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2016-372-Minutes for Meeting May 31,2016 Recorded 7/8/2016DESCHUTES NANCY BLANKENSHIP,FCOUNTY CLERKS CJ 7016'317 COMMISSIONERS' JOURNAL 07/08/2016 11:20:08 AM 111IIlIlIIIIIIlIIlIIIU06-2 IIII For Recording Stamp Only Deschutes County Board of Commissioners 1300 NW Wall St., Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF BUDGET MEETING — HEALTH SERVICES TUESDAY, MAY 31, 2016 Allen Room, Deschutes Services Building Present were Commissioners Anthony DeBone, Alan Unger and Tammy Baney. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; Mike Maier, Jim Burton and Bruce Barrett, citizen members of the Budget Committee; and Wayne Lowry and Loni Burk, Finance. Attending from the Health Department were Jane Smilie, Health Services Director; Hillary Saraceno, Deputy Director, Public Health; DeAnn Carr, Deputy Director, Behavioral Health; Sherri Pinner, Pamela Ferguson, Nicole Chunestudy, Jenny Faith, Tom Kuhn, Shannon Vandergriff, Melissa Rizzo, and Channa Lindsey. Meeting minutes were taken by Sandy Ringer Chair Bruce Barrett opened the meeting at 4:30 p.m. Jane Smilie had everyone introduce himself or herself. She noted that she is in transition and will be leaving the County on 7/1/16, and has enjoyed her stay at Deschutes County. She noted that the County had a desire to integrate both Behavioral Health and Public Health, and there was interest in transparency in the budget. The Department has been working on this process since 2011. There was also an interest in greater accountability, and a piece about culture, which include addressing some morale issues, etc. She then began to explain the Budget Committee the binder that has been produced. Minutes of Budget Meeting Tuesday, May 31, 2016 Page 1 of 7 Grants: A listing of grants in the binder that are either new this year or have been applied for this year. Client Satisfaction: Results of Surveys. Integrated Management System at DCHS: We are a specialty Health Services Department. There is truly no other entity like us. She then discussed the wheel noting that we increasingly try to tie the budget to the objectives. This takes some time. Regional Health Assessment and Improvement Plan: This is the basis of our work in an ideal world. Draft Strategic Plan — 2016-2020: Various Health Improvement Plans for each area. We have paid special attention to the Health improvement Plan. Funds are shifting. The traditional funding sources are not going to be sufficient. This is about funding those pieces of Health Services that we are not paid for, but that have to happen in order to keep our community healthy. The question is "What should Public Health be doing and how should we fund it?" She also discussed Certified Community Behavioral Health Clinics — Integration of Physical Health and Behavioral Health, and Health Modernization. We are poised for further transformation again. We have lined up our work with the Strategic Plan and with the Regional Health Improvement Plans, charges from various grants, CCBHC grants. We have moved to more population -based work in Public Health, while Behavioral Health has moved to client -based work. We are now back in the East Cascades OB-Gyn Clinic and in every clinic. Foundational Capabilities — Assessment — Epidemiology — our base is quite strong. We are poised to move to those new funding sources. Medicaid expansion is not enough for future funding. Change is coming. She then discussed how the budget is formatted - Program -by -Program Budget, and Program -by -Program Operational Plan. Jane then gave a review of services provided by funding code. There is one single departmental budget. We have integrated our Medical Records, our departments, Accounts Payable, Accounts Receivable. Having one budget is our last project for integrating the department. Minutes of Budget Meeting Tuesday, May 31, 2016 Page 2 of 7 This budget is very tight, as we have seen some revenue sources decline. We worked very hard to give the Committee our most accurate budget. Wayne Lowry allowed us to offset 6% of our personnel budget because we can never be completely staffed. This budget does not have a lot of push. Sherri Pinner noted that there are bigger variances because of the way we allocated funds this year. There were really no variances in the number of administrative staff, but with the integration of Behavioral Health and Public Health administrative staff, it changed many of our methodologies. Tom Anderson expressed his appreciation for Health Services keeping FY 16 in the proposed budget. We matched the Operational Plans with the Cost Centers (Budget). It is separated by Behavioral Health, Public Health, Admin/Ops/Support Services, and Totals. Conceptual Framework for Governmental Health Services — PowerPoint. Helps us stay consistent with the integration framework. There has been much interest in data and health outcomes. Deann Carr — New Model — Deann noted that there is a new provider type in Medicaid- Oregon will certify up to 30 CCBHC's if we become one of the eight states that are granted funding. We submitted an application to become one of the CCBHC's. There will be a New Prospective Payment System (PPS) — provides additional funding for previously unfunded coordination of care. This is the direction Behavioral Health is going. It is a Demonstration Plan that it is hoped that Oregon will try. The plan is to roll this out across the country. The framework was created with Commissioner Baney in a leadership position. Each Health Department created a Needs Assessment — showing what has been spent and what will be needed for future. There are improvement opportunities — Deschutes County 1. Access to Clinical Preventive Services 2. Communications 3. Prevention and Health Promotion 4. Policy and Planning 5. Assessment and Epidemiology Minutes of Budget Meeting Tuesday, May 31, 2016 Page 3 of 7 Hillary Saraceno - the Early Learning Hub has been a three-year process. A Regional Director has been hired by WEBCO. We are working to transition temporary staff into permanent staff. Funding has been competitive. We have been successful in bringing some of those sources in. Ten competitive grants have been awarded, totaling almost $2M. We have consolidated three Healthy Families Oregon Home Visiting Programs into one Regional Program. We have also created parent focus groups in high-risk communities to better understand needs in La Pine, Prineville, etc. These are provided in Spanish as well as English. The four-year strategic plan has been completed and approved. We were given 17 new performance metrics that had to be put together for the Central Oregon area — not just Deschutes County. We had to align it with 19 other Regional Health Improvement Plans. This has also been fully integrated into public health — staff is now fully integrated. Melissa Rizzo — I/DD Program — went through a change since 2013. The K Plan Began 7/1/13. This allows us to provide in-home support to those who need our services. We have had a 48% growth in our clientele. We received funding to hire and train 11 additional staff. Our caseload is around 40 at this time. There are 223 Personal Support Workers — supplying assistance with daily living skills. We developed 15 adult homes and three child foster homes — separate from the State of Oregon. They will begin this in La Pine twice per week beginning 7/1/16. Tom Kuhn — State of Oregon has had a higher suicide rate than the national average. Deschutes County has had a higher rate than the State. We have had 15 trainings in "question, persuade, refer" (QPR) for Bend -La Pine School District staff in an effort to train them how to assess and get students help. We have also begun the Central Oregon Suicide Prevention Alliance (COSPA), which is a regional effort to share resources to get the suicide rates down. Jenny Faith — We have been lacking data on Health Statistics on our website, so we now have a Health Statistics Page on our website. There are also some statistics for the tri -county area. There are statistics about tobacco and alcohol use. We will continue to add information to the website. We have begun the Behavioral Health Client Profile Project. The goal is to better describe who our clients are, overall and by program. Statistics will be generated for each program. Jenny is also working on issues in the tri -county area. Minutes of Budget Meeting Tuesday, May 31, 2016 Page 4 of 7 Nicole Chunestudy — Epic Implementation Success - a very important piece of integrating Behavioral Health and Public Health. We now have both on the same Electronic Health Record System. Project Plan — Financial impact and risk management assessments, developed new workflow process and resource materials, built in system customization, developed a data migration and a 2-1/2 month training plan. Results have been on time, on budget, with greater user functionality and knowledge base, and user resources for support (able to use the resources and complete work on their own). Jane Smilie - Response to Healthcare Reform — we have increased visits to 89,801 clients — referred 2,455 clients to external providers, which is an increase of 51% from 2014, 132% from 2013. The difference in the number of visits provided reflects the acuity of clients served in each setting. Our clients see 23 visits per year and external providers see 10 visits per year. Integration — DCDC/Mosaic Outcomes — 41% decrease in inpatient admissions, 20% decrease in ED use. Medical appointment attendance increased from 13% to 92%. We will adding dental care as well. Program Enhancements — Living Well — added chronic pain curriculum, Smoke - Free Oregon campaign on regional CET buses, and a SPArC grant to explore tobacco use. Workplace culture - Continued internal integration, implemented customer satisfaction, instituted formal project management, brought in a workplace consultant, conducted leadership training, instituted trauma -informed care and organization, upgraded our facilities, several quality improvement methods, and an integrated management system Budget Process Improvements - Created one operating fund, developed consistent methods of allocating support services, indirect charges, and administration, a tighter budget — based on past years; and we underspent. OHP and other revenue sources have declined, so we had to budget to spend some reserves. If we had no new revenue, and if nothing changes and no new CCBHC comes, we would still have after 3 years responsible reserves. Total Resources - $39,121,712 and requirements — $1.3M less than FY 16 adopted and amended budget, includes .5 FTE Environmental Health Specialist, $100,000 in one-time only County General Funds for Courtney Front Desk Remodel, $175,966 to offset a portion of direct charges. Minutes of Budget Meeting Tuesday, May 31, 2016 Page 5 of 7 Rationale for Request — Asked for 3.3 FTE for 2016. We are asking for assistance with indirect costs (12%). The one-time expense request is to increase efficiency/client experience. The .5 FTE funded with fees is for Environmental Health. We want to cross -train front desk personnel so that when people come into our lobby, they can be assisted by whomever they come up to. Mike Maier stated that he feels they should give Health Services whatever it is they asked for. Commissioner Baney asked about the Early Learning Hub - $185,000. Sherri Pinner noted that $93,500 is from the Alternatives to Incarceration Funds, the three evidence based programs. Commissioner Baney asked if General Fund was still paying for grants that have not been competitive. Hillary Saraceno noted that these grants were never intended to be competitive. Sherri Pinner also noted that there were some variances because of the way we reallocated the support staff when we combined the funds. Wayne Lowry, County Treasurer noted that we combined three funds to a $4M total and increased that by $175,000 as discussed earlier today. On the green sheets, he stated that we have split the general funds up into the various programs it is being used to fund. Commissioner Baney noted that the Early Learning Hub has been shifted to WEBCO. Hillary Saraceno replied that parts of it has been shifted, but not all of it. Jane Smilie noted that each County has maintained some revenue separately. Commissioner Baney noted that this, in addition to the School Based Health Centers, is coming out of the general fund and it is a policy decision of the Board whether or not we still want to fund these. Tom Anderson suggested that we bring back more specifics on the Early Learning Hub and perhaps the School Based Health Centers on Friday morning. There was a $70,000 reduction from the previous year as part of a good faith effort. Commissioner Unger noted that when we started, we didn't know some of the services landed in SBHC's. Jane Smilie stated that we are down in staffing for SBHC's; however, we do have a new SBHC that we didn't have previously, which is an increase. Commissioner Baney noted that this budget is incredible in detail and scope. Minutes of Budget Meeting Tuesday, May 31, 2016 Page 6 of 7 Tom Anderson asked about the capital project at the Courtney Building — this is recommended at $100,000 in the 2017 Budget. Commissioner DeBone asked why we are transferring from General Fund to Health Services and not Building Services — Sherri Pinner noted that it is an Interfund Project. Tom Anderson noted that Health Services was originally going to pay for it but with the reduction in revenue sources, the department staff are asking for this contribution. Commissioner DeBone stated that this has been a wonderful presentation. Chair Barrett noted that the budget meetings would continue on Wednesday, June 1, 2016 at 9:00 a.m. Being no further discussion, the session ended at 5:12 p.m. / .1411 DATED this (P -- Day of Deschutes County Board of Commissioners. 0 ATTEST SIGNATURES: Recording Secretary Minutes of Budget Meeting Alan Unger, Unger, Chair 2016 for the 11/.6Tammy Ban:,\Sce Chair Anthony DeBone, Commissioner Tuesday, May 31, 2016 Page 7 of 7 Deschutes County Extension and 4-H Service District (Cont'd) 10:15 - 10:30 AM 10:30AM - 1:OOPM 1:00 - 1:30 PM 1:30 - 2:00 PM 2:00 - 2:45 PM 2:45 - 3:00 PM 3:00 - 5:00 PM BUDGET COMMITTEE AGENDA Tuesday, May 31st, 2016 • Motions to: 1) Approve Deschutes County Extension & 4-H Service. District operating budget of $626,245 and set tax rate at $.0224 per $1,000 of assessed valuation (Fund 720) 2) Approve Deschutes County Extension & 4-1-1 Service. District Reserve budget of $538,000 (Fund 721) • Motions to be seconded • Budget Committee votes • Close budget meeting Break Deschutes County Budget Pronosal/Lunch • Open public meeting • Deschutes County Budget Proposal Service Partners Economic Development of Central Oregon (EDCO) Central Oregon Visitors Association (COVA) Other Funds Health Benefits Fund (Fund 675) PERS Reserve (Fund 135) Economic Development Fund (Fund 105) Video Lottery (Fund 165) Break Health Services • Introductions • Budget discussion; Special Requests 14/419 Continue the Deschutes County budget meeting to Wednesday, June 1st , at 9:00 AM Program Budget Tab/Page Page 2 6 / 243 6 / 249 6 / 236 6 / 232 5/192 -0 Improvements Ln Li9 0L rimaG)-0CX) C 4— CO L. a) a O 4u c 0 -o CD CO ) L V V V) O a a cm bD CO 0 0 CO 4--- O V) 0 -I-▪ -+ 4U E 4--, C CD cam/) C 0 0 c O ez (o L._ 4-, V) o E 7:3 (o t/)°' cu aci Co _c0 0 2la V) CD V CO Ln >- LL 4- 0 c .O (o .V c O 0 L cu 4J a) a E O 0 A. 73 ci)E O 4-- c C 0 -1 11 CO N • emiuma 0 LLL. = C C6 CU (o 4) a--+ CT 0 a) a, i Ln N >- >- LL A. 4--, C 0 V 0 C L— a) i O -oc co a_ 0 4- 0 CD V) 4U N E (0 2 .. revenue V) -oc 4- c 4u a) Q) 4J 0 C CO V) otpV) C CO a) CO C E LLJ 0 N_ •E co 0 cu s.. se) cu ttis 4.,a3 z cv cui?.. +8 E silsj OD 4"j CO • C R5 C to tll .- p lap (el) ca Lill 1 i i s.,. 4. 4.J C co0s... c% E (J) c 12 E .— 0 CO • 4-'5Z 8 C .� .— 0 a"I E 14' sia. 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SistersSBHC Sisters_ Redmond HS SBHC Powell -Butte - North County Hub Wall Street Services Building Tumato Deschutes -'fDeschutes National Forest Alf Becky Johnson Center KIDS Center Lynch SBHC MNican Mike Maier Buildin Main Clinic cao Bend HS SBHC Downtown Clinic La Pine La Pine HS SBHC Ensworth SBHC CO 0. X CU 0 v) a) c t CO 0. c0 N 0 U U 120 O i r0 a) >- 01 M 00 N iJ? 0 N O M CD a) -O co 0 a) CU 0 a) roro 0) 0 U O U O 13 of O C O c r0 r0 N c CU -CO c c 76 E cn U c 0 a) a) 0` N a) CU a • r0 � p • L N f0 E >" r -I 4 o O O L C CI- O C E0) a) coCU0) c co EE. C a) m a) + ' C o f0 000 s '5 R o +� p U r0 +, Q C U > c aII,) r0 C O >, c▪ o c c c o E O Oo of L ca a) > 0) 0 U U co .n O c c0 0 .c O U co r0 c r0 E 0) 00 0 Substance Abuse and Mental Health Services Administration in L R) v a 5-4 N 0000 O N _ L c O c • o,, v, O 0 a) c a) 0. > E > a) co F.:, 0CD 7- bo 7; L c_ c v) Y ate, O 7 C 0 r0 .0 .1.-: 0. .0 02 OD Y .0 -+ N 4F, CO 'O ' 0 00 O C C 04 i•+ O C *' Q. O a) E N r0 i N N a) -0 co in E a 0 >. Q , v) s- 0.) a) M O O 0 n M 't/2- 00 /}00 ri O N 0 01 O 0 Z.; CU > 0) a (.2 00 0) r0 V) s 4-+ a) x c 0 00 0) 0 N i 4-,0 E 00 c -i 0 00 iti ih r-1 ri O N 0 M O a-, COc OD ‘C.) i = a O N s ra a) X to -c 0 a 0D O 0. (0 .0. E • v E C i O f0 ▪ 7. 6 C Nf, 0 00 00 00 C 12 E cn 4 co C 4- a) O U c of O O L U ice, CO v) co r V) r0 W a) U roN U cc a) aDO E E 0 r0 v) L1 a) U 0 OD 0) L O 0) 0) LL a) Y 0 N c eD 0 ea 0ro ccN U 00 c =a c L CU OD 4-. c _I c T. U a) -C c 0. X a) 0 0 c LL 5- a) a) >- ri On N N .--I i/} a) CO 4- 0 0 U U L 3 U N 0 c 0 U 0 c O t U E r0 0D 0 0. V) a) c E E O U r0 CU 2 0) 00 O .0 Tobacco cessation facilitator training Increase mental health capacity within SBHCs c C H C▪ O - 4- 0) us U• iA C C a) -D 3 .0 c O c co c Y 0. 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M CO 0 01 0 0 0 4-1 C- 0 M 0 O 01 O m O O O 01 O O O O 01 to (0 0 0 O to O 0 N 0 O 01 N Ol to M tri tri. 01 O O O O nzr 0- M J). .- t/? Lf) l0 M 01 V) V) t/? t/? t/? i/)- t/? e -i N N N rj t/? t/? t/? t/? Lry tN S.0'.0 LO `i N N N- t0 (NI 13 O 0 NONI 0 0 0 0 LO 0 O O OMO O O O M E \\MN\\\\Nsa \ O 01 Ol LO e 1 t.0 t0 01 Cr) r -I V) V) 4 -I N 41 4 Y - co O O .w E a 3 a) C O O a a 0 ti„•�Z Z `O Iv 0) Q) Q) co 'O N C e -I N co (o at C •Q �k k > U U >> '^ Q) (6 L U U fs6 C1073 73 O UI > (0 s_ s- i U U U V a) C D -, c -, e a Q O N-0 a-0 a= a a� > Lc_ 0 C C > (o J O _i 0 0 E N . O Q O Q) _\ Y a1 O ty1 OA O) O_ >• >� •� >. •� L L O V1 L a) L O) L G) O � OU gJ UO Q) O Q) > 4O- .• in w �. w �. UJ c LL L L �. O �. O cn U Justice and Mental Health C C +I+ cu v cu cu a > E > > > ao O E m +7' OIP +, +, Q v t 0 as 0 co a= a a a a) >'_., c w> 'C v O O O t� O E O E O 0_ C a Q W — W (L° E E _y O_ s +i O ++ Q) ++ 0 +i O .t.i O ++ 0 O A Q. o C. > O. ° Q. Q. v O E �3 O.ca. 0o °'o =c Co C•> �= �, 0 0 0 0 �D .. woo co b.0 9 o°a V 40 U bl) V yac.�', E aao 0 To a) Ecc C L L a) it L -o L -a L -a "' O L 0 D 0 0 0 Lu O to O W O W O W 0 0 LL Behavioral Health Satisfaction Survey Further analysis for the survey statements with the lowest ratings is provided below. The table reports the number of responses for each question, as well as the percentage of respondents who selected each answer choice. The graphs show the percentage of respondents who agreed or strongly agreed, broken down by length of time in services. My relationships have improved. I learned some new ways to deal with problems. 64 53.8% 73 60.8% 30 25.2% 34 28.3% *Based on responses of "Agree" (4) or "Strongly Agree" (5) My relationships have improved. I learned some new ways to deal with problems. 2/9/16 24, 0 20.2% 0.8% 0% 13 0 0 0% 10.8% 0% trent sfaction 4.3/5.0 79.0%* 4.5/5.0 89.2%*. 100% 80% < 1 mo. 1-3 mo. 3-6 mo. 6-9mo. Length of Time in DCBH Services 83% 20% 0% 88% > 9 mo. 88% 92% < 1 mo. 1-3 mo. 3-6 mo. 6-9 mo. Length of Time in DCBH Services > 9 mo. i 2 • Behavioral Health Satisfaction Survey All DCBH Locations In December 2015, DCBH administered a bi-yearly satisfaction survey at all behavioral health clinics. Sur- vey statements were developed using a 5 -point Likert scale, ranging from Strongly Agree (5) to Strongly Disagree (1). One hundred twenty-three individuals participated in the survey. 4.6/5.0 Overall Client 92.4% Satisfaction "The level of care is amazing! I don't feel embarrassed to come in for treatment and I feel better fit to mix in society. The medicine & 1 -on -1 sessions have given me confidence and hope." "Everyone is friendly from the moment 1 arrive until the time I leave." Percentage based on responses of "'like going to see my primaryand mycounselor and my psychologist "Agree" (4) or "Strongly Agree" (5) ur°vey Statement I felt welcomed by the front desk staff. My clinician worked with me to choose treatment goals. I felt comfortable talking about my feelings and concerns. My relationships have improved: Staff were sensitive to my cultural background. I learned some new ways to deal with problems., My clinician treated me with respect (listened, supported, etc.). felt I could trust my clinician. 1 plan to use what I learned in treatment. Staff were available when I was in crisis: I am satisfied with the services I receive. Length of Time in DCBH Services at the same facility." ree 95.8% 95.7% 93.1% 78.6% 90.7% 89.0% 97.4% 95.8% 96.6% 90.4% 97.4% % Neutral 4.2% 4.3% 0.0% 6.0% 0.9% 20.5% 0.9% 9.3% 0.0% 11.0% 0.0% 2.6% 0.0% 4.2% 0.0% 2.5% 0.8% 6.7% 2.9% 1.7% 0.9% Disagreed 0.0% Location Where Respondents Usually Receive Services 3% <1month 1-3 months 3-6 months 6-9 months >9months 2/9/16 m Courtney • DCDC ■ NOCO ▪ SBHC • SOCO ■ WSSB *No responses received for KIDS Center 1 *Programs may not be listed due to log:; response rates Methodology: The survey was conducted from April 11-15, 2016, and was distributed at all DCHS Public Health locations. The surveys were predominately conducted via Survey Monkey on tablet computers in English and Spanish. Paper versions were also made available in English and Spanish. The surveys were voluntary and participants were assured that the responses were anonymous and would not influence their ability to obtain future services. Programs evaluated include Immunizations, Reproductive Health, WIC, and Environmental Health. To incentivize clients and increase the response rate, each respondent was entered into a raffle for a $20 Safeway Gift Card. One winner was selected. Overall Repro- ductive Health 9ci 0 Satisfaction 0 Satisfaction d/ IWP /0 Satisfaction Background and Rationale The Deschutes County Health Services (DCHS) Public Health (PH) improve the quality of service if t -�r R',�, "nd M7 11,r01, Customer Satisfaction Surve rr� , • - , - inform taff a • Implementation of at least two Health Services general client satisfaction surveys in FY 2016 was a Strategic Plan Goal. Additionally, implementation of the survey aligns with the Public Health Accreditation Board Standard 9.1.4A, which calls for a systematic process for assessing customer satisfaction' with health department services" Overall: Respose Breakdown Response Count= 44 The majority of surveys were conducted at the Bend Main Clinic No surveys were completed in either Redmond or La Pine. Bend Main Clinic (Court.. (95%) SBHC in Sisters (for WIC) (5%) Reception experience Services received Ability to reach someone helpful in a timely manner Courteous and professional treatment Staff knowledge and skill Wait time for services today Consistent quality of services. and information Response Count= 44 No surveys were completed for either Vital Records or the Prenatal Access Program Immunizations (2%) M WIC (36%) EH (7%) Reproductive Health (52%) M Other (2%) Satisfaction Score 100% 95% 98% 2% 2% 2% Staff sensitivity toward my culture and background Response Count= 44 98% 2% 100% 0 10 20 30 40 50 60 70 80 90 100 Satisfied to Very Satisfied M Neutral to Very Dissatisfied ,;' N/A Reproductive Health: Respose Breakdown Reception experience Services received Ability to reach someone helpful in a timely manner Courteous and professional treatment Staff knowledge and skill Wait time for services today Consistent quality of services, and information Staff sensitivity toward my culture and background Satisfaction Score 100% 100% 100% 96% 4% 100% 0 10 20 30 40 50 60 70 80 90 100 a Satisfied to Very Satisfied • Neutral to Very Dissatisfied NiA Reception experience • Services received Ability to reach someone helpful in a timely manner Courteous and professional treatment Staff knowledge and skill • Wait time for services today • Consistent quality of services and information Satisfaction Score 94% 94% 6%; 6% Staff sensitivity toward my, culture and background 100% 94% 100% 100% 6% 0 10 20 30 40 50 60 70 80 90 100 III Satisfied to Very Satisfied • Neutral to Very Dissatisfied 3 o 0 7• 's s '' U 4) 4) N � G �7 S, 0. 'y o Z..""*".. 7 e d R of G `( 4 o d O O 4-0). Cil ? p) -a i to 0 � N o '• G y O u G v 7 N 4 O = l d QJ T N N ati3c6.0 N i cn y p 3 s, N G r 4)) c, " • 0,.9 to 3 ca 00 tf$is c N 6- o G S. LL Zn y O • ✓ Y , 0 as n (‘-i) S, Q s .O ( , •�- 7- }' o CO cO N -0 tON �7 a 4 N� • (d tJ( i ...^ ✓ oA st (4 4) t) VI s c s a) 4) C. 4) '^ a) 0 3 0) N oD s 3 o7i (o = To 'sa ?a c�a "� is 3 L Z. o '<a o W m ,o o 7- .r+ tJs - .ice 3 t.) o �' OA l p v o a a' J' O o ° o ��/' t� }N, tN p 6 .6 O O i O N -• a) 0 i *" 4- ? 7 .3 Z °Cr, d Q 2. s,oa =-0 `\' ( o 0 3¢ o �► fi 0 t°o °u oY o m o — O•P Jp Zo"3a a) i o- ca (4 y ap 3 Ld a a cis mc. o N !°' 0o o v 4 a 0 15 O n yu O .C. v o or- s f ° tiN cr,G• til n 'To "0 -d d �G m 2 2 t4) CI-uQ R co oG v,o D , o Ad 0 so i d? o C. p a' v a)s o a � a e aZ a� .0= a io) s 3 p o �, r 0. = a) c s d 3 p 3 N o -- O is G �a Z (o y 0,) A sa 0P -. � s J' a) tij) O -0 o N 5 v 7 t) o o N • ") r a v0 a CI d 'a) o Y ass, u t▪ RS .� 'net,. ' C' 3 G O0 0) 1.O Q �+ >,- N O L) Q �oa)J 'G nD 3 v T V N u O Y ) .o O ea N s -Cj O L N 0C3^ -CS o 0) d, cis d o CI 0 to y 'd {y Y ca i ONteO� N N v *.^ aS3 -o 6 O .7N G % 1 0aN Na ..( '< ii •p c) o Z E cu as / W c ...... .2 0 C u E 4ii 1 ca cr) TILO c co t- $- o) 'E- x 11:3, co bA 0. 0 co 2 0 IA +. v7 au w 22g., co Cti LL. .0 0 Ct 2 E = I— cu a) X c u co fillIfiluliCodrid,111 Or, 1410111IIw IhOd ptlnlf�hW ?mt lru ��A�llu�flAlie�mll�i(�d u�nl� i GVVV ♦'VVV'V' Deschutes County Health Services FY 2017 Requested Budget Analysis by Program/Service With Program Operational Plans Deschutes County Health Services Budget Process Improvements Before you is a document designed to provide you with as much information as possible about the DCHS budget and our -ograms and services. We ask for your understanding that comparisons between FY 2016 and FY 2017 budgets be .dterpreted with caution for the reasons listed below. 1. For FY 2017, DCHS has a single department budget. 2. The FY 2016 budget was not based on past year's actual expenditures, while the FY 17 budget was based on FY 15 actuals and year-to-date FY 16 information on use of OHP funds. 3. The FY 2016 budget information provided here is neither the FY 2016 adopted budget nor the FY 2016 adopted and amended budget. It is from an internal budget management tool and is "revised" throughout the year. While there are some changes you might expect to see, for example, a jump in personnel costs in our I/DD program due to adding 11 FTE, those were incorporated into the FY 2016 "revised budget." 4. In FY 2017, we have offset 6% of our personnel costs because we have historically underspent in this category. 5. We right -sized materials and services based on FY 15 actuals. 6. With the combining of funds, we made changes in methods of allocating indirect costs, support services, administration and overhead to bring more consistency across the department. 7. Increases in all of the various costs of doing business (health benefits, COLAs, county indirect charges, etc.) have typically been absorbed into the budget. This year we are requesting a portion of this increase in our budget request. Progress has been made, there is more work ahead Over the past two years, DCHS has worked diligently to increase the precision with which we budget and to make more rnsparent how Deschutes County Health Services allocates and expends its various types of funding to deliver programs and services. It is important to acknowledge that the current county finance system requires substantial manual work for the department to create detailed program/service- level information like what is before you today. Credit is due to Sherri Pinner, DCHS business manager, for her recent work to help move this goal forward, and her work through the years to keep the agency on track effectively managing millions of dollars. For the first time and in order to better inform our budget process, a full reconciliation of expenditures was completed at the end of FY 2015. This determined exactly how much of each type of funding was utilized by each program/service. While we used the FY 2015 reconciliation to develop the FY 2017 budget, this type of information was not available when the FY 16 budget was prepared. Nonetheless, last year with the information that was available, we made some changes in the right direction. We attempted to use service data to better estimate service mix and allocate funding accordingly; adjusted methodologies for allocating indirect costs; and maximized the use of non -county funds. The FY 2015 reconciliation will provide a foundation moving forward to examine trends in the use of funds by program/service, and will inform future budgets. For example, next year this committee could see FY 2015, FY 2016 actual expenditures, and possibly FY 2017 projections, alongside a proposed FY 2018 budget. This type of information should help illustrate the rationale for a future budget. Overall, we have achieved significant progress in the evolution of our budget methodology. The resulting limitation in comparability between fiscal years will resolve as additional budget years yield comparable data. 1 1 i Deschutes County Health Services FY 17 Requested Budget Analysis by Project 4nalysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Revenue Sources Total Resources REQUIREMENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead ^ontingency Total Requirements Access MAT FY 17 % of FY 16 Revi sed % of Budget $ 62,825 5% $ 58,994 0% 19,226 1% 19,226 0% - 1,032,180 80% 974,472 54,459 4% 149,321 119,431 9% 12,067 $ 1,288,121 100% $ 1,214,080 $ 889,749 69% $ 19,025 1% 0% - 0% 379,347 29% 0% 100% $ $ 1,288,121 Program Services FTE 9.22 Admin and Support Services FTE 2.02 Variance 5% $ 3,831 0% 2% 0% 80% 57,708 12% (94,862) 1% 107,364 100% $ 74,041 826,882 68% $ 62,867 16,950 1% 2,075 0% 0% 370,248 30% 9,099 0% 1,214,080 100% $ 74,041 Programs/services: • Assessment and screening services for persons seeking behavioral health services. • Connect individuals with treatment resources available from DCHS and other providers. • Assessment and screening services are available in Bend, Redmond and La Pine. Changes/issues: • Changes were made to allow clients to self -refer to community providers without being first assessed for level and type of need by DCHS. DCHS has experienced no change in volume due to this change in process. This is being monitored closely. Clients/population served: Population: Individuals seeking mental health or substance use disorder services. Clients served: 5,311 client visits to 3,748 individuals, averaging 1.4 visits per individual served. 2 te▪ i CV Metric (Outcome #) E \ } enings by location, monthly E ssments by location, monthly umber of as d: Amber Clegg Action Plan E \� tor E /\# ;_9 E i 0 z 0 0 00 1.0 Desired Outco sment in a timely manner. /e >> / , - § ! // ) m\ °2® w| c ;4 | (\j( ±- k /\�§)2 ƒo (5 In 'c) >. /!7!`ij O _,#To'' c§ ( �u • a= `° Te, !©.1:4o2 != a=E\{\I� ! 0 \ 9§))/2/ƒ/§§)$!a a=GQ¥93Raae=a k]Jf00000 \ a 0000 642 at \ z Ou Track number of referrals (internal and exter 1-1 • m � -1 C C C \ O O O CO 01 O1 01 O O O 0 10 l0 10 ti N •V C \ti ti - y N \ \E N N N a C T d V N C N C y E d V12 W E a a • < U • V 76.> o YE v E v `�d c 8 v v 0 >-a. L Y u J v y '6. 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A)mv adm> 351 m 01 rn m c c c .5 'o 'o 01 01 01 O O O 0 0 \ \ N N 01 O1 01 01 01 O1 0 c c 'o 'o c c 'o c ' -00 'o 01 O1 0) 01 01 m C C C C C C O O O O O O O /0 0 0 0 0 N r . rf \-1 r\1 +.1 •1 ▪ ti N N N ▪ N N N c 0 c 0 (0 .\i 10 10 N 00 ti N Vmud s en d du'0 d 'd>NU H_C u m N UI ‘viii 01 N 10 UN N m 0N 0 `,..h 0 N N aE u m m um m 0 m .0 Cu :2, u i E. '� '3a, TAa.iJ a-<Da1 a'5 1 a a 2 to m 0 m N 'C2 3 01 mc — i v av _Lui U .05bj, Em cdod0 N git' w N.O,C vvd C SN �£ ancd,am Un 5-"E 12d ::',5{11' rnm uoOi m 3v2-oE ma0omv y c m m V dC w p EEca m avo m N o n m dFmv doE3uNy c;;8 tiv E5>' .O Ou La ti- TIP', 'Cwyd 'ou m vV5vc mu=Nm QWO cypa ZE u o0)2 ` -,73.2„ um odoU uuo. im vCma L_ £ m u m v mjd —C d 0>D� = c Zi OvO t5. 'a3, ¢ w o y C En ic iUna0UU aummma LUU3 w Nnun aod._SWu w nm a0 rng v00m vO m w.17. sm Core Activity Tasks ›� {t « 3 # t • \}�\�\}� \.k #\!]k2§§at`` ' ® ct.0— 2:\»®\\® !! ®©®\t#)&;! §¥¥!/ yo -.a u {/{,.{ \\ ■`!0 co to el 0 oo000000 co \i zb ®®k! g 0.1 i� 0/ /\ _. n £ �a—,3 o $ & E '1! \akaa. \\§\) `� ©`*®� ae(£>!;®a` - SU �ak){})k{)\ \E ,-22*\�e�( ea §t», ! , $ E/ 2 2\« 7/ E ■f«»f x�eu2(0 e§»&§(� (/)90-oE)(( 27ƒ}£f)\±?) ta2f3�<�� z Zza*±IJ*k2$) U N � m N C Deschutes County Health Services FY 17 Requested Budget Analysis by Project iknalysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Reenue Sources Total Resources REQUIREMENTS Personnel Materials and Serces Transfers Out Capital Outlay Admin, Support SeNcaa&Overhead ,onUngancy rotal Requirements Program Serices FTE Admin and Support SenAces FTE MCOP, $ 232,855 295,617 5,834,193 200,113 939,279 $ 7,502,056 $ 4,818,975 627,413 2,011,006 44,662 $ 7,502,056 48.87 10.69 3% $ 105,244 0% 4% 328,244 0% ' 78% 6'376'403 3% 182'909 13% 347'868 100% $ 7'340'668 64% $ 4,870,761 8% 468,920 0% 0% _ 27% 1,991,673 1% 9,314 100% $ 7,340,668 1% $ 127,611 0% 4% (32,627) 87% (E42,210) 2% 17,204 5% 591'411 100% $ 161,388 66% $ (51J86) 6% 158,493 C% 0% 27% 19,333 0% 35,348 100% $ 161,388 Programs/services:' • Services for individuals, children and families struggling with mental illness and addictions in a variety of settings including officehome, schools, and the community. • Assessment, behavioral health treatment, case management and medication management. • Services are provided in Bend, Redmond and La Pine. • Therapeutic classes are available addressing anxiety and depression management, addiction, Living Well with Chronic Conditions, seeking safety, active recovery, anger management, trauma, and dealing with loss. Changes/issues: • Decrease in OHP revenues. Clients/population served: Population: Children, adults, and families experiencing mental health or substance use disorder challenges that require specialty mental health intervention Clients served: 35,668 client visits to 2,674 individuals, averaging 13.3 visits per individual served. l Deschutes County Health Services FY 17 Requested Budget Analysis by Project 'knalysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Revenue Sources Total Resources REQUI REM ENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead "ontingency Total Requirements Program Services FTE Admin and Support Services FTE BH Contracts MPCON FY 17 % of FY 16 Revised % of Budget 2,292,510 72,000 $ 2,364,510 2,364,510 $ 2,364,510 0% $ 0% 97% 0% 0% 0% 3% 100% $ 0% $ 100% 0% 0% 0% 0% 100% $ 2,338,373 20,000 20,000 72,000 2,450,373 2,450,373 2,450,373 Variance 0% $ 0% 95% (45,863) 0% 1% (20,000) 1% (20,000) 3% 100% $ (85,863) 0% $ 100% (85,863) 0% 0% 0% 0% 100% $ (85,863) Programs/services: • Funds are for specific drug and alcohol services and are used for contracts with area addiction treatment providers for prevention, indigent addiction treatment, and court mandated DUI' services. • This also includes funding for residential treatment services for individuals with complex mental health needs. Changes/Issues: None Clients/population served: Population: Individuals with addiction issues and those needing residential treatment for complex mental health needs. Clients served: Service counts were not readily available from contracted providers. 4 Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Fiscal code: RESOURCES BH Drug Court MFDC FY 17 %of FY 16 Revised % of Budget Variance Beginning Net Working Capital $ 0% $ 0% $ Federal Grants 201,697 100% 201,697 100% State Grant Award 0% 0% State Pmts Other 0% 0% OHP Capitation 0% 0% County General Fund 0% 0% Other Revenue Sources - 0% 0% Total Resources $ 201.697 100% $ 201,697 100% $ REQUIREMENTS Personnel $ - 0% $ 0% $ Materials and Services 201,697 100% 201,697 100% Transfers Out 0% 0% Capital Outlay 0% - Admin, Support Services & Overhead 0% 0% Thntingency 0% - 0% Total Requirements $ 201,697 100% $ 201,697 100% $ Program Services FTE Admin and Support Services FTE Services: • Grant funded program administered by DCHS with funds passed through to service providers. • Intensive services for individuals who have come into contact with the court system due to addictions. Offers an alternative to incarceration. Changes/issues: None Clients/population served: Population: Individuals involved with the court system due to addictions. Clients served: Direct services are primarily contracted out. Internal services provided are included in the Adult Outpatient numbers. 5 rn Metric (Outcome #) ved by team, Action Plan 0 O N a @ a) E N vi aE o a a0 u 0). ro � m m O 70 75 E5 o 2 c u r2 Tf Q) O Y o c a E zn v 0 tr CI' Y 0 0 in S3 00 Q� W atri 0 m A O 0 a0 E 0 v 01 .. a+ m C c c c C o o 'o al 01 c an c 0 0 0 0 yat 01 C y G G 01 to' 0 0 C C a a 0 I c 0 Q1 O Ti E N W N N a E c0i 0 0) G (0 � � W N N N a) 1D VD tO t6 M .-+ ti .~-1 .fit Nel el 0 u U _ T th symptoms. to the needs of 0 m 1. Clients exper h N m C ar d ar m m m ro@ a a7 00000 U u .2 t0 f.7(7 C7 C.4 C9 °a "' dr a fn 0 Outcome & Process Performance Meas -a -0 U O O o O O O V1 O7 ip W � m m @ 7. ++ 'C C 2 'C C N ,, N 0 Q z Yn a z II 10 INO w m, a W IL Z W 9 Metric (Outcome #) :n O 1-I in which AQP Number of community event Personnel Allocation rev 00000 0000co As appropriate Therese Poncy, MSW, QMHP Marta Richards, MA, LPC. CADC II, QMHP Christal Rothrock, MA, LPC, CADC-II, QMHP Chrissi Wright, MS LPCi, QMHP Janice Garceau, LCSW, Program Manager Core Activity Tasks 6 d u E 0 F). E systems & resources 0. et 0 << < < < ..... .... -. .- z z z z z c. F0 0 c. . 0 0, f> -5 -5 o 5 t 0, 0, 0, 0 . 00 o 0 0 0 8 0 Z Z 0 < < < •••••. *(30 a a or 0' 0' 0' ¢A.-gaFouE'rece -o -o g 1=1 6 .y8 trii 0 E 0 0. n Lead: Mary Operational PI Desired Outcomes -o c ,- ro "'',., 22 .2a) o•r••• E ao a)0 .. as To 00 x= E inc.' 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E L 0' 0 L 0' O a• N N 0' O t > > m L a)• @ EL w @ c c w m E a 0 ▪ O L U z Conduct safe school assessments Supported Strategic Plan Goals 0' z m C U a 0' 0' C C 0 0' 0, O 0 0 a a a z z z 0 0 a O O c E U .5 m C V m 0 U z ai c � j U m C E U 0 0 U O O 0. ro June 2016 E Z t w ip.mpc PONC N y mm mc c 0c `nuu.00 3 0 > 02 -c-0a m :Ty ca • O.O Ca' C o 42 f O o m u°c0 11-, 45 '62 cm e m majo a Co c « oa�nYVo7, a'Voo0F0O•>O Cu� C Ecr'0 omc¢u@c um EN1E •m.TE'@'Oyti.0 .0w do to' UL iw L„U`mi2 oS p a ,m, 0a°,m a 2 EL a va 01o. nal Culture Outcome & Process Performance Measures Metric (Outcome #) c •0 O 0 >. E m a E u 0 0 0 E E 5 c 2 E 1..1 0 a) Vm O' E .5 o Y O W Q d L L N 0 0 o . ?L;' o m u m m p 5 w o n m y O E a c o.• m 000 0'0 0m o z c m o c] c 0 0 O O. E >. 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N w dC 6\ C dm C 0O w N ww0 .0 'CQ v a• ` c i 0 ° o E .E- 1- w.c o N ,.. o I 0 a 0 m l 2 0' x mo a E w o aN Z E w Z � •c v v 10 m. . nE+ V a y v c y O E cu w w w T i E E x E a a o w m w E W '[az' U= s f LL w Allocation Jodi Love, QMHP 0 5 0 O O O .21 .21 .-i Misty Groom, QMHP w isis .0 .� O. 0. 0 0 a a n n m 0 0 0 O .0 C C O1 m N .N a a N N 0 m c 0 m w u £ n N E N o_ W O o C V% a a � 3 w � 9 N 0 1 nE r 0 \0 § ] !° N r4 )173 \ / o0 0 2a 2$ Desired Outcom Supported Strategic Plan Goals 0 / R { 1.776 \\ 2' rsi 12 to 5 0 3 J §t§ 0 0 ) 0 0 f Michelle Anderson .tenni Stephenson 0 e _^®!:, E e. • 43 g.E 911' � f7\Jf{!5ƒ;! Core Activity Tasks Personnel N m ' t O O.- Q- - -.�.. Ye 0.a. d L 1 ▪ a, a > fu c 0 -i0 0 -Q m m Ea'C 0 t V U cm oUcu u 14 'n cav—w rnrn Ti rna u c m T c.iao m Yma ia :'Kwvzin Nv T\cuFo'ov a°cpN71ES m E wpavuN -FaE QaNu !¢ ¢z a0 mu v0 ¢ o a r- Li) N 0i,, v o a CA t- LL u w bo¢ vuouoEu G rE (%w c ittLttttLL go 0 0 0 0 0 0 0 0 0 Evan Giudice Christen Danford Fred Doolin Michelle Anderson Kevin Shaw, Supervisor Action Pian Administrative O 0 0 Program: South Cou 0 m w 41) N O 47 C C C • m 01 m 3 Q 4 0 E t- 0 u) E SoCo Team SoCo Team m 0 m cn rn C C 0 O O E t- o 0 U E N 0 C O 1 SoCo Team SoCo Team C 0 Desired Outcomes O integrated community services. Develop and main 0 Outcome & Process Performance Measu Vi 3 A N 0 Metric (Outcome #) T 0 O O c b a m E- c m o o > o "±); c a N a ¢ iti =E _ \( 2 / : §/ § is — /) .... -8 \_\/ /) �/3 r - !: /{ E0) k\c. \- >. \ 2, �5f=,� - |$»A&f 2[ E{557§01ƒk=\/ I{ \;,-u. 1 F_ 8. 0000 ca0 E o 2o. E 0 2&}Lf) e_2-0& mEe }o2B__ [Ea§aaee;e2&k::.: F. })\{ 2£242.td2a#a�Ea§be_ji m+a Core Activity T $8 • E ■a \ (0 \ \ Fri o ( • ( \ To o \ E \ \ E 8 E 13 2 .9 )\.0 �(\\ }�£3 Behavioral health assessments .92 E§ 5ca/ k/ 2 to ® t\ //,/ FA a }§ §f' 2 Case management Trauma informed care 0 (Ein' 30 o � \ \/\\ (\ \ E > ! k E E /) a 3 ] Action Pian rn 0 0) c 0 Jennifer Weeks Program: Maternal Ment Id, LPC clinical supervisor Operational Plan Lead: Elizabeth Fitzg 0 -0a ' f -g12 CO d L L o .0 N 0) E 0) 'art" c 0 a, 0 01 C 0 IUC aTi t' i c ro 0) N i 0 Q y p E 0 E a`r, EE O2 0 a p F 'o c o d a .VT L N O c o d U to N fr = V) y a• O � p, y S. N E 1 U N E N a E E ' N E ro A .c u ^� x ro> v m o V 'a c n ° c 3 5 �� m u m 41 > 0 'O E c y _ti,,, o m ro N ,2‘- !!!:!:!;;;:5 C to Gt sroJ w a v1-4, ..-em O t7 d U c c ,1a, ro O 'a - 0 0 > v N L�. v� 'E :� ro a a !¢ a 3 E UU)) a m W )i Q a Jennifer Weeks 0 10 rsi0) ti Jennifer Weeks Desired Outcom 0 Reduced risk of high adverse childhood experlen Improved social and emotional health of at risk I young children Increased access to maternal mental health sery Supported Strategic Plan Goals Outcome & Process Performance Measure O o = G O 4 O 0 0 E c c ro t m a ' o a1 a. # E E .o ° .o V c to V 0 N N 0 W V Ov 3 a Y U) N C d N U c N L ;FigN 0 O' N N .0 • 0 3 0 a O o 5 w s 0 ,C, Action Plan y W 73 n m 20 0 U W 10 0 0 •0 C W ol 1-4 N a A H A. Direct Service All LMP staff m O All LMP staff T O 0 Ot C 0 0 All RN staff m C 01 C •0 O 01 C 0 0 O1 C 0 O m Tr? 0 0 t0 M .N. 1.0 M m c 0) 0 0 All LMP staff Y a F m c 0 O m C 0 O n � b t0 -I 10 M M . .. .. 0) M 1170 N 2 J Lori Hill/LMP staff Program: BH Medical Team Operational Plan Lead: Lori Hill 0 a O 0. O C .0 ▪ C U 7. N u N E a R " G a O C N 0 To c @ ` 0 0f) C L w r !0:1 0 o a .- p y 0 0 = U C V V -0 c 0 UTI "0 0. 0 m 0 E a a C j i0 0 o d a v1 o 2 • 0 0 O 0 m d 0, u 10 c a E•5 Desired Outcomes N 0 1C4, 0f U N C t a 0 .-1 N 7 d 0 0 0 o O z(5t9((D)2(5 0 a O. co 0 O t.7 L9 Outcome & Process Performance Measures N 0 0 (0 0 .O C• _ 0 c"0' • c 0 '• —y a a m Metric (Outcome #) 0 O C 0 N N 0 0 C 0 a C 0 'v a N 0 0 0 m z 0 C 0 rrt N N 100 m C a C 0 0 N v o N 0 C Core Activity Tasks H Lori Hili/LMP staff Assess medication effect' c E T Ero E O U N O E V c c E m u m uT 01 - o n -C n � U)v w • u o o n c m m E. _ 0 L N E c v • a � O E_ n o N 0 W y V L 'O i ui .3 0 o m 3 c...J..E_ .N. _.L .,_ oiocp 01 _ .0yV uQ aU c � 2i E O u v N 'Pg. cE O 10 i° w C .Gv E m yo U°yo c N avy C p N u• w a E. 0N'N a+ • C . c C 'O U 'N rU • 3yui aT N Cc''a y v Y R oN0 R: 9oENOvco '6 ` `a2aw>E¢:•ua'.aU x¢ 5 f U i & 8 8 2 0 `00 N 0 •3 • Hire a Medical Director D. Provide and Participate in Professional Deve opment and Training 0 0 O O 01 O VD 00 U N 2 N E a d a C ON N Q m O • U O • 0 0 ! + 0 + O O O N O O 01 0 .- 0 Julie Aldous RN, QMHA 0 0 Mary Brothers RN, QMHA e 0 0 O u c 0 0 O 0 0 m E c C 0.. 0.. 0 0 10 O O O 0 ¢ n _O m E a 1 d o' za_ CY = z E • r = = 'o a z d N c 0' a N G z °' a = E O ° 0 • m c c` E m U C7 .c o C 0' C d^ O !n o c O r m E U y c a m c 0 L 0 N o. c >. 19 N Y v � � v1 � r= � Kirk Wolf MD, Psychiatrist Assist with OHP renewals Deschutes County Health Services FY 17 Requested Budget Analysis by Project \nalysis by Project Program Fiscal code: RESOURCES Crisis MACCA, MACRIS FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 78,315 6% $ 55,511 4% $ 22,804 Federal Grants - 0% - 0% State Grant Award 680,807 49% 729,209 52% (48,402) State Pmts Other 0% - 0% - OHP Capitation 285,613 20% 432,070 31% (146,457) County General Fund 67,886 5% - 0% 67,886 Other Revenue Sources 289,613 21% 173,364 12% 116,249 Total Resources $ 1,402,234 100% $ 1,390,154 100% $ 12,080 , REQUIREMENTS Personnel $ 794,503 57% $ 811,112 58% $ (16,609) Materials and Services 258,347 18% 216,562 16% 41,785 Transfers Out 0% 0% - Capital Outlay 0% 0% Admin, Support Services & Overhead 34.9,385 25% 342,144 25% 7,241 "'ontingency 0% 20,334 1% (20,334) Total Requirements $ 1,402,234 100% $ 1,390,152 100% $ 12,082 Program Services FTE 8.49 Admin and Support Services FTE 1.86 Programs/services: • Crisis Team provides crisis walk-in services during clinic hours, and assists with critical care coordination for hospitalized individuals or those needing pre -commitment services. . • Mobile Crisis Assessment Team delivers rapid response on a 24/7 basis to adults and children experiencing mental health crises and at risk for hospitalization. • Work with law enforcement and contribute staff to the Crisis Intervention Training Program that assists officers to respond to mentally ill individuals experiencing difficulties in the community. Changes/issues: • Decrease in OHP revenues. Clients/population served: Population: Individuals experiencing emergent levels of mental health related distress and/or may be a danger to themselves or others. Clients served: 2,779 client visits to 1,042 individuals, averaging 2.7 visits per individual served. 6 Core Activity Ta c c o d 1'1 .0 To 9E O 0 u =.= = u u _o O d d 4 (0 c La O = O 0 (0 N T.9 -Eo a 0. 0 0)) o o —0 d u O W C -00 a 0 d E c m 1 N 'dam t w (0 D N -7=C (0 Y d to in w ,c., 2 td m o •`,÷,' = 0 - 0. _, `u a w a u 3 U00 L 44 0 0. 0 5 5 c N a_ 0E 2 u` w 0. 0 2 •� N .0 ' y E E d '3 V C o y u0 U 0 U Case management 0 a L E 3 05 24, d a w 0) C O Q d c c 3 '1 C...3 d -c Y OG • d " (0 O N C L 30 0 w', a d N j u .m N m c a U W 03 3 C 0 )0 a UC' d £ 11,,' E N ¢' O' N d U E o. V, 0) (0 > > U 04 V) 112:(1) co < W .i l0 c t C .0 a N N 0 (0'3 O m CD i c C .0 1n 0 C y '" a C' o E i0 0 O 3 C >. Q) '- 0 4>,Ed�-dd�a1da V 0 (1 > 2 N 7 0 0 5 U O 2 9 d d 0. a ut S U LLl li VI a, W IncR z.O N •N E O d ` O E ° o c v o w s C a 0 E J N N 0 z' a m u m d •0 > c G d = 0 E a 8 2 al, E a 0 w w O O d to . y y v I=v.�N E.173 o F a > 'C a u d N C o N T u 0 H C 2 40 0 NO. E. Crisis Administrative Activities Data as to number of individuals Lindsey Poullion seen for crisis psych appointments, type of insurance, and % kept in house. Personnel 0 O 10 00 0 a+ Anne Muir, MCAT 3o o Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Revenue Sources Total Resources REQUIREMENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead ' ontingency Total Requirements Intensive Adult Services MAI CS, MASPMI, MATSR, MAEMP, MAPATH, MAMHI FY 17 % of FY 16 Revised %of Budget Variance $ 424,890 8% $ 0% 1,114,015 20% 22,000 0% 2,875,653 52% 544,276 10% 551,929 10% $ 5,532,763 100% $ $ 3,127,764 868,339 1,501,162 35,498 $ 5,532,763 314,729 1,208,541 22,000 3,303,547 664,869 415,751 5,929,437 57% $ 3,479,732 16% 854,679 0% 0% 27% 1,555,803 1% 39,223 100% $ 5,929,437 5% $ 110,161 0% 20% (94,526) 0% 56% (427,894) 11% (120,593) 7% 136,178 100% $ (396,674) 59% $ (351,968) 14% 13,660 0% 0% 26% (54,641) 1% (3,725) 100% $ (396,674) Program Services FTE 36.48 Admin and Support Services FTE 7.98 Programs/services: • Case management, counseling, medication management and treatment for persons with severe and persistent mental illness and/or dual diagnoses, and those transitioning from the corrections system. Specialty services include homeless outreach, supported housing and rental assistance. • Older adult services include intensive treatment, outreach and consultation to individuals, family members and care givers. • Assertive Community Treatment offers intensive treatment, case management and outreach for individuals with a serious mental illness who are under civil commitment, are at risk of being admitted to the Oregon State Hospital or are under the jurisdiction of the Oregon Psychiatric Review Board. • In coordination with Mosaic Medical, provide integrated behavioral health and primary health care services to individuals with serious mental illness. Changes/issues: • Decrease in FTE due to internal changes to better address service needs. • Decrease in OHP revenues. Clients/population served: Population: Individuals with a Severe and Persistent Mental Illness who require intensive community based services and Torts. clients served: 32,105 client visits to 550 individuals, averaging 58.4 visits per individual served. 7 Deschutes County Health Services FY 17 Requested Budget Analysis by Project 'knalysis by Project Rental Program Assistance Fiscal code: MARENT FY 17 % of FY 16 Revised % of Budget Variance RESOURCES Beginning Net Working Capital $ 16,202 4% $ 0% $ 16,202 Federal Grants - 0% - 0% State Grant Award 394,796 93% 771,276 100% (376,480) State Pmts Other 0% 0% OHP Capitation - 0% 0% County General Fund 14,044 3% 0% 14,044 Other Revenue Sources - 0% - 0% Total Resources $ 425,042 100% $ 771,276 100% $ (346,234) REQUIREMENTS Personnel $ 140,513 33% $ 154,125 20% $ (13,612) Materials and Services 199,717 47% 505,962 66% (306,245) Transfers Out 0% 0% Capital Outlay - 0% - 0% - Admin, Support Services & Overhead 84,812 20% 84,698 11% 114 "ontingency 0% 26,491 3% (26,491) Total Requirements $ 425,042 100% $ 771,276 100% $ (346,234) Program Services FTE 2.06 Admin and Support Services FTE 0.45 Se rvices: • Rental assistance grant provides financial support to individuals with serious mental illness to assist with their rent. Guidelines allow for partial rental assistance. Changes/issues: • Change in method of accounting for prior year balances. Clients/population served: Population: Intensive Adult Services population (Individuals with a Severe and Persistent Mental Illness). Clients served: Included in the Intensive Adult Services numbers. 8 Metric (Outcome #) clients for the time frame) (1) Program: Assertive Community Treatment (ACT) Operational Plan Lead: Becky Eiger T .0 E E u a) C 0 ID v c c a) u c m ac) a.0 a m m d 0 E O •c V m Cc a) U N Program fidelity score, annually (1) Supported Strategic Plan Goals Action Plan 5 iim a Q a Q Q Q Q a n0 z z z z z z z z E 0 0 Due Date m 0 0 01 pi O O On On OnO' O� c c_ c_" '0 c c M ',y M C C C m N C C Q 0 0 0 Z 0 0 9 ''0 ga d Q Q Q Q Q Q N Q Q m Z Z Z Z Z Z a Z Z N IOi Q 9 N E 1.1. C .N a E E E E E E E m E E E < W r Y 2 2 y> 2 a a a b b b a m< b a a I as°N m u 2' am. CCNd '.T. N 2 C d CCE Ira vNm om N Y. mNy .c ' N m c O' c , 5 E 3z d Nm9 0E .8 c o'y 3 aE aTmOaS u m t'E m° gON15 a =ai o m m = o 9 a! a, a o' c C f• Ig m 8 a, , ft o u o ' o. 2 oF LHa ''>' Nau e pEOa vyiC E cm i v u E E T ydE' h o '"� S m m Ir. ; u > a) 0 3. 0) rill G vi d �.ll w E u E¢ m: 1'n c w w ¢ 1 U am' -1 a` u< n n C 1 .-I N M C N 10 1, C7 C7 C7 U' C7 C7 C7 Outcome & Process Performance Measures Metric (Outcome #) E .t2 a 0 a G a) o :N a C C m o 0 = 3 m Ic m a E m� d 0.y 0 O E C E. m u Q 01 c a m •c 'O C a .0 o m 1O v . 53 E5 °' 0 5 o C N 9 2 E n 2 0 .. aS N 'O 2 ` m a co 4.6c'" y E l''' ii w u v c a 5 ,O o E m -0 u c ✓ m n n O di El ▪ N n• a m u, .0 c V m E vy d' y0. p..U1. m 0 m y m N m u Qr — N Y hiC... A cm7c mY m N gto! gcca c 'u o6rnw¢ t • Q n m •m _= u O " m • `vw It GV3 7mtOY>EyLO O-3CT'33- rnm° ^ >.,-.-41-‘ u, il crn`ot woNoNP.o3ELaw'ac2ncwv.0rnrn.gNgv'�1!g'nEO a 0 C OnO c pWupE'EO= vON L U b, m N d 0 i 7, '5 o N C m lyl yU mOOc, v 9 U L 12 1 m -.0U k y 'N y a ymv2 E . E o' E >t im v, .O c 7-0 N m t ° C i. Omc2cmN m O mumO `dm ., 0c.m`0oN—.OdwOW U .4,fEUnafNNE2�¢a�§NN2LLaa0KUF-'aU'�UZ2¢EQmQQYF-NWJ-T0 U -f Due Date 9 N • A �N Q N Q Z Z y M (.1 C C • O1 E 0 > O T O OO, Ol 0, T N N N O O O OIL L1.1 LULU LIJUJLLLLLtttt 0 0 0 0 0 0 0 N N 9 9 m w LL u°± LL March 2016 Z Allocation 9 d m a s a a m a a E o z z z z z z z m o U L v i a, 0,c it Tm 01 0= vNN O=• N O O dvC c m E d vOO O 0 a v E cO of /m1 1 o E 5 w, E F D l0 C ,o E Y L.O yE 9m u m li N C lD ¢ a a Q a a a a 'y 0 Z Z Z Z Z z Z Z 2 al rn u G t m t v m o o 0 0 OE m N N 0 m • o N LO 0- z z '-;"' m 0 O U t+ O Q 9 al 9 m c 0 v o c a m c , o V E E E a E E E E `o v y 'N a a. w . E 0 w u • Kr v v2 jm ao. u °_ Q W om01 CO i 02 aN� N - 11a aa� a aA a E a Y z OC mv a E aHm VN NN 7 c T 52 9 —0 y y 0 :2>' c T NT O N iOV 6c • iiN C 9 5 I 1 G Y3mg m 03- oQ C vE E d 5 a E E E E -o a oo3vm U a o e EP- ET° w. ua 'y 2 • "• - `^ m or o m N . -m nv E UO c v ato cCa ...-d$ O N a cn 30 Y �` u V a vv acU Y52No$ cNomQ YC > m m v E o W 2 mm.. a W U V a V i Co2 �5`^2, N cLU Z E 'j mNvvnoc o cvc n o E a a 5 o. o m w 9 ovaorEaov o= o v 9 ? o 2 ` a 2 2 8 l' ° .;:° 8 2 5 m 2 o" 8°%u 'm am o v = Ua''cmg' ivovtTomaiUw nc-rc cmcuo 9 ,c, U a o- a- Eo.5vac % E 0 iE°aoca° 0ca0 .wov'' Metric (Outcome #) Program: Psychiatric Security Review Board (PSRB) Operational Plan Lead: Becky Eiger Desired Outcomes N_ m O y N v, a v m v v 2 0 3 Emy C O o Co U E L C O y 7:5 ,gri 0 U W LE m • O m(0E o = Wn o o (,) E Ea ..r E.° ••2 m Ea'. ° o o o ,,. 3 f ooy 0 n opm oo,o2 L' m 2 E m0 2 E 1,2 m +▪ m' E 'CO C li W C l0 it /C 0 0 m IL m Om ,c,E t �a o 0 _ 2 .cm v m m d TvB Ro O 0m U(C Q oEVn oo W .4, ✓ co v m> i- E c .omw v Ln m oc>. T p, 2 O_ .-F, = N0 d w 2 a m T 0 0 �q a c m O' o m m 0 (0 10 v m s ' m EE • > 0 10CE m ? °E m'o 2 $Nm yu Ecai 3NT i E m c> m yc mo=a vzV"0a8 u Tcf: iro ,":1u c v O, E rn c H O 0 o- .c Ce co a g cc A a` w¢ • W o u 3 Nw .Y� ,nN N °. . H .y N v,O a;.Nl ° d c c'> c7 a in m dS m v : v N a z V� N 0 0 0 0 0 0 m , N U S ' v U C 0 0 a t (-9(..900(...90 £ `o T `o v `o s O 3 O• Y -'a v v v .ti ni ni + u u v u E a m a m a `., Me ul Ou N vi 0 P2 K m j v a+ w m c c U a o p a y U n a yW U p W p K E i o d c K v. m E o C+ E m m i E v y o 5 m luA E > m * w 3o N12.0 - o. gLi anVCi E1 pcvnen rA T'oE.'oUuEE .c Eoreo,,1.z.cao c c a E 3 v 6 o. of E .� m E` c 2 m E n e p o 10 c n o omFn - cE �E��m mm gm a >� E m o c a u' > ¢Llg m=wt-UdU2a IsaUU=a o m •. U a o ui d d c m 0 U Allocation m v d ay" c a c O n 0 y m 0 O o a N c H O 4 Q 2 ul N • ier court 0 a C outcome tool 0) U a) LL o o N (0 O 0 C U " L'• m CU m i Core Activity Tasks A. Act As a Safety Net for Clientele d d r a E° 0 01 E. Ln0 T i'''c 0 0 O E , ¢ in' at E E " r▪ T, T v n O rn 15 .5 O o al c O 0 Allocation 0 0 0 0 0 0 ti ti Melissa Frazier DD/MH coordination (group and individual) 1- 3 Action Plan Due Date Jan 2016 Jan 2016 0 N U 4J 0 c O 0) O O1 c c c o 0 0 m o. 0) C 0 0 O O 0 rn c 0 0 O 0) O Q ).al C i C o r- 0 = w 9 r- ,._'- To 10 i0 U la m f0 `m •C L N O _ N m @ IV) � U) � U1 N (11 In m u fn O N In W w w m w w w w a W W m W W W (l) !n !n Y (!) !n In (A 9 N N N E )n !n )n Q L 0 1A C O C O) O) N 2 m C O O o �/+ O co at C O) d C O O a y 4. Ill On O N o �v0i C o3 u C a p •� o ,—', a y )- in E K m t 0' E 'F • m Y y '� a..V a •E O > E o E .v a n .2• � u °1 yd 11:::::, u E ,� o w o Q a� �n a) O m o °a c a f0 n E c c o o`` c ,L = E .L., u O m t o t a a w O iti p) m a N '3 N N o 3 .� -a', O• o m' tl y m o o) > u 1•. 1p O 7 aS G C (0 T Y U1 V ) T = d C In 0 Q C 9 V c o `o E'er a� o m v u v NY C c a o .N= �C m E m y t- m F E ac n° o ° "° a .�. v o> fA H pap riiut o c ars c �+ c c 10 a) u) 3 u o ? c o 0) $s -3 ',.,74 u d i� L 0 c a C w_ r ° .3+ o US 0 O N C -E a= a-' O O. N N 'L' = O 9 C a) O •u d 'V al y m 10 C a 'O o °� Y s_ t a .0 pn .a 9 a O IL 'p 0. ur = ,., rn a 2 rn 'C m u '9 a) .. o n ¢ :u Ch c a� m '> `m ••E aZ m ^ o, n m '> v o E E u '" w > o > > �' O u a U) O N N' O0 > C O V O O) ` O i O O in <¢ o a` _ w to )n m D a E a m m E `o a� to = p. U U U w C a ui w m a) Program: Supported Employment Operational Plan Lead: Kara Cronin Supported Strategic Plan Goals u v w 0 m O O O O O O O O 00000000 0 Outcome & Process Performance Measures a)t 3t0 %'D 0) N an) In t N 't rq O al IC 0 L .) vin v o H L w n ( V2 m (.7 -o 0) 01 a1a+ 0 O O O O 1-- ro 1- To u Metric (Outcome #) Percent of clients employed, quarterly (2) Number of job starts, quarterly (2) 0 N 0 an .) O Fidelity score, annually (1,2) .0 a v N N E o u w E o 0- o. 0 C O o E u 0 > O 0 ut u a 00 0re) N Core Activity Tasks N m C , S oO °Q C o ci. C •`- R 0. w w j R O m N c m w G O C as o. Z, C cg•c o :, > n -m 0 3 f E N IF m O Q - _ �YO ,..0 w C I c c gull, Ir , J L U] C dw w .1.-, O O diO 0 d=U 0Cm6 6 Cy] �.Ug.. e m Ow C UOO N L- y 0 Y uC .c 'y . o != uc °m 0 ` c == c C Ro.icwwwC m uoo ofmN uww „Nmy maa rC Clc uC C L..? .7" 1' a ff§ tA okyv tus N v o c o w w g a g ] E E r m° v p N w d o t9an o ru dc o o 'rn ?EnVocp;o o o v o N w 0 n— Z Ca ]o 0, 2w^vaIom Nf0 vNa] m>. ] m w w c m,o� ow N w F m o >. w y o m poo0c ';c IS o .n " m 2u 3 YE. t; NE .a w2 E E c ya v > umi 'Q Zm N ._ _ U .O i v cu ^ w o ''Q w c N t Ea o N; E x-, E v >0, a P]E o 2 u S' K !S.`0.nnN v S v uwVw] 01 u 'V. 2w >w a, 'en' O Q m U a 5C8QO82 202KU O F - C W fw UJ.00 0 u. U F L > K O O > h d. K U -O O :Lb'E Due Date k 0 S N 0 C a O 0 0 `0 v 0 2 N Q 0 0 9 V] IA 0 0 .-. .ti 0, R N N N 0 0 a .00 E a o N 4 1 Sarah Haefele Sarah Haefele Sarah Haefele O 0 0 Sarah Haefele, LCSW Team lead ,n Action Plan d la dy cm Eo 0 U d m c c = m o) c c c 0) 0, 0, '0 'O 00+ C c c O1 T c CI = O 0 0 Oc N O G) C d t d a o > N a C c E E o C 1 O O O V O O t 0)'= y a c c c 9 c c < E W v 5 w - v vin 6 (0 01 - 0) C y O >, ( G N C - .2 a Ol .2 (0 1 3 Tu 5 V O U t 5 O N C W O) N C ? 'O O C O 0 N O N o 0 w a c va m> E u� E as m o o E _ 'y v 'o C .cC .c y c v o (0 y I y a5 a L u y a 0. .0 0 0. 