Providence Hood River Memorial Hospital 2010 Community Assets and Needs Assessment Report Produced by Lauren M. Fein, M.P.H. How the study was conducted Every three years, Providence Hood River Memorial Hospital assesses the needs and assets of Columbia River Gorge communities with a focus on Hood River County. This, the fourth and most comprehensive Community Assets and Needs Assessment (CANA), differentiates survey respondents and focus group participants as either recipients or providers of health care, social services, education or faith-based services. This method highlights differing opinions of health needs based on one s perspective within our community. Recipients of care, who include Hood River County Fair attendees, community members and packing-house workers, were asked to prioritize unmet health needs by reflecting on their individual health concerns. Providers of care, who include faith leaders, educators and school district staff, and medical and social services providers were asked to highlight the critical unmet health needs that most affect the population sectors with which they work and prioritize based on personal opinion the top needs using a dot-voting method. Top health priorities identified by recipients of care in Hood River County: 1) Chronic disease support and management 2) Access to primary care 3) Preventive health care 4) Basic needs 5) Community based behavioral health Top health priorities identified by providers of care in Hood River County: 1) Basic needs 2) Community based behavioral health 3) Preventive health care 4) Access to primary care 5) Access to health insurance
CANA by the numbers 135 people interviewed in 11 focus groups; results were prioritized using a dot-voting method 101 online surveys from medical service providers, faith leaders and school district staff 274 Oregon Health Study surveys conducted at the Hood River County Fair and a community meeting in Cascade Locks 304 additional OHS surveys from individuals on the OHP waitlist in our service area o Data analysis conducted by Providence Center for Outcomes Research Education Total sample size represents 814 community members; roughly 3.7 percent of the Hood River County population The CANA: Identifying community assets and unmet health needs We examined the community by differentiating six different sectors to include: ages 0 to 12, ages 13-19, single adults, couples and families, the elderly and diverse populations. We targeted service providers of care who work directly with these specific sectors. Focus groups were held with the following agencies: Hood River Country Commission on Children and Families Early Childhood Intervention, Faith Connection Coalition, Mid-Columbia Center for Living, Providence Gorge Counseling & Treatment Services, La Clinica Del Carino Family Health, The Next Door Inc., Hood River County Health Department, Providence Hood River Memorial Hospital medical staff, Hood River Fire/Emergency Medical Services, and Age with G.R.A.C.E. LLC. In addition, we met with two community groups viewed as recipients of care, including a local Latino cherry-packing crew and a citizen group from Cascade Locks. While each of these groups shared many of the same concerns, each brought different perspectives on what critical unmet health needs are facing our community and what services currently exist to serve the community. Community Assets: Strength in collaboration Major community health assets identified by survey respondents include the programs and services of the agencies listed above as well as the Commission on Children and Families, Alcohol, Tobacco and Other Drug Prevention Coalition, WINGS, Lions Clubs, F.I.S.H. Food Bank, Providence Hood River Mobile Health Unit, Head Start, Health Media Clubs, prescription assistance, Women Infants and Children (WIC) program, local faith group initiatives, Community Education and after-school programs. In addition, the Oregon Community Foundation highlighted the following community assets in their recent site visit to Hood River: robust social capital, integrated community, strong volunteerism ethic, connected faith community, collaborative nonprofit organizations and grassroots philanthropy. Identifying each of these assets helps us to build on success and use proven programs to help meet needs.
Providence Health & Services CANA health need categories Access to health insurance Access to medications Access to primary care Access to inpatient care Basic needs Care navigation Chronic disease management Community based behavioral health Culturally competent care Dental care End of life care Environmental health Inpatient behavioral health Long term care Preventive health care Unemployment/livable wages CANA purpose, background and methodology The CANA process undertaken in Hood River County utilized a variety of methods to collect data. In addition to focus groups and one-on-one interviews, several surveys, partner agency data and local statistics were used to assess the top unmet health needs facing our community. The identified needs were prioritized by respondents based on personal opinion and individual experience. The primary goal of the CANA process is to identify unmet health needs; especially those Providence can act quickly on through health care delivery, and those that strategically direct our resources toward preventive health efforts. This work is often accomplished in partnership with many of the local agencies identified as community assets. A comprehensive report is produced to support our partner agencies and organizations efforts as we work together to better serve the community and as we build a platform for collaboration and consensus building around priority goals. In addition, this report can also serve as a supportive document when seeking grant funding.
