2016-2019 community health needs assessment and ... · whatcom alliance for health advancement...
TRANSCRIPT
___________________________________________________
2016-2019
Community Health Needs Assessment and Implementation Plan
Adopted by Community Health Board: June 30, 2016
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 1
Table of Contents
I. EXECUTIVE SUMMARY .......................................................................................................................... 2
II. OVERVIEW ............................................................................................................................................ 6
State, Regional and Community Partners ...................................................................................... 6
Community Health Framework ...................................................................................................... 8
III. 2013 CHNA REVIEW .............................................................................................................................. 9
IV. WHATCOM COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE ............................................. 12
V. KEY HEALTH INDICATORS .................................................................................................................... 15
Method ......................................................................................................................................... 15
Healthy, Active Living ................................................................................................................... 16
Child & Family Wellbeing ............................................................................................................. 21
Health Delivery Systems ............................................................................................................... 26
Equity ............................................................................................................................................ 31
VI. COMMUNITY CONVENING .................................................................................................................. 34
Method ......................................................................................................................................... 34
VII. IMPLEMENTATION PLAN .................................................................................................................... 40
Selected Strategies ....................................................................................................................... 40
Significant Health Needs Not Addressed by Implementation Plan .............................................. 42
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 2
I. EXECUTIVE SUMMARY
Overview
PeaceHealth St. Joseph Medical Center
PeaceHealth St. Joseph Medical Center (PeaceHealth St. Joseph) is one of ten hospitals within
PeaceHealth, an integrated, not-for-profit health system in the Pacific Northwest. Located in Bellingham,
Washington, the primary service area for PeaceHealth St. Joseph is Whatcom County, Washington.
Community Health Needs Assessment
PeaceHealth St. Joseph and partners conducted a Community Health Needs Assessment (CHNA), a
systematic process involving the community to understand community health needs in order to
prioritize, plan and outline solutions.
The 2016 CHNA was carried out with community input, including public health and nonprofit community
groups representing minority and low-income residents. Both primary and secondary data were
collected and incorporated. We also interviewed key informants and held a community forum in which
needs were affirmed and possible strategies to address the needs were identified.
Data and local perspectives are presented and analyzed using a four-pillar structure of community
health: 1) Healthy, Active Living; 2) Child & Family Wellbeing; 3) Integrated Health Delivery Systems
(including medical dental and behavioral health services); and 4) Equity.
PeaceHealth St. Joseph conducted this CHNA in conjunction with state, regional, and local community
health planning in Washington, the North Sound Region and Whatcom County.
2013 CHNA
The problem of health care access and lack of insurance coverage was identified in all PeaceHealth
communities in 2013 as a major need and was therefore chosen as a major focus area in our 2013 CHNA
implementation plans. PeaceHealth worked as part of the community coalitions that were formed
across the state for the purpose of helping people sign up for commercial health insurance and Apple
Health, i.e. Medicaid. By any measure these efforts were successful.
Summary of the 2016 Community Health Needs Assessment
Demographic and Secondary Data
Whatcom County has about 205,000 residents. 24% are children 0-19 years old, 65% are adults age 18-
64, and the remaining 14% are seniors age 65+. Bellingham is the largest city in the county representing
approximately 40% of the county’s population. Approximately 41% of Whatcom County residents are
either “Asset Limited, Income Constrained, Employed” or live below the poverty line. 8% of the
County’s population is Hispanic and 4% of the population is American Indian/Alaska Native.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 3
Key health indicators were organized into the four community health pillars using primary data from
Robert Wood Johnson’s 2016 County Health Rankings and other state sources. Health outcomes gaps in
each area are summarized below.
HEALTHY, ACTIVE LIVING: Major issues identified include the abuse of opiates and excessive adult
drinking. The county ranks 3rd in negative effects from heroin abuse and 6th of 39 counties in negative
effects from prescription drug use.
CHILD & FAMILY WELLBEING: Adverse Childhood Experiences and low vaccination completion rates are
major concerns for Whatcom County. These factors put Whatcom County residents at greater risk of
poor health outcomes or greater risk of serious infections.
HEALTH DELIVERY: Data show that there are significant differences in uninsured rates by race/ethnicity,
and racial/ethnic differences in the quality of preventive care received by Medicare beneficiaries.
Addressing these inequities is important to the health of the community.
EQUITY: Affordable housing is a key component of financial wellbeing and stability, and forms the basis
of good health. A high percentage of cost-burdened housing in certain areas of Whatcom County
imperils the wellbeing of affected households and the community as a whole.
Community Engagement and Local Perspectives
PeaceHealth St. Joseph interviewed 10 key informants from organizations throughout the County
representing public health and health care for non-majority populations to identify health gaps and
possible health solutions.
The key informant interviews were conducted in advance of a convening that was held on May 19, 2016
wherein more than 60 community leaders from public health, health and social services, business,
schools, and government met to confirm, refine, and identify health needs/gaps and possible solutions.
The chart below summarizes the results of the community stakeholder meeting. It should be noted that
the lists of gaps and strategies represented in the table were generated in two separate set of group
processes at the meeting, i.e. the strategies were not necessarily identified as specific solutions to the
identified gaps.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 4
Table 1. Results of the Community Stakeholder Meeting
Major Health Problems/Gaps Prioritized Evidence-Based Strategies
Healthy,
Active
Living
Adult alcohol use
Teen tobacco use
Food and beverage environments at
school and in the community
Elder isolation
Physical inactivity
Community Health Worker programs
School-based early intervention
School nutrition programs
Child &
Family
Wellbeing
Low immunization rates
Low graduation rates, particularly
among homeless and low-income
families
Maternal smoking during pregnancy
High cost of childcare
ACEs
Prenatal and early childhood home
visiting programs
Levy to support early childhood
services
‘ Early Pathways’/home-based
mental health
Health
Delivery
Systems
High rates of opiate abuse/pain management, e-cigarette use, DUI rates
Racial/ethnic disparities in health insurance
Unaffordable health care Lack of dental and behavioral health
care providers
Supported housing programs
Expand triage/crisis stabilization
Linking social services and medical
services
Equity
High poverty and low educational attainment concentrated around Bellingham and certain rural areas
Cost-burdened housing Underrepresentation of non-
majority persons at all levels of health and social service delivery systems
Limited economic opportunities Lack of affordable child care for
ALICE populations Transportation barriers
Expanded Housing First programs
School based health centers
Community Health Workers / patient
navigators
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 5
Implementation Plan
The Implementation Plan strategies summarized below were extrapolated from the data and from
community input. Our plan is comprehensive in the sense that there are strategies that impact the focus
areas within each of the community health pillars (and a number of strategies cross pillars). The display
of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake
with its community partners to affect the health status of the community. Rather, it is a statement of
our community health priorities.
PeaceHealth St. Joseph CHNA 2016 Priorities
Ensure effective information exchange and care coordination for particular populations (e.g. PeaceHealth Medical Group patients with complex health and psychosocial conditions who are served by multiple organizations) through the PeaceHealth Transforming Clinical Practice Initiative (TCPI) and other community collaborations.
Increase participation in the PeaceHealth employee wellness program, particularly for caregivers at the lower end of the compensation scale.
As part of our ongoing efforts to create an inclusive organization that exercises cultural humility, recruit for and support a workforce that reflects the changing ethnic, racial and cultural diversity of the communities that we serve.
