2014 2014 ST. LOUIS COUNTY
ST. LOUIS COUNTY COMMUNITY HEALTH
COMMUNITY HEALTH IMPROVEMENT PLAN IMPROVEMENT PLAN
St. Louis County Partnership for a Healthy
Community
Table of Contents Table of Contents I.
Mission, Vision, and Values Statements ............................................................................. 1
II. I.
Executive Summary Mission, Vision, and ............................................................................................................ Values Statements.............................................................................. 12
II. Demographic Executive Summary............................................................................................................. III. Profile for St. Louis County .......................................................................... 24 III. The Demographic Profile for St. Louis County............................................................................ IV. Framework: a Strategic Planning Model...................................................................... 45 IV. Past The Framework: a Strategic Planning Model.......................................................................10 5 V. Accomplishments ..................................................................................................... V. Public Past Accomplishments. ...................................................................................................... 10 VI. Health Priority Issues, Goals, Objectives, Measures, and Strategies:
•VI. ••
Public Health Priority Issues,Care Goals, Objectives, Measures, and Strategies: Priority 1: Access to Health ..................................................................................... 12 Priority 2: 1: Access to Health ...................................................................................... 12 Priority Behavioral HealthCare. ............................................................................................. 18
• • • • •
Priority 2: Behavioral Health.............................................................................................. 18 Priority 3: Healthy and Safe Environment: Asthma .......................................................... 30 Priority 3: Healthy and Safe Environment: Asthma............................................................ 30 Priority 4A: Prevention and Disease Management: Obesity ............................................ 36 Priority 4A: Prevention and Disease Management: Obesity.............................................. 36 4B: Prevention and Disease Management: Sexually Transmitted Infections ............ 44 4B: Prevention and Disease Management: Sexually Transmitted Infections........................... 44 VII. Appendix ........................................................................................................................... 49 VII. Appendix............................................................................................................................ 49
St. Partnership for for a a Healthy Healthy Community Community St. Louis Louis County County Partnership
St. Louis County Partnership for a Healthy
Charlie A. Dooley Charlie A. Dooley Saint Louis County County Executive, County Executive, Saint Louis County
Community
Dolores J. Gunn, MD Dolores J. Gunn, MDCounty Department of Health Director, Saint Louis
Director, Saint Louis County Department of Health
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I. St. Louis County Partnership for a Healthy Community Mission, Vision, and Values Statements The mission was developed by the Stakeholder Advisory Committee and the Leadership Team. It will be used to guide the partnership and help define what the partnership wants to achieve, what the partnership will do to achieve it, and how the partnership will go about its work.
Mission: As partners, we will join forces to improve the health of St. Louis County residents through comprehensive and accountable assessment, planning, programming, and measurement.
To develop a vision for St. Louis County, the Saint Louis County Department of Health hosted a visioning session on September 30, 2013. From this session, the stakeholders developed a vision with a focus on how the community will be improved, changed, or become different if the partnership is successful in achieving its purpose.
Vision: Healthy people, healthy choices, healthy St. Louis County!
Partnership Values: Values are the principles, beliefs, and underlying assumptions that will guide the partnership. They serve as foundational principles for the partnership in regards to what the partnership is about, what its priorities are, and how the partnership will be carried out. • Inclusivity – The stakeholder group will be inclusive in addressing the common good of the county by being open, transparent, and accountable to all interested parties regardless of cultural, educational, lifestyle, or other socio-economic factors. • Collaboration – The effort will be undertaken through a collaborative partnership composed of individuals and organizations empowered to work in a team environment and pursue collective output. • Quality – The partnership’s strategies will focus on data-driven best practices centered on strategic change and adherence to professional standards. • Equity – The partnership will ensure that outcomes are equal across all residents: providing care, advocating for the underserved, and working to advance improved health outcomes for all residents.
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II. Executive Summary The St. Louis County Partnership for a Healthy Community is pleased to present the following Community Health Improvement Plan (CHIP) to county residents, community organizations, and civic groups. A CHIP is grounded in data and created in collaboration with community partners to set priorities and coordinate and target resources. It is critical for developing policies and defining actions to promote efforts that improve health. The CHIP process is an ambitious and bold effort at community engagement for a common good. No single organization has the depth of resources needed to raise community health to an optimal level or even maintain it at its current level. In 2013, a broad array of public health stakeholders from St. Louis County (see Appendix) convened as the St. Louis County Partnership for a Healthy Community. The partnership is comprised of member organizations and individuals who represent a broad spectrum of the community and who subscribe to a broad definition of health. Over the months that followed, the St. Louis County Partnership for a Healthy Community worked on its mission to “join forces to improve the health of St. Louis County residents through comprehensive and accountable assessment, planning, programming, and measurement” by conducting a Mobilizing for Action through Planning and Partnerships (MAPP) process. MAPP is the gold standard for community health assessment and planning. It is a community-driven strategic planning framework that assists in developing and implementing efforts around the prioritization of public health issues and the identification of resources to address them as defined by the Ten Essential Public Health Services. The MAPP process includes four assessment tools:
• Community Health Status Assessment (CHSA): This assessment answers the questions, “How healthy are our residents?” and “What does the health status of our community look like?” The results of the CHSA provide the Stakeholder Advisory Committee with an understanding of the community’s health status and ensure that the community’s priorities include specific health status issues. • Community Themes and Strengths Assessment: This assessment includes the identification of community assets and strengths to support the health of the community. It solicits the perceptions regarding community health priorities and needs from residents and stakeholders. • Forces of Change Assessment: This assessment activity focuses on the identification of any legislative, social, economic, technological, legal, environmental, or scientific forces or impending changes (trends/events/factors) that may affect the health of the community. • Local Public Health System Assessment: This assessment utilizes a standard tool developed by the Centers for Disease Control and Prevention (CDC) to discuss and self-evaluate the capacity and capability of the local public health system.
The community health assessment data was both quantitative and qualitative. Input was gathered from residents through community focus groups, key stakeholder interviews, and telephone surveys that included over 2,100 responses. Other assessments included data from the Saint Louis County Strategic Planning Survey, the Children’s Mental Health and Substance Abuse Services Needs Assessment for St. Louis County, and the Regional Health Commission’s Decade Review of Health Status report. The resulting data was examined by the Stakeholder Advisory Committee to identify the most important issues.
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The committee then tried to align them with local priorities and applied prioritization criteria to narrow Thefocus committee tried to align thempriority with local priorities and applied prioritization criteria to narrow the down then to four specific health issues: the focus down to four specific health priority issues:
• Access to Health Care • Access to Health Care • Behavioral Health (Mental Health and Substance Abuse) • Behavioral Health (Mental Health and Substance Abuse) • Prevention – Obesity and Sexually Transmitted Infections • Prevention – Obesity and Sexually Transmitted Infections • Healthy and Safe Environments – Asthma • Healthy and Safe Environments – Asthma
The CHIP includes a plan for each priority issue with goals, measurable objectives, and strategies to The CHIP includes a plan for each priority issue with goals, measurable objectives, and strategies to achieve the objectives. The next step in the process is an anticipated five-year action cycle during achieve the objectives. The next step in the process is an anticipated five-year action cycle during which the strategies deemed deemedmost mostpromising promisingwill willbe beimplemented. implemented.The Thefour fouraction actionteams, teams,composed composed which the strategies of and groups groups committed committedtotofocusing focusingon onthe theidentified identifiedhealth health issues, are beginning of individuals individuals and issues, are beginning thethe process of developing implementation plans. Residents and community groups are encouraged join process of developing implementation plans. Residents and community groups are encouraged toto join the health improvement improvementplanning planningprocess processasasit itenters entersthe theaction action phase. the community community health phase. Living community where where one onecan canachieve achieveoptimal optimalhealth healthisisananimportant important goal everyone. The Living in a community goal forfor everyone. The St. Partnershipfor foraaHealthy HealthyCommunity Communitybelieves believesthat thattogether together can reach that goal. St. Louis County Partnership wewe can reach that goal.
Stakeholders gather at the Forces of Change Assessment Meeting to discuss those forces that affect public health in St. Louis County Stakeholders gather at the Forces of Change Assessment Meeting to discuss those forces that affect public health in St. Louis County
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III. Demographic Profile of St. Louis County III. Demographic Profile of St. Louis County St. Louis County is located on the eastern side of the state of Missouri (please note note that that the the City City of of St. St. Louis Louis is is aa separate separate political political entity entity and and is is (please not part of the county). St. St.Louis LouisCounty Countyisisthe themost mostpopulous populouscounty countyininthe the state despite despite aa slight slight population population decline between 2000 and 2010. 2010. ItItisisthe state decline between 2000 and the 40th The population populationof ofSt. St.Louis LouisCounty County 40th largest largest county county in in the the United United States. States. The peaked in 2000 2000 with with 1,016,300 1,016,300 residents, residents, and and for for the the first first time decreased decreased by by 1.7 percent to 998,954 residents in 2010. They represent 36% of the region’s 1.7% to 998,954 residents in 2010. They represent 36% of the region’s population of 2.8 million people, and they account for for over over 16% 16% of of Missouri’s Missouri’s total population. total population. There are There are 91 91 municipalities municipalities in in St. St. Louis Louis County County and and they they have have primary primary responsibility responsibility within within their their jurisdictions for for services services such such as as public public safety, safety, planning planning and and zoning, zoning, local local street street maintenance, maintenance, and and jurisdictions building code enforcement. The unincorporated areas, which contain nearly a third of the county’s building code enforcement. The unincorporated areas, which contain nearly a third of the county’s population and and aa third third of of its its area, area, come come under under the the direct direct jurisdiction jurisdiction of of county county government. government.However, However, population the Saint Louis Count Department of Health’s jurisdiction is countywide, applying to both the the Saint Louis Count Department of Health’s jurisdiction is countywide, applying to both the unincorporated and and incorporated incorporated portions portions of of the the county. county. unincorporated The county’s county’s 24 24 school school districts districts are are independent independent governmental governmental entities, entities, as as are are the The the 23 23 fire fire protection protection districts, which share fire protection responsibilities with the 20 municipal fire departments. Specials districts, which share fire protection responsibilities with the 20 municipal fire departments. Special service districts provide sewer, library, junior college, and cultural facilities within the county. Privatelyervice districts provide sewer, library, junior college, and cultural facilities within the county. Privatelyowned utilities utilities provide provide electrical, electrical, natural natural gas, gas, water, water, and and telephone telephone service. service. The Thecounty countyisisdivided dividedinto into owned seven council districts, each represented by a council member. Each of the seven districts has vastly seven council districts, each represented by a council member. Each of the seven districts has vastly different demographic demographic and and health-related health-related characteristics. characteristics. different St. Louis Louis County’s County’s population population is is diverse diverse in in terms terms of of age, age, race race and and ethnicity, ethnicity, and and family family composition, composition,but St. but these characteristics tend to be geographically concentrated in different parts of the county. these characteristics tend to be geographically concentrated in different parts of the county. In addition, In addition, St. Louis County continues to become more diverse. Since 2000, the African-American St. Louis County continues to become more diverse. Since 2000, the Black/African-American population population has20.5%. increased 20.5 percent. African-Americans represent 23.3 percent ofnearly the population, has increased Blacks/African Americans represent 23.3% of the population, double the nearly double the national average of 12.6 percent. Though small, the Asian and Hispanic national average of 12.6%. Though small, the Asian and Hispanic communities are also growing. In 2010, communities also in growing. InCounty 2010, the number Asians in St.3.5% LouisofCounty was 34,597, the number ofare Asians St. Louis was 34,597,ofrepresenting the population, slightly below representing 3.5 percent of the population, slightly below the national average of 4.8 percent. the national average of 4.8%. Since 2000, the Asian population has increased by 53%. The number of Since 2000, the Asian populationashas increased by 53 percent. TheInnumber of people whototaled identifynearly people who identify themselves Hispanic continues to increase. 2010, their numbers themselves as Hispanic continues to increase. In 2010, their numbers totaled nearly 25,000, 25,000, or 2.5% of the population. This is well below the national average of 16.3%. While stillora small 2.5 percent of the population. This is well below the national average of 16.3 percent. While still group, the number of Hispanics has increased by 71.1% since 2000. a small group, the number of Hispanics has increased by 71.1 percent since 2000.
