Community Health Needs Assessment 2013 Akron Children s Hospital Mahoning Valley Beeghly Campus 6505 Market Street Boardman, Ohio 44512 www.akronchildrens.org
TableofContents ExecutiveSummary...2 Background Purpose...3 RequestCopiesandMoreInformation...4 DescriptionofHospitalFacility...4 DescriptionofCommunityServed...5 Methodology Approach...7 EpidemiologicData...8 CommunityLeaderInterviews...9 CommunityResidentFocusGroups...10 OtherCommunityHealthNeedsAssessments...14 PrioritizationProcess...15 CommunityResources...16 SummaryofResults...19 Conclusions...20 Acknowledgements...22
CommunityHealthNeedsAssessment EXECUTIVESUMMARY Akron Children s Hospital operates two hospitals: one at its Akron campus and one at its Beeghly campus in Boardman, Ohio in Mahoning County. The area s only pediatric hospital, AkronChildren shospitalmahoningvalleyopenedindecember2008.thisnon[profit,32[bed pediatrichospitaloffersafullrangeofpediatricservicestothechildrenofthemahoningvalley and surrounding areas, including access to a 24/7 emergency department, laboratory, radiology, outpatient surgical center, endocrinology, rehabilitation and EEG/ECHO/EKG services,aswellasahematology/oncologyclinicandinfusioncenterandchildadvocacycenter. In 2013, Akron Children s Hospital Mahoning Valley partnered with Kent State University to conduct a Community Health Needs Assessment (CHNA). During the CHNA process, epidemiologic data were reviewed and compared to the rates for Trumbull, Mahoning, and Columbiana Counties to two peer counties, the state, the nation, and Healthy People 2020 objectives. Input was also obtained from community leaders and community residents and CHNAsconductedbyothercommunitygroupswereconsulted.Allofthisinformationwasused todevelopalistofprioritizedhealthneedsforchildrenintrumbull,mahoning,andcolumbiana Counties. Theunrankedlistofprioritizedhealthneedsforchildrenthatwereidentifiedacrossallthree countieswere: ChronicDiseases Asthma Diabetes MaternalInfantHealth PrematureBirths LowVeryLowBirthWeight Infant,Neonatal,Post[NeonatalMortality ChildLifestyleFactors OverweightObesity Exercise Nutrition MentalHealth SubstanceAbuse OpioidDrugAbuse SexuallyTransmittedDiseases AdolescentGonorrhea AccesstoHealthCare HealthInsuranceCoverage AccesstoDentalCare MentalHealthInsuranceCoverage NumberofPediatricSpecialists EnvironmentalFactors AccesstoHealthyFood TheseprioritizedhealthneedsarebeingusedbyAkronChildren shospitalmahoningvalleyto guideinterventionandoutreacheffortsaimedatimprovingcommunityhealth. Background information on the CHNA, the methodology used to conduct the CHNA, and the results of the analysis are contained in this report. The activities undertaken by Akron Children shospitalmahoningvalleytoaddresstheseprioritizedhealthneedsarecontainedin the ImplementationStrategy, whichisalsolocatedonthehospital swebsite. 2
CommunityHealthNeedsAssessment BACKGROUND Purpose In keeping with Akron Children s Hospital s mission, relationships have been established with variouscommunityandprofessionalorganizationswhosharecommongoalsforthedeliveryof servicestochildrenandfamilieswithafocusonaccessandimprovementofhealthoutcomes. To better identify the health needs of the community, Akron Children s Hospital Mahoning ValleyengagedinamoreformalizedprocesswithKentStateUniversitytoprovideaCommunity HealthNeedsAssessmenttovalidateandprioritizetheneedsofthecommunityweserve. InMarch2010,theUSCongresspassedandPresidentObamasignedthePatientProtectionand AffordableCareAct(ACA).TheACAcontainsnumerouschangestotheUShealthcaresystem, including requiring non[profit hospitals to conduct CHNAs every three years. The Internal Revenue Service (IRS), the federal agency that is charged with enforcing these new requirements, has issued regulations pertaining to these new reporting requirements ofnon[ profithospitals.theseregulationsrequirechnastoincludeadescriptionof: Thecommunityservedandhowitwasdefined; Theprocessandmethodsusedtoconducttheassessment,includingadescriptionofthe sources and dates of the data and other information used in the assessment and the analyticalmethodsappliedtoidentifycommunityhealthneeds; Theinformationgapsthatimpacttheabilitytoassesshealthneeds; CollaboratinghospitalsandvendorsusedwhileconductingtheCHNA; How input was receivedfrompersonswhohave expertise in public health and from personswhorepresentthebroadinterestsofthecommunity,includingadescriptionof whenandhowthesepersonswereconsulted; The prioritized community health needs, including a description of the process and criteriausedinprioritizingthehealthneeds; Existing health care facilities and other resources within the community available to meettheprioritizedcommunityhealthneeds; AkronChildren shospitalmahoningvalleyhasalonghistoryofcollaborationonawiderange of projects aimed at improving community health. The results of this CHNA will help guide theseinterventioneffortsandwillalsoactasaresourceforothercommunitygroupsworking towardimprovingthehealthofthecommunity. 3