Advocate for and actively support the development of a comprehensive continuum of behavioral health services that includes access to crisis stabilization, transitional and long housing, substance abuse treatment services, and psychiatry that is available to children and seniors.
Work with local school districts, Head Start, and others to advocate for and support the wide-spread availability of early learning opportunities for all children.
Develop a Community Health Worker initiative that empowers individuals within specific communities to serve a liaison/linking/intermediary role between health/social services and the community to facilitate access and improve the quality and cultural competence of service delivery.
Advocate for and support policies and programs geared to promoting healthy nutrition, activity and lifestyles for youth aged 8-11, with a particular focus on lower income families.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 6
“ ”
II. OVERVIEW
Founded by the Sisters of St. Joseph of Peace in 1890, PeaceHealth is a Catholic Healthcare Ministry
serving in the communities of Alaska, Washington and Oregon. Today, PeaceHealth is a 10 hospital
integrated not-for-profit health system that offers a full continuum of health and wellness services.
PeaceHealth’s mission is to carry on the healing mission of Jesus Christ by promoting personal and
community health, relieving pain and suffering, and treating each person in a loving and caring way. The
fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. We have
embraced the CHNA process as a means of engaging and partnering with the community in identifying
disparities and prioritizing health needs, and importantly, in aligning our work to address prioritized
needs.
Caring for those in our community is not new to PeaceHealth; it’s been in practice since the Sisters of St.
Joseph of Peace arrived in Fairhaven, Washington to serve the needs of the loggers, mill workers,
fishermen and their families more than 125 years ago. Even then, they knew that strong, healthy
communities benefit individuals and society, and that social and economic factors can make some
community members especially vulnerable. The Sisters believed they had a responsibility to care for
them, and that ultimately, healthier communities enable all of us to rise to a better life. This philosophy
inspires us today and guides us toward the future.
State, Regional and Community Partners
PeaceHealth’s 2016 CHNA process was undertaken in the context of other recent or concurrent planning
activities in the State, region and County related to community health:
The Washington State Health Improvement Plan (2014-2017 Creating a Culture of Health in
Washington) provides a statewide framework for health improvement efforts.
PeaceHealth St. Joseph Medical Center and Whatcom County Health Department in
collaboration with multiple community partners developed the Whatcom County Community
Health Improvement Plan for 2012-2016. The Health Department’s 2015 Community Health
Improvement Annual Report provides an update to this report and associated activities. The
annual report identifies three community priorities: improving access to health care and service
Wellness is something we nurture, something we build into our policies,
something we come together to create as public health professionals,
doctors, nurses, lawyers, transportation planners, neighborhood
advocates and PTAs, and others.
John Wiesman, DrPH, MPH Washington State Secretary of Health
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 7
delivery, enhancing family and child well-being (which includes ensuring that all children are
healthy and safe) and promoting healthy active living (this includes enhancing access to healthy
foods, particularly for low-income and isolated populations and limiting exposure to tobacco,
alcohol and other harmful substances, especially for youth).
The North Sound Accountable Community of Health (NS-ACH) includes representatives from
the five-county area that includes San Juan, Island, Skagit, Snohomish and Whatcom counties.
An Accountable Community of Health (ACH) is
a regional coalition consisting of leaders from
a variety of different sectors working together
to improve health in their region. As part of the
Healthier Washington Initiative, nine ACHs began
formally organizing across Washington in 2015.
They are intended to strengthen collaboration,
develop regional health improvement plans and
projects, and provide feedback to state agencies
about their regions’ health needs and priorities. The
Health Care Authority (HCA) is supporting ACH
development through guidance, technical assistance
(TA), and funding.
Whatcom Alliance for Health Advancement (WAHA): WAHA is an organization with a mission to
connect people to health care and facilitate transformation of the current system into one that
improves health, reduces cost and improves the experience of care for all. PeaceHealth is a
major sponsor of WAHA and anticipates working with WAHA to carry out a number of the
identified CHNA health improvement strategies.
Map 1. Accountable Community of Health Regions
Source: Washington Health Care Authority
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 8
Community Health Framework
Drawing from the CHNAs conducted by PeaceHealth hospitals in 2013, and after reviewing existing
community health improvement plans and collecting public data on health status and the social
determinants of health, a PeaceHealth Community Health Framework was developed. This four-pillar
framework, depicted below, was used to organize data and collect input from community stakeholders.
The subcategories, or “focus areas” were used as guideposts for considering community health
improvement strategies.
Figure 1. 2016 PeaceHealth Community Health Framework Pillars
Healthy,
Active Living
Child & Family
Wellbeing
Integrated Health
Delivery Systems Equity
Physical activity
Healthy Eating
Tobacco, alcohol
and other drug
prevention
Social engagement
Maternal-child
health
Adverse Childhood
Experiences (ACEs)
and family resiliency
Access to quality
and affordable
medical, behavioral
health and dental
services
Assistance for
people who are
homeless
Cultural humility
There are two terms that are used in the above table that perhaps need to be defined, and they are:
Adverse Childhood Experiences (or ACEs) are traumatic events that occur in childhood and
cause stress that changes a child’s brain development. Exposure to ACEs has been shown to
have a dose-response relationship with adverse health and social outcomes in adulthood,
including but not limited to depression, heart disease, COPD, risk for intimate partner violence,
and alcohol and drug abuse.
Cultural humility is a term used to describe a way of infusing multiculturalism into a workplace.
Replacing the idea of cultural competency, cultural humility is based on the idea of focusing on
self-reflection and lifelong learning.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 9
III. 2013 CHNA REVIEW
During the 2012-2013 timeframe, the Whatcom County Health Department and PeaceHealth St. Joseph
conducted a comprehensive Community Health Assessment and, along with a wide array of community
partners, developed an equally comprehensive Community Health Improvement Plan (CHIP).
PeaceHealth contributed to this effort both as an organizational sponsor and a leader of the work
associated with the health care section of the plan. The PeaceHealth 2013 CHNA implementation plan
focused on health care delivery and associated issues. The table below summarizes the 2013-2016
PeaceHealth CHNA and includes available metrics which summarize measurable progress to date.
Table 2. 2013 CHNA Summary and Current Status
Objectives Strategies Outcomes
Baseline Current
Objective 1: Ensure access to essential health care services for all County residents
Increase Medicaid and Health Insurance (HIE) enrollment Increase Whatcom County primary care capacity at PHMG and at the Interfaith Community Health Center
Whatcom County adult un-insurance rate: 16%
Whatcom County health care provider ratios:*
PCP: 1,126:1
Dentists: 1,588:1
Whatcom County adult un-insurance rate: 9%
Whatcom County health care provider ratios:*
PCP: 1,140:1
Dentists: 1,400:1
Objective 2: Improve support for children, adults, and seniors with complex health needs
Develop community response to high-utilizing patients Integrate mental health care with primary medical care
Avoidable emergency room visits to PeaceHealth St. Joseph (defined as ‘low acuity’)
Medicaid: 20.2%
Commercial/Other: 18.9%
Avoidable emergency room visits to PeaceHealth St. Joseph (defined as ‘low acuity’)
Medicaid: 18..2%
Commercial/Other: 16.0%
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 10
Objectives Strategies Outcomes
Baseline Current
Objective 3: Provide welcoming, culturally aware health care for every patient
Institute ongoing dialogue with Tribal
Health leadership, social workers and
others within the Lummi and Nooksack
communities
Review organizational practices; institute cultural sensitivity training for PeaceHealth caregivers
Over the last three years PeaceHealth convened quarterly meetings with Tribal health leaders, area social service and health care providers and others that has resulted in greater trust and improved operational relationships.
