Columbia Gorge Community Health Assessment Full Document ...kvhealth.nextmp.net/images/CGRCHA-2016.pdf · In 2013, the Columbia Gorge Region came together to create an integrated

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CommunityClinicsHospitals PublicHealth CommunityPartners

COLUMBIAGORGEREGIONALCOMMUNITYHEALTHASSESSMENT2016CollaboratingforOptimumHealthandOptimizedHealthcare

AsummaryoftheneedsforimprovedhealthfortheresidentsoftheColumbiaGorgeRegionincludingHoodRiver,Wasco,Sherman,Gilliam,WheelercountiesinOregonandSkamaniaandKlickitatcountiesinWashington–Fall2016

NorthCentralPublicHealthDepartment

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AresultthatisrewardingInaruralcommunity,workingtogetherisparamountforsuccess.TheformationoftheColumbiaGorge

CoordinatedCareOrganizationwithPacificSourceCommunitySolutionsaidedustoturnanordinaryrequirementfromOregonlawmakersintoanextraordinaryopportunitytoimprovethehealthandwellnessofallresidents.WeareproudofouraccomplishmentsanddelightedthattheRobertWoodJohnsonFoundationrecognizedourwork.

Weinvitethecommunitytousethismaterialinthepursuitofbetterhealthforall.

***ForthefulldocumentlookontheColumbiaGorgeHealthCouncilwebsiteatcghealthcouncil.org

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20162013

QUESTIONS

COUNTY

COHORT

SOCIAL

DETERMINANTS

HEALTHCARE

CONNECTED

VS

6Counties:4Oregon+

2Washington

7Counties:5Oregon+

2Washington

65QuestionsincludingFood,

HousingandTransportation

72QuestionsincludingTrauma

andSupportforCaregivers

4hospitals;4HealthDeparts;

OneCommunityHealth;

CountyMentalHealth

ColumbiaGorgeCCO

2013cohort+UnitedWay;Four

RiversEarlyLearningHub

Housing&Food;

Transportation;Jobs

AdultDentalAccess;Physical

andMentalhealthtogether;

MentalHealthaccessfor

Children&Youth

Coordinationwithhealthcare&social

services;Healthinsurancere-

enrollment;SupportingDevelopmental

andHealthyGrowthintheEarlyYears

Employmentratebetter;

otherareasremainaconcern

DentalAccessremains#1gap;

ProgressonMentalHealthAccess;

PCPAccessharder

Coordinationwithprimarycareand

mentalhealth=good;Morepeopleare

insured;Familieswithchildren0-5more

likelytogowithoutbasicneeds

ColumbiaGorgeRegional

CommunityHealthAssessment

Hospitals:ProvidenceHoodRiver,Mid-ColumbiaMedicalCenter,KlickitatValleyHealth,SkylinePublicHealth:HoodRiverCounty,KlickitatValley,NorthCentral,Skamania

OneCommunityHealth,Mid-ColumbiaCenterforLiving,PacificSourceCommunitySolutionsUnitedWayoftheColumbiaGorge,4RiversEarlyLearningHubInpartnershipwith:

SURVEYS

Mail=457

Hand-fielded=691

Mail=674*statisticalsignificance

Hand-fielded=694

DEMOGRAPHICS

Non-HispanicWhite=827

Hispanic/Latino/Other=290

LowIncome=668

Non-HispanicWhite=1043

Hispanic/Latino/Other=301

LowIncome=631

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ColumbiaGorgeRegionalHealthAssessment-2016

GeneralPopulation

BasicNeeds

IncomeSecurity

FoodSecurityandHealthyEating

TransportationAccess

HousingSecurity

HealthInsurance

SocialCohesion

SupportforCaregivers

1in3hadtroublepayingforbasicneeds

7%hadtogowithoutstablehousing

25%areworriedabouttheirhousingsituation

morethan1in10hadtogowithoutfood

1in4hadtogowithoutabasicneedAND1in4hadtogowithoutahealthcareneed

13%hadtogowithouttransportation

8%areuninsured

1in3areworriedaboutrunningoutoffood*

oftheuninsured,21%liveinWashingtonand69%liveinOregon

21%donothavesomeonetomakethemfeellovedorwanted

22%donohavesomeonetogivethemgoodadvice

29%donohavesomeonetorelaxwith

26%donothavesomeonetotalktoaboutproblems

29%donothavesomeonetohelpiftheywereconfinedtoabed

1in5arecaregivers

6outof10caregiversdon'tfeelthattheyhaveadequatesupport

13%thinkpeopleintheircommunityareunwillingtohelp

25%feeltheycannottrustpeopleintheircommunity

20%cannotcountonadultsintheircommunity

10%donotfeelsafeintheircommunity

SocialSupport

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BasicNee

dsCo

mmun

ityand

Soc

ialE

nviro

nmen

t

*GorgeWideFoodSurvey

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Populationswithdisparitiesbyrace/ethnicity,income,orinsurance

BasicNeeds

IncomeSecurity

FoodSecurityandHealthyEating

TransportationAccess

HousingSecurity

HealthInsurance

SocialCohesion

SupportforCaregivers

MorethanhalfoftheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtroublepayingforbasicneeds

16%ofthesepopulationshadtogowithoutstablehousing

About40%inHispanic/Latino/Other,Uninsured,andMedicaidpopulationsareworriedabouttheirhousingsituation

1in4intheHispanic/Latino/Other,Uninsured,andMedicaidpopulationshadtogowithoutfood

4in10intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithoutabasicneedandhealthcareneed

Hispanic/Latino/OtherandLowincomepopulationsareabouttwiceaslikelytobeuninsuredthanthegeneralpopulation

Lowincomewaslesslikelytofeelliketheyhadthesesocialsupportsthanhigherincomes

UninsuredandMedicaidpopulationswerelesslikelytofeelliketheyhadthesesocialsupportsthanthePrivateandMedicarepopulations.

6outof10caregiversdonotfeelliketheyhaveadequatesupport

25%oftheUninsuredthinkpeopleintheircommunityareunwillingtohelp

35%ofLowincome,Uninsured,andMedicaidpopulationsfeeltheycannottrustpeopleintheircommunity

25%ofHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationscannotcountonadultsintheircommunity

20%oftheUninsureddonotfeelsafeintheircommunity

SocialSupport

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37

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37

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BasicNee

dsCom

mun

ityand

Soc

ialE

nviro

nmen

t

About1in4intheHispanic/Latino/Other,Lowincome,Uninsured,andMedicaidpopulationshadtogowithouttransportation

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Adults(ages18-98)

ChronicMedicalConditions

MentalHealthConditions

TraumaandResilience

GeneralHealth

Alcohol,Tobacco,OtherDrugs

PhysicalHealthcareAccess

MentalHealthcareAccess

DentalHealthcareAccess

SubstanceUseTreatment

Medications

Specialists

1in4ratedtheirhealthasfairorpoor

Highbloodpressureisthemostcommonchroniccondition

Depressionisthemostdiagnosedmentalhealthcondition

3outof4experiencedoneormoretraumaticevent

21%havethreeormoredrinksonthedaystheydrink19%usetobacco

1in5donothaveaprimarycareproviderandaregoingwithoutneededcare

Greatestunmethealthcareneed:344peoplearegoingwithoutcare

Accessgreatlyimprovedfrom2013

7%neededsubstanceusecare,ofthose68%arereceivingtreatment

1in10cannotgetalltheirmedications

Neurology,substanceusetreatment,andcancertreatmenthadhighestunmetneed

2outof3areoverweightorobese

Morethanhalfhaveachronicmedicalcondition

About4outof10hadsomeonedosomethingharmfultothem

Mostpeopleuselocalservices


46%gotcarefromprimarycareprovider30%gotcarefromcountymentalhealthclinics

1in3haveamentalhealthcondition

1in4aregoingwithoutneededcare

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15%usemarijuana7%useotherdrugs

Hea

lthStatus

Hea

lthca

reAcc

ess

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Adultswithdisparitiesbyrace/ethnicity,income,orinsurance(ages18-98)



TraumaandResilience

GeneralHealth






Medications

Specialists

35%ofLowincomeandMedicaidpopulationsratedtheirhealthasfairorpoor

AnxietyisthemostdiagnosedmentalconditionforLowincomeandMedicaid

TheUninsuredandMedicaidpopulationweremorelikelytohavethreeormoredrinks,usetobacco,anduseotherdrugsthangeneralpopulation

HalfoftheMedicaidpopulationhasexperienced3ormoretraumaticevents

1in4oftheUninsuredandMedicaidpopulationsaregoingwithoutneededcare

15%ofMedicaidrecipientsneededsubstanceusecare

Nosignificantdisparities

Lowincomehadmoreunmetorthopedicneedsthanthegeneralpopulation

Privateinsurancehadmoreunmetcardiologyneedsthanthegeneralpopulation

Medicaidhadmoreunmetskinconditionneedsthanthegeneralpopulation

3outof4onMedicarehaveachronicmedicalcondition

Lowincomewasmorelikelytousetobaccothanthegeneralpopulation


NearlytwiceasmanyMedicaidrecipientsaregoingwithoutneededcarethanthegeneralpopulation

