St. Joseph County

Community Health

Needs Assessment

2016

Why a Community Health Assessment?

What We Know….

• Michigan Accreditation Program for Local Public Health requires evidence that a community health assessment has occurred.

• New IRS rules effective on tax years beginning after March 23, 2012, requires each 501(c) (3) hospital facility to conduct a community health needs assessment at least once every three taxable years.

• Community Health Center Grant (FQHC) requires a community health assessment. …. [it] looks outside of the performance

of an individual organization serving

a specific segment of a community

to the way in which the activities

of many organizations contribute

to community health improvement .

Why a Community Health Assessment?

What We Did….• Surveyed St. Joseph residents to

identify their most pressing health needs:

• 478 people responded.

• 43 local experts assisted.

• Five issues were identified:

• Obesity/Physical Inactivity

• Mental Health/Suicide

• Physician Services

• Education/Prevention

• Diabetes

…. [it] looks outside of the performance

of an individual organization serving

a specific segment of a community

to the way in which the activities

of many organizations contribute

to community health improvement .

What We Know….Obesity/Physical Inactivity….

Healthy WeightWhat We Know…Obesity/Physical Inactivity• Obesity/Physical Inactivity was ranked as the #1 health

issue among public health experts and #2 issue by the community (48% of respondents).

• St. Joseph ranked 64th among 83 counties for adult obesity.

• 34% of St. Joseph County adults are obese and an additional 37% adults are overweight.

• Between 2001 and 2009, percentages of obesity have grown for both St. Joseph County men and women.

• Percentages have grown by 4.7 points for St. Joseph County men

• Percentages have grown by 11.4 points for St. Joseph County women

• St. Joseph ranked 77th among 83 Counties for Adults who reported no leisure time activity (29%)

• In addition to its serious health consequences, (i.e., high blood pressure, diabetes, coronary heart disease, stroke, gallbladder disease, high cholesterol, and some cancers) obesity has real economic costs. The estimated annual health care costs of obesity-related illness are a staggering $190.2 billion or nearly 21% of annual medical spending in the United States

Only 1 out of 4 St. Joseph County Adults

maintains a Healthy Weight

What We Know…Obesity/Physical Inactivity• 20.4% of St. Joseph County High School Students are

obese and 14.1% are overweight.

• 11th graders were more likely to be obese than 9th

graders.

• Males were more likely to be obese then females.

• African Americans and Hispanics were more likely to be obese than Whites.

• 60% of female students were trying to lose weight even though only 33.3% were overweight/obese.

• More than 1 in 5 (22.5%) watched 3 or more hours of TV on an average school day.

• More than 1 in 3 (34.7%) played video games or used a computer for something that is not school work 3 or more hours per day on an average school day.

• Overweight adolescents have a 70% chance of becoming overweight adults.

Childhood Obesity

Worksite WellnessWhat’s Been Done…Sturgis

• Co-sponsor “biggest loser” contests open to community as well annual internal “biggest loser” contest

• “Create your Weight” weight-loss program run by registered dietician that is open and advertised to the community and subsidized by the Hospital; scholarships also available to help cover costs

Three Rivers

• Sponsor of annual Color Run

• Sponsor of Correy Lake triathlon

• HealthTRAC Fitness Center serves community

Collaborations/Shared Initiatives

• Occupational Wellness programs in business

• Step Up St. Joseph County

• Evidenced-based education through School-linked clinics

Worksite wellness programs that include nutrition and physical activity components have claimed to improve morale, improve productivity, increase energy and decrease

sick time among employees. Programs often aim to assist employees with smoking

cessation, maintaining a healthy weight and preventative screenings for

cholesterol, blood pressure, cancer and other conditions.

Worksite WellnessWhat’s Being Done…Sturgis

• Partnering with Senior Enrichment Center for free health assessments, lunch ‘n’ learns with registered dietician

• Hispanic obesity programs and seeking grant funding

Three Rivers

• Start senior annual wellness visits at primary care clinic (Accountable Care Organization)

• Walking trail connecting parks for exercise opportunities (non-motorized trail)

Collaborations/Shared Initiatives

• Collaboration with Step Up St. Joseph promoting local resources and opportunities for physical activity reaching the community through Facebook with healthcare challenges, website with listing of local events, and monthly radio and newspaper topics (includes representatives from local gyms, chamber of commerce, parks and recreation, etc.)

• Ongoing monitoring of efforts and indicators

Step Up to a Healthier You!

1 Mile = 2,000 steps and 100 calories burned

1 Pound = 3,500 calories

1 Pound weight loss per week = 500 calorie deficit per day

To lose 1 pound per week you need to add 10,000 steps to your day.

