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SALINE COUNTY MAPP FOR A HEALTHY FUTURE
PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT
PROJECT REPORT
November 29, 2007
Network Overview
The Saline County MAPP for a Healthy Future Health Network is supported by the Public Health Solutions District Health Department. The network was established as an effective entity in the fall of 2007. It is not incorporated, but functions as an association of agencies and individuals interested in the health and welfare of the community. The core network service area is Saline County. However, it is also part of the larger health planning initiative of the department called MAPPS for Future Health which also covers Gage, Jefferson, Fillmore and Thayer counties.
Saline County Overview |
Land area, 2000 (square miles) |
575 |
Persons per square mile, 2000 |
24.1 |
Total population, 2005 estimate |
14,195 |
The City of Crete has the fastest-growing Hispanic population in Nebraska. The last State estimates show that persons of Hispanic origin made up 15.3% of the population in Saline County, versus 7.1% for Nebraska. Information from other sources including early results of the Department sponsored Behavioral Risk Factor Survey System (BRFSS) strongly suggests this is a dramatic underestimate. Hispanics immigrate to Crete to work within the area food processing plants. The immigrants include legal and illegal immigrants although no information is available on the proportion of each. Many residents use several different names and also may frequently change employers. Regardless, there has been an immeasurable increase in the immigrant population over the last ten years.
Jane Ford Witthoff, Health Director and Natalie Kingston have been the primary staff support for this project. This report and those of other Department activities are included on the Department website, www.phsneb.org. Participants in the Saline County Network include:
MEMBER ORGANIZATION
Carol Friesen, CEO Crete Area Medical Center
Dr. Robert Quick Crete Area Physicians Network
Cindy Havlat, R.N. Warren Memorial Hospital
Lee DeBevoise The Friend Sentinel (Media)
Aloha Zimmer Friend Spirited Citizen
Rick Sheehan Friend Spirited Citizen
Dr. Marjie Heier Saline Area Medical Specialties
Tammy Schroeder, APRN Saline Area Medical Specialties
Senator Russ Karpisek Legislative Representative
Sergio Castaneda Department of Health & Human Services
Marcia Koehler Department of Health & Human Services
Josie Filipi ESL/Migrant Education at Crete Public Schools
Tim Renker Nestle/Purina
Judy Henning Public Health Solutions Board of Health
Kim Buser Saline Eldercare
Bob Courtney Eldercare/LAAA Legislative Liaison
Randy Pryor University of Nebraska Cooperative Extension
Cindy Togstad Wilber Chamber of Commerce
Chief Steve Hensel Crete Police Department
Chief Ron Murphey Wilber Police Department
Janie Fralin Blue Valley Community Action
This project and the establishment of the network were aided by HRSA funding. In January 2007, the Department restarted its work to establish community ownership and involvement in the HRSA funded project to address access to health care issues. Recruitment for the community meetings focused on the areas of Aging, Business, Children & Youth, Churches, Colleges, Community Action, County Extension, Crisis, Daycares/Preschools, Dentists, Emergency Services/Local Law Enforcement, Farming, Handicapped Services, Home Health, Local Government, Local Newspapers, Medical, Mental Health, Optometrists, Pharmacists, Rural Health, Saline County Schools, Service Clubs & Organizations and Local Veterinarians.
The Network’s supporting governing body at the present time is the Public Health Solutions District Health Department (PHSDHD) Board of Health. The Board of Health is composed of 12 representatives from the five counties that make up the District. Each of the five County Boards appoints two (2) Members. One is a member of the County Board and the other is a public spirited person interested in the health of the County. In addition, there are two at large members: a physician and a dentist. Both are selected by a majority vote of each of the five County Boards. The Board of Health is responsible for providing administrative oversight and for the establishment of policy for PHSDHD.
There are currently 10 health and human service providers encompassed by the network. Estimates of the number of patients/clients served by the network’s providers are presented as follows:
The Crete Area Medical Center, a subsidiary of Bryan LGH, features 25 private patient rooms, two surgery suites, physical therapy and cardiac rehabilitation space, a trauma area within the emergency department and a helicopter pad. It serves an average of 500 patients per year with 41,891 outpatient visits.
