2013

Community Health Needs Assessment Kaiser Foundation Hospital – VALLEJO License #110000026

To provide feedback about this Community Health Needs Assessment, email [email protected].

KAISER PERMANENTE NORTHERN CALIFORNIA REGION COMMUNITY BENEFIT CHNA REPORT FOR KFH-VALLEJO I. EXECUTIVE SUMMARY a. Community Health Needs Assessment (CHNA) background The Patient Protection and Affordable Care Act (ACA), enacted on March 23, 2010, added new requirements, which nonprofit hospital organizations must satisfy to maintain their taxexempt status under section 501(c) 3 of the Internal Revenue Code. One such requirement added by ACA, Section 501(r) of the Code, requires nonprofit hospitals to conduct a community health needs assessment (CHNA) at least once every three years. As part of the CHNA, each hospital is required to collect input from designated individuals in the community, including public health experts as well as members, representatives or leaders of low-income, minority, and medically underserved populations and individuals with chronic conditions. While Kaiser Permanente has conducted CHNAs for many years to identify needs and resources in our communities and to guide our Community Benefit plans, this new legislation has provided an opportunity to revisit our needs assessment and strategic planning processes with an eye toward enhanced compliance and transparency and leveraging emerging technologies. The CHNA process undertaken in 2013 and described in this report was conducted in compliance with these new federal requirements. Summary of Prioritized Needs KFH-Vallejo Service Area encompasses all of Napa County and the cities of Benicia and Vallejo in Solano County. A collaborative was established in each county to support the CHNA process. The Solano CHNA workgroup included representatives from Kaiser Foundation Hospital (Vallejo), Solano County Public Health, Sutter Solano Medical Center (Vallejo), North Bay Medical Center (Fairfield), Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica in the 2013 CHNA process. In Napa County, the Live Healthy Napa County (LHNC) collaborative process involved three planning groups, each composed of diverse stakeholders-the Steering Committee, the LHNC Core Support Team, and Subcommittees. The process of both collaborations included a comprehensive review of secondary data on health outcome drivers, conditions, and behaviors in addition to the collection and analysis of primary data through community conversations with members of vulnerable populations in the KFHVallejo service area. In preparation for the Vallejo Hospital Contributions Committee to better understand the community health needs, to discuss them, and to prioritize them, the twenty five health needs were grouped and categorized into broader needs areas, resulting in a total of ten community health needs. The Vallejo Hospital Contributions Committee reviewed the identified needs and selected the top five community health needs with particular relevance for vulnerable populations in the KFH-Vallejo hospital service area (listed in priority order).

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1. Lack of employment and vocational training 2. Lack of safe places to walk, bike, exercise, or play 3. Lack of access to culturally appropriate, affordable health care (including prevention and treatment) 4. Access to affordable healthy food 5. Lack of substance abuse treatment and rehabilitation II. INTRODUCTION/BACKGROUND a. Purpose of the Community Health Needs Assessment (CHNA) Report This report was written in order to comply with federal tax law requirements set forth in Internal Revenue Code section 501(r) requiring hospital facilities owned and operated by an organization described in Code section 501(c)(3) to conduct a community health needs assessment at least once every three years. The required written plan of Implementation Strategy is set forth in a separate written document. At the time that hospitals within Kaiser Foundation Hospitals conducted their CHNAs, Notice 2011-52 from the Internal Revenue Service provided the most recent guidance on how to conduct a CHNA. This written plan is intended to satisfy each of the applicable requirements set forth in IRS Notice 2011-52 regarding conducting the CHNA for the hospital facility. b. About Kaiser Permanente (KP)* Founded in 1942 to serve employees of Kaiser Industries and opened to the public in 1945, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of health care. Among the innovations Kaiser Permanente has brought to U.S. health care are:   

Prepaid health plans, which spread the cost to make it more affordable A focus on preventing illness and disease as much as on caring for the sick An organized coordinated system that puts as many services as possible under one roof—all connected by an electronic medical record

Kaiser Permanente is an integrated health care delivery system comprised of Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, and physicians in the Permanente Medical Groups. Today we serve more than 9 million members in nine states and the District of Columbia. Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. c. About Kaiser Permanente Community Benefit* For more than 65 years, Kaiser Permanente has been dedicated to providing high-quality, affordable health care services and to improving the health of our members and the communities we serve. We believe good health is a fundamental right shared by all and we 2   

recognize that good health extends beyond the doctor’s office and the hospital. It begins with healthy environments: fresh fruits and vegetables in neighborhood stores, successful schools, clean air, accessible parks, and safe playgrounds. These are the vital signs of healthy communities. Good health for the entire community, which we call Total Community Health, requires equity and social and economic well-being. Like our approach to medicine, our work in the community takes a prevention-focused, evidence-based approach. We go beyond traditional corporate philanthropy or grant making to pair financial resources with medical research, physician expertise, and clinical practices. Historically, we’ve focused our investments in three areas—Health Access, Healthy Communities, and Health Knowledge—to address critical health issues in our communities. For many years, we’ve worked side-by-side with other organizations to address serious public health issues such as obesity, access to care, and violence. And we’ve conducted Community Health Needs Assessments to better understand each community’s unique needs and resources. The CHNA process informs our community investments and helps us develop strategies aimed at making long-term, sustainable change—and it allows us to deepen the strong relationships we have with other organizations that are working to improve community health. d. Kaiser Permanente’s approach to Community Health Needs Assessment About the new federal requirements* Federal requirements included in the ACA, which was enacted March 23, 2010, stipulate that hospital organizations under 501(c)(3) status must adhere to new regulations, one of which is conducting a CHNA every three years. With regard to the CHNA, the ACA specifically requires nonprofit hospitals to: collect and take into account input from public health experts as well as community leaders and representatives of high need populations—this includes minority groups, low-income individuals, medically underserved populations, and those with chronic conditions; identify and prioritize community health needs; document a separate CHNA for each individual hospital; and make the CHNA report widely available to the public. In addition, each nonprofit hospital must adopt an Implementation Strategy to address the identified community health needs and submit a copy of the Implementation Strategy along with the organization’s annual Form 990. SB 697 and California’s history with past assessments* For many years, Kaiser Permanente hospitals have conducted needs assessments to guide our allocation of Community Benefit resources. In 1994, California legislators passed Senate Bill 697 (SB 697), which requires all private nonprofit hospitals in the state to conduct a CHNA every three years. As part of SB 697 hospitals are also required to annually submit a summary of their Community Benefit contributions, particularly those activities undertaken to address the community needs that arose during the CHNA. Kaiser Permanente has designed a process that will continue to comply with SB 697 and that also meets the new federal CHNA requirements. Kaiser Permanente’s CHNA framework and process Kaiser Permanente Community Benefit staff at the national, regional, and hospital levels worked together to establish an approach for implementing the new federally legislated CHNA. From data collection and analysis to the identification of prioritized needs and 3   

