diabetes Expos Heart Health Expo Lung Cancer Awareness month Programming Baby Centered Recovery Family Fit Move More Adena Quit Clinic expansion Free Lung Cancer screenings Primary Care Depression Screening Financial Support Drug Prevention Program Healthy Kids Programs Smoking prevention 211 Directory 8 P age

Table 3: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Addiction Addiction Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Pike Medical Center will begin participation in the new Pike County Heroin Task Force. In addition, AHS will facilitate partnership with Maryhaven to provide individual outpatient therapy, medication assisted treatment and housing for recovering addicts in the region in and around Ross County Ohio, including Waverly and Pike County. Advocacy Adena Health System and Adena Pike Medical Center will continue participation in the new and developing Pike County Heroin Task Force. In addition, the communication and marketing department of Adena Health System will develop public service announcements to increase community awareness and education of drug use and services using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Waverly. One event will focus on drug addiction, intervention and treatment options. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held once per month in Pike County and Downtown Waverly and have approximately 50-60 in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on addiction symptoms and interventions Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Pike Medical Center. Programming Adena Regional Medical Center will continue to deliver the Baby Centered Recovery program. This is a nine month program that provides weekly medication assisted treatment and group counseling to pregnant women with addiction issues by an Adena Social Worker. Approximately 50 women per year from in and around Ross County are served through the program, including women from Pike County. Financial Support Adena Health System and the Adena Regional Medical Center will provide financial support to drug prevention program in Pike County high schools Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, reported drug and alcohol use and overdose deaths will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to overdose. AHS/AGMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. 9 P age

Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported drug and alcohol use. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) AHS/APMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/APMC has several community partners, including agencies participating in the Pike County Health Collaborative, that have expressed interest in collaborating on regional initiatives and community programming, including Scioto Paint Valley Mental Health, ADAMH and the Recovery Council. 10 A dena Health System CHNA Implementation Strategies

Table 4: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Obesity and Diabetes Obesity and Diabetes Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Pike Medical Center will participate with Pike County partners in convening an obesity and diabetes prevention sub-committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. AHS Community Health Advancement will continue operation an internal Health & Wellness team to create an evidence-based health and wellness platform by developing and refining programs for health system employees (residents of the service region) that can later be implemented on a larger scale in the community the following year. Advocacy Adena Health System and Adena Pike Medical Center will provide a representative to participate on the obesity and diabetes committee. In addition, the communication and marketing department of Adena Health System will develop public service announcements to increase community awareness and education of fitness and nutrition information using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in Waverly. One event will focus on obesity related interventions include diet and exercise. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held once per month in Pike County and Downtown Waverly and have approximately 50-60 in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on fitness and nutrition. Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Pike Medical Center. Programming Adena Health System and Adena Pike Medical Center will begin delivering the Adena Family Fit program at the Pike County YMCA. This is a six week program delivered for two hours once per week to approximately 10 families or 40-50 people. Dieticians deliver education and cooking tips, while YMCA representatives lead the groups in physical activity. Fitness and proper nutrition are the focus of the program. Adena Health System and Adena Pike Medical Center will continue to coordinate the Move More Challenge in Pike County. Approximately 1,000 people participate each year in the 12 week challenge designed to encourage at least 90 minutes of exercise per week. Adena Health System and Adena Regional Medical Center will fund and coordinate a Diabetes Expo and a Heart Health Expo in Pike County in 2017. These four hour events have providers and clinicians speak on disease, medication and nutrition management. Community partner provide cooking and fitness demonstrations as well. 11 P age

Financial Support Adena Health System and the Adena Pike Medical Center will provide financial support to the Pike County Bookworm/Healthy Kids Summer Challenge. Approximately 400 Pike County children sign up for the program each summer and are challenged to try healthy activities as part of the reading challenge. Small incentives are provided after challenges are completed. Anticipated Impact Impact Evaluation To develop and refine evidence-based health and wellness initiatives and programming, as well as using health risk assessment tools to measure impact and success rate. By starting with its employees, AHS will have the opportunity for greater success in initiatives delivered on a broad base to community. It is anticipated that reduction in key health indicators, blood pressure, blood glucose and BMI will be seen on engaged populations in the more immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to heart disease. AHS/APMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) Health Risk Assessment data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Health risk assessment data will evaluate the initiative and programming impact of the internal Health & Wellness program on employees. This will include movement in key obesity related risk factors such as blood pressure, blood glucose, BMI and cholesterol. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) AHS/APMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/APMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the YMCA, other local fitness centers, and the local health department. 12 A dena Health System CHNA Implementation Strategies