2of5oftheLowincomepopulationhaveamentalhealthcondition

About37%oftheLowincome,Uninsured,andMedicaidpopulationsaregoingwithoutneededcare

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HealthStatus

HealthcareAccess

HalfofMedicaidrecipientshaveamentalcondition

MorethanhalfoftheUninsureddonothaveaprimarycareprovider

Highincome,Uninsured,andPrivateinsurancepopulationsweretwiceaslikelytogowithoutneededcarethanthegeneralpopulation

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Youth



TraumaandResilience

GeneralHealth






Medications

1in10ratedtheirhealthasfairorpoor*

Asthmaisthemostcommonchronicmedicalcondition

Anxietyisthemostdiagnosedmentalhealthcondition

Nearly1outof4hadanadulthurtthemonpurpose*

20%havehadalcohol*14%haveusedtobacco*

1in5youthfeeltheyarenotgettingallneededcare*

1in5teenshaven'tbeentothedentistinthepast12months

7%neededsubstanceusecare,ofthose22%arereceivingtreatment^

1in20teenshaveusedprescriptiondrugswithoutadoctor'sorders*

1outof3areoverweightorobese*


1in10parentssaidtheirchildrenarenotgettingallneededcare

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1in10parentssaidtheirchildrenarenotgettingallneededcare

8%parentssaidtheirchildrenarenotgettingallneededcare

15%youthfeeltheyarenotgettingallneededcare*

1in4haveamentalhealthcondition

15%haveusedmarijuana*5%haveusedotherdrugs*

VS

VS

Health

Status

Health

careAccess

(ages0-17)

VS

*ThisinformationisfromtheOregonandWashingtonHealthyTeenSurvey^ThisinformationcamefromtheOregonHealthAuthority(OHA)BehavioralProfilesAllotherinformationisfromthe2016CommunityHealthSurvey

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ColumbiaGorgeRegionalCommunityHealthAssessment-2016TheCohortIn2013,theColumbiaGorgeRegioncametogethertocreateanintegratedColumbiaGorgeRegionalCommunityHealthAssessment.Thefirstintegratedassessmentrepresentedhealthcareprovidersfromsixcounties,aswellasnon-profitsandsocialserviceagencies.Theyworkedtogethertocreateaprioritizedsetofneedsfortheregion,aswellasidentifyuniqueneedsinspecificareasandgroupswithintheregion.

Keepingwiththatspiritofcollaboration,theorganizationslistedworkedtogetheragainin2016tocreateanewregionalhealthassessment.Inadditiontothe2013cohortmembers,weaddedanewcountytotheregion,Wheelerandtwoneworganizations,UnitedWayoftheColumbiaGorgeandFourRiversEarlyLearningHub.WeusedtheColumbiaGorgeHealthCouncilwithitsConsumerAdvisoryCouncilastheorganizers.

Wewereonceagainabletolookatsocialandeconomicconditions,inadditiontokeyhealthcareinformationintheregion.Bydoingsowewereabletorecognizethemostimportantissuesthatfaceourpopulation.Thismethodofcrossorganizational,cross-countyforumwasabletoservetheneedsofmultipleorganizations.OurPrinciplesofCollaborationremainedthesameandoutlineourmutualintention:

• AcollaborativeapproachtotheCommunityHealthSurvey(CHA)andtheCommunityHealthImprovementPlan(CHIP)isbetterforourregion,yieldingmoreaccurateandmoreactionableproducts,ascommunityprovidersagreeontheneedswithinourregionandcommunitiesandaswealignourabilitiestoaddressthoseneedstogether.

• AcollaborativeapproachtotheCHAandCHIPwillmaximizecollectiveresourcesavailableforimprovinghealthintheregion.

• AcollaborativeapproachtotheCHAandCHIPmustbetrulycollaborative,requiringcommitmentsofcashorin-kindresourcesfromallparticipantswhowoulduseittosatisfyaregulatoryrequirement.

Therestofthisdocumentillustratesourcollaborativeeffort,andoursharedrecognitionofthegreatestneedsintheColumbiaGorgeRegion.

TheCohort

ColumbiaGorgeHealthCouncil

FourRiversEarlyLearningHub

HoodRiverCountyHealthDepartment

KlickitatValleyHealth

KlickitatPublicHealth

Mid-ColumbiaMedicalCenter

Mid-ColumbiaCenterforLiving

NorthCentralPublicHealthDistrict

OneCommunityHealth

PacificSourceCommunitySolutions

ProvidenceHoodRiverMemorialHospital

SkamaniaCountyHealthDepartment

SkylineHospital

UnitedWayoftheColumbiaGorge

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AbouttheRegionTheColumbiaGorgeRegioniscomprisedofsevencountiesandliesonbothsidesoftheColumbiaRiver.InOregon,theColumbiaGorgeregionisrepresentedbyHoodRiver,Wasco,Sherman,Gilliam,andWheelercounties.SkamaniaandKlickitatcountiesmakeuptheWashingtonsideoftheColumbiaGorgeregion.Thesecountiescover10,284squaremilesandarehometoapopulationofapproximately84,000.

TheColumbiaGorgeRegionisamostlyruralareawithonlyafewtownsthatarelargerthan1,000people.Agricultureisalargeindustryinalmosteverycounty.Tourism,healthcare,forestry,andgrowingtechnologyfirmsalsodrivetheeconomy.Manyofourindustriesrelyonseasonalemployment.Therefore,weexperiencealargeinfluxofworkers,especiallymigrantandseasonalfarmworkers.

Washington

Oregon

Figure1-MapofColumbiaGorgeRegion

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DemographicsOverallRegionDemographicsThecurrentpopulationoftheColumbiaGorgeRegionis84,234.HoodRiver,Klickitat,WascoandShermancountieshaveseenasteadyincreaseinpopulationsince2013,whileGilliamandSkamaniahaveseenanoverallpopulationdecrease.OverallthepopulationinthesecountiesisolderthanthegeneralpopulationofWashingtonandOregon.Also,theHispanicpopulationhasgrowninalmosteverycounty.TheregionisalsorepresentedbyrelativelysmallpopulationsofBlacks,AmericanIndians,andAsianorPacificIslanders.

SurveyParticipantDemographics TheColumbiaGorgeHealthSurveywascompletedby1,368adultsandwasrepresentativeof3,590adultsandchildren.84%ofparticipantswereEnglishspeakers,while10%wereSpanishspeakers.MostadultswereNon-Hispanicwhites.Therewasalsoahighervolumeofolderadultsinrelationtothegeneralpopulationofregion.Ofthosethatresponded48wereDualeligible.60%ofthemareundertheageof65.

Table2-SurveyParticipantDemographics

Source:DatafromTruvenMarketExpert2016

Table1-OverallDemographics

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ForcesofChangeForcesofchangeare“trends,factorsorevents—thatareorwillbeinfluencinghealthandqualityoflifeofthecommunityandthelocalpublichealthsystem”(NACCHO).ThereareseveralforcesofchangeaffectingtheColumbiaGorgeregionthatimpactourhealthandhealthsystem.

SourcesofInformationTocreatethe2016CommunityHealthSurvey,wepartneredwithProvidence’sCenterforOutcomesResearchandEducation(CORE)todesignabasesurveyof36questions.Inaddition,theCommunityAdvisoryCouncil(CAC)formulatedanadditional91questions.Fromwhich,36wereselectedtoappearonthesurvey.Theseadditionalquestionsenabledustocollectinformationaboutaccesstospecifickindsofcare,traumahistory,housingsecurity,andsocialsupport/socialcohesion.SurveyswereavailableanddistributedinbothSpanishandEnglish.Additionally,weusedseveralothersourcesofinformationfromthecommunitytosupplementourdataandprovideadditionalresources.

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Mailsurvey2,500householdsreceivedthesurveybasedonarandommailingaddressbasedsamplingmethod.Themailsurveywasrepresentativeofhealthcareneedsforthosewhohaveastableaddress.Iftheaddress’szipcodewasinanareawhereatleast10%ofthehouseholdsreportedSpanishwasspokenathome,aSpanishandEnglishsurveywasmailedtothem.Ofthe2,500surveysthatweremailed,675werereturned,13ofwhichwereSpanishlanguagesurveys.Althoughmoresurveyswasreturned,theresponseratewas27%comparedtoa35%responseratein2013.

Hand-fieldedsurveyThehand-fieldedsurveywasmeanttoreachthepopulationsthatdidnothavestablehousingorwhodidnotspeakEnglish,astheywerelesslikelytorespondtothemailedsurvey.Todothis,volunteershandedoutsurveysatlocationsthatmaybefrequentedbythosewhowerelesslikelytoparticipateinthemailedsurvey.PlacesthatthesurveywasavailableincludedMealsonWheels,DepartmentofHumanServicesSelfSufficiencyagencies,andcountymentalhealthclinics.Withthehelpoftheseagencieswewereabletocollect694surveys,whichwasslightlymorethanthenumbercompletedin2013.

OregonHealthyTeenSurveyTheOregonHealthyTeenSurveyisacompletelyanonymousandvoluntarysurveythatisconductedamongthe8thand11thgradersacrossOregon.Itattemptstomonitorthehealthandwell-beingofyouthinallcounties.Consequently,questionsthatarerelatedtoalcohol,tobacco,druguse,personalsafety,violence,diet,exercise,andaccesstocareareasked.Thesurveyisonlyconductedinoddyears,thereforethedataweuseisfrom2015.Thedataisrepresentativeof717teensfromWasco,HoodRiver,Gilliam,andShermancounties;Wheelerdidnotparticipate.

