Mercer County Community Health Improvement Plan 2013-2015

Mercer County Strategic Plan 2013-2015 Commissioned By: Mercer County Community Organizations Linking Together (COLT)

Table of Contents Executive Summary and Vision/Mission Statements

Page 3-5

Alignment with National and State Standards

Page 5

Partners

Page 6

Strategic Planning Model

Page 7

Needs Assessment & Priorities

Pages 8-9

Forces of Change

Pages 10

Local Public Health System Assessment

Pages 11

Community Themes and Strengths

Pages 12-13

Quality of Life Survey Results

Pages 14

Strategy #1 Reducing Obesity

Pages 15-25

Strategy #2 Reducing Adult Alcohol Abuse and Youth Alcohol Use

Pages 26-34

Strategy #3 Reducing Adult and Youth Drug Abuse

Pages 35-41

Measuring Outcomes & Contact Information

Mercer County 2013-2015 Community Health Improvement Plan

Page 42

2

Executive Summary In 2012, Mercer County conducted a community health assessment (CHA) for the purpose of measuring and addressing health status. This community health assessment was cross-sectional in nature and included a written survey of adults within Mercer County. The majority of the questions on the survey instrument were derived from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). This has allowed Mercer County to compare the data collected in their CHA to national, state and local health trends. From the beginning phases of the CHA, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. The Mercer County CHA has been utilized as a vital tool for creating the Mercer County Community Health Improvement Plan (CHIP). This CHIP process represents the first time that Mercer County stakeholders have come together to prioritize the health issues that will require the commitment of every sector of the community to address these issues effectively. It is hoped that as a result of this plan, Mercer County will rally around the issues identified and work together to implement best practices that will improve the health of Mercer County. The Mercer County – Celina City Health District invited key community leaders to participate in an organized process of strategic planning to improve the health of residents of the county. The National Association of City County Health Officer’s (NACCHO) strategic planning tool, Mobilizing for Action through Planning and Partnerships (MAPP), was used throughout this process. The MAPP process includes four assessments, Community Themes & Strengths, Forces of Change, the Local Public Health System Assessment and the Community Health Status Assessment. These four assessments were used by the Mercer County CHIP Committee to prioritize specific health issues and population groups which are the foundation of this plan. The diagram below illustrates how each of the four assessments contributes to the MAPP process.

Mercer County 2013-2015 Community Health Improvement Plan

3

Executive Summary, continued The Mercer County CHIP participants were asked to draft a vision and mission statement. Vision statements define a mental picture of what a community wants to achieve over time while the mission statement identifies why an organization/coalition exists and outlines what it does, who it does it for, and how it does what it does. Vision: Through collaboration, Mercer County will become the healthiest county in Ohio Mission: The mission of the C.O.L.T. Health Committee is to actively seek and identify opportunities in the Mercer County community and to promote the delivery of effective and efficient services to meet those needs through the organization of existing resources

Strategies: Priority Health Issues for Mercer County 1. Decrease adult and youth obesity 2. Decrease adult alcohol abuse and youth alcohol use 3. Decrease adult and youth drug use

Target Impact Areas: To decrease youth and adult obesity-related behaviors, Mercer County will focus on the following target impact areas: 1) Increase consumption of fruits and vegetables, 2) Increase awareness of community wellness resources and 3) Increase policies that encourage Mercer County residents to make positive healthy choices. To decrease adult alcohol abuse and youth alcohol use, Mercer County will focus on the following target impact areas: 1) Decrease binge drinking, 2) Decrease drinking and driving, and 3) Increase youth prevention programs. To decrease adult and youth drug use, Mercer County will focus on the following target impact areas: 1) Decrease prescription drug abuse, 2) Increase awareness of current trends, and 3) Increase youth prevention programs.

Action Steps: To work toward decreasing youth obesity, the following action steps are recommended: 1) Implement a healthier choices campaign, which will lead to increased fruit and vegetable consumption. To work toward decreasing adult obesity, the following action steps are recommended: 1) Increase nutrition/physical education materials being offered to patients by primary care physicians, 2) Partner with local grocery stores to encourage low-cost healthy food choices, 3), Create a wellness community calendar, 4) Encourage and recognize local restaurants making efforts to offer healthy choice menu items, 5) Increase opportunities for businesses/organizations to provide wellness and insurance incentive programs for their employees, and 6) Increase community gardens and farmer’s markets in Mercer County. To work toward decreasing youth alcohol use and adult alcohol abuse, the following actions steps are recommended: 1) Implement evidence-based youth prevention programming in Mercer County schools, 2) Implement responsible beverage service trainings, 3) Explore opportunities for a bed-tracking system in Mercer County 4) Increase the number of ER and primary care physicians who screen for at-risk drinking and alcohol abuse, and 5) Increase awareness of the risks associated with impaired driving and binge drinking.