The residents of Crete and surrounding area are served by two medical clinics, Crete Medical Center Clinic and Saline Medical Specialties. The Crete Medical Center Clinic serves an estimated 17,369 patients per year. Saline Medical Specialties serves an estimated average of 1,800 patients/clients a month.
Warren Memorial Hospital also located within Saline County has 25 acute care beds. Warren Memorial provides acute care, long-term care, outpatient clinics, outpatient surgery, skilled care & therapy, and community and special services. It serves an estimated 25 patients/clients monthly. Friend Medical Center and the Wilber Medical Clinic are primary care providers.
The ESL/Migrant Education Program at Crete Public Schools served 221 adult students within the past year of which 195 met the State’s retention requirements. In addition, the school sponsors a federally funded Even Start Program that is important for the support and wellbeing of pregnant teens. The service statistics for the Even Start program follow:
The Department of Health & Human Services reports a great need to increase the accessibility to health services within Saline County because of the large influx of immigrants. The number of individuals enrolled in Medicaid or children enrolled in Kid’s Connection within Saline County were not readily available.
Blue Valley Community Action Partnership (BVCA) operates over 30 programs that interact with and complement each other. The programs are part of the overall mission of increasing self sufficiency and eliminating poverty. These include emergency assistance, case management, the Women Infant and Children (WIC) Nutrition Program and the Healthy Babies Program for Hispanic pregnant and postnatal women, immunizations, housing and other assistance to prevent and ameliorate poverty. The agency reports that it serves an average of 1,862 annually in Saline County.
Funding of Network Development
The HRSA funding was originally awarded for a twelve month period. However, because of staff and leadership changes the PHSDHD received a no-cost extension of the project. Consequently, the grant funding extended from March 1, 2006 through August 31, 2007. Project Revenue and Expenditures for the grant period 03/01/06 to 08/31/07 totaled $108,431.63. Of this $23,431.63 represents the Department’s general fund expenditures and network participation
The project expenditures by the Department for the period of September 1, 2007 to October 31, 2007 totaled $5,965.90. This included Department personnel and direct expenses alone. These funds were expended from the PHSDHD general fund allocation for the operation of a local health department.
Expenditures of PHSDHD from September 1, 2007 to October 30, 2007 |
Staff |
$5,694.49 |
Rent |
$180.00 |
Other Direct Expenses |
$91.41 |
TOTAL |
$5,965.90 |
The projected budget for future Network staff support from Public Health Solutions District Health Department would be $16, 697.20/yr. An additional $6,500 was earmarked by the Department for the BRFSS survey initiated in February 2007. The expenses to be incurred by individual Network partners were not estimated.
HRSA Project Work Plan
The goal of the HRSA grant was to develop collaborative relationships across a spectrum of public and private entities (the Network) to achieve greater access to quality health care services.
Problems emerged that caused the HRSA approved work plan to stall early in the project. The Health Director resigned and staff vacancies existed. Faced with this, the Board had to contract with a consultant to fill the Project Manager position. The Project Manager was unable to build on the existing community support to establish the project in the absence of a Department Director. A review of the record showed that the project meetings held in 2006 were not well attended. By then, the community interest was insufficient to enable the formation of a Network and generate interest in resolving the problems relating to health care access. The initial effort to establish a Network dissolved, the community became polarized and there was opposition to the project.
The Board appointed a new Health Director on January 16, 2007. The consultant was phased out and a local resident with experience in public health was hired to work on the project as the Community Development Specialist. In addition, the Health Director worked on the project. When the project was reestablished a Network was organized that identified factors that affect health in Saline County, what they want to see for a healthy Saline County and the priority issues to be addressed.
The work to support the network will continue. The HRSA approved work plan as modified in the spring of 2007 follows.