What We Know….Mental Health/Suicide….

2. Diagnose & investigate

health problems & health

hazards.

St. Joseph High School Students

Prevent and control epidemics and

contain diseases/injuries. Examples

include:

• Investigate foodborne outbreaks

• Communicate serious health threats

to community in timely manner

• Develop emergency response plans

for public health emergencies

• Respond to public health

emergencies including disease

outbreaks or terrorism

• Ensure access to laboratory with

capacity for sampling

- Adults

35.4%Felt sad or

hopeless for 2 ore more

weeks in a row

11.6%attempted

suicide 26.4%Bullied on

school property in

last year

8.2% Threated or

injured with

weapon on school prop.

11.4% receive

Special Ed. Svcs.

Mental disorders are common….

Approximately 1 in 4 of adults are diagnosed

for one or more disorders.

About 1 in 17 suffer from a seriously

debilitating mental illness.

12.9% Pressured

into unwanted

sex by person they were dating

Mental Health / Suicide

2. Diagnose & investigate

health problems & health

hazards.

Mental Health / SuicideCommunity Concerns

Prevent and control epidemics and

contain diseases/injuries. Examples

include:

• Investigate foodborne outbreaks

• Communicate serious health threats

to community in timely manner

• Develop emergency response plans

for public health emergencies

• Respond to public health

emergencies including disease

outbreaks or terrorism

• Ensure access to laboratory with

capacity for sampling

What We Know…Depression• On average, St. Joseph County adults

reported 3.8 mentally unhealthy days reported in past 30 days

• Between 2010-2014, St. Joseph County’s age-adjusted suicide rate was 16.3 compared to 12.3 for Michigan.

Substance Abuse

• In 2015, St. Joseph County reported 89alcohol-related vehicle crashes.

• 347 St. Joseph County under the age of 18 years confirmed victims of child abuse and/or neglect. 1/3rd to 2/3rds of these cases more than likely involved some degree of substance abuse.

Methamphetamine

• Between Jan. 2012 and March 2013, about 6.5days' worth of cold medicine per person, was sold in St. Joseph County making it #1 in the state for pseudoephedrine sales.

62%

53%

52%

46%

44%

26%

20%

Mental Health

Adult Substance Abuse

Youth Drug Use

Youth Alcohol Use

Meth Lab Site Clean Up

Household Issue -Anxiety/Stress

Household Issue -Depression

Major Issues

2. Diagnose & investigate

health problems & health

hazards.

Prevent and control epidemics and

contain diseases/injuries. Examples

include:

• Investigate foodborne outbreaks

• Communicate serious health threats

to community in timely manner

• Develop emergency response plans

for public health emergencies

• Respond to public health

emergencies including disease

outbreaks or terrorism

• Ensure access to laboratory with

capacity for sampling

What’s Been Done…Sturgis

• Established school-linked clinic which includes an adolescent behavioral health counselor

• Expanded behavioral health services throughout primary care practices and into the pain clinic (only in one location before)

Three Rivers

• Three Rivers PAWS Clinic provides mental health services and counseling to youth (18 or under); also provides substance abuse counseling

• Collaborate with CMH to assess patients presenting at ER with mental health issues, as well as to link women with substance abuse issues to primary care providers

• Collaborating with CHM and other partners to provide trauma-informed services

Others

• ISD has been working with its partners to develop trauma training and to train all providers and their staff within the county

Current Initiatives

2. Diagnose & investigate

health problems & health

hazards.

Counseling

Prevent and control epidemics and

contain diseases/injuries. Examples

include:

• Investigate foodborne outbreaks

• Communicate serious health threats

to community in timely manner

• Develop emergency response plans

for public health emergencies

• Respond to public health

emergencies including disease

outbreaks or terrorism

• Ensure access to laboratory with

capacity for sampling

What’s Being Done…Sturgis

• Collaborating to develop FQHC, which includes behavioral health services

• Counselor with school-linked clinic will be providing education to teachers to help identify and address mental health issues in students

• Research ways to expand mental health services through primary care practices

• Working geriatric-psych inpatient unit

Three Rivers

• Expand behavioral health services throughout primary care practices

• Partnering with CMH to place Recovery Coaches in the facility to provide outreach

• Participating in training provided by CMH to help primary care providers identify substance abuse

What We Know….Physician Services

Population to Physicians/Medical

ProfessionalsRatios

What We Know…Lack of Health Professionals• St. Joseph ranked 65th among 82 counties in its

population to primary care physician ratio.