Analysis of top overall health needs identified by recipients and providers of health, faith education and social services What do Basic Needs mean to Hood River County? Childcare Debt Domestic violence Families in crisis Food and nutrition Healthy homes Housing Immigration status Neglect Poverty Single parenting Stress due to deportation Transportation Basic needs received 17 percent of overall votes. They made up 10 percent of needs identified by recipients of care and 14 percent of needs identified by What does Chronic Disease Management and Support mean to Hood River County? Allergies Arthritis Asthma Cancer Chronic pain Diabetes Disabilities Heart disease High blood pressure Obesity Chronic disease support and management received 16 percent of overall votes. It made up 46 percent of needs identified by recipients of care and four percent of needs identified by What does Access to Primary Care mean to Hood River County? Deferred care when patients neglect to treat illness, follow-up or seek well-care Financial barriers to needed care Geographic barriers limiting access to care Transportation to appointments Access to primary care received 12 percent of overall votes. It made up 17 percent of needs identified by recipients of care and 10 percent of needs identified by What does Community Based Behavioral Health mean to Hood River County? Addiction treatment Depression Drug/alcohol abuse Family and couples' counseling needs Isolation Therapy for victims of child abuse Mood problems Stress Community based behavioral health received 12 percent of overall votes. It made up eight percent of needs identified by recipients of care and 14 percent of needs identified by What does Preventive Health Care mean to Hood River County? Age appropriate activities Education Fall prevention No library Safety Screening Social and physical activity Nutrition Teen pregnancy Vaccinations Preventive care received 12 percent of overall votes. It made up 12 percent of needs identified by recipients of care and 12 percent of needs identified by What does Access to Health Insurance mean to Hood River County? Ability to access health insurance Assistance with selecting plans (OHP, Medicare) High deductibles Lack of insurance Services not covered by insurance Underinsured Uninsured Access to Health Insurance received six percent of overall votes. It made up 12 percent of needs identified by Recipients of care did not raise this issue.
The Oregon Health Study survey: Assessing recipients of care at the Hood River County Fair The CANA team was granted access to use the Oregon Health Study survey (OHS) to assess and identify issues related to access to care, utilization of care, financial barriers to care and selfreported health status. We administered surveys to 274 Hood River County residents at the Hood River County Fair and at a Cascade Locks community focus group meeting. The issues highlighted by the OHS survey results support findings from other recipients of care about concerns of chronic disease, access to care, preventive care, and issues meeting basic needs. OHS demographics for Hood River County Respondents included: 65 percent female 20 percent unemployed 69 percent white/non-hispanic 26 percent Hispanic 79 percent with some form of insurance (See bar graph below for more detail) 60 percent with less than a high school education Eight percent with a four-year college degree or more 85 percent with a usual source of health care mainly a private doctor s office or clinic 64 percent needed care in the last six months; 15 percent of this group could not access care due to cost, lack of insurance or other issues (see pie chart below for more detail) 29 percent owed money to a provider, credit card company, or other party for medical expenses; 14 percent owed $500 or more 21 percent have had to borrow money, skip paying other bills or pay other bills late to cover health care costs Nine percent had a physical, mental or emotional problem limiting their ability to work 46 percent have been diagnosed with a chronic disease like diabetes, cancer, heart disease or high blood pressure Source of Insurance for Respondents 50% 46% 45% OHP 40% 35% 31% 37% Medicare 30% 25% 20% 15% 10% 5% 10% 5% 15% 11% 12% 19% 6% 1% 6% Employer Sponsored Plan Private Coverage Uninsured 0% Non-Hispanic (N=203) Hispanic (N=71) Other
Reasons for Unmet Health Needs Cost too much No insurance 12% 4% 12% 8% 48% Doctor refused insurance type Owed money to provider 12% Couldn't get appointment 4% 44% Office wasn't open Didn't have a doctor Other 2011-2013 Community Benefit Plan Based upon the findings of our 2010 Community Assets and Needs Assessment and with input and validation from community partners, the following goals and strategies are proposed: Goal 1: Mental Health and Substance Use Goal 2: Chronic Condition Management and Support Goal 3: Preventive Care Services Goal #1a: Low-income residents of Hood River County will report improved access to mental health services and a decrease in rates of untreated depression and poor mental health days. Strategies: 1. Support a pilot demonstration of integrated behavioral health in the context of a patient-centered medical home or school-based clinic approach. 2. Restructure Gorge Counseling and Treatment to improve services to the target population. 3. Explore development of mental health hold room. 4. Convene the following agencies to further understanding and development of programs: La Clinica del Carino, PMG internal medicine clinics, Gorge Counseling and Treatment Services, primary care and other providers, Mid-Columbia Center for Living