0) O) m 8 @i V c 0 .0 N (0 ~ !0 c C w ++ m O O) On C i O d y C N C O o C G O = C 0 O C O 8 C v a 0 v 0 u N m 0) E a c t' E c u 0 a` v o) v' u_ •- a E 'o m 2 )p L d 'v v > c , a U` Ou L o.2 a `o m m 'C m (a a` E¢ O av 5 to a m a 5 3 U Ui,5 a .v C Coll Col', Col Col Allocation A Program: PATH Operational Pian Lead: Kara Cronin Desired Outcomes Supported Strategic Plan Goals 2 2 0) N 0) 0 (0 0 0 Outcome & Process Performance Measures Personnel Actual Target Metric (Outcome #) O n t '0 t' t' O O N D. wIn Din O. �� ti LL 17.1 T�T4 h' 0 `G 0 i 0 O I L f N U 2 ON 10 E ON NO 10 -2 O O O O - a . -I' NIO AI N Al AI C0) S alN H 1O a o u, L tv 0 (0 0) a o y 0 — N G 0 v 0 "i 3 T E T o E 3t ut 0 2 0 Q A O' .O N (t.L ` c 412 a d a 2Z' 0 o c N 0) 0 0 u_ .0 m E Z E >, 25,z''° L 0) c 0) 0 0) Y icj 0) u T F N 0. 0 0) 0) a u N z� L,7 0 0. V c 0 0) .0) co m " 'V T c (0 c c 1' C 0 v 0 O Ea a5' d N N m a a oa N > t il ca Ce aa orn 'yy B. mc •c 'N E -c Cq• 9 'Ili il tNvUNcNmamUC It Q m U vmcY eC_mOEOItc a'° 1N. -" vmlcwa NQuvo1N2 ptaY LLu�YYrvya3atm_aOm aH uaa dO c o iUKaw no;o opa-¢'UoUnz ga>mOm wG UVUUKuM Umi< 0md v o d Action Plan VD 01 C O M M 01 N N 0 O O N N .0 y .� N 0U) 3 10 - IA N L 0 .y 01 0 0 N O 0 0 0 0 N N N N N N U 00)) 0 O N N 0)) 0 N y 0 x 0 0 0 0 0 Kara Cronin N N y 0 c N E 0 E m m 2 U u 0 u t� 'C N C Y z E z E G) � 01 L N i 0 O L >N y N 0 . y u c c O m C i El?... -‘13 -0 0 S yLN a .0O O ' a mu CmV.L ...-.E r`.; 0 m0)0> yEE dovuSE d mo m`o$ou' o >.E 1- C « u L :-.5-0-07.2!.32",-, U- 3 V W - >, Y CO >, E 2 9 0 0 10 T.O -.2; Ip f0 a 1- w; 2 V N '( C C. C 2 O y Q 0 0 0 U= a O. 0 -O N N Q Program: Older Adults Operational Plan Lead: Kara Cronin Desired Outcomes 0 R = J O 0 y 0 m p O aon T.0 m vo o - m Y m 4., 0 0, 2=2 2›4', 0 m U O O1O 0) .0 U L O. Q Z' O U fa 0) u w y L 0 m E > > N C O_ y O N V v O E9 ` !.c2 u=m0 01 m 0 u C u >.2 N E n�O`V u N .0 _ O. ` U UEI m m E U N b C d a 10 C N m m N m° j�> U ' 45 2, 0 0 C CO tL N Supported Strategic Plan Goals Kara Cronin N tel 0 N 0 N O 20 O u 01 0 c O 0 0 m O ti Monica Ramirez Allocation Continue to identify other Medicare providers for external referrals, ongoing Update list of Medicare providers for external referrals, annually B. Treatment Interventions Determine a way to track time spent on calls for pre -enrolled individuals /communitvpartners Therapy and behavioral interventions, ongoing C. Coordination of Care Determine if the Older Adults program wants to consider level of care for clients, and when to keep clients in services Find a way to track the number of miles travelled for work Transfer and close case management phone line Personnel Employee Kara Cronin, LPC Nessa Wilson, LCSW, QMHP Monica Ramirez, QMHP Outcome & Process Performance Measures t n t n -E n a .... a o O. o .c v=( d 0 N d 0 I a a.a it In 1.2 N ir N jy N O m 01 tO 02 O O m N Al u L 1- 0 N • Q Metric (Outcome #) U m cu> O L C 3 c 0 0 w y 0a 0) aci ai - U o a m 9 U E2 Z 27. O1 50 C 50 C m m o o v L c C uE o E u 0 0 c `0 .0 U E Z �C Core Activity Tasks Chart note documentation £ o §\\& ƒ: %\ƒ0 se \©s% aa 't.1-05% ® \ 6\\\ / t\ . a) 3; % ƒƒ� \f «% $ ,-o§ » ® \\, %9,0.0-“?. » + ® % of \e\\\\\k\fƒ\, \© 21 \ e \%\ e \ƒ \ &\\ \ƒ\\t\? s °\$*t% \ ©% g e ®\® \ s%t %\\«\ƒ\ t \}%\ \, s t - si,K { ` ° \\�/*\- '\ s°V0 ®®�-% \\� 1®®���/~@° §\\ \\ƒ\ \\ k\ @»®.''\ \%-mo»% `0% ©3 \'. « «ƒ4y\% w t®§ ®& «% s%%atm ƒ\ 0g. . s� $° \\3 ae §�asf 0 v _ m c 0 > w o v o v c v v v o T R L u v uv rn C `o E c o W v Y a o c E U _o C N ,U `1 E W .0 d W w E O L 0 C U m E N n R W . O •-• 2;2- n O j au W FE N A W W O r n U C U E N U) a ^ U W R O O C T y U o .'z',7, _2 a E c c E rn a� W -or:— . c v x W S w c a co 3 -0.60 m �. S n R 2- v c W a c m m a o o Ni o c m c n c o Elan o N c N w L u c m V u c v ..,,T.,-02. E c_m mJ' Y W E v v o »L wE U W O O N U O o y a . p. J 'ATO W m v 2 3 N Y v N c m ;11P c m Y :m77 u 6='"5 -2i ` o u Q o. o - v U1 a+ d$ R J 3 L - L x o inf -,°E >. L C T n 'WO N C V J R O U C m 2 2g,?, R _ . > a u E L .w N 0.020O i p a C C N wa U y U y W J W C a L U T c R N v y0 y d.$ l 9 U E w a o o E v 'o V N R N L W a H 0 C O t Y J O _ L D a v u<55; N 0> W E L g Y i y W C R E a c a•E a .o n a v LLL Op y , t a N € E E v c E ` in =W-�UUma ouO.. miUaIaoOEZ. 10.� ¢Eu ¢ . . . . . . . . . . . C7 . . . . . . . • . . . . . E O U E h LU L 2 Lu LU UWJvR M CS omCo. LCR W^NC Lw w T .> u0 NN Lttto to Jy oa nN o .t74 OfyC O fl LiL ill 2 mV) xaN'N SI o cLTon ss Wcw LL a 5al 2NU a .o�u Il ih Y Cma o c caN6 Ea = N mWO c 410J WROW OR "c Tc Yu EW.3 `ya aWOm Nu n oWRCpR E aaoo2,7.='2'mL v> u W ?oai v OwL 1 x N0 _iv_=ayOd c u CyCY VL !ill (012vw .EO � .'% atNN E O-ou �5cnow`70O>o>NW0)0)o cERaJ-L JO92a )mOUQ Ud .9 ynUdmE.I3oumaogwA WNVNvL V°wWE uBoAwcwwMCa iUv yH 9lOL_ 2 OC (n d x DyU C"' °' R °." Ru) jW N'NWWba 0a sOwQ WedKUt-wazw<¢ VW .. 'cLauJ iU mm m 821-3ZdUwmU '-WO '05 m CVin U 4 IC Action Plan z cs E 0000 7 0 0 0 0 0 '0 Ln tn 0J . .... Ce % IN ry II CI LI0 O iii 6 0 0 M C c c C C C C C ..0 .0 .0 .0 .0 .0 .0 .0 .0 *0 $ 0 0 0 0 0 0 . 0 0 , - - , , 2 - E, c . e . a- C' c c e • e e TA 0 77t .<- 0 <' . 0 Z zi 0 0 ..7 0 2 2 2 2 2 2 .2 2 0 2 .0 ; g 2 < • w f., .c ..c 'E .c 'E .c 'E .c .c %7 .c E ..c .c - .7.. 0 a ... = < 0 .7c 0 — .:-.1 ..JZ ...... z 2 . _ _ . g 0 2 o 2 0 „,,c, 2, t 2 o 0 2 000 --. z 2 6 I Eq) F, '4'- . i . 2 E 0 B t a kil F. O. 0_ u. .,, E • t 2' Ti'" 12 t O 0 >= 'c II 00. t 0 ;12 2 '1 Ta E 2 1.- ,, 1. • 0 - a ,Taa0 •Y2--5- 02 0. :" "c ...2 :P-9 c • 5, rns 111 '13- 29 f, g 2 T. >. s) 1- to •'' , 0, . - - _ - ,- 0 0, 1 ▪ te ▪ cut .2.6. ›.3 7,3_ 02 452).a,.: t:3 i.,5,,E I'd If1LP; c g m o 0 u es a v "2 te ', c — u = - F. 7. - .0 v-2 2 595 0°2 47..5i73 ?5 2 g',ces - ozc....0 c.,,,,...,02 "' `3 c ▪ iii 2 .1i3 .(.6,t2111t. "5 z i3,11. g tl. t. ,,‘; g 1B. 3 (51 a u c', 8 a a' Lji r'S' r' '&" Program: Bridg Operational Plan Lead: Kara Cronin management to Desired Outcomes f committing new crimes. 1. Clients are at reduced ri 2 2 ed from incarceration are suc 3. Clients are achieving their treatment goals. Supported Strategic Plan Goals f0 ID III M13 CO 0 0 0 0 0 o t7 (..9 L9 Outcome & Process Performance Measures Metric (Outcome #) Medication out 0 0 -a o 130 5 t o 19" '03 a a. F. *0"2 t 0 0. 0. c, 0- -o 22 00 c 0.Zo. 0 0 c 0.00 0 ° E ‘-3 ro 0 o .a 4 E 1;111 t :5 0 ro §E°1•5 Of, UJ w 0 0 Personnel O� C O c c c or - O1 O1 01 0 0. 0 0 0 ) n c G m rn_ E 0. Q W L Rachael Marble Rachael Marble 0 0 Program: Supported Housing Operational Pian Lead: Kara Cronin (0 E E 01i E 01 O 0. c 0 O) E 0) 0 V 0 8-1 a as J � 0 Uw 0 L U7 .c O 2 N J O ac 0. 0 J > _ � V d C N O E o u a a O p 0] d a 6 fp 0 Ol a a C Rachael Marble 0 O' c c o Ol 0 J O U 0 L O O c2' N O) E a0 C J Ol 0. U c m o 01 y a c .5 0 3 u a m 'c 0 c u m ' > w a D- .0c 0 1- 0 C J 0 U > t a a) J a L O u a w u c ow .N L 0 0 o 23 O1 0 C C c L U Tm O > t Za CU O u. EL O) O C 0 ca.EA N (0 E O J L O 0 = L «0 t C L 0 0 3 a� J N J0) m Q i- E Supported Strategic Pian Goals Rachael Marble O 0) tD0 v .0 .0 N E E a) 01 0 0 a O 0 0 N 0 0 0 N N N 0( rn O c 0 0 Of 0 o occB c c c n a n Rachael Marble a 0) 0) ‚0.00 .0 c i 0 0.O .= 0 p V' 8 _c J a Y a m wa r, 2 3 v c c E�o m o O J 0 c ) f 0 .0 o 0) = a O) O - ° E a 5 �' w 0 Z to 5 o 0 E O O m o E 000.00 0. 0 00) Lan) `,81 0 N j gw c = 8 m > C L E . 0 = a a N N 0 c 0) K N 0) Z - 3. y O a O 0 O 0 a` w ¢ ti N t0 0, 0000 0 0 0 (.90(.90 Outcome & Process Performance Measures Rachael Marble 0) 0 2 O. o v 0) 0) o 4 O) .o E m E.m p 0) c = 0 L 0 0 0 0 = .c L L L m a t• cL a' a' K a O CI al ro 0 0) a m O. v0q0 wc $ =mrn La 8 (a•a 6 c O Oo 0 i c N y 0 0 od m d VLc i O p 0C c 'cNJ �4c `" u oY y .,7 •OOaOa oU0 l'o' v m V Oa c 0ccmOW 5aUo f J i'''111in v. • I' 07.mOy iW0 J ac� T LLUO/ a 1 '�uy0aoa1112o3u2a.u 63, ;mAZ o y 0 0 y i O a)1 3E.0 2's Eat Eoa> $ 2. c 0 0 0 0 ch 2 0 .2 0< E 0 0 0 2<) * I :- Mi" t ko .0 d 0 O .-I u_N 'i. N N O O) d r A 7 0 E t a .`O -I a E 0 v ji ON O C N T O N V a= a J 2 1. 0) 0N d E o o m > �s �+ 10 "a N -U .r - ii E i Metric (Outcome #) w > u o ts Z E N C d E n( o)fa N c a d O Action Pian 0 0 c O = 1,..6) 0 a 0 O. 7 •-• a 0 (I) main O a J .O O) ) N u 3 d F c E y MCC fa 0 al 0 u w Et2 %ElLL E O Q E 0)) O 0. N M Action Plan Due Date cC O c c 0) O 0 T a+ a c c '�'' 00., o1 .c c E O 0 0) C 'E c .@ E t o a y w c 0 00 0 i • o 0O 0m m m0•1 a 0 d HE E a '0 a a oaW)L c'c c`- c o V O r9 iNO�1 2 N OU) CLL U) li UI.1_ UT ) uo2S w ° G a 0+ 0.o: o0) c� 0) ( 0) y 0 in H 2 °' E s, Lo o. c( u y 0 °N2 .N o rn•O 3 m c y m o L� 1 Y R m c -o �" o E 0-'C 0 F tx G E L v . o 0 v i E L a'o c o d di 0 o c u u rn of E 0 -' U to a _ N 0) O % 0i O 0i 0. d E o>' a O 3 i o 0. .1.8.°°73: N a� w E c� w c m u m m v o 9 a a 2 � v o t E c U a> vc`m oai aSa c a� 'N, ;c m am S N n ci Program: Foundations Rental Assistance Operational Plan Lead: Kara Cronin Purpose: Provide access to rental assistance and supports for the neediest SPMI clients Desired Outcomes Clients are able to access housing in their community. Clients remain in stable housing for 26 months. Supported Strategic Pian Goals 0) Foundations 0 v 0 N N 3 m 0 0 O v a `m c c 0 0 dro m U -0 c L (o c )i U 0) m U 0 0 U ci E) a F N R V 7 T H Q U) 7 V 0) 0 �J U) I N N = W c 0 _O> W CE a N 0. d Liv !,T U aO .O 1 ay w i g • Ca 0 2O > N W 0: R LLNCC Nf0 = a) .c V O y ti y O I _ c = d m d 0 n T ITI v >'.. �' o w.4°),y tan 0 o o =Er vww cY LO O N V i 7.1 .O O' 'C y N N a 0 Q M LO d 0 10 a -ca > a t m w a w N a m Q ' a al 'i N l0 O1 a o 0 0 E O L L N o m t:=1 O a m m L — L U U' c9 (U E O T O Eu^ O y `1 C -= O 1'o m 01 1,1 l v v i a E d u u u u U O n D. O. k42.§ aD 00 .o.o 0 v L N E. Education, Advocacy, & Partnership cc a 0 = N Start using HMIS 0 M Rachael Marble o c NCU O 0 O Lrl 10 N 0 N N 3 0 Rachael Marble Rachael Marble 0. C a .cc i ++ m 0) ril Ln a •c O w O H 'u N v 01.2 a E a 1 o 0 0 .. I' o 0 ` t'' a v .2 ao 5 <001. D 0. z Z o. 0. !2 0 [ �j !§ J - - - 7\ & e£ a G ]! _; w f! ) _ /] \ \ § f } 0. / —— C `«\r 5 nis _ |>!� `2� ® /�/\\{\� -_2E f$ §2 f mi tf kk ! ek /«�\\/ \ \{/\�\)km ƒk»;B,®f$!/&){2q“2aE. !t ,, ` ® { !e «;#!;{!#7#r)Brm,&;{E° -2 ;_#Z«Jaa; ,R__)!� ����e=-J;§ ,/§-�z-e,,!$«7fe ;rt3{_=>.fk 1-C4--#_Ef«!& :-1\#®;a�� .e Ze;2u=§;f«| - - -- k{7§}#2»?-»-�_,®/E.t��y#=�■»,;.[-a-«�_-_,: y�1«,®)\!§:�®{)2® _3S$)- ^K®¥`r=[-` 0w,0aw <0U(=00 t.) a EO »w1o(5w )&370 <110 §&2/1¥/a!\ ‘73 EA a9 {_) « E; )\( 0 O fj }/0 0 0 Core Activity Tasks sr, 1 Deschutes County Health Services FY 17 Requested Budget Analysis by Project '`nalysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Revenue Sources Total Resources REQUIREMENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead —ontingency Total Requirements Program Services FTE Admin and Support Services FTE Intensive Children's Services MYAT, MCI NT FY 17 %of FY 16 Revised %of Budget Variance $ 155,525 453,947 1,913,931 134,814 422,594 $ 3,080,811 $ 1,972,693 165,715 942,403 $ 3,080,811 22.90 5.01 5% $ 0% 15% 0% 62% 4% 14% 100% $ 19,070 1% $ 136,455 0% 590,082 17% (136,135) 2,453,957 79,167 302,908 3,445,184 64% $ 2,070,121 5% 417,144 0% 0% 31% 938,353 0% 19,566 100% $ 3,445,184 0% 71% (540,026) 2% 55,647 9% 119,686 100% $ (364,373) 60% $ (97,428) 12% (251,429) 0% 0% - 27% 4,050 1% (19,566) 100% $ (364,373) Services: • Wraparound provides intensive community-based treatment and support services to childrenup to 18 years old and their families. • Early Assessment and Support Alliance offers intensive outreach and treatment services for youth and young adults experiencing their first psychotic break. • Young Adults in Transition provides intensive treatment and support services for transition age youth and young adults 14 — 25 years of age. Changes/issues: • Decrease in OHP revenues. Clients/population served: Population: Children and young adults with behavioral health challenges who require intensive community based services and supports due to the complexity of their challenges. Clients served: 311,487 client visits to 247 individuals, averaging 46.5 visits per individual served. 9 Outcome & Process Performance Measures Metric (Outcome #) Program: EASA/YAT 0 0 ea [D .Nc 2 G a O Vi E .5 10 • y TO 2_.vm 3 0 a, m a) c m 10 7 cooc N c N a E 2 0 m c E Y 0' m Vi 0 o 0 C v d Y t 3 v a) V 0 N L OL if) V O U C O • N'0.112 o ro u o> N C E o o E N T CA" --"La a0 c0 n.co¢ Operational Plan Lead: Shannon Brister / Tara Hare N 0 To 0, [1C 7)).v .0 O 01 C v O 0 L no m . c y 3E= v . c O 0y 0J E 0 N N i m —R D 5) 0 0 O) EASA fidelity score, biannually (2 years) (3) N Action Plan 0 0 a n fo' z z E G 0 Due Date > T T > t• t N N N of a) ro a a a N d 0 C m 0 O N CI to N N N. Q N N 'i a d E a uN E c O • y( C n, C in • 0' ti N n o N C tC O1 a) O1 C V •O V O Y C >_ C 0) C O c N O u C 1 Q) fLn N = t6 c o Ey�ac m V 4L c 1.1' C L „a`2 L Y a, E O vi o c 02° w o� E m °' > y J ^ T L �' VI T N V Y O a) aJ ul L W C - O N f0 "O y y n C V_ J a) N > a w c Z `o u v c c o Y. y E > i. a c 0L3 Yu ° 4N m.O_ =iN 0. z•C-c cJ oNN i3 wrnm 6 mm m cZC• .' a0om0 n C O aw E c acU Y o 'd > ,, 'u E u o Nb JanwE y •0 W 'm>rn Em m LE W Z caC y Cnac@ W i 'Ey 0N inoovU^= 0 E E44 ai o )a E c m • o � c zi >cm -2a 0 a)io• a =b0zY • J 'a E a)o o " E 0ai m E y m > E. u N cu m o .c 4EuNY0 a F 1m m •e vm o> N a) a) N y n u E C N v N 0 EL0 0 .1 UTC 3V O h , 0L3 >�L000-am �rEE? O N 3 i T uO C 33Ec J0 2 3-6,— c o5.oti 0 T u u va o o yNv4 m + 1--a m mw vcN3o m v a3Nvo_ycmJooc m yUv? g§ Z' llt in E uac c m e u a)0 W° ° d ` C VQ N iNu0 Q•Ea• Ta°Oa.O mU MI ° E vu. L m >d@ -LS w J N > d Vv a4cc O N 3 N cu u >. E in`w N- i ¢ y >L°J t o yN ▪ °) rn asp N0ny ay a= "uav3 O "0°'Fn w} >.aJnd u m o`cEE C Y a. am L oT aa 5 > g co= L ETaLmLut 0ya ti m N N Uu c 3aJOmmyJ G CCOc • Y0 N En 4 N ti . - 00 v wN mv0y -8a) :5 U'IE a Itim v4,w06E c =w d O y '-c.-n' j u T N V c XN Y o mC L 'C C :.+CU cT.LG>Ln:-c>5 nm myma>0>c y .0 ▪ m°T CcUcN)p a)N . , al W C T 0c cuJLc Ooz Ow y °o v iJ NJ a) o .J 1: 12.. 0E L T° N o^om- m cN E1JE. 00a.+ >. N a) C E a)u T TV O .LOpE cam eJNO O w a Q w S 4, :L., i iN NN oCL u,C O'+-0 E L V :4N NCL EmO` > ) E E L m (0 N O 0( L) E O V 0 o O L o o o o O. 4J E 0 N O •O c t Oy N d 0 0 0 0 0 0 0 n4, vf0- } as0)0 u }:E V >-"6 O m 0 C'1 C70007 (. • O C.•.a N M wfl' 0. Des Sui y y T p w O • C ti 0 a) t t0 a) L (^ m a u 3 N 0 3 v -2 01 a 7, :al' n o al c E Z. 01 u O O % aw C fo) y E 3 m 0 a co Em 0 w E nao a co co w w E. o. E N .w0Y orn o, u 2 N ' X O m01 JC a Jc z uo -E, E U, 100E Y o o -0 2.,., U moy N w E 1:7.' 2 vi oI v o wo y._m a . T a ao 0, 8 cE '0_u.,c vt n o E. v Q C w=Cvw.0JE01uIEdc o u2ya o+ v r.5EN .az oN. woN Bow vN N E NV D �ILYLVN D .L C n C> wou g. z TJ w_Y ` tN y a' O wNNa1J -71.) U 1 UOw j 6'0 mg - O UCOxU- r. d FI- xnzF.ua¢ it o.' 3or ozz3aOzu.cooz am 10_ 01 M N T T ? > T 6 O O a) U) 0) To 1 N OI 01 t faCOm ~ C a a a a a ¢ 0 0 In (o u' u'111 .-I .u'. . LA. • N NNNN N 0O O N \N N \ \ \ \ .i Nti .i H H\ • .,., \ \ • r. n t\ n n n n N . ((0 C (L O w da1— m IT - 1— 1— 1— Y1, \ \ \ ya1} } }} OOOE O O E 0. E Q W Q Q ▪ Q Q Q al L L L N (' to (0 w w w w LU > U) In V) J H U1 V) J 0 a 4, o o p o o C o $ c 0 oI E a c E `m o O w y _ n i ‘70) m cp co w a7 1- o. o .w. u '° is co " U C' E= E gi t v w > L Z u g to 2 m d Jo c w d m N w w a 1 0 i'!-, E J y u)_ 2 w 0. < (J E w m Li - o v w ¢ w o u , _ 3 n 0 a F- a N o O w n. U z Crisis (safety) Multi -family CISM team } a 0 0 0 w 0 a a) co c %c m 0N = C ro m 0 iii • I- m Jenniffer Longo 0 co LA v 0 0 vi t0 L N w N N u Y w 0) N N m ` O C "O 16 i= m (1 m m L N w m N V f0 — — c n Q Y E 3 F- a all L 0) C E ' i0 ).- .1., p T a1 m m e I`— c m Ln mi ¢ H . o m v G 7 c c= z \ 3 d ¢ ¢ a N a 1n in In V1 in Y l0 t0 In III e v o 0 0 0 o E o 0 0 0 0 N N Q n N N N N R ti - N .~. .~. 9 c co a w H O 1) 0) 01 N u E O E E 0 u 0 0 Tara / Shannon U Shannon / Bre C A i 0 m a A FT 12 c c o co °c ti) in c c 0 co N t N O N N U1 J In J y J J i. . C d m ` c L W Q '0 O C N 176 m L c f0 E d m m > a0 C C1 rn — E v u to c E °o d Al > N C C U C o E � •` . •. C n .L E E i W O rn In.51' v ¢e. 0 E? c a v > = 0 0 �. � .D 10 d 3 ',I" O E a 0 w i% rz u F w Shannon / Liz Shannon / Liz Shannon / Liz Coordination with Intercept 0 O m a v .c 0 Q c S 0 0 0 0 0 0 " 0 0 0 0 c m N .0 +C-' _� N ) C 2 m C Ol m m J L T w = O n C m Y N +=. N N i 6 w (n m U1 z d ii U d w w 3i Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project . rogram Fiscal code: RESOURCES Intellectual and Developmental Disabilities MDDAD, MDDCM, MDDRG, MDDPT FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 470,304 14% $ 35,881 1% $ 434,423 Federal Grants 0% - 0% State Grant Award 2,313,761 70% 2,774,742 90% (460,981) State Pmts Other 0% 0% OHP Capitation 0% - 0% County General Fund 537,676 16% 281,036 9% 256,640 Other Revenue Sources - 0% 0% Total Resources $ 3,321,741 100% $ 3,091,659 100% $ 230,082 REQUIREMENTS Personnel $ 2,027,574 61% $ 2,062,712 67% $ (35,138) Materials and Services 202,760 6% 682,694 22% (479,934) Transfers Out 0% 0% Capital Outlay - 0% 0% Admin, Support Services & Overhead 1,091,408 33% 340,636 11% 750,772 Contingency - 0% 5,617 0% (5,617) Total Requirements $ 3,321,741 100% $ 3,091,659 100% $ 230,082 Program Services FTE 26.52 Admin and Support Services FTE 5.80 Programs/services: • Support to a growing population that, with the right supports, can live as independently as possible in the least restrictive environment. Services are aimed at greater access to social interaction, community engagement and employment opportunities. • Case management services promote health, safety, and quality of life to individuals who meet state eligibility guidelines. Oversight of eligibility and monitoring is provided to individuals who receive services from a local non- profit organization. • Children and adults requiring comprehensive services are in foster care or 24-hour residential facilities. • Responsible for all aspects of the foster care services including recruiting, training, licensing, and monitoring of providers. • Management of a sub -contracted system of residential, transportation, and vocational/employment services. Changes/Issues: • Significant increase in state grant. • Elimination of pass-through funds fo"r community providers. • 11.45 FTE added during FY 16. • Included in departmental administrative allocation. —dents/population served: Population: Individuals with intellectual and/or developmental disabilities. Clients served: Currently 471 clients enrolled (48% growth since K Plan was implemented). 10 Action Plan 0) sa 450 d A r m a, 0 ^y c o o 0) o, w 0 0 y 0 •0 C d A C d .0 01 A a+ N d .c o a, c y S m o c a, C > u N w !n O C co VI d C 0f 41 CU 01 0C W 5 L O 5 U vi '• s 5 N.r.T T 10 u > a) a in r.....'m C o 'O 'C > ut Y om„ 0 v a Q a 0) in c 7 w ,n 0) an d 1- h et .c 0) E 5 0) 71 a e a o c` m , 0 d O .'o m'0 T C O. y 0) d O C T 3 0 0 N n H = N a c (4 > c 2 .E 0. .E c a c a N Q U N R' N O! N f u U U m 0 0 Catherine Lowery Catherine Lowery aJ A a 0 c m a c Program: Intellectual/Developmental Disabilities Operational Plan Lead: Melissa Rizzo Melissa Rizzo 0 N 0( c 0, 00, 0 Catherine Lowery 0, 0 0 Catherine Lowery Catherine Lowery 0' Melissa Rizzo Supported Strategic Plan Goals a) 0) lo1- m a..+ U_ a, Q 3 d inV d c u f0 0 a a T C M m 'E 0 0 .c 0 (0 0 4' O ty,2 o` = 1- > T 0) 0) c = a v x w L 0) o > m c 0 °. a v c E yC Lu a R 0 0 03 6 0 0 s . . • . Outcome & Process Performance Measures 0 0) rn c a) — E o O0, C 5a Edi ce O U 0 E OI ='2' 0)) s c • v •;a' i )N 0 E 5 0 L 0 m c� E a00 Core Activity Tasks ■ [[[[/([[ Employee/Position \j Program Development Assistant Deschutes County Health Services FY 17 Requested Budget Analysis by Project '\nalysis by Project Program Fiscal code: RESOURCES Communicable Disease HBT, HCD, HHI, HHIRW, HIM FY 17 % of FY 16 Revised % of Budget Variance Beginning Net Working Capital $ 136,649 12% $ 23,915 2% $ 112,734 Federal Grants 0% 0% State Grant Award 424,322 36% 451,556 37% (27,234) State Pmts Other 25,250 2% 53,000 4% (27,750) OHP Capitation 0% 0% County General Fund 514,789 44% 539,150 44% (24,361) Other Revenue Sources 70,365 6% 161,573 13% (91,208) Total Resources $ 1,171,375 100% $ 1,229,194 100% $ (57,819) REQUIREMENTS Personnel $ 751,443 64% $ 707,404 58% $ 44,039 Materials and Services 93,289 8% 108,728 9% (15,439) Transfers Out 0% 0% Capital Outlay 0% 0% Admin, Support Services & Overhead 326,643 28% 411,510 33% (84,867) "ontingency 0% 1,552 0% (1,552) Total Requirements $ 1,171,375 100% $ 1,229,194 100% $ (57,819) Program Services FTE 7.24 Admin and Support Services FTE 1.58 Programs/services: • Communicable disease prevention and control efforts identify, investigate, prevent, and control communicable diseases and outbreaks that pose a threat to the health of the public. • DCHS receives reports and works with providers to ensure proper follow-up and contact investigation necessary to prevent additional illnesses. • Disease tracking, epidemiological investigation and control, HIV and Hepatitis C prevention, case management services for persons with HIV infection, immunizations and public health emergency preparedness. Changes/Issues: • Increase in FTE due to internal changes to better address service needs. Clients/population served: Population: All Deschutes County residents are served by prevention and control activities, as well as education. Clients served: The program responded to 1,000 cases of reportable communicable disease and 26 outbreaks in 2015. 45-50 HIV-positive individuals are served each year with case management services. 11 N N d al 10 6 A E� 0 0 C 0 o A C C� C 01 C >. ~ M G 0 C O . 0 O O O O p "1 L •O O O H n C m C C C O O E O, C O, 0 o o o o o (N N (5 0 0 0 8 Ts 9 19 t co d (1) IT TP ata H 0 u U a c 10 — u y 9 v 3 > 0 d y '5 U F m _ N C 0 C es ach �0 a a ° Q C ° y -c a c to in in ffi v al o d a, a! n m0 aW 0 0 0 0 0 .C,� t 0 m 9 a co wm v 0 0 0 19 v Of w 5 o v .� C ?� Q a Q Q 1 U) = S y 0 3 N Q w yj ae NN .0 1-1C = i C 7 p ;: 3.0 el O 0 u OCav C r a 0) om,In O 0 •00 O 0 a o °yOOON m 0 u E u U u % g',> o N ay Cv E N C T W d 0> Caa C (2 aNa N OOO N O p N `+ 0�N6 U, C N 1•1E aV) N°0 ` > 5 • 0 0`C)')mo F 0 oY .0u E ENNE7a,C•oH''m . H m a N v N n o C N u T t 12 t 2- N NuCuc°`60 m 13 .0C m u a o 0 C vmiv ~i Y a m_ o �! ai a o NLa 3 a) o a) a) % s. m G m m 0 43 a 2 °' E •o m E m •o `o N 0 .0 u C N o m c �o . 3 v G 4J 8 C V O. i v O U 0 i V V O E C nl V N d U C C 7~ ,. vs u O 0 O O C Q a ¢ < < a 8 5 E .o,,, a a' 2 u a m n a a ;; 3 S w m o m Q m U o ti U m Metric (Outcome #) Program Communicable Disease & Immunization Program Operational Plan Lead: Heather Kaisner Desired Outcomes Further spread of disease is prevented. 0' 0 OO 0 .0 m N Ol C m .3 v E c a' 5 w a E 2 u m o. m O 6 N d a' a' m = IC ,, U w N C N 7' d O fa O u `o. v r N o `m v C T 0 v, N 0 L a U a tn 0(010 ,an, 0) T 3 Z. N 09 o N C O C U o E 0, N 0 N E C N 0 as = .0 0 m w E IA E LS' ~ m E o .-1 N M CF Supported Strategic Plan Goals Goal 1. Promote Health and Prevent Disease Goal 2. Ensure Needed Health & Human Services Goal 3. Promote Health Through Policy Goal 4. Monitor Community Health Outcome & Process Performance Measures N m N a m 0 0 o 0 o 0 a' O 10 W CO CO C 10 01 0, m c y V o. ns o Metric (Outcome #) Number of HAN alerts distributed. Annual. (2) 2 C VI O ro o .0 C 3 0 0 U 0 0 U 0 C 0 0 N C N 0C E 5 E V V, H o U Q ` N T 3 N d o 0) v a 0 m d d n m o 0 U LD l0 01 m vI00. C C '-4 ..i M CO 04 4 C C �.i ti O O •0 0) d N a E 0 U Control Department a) a) ra L L 0 O) - O '^ v = N G) £ v E 0 O La ? O N • 00 40 • i N j " E 0 E a E „ V 3i h C 00 N E E O m v u u E o.. o N w _ o w N .00 o c •�' 0 •3 `o. 0 40 o a 0 m 0 0 E a N U,o, a a V Z � 2v 04O1 Ot �.Oj N •� 0) C C C 0 O O C Y O N T 01 m i N 0 0 0 0 0 � o C m N � All CD Staff All CD Staff All CD Staff G1 W � y 0• c E � '1'03 E c m C C J N v u a y Y v D. Immunizations Outreach, Prevention, & Education Personnel Heather Kaisner l 01 O1 Ul C C M04 C 01 N C 0 C IN ...-i X O O Debbie Amberson 0 O E 3 1 N O m LO0) N Jill and Heather E. Ensure School Immunization Law Compliance O 0 Jill and Tami F. Provide Communication & Public Awareness 04 04 m C C t) al O O 0 L N N _ _ All CD Staff r \ '.5. { S - f \\ \ $11 \ / / / ( / \{ 3 \ �3 cs t` ° a§ %f 37 \\ % §\ \\ \ \\ \} »\\ £ °\ $ /( a9 \\\ t \ \p ;$«# 5 , $ ' /9 /\// \k $ {k/ / / \ $»® \t g«Ga t , { ƒ� t«$\ i{ ®mak\ a. » ƒ\ \\ƒk \ /%'% k i a # ,, m <$« \ \ G $ t \\ \ \ § &AQ at % \ \ % \\\ag%/ $ \\\ % \ % r\ % kk�\§`» k . , u T-- . g_ k % �/ T. ® ®® 4 \sti \ t$ o 0. Allocation O > 0) m t t t t L W M O M U O V m 0. 0. O1 01 0 c a tn c o Ol m o C E L 01 : O m > c rn O 'C N c 0) >, O H N N O) u iC _ E T Q V L .3 z a a c c i O) In a o u a E Kathy Christensen Heather Kaisner (1) investigations C. Deliver clinic services Kathy and Holly provide NIX kits and services to clients 0 m ` a i 6 n > J2 4 2 q m m v ; L0 w d Z x 0) T R T C 0 G a m ti x 0 0 3 o c > E O .t rn u E01 N u 2 i m C t m 0 0 Counsel clients and community members on STIs/ HIV/ Hep C risk/ reduction/ testing requirements E. Provide HIV case management Educate cases, contacts, and 'clients on risk reduction 0 0 N O 0_ Counsel clients on follow-up testing (self -manage) coach/ teach student intern(s) to do HIV services, etc. Treat infections > c m a .o = rn x e y m m 72 0 > 5 O _ g o vai v o ' y x n 0. N. C N.- C m m O E u a Y_ � E u_ ?.>, u o rn o m E 0 a m t m 13 = m '0 a Nm Y a 'G U t C c c m m > c •� ,z_, O v N x � - - m > U 9 H N KN O C U OO N N m c na 0 m a w - 0 a n u N E 2 E In 72 a w a E n 3 c a l 0 E g E c .O1 .� ". E x a �' a N U N c g E o o w y> r. En N N `m C a+ Of `1,3 U y m L m c a a; D a m c x c v iii m 0 u • rn N u .p m 'C 't H 0 O w a i ?� v~i o> 3 72 a a u 02 0' i d m 3 C., n a 7'1' 10 5ti, 70 .072 2 m .a m 9 m -1"- m > > c >>> c u '�' c l o c c 7 0. 0. 0 U o t) L- U a as U, 0. U U U 01 01 01 O C C O C 0 01 CP 01 0 0 0 0 0 0 Contact and assess clients with Susan HIV Counsel clients, respond to Susan and calls, and write case notes with Debbie every interaction F. Educate and collaborate with providers as V) Y (0 O 07 C 0 L) i 10 tel • w 4,• 1 • o 0 4 ! 0 10 2 le is 0-11), qua E 0 0 gency Preparedness LIJ E g o2 ct. • E u. rational Plan Lead: Mary Good Core Activity/Task E E 0 0 01 0 01 00 0) m• c • °- 0. 2 al 0 6 2 °0. ° E E • ro E t g0 7, t3 i :g E 0. E 2 8 E Desired Outcomes kr, 0 en nc; k0 trt 01 01 0 10 At least two staff members will receive social media training At least one PIO designee will take EMI PIO training B. Partner engagement Strengthen partnership with American Red Cross by meeting quarterly. Invite cleric who represents the ecumenical religious community to join the Emergency Management Planning Committee With County Emergency Manager, Integrate Personnel and Property and Facilities into Volunteer Management Plan Actively contribute to and participate in partnership meetings: Regional Healthcare Preparedness Program, DC Emergency Management Planning Committee, Trl County Access and Functional Needs Preparedness Workgroup, CLHO Preparedness Committee Supported Strategic Plan Goals Goal 1. Promote am e c;, 0 CN 0 0 0 I'll o >. 79,- >. O 0' 7, 0 0 x 254' c t g i g E z.,,, t 0 > .. E 5i' 0 as 0 w o t a o' as° E o .c.>" 'i' 7-FCO 20 (0 .c2c . ^EaEjI' E MI • 4, 00. 5t z 0 .:: - P. ,, E •-q, z--' :,' ,, 0 0. 0 0 -9 _ — - > 0 0.0 o es iZ —, at 1.5 ill t ..a't 5 t 0 E £-- .0 t 2 E'.`gt,'St _go 8 80 88,:8 -- -504' -E a) 0 E nt of PH staff trained in ICS, annually 0) Implement partner satisfaction E E' pcn' * Tt in 73 00 o So 00 111-4 t t •-,E 1\ Deschutes County Health Services FY 17 Requested Budget Analysis by Project ''nalysis by Project Program Fiscal code: RESOURCES Early Learning CFGO, CFSH, CFCDS FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ - 0% $ 274,299 23% $ (274,299) Federal Grants 122,635 28% 276,387 24% (153,752) State Grant Award 48,838 11% 269,246 23% (220,408) State Pmts Other 0% 0% OHP Capitation - 0% 0% County General Fund 185,681 43% 264,350 23% (78,669) Other Revenue Sources 79,014 18% 83,414 7% (4,400) Total Resources $ 436,168 100% $ 1,167,696 100% $ (731,528) REQUIREMENTS Personnel $ 106,716 24% $ 140,710 12% $ (33,994) Materials and Services 297,925 68% 554,009 47% (256,084) Transfers Out 0% 0% Capital Outlay 0% - o% Admin, Support Services & Overhead 31,527 7% 297,842 26% (266,315) —ontingency 0% 175,135 15% (175,135) Total Requirements $ 436,168 100% $ 1,167,696 100% $ (731,528) Program Services FTE 1.02 Admin and Support Services FTE 0.22 Programs/services: • Ensure children, prenatal through age eight, and their families receive the opportunities and supports they need to be healthy and successful in school. • This effort brings together leaders in health, education, human services, early care and learning, and business, as well as families and care givers to work toward this goal and to maximize resources and community assets. • Efforts in Central Oregon have leveraged significant grant funding; engaged parents; aligned services to create efficiencies; and developed plans and infrastructure for expansion. Changes/issues: • Regional Early Learning Hub was established at WEBCO and resulted in some grants and functions being transferred. • Decrease in FTE due to transition to Regional Early Learning Hub. • Incorporated into Public Health Division at DCHS to infuse early learning efforts across programs. Clients/population served: Population: Low-income families, rural under -resourced communities, children with cultural and linguistic needs, differently abled children, children in disruptive and unstable family environments and children at risk for adverse -`ects of toxic stress and trauma. .ents served: There are 17,178 children, ages birth through six years, in the target population in Central Oregon, while the emphasis is on vulnerable children (estimated to be 9,822, utilizing 200% of the federal poverty level as a proxy). 12 N 2 k - c 01 )e ! { o cn r �@ |■ 7. §) { ¢I} • ) ! ; 7® ▪ a /fA} !kk}( )m ) .1/k 2} {S {�j - y }\ 7 a a . . _. JJ]) c2 <\ /{{) '• §f){\ (7, \= z -_«4#f • \ 12 ) §�® {{{{/() J 0. =O \}}§kE®{)/� `�3r-#/{®)£]_&Ef ~©# oi E_±=§«£§§;/ee«A\0 3§c$!lz�.o.. §■4 Assigned Date Action Plan (Notes Each strategy listed has associated activities In the Cady Learning Hub's 2035-2017 Strategic Work Plan) C. Increase access to quality early learning services, opportunities & supports 00 \� o En 0 January 2016 00 /\ ns 0 as cn 0 \ /.0S _®(2® 0E /to !)|(})\kk §/f =Eo`,`°f }�t 3»\ \{{-'5kk>§k*»K (f;\g ]�«f|c. ®\«§rE= co o ■# (\}3n, {\\)).-E. E' 2 g'{~5 \°) {)\ )t \\ )k j�} ! ƒ/*»k{� $kƒ&k i 6 •0 0. tilw 2 T. 0.10 E 0 0 ro 00 Assigned Date •0 1; 50 0) kas 0 Assigned Date 0) 01 00 01 E0 c c u‹..) 0= Lti tr) co 1-- .0 105: as , 2 ..,` 6' re ' 0 .4,4 5,j.:,..1... t 0 a) E 0 >, C25.2.23 1 ': ; 4' (41 3 0a,, -ca , O a a) 0590 —3tEtt 2 li; 0. vs E. 43 19 -2es -`-' 0, a. (0,2Lu-zat=862 6 cu a 2 2 ,,- 2 '2 x 8 'd. 4 E 01 0 0 0, 00 5 0 00 Sarah Peter 0) 0 0, 0 0, 00 0, 0o0 0 5 2 t 0. 0. )1)5 I 2 g 0 1 0 0 1 W ra g E 8 4-0 O 10 a) E E 01• 00 2 10 0) Core Activity Tasks 0)0 <10 10 75 •0 0 0 0) 0) 02; 0 4) ta to 0. 1T, 0. (based on identified needs) at are identified as ational materi 0) 0010 10 10 0 10 0 0 0 10 (0 c 0 ti 50 aaz 510 :S 0 E c o x E 1 ri (0 (2 p2 O Ca ft 0 LS U -) U 0 W -j 0 e_ • —- I 432.028.0 al C W 0'71 1 1 (f)g ! Mg. Nr3 UJ Z w' O 8.4d2; t1 PI 0 14 t-Mes *CI • a?) Z • 0 tj > .8 L8 -0 *0 a) Co' E 2€02.=:6 -6 ,0 t' C to• t 0:1 0, to s- 2,01 ".§ 1a 611. 10• E Ic 2-v 45c, 0 st€"1S ) `) cb,2 :a22226c E c). >-202-5. Dt`1,H vey 01 01 0, 0) •2 6, 01 010, 0 0 0 Sarah Peterson a) 0) 0) t "g 5 0) co gi O 0 0 O 0 0 •0 ro (2) 0. 0 0 ti 2 0 E Building maintenance Administrative 0 0 2 u 0 ro 11) N 0 0. u, 0. -0 (00 • . T.) 0 • C • 4, • ▪ 6' futc E E 8 0 .0 • „," E E oo t g E • Z tis" ° c a o m iii N 0) E N cn m C 0 2 c 01 O. 'N c O '‘06') - E m G O N ma a O tA m m m c c G m .0 6, - a c w c E m .0 E 01 a c v a.vzm m e y m II, "0 in - c P.,„ e -0mo ma dc a m 01 ma a,nm m O 1n Aro vm 1-2 ,« O L C Y 1` O 0 W V U N m 0 m 3 of m 0 y ,cc 0 'c o, o u 2 o to E. L °::„ .i E y ,� O a C = 9 c C > c 0 a•. e m C Q N a F•, D )i c/ w f Ili Communications 1) 2 o. N 01 L O O N 0 U) 0) 0. ro y O ct - c c 0 > . yE. _O .. .. . m c m o) m •)0 E E :c 0. m °' o c a) c u1 a) c u .o - o m m m tc 3 a? ou 0 m c o c c aC .) 110 c• �.' m m c > y E w .2m 0 O 0 0 E m 0 m m E T E o cn m m0 N C C E O N mE ` ' oN E a ro to o Ti z to 0 a 01 c c c m 0. O1 0 N c .1E2 c 0) W c 0_ w = E E 2. 0 c m a 0 2 L G `o v mt E t 1n O m 0 m O 0) c u > u c O U a° i 0) m U , and supervisory meetings, events, and trainings Department, manageme 01an •0 ,0 m m v m 0) 0 nv -0 c m> Y f4 d a > O) y, A N N M_ m > c c d _ �� 0 .s .m N C A O c .0 R 3 N0 HT. a m N m d d O O O: t E 1^ -O o 0 C a 0 p 0 o v C O m E 0 N O. Ycc1 c N G a N t' y 6 V A ..2 .8 .E 4 'Q N m m C C t m . 2 o au m C;_ v a t''O a E 3 v coa* L0) 00(0(0 N + 7 'C o y E o 2 .3 " u C uo a tc O m 0 10 E C a N Q o yOrC E na`cc UNcv jNw o$om m » m c .� a naaom.OcL•m , n y m 15 .y rn a- 6mi •••. tNCo v. m w G a 4 U¢ z U U Q Manage state and federal grants CO Deschutes County Health Services FY 17 Requested Budget Analysis by Project 4nalysis by Project Program Fiscal code: RESOURCES Environmental Health HDW, HLF FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 44,886 Federal Grants State Grant Award 93,862 State Pmts Other OHP Capitation County General Fund 167,761 Other Revenue Sources 915,350 Total Resources $ 1,221,859 REQUI REM ENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead r'ontingency Total Requirements 4% $ 0% 8% 0% 0% 14% 75% 100% $ $ 899,031 74% $ 50,625 4% 0% 0% 272,203 22% 0% 100% $ 1,119,176 $ 1,221,859 Program Services FTE 8.81 Admin and Support Services FTE 1.93 24,153 93,863 198,710 802,450 1,119,176 2% $ 0% 8% 0% 0% 18% 72% 100% $ 852,084 76% $ 60,575 5% 0% 0% 206,517 18% 0% 100% $ 20,733 (1) (30,949) 112,900 102,683 46,947 (9,950) 65,686 102,683 Programs/services: • Protect the public from illness and death caused by exposure to biological, chemical, and physical factors in the environment. • Activities include reviews; consultations; and inspections of regulated public facilities including restaurants, pools, water systems, temporary food services, child care centers, and tourist facilities. All include a focus on education. • Regulate public water systems to ensure safe drinking water and participate in disease investigation and response. • Promote awareness regarding radon, lead, mold, blue-green algae and animal bites. Changes/issues: • FTE request: .50 Environmental Health Specialist II funded through increased fees effective January 2016. Clients/population served: Population: These services protect all Deschutes County residents and visitors that use licensed establishments such as restaurants, hotels/motels and pools. Clients served: The program performed approximately 2,841 inspections and issued 1,664 licenses in 2015. 13 Core Activity Tasks A r h a. E ; c wo c6+ % O :+ P, c ' F R ` . 040— m a NN a; O E w . 6 5 a v « iacr o w a a g f 2 5-2;& 0 3 a s m 7 ff E �t $' sa O t, a D. Program Administration 0 d 0 a C O 3 O LIJ 0 .21 LEJ 0 O c O • W w E H Jeff Freund UJ O John Mason UJ O Melissa Kauffman UJ 0 Sandy Ringer 4-1 0 U0 10 C9 Lisa Michael Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Fiscal code: RESOURCES Maternal Child Home Visiting HMCHV FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 79,169 5% $ 168,608 10% $ (89,439) Federal Grants - 0% 0% State Grant Award 94,696 6% 105,027 6% (10,331) State Pmts Other 801,159 49% 801,159 49% OHP Capitation - 0% 0% - County General Fund 658,352 40% 564,427 34% 93,925 Other Revenue Sources - 0% 0% Total Resources $ 1,633,376 100% $ 1,639,221 100% $ (5,845) REQUIREMENTS Personnel $ 888,417 54% $ 795,109 49% $ 9.3,308 Materials and Services 326,090 20% 325,290 20% 800 Transfers Out 0% 0% Capital Outlay - 0% 0% Admin, Support Services & Overhead 418,869 26% 508,490 31% (89,621) ^•ontingency - 0% 10,332 1% (10,332) Total Requirements $ 1,633,376 100% $ 1,639,221 100% $ (5,845) Program Services FTE 9.29 Admin and Support Services FTE 2.03 Programs/services: • Nurse Home Visiting serves high-risk pregnant women and their children to improve timely access to prenatal care, breast feeding, maternal mental health and developmental screenings. • Services are delivered through several programs including Maternity Case Management, Nurse Family Partnership, Babies First. and CaCoon. • Oregon MothersCare (OMC) provides prenatal needs assessments and coordinates pregnancy testing, prenatal care, depression screening, WIC certifications, OHP enrollment, and referrals to critical services. • OMC services are offered at the Courtney Building and St. Charles Center for Women's Health Clinics in Bend and Redmond. Changes/issues: • Increase in FTE due to internal changes to better address service needs. Clients/population served: Population: Families at risk for poor health outcomes. Clients served: The program is currently serving approximately 211 families. In 2015, the program provided 2,100 visits. 14 y 0 0 tet' o o 8 N co a) °° 0 to c Oy N . co 3 .3 N T U C U 'O o ° ° a) V �0 V Ta 9 V i ¢ .0 y m o u .a a=. N 8, 2 a)a) V N ° a) O O y. i N o ° N V T 0 YO V It'll lO G °' N L C N N N '�'. G O ai 61 N 6+ Q > W d ° N V e• L Y N a O u w o E w • v 0) .3 d> E- c w d 3 m s w 0 N = (...) R N 9 T O 0 O 7 y.3 0) y 0 9 9 6 I.:; CN N p s N O V d V d L ICO O N G N O ¢ O y> O O o d Y j C N N N L O) N R C 3 y 'O"' N i, a0 L 0) YO L N W ✓ V N i T 1011 L V {O C V 961 = 8 R '' O • • N 04 V N N V N 'O 16 N 2 O V 6 i C 0)V '"C'' N C tya N 0) +' O. y6 0 0 ° u ° 3 0. C d 3 m b t- 6 d d 2 @ O 0 9 m N 3 '"' (.=&0., E y rn ' d gar @ o g. -ret, ; i o W c.1 H 6 ei l 3 eC n O a tD 4 0 Ui I J N • sD r • O+ - 3 N V u y 6 A O- - . 3 o • 0 ° O O V` •N/^ OOU` 0 th T u ) `o✓ Y G V 0) 0) N O U Y 6 ao � C Oto G N 0) d a Core Activity Tasks d 0 N Allocation O • Ol tt) Ln O O Ln CO LO LO .-� O o O O O O Sarah Holloway Toni Whitehead N ID m J O w V L 1.0 N ID W Jean Clinton Anne Olson Pamela Ferguson hel Deschutes County Health Services FY 17 Requested Budget Analysis by Project ikna lysis by Project Program Fiscal code: RESOURCES Prevention Programs HGP, HADP, HSPF, HADT, HSP, HMHPP, HIPP, HDFC, HSCC FY 17 % of Budget FY 16 Revised % of Budget Variance Beginning Net Working Capital $ 49,200 5% $ 35,848 3% $ 13,352 Federal Grants 209,000 19% 212,868 20% (3,868) State Grant Award 387,959 36% 446,270 42% (58,311) State Pmts Other 0% 0% OHP Capitation - 0% - 0% County General Fund 186,640 17% 97,327 9% 89,313 Other Revenue Sources 244,411 23% 266,627 25% (22,216) Total Resources $ 1,077,210 100% $ 1,058,940 100% $ 18,270 REQUIREMENTS Personnel $ 471,562 44% $ 484,621 46% $ (13,059) Materials and Services 384,014 36% 429,799 41% (45,785) Transfers Out 0% 0% Capital Outlay 0% 0% Admin, Support Services & Overhead 221,634 21% 116,740 11% 104,894 "ontingency 0% 27,780 3% (27,780) Total Requirements $ 1,077,210 100% $ 1,058,940 100% $ 18,270 Program Services FTE 4.91 Admin and Support Services FTE 1.07 Programs/services: • Substance use/abuse and problem gambling prevention efforts geared toward youth and young adults. • Resources and professional development for K-12 teachers, counselors and administrators; grant writing, training and technical support to partners; and prevention messaging. • Suicide Prevention Program provides community education, awareness and training to prevent suicide attempts and deaths for people of all ages. • Mental Health Promotion Program assists schools with the inclusion of emotional/mental health curricula. Changes/issues: • New Drug Free Communities Grant — 5 year grant, $125,000 per year. • New request: $53,412 county general fund to support suicide prevention .50 FTE Health Educator II. • Included in departmental administrative allocation. Clients/population served: Population: Serves all Deschutes County residents with an emphasis on educating youth and working with school personnel, health systems, health care providers and others to educate and create policy and environments that -ourage a healthy lifestyle. _.,ents served: These school and community based services do not result in a specific "number served." 15 Deschutes County Health Services FY 17 Requested Budget Analysis by Project analysis by Project Program Fiscal code: RESOURCES Tobacco Use Prevention HTO FY 17 % of Budget FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 6,268 4% $ 4,065 2% $ 2,203 Federal Grants - 0% 0% State Grant Award 133,323 81% 133,323 78% State Pmts Other 0% 0% OHP Capitation - 0% 0% County General Fund 24,047 15% 33,444 20% (9,397) Other Revenue Sources - 0% 0% Total Resources $ 163,638 100% $ 170,832 100% $ (7,194) REQUI REM ENTS Personnel $ 93,467 57% $ 93,253 55% $ 214 Materials and Services 20,400 12% 9,550 6% 10,850 Transfers Out 0% 0% Capital Outlay - 0% 0% - Admin, Support Services & Overhead 49,771 30% 68,029 40% (18,258) ` ontingency 0% - 0% Total Requirements $ 163,638 100% $ 170,832 100% $ (7,194) Program Services FTE 1.10 Admin and Support Services FTE 0.24 Programs/services: • Tobacco Prevention Program works to prevent tobacco use among youth and young adults, promote cessation, eliminate exposure to secondhand smoke and reduce tobacco -related disparities. • Activities include increasing smoke- and tobacco -free areas, collaborating with partners to provide cessation services, educating the public on the harms of tobacco use, increasing referrals to the Oregon Tobacco Quit Line, and limiting the marketing and sale of tobacco products to youth. Changes/issues: None Clients/population served: Population: Serves all Deschutes County residents with a focus is on educating youth and working with school personnel, healthcare providers, government agencies and businesses to create policy and environments that encourage tobacco free living. Clients served: These school and community based services do not result in a specific "number served." 16 Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Chronic Care - Healthy Communities and the Living Well Series Fiscal code: HCC FY 17 %of Budget FY 16 Revised %of Budget Variance RESOURCES Beginning Net Working Capital $ 30,208 14% $ 0% $ 30,208 Federal Grants 0% 0% State Grant Award 73,125 34% 73,125 29% State Pmts Other 0% 0% OHP Capitation 0% 0% County General Fund 113,678 52% 157,411 62% (43,733) Other Revenue Sources 1,000 0% 21,904 9% (20,904) Total Resources $ 218,011 100% $ 252,440 100% $ (34,429) REQUIREMENTS Personnel $ 130,548 60% $ 132,877 53% $ (2,329) Materials and Services 25,250 12% 35,152 14% (9,902) Transfers Out - 0% 0% Capital Outlay - 0% - 0% Admin, Support Services & Overhead 62,213 29% 84,411 33% (22,198) Contingency 0% - 0% Total Requirements $ 218,011 100% $ 252,440 100% $ (34,429) Program Services FTE 1.38 Admin and Support Services FTE 0.30 Programs/services: • Healthy Communities Program (HCCP) works to create environments and systems that encourage residents to make healthy choices related to physical activity and nutrition, including worksite wellness programs. • Living Well Series offers a menu of workshops in English and Spanish to help people manage their chronic conditions, including diabetes, cardiovascular disease, asthma and chronic pain. Programs were developed and evaluated by Stanford University. • Diabetes Prevention Program is based on clinical trials and targets people at risk for developing type 2 diabetes and can reduce a person's risk by 58%. Changes/issues: • New request: $41,647 to support diabetes prevention program coordinator .50 Health Educator II. DCHS is applying for funding through COHC. If received, county general funds will not be needed. This has been identified as a priority in the regional health improvement plan. • Expired Grant — OHA SRCH grant funded the diabetes prevention program for a one-time pilot. Clients/population served: Population: The Healthy Communities initiative is intended to create policy, systems changes and environments that ,sitively impact health. Partnerships include health systems, healthcare providers, government agencies, schools, and ,i -profit organizations. The Living Well series serves persons with chronic conditions. Clients served: In addition to the population -based work described above, approximately 200 clients were served with disease management programming in 2015. 17 N dd n0 E 0 U 0 O ja C O 'o a O1 C 0 a e a N a 0 N Uj N y C N m W O R_ .1)_U.O J 2 '15' rn F o .o 6 e, ¢ E .D ` a Y m 4 m N U) 0.°' m E u Ea ‘D`'?,``' a8i a u 2 u m o C F o,o %Da°V=a 0 o 'E m t` m o 2 O v¢ E to a ani E '3 0 2 0 E a' aE O '° 0 0 E E m E 0 E n E a a., v d d 2 E E > > > E > > > m L v N d d d 0000.0. Will -1002 a a a N m y Metric (Outcome #) 01 m O Ot 0 C C 0.0 G C a,0 O1 O1 H 01 O1 N O 0 0 c 0 0 a) N O0 fa 0 c 0 10 o J n 0 0 L C N N .(5 Prevention Team Recruit and supervise interns Prevention Team Prevention Team C > a O U L 0 w m 0. E U C1 m 0 J c 01Ot V C ;� O C N d i0 C O '>O C a/ m m Of 0 N ::: >.°- oO T O m o0 m;°u_-2 :;.: „„t:J E cmvm o J c ar m i0 c 4cO0U) '9 n o Sw` wDmo c� _uN ,-. � � cU a O% aJtTQ>> '° :; N N O J c u N J a) c E E a E a° O Q) p m H m a .4_0:.i...,, 'r) m N a02&a c E, u V. o'mUU 10 F2; 8 •C N a) m N > o° p> c m` °�° v Y a a> E a O -.5 c c 0) N° U o m V m v ', '(g ° '9 o E v o a c=n o o w m a w z E Ci u E U 0. to to 3 co n o U F- O to U D a 5 E 1°3 al d a m E 0 O 0 0 ei es cm 0 c C c c 0 • 'E c 'E 'c m a O 0 0 0 — 9 c a) pi 8 H 0 4 E 0 • v w N O N O E m O >' 01 0 E 10 a N 01 o - C m N vm N ca), 0 E Y 00 O a.0 Action Plan L a) 51.2 E W E ✓ o N N E O 0 N 0 C O c 0 N 0 Prevention Team Prevention Team N 0 0 o a O c C ▪ E = o o N o 01 01 N u N C C 0 0 m .y O N N Brenda, Sarah Prevention Team Celebrate accomplishments at Due Date VD tD l m MD 0) .ti o O 0 o c O .0 O o N N N N O N 5 0) 01 0) 0) 0 0) U N 0) o 0 c c c O ^ a) N •0 in Ln LI-) in Li-, � V is in C0) 0 0 0 0 0 0 O 0 0 p N N N N •N Q T >. >. T j = a = Q '�-, .moi �-�-. n „ ., 9 ., . c m N N E 5 .0 c a N i c 0 O f0 .N a it m m a m W f0 a+ .O V T U '6 a+ 'O Q W c -> 5 c n O) N ''.:1°3 0) 0) 3 MI 0 3 d .Oi m n A' E m n O .p v Y o c E io C i U w y c y i y c N O) N -.5 c0 .p w O C j Co) . a/ c O •O m C O 2 o aa, .0 H y •E ° E m c .-1 c c y 0) 012 0 4 6) 0,, c- c 10 0 0 .E, .c c 2> o 2 m v m c c w c a c o. o m y t.,,,,-L%.'� _ ,E y V c N`. y N .cu Y a) w U D a' O" c o� a) .c U. t. u L O m O w y u o 0 K y E - O H c d 21 O 21 0 O O o o m G 0 i N Y 3 C O i N m N t+ 0 Y' y 0. I- 0. O Y a i 04 04 -p 0G40Oaa~ d V x m a) N Q 0 •C @= c L Q Y mU) !a 'O 1�)) > U m m m T E ,� aU c h' -'O. a Q L to C p U O., *3m y O )p a T N CJ V) in O O. m 6 N 5 0 0) c 2 v o 3 0 E a m 3 m$ w u s E a 0) m o r m Y o m c o c E a) N 0 G o> m o w w a 0) 0 E ar -a',7,75.- m t - Y 0 40 0 'o) 0 o) u o 2 o m> •G m d E s o m y m C a .c n c o :S s a a s c v 8 v d ')n '^ E Vl c o m> rn v aci E 0 o. 0 g m m a m > c 7' 2 a` . E 5 m a` 5 0 E .__ w m a` E m .� w m .5 o. E a .,m.7, ..i 0 o. >. O 2 L. 5 u ri E£ o° 8 m O m N v a0 O 0 N O N 7 '63 111 j0 b a a 40 a a a a a l0 O o E E E+ E E E E o N O 0) O O) 0 0) 0 a) 40 0) l0 0) t0 m 40 c O O T N V N V N U N V .i V .-) 0 .-) 0 .-I ^ N V N 0 O) 0) 0) a) O 0) 0 0) 0 0) 0 0 O N O N O N O N y 40 1 0 50N a C O N m •o y 0 0) 1- a4 C > 0) c 0 10 0 •9 a rn .- o E c W E meeting agenda Prevention Team O V) y N N 0 0 ti .moi .moi .moi ~ •OO t!1 .L ul N N N N N E', N N E* E.a N O. N >. T > N o O rsi Staff trained in CADCA Academy N 0) C a+ a t U U U .N = U .E U •U .� .� .� N o 0 0) 0) E 0) 0) E 0 E o p .o •O '' 7 J L 2 U c a) :u 'o V C O c..) 'i 2 a _, a) a) o c v s 0 = a 0 m E L c U E€ 00 C m t .N -I c LL C w N52 c .'0. a.s M u V m .O 7° L cn iii E 3 m o 0 3 m a 'i v a o ar c 0 d o c o i 2 0 5'a) •o o Q o 0 a p. U N 'EO !E +` a aZ m= y U° ° c E E a 0 v o a .E c u a` O u o •C t' • i: o m o S./ o ° c c U) u cd Q o`, o v°�i co 1r v a` 0 co • 0 0. o U) m 'aa) m 0 Core Activity Tasks A. Population and Health Needs Assessment Collect data H 0. .0 0 O t W 'T°) a) .0 Y s- C O A D 0. o c E g, to a A a s+ SI d W 7 c CD c m C u m ki a X,' E '0.1 ° c m E 'o o.cl g m v u A c0 c c 0, d c0 O. >. >>u n U' E wo w u 0 0 2 c m o ai m c . x , n O d O. V O d E° '0 a 0 d E 10 00 r 0 U ? c o Ec d O E u a o o .2 u .o . ' (0 0 _ . 8 .o. .2- E.,o c. 00 ... e. N B m o p c E E 0 y 0 9 d 0 0 > c d 0 0 •C c O l0 O O (0 0 0 00 U 'c a= .c E > E 0 (0 c ` y 0 a 0 E a 1--',L, m c W a u o o c d 'c E u 0 c d c ti m y <n u, .u.. oL, u' 3 (0 D a o aTi E 5 W> c y ti ( c v (n .d, E EE 0 C 0 E A o o ti E c = E m d W> 3 m u m> c C c c E u u, m a m rn W •� .0 c v c C -o v0i 0u (0 w al 3 o d y o o °' c m T' aui c 3 (0 f0 udi o a d N F2 E d 0 ti c c y c .� c ..>� Y c u°` u 3' d c A N ,°� d a '° > d O o (d/1 E O: 0 o 0 O( 'V 00 U d '> U U O i00 �.-,w,(0 0 0 m a f U U ad's,11,00),%) U a ad' a U 1'C 0 0 E in cn N ad' c4.1 n Q a U ce Q ad' C7 C7 w c v a d 9 d y d a E 0 W O 0 U 0 O 0 d M Ofd d ra sol0 to N a C ,c 0 E E ,C NN NN CO > 0 rC p0 0 0n 9 O 0 y•Lo -( .--0 0 r --i c 0 4. N N N N W a E Q n n n n V O C W m 0 c T m W ( C E a 0. to E a a W c Y c i 00) U d @> C o -Z-' a o z00 U) n a 0 o m 2 -. co d o T J d c O 0 •N c 0 d 01 > 4. V > Z .0 G W d d c c 0 `00.. d x ID y c O 13 E - '0 W 5 n d d a W W c E o C V H _ a n E Ce a o n D y 9 a c 'i _ O 0 a 00 d N 40 E O '5 45E7, E 0 . 0 a H 3 cn 2.,E'5' C 0 C C a ° d d U 1/1 0 '(a m C (0 W N O' d (L C o 1 3 c d a i E 'O a d_ c_ Cn 1 a i 0 d0 0 E. June 2016 u.c.dE �'a��a'02Y�Ev�o+ L. Project and Program Evaluation l0 d 0 0 E 2 W 0 0 0 C c d n n 0 Lf, y 0 E m , >` N N c N nn O t Y d . V N U •z un •z d i O n t 2 v o E 0 O o (` m 0 0 d m 0 2 o E o W (0 C •o c > > U 3 (0 a 2 d = UI Low a) . .0 c d 00 8 00 ^ E ut a (0 c o (0 c CO o N L u d V U c C o N N o o E 0) u 0 a m 0 E > E E V d (0 LL 0 v c m N 00 >. d E aW > c E 0 E > u 2 0 d c c d �p c o 00 IL L LU LU LU LLI 11J U.I Lttttt O N 0 0 0 0 0 0 ., o ., .4 .4 .4 ., .4 Penny Pritchard Julie Spackman David Visiko Sarah Worthington 0 N ro W U O C R O co C C N Cl., •E L i a 7 N O. 23,.„, r N d a u E m drn 0. E m c ti o 0 E p 0 in Vi 0 V 0 ' a O U ,� V o 0. 0 V 6 C ,cro, in u m A N rn u .0 C al cii • m U V N m N 01 E. 0 .00 a . N Ey a oL 9 N g E A i C C 3 i am6; w0 C o1 C y� i� 0 ,�+ O N m oi d m o) o BQ o@ -u a o ti v m N j u t ti 3 m v) H a i s r o r a 0 0 C C 8 v 0 O 0 .0 E 0 c 0 0 5 u .. U) N u W O a • 0 t N R R N Q O) v C a Yrn 0- = o 'u v u °0 E 0 y E m ° ,cv m0 v 10 c cn N aR 0 0 0 N c aN m E w w E • L E 00 u E E 9 N m o �^ 6 u m • w O. 0 Q G L c v ,v+ O ,'c. L 0 0 O) V O E YN 0 0) Oa C > 3 N 0 N e v v N O 't0 N N r N E i0 > O a O N 0" 0 h U>) U —Cr) C V ri Q CL' VY V D. a u 10 c d c 0 > +• m m o a V U o a 0( E 0 Tun' 0 m Z' 11 'C m O fa E m a E o N U C N L a CT 2_, a o .v+ y�• a '� E > 3 0 m w o m 0 E c w 0 0 - ', d C al C Y N o N o Lf0 N O m a m > O m o .o, a . • (0 r a c 5 0 v 3 N o rn a E n uig o. as .00 o v O 0 a o y zi ;3 >i w a 2 ._ d 2 ami Develop targeted media campaigns u m 8 Create communication plans for policies Quarterly and annual reports Deschutes County Health Services FY17 Requested Budget Analysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Reenue Sources Total Resources REQUIREMENTS Personnel Materials and SerAces Transfers Out Capital Outlay Admin, Support Services & Oerhead runtingenoy Total Requirements Program Ser,ces FTE Admin and Support Serces FTE Reproductive Health Education and Prevention HMFC, HPREP $ 15,647 6% $ 33,224 12% $ 82,085 31% 82,085 29% 98,493 37% 98,493 35Y6 - 0% O% - 0% - 0Y6 59,147 22Y6 56,042 20Y6 7,728 3% 10,516 4% � 161,015 6196 $ 26,500 10% 0% O% 75,585 29% 0% 1.67 0.37 (17,577) 3,105 (2,788) (17,260) 144,964 52% $ 16,051 40,814 15% (14'314) 0% 0% 94'582 34% (18,997) 0% 280,360 100% $ (17,260) Programs/services: • Classes for students covering topics including healthy sexualityrisk reduction, healthy relationships, teen dating and violence prevention. • My Future My Choice is an abstinence -based, age-appropriate sexual health and life skills curriculum for 6th and 7th grade students that involves high school students as volunteers. � Cukfate is a pregnancy prevention initiative focused on Latino youth ages 13-18 in the tri -county area. Changes/issues: None Clients/population serve : Pomulatimn: Adolescents Clients served: The program served 6,181 middle and high school students in 2015. 0 t T - Y 10a F 0w to i G. y c c 0 E o E �,' u 'O Q Al d Q L1 0 M ti m O m 0 ti 0 > > > L c u h E cc u E V .i ro �, m j E E E E E c E Y c. E O E w ww ww n UEs.0 0 E E 0 .0 a0 y .0— O m m 0 O E T 0 2 Sri m a 4 BU to B. C .0 m U A N U ! try z 0 m ro 0c m � c.o 0 N z 0 O a to U = N E o m 0 N s� R o m y au Ea 0 a o E 1 Plan Lead: Kathy c 2fi j L a ro o, L c a ar Tv 0 En c — a 'y 0 ,- o a! m m i o 0 N = a �a L= ro E 1 0 d ro m C .0 v 0 ti Vi a).0 E rn aL.. 0 c u c o N N �. E ' C .. u1 N O N i0 U T 0 0 v aL., N ro V c 02 ti U M KJ ro .c a) 0 2 m 0 0 o Z 3 a o = E T a '° _ o ce _ 0m m c t6 Y T O i O' .z, o v N v a .,. D o c 2 E (- m- —y c m° LL ro E° 0 xi m y. Z 0 a ? E a J Y W O w U 5 z u cos C m N.o m 3 . . ct 7= -0a, .m c a) 0 m Em17).=a-1"q) f P, 2 a — cis a ....'3 na m m 5 5 v ° u N u 0. 0 n as o E v, a0 o 0 > o ai m u m 0. T aN1 L v c0N a0.N ao �0c 0 L0t' 0 N 0 0 RS 1-4 a'in ,o C 0 o — 0 a .. o 0 O 0 a i b n c c u E a. E S o v 5 A Z U 0 t a a c m o w o o > � Eo N.E o a = 2, ,E). 0 co a` o a3 U5 t awF a " N V y N — a N p 0 0 0 0 VS l7Ql7 40 O young adult hub Outcome & Process Performance is Q Metric (Outcome #) a o a0i0 .0 1) z0 01 c ID N c — o m E c o o O u O C c aT+ 0 0 m_ ro a 0 0 3 o E m c 0 ro 5 E m m ° E o c E c o a U`... T ro c� c c '0 00 Fu new venues for ,(2 0 0 E (0 c T N o ro c T m w i E c ns 5 U- a( Ta )) 0 it 2 O i L ,., ro L 0 o } c 05 0 (0 Uc m (a o +0 � 00. 7 0 tjc as c m U at sa a,= 3 o. •E w U.1.1 w E Ww is '0 = JN.1 0 = c a 0( () 7 O om CA cT 0 L U u 7 a E � 3 ro 0 n a, a mas m O 0, o 0 t O u 0 o.^s O N 2 N t0 5 0 z. O N tn'7 > 0 T .� c c a E E f. 10 O V y u 0 .0 0 () rn c Z O = o Number of teen e • 0 uu '17 o 2o 9 2 al a, .c) E 03 tht.' ,. E C.) ..o E Rai I- O U a L. 0)c E 2 c ta g tn 0 t's 0 C' o 0 6:i ro ,3 m ‘.. ..- 0 •,:: 9, -o o. v 8, 0▪ ) ▪ U E 1 4.g E .2 • ... — 2 2 o 8 E a al 2 55 E = 0 co 5` ,,, T.) 2 0) S' 4-, 5,7' 8 I°. : 8 cn eara3 •B B E : 7.2 3 u.2 '5 .c .E 0. C 0 772 ..tii '2 On.--ct00inbuci ith school districts 0) g 0. Al E 4.) W it; t rs! 10 0 0 ro Tr; 0 0) a at 2 4 us 4▪ 5 to at }- 76 01 10) tu U-1 t x 5 cn 71 0 `5 u 41 15 "6 '95 t -132 t 2 r,10 O E `8' > E • o /3 5 Fa 2 71 5' 2 8. a. 0 _1 Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Fiscal code: RESOURCES Clinical Preventive Services - Reproductive Health H REP FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 62,525 6% $ 0% $ 62,525 Federal Grants - 0% 0% - State Grant Award 148,520 14% 157,869 12% (9,349) State Pmts Other 300,000 27% 350,000 27% (50,000) OHP Capitation - 0% 0% County General Fund 236,710 22% 396,857 31% (160,147) Other Revenue Sources 348,000 32% 371,500 29% (23,500) Total Resources $ 1,095,755 100% $ 1,276,226 100% $ (180,471) REQUIREMENTS Personnel $ 615,577 56% $ 650,506 51% $ (34,929) Materials and Services 237,450 22% 226,500 18% 10,950 Transfers Out 0% 0% Capital Outlay 0% - 0% Admin, Support Services & Overhead 242,728 22% 399,220 31% (156,492) ^ontingency - 0% - 0% rota) Requirements $ 1,095,755 100% $ 1,276,226 100% $ (180,471) Program Services FTE 5.38 Admin and Support Services FTE 1.18 Programs/services: • Voluntary, comprehensive reproductive health services to low-income individuals. • Prevention, education, screening and follow up services to prevent and intervene in the spread of sexually transmitted infections (STIs), human immunodeficiency virus (HIV) and Hepatitis C, and reduce the complications from these diseases. • Education and testing in the county jail and alcohol and drug treatment agencies in Bend and Redmond. • Presentations for students. • Care and treatment services for eligible HIV positive persons and some of their significant others through the Ryan White Case Management Program. Changes/issues: • Decrease in FTE due to internal changes to better address service needs. Clients/population served: Population: Men and women seeking reproductive health services, targeting low-income individuals. Clients served: The program provided approximately 6,300 client visits in 2015 and prevented an estimated 411 "ntended pregnancies. 19 1 nes, annually (5). O v N c C O E d R m 00 0 d W CO 0 Y Y a L O N c y T E a� O c .4 co. < V7 Program: Reprod Operational Plan Lead: g .0 N T Y 0 00 Desired Outcomes: Supported Strategic Plan Goals Program Measures +0 0 C 0 C a u m C � 8 v t . c N r0 C 00 N m 0) Y O S w -up with patients C. Support clinic operations Evaluate clinic schedules and clinic flow based on utilization and wait times. c Cl. EHR Optimization t 0 to O C1 fA it 97 m N 0.3 C 0 M c O uj O L C r0 O 0 e 3 di m u G N N N '.O- '9 3 c 0 d C N —> E N .10 o.. N > a E CO • midc u imm : s > d m cL a771. uO c 0 &a S1} Fa' m 3 ami m me>ci^y �,w .72 8, Z., z U m.Q�vywd • vU 7 a N a N 0 N moE.c E vcv' wa oNLN_T_\qd dN(N13O@t)N.ECD.u"uw E Ws tuE E v v 6 V N N g N E - a UOnca8-0- r0 >v 0 0OttO m N Core Activities D. Program coordination IS b 7 o (\� -c \/ \ «}{\ } \ \ro \ ti -i-la }tea r/\• -e"; * a_c= -;!. ; , -- -2x82 I�0- %0002 ke \kk) 0 0-°I a. g0 Eokk{f§\)\{}'o \ r§[{. -{fg%!S@Eƒ]E_kI§<--;�f,�n®7,f±3E223.0 '0 a¥.ƒ}§\k ;.e.... !a£B£=3$\l=�,.!®!_>■5-t • - -°`®&+$*/w«f|®Is§2i��f\&«!}/&ƒ�*§(/{ }.Eo56 \f 28892 oasJaftG0' o. 5£io2£Z!_&:ot3< g id C7 s L0 A ® \zz 2 /f - D4. Revise meeting structure Personnel a. 0. & [ 111 [ t [ [ [ [ Kathy Christensen Holly Nyquist Carrie McGuigan Claudia Wiseman Deschutes County Health Services FY 17 Requested Budget Analysis by Project 4nalysis by Project Program Fiscal code: RESOURCES School Based Health Centers HSBHC, HSBEG FY 17 %of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 67,279 6% $ - 0% $ 67,279 Federal Grants 0% - 0% State Grant Award 800,400 71% 815,234 82% (14,834) State Pmts Other 0% 0% OHP Capitation 0% - 0% - County General Fund 254,738 23% 181,214 18% 73,524 Other Revenue Sources 0% 0% - Total Resources $ 1,122,417 100% $ 996,448 100% $ 125,969 REQUIREMENTS Personnel $ 503,007 45% $ 614,504 62% $ (111,497) Materials and Services 355,627 32% 226,115 23% 129,512 Transfers Out 0% 0% Capital Outlay - 0% - 0% - Admin, Support Services & Overhead 263,784 24% 155,829 16% 107,955 ^•ontingency - 0% 0% - Total Requirements $ 1,122,417 100% $ 996,448 100% $ 125,969 Program Services FTE 5.85 Admin and Support Services FTE 1.28 Programs/services: • School -Based Health Centers (SBHCs) offer comprehensive physical, behavioral and clinical preventive services for youth and adolescents. SBHCs are located on or near school grounds. • SBHCs are certified by the state and sponsored by community medical partners including St. Charles Health System, Advantage Dental, La Pine Community Health Center and Mosaic Medical. • Six centers in Bend, Redmond and Sisters high schools, Lynch and Ensworth elementary schools and La Pine Community Campus. • In addition to direct medical, behavioral health and dental services provided by DCHS and medical sponsors, DCHS coordinates Youth Advisory Councils to work with youth to implement health-related projects in the schools. Changes/issues: • Included in departmental administrative allocation. Clients/population served: Population: School aged individuals seeking services from their local SBHC. Clients served: 2,451 client visits to 152 individuals, averaging 16.1 visits per individual served. 