the development of an implementation strategy, the intent was to develop a rigorous process that would yield meaningful results. Kaiser Permanente, in partnership with the Institute for People, Place and Possibility (IP3) and the Center for Applied Research and Environmental Studies (CARES), developed a web-based CHNA data platform to facilitate implementation of the CHNA process. Because data collection, review, and interpretation are the foundation of the CHNA process, each CHNA includes a review of secondary and primary data. To ensure a minimum level of consistency across the organization, Kaiser Permanente included a list of roughly 100 indicators in the data platform that, when looked at together, help illustrate the health of a community. California data sources were used whenever possible. When California data sources weren’t available, national data sources were used. Once a user explores the data available, the data platform has the ability to generate a report that can be used to guide primary data collection and inform the identification and prioritization of health needs. In addition to reviewing the secondary data available through the CHNA data platform, and in some cases other local sources, each KP hospital collected primary data through key informant interviews, focus groups, and surveys. They asked local public health experts, community leaders, and residents to identify issues that most impacted the health of the community. They also inventoried existing community assets and resources. Each hospital/collaborative used a set of criteria to determine what constituted a health need in their community. Once all of the community health needs were identified, they were all prioritized, based on a second set of criteria. This process resulted in a complete list of prioritized community health. The process and the outcome of the CHNA are described in this report. In conjunction with this report, Kaiser Permanente will develop an implementation strategy for each health need identified. These strategies will build on Kaiser Permanente’s assets and resources, as well as evidence-based strategies, wherever possible. The Implementation Strategy will be filed with the Internal Revenue Service using Form 990 Schedule H. III. COMMUNITY SERVED a. Kaiser Permanente’s definition of community served by hospital facility* Kaiser Permanente defines the community served by a hospital as those individuals residing within its hospital service area. A hospital service area includes all residents in a defined geographic area surrounding the hospital and does not exclude low-income or underserved populations. KEY LEADERSHIP AT KFH-VALLEJO Max Villalobos

Senior Vice President and Area Manager

Vicky Locey Kyle Wichelmann

Chief Operating Officer Area Finance Director 4 

 

Steven Stricker, MD Sandra Rusch Michelle Odell Cynthia Verrett

Physician in Chief Medical Group Administrator Public Affairs Director CB/CH Manager

The KFH-Vallejo service area includes communities in Napa and Solano counties. The major communities are Benicia and Vallejo in Solano County and American Canyon, Calistoga, Napa, Oakville, Rutherford, St. Helena, and Yountville in Napa County. The service area is further defined by Highway 29 leading from Vallejo to Napa and Interstate 80 in Solano County. Total population: Population: no high school diploma Uninsured: Percentage living in poverty: Percentage unemployed: Percentage uninsured:

274,309 15.79% 13.88% 11.37% n/a 13.88%

Caucasian: African American Hispanic/Latinos Asian Pacific Islander Native American Other Races Multiple Races

45.5% 10.0% 24.9% 14.1% 0.6% 0.4% 0.3% 3.3%

The primary focus of our community benefit programs is on the needs of vulnerable populations. Through a collaborative process with other hospitals and safety net providers 5   

serving Napa County and the cities of Benicia and Vallejo in Solano County, we defined vulnerable populations as those with evidenced-based disparities in health outcomes, significant barriers to care and the economically disadvantaged. The KFH-Vallejo Communities of Concern include the cities of Vallejo, American Canyon, Calistoga, and parts of Napa. The populations at the highest risk (highest poverty rates, lowest levels of health insurance and lowest rates of high school degree completion) in these areas are African Americans and Latinos.