As of the end of July, 2014, the county had a somewhat higher unemployment rate (6.5%) than the state As of the end of July, 2014, the county had a somewhat higher unemployment rate (6.5%) than the (6.2%), but a much lower percentage of adult residents without a high school degree (8.2%) than the state (6.2%), but a much lower percentage of adult residents without a high school degree (8.2%) than state (12.8%). St. Louis County also had a lower percentage of people living below the federal poverty the state (12.8%). St. Louis County also has a lower percentage of people living below the federal line (10.5%) than either the state (15.0%) or nation (14.9%). However, given its size, St. Louis County still poverty line (10.5%) than either the state (15.0%) or nation (14.9%). However, given its size, St. Louis has one of the largest populations in Missouri living below the federal poverty line. County still has one of the largest populations in Missouri living below the federal poverty line.
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IV. The Framework: Framework: a a Strategic Strategic Planning Planning Model Model In 2010, 2010,the theSaint SaintLouis LouisCounty CountyDepartment DepartmentofofHealth Health In contractedwith withthe theUniversity UniversityofofNew New England compile and contracted England to to compile and analyze community demographics, health status, and health analyze community demographics, health status, and health behaviordata datatotoidentify identifyhealth healthproblems problemsininthe the community. behavior community.
Organize Partnership for Success Development Visioning Four MAPP Assessments Identify Strategic Issues Formulate Goals and Strategies Evaluate
Plan Action
Implement
Com alt h S t a m u nity H e n t tus Assess m e
al Public He Loc m Assess alth men te t Sys
es of Cha Forc ssm nge ent Asse
munity Themes Com gths Assessm & n ent e St r
PublicHealth HealthSummit Summitwas washosted hostedbybythe thedepartment department AA Public in in December 2011 to share the results of the report and foster December 2011 to share the results of the report and foster early action. action.During Duringthe thesummit, summit, the director early the director of of thethe department, Dolores J. Gunn, MD, invited hospital partners department, Dolores J. Gunn, MD, invited hospital partners inthe theregion regiontotocollaborate, collaborate,since sinceboth bothhospitals hospitals and in and thethe health aa healthdepartment departmenthave haveaasimilar similarrequirement requirementtotodevelop develop community communityhealth healthneeds needsassessment assessmentfor fortheir theirrespective respective service complete a health serviceareas. areas.Hospitals Hospitalsare arerequired requiredtoto complete a health needs needsassessment assessmentas asone oneprovision provisionofofthe thePatient PatientProtection Protection and andAffordable AffordableCare CareAct Actofof2010 2010(ACA). (ACA).
A leadership team Greater St.St. Louis, team was was formed formedwith withrepresentatives representativesfrom fromthe theUnited UnitedWay Wayofof Greater Louis, BJC BJC HealthCare, Health Care-St. Mercy, andSt. theLouis, Saint Louis County of Department Health. HealthCare, SSMSSM HealthCare St. Louis,Louis, Mercy Hospital and the Saint Department Louis County The team was with tasked providing oversight foroversight the development of a Community Assessment of Health. Thetasked team was with providing for the development of aHealth Community Health (CHA) and Community Improvement Plan (CHIP). The thepurpose CHIP is of to describe Assessment (CHA) andHealth Community Health Improvement Planpurpose (CHIP). ofThe the CHIPhow is to public andhow private organizations members ofand themembers community together and align their efforts describe public and privateand organizations of can the work community can work together and to improve the health of county residents. align their efforts to improve the health of county residents. To health department contracted with thethe Illinois To facilitate facilitate the the planning planningprocess processfor forSt. St.Louis LouisCounty, County,the the health department contracted with Illinois Public assessment and strategic planning Public Health Health Institute Instituteto toaid aidininthe thedevelopment developmentofofa acommunity community assessment and strategic planning model. through Planning and Partnerships (MAPP) framework was chosen as as the model. The TheMobilizing Mobilizingfor forAction Action through Planning and Partnerships (MAPP) framework was chosen planning tool.tool. MAPP is theisgold for community health health assessment and planning. It includes the planning MAPP the standard gold standard for community assessment and planning. It includes a robust assessment, active community engagement, and participation in strategic thinking and planning. a robust assessment, active community engagement, and participation in strategic thinking and planning. To lasting change, thethe leadership To develop develop aa shared shared vision vision and andplan planfor forthe thecommunity communityand andhelp helpsustain sustain lasting change, leadership team and team invited invited representatives representativesfrom fromvarious variousorganizations organizationstotoparticipate participateininthe thethree threeassessments assessments and serve as members of the MAPP Stakeholder Advisory committee. These invitees represent numerous serve as members of the MAPP Stakeholder Advisory committee. These invitees represent numerous organizations oror more ofof thethe Ten Essential Public organizations and and other other entities entitiesthat thatcontribute contributetotothe thedelivery deliveryofofone one more Ten Essential Public Health Services in St. Louis County. The role of the Stakeholder Advisory Committee is to provide Health Services in St. Louis County. The role of the Stakeholder Advisory Committee is to provide feedback feedback and and guidance. guidance. The MAPP framework framework allowed beyond just health status and The MAPP allowedthe theStakeholder StakeholderAdvisory AdvisoryCommittee Committeetotolook look beyond just health status and take a more community-driven approach by looking at community perceptions, public health assets and take a more community-driven approach by looking at community perceptions, public health assets and resources, a self-evaluation of the local public resources, forces forces of of change changeininthe thecommunity, community,and andbybyconducting conducting a self-evaluation of the local pubhealth system. As part of this approach, four specific assessments were conducted by participating lic health system. As part of this approach, four specific assessments were conducted by participating community assessments areare explained in in detail onon thethe following twotwo community members membersand andagencies. agencies.These Thesefour four assessments explained detail following pages. pages.
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Community Health Status Assessment: The Community Health Status Assessment answers the following questions:
• How healthy are our residents? • What does the health status of our community look like?
The St. Louis County Community Health Status Assessment is taken from the 2011 Community Health Needs Assessment Report. The primary data source was a community household survey of 2,149 residents. Secondary data sources for the report included: population and demographics; birth and mortality records; hospital inpatient and emergency department data; cancer registry data; unintentional injury data; Missouri Youth Risk Behavior Surveillance System data; and Missouri Behavioral Risk Factor Surveillance System data. Forces of Change Assessment: On March 5, 2013, the MAPP Stakeholder Advisory Committee met to learn more about the MAPP process, develop a vision and guiding principles to guide their work, and to participate in a Forces of Change Assessment. This assessment activity focused on the identification of various forces (trends/events/factors) or impending legislative, social, economic, technological, legal, environmental, or scientific changes that may affect the overall health of the community or the local public health system. To accomplish this, the Stakeholder Advisory Committee divided into small groups. Each group brainstormed and listed relevant forces of influence and accompanying threats and opportunities. The small groups moved around the room to each category of influence adding input to the previous groups’ ideas until the process of review was completed for each category of influence. The committee then came back together for a large group discussion and voting session. The forces with the most votes earned through the multi-voting process were ranked as the most prominent forces of change. The analysis of the cross-cutting themes from all categories within the Forces of Change Assessment and their prioritization by the Stakeholder Advisory Committee produced six core issues. These six leading forces of change include:
• Aging and End of Life Issues • Health Care Reform • Inequality and Health Disparities • Violence and Crime • Food Insecurity and Food Deserts • Mental Illness
Community Themes and Strengths Assessment: On March 26, 2013, the MAPP Stakeholder Advisory Committee met again to participate in a Community Themes and Strengths Assessment. This assessment includes the identification of community assets and strengths to support the health of the community. It solicits the perceptions of residents and stakeholders regarding community health needs and priorities. The committee participated in a two-hour meeting to identify assets and share thoughts, opinions, and observations regarding community priority needs.
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In addition, from April through June of 2013, eight focus groups of residents from the four sub-county regions identified in the community health status report were conducted by employees from the Saint Louis County Department of Health to answer the following questions:
• What is important to our community? • How is quality of life perceived in our community? • What are our assets?
Among the stakeholder focus groups and community focus groups, the three most important factors necessary for a healthy community mentioned across almost all groups were: 1) a clean environment; 2) safety; and 3) alternative transportation, including walking, biking, and public transit. Cohesive communities and access to care were also frequently mentioned as essential elements of a healthy community. Environmental and community-level health determinants constituted the vast majority of factors mentioned across the focus groups as contributing to the creation of a healthy community. Local Public Health System Assessment (LPHSA): On April 19, 2013, the Stakeholder Advisory Committee, along with an additional 70 community leaders, came together to participate in a Local Public Health System Assessment (LPHSA). This assessment utilizes a standardized tool developed by the Centers for Disease Control and Prevention (CDC) to discuss and self-evaluate the capacity and capability of the local public health system. Those gathered looked critically at the local public health system and scored its performance based on the representatives’ understanding of the collective effort needed to address the Ten Essential Public Health Services. (St. Louis County used version 3.0 which is the newest version of this assessment tool.) The assessment retreat began with a 60-minute plenary presentation to welcome participants, provide an overview of the process and the Ten Essential Public Health Services, introduce the staff, and answer participant questions. Participants then divided into five groups. Each breakout group was responsible for conducting the assessment for two of the Ten Essential Public Health Services. The groups were professionally facilitated, recorded, and staffed by a note taker. The assessment concluded with a wrap-up session during which highlights were reported by one or more member of each group. Event organizers facilitated the end-of-day dialogue and outlined the next steps to enter and analyze and report LPHSA data to the St. Louis County MAPP Team and retreat participants. In addition, participants were given an opportunity to provide feedback about the event and sign up for participation in further MAPP activities. Throughout the discussions of the Ten Essential Public Health Services, a number of cross-cutting themes emerged in the dialogue among each group. The themes arose as strategic areas to address to improve the functioning, capacity, and effectiveness of the local public health system in St. Louis County. These included:
• • • •
System Coordination Long-Term Partnerships and Collaborations Communication across Organizations Data and Information Sharing
To improve the provision of the Ten Essential Public Health Services and to promote and improve the health and well-being of St. Louis County residents, stakeholders in the local public health system will need to enhance efforts to function as a coordinated system in order to maximize capacity and resources.