20 ] E2 Eu o (1) Q k \.k \= ii ( 7)ƒ5EG))Z k§§§§k})) 0� 0 0 o 2 )0) (0 it 0. Ta §f o o - 0 e ) X 7 f ro 5 ƒ! £_ ..51-cE•ra== 0\/(\\(�) £sir_1*«««a ol \ ( k/{ &%A @//) 012 f0 Z 00 .0003=@E « < U E .a, 0 0 0 0 | / \£ 0 ro c To an 01 LU ey outputs and } ic As appropriate tfi EEta12 EC of Lead SBHC Core Activity Tasks Core Activity Tasks acuity, planning, Core Activity Tasks tO 8 Wel ,e56 t, mit .......... Deschutes County Health Services 'Y 17 Requested Budget Analysis by Project talysis by Project Program Fiscal code: RESOURCES WIC HW IC, HWPCG FY 17 %of Budget FY 16 Revised % of Budget Variance Beginning Net Working Capital $ 166,650 11% $ 21,575 2% $ 145,075 Federal Grants - 0% 0% - State Grant Award 655,189 45% 663,132 54% (7,943) State Pmts Other 0% 0% OHP Capitation 0% - 0% - County General Fund 629,382 43% 541,997 44% 87,385 Other Revenue Sources 0% - 0% Total Resources $ 1,451,221 100% $ 1,226,704 100% $ 224,517 REQUIREMENTS Personnel $ 914,721 63% $ 923,958 75% $ (9,237) Materials and Services 12,210 1% 12,893 1% (683) Transfers Out 0% 0% Capital Outlay - 0% - 0% "dmin, Support Services & Overhead 524,290 36% 289,853 24% 234,437 intingency - 0% 0% - Total Requirements $ 1,451,221 100% $ 1,226,704 100% $ 224,517 Program Services FTE 11.62 Admin and Support Services FTE 2.54 Programs/services: • Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a nutrition education and referral program that provides food for pregnant, breastfeeding and postpartum women, infants and children up to age five. • WIC provides education classes on infant and child feeding, prenatal nutrition and exercise, breastfeeding and referrals to other DCHS programs. • Clinic services are available in Bend, Redmond, La Pine and Sisters, including at the St. Charles Center for Women's Health clinics in Bend and Redmond. Changes/issues: • Included in departmental administrative allocation. Clients/population served: Population: Women, infants, and children who meet income and eligibility requirements. r Clients served: WIC served approximately 6,000 women, infants and children in 2015, providing 1,200 appointments per month. 21 1 d N a Q A 3 p O S m V O C ca to lTcs O RO 01 �+ M fwi O a O G In a) o° p C .a _ _ CD PZ I - in + N_ r` CI N �+ N to oN Q M a+ f0 N M rn N m G ° 4 b o 0 V rn W oa 5 ~ ~ tT V O " °' C Z} 0 3 a ° d v d cc' a W m Z o. v y o IIZ c to as _co '"-P: a c a c 0 2 0 t. m m E c T U c c m m L cr)g o z__ i E v o Z c'6-,' 0. —: c ° tr > o 0 5, a 4 c R i a c o m co ° w 4� E 01 a > a ° m E g C v 27 il . 4cr '3o °c' a u, dS c vim' '� a' E d ° c tv Ucv°E mro aC 4 it m Orm6 O 'N d o0 it 3 ? C I'71 - u, '-' ao m iNAc m mN iu 9 cv onC L T mnO5N c v4 y w o w C;wv U NN ii N m N m ti m VDaO OG Y0 5 L a df" •N m01 0. r L C tG . LL NN 5 E up T C i V S. V 2 YCN u N1. 4 4 Q Q O u a 6 N 4 T N 101 N f0 1-1 V N O T 40 N Y ✓ n vC v 0.,-- av 6 m 7 2 10 i.'ni' U_ G V -2,r ° G N m 'L5 a R tJ O C @ U Q.Oi +d 4 V aO Q 0' „'WP'i 0 yOVI O N ril 1. , O�` K V 0-0' Cd G m, 5 or a4r N Oy m E 4 0 m Ung °c ` 0 N 0r-+6' N T+N x v a. 3 '5 iii co . o L.o" E u ow o dt-5 �,_"'�qa. W ESc 3 ppV T ` N 4Oy4NmiQO a..,1/45 - ?,.:8 c N O V6 0c'dfa0 a C i d EE 3 r Lpm$um5,05 yc + z £ 0 E ! V, >-- til ovut a m v .. rvri ivi,oh 3 0 a z o.' an--' H Q w L4 0 0 Eo 0 v Due Date 0, 0 Maddie McKinney Laura Spaulding Di. 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Inter- & Intra -Agency Coory ination 0 O a iD (0 0'+ ti ID N E N Anne Olson Finalize internal referral Laura Spaulding Pamela Ferguson F. Client Intake & Enrollment e 0 ko 1-1 LOu M O a o M 01 UJ UJ LLI LLI LIJ IIJ 111 UJ LU 1-1 It F F F O co N 0 LO l0 0 0 O CO ti OO .4 O O ti .4 .4 . O N C 0 •l0 0O N CO N Laura Spaulding Personnel Monica Dennis Shannon Bird Susan Christensen Grace Kennedy Marla O'Neill Michael Rossi Alejandra Talavera a M 0, Deschutes County Health Services FY 17 Requested Budget Analysis by Project Analysis by Project Program Fiscal code: RESOURCES Health Services Administration FY 17 % of FY 16 Revised %of Budget Variance Beginning Net Working Capital $ 3,727,932 94% $ 3,962,455 90% $ (234,523) Federal Grants 68,000 2% 17,000 0% $ 51,000 State Grant Award 0% 86,481 2% $ (86,481) State Pmts Other - 0% - 0% $ OHP Capitation 185 0% 252,038 6% $ (251,853) County General Fund 100,000 3% - 0% $ 100,000 Other Revenue Sources 77,487 2% 106,700 2% $ (29,213) Total Resources $ 3,973,604 100% $ 4,424,674 100% $ (451,070) REQUIREMENTS Personnel $ 215,541 5% $ 77,226 2% $ 138,315 Materials and Services 214,7.00 5% 487,784 11% $ (273,084) Transfers Out 0% 209 0% $ (209) Capital Outlay 0% 210,740 5% $ (210,740) Admin, Support Services & Overhead 0% 0% $ "ontingency 3,543,363 89% 3,648,715 82% $ (105,352) Total Requirements $ 3,973,604 100% $ 4,424,674 100% $ (451,070) Program Services FTE Admin and Support Services FTE This funding includes required contingency funds, as well as a request for one-time only county general fund for construction. The Director's Office, Operations and Support Services Division and the Behavioral Health Medical Director, county -level and agency -level indirect service pools, insurance, building -related costs and other charges are allocated across programs/services. Allocation methodologies are based on FTEs and vary among public health, behavioral health and environmental health based on the types of services used in each. This year with creation of a single budget, some past practices regarding allocation of these costs were modified to achieve consistency across the department. The total of these costs including 46.8 FTE is $8.6M. The FTE and services they provide are included in this chart and are described on the next pages. Personnel $ 4,376,342 Indirect Service Charges $ 2,526,877 Liability Insurances $ 231,916 Electronic health record/IT systems $ 439,693 Miscellaneous (Util, maint, supl, equip, etc $ 602,720 Debt Service on building $ 300,000 Vehicle Replacement $ 145,740 $ 8,623,288 22 Director's Office The Director's Office provides leadership and direction, and is responsible to assure partnership development, policy ,d planning, communications, health equity and other foundational capabilities. The FY 17 budget includes a deputy r behavioral health that is allocated across behavioral health programs, a deputy for public health that is allocated across public health programs, and a deputy for operations and support services/chief financial officer that is allocated across the department. • Director and Administrative Support: 2.0 FTE Behavioral Health Medical Team The BH Medical Team provides medication management, therapeutic services to complex clients, clinical direction to BH and consultation to community providers. 10.0 FTE for medical staff members and contracts for medical services are included in BH programs described in earlier in this document. In addition, the following FTE is part of the Medical Team and provides clinical direction and medical oversight. • BH Medical Director: 1.0 FTE Operations and Support Services Division The Operations Team provides front office and client intake services, facilities, equipment and technology, human resource and personnel support, workforce development; and project management. • Reception and intake at 8 locations: 17.6 FTE • Operations and project management: 1.0 FTE • Electronic health records: 3.0 FTE Total FTE: 21.60 sults: • Reception and intake staff supported more than 133,000 client visits in CY 2015 o Each FTE supported 1,700 in person client visits per month. o For many client visits, these staff also had a phone interaction. o For new clients, intake processes are also provided by these staff. • Project management staff supported 60 projects in FY 2016. • EHR staff converted two major systems, integrating the entire organization on the OCHIN/EPIC system in FY 2016, while maintaining routine help desk services for several systems. • Coordinated the remodeling of South County and Wall Street Services Buildings. The Systems Performance Team provides quality assurance, performance management, assessment and epidemiology, staff credentialing, oversight of confidentiality practices, reporting to certain funders, coordination of accreditation, an agency -wide performance management system and operation of a compliance program. • Compliance, quality assurance: 2.5 FTE • Performance management, accreditation: 2.5 FTE • Contracts, credentialing: 2.0 FTE • Assessment, epidemiology: 1.0 FTE • Medical records, oversight of HIPAA/confidentiality: 4.0 FTE Total FTE: 12.0 Results: • In 2015, this team staffed creation of our Integrated Management System. o This included supporting development of and tracking progress on the Regional Health Improvement Plan, DCHS Strategic Plan and 40 program -specific operational plans. • It created and processed 135 contracts. • Assured credentialing of more than 150 service providers. 23 F • The team is responsible for assuring compliance with state and federal healthcare regulations, analyzing data and assuring we meet or exceed quality measurements. o Maintained behavioral health data integrity scores above the required 80% benchmark, achieving 93% in the most recent complete quarter of FY 2016. o Supports data analysis, compliance with and reporting on: • CCO quality incentive metrics and financial information. • Access measures to the CCO and OHA. • This team is responsible for assuring compliance with, preparing and supporting site visits and audits. In 2015, o Supported the triennial public health review. o Assured DCHS maintained its public health accreditation. • In FY 2016, this team developed substantial expertise in established quality improvement methods and supported two full-scale Kaizen quality improvement events. o One established an electronic referral process for internal DCHS programs and services. o The other developed a plan for integration of our front desk operations in Courtney Building in order to create efficiencies and improve the client experience. The Fiscal Services Team provides financial and business services including administration of the budget, grant management, accounts receivable and payable, and payroll. • Finance, budget: 1.0 FTE • Accounting: 3.0 FTE • Billing: 6.20 FTE Total FTE: 10.20 Results: • In FY 2016, this team made substantial improvements to the DCHS budget processes and created a single consolidated budget. o Processed more than 3,500 vouchers per year. o Submitted more than 31,771 medical claims for credit toward capitation and reimbursement. 24 GCT 0 ,o N p z 00 N 4 a V 1 8 ed G •0 0 0 N 00 0 .08 T.O N Cad*i-) 7,..c.", O T' O 0O N O �' a a N£ m c -t 4— 6 T. " O N N O 4 V... C @ I L G p a t] y y L d y t' C d N V •L N r . C Oa G y .i N u� a 7 n N w R Q W Y a R C L - X@vod 0 c da y ywON S. 'C N 2 .,E 9 mV5 d s. 'OCd 'i0 46 y 4 uoo 0 16 dE Z E CON G Tw m 6 w e '• O % R c o NN •O X C fl a Aa a.' d /6 u 0 0 N Y E.y 'O N G .0. 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Y ui P a > v -2x m awa d a=Y ;v 5„ Q u 8 .cY v o g v oc c • ` c v v w :E U aO3Y3¢3Omus2¢wlnLLua2(Ll'caa¢aa¢o E a, IS" o- E v a j 2 4.5 UO W N N E a u a O L j N Deschutes County Health Services FY 17 Requested Budget Analysis by Project 4nalysis by Project Program Fiscal code: RESOURCES Beginning Net Working Capital Federal Grants State Grant Award State Pmts Other OHP Capitation County General Fund Other Revenue Sources Total Resources REQUIREMENTS Personnel Materials and Services Transfers Out Capital Outlay Admin, Support Services & Overhead ^ontingency Total Requirements Program Services FTE Admin and Support Services FTE Vital Records HVR FY 17 % of FY 16 Revised % of Budget Variance 175,000 $ 175,000 0% $ 12,644 0% 0% 0% 0% 0% 100% 140,000 100% $ 152,644 $ 80,091 46% $ 79,752 2,850 2% 4,200 0% 0% 50,599 29% 68,692 41,460 24% $ 175,000 100% $ 152,644 1.12 0.25 8% $ 0% 0% 0% 0% 0% 92% 35,000 100% $ 22,356 (12,644) 52% $ 339 3% (1,350) 0% - 0% 45% (18,093) 0% 41,460 100% $ 22,356 Programs/services: • Issue official, legal birth and death records. • A critical source of public health data providing information on leading causes of disease and death, provision of health services, adverse outcomes of pregnancy, maternal and infant risk factors and more. Changes/issues: None Clients/population served: Population: Deschutes County residents Clients served: 4,380 residents were served in 2015. 25 Action Plan E010 0.• 10 10 10 41▪ , pi 74 ° 2 t • E • u, Certificates • t Fa O 0 0 • >. .a• ° 0. t4 °G)orD >- >- 6>- 76 16 a) 0 0 0 • 0 0 20. O 00,000 0 0 C3 0 O 2 -• c 0) .0 4-) m..,.., 0 ro in 2 2 2 2 -2 0 . c4 2 10 '0 TS 13 13 CS 4))) LU 00000C19> C < < < < < < 0 < aLf ft) t2 2 S t o j3 0o ro- .01 i .c c to 2 2 t. V, g 2 tl 9 2 Ft, — ,_ o 9 ,u 2 6 Lo2 I .c ... 0 4▪ i.tq. i) 2 2 -G o 2 a 2.L. u,e3t,.-3„oE i> 0. •i '-'C-: eti ni < < < 'V' t8 2--. -ci N rn 10 to 0) 0 z Program: Vital Records Operational Plan Lead: Shirley Overman & Andria Mitchell 0. .0 2 ID Ws' ro 11) 5 -o 0. to 0 0 E v• *, T3,1 ,• 7) -a Z' cr o O E • t Supported Strategic Plan Goal 2b. Enter orders into database Andria As Needed :0:0 -0 0 0 100 0, 0 0 901 0 -0 0 0 O 0) 0 to a) O 4) 0) 4) a) ZZ z z z to o < -',' -< "' o < uJ L. "0 '0 30 '0 100) a) a) 17 '0 '0 CU 0 0.) at a) CU 4) 0 a Z Z Z 0)10 ' < 00 ID -o -o O 0 • a 0.)• 0 z As Needed 01 0. 01 2 a 0 0 8 ▪ E m 2 2 : u F7, 0) 2 0 -. ce 0 0 , . O 0 0 E > a a a 0 0 Outcome & Process Performance Meas 10 10 0) x -0 i•O' 2 2 z 3 2 2 = uu 1• -4 t 0c9 0'O u • 0 E worno0:0) rx 0 lc -§ f! > .2 2 L.) 41 rti to 0 O Z ko = ,,,,, .= 1.0 = ,--1 1— S .:;.,: ,§ 'e 01 tt 01 ''' , ...1 .., 0 2 r9 2 ^1 -, --.• .-. ---. o --- 0 s . o c ,L, rs of revenue generated, annually (1) 4.1 0 0 -0 0 104) 00) E 2 8 NE. U1 ID c C • e 44 0 0 C C .4>. to 0 in 5 to 3 at 3 .0 212 ;_' 0,c` E E ▪ >. Tr; o 010 g Cr • J., 0 f0 ?3 c>,(10)0 OIOjtt >0 >0) (-) m. a O a E w a i 01 Lu V O 0 a N Danelle Beebe (for bac Deschutes County Health Services FY17 Requested Budget Analysis by Project Analysis by Project rogram Fiscal code: RESOURCES Totals FY17 %of FY16Revised %of Variance Beginning Net Working Capital $ 5,827,329 15% $ 5,150,215 13% $ 677,114 Federal Grants $ 683,417 2% 790,037 2% $ (106 ,620) State Grant Award $ 10,523,406 27% 12,153,312 30% $ (1,629,906) State Pmts Other $ 1,148,409 3% 1,226,159 3% $ (77,750) OHP Capitation $ 11,941,755 31% 13,812,487 34% $ (1,870,732) County General Fund $ 4,684,192 12% 4,408,231 11% $ 275,961 Other Revenue Sources $ 4,313,201 11% 3,288,642 8% $ 1,024,559 Total Resources $ 39,121,710 100% $ 40,829,083 100% $ (1,707,373) REQUIREMENTS Personnel $ 19,602,907 50% $ 19,972,413 49% $ (369,506) Materials and Services 6,954,453 18% 8,336,390 20% $ (1,381,937) Transfers Out 0% 209 0% $ (209) Capital Outlay 210,740 1% $ (210,740) Admin, Support Services & Overhead 8,899,369 23% 8,325,270 20% $ 574,099 Contingency 3,664,982 9% 3,984,061 10% $ (319,079) Total Requirements $ 39,121,710 100% $ 40,829,083 100% $ (1,707,373) Program Services FTE 213.95 Admin and Support Services FTE 46.80 26 Deschutes County Health Services Strategic Plan 2015 Update In November 2014, Deschutes County Health Services (DCHS) initiated a strategic planning process, based on the principles of the Balanced Scorecard. The Balanced Scorecard is a strategic planning and management system that is used extensively in the private and public sectors to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organizational performance against strategic goals. The Balanced Scorecard suggests strategic goals, objectives, performance measures, and initiatives address four different perspectives, or domains, of an organization: Community/Customer/Stakeholder, Financial Stewardship, Internal Business Processes, and Organizational Capacity. Managers and supervisors identified organizational priorities, defined strategic goals, and developed strategies, measures, and deliverables for each goal. The plan presented here included a review of the DCHS strategic plan that was adopted in March 2012 to guide the organization through 2014. It was determined that the agency had successfully met 42 of the 71 goals outlined in that plan. Relevant unmet goals and activities from that plan and the Ten Essential Public Health Services were incorporated into the current strategic plan. Development of the next DCHS strategic plan will begin in 2015 and will synchronize with the next iteration of the Central Oregon Health Improvement Plan. Final 3/4/2015 2 Deschutes County Health Services Strategic Plan 2015 Update /isiion Deschutes County residents experience excellent health and the highest quality of care. ssion To promote and protect the health and safety of our community. Improved health of people in Deschutes County Strategic Themes Better Care Improved service quality, access, reliability, safety, and satisfaction 2015 Strategic Goals Community/Client/Stakeholder 1. Promote Health and Prevent Disease 2. Ensure Needed Health and Human Services 3. Promote Health Through Policy 4. Monitor Community Health 7. Evaluate and Enhance System Performance 8. Improve Business Processes 9. Integrate Health and Human Services Final 3/4/2015 Contained per capita cost; preventive care and health education Financial Stewardship 5. Improve Fiscal Stability 6. Allocate and Use Resources Effectively Organizational Capacity 10. Develop Workforce 11. Realign Organizational 12. Enhance Positive Organizational Culture Structure 3 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Reduced prevalence and incidence of disease • Increased healthy behaviors and improved mental health • Decreased health disparities and increased health equity A. Develop a system of community supports to prevent child abuse and neglect, to safely reduce the number of children in foster care, and to prevent family violence B. Develop a diabetes prevention program C. Implement Trauma Informed (11) practices D. Increase capacity for responding to communicable disease E. Expand public health home visiting services to reach a greater proportion of the population in need F. Enhance emergency preparedness capacity • Collaborate with existing child abuse and intimate partner violence (IPV) prevention efforts in the region • Develop a work plan for establishing a community support system for children, youth, and families reduce the number of children in foster care • Adopt and implement DCHS IPV Prevention Policy • Provide diabetes prevention program services to first cohort of Central Oregonians • Train 30 Child and Family Behavioral Health clinicians to use attachment -based family therapy and implement throughout program • Complete agency and cross systems assessment of TI practices and provide needed training • Increase application of 11 practices and work flow processes within DCHS, DHS, and the region's home visiting staff • Increase staffing and training in communicable disease prevention, surveillance, and investigation • Implement quality improvement process to improve communicable disease and environmental health reporting by community • Increase number of families served by public health home visiting • Identify outcomes that align with Coordinated Care Organization metrics • Integrate all DCHS programs into emergency preparedness work plan Final 3/4/2015 4 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes Increased access to services in the community and improved health through collaboration with community partners A. Work with Coordinated Care Organization • and Central Oregon Health Council for public health/behavioral health partnerships B. Secure additional child psychiatric services for Central Oregon C. Assess Public Health clinical services to identify gaps, needs, and opportunities Initiate strategic Coordinated Care Organization/Central Oregon Health Council collaboration • Increase availability of child psychiatric services in tri -county area • Complete written assessment and recommendations report on Public Health clinical services D. Expand access to other community settings • Increase provider capacity for people with intellectual and developmental disabilities E. Respite for crisis Final 3/4/2015 • Convene with community partners to develop strategies for creation of crisis respite resources in Central Oregon 5 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes Health-related policies to address priority population health needs and disparities are implemented A. Participate in county process for the 2015 Oregon Legislative session • Track legislation and recommend positions on health policy as aligned with our priorities • Identify 3 local policy priorities to support in 2015 B. Include legislative and policy discussions as • Identify DCHS legislative role and processes a priority in regular management meetings Final 3/4/2015 6 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • The health of Deschutes County residents is monitored regularly • Critical health issues are prioritized A. Participate in development of Regional Health Assessment and Improvement Plan (RHA and RHIP) and Behavioral Health Assessment and Improvement Plan (BHA and BHIP) • Complete RHA, RHIP, BHA, and BHIP • Review and analyze results and implications of RHA, RHIP, BHA, and BHIP • Align 2016-2019 Strategic Plan with identified priorities B. Develop data analytic capabilities (e.g. hire • Develop and implement a process to enable an epidemiologist) staff to utilize data in a meaningful way Final 3/4/2015 7 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Increased fee-for-service revenues and approved encounters • Revenue and expenditures match both in amount and client funding mix • Capitation utilized at 100% A. Train staff on compliance and funding streams B. Team/program targets are set based on organizational needs, including productivity, safety net, and compliance functions C. Assess cost-effectiveness of programs and service delivery models D. Pursue grants based on Regional Health Improvement Plan and strategic plan priorities, as well as viability and duration of the grant • Decrease percent of encounter dollars that must be invalidated • Meet 100% of set standards for each individual, team, and program • Develop supervisor response protocols • Ensure reviewed claims pass audit at __90% • Establish a cost/benefit analysis process and schedule for all programs • Implement Grant Application Request procedure Final 3/4/2015 8 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes Resources are maximized to meet obligations, address strategic priorities, and support community health A. Use data to assess and align resource allocation with strategic priorities Final 3/4/2015 • Identify and assess data requirements for programs • Develop data -informed budgets for every program using identified data requirements • Align resource allocation with strategic priorities 9 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Data -informed environment where decisions and processes are linked to strategic goals and outcomes • Integrated Management System established • Operating an integrated Electronic Health Record that increases efficiency and effective service delivery A. Evaluate clinical outcomes • Select, pilot, and implement outcomes tracking tool B. Assess customer service practices • Develop, conduct, and analyze client customer service surveys C. Increase integration of electronic health record systems D. Develop and implement an Integrated Management System E. Develop and implement a Learning Management System (e -learning) • Implement OCHIN/Epic in Behavioral Health and Maternal Child Health departments • Create team -specific operational plans • Establish team specific training plans Final 3/4/2015 10 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Consistent use of a project planning model • Up-to-date and relevant policies and procedures across the agency A. Review all department policies, procedures and protocols to determine relevance, define scope and consolidate wherever possible • Transition 100% of relevant policies, procedures, and protocols to new format • Organize shared Health Services electronic policy manual • Publish revised policies, procedures and protocols to shared Health Services electronic policy manual B. Implement project planning model • Pilot, evaluate, and revise project planning model Final 3/4/2015 11 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Staff are aware of and understand the service array delivered across DCHS • Clients and the community experience a streamlined and coordinated system of services A. Create task force to increase integration within DCHS • Identify opportunities for integration efforts, building on existing efforts • Increase the number of integrated projects • Increase education of staff on organizational services B. Develop process for tracking client referrals • Establish baseline and set a target for (warm handoffs) increasing cross team/program client referral C. Develop capacity and model to offer short- • Establish policy and procedure, conduct term psychiatric consultation to primary care pilot, and develop program wide roll-out plan practices (children and adults) D. Improve collaboration with community providers • Complete and review Deschutes County Downtown Clinic integration evaluation • Facilitate referrals to Central Oregon Community College Dental Program and Advantage Dental Final 3/4/2015 12 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Opportunities to enhance career goals and skills are available • Core competencies are identified and achieved • Employees know standard department processes • Leadership development strategy and plan are in place A. Revise and implement workforce development plan • Assessment Complete Workforce Development Needs • Identify and enhance core competencies for each position/program/department, informed by best practice research • Identify and implement method for monitoring employee retention • Evaluate and revise new employee onboarding and orientation process for core competencies • Identify training needs based on core competencies • Complete annual trainings in Learning Management System for all staff • Utilize Learning Management System to facilitate understanding of department policies and procedures Final 3/4/2015 13 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Clear responsibilities and accountable expectations • Balanced manager/supervisor/staff ratios • Aligned and integrated programs and services that maximize our effectiveness • Efficient and streamlined service delivery model that aligns with the budget and informs how to address staff ratios A. Use FY2016 budget development process to assess staff ratios, program and service alignment, and organizational structure • Balance Manager/Supervisor/Staff ratios and revise organizational structure to reflect integration and better alignment of work Final 3/4/2015 14 Deschutes County Health Services Strategic Goals 2015 Intended Results and Outcomes • Staff share and demonstrate a common vision and purpose • Employee involvement, accountability, and strong/positive interactions A. Use external consultant to help facilitate discussion regarding culture B. Examine Trauma Informed Care, Trauma Informed Oregon, and other trauma - informed initiatives with the potential to implement strategies C. Use surveys to assess DCHS staff perceptions related to shared organizational identity • Consider recommendations of consultant and develop strategies as appropriate • Develop written framework to implement trauma -informed care • Establish baseline for staff sense of DCHS identity Final 3/4/2015 15 Deschutes County Health Services DRAFT Strategic Plan 2016-2020 The Deschutes County Health Services (DCHS) 2016-2020 strategic plan was developed with an intensive planning process that included input from DCHS staff, advisory boards, and the management team. The planning process is based on the principles of the Balanced Scorecard, which suggests strategic goals address four different perspectives of an organization: Community/ Client/ Stakeholder Internal Processes & Performance Vision & Strategy Financial Stewardship Staff & Organizational Capacity The strategic plan includes five goals with intended results/outcomes, strategies, and indicators identified for each goal. For every strategy, key actions were identified and prioritized for each year of the plan. Strategic plan actions have a regional or department level impact, including strategies from the Central Oregon Regional Health Improvement Plan (RHIP). Additionally, actions were considered through the lenses of Public Health Modernization (PH Mod.) and Certified Community Behavioral Health Clinic (CCBHC) criteria, two state level initiatives with potential for significant impact on DCHS. The action plan for Year 1 can be found in Appendix A. The strategic plan will be implemented using the DCHS Integrated Management System (IMS) (see Figure A). All DCHS programs have developed operational plans, which contain many of the key actions necessary to achieve our department goals. These operational plans will be used and reviewed regularly at the program and department level, and the strategic plan will be reviewed and updated annually. All DCHS plans, including operational plans, are designed to align with one another and ensure our actions are tied to community needs and agency strategy in order to have the greatest possible impact on the health and safety of our community (see Figure B). Draft 5/20/16 Deschutes County Health Services Strategic Plan 2 ,_. Wif244:40rAtit,Wilt.est..44, ,,,,,,1%44,tMegra*ror 01 Plan Draft 5/20/16 [ RHA/RHIP 1 Strategic Plan 1 Program Operational Plans 1 01 Projects Risk Mitigation Division ,Operational Plans, Deschutes County Health Services Strategic Plan 3 Deschutes County Health Services Strategic Plan 2016-2020 Mission To promote and protect the health and safety of our community. Vision Deschutes County Health Services provides leadership, programs, services, education, and protections to improve the health of individuals, families and communities so people enjoy longer and healthier lives. Values Deschutes County Health Services promotes the following values in all we do: Advocacy Collaboration Equity & Inclusion Excellence Healthy Workplace Leadership Professionalism Stewardship Supporting individual and community health by ensuring access to health care for all. Building relationships that reflect growth, authenticity, and mutual respect. Demonstrating awareness and respect for the diversity in our workplace and community. Committing to use the best data, science, and information available to make decisions that result in high quality services. Promoting respectful interactions, healthy lifestyles, emotional and physical safety in work environments (trauma -informed practices). Advancing a shared vision with inspiration that guides our work at all levels of the organization and in the community. Conducting oneself with the highest level of personal integrity, conduct and accountability. Using public resources effectively and efficiently. Strategic Goals 1. Promote Health and Prevent Disease 2. Assure Needed Health and Human Services 3. Acquire and Use Resources Effectively 4. Evaluate and Improve Agency Processes and Performance 5. Develop Workforce and Enhance Positive Organizational Culture Draft 5/20/16 Deschutes County Health Services Strategic Plan 4 Intended Results and Outcomes • Reduced prevalence and incidence of disease • Increased healthy behaviors and improved mental health • Decreased health disparities and increased health equity • Health-related policies to address population health needs and disparities are implemented • The health of Deschutes County residents is monitored regularly and critical health issues are prioritized A. Develop, advocate for, and implement policies that support individual and community health B. Implement evidence -based programs and/or best practices in health promotion and prevention C. Provide information and education to individuals and the community D. Enforce laws and regulations that promote and protect health E. Monitor disease, health behaviors, disparities, social determinants and other factors that affect health to assure programs and services meet documented needs Draft 5/20/16 • Decrease the prevalence of cigarette smoking among adults from 18% to 16% • Decrease the prevalence of smoking among 11th and 8th graders from 12% and 6%, respectively, to 9% and 3%, respectively • Decrease the prevalence of adults who report no leisure time physical activity from 14% to 12% • Decrease the prevalence of 11th graders and 8th graders who have zero days of physical activity from 11% and 6% to 10% and 5%, respectively • Decrease the percentage of 8th graders who used alcohol at least once within the last 30 days from 20.9% to 18.9% • Decrease the percentage of 6th, 8th, and 11th graders reporting that they seriously considered attempting suicide over the past year from 7.4%, 15.0%, and 19.3%, respectively, to 6.4%, 14.0%, and 17.3%, respectively • 95% of licensed facilities receive inspections by environmental health staff per state requirements • 95% of communicable disease investigations will be completed within 10 days, as defined by the Oregon Health Authority • Decrease the prevalence of 8th graders who report using marijuana at least once over the past 30 days to < 9.5% Deschutes County Health Services Strategic Plan 5 Intended Results and Outcomes • Increased access to services in the community and improved health through collaboration with community partners • Clients and the community experience a streamlined and coordinated system of services A. Coordinate and integrate services through collaborative community partnerships B. Implement, provide, and support a full continuum of screening, referral, evidence -based services, and best practices C. Ensure services and environment are trauma -informed and linguistically, culturally, and developmentally appropriate D. Increase use and ease of access to appropriate services by underserved, marginalized, and at risk populations E. Improve delivery of clinical preventive services F. Support client engagement and self - advocacy in the design, delivery, and effectiveness of services • Increase the number of women in Central Oregon who receive prenatal care beginning in the first trimester from 81% to 90% • Increase the Central Oregon State Performance Measure - Child Immunization Status rate (0-24 months) from 60% to 80% • 79% of individuals discharged from a psychiatric hospital receive an outpatient behavioral health visit within 7 calendar days of discharge • 100% of Behavioral Health Oregon Health Plan clients are seen within state timelines as specified in the following categories: 1) Emergent: Within 24 hours, 2) Urgent: Within 48 hours, and 3) Routine: Within 2 weeks • 90% of children and adolescents referred by DHS receive a behavioral health assessment within 60 calendar days of notification • Increase the percent of children who receive a developmental screen before the age of 3 from 56% to 62% • Establish baseline and monitor behavioral health outcomes using ACORN tool • 90% of respondents to DCHS client satisfaction surveys are satisfied with staff sensitivity toward their culture and background • 75% of reproductive health clients age 12 and older will receive an annual alcohol and drug screening using the CRAFFT or SBIRT screening tools • Determine the extent to which we are serving underserved, marginalized, and at risk populations — establish benchmark in Year 1 Draft 5/20/16 Deschutes County Health Services Strategic Plan 6 Intended Results and Outcomes ° Resources are maximized to meet obligations, address strategic priorities, and support community health • Annual revenue generated meets or exceeds annual expenses • Capitation utilized at 100% A. Increase accuracy of claims and encounter data resulting in maximum revenues and approved encounters B. Ensure program expenses do not exceed budgeted program revenue C. Ensure all internal processes maximize revenue, increase efficiencies, and minimize cost D. Consider state and national standards/ frameworks when making decisions about organizational priorities and resources E. Analyze data to align and allocate resources with strategic priorities F. Secure monetary and non -monetary resources that address identified needs .��'�.^ • Establish a baseline and increase annually the dollar amount of non -OHP claims billed and collected • 100% of programs will spend less than the amount of revenue budgeted by program • No more than 12% of DCHS revenue will consist of county general funds • Maintain contingency funds at 8.3% of the total budget and OHP reserve funds at 25% of annual capitation • Meet 100% of external fiscal audit standards • The total dollar amount of invalid behaviora health claims will not exceed 2% of the total value of behavioral health claims • Develop and implement tools for close monitoring of program, division, and department budgets Draft 5/20/16 Deschutes County Health Services Strategic Plan 7 Intended Results and Outcomes • Aligned and integrated programs, services, and plans that maximize our effectiveness • Operating an integrated Electronic Health Record that increases efficiency and effective service delivery • Consistent use of a project planning model • Up-to-date and relevant policies and procedures across the agency • Employees know standard department processes • Balanced manager/supervisor/staff ratios • Decisions and processes are informed by a variety of data and information sources and linked to strategic goals and outcomes • Clear and consistent multidirectional communication A. Review organizational structure annually, and align to meet agency needs B. Monitor, evaluate, and continuously improve service and program outcomes using the DCHS Integrated Management System and other tools C. Improve external communication process D. Document, evaluate, and update work processes, policies, and procedures E. Optimize use of technology to create efficiencies, support our work, and meet agency needs F. Increase internal collaboration among programs and divisions • 90% of respondents to DCHS client satisfaction surveys are satisfied with their experience • DCHS will complete four organization or division level quality improvement projects annually • Establish a baseline for achievement of operational plan metrics, set targets in year 2, and monitor annually • Maintain positive performance/findings on Triennial Review, OHA audit, OPAR audit, Public Health accreditation, and other programmatic reviews • Percentage of programs that are currently implementing evidence -based interventions — establish benchmark in Year 1 Draft 5/20/16 Deschutes County Health Services Strategic Plan 8 Intended Results and Outcomes • Opportunities to enhance career goals and skills are available • Core competencies are identified and achieved • Leadership development strategy and plan are in place • Staff are aware of and understand the service array delivered across DCHS • Employee involvement, accountability, and strong/positive interactions • Staff share and demonstrate a common vision and purpose • Clear responsibilities and accountable expectations • Clear and consistent multidirectional communication A. Promote and sustain a safe and respectful workplace (i.e., become a certified trauma - informed organization) in which every individual's role and contribution is valued B. Attract, develop, and retain a talented workforce C. Empower staff to share responsibility for team and organizational culture and outcomes D. Develop leadership practices that cultivate healthy relationships, teams, and organization E. Improve internal communication process Draft 5/20/16 • 100% of staff have individual development goals articulated in their performance evaluations • 100% of positions have identified core competencies • Percent of staff who rate their overall level of job satisfaction as "very satisfied" or "satisfied" — establish benchmark in Year 1 • Percent of staff who rate their level of satisfaction with internal communication as "very satisfied" or "satisfied" — establish benchmark in Year 1 • 100% of facilities have at least one completed safety and emergency response drill annually • Monitor retention rate and review quarterly • 100% of staff performance evaluations are completed on time Deschutes County Health Services Strategic Plan 9 la. Develop, advocate for, and implement policies that support individual and community health lal. Actively engage in regional/community processes to ensure DCHS leadership in health system development. (CCBHC, PH Mod.) 1a2. Assess the feasibility of implementation of a tobacco retail licensing program that will eliminate illegal sales to minors, prevent retailers from selling tobacco within 1000 feet of schools, raise the age of purchase to 21, and eliminate sales of flavored tobacco products. (RHIP) lb. Implement evidence -based programs and/or best practices in health promotion and prevention 1b1. Identify and develop harm reduction and prevention strategies for at risk populations to reduce substance abuse and communicable disease transmission (e.g., needle exchange). (RHIP) 1b2. Implement a regional Diabetes Prevention Program (DPP). (RHIP) 1b3. Work with providers to increase referrals to chronic disease self-management and prevention programs. (RHIP) lc. Provide information and education to individuals and the community lc'. Develop and implement an annual community education plan (i.e., low risk drinking, mental health promotion). (RHIP) 1c2. Promote annual well-child visits, immunizations, and developmental screenings in first 3 years of life. (RHIP) 1c3. Provide education and consultation to local clinics and providers (Le., "2As and R" or "5As" tobacco cessation counseling, Oregon Tobacco Quit Line, pregnancy intention screening with One Key Question®). (RHIP) id. Enforce laws and regulations that promote and protect health ldl. Continue to build capacity and expertise for regulatory, educational, and risk mitigation environmental health activities. (PH Mod.) le. Monitor disease, health behaviors, disparities, social determinants and other factors that affect health to assure programs and services meet documented needs lel. Serve as an epidemiology resource for the community and produce regular reports on health issues important to Deschutes County residents and providers. (PH Mod.) 1e2. Work with community partners to develop a four-year Education and Health Work Plan with emphasis on the social determinants of health and kindergarten readiness. (RHIP) 2a. Coordinate and integrate services through collaborative community partnerships 2a1. Identify existing referral pathways and gaps in pathways for primary care providers to use post screening for substance use disorders and mental health. (RHIP) 2a2. Expand integration of behavioral health and public health with primary care. (CCBHC) Draft 5/20/16 Deschutes County Health Services Strategic Plan 10 2a3. Implement and coordinate the regional AFIX (Assessment, Feedback, Incentives, and eXchange) project to increase 2 year old immunization rates. (RHIP) 2b. Implement, provide, and support a full continuum of screening, referral, evidence -based services, and best practices 2b1. Increase substance use disorder services for young adults in transition and adolescents. (RHIP) 2b2. Implement universal nurse home visiting (Family Connects) as part of a regional perinatal continuum of care system in partnership with public health, primary care medical providers and the CCO. (RHIP) 2c. Ensure services and environment are linguistically, culturally, and developmentally appropriate 2c1. Increase language services and best practices for use of interpreters. 2d. Increase use and ease of access to appropriate services by underserved, marginalized, and at risk populations 2d1. Increase outreach to and intervention with vulnerable children ages 0-5 and their parents. (RHIP) 2d2. Hire a behavioral health medical director. (CCBHC) 2d3. Ensure Courtney building provides an efficient and welcoming client experience. 2d4. Expand evidence -based home visiting programs that work to improve family well-being and to reduce child maltreatment by coordinating services. (RHIP) 2e. Improve delivery of clinical preventive services 2e1. Work with the CCO and other health system partners to increase provisions of clinical preventive services including: immunizations, tobacco counseling and cessation, STD screening and follow-up, highly effective contraception, and early prenatal care. (RHIP) (PH Mod.) 2f. Support client engagement and self -advocacy in the design, delivery, and effectiveness of services 2f1. Engage parents, youth, and/or clients through focus, support, and/or advisory groups. (CCBHC) 3a. Increase accuracy of claims and encounter data resulting in maximum revenues and approved encounters 3a1. Complete paybacks/data accuracy project and monitor effectiveness. 3a2. Develop internal support for staff providing client services (a. coding training, b. prebilling audit "real time" feedback, c. service plan and delivery training). 3b. Ensure program revenues, by funding type, match expenditures associated with programs and services 3b1. Reconcile program revenues to expenditures annually. 3c. Ensure all internal processes maximize revenue, increase efficiencies, and minimize cost 3c1. Implement service entry processes that address requirements associated with insurance types, including copays. 3c2. Provide additional trainings for Epic Super Users. Draft 5/20/16 Deschutes County Health Services Strategic Plan 11 3d. Consider state and national standards/frameworks when making decisions about organizational priorities and resources 3d1. Develop a process and criteria for decision-making based on the CCBHC and Public Health Modernization standards. (CCBHC, PH Mod.) 3e. Analyze data to align and allocate resources with strategic priorities 3e1. Review data annually to set program standards and adjust resources accordingly across programs to meet business needs. 3e2. Establish department dashboard/data points that are tracked, analyzed and reported on monthly basis, making use of info graphics and other accessible apps. 3f. Secure monetary and non -monetary resources that address identified needs 3f1. Continue to identify, apply for, and secure public/private, local, state and federal resources to address identified and prioritized needs. 4a. Review organizational structure annually, and align to meet agency needs 4a1. Incorporate organizational structure review into annual budget process. 4a2. Identify and consider best practices when reviewing organizational structure. 4b. Monitor, evaluate, and continuously improve service and program outcomes using the DCHS Integrated Management System and other tools 4b1. Identify, pursue, and achieve/maintain national recognized performance standards and measures (e.g., Public Health Accreditation Board, CCBHC). (CCBHC) 4b2. Implement ACORN tool for behavioral health programs and clients to evaluate behavioral health clinical outcomes. (CCBHC) 4c. Improve external communication process 4c1. Create and implement a department plan for external communication. (CCBHC, PH Mod.) 4d. Document, evaluate, and update work processes, policies, and procedures 4d1. Establish behavioral health clinical vision to guide service provision. (CCBHC) 4d2. Improve efficiency, effectiveness, and communication through the meeting improvement project. 4d3. Review, update, and disseminate department policies, procedures, and protocols. 4e. Optimize use of technology to create efficiencies, support our work, and meet agency needs 4e1. Actively participate in the successful implementation of the Tyler Finance and HR system. 4e2. Review existing technology on an annual basis to determine if agency needs are being met, taking into consideration future needs as well. 4f. Increase internal collaboration among programs and divisions 4f1. Use IMS reporting to share information across programs and divisions. Draft 5/20/16 Deschutes County Health Services Strategic Plan 12 5a. Promote and sustain a safe and respectful workplace (i.e., become a certified trauma -informed organization) in which every individual's role and contribution is valued 5a1. Implement trauma -informed care at DCHS and increase trauma -informed practices in the community. (RHIP) (CCBHC) 5a2. Evaluate each facility's needs, uses, and safety at least once every 4 years and use the results for long term facility planning. 5b. Attract, develop, and retain a talented workforce 5b1. Define roles and responsibilities, connect to core competencies, and implement. 5b2. Develop and implement staff appreciation and recognition process. 5b3. Enhance and maintain workforce development plan. 5b4. Develop and implement a training plan for all divisions. (CCBHC, PH Mod.) 5b5. Develop and implement grant writing capacity, support, and training. 5c. Empower staff to share responsibility for team and organizational culture and outcomes 5c1. Develop method to determine time availability for staff and teams to participate on projects, committees, and non-core duties. 5d. Develop leadership practices that cultivate healthy relationships, teams, and organization 5d1. Provide information and education to county decision -makers about programs, services, system changes, and accomplishments on a regular basis. 5e. Improve internal communication process 5e1. Create and implement a department plan for internal communication. Draft 5/20/16 Deschutes County Health Services Strategic Plan 13 ca › - u: _c -Z.LCn E0›ao ro ›- ,. a 0 4- 0 u.) -VCj" ..E..ECa (0 au o Li, vi on —I 7.'40 c a) u V. o ca - a) ra .- 013 U- %.- c0 , 2- _E ' "Ow v' '5 ° ' > " . w ' - : 5- 3 c2-0. , V &- c.; a) on vi• as V) v) .- 03 cO 3 1- i.-- c o . 0) U./ >••• rvCC Cl./11•0 C.0 a) In a) c .5.-, 0 co e.- 1C3 CC >. 