Area Served El Paso County Priorities Obesity Intentional Injury Access to Care Community Health Implementation Plan (CHIP) FY 2017-2019 Community Health Action Plan (CHAP) FY 2018 (CHIP) FY 2017-2019 (CHAP) FY 2017 1
Introduction The Patient Protection and Affordable Care Act, enacted March 23, 2010, added new requirements for nonprofit hospitals to maintain their tax-exempt status, including a requirement to conduct a Community Health Needs Assessment (CHNA) once every three years to gauge the health needs of their communities and to develop strategies and implementation plans for addressing them. Additionally, following the CHNA a Community Health Implementation Plan (CHIP), which defines specific goals on how the prioritized needs will be addressed, is required. A yearly Community Health Action Plan (CHAP) will provide the specific actions and metrics for each goal. The CHNA, CHIP, and CHAP were conducted in compliance with these new federal requirements and as an opportunity for Penrose-St. Francis Health Services to fulfill our commitment to our organizational mission to extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. 2 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
chna Community Health Needs Assessment Every 3 Years Posted to www.centura.org and individual hospital websites. chip Community Health Implementation Plan FY2017-2019 An overarching 3 year strategy to address prioritized needs identified by the CHNA with specific goals. chap FY 2017 Community Health Action Plan FY 2017 A one year plan with specific, measureable, achievable, relevant, and time bound (SMART) goals and actions with an evaluation design. chap FY 2018 Community Health Action Plan FY 2018 A one year plan with specific measureable, achievable, relevant, and time bound (SMART) goals and actions with an evaluation design. chap FY 2019 Community Health Action Plan FY 2019 A one year plan with specific measureable, achievable, relevant, and time bound (SMART) goals and actions with an evaluation design. (CHIP) FY 2017-2019 (CHAP) FY 2017 3
Prioritized Need: Obesity El Paso County Health Department (EPCHD) data shows a trend of increasing obesity rates for all ages, but especially among our youth. The decision was made to narrow the focus on children and youth to include a targeted approach to families whenever possible, and to narrow the priority further to focus on specific disparately affected communities. El Paso County s low income population with low food access is 9.25% compared with Colorado s 6.4%. Recreation and fitness facility access of 9 per 100,000 populations is also lower than the Colorado population average of 10.8. Both of these factors assisted in determining strategy. In our community, 21.2% of adults are obese, compared to Percentage of adults who are overweight 37% 36% 35% 34% 33% 32% 31% 30% 29% 28% 36.9% Penrose-St. Francis Service Area 35.3% Colorado 20.2% in the state. Additionally, 36.9% of adults are overweight, compared to 35.3% of adults in Colorado. Research shows that this trend starts young. Overweight 5 year olds are 5x more likely to become obese adults. Reducing adult obesity rates are most effective when lifestyle changes can be introduced and accepted as a child or in young adulthood. In El Paso County 1 in 4 children are identified as overweight or obese. Our three goals for this priority utilizes the evidence-based practice approaches of breastfeeding and the incorporation of education and access for disparate communities to Healthy Eating Active Living. Partners and Inputs: St. Francis Medical Center Birth Center; Women, Infants, and Children (WIC); El Paso County Health Department (EPCHD); Peak Vista Community Health Center, Penrose-St. Francis OB Providers; Penrose-St. Francis Neighborhood Nurse Centers; Southeast Soccer Initiative; Build Health Challenge ( ACCESS) Program; YMCA; Live Well Colorado; Churches and Schools; Care and Share; EPCHD Supplemental Nutrition Assistance Program (SNAP); Community Partnership for Child Development; Pikes Peak United Way; Build Health Challenge. 4 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
Goal 1 Obesity across the lifespan begins through an intentional focus on breastfeeding through advanced education and support regarding benefits of breast feeding that include the reduction of obesity. ACTIVITY 1: Cultivate the Baby Friendly Hospital national designation for St. Francis Medical Center to include staff and community education with special emphasis on low income mothers and the barriers they identify. METRICS (How we did for FY17): National designation awarded March 2017. National Baby Friendly designation by December 2018 to include required 100% staff education and 50% breast fed babies when discharged. ACTIVITY 2: Develop education model for addressing cultural awareness including the culture of poverty for educational partners to