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Two major major health health issues issues frequently frequently cited cited as as gaps gaps in in the the LPHSA LPHSA were: were: Two
Substance Abuse Abuse • • Substance • Mental Health • Mental Health
These two two health health issues issues surfaced surfaced throughout throughout essential essential service service discussions discussions as as areas areas of of critical critical need need for for These the county and areas in which minimal coordinated efforts currently exist. the county and areas in which minimal coordinated efforts currently exist. Key strengths strengths of ofthe theLPHS LPHS that that were were noted notedthroughout throughoutthe theassessment assessmentincluded: included: Key
• • • •
Emergency Preparedness Preparedness and and Surveillance Surveillance Emergency Monitoring and Mitigating Infectious Disease Monitoring and Mitigating Infectious Disease
These areas emerged throughout discussions as areas in which the local public health system excels These areas emerged throughout discussions as areas in which the local public health system excels and functions well at a system-level to communicate and coordinate efforts and to leverage collective and functions well at a system-level to communicate and coordinate efforts and to leverage collective resources and capacity. resources and capacity. Full reports with key findings for each assessment are available at the following link: Full reports with key findings for each assessment are available at the following link: www.stlouisco.com/Portals/8/docs/Health/Health%20Education/CommunityHealthNeedsAssesswww.stlouisco.com/Portals/8/docs/Health/Health%20Education/CommunityHealthNeedsAssessment l.pdf. ment l.pdf. After completing the assessments, the leadership team voted to formalize the partnership and adopt as After completing the assessments, the leadership team voted to formalize the partnership and adopt as the name of the group, “The St. Louis County Partnership for a Healthy Community.” the name of the group, “The St. Louis County Partnership for a Healthy Community.” On June 25, 2013, and September 30, 2013, the St. Louis County Partnership for a Healthy Community On June 25, and September 30, 2013, the St. Louis County Partnership a Healthy Community reviewed the2013, assessment data, identified cross-cutting themes and issues, andforapplied criteria to reviewed the assessment data, identified cross-cutting themes and issues, and applied criteria to prioritize issues. The group looked for alignment with the St. Louis County government strategic plan, prioritize issues. The groupoflooked alignment with the State St. Louis County government the Missouri Department Healthfor and Senior Services’ Health Department planstrategic and otherplan, hospital the Missouri Department of Health and Senior Services’ State Health Department plan and other hospital plans that were available. This resulted in four priority health issues: plans that were available. This resulted in four priority health issues:
• • • • • • • •
Access to Health Care Access Health Healthy to and Safe Care Environments Healthy andand SafeDisease Environments Prevention Management Prevention and Disease Management Behavioral Health (Mental Health and Substance Abuse) Behavioral Health (Mental Health and Substance Abuse)
This wall notes is This wall of of sticky sticky notes is an an example example of of how how information information was was aggregated aggregated at community meetings, allowing everyone’s input to count. at community meetings, allowing everyone’s input to count. 2014 SAINT LOUIS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN
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The partnership began the process of developing strategies and action plans to address the priority health issues. Action Teams were formed and met monthly to develop and finalize draft strategies for action. The draft plans were submitted to the Leadership Team who reviewed and provided feedback on them. In May 2014, the St. Louis County Partnership for a Healthy Community started the final phase, which is the development and implementation of action plans for each of the four priority health issues. During this phase, the Partnership’s Stakeholder Advisory Committee will monitor implementation and provide support to the action teams to ensure progress is made on the four priority issues. The Advisory Committee will meet quarterly to review the progress of the action teams and to continue identifying emerging priorities and forces that may have an impact on the health of the community. Quality improvement activities will be initiated as needed to improve process and outcome results. Below is a diagram of the MAPP Structure and how it functions:
MAPP Structure Provides oversight for CHA/CHIP. Staffs and leads the process. Provides resources to conduct assessment and planning
Provides feedback and guidance. Participates in assessments. Identifies and engages LPHS representatives. Identifies and prioritizes issues. Assists in leading action teams, implementation and evaluation. Participates in LPHS assessment. Participates on and leads action teams.
These four teams develop measurable action plans, works with Leadership Team and other stakeholders to implement and evaluate action plans.
Leadership Team
United Way of Greater St. Louis BJC HealthCare SSM Health Care-St. Louis Mercy Saint Louis County Department of Health
Stakeholder Advisory Committee
All Local Public Health System Representatives
Behavioral and Mental Health Team
Access to Care Team
Healthy and Safe Environment Team
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Prevention and Disease Management Team
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V. Past Accomplishments The Saint Louis County Department of Health and its community partners have been working together for years to improve the health of county residents. Through the Mobilizing Action through Planning and Partnerships (MAPP) process, the department continues to work collaboratively while expanding its reach within the local public health system. While many organizations and coalitions have been in place to address these priority health issues, others are being newly created as a result of the MAPP process. Below is a brief synopsis of the department’s past accomplishments.
Access to Health Care: In 2001, the last remaining public hospital in the St. Louis region closed, which jeopardized the area’s healthcare safety net. Civic Progress, an organization comprised of the leading corporate executives in St. Louis, formed a task force to address the immediate crisis. The Regional Health Commission (RHC) – a consortium of government representatives, providers of care, and members of the community – was formed to manage the response. The RHC developed and implemented a long-range plan to improve health care access and delivery to the uninsured and underinsured. The Saint Louis County Department of Health assumed a leadership role with this initiative.
• Helped form the St. Louis Integrated Health Network (IHN), an umbrella organization of safety net providers in the St. Louis region. • Led the Eastern Region Behavioral Health Initiative, bringing together mental health and substance abuse providers and community advocates to integrate behavioral and physical health providers, out of which the Behavioral Health Network (BHN) was formed. • Piloted the Gateway to Better Health Demonstration project, helping to transition 25,000 uninsured and underinsured individuals into a coverage model in preparation for the implementation of federal healthcare reform.
Behavioral Health: St. Louis County has been working on the issue of behavioral health through
the Behavioral Health Network of Greater St. Louis (BHN). The BHN is a collaborative effort of providers, advocacy organizations, government leaders, and community members dedicated to developing an accessible and coordinated system of behavioral healthcare throughout the eastern region of Missouri, with an emphasis on services to the uninsured and underinsured. Some of the past accomplishments of the BHN include:
• The Hospital Community Linkage Program which connects people admitted to the hospital for acute mental health episodes to community mental health agencies. • The BHN Emergency Department Enhancement project which connects people who visit emergency departments with acute mental health episodes to community mental health resources. • The Integrated System of Care program which increases access to quality behavioral health services for the uninsured and underinsured through the integration of primary care services and behavioral health through the Saint Louis County Department of Health.
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Healthy and Safe Environments: The Saint Louis County Department of Health was awarded a grant from the U.S. Department of Health and Human Services in 2009 for a tobacco use prevention project under the Communities Putting Prevention to Work (CPPW) program which was administered by the U.S. Centers for Disease Control and Prevention. The project began in 2010 and was entitled “Changing Tobacco Norms in St. Louis County” and achieved many important accomplishments: • • •
Thirteen (13) of the 23 public school districts in St. Louis County adopted new tobacco free or smoke free policies, joining six (6) other districts that already had comprehensive policies. Six (6) of nine (9) area colleges and universities adopted new comprehensive tobacco free or smoke free campus policies. Two St. Louis County municipalities (Brentwood and Creve Coeur) adopted comprehensive smoke free ordinances, and the City of Clayton strengthened its comprehensive smoke free ordinance by adding parks and other city-owned outdoor property.
Prevention – Obesity: In October of 2013, the kickoff of JUMP N2 Shape, a regional health movement aimed at reducing obesity, was announced by the mayors of the cities of St. Louis and East St. Louis and by the County Executive of St. Louis County. This initiative is designed to promote weight loss and increase fitness among residents in the metropolitan area. JUMP N2 Shape encourages individuals to Join in the movement, Unite to improve their health, Motivate each other, and Participate in activities associated with the challenge.
Prevention – Sexually Transmitted Infections: In 2010, the Saint Louis County Department of Health collaborated with the STD/HIV Prevention Training Center and the Division of Infectious Diseases at the Washington University School of Medicine to develop and implement an Expedited Partner Therapy protocol for STIs. This protocol provided guidance to healthcare providers on ensuring compliance with CDC Guidelines for the treatment of sexual partners of individuals being treated for STIs. In 2012, the Saint Louis County Department of Health entered into a formal contract with Washington University to conduct formative research leading to the development of a youth-focused website for STI education, screening, and treatment. After extensive research (including focus groups), a website (www.STLProtectYours.org) was launched in the fall of 2013. Promotion and marketing efforts for the website are ongoing.
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VI. Public Health Priority Issues, Goals, Objectives, Measures, and Strategies: • Priority One: Access to Health Care Partners:
• Anthem Blue Cross and Blue Shield • BJC HealthCare • Maternal and Child Health Coalition • Mercy • Missouri Foundation for Health • Saint Louis County Department of Health
• St. Louis Integrated Health Network • St. Louis Regional Health Commission • St. Luke’s Hospital • SSM Health Care-St. Louis • Washington University’s Institute for Public Health
Description of the Problem: Access to and the availability of high-quality primary health care, especially for the populations with chronic health conditions, is inconsistent across St. Louis County. Based on the data presented in the Community Health Assessment, it is unclear whether this is due to an inadequate availability of providers in certain areas, the lack of health insurance coverage, insufficient resources for patient opportunities in self-management, or some combination of these as well as other factors. Data: Data Source
Brief Description of Data
2011 Saint Louis County Department of Health Needs Assessment
• A relatively high percentage of St. Louis County residents (78%) have had a medical checkup within the previous two years, with lower rates among the uninsured. • St. Louis County adults in South and West County were more likely to have a regular source of care than other adults in the county and the state. • St. Louis County residents who had a usual source of care were slightly more likely to visit a doctor’s office or clinic instead of an emergency department (ED) or hospital outpatient clinic when sick. • Approximately 11% of St. Louis County residents reported that they had needed prescription drugs within the previous 12 months but had been unable to get them because of cost. Rates were higher in Mid (14%) and North County (16%). • ED utilization and hospitalization rates were comparatively high in North County for both the insured and uninsured populations.
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Data Source
Brief Description of Data
2011 Saint Louis County Department of Health Needs Assessment
• The national target for Healthy People 2020 (HP 2020) is that 84% of U.S. adults should have a usual source of primary care by 2020, representing an 8% increase over the 2007 U.S. rate of 76%. Both Missouri and St. Louis County were close to achieving this goal, with only 17% of Missourians and 16% of St. Louis County residents having reported the lack of a regular primary care provider. However, North County had a higher proportion of residents without a regular source of care (20%) than the other study regions. Also of note: both Mid and North County had a large percentage of males reporting no usual source of care – 24% in Mid and 26% in North County. • Insurance status had a significant impact on whether individuals had a usual source of care. In St. Louis County, 64% of uninsured adults did not have a usual source of care as compared to 10% of those with insurance. Even among those who were insured at the time of the survey but had been uninsured at some point during the previous year, 26% reported not having a usual source of care. • Gender and race/ethnicity are also critical factors to consider. St. Louis County men were less likely to have a usual source of care than women (19% vs. 13%, respectively). Likewise, Black/ African American county residents were much less likely to have a usual source of care than Caucasian county residents (28% vs. 12%, respectively). • Of adults who had a usual source of care, 21% had visited the ED at least once within the previous 12 months; of those without a usual source of care, 27% had visited the ED at least once. • Insured residents who had visited the ED at least once within the previous 12 months had done so at a much lower rate (20%) than those who were uninsured (38%) or had been uninsured within the previous 12 months (28%). Uninsured residents had also been more likely to use the ED than insured residents. Among those who had previously been uninsured or were uninsured at the time of the survey, 11% and 13% had used the ED at least twice within the previous 12 months as compared to 6% among insured residents • Overall, ED utilization in St. Louis County (28,444 ED visits per 100,000 people) was lower than the state average (37,481 ED visits per 100,000). Only one study region had an overall ED utilization rate higher than the state rate: North County with 50,963 ED visits per 100,000.