Mercer County 2013-2015 Community Health Improvement Plan

4

Executive Summary, continued To work toward decreasing adult and youth drug use, the following actions steps are recommended: 1) Implement evidence-based youth prevention programming in Mercer County Schools, 2) Explore opportunities for a bed-tracking system in Mercer County, 3) Increase awareness of prescription drug abuse and prescription drop-off locations, 4) Increase medication-assisted treatment opportunities for criminal offenders, and 5) Increase awareness of adult and youth drug trends for parents, guardians and community members. Two additional action steps will be implemented to collect youth data for the 2015 Mercer County Health Assessment and for raising funds for the 2015 Mercer County Health Assessment.

Alignment with National and State Standards The 2013-2015 Mercer County Health Improvement Plan priorities align perfectly with state and national priorities. Mercer County will be addressing the following priorities: obesity, alcohol use, and drug use. Mercer County priorities very closely mirror the following 2012-2014 Ohio State Health Improvement Plan priorities: chronic disease and integration of physical and behavioral health. The Mercer County Plan also aligns with three of the seven National Prevention Strategies for the U.S. population: preventing drug abuse and excessive alcohol use, healthy eating, and active living. Mercer County’s priorities also fit specific Healthy People 2020 goals. For example:  Nutrition and Weight Status(NWS)-8: Increase the proportion of adults who are at a healthy weight  Substance Abuse (SA)-2: Increase the proportion of adolescents never using substances There are 20 other substance abuse objectives and 21 weight control objectives that support the work of the Mercer County CHIP.

Mercer County 2013-2015 Community Health Improvement Plan

5

Partners Acknowledgements The Mercer County – Celina City Health District wishes to acknowledge the numerous contributions of the following partners and stakeholders. Their continued commitment to the mission of the health department helps to make Mercer County a great place to live and work.

Mercer County Community Health Improvement Plan (CHIP) Planning Committee Members: Barb Heckman-Head Start Diane Lefeld-Mercer Health & Mercer County-Celina City Health District Kathy Mescher-OUR Home Brittany Hemmelgarn- Mercer County-Celina City Health District Brian Engle-Foundations Behavioral Health Services Anita Kremer-Mercer County Jobs and Family Services Mindy Kremer-Mercer Health Gloria Miller-Mercer County Council on Aging Karen Howick- Mercer County Council on Aging Barb Hennard-OSU Extension Dale Palmer- Mercer County-Celina City Health District Teresa Smith-Take Shape For Life Lisa Klenke-Mercer Health Renee Kinney-Mercer Health Jodie Lange-Mercer County Sheriff’s Office Abbey Grieshop-Mercer Health Robin Johnson-West Central Ohio Regional Health Care Alliance, Ltd. (WCORHA) Julie Miller-Wright State University- Lake Campus Pam Buschur-Celina-Mercer County Chamber of Commerce David Collins-Red Cross Jana Ranly-Briarwood Village

This community health improvement planning process was facilitated by Britney Ward, MPH, Assistant Director of Health Planning, and Michelle Von Lehmden, Health Assessment Coordinator, both from the Hospital Council of Northwest Ohio.

Mercer County 2013-2015 Community Health Improvement Plan

6

Strategic Planning Model Beginning in February 2013, the Mercer County CHIP Committee met seven (7) times and completed the following planning steps: 1.

Initial Meeting- Review of process and timeline, finalize committee members, create or review vision

2.

Choosing Priorities- Use of quantitative and qualitative data to prioritize target impact areas

3.

Ranking Priorities- Ranking the health problems based on magnitude, seriousness of consequences, and feasibility of correcting

4.

Resource Assessment- Determine existing programs, services, and activities in the community that address the priority target impact areas and look at the number of programs that address each outcome, geographic area served, prevention programs, and interventions

5.

Forces of Change and Community Themes and Strengths- Open-ended questions for committee on community themes and strengths

6.

Gap Analysis- Determine existing discrepancies between community needs and viable community resources to address local priorities; Identify strengths, weaknesses, and evaluation strategies; and Strategic Action Identification

7.

Local Public Health Assessment- Review the Local Public Health System Assessment with committee

8.

Quality of Life Survey- Review Results of the Quality of Life Survey with committee

9.

Best Practices- Review of best practices and proven strategies, Evidence Continuum, and Feasibility Continuum

10.