HRSA Project Work Plan (goals, objectives, activities and outcomes):
Goal(s):
To develop collaborative relationships across a spectrum of public and private entities to achieve greater access to quality health care services. |
Measurable Objective:
Develop a sustainable network of at least 10 members. |
Specific Activity |
Person/Organization Responsible |
Timeframe |
Outcome and/or Process Measures |
Review work to date, revise work plan and request a six-month no-cost extension |
PHS Health Director |
January-February |
* New work plan
* New budget set
* Approval from HRSA |
Reconvene steering committee to establish common focus and direction for remainder of project, including
new list of potential network members |
PHS Health Director and Community Development
Specialist |
March-April |
* Attendance list of meeting(s)
* New lists of potential network members compiled in Crete, Friend and Wilber |
Develop an inventory of existing resources of health care and support services |
Community Development
Specialist |
April-May |
* Inventory compiled
|
Hold community meetings (expanded group) to review need data, inventory of resources, anecdotal and other
qualitative information to identify priorities |
Network Members,
Community Development
Specialist and Health
Director |
June-July |
* Network attendance rosters and meeting minutes
* Priorities compiled
* Participation of network members |
Hold network meetings to discuss potential alternatives that address established priorities; evaluate feasibility, timeliness and appropriateness; and agree on which alternative(s) to implement. Write a work plan for a network project. |
Network Members
Community Dev. Specialist
and Health Director |
August-September
October
|
* Network attendance rosters and meeting minutes
* Top 2 Priorities identified
* Identification of desired project pending
* Work plan in development |
Begin implementation of activities toward network project |
Network Members and Health Director |
Post-grant
Period |
* Progress on work plan |
Goal(s):
To develop collaborative relationships across a spectrum of public and private entities to achieve greater access to quality health care services. |
Measurable Objective:
Develop at least 3 primary priorities and strategies related to improving access to health care, with special attention given to the needs of the large Hispanic population in the service area, as well as shortages in mental health and dental services |
Specific Activity |
Person/Organization
Responsible |
Timeframe |
Outcome and/or Process Measures |
Review related Healthy People 2010 focus areas, service area needs assessment documents, and other
pertinent data provided by network members related to accessibility of health care services |
Network members
Community Development
Specialist and Health
Director |
March - May |
* Engaged agencies in discussion
* Variance in list by county
* Objective prioritization of problems |
Hold discussions within network member agencies, member agency board meetings, community events, and hospital and clinic waiting rooms, key businesses to elicit anecdotal qualitative data for use in prioritization of need. |
Network members and Community Development Specialist |
August-September |
* Involvement of communities
(constituents and professionals)
* List of priorities based on anecdotal information |
Assess and analyze all information and determine priorities.
|
Network members,
Community Development
Specialist and Health
Director |
October |
* Final list of priorities (beginning
point for development of a work plan to implement a network project) |
Network Development
In order to establish the Network in the face of the previous failure, considerable work was done to involve all sectors of the county and all groups of people. Careful consideration was given to assuring involvement of as many diverse groups, individuals, businesses and employees as possible. Personalized invitations and personal contact was made with all potential participants. Network Resource Lists were developed for each community within Saline County encompassing the following areas: Aging, Business, Children & Youth, Churches, Colleges, Community Action, County Extension, Crisis, Daycares/Preschools, Dentists, Emergency Services/Local Law Enforcement, Farming, Handicapped Services, Home Health, Local Government, Local Newspapers, Medical, Mental Health, Optometrists, Pharmacists, Rural Health, Saline County Schools, Service Clubs & Organizations and local Veterinarians. These measures were extremely valuable and resulted in getting broad community involvement.
Health related data was needed to inform and educate the community regarding existing health issues. Pertinent health data for Saline County was organized and disseminated. Given that little current information existed regarding the Hispanic population in the community and their health status, the Department contracted for the performance of a Minority Behavioral Risk Factor Survey System (BRFSS). This is to be completed in February of 2008. The existing health data for Saline County appears as Appendix A, Saline County Data. While information about Saline County health and health related resources and services was collected and documented, problems with the adequacy and accessibility of this information was subsequently identified. This need was expressed by both consumers and providers of health care.
There was substantial development of broad community interest in assessing and resolving health access problems within Saline County. This was evidenced by the great increase in the number of community members attending community focus group meetings. These meetings were held in the communities of Crete, Friend and Wilber. The attendance at the meetings included 50 in Crete, 27 in Friend and 16 in Wilber. The Department used an outside facilitator, and a local physician served as the meeting chair The discussion was guided by a focus question:
If we are to make Saline County a healthier place to live, work and play, what should our priorities be over the next 3-5 years?
Following a preparatory exercise about individual ideas, the groups were asked to come to consensus on the overall focus question, listing their key priorities for community action regarding health and quality of life. Key priorities included:
Crete |
Friend |
Wilber |
- Cultural integration
- 24-hour urgent care
- Central location for public health information and communication (preventative health services)
- New multi-purpose community center
- Engage elected officials (government) in community vision
- Plan for downtown (“Increase personal responsibility” listed in all areas)
|
- Community spirit
- Youth involvement and activities
- Community growth (business, population, etc.)