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Data Source
Brief Description of Data
2011 Saint Louis County Department of Health Needs Assessment
• Residents aged 18-44 years visited the ED at a higher rate than other age groups in both St. Louis County and in the state (36,781 and 45,218 per 100,000 people, respectively). Among the four study regions, the age group with the highest ED visit rate varied. In Mid and North County, those aged under 18 years had the highest ED visit rate (68,342 and 75,119 per 100,000, respectively). In West County, those aged 65 years and older had the highest ED visit rate (22,150 per 100,000). In South County, those aged 18-44 years had the highest ED visit rate (26,925 per 100,000). It should be noted, however, that ED utilization was highest in North County for each age group reported. • Approximately 9.2% of St. Louis County residents did not receive needed medical care during the previous 12 months due to cost; this includes 56% of those who were uninsured and 4.3% of those who were insured. Unmet medical care needs varied throughout the study regions from low in West County (4.9%) to highs in Mid (13%) and North County (11%). However, these rates of unmet care due to cost were lower than the state rate of 14%. • Approximately 11% of St. Louis County residents reported not having been able to pay for needed prescription drugs within the previous 12 months. Rates were highest in Mid (14%) and North County (16%). Rates were also highest among those who were uninsured at the time of the survey (44%) and among those who had been uninsured at some point within the previous 12 months (38%). • Higher rates of hospitalization and ED use for Acute Coronary Syndrome (ACS) conditions can sometimes be an indicator that access to and/or quality of primary care in a particular region may need to be improved. Higher visitation rates can also be the result of poorer underlying health status (disease prevalence) in a population. For example, higher prevalence of disease may account for elevated ACS hospitalization rates when comparing two geographic areas. Differences in prevalence can sometimes be compared to differences in visitation rates to help identify inconsistencies in access and/or quality.
2013 Community Themes and Strengths Assessment
• Both in resident and community stakeholder focus groups, social determinants of health were frequently cited as playing a critical role in compromising community health and well-being. The failure to implement the Affordable Care Act was identified as a barrier to access to health care in the county.
2013 Forces of Change Assessment
• The analysis of cross-cutting themes from all categories within the Forces of Change Assessment and their prioritization by the Stakeholder Advisory Committee produced six core issues. Health Care Reform was identified as one of those six issues.
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Data Source
Brief Description of Data
Regional Health Decade in Review of Health Status
• In both St. Louis City and County, Black/African-American adults were more than twice as likely to be uninsured as compared to Caucasian adults. This lack of coverage resulted in some individuals not receiving medical services when needed, as reported by approximately 12% of Blacks/African Americans and 5% of Caucasians in the St. Louis region.
The following Healthy People 2020 objectives closely relate to the goals and objectives in this plan:
1. Ensure adequate distribution of health care providers. 2. Increase the proportion of persons with health insurance. 3. Reduce the proportion of preventable emergency room visits. 4. Reduce the improper use of the emergency department. 5. Increase the proportion of persons with a usual primary health care provider.
Goal: Improve access to high-quality health care. Objectives: 1. By December 2017, through the Alive and Well STL Program, inform, educate, and engage the St. Louis community around key health and safety net topics. 2. By December 2019, increase the percentage of North County residents who report having a usual source of care from 80% of adults to the national target for Healthy People 2020 of 84%. 3. By December 2019, decrease by 2% the ED utilization rate in North County from 50,963 to 49,944 per 100,000 people, to move closer to the state average of 37,481 per 100,000.
Project Leads
Selected Strategies
Integrated Health Network
Utilize the Referral Coordinators from the Community Referral Coordinator Program to connect hospital patients from either the inpatient units or ED with a primary care provider for follow-up and preventive care with a focus on serving Medicaid and uninsured patients in need of a medical home.
Possible Indicators • • •
2014 SAINT LOUIS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN
The percentage of North County residents who report having a usual source of care. The ED utilization rate in North County. The number of participants in the Community Referral Coordinator Program.
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Project Leads
Selected Strategies
Possible Indicators
Regional Health Commission
Provide access to primary and specialty health care services through the Gateway to Better Health Demonstration Project for low-income, uninsured individuals in St. Louis County.
• The number of people signed up for Gateway to Better Health.
Saint Louis County Department of Health and Midwest Health Initiative
GIS mapping of “The Doctor Is In” report to identify geographical gaps in access to care. Adopt organization and state level policies to incentivize physicians to practice in underserved areas.
• Map of practicing primary care physicians by zip code.
Missouri Foundation for Health, Regional Health Commission, Missouri Hospital Association
Educate legislative staff and elected representatives on the necessity for Medicaid expansion in Missouri.
• The number of policy makers educated about and/or in support of Medicaid expansion.
Missouri Health Net, Saint Louis County Department of Health
Achieve designation of Missouri Primary Care Health Home Initiative for safety net population.
• The number of health centers designated as Missouri Primary Care Healthcare Homes.
Federal Exchange, Increase enrollment in the Health Care Integrated Health Net- Exchange under the Affordable Care Act. work, Missouri Foundation for Health
• The number of enrollees in the Federal Exchange.
Saint Louis County Department of Health
• The number of people who have received targeted health education.
Provide targeted health education to sub-county regions based on health assessment data.
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Community Assets and Resources Missouri Foundation for Health Program Enrollment Campaign – Cover Missouri The Saint Louis County Department of Health providing three primary care health centers and financial support for the Regional Health Commission Funding from local hospitals and coordination from the Integrated Health Network in order to implement the Community Coordinator Referral Program Funding from the Missouri Foundation for Health/Anthem/Missouri Health Net to create local primary-centered medical homes (PCMH) Federal funding for the Gateway to Better Health Demonstration Project
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• Priority Two: Behavioral Health (Substance Abuse and Mental Health) Partners: • Behavioral Health Network • • Behavioral Health Response • BJC Behavioral Health • • Bridgeway Behavioral Health • Hyland Behavioral Center at St. Anthony’s • • Lutheran Family and Children’s Services • • Mental Health America • • Mercy Clinic Child and Adolescent Psychiatry-Edgewood • • Mercy • The Missouri Department of Correction’s • Division of Probation and Parole • • Missouri Department of Health and Senior Services •
The Missouri Department of Mental Health’s Division of Behavioral Health National Council on Alcohol and Drug Abuse-St. Louis Provident Counseling St. Louis County’s Children’s Service Fund The Saint Louis County Department of Health’s Family Mental Health Collaborative Saint Louis County Police Crisis Intervention Team St. Louis County Special School District St. Louis City Public Schools SSM Health Care-St. Louis
Description of the Problem: According to the St. Louis County 2011 Community Health Needs Assessment, St. Louis County appeared to have more mental health resources available than most communities; however, more effort is needed to adequately address mental health and substance abuse needs within the county. There is a particular need among disadvantaged populations like those found in North County. While behavioral health problems may be widespread, many community residents are unlikely to recognize them. For example, although there is a lower reported prevalence of mental disorders in North County, there is a higher level of hospital admissions for certain mental health problems. This suggests that many conditions are going undiagnosed or, if diagnosed, going untreated. (Note: the available statistics do not cover the time period after the closure in July of 2010 of a mental health facility that served North County.) The planning group met biweekly for six months and chose to narrow the focus to reducing the stigma associated with behavioral health through education that results in policy and systems change.
Data: Data Source
Brief Description of Data
Community Themes and Strengths Assessment from the 2013 St. Louis County MAPP Process
Qualitative data as reported by the following groups: • Teen Mothers In North County o Biggest issues that should be addressed? Drugs. o Areas for improving health? More consequences for drug use. • Immigrant Teenagers, South County, Bayless High School o Biggest issues that should be addressed? Substance abuse. • Seniors, Mid-East Area Agency on Aging, West County Senior Center o Barriers to health in your community? Illegal drugs.
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Data Source
Brief Description of Data
Community Themes and Strengths Assessment from the 2013 St. Louis County MAPP Process
• Seniors, Mid-East Area Agency on Aging, Affton Senior Center South County o Ideas for improving health? More mental health services. • Female Veterans o Biggest Issue that should be addressed? Drug control. o Ideas for improving health? Laws to control drugs. • Fathers Support Group o Barriers to health in your community? Lack of mental health support. • National Alliance of Mental Illness o What does a health community look like? People can openly talk about mental illness and not be stigmatized, but supported. No drugs. More places to talk to someone who is suicidal rather than being hospitalized. o Biggest Issue that should be addressed? Drug use. o One big thing we can do to improve health? More drug rehabilitation services. • Beyond Housing o What does a healthy community look like? Good mental health. o Barriers to health in your community? Depressed community. o Biggest issues that should be addressed? Loss of hope and depression. Stigma around mental health. o Ideas for improving health? Find different way to talk about mental health and address stigma. o Services the hospitals and health department can provide? Talk about mental health issues in schools.
Forces of Change Assessment from the 2013 St. Louis County MAPP Process
• What is occurring that affects the health of our community or the local public health system or what specific threats or opportunities are generated by these occurrences? Mental illness participants mentioned mental illness stigma as a social force, receiving seven votes. They also cited concerns with the highly restricted number of involuntary commit beds for those with mental illness. • Threats? Insufficient preventative services and access to care. Fear of treatment. Harm to self and others. • Opportunities? Offer prevention and treatment services. Potential opportunities for early treatment. • Questions/information needed? What are the resources available to us to address mental health issues? What legislative action can be taken to address mental health needs?
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Data Source
Brief Description of Data
Local Public Health System Assessment from the 2013 St. Louis County MAPP Process
• Essential Public Health Service (EPHS) 1: Monitor Health Status to Identify Community Health Problems. o Weakness: Improvements needed in maintaining mental health and substance abuse registries. • EPHS 2: Diagnose and Investigate Health Problems and Health Hazards. o Opportunities for long-term improvement: Build and strengthen partnerships with mental health providers in emergency management. Improve mental health surveillance. • EPHS 5: Develop Policies and Plans that Support Individual and Community Health Efforts. o Weakness: Lack of resources for the health department to adequately address mental health.
Saint Louis County Department of Health 2011 Community Health Needs Assessment
Rates of problem alcohol use and alcohol-related health services varied in St. Louis County, and three regions had elevated hospital admission rates. Discharge data showed regional ED utilization variations for alcohol and drug-related conditions.
• Binge drinking was slightly elevated in Mid (19%) and South County (20%), especially among adults aged 18-64 years and among seniors (age 65 years and older) in North and West County. • The substance abuse hospital admission rate for North County (162 per 100,000 people) was considerably higher than the state rate of 155 per 100,000. The rate for seniors in West County was 101 per 100,000, which was high as compared to the state rate of 74 per 100,000 for this population. • Hospital admission rates for alcohol-related psychoses for most of the county were close to the state rate of 51 per 100,000 people, except in North County which was slightly higher with a rate of 62 per 100,000. • Acute alcohol-related mental disorder ED rates in Mid (57 per 100,000 people) and North (64 per 100,000) County were much higher than the state rate of 29 per 100,000.
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Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
Mental health problems, hospital admission rate, and suicide mortality rates varied across St. Louis County. Mental health-related admissions were not always positively correlated with risk factors and prevalence rates, suggesting that factors such as the availability of services and stigma (among others) may have influenced the likelihood of receiving treatment. High ED utilization for certain mental health related conditions may indicate access barriers to inpatient, ambulatory, and/or crisis services.