assist with discharge planning for all breast feeding parents. for FY17): Model developed for implementation of classes in place June 30, 2017. Two educational classes based on Culture of Poverty to be held in FY 2017-18 with emphasis on breast feeding moms. Model development is on track for implementation in FY2017-2018. Building Bridges to healthcare was co-sponsored with Community Health Partnership (CHP) in May 2017. ACTIVITY 3: Collaborate with community partners to identify gaps in processes for the support of breast feeding moms post hospital discharge. for FY17): Cooperative process in place with/through St. Francis Medical Center, WIC, PVCHC, and community providers. Provide alternative community options for obtaining breast pumps and education classes for breastfeeding moms by July 2017. 100% of new moms who choose to breast feed will have needed access to breast pumps and supportive education prior to hospital discharge by December 2017. (CHIP) FY 2017-2019 (CHAP) FY 2017 5
ACTIVITY 4: Identify culturally appropriate sites to offer supportive education for mothers who choose breastfeeding. Goal 2 METRICS (How we did for FY17): Culturally appropriate neighborhood sites will be identified through the Neighborhood Nurse Centers. Complete-Westside Community Center, Mercy s Gate, and The Care Center identified as culturally appropriate sites. Identify and improve access to low or no cost physical activity opportunities for school age children in identified disparate areas of El Paso County. ACTIVITY 1: Identify and convene sustainable community partnerships to map current low/no cost and safe physical activities as well as current participation numbers. for FY17): Community mapping of current and potential activities that increase physical activity in children that are currently available in targeted areas by February 2017. Mapping completed according to Build Health Partnerships. ACTIVITY 2: Develop a community plan to increase participation in low/no cost activities for children in targeted areas. METRICS (How we did for FY17): Utilizing mapping, develop process by July 2017 for disseminating and promoting identified activities and resources within potential community organizations such as schools, churches, day cares, and community centers. Meeting with El Paso County Health and Build Health Project to review and disseminate information. 6 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
ACTIVITY 3: Develop a community plan to increase participation in low/no cost activities for children in targeted areas. Goal 3 METRICS (How we did for FY17): Working on community plan to identify partners. Convene and collaborate with community partners to identify resources for 2-3 new access programs by July 1, 2019. Identify and improve access to food sources utilizing evidenced based strategies that lead to a reduction in food insecurity and hungry in identified disparate areas of El Paso County. ACTIVITY 1: Collaborate with community partners to survey food sources in the targeted zip code areas to include food banks, community gardens, WIC and SNAP resources, and eligible children enrolled in school lunch programs. for FY17): Map available resources for food distribution in targeted areas. Completed by December 2016. Completed with Care and Share. Develop a flyer specific to food resources in targeted areas. Those flyers to be distributed in those identified zip codes by July 2017. Increase pantry participants, by 10%, from 2017 to July 2018. ACTIVITY 2: Implement a pilot food insecurity screening utilizing the USDA 6 question screening tool. for FY17): Screening Tool disseminated in 8 community food pantries, 14 CPCD collaborative sites, as well as the CPCD Website. Assess screening tools and utilize collated information for determination of community food access needs by December 2017. ACTIVITY 3: Identify 4 new community programs per year to increase food access in the targeted area. One CPCD program, one church, and one Penrose-St. Francis Neighborhood Nurse Center. for FY17): Four new SNAP program collaborations implemented in 2017. Collaborative work begun with CPCD and Fountain Community Collaborative, as well as El Paso County Health Department Healthy Community Collaborative. Collaborate with community partnerships to implement 4 new sites targeted through USDA screenings conducted by July 2018. (CHIP) FY 2017-2019 (CHAP) FY 2017 7