Efforts to use the standard patient experience survey to track the experience of care for selected sub-populations were not successful.
Ongoing diversity training not instituted; planning underway for “cultural humility” pilot trainings.
*Data methods changed/can’t compare to prior years. Sources: Washington State Health Care Authority; Robert Wood Johnson
Foundation County Health Rankings; PeaceHealth Internal Data
As we move forward in adopting the 2016 CHNA, we reflect on lessons learned and accomplishments of
our process, goals, and implementation of the previous (2013) CHNA:
Lessons Learned
Begun in 2013, the WAHA Intensive Case Management (ICM) program consisted of case
managers working in a multi-disciplinary team across organizational boundaries to provide the
appropriate level of support for complex patients. The effort was supported in part by
PeaceHealth St Joseph and involved a local FQHC and representatives from the Criminal Justice,
Emergency Medical Services (EMS) and behavioral health sectors with the aim of coordinating
care management for the most difficult to serve patients.
Over the three year period, the program met with initial success, but had trouble scaling up to meet
demand and was eventually absorbed into the State Health Home program designed to provide
case management for a similar patient population. The lessons learned were that a lot can be
accomplished when local organizations work across organizational boundaries, but, in the end, the
question of cost in relation to outcome needs to be adequately addressed. The other lesson is that
health care reform in Washington State is calling for regional collaboration with Medicaid insurance
plans, and intensive case management for the Medicaid population needs to be implemented
collaboratively with the Medicaid Pans.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 11
Accomplishments
The Hospital Community Connector program is a successful partnership between PeaceHealth St.
Joseph and the two area FQHCs, (Sea Mar CHC and Unity Care NW). Both organizations embed care
coordinators in the hospital emergency department and work with hospital caregivers to ensure
appropriate primary care follow-up and social service linkage, particularly for higher-risk patients.
Over the last three years, PeaceHealth St. Joseph has contributed more than $1.5 million and
ongoing technical assistance to support the activities of key nonprofit organizations providing
primary health care, child abuse prevention services, pediatric dentistry, behavioral health
services, nutrition and native food programming, services for people who are homeless and
health insurance assistance for lower income individuals, families and seniors.
The 2013 PeaceHealth CHNA identified the problem of health care access and lack of insurance
coverage as the one issue that we wanted to focus on across all of our communities.
PeaceHealth worked as part of the community coalition that was led by WAHA for the purpose
of helping people sign up for commercial health insurance and Apple Health, i.e. Medicaid. By
any measure these efforts were successful.
Between 2013 and 2014 there was a more than 41% increase in Medicaid enrollment.
Enrollment continued to increase in 2015 but not at the pace of the initial increase. Adult
enrollment rose nearly 63% from 2013 to 2015 and child enrollment rose 41% over the same
period. As a result, uninsured adults in Whatcom County decreased from 16% in 2013 to 9% in
2015.
Figure 2. Medicaid Enrollment and Percent Uninsured, Whatcom County
.
16%
9%
2013 2015
34876 36514
5151555929
2012 2013 2014 2015
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 12
Figure 3. Medicaid Enrollment by Adults and Children, Whatcom County
Source: Health Care Authority, State of Washington. Children are defined as under age 19.
IV. WHATCOM COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE
Map 2, Whatcom County
PeaceHealth St. Joseph serves the North Sound region of Washington, with
Whatcom County being its primary service area and the focus of this CHNA1.
1 All data in this section is from the American Community Survey (US Census Bureau) unless otherwise noted.
15,063 15,942
20,836 22,480
19,813 20,572
30,679 33,449
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2012 2013 2014 2015
Children Adults
Of Note:
The 2015 United Ways of the Pacific Northwest ALICE report summarizes the status of ALICE families—an acronym that stands for Asset Limited, Income Constrained, Employed. These are families that work hard and earn above the Federal Poverty Level (FPL), but do not earn enough to afford a basic household budget of housing, child care, food, transportation, and health care. Most do not qualify for Medicaid coverage.
In Whatcom County, 41% of all households are either in poverty or are ALICE households. This is greater than Washington State overall, wherein 32% of all households are either ALICE or in poverty.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 13
Current Profile
Whatcom County has about 205,000 residents
11,413 (5%) are preschoolers age 5 or younger
38,321 (19%) are 5-19 years old
133,438 (65%) are adults age 18-64
29,345 (14%) are seniors age 65+
17,264 (8%) are Hispanic (stasis since 2010)
8,380 (4%) are American Indian/Alaska Native (growth of 32% since 2010)
Approximately 40% of Whatcom County residents live in Bellingham. In terms of the socioeconomic
determinants, Countywide:
91% of adults have a high school diploma
16% of individuals live below the FPL
41% of all households are either in poverty or cannot afford basic household expenses
652 people are homeless in Whatcom County, both sheltered and unsheltered (Homelessness in
Washington State,2015, Annual Report on the Homeless Grant Programs)
In the Bellingham, WA school district, 477 children in grades k-12 are reported from homeless
families (239) or doubled up (living with other families) (239). (http://www.k12.wa.us/HomelessEd/pubdocs/StatewideHomelessReportByDistrict2015.pdf
Table 3, Whatcom County, WA Sociodemographic Profile
City High school
diploma (%)
Individuals living
below the FPL (%)
Median
Household
Income
People over age 5
who are
linguistically
isolated
Bellingham 92.6% 23.2% $42,440 9.6%
Blaine 93.2% 9.7% $55,229 4.6%
Everson 74.4% 15.6% $51,735 14.2%
Ferndale 85.9% 16.0% $51,944 8.7%
Lynden 90.7% 8.6% $59,021 4.3%
Nooksack 93.3% 13.4% $65,368 2.1%
Sumas 85.6% 6.7% $55,526 5.3%
Whatcom County 91.0% 16.2% $53,025 4.7%
Washington State 90.2% 13.5% $60,294 7.8%
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 14
The Community Need Index (CNI), a tool created by Dignity Health, measures a community’s social and
economic health on five measures: income, cultural diversity, education level, unemployment and
health insurance, and housing. The CNI demonstrates that within Whatcom County, there are pockets
of higher and lower need:
Map 3, Whatcom County Community Need Index Map, 2015
Source: Dignity Health
Key Take-Aways
Nearly half of all Whatcom County residents are either below the FPL, or are ALICE households and live
above the poverty level but do not earn enough to afford a basic household budget of housing, child
care, food, transportation, and health care.
Within Whatcom County, there are pockets of high poverty and low educational attainment,
with highest need areas concentrated in and around Nooksack, Everson, Bellingham, and the
inland areas of the county.
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V. KEY HEALTH INDICATORS
Method
Data for each of the four PeaceHealth pillars is detailed on the following pages. For each pillar, we
provide a description, how the community compares to other Washington counties, provide a profile of
the community, identify important indicators and provide key takeaways.
PeaceHealth selected the most currently available data from publically available sources. Data elements
were selected that align with the focus of the CHNA. The goal was to identify metrics that could be
consistently measured, monitored and benchmarked for all PeaceHealth communities throughout the
Pacific Northwest.