CommunityHealthNeedsAssessment RequestCopiesandMoreInformation Inadditiontobeingpubliclyavailableonourwebsite,alimitednumberofreportshavebeen printed. If you would like a copy of this report or if you have any questions about it, please contact: HeatherWuensch AkronChildren shospital OnePerkinsSquare Akron,OH44308 Phone:330[543[8130 Email:hwuensch@chmca.org http://www.akronchildrens.org RoseannMarsico AkronChildren shospitalmahoningvalley BeeghlyCampus 6505MarketStreet Boardman,OH44512 Phone:330[746[8701 Email:rmarsico@chmca.org http://www.akronchildrens.org/mv DescriptionofHospitalFacility Akron Children s Hospital operates two hospitals: one at its Akron campus and one at its Beeghly campus in Boardman, Ohio in Mahoning County. The area s only pediatric hospital, AkronChildren shospitalmahoningvalleyopenedindecember2008.thisnon[profit,32[bed pediatrichospitaloffersafullrangeofpediatricservicestothechildrenofthemahoningvalley and surrounding areas. The hospital provides access to a 24/7 emergency department, laboratory, radiology, outpatient surgical center, endocrinology, rehabilitation and EEG/ECHO/EKGservices,aswellasahematology/oncologyclinicandinfusioncenterandchild advocacycenter.duringcalendaryear2012,thefollowingpatientencountersoccurredonthe Beeghly campus: 1,739 inpatient and observation admissions, 27,774 emergency room visits, and22,528specialtyvisits. AkronChildren salsoownsandoperatesa19[bedleveliispecialcarenurseryatthehospital s Beeghly campus and a 25[bed Level IIIB Neonatal Intensive Care Unit at St. Elizabeth Health Center in Youngstown. Akron Children'sneonatal teamis committed to providing the most effective and efficient care for our tiniest patients, as well as providing parents with the emotionalandeducationalsupporttheyneed. AlsolocatedintheMahoningValleyistheCommunityOutreach,EducationSupportCenter, which provides education and support for children and their families. These programs meet specified criteria of nationally accredited disease management programs, as well as Akron Children's criteria and monitoring requirements. Our community health outreach includes asthma and diabetes education and support, school programs, disease[specific camps and support groups, fitness programs, community events and educational programs that touched morethan45,000individualsincalendaryear2012. In 2012, Akron Children s Hospital was re[designated as a Magnet hospital by the American Nurses Credentialing Center s (ANCC) Magnet Recognition Program. This is the highest recognition granted by ANCC and recognizes the very best in nursing care. Ranked a Best Children s Hospital by US News World Report, Akron Children s Hospital is the largest 4
CommunityHealthNeedsAssessment pediatric provider in northeast Ohio. Akron Children s Hospital has been caring for children since1890guidedbythreepromisesthatweconsidersacred:tocareforallchildrenasifthey wereourown;totreateveryonethewaywewouldwanttobetreated;andtoturnnochild awayforaninabilitytopay.formoreinformation,visitwww.akronchildrens.org/mv. DescriptionofCommunityServed Akron Children s Hospital Mahoning Valley has and continues to serve patients and families frommanycommunitiesacrosstheregion.mostpeoplewhoreceiveservicesfromthehospital are located in Mahoning, Trumbull and Columbiana Counties. Thus, for the purposes of this report,thecommunityidentifiedforthischnaconsistsofthosecounties. AkronChildren'sHospitalMahoningValleyCommunity DischargesfromAkronChildren'sHospitalMahoningValleyNICU, SpecialCareNurseryandPediatricsUnit(2012) CountyWherePatientsReside AkronChildren'sHospitalMahoningValley% MahoningCounty 55% TrumbullCounty 20% ColumbianaCounty 14% AllOther 11% TrumbullCounty Thereareapproximately207,406peoplelivinginTrumbullCounty,whichisadecreaseof1.4% since 2010. There are 7 cities and 5 villages in Trumbull County, with the county seat being Warren.ComparedtotheStateofOhio,TrumbullCountyhasaslightlysmallerproportionof children (under 18 years old) and a larger proportion of older adults (65 years and older). Nearly 8% of the population in Trumbull County is Black or African American and 1.5% is HispanicorLatinocomparedto12.5%and3.3%,respectively,intheStateofOhio.Educational attainmentintrumbullcountyislowerthanthestateofohiowith87.1%havingahighschool diplomaorhigherand16.6%havingabachelor sdegreeorhigher.similarly,annualpercapita incomeintrumbullcountyislowerthanthestateofohioandthepercentoftrumbullcounty residentslivinginpovertyishigherthanthatofthestate. MahoningCounty Thereareapproximately235,145peoplelivinginMahoningCounty,whichisadecreaseof1.5% since2010. There are 7 cities and 7 villages in Mahoning County, with the largest being Youngstown. Compared to the State of Ohio, Mahoning County has a smaller proportion of children (under 18 years old) and a higher proportion of older adults (65 years and older). SixteenpercentofthepopulationinMahoningCountyisBlackorAfricanAmericanand5.0%is HispanicorLatinocomparedto12.5%and3.3%,respectively,intheStateofOhio.Thepercent ofmahoningcountyresidentswithahighschooldiplomaorhigherisroughlythesameasthe StateofOhio,butthepercentwithabachelor sdegreeorhigherislowerthanthestate.the annualpercapitaincomeinmahoningcountyislowerthanthestateofohioandthepercent ofmahoningcountyresidentslivinginpovertyishigherthanthestateaverage. 5