WashingtonHealthyTeenSurveyTheWashingtonHealthyTeenSurveyisalsoananonymoussurveygivento6th,8th,and10thgradersacrossWashington.ItaimstoprovideaglimpseofthehealthofadolescentsinWashingtonbyaskingquestionsabouthealth,risk,safety,andsubstanceusebehaviors.Thissurveyisconductedinevenyears,sothisdataisfrom2014.Thedataisrepresentativeof318studentsfrombothSkamaniaandKlickitatcounties.

GorgeWideFoodSurvey

TheColumbiaGorgeHealthCouncilandtheCommunityAdvisoryCouncilconductedasurveytoaddressfoodinsecurityintheGorge.Itaddressedquestionssuchas“didyouskipameal”,“areyouworriedaboutfoodrunningout”,and“whatmakesitdifficulttoaccessfood.”Thesurveywasdistributedinfivecounties:HoodRiver,Wasco,Sherman,SkamaniaandKlickitat.Duetothiscollaborativework,thesurveyisrepresentativeof4,664people,manyofwhichrepresentvulnerablepopulationsinourregion.ThemajorityofparticipantswereEnglishspeakingandaboutathirdidentifiedasHispanic.NearlyhalfoftheparticipantswerereceivingSNAP,WIC,orFreeandReducedLunch.

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OregonHealthAuthorityBehavioralHealthProfilesThisOregonHealthAuthority(OHA)dataaddressesbothmentalhealthandsubstanceuseconditionsinMedicaidpatientsinHoodRiver,Sherman,andWascocounties.Thedataprovidesestimatesofthosethathaveamentalhealthorsubstanceusecondition.Toderivetheseestimates,OHAlookedatinsurancecodesonpatientsrecordsandrecordedanythathadtodowithamentalhealthservice,substanceuseservice,diagnosesofeither,orprescriptions,etc.Thisderivedprevalence,basedoninsurancecodes,indicatesactualdiagnoses.TheOHAdataalsoincludesthosethatarereceivingtreatmentfortheseconditions.

PacificSourceMedicaidUtilizationRates

ThisdataisrepresentativeofOregoniansintheColumbiaGorgeCCOregionthatareonMedicaid.Thedatapresentedshowsthenumberoftimesmembersvisitedtheirprimarycareprovider,behavioralhealth,ordentist.Thedatacovers2013-2016,howeverthereisnodatafordentalvisitsin2013becausedentalcoveragewasnotapartoftheCCOuntil2014.

CoordinatedHumanServicesTransportationPlanData

Mid-ColumbiaEconomicDevelopmentDistrictdistributedasurveyinWasco,HoodRiver,andShermancountiestogetabettersenseofthesecommunities’needsinregardstotransportation.Questionsregardedtheuseoftransportation,theirdestinations,whetheritwasabarriertoreceivingservices,etc.Thesurveywaspassedouttoclientsatsocialserviceagencies,aswellasthestaffthemselves.Itwasalsodistributedatseniorcenters,tothepublic,andtothepublictransportationprovidersineachcounty.About775peoplecompletedthesurvey.EmergencyDepartmentUtilizationCollectiveMedicalTechnologies(CMT)usesreal-timedata,riskanalytics,notifications,andsharedcareguidelinestopromptandguideproviderdecisionmakinginawaythatdrivesdifferentialoutcomesintermsofreducedEDutilizationandinpatientreadmissions.CMTwasabletoprovideuswithaccurateuptodateinformationaboutEmergencyDepartmentUtilizationbasedonEmergencyDepartmentInformationExchange(EDIE).

HealthcareandAgencyEcosystemDuetotherelativelysmallsizeoftheregionalpopulation,manyhealthcareprofessionals,socialserviceagencies,andnon-profitsintheColumbiaGorgeRegionservepatientsandclientsacrosscountyandstateboundaries.Therefore,thisregionalapproachtoacommunityhealthneedsassessmentprovidestheopportunityformultipleorganizationstoleverageourcollectiveworkforthebenefitoftheentirecommunity.

HealthcareProfessionalsTheColumbiaGorgeRegionisservedbyfourhospitals:ProvidenceHoodRiverMemorialHospital(HoodRiver^1),SkylineHospital(WhiteSalmon),Mid-ColumbiaMedicalCenter(TheDalles),andKlickitatValley

1HoodRiverCountyalsohasacitycalledHoodRiver.ThenotationHoodRiver^meansthecity.AllotherreferencesofHoodRivermeanthecountyofHoodRiver

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Hospital(Goldendale).EachhasbeendesignatedasaCriticalAccessHospital,exceptMid-ColumbiaMedicalCenter.

Eachofthesevencountieshasaccesstoaprimarycareprovider.Gilliam,Sherman,andWheelercountiesareabletoreceivecarelocallythroughmid-levelproviders.Fortherestofthecounties,bothmid-levelandphysiciansareavailableforcare.TheColumbiaGorgeRegionisalsoservedbyOneCommunityHealth,whichhasbeendesignatedasaFederallyQualifiedHealthCenter(FQHC).OneCommunityHealthhasofficesinTheDallesandHoodRiver^.

AcknowledgmenttotheClinicalAdvisoryPanel(CAP)TheClinicalAdvisoryPanel,orCAP,isapanelofprovidersspecializinginvarietyoffieldsincludingprimarycare,physicaltherapy,dental,familymedicine,psychiatrist,etc.Theirgoalsfocusonbuildingnetworksofcarethatpromoteimprovingcare,improvingexperienceofcare,andreducingcost.Theyhelpsetclinicalstandardswithinthecommunityanddeterminehowclinicalprioritiesareimplemented.

TheCAPhasbeeninvolvedinseveralprojectsaimedatbetteringcommunityhealth.Theyhaveadvocatedformentalhealthservices.Infact,asaresultoftheexpansionofbehavioralhealthconsultantsintoprimarycaresettings,morepeoplearegettingthementalhealthservicestheyneed.ThepanelwasalsosupportiveintheefforttoestablishthefirstschoolbasedhealthcenterintheregionatHoodRiverValleyHighSchool.Inshort,theCAPistryingtocreateabetterhealthandhealthcareenvironmentintheColumbiaGorgeRegion.

Table3-ParticipatinghealthorganizationsintheCAPAdvantageDentalColumbiaGorgeFamilyMedicineDeschutesRimHoodRiverCountyHealthDepartmentHoodRiverCountySchoolDistrictKidsDentalZoneLittleShreddersDentalMid-ColumbiaCenterforLiving

Mid-ColumbiaMedicalCenterNorthCentralPublicHealthDepartmentNorthwestPediatricsandAdolescentMedicineOneCommunityHealthOregonHealthandScienceUniversityOregonHealthAuthorityPacificSourceCommunitySolutionsProvidenceHoodRiverMemorialHospital

SocialServiceandGovernmentalAgencies AcknowledgmenttotheCommunityAdvisoryCouncil(CAC)TheCommunityAdvisoryCouncil,orCAC,iscomprisedofMedicaidconsumers,communitymembers,andlocalorganizations.Theirmissionistogivethecommunityavoicesothattheconsumerandcommunityhealthneedsareheard.Theyprovidefeedbackoncurrentservicesandprogramsandgivetheirinputonnewprogramideas.Theyalsohelpconnectorganizationswhichinturnimprovescommunityconnectedness.

TheCACalsoplaysalargeroleinoverseeingtheCommunityHealthAssessment.Aspartofthisrole,theCACplayedanintegralroleincreatingsurveyquestions.Theadditionalquestionstheydraftedhelpedtohighlightthecommunityneeds,suchastraumainformedcare.Additionally,manyCACagencieshelpedtodistributethehand-fieldedsurveysandenterthedata.

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TheCACisalsoresponsiblefortheCommunityHealthImprovementPlan(CHIP).ThroughtheCommunityHealthSurveydata,theyareabletocalloutareaofconcernsintheregion.Theygofurtherandsupportthecommunityinaddressingthesetopics.Byendorsingproposals,signinglettersofsupport,andcontinuouslyadvocatingforCHIPtopicstheyarethevoiceofcommunityinput.

Overall,theCommunityAdvisoryCouncilisanessentialvoiceofthecommunitytocreateabetterandhealthierregion.Table4-CommunityAdvisoryCouncil(CAC)members

• 211Info• AgingintheGorgeAlliance• ColumbiaGorgeHealthCouncil• HoodRiverCountySchoolDistrict• Mid-ColumbiaCouncilofGovernments

• Mid-ColumbiaHousingAuthority• OregonChildDevelopmentCoalition• GorgeGrown• HAVEN• HelpingHandsAgainstViolence• HoodRiverCountyPreventionDepartment

• OregonDepartmentofHumanServices

• OregonHealthAuthority• OregonStateExtensionProgram• PacificSource• RevellCoyInsurance• ShermanCountyCommissioner• TheNextDoor• UnitedWayoftheColumbiaGorge• YOUTHTHINK

• AdvantageDental • ColumbiaGorgeFamilyMedicine • KlickitatPublicHealth • KlickitatValleyHospital • Mid-ColumbiaCenterforLiving • Mid-ColumbiaMedicalCenter • NorthCentralPublicHealthDistrict • OregonHealthandScienceUniversity • GreaterOregonBehavioralHealthInc.