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Table of Contents 2 ACKNOWLEDGEMENTS 4 SUMMARY 5 INTRODUCTION 7 METHODS AND LIMITATIONS 8 DEMOGRAPHICS OF CENTRAL OREGON 9 POPULATION 9 SOCIOECONOMIC STATUS 10 DISABILITY 11 FOOD INSECURITY 11 SAFETY AND VIOLENCE 12 HOUSING 13 CAUSES OF DEATH 14 YEARS OF POTENTIAL LIFE LOST (YPLL) 16 QUALITY OF LIFE 17 CHRONIC DISEASES 18 ASTHMA 18 CANCER 21 CARDIOVASCULAR DISEASE 25 DIABETES 27 RISK FACTORS AND COMPLICATIONS FOR CHRONIC DISEASE 30 CCO MEASURES 34 COMMUNICABLE DISEASES 35 IMMUNIZATIONS 35 VACCINE PREVENTABLE DISEASES 37 HEPATITIS 38 SEXUALLY TRANSMITTED INFECTIONS 39 VECTOR BORNE DISEASE 41 DIARRHEAL DISEASE 41 HEALTHCARE ASSOCIATED INFECTIONS (HAI) 42 CCO MEASURES 42 MATERNAL HEALTH AND PREGNANCY 43 PRENATAL CARE 43 BIRTHS 44 PREGNANCY RISK FACTORS 46 UNINTENDED PREGNANCY 49 CCO MEASURES 49 INFANT, EARLY CHILDHOOD AND ADOLESCENT HEALTH 50 BREASTFEEDING 50 CHILD AND FAMILY SUPPORT 51 CHILDHOOD HEALTH AND EDUCATION 52 CHILD AND ADOLESCENT HEALTH RISK FACTORS 53 ADVERSE CHILDHOOD EXPERIENCES (ACES) 54 CCO MEASURES 55 Table of Contents 3 MENTAL HEALTH YOUTH ADULTS SUICIDE CCO MEASURES ALCOHOL, TOBACCO AND OTHER DRUG USE ALCOHOL TOBACCO PRESCRIPTION OPIOIDS CCO MEASURES UNINTENTIONAL INJURIES MOTOR VEHICLE CRASHES POISONING FALLS RISK FACTORS FOR INJURY ORAL HEALTH CHILDREN ADULTS ENVIRONMENTAL HEALTH TRANSPORTATION AIR QUALITY WATER QUALITY LEAD ACCESS TO HEALTHCARE COMMON REASONS TO ACCESS HEALTHCARE SPECIFIC ACCESS TOPICS GAPS IN CARE CCO MEASURES GLOSSARY AND ACRONYMS RESOURCES APPENDIX A APPENDIX B 56 56 57 57 58 59 59 59 62 62 63 65 66 67 68 69 70 72 73 73 75 76 76 77 78 79 80 83 84 86 87 88 Acknowledgements Thank you to the follow people for their contribution to this document Alfredo Sandoval Angela Kimball Anna Higgins Channa Lindsay Chris Ogren Christy McLeod Chuck Frazier Devin O'Donnell Heather Kaisner Jane Smilie Jason Parks Jeff Davis Jeff White Jessica Jacks Jill Johnson Karen Steinbock Kate Wells Ken House Kenny LaPoint Kris Williams Leslie Neugebauer Lindsey Hopper Lori Wilson Maggie O'Connor Michelle Kajikawa Muriel DeLaVergne-Brown Nancy Tyler Nikole Zogg Pamela Ferguson Paul Andrews Penny Pritchard Rebeckah Berry Renee Boyd Rick Treleaven Sarah Kingston Sarah Worthington Scott Montegna Scott Willard Steve Strang Steven Helgerson Thomas Kuhn Tom Machala Tom Schumacher PRAMS Coordinator Innovator Agent Coordinator of Student Success Quality Improvement Specialist Intern Chief Operating Officer Community member, Retired Pharmacist Intern Communicable Disease Program Supervisor Director Improvement Data Analyst Executive Director Member Prevention Coordinator Immunization Program Coordinator Health Quality Program Director Director, Community Health Development Director of Data and Analytics Housing Integrator Tobacco Prevention and Education Coordinator Central Oregon CCO Director Executive Director Virtual Assistant Community Benefit and Wellness Manager Community Health Worker Public Health Director Adult Treatment Program Manager Central Oregon Regional Manager Nurse Program Manager Deputy Superintendent Tobacco Prevention Coordinator Operations and Project Manager BRFSS and OHT Survey Coordinator Executive Director Senior Data Analytics Specialist Chronic Disease Program Manager Health Systems Coordinator Executive Director Director of Operations Contractor Community Health Program Manager Director Director, St Charles Cancer Center Oregon Health Authority Oregon Health Authority High Desert Education Service District Deschutes County Health Services Central Oregon Health Council Bend Memorial Clinic Central Oregon Health Council Deschutes County Health Services Deschutes County Health Services St. Charles Health System Wellness and Education Board of Central Oregon Community Advisory Council Deschutes County Health Services Deschutes County Health Services Central Oregon Independent Practice Association PacificSource Community Solutions Mosaic Medical Oregon Housing and Community Services Crook County Health Department PacificSource Community Solutions Central Oregon Health Council Central Oregon Health Council St. Charles Health System Central Oregon Independent Practice Association Crook County Health Department Deschutes County Health Services Advantage Dental Deschutes County Health Services High Desert Education Service District Deschutes County Health Services Central Oregon Health Council Oregon Health Authority BestCare Treatment Services PacificSource Community Solutions Deschutes County Health Services Oregon Health Authority Lutheran Social Services Bridges Health by Mosaic Medical Deschutes County Health Services Deschutes County Health Services Jefferson County Health Department St. Charles Health System Summary 5 Access to healthcare and services • The population is growing in certain areas of Central Oregon, yet housing and transportation services are lacking. • Healthcare coverage dramatically increased between 2013 and 2014 as measured by enrollment into the Or- egon Health Plan (OHP). Customers reported high quality in the care they are receiving. • Gaps exist in the specialized care that is available, including certain providers, like dentists, mental health specialists, and others. • Central Oregon has a larger proportion of persons aged 65 years and older than Oregon overall. The preva- lence of chronic diseases and disability increases with age. Also, this population is at increased risk for influ- enza, pneumonia, and other communicable diseases. Mortality • All -cause mortality rates are not equal between sexes and among racial categories. American Indian/Alaska Natives have significantly lower life expectancies than other racial groups in Central Oregon. • In Oregon, people with co-occurring serious mental illnesses and substance use disorders have a particularly young average age at death. Chronic Disease • Mortality due to some chronic diseases has significantly decreased since 2000. However, thousands of people in Central Oregon smoke tobacco, a leading cause of death. Adults enrolled in OHP smoke tobacco at even higher rates than those not enrolled in OHP. Resources like the Tobacco Quit Line are available, yet underuti- lized. • Chronic diseases or their risk factors are associated with mental health and substance use problems. Ap- proaches for preventing or treating chronic diseases need to address the whole person and their environment, particularly targeting screenings and support for mental health and substance use issues. • Screening for chronic diseases can detect a condition early and allow for early intervention. More can be done to address screening for diseases like colorectal cancer and cardiovascular disease, especially among the OHP population. • Four modifiable risk factors cause much of the early death related to chronic diseases. They are tobacco use, physical inactivity, high blood pressure, and alcohol consumption. Communicable Disease • While the rate of some vaccine preventable diseases is lower in Central Oregon than in the state overall, too many children in Central Oregon are not up-to-date on age appropriate immunizations, which places them and others at risk. • Sexually transmitted diseases are preventable. Yet, the incidence rate of chlamydia has increased since 2004. • Water -borne diseases are common in some Central Oregon counties and were reported at rates higher than the state overall. Maternal and Infant Health • Between 2000 and 2013, the percent of mothers who smoked during pregnancy was trending downward, though 1 in 10 pregnant women still reported smoking during their pregnancy. An even higher percent of women enrolled in OHP reported they smoked during their pregnancy. • Nearly 42% of pregnancies in Central Oregon were considered unintended. Unintended pregnancy and teen pregnancy are associated with high number of adverse childhood events (ACEs). Summary Child and Adolescent Health • The percent of adolescents reporting having participated in a risky behavior like smoking, drinking alcohol, or using drugs increases by as much as two to three times between 8th and 11th grades. Intervening early is important. • Healthy habits and behaviors are established in childhood. Unhealthy behaviors like tobacco use are primar- ily initiated during adolescence. Unintentional Injuries • Unintentional injuries refer to those injuries where there was no intent to do harm. Unintentional injuries are no longer considered "accidents" because they are preventable. The majority of injury -related deaths in Central Oregon were unintentional. • The mortality rate due to motor vehicle crashes is decreasing in Central Oregon, but the rate for unintentional poisoning and falls is increasing. The mortality rate due to a fall exponentially increases after the age of 65 years. • Alcohol -impaired -driving -fatalities accounted for a third of all motor vehicle crash fatalities Oregon. Mental Health • About one in five adults in Central Oregon reported they had depression. Poor mental health is associated with other significant health outcomes like tobacco and other substance abuse/misuse, chronic diseases, and injuries, as well as socioeconomic factors like lack of housing, education, and employment. • The age-adjusted race -specific suicide mortality rate was similar between Central Oregon and Oregon overall, except for American Indians. The suicide mortality rate among American Indians in Central Oregon was about double the rate among American Indians in Oregon overall and about 1.5 times the rate of non -His- panic whites. • Experiencing multiple ACEs during childhood has been associated with several poor health outcomes. About one in three adults enrolled in OHP reported a high number of ACEs, while about one in five adults in the general population reported a high number of ACEs. Substance Abuse • Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an underused intervention for address- ing unhealthy drinking. About 1 in 5 adults in Crook and Deschutes Counties and 1 in 7 adults in Jefferson County reported binge drinking in the last month. • People with substance use disorders have a very high incidence of using tobacco, which is often one of the leading causes of early death and disability for this population. • Substance abuse can place a person who injects drugs at risk for blood borne pathogens like hepatitis C and HIV. Expanding harm reduction approaches can help protect this population. Oral Health • Poor oral health can be a costly and painful. At least one in four children and one in three adults in Central Oregon reported they did not see a dental hygienist or other dental practitioner in the last year. • The Central Oregon region is considered a dental professional shortage area due to its geography, low-income populations, and homeless populations. Among adults in the region, income was directly related to having seen a dentist or hygienist in the last 12 months. • • Income is related to dental health among adults in Oregon. This is especially notable among adults aged 65 years and older. Many are on fixed incomes and may not receive routine dental care because Medicare, the leading insurer for adults 65 years and older, provides little to no coverage. Introduction 7 What is a Health Assessment? A health assessment is a snapshot of the health of a community at a point in time. It describes a variety of health topics, as well as social and economic factors that influence health. These comprehensive reports are intended to guide communities and organizations to strategically address health-related issues with partners working together to maximize the use of resources and target populations most at risk. Assessing the health of a community or region is an ongoing process that involves not only monitoring population health, but measur- ing progress toward improving it. Community Input Central Oregon residents and health organizations care a great deal about working together to improve the health of our communities. From January through August 2015, Central Oregon health system partners cre- ated the Central Oregon Regional Health Assessment (RHA), with leadership from the Central Oregon Health Council. The Operations Council of the Central Oregon Health Council used a planning process called Mobilizing for Action through Planning and Partnership (MAPP) to guide creation of the RHA. The RHA was developed with data, input and information from a wide variety of health and community-based organizations, stakeholders and community members. Input was solicited from the Central Oregon Health Council's Community Advisory Council, a number of health-related advisory boards and groups, and during community meetings in Crook, Deschutes, and Jefferson Counties. Information from these community meetings not only informed develop- ment of this document, but was used to develop priority health issues that will be addressed in the Central Oregon Health Improvement Plan. How to Use the RHA Stakeholders gather regularly and deliberate about how to best address issues that have been described in the RHA. The RHA is a resource to ground deliberations in data and information, and to focus resources on impor- tant health issues for which there are effective services, programs and interventions that can be brought to bear. The RHA is not an exhaustive compendium of health indicators or analyses. Thus, readers are encouraged to dig deeper and use additional information as Central Oregon health partners continue to construct a more in- depth understanding of the health of the population. Methods and Limitations This RHA focuses on the three Central Oregon counties: Crook, Deschutes, and Jefferson. When possible, comparisons were made to the state, the nation, and Healthy People (HP) 2020 goals as well as between relevant demographic and socioeconomic groups. Data about specific populations or topics were combined to describe the overall health and well-being of the com- munity. These data come from a variety of sources including population level surveys, medical claims, disease registries, birth certificates, death certificates, and program records. Please see the Glossary and Acronym section (page 84) to find more information for most data sources and definitions of major statistical or epidemiological terms used throughout this report. The Oregon Health Authority (OHA) uses Coordinated Care Organization (CCO) quality health measures to improve care, reduce disparities, and reduce cost of care. In this report, quality health measures are listed in each relevant section. A table of all quality health measures can be found in Appendix A (page 87). Some charts include 95% Confidence Intervals (CI). A CI is a range of numbers in which the true estimate would be found 95% of the time if the sample were taken an infinite number of times. When two CIs overlap, the estimates are not significantly different from each other. In the example below, estimate 2 is the only significantly different number in the figure. Even though estimate 1 is higher than estimate 3, the CIs overlap. Those estimates would be considered similar. This RHA is not a complete look at all health indicators, but rather is meant to be an overview of topics addressed by the region's health system. A variety of agencies and organizations maintain detailed data on indicators not shown here. Please see the Resources section at the Estimate -_m� 1 Estimate 2 Estimate mimv__H 3 8 end of this report (page 86) to learn where to find more information about a specific topic or data source. Some data are not collected at the county level or may not be appropriate to report at the county level. Data reported in this RHA follow data use guidelines specific to each data set. When appropriate, each data source is marked with limitations. Also, some indica- tors may have been derived from a sample population that was small and therefore resulted in an unstable statistic. These instances are also marked. Demographics Demographic factors like population density, education level, household income, age of the population, and pov- erty, among others, influence the health of the population. Population • In 2013, the estimated total population of the Central Oregon Region was 207,914. Since the 2010 Census, Deschutes County has grown 5.2%, while Crook and Jefferson Counties have decreased in population (Table 1). Table 1. Population of Central Oregon Counties, ACS, 2013 2013 population Population change since 4/1/2010 Population density, persons per square mile Oregon Crook Deschutes Jefferson 3,930,965 20,815 165,954 21,145 2.6% -0.8% 5.2% -2.6% 39.9 7.0 52.3 12.2 • Crook County had a higher proportion of residents aged 65 years and older than the other Central Oregon counties (Figure 1). • There was approximately the same proportion of females and males among the Central Oregon counties (Fig- ure 1). A larger proportion of Jefferson County residents identified as American Indian or of Hispanic/Latino ethnic- ity (any race) than among the other Central Oregon counties (Figure 1). Figure 1. Demographics of Central Oregon Counties, ACS, Oregon, 2013 100 - 90 - 80 - �, 70 - C • 60 - to 50 - a 40 30 - 20 - 10- 4.4 0 -.-'1. Under 5 yrs Under 18 65 yrs and Female White AI/AN Other Hispanic/ yrs older Latino (any race) 1.4 1.1 2.1 ikt 5.1 /el 09 Name U. Age Groups 9 Sex Race • Crook Deschutes ° Jefferson — Oregon Ethnicity Demographics Socioeconomic Status Socioeconomic status is a measure of a person's or family's economic and social position compared to others based on their income, education, and occupation. This section presents a few key factors related to socioeco- nomic status in Oregon and the Central Oregon counties. Other measures are found throughout the report. • One in five people in Crook and Jefferson counties live in poverty (Table 2). 10 Table 2. Socioeconomic status of Central Oregon Counties, ACS, Oregon, 2009-2013 Household Income Median household income Percent owning their home Poverty. Percent of persons below poverty level -Education: Percent Bachelor's degree or higher (Among people 25+ years) Percent high school graduate or higher (Among people 25+ years) Employment Unemployment rate WfC enrollment Number of families served Percent working families Oregon Crook Deschutes;. $50,229 $38,795 $50,209 62.0 70.5 65.5 16.2 19.5 29.7 14.5 89.4 84.9 14.5 31.0 93.1 e arson $43,373 65.4 19.8 17.3 84.7 N/A N/A 479 63 2,593 71 t As defined by the Census Bureau: househo d income compared to appropriate threshold § State of Oregon Employment Department, April 2015 -seasonally adjusted ##WIC enrollment N/A =data not available 499 72 • Approximately 60,000 Central Oregon residents were employed in the private sector in 2012 (Table 3). The region's wages in the private sector were nearly 20% lower than the state's private sector wages. Table 3. Distribution of private sector employment and income, Oregon Quarterly Census on Employment and Wages, 2012 Employment Total payroll (in millions) Average wage ($) % of region employment % of statewide average wage 1,373,607 1 59,948.70 43,643 100 1 escn,utes 4,377 51,943 172.6 1,845.20 39,429 35,523 7.3 86.8 90.3 1 81.4 ffOOP. : aZeg10" 3,489 1 59,809 101.9 2,119.60 29,205 35,440 5.8 100 66.9 1 81.2 Demographics 11 Disability Disability refers to anyone with a visual, hearing, cognitive, ambulatory, self-care, or independent living difficulty. Having different abilities may limit a person's capacity to work and provide for themselves. There was a higher proportion of people living with a disability in Crook County than the other Central Or- egon counties or Oregon overall (Table 4). Table 4. Percent of the population living with a disability, ACS, Oregon, 2009-2013 Oregon Total, non -institutionalized population 14.1 Male 14.2 Female 14.0 White, Non -Hispanic 15.3 Hispanic 8.0 Crook 20.9 22.5 19.3 21.7 14.1 Deschutes 11.9 13.2 10.7 12.6 5.7 Jefferson 16.6 17.4 15.9 19.6 9.0 Food Insecurity Access to healthy food promotes a healthy diet. However, healthy food must be available and affordable to the population. Food insecurity refers to having limited or uncertain access to adequate food while hunger is the physiologic conditions that may result from food insecurity. • Nearly 32,000 people in Central Oregon had limited access to a grocery store (i.e. live more than 1 mile from a supermarket or large grocery store if in an urban area, or more than 10 miles from a supermarket or large grocery store if in a rural area). About 10,300 were both low income and have limited access to grocery stores (USDA Food Environment Atlas). • Adults enrolled in OHP had a much higher frequency of food insecurity and hunger than did the total adult population of Oregon (Figure 2). Data to compare the prevalence of food insecurity in the general Central Oregon population were not available. Figure 2. Prevalence of stress and food security among adults enrolled and not enrolled in OHP, MBRFSS, Oregon, 2014 High -stress based on 4 -item scale 10.8 Food insecurity - food 21-8 insecure Food insecurity - hunger Oregon -General Population • Central Oregon -OHP 52.S 8.2 # Estimate not available for general population H =9S% Confidence Interval Note: General population percents may not be directly comparable to OHP percents due to survey differences. They are provided for a reference. Percent Demographics Safety and Violence Various types of violence can occur in a community or home as well as at different times during a person's life. Examples of violence include child maltreatment and neglect, intimate partner violence, and elder abuse. Vio- lence can lead to physical, mental, and emotional health problems as well as death. In a community, violence can reduce property value, decrease productivity, and weakening social services (CDC, Violence Prevention). • One in five (21%, 95% CI 17.1%-25.5%) adults enrolled in OHP in Central Oregon reported that their neigh- borhood was "not at all" or "slightly" safe (MBRFSS, 2014). Data for comparison to other populations were not available • One estimate of the crime index in Bend in 2011 was 224/100,000 population. For comparison, the rate in Redmond was 452/100,000 population, Prineville was 204/100,000 population, and Madras was 350/100,000 population. The US average was 309. (City -Data). The City-data.com crime index counts serious crimes and violent crime more heavily and it adjusts for the number of visitors and daily workers commuting into cities. • The Oregon Sexual and Domestic Violence Programs offer several services to those experiencing intimate partner violence. In 2014, there were 2,367 calls to the helpline and 131 people sheltered in Central Oregon (Table 5). Table 5. Services provided by Sexual and Domestic Violence Programs, Central Oregon, 2014 Number of calls to emergency hotline, by primary reason for call Number of people sheltered, by age Domestic Sexual Stalking violence : assault 1,969 33 157 Children ;;Children Number of shelter nights, by age 1,790 1,657 Length of shelter stays (percent of total) 12 Demographics 13 Housing Stable, healthy housing is a basic need for people and offers a place of security and an area to rest. However, limited housing stock or low rental vacancy rates can lead to an increase in housing prices. High rent may force a person or family into substandard housing or into a situation where they are rent burdened, meaning more than 30% of their income is spent on housing. Unstable housing is a significant contributor to poor outcomes for people with chronic medical or behavioral health conditions. The 2014 one-night homeless count in the Central Oregon region was 2,410 people (Homeless Leadership Coalition, 2014). The most common answers for being homeless were that the respondent could not afford rent or that they were unemployed. However, many reasons were given, including being kicked out of the house by family or friends, being evicted, domestic violence, and poor credit. About 200 people reported they were homeless by choice (Homeless Leadership Coalition, 2014) The Oregon Department of Education tracks the number of students who are homeless or in an unstable housing situation. Nearly 1 in 5 students in the Culver School District in Jefferson County were homeless or in unstable housing situations at the time of survey (Table 6). Table 6. Number and percent of students grades K-12 who were homeless or in an unstable housing situation, by school district, ODOE, 2013-2014 School District Crook County Crook Deschutes County Bend -La Pine Redmond Sisters Jefferson County Ashwood 0 Black Butte 0 Culver 126 Jefferson Co 114 Number Percent of district enrollment 52 1 650 545 30 1.6 3.9 7.7 2.6 0.0 0.0 18.6 3.9 • Focus groups conducted in the region demonstrated limited rental housing availability, including low-income housing, in several of the Central Oregon cities and that there is a need for education regarding the link be- tween health and housing (Community Advisory Council (CAC) Panel Report, 2014). • The housing authority in Central Oregon manages about 1,200 housing vouchers a year. However, the demand for vouchers exceeds the number available and they also manage a wait list of thousands of people (Housing Works). • Central Oregon is demonstrating best practices by integrating housing and healthcare. In 2014, Housing Works, Mosaic Medical, and EPIC Property Management came together to make improvements to existing affordable housing units, including the inclusion of a medical clinic to serve the residents and the surround- ing community (Oregon Housing and Healthcare Best Practices). Causes of Death Some diseases and health events are more likely to lead to death than others and are influenced by social deter- minants of health like those discussed in the previous section. The public health and healthcare systems work to address the health disparities that lead to reduced quality of life and life span. • The five leading causes of death in Oregon were malignant neoplasms (cancer), heart disease, chronic lower respiratory disease, cerebrovascular events, and unintentional injury (Table 7). The leading causes of death in Central Oregon are the same as in Oregon. • Specific discussion about leading causes of death in children can be found in the Infant, Early Childhood and Adolescent Health section of this report (page 50). • Unintentional injury (injuries where there was no intent to do harm) was the leading cause of death for people aged 1-44 years while malignant neoplasms (cancer) were the leading cause of death for people aged 45 years and older (Table 7). Table 7. Leading Causes of Death in Oregon, CDC WISQARS, Oregon, 2013 Rank 1 2 <1 Congenital Anomalies Short Gestation 3 SIDS Maternal 4 Pregnancy Complications Placenta Cord Membranes 5 1-4 5-9 10-14 Unintentional Unintentional Unintentional Injury Injury* Injury* Malignant Malignant Neoplasms* Neoplasms* Suicide* Congenital Malignant Anomalies* Homicide* Neoplasms* Benign Benign Congenital Neoplasms* Neoplasms* Anomalies* Homicide* Chronic Lower 6 Unintentional Respiratory Injury* P ry Disease* Congenital Heart Anomalies* Disease* Influenza & Benign Pneumonia* Neoplasms* Necrotizing Heart 7 Septicemia* Disease` Septicemia* 8 9 Neonatal Influenza & Hemorrhage* Pneumonia* Bacterial Meningococca Sepsis* IInfection* 10 Two tied* * Rank based on less than 10 deaths 14 Diabetes Mellitus* Age Groups 15-24 25-34 Unintentional Unintentional Injury Injury Suicide Suicide Malignant Malignant Neoplasms Neoplasms 35-44 Unintentional Injury Malignant Neoplasms Suicide 45-54 Malignant Neoplasms 55-64 Malignant Neoplasms 65+ Malignant Neoplasms All Ages Malignant Neoplasms Heart Disease Heart Disease Heart Disease Heart Disease Chronic Lower Chronic Lower Chronic Lower Unintentional Respiratory Respiratory Respiratory Injury Disease Disease Disease Homicide Heart Disease Heart Disease Liver Disease Heart Disease* Unintentional Cerebrovascul Cerebrovascul Injury ar ar Homicide Liver Disease Suicide Liver Disease Congenital Diabetes Diabetes Diabetes Anomalies* Mellitus Mellitus Mellitus Chronic Lower Congenital Respiratory Anomalies Disease* Complicated Liver Disease Pregnancy* Diabetes Mellitus* Five tied* Alzheimer's Unintentional Disease Injury Diabetes Unintentional Alzheimer's Mellitus Injury Disease Cerebrovascul Diabetes Diabetes Homicide Viral Hepatitis ar Mellitus Mellitus Chronic Lower HIV Respiratory Suicide Hypertension Suicide Disease Cerebrovascul Cerebrovascul Cerebrovascul Viral Hepatitis are ar ar Complicated Congenital Hypertension Hypertension Pregnancy* Anomalies Influenza & Pneumonia Parkinson's Disease Liver Disease Hypertension Causes of Death • The all -cause mortality rate varies by race and Hispanic ethnicity between Oregon and the Central Oregon counties (Figure 3). Figure 3. Age-adjusted all -cause mortality rate per 10,000 population by race, Oregon, OPHAT, 2009-2013 Oregon 73.1 Deschutes 72.6 32.0 ; 73.6 1---1 67.1 H 85.1 44.8 76.1 'I-1 Rate per 10,000 population • Total American Indian/Alaska Native NH Hispanic White NH H =95% confidence interval NH -Non -Hispanic Note: the ability to report other race -specific rates in Central Oregon is limited by the small populations of these races • The all -cause mortality rate varies by race and Hispanic ethnicity between Oregon and the Central Oregon counties (Figure 3). Figure 4. Age-adjusted all cause mortality rate per 10,000 population by sex, Oregon, OPHAT, 2009-2013 Rate per 10,000 population 15 120 100 - 80 - 60 - 40 - 20 - 0 - Oregon Significantly different Crook Deschutes • Female Male Jefferson Causes of Death 16 • American Indians/Alaska Natives in Jefferson County and Oregon overall had a lower life expectancy when compared to the total life expectancy in the area (Table 8). Table 8. Life expectancy (in years) at birth by race, Oregon, OPHAT, 2013 American Indian/Alaska Native NH Hispanic White NH Total tUnstable estimate Note: the ability to report other race -specific life expectancies in Central Oregon is limited by the small populations of these races NH: Non -Hispanic 1 Significantly lower than the total life expectancy Oregon. Crook. Deschutes 78.3 80.7t 79.0 79.8 86.2t 79.6 78.2 79.7 78.9 83.4 80.7 81.0 Jefferson- 82.0 76.8 79.0 Central:.Oregon. 83.3 80.3 80.3 • According to a 2008 study by the Oregon Division of Addiction and Mental Health, people with co-occurring mental health and substance use disorders have an average age at death of 45 years (OHA, 2008). Years of Potential Life Lost YPLL measures the number of years of life lost due to a premature death. While it is a good indicator of the bur- den due to death at an early age, it may not capture the full burden of chronic diseases experienced later in life. • In Oregon, 633.8 years of life were lost before age 75 for every 10,000 people under the age of 75 years (Figure 5). • Deschutes County had a lower YPLL rate than Oregon, while Jefferson and Crook Counties had a higher rate. Figure 5. Years of potential life lost before the age 75 per 10,000 population, Oregon, OPHAT, 2009-2013 c 1,200 - a 1,000 q 800 - 0. S 600 - 0 4 400 - a a' 200 - cu 6334 ce 0 Oregon IMEMILIM Crook * Significantly higher than the state overall **Significantly lower than the state overall Data from 2009-2011, healthindicators.gov 555.7 Deschutes Jefferson Quality of Life Health-related quality of life includes the physical, mental, and emotional well-being of an individual. This can include socioeconomic status, health risks and diseases, and social support. In a community this refers to the policies, resources, and conditions that influence a person's health. Health-related quality of life is considered an important outcome of a program or service needs of a population. Health-related quality of life is associated with chronic disease prevalence and risk factors. The following sections of this document address specific topics pertaining to health-related quality of life. 85%-89% of adults in Central Oregon reported their general health was excellent, very good, or good (Fig- ure 6). Only about 3 of 4 adults enrolled in OHP in Central Oregon reported good or better general health (72.2%, 95% CI 62.7%-76.4%) (MBRFSS, 2014). Figure 6. Age-adjusted prevalence of self -reporting excellent, very good, or good general health, Oregon, BRFSS, 2008-2011 100 80 H 6) 60 u °1 40 20 _I 0 86.3 Oregon 84.9 Crook 88.9 Deschutes Jefferson Note: Due to a BRFSS method change in 2011, data from prior years are not comparable to current years. • One quarter to one third of adults reported limitations due to physical, mental, or emotional problems (Fig- ure 7). However, there were no statistical differences between the counties and Oregon overall. Figure 7. Age-adjusted prevalence of having any limitations due to physical, mental, or emotional problems, Oregon, BRFSS, 2008-2011 35 - 30 25 - LI 20 LI 15 - a 10 - 5 - 24.1 0 Oregon 32.5 Crook 24.9 Deschutes Jefferson Note: Due to a BRFSS method change in 2011, data from prior years are not comparable to current years. 17 Chronic Diseases Chronic diseases are those conditions that a person may live with for many years or a lifetime. In 2012, about one in four adults in the US had two or more chronic diseases (CDC, 2014). Chronic diseases can lead to early death, decreased quality of life, and added personal expense in healthcare spending. Chronic diseases account for a large proportion of healthcare expenditures in the US. • Adults enrolled in OHP in Central Oregon had similar prevalence of chronic diseases as adults enrolled in OHP in Oregon, except for stroke, for which the self-reported prevalence was lower (data not shown). • Though not directly comparable due to some measurement differences, the OHP population appears to have a higher prevalence of some diseases than does the general population (Figure 8). Data to compare the preva- lence of chronic diseases in the general Central Oregon population are available throughout this section. Figure 8. Prevalence of chronic diseases among adults enrolled and not enrolled in OHP, Oregon, MBRFSS, 2014 Any chronic disease Depression Disability Arthritis Asthma (current) Diabetes COPD Cancer Angina Heart attack Stroke 58.3., 64.2 Oregon -General Population • Central Oregon -OHP Percent H=95% Confidence Interval Note: General population percents may not be directly comparable to the OHP percents due to survey differences. They are meant to serve as a reference. Asthma Asthma is a chronic condition of the respiratory system characterized by inflammation and narrowing of the airways. While asthma affects people of all ages, asthma is one of the most common chronic diseases among chil- dren. Approximately 320,000 people in Oregon in 2011 reported that they currently had asthma (Asthma Burden Report, 2013). When monitored and treated with proper medication, asthma should not limit a person's activities or affect their quality of life. Yet thousands of adults and children miss work and school and limit their activities due to their asthma each year. • Nationally and in Oregon, the prevalence of asthma is higher in female adults than in male adults (data not shown). 18 Chronic Diseases 19 Asthma Continued • Nationally and in Oregon, the prevalence of asthma is higher in female adults than in male adults (data not shown). • The prevalence of asthma in Oregon and Central Oregon is similar, except in Jefferson County where the prevalence of current asthma is about 24% (Figure 9). Figure 9. Percent of adults with current asthma, Oregon, BRFSS, 2010-2013 30 _ 25 20 i • 15 10 5 - 10.4 0 Oregon Crook t Statistically unreliable Deschutes U.S. 9.2 Jefferson It is important for people with asthma to have the disease well-controlled. This includes rarely using rescue medi- cations (other than before exercising), waking up due to asthma, experiencing daytime symptoms, and limiting activities due to asthma. Emergency department (ED) visits and hospitalizations are a sign that a person's asthma is not in control. • Crook and Jefferson Counties had asthma -related ED discharge rates significantly higher than did the state overall (Figure 10). Jefferson County had an asthma hospitalization rate significantly higher than the state. • The US asthma ED rate was 69.7/10,000 population and the hospitalization rate was 14.1/10,000 population in 2009 and 2010, respectively. • The median cost for an asthma -related ED visit among OHP members in Central Oregon facilities was $301 and for an asthma -related hospital stay the cost was $3,690 (Central Oregon CCO, 2012-2014). Figure 10. Age-adjusted rate per 10,000 population of one or more asthma -related ED visits and hospitalizations by county, Oregon, Oregon Hospital Discharge Data, 2011 F 70 3 60 o 50 S 40 o 30 20 Q -' 10 5.8 w 0 -'---- CC -- CC Oregon Significantly higher than the state overall **Significantly lower than the state overall 5.4 Crook Deschutes ■ ED Hospitalization 9.1 Jefferson Chronic Diseases Asthma Continued • Oregon has met all of the age-specific HP 2020 goals related to asthma hospital discharge rates (Table 9). ED discharge rates were not available for Central Oregon. Table 9. Asthma hospital discharge rates per 10,000 population by HP 2020 age groups, Oregon, HCUP, 2013 Age Group Central"Oregon-; 0 —4 10.5 5-64 4.1 65+ 4.5 „Oregon` 10.7 4.0 8.6 HP 2020 18.2 8.7 20.1 • A larger percent of OHP members aged 5-64 years from Jefferson County (33.7%) with asthma went to the ED for asthma than in the other Central Oregon counties (Crook=16.9%, Deschutes=18.3%) and the state overall (17.1%) (OHP, 2011). Asthma self-management education is integral for achieving asthma control. Self-management education in- cludes being taught how to respond to an attack, knowing the signs, symptoms, and triggers of an asthma attack, using medication and devices properly, using a peak flow meter to track lung function, having an asthma action plan (AAP), and having taken a class on asthma management. • Adults and children in Oregon have met the HP 2020 goal for learning how to respond to an asthma attack. However, more can be done to address a wide range of asthma control issues in the state (Figure 11). 20 Figure 11. Percent of adults and children with asthma who reported having received key asthma self-management education, Oregon, BRFSS-ACBS, 2011 100 - 90 - 80 - 70 - m • 60 50 - a 40 30 - 20II 10 - 78.8128 68.07x1: 410 357: 342 6.26.9- 0 �, How to respond How to Taught to use Advised by HCP Received an Took course on to an attack recognize early peak flow to change things AAP asthma symptoms at home management • Adults Children — HP 2020 goal Note: not all measures have an applicable HP 2020 goal Chronic Diseases 21 Asthma Continued • Tobacco is a significant asthma trigger. Adults with current asthma reported smoking at a rate similar to those without asthma (Figure 12). Figure 12. Prevalence of smoking among adults with and without current asthma, Oregon, BRFSS, 2010-2013 40 35 30 t 25 L 20 CV. 15 10 5 0 20.0 Crook Deschutes Jefferson t Statistically unreliable 18.1 Central All other Oregon counties • With current asthma No current asthma Cancer Cancer refers to a group of cells that grow out of control and no longer function as intended and may spread to other areas in the body. Cancer is the leading cause of death for adults aged 45 years and older in Oregon. Sig- nificant advances have been made recently to extend the life of persons with cancer or even eliminate the cancer completely. Early detection can help increase the chances of surviving cancer. Overall Cancer Mortality Cancer can occur at most sites in the body. Some cancers are far more common than others. The overall cancer mortality rate refers to deaths related to all types of cancer in the state. • The cancer mortality rate has been decreasing in Oregon since 2000 (Figure 13). • All of the Central Oregon Counties are nearing or have passed the HP 2020 goal (161.4/100,000) for cancer mortality (Figure 13). Figure 13. Age-adjusted cancer mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 = 250 0 200 ®. Ct. *41 "oft �.... a 150 0 100 m 50 0. °J 0 o cc 2000 2002 2004 2006 2008 2010 2012 Oregon Crook Deschutes Jefferson AHP 2020 Chronic Diseases 22 Cancer Continued • Deschutes and Crook Counties had significantly lower cancer mortality rates than Oregon overall (Figure 14). The US cancer mortality rate was 173.1/100,000 population. • Males in Oregon and Deschutes County had significantly higher cancer mortality rates than females in those areas (Figure 14). Figure 14. Age-adjusted cancer mortality rate per 100,00 population by sex, Oregon, OPHAT, 2009-2013 c 250 - c� 1200 - Q. 150 - 0 100 0 `a 50 a 0 47.3 199.5 Oregon 146.0 125.7 171.2 154,5 128.1 1883 Crook Deschutes ■ Total Female Male * Significantly higher than females ** Significantly lower than the state overall 168.6 148.2 185.8 Jefferson • Central Oregon counties have met the HP 2020 goal for breast and prostate cancer mortality, but these rates could be lower still and more could be done to address mortality rates from other cancers (Table 10). Table 10. Age-adjusted cancer mortality rates per 100,000 population, Oregon, OPHAT, 2009- 2013 Dancer site Breast Colorectal Lung Melanoma rego 22.2 20.4 15.7 14.8 48.5 45.4 2.8 3.3 Prostate 22.0 22.0 § Data from 2005 Significantly lower than the state overall erson. 12.6 11.8 13.1 17.2 42.7 37.6- 43.6 7.0 4.1 3.9 20.2 21.0 20.3 2020' 20.7 14.5 45.5 2.4 21.8 Overall Cancer Incidence Incidence refers to newly diagnosed cases. The overall cancer incidence rate measures the number of new can- cer cases in a certain population within a specific time frame. • The cancer incidence rate in the US was 459.8/100,000 population (statecancerprofiles.cancer.gov, 2007- 2011). Chronic Diseases 23 Cancer Continued • Jefferson County had a lower cancer incidence rate than did Oregon or the US (Figure 15). Deschutes County had a higher cancer incidence rate than did the US and Oregon overall. The incidence rate in the US was 459.8/100,000 population. • Males in Deschutes County and Oregon overall had a higher incidence of cancer than did females in those regions (Figure 15). Figure 15. Age-adjusted cancer incidence rates per 100,000 population by sex, Oregon, State Cancer Profiles, 2007-2011 c 600 - 0 500 - c 400 - o. a 300 - S S 200 - a100- 0. d 0 cc 425.3 498.9 Oregon * 431.7 549.5 Crook Deschutes ■ Total Female Male Significantly higher than females **Significantly different than the state overall 374.1 378.8 Jefferson Specific Cancer Sites Lung cancer is the most commonly diagnosed reportable cancer. Most risk factors for lung cancer are avoid- able. Tobacco use or exposure to secondhand tobacco smoke is the leading cause of lung cancer. However, even people who have never smoked are diagnosed with lung cancer. Environmental factors like exposure to asbestos or radon also can cause lung cancer. Breast cancer most commonly occurs in women, but can occur in men. It is one of the leading cancer sites. The risk for breast cancer is associated with older age and white race, obesity, physical inactivity, genetic predis- position, and reproductive history. Colorectal cancer occurs in the colon or rectum. Factors related to colorectal cancer are older age, being male, black/African American race, poor diet, smoking, a history of polyps, and genetics. Melanoma, a type of skin cancer, is one of the most common cancers in the US and is the most deadly of the skin cancers. Risk for melanoma can be reduced by limiting exposure to the sun, avoiding sunburns, especially early in life, and not using indoor tanning beds. Other risk factors for melanoma are having lighter skin or skin that burns, reddens, or freckles easily. The prostate is a gland found only in males. Prostate cancer is one of the most common cancers among men and when detected early can usually be treated successfully. Risk factors for prostate cancer in- clude older age (65 years and older), African-American race, and family history or genetic changes. Chronic Diseases Cancer Continued • Incidence rates of specific cancers are shown in Figure 16. • The lung cancer incidence rate did not differ between the Central Oregon counties and Oregon overall. • The breast cancer incidence rate was significantly lower in Jefferson County than in Oregon, but no differ- ent than the US rate. • The colorectal cancer incidence rate did not differ between the Central Oregon counties and Oregon. • Deschutes County had a melanoma incidence rate that was significantly higher than the Oregon rate. • Deschutes County had a significantly higher prostate cancer incidence rate than did Oregon. Figure 16. Age-adjusted cancer incidence rate per 100,000 population by cancer site, Oregon, State Cancer Profiles, 2007-2011 Breast (Female) Colorectal Lung Melanoma Prostate 26' 36.1 * Significantly dif#erentfrom Oregon H =95% Confidence Interval 24 Rate per 100,000 population US m Oregon • Crook Deschutes m Jefferson Chronic Diseases 25 Cardiovascular Disease Cardiovascular disease is a classification of diseases of the heart and blood vessels. It is one of the leading causes of death in Oregon and the US. Cardiovascular disease is preventable with good nutrition, exercise, and by not smoking. • Among males and females admitted to St. Charles facilities in Central Oregon, 21% and 14% respectively, were for cardiovascular disease events (St. Charles Health System, 2014). Heart Disease and Heart Attack • Heart disease includes several conditions, including angina (chest pain), myocardial infarction (heart at- tack), and other conditions that affect the heart muscle, rhythm, or valves. • The mortality rate due to ischemic heart disease (disease of the heart's major blood vessels) has decreased significantly in Oregon and Deschutes County since 2000 (Figure 17). The rate has also been decreasing in the US and was 116.1/100,000 population in 2009 (CDC MMWR). Figure 17. Age-adjusted ischemic heart disease mortality rate per 100,000 popualtion, Oregon, OPHAT, 2000-2013 250 - c200 0 3150 c. 0 Q°100 S 8 50 1 L Q 0 rw 2000 2002 2004 2006 2008 2010 2012 cc Oregon = Crook Deschutes ® , ° & Jefferson HP 2020 • The prevalence of heart disease or having had a heart attack (and survived) is similar in the three Central Oregon counties (Figure 18). In 2013, the prevalence in the U.S. was 4.1% for heart disease and 4.3% for heart attack (BRFSS, 2013). Figure 18. Age-adjusted prevalence of heart disease or a history of heart attack, Oregon, BRFSS, 2010-2013 5 4 V 3 2 aa, 2 1 0 Oregon t Statistically unreliable t 40 : 1.9. "IL , Crook Deschutes Jefferson • Heart disease History of heart attack Chronic Diseases Cardiovascular Disease Continued • There were no differences in the mortality rate due to ischemic heart disease among the Central Oregon counties when compared to each other or the state (Figure 19). • Males in Crook County, Deschutes County, and Oregon had a higher ischemic heart disease mortality rate than females (Figure 19). Figure 19. Age-adjusted mortality rate per 100,000 population of ischemic heart disease by sex, Oregon, OPHAT, 2009-2013 c 120 - 100 - CO a 80 - Q. 60 0 40 - 0 20 0.. a «. Oregon ICZ *Significantly higher than females 70.1 464 Crook Deschutes ■ Total Female °== Male Jefferson Cerebrovascular Disease and Stroke Cerebrovascular disease is a group of diseases dealing with blood flow in the brain. Stroke is one of the cere- brovascular diseases and is a leading cause of death and disability. A stroke is caused by a blood vessel break- ing or an artery becoming clogged in the brain that leads to reduced blood flow and brain damage. Knowing the signs and symptoms of stroke can save lives. A healthy lifestyle and medication can help reduce the risk of a stroke. The mortality rate due to cerebrovascular disease has significantly decreased in Oregon and Deschutes County since 2000 (Figure 20). 26 Figure 20. Age-adjusted cerebrovascular disease mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 Rate per 100,000 population 120 - 2000 2002 2004 2006 2008 2010 2012 37.2 Oregon — Crook - Deschutes s ° ° ° ° Jefferson HP 2020 Chronic Diseases Cardiovascular Disease Continued • The age-adjusted prevalence of stroke (and survived) was similar in Central Oregon (Figure 21). The prevalence in the U.S was 2.8% in 2013 (BRFSS, 2013). Figure 21. Age-adjusted prevalence of stroke, Oregon, 2010-2013 3 - 23 0 Oregon t Statistically unreliable Crook not reported t Deschutes Jefferson Diabetes Diabetes is characterized by having high blood glucose levels and can lead to serious adverse outcomes if left untreated. There are several types of diabetes, including type 1, type 2, and gestational diabetes. Type 1 diabe- tes is an autoimmune disorder usually diagnosed at an early age. Type 2 diabetes is often diagnosed in adult- hood. Many people are at risk for developing type 2 diabetes, a condition known as pre -diabetes. Pre -diabetes is characterized by high blood glucose levels, but not high enough to be considered diabetes. Pre -diabetes places a person not only at risk for developing diabetes, but also heart disease and stroke, however this risk can be lowered by losing weight and exercising. Gestational diabetes is a condition only pregnant women acquire during pregnancy and often resolves once the baby is born. If left untreated, gestational diabetes may cause problems for the mother and baby. In addition, gestational diabetes puts women at increased risk for later developing type 2 diabetes. • Diabetes prevalence has been increasing in the US and Oregon. In 2013, diabetes affected an estimated 287,000 adults in Oregon (Oregon Diabetes Report, 2015). • CDC estimates that about 37% of adults with pre -diabetes are not aware they have it. That translates to about 1.1 million adults in Oregon living with pre -diabetes (Oregon Diabetes Report, 2015). • There were no statistical differences in diabetes prevalence among adults in the three Central Oregon Counties (Figure 22). 27 Figure 22. Prevalence of diabetes, Oregon, BRFSS, 2010-2013 12 - 10 = g - 2 - 0 8:2 Oregon t Statistically unreliable t 7.7 Crook 4.5 Deschutes us, 9.7 Jefferson Chronic Diseases Diabetes Continued A key part of diabetes control is self-management education. Diabetes self-management education includes taking classes to learn how to self -monitor blood glucose and maintain a healthy lifestyle, as well as monitoring key clinical outcomes like blood Al C levels, as well as eye and foot health. • Two of the three HP 2020 goals for diabetes self-management education have been met in Oregon (Figure 23). Figure 23. Percent of adults with diabetes who reported having received key diabetes self-management education, Oregon, BRFSS, 2011 80 70 60 50 40 a 30 20 10 0 10 1 1 63.0 AIC checked 2+ Ever taken a Eye exam within Self blood Foot monitoring times by HCP in class on the past year glucose 1+ times per the last year managing monitoring 1+ day diabetes times per day •® HP 2020 goal Note: not all measures match HP goals • The age-adjusted mortality rate for diabetes in the US was 21.2/100,000 population (CDC, 2013). • Jefferson County had a higher diabetes mortality rate than did Oregon or the US (Figure 24). • Males in Oregon and Deschutes County had higher mortality rates due to diabetes than females in those regions (Figure 24). Figure 24. Age-adjusted diabetes mortality rate per 100,000 population by sex, Oregon, OPHAT, 2009-2013 Rate per 100,000 population 60 - 50 - 40 - 30 - 20 - 10 - 0 - Oregon Crook Deschutes •Total Female Male Significantly higher than females •" Significantly higher than the state overall 28 Jefferson Chronic Diseases Diabetes Continued • In 2014, 200 diabetes -related inpatient and 290 ED visits (primary diagnosis) occurred in St. Charles Health System facilities (St. Charles Health System, 2014). • The rate of hospitalizations where diabetes was the primary reason for admission did not differ from the rate in Oregon (11.3 vs. 11.9/10,000 population, respectively) (Figure 25). • There were no statistical differences in age-specific diabetes hospitalization rates between Central Oregon and Oregon overall (Figure 25). Figure 25. Hospitalization rate per 10,000 population due to diabetes by age group, Central Oregon and Oregon, HCUP, 2013 25 0 20 0. 0 a 15 0 8 - 10 iv O. 01 5 R ce ' �I + 4.5 10. 9.9 0-14 15-24 1 =9S% Confidence Interval t Statistically unreliable Note: due to data availability, Central Oregon region was based on patient zip code of residence. 111.5 8.011.5 + 25.7 15.6 16.4 17.2 25-34 35-44 45-54 55-64 65-74 75+ • Central Oregon Oregon Total • The rate of non-traumatic lower -extremity amputation among people with diabetes was similar in Central Oregon (2.1/10,000 population 95% CI 1.5-2.8) as Oregon (2.8/10,000 population 95% CI 2.5-2.9) (Oregon HDD, 2013). There were 43 non-traumatic lower -extremity amputations among people with diabetes in Central Oregon in 2013. • About one-third of end-stage renal disease (ESRD) was attributed to diabetes in Oregon and the US. In Jefferson County, nearly two-thirds of ESRD was attributed to diabetes (Table 11). 29 Table 11. Prevalence of end stage renal disease as of 12/31/2011, Oregon and US, US Renal Data System, 2012 Total number Number due to diabetes 228,896 1,885 Percent due to diabetes 37.8 34.1 Percent ESRD due to White 60.7 84.2 diabetes by reported race Other 39.3 15.8 fToo few cases to report $Unable to calculate Data source: U.S. Renal Data System, USRDS 2012 Annual Data Report: Atlas of End -Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012. US Oregon Crook 605,055 5,527 27 Deschutes 176 53 30.1 96.2 3.8 Jefferson 39 25 64.1 64 36 Chronic Diseases Risk Factors and Complications of Disease Several factors increase a person's risk of developing a chronic disease. While some people are genetically pre- disposed to developing a chronic disease, many other factors are modifiable. These include tobacco use, high body mass index (BMI), physical inactivity, multiple adverse childhood experiences (ACEs), and not receiving specific disease screenings. People with significant and chronic mental health and substance use problems are particularly prone to develop one or more chronic diseases. • There were no statistical differences between adults enrolled in OHP in Central Oregon versus those throughout the state regarding risks for chronic disease (data not shown). Though not directly comparable due to survey differences, adults enrolled in OHP in Central Oregon experienced some risk factors for chronic diseases at higher frequencies than the general population in Oregon (Figure 26). Data to com- pare the prevalence of chronic disease risk factors in the general Central Oregon population are available throughout this section Figure 26. Percent of adults enrolled and not enrolled in OHP who reported chronic disease risk factors, Oregon, MBRFSS, 2014 Overweight or obese High blood cholesterol Insufficient sleep (<7 hours for most) Obese 26:9: '' `r No physical activity outside work in last 30 days Secondhand smoke exposure (1+ hours/week) High blood pressure Sugar -sweetened beverages a day -1+ daily Morbidly obese Pre -diabetic Oregon -General Population ■ Central Oregon -OHP H. 95% Confidence Interval Percent Note: General population percents many not be directly comparable to OHP percents due to survey differences. They are provided as a reference. Tobacco Cigarette smoke is associated with many chronic diseases and is a leading cause of preventable death in the US. Smoking tobacco is linked to about 20% of deaths (CDC OSH, 2014). Cigarette smoking and even exposure to cigarette smoke can lead to a higher risk for heart disease, many cancers, stroke, asthma, and other diseases. See the Alcohol, Tobacco, and Other Drug Use section (page 59) for more information about tobacco. • The prevalence of smoking tobacco among adults had been declining in the US, but one in five adults (21%) in the US still smoke tobacco (CDC Vital Signs, 2010). • About 1 in 3 adults (36%) with a mental illness in the US smoked cigarettes (CDC Vital Signs, 2013). 30 Chronic Diseases Nearly one in three adults in Crook County report smoking tobacco (Figure 27). See the Child and Adoles- cent Health section (page 54) of this report for more information on youth tobacco use. Figure 27. Age-adjusted prevalence of adult current smokers, Oregon, BRFSS 2010-2013 35 - 30 - v 25 - a, 20 a 15 10 5 - 0 Oregon *National Health Inteview Survey, 2011 Crook Deschutes Jefferson Body Mass index (BM!) Many chronic diseases are associated with being overweight (BMI between 25 and 29) or obese (BMI 30 or greater), including heart disease, cancer, diabetes, and stroke. BMI can particularly be high for people with a serious mental illness as a mental illness may lead to sedentary lifestyle and physical inactivity. The medica- tions used to manage mental health illnesses may also lead to a rapid weight gain (US DHHS, 2010). 40% of adults were obese in Jefferson County (Figure 28). Figure 28. Age-adjusted 45 40 35 30 4- 6$ 25 a 20 15 10 5 25.9 0 Oregon 31 prevalence obesity among adults, Oregon, BRFSS, 2010-2013 25.1 Crook 21.8 Deschutes Jefferson Chronic Diseases Mental Illness and u stance Use Disorders Mental illness is associated with many chronic diseases, including cardiovascular disease, diabetes, asthma, and arthritis, among others. Furthermore, several risky behaviors are common to mental illnesses and chronic disease including tobacco and alcohol use, physical inactivity, and poor nutrition (CDC, 2012). • Data from several studies show an association between asthma and other respiratory symptoms and anxi- ety disorders among youth. Clinical data has also shown that anxiety is associated with increased sever- ity of asthma symptoms, healthcare use, functional impairment and poorer asthma control, compared to youth without anxiety (Goodwin et al, 2012). • The American Heart Association recommends that all cardiac patients be screened for depression (AHA, 2008). • People with mental illness, substance use disorders, or both are at increased risk for developing diabetes. Untreated behavioral health disorders can exacerbate diabetes symptoms and complications (SAMHSA Advisory, 2013). An estimated 28.5% of people with diabetes meet criteria for clinical depression (Mauer & Jarvis, 2010). • In the US, co-occurring mental illness and drug and alcohol disorders for Medicaid enrollees with com- mon chronic diseases like asthma, cardiovascular disease, and diabetes led to a two to three fold increase in healthcare costs (Boyd, et al., 2010). Disease Monitoring and eal Screenings Several chronic diseases can be monitored regularly to ensure that they are under control. Other diseases have methods for regular screening. Screening may help detect disease earlier and allow for early intervention or may help avoid the disease all together. Examples are monitoring blood cholesterol or blood pressure to help decrease risk of heart disease and stroke, and screening using the PAP test for cervical cancer, mammogram for breast cancer, fecal occult blood test or colonoscopy for colorectal cancer, and total body skin check for melanoma, among others. Screening can also be done for chronic disease risk factors like mental health status, alcohol use, and other substance use. • There were no differences in the prevalence of high blood pressure among adults in the Central Oregon Counties (Figure 29). 32 Figure 29. Age-adjusted prevalence of high blood pressure or high blood cholesterol, Oregon, BRFSS, 2010-2013 35 - 30 - 4. 25 - a 20 - w 15 - a 10 - 5 - 0 Oregon Crook • High blood pressure t Statistically unreliable Deschutes Jefferson High blood cholesterol Chronic Diseases The percent of adults who are current with a cholesterol check is nearing the HP 2020 goal of 82.1% (Fig- ure 30). Figure 30. Age-adjusted prevalence of having had a cholesterol check in the last 5 years, Oregon, BRFSS, 2010-2013 90 80 70 c 60 V, 50 v 40 30 20 10 0 70.8 Oregon Crook Deschutes Jefferson • Though the estimates are not directly comparable, adults enrolled in OHP tended to have a lower frequen- cy of having received key screenings for chronic diseases than the general population (Figure 31). 33 Figure 31. Percent of adults enrolled and not enrolled in OHP who have received key chronic disease screenings, Oregon, MBRFSS, 2014 Pap test in last 3 years (women age 21-65 years w/cervix) 82.9 Mammogram in last 2 years 73.8 (women age 50-74 years) Blood cholesterol checked within 74.4 past 5 years Current on colorectal cancer screening (age 50-75 years) High blood sugar/diabetes test in last 3 years (age 45 years or older) 64.0 66.0 50.9 Oregon -General Population •Central Oregon -OHP 1-1=95% Confidence Interval $ No estimate available Note: General population percents may not be directly comparable to OHP percents due to survey differences. They are provided for a reference. Chronic Diseases • Only one third of adults in Crook County reported being current for colorectal cancer screening (Figure 32). • Deschutes County was nearing the HP 2020 goals for cancer screening (Figure 32). Figure 32. Age-adjusted prevalence of having received cancer screening, Oregon, BRFSS, 2010-2013 100 - 80 - a 60 - u L i40 - not not reported reported 20 t 89.9 t 0 PAP test in last 3 years Mammogram in last 2 years Current on colorectal cancer screening • Crook Deschutes =4 Jefferson — Oregon — HP 2020 t Statistically unreliable CCO Measures Several chronic diseases can be monitored regularly to ensure that they are under control. Other diseases have methods for regular screening. Screening may help detect disease earlier and allow for early intervention or may help avoid the disease all together. Examples are monitoring blood cholesterol or blood pressure to help decrease risk of heart disease and stroke, and screening using the PAP test for cervical cancer, mammogram for breast cancer, fecal occult blood test or colonoscopy for colorectal cancer, and total body skin check for melanoma, among others. Screening can also be done for chronic disease risk factors like mental health status, alcohol use, and other substance use. • There were no differences in the prevalence of high blood pressure among adults in the Central Oregon Counties (Figure 29). 34 Percentage of adult patients (ages 18-75 years) with diabetes who received at least one A1c blood sugar test. Percentage of adult patients (aged 18-75 years) with diabetes who received an LDL -C (cholesterol) test. Percentage of patients (18-75 years of age) with diabetes who had hemoglobin Alc>9.0% during the measurement period. Percentage of adult members (ages 50-75 years) who had appropriate screening for colorectal cancer. Percentage of women (aged 21 to 64 years) who got one or more Pap tests for cervical cancer in the past three years. Percentage of patients 18-85 years of age who had a diagnosis of hypertension (high blood pressure) and whose blood pressure was adequately controlled. Rate of adult patients (18 years and older) with diabetes who had a hospital stay because of a short-term problem from their disease (per 100,000 member years). (PCU 01) Rate of adult patients (aged 18 years and older) who had a hospital stay because of congestive heart failure (per 100,000 member years). (PCI 08) Rate of adult patients (age 40 years and older) who had a hospital stay because of asthma or chronic obstructive pulmonary disease (per 100,000 member years). (PCU 05) Rate of adult members (ages 18-39 years) who had a hospital stay because of asthma (per 100,000 member years). 14.7 e • 4 71.2 163.1 .,moi 197.2 60.9 CO Ij 34 0 269.9 436.6 80.8 M 81.0 80.0 0 State •Central Oregon CCO OBenchmark la 720.9 Communicable Diseases Communicable disease refers to infectious diseases that can be transmitted among people either directly or indirectly. Public health officials track infections that are of most importance to the health of the population in order to help stop their spread. Public health surveillance is conducted to monitor outbreaks and disease bur- den, describe burden of new or emerging disease, and locate and inform people exposed to a communicable disease. Immunizations Immunizations are a key public health measure for preventing the spread of disease (CDC). Immunizations have successfully reduced the number of some diseases to historic lows. However, some people are unable to receive immunizations due to a medical condition or they decline immunizations for other reasons. • Non-medical exemptions for kindergarteners were more common in Deschutes County (8.3%) than Jef- ferson County (1.0%) and Crook County (2.7%). The non-medical exemption rate for kindergartners in Oregon was 5.8% (OHA, 2014-2015). There were 159 non-medical exemptions in Deschutes County dur- ing the 2014-2015 school year. • All three counties and the state overall reported a drop in non-medical exemption rate for the 2014-2015 school year. A new law went into effect on March 1, 2014 requiring parents seeking non-medical exemp- tion to receive education about the risks and benefits of vaccines. Childhood A series of immunizations are delivered to children to ensure their immunity to many diseases. Some im- munizations require several doses to establish immunity. To be up-to-date, children should receive 4 doses of Diptheria, Tetanus, and acellular Pertussis (DTaP), 3 doses of Polio vaccine, 1 dose of Measles, Mumps and Rubella (MMR), 3 doses of Haemophilus Influenzae Type b (HiB), 3 doses of Hepatitis B, 1 dose of Varicella, and 4 doses of pneumococcal conjugate vaccine (PCV) by their second birthday. • Two -year-olds in Jefferson County were more frequently up to date with immunizations than were two- year -olds in the other Central Oregon Counties and the state overall (Figure 34). 