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THE MOSTCHALLENGINGHEALINGTMINTEGRIS
Table of ContentsCommunity Contributors . 3Canadian County Coalition for Children and Families . 4Introduction. 6Demographics. 7The MAPP Process. 8Community Health Status Assessment.11Community Themes and Strengths Assessment . 15Local Public Health System Assessment.16Forces of Change Assessment . 17Priority Elements.19Next Steps. 26Resources. 272013 INTEGRIS Canadian Valley Hospital Survey. Attachment A2012 Oklahoma Prevention Needs Assessment Survey .Attachment BLocal Public Health System Assessment. Attachment C2011 Oklahoma’s State of the State’s Health Report. Attachment D2011 OSDH Annual Summary of Infectious Diseases.Attachment E2014 State of the County’s Health Report. Attachment FOklahoma Kids Count Data Center . Attachment G2014 County Health Rankings and Roadmaps . Attachment HU.S. Census Data.Attachment ICommunity Health Needs Assessment, IP3.Attachment JForces of Change Assessment .Attachment KCommunity Focus Groups . Attachment LINTEGRIS Health Community Needs Survey 2016.Attachment M2
Community ContributorsCanadian County Board of HealthCanadian County District Attorney’s OfficeOklahoma Commission on Children andYouthCentral Communities Health Access NetworkOklahoma Department of Human ServicesCanadian County Health DepartmentOklahoma Department of Mental Health andSubstance Abuse Services Systems of CareCanadian County Juvenile BureauOklahoma Department of RehabilitationServicesCanadian County Systems of Care(Red Rock)Oklahoma Family Counseling ServicesCheyenne and Arapaho TribesOklahoma Family NetworkCity of PiedmontOG&E Energy CorporationCity of YukonOklahoma LENDChildren’s Justice CenterOklahoma Health Care AuthorityDarlington Public SchoolOpportunities Mental Health ServicesEl Reno Chamber of CommerceEl Reno Carnegie LibraryOU National Center for Disability Educationand TrainingEl Reno Public SchoolsRed Rock Regional Prevention CoordinatorEl Reno TribuneRedlands Community CollegeEquiBalanceSafe Kids OklahomaEvolution FoundationSmart Start Canadian CountyGirl Scouts of Western OklahomaSooner SuccessIndian Health ServicesThe Child Abuse Response Team HouseINTEGRIS Canadian Valley HospitalTobacco Settlement Endowment TrustCommunities of Excellence – TobaccoControlMercy Hospital El RenoMustang Public SchoolsTurning PointNorthwest Area Health Education CenterRural Health ProjectsVarangon AcademyYouth and Family Services of OklahomaOklahoma City - County Health DepartmentFetal and Infant Mortality ReviewYukon Public Schools3
The Canadian County Coalition for Children and Families was organized in September 1996,when the District Child Abuse Prevention Task Force, the Oklahoma Commission on Children andYouth and the El Reno Early Childhood Task Force combined into one group.The coalition currently serves as the “umbrella organization” for a number of programs includingthe Task Force on Child abuse Prevention, OCCY Community Partnership Board, CanadianCounty Caring for Kids (Systems of Care), Sooner SUCCESS, Smart Start, TSET TobaccoPrevention Grants, and the Red Rock Regional Prevention Coordinator. The coalition provides aforum for networking, sharing of information, professional training and public awareness on issuesrelating to children.One of the biggest areas of concern for the Canadian County Coalition for Children and Familieshas been seeking access to health care. The process began in 2006 after coalition membersattended a retreat to discuss the issues facing Canadian County residents.From that retreat, an Access to Health Care Committee was developed with the mission toimprove health care access for Canadian County residents. From that task force, a next step wasto partner with the El Reno Community Clinic since they were already an established 501c3 nonprofit organization with similar goals. In 2008, the Access to Health Care Committee morphedinto what is now called the PHCC (Partnership for Healthy Central Communities). The OklahomaHealth Care Authority funded the Health Access Network, now titled the CC-HAN (CentralCommunities Health Access Network), in 2011.Since then a fulltime project/care manager has been joined by two part-time RN care managers;two other independent contractors provide IT support services. The CC-HAN has grown toinclude 22 providers from six different medical home practices and has a roster of over 3,500members who are enrolled in the state’s SoonerCare Choice (Medicaid) program. Servicesprovided by the CC-HAN include care management for members with complex health needs,support to the contracted providers, and various strategies to increase access to care, to improvequality of care and to address cost reductions.4