Data from the Robert Wood Johnson Foundation (RWJF) was used as a primary source. RWJF’s county
health rankings data compare counties within each state on more than 30 factors. Counties in each of
the 50 states are ranked according to summaries of a variety of health measures. Counties are ranked
relative to the health of other counties in the same state. RWJF calculates and ranks four summary
composite scores used in this report:
Overall Health Outcomes
Overall Health Delivery Factors
Health Factors – Health behaviors
Health Factors – Social and economic factors
This is a nationally recognized data set for measuring key social determinates of health. RWJF is
committed to continually measuring these metrics.
Data in this evaluation is also supplemented with sources from state and local agencies in Washington.
Unless otherwise noted all data cited in this section is from RWJF or the following sources:
Behavioral Risk Factor Surveillance System; Washington Healthy Youth Survey; Washington Department
of Health, Vital Statistics; US Census Bureau; The University of Washington’s Alcohol and Drug Abuse
Institute; WA Office of the Superintendent for Public Instruction; Feeding America; Enroll America;
Centers for Medicare & Medicaid Services; Community Commons and Whatcom County Health
Department WIC.
Next to each local indicator we've shown whether the local rate (percentage) is less than, greater than,
or equal to the state rate (percentage). With any indicator, there is a range of possible 'true' values
because data collection always entails some error. Often, percentages that appear different are rated as
'equal.' This is because, statistically speaking, there is a large chance that the 'true' value of the data at
the state and county level is equal, rather than different, due to error inherent in the data collection
process.
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Healthy, Active Living: Whatcom County Health Indicators, 2016
What is Healthy, Active Living?
Healthy, Active Living is a key pillar of a healthy community. We envision a community where the
environment and resources of that community allow adults, teens, and children to be physically active,
to eat nutritious meals, to be free of the burdens of substance abuse and chronic disease, and to live
with an ample sense of wellbeing and connection to others.
How Does Whatcom County Compare to Other Counties?
Whatcom County is ranked 5 out of 39 Washington Counties for its food and physical activity environment, as well as the adult behavioral health indicators such as excessive drinking and smoking. This means we’re doing well compared to nearly 9 out of 10 counties in Washington.
Healthy, Active Living Profile:
Adults:
Adult obesity: 21% (<WA: 27%)
Adult physical inactivity: 16% (=WA: 18%)
Adult diabetes: 11% (=WA: 9%)
Youth:
10th graders who are obese: 12.4% (=WA: 11.2%)
10th graders reporting physical inactivity: 13.2% (=WA: 12.0%)
Environment:
Reasonable access to exercise opportunities: 87% of residents (=WA: 88%)
Food environment index: 2016: 7.2 (=WA: 7.5)
Substance abuse:
Opiate use:
o Whatcom County ranks 3rd of 39 counties in Washington for overall negative impacts
from heroin abuse
o Whatcom County ranks 6th of 39 counties in Washington for overall negative impacts
from prescription opiates
o Deaths attributed to any opiate: 8.2 per 100,000 population (=WA: 8.6 per 100,000
population)
o Publicly funded treatment admissions involving any opiate: 380.5 per 100,000
population (>WA: 176.3 per 100,000 population)
o Some of the highest rates of Buprenorphine prescription for Suboxone treatment for
opiate addiction in all of Washington counties
Adult excessive drinking: 22% (>WA: 19%)
Adult smoking: 14% (=WA: 15%)
10th graders smoking cigs in past 30 days: 8.7% (=WA: 7.9%)
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 17
Closer Look:
Growth in opiate abuse
Opiate abuse, including heroin and prescription opiates, has grown steadily in
the past fifteen years. Several measures, including the rate of Whatcom
crime lab results related to an opiate, the rate of residents treated for opiate
addiction and the rate of deaths attributed to any opiate, have increased
significantly in Whatcom County between 2002-2004 and 2011-2013. Opiate
use and abuse is a significant health and political issue in Whatcom County
that requires cross-sector collaboration in order to alleviate its negative
health and social consequences for our community.
Figure 4. Opiate use and abuse growth over time,
Washington State, 2002-2004 to 2011-2013
Of note:
Caregiver Wellness As the largest employer in the community, PeaceHealth is working to support Active Healthy living in its workforce by offering an employee wellness program. Workplace wellness programs are evidence-based strategies to improve physical fitness and risk factors. At PeaceHealth, we can make an impact on community wellness by improving our employees’ wellness, but there are differences based on income levels:
60.6% of eligible PeaceHealth St. Joseph employees participate in a wellness program 26.3% of eligible PeaceHealth St. Joseph employees earning $25,000 - $40,000 participate in a wellness program
Participation by Income Group
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Figure 5. Increase in Opiate-related Deaths by county, Washington State, 2002-2004 to 2011-2013
Source: Univ. of WA Alcohol & Drug Abuse Institute, “Opioid Trends Across Washington State,” April 2015)
Excessive drinking among adults
Whatcom County adults report higher levels of excessive drinking (binge drinking, defined as four drinks
in a sitting for women and five drinks in a sitting for men, or drinking an average of two servings of
alcohol per day for men and one serving per day for women). Excessive drinking leads to injury and is
the third-leading cause of lifestyle-related death in the U.S.
Figure 6. Excessive drinking among adults, Washington State, results by county, 2016
(Figure source: Robert Wood Johnson County Health Rankings)
Additional Indicators with Trend Data
The Behavioral Risk Factor Surveillance System is used to measure chronic diseases and health behaviors
among a population of adults in all 50 states at the county level. The Washington Healthy Youth Survey
measures health risk behaviors and outcomes among 6th, 8th, 10th, and 12th graders in Washington
State. It should read: The Washington Department of Vital Statistics measures causes of death and
circumstances of prenatal outcomes and birth. The Robert Wood Johnson Foundation County Health
Rankings aggregates BRFSS, Vital Statistics, US Census, and business data to provide an overview of
measures that matter for health. The University of Washington’s Alcohol and Drug Abuse Institute
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 19
measures markers of opiate abuse over time in Washington counties, and the Whatcom County
Department of Health added important data on opiate abuse over time in Whatcom County.
Table 4 Healthy, Active Living: Whatcom County vs. Washington State, 2016
Better Equal Worse
Chronic Conditions
Adult diabetes ●
Heart disease death rate ●
Adult obesity ●
Risk behaviors
Adult physical inactivity ●
Adult excessive alcohol use ●
Adult smoking ●
Deaths due to any opiate ●
Suicide death rate ●
Environment
Grocery availability & food insecurity ●
Access to exercise opportunities ●
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 20
Table 5 Healthy, Active Living: Whatcom County 10th Graders,
Health Indicators vs. Washington State, 2014 and Trend Since 2010
Better Equal Worse Trend
Chronic Conditions
Obesity ● stasis
Depression ● stasis
Risk behaviors
Smoking cigarettes ● improving
Drinking alcohol ● improving
Using marijuana/hashish ● improving
Binge drinking ● improving
Eat 5+ fruits/vegetables per day* ● stasis
Consumed no sugar-sweetened beverages in past 7
days ● **
Reports no leisure-time physical activity for 60
min/day in past 7 days ● stasis
Reports ‘seriously considering suicide’ ● stasis
Environment
Bought sugar-sweetened beverages at school ● improving
*trend since 2012 **no trend data available due to methodology change
Key Take-Aways
Abuse of opiates has grown in Whatcom County since the early 2000s; Whatcom County crime
lab reports are more likely to have an opiate result than most other counties in the state, and
the rate of treatment for opiate addiction is higher than most other counties in the state.
Whatcom County ranks 3rd of 39 counties in negative effects from heroin abuse and 6th of 39
counties in negative effects from prescription drug use.