• St. Joseph ranked 61st among 82 counties in its population to dentists.

• St. Joseph ranked 29th among 81 counties in its population to mental health provider ratio.

• St. Joseph County has been designated Health Professional Shortage Areas (HPSA) for primary care and mental health and has received a partial county designation for being medically underserved.

• St. Joseph ranked 77th out of 83 counties for the number of hospital stays for ambulatory-care sensitive conditions per 1,000 Medicare

• From survey respondents, 26% had three or more problems accessing healthcare due to cost; 33% had issues with medical bills or medical debt in the last year and 42% have left the county in the last two years in search of health care.

Physician 2,903:1 1,240:1 1,040:1

Dentist 2,770:1 1,450:1 1,340:1

Mental Health Professional

592:1 450:1 370:1

Other Primary Care Providers

2,344:1 1342:1 n/a

2016 County Health Rankings

1.Monitor Health Status

Monitor health status to identify

community health problems. Collect,

manage, and analyze health related

data for knowledge-based decisions.

Examples include:

• Conduct community health

assessment to identify public

health risks and inform public

health planning

• Develop community health profile

to educate community and community

leaders about public health

promotion

• Establish website to provide

community information about

persistent health problems within

community and how to prevent these

problems

What’s Been Done…Sturgis

• Added one urgent care center including additional providers

• Recruited 3 full-time midlevel providers

• Established Student Help & Healing Center –Gesundheit – school-linked clinic

Three Rivers

• Recruited new providers at Three Rivers Health, including ENT

• Added nurse midwives to improve appointments

• Revised Community Wellness Programs

Others

• Federally Qualified Health Center established

• Health Department became Navigator Organization and a DHHS Community Partner to help with health insurance enrollment.

School-Linked Clinics

Located at:Three Rivers Family Care Clinic

721 Sixth Ave.Three Rivers, MI 49093

Located at:Sturgis Hospital Medical Commons II

1555 East Chicago Road, Sturgis, MI 49091

1.Monitor Health Status

Monitor health status to

identify community health

problems. Collect, manage,

and analyze health related

data for knowledge-based

decisions. Examples

include:

Conduct community health

assessment to identify

public health risks and

inform public health

planning

Develop community health

profile to educate community

and community leaders about

What’s Being Done…Sturgis

• 2 Urgent Care centers and Fast Care Clinic at Meijer's

• Part-time Physician Recruiter hired to bring in new providers

• Qualified Choice Site so veteran’s who live greater than 40 miles from VA facility can receive services locally

Three Rivers

• Open scheduling at Family Clinic

• Promote new providers through quarterly newsletter.

Collaborations/Shared Initiatives

• Telestroke Programs – using technology to maximize access

• Care Coordinators hired for ACO Project

• Partnering with Covered Bridges

• Increased specialty providers/clinics

• Dental Clinic expansion in Sturgis.

Telestroke Initiative

What We Know….Diabetes

Age-Adjusted Death Rates* - Diabetes Mellitus,

St. Joseph County, Michigan & US, 2010 -2014

35.7% 33.4%35.5% 36.1%

43.9%

23.9% 24.2% 23.0% 23.7% 23.6%

20.8% 21.6% 21.2% 21.2% 20.9%

2010 2011 2012 2013 2014

St. Joseph County Michigan U.S.

*per 100,000 population

Diagnosed Diabetes Age-Adjusted Percentage,

St. Joseph County, Michigan and US, 2013

9.2%

10.2%

8.4%9.2%

10.2%

8.5%8.7%

6.9%6.1%

All Male Female

St. Joseph County Michigan U.S.

What We Know…Diabetes• Diabetes is the 5th leading cause of death in St.

Joseph County and claimed the lives of 32 people in 2014.

• More than 1 out of 11 of St. Joseph County have diabetes.

• Prediabetes, an underreported condition, impacts one out of three people, yet only 11% are aware of their condition.

• Diabetes was the 6th leading cause of preventable hospitalizations in St. Joseph County in 2014.

• St. Joseph ranked 73rd among 83 Michigan counties for its diabetes death rate (crude rate) per 100,000 population (2014).

• St. Joseph ranked 54th among 65 peer counties nationwide

• Diabetes lowers life expectancy by up to 15 years and increases the risk of heart disease by 2 to 4 times.

• Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.

Diabetes Education

Diabetes ScreeningWhat’s Been Done…Sturgis

• Certified Diabetes Educator for patients and provides scholarships to help with program costs.

• Keys to Managing Diabetes – annual public event that includes: speakers, food demonstrations, screenings, educational materials

• Offers free or reduced-cost community health screenings for: healthy eating habits, activity, risk assessment BMI, cholesterol and glucose.