35 Figure 34. Two-year old up-to-date* immunization rates, ALERT, Oregon, 2013 100 - 90 - 80 - 70 - c 60 - 50 - a.L. 40 - 30 - 20 - 10 - 58.2 0 1 1 Oregon Crook Deschutes Jefferson " 4 doses DTaP, 3 doses IPV, 1 dose MMR, 3 doses Hib, 3 doses HepB, 1 dose Varicella, 4 doses PCV 1=95% confidence interval t National Immunization Survey, 2013 HP 2020, 80.0 ust, 70.4 Communicable Diseases Immunizations Continued • Jefferson County two -year-olds enrolled in the Women, Infants, and Children (WIC) Program and OHP were more frequently up-to-date with immunizations than were those enrolled in those programs in Or- egon (Figure 35). • Deschutes County two -year-olds not enrolled in WIC and OHP were less frequently up-to-date with im- munizations than were those enrolled in those programs in Oregon (Figure 35). Figure 35. Two-year old up -to -dater immunization rates by program, ALERT, Oregon, 2013 100 90 80 70 c 60 w 50 a 40 30 20 10 0 WIC Non -WIC OH P • Crook Deschutes Jefferson — Oregon $ 4 doses DTaP, 3 doses IPV, 1 dose MMR, 3 doses Hib, 3 doses HepB, 1 dose Varicella J=95% confidence interval Non -OHP Adolescents Other vaccines are available to reduce the risk of some diseases among adolescents. Adolescents are eligible for vaccine coverage from human papilloma virus (HPV) and meningococcal disease. It is also important to maintain immunity for diseases covered in the Tetanus, Diptheria, and acellular Pertussis vaccine (TDaP) and influenza vaccine. • Adolescent immunization rates are shown in Figure 36. Figure 36. Adolescent (aged 13-17 years) immunization rates by type of vaccine, ALERT, Oregon, 2013 36 100 - 90 - 80 - 70 60 - L c 50 - w40 - 30 - 20 - 10 - 0 Tdap Meningococcal 1+HPV Female 3+ HPV Female 1+HPV Male 3+HPV Male Influenza (last season) ■ Crook Deschutes k;_ Jefferson — Oregon HP 2020§ Healthy People 2020 goal is for adolescents 13-15 years Communicable Diseases Adults As people age, there is still a need to receive new immunizations or update past immunizations. Some factors such as age, lifestyle, travel, history of having received a vaccine, and existing health conditions may also deter- mine the need for adult immunizations. Some vaccines may be new and were not available during childhood, like the herpes zoster vaccine for shingles. • Deschutes County adults aged 65 years and older had a significantly higher frequency of receiving an an- nual influenza vaccine than did those in Oregon overall. There were no differences in having ever received a pneumococcal vaccine (Figure 37). Figure 37. Age-adjusted percent of adults aged 65 years and older who recieved key immunizations, Oregon, BRFSS, 2008-2011 90 - 80 - 70 - c 60 u 50 `a 40 - a. 30 - 20 - 10 - 0 61.6 Any influenza vaccine in the last 12 months 72.7 78.2 Ever received a pneumococcal vaccine • Crook Deschutes Jefferson — Oregon Vaccine Preventable Diseases Despite having a vaccine available for prevention, the diseases below still occur in Oregon and the Central Oregon Counties. • Influenza (flu) is a vaccine preventable disease that causes mild to severe respiratory illness. In the US, thousands of influenza -associated deaths occur each year. The severity of influenza varies year-to-year depending on what versions of the virus are spreading, timing of flu season, and how well the vaccine matches the viruses that are causing illness. Another key factor is how many people get vaccinated. Dur- ing the 2013-2014 influenza season, an estimated 7.2 million influenza -associated illnesses were prevented by influenza vaccination in the US (CDC, 2015). • Between 2004 and 2013, the incidence rates of Haemophilus influenzae (a bacterial infection) and menin- gococcal disease in Central Oregon were similar to the Oregon rate (Table 12). • Between 2004 and 2013, the incidence rate of pertussis was lower in Central Oregon than in Oregon overall (Table 12). However, in 2014, 60 cases of pertussis were identified in Deschutes County, more than identified in the previous 10 years. Pertussis is now considered widespread in Deschutes County. • Other vaccine preventable diseases are not shown here because they occur infrequently. 37 Table 12. Age-adjusted rate per 100,000 population of vaccine preventable diseases, Oregon, OPHAT, 2004-2013 Haemophilus influenzae 1.5 (630) Meningococcal disease 1.0 (371) Pertussis (whooping cough) 11.4 (3,892) (#) I Number of cases Significantly lower than the state overall entral_Oregarr. 1.8 (39) 1.6 (29) 3;0.(55) • Communicable Diseases Hepatitis There are several hepatitis viruses present in the world. The most common in the US are hepatitis A, B, and C. Some hepatitis viruses are spread through sexual activity, others via contact with blood or items contaminated with blood, and some are spread through contaminated food and water. While hepatitis A, B, and C can be acute infections, hepatitis B and C can progress into a serious lifelong, chronic disease. Hepatitis A and B are prevent- able with a vaccine. Currently, there is no vaccine for hepatitis C. However, treatment options are available for hepatitis C and it may be cured. • Chronic hepatitis B occurred less frequently in the Central Oregon Counties than in the state overall (Table 13). • The age-adjusted rate of past or present hepatitis C in Central Oregon was similar to the Oregon rate (Table 13). However, the age-adjusted rate in Jefferson County for past or present hepatitis C was higher than in the state overall (272.9/100,000). • Nationally, there was a 151.5% increase in acute hepatitis C cases from 2010 to 2013. This increase is thought to be due to both true increases in incidence and improved case reporting and detection (CDC, 2013). Table 13. Age-adjusted rate per 100,000 population of hepatitis, Oregon, OPHAT, 2004-2013 Hepatitis A Hepatitis B (acute) Hepatitis B (chronic) Hepatitis C (acute) Hepatitis C (past or present) (#) J Number of cases l Significantly lower than the state overall 38 0.4 (86) 1.0 (189) 11.0 (2,137) 0.7 (122) 122.0 (25,448) ntra`I,:O;:r:ego 0.5 (5) 0.9 (9) 0.7 (6) 114.3 (1,276) Communicable Diseases Sexually Transmitted Infections Sexually transmitted infections (STIs) are preventable with proper precautions, testing, and treatment. Clini- cians and public health staff work diligently to stop the spread of STIs by breaking transmission via screening and helping patients with partner notification. In Oregon, the use of expedited partner therapy allows a patient to provide medication to their sexual partners without a healthcare provider first examining the partner. • Chlamydia is the most commonly reported STI in the US and in Central Oregon. If left untreated, chlamydia can lead to infertility and tubal pregnancy. Gonorrhea is another common STI that is readily treatable, yet has serious long-term effects if left untreated. Gonorrhea is less common than is chlamydia. Chlamydia and gonorrhea can be present without symptoms, so women and men with specific risks should be tested annu- ally. Syphilis is a rarer STI, but can have serious implications if left untreated. • There were 13 cases of early syphilis in Central Oregon between 2009 and 2013 (OPHAT, 2009-2013), an average of 2-3 cases a year. There were 4 cases reported in 2014 (Provisional data, OHA). • Chlamydia rates have been increasing in Oregon since 2004 (Figure 38). There were 721 cases of chlamydia reported in Central Oregon in 2014 (Provisional data, OHA) • The chlamydia rate is higher in Jefferson County, though the difference has not reached statistical signifi- cance (Figure 38). Figure 38. Age-adjusted chlamydia incidence rate per 100,000 population, Oregon, OPHAT, 2004-2013 800 0 700 - 1::'o 400 - o s .^r 381.9 0 300 - 244.5 200 - MI cu100- a. cc 0 2004 2006 2008 2010 2012 • Ages 18-24 years had the highest rates of chlamydia (Figure 39). • Deschutes and Jefferson Counties had higher rates than did Oregon overall for several age groups (Figure 39). Other age groups are not presented due to very low case numbers. Figure 39. Chlamydia incidence rate per 100,000 population by age group, Oregon, OPHAT, 2009-2013 39 Rate per 100,000 population 4000 3500 3000 2500 2000 1500 1000 500 0 1 t 10-14 15-17 18-19 20-24 25-29 ■ Crook " Significantly higher than the state overall t Too few cases to report Deschutes 30-34 t tttt 35-39 40-44 45-49 Jefferson .® Oregon Communicable Diseases Sexually Transmitted Infections Continued • The incidence rate of gonorrhea was lower in Deschutes County than in Oregon overall (Figure 40). • Between 2009 and 2013, there were 79 cases of gonorrhea reported in Central Oregon (data not shown), an average of about 16 cases a year. In 2014 alone, there were 49 cases of gonorrhea reported in Central Oregon (Provisional data, OHA). Figure 40. Age-adjusted gonorrhea incidence rate per 100,000 population, Oregon, OPHAT, 2009-2013 c o 40 - co 35 0. O 30 - 0 25 c 20 0 15 10cu 5 - 37:4 0 ea Oregon Crook 23.5 * Significantly lower than the state overall s 5.3 Deschutes Jefferson • Human Immunodeficiency Virus (HIV) is transmitted via infected bodily fluids, such as blood, semen, vaginal secretions, and breast milk. HIV leads to the development of Acquired Immune Deficiency Syn- drome (AIDS) and is a serious, chronic disease that makes a person susceptible to many other infections and diseases. There is no vaccine or cure for HIV. • Between 2003 and 2012, an average of 5-6 people were diagnosed with HIV each year in Central Oregon (HIV/AIDS Epidemiologic Profile, 2012) 40 Communicable Diseases 41 Vector Born Diseases • Vector borne diseases are rare in Central Or- egon (Table 14). • Malaria and dengue fever cannot be contracted in Central Oregon, as the vector that transmits the disease is not present. The cases presented in this report represent residents of Central Oregon who traveled to malaria or dengue fever endemic areas and contracted the dis- ease. These data suggest more could be done to inform travelers about their risks when leaving the area. Table 14. Number of vector borne diseases reported in Oregon and Central Oregon§, OPHAT, 2004-2013 Colorado tick fever Dengue fever* Hantavirus Lyme disease* Malariat Rocky mountain spotted fever West Nile virus Oregon 7 43 14 380 145 16 172 Central Oregon <5 <5 6 10 7 <5 <5 § May not be region of acquisition # While the vector for Lyme disease exists in Oregon, it has not been found in Central Oregon t Acquired elsewhere Diarrhea) Diseases Diarrheal diseases are often associated with contaminated water or food. Many efforts are made by public health officials to ensure clean drinking water and food safety guidelines are followed. See the Environmental Health (page 63) and Water Quality (page 76) sections for more information. • Water -borne diseases are common in the Central Oregon counties and were reported at higher rates than in Oregon overall (Table 15). However, note that many water -borne diseases go unreported. Higher rates may be related to capacity to detect disease. • There were too few cases of legionellosis and listeriosis in Central Oregon to report (Table 15). Table 15. Age-adjusted incidence rate per 100,000 population of water -borne diseases, Oregon, OPHAT, 2004-2013 Campylobacteriosis Cryptosporidiosis E. coli (STEC) Giardiasis Legionellosis Listeriosis Salmonellosis (non - typhoidal) Shigellosis Vibriosis (non cholera) Yersinosis (#) J Oregon, 20.4 (7,727) 4.2 (1,568) 3.3 (1,207) 11.7 (4,296) 0.5 (197) 0.3 (113) 11.1 (4,098) 2.3 (823) 0.4 (158) 0.5 (191) Too few cases to calculate a rate Number of cases Significantly higher than the state overall Significantly lower than the state overall roo 26.8 (52) t (9) 5.7 (12) 53 (12) ;; t (<5) t (<5) 13.0 (26) Deschutes t (<5) t (<5) 9.9 (149) t (<5) 1:.0_(14)'_ t (<5) t (<5) 0.8 (13) ** (5) Jefferson. 26.4 (56) t (<5) t (8) 10.2 (22) t (<5) t (<5) 9.3 (19) .4::(26) t (<5) t (<5) 10.2 (194) 1.9 (35) 0.7 (15) t (7) Communicable Diseases Healthcare Associated Infections Significant effort has focused recently on the prevention of HAIs. These include central line associated blood- stream infections (CLABSI), infections related to coronary artery bypass grafts (CABG), and Clostridium difficile infections. Hospitals and healthcare providers have instituted processes and protocols to help reduce the inci- dence of HAIs in their facilities. • The Standardized Infection Ratio (SIR) is a measure used to track HAI prevention progress. According to CDC, the SIR compares the number of infections in a facility or state to the number of infections that were "predicted"; or would be expected, to have occurred based on previous years of reported data (national base- line). Lower SIRs are better. The SIR is low for most HAIs in Central Oregon facilities. (Table 16) • The SIR is higher than the national baseline for C. difficile in the St. Charles Health System in Redmond and Bend (Table 16). Table 16. Standard Infection Ratios of selected HAI among Central Oregon healthcare facilities, Oregon Health Authority, 2013 CLABSI-adult CLABSI-neonatal CABG Knee replacement Colon surgery Hysterectomy Hip replacement Laminectomy C. difficile Prineville — Not measured at this facility SIR<1 and is not different than national baseline or facility had 0 HAI SIR>1 and is not different than national baseline SIR>1 and is greater than the national baseline Data from: Oregon Health Authority Vaccination of healthcare staff from influenza is an effective way to reduce spread to vulnerable patients and to reduce staff illness. • St. Charles -Madras staff had a higher healthcare worker influenza vaccination rate than other Central Or- egon healthcare facilities (OHA, 2013-2014). The HP 2020 goal is a 90% vaccination rate. -Bend: 73%, Madras: 78%, Redmond: 75%, Prineville: 77% CCO Measures • Central Oregon CCO has met the quality measure goal for testing children with a sore throat for strep before getting an antibiotic (Figure 41). Figure 41. Central Oregon CCO quality measures related to communicable disease, June 2014 42 Percentage of adolescents who received recommended vaccines before their 13th birthday. Percentage of children who received recommended vaccines before their second birthday. Percentage of children with a sore throat (pharyngitis) who were given a strep test before getting an antibiotic. Percentage of sexually active women (ages 16-24 years) who had a test for chlamydia infection. • 620 • 64.0 77.1 5 32.0- O State • Central Oregon CCO El Benchmark Maternal Health and Pregnancy Introduction The health of a child begins with a healthy mother and a healthy pregnancy. Factors like not using tobacco, alcohol, or other drugs, maintaining a healthy weight, receiving prenatal care, maintaining good oral health, breastfeeding, and preventing injuries and adverse childhood experiences (ACEs) are key for starting an infant's life in a healthy manner. See the Adverse Childhood Experiences section (pages 54-55)for more information on this topic. Several programs exist to support mothers and infants. One program is the Women, Infants, and Children (WIC) Program, a special supplemental nutrition program that "provides supplemental foods, healthcare refer- rals, and nutrition education for low-income pregnant, breastfeeding, and non -breastfeeding postpartum wom- en, and to infants and children up to five years of age who are found to be at nutritional risk" (USDA). Another program is the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. Home visiting is a proven strategy for strengthening families and improving the health status of women and children. There are a variety of home visiting programs available in Central Oregon, including: Maternity Case Management, Nurse Family Partnership, Babies First!, CaCoon, and Healthy Families Oregon. • In 2013, there were 770,514 women of childbearing age (15-44 years) in Oregon and 36,801 in Central Or- egon representing 19.6% and 17.7% of the total population, respectively. - 3,177 in Crook County - 30,069 in Deschutes County - 3,555 in Jefferson County Prenatal Care Prenatal care is the healthcare a woman receives during pregnancy. Beginning early in pregnancy, visits to a healthcare provider are recommended based on a specific schedule. A dental visit is also recommended after the first trimester. Prenatal care helps healthcare providers detect problems early to improve the health of the mother and baby and may even prevent or cure some conditions. • One method to measure adequate prenatal care is the Kotelchuck index. Adequate prenatal care is defined as having received at least 80% of expected prenatal visits. Jefferson County had a lower frequency of mothers receiving adequate prenatal care than Oregon overall (Table 17). 43 Table 17. Timeliness of prenatal care, Oregon, OPHAT, 2013 Percent of births Central Paid by Deschutes Jefferson HP 2020 Oregon OHP Adequate Prenatal Care-Kotelchuck 72.2 70.3 69.9 Index Prenatal care started in 1st 77.8 68.6 81.0 trimester Prenatal care started in 2nd 17.9 27.6 15.9 trimester Prenatal care started in 3rd 3.6 3.8 2.8 trimester 68.0 77.9 18.8 4.0 3.1 No prenatal care 0.7 Significantly different than the state overall Too few births to report Percent of births in Central Oregon paid by the Oregon Health Plan 0.3 No measure 66.6 77.9 72.7 No measure No measure No measure 22.9 4.1 Maternal Health and Pregnancy Prenatal Care Continued • About 3 of 4 (77%, 95% CI 68.2%-85.2%) of Central Oregon mothers said that they received an HIV test sometime during their most recent pregnancy or delivery. The proportion for the rest of the state was 68.8% (95% CI 66.6%-71.0%) (PRAMS, 2009-2011). • 60.9% (95% CI 51.4%-70.4%) of mothers in Central Oregon reported they were offered an influenza vaccine or were told to get one during their last pregnancy. This was significantly lower than in the rest of the state (77.8% 95% CI 76.0%-79.6%). Births Healthcare is important during and immediately after birth. At this point, breastfeeding can be implemented and safety topics can be addressed. Reviewing the birth rates in an area can help identify a specific population's fertil- ity patterns and identify the need for reproductive health services. • The fertility rate (the number of pregnancies per 1,000 women of childbearing age) has not significantly changed since 2000 among the three Central Oregon Counties. However, there has been a significant de- crease in the fertility rate in Oregon overall (Figure 42). • In 2013, Jefferson County had the highest fertility rate among women aged 15-44 years among the Central Oregon Counties and as compared to Oregon overall (Figure 42). Figure 42. Fertility rate per 1,000 women aged 15-44 years, Oregon, OPHAT, 2000-2013 c120 - g 100 - 80 63.4 $ 60 -. 4. 40 - a 20 - 2000 2002 2004 2006 2008 2010 2012 Oregon — . Crook .--.. Deschutes • • • • • ° Jefferson * 2013 rate significantly higher than other counties and state overall 58.6 • American Indians and whites in Jefferson County had a higher fertility rate than the state overall (Figure 43). 44 Figure 43. Fertility rate per 1,000 women aged 15-44 years by race and ethnicity, Oregon, OPHAT, 2013 c 100 - d E 80 - 0 c 60 40 0,°) 20 - a 0 American Indian/Alaska Native NH ■Crook '= Deschutes gJefferson ®Oregon " Significantly higher than the state race -specific rate t Too few births to report 78.0 Hispanic White NH Maternal Health and Pregnancy Births Continued • Teen parents and their children experience several long-term impacts that lead to significant socioeconomic costs (CDC, Teen Pregnancy). The fertility rate among teens was higher in Jefferson County than in Oregon overall (Figure 44). However, the total number of births to teens aged 15-19 years in Central Oregon has decreased from 215 in 2004 to 128 in 2013 (data not shown). • The fertility rate among women aged 20-24 years old was higher among all the Central Oregon counties than those aged 20-24 years in Oregon (Figure 44). Figure 44. Fertility rate per 1,000 women aged 15-44 years by age group, Oregon, OPHAT, 2009-2013 180 - a 160 - c 140 - 3 120 - 0100- o 80 - t- 60 - 0 40- .. 20 - 16.0 Atia01 ,21•: m 0 cc 15-17 18-19 20-24 25-29 Age Group Crook Deschutes ' ' Jefferson °® Oregon " Significantly higher than the age-specific state rate **Significantly tower than the age-specific state rate 30-34 413.6;392 6.8 91 9.3 35-39 40-44 • There are approximately 45,000 births each year in Oregon and 2,200 in Central Oregon (Table 18). Table 18. Total number of births by county and payer, Oregon, OHA Birth Certificate Data, 2013 Oregon Central ,Oregon '',-'Crook ,._Deschutes Jefferson Number of births 45,136 2,216 192 1,723 301 Percent of births paid by OHP 43.6 49.1 55.5 44.9 68.9 • The percent of births paid for by OHP varies by age group and race (Figure 45). 45 Figure 45. Percent of births paid for by OHP by age group and race/ethnicity, Oregon, OPHAT, 2013 100 80 60 a 40 20 0 15-19 20-24 25-29 30-34 35-44 Age Group White American Hispanic, Indian any race Race/Ethnicity • Crook Deschutes Jefferson —Oregon Significantly higher than Oregon overall t Too few births to report Maternal Health and Pregnancy Pregnancy Risk Factors There are several risk factors related to poor pregnancy outcomes, such as use of tobacco, alcohol, certain medi- cations, controlled substances, and poor nutrition during pregnancy. Other factors like maternal age and existing health conditions may also complicate a pregnancy. • 4.7% of Central Oregon mothers reported that they drank alcohol in the last 3 months of their pregnancy (95% CI 0.9%-8.6%). The prevalence was 8.2% for the rest of the state (95% CI 7.0%-9.5%) (PRAMS, 2009- 2011). • 60.3% (95% CI 51.3%-69.3%) of Central Oregon mothers reported that they drank alcohol in the 3 months before their pregnancy. The prevalence for the rest of the state was 55.8% (95% CI 53.8%- 57.8%). • The National Institute on Drug Abuse states that, "THC exposure very early in life may negatively affect brain development.... However, more research is needed to separate marijuana's specific effects from other envi- ronmental factors, including maternal nutrition, exposure to nurturing/neglect, and use of other substances by mothers.... Breastfeeding mothers are cautioned that some research suggests that THC is excreted into breast milk in moderate amounts. Researchers do not yet know what this means for the baby's developing brain." • Though not statistically significant, Crook County had a higher rate of smoking during pregnancy than the other Central Oregon Counties (Figure 46). The percent of mothers who smoked during pregnancy in Crook County peaked in 2008 and has been declining since. However, the rate is still much higher than the HP 2020 goal of 1.4%. Figure 46. Percent of mothers who smoked during pregnancy, Oregon, OPHAT, 2000-2013 25 - r: 20 t 15 i 12 , 0.10- 5 - 0 2000 2002 2004 2006 2008 2010 2012 46 10.2 Oregon = "s' Crook — Deschutes " * Jefferson HP 2020 Maternal Health and Pregnancy Pregnancy Risk Factors Continued • The frequency of smoking during pregnancy was six times higher Oregon than those with private insurance (Figure 47). Figure 47. Prevalence of smoking during pregnacy by type of insurance, Central Oregon, OHA, 2010-2012 among women enrolled in OHP in Central 30 - 25 - 3.9 28.0 6.6 Oregon Crook 2.5 3.1 Deschutes Jefferson ■ OHP Private Insurance L8 Central Oregon • Pregnancy risk factors occurred at similar frequencies among mothers enrolled in OHP and the general population (Table 19). Table 19. Percent of births with specific regnancy risk factor, Oregon, OPHAT, 2013 Gestational diabetes Pre -pregnancy diabetes Eclampsia Gestational hypertension Pre -pregnancy hypertension regoin Oregon=OH P 7.6 8.0 0.9 0.8 6.1 1.6 0.9 5.8 1.6 Central Oregon 6.4 0.9 0.7 6.4 1.2 Central Oregon -OHP 7.2 0.9 0.9 5.9 1.2 Significantly higher than Oregon total The prevalence of gestational diabetes nearly doubled between 2004 and 2013 (Figure 48). Figure 48. Prevalence of gestational diabetes, Oregon, OPHAT, 2004-2013 c c. 47 9 8 7 6 5 4 3 2 1 0 4.1 T I 13.4 2004 2005 2006 2007 2008 2009 Central Oregon 2010 2011 2012 Oregon 6.4 2013 Maternal Health and Pregnancy Pregnancy Risk Factors Continued • The prevalence of preterm birth is higher among women enrolled in OHP in Central Oregon than the state overall (Table 20). Table 20. Percent of births by gestational age at birth and birth weight, Oregon, OPHAT, 2013 Preterm birth Birth Weight <36 weeks 32-36 weeks <32 weeks < 2500 grams (low birth weight) >=4000 grams (high birth weight) Significantly higher than the Oregon total Oregon 7.8 6.4 1.2 6.3 ` Oregon - OHP 8.0 6.7 1.3 6.9 Central'. ` ` .Central :: ; "> `'HP 2020 Oregon Oregon OHP ,.; 7.6 7.1 0.7 0.9 1.2 11.4 6.4 8.1 10.6 9.1 8.0 6.2 7.8 • Healthcare providers discuss several topics during prenatal visits to ensure a mother and her baby are kept safe (Figure 49). The percent of mothers reporting their healthcare provider discussed these topics with them was not significantly different in Central Oregon than in the remainder of the state (data not shown). Figure 49. Percent of mothers who state their health care professional discussed topics with them about most recent pregnancy, Central Oregon, PRAMS, 2009-2011 Medications that are safe to use during pregnancy What to do if labor starts early _ Screening test for birth defects _ Breastfeeding their baby _ Signs of preterm labor _ Getting tested for HIV _ Eating fish high in mercury What to do if feel depressed during pregnancy _ How drinking alcohol could affect baby _ How smoking tobacco could affect baby _ How using illegal drugs could affect baby _ Physical abuse by their partners Using a seatbelt 90.1 89.0 84.9 82.0 81.8 74.6 70.9 69.1 64.7 59.0 55.4 48.0 0 10 20 30 40 50 1-1=95% Confidence Interval 48 Percent 60 70 80 90 100 Maternal Health and Pregnancy Unintended Pregnancy Unintended pregnancy refers to pregnancies that are mistimed, unplanned, or unwanted. About 51% of preg- nancies in the US are unintended (Guttmacher Institute, 2015). Measuring rates of unintended pregnancy helps gauge a population's needs of contraception and family planning. Unintended pregnancy is associated with in- creased risk of health problems for the baby as the mother may not be in good health or delay prenatal care upon learning of the pregnancy. • 41.7% (95% CI 32.4%-51.0%) of pregnancies in Central Oregon were considered unintended. The propor- tion for the rest of the state was 37.9% (95% CI 35.9%-40.0%) (PRAMS, 2009-2011). • The abortion rate (induced abortions) decreased to 10.6 per 1,000 women aged 15-44 years in 2013. During the past 20 years, Oregon's abortion rate for women aged 15 to 44 years has generally declined from a high of 21.4 in 1991 to a low in 2013 of 10.6. (Oregon Vital Statistics Annual Report, 2013). • Contraceptive failure is not the reason for the majority of abortions in Central Oregon. For about 3 of 4 abortions, no contraceptive was used (Figure 50). Figure 50. Percent of abortions with contraceptive use, Oregont-, Vital Statistics, 2011-2013 90 80 70 60 d 50 Itro 40 a. 30 20 10 0 9.4 None Birth Control Pills 11.3 7.7 mat .,, SrS.VIM 3.8 1.1 Condom 7.8 0.0 0.4 1.1 MEM Other Unknown Contraceptive Use ■ Crook Deschutes Jefferson ® Oregon $ Includes Oregon and non -Oregon residents, excludes abortions among Oregon residents that occured in other states CCO Measures • Figure 51 contains the maternal and infant -related CCO measures. The Central Oregon CCO has met the goal of providing postpartum care visits to women within a specific time frame. Figure 51. Central Oregon CCO quality measures related to maternal and infant health, June 2014 49 Percentage of pregnant women who received within the first trimester or within 42 days of enrolling in Medicaid. Percentage of women who had an elective delivery between 37 and 39 weeks of gestation. Percentage of women who had a postpartum care visit on or between 21 and 56 days after delivery. Percentage of children up to 15 months old who had at least 6 well child visits with a HCP. 0 50 2.3 82.9 (86.o 7 41) CO 00.2 "` 77. 0 State • Central Oregon CCO 0 Benchmark 90.0 Child and Adolescent Health Infant, Early Childhood and Adolescent Health Children are exposed to and react to environmental and physical exposures differently than adults. Adolescents are entering a time in their life when they are exploring and establishing health patterns and behaviors. Ensuring their safety and knowledge of health behaviors is vital to their overall health. For information on childhood im- munization see the Immunizations Section (page 35-36). • From 2004 to 2013, the average number of infant deaths each year in Central Oregon was 11. The leading causes of death for infants were conditions originating in the perinatal period, congenital malformations, and unintentional injuries (OPHAT, 2004-2013). • Between 2004 and 2013, there was an average of 10 deaths per year among children and adolescents (1-17 years) in Central Oregon. The three leading causes of death for children and adolescents were unintentional injuries, suicide, and malignant neoplasms (cancer) (OPHAT, 2004-2013). • The leading causes of unintentional injury -related death for children and adolescents (1-17 years) were mo- tor vehicle crash and drowning in Central Oregon and Oregon overall (OPHAT, 2004-2013). • The most common childhood cancers in the United States are leukemia and brain or central nervous system tumors (American Cancer Society). Breastfeeding Breastfeeding is an important source of nutrition for a baby with several health benefits for the mother and the baby. A mother's milk can deliver important antibodies to an infant to help fight infections and has been shown to decrease incidence of allergies and asthma. Breastfeeding is also a low cost method for feeding infants that promotes bonding between a mother and baby. Breastfeeding for longer periods and exclusively can increase the health benefits for both the mother and the baby. Recommendations suggest exclusively breastfeeding a baby for at least six months and then supplementing solid food with breast milk. Many mothers initiate breastfeeding, but several barriers lead to discontinuation or decreased breastfeeding as the infant grows. • The Maternity Practices and Infant Nutrition and Care (mPINC) survey ranked Oregon 5th among state and territory respondents (2013). This survey focuses closely on breastfeeding practices. • Breastfeeding as reported on the birth certificate was similar in Crook and Deschutes Counties (90.5%, 90.3%, respectively) as it was in Oregon (89.2%). Jefferson County's breastfeeding rate at birth was slightly lower (85.0%) (Birth Certificates, 2011-2013). The HP 2020 goal is 81.9%. • The WIC Program supports families with supplemental nutrition and promotes healthy behaviors, like breastfeeding. In 2014, WIC served over 8,500 individuals in Central Oregon in 2014 (Table 21). Table 21. Percent of mothers enrolled in WIC who breastfeed and number of WIC clients served in Central Oregon, WIC County Data Reports, 2014 Number of individuals served Percent initiated breastfeeding Percent still breastfeeding at six months N/A=data not available § Data from 2013 Annual Report 50 reg 161,335 93§ N/A 1,072 89 40 6,303 95 40 Child and Adolescent Health Child and Family Support Some children and families need extra support in order to ensure they receive the healthiest start in life. The child welfare system includes various services to support children, promote safety, and strengthen families in an effort to prevent abuse and neglect. The Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs work to provide support for low-income families and individu- als and help them become self-sufficient. Other state services also are available to help families provide best for themselves including free or reduced lunch and foster care. Free and reduced cost lunch programs ensure that access to healthy food at school is available to all students, regardless of family income. Between 26% and 31% of children live in food insecure houses in Central Or- egon (Table 22). The foster care system links children with temporary living arrangements during times when their biologi- cal parents cannot care for them. Children are often in foster care due to abuse and neglect. About 1% of children in Central Oregon were in foster care for at least 1 day in 2012 (Table 22). That equates to about 350 children. Table 22. Information related to child and family support, Oregon Number in SNAP (Food stamps) Number in TANF$ (Cash assistance) Average monthly number of children in employment Oregon' :Crook ` Deschutes Jefferson 297,162 1,797 12,148 3,071 63,016 388 2,222 838 related day care program 16,289 37 570 119 Percent of children in food insecure housett 27.3 30.4 26.1 31.2 Percent of students eligible for free or reduced lunch§ 52.0 56.5 46.8 81.0 Rate of available childcare providers per 100 children under 13 years$ 17 10 20 19 Rate of child victims of abuse or neglect per 1,000 children under age 18ttt 11.6 19.9 9.2 9.7 Rate of children in foster care per 1,000 children (point in time) fit 1.5 1.2 0.7 0.8 Rate of referrals to juvenile justice per 1,000 children aged 0-17 yearsttt 17.5 41.2 24.4 31.8 $ Data from 2013 tt Data from 2012 § Data from 2013-2014 t Data from 2010 ttt Data from Oregon DHS: Children, Adults, and Families Division http://datacenter.kidscount.org 51 Child and Adolescent Health Childhood Health and Education Good nutrition, access to physical activity, abstinence from alcohol and other drugs of abuse, and emotional sup- port have been linked to better academic performance. Academic performance is measured regularly throughout a child's primary and secondary school years and ends in an on-time graduation from high school. Early care and education centers play an important role in a young child's dietary and physical activity behav- iors. In 2012, an estimated 37.3%, 39.4%, 25.7% of 3 and 4 -year-olds were enrolled in early education in Crook, Deschutes, and Jefferson Counties, respectively. The frequency was 42.0% in Oregon (Children First For Oregon 2014 Report). • In an assessment of Kindergarteners, children from underserved races and ethnicities in Central Oregon scored lower than those of other races and ethnicities with regards to number recognition, letter names, and letter sounds (ODE, 2014). • The percent of students meeting or exceeding standards for writing skills were 39%, 64%, and 41% among Crook, Bend -La Pine, and Jefferson students, respectively (ODE, 2014). • 68% of 8th graders in Central Oregon are math proficient (ODE, 2013-2014). • Bend -La Pine schools has consistently had a higher percent of students meeting or exceeding standards than the other Central Oregon school districts (Figure 52). • Despite the percent of students meeting or exceeding standards being lower in early grades, by the time students reached 1 lth grade, the percent meeting or exceeding standards for reading and science were ap- proximately the same among all schools (Figure 52). Crook County schools had lower percent of students meeting or exceeding math standards in 11th grade than did Bend -La Pine and Jefferson students. Figure 52. Percent of students that meet or exceed standards for math, reading, science by grade, Central Or- egon, ODE, 2014 ?iiY13 :�-:e tmL 11 6rd $Rqy tai CO — ._. 43A,1,la Pr,* 11 • Students who are economically disadvantaged or are of an underserved race or ethnicity have a lower four- year graduation rate than the rate for the region (economically disadvantaged=59.2%, underserved race/eth- nicity=55.3%, respectively) (Better Together Baseline Report, 2015). 52 Child and Adolescent Health • The four-year graduation rate (excluding GED) in Crook County was 30.5%, 75.6% in Deschutes County, and 62.5% in Jefferson County (Oregon Department of Education, 2015) (Table 23). Table 23. Percent of students who graduate high school in four and five years, by Central Oregon school district, ODOE, 2013-2014 School District Oregon Central Oregon Crook Bend -La Pine Redmond Sisters Ashwood Culver Jefferson Co 4 year:percent 72.0 67.6 Crook County 30.5 Deschutes County 77.2 70.5 82.8 Jefferson County' 100.0 76.6 57.5 5 year percent 75.9 76.9 § May be artificially low due to an error when the data were reported 53.7 82.0 75.2 90.9 88.9 75.9 Child and Adolescent Health Risk Factors Many of the risk factors for child and adolescent health are the same as adults. However, addressing the specific risks may require different approaches. Avoiding these risks early in life is important for leading a long and healthy life. • Risky sexual activity places an adolescent at risk for STIs and unplanned pregnancy. About half of Central Oregon 11th graders reported having ever had sexual intercourse (Figure 53). This was a large increase from the percentages reported among 8th graders. Among 8th grade student the prevalence of having ever had sexual intercourse was 12.5%, 11.5% and 10.3% in Crook, Deschutes, and Jefferson Counties, respectively (OHTS, 2013). Figure 53. Percent of 11th graders who reported sexual activity, Oregon, OHTS, 2013 60 50 c 40 2 30 CL 20 10 0 53 14.8 NEMO 13. Ever had sexual Ever physically forced to Ever given into sexual intercourse have sexual intercourse activity when you didn't want to because of • Crook Deschutes Jefferson — Oregon pressure Child and Adolescent Health Child and Adolescent Health Risk Factors Continued • 1lth graders in Deschutes County reported using marijuana and drinking alcohol at least once in the last 30 days more frequently than the other Central Oregon counties and Oregon overall (Table 24). • One in five 1lth graders in Crook County reported smoking cigarettes in the last month (Table 24).While use of other substances like tobacco, marijuana, and alcohol increases with age, use of inhalants to get high decreases with age in Central Oregon (Table 24). Table 24. Percent of personal health risks among 6th, 8th, and 11th graders, Oregon, OSWS, 2014 6th 8th Oregon Crook Deschutes Jefferson Oregon Crook Deschutes Jefferson llth Oregon Crook Deschutes Jefferson In the last 30 days, rode in a vehicle driven by a teenager n/a n/a n/a n/a who had been drinking alcohol Drove a vehicle at least 1 time while drinking alcohol in the n/a n/a n/a n/a last 30 days Drank alcohol on at least 1 day in last 30 days n/a n/a n/a n/a 7.2 7.0 9.3 11.8 n/a n/a n/a n/a 4.6 4.2 6.5 6.2 4.5 6.7 6.2 3.0 16.9 24.6 20.9 15.2 33.5 35.2 43.9 35.4 ®I■■ Use inhalent to get 4.6 7.6 4.4 4.9 4.9 7.7 5.3 6.0 1.6 2.8 0.8 0.0 high in the last 30 days -s-ii. ®saw. Used illicit drug (other than marijuana) in the 0.5 1.2 0.8 1.7 1.5 0.0 2.5 1.0 2.3 3.4 3.0 2.8 last 30 days _. _ _ _ Used prescription drugs at least 1 time in 1.0 2.1 1.5 0.0 3.3 0.6 4.3 1.0 7.1 7.7 8.7 6.9 last 30 days Used marijuana at least 1 time in last 30 1.4 1.4 1.5 4.0 9.4 6.5 10.7 10.1 21.2 18.7 27.1 17.7 days Used other tobacco products during the 0.5 0.7 0.5 1.0 3.0 3.0 3.1 5.2 7.3 7.8 13.7 14.8 last 30 days s ■ ■ lSmoked at least 1 day in tte last 30 days 0.8 0.7 1.2 0.0 _ _ _ 4.5 6.7 5.0 4.1 _ - __ 10.0 23.1 i Minimum vertical axis value is zero and maximumvertical axis value is 50 for each chart. Bars are in order of table columns (Oregon, Crook, Deschutes, Jefferson). 11.2 9.6 • Cigarette use among high school students in Oregon declined from 11.5% to 9.4% from 2011 to 2013 (OHTS). However, electronic cigarette (e -cigarette) use among 11th grade students in Oregon rose from 1.8% to 5.2% from 2011 to 2013 (OHTS 2011, 2013). E -cigarette use among high school students tripled from 4.5% in 2013 to 13.4% across the US (CDC, 2015). A similar increase was seen among middle school students, though the prevalence was not as high (1.1% in 2013 to 3.9% in 2014). • Hookah smoking roughly doubled among middle and high school students across the U.S. Hookah use rose from 5.2% in 2013 to 9.4% in 2014 among high school students and from 1.1% to 2.5% among middle school students (CDC, 2015). In 2013, hookah use among 1lth graders in Crook, Deschutes, and Jefferson Counties was 6.8%, 12.7%, and 5.6%, respectively. The state average was 8.9% (OHTS, 2013). Adverse Childhood Experiences ACEs refer to physical, emotional, and sexual abuse, parental substance abuse, adult mental illness, a miss- ing parent at home due to separation, divorce or incarceration, and intimate partner violence experienced before the age of 18 years. Research has shown that experiencing several ACEs, especially early in life, is as- sociated with increased risk for chronic disease, substance abuse, poor mental health, and other risky health behaviors. Children in non -parental care, such as living with grandparents or in foster care, are particularly likely to have experienced a high number of ACEs compared to children living with two biological parents. These experiences may have contributed to their current living situation (CDC Data Brief, 2014). In order to prevent ACEs, families should be encouraged and supported in order to provide nurturing and supportive environments for children. 54 Child and Adolescent Health Adverse Childhood Experiences Continued • Similar to the original ACEs study published in 1998, the most common ACEs during childhood in Or- egon were (Oregon ACEs Report, 2012): o Living with someone who was a problem drinker or alcoholic, or using illegal drugs or abusing prescription medications o Having a parent or adult swear at, insult, or put them down more than once o Experiencing physical abuse o Living with a family member who has a mental illness • 16% of Oregon adults reported 4 or more ACEs. In the original study, 12.5% of adults in the US reported 4 or more ACEs. • Over a third (35.6% 95% CI 30.7%-40.9%) of adults enrolled in OHP in Central Oregon reported a high ACEs score (based on 11 point scale). For reference, one fifth of the total Oregon population reported a high ACEs score (MBRFSS, 2014). • About half of 11th graders in Central Oregon reported that their parents were divorced or separated some- time since they were born (Figure 54). About a quarter have ever lived with someone who uses or used illegal drugs. Figure 54. Percent of llth graders who reported adverse childhood experiences, Oregon, OSWS, 2014 55 Parents ever separated or divored after child was born Ever lived with someone who is/was a problem drinker or alcoholic Ever lived with a household member who is/was depressed or mentally ill Ever lived with someone who uses/used street drugs Ever felt that they did not have enough to eat Ever felt that they had no one to protect them Ever felt that they had to wear dirty clothes 0 10 • Oregon • Crook 20 30 40 Percent Deschutes '" Jefferson 50 COO Measures • The Central Oregon CCO has met the goal for screening children for developmental, behavioral and social delays. (Figure 55). Percentage of adolescents and young adults (ages 12-21 years) who had at least on well -care visit during the year. Percentage of children who were screened for risks of developmental, behavioral and social delays using standardized screening tools in the 12 months preceding their first, second, or third birthday. 32.0 57 6 0 State • Central Oregon CCO 0 Benchmark Mental Health Introduction Mental health is defined as "our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is im- portant at every stage of life, from childhood and adolescence through adulthood" (mentalhealth.gov). Mental illness refers to diagnosable mental disorders. Mental disorders are one of the top five most costly conditions according to most current data (AHRQ, 2014), with depression being the most common (Mental Health Basics, CDC). While good mental health is associated with positive health outcomes, mental illness is associated with poor health outcomes like chronic diseases, injury, and a history of ACEs. As with good physical health, the social determinants of health need to be present to support good mental health. These include appropriate housing, safe neighborhoods, equitable employment, education opportunities, and equity in access to quality healthcare. • Central Oregon Counties have a residential capacity of about 280 people in their approximately 100 addic- tion or mental health programs (Behavioral Health MAP data, 2014). Youth Good mental health in children allows them to grow, learn, and interact socially at home, in the community, and at school. Several mental illnesses affect children and need to be addressed promptly to ensure proper development. Parents can be informed in order to monitor any mental health changes in their children, health- care providers can diagnose issues early and, if necessary, provide treatment, and other professionals like teach- ers can communicate concerns to parents. • A large proportion of 6th and 8th graders in Central Oregon report being harassed at school (Table 25). • One in four 8th graders in Crook County reported they had seriously considered attempting suicide in the last year (Table 25). • The frequency of reporting fair or poor emotional and mental health increased with age (Table 25). Table 25. Percent of mental health risks among 6th, 8th, and 11th graders, Oregon, OSWS, 2014 6th 8th 11th Oregon Crook Deschutes Jefferson Oregon Crook Deschutes Jefferson Oregon Crook Deschutes Jefferson Fair or poor general health 6.5 5 6.4 6.6 0,__- 8.9 7.4 8.8 10.1 13.3 11.0 11.1 13.3 awes Fair or poor emotional and mental health 7.1 7.1 6.5 7.4 �ea.v 14.2 15.5 12.7 9.9 10 ■oma 18.5 18.0 14.7 13.9 `;._;®■■ felt sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual''' ' [;1 I'' activities 18.2 27.3 16.3 19.8 : 24.7 27.9 23.5 29.0 29.2 27.4 27.6 22.9 In last 12 months, seriously considered attempting suicide 8.5 13.1 7.4 8.6 €:s ®maga 17.4 25.6 15.0 15.2 MIMI 17.7 13.7 19.3 12.3 Harassed at school for any reason in the last 30 days 46.1 62.0 43.5 54.3` 11 49.1 61.5 53.7 56.4 '" 39.5 39.7 45.5 35.0 ,', Minimum vertical axis value 5 zero and maximumvertical axis value is 65 for each chart gars are 0 order of table columns (Oregon, Crook, Deschutes, Jefferson). • See the Child and Adolescent Health section (page 54) for more information on substance abuse and mis- use among children and adolescents and see the Access to Healthcare section (page 77) for more informa- tion about available services related to mental health. 56 Mental Health Adults Nearly one in five adults in the United States had a mental illness (SAMHSA, 2012). Serious mental illness (SMI) among people ages 18 years and older is defined as "having, at any time during the past year, a diagnos- able mental, behavior, or emotional disorder that causes serious functional impairment, that substantially interferes with or limits one or more major life activities:' Intervening early, soon after the first SMI, has been shown to be effective. People with mental health issues can identify a support group, join recovery groups, and work collaboratively with a healthcare provider on a treatment and recovery plans (Mental and Substance Use Disorders, SAMHSA). • In Oregon, people with co-occurring mental health and substance use disorders had an average age at death of 45 years (OHA, 2008). • Depression among adults in Central Oregon is common. When surveyed, about 25%, 21%, and 24% of adults in Crook, Deschutes, and Jefferson Counties, respectively, reported that they had depression (BRFSS, 2010-2013). About 4.8% of adults in Oregon reported SMI. That translates to about 7,800 adults in Central Oregon (SAMHSA Behavioral Health Barometer, 2014). • Mental health disorders like depression and anxiety are common among pregnant women. One in four women in Oregon reported prenatal or postpartum depression after pregnancy (OHA, 2010). • In Oregon, postpartum depression was more common among women who lived below the federal poverty line, who smoked, were of racial/ethnic minority, or were teen mothers (OHA, 2010). Suicide Suicide is directed violence towards oneself with the intent to end their life. Suicide is a complex public health issue involving several risk factors like history of depression or other mental illness, alcohol or drug abuse, family history of suicide or violence, physical illness, feeling alone, or previous suicide attempt(s). Many more people survive suicide than die and may live with serious physical injuries (CDC Factsheet). • Since 2000, the highest suicide mortality rate occurred in 2010 in Central Oregon at a high of 26.8 per 100,000 population (Figure 56). The Central Oregon suicide mortality rate in 2013 was not significantly different from what it was in 2000. • Between 2004 and 2013, there was an average of 38 suicides per year in Central Oregon and 78% occurred among Deschutes County residents (OPHAT, 2004-2013). 57 Figure 56. Age-adjusted suicide mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 30 - 25 - Rate per 100,000 population 20 - 15 5 0 2000 2002 2004 2006 2008 2010 2012 Oregon Central Oregon HP 2020 16.8 15.2 10.2 The age-adjusted race -specific suicide mortality rate was similar between Central Oregon and Oregon overall, except for American Indians (Figure 57). On average, there were about two suicides deaths a year among American Indians in Central Oregon between 2004 and 2013. While this translates to a relatively small number, Central Oregon American Indians accounted for about 22% of all suicides among American Indians in the state in the last decade, but accounted for only 10% of the state's American Indian popula- tion. The overall age-adjusted suicide mortality rate was also significantly higher than the Oregon rate. Mental Health Figure 57. Age-adjusted suicide mortality rate per 100,000 by race, OPHAT, Oregon, 2004-2013 40 35 30 25 20 15 Rate per 100,000 population 10 5 0 -- — — —: American Indian/ Hispanic White NH All races Alaska Native NH NH=non-Hispanic - Oregon g Central Oregon t Too few cases to report "Significantly higher than the state race -specific rate • The majority (58%) of suicides in Central Oregon occur among people aged 30-59 years. One in five (21%) occur among people aged 60 years and older (OPHAT, 2009-2014). • When compared to the same age group in Oregon, people aged 15-24 years in Central Oregon had a higher suicide rate (Figure 58). Figure 58. Age-specific suicide mortality rate, OPHAT, Oregon, 2009-2014 =30- 0 fa 25 0 20 0. 0 15 0 • 10 5 0. ca • 0 15-24 " Statistically higher than in Oregon 25:6 25-44 45-64 Age Groups Oregon • Central Oregon 224 21.0 65+ • In the Central Oregon counties, the three leading mechanisms related to suicide were firearm (55%), suf- focation (22%), and poisoning (15%) (OPHAT, 2009-2013). These were also the leading mechanisms for suicide in Oregon. CCO Measures • The Central Oregon CCO has met the benchmark for three of four mental health-related CCO measures (Figure 59). Figure 59. Central Oregon CCO quality measures related to mental health, June 2014 58 Percentage of children aged 4+ years that receive a mental health assessment and physical health assessment within 60 days of the state notifying CCOs that the children. Percentage of patients (aged 6+) who received a follow up with a HCP within 7 days of being discharged from the hospital for mental illness. Percentage of children (aged 6-12 years) who had one follow up visit with a provider during the 30 days after receiving a new prescription for ADHD medication. Percentage of patients ages 12 years and older who were screened for clinical depression using an age-appropriate standardized depression screening tool and if positive, have a documented follow-up plan. 2s 0 27 010 , 28.0 41) Q90.0 O State *Central Oregon CCO ®Benchmark Alcohol Tobacco and Drug Use Introduction Substance abuse is the ongoing use of drugs or alcohol that leads to impairments in health, work and family life. Poor mental health and substance abuse often occur together. About 9% of adults in the US have a sub- stance abuse use disorder and more than one in four adults with mental health issues also has a substance abuse problem (mentalhealth.gov) (SAMHSA, 2012). Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems. Addiction may stem from the harmful effects that drugs can have on the brain and may also result from a mix of factors like unstable family relationships, exposure to physical or sexual abuse, genetics, or mental illness (NIDA, Science of Addiction). Heavy drinking, tobacco use, and drug use are associated with higher rates of all -cause mortality, chronic disease, violence and abuse. Excessive alcohol and drug use is also a risk factor for motor vehicle fatalities, fetal alcohol syndrome, interpersonal violence, overdose and STIs. This has impact on families, schools, workplaces and the community. Treatment programs for substance abuse have been shown to have a positive return on investment and can improve the quality of life for people with substance use disorders (Robert Wood Johnson Foundation, 2007). Alcohol The majority of people who use alcohol at levels that impact their health and mental health do not meet depen- dency criteria and are inappropriate for specialty treatment programs. Screening, Brief Intervention and Refer- ral to Treatment (SBIRT) is an evidence -based practice that targets patients in primary care with nondependent substance use. It is a strategy for intervention prior to the need for more extensive or specialized treatment. For more information on alcohol use see the Child and Adolescent Health Risk Factor Section (page 53 and 54) and Unintentional Injuries Section (page 63). • In Oregon, an estimated 1,302 deaths and 33,933 years of potential life lost are attributed to excessive alco- hol use each year (Prevention Status Report, CDC, 2013). • About 1 in 5 adults in Crook and Deschutes Counties and 1 in 7 adults in Jefferson County reported binge drinking in the last month (BRFSS, 2010-2013). • Eleventh graders frequently said that drinking more than five drinks in one sitting once or twice a week (65.3%, 74.6%, 72.0%, respectively) and smoking at least a pack of cigarettes every day (77.8%, 89.2%, 82.9%, respectively) was a moderate or great risk to one's health (OSWS, 2014). Only about 40% of 1 lth graders in Crook, Deschutes, and Jefferson Counties said that smoking marijuana once or twice a week places someone at moderate to great risk for harming their health (43.7%, 42.6%, 41.0%, respectively) (OSWS, 2014). Tobacco Smoking cigarettes and smokeless tobacco use are initiated and established primarily during adolescence. Nearly nine of 10 cigarette smokers first tried smoking before the age of 18 (CDC OSH, 2015). Tobacco use causes multiple diseases such as cancer, respiratory disease and other adverse health outcomes. • During 2009-2011, the prevalence of cigarette smoking was higher among adults with any mental illness 5 9 than those without mental illness (36.1% vs. 21.4%) and was highest among males, those aged less than 45 years, and those living below the poverty level. Adults with mental illness smoked 30.9% of all cigarettes smoked by adults during this time frame (CDC, 2013). Alcohol Tobacco and Drug Use Tobacco Continued • Over a third of OHP members in Central Oregon smoke tobacco (Figure 60). This is comparable to the overall OHP adult population's smoking rate (34%) (CAHPS, 2014). • Three out of four adults enrolled in OHP want to quit smoking tobacco (Figure 60). • Males (48%) and adults aged 45-54 years (49%) had the highest rates of using tobacco compared to females (26%) and other age groups (17%-36%) among OHP members (CAHPS, 2014. Figure 60. Percent of adults enrolled and not enrolled in OHP who use tobacco and e - cigarettes, Oregon, MBRFSS, 2014 77.3. Smokes tobacco and wants to quit Attempted to quit smoking in last year Current tobacco user Ever use e -cigarette Current cigarette smoker Current e -cigarette use Current tobacco chewer $ No estimate available H=95% Confidence Interval 78.1 53.2 63.8 19:8 36.2 4.0 �-1 5.0 Oregon -General Population ■ Central Oregon -OHP Note: General population percents many not be directly comparable to OHP percents due to survey differences. They are provided as a reference. • Indoor air quality is greatly affected by second-hand smoke. Most adults in Oregon and the Central Or- egon counties reported having rules to limit exposure to second-hand tobacco smoke in their homes and cars (Figure 61). 