Goal #1b: Low-income residents of Hood River County will report improved access to effective substance abuse treatments and services. Strategies: 1. Convene a substance abuse summit, offering networking and education for local health care and social service providers to improve referral quality and access to appropriate treatment. 2. Develop strategies to increase the capacity of schools and/or outpatient programs to provide substance abuse treatments and services for youth and adolescents 3. Convene the following agencies to further understanding and development of programs: Gorge Counseling and Treatment Services, Mid-Columbia Center for Living, Comprehensive Mental Health, local primary care and other providers, Service Area school districts, Service Area health departments, Hood River County Commission on Children and Families. Goal #1c: Children who are victims of abuse and neglect from low-income households will have access to specialized mental health treatments and services. Strategies: 1. Sponsor and equip local mental health providers with specialized training to address the unique needs of children who are victims of abuse or neglect. 2. Convene the following agencies to further understanding and development of programs: Columbia Gorge Children s Advocacy Center, Mid-Columbia Center for Living, Gorge Counseling and Treatment Services, local private practice mental health providers, pediatric health care providers, County Victim s Assistance programs, New Parent Services, Healthy Start, Head Start. Goal #2: Low-income residents will have improved access to primary care, education, medications and assistance in navigating the health care system to improve and manage their chronic conditions. Strategies: 1. Develop educational methods and materials that are culturally-competent and focused on assisting individuals in understanding their diagnoses and the complexities of their medical issues. 2. Explore development of culturally-comptetent models and resources proven to be effective in management of chronic disease such as: medical home, community health workers, education, case management and electronic health management applications. 3. Support training resources and promote participation in the Living Well With Chronic Conditions program in Hood River County.
4. Continue to leverage medication resources through Providence s current medication assistance program (MAP) and explore opportunities to optimize community resources through collaboration with other MAP s. 5. Continue dialogue with Hood River County Health Department to integrate chronic disease management and support and CDC Change Assessment recommendations. 6. Identify and support existing best practice models in the community. 7. Improve access to care via improved transportation services for target populations in outlying communities. 8. Convene the following agencies to further understanding and development of programs: Hood River County Health Department, Mid-Columbia Council of Governments, primary care clinics, La Clinica del Carino, The Next Door, Inc., Better Health for Busytown hotspotter project, Faith in Action Providence Community Caregivers, Oregon State University Extension. Goal #3: Low-income residents will have improved access to primary care, education, treatments and services that focus on the prevention of chronic illness and disease. Strategies: 1. Facilitate the establishment of Mid-Valley Community Resource Center; support and staff health education programming for low-income adults and children with focuses on nutrition, physical activity, well-child check-ups and immunizations. 2. Explore expansion of the community health worker model to improve health literacy, nutrition and physical activity access to primary care and utilization of preventative services, for Hispanic, low-income, and limited education populations, such as immigrants and farmworkers. 3. Deploy community benefit resources to improve access and utilization of preventive primary care services through local clinics. 4. Continue community initiatives to improve nutritional health and food security for target populations through support of food banks, community gardens and education. 5. Participate in school and community initiatives to promote physical activity, especially in youth and adolescents. 6. Convene the following agencies to further understanding and development of programs: Healthy Active Hood River County coalition, HRC Health Dept., Mid-Valley Elementary, local providers and clinics, FISH food bank, Hood River Middle School garden project, Hood River Valley High School athletics, Gorge Grown Food Network, Happy Wheels Foundation, Oregon State University Extension
Giving Back to Gorge Communities: Providence Hood River Community Benefits Providence cares about the people of the Columbia River Gorge and is committed to helping meet their health care needs, regardless of their ability to pay. Throughout our history, Providence has responded to community need, with special concern for the most vulnerable. During these times of economic stress we have found strength in joining hands with many community organizations to support and care for those facing hardship. During 2010, Providence Hood River provided $6.3 million in community benefits, including $3.8 million in free or reduced-cost care to our patients in need. Across Oregon, Providence provided more than $203 million in community benefits. To learn more about Providence s community benefits program, please visit www.providence.org/cares.
This report was produced in part through the generous commitment of time and energy of local health care providers, community leaders, key stakeholders, faith groups, teachers, counselors, school district staff and members of our community. We are grateful for your contributions and welcome your comments and feedback on this report and input on ways it may be improved in the future. PROVIDENCE MISSION: As People of Providence we reveal God s love for all, especially the poor and vulnerable, through our compassionate service. CORE VALUES: Respect Compassion Justice Excellence Stewardship www.providence.org/hoodriver