• North (10%) and Mid (9.1%) County reported the highest percentage of respondents who had poor mental health for at least 11 of the previous 30 days as compared to 12% of all Missouri residents. • 7.4% of Mid County and 7.1% of North County residents reported that they had a need for mental health treatment at least once within the previous 12 months and did not receive it as compared to 6.8% of Missouri residents. • The hospitalization rates of those aged 17 years and younger for bipolar disorder for Mid (472 per 100,000 people) and North (582 per 100,000) County were especially high as compared to the state rate of 359 per 100,000. • Major depression hospital admission rates for North County (336 per 100,000 people) were much higher as compared to the rate for the county overall (264 per 100,000) and Missouri (244 per 100,000). • Hospital admission rates for schizophrenia and related disorders in Mid County (257 per 100,000 people) were about 75% higher than the state (150 per 100,000), and the North County rate (363 per 100,000) was more than 2.5 times higher than the state. • Males who lived in North County had a suicide rate of 23 per 100,000 people. This was much higher than the overall combined suicide rate for men and women in North County of 13 per 100,000, but it was comparable to the state rate of 22 per 100,000 for males only.
Psychosis accounted for the highest rate of mental health-related hospital admission in St. Louis County at 796 per 100,000 people. The rates were significantly higher in North County (1,248 per 100,000) and slightly higher in Mid County (916 per 100,000). Overall, it was highest among the 18-44 year old age group (1,206 per 100,000).
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Data Source
Brief Description of Data
Progress Towards Building a Healthier St. Louis: 2012 and 2013 Access to Care Data Book (St. Louis Regional Health Commission Released, November 2012)
Local ED visits for which mental health or substance abuse was a primary or secondary diagnosis continued to rise as indicated by their increased percentage of overall ED visits. Increases among this diagnostic category outpaced the growth in total ED encounters by more than three-fold.
Year
# of MH or SA visits
Percent (%) of overall ED visits
2009
107,539
17%
2010
126,077
19%
2011
139,392
20%
2012
165,115
22%
This represents an overall increase of 5% from 2009 to 2012. Decade Review of Health Status for St. Louis City and County 2000-2010. An update to Building a Healthier St. Louis (St. Louis Regional Health Commission, released December 2012.)
• High rates of acute mental health disorders in 2008 and 2009 appeared to be highly concentrated in areas of the city and part of North County. • Following a decline between 2000 and 2006, the annual number of suicides increased in the region. This increase was driven largely by the number of suicides in the county. • From 2000 to 2009, ED visits in the region for alcohol-related mental disorders and affective disorder diagnoses increased 21% and 81%, respectively. • In 2008 and 2009, ED visits for a primary diagnosis of mental disorder accounted for 3% of total ED visits and 17% for mental disorders as primary or secondary to another medical condition. • While drug arrests in the city dropped 19% from 2008 to 2010, drug arrests in the county increased 37% during this same time. • It was estimated that 18% of St. Louis City and St. Louis County adults were binge drinkers.
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The following Healthy People 2020 objectives closely relate to the goals and objective in this plan:
• Increase the number of adults with a mental health disorder who receive treatment. • Increase the number of persons who receive alcohol and/or illicit drug treatment.
Goal: Improve access to mental health and substance abuse services in St. Louis County. Objectives:
1. By December 2014, the Saint Louis County Department of Health’s Building an Integrated System of Care (BISC) Behavioral Health Consultant will increase the number of patient encounters in the department’s health centers from 509 per year to 1000 per year. 2. By December 2014, the Saint Louis County Department of Health’s Behavioral Health Workgroup will establish a system of measurement to track the number of St. Louis County participants who complete the Mental Health First Aid Course. 3. By December 2016, the Saint Louis County Department of Health will develop and distribute a health data profile for behavioral health to support public health improvement planning processes. 4. By December 2015, the Saint Louis County Department of Health will increase substance abuse services for county residents by increasing the referrals to Bridgeway from 86 per year to 200 per year. 5. By December 2019, decrease the hospital admission rate for major depressive disorder by 5% from 246 per 100,000 people to 234 per 100,000. 6. By December 2019, decrease the Emergency Department (ED) visit rate for major depressive disorder by 5% from 68 per 100,000 people to 65 per 100,000.
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Project Leads
Selected Strategies
Possible Indicators
Behavioral Health Network HospitalCommunity Linkage Program.
Connect people admitted to the hospital for acute mental health episodes to community mental health agencies through the BHN HospitalCommunity Linkage Program.
• The number of appointments scheduled with the BHN Hospital-Community Linkage Program. Resource: BHN Hospital-Community Linkages report. • Decreased Emergency Department visits for mental health. Resource: Progress Towards Building a Healthier St. Louis: 2012 and 2013 Access to Care Data Book.
Behavioral Health Network Emergency Department Enhancement Project
Connect people who visit the ED with acute mental health episodes to community mental health resources through the BHN Emergency Department Enhancement project.
•
Saint Louis County Department of Health
Increase access to quality behavioral health services for the uninsured and underinsured through the integration of primary care services and behavioral health through the Saint Louis County Department of Health’s Building an Integrated System of Care Program (BISC).
• The number of Behavioral Health Consultant (BHC) visits at the Saint Louis County Department of Health’s. • Stigma survey of Primary Care staff at the Saint Louis County Department of Health’s. Resource: BISC Yearly Grant report.
Saint Louis County Department of Health
The Saint Louis County Department of Health will partner with community agencies to improve data collection on behavioral health within St. Louis County in order to create a community profile.
• Community health data profile for behavioral health.
The number of appointments scheduled with the BHN-ED Enhancement Program. Resource: BHN ED Enhancement report.
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Project Leads
Selected Strategies
Possible Indicators
Saint Louis County Department of Health
The Saint Louis County Department of Health’s Building an Integrated System of Care (BISC) staff will work with DOH Health Center staff to improve the referral process and assure patients with substance abuse disorders are referred to the Bridgeway program at NCCHC.
•
National Council on Alcohol and Drug Abuse (NCADA) and Behavioral Health Response
Train the community at large to identify, understand, and respond to signs of mental illness and substance abuse disorders by offering free mental health first aid courses in order to reduce stigma. (The Children’s Services Fund and Behavioral Health Response are funders. Mental Health First Aid is providing the program).
• The number of people who participate in the Mental Health First Aid Training Program. Resource: National Council on Alcohol and Drug Abuse (NCADA) and Behavioral Health Response (BHR) reporting. • The number of people who participate in suicide intervention training by Behavioral Health Response (BHR). Resource: Behavioral Health Response reporting.
The number of patients referred to the Bridgeway program at NCCHC. Resource: BISC reporting.
Goal: Improve access to mental health and substance abuse prevention, treatment, and recovery
services for all persons while reducing the associated stigma.
Objectives:
1. By December 2014, the Saint Louis County Department of Health’s Behavioral Health Workgroup will identify an evidence-based anti-stigma plan or partner with a local public health research/ evaluation agency on an evidence-based anti-stigma program. 2. By December 2014, the Saint Louis County Department of Health’s Behavioral Health Workgroup will have a formalized process for educating the community on Behavioral health and assure improved collaboration and sharing of information between members. 3. By March 2015, the Saint Louis County Department of Health’s Behavioral Health Workgroup will have a tracking system of participants who attend trainings/presentations by member agencies. 4. By December 2016, the Saint Louis County Department of Health’s Behavioral Health Workgroup will implement an evidence-based media anti-stigma campaign that is directed at the community to increase their awareness and use of available mental health and substance abuse services. 5. By December 2017, the Saint Louis County Department of Health’s Behavioral Health Workgroup will partner with institutions of higher learning to ensure that mental health and substance abuse training is included in the curriculum during undergraduate medical and paramedical studies to ensure adequate supply of trained primary care professionals.
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Project Leads
Selected Strategies
Possible Indicators
Saint Louis County Department of Health Behavioral Health Workgroup
Partner with a local public health research/evaluation agency to identify or create evidence-based anti-stigma program.
• Identification or creation of an evidence-based anti-stigma campaign.
National Council on Alcohol and Drug Abuse (NCADA) -St. Louis
Conduct best practice and evidence-based substance abuse prevention programs with K-12 students in St. Louis County schools
• The number of K-12 students in St. Louis County schools who participate in substance abuse prevention programs led by NCADA-St. Louis.” Resource: NCADA -St. Louis reporting in collaboration with the DOH Behavioral Health Workgroup.
National Council on Alcohol and Drug Abuse (NCADA) -St. Louis
Conduct skill-building and substance abuse training programs with administration, faculty, and staff in St. Louis County schools.
• The number of faculty, administration, and support staff who participate in skill-building and substance abuse training programs led by the NCADA-St. Louis.” Resource: NCADA -St. Louis reporting in collaboration with the DOH Behavioral Health Workgroup.
Community Resources United to Stop Heroin (CRUSH)
Provide outreach and education to the community, legislators, organizations, and businesses about policy and legislation related to the treatment and prevention of substance abuse.
•
The number of people who participate in presentations by CRUSH agencies. Resource: CRUSH reporting.
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Project Leads
Selected Strategies
Possible Indicators
Saint Louis County Department of Health’s Behavioral Health Workgroup
Increase the communication of behavioral health services, programs, trainings, and presentations through improved collaboration between member agencies.
• The number of collaborations between member agencies, MOU’s between agencies, and the process for sharing information. Resource: DOH Behavioral Health Workgroup meeting minutes.
Saint Louis County Department of Health’s Behavioral Health Workgroup/ NCADA -St. Louis
Work with local institutions of higher learning to include mental health and substance abuse training in their curriculum for professionals and paraprofessionals.
• The number of institutions of higher learning that include behavioral health in their curriculum. Resource: Curriculum of local institutions of higher learning.
National Council on Alcohol and Drug Abuse (NCADA) -St. Louis and Behavioral Health Response
Train the community at large to identify, understand, and respond to signs of mental illness and substance abuse disorders by offering free mental health first aid courses. (The Children’s Services Fund and Behavioral Health Response are funders. Mental Health First Aid is providing the program).
• The number of people who participate in the Mental Health First Aid Training Program. Resource: National Council on Alcohol and Drug Abuse (NCADA) and Behavioral Health Response (BHR) reporting. • The number of people who participate in suicide intervention training by Behavioral Health Response (BHR). Resource: Behavioral Health Response reporting.