CommunityHealthNeedsAssessment ColumbianaCounty There are approximately 106,507 people living in Columbiana County, which is a decrease of 1.2%since2010.Thereare3cities,11villages,and18townshipsinColumbianaCounty,with the largest being Salem. Compared to the State of Ohio, Columbiana County has a smaller proportion of children(under 18 years old) and a higher proportion of older adults(65 years and older). Approximately 2.4% percent of the population in Columbiana County is Black or AfricanAmericanand1.4%isHispanicorLatinocomparedto12.5%and3.3%,respectively,in thestateofohio.thepercentofcolumbianacountyresidentswithahighschooldiplomaor higheris lower than the State of Ohio and the percent with a bachelor s degree or higher is nearly half of the State average (13.0% versus 24.5%). The annual per capita income in Columbiana County is much lower than the State of Ohio and the percent of Columbiana CountyresidentslivinginpovertyishigherthantheStateaverage. Table1.DemographicCharacteristicsofCommunitiesServedandtheStateofOhio Trumbull Mahoning Columbiana Ohio Totalpopulation 1 207,406 235,145 106,507 11,544,225 Percentpopulationchange 2 [1.4% [1.5% [1.2% 0.1% Percentunder18yearsold 1 21.5% 20.9% 21.2% 23.1% Percent65yearsandolder 1 18.4% 18.4% 17.3% 14.8% Percentfemale 1 51.4% 51.5% 49.7% 51.1% PercentBlackorAfricanAmerican 1 8.4% 16.0% 2.4% 12.5% PercentHispanicorLatino 1 1.5% 5.0% 1.4% 3.3% Percentwithhighschooldiplomaorhigher 3 87.1% 87.9% 85.7% 87.8% Percentwithbachelor sdegreeorhigher 3 16.6% 20.9% 13.0% 24.5% Homeownershiprate 4 73.7% 71.6% 74.5% 68.7% Medianvalueofowner[occupiedhousingunits 4 $100,500 $97,800 $97,700 $135,600 Personsperhousehold 4 2.39 2.36 2.46 2.46 Annualpercapitaincome 4 $22,127 $23,261 $20,691 $25,618 Medianhouseholdincome 4 $42,441 $40,570 $41,003 $48,071 Percentlivingbelowpovertylevel 4 16.4% 17.1% 15.9% 14.8% Notes: 1 2012estimate, 2 Since2010, 3 personsage25+,2007[2011, 4 2007[2011 Source:USCensusBureau(http://quickfacts.census.gov/qfd/maps/ohio_map.html) 6
CommunityHealthNeedsAssessment METHODOLOGY Approach ToconducttheCommunityHealthNeedsAssessment,amodifiedversionofawell[established frameworkforstrategicplanninginpublichealthcalled MobilizingforActionthroughPlanning andpartnerships ormappprocesswasfollowed.mapphasbeenutilizedbynumerouspublic health stakeholders to strengthen and improve local community health through collaborative andmethodicalprocessesinvolvingmultiplestakeholders. TheMAPPprocesshassixphases: 1. Organizingforsuccessand developingpartnerships 2. Visioning 3. ConductingMAPPassessments 4. Identifyingstrategicissuesand prioritizingidentifiedissues 5. Formulatinggoalsandstrategies 6. Takingaction(planning, implementing,andevaluating programs/policies) In the first phase, Akron Children s Hospital Mahoning Valley convened meetings and discussed the new IRS requirements pertainingtochnas,theresourcesneededto conductthechna,andthedesiretohireacontractortohelpfacilitatetheprocess.attheend ofthefirstphase,thehospitalsolicitedaproposalfromkentstateuniversitycollegeofpublic Health(KSU[CPH)andthenhiredKSU[CPHtofacilitatethedevelopmentoftheCHNA. Inthesecondphase,meetingswereheldtoidentifyavisionandprocesstoconducttheCHNA, whichweredeterminedprimarilybythespecificrequirementsofchnasmandatedbytheirs. Aworkplanwithanticipatedtimelineswasalsocreated. Inthethirdphase,existingcounty[levelepidemiologicdataweregatheredinsteadofcollecting datathroughasurveyduetoconcernsofself[reportbiaswiththelatterapproach.inaddition, interviews with community leaders and focus groups with community residents were conducted.somehospital[baseddatawerealsoaddedtotheanalysis.alocalpublichealth SystemAssessmentandaForcesofChangeAssessmentwerenotconductedbecausetheTri[ CountyCommunityHealthAssessmentPlanningInitiativeconductedthemin2011. In the fourth phase, a series of meetings were held to identify the prioritized health needs basedontheepidemiologicdata,theinputfromcommunityleadersandresidents,andother CHNAs that had been previously been conducted. Health needs were prioritized for children only. 7