Whatcom County adults are more likely to drink to excess than adults in Washington state
overall, which imperils the health of the community.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 21
Child & Family Wellbeing:
Whatcom County Health Indicators, 2016
What is Child & Family Wellbeing?
Child & Family Wellbeing is a key pillar of a healthy community. Circumstances in pregnancy through
early childhood are key predictors of health and wellbeing later in life. We envision a community where
all pregnant women and families with children are well-fed, safe, and equipped with resources and
knowledge to succeed in school, from kindergarten to high school graduation.
How Does Whatcom County Compare to Other Counties?
In social and economic factors, including the percentage of adults who have completed high school and
have some college education, as well as the percentage of babies born to single mothers, Whatcom
County is ranked 9th of 39 counties in Washington.
Child & Family Wellbeing Profile:
Percent of students who demonstrate expected skills in 6 of 6 domains: 51.5% (>WA: 39.5%)
Childhood food insecurity: 22.3% (=WA: 21.0%)
Graduation rate: 75.2% (=WA: 77.2%)
Maternal smoking in third trimester of pregnancy: 7.7% (=WA: 7.3%)
Low birth weight: 5% (<WA: 6%)
Prenatal care beginning in first trimester: 75% (=WA: 74.7%)
19-35-month olds up-to-date with vaccinations: 50% (<WA: 56%)
Teens up-to-date with vaccines: 28% (<WA: 34%)
WIC infants fully or partially breastfed: 44% (Whatcom County Health Dept WIC) (=WA: 41.3%)
Closer Look:
Readiness to Learn Inequities
In the Bellingham School District, as in Washington State, children from low-income families and
children with limited English are significantly less ready for kindergarten than their peers as measured
by skills in six domains of ability of average 5-year olds. These domains include social/emotional
functioning, physical functioning, language ability, and cognitive, literacy, and math abilities. These
kindergarten deficits are difficult to make up over time and can lead to lower levels of high school
completion and a host of vulnerabilities later in life.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 22
Figure 7. Percentage of entering kindergarteners demonstrating
kindergarten-level skills in 6 of 6 domains, 2014-2015
Adverse Childhood Experiences (ACEs)
Adverse Childhood Experiences, or ACEs, are traumatic events that occur in childhood and cause stress
that changes a child’s brain development. Exposure to ACEs has been shown to have a dose-response
relationship with adverse health and social outcomes in adulthood, including but not limited to
depression, heart disease, COPD, risk for intimate partner violence, and alcohol and drug abuse.
Adverse Childhood Experiences include emotional, physical, or sexual abuse, emotional or physical
neglect, seeing intimate partner violence inflicted on one’s parent, having mental illness or substance
abuse in a household, enduring a parental separation or divorce, or having an incarcerated member of
the household.
Figure 8. Association between ACEs and Negative Outcomes
Source: Centers for Disease Control & Prevention, "Association between ACEs and negative outcomes"
Of Note:
49% of kindergarteners entering school are not ready for kindergarten in at least one domain in Whatcom County.
Nearly three quarters of teens in Whatcom County are not up-to-date with vaccinations.
Nearly a quarter of Whatcom County children lack access to adequate, nutritious food.
0%
10%
20%
30%
40%
50%
60%
All Low-income Limited English
Bellingham SD WA State
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 23
We can examine ACEs reported by adults in Washington and see that many Whatcom County adults are
bearing childhood traumas that put them at risk for poor health and social outcomes in adulthood.
Figure 9. Adverse Childhood Experiences reported by adults in Whatcom County and Washington State, 2011
Source: Washington State Behavioral Risk Factor Surveillance System
Child and teen vaccination rates
The percentage of toddlers and teens in Whatcom County that have completed the recommended
vaccine series is lower than Washington State overall. Lack of vaccination puts children and teens, as
well as immunocompromised people in Whatcom County like pregnant women, newborns, and the
elderly at risk of serious infectious diseases like pertussis and measles.
Figure 10. Rate of vaccine completion, toddlers and teens, 2014
Source: Washington State Department of Health
0%
10%
20%
30%
40%
50%
60%
70%
1+ ACEs 2+ ACEs 3+ ACEs 4+ACEs
Whatcom County Washington State
0%
10%
20%
30%
40%
50%
60%
19-35-month olds 13-17-year olds
Whatcom County WA State
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 24
Food insecurity is more complicated than simply going hungry; in fact, some families are food insecure
without being hungry because they are forced by their limited resources of time, money, and availability
to subsist on cheap convenience foods with little nutritional value. Low-income families that are food
insecure often live in a nexus of environmental factors that impede their ability to adopt healthy
lifestyles. According to the Food Research & Action Center, food insecure households tend to “lack
access to healthy, affordable foods,” be vulnerable to “cycles of food deprivation and overeating” due to
the instability of their financial and other resources, and are often at “greater exposure to marketing of
obesity-promoting products,” such as billboards and other advertisements.
Due to these and other environmental factors typical of the neighborhoods of low-income, food-
insecure families, childhood food insecurity has been shown by many studies to be related to
childhood overweight and obesity, in addition to children’s performance in school and social and
emotional development. Food insecurity is therefore a crucial, justice-oriented metric of childhood
wellbeing that affects their development and opportunities throughout the life course.
22% of all children in Whatcom County are food insecure, slightly higher than the rate in Washington.
Figure 11. Childhood food insecurity rate, all counties, Washington, 2013
Child & Family Wellbeing Data Sources:
The Washington Department of Vital Statistics measures causes of death and circumstances of
prenatally and birth. The Washington Department of Health measures vaccine rates and
conducts the BRFSS, which compiles rates of Averse Childhood Experiences. The Robert Wood
Johnson Foundation County Health Rankings aggregates BRFSS, Vital Statistics, US Census, and
business data to provide an overview of measures that matter for health. The Office of the
Superintendent for Public Instruction measures “Readiness to Learn” among entering
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 25
kindergarteners in Washington State in 6 domains: social-emotional, physical, language,
cognitive, literacy, and math. The USDA Women, Infant, and Children nutrition program
measures breastfeeding among its program recipients by individual WIC site—the numbers for
Whatcom County come from the Whatcom County Health Department WIC site. Low birth
weight is compiled in a seven-year period by RWJF County Health Rankings from WA State Vital
Statistics data (2007-2013). Childhood food insecurity is measured by the USDA and Feeding
America, and is characterized by a lack of consistent, sufficient, and varied nutrition.
Table 6. Child & Family Wellbeing: Whatcom County Health Indicators vs. Washington State, 2016
*Data aggregated from 2007-2013 *no trend data available
Key Take-Aways
Inequities in readiness for kindergarten make it harder for children of low-income families and
children with limited English skills to do well in school.
Over half of adults in Whatcom County endured in childhood at least one Adverse Childhood
Experience that puts them at greater risk of poor health outcomes, negative health behaviors,
and poor social outcomes.
Rates of vaccine completion are low in Whatcom County relative to the state and imperil the
health of the community; not only are children and teens affected, but vulnerable populations
like newborns, pregnant women, and the elderly are at increased risk for serious infectious
diseases when vaccine rates are low.
Low rates of low birth weight demonstrate exceptional health outcomes for newborns and
pregnant women and are an important source of health resilience.