60 Figure 61. Percent of adults who reported having rules against tobacco use in the home and car, Oregon, BRFSS, 2011 100 - 80 - 60 v L a 40 - 20 - 0 Oregon Crook Deschutes Jefferson • Rules against smoking in home Rules against smoking in family cars An estimated 26,200 people in Central Oregon smoke tobacco leading to serious illness, death, and signifi- cant healthcare costs (Table 26). The Tobacco Quit Line (1 -800 -QUIT -NOW) serves the Central Oregon counties to support tobacco cessation for its residents. However, during 2014 only 325 tobacco users in the region used this service (Health Promotion and Chronic Disease Prevention, OHA). Alcohol Tobacco and Drug Use 61 Tobacco Continued Table 26. Tobacco Use in Central Oregon Counties, County Tobacco Fact Sheets, 2014 In one year: Number that regularly smoke cigarettes Number that suffer from a serious illness caused by tobacco Number that died from tobacco Amount spent on medical care Productivity lost due to tobacco -related deaths Crook Deschutes 4,200 1,334 68 $13.6 million $10.9 million 18,500 4,930 Jefferson 3,500 899 252 46 $50.3 million $9.2 million $40.3 million $7.4 million • In 2012, four focus groups held in La Pine, Bend, Redmond, and Sisters assessed 39 residents' feelings about tobacco smoke in their respective downtown areas. Perceived need for a smoke free downtown area policy varied depending on location of the focus group. Regardless of support for the policy, a common concern was whether a smoke free downtown policy could be enforced. However, several other sugges- tions were made to address tobacco in the downtown areas including enforcing a smoke free area in front of libraries, in multi -unit housing, and at events. Of note was that no focus group participants were current tobacco smokers (Deschutes County Smoke Free Report, 2012). • In 2014, the Oregon Health Authority Tobacco Prevention Education Program conducted a Community Readiness Assessment (CRA) in all counties across Oregon. The purpose of the assessment was to deter- mine the willingness and preparedness of each county in Oregon to take action related to local tobacco prevention and education. Key local government, business and school district sector stakeholders were interviewed. The CRA results from each county are not intended to represent the opinions of the whole community, but rather what community stakeholders think about the opinions of the community. The key respondents are not only proxies for representing the community in general, but they are also key decision makers who have an impact on and deeper understanding of the community. The findings from the CRA in Deschutes, Crook, and Jefferson County suggest that stakeholders perceive tobacco use is of concern to community members, however general knowledge of the tobacco burden and its causes are not understood in depth and stereotyped. Therefore, the political will to support tobacco prevention policies seem low. Oregon is one of few states that does not have a tobacco retail -licensing program. Licensing tobacco retailers is considered an effective tool to enforce point of sale and tax laws (Public Health Law Center). However, imple- menting a tobacco retail licensing alone will not reduce the prevalence of tobacco use among youth. A com- prehensive approach that eliminates price discounts, coupon redemption, and candy, fruit, and dessert flavored tobacco products should also be considered. • Oregon has had the highest number of retailers who sell tobacco products illegally to minors for the last 5 years (Synar, 2009-2013). In 2013-2014, Deschutes County had a higher (26.7%) non-compliance rate among tobacco retailers compared to the state average (21.3%) (Synar Report, 2013-2014). • In 2013, nearly one in five tobacco retailers in Deschutes County were within 1,000 feet of school prop- erty. In Crook County, half of retailers were within 1,000 feet of a school. Research shows that areas with a higher concentration of tobacco retailers near schools have a higher youth smoking prevalence (Deschutes County Retail Assessment, 2013; Crook County Retail Assessment, 2013). Alcohol Tobacco and Drug Use Prescription Opiods Recent concern related to substance abuse has been related to the misuse of prescription drugs. The mortality rate due to prescription drugs has dramatically risen in the US since 1999. This rise has been linked with the increased availability of opioid pain medications (Paulozzi, 2006). The misuse of prescription opioids has been associated with injection drug use, which places a person at risk for diseases like hepatitis C and HIV and at risk for other drug use like heroin (CDC, 2015). There are several recommendations for preventing the misuse of prescription medications, including medication "Take Back" days, providing provider education on pain management and prescribing guidelines, and using tools like prescription drug monitoring programs and clini- cal decision support tools to manage prescriptions (US DHHS). • The opioid -related unintentional prescription drug mortality rate has tripled in Oregon since 2000 (Figure 62). • The 5 -year average age-adjusted opioid -related unintentional prescription drug mortality in Central Or- egon was 3.6/100,000 population (95% CI 2.5-5.1) (CDC Wonder, 2009-2013). The 5 -year average rate in Oregon during this time period was 4.1/100,000 population (95% CI 3.8-4.4). • The opioid prescription drug hydrocodone, was the leading drug prescribed among Central Oregon OHP members. Over 24,200 prescriptions were written for hydrocodone between November 2012 and October 2014 (CCO Annual Report, December, 2014). Figure 62. Age-adjusted opioid -related unintentional poisoning mortality rate per 100,000 population, Oregon, CDC WONDER, 2000-2013 • 6 0 • 5 4- 0 3 0 2 1.1 ;, 0. w 0 • 2000 2002 2004 2006 2008 2010 2012 Cause of death was unintentional poisoning due to prescription drug (ICD 10 X40 -X44) with an underlying cause of death mentioning an opioid (ICD 10 T40.2 -T40.4) 3.3 CCO Measures • The Central Oregon CCO has not met goals related to tobacco (Figure 63). The measure related to screen- ing and intervention for alcohol or other substance abuse among adults remains low. Figure 63. Central Oregon CCO quality measures related to alcohol, tobacco, and other drugs, June 2014 62 Percentage of adults members (ages 18 years and older) who had appropriate screening and intervention for alcohol or other substance abuse (SBIRT measure) Percentage of patients (aged 13 and older) newly diagnosed with alcohol or other drug dependence and who began treatment within 14 days of the initial diagnosis Percentage of patients (aged 13 and older) who had two or more additional services for alcohol or other drug dependence within 30 days of their initial treatment Percentage of adult tobacco users advised to quit by their doctor Percentage of adult tobacco users whose doctor discussed or recommended medication to quit smoking Percentage of adult tobacco users whose doctor discussed or recommended strategies to quit smoking Percentage of adult Medicaid members (ages 18 years and older) who currently smoke cigarettes or use other tobacco products. 7.3 10.6 13 38.2 21 39.2 46.91) E9 57.5 IZ) 50.7 81.3 0 State • Central Oregon CCO 0 Benchmark 1 Unintentional Injuries Introduction Injuries are classified by intent and mechanism. Some injuries are considered unintentional, meaning there was no intent to do harm, while others are intentional (suicide and homicide). Unintentional injuries are pre- ventable events and are no longer considered "accidents." In the case of some injuries, the intent is unknown. Many measures have been put in place in the last several decades to reduce the number of unintentional injuries including increased seatbelt use in cars, increased helmet use during many activities, promotion of life jackets while in or near water, and safe sleeping habits for babies, among many others. Injuries are caused by a variety of mechanisms and these mechanisms vary with age. • The leading causes of unintentional injury -related death in Oregon were falls, poisoning, and motor vehicle crashes (MVC) (Table 27). The leading causes of unintentional injury -related death were the same in Cen- tral Oregon. • Drowning and MVC were a leading cause of injury -related death for children. Table 27 Leading causes of unintentional injury in Oregon, CDC WISQARS, 2013 Age Groups 1 Rank 1 2 l 3 <1 1-4 5-9 10-14 Suffocation* Drowning* MV -traffic" MV -traffic* Pedestrian, Drowning" Fire/Burn* Drowning* other* Poisoning Fall' Suffocation* Fire/Burn* Drowning* Drowning* 15-24 MV -traffic 4 Fire/Burn* Fall* Natural/ Pedestrian, Fire/Burn• Environment* other* 5 6 7 8 9 10 Firearm* MV -traffic" 25-34 35-44 Poisoning Poisoning Poisoning 45-54 55-64 Poisoning 65+ Fall All Ages Fall MV -traffic MV -traffic MV -traffic MV -traffic MV -traffic Poisoning Fall* Suffocation* Fall Fall Suffocation MV -traffic Drowning* Drowning* Drowning Suffocation Poisoning Suffocation Pedestrian, Other land Other land Other, other" transport' Firearm" transport* specified" Fire/Burn* Drowning Unspecified Drowning Other, notOther, not Eighttied* Suffocation* Fall* Suffocation* Fire/Burn* Unspecified classifiable classifiable* Eight tied* Five tied' Other land Other Other, not Fire/Burn Fire/Burn transport* transport* classifiable" Eight tied* Five tied' Four tied* Other land Struck Natural/ Other, not transportby/against* Environment classifiable Eight tied* Five tied* Four tied* Other, Other," Other, Other, specified* specified specified specified Eight tied* Five tied* Four tied' Other, Two tied* Drowning* Natural/ unspecified* Environment • Most injuries are unintentional. Two-thirds of all injuries in Oregon and Deschutes County were uninten- tional. In Crook County 57% of injuries were unintentional and in Jefferson County the proportion is 83% (OPHAT, 2013). 63 Unintentional Injuries The unintentional injury mortality rate has not changed significantly in Oregon since 2000 (Figure 64) and the 2013 rate was similar to the US age-adjusted rate (38.8/100,000) (CDC WONDER, 2013) • The unintentional injury mortality rate in Jefferson County was significantly higher than the state overall in 2013 (Figure 64). Figure 64. Age-adjusted unintentional injury mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 120 - 100 - 0. 0 s0 a 60 - a 0 40 0. 34.5 ca 20 cc 0 2000 2002 2004 2006 2008 2010 2012 39.6 36.4 -Oregon Crook Deschutes ° ° ° ° ° ° Jefferson HP 2020 • The primary mechanism involved in unintentional injuries varies with age (Figure 65). Falls are more common in younger and older ages while MVC are more common between the ages of 15-64 years. Figure 65. Percent of unintentional injury hospitalizations by age group and mechanism, Central Oregon and Oregon, HCUP, 2013 100% - 90% - 80% • 70% ' 60% - 50% 40% • 30% - 20% - 10% - 0% 64 20.0 34.9 .8,0.; Central Oregon 0-14 15-24 20.6 157.- 25-44 Age Groups 7.0 17.4 11:7 AS Other Injuries 0 Other transport Falls Poisoning • Motor vehicle crash 45-64 65+ Oregon 0-14 15-24 25-44 Age Groups 45-64 65+ Unintentional Injuries Motor Vehicle Crashes MVC refer to any injury occurring in traffic. The person injured may be a driver or occupant of a vehicle, a pedestrian or cyclist struck by a vehicle, or a motorcyclist. • The mortality rate due to MVC has significantly decreased since 2000 in Oregon and Central Oregon (Fig- ure 66). Figure 66. Age-adjusted unintentional motor vehicle crash (traffic) mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 35 c 30 0 as 25 mg 3 c 20 0 15 Q 12.4 O 10 13.3 "`n•.r,� 7.8 ri 5 6.8 i - CU CI' 0 el cc ▪ 2000 2002 2004 2006 2008 2010 2012 Oregon Central Oregon HP 2020 • Residents of Jefferson County had a significantly higher mortality rate due to MVC than Oregon overall (Figure 67). • Males had a significantly higher mortality rate due to MVC than did females in Oregon, Deschutes County, and Jefferson County (Figure 67). • Between 2004 and 2013, there were 280 motor vehicle fatalities in Central Oregon. Seventy of those fatali- ties were in Jefferson County (OPHAT, 2004-2013). 65 Figure 67. Age-adjusted mortality rate per 100,000 population for unintentional motor vehicle crash (traffic), Oregon, OPHAT, 2004-2013 60 0 co 50 0.3 O 40 § 30 ci .-� 20 0 a 10 10 Oregon Crook Deschutes ■ Total Female Male * Significantly higher than the state overall **Significantly higher than females overall Jefferson 1 Unintentional Injuries Poisoning Poisoning is the ingestion or inhalation of a toxic substance or a substance that if consumed in high enough quantities becomes toxic. Recently, focus has been placed on unintentional poisoning due to the increased number of toxic exposure deaths related to prescription medications. • In Oregon, the unintentional poisoning mortality rate has more than doubled since 2000 (Figure 68). • Though not statistically different, the rate in Central Oregon has also increased (Figure 68). • On average, there were 14 unintentional poisoning deaths in Central Oregon each year between 2004 and 2013 (OPHAT, 2004-2013). Figure 68. Age-adjusted mortality rate per 100,000 population for unintentional poisoning, Oregon, OPHAT, 2000-2013 o • 12 s • 10 0. 0 g - 8 6 - cs. • 4 a) o. 2 4.6 3.9 2000 2002 2004 2006 2008 2010 2012 Oregon Central Oregon 9.5 9.2 • Men in Oregon had a higher unintentional poisoning mortality rate than did females (Figure 69). 66 Figure 69. Age-adjusted mortality rate per 100,000 population for unintentional poisoning by sex, Oregon, OPHAT, 2004-2013 c 14 0 ..1g, 12 00. 10 - a. 8 8 0 0 6 1-• 4 - at; o_ • 2 cc 0 -1 Oregon Crook Deschutes • Total TiFemale g Male *Significantly higher than females overall Jefferson Unintentional Injuries 67 Falls Falls can occur at any age, but are a serious risk for young children and older adults. The highest risk for death due to a fall, however, is among older adults. The mortality rate due to a fall exponentially increases after the age of 65 years (OPHAT, 2009-2013). Maintaining a hazard free home, performing strength and balance exer- cises, and reviewing medications regularly can help older adults avoid falls. • In Oregon, the unintentional fall mortality rate has significantly increased since 2000 in Oregon. Though not statistically significant, the unintentional fall mortality rate has increased in Central Oregon (Figure 70). Figure 70. Age-adjusted unintentional fall mortality rate per 100,000 population, Oregon, OPHAT, 2000-2013 c 20 0 m 18 16 a 14 $ 12 0 10 - f8 - 7,....► CL. 6 - 7.4 , 4 ccc 2 - 0 13.2 11.4 amaze 7.2 2000 2002 2004 2006 2008 2010 2012 Oregon Central Oregon cizzawasDHP 2020 The age-adjusted fall mortality rate was higher in Jefferson County than in the state overall (Figure 71). Figure 71. Age-adjusted mortality rate per 100,000 population for unintentional fall by sex, Oregon, OPHAT, 2004-2013 30 0 res25 a 20 o$ 15 10 Ca. 5 - d co ac 0 Oregon Crook Deschutes • Total Female gi Mate `Significantly higher than the state overall **Significantly higher than females overall 9.0 Jefferson • The fall mortality rate among adults aged 65 years and older was significantly lower in Deschutes County than in Oregon overall (69.2/100,000 vs. 90.3/100,000). The rate in Jefferson County was 121.1/100,000 and in Crook County it was 62.9 (OPHAT, 2009-2013). None of these rates met the HP 2020 goal of 47.0 deaths/100,000 population or less. Unintentional Injuries Risk Factors for Injury Risk factors for injury vary dramatically by age. However, reducing drug and alcohol use and increasing appro- priate use of safety equipment are important behaviors to prevent injuries at any age. • 1 lth graders in Deschutes County reported using marijuana and drinking alcohol at least once in the last 30 days more frequently than 1 lth graders in the other Central Oregon Counties and Oregon overall (see the Child and Adolescent Health Risk Factors section). • In 2013, alcohol was listed as a contributing factor for a MVC at about the same rate among all of the Cen- tral Oregon Counties (Crook 5.1%, Deschutes 6.1%, Jefferson 6.5%) (ODOT Crash Data, 2013). • One in three MVC fatalities was considered alcohol -impaired (blood alcohol concentration over 0.08) in Oregon in 2013 (NHTSA, 2013). • The top three causes for a MVC in the Central Oregon Counties were driving too fast, failing to yield, and following too close (ODOT Crash Data, 2013). • Oregon adult females more frequently reported that they always or nearly always wear a seatbelt than did adult males (99.3% vs. 96.7%) (BRFSS, 2013). 68 Oral Health Dental caries (cavities) are largely preventable. However, tooth decay is one of the most common chronic diseases among children. Untreated tooth decay causes problems with eating and speaking, and causes pain, which can disrupt learning and personal growth. Some community water systems treat their water with fluo- ride, which has been shown to strengthen teeth and reduce tooth decay (CDC Oral Health Program). How- ever, Central Oregon does not fluoridate the public water systems. Reducing dental caries rates is possible without water fluoridation and with limited resources through effective use of the existing healthcare work- force. The focus should be on identifying high-risk children and pregnant women to receive proven communi- ty-based preventive care. Several oral health services in Central Oregon exist to provide the best care possible -Advantage Dental: Community Outreach: Partners with community organizations in the tri -county region to deliver preventive oral health services using expanded practice permit dental hygienists. This service also promotes coordinated and seamless care between providers. - Kemple Memorial Children's Dental Clinic: Provides critical preventative, educational and dental treatment services for children whose families cannot access basic dental care. - Central Oregon Community College Dental Assistant School: Partners with Deschutes County Health Ser- vices to provide dental care to low-income individuals. -Volunteers in Medicine: Identifies uninsured/underinsured patients with unmet oral health needs and refers them into their dental hygienist or refers them to local services. -Mosaic Medical: Offers primary care clinics and dental care services. - La Pine Community Health Center: Partners with Advantage Dental to provide low cost dental services to uninsured individuals. - Sisters School-based Health Center: Operates under an integrated care model with primary care, mental health, and dental services available for students aged 0-21 years regardless of ability to pay. -Deschutes Family Drug Court: Partners with Advantage Dental to coordinate dental care for families enrolled in the Deschutes Family Drug Court. • Using the hospital and ED for dental care is an indication of poorly managed oral health. People enrolled in OHP accessed dental care in hospitals and EDs at similar rates in the Central Oregon Counties (Figure 72). Figure 72. Rate of dental care received in a hospital or ED among those enrolled in OHP, Central Oregon, PacificSource, 2015 N Y O • 2.5 E 2.0 - E 1.5 - E 1.0 - S 0.5 - is. • 0.0 0cc 69 0.12 0.14 OHP enrolled who received dental OHP enrolled who utilized the ED for care in a hospital non-traumatic dental problems •Crook Deschutes Jefferson Oral Health • Jefferson County residents enrolled in OHP accessed dental care less frequently than residents of Crook and Deschutes Counties (Figure 73). Figure 73. Percent of those enrolled in OHP who accessed dental care, Central Oregon, PacificSource, 2015 25 - 20 - 15 10 CJCJ 4.1 5 a a 0 12.2 13.7 OHP enrolled who had a dental visit OHP enrolled adults with diabetes who between 7/2014 and 4/2015 accessed dental care in the past year ■ Crook Deschutes Jefferson Note: there are many ways that members can be identified as having diabetes. The method for identification used is based on claims and may underrepresent the true number of members living with diabetes in the population Children Good oral health starts in childhood. This includes regular visits to a dentist, regular brushing, and a healthy diet. • The Kemple Memorial Children's Dental Clinic assesses the oral health of thousands of children in the region. During the 2013-2014 school year: - Over a quarter (26.3%) of screened students were determined to need improved home oral health hygiene. - About half (49.9%) of screened children needed sealants, which are thin, plastic coatings painted on the chewing surfaces of the back teeth that help prevent tooth decay. -4.5% of those screened had serious immediate oral health needs. • Only 59% of Jefferson County 8th graders reported having gone to a dentist or dental hygienist in the last 12 months (Table 28). • About three of four 8th and 1 lth graders reported having ever had a cavity (Table 28). 70 Trent to a 8th llth Oregon Crook Deschutes Jefferson Oregon Crook Deschutes Jefferson dentist or dental1111 hygienist for a check- up, exam, teeth 72.8 75.3 74.2 59.0 74.5 62.8 72.6 72.9 Ever had a cavity 70.1 76.3 71.7 73.7 REM 74.0 70.5 72.1 78.8 RUNE Brushed your teeth in the past 24 hours 95.5 91.4 95.1 90.9 IIII 96.0 98.2 94.3 94.1 ill! Minimum vertical axis value is zero and maximumvertical axis value is 100 for each chart. Bars are in order of table columns (Oregon Crook, Oral Health Children Continued Good oral health starts in childhood. This includes regular visits to a dentist, regular brushing, and a healthy diet. • 8th and 11th graders in Jefferson County more frequently reported missing school due to a toothache or painful tooth than in Oregon (Table 29). Table 29. Percent of 8th and 11th graders who reported specific oral health indicators, Oregon, 01-113, 2013 8th 11th Oregon Crook Deschutes Jefferson Oregon Crook Deschutes Jefferson Missed one or more hours of school due to toothache or painful tooth Missed one or more hours of school due to mouth hurting Ivlissea one or more hours of school due to going to the hospital emergency room because of tooth or mouth pain 2.6 1.8 2.8 8.2 Ma M . 1 2.7 3.6 4.7 5.5 • U 1 2.2 1.8 3.0 3.2 rti _ me 1,8 0.5 2.3 0.2 0.0 2.7 4.0 5.3 0.5 0.0 0.5 0.8 Missed one or more hours of school due to a mouth Injury from playing a sport 1.4 2.9 1.7 1.6 ass 1 mi oil 0.8 0.9 0.7 2.1 Missed one or more hours of school due to going to the dentist because of tooth or, , , mouth pain 4.2 6.4 4.8 4.9 ® 1 1111 4.2 5.4 6.5 5.4 Injured in mouth area while playing a recreational sport 8.7 9.0 10.2 12.1 311 1 6.5 8.0 8.5 7.1 11 • Do you wear piercing or jewelry in or around the mouth area? 3.9 5.2 4.6 10.3 EAKIMI 4.6 7.1 5.2 9.0 1 ■ 1 Injured in mouth area while playing an ' ®® organized sport 13.7 15.7 12.0 12.7 11 10.0 12.5 8.3 11.3 Minimum vertical axis value is zero and maximumvertical axis value is 20 for each chart. Bars are in order of table columns (Oregon, Crook, Deschutes, Jefferson). One quarter to one half of first and second graders that were screened in selected Central Oregon schools had untreated tooth decay (Fizure 74). Figure 74. Percent of screened first and second graders§ with untreated dental decay, Central Oregon, School Dental Sealant Program, 2013-2014 71 60 50 .. 40 e 30 a 20 10 0 111111.30111,1,!. P.;1, O`) <=-0 ,e, e`0 ,°ce�� mot, +(Sem .'s <('N `��¢s��\\ �,ae ce eQ,a�¢ L�\y¢` k,(''' *C ,, - CP J` a¢a�`,�c 4s, °,a.:<, y4 °°� tee`' o� sic is°c ,0Qa �e e5Cs J.seS yQsc �ie�`'°c J�¢5� SJen cry\ C`o° '\\4 ¢e`L Cf" Lt O¢<` �'¢0., Oe> 'eke ` Jae rJ�ey, e�`is Oey� e�` Jae ' ,e e,`r `, Cr` ``o°� 4's J`e5. es` sic Cf Oey eyc. C C3O Oen, Oey O O § Schools are invited to participate if >50% of the students are eligible for the free or reduced lunch program. Only students with parental permission are screened. Oral Health Adults Good oral health as an adult helps maintain adult teeth. Poor oral health can be a costly and painful condition. Some health conditions and behaviors like diabetes, HIV, cancer, and tobacco use increase the chance of having oral health problems (CDC, 2006). About half of adult OHP members in Central Oregon (52.3%, 95% CI 47.3%-57.2%) reported having had a dental visit in the last year. For reference, nearly two-thirds of the general adult population in Oregon (66.9%) said they had had a dental visit in the last year (MBRFSS, 2014). • Half (52.4%) of adults in Jefferson County have lost one or more permanent teeth (Table 30). This was significantly higher than the rest of the state's population. Table 30. Age-adjusted tooth Toss and edentulous rates in Central Oregon, Oregon, BRFSS, 2010- 2013 Adults aged n18 years with one or more tooth loss Adults aged n18 years who are edentulous (have no teeth) Ci Percent.: 42.3 32.2- 53.1 Percent;' , 95%'CI Jefferson ercent ; ; 95%;CI ,All other counties:, Percent 95%;GI 35.5 31.4-39.7 52.4 39.9-64.6 38.5 37.6-39.3 6.3 3.1-12.2 2.4 1.7-3.4 4.0 2.0-7.7 4.2 3.9-4.6 • Income is related to dental health among adults in Oregon (Table 31). This is especially notable among adults aged 65 years and older. Many are on fixed incomes and may not receive routine dental care because Medicare, the leading insurer for adults 65 years and older, provides little to no coverage. Older adults with dental insurance are 2.5 times more likely to visit the dentist routinely (Oral Health America). 72 Table 31. Prevalence of dental health factors by income, Oregon, BRFSS, 2012 Total Less than $15,000 $15,000- 24,999 $25,000- 34,999 $35,000- 49,999 $50,000+ 41.1 39.3-42.9 14.0 12.9-17.1 63.5-67.0 58.0 52.0-64.0 1 31.5 21.5-41.5 47.0 41.2-52.9 48.1 43.2-53.1 28.1 21.9-34.3 43.5 38.6-48.4 65.3 49.3 43.3-55.2 12.9 7.4-18.5 59.3 53.5-65 46.4 41.6-51.2 10.6 5.9-15.3 68.9 64.3-73.5 27.4 1 24.9-29.8 5.4 3.1-7.8 80.4 78-82.9 Environmental Health Introduction Where people work, live and play can dramatically affect their health. Environmental health "addresses the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors" (WHO). These topics include air and water quality, the built environment, and consumer product exposures. Environmental Health Specialists in Central Oregon inspect and license several types of public facilities to ensure the public remains safe and healthy. This includes issuing over a thousand licenses in 2014 alone for res- taurants, mobile food units, temporary restaurants, commissaries, food warehouses, and bed and breakfasts. In 2014, over 300 licenses were also issued for pools, spas, hotels, motels, and recreational vehicle parks. Inspec- tions are also conducted regularly for all of these facilities as well as school lunch programs, childcare centers, residential institutions. In Central Oregon, a recreation needs assessment that included a community interest and opinion survey and focus groups was summarized in the 2012 Parks, Recreation, and Green Spaces Comprehensive Plan. This needs assessment found that: • Respondents felt the most needed facilities were small neighborhood and large community parks, swim- ming pools, natural areas, and trails. • Respondents were most supportive of the region improving multi-purpose trails, connecting existing trails, preserving open space and repairing older parks. Respondents were willing to spend tax dollars on these initiatives. • Drinking fountains, trash and recycling containers, and permanent restrooms were listed as needed fea- tures. • Reasons for not using facilities or programs were "no interest;' hours were not conducive to use, and fees were too high. • From the 2012 report, a strategic plan has been written and will be implemented through 2017. Transportation Transportation is a vital part of a community by increasing access to services, moving goods in and out of the area, and engaging the community socially. Recently, more focus has been placed on active transportation to help reduced chronic disease and obesity by encouraging walking, biking, or other physical activities to move about the community. Policy has focused on ensuring low-income, the aged, and rural populations have trans- portation options available to access goods and services that will help them maintain or improve their health. • Surveys were implemented at eight community events in Central Oregon in 2011 to gauge resident inter- est in public transportation. Summary results indicated that 65% of Central Oregon residents spend $100 dollars or more a month on gas and 64% would ride the bus if it were more convenient (Health Impacts of Transportation in Central Oregon, 2012). • About two of three people in the Central Oregon counties commuted less than 20 minutes to work (ACS 3 -year Estimates, 2011-2013). About half (50.3%) of commuters in Oregon had a commute that was less than 20 minutes to work. • The 2012 Health Impacts of Transportation in Central Oregon report summarized data from community surveys, local experts, and an advisory council to identify four key recommendations: -Invest in strategies that increase use of active and public transportation. -Increase access to healthcare services for rural and transportation disadvantaged populations. 73 -Increase access to employment opportunities for rural and transportation disadvantaged populations. -Consider the safety and needs of all road users (including vulnerable populations) in planning and design standards. Environmental Health Transportation Continued • Less than 6.3% of the population in all of the Central Oregon counties uses active transportation (walk, bike, etc.) to work (Figure 75). Figure 75. Percent of working population that uses active transportation, Oregon, EPHT, 2011 Classified by four natural breaks based on values for all counties 0 S 6.3 6.4 • 10.3 10.4 - 14.2 ® Unreliable • As previously referenced in the Socioeconomic Status section (page 10), food insecurity and access to healthy food is an issue in Central Oregon. Of the Central Oregon Counties, the shortest walking distance to food retailers and restaurants is in Deschutes County (Figure 76). Figure 76. Average walk distance in miles to food retailers and restaurants, Oregon, EPHT, 2012 Classified by four natural breaks based on values for all counties Q <_ 1.86 1.95-4.46 4.56 - 7.73 ® X7.93 74 Environmental Health Air Quality Air quality refers to the amount of pollutants in the air and can refer to air indoors or outdoors. Research has identified six pollutants most linked with harmful effects to health. They are ozone, particulate matter, nitrogen oxides, sulfur oxides, carbon monoxide, and lead. The amount of these pollutants (except lead) in the air can be classified using the Air Quality Index. The higher the index score is, the worse the air quality. Poor air qual- ity has been linked to respiratory disease, including asthma and lung cancer, as well as heart disease, stroke, and other health conditions (World Health Organization). Since 2010, Crook County has experienced a lower frequency of good air quality days than the other Cen- tral Oregon Counties (Figure 77). Figure 77. Percent of days that had good air quality (when air quality was recorded), Central Oregon, airnow.gov, 2010-2013 100 - 96.4 85.2. 80 - 84.7 a 60 u a 40 - 20 - 89.9 75.3 2010 2011 87.4 78.3 93.6 89.0 2012 2013 67.9 Crook Deschutes - Jefferson • In 2013, poor air quality days occurred during certain parts of the year in Central Oregon (Figure 78). Air quality varies year to year as factors influencing it change depending on a variety of factors, like weather. Figure 78. Air Quality Index values by day and month, Central Oregon, airnow.gov, 2013 Crook County JAN FEB MAR SUNDAY MONO AY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Deschutes County NU • WWI EWA i ■ ■M IIN ■ ■ ii NNW ■Ii••.MOM IN ■ MOW *NW WO SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Jefferson County .,411 FEB APR MAY JUL AUG SEP MAR APR MAY JUL AUG SEP OCT DEC NMS 11 3 IRIR MND - 11- 1111 11EMMEN ■ 'l•! mum imm $* MOMS MON ■M 1(i Ni®_ ■ OCT NOV DEC 5 ■■ 111 imam um 1 ■ ■ 11 • . 5 ■ • ■ ■ 75 SUNDAY MONDAY RAWA H E[PRESDAY THURSDAY; - FRIDAY' 6ARAM AY JAII FEB MAR APR MAY JUN JUL AUG OCT NOV DEC - -r Good (<=50 AQI) Moderate (51-100 AQI) Unhealthy for Sensitive Groups (101-150 AQI) Unhealthy (151-200 AQI) Very Unhealthy (>=201 AQI) Data source: airnow.gov Environmental Health Water Quality Water contains varying levels of inorganic and organic compounds, like minerals, microorganisms, lead, ni- trates, sulfates, radon, and other chemicals. Water quality refers to the levels of these compounds in the water. Water quality can be classified into several categories based on its use. For example, there are water quality standards for human consumption, use for agriculture and irrigation, domestic use, and environmental water quality (lakes and rivers). For more information about water -borne diseases see the Diarrheal Disease section (page 41) of this document. • Water quality (Oregon Drinking Water Quality Database, 2014) - Crook: 8 systems with alerts in 2014 - Deschutes: 20 systems with alerts in 2014 -Jefferson: 0 systems with alerts in 2014 Lead Lead poisoning is an environmental exposure that can cause irreversible health effects. No level of lead in the blood is safe and lead poisoning can occur among people of any age. Over the last few decades the prevalence of lead poisoning has significantly decreased. However, it is still a risk, especially for children. Lead can be found in old paint (before 1978), dust (some related to occupations like working in a gun range), and toys or fake jewelry, among other items. Prevention steps can include renovating your home safely by a certified reno- vator, staying current on recalled toys and items with lead, and considering lead testing for your home if it was built before 1978. • Among those people tested in Oregon, there were no differences in detectable blood lead levels by race (Table 32). Table 32. Average blood lead level (µg/dL) among screened children by race, Oregon, Northwest Tribal Epidemiology Center, 2012 , 2005-2010 rife American Indian/Alaska Native White Black Asian/Pacific Islander Hispanic Mixed Race Other Unknown/Missing Total Data from: Northwest Tribal Epidemiology Center, 2012 76 1718 1.07 1.73 0 20 19702 1.43 2.05 0 72 3159 2.02 2.12 0 24 1718 2.11 3.14 0 46 19 2.74 3.03 0 10 14 1.79 2.15 0 8 37 1.73 2.43 0 12 52362 1.23 2.05 0 65 78729 1.33 2.09 0 72 Access to Care Ensuring equal access to healthcare is important. The topics previously discussed in this document highlight the factors that can lead to varying access to healthcare, like socioeconomic status, language or cultural barri- ers, or environmental factors like availability of services and transportation. • OHP provides healthcare access to lower income populations in the state. Recently, Oregon expanded OHP to allow for the inclusion of more people. Younger age groups make up a large portion of the Cen- tral Oregon OHP membership. However in 2014 the expansion of OHP allowed membership to increase dramatically for those aged 20-64 years (Figure 79). Figure 79. Central Oregon CCO total OHP membership by age group and year, PacificSource, 2013-2014 9,000 8,000 7,000 y 6,000 5,000 Z 4,000 3,000 2,000 1,000 0 10 20 30 40 Age in Years 50 60 75 85 The 2012 Small Area Health Insurance Estimates are based on modeled estimates from the American Community Survey (ACS). These estimates calculated the percent of the population that was uninsured in Central Oregon (Crook: <1, Deschutes: 2.6, Jefferson 4.6, Oregon 5.6) (Health Insurance Coverage in Oregon Report, 2015). • According to the CAHPS Survey in 2013, OHP members in Central Oregon reported they usually got care in a timely fashion. They also reported receiving support when needed from customer service (Figure 80). Most of these rates were no different than the state overall. • There were no significant differences by Hispanic ethnicity (data not shown). 77 Figure 80. Quality Measures for Oregon and Central Oregon OHP members, CAHPS Survey, 2013 i m 100 - 80 - GO - 40 - 20 0 80 Usually or always Usually or always Health plan's Usually or always Health plan's Usually or always got care needed for quickly got routine customer service got Info/help customer service got info/help an illness or injury care when needed usually or always needed from plan's usually or always needed from plan's (adults) (adults) treated you with customer service treated you with customer service courtesy and (adults) courtesy and (child) respect(adults) respect (child) " Significantly higher than Oregon OHP • OHP Central Oregon -OHP Access to Care • The Central Oregon CCO strives to meet specific quality measures. Not all measures apply to all popula- tions. Figure 81 demonstrates progress towards meeting incentive measures for specific population groups. Five out of seven incentive measures for Hispanics, males, and whites were being met at the end of 2014. Figure 81. Number of incentive measures meeting or exceeding benchmark or target by specific population, Central Oregon CCO, OHA CCO Dashboard, 2014 8 7 6 - `w S E4 z 3 2 1 0 Illm I II 11_Thav ac•- awe cue ac a�▪ `r ai\e `4,6 Q�.� y`o� `�� e��a ��y;Q , ei* ace <<e' pp+ ca9 te`' `yaso tri ago acw P ae4 O ratiov. • Met Unmet Common Reasons to Access Healthcare The population's health can also be described by quantifying the leading reasons for accessing healthcare or the most common pharmaceuticals prescribed. The All Payers All Claims (APAC) is comprised of medical and pharmacy claims, and information about a member's eligibility and provider files, as collected from health insurance payers for residents of Oregon. The data include fully -insured and self-insured persons. The APAC database allows for a detailed understanding of the Oregon healthcare delivery system by providing access to timely and accurate data about healthcare utilization. • Opioid analgesics are the most numerous prescriptions (RX) among those with commercial insurance and Medicaid in Central Oregon. They are the third most common prescription among those enrolled in Medicare (Table 33). • In terms of total cost (number of prescriptions multiplied by cost), anti-inflammatory analgesics are the most expensive prescriptions for those enrolled in commercial insurance, while antipsychotics are the most expensive for those enrolled in Medicaid. Antineoplastics (anticancer drugs) are the most expensive for those enrolled in Medicare (Table 33). 8 • 1, Antiasthmatic Analgesics -Analgesics - Analgesics - And Opioid Thyroid Agents Antihypertensives Thyroid Agents Antihypertensives Opioid Opioid Bronchodilator Agents Ulcer Drugs Analgesics - Psychotherapeutic Psychotherapeutic Passive Antipsychot Adhd/Anti- Anti- And Neurological Antidepressants Antineoplastics And Neurological Immunizing ics/Antiman Antidepressants Narcolepsy/Anti- Inflammatory Agents - Misc. Agents - Mise. Agents is Agents Obesity/Anorexiants Analgesics - Thyroid Agents Antihypertensives Antihypertensives Thyroid Opioid y YP yP y Agents Antiasthmatic Analgesics - Analgesics - And Opioid Opioid Bronchodilator Agents Ulcer Drugs Analgesics - Psychotherapeutic Antiasthmatic And Antipsychoti Antipsychot Analgesics - Anti- Anti- And Neurological Antidiabetics Bronchodilator cs/Antimanic ics/Antiman Antidepressants Antidiabetics Inflammatory Inflammatory Agents - Misc. Agents Agents is Agents Access to Care • The most common claim for people enrolled in commercial insurance in Central Oregon is for routine gynecological exams, while the number one claim for those enrolled in Medicare is for diabetes (Table 34). The most common claim for those enrolled in Medicaid was for a reason that could not be specified with available codes. • By total amount paid (number claims multiplied by cost), rehabilitation for a specific procedure was the most expensive among members of Medicare and Medicaid. Osteoarthritis in the lower leg was the most expensive claim for members of commercial insurance (Table 34). able 34. Medical claims from all payors in Central Oregon and Oregon by total number and total amount paid, APAC Database, 2013 Commercial Medicare Medicaid 2 3 1 2 3 1 2 3 Diabetes Mellitus Routine Nonallopathic Without Mention Of Unspecified Gynecological Lumbago Lesions, Complication, Type 0 Essential Atrial Examination Cervical Region Or Unspecified Type, Fibrillation Hypertension Not Stated As Uncontrolled Osteoarthrosis, Single Liveborn, Localized, Not Special Care Involving Other Exudative Care Involving Born In Hospital, Specified End Stage Screening For Specified End Stage Senile Other Specified Delivered Whether Primary Renal Disease Malignant Rehabilitation Renal Disease Macular Rehabilitation Without Mention Neoplasms Of Or Secondary, Colon Procedure Degeneration Procedure Of Cesarean Lower Leg Section Care Involving Other Unknown Single Liveborn, Encounter For Routine Infant Other And Unspecified Born In Hospital, End Stage Renal AntinDelivered eoplastic Or Child Health End Stage Renal Specified Atrial Cause Of Disease Without Mention Chemotherapy Check Disease Rehabilitation Fibrillation Morbidity And Procedure Mortality Of Cesarean Section Other Unknown And Unspecified Routine Infant Or Unspecified Cause Of Child Health Psychosocial Morbidity And Check Circumstance Mortality Routine Gynecological Examination Routine General Medical Examination At A Health Care Facility Routine Infant Or Child Health Check Diabetes Mellitus Without Mention Of Complication, Type li Atrial Or Unspecified Type, Fibrillation Not Stated As Uncontrolled Unspecified Schizophrenia, Unspecified Unspecified Schizophrenia, Unspecified Chronic Other Unknown Airway And Unspecified Routine Infant Or Unspecified Obstruction, Cause Of Child Health Psychosocial Not Elsewhere Morbidity And Check Circumstance Classified Mortality Specific Access Topics Recent data collected focused on topics related to access to healthcare. Focus group participants reported a variety of barriers and concerns related to their care or the care of others. Other services have focused on ad- dressing gaps in healthcare like healthcare provider shortages or areas with higher need than others. OHP Expansion With changes to healthcare and insurance availability, the Central Oregon Health Council Community Advi- sory Council (CAC) gathered information on residents' thoughts about the expansion (CAC reports, 2014). Some themes included: • Need for ongoing assistance about using health insurance and what primary care means. • Need for more support for Hispanics, especially to address language barriers. • Need to address misinformation and community perceptions about who is eligible and data security related to OHP enrollment. Adolescents Another area of concern related to access to care was for adolescents. Specific focus groups were centered on gathering information about this population (CAC reports, 2014). Findings suggested: • Children receive sports physicals, but these visits are missed opportunities for well-child visits for adoles- cents. • Benefits could come from more reminders or scheduling well-child visits ahead of time, emphasizing the importance of well-child visits for adolescents, and potentially expanding health screenings past 3rd grade. • Adolescents fear they will find out something bad about their health during a healthcare visit. 79 Access to Care Emergency Medical Services Health emergencies need a timely response. Distance from a healthcare facility or preparedness to handle a serious trauma can delay care and affect long-term health outcomes. • In Central Oregon there are 4 trauma -designated hospitals. There is one level II hospital in Bend, one level III hospital in Redmond and two level IV hospitals, one in Madras and one in Prineville (Trauma Registry Reports, 2010-2011). • The average travel time to a hospital in Oregon is 24 minutes. Most of Central Oregon had a travel time less than the state average. The Sisters area, however, was 29 minutes (Areas of Unmet Healthcare Need in Rural Oregon Report, 2015). Gaps in Care A key factor in accessing care is that the services are available nearby in the community. Health professional shortages can limit access to specialized care and may delay care. Services need to be culturally consider- ate and provide convenient locations and hours. Areas with limited healthcare workforce are often classified into Healthcare Provider Shortage Areas (HPSA) and Medically Underserved Areas or Populations (MUA/P). Areas qualify as a HPSA because of a high population -to -provider ratio. This includes having specialized care that is either not available or is at or over capacity in the surrounding areas. Additionally, certain types of facili- ties and population groups within a geographic area are eligible for designation. HPSAs may be designated as having a shortage of primary medical care, dental or mental health providers. MUA/Ps are identified by measuring population to provider ratios, infant mortality rates, poverty rates, and other key data points. There are federally defined rules that identify which data to use to define a HPSA and MUA/P (HRSA). Five distinct types of designations are available: • Geographic: the entire population in the designated area is identified as underserved and resources are considered over -utilized. • Population: an underserved population identified within a specific area. Eligible populations include: - Low-income: there must be at least 30% of the population at or below 200% of the Federal Poverty Level. -Migrant farmworkers: migrant farmworkers and their non-farm working family members. - American Indians: American Indians or Alaska Natives that are not part of a group that is already automatically designated. -Other populations that face access barriers due to language, cultural or disability barriers. • Facility: a facility that may or may not be in a designated area, but that serves residents located from a shortage area. • Federal and state correctional facilities that are considered either a maximum- or medium- security facility. • Federally recognized tribes. Healthcare Provider Workforce Having an adequate number of healthcare providers and facilities in an area is important for accessing health- care. Specific medical associations track the number of healthcare providers that hold a specific license. For example, the American Medical Association maintains a master file of physicians and surgeons and the Ameri- can Dental Association, the dentists. These lists can be used to describe the number of healthcare providers 8 practicing in a specific area. Access to Care Healthcare Provider Workforce Continued • Some of the highest provider to population ratios in Central Oregon were for certified nurse anesthetists, psychologists, general surgeons, and licensed counselors and therapists (Table 35). There are no obstetri- cian/gynecologists in Crook County and no psychologists or general surgeons in Jefferson County. Table 35. Licensed health professional ratios by profession, Oregon, Office of Oregon Health Policy and Research, 2013 Crook. .. Deschutes:. Jefferson Oregon Cert. Reg. Nurse Anesthetist 20,978 52,578 5,430 10,082 Obstetrician/Gynecologist 2,850 10,469 4,047 Psychologists 20,978 3,356 ;i; 1,703 General surgeon 10,489 7,887 # 12,085 Nurse Practitioner 6,993 1,813 2,413 1,763 Licensed counselors and therapists 6,993 1,678 21,720 1,976 Dentist 4,196 1,396 3,103 1,616 Social Workers 4,196 1,282 3,620 1,141 Physician Assistant 3,496 1,792 7,240 3,941 Dental hygienists 3,496 1,348 3,103 1,641 Primary Care Physician 2,622 998 1,671 1,010 Pharmacists 2,098 1,337 1,671 1,162 Physicians, total 1,498 329 987 365 Nurses 247 92 170 102 t No professional practicing in the county Data from: Office of Oregon Health Policy Research Healthcare Safety Net Clinics The Oregon Primary Care Office defines the term "healthcare safety net" as "the array of clinical sites around the state that provide healthcare opportunities for those who otherwise would have barriers to accessing quality health services. These barriers include lack of coverage, geographic isolation, language and culture, mental ill- ness and homelessness." There are several safety net clinics in Central Oregon including hospitals, clinics, and school based clinics (Oregon Primary Care Office). Central Oregon contains: • 1 Urban hospital • 2 Critical access hospitals • 1 Rural hospital • 1 Federally qualified health center -School based health center • 3 Rural health clinics • 4 Federally qualified health centers • 5 School based health centers • 1 Indian Health Service facility 81 Access to Care Health Professional Shortage Areas in Central Oregon • Jefferson County is considered a HPSA due to its geography. Crook County also falls in this category due to its population's low-income status. (Oregon Primary Care Office, 2015). Dental • All Central Oregon counties are classified as dental professional shortage areas. Jefferson County for its geography, Crook County for low income populations, and Deschutes County for low income populations, homeless populations, and migrant farmworker populations (Oregon Primary Care Office, 2015). Mental Health • Crook and Jefferson Counties are mental health HPSA due to geography and Deschutes County is a mental health HPSA due to low-income populations (Oregon Primary Care Office, 2014). • There are shortages of more advanced mental health treatment options for children and adolescents beyond what is currently available (Central Oregon Behavioral Health Needs Assessment, 2015). • There are shortages of specialized prescribers of psychiatric medications in Central Oregon. Also, there is limited access to psychiatric prescribers for OHP and Medicare members (Central Oregon Behavioral Health Needs Assessment, 2015). • There are shortages of private mental health professionals in Central Oregon (Central Oregon Behavioral Health Needs Assessment, 2015). • Individuals with depression average twice as many visits to their primary care doctor than do non-de- pressed patients and have nearly twice the annual healthcare costs. (Mauer & Jarvis, 2010). Medically Underserved and Populations in Central Oregon • There are several medically underserved areas and populations in Central Oregon (Figure 82). Figure 82. Medically underserved areas or populations, Oregon, Oregon Primary Care Office, 2011 82 r_. __., Not Designated 722 MUA ENA MUP Governor - MUP MUA & MUP Data Source: Health Resources S Services Administration (HRSA), Bureau of Health Professions Prepared By- Oregon Health Policy and Research t1/2912011 Access to Care Public Health Workforce Public health systems are often defined as "all public, private, and voluntary entities that contribute to the deliv- ery of essential public health services within a jurisdiction:' (CDC) Employees of public health organizations work to provide the 10 essential public health services. Having a well -staffed and funded public health work- force is key for providing these services. • Directors of the three Central Oregon health departments were asked to quantify the number of staff by position and programmatic area in the spring of 2015. Estimates suggest: • The most common positions in Crook, Deschutes, and Jefferson County Health Departments are admin- istrative and fiscal, health educators, and public health nurses. The least common are epidemiologists, biostatisticians, and mental health specialists. The most commonly staffed areas were in reproductive health and maternal and child health, followed by communicable disease control and environmental health. The areas with some of the fewest staff were chronic disease control, substance abuse prevention, and performance management. Self-reported public health service needs of the Central Oregon region were in emergency preparedness, chronic disease prevention and control, and grant writing/management. Deschutes County and Crook County participated in a workforce needs assessment conducted by the University of Washington's Northwest Center for Public Health Practice to identify specific areas for staff development. Results for Jefferson County were not available. In Deschutes County, communications and cultural competency were high priority areas for training, while supervisors wanted extra training in per- formance management and conducting health impact assessments. In Crook County, leadership, commu- nication, management and systems thinking were high priority areas for training. Training in emergency preparedness and health impact assessments was also mentioned as an interest. CCO Measures • The Central Oregon CCO performance on healthcare utilization metrics are similar to the state perfor- mance overall (Figure 87). There is no benchmark for the percent of CCO members enrolled in a patient - centered primary care home or avoidable ED utilization. 83 Percentage of members (adults and children) who thought they received appointments and care when they needed them. Percentage of Medicaid members (adults) who report their overall health as excellent or very good. Percentage of Medicaid members (children) who report their overall health as excellent or very good. Percentage of members (adults and children) who received needed information or help, and thought they were treated with courtesy and respect by customer service staff. Percentage of adult members (ages 18 years and older) who had a hospital stay and were readmitted for any reason within 30 days of discharge. Percentage of eligible providers within a CCO's network and service area who qualified for a "meaningful use incentive payment during the measurement year through the Medicaid, Medicare, or Medicare Advantage EHR Incentive Programs. Percentage of CCO members who were enrolled in a recognized patient -centered primary care home. 10.5 41011.4 Rate of patient visits to an emergency department for conditions that could have . been more appropriately managed by or referred to a primary care provider in an 7.4 office or clinic setting. 44 Rate of patient visits to an emergency department per 1000 member months. 47.3 41.9 Rate of outpatient services per 1000 member months. 0 State 67.2 67 0 72,0 ��� \8J333.88 / 880 95.0 286.) 297.5 • Central Oregon CCO OBenchmark .173 1 Glossary and Acronyms Age-adjusted: A method for standardizing and comparing rates when the populations differ significantly by age. In this report, populations were weighted using the 2000 census. American Community Survey (ACS): A survey conducted annually between census years by the US Census Bureau. Asthma Call-back Survey (ACBS): A follow-up survey conducted after the Behavioral Risk Factor Surveillance System Survey with people who indicated they had or currently have asthma. Behavioral Risk Factor Surveillance System (BRFSS): A phone survey conducted among randomly selected, non -institutionalized adults that asks about a variety of health risks and behaviors. Body Mass Index (BMI): Use both weight and height to determine the size of an individual. BMI is divided into four categories: underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), obese (30.0 or greater). Centers for Disease Control and Prevention (CDC): The federal organization that protects the health of the na- tion's residents and helps local communities do the same. Community Advisory Council (CAC): A group of individuals that guides the Central Oregon Health Council on the organization's direction and makes recommendations that support the community. Central Line Associated Bloodstream Infection (CLABSI): Infection of the blood related to an intravascular catheter. Chronically homeless: A person who is 18 years or older, has a disability, and has been homeless for the past 12 or more months or has had 4 episodes of homelessness in the past 3 years. Confidence Interval (CI): A range of numbers in which the true estimate would be found 95% of the time if the sample were taken an infinite number of times. Consumer Assessment of Healthcare Providers and Systems (CAHPS): A survey that asks consumers and patients to report on and evaluate their experiences with healthcare. Coronary Artery Bypass Graft (CABG): Procedure used to treat coronary artery disease. Crude rate: A method for reporting disease counts. They are calculated by dividing the number of people (cases) by the number of people at risk (or in the population). Rates are often standardized to per 100,000 people. Emergency Department (ED): Part of a hospital that serves people in need of immediate care. Environmental Public Health Tracking (EPHT): Public health surveillance, data analysis, and reporting on environmental exposures that can affect health. Twenty-six sites are funded from CDC to perform EPHT. Fecal Occult Blood Test (FOBT): A screening test for colorectal cancer. Health Resource and Services Administration (HRSA): An agency of the US Department of Health and Hu- man Services that focuses on improving access to healthcare. Healthcare Associated Infection (HAI): Infection associated with the use of a medical device like a catheter or 8 4 ventilator or infections at a surgical site. Healthcare Provider (HCP): A licensed individual that delivers health services. Healthcare Providers Shortage Area (HPSA): Geographic areas with limited healthcare professional workforce. Glossary and Acronyms Healthy People 2020 (HP 2020): National goals to meet by the year 2020. Healthcare Cost and Utilization Project (HCUP): A collection of longitudinal hospital care data for the United States. Incidence: The number of new cases that occurred in a population. Often used for communicable disease re- porting. Long-acting Reversible Contraception (LARC): Birth control methods that provide effective, reversible contra- ception for extended periods of time without requiring user action. Medicaid Behavioral Risk Factor Surveillance Survey (MBRFSS): The BRFSS conducted among adults en- rolled in Medicaid (OHP). Medically Underserved Area or Population (MUA/P): Geographic areas with high population to provider ra- tios, infant mortality rates, and poverty rates. Oregon Health Plan (OHP): Healthcare coverage program for low-income Oregonians. Oregon Healthy Teens Survey (OHT): School-based, anonymous and voluntary survey conducted among 8th and 1lth graders that informs schools, communities, and the state about strengths or areas for improvement related to student health and health behaviors. Oregon Public Health Analysis Tool (OPHAT): A data warehouse containing datasets with vital records and reportable condition counts. This is a tool for authorized personnel to use when performinOregon School Well- ness Survey (OSWS): A survey conducted in even numbered years to assess mental health and substance use of 6th, 8th, and 1lth graders. Pregnancy Risk and Monitoring Survey (PRAMS): A survey of mothers who recently gave birth that addresses prenatal care, health behaviors and risks, and post -partum topics. Prevalence: The number of cases that exist in a population. Often used for chronic disease reporting. Prevention Quality Indicator (PQI): Quality measures used to identify areas for performance improvement. Mea- sures are focused on conditions where good outpatient care could prevent the need for a hospitalization. Severe and Persistent Mental Illness (SPMI): Mental illnesses that lead to significant disability, including need for medications, rehabilitation, and other support. Supplemental Nutritional Assistance Program (SNAP): Nutrition assistance program for low-income families. Standard Infection Ratio (SIR): A summary measure that is adjusted for various risk factors and is used to track the prevention of healthcare acquired infections. A lower number is better. Temporary Assistance for Needy Families (TANF): A program to help families reach self-sufficiency. The four goals of the program are 1) support families so that children can be cared for in their own homes, 2) promote job preparation, work and marriage, 3) promote planned pregnancies, and 4) encourage two-parent families. Women, Infants, and Children (WIC): A Federal program for low income and nutritionally at risk women, infants and children. Participants receive education, screening, and support in purchasing nutritious foods. 