CommunityHealthNeedsAssessment Inthefifthandsixphases,ImplementationPlansweredevelopedthatidentifiedthestrategies the hospital will undertake to address some of the prioritized health needs identified in the fourth phase. The hospital s Implementation Plans will be publicly available at www.akronchildrens.orgbydec.31,2013. EpidemiologicData Theepidemiologicdatausedinthisreportwerecollectedfromavarietyofsourcesthatreport information at the county, state, and national levels. The epidemiologic data collected representedaverywiderangeoffactorsthataffectcommunityhealthsuchasmortalityrates, healthbehaviors,environmentalfactors,andhealthcareaccessissues. CountyHealthRankings TheCountyHealthRankingsRoadmapsprogramisacollaborationbetweentheRobertWood JohnsonFoundationandtheUniversityofWisconsinPopulationHealthInstitute.Theprogram collectsinformationonmortality,morbidity,healthbehaviors,clinicalcare,socialandeconomic factors,andphysicalenvironmentatacounty[levelfornearlyallcountiesintheunitedstates. Some data reported are actual counts based on actual reports (i.e., reported disease diagnoses),somedataareestimatedbasedonsamples(i.e.,thebehavioralriskfactorsurvey), andsomedataaremodeledtoobtainamorecurrentestimate(i.e.,projected2012estimates basedon2010censusdata).formoreinformationaboutthecountyhealthrankingsprogram, pleasevisit:www.countyhealthrankings.org. CommunityHealthStatusIndicators The Community Health Status Indicators project is a partnership between the Centers for DiseaseControlandPrevention,theNationalInstitutesofHealth/NationalLibraryofMedicine, thehealthresourcesservicesadministration,thepublichealthfoundation,theassociationof State and Territorial Health Officials, the National Association of County and City Health Officials,theNationalAssociationofLocalBoardsofHealth,andtheJohnsHopkinsUniversity SchoolofPublicHealth.SimilartotheCountyHealthRankingsproject,theCommunityHealth Status Indicators project collects information on a variety of sources and generates county profiles.currently,mostofthedataarefrom2009,howeveritdoescontaininformationthat the County Health Rankings does not. For more information about the Community Health StatusIndicatorsproject,pleasevisit:wwwn.cdc.gov/CommunityHealth/HomePage.aspx. CommunityHealthNeedsAssessmentToolkit The Community Health Needs Assessment Toolkit is a collaborative partnership between the KaiserPermanente;theInstituteforPeople,Place,andPossibility(IP3);theCentersforDisease Control and Prevention; and other partners that seek to make freely available data that can assist hospitals, non[profit organizations, state and local health departments, financial institutions,andotherorganizationsseekingtobetterunderstandtheneedsandassetsoftheir communitiesandtocollaboratetomakemeasureableimprovementsincommunityhealthand well[being. Similar to the County Health Rankings program, the Community Health Needs AssessmentToolkitprojectcollectsinformationfromavarietyofsourcesandcreatescounty[ 8
CommunityHealthNeedsAssessment level profiles for comparison purposes. For more information about the Community Health NeedsAssessmentToolkit,pleasevisit:assessment.communitycommons.org. OhioDepartmentofHealth TheOhioDepartmentofHealthisacabinet[levelagencythatadministersmostofthestate s state[levelhealthprogramsincludingcoordinationoftheactivitiesforchildandfamilyhealth services, health care quality improvement, services for children with medical handicaps, nutrition services, licensure and regulation of long[term care facilities, environmental health, prevention and control of injuries and diseases, and others. County[level data that could be comparedtonationalstatisticswerecollectedinavarietyofareasandusedinthischna.for more information about the data available at the Ohio Department of Health, please visit: www.odh.ohio.gov/healthstats/datastats.aspx AnnieECaseyFoundation The Annie E Casey Foundation runs a program called KIDS COUNT, which is a national and state[by[state effort to track the wellbeing of children in the United States. KIDS COUNT collects and reports data at the county[level in a variety of areas related to child health including demographics, education, economic well[being, health, safety and risky behaviors, andotherindicators.mostofthedatainkidscount forohioissuppliedbyohio schildren s DefenseFundandistakenfromavarietyofsources,includingtheOhioDepartmentofHealth. FormoreinformationaboutKIDSCOUNT,pleasevisit:datacenter.kidscount.org. OhioHospitalAssociation Established in 1915, the Ohio Hospital Association is the nation s first state[level hospital association. OHA collaborates with member hospitals and health systems to meet the health care needs of their communities and to create a vision for the future of Ohio s health care environment.oha, in coordination with member hospitals, have developed new web based software called Insight that