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IV. WHO WAS INVOLVED IN THE ASSESSMENT KFH-Vallejo serves communities of Napa County and parts of Solano County. The Solano CHNA collaborative include representatives from Kaiser Foundation Hospital Vallejo, Solano County Public Health Department, Sutter Solano Medical Center (Vallejo), North Bay Medical Center (Fairfield), Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica in the 2013 the Community Health Needs Assessment. The members of the Live Healthy Napa Collaborative include representatives from Kaiser Foundation Hospital (Vallejo), Queen of the Valley Medical Center, St. Helena Medical Center, Napa County Public Health Department and Napa Valley Coalition of Nonprofit Agencies. Solano County Consultants The Solano County collaborative workgroup retained Valley Vision, Inc., to lead the assessment process. Valley Vision, Inc. (www.valleyvision.org) is a non-profit [501 (c) (3)] consulting firm serving a broad range of communities across Northern California. The organization’s mission is to improve quality of life through the delivery of high-quality research on important topics such as healthcare, economic development, and sustainable environmental practices. Valley Vision also designed and facilitated primary data collection as well as a prioritization session that engaged public and community health experts from across Solano County. Chris Aguirre, Senior Project Manager, Valley Vision, Inc. Mr. Aguirre joined Valley Vision in Jan 2006 and holds a master’s degree in Community Development. His fields of study were economic development, affordable housing, urban design, community participation, labor and nonprofit organizations. Mr. Aguirre also completed internships with the Senate Office of Research and the California Legislature’s Select Committee on Economic Development. Chris supports the many facets of the Youth Development Project, The Community Needs Assessment, and manages fundraising and stakeholder outreach projects. Napa County Consultants Live Healthy Napa County collaborative retained two consulting organizations to design and facilitate the needs assessment process. 1) Harder & Company assists non profits, public agencies, and foundations to pursue their missions through high quality research and consulting services. They provide data driven analysis to help organizations understand the results of their programs and initiatives—and translate that data into actionable improvements. Their expertise spans a wide range of social impact areas such a s healthcare, social services, community development, education achievement, and sustaining environments that support human development. They embrace inclusivity and encourage community and stakeholder interaction in all of their projects. 2) MIG focuses on planning, designing and sustaining environments that support human development. The agency embraces inclusivity and encourages community and stakeholder interaction in all of community projects. For each endeavor — in planning, design, management, communications or technology — our approach is strategic, context-driven and holistic, addressing social, political, economic and physical factors to ensure clients achieve the results they want. Both of the agency’s area of expertise are crucial in achieving the goal of a Community Health Improvement Plan to serve Napa County.

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Kym Dorman is a leading public sector consultant who excels at planning and evaluating complex community efforts that emphasize organizational and community capacity. With more than fifteen years of experience as an applied researcher and facilitator, Kym’s professional expertise spans a range of public health issues, including violence prevention, early childhood development, health care access, HIV prevention planning, and prison diversion programs for mentally ill offenders. She is skilled in a wide range of qualitative and quantitative research methods, and has considerable experience using research to help organizations make informed decisions for their future. Prior to her work at Harder+Company, Kym worked with Bay Area Legal Aid and Asian Health Services to provide violence prevention resources to a range of constituents, including multicultural and Lesbian, Gay, Bisexual, and Transgender youth. Kym earned a Master’s in Public Health from San Francisco State University. She is fluent in Spanish. Mariana Sáenz’s health and human services policy experience and Spanish fluency make her an important contributor to our community planning and evaluation projects. Her primary responsibilities include data collection, focus group facilitation, phone interviews, and assisting with instrument development. Since joining Harder+Company, Mariana has implemented field data collection with over two hundred families whose primary language is Spanish. She has served as a core member of multiple numerous evaluation and planning efforts in the areas of health, early childhood development, education, and food security, among others. She has been responsible for primary data collection activities including interviews with families, organizational leaders, and service providers; focus groups with youth and adults; and webbased survey research. Prior to joining Harder+Company, Mariana worked at a community clinic serving the uninsured and individuals with complex health needs. There she was involved in grant proposals and appeals to foundations, corporations, and individuals to achieve fundraising goals. She earned her undergraduate degree in International Political Economy from UC Berkeley. Carolyn Verheyen serves as the Principal, Chief Operating Officer of MIG and is an expert in strategic planning, community services planning, public involvement, policy planning and organizational development. Her experience includes public participation program design and implementation; public opinion research; and strategic and organizational planning. She directs a range of projects addressing social policy, parks and recreation planning, transportation and community planning. Ms. Verheyen has designed and managed large-scale, high-stakes stakeholder outreach programs and strategic planning processes addressing a variety of social policy issues, including child welfare reform plans, child development plans, mental health services investment plans, homeless support services plans, public health alternatives, regional coordination plans, statewide system development plans, and welfare-to-work transportation plans. Her facilitative leadership skills, content knowledge, action-research orientation and strategic thinking combine to provide clients with a steady guide and valueadded service. With 23 years at MIG, she is in charge of firm-wide operations. Diana Sherman is a project manager with MIG's Berkeley office. She has experience in successful outreach and policy development working in both the public and nonprofit sectors on a variety of projects, including visioning processes and community plans; community outreach and health policy development for general plans; neighborhood health action plans and health policy briefs; and strategic plans.

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Ms. Sherman received her master’s degree in city planning from the Department of Urban Studies and Planning at the Massachusetts Institute of Technology, where she specialized in community design and development with a focus on public participation. Her background also includes extensive work with neighborhood organizations, community outreach processes, housing and transportation policy, and urban design. Dr. Jennifer Henn is a Public Health Epidemiologist. She received her PhD in epidemiology, with a specialization in zoonotic and vector-borne diseases, from the University of California, Davis in 2006. She was a California Epidemiology Investigation Service fellow at the California Department of Public Health’s Infectious Disease Branch in 2006/2007 and has worked for the Napa County Public Health Division since 2007. Dr. Henn provides epidemiology support and consultation to programs across the Napa County Public Health Division, including the Emergency Preparedness Program, the Communicable Disease program, the Vital Statistics program and the Maternal, Child and Adolescent Health program. Nancy Shemick is responsible for consolidating the county processes and writing the CHNA report. She conducted data analysis of the CARES database, and facilitated the prioritization process. Ms. Shemick holds a Masters Degrees in Public Administration and has been working with community and public health organizations for 35 years. She completed the required California SB 697 Community Needs Assessments for other Northern California Kaiser Foundation hospitals in 2004, 2007, and 2010. Ms. Shemick has also worked as a consultant to the Solano Coalition for Better Health and other community agencies in Solano County. She conducts data analysis, performs strategic planning for health care nonprofits, leadership development for nonprofit health care boards of directors and conducts group facilitation. V. PROCESS AND METHODS USED TO CONDUCT THE CHNA Solano County (secondary data and community input) The majority of the secondary data used in this CHNA included health outcomes, demographic data, behavioral data, and environmental data. A key focus was to show specific communities (defined geographically) experiencing disparities as they related to chronic disease and mental health. To this end, ZIP code boundaries were selected as the unit-of-analysis for most indicators. This level of analysis allowed for examination of health outcomes at the community level that are often hidden when data are aggregated at the county level. Some indicators (demographic, behavioral and environmental in nature) were included in the assessment at the census tract level, the census block, or point prevalence, which allowed for deeper community level examination. Once communities of concern were identified, a review of specific secondary data for the Vallejo hospital service area was conducted for presentation to the Vallejo Community Benefits Advisory Committee. The Kaiser Permanente (KP) Community Health Needs Assessment (CHNA) Data Platform, powered by the Center for Applied Research and Environmental Systems (CARES), and the Institute for People, Places, and Possibility (iP3) were other sources of data used. Health Outcomes data from the platform were downloaded for KFH-Vallejo and compared to benchmarks defined either by Healthy People 2020, relevant County-level rates or State-level rates. After identifying those outcomes indicators for which the population in the KFH-Vallejo service area were seen to compare poorly to benchmarks, associated indicators of health (health behaviors, clinical care, physical environment and social and economic factors) were reviewed and analyzed to see where these indicators also showed poor performance relative to benchmarks. 9   