85 Wide-ranging Online Data for Epidemiologic Research (CDC WONDER): Menu -driven web -based system that makes public health data available to the public. Years of Potential Life Lost (YPLL): A measure of premature mortality. Calculated by subtracting the age at death from a predetermined life expectancy age, usually 75 years. Resources 1. Adverse Childhood Experiences (ACEs) CDC: http://wwwcdc.gov/violenceprevention/acestudy/ 2. Better Together Baseline Report, Winter 2015: http://www.hdesd.org/files/2015/02/2015-Better-Together- Baseline-e-report.pdf 3. Centers for Disease Control and Prevention: www.cdc.gov 4. BRFSS (Behavioral Risk Factor Surveillance System), Data Analysis Tools: http://www.cdc.gov/brfss/data_ tools.htm b. WONDER (Wide-ranging Online Data for Epidemiologic Research): http://wonder.cdc.gov c. WISQARS (Web -based Injury Statistics Query and Reporting System): http://www.cdc.gov/injury/ wisqars/ 5. Central Oregon Homeless Leadership Coalition: http://wwwcohomeless.org 6. Central Oregon Housing Works: http://housing-works.org 7. Crook County Health Department: http://co.crook.or.us/Departments/HealthDepartment/HealthHome/ tabid/2169/D efault. aspx 8. Deschutes County Health Services: http://www.deschutes.org/services?category=47 9. Economic Research Service (ERS), U.S. Department of Agriculture (USDA). Food Environment Atlas. http:// www.ers.usda.gov/data-products/food-environment-atlas.aspx. 10. Environmental Public Health Tracking (Oregon): http://epht.oregon.gov 11. Healthy People 2020: http://www.healthypeople.gov/2020/topicsobjectives2020/default 12. Jefferson County Health Department: http://wwwco.jefferson.or.us/PublicMentalHealth/PublicHealthDe- partment/tabid/3777/language/en-US/Default.aspx 13. Kids Count Data Center: http://datacenter.kidscount.org/ 14. Oregon Department of Education: http://wwwode.state.or.us/home/ 15. Oregon Health Authority Data: https://public.health.oregon.gov/DataStatistics/Pages/index.aspx 16. Substance Abuse and Mental Health Services Administration: samhsa.gov a. Behavioral Health Barometer: http://store.samhsa.gov/product/Behavioral-Health-Barometer- 2014SMA15-4895 17. United States Census Bureau: http://wwwcensus.gov 18. United Way: http://www.deschutesunitedway.org 86 Appendix A CCO Quality Health Measures Access to Healthcare Percentage of members (adults and children) who thought they received appointments and care when they needed them. Percentage of Medicaid members (adults) who report their overall health as excellent or very good. Percentage of Medicaid members (children) who report their overall health as excellent or very good. Percentage of members (adults and children) who received needed information or help, and thought they were treated with courtesy and respect by customer service staff. Percentage of adult members (ages 18 years and older) who had a hospital stay and were readmitted for any reason within 30 days of discharge. Percentage of eligible providers within a CCO's network and service area who qualified for a "meaningful use" incentive payment during the measurement year through the Medicaid, Medicare, or Medicare Advantage EHR Incentive Programs. Percentage of CCO members who were enrolled in a recognized patient -centered primary care home. Rate of patient visits to an emergency department for conditions that could have been more appropriately managed by or referred to a primary care provider in an office or clinic setting. Rate of patient visits to an emergency department per 1000 member months. Rate of outpatient services per 1000 member months Percentage of adults members (ages 18 years and older) who had appropriate screening and intervention for alcohol or other substance abuse(SBIRT measure) o Percentage of patients (aged 13 and older) newly diagnosed with alcohol or other drug dependence and who began treatment within 14 days of the initial diagnosis 3 Percentage of patients (aged 13 and older) who had two or more additional services for alcohol or other drug dependence within 30 days of their initial treatment Percentage of adult tobacco users advised to quit by their doctor rPercentage of adult tobacco users whose doctor discussed or recommended medication to quit smoking ;20 Percentage of adult tobacco users whose doctor discussed or recommended strategies to quit smoking :Tc, Percentage of adult Medicaid members (ages 18 years and older) who currently smoke cigarettes or use other tobacco products. c Percentage of adolescents and young adults (ages 12-21 years) who had at least on well -care visit during the year. F.r o r Percentage of children who were screened for risks of developmental, behavioral and social delays using standardized screening a tools in the 12 months preceding their first, second, or third birthday. Chronic Disease d a A v E • 0 u A C N L E CA V Mental Health Percentage of adult patients (ages 18-75 years) with diabetes who received at least one A1c blood sugar test Percentage of adult patients (aged 18-75 years) with diabetes who received an LDL -C (cholesterol) test Percentage of patients (18-75 years of age) with diabetes who had hemoglobin A1c>9.0% during the measurement period. Percentage of adult members (ages 50-75 years) who had appropriate screening for colorectal cancer. Percentage of women (aged 21 to 64 years) who got one or more Pap tests for cervical cancer in the past three years. Percentage of patients 18-85 years of age who had a diagnosis of hypertension (high blood pressure) and whose blood pressure was adequately controlled. (<140/90mmHg) during the measurement period. Rate of adult patients (18 years and older) with diabetes who had a hospital stay because of a short-term problem from their disease (per 100,000 member years) (PQI 01) Rate of adult patients (aged 18 years and older) who had a hospital stay because of congestive heart failure (per 100,000 member years) (PQI 08) Rate of adult patients (age 40 and older) who had a hospital stay because of asthma or chronic obstructive pulmonary disease (per 100,000 member years) (PQI 05) Rate of adult members (ages 18-39 years) who had a hospital stay because of asthma (per 100,000 member years). Percentage of adolescents who received recommended vaccines before their 13th birthday. Percentage of children who received recommended vaccines before their second birthday. Percentage of children with a sore throat (pharyngitis) who were given a strep test before getting an antibiotic. Percentage of sexually active women (ages 16-24 years) who had a test for chlamydia infection Percentage of pregnant women who received within the first trimester or within 42 days of enrolling in Medicaid. Percentage of women who had an elective delivery between 37 and 39 weeks of gestation. Percentage of women who had a postpartum care visit on or between 21 and 56 days after delivery. Percentage of children up to 15 months old who had at least 6 well child visits with a HCP. Percentage of children aged 4+ years that receive a mental health assessment and physical health assessment within 60 days of the state notifying CCOs that the children were placed into custody with the DHS. Percentage of patients (aged 6+) who received a follow up with a HCP within 7 days of being discharged from the hospital for mental illness Percentage of children (aged 6-12 years) who had one follow up visit with a provider during the 30 days after receiving a new prescription for ADHD medication Percentage of patients ages 12 years and older who were screened for clinical depression using an age-appropriate standardized depression screening tool and if positive, have a documented follow-up plan. Appendix B 88 Data Set/Program Acronym Year of data Adverse Childhood Experiences Study American Cancer Society American Community Survey Asthma Call Back Survey Behavioral Risk Factor Surveillance System Birth Certificates Centers for Disease Control and Prevention CDC Wide-ranging Online Data for Epidemiologic Research Consumer Assessment of Healthcare Providers and Systems Survey Community Advisory Council Coordinated Care Organization Quality Measures Death Certificate Deschutes County Smokefree Report Environmental Public Health Tracking Environmental Protection Agency Air Quality Data Guttmacher Institute Health Impacts of Transportation in Central Oregon Healthy People 2020 Kids Count Maternity Practices and Infant Nutrition and Care Survey Medicaid Behavioral Risk Factor Surveillance Survey National Health Interview Survey National Immunization Survey National Institute of Drug Abuse Northwest Tribal Epidemiology Center Office of Oregon Health Policy and Research Oregon ALERT Immunization Information System Oregon Census on Employment and Wages Oregon Dental Sealant Program Oregon Department of Education Oregon Department of Transportation Crash Data Oregon Drinking Water Quality Database Oregon Health Authority Oregon Healthy Teens Survey Oregon Hospital Discharge Data Oregon Primary Care Office Oregon Public Health Analytic Tool Oregon Student Wellness Survey Oregon Tobacco Quit Line data PacificSource Community Solutions Parks, Recreation, and Green Spaces Comprehensive Plan Pregnancy Risk Assessment Monitoring System State Cancer Profiles Substance Abuse and Mental Health Services Association Synar Report State Trauma Registry US Renal Data System Web -based Injury Statistics Query and Reporting Women, Infant, Children Program World Health Organization ACEs ACS ACBS BRFSS CDC CDC WONDER CAHPS CAC CCO 1998 2015 2011-2013 2011 2008-2013 2000-2013 2009, 2010, 2013 2000-2013 2013 2014 2014 2000-2013 2012 EPHT 2011-2012 EPA airnow 2010-2013 2015 2012 HP2020 Varies 2010-2014 mPINC 2013 MBRFSS 2014 NHIS 2011 NIS 2013 NIDA 2014 2012 2013 2013 2012 2013-2014 ODE 2013-2014 ODOT 2013 2014 OHA 2014-2015 OHTS 2013 HDD 2011, 2013 2015 OPHAT 2000-2013 OSWS 2014 2014 PSCS 2014-2015 2012 PRAMS 2008-2011 2007-2011 SAMHSA 2012, 2014 2009-2013 STR 2010-2011 2012 WISQARS 2012 WIC 2015 WHO 2015 0 2016-2019 CENTRAL OREGON REGIONAL HEALTH IMPROVEMENT PLAN I A Message from the Central Oregon Health Council Board of Directors Central Oregon health system partners are making important strides to improve the health of residents. These strides will continue to be facilitated by partnerships among healthcare providers, local governments, educators, community-based and non-profit organizations, citizen groups and other entities in the region. To further our vision of a healthier Central Oregon, regional partners have collaborated to create the Central Oregon Regional Health Improvement Plan (RHIP). The nature of Central Oregon's economy varies among and within communities and the region is sensitive to fluctuations in the state and national economic conditions. In Central Oregon, many people enjoy an elevated quality of life, experience the natural beauty of the great outdoors, and pursue their dreams. Creating a healthier Central Oregon is critical to our region's continued success. This plan offers a roadmap through which this can be achieved. As the Central Oregon Health Council (COHC) Board of Directors, we are committed to the following: Pursuing the priorities, goals and strategies described in this plan. Continuing to build a health system that supports these priorities and meets the needs of our region. Aligning plans of our respective organizations with the priorities and goals of the RHIP. Facilitating partnerships to achieve these goals. To the extent these goals are achieved, there will be a healthier Central Oregon and healthier citizens to enjoy the special place in which we live, work, and play! Tammy Baney, Chair Commissioner, Deschutes County v/(1% - Mike Ahern Commissioner, Jefferson County Megan Haase, FNP CEO, Mosaic Medical J Stephen Mann, DO Chair, Provider Engagement Panel Central Oregon IPA Representativee Joseph Sluka CEO, St. Charles Health System Mike Shirtcliff, DMD, Vice Chair President, Advantage Dental Ken Fahlgren Commissioner, Crook County -151 Greg Hagfors Chair Finance Committee CEO, Bend Memorial Clinic Linda McCoy Chair, Community Advisory Council Dan Stevens Executive VP, PacificSource Health Plans Table of Contents 3 1 Acknowledgements 4 Introduction 6 What is a Health Improvement Plan? 6 Factors that Affect Health 6 Clinical -Community Linkages 7 Community Input 8 How This Plan Is Organized 8 Implementation and Accountability 9 Behavioral Health: Identification and Awareness 10 Behavioral Health: Substance Use and Chronic Pain 14 Cardiovascular Disease 18 Diabetes 21 Oral Health 25 Reproductive and Maternal Child Health 29 Social Determinants of Health Part One: Education & Health 33 Social Determinants of Health Part Two: Housing 38 Appendix A: Acronyms 44 Appendix B: References 44 Behavioral Health 44 Cardiovascular Disease 44 Diabetes 44 Oral Health 45 Reproductive and Maternal Child Health 45 Social Determinants 46 Acknowledgements Thank you to the following people for their contribution to this document Alison Little Brad Hester Bruce Abernethy Bruce Brundage Channa Lindsay Charla DeHate Christine Pierson Christy McLeod Chuck Keers Dan Stevens Dana Perryman David Holloway DeAnn Carr Divya Sharma Donna Mills Doug Kelly Elaine Knobbs Elizabeth Schmitt Gary Allen Greg Hagfors Harold Sexton Heather Simmons Jane Smilie Jeff Stewart Jeff White Jenn Welander Jessica Jacks Joseph Sluka Julie Rychard Kathe Hirschman Karen Steinbock Kat Mastrangelo Kathy Drew Kate Wells Ken Fahlgren Ken House Ken Wilhelm Kim Swanson Kristin Powers 1 Medical Director for Medicaid (PEP Member) Owner Grant Writer (CAC Member) Retired Cardiologist Quality Improvement Specialist Chief Executive Officer (OPs Member) Medical Director (PEP Member) Chief Operating Officer (OPs Member) Executive Director (CAC Member) Executive Vice President (Board Member) Pediatrician (PEP Member) Chief Medical Officer (PEP Member) Behavioral Health Deputy Director (OPs Member) Medical Director (PEP Member) Executive Director Division Chief (OPs Member) Director of Programs & Development (CAC Vice -Chair) (CAC Member) Dental Director (PEP Member) Chief Executive Officer (Board Member) Director (Board Member & PEP Member) Dental Services Program Manager Director (OPs Member) Administrator (OPs Member) (CAC Member) Chief Financial Officer (Finance Member) Prevention Coordinator President and Chief Executive Officer (Board Member) Personal Agent (CAC Member) Administrative Supervisor Health Quality Program Director (OPs member) Executive Director (OPs Member) Community Member Director of Community Health Development Commissioner (Board Member) Director of Data and Analytics Executive Director (CAC Member) Clinical Psychologist (PEP Member) Manager of Health Integration PacificSource Community Solutions Bend Family Dentistry Bend -La Pine School District Professor Emeritus UCLA Deschutes County Health Services La Pine Community Clinic Mosaic Medical Bend Memorial Clinic Family Resource Center PacificSource Community Solutions Central Oregon Pediatric Associates Bend Memorial Clinic Deschutes County Health Services COIPA and Mosaic Medical Central Oregon Health Council Redmond Fire & Rescue Mosaic Medical Community Advisory Council Advantage Dental Bend Memorial Clinic Deschutes County Behavioral Health PacificSource Community Solutions Deschutes County Health Services East Cascade Women's Group Community Advisory Council St. Charles Health System Deschutes County Health Services St. Charles Health System Full Access High Desert Deschutes County Health Services Central Oregon Independent Practice Association Volunteers in Medicine Gero-Leadership Alliance PacificSource Community Solutions Crook County Mosaic Medical United Way of Deschutes County St. Charles Medical Group St. Charles Health System Acknowledgements 5 1 Thank you to the following people for their contribution to this document Kyle Mills Laura Gratton Laura Pennavaria Leslie Neugebauer Linda McCoy Lindsey Hopper Lori Wilson MaCayla Arsenault Maggie O'Connor Malia Ladd Mary Ann Wren Megan Haase Miguel Herrada Mike Ahern Mike Franz Mike Shirtcliff Muriel DeLaVergne-Brown Nicole Rodrigues Nikole Zogg Pamela Ferguson Paul Andrews Penny Pritchard Rebeckah Berry Regina Sanchez Rick Koch Rick Treleaven Robert Ross Robin Henderson Sarah Worthington Scott Willard Sean Ferrell Sharity Ludwig Stephen Mann Steve Strang Suzanne Browning Tammy Baney Therese McIntyre Thomas Kuhn Tom Machala Wade Miller Pharmacist (PEP Member) Regional Medical Director Medical Director (PEP Member) Central Oregon CCO Director (OPs Member) (Board Member & CAC Member — Chair) Vice President of Medicaid Programs Virtual Assistant Operations Assistant Community Benefit and Wellness Manager Inclusion Coordinator (CAC Member) Regional Manager & Community Liaison (OPs Member) Chief Executive Officer (Board Member) Health Equity Coordinator Commissioner (Board Member) Medical Director of Behavioral Health President (Board Member) Public Health Director (PEP & OPs Member) Coding Supervisor (CAC Member) Central Oregon Regional Manager (OPs Member) Nurse Program Manager Deputy Superintendent (OPs Member) Tobacco Prevention Coordinator Operations and Project Manager Enrollment Assister (CAC Member) Director of Echocardiography Executive Director (OPs Co -Chair) Medical Director of Community Health Strategy (PEP Member) Chief Behavioral Health Officer & Vice - President of Strategic Integration (OPs Member) Chronic Disease Program Manager Executive Director (OPs Member) Program Manager (CAC Member) Director of Community Dental Programs (PEP Member) Medical Director (Board Member & PEP Chair) Director of Operations (OPs Co -Chair) Executive Director (CAC Member) Commissioner (Board Chair) Patient Population Specialist Community Health Program Manager Public Health Director (OPs Member) Chief Executive Officer (OPs Member) Mosaic Medical Mosaic Medical La Pine Community Health Center PacificSource Community Solutions Community Advisory Council PacificSource Community Solutions Central Oregon Health Council Central Oregon Health Council St. Charles Health System Neighborlmpact Advantage Dental Mosaic Medical PacificSource Community Solutions Jefferson County PacificSource Community Solutions Advantage Dental Crook County Health Department St. Charles Health System Advantage Dental Deschutes County Health Services High Desert Education Service District Deschutes County Health Services Central Oregon Health Council Crook County Health Department Bend Memorial Clinic BestCare Treatment Services St. Charles Medical Group St. Charles Health System Deschutes County Health Services Lutheran Social Services Forest Service Advantage Dental High Lakes Healthcare Bridges Health by Mosaic Medical Kemple Memorial Children's Dental Clinic Deschutes County Mosaic Medical Deschutes County Health Services Jefferson County Health Department COPA Introduction 6 1 What is a Health Improvement Plan? The Centers for Disease Control and Prevention defines a health improvement plan as "a long-term, systematic effort to address public health problems on the basis of the results of health assessment activities and the health improvement process." System partners to address priorities coordinate efforts and target resources will use the Central Oregon Regional Health Improvement Plan (RHIP). A health improvement plan is critical for developing policies and taking actions that promote health. It defines the vision for the health of the community through a collaborative process and offers strategies to improve the health status of that community. In 2015, Central Oregon health system partners created the Central Oregon Regional Health Assessment (RHA). A health assessment gives organizations comprehensive information about the community's current health status, needs, and issues. This information provided the central guidance for creation of this health improvement plan. Benefits of a health assessment and improvement process and plan include: • Improved organizational and community coordination and collaboration • Increased knowledge about health and the interconnectedness of activities • Strengthened partnerships within Local health systems • Identified strengths, weaknesses, and gaps to address quality improvement efforts • Measured benchmarks for public health and healthcare practice improvement Factors that Affect Health A person's health is determined largely by social and economic factors, although prevention and healthcare services contribute substantially to maintaining health. According to the World Health Organization (1948), "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity:' Where we live, go to school, and work affects our overall health, as does the safety and livability of our communities, whether we are economically stable or struggling to get by, and whether we have strong social connections. These factors are called social determinants of health and help explain why certain segments of the population experience better health outcomes than others. They also explain how external factors influence our ability to live healthy. The public health and healthcare systems implement strategies on multiple levels to improve the health of individuals and families, as well as the population at large. The five -tier pyramid, shown below, illustrates how different types of interventions affect health. Smallest impact Factors that affect health Examples dseliiiq, edtteatioii Advice to eat heathy, be Q7rsxa ri active Rx for nigh b-eee pressure, Iegh cholesterol, diabetes intervertlora smoking cessate{:, colon:oxeye Largest impact t�aagtng;the tke indiv dual's d decisions health) cioeconomicfactc ;adaatian, smoke -Pee. cigarette tax Poverty, educat oe. housng, e epuae y Source: Thomas R. Frieden, MD, MPH. A Framework for Public Health Action: The Health Impact Period. American Journal of Public Health. 2010 April; 100(4): 509-595. Doi:10.2105/ALPH.2009.185652 PMCCID: PMC2836340 Introduction Factors that Affect Health (continued) The Central Oregon RHIP necessarily incorporates strategies from all levels of the pyramid. Interventions in the top two tiers of the pyramid commonly occur in a healthcare setting. These interventions are essential to protect and improve an individual's health, but they often have a limited impact on the population's achievement of optimal health. Interventions in the middle and at the base of the pyramid are geared toward improving the health of the entire population by focusing on prevention, making health resources readily available, ensuring the healthcare system is equipped to address health needs, and enacting policy that makes healthy choices the default and addressing socioeconomic factors that affect health. These interventions can have the greatest potential to affect health because they influence the entire population, in contrast to focusing on one individual at a time. However, it may take generations to see the effects of interventions designed to change socioeconomic factors. Clinical -Community Linkages Clinical -community linkages receive special attention because they are required to ensure the success of strategies identified in the RHIP. The Agency for Healthcare Research and Quality (AHRQ) recommends clinical - community linkages that help to connect healthcare providers, community organizations, and public health agencies. Creating sustainable, effective linkages between the clinical and community settings can improve patients' access to preventive and chronic care services by developing partnerships between organizations that share a common goal of improving the health of people and the communities in which they live. These linkages connect clinical providers, community organizations, and public health agencies. The goals of clinical -community linkages include: • Coordinating healthcare delivery, public health, and community-based activities to promote healthy behavior. • Forming partnerships and relationships among clinical, community, and public health organizations to fill gaps in needed services. • Promoting patient, family, and community involvement in strategic planning and improvement activities Strategies that improve access to clinical preventive services (such as screening and counseling), community -level activities, and appropriate medical treatment have been shown to reduce and prevent disease in communities. 7 1 Introduction 8 1 Community Input The Operations Council of the Central Oregon Health Council (COHC) used a community driven strategic planning process, "Mobilizing for Action through Planning and Partnership (MAPP)," to guide creation of the Central Oregon RHA and RHIP. The RHA includes data and information that describes the health status of Central Oregon residents. Input on the assessment was solicited from the COHC's Board of Directors, Community Advisory Council, Provider Engagement Panel, county and regional health-related advisory boards and groups, and during community meetings in Crook, Deschutes, and Jefferson counties. During June through August 2015, partners completed a series of regional community and professional meetings to understand community, partner, and stakeholder perceptions related to health issues and forces of change that influence Central Oregon. The input and information gathered from these meetings established the RHIP priority areas and laid the foundation for the plan. Two documents summarize results of the RHA: the "2015 Central Oregon Regional Health Assessment" and "Community Conversations: Creating the Regional Health Assessment and Health Improvement Plan, 2015." Both of these documents can be found at this link: http://cohealthcouncil.org/regional-assessments/. From September through December 2015, the Operations Council developed the RHIP with input solicited from local experts, the COHC's Board of Directors, Community Advisory Council, Provider Engagement Panel, and health-related advisory boards and groups in Crook, Deschutes, and Jefferson counties. Evidence -based goals and strategies to address the priority areas were developed with input from Operations Council members, and with external expert guidance and support. These priorities, goals, and strategies became the outline for the RHIP. To ensure new information aligns with community perception, community input and collaboration will be an ongoing activity. How This Pian Is Organized The health issues addressed in this plan were identified by a number of processes. Healthcare professionals and community stakeholders from the Operations Council completed the initial process with a scoring method using assessment data and information. The second process was completed by members of the Community Advisory Council using selection criteria based on intimate knowledge of communities and the region. The third process was a combined meeting with members of the COHC Board of Directors, Community Advisory Council, and the Operations Council. During this meeting these members reviewed the highest priorities from the Operations Council and the Community Advisory Council meetings. The health improvement priorities that surfaced during the joint meeting were: • Behavioral Health (Identification & Awareness/Substance Use & Chronic Pain) • Cardiovascular Disease • Diabetes • Oral Health • Reproductive and Maternal/Child Health • Social Determinants of Health Introduction 9 1 How this Plan is Organized (continued) The plan includes evidence -based strategies to address the health improvement priorities arranged as follows: • Prevention/health promotion • Clinical • Policy • Health equity • Health system/access • Childhood health This plan has the requisite focus to ensure efforts are not so diluted as to become ineffective, but also attends to the interrelationships among the health improvement priorities selected. Arranging the plan as described above highlights where strategies impact more than one health condition and where addressing one health behavior can impact more than one health condition. For example, a prevention and health promotion strategy in Behavioral Health Identification and Awareness is alcohol, tobacco, and other drug health curriculum consistently and accurately being taught in schools to align with Oregon Department of Education (ODE) standards for health and evidence -based practice. This strategy aligns with prevention and health promotion efforts for cardiovascular disease as well, due to the linkages between tobacco and cardiovascular disease. Furthermore, while the plan focuses on specific priorities, the final chapter emphasizes the need to address the broader social determinants of health, where we have the greatest potential to impact the health of the entire population and "whole person" health. Implementation of the plan will require further integration of public health, healthcare, behavioral health and human services at the individual, provider, system, community and regional levels. It is also intended to encourage positive change in our delivery systems to improve access, encourage efficiency, improve quality, and achieve measurable improvements in health outcomes. The COHC did not identify workforce development as a priority area of the RHIP—largely because it is implicit in all of the work outlined in this guiding document. The COHC acknowledges that none of the work proposed in the RHIP to address regional health improvement priorities or address social determinants of health will be possible without the work conducted by community partners to recruit, train, and educate employees. The COHC, working by and through its community partners, is eager to participate in efforts to expand workforce development opportunities. It is not possible to overstate the connection between stable and living wage jobs for a well-developed workforce and a healthier Central Oregon. Implementation and Accountability The RHIP includes specific measurable health indicators for each of the priority areas that will be addressed from 2016 through 2019. This will allow us to track our progress, celebrate achievements, and change course when desired outcomes are not being met. Work plans with specific timelines will guide implementation of strategies and will document progress made. The COHC and its committees will take the lead on implementing and tracking progress and will provide updates to the community. Further, regional health system partners have committed to use the RHIP as a guiding document for developing their organization -specific strategic plans. Behavioral Health Identification and Awareness The Problem Stigma and the lack of integrated care pathways lead to a dramatic under -assessment and treatment of behavioral health issues in primary care settings. There is considerable overlap between poor outcomes for chronic diseases and significant mental health and substance use problems. Approaches for preventing or treating chronic diseases need to address the whole person and their environment, particularly targeting screenings and support for mental health and substance use issues. Per capita costs among Medicaid -only beneficiaries with disabilities for coronary heart disease is nearly triple for people who also have co-occurring mental health and substance use disorders (SUDs) compared with people without either (Boyd, et al., 2010). Per capita costs are 3.8 times higher for diabetics with co-occurring mental health and substance use disorders than for diabetics with neither mental health nor substance use disorders (Boyd, et al., 2010). Individuals with depression average twice as many visits to their primary care doctor than do non-depressed patients and have nearly twice the annual healthcare costs. (Mauer & Jarvis, 2010). The risk factors for depression and chronic diseases are bi-directional, with chronic diseases increasing the risk of depression, and conversely, depression increasing the risk of chronic diseases. Depression and unhealthy alcohol use is present in a significant percentage of people with diabetes and cardiovascular disorders. Depression has been proven to be such a risk factor in cardiac disease that the American Heart Association has recommended that all cardiac patients be screened for depression (AHA 2008). The presence of Type 2 diabetes nearly doubles an individual's risk of depression and an estimated 28.5% if diabetic patients meet criteria for clinical depression (Mauer & Jarvis, 2010). People with mental illness, substance use disorders (SUDs), or both are at increased risk for developing diabetes. Untreated behavioral health disorders can exacerbate diabetes symptoms and complications. In addition, companion features of behavioral health disorders — such as poor self-care, improper nutrition, reduced physical activity, and increased barriers to preventive or primary care — can adversely affect management of co-occurring diabetes (SAMHSA Advisory, 2013). The majority of people who use alcohol at levels that impact their physical health and behavioral health do not meet dependency criteria and are inappropriate for specialty treatment programs. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence -based practice that targets patients in primary care with nondependent substance use. It is a strategy for intervention prior to the need for more extensive or specialized treatment. The utilization rate of SBIRT in Central Oregon remains at a fraction of the State benchmark, blunting the impact of this evidence -based practice. When primary care practitioners do identify a severe substance use disorder in a patient, the rate of successful referral to specialty SUD care remains very low, mainly due to low readiness -to -change in the patient, no system to develop the motivation, and close collaboration necessary for a successful treatment referral. Behavioral Health Identification and Awareness Goals Clinical Goals 1. Increase screenings for depression, anxiety, suicidal ideation, and substance use disorders. 2. When screenings are positive, increase and improve primary care -based interventions, and, when appropriate, referrals and successful engagement in specialty services. Prevention Goal Normalize the public's perception of accessing resources for depression, anxiety, suicidal ideation, and substance use. Health Indicators by2019 QIM :stateHP Measure Measure 20202 0 1. Number of SBIRT/CRAFFT screenings provided in healthcare settings shall exceed 12% (Oregon Health Authority, 2015). 2. Number of Depression screenings and follow-up care provided in healthcare settings shall exceed 25% (Oregon Health Authority, 2015). 3. First year develop a baseline of successful referral and engagement in specialty care from primary care. Second year develop performance improvement benchmarks. J Action Area Strategy Prevention and Health Promotion • Implement a program like the "Mind Your Mind" campaign. • Social/emotional health curriculum taught in schools aligned with Oregon Department of Education (ODE) standards for health and evidence based practice. • Alcohol, tobacco, and other drug health curriculum taught in schools aligned with ODE standards for health and evidence based practice. • Implement a low risk drinking guideline (compliment to SBIRT) in the community. Behavioral Health Identification and Awareness Action Area Strategy Clinical Policy Health Equity Health System/ Access 12 1 • Create a comprehensive identification and response system that is reflective of the entire primary care practice (from appointment scheduling to office visit). • Use SBIRT/CRAFFT, PHQ 2 & 9, GAD -7, and other evidence -based screening tools within healthcare settings. • Create a common response matrix that clinics could adopt, including physician intervention, BHC intervention, short-term BH intervention at PCP clinic, and referral to specialty BH services. • Create pathway/mapping for referral to specialty care. • Create clear referral and communication protocols. • Health information shared with primary care coordination team for review and provider follow up. • Ongoing regional trainings in screening tools and brief intervention response. • Promote policies that support routine screening and follow-up care for Substance Use, depression and anxiety. • Promote policies that support public awareness and acceptance of mental health and substance use wellness strategies. Screenings, interventions, and specialty services need to be culturally and linguistically specific in order to be successful. Please refer to the chapter on social determinants of health for additional strategies. • The creation of a common response matrix to screenings (i.e., brief provider intervention, BHC, or referral to specialty clinic) will improve the number of screenings and spread the cost-effective utilization of behavioral health interventions in healthcare settings. • Increased public awareness of the role of behavioral health wellness in overall wellness will improve patient acceptance of behavioral health screenings. • Assessment of resource needs within the community that will be addressed in partnership through multiple organizations, such as payees, public health, hospital, etc. Behavioral Health Identification and Awareness Action Area Strategy Childhood Health • Substance use and depression are significant contributors to poor childhood health. Regular screening and follow-up care will increase childhood health outcomes. Examples of Key Partnerships 13 1 • Health systems and healthcare providers • Public health departments • High schools (school nurses, school-based health centers) • School boards • Places of worship • Employers • Colleges • Addictions and treatment centers • State health promotion and prevention programs Behavioral Health Substance Use and Chronic Pain 1 The Problem People with severe Substance Use Disorders (SUDs) also carry a high medical burden and respond poorly to medical interventions, leading to extremely high utilization rates. The current disjointed practice pattern between medical care and specialty SUD services actually contributes to poor medical and behavioral health outcomes and increases the number of people with Opioid Use Disorder. In a large-scale review of adult Medicaid beneficiaries in six states in 1999, between 16% and 40% of beneficiaries had diagnoses of moderate to severe substance use disorders (SUDs). In all states SUDs, were associated with higher rates of hospitalization for inpatient psychiatric and medical care. Importantly, beginning at age 50, medical costs for persons with SUDs almost doubled (Clark, Samnaliev, & McGovern, 2009). People with moderate-to-severe SUDs have nine times greater risk of congestive heart failure (Mertons, et al., 2003), likely due to poor nutrition, little exercise, and high rates of smoking in combination with the impact of their substance use. The comorbid combination of alcohol abuse, depression, and diabetes is often common in homeless and Native American populations (Am Indian Alsk Native Mental Health Rev, 2007). According to a 2008 study by the Oregon Division of Addiction and Mental Health, people with co-occurring mental health and SUDs have an average age at death of 45 years. Providing SUD treatment to those who need it has been shown to slow disease progression and growth in medical costs (Mancuso & Felver, 2010). There has been a dramatic increase in opioid prescription drug availability over the past 15 years, which has resulted in an equally dramatic increase in prescription drug abuse and the related increase in heroin use in Central Oregon. In this manner, prescription practices by physicians can have serious public health consequences. The opioid -related unintentional prescription drug mortality rate has tripled in Oregon since 2000. The 5 -year average age-adjusted opioid -related unintentional prescription drug mortality rate in Central Oregon was 3.6/100,000 population (95% CI 2.5-5.1) (CDC Wonder, 2009-2013). The 5 -year average rate in Oregon during this time period was 4.1/100,000 population (95% CI 3.8-4.4). Injection drug users are the largest single risk group for Hepatitis C (CDC Surveillance for Viral Hepatitis 2013). Surveys have indicated that within one year of use, 50-80% of injection drug users test positive for the Hepatitis C antibody. Nationally, there was a 151.5% increase in acute Hepatitis C cases from 2010 to 2013, largely attributed to drug use (CDC 2013). With Central Oregon experiencing a significant increase in prescription opiate and heroin use, the region can expect to see an increase in Hepatitis C rates. Finding alternative resources to opioids for people suffering from chronic, non -cancer pain is one of the highest priorities identified by local physicians. To decrease the chronic over -availability of prescription opiates in our community requires, in part, providing evidence -based holistic approaches to chronic, non -cancer pain. 14 1 Behavioral Health Substance Use and Chronic Pain Goals Clinical Goal Create a bi-directional integration approach for people with severe substance use disorders. Prevention Goal Implement a community standard for appropriate and responsible prescribing of Opioids and Benzodiazepines. Health Indicators by 2019 I Increase the rate of successful referrals from medical settings to specialty SUD services of people with moderate-to-severe SUDS. 2. First year develop a baseline on the pharmacy, hospital, acute psychiatric, and emergency department expense related to people with moderate-to-severe SUDs. Second year set performance improvement benchmarks. 3. First year develop a baseline for number of people receiving greater than 120 mg morphine equivalent for more than three months. QIM State HP Measure Measure 2020 J Action Area Strategy Prevention and Health Promotion 15 1 • Expand Prescription Drug Monitoring Program (PDMP) use by primary care providers. • Develop plan for implementing alternative & complimentary pain treatment therapy. • Compassionate care education for community providers. • Expand needle exchange programs. • Expand the availability of Naloxone. • Expand medication disposal programs. • Develop a process and care path for affected family and children to impact ACEs and behavioral health factors. Behavioral Health Substance Use and Chronic Pain Action Area Strategy Clinical Policy Health Equity 16 1 • Develop high functioning patient pathways from hospital and primary care settings into SUD specialty care. • Create a "Hub and Spoke" model for Medication Assisted Treatment (MAT) that links the MAT specialty provider with (a) other SUD and mental health providers, and (b) primary care providers. • Create an efficient, effective, and coordinated system of outreach, engagement, and care coordination services to medically significant populations, including: pregnant women who still use drugs, people who use illicit IV drugs, identified high utilizers of medical and pharmacy services, identified utilizers of mental health acute care services, and identified hospital patients. • Provision of cost-effective medical/nursing support and alternative chronic pain management/chronic disease management skills training in selected SUD specialty care programs. • Implementation of an outcomes system for each of the above four strategies focused on engagement and retention in specialty SUD services and on patterns of healthcare utilization. • Support the efforts of the Chronic Pain Task Force to educate physicians to best practice standards and to support alternative pain management strategies. • Advocate with OHA to make alternative and complimentary pain treatment therapy a reimbursable service. • Support legislation to make Naloxone available through the pharmacy without a physician's prescription. • Expand needle exchange and harm reduction education for people injecting illicit drugs. • Expand prescription drug return programs. • Cultural and language specific treatment strategies for Latino clients. • Safe and sober housing availability. • Intentional Peer Support outreach for severely disadvantaged people with SUDs, including people who are homeless, Native American, public inebriates, IV drug users, and pregnant women who use drugs. • Support employment strategies for people with criminal records. • Please refer to the chapter on social determinants of health for additional strategies. Behavioral Health Substance Use and Chronic Pain Action Area Strategy Health System/ Access Childhood Health • Make available SUD engagement services at hospitals and primary care clinics. • Identification of clients in SUD services who have high medical burden and develop, with the PCP, a whole healthcare and support plan. • Development of alternative and complementary pain programs widely available in the community. • Develop a community care plan for impacted children and family. • Substance use is a significant predictor to all of the Adverse Childhood Events (ACEs). Treating the parent, who has a severe substance use disorder, decreases the number of ACEs a child experiences and increases that child's resiliency, thus improving long-term health status. Examples of Key Partnerships 17 1 • Health systems and healthcare providers • Public health departments • High schools (school nurses, school-based health centers) • School boards • Places of worship • Employers • Colleges • Addictions and treatment centers • State health promotion and prevention programs • Sheriff and Police Departments in Central Oregon Cardiovascular Disease The Problem Cardiovascular disease (CVD) is a classification of diseases of the heart and blood vessels that includes chest pain, heart attack, and other conditions that affect the heart muscle, rhythm, or valves. Cardiovascular diseases are preventable with good nutrition and exercise, and by remaining tobacco free. People with cardiovascular disease or who are at high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes or hyperlipidemia) need early detection and management using counseling and medications, as appropriate. Smoking causes one of every three deaths from CVD, according to the 2014 Surgeon General's Report on smoking and health. It is a leading cause of preventable death in the US and doubles a person's risk for stroke (USDHHS, 2014). Nearly one in three adults in Crook County, one in six adults in Deschutes County, and one in four adults in Jefferson County report smoking tobacco. Age-adjusted prevalence of adult current smokers (Oregon BRFSS, 2010-2013) 35 - 30 25 - 20 15 - 10 - 5- 0 Oregon §National Health Inteview Survey, 2011 Crook Deschutes Jefferson The most common type of CVD in the United States is coronary artery disease, which affects the blood flow to the heart. It is one of the leading causes of death in Oregon and the US. In fact, among males and females admitted to St. Charles facilities in Central Oregon, 21% and 14%, respectively, were for CVD events (St. Charles Health System, 2014). Cerebrovascular disease is another major form of CVD that affects blood flow in the brain. Stroke is one of the cerebrovascular diseases and is a leading cause of death and disability. A stroke is caused by a blood vessel breaking or an artery becoming clogged in the brain, which leads to reduced blood flow and brain damage. Knowing the signs and symptoms of stroke can save lives. 18 1 Cardiovascular Disease 19 1 Goals Clinical Goal Improve hypertension control. Prevention Goal Increase awareness of the risk factors for cardiovascular disease including tobacco use, uncontrolled hypertension, high cholesterol, obesity, physical inactivity, unhealthy diets, and diabetes. QIM State HP Measure M� Health Indicators by 2019 Measure 2020 t r Increase the percentage of OHP participants with high blood pressure that is controlled (<140/90mmHg) from 64% to 68% (Baseline: QIM NQF 0018 - Controlling high blood pressure, 2014). • Decrease the prevalence of cigarette smoking among adults from 18% to 16% (Baseline: Oregon BRFSS, 2010-13; QIM Cigarette Smoking Prevalence). Decrease the prevalence of smoking among 1 lth and 8th graders from 12% and 6%, respectively to 9% and 3%, respectively (Baseline: Oregon Healthy Teens Survey, 2013). Decrease the prevalence of adults who report no leisure time physical activity from 16% in Crook County, 14% in Deschutes County and 17% in Jefferson County to 14%, 12%, and 15 % respectively (Baseline: Oregon BRFSS, 2010-13). Decrease the prevalence of 1lth graders and 8th graders who have zero days of physical activity from 11% and 6% to 10% and 5%, respectively (Baseline: Oregon Healthy Teens, 2013) J J Action Area Strategy Prevention and Health Promotion • Encourage healthcare providers to increase referrals, including electronic referrals, to the Oregon Tobacco Quit Line. • Promote the Oregon Health Authority statewide Smokefree Oregon campaign for youth. • Offer training and assistance to healthcare providers to implement "2As and R" or "5As" tobacco cessation counseling. • Implement a community-based educational campaign on blood pressure control (i.e., Measure Up/Pressure Down). • Engage community-based organizations (schools, dentists, colleges, employers, hospital, etc.) in an educational program/campaign around BP control and monitoring and CVD relationship. • Engage employers to offer worksite health promotion programs that support improved employee weight status by targeting nutrition and physical activity Cardiovascular Health Action Area Strategy Clinical Policy Health Equity Childhood Health • Implement evidence -based guidelines for the control of hypertension. • Provide assistance to patients to self -monitor blood pressure, either alone or with additional support. • Increase referrals to the Oregon Tobacco Quit Line. • Implement "2As and R" or "5As" tobacco cessation counseling. • Implement a tobacco retail licensing program that will eliminate illegal sales to minors, prevent retailers from selling tobacco within 1000 feet of schools, raise the age of purchase to 21, and eliminate sales of flavored tobacco products. • Increase the number of schools using the CDC School Health Index to improve their health policies and programs. • Encourage healthy community design and policies that increase opportunities for physical activity, access to healthy foods, and other health -enhancing features. • Identify, develop and implement culturally competent materials and programs such as Smokefree Oregon ads for culturally disparate populations. • Please refer to the chapter on social determinants of health for additional strategies. • Engage schools to promote CVD prevention using best -practice, school- based model. Examples of Key Partnerships • Health systems and healthcare providers • Public health departments • High schools (school nurses, school-based health centers) • School boards 20• Places of worship Employers • Colleges • State health promotion and prevention programs • Farmers markets • Grocery stores Diabetes 21 1 The Problem Diabetes is characterized by having high blood sugar levels and can lead to serious adverse outcomes if left untreated. There are several types of diabetes, including type 1, type 2, and gestational diabetes. Type 1 diabetes is an autoimmune disorder usually diagnosed at an early age. Type 2 diabetes, which makes up 95% of diabetes cases, is often diagnosed in adulthood (Lloyd -Jones D, et al., 2009). Gestational diabetes is a condition that affects pregnant women and often goes away once the baby is born. If left untreated, gestational diabetes may cause problems for the mother and baby. In addition, gestational diabetes puts women at increased risk for later developing type 2 diabetes. Prediabetes is a condition in which an individual has blood sugar levels that are elevated but not high enough to be considered diabetes. In all cases, a diagnosis of diabetes has significant impacts on quality of life. If left untreated or poorly managed, diabetes can lead to major life-threatening and costly complications including kidney disease, blindness, cardiovascular disease and lower extremity amputations. Many of the risk factors for prediabetes, diabetes and cardiovascular disease are the same and include physical inactivity, overweight/obesity, high blood pressure, tobacco use, and an unhealthy diet. This means that many individuals can focus on adopting the same healthy strategies to prevent the most common chronic health problems. Strong evidence shows that lifestyle interventions for persons at risk for developing diabetes significantly reduces risk of developing type 2 diabetes (DPP Research Group, 2009). These programs include coaching and counseling to maintain a healthy weight, increasing physical activity, eating healthy, and controlling hypertension, and can reduce the risk of developing type 2 diabetes as well as cardiovascular disease. In Oregon, 9% of adults reported having diabetes in 2013, reflecting a doubling in prevalence over the past 20 years (Oregon Health Authority, 2015). For these adults, a key element of diabetes control is self-management education. Recent studies estimate that more than 1 out of 3 US adults (38%) — or 1 million Oregon adults have prediabetes; 9 out of 10 adults with prediabetes are not aware they have it (CDC, 2014). American Indians/Alaska Natives, African Americans and Latinos have a higher prevalence of diabetes than non -Latino Whites. Percent of adults with diabetes who reported having received key diabetes self-management education (Oregon BRFSS, 2011) 80 70 60 c 50 L 40 a30 20 10 0 AIC checked 2+ times by HCP in the last year Ever taken a class on managing diabetes Note: Not all measures match HP goals Eye exam within the past year Self blood glucose monitoring 1+ times per day — HP 2020 goal Foot monitoring 1+ times per day Diabetes Goals Clinical Goal Improve control of type 2 diabetes. Prevention Goal Decrease the proportion of adults and children at risk for developing type 2 diabetes. Health Indicators by 2019 astate HP �Mesure�Measure 2020 Decrease the prevalence of adults who are overweight (BMI 25 to 29.9) from 33% to 31% (Baseline: Oregon BRFSS 2010-13). Decrease the prevalence of l lth graders and 8th graders who are overweight from 14% and 16%, respectively, to 13% and 14%, respectively (Baseline: Oregon Healthy Teens, 2013). Decrease the percentage of OHP participants 18-75 years of age with diabetes who had HbAlc >9.0% from a baseline of 14.7% to 11% (Baseline: QIM NQF 0059 - Diabetes: HbAlc Poor Control, 2014). Increase the percentage of OHP participants 18-75 years of age with diabetes who received an annual HbAlc test from a baseline of 77% to 87% (Baseline: NQF 0057 - Oregon State Performance Measure, 2014). Decrease the percentage of OHP participants with BMI greater than 30 from 31.5% to 30.9% (Baseline: Oregon State Core Performance Measure, MBRFSS 2014). 1 J J Action Area Strategy 22 1 Prevention and Health Promotion • Implement a Diabetes Prevention Program (DPP). • Increase availability of diabetes self-management programs. • Engage employers to offer worksite health promotion programs that support improved employee weight status by targeting nutrition and physical activity. • Partner with grocery stores and farmers markets to increase pre -diabetes and diabetes awareness programs. • Develop targeted strategies to improve Diabetic Medication Adherence (i.e.: refrigeration, MedMinders, etc.). • Create partnership with Parks and Recreation offices to offer peer led exercise sessions. Diabetes Action Area Strategy Clinical Policy • Increase referrals to diabetes self-management and prevention programs. • Improve medication adherence among patients with diabetes. • Increase postpartum screening and follow-up for patients with gestational diabetes. • Increase the use of case management interventions for patients with diabetes with CCO support for clinic innovations. • Improve coordination between medical and dental providers to provide the tools and education needed about the correlation between oral health and diabetes (i.e.: Dental Medical Integration (DMI) Project). • Increase the number of schools using the CDC School Health Index to improve their health policies and programs. • Increase provider and community referrals to the Spanish language Tomando Control chronic disease self-management program. • Create diabetes awareness campaigns that are culturally aligned, health Health Equity literate, and community specific. • Encourage healthy community design and policies that increase opportunities for physical activity, access to healthy foods, and other health -enhancing features. • Please refer to the chapter on social determinants of health for additional strategies. Health System/ Access Childhood Health 23 1 • Engage health systems to implement systematic EHR referrals to diabetes self-management and prevention programs. Improve provider and community awareness of diabetes self-management programs. Promote coordinated school health programs that prevent risk behaviors that contribute to heart disease and stroke: o Maintain or establish enhanced physical education classes. o Prohibit withholding recess as punishment. • Engage schools to provide evidence -based interventions to promote physical activity and nutrition education in schools. Diabetes Examples of Key Partnerships 24 1 • Health systems and healthcare providers • Public health departments • Grocery stores • Farmers markets • Schools (policies around PE and physical activity during school hours) • Parks and Recreation officials • Pharmacies • Employers • Health clubs • Places of worship • Non-profit organizations Oral Health The Problem The health of the mouth and surrounding structures is central to a person's overall health and well-being. Dental caries (cavities) is a communicable infectious disease most frequently caused by the bacterium Streptococcus mutans. Preventing the transmission from one person to another or controlling bacteria load in the mouth is possible and can eliminate or decrease tooth decay. Dental caries is the most common chronic disease among children and is 5 times more common than asthma (American Academy of Pediatric Dentistry, n.d.). Untreated decay or other oral health problems in children can result in attention deficits, learning and behavior challenges in school, and problems speaking, sleeping and eating (The California Society of Pediatric Dentistry and California Dental Association, n.d.). In Central Oregon, one-quarter to one-half of first and second graders that were screened in selected Central Oregon schools had untreated tooth decay (Kemple Memorial Children's Dental Clinic, n.d.). Moreover, between 71.7% and 76.3% of Central Oregon 8th graders reported having at least one cavity, and between 4.8% and 6.4% missed one or more hours of school due to going to the dentist because of tooth or mouth pain (Oregon Health Authority, 2015). Among adults, poor oral health may negatively affect a person's ability to obtain or keep a job and form relationships (National Institute of Dental and Craniofacial Research, 2000). In Central Oregon, one safety net clinic reported 40% of low-income patients seeking care for their physical health had dental issues that impacted their ability to eat or sleep (Volunteers in Medicine, 2013). Nationally, employed adults lose more than 164 million hours of work each year due to dental disease and dental visits (Centers for Disease Control and Prevention, 2006). Poor oral health is also associated with adverse pregnancy outcomes and other disease and conditions such as diabetes, cardiovascular disease, stroke and respiratory disease (National Institute of Dental and Craniofacial Research, 2000). Limited data exists regarding the older population but the 2014 Strategic Plan for Oral Health states that 33% of Oregonians ages 33-44 still have all of their teeth, while 37% of individuals age 65 and over have lost six or more teeth (Oregon Oral Health Coalition, 2014). Minorities and low-income populations are significantly more likely to report oral health problems (World Health Organization, 2012). Oral Health Goals Clinical Goal Improve oral health for pre and post -natal women. Prevention Goal Keep children cavity -free. Health Indicators by2019 Q1N1 state HP Measures Measure:; 2020 1. By 2019, increase the percent of pre and postnatal women who had a dental visit from 55.2% to 60% (Baseline: PRAMS, 2011). 