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Community Assets and Resources Saint Louis County Police Crisis Intervention Team National Alliance on Mental Illness – tracking of suicide incidents for 19 years old and younger. Behavioral Health Network – has reports and data related to Bridges to Care ED enhancement Project and Hospital Community Linkages project. Missouri Department of Mental Health, Division of Behavioral Health – fund substance abuse treatment; certify programs, advocacy to legislators, fund prevention. Children’s Services Fund – tax-based community children's service fund that provides mental health and substance abuse services for children and youth ages nineteen and under in St. Louis County. The Saint Louis County Department of Health’s Family Mental Health Collaborative – therapy and psychiatry provided to county residents that are patients of the county health centers; a collaboration of BJC Behavioral Health, Catholic Family Services, Lutheran Family and Children’s Services of Missouri, Jewish Family & Children’s Services, Provident, and SLU Psychiatry. Behavioral Health Response • A professionally-staffed, 24/7 crisis hotline • 24/7 face-to-face evaluations in the community (mobile outreach services) • Next day urgent appointments at community mental health centers • Crisis Stabilization Beds • Primary Access Point in Eastern Region for Missouri Department of Mental Health’s Emergency Department Enhancement Project • Primary Access Point for Community Mental Health Liaison and assistance with Civil Involuntary Detention • Youth Connection Helpline services, including SMS Texting and online chat access to mental health professionals • Follow-up and care coordination Mental Health America – education and referral SSM Health Care-St. Louis – provide funding for the Psychiatry Stabilization Unit. Lutheran Family and Children’s Services – LFCS provides: mental health counseling (children, adults, couples, family); school counseling; community services for youth and children (mentoring, Step-Up curriculum); disaster case management; adoption (domestic and international); foster and respite care; and programs for pregnant teens. St. Louis Special School District – in collaboration with partner districts, provide technical education and a wide variety of individualized educational and support services designed for each student’s successful contribution to our community. Bridgeway Behavioral Health – substance abuse services Mercy Clinic Child and Adolescent Psychiatry-Edgewood – provides psychiatric treatment Missouri Department of Health and Senior Services – provide technical assistance to DMH Systems of Care teams that wish to utilize the public health approach to preventing behavioral health issues in children. 2014 SAINT LOUIS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN
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Community Assets and Resources National Council on Alcohol and Drug Abuse–St Louis – assessment and referral for substance abuse; prevention through education. Missouri Department of Corrections, Division of Probation and Parole – assessment and referral to substance abuse and mental health treatment. In conjunction with treatment professionals, hold the client accountable to intervention goals through a series of graduated sanctions. Monitor client’s sobriety and facilitate relapse management activities if warranted. Queen of Peace – substance abuse treatment/counseling Preferred Family Health Care – prevention and treatment for substance abuse St. Anthony’s: Highland Center – mental health treatment BASIC – substance abuse treatment New Beginnings – substance abuse treatment Midwest Institute for Addictions – substance abuse treatment Assisted Recovery Centers of America – substance abuse treatment Valley Hope – substance abuse treatment Center for Life Solutions – substance abuse treatment (methadone) West End Clinic – substance abuse treatment (methadone) St. Louis Metro – substance abuse treatment (methadone) Gateway Foundation – substance abuse treatment for the DOC population Centerpoint – substance abuse treatment BJC Behavioral Health – mental health treatment Independence Center – mental health treatment Places for People – mental health treatment ADAPT – mental health treatment Grace Hill – mental health treatment Psychiatric Stabilization Center – mental health treatment Correctional Facilities – mental health treatment Alcoholics Anonymous – alcohol support groups Narcotics Anonymous – narcotic support groups Local Universities – research, evaluation, consulting, collaboration, and advocacy.
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• Priority Three: Healthy and Safe Environments (Asthma) Partners: • • • • • • • • • •
American Lung Association • Asthma and Allergy Foundation • Asthma Coalition • Asthma Ready Communities • BJC HealthCare • Hazelwood School District Dr. William Kincaid (Asthma Coalition) • Dr. John Kraemer (Southeast Missouri • State University) • Maternal, Child, and Family Health Coalition • Missouri Department of Health and Senior Services
Normandy School District St. Louis Children’s Hospital St. Louis City Health Department St. Louis College of Pharmacy The Saint Louis County Department of Health’s Healthy Homes program Saint Louis County Department of Planning St. Louis Integrated Health Network United Way of Greater St. Louis University of Missouri Extension
Description of the Problem: Asthma, the leading chronic condition among children, is a lung disease characterized by periods of wheezing, chest tightness, shortness of breath, and coughing. Asthma remains a common chronic health issue in the St. Louis region. Uncontrolled asthma is often assessed by rates of ED visits and hospitalizations in public health studies. ED visits for children in St. Louis County were one and a half times higher than in Missouri overall. In St. Louis County, hospital admission rates for asthma were 402 per 100,000 people as compared to the state rate of 385 per 100,000. Mid and North County admission rates (919 and 869 per 100,000, respectively) were well above both state and county rates. Among children in Missouri, asthma is more common among Blacks/African Americans (21.8%) than among other minorities (10.6%) or Caucasians (8.5%). This data suggests potential disparities in access and quality of care including patient self-management. Access to and the availability of primary prevention and treatment modalities for asthma in these communities are priorities for follow up. Data: Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
• The percentage of adults in St. Louis County that reported having asthma at the time of the survey was 8.4%. • Asthma prevalence among St. Louis County youth was 13% as compared to the state prevalence of 15%. The percentage of parents reporting that a child had been diagnosed with asthma ranged from 12% in North County to 15% in Mid County.
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Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
• The prevalence of current smoking among adults in St. Louis County was low as compared to the state (15% versus 22%). Male smoking rates were similar to female rates across the county, except for Mid County where the male rate was higher (23% versus 15%). • In St. Louis County, hospital admission rates for asthma were 402 per 100,000 people which was greater than the state rate of 385 per 100,000. Mid and North County rates (919 and 869 per 100,000, respectively) were well above the state and county rates. Hospital admission rates for pneumonia, bronchitis, and asthma were highest for the 65 years of age and older cohort living in West County. • The county rate of ED visits for asthma was slightly below the statewide rate (395 versus 420 per 100,000 people), but both Mid and North County had markedly higher rates at 901 and 855 per 100,000, respectively. • Asthma prevalence among St. Louis County youth was 13% as compared to the state rate of 15%. The percentage of parents reporting that a child had been diagnosed with asthma ranged from 12% in North County to 15% in Mid County. • The prevalence of adults diagnosed with asthma was similar to the state rate (8.4% versus 9.2%), but much higher in Mid and North County (11% and 12%, respectively).
St. Louis Regional Health Commission’s Decade in Review
• Among children in Missouri, asthma was more common among Blacks/African Americans (21.8%) than among other minorities (10.6%) or Caucasians (8.5%). • In 2008 and 2009, 71% of all ED visits for asthma in the region (city and county combined) were paid for by Medicaid.
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The following Healthy People 2020 objectives closely relate to the goals and objective in this plan: • • • •
Reduce ED visits for asthma. Increase the proportion of persons with current asthma who receive formal asthma education. Reduce the proportion of persons with asthma who miss school or work days. Increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines.
Goal: Reduce asthma ED visits with a special focus on disparate populations. Objectives:
1. By July 2015, obtain approval for Medicaid reimbursement for the home environmental health assessments as they pertain to asthma. 2. By December 2019, increase by 25% the number of completed environmental health assessments for trigger reduction in St. Louis County residents. 3. By December 2019, reduce by 25% the number of ED visits for asthma in North County (from 2,080 per 100,000 people to 1,560 per 100,000). 4. By December 2019, reduce by 25% the rate of ED visits for asthma in Mid-County (from 1,092 per 100,000 people to 819 per 100,000). 5. By December 2015, establish an asthma clinic based on Expert Panel Report-3 guidelines in one of the North or Mid County Saint Louis County Department of Health’s health centers. 6. By May 2014, identify and coordinate the dissemination of acute asthma prevention messages to the general public. 7. By December 2019, after establishing a current baseline, increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines. 8. By December 2019, after establishing a current baseline, increase the number of school nurses who conduct asthma control assessments per a standardized evidence-based approach as recommended by the Missouri Asthma Prevention and Control Program.
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Project Leads
Selected Strategies
Possible Indicators
Asthma and Allergy Foundation, the Asthma Consortium, Dr. John Kraemer of Southeast Missouri State University
Utilize data from the NACCHO project that demonstrated the more cost-efficient method (as compared to ED utilization) of using Medicaid reimbursement to provide in-home trigger assessments of environmental trigger to reduce asthma incidents.
•
The Saint Louis County Department of Health’s Healthy Homes Program
Provide environmental trigger reduction health assessments to 25 county families as part of a NACCHO demonstration project to track the outcomes of the asthma health of children.
• Completed environmental health assessments for trigger reduction in St. Louis County residents.
Integrated Health Network
Utilize referral coordinators to connect hospital patients from either the inpatient units or ED with a primary care provider for follow-up and preventive care, with a particular focus on serving Medicaid and uninsured patients in need of a medical home through the Community Referral Coordinator Program.
•
Asthma Ready Communities
Provide training to professionals on the asthma Expert Panel Report-3 national guidelines on diagnosis and management of asthma through the Asthma Ready Communities program.
• Number of health care providers trained on EPR-3 guidelines for asthma care
The Saint Louis County Department of Health’s Healthy Homes Program
Implement an asthma clinic and referral process to the Environmental Trigger Reduction Health Assessment program through one of the Saint Louis County Department of Health’s health centers.
• •
Enactment of Medicaid reimbursement for the home environmental health assessments as they pertain to asthma.
Number of Medicaid and uninsured patients in need of a medical home through the Community Referral Coordinator Program who followed up with a primary care provider.
Implementation of an asthma clinic in North County. Implementation of a holistic approach to treatment of asthma by developing a referral process from the asthma clinic to the Healthy Homes Environmental Assessment.
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Project Leads
Selected Strategies
Possible Indicators
Asthma Ready Communities
Educate school nurses on asthma action plans and asthma resources.
• Number of school nurses educated on asthma action plans and resources in the community.
American Lung Association
Certify health care providers as asthma educators through the American Lung Association’s Asthma Education Institute.
• •
Asthma Ready Communities
Provide an annual Asthma Surge Outreach project targeting high-risk populations to improve asthma care management for children with severe asthma.
• Number of high-risk children enrolled in an asthma care management program.
The establishment of a baseline that outlines the number of school nurses who conduct asthma control assessments per a standardized evidence-based approach as recommended by the Missouri Asthma Prevention and Control Program. Number of healthcare professionals certified as asthma educators.
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Community Assets and Resources Strong interagency and community collaborations with: the Asthma and Allergy Foundation, Asthma Consortium, American Lung Association, the City of St. Louis Health Department, Integrated Health Network, and the Saint Louis County Department of Health Funding opportunities such as the NACCHO grant State Health Department Asthma Plan Asthma Ready Communities Asthma Surge Outreach project American Lung Association South East Missouri State University
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• Priority Four (A): Prevention and Disease Management/Obesity Partners: • • • • • • • •
American Heart Association BJC HealthCare The Business Health Coalition’s Midwest Health Initiative Community Action Agency-STL Gateway Greening The Magic House Maplewood-Richmond Heights School District Mercy
• • • • • • • • •
St. Louis City Health Department Saint Louis County Department of Health Saint Louis County Parks Department St. Luke’s Hospital SSM Health Care-St. Louis Trailnet University of Missouri Extension United Way of Greater St. Louis YMCA of Greater St. Louis
Description of the Problem: Cardiovascular disease (CVD) is a category of disorders affecting the heart and blood vessels and includes coronary heart disease, diseases of the heart, arteriosclerosis, hypertension, and cerebrovascular disease (stroke). The major behavioral risk factors for CVD are smoking, physical inactivity, hypertension, and being overweight or obese. Diabetes is a medical risk factor for CVD. The prevalence of hypertension was similar throughout St. Louis County at 31%, except in North County where the rate was higher at 38%. Obesity prevalence and sedentary lifestyles were also higher in North County. This affects how well patients with hypertension are able to manage their conditions. The combined effect of behavioral and medical risk factors for CVD also puts this population at risk for additional health problems and disease complications. Behavioral risk factors for cardiovascular disease are not high overall, but there is variation within the county. Risks related to being overweight and obese are a significant issue in the U.S., including Missouri. Approximately 31% of adults in Missouri were obese, having a body mass index equal to or greater than 30. This compares to the U.S. rate of 28% and a St. Louis County overall adult obesity rate of 27%. The rate in St. Louis County was driven in large part by the higher rate in North County (36%). Diabetes in the U.S. adult population is a persistent and growing health issue among all age groups. Risk factors for diabetes, such as being overweight, obese, or having a sedentary lifestyle, correlate with diabetes prevalence in most communities. The prevalence of diabetes across St. Louis County is higher in those regions with higher obesity and sedentary lifestyles, in particular Mid-County and North County. The prevention management action team decided that by addressing obesity, these same strategies will positively affect cardiovascular disease and diabetes.