Better Equal Worse Trend
Social Indicators
High school graduation rate ● stasis
Childhood food insecurity ● stasis
Entering kindergarteners demonstrating Readiness
to Learn in 6 of 6 domains* ● stasis
Health Indicators
Prenatal care in 1st tri. of pregnancy ● stasis
Maternal smoking in 3rd tri. of pregnancy ● stasis
Low birth weight* ● *
WIC infants partially or fully breastfed ● stasis
Toddlers up-to-date with vaccines ● **
Teenagers up-to-date with vaccines ● **
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 26
Health Delivery Systems:
Whatcom County Health Indicators, 2016
What are Health Delivery Systems?
Health Delivery Systems are a key pillar of a healthy community. Access to quality, affordable,
comprehensive care throughout the life course is an important facet of community wellness. We
envision a community where all people have access to quality, affordable preventive and acute care,
including mental health and dentistry, throughout the life course.
How Does Whatcom County Compare to Other Counties?
In health delivery factors including the ratio of physicians, dentists, and mental health providers to the
population, as well as certain measures of quality of care like the percentage of Medicare recipients that
receive mammograms and diabetic monitoring, Whatcom County ranks 17th out of 39 counties in
Washington—near the median score of Washington counties.
Health Delivery Systems Profile:
Ratio of residents to care providers:
o Primary care: 1,140:1 (=WA: 1,190:1)
o Dentists: 1,400:1 (>WA: 1,290:1)
o Mental health: 260:1 (<WA: 380:1)
Uninsured rate among adults below age 65: 8% (=WA: 8%)
10th graders who saw a doctor for a physical in the past year: 64.7% (=WA: 66.1%)
10th graders who saw a dentist for a checkup, exam, teeth cleaning, or other dental work:
78.8% of 10th graders in 2014 (=WA: 79.0%)
Closer Look:
Health Insurance Inequities
Though Whatcom County’s overall insurance rate is improving, there are inequities in health insurance
rate by race/ethnicity, with Hispanic/Latino adults being less likely to have insurance than other groups.
(Figure 12.)
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 27
Figure 12. Uninsured rate among adults <65 years, 2015
Preventive Hospital Stays
Preventable Hospital Stays (Figure 13) is the hospital discharge rate for ambulatory care-sensitive
conditions per 1,000 fee-for-service Medicare enrollees. Ambulatory care-sensitive conditions include:
convulsions, chronic obstructive pulmonary disease, bacterial pneumonia, asthma, congestive heart
failure, hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and
dehydration. This measure is age-adjusted.
Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided
in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse
hospitals as a main source of care.
Lower numbers on this measure are the goal. Whatcom County ranks below the nation, but at the State
of Washington average. The data suggest that there are opportunities to better serve populations with
improved primary care delivery.
Of Note:
Whatcom County Medicare beneficiaries have a rate of 35 preventable hospital stays per 1,000 beneficiaries per year, equal to WA State (36 preventable hospital stays per 1,000 beneficiaries per year).
Racial/ethnic disparities in access to insurance and preventive care exist in Whatcom County.
0%
2%
4%
6%
8%
10%
12%
14%
All Black White Hispanic orLatino
Asian
Whatcom County WA State
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 28
Figure 13. Preventable Hospital Stays in Whatcom County
Preventive care inequities among Medicare beneficiaries
The preventive care received by Hispanic Medicare beneficiaries in Whatcom County is worse than the
preventive care received by White Medicare beneficiaries in Whatcom County.
High-quality preventive care, like seeing a primary care doctor frequently and monitoring one’s blood
sugar and blood pressure, can improve health outcomes. One way to look at possible differences in the
quality of care is to examine Medicare beneficiaries (people aged 65 years and older that have access to
government-sponsored health insurance) of different races and ethnicities, since they have the same
source of health insurance.
In order to understand if differences in quality of preventive care exist, we can look at a measure of the
overall quality of care of diabetes using a composite measurement called Prevention Quality Indicators
among Hispanic and White Medicare beneficiaries by county in Washington State. The data in the map
below show that Whatcom County has some of the state’s most glaring inequities in preventive care for
diabetes by race/ethnicity. White Medicare beneficiaries have 70 PQIs per 100,000 beneficiaries, while
Hispanic Medicare beneficiaries have 0 PQIs per 100,000 beneficiaries.
The preventive care received by Hispanic Medicare beneficiaries in Whatcom County is worse than the
preventive care received by White Medicare beneficiaries in Whatcom County. Greater access to quality
primary care among minority communities is an important strategy to mitigate these unequal health
outcomes.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 29
Figure 14. Age-adjusted Prevention Quality Indicators for Diabetes, Medicare beneficiaries, 2014
Source: Center for Medicare & Medicaid Office of Minority Health, “Disparities Mapping Tool”
Emergency Room Use
Treating patients with low-acuity conditions in the emergency room is an issue because it is not the best
care setting for those conditions and it contributes to unnecessary overcrowding and increased cost.
Approximately 16.1% of emergency room visits to PeaceHealth St Joseph could be considered avoidable
given their low acuity. When viewed by payer, Medicare patients have the lowest rate of these visits,
representing nearly 6.5% of all Medicare emergency room encounters. Medicaid patients have the
highest rates, 18%. However, these rates have generally deceased since 2013.
Figure 15. Low-Acuity ED Visits by Payer, PeaceHealth St. Joseph, 2013-2015
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 30
Source: PeaceHealth Internal Data
Health Delivery Systems Data Sources:
The Washington Healthy Youth Survey measures health risk behaviors and outcomes among
6th, 8th, 10th, and 12th graders in Washington State, including health care access. The Robert
Wood Johnson Foundation County Health Rankings aggregates provider and US Census data to
provide an overview provider to resident ratios and overall clinical care relative measures. Enroll
America aggregates measures of insurance across all 50 states at the county and state level. The
Centers for Medicare & Medicaid Services Office of Minority Health Disparities Mapping Tool
shows measures of health inequities at the county level across the US for different health
delivery indicators.
Table 7. Health Delivery Systems: Whatcom County Health
Indicators vs. Washington State, 2016 and Local Trend since 2010
Better Equal Worse Trend
Primary Care Provider to resident ratio ● improving
Dentists to resident ratio ● improving
Mental Health Providers to resident ratio ● improving
Uninsured adults below age 65 ● improving
Saw a doctor for a physical in the past year (10th
graders) ● stasis
Saw a dentist for checkup, cleaning, or other work
in past year (10th graders) ● stasis
Key Take-Aways
Overall access to care in Whatcom County appears similar to Washington State as a whole
Significant disparities in uninsured rates and quality of preventive care received exist along
racial/ethnic gradients in Whatcom County.
About 15% of emergency room visits to PeaceHealth St Joseph, (18% for Medicaid visits) could
be considered avoidable given their low acuity.
Over a third of Whatcom County 10th graders did not have a physical in the past year, and
nearly a quarter did not see the dentist.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 31
Equity: Whatcom County Health Indicators, 2016
What is Equity?
Equity is a key pillar of a healthy community. Health equity will be achieved when everyone is
given the opportunity to reach their full health potential. Affordable, safe housing, and employment
that allows sufficient resources to meet a household budget are important facets of equity.
How Does Whatcom County Compare to Other Counties?
In social and economic factors, including the percentage of children in poverty, violent crime, and
income inequality, Whatcom County is ranked 9th of 39 counties in Washington. This means that we’re
doing better than 3 out of 4 counties in Washington.