Each Community of Concern was determined by health outcomes, and population characteristics residing in these communities, as well as health behaviors and environmental conditions. Primary Data- The Community Voice Primary data collection included qualitative data gathered in four ways: 1. Meetings with the CHNA workgroup, i.e. Kaiser Permanente, NorthBay Healthcare, Sutter Health Sacramento Sierra Region, Solano Coalition for Better Health, Solano County Public Health Department, Community Clinic Consortium, and La Clinica 2. Key informant interviews with area health and community experts 3. Focus groups with area community members 4. Community health asset collection via phone interviews and website analyses CHNA Workgroup The Solano CHNA workgroup was an active contributor to the qualitative data collection. Using the previously described CBPR approach, regularly scheduled meetings were held with the workgroup at each critical stage in the assessment process. This data (combined with demographical data) informed the location and selection of key informant interviews for the assessment. Key Informant Interviews Key informants are health and community experts familiar with populations and geographic areas within in the HSA. To gain a deeper understanding of the health issues pertaining to chronic disease and the populations living in these vulnerable communities input from 17 key informant interviews were conducted using a theoretically grounded interview guide. Each interview was recorded and content analysis was conducted to identify key themes and important points pertaining to each geographic area. Findings from these interviews were used to identify communities in which focus groups would most aptly be performed. A list of all key informants interviewed, including name, professional title, date of interview, and description of knowledge and experience is detailed below. Key Informants Name & Title Minerva Arellano Clinical Manager

Heli Karkkainen Regional Center Director Robin Cox Health Education Director Ivonne Vaughn Senior Program Manager

Affiliation or Organization Dixon Community Medical Centers

Area of Expertise

Date

Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs

6/21/12

Planned Parenthood

Clinical, community health, low 6/21/12 income persons, medically underserved persons Public Health Expert 6/21/12

Solano County Public Health Dept. City of Vacaville A.T.O.D. Program

Community and youth resources

7/9/12

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Jacqueline Jones Site Manager

La Clinica

Viola Lujan Director of Business & Community Relations

La Clinica

Maria Reyes Health Educator

La Clinica

Margaret Anderson Executive Director

Rio Vista CARE/FRC

Adriana Bejarano Executive Director

Rio Vista CARE/FRC

Gloria Diaz Senior MSW Ana Isabel Montaño MSW

City of Vacaville FIRST City of Vacaville FRC

Maria Moses Volunteer Support Coordinator

Children’s Network

Zoila Perez-Sanchez Family Resource Center Director Cookie Powell Executive Director

Fairfield-Suisun Unified School District and FRC Dixon Family Services

Josephine Wilson Family Resource Center Director Halsey Simmons Mental Health Director

Fighting Back Partnership/Vallejo FRC Solano County Mental Health Dept.

Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs Clinical, community health, medically underserved persons, low income persons, populations with chronic disease needs Family and community resources, low income persons Family and community resources, low income persons Family and community resources Family and community resources, low income persons Family and community resources, low income persons

8/16/12

Family and community resources, low income persons Family and community resources, low income persons Family and community resources, low income persons Mental health

8/16/12

8/16/12

8/16/12

8/16/12

8/16/12

8/16/12 8/16/12

8/16/12

8/16/12

8/16/12

9/4/12

Focus Group Selection Selection of locations for focus groups was determined by feedback from key informants, CHNA team input, and analysis of health outcome indicators (ED visits, hospitalization, and mortality rates) that pointed to disease severity. Key informants were asked to identify populations (in demographic subgroups or particular areas of the county) that were most at risk for chronic health disparities and mental health issues. In addition, analysis of health outcome indicators by ZIP code, race and ethnicity, age, and gender revealed communities with high rates that exceeded county benchmarks. 11   

This information was compiled to determine the location of focus groups within the Solano County HSA. Focus Groups Members of the community representing demographic subgroups (based on race and ethnicity, age, or gender) were recruited to participate in focus groups. A standard protocol was used for all focus groups to understand the lived experience of these community members as it relates to health disparities and chronic disease. In all, a total of five focus groups (see chart below) were conducted. Content analysis was performed on focus group interview notes and/or transcripts to identify key themes and salient health issues affecting the community residents. The Solano residents who participated in the focus groups represented the entire county, including communities outside the Vallejo hospital service area. As with the health indicator findings, we learned that the highest areas of community health need include areas of Vallejo. The issues and associated drivers identified by these focus groups were verified by Vallejo key informants as well as by the Vallejo Contributions Committee. Focus Groups Location Dixon Migrant Center

Date 10/5/12

Age 30s-40s

Mission Solano

10/15/12

20s-50s

Vacaville FRC

10/18/12

20s and 50s

Bayanihan Center

10/19/12

40s-60s

Mt. Calvary Fairfield

10/30/12

30s-50s

Demographic Information Female; Latino; rural; Spanish speaking; medically underserved; low-income Latino; Black; Caucasian; Asian; Male; medically underserved; chronic disease needs group; low-income Caucasian; Latino; medically underserved; low-income Filipino; female; medically underserved; low-income Black; female; low-income, medically underserved

Secondary Data Secondary data were collected in three main categories: demographic information, health outcome data, and behavioral and environmental data (see Appendix B for details). 