- Health care education
- Elder care
- Supplemental funding for health care
|
- Transportation
- Immigrant integration
- Economic development
- Adequate health care for all
- Saline County Improvement Association (Brain trust)
- Spiritual leadership
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A community focus group document that summarized these results was produced and distributed.
With the aid of an interpreter information was drawn from those who might not have attended the formal meetings but who have problems accessing services. This was done through an additional 20 group focus sessions, interviews and questionnaires. Many “pockets of humanity” were also subsequently identified as underserved groups in the community. Feedback from the group focus sessions, interviews and questionnaires was compiled with the results of the formal community focus groups for review.
Themes emerged through the staff and Network review of the compiled information from the data, community meetings, focus groups and surveys. The themes scored to show the intensity of support for each: were:
Group Priority Rating of Themes Identified in Community Meetings
Score Theme
19 Access to Health Care
- Problem of Teen Pregnancy Prevention and Impact
- Access to Health, Dental and Mental Health Services
- Need for 24 hr. Non-Emergent Care
- Transportation to Services
- Language and Social Barriers
17 Need for Health Education, Information and Promotion
- Information about Access to Services
- Promoting Healthy Choices
- Information about Available Services
- Environment and Community that Encourages Health
12 Concern about Community Vitality
- Community Pride vs. Apathy
- Lack of Volunteerism
- Commitment to Community Improvement
- Lack of Community Participation and Involvement
11 Concern about Child Health, Safety and Well Being
- Health and Welfare of Children When Parents Work/Shift Work
- Safety Issues Related to Transportation
- Safety Related to Crime and Criminal Influences
- Childhood Obesity and Lack of Exercise
6 Impact of Changes in Population
- Overall Aging of the Population
- Youth Moving On
- In Migration Legal and Illegal
- Cultural Shifts in the Population
5 Challenges to Economic Well Being
- Population Decline and the Impact
- Balance Between Rural and Urban
- Impact on County and on Communities
- Competition for and Lack of Economic Opportunities
2 Need for Recreational Facilities and Environment
- Activities and Facilities for Children
- Availability and Access to Activities and Facilities for Adults and Families
- Need for Recreation and Facilities for Teens and Young People
- Environment Conducive to Exercise Recreation and Community
SALINE COUNTY NEEDS ASSESSMENT
NETWORK IDENTIFIED PRIORITIES
November 28, 2007
ACCESS TO HEALTH CARE IN GENERAL AND FOR SPECIAL GROUPS
Access to Health and Health Related Care
The issue of access to care is very complicated. The following issues interfere with access or need to be addressed to increase access:
Funding is needed and there are limited funds
Programs and services must be sustainable
Health Care Providers want communication about needs on an ongoing basis
Language and cultural differences interfere, example of dispatch
Differing values related to health care need to be considered
Access is needed to dental and mental health services- not just physical health services.
Public perception that 24 hour non-emergent care is needed
Services need to be related to time and work schedules
Transportation to services is a problem particularly for those who are Spanish speaking
Differing expectations of what access is or what it should be
Language and social barriers
Policies of businesses related to health care of employees
Numbers are high of those in need
Information about access related to finances and how to pay
Impact of legal status related to immigration
Services are needed for all areas of the County
Child Health, Safety and Wellbeing
Concern about teen pregnancy prevention and impact
Health and welfare of children when parents work/shift work
Quality of school lunches
Childhood obesity and lack of exercise
Nutrition of children- backpacks of food a solution?
Safety issues related to children
Safety issues related to crime and criminal influences
Child care for all areas of the county
Alcohol and Drugs
Concern about Elders and Health of the Populations at Large
Impact of government policies has negative impact on elder health
Need to influence and change policies of government
Insurance problems influenced by governmental policies
Providers need to know the needs of the community
Transportation is an issue for those needing services
Bringing services to the community is also an issue
Special access problems of elders, isolation/values
Concern about elders, is it decreasing as a public policy?