Draft Plan- Review of all steps taken; Action step recommendations based on one or more the following: Enhancing existing efforts, Implementing new programs or services, Building infrastructure, Implementing evidence based practices, and Feasibility of implementation

Mercer County 2013-2015 Community Health Improvement Plan

7

Needs Assessment The CHIP Committee reviewed the 2012 Mercer County Health Assessment. Each member completed an “Identifying Key Issues and Concerns” worksheet. The following two tables are the group results. What are the most significant ADULT health issues or concerns identified in the 2012 assessment report? Key Issue or Concern 1. Obesity and related indicators (9 votes) Cardiovascular Disease (5 votes) Diabetes (1 vote) Arthritis (1 vote) 2. Alcohol Abuse/Binge Drinking (9 votes) *6% of all crashes in Mercer County were alcohol-related (Source: Ohio Department of Public Safety, Crash Reports, 2011 Traffic Crash Facts)

3. Adult & Youth Drug Use – heroin and prescription drug abuse (7 votes) *2% of pregnant women reported using drugs not prescribed to them. 4. Mental Health (7 votes) Depression Considered attempting suicide

% of Population Most at Risk 33% total population Heart Attack 6% total population 10% total population 28% total population

Age Group Most at Risk

Gender Most at Risk

60+ (37%)

Male (34%)

60+ (12%)

Male/Female

60+ (22%) 60+ (67%) & Income < $25,000 (49%)

Male (11%) Male/Female

25% binge drinkers Age 30 and under (65%)

Male

Income < $25,000 (15%)

Male (13%)

Income < $25,000 (14%)

Male

13% of population had been diagnosed with some form

60+ (27%)

Male/Female

41% of adults ages 65+

65+

Male/Female

Income < $25,000

Male/Female

47% of drinkers binged in past month

10% total population misused prescription drugs

9% total population depressed 3% considered suicide

5. Cancer (5 votes) *From 2000-2008 cancer caused 24% of all Mercer County deaths. 25% of cancer deaths were from lung and bronchus cancer. (Source: ODH Information Warehouse)

6. Low pneumonia vaccine utilization (4 votes) 7. High risk for low income population (3 votes) Multiple indicators

Mercer County 2013-2015 Community Health Improvement Plan

8

Priorities Chosen The Mercer County CHIP Committee completed an exercise where they ranked the key issues based on the magnitude of the issue, seriousness of the consequence, and the feasibility of correcting the issue. A total score was given to each priority. The max score was 30. All committee members’ scores were combined and then average numbers were produced. Based off these parameters, the group decided to focus on the following three issues: adult and youth weight control, adult and youth alcohol abuse/use and adult and youth drug abuse. The results were sent out to the full committee for approval. The rankings were as follows: 1. Obesity (includes CVD, Diabetes & Arthritis) (26.3) 2. Alcohol Abuse/Binge Drinking (23.5) 3. Drug Use (23.4) 4. Mental Health (21.5) 5. Cancer (19.8) 6. High Risk/Low Income (19.7) 7. Low Pneumonia Vaccine (18.8)

Mercer County 2013-2015 Community Health Improvement Plan

9

Mercer County Forces of Change Brainstorming Exercise The Mercer CHIP Committee was asked to identify positive and negative forces which could impact community health improvement and overall health of this community over the next three to five years. This group discussion covered many local, state, and national issues and change agents which could be factors in Mercer County in the near future. The table below summarizes the forces of change agent and its potential impacts.

Force of Change

Impact

Increase in population of Hispanic, Latino and Pacific Islanders

     

Struggles with education Language barriers Cultural barriers Agencies need to deliver services differently Resources may become limited Shifts in demographics

  

Decreases in revenue Reimbursement rates are impacting services Some companies may not want to grow, they may want to stay below 50 employees 27% reduction for physicians Physicians may choose to retire Increased emphasis on preventive care Pushing many jobs to part-time status May effect family sizes, could lead to smaller families

Increase in clients coming from Indiana to access services at the health department (vaccinations) Affordable Care Act

New Health Care Exchanges/Insurance Market Increase in heroin and prescription drug abuse Distracted driving

House Bill 59

Electronic Medical Records (EMR)

Fear of change and uncertainty Algae outbreak at Grand Lake St. Marys PERS liability requirement Workforce development

                         