Table 5: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Respiratory and Lung Issues Respiratory and Lung Strategies Infrastructure building Advocacy Education Programming Actions Infrastructure Building Adena Health System and Adena Pike Medical Center will participate in convening lung and respiratory sub-committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. Advocacy Adena Health System and Adena Pike Medical Center will provide a representative to participate on a lung and respiratory committee coordinated with Pike County partners. In addition, the communication and marketing department of the hospital will develop public service announcements to increase community awareness and education on the dangers of smoking and lung cancer screening events using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Waverly. One event will focus on respiratory related interventions including smoking cessation. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held once per month in Pike County and Downtown Waverly and have approximately 50-60 in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 education on smoking cessation and the dangers of smoking. Education and smoking cessation will also be provided to patients who request information by physicians, providers and pharmacists of Adena Health System and Adena Pike Medical Center. Programming Adena Health System and Adena Pike Medical Center will continue to deliver the Adena Quit Clinic located on the campus of the Adena Regional Medical Center. This is a three month program delivered in 15 minute appointments with a pharmacist every two weeks to approximately 40-50 people per year. Adena Health System and Adena Pike Medical Center will also continue to coordinate free lung cancer screenings (CT scan) for more than700 patients each year at the Adena Cancer Center located on the campus of the Adena Regional Medical Center. Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, reported tobacco use and lung cancer occurrence will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower rates of death due to lung cancer. AHS/APMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported tobacco use, lung cancer occurrence and death. Aggregate data on patient population will be utilized to measure long term, 13 P age

Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) broad based community programming and initiatives, as well County Health Rankings data. AHS/APMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/APMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the Pike County Health Department. 14 A dena Health System CHNA Implementation Strategies

Table 6: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Mental and Behavioral Health Mental and behavioral health Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Pike Medical Center will participate with local Pike County partners in convening a mental health sub-committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. Advocacy Adena Health System and Adena Pike Medical Center will provide a representative to participate on the mental health committee. In addition, the communication and marketing department of the hospital will develop public service announcements to increase community awareness and education on mental health issues using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Waverly. One event will focus on depression related interventions. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held Once per month in Pike County and Downtown Waverly and have approximately 50-60 in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on depression and recognizing symptoms. Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Pike Medical Center. Programming Adena Health System and Adena Pike Medical Center will screen primary care patients starting in 2017. Adena provides more than 170,000 primary care visits per year. Referral to counseling and other community resources will be provided as needed. Financial Support Adena Health System and the Adena Pike Medical Center will provide financial support to the mental health committee, as well as Scioto Paint Valley Mental Health to support operation and improvement of the 2-1-1 directory housed by their organization. This phone directory provides navigation to many healthcare and social services, including mental health resources in a five county area including Pike. Anticipated Impact Impact Evaluation It is anticipated that reduction in key health indicators, poor mental health days and quality of life ratings will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower suicide rates and overdose deaths. AHS/APMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported poor mental health days and low quality of life ratings. Aggregate data on patient population will be utilized to measure 15 P age

Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) long term, broad based community programming and initiatives, as well County Health Rankings data. AHS/APMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/APMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the Scioto Paint Valley Mental Health Center, ADAMH, Recovery Council and FRS Services. 16 A dena Health System CHNA Implementation Strategies

Table 7: Strategies, Actions, Impact, Evaluation Commitment and Collaboration to Address Infant Mortality and Child Protection Infant Mortality and Child Protection Strategies Infrastructure building Advocacy Education Programming Financial support Actions Infrastructure Building Adena Health System and Adena Pike Medical Center will participate with local Pike County partners in convening an infant mortality and child protection committee. In addition, standard health continuum progress reporting and metrics will be developed for the group. Anticipated Impact Advocacy Adena Health System and Adena Pike Medical Center will provide a representative to participate on the infant mortality and child protection committee. In addition, the communication and marketing department of the hospital will develop public service announcements to increase community awareness and education on infant mortality and child abuse issues using local media and social media outlets. Education Adena Health System will coordinate a Here for Life education series that will provide education to approximately 50 participants during a two hour event in downtown Waverly. One event will focus on infant mortality and child protection issues. In addition, Adena will use its Walk With a Doc program to provide education on the topic. These events are held Once per month in Pike County and Downtown Waverly and have approximately 50-60 in attendance at both events. This is a one hour event where the physician leading the walk will provide a 20 minute education on safe sleep and infant care. Education will also be provided to patients who request information by physicians and providers of Adena Health System and Adena Pike Medical Center. Programming Adena Health System and Adena Pike Medical Center will provide bedside education to the more than 1,100 new parents that have babies at the Adena Regional Medical Center. Referral to community resources for cribs and car seats and other community resources will be provided as needed. Adena Regional Medical Center has the only emergency department within the region that has sexual assault nurse examiners on staff to assist, as well as an advocate team that supports children and adults who are victims of assault. Victims from all surrounding counties, including Pike County, are transported here for services. Financial Support Adena Health System and the Adena Pike Medical Center will provide financial support to the committee, as well as Scioto Paint Valley Mental Health to support operation and improvement of the 2-1-1 directory housed by their organization. This phone directory provides navigation to many healthcare and social services, including mental health resources in a five county area including Pike. It is anticipated that reduction in key health indicators, poor mental health days and quality of life ratings will be seen on engaged populations in the immediate future (5 years), with the longer term (10 years) effects resulting in lower suicide rates and 17 A dena Health System CHNA Implementation Strategies