Demographic Variables Collected from the US Census Bureau (U.S. Census Bureau, 2013a; U.S. Census Bureau, 2013b)



ZIP Demographic Information (Dignity Health, 2011)



2011 OSHPD Hospitalization and Emergency Department Discharge Data by ZIP Code



CDPH Birth and Mortality Data by ZIP Code



Behavioral and Environmental Variable Sources

The biggest challenge to the clear analysis and interpretation of data was the difficulties in acquiring secondary data and assuring community representation via primary data collection. Emergency 12   

Department and hospitalization data used in the assessment are markets of prevalence, but do not fully represent the prevalence of disease in a given ZIP code. Similarly, behavioral data sets at the sub-county level were difficult to obtain and were not available by race and ethnicity. Napa County (secondary data and community input) The Napa County Public Health Division, in collaboration with Harder+Company and a subcommittee of Napa County stakeholders (the CHSA subcommittee) , conducted a comprehensive review of secondary data sources to obtain the most current and reliable data for the CHSA. Secondary data sources and resources include, but are not limited to, the US Census, the American Community Survey, the California Department of Public Health (CDPH), the California Department of Education (CDE), California Health Interview Survey (CHIS), California Healthy Kids Survey (CHKS), the Behavior Risk Factor Survey and Surveillance (BRFSS), the CDC National Center for Health Statistics, California Department of Justice, Healthy People 2020 (HP 2020), and the 2012 County Health Rankings and Roadmaps. Data collected through the Napa County Public Health Vital Statistics Office and the Public Health Communicable Disease Control programs are also utilized in this report. In all cases, the CHSA presents the most current data and analyses available at the time this report was written. When needed, raw data were exported in database formats, cleaned, and basic descriptive statistics were calculated. SAS and EpiInfo were utilized for data analysis. Data considered for inclusion in this report were carefully reviewed by the CHSA subcommittee to ensure that they met specific criteria with respect to data quality, availability and relevance to health in Napa County. Sample sizes for datasets were examined to ensure that they were large enough for analyses, particularly for sub-populations. If sample sizes were not large enough, results were either aggregated over several years, were not presented, or the indicator was presented as “statistically unstable.” A limitation of the cross-sectional data currently available is that it does not allow for examination of the cumulative or interactive effects of various factors that may impact health status. For example, being poor, female, Latino, and living in a certain neighborhood may have cumulative effects on health outcomes that are not reflected in individual indicators. In addition, while geographic boundaries do not necessarily reflect residents’ personal definitions of neighborhood, geographic data are presented in the format in which they are available (i.e., census tract). Finally, population descriptions (e.g., demographic categories) may vary slightly throughout the report based on the source of the data. The Live Healthy Napa County (LHNC) core support team conducted a Comprehensive Community Health Assessment that aims to establish the foundation for sustainable improvements for health in Napa County. As part of the comprehensive assessment LHNC conducted three community assessments. 

The Community Strengths, Themes, and Forces of Change Assessment provides a deep understanding of the issues that local residents, business and neighborhood groups feel are important to the health of their neighborhoods and communities. It also identifies forces such as legislation, technology and other impending changes that will affect Napa County’s health.



A Local Public Health System Assessment – a county-wide effort to assess the capacity and capability of the local public health system. The goals of the assessment were: 1) to create stronger systems through collaboration; 2) to identify strengths and challenges; 3) to foster quality improvement planning efforts; 5) and, ultimately, to positively impact health outcomes for all Napa County residents. 13 

 



The Community Health Status Assessment uses data to illuminate the health status of Napa County and its residents, helping to answer questions including: How healthy are Napa residents? What does the health status of Napa County look like?

The first step of the Community Strengths, Themes, and Forces of Change process was to identify local area community partners from all sectors of the county. Close to 50 community members (public health practitioners, community based organizations, and other local partners) attended an introductory meeting and had the option to become a part of the LHNC Steering Committee. There were approximately 40 community members that committed to participate as Steering Committee members. A second meeting was held to provide committee members with a toolkit designed to inform participants of the LHNC health planning process and to solicit community opinion about the strengths and needs related to public health in Napa County. The solicitation process was conducted in two ways. In November 2012, a Forces of Change Brainstorming session was conducted with the LHNC steering committee members and approximately 20 audience participants. This session was to identify the political, cultural, environmental, and social factors that affect health and quality of life in Napa County. In addition to the Forces of Change brainstorming session, the LHNC Core Support Team conducted a survey of residents, service providers, and other stakeholders throughout the county to gather data on how participants perceive health in Napa County, what the critical issues are, and how community members are currently accessing services. Focus groups and key informant interviews were included in this process. The next phase of this process is to develop a Community Health Improvement Plan (CHIP) which will continue to engage a broad range of stakeholders in the development of concrete strategies that will address issues identified by the Community Health Assessment.   Key Informants interviews were conducted between November and December 2012 Public Health Experts Name and Title

Affiliation or Organization

Areas of Expertise

Dr. Karen Smith, MD, MPH Public Health Officer/ Deputy Director

Napa County Public Health

Randy Snowden, JD Director Napa County Health and Human Services

Napa County Health and Human Services

Over 20 years’ experience in local public health; knowledge of: public health practice; community health assessment; health equity and health disparities; public health law and advocacy. Community health, medically underserved, low income, populations with chronic disease needs, substance abuse, minority populations

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Individuals from Health Departments and Agencies

Tanir Ami, CEO

Community Health Clinic Olé, Local Federally Qualified Health Center (FQHC)

Clinical, community health, medically underserved persons, low income, populations with chronic disease needs, minority populations.