allows hospitals to run customized and standard reports for Marketing, Physician Recruiting, Business Development and Benchmarking purposes. Several health indicators were drawn from OHA s Insight system with their permission. For more informationaboutohainsight,pleasevisit:http://www.ohanet.org/insight/ CommunityLeaderInterviews Inadditiontoexaminingthecounty[levelepidemiologicdata,interviewswereconductedwith communityleadersinjuly August2013togaintheirinsightonwhattheythoughtwerethe significant health needs of children and adults in their communities, the factors that affect thosehealthneeds,otherexistingcommunityhealthneedsassessments,possiblecollaboration opportunities, and to get suggestions on what the hospitals can do to address the significant healthneedsidentifiedinthechna.thesecommunityleadersrepresentthebroadinterestsof the communities served by the hospital facility including the medically underserved, low[ income persons, minority groups, those with chronic disease needs, and leaders from local public health agencies and departments who have special knowledge and expertise in public health. 9
CommunityHealthNeedsAssessment LeadersfromthefollowingcommunityorganizationswereconsultedduringthisCHNA: YoungstownCityHealthDistrict,ActingHealthCommissioner Youngstown/WarrenRegionalChamber,PresidentChiefExecutiveOfficer PediatricAssociatesofYoungstown,Physician MahoningCountyChildren sservices,qualityimprovementsupervisor HelpHotlineCrisisCenter,ChiefExecutiveOfficer MahoningCountyDistrictBoardofHealth,HealthCommissioner TrumbullCountyWomen,Infants,andChildren(WIC)Program,Director Trumbull County Mental Health and Recovery Board, Director of Evaluation Quality Improvement TrumbullCountyChildren sservices,executivedirector St.JosephHealthCenter,ChairofPediatrics ColumbianaCountyMentalHealthandRecoveryServicesBoard,ExecutiveDirector Portage/ColumbianaCountiesWomen,Infants,andChildren(WIC)Program,Director TheMorningJournal,Editor SalemCommunityHospital,VicePresidentforMedicalAffairs ColumbianaCountyEducationalServiceCenter,Superintendent Columbiana County Department of Job and Family Services, Children s Services Administrator CoordinatedActionforSchoolHealth(CASH)Coalition,Coordinator ColumbianaCountyHealthDepartment,HealthCommissioner CommunityResidentFocusGroups In addition to the input from community leaders, focus groups were conducted with communityresidentsinaugust September2013togettheirinputonwhattheythoughtwere thesignificanthealthneedsofchildrenandadultsintheircommunities,thefactorsthataffect thoseneeds,thesolutionstheythoughtwouldsolvethoseneeds,andwhatthehospitalsand other community groups could do to address those needs. Due to the observed information gapintheepidemiologicdataonthehealthofchildren,adultandchildsubstanceabuseissues, andadultandchildmentalhealthissues,severalquestionswereaskedtoprobemoredeeply on these issues. In addition, a questionnaire was distributed to focus group participants to gather demographic information and basic perceptions of community health. The discussion guide, questionnaire, and protocol were reviewed and approved by the Kent State University InstitutionalReviewBoard. Recruitment Community residents were recruited to participate in the focus groups by posting and distributingflyersinthecommunity.thesiteswherethecommunityresidentgroupswereheld were selected based on proximity to population areas, ease of access(including free parking andbuslines),andrecommendationsfromlocalcommunityleaders.communityresidentsthat participated in the focus groups were given a $50 Visa gift card as a thank you and to 10
CommunityHealthNeedsAssessment compensate them for their time and expense. A total of 82 people participated in the CommunityResidentFocusGroups. CharacteristicsofParticipants As noted in Table 2, participants were drawn from across the region and were diverse. Fifty percentofparticipantswerefromtrumbullcounty,31.7%frommahoningcounty,and18.3% were from Columbiana County.The average number of years that participants lived in their homecountywas36.6years.sixpercentofparticipantswereafricanamerican,90.2%were Caucasian,and2.4%wereHispanic. Table2.DemographicCharacteristicsofCommunityResidentFocusGroupParticipants(n=82) Characteristic Number Percent CountyofResidence TrumbullCounty 41 50.0% MahoningCounty 26 31.7% ColumbianaCounty 15 18.3% NumberofYearsLivedinCounty(averageandSD) 36.6 21.0 RacialBackground AfricanAmerican(orBlack) 5 6.1% AsianAmerican 0 0.0% Caucasian(orWhite) 74 90.2% NativeHawaiianorOtherPacificIslander 1 1.2% AmericanIndianorAlaskaNative 0 0.0% Other/Missing 2 2.4% EthnicBackground HispanicorLatino/a 2 2.4% NotHispanicorLatino/a 73 89.0% Missing 7 8.5% AsnotedinTable3(nextpage),participantshaddiversehouseholdcharacteristics.Nearly16% percent of participants lived by themselves, 32.9% lived with one other person, 24.4% lived withtwootherpeople,15.9%livedwiththreeotherpeople,and9.8%livedwithfourormore people.nearly66%percenthadnochildreninthehome,8.5%hadonechild,6.1%hadtwo children,and7.3%hadthreeormorechildreninthehome. 11