In 2011 the coalition held its first annual Community Baby Shower Fun Day, where participantscould gather resources to improve the health of their children. From tobacco prevention, SIDS(sudden infant death syndrome) information, car seat safety, safe sleep methods, breastfeedingsupport resources to free toys, car seats, baby items, such as swings, highchairs and even diapers.This event helped provide resources to around 50 participants in order to increase the health ofCanadian County children.Canadian County was awarded the SPF-SIG, which stands for the Strategic Prevention FrameworkState Incentive Grant. It is funded through Oklahoma Department of Mental Health andSubstance Abuse Services. Based on data throughout the region Canadian County was pickedas the county of focus and is working on the non-medical use of prescription drugs. Our goal isto reduce opiate overdose deaths by promoting the prescription monitoring program (to reducedoctor shopping) promoting prescription drop boxes, and media advocacy to increase knowledgeof the dangers of prescription sharing. So far this year, three drop boxes have been placed withinCanadian County to take back prescription drugs.The coalition has agreed to utilize the framework of MAPP (Mobilizing for Action throughPlanning and Partnership) as a tool to assess the health of Canadian County to strategicallyplan the activities, initiatives and objectives that they pursue to help create a healthier CanadianCounty.5
IntroductionCommunity health assessments are a critical part of public health practice. They are utilized to describethe health of a community to local residents, decision makers and key stake holders. The CommunityHealth Assessment is the basis for all local public health planning, giving the local public health system theopportunity to identify and interact with key community leaders, organizations and interested residentsabout the health outcomes and concerns of their county.The assessment helps to identify community needs and populations at risk of poor health outcomes inthe community. It helps to better understand the barriers that are affecting the health of the communityand the citizens who reside in Canadian County. Ultimately the Community Health Assessment serves asa guide to create intervention strategies that are aligned with the communities resources and interests inorder to create a state of health in Canadian County.In the fall of 2012, the Canadian County Coalition for Children and Families engaged the communityto assess the health status of county residents using the MAPP model as a tool to collect data fordeveloping strategies to improve health. MAPP consists of four assessment methods in a structuredprocess for gathering and utilizing data for intervention strategies. Utilizing these assessments provides acomprehensive view of the current health status, both real and perceived, that influence this community’shealth.Ten elements of health were identified for Canadian County. The community will select among thesepriority areas to create strategies for improvement. They include the following. Child HealthDiabetesHeart DiseaseInfant MortalityMental Health/Substance Abuse ObesityStrokeSuicideTobaccoUnintentional InjuryThis report will briefly discuss the data collected from the four Community Health Assessments as well asthe 10 identified elements of health and the factors that resulted in their consideration for targeted healthimprovement.6
Demographics2010 DemographicsTotal PopulationOklahoma%3,751,351Canadian County%115,541Age19 years and under20 - 64 years65 ite2,706,8457296,05883.1Hispanic or Latino332,00797,7946.7African an Indian & Alaska Native321,68795,5494.84,369 170 1154,40942,6962.3221,32164,7524.1Mean household income (dollars)65,977X72,154XMedian household income (dollars)49,937X61,404XMean travel time to work (minutes)27.0X23.0XPercent unemployed6.6X6.1XNative Hawaiian & Pacific IslanderOtherIdentified by two or moreSelected Economic Characteristics2010 Census Bureau Report7