Dr. James Cotter, MD Chief Physician

Kaiser Permanente, Napa Medical Offices

Clinical, low income, populations with chronic disease needs

José Hurtado Vice President

NVUSD Board of Education

Vice President NVUSD Board of Education and leader in the Latino Community

Esmeralda Mondragon Superintendent

Calistoga School District

Superintendent of the Calistoga School District

Community Leaders

Representatives of Broad Interests of the Community Joelle Gallagher Executive Director

COPE Family Resource Center

Sara Cakebread Executive Director

St Helena Family Resource Center

Victoria Li Executive Director

Calistoga Family Resource Center

Sally Sheehan Brown Executive Director

First 5

Leslie Medine Executive Director

On the Move

Sherry Tennyson Executive Director

American Canyon Family Resource Center

Kathleen Dreessen Executive Director

Napa Valley Community Housing and Chair of the Coalition's Housing Committee

Walt Mickens Executive Director

St. Joseph Health, Queen of the Valley Medical Center

Family and community resources, low income, medically underserved, minority populations Family and community resources, low income, medically underserved, minority populations Family and community resources, low income, medically underserved Family and community resources, low income, minority populations Family and community resources, low income, medically underserved, minority populations Family and community resources, low income, medically underserved, minority populations Family and community resources, low income, minority populations Low income, medically underserved, minority populations, populations with

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Trustee, President and CEO

chronic disease needs

Contracted Third Party Kym Dorman and Mariana Saenz Harder + Company Community Research Consultants

Focus Groups were held between October 13 and November 20, 2012 Group Napa Valley Lutheran Church St. John Focus Group

# of Participants

Age Group

12

16 - 60+ no response 8th grade no response

5

St. John's 8th Grade

no response

Movimiento Familiar

36

Group Characteristics Church group. High schoolers (3), middle age (6) and retired persons (3). no response Eighth grade students

Yountville community McPherson Elementary Parents Focus Group

12

no response They don't have a driver. All Seniors unanimously voiced transportation (especially after 4pm) as the #1 problem. no Affordable housing and affordable response shopping were also concerns. Managers, directors and care management. Staff of Community Action of Napa Valley. Many (7) work day-to-day with the lowest income members of our 24 - 66 community. yrs old 32 - 50 Support group for parents with troubled yrs old youth This group is comprised of a diverse group of individuals representing and advocating for the needs of mental health consumers. This group includes professionals, family members, 25 - 60+ consumers and interested community members. yrs old Hotel Administrator, Veterans Home 35 - 68 Admin. Staff, Chamber Board, Council yrs old Members, Veterans Home Member.

14

28 - 60 yrs old

Filipino American Association of American Canyon

9

40 - 55 yrs old

Latino Elders

no response

Community Action of Napa Valley Parent support group

8

MHB (Mental Health Board)

14

9

Parents of McPherson Elementary students Officers and core members of the Filipino American Association of A.C. All members/officers are first generation Filipinos (born in the Philippines) and have been living in A.C. since the late 80's - early 90's. Some of the male members are veterans.

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American Canyon Family Resource Center LAYLA Youth Focus Group Berryessa Senior Center

8

NEWS

20

6 9

Cope Family Center

Non-profit employees Unknown group--notes may have wandered from original PEP is an adult resource center for individuals with mental health needs. This group is open to anyone.

15

21 - 65 yrs old

Parent and Children Activities Group

8

40 - 50 yrs old

Section 8 recipients. (2 Spanish speakers) Non-profit staff and volunteers. 1 male and 13 females. 5 Latinos.

8

25 - 50 yrs old 32 - 56 yrs old

15

25 - 40 yrs old

none given

Parents CAN Rancho de Calistoga

Senior Center lunch group

3

14

Basic ESL class from St. Helena Family Center Creative Living Calistoga

Youth leadership group

19 - 70 yrs old no response No response

PEP Napa LGBTQ Project Active Minds Program Parent Group Section 8 Family Self-Sufficiency Program Staff and volunteers of Cope Family Center

ESL advanced classes

19 - 56 yrs old 16 - 18 yrs old 55 - 80 yrs old 24 - 60+ yrs old

American Canyon Family Resource Center Staff including: Case Manager, Employment Specialist, Parent Educator, AmeriCorps VISTA Member, Credit Coach from Catholic Charities. Mixed Ethnicity: Mexican and Filipino.

23

9 23

14 no response 6

25 - 65 yrs old 50+ yrs old

no response Hispanic (13 from Mexico, 2 from EL Salvador), people living in Napa (1), Pope Valley (2), Conn Valley Rd. close to Lake Hennesey (1), and St. Helena (11); all working in St. Helena. Most of them with children going to St. Helena Unified School District. 7 Hispanic students (1 from Rutherford, 1 from Calistoga, 3 from St. Helena) and 2 American teachers - all on a basic ESL class. group of "older" adults that meet weekly for activities, lunch and support. Parents, caregivers and relatives of children and young adults with special needs. We all participate in a focus group at ParentsCAN

20 - 80 yrs old 41 - 62 yrs old Senior citizens no response no response

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Vineyard Valley

no response

Rianda House Current Events class

no response

This was a predominately white group. All Seniors unanimously voiced transportation (especially after 4pm) as no the #1 problem. Affordable housing and response affordable shopping were also concerns. High intellect group. All Seniors unanimously voiced transportation (especially after 4pm) as the #1 problem. Affordable housing and affordable no response shopping were also concerns.