CommunityHealthNeedsAssessment Table3.HouseholdCharacteristicsofCommunityResidentFocusGroupParticipants(n=82) Characteristic Number Percent NumberofPeopleinHome One 13 15.9% Two 27 32.9% Three 20 24.4% Four 13 15.9% FiveorMore 8 9.8% Missing NumberofChildrenintheHome None 54 65.9% One 7 8.5% Two 5 6.1% ThreeorMore 6 7.3% Missing 10 12.2% AsnotedonTable4,participantsrangedintermsoftheirincomeandhealthinsurancestatus. Twelvepercentofparticipantsreportedamonthlyhouseholdincomebetween$0[$999,14.6% between $1,000[$1,999, 11% between $2,000[$2,999, 17.1% between $3,000[$3,999, 6.1% between $4,000[$4,999, and 22% reported monthly household income exceeding $5,000 per month. In addition, 15.9% reported they had no health insurance, 39% had private health insurance, 1.2% had health insurance as a veteran or member of the military, 24.4% had Medicare,and17.1%hadMedicaid. Table4.IncomeandInsuranceStatusofCommunityResidentFocusGroupParticipants(n=82) Number Percent TotalHouseholdMonthlyIncome 0[$999 10 12.2% $1,000[$1,999 12 14.6% $2,000[$2,999 9 11.0% $3,000[$3,999 14 17.1% $4,000[$4,999 5 6.1% $5,000andHigher 18 22.0% Missing 14 17.1% PrimaryTypeofHealthInsurance Uninsured 13 15.9% PrivateHealthInsurance 32 39.0% Veterans/Military 1 1.2% Medicare 20 24.4% Medicaid 14 17.1% Other 0 0.0% Missing 2 2.4% 12
CommunityHealthNeedsAssessment AsnotedinTable5,participantshaddiversehealthcareutilizationexperiences.Fortypercent statedthatsomeoneintheirhomedidnotreceivehealthcareduetothecostandthat42.7% of them had someone in their home with a chronic disease or condition. Seven percent reportedthattheyusuallydon tgotoadoctorduringtheyear,12.2%goonceperyear,24.4% gotwiceperyear,9.8%gothreetimesperyear,15.9%gofourtimesperyear,11%gofiveto ninetimesperyear,and8.5%gotenormoretimesperyear. Table5.HealthCareStatusandUtilizationofCommunityResidentFocusGroupParticipants(n=82) Number Percent HadSomeoneinHomeWhoDidNotReceiveHealthCareDuetoCost 33 40.2% HasSomeoneinHomeWithaChronicDisease 35 42.7% TimesPerYearThatParticipantGoesToaDoctor None 6 7.3% One 10 12.2% Two 20 24.4% Three 8 9.8% Four 13 15.9% FivetoNine 9 11.0% TenorMore 7 8.5% Missing 9 11.0% Participant sdescriptionofcurrenthealth Excellent 10 12.2% VeryGood 30 36.6% Good 28 34.1% Fair 8 9.8% Poor 1 1.2% Missing 5 6.1% Lastly,asnotedinTable6(nextpage),participantsreportedfairlydiverseviewsofthehealthof adultsandchildrenintheircounty.onepercentofparticipantsdescribedthecurrenthealth statusofadultsintheircountyas excellent, 1.2%describeditas verygood, 32.9%described itas good, 54.9%describeditas fair, and4.9%describedthecurrenthealthstatusofadults in their county as poor. Participants rated the current health status of children in their Countyslightlyhigher.Nonedescribeditas excellent, 4.9%describeditas verygood, 50% described it as good, 35.4% described it as fair, and 3.7% described the current health statusofchildrenintheircountyas poor. 13
CommunityHealthNeedsAssessment Table6.CommunityHealthPerceptionsofCommunityResidentFocusGroupParticipants(n=82) Number Percent Participant sdescriptionofcurrenthealthofcountyadults Excellent 1 1.2% VeryGood 1 1.2% Good 27 32.9% Fair 45 54.9% Poor 4 4.9% Missing 4 4.9% Participant sdescriptionofcurrenthealthofcountychildren Excellent 0 0.0% VeryGood 4 4.9% Good 41 50.0% Fair 29 35.4% Poor 3 3.7% Missing 5 6.1% OtherCommunityHealthNeedsAssessments Lastly,priorcommunityhealthneedsassessmentsthatwereconductedintheregionwerealso reviewedandhelpedtoinformthischna.someofthesechnaswereknowntothesteering Committee,somewerefoundusingInternetsearches,andsomeweresenttousbyCommunity Leaders. TheotherCHNAsthatwerereviewedduringthepreparationofthisCHNAincluded: HumilityofMaryHealthPartners,St.ElizabethHealthCenter Tri[CountyCommunityHealthAssessmentPlanningInitiative EastLiverpoolCityHospitalandSalemCommunityHospitalCHNA HumilityofMaryHealthPartners,St.JosephHealthCenter 14