The MAPP ProcessCanadian County Coalition for Children and Families utilized the model MAPP (Mobilizing for Actionthrough Planning and Partnerships) as a tool to collect data for developing health improvement strategies.The following description of MAPP is taken from the NACCHO (National Association of County and CityHealth Officials) website, and can be found at the following pp/framework/mappbasics.cfmMAPP is a strategic approach to community health improvement. This tool helps communities improvehealth and quality of life through community-wide strategic planning. Using MAPP, communities seek toachieve optimal health by identifying and using their resources wisely and forming effective partnershipsfor strategic action while taking into account their unique circumstances and needs.The Benefits of MAPPThe benefits of using the MAPP process, as identified by NACCHO, include the following. Create a healthy community and a better quality of life. The ultimate goal of MAPP is optimalcommunity health – a community where residents are healthy and safe, and have a high quality of life.Here, a “healthy community” goes beyond physical health alone. Increase the visibility of public health within the community. By implementing a participatory andhighly publicized process, increased awareness and knowledge of public health issues and greaterappreciation for the local public health system as a whole may be achieved. Anticipate and manage change. Community strategic planning better prepares local public healthsystems to anticipate, manage and respond to changes in the environment. Create a stronger public health infrastructure. The diverse network of partners within the local publichealth system is strengthened through the implementation of MAPP. This leads to better coordination8
of services and resources, a higher appreciation and awareness among partners and less duplication ofservices. Engage the community and create community ownership for public health issues. Throughparticipation in the MAPP process, community residents may gain a better awareness of the area inwhich they live and their own potential for improving their quality of life. Community-driven processesalso lead to collective thinking and a sense of community ownership in initiatives and, ultimately,may produce more innovative, effective and sustainable solutions to complex problems. Communityparticipation in the MAPP process may augment community involvement in other initiatives and/orhave long-lasting effects on creating a stronger community spirit.nity ThemesmmuCo gths Assessm &entenStres of ChaForc ssme ngentAsseFour MAPP AssessmentsIdentify Strategic IssuesFormulate Goals and Strategiesal Public HealLoc m Assessm thentteSysOrganizePartnershipfor mentComlt hS ta m u n it y H e a ttu s A sse ss m e nThe Four MAPP Assessments1. Community Health Status Assessment takes an objective look at the community’s health status andquality of life. Data within this assessment focuses on health outcomes and risk factors. It provides afundamentally objective overview of the community’s health.Data for this assessment was taken from Oklahoma’s 2011 State of the State’s Health Report(Attachment D), Oklahoma’s 2011 Annual Summary of Infectious Diseases (Attachment E), the2014 State of the County’s Health Report (Attachment F), Oklahoma Kids Count Data Center2013 (Attachment G), 2014 County Rankings and Roadmaps (Attachment H), U.S. Census Data(Attachment I), and the Community Health Needs Assessment Report by the Institute for People,Place and Possibility (Attachment J).2. Community Themes and Strengths Assessment provides insight into issues that residents perceive asimportant. It delves into perceived quality of life issues in the community and looks into assets andresources recognized by community members. Three assessment tools were used for the Canadian9
County Community Themes and Strengths Assessment: the 2013 INTEGRIS Canadian Valley HospitalSurvey (Attachment A), the 2012 Oklahoma Prevention Needs Assessment Survey (Attachment B)conducted by the Oklahoma Department of Mental Health and Substance Abuse, and communityfocus groups (Attachment L).3. Local Public Health System Assessment focuses on the public health system within the county andincludes any entity that contributes to the public’s health. It breaks down the system into its individualcomponents as they contribute to the 10 essential services of public health. Those components are thenevaluated for their effectiveness within the public health system. The 10 essential services of publichealth include the following.Monitor Health StatusEnforce Laws and RegulationsDiagnose and InvestigateLink People to Needed Services / Assure CareInform, Educate, and EmpowerAssure a Competent WorkforceMobilize Community PartnershipsEvaluate Health ServicesDevelop Policies and PlansResearchThe Local Public Health System Assessment