• OneCommunityHealth • ProvidenceHoodRiverMemorialHospital

• SkylineHospital

• Parentofchildwithdisabilities• Grandparentofchildwithdisabilities

• Adultwithdisabilities• Adultwithdualdiagnosis• Parentofchildwithbehavioralissues

• Low-income• Englishasasecondlanguage• Migrant/SeasonalFarmworkerliaison

Healthcare MemberPerspectives SocialServiceandGovernmentalAgencies

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HowtoReadtheResultsoftheAnalysisThefollowingdiagramwillhelpyoureadtheresultsthatwillbepresentedinthefollowingpages.These

pagesincludetheresultsofhandfieldedsurveys,mailbasedsurveys,andalternatedatasourcestosupplementthehealthassessmentdata.

1. Thetopicheadingreferstotheoveralltopicthatwillbeanalyzed.2. Thesubtopicsofeachmainsectionwithimportantdatapointsorsurveyquestions.

a. Eachquestionisbasedonanegativeview,suchasdidnotreceivecare,soinmostcaseslowernumbersarebetter.

3. TheRegioncolumnrepresentstheresultsofall7countiestogether.4. TheChangecolumncomparesdata,whereapplicable,fromthe2013communityhealthassessment

tothe2016communityhealthassessment.Thiscolumnfirstdisplaysanarrowfollowedbyagraph.

Ifthearrowisgreenandpointingdown ,thetopicimproved,whileared,pointingupwardsarrowindicatesthetopicworsenedfrom2013.Inthebargraph,thedarkbluerepresents2016andthelightbluerepresents2013.**Itshouldbenotedthatthe2016mailsurveydatawasweightedbasedonagebecausetheolderpopulationrespondedatamuchhigherrateandwasnotreflectiveofthegeneralpopulation.Therefore,weneedtotakenoticethatthecomparisonsarenotperfect.

5. Race/EthnicityView(red)showsresultsforNon-HispanicwhitesandHispanic/Latino/Others.TheothercategoryincludesAsian,Black,NativeHawaiianorPacificIslander,andAmericanIndianorAlaskaNative.

6. IncomeView(green)showsresultsforthoseunder200%FederalPovertyLevel(FPL)andthoseabove201%FederalPovertyLevel.

7. InsuranceView(purple)showstheresultsforthosewithPrivateinsurance,Medicare,Medicaid,andthosethatareuninsuredorhaveanothertypeofinsurance.

FederalPovertyLevelGuidelines

2013

200%FPL2016

200%FPL1personhousehold $22,980 $23,7604personhousehold $44,100 $48,600

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**Ifaboxhasadoublelinedborderandthenumberisinthemiddle,thisrepresentsthatthenumberissignificantlydifferentfromtheresultsoftheoverallregion**Ifdatahadlessthan25peopleanswerthequestiontheinformationwasomitted

Additionally,thisdocumentisbestreadincolor.Withinthenarratives,iftextisboldandblackitmeansthatthetopicisofnotableconcernforthewholeregion.Ifthetextisboldandcolored,thecolorindicatesthatthetopicisadisparityforaparticulargroup.Ifthecoloris….

1. Red-thedisparityiswithinaparticularraceorethnicity2. Green-thedisparityiswithintheincomepopulation3. Purple-thedisparityiswithinaparticularinsurancepopulation4. Blue-thisisimportantdatafromanothersurvey

*Alldataisfromthe2016CommunityHealthSurveyunlessotherwisenoted

BasicNeedsSocialDeterminantsofhealth,orbasicneeds,are“theconditionsintheplaceswherepeoplelive,learn,

work,andplay”(CDC)thatdirectlyimpactpeople’shealth.Examplesofthesebasicneedsinclude:

• Income• Food• Housing• Transportation• HealthInsurance

IntheColumbiaGorgeRegion,nearly1in4peoplearegoingwithoutabasicneed.Thosewithlowerincomesare7timesmorelikelytogowithoutabasicneedthansomeonewithahigherincome.Despitedisparitiesacrosspopulationcategories,allgroupssaidthatfoodandtransportationarethebiggestunmetneeds.Similarly,1in4peoplearegoingwithoutahealthcareneed.Thehealthcareneedpeoplearegoingwithoutthemost,inallpopulationcategories,isdentalhealthcare.Thisunmetneedisaffectingabout1outof3peopleintheuninsuredpopulation.Inshort,goingwithoutanyoneofthesenecessitiescangreatlyaffecthealth.

IncomeSecurityIncomesecuritymeanshavingtheamountofincomenecessarytocoverthebasicnecessitiesoflife.Following

thisdefinition,1outof3peopleareexperiencingsomekindoffinancialinstability.IncomeinsecurityaffectedtheHispanic/Latino/other,lowincome,Medicaid,anduninsuredpopulationsatamuchhigherratethanotherpopulations.

FoodSecurityandHealthyEatingIn2013foodsecuritywasidentifiedasaCommunityHealthImprovementPlan(CHIP)topic.Toaddressthis

issue,programssuchasVeggieRxwereinitiatedinthehopesofmakinghealthyfoodmoreaccessible.However,the2016CommunityHealthSurveyrevealedthatfoodsecurityisstillamajorissuefortheColumbiaGorgeRegion.AccordingtotheGorgeWideFoodSurvey,1in5peopleranoutoffoodand1in3wereworried

19

aboutrunningout2.ItalsoindicatedthatfoodsecuritywasamajorissueespeciallyforpeoplereceivingWIC,SNAP,andFreeandReducedLunchprograms.TheCommunityHealthSurveyshowedthatmorethan1in10peoplearegoingwithoutfood.However,thoseintheMedicaid,uninsured,orHispanic/Latino/Otherpopulationsgowithoutfoodatarateof1in4.Infact,thosewithlowerincomesarealmost10timesmorelikelytogowithoutfoodthanthosewithhigherincomes.Additionally,intheHealthyTeenSurvey,1in7teenssaidthattheyatelessthantheyshouldbecausetherewasn’tenoughmoneytobuyfood3.

Foodsecurity,however,doesnotstopwithhavingenoughfoodbutalsohavingaccesstohealthyfood.Inaregionwhereagricultureisalargeindustryonemaybelievethathealthyfoods,suchasfruitsandvegetables,

wouldbeeasilyaccessible.However,thisdoesnotseemtobethecase.AccordingtotheUnitedStatesDepartmentofAgriculture,weshouldbeeatingatleast5servingsoffruitsandvegetablesaday.Yet,4in10peopleareeatinglessthanhalfoftherecommendedamountandonlyaquarteraregettingtherecommendedaverage.Similarresultsappearedinthehealthyteensurvey.Halfoftheteensate2orlessservingsoffruitandvegetableswhileonlyaquartergottherecommendedamount3.Thiswasthecaseforallpopulationsregardlessofrace,

income,orinsurance.Ifarespondentdidnothavechildren,theyweremorethan2timesaslikelytoeatlessthantherecommendedamountthanthosewithchildren.

HousingSecurityHousingSecuritywasalsochosen

asaCHIPtopicin2013.Withhousingandrentpricesontheriseandlimitedlongtermhousingoptions,housingsecurityremainsalargesourceofdisparityintheColumbiaGorgeRegion.Approximately1outof10peoplehadtogowithouthousingin2016.Evenmore,aboutaquarterofthepopulationisworriedabouttheircurrenthousing

situation.Thisinsecurityfacedthelowerincome,Hispanic/Latino/Other,uninsured,andMedicaidpopulationsthemost.10%ofthepopulationispayingmorethan$1,500forhousingamonth.Ofthe10%

2Source:GorgeWideFoodSurvey3Source:OregonandWashingtonHealthyTeenSurvey

4in10eat2orlessservingsoffruitandveggiesaday

1outof4areworriedabouthousing

Onlyaquartereatrecommended

servings

20

paying$1,500,13%ofthemfallbelow200%FPL.Approximatelyhalfofthepopulationarecostburdened,whichmeanstheyspendmorethan30%oftheiryearlyincomeonhousing.

TransportationAccessAccesstotransportationwasthefinalCHIPtopicof2013inthesocialandeconomicconditionscategory.Itwas

thesecondmostcommonbasicneedpeoplehadtogowithoutbehindfood.DespiteeffortsmadetocombatthisproblemandduetolimitedpublictransportationintheGorge,transportationisstillasignificantproblem.Thedisparitywasmostnotableamongthoseofthelowerincomepopulation,whowere10timesmorelikelytogowithouttransportationthanthosewithhigherincomes.

AccordingtotheCoordinatedHumanServicesTransportationPlansurvey,mostpeopleneedtransportationfor:

• Medicalcare• Essentialshopping• Goingtowork

Lackoftransportationisafrequentbarriertogettingnecessaryhealthcareforbothadultsandyouth.Furthermore,inthelocaltransportationsurvey,socialserviceagencieswereaskediftransportationwasaninterferenceintheeffectivenessofservingtheirclients.Ofthecountiesthatparticipated,lackoftransportationwascitedasabarrieratthefollowingrates4

• Wasco:49%• HoodRiver:38%• Sherman:60%

Thus,lackoftransportationisnotonlyinhibitingpeoplefromthemedicalcaretheyneed,butalsosocialserviceprogramstheycouldgreatlybenefitfrom.