2. By 2019, increase the percent of children 6-14 years who received a dental sealant to 20% (Baseline: Oregon Health Authority, 2015). 3. By 2019, decrease the percent of 1st and 2nd graders with untreated dental decay in schools that participate in the School Dental Sealant Program by 5% (Baseline: School Dental Sealant Program, 2013-2014). 4 By 2019, decrease the percent of 8th graders who missed one or more hours of school due to going to the dentist because of tooth or mouth pain by 0.5% (Baseline: Oregon Health Teens Survey, 2013). 5 By 2019, increase the percent of children 0-5 years who received a dental service within the reporting year to 40% (Baseline: PRAMS, 2011). J J 1 Action Area Strategy 26 1 Prevention and Health Promotion Partner Dental Care Organizations (DCOs) with pediatricians to provide post -natal moms with oral hygiene instruction and 90 day supply of xylitol at two-week post -natal visit. • Provide education to providers asking the One Key Question® regarding importance of a dental visit prior to pregnancy. • Decrease fear of the dentist by increasing provider awareness of Adverse Childhood Experiences (ACEs). • Work with schools to ensure children receive toothbrush kits on a regular basis. • Work with community-based entities to increase outreach, education, and intervention to underserved individuals. • Assess oral health literacy. • Implement Brush, Book, Bed (AAP). • Provide nutrition counseling. • Provide tobacco cessation resources. Oral Health Action Area Strategy Clinical Policy Health Equity Health System/ Access 27 1 • Patients who indicate they plan to get pregnant in the next year get referred into dental care. • Deliver preventive dental services to children and pregnant women in non- traditional settings. • Primary care clinician prescribes oral fluoride supplementation starting at 6 months of age for children whose water supply is deficient in fluoride. • Primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. • Develop policies and practices to fast track pregnant women into dental care. • Work with legislators to include fluoridated toothpaste in the SNAP benefits. Work with legislators to get fluoridated toothpaste to be covered as a prescription benefit for OHP members. • Adopt trauma -informed care model policies within dental practices. • Adopt a policy to see patients in the first year of life within dental practices. • Establish optimally fluoridated community water systems. Business practices and services will be culturally and linguistically competent in all dental locations. Please refer to the chapter on social determinants of health for additional strategies. • Integrate oral healthcare into the standard practice of care for all healthcare settings. • All providers, including school-based health centers, shall adopt a minimum of two questions to assess oral health status and refer as appropriate. • All primary care providers and primary care dentists shall adopt the One Key Question® and make appropriate referrals based on intent to become pregnant. • All primary care providers, behavioral health professionals, and primary care dentists will administer or have knowledge of their patients' ACEs score. • OB/GYN practices shall adopt policies/practices to assess oral health and refer to care. • Expand comprehensive community-based oral health. • Expand First Tooth program beyond clinic providers to include home visitors and lay persons such as licensed childcare workers and school nurses. Oral Health Action Area Strategy Childhood Health • See previous Oral Health Action Areas and Strategies that address Childhood Health through their efforts. Examples of Key Partnerships 28 1 • Health systems and healthcare providers • Public health departments • High schools (school nurses, school-based health centers) • School boards • Places of worship • Employers • Colleges • State health promotion and prevention programs Reproductive & Maternal Child Health The Problem Maternal and child health indicators describe the health and well-being of mothers, infants, children, and families. A mother's health and well-being before, during, and after pregnancy has direct and sometimes lifelong effects on the health of her child. As a focus of maternal child health, low birth weight (LBW) is a serious public health challenge. Babies who have very LBW can be at higher risk of death and other complications as they grow up. LBW infants are more likely to die before their first birthday and more likely to suffer from cognitive development issues and chronic health conditions, such as high blood pressure and asthma. The problems associated with LBW also continue into adulthood: Compared to their peers, LBW individuals attain less education and earn less income. LBW is associated with tobacco, alcohol, and drug use; lack of early prenatal care, lack of maintaining a healthy weight. In Central Oregon, 77.9% of infants received prenatal care in the first trimester as compared to 77.8% in Oregon (OHA — Performance Measures, 2015). Differences between the counties in 2014 show Deschutes at 81%, Crook at 70.4%, and Jefferson at 68.5% (OHA, 2014). Timeliness of prenatal care is a current quality incentive measure for the CCO. Table t Percent of women on OHP versus private The rate per 1000 for smoking insurance who smoked during pregnancy during pregnancy was six times higher among women enrolled in OHP in Central Oregon than those with private insurance as Private 3.9 demonstrated by the inset table. Cigarette smoking prevalence is a 2016 CCO quality incentive measure. 6.6 2.5 3.1 Unintended pregnancy refers to pregnancies that are mistimed, unplanned, or unwanted. About 51% of pregnancies in the United States are unintended (Guttmacher Institute, 2015). Measuring rates of unintended pregnancy helps gauge a population's needs for contraception and family planning. Unintended pregnancy is associated with increased risk of health problems for the baby as the mother may not be in good health or delay prenatal care upon learning of the pregnancy. Almost 50% of pregnancies in Oregon are unintended, and have been for more than three decades (Finer & Kost, 2011). In 2011, the most recent year for which there is state - level data on pregnancy intentions, there were 45,136 births, 37% of which were considered unintended. That year there were 9,567 elective abortions. Also in 2011, the unintended pregnancy rate was 36.6% for Oregon, 38.8% for Central Oregon, 37.7% for Deschutes County, and 35.3% for Jefferson County. The total unweighted denominator for Crook County was too small to report. (OHA, 2011; PRAMS, 2011). A published study in 2013 found that Medicaid paid for approximately 63% of unintended births in Oregon (Sonfield & Kost, 2013). Among women ages 19 and younger, more than four out of five pregnancies were unintended. The proportion of unintended pregnancies is highest among teens younger than 15 years, with 98 percent of these pregnancies being unintended (Finer and Zolna, 2014). 2 Immunizations are a key public health measure for preventing the spread of disease. A series of immunizations are delivered to children to ensure their immunity to many diseases. The trend over the past few years has shown a decrease in the immunization rates and there have been outbreaks throughout the nation. Central Oregon's rates have decreased to a point of concern. As noted in the 2015 Regional Health Assessment, two -year-olds in Jefferson County were more frequently up to date with immunizations than were two -year-olds in Crook and Deschutes County. Central Oregon practices and public health departments who provide vaccinations should assess and develop approaches to increase immunization rates in their practices to improve the health of Central Oregon children. 1 Reproductive & Maternal Child Health Goals Clinical Goal Reduce the prevalence of low birth weight among live-born infants by improving prenatal/postnatal care for mothers and infants. Prevention Goals Prevent unintended pregnancies. Improve immunization rates of children birth to two years. Health Indicators by 2019 By 2019, increase the number of women in Central Oregon who receive prenatal care beginning in the first trimester from 86% to 90% (Baseline OHA: Performance Measures - Central Oregon Region - PS - May 2015; Oregon Health Authority 2013: Crook (77.8) Deschutes (81.0) Jefferson (66.3) (Baseline: Healthy 2020 - 70.8%). By 2019, decrease the percent of tobacco use among Central Oregon pregnant women from an average of 12.1% to 7.0% (Baseline: Oregon Health Authority Annual Report, 2013; Crook (15.0%) Deschutes (9.8%) Jefferson (11.4%) (Tobacco Smoking Prevalence - 2016 Metric). By 2019, reduce low birth weight (LBW) (less than 2500 g {less than 5 lbs. 8 oz.}) to an incidence of no more than 5% of live-born infants in Central Oregon (Baseline: OHA, 2014; Healthy People 2020 - Goal). By 2019, increase effective contraceptive use among women of childbearing age in Central Oregon from 31.4% to 50% (Baseline OHA: Performance Measure - Central Oregon Region - PSCS - May 2015). 5. By 2019, increase the Central Oregon State Performance Measure - Child Immunization Status rate (0-24 months) (NQF 0038) from 62.1% to 80% (Baseline OHA: Performance Measure - Central Oregon Region - PS - May 2015; Immunization Rates, Oregon, 2014 (4.3.1.3.3.1.4) Crook (63%) Deschutes (60%) Jefferson (70%); Healthy People 2020 - 80%. QIM State HP Measure Measure 2020 J J J 1 J J 1 Reproductive & Maternal Child Health 31 1 Action Area Strategy Prevention and Health Promotion Clinical Policy • Increase 2 -year-old children immunization rates by implementing the Central Oregon Regional Immunization Rate Improvement Project (IRIP) in Deschutes, Crook and Jefferson County using the AFIX Program in Coordinated Care Organization (CCO) participating clinics. • Expand prenatal and postnatal home visiting services to high-risk women in Central Oregon (NQF 1517). • Provide home visits with the intent of educating on topics that include vaccinations, tobacco, alcohol, and key referrals for community resources. • Screen women for their pregnancy intention on a routine basis by implementing "One Key Question© with all providers in Central Oregon. • Support and promote contraception immediately following pregnancy. • Provide referral to oral health services in pregnancy. • Provide evidence -based community messaging and curricula to adolescents focusing on preventing unintended pregnancy, HIV/AIDS, and STIs. Ensure timely access to contraceptives and STI support. Support the initiation and sustainment of breastfeeding for new mothers with programs such as WIC, home visiting and "Baby -Friendly" hospitals. • Screen 100% of pregnant women and refer them to appropriate medical, dental, behavioral and social services. • Implement the "2As and R" and "5As" tobacco cessation and counseling in all healthcare settings. • Increase referrals of pregnant women who use tobacco to the Oregon Tobacco Quit Line. • Promote the inclusion of age appropriate, medically accurate sexual health education in our schools (ODE, HB2509 — ORS336.455). • Promote policies that support barrier free access to contraceptives. • Promote policies that increase access to prenatal care with equity and rural concerns considered. • Promote policies that support the use of LARC (long acting reversible contraceptives) as the most effective birth control option for women at highest risk for pregnancy. Health Equity ' Please refer to the chapter on social determinants of health for additional strategies. Reproductive & Maternal Child Health Action Area Strategy Health System/ Access Childhood Health • Implement universal nurse home visiting (Family Connects) as part of a regional perinatal continuum of care system in partnership with public health, primary care medical providers and the CCO. • Expand access/marketing to improve effective contraceptive rates in primary care and public health. • Reduce child maltreatment using evidence -based home visiting programs (i.e., Family Connects, Healthy Families) that work to improve family well-being and to reduce child maltreatment by coordinating services for high-risk families. • Provide referrals that link clients to community services, resources and support (Early Learning Metric). Examples of Key Partnerships • Health systems and healthcare providers • Public health departments • High schools (school nurses, school-based health centers) • School boards • Places of worship • Employers • Colleges • State health promotion and prevention programs 32 Social Determinants of Health Part 1 Education and Health 33 1 The Problem Healthy People 2020 highlights the importance of addressing the social determinants of health (SDOH) by including "create social and physical environments that promote good health for all" as one of its four overarching goals for the decade. The initiative has created a "place -based" organizing framework that categorizes SDOH into five (5) key areas: • Economic Stability • Education • Social and Community Context • Health and Healthcare • Neighborhood and Built Environment The SDOH span a wide range of complex and intertwined social conditions. Few, however, would argue that without a good education, people are significantly less likely to find stable employment with living -wage earnings. They are more likely to be living in poverty — which involves unstable/low-quality housing, unsafe neighborhoods, limited access to healthcare, transportation disadvantages and limited access to basic needs like affordable, healthy food (Low et al, 2005). While this is logical, what may be less intuitive is how strongly educational attainment is linked to health outcomes. The Robert Wood Johnson Foundation, arguably the largest and most powerful think tank related to SDOH in the United States, commissioned a white paper in 2011 highlighting strong evidence that consistently connects educational attainment and health, even when other SDOH factors, such as income, are taken into account (Mirkowsky et al, 1999 and 2003). The study examined the interrelated pathways in which education is linked with health, including health knowledge and behaviors; employment and income; and social and psychological factors, including sense of control, social standing, familial context and social networks. One could conclude from this study that to impact SDOH at a population level, educational achievement should be a primary focus. Figure 1. Percent of adults, ages 25-74 years, in less than very good health* 84.1 Black, non -Hispanic Hispanic 70.4 Asian 70.6 69.4 American Indian or White, non -Hispanic Alaska Native • Less than high-school graduate • High-school graduate E Some college College graduate § Source: Behavioral Risk Factor Surveillance System Survey Data, 2005-2007. t Based on self-report and measured as poor, fair, good, very good or excellent • Age-adjusted. Social Determinants of Health Part 1 Education and Health Kindergarten Readiness and Third-grade Reading Scores 34 1 Equality dcesnImean Equity There are several early milestones that are closely linked to a child's future academic achievement. In elementary school, these include kindergarten readiness, third grade reading and fourth grade math. Data from across the states suggest that as a child's kindergarten readiness scores improve, the later milestone scores rise accordingly (Duncan et al, 2008). Furthermore, third grade reading level scores has been linked to high school graduation rates (Silver and Saunders, 2008). Both kindergarten readiness and third-grade reading are key indicators of future success because children with low scores at these milestones face a confounding learning disadvantage going forward (Maryland Department of Education, 2010). Equity, Disparities and Vulnerable Populations There are a variety of SDOH factors that are barriers to educational achievement. These include adverse family context, food insecurity, culture and language differences and presence of childhood trauma (toxic stress). Though we know less education is linked with worse health across all racial and ethnic sub -groups (see Figure 1), there are populations that have different experiences and levels of exposure to these barriers. Many school boards across Oregon struggle to meet the needs of students and families who have cultural or linguistic needs, special needs, live in poverty or have other barriers such as adverse family situations. Just as healthcare reform highlights the need for an equity lens as a key strategy, education reform has a similar calling. This focus on equity on both sides means that programs and policies aimed at outcomes such as increasing educational achievement should take all differences between and within subgroups into account and all programs should be tailored to address such differences. In Central Oregon, geographic differences also need to be examined and any programs and efforts to address educational achievement need to be in balance with community needs and demographics. For example, the 501J School District in Jefferson County is one of the most diverse in the state. One-third of students are Latino, one- third White non -Hispanic, and one-third Native American. Early Childhood Adversity, Toxic Stress, and the Role of Community Neuroscience is catching up with what we have long suspected about social determinants of health affecting children's learning and development. The original study on Adverse Childhood Experiences (ACEs) was published almost 20 years ago in collaboration between the CDC and Kaiser Permanente. Recently, growing understanding of the science behind toxic stress outcomes is generating renewed interest and investment, resulting in a push for strategies and practices that would prevent ACEs by targeting protective changes in the child's early life context. The American Academy of Pediatrics (AAP) calls these contexts "early childhood ecology:' In their 2012 policy statement, the AAP states: "The effective reduction of toxic stress in young children could be advanced considerably by a broad-based, multi -sector commitment in which the profession of pediatrics plays an important role in designing, implementing, evaluating, refining, and advocating for a new generation of protective interventions:' Social Determinants of Health Part 1 Education and Health 35 1 Opportunity -Connecting the Dots Central Oregon has the right combination of state and local healthcare, community-based, public health and education system reform initiatives that if properly aligned, could have the potential to change health -shaping contexts for children and families. The following initiatives are either in development or being implemented regionally: • Coordinated Care Organizations (CCO) - trans- formation of the Medicaid delivery system (60+% children, disproportionate poverty). • Cradle to Career: Early Learning Hub/Regional Achievement Coalition (Better Together). • Health and housing. • Public health/primary care partnership (Perinatal Collaborative) to improve outcomes for at -risk moms, children and families. • A growing interest in addressing Adverse Child- hood Experiences (ACEs) and toxic stress (EL Hub, United Way of Deschutes County, Pacific - Source CCO). Rather than coming at ACEs, child development and education from separate silos, what if all these stakeholders were to come together and adopt one, unified and powerful goal - that all children in Central Oregon enter kindergarten ready to learn, graduate from high school and go on to college? Given the strong and conclusive evidence that intertwines ACEs, educational achievement and long-term health, impact indicators, such as kindergarten readiness, could be easily tracked - with positive results giving us good confidence that we are removing SDOH barriers for both children and their families. Furthermore, if the perinatal population is targeted and children and their families are followed through their first 4-5 years with strong evaluation supports in place, the community will learn and improve upon how our multi -sectoral approach is performing with data and information as soon as the end of this RHIP cycle. COMMUNITY SPOTLIGHT United Way & ACES United Way in Central Oregon is pursuing collective impact methods to heighten its impact on important social determinant needs and issues. As part of a long-term planning process, childhood trauma or Adverse Childhood Experiences (ACEs) has emerged as a critical issue of strategic importance to both United Way and its partnering agencies. The organization has initiated a broad- based effort to advance the prevention and treatment of childhood trauma. Goals include: Increasing awareness of ACEs and their negative impact on health and education outcomes Developing shared understanding and language for discussing ACEs, toxic stress , and resiliency • Aligning agencies and programs around common goals • Integrating trauma informed practices in programs and services • Ensuring consistent, quality training and support for front-line workers As a community-based organization, United Way is uniquely positioned to build the capacity of the community to address ACEs and trauma. They have a track record of community impact, as well as, competencies that include a broad-based network of partner agencies and donors, and a proven ability to raise and manage significant funds. For all these reasons, United Way will be a critical partner throughout implementation of the RHIP education and health strategy. Social Determinants of Health Part 1 Education and Health 36 1 Example Successful Cross -Sectoral Interventions Fortunately, Central Oregon would not have to start from scratch in organizing and developing a strategy to change the early childhood ecology for vulnerable children and families. There is already momentum and planning taking place with healthcare representation through the work of the Early Learning Hub. There are also many best practices that could be studied to inform a community strategy that addresses ACEs by wrapping education, health and social supports (i.e. housing, transportation, employment) around families to impact children and youth educational achievement goals (Department of Vermont Health Access, 2015). Listed below are a few examples of multi -sectoral programs that are showing positive results nationally: • Child -Parent Education Centers (CPC): CPC programs provide comprehensive educational, family support and healthcare services to economically disadvantaged children from ages 3-9. First developed in the 1960s, CPC initially launched in 25 sites in Chicago. The key goals were to improve school achievement, attendance, and parent engagement. • Northside Achievement Zone: The Northside Achievement Zone (NAZ) exists to permanently close the achievement gap and end generational poverty for communities of color in North Minneapolis. Similar to Harlem's Children Zone, NAZ uses a family -centered, wraparound framework (housing, healthcare, parenting education supports) starting in the perinatal years, effectively supporting low-income families overtime so that their "scholars" will graduate from high school and be prepared for college. NAZ-enrolled families are making remarkable strides. Children are not only showing improved academic outcomes at key kindergarten and third grade benchmarks, but families are stabilizing their housing, employment, and health. A study by Wilder Research demonstrated that each dollar invested in NAZ provides more than a $6 societal return. • Durham Connects: Increases child well-being by bridging the gap between new parent needs and community resources. The project is a collaborative effort among the Center for Child & Family Health, The NC Department of Social Services, and the Durham County Health Department. Durham Connects hires and trains nurses to provide in-home health assessments of mothers and newborns, as well as to discuss the social conditions affecting the family. A study conducted between July 2009 and December 2010 showed increased positive parenting behaviors, father involvement, childcare selection, and reduced infant hospitalization among Medicaid recipients. Center -Based Early Childhood Education: Prepares children by providing skills development and readiness training, while also focusing on health and social development. ECE programs aim to improve the cognitive and social development of children ages 3 or 4 years. COMMUNITY SPOTLIGHT: M.A. Lynch Elementary School M.A. Lynch Elementary School had the highest percentage of students impacted by poverty in Deschutes County. After becoming a full-service Community School, it went from a "School in Improvement, status under No Child Left Behind to a "Champion School;' within three years. At the time of the State Recognition, 93% of students met or exceeded the reading benchmark, and 88% met or exceeded the math benchmark. The Community School model expands before and after school programs for students and families and maximizes instructional time during the day. Enrichment and targeted academic support is provided for students and a wide range of services are provided to support parents such as GED programming, English language instruction, workshops on parenting and how to cope with stress, and financial preparation. To serve its growing Latino population, Lynch brought on a bilingual Community School Coordinator. Health was also a key support. Deschutes County Health Services and FQHC Mosaic Medical teamed up to open a school-based health clinic at Lynch to provide a range of physical and behavioral health services. More recently, the school has hosted a Head Start preschool program, creating a new bridge between early learning and the K-12 education system. Social Determinants of Health Part 1 Education and Health Education & Health Strategy Implementation Recommendations 37 1 1. There are five key strategies that the Central Oregon CCO and larger health system can take to advance educational achievement (i.e. kindergarten readiness) as a central SDOH goal (depicted as inputs in figure 2): 2. Inventory and understand the potential confluences that could be strengthened in partnership with community and education -based systems, such as the Early Learning Hub and public health nurse home visiting programs. 3. Align with and leverage the growing interest from healthcare, education and community-based organizations (i.e. United Way), in the prevention and treatment of early childhood trauma. 4. Support the formation of a workgroup that would bring together, education (Early Learning/Better Together), community-based and health system partners to identify achievement gaps "hot spots" and develop strategies to health, social service and education supports around children and families. 5. Intervene as early as possible to build resiliency in children and families, but also support youth whose lack of basic needs or poor health gets in the way of learning while already in school. The health system can support all children, youth and families by: • Promoting and providing annual well-child visit and conducting developmental screenings in the first 3 years of life • Promoting and providing annual adolescent well visits • Screening for ACEs (parents and children) and referring to treatment when appropriate • Meaningful and measurable collaboration with education, community and social support system • Develop innovative funding mechanisms to sustain outcome -producing models The COHC, through the Operations Council, will develop a four-year work plan, in partnership with the above mentioned stakeholders, to implement strategies that pertain to the health system's role, starting with Board adoption of kindergarten readiness as a system metric. This work plan should be vetted by numerous stakeholder groups and by the COHC, to be given final approval by no later than April 1, 2016. Figure 2. Education & Health Strategy At a Glance Inputs Health System: Communityclinic linkages; focus on ACEs/toxic stress Education and Early Learning: etter systems alignment, program development Programming: Cross -sectoral intervention (such as NAZ, Harlem modeled-tbd) Social Partners Aligned United Way, DHS, FAN, food systems, housing Funding: Innovative/sustainable payment model people helped, number. artnering orgs, activities delivered Families & Children: # families engaged, #children; served, testimonials, parenting classes completed Health System/Triple Aim: Well-child visits (infant, child and adolescents), development screens, ACEs screening, optimize nurse home visiting and perinatal model Families & Children Dora vio ernce ratesdown ACES lowered or prevented children rn stabbe housing, parentsmployed, increase in kinderga ten ea mess, 3 grade read ri Health System/Triple Aim. Lower overall medical costs, highe quality of care for at -risk families; Reduced ED visits — 0-4; improved birth outcomes Social Determinants of Health Part 2 Housing The Problem The home has deep cultural ties in America — a place where friends and families gather. The home is an anchor in the larger community, where connections and health -protective social networks flourish. As is the case with education, access to safe and stable housing constitutes one of the most basic and powerful social determinants of health. In addition to what we know intuitively about housing and health, there is growing scientific evidence that links access to safe and affordable housing with good health outcomes. Ensuring both housing stability and safety — i.e. free of health structural, bio -chemical health hazards, has become a public health priority worldwide. The World Health Organization recommends using the growing body of evidence linking housing and health to guide "primary preventive measures related to housing construction, renovation, use and maintenance, which can promote better overall health:' The lack of safe and affordable housing has become a public health crisis in Central Oregon. Low-income families in all three counties struggle to find affordable housing. Even mid -income families, who do not normally struggle to find housing, are now finding it harder and harder to make ends meet as escalating rent and mortgage costs squeeze out room to budget for other living expenses. In Bend, Central Oregon's largest city, affordable housing is not the only problem. Simply finding a place to live is also extremely difficult with low housing and apartment inventory and high market demand. Given all we know about the importance of housing to health, the current housing environment in this region has the potential to widen and exacerbate inequities and health disparities that impact people with fewer financial and support resources. This is particularly true for individuals and families trapped in a cycle of crisis and housing instability due to extreme poverty, trauma, violence, mental illness, addiction or other chronic health conditions. Promising Approach The state of Massachusetts provides housing and supportive services to chronically homeless individuals through their Healthy and Home for Good (HHG) model. This has proven less costly and more effective overall than managing their homelessness and health problems on the street or in a shelter. As of their latest evaluation report, 766 chronically homeless individuals were placed in supportive housing. In the six months prior to housing, those participants accumulated 1,812 emergency department visits, 3,163 overnight hospital stays, 847 ambulance rides and 2,494 detox stays. The estimated total cost per person for measured services, including Medicaid ($26,124), shelter ($5,723) and incarceration ($1,343) amounted to $33,190 per year (Massachusetts Housing and Shelter Alliance, 2014). After one year in the program, the total per person costs for these same services fell to $8,603. With the cost of housing and services through the HHG program amounting to $15,468 per tenant, the total estimated return on investment to the state was $9,118 per person. This is just one of dozens of studies that have shown health care and societal returns as a result of wrapping housing and supportive services around individuals with chronic, unstable housing conditions. 38 Social Determinants of Health Part 2 Housing Implementation Recommendation As part of its contract with the Oregon Health Authority, PacificSource Community Solutions, Central Oregon's Coordinated Care Organization, has outlined a plan to begin to address the housing crisis by bridging housing solutions with the health system (Transformation Plan Element 4.2). The COHC, through the Operations Council, will develop a four-year work plan around housing and health in alignment with the 2 -year Transformation Plan deliverables as described below. Strategies that pertain to the health system's role will be endorsed by the COHC Board of Directors, with Board adoption of one or more housing related metrics to track and monitor performance toward this goal. This work plan should be vetted by numerous stakeholder groups and by the COHC, to be given final approval by no later than May 1, 2016. Transformation Plan Milestone (July 30, 2016) and Benchmark (July 30, 2017): • By July 30, 2016: Study promising and existing local, regional and national strategies. CCO, COHC and key partners secure funding for a pilot program that bridges housing and health care for those members who are homeless or at -risk for homeless and also have complex medical and behavioral health needs. • By July 30, 2017: Partnerships are formalized (e.g. developer, property owner, housing agency). Pilot program begins implementation, dissemination of early findings provided to COHC and CAC. 39 Appendix A: Acronyms 40 1 Adverse Childhood Experiences (ACEs): An adverse childhood experience (ACE) describes a traumatic experience in a person's life occurring before the age of 18 that the person remembers as an adult. The ACE score is a measure of cumulative exposure to adverse childhood conditions. Acquired Immunodeficiency Syndrome (AIDS): A condition caused by a virus, in which lymphocytes are destroyed, resulting in a loss of the body's ability to protect itself against disease. Assessment, feedback, incentive, and exchange (AFIX): A quality improvement program used to raise immunization coverage levels, reduce missed opportunities to vaccinate, and improve standards of practices at the provider level. American Academy of Pediatrics (AAP): An organization dedicated to the health and well-being of infants, children, adolescents and young adults. American Heart Association (AHA): A non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. Behavioral Health Consultants (BHC): Behavioral health generalists who provide treatment within a healthcare setting for a wide variety of mental health, psychosocial, motivational, and medical concerns. BHCs also provide support and management for patients with severe and persistent mental illness and tend to be fa- miliar with psychopharmacological interventions. Behavioral Risk Factor Surveillance System (BRFSS): A phone survey conducted among randomly selected non -institutionalized adults that asks about a variety of health risks and behaviors. Blood Pressure (BP): The pressure of the blood in the circulatory system. Body Mass Index (BMI): Use both weight and height to determine the size of an individual. BMI is divided into four categories: underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), obese (30.0 or greater). Cardiovascular Disease (CVD): A classification of diseases of the heart and blood vessels that includes chest pain, heart attack, and other conditions that affect the heart muscle, rhythm, or valves. Centers for Disease Control and Prevention (CDC): A federal organization that protects the health of the nation's residents and helps local communities do the same. Central Oregon Health Council (COHC): The COHC is the governing body of our region's CCO. The COHC is dedicated to improving the health of the region and providing oversight of the Medicaid population and Coordinated Care Organization (CCO). The COHC's mission is to serve as the governing Board for the CCO and to connect the CCO, patients, providers, Central Oregon, and resources. Child -Parent Education Centers (CPC): CPC programs provide comprehensive educational, family support and healthcare services to economically disadvantaged children from ages three to nine. Community Advisory Council (CAC): The overarching purpose of the CAC is to ensure the CCO and COHC remains responsive to OHP consumer and community health needs. The CAC includes healthcare consumers of the CCO as well as representatives of public and private agencies that serve CCO members. Appendix A: Acronyms 41 1 Coordinated Care Organization (CCO): Is a network of all types of healthcare providers who have agreed to work together in their local communities for people who receive healthcare coverage under the Oregon Health Plan (Medicaid). Car, Relax, Alone, Forget, Friends, and Trouble (CRAFFT): A short clinical assessment tool designed to screen for substance -related risks and problems in adolescents Dental Care Organizations (DCO): There are eight DCOs in Oregon and they provide dental services to over 96 percent of the OHP clients eligible to receive dental benefits and services. Diabetes Prevention Program (DPP): A prevention program aimed at improving Diabetes in a specified population. The program should be evidence -based. Dental Medical Integration (DMI): Dental medical integration is the effort in improve coordination between medical and dental providers to improve client health. Early Childhood Education (ECE): A program that prepares children by providing skills development and readiness training, while also focusing on health and social development. Electronic Health Record (EHR): An electronic version of a patient's medical history. Generalized Anxiety Disorder -7 (GAD -7): A concise self-administered screening and diagnostic tools for mental health disorders. Glycated hemoglobin (HbAlc): A form of hemoglobin that is used to measure blood glucose concentration over time. Healthy Eating and Active Living (HEAL): A coalition with diverse membership with the goal of health promotion. Healthy People 2020 (HP 2020): National goals to meet by the year 2020. Human Immunodeficiency Virus (HIV): A virus that causes HIV infection and over time acquired immunodeficiency syndrome. Intravenous drug (IV drug): A drug that is administered into a vein or veins. Immunization Rate Improvement Project (IRIP): A program to increase immunization rates in children. Low Birth Weight (LBW): The birth weight of a live-born infant of less than 5 pounds 8 ounces regardless of gestational age. Long -Acting Reversible Contraception (LARC): Birth control methods that provide effective, reversible contraception for extended periods of time without requiring user action. Medically Assisted Treatment (MAT): A program that combines behavioral therapy and medications to treat substance use disorders. Coordinated Care Organization (CCO): Is a network of all types of healthcare providers who have agreed to work together in their local communities for people who receive healthcare coverage under the Oregon Health Plan (Medicaid). Car, Relax, Alone, Forget, Friends, and Trouble (CRAFFT): A short clinical assessment tool designed to screen for substance -related risks and problems in adolescents Dental Care Organizations (DCO): There are eight DCOs in Oregon and they provide dental services to over 96 percent of the OHP clients eligible to receive dental benefits and services. Diabetes Prevention Program (DPP): A prevention program aimed at improving Diabetes in a specified population. The program should be evidence -based. Appendix A: Acronyms 42 1 Coordinated Care Organization (CCO): Is a network of all types of healthcare providers who have agreed to work together in their local communities for people who receive healthcare coverage under the Oregon Health Plan (Medicaid). Car, Relax, Alone, Forget, Friends, and Trouble (CRAFFT): A short clinical assessment tool designed to screen for substance -related risks and problems in adolescents Dental Care Organizations (DCO): There are eight DCOs in Oregon and they provide dental services to over 96 percent of the OHP clients eligible to receive dental benefits and services. Diabetes Prevention Program (DPP): A prevention program aimed at improving Diabetes in a specified population. The program should be evidence -based. Dental Medical Integration (DMI): Dental medical integration is the effort in improve coordination between medical and dental providers to improve client health. Early Childhood Education (ECE): A program that prepares children by providing skills development and readiness training, while also focusing on health and social development. Electronic Health Record (EHR): An electronic version of a patient's medical history. Generalized Anxiety Disorder -7 (GAD -7): A concise self-administered screening and diagnostic tools for mental health disorders. Glycated hemoglobin (HbAlc): A form of hemoglobin that is used to measure blood glucose concentration over time. Healthy Eating and Active Living (HEAL): A coalition with diverse membership with the goal of health promotion. Healthy People 2020 (HP 2020): National goals to meet by the year 2020. Human Immunodeficiency Virus (HIV): A virus that causes HIV infection and over time acquired immunodeficiency syndrome. Intravenous drug (IV drug): A drug that is administered into a vein or veins. Immunization Rate Improvement Project (IRIP): A program to increase immunization rates in children. Low Birth Weight (LBW): The birth weight of a live-born infant of less than 5 pounds 8 ounces regardless of gestational age. Long -Acting Reversible Contraception (LARC): Birth control methods that provide effective, reversible contraception for extended periods of time without requiring user action. Medically Assisted Treatment (MAT): A program that combines behavioral therapy and medications to treat substance use disorders. Medicaid Behavioral Risk Factor Surveillance Survey (MBRFSS): The BRFSS conducted among adults enrolled in Medicaid (OHP). Northside Achievement Zone (NAZ): Exists to permanently close the achievement gap and end generational poverty for communities of color in North Minneapolis. National Quality Forum (NOF): A non-profit organization that works to improve quality of healthcare through several mediums, including the endorsement of evidence -based measures. Obstetrics/ gynecology (OB/GYN): An obstetrician is a physician who delivers babies. A gynecologist is a physician who specializes in treating diseases of the female reproductive organs. Appendix A: Acronyms Operations Council (OPs): OPs is housed within the COHC, and member promote and facilitate accessi- ble, affordable, quality health services including mental, behavioral, oral, and physical health for Central Oregon residents. This group provides strategic, fiduciary, and operational advice to the COHC in a effort to design and implement key initiatives. Oregon Department of Education (ODE): The Oregon Department of Education is responsible for implementing Oregon's public education policies, including academic standards and testing, credentials, and other matters not reserved to the local districts and boards. Oregon Health Plan (OHP): Healthcare coverage program for low-income Oregonians. Patient Health Questionnaire (PHQ): A concise, self-administered screening and diagnostic tools for mental health disorders. Performance Improvement Project (PIP): The purpose of a PIP is to assess areas of need and de- velop a project intended to improve health outcomes. The Oregon Health Authority (OHA) contract requires Coordinated Care Organizations (CCO's) to conduct PIP's that are "designed to achieve, through ongoing mea- surements and intervention, significant improvement, sustained over time, in clinical and non -clinical areas that are expected to have favorable effect on health outcomes and OHP Member satisfaction. Prescription Drug Monitoring Program (PDMP): A state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. Primary Care Provider (PCP): A healthcare practitioner who sees people that have common medical problems. Pregnancy Risk and Monitoring Survey (PRAMS): A survey of mothers who recently gave birth that addresses prenatal care, health behaviors and risks, and post -partum topics. Provider Engagement Panel (PEP): This is a committee housed within the COHC, and provides a highly valued clinical perspective to the work the CCO and the COHC. Providers of the PEP represent a variety of healthcare organizations that serve the OHP population. Quality Improvement Measure (QIM): State defined tolls that help measure and track the quality of healthcare services provided by eligible professionals and eligible providers of Medicaid within our healthcare systems. Screening, Brief Intervention and Referral to Treatment (SBIRT): An evidence -based practice that targets patients in primary care with nondependent substance use. Social Determinants of Health (SDOH): Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality -of -life outcomes and risks. Substance Use and Mental Health Services Administration (SAMSHA): The Substance Use and Mental Health Services Administration is a branch of the U. S. Department of Health and Human Services. Sexually Transmitted Infection (STI): An infection transmitted through sexual contact, caused by bacteria, viruses, or parasites. 43 Supplemental Nutritional Assistance Program (SNAP): Nutrition assistance program for low-income families. Substance Use Disorder (SUD): A condition developed when the use of one or more substances leads to a clinically significant impairment or distress. To Be Determined (TBD): Indicates the need to further develop a particular idea or strategy. Women, Infants, and Children (WIC): A Federal program for low income and nutritionally at risk women, infants and children. Participants receive education, screening, and support in purchasing nutritious food. Appendix B: References 44 1 Behavioral Health Boyd, C., Leff, B., Weiss, C., Wolff, J., Hamblin, A., & Martin, L. (2010). Clarifying multimorbidity patterns to improve targeting and delivery of clinical services for Medicaid populations. A study published by the Center for Healthcare Strategies, Inc. Centers for Disease Control and Prevention. (2015). CDC wonder, underlying cause of death. 2009-2013. Available at www.wonder.cdc.gov. Centers for Disease Control and Prevention. (2013). Viral hepatitis surveillance. Available at www.cdc.gov/ hepatitis/statisitics/2013 surveillance. Clarke, R.E., Samnaliev, M., & McGovern, M.P. (2009). Impact of substance use disorders on medical expenditures for Medicaid beneficiaries with behavioral health disorders. Psychiatric Services, 60 (1), 35-42. Lichtman, J.H., Bigger, J.T., Blumenthal, J.A., Frasure-Smith, N., Kaufmann, P.G., Lesperance, F., Mark, D.B., Sheps, D.S., Taylor, C.B., & Froelicher, E.S. (2008). AHA Science Advisory: depression and coronary heart disease. Circulation, 118-1768-1775. Mancuso, D., & Felver, B. (2010). Bending the healthcare cost curve by expanding alcohol/drug treatment. Report done by the Washington State Department of Social and Health Services, Research Data Analysis Division. Mauer, B., & Jarvis, D. (2010). The business case for bidirectional integrated care. Available from The Integration Policy Initiative at http://www.cimh.org/Initiatives/Primary-Care-BH-Integration.aspx. Mertens, J.R., Lu, Y.W., Parthasarathy, S., Moore, C., & Weisner, C.M. (2003). Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO. Arch Internal Medicine, 163:2511-2517. SAMHSA. (2013). Diabetes care for clients in behavioral health treatment. HHS Publication No. (SMA) 13-4780. Tann, S.S., Yabiku, S.T., Okamoto, S.K., & Yanow, J. (2007). TRIADD: the risk for alcohol abuse, depression, and diabetes multimorbidity in the American Indian and Alaskan Native population. 14(1)5-27. Journal of American Indian and Alaska Native Mental Health Research. Cardiovascular Disease U.S. Department of Health and Human Services. The Health Consequences of Smoking -50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 5]. Diabetes Lloyd -Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics — 2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. http://circ. ahajournals.org/content/119/3/e21.extract. Circulation. 2009; 119: e21 -e181. Accessed April 9, 2014 Diabetes Prevention Program Research Group (October 29, 2009). 10 -year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. The Lancet. Published Online. Oregon Health Authority (2015). Oregon Diabetes Report A report on the burden of diabetes in Oregon and progress on the 2009 Strategic Plan to Slow the Rate of Diabetes. Retrieved from https://public.health.oregon. gov/DiseasesConditions/ChronicDisease/Pages/pubs.aspx Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014. (http://wwwcdc.gov/diabetes/pubs/statsreportl4/national-diabetes- report-web.pdf) Appendix B: References 45 1 Oral Health American Academy of Pediatric Dentistry. (n.d.). From American's Pediatric Dentists mychildrensteeth.org The Big Authority on Little Teeth: http://www.mychildrensteeth.org/assets/2/7/ECCstats.pdf Centers for Disease Control and Prevention. (December 2006). Division of Oral Health: Oral Health for Adults. From Centers for Disease Control and Prevention: http://www.cdc.gov/oralhealth/publications/factsheets/adult_ oral_health/adults.htm Kemple Memorial Children's Dental Clinic. (n.d.). Dental Screening Data, 2014-2015. Bend, Oregon. National Institute of Dental and Craniofacial Research. (2000). Chapter 6: Effects on Well-being and Quality of Life. From National Institute of Dental and Craniofacial Research: http://www.nidcr.nih.gov/DataStatistics/ SurgeonGeneral/sgr/chap6.htm Oregon Health Authority. (November 2015). Oregon Health Authority: Office of Health Analytics. From Oregon Health Authority: Dental Sealants on Permanent Molars for Children - Guidance Document: http://www. oregon.gov/oha/analytics/CCOD ata/Dental%20Sealant%20Guidance%20Document%20-%20Nov%202015.pdf Oregon Health Authority. (2015). Oregon Healthy Teens 2015 Results. From Oregon Health Authority: Public Health: https://public.health.oregon.gov/BirthDeathCertificates/Surveys/OregonHealthyTeens/ Documents/2015/2015_OHT_State_Report.p df Oregon Health Authority. (2011). Oregon PRAMS: 2011 Results. From Oregon Health Authority: Public Health: https: //public.health.oregon.gov/HealthyPeopleFamilies/D ataReports/prams/Documents/OregonPRAMS2011. pdf#Oral_Health Oregon Oral Health Coalition. (2014). Strategic Plan for Oral Health in Oregon: 2014-2020. From Oregon Oral Health Coalition: http://staticl.squarespace.com/static/554bd5a0e4b06ed592559a39/t/55a7f5aae4bOld3d0f766 de4/ 1447361848914/Strategic+Plan+for+Oral+Health+in+Oregon.pdf The California Society of Pediatric Dentistry and California Dental Association. (n.d.). The Consequences of Untreated Dental Disease in Children: Looking Closer at California's Children. From California Dental Association: http://www.cda.org/Portals/0/pdfs/untreated_disease.pdf Volunteers in Medicine. (2013). Bend, Oregon. World Health Organization. (2012). Media Centre: Oral Health. From World Health Organization: http://www. who.int/mediacentre/factsheets/fs318/en/ Reproductive and Maternal Health Department of Health and Human Services, Health Resources and Services Administration Maternal and Child Health Bureau. Women's health USA 2011. Rockville (MD): DHHS; 2011. Finer, L. and Kost, Unintended Pregnancy Rates at the State Level, Perspectives on Sexual and Reproductive Health, 2011, 43(2): 78-87. Finer and Zolna. Shifts in Intended and Unintended Pregnancies in the United States, 2001-2008. American Journal of Public Health, 2014; 104:S43 -S48 Guide to Community Preventive Services. Violence Prevention: Child Childhood Home Visitation. http://www thecommunityguide.org/violence/home/index Health Disparities in Rural Women. Committee Opinion No. 586. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014; 123:384-8. Appendix B: References 46 1 Reproductive and Maternal Health (continued) Healthy Families America. www.healthyfamiliesamerica.org https://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html http://www.cdc.gov/reproductivehealth/unintendedpregnancy/ http://www.onekeyquestion.org/ Injury Prevention & Control: Division of Violence Prevention; Child Maltreatment Prevention Strategies; http:// www cdc.gov/violenceprevention/childmaltreatment/prevention.html Oregon Health Authority, Public Health Division, Center for Health Statistics — Vital Statistics, 2013. https:// public.health.gov/HealthyPeopleFamilies/DataReports/Pages/nurse-home-visting. aspx Oregon Health Authority — Public Health; Oregon Vital Statistics Annual Report 2011, Volume One. https:// public.health. oregon.gov/BirthDeathCertificates/VitalStatistics/annualreports/Volume l /Pages/2011.aspx Oregon Pregnancy Risk Assessment Monitoring System, 2011 Results https: //public.health.oregon.gov/HealthyPeopleFamilies/D ataRep orts/prams/Pages/index. aspx Social Determinants of Health: Know What Affects Health; Tools for Putting Social Determinants of Health into Action; http://www.cdc.gov/socialdeterminants/tools/index.htm Sonfeld A. and Kist K., Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy and Infant Care: Estimates for 2008, New York: Guttmacher Institute, 2013. http:// guttmacher.org/pubs/public-costs-of-UP.pdf The Community Guide — The Guide to Community Preventive Services; Increasing Appropriate Vaccination; http://www.thecommunityguide.org/vaccines/homevisits.html The Community Guide — The Guide to Community Preventive Services; Tobacco Policy Strategies; http://www thecommunityguide.org/tobacco/smokefreepolicies.html Social Determinants of Health Cutler D, Lleras-Muney A. Education and Health: Evaluating Theories and Evidence. Bethesda, MD: National Bureau of Economic Research; 2006 June 2006. Duncan et al. School Readiness and Later Achievement. Developmental Psychology 43(6):1428 —1446.2007. Department of Vermont Health Access. Integrating ACE -Informed Practice into the Blueprint for Health. 2015. Maryland State Department of Education. Getting Ready: The 2010-2011 Maryland School Readiness Report. Annapolis, Maryland: Department of Education. 2010. Massachusetts Housing and Shelter Alliance, 2014. Home and Healthy for Good June 2014 Progress Report. Available at: http://www.mhsa.net/matriarch/documents/June%202014%20HHG%20Report.pdf Mirowsky J, Ross CE. Refining the association between education and health: the effects of quantity, credential, and selectivity. Demography 1999; 36(4):445-60. Mirowsky J, Ross CE. Education, social status, and health. Hawthorne, NY: Aldine de Gruyter; 2003. Low MD, Low BJ, Baumler ER, Huynh PT. Can education policy be health policy? Implications of research on the social determinants of health. J Health Policy Law 2005;30(6):1131-62. Silver, D., & Saunders, M. What factors predict high school graduation in the Los Angeles unified school district? Santa Barbara, CA: University of California. 2008. ��._.��<.`m 0 `