The community survey included a series of 28 multiple a series of 28 multiple-choice questions that asked respondents to consider quality of life in Napa County, key health issues, access or barriers faced relating to health care, views on economic and housing conditions, and types of recreational and volunteer activities they were involved in. The survey also collected optional demographic and geographic data on survey takers. The survey was offered in both Spanish and English, and participants could choose to fill out an online or hard copy version that was available from October 17 through December 4, 2012. In all, 2,383 individuals completed surveys. Of these, 1,452 completed the survey online, while 931 completed the survey in hard copy. Approximately 356 respondents completed the survey in Spanish; the remaining respondents completed the survey in English. The participants of the Community Strengths, Themes, and Forces of Change process consistently emphasized the importance of ensuring that residents have access to a broad range of services and activities that, together, create a healthy, thriving community and healthy community members. Examples include having access to affordable health-related services, education, healthy foods, transportation, active lifestyle options (e.g., sidewalks and safe parks), employment and housing opportunities, and access to mental health services. Conclusion Public health researchers have helped expand our understanding of community health by demonstrating that health outcomes are the result of the interactions of multiple, inter-related variables such as socio-economic status, individual health behaviors, access to health related resources, cultural and societal norms, the built environment, and neighborhood characteristics such as crime rate. The results of this assessment help to shine a light on the relationships of some of these variables that were collected and analyzed to describe the communities of concern. Hospital community benefit managers and personnel can use this expanded understanding of community health, along with the results of these assessments to target specific interventions and improve health outcomes in some of the area’s more vulnerable communities. The cities identified with the most vulnerable populations and high-risk outcomes were American Canyon, Calistoga, parts of Napa, North Vallejo and St. Helena. By knowing where to focus community health improvement plans—identified communities of concern—and the specific conditions and health outcomes experienced by their residents, community benefit programs can develop plans to address the underlying contributors of negative health outcomes. Based on the experience of the expert stakeholders as well as the direct information we received from members of under-served or at-risk populations, we are confident that the community health needs we identified have a significant impact of vulnerable populations. 18   

VI. IDENTIFICATION AND PRIORITIZATION OF COMMUNITY’S HEALTH NEEDS For the purposes of the CHNA, Kaiser Permanente defines a health need as:  a poor health outcome and its associated health driver(s) or  a health driver associated with a poor health outcome where the outcome itself has not yet arisen as a need. Health needs arise from the comprehensive identification, interpretation, and analysis of a robust set of primary and secondary data. Kaiser Foundation Hospital Vallejo identified a list of ten community health needs. The criteria used to create the list of community health needs are: o The community health need arises from comprehensive review and interpretation of a robust set of data; o More than one indicator and/or data source (i.e., the health need is suggested by more than one source of secondary and/or primary data) confirms the community health need; o Indicator(s) related to the health need perform(s) poorly against a defined benchmark (e.g., county/state average or HP 2020); o Poor health outcomes along with their associated drivers (s) Community Health Needs for the Kaiser Foundation Hospital Vallejo service area were defined and prioritized through the following sequential steps: 1. Analysis of secondary data on health outcomes, identifying all of the health outcomes for which the data showed poor performance relative to benchmark, as described in the Appendix: Community Health Profiles. 2. For each of the health outcomes showing poor performance, related health drivers, behaviors and conditions were also analyzed to determine which are of concern in the Vallejo hospital service area and thus are likely to be factors contributing to health status. 3. Conversations with Key Informants and with community focus groups to test the data findings, assess community knowledge about the issue and understand available community resources. 4. A synthesis of all of the data and community input to define a set of community health needs. 5. Discussion and prioritization of community health needs with the Vallejo Hospital Contributions Committee, familiar with issues in the service area (See list of criteria and prioritized community health needs below). Overall, health outcome indicators for the City of Vallejo measure poorly in relation to benchmarks. Valley Vision’s review of the data identified Vallejo as a community of concern in every case, as noted in the table below. Focus groups and key informants verified the poor outcomes, and shared their opinions on the drivers associated with those indicators. From that process, Valley Vision identified twenty-five detailed community health needs for Solano County. Again, in each case, the issues identified for the County were identical for Vallejo. In preparation for the Vallejo Hospital Contributions Committee to better understand the community health needs, to discuss them, and to prioritize them, the twenty five health needs were grouped and categorized into broader needs areas, coming to a total of ten community health needs. For Napa, the data and the community input from the Napa County process yielded a total of ten community health needs. These needs were then verified using the CARES database. The ten needs are located on the table below. The ten community health needs identified in Napa overlap with the community health needs in Vallejo as can be seen in the table. 19   

The ten community health needs identified from the combined Solano and Napa process, listed in the table below, were presented to the Vallejo Hospital Contributions Committee.

  Community Health Need 

Communities Most Affected 

Access to culturally appropriate, affordable  health care services  

American Canyon, Calistoga, Napa, and Vallejo 

Access to Affordable Healthy Food 

American Canyon, Calistoga, Napa, St. Helena, and  Vallejo 

Lack of safe place to walk, bike, exercise or  play 

American Canyon, Calistoga and Vallejo 

Transportation limitations 

Calistoga and Vallejo 

Lack or limited access to dental care 

American Canyon, Calistoga, Napa and Vallejo 

Limited places and social space for civic  engagement 

Vallejo 

Lack of employment and vocational training 

American Canyon, Calistoga, Napa, and Vallejo  

Unstable housing and homelessness 

Calistoga, Napa, St. Helena and Vallejo 

Lack of substance abuse treatment and  rehabilitation 

American Canyon, Calistoga, Napa and Vallejo 

Exposure to unclean air, environmental  toxins and pesticides 

American Canyon, St. Helena, and Vallejo  

 

Using these combined community health needs as a basis for Committee discussion, the members reviewed the drivers for each community health need, the benchmarks and the specific neighborhoods and zip codes within the Vallejo service area. Once the Committee discussed the indicators, community health needs and the drivers associated with each need, the Committee members agreed on the following criteria to be used for prioritizing those needs for the Vallejo hospital service area: • • • • • •