Three Rivers

• Provide A1C screenings at reduced costs at health fairs.

• Dieticians that provide diabetes education/counseling

Others

• MSUE offers several diabetes and nutrition programs to the community.

• AAA offers evidence-based PATH program for trainers and the community.

What Can You Do? Diabetes EducationWhat’s Being Done…Sturgis

• Collaborate with MSU Extension to offer Dining with Diabetes class in Spanish

• Initiation of Diabetes Care Teams to work with providers to help patients manage their diabetes.

Three Rivers

• Implement outpatient diabetes education program

Collaborations/Shared Initiatives

• Work with ACO coordinator to monitor Medicare population with Diabetes

• Working through Step Up St. Joseph County, initiate educational campaigns during National Diabetes Month (November)

Education and Prevention

Social Vulnerability – St. Joseph County

What We Know…• The median income in St. Joseph County in 2014

was $44,145 compared Michigan and U.S. incomes of $49,087 and $53,482, respectively.

• 2 out of 5 county residents live below 200% of poverty.

• Nearly 3 out 5 children (58.4%) attending St. Joseph County School Districts are economically disadvantaged.

• 16,475 (27%) of county residents have Medicaid and/or Healthy Michigan (Medicaid expansion) coverage and 11,767 (19%) are on Medicare.

• St. Joseph County population is represented by the following racial/ethnic groups:

• White: 94.8%

• African/American: 3.6%

• Hispanic: 7.3%

• Amish: 2.1% (proxy indicator)

Socioeconomic Characteristics - 2014

5.7%

11.7%

17.8%

27.3%

40.2%

7.3%

10.1%

16.9%

23.7%

34.7%

Unemployment

Uninsured

% Below Poverty

Children <18years Below

Poverty

Below 200% ofPoverty

Michigan St. Joseph Co.

What We Know…• In St. Joseph County, less than ½ the population

(46.1%) has attended college which is considerably lower than Michigan’s percentage.

• 22.4% of St. Joseph infants born were to mothers without a high school diploma, compared to Michigan where only 12.3% were born to mothers without a high school diploma.

• Identified needs of priority population include: transportation for low-income groups and residents in rural areas; and the need for bilingual health providers, translators, and health information in Spanish.

• In addition:• Adult Smoking –22% of St. Joseph Co. residents smoke,

compared to MI (20%) and US best (14%) and 36% of respondents reported living with someone who used tobacco products.

• 56% of respondents perceive that there are problems with living healthy lifestyles.

• More than 40% of respondents identified Poverty, Bullying, Low Educational levels as major community issues.

Educational Attainment

3.3% 5.5%7.4%

9.8%

30.2%

38.6%

23.9%

23.2%8.8%

7.9%16.1%

9.3%

10.3%5.7%

MI St. JosephCo.

Grad/Prof.

Bachelor

Associate

SomeCollege

H.S. Grad.

9th to 12th,no diploma

<9th Grade

What’s Been Done…Sturgis & Three Rivers

• Published /presented 2012 Community Needs Assessment to the community /various groups to educate them on the community ‘s needs

• Worked with community partners, (schools,Chambers of Commerce, United Way, Health Department, CMH and others) to establish the Step Up St. Joseph County website, Facebook and promotional activities

• Offer free/low cost screenings, health fairs, educational offerings

• Evidence-based curriculum offered through student-linked clinics

Others

• Target promotion o local resources/programs for various health /human service providers (i.e., Project Connect, Community Baby Showers, Back to School events)

• Maternal Smoking Cessation program being developed by Certified Tobacco Specialist (Health Department) and Matter of Balance (AAA)

CliniciansCurrent Initiatives

Community Health Needs Assessment of St. Joseph County

What’s Being Done…

Sturgis

• Continue existing activities

• Expand health and wellnessofferings/online marketing initiatives

Three Rivers

• Continue existing activities

• Grow and develop social mediapresence

• Increase community education

Others

• Increase use of social media efforts

• Senior Reach Project

• Expand Step Up St. Joseph Countyefforts to include community challenges, worksites, etc.

CliniciansCurrent Initiatives

Check us out @Stepupsjc.net

Or like us at Facebook@www.facebook.com/StepUpSt.JosephCounty

What’s Next?For More Information, go to…

• You can visit one of the following websites and click on the Community Health Needs Assessment button to learn more:

• www.bhsj.org

• www.sturgishospital.com

• www.threerivershealth.org

• www.stjoecmh.org

We want to hear from you!