Mercer County 2013-2015 Community Health Improvement Plan

Creates a stress on the health care and court system More women delivering drug addicted babies Increase in accidents due to distracted driving Increase in deaths due to distracted driving More demands are being put on young people Local health departments must become accredited by 2018 Increase mandates for local health departments Unfunded mandates Possible mergers between local health departments Possible hospital mergers Drain of financial resources Must be in place by 2017 or you could face a reduction in reimbursement Lack of education for communicating the system Healthcare Government shutdowns Created positive communication to make changes in farming practices State’s retirement liability is being pushed to employers Creates budget constraints Skill sets need to change Changes in reimbursement for higher education Difficult to recruit physicians to rural areas 10

Mercer County Local Public Health System Assessment The Local Public Health System Assessment (LPHSA) answers the questions, "What are the components, activities, competencies, and capacities of our local public health system?" and "How are the Essential Services being provided to our community?" This assessment involves the use of a nationally recognized tool called the National Public Health Performance Standards Local Instrument. Members of the Mercer County – Celina City Health District administrative team met to discuss the 10 Essential Public Health Services and how they are being provided within the community. The group completed the performance measures instrument. Each model standard was discussed and the group came to a consensus on responses for all questions. The LPHSA results were then presented to the full CHIP committee for discussion. The challenges and opportunities that were discussed were then used in the action planning process. The CHIP committee identified 14 indicators that had a status of “minimal”. To see the full results of the LPHSA, please contact the Mercer County – Celina City Health District, or visit Link to website

The 10 Essential Public Health Services The 10 Essential Public Health Services describe the public health activities that all communities should undertake and serve as the framework for the NPHPS instruments. Public health systems should 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships and action to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. (Source: Centers for Disease Control; National Public Health Performance Standards; http://www.cdc.gov/nphpsp/essentialservices.html)

Mercer County 2013-2015 Community Health Improvement Plan

11

Mercer County Community Themes and Strengths The Mercer County CHIP committee participated in an exercise to discuss community themes and strengths. The results were as follows: Mercer County community members believed the most important characteristics of a healthy community were:  Amenities- bike paths, sidewalks, parks  Good public education  Accessible health care  Thriving industry  Support systems (safety net for people who can’t take advantage of opportunities)  Balanced population  Pride in the community Mercer County community members were most proud of the following regarding their community:  Work ethic  Everyone knows one another  A strong focus and support for youth  Strong faith-based community  Always something to do (free community events)  Celebration of the community The following were specific examples of people or groups who have worked together to improve the health and quality of life in the community:  Community Health Improvement Plan Committee (CHIP)  Lake Restoration Commission  Churches  Health care services- healthy workforce initiatives  Angel Tree project  Mercer Healthy Living Exposition  Health Kids Day  Hometown Opportunity  Neighborhood Nurse Program  Strong service groups that collaborate  Physicians working together to offer free prostate and breast cancer screenings  Increasing access through tele-medicine The most important issues that Mercer County residents believed must be addressed to improve the health and quality of life in the community were:  The priorities addressed in the Mercer County CHIP (adult and youth obesity, adult alcohol abuse and youth alcohol use, and adult and youth drug use)  Lower income needs (high risk populations)  Lack of health insurance  Implement the ImPACT system for head traumas

Mercer County 2013-2015 Community Health Improvement Plan

12

Mercer County Community Themes and Strengths, continued The following were barriers that have kept our community from doing what needs to be done to improve health and quality of life:  Funding  Resources  Man power  Lack of empowerment  Attitudes around alcohol use  Social acceptance of being unhealthy, overweight, or obese  Complacency with personal lifestyle choices  Meeting needs of lower income Mercer County residents believed the following actions, policies, or funding priorities would support a healthier community:  Seeking new grants to subsidize programs  Insurance reform to promote wellness incentives  Early detection and screening for the entire population  More prevention efforts Mercer County residents were most excited to get involved or become more involved in improving the community through:  Positive outcomes  Community receptiveness  Engagement of the community  Making something visible- market your brand  Willingness to partner  Regional collaboration efforts  Getting schools involved

Mercer County 2013-2015 Community Health Improvement Plan

13

Quality of Life The Mercer County CHIP Committee urged community members to fill out a short Quality of Life Survey via Survey Monkey. There were 233 Mercer County community members who completed the survey. The goal of the Mercer County CHIP Committee is to repeat the Quality of Lie Survey on an annual basis and increase participation. Mercer County survey respondents reported the following educational backgrounds: never finished high school (0%), GED or high school diploma (8%), some college or technical school (23%), and college degree (69%). Of the respondents for the survey, 80% live in Mercer County and 83% work in Mercer County. Zip Code Breakdown Other 29% 45883 9% 45860 10%

45822 35% 45828 17%

45822 45828 45860 45883 Other

Quality of Life Questions 1.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

13.

What is your age? □ Less than 20 years old (