is a prescribed assessment created by the National PublicHealth Performance Standards Program, a collaborative effort of seven national partners including thefollowing. CDC / OSTLTS (Centers for Disease Control and Prevention, Office for State Local, Tribal andTerritorial Support) APHA (American Public Health Association) ASTHO (Association of State and Territorial Health Officials) NACCHO (National Association of County and City Health Officials) NALBOH (National Association of Local Boards of Health) NNPHI (National Network of Public Health Institutes) PHF (Public Health Foundation)The report on this assessment is found in Attachment C.4. Forces of Change Assessment identifies external or internal forces that could impact the communityand the public health system. These forces can include legislative or technology issues, but may alsoinclude economic impacts from changes in the business community. The findings of this focus groupare included in Attachment K.Each assessment is designed to yield important information for improving community health. However,the value of the four MAPP assessments is multiplied by considering the findings as a whole for a singlecomprehensive community health assessment. It is only after conducting all four assessments thatparticipants will gain a complete understanding of the factors that affect the local public health systemand, ultimately, the health of Canadian County.10
Community Health Status Assessmentnity ThemesmmuCo gths Assessm &entenrtSes of ChaForc ssme ngentAsseFour MAPP AssessmentsIdentify Strategic IssuesFormulate Goals and Strategiesal Public HealLoc m Assessm thentteSysOrganizePartnershipfor mentComlt hS ta m u n it y H e a ttu s A sse ss m e nSituated in west-central Oklahoma, Canadian County is bounded by Kingfisher County on the north,Oklahoma and Cleveland counties on the east, Grady County on the south, Caddo County to thesouthwest, and Blaine County to the northwest. Canadian County lies mostly within the Red Bed Plains,a sub-region of the Osage Plains physiographic region. The county’s northwestern corner is situated inthe Gypsum Hills. Drained by the North Canadian and the Canadian rivers, which cross the county fromnorthwest to southeast, the county consists of 905.17 square miles of land and water. At the turn of the21st century incorporated towns included Calumet, Mustang, Okarche, Piedmont, Union City, Yukon andEl Reno, the county seat.DemographicsCurrent demographics and the way they change in Canadian County play a major role in determining whatresources and services are needed in order to reach a healthier community.PopulationCanadian County is home to approximately 115,541 residents. This represents a 31.7% increase in totalpopulation since 2000. This increase in population, over time, could potentially impact health careproviders and community resources. The population density per square mile is 126.23. Total populationby gender is comprised of 49.5% male and 50.5% female. The following population density graphicis taken from the Community Health Needs Assessment Report by the Institute for People, Place andPossibility.Population, Density (Persons per Sq Mile) by Tract, 2007-11Over 5,000CANADIANEl Reno1,001 - 5,000Yukon400.1 - 1,00050.1 - 400.00OklahomaCityUnder 50.1No Data or Data Suppressed11
Physical EnvironmentCanadian County ranked 60 out of 77 Oklahoma counties in this category. This indicator includesall parts where residents live and work (homes, buildings, streets, sidewalks, parks, etc.). The rankingcontinues to get worse. The following, taken from the Community Health Needs Assessment Report bythe Institute for People, Place and Possibility, are physical environment indicators, all of which are in the“red” of this report’s dashboard indicator scale.Park AccessThis indicator reports the percentage of population living within 1/2 mile of a park. This indicator is relevant becauseaccess to outdoor recreation encourages physical activity and other healthy behaviors.Report AreaCanadian County, OklahomaOklahomaUnited StatesTotal PopulationTotal Population Within1/2 Mile of a ParkPercent Population Within1/2 Mile of a 37120,503,66439%Percent Population Within1/2 Mile of a Park050%Canadian County,Oklahoma (28%)Note: This indicator is compared with the state average. No breakout data available.Data Source: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, 2010. Source geography: County.Oklahoma (33%)United States (39%)Population with Low Food AccessThis indicator reports the percentage of the population