HealthInsuranceStatusSince2013andtheimplementationoftheAffordableCareActthe

numberofuninsuredintheregionhasbeencutinhalf.ThosethatremainuninsuredaremorelikelytobeapartofthelowerincomeandHispanic/Latino/Otherpopulations.AmajorityoftheuninsuredarealsofromOregon.ThemostcommonformofinsuranceisMedicarefollowedbyMedicaid.

4Source:CoordinatedHumanServicesTransportationPlanSurvey

34%

27%1%

30%

8%InsuranceType

Medicare Private Military

Medicaid Uninsured

0%1%2%3%4%5%6%7%

Physcial Dental Mental Prescriptions

BarrierstoHealthcareAccessNeededTransportation

21

*refertopage14forinstructionsonhowtoreaddatatables

Figure2-BasicNeeds/SocialDeterminants

22

AdultHealthStatusOverallHealthStatus-Adult

Aquarterofthepopulationratedtheirphysicalhealthasfairorpoor.ThisratingwasmoretypicalamongstthosewithonlyahighschooldiplomaorGEDandtheunemployed.

Additionally,theBMIforadultswascalculatedbasedontheheightandweighttheyprovided.Thisrevealedthatthe40to64yearoldcategorywasthemostlikelytobeoverweightorobese.Italsoshowedthatabout2outof3peopleintheregionare

overweightorobese,whichisaboutthesameasthenationalaverage.

ChronicMedicalConditions-AdultAchronicmedicalconditionisaconditionor

diseasethatlastsforlongerthanthreemonths.IntheGorgemorethanhalfoftheadultpopulationisaffectedbyatleastoneoftheseconditions.Themostcommonconditionishighbloodpressurefollowedbyhighcholesterol.Non-HispanicwhitesandMedicarerecipientsaremorelikelytohaveachronicdiseasethanotherpopulations.

MentalHealthConditions-AdultMentalhealthdiagnosesaremorewidespreadamongtheNon-Hispanicwhites,lowincome,andMedicaidpopulations.Morethan1in3haveamentalhealthcondition,themostcommonbeingdepression.Aquarterofthepopulationisexperiencingonephysicalconditionandonementalcondition.

0%10%20%30%40%50%

18-39years

40-64years

65-79years

80+years

OverweightandObesity

Overweight Obese

0% 10% 20% 30% 40%

HighBloodPressure

HighCholesterol

Asthma

Diabetes

ChronicMedicalCondtions

1outof4thinktheyhavefairorpoorhealth

37%haveatleastonementalhealthcondition

23

TraumaandResilience-AdultAtraumaticeventisany

eventthatcausesphysical,emotional,spiritual,orpsychologicalharm.Scientificevidencehasshownhowthesetraumaticevents,especiallythosethathappeninouryouth,canleadtolongtermhealthoutcomes.Peoplewhohaveexperiencedatraumaticeventaremorelikelytohaveachronicmedicalcondition,mentalhealthcondition,andanearlydeath.Withmoreemphasisbeingplacedontraumainformedcare,wethoughtitwasimportanttoseehowtraumaticeventshaveimpactedthosewithinourcommunity.Assuch,the2016surveyfeaturedanewsectioncenteredontraumaticevents.ManyofourquestionswerebasedontheAdverseChildhoodExperiences(ACEs)studyquestionsaswellasafewofourown.Whileafewofthesequestionswereaskedinthe2013CommunityHealthSurvey,theywerepresentedinadifferentwayin2016.Inthemostrecentsurveytherewasonequestionthataskedparticipantstowhatextenttheyhadexperiencedsomeeventintheirlifeasopposedtoseparatequestionsforeachhardship.Whengroupedthiswaytheresponsesweredrasticallydifferent.Forexample,in2013thequestion“Haveyoubeenforcedtodosomethingsexualthatyoudidn’twanttodo”hadaresponseratearound1%;whengroupedwithotherquestionstheresponsewas15.7%.

Theresultsofthisnewsectionshowedthatmorethan3outof4peoplehaveexperiencedatleastonetraumaticevent,while2outof5peoplehaveexperiencedthreeormoretraumaticeventsintheirlives.Ofthosethathaveexperiencedatraumaticevent,40%hadsomeonedosomethingharmfultothem.Thisincludesthecategoriesofneglectorabuseofanykind,physicallyhurtbyapartner,witnessedorexperiencedviolence,andforcedtodosomethingsexualtheydidn’twanttodo.Therewerenotsignificantdisparitieswithinanysubpopulationgroup.Themostcommon

traumaticeventsexperiencedwerelifechangingillnessorinjury,livedwithsomeonewithmentalillnessorsubstanceabuse,andtheunexpecteddeathofalovedone.

3outof4haveexperiencedatleastone

traumaticevent

2outof5peoplehaveexperienced3ormoretraumaticevents

24

Alcohol,Tobacco,andOtherDrugs-Adult AlcoholUse

1in5adultsdrink4ormoretimesaweek.ThiswasmoreusualforNon-Hispanicwhitesandthosewithhigherincomes.Onthedaysthatonedrank,1in5arehaving3ormoredrinks.Having3ormoredrinksadayismostcommonamongtheuninsured.

TobaccoUse1in5peopleusetobacco.Thisismorecommonamonglowerincome,Medicaid,anduninsuredpopulations.Useoftobaccowasalsohigherforthosethathadexperiencedatraumaticevent.

OtherDrugsUseSince2013marijuanaandotherdrugusehasincreased.Theuseofmarijuanaisconsistentthroughoutallpopulationgroups.However,otherdruguseismostprevalentinthelowerincome,Medicaid,anduninsuredpopulation.Nonprescribedopioidswerethemostuseddrugbesidesmarijuana.Thosethathaveexperiencedatraumaticeventusedmarijuanaandotherdrugsatamuchhigherratethanthegeneralpopulation.

25


Figure3-AdultHealthStatus

26

AdultHealthcareAccessPhysicalHealthcareAccess-AdultPhysicalhealthcareaccessimprovedin2016.

Incomparisonwith2013,peoplearenowmorelikelyto:

• Haveanormalsiteforhealthcare• Haveaprimaryhealthcaredoctor• Receiveallthecaretheyneed

Themostcommonplacestoreceivecareare:

• Doctor’soffice• Publichealthclinic

Themajorityofadultsreceivedcarein:

• HoodRiver^• TheDalles• Portland/Vancouver• WhiteSalmon

Whilethenumberofthosereceivingcaredidimprove,about1in5adultsarestillgoingwithoutnecessarycare.Thisunmetneedisgreateramongpeoplewithlowerincomes.Themostcommonbarrierstocarearecost,notbeingabletogetanappointmentquicklyenough,andnothavingaregularprovider.AccordingtoareportaboutMedicaidmembersinOregon,thenumberofprimarycarevisitshasbeenonadownwardtrendsince2013.

DentalHealthcareAccess-AdultDentalhealthcareaccessremainsthegreatest

unmethealthcareneedin2016.Aquarterofthepopulationisnotgettingnecessarydentalcare.Thisismainlyduetocostandnothavingaregularprovider.Thosethatfaceunmetneedthemostarelowincome,Medicaid,anduninsured.Infact,morethan1in3Medicaidrecipientshaveanunmetneed.Ofthosewithunmetneed,63%ofWashingtonMedicaidusersand52%ofOregonMedicaiduserssaiditwasduetocost.However,dentaliscoveredunderMedicaidandassuchthereshouldbenocost.

0%

5%

10%

15%

20%

25%

30%

BarrierstoPhysicalHealthcare

18%ofadultshaveunmethealthcareneeds

0%

10%

20%

30%

40%

BarrierstoDentalHealthcare

27

About1in3peoplealsosaidthattheydidnotneeddentalcare.AccordingtoanOHAsurvey,ofOregonMedicaiduserstheaveragenumberoftimesamemberseesadentistisaboutonceayear.However,preventativedentalhealthcaresuggestspeopleshouldbevisitingthedentisttwiceayear.Theseresultssuggestthateducationaboutgooddentalhealthcareandinsurancebenefitscouldplayabigroleindentalaccess.

MentalHealthcareAccess-AdultAccordingtothe2016survey,mentalhealthcareaccessgreatlyimprovedfrom2013.Lessthan1in10peoplearenotgettingalloftheirmentalhealthcareneedsmet.

Mostcommonplacestoreceivecareare:

• Primaryhealthcareprovider• Countymentalhealthclinic

LowincomeandMedicaidpopulationsfacedthisaccessdisparitythemost.Mostunmetneedsarearesultofcost,notknowingwheretogo,andnothavingaregularprovider.

DatafromOregonHealthAuthority(OHA)sourcesonWasco,HoodRiver,andShermancountiesshowsthat39%ofadultsinthethreecountiesareestimatedtohaveamentalhealthcondition.Only11%ofthosewithamentalhealthconditionarereceivingtreatmentwhile28%arenotgettingthenecessarycare.5However,accordingtotheCommunityHealthSurveyonly18%ofadultsreportedhavingmentalhealthcondition.About11%arereceivingallthecaretheyneedwhile7%haveunmetneeds.