Equity Profile
Individuals living below the Federal poverty level: 16% (>WA: 13.5%)
Individuals in poverty or ALICE (Asset-Limited, Income Constrained, Employed): 41% (>WA: 32%)
Linguistic isolation: 4.7% (<WA: 7.8%)
Households with ‘severe housing problems,’ including cost-burdened housing: 22% (>WA: 18%)
Unemployment rate: 9% (=WA: 9%)
Veteran population: 9% (=WA: 11%)
Income inequality (ratio of income at the 80th percentile to income at the 20th percentile): 4.7 (=WA: 4.5)
Closer Look
Cost-burdened housing
Affordable housing is a key component of financial wellbeing and stability, and forms the basis of good
health. Whatcom County residents in nearly every area have high rates of high housing costs.
Figure 16. Percentage households where housing costs exceed
30% of household income, Whatcom County, 2010-2014
Source: Community Commons
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 32
High percentage of households struggling economically
Nearly half—41%--of Whatcom County residents either live in poverty or are
“Asset Limited, Income Constrained, Employed” (ALICE), meaning that they
are employed and make a wage above the poverty line but below the
threshold of a stable household budget for housing, food, transportation,
health care, and childcare.
Lack of economic resources imperils the health of these families and is a
significant detriment to their wellbeing.
Figure 17. Asset Limited, Income Constrained, Employed and Impoverished
Households, 2013
(Source: United Way of Whatcom County, “ALICE Report”)
Homelessness
Homelessness affects the health and wellbeing of 652 County residents. This population requires
linkages between health and social services to implement sustainable solutions to alleviate the burden
of homelessness. The count is a point in time enumeration that seeks to document the number of
people without a permanent, habitable place to call home. The data collected is critical to assessing
strategies and funding decisions by policymakers seeking to successfully meet the needs of homeless
individuals and families.
Equity Data Sources
The US Census measures the percentages of individuals living in poverty, in linguistic isolation, and
adults who are unemployed. The Robert Wood Johnson County Health Rankings provide estimates of
individuals who have ‘severe housing problems,’ meaning individuals who live with at least 1 of 4
conditions: overcrowding, high housing costs relative to income, or lack of kitchen or plumbing, as well
as a measure of income inequality at the county and state level, which is the ratio of household income
Of Note:
Changing demographics call for employers to monitor their workforce so that it reflects the composition and diversity of the community.
Increasing racial and ethnic diversity among licensed health professionals is particularly important because evidence indicates that among other benefits, it is associated with improved access for non-majority patient groups, increased patient satisfaction and an overall decrease in health care disparities.
.
0%
5%
10%
15%
20%
25%
30%
ALICE Households Households in Poverty
Whatcom County WA State
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 33
at the 80th percentile to income at the 20th percentile. Community Commons provides maps of census-
tract level data, including housing cost burden. The United Way of Whatcom County produced an in-
depth ALICE report that profiles the population of Whatcom that is above poverty but cannot afford a
household budget in Whatcom County.
Table 8. Social Equity: Whatcom County Health
Indicators vs. Washington State, 2016 and Local Trend since 2012
Better Equal Worse Trend
Individuals living below the poverty line ● stasis
ALICE Households ● **
Individuals over age 5 in linguistic isolation ● stasis
Households with ‘severe housing problems’ ● stasis*
Unemployment rate ● stasis
Income inequality ● **
*Baseline trend data aggregated from 2006-2010 **No trend data available
Key Take-Aways
Whatcom County does very poorly in measures of affordability—nearly half of Whatcom
residents cannot afford a basic household budget.
Levels of income inequality are similar to overall Washington State income inequality levels
A high percentage of cost-burdened housing in certain areas of Whatcom County imperils the
wellbeing of affected households and the community as a whole
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 34
VI. COMMUNITY CONVENING
Method
Key informant Interviews
PeaceHealth St. Joseph interviewed key informants from organizations throughout Whatcom County
representing perspectives from public health and medically underserved and vulnerable groups. The
interviews were conducted in advance of a community convening session that was held on May 19,
2016. The interviews were conducted to elicit perspectives on the health needs and gaps of the
community, to get feedback on the continuing relevance of the 2013 CHNA priorities and health
priorities found through the secondary data gathering of the 2016 CHNA, and to understand possible
solutions that local experts support.
Table 9. Organizations to which key informants belong, 2016 CHNA
Organization Population Served
Whatcom Community Foundation
All Whatcom County residents.
United Way of Whatcom County
All Whatcom County residents; particularly lower-income children and families, homeless, and immigrant and ethnic minority groups.
Chuckanut Health Foundation
All Whatcom County residents.
Sea Mar Community Health Center
All Whatcom County residents; particularly low-income children and families, homeless, and migrant and Spanish-speaking community.
Unity Care NW All Whatcom County residents; particularly low-income children and families, homeless and immigrant groups.
Whatcom County Health Department
All Whatcom County residents and people have mental illness and chemical dependency
Opportunity Council All Whatcom County residents; particularly low-income children and families, and people who are homeless
Whatcom Alliance for Health Advancement
All Whatcom County residents; particularly people are have lower incomes
Community Convening
The key informant interviews were conducted in preparation for a community convening session that
was held on May 19, 2016. More than 60 community leaders from local and regional public health,
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 35
health and social services, business, schools, and government were convened for approximately three
hours.
Community convening participants were led through a two-part process to identify gaps and needs and
then to rank community health improvement strategies that were organized into the community health
pillars. The process was designed to build on the considerable amount of time and effort that the
County Health Department, PeaceHealth and others have put into health assessments over the last
several years and to focus more on what we can actually do together to address the problems.