Severity of issue/impact of related poor health outcomes Size of the population affected Community prioritizes issue over others Effective and feasible interventions exist A successful solution/intervention has the potential to solve multiple problems Opportunity to intervene at the prevention level 20 

 

Listed below are the top five community health needs as chosen by the Napa-Solano Area Contributions Committee Meeting attendees on January 23, 2013: 1. Lack of employment and vocational training 2. Lack of safe places to walk, bike, exercise, or play 3. Lack of access to culturally appropriate, affordable health care (including prevention and treatment) 4. Access to affordable healthy food 5. Lack of substance abuse treatment and rehabilitation Community assets and resources available to respond to the identified health needs of the community  SIGNIFICANT COMMUNITY ASSETS AND RESOURCES RELATED TO CHNs  Community Health Needs  Lack of employment and vocational training

Lack of safe places to walk, bike exercise, or play

Access to culturally appropriate, affordable health care services

Existing Community Assets and Resources  SparkPoint (American Canyon) Napa Valley College (Napa) Lincoln Adult School (Napa) VOICES (Napa) Solano County College (Suisun Valley) The Workforce Investment Board of Solano County (Fairfield-serves county) Phillip West Aquatic Center (American Canyon) Kimberly Park (American Canyon) Silver Oak Park (American Canyon) American Canyon Parks and Recreation Calistoga Parks and Recreation Pioneer Park (Calistoga) Ritchey Creek Campgroupd (Calistoga) Kennedy Park (Napa) Dry Creek Park (Napa) O’Brien Park (Napa) Napa Parks and Recreation St. Helena Parks and Recreation Crane Park (St. Helena) Jacob Meily Park (St. Helena) Stonesbridge Park (St. Helena) Blue Rock Springs Park (Vallejo) Greater Vallejo Recreation District (Vallejo) Dan Foley Park (Vallejo) Hanns Park (Vallejo) Excel Care Immediate Care Center (American Canyon) Community Health Clinic Ole’ (Napa) Queen of the Valley Medical Center (Napa) Kaiser Permanente MOB (Napa) Napa County Health and Human Services (Napa) St. Helena Hospital (St. Helena) Planned Parenthood (Napa) Great Beginnings Prenatal Clinic (Vallejo) LaClinica de la Raza (Vallejo) 21 

 

Community Health Needs 

Existing Community Assets and Resources  Kaiser Permanente Medical Center (Vallejo) Elsa Widenmann School Based Clinic (Vallejo) Kaiser Permanente (School based Teen Clinic-Jesse Bethel HS) (Vallejo)

Access to affordable healthy food

Cal Mart (Calistoga) Farmer’s Market (downtown Vallejo and Kaiser Permanente Vallejo) Food Maxx (Vallejo) Farmer’s Market (downtown Napa) Whole Food Markets (Napa) Nature Select Foods (St. Helena)

Lack of substance abuse treatment and rehabilitation

Genesis House (Vallejo) Napa Valley College Mental Health Center (Napa) Napa County Health and Human Services (Napa) Mental Health and Behavioral Programs (Napa and Solano counties) Alternatives for Better Living (Napa) Wolfe Center (Napa) County of Napa Alcohol and Drug Services (Napa) St. Helena Recover Center (St. Helena)

   

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Appendix A: Community Health Need Profiles 

1. Lack of employment and affordable training ‐ The low high school graduation rate is of grave concern, and there are limited training  programs, employment placement services and jobs available. Adults recognize the importance of good role modeling; in addition to parenting  skills and support were identified as a need by all of the community groups. The need relates to understanding how to raise children in a healthy  way, using effective discipline as well as good cooking and eating habits.  Parents also wanted skills and support in addressing mental health and  substance use/abuse issues with their children.   Rationale: Parents felt that improved skills and support is a critical need in families that lack resources, or where parents are struggling to  manage jobs, commutes and children    Vallejo Hospital Service Area  Indicators and Health Outcomes   Poor mental health = 18.34%    Substance Abuse ED visits =  312.9/10,000  Homicide = 8.20/100,000  Diabetes  Adult Incidence = 7.97% 

Health Outcomes Benchmarks  Poor mental health =14.21%  County – 407.2/10,000  State – 232.0/10,000  State = 5.15/100,000  State average = 7.57% 

  Youth Obesity = 25.51%  Youth overweight = 36.93% 

Youth overweight = 14.3%  Youth obesity = 29.82% 

Related Factors  High school graduation rate   Employment rate   Youth tobacco expenditures  Youth drug and alcohol use        Poverty rate   High school graduation rate   Employment rate     

       

23   

  2. Lack of places to walk, bike, exercise or play. These areas are needed to improve multiple health outcomes, including obesity,  diabetes, cardiovascular disease, and mental health. In addition, intentional injuries such as assault and homicide, are less likely   Rationale:  A lack of exercise and physical activity contributes to multiple poor health outcomes. Parents and youth throughout the  entire County, including Vallejo indicated that they are concerned about both safety and costs related to having their children in parks  and youth sports.  Vallejo Hospital Service Area Indicators  Health Outcomes Benchmarks  Related Factors  and Health Outcomes Adult obesity = 24.51%  Adult obesity = 23.25%  Youth overweight = 16.05%  Youth overweight = 14.3%  Youth obesity = 26.33%  Youth obesity = 29.82%  Diabetes  State average = 7.57%  Adult Incidence = 7.97%  Physical inactivity  Park access  Heart disease mortality =102.90/100,000  Heart disease mortality = 100.8/100,000 Walkability Stroke mortality =39.90 /100,000 Stroke mortality = 39.46/100,000 Mental Health:  Poor mental health =14.21%  Poor mental health = 18.34%  Suicide