living in census tracts designated as food deserts. A fooddesert is defined as a low-income census tract (where a substantial number or share of residents has low access to asupermarket or large grocery store. This indicator is relevant because it highlights populations and geographies facingfood insecurity.Report AreaCanadian County, OklahomaOklahomaUnited StatesTotal Population115,541Population withLow Food AccessPercent Population withLow Food 53872,905,54023.61%Percent Population Within1/2 Mile of a Park030%Canadian County,Oklahoma (40.55%)Note: This indicator is compared with the state average. No breakout data available.Data Source: U.S. Department of Agriculture, Food Access Atlas, 2013. Source geography: Tract.Oklahoma (28.66%)United States (23.61%)SNAP-Authorized Food Store AccessThis indicator reports the number of SNAP-authorized food stores as a rate per 100,000 population. SNAP-authorizedstores include grocery stores as well as supercenters, specialty food stores and convenience stores that are authorizedto accept SNAP (Supplemental Nutrition Assistance Program) benefits.Report AreaCanadian County, OklahomaOklahomaUnited StatesTotal PopulationPopulation withLow Food AccessPercent Population withLow Food 255,51182.04Note: This indicator is compared with the state average. No breakout data available.Data Source: U.S. Department of Agriculture, Food Environment Atlas, 2012. Source geography: County.SNAP-Authorized RetailersRate per 100,000 Population0100Canadian County,Oklahoma (53.56)Oklahoma (91.73)United States (82.04)12
WIC-Authorized Food Store AccessThis indicator reports the number of food stores and other retail establishments per 100,000 population that areauthorized to accept WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children) benefitsand that carry designated WIC foods and food categories. This indicator is relevant because it provides a measure offood security and healthy food access for women and children in poverty as well as environmental influences on dietarybehaviors.Report AreaCanadian County, OklahomaOklahomaUnited StatesTotal PopulationPopulation withLow Food AccessPercent Population withLow Food ,04215.60WIC-Authorized Food StoreRate (per 100,000 Pop.)025Canadian County,Oklahoma (20.92)Note: This indicator is compared with the state average. No breakout data available.Data Source: U.S. Department of Agriculture, Food Environment Atlas, 2012. Source geography: County.Oklahoma (22.20)United States (15.60)INTEGRIS Survey Update2016 UpdateFrom November 2015 to January 2016, INTEGRIS Health conducted a health needs survey. Surveyquestions addressed the community’s priority health issues. Participants were asked to rank healthindicators in terms of importance according to their local community. The survey was distributed statewide through paper copies, emails, survey links and social media. One thousand, seven hundred thirtyseven surveys were returned.Survey results showed participants ranking the health issues in the following order: obesity, diabetes, heartdisease, substance abuse, high blood pressure, anxiety/depression, stroke, suicide, and respiratory illness.All of the issues have a common thread between obesity, heart disease and mental health. Therefore,the community partners chose to focus on priority issue one, obesity, which will include nutrition andimproving sedentary lifestyles. Priority issue two will be heart disease, which includes high blood pressure,stroke and diabetes. Priority issue three will be mental health, which includes issues such as anxiety/depression, substance abuse and suicide.Incorporating the survey results into the Community Health Improvement Plan will help with leveragingresources and will assist with the successful implementation of the coalition’s strategic plan.The chart below indicates the number of surveys obtained from the most significant ZIP codes.Canadian County9.73%165Deleware County9.67%164Garfield County10.55%179Oklahoma County49.82%845Ottawa County9.67%164Uncategorized10.55%17913
Out of the 1,737 surveys, 1,696 provided their ZIP code. Surveys were distributed by hand at specialevents and some small focus groups. Survey participants consisted of community stakeholders, healthcare providers, the general public, special minority groups and those underserved. The uncategorized ZIPcodes did not have a sufficient amount of surveys to count as significant for the representing county.The chart below represents how the participants ranked the community health needs.What health issues do you feel should bethe highest priority in your community?Answered: 1,718Skipped: 19100%80%60%40%20%0%HeartdiseaseObesityHighest priorityAnxietyStrokeDibetesImportant but not a priorityThis is not a problem in our city/town*INTEGRIS Health Community Needs Survey 201614SuicideSub.abuseNot importantHighbloodpress.Resp.illness