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Data: Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
• The proportion of adults who reported engaging in at least 30 minutes of physical activity five or more times a week was highest in South County (24%), while the overall county rate was lower than the state rate (20% and 28%, respectively). Twenty-two percent (22%) of St. Louis County adults had a sedentary lifestyle (as measured by adults who reported no physical activity) as compared to 33% in the state. Sedentary lifestyles were most prevalent for adults in North County at 29%. • Risks related to being overweight and obese are a significant issue in the U.S., including Missouri. Approximately 31% of adults in Missouri were obese, having a body mass index equal to or greater than 30. This compares to the U.S. rate of 28% and a St. Louis County overall adult obesity rate of 27%. The rate in St. Louis County was driven in large part by the higher rate in North County (36%). • The prevalence of high blood pressure was similar in all regions of the county except North County, which was higher at 38%. The prevalence of obesity and sedentary lifestyles were also higher in North County, which can affect how well those with high blood pressure are able to manage their conditions. • The prevalence of obesity among those who reported having been diagnosed with high blood pressure was 42%. In addition, 36% of those with high blood pressure were classified as overweight. Obesity prevalence ranged from a high of 36% in North County to a low of 20% in West County. • The prevalence of obesity and overweight was 34% and 40%, respectively, among those who reported they had been diagnosed with high cholesterol. • Those with high blood pressure or high cholesterol were more likely to be sedentary. Among those diagnosed with high blood pressure, 26% led sedentary lifestyles. Among those diagnosed with high cholesterol, 33% led sedentary lifestyles.
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Data: Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
• Overall diabetes prevalence in St. Louis County was 9.4% as compared to 8.7% in Missouri and 8.8% nationwide. The prevalence in Mid and North County was much higher at 11% and 12%, respectively. These were also the regions with the highest prevalence of obesity and sedentary lifestyles. The diabetes mortality rate was highest in North County. • About 90% of adults with diabetes had Type II (adult onset) diabetes. Several factors contribute to Type II diabetes. These include behavioral elements (e.g., increased fat consumption and other nutritional factors, decreased physical activity, and obesity), demographic changes (e.g., aging and the growth of at-risk populations), and the limited effectiveness of interventions to change individual, community, or organizational behaviors. The aging of the population can potentially increase disease burden. However, the increased onset in the 18-44 year age group suggests that risks such as inactivity and obesity may be the prime drivers. Primary prevention efforts targeting diet and activity levels are a priority health issue in Mid and North County. • Among adults who reported that they had been diagnosed with diabetes, 31% were also classified as overweight and 54% were obese. Additionally, the prevalence of a sedentary lifestyle among those who reported they had been diagnosed with diabetes was 33%, which was higher than those without the disease (21%). • Behavioral risk factors for cancer such as smoking, obesity, and a sedentary lifestyle were not generally high in St. Louis County; only in North County was the rate of obesity high. • St. Louis County youth were less likely than youth statewide to engage in at least 60 minutes of physical activity on five (5) of the previous seven (7) days (45% versus 52%); however, data by region was not available. • St. Louis County residents believed the cost of care, obesity, and access to health insurance to be the three most significant health issues in the community.
Forces of Change Assessment from the 2013 St. Louis County MAPP Process
• Participants listed food insecurity and food deserts as an environmental force, which received thirteen votes as a priority issue. This issue was thus labeled a core Force of Change despite having limited specific threats and opportunities identified by the stakeholders.
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The following Healthy People 2020 objectives closely relate to the goals and objective in this plan: • • • •
Reduce the disease and economic burden of diabetes mellitus (DM) and improve the quality of life for all persons who have or are at risk for DM. Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events. Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. Improve health, fitness, and quality of life through daily physical activity.
Goal: To promote health and reduce chronic disease risk in St. Louis County residents by the maintenance of healthy body weights through healthy diets as well as by incorporating physical activity as a part of daily living.
Objectives: 1. By August 2016, increase the proportion of adults who report engaging in at least 30 minutes of physical activity five or more times a week from 20% to 25%. 2. By August 2016, increase the proportion of children in St. Louis County who report engaging in at least 60 minutes of physical activity from 45% to 50%. 3. By December 2019, reduce the percentage of children who are obese in St. Louis County by 2%. 4. By December 2019, reduce the percentage of adults who are obese in St. Louis County by 2%.
Project Leads
Selected Strategies
American Heart Association and The Saint Louis County Department of Health
Develop a regional coalition focused on obesity prevention in the St. Louis region to coordinate local resources in order to enhance access to exercise, nutrition, and treatment modalities.
The Saint Louis Map current initiatives for healthy County Department of eating and physical activity, access to Health fruits and vegetables, food deserts, food swamps, walking paths, and farmers’ markets to overlay with concentrations of poverty.
Possible Indicators • Establishment of a regional coalition focused on obesity prevention in the St. Louis region.
• GIS mapping to enable more targeted interventions.
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Project Leads
Selected Strategies
Possible Indicators
Obesity Coalition
Increase the availability of healthy foods through community-level programs such as farmers’ markets, community gardens, or mobile units that sell fresh fruits and vegetables as promoted by the Department of Agriculture.
• Increased availability of fruits and vegetables in food desert regions.
University of Missouri Extension
Provide training on the preparation, storage, and cooking skills for healthy meals as well as cooking on a budget.
• Number of participants who are educated in the Cooking Matters Program.
St. Louis Midwest Health Initiative
Promote the Live Well St. Louis website which is an interactive tool to connect to physical activity, healthy eating, weight loss and health education resources.
• Number of hits on the Live Well St. Louis website.
Saint Louis County Department of Health
Partner with hospitals to provide Stanford’s Chronic Disease Self-Management Program.
•
Number of participants who complete the Stanford’s Chronic Disease SelfManagement Program.
Obesity Coalition
Create public service announcements (PSA’s) to educate the public about the benefits of consuming fruits and vegetables and engaging in physical activity.
•
The number of PSA’s created to educate the public about the benefits of consuming fruits and vegetables and engaging in physical activity.
American Heart Association
Increase the number of middle schools in St. Louis County who participate in the NFL Play 60 Program.
•
The number of middle schools in St. Louis County who participate in the NFL Play 60 Program.
YMCA
Increase the number of preschools and before and after care programs that implement the YMCA program.
• Number of preschool children who engage in physical activity.
Saint Louis County Department of Health
Educate child care providers in St. Louis County on the importance of adopting a screen time policy.
• Number of screen time policies adopted.
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Project Leads
Selected Strategies
Possible Indicators
Saint Louis County Parks Department
Promote physical activity through the St. Louis County Parks 30 /30 Hikes program.
• Number of residents utilizing the 30/30 Hikes program.
Great Rivers Greenway and Trailnet
Update the Gateway Bike master plan.
•
Obesity Coalition
Advocate for the adoption of the Gateway Bicycle plan for St. Louis County.
• An adopted plan for St. Louis County.
American Heart Association
Increase the number of employers who implement Workplace Wellness-programs.
• The number of employers who implement AHA Workplace Wellness programs.
Trailnet
Conduct a walkability audit in distressed regions of St. Louis County.
• Completed walkability audits in distressed regions of St. Louis County.
Saint Louis County Planning Department
Conduct an assessment of the 91 municipalities for municipallysponsored fitness opportunities.
• Number of municipalities that have fitness centers.
Saint Louis County Highways and Traffic and the Saint Louis County Planning Department
Develop bicycle and pedestrian facilities to connect neighborhoods to nearby parks, community facilities, and neighborhood commercial areas.
•
Saint Louis County Department of Health
Advocate for a Saint Louis County Government Healthy Eating Vending Machine policy.
• Adoption of a Saint Louis County Government Healthy Eating Vending Machine policy.
Obesity Coalition
Implement the Prescription for Health Program to connect patients in medical clinics to their local farmers’ market.
• Increased fruit and vegetable consumption.
An updated plan that includes a connected system of on-road bicycle routes between communities, transit centers, greenways, and trails in St. Louis County.
Increased number of neighborhoods with access to nearby parks, community facilities, and neighborhood commercial areas.
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Project Leads
Selected Strategies
Obesity Coalition
Provide schools with technical training to work with food service vendors to increase use of fruit/ veggies in school lunches.
• Number of schools that adopt the gold standard for food service contracts.
University of Missouri Extension
Train school food service workers to prepare meals with fresh fruits and veggies.
• Number of trainings.
Gateway Greening
Increase the number of active community gardens in St. Louis County.
• Number of active community gardens in St. Louis County.
University of Missouri Extension
Increase the number of childcare centers that receive the “Eat Smart” designation.
• Number of childcare centers that receive the “Eat Smart” designation.
Missouri Council for Activity and Nutrition, and the University of Missouri Extension
Implement the “Eat Smart in Parks” pilot project in St. Louis County parks.
• Number of parks in St. Louis County that adopt the “Eat Smart” policy.
Obesity Coalition
Increase access to fresh fruits and vegetables in communities identified as food deserts and or food swamps utilizing the Healthy Corner Store model.
• Number of corner store projects established.
Saint Louis County Department of Health
Utilize education materials developed through national initiatives to promote healthy lifestyles, such as MyPlate, FITWIC, and Let’s Move!
• Increased number of children and adults who report eating 5 servings of fruits and vegetables per day. • Percentage of WIC children with a BMI less than the 85th percentile. • Increasing consumption of fruits and vegetables. • Increase the number of women who initiate and sustain breastfeeding.
Locate WIC offices near public transportation lines and large chain grocery stores that provide a variety of fruits and vegetables (WIC participants receive checks for nutritious foods and food vouchers specifically for fruits and vegetables).
Possible Indicators
Offer breastfeeding classes and support groups to encourage women to initiate and sustain breastfeeding.
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Community Assets and Resources Strong interagency and community collaboration to improve issues, including: the American Heart Association, Trailnet, Gateway Greening, the City of St. Louis Health Department, BJC HealthCare, St. Luke’s Hospital, Mercy, SSM Health Care-St. Louis, the Saint Louis County Parks Department, University of Missouri Extension, the Saint Louis County Planning Department, the Saint Louis County Department of Health’s WIC Program and Health Education Section, and the YMCA of Greater St. Louis. Strong existing programs that address issues such as obesity prevention and healthy eating. Strong network of existing and well maintained parks. Gateway Greening and Missouri Foundation for Health funding opportunities for additional community gardens in St. Louis County. The Missouri Department of Health and Senior Services’s Chronic Disease Program. The YMCA of Greater St. Louis and funding through the community transformation grant. Midwest Health Initiative and funding from the Missouri Foundation for Health for the Live Well St. Louis website.