Prioritized Need: Intentional Injury; Youth Suicide Penrose St. Francis and its community partners identified Intentional Injury as an urgent issue in our community. As such, we have prioritized youth suicide and have developed an implementation plan that brings our hospital system resources in partnership with community resources to address this need. Our strategy is to build community and organizational capacity to improve utilization of evidence based practices in mental health screenings and trainings to increase awareness and referrals to appropriate resources in cooperation with community partnerships addressing the issue of youth suicide and mental health. Partners and Inputs: Behavioral Health and Psychiatric Emergency Triage Team (PETT), Neighborhood Nurse Centers, Aspen Pointe, Colorado Springs Fire Department Crisis Response Team (CRT), El Paso County Health Department, Peak View Behavioral Health, Communities of Faith, Suicide Prevention Program, EPCHD Child Fatality Review Team Teen Suicide Prevention Program, Mental Health Begins with ME, CHI Violence Prevention Initiative, Build Health Challenge (Access), Peaceful Households, Safe to Tell, Social Services Agencies, Neighborhood Nurse Centers, YMCA, NAMI, Faith Based Organizations. Suicide Rate per 100,000 20 15 16.2 17.2 10 10.2 5 0 Penrose-St. Francis Service Area Colorado Healthy People 2020 8 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
Goal 1 Develop coordinated efforts to promote and implement programs to identify risk and early indicators of mental, emotional, and behavioral problems among youth and ensure referral to appropriate resources. ACTIVITY 1: Survey current screening tools used in all Penrose-St. Francis-affiliated physician and in-patient programs and community partners to identify youth at high risk for suicide. Provide survey results with feedback on appropriate researchdriven recommendations to all those surveyed. for FY17): 25 surveys completed and analyzed with recommendation provided to surveyed providers on most utilized tools that comply with current research and provide best practice for suicide intervention in high risk youth by March 1, 2016. By June 2018, 50% of surveyed providers will be utilizing recommended tools within the EMR systems and a completed evaluation of the process will be completed. ACTIVITY 2: Contribute in concerted teen suicide prevention partners and current community collaborative to define a gap analysis of referral resources for high risk youth to include the Penrose-St. Francis School Based Health Center in Cripple Creek. Goal 2 METRICS (How we did for FY17): By July 1, 2017 a gap analysis will be complete. We will disseminate a resource referral tool that will be used to assist clients with timely and appropriate referrals to social services and partnering networks in order to support and treat high-risk youth with suicidal ideations. By July 1, 2018 therapist will be surveyed and resource referral tool will be evaluated for effectiveness within the teen suicide collaborative. Develop coordinated effort to implement and promote Penrose-St. Francis internal and external community training in Adverse Childhood Experiences (A.C.E), Mental Health First Aid (MHFA), and Youth MHFA training to identify signs of depression and suicide for early intervention and stigma reduction. (CHIP) FY 2017-2019 (CHAP) FY 2017 9
ACTIVITY 1: Collaborate to provide quarterly ACE, MHFA, and Youth MHFA and suicide prevention trainings through Penrose- St. Francis, schools, community, and faith-based partnering sites. for FY17): Completed 7 classes/trainings with 225 participants so far. Provide 12 training by July 2019 with minimum of 500 total participants to community partners. ACTIVITY 2: Use evaluation tools for trainings and analyze responses to determine effectiveness in understanding of mental health issues. METRICS (How we did for FY17): 75% of participant evaluations will show an increase in understanding of mental health illness. Complete. ACTIVITY 3: Promote and assist with suicide stigma reduction education with partner organizations both internally and within the community. METRICS (How we did for FY17): 4 completed weekly sponsorship of NAMI s provider education from September 12 October 13, 2016. 25 participants total. Sponsored Teen Suicide Prevention education programs with pre-post testing to measure level of awareness for those at risk of committing suicide. We will hold a minimum of 6 programs by July 2019. ACTIVITY 4: Provide education and supportive opportunities for Faith Community Partners in utilizing the role of faith as a prevention tool. for FY17): Working on planning to partner with Faith Community Partners. Convene faith based group to collaborate to support programming in faith communities. Four faith based youth groups to host education program each year for a total of 12 programs by July 2019. ACTIVITY 5: Create Gatekeeper Model to assist LGBTQ. for FY17): Gatekeeper Model in place with utilization process evaluation by June 2017. Complete model in place. 10 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