5Source:OregonHealthAuthorityBehavioralHealthProfiles

26%ofadultshaveunmetdentalneeds

61%

11%

28%39%

OHAMentalHealthWasco-HoodRiver-Sherman(estimates)

NoMHcondition Receivedcare Unmetneed

82%

11%

7%

18%

2016SurveyMentalHealthWasco-HoodRiver-Sherman(responses)


0%5%

10%15%20%25%30%35%

BarrierstoMentalHealthcare

28

Figure4-AdultUtilization-PacficSourceMedicaidUtilizationRatesSubstanceUseTreatment-AdultAccordingtothe2016surveyresponses,lessthan100peopleneededsubstanceusetreatmentintheGorge.Ofthosethatdidneedsubstanceusetreatment,2outof3peoplereceivedlocalservices,asmall

percentageusedoutofareaservices,andtherestarenotgettingtheneededservices.Theuninsuredhavemoretroublegettingtheneededservicesthanotherpopulationgroups.

DatafromOHAsourcesonWasco,HoodRiver,andShermancountiesshowsthat9.1%ofadults,or815adults,inthethreecountiesareestimatedtohaveasubstanceuseissue.Havingasubstanceuseproblemwasmorepronouncedinthe18-25category.Inthisagerangeabout20%wasestimatedtohaveasubstanceuseproblem.6%ofthoseonMedicaidintheseregionsarereceivingsomesortofsubstanceusetreatment.6

6Source:OregonHealthAuthorityBehavioralHealthProfiles

00.51

1.52

2.53

3.54

4.5

2013 2014 2015 2016

HoodRiver^&TheDalles18-64Utilization

primarycarevisits behavioralhealthvisits

dentalvisits

00.51

1.52

2.53

3.54

4.5

2013 2014 2015 2016

Rural18-64Utilization


dentalvisits

0

1

2

3

4

5

2013 2014 2015 2016

HoodRiver^&theDalles65+Utilization


dentalvisits

0

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5

2013 2014 2015 2016

Rural65+Utilization


dentalvisits

29

Medications-AdultAmajorityoftheadultpopulationneededsomekindofprescriptionmedicationinthelast12months.However,1in10arenotgettingalltheprescriptionsthattheyneed.Thisproblemismorepronouncedinthelowincome,Medicaid,anduninsuredpopulations.Costisthelargestbarriertogettingalltheprescriptionsneeded.

Specialists-AdultSpecialistsareproviderswhofocusinoneareaofhealthcare.HereintheGorge,morethanhalfofadultsneededcarefromsometypeofspecialist.

Themostneededtreatment:

• Skinconditions(acne,moles,skincancers,etc)

• Orthopedics

Thetreatmentwithmostunmetneed(intermsofnumbersnotpercent):

• Neurology• SkinConditions• Orthopedics

Thosethatdidreceivetheneededservicesweretypicallyabletouselocalservices.Orthopedicshadthelargestnumberofpeopleusingnonlocalservices.

2013CHIPTopics-AdultDentalAccessDentalaccessstillremainsthegreatestunmethealthcareneed.Although,someimprovementhasbeenmadesince2013.

PhysicalandMentalHealthTogetherNearlyhalfofadultsthatneededmentalhealthusedtheirprimarycareofficetoreceivecare.Ofthosethatwenttotheirprimarycareoffice,morethanhalfgotallthecaretheyneeded.Thiswasalsothecaseiftheywentelsewheretoreceivetheirmentalhealthcare.

60%ofadultsneededspecialistcare

0%

5%

10%

15%

20%

25%

0%

20%

40%

60%

80%

100%

Needofspecialistcareandhowitisbeingmet

Usedlocalservices Usedoutofareaservices

Hadunmetneeds NeededCare

2061397915387235189

**Numberontopisnumberofpeoplethatneededservices

need

edcare

Howneedsweremet

30


Figure5-AdultHealthcareAccess

31

YouthHealthStatusThedataonouryouthcomesfromavarietyofsurveys.AportionofthedatacomesfromtheOregonHealthyTeensurveyandtheWashingtonHealthyTeensurvey.Wealsohaveparentresponsesabouttheirchildrenfromthecommunityhealthassessment.Thisprovidedaninterestingcomparisonintohowthekidsfelttheirneedswerebeingmetversushowparentsviewedtheirchildren’sneedsbeingmet.

OverallHealthStatus-YouthWhenaskedtoratetheirownphysicalhealth,themajorityoftheteensthoughttheywereingood,verygood,

orexcellentphysicalhealth.Oftheteensparticipatingnearly1in5areoverweightandslightlymorethan1in10youthareobese.7

ChronicMedicalConditions-YouthAbout14%ofyouthswerediagnosedwithachronicmedicalcondition.Thiswasmorenotableamongthe

Non-Hispanicwhitesandhigherincomepopulations.Themostcommonchronicmedicalconditionisasthma.

MentalHealthConditions-YouthNearly1in5teensrespondedthattheythoughtthattheirmentalhealthwasfairorpoor.Aquarteroftheyouthpopulationhasbeendiagnosedwithamentalhealthcondition.ThiswasmorecommonamongtheNon-HispanicwhitesandMedicaidpopulations.Themostcommonmentalhealthconditionisanxiety.

TraumaandResilience-YouthIntheOregonHealthyTeenSurveytherewereseveralquestionsaboutunwantedsexualencountersandviolence.Thesequestionswereonlygiventothe11thgraders.Ofthe11thgraders,morethan1in5hadbeenintentionallyhitorhurtbyanadult.Also7%hadbeenforcedtodosomethingsexualthattheydidnotwanttodo.

Bullyingisalsoatraumaticeventthatmanyyouthfaceduringtheirteenyears.21%ofteensarebeingbulliedbysomeoneusingaformoftechnology.

Themainreasonsteensarebeingbullied:

• Physicalappearances• Friendgroup• Receivingunwantedsexualcomments

Also,about10%ofteensarenotgoingtoschoolbecausetheyfeltasthoughtheywouldbeunsafeatschoolorontheirwaytoorfromschool.Finally,1in10studentshavebeeninoneormorefightsatschool.7

7Source:OregonandWashingtonHealthyTeenSurvey

18%thinktheyhavefairorpoormentalhealth

32

Alcohol,Tobacco,andOtherDrugs-Youth8 AlcoholUse

1in5teenshadatleastonedrinkofalcoholinthepastthirtydays.Themostcommonbeveragewhentheydodrinkisliquor.Mostofthosethatdrankwere11thgraders.Finally,themajorityof11thgraderssaidthatobtainingalcoholwouldberelativelyeasy,whilemorethanhalfof8thgradersthoughtitwouldbedifficult.

TobaccoUseAlmost1in5teenshaveusedtobaccointhepastthirtydays.Mosthadneverfinishedawholecigarette,justtookoneormorepuffs.Moreover,abouthalfoftheteensagreethatcigarettecompaniesdeliberatelyadvertiseandpromotecigarettestoyouthunder18.

MarijuanaUse15%haveusedmarijuanainthepastthirtydays.29%ofthe11thgradershadmarijuanainthepast30dayswhichwasadrasticincreasefrom2013whenonly19%hadusedmarijuana.However,theuseofmarijuanaforthe8thgradersdecreased.In2015,5%hadusedmarijuanacomparedto9%in2013.Themostcommonwaypeoplegotmarijuanawasthroughfriends.

OtherDrugsUse1in20teensareusingprescriptiondrugswithoutadoctor’sorder.


33


Figure6-YouthHealthStatus

34

YouthHealthcareAccess9PhysicalHealthcareAccess-YouthPhysicalhealthcareaccessremainsthesameas2013.Accordingtoparent

responsesabout1in10childrenarenotgettingallthecaretheyneed.Thiswastrueforallpopulationgroups.Thereasonfortheunmetneedwasmostlyduetocostandnotbeingabletogetanappointmentquicklyenough.However,whentheyouthanswerthisquestionnearly1in5teensfelttheywerenotgettingthenecessarycare.

DentalHealthcareAccess-YouthDentalhealthcareaccessremainsthelargestunmetneedamongchildren.However,accessdid

improveslightlyfrom2013.Accesswasmoredifficultforthoseamongthelowerincomeanduninsuredpopulations.Costisthebiggestbarriertoreceivingdentalcare.TheHealthyTeenSurveyalsoaskedwhenwasthelasttimetheteenhadseenadentist.1in5youthhadnotbeentothedentistinthepastyear.Again,preventativedentalhealthsuggeststhatwevisitthedentisttwiceayear.Educationisparticularlyimportantindentalhealthcareaccess.

MentalHealthcareAccess-YouthAccesstomentalhealthcareforyouthgreatlyimprovedin2016.Lessthan10%ofchildrenhad

anunmetneedaccordingtotheparents.However,theteenresponsetounmetcarewasnearlytwicetheparentresponseat15%.Themainbarriertoaccessingmentalhealthcarewascost.


1in10parentsfeltasthoughtheirchildhadunmethealthcareneeds

2in10youthfeelasthoughtheyhaveunmethealthcareneeds

1in5youthhavenotbeentodentistinpastyear

84%

9%

7%

16%

2016SurveyMentalHealthYouthWasco-HoodRiver-Sherman(responses)


72%

10%

18%

28%

OHAMentalHealthYouthWasco-HoodRiver-Sherman(estimates)


35

DatafromOHAonWasco,HoodRiver,andShermancountiesillustratedthatabout28%ofyouthinthethreecountiesareestimatedtohaveamentalhealthcondition.However,only1in10childrenarereceivingtreatment.Accordingtothe2016survey16%ofyouthhavebeendiagnosedwithamentalhealthcondition.Morethanhalfaregettingallthecaretheyneed.10

SubstanceAbuseTreatment-YouthAccordingtodatafromOHAsourcesonWasco,HoodRiver,andShermancounties,about7%ofyouthinthe

threecountiesareestimatedtohaveasubstanceuseissue.However,only1%ofyoutharereceivingtreatment.10

Figure7-YouthUtilization-PacficSourceMedicaidUtilizationRates2013CHIPTopics-Youth PhysicalandMentalHealthTogether

Morethanaquarterofchildrenthathadamentalhealthneedusedtheirprimarycaretoreceivecare.Ofthosethatwenttotheirprimarycareofficeforcare,morethan80%gotallthecaretheyneeded.