Impact Evaluation Hospital Committed Program(s) and Resource(s) Planned Collaboration(s) overdose deaths. AHS/APMC will evaluate programs and initiatives to determine impact. The evaluation will be organized around the following domains: 1.) health survey data; 2.) public health data; 3.) aggregate patient population data; and 4.) County Health Rankings data. Public health survey data will evaluate the initiatives and programming impact. This will include movement in risk factors such as reported poor mental health days and low quality of life ratings. Aggregate data on patient population will be utilized to measure long term, broad based community programming and initiatives, as well County Health Rankings data. AHS/APMC will commit both human and financial resources directed through the Community Health Advancement office to coordinate, deliver and evaluate initiatives, and community programming. AHS/APMC has several community partners, including local agencies that have expressed interest in collaborating on regional initiatives and community programming, including the Child Protection Center, Scioto Paint Valley Mental Health Center, ADAMH, Recovery Council and FRS Services. ADDITIONAL INITIATIVES AND RESOURCES While Adena Health System and Adena Pike Medical Center have targeted programs towards many of the significant priority health needs identified in the 2016 CHNA, there are also other initiatives and resources that address these and other health concerns in the community. Unintentional injuries, in general, were not addressed as part of the implementation plan. The primary cause of unintentional injuries in Pike County is automotive accidents and drug overdose deaths. AHS and APMC does not have the capabilities or resources to deliver a driver safety campaign. The APMC does deliver Narcan and resource referrals to those presenting with a drug overdose in its emergency room. Adena Family Medicine - Residency Clinic The Adena Family Medicine - Residency Clinic is a hospital clinic providing affordable, quality health care. The Clinic pairs accessible primary care medical services provided by physician interns and residents of Adena s Graduate Medical Education program, family and internal medicine preceptors and a certified nurse practitioner also providing services to patients in the clinic. For more information, go to: http://www.adena.org/locations/department.dt/residency-clinic The Clinic at Walmart Chillicothe and Washington Court House In 2012, AHS entered into agreements to enhance access to high quality, affordable health care services in Chillicothe and Washington Court House at local Walmart stores in these respective locations. In each community, Adena opened and maintained a walk-in, retail clinic with extended evening and weekend hours. The clinic and its team specialize in quick, walk-in appointments for cold, flu, sinus infections, immunizations, sports and school physicals. 18 A dena Health System CHNA Implementation Strategies

Hope Clinic of Pike County The Adena Health System provides both financial and volunteer resources to the Hope Clinic of Pike County. Hope clinic provides free medical, dental and vision care to uninsured individuals from the surrounding region one evening per week at its location in Waverly. More than a dozen Adena nurses and physicians volunteer their time at the clinic. Community Health Programs AHS and APMC offers community health programs and events in various locations throughout the year to help our community lead healthier lives through wellness education and the prevention of illness and injury. Topics include, but are not limited to the following: cancer; diabetes; heart disease; bone and joint care; childbirth; multiple sclerosis; stroke; and wellness. Following these health seminars, an evaluation form is distributed to request feedback about both the content of the program as well as the speaker. It also asks for other topics of interest and general feedback. Adena Health System and Adena Pike Medical Center also provide free and reduced cost breast health screenings and diagnostics for qualifying patients as a grant recipient of Komen Columbus. More than 75 women, of which 15% are Pike County residents, are provided services through this program each year, AHS coordinated and facilitated the Head to Toe Expo at the Chillicothe Middle School in 2015 which engaged more than 200 community members on orthopedic and neurologic health issues. The event, attended by members of the Pike County community, included a vendor expo that showcased community health partners and Adena Health System services, provided blood pressure checks, diabetes information, and bone density screenings (there was no invasive testing ), as well as offered six concurrent education sessions and featured a celebrity guest speaker. Community Collaborations Adena Health System has three employees who participate as part of the Pike County Health Coalition. This coalition meets quarterly and has eight agencies that participate regularly as part of the coalition. Community Events AHS and APMC also participates in general health fairs/community events, employer health fairs and senior health fairs, often organized by other community organizations. At the general health fairs/community events, Adena provides bone density screenings, Ask the Doctor opportunities, diabetes information, pediatricians - general information, and geriatricians - general information. There is no invasive testing e.g., blood sugar, cholesterol, etc. at any of these events. 19 A dena Health System CHNA Implementation Strategies