Prioritized Need: Access to Care In addition to the above prioritized health needs, Penrose St. Francis Health Services recognizes that access to care is a critical factor to assess, screen, and provide treatment that improves and maintains health and we have a primary duty to ensure we address barriers to access, and link our communities to the care they need have a major effect on each of the prioritized areas. The Colorado Health Institute estimates around 31,000 residents of El Paso County are yet to remain uninsured that would qualify for an insurance product. Center ( PVCHC), AspenPoint, Penrose- St. Francis Neighborhood Nurse Centers (PENROSE-ST. FRANCIS NNC), Coordinated Access to Community Health (CATCH), El Paso County Health Department (EPCHD), Pikes Peak United Way (211), Enroll America, Churches and Schools, CHPG neighborhood primary care practices, YMCA. Additionally, the recent expansion of Medicaid has greatly increased the number of patients in our communities seeking specialty care. This increased demand has led to access barriers for our Medicaid populations who are typically the most vulnerable and underserved members of our community. Partners and Inputs: Centura Health Advocates ( CHA), Peak Vista Community Health (CHIP) FY 2017-2019 (CHAP) FY 2017 11
Goal 1 Increase number of El Paso County residents who receive assistance in the enrollment process leading to an insurance product. ACTIVITY 1: Recruit Enrollment specialist/ CHA to staff all outreach activities connected to the Penrose-St. Francis NNC sites. for FY17): Increased number of outreach enrollment events to include a partnership with El Paso County Health Department and Connect for Colorado to co-locate at outreach sites. Increase outreach efforts and Medicaid enrollment by 15% to 1090 beneficiaries. ACTIVITY 2: Provide and assess enrollment assistance and navigation information to community agencies without their own specialist on site. Goal 2 METRICS (How we did for FY17): Ten new agencies will have received enrollment education and five will have enrollment options for their clients by June 2017. Exceeded 7 school-based health care centers. Increase health insurance and health care literacy for newly enrolled community members needing assistance navigating the health care systems. ACTIVITY 1: Develop and distribute a navigation tool for residents that may need referral or literacy resources to further enable access to care. for FY17): 1. Navigation Literacy tool completed by December 2016. 2. Distribution and evaluation of tool by June 2017. Based on 2017 evaluation, make adjustments to tool and distribute to 10 new sites by July 2018. ACTIVITY 2: Develop screening survey tools for NNC to use in social ministry and community sites for assessing insurance and health care access literacy. for FY17): Decreased # of patients not enrolled in Medicaid or insurance product as evidence by CHI statistics by June 2017. Complete, screening survey tool in place. 12 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
The Socio-Ecological Model that Informs Our Goals To achieve long-term health outcomes among our communities, changes at every level of the model will both support people making the healthy choices and removing the barriers to making the healthy choices. Public Policy Community Cultural values, norms Organizational Environment, ethos Interpersonal Social network Individual Knowledge, attitude, skills (CHIP) FY 2017-2019 (CHAP) FY 2017 13
Population Demographics in Penrose-St. Francis Health Services s Area Race Ethnicity n White 81.11 n Black 6.34% n Asian 5.54% n Native American/Alaska Native.77% n Native Hawaiian/Pacific Islander.32% n Other 4.99% n Multiple races 5.18% Non-Hispanic 84.93% Hispanic 15.07% 0% 20% 40% 60% 80% 100% 14 PENROSE-ST. FRANCIS HEALTH SERVICES/CENTURA HEALTH
Associate s Degree or Higher PSF Service Area State Average 45.5% 44.7% High School Graduation Rate PSF Service Area State Average 78.4% 77.6% Limited English Proficiency 4.2% PSF Service Area 6.7% State Average Unemployment Rate 5.1% PSF Service Area 4.0% State Average Households Below 200% of Federal Poverty Level 29% PSF Service Area 29.6% State Average (CHIP) FY 2017-2019 (CHAP) FY 2017 15
Douglas Legend Stark Service Area Centura Facilities v Hospital "? NHC GF Urgent Care! Other Perry Park ST 105 ST 18 Larkspur ST 83 Kiowa Penrose St. Francis Stark ST 86 Service Area Facilities Map Elbert Elbert CO-86 Westcreek 25 ST 67 US-2 4 Divide Cripple Creek GF Pike National Forest Woodland Park Green Mountain Falls US-24 W Cascade 24 Palmer Lake Monument!! GF "? United States Air Force Academy United States Air Force Academy Gleneagle CO- 8 3 S Manitou!! Springs!! Penr ose Colorado Springs!! v!! v ST 21 E Platte Ave "? 24 85 "? CO-115 N "? CO-21 N GF! ST GF 83 Stratmoor Fort Carson Black Forest St Francis Cimarron Hills El Paso ST 217 ST 94 24 Peyton CO-94 Calhan Victor Teller ST 16 Fountain 25 Fremont ST 115 Fort Carson GF "? CO -67 50 CO-115 Penrose Pueblo Penrose Hospital (Penrose-St. Francis Health Services) 2222 N. Nevada Avenue Colorado Springs, CO 80907 719-776-5000 www.penrosestfrancis.org