MentalHealthAccessforChildren MentalHealthAccessimprovedforchildrensince2013.

SupportingDevelopmentalandHealthyGrowthintheEarlyYears 251householdsfromthosethatparticipatedinthe2016surveyhadchildrenages0-5.Ofthosehouseholds,morethanhalfarebelow200%FPLandabout44%areonMedicaid.Additionally,about1in3ofthesehouseholdsaregoingwithoutabasicneedorhealthcareneed.Finally,theratesofadultssmokingtobaccoandmarijuanaarehigherinthispopulationthaninthegeneralpopulation.


0

1

2

3

2013 2014 2015 2016

HoodRiver^&TheDalles0-17Utlization


dentalvisits

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2013 2014 2015 2016

Rural0-17Utlization


dentalvisits

36


2013CHIPTopicSocialServiceAgenciesandHealthcareProvidersinthecommunitywereasked10questionsregardingtheirreferralprocesstootherorganizationsincludingPrimaryCare,MentalHealth,Dental,PublicHealth,Transportation,Housing,FoodandotherSocialServices.Thequestionssurveyedtheorganizationsonthefrequencyofreferrals,howreferralsaremade,thedegreeofcarecoordinationforsharedclientsandinformationshared.Inaddition,surveyparticipantsindicatedbarrierstheyfacewhenreferringclients.Thesequestionswereinresponsetothe2013CHIPtopicsofCoordinationAcrossallHealthcareProvidersandCoordinationAcrossHealthcareandSocialServices.

CoordinationAcrossallHealthcareProviders Coordinationbetweenprimarycareandmentalhealthprovidersiscommonandthecommunicationandcoordinationbetweentheseprovidersgenerallyworkswell.However,primarycareandmentaldentalgeneratefarfewerreferralstodentalandcommunicationisnotaseffectiveasthecommunicationbetweenprimarycareandmentalhealth.

CoordinationAcrossHealthcareandSocialServices Coordinationacrosshealthcareandsocialservicesisinitiatedoftenandworkswell.Coordinationwithprimarycarehappensthemostfrequentlyandisthemosteffectivefollowedbymentalhealth.However,thereferralloopisnotalwaysclosedandthisvariesbasedontheorganizationtheyarereferringto.ThemostfrequentsocialservicereferralisTransportationfollowedbyfood.

AssetsandBarriersintheReferralprocess Localproviderssaidthathavingsocialworkers,casemanagers,orcommunityhealthworkershelpscoordinatingcare.Theysaidthatthebiggestbarrierstocoordinatingcarewasnothavingreleaseofinformationfromtheclient,lackofconnectivitytoreferringorganizations,andlackoflocalservicesfortheirclients.

Figure8-YouthHealthcareAccess

37

CommunityandSocialEnvironmentSocialconnectednessreferstorelationshipswehavewithothers.Theserelationshipswithfriendsandfamily,aswellasourcommunitycaninfluenceourhealthinbothpositiveandnegativeways.Assuch,socialconnectednesshasproventobeamajorpredictorofgoodhealth.Accordingtomanystudies,goodrelationshipswiththoseinourcommunitycanorareassociatedwith:

• Lowerriskofchronicmedicalconditions• Healthierhabits• Promotepositivementalhealth• Betterrecoveryafteramajorillness

Therefore,ourfeelingsaboutoursocialsupportorsocialcohesioncouldbeagoodexplanationofouroverallhealth.

SocialSupportSocialsupportmeansfeelingasthoughyouhavesomeoneinyourlifetosupportyouinavarietyofways.Thefeelingsofsocialsupportimprovedfrom2013.Thebiggestdisparitiesinthistopicarewiththelow

incomepopulation.Themainareaswherepeopledonotfeelthattheyhadsupportwasiftheywereconfinedtoabedandnothavingsomeonetogettogetherwithforrelaxation.

SocialCohesionSocialcohesionreferstohowpeopleperceivethecommunityandpeopleinthecommunityinwhichtheylive.Ingeneral,peopleintheGorgefeelpositiveaboutthecommunitytheylivein.Hispanic/Latino/Other,lowincome,Medicaid,anduninsuredpopulationsaremorelikelytohavehesitationsabouttheircommunity.Forexample,intheoverallpopulation1in10peopledidnotfeelsafeintheircommunity.Butthoseoflowerincomeswereabout5timesmorelikelytofeelunsafethanthoseofhigherincomes.

SupportforcaregiversWithanagingpopulation,theroleofcaregiverhasbecomemorecommoninoursociety.IntheColumbiaGorge1in5peoplearecurrentlyprovidinghelptoarelativeorlovedone.However,morethanhalfofthesecaregiversdonotfeelasthoughtheyhaveadequatesupportfortheircaregivingrole.Thiswassimilaracrossallpopulationgroups.

22%ofadultsareactingasacaregiver 60%ofcaregiversdon'tfeelthey

haveadequatesupport

38


Conclusion Overall,the2016communityhealthassessmentillustratedthattheregionhasthesameneeds,despitecountylines.Thus,itagainshowedtheimportanceofworkingtogethertoaddressareasofconcernintheregion.Italsoshowedusseveralissuesaboutthecurrenthealthandhealthcaresystemoftheregion.

1. Foodandhousingsecurityarestillhighconcernareas.2. Thenumberofinsuredgrew.Despitemorecoverage,thenumberofthosereceivingcaregotslightly

better.3. Whilethosereceivingdentalcaredidimproveitisstillthelargestunmetneedintheregion.4. Transportationcontinuestobeabarrierandthusutilizationoftransportationservicesislower.5. Parentsunderestimatetheneedsthattheirchildrenface.6. Householdswithchildren0-5aremorelikelytogowithoutbasicneedsthanthosewithoutchildren

0-5.7. Aswecanseethroughthesurveyresults,traumaisarealpartofourcommunityandweneedto

acknowledgeit.

Figure9-CommunityandSocialEnvironment

39

Appendix ListofFiguresandTables

Table1-OverallDemographics...................................................................................................................................11Table2-SurveyParticipantDemographics.................................................................................................................11Table3-ParticipatinghealthorganizationsintheCAP...............................................................................................15Table4-CommunityAdvisoryCouncil(CAC)members..............................................................................................16Figure1-MapofColumbiaGorgeRegion...................................................................................................................10Figure2-BasicNeeds/SocialDeterminants................................................................................................................21Figure3-AdultHealthStatus......................................................................................................................................25Figure4-AdultUtilization-OregonHealthAuthorityBehavioralHealthProfiles.......................................................28Figure5-AdultHealthcareAccess..............................................................................................................................30Figure6-YouthHealthStatus.....................................................................................................................................33Figure7-YouthUtilization-OregonHealthAuthorityBehavioralHealthProfiles......................................................35Figure8-YouthHealthcareAccess..............................................................................................................................36Figure9-CommunityandSocialEnvironment.............................................................................................................38

40

MSFW-MigrantandSeasonalFarmWorker Aseasonalfarmworkerissomeonewhohasdonefarmworktoearnatleasthalfoftheirincome,howevertheyarenotemployedinfarmworkyearroundorbythesameemployer.Amigrantseasonalfarmworkerisaseasonalfarmworkerwhohastotraveltoworkandcanthereforecannotreturntotheirpermanentplaceofresidence.

MigrantandSeasonalFarmWorkersareanimportantpopulationintheColumbiaGorgeRegion.Theymakeupabout7%ofthepopulation.Ofthose,about2/3areunder200%FPLandareHispanic.ThemajorityareonMedicaid.

TheMSFWpopulationwasmorelikelytogowithoutabasicneedorhealthcareneedthantheoverallpopulation,howevertheirratesofgoingwithouttheseitemsweresimilartothelowincomepopulation.Theywerealsomorelikelytohavetogowithoutfoodandhousing.Finally,abouthalfofthispopulationhadsometypeoffinancialinsecurity.

Morefarmworkersratedtheirhealthasfairorpoorthantheregion.However,theirratesofchronicdiseaseandmentalhealthconditionsweremuchlowerthanthegeneralpopulation.Alsotheirtroubleaccessingcarerivaledthatofthegeneralpopulation.Therewasnonotabledisparityingettingallthecaretheyneededforbothchildrenandadults.

Finally,theirfeelingsaboutsocialsupportandsocialcohesionweresimilartothegeneralpopulation.Infact,theyfeltaslightlybetterabouttheircommunitythanthegeneralpopulation.