Community Themes and Strengths Assessmentnity ThemesmmuCo gths Assessm &entenrtSes of ChaForc ssme ngentAsseFour MAPP AssessmentsIdentify Strategic IssuesFormulate Goals and Strategiesal Public HealLoc m Assessm thentteSysOrganizePartnershipfor mentComlt hS ta m u n it y H e a ttu s A sse ss m e nParticipants perceived that the most important behavioral health concern in Canadian County wasdepression. This was an unexpected result. However, by observing other findings throughout all fourassessments, the issues of mental health became apparent.7. What do you think are the 5 most important behavioral health concerns in yourcommunity? (Check only your top ger52.9%108Anxiety44.6%91Self Harm (butting, biting)16.2%33Eating Disorder (Anorexia, bstance Abuse63.2%129ADD/ADHD25.5%52Suicidal thoughts21.6%44Domestic/partner violence40.7%83Sexual abuse23.0%47Prescription drug abuse61.8%126answered question204skipped question14915
Local Public Health System Assessmentnity ThemesmmuCo gths Assessm &entenrtSes of ChaForc ssme ngentAsseFour MAPP AssessmentsIdentify Strategic IssuesFormulate Goals and Strategiesal Public HealLoc m Assessm thentteSysOrganizePartnershipfor mentComlt hS ta m u n it y H e a ttu s A sse ss m e nParticipants scored the public health system’s effectiveness using the following options.Table 1. Summary of Assessment Response OptionsOptimal Activity(76-100%)Greater than 75% of the activity described withinthe question is met.Significant Activity(51-75%)Greater than 50%, but no more than 75% of theactivity described within the question is met.Moderate Activity(26-50%)Greater than 25%, but no more than 50% of theactivity described within the question is met.Minimal Activity(1-25%)Greater than zero, but no more than 25% of theactivity described within the question is met.No Activity(0%)0% or absolutely no activity.A summary of the average assessment scores for each of the 10 essential services can be seen in thisgraphic. Take note that the first category shown is an average overall score from across all 10 essentialservices. This overall score indicates a performance level of “significant activity” for the public healthsystem in Canadian County.Figure 2. Summary of Average Essential Public Health Service Performance ScoresSummary of Average ES Performance Score0.0Average Overall Score56.9ES 1: Monitor Health Status52.8ES 2: Diagnose and Investigate73.6ES 3: Educate/Empower55.6ES 4: Mobilize Partnerships65.6ES 5: Develop Policies/Plans56.3ES 6: Enforce Laws60.4ES 7: Link to Health Services50.0ES 8: Assure Workforce54.9ES 9: Evaluate Services50.0ES 10: Research/Innovations50.020.040.01660.080.0100.0
Forces of Change Assessmentnity ThemesmmuCo gths Assessm &entenrtSes of ChaForc ssme ngentAsseFour MAPP AssessmentsIdentify Strategic IssuesFormulate Goals and Strategiesal Public HealLoc m Assessm thentteSysOrganizePartnershipfor mentComlt hS ta m u n it y H e a ttu s A sse ss m e nForces of Change Assessment SummaryCanadian CountyApril 20131. What do you believe are the most important issues to improve in order to create a healthyCanadian County? Improve access to health care.Create walk-ability in communities.Make fitness and health an integral part of the lifestyle of Canadian County.Increase places to exercise, via walking trails, parks, facilities.Increase access to healthy food through farmers markets, fresh foods and healthier food chains inCanadian County. Increase integration between schools and communities. Decrease tobacco use.2. What do you believe is keeping our community from doing what needs to be done to improve thehealth and quality of life for Canadian County? Lack of community support and buy-in to health.Lack of communication across the county between schools, communities, towns, business, etc.Resources (funding and time).Lack of transportation (personal and public).Increase in population due to being a county close to Oklahoma City. This causes for morepeople to move in and no
into what is now called the PHCC (Partnership for Healthy Central Communities). The Oklahoma Health Care Authority funded the Health Access Network, now titled the CC-HAN (Central Communities Health Access Network), in 2011. Since then a fulltime project/care manager has been j