Perception of need for One Stop Shop
Availability of services, what is needed here
Do we have services available or is there a lack of information
NEED FOR HEALTH EDUCATION, INFORMATION AND PROMOTION
Need for Public Information and Education
There is an obvious need for education and information to the public. Many are unaware of services; do not know how to overcome access problems or how to use services to their benefit. This includes:
Information about access to health services
Promoting healthy choices
Information about available services
Environment and community that encourages health
Nutrition of elders
Information about medication use-Brown Bag pharmacy sessions
Information about financing available for care
Need for Provider Information and Education Lack of Consumer and Provider Information and Communication
Need a Directory of resources
Providers need an awareness of services
Prevention is Important
Do we have services available or is there a lack of information
A lot of people don’t know about eldercare
Lack of information about specialists and specialized services
Need information about access to services
Health care Providers need to know Needs of Community
Need for a community environment conducive to health including recreational services and physical environment that encourages healthy lifestyle choices.
Is United Way Active? Role/opportunity
Activities and facilities for children
Availability and access to facilities for adults and families
Need for recreational facilities for teens and young people
Important to reduce crime-something to do
Environment conducive to exercise and recreation
Lack of information about this is related
Areas of County have different problems and resources
Cross Cutting Issues that Contribute to or Complicate Resolution of Priorities:
Community vitality and involvement
Alternatives uses of empty stores
Community pride vs. apathy
Lack of volunteerism
Commitment to community improvement
Lack of community participation and involvement
Need services to stay in the community-groceries, restaurants and dentists
Impact of Changes in Population
Overall aging of the population
Youth moving on
In migration/legal and illegal
Cultural shifts in the population
Challenges for service providers
There are opportunities
Finance problem-wait until last minute
Challenges to Economic Wellbeing
Population decline and its impact
Balance between rural and urban
Impact on counties and communities
Competition for and lack of economic opportunities
Poverty rates of families with children
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Next Steps:
In the coming months, the Network will further define the strategies they identified. These strategies were aimed at increasing access to health care and providing more effective health information and health referral information to health care providers as well as residents. The Network included the full range of health and health related services and conditions in their discussions of the problems. The next steps in this process involve the delineation of alternatives, resources and the selection of strategies to address the priority needs identified. This process will include consideration of available resources, opportunities, community readiness and impact. A rough draft staff work plan follows.
ROUGH DRAFT
Proposed Staff Work Plan for the Network
1. Strengthen the Network as an effective means of addressing community problems.
- Assure that appropriate parties are present on the network.
- Subgroups will be established to address the two major needs areas.
- The Department will continue to allocated staff time to support the work of the Network.
2. The network and the department will analyze the Behavioral Risk factor Survey (BRFSS) data in the coming year.
- The actual survey will be completed in February of 2008. The analysis of this survey will be completed with the assistance of the State.
- The results will be made available to health care and health related providers for their use. This fits into the Network priority for information sharing among health care providers.
3. Address health access and the needs of particular population groups as priorities.
- Work will be undertaken to assemble relevant data and refine the estimate of persons in need and the range of services needed.
- Determine existing resources available to address needs and issues.
- Funding needs, service needs and support must be clarified
- Various strategies to address needs and issues will be explored.
- Explore feasibility and desirability of expansion of the People’s Health Center (Federally Qualified Health Center) to Saline County.
4. Address the development of a bilingual consumer services directory as a priority.
- Identify alternatives for a framework for making information available and maintaining it.
- Gather information for a bilingual information and referral resource for the public and service providers.
- Identify funding sources and the best tool for maintaining and offering this service.
- Potential collaborators have been identified and must be contacted.
5. Increase communication among health care providers and increase their awareness of population needs.
- Methods for increasing communication among providers will be explored. These will include periodic meetings, bulletins and networking events.
- The BRFSS survey results other data will be assembled and made available to health care providers.
- Means to communicate changes in the availability and accessibility of services, availability of resources and information about service use will be explored.
6. Individual subgroups of network members will be established to address the needs of special population groups and the need to increase the degree to which the community environment contributes to the health of the public.
- The three areas include families, elders and adults
- The need for services, accessibility and or information and referral will be studied for each.
- The community structure and infrastructure will be examined with respect to its capacity to support health and wellness.
- The prospects for a community wellness and or activity center needs to be explored. This would address concerns for family supporting recreation, positive activities for youth and community unity.
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