**percentdon’talwaysaddupto100duetonoresponsesanswers

Number Percent

93 6.8%

200%andbelow 61 65.6%

201%andabove 13 14.0%

Hispanic/Latino/Other 64 68.8%

NonHispanicwhites 27 29.0%

Uninsured 18 19.4%

Medicaid/Dual 40 43.0%

Medicare 9 9.7%

Private 16 17.2%

18-39years 50 53.8%

40-64years 30 32.3%

65-80years 7 7.5%

80+years 1 1.1%

Worriedabouthousing 19 20.4%

Payslessthan750 40 43.0%

Pays750-1500 24 25.8%

Paysmorethan1500 7 7.5%

Wentwithoutabasicneed 35 37.6%

Wentwithouthealthcare 34 36.6%

Wentwithoutfood 21 22.6%

Wentwithouttransportation 14 15.1%

Wentwithouthousing 16 17.2%

Anyfinancialinsecurity 50 53.8%

Generalhealth-fairorpoor 27 30.1%

Overweight 26 28.0%

Obese 26 28.0%

ChronicDisease 23 24.7%

MentalHealthCondition 22 23.7%

MentalandPhysical 10 10.8%

TraumaticEvent 58 62.4%

3ormoretraumaticevents 26 28.0%

Doesn'thaveusualplaceof

care 10 10.8%

UnmetPhysicalNeed 15 16.1%

UnmetDentalNeed 23 24.7%

UnmetMentalNeed 4 4.3%

UnmetPrescriptionNeed 11 11.8%

NeededSpecialistcare 29 31.2%

UnmetPhyscialNeed 4 7.7%



Peopleinmycommunity

arewillingtohelp 13 14.0%

Peopleinmycommunity

canbetrusted 17 18.3%Ifeelsafeinmy

community 13 14.0%

Caregiversfeellikethey

haveadequatesupport

12

(21arecg) 57.1%

Hassomeonetolovethem

andmakethemfeel 19 20.4%

Hassomeonetoconfidein 25 26.9%

*cg=caregiver

Socialand

Community

Environment

(%disagree)

MigrantandSeasonalFarmWorkers

Youth

Healthcare

Access (n=52)

HealthStatus

Healthcare

Access

BasicNeeds

Age

TotalPopulation

FPL

Race/Ethnicity

Insurance

41

CaregiversCaregiversareunpaidpeoplewhohelpotherswiththeirdailylifeactivities.Duetotheincreasingageofthepopulation,caregivinghasbecomeamorecommonroleinoursociety.IntheColumbiaGorgeRegion1in5adultsactasacaregiverforalovedone.

Ofthecaregivers,2outof5arelowincomeandthemajorityareNon-Hispanicwhites.About1in3caregiversareonprivateinsurance.Themostcommonageofthispopulationisthe40-64yearoldcategory.

Thispopulationofcaregiverswasmorelikelytogowithoutahealthcareneedthanthegeneralpopulation.Theywerealsomorelikelythanthegeneralpopulationtoexperiencefinancialinsecurity.However,theyexperiencethesehardshipslessthanthevulnerablepopulations,Hispanic/Latino/Other,lowincome,uninsured,andMedicaid

Caregiversalsoweremorefrequentlydiagnosedwithamentalhealthconditionandweremorelikelytosufferfromonementalhealthconditionandonephysicalhealthcondition.Theywerealsomorelikelytohaveexperiencedatraumaticeventintheirlife.Alsotheirtroubleaccessingcarerivaledthatofthegeneralpopulation.Therewasnonotabledisparityingettingallthecaretheyneededforbothchildrenandadults.

Finally,theirfeelingsaboutsocialsupportandsocialcohesionweresimilartothegeneralpopulation.

**percentdon’talwaysaddupto100duetonoresponsesanswers

Number Percent

268 19.6%

200%andbelow 104 38.8%

201%andabove 93 34.7%



Uninsured 25 9.3%


Medicare 71 26.5%

Private 81 30.2%

18-39years 59 22.0%

40-64years 131 48.9%

65-80years 57 21.3%

80+years 14 5.2%



Pays750-1500 81 30.2%







Anyfinancialinsecurity 111 41.4%


Overweight 78 29.1%

Obese 93 34.7%






Doesn'thaveusualplace

ofcare 18 6.7%









Peopleinmycommunity


Peopleinmycommunity

canbetrusted 64 23.9%Ifeelsafeinmy

community 27 10.1%


haveadequatesupport

153

(268arecg) 57.1%


andmakethemfeel 54 20.1%


*cg=caregiver

BasicNeeds

HealthStatus

HealthcareAccess

YouthHealthcare

Access (n=75)

SocialandCommunityEnvironment(%disagree)

Age

Caregivers

TotalPopulation

FPL

Race/Ethnicity

Insurance

42

CountySlices

Number Percent110 8.0%

200%andbelow 33 30.0%

201%andabove 31 28.2%



Uninsured 5 4.5%


Medicare 29 26.4%

Private 28 25.5%

18-39years 21 19.1%

40-64years 52 47.3%

65-80years 24 21.8%

80+years 9 8.2%



Pays750-1500 25 22.7%








Overweight 36 32.7%

Obese 37 33.6%






Has3ormoredrinksaday 20 18.2%

TobaccoUse 10 9.1%

MarijuanaUse 9 8.2%

Otherdruguse 8 7.3%


care 4 3.6%












Peopleinmycommunity


Peopleinmycommunity

canbetrusted 18 16.4%

Ifeelsafeinmycommunity 10 9.1%


haveadequatesupport

18

(29arecg) 62.1%


andmakethemfeelwanted 24 21.8%


Age

SkamaniaCounty

TotalPopulation

FPL

Race/Ethnicity

Insurance

*cg=caregivers

BasicNeeds

HealthStatus

HealthcareAccess

YouthHealthStatus(n=27)

YouthHealthcare

Access(n=27)



200%andbelow 94 27.6%

201%andabove 152 44.7%



Uninsured 17 5.0%


Medicare 104 30.6%

Private 126 37.1%

18-39years 81 23.8%

40-64years 134 39.4%

65-80years 97 28.5%

80+years 20 5.9%



Pays750-1500 95 27.9%








Overweight 95 27.9%

Obese 120 35.3%







TobaccoUse 63 18.5%

MarijuanaUse 51 15.0%

Otherdruguse 24 7.1%


care 19 5.6%












Peopleinmycommunity


Peopleinmycommunity

canbetrusted 83 24.4%



haveadequatesupport

40

(70arecg) 57.1%




Age

KlickitatCounty

TotalPopulation

FPL

Race/Ethnicity

Insurance

*cg=caregiver

BasicNeeds

HealthStatus

HealthcareAccess


YouthHealthcare

Access(n=75)


43

Number Percent

392 28.7%

200%andbelow 145 37.0%

201%andabove 131 33.4%



Uninsured 30 7.7%


Medicare 96 24.5%

Private 118 30.1%

18-39years 93 23.7%

40-64years 164 41.8%

65-80years 86 21.9%

80+years 32 8.2%



Pays750-1500 116 29.6%








Overweight 110 28.1%

Obese 126 32.1%







TobaccoUse 97 24.7%




care 39 9.9%












Peopleinmycommunityare

willingtohelp 55 14.0%

Peopleinmycommunitycan

betrusted 89 22.7%


Caregiversfeelliketheyhave

adequatesupport

37

(72arecg) 51.4%




Age

WascoCounty

TotalPopulation

FPL

Race/Ethnicity

Insurance

*cg=caregivers

BasicNeeds

HealthStatus

HealthcareAccess

YouthHealthcare

Access(n=105)




200%andbelow 151 37.9%

201%andabove 130 32.7%



Uninsured 40 10.1%


Medicare 82 20.6%

Private 136 34.2%

18-39years 138 34.7%

40-64years 145 36.4%

65-80years 65 16.3%

80+years 31 7.8%



Pays750-1500 112 28.1%








Overweight 114 28.6%

Obese 98 24.6%







TobaccoUse 48 12.1%



Doesn'thaveusualplaceofcare 24 6.0%












Peopleinmycommunityare

willingtohelp 38 9.5%

Peopleinmycommunitycanbe

trusted 65 16.3%


Caregiversfeelliketheyhave

adequatesupport

49

(83arecg) 59.0%

Hassomeonetolovethemand

makethemfeelwanted 64 16.1%


Age

HoodRiverCounty

TotalPopulation

FPL

Race/Ethnicity

Insurance

*cg=caregivers

BasicNeeds

HealthStatus

HealthcareAccess


YouthHealthcare

Access(n=152)


44

EmergencyRoomUtilizationTheERdatawasprovidedbyCollectiveMedicalTechnologies.Itisrepresentativeofresidentsofallzip

codesfoundinthe7countiesacrossallhospitals.ThereasonsforvisitingtheERwasbasedondxcodes.ThehospitalsthatwerevisitedthemostwereMid-ColumbiaMedicalCenter,ProvidenceHoodRiverMemorialHospital,KlickitatValleyHealthandSkylineHospitalintherespectiveorder.MostvisitswerepayedthroughMedicare,MedicaidOregon,PacificSourcePlus,andAARP.Thedataisbrokenintofourdifferentagecategoriessothatwecanseewhatmedicalneedsaffectseachagecategorythemost.

45

LeadingCausesofDeath Thistableshowsthenumberofdeathsineachcountyin2015duetothereasonlisted.Thenumbersarebasedonarateof100,000.ThedatawasprovidedthroughWashingtonandOregonstatewebsites.

46

CommunityHealthSurvey

47

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49

50

51

52

MOUfromCohort

53

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Documents

Columbia Gorge Community Health Assessment Full Document ...kvhealth.nextmp.net/images/CGRCHA-2016.pdf · In 2013, the Columbia Gorge Region came together to create an integrated