CommunityHealthNeedsAssessment PrioritizationProcess As mentioned previously, epidemiologic data for children were collected from a variety of sources. To prioritize these health indicators, the data from Trumbull, Mahoning, and Columbiana Counties were compared to their two peer counties in Ohio that were demographicallysimilar,thestateandusaverages,andthehealthypeople2020target,ifone wasavailable.toaidtheprioritizationprocess,theindicatorswereplottedonmatrices. Indicators listed on the left[hand side of the matrix compared unfavorably to the two comparison counties, the state, and the US. Indicators on the right[hand side of the matrix compared favorably to those benchmarks. In addition,oneachsideofthematrix,itwasnoted iftheindicatorswerehigher/lowerthan2,3,or4 of the benchmarks. For example, indicators in the upper left box of the matrix(shaded in red) were worse in Mahoning County compared to thetwocomparisoncounties,thestate,andthe US. Indicators in the bottom right (shaded in blue) were better in Mahoning County compared to these benchmarks. The use of these matrices helped the Steering Committee quickly compare the vast amount of data to key benchmarks and identify the prioritized health needsbasedontheepidemiologicdata. The list of prioritized health needs resulting from the epidemiologic analysis was then supplemented with additional health needs identified by community leaders and community residents.acontentanalysiswasconductedonthenotesandtranscriptsofcommunityleader interviewsandcommunityresidentfocusgroupstoidentifythemesthatconsistentlyemerged. The health areas listed below were the health needs identified for children by community leadersandresidentsthatwereaddedtothelist. CommunityLeaders Nutrition Physicalactivity Obesity Mentalhealth Substanceabuse Numberofpediatricspecialists CommunityResidents Obesity Mentalhealth Diabetes Sexuallytransmitteddiseases 15
CommunityHealthNeedsAssessment COMMUNITYRESOURCES Thereareawidevarietyofresourcesinthecommunitythatcanhelpaddresstheprioritized healthneedsidentifiedinthischna. TrumbullCounty AccessHealthMahoningValley BelmontPines ChildandFamilySolutions Children'sRehabilitationCenterofWarren,Ohio ChurchillCounseling ColemanProfessionalServices ComprehensivePsychServices EasterSeals,Mahoning,TrumbullandColumbianaCounties FamilyandChildrenFirstCouncil GirlScoutsofNortheastOhio H.C.MinesIntermediateSchool(Howland) HealthBoard:TCAPHeadStart HMHP,St.JosephHealthCenter HomesforKids KentStateUniversity NilesCityHealthDepartment OneHealthOhio PotentialDevelopment PsyCare TheMayorRalphA.InfanteWellnessCenter TheTrumbullCountyMentalHealthandRecoveryBoard TrumbullCountyCareerandTechnicalCenter(TCCTC) TrumbullCountyChildren'sServices TrumbullCountyEducationalServiceCenter TrumbullCountyHealthDept TrumbullCountyJuvenileJusticeCenter UnitedMethodistCommunityCeter ValleyCare,HillsideRehabilitationHospital ValleyCare,TrumbullMemorialHospital WarrenCityHealthDepartment WarrenCitySchools WIC,TrumbullCounty 16
CommunityHealthNeedsAssessment MahoningCounty AccessHealthMahoningValley BeatitudeHouse CentralYMCA,Youngstown,Ohio ComprehensivePsych DECounseling DavisFamilyYMCA,Boardman,Ohio EasterSeals,Mahoning,TrumbullandColumbianaCounties HelpHotlineCrisisCenter,Inc. HMHP,St.ElizabethHealthCenter JewishCommunityCenterofYoungstown MahoningCountyBoardofHealth MahoningCountyChildren'sServices MahoningCountyEducationalServiceCenter MahoningCountyJuvenileJusticeCenter MahoningCountyMentalHealthBoard MahoningYoungstownCommunityActionPartnership OneHealthOhio PediatricAssociatesOfYoungstown PioneeringHealthierCommunities;Youngstown PotentialDevelopment SecondHarvestFoodBankoftheMahoningValley SojournerHouse TheMahoningCountyBoardofDevelopmentalDisabilities TheRichCenterforAutism UnitedMethodistCommunityCenter UnitedWayofYoungstownandtheMahoningValley ValleyCareHealthSystem,NorthsideMedicalCenter ValleyCounseling WIC,MahoningCounty YoungstownCityHealthDepartment YoungstownCitySchools YoungstownHearingandSpeech YoungstownStateUniversity 17
CommunityHealthNeedsAssessment ColumbianaCounty ColumbianaCountyCareerandTechnicalCenter(CCCTC) ColumbianaCountyCommunityActionAgency(HeadStart) ColumbianaCountyDeptofJobandFamilyServices ColumbianaCountyEducationalServiceCenter ColumbianaCountyHealthDept ColumbianaCountyJuvenileCourt ColumbianaCountyMHRSBoard ColumbianaCountyMRDD DamascusElementary EastLiverpoolCityHospital EasterSeals,Mahoning,TrumbullandColumbianaCounties HannahMullinsSchoolofPracticalNursing SalemCommunityCenter SalemCommunityHospital SalemYMCA WIC,ColumbianaCounty NationalOrganizations AmericanAssociationofPediatrics,OhioChapter AmericanDiabetesAssociation AmericanLungAssociation Children'sHospitalAssociation 18
CommunityHealthNeedsAssessment SUMMARYOFRESULTS Thefinallistofprioritizedhealthneedsforchildren(basedontheepidemiologicdataandinput from community leaders and community residents) were then grouped into broad categories representingthetypeofhealthindicator: Table9.PrioritizedHealthNeedsByCountyforChildren Trumbull Mahoning Columbiana ChronicDiseases Asthma X X X Diabetes X X X MaternalInfantHealth PrematureBirths X X X LowVeryLowBirthWeight X X X Infant,Neonatal,Post[NeonatalMortality X X X ChildLifestyleFactors OverweightObesity X X X Exercise X X X Nutrition X X X MentalHealth X X X SubstanceAbuse OpioidDrugAbuse X X X SexuallyTransmittedDiseases AdolescentGonorrhea X X AccesstoHealthCare HealthInsuranceCoverage X X X AccesstoDentalCare X X X MentalHealthInsuranceCoverage X X X NumberofPediatricSpecialists X X X EnvironmentalFactors AccesstoHealthyFood X X X 19