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• Priority Four (B): Prevention and Disease Management/ Sexually Transmitted Infections Partners: • • • • • • • • •
The Beacon Project The Expanded (HIV) Testing Initiative Girls Holla Back Program HEAT (HIV Engagement Adherence Team/Linkage to Care) Missouri Institute of Mental Health Planned Parenthood Project Ark The Ryan White Planning Council The St. Charles Department of Community Health and the Environment’s STD Clinic
• • • • • • • •
The St. Louis City Health Department’s STD-HIV Programs Saint Louis County Department of Health St. Louis Effort for Aids (EFA) The St. Louis Regional HIV Prevention and Planning Group St. Louis STD Prevention and Training Center The SPOT (Supporting Positive Opportunities for Teens) SSM St. Mary’s Health Center Washington University’s School of Medicine
Description of the Problem: According to the Centers for Disease Control and Prevention, the St. Louis area (both city and county) consistently ranks among the top three areas in the nation for rates of chlamydia and gonorrhea. Syphilis and HIV also continue to be a major public health challenge in the region. An adequately-funded regional approach to Sexually Transmitted Infections (STI) – both prevention and treatment – is needed to address this issue. The target populations are females 15 to 30 years of age and males 15 to 30 years of age. Black/African-American females 15 to 24 years of age are disproportionately affected by chlamydia and gonorrhea. Chlamydia and gonorrhea often act as sentinel STI’s for the risk of acquiring HIV. Data: Data Source
Brief Description of Data
Saint Louis County Department of Health 2011 Community Health Needs Assessment
• The hospital admission rate for HIV-positive diagnoses for 2008 to 2009 in St. Louis County was 11 per 100,000 people. The hospital admission rate for HIV infections was highest in North County (27 per 100,000), followed by Mid County (13 per 100,000). Many whose HIV infection had progressed to AIDS were being treated on an ongoing basis and mortality rates were extremely low. Illustrative of this trend were low mortality rates associated with HIV-infection despite high incidence rates, such as in Mid and North County (4 deaths per 100,000 people). Missouri tracks two other sexually-transmitted diseases- gonorrhea and chlamydia – with incidence rates in St. Louis County of 150 and 501 cases per 100,000 people, respectively. The rate of new cases of gonorrhea has continued to fall nationally in recent years, to a 2009 national rate of 111 cases -the lowest rate since the CDC started tracking the disease in 1941.
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Data Source
Brief Description of Data
The Saint Louis County Department of Health’s Communicable Disease Control Services Program STD Surveillance Report 2013
• Chlamydia totals were 3% lower in 2013 as compared to 2012. Chlamydia has declined slightly more for females than males (-3% vs. -2%). Among teenage females, aged 15-19 years, chlamydia totals in 2013 were at the lowest level since 2004.
The Missouri Department of Health and Senior Services’s Missouri Public Health System at a Glance Report on St. Louis County and the Saint Louis County Department of Health’s STD Surveillance Report for 2012-2013
• The county’s gonorrhea rate was 10% higher than the state rate and 60% higher than the national rate. Adult women in the county were 54% less likely to have had a pap test in the past three years as compared to the state as a whole.
Community Themes and Strengths from the 2013 St. Louis County MAPP Process
• Four focus groups envisioned a community absent of STI’s. One of the focus groups identified the need for more STI education.
Regional Health Commission: Decade Review of Health Status
• Rates of STI’s increased approximately 26% throughout the region from 2000 to 2010. Notably, chlamydia infections rose steadily in the county during this period. The zip codes with the greatest increases are primarily located in North County.
The Missouri Department of Health and Senior Services’s State Public Health Bureau of HIV, STD and Hepatitis, STD Site Report Cards
• In 2013, the screening program among St. Louis County Juvenile Detention residents resulted in a 15% positivity rate (84 positives out of 572 specimens). Comparatively, the screening program among adults resulted in a 6% positivity rate (198 out of 3,259).
The Missouri Department of Health and Senior Services’s WebSurv, CD Registry
• In 2013, STI’s among St. Louis County youth aged 15-24 years accounted for 69% of all positive gonorrhea and chlamydia cases (4,832 out of 6,957).
• Early syphilis (under one year duration) increased 10% from 71 cases in 2012 to 78 cases in 2013. All but five of the early syphilis cases reported in 2013 occurred among males. Males aged 20-24 years accounted for 45% (29 of 73) of early syphilis cases reported among men. Overall, the early syphilis totals were low among St. Louis County residents, with the 78 cases reported in 2013 representing an annualized case rate of 7.8 per 100,000 people.
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The following Healthy People 2020 objectives closely relate to the goals and objective in this plan: • • •
Reduce the proportion of females aged 15 to 24 years with Chlamydia trachomatis infections. Reduce gonorrhea rates among females aged 15 to 44 years. Reduce gonorrhea rates among males aged 15 to 44 years.
Goal: Reduce the number of new chlamydia and gonorrhea infections in both males and females
in the 15-30 year age group.
Objectives:
1. By December 2015, partner with two agencies working on substance abuse and mental health to correlate information with the risk behavior profile of target populations with a view to improving and/or expanding services. 2. By December 2015, enhance the Saint Louis County Department of Health’s capability to support and maintain an STI-focused website (www.stlprotectyours.org) with a view to adding more modules (e.g., partner counseling and referral information). 3. By December 2016, collaborate with community partners and other public health agencies to define and address specific risk behavior issues for the target populations. 4. By December 2019, decrease by 10% the number of males and females 15 to 30 years old who are newly diagnosed with chlamydia or gonorrhea in St. Louis County. 5. By December 2019, implement a regular schedule of epidemiological profile reporting (inclusive of descriptive epidemiology) with usable/actionable data to be shared with community partners and other agencies twice a year. 6. By December 2019, maximize the use of social media for community awareness and health promotion/risk reduction messaging to reach 15,000 men and women between 15-24 years of age.
Project Leads
Selected Strategies
Saint Louis County Department of Health
Identify and establish formal MOU’s with community-based organizations and other partner agencies to increase screenings for STI’s and linkage to treatment and care across St. Louis County.
Possible Indicators • Number of new diagnoses for chlamydia and/or gonorrhea in St. Louis County residents at public health screening and treatment sites tracked through laboratory reports and data from the Missouri Department of Health and Senior Services. • Number of new HIV-positive individuals referred for treatment and case management services to an appropriate agency in the St. Louis region.
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Project Leads
Selected Strategies
Possible Indicators
Saint Louis County Department of Health
Establish a network of linkage to care and the seamless transition of clients from one service provider to another without loss to follow up.
• Track the establishment of formal MOU’s signed with community partner agencies (the SPOT, Planned Parenthood, hospital systems, urgent care centers, and community-based organizations).
Saint Louis County Department of Health
Track and report on usage of data for STI website and social media accounts.
• Report on website hits for information and customer feedback on modules of information provided at www.STLProtectYours.org. • Report on Facebook and Twitter messages/hits pertaining to HIV/STI services provided by the Saint Louis County Department of Health.
Saint Louis County Department of Health
The Expanded Testing Initiative (ETI) encourages integration of HIV program efforts with public health programs targeting sexually transmitted Infections (STI’s). The Saint Louis County Juvenile Detention Center selected as ETI site.
• Number of positive gonorrhea and/or chlamydia cases.
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Community Assets and Resources The Expanded Testing Initiative (ETI) encourages the integration of HIV program efforts with public health programs targeting sexually-transmitted diseases (STDs). The establishment of routine HIV testing in these contexts increases the opportunities public health systems have to reach at-risk individuals. The Saint Louis County Department of Health performs opt-out urine-based STD screenings at the two detention facilities within St. Louis County government. As a way to work towards the CDC push for regions to combine prevention and care, the Saint Louis County Department of Health’s STD Program participates in the St. Louis TGA Ryan White Planning Group, the Care Strategy Committee, the Prevention and Care Subcommittee, and the St. Louis Regional HIV Planning Advisory Group (RPAG). Through the working relationships formed with planning group counterparts consisting of AIDS service organizations and community-based agencies along with regular updates on STD morbidity among county youth and high positivity rates reported from juvenile detention screening efforts, the Saint Louis County Juvenile Detention Center was selected to be an ETI site. The STD Program serves as the lead on the ETI project for both the Saint Louis County Department of Health and the Ryan White Planning Council workgroup as the as co-chair for the Prevention and Care Subcommittee. In addition to regional Aids Service Organization, the workgroup engaged and trained Saint Louis County Department of Health clinical services staff and multiple departments within St. Louis County Family Courts. Currently this is the first project targeting detained populations in the state of Missouri. Testing efforts are expected to commence mid-year, 2014.
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Appendix: Stakeholder Advisory Committee The Stakeholder Advisory Committee provides feedback and guidance by participating in the Mobilizing for Action through Planning and Partnership (MAPP) assessments. The committee identified and engaged local public health system representatives and prioritized and selected issues based upon the assessment data. They assisted in leading actions teams and are monitoring action plan implementation. American Cancer Society
Operation Food Search
American Heart Association of Greater St. Louis
Ranken Jordan
American Lung Association
St. Anthony’s Medical Center
Animal Protective Association of Missouri
St. Louis Business Health Coalition
Asthma and Allergy Foundation St. Louis Chapter
St. Louis Children’s Hospital
Asthma Coalition
St. Louis City Health Department
Barnes Hospital West County Campus
St. Louis College of Pharmacy
Barnes-Jewish Hospital
Saint Louis County Children’s Service Fund
Behavioral Health Network
Saint Louis County Council
Behavioral Health-National Alliance of Mental Illness
Saint Louis County Department of Health
Beyond Housing
Saint Louis County Department of Human Services
Bridgeway Behavioral Health
Saint Louis County Health Advisory Committee
BJC HealthCare
St. Louis County Municipal League
Cooperating School Districts
Saint Louis County Parks Department
Daughters of Charity Foundation of St. Louis
Saint Louis County Planning Department
DePaul Medical Center
Saint Louis County Police Department/North County Precinct
Gateway Greening
St. Louis County Special School District
Housing Authority of St. Louis County
St. Louis Integrated Health Network
International Institute of St. Louis
St. Louis Regional Health Commission
Jewish Community Center
St. Louis University College for Public Health and Social Justice
Lutheran Family and Children’s Services
St. Luke’s Medical Center
Maternal, Child, and Family Health Coalition
St. Mary’s Health Center
Mercy
Shriners’ Hospital
Missouri Baptist Medical Center
SSM Health Care-St. Louis
Missouri Department of Corrections/ Division of Probation and Parole
Trailnet
Missouri Department of Health and Senior Services
United Way of Greater St. Louis
Missouri Foundation for Health
University of Missouri Extension
National Council on Alcohol and Drug Abuse St. Louis
Washington University
Operation Food Search
YMCA of Greater St. Louis
2014 SAINT LOUIS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN
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Leadership Team The leadership team is a small group of representatives from lead agencies/ organizations that are responsible for championing the assessment, plan development, implementation, and evaluation of the Community Health Improvement Plan.
Kim Bakker Director of Community Affairs SSM Health Care-St. Louis Ed Hennessy Funding Manager/Community Investment United Way of Greater St. Louis Karley M. King Community Benefit Manager BJC HealthCare Sharon Neumeister, RN, BSN, MA Director, Community Health & Access Mercy Jamie Opsal, MSG Public Health Coordinator Saint Louis County Department of Health Gena Traver, CHES Community Health Manager Saint Louis County Department of Health
2014 SAINT LOUIS COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN
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For more information about this report reportCommunity, or about theFor St.more Louisinformation Partnershipabout for athis Healthy or about the St. Louis please Partnership for a Healthy Community, contact: please contact:
SAINT LOUIS COUNTY DEPARTMENT OF HEALTH SAINT LOUIS COUNTY DEPARTMENT OF HEALTH 6121 North Hanley Road, Berkeley, MO 63134 6121 North Hanley Road, Berkeley, MO 63134 www.stlouisco.com/healthandwellness www.stlouisco.com/healthandwellness (314) (314) 615-0600 615-0600
St. Louis County Partnership for a Healthy
Community