Following an update regarding secondary data and key informant perspectives for each of the
community health pillars, participants were asked to identify health and social needs /gaps, and strategy
opportunities. There was repetition and overlap between the key informant and group process input,
with the community convening participants adding infill to the key informant perspectives.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 36
Gaps and opportunities
Table 10. Summary of health and social gaps/needs and strategy opportunities according to key
informants and community convening participants, by community health pillar, May 2016
Healthy, Active Living Child & Family Wellbeing
Needs/Gaps
Adult alcohol use
Teen tobacco use
Food and beverage
environments at school and
in the community
Elder isolation
Physical inactivity
Low immunization rates
Low graduation rates, particularly
among homeless and low-income
families
Maternal smoking during pregnancy
Unintended pregnancies
High cost of childcare
ACEs
Strategy
Opportunities
Community building and
collaboration to reduce
social isolation and
attachment to places
Address food insecurity and
healthy food availability
Reduce sugar-sweetened
beverage availability in
schools
Physical activity
Improve places to play and
be active, especially for
vulnerable populations
Community policies for
water fluoridation
Community Health Workers
Nontraditional prescriptions
for parks, healthy foods,
and other lifestyle changes
“Age in place” orientation
Community initiatives aimed at
providing new families useful
information, support, and ongoing care
Tax levy to support early childhood
services
Support child and families after ACEs
through evidence-based programs and
supports
Affordable child/infant care—
employer-sponsored childcare is a
solution
Additional supports for vulnerable
parents and children, including early
screening for developmental
disabilities
Family-friendly policies and
environments
North Sound ACH LARC project
Pregnancy supports
Education system
- Supports for bullying, depression
- Mentorship
- Change school start times
- Health literacy programs
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 37
Table 11. Summary of health and social gaps/needs and strategy opportunities according to key
informants and community convening participants, by community health pillar, May 2016
Health Delivery Systems Equity
Needs/ Gaps
High rates of opiate abuse/pain management, e-cigarette use, DUI rates
Racial/ethnic disparities in health insurance
Unaffordable health care; high deductible plans
Lack of dental and behavioral health care providers
High poverty and low educational attainment concentrated around Bellingham
Cost-burdened housing
Underrepresentation of non-majority persons at all levels of health and social service delivery systems
Poor economic opportunities
Lack of affordable child care for ALICE populations
Transportation barriers
Strategy
Opportunities
Access to health care:
More primary care and dental
providers that accept Medicaid and
Medicare; incentives for providers
Access to specialty care
Expanded practice for midlevel dental
care providers
Integration of medical care with:
Dental care
Mental health
Behavioral health
Mobile health services - rural
School-based health centers
Care coordination:
CHWs
Behavioral health/mental health and
chemical dependency
Chronic pain management
Heroin addiction treatment
Residential treatment services
Staff training on mental health crisis
response and rapid treatment
Suicide prevention/depression
management
Process:
Should focus on action
Include vulnerable populations
in planning and implementation
Should have a systemic
approach, including schools,
hospitals, and criminal justice
Economic barriers:
Living wage jobs
Vulnerable populations:
Housing affordability and infill
Culturally-appropriate care
Community Health Workers
Faith-based outreach
Improve affordability of quality
child care for ALICE and groups
in poverty
Bring care to the community
Homelessness:
Homeless one-stop center
Housing First policies
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 38
Strategies for Consideration in Implementation Plan
In the third part of the Community Convening, participants were provided with a packet of evidence-
based intervention strategies for each of the four community health pillars. Given their understanding
of community needs, participants were asked to collectively discuss strategies and then individually
select up to three evidence-based strategies within each pillar or write in a preferred strategy based on
the following criteria:
Magnitude of need
Organizational capacity in the community to address
Realistic to implement
Personal interest and passion
Table 12. Top evidence-based strategy solutions identified at the community convening
Strategy Needs Addressed
Healthy,
Active
Living
Community Health Worker
programs
Social isolation, chronic diseases, poor health
outcomes for undocumented/vulnerable groups,
transportation to health care appointments, chronic
disease management
School nutrition programs Chronic disease, access to healthy foods
School-based early intervention E-cigarette use, teen substance abuse
Child &
Family
Wellbeing
Prenatal and early childhood home
visiting programs
Care coordination for prenatal/postpartum
vulnerable mothers, infants, and children, maternal
smoking, ACEs
Levy to support early childhood
services
Affordable childcare, early developmental
screening, ACEs
‘Early Pathways’/home-based
mental health
Mental health services for families and children,
follow-up for high-risk mothers and children
Health
Delivery
Systems
Supported housing programs
Affordable housing, integration of primary care and
behavioral/dental/mental health care, care
coordination for vulnerable populations
Expand triage/crisis stabilization Improved mental health care, improved pain
management without opiates
Linking social services and medical
services Care coordination for vulnerable populations
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 39
Strategy Needs Addressed
Equity
School based health centers Access to health care for rural populations,
transportation barriers
Expanded Housing First programs
Care for the chronically mentally ill and homeless,
interface between criminal justice and health care
systems, affordable housing
Patient navigators
Poor access to social and health services for the
undocumented and isolated, chronic disease care
coordination and follow-up, transportation barriers
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 40
VII. IMPLEMENTATION PLAN
Selected Strategies
Adopted by our authorized body, the statement of strategies below will serve as the basis for a more
detailed CHNA implementation plan which will be published no later than November 30, 20162. The
Implementation Plan strategies summarized below were extrapolated from the data and from
community input. Our plan is comprehensive in the sense that there are strategies that impact the focus
areas within each of the community health pillars (and a number of strategies cross pillars); and the
display of strategies is not intended to be a complete listing of all of the activities that PeaceHealth will
undertake with its community partners to affect the health status of the community. Rather, it is a
statement of our community health priorities.
The PeaceHealth St. Joseph Board will approve an annual CHNA implementation plan that includes
tactics, timelines and metrics.
Table 13. 2016 PeaceHealth St. Joseph Implementation Plan Summary
Strategies Target population Potential partners
1. Ensure effective information exchange and care coordination for select populations (e.g. PHMG patients with complex health and psychosocial conditions who are served by multiple organizations) through the PeaceHealth Transforming Clinical Practice Initiative (TCPI) and other community
collaborations.
Children and adults
who receive
Medicaid and have
particularly complex
health psychosocial
conditions.
PeaceHealth Medical group
and the WAHA convened
Provider Council among other.
2. Increase participation in the PeaceHealth
employee wellness program, particularly for
caregivers at the lower end of the
compensation scale.
PeaceHealth
Caregivers
PeaceHealth HR; potential
partners could include union
representatives
2The final IRS regulations (published in the Federal Register on December 31, 2014) provide hospital facilities
with an additional four and a half months to adopt the implementation strategy, specifically requiring an
authorized body of the hospital facility to adopt an implementation strategy to meet the health needs identified
through a CHNA on or before the 15th day of the fifth month after the end of the taxable year in which the
hospital facility finishes conducting the CHNA.
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 41
Strategies Target population Potential partners
3. As part of our ongoing efforts to create an inclusive organization that exercises cultural humility, recruit for and support a workforce that reflects the changing ethnic, racial and cultural diversity of the communities that we serve.
Hispanic, American
Indian, and other
non-majority
populations within
the County.
Workforce Development
Council; Community and
Technical colleges; Tribal
Health Centers and others
4. Advocate for and actively support the development of a comprehensive continuum of behavioral health services that includes access to crisis stabilization, transitional and long housing, substance abuse treatment services, and psychiatry that is available to children and seniors.
Children and adults
experiencing mental
health conditions
and/or substance
use disorders
Regional Behavioral Health
Organization (BHO); Compass
Health; Whatcom County
Health Department and
others
5. Work with local school districts, Head Start, and others to advocate for and support the wide-spread availability of early learning opportunities for all children.
Children between
the ages of 3 and 5
and their families,
particularly those
with lower incomes.
Head Start; area School
Districts; Whatcom Center for
Philanthropy and others
6. Develop a Community Health Worker
initiative that empowers individuals within
specific communities to serve a
liaison/linking/intermediary role between
health/social services and the community to
facilitate access and improve the quality and
cultural competence of service delivery.
Specific target
populations to be
determined
Whatcom Alliance for Health
Advancement; Chuckanut
Health Foundation and others
7. Advocate for and support policies and
programs geared to promoting healthy
nutrition, activity and lifestyles for youth
aged 8-11, with a particular focus on lower
income families.
Children between
the ages of 8-11 and
their families,
particularly those
with lower incomes.
YMCA, Bellingham Parks and
Rec, primary care physicians,
Whatcom Food Network and
others
Community Health Needs Assessment | PeaceHealth St. Joseph Medical Center 42
Significant Health Needs Not Addressed by Implementation Plan
PeaceHealth St. Joseph has expertise in providing primary, specialty and tertiary care for Whatcom
County residents. We are able to address care access and coordination challenges for specific
populations, as well as employee wellness and cultural humility within our own organization. We look
forward to partnering with public health, local non-profit organizations and others to address the
broader issues of population and community health that are outlined in our CHNA.
The issues that we have prioritized with input from the community leverage our resources and expertise
and address significant community needs. In prioritizing some issues however, others are not directly
addressed. These include low graduation rates, immunization rates, the overall affordability of health
care and the effect of high deductible plans on lower income people not eligible for Medicaid; lack of
dental care, and poverty disparities.