CommunityHealthNeedsAssessment CONCLUSIONS Our analysis of the epidemiologic data, the input received from community leaders and community residents, and our review of other CHNAs identified a broad range of prioritized healthneedsforchildreninourcommunity.theseincludephysical,mental,andenvironmental healthoutcomesaswellasriskfactorsfordiseasesorconditions. ChronicDiseases Chronic diseases are a type of disease where the person can live with the disease for a long time,sometimesindefinitely.peoplewithchronicdiseasesusuallyneedtoseetheirdoctorson aregularbasistomonitortheprogressionoftheirdiseaseandgettreatment.theprioritized chronicdiseasehealthneedsforchildreninourcommunityincludeasthmaanddiabetes. MaternalInfantHealth Maternalandinfanthealthisabroadcategoryoffactorsthataffectpregnancyandchildbirth. The prioritized maternal and infant health needs for children in our community include premature births; low and very low birth weight; and infant, neonatal, and post`neonatal mortality. ChildLifestyleFactors Lifestyle risk factors are everyday behaviors that children engage in that can negatively impacttheirhealth.childrenthatengageintheselifestyleriskfactorsareathigherriskfora largenumberofchronicdiseasessuchasheartdisease,diabetes,andcancer.theprioritized lifestyle factors for children in our community are overweight and obesity, exercise, and nutrition. MentalHealth Mentalhealthreferstothesuccessfulperformanceofmentalfunction,resultinginproductive activities,fulfillingrelationshipswithotherpeople,andtheabilitytoadapttochangeandcope with adversity. Mental health is particularly important for children since it can affect psychologicalandemotionaldevelopment,schoolperformance,familyandpeerrelationships, andphysicalhealth.forthisreason,allmentalhealthconditionswereidentifiedasprioritized communityhealthneedsforchildreninourcommunity. SubstanceAbuse Substance abuse refers to a set of conditions associated with the consumption of mind[ and behavior[alteringsubstancesthathavenegativebehavioralandhealthoutcomes.theimpact ofsubstanceabuseonthebodiesofgrowingchildrenisaveryseriousconcernsinceitcanhave lastingnegativeeffects.theprioritizedsubstanceabuseissueforchildreninourcommunityis opioiddrugabuse. 20
CommunityHealthNeedsAssessment SexuallyTransmittedDiseases Sexuallytransmitteddiseasesarespreadthroughunprotectedsexandcanresultinsignificant health problems, including infertility. The sexually transmitted disease identified as a prioritizedhealthneedforchildreninourcommunityisadolescentgonorrhea. AccesstoHealthCare Access to health care is a broad term used to describe the availability, acceptability, affordability,andaccessibilityofhealthcaresystemsandproviders.amongkids,lackofaccess to health care means that children can t get the immunizations and screenings they need, whichcanincreasetheirriskfordiseaseandpoordevelopment.theprioritizedaccesstocare needsforchildreninourcommunityarehealthinsurancecoverage,accesstodentalcare,and mentalhealthinsurancecoverage,andnumberofpediatricspecialists. EnvironmentalFactors Environmentalriskfactorsareabroadcategoryofexternalconditionsthatcannegativelyaffect healthoutcomes.theprioritizedenvironmentalfactorforchildreninourcommunityisaccess tohealthyfood. For detailed charts and data on these prioritized health needs for every county in our community,pleaseseethedetaileddataappendix. 21
CommunityHealthNeedsAssessment ACKNOWLEDGEMENTS The Kent State University College of Public Health (KSU[CPH) was hired to conduct this Community Health Needs Assessment under the direction of a Steering Committee that was comprised of representatives from Akron Children s Hospital Mahoning Valley and Akron Children shospitalinakron.thesteeringcommitteemembersare: AkronChildren shospitalmahoningvalley SharonA.Hrina,MSN,RN,NE[BC Vice%President,%Akron%Children s%hospital% Mahoning%Valley% LisaTaafe,MSN,RN,CNP Clinical%Administrative%Director,%Akron% Children s%hospital%mahoning%valley% RoseannMarsico,BA Executive%Secretary% TheKSU[CPHauthorsofthisreportwere: WillieH.Oglesby,PhD,MSPH,FACHE Assistant%Professor%of%Health%Policy%% Management%and%% Assistant%Director,%Office%of%Public%Health% Practice%and%Partnerships%% % DianaM.Kingsbury,MA,MPH Graduate%Research%Assistant JosephSmith,MPH Graduate%Research%Assistant % AkronChildren shospitalinakron BernettL.Williams,MPA Vice%President,%External%Affairs% % MichaelWellendorf,MPA Government%Relations%Liaison% % HeatherWuensch% Director%of%Community%Benefit,%Advocacy%and% Outreach% KenSlenkovich,MA Assistant%Dean% % TeganAnneBeechey,MPA Graduate%Research%Assistant% OliviaHartman,BSPH Graduate%Research%Assistant% PatrickGorby